Specific Personality Disorders Research Articles

Anxiety Disorders and Personality Disorders: A Review

This paper reviews studies of the relationship between anxiety and personality disorders. We begin by reviewing models of the relationship between Axis I and Axis II disorders, methodological limitations of studies that have attempted to provide evidence for these models, and findings of general studies of comorbidity of anxiety and personality disorders. We then review studies of the relationship between specific anxiety and personality disorders. Although this research has clear limitations, when taken together with advances in our understanding of the nature of these disorders, it has important clinical and theoretical implications.

An evaluation of the structure of schizophrenia spectrum personality disorders

Research into the genetics of schizophrenia has revealed the importance of a spectrum of conditions that may indicate the underlying genetic diathesis for this condition. Important among these are specific personality disorders; schizotypal, paranoid, and schizoid. Despite specified criteria in the DSM-III-R, demonstration of their validity remains inconclusive and therefore a phenotype for use in genetic analyses is lacking. This article describes the internal structure of these personality disorders. Six hundred and twenty-one relatives of schizophrenic probands in multiple-affected families were examined using a modified SIDP. Latent class analytic techniques were employed to study the interrelationships of the individual DSM-III-R personality disorder criteria. The results reveal a unidimensional structure for DSM-III-R paranoid and schizoid personality disorders. The degree to which an individual belongs to each disorder is related to the number of criteria met. The DSM-III-R criteria defined for sch...

Personality disorders: an overview for the physician.

Personality disorders are common clinical syndromes that often go unrecognized in medical practice. Because patients with personality disorders receive care in all clinical settings, physicians could profit from a heightened awareness of the personality psychopathology of their patients and its impact on medical practice. Personality traits are universal and describe the "normal" range of behavior, while personality disorders are characterized by enduring maladaptive patterns. The etiology of personality disorders is multifactorial. Physician awareness of the multiple manifestations of specific personality disorders is helpful in matching the proper interventions to appropriate patients. Although management is symptomatically palliative rather than curative, physicians and patients alike can benefit from appropriate recognition and treatment of personality disorders.

Personality Disorders and Overseas Missions: Guidelines for the Mental Health Professional

Mental health care professionals are in a unique position to advise mission organizations in the selection process. This is especially the case in helping newer inexperienced boards avoid overseas placement of personality disordered individuals. The article reviews specific personality disorders and their impact in the overseas setting. The dilemma of compassion vs. administrative wisdom is addressed. Suggestions are included to help missions refine selection policies using the MMPI, understanding its limits, using occupational history review, personal interviews, and individual follow-up on letters of recommendation. The article is not intended to be a handbook for the selection process, but to call attention to an often neglected area of psychopathology that needs to be addressed in the screening evaluation.

The relationship between personality and DSM-III axis I disorders in the population: results from an epidemiological survey.

The aim of this study was to assess the relationships between specific personality disorders and DSM-III axis I conditions in a community sample. A total of 810 subjects were examined by psychiatrists in the second stage of the Eastern Baltimore Mental Health Survey, part of the Epidemiological Catchment Area Program of the National Institute of Mental Health. A semistructured examination, the Standardized Psychiatric Examination, was employed to assess axis I and axis II conditions. Scales for compulsive and antisocial personality disorders were derived from DSM-III criteria. The relationships between scores on these personality disorder scales and the presence of generalized anxiety disorder, alcohol use disorders (alcohol abuse and alcohol dependence), and simple phobia were evaluated by using logistic regression. Higher compulsive personality scores were associated with a greater odds of generalized anxiety disorder and simple phobia but a smaller odds of alcohol use disorders. In contrast, higher antisocial personality scores were associated with a greater odds of alcohol use disorders but a smaller odds of generalized anxiety disorder. There was no relationship between antisocial personality scores and simple phobia. Personality disorders have specific relationships to axis I conditions, which suggests different vulnerabilities but also different protective influences.

Validation of the tridimensional personality questionnaire in a sample of male drug users

One hundred seventy-three male drug using volunteers for drug-related studies completed the Cloninger Tridimensional Personality Questionnaire (TPQ), with most of these Ss also completing the Eysenck Personality Questionnaire, the Eysenck I.7, the Buss-Durkee Hostility Inventory, the Symptom Check List 90, the Elliott-Huizinga Lifetime Criminality Measure, the Diagnostic Interview Schedule for DSM-III, and the Personality Disorders Questionnaire. TPQ novelty seeking was correlated with impulsivity, aggression, and criminality, TPQ harm avoidance was correlated with introversion, neuroticism, low venturesomeness, and high psychological distress, while TPQ reward dependence was correlated with extraversion, low psychoticism, and empathy. With the possible exception of novelty seeking, the TPQ scales did not, as predicted by Cloninger, correlate with specific personality disorders or alcohol and drug abuse. The rationale for the construction of the TPQ scales was generally not supported in the present sample.

The Munich Diagnostic Checklist for the assessment of DSM-III-R Personality Disorders for use in routine clinical care and research.

Diagnostic checklists for the assessment of DSM-III-R Axis I diagnoses have proven to be a reliable and feasible instrument in research and routine clinical care. Therefore, a checklist for the assessment of the DSM-III-R Personality Disorders (MDCL-P) has been developed. An English version of the MDCL-P is available. The MDCL-P has been tested for reliability in a test-retest design. The average duration of the interview was 36 min. Of the patients, 48% received a diagnosis of at least one personality disorder. The Kappa value concerning the distinction personality disorder as opposed to no personality disorder was 0.62. The range of Kappa values of specific personality disorders, which were diagnosed at least five times, was from 0.35 to 0.79.

DSM-III-R personality disorders in panic and obsessive-compulsive disorder: A comparison study

Forty-eight patients with panic disorder/agoraphobia (PAD) and 30 with obsessive-compulsive disorder (OCD) were assessed for DSM-III-R axis II personality disorders (PD) and the presence of the same anxiety disorder in the relatives of probands (homotypic disorders). No specific personality disorder was present significantly more often in either of the two groups. Agoraphobia was not associated with higher rates of axis II disorders in PAD patients. Duration of illness did not influence the presence of a PD in patients of both groups. Secondary cases of the same anxiety disorder were significantly more common among first-degree relatives of PAD patients. A discriminant analysis performed on the most frequent personality traits of both groups provided a correct classification of cases of 97.4%. Our results do not support the hypothesis of PD as secondary to anxiety disorders and confirm previous findings of a lack of specificity between DSM-III-R axis II categories and OCD and PAD.

Prediction of Outcome in Borderline Personality Disorder

In order to study outcome heterogeneity in borderline personality disorder (BPD), the author performed correlations of more than 50 predictor variables with 7 independent outcome dimensions, assessed at a mean of 14 years after the index hospitalization, in a group of 33 BPD patients selected for minimal comorbidity with affective illness, substance dependence, or other personality disorders. Predictors are reported that achieved statistical significance, generally across multiple outcome dimensions. Results suggest that outcome prediction in BPD differs from outcome prediction in schizophrenia. A history of parental divorce, long duration of prior hospitalization, and the presence of specific personality disorder criteria predicted poor outcome in BPD. The presence of self-destructive acts during the index treatment predicted good outcome.

Effect of Personality Disorders on Outcome of Treatment

Although many clinicians have long believed that personality pathology may interfere with the effectiveness of treatment of axis I disorders, until recently there were no empirical studies on the subject. This report reviews the recent literature with regard to the following questions: a) Does personality pathology predict negative outcome of treatment for axis I disorders? b) If so, are there specific personality traits or disorders that account for such a negative outcome? The literature review reveals a robust finding that patients with personality pathology have a poorer response to treatment of axis I disorders than those without such pathology. Specific axis I disorders reported on include DSM-III major depression, panic disorder, and obsessive-compulsive disorder. Both inpatients and outpatients have been studied. There is too little literature to determine whether certain pathological personality traits are especially important, but there is enough to provide methodological guidance for future studies. Such studies should use standardized measures of personality and outcome, should match personality and nonpersonality groups on severity of the axis I disorder, and should be certain that axis I diagnoses are not confounded by axis II symptoms.

Personality features related to generalized anxiety disorder

Forty-six patients with generalized anxiety disorder (GAD) without any other coexisting axis I diagnoses were compared with 50 control subjects for assessment on axis II. No specific personality disorder (PD) was found to be significantly associated with chronic anxiety, although the majority of anxious patients showed significantly more maladaptative traits than controls. Discriminant analysis selected a list of items able to provide a correct classification rate of 91% based on personality features selected in canonical function. Factor analysis indicated that personality characteristics of expectation of damage were more closely related to GAD in our sample.

An Investigation of Adherence to Diagnostic Criteria: Clinical Diagnosis of the DSM-III Personality Disorders

The degree to which DSM-III criteria are followed in diagnosing personality disorders was examined by obtaining diagnostic material from a national sample of clinicians. A total of 291 patients with personality disorders were clinically diagnosed by clinicians familiar with their history, and then the clinicians were queried about the presence or absence of each of the DSM-III criteria for the specific personality disorders in their patients. The resultsrevealed jnuch incongruity between clinical diagnoses and diagnoses derived from DSM-III criteria. An intensive examination of the assignment of selected personality disorder diagnoses revealed that in most cases these inconsistencies were primarily related to the symptomatic presentation of the patient, rather than to demographic characteristics such as gender or socioeconomic status.

Trends in the Use of the Borderline Diagnosis in Denmark From 1975 to 1985

As elsewhere in the Western world there has been an ardent discussion in recent years in Denmark concerning the validity of the borderline diagnosis. The present study examines several demographic variables for patients diagnosed with specific personality disorders admitted to Danish psychiatric departments in the years 1975, 1980, and 1985. The total numbers of patients admitted were largely unchanged, but the prevalence of the borderline diagnosis increased from 5% to 20%. For males, it appears that those who had previously been diagnosed as psychopathic deviants are now labeled as borderlines. The shift is less distinct for females; in general, women diagnosed borderline today would likely have been labeled immature, hysterical, or psychopathic in 1975. It is clear that explicit diagnostic criteria for personality disorders must be employed if epidemiologic trends are to be determined, especially among new categories such as the borderline. Otherwise it will be difficult to know if changes in diagnosti...

Antecedents of Personality Disorders in a Community Sample of Men

The authors examine the prevalence, the relationship to alcoholism, and the childhood antecedents of specific DSM-III personality disorders in a longitudinally followed community sample of middle-aged men. Dependent personality disorders (10% of sample) and passive-aggressive personality disorders (8% of sample) were the most common diagnoses and overlapped extensively with other Axis II diagnoses. Comorbidity with alcoholism was extensive, particularly for the “dramatic, emotional, erratic” cluster of personality disorders. When alcoholics were removed from the sample, childhood measures of constitution (low IQ and poor health) and behavior (poor task competence and emotional problems) proved moderately strong predictors of specific personality disorders over 30 years later. On the other hand, measures of childhood environment (low social class and environmental weaknesses) were generally poor predictors of specific personality disorders.

Axis II Personality Disorders: Diagnostic and Treatment Issues

The placement of personality disorders on a separate axis in DSM-III reflects increased interest in their diagnosis and treatment and encourages clinicians to consider the effects of personality style on axis I clinical syndromes. In this review of axis II personality disorders, the authors discuss methodological issues related to the diagnosis of all personality disorders, review the use of various treatment modalities, and present current issues and controversies related to specific personality disorders. They urge that any revision of DSM-III incorporate more reliable and clinically meaningful criteria, perhaps substituting a multidimensional classification system for the current categorical model.

DSM-III and the diagnosis of borderline.

In order to achieve more understanding of the diagnosis of borderline personality, particularly as it relates to DSM-III, a historical review of influential diagnostic approaches is undertaken. DSM-III defines the borderline personality disorder in a simple way, enhancing reliability and research value. In comparison to other influential approaches, however, there is an overemphasis on affective disturbance, plus an obvious omission amongst the diagnostic criteria of the vulnerability to brief psychotic regressions under stress. The checklist approach of DSM-III greatly takes away from dynamic understanding and makes potentially valuable items such as defensive organization difficult to include. The DSM-III concept of the borderline personality as one of many distinct personality disorders seems unfounded. The concept of the borderline as a superordinate diagnosis under which more specific personality disorders would fall, appears more reasonable.