Comorbidity of DSM-IV Personality Disorders in unipolar and bipolar affective disorders: a comparative study

The aim of this study was to compare the prevalence of Personality Disorders assessed by Structured Clinical Interview for Axis-II in 155 inpatients diagnosed with Unipolar Disorder vs inpatients with Bipolar Disorder (39). The most frequent Axis II diagnoses among Unipolar inpatients were Borderline (31.6%), Dependent (25.2%), and Obsessive-Compulsive (14.2%) Personality Disorders. Among Bipolar inpatients, the most prevalent personality disorders were Borderline (41%), Narcissistic (20.5%), Dependent (12.8%), and Histrionic disorders (10.3%). Using chi squared analysis, few differences in distribution emerged between the two groups: Unipolar patients had more recurrent Obsessive-Compulsive Personality Disorder than Bipolar patients (chi(1)2=6.24, p<.005). Comorbid Narcissistic Personality Disorder was significantly more frequent in the Bipolar than in the Unipolar group (chi(1)2=6.34, P<.01). Considering the three clusters (DSM-IV classification), there was a significant difference between the groups, Cluster C (fearful, avoidant) diagnoses being more frequent in the Unipolar than in the Bipolar group (48.4% vs 20.5%, respectively). Cluster B (dramatic, emotionally erratic) diagnoses were found more frequently in patients with Bipolar Disorders (71.8% vs 45.2% in Unipolar patients, chi(2)2=10.1, p<.006). The differences in the distribution and prevalence of Personality Disorders between the two patient groups are discussed.     

Emerging as a Personality Disorder Service

Personality Disorder Services working along psychotherapeutic lines are gaining appeal with Health Care Commissioners following the publication of the NICE guidelines for Borderline & Antisocial Personality Disorders and the emerging successful application of psychoanalytically-derived approaches.

Establishing a new Personality Disorder Service is akin to constructing a ‘home’ within which the therapeutic work with patients can develop. As clinicians, we are required to question what facets are important to the development of this new home, and to further to endure the unfamiliar state of being ‘not at home’ while the identity of the service is established.

We address how this process parallels the task facing the patient as they struggle to establish their own identity. We also highlight some important tenets in the work of securing a robust identity for both the service and the patient suffering from a personality disorder.     

老年肺癌患者个性特征调查给我们的启示

采用症状自评量表(SCL-90)、成人艾克人格问卷(EPQ)、抑郁自评量表(SDS)对127例老年肺癌患者进行调查。发现老年肺癌患者存在着特定的个性特征和情绪障碍,并且不同病期间相似。我们在老年肺癌诊疗决策中要给予足够的关注。     

Dysfunctional beliefs and psychopathology in Borderline Personality Disorder

This study examined the factor structure of the Borderline Personality Disorder subscale of the Personality Beliefs Questionnaire (PBQ-BPD; Butler, Brown, Beck, & Grisham, 2002), and the relationships between the emergent factors and psychopathology. The sample comprised 184 patients diagnosed with borderline personality disorder (BPD). Exploratory factor analysis yielded three factors relating respectively to dependency, distrust, and the belief that one should act preemptively to avoid threat. Although the three factors were significantly associated with depression, only dependency and distrust significantly correlated with hopelessness. Distrust was the sole factor that correlated significantly with suicide ideation. These findings support the dimensional structure of the PBQ-BPD. Given its multidimensional structure, the scale can be used as a measure of belief profiles associated with BPD and as an aid to conceptualizing beliefs underlying a range of psychopathology associated with patients with BPD.     

Temperament, character, and attachment patterns in borderline personality disorder.

The aim of this study was to assess the specificity of the association between temperamental vulnerability, character deficits, and Borderline personality disorder (BPD), controlling for the effects of attachment patterns. A total of 44 BPD patients were compared with 98 non-BPD patients with other cluster B Personality Disorder (PD) diagnoses, 39 patients with any cluster A or cluster C PD diagnoses, 70 patients with no PD diagnosis, and 206 nonclinical patients. All patients were administered the Temperament and Character Inventory, the Parental Bonding Instrument, and the Attachment Style Questionnaire. Multivariate and univariate tests showed that BPD patients differed significantly from all control groups on Novelty Seeking and Cooperativeness. These differences remained significant when controlling for the effect of attachment.     

人格与青少年犯罪的关系研究

简要介绍了有关青少年犯罪的人格理论,然后按照研究中所采用的不同的人格测量工具：明尼苏达多相人格测验、艾森克人格问卷、卡特尔16项人格因素测验和加利福尼亚人格问卷,以及大五人格问卷分类综述了近10年来人格与青少年犯罪的关系研究。近五年的研究主要采用大五人格结构,将变量中心法和个体中心法相结合,以及将人格和环境因素相结合来研究人格对青少年犯罪的影响作用。进一步的研究需要在人格测量和研究设计上予以改进,深入揭示人格对青少年犯罪的影响机制     

Personality Disorders in Older Adult Inpatients with Chronic Mental Illness

It has been hypothesized that some types of personality disorders tend to remit with age whereas others may become more prominent. The present study determined the prevalence and nature of 13 personality disorders with a self-report inventory (Coolidge Axis II Inventory) in an older group of chronically mentally ill inpatients (N = 30, mean age = 63 years) and a younger group of similar patients (N = 30, mean age = 39 years). All patients met DSM-IV criteria for either Schizophrenia, Schizoaffective Disorder, Bipolar Disorder, or recurrent severe Major Depression with psychotic features. The prevalence rate of personality disorders was high for both groups: 58% for the older sample and 66% for the younger group. The younger group was more likely to be diagnosed Antisocial, Borderline, Passive-Aggressive, Sadistic, and Schizotypal, but the groups were not different in the rates of Obsessive-Compulsive Disorder. This study supports the hypothesis that some personality disorders remit with age. However, no evidence was found to suggest that other personality disorders become more prominent in older adult psychiatric populations. Suggestions for future research are offered.     

Construct validity of the Psychopathic Personality Inventory in a correctional sample

The relations between the Psychopathic Personality Inventory (PPI; Lilienfeld & Andrews, 1996) and 4 theoretically related constructs (empathy, aggression, work ethic, and borderline personality disorder) were examined. Additionally, the relation between the PPI and heroism was explored. One hundred male inmates were administered the PPI, the Questionnaire Measure of Emotional Empathy (Mehrabian & Epstein, 1972), the Aggression Questionnaire (Buss & Perry, 1992), the Protestant Ethic Scale (Mirels & Garrett, 1971), the Self-Report for Borderline Personality Scale (Oldham et al., 1985), and the Activity Frequency Inventory (Lilienfeld, 1998). As predicted, the PPI was significantly negatively correlated with empathy and significantly positively related to aggression and borderline personality. Contrary to prediction, the correlation between the PPI and work ethic was not significant. Eight of 11 hypotheses regarding the relations of the PPI subscales to these 4 constructs were corroborated. Results support the construct validity of the PPI in a correctional sample. The exploratory analysis of the relation between the PPI and heroism revealed no significant relations.     

The criterion validity of the Borderline Personality Features Scale for Children in an adolescent inpatient setting

The purpose of the current study was to examine the criterion validity of the Borderline Personality Features Scale for Children (BPFS-C) by assessing the performance of the self-report and a newly developed parent report version of the measure (BPFS-P) in detecting a borderline personality disorder (BPD) diagnosis in adolescent inpatients. This study also examined parent-child agreement and the internal consistency of the BPFS subscales. An inpatient sample of adolescents (n = 51) ranging from ages 12-18 completed the BPFS and were administered the Child Interview for DSM-IV Borderline Personality Disorder (CI-BPD) by trained clinical research staff. ROC analyses revealed that the BPFS-C has high accuracy (AUC = .931; Se = .856; Sp = .840) in discriminating adolescents with a diagnosis of BPD, as measured by the CI-BPD, while the BPFS-P has moderate accuracy (AUC = .795; Se = .733; Sp = .720). Parent-child agreement on total scores was significant (r = .687; p < .005). Cronbach's alphas suggested internal consistency for the four subscales of the BPFS. These findings support the criterion validity of this measure, particularly the self-report version, in adolescent inpatient settings.     

An Investigation of the Relationships among Negative Affect, Difficulties in Emotion Regulation, and Features of Borderline Personality Disorder

This study investigated the indirect effects of problematic emotion regulation on features of Borderline Personality Disorder (BPD) when accounting for negative affect in 456 participants from two distinct geographic regions. Participants completed the Affect Intensity Measure (AIM), Difficulties in Emotion Regulation Scale (DERS), the Emotion Regulation Questionnaire (ERQ), and the Borderline Symptom List (BSL). Results from this study supported a model in which there were significant indirect effects of both a lack of emotional clarity and limited access to emotion regulation strategies on features of BPD when accounting for negative affective intensity. Results also supported a second model in which there were significant indirect effects of both limited access to emotion regulation strategies and difficulties engaging in goal-directed behavior on features of BPD when accounting for negative affective reactivity. The results highlight important inter-relationships among features of BPD, difficulties regulating emotions, and negative affective intensity and reactivity.     

Dissociation predicts poor response to Dialectial Behavioral Therapy in female patients with Borderline Personality Disorder

A substantial proportion of Borderline Personality Disorder (BPD) patients respond by a marked decrease of psychopathology when treated with Dialectical Behavioral Therapy (DBT). To further enhance the rate of DBT-response, it is useful to identify characteristics related to unsatisfactory response. As DBT relies on emotional learning, we explored whether dissociation-which is known to interfere with learning- predicts poor response to DBT. Fifty-seven Borderline Personality Disorder (BPD) patients (DSM-IV) were prospectively observed during a three-month inpatient DBT program. Pre-post improvements in general psychopathology (SCL-90-R) were predicted from baseline scores of the Dissociative Experiences Scale (DES) by regression models accounting for baseline psychopathology. High DES-scores were related to poor pre-post improvement (β = -0.017 ± 0.006, p = 0.008). The data yielded no evidence that some facets of dissociation are more important in predicting DBT-response than others. The results suggest that dissociation in borderline-patients should be closely monitored and targeted during DBT. At this stage, research on treatment of dissociation (e.g., specific skills training) is warranted.     

Daily Occupations and Adaptation to Daily Life Described by Women Suffering from Borderline Personality Disorder

Clients suffering from Borderline Personality Disorder have significant impairments in relation to health. Despite this, their occupational status is rarely described. The aim of this study was to examine how women with Borderline Personality Disorder describe their daily occupations and adaptation to daily life. The study included nine participants. The data were collected using a semi-structured interview and were analyzed using content analysis.

Theme: Having few organized daily activities and poor personal causation prevent changes in adaptation to daily life. Two categories: performance and self-image, and four subcategories: competent or incompetent to perform, positive self-image, and lack of self-image were identified.     

Specific Personality Traits and General Personality Dysfunction as Predictors of the Presence and Severity of Personality Disorders in a Clinical Sample

This study examined the associations of specific personality traits and general personality dysfunction in relation to the presence and severity of Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM–IV]; American Psychiatric Association, 1994) personality disorders in a Dutch clinical sample. Two widely used measures of specific personality traits were selected, the Revised NEO Personality Inventory as a measure of normal personality traits, and the Dimensional Assessment of Personality Pathology-Basic Questionnaire as a measure of pathological traits. In addition, 2 promising measures of personality dysfunction were selected, the General Assessment of Personality Disorder and the Severity Indices of Personality Problems. Theoretically predicted associations were found between the measures, and all measures predicted the presence and severity of DSM–IV personality disorders. The combination of general personality dysfunction models and personality traits models provided incremental information about the presence and severity of personality disorders, suggesting that an integrative approach of multiple perspectives might serve comprehensive assessment of personality disorders.     

The clinical utility of the MMPI-2 Antisocial Practices Content Scale

This study explored the ability of the MMPI-2 Antisocial Practices Content Scale (ASP) to correctly classify DSM-IV Antisocial Personality Disorder (APD). ASP scores and scores on the MMPI-2 Psychopathic Deviate (Pd) scale were compared in an APD group (n = 10), a Borderline Personality Disorder group (n = 16), a Narcissistic Personality Disorder group (n = 9), an Other Personality Disorder group (representing personality disorders from Clusters A and C; n = 14), and a nonclinical population (NC; n = 67). The ASP exhibited an ability to differentiate APD from other personality disorders and was significantly correlated to DSM-IV diagnostic criteria for APD while the Pd was not. Diagnostic efficiency statistics (sensitivity, specificity, positive predictive power, negative predictive power, overall correct classification rate, and kappa) were calculated under four different conditions in a clinically relevant manner (Kessel & Zimmerman, 1993. Psychological Assessment, 53, 395-399). The results of this study illustrate the usefulness of the ASP as a tool for the assessment of antisocial attitudes, beliefs, and behaviors in individuals suspected of having APD. This information may be valuable to clinicians who are planning treatment or assessing treatment outcome for clients with APD.     

An investigation of psychopathology in nonreferred suicidal and nonsuicidal adolescents

This investigation examined self-reported psychopathology in a school-based sample of 456 suicidal and nonsuicidal adolescents. The sample consisted of four groups: three at-risk for suicidal behavior based on current suicidal ideation as assessed by the Suicidal Ideation Questionnaire (SIQ; Reynolds, 1988), past suicide attempts, or both; and one nonsuicidal comparison group. Psychopathology was examined using ten scales from the Adolescent Psychopathology Scale (APS; Reynolds, 1998a) including: Major Depression, Conduct Disorder, Substance Abuse, Schizophrenia, Adjustment Disorder, Anorexia Nervosa, Borderline Personality Disorder, Obsessive-Compulsive Personality Disorder, Schizotypal Personality Disorder, and Avoidant Personality Disorder. Analyses were conducted separately for males and females using a MANOVA design that examined psychopathology severity among the four groups. Adolescents who engaged in past or current suicidal behavior had higher psychopathology severity scores compared to their nonsuicidal peers. Males with current suicidal thoughts who had attempted suicide had the highest levels of psychopathology severity compared to males in the other three groups. Females with a past suicide attempt or current suicidal ideation had higher psychopathology severity scores compared to nonsuicidal females. Results show greater psychopathology in school-based adolescents who have engaged in past and/or current suicidal behavior. The need for clinicians and mental health professionals working with at-risk youth to focus on concurrent psychopathology along with suicidal behavior is discussed.     

Neuropsychological Dysfunction in Children with Borderline Personality Disorder Features: A Preliminary Investigation

Borderline personality disorder (BPD) is often linked to neuropsychological deficits, yet few studies have examined BPD or its features and concomitant neuropsychological dysfunction in childhood. This study examined children with borderline features (n = 21) using the Coolidge Personality and Neuropsychological Inventory for Children and compared them to controls (n = 21) with features of at least one personality disorder, but not BPD. As hypothesized, the BPD group scored significantly higher than the control group on the Attention Deficit/Hyperactivity Disorder, Executive Functions Deficits, Mild Neurocognitive Disorder, Conduct Disorder, and Oppositional Defiant Disorder scales. It appears that behavioral disturbances associated with BPD are linked strongly with neuropsychological dysfunction. Because none of the children with BPD features in the present sample had a history of traumatic brain injury (TBI), it appears likely that TBI in the histories of adult BPD patients may not be the cause of BPD, but traits such as anger and impulsivity in BPD may cause TBI. Clinical implications and future research directions are discussed.     

MACI Personality Patterns and DSM-IV Symptomology in a Sample of Troubled Mexican-American Adolescents

Bivariate and multivariate correlation analyses were used to investigate personality trait variables and their relation to DSM-IV symptomology in a clinically-identified sample of 142 Mexican-American adolescents. Personality variables were measured with the Personality Style subscales of the Millon Adolescent Clinical Inventory. DSM-IV symptomology was assessed by four clinical subscales of the Adolescent Psychopathology Scale. Canonical correlation analysis revealed two independent and salient patterns of correlation between the personality variables and symptomology which together accounted for 86% of the variance. We conceptualized these patterns as outgoing conformity and egotistical unruliness. Results are discussed in terms of cross-cultural issues and implications for mental health services for minority youth.     

Borderline Personality Disorder in Adolescence Through the Lens of the Interview of Personality Organization Processes in Adolescence (IPOP-A): Clinical Use and Implications

Borderline personality disorder can be assessed in adolescence mainly through a dimensional approach that takes into account strengths and weaknesses of emerging personality patterns. Clinical interviews could help clinicians to gather information about adolescent’s functioning, fostering therapeutic alliance and promoting a mentalizing stance during the assessment of borderline adolescents. In this article, the Interview of Personality Organization Processes in Adolescence (IPOP-A) is presented through clinical case material to show its usefulness in clinical and research settings. The IPOP-A assesses an adolescent’s emerging personality along three dimensions: identity, quality of object relations and affect regulation. These dimensions are the core of borderline personality in adolescence.     

智力和人格内隐观对大学生应对方式和抑郁的影响——变量中心和个体中心分析

为考察智力和人格内隐观对大学生应对方式和抑郁的影响,采用智力和人格内隐观问卷、简易应对方式问卷和抑郁量表对624名大学生进行测查。结果如下：（1）变量中心的分析结果表明,整体上大学生智力和人格内隐观仅对积极应对的预测作用显著。（2）为考察智力和人格内隐观在大学生群体中的组合类型,采用个体中心的分析思路对智力和人格内隐观得分进行潜在剖面分析,可将大学生的内隐观划分为四种类型：智力/人格固存观型、智力/人格内隐观适中型、智力增长观/人格可塑观型、智力固存观/人格可塑观型。四类大学生在智力内隐观上的得分两两差异显著;除智力增长观/人格可塑观型与智力固存观/人格可塑观型外,四类大学生在人格内隐观上的得分也两两差异显著。（3）智力增长观/人格可塑观型大学生的积极应对得分显著高于其他三类大学生,而消极应对和抑郁显著低于其他三类大学生;智力固存观/人格可塑观型大学生的消极应对和抑郁显著高于其他三类大学生。     

Assumptions in borderline personality disorder: specificity, stability and relationship with etiological factors.

The specificity and stability of a set of assumptions hypothesized to be characteristic of Borderline Personality Disorder (BPD) was investigated. BPD patients (n = 16) were compared to cluster-C personality disorder patients (n = 12) and to normal controls (n = 15). All subjects were female and diagnosed with SCID-I and -II. Subjects rated a short version of the Personality Disorder Beliefs Questionnaire (PDBQ), with six sets of 20 assumptions each, hypothesized to be characteristic of avoidant, dependent, obsessive-compulsive, paranoid, histrionic and borderline personality disorder. The BPD assumptions (Cronbach alpha = 0.95) proved to be the most specific to BPD patients. Subjects rated the shortened PDBQ again after viewing an emotional video fragment one week later. Despite increased negative emotions, the PDBQ ratings remained relatively stable. Confirming the cognitive hypothesis, regression analyses indicated that the BPD assumptions mediate the relationship between self-reported etiological factors from childhood (sexual abuse and emotional/physical abuse) and BPD pathology assessed with the SCID-II. It is suggested that a set of assumptions is characteristic of BPD, and is relatively stable despite the instability of the behaviour of people diagnosed as having BPD.