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.     

Personality disorders in a Dutch forensic psychiatric sample: convergence of interview and self-report measures

Convergence of PDQ-R- and SIDP-R-derived personality disorder diagnoses was studied in a sample of 85 forensic psychiatric patients. For categorical diagnoses, the mean kappa was .34, but on a dimensional level convergence was somewhat higher. Paranoid, antisocial and borderline personality disorders had prevalence rates around 40%; the other personality disorders occurred with much lower frequency. The PDQ-R yielded more diagnoses, except for antisocial, histrionic, narcissistic, and sadistic personality disorder. Because the latter disorders are among the most prevalent in forensic settings, and because they have important risk and treatment implications, the PDQ-R is not suitable as a screening device in forensic populations. Semistructured interviews that make use of collateral information are recommended for diagnosing personality disorders in forensic subjects.     

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 MMPI, prototypal typology, and borderline personality disorder

This study demonstrates inherent features in the DSM-III diagnostic criteria for personality disorders (i.e., overlapping diagnoses and heterogeneous symptomatology) that limit efforts to identify a sensitive and specific MMPI profile for the borderline personality disorder. A sample of 71 inpatients was administered an MMPI and a semistructured interview that systematically evaluated each of 81 symptoms for the 11 DSM-III personality disorders. Interrater reliability was substantially higher than has been obtained with unstructured interviews. The effect on the borderline MMPI profile of variation in the number of borderline symptoms and overlap with the schizotypal, histrionic, and antisocial diagnoses was demonstrated. We discuss implications with respect to a prototypal model of classification.     

The MMPI,Prototypal Typology,and Borderline Personality Disorder

This study demonstrates inherent features in the DSM-III diagnostic criteria for personality disorders (i.e., overlapping diagnoses and heterogeneous symptomatology) that limit efforts to identify a sensitive and specific MMPI profile for the borderline personality disorder. A sample of 71 inpatients was administered an MMPI and a semistructured interview that systematically evaluated each of 81 symptoms for the 11 DSM-III personality disorders. Interrater reliability was substantially higher than has been obtained with unstructured interviews. The effect on the borderline MMPI profile of (a) variation in the number of borderline symptoms and (b) overlap with the schizotypal, histrionic, and antisocial diagnoses was demonstrated. We discuss implications with respect to a prototypal model of classification.     

The relationship between childhood abuse and adult personality disorder symptoms

This study assessed personality disorder symptomatology in a community sample of healthy adults without diagnosable DSM-IV-TR Axis I psychiatric disorders who reported a history of childhood abuse. Twenty-eight subjects with a history of moderate to severe physical, sexual, and/or emotional abuse according to the Childhood Trauma Questionnaire were compared to 33 subjects without an abuse history on symptoms of personality disorders. Subjects in the Abuse group were more likely to report subclinical symptoms of paranoid, narcissistic, borderline, antisocial, obsessive compulsive, passive-aggressive, and depressive personality disorders. These findings link reports of childhood abuse with symptoms of personality disorders in the absence of Axis I psychiatric disorders in a community sample of healthy adults.     

The association between axis I and II psychiatric symptoms and high-risk sexual behavior during adolescence

This study was conducted to investigate the association between psychiatric disorders and high-risk sexual behavior among adolescent primary care patients. Interviews assessing anxiety, conduct, depressive, eating, substance use, and personality disorders (PDs), as well as histories of sexual behavior were administered to 119 male and 284 female adolescent primary care patients. Results indicated that, after co-occurring psychiatric disorders were controlled statistically, adolescents with elevated PD symptom levels were more likely than adolescents without elevated PD symptom levels to report a high number of sexual partners during the past year and during their lifetime. Adolescents with a history of conduct disorder were more likely than adolescents without such a history to report a high number of lifetime unsafe sexual partners. Elevated antisocial, dependent, and paranoid PD symptom levels were associated with high-risk sexual behavior after co-occurring psychiatric disorders were controlled. Further, certain specific antisocial, borderline, dependent, histrionic, narcissistic, obsessive-compulsive, paranoid, and schizotypal PD symptoms were independently associated with high-risk sexual behavior after co-occurring psychiatric disorders and overall PD symptom levels were controlled. The association between overall PD symptom levels and the number of sexual partners was significantly stronger among the females than among the males in the sample. Increased recognition and treatment of PDs, coupled with increased recognition of high-risk sexual behavior may facilitate the prevention of sexually transmitted diseases and teenage pregnancy among adolescents.     

Dimensions of DSM-IV personality disorders and life-success

This study examined associations between dimensional representations of DSM-IV personality disorders and life-success in a community sample of 304 men at age 48. Measures included a standardized social interview and the SCID-II for assessment of personality disorders. The identified indicators of life-success were factor-analyzed resulting in two moderately correlated components representing "status and wealth" and "successful intimate relationships." Avoidant, obsessivecompulsive, and narcissistic dimensional scores were positively associated with "status and wealth." Inverse relationships were found between dependent, schizotypal, schizoid, and adult antisocial personality disorder dimensions and this domain of life-success. Avoidant, schizoid, and borderline personality disorder dimensions were negatively associated with "successful intimate relationships." The findings suggest that although most personality disorders are associated with impaired psychosocial functioning and life-failure, some personality disorder traits (even if considered as pathological) can contribute positively to one important aspect of life-success: status and wealth.     

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.     

Symptomatology of adopted and nonadopted adolescents in a psychiatric hospital

This study compared the symptomatology and diagnoses of adopted and nonadopted adolescents in a psychiatric hospital. Data were gathered from the hospital charts of adolescents who already had been discharged from the hospital. Contrary to expectations, adoptees were no more likely than nonadoptees to have received personality disorder diagnoses, nor were they more likely to be hospitalized as the result of antisocial behavior. However, in comparison with nonadopted adolescents, the adopted adolescents were younger upon admission to the hospital, significantly less often diagnosed psychotic, and significantly more often diagnosed adjustment reaction. It was suggested that adopted adolescents may be less likely than nonadopted adolescents to require severe or prolonged pathology in order to be admitted to a psychiatric hospital. It was also suggested that the antisocial symptomatology so frequently observed in adopted children in mental health settings does not account for the hospitalizations of those receiving inpatient treatment.     

Aesthetic preference and DSM-IIIR personality disorders

This report tested whether those individuals with a cluster B DSM-IIIR personality disorder (narcissistic, borderline, antisocial or histrionic) had higher scores for aesthetic preference for visually complex drawings using the Barron-Welch Art Scale. In a sample of 141 patients and controls, the 56 subjects who met the criteria for one of the cluster B personality disorder diagnoses displayed higher Barron-Welch Art Scale Scores. A multiple regression analysis showed that narcissistic and borderline personality disorder contributed positively, while dependent personality disorder, negatively to preference for complexity. The findings support the notion that aesthetic choices and values reflected through the dimension of openness to experience may contribute to the behavioral manifestations of the personality disorders.     

Recent trends in the pharmacotherapy of personality disorders

This article reviews pharmacologic trials conducted between 2000 and 2003 directed at the treatment of borderline personality disorder, antisocial personality disorder, and schizotypal personality disorder. Atypical antipsychotics, antiepileptics, selective serotonin reuptake inhibitors, omega fatty acids, and opioid antagonists have all been studied in the treatment of borderline personality disorder with positive results. Atypical antipsychotics have been studied in both schizotypal personality disorder and antisocial personality disorder, again with encouraging outcome reports. Implications of personality changes in response to pharmacologic treatment are discussed. Based on the prevalence of these disorders and the burden they cause to afflicted individuals and society, further trials are unequivocally indicated.     

Are personality disorders associated with social welfare burden in the United States?

This study examined the association between personality disorders and use of major social welfare services in a nationally representative sample of U.S. adults (N = 43,093). Social welfare services received and diagnoses of personality, substance use, mood, and anxiety disorders were assessed with the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV-version. Analyses quantified the association between personality disorders and forms of public assistance while controlling for numerous confounds. Logistic regression analyses revealed dependent personality disorder, paranoid personality disorder, antisocial personality disorder, and avoidant personality disorder were significantly associated with increased odds of receiving public assistance. In contrast, persons diagnosed with histrionic, schizoid, and obsessive-personality disorder were not significantly more likely to receive any public welfare service. Development of effective prevention and treatment of personality disorders would likely lead to reductions in overall social welfare burden.     

The almost untreatable narcissistic patient

Clinical experience in the Personality Disorders Institute at Weill Cornell Medical College suggests that patients with borderline personality organization and a narcissistic personality disorder have a more serious prognosis than all other personality disorders functioning at the borderline level, and that those who in addition present significant antisocial behavior have an even worse prognosis (Clarkin, Yeomans, and Kernberg 1999; Stone 1990). This negative trend culminates in a group of practically untreatable patients with antisocial personality disorder, who represent the most severe cases of pathological narcissism. There are also patients with severe narcissistic personality disorder, functioning at an overt borderline level with significant antisocial features, but not presenting an antisocial personality disorder proper, who at times respond to treatment, while others do not. These patients are explored here, with a focus on particular psychotherapeutic techniques that have proven helpful, as well as on the limits of these technical approaches.     

Convergent and discriminative validity of interview and questionnaire measures of personality disorder in mentally disordered offenders: a multitrait-multimethod analysis using confirmatory factor analysis

Measures of personality disorder from the International Personality Disorder Examination, Personality Diagnostic Questionnaire, and Millon Clinical Multiaxial Inventory (MCMI-II) were obtained from detained male mentally disordered offenders (N = 156), and convergent and discriminant validity were examined by confirmatory factor analysis of the multitrait-multimethod matrix. Hierarchical comparisons of models varying in their specification of trait and method variance established the appropriateness of a model supporting both convergence and discrimination across methods, but these were variable across constructs and measures. Convergence was good for avoidant, schizoid, and antisocial disorders, but poor for histrionic, narcissistic, and obsessive-compulsive disorders. Avoidant, schizoid, and schizotypal disorders were not clearly distinguishable from each other. Measurement error attributable to method variance was substantial for all instruments and for most disorders. The commonly alleged superiority of interview over questionnaire methods was not supported, and the MCMI-II demonstrated proportionately more "true" variance. However, assessment methods may be differentially sensitive to different kinds of personality disorder problems.     

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.     

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.     

An invariant dimensional liability model of gender differences in mental disorder prevalence: evidence from a national sample

Epidemiological studies of categorical mental disorders consistently report that gender differences exist in many disorder prevalence rates and that disorders are often comorbid. Can a dimensional multivariate liability model be developed to clarify how gender impacts diverse, comorbid mental disorders? We pursued this possibility in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; N = 43,093). Gender differences in prevalence were systematic such that women showed higher rates of mood and anxiety disorders, and men showed higher rates of antisocial personality and substance use disorders. We next investigated patterns of disorder comorbidity and found that a dimensional internalizing-externalizing liability model fit the data well, where internalizing is characterized by mood and anxiety disorders, and externalizing is characterized by antisocial personality and substance use disorders. This model was gender invariant, indicating that observed gender differences in prevalence rates originate from women and men's different average standings on latent internalizing and externalizing liability dimensions. As hypothesized, women showed a higher mean level of internalizing, while men showed a higher mean level of externalizing. We discuss implications of these findings for understanding gender differences in psychopathology and for classification and intervention.     

Psychological trauma and schizotypal personality disorder

Two studies examined the relation between psychological trauma and schizotypal symptoms. In Study 1, in which 1,510 adults completed telephone interviews, both childhood maltreatment and the experience of an injury or life-threatening event were significantly associated with schizotypal symptoms. In Study 2, in which 303 adults (oversampled for having elevated levels of schizotypal symptoms) completed extensive in-person assessments, both childhood maltreatment and meeting posttraumatic stress disorder (PTSD) Criterion A were significantly associated with schizotypal symptoms. The links between schizotypal symptoms and at least some forms of psychological trauma could not be fully accounted for by shared variance with antisocial and borderline personality disorders, absorption/dissociation, PTSD symptom severity, family history of psychotic disorder, or signs of neurodevelopmental disturbance (as indexed by minor physical anomalies and inconsistent hand use). Schizotypal symptoms were more strongly associated with childhood maltreatment among men than among women, whereas schizotypal symptoms were more strongly associated with PTSD Criterion A among women than among men. Finally, among men, the association between childhood maltreatment and schizotypal symptoms was moderated by signs of neurodevelopmental disturbance.     

Gender role and personality disorders

Many researchers have hypothesized relationships between personality disorders and gender role (i.e., masculinity and femininity). However, research has not addressed if people who are masculine or feminine more often meet the criteria for personality disorders. The present study examined whether college students (N = 665, 60% women) higher in masculinity or femininity more often exhibited features of the 10 DSM-IV personality disorders. Feminine men exhibited more features of all the personality disorders except antisocial. Dependent traits were associated with higher femininity and lower masculinity. Antisocial traits were associated with masculinity. Both men and women who typically behaved consistent with their gender had more narcissistic and histrionic features, whereas participants who typically behaved unlike their gender had more features of the Cluster A personality disorders.