Personality Disorder Symptomatology Research Articles

Preventing Wounds From Healing and Borderline Personality Symptomatology

To the Editor: Borderline personality disorder is a personality dysfunction characterized by chronic self-harm behavior. In psychiatric populations, self-harm behavior in borderline personality disorder traditionally manifests as self-mutilation (eg, cutting, scratching, burning oneself), sadomasochistic relationships with others, and suicide attempts. However, in medical settings, self-harm behavior may take on more somatic overtones and medical themes, including preventing wounds from healing. A relationship between intentionally preventing wounds from healing and borderline personality disorder symptomatology has been reported in both psychiatric1 and internal medicine samples,1,2 but not in obstetrics/gynecology samples. Method. Participants consisted of 370 consecutive obstetrics/gynecology outpatients who ranged in age from 18 to 61 years (mean = 26.33, SD = 7.51). Exclusion criteria were medical or cognitive impairment of sufficient severity to preclude the successful completion of a survey. Participants were primarily white (54.3%) or African American (39.4%). Most had never been married (72.7%), with 16.5% being married, 6.9% divorced, 3.3% separated, and 0.6% widowed. Approximately 88% had at least completed high school, with 13.3% having completed a college degree. Most reported government (79.2%) or private insurance (5.5%), with the remaining 15.3% reporting self-pay or no insurance. As patients arrived at the clinic, one researcher (J.C.) solicited each for participation, informally assessed exclusion criteria, and invited candidates to complete a 4-page survey. The cover page of the survey contained the elements of informed consent, and completion of the survey was presumed to be implied consent (specified on the cover page). The survey contained (1) the Self-Harm Inventory,3 which has 1 particular query, “Have you ever intentionally, or on purpose, prevented wounds from healing?” and (2) the borderline personality disorder scale of the Personality Diagnostic Questionnaire-4 (PDQ-4),4 a 9-item, true/false, self-report version of the criteria for borderline personality disorder as described in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Data were collected in October 2010. The project was approved by an institutional review board. Results. In this sample, 13 participants (3.5%) reported preventing wounds from healing and 75 participants (20.3%) met criteria for borderline personality symptomatology according to the PDQ-4, using the traditional cutoff score of 5. The correlation between preventing wounds from healing and borderline personality symptomatology was r = 0.30. Likewise, as determined via χ2 analysis, the prevalence of prevented wounds from healing among participants with borderline personality symptomatology was statistically significantly higher than among participants without borderline personality symptomatology, χ21 = 26.76, P < .001 (N = 370). The potential limitations of this study include the self-report methodology, possible overinclusiveness of the borderline personality measure (ie, risk of false positives), and an atypical sample type (eg, low-income single women). However, in this sample, preventing wounds from healing was reported by nearly 1 in 25 participants and was associated with borderline personality symptomatology—a finding of high relevance to the general health care of women. It may be that preventing wounds from healing is functioning as a self-harm equivalent in the context of borderline personality disorder.

BIS and BAS Interact with Perceived Parental Affectionless Control to Predict Personality Disorder Symptomatology

The objective of this study was to examine if and how two basic dimensions of temperament-behavioral inhibition system (BIS) and behavioral approach system (BAS) sensitivity-might interact with exposure to perceived parental affectionless control (AFC) to predict personality disorder (PD) symptomatology. Measures of BIS, BAS, AFC, and PD symptomatology were administered to a large nonclinical sample (n = 318). As predicted, exposure to AFC was positively associated with PD symptoms in general, BIS was positively associated with Cluster A and C symptoms, and BAS was positively associated with Cluster B symptoms. BIS and BAS were also found to interact with each other to predict Cluster B symptomatology. In addition, BIS, BAS, and maternal AFC interacted to predict Cluster A symptomatology. In the latter case, it was found that individuals who reported high BIS, high BAS, and high maternal AFC reported the highest overall level of Cluster A symptoms.

Employment histories among patients with borderline personality disorder symptomatology

Whereas past research has characterized the course of symptoms in borderline personality disorder, functionality with regard to employment is less well-known. In this study, we examined 324 internal medicine outpatients with regard to employment history and borderline personality disorder symptomatology, using two self-report measures. In comparison with participants who did not exceed the cut-off scores on either measure of borderline personality disorder, those who did had a greater number of jobs since age 18, were employed less overall since age 18, were more likely to be paid under the table, and were more likely to be fired from a job. In the subsample with borderline personality disorder symptomatology, there were few employment differences between those with versus without past histories of psychiatric hospitalization. Findings suggest that individuals with borderline personality symptomatology do not fare as well with employment as their non-borderline peers.

Incremental validity of maladaptive schemas over five-factor model facets in the prediction of personality disorder symptoms

The present study investigated the prediction of personality disorder symptoms from early maladaptive schemas (EMSs) and the facets of the five-factor model of personality (FFM). The hypothesis that EMSs add to the understanding of personality disorder symptoms beyond normal personality traits was tested. One hundred and forty-five psychiatric outpatients completed the NEO PI-R, the SQ-SF, and the DIP-Q. Results showed a high degree of overlap of EMSs and FFM facets with personality disorder symptomatology. Hierarchical regression analyses indicated that EMSs contributed significantly to the prediction of personality disorder symptoms beyond FFM facets. Implications of the findings for the understanding of personality disorders are discussed.

Current Status of the Scientific Study of the Personality Disorders: an Overview of Epidemiological, Longitudinal, Experimental Psychopathology, and Neurobehavioral Perspectives

Research on the nature and development of personality disorders has grown immensely over the past thirty years. A selective summary overview is given of the current status of the scientific study of the personality disorders from several perspectives, including the epidemiological, longitudinal, experimental psychopathology, and neurobehavioral perspectives. From this research, we now know that approximately 10 percent of the general population suffer from a diagnosable personality disorder. Moreover, contrary to nearly a century of theory and clinical pedagogy, modern longitudinal studies clearly suggest that personality disorders decrease in severity over time. The mechanisms by which this change occurs are not understood at present, though it is not likely that change in underlying normal personality systems drives the change in personality disorder. The methods of the experimental psychopathology laboratory, including neuroimaging approaches, are being brought to bear on the nature of personality disorders in efforts to relate neurobiological and neurocognitive functions to personality disorder symptomatology. A model that links personality disorder feature development to underlying, interacting brain-based neurobehavioral systems is reviewed in brief. Current issues and findings illustrative of these developments are given using borderline personality disorder as an exemplar. Finally, areas of intersection between psychoanalytic treatment approaches and the growing science of personality disorder are highlighted.

An integrative dimensional classification of personality disorder.

Psychological assessment research concerns how to describe psychological dysfunction in ways that are both valid and useful. Recent advances in assessment research hold the promise of facilitating significant improvements in description and diagnosis. One such contribution is in the classification of personality disorder symptomatology. The American Psychiatric Association's diagnostic manual considers personality disorders to be categorically distinct entities. However, research assessing personality disorders has consistently supported a dimensional perspective. Recognition of the many limitations of categorical models of personality disorder classification has led to the development of a variety of alternative proposals, which further research has indicated can be integrated within a common hierarchical structure. This article offers an alternative integrated dimensional model of normal and abnormal personality structure, and it illustrates how such a model could be used clinically to describe patients' normal adaptive personality traits as well as their maladaptive personality traits that could provide the basis for future assessments of personality disorder. The empirical support, feasibility, and clinical utility of the proposal are discussed. Points of ambiguity and dispute are highlighted, and suggestions for future research are provided.

Social context during non-suicidal self-injury indicates suicide risk

The link between non-suicidal self-injury (NSSI) and suicide is complex. Previous research indicates that self-injurers endorsing automatic/intrapersonal functions (as opposed to social/interpersonal functions) for NSSI are more likely to have considered and attempted suicide. Subsequent research suggests that those endorsing automatic/intrapersonal functions are more likely to self-injure exclusively while alone. Based on these findings, we hypothesized that the social context during NSSI (i.e., the extent to which one self-injures alone versus around others) represents an easily measurable and theoretically meaningful marker for suicide risk among those who self-injure. Participants were 205 young adults who had performed one or more NSSI behaviors and completed several clinical measures. In general, self-injurers scored higher on measures of suicidality and suicide risk factors (i.e., depression, anxiety, borderline personality disorder symptomatology) than a non-injuring control sample ( n = 596). In addition, self-injurers who engage in NSSI alone were more likely to report a history of suicide ideation, plans, and attempts compared to other self-injurers. Endorsement of automatic/intrapersonal functions only partially explained the relationship between the social context during NSSI and suicidality. Consistent with the study hypothesis, social context during NSSI appears to be a marker for suicide risk in individuals who engage in NSSI.

Ethnic variations in the structure of borderline personality disorder symptomatology

The goal of this study was to examine differences in the factor structure of borderline personality disorder symptoms among different ethnic groups. The authors obtained information regarding ethnic identity and endorsement of borderline personality disorder criteria for an ethnically diverse community sample of 1140 young adult subjects from south Florida. Using this information the authors conducted an exploratory factor analysis examining differences between Caucasian, Hispanic and African American groups. A principal-components factor analysis (PCA) with Varimax rotation for each ethnic group revealed a reasonably generalizable four-factor structure: affective dysregulation, cognitive disturbance, disturbed relatedness and behavioral dysregulation. The emergence of a four-factor structure across three separate, relatively large samples suggests that the factors obtained have merit. However, the loadings of some BPD symptoms, such as impulsivity, varied for each ethnic group. The results of this study indicate that ethnic variations in borderline personality disorder should be considered during assessment and treatment of this disorder. Also, future research should examine if this same factor structure holds for ethnic minorities with BPD diagnoses, examine ethnic differences in the etiology and maintenance of BPD symptomatology, and explore the effects that these differences might have in treatment settings.

Utilisation du modèle de personnalité à cinq facteurs (FFM) dans l’évaluation des troubles de la personnalité du DSM-IV

Introduction Widespread and long-standing dissatisfaction with the current DSM-IV diagnostic system for the personality disorders (PDs) revolves around five specific issues: use of a dichotomous, categorical model; extremely high rates of comorbidity within the PDs, as well as with Axis I disorders; excessive heterogeneity within the PDs; nonempirically derived diagnostic cut-offs and limited coverage of the personality pathology seen by clinicians. Many critics have suggested that the personality pathology might be better characterized using a dimensional trait model of general or pathological personality. Much research documents support relations between the PDs and the five-factor model of personality (FFM), a prominent model of general personality functioning. Recent research has examined the ability of FFM trait configurations to assess the DSM-IV PDs. Initial work focused on matching individual FFM profiles to prototypical PD profiles derived from expert ratings. Although this initial work showed that these FFM-assessed PDs performed like explicit PD assessments, the prototype matching approach was deemed cumbersome and a simpler, alternative count technique derived from the expert profiles was developed. The FFM PD counts sum the facets rated as being particularly prototypic (high or low) of a PD. The current study The current study tests the FFM PD counts by examining their convergent and discriminant validity correlations with explicit measures of DSM-IV PD symptomatology in two clinical samples (one French; one Belgian). In addition, “receiver operator characteristics” (ROC) analyses are used to provide information on the clinical utility of the FFM PD counts. Method The French clinical sample consisted of 100 female inpatients hospitalized for treatment of an eating disorder, whereas the Belgian clinical sample consisted of 130 psychiatric inpatients (47% women) with diverse presenting problems. Translated versions of the NEO PI-R were used to assess the FFM in each sample and to generate the FFM PD counts. DSM-IV PD symptom counts and diagnoses were obtained via structured interview in the French sample and via self-reports in the Belgian sample. Results In the French sample, convergent validity correlations between the FFM PD counts and DSM symptom counts ranged from 0.20 to 0.65 with a median r of 0.47. In the Belgian sample, these correlations ranged from 0.17 to 0.61 with a median r of 0.45. For the French sample, the median discriminant correlations for each FFM PD ranged from −0.23 to 0.35; for the Belgian sample they ranged from −0.13 to 0.28. Finally, ROC analyses were conducted for the PDs in which 10 or more individuals met the DSM diagnosis. ROC analyses provide “areas under the curve” (AUC), as well as other diagnostic efficiency statistics. An AUC of 0.50 indicates that the FFM PD count is no better at distinguishing between those with and without a given PD diagnosis than chance. AUCs were significant for all PDs examined except for the OCPD, ranging from 0.57 to 0.94 with a mean of 0.75. Average diagnostic efficiency statistics were also generally good. Discussion The FFM PD counts adequately assess the majority of extant DSM PDs. With the recent development of normative data and scoring sheets, these FFM counts can be applied in most clinical settings. Importantly, FFM data can be used flexibly with a focus either on the role of specific domains and facets or on specific trait configurations. Additionally, there are theoretical benefits to conceiving of PDs as constellations of FFM trait. Comorbidity is to be expected to the degree that the PDs include the same traits. The FFM PD counts are inherently dimensional, representing approximations to a prototype; thus, concerns surrounding the PDs as categories are rendered inert. Using the FFM to conceptualize the PDs allows basic research on personality to inform research on the etiology, course and treatment of the PDs.

The Utility of Forms and Functions of Aggression in Emerging Adulthood: Association with Personality Disorder Symptomatology

A sample of 679 (341 women) emerging adults (M = 18.90 years; SD = 1.11; range = 18.00–22.92) participated in a study on the utility of forms (i.e., physical and relational) and functions (i.e., proactive and reactive) of aggression. We examined the link between these four subtypes of aggression and personality pathology (i.e., psychopathic features, borderline personality disorder features, and antisocial personality disorder features). The study supports the psychometric properties (i.e., test–retest reliability, internal consistency, discriminant validity) of a recently introduced measure of forms and functions of aggression during emerging adulthood. Aggression subtypes were uniquely associated with indices of personality pathology. For example, proactive (i.e., planned, instrumental or goal-oriented) and reactive (i.e., impulsive, hostile or retaliatory) functions of relational aggression were uniquely associated with borderline personality disorder features even after controlling for functions of physical aggression and gender. The results highlight the differential associations between forms and functions of aggression and indices of personality pathology in typically developing emerging adults.

The Relationship Between Childhood Abuse and Adult Personality Disorder Symptoms

This study assessed personality disorder symptomatology in a community sample of healthy adults without diagnosable DSM-IV-TR Axis I psychiatric disorders who reported a history of childhood abuse. Twenty-eight subjects with a history of moderate to severe physical, sexual, and/or emotional abuse according to the Childhood Trauma Questionnaire were compared to 33 subjects without an abuse history on symptoms of personality disorders. Subjects in the Abuse group were more likely to report subclinical symptoms of paranoid, narcissistic, borderline, antisocial, obsessive compulsive, passive-aggressive, and depressive personality disorders. These findings link reports of childhood abuse with symptoms of personality disorders in the absence of Axis I psychiatric disorders in a community sample of healthy adults.

Personality Disorder Symptomatology and Neuropsychological Functioning in Closed Head Injury

Personality Disorder Symptomatology and Neuropsychological Functioning in Closed Head Injury

Millon's Dimensional Model of Personality Disorders: A Comparative Study

Millon has proposed six fundamental dimensions of general personality functioning as providing the underlying structure of personality disorders. However, this widely-cited theoretical model has been the subject of few empirical studies. The purpose of the current study was to directly compare the validity of this model to the five-factor model with respect to their hypothesized relationships with personality disorder symptomatology. Participants were administered the predominant measures of general personality functioning for each theoretical model, along with an assessment of personality disorder symptomatology. The results found only weak support for the theoretical model of Millon. Limitations and suggestions for future research are discussed.

Personality Disorder Symptomatology and Neuropsychological Functioning in Closed Head Injury

Despite an emerging literature characterizing the neuropsychological profiles of borderline, antisocial, and schizotypal personality disorders, relations between personality disorder traits and neurocognitive domains remain unknown. The authors examined associations among Millon Clinical Multiaxial Inventory-III personality disorder scales and eight neuropsychological domains in 161 patients referred for neuropsychological evaluation following closed head injury. Most personality disorder scales were associated with some decrement in cognitive function, particularly speeded processing, executive function, and language, while histrionic and narcissistic scales had positive relations with neuropsychological functioning. Results suggest that many personality disorder traits are related to neurocognitive function, particularly those functions subserved by frontal and temporal regions.

Should Self-Defeating Personality Disorder be Revisited in the DSM?

Self-defeating personality disorder (SDPD) was proposed for consideration in the DSM-III-R, but was eventually removed from the manual because of the lack of evidence to support its validity. Yet, after DSM-IV was published, some studies suggested that SDPD may be a viable diagnosis. The purpose of this study was to evaluate SDPD's viability as a diagnostic category. Consequently, SDPD's internal consistency, comorbidity with other Axis I and II disorders, association with psychosocial impairment, and its ability to predict overall impairment in past, current, and global levels of functioning beyond other personality disorder symptomatology was assessed in 1,200 psychiatric evaluated with the Structured Clinical Interview for DSM-IV Personality (Pfohl, Blum, & Zimmerman, 1997). Cronbach's alpha for SDPD criteria was 0.61, and item-total correlations ranged between 0.22-0.38. There was substantial comorbidity of SDPD with depressive, avoidant, and borderline personality disorders, as well as major depression and anxiety disorders. The SDPD group did not significantly differ from psychiatric controls on multiple measures of psychosocial impairment, global functioning, and suicidality. SDPD did not meaningfully add to the prediction of impairment above and beyond other measures of Axis II pathology. It is concluded that the data do not support the reliability, validity, and utility of the SDPD diagnosis.

Treating the “Mischances of Character,” Simply and Effectively

Cluster B personality disorders, particularly borderline personality disorder (BPD) and narcissistic personality disorder (NPD), are simultaneously among the most disruptive and impairing and among the least well studied, especially regarding treatment. In this paper we present an approach to treating these disorders that emphasizes motivation for treatment, self-control, and a highly structured way to reduce personality disorder symptomatology. Initial testing of the approach on nine patients with BPD and six patients with NPD indicates promise. Case reports are used to illustrate the approach.

Where is the Personality in Personality Disorder Assessment? A Comparison Across Four Sets of Personality Disorder Scales

The present research examined the amount and kind of personality measured within four sets of personality disorder (PD) scales. Three samples of undergraduate students (Ns = 326, 537, and 617) completed at least one PD measure and a combined interpersonal circumplex model (ICM) and five-factor model (FFM) measure. The FFM dimensions were found to account for between 5% to 57% of the variance in personality disorder symptomatology depending on the PD examined and the PD measure employed. Consistent with previous research, Neuroticism and low Extraversion often emerged as the primary predictors of PD symptomatology, but variability in the particular aspects of personality assessed within each of the PD measures was apparent within the ICM and FFM findings. The implications of the findings for conceptualization and measurement of PDs are discussed.

Borderline personality disorder and multiple aspects of emotional intelligence

Although considerable attention has begun to be focused on personality disorders in recent years, relatively little is known about the relationship between personality disorders and emotional intelligence. In response to the need to better understand this relationship, the present research was designed to determine whether personality disorder symptomatology would be associated with six aspects of emotional intelligence: emotional clarity, emotional attention, emotional regulation, private emotional awareness, private emotional preoccupation, and public emotional monitoring. The results indicated that several personality disorders were systematically associated with these aspects of emotional intelligence.

Polymorphisms of DRD4 and DRD3 and risk of avoidant and obsessive personality traits and disorders

We investigated whether polymorphisms of the dopamine D4 receptor ( DRD4) and polymorphisms of the dopamine D3 receptor ( DRD3) were associated with personality disorder symptomatology rather than with personality traits such as novelty seeking. DNA was obtained from 145 depressed patients in a clinical trial. These patients were assessed for the presence of personality disorder symptoms and disorders. The 2-repeat allele of the DRD4 exon III polymorphism was associated with increased rates of avoidant and obsessive personality disorder symptomatology. The T,T genotype of the DRD4 −521 C>T polymorphism was also associated with increased rates of avoidant and obsessive personality disorder symptomatology. The Gly9,Gly9 genotype of the DRD3 Ser9Gly polymorphism was associated with increased rates of obsessive personality disorder symptomatology. None of these three polymorphisms were associated with novelty seeking or other temperament traits on the Temperament and Character Inventory. Our results suggest that genetic polymorphisms of DRD4 and DRD3 may well be associated with personality traits, and that conflicting findings to date may arise from the problem of phenotype definition.

The relationship among binge severity, personality psychopathology, and body mass index.

To determine the relationship among binge severity, personality psychopathology, and body mass index (BMI) among individuals with binge eating disorder (BED). Participants were 50 individuals from the community who responded to advertisements for a medication treatment study of compulsive overeating and met BED criteria. Participants completed the Eating Disorder Examination and the Structured Clinical Interview for DSM-IV Personality Disorders. Binge eating severity was significantly and positively correlated with BMI and personality disorder symptomatology. The frequency of binge eating episodes, but not binge size, was associated with greater levels of personality psychopathology. BMI and personality psychopathology were unrelated. Twelve percent of the participants met full criteria for avoidant personality disorder (APD) and 10% met full criteria for obsessive-compulsive personality disorder (OCPD). Findings suggest that eating pathology, rather than weight, is related to personality psychopathology. APD and OCPD traits may be of particular relevance when considering treatment interventions for individuals with BED.