Psychological test signs of borderline personality disorder: a review of the empirical literature

Recent empirical work aimed at identifying test signs of borderline personality disorder is reviewed. The review focuses on commonly employed clinical tests, including the Wechsler Adult Intelligence Scale (WAIS), the Rorschach, and the Minnesota Multiphasic Personality Inventory (MMPI). Possible test signs are considered in relation to their sensitivity to and specificity for the diagnosis and in relation to the criteria of DSM-III, which define the disorder. Although consistent patterns of potentially useful test signs have begun to appear, methodological difficulties have hampered any subsequent development of clinically useful indices. Greater attention to sample size and its composition and definition as well as demonstrations of adequate reliability and predictive utility are required for further development of these signs.     

Neurological and neuropsychological signs in obsessive compulsive disorder: interaction with behavioural treatment

The main aim of this study was to test the hypothesis that neurological soft signs and neuropsychological abnormalities associated with obsessive-compulsive disorder (OCD) predict poor response to behavioural treatment. The design permitted investigation of secondary hypotheses, regarding correlations among these neurological markers and levels of symptomatology, and their stability in relation to changes in levels of symptomatology. Thirty-five participants satisfying DSM-IV diagnostic criteria for OCD were assessed pre- and postbehavioural treatment using a scaled measure of symptom severity, and a battery of tests sensitive to neuropsychological deficits associated with OCD. Eighteen of the participants were also assessed on an inventory of neurological soft signs. Neither neuropsychological test deficits nor neurological soft signs pretreatment predicted response to behavioural treatment. Lower performance on neuropsychological tasks and symptom severity were both significantly correlated with levels of soft signs. Some neurological markers were less severe posttreatment, but these changes were not related to treatment response.     

From early markers to neuro-developmental mechanisms of autism

A fast growing field, the study of infants at risk because of having an older sibling with autism (i.e. infant sibs) aims to identify the earliest signs of this disorder, which would allow for earlier diagnosis and intervention. More importantly, we argue, these studies offer the opportunity to validate existing neuro-developmental models of autism against experimental evidence. Although autism is mainly seen as a disorder of social interaction and communication, emerging early markers do not exclusively reflect impairments of the “social brain”. Evidence for atypical development of sensory and attentional systems highlight the need to move away from localized deficits to models suggesting brain-wide involvement in autism pathology. We discuss the implications infant sibs findings have for future work into the biology of autism and the development of interventions.     

Neurological soft signs and school achievement: The mediating effects of sustained attention

A group of 115 black male adolescents drawn from a clinically unselected birth cohort, half of whom were known to have had neurological soft signs at age 7, were examined at age 17 to determine the relation between soft signs and performance on standard tests of school achievement and sustained attention. Three signs measured at age 17-dysgraphesthesia, difficulties with rapid alternating movements (dysdiadochokinesis), and motor slowness—were related to lower concurrent and past IQ and to impaired performance on laboratory and paper-and-pencil measures of sustained attention. The relation between signs and the attentional measures remained significant after IQ was statistically controlled. The three age 17 soft signs as well as age 7 signs were related to impaired performance on standardized tests (age 17) of school achievement. Most of the relation between signs and school achievement could be accounted for by the variance signs shared with sustained attention. One sign, mirror movements, was unrelated to all other attentional and cognitive measures.The study was supported by center grant MH 306906 and research training grant 5 T32 MH 13043-13 from the National Institute of Mental Health, as well as by the City College and the City University Computing Centers. We thank Lillian Belmont and two reviewers for their critical comments on an earlier version of the paper. We dedicate this paper to the memory of Joseph Barmack.     

Neuropsychological characteristics and test behaviors of boys with early onset conduct problems.

School-age children and adolescents with conduct problems typically exhibit deficits in verbal IQ, language abilities, and executive functions. This study examined the extent to which this pattern was evident in a clinic group of preschool boys with early onset conduct problems who met criteria for oppositional defiant disorder (ODD) with and without attention deficit hyperactivity disorder (ADHD). A 2nd question focused on the strength of relation between clinic boys' uncooperative or inattentive test behaviors and their test performance. As expected, the clinic boys showed a neuropsychological profile highly similar to the one found in older conduct problem populations. Verbal tests distinguished clinic from matched comparison boys even after controlling for observers' ratings of disruptive behavior during testing. Clinic boys with ODD and ADHD had lower verbal and executive function scores than clinic boys with ODD alone. After general vocabulary knowledge and test behavior were controlled, clinic boys were found to have poorer vocabularies for describing affective states than comparison group boys.     

Psychological trauma and schizotypal personality disorder

Two studies examined the relation between psychological trauma and schizotypal symptoms. In Study 1, in which 1,510 adults completed telephone interviews, both childhood maltreatment and the experience of an injury or life-threatening event were significantly associated with schizotypal symptoms. In Study 2, in which 303 adults (oversampled for having elevated levels of schizotypal symptoms) completed extensive in-person assessments, both childhood maltreatment and meeting posttraumatic stress disorder (PTSD) Criterion A were significantly associated with schizotypal symptoms. The links between schizotypal symptoms and at least some forms of psychological trauma could not be fully accounted for by shared variance with antisocial and borderline personality disorders, absorption/dissociation, PTSD symptom severity, family history of psychotic disorder, or signs of neurodevelopmental disturbance (as indexed by minor physical anomalies and inconsistent hand use). Schizotypal symptoms were more strongly associated with childhood maltreatment among men than among women, whereas schizotypal symptoms were more strongly associated with PTSD Criterion A among women than among men. Finally, among men, the association between childhood maltreatment and schizotypal symptoms was moderated by signs of neurodevelopmental disturbance.     

Reading the situation: The relationship between dyslexia and situational awareness for road sign information

Road signs are tools that provide crucial information to drivers about various roadway situations. Therefore, the present study aimed to assess the levels of ‘situation awareness’ held by drivers in relation to these signs. This study also assessed the relationship between dyslexia, road sign comprehension, and road sign situation awareness, thus building on the limited research in this area. Drivers completed measures of road sign comprehension and dyslexia. Drivers then completed three drives on a driving simulator; each followed by a probe containing queries about the perception, comprehension and projection of road signs seen in the preceding drive. Situation awareness was lowest at the level of projection. Further, dyslexia was negatively associated with road sign comprehension, and road sign situation awareness, suggesting that the disorder may be detrimental for multiple forms of road sign processing. Implications are provided in the form of a ‘SAFE’ driver training program that targets a holistic form of road sign processing which takes into account sign meanings in relation to both in-vehicle and outer-vehicle factors; thus encouraging proactive driver behaviour.     

Deconstructing dependency in a five-factor world: a meta-analytic review

Meta-analysis of studies assessing the relation between interpersonal dependency test scores and five-factor model (FFM) domain scores revealed that dependency scores are positively correlated with FFM Neuroticism and Agreeableness scores and negatively correlated with FFM Extraversion, Openness, and Conscientiousness scores. The magnitudes of these correlations were all in the small-to-moderate range, and comparable score intercorrelations were obtained when participants' dependency levels were assessed by means of a trait dependency questionnaire, dependent personality disorder questionnaire, or dependent personality disorder interview. These findings have implications for researchers' efforts to deconstruct dependency into its basic trait elements and for the dimensional approaches to personality disorders being considered for future versions of the Diagnostic and Statistical Manual of Mental Disorders.     

Test anxiety,anxiety disorders,and school-related wellbeing: Manifestations of the same or different constructs?

Previous studies have shown that highly test anxious persons are more likely to meet criteria for an anxiety disorder and report more frequent symptoms of anxiety disorders than their low test anxious counterparts. However, it is unclear whether test anxiety should be treated as distinct to, or a manifestation of, anxiety disorders. Furthermore, the Dual Factor Model of Mental Health proposes that high subjective wellbeing cannot be solely inferred from the absence of psychopathology. To date, no studies have examined the Dual Factor Model in relation to test anxiety. In the present study, we examined how test anxiety, two common anxiety disorders (i.e., generalized anxiety disorder [GAD] and panic disorder [PD]), and subjective wellbeing in the school domain (i.e., school-related wellbeing) were related in a sample of 918 adolescents (M age = 15.77 years) using network analysis and latent profile analysis. Results from the network analysis indicated that test anxiety, GAD, PD, and school-related wellbeing were represented as distinct constructs. Bridge nodes were identified that linked test anxiety with GAD, PD, and school-related wellbeing. The latent profile analysis identified three of the four profiles predicted by the Dual Factor Model, including (a) troubled (i.e., low school-related wellbeing, high test anxiety, GAD, and PD), (b) complete mental health (i.e., high school-related wellbeing, low test anxiety, GAD, and PD), and (c) symptomatic but content (i.e., average school-related wellbeing, test anxiety, GAD, and PD). We concluded that test anxiety was distinct from, rather than a manifestation of, GAD and PD. We found support for the Dual Factor Model, albeit not unequivocal, using test anxiety as an additional indicator of psychopathology to that of GAD and PD.     

Temperament, ADHD and peer relations among schoolchildren: the mediating role of school bullying

The goal of the study is to investigate the link between temperament, attention-deficit hyperactivity disorder (ADHD) symptoms, social preference, bullying and victimization. The study sample consisted of 195 children attending the fourth and fifth grade (age 8-10), their mothers and their teachers. A multiinformant approach was used: mothers were interviewed about the temperament of their children; teachers were asked about ADHD symptoms; children responded to a peer nominations inventory designed to investigate their roles as bullies and/or victims and their social preferences (liked and disliked peers). A Structural Equation Model multigroup analysis (males and females) was used to test the relationships among variables hypothesized by the authors. The analysis showed that temperamental variables have a direct relation to ADHD symptoms, that ADHD has a direct relation to bullying behavior in males and to victimization in females and that bullies and victims are less well accepted than peers who belong to neither category. ADHD has only an indirect relation to social preference through the mediating role of school bullying.     

Maternal avoidance,anxiety cognitions and interactive behaviour predicts infant development at 12 months in the context of anxiety disorders in the postpartum period

BackgroundFew studies have examined the relation between anxiety disorders in the postpartum period and cognitive as well as language development in infancy.AimsThis longitudinal study investigated whether anxiety disorder in the postpartum period is linked to infant development at twelve months. A closer look was also taken at a possible link between maternal interaction and infant development.Study designSubjects were videotaped during a Face-to-Face-Still-Face interaction with their infant (M = 4.0 months). Specific maternal anxiety symptoms were measured by self-report questionnaires (Anxiety Cognition Questionnaire (ACQ), Body Sensations Questionnaire (BSQ), Mobility Inventory (MI)) to check for a connection with infant development. The Bayley Scales of Infant and Toddler Development-III (Bayley-III) were used to assess infant language and cognitive development at one year of age.Subjectsn = 34 mothers with anxiety disorder (SCID-I; DSM-IV) and n = 47 healthy mothers with their infant.Outcome measuresInfant performance on Bayley-III language and cognitive scales.ResultsInfants of mothers with anxiety disorder yielded significantly lower language scores than infants of controls. No significant group differences were found regarding infant cognitive development. Exploratory analyses revealed the vital role of “maternal avoidance accompanied” in infant language and cognitive development. Maternal neutral engagement, which lacks positive affect and vocalisations, turned out as the strongest negative predictor of cognitive development. Maternal anxiety cognitions and joint activity in mother-infant interaction were the strongest predictors of infant language performance.ConclusionsResults underline the importance to also consider the interaction behaviour of women with anxiety disorders to prevent adverse infant development.     

Occupational Therapy Assessment of Neurodevelopmentally Disordered Children and Adolescents

ABSTRACT

Research suggests that many children and adolescents with neurodevelopmental disorders such as attention deficit hyperactivity disorder or Tourette syndrome exhibit neurological soft signs including sensory misperception. The parents of 52 children or adolescents, ages 6 to 16, entering the Neurodevelopmental Disorders Clinic at St Boniface General Hospital completed a structured questionnaire measuring sensory and motor systems. The questionnaire formed the basis of a semi-structured interview involving parent(s) and child or adolescent. Results suggested altered sensory and motor processing and indicated an increased sensory sensitivity regarding tactile, auditory, olfactury, gustatory and visual sensations. The literature regarding sensory defensiveness and neurodevelopmental systems is discussed in relation to the findings from the sample.     

The relation between attention deficit hyperactivity disorder and substance abuse: what role does conduct disorder play?

This paper presents a comprehensive review of the literature examining the relation between childhood attention deficit hyperactivity disorder (ADHD) and substance abuse. A number of researchers have statistically controlled for conduct disorder (CD) when examining the ADHD—substance-abuse relation. These studies have generally found that the ADHD—substance-abuse relation disappears when the high overlap between ADHD and CD is taken into account. On this basis, one may conclude that ADHD is unimportant to substance abuse. However, there is some evidence from both empirical studies and related fields that ADHD and CD may interact to afford a higher risk for substance abuse than may either disorder alone. Thus, ADHD appears to be important to substance abuse in that it interacts with CD to increase the risk. This paper calls for more research that directly examines the joint effects of ADHD and CD on risk for substance abuse. There is also a need for more research that examines gender differences, and mechanisms of the relations among ADHD, CD, and substance abuse.     

Examining Anxiety and Depression as Moderators of the Associations Between ADHD Symptoms and Academic and Social Problems in Hispanic Adolescents

The effects of attention-deficit/hyperactivity disorder (ADHD) symptoms on the psychosocial functioning of Hispanic youth have been understudied. It also remains unclear if the well-established associations between ADHD symptoms and academic and social impairment are exacerbated by co-occurring internalizing symptoms. The purposes of the present study were to (1) examine whether ADHD symptoms would be associated with academic and social problems while also controlling for oppositional defiant disorder (ODD) symptoms, and (2) test the hypothesis that anxious and depressive symptoms would moderate the relations between ADHD symptoms and academic and social problems. Participants were 142 at-risk Hispanic adolescents (54 % male, ages 14–19) who reported on their anxious and depressive symptoms, as well as their teachers who reported on adolescents’ ADHD symptoms, ODD symptoms, academic problems, and social problems. When the psychopathology variables were included simultaneously in a path model, ADHD was the only domain significantly positively associated with academic problems. In contrast, ODD and depressive symptoms were the only domains significantly positively associated with social problems when all of the psychopathology variables were included in the path model. No moderation effects were found in relation to academic problems, although a significant ADHD × depression interaction was found in relation to social problems. Specifically, ADHD symptoms were not associated with social problems among adolescents who reported low levels of depressive symptoms, but the association between ADHD symptoms and social problems was significant at higher levels of depression. In addition to targeting oppositionality, attending to the combined presence of ADHD and depressive symptoms will be important for reducing the social impairments among Hispanic adolescents.     

Prospects for a cognitive neuropsychology of autism: Hobson's choice

Leslie (1987b) proposed a new, metarepresentational model for the cognition of pretense. This model identified a cognitive component necessary for the normal development of a "theory of mind." In this article, the relation of the child's early affective sensitivities to this component is considered. Early affective sensitivities seem to be cognitively distinct from the metarepresentational component. Childhood autism provides an interesting opportunity to study this problem. Three theoretical possibilities for the pathogenesis of this condition are presented: (a) a basic affective disorder as proposed by Hobson (this issue, p. 114), (b) a basic affective disorder and a basic cognitive disorder jointly, and (c) a basic cognitive disorder. There is little evidence for Option a, and a growing body of evidence supports Option c. Option b is sidelined for the time being on grounds of parsimony. Leslie's original theoretical proposals are revised, and some resulting implications are presented for the future investigation of the cognitive neuropsychology of autism.     

Cognitive deficits in major depression

Major depression is a mood disorder that is often accompanied by the impairment of cognitive functions. Although suggestive, the large range of existing neuropsychological, neuropsychiatric, and, lately, neuroimaging investigations have not yet given a consistent picture of the psychological and biological disturbances involved in this psychiatric disorder. The present study of the cognitive functions in depression was part of an extensive investigation, including neuropsychological testing, psychiatric examination, and neuroimaging. A representative sample of 40 severely depressed hospitalized patients and a group of 49 closely matched control subjects were tested with an extensive neuropsychological test battery. Results, corrected for various confounding factors, confirmed the current notion that depressed patients suffer from wide-spread cognitive impairments. The group analysis did not allow any hypothesis on a possible pattern to the dysfunctions, but heterogeneity in the test performances calls for further analysis of the data in patient subgroups in relation to neuroimaging results.     

The clenching-grinding spectrum and fear circuitry disorders: clinical insights from the neuroscience/paleoanthropology interface

This review discusses the clenching-grinding spectrum from the neuropsychiatric/neuroevolutionary perspective. In neuropsychiatry, signs of jaw clenching may be a useful objective marker for detecting or substantiating a self-report of current subjective emotional distress. Similarly, accelerated tooth wear may be an objective clinical sign for detecting, or substantiating, long-lasting anxiety. Clenching-grinding behaviors affect at least 8 percent of the population. We argue that during the early paleolithic environment of evolutionary adaptedness, jaw clenching was an adaptive trait because it rapidly strengthened the masseter and temporalis muscles, enabling a stronger, deeper and therefore more lethal bite in expectation of conflict (warfare) with conspecifics. Similarly, sharper incisors produced by teeth grinding may have served as weaponry during early human combat. We posit that alleles predisposing to fear-induced clenching-grinding were evolutionarily conserved in the human clade (lineage) since they remained adaptive for anatomically and mitochondrially modern humans (Homo sapiens) well into the mid-paleolithic. Clenching-grinding, sleep bruxism, myofacial pain, craniomaxillofacial musculoskeletal pain, temporomandibular disorders, oro-facial pain, and the fibromyalgia/chronic fatigue spectrum disorders are linked. A 2003 Cochrane meta-analysis concluded that dental procedures for the above spectrum disorders are not evidence based. There is a need for early detection of clenching-grinding in anxiety disorder clinics and for research into science-based interventions. Finally, research needs to examine the possible utility of incorporating physical signs into Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition posttraumatic stress disorder diagnostic criteria. One of the diagnostic criterion that may need to undergo a revision in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition is Criterion D (persistent fear-circuitry activation not present before the trauma). Grinding-induced incisor wear, and clenching-induced palpable masseter tenderness may be examples of such objective physical signs of persistent fear-circuitry activation (posttraumatic stress disorder Criterion D).     

Physical activity does not provoke panic attacks in patients with panic disorder: A review of the evidence

Abstract

This paper summarizes the results of published studies in which physical activity has been performed by patients with panic disorder. Several case studies of apparent exercise-induced panic attacks were found. However, in field studies that involved ambulatory monitoring of panic disorder patients only 1 of 91 panic attacks that were monitored actually occurred while the test subject was engaged in moderately intense physical activity. Moreover, only five panic attacks occurred in association with 444 exercise bouts performed by 420 panic disorder patients in laboratory settings despite the fact that exercise induces somatic signs and symptoms of anxiety. Thus, the weight of the published evidence shows that acute physical activity does not provoke panic attacks in panic disorder patients.     

Mimetic Relation as Matching-to-Sample Observing Response and the Emergence of Speaker Relations in Children with and without Hearing Impairments

This study investigated the effect of matching-to-sample and mimetic-relations teaching on the emergence of signed tact and textual repertoire through a multiple-baseline design, across three groups of three words in children with and without hearing impairments and with no reading repertoire. Following mimetic-relations teaching and the establishment of nine three-member stimulus classes containing signs, pictures, and printed words via matching-to-sample procedure, including the mimetic relation as the differential observing response, tact (signing in the presence of a picture) and textual (signing in the presence of a printed word) emergent repertoires were tested. Results showed the emergence of signed tact and textual responses. The mimetic relation brought in under the contextual control of a matching-to-sample task may have allowed participants to simultaneously learn speaker and listener relations to the particular signs used.