Patterns of personality pathology in patients with generalized anxiety disorder, panic disorder with and without agoraphobia, and social phobia

The relationship between co-occurring personality disorders and anxiety disorders (panic disorder with or without agoraphobia, social phobia, and generalized anxiety disorder) was examined, taking into account the effect of major depression. This article describes findings for 622 participants in the Harvard/Brown Anxiety Research Project, a longitudinal follow-up study of DSM-III-R-defined anxiety disorders. A total of 24% of participants had at least one personality disorder, with avoidant, obsessive compulsive, dependent, and borderline most common. Generalized anxiety disorder, social phobia, and major depression were positively associated with the occurrence of one or more personality disorders, whereas panic disorder with agoraphobia was not associated. Major depression was associated in particular with dependent, borderline, histrionic, and obsessive compulsive personality disorders and social phobia was associated with avoidant personality disorder. Whereas some of our findings confirm results from earlier studies, others are somewhat inconsistent with previous results and indicate the need for further investigation.     

Cardiac morbidity risk and depression and anxiety: a disorder, symptom and trait analysis among cardiac surgery patients

The aim of this study was to examine depression and anxiety disorders and their characteristic symptoms (anhedonia/low positive affect and anxious arousal, respectively), along with measures of state negative affect (NA) and Type D personality, in relation to cardiac surgery related morbidity. Patients awaiting elective coronary artery bypass graft surgery (n=158; 20.9% female; 11.4% concomitant valve surgery; age M=64.7, SD=10.6) underwent the structured MINI International Neuropsychiatric Interview to determine current affective disorders. Patients also completed the Mood and Anxiety Symptom Questionnaire and a measure of Type D personality traits. Postoperative cardiac morbidity was confirmed after surgery during the index hospitalization and included stroke,renal failure, ventilation>24 h, deep sternal wound infection, reoperation, arrhythmia and 30-day mortality at any location (n=59, 37.3% of total). After adjustment for age, recent myocardial infarction, heart failure, hypertension, urgency of surgery and time spent on cardiopulmonary bypass generalized anxiety disorder was associated with cardiac morbidity (odds ratio [OR]=3.26, 95% confidence interval [CI] 1.10-9.67, p=0.03). Adjusted analysis of personality traits revealed the NA component of Type D personality was associated with cardiac morbidity (OR=1.07, 95% CI 1.01-1.14, p=0.03). The Mood and Anxiety Symptom Questionnaire subscales were not associated with increased morbidity risk. Affective disorders, affective phenotypes, and personality traits were differentially associated with post-cardiac surgery morbidity outcomes independent of cardiac surgery morbidity risk factors. Concurrent investigation of depression and anxiety with respect to cardiac outcomes warrants further research.     

Personality and affect characteristics of outpatients with depression

This investigation was designed to examine the relationship between depression severity and personality disorders measured by the Millon Clinical Multiaxial Inventory-II (Millon, 1987) and affectivity measured by the Positive Affectivity/Negative Affectivity Schedule (Watson, Clark, & Tellegen, 1988). Discriminant analyses were employed to identify the personality and affective dimensions that maximally discriminate between 4 different levels of depressive severity. Differences between the 4 levels of depressive severity are suggestive of unique patterns of personality characteristics. Discriminant analysis showed that 74.8% of the cases were correctly classified by a single linear discriminant function, and that 61% of the variance in depression severity was accounted for by selected personality and affect variables. Results extend current conceptualizations of comorbidity and are discussed with respect to depression severity.     

Assessment of Problematic Situations and Coping Strategies in Women with Eating Disorders: Initial Validation of a Situation-Specific Problem Inventory

The current study examined the psychometric properties of the Anorexia and Bulimia Problem Inventory (ABPI; Eason, 1983) in women with and without diagnosed eating disorders. The ABPI was initially constructed in accordance with the Behavior-Analytic model of instrument development (Goldfried & D'Zurilla, 1969). In this investigation, the ABPI was refined to consist of 38 audiotaped problematic situations, including those related to eating and weight, academic, family, and interpersonal relationship issues, and scoring criteria to rate the effectiveness of responses. Convergent and discriminant validity were established between ABPI-R scores and the Eating Disorder Inventory (EDI; Garner, Olmsted, & Polivy, 1983) scales. As evidence of disciminative validity women with eating disorders received less ratings indicating less effective problem-solving on the ABPI-R scales than women without eating disorders. A significant increase in effective coping as measured by the ABPI-R was found for women following an 8-week outpatient eating disorders treatment program. Potential uses of this measure in research and clinical practice are discussed.     

Seizure episodes and death by drowning

473 cases of death by drowning were examined for evidence of previous neurological disorders linked with the occurrence of epileptic fits. It was found that 16 persons (3.4%) were undergoing medical treatment for epilepsy. In a further 10 cases there was evidence of the possibility of previous disorders in which epileptic fits and syncopal attacks played a dominant part. Besides the risks from the previous disorders, additional risk factors are discussed.     

Panic-relevant predictability preferences: a laboratory test

In the present investigation the authors evaluated the role of verbally instructed safety periods as they relate to predictability preference within a single-session challenge paradigm involving recurrent administrations of 20% carbon dioxide (CO-sub-2) enriched air. Participants included 160 nonclinical young adults (91 women, 69 men) between the ages of 18 and 59 (M=21.6 years; SD=7.23). Results indicated that equivalent levels of anxiety were experienced during predictable and unpredictable administrations of 20% CO-sub-2, yet participants preferred predictable compared with unpredictable trials, with women showing a stronger predictability preference than men. Lower anxiety was reported during known safety periods (predictable room air trials) but not during predictable compared with unpredictable administrations of 20% CO-sub-2. Findings are discussed in relation to theoretical and applied implications for the role of predictability in the nature of anxiety and its disorders.     

Genetic Testing of Children for Predisposition to Mood Disorders: Anticipating the Clinical Issues

Large-scale sequencing information may provide a basis for genetic tests for predisposition to common disorders. In this study, participants in the Coriell Personalized Medicine Collaborative (N?=?53) with a personal and/or family history of Major Depressive Disorder or Bipolar Disorder were interviewed based on the Health Belief Model around hypothetical intention to test one’s children for probability of developing a mood disorder. Most participants (87 %) were interested in a hypothetical test for children that had high (“90 %”) positive predictive value, while 51 % of participants remained interested in a modestly predictive test (“20 %”). Interest was driven by beliefs about effects of test results on parenting behaviors and on discrimination. Most participants favored testing before adolescence (64 %), and were reluctant to share results with asymptomatic children before adulthood. Participants anticipated both positive and negative effects of testing on parental treatment and on children’s self-esteem. Further investigation will determine whether these findings will generalize to other complex disorders for which early intervention is possible but not clearly demonstrated to improve outcomes. More information is also needed about the effects of childhood genetic testing and sharing of results on parent–child relationships, and about the role of the child in the decision-making process.     

The association between depression and thyroid disorders in a regionally representative Canadian sample

A subsample of six provinces (n = 67,621) from the 2005 Canadian Community Health Survey was used to determine the gender-specific prevalence of depression among those with and without thyroid disorders. Information was not available on the type of thyroid disorder. Logistic regression analyses were conducted to determine the odds and socio-demographic correlates of depression among those with and without thyroid disorders. Women had a significantly higher prevalence of thyroid disorders (9.3%) and depression (6.6%) than men (2.4% and 3.7%, respectively). Thyroid disorders were associated with 22% higher odds of depression in women after adjusting for socio-demographic factors, but no association was found in men. Among women with and without thyroid disorders, younger age, lower income, and limitations in Activities in Daily Living (ADL) were associated with higher odds of depression. Results suggest that women with thyroid disorders are more vulnerable to depression, and socio-demographic correlates of depression are similar among women with and without thyroid disorders.     

Childhood maltreatment associated with adult personality disorders: findings from the Collaborative Longitudinal Personality Disorders Study

Adverse childhood experiences such as abuse and neglect are frequently implicated in the development of personality disorders (PDs); however, research on the childhood histories of most PD groups remains limited. In this multisite investigation, we assessed self-reported history of abuse and neglect experiences among 600 patients diagnosed with either a PD (borderline, schizotypal, avoidant, or obsessive-compulsive) or major depressive disorder without PD. Results indicate that rates of childhood maltreatment among individuals with PDs are generally high (73% reporting abuse; 82% reporting neglect). As expected, borderline PD was more consistently associated with childhood abuse and neglect than other PD diagnoses. However, even when controlling for the effect of borderline PD, other PD diagnoses were associated with specific types of maltreatment.     

A family study of outpatients with borderline personality disorder and no history of mood disorder

While several studies have examined psychiatric disorders in the relatives of individuals with borderline personality disorder, many of these studies have not employed a family study methodology and suffer from other methodological shortcomings. Thus, the conclusions from family data addressing the validity of borderline personality disorder, its relation to other conditions, and its distinction from mood disorders, continue to be debated. The present investigation employed a family study design with direct interviews with relatives, structured diagnostic interviews with both probands and relatives, and blind assessment of relatives. Rates of psychiatric disorders were examined in 563 relatives of outpatients with mood disorders (n = 119), 54 relatives of outpatients with borderline personality disorder and no history of mood disorder (n = 11), and 229 relatives of never psychiatrically ill controls (n = 45). Results indicate increased rates of mood disorders and personality disorders in the relatives of borderline probands compared with never psychiatrically ill controls. Familial aggregation of psychiatric disorders was generally similar for borderline personality and the mood disorder comparison group. The results suggest there may be common etiological factors between borderline personality disorder and mood disorders.     

Clinical tests of memory in dementia, depression, and healthy aging

In Study 1, carefully screened elderly adults with primary degenerative dementia or major depression were compared to healthy aged control subjects on three tests of learning and memory: the Benton Visual Retention Test, Inglis Paired-Associate Learning Test, and the Fuld Object-Memory Evaluation (OME). The sharpest distinction in performance among the groups was observed on the OME, and discriminant equations based on this test correctly classified a high percentage (greater than or equal to 90%) of participants. Study 2 applied the classification rules derived in the first investigation to an unselected series of geropsychiatry inpatients referred for neuropsychological evaluation. There was agreement between memory test classification and general categories of clinical discharge diagnosis (organic vs. functional) for 21 of 25 patients, and with status at follow-up approximately 18 months later. Predictive value computations suggested that the OME is more accurate in confirming true dementia than in detecting dementia syndromes associated with functional disorders.     

Pathological gambling and personality disorders: a pilot-study with the MCMI-II

In this paper, the most frequent personality disorders related to pathological gambling are described. A sample of 50 pathological gamblers, who were assessed with the MCMI-II before treatment, and of 50 normative subjects from general population with the same demographic features (age, sex and socioeconomic level) was selected. According to the results, the 40% of clinical sample (versus the 14% of normative sample) showed at least one personality disorder. The most prevalent one was the Narcissistic (32%), followed by the Antisocial and Passive-Aggressive (16% each one of them). Furthermore, the gamblers with personality disorders presented an average of 2.2 disorders and tended to be more impulsive. Likewise pathological gamblers abused of alcohol, showed a mild anxiety and were not so adapted to everyday life as much as the control group. Finally, implications of this study for clinical practice and future research in this field are commented upon.     

Frequency of borderline personality disorder among psychiatric outpatients in Shanghai

The objective of this study was to investigate the frequency, clinical characteristics, and comorbidity of borderline personality disorder (BPD) among psychiatric outpatients in two clinics at Shanghai Mental Health Center. A cross-sectional investigation was conducted. From 3,075 outpatients screened using the Personality Diagnostic Questionnaire-IV+, 2,284 patients positive for a personality disorder were assessed using the Structured Clinical Interview for DSM-IV Personality Disorders. The frequency of BPD among the psychiatric outpatients was 5.8%, with a frequency of 3.5% among males and 7.5% among females (p < .01). BPD was found to have extensive comorbidity with Axis I and II disorders. This study proves that BPD does occur in China. The detected frequency among outpatients is lower than that reported in North America.     

Chronic stress and depressive disorders in older adults

Current and lifetime rates of Diagnostic and Statistical Manual (rev. 3rd ed.) disorders were compared in 86 older adults caring for a spouse with a progressive dementia and 86 sociodemographically matched control subjects. Dementia caregivers were significantly more dysphoric than non-care givers. The frequencies of depressive disorders did not differ between groups in the years before care giving, and there were no group differences in first-degree relatives' incidence of psychiatric disorder. During the years they had been providing care, 30% of care givers experienced a depressive disorder (major depression, dysthymia, or depression not otherwise specified) versus 1% of their matched controls in the same time period. Only two care givers who met criteria during care giving had met criteria for a depressive disorder before care giving, and family history was not even weakly related to the identification of at-risk care givers. In contrast to these group differences in depressive disorders, there were no significant differences in other Axis I disorders either before or during care giving. Thus, the chronic strains of care giving appear to be linked to the onset of depressive disorders in older adults with no prior evidence of vulnerability.     

Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample.

The comorbidity of current and lifetime DSM-IV anxiety and mood disorders was examined in 1,127 outpatients who were assessed with the Anxiety Disorders Interview Schedule for DSM-IV: Lifetime version (ADIS-IV-L). The current and lifetime prevalence of additional Axis I disorders in principal anxiety and mood disorders was found to be 57% and 81%, respectively. The principal diagnostic categories associated with the highest comorbidity rates were mood disorders, posttraumatic stress disorder (PTSD), and generalized anxiety disorder (GAD). A high rate of lifetime comorbidity was found between the anxiety and mood disorders; the lifetime association with mood disorders was particularly strong for PTSD, GAD, obsessive-compulsive disorder, and social phobia. The findings are discussed in regard to their implications for the classification of emotional disorders.     

Hospital-Treated Psychiatric Disorders in Adults with a Single-Parent and Two-Parent Family Background: A 28-Year Follow-up of the 1966 Northern Finland Birth Cohort

This study investigates the relationship between the family type (two-parent and 4 different single-parent types, mainly divorced) during childhood up to 14 years of age and adult hospital-treated psychiatric disorders in a sample from the unselected, general population Northern Finland 1966 Birth Cohort (N = 11,017). Up to the end of 1994, a total of 387 individuals (3.5%) had a hospital-treated psychiatric disorder, with 3.1% in two-parent families and 5.4% in single-parent families (p < .001). The single-parent family was not associated with the child's schizophrenia or other psychotic disorders. The adjusted odds ratios (OR) for personality disorders were highest among individuals without a father before the age of 14 years (OR 4.8), or at birth only (OR 4.0), or with a history of parental divorce (OR 2.8). Parental divorce was also associated with alcoholism (OR 3.7) and parental death with depressive disorders (OR 3.4). In conclusion, we found an elevated risk of hospital-treated nonpsychotic disorder among individuals from a single-parent family background. It is likely that a combination of the single-parent family and psychosocial and/or genetic risk may influence the development of these disorders.     

Early maladaptive schemas of personality disorder subtypes.

This investigation attempted to examine the cognitive schemas of five distinct clusters that emerged from a cluster analysis of the personality disorder scales of the Millon Clinical Multiaxial Inventory-II (Millon, 1987). Specifically, the degree to which early maladaptive schemas, as measured by the Cognitive Schema Questionnaire-Short Form (Young, 1994), could correctly identify empirically derived patterns of personality disorders was examined. Between-cluster differences centered on five personality components and five schemas. Discriminant analyses revealed two significant functions composed of cognitive schemas, which correctly identified 61.2% of the entire sample in terms of cluster group membership. The total proportion of variance in the two significant functions associated with cluster group differences was 76.8%. Findings are discussed in relation to the domain theory of personality disorders posited by Millon and Davis (1996).     

Emotions as wishes and beliefs

Emotions can be assessed by means of different diagnostic methods, for example, by self-report instruments, ratings of facial expressions, or by projective techniques. This study presents an alternative approach: a computerized investigation of verbally expressed emotions by means of the Affective Dictionary Ulm (ADU; Dahl, H?lzer, & Berry, 1992), which was applied to responses in the Holtzman Inkblot Technique (HIT; Holtzman, 1988; Holtzman, Thorpe, Swartz, & Herron, 1961). A normal group (n = 30), patients with neurotic disorders (n = 30), borderline patients (n = 30), acute schizophrenics (n = 25), and chronic schizophrenics (n = 25) were compared in regard to verbally expressed emotions. According to the results, patients with neurotic disorders did not differ from the normal group in regard to verbally expressed emotions. Borderline patients expressed fear and emotions in general significantly more frequently than all other diagnostic groups. Furthermore, borderline patients differed in regard to specific emotions from patients with neurotic disorders, acute schizophrenics, and chronic schizophrenics. Acute schizophrenics did not differ from the normal group in regard to the expression of emotions, whereas chronic schizophrenics expressed anger, fear, anxiety, and emotions in general significantly less frequently than normals. By a discriminant analysis using verbally expressed emotions as predictors of the diagnosis, hit rates between 87% and 100% could be achieved. Furthermore, hypotheses about correlations between emotions on the one hand and internalized primitive object relations and bizarre-idiosyncratic thinking were tested empirically. Significant correlations could be demonstrated. These results support the validity of assessing emotions through a lexical content analysis of the HIT by use of the ADU.     

Psychische Beschwerden und Störungen von Studierenden

Background

Psychological distress among students is receiving growing attention in the scientific community as well as in the general public. There are counseling services available in student societies and universities which address psychological distress among students but scientific research in this area is rudimentary and poorly represented.

Problem in question

In order to present the prevalence, extent and type of psychological disorders in students and the alterations over time, an investigation was carried out to show which psychological complaints and disorders were present in students who consulted a psychotherapeutic counseling center. These data were compared with the psychological complaints of a student field study population. Furthermore, alterations in the psychological complaints and disorders of students over periods of 10 and 15 years will be presented.

Methods

The prevalence and change over time of psychological syndromes in students were identified by a comparison between an unselected sample of counseling center clients and several student field samples from the previous 15 years. The type of distress and severity of symptoms were measured with a Symptom Checklist (SCL-90-R), the Psychosocial Complaints List (PSB), the Satisfaction With Life And Studies Scale (LSZ), the diagnostic assessment according to International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10), the Complaints Severity Score (BSS) and Global Assessment of Functioning (GAF).

Results

Previous results of investigations which showed that 20–25% of students suffer from psychological disorders could be confirmed in this study. However, 60–65% of the clients of a counseling center suffered from clinically relevant psychological disorders, which is significantly higher. The most common disorders were depressive moods, lack of self-confidence and exam anxiety, which can mostly be diagnostically assigned to adjustment, depression and anxiety disorders. The comparison with previous studies showed that the types and severity of psychological distress among students have remained stable over the last 15 years, with the exception of test anxiety which increased by 51% from 1993 to 2008. With respect to alcohol abuse, considerably less impairments were found than had been assumed based on the earlier investigations.

Conclusions

Psychological complaints and disorders are frequently found among students and they cause individual suffering as well as economic expenses. Noticeable was the obvious increase in clinically relevant exam anxiety. Psychological-psychotherapeutic counseling centers make an important contribution to screening, clinical assessment, primary health care and prevention of severe mental disorders among students and have shown a continuously increasing number of cases in recent years. Further studies especially in a process-outcome design of the mostly eclectic counseling centers are needed and possibilities will be presented.     

A Comparison of Simultaneous Prompting and Constant Time Delay Procedures in Teaching State Capitals

This investigation compared the effectiveness and efficiency of constant time delay (CTD) and simultaneous prompting (SP) procedures in teaching discrete social studies facts to 4 high school students with learning and behavior disorders using an adapted alternating treatments design nested within a multiple probe design. The results indicated that both procedures were effective, with the simultaneous prompting procedure being slightly more efficient in terms of errors during instructional and maintenance phases. In addition, when interviewed about their preferences, both the instructor and participants preferred the simultaneous prompting procedure. This investigation extends current research as there are small numbers of studies comparing SP to other response prompting strategies, and to date, SP and CTD have not been compared with high school students with high-incidence disabilities. Future research issues are discussed.