Sociotropy,autonomy, and personality disorder criteria in psychiatric patients

Sociotropy and autonomy (Beck, 1983) are sets of beliefs, concerns, and behavioral tendencies that are proposed to create vulnerability to depression and other psychopathology and to influence its manifestation and treatment response. Other theoretical frameworks (Blatt, 1974) have made similar suggestions. We investigated the differential relations of sociotropy and autonomy to dimensional scores for each DSM-III-R personality disorder (PD) in a sample of 188 psychiatric patients, controlling for the other set of characteristics and for the other PDs. Histrionic and dependent PD traits were related specifically to sociotropy. Paranoid, schizoid, schizotypal, and passive-aggressive PD traits were related specifically to autonomy. Borderline, narcissistic, avoidant, and self-defeating PD traits were related significantly and about equally to both sociotropy and autonomy. Obsessive-compulsive PD traits were not related consistently to either. Results were mostly as predicted and suggest that sociotropy and autonomy may be useful constructs for understanding and treating PDs.     

Does personality disorder co-morbidity impact treatment outcome for patients with major depression? A multi-level analysis

In literature, there exists disagreement regarding the impact of comorbid personality disorder(s) (PD[s]) on treatment outcome for patients with major depressive disorder (MDD). The aim of this paper was to investigate whether statistical heterogeneity and inter-dependency are potential moderators of the effect of co-morbid PDs on outcome for patients with MDD. Clinician-rated MADRS scores and DSM-IV Axis II personality disorder diagnoses were obtained from 562 outpatients with MDD who received 6 months of combined psycho- and pharmacotherapy. Single-level regression showed significantly worse treatment outcome among patients with co-morbid PD, as compared to patients with no PD. After controlling for statistical heterogeneity and interdependency, treatment outcome was no longer significantly worse for patients with co-morbid PD. In conclusion, heteroscedasticity and inter-dependency should be considered as potentially compelling explanations for inconsistencies in findings on treatment outcome for depressed patients with co-morbid PDs.     

Dependency,impulsivity, and self-harm: traits hypothesized to underlie the association between cluster B personality and substance use disorders

Cluster B personality disorders (PDs) (i.e., antisocial, borderline, histrionic, and narcissistic) typically show a high degree of comorbidity with substance use disorders (SUDs). Previous research suggests that the broad-based personality domains of Disinhibition and Negative Temperament/Neuroticism may be common factors to both types of disorders. Using a two-phase process (i.e., screening and follow-up), this study examined three lower-order personality traits (i.e., dependency, impulsivity, and self-harm) that fall within the Disinhibition and Neuroticism domains. The study evaluated the hypotheses that these traits (a) are related both to cluster B PDs and to SUDs; and (b) underlie the association between the two types of disorders. Results indicate that impulsivity and self-harm play a significant role in cluster B PDs and SUDs, as well as in their association with each other. However, dependency was not associated with either type of disorder. These results indicate that sets of individual traits can be of significant utility in understanding the comorbidity between PDs and SUDs.     

Beyond dysfunction and threshold-based classification: a multidimensional model of personality disorder diagnosis

An alternative dimensional model of personality disorder (PD) diagnosis that addresses several difficulties inherent in the current DSM conceptualization of PDs (excessive PD overlap and comorbidity, use of arbitrary thresholds to distinguish normal from pathological personality functioning, failure to capture variations in the adaptative value of PD symptoms, and inattention to the impact of situational influences on PD-related behaviors) is outlined. The model uses a set of diagnostician-friendly strategies to render PD diagnosis in three steps: (1) the diagnostician assigns every patient a single dimensional rating of overall level of personality dysfunction on a 50-point continuum; (2) the diagnostician assigns separate intensity and impairment ratings for each PD dimension (e.g., narcissism, avoidance, dependency); and (3) the diagnostician lists any personality traits-including PD-related traits-that enhance adaptation and functioning (e.g., histrionic theatricality, obsessive attention to detail). Advantages of the proposed model for clinicians and clinical researchers are discussed.     

Active versus reactive cooperativeness in Borderline Psychopathology: A dissection based on the HEXACO model of personality

The concept of personality disorders (PDs) is shifting from categorical to dimensional, conceptualizing PDs as maladaptive variants of basic personality traits. The Agreeableness trait in the Five Factor Model of personality classically represents dispositional cooperativeness, which is associated with PDs characterized by interpersonal impairments. However, recent research designates two separate dispositional tendencies: active and reactive cooperativeness. Using the HEXACO model of personality we assessed traits representing these tendencies (Honesty–Humility and Agreeableness) and investigated their relation to Borderline features in 602 individuals. Borderline features were associated with low Agreeableness scores, representing low reactive cooperation, entailing a tendency to retaliate. Yet, there was no association with Honesty–Humility, implying intact active cooperativeness and non-exploitation. These findings extend prior results on the relation between Borderline PD and basic personality dimensions driving prosocial behavior. Implications for the understanding of interpersonal problems in PDs and the refinement of existing therapies are discussed.     

The association of affiliation and achievement personality styles with DSM-IV personality disorders

Investigators from theoretically diverse backgrounds have long described two personality styles associated with depression. The affiliation style describes individuals with interpersonal concerns; the achievement style describes individuals who have concerns with personal failure. Although primarily related to risk for depression, there has also been recognition that extreme forms of these styles are related to personality disorders (PDs). The current study examines the relation between the DSM-IV PDs and the two personality styles, assessing the latter using two approaches: (a) dependency/self-criticism (Blatt, 1974) and (b) sociotropy/autonomy (Beck, 1983). Results show that whereas the achievement style is associated with most PDs (except for the histrionic and dependent PDs), the affiliation style is associated only with histrionic, dependent, and depressive PDs. Controlling for shared PD variance leaves only two associations, affiliation with dependent PD and achievement with narcissistic PD. Results are discussed in the context of current efforts to capture personality psychopathology within a comprehensive dimensional framework.     

Predicting self-damaging and suicidal behaviors in female borderline patients: reasons for living, coping, and depressive personality disorder.

The aims of this study are to examine (1) whether reasons for living predict self-damaging and suicidal behaviors, (2) the associations of reasons for living with coping strategies and depressive personality disorder (PD), and (3) the unique predictive validity of reasons for living in a multivariate predictor model. Reasons for living (RFL), coping strategies, and depressive personality disorder were measured at baseline in 38 patients who met DSM-IV criteria for borderline personality disorder (BPD). Frequency of self-damaging and suicidal behaviors in the 6-month period following baseline was measured prospectively at 3- and 6-month follow-ups. The RFL has only one subscale that predicts parasuicidal behaviors (i.e. Survival and Coping Beliefs [SCB]). Participants who scored low on this subscale were 6.8 times more likely to exhibit self-damaging and suicidal behaviors in the follow-up period than their high-scoring counter-parts. However, SCB was substantially correlated with the coping strategies "reassuring thoughts," "active coping," and "palliative reaction pattern," as well as with depressive personality traits. In a multivariate model, the predictive power of SCB appeared to be accounted for by reassuring thoughts and depressive PD. Coping scales might be preferable over the RFL as a predictor of self-damaging and suicidal behaviors in borderline patients.     

Personality Disorders and Spinal Cord Injury: A Pilot Study

A substantial body of research has found that spinal cord injury (SCI) patients have relatively high degrees of energy, impulsivity, and risk-taking (W. Fordyce, 1964; G. P. Taylor, 1970; B. Woodbury, 1978). The present study endeavors to extend our knowledge to the personality disorder (PD) domain. Forty SCI participants and 40 matched controls were given a semistructured diagnostic interview and a self-report personality disorder instrument. Findings indicated that 27.5% of SCI patients, and a similar number of controls, have PDs. Unexpectedly, impulsive/externalizing disorders (histrionic, narcissistic, antisocial, and borderline) were not unusually high in SCI patients, and were not higher than controls. Avoidant and depressive disorders were unexpectedly high.     

The assessment of personality characteristics in depressed and dependent psychiatric inpatients

The diagnosis and treatment of depression may be complicated by the presence of excessive dependency needs. Previous research has found stable personality traits useful in identifying depressive subtypes. This study was designed to assess the personality characteristics of 106 psychiatric inpatients. Subjects were grouped according to the presence or absence of two primary dimensions: depression and dependency. Results indicated that both depression and dependency were significantly related to various indices of psychopathology. Main effects were more useful than interactions, implying that depression and dependency both affect symptomology directly rather than interactively. Although the assessment of personality traits may be complicated by the presence of a major psychiatric disorder, results from our study suggest that the assessment of both Axis I and Axis II variables can be useful in understanding the current clinical picture.     

Personality profiles and the prediction of categorical personality disorders

Personality disorders (PDs) are usually construed as psychiatric categories characterized by a unique configuration of traits and behaviors. To generate clinical hypotheses from normal personality trait scores, profile agreement statistics can be calculated using a prototypical personality profile for each PD. Multimethod data from 1,909 psychiatric patients in the People's Republic of China were used to examine the accuracy of such hypotheses in the Interpretive Report of the Revised NEO Personality Inventory. Profile agreement indices from both self-reports and spouse ratings were significantly related to PD symptom scores derived from questionnaires and clinical interviews. However, accuracy of diagnostic classification was only modest to moderate, probably because PDs are not discrete categorical entities. Together with other literature, these data suggest that the current categorical system should be replaced by a more comprehensive system of personality traits and personality-related problems.     

Regional Analysis of Self‐Reported Personality Disorder Criteria

ABSTRACT Building on the theoretical work of Louis Guttman, we propose that the core problem facing research into the multidimensional structure of the personality disorders is not the identification of factorial simple structure but rather detailed characterization of the multivariate configuration of the diagnostic criteria. Dimensions rotated to orthogonal or oblique simple structure are but one way out of many to characterize a multivariate map, and their current near universal application represents a choice for a very particular set of interpretive advantages and disadvantages. We use multidimensional scaling and regional interpretation to investigate the structure of 78 self‐reported personality disorder criteria from a large sample of military recruits and college students. Results suggest that the criteria have a three‐dimensional radex structure that conforms only loosely to the 10 existing personality disorder (PD) categories. Regional interpretation in three dimensions elucidates several important aspects of PDs and their interrelationships.     

Structures of Personality and Their Relevance to Psychopathology: II. Further Articulation of a Comprehensive Unified Trait Structure

ABSTRACT There is increasing agreement that the current categorical system of personality disorders (PDs) in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM‐IV; American Psychiatric Association, 2000) should be replaced by a trait dimensional scheme in DSM‐V. In particular, the consensus appears to be converging on a hierarchical Big Four model. The broad factors that form the apex of this hierarchy are essentially maladaptive variants of the Big Five traits of normal personality, minus Openness. We argue that this Big Four model is incomplete, however, in that it fails to model characteristics related to the “odd or eccentric” Cluster A PDs adequately. We report the results of three studies that examine these odd, eccentric characteristics in relation to basic dimensions of normal and abnormal personality. The results of these studies establish the existence of an Oddity factor that is (a) broader than the Cluster A traits and (b) distinct from Openness and the other Big Five dimensions. Consequently, its addition yields an alternative five‐factor model of personality pathology (considering only abnormal traits) and an expanded, integrated Big Six taxonomy that subsumes both normal and abnormal personality characteristics.     

Relations between cyclothymic temperament and borderline personality disorder traits in non-clinical adolescents

ObjectivesThe aim of the present study was to examine the relation between cyclothymic temperament and borderline personality disorder traits in adolescents and to identify a typology of adolescents based on temperamental traits (cyclothymic temperament and BPD traits).Participants and methodsA sample of 312 adolescents completed several questionnaires assessing cyclothymic temperament, borderline personality disorder traits, depressive symptoms, suicidal ideation, antisocial behaviors and frequency of cannabis use.ResultsThe Cyclothymic-Hypersensitive Temperament (CHT) questionnaire and the Borderline Personality Features Scale for Children (BPFS-C) were highly correlated which suggests that these scales may measure the same construct. Factor analyses of the pooled items of both scales yielded two factors, ‘anger–impulsivity’ and ‘affective instability’, both composed half of items from both scales. The relation between these traits and suicidal ideation was fully mediated by depressive symptomatology. Cluster analysis showed that these traits may occur independently and that adolescents with both traits had the highest levels of depressive symptoms, suicidal ideations and antisocial behaviors.DiscussionThe CHT questionnaire and the BPFS-C may measure the same construct which appeared relevant for defining a subgroup of adolescents with high levels of depressive symptoms, suicidal ideations and antisocial behaviors.     

Dimensional personality traits and the prediction of DSM-IV personality disorder symptom counts in a nonclinical sample

The third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III; APA, 1980) set forth a categorical system of personality psychopathology that is composed of discrete personality disorders (PDs), each with a distinct set of diagnostic criteria. Although this system is widely accepted and highly influential, alternative dimensional approaches to capturing personality psychopathology have been proposed. Three dimensional models of personality have garnered particular attention-the Five-Factor Model (FFM; Costa & McCrae, 1992), the Seven-Factor Psychobiological Model of Temperament and Character (Seven-Factor Model; Cloninger, Svrakic, & Przybeck, 1993); and the 18-factor model of personality pathology (18-factor model; Livesley, 1986). Although the personality traits from each of these models has been examined in relation to the ten personality disorders in the DSM-IV, no study has examined the comparative and incremental validity of these models in predicting PD symptoms for these ten disorders. Using self-report instruments that measure these models and the ten DSM-IV PDs, correlation and linear regression analyses indicate that traits from all three models had statistically significant associations with PD symptom counts. Hierarchical regressions revealed that the 18-factor model had incremental predictive validity over the FFM and Seven-Fac-tor Model in predicting symptom counts for all ten DSM-IV PDs. The FFM had incremental predictive validity over the Seven-Factor Model model for all ten disorders and the Seven-Factor was able to add incremental predictive validity over the 18-factor model for five of the ten PDs and for eight of the ten disorders relative to the FFM.     

On the Psychoanalytic Treatment of the Depressive Personality

In order to discuss the depressive personality we have first to distinguish between this clinical entity and other types of depressive psychopathology that might also be chronic. The character traits and psychodynamics of the depressive personality confirm that there is a special group of patients, who belong to a depressive disorder continuum. The particular technical problems that depressive personality present are: (1) the inability to enjoy anything and the consequences of this on the therapist's experience and interventions, and (2) the negative therapeutic reaction which threatens the analytic process and the therapist's competence. If we combine transference/extratransference interpretations with an "empathetic understanding" approach to systematic confrontation and interpretation, we can therefore justify the need for a slightly modified psychoanalytic technique in the treatment of the depressive personality.