Gender differences in a clinical sample of patients with borderline personality disorder

The aim of the study was to investigate gender differences and similarities in patients with borderline personality disorder (BPD) with respect to Axis I comorbidity, Axis II comorbidity, general psychopathology (Symptom Checklist 90-Revised), and dimensional personality traits (NEO-Personality-Inventory Revised [NEO-PI-R] and the Dimensional Assessment of Personality Profile Basic questionnaire [DAPP-BQ]). Fifty-seven men and 114 women with BPD were included in the study. Regarding Axis I and II disorders in an exploratory analysis, men with BPD more often fulfilled the diagnostic criteria for binge eating disorder, antisocial personality disorder, narcissistic personality disorder, and conduct disorder in childhood, whereas women had higher frequencies of bulimia nervosa, posttraumatic stress disorder, and panic disorder with agoraphobia. After correcting for multiple tests, only the gender differences in narcissistic and antisocial personality disorder remained significant. In the SCL-90-R profile, no significant gender differences could be identified. In the exploratory analysis of the dimensional personality traits, women showed higher rates on the NEO-PI-R main factors (Neuroticism and Agreeableness) compared to men. In the DAPP-BQ profile, men reached higher sores on the main factor, Dissocial Behavior. When correcting for multiple tests, gender differences still existed for Neuroticism and Dissocial Behavior. Our results argue for gender differences in Axis I and II comorbidity and dimensional personality traits in BPD. However, in general, more similarities than differences were shown in this study.     

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.     

Interpersonal analysis of grandiose and vulnerable narcissism

This article examines the validity of grandiose and vulnerable subtypes of narcissistic character styles through an analysis of personality disorder criteria, interpersonal problems, and adult attachment styles in a nonclinical population. The grandiose personalities in this sample were rated high in the dramatic traits associated with narcissistic, antisocial, and histrionic personality disorders based on a diagnostic interview, and they reported domineering and vindictive interpersonal problems. However, despite the observation of narcissistic personality pathology, they denied interpersonal distress related to their interpersonal problems and the majority reported adult attachment styles reflective of positive self-representations (Secure, Dismissive). Vulnerable narcissistic individuals were represented by high ratings on avoidant personality disorder based on a diagnostic interview. They reported high interpersonal distress and greater domineering, vindictive, cold, and socially avoidant interpersonal problems. The majority reported adult attachment styles reflective of negative self-representations (Fearful, Preoccupied). The validity of grandiose and vulnerable narcissism based upon the results of this study was discussed in terms of clinical theory and with reference to the implications of two subtypes of narcissism for diagnosis and treatment.     

Social phobia: Axis I and II correlates

The presence of Axis I and Axis II disorders in 71 social phobic patients was examined. Generalized anxiety disorder was the most common secondary Axis I disorder, followed by simple phobia. Avoidant personality disorder and obsessive-compulsive personality disorder were the most common Axis II diagnoses, and 88% of the sample exhibited features of these 2 personality styles. Subjects with additional Axis I diagnoses were more anxious and depressed than those with no additional Axis I disorder. Social phobics with additional Axis II disorders were more depressed but not more anxious than those with no Axis II diagnosis. Furthermore, those with an additional Axis I disorder had higher scores on measures of neuroticism, interpersonal sensitivity, and agoraphobia. The prevalence and impact of additional Axis I and II disorders on the etiology, maintenance, and treatment outcome for persons with social phobia are discussed.     

Socio-demographic conditions, subjective somatic health, Axis I disorders and personality disorders in the common population: the relationship to quality of life

Quality of life (QOL) was studied in a population of 2,065 subjects in Norway. A broad concept of QOL was applied, including subjective well-being, self-realization, negative life events, and a number of interpersonal relationships. The assessment of QOL, based on interview, was related to a number of socio-demographic variables, subjectively experienced somatic health, the most common Axis I disorders, and all Axis II personality disorders (PDs). The results of multivariate analyses showed that being female and living with a partner in the outskirts of a city and having good physical health are important positive correlates of QOL. Controlling for all these variables, major depression, dysthymic disorder, and somatoform disorders were the Axis I disorders that have a negative statistical effect on global QOL. Specific anxiety disorders did not add to the effects. Among the PDs, avoidant, schizotypal, paranoid, and schizoid PD traits were the most important statistical negative determinants of QOL, followed by borderline, dependent, antisocial, and also self-defeating and narcissistic PDs, restricted to some specific sub-indexes of QOL. The study also showed that our results vary and are sometimes the opposite, depending on the sub-index of QOL examined. The study showed that it is necessary to apply a broad concept of QOL to disclose the real nature or the relationship between mental disorders and QOL. Furthermore, demographic variables, subjectively experienced somatic health, Axis I disorders, and PD traits appeared to be independently associated with QOL.     

Diagnostic profiles of offenders in substance abuse treatment programs

This study examined the association of Axis I and Axis II disorders among offenders who were in prison-based substance abuse treatment in a national multi-site study. Participants (N = 280) received a psychosocial assessment and a structured diagnostic interview in two separate sessions. Logistic regression models examined the association between lifetime mood and anxiety disorders with two personality disorders, and the relationship of Axis I and Axis II disorders (alone and in combination) to pre-treatment psychosocial functioning. Over two-thirds of the sample met criteria for at least one mental disorder. Borderline personality disorder was strongly associated with having a lifetime mood disorder (odds ratio = 7.5) or lifetime anxiety disorder (odds ratio = 8.7). Individuals with only an Axis II disorder, or who had both Axis I and Axis II disorders, had more severe problems in psychosocial functioning than those without any disorder. Clinical treatment approaches need to address this heterogeneity in diagnostic profiles, symptom severity, and psychosocial functioning.     

Associations in the course of personality disorders and Axis I disorders over time

In this study, the authors examined time-varying associations between schizotypal (STPD), borderline (BPD), avoidant (AVPD), or obsessive-compulsive (OCPD) personality disorders and co-occurring Axis I disorders in 544 adult participants from the Collaborative Longitudinal Personality Disorders Study. The authors tested predictions of specific longitudinal associations derived from a model of crosscutting psychobiological dimensions (L. J. Siever & K. L. Davis, 1991) with participants with the relevant Axis I disorders. The authors assessed participants at baseline and at 6-, 12-, and 24-month follow-up evaluations. BPD showed significant longitudinal associations with major depressive disorder and posttraumatic stress disorder. AVPD was significantly associated with anxiety disorders (specifically social phobia and obsessive-compulsive disorder). Two of the four personality disorders under examination (STPD and OCPD) showed little or no association with Axis I disorders.     

Personality characteristics of ADHD adults assessed with the Millon Clinical Multiaxial Inventory-II: evidence of four distinct subtypes

This study compared the personality characteristics of 104 adults diagnosed with attention deficit hyperactivity disorder (ADHD). Personality features were assessed with the MCMI-II (Millon, 1987). Participants were divided into 4 groups based on the presence of persisting oppositional defiant disorder (ODD) or other comorbid diagnoses (ADHD only, ADHD-comorbid, ADHD-ODD, ADHD-ODD-comorbid). Significant differences between these groups were present for 9 of the 13 MCMI-II personality scales, resulting in 4 modal personality styles. ADHD-only adults evidenced mild histrionic traits, whereas the ADHD-comorbid group was more often avoidant and dependent in personality style. ADHD-ODD adults showed histrionic, narcissistic, aggressive-sadistic, and negativistic traits whereas the ADHD-ODD-comorbid group had a combination of avoidant, narcissistic, antisocial, aggressive-sadistic, negativistic, and self-defeating personality features. Implications for treatment are discussed.     

Screening of personality disorders among chinese college students by Personality Diagnostic Questionnaire-4+

Four thousand eight hundred and eleven students were sampled from 26 universities in 21 cities of China and evaluated using the Personality Diagnostic Questionnaire-4+(PDQ-4+). Results showed that male students obtained significantly higher scores than female students on paranoid, schizotypal, antisocial, narcissistic, passive-aggressive, and depressive personality disorder scales, and lower scores on the borderline scale. Students from rural areas scored higher than those from urban areas on the schizoid, schizotypal, narcissistic, avoidant, compulsive-obsessive, passive-aggressive, and depressive personality disorder scales, and lower on the paranoid and dependent scales. Singleton students obtained significantly higher scores than nonsingletons on paranoid, antisocial and dependent scales, and lower on schizoid, avoidant, compulsive-obsessive, passive-aggressive, depressive scales. Students from single-parent families scored significantly higher on the schizotypal scales; and students from foster families scored significantly higher on the antisocial, passive-aggressive, and depressive scales. Students from poor families scored significantly higher than those from average or wealthy families on schizoid, schizotyal, antisocial, borderline, narcissistic, avoidant, obsessive-compulsive, passive-aggressive, and depressive personality disorders. The results suggest that low family income, low social status, and parental style contribute to the development of personality disorders.     

Addicted patients with personality disorders: traits, schemas, and presenting problems

We evaluated the association of Structure Clinical Interview for the DSM-IV Axis II (SCID-II) severity and personality traits, early maladaptive schemas, and presenting symptoms in 41 methadone-maintained patients meeting criteria for either antisocial, borderline, avoidant, or depressive personality disorder. Correlational analyses indicated that the severity of each personality disorder was associated with a unique profile of presenting problems and underlying traits and schemas. The evaluation of multiple psychological indicators appears to be a useful method for case conceptualization and planning interventions within a promising individual therapy model that focuses both on substance abuse and psychiatric symptoms and maladaptive schemas and coping styles.     

Rorschach aggression variables: a study of reliability and validity

This study investigated the extent to which 6 Rorschach variables of aggression (A1, A2, AG, MOR, AgC, AgPast) are related to one another, to the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) Cluster B personality disorder criteria, and to self-report measures of anger, aggression, and antisocial behavior. Seventy-eight patients were found to meet DSM-IV criteria for an Axis II disorder, Cluster A personality disorder (paranoid, schizoid, schizotypal) = 9, Cluster B (antisocial personality disorder [ANPD] = 16, borderline personality disorder [BPD] = 23, histrionic personality disorder = 5, narcissistic personality disorder = 12) = 56, and Cluster C personality disorder (avoidant, dependent, obsessive-compulsive) = 13. The results of this study indicated that (a) these 6 Rorschach aggression variables can be scored reliably; (b) 2 factors, revealed by factor analysis, accounted for 77% of the total variance; (c) selected variables were found to be empirically related to DSM-IV diagnostic criteria for ANPD and BPD; and (d) selected variables were found to be empirically related to a self-report measure of anger and antisocial practices. The conceptual nature and clinical utility of these Rorschach aggression variables as well as implications for future research are discussed.     

Differentiation of Axis I and Axis II disorders

The revised 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1987) distinguishes between Axis I and Axis II disorders: Axis II includes personality (and developmental) disorders, and all others are on Axis I. This distinction is often useful, but the reification of Axis I and II constructs through diagnostic criteria sets that demarcate categorically distinct entities is at times problematic. We review the issues of differentiating personality from Axis I disorders, specifically illustrated by schizotypal and schizophrenic disorders, borderline and mood disorders, antisocial and substance use disorders, and avoidant personality from social phobia. The options for addressing their differentiation include adding exclusion criteria, shifting the placement of disorders, deleting overlapping criteria, adding differentiating criteria, and converting to a dimensional format.     

Gender differences in the frequency of personality disorders in depressed outpatients

We examined gender differences in the frequency of DSM-III-R personality disorder diagnoses and symptomatology in a sample of 225 depressed outpatients. This research partially replicates and extends one of the first studies in this area by Golomb et al. (1995). Males were significantly more likely than females to meet diagnoses for schizotypal, paranoid, narcissistic, antisocial, obsessive compulsive, and borderline personality disorder. Compared to females, males were also significantly more likely to have schizoid, schizotypal, narcissistic, antisocial, and obsessive-compulsive personality disorder symptomatology. Females did not predominate in any personality disorder symptomatology or diagnoses. A possible explanation for these findings is discussed. The results of this study challenge traditional assumptions about gender differences in the frequency of personality disorders, and confirm the need for future studies to investigate the relation between gender and personality disorders in specific Axis I samples.     

Psychoanalytic patients in the U.S., Canada,and Australia: II. A DSM-III-R validation study

A study was conducted to validate our previous work on the DSM-III-R disorders diagnosed in patients in psychoanalysis in the U.S., Canada, and Australia and to determine which specific mood, anxiety, and personality disorders were the most common in these patients. The earlier study consisted of three surveys of psychoanalytic practice that together obtained data on 1,718 patients, through extensive mail surveys to analysts in the three countries. In the validation study, 206 patients were diagnosed using a different technique. Analysts similar in important respects to those who participated in the original surveys rated patients diagnostically before and after DSM-III-R training. After training, no significant changes appeared in the rates for any of the specific mood disorders. For the thirty disorders examined, training effects decreased the identification of the generalized anxiety disorder, and increased the identification of three personality disorders: avoidant, dependent, and personality disorder not otherwise specified. Thus, analysts slightly underdiagnosed the number of personality disorders, and some "anxious" patients appear to have qualified for personality disorders. Some limitations of the DSM-III-R notion of narcissistic personality are discussed, as are the importance and stability of the self-defeating (masochistic) personality disorder. The most common Axis I disorder in psychoanalytic patients was dysthymia, followed by major depression, recurrent. This study reinforces the findings of the original three surveys. Minor corrections were developed to adjust the original three surveys.     

Measures to assess maladaptive variants of the five-factor model

The five-factor model (FFM) is the predominant dimensional model of general personality structure. A considerable body of research supports the hypothesis that personality disorders can be conceptualized as extreme or maladaptive variants of the domains and facets of the FFM. However, existing measures of the FFM are confined largely to the normal variants. The purpose of this special section of the Journal of Personality Assessment is to provide the development and initial validation of self-report inventory scales to assess obsessive-compulsive, borderline, narcissistic, avoidant, and dependent personality traits from the perspective of the FFM, which complement the similarly constructed existing measures for psychopathic, histrionic, and schizotypal personality traits.     

日周期类型与心理健康

个体间表现出的昼夜节律差异现象可以从日周期类型上进行分类, 包括偏爱早睡早起的清晨型, 偏爱晚睡晚起的夜晚型以及处于两者之间的中间型。已有研究表明, 夜晚型与心境障碍、注意缺陷多动障碍和进食障碍等心理疾病有关, 而日周期类型与心理健康的关系可能受到基因、社会时差、人格等因素的影响。未来应改进研究设计和测量方法, 深入考察日周期类型与心理健康的关系及其作用机制, 以及在我国文化背景下推进日周期类型与心理健康的关系研究。     

The construct validity of depressive personality disorder

This study examined the construct validity of depressive personality disorder (DPD: American Psychiatric Association, 1994). Adult psychiatric outpatients (N = 900) underwent comprehensive Axis I and II evaluations and provided data on 4,768 of their 1st-degree relatives. Despite modest overlap, DPD was not redundant with any Axis I or II disorder. Participants with DPD exhibited more Axis I and Axis II comorbidity, and greater psychosocial dysfunction, than participants without DPD. Relatives of participants with DPD had higher rates of mood disorders, alcohol abuse, and antisocial personality. Results are consistent with findings of several other similar investigations. The authors argue that DPD is a valid construct and should be conceptualized as a personality disorder as opposed to a mood disorder.     

Personality and Psychopathology: An Application of the Five-Factor Model

Our review is concerned with the relationship of the five-factor model of personality to psychopathology, focusing in particular on Axis II personality disorders and depression. The five factors provide a particularly compelling model for interpreting the Axis II personality disorders as maladaptive variants of normal personality traits. However, we also discuss methodological and conceptual limitations of this application. There has been little research on the relationship of Openness, Agreeableness, and Conscientiousness to Axis I mental disorders, but considerable attention has been given to Neuroticism and Extraversion. We focus in particular on the difficulty in distinguishing between the various ways in which personality can relate to depression, either as a predisposition to, a complication of, a pathoplastic effect upon, or a spectrum variant of the mental disorder. We conclude with recommendations for future research.     

Multidimensional perfectionism and the DSM-5 personality traits

Encouraging further research on the dimensional assessment of personality disorders (PDs), Section III of the DSM-5 introduced a hybrid model for the assessment of six PDs employing self-reports on 25 maladaptive personality traits (“DSM-5 personality traits”). Following suggestions that multidimensional perfectionism is an important characteristic across various personality disorders (Ayearst, Flett, & Hewitt, 2012), the present study investigated how personal (self-oriented) and interpersonal (other-oriented and socially prescribed) forms of perfectionism predicted the DSM-5 personality traits in a sample of 311 university students. Multiple regressions (controlling for the overlap between the different forms of perfectionism) showed that socially prescribed perfectionism positively predicted the traits defining schizotypal, borderline, avoidant, and obsessive-compulsive PD; other-oriented perfectionism positively predicted the traits defining narcissistic PD; and both socially prescribed and other-oriented perfectionism positively predicted the traits defining antisocial PD. In contrast, self-oriented perfectionism positively predicted only one of the four traits defining obsessive-compulsive PD (rigid perfectionism). Showing that multidimensional perfectionism predicted all DSM-5 traits defining the personality disorders of Section III, the findings suggest that future DSM-5 updates may profit from including interpersonal aspects of perfectionism as a diagnostic criterion.     

The central domains of personality pathology in psychiatric patients

There is general agreement that the classification of personality disorders in DSM-IV is unsatisfactory. We systematically reviewed all studies that have analyzed patterns of personality disorder symptoms and signs in psychiatric patients; twenty-two papers were included in the final synthesis. There is reasonable consistency over the number and type of personality pathology traits reported despite differing samples, varying assessment methods, and different statistical manipulations. There are three or four high order traits; an externalizing factor incorporating borderline, narcissistic, histrionic, and antisocial traits (the latter is sometimes recorded as a separate trait); an internalizing factor incorporating avoidant and dependent traits; a schizoid factor; and often a compulsive factor. Using these domains of personality pathology would simplify classification, have higher clinical utility, and allow relatively easy translation of current research.