Histrionic personality disorder and antisocial personality disorder: sex-differentiated manifestations of psychopathy?

Little is known about the etiology of histrionic personality disorder (HPD) or its relation to other personality disorders. In this study, we examined whether HPD is etiologically related to psychopathy and more specifically whether HPD and antisocial personality disorder (ASPD) are sex-typed alternative manifestations of psychopathy. In addition, based on Newman's (1987) response modulation hypothesis of psychopathy, we examined the associations between psychopathic, HPD, and ASPD features and performance on laboratory measures of passive avoidance errors and interference effects. Seventy-five live theater actors completed self-report questionnaires and two laboratory measures of response modulation, and peers completed questionnaires concerning the participants' personality disorder features. The results provided weak and inconsistent support for the hypotheses that HPD is a female-typed variant of psychopathy and that ASPD is a male-typed variant of psychopathy. Contrary to previous findings, scores on response modulation tasks were not significantly related to psychopathy, or to either HPD or ASPD. The limitations of this study and possibilities for future research in this area are outlined.     

The relationship between five-factor personality measurements and ICD-10 personality disorder dimensions: results from a sample of 229 subjects

This article examines the relationship between the five-factor model (FFM) and dimensional ICD-10 personality disorders. In a follow-up study of a child and adolescent psychiatric cohort, former patients and controls were assessed with NEO-FFI and the IPDE interview (CD-10 personality disorder). Full data were available for 229 subjects (149 former patients, 80 controls). Multiple regression analysis showed that the five factors of the FFM as independent variables explained between 5% (schizoid personality disorder) and 32% (anxious personality disorder) of the variance of ICD-10 dimensional personality disorder scores. For the two types of emotionally unstable personality disorder dimension (impulsive and borderline), for anxious (avoidant) personality disorder dimension and for the total score of any personality disorder dimension, FFM explained between 17% and 32% of the variance with almost identical results for the former patient group and the control group. High neuroticism was a feature of paranoid, emotionally unstable, histrionic, anankastic, anxious (avoidant), and dependent personality disorder dimensions, whereas low agreeableness was found in dissocial, emotionally unstable and histrionic personality disorder dimensions. Low extraversion was found in schizoid, anxious (avoidant) and dependent personality disorder dimensions, whereas histrionic PD dimension correlated with high extraversion. We find that the FFM is valuable for the further understanding not only of DSM-IV but also of ICD-10 personality disorder dimensions. The differences between ICD-10 and DSM-IV in this respect seem to be small.     

Characteristic interpersonal behavior in dependent and avoidant personality disorder can be observed within very short interaction sequences

We present a behavior observation study of interpersonal behavior in 96 female subjects, who had been screened for the presence of dependent, avoidant, narcissistic and histrionic personality disorder features. Each subject took part in three short role-plays, taken from assertiveness training. Afterwards, both the subject and her role-play partner judged, how assertive the subject had been. Although observation time was very short, dependent and avoidant subjects could be easily identified from their overly submissive behavior in the role-plays. Histrionic and narcissistic subjects did not show distinctive interpersonal behavior. Contrary to a common belief, higher scores on some personality disorder (PD) scales were positively related to cross-situational variability of behavior. Results are discussed with regard to their implications for clinical diagnostics, therapy and the methodology of personality disorder research in general.     

Personality Disorders and Spinal Cord Injury: A Pilot Study

A substantial body of research has found that spinal cord injury (SCI) patients have relatively high degrees of energy, impulsivity, and risk-taking (W. Fordyce, 1964; G. P. Taylor, 1970; B. Woodbury, 1978). The present study endeavors to extend our knowledge to the personality disorder (PD) domain. Forty SCI participants and 40 matched controls were given a semistructured diagnostic interview and a self-report personality disorder instrument. Findings indicated that 27.5% of SCI patients, and a similar number of controls, have PDs. Unexpectedly, impulsive/externalizing disorders (histrionic, narcissistic, antisocial, and borderline) were not unusually high in SCI patients, and were not higher than controls. Avoidant and depressive disorders were unexpectedly high.     

Histrionic Personality Disorder, Physical Attractiveness, and Social Adjustment

Histrionic personality disorder (HPD) is the only DSM-IV personality disorder (PD) explicitly linked to a person's physical appearance. This study examined the HPD–attractiveness link in a mixed-sex sample of college students. Consistent with expectations, HPD women were rated higher in attractiveness than women with other PDs or no PD. However, a parallel HPD–attractiveness link was not found in men. Subsequent analyses indicated that, relative to less attractive HPD women, more attractive HPD women (a) had a more varied and supportive social network, (b) exhibited more negative behaviors in important relationships, and (c) showed greater use of immature defenses, and less reliance on image-distorting, self-sacrificing, and mature defenses. Similar attractiveness–defense relationships were found in HPD men, but parallel results did not emerge for men in the other two domains. Implications of these findings are discussed, and suggestions for future studies are offered.     

Who sees trees before forest? The obsessive-compulsive style of visual attention

It has been suggested that individuals with obsessive-compulsive personalities tend to focus on small local details in their surroundings, whereas histrionic individuals are characterized by more global information processing. Using the global-local hierarchical-letters paradigm, we were able to provide support for the first but not the second hypothesis. Measures related to obsessive-compulsive personality disorder were associated with excessive visual attention to small details of the hierarchical letters. Specifically, the obsessive-compulsive cognitive style was associated with local interference, which reflects the effects of distraction by to-be-ignored small details on identification of global information.     

Personality disorder and antisocial deviance: comments on the debate on the structure of the psychopathy checklist-revised

The recent debate on the structure of the Psychopathy Checklist-Revised (PCL-R: Hare, 1991; 2003) has been presented primarily as a statistical issue, but underlying it are longstanding conceptual issues about the relationship of personality concepts to deviant behavior and of psychopathy to criminality and personality disorder. I discuss these issues in this paper. The antisocial items of the PCL-R seem to reflect a propensity to commit crimes that has long been of interest to criminology. This disposition overlaps with, but differs conceptually from personality dispositions, but these surface dispositions do not provide a causal account of criminality. I present data that indicate that the core personality characteristics of psychopathy are more closely related to narcissistic and histrionic personality disorders than to antisocial personality disorder. Overemphasis on involvement in crime has obscured the nature of psychopathy as a disorder of personality characterised by interpersonally harmful behavior that need not necessarily take criminal form.     

Personality characteristics of ADHD adults assessed with the Millon Clinical Multiaxial Inventory-II: evidence of four distinct subtypes

This study compared the personality characteristics of 104 adults diagnosed with attention deficit hyperactivity disorder (ADHD). Personality features were assessed with the MCMI-II (Millon, 1987). Participants were divided into 4 groups based on the presence of persisting oppositional defiant disorder (ODD) or other comorbid diagnoses (ADHD only, ADHD-comorbid, ADHD-ODD, ADHD-ODD-comorbid). Significant differences between these groups were present for 9 of the 13 MCMI-II personality scales, resulting in 4 modal personality styles. ADHD-only adults evidenced mild histrionic traits, whereas the ADHD-comorbid group was more often avoidant and dependent in personality style. ADHD-ODD adults showed histrionic, narcissistic, aggressive-sadistic, and negativistic traits whereas the ADHD-ODD-comorbid group had a combination of avoidant, narcissistic, antisocial, aggressive-sadistic, negativistic, and self-defeating personality features. Implications for treatment are discussed.     

Ana?s Nin and the developmental use of the creative process.

Ana?s Nin had the capacity to work through the wound of self-injury through the combination of poetic and analytic exploration demonstrated in her writing. She recreated her father, and confronted the fallacies of her idealization, as well as the suppressed anger that kept her enslaved in wishes for his mirroring admiration. There was no escape from injury for Nin. After the father's departure, she scrutinized herself for flaws, trying to discover a reason for her father's betrayal. Yet, the humiliation was modified by some knowledge of the narcissistic bind that she was in, and by some evidence that her father was unworthy of the kind of worship that she clung to from childhood. Nin transcends retaliation. Her fictional abandonment of her father does not come from vindictiveness. Rather, it comes through growing insight into herself and into her own needs. There is a letting-go of past fantasies of idealization, and a mourning process that is based on both awareness and acceptance of the disappointments in these idealized fantasies. Separation and loss stem from surrendering the fusion with the idealized object and its counterpart grandiose self, a grandiose self seen here as a false self that exists through resonating with image projections and their reflections.     

A Micro-Process Analysis of Functional Analytic Psychotherapy's Mechanism of Change

This study sought to clarify the micro-process of Functional Analytic Psychotherapy (FAP) by using the Functional Analytic Psychotherapy Rating Scale (FAPRS) to code every client and therapist turn of speech over the course of successful treatment of an individual meeting diagnostic criteria for depression and histrionic personality disorder. Treatment consisted of cognitive behavioral therapy alone followed by the addition of FAP techniques in a unique A / A + B design. In-session client behavior improved following the shift to FAP techniques, and micro-process data suggested that client behavior was effectively shaped by in-vivo FAP procedures. These results support FAP's purported mechanisms of change and highlight the advantages of utilizing molecular coding systems to explore these mechanisms.     

Personality disorders in a Dutch forensic psychiatric sample: convergence of interview and self-report measures

Convergence of PDQ-R- and SIDP-R-derived personality disorder diagnoses was studied in a sample of 85 forensic psychiatric patients. For categorical diagnoses, the mean kappa was .34, but on a dimensional level convergence was somewhat higher. Paranoid, antisocial and borderline personality disorders had prevalence rates around 40%; the other personality disorders occurred with much lower frequency. The PDQ-R yielded more diagnoses, except for antisocial, histrionic, narcissistic, and sadistic personality disorder. Because the latter disorders are among the most prevalent in forensic settings, and because they have important risk and treatment implications, the PDQ-R is not suitable as a screening device in forensic populations. Semistructured interviews that make use of collateral information are recommended for diagnosing personality disorders in forensic subjects.     

Aesthetic preference and DSM-IIIR personality disorders

This report tested whether those individuals with a cluster B DSM-IIIR personality disorder (narcissistic, borderline, antisocial or histrionic) had higher scores for aesthetic preference for visually complex drawings using the Barron-Welch Art Scale. In a sample of 141 patients and controls, the 56 subjects who met the criteria for one of the cluster B personality disorder diagnoses displayed higher Barron-Welch Art Scale Scores. A multiple regression analysis showed that narcissistic and borderline personality disorder contributed positively, while dependent personality disorder, negatively to preference for complexity. The findings support the notion that aesthetic choices and values reflected through the dimension of openness to experience may contribute to the behavioral manifestations of the personality disorders.     

Assumptions in borderline personality disorder: specificity, stability and relationship with etiological factors.

The specificity and stability of a set of assumptions hypothesized to be characteristic of Borderline Personality Disorder (BPD) was investigated. BPD patients (n = 16) were compared to cluster-C personality disorder patients (n = 12) and to normal controls (n = 15). All subjects were female and diagnosed with SCID-I and -II. Subjects rated a short version of the Personality Disorder Beliefs Questionnaire (PDBQ), with six sets of 20 assumptions each, hypothesized to be characteristic of avoidant, dependent, obsessive-compulsive, paranoid, histrionic and borderline personality disorder. The BPD assumptions (Cronbach alpha = 0.95) proved to be the most specific to BPD patients. Subjects rated the shortened PDBQ again after viewing an emotional video fragment one week later. Despite increased negative emotions, the PDBQ ratings remained relatively stable. Confirming the cognitive hypothesis, regression analyses indicated that the BPD assumptions mediate the relationship between self-reported etiological factors from childhood (sexual abuse and emotional/physical abuse) and BPD pathology assessed with the SCID-II. It is suggested that a set of assumptions is characteristic of BPD, and is relatively stable despite the instability of the behaviour of people diagnosed as having BPD.     

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.     

Disinhibitory trait profile and its relation to Cluster B personality disorder features and substance use problems

Certain personality and motivational traits may present vulnerability towards disinhibitory psychopathology (e.g. antisocial personality disorder, substance abuse). Cluster analysis was used to separately group 306 women and 274 men on impulsivity, Constraint, Negative Emotionality, behavioural activation system (BAS), and behavioural inhibition system (BIS) scores. As expected, a ‘disinhibited’ group with low Constraint, high impulsivity, weak BIS, and strong BAS emerged that showed elevated drug use problems, and histrionic and antisocial personality disorder features across gender. A ‘high affectivity’ group with high Negative Emotionality and strong BIS also showed elevated drug use problems and personality disorder features. Results suggested that two different trait profiles are associated with disinhibitory psychopathology and both may present vulnerability toward the development of such disorders. Copyright © 2006 John Wiley & Sons, Ltd.     

Are personality disorders associated with social welfare burden in the United States?

This study examined the association between personality disorders and use of major social welfare services in a nationally representative sample of U.S. adults (N = 43,093). Social welfare services received and diagnoses of personality, substance use, mood, and anxiety disorders were assessed with the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV-version. Analyses quantified the association between personality disorders and forms of public assistance while controlling for numerous confounds. Logistic regression analyses revealed dependent personality disorder, paranoid personality disorder, antisocial personality disorder, and avoidant personality disorder were significantly associated with increased odds of receiving public assistance. In contrast, persons diagnosed with histrionic, schizoid, and obsessive-personality disorder were not significantly more likely to receive any public welfare service. Development of effective prevention and treatment of personality disorders would likely lead to reductions in overall social welfare burden.     

Rorschach aggression variables: a study of reliability and validity

This study investigated the extent to which 6 Rorschach variables of aggression (A1, A2, AG, MOR, AgC, AgPast) are related to one another, to the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) Cluster B personality disorder criteria, and to self-report measures of anger, aggression, and antisocial behavior. Seventy-eight patients were found to meet DSM-IV criteria for an Axis II disorder, Cluster A personality disorder (paranoid, schizoid, schizotypal) = 9, Cluster B (antisocial personality disorder [ANPD] = 16, borderline personality disorder [BPD] = 23, histrionic personality disorder = 5, narcissistic personality disorder = 12) = 56, and Cluster C personality disorder (avoidant, dependent, obsessive-compulsive) = 13. The results of this study indicated that (a) these 6 Rorschach aggression variables can be scored reliably; (b) 2 factors, revealed by factor analysis, accounted for 77% of the total variance; (c) selected variables were found to be empirically related to DSM-IV diagnostic criteria for ANPD and BPD; and (d) selected variables were found to be empirically related to a self-report measure of anger and antisocial practices. The conceptual nature and clinical utility of these Rorschach aggression variables as well as implications for future research are discussed.     

Reconceptualizing personality pathology in DSM-5: limitations in evidence for eliminating dependent personality disorder and other DSM-IV syndromes

The DSM-5 Personality and Personality Disorders Workgroup proposed that five DSM-IV personality disorders be eliminated as formal diagnostic categories (paranoid, schizoid, histrionic, narcissistic, and dependent), because these syndromes purportedly have low clinical utility and minimal evidence for validity. Scrutiny of studies cited in support of this proposal reveals difficulties in three areas: (1) Inadequate information regarding parameters of the literature search; (2) Mixed empirical support for proposed changes; and (3) Selective attention to certain disorders and not others. Review of validity and clinical utility data related to dependent personality disorder indicates that evidence regarding this syndrome does not differ from that of syndromes proposed for retention in DSM-5. Limitations in the research base cited by the workgroup illuminates gaps in the personality disorder literature, and may serve as a starting point for systematic research on personality pathology so that adequate empirical data are available to decide which syndromes to retain, revise, or remove in future versions of the diagnostic manual.     

Gendered Mental Disorders: Masculine and Feminine Stereotypes About Mental Disorders and Their Relation to Stigma

Research indicates that stereotypes can intersect. For example, the intersection of stereotypes about gender and mental disorders could result in perceptions of gendered mental disorders. In the current research, Studies 1 and 2 showed that people view specific disorders as being masculine or feminine. The masculine stereotype included antisocial personality disorder, addictions, and paraphilias. The feminine stereotype included eating disorders, histrionic personality disorder, body dysmorphia, and orgasmic disorder. In both studies, the perception of disorders as masculine was positively correlated with stigma. Study 3 showed that the positive correlation between masculinity and stigma also occurred when examining specific symptoms rather than full mental disorders. The findings provide further evidence for the intersection of stereotypes and indicate a novel factor in the understanding of stigma.