Aktuelle Entwicklungslinien in der Pers?nlichkeitsforschung im Jugendalter

Personality disorders in juveniles are still a controversially discussed topic. The aim of this paper is to describe the recent trend in personality research in adolescence and to outline perspectives in research and assessment. Recent study results have pointed out that personality disorders in juveniles can be reliably assessed with diagnostic instruments that have been developed for adults. At the same time there is a lack of specific instruments that can represent the characteristics during adolescence and that can differentiate personality disorders from youth crises. As some personality disorder dimensions also describe unstable developmental criteria we will focus separately on this differential diagnosis and meaning of stable versus transient personality characteristics in youth. The prevalence of personality disorders seems to be higher in adolescence than in adulthood. The stability, however, is comparable in adolescence and adulthood. Psychopathy as a subtype of the antisocial personality disorder ?C that can also be assessed in juveniles ?C will be discussed regarding its core and behavioral dimensions as well as primary and secondary subtypes. Furthermore, we discuss forensic issues when assessing personality disorders with respect to criminal responsibility. Overall we can show that more diagnostic longitudinal studies are essential in order to clarify under which conditions personality disorders develop, which factors influence its course and which interventions can change them.     

Change in self-concept differentiation after psychotherapy and its relation to psychological maladjustment

The research was carried out with a group of 105 psychotherapy participants, diagnosed with neurosis or personality disorders, and 36 controls. Analysis supported the hypotheses that self-concept differentiation (SCD) decreases after psychotherapeutic interventions and that the reduction in SCD is positively correlated with an improvement in neurotic symptoms and neurotic personality traits.     

国外人格障碍五因素模型研究述评

近些年来,国外许多心理学家致力于将基础的人格理论和人格障碍研究相结合的工作,其中将五因素模型引入人格障碍的研究已经取得了很大进展。文章主要总结了这方面的研究成果,探讨了将五因素模型应用于临床诊断和干预的可能性,最后讨论了未来人格障碍的研究方向     

The relationship between comorbid personality disorders and treatment received in patients with anxiety disorders

Few studies have addressed the relationship between the presence of a comorbid personality disorder and the amount of psychiatric treatment received by patients with an Axis I disorder. This issue has not been studied in patients with anxiety disorders. In a prospective, naturalistic, longitudinal study of anxiety disorders, 526 subjects were assessed with the Personality Disorder Examination, and types of treatment received in 1991 and 1996 were identified. In 1991, compared to subjects without a personality disorder, subjects with a personality disorder were as likely to receive medication and they received a greater number of medications. Subjects with borderline personality disorder were more likely to receive heterocyclic antidepressants and interventions characteristic of psychodynamic psychotherapy and cognitive therapy; they also reported receiving a greater number of medications and types of psychosocial treatment than other subjects. In 1996, subjects with borderline personality disorder were more likely to receive psychodynamic interventions. These findings suggest that in patients with an anxiety disorder, the presence of a comorbid personality disorder is associated with receiving a greater number of medications but not with a greater likelihood of receiving pharmacologic or psychosocial treatment. However, the presence of borderline personality disorder is associated with a greater likelihood of receiving, and receiving a greater number of, certain types of somatic and psychosocial treatments.     

When REBT Goes Difficult: Applying ABC-DEF to Personality Disorders

ABC-DEF framework is at the core of rational emotive behavior therapy. It is a highly flexible framework and has proven to be applicable to many emotional disorders. We cannot take for granted, however, that this framework can be used successfully with all clients, particularly with those suffering from severe disorders or personality disorders. In fact, the difficulties of these clients in recognizing, naming and reflecting upon states of mind, their dysregulated emotions and self-defeating behavior, and their difficulty in establishing a strong working alliance with a therapist may hamper the correct implementation of the ABC-DEF framework and the disputing of their irrational beliefs. This paper aims to describe in detail the challenges that clients with personality disorders may pose during treatment and offer possible technical suggestions, derived from either REBT or non-REBT literature, that can help REBT and CBT practitioners adapting their interventions to resistant clients.     

Temporal change: the third dimension of personality disorder

Until fairly recently, almost everyone who learned about, or carried out research into, personality disorders was taken in by the notion that personality disorder was a stable entity whose main characteristic was persistence, at least between the time of adolescence to middle age. We also suspected that those with these disorders, unless they received specific and necessarily powerful interventions, would remain continuously handicapped. Now it is clear that change in personality is possible, often rapidly so in some groups, and undergoes dynamic development from its genesis in childhood onward, and, though often achieving equilibrium, can never be said to be fixed in its manifestations. Longitudinal studies also show that personality abnormality identified early in life, whether temporary or longer-lasting, has a major influence on mental development and disorder generally, and, while it is impossible to say at present whether this influence is causal, it does suggest that early intervention could confer long-term benefits. An initiative such as that currently developed for early intervention in psychosis is at least as apt for personality disorder.     

Assessment is not enough: the SPA should participate in constructing a comprehensive clinical science of personality. Society of Personality Assessment

Several proposals for a comprehensive clinical science of personality are enumerated in this Klopfer award article, namely (a) the need to integrate the study of personality within a framework of universal principles from which its theories can be derived, its categories organized, its assessment tools constructed, and its therapeutic interventions designed; (b) the wisdom of conceptualizing personality disorders, not as discrete "disease entities" but as psychological prototypes; (c) the shift from the Diagnostic and Statistical Manual of Mental Disorders Axis I to Axis II distinction to a 3-part complexity continuum demarcated by simple reactions, complex syndromes, and personality patterns; (d) the utility of expanding the range and comparability of routinely appraised clinical domains; and (e) the refining and differentiation of personality style and personality pathology subtypes.     

The suicidal risk in severe personality disorders: differential diagnosis and treatment.

This article describes the clinical approach to patients with severe personality disorders who present suicidal intention and behavior, developed at the Personality Disorders Institute of the Department of Psychiatry at Cornell University Medical College and the Westchester Division of the New York Presbyterian Hospital. It describes the diagnostic evaluation of patients' suicidal potential, personality disorder, and the presence or absence of a spectrum of regressive illness. The analysis of the combined features in these three symptomatic domains determines alternative strategies of psychotherapeutic and psychopharmacological interventions. Within these strategies, transference-focused psychotherapy is described as a specific psychodynamic psychotherapy geared to treat characterologically based suicidal and parasuicidal tendencies in the context of the treatment of the patient's personality disorder.     

Psychodynamische Kurzzeittherapie bei dependenter und vermeidender Persönlichkeitsstörung

Although dependent and avoidant personality disorders are frequent in patient populations, there are only few studies in which the efficacy of psychotherapeutic interventions for these two personality disorders was reviewed. The purpose of this study was to examine whether psychodynamic short-term therapy based on the model of the cyclic maladaptive pattern (CMP) is effective for reducing the mental impairment of patients diagnosed with a dependent or an avoidant personality disorder. Data were collected via a self-report scale (Symptom-Checklist, SCL) and expert ratings by therapists [Global Assessment of Functioning (GAF) Scale and Severity of Impairment-Score (Beeinträchtigungsschwere-Score, BSS)]. In the study 20 patients received 25 sessions of outpatient therapy. Mental impairment decreased significantly from the beginning to the end of the therapy; moreover this decrease remained stable over a 2-year period following completion of the therapy. The findings show that psychodynamic short-term therapy can lead to an enduring improvement in the mental health of patients with a dependent or an avoidant personality disorder.     

A framework for integrating dimensional and categorical classifications of personality disorder

Although empirical evidence strongly supports a dimensional representation of personality disorder, there is strong resistance to dimensional classification due in part to concerns about clinical utility. Acceptance of an evidence-based dimensional classification would be facilitated by information on how such a system would map onto existing diagnoses. With this objective in mind, an integrated framework is proposed that combines categorical and dimensional diagnoses. A two-component classification is adopted that distinguishes between the diagnosis of general personality disorder and the assessment of individual differences in the form the disorder takes. Then, the DSM definition of personality disorders is extended by defining individual disorders as categories of trait dimensions. This makes it possible to develop an integrated classification organized around a set of empirically derived primary traits. Assessments of these traits may then be combined to generate categorical and dimensional diagnoses. It is argued that this approach would introduce an etiological perspective into the classification of personality disorder and improve categorical classification by providing an explicit definition of each diagnosis. The clinical utility of incorporating a dimensional classification is discussed in terms of convenience and acceptability, value in predicting outcomes and treatment planning, and usefulness in organizing and selecting interventions.     

The longitudinal relationship of personality traits and disorders

Personality disorders are presumed to be stable because of underlying stable and maladaptive personality traits, but while previous research has demonstrated a link between personality traits and personality disorders cross-sectionally, personality disorders and personality traits have not been linked longitudinally. This study explores the extent to which relevant personality traits are stable in individuals diagnosed with 4 personality disorders (schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders) and examines the assumption that these personality disorders are stable by virtue of stable personality traits. This assumption was tested via the estimation of a series of latent longitudinal models that evaluated whether changes in relevant personality traits lead to subsequent changes in personality disorders. In addition to offering large consistency estimates for personality traits and personality disorders, the results demonstrate significant cross-lagged relationships between trait change and later disorder change for 3 of the 4 personality disorders studied.     

NARCISSISTIC DEFENSES IN THE DISTORTION OF FREE ASSOCIATION AND THEIR UNDERLYING ANXIETIES

This paper examines particular distortions in the process of free association characteristics of patients with narcissistic personality disorders. The author proposes that the dominant narcissistic transference developments typical of the early and middle phases of the analytic treatment of these patients are reflected in these distortions of free association. This paper gathers the various patterns that these defensive distortions present, along with technical interventions geared to deal with them.     

Chronic suicidality and borderline personality

Suicidal ideation is a complex clinical event. In this article, acute suicidal ideation is compared with chronic suicidal ideation, specifically their different meanings, relationships with Axis I and Axis II disorders, intrapsychic functions, approaches to assessment, and interventions. The potential risks of acute hospitalization of the chronically suicidal borderline personality disorder patient are discussed as well as a longitudinal, multidimensional treatment strategy for the chronically suicidal individual.     

Emotion Focused Therapy for Avoidant Personality Disorder: Pragmatic Considerations for Working with Experientially Avoidant Clients

Emotion-focused therapy (EFT), an empirically supported treatment for depression and interpersonal difficulties, is now being directed towards clients with personality disorders, such as borderline and avoidant personality disorder. In this paper, both the value of, but also potential difficulties therapists can encounter while engaging in, active EFT chair interventions with clients with avoidant personality disorder (AVPD) are described. While EFT interventions can effectively transform emotion schemes at the heart of both intra and interpersonal difficulties, avoidant clients may have difficulties engaging in EFT interventions that activate core maladaptive emotion schemes related to self and negative/unaccepting representations of ‘others’. Alliance ruptures, intransigent experiential avoidance, or ‘unresolvable stand-offs’ may result. To avoid these problems, the importance of working with a more refined and content based case conceptualization of the particular avoidant client is highlighted. Guidance in optimal emotional processing in order to transform layers of maladaptive emotion schemes present within the client with AVPD is provided. Supporting these clients’ full striving for life, and their capacity to self-soothe is also discussed. A case example illustrates application of the model and principles.     

Cluster A Personality Disorders: Schizotypal,Schizoid and Paranoid Personality Disorders in Childhood and Adolescence

Cluster A personality disorders (PD), including schizotypal personality disorder (SPD), paranoid personality disorder (PPD), and schizoid PD, are marked by odd and eccentric behaviors, and are grouped together because of common patterns in symptomatology as well as shared genetic and environmental risk factors. The DSM-IV-TR describes personality disorders as representing stable and enduring patterns of maladaptive traits, and much of what is understood about Cluster A personality disorders in particular stems from research with adult populations. Less in known about these disorders in children and adolescents, and controversy remains regarding diagnosis of personality disorders in general in youth. The current paper reviews the available research on Cluster A personality disorders in childhood and adolescence; specifically, we discuss differentiating between the three disorders and distinguishing them from other syndromes, measuring Cluster A disorders in youth, and the nature and course of these disorders throughout childhood and adolescence. We also present recent longitudinal data from a sample of adolescents diagnosed with Cluster A personality disorders from our research laboratory, and suggest directions for future research in this important but understudied area.     

Inpatient adolescent group therapy as a social system

This paper describes a method of group therapy that 1) utilizes open systems theory to describe the social structure of group therapy, and 2)presents interventions drawn from Masterson's ideas for treating borderline personality disorders. Illustrations from a group therapy program for chemically dependent adolescents in a short-term, inpatient treatment unit of a general hospital are offered. It is proposed that under constrained conditions of treatment, such as those described, group therapy can be effective if there is precision about the system boundaries of task, role, time and place, and if group interventions are based upon a theoretically and clinically consistent model such as Masterson's.     

Treatment rejecting and treatment seeking personality disorders: Type R and Type S

An important distinguishing feature of one group of personality disorders is the wish of the sufferer to seek treatment. For another group this wish is rarely entertained. Although there is some variation between different types of personality disorder the wish to change is not confined to any one diagnostic category. A useful subclassification of personality disorders is therefore into Type R (treatment rejecting) and Type S (treatment seeking) personality disorders, and these are defined operationally. The classification of 68 personality disordered patients on the caseload of an assertive community team using a simple scale showed a 3 to 1 ratio between Type R and Type S personality disorders with Cluster C personality disorders being significantly more likely to be Type S, and paranoid and schizoid (Cluster A) personality disorders significantly more likely to be Type R than others. It is suggested that this typology is useful for those contemplating treatment with those who have personality disorders.     

Dimensions and categories: the "big five" factors and the DSM personality disorders

The five-factor model of personality, which has been widely studied in personality psychology, has been hypothesized to have specific relevance for DSM-defined personality disorders. To evaluate hypothesized relationships of the five-factor model of personality to personality disorders, 144 patients with personality disorders (diagnosed via a structured interview) completed an inventory to assess the five-factor model. Results indicated that the majority of the personality disorders can be differentiated in theoretically predictable ways using the five-factor model of personality. However, while the personality disorders as a whole appear to be differentiable from normal personality functioning on the five factors, the patterns are quite similar across the disorders, a finding that may provide some insight into the general nature of personality pathology but may also suggest problems with discriminant validity. Third, it does not appear that considering disorders as special combinations of features (as might be expected in some categorical models) is more informative than considering them as the sum of certain features (as might be expected in a dimensional model).     

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.