The relationship between the MCMI personality scales and DSM-III, axis II

Compared were the personality scales of the Millon Clinical Multiaxial Inventory (MCMI) to the diagnosis of personality disorder, according to the Diagnostic and Statistical Manual of Mental Disorders (3rd ed. [DSM-III]; American Psychiatric Association, 1980), obtained by means of the Structured Interview for the DSM-III Personality Disorders (SIDP). The results from 272 psychiatric outpatients show a good correspondence for the Avoidant and the Dependent scales, a fairly good correspondence for the Schizotypal, the Histrionic, the Borderline, the Narcissistic, and the Paranoid scales, and no correspondence for the Schizoid, the Passive-Aggressive, and the Compulsive scales. The Passive-Aggressive scale seems to be positively correlated to personality disorders in general, whereas the Compulsive scale seems to be negatively correlated to a number of personality disorders.     

The Relationship Between the MCMI Personality Scales and DSM-III,Axis II

Compared were the personality scales of the Millon Clinical Multiaxial Inventory (MCMI) to the diagnosis of personality disorder, according to the Diagnostic and Statistical Manual of Mental Disorders (3rd ed. [DSM-III]; American Psychiatric Association, 1980), obtained by means of the Structured Interview for the DSM-III Personality Disorders (SIDP). The results from 272 psychiatric outpatients show a good correspondence for the Avoidant and the Dependent scales, a fairly good correspondence for the Schizotypal, the Histrionic, the Borderline, the Narcissistic, and the Paranoid scales, and no correspondence for the Schizoid, the Passive-Aggressive, and the Compulsive scales. The Passive-Aggressive scale seems to be positively correlated to personality disorders in general, whereas the Compulsive scale seems to be negatively correlated to a number of personality disorders.     

Personality Disorders in Older Adult Inpatients with Chronic Mental Illness

It has been hypothesized that some types of personality disorders tend to remit with age whereas others may become more prominent. The present study determined the prevalence and nature of 13 personality disorders with a self-report inventory (Coolidge Axis II Inventory) in an older group of chronically mentally ill inpatients (N = 30, mean age = 63 years) and a younger group of similar patients (N = 30, mean age = 39 years). All patients met DSM-IV criteria for either Schizophrenia, Schizoaffective Disorder, Bipolar Disorder, or recurrent severe Major Depression with psychotic features. The prevalence rate of personality disorders was high for both groups: 58% for the older sample and 66% for the younger group. The younger group was more likely to be diagnosed Antisocial, Borderline, Passive-Aggressive, Sadistic, and Schizotypal, but the groups were not different in the rates of Obsessive-Compulsive Disorder. This study supports the hypothesis that some personality disorders remit with age. However, no evidence was found to suggest that other personality disorders become more prominent in older adult psychiatric populations. Suggestions for future research are offered.     

Narcissism, Perfectionism, and Self-Termination from Treatment in Outpatient Cocaine Users

This study examines perfectionism in individuals with a Diagnostic and Statistical Manual-IV, Text Revised [American Psychiatric Association, 2000. Diagnostic and statistical manual of mental disorders (4th ed.). Text revision (DSM-TV-TR). Washington, DC: American Psychiatric Association] diagnosis of Narcissistic Personality Disorder and a coexisting diagnosis of cocaine abuse or dependence. Participating clients were treated in outpatient settings that provided cognitive-behavioral therapy. Clients were administered Hewitt and Flett's (1991b) [Journal of Personality and Social Psychology, 60, 456-470] Multidimensional Perfectionism Scale prior to treatment. Scores for dimensions of perfectionism were compared with those obtained from cocaine abusers in treatment with diagnoses of Antisocial Personality or Affective Disorder. Clients with Narcissistic Personality Disorder were characterized by relatively higher levels of other-oriented and socially prescribed perfectionism. Survival analysis suggests that self-termination from treatment by cocaine-abusing clients with a diagnosis of Narcissistic Disorder is related to high levels of other-oriented perfectionism. The clinical implications and limits of this study are discussed.     

The prevalence of personality disorders in a Kenyan inpatient sample

DSM-IV Axis I and II comorbidities and the pattern of Axis II diagnoses in patients admitted at Mathari (Psychiatric) Hospital, Nairobi, Kenya are unknown. To determine DSM-IV Axis I and II comorbidities and patterns of Axis II diagnoses in patients admitted at Mathari Hospital. Cross-sectional study on 148 randomly sampled patients. Twenty percent of the patients were confirmed for an Axis II diagnosis. Eighty-seven percent of the Axis II disorders were Cluster B Personality Disorders of various types. Using chi2 tests, significant associations were found between Axis I and II diagnoses and substance use/dependence (p < 0.001; 66.7%), mood disorder (p = 0.002; 46.7%) and schizophrenia (p < 0.001; 23.3%). The prevalence of personality disorders was lower than that reported in psychiatric patients in USA and Europe. The results are likely to be a true reflection of the actual epidemiological situation, but cannot be generalized to outpatient or general populations.     

Personality Characteristics and Development of Psychopathology in Bipolar I and Borderline Personality Disorder Patients

The debate whether Bipolar Affective Disorder and Borderline Personality Disorder fall under the same spectrum or they represent separate categories has received much research attention. However, the question of their underlying psychological aetiology as well as their personality correlates has remained largely un-explored. The present study aims at gaining knowledge about and insights into these questions. The sample studied consists of 10 Bipolar I patients and 10 patients with Borderline Personality Disorder. Following a cross-sectional design, after determining the remitted phase of Bipolar I patients using Hamilton Depression Rating Scale and Young’s Mania Rating Scale, the Temperament and Character Inventory, Attachment Style Questionnaire, Defense Style Questionnaire and Rorschach Inkblot Test were administered individually by the researcher. Both group of patients showed features of immaturity and instability. A correlational analysis indicated the probable pathway of development of psychopathology. The parallels of the findings to Kernberg’s concept of borderline personality organization have been discussed.     

The clinical utility of the MMPI-2 Antisocial Practices Content Scale

This study explored the ability of the MMPI-2 Antisocial Practices Content Scale (ASP) to correctly classify DSM-IV Antisocial Personality Disorder (APD). ASP scores and scores on the MMPI-2 Psychopathic Deviate (Pd) scale were compared in an APD group (n = 10), a Borderline Personality Disorder group (n = 16), a Narcissistic Personality Disorder group (n = 9), an Other Personality Disorder group (representing personality disorders from Clusters A and C; n = 14), and a nonclinical population (NC; n = 67). The ASP exhibited an ability to differentiate APD from other personality disorders and was significantly correlated to DSM-IV diagnostic criteria for APD while the Pd was not. Diagnostic efficiency statistics (sensitivity, specificity, positive predictive power, negative predictive power, overall correct classification rate, and kappa) were calculated under four different conditions in a clinically relevant manner (Kessel & Zimmerman, 1993. Psychological Assessment, 53, 395-399). The results of this study illustrate the usefulness of the ASP as a tool for the assessment of antisocial attitudes, beliefs, and behaviors in individuals suspected of having APD. This information may be valuable to clinicians who are planning treatment or assessing treatment outcome for clients with APD.     

Affect regulation and Depressive Personality Disorder

Depressive Personality Disorder (DPD) has been under consideration for inclusion in the Diagnostic and Statistical Manual of Mental Disorders since 1994; yet, few studies have been published that test whether those with DPD have affective experiences that are characterized exclusively by depression and negative affect. One hundred ninety-seven undergraduate students were interviewed for DPD and Borderline Personality Disorder with the Personality Disorder Interview for DSM-IV (Widiger, Mangine, Corbitt, Ellis, & Thomas, 1995), in order to control for frequently co-occurring BPD which is characterized by affective lability. Participants also were administered measures of affective lability, affective intensity, anxious and depressive states, and more trait-like manifestations of depression, anxiety, and anger. Results indicate that those with DPD may be described as having a mood state characterized by transitions from a baseline neutral mood to one of anxiety, with their experiences being more prominently depressed and dysphoric. They also have tendencies toward angry hostility, though they may not report frequent shifts from a baseline neutral mood to anger. Those with DPD also report intense, frequent experiences of depression and dysphoria, with many shifts between depression and anxiety.     

Thought Disorder on the WAIS-R Relative to the Rorschach: Assessing Identity-Disordered Adolescents

Clinical researchers have noted that compared with other diagnostic groups, adults with Borderline Personality Disorder tend to demonstrate relatively more thought disorder on unstructured projective tests (e.g., Rorschach) than on structured objective tests of cognitive performance (e.g., Wechsler Adult Intelligence Scale; WAIS). Using archival data, our study found evidence that adolescents with Identity Disorder tend to exhibit this same phenomenon. The records of 62 adolescent inpatients who had been administered the WAIS or WAIS-R and the Rorschach were examined. Of the 62 cases, 25 were diagnosed with Identity Disorder, 14 with Conduct Disorder (Group Type), 15 with Oppositional Defiant Disorder, and 8 with Schizophreniform Disorder. For each participant, the WAIS or WAIS-R and the Rorschach were scored according to the Thought Disorder Index (TDI; Johnston & Holzman). Adolescents with Identity Disorder revealed a significantly larger discrepancy between TDI scores on the WAIS or WAIS-R and TDI scores on the Rorschach than did adolescents with other diagnoses. The findings suggested that the discrepancy between the degree of thought disorder on structured versus unstructured psychological tests (i.e., differential decompensation) is related to diagnosis.     

Reliability and validity of the borderline personality disorder severity index

The psychometric properties and validity of the Borderline Personality Disorder Severity Index (BPDSI), a semistructured interview assessing the frequency and severity of manifestations of Borderline Personality Disorder (BPD) during a circumscribed period, were investigated in two studies. In study 1, patients with BPD (n = 15), with other personality disorders (PD; n = 18), and without Axis II disorders (but with Axis I disorders; n = 10) assessed with the SCID were interviewed with the BPDSI (1-yr. version). Patients also filled out a number of questionnaires. A second rater judged taped BPDSI interviews. The BPDSI appeared to yield highly reliable (ICC = .93) and internally consistent (Cronbach's alpha = .85) scores. The BPDSI strongly discriminated BPD patients from other patients, and was not related to other Axis II pathology. Concurrent and construct validity was excellent. In study 2, a version of the BPDSI suitable for use in treatment outcome research was investigated (3-month version) in a sample of 64 BPD patients, 23 Cluster C PD patients, and 20 nonpsychiatric controls. Again, reliability coefficients were excellent (ICC = 0.97; Cronbach's alpha = 0.93), and validity indices were good. Clinical norms were also derived. In a sample of 28 BPD patients, the instrument detected improvement during 6 months of psychotherapy.     

An investigation of psychopathology in nonreferred suicidal and nonsuicidal adolescents

This investigation examined self-reported psychopathology in a school-based sample of 456 suicidal and nonsuicidal adolescents. The sample consisted of four groups: three at-risk for suicidal behavior based on current suicidal ideation as assessed by the Suicidal Ideation Questionnaire (SIQ; Reynolds, 1988), past suicide attempts, or both; and one nonsuicidal comparison group. Psychopathology was examined using ten scales from the Adolescent Psychopathology Scale (APS; Reynolds, 1998a) including: Major Depression, Conduct Disorder, Substance Abuse, Schizophrenia, Adjustment Disorder, Anorexia Nervosa, Borderline Personality Disorder, Obsessive-Compulsive Personality Disorder, Schizotypal Personality Disorder, and Avoidant Personality Disorder. Analyses were conducted separately for males and females using a MANOVA design that examined psychopathology severity among the four groups. Adolescents who engaged in past or current suicidal behavior had higher psychopathology severity scores compared to their nonsuicidal peers. Males with current suicidal thoughts who had attempted suicide had the highest levels of psychopathology severity compared to males in the other three groups. Females with a past suicide attempt or current suicidal ideation had higher psychopathology severity scores compared to nonsuicidal females. Results show greater psychopathology in school-based adolescents who have engaged in past and/or current suicidal behavior. The need for clinicians and mental health professionals working with at-risk youth to focus on concurrent psychopathology along with suicidal behavior is discussed.     

Trait Anger and Axis I Disorders: Implications for REBT

Anger has a prominent role in basic theories of emotion. And while many psychiatric disorders can be conceived of as emotional disorders (e.g., depressive disorders, anxiety disorders), there are no disorders for which anger is the cardinal feature. We analyzed diagnostic data on 1,687 (as later) psychiatric outpatients and looked at the co-occurrence of high trait anger (as assessed by criterion 8 of Borderline Personality Disorder) and Axis I disorders, and Borderline and Antisocial Personality Disorders. The purpose was to examine whether dysfunctional anger met criteria necessary to be considered a valid diagnostic category. Results showed that high trait anger was not fully accounted for by any particular Axis I diagnosis, or any set of Axis I diagnoses, or by the combination of Axis I diagnoses and Borderline and Antisocial PDs. Trait anger also accounted for significant amounts of unique variance in several indicators of psychiatric impairment and psychosocial functioning. We describe the anger disorder diagnoses of Eckhardt and Deffenbacher (Anger disorders: Definition, diagnosis and treatment. Taylor & Francis, Bristol, PA, 1995), and discuss the implications of those diagnoses for the practice of REBT and CBT.

Opinions of personality disorder experts regarding the DSM-IV personality disorders classification system

OBJECTIVE: To survey the opinions of personality disorder (PD) experts on possible revisions in the classification system for PDs in the DSM-V. METHOD: Four hundred members of two international associations, the Association for Research on Personality Disorders, and the International Society for the Study of Personality Disorders, were asked to take a 78-item web survey. RESULTS: Of the experts who completed the survey (N = 96), 74% felt that the DSM-IV's categorical system of PD diagnosis should be replaced. Eighty percent felt that PDs are better conceived of as personality dimensions or illness spectra, than as categories. The most frequently endorsed alternative system for PDs was a mixed system of categories and dimensions. Most experts preferred the PDs to remain on Axis II. Only 31.3% wanted the term, "Borderline Personality Disorder," retained in the DSM-V. CONCLUSIONS: A clear majority of the PD experts were dissatisfied with the current diagnostic system for PDs.     

Criterion Validity of the MSI-BPD in a Community Sample of Women

The criterion validity of the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD; Zanarini et al., Journal of Personality Disorders 17:568–573, 2003) as a quick screening device for borderline personality disorder (BPD) was evaluated alongside the more established Personality Diagnostic Questionnaire-4+ Borderline subscale (PDQ-BPD; Hyler 1994) using receiver operator characteristic (ROC) analysis. Both instruments demonstrated adequate criterion validity with the diagnosis of BPD derived from a clinician-administered diagnostic interview. Optimal cutoffs for each measure were determined using sensitivity, specificity, and positive and negative likelihood ratios. The previously established cutoff for the MSI-BPD of seven (Zanarini et al., Journal of Personality Disorders 17:568–573, 2003) was confirmed. The current study provides the first support for the use of the MSI-BPD as a screening measure for use in community-based studies of BPD.     

Evaluating NEO Personality Inventory-Revised profiles in veterans with personality disorders

Fifty-one psychiatric, veteran outpatients were assessed for personality disorders on the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II; First, Gibbon, Spitzer, Williams, & Benjamin, 1997a) and were also administered the NEO Personality Inventory-Revised (NEO-PI-R; Costa & McCrae, 1992). Results were compared to Trull and Widiger's (1997) hypotheses about the profiles of such patients and similar past studies. Correlations between NEO-PI-R facets and SCID-II personality disorder symptom clusters generally occurred in the expected direction. Facets hypothesized to be associated with a given personality disorder were able to predict variance in their respective SCID-II personality disorder scores for seven of ten personality disorders. In general, results support the facet-level conceptualizations of these disorders, except for Obsessive-Compulsive Personality Disorder.     

Heritability of personality disorders in childhood: a preliminary investigation

The heritability of personality disorder features was investigated in 112 child (ages 4-15 years) twin pairs (70 monozygotic and 42 dizygotic pairs). Parents assessed personality disorder features using the Coolidge Personality and Neuropsychological Inventory for Children (CPNI; Coolidge, 1998) that measures 12 personality disorders according to the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (American Psychiatric Association, 1994). Structural equation model-fitting methods indicated that the median heritability coefficient for the 12 scales was .75 (ranging from .81 for the Dependent and Schizotypal Personality Disorder scales to .50 for the Paranoid and Passive-Aggressive Personality Disorder scales). These results suggest that childhood personality disorders have a substantial genetic component and that they are similar to heritability estimates of personality disorder traits in adults and counter hypotheses that only temperaments and higher-order personality disorder traits have significant genetic components (Paris, 1997).     

Subtyping borderline personality disorder by suicidal behavior

Course and outcome of Borderline Personality Disorder (BPD) are favorable for the vast majority of patients; however, up to 10% die by suicide. This discrepancy begs the question of whether there is a high lethality subtype in BPD, defined by recurrent suicidal behavior and increasing attempt lethality over time. In a prospective, longitudinal study, we sought predictors of high lethality among repeat attempters, and defined clinical subtypes by applying trajectory analysis to consecutive lethality scores. Criteria-defined subjects with BPD were assessed using standardized instruments and followed longitudinally. Suicidal behavior was assessed on the Columbia Suicide History, Lethality Rating Scale, and Suicide Intent Scale. Variables discriminating single and repeat attempters were entered into logistic regression models to define predictors of high and low lethality attempts. Trajectory analysis using three attempt and five attempt models identified discrete patterns of Lethality Rating Scale scores. A high lethality trajectory was associated with inpatient recruitment, and poor psychosocial function, a low lethality trajectory with greater Negativism, Substance Use Disorders, Histrionic and/or Narcissistic PD co-morbidity. Illness severity, older age, and poor psychosocial function are characteristics of a poor prognosis subtype related to suicidal behavior.     

Psychiatric and behavioral problems in aggressive drivers

Motor vehicle accidents (MVAs) are a leading cause of accidental death and injury, and aggressive driving has been identified as a risk factor for MVAs. Assessing psychiatric and behavioral disturbances in aggressive drivers is germane to the development of prevention and intervention programs for this population. The present study compared the prevalence of psychiatric diagnoses and behavioral problems in young adult drivers with self-reported high driving aggression to that of drivers with low driving aggression. Aggressive drivers evidenced a significantly higher current and lifetime prevalence of Oppositional Defiant Disorder, Alcohol and Substance Use Disorders, and Cluster B Personality Disorders, and a significantly greater lifetime prevalence of Conduct Disorder, Attention-Deficit/Hyperactivity Disorder, and Intermittent Explosive Disorder. Aggressive drivers also had a significantly greater prevalence of self-reported problems with anger, as well as a greater family history of anger problems and conflict. The findings suggest that prevention and intervention programs designed to reduce aggressive driving may need to address the presence of psychiatric and behavioral problems that could potentially complicate treatment or impede responses to treatment.     

Personality disorders in patients with burning mouth syndrome

Burning Mouth Syndrome (BMS) presents high rates of comorbid Axis I disorders while no controlled studies have addressed the question of Axis II comorbidities. The aim of the present study was to examine DSM-IV (APA, 1994) Axis II comorbidity in BMS patients and to control for the specificity of this association. Seventy BMS patients were compared to a nonpsychiatric population sample and to patients with other Somatoform Disorders for the presence of personality disorders (assessed with the Structured Clinical Interview for DSM-IV Axis II Personality Disorders [SCID-II; First, Gibbon, Spitzer, & Williams, 1997). Prevalence rates were compared using the Pearson's chi square test. At least one personality disorder (PD) was found in 85.7%, 24.3%, and 88.6% of subjects in the three groups, respectively. When examining PD subgroups, significant differences emerged even between the BMS and the somatoform disorder group, with BMS patients showing more Cluster A and fewer Cluster B PDs. Our results suggest that BMS is associated with a specific pattern of Axis II comorbidity.     

Are DSM-IV-TR Borderline Personality Disorder, ICD-10 Emotionally Unstable Personality Disorder, and CCMD-III Impulsive Personality Disorder Analogous Diagnostic Categories Across Psychiatric Nomenclatures?

This study examined the validity of the borderline construct which encompasses diagnostic criteria from the DSM-IV-TR Borderline Personality Disorder (BPD), ICD-10 Emotionally Unstable Personality Disorder (EUPD), and CCMD-III Impulsive Personality Disorder (IPD) in a sample of 1,419 Chinese psychiatric patients. Participants completed the Chinese Personality Disorder Inventory and the Chinese Personality Assessment Inventory-2 assessing various disordered personality features. Adequate internal consistency was found for the borderline construct (α = .83). Exploratory factor analysis revealed two components: (1) affective and cognitive disturbances, and (2) impulse dysregulation, which were replicated by confirmatory factor analysis. Item analysis indicated that the various borderline criteria displayed similar levels of diagnostic efficiency, which does not support the elimination of fear of abandonment and transient psychotic features from the EUPD and IPD criteria set. Findings of this study suggest that BPD, EUPD, and IPD may represent analogous diagnostic categories across classification systems.