Therapists' emotional reactions to patients as a mediator in cognitive behavioural treatment of panic disorder with agoraphobia

The aims of this study were to examine whether therapists' emotional reactions to their patients mediate the effect of personality disorders and interpersonal problem behaviours on the outcome of treatment, focusing on an Axis I disorder; and whether therapists' reactions mediate the effect of personality disorders on the course of interpersonal problems. Therapists completed a checklist of emotional reactions to individual patients after the end of residential cognitive or guided mastery therapy for 46 inpatients with panic disorder with agoraphobia. The severity of DSM-III-R personality disorder was related to therapists' insecurity feelings, but not to interest and anger. A higher level of therapists' insecurity feelings was related to less reduction in self-reported agoraphobic avoidance during treatment, whereas therapists' emotions were unrelated to symptomatic course after treatment. Therapists' insecurity feelings appeared partly to mediate the relationship between patients' severity of personality disorder and persistence of patients' interpersonal dominance and nurturance problems.     

Aktuelle Entwicklungslinien in der Pers?nlichkeitsforschung im Jugendalter

Personality disorders in juveniles are still a controversially discussed topic. The aim of this paper is to describe the recent trend in personality research in adolescence and to outline perspectives in research and assessment. Recent study results have pointed out that personality disorders in juveniles can be reliably assessed with diagnostic instruments that have been developed for adults. At the same time there is a lack of specific instruments that can represent the characteristics during adolescence and that can differentiate personality disorders from youth crises. As some personality disorder dimensions also describe unstable developmental criteria we will focus separately on this differential diagnosis and meaning of stable versus transient personality characteristics in youth. The prevalence of personality disorders seems to be higher in adolescence than in adulthood. The stability, however, is comparable in adolescence and adulthood. Psychopathy as a subtype of the antisocial personality disorder ?C that can also be assessed in juveniles ?C will be discussed regarding its core and behavioral dimensions as well as primary and secondary subtypes. Furthermore, we discuss forensic issues when assessing personality disorders with respect to criminal responsibility. Overall we can show that more diagnostic longitudinal studies are essential in order to clarify under which conditions personality disorders develop, which factors influence its course and which interventions can change them.     

Therapists' Emotional Reactions to Patients as a Mediator in Cognitive Behavioural Treatment of Panic Disorder with Agoraphobia

The aims of this study were to examine whether therapists' emotional reactions to their patients mediate the effect of personality disorders and interpersonal problem behaviours on the outcome of treatment, focusing on an Axis I disorder; and whether therapists' reactions mediate the effect of personality disorders on the course of interpersonal problems. Therapists completed a checklist of emotional reactions to individual patients after the end of residential cognitive or guided mastery therapy for 46 inpatients with panic disorder with agoraphobia. The severity of DSM‐III‐R personality disorder was related to therapists' insecurity feelings, but not to interest and anger. A higher level of therapists' insecurity feelings was related to less reduction in self‐reported agoraphobic avoidance during treatment, whereas therapists' emotions were unrelated to symptomatic course after treatment. Therapists' insecurity feelings appeared partly to mediate the relationship between patients' severity of personality disorder and persistence of patients' interpersonal dominance and nurturance problems.     

A study of temperament and personality in anorexia and bulimia nervosa

Although temperament and personality traits could influence the development and course of eating disorders, only a few studies examined the similarities and differences in personality between anorexia and bulimia nervosa. We compared 72 patients with DSM-IV eating disorders and 30 healthy controls. Dimensions of personality and personality disorders were evaluated with the Eysenck's EPQ, Cloninger's TCI, and the SCID-II questionnaires. The rates of impulsivity and clinical features were evaluated using specific rating scales. A comorbid personality disorder was found in 61.8% of patients with eating disorder. Avoidant personality disorder appeared was relatively common in anorexia nervosa restricting type; borderline personality disorder was most frequent in bulimia nervosa and the binge eating-purging type of anorexia nervosa. From a dimensional perspective, anorexic patients presented high scores in the dimension of persistence. Higher harm avoidance and impulsivity was found in bulimic patients. The overall eating disorders group presented high scores in neuroticism and low scores in self-directedness. Eating disorder patients have heterogeneous features of temperament and personality traits. Cluster C personality disorders seem more common in anorexia nervosa restricting type and impulsive personality features are associated with bulimic symptoms. Impulsivity seems to be a key aspect of temperament of bulimic patients, whereas anorexic symptoms are linked to persistent temperament traits.     

Cluster A Personality Disorders: Schizotypal,Schizoid and Paranoid Personality Disorders in Childhood and Adolescence

Cluster A personality disorders (PD), including schizotypal personality disorder (SPD), paranoid personality disorder (PPD), and schizoid PD, are marked by odd and eccentric behaviors, and are grouped together because of common patterns in symptomatology as well as shared genetic and environmental risk factors. The DSM-IV-TR describes personality disorders as representing stable and enduring patterns of maladaptive traits, and much of what is understood about Cluster A personality disorders in particular stems from research with adult populations. Less in known about these disorders in children and adolescents, and controversy remains regarding diagnosis of personality disorders in general in youth. The current paper reviews the available research on Cluster A personality disorders in childhood and adolescence; specifically, we discuss differentiating between the three disorders and distinguishing them from other syndromes, measuring Cluster A disorders in youth, and the nature and course of these disorders throughout childhood and adolescence. We also present recent longitudinal data from a sample of adolescents diagnosed with Cluster A personality disorders from our research laboratory, and suggest directions for future research in this important but understudied area.     

Negative life experiences and the development of cluster C personality disorders: a cognitive perspective

Early negative experiences have long been thought to play an important role in the development of personality disorders. Most of the literature regarding these early life experiences has focused on borderline personality disorder, with only occasional focus on other personality disorders. Utilizing cognitive theory of personality disorders (Beck et al., 2004), the authors conceptualize cluster C personality disorders (avoidant, dependent, and obsessive-compulsive). They then critically review the relevant literature on early negative life experiences and later development of these disorders to determine whether the theory is supported by the empirical data. The theory regarding avoidant and dependent personality disorders has limited support, whereas data relating to obsessive-compulsive personality disorder are much weaker. Implications and future research suggestions are discussed.     

Persönlichkeitsstörung und Intelligenzminderung

There have previously been only few objective investigations on the combined occurrence of intellectual disability and personality disorder. Despite this difficulty, from the current clinical viewpoint there is no doubt that at least people with mild intellectual disability can also develop personality disorders. In slight degrees of intellectual disability it is possible to psychopathologically describe the typical symptoms objectively. For the disorder symptomatic of combined personality disorder in people with an intellectual disability, there are no confirmed facts, publications or diagnostic rules. The diagnostic assignment of behavioral abnormalites as combined personality disorder with dependent and infantile components in people with intellectual diasabilities still does not seem to be justified. In people with medium to severe mental disorders only the comprehensive term “behavioral abnormalities” should be applied.     

Publication trends in individual DSM personality disorders: 1971–2015

Growth in personality disorder research has been documented by previous authors up to 1995. The aim of the present study was to extend this by examining publications rates for individual DSM personality disorders over the period 1971–2005, and making projections to 2015 based on these data. It was found that personality disorder research has grown in absolute terms, and as a proportion of overall psychopathology research. Research output is dominated by borderline personality disorder, with strong publication rates in other conditions such as antisocial and schizotypal personality disorders. In contrast, several personality disorders such as schizoid and paranoid personality disorder have failed to attract research interest. Based on current projections, there is expected to be no research output in 2015 for schizoid personality disorder. It was found that the rate of publications for personality disorders was not influenced by the publication of the last three revisions of the DSM diagnostic criteria. Several potential explanations such as the difficulty in conducting certain types of personality disorder research, and the validity of the current DSM diagnostic taxonomy are discussed.     

Negative Life Experiences and the Development of Cluster C Personality Disorders: A Cognitive Perspective

Early negative experiences have long been thought to play an important role in the development of personality disorders. Most of the literature regarding these early life experiences has focused on borderline personality disorder, with only occasional focus on other personality disorders. Utilizing cognitive theory of personality disorders (Beck et al., 2004), the authors conceptualize cluster C personality disorders (avoidant, dependent, and obsessive–compulsive). They then critically review the relevant literature on early negative life experiences and later development of these disorders to determine whether the theory is supported by the empirical data. The theory regarding avoidant and dependent personality disorders has limited support, whereas data relating to obsessive–compulsive personality disorder are much weaker. Implications and future research suggestions are discussed.     

Axis I and axis II disorders as predictors of prospective suicide attempts: findings from the collaborative longitudinal personality disorders study

This study examined diagnostic predictors of prospectively observed suicide attempts in a personality disorder (PD) sample. During 2 years of follow-up, 58 participants (9%) reported at least 1 definitive suicide attempt. Predictors that were examined include 4 PD diagnoses and selected Axis I diagnoses (baseline and course). Multivariate logistic regression analyses indicated that baseline borderline personality disorder (BPD) and drug use disorders significantly predicted prospective suicide attempts. Controlling for baseline BPD diagnosis, proportional hazards analyses showed that worsening in the course of major depressive disorder (MDD) and of substance use disorders in the month preceding the attempt were also significant predictors. Therefore, among individuals diagnosed with PDs. exacerbation of Axis I conditions, particularly MDD and substance use, heightens risk for a suicide attempt.     

Outcome and epidemiological research on personality disorders: implications for classification

The construct of personality disorder has an overall definition that describes chronicity. However, the findings of outcome research indicate that while many patients stop meeting criteria for specific categories of disorder over time, they often continue to suffer from dysfunctional traits. One can also interpret epidemiological findings on personality disorders as overestimating disorders due to a failure to distinguish them from traits. Taken together, these findings point to the need for a revision of the classification of personality disorders that would separate enduring traits from reversible symptoms.     

Using DSM axis II information to predict outcome in short-term individual psychotherapy

The present study considered three methods of using DSM Axis II information to examine the effect of personality disorder on outcome in two forms of short-term, individual psychotherapy (interpretive and supportive). The first method involved examining whether the presence of any personality disorder influenced treatment outcome. The second method involved examining the effect of the number of personality disorders on outcome. The third involved examining outcome for specific personality disorders. The study found that a diagnosis of any personality disorder did not influence the outcome of therapy. In contrast, the number of personality disorders was significantly related to outcome at post-therapy and at 12-month follow-up. The findings indicated that a greater number of personality disorders was associated with less favorable outcome across both forms of therapy. This supports the notion that personality pathology is more severe when it involves a greater number of personality disorders. In an exploratory set of analyses, the study also found some evidence of differences in outcome for specific personality disorders.     

Abh?ngigkeitserkrankungen und Pers?nlichkeitsst?rungen

Substance use disorders and personality disorders often co-occur in clinical treatment. In this review the association between substance use disorders and personality disorders is described and discussed. Clinical and neurobiological data as well as psychodynamic concepts are included to focus on the therapeutic implications for patients with these comorbidities. The consumption of substances often begins as a kind of self-medication. Patients suffering from severe personality disorders need these substance effects to avoid severe destructive affects and to regulate their self-esteem. Patients with chronic substance dependence often show changes in brain structure. In the dependency stage of addiction clinical symptoms can make the diagnosis of a specific personality disorder very difficult. The treatments can be classified by the severity of substance use disorders and personality disorders. Substance misuse can be treated with psychotherapy. In substance dependence, specific forms of addiction therapy should be included. In patients with the frequent comorbidity of substance use disorders and severe personality disorders, disorder-specific treatment can be used with good results.     

Taxonomic implications of three prospective studies on the course and outcome of personality disorders

The Children in the Community (CIC) Study (Cohen, Crawford, Johnson, & Kasen, this issue), the McLean Study of Adult Development (MSAD; Zanarini, Frankenburg, Hennen, Reich, & Silk, this issue), and the Collaborative Longitudinal Personality Disorders Study (CLPS; Skodol et al., this issue) are three large prospective studies on the course and outcome of psychiatric disorders, borderline personality disorder, and personality disorders, respectively. These studies, involving approximately 2,000 subjects, have yielded an enormous amount of scientifically and clinically relevant information. In this commentary, I primarily aim to discuss the implications for future revisions to the DSM classification of personality disorders.     

Personality and anxiety disorders: a review

In this article, we summarize research on how normal personality and personality disorder traits may relate to anxiety disorders as predisposing factors, complications, and results of common underlying etiologies. We outline important questions and how these may be addressed through future research using genetically informative longitudinal and other designs, including: Are high neuroticism/cluster C personality traits causally related to the development of anxiety disorders? To what extent does the state of having an anxiety disorder influence the assessment of personality traits? Do high neuroticism/personality disorder traits and anxiety disorders co-occur because of shared genetic and environmental determinants? And, do personality disorder traits add to the prediction of anxiety disorders when normal personality traits are taken into account?     

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.     

Personality disorder cognitions in the eating disorders

The eating disorders are frequently found to be comorbid with Axis II cluster B and C personality disorders. It is important to identify the personality-level cognitions that typify these disorders. This study of a clinical group examines the personality disorder cognitions in the eating disorders. The cognitions that were most relevant to the eating disorder pathology were those relating to avoidant and obsessive-compulsive personality disorder. Other personality disorder cognitions were associated with comorbid psychopathology in largely clinically meaningful ways. These findings extend our understanding of the comorbidity of eating disorders and personality pathology, suggesting that some cases need to be assessed and formulated with such cognitions in mind. Treatment strategies are required that address both the eating and the personality pathology, while considering the impact of these cognitions on the therapeutic relationship.     

Dimensions of DSM-IV personality disorders and life-success

This study examined associations between dimensional representations of DSM-IV personality disorders and life-success in a community sample of 304 men at age 48. Measures included a standardized social interview and the SCID-II for assessment of personality disorders. The identified indicators of life-success were factor-analyzed resulting in two moderately correlated components representing "status and wealth" and "successful intimate relationships." Avoidant, obsessivecompulsive, and narcissistic dimensional scores were positively associated with "status and wealth." Inverse relationships were found between dependent, schizotypal, schizoid, and adult antisocial personality disorder dimensions and this domain of life-success. Avoidant, schizoid, and borderline personality disorder dimensions were negatively associated with "successful intimate relationships." The findings suggest that although most personality disorders are associated with impaired psychosocial functioning and life-failure, some personality disorder traits (even if considered as pathological) can contribute positively to one important aspect of life-success: status and wealth.