The nature of borderline personality disorder: multiple dimensions, multiple symptoms, but one category

Borderline personality disorder (BPD) is a multidimensional syndrome that is not rooted in a single diathesis. Each of its features (affective instability, impulsivity, unstable relationships, and cognitive defects) reflects different diatheses. BPD differs from other Axis II disorders in its high level of symptoms, but is not a variant of an Axis I disorder and is difficult to describe through dimensional traits. This review suggests that BPD needs to be diagnosed with a narrower set of criteria that cover all of its domains. In the long run, the disorder will need to be redefined on the basis of its etiology and pathogenesis.     

Multiple imputation for item scores when test data are factorially complex

Multiple imputation under a two‐way model with error is a simple and effective method that has been used to handle missing item scores in unidimensional test and questionnaire data. Extensions of this method to multidimensional data are proposed. A simulation study is used to investigate whether these extensions produce biased estimates of important statistics in multidimensional data, and to compare them with lower benchmark listwise deletion, two‐way with error and multivariate normal imputation. The new methods produce smaller bias in several psychometrically interesting statistics than the existing methods of two‐way with error and multivariate normal imputation. One of these new methods clearly is preferable for handling missing item scores in multidimensional test data.     

Predicting self-damaging and suicidal behaviors in female borderline patients: reasons for living, coping, and depressive personality disorder.

The aims of this study are to examine (1) whether reasons for living predict self-damaging and suicidal behaviors, (2) the associations of reasons for living with coping strategies and depressive personality disorder (PD), and (3) the unique predictive validity of reasons for living in a multivariate predictor model. Reasons for living (RFL), coping strategies, and depressive personality disorder were measured at baseline in 38 patients who met DSM-IV criteria for borderline personality disorder (BPD). Frequency of self-damaging and suicidal behaviors in the 6-month period following baseline was measured prospectively at 3- and 6-month follow-ups. The RFL has only one subscale that predicts parasuicidal behaviors (i.e. Survival and Coping Beliefs [SCB]). Participants who scored low on this subscale were 6.8 times more likely to exhibit self-damaging and suicidal behaviors in the follow-up period than their high-scoring counter-parts. However, SCB was substantially correlated with the coping strategies "reassuring thoughts," "active coping," and "palliative reaction pattern," as well as with depressive personality traits. In a multivariate model, the predictive power of SCB appeared to be accounted for by reassuring thoughts and depressive PD. Coping scales might be preferable over the RFL as a predictor of self-damaging and suicidal behaviors in borderline patients.     

Dimensions of Picture Identification Test need associations

To find a simple and more general structure for need association matrices obtained from Picture Identification Test (PIT) results, PIT need association matrices of eight college student groups were analyzed by INDSCAL, a multidimensional scaling technique. A common three dimensional structure was found. Based on the scale locations of the 22 needs, the dimensions were labeled the Combative, the Personal, and the Competitive dimensions. The INDSCAL model was used as a target for six other comparison groups including male and female English college students, male addicts and controls, and male delinquents and controls. There was enough similarity between the dimensional structure of the need associations of the comparison and target groups to assume that all groups shared the same basic structure of need associations. There were enough differences, however, to suggest that personality characteristics of groups may be related to deviations in the associative structure of their motivation systems. Applications of the techniques to clinical and personality evaluations of groups and individuals were discussed.     

The Big Five personality factors as a model for the structure of children's peer nominations

The validity and usefulness of the five‐factor theory of personality as a model for children's peer nominations is assessed. Eighty‐nine groups of ten school children, attending the same class, aged 9 to 12 years, nominated the pupil that was the most or the least typical example for 25 bipolar trait pairs, covering the ‘Big Five’ personality factors. Factor analysis of summed and transformed peer nominations for the total sample shows that children's nominations can be represented by three factors: Agreeableness, a combined Extraversion–Emotional Instability component, and a combined Intellect–Conscientiousness factor. A second study with a smaller but independent sample confirms the factorial structure of the peer nomination scales. The reasons for the less differentiated peer nomination structure of children and the relevance of multidimensional assessment of peer perception are discussed. Copyright © 2000 John Wiley & Sons, Ltd.     

Personality disorders in offenders: categorical versus dimensional approaches.

The present study focused on the consequences of cut-off scores in personality disorder diagnoses for their association with criminal behavior. Using ICD-10 personality disorder criteria eliminating offence-related symptoms, we studied the distributions of categorically diagnosed personality disorders and of dimensional personality disorder scores in a group of offenders and a noncriminal control group. Whereas the dimensional scores of the offender group differed significantly from those of the control group for all personality disorders under study, the frequency of categorical diagnoses differed significantly for two personality for two personality disorders only. Moreover, prediction of group membership (offenders vs. nonoffenders) from personality disorder scores was substantially more precise than prediction from categorical diagnoses. It is concluded that a dimensional approach to personality disorder diagnosis is not only superior theoretically but also yields more precise information about the specific associations with criminal behavior.     

Assessment of DSM-IV personality disorders in obsessive-compulsive disorder: comparison of clinical diagnosis, self-report questionnaire, and semi-structured interview

In patients with obsessive-compulsive disorder, personality disorders are not many times assessed according to DSM-IV criteria. The purpose of the present study is to examine the prevalence of personality disorders diagnosed according to the DSM-IV in a severely disordered OCD population (n=65) with three different methods of assessing personality disorders (structured interview, questionnaire, and clinical diagnoses). Furthermore, correspondence between these different methods was investigated and their construct validity was examined by relating the three methods to external variables. Each method resulted in a predominance of Cluster C personality disorders, and obsessive-compulsive personality disorder had the highest prevalence. However, there was generally low correspondence regarding which patient had which personality disorder. Results concerning the relation of external variables were the most promising for the structured clinical interview.     

Influence of Co‐Morbid Generalized Anxiety Disorder,Panic Disorder and Personality Disorders on the Outcome of Cognitive Behavioural Treatment of Obsessive‐Compulsive Disorder

This study examined co‐morbid generalized anxiety disorder and/or panic disorder and personality disorders as predictors of treatment outcomes in adult outpatients with obsessive‐compulsive disorder. The patients received exposure with response prevention (ERP) treatment with the addition of either elements of cognitive therapy (ERP+CT) or relaxation training (ERP+REL). It was hypothesized that the addition of cognitive interventions would yield better treatment outcomes for patients with co‐morbid generalized anxiety disorder and/or panic disorder. It was also hypothesized that patients with any personality disorder would show less treatment gains in both conditions. Using intention‐to‐treat criteria, patients with generalized anxiety disorder and/or panic disorder co‐morbidity showed less treatment gains at post‐treatment across both treatment conditions. This group showed significantly more treatment gains in the ERP+CT condition at the post‐treatment and the 12‐month follow‐up assessments compared with patients in the ERP+REL condition. However, this was not significant when comparing treatment completers. Patients with a co‐morbid Cluster A or B personality disorder showed significantly less treatment gains in both treatment conditions at the 12‐month follow‐up assessment. Among treatment completers, patients with a Cluster C personality disorder showed significantly better outcomes at the post‐treatment assessment in the ERP+REL treatment condition. These results, clinical implications, and the importance of further investigations are discussed.     

Explicating the Openness to Experience Construct and its Subdimensions and Facets in a Work Setting

Recent meta‐analyses (e.g. Barrick, Mount, & Judge, 2001 ) found openness to experience, a factor in the five‐factor model of personality, to be uncorrelated with job performance. We argue that, among others, insignificant validity is due to the broad and heterogeneous nature of the construct. In line with our hypotheses, we found internal structure of openness to be multidimensional. Further analyses on subdimensional and facet level revealed large differences in criterion‐ and construct‐related validity. It could be demonstrated that a subdimension labeled epistemic curiosity and, especially, the facet openness to ideas, which includes aspects like curiosity, flexibility, willingness to learn, and creativity, are highly relevant for work‐related criteria and so far understudied in organizational research.     

Higher-order dimensions of personality disorder: hierarchical structure and relationships with the five-factor model, the interpersonal circle, and psychopathy

Two studies examined the higher-order factor structure of DSM-IV personality disorders using the International Personality Disorder Examination in male forensic psychiatric patients. In Study 1 (N = 168), exploratory factor analysis at the level of individual personality disorder criteria indicated nine primary factors. Exploratory and confirmatory factor analyses of these first-order factors supported a hierarchical structure in which two of three second-order factors covaried to yield a third-order factor. The two resulting superordinate factors were labelled Anxious-Inhibited and Acting Out. In Study 2 (N = 160), we used exploratory and confirmatory factor analyses to test hypotheses of common dimensions underlying these superordinate factors of personality disorder and superordinate factors of the five-factor model of personality, dimensions of the interpersonal circle, and psychopathy. Of three common factors, one combined Anxious-Inhibited disorders, "neurotic introversion," and hostile-submission. The other two factors of Acting Out/ psychopathy and antagonism/hostile-dominance covaried to yield a superordinate factor. Possible substrates underlying two superordinate dimensions common to normal and abnormal personality were identified in the theoretical literature.     

Personality,interests, and career indecision: a multidimensional perspective

Researchers have consistently linked neuroticism to career indecision; however, other personality traits have been inconsistent predictors despite sound theoretical arguments. Similarly, little research has examined a trait‐based analysis of the relationship between vocational interests and career indecision. The purpose of the current study was to evaluate the structure of career indecision and to examine the prediction of this construct as both a unidimensional and multidimensional construct. Results suggest that career indecision is multifaceted and that both personality and vocational interests are more strongly related to career indecision than has been suggested by past research. Furthermore, consideration of this multidimensional nature can explain past inconsistencies in the relationships between indecision and personality.     

Age-related differences in individual DSM criteria for borderline personality disorder

This study examined age-related effects of individual DSM criteria for borderline personality disorder (BPD) and symptoms of depression and anxiety in three groups: patients diagnosed with BPD, another personality disorder, or no personality disorder. The goal was to determine if distinctive age effects emerged within the BPD group. This mixed clinical and community sample (N = 380) ranged from 20-50 years old. Each participant was assessed for symptoms of axis I and II psychopathology. We found significant interactions for personality disorder group x age for the suicidal behavior and impulsivity criteria that reflected distinctive changes in the BPD group. The BPD group reported significantly more anxious and depressive symptoms. However, no main effect for age or personality disorder x age interaction emerged with symptoms. These results demonstrate that older individuals with BPD report less impulsivity and fewer suicidal behaviors, although symptoms of distress persist.     

Are Dishonest Extraverts More Harmful than Dishonest Introverts? The Interaction Effects of Honesty‐Humility and Extraversion in Predicting Workplace Deviance

Honesty‐Humility, one of the six major personality dimensions included in the HEXACO model of personality structure, has previously been found to show negative correlations with workplace deviance. In this study, we hypothesised that Extraversion would moderate the relationship between Honesty‐Humility and workplace deviance. In particular, we posited that the relation between Honesty‐Humility and workplace deviance would be stronger among employees who are high on Extraversion than among those low on Extraversion. The hypothesis was tested using three different samples across Australia, Canada, and the Netherlands. It was found in two of the three samples that high levels of Extraversion did indeed amplify the relationship between (low) Honesty‐Humility and workplace deviance. Results suggest a potentially important role for multiplicative effects of personality variables on workplace criteria.     

Dysfunctional beliefs and psychopathology in Borderline Personality Disorder

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

Publication trends in individual DSM personality disorders: 1971–2015

Growth in personality disorder research has been documented by previous authors up to 1995. The aim of the present study was to extend this by examining publications rates for individual DSM personality disorders over the period 1971–2005, and making projections to 2015 based on these data. It was found that personality disorder research has grown in absolute terms, and as a proportion of overall psychopathology research. Research output is dominated by borderline personality disorder, with strong publication rates in other conditions such as antisocial and schizotypal personality disorders. In contrast, several personality disorders such as schizoid and paranoid personality disorder have failed to attract research interest. Based on current projections, there is expected to be no research output in 2015 for schizoid personality disorder. It was found that the rate of publications for personality disorders was not influenced by the publication of the last three revisions of the DSM diagnostic criteria. Several potential explanations such as the difficulty in conducting certain types of personality disorder research, and the validity of the current DSM diagnostic taxonomy are discussed.     

Beyond the Score: Clinical Evaluation Through Formal Psychological Assessment

Questionnaires generate numerical scores, but endorsing different sets of items could produce the same score despite reflecting qualitatively different configurations of clinical features. Formal psychological assessment (FPA) attempts to overcome this by identifying the clinical features entailed by observed response patterns. This study illustrates an application of FPA to the cleaning subscale of a questionnaire assessing obsessive–compulsive symptoms and DSM–IV–TR diagnostic criteria for obsessive–compulsive disorder. A deterministic model of the items–criteria relationships was constructed by mapping each item to each diagnostic criterion. The resulting model was tested on a large community sample (N = 4,412). Results indicate that the theoretical model has adequate fit; item error rates and probabilities for each of the criteria are examined. Clinically relevant examples of the items–criteria relationships are discussed. Possible applications of FPA to personality assessment are also discussed, including long multidimensional questionnaires and questionnaires that use subtle item content.     

Therapists' Emotional Reactions to Patients as a Mediator in Cognitive Behavioural Treatment of Panic Disorder with Agoraphobia

The aims of this study were to examine whether therapists' emotional reactions to their patients mediate the effect of personality disorders and interpersonal problem behaviours on the outcome of treatment, focusing on an Axis I disorder; and whether therapists' reactions mediate the effect of personality disorders on the course of interpersonal problems. Therapists completed a checklist of emotional reactions to individual patients after the end of residential cognitive or guided mastery therapy for 46 inpatients with panic disorder with agoraphobia. The severity of DSM‐III‐R personality disorder was related to therapists' insecurity feelings, but not to interest and anger. A higher level of therapists' insecurity feelings was related to less reduction in self‐reported agoraphobic avoidance during treatment, whereas therapists' emotions were unrelated to symptomatic course after treatment. Therapists' insecurity feelings appeared partly to mediate the relationship between patients' severity of personality disorder and persistence of patients' interpersonal dominance and nurturance problems.