Personality Disorder Severity Research Articles

Sleep Disturbance in People with Anxiety or Depressive Disorders over 30 Years, and the Influence of Personality Disorder.

Sleep disturbance is commonly reported by people with anxiety, depressive, and personality disorders, but longitudinal studies exploring the interplay of the three with disturbed sleep have not previously been described. In this study, sleep disturbance was examined among 89 patients initially presenting with anxiety or depressive disorders who provided follow-up at 12- and 30-year time points in the Nottingham Study of Neurotic Disorder. Multilevel models were used to identify factors most predictive of changes in sleep quality over time. There were strong associations between poor sleep and contemporaneous severity of personality disorder and the presence of other mental disorders at 12 and 30 years follow-up, but not with disorder presence at other time points. Improvements in personality disorder were associated with improvements in sleep between time points and attenuated the positive unadjusted effects of recovery from anxiety or depressive disorders to non-significance. Relapse into further episodes of mental disorder predicted poorer sleep, whereas worsening personality disorder was not predictive of significant changes when adjusting for other factors. This study demonstrates the complex interplay between anxiety, depressive, and personality disorders and sleep disturbance over a long follow-up period. Future research might look to examine the relationship between personality disorder and disturbed sleep with interventional studies and by integrating personality trait research.

Association of intravenous ketamine with change in depressive symptoms in a large integrated health care system

ObjectiveRacemic ketamine intravenous treatments (KIT) are widely used in community clinics for treatment resistant depression (TRD), but we lack studies on symptom improvement during standardized delivery to clinically complex patients with TRD. We aimed to assess depression symptom change for patients receiving standardized KIT for TRD in a large integrated health care delivery system relative to similar patients receiving standard medication management. MethodsIn this retrospective cohort study (n = 570), depression symptom change measured by the 9-item Patient Health Questionnaire (PHQ-9) was examined in 143 adults with TRD receiving 0.5mg/kg 40-minute KIT infusion twice weekly for 3 weeks from 01/01/2018 to 12/31/2022 and 427 contemporaneous patients with medication management (MM) matched on variables including sex, race, age, and baseline depression symptom score. We excluded patients with major neurocognitive disorder, schizophrenia, or pregnancy. ResultsThe KIT group was more likely to achieve depression response (PHQ-9 reduction >50 %) compared to MM (adjusted risk ratio [aRR]= 1.72, 95 % CI = 1.17 - 2.53; P = 0.006). The KIT group (8 % vs 5 %) was more likely to achieve depression remission (i.e. PHQ-9 < 5); however, the adjusted risk with KIT vs MM was not statistically significant. Baseline depression symptoms were associated with higher depression symptoms at follow up, as were co-occurring anxiety and personality disorders. ConclusionsKIT was significantly associated with depression response and symptom improvement compared to MM. Clinicians should consider comorbid personality disorder, anxiety disorders, and baseline depression severity as potential predictors of KIT and other treatment response in TRD.

The impact of demoralization on the stability of personality traits in a clinical sample.

This study examined whether reductions in the severity of personality disorders (PD) mainly reflect changes in personality traits or rather an alleviation of a demoralized state involving nonspecific unpleasant affect. We used 4 years of longitudinal data from the Collaborative Longitudinal Personality Disorders Study, in which patients (N = 419) completed the Neuroticism-Extraversion-Openness Personality Inventory-Revised (NEO-PI-R) three times over 4 years (at baseline and at 6-month and 4-year follow-up assessments). We compared the NEO Demoralization scale with NEO-PI-R domain scales adjusted for demoralization-related items to determine whether changes in demoralization are more pronounced than changes in adjusted personality traits. Results showed that adjusted Neuroticism and Demoralization changed at similar rates and both changed more than other traits. These changes were most pronounced in the first 6 months and tapered thereafter. Rank-order correlations were somewhat lower for Demoralization than adjusted traits. Our findings suggest that decreases in PD symptoms over time have to do with reductions in negative affect and that Demoralization as assessed via a subset of NEO-PI-R items is limited in its ability to distinguish negative affect from trait Neuroticism. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Pain prevalence rates and the mediating role of negative affect in adults referred to personality disorder treatment: A cross-sectional study

Personality disorders (PDs) are prevalent among individuals with chronic pain, but less is known about the prevalence of pain in the PD population. This study therefore sought to explore the prevalence of current or everyday pain among individuals referred to outpatient PD treatment, and further explore the mediating role of negative affect in the relationship between PD severity and current pain. Data was retrieved from the Norwegian Network for PDs’ quality register which included 4361 participants. Pain was operationalized using the EQ-5D-3L “pain or discomfort” item and four SCL-90-R pain-related items (“pain bothersomeness”). Rates of self-reported pain were explored both pre and post treatment to determine the persistency of the pain-related symptoms. The role of negative affect in the relationship between PD severity and pain was investigated by linear regression analysis. A substantial burden of pain-related symptoms was demonstrated, as 71% and 80% reported moderate to extreme pain or discomfort and pain bothersomeness, respectively. Muscle soreness was the most common pain (59%) followed by headache (48%), low back pain (46%), and heart or chest pain (34%). Moderate to extreme pain or discomfort was persistent for 77% of the participants who provided end of treatment data (mean treatment duration was 82 weeks). Negative affect mediated the relationship between PD severity and pain. To our knowledge, this is the first large-scale study on everyday pain in patients with PDs. The findings reveal that moderate to extreme pain is prevalent among persons with PDs and that this co-occurrence is driven by negative affect. PerspectivePain is a prevalent and potentially underrecognized symptom in personality disorders and persists until treatment termination for a large group of patients. This co-occurrence may be driven by a susceptibility to negative affect that is enhanced by personality disorder features.

Gender bias in assessing narcissistic personality: Exploring the utility of the ICD-11 dimensional model.

Narcissistic personality disorder as captured in categorical diagnostic systems (e.g., DSM-5) emphasizes grandiose features more associated with masculine norms and under-emphasizes vulnerable features more associated with femininity. This poses significant implications in diagnostic outcome and clinical treatment in women with narcissistic preoccupations. Research finds that clinicians using the DSM-5 categorical system tend to diagnose vulnerable narcissism in women as other 'feminized' personality disorders (e.g., borderline), but no research has explored gender differences in narcissism using the new ICD-11 dimensional framework for personality disorders. This study investigated the clinical utility of the ICD-11 approach in capturing gender differences in narcissistic presentations. Adopting an online vignette-based study, mental health clinicians (N = 157; 71.3% female) completed ratings of ICD-11 personality disorder severity and trait domains for two cases reflecting 'grandiose' and 'vulnerable' narcissism in hypothetical male or female patients. The results showed that ratings of core impairments in personality functioning and overall severity were consistent irrespective of patient or clinician gender, contrasting prior research using categorical models. While some differences were observed in trait domain (e.g., negative affectivity) between patient gender, these results suggest the clinical utility of the ICD-11 model as emphasizing elements of personality functioning in the process of assessment and diagnosis, therefore potentially being less susceptible to influences of gender stereotype in aiding clinical conceptualization.

Self-Reported ICD-11 Personality Disorder Severity in Peruvian Adolescents: Structure, Validity, and Tentative Cutoffs.

Personality disorder (PD) is particularly common in adolescents, which underscores the significance of early screening, diagnosis, and intervention. To date, the definition of PD in the new ICD-11 has not yet been investigated in adolescents. This study therefore aimed to investigate the unidimensionality and criterion validity of self-reported ICD-11 PD features in Peruvian adolescents using the Personality Disorder Severity ICD-11 (PDS-ICD-11) scale. A total of 1,073 students (63% female; age range 12-16 years) were administered the PDS-ICD-11 scale along with criterion measures of personality pathology and symptom distress. The PDS-ICD-11 score showed adequate unidimensionality and conceptually meaningful associations with external criterion variables. The findings indicate that ICD-11 PD features, as measured with the PDS-ICD-11 scale, are structurally and conceptually sound when employed with adolescents. Norm-based cutoffs derived from the present study may be used for clinical interpretation. The PDS-ICD-11 may be employed as an efficient screening tool for personality dysfunction in adolescents.

Internal consistency of measures for ICD-11 personality disorder severity and traits: A systematic review and meta-analysis.

A number of measures and scales have been developed for the ICD-11 personality disorder (PD) diagnosis, including severity and trait dimensions. The present systematic review and meta-analysis sought to evaluate the internal consistency of these measures across different populations and cultures. A systematic search was conducted across four databases where relevant studies were subjected to explicit eligibility criteria resulting in 49 included studies and 370 effect sizes. Study characteristics were tabulated, their methodological quality was evaluated, and findings were synthesized using random effects meta-analysis. Findings overall indicated that measures of ICD-11 PD severity and trait domains have adequate levels of internal consistency (α/ω = 0.82, 95% CI [0.81; 0.83], I2 = 97.3%). Aspects such as sample, country, language, format, and measured construct were significant sources of variation. Additional meta-analyses revealed that some measures performed better than others for certain dimensions. Internal consistency was overall supported across ICD-11 measures of severity and trait domains. Future research should further investigate the interrater reliability, test-retest reliability and stability, and alignment with interview-based PD diagnoses.

Reliability and validity of the Personality Disorder Severity ICD-11 (PDS-ICD-11) scale and the Revised Personality Assessment Questionnaire for ICD-11 (PAQ-11R) in a Norwegian community sample.

In the ICD-11, a new model for the diagnosis of personality disorders is included, consisting of an assessment of the severity of personality impairment as well as an optional evaluation of pathological personality traits. This study aimed to examine the reliability, structural validity, and convergent and discriminant validity of the Norwegian versions of the Personality Disorder Severity ICD-11 (PDS-ICD-11) scale for the assessment of personality disorder severity and the Revised Personality Assessment Questionnaire for ICD-11 (PAQ-11R) for the assessment of the ICD-11 pathological personality traits in a Norwegian community sample. The sample consisted of 295 participants (75.9% female) with a mean age of 30.0years (SD = 10.7years). The participants answered the PDS-ICD-11, PAQ-11R, Level of Personality Functioning Scale-Brief Form 2.0 (LPFS-BF 2.0), and the Personality Inventory for DSM-5-Brief Form Plus Modified (PID5BF + M). The Norwegian PDS-ICD-11 showed good reliability. Support for a unidimensional model and a high convergent correlation with the LPFS-BF 2.0 was found. The reliability analysis of the Norwegian PAQ-11R scales yielded mixed findings with suboptimal reliability estimates for the PAQ-11R detachment, disinhibition, and dissociality scales. Analyzing the structure of the PAQ-11R items, four factors emerged (negative affectivity, detachment, disinhibition, and anankastia). The PAQ-11R scales showed good convergent and, overall, adequate discriminant validity with the PID5BF + M scales. The findings support the use of the PDS-ICD-11 for assessing severity in the ICD-11 PD model in Norway. The Norwegian PAQ-11R appears to be a useful screening tool for the ICD-11 PD trait domains.

Attachment Problems and Mentalizing Capacity Relate to Parent-Child Informant Discrepancies in Female Adolescents with Borderline Personality Disorder.

Parent-child informant discrepancies on psychopathology provide important knowledge on the parent-child relationship and the child's mental health, but mechanisms underlying parent-child informant discrepancies are largely unknown. Therefore, we investigated the relationship between attachment problems and mentalizing capacity and parent-child informant discrepancies on borderline personality disorder (BPD) severity, internalizing, and externalizing pathology in a clinical sample of 91 adolescent girls with BPD and their parents. Results showed that more attachment problems to parents and peers were related to adolescents reporting more severe BPD than parents. Adolescents who described more internalizing symptoms relative to parents, reported more parental attachment problems, but enhanced peer attachment, suggesting those adolescents who do not feel recognized by their parents might turn to their friends. When parents rated adolescents higher on externalizing behaviors, the adolescent reported more attachment problems to parents and lower mentalizing capacity, indicating that this sub-group of adolescents may reflect less about how their behavior affects others.

The Effectiveness of Dialectical Behavior Therapy Compared to Schema Therapy for Borderline Personality Disorder: A Randomized Clinical Trial

Introduction: In the treatment of borderline personality disorder (BPD), there is empirical support for both dialectical behavior therapy (DBT) and schema therapy (ST); these treatments have never been compared directly. This study examines whether either of them is more effective than the other in treating patients with BPD. Methods: In this randomized, parallel-group, rater-blind clinical trial, outpatients aged between 18 and 65 years with a primary diagnosis of BPD were recruited in a tertiary outpatient treatment center (Lübeck, Germany). Participants were randomized to DBT or ST with one individual and one group session per week over 1.5 years. The primary outcome was the BPD symptom severity assessed with the mean score of the Borderline Personality Disorder Severity Index at 1-year naturalistic follow-up. Results: Between November 26, 2014, and December 14, 2018, we enrolled 164 patients (mean age = 33.7 [SD = 10.61] years). Of these, 81 (49.4%) were treated with ST and 83 (50.6%) with DBT, overall, 130 (79.3%) were female. Intention-to-treat analysis with generalized linear mixed models did not show a significant difference at 1-year naturalistic follow-up between DBT and ST for the BPDSI total score (mean difference 3.32 [95% CI: –0.58–7.22], p = 0.094, d = −24 [–0.69; 0.20]) with lower scores for DBT. Pre-to-follow-up effect sizes were large in both groups (DBT: d = 2.45 [1.88–3.02], ST: d = 1.78 [1.26–2.29]). Conclusion: Patients in both treatment groups showed substantial improvements indicating that even severely affected patients with BPD and various comorbid disorders can be treated successfully with DBT and ST. An additional non-inferiority trial is needed to show if both treatments are equally effective. The trial was retrospectively registered on the German Clinical Trials Register, DRKS00011534 without protocol changes.

Reliability of the ICD-11 personality disorder severity ratings and diagnosis.

The present study aimed to investigate the interrater reliability of the dichotomous and dimensional personality disorder (PD) diagnoses based on the overall severity assessment on a rating form consisting of 18 anchored items encompassing diagnostic requirements of the International Classification of Diseases 11th Revision (ICD-11). We also aimed to examine the extent of consistency within the diagnostic requirements grouped under the domains of self- and interpersonal functioning, specific manifestations of personality dysfunction, and distress and impairment in psychosocial functioning. Our data involved a total of 184 inter-ratings of 46 consenting patients by the same set of four clinicians. The chance-corrected agreement levels were estimated at intraclass correlation coefficient (ICC) = 0.89 for the overall severity composite, ICC = 0.83 for the dimensional PD diagnosis and Fleiss' kappa = 0.77 for the dichotomous PD diagnosis. Internal consistency analysis of the overall severity composite and the domain composites revealed Cronbach's alpha coefficients approaching or exceeding 0.90 level. Our findings suggest that the diagnostic requirements listed in the ICD-11 and related documents for the severity determination in PD compose an internally consistent set. With the guidance of a rating form comprised of anchored items covering this set, competency-level clinicians are likely to perform reliable evaluations of the severity of personality disturbance, and dimensional and dichotomous PD diagnoses. The development of semi-structured interviews that would further facilitate the task of inspecting and rating each diagnostic requirement reliably will possibly enhance the implementation of the ICD-11 classification for PD around the world.

Maternal Borderline Personality Disorder Severity and Parenting Behaviors During Conflict Discussions With Adolescent Offspring

Examining the impact of maternal borderline personality disorder (BPD) on parent-child interactions could elucidate pathways of intergenerational risk and inform intervention. The current study used an expanded version of the Observing Mediational Interactions to investigate (a) associations between maternal BPD symptom severity and mediational parenting behaviors during conflict discussions with clinically referred early adolescent offspring (N = 56, age = 10-15, 54% female) and their mothers, and (b) the potential moderating role of early adolescent BPD symptom severity in those associations. Consistent with hypotheses, mothers with higher levels of BPD symptom severity engaged in fewer positive emotional/attachment-based behaviors and more negative (i.e., invalidating, controlling, coercive, or insensitive) parenting behaviors. Only parent-reported, but not self-reported, adolescent BPD severity moderated these associations; maternal BPD severity was significantly associated only with negative parenting in dyads with low-to-moderate levels of parent-reported adolescent BPD severity. We discuss implications including targeting attachment-based and negative parenting behaviors in intervention.

Physical multimorbidity in psychiatric patients with personality disorders: Insights within the ICD-11 framework

ObjectiveRecent research has revealed poor physical health among individuals with personality disorders (PDs). We aimed to compare chronic physical illnesses (CPI) and chronic physical multimorbidity (CPM) prevalence between the general population (GEP) and PD patients, and to explore the relationship between CPM and various aspects of PD, predominantly within the ICD-11 framework. MethodsThis cross-sectional study included 126 PD patients and 126 matched controls from the GEP. Patients were evaluated for the ICD-11 PD severity and maladaptive personality domains, subjective emptiness, and reflective functioning. CPI was assessed using a standardized self-report questionnaire. ResultsPD patients had a higher mean number of CPIs (2.05 vs. 1.02) and a more frequent CPM occurrence (49.2% vs. 26.2%) compared to the matched controls (p < .001). The ICD-11 PD severity (OR = 1.143, p = .007) and maladaptive domain Negative affectivity (OR = 4.845, p = .002), and poor reflective functioning (OR = 1.694, p = .007) were significant predictors of CPM, independent of sociodemographic, clinical and lifestyle factors. Negative affectivity showed the most robust effect on CPM, while smoking did not significantly mediate these relationships. ConclusionOur study found increased CPM burden in PD patients and a link between CPM and various PD aspects under the ICD-11 framework, highlighting the need for more integrated healthcare.

Examining the validity and factor structure of the ICD-11 trait domains.

The International Classification of Diseases, 11th Edition (ICD-11) includes a new personality disorder (PD) severity diagnosis that may be further characterized using up to five trait domain specifiers. Most of the previous studies have investigated the ICD-11 trait domains using self-report measures. The present study aimed to validate ICD-11 PD trait domains using a multimethod design in a community mental health sample (n = 336). We conducted two confirmatory factor analyses to examine the factor structure of the ICD-11 PD trait model, utilizing clinician-rating, self-report, and informant-report measures. Finally, we examined associations between clinician-rated, self-reported, and informant-reported ICD-11 trait domains with external criteria, specifically traditional PD symptoms and the five-factor model of normal personality. All clinician-rated, self-reported, and informant-reported domain scores loaded meaningfully on their expected factors when controlling for nontrivial method factors. Generally, the trait domains exhibited meaningful associations with conceptually relevant external criteria, although the anankastia domain exhibited more variability in its pattern of correlations across methods. Overall, the ICD-11 trait domain model shows promising reliability and validity, indicating good progress within the field of PD assessment toward a more useful PD operationalization. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Group schema therapy versus group cognitive behavioral therapy for patients with social anxiety disorder and comorbid avoidant personality disorder: A randomized controlled trial

BackgroundPatients with social anxiety (SAD) and comorbid avoidant personality disorder (AVPD) are severely impaired. Group cognitive behavioral therapy (GCBT) is considered an effective treatment for SAD. More knowledge on treatment of SAD with comorbid AVPD is needed. Schema therapy, developed for personality and chronic mental disorders, may be a promising treatment. MethodsWe conducted a randomized controlled trial in an outpatient population (n = 154) with both SAD and AVPD. Group Schema Therapy (GST) and GCBT were compared on SAD symptoms (Liebowitz Social Anxiety Scale) and manifestations of AVPD (Avoidant Personality Disorder Severity Index). ResultsIntention-to-treat analysis showed no significant differences between treatments at 3 months post-treatment and one-year follow-up. Both modalities led to significant and substantial improvements. No significant between-differences were found in depressive symptoms (Inventory of Depressive Symptoms) and quality of life (World Health Organization Quality of Life-BREF). Per-protocol analysis showed similar outcomes and no significant differences in recovery from SAD and AVPD. Significantly more patients completed GST. ConclusionGST and GCBT are valuable treatments for SAD with comorbid AVPD. The higher treatment retention in ST indicates ST is more acceptable than GCBT. Future studies should focus on enhancing treatment effects and improving retention to GCBT.

Physical illness and multimorbidities in patients diagnosed with personality disorder

IntroductionPeople with personality disorder (PD) often experience suffering, suboptimal psychiatric treatment outcomes, and early mortality due to chronic physical illness (CPI) and multimorbidity (≥2 CPI) (CPM). Increasing research underscores the elevated prevalence of CPI and CPM in those with PD.ObjectivesTo compare the prevalence of CPI/CPM between the general population and those with PD and to explore the relationship between CPI/CPM and various aspects of PD.MethodsThis cross-sectional study enrolled 126 PD patients (70.6% female, mean age 41.22 years) based on the ICD-10 criteria, and 126 socio-demographically matched individuals from the general population. The participants completed the following instruments: the ICD-11 Personality Disorder Severity Scale (PDS-ICD-11), the Personality Assessment Questionnaire for ICD-11 (PAQ-11), Subjective Emptiness Scale (SES), the Reflective Functioning Questionnaire-Revised-7 (RFQ-R-7), and self-reported chronic physical illnesses questionnaire.ResultsThe mean number of CPI in patients with PD and matched controls was 2.69 (SD=2.371) and 1.02 (SD=1.702), respectively, and this difference was statistically significant. Patients with PD also suffered more often from CPM than none or one CPI, compared to matched controls. In the multivariate logistic regression analyses among the patients with PD, higher personality disorder severity, increased trait Negative Affectivity and poorer reflective functioning/mentalizing were predictive of having CPM. These relationships were independent of age, gender, education status, income level, length of psychiatric treatment, and smoking status. Subjective emptiness was not significantly predictive of having CPM.ConclusionsThis study highlights a higher prevalence of CPI and CPM in individuals with PD compared to the general population. Factors such as higher PD severity, increased Negative Affectivity, and poorer reflective functioning were identified as predictors of CPM. These findings underscore the necessity for integrated healthcare approaches to address the multifaceted needs of PD patients, emphasizing the importance of considering both mental and physical health in treatment strategies.Disclosure of InterestNone Declared

Multidimensional assessment of personality disorders using different theoretical models: a comparison of the Young Schema Questionnaire, the SCID-5-AMPD structured diagnostic interview, and the PDS-ICD-11 self-report questionnaire

IntroductionThere has been a recent shift in the conceptualisation of personality disorders in diagnostic systems such as DSM-5 or ICD-11, from a categorical approach towards a dimensional approach reflecting severity in general or severity of dysfunction and related pathological traits. In addition, several psychotherapeutic approaches work with their own model of personality pathology, which similarly capture symptoms of personality disorders and their underlying processes in a more subtle way from multiple aspects, and along different constructs.ObjectivesThe aim of our study was to investigate similarities and differences between conceptualisations of personality disorder and instruments used for evaluation based on the BNO-11 Personality Disorders Severity Questionnaire (PDS-ICD-11), Module I. of the Structured Diagnostic Interview for the DSM-5 Alternative Personality Model (SCID-5-AMPD) measuring level of personality function, and the Young Schema Questionnaire assessing early maladaptive schemas.MethodsHospitalized borderline patients were assessed using the Young Schema Questionnaire, the PDS-ICD-11, and Module I. of the SCID-5-AMPD assessing personality function level. Data are analysed using correlation and linear regression models.Results Only part of the results are shown. The PDS-ICD-11 Severity Index and Self-function Index showed significant (p&lt;0.05) and strong correlations with the Abandonment (r=0.98, r=0.94), Vulnerability to harm and illness (r=0. 92, r=0.98), Insufficient Self-Control (r=0.91, r=0.88) and Negativism/Pessimism (r=0.95, r=0.90) schemas. The mean score and all domains of the SCID-5-AMPD Module I (level of personality function) showed significant strong correlations with the Vulnerability to harm and illness schema (AMPD-Average r=0.87; AMPD-Identity r=0.86, AMPD-Objectivity r=0.81, AMPD-Empathy r=0. 77, AMPD-Intimacy r=0.80, p&lt;0.05); moreover, a strong significant correlation was found between the Abandonment schema and AMPD-Average (r=0.81, p&lt;0.05), AMPD-Identity (r=0.98, p&lt;0.05), and AMPD-Intimacy domains (r=0.77, p&lt;0.05).ConclusionsThe main indicators of measures that operationalise a dimensional approach to personality disorders show distinct patterns of strong overlap with some of the maladaptive schemas but cover only a part of the schema domains. For a careful diagnosis and psychotherapeutic plan, the combined use of these measures can provide in-depth and multifaceted information.Disclosure of InterestNone Declared

Effectiveness of Day Treatment Group Schema Therapy for Personality Disorders: A Multiple Baseline Single-Case Study.

Schema therapy is effective for most outpatients with personality disorders (PDs). However, a subgroup does not sufficiently benefit from outpatient programmes. Despite its common clinical use, a thorough evaluation of day treatment group schema therapy (GST) is lacking. This study aimed to investigate the effectiveness of day treatment GST for patients with PDs. Negative core beliefs were the primary outcome in a multiple baseline single-case design, measured weekly before and during 30 weeks of day treatment GST. Secondary outcomes included severity of primary PD, early maladaptive schemas (EMS), schema modes and general psychopathology measured before and after day treatment GST. Intervention effects were evaluated through visual inspection and randomization test analysis, with a reliable change index calculated for the secondary outcome measures. A total of 79% of treatment completers showed a significant positive effect of day treatment GST with large effect sizes (Cohen's d: 0.96-10.04). Secondary outcomes supported these findings: 56% had a significant decrease in the severity of primary PD and 53% in general psychopathology. In addition, 63% of EMS and 72% of schema modes (87.5% for functional schema modes) showed significant positive reliable changes. This is the first empirical study that demonstrated the effectiveness of day treatment GST in patients with severe PDs. Day treatment GST can serve as a stepped care treatment option for nonresponsive patients in outpatient programmes. Further randomized controlled (cost-)effectiveness research is necessary to substantiate these findings and investigate the specific patient populations for which day treatment is essential.

Can personality disorder be accurately assessed in older age? A differential item functioning analysis of ICD-11 inventories.

The contested categorical personality disorder (PD) criteria are not well suited to inform PD diagnoses in older adults. Yet, the classification of PDs is undergoing a critical transition phase with a paradigm shift to a dimensional approach for diagnosing PDs. No special attention was given to the expression of PDs in older age when the dimensional ICD-11 model was developed. Given that PDs are highly prevalent in older adults, there is an urgent need to examine if ICD-11 related instruments are able to adequately assess for PDs in older adults. The age-neutrality of ICD-11 measures was examined in a sample of 208 Dutch community-dwelling adults (N=208, M age=54.96, SD=21.65), matched on sex into 104 younger (age range 18-64) and 104 older (age range 65-93) adults. An instrument is considered not to be age-neutral if a collective large level of differential item functioning (DIF) exists in a group of items of an instrument (i.e., 25% or more with DIF). We therefore set out to detect possible DIF in the following ICD-11 self-report measures: the Standardized Assessment of Severity of Personality Disorder (SASPD), the Personality Inventory for ICD-11 (PiCD), and the Borderline Pattern Scale (BPS). DIF analyses using a non-parametric odds ratio approach demonstrated that SASPD, PiCD, and BPS were age-neutral with less than 25% of items showing DIF. Yet, impact of DIF at scale level, examined by way of differential test functioning (DTF), indicated a DTF effect on the SASPD total score. These results of age-neutrality of the PiCD and BPS are promising for measuring ICD-11 traits and the borderline pattern. Yet, the age-neutral measurement of PD severity requires further research. With a rapidly aging population, its accurate assessment across the entire adult life span, including older age, is a prerequisite for an adequate detection of PDs.

How changes in depression severity and borderline personality disorder intensity are linked – a cohort study of depressed patients with and without borderline personality disorder

BackgroundBorderline personality disorder (BPD) is often complicated by comorbid major depressive episodes (MDEs), which can occur as part of major depressive disorder (MDD) or bipolar disorder (BD). Such comorbidity is related to worse outcomes in both disorders. Subsyndromal features of BPD are also common in depression. However, studies of simultaneous changes in BPD and depression severities are scarce, and their interactions are poorly understood.AimsStudying the associations between changes in BPD and depression symptoms over the course of an MDE.MethodsIn a 6-month naturalistic cohort study of MDE/BPD, MDE/MDD, and MDE/BD patients (N = 95), we measured change in BPD features between baseline and six months with the Borderline Personality Disorder Severity Index (BPDSI), an interviewer-rated instrument quantifying recent temporal frequency of BPD symptoms. We examined changes in BPD severity and their correlation with depression severity and other clinical measures and compared these across patient groups.ResultsThere were significant reductions in BPD severity, both in number of positive BPD criteria (-0.35, sd 1.38, p = 0.01672) and in BPDSI scores (-4.23, SD 6.74, p < 0.001), reflecting mainly a reduction in temporal frequency of symptoms. These were similar in all diagnostic groups. In multivariate regression models, changes in depression severity independently associated with changes in symptoms in the BDSI. This relationship was strongest in MDE/BPD patients but was not found in MDD patients without BPD.ConclusionsIn the six-month follow-up, BPD features in MDE patients alleviated mainly by decreasing temporal symptom frequency and intensity. In BPD patients with comorbid MDE, changes in both conditions are strongly correlated.