High-risk situations associated with parasuicide and drug use in borderline personality disorder

Both parasuicide and drug use continue to be difficult problems to treat in borderline personality disorder (BPD). One useful approach that has not yet been applied to BPD is to develop a taxonomy of triggering situations for these problems. Once these high-risk precipitants are identified, then the behaviors can be targeted with skills training. This model has been applied by Marlatt (1996) with very influential results. To examine high-risk situations for parasuicide and drug use in BPD, the current study examined women with BPD who came to treatment for two different primary problems: parasuicide (N = 75) and drug dependence (N = 47). Participants identified the situation associated with highest risk for relapse in either the parasuicide or drug category. A taxonomy is presented, which divides results into six main categories. Differences between high-risk situations for drugs and parasuicide were also explored. Parasuicide was significantly more likely to be linked to interpersonal problems, whereas drug use was more likely to be preceded by addiction cues (i.e., being near drugs or people who use drugs).     

Delusional thinking and cognitive disorder

A hypothesis is presented regarding the genesis of paranoid delusion that attempts to take into account certain data. The data of interest are (a) the failure to find evidence of cognitive impairment in diagnosed paranoid patients, (b) the evidence of perceptual disorder as a primary and prior condition in the natural history of the clinical development of delusions and the empirical relationship of the perceptual disorder to presence of “thought disorder,” (c) the failure to find evidence supporting universal psychodynamic patterns of etiology, (d) appearance of “delusional” phenomena in normal subjects in situations of deviant sensory experience, and (e) the reports of articulate patients writing of their experiences.     

Personality,counterfactual thinking,and negative emotional reactivity

ObjectivesPeople differ substantially in their emotional responses to negative stimuli. Separate lines of research have reported that individual differences and mental simulations contribute to emotional symptoms. Here, we explore the independent and interrelated contribution of personality traits and counterfactual thoughts to the intensity, duration, and overproduction of negative emotions.MethodA sample of mixed-level athletes (n = 243) completed questionnaire assessments in relation to their most recent unsuccessful competition.ResultsWe found that personality dimensions (extraversion, neuroticism, and openness) relate to the direction and magnitude of person counterfactuals. We also found that personality dimensions (neuroticism, extraversion, openness, and agreeableness) and the direction of counterfactual thoughts (upward or downward) relate to the intensity, duration, and/or overproduction of negative emotions. Lastly, we found that personality and counterfactual thoughts had independent rather than interrelated contributions to the experience of unpleasant emotions.ConclusionsThese findings carry important theoretical and practical implications with regard to identifying individuals susceptible to experiencing elevated emotional symptoms in response to short-term stressors.     

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.     

Personality and mood correlates of avoidant personality disorder

Avoidant personality disorder (APD) has been recognized as prevalent and clinically important; however, it is not clear how APD maps onto established personality and mood dimensions. In this cross-sectional survey study, 365 college students completed questionnaires assessing APD features and theoretically relevant personality and mood dimensions. Based on these self-report data, 6.6% may meet DSM-IV criteria for APD. Hierarchical regression analyses showed that APD features were associated with introversion, neuroticism, low self-esteem, and pessimistic expectancies. Additionally, APD features were linked with self-reports of elevated emotional responsiveness to threats and reduced emotional responsiveness to incentives (the behavioral inhibition system and behavioral activation system scales). After controlling for the effects of other personality, temperament, and cognitive measures, affective distress (i.e., anger, anxiety, and depression) was no longer related to APD. Results are consistent with APD models that emphasize the joint influences of emotional vulnerability and social-cognitive triggering and sustaining factors.     

Personality disorder research agenda for the DSM-V

The American Psychiatric Association is sponsoring a series of international conferences to set a research agenda for the development of the next edition of the diagnostic manual. The first conference in this series, "Dimensional Models of Personality Disorder: Etiology, Pathology, Phenomenology, and Treatment," was devoted to reviewing the existing research and setting a future research agenda that would be most effective in leading the field toward a dimensional classification of personality disorder. The purpose of this article, authored by the Steering Committee of this conference, was to provide a summary of the conference papers and their recommendations for research. Covered herein are the reviews and recommendations concerning alternative dimensional models of personality disorder, behavioral genetics and gene mapping, neurobiological mechanisms, childhood antecedents, cross-cultural issues, Axes I and II continuity, coverage and cutoff points for diagnosis, and clinical utility.     

The presence of magical thinking in obsessive compulsive disorder

Two research groups have raised the possibility that magical ideation may be a fundamental feature of obsessive-compulsive disorder. It has been proposed to underlie thought action fusion and superstitious beliefs. In this study, the Magical Ideation scale, the Lucky Behaviours and Lucky Beliefs scales, the Thought Action Fusion-Revised scale, the Padua Inventory, and the Obsessive Compulsive Inventory-Short Version were completed by 60 obsessive compulsive patients at a hospital clinic. Of all the measures, the Magical Ideation (MI) scale was found to be the most strongly related to obsessive compulsive symptoms. Large and significant relationships between MI scores and the measures of OCD were obtained even when alternative constructs (Lucky Behaviours, Lucky Beliefs, Thought Action Fusion-Revised scales) were held constant. No other variable remained significantly related to the Obsessive Compulsive Inventory-Short Version when magical ideation scores were held constant. The findings suggest that a general magical thinking tendency may underpin previous observed links between superstitiousness, thought action fusion and OCD severity.     

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] greater than .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.     

Personality disorder in university students: a multitrait-multimethod matrix study.

The present study examined the prevalence of personality disorders (PDs) in a sample of first-year university students. The three self-report measures used to assess personality disorders were the (a) Coolidge Axis II Inventory (CATI); (b) Millon Clinical Multiaxial Inventory-II (MCMI-II); and (c) Minnesota Multiphasic Personality Inventory-Personality Disorder Scale (MMPI-PD). The prevalence of PD was estimated by including the number of participants above the cut-off scores selected for each of the three PD instruments. The results indicate prevalence in the range of 0% to 16% for the males, and approximately 1% to 26% for the females. These findings generally confirm the prevalence range of 5% to 15% reported in other investigations of nonpatient samples. With few exceptions, the three tests are generally consistent in their estimates of PD prevalence of all the 11 personality disorders. The multitrait-multimethod matrix reveals that the disorders are generally positively correlated with each other on all the three tests, suggesting considerable construct overlap. Specifically, passive-aggressive and schizotypal disorders produce the most convergent correlations. On the MMPI-PD, however, schizoid is a relatively more discriminant disorder.     

Personality disorder and violence: making the link through risk formulation

The extant research demonstrates that the combination of personality disorder and violence implies severe dysfunction, poor responsivity to treatment, more serious and persistent violence, and higher recidivism rates. Thus, it comes as no surprise that personality disorder is included in many of the available guidelines for assessing and managing violence. Unsurprisingly, the combination of personality pathology and violence frequently presents the greatest challenge to services, even those in whom violence risk assessment and management practice is established and routine. Conceptual and methodological limitations pervade the literature and a full explanation of the nature of the association between personality pathology and violence is still awaited. Furthermore, current approaches to risk assessment fail to provide a systematic framework for assessors to use to make sense of the heterogeneous presentations typically found in individuals with personality disorder and violence. In this paper, formulation is proposed as the critical process linking risk assessment and risk management. It is argued that assessors must move beyond a simple listing of risk factors and should instead produce detailed, comprehensive, individualized explanations of risk potential and risk management needs. Personality disorder is used in this paper to illustrate the important contribution of formulation to the risk assessment process, and in doing so, the link between personality pathology and violence is explored.     

Personality judgment and personality pathology: self-other agreement in adolescents with conduct disorder

We examine two issues linking personality pathology and judgment of traits within the Five-Factor Model of personality. We hypothesize that pathology moderates self-other agreement--"target" participants with pathology should be less judgable than participants without pathology. In addition, we hypothesize that pathology could partially produce agreement across a variety of traits, particularly those traits fundamental to the pathology. In an adolescent sample including a group with Conduct Disorder (CD) and a Control group, we examine agreement between adolescents' self-reports and their mothers' informant reports. Using trait-centered and person-centered perspectives, we find support for both hypotheses. Results have implications for understanding the processes affecting personality judgment, for increasing integration of traditional personality research and personality pathology, and for personality assessment.     

Personality traits and critical thinking skills in college students: empirical tests of a two-factor theory

The two-factor theory defines critical thinking skills as a combined effect of cognitive abilities and personality dispositions. Although the available research supports the association between critical thinking and measures of cognitive ability, the specific traits contained in the dispositional factor have not been clearly identified through empirical research. In Study 1,101 undergraduate students completed the Watson-Glaser Critical Thinking Appraisal (WGCTA), three subtests of the Wechsler Adult Intelligence Scale-Third Edition, and the revised NEO Personality Inventory. Hierarchical multiple regression analyses showed that Openness to Experience scores accounted for significant incremental variance in WGCTA scores beyond that accounted for by Similarities subtest scores. In Study 2, similar analyses of data from 105 students also showed significant incremental effects for Openness to Experience, even after more variance in the cognitive factor was accounted for by the Verbal Comprehension Index. Implications of these findings for the enhancement of critical thinking skills in college students are discussed.     

Creative thinking in adolescents with attention deficit hyperactivity disorder (ADHD).

A widened attentional focus, that is typically associated with ADHD, has been postulated to be accompanied by enhanced creative ability. However, creativity has been only limitedly examined in ADHD. Performance across several creativity measures were investigated in three groups: adolescents with ADHD, those with conduct disorder, and a healthy control sample. The ADHD group exhibited selective cognitive advantages and disadvantages by demonstrating an enhanced ability in overcoming the constraining influence of examples, but a reduced capacity to generate a functional invention during an imagery task. These findings are interpreted with reference to inhibitory control mechanisms and the contextual modulation of creative cognition.     

The extent and nature of imagery during worry and positive thinking in generalized anxiety disorder

Clients in treatment for Generalized Anxiety Disorder (GAD) were compared to a control group to assess the extent and nature of imagery during worry or while thinking about a personally relevant positive future event. Two methods were used to assess mentation and were completed in counter balanced order within the worry and positive conditions. One method assessed the occurrence of imagery by requiring participants to categorize their mentation as verbal thoughts or images every 10 s. The other method involved participants estimating the duration of any imagery that occurred in the previous 10 s. Imagery during worry occurred less often than while thinking about a positive event for both groups, but GAD clients had a more pronounced deficit of imagery during worry than the control group. Images that occurred were briefer during worry than while thinking about a positive future event and were briefer in the GAD than the control group for both worry and positive conditions. The results thus confirmed that imagery is less common during worry in clients with GAD but also demonstrated that the imagery that does occur in GAD is briefer.     

A cross-cultural study of suicide intent in parasuicide patients

As part of the WHO/EURO Multicentre Study on Parasuicide, the level of suicide intent among female and male parasuicide patients from various European regions was compared. From nine regions, a total of 1,212 parasuicide patients, 752 females and 460 males, were included in the study. Although some statistical significant differences in level of suicide intent between the regions and genders were found, the effect sizes of these relationships were so small that the differences have neither theoretical nor practical significance. As far as level of suicide intent is concerned, the WHO study has succeeded in recruiting a relatively homogeneous group of self-harming patients across borders of region, culture, and country.     

Personality in DSM-5: helping delineate personality disorder content and framing the metastructure

The transition from the Diagnostic and Statistical Model of Mental Disorders (4th ed., text revision [DSM-IV-TR]; American Psychiatric Association, 2000 ) to the fifth edition (DSM-5) represents an unprecedented opportunity to integrate dimensional personality trait models into the official nosology. Not surprisingly, a variety of issues have arisen in contemplating this challenging integration. In this article, we address how a dimensional personality trait model could be a helpful component of DSM-5, from the perspective of our roles as work group members and advisors involved in the creation of a trait model and corresponding assessment instrument. We focus in particular on two potential roles for a trait model in DSM-5 that are under official consideration. First, a dimensional personality trait model might be helpful in delineating the content of personality disorders. Second, a trait model might assist in organizing the "metastructure" of DSM-5 (i.e., the arrangement of chapters and other broader classificatory rubrics).