Self-defeating Personality Disorders Research Articles

Malignant self-regard: Accounting for commonalities in vulnerably narcissistic, depressive, self-defeating, and masochistic personality disorders

Several personality disorders (PDs) have been of interest in the clinical literature, yet failed to have been adequately represented in the diagnostic manuals. Some of these are masochistic, self-defeating, depressive, and narcissistic PDs. The theoretical and empirical relationships among these disorders are reviewed. It is proposed that a particular type of self-structure, malignant self-regard (MSR), may account for similarities among all of them and provide a better framework upon which to understand the nature of these personality types and their discrimination from related constructs. Subsequently, a questionnaire to assess MSR was created and evaluated for its psychometric properties. The measure was found to be reliable (Cronbach's alpha=.93) and valid, given its correlations with measures of self-defeating, depressive, and vulnerably narcissistic personalities (rs range from .66 to .76). MSR also can be meaningfully differentiated from a nomological network of related constructs, including neuroticism, extraversion, depression, and grandiose narcissism. The utility of assessing self-structures, such as MSR, in the diagnostic manuals is discussed.

Is the Appendix A Useful Appendage? An Empirical Examination of Depressive, Passive-Aggressive (Negativistic), Sadistic, and Self-Defeating Personality Disorders

Decisions about whether to include depressive, passive-aggressive, sadistic, and self-defeating disorders in Axis II have been made difficult by a relative dearth of data. We report the results of a study identifying potential defining features of these diagnoses and assessing their distinctiveness from other Axis II personality disorders (PDs). A national sample of experienced psychiatrists and psychologists used the SWAP-200 to describe a patient with a current axis II disorder or an appendix or deleted PD from DSM-II-R. We examined clinicians' descriptions of patients to identify their most characteristic features, and then applied an empirical clustering procedure, Q-factor analysis, to see whether versions of these disorders would emerge empirically. As currently conceptualized, only passive-aggressive PD was distinct from other PDs. When the data were subjected to Q-factor analysis, the first and largest grouping was a dysphoric (depressive) PD. A hostile-negativistic subcategory emerged that resembled passive-aggressive PD, along with a revised dependent diagnosis that included many self-defeating/masochistic features. The results suggest that a depressive or dysphoric personality may represent an internalizing spectrum of personality pathology, and that a hostile-negativistic PD may be distinct from the disorders in the text of DSM-IV. Sadistic and self-defeating PD do not appear to represent distinct disorders, although they include personality traits (sadism and revictimization) associated with distinct developmental histories.

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.

Personality Profiles of Women in Multiple Abusive Relationships

Personality profiles of women with multiple abusive relationship histories (N = 42) were compared to either abused women with 1 abusive relationship (N = 33) or a control group (N = 52) on the Coolidge Axis II Inventory (Coolidge & Merwin, 1992, J. Pers. Assess. 59: 223–238), a self-report measure based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994). Women with multiple abusive relationships had higher rates and greater levels of dependent, paranoid, and self-defeating personality disorders than women in the other 2 groups. Women in multiple abusive relationships had significantly more depression, and women in this group with posttraumatic stress disorder (PTSD) had significantly more personality disorders than women with single abusive relationships with PTSD. Women in single abusive relationships did not exhibit more psychopathology than women in the control group with matched marital status. Theoretical and methodological issues, and treatment recommendations are discussed.

A 6-year follow-up study of anxiety disorders in psychiatric outpatients: Development and continuity with personality disorders and personality traits as predictors

The aim of the study was to examine the clinical determinants of chronicity and development in new cases of anxiety disorders. Two hundred and eighty-four patients with different psychiatric diagnoses treated at an outpatient unit were followed up after a period of 6 years. Almost 40% of those with anxiety disorder on admission (131 patients) still had an anxiety disorder at follow up. Less than 10% of those without an anxiety disorder (153 patients) had developed an anxiety disorder. Social phobia appeared to be the most chronic, and generalized anxiety disorder the least chronic. Co-occurrence of different anxiety disorder predicted the chronicity of the specific anxiety disorder. One anxiety disorder often predicted the development of another anxiety disorder. Several personality disorders and personality traits predicted the chronicity and development of new anxiety disorders. Borderline, obsessive-compulsive, paranoid, self-defeating, and avoidant personality disorders were the most important long-term predictors of anxiety disorders at follow up.

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.

DSM-III-R self-defeating personality disorder criteria evaluated by patients' self-report questionnaire: relationships with other personality disorders and positive predictive powers of the individual criteria.

A self-report questionnaire for DSM-III-R personality disorders (PDs) was completed by 64 patients in adult psychiatric practice and their informants. Various correlations and associations of the number of patients' positive criteria (scores) for the controversial category of self-defeating PD (SDPD) are reported. When evaluated by a patient's self-report, the highest correlations of SDPD scores were with borderline PD in relation to individual PDs, and cluster C in relation to the 3 DSM-III-R PD clusters. Criteria 2 and 7 had positive predictive powers of 0.75 and 0.67 for membership of the subgroup based on scores of 5 or more positive criteria for SDPD. Positive ratings for criterion 5, involving anhedonia, were significantly associated with informants' ratings. SDPD features appear to be present in many psychiatric patients with PD and should be evaluated in PD assessment.

Prevalence and characteristics of sadistic personality disorder in an outpatient veterans population

This study is designed to examine the prevalence, demographics, and the Axis I and Axis II diagnoses of sadistic personality disorder (SPD) in a previously unexamined population (outpatient veterans). It also represents the first attempt to examine the family history of those with SPD. Standardized methods were used to select 144 nonpsychotic subjects from a veterans psychiatric outpatient clinic. The population was then divided into three groups: those with SPD, those without SPD but with antisocial personality disorder or traits, and those with no Axis II disorders. A fourth group consisted of 28 control veterans without psychopathology. Subjects with SPD tended to be younger and to have lower scores on the Global Assessment Scale than did clinical control subjects without personality disorders; they also had significantly more bipolar and panic disorder than were found in the antisocial traits group. High levels of depression and alcohol dependence were also present. SPD traits correlated with DSM-III-R dramatic cluster, compulsive, passive-aggressive, and self-defeating personality disorders. The SPD group could be distinguished from other groups on the basis of family history. It was concluded that sadistic personality traits and disorders are prevalent (8.1%), associated with reduced functioning, and may have specific associations with certain Axis I and Axis II disorders. It is possible that they have a distinct familial pattern.

Gender weighting of DSM-III-R personality disorder criteria

This study explored the gender weighting of the diagnostic criteria for personality disorders. Gender weighting was defined in terms of how 33 female and 17 male nonclinicians ranked the diagnostic criteria along a male-female dimension. Although the a priori expectation was that antisocial would be the prototypically masculine personality disorder and histrionic the feminine, the subjects ranked criteria from the sadistic category as the most masculine and those from the dependent category as the most feminine. These results and the subjects' gender weighting of criteria for borderline, obsessive-compulsive, and self-defeating personality disorders are analyzed in detail.

The Politics of Personality Disorder

This research tested the hypothesis that the gender distribution of personality disorders stems from the resemblance between each personality disorder and the role/role-stereotype of the status group for whom the disorder is prevalent. The first study found that undergraduates attributed descriptions of each personality disorder to the gender, social class, and marital status of the group that tends to receive that label; the second study found that the Sadistic and the Self-Defeating Personality Disorders of the DSM-IIIR were attributed to white males and middle-class females, respectively. It is suggested that personality disorders represent the roles/role-stereotypes of both genders.

Self-Defeating and Sadistic Personality Disorders: Needed Additions to the Diagnostic Nomenclature

I strongly support the inclusion of self-defeating personality disorder and sadistic personality disorder in our diagnostic nomenclature because I believe that these are valid clinical entities that need to be diagnosed before appropriate treatment can be undertaken. Failure to diagnose these conditions will lead to inadequate and imprecise treatment at best, or at worst, no treatment at all.