Distinguishing general and specific personality disorder features and implications for substance dependence comorbidity

Clinical and population-based samples show high comorbidity between Substance Use Disorders (SUDs) and Axis II Personality Disorders (PDs). However, Axis II disorders are frequently comorbid with each other, and existing research has generally failed to distinguish the extent to which SUD/PD comorbidity is general or specific with respect to both specific types of PDs and specific types of SUDs. We sought to determine whether ostensibly specific comorbid substance dependence-Axis II diagnoses (e.g., alcohol use dependence and borderline personality disorder) are reflective of more pervasive or general personality pathology or whether the comorbidity is specific to individual PDs. Face-to-face interview data from Wave 1 and Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions were analyzed. Participants included 34,653 adults living in households in the United States. We used hierarchical factor models to statistically partition general and specific personality disorder dimensions while simultaneously testing for specific PD-substance dependence relations. Results indicated that substance dependence-Axis II comorbidity is characterized by general (pervasive) pathology and by Cluster B PD pathology over and above the relationship to the general PD factor. Further, these relations between PD factors and substance dependence diagnoses appeared to largely account for the comorbidity among substance dependence diagnoses in the younger but not older participants. Our findings suggest that a failure to consider the general PD factor, which we interpret as reflecting interpersonal dysfunction, can lead to potential mischaracterizations of the nature of certain PD and SUD comorbidities.     

Drinking motives as mediators in the relation between personality disorder symptoms and alcohol use disorder

Research shows high comorbidity between Cluster B Personality Disorders (PDs) and Alcohol Use Disorders (AUDs). Studies of personality traits and alcohol use have identified coping and enhancement drinking motives as mediators of the relation among impulsivity, negative affectivity or affectivity instability, and alcohol use. To the extent that certain PDs reflect extreme expression of these traits, drinking motives were hypothesized to mediate the relation between PD symptoms and presence/absence of an alcohol use disorder (AUD). This hypothesis was tested using a series of cross-sectional and prospective path models estimating the extent that coping and enhancement drinking motives mediated the relation between cluster A, B, and C PD symptom counts and AUD diagnosis among a sample of 168 young adults between ages 18 and 21. Enhancement motives mediated the cross-sectional relation between Cluster B symptoms and AUD. Prospectively, enhancement motives partially mediated the relation between Cluster B personality symptoms and AUD through the stability of Year 1 AUD to Year 3 AUD. Results suggest that enhancement motives may be especially important in understanding the relation between Cluster B personality disorders and AUDs.     

Pattern of comorbidity among anxious and odd personality disorders: the case of obsessive-compulsive personality disorder

The aim of this study was to examine the pattern of comorbidity among obsessive-compulsive personality disorder (OCPD) and other personality disorders (PDs) in a sample of 400 psychiatric inpatients. PDs were assessed using the Semistructured Clinical Interview for DSM-III-R Personality Disorders (SCID-II). Odds ratios (ORs) were calculated to determine significant comorbidity among OCPD and other axis II disorders. The most elevated odds ratios were found for the cooccurrence of OCPD with cluster A PDs (the "odd" PDs, or paranoid and schizoid PDs). These results are consistent with those of previous studies showing a higher cooccurrence of OCPD with cluster A than with cluster C ("anxious") PDs. In light of these observations, issues associated with the nosologic status of OCPD within the Diagnostic and Statistical Manual of Mental Disorders clustering system remain unsettled.     

The Initial Efficacy of Stand-Alone DBT Skills Training for Treating Impulsivity Among Individuals With Alcohol and Other Substance Use Disorders

Impulsivity is considered a core feature of substance use disorders (SUDs), including personological (i.e., negative urgency, positive urgency, lack of premeditation) and neuropsychological (i.e., cognitive and motor disinhibition, impulsive choice) dimensions. Dialectical Behavior Therapy Skills Training (DBT-ST) as a stand-alone treatment is an effective intervention for alcohol use disorder (AUD) and other SUDs. However, there are no studies that have investigated changes in impulsivity levels during a DBT-ST program, especially testing the therapeutic effects of DBT skills. Twenty-nine patients with AUD and other SUDs were admitted to a 3-month DBT-ST program. Self-report (i.e., UPPS-P) and computerized neuropsychological (i.e., Attentional Network test; Go/No-Go task; Iowa Gambling Task) measures of impulsivity were administered at the beginning and end of the DBT-ST. Distress tolerance (DTS), mindfulness (MAAS, FFMQ) and emotion regulation (DERS) were also assessed pre- and post-intervention. The study included two age- and gender-matched control groups: (a) untreated patients with SUDs (N = 29); (b) healthy controls (HCs) (N = 29). Twenty-four (82.7%) patients concluded the DBT-ST program. Emotion-based forms of impulsivity significantly improved during the program. At the end of treatment, impulsivity levels were significantly lower than those of untreated patients with SUDs and they were not significantly different from HCs. Cognitive disinhibition significantly decreased during the treatment. The improvement in impulsivity was explained by pre- posttreatment changes in distress tolerance, mindfulness and emotion regulation. Motor disinhibition did not improve during the treatment. These findings supported the initial efficacy of the DBT-ST program for addressing different features of impulsivity among individuals with AUD and other SUDs. Future follow-up studies should demonstrate the role of impulsivity domains in long-term relapse prevention.     

Contextualizing neuroticism in the Hierarchical Taxonomy of Psychopathology

Neuroticism is the personality trait most consistently and strongly connected to psychopathology. The majority of research on the relationship between traits and mental illness has focused on neuroticism’s connection with broad psychopathology spectra or discrete disorders. However, both personality and psychopathology are hierarchically-organized domains that may be examined at multiple levels of fidelity and bandwidth from very specific thoughts, feelings, and behaviors (i.e., nuance traits or symptoms) to very broad patterns indexing many interrelated tendencies (i.e., general factors). The Hierarchical Taxonomy of Psychopathology (HiTOP) is a recently proposed nosologic framework for psychopathology symptoms and domains that accounts for this tiered organization. Here, we illustrate how neuroticism-psychopathology relationships—both what is known and unknown—may be elucidated through the HiTOP system.     

Adolescent personality disorders and conflict with romantic partners during the transition to adulthood

Longitudinal data were used to investigate the association of adolescent personality disorders with conflict between romantic partners during the transition to adulthood (i.e., age 17 to 27). Findings indicated that adolescent personality disorders (PDs) assessed at mean age 16 were associated with subsequent elevated partner conflict. Cluster B PD was associated with sustained elevations in partner conflict throughout the transition to adulthood. Cluster A and C PDs were associated with elevated partner conflict before age 23. Paranoid, schizoid, schizotypal, borderline, narcissistic, and obsessive-compulsive PD symptoms were independently associated with sustained elevations in partner conflict.     

The Levenson Self-Report Psychopathy scale: an examination of the personality traits and disorders associated with the LSRP factors

There are several self-report measures of psychopathy, most of which use a two-factor structure. There is debate regarding the convergence of these factors, particularly with regard to Factor 1 (F1), which is related to the interpersonal and affective aspects of psychopathy; Factor 2 (F2) is related to the social deviance associated with psychopathy. This study examines the relations between the Levenson Self-Report Psychopathy (LSRP) factors and personality traits and disorders (PDs) in an undergraduate sample (n = 271). LSRP Factor 1 is related to an antagonistic interpersonal style (i.e., low Agreeableness; high Narcissistic PD and ratings of prototypical psychopathy), whereas Factor 2 is more strongly related to negative emotionality (i.e., Neuroticism), disinhibition (i.e., low Conscientiousness) and a broad array of PD symptoms. The authors interpret these findings in the context of alternative measures of psychopathy and suggest that the LSRP is a reasonable, albeit imperfect, measure of psychopathy.     

A comparison of the Psychological Entitlement Scale and the Narcissistic Personality Inventory's Entitlement Scale: relations with general personality traits and personality disorders

Given the negative consequences of psychological entitlement, it is important to have a reliable and valid measure of the construct. We used an undergraduate sample (N = 271) to examine the Entitlement subscale (ENT) of the Narcissistic Personality Inventory (Raskin & Terry, 1988) and the Psychological Entitlement Scale (PES; Campbell, Bonacci, Shelton, Exline, & Bushman, 2004) in relation to general personality traits (i.e., Revised NEO Personality Inventory; Costa & McCrae, 1992) and personality disorders (PDs; Personality Diagnostic Questionnaire-4; Hyler, 1994). We found similar personality correlates (e.g., disagreeableness; Cluster B PDs) for both measures, although ENT was comprised of greater disagreeableness and less warmth and positive affect. ENT was also more positively associated with schizoid and borderline PDs compared to the PES. Overall, these measures are closely related with regard to their relations with general and pathological personality dimensions, although the ENT scale may capture a slightly more pathological variant.     

Treatment utilization and satisfaction: examining the contributions of Axis II psychopathology and the Five-Factor Model of personality

Numerous studies have demonstrated a link between personality disorders (PDs) and increased treatment utilization and decreased satisfaction. However, few studies have examined the link between general personality models, such as the Five-Factor Model (FFM), and these treatment variables. The current study examines the role of depression, anxiety, and functioning, PDs, and the FFM in accounting for psychiatric treatment utilization and satisfaction with care in two distinct clinical samples (n = 99 and 544, respectively). The results suggest that both maladaptive personality symptoms and general personality traits are predictive of these outcome variables. Importantly, the findings regarding treatment utilization replicate across samples and level of personality assessment (i.e., FFM and PDs). It is argued that both types of personality information should be included in the initial treatment planning and implementation stages.     

The relationship between DSM-IV cluster B personality disorders and psychopathy according to Hare's criteria: clarification and resolution of previous contradictions

This study examines the relationship between DSM-cluster B personality disorders (PDs) and psychopaths according to Hare's criteria as detected by the Psychopathy Checklist (PCL:SV) in 299 violent offenders. To clarify some contradictions among several previous studies on this issue, individual cluster B PDs were looked at alone, excluding any cases of comorbidity with other PDs of this cluster. We found highly significant relationships between antisocial and borderline PD and Factor II of the PCL and a highly significant correlation between narcissistic PD and Factor I of the PCL. These results were to be expected from the theoretical basis of the development of the PCL and provide a contribution to the construct validity of the PCL, which until now has not been validated on such a large sample in Germany.     

The Relationship Between Personality and Subjective Well-Being: Different Association Patterns When Measuring the Affective Component in Frequency and Intensity

The aim was to determine whether the relationship between personality traits and Subjective Well-Being (SWB) differs when the affective component of SWB is measured in terms of frequency or intensity. Extraversion and Neuroticism were expected to show significant but different associations to SWB depending on the dimension of the affective component. Swedish undergraduate students (N = 153) self-reported personality, life satisfaction (LS), and affect measured in both frequency (i.e., how often they feel certain affects) and intensity (i.e., how strongly they feel certain affects). Two types of SWB-scores were constructed by merging LS with affect measured in either frequency or intensity. While Extraversion had a similar effect on both types of SWB, Neuroticism had a significantly stronger effect on SWB when the affective component was measured in frequency. More importantly, the effect of Neuroticism, compared to Extraversion, was stronger on SWB regardless of the dimension of the affective component. These findings suggest that future research should clearly distinguish between intensity and frequency when measuring the affective component of SWB. The distinction is important, not only due to the distinctiveness of the affective dimensions per se, but also due to different association patterns between personality traits and both dimensions.     

The core elements of neurosis: mixed anxiety-depression (cothymia) and personality disorder

Although there has been great diagnostic activity within the conditions formally included under the general rubric of neurosis in the last 20 years, there is little evidence that the many new diagnoses (i.e., generalized anxiety disorder, panic disorder, social anxiety disorder, and dysthymic disorder) have helped clinicians and improved the health of those diagnosed. This is largely because of the extensive comorbidity between these disorders negates much of their attempted separation and it is argued that the core of neurosis is a mixed anxiety-depressive disorder, or cothymia, combined with significant personality disorder of any type. The specific association of the anxious-fearful personality cluster (cluster C) and neurosis, called the general neurotic syndrome, is also relevant but appears to have lesser significance as the personality elements are not stable. Data are presented that justify these conclusions from a long-term follow-up study of anxiety and depressive disorders.     

Personality and obesity across the adult life span

Personality traits contribute to health outcomes, in part through their association with major controllable risk factors, such as obesity. Body weight, in turn, reflects our behaviors and lifestyle and contributes to the way we perceive ourselves and others. In this study, the authors use data from a large (N = 1,988) longitudinal study that spanned more than 50 years to examine how personality traits are associated with multiple measures of adiposity and with fluctuations in body mass index (BMI). Using 14,531 anthropometric assessments, the authors modeled the trajectory of BMI across adulthood and tested whether personality predicted its rate of change. Measured concurrently, participants higher on Neuroticism or Extraversion or lower on Conscientiousness had higher BMI; these associations replicated across body fat, waist, and hip circumference. The strongest association was found for the impulsivity facet: Participants who scored in the top 10% of impulsivity weighed, on average, 11Kg more than those in the bottom 10%. Longitudinally, high Neuroticism and low Conscientiousness, and the facets of these traits related to difficulty with impulse control, were associated with weight fluctuations, measured as the variability in weight over time. Finally, low Agreeableness and impulsivity-related traits predicted a greater increase in BMI across the adult life span. BMI was mostly unrelated to change in personality traits. Personality traits are defined by cognitive, emotional, and behavioral patterns that likely contribute to unhealthy weight and difficulties with weight management. Such associations may elucidate the role of personality traits in disease progression and may help to design more effective interventions.     

Possible barnum effect in the five factor model: do respondents accept random neo personality inventory-revised scores as their actual trait profile?

This study investigated a possible Barnum effect in personality traits, i.e., that persons accept a false trait profile as correct. Having answered the Norwegian translation of the NEO Personality Inventory-Revised, a group of 75 students, 56 (five women military aviation cadets and 19 (10 women) graduate students, received a random T-score profile and were asked to rate their agreement on a 7-point scale. For all personality traits, i.e., facets and domains measured by the NEO Personality Inventory-Revised, positive correlations ranging from .08 to .64 were found between the agreement ratings and the similarity between the random false scores and the actual scores. The respondents identified and rejected random T scores that deviated far from their actual scores, which works against the Barnum effect. Correct identification correlated negatively with Neuroticism r = -.41) and positively (r = .53) with Conscientiousness.     

Personality Assessment in the Diagnostic Manuals: On Mindfulness,Multiple Methods,and Test Score Discontinuities

Recent controversies have illuminated the strengths and limitations of different frameworks for conceptualizing personality pathology (e.g., trait perspectives, categorical models), and stimulated debate regarding how best to diagnose personality disorders (PDs) in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.), and in other diagnostic systems (i.e., the International Classification of Diseases, the Psychodynamic Diagnostic Manual). In this article I argue that regardless of how PDs are conceptualized and which diagnostic system is employed, multimethod assessment must play a central role in PD diagnosis. By complementing self-reports with evidence from other domains (e.g., performance-based tests), a broader range of psychological processes are engaged in the patient, and the impact of self-perception and self-presentation biases can be better understood. By providing the assessor with evidence drawn from multiple modalities, some of which provide converging patterns and some of which yield divergent results, a multimethod assessment compels the assessor to engage this evidence more deeply. The mindful processing that ensues can help minimize the deleterious impact of naturally occurring information processing bias and distortion on the part of the clinician (e.g., heuristics, attribution errors), bringing greater clarity to the synthesis and integration of assessment data.     

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.     

Early adolescents’ personality and life satisfaction: A closer look at global vs. domain-specific satisfaction

We examined relations between US early adolescents’ major personality traits and global life satisfaction (LS) and satisfaction in five specific domains (i.e., family, friends, school, self, living environment). A sample of 344 7th graders completed the Adolescent Personal Style Inventory (Lounsbury et al., 2003), which assesses the Big Five traits of neuroticism, extraversion, openness, agreeableness, and conscientiousness. Furthermore, participants completed the Students’ Life Satisfaction Scale (Huebner, 1991) and the Multidimensional Students’ Life Satisfaction Scale (Huebner, Zullig, & Saha, 2012), assessing global and domain-specific satisfaction, respectively. Neuroticism (inversely), and conscientiousness, agreeableness, and extraversion (positively) were uniquely associated with early adolescents’ global LS, with neuroticism showing the strongest association. With respect to domain-specific satisfaction, neuroticism (inversely) and conscientiousness (positively) were uniquely related to satisfaction in all five domains. Extraversion displayed the strongest, unique (positive) association with friend and self-satisfaction reports. Openness displayed the strongest, unique (positive) association with school satisfaction. Agreeableness demonstrated a unique (positive) association with family satisfaction. The results demonstrated the importance of neuroticism in understanding early adolescents’ global LS, while the personality variables revealed varying patterns of relationships with domain-specific satisfaction reports.     

DSM-5 personality traits and DSM-IV personality disorders

Two issues pertinent to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) proposal for personality pathology, the recovery of DSM-IV personality disorders (PDs) by proposed DSM-5 traits and the validity of the proposed DSM-5 hybrid model, which incorporates both personality pathology symptoms and maladaptive traits, were evaluated in a large undergraduate sample (N = 808). Proposed DSM-5 traits as assessed with the Personality Inventory for DSM-5 explained a substantial proportion of variance in DSM-IV PDs as assessed with the Personality Diagnostic Questionnaire-4+, and trait indicators of the 6 proposed DSM-5 PDs were mostly specific to those disorders with some exceptions. Regression analyses support the DSM-5 hybrid model in that pathological traits, and an indicator of general personality pathology severity provided incremental information about PDs. Findings are discussed in the context of broader issues around the proposed DSM-5 model of personality disorders.     

Personality Traits,Income, and Economic Ideology

While the psychological underpinnings of social ideology are well established, less is known about the psychological underpinnings of economic ideology. In this study, I assess whether Big Five personality traits are associated with economic ideology and when personality traits are more strongly or more weakly associated with economic ideology. I hypothesize that low income attenuates the association between the Big Five traits and economic ideology. Studies conducted in Denmark, the United Kingdom, and the United States show that Conscientiousness is positively correlated with economic conservatism, while Agreeableness and Neuroticism are negatively correlated with economic conservatism. Moreover, low income attenuates the association between personality traits and economic ideology. I report a weaker association between Agreeableness and economic ideology among poor people compared to wealthier people in all three countries. Low income also attenuates the association between economic ideology and the traits Openness (Denmark), Extraversion (United Kingdom), and Neuroticism (United States). I contribute to the literature addressing the psychological correlates of economic ideology by showing that (1) economic ideology has a distinct set of personality correlates and (2) low income attenuates the association between some personality traits and economic ideology.