Development of personality disorder symptoms and the risk for partner violence

In a community sample (N = 543) followed over 20 years, the authors studied associations among childhood family violence exposure, personality disorder (PD) symptoms, and adult partner violence. PD symptoms (DSM-III-R Clusters A, B, and C) in early adulthood partially mediated the effect of earlier childhood risks on the odds of perpetrating partner violence. The authors tested whether stability of PD symptoms from adolescence to the early 20s differs for individuals who later perpetrated partner violence. Cluster A ("Odd/Eccentric") symptoms declined less with age among partner violent versus nonviolent men and women. Cluster B ("Dramatic/Erratic") symptoms were more stable through late adolescence in partner violent men, compared with nonviolent men and violent women. Cluster C ("Anxious") symptoms were most stable among partner violent men.     

Sadistic personality disorder in sex offenders: relationship to antisocial personality disorder and sexual sadism.

To investigate the relationship of sadistic personality disorder (SPD), as defined in the appendix of DSM-III-R, to other personality disorders and to sexual sadism, 70 sex offenders (27 child molesters, 33 rapists, and 10 murderers) were assessed by the International Personality Disorder Examination. In 19 subjects (27.2%) from the total sample, SPD was diagnosed. The highest overlap appeared with borderline personality disorder (31.6%) and antisocial personality disorder (42.1%). However, in four cases SPD was the only personality disorder diagnosed. Factor analysis of the antisocial and sadistic criteria resulted in four major factors--one factor with high loadings on the sadistic criteria and the violent criteria of antisocial personality disorder, two factors with different forms of adult and juvenile aggression, and a fourth factor with high loadings on the antisocial criteria covering exploitative behavior. The results do not support SPD as a discrete disorder. Nevertheless, SPD may be seen as an important subdimension of antisocial personality disorder, distinct from more exploitative forms of antisocial behavior with less violence. Of those patients with SPD, 42.1% also had a DSM-III-R diagnosis of sexual sadism, which may be the most dangerous configuration.     

Age-related changes in word retrieval vary by self-reported anxiety but not depression symptoms

Tip-of-the-tongue states (TOTs) are known to increase in frequency across adulthood, but there is wide variability in older adults’ TOT rates, suggesting that individual difference factors contribute to TOT incidence. We investigated the role of affect by examining the relationship between self-reported anxiety and depression symptoms and the frequency of TOTs during a laboratory task. Participants were young, middle-aged and older adults in a population-based sample of adults aged 18–87. Increased anxiety was associated with fewer TOTs for the middle-aged group but more TOTs for the older adult group. There was no relationship between anxiety and TOTs for younger adults and no relationships between depression symptoms and TOT incidence for any age group. We discuss our results in terms of attentional control theory, which provides an explanation of how age may affect the relationship between anxiety and TOTs.     

Borderline personality disorder in an intermediate psychological therapies service

The intermediate psychological therapies service is provided for individuals referred with common mental health problems within the primary care psychological therapies service, but whose difficulties are longstanding and/or complex. The prevalence of borderline personality disorder (BPD) in intermediate psychological therapy services has not been researched to-date. The current study aimed to measure the prevalence of BPD amongst patients attending intermediate psychological therapies (n?=?63). The prevalence of BPD was established by identifying the number of patients who met DSM-IV criteria. BPD prevalence amongst patients attending an intermediate psychological therapy service was 37%. The high proportion of patients presenting with BPD indicates the potential need for staff training and supervision in how to manage such high levels of need at this service level. This is the first study to report prevalence rates of BPD specifically in an intermediate care psychological therapy service.     

Differential effects of psychopathy and antisocial personality disorder symptoms on cognitive and fear processing in female offenders

Psychopathy and antisocial personality disorder (APD) have long been considered important risk factors for criminal behavior and incarceration. However, little is known about the psychobiological underpinnings that give rise to the disinhibited behavior of female offenders. Using an instructed fear-conditioning paradigm and a sample of incarcerated female offenders, we manipulated attentional focus and cognitive load to characterize and differentiate between the dysfunctional cognitive and affective processes associated with these syndromes. We used fear-potentiated startle (FPS) and event-related potentials as measures of affective and cognitive processing, respectively. After controlling for APD symptoms, psychopathic women displayed greater FPS while attending directly to threat-relevant stimuli and displayed less FPS while performing a demanding task that directed attention to threat-irrelevant information. Conversely, controlling for psychopathy, women with high APD symptoms displayed less overall FPS, especially when instructed to focus on threat-relevant stimuli. However, as the demands on cognitive resources increased, they displayed greater FPS. For both psychopathy and APD, analysis of the event-related potentials qualified these findings and further specified the abnormal cognitive processes associated with these two syndromes. Overall, simultaneous analysis of psychopathy and APD revealed distinct patterns of cognitive processing and fear reactivity.     

Low self-esteem is related to aggression, antisocial behavior, and delinquency

The present research explored the controversial link between global self-esteem and externalizing problems such as aggression, antisocial behavior, and delinquency. In three studies, we found a robust relation between low self-esteem and externalizing problems. This relation held for measures of self-esteem and externalizing problems based on self-report, teachers' ratings, and parents' ratings, and for participants from different nationalities (United States and New Zealand) and age groups (adolescents and college students). Moreover, this relation held both cross-sectionally and longitudinally and after controlling for potential confounding variables such as supportive parenting, parent-child and peer relationships, achievement-test scores, socioeconomic status, and IQ. In addition, the effect of self-esteem on aggression was independent of narcissism, an important finding given recent claims that individuals who are narcissistic, not low in self-esteem, are aggressive. Discussion focuses on clarifying the relations among self-esteem, narcissism, and externalizing problems.     

Borderline personality disorder and age of onset in major depression

In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we tested the hypothesis that borderline personality disorder (BPD) accounts for the observed differences between early and late onset major depressive disorder (MDD). A total of 440 depressed outpatients were evaluated with semistructured interviews. Patients were subdivided by age of onset and the presence or absence of comorbid BPD. The overall pattern of clinical and demographic variables differed and two separate, multiple, logistic regression analyses addressed the association between age of onset and BPD in MDD patients. Comorbid BPD was not significant in the multivariable age of onset equation and the results of the multivariable analyses support the idea of difference between subtypes. It is concluded that although early age of onset is predictive of BPD, BPD is not a universal feature of early-onset MDD.     

Substance use and violent behavior in women with antisocial personality disorder

The purpose of this study was to examine the relationship between substance abuse and dependence and violent behavior in a sample of incarcerated women with antisocial personality disorder (ASPD). Among male populations, substance dependence is associated with aggression and criminal behavior. Individuals with ASPD have more severe substance dependence, including higher symptom counts, earlier age of onset, and more frequent co-morbidity. Incarcerated women have a high prevalence of ASPD and substance dependence, but there has been little detailed work regarding addiction severity. Similarly, work on association of substance abuse and dependence with specific violent behaviors has been limited. This study examined a group of 41 mid-sentence female felons with a diagnosis of ASPD to determine associations with substance abuse and dependence. Data were gathered through administration of the Semi-Structured Assessment of the Genetics of Alcoholism II (SSAGA II). Substance dependence was highly prevalent (i.e., alcohol dependence, 56.1%; opiate dependence, 48.8%; cocaine dependence, 61.0%). While specific diagnoses were not associated with violent behavior and offending, symptom severity (i.e., age of onset, symptom count, co-morbidity) was associated with violent behavior in women dependent on opiates, alcohol, and cocaine. Arrest for an assault 1 was associated with alcohol dependence and opiate dependence. These data suggest that measurement of symptom severity and co-morbidity is important in assessing violent behavior in incarcerated women with ASPD. These findings are potentially important in examining non-incarcerated, substance-dependent women.     

Newborn right-holding is related to depressive symptoms in bottle-feeding mothers but not in breastfeeding mothers

This study examines the relationships between infant holding preferences and maternal depression according to the newborn feeding mode. Links between depression and infant holding biases have been observed in mothers [Vauclair, J., Scola, C. (in press). Dépression, alexithymie et latéralisation dans la fa?on de porter un nouveau-né [Infant holding biases in relation to depression, alexithymia and laterality]. Annales Médico-psychologiques; Weatherill, R. P., Almerigi, J. B., Levendosky, A. A., Bogat, G. A., von Eye, A., & Harris, L. J. (2004). Is maternal depression related to side of infant holding? International Journal of Behavioral Development, 28, 421-427] but the fact that breastfeeding has never been studied in relation to these two factors is surprising as breastfeeding has some influence on depression (e.g., [Mezzacappa, E. S., Guethlein, W., Vaz, N., & Bagiella, E. (2000). A preliminary study of breast-feeding and maternal symptomatology. Annals of Behavioral Medicine, 22, 71-79]) and must also affect holding biases. Mothers who just gave birth (N=100) were tested few days after delivery. Measures of handedness, infant holding-side preferences, and level of depressive symptoms expressed by mothers (assessed with the CES-D scale) were collected via questionnaires. Asymmetries in emotional perception were assessed via a Chimeric Figure Task and a Dichotic Listening Task. Results showed that breastfeeding (1) reduced left-side bias for holding newborns and (2) was associated with lowest levels of depressive symptoms. Moreover, holding biases were related to maternal depression in bottle-feeding but not in breastfeeding mothers, namely that holding on the right-side while bottle-feeding was associated with higher levels of depressive symptoms. These results were not due to hemispheric specialization as auditory and visual asymmetries were similar between breastfeeding and bottle-feeding mothers. The discussion emphasizes the striking role of the early mother/child relationship's establishment on infant holding biases.     

Sustained attention is related to heartbeat counting task performance but not to self-reported aspects of interoception and mindfulness

Although association between sustained attention and various aspects of interoception (i.e. the perception of the body state) seems plausible, research on this subject is scarce. In the present study, 74 undergraduate students (41 females; age: 22.3 ± 4.04 yrs) filled out the Body Awareness Questionnaire, the Mindful Attention Awareness Scale, and the Somatosensory Amplification Scale and completed the Heartbeat Counting Task (HCT), a sensory-perceptual measure of cardiac interoception and the PEBL Continuous Performance Test (CPT) assessing sustained attention. The HCT score showed a weak to moderate negative correlation with the number of commission errors shown in CPT, indicating a lack of response inhibition (frequentist analysis: r_s = −0.313, p = 0.008; Bayesian analysis: τ_b = −0.216, BF₁₀ = 5.865). Questionnaire measures did not show any connection with CPT-performance. These findings suggest that the subjective representation of attentiveness to bodily processes is unrelated to the objectively measured sustained attention. Response inhibition, however, is moderately related to HCT performance.     

Inhibitory control and negative emotional processing in psychopathy and antisocial personality disorder

The field of personality disorders has had a long-standing interest in understanding interactions between emotion and inhibitory control, as well as neurophysiological indices of these processes. More work in particular is needed to clarify differential deficits in offenders with antisocial personality disorder (APD) who differ on psychopathic traits, as APD and psychopathy are considered separate, albeit related, syndromes. Evidence of distinct neurobiological processing in these disorders would have implications for etiology-based personality disorder taxonomies in future psychiatric classification systems. To inform this area of research, we recorded event-related brain potentials during an emotional-linguistic Go/No-Go task to examine modulation of negative emotional processing by inhibitory control in three groups: psychopathy (n = 14), APD (n = 16), and control (n = 15). In control offenders, inhibitory control demands (No-Go vs. Go) modulated frontal-P3 amplitude to negative emotional words, indicating appropriate prioritization of inhibition over emotional processing. In contrast, the psychopathic group showed blunted processing of negative emotional words regardless of inhibitory control demands, consistent with research on emotional deficits in psychopathy. Finally, the APD group demonstrated enhanced processing of negative emotion words in both Go and No-Go trials, suggesting a failure to modulate negative emotional processing when inhibitory control is required. Implications for emotion-cognition interactions and putative etiological processes in these personality disorders are discussed.     

Unique roles of antisocial personality disorder and psychopathic traits in distress tolerance

Previous research indicates that individuals with antisocial personality disorder (ASPD) evidence low distress tolerance, which signifies impaired ability to persist in goal-directed behavior during an aversive situation, and is associated with a variety of poor interpersonal and drug use outcomes. Based on theory and research indicating that psychopathic traits are associated with hypo-reactivity in emotional responding, a unique hypothesis emerges where psychopathic traits should have the opposite effect of ASPD and be related to high levels of distress tolerance. In a sample of 107 substance-dependent patients in an inner-city substance use residential treatment facility, this hypothesis was supported. ASPD was related to lower distress tolerance, while psychopathic traits were related to higher distress tolerance, with each contributing unique variance. Findings are discussed in relation to different presentations of distress tolerance as a function of psychopathic traits among those with an ASPD diagnosis.     

Reliability of personality disorder symptoms and personality traits in substance-dependent inpatients

The authors compared the internal consistency, 1-year temporal stability, and self-informant agreement of ratings of personality trait (NEO Five-Factor Inventory; NEO-FFI; P. T. Costa & R. R. McCrae, 1992) and personality disorder symptom severity (Structured Clinical Interview for DSM-III-R Personality Disorders Questionnaire; SCID-II-Q; R. L. Spitzer, J. B. W. Williams, M. Gibbon, & M. First, 1990) in 131 substance-dependent inpatients. Internal consistency coefficients were acceptable to very good for most NEO-FFI and SCID-II-Q scales, and temporal stability correlations were significant for all measures. Agreement between patient and informant ratings was more modest. Substance abuse and depression symptom severity moderated the temporal stability and self-informant agreement of several personality trait and disorder ratings. The authors did not find that the five factors were more reliable than the Axis II symptoms. Issues related to the reliability of personality assessment in multiply diagnosed patients are discussed.     

Dispositional pessimism but not optimism is related to sickness absence caused by musculoskeletal symptoms

Musculoskeletal disorders account for a higher proportion of sickness absence from work in the European Union than any other health condition. The present study examined the associations between work environment, dispositional optimism/pessimism and medically certified sickness absence caused by musculoskeletal complaints in a sample of employees from the Norwegian Armed Forces (N = 1190, 77.5% men). Dispositional pessimism, but not optimism, predicted the amount of absence also when taking into account the effects of age and the work environment. Overall, our results support previous studies suggesting that pessimism is a more salient predictor of physical health than optimism. Our results also suggest that it may be beneficial for employers to combine medical treatment of musculoskeletal symptoms with psychological treatment targeting pessimistic outcome expectancies in order to reduce the amount of sickness absence.     

Childhood antisocial behaviors as predictors of psychotic symptoms and DSM-III-R borderline criteria among inpatients with borderline personality disorder.

Structured clinical interviews of 107 female inpatients diagnosed with borderline personality disorder (BPD) were used to determine whether antisocial personality disorder (APD) diagnostic criteria evident prior to age 15 could be used to predict current Axis I and Axis II psychopathology. Diagnostic information was gathered using the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) and the Structured Clinical Interview for DSM-III-R-Patient Version (SCID-P). Childhood APD criteria were subjected to principal-components analysis, and three factors--rule-breaking, assault, and sadism--emerged. The severity of the childhood APD criteria was related to psychotic symptoms, as well as to the unstable relationships and labile affect BPD criteria and the current overall severity of BPD criteria. Sadism predicted psychotic symptoms and BPD severity, while rule-breaking predicted unstable relationships and BPD severity. Childhood APD severity also had a larger effect on BPD severity than on psychotic symptoms. Possible explanations for these findings are explored and discussed.     

Borderline personality disorder symptoms as predictors of 4-year romantic relationship dysfunction in young women: addressing issues of specificity

The relationships between romantic relationship dysfunction and symptoms of borderline personality disorder (BPD), other personality disorders, and depression were examined prospectively in a community sample of 142 late adolescent women. Although BPD symptoms predicted 4-year romantic dysfunction (romantic chronic stress, conflicts, partner satisfaction, abuse, and unwanted pregnancy), the associations were not unique to BPD. Instead, relationship dysfunction was better predicted by a cumulative index of non-BPD Axis II pathology. Depression did not predict outcomes uniquely when Axis II symptoms were included, except in the case of unplanned pregnancy. The results suggest that although BPD is associated with relationship dysfunction, the effect is a more general phenomenon applying rather broadly to Axis II pathology. The results also highlight the importance of subclinical psychopathology in the construction of early intimate relationships.     

Facial asymmetry is negatively related to assertive personality but unrelated to dominant personality in men

Fluctuating asymmetry (FA) is a putative indicator of development instability in humans and other species, and some literature supports a women’s preference for low degree of FA in opposite sex (e.g., symmetrical face). Also some personality traits associated to social status (e.g., dominance and assertiveness) are attractive to women due to direct and indirect benefits associated to high status. The aim of this work was to study the relationship between facial FA and dominant and assertive personalities. We found a negative correlation between facial FA and assertive personality but not between facial FA and dominant personality. Moreover, we found a positive correlation between assertive and dominant personality. Our results suggest that a low facial FA and assertive personality can be related to be advertising desirable traits and high status in men in order to be more attractive to women. This study supports the evidence shown by previous works which shows that a low facial FA is related with socially desirable and attractive aspects of personality.     

An empirical study of object relations and defensive operations in antisocial personality disorder

This study assessed the object relations, defensive operations, and level of psychopathy and narcissism in a group of antisocial personality disordered offenders. The Rorschach protocols of 33 subjects who met the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R], American Psychiatric Association, 1987) criteria for antisocial personality disorder were analyzed utilizing Kwawer's (1980) criteria for borderline object relations categories (borderline phenomena), the Lerner and Lerner (1980) Defense Scale, and a number of experimental criteria including Cooper and Arnow's (1986) defense criteria. Level of narcissism was assessed utilizing Exner's (1973) Self-Focus Sentence Completion Test. Hare's Psychopathy Checklist was used as an independent variable to determine a subject's level of psychopathy. Those subjects scoring 30 or more on the psychopathy checklist were compared to subjects scoring less than 30. The level of narcissism or proportion of defenses did not differ significantly between the severe psychopaths (greater than or equal to 30) and the moderate psychopaths (less than 30). The severe psychopaths produced a significantly greater number of borderline object relations. I conclude that antisocial individuals tend to be highly egocentric, and that narcissism is one component of psychopathy. Severe psychopaths, as a group, tend to be more borderline in their functioning than those exhibiting moderate levels of psychopathic disturbance. I also conclude that individuals who are incarcerated for felony offenses and also meet the DSM-III-R criteria for antisocial personality disorder exhibit degrees of borderline personality organization.