Severity Of Personality Disturbance Research Articles

Premature mortality of people with personality disorder in the Nottingham Study of Neurotic Disorder.

It is known that people with personality disorders die prematurely. This may be connected to high levels of co-morbidity with other psychiatric disorders. To test whether mortality was independent, deaths were examined in a 31-year cohort study of anxious and depressed patients (Nottingham Study of Neurotic Disorder) who also had their personality status assessed at baseline. The severity of personality disturbance was assessed using a method previously used to separate personality disorders into ICD-11 categories. Over the follow-up period, 71 of the cohort of 201 patients had died. Age at death was 5.1 (M) and 5.2 (F) years younger in those with personality disorder compared with no personality disorder, but after adjusting for age at randomization and clinical diagnosis at baseline, these differences reduced to 1.5 (M) and 1.6 (F) years. The longevity of the group was 12 to 18 years less than the general population (p < 0.0001), reinforcing previous findings of premature mortality in common mental illness. Analysis of causes of death showed no meaningful differences in personality groups. The hypothesis that premature death in personality disturbance is independent of mental health status was not supported in this study, despite other evidence from this cohort that general clinical outcome is worse in those with personality disorder. © 2019 John Wiley & Sons, Ltd.

Can Callous-Unemotional Traits be Reliably Measured in Preschoolers?

Callous-unemotional (CU) traits designate an important subgroup of antisocial individuals at risk for early-starting, severe, and persistent conduct problems, but this construct has received limited attention among young children. The current study evaluated the factor structure, psychometric properties, and validity of scores on a comprehensive measure of CU traits, the Inventory of Callous-Unemotional Traits (ICU), in relation to measures of antisocial/prosocial behavior and emotional processing, administered to preschool children. The sample included 214 boys (52%) and girls (48%, M age=4.7, SD=0.69) recruited from mainstream and high-risk preschools. Confirmatory factor analyses supported a two-factor structure including callous and uncaring dimensions from 12 of the 24 original ICU items. Scores on the parent- and teacher-reported ICU were internally consistent and combined CU scores showed expected associations with an alternate measure of CU traits and measures of empathy, prosocial behavior, conduct problems, and aggression. Preschool children high on CU traits were less accurate, relative to children scoring low, in recognizing facial expressions. They were also less attentionally engaged by images of others in distress when co-occurring conduct problems presented. Findings extend the literature by supporting the psychometric properties of the ICU among young children, and open several avenues for studying early precursors to this severe personality disturbance.

Impact of clinical severity on outcomes of mentalisation-based treatment for borderline personality disorder

Evidence of remission from borderline personality disorder (BPD) without specialised treatment is accumulating. To establish whether specialised treatments are indicated for patients with clinically severe disorder. The impact of clinical severity on outcomes of a randomised controlled trial of mentalisation-based treatment (MBT) was contrasted with structured clinical management (SCM). Severity indicators were defined as severity of comorbid psychiatric syndromes, severity of BPD, severity of personality disturbance and severity of symptom distress. Logistic regressions were used to predict the likelihood of recovery at 18 months, and mixed-effects regression analysis was applied to examine the association of severity and rates of improvement across time in the two treatment groups. None of the severity criteria predicted outcome at the end of treatment on logistic regression. However, testing the significance of distribution of cases of recovery v. non-recovery suggested that multiple Axis II diagnoses and symptom distress influenced outcomes. Borderline personality disorder with significant Axis II comorbidity is a possible but uncertain indicator for specialist treatment. Patients whose only personality disorder diagnosis is BPD do equally well with SCM. Prospective studies are needed.

Critical Issues in the Assessment of Adolescent Psychopathy: An Illustration Using Two Case Studies

To explore critical issues in the conceptualization and assessment of adolescent psychopathy, we report on the use of the Youth Version of the Hare Psychopathy Checklist-Revised (PCL:YV; Forth, Kosson, & Hare, 2003) and the Comprehensive Assessment of Psychopathic Personality-Institutional Rating Scale (CAPP-IRS; Cooke, Hart, Logan, & Michie, 2004)—both derived from procedures for assessing psychopathy in adulthood—to assess two incarcerated youth identified by clinical staff as demonstrating features of adolescent psychopathy. Consistent with the views of clinical staff, the PCL:YV and CAPP-IRS ratings indicated the presence of serious psychopathy-related personality disturbance in both cases. The PCL:YV and CAPP-IRS also revealed between-case differences in the specific nature or features of personality disturbance present, despite similarities in the overall level or severity of personality disturbance. Raters found it was relatively easy to administer the PCL:YV and the CAPP-IRS, although they identified some challenges, particularly with respect to the assessment of disturbance of self functions. Relative to the PCL:YV, which may be considered the gold standard for assessing the PCL:YV, the CAPP-IRS had some strengths and limitations. We discuss these findings in light of the literature on assessment of adolescent psychopathy and consider their implications for future research.

Symptom severity and treatment course of bulimic patients with and without a borderline personality disorder

There are contradictory results concerning the frequency of borderline personality disorder (BPD) in bulimic patients and its impact on eating pathology and treatment outcome. We evaluated 240 patients with bulimia nervosa using EDI-2, SIAB and SCL-90-R. Only a minority of patients had a BPD (13.8%). There were no differences in binging or purging behaviour between patients with and without BPD, but borderline patients had significantly more feelings of ineffectiveness and more disturbances in interoceptive awareness. Bulimic patients with BPD showed significantly more general psychopathology. Although, BPD patients started with higher levels of pathology, there were similar reductions of symptoms over the course of treatment in both groups. Psychotherapy in bulimic patients with a BPD has to focus not only on eating pathology but also on aspects that are caused by the severe personality disturbance.

Relationships between attempted suicide, temperamental vulnerability, and violent criminality in a Swedish forensic psychiatric population

The relationship between suicide attempts and different vulnerability factors was investigated in 61 male subjects during forensic psychiatric examination. Personality traits and psychopathy were determined by means of the Karolinska Scales of Personality (KSP) and the Psychopathy Checklist-Revised (PCL-R). Clinical diagnoses were determined by the use of Structured Clinical Interview for DSM-III-R (SCID). Platelet monoamine oxidase (MAO) activity was investigated in 58 subjects. Suicide attempters had extremely low socialization and high impulsive aggression. This was independent of a history of repeatedly criminal violence or not. They had higher PCL-R scores and lower levels of platelet MAO activity than non-attempters. No relationship was found between suicide attempts and repeated violent criminality. However, among the subjects with repeated criminal violence there was a highly significant difference between suicide attempters and non-attempters, indicating different personality profiles in violent offenders with and without suicidal behavior. Suicidal behavior was significantly associated with borderline personality disorder, but not with any other single DSM-III-R disorder. The results show a far more severe personality disturbance in suicide attempters than in other violent patients in this type of population. Suicidal behavior should therefore be evaluated and treated per se.

The SCL-90-R as a screening instrument for severe personality disturbance among outpatients with mood and anxiety disorders.

Our objective was to examine whether the SCL-90-R, a widely used self-report measure of distress and psychopathology, could screen for personality disorders in general and for severe personality disturbance (SPD) in particular, at the time when patients seek treatment for a state (mood or anxiety) disorder. The SCL-90-R was administered to 112 consecutive outpatients with various mood and anxiety disorders. The personality severity index (PSI) score, defined as the mean value of the scores on the SCL-90-R subscales of interpersonal sensitivity, hostility, and paranoid ideation, was compared with the current symptom index (CSI) score, defined as the mean value of the scores on the remaining six SCL-90-R subscales. A positive screen was considered if PSI > CSI. SPD was defined as the presence of any DSM-III-R Cluster A and/or Cluster B personality disorder. The accuracy of the screen was verified by means of the Structured Clinical Interview for DSM-III-R Personality Disorders. The sensitivity of the PSI > CSI criterion to screen for SPD was 89.4%, while its sensitivity to screen for any DSM-III-R personality disorder was 72.9%. The SCL-90-R subscales that contributed the most to the screening discriminability of this SCL-90-R-derived screening measure were hostility, paranoid ideation, somatization, and obsessive-compulsive behavior. The SCL-90-R may be used to screen for SPD in routine work with outpatients with mood and anxiety disorders, but the results of the screening need to be verified because of the possibility of false negatives and false positives, although that possibility is apparently low. These findings may have important prognostic and treatment implications.

Effects of severe personality disturbance on the outcome of intensive, integrative treatment of panic disorder with agoraphobia

Effects of severe personality disturbance on the outcome of intensive, integrative treatment of panic disorder with agoraphobia

Bilateral autoenucleation in a man with a severe personality disorder

AbstractA case of self-inflicted eye injury is described in a setting of alcohol intoxication and severe personality disturbance. The case is believed to be the only one of its type described this century. The relevant classical and contemporary literature is reviewed and psychopathological explanations discussed. Possible indicators of impending self-violence are reviewed.

Therapeutic Process in Dynamic Therapy for Personality Disorders: The Joint Influence of Acute Distress and Dysfunction and Severity of Personality Pathology

Although a variety of treatment outcome studies have demonstrated an association between personality disorder and poor treatment outcome, few have empirically elucidated the psychotherapy processes underlying this relationship. In the present paper we address questions about the relationship between personality pathology, acute distress and dysfunction, and early psychotherapy process as conceptualized in the Generic Model of Psychotherapy. Overall, severity of personality disturbance was directly related to more frequent interventive activity whereas acute distress and dysfunction was associated with attenuated openness. Psychotherapy process was also influenced by interactions between personality pathology and acute distress and dysfunction. The discussion highlights the complexity of the factors related to the psychotherapy processes associated with successful treatment of patients suffering from personality pathology.

What does borderline mean?

The word borderline, unlike other clinical descriptive terms, has no obvious affective or action referent in the patient. This observation may shed light on the kind of misalliance so endemic to the work that occurs with these patients. The possibility that the diagnosing of «borderline» might reflect a misrecognition of who has what problem within an analytic treatment, that it might seriously affect the frame of the treatment, and that it might be an act of projective identification by the analyst are explored. I argue that (a) borderline pathology is not an entity, but rather the vast developmental territory of severe personality disturbance, and (b) Winnicott's theoretical contributions to an understanding of the psychopathology of the dyad, particularly around boundary development, are especially helpful

Ego functioning predicts first-year status in adults with anorexia nervosa and bulimia nervosa.

Severe personality disturbance is a feature that possibly explains chronicity in eating disorders, a largely inexplicable development in terms of previously investigated factors. We tested this hypothesis in a group of 41 anorectics and bulimics with ratings of 13 ego functions and of status at 1-year follow-up. Patients who still were preoccupied with weight or shape and had a DSM-III-R eating disorder at follow-up had more severe ego disturbance at initial presentation than those who were free from symptoms. The relevance of demographics, syndromal diagnosis and clinical factors other than ego functioning was limited. The importance of ego functioning for prognosis in eating disorders thus appears to overshadow that of several factors that have been extensively cited in the literature.

The borderline patient and military life

The view that the borderline patient can cope surprisingly well in a highly structured environment despite long-standing severe personality disturbance is studied. Military life provides such a structured environment and its role in the lives of these patients is presented through two case reports. The concept that the Army becomes 'military parents', accepts massive projections and survives splitting whilst providing a 'universal ego and super-ego' is developed and felt to be fundamental to the stability that borderline patients can achieve within the Services.

Psychological correlates of the course of Sydenham's chorea. Repeat evaluations of a case.

Published reports provide contradictory evidence concerning the cause, nature, and course of Syndeham's chorea: physiological, psychological, and interractional hypotheses have been advanced. Reports supporting any of these views suffer from lack of detail, objective observations, and/or longitudinal behavioral sampling. This case was studied longitudinally with numerous psychological tests. They revealed acute encephalopathy and severe personality disturbance in the acute stage, followed by rapid and lasting clearing of both symptoms. Thus, this case provided evidence consistent with virtually all published reports and with each hypothesis about Sydenham's chorea, suggesting the need for more careful longitudinal studies and a conceptual framework which can more fully embrace all the data.

Treatment of Marital Conflict Resulting from Severe Personality Disturbance

Treatment of Marital Conflict Resulting from Severe Personality Disturbance

THE RELATIONSHIP BETWEEN SEVERITY OF PERSONALITY DISORDER AND CERTAIN ADVERSE CHILDHOOD INFLUENCES.

This paper reports the result of an investigation into the hypothesis that severity of personality disturbance is positively related to the frequency of certain early adverse childhood influences.