An Overview of Issues Related to Categorical and Dimensional Models of Personality Disorder Assessment

Despite long-standing efforts to improve the current diagnostic system for Axis II, problems remain with the categorical conceptualization of personality disorders (PDs). Due in part to these problems, interest has developed in dimensional models of PD classification. In this article, we discuss four issues relevant to categorical vs. dimensional assessment of PDs: (a) problems with self-reports in PD patients, (b) methodological issues in behavioral and clinician assessment of PDs, (c) challenges that arise when dimensional models are applied to patient and nonpatient samples, and (d) clinical implications of categorical and dimensional PD models. We suggest that researchers and clinicians address these concerns to avoid implementing a new PD assessment model that—although different from the current system—would otherwise remain fraught with difficulties.     

Age-Related Personality Differences in Inpatients with Personality Disorder: A Cross-Sectional Study

There are few empirical studies of age-associated differences in personality characteristics of individuals diagnosed with Personality Disorder (PD), and none that comparatively examine multiple personality characteristics, with a variety of psychological measures, across a wide age range in adults diagnosed with PD and coexisting substance abuse. Personality test data of 392 psychiatric inpatients diagnosed with PD were analyzed by age group. Patients were assessed with the California Psychological Inventory, Psychological Inventory of Personality and Symptoms, Diagnostic Inventory of Personality and Symptoms, Minnesota Multiphasic Personality Inventory-1, and the Millon Clinical Multiaxial Inventory-1. There were no age differences in the number of patients diagnosed with PD, but older adults were significantly less likely to be diagnosed with more than one PD. Older patients with PD were significantly less impulsive, paranoid, high-energy, antisocial, and irresponsible than younger patients with PD. It appears that, with aging, there is a general mellowing of personality for those diagnosed with PD, which may be related to the proposed geriatric variants of PD.     

纯粹实践理性批判与定言命令演绎

普通人类知识在实践运用中出现自然辩证法,引发对定言命令有效性的怀疑,使纯粹实践理性批判成为必要。纯粹实践理性批判通过追问三个问题,防止实践理性的僭越,确立了定言命令演绎的实践的立场。这三个问题分别对应《道德形而上学的奠基》前面三节,说明道德法则除了自由之外,别无根据;自由除了道德法则之外,没有其他基础;追问对道德法则的兴趣,容易把情感当作道德法则的根据。这些观点与《实践理性批判》是一致的。康德从一开始就不是从理论的角度来演绎定言命令,也没有出现主流学界所批判的失败。     

Hypermentalizing in Borderline Personality Disorder: A Model and Data

Interpersonal difficulties are a widely accepted characteristic of borderline personality disorder (BPD). However, the results of empirical findings of deficits in social-cognitive abilities that may underlie interpersonal difficulties in this population have been mixed. In this paper, we review the literature on social-cognitive impairment in BPD by organizing studies based on patterns of positive and negative of findings. We provide a new model of mentalizing impairment in BPD by integrating findings into one framework that suggests hypermentalizing as the core feature of social-cognitive impairment in BPD. We review data in support of a hypermentalizing model of BPD and situate this data in the broader context of current work on hypermentalizing.     

Narcissistic Personality Disorder as an Intrapsychic Trajectory to Real Self-Love: A Case Report

The intrapsychic mechanism of remission in a forensic psychiatric patient with narcissistic personality disorder and comorbid antisocial features is examined. The positive impact of a therapeutic and academic program on the patient’s development and recovery and correlated increase of true self-love is analyzed and discussed. Real self-love appeared to be associated with stable selfesteem and enhancement of self-insight, authenticity, and reality testing capacities.     

Comparative Personality Judgments: Replication and Extension of Robust Findings in Personality Perception Using an Alternative Method

The scientific study of accuracy in personality judgment typically involves the utilization of rating scales to make absolute decisions about a target individual. Although this method has many merits, it restricts some experimental options and is further removed from ecological validity than one would desire. These studies represent an attempt to develop an alternative methodology for the study of personality judgment—specifically for use in explorations of judgment process. A series of photo sets containing pictures of 3 individuals, each representing a different level of a specific personality trait, was created. The participant's task was to select high and low scorers on a dimension from the photos. Study 1 demonstrates that people can select targets with extreme scores from a photo lineup at a rate better than chance across several personality dimensions. Study 2 shows that this ability has some degree of temporal consistency. Study 3 represents an improvement on the general method via enhanced criteria for stimulus selection, incorporating both self and peer reports.     

Comorbidity of Personality Disorders and Somatization Disorder: A Meta-analytic Review

Meta-analysis of studies assessing the comorbidity of somatization disorder (SD) with one or more personality disorders (PDs) revealed that-contrary to the assertions of the Diagnostic and Statistical Manual of Mental Disorders (4th edition, text revision)-SD co-occurs with the majority of Axis II PDs. Although comorbidity effect sizes (rs) linking SD with paranoid PD and obsessive-compulsive PD were small, effect sizes for antisocial, borderline, narcissistic, histrionic, avoidant, and dependent PD yielded rs about or above 0.20. Comorbidity information in future versions of the DSM should be revised to reflect the greater number of PDs empirically linked with SD.

Experimental Personality Designs: Analyzing Categorical by Continuous Variable Interactions

Theories hypothesizing interactions between a categorical and one or more continuous variables are common in personality research. Traditionally, such hypotheses have been tested using nonoptimal adaptations of analysis of variance (ANOVA). This article describes an alternative multiple regression-based approach that has greater power and protects against spurious conclusions concerning the impact of individual predictors on the outcome in the presence of interactions. We discuss the structuring of the regression equation, the selection of a coding system for the categorical variable, and the importance of centering the continuous variable. We present in detail the interpretation of the effects of both individual predictors and their interactions as a function of the coding system selected for the categorical variable. We illustrate two- and three-dimensional graphical displays of the results and present methods for conducting post hoc tests following a significant interaction. The application of multiple regression techniques is illustrated through the analysis of two data sets. We show how multiple regression can produce all of the information provided by traditional but less optimal ANOVA procedures.     

The Relationship between Personality Disorder Features and Symptom Improvement at an Inpatient Treatment Program for Posttraumatic Stress Disorder

This study examined the association between personality disorder (PD) features and symptom improvement among adult survivors of childhood trauma in an inpatient program for posttraumatic stress disorder (PTSD). Participants completed questionnaires at admission, discharge, and six months following discharge. Multiple regression analyses were used to assess the combined effects of personality features on symptom improvement. Results indicated that improvement in trauma-related symptoms was not related to PD features. By contrast, the PD features were associated with change in other Axis I symptoms often comorbid with PTSD. Overall, results suggested that PD features do not impede improvement in trauma-related symptoms; however, specific accommodations might be needed to address comorbid disorders among individuals with PTSD.     

Personality in Panic Disorder With Agoraphobia: A Rorschach Study

In this study, we tested several hypotheses derived from self psychology (Diamond, 1987) regarding personality features of patients suffering from panic disorder and agoraphobia (PDA). PDA patients are thought to suffer from a deficit in negative affect-regulating capacity, surrounded by defenses such as avoidance, repression, denial, and reaction formation against dependency needs. These defenses are thought to lead to a greatly impoverished affective life. The Rorschach Comprehensive System was used to assess the personality features of avoidance, restricted affective life, and reaction formation against dependency needs. We found evidence for the presence of a highly avoidant information-processing style (86% of protocols had lambda [L] > .99) and a constricted affective life (low weighted sum color [WSumC] and low affective ratio [Afr]). Our results were consistent with the hypothesis of reaction formation against dependency needs (low food content [Fd]). Findings are discussed in light of studies that found a high incidence of avoidant personality disorder in PDA patients.     

Empathy Deficit in Antisocial Personality Disorder: A Psychodynamic Formulation

Empathic difficulty is a highly consequential characteristic of antisocial personality structure. The origin, maintenance, and possible resolution of this profound deficit are not very clear. While reconstructing empathic ability is of primary importance in the treatment of antisocial personality, not many proven procedures are in evidence. In this article, the author offers a psychodynamic formulation of the origin, character, and maintenance of the empathic deficiency in antisocial personality. The author discusses some of the treatment implications from this dynamic formulation.     

Autonomic impairment in Borderline Personality Disorder: A laboratory investigation

Recent research suggests that emotional dysfunction in psychiatric disorders can be reflected in autonomic abnormalities. The present study examines sympathetic and parasympathetic autonomic nervous system activity in individuals with Borderline Personality Disorder (BPD) before, during, and following a social stressor task. Data were obtained from an analogue sample of participants screening positive for BPD (n = 12) and healthy controls (n = 28). In general, BPD participants exhibited increased sympathetic activity (indexed by Cardiac Sympathetic Index, CSI; Toichi et al., 1997) and decreased parasympathetic activity (indexed by Respiratory Sinus Arrhythmia, RSA) compared to controls. During the stressful task, BPD and control participants exhibited different trajectories of sympathetic activation: estimates of sympathetic activity increased for BPD participants and decreased for controls. Furthermore, BPD participants reported the task (but not baseline or recovery phases) to be more frustrating than controls. Findings are interpreted in the context of Polyvagal theory.     

Autonomic impairment in Borderline Personality Disorder: A laboratory investigation

Recent research suggests that emotional dysfunction in psychiatric disorders can be reflected in autonomic abnormalities. The present study examines sympathetic and parasympathetic autonomic nervous system activity in individuals with Borderline Personality Disorder (BPD) before, during, and following a social stressor task. Data were obtained from an analogue sample of participants screening positive for BPD (n = 12) and healthy controls (n = 28). In general, BPD participants exhibited increased sympathetic activity (indexed by Cardiac Sympathetic Index, CSI; Toichi et al., 1997) and decreased parasympathetic activity (indexed by Respiratory Sinus Arrhythmia, RSA) compared to controls. During the stressful task, BPD and control participants exhibited different trajectories of sympathetic activation: estimates of sympathetic activity increased for BPD participants and decreased for controls. Furthermore, BPD participants reported the task (but not baseline or recovery phases) to be more frustrating than controls. Findings are interpreted in the context of Polyvagal theory.     

Amygdalar Volume in Borderline Personality Disorder With and Without Comorbid Post-traumatic Stress Disorder: A Meta-analysis

IntroductionFour studies have found a smaller amygdalar volume in patients with borderline personality disorder (BPD) relative to controls, whereas four other studies have found similar amygdalar volume in BPD patients relative to controls. This study aims to compare amygdalar volumes of BPD patients with controls, and also to compare BPD patients with and without post-traumatic stress disorder (PTSD) with controls in order to determine whether PTSD can explain the heterogeneity of findings.MethodSystematic review and meta-analysis of magnetic resonance imaging studies that measured amygdalar volumes in BPD patients and healthy controls.FindingsA significant reduction of amygdalar volumes in BPD patients was confirmed (p < .001). However, data from the studies that discriminated BPD patients with and without PTSD indicated that amygdalar volumes were significantly smaller in BPD patients without PTSD relative to controls (left: p = .02; right: p = .05), but not in BPD patients with PTSD relative to controls (left: p = .08; right: p = .20).ConclusionThis meta-analysis suggests that amygdalar volumes are reduced in patients with BPD. This pattern is confirmed in BPD patients without PTSD, but not in BPD patients with PTSD, raising the possibility that reduced amygdalar volume in BPD patients cannot be explained by comorbid PTSD.     

Millon's Evolutionary Model of Personality Assessment: A Case for Categorical/Dimensional Prototypes

Theodore Millon (1928–2014) was arguably one of the most influential figures in conceptualizing and detailing personality styles and disorders in the latter 20th and early 21st centuries. A prominent member of the Axis II Work Group of DSM–III, III–R, and IV, Millon continued refining his evolutionary model long after his active involvement with these committees, and remained focused on the future of personality assessment until his death in 2014. This article is an exploration of his latter works, critiques of recent DSM–5 developments, and commentary on the usefulness of his deductive methodology as it continues to apply to the study, classification, and clinical application of personality assessment.