Distinguishing general and specific personality disorder features and implications for substance dependence comorbidity

Clinical and population-based samples show high comorbidity between Substance Use Disorders (SUDs) and Axis II Personality Disorders (PDs). However, Axis II disorders are frequently comorbid with each other, and existing research has generally failed to distinguish the extent to which SUD/PD comorbidity is general or specific with respect to both specific types of PDs and specific types of SUDs. We sought to determine whether ostensibly specific comorbid substance dependence-Axis II diagnoses (e.g., alcohol use dependence and borderline personality disorder) are reflective of more pervasive or general personality pathology or whether the comorbidity is specific to individual PDs. Face-to-face interview data from Wave 1 and Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions were analyzed. Participants included 34,653 adults living in households in the United States. We used hierarchical factor models to statistically partition general and specific personality disorder dimensions while simultaneously testing for specific PD-substance dependence relations. Results indicated that substance dependence-Axis II comorbidity is characterized by general (pervasive) pathology and by Cluster B PD pathology over and above the relationship to the general PD factor. Further, these relations between PD factors and substance dependence diagnoses appeared to largely account for the comorbidity among substance dependence diagnoses in the younger but not older participants. Our findings suggest that a failure to consider the general PD factor, which we interpret as reflecting interpersonal dysfunction, can lead to potential mischaracterizations of the nature of certain PD and SUD comorbidities.     

Did lifetime rates of alcohol use disorders increase by 67% in 10 years? A comparison of NLAES and NESARC

Two nationally representative epidemiological samples (the National Longitudinal Alcohol Epidemiological Survey and the National Epidemiological Survey of Alcohol and Related Conditions) have been used to track changes in the prevalence of alcohol use disorders (AUDs) between 1992 and 2002 in the United States. Strikingly, estimates from these two data sets suggest that the lifetime prevalence of AUD increased by approximately 67% (from 18.2% to 30.3%) during this time frame. This article explores potential reasons for these discrepant estimates. Analyses indicated that a vast majority of change in lifetime AUD occurred with respect to alcohol abuse and not alcohol dependence. Most of this increase in abuse was attributable to self-reported changes in hazardous use that did not track with other archival measures of outcomes related to hazardous use in the population. Key methodological differences regarding the frequency requirements for prior-to-past-year alcohol abuse appeared to explain most of the discrepancy in lifetime AUD estimates. These findings, in conjunction with the relative lack of differences in the 12-month prevalence of AUDs, suggest that the discrepant lifetime estimates are likely due to methodological differences between the two surveys. These findings have important implications for substance use and other psychiatric surveillance and epidemiology where meaningful cross-temporal comparisons are desired.     

What’s Unique About Immigrant Protest?

Increasingly, western democratic countries are bearing witness to immigrant protest, that is, protest by immigrants who are dissatisfied with their status in the host community. In protesting, the immigrants object to the ways in which various laws and practices have proved to be obstacles to their full integration. Because immigrants, upon entering, have consented to abide by the rules and regulations of the host state, it might be thought that these forms of civil disobedience are, effectively, contract violations. Immigrants might therefore be thought to have a particularly stringent duty to abide by the laws of their host state. This paper evaluates whether immigrants are indeed under a special duty to abide by the laws of their host state. First, it suggests that it is useful — although incomplete — to apply the device of the ‘contract’ to understanding the relationship between new immigrants and the host community. Second, it argues that there are limits to what can be demanded of and by immigrants as well as of and by host communities. It then turns to offering principles that help to evaluate the motivations of immigrant protestors, as well as that help guide their actions, when they believe that the community they have joined is treating them unjustly. These principles suggest that immigrant protest actions are subject to the restriction that they do not undermine the possibility of an inclusive democratic community.     

Relationship of negative self-schemas and attachment styles with appearance schemas

The purpose was to test, among women, the relationship between negative self-schemas and styles of attachment with men and women and two types of appearance investment (Self-evaluative and Motivational Salience). Predominantly Caucasian undergraduate women (N = 194) completed a modified version of the Relationship Questionnaire, the Young Schema Questionnaire-Short Form, and the Appearance Schemas Inventory-Revised. Linear multiple regression analyses were conducted with Motivational Salience and Self-evaluative Salience of appearance serving as dependent variables and relevant demographic variables, negative self-schemas, and styles of attachment to men serving as independent variables. Styles of attachment to women were not entered into these regression models because Pearson correlations indicated they were not related to either dependent variable. Self-evaluative Salience of appearance was related to impaired autonomy and performance negative self-schema and the preoccupation style of attachment with men, while Motivational Salience of appearance was related only to the preoccupation style of attachment with men.     

Motor asymmetry and substantia nigra volume are related to spatial delayed response performance in Parkinson disease

Studies suggest motor deficit asymmetry may help predict the pattern of cognitive impairment in individuals with Parkinson disease (PD). We tested this hypothesis using a highly validated and sensitive spatial memory task, spatial delayed response (SDR), and clinical and neuroimaging measures of PD asymmetry. We predicted SDR performance would be more impaired by PD-related changes in the right side of the brain than in the left. PD (n = 35) and control (n = 28) participants performed the SDR task. PD participants either had worse motor deficits on the right (RPD) or left (LPD) side of the body. Some participants also had magnetic resonance imaging for measurement of their substantia nigra (SN) volumes. The LPD group performed worse on the SDR task than the RPD and control groups. Right SN volume accounted for a unique and significant portion of the variance in SDR error, with smaller volume predicting poorer performance. In conclusion, left motor dysfunction and smaller right SN volume are associated with poorer spatial memory.     

Prospective and positive mental imagery deficits in dysphoria

We know less about positive mental imagery than we do about negative mental imagery in depression. This study examined the relationship between depressed mood and the subjective experience of emotion in imagined events; specifically, prospective imagery, and imagery in response to emotionally ambiguous stimuli. One hundred and twenty-six undergraduates completed measures of depression, imagery vividness for future events, and a homograph interpretation task in which they generated images and subsequently rated image pleasantness and vividness. As predicted, compared to low dysphoria, high dysphoria was associated with poorer ability to vividly imagine positive (but not negative) future events. These findings were augmented by the observation that high dysphorics provided lower pleasantness ratings of images generated in response to homographs they interpreted as positive. We suggest that an imbalance in the inability to vividly imagine positive but not negative future events may curtail the ability of high dysphorics to be optimistic. High dysphoric individuals are further disadvantaged: even when they interpret ambiguity positively, the resulting images they generate are associated with less positive affect. Therapeutic strategies that address both such positive-specific imagery biases hold promise for depression treatment innovation.     

Premarital precursors of marital infidelity

Premarital precursors of infidelity were evaluated in a sample of 72 couples (N = 144) who were taking part in a longitudinal study of marriage. Premarital self-report and observational data were compared for couples who experienced infidelity and those who did not experience infidelity in the first years of marriage. Couples in which the male engaged in marital infidelity were characterized, premaritally, by significantly lower male sexual satisfaction, lower male positive communication, and higher female invalidation, whereas couples in which the female went on to engage in infidelity were characterized, premaritally, by significantly lower levels of female positive communication, higher levels of male and female negative communication, and higher levels of male and female invalidation. Implications of the findings for future research on the prediction and prevention of infidelity are discussed.     

Drinking motives as mediators in the relation between personality disorder symptoms and alcohol use disorder

Research shows high comorbidity between Cluster B Personality Disorders (PDs) and Alcohol Use Disorders (AUDs). Studies of personality traits and alcohol use have identified coping and enhancement drinking motives as mediators of the relation among impulsivity, negative affectivity or affectivity instability, and alcohol use. To the extent that certain PDs reflect extreme expression of these traits, drinking motives were hypothesized to mediate the relation between PD symptoms and presence/absence of an alcohol use disorder (AUD). This hypothesis was tested using a series of cross-sectional and prospective path models estimating the extent that coping and enhancement drinking motives mediated the relation between cluster A, B, and C PD symptom counts and AUD diagnosis among a sample of 168 young adults between ages 18 and 21. Enhancement motives mediated the cross-sectional relation between Cluster B symptoms and AUD. Prospectively, enhancement motives partially mediated the relation between Cluster B personality symptoms and AUD through the stability of Year 1 AUD to Year 3 AUD. Results suggest that enhancement motives may be especially important in understanding the relation between Cluster B personality disorders and AUDs.     

Risky drinking in college changes as fraternity/sorority affiliation changes: a person-environment perspective.

This study aimed to resolve the direction of the relation between Greek affiliation and substance use by taking advantage of the quasi-experimental nature of change in college fraternity/sorority affiliation. Precollege individual differences and college substance use were examined as a function of time-varying Greek status to characterize self-selection (by which heavy substance users opt into Greek systems) and socialization (by which Greek systems foster heavy substance use). Prospective data on continuously enrolled college students (N=2,376), assessed at precollege and in the first 6 semesters of college, were used. Latent class analysis indicated 4 discrete groups of status: constant Greek members (30%), constant nonmembers (64%), late joiners (2%), and droppers (4%). Random coefficient models demonstrated disaffiliation with Greek systems is associated with decreases in risky drinking and alcohol-conducive environmental factors (peer norms and alcohol availability), whereas affiliation is associated with increases, indicating Greek socialization via sociocognitive and physical environments. Future Greeks differed from nonmembers in diverse individual characteristics and heavier substance use at precollege, suggesting multiple selection paths into Greek systems. Findings suggest a reciprocal relation between Greek environment and individuals in determining the trajectories of college drinking and heterogeneity in drinking as functions of changes in Greek affiliation.     

Lack of a close confidant: prevalence and correlates in a medically underserved primary care sample

The present study examined prevalence of lack of a close confidant in a medically underserved primary care sample, and evaluated demographic, medical, and psychological correlates of patients' deficits in close, personal contact. Adult patients (n = 413) reported on confidant status and symptoms of depression and anxiety. Sociodemographic and medical information were obtained through chart review. One-quarter of patients endorsed lack of a close confidant. Past month anxiety and depression symptoms, but not medical status, were associated with unmet socioemotional needs. Implications for primary healthcare interventions are discussed.