Self-defeating Personality Disorder Research Articles

Examining the Interpersonal Profiles and Nomological Network Associated with Narcissistic Grandiosity and Narcissistic Vulnerability

Theory and research have consistently shown that pathological narcissism can best be described by 2 phenotypic expressions, narcissistic grandiosity and narcissistic vulnerability. The current study sought to examine the specific types of interpersonal problems reported by those high in narcissistic grandiosity and high in narcissistic vulnerability as well as examine the nomological network associated with these 2 manifestations of narcissism. In a sample of university students who completed self-report measures of pathological narcissism, interpersonal problems, depression, self-esteem, malignant self-regard, self-defeating personality disorder symptoms, and anger, we found that narcissistic grandiosity (n = 108) was associated with one distinct interpersonal profile, for example, being overly intrusive in relationships with others, while narcissistic vulnerability (n = 88) was associated with a wider range of interpersonal problems on the interpersonal circumplex. Using cluster analysis, we found 3 interpersonal subtypes associated with narcissistic vulnerability, an intrusive subtype, a cold subtype, and a socially avoidant subtype. Further examination of group differences showed that the 3 interpersonal subtypes associated with narcissistic vulnerability could also be distinguished based on their experience and expression of anger. This suggests the importance of assessing profiles of interpersonal functioning and anger in narcissistic vulnerability. The clinical implications of our results are discussed.

The effect of positive childhood experiences on adult personality psychopathology

Most of the current literature on the subject focuses on the relationship between adverse childhood experiences and adult personality psychopathology; however, as far as is known, there is no research investigating the relationship between positive childhood experiences and adult personality disorder symptoms. The present study aims to highlight the association between positive childhood experiences and adult personality psychopathology. To investigate this association, 341 participants were recruited for this study, in which the Adverse Childhood Experiences Scale, the Benevolent Childhood Experiences Scale and the Coolidge Axis II Inventory Plus were used. Stepwise linear regressions supported the position that despite the presence of adverse childhood experiences, there are independent relationships between positive childhood experiences and 11 out of 14 personality disorder symptoms (Antisocial, Avoidant, Borderline, Dependent, Depressive, Obsessive-Compulsive, Paranoid, Passive-Aggressive, Schizoid, Schizotypal and Self-defeating Personality Disorder (PD) symptoms). Results did not support an independent relationship between positive childhood experiences and histrionic, sadistic or narcissistic personality disorder traits. The results of the study illuminate how positive childhood experiences may counteract long-term effects of childhood adversity.

Relationships among depressive, passive-aggressive, sadistic and self-defeating personality disorder features with suicidal ideation and reasons for living among older adults

Objectives: Suicide among older adults is a major public health problem in the USA. In our recent study, we examined relationships between the 10 standard DSM-5 personality disorders (PDs) and suicidal ideation, and found that the PD dimensions explained a majority (55%) of the variance in suicidal ideation. To extend this line of research, the purpose of the present follow-up study was to explore relationships between the four PDs that previously were included in prior versions of the DSM (depressive, passive-aggressive, sadistic, and self-defeating) with suicidal ideation and reasons for living.Method: Community-dwelling older adults (N = 109; age range = 60–95 years; 61% women; 88% European-American) completed anonymously the Coolidge Axis II Inventory, the Reasons for Living Inventory (RFL), and the Geriatric Suicide Ideation Scale (GSIS).Results: Correlational analyses revealed that simple relationships between PD scales with GSIS subscales were generally stronger than with RFL subscales. Regarding GSIS subscales, all four PD scales had medium-to-large positive relationships, with the exception of sadistic PD traits, which was unrelated to the death ideation subscale. Multiple regression analyses showed that the amount of explained variance for the GSIS (48%) was higher than for the RFL (11%), and this finding was attributable to the high predictive power of depressive PD.Conclusion: These findings suggest that depressive PD features are strongly related to increased suicidal thinking and lowered resilience to suicide among older adults. Assessment of depressive PD features should also be especially included in the assessment of later-life suicidal risk.

DSM-5 and beyond: A critical feminist engagement with psychodiagnosis

The history of critical feminist engagement with psychiatry is a long one. It stretches at least to 1892, the year when Charlotte Perkins Gilman published her autobiographical novella, The Yellow Wallpaper. Gilman delivered a searing indictment of the ‘rest cure’ prescribed for her by Dr S Weir Mitchell. Some 70 years later, Friedan’s The Feminine Mystique (1963) blasted Freudian ideas about women and femininity, ideas that held sway among psychiatrists and many clinical psychologists in the US. Friedan’s book, described by one social critic as ‘pull[ing] the trigger on history,’ galvanized the Women’s Liberation Movement. It is now 50 years since The Feminine Mystique was published. Over those years, feminists have relentlessly challenged many psychiatric diagnoses, psychological theories, and clinical practices. Feminist psychologists like Chesler (1972) and Weisstein (1968/1993) argued that much of what was passed off as scientific knowledge was, as Ehrenreich and English (1978/2005: 5) put it, ‘the ideology of a masculinist society dressed up as objective truth.’ In the mid-1980s, feminists in the mental health professions organized a concerted protest against the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994; hereinafter, DSM), a protest that would stretch to the present day. They were spurred on by three new diagnostic categories proposed for the DSM-III-R: masochistic personality disorder (later renamed selfdefeating personality disorder), premenstrual dysphoric disorder (renamed many times over), and paraphilic rapism (later called paraphilic coercive disorder and sexual sadism disorder). To block the inclusion of these categories, prominent

Do changes on MCMI-II personality disorder scales in short-term psychotherapy reflect trait or state changes?

The Millon Clinical Multiaxial Inventory (MCMI) has become an important and commonly used instrument to assess personality functioning. Several studies report significant changes on MCMI personality disorder scales after psychological treatment. The aim of the study was to investigate whether pre–post-treatment changes in 39-session psychodynamic group psychotherapy as measured with the MCMI reflect real personality change or primarily reflect symptomatic state changes. Pre–post-treatment design included 236 psychotherapy outpatients. Personality changes were measured on the MCMI-II and symptomatic state changes on the Symptom Check List 90-R (SCL-90-R). The MCMI Schizoid, Avoidant, Self-defeating, and severe personality disorder scales revealed substantial changes, which could be predicted from changes on SCL-90-R global symptomatology (GSI) and on the SCL-90-R Depression scale. The MCMI Dependent personality score was the only MCMI personality scale showing significant change when the SCL-90-R Depression change score was included as a covariate. Splitting patients into those with and without personality disorders did not change the results. Observed changes on MCMI-II personality disorder scales in short-term psychotherapy reflect change in symptomatic state. The MCMI-II Base Rate cut-off points probably include too many patients, justifying the introduction of new scoring procedures in the MCMI-III.

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.

Axis II comorbidity of borderline personality disorder: description of 6‐year course and prediction to time‐to‐remission

The purpose of this study was to compare the axis II comorbidity of 202 patients whose borderline personality disorder (BPD) remitted over 6 years of prospective follow-up to that of 88 whose BPD never remitted. The axis II comorbidity of 290 patients meeting both DIB-R and DSM-III-R criteria for BPD was assessed at baseline using a semistructured interview of demonstrated reliability. Over 96% of surviving patients were reinterviewed about their co-occurring axis II disorders blind to all previously collected information at three distinct follow-up waves: 2-, 4-, and 6-year follow-up. Both remitted and non-remitted borderline patients experienced declining rates of most types of axis II disorders over time. However, the rates of avoidant, dependent, and self-defeating personality disorders remained high among non-remitted borderline patients. Additionally, the absence of these three disorders was found to be significantly correlated with a borderline patient's likelihood-of-remission and time-to-remission; self-defeating personality disorder by a factor of 4, dependent personality disorder by a factor of 3 1/2, and avoidant personality disorder by a factor of almost 2. The results of this study suggest that axis II disorders co-occur less commonly with BPD over time, particularly for remitted borderline patients. They also suggest that anxious cluster disorders are the axis II disorders which most impede symptomatic remission from BPD.

Are Short-Term Psychotherapies Helpful for Cluster C Personality Disorders?

Personality disorders, often intransigent, usually inspire treatment plans favoring long-term psychotherapies. To examine the impact of short-term therapies, researchers randomized 50 patients with at least one DSM-IIIR cluster C personality disorder or self-defeating personality disorder to 40 weekly sessions of short-term, dynamically oriented psychotherapy (based on the model of Vaillant and Malan) or …

Personality disorders, history of trauma, and posttraumatic stress disorder in subjects with anxiety disorders

The purpose of the study was to examine the association of personality disorders, history of trauma, and posttraumatic stress disorder (PTSD) in a large sample of subjects with anxiety disorders. Categorical and continuous indices of personality disorders were compared in three groups from the Harvard/Brown Anxiety Disorders Research Project (HARP): subjects with no history of trauma (n = 403), subjects with a history of trauma but no history of PTSD (n = 151), and subjects with a current or past diagnosis of PTSD (n 68). Subjects with PTSD were more likely to meet criteria for borderline or self-defeating personality disorder than subjects in the other two groups. PTSD subjects also had higher scores on the continuous measures (total number of criteria met) for borderline and self-defeating personality disorder than the other two groups. The findings suggest that a diagnosis of PTSD rather than a history of trauma is associated with borderline and self-defeating personality disorder features. Alternative conceptualizations of axis II features in individuals with PTSD are discussed.

Self-defeating personality disorder reconsidered.

The objective of this study was to assess the distinctiveness, incremental validity, and gender bias of self-defeating personality disorder (SDPD) symptoms. A total of 441 nonclinical subjects completed personality disorder questionnaires. Structural equation modeling and regression analyses indicated that SDPD symptoms were distinctive, predicted impairment/distress beyond other personality disorder symptoms, and showed no gender bias. SDPD warrants reconsideration as a valid nosological category.

Diagnoses Under Consideration—Self-Defeating and Depressive Personality Disorders: Current Status and Clinical Issues

In this article, we discuss the DSM-III-R self-defeating personality disorder and the DSM-IV depressive personality disorder. Descriptions of and empirical studies on the DSM conceptualizations of these two disorders are provided, along with descriptions from various theoretical perspectives. Although these two disorders have not been formally recognized in the diagnostic nomenclature, clinical descriptions and empirical findings suggest that consideration of treatment strategies for these disorders is warranted. Issues of differential diagnosis, transference and countertransference, and appropriate interventions throughout the course of psychotherapy are addressed. A case study is presented to illustrate assessment and treatment considerations. Recommendations for future research are also provided.

Response to light therapy in seasonal affective disorder: personality disorders and temperament as predictors of outcome

Outcome after 6 days of morning light therapy in subjects fulfilling criteria for winter seasonal affective disorder (SAD) was examined. Responders had significantly fewer previous episodes of SAD. Patients with a diagnosis of any DSM-III-R, axis II personality disorder, were significantly less likely to respond to light therapy than patients without axis II pathology. Poor treatment outcome was also significantly associated with: one or more personality disorders in cluster C, avoidant personality disorder, high number of positive criteria for self-defeating personality disorder and high score on the harm avoidance scale of the Tridimensional Personality Questionnaire. Temperament accounted for 25% of the variance in treatment outcome.

Self-Defeating Personality Disorder: Diagnostic Accuracy and Overlap with Dependent Personality Disorder

This study was designed to determine: (1) whether self-defeating personality disorder can be accurately diagnosed by psychologists from written case studies and (2) the extent of overlap between ratings of self-defeating personality disorder and dependent personality disorder. Participants were 118 psychologists recruited from a state psychological association. The psychologists were asked to assign an Axis II diagnosis, if warranted, to each of six case studies. Three of the four self-defeating cases were accurately diagnosed at a rate significantly greater than chance, with female psychologists more accurately diagnosing self-defeating personality disorder than male psychologists. Psychologists also were asked to rate each case along several personality dimensions, including self-defeating and dependent. Four of the six cases had nonsignificant correlations between ratings of self-defeating and dependent personality dimensions. These results suggest that psychologists can accurately diagnose self-defeating personality disorder from written case studies, and that, in general, psychologists perceive that there is a self-defeating personality dimension that exists independently from a dependent personality dimension. However, these findings supporting the utility of the self-defeating personality disorder category were tempered by the finding that the self-defeating cases were not diagnosed as accurately as were the borderline and dependent cases.

Prevalence and correlates of anger attacks: A two site study

Although anger attacks have been described in depressed outpatients, they have not been well studied in other disorders. In Study 1, we examined the prevalence of anger attacks in 50 outpatients with panic disorder. In Study 2, we replicated the initial findings at an independent site and examined the specificity of anger attacks by comparing their occurrence in patients with panic disorder, patients with other non-panic anxiety disorders and patients with a depressive disorder. At both sites, we also explored the relationship between anger attacks and demographic and clinical characteristics, such as gender, presence and severity of depression, and social anxiety measures. In both sites, the prevalence of anger attacks in patients with panic disorder was approximately one-third. However, anger attacks were not unique to panic disorder, with similar rates emerging for patients with other anxiety disorders. Furthermore, patients with depressive diagnoses had twice the prevalence of anger attacks than did anxiety patients. At both sites, those with anger attacks were significantly more depressed and were likely to have either current or past history of major depression. Anger attacks were not associated with social anxiety measures, but were related to cluster B, cluster C and self-defeating personality disorder traits. Our findings support the notion that anger attacks are best conceptualized as an associated feature of depression.

They Say You're Crazy: How the World's Most Powerful Psychiatrists Decide Who's Normal

The main point of this book is to contest the use of self-defeating personality disorder (SDPD) and late luteal phase dysphoric disorder (LLPDD) as diagnoses for women. Dr Caplan, a psychologist, feels that women who are labeled with these diagnoses are going to be damaged by the intervention. Accordingly, she wants to expose the decisionmaking process about who is normal, as she feels that being knowledgeable about this background can help persons overcome the damage done to them when they are called abnormal. It is the author's opinion that the constructing of the Diagnostic and Statistical Manual, Fourth Edition (DSM-IV) , of the American Psychiatric Association (APA) was a disingenuous and dishonest process. Dr Caplan underscores most people's concern with being classified as normal, and she appropriately notes that being labeled mentally abnormal causes countless people to have a poor self-image. She feels mental health professionals tend to overdiagnose rather than

The Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II). Part I: Description

The history and description of the Structured Clinical Interview for DSM-HI-R Personality Disorders (SCID-II) is presented. The SCID-II is a clinician-administered semistructured interview for diagnosing the 11 Axis II personality disorders of the Diagnostic and Statistical Menual of Mental Disorders (3rd ed., rev.), plus the Appendix category self-defeating personality disorder. The SCID-II is unique in that it was designed with the primary goal of providing a rapid clinical assessment of personality disorders without sacrificing reliability or validity. It can be used in conjunction with a self-report personality questionnaire, which allows the interview to focus only on the items corresponding to positively endorsed questions on the questionnaire, thus shortening the administration time of the interview.

Self-Defeating Personality Disorder

The clinical utility of the DSM-II-R-proposed diagnostic category self-defeating personality disorder (SDPD) was assessed through the presentation of prototypic case histories to American and British psychiatrists and clinical psychologists. The most frequent diagnoses assigned were SDPD and personality disorder not otherwise specified; no alternative diagnoses were consistently provided. More than one in two professionals reported treating patients with a condition similar to the SDPD cases, and approximately 65% of these patients were reported to be female. American and British nonpatients were also assessed through the administration of an SDPD self-report questionnaire. The results suggest that the reported high prevalence of SDPD in the practitioners' patients is not a result of the expression of a general personality trait, and the reported greater incidence of SDPD in women is not a reflection of a normal, culturally learned, female behavior pattern.

Validity of self-defeating personality disorder

The purpose of this study was to assess the validity of DSM-III-R self-defeating personality disorder. Applicants for inpatient treatment of personality disorders (N = 100) or psychoanalysis (N = 100) were independently evaluated face to face by experienced clinicians using the Structured Clinical Interview for DSM-III-R and the Personality Disorder Examination. Internal consistency; agreement between assessments; diagnostic efficiency of criteria; prevalence; sex ratio; comorbidity with axis I and II disorders; and relationship to education, current employment, and selection for psychoanalytically oriented treatment were examined. The internal consistency of the criteria set and the agreement between psychiatric assessments of self-defeating personality disorder were fair. The most discriminating criteria were those referring to a) choices leading to disappointment, failure, or mistreatment and b) rejection of opportunities for pleasure. A consensus diagnosis of self-defeating personality disorder was more common than all but three other axis II disorders. The sex ratio of the subjects with this diagnosis was not significantly different from the sex ratio of the entire subject group or of patients with other personality disorders. Significant comorbidity with borderline and dependent personality disorders and with current mood disorders was found. Patients with self-defeating personality disorder resembled patients with other personality disorders in educational attainment and treatment assignment. They were more likely to be employed. These data lend little support to the validity of self-defeating personality disorder as a separate personality disorder category.

SELF-DEFEATING PERSONALITY: IS THERE A SECONDARY GAIN?

Summary.-No support was found for the hypothesis that self-defeating behavior results in secondary gain, i.e., more supportive behaviors from others. Two of the eight criteria for diagnosing self-defeating personality disorder involve rejecting opportunities for pleasure (criterion five) and being uninterested in and rejecting people who treat one well (criterion seven). Berglas (1989) has suggested there is a secondary gain for people with self-defeating personality disorder, particularly for those with these two characteristics. Supposedly, certain people respond to these individuals' lack of enjoyment and their disinterest or reiection with efforts to nurture or rescue them. To assess whether this is the case, 53 men and 57 women volunteers from introductory psychology took Schill's SeU-defeating Personality Scale (1990) which has 48 items, six for each of the criteria used in diagnosing this disorder. Sample means (and standard deviations) were for men 21.20 (5.65) and for women 17.95 (5.06). They also took Barrera, Sander, and Ramsay's (1981) Inventory of Socially Supportive Behaviors. Sample means (and standard deviations) were for men 110.50 (28.06) and for women 112.59 (26.87). If Berglas is right, people having more characteristics of self-defeating personality, particularly characteristics associated with criteria five and seven, should report receiving more supportive transactions from others during the past

Reported History of Physical and Sexual Abuse in Relation to Dissociation and Other Symptomatology in Women Psychiatric Inpatients

Among 88 women patients in an adult inpatient setting, 81% reported a history of sexual abuse physical abuse, or both. The scores on the Dissociative Experiences Scale (DES) and on the anxiety, hostility, and psychoticism scales of the Symptom Checklist 90-Revised (SCL 90-R) early in hospitalization were significantly higher among those who reported a history of abuse than among those who reported no such history. Also, those with a DSM-III-R diagnosis of a dissociative disorder had significantly higher scores on the DES. Reported abuse also was associated with higher scores on the borderline, antisocial, schizoid, and self-defeating personality disorder scales of the Personality Disorder Questionnaire (PDQ-R).