Outpatient group psychotherapy following day treatment for patients with personality disorders

This prospective, naturalistic study evaluated the practice and effectiveness of an outpatient group therapy program following day treatment for patients with personality disorders (PDs). One hundred and eighty-seven patients (86% patients with PDs and 14% with no PDs), were treated in outpatient psychodynamic group therapy. Outcome was assessed by Global Assessment of Functioning, Symptom Check List 90-R, and Inventory of Interpersonal Problems-Circumplex, short version, at admission and discharge from day treatment, and at the end of outpatient group therapy. Average length of outpatient therapy was 24 months. Forty-three percent terminated in an irregular manner. Outcome of the continuation therapy was satisfactory for patients without PDs. For PD patients, the improvement from the day treatment was maintained during outpatient therapy, but further improvements were modest for symptoms and interpersonal distress, somewhat better for global functioning. Implications for further treatment development are discussed.     

A developmental perspective on personality disorders: lessons from research on normal personality development in childhood and adolescence

Recent work on normal personality development in children and adolescents points to several conclusions that are relevant for understanding personality pathology. First, child temperament and adult personality traits share many features in common. Second, youths' individual differences can be described in terms of the Big Five personality traits observed in adults; an integrative taxonomy of individual differences in childhood and adolescence is articulated in this article. Third, personality is already moderately stable by the preschool years, but considerable personality change occurs well into the adult years. Taken together, these findings suggest that childhood personality functioning can and should be integrated into developmental research and applied work on personality disorders.     

Stability of the personality and symptom scales of the Millon Clinical Multiaxial Inventory

This study examines the stability of the basic and pathological personality and symptom scales of the Millon Clinical Multiaxial Inventory (MCMI) in three clinical samples. Consistent with the theory upon which the MCMI is based, higher stability estimates were found among basic personality scales in comparison with symptom scales. However, stability estimates which included initial MCMI administrations at intake into treatment were generally lower than those based upon administrations which occurred later in the treatment process. This later finding suggests the need to consider timing of administration when interpreting the MCMI.     

Use of transference interpretations in dynamically oriented individual psychotherapy for patients with personality disorders

The use of transference interpretations in the individual treatment of patients with personality disorders is a controversial issue. Both expressive approaches that stress the importance of transference interpretations and supportive approaches that avoid interpretation of the transference have been advocated by dynamically oriented therapists. Literature is reviewed regarding recommendations for individual psychotherapy and the different views on interpretation of the transference. Available research that has attempted to illuminate the impact of these interventions is also summarized. Although the findings are limited by a number of methodological shortcomings, three implications have emerged. First, a strong therapeutic alliance is imperative for successful exploration of the transference. Second, transference-focused work should be balanced with supportive interventions. Third, the patient's quality of object relations and his or her ability to work within the transference should be considered. However, without further research to guide clinical decision making, clinicians will be left with a confusing array of recommendations and only their intuition.     

Longitudinal studies of personality disorders: four lessons from personality psychology

The three longitudinal projects described in this special section of the Journal of Personality Disorders raise a number of intriguing questions concerning the natural history of personality disorders and offer more than their share of surprises. In addition, they underscore several valuable lessons derived from the literature on normal-range personality traits. Drawing in part from the writings of the American trait psychologist Gordon Allport, I describe four such lessons: (1) change and continuity of personality traits and disorders can and do coexist, (2) the covariation among personality traits helps to account for the "comorbidity" among personality disorders, (3) personality traits and disorders influence how individuals interpret life events, and (4) personality traits must be distinguished from behavioral adaptations to these traits. These lessons remind us that the science of personality disorders must be informed by the basic science of personality.     

The battle within the self,II: An existential approach to psychotherapy with personality disorders

Individuals who suffer from personality disorders are dominated by an internalized self-attacking mechanism which is labeled here as the enemy. This force is the incorporated voice of the parent incessantly operating and producing the psychological pain which very much characterizes the patient's existence. By anthropomorphizing this destructive aspect of the personality structure, the therapist is better able to become an ally with the healthy parts of the patient against this critical internal enemy. As patients more fully comprehend the wide extent of the ongoing battle within the self, they begin to develop the necessary resources to effect significant behavioral changes.     

Validity of the Millon Clinical Multiaxial Inventory in the assessment of affective disorders

The Millon Clinical Multiaxial Inventory (MCMI) was administered to 270 adult outpatients with major affective disorders at the same time that a semistructured, diagnostic interview was conducted by a clinician. The mood of the patient was then rated, and the clinician completed the Hamilton Depression Rating Scale and the Mania Rating Scale. A consensual diagnosis was arrived at by the team of investigators using DSM-III criteria. Significant correlations were found between four MCMI affective scales and the global mood state of the patient. Analysis of covariance indicated that the MCMI affective scales are significantly related to DSM-III affective disorders even after the effect of the current mood of the patient is partialled out. The clinical usefulness of each of the scales is discussed.     

Negative life experiences and the development of cluster C personality disorders: a cognitive perspective

Early negative experiences have long been thought to play an important role in the development of personality disorders. Most of the literature regarding these early life experiences has focused on borderline personality disorder, with only occasional focus on other personality disorders. Utilizing cognitive theory of personality disorders (Beck et al., 2004), the authors conceptualize cluster C personality disorders (avoidant, dependent, and obsessive-compulsive). They then critically review the relevant literature on early negative life experiences and later development of these disorders to determine whether the theory is supported by the empirical data. The theory regarding avoidant and dependent personality disorders has limited support, whereas data relating to obsessive-compulsive personality disorder are much weaker. Implications and future research suggestions are discussed.     

Convergence of narcissism measures from the perspective of general personality functioning

The construct of narcissism has a lengthy history and has been operationalized and measured by a variety of instruments. In this study, five narcissism scales were compared in terms of alternative conceptualizations of narcissism offered by C. C. Morf and F. Rhodewalt (2001), D. L. Paulhus (2001), and S. Vazire and D. C. Funder (2006), using the domains and facets of the five-factor model as a common point of comparison. The findings provided little support for the conceptualizations of Morf and Rhodewalt or Vazire and Funder. Support was obtained for the conceptualization of Paulhus, particularly as assessed by the Narcissistic Personality Inventory and, secondarily, the Millon Clinical Multiaxial Inventory-III. Implications for the assessment and conceptualization of narcissism are discussed.     

DSM-III-R personality disorders and the five-factor model of personality: an empirical comparison.

The relationship between the five-factor model (FFM) of personality and the Diagnostic and Statistical Manual of Mental Disorders (rev. 3rd ed.; DSM-III-R) personality disorders was examined in a sample of 54 psychiatric outpatients. Correlations between raw scores on the NEO-Personality Inventory (NEO-PI) and the number of DSM-III-R personality disorder symptoms rated present using a semistructured interview were computed. In addition, correlations between NEO-PI scores and scores on two self-report personality disorder inventories were also examined to determine which results replicated across instruments. Results indicated that the FFM personality dimensions of Neuroticism, Extraversion, and Agreeableness were most apparent in the DSM-III-R conceptualizations of the personality disorders.     

Anger and hostility from the perspective of the Big Five personality model

Sanz, J., García‐Vera, M. P. & Magán, I. (2010). Anger and hostility from the perspective of the Big Five personality model. Scandinavian Journal of Psychology, 51, 262–270. This study was aimed at examining the relationships of the personality dimensions of the five‐factor model or Big Five with trait anger and with two specific traits of hostility (mistrust and confrontational attitude), and identifying the similarities and differences between trait anger and hostility in the framework of the Big Five. In a sample of 353 male and female adults, the Big Five explained a significant percentage of individual differences in trait anger and hostility after controlling the effects due to the relationship between both constructs and content overlapping across scales. In addition, trait anger was primarily associated with neuroticism, whereas mistrust and confrontational attitude were principally related to low agreeableness. These findings are discussed in the context of the anger‐hostility‐aggression syndrome and the capability of the Big Five for organizing and clarifying related personality constructs.     

Self-concept correlates of the personality disorders

This study investigated the extent to which the DSM personality disorder dimensions are associated with discrete patterns of self-concept. Participants were 366 men and women who were receiving mental health services and who completed the Wisconsin Personality Disorders Inventory to assess the personality disorders and Benjamin's INTREX questionnaire to describe their "typical" self-concepts. Although there was some overlap between categories, most were associated with fairly distinct patterns of self-concept. The disorders also clustered together in meaningful ways along the major axes of Benjamin's interpersonal model of the self-concept.     

Structural models of psychotherapy groups and their effect on inpatients with borderline personality disorders: Patients' perceptions

This research compares the way in which various group structural models affect self-understanding, interpersonal relationships and catharsis in hospitalized patients with borderline personality disorders. Each of the models is characterized by a different combination of group focus and leadership style. Three psychotherapy groups were chosen as paradigms: the dynamic psychotherapy group; the therapeutic games group, and psychodrama group. Sixty three inpatients with borderline personality disorders participated in the study. The one-way ANOVA yielded significant differences between the group models. Results of the post-hoc t-test showed that the dynamic and the games groups were perceived by the patients as more beneficial than psychodrama.     

Universal features of personality traits from the observer's perspective: data from 50 cultures

To test hypotheses about the universality of personality traits, college students in 50 cultures identified an adult or college-aged man or woman whom they knew well and rated the 11,985 targets using the 3rd-person version of the Revised NEO Personality Inventory. Factor analyses within cultures showed that the normative American self-report structure was clearly replicated in most cultures and was recognizable in all. Sex differences replicated earlier self-report results, with the most pronounced differences in Western cultures. Cross-sectional age differences for 3 factors followed the pattern identified in self-reports, with moderate rates of change during college age and slower changes after age 40. With a few exceptions, these data support the hypothesis that features of personality traits are common to all human groups.     

Monitoring psychotherapy with performance-based measures of personality functioning

In this commentary, I review a meta-analysis and three original research reports concerning the Rorschach (Exner, 2003; Rorschach, 1921/1942) and the Thematic Apperception Test (TAT; Murray, 1943) assessment in psychological treatment planning and outcome evaluation. The information in these four articles bears witness to the potential utility of performance-based personality assessment measures for this purpose. The strengths and limitations of the articles suggest several guidelines for future research designed to examine this Rorschach and TAT application including an emphasis on effectiveness studies, longitudinal data, integrated independent variables, observable dependent variables, sophisticated data analysis combining nomothetic and idiographic presentation, and the incremental contribution of performance-based measures to psychotherapy-related personality assessment.