Gender differences in comorbid disorders among offenders in prison substance abuse treatment programs

This study examined gender differences in a range of lifetime psychiatric disorders in a sample of 272 offenders newly admitted to a prison substance abuse program. Although these men and women did not differ in severity of substance use in the six months prior to incarceration, women were significantly more likely than men to report a lifetime psychiatric disorder and a lifetime severe disorder. Furthermore, gender differences emerged in the pattern of lifetime psychiatric comorbidity. Women reported greater lifetime major depression, posttraumatic stress disorder, eating disorder, and borderline personality disorder; men were more likely than women to meet criteria for antisocial personality disorder. Additionally, female offenders were found to have a higher degree of internalizing disorders than male offenders, but there were no gender differences in degree of externalizing disorders. The study concluded that women offenders newly admitted to a prison substance abuse program present with a greater psychiatric vulnerability and a different pattern of psychiatric comorbidity than their male counterparts.     

心身障碍共病与慢性疼痛关联的结构模型

常见的心身障碍共病可以理解为一种新的精神疾病结构模型：情绪障碍、抑郁、焦虑及躯体化障碍等归为内化性疾病谱系的组成元素,物质滥用和反社会行为障碍归为外化性疾病谱系的组成元素。本文分析探讨评估慢性疼痛与这一模型的联系。社会心理和生物学的研究证据表明慢性疼痛与内化性障碍密切相关,提示内化-外化性疾病模型可以作为一个有效的研究架构,为探讨慢性疼痛与情感、抑郁焦虑及其他相关精神障碍的关联共病机制提供新的研究方向和新思路。     

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.     

The role of gender in the clinical presentation of patients with borderline personality disorder

This study examined gender differences in the pattern of comorbid disorders and degree of impairment among outpatients with borderline personality disorder (BPD). A total of 130 outpatients with BPD were assessed for various lifetime impulse-related disorders and post-traumatic stress disorder and for indices of impairment. Compared with women with BPD, men with BPD reported significantly more lifetime substance abuse disorders, antisocial personality and met criteria of intermittent explosive disorder that did not overlap with a diagnosis of BPD. Women with BPD reported significantly more lifetime eating disorders than men with BPD. No gender differences were found in degree of overall impairment. These results suggest that male and female patients with BPD, although equally distressed, present with different lifetime patterns of impulse-related disorders.     

Comorbid attention-deficit/hyperactivity disorder in borderline patients defines an impulsive subtype of borderline personality disorder

In order to examine the impulsive profile of a BPD sample with comorbid ADHD, adult patients who met criteria for BPD were assessed for ADHD with the CAADID and the WURS. A high rate of ADHD in the BPD sample was found, with sixty-nine (38.1%) BPD patients diagnosed as having comorbid adult ADHD. BPD-ADHD group had higher rates of general substance use disorder (59.4% vs. 38.4%), antisocial personality disorder (7.2% vs. 0.9%) and obsessive-compulsive personality disorder (21.7% vs. 6.3%). The BPD group without comorbid adult ADHD showed a higher rate of mood disorders (62.5% vs. 37.7%), panic disorders (54.5% vs. 23.1%) and benzodiazepine abuse (18.8% vs. 5.8%). Only in BPD patients without ADHD was comorbid avoidant personality disorder found. BPD patients could be distinguished in two clear subgroups related to the adult ADHD comorbidity. BPD-ADHD patients showed a more homogeneous and impulsive profile while BPD without ADHD comorbidity had more anxiety and depressive disorders.     

Personality-based latent classes of posttraumatic psychopathology: personality disorders and the internalizing/externalizing model

Prior research using the Brief Form of the Multidimensional Personality Questionnaire (MPQ-BF; Patrick, Curtin, & Tellegen, 2002) has shown evidence of 3 temperament-based subtypes--termed internalizing, externalizing, and simple PTSD--among individuals with symptoms of posttraumatic stress disorder (PTSD; Miller, Greif, & Smith, 2003). This study sought to replicate and extend research in this area by conducting a latent profile analysis of higher order temperament scales from the MPQ-BF using a new sample of 208 veterans with symptoms of PTSD. Results suggest that a 3-class solution reflecting internalizing, externalizing, and simple subtypes of posttraumatic psychopathology provided the best fit to the data. The externalizing subtype was characterized by features of antisocial, borderline, histrionic, and narcissistic personality disorders on the International Personality Disorder Examination (Loranger, 1999) as well as low levels of constraint and high levels of negative emotionality on the MPQ-BF. In contrast, individuals in the internalizing class exhibited features of schizoid and avoidant personality disorders, low levels of positive emotionality, and high levels of negative emotionality. The simple subtype was defined by low levels of comorbid personality disorder features and relatively normal personality profiles. Findings support the reliability of this typology and support the relevance of the internalizing and externalizing model to the structure of personality disorders.     

Brain structure abnormalities in young women who presented conduct disorder in childhood/adolescence

The phenotype and genotype of antisocial behavior among females are different from those among males. Previous studies have documented structural brain alterations in males with antisocial behavior, yet little is known about the neural correlates of female antisocial behavior. The present study examined young women who had presented conduct disorder (CDW) prior to age 15 to determine whether brain abnormalities are present in adulthood and whether the observed abnormalities are associated with comorbid disorders or maltreatment that typically characterize this population. Using magnetic resonance imaging and voxel-based morphometry, we compared gray matter volumes (GMV) of 31 women who presented CD by midadolescence and 25 healthy women (HW), age, on average, 23 years. Participants completed structured, validated interviews to diagnose mental disorders, and validated questionnaires to document physical and sexual abuse. Relative to HW, CDW presented increased GMV in the left superior temporal gyrus that was associated with past alcohol and drug dependence, current use of alcohol and drugs, and current anxiety and depression symptoms and maltreatment. Additionally, CDW displayed reduced GMV in lingual gyrus, hippocampus, and anterior cingulate cortex that was associated with past comorbid disorders, current alcohol and drugs use, current anxiety and depression symptoms, and maltreatment. The CDW also presented reduced total GMV that was associated with past comorbid disorders and current anxiety/depression symptoms. Alterations of brain structure were observed among young adult females with prior CD, relative to HW, all of which were associated with internalizing and externalizing disorders and maltreatment that typically accompany CD.     

Personality and psychopathology: working toward the bigger picture

There are systematic and meaningful links among normal and abnormal personality traits and Axis I and II constructs from the DSM. Nevertheless, much research in this area focuses on pairs of constructs (e.g., the link between personality traits and a specific Axis I disorder), rather than on the broader multivariate structure of the personality-psychopathology domain. We underscore the need for this broader perspective, a perspective that would transcend largely artificial boundaries between current constructs (e.g., normal and abnormal personality). We outline our approach to research from this perspective and we emphasize the internalizing (mood and anxiety) and externalizing (substance use and antisocial behavior) spectra as promising foci for initial research on the joint structure of personality and psychopathology.     

Co-occurring mental health and substance use problems in offenders: implications for risk assessment

We undertook a secondary data analysis to study issues relevant to co-occurring mental health and substance disorder in a combined sample of offenders (N = 3,197). Using the Personality Assessment Inventory, we compared the frequency of depressive, traumatic stress, and personality disorder symptom elevations across offenders with and without substance problems, identified the extent to which co-occurring problems were accompanied by risk factors for suicide and aggression, and tested for gender differences. Offenders with substance problems were more likely than others to have increased mental health problems and risk factors for suicide or aggression. Women with substance problems, compared with men, had higher depression, traumatic stress, and borderline features, in addition to lower antisocial features. The frequency with which suicide and aggression risk factors were associated with mental health problems was generally similar across men and women. Measurement issues relevant to co-occurring disorder and risk assessment are discussed.     

How Transdiagnostic Factors of Personality and Psychopathology Can Inform Clinical Assessment and Intervention

Research suggests that many mental disorders—mood and anxiety, substance use, and personality psychopathology—are related through relatively few latent transdiagnostic factors. With regard to the comorbidity of personality disorders and common mental disorders, factor structures such as internalizing–externalizing have been replicated in numerous samples, across the life span, and around the globe. One critical feature of transdiagnostic factors is that they serve as a point of intersection between personality and psychopathology, making them particularly relevant phenomena for applied clinical work. Although numerous studies have supported the significance of transdiagnostic factors for research and classification purposes, there has been comparatively less articulation of how such factors might be of benefit to practicing assessment clinicians. Herein, we present an overview of transdiagnostic factor research findings, and we apply these findings to the clinical topics of assessment, diagnosis, and treatment. For clinicians as well as researchers, the use of transdiagnostic constructs presents positive implications for efforts to understand, characterize, and ameliorate psychopathology—including its manifestations as personality disorder—in a valid, effective, and efficient way.     

Psychiatric Comorbidity in Children with Autism Spectrum Disorders: A Comparison with Children with ADHD

The present study was conducted with the aim to identify comorbid psychiatric disorders in children with autism spectrum disorders (ASD) (n = 40) and to compare those comorbidity rates to those in children with attention deficit hyperactivity disorder (ADHD) (n = 40). Participants were clinically referred children aged 7–18 years. DSM-IV classifications were used for the primary diagnosis (ASD/ADHD), while comorbid psychiatric disorders were assessed using a structured diagnostic interview, the structured clinical interview for DSM-IV, childhood diagnoses (KID-SCID). Twenty-three children with ASD (57.5 %) had at least one comorbid disorder, whereas 16 children with ADHD (40.0 %) were classified as having at least one comorbid disorder. No group differences were found with respect to this comorbidity rate or for the rate of comorbid externalizing disorders (ODD and/or CD). However, children with ASD had more comorbid internalizing disorders compared to children with ADHD. More specifically, children with ASD had higher rates of anxiety disorders, but not mood disorders. No associations between comorbidity and age or between comorbidity and the intelligence quotient was found. It is important for clinicians to always be aware of, and screen for, comorbidity, and to consider treatment for these comorbid disorders. In addition, research should focus on establishing valid and reliable screening tools as well as effective treatment options for these comorbid disorders.     

Marital dissatisfaction and psychiatric disorders: results from the National Comorbidity Survey

The association between marital dissatisfaction and 12-month prevalence rates of Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev., 1987) Axis I psychiatric disorders was examined in married respondents from the National Comorbidity Survey (N = 2,538). Results indicate that marital dissatisfaction was associated with the presence of any disorder, any mood disorder, any anxiety disorder, and any substance-use disorder; dissatisfaction was also associated with 7 of 12 specific disorders for women and 3 of 13 specific disorders for men. To evaluate the unique association between marital dissatisfaction and psychiatric disorders, analyses were conducted controlling for comorbid disorders. Covariance analyses generally attenuated the bivariate associations between marital dissatisfaction and specific disorders and groupings of disorders. Results indicate that marital dissatisfaction was uniquely related to major depression and posttraumatic stress disorder for women and dysthymia for men.     

Personality traits in late adolescence predict mental disorders in early adulthood: a prospective-epidemiological study

Prospective relations between personality traits and mental disorders were assessed in a longitudinal study of a representative birth cohort of young men and women from Dunedin, New Zealand. Personality traits were assessed via self-report questionnaire at age 18, and mental disorders were assessed via diagnostic interview at both ages 18 and 21. High "negative emotionality" (a propensity to experience aversive affective states) at age 18 was linked with affective, anxiety, substance dependence, and antisocial personality disorders at age 21 when corresponding mental disorders at age 18 were controlled. Low "constraint" (difficulty inhibiting the expression of affect and impulse) at age 18 was linked with substance dependence and antisocial personality disorders at age 21 when corresponding mental disorders at age 18 were controlled. The findings are discussed in terms of their implications for the development and treatment of mental disorders in young adulthood.     

Disinhibitory trait profile and its relation to Cluster B personality disorder features and substance use problems

Certain personality and motivational traits may present vulnerability towards disinhibitory psychopathology (e.g. antisocial personality disorder, substance abuse). Cluster analysis was used to separately group 306 women and 274 men on impulsivity, Constraint, Negative Emotionality, behavioural activation system (BAS), and behavioural inhibition system (BIS) scores. As expected, a ‘disinhibited’ group with low Constraint, high impulsivity, weak BIS, and strong BAS emerged that showed elevated drug use problems, and histrionic and antisocial personality disorder features across gender. A ‘high affectivity’ group with high Negative Emotionality and strong BIS also showed elevated drug use problems and personality disorder features. Results suggested that two different trait profiles are associated with disinhibitory psychopathology and both may present vulnerability toward the development of such disorders. Copyright © 2006 John Wiley & Sons, Ltd.     

Externalizing and internalizing subtypes of combat-related PTSD: a replication and extension using the PSY-5 scales

This study replicated and extended prior findings of internalizing and externalizing subtypes of posttraumatic response (M. W. Miller, J. L. Greif, & A. A. Smith, 2003). Cluster analyses of the Minnesota Multiphasic Personality Inventory--2 Personality Psychopathology--Five (MMPI-2 PSY-5; A. R. Harkness, J. L. McNulty, Y. S. Ben-Porath, 1995) profiles obtained from 736 veterans with posttraumatic stress disorder (PTSD) partitioned the sample into a low pathology cluster defined by personality scores in the normal range, an externalizing cluster characterized by low constraint and high negative emotionality, and an internalizing cluster with high negative emotionality and low positive emotionality. Externalizers showed the highest rates of alcohol-related and antisocial personality disorders; internalizers, the highest rates of panic and major depressive disorder. These findings support the development of a personality-based typology of posttraumatic response designed to account for heterogeneity in the expression of PTSD and associated psychopathology.     

Gender differences and developmental change in externalizing disorders from late adolescence to early adulthood: A longitudinal twin study

Using data from over 1,000 male and female twins participating in the Minnesota Twin Family Study, the authors examined developmental change, gender differences, and genetic and environmental contributions to the symptom levels of four externalizing disorders (adult antisocial behavior, alcohol dependence, nicotine dependence, and drug dependence) from ages 17 to 24. Both men and women increased in symptoms for each externalizing disorder, with men increasing at a greater rate than women, such that a modest gender gap at age 17 widened to a large one at age 24. Additionally, a mean-level gender difference on a latent Externalizing factor could account for the mean-level gender differences for the individual disorders. Biometric analyses revealed increasing genetic variation and heritability for men but a trend toward decreasing genetic variation and increasing environmental effects for women. Results illustrate the importance of gender and developmental context for symptom expression and the utility of structural models to integrate general trends and disorder-specific characteristics.     

Clinical syndromes, personality disorders, and neurocognitive differences in male and female inmates

This study examined clinical syndromes, personality disorders, and neurocognitive problems in adult male (n = 523) and female inmates (n = 523) and a sample of unincarcerated adult women (n = 523). Inmates were administered the Coolidge Correctional Inventory (CCI), and the unincarcerated sample was given an identical test, the Coolidge Axis II Inventory. Although there were significant differences between the two inmate groups on a majority of the 32 CCI scales, only two scales achieved a medium effect size. The two inmate groups were found to be highly similar in a comparison of ranked personality disorder prevalence rates. Consistent with previous literature, male inmates had a significantly higher prevalence of antisocial personality disorder than female inmates (24% vs. 18%). Female inmates had double the prevalence of male inmates on the borderline and histrionic personality disorder scales. Female inmates also reported significantly more general neuropsychological dysfunction, specifically memory problems and neurosomatic symptoms, than male inmates. Female inmates also reported significantly higher levels of anxiety, depression, symptoms of schizophrenia, post-traumatic stress disorder, attention deficit hyperactivity disorder, and depersonalization than male inmates. Overall, the findings support previous research of high levels of psychological and neuropsychological problems in inmates, regardless of gender, and reinforces the need for comprehensive mental health screening of offender populations. Copyright © 2011 John Wiley & Sons, Ltd.     

Women and anxiety disorders: implications for diagnosis and treatment. Proceedings of a conference, November 19-21, 2003, Chantilly, Virginia, USA

Community studies indicate that 19% of men and 31% of women will develop some type of anxiety disorder during their lifetime. The impact of gender is profound in that it increases the likelihood of developing an anxiety disorder by 85% in women compared to men. Sex difference in prevalence rates are apparent as early as age 6, when girls are twice as likely as boys to have an anxiety disorder. In the National Comorbidity Survey, the prevalence rates for panic disorder in women and men were 5% and 2%, respectively. Agoraphobia, which often coexists with panic disorder, has a lifetime prevalence rate of 7% in women and 3.5% in men. Prevalence of trauma is increased in young women as well, and is experienced earlier in life; 62% of sexual assaults are inflicted on females < or = 18 years of age, and 29% occur in children < 11 years of age. Comorbidity of anxiety in women complicates other medical conditions as well. For example, panic disorder is highly comorbid with CHD, which remains the leading cause of death in women in developed countries. Fluctuations in reproductive hormone levels during the female life cycle is thought to be responsible for modulating anxiety. This is often implicated in the later age of onset, the more sudden and acute symptom emergence, and the more episodic course of OCD in women, and in the high prevalence(47.4%) of PMDD. Pregnancy appears to be a protective period for some anxiety disorders, including panic, while for others, such as OCD, it may be associated with onset. Hormonal changes during pregnancy, such as increased prolactin, oxytocin, and cortisol, may contribute to the suppression of stress response that occurs during this period. Despite a large and growing body of literature on anxiety disorders in general, the available data relating to women and girls falls short of informing aspects of diagnosis, treatment, and prevention that may entail sex differences. Additional work is required to understand the biological and psychosocial causes of these differences.     

The joint structure of DSM-IV Axis I and Axis II disorders

The Diagnostic and Statistical Manual (4th ed. [DSM-IV]; American Psychiatric Association, 1994) distinction between clinical disorders on Axis I and personality disorders on Axis II has become increasingly controversial. Although substantial comorbidity between axes has been demonstrated, the structure of the liability factors underlying these two groups of disorders is poorly understood. The aim of this study was to determine the latent factor structure of a broad set of common Axis I disorders and all Axis II personality disorders and thereby to identify clusters of disorders and account for comorbidity within and between axes. Data were collected in Norway, through a population-based interview study (N = 2,794 young adult twins). Axis I and Axis II disorders were assessed with the Composite International Diagnostic Interview (CIDI) and the Structured Interview for DSM-IV Personality (SIDP-IV), respectively. Exploratory and confirmatory factor analyses were used to investigate the underlying structure of 25 disorders. A four-factor model fit the data well, suggesting a distinction between clinical and personality disorders as well as a distinction between broad groups of internalizing and externalizing disorders. The location of some disorders was not consistent with the DSM-IV classification; antisocial personality disorder belonged primarily to the Axis I externalizing spectrum, dysthymia appeared as a personality disorder, and borderline personality disorder appeared in an interspectral position. The findings have implications for a meta-structure for the DSM.