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M Tracie Shea

Publications and source records attributed to M Tracie Shea.

49 records · Page 3Linked to original sources
PubMed2002

Personality disorders and time to remission in generalized anxiety disorder, social phobia, and panic disorder.

BACKGROUND: This investigation assessed the effect of personality disorders (PersDs) on time to remission in patients with generalized anxiety disorder, social phobia, or panic disorder. METHODS: Selected Axis I and II predictors of time to remission during 5 years of follow-up were assessed in 514 patients with 1 or more of these anxiety disorders who participated in the Harvard/Brown Anxiety Research Program, a multisite, prospective, longitudinal, naturalistic study. RESULTS: The presence of a PersD predicted a 30% lower likelihood of generalized anxiety disorder remission, a 39% lower likelihood of social phobia remission, and no difference in likelihood of panic disorder remission. More specifically, a lower likelihood of remission from generalized anxiety disorder was predicted by the presence of avoidant PersD (34% lower) and dependent PersD (14% lower). The presence of avoidant PersD predicted a 41% lower likelihood of social phobia remission. The presence of major depressive disorder did not account for these findings. CONCLUSIONS: Our findings provide new data on the pernicious effect of PersDs on the course of generalized anxiety disorder and social phobia but not panic disorder, suggesting that PersDs have a differential effect on the outcome of anxiety disorders.

Adult↗
PubMed2002

Confirmatory factor analysis of DSM-IV borderline, schizotypal, avoidant and obsessive-compulsive personality disorders: findings from the Collaborative Longitudinal Personality Disorders Study.

OBJECTIVE: To test the diagnostic constructs implied by DSM-IV Axis-II personality disorders by examining relationships between different combinations of DSM-IV criteria. METHOD: Confirmatory factor analysis was used to test the borderline, schizotypal, avoidant and obsessive-compulsive personality disorder constructs in a large treatment-seeking sample (N= 668) from a multisite study. A model based on the three DSM-IV Axis II clusters was also tested. Both models were tested against a unitary 'generic' model constructed from four criteria sets combined. RESULTS: Goodness-of-fit for both the three-cluster and four disorder models was significantly better than the unidimensional model, and the four-disorder model was significantly better than the three-cluster model. Results were replicated using data from 2-year follow-up obtained by interviewers blind to original Axis II diagnoses at baseline. CONCLUSION: Support is provided for the DSM-IV disorder-level classification for schizotypal, borderline, avoidant and obsessive-compulsive personality disorders in a treatment-seeking sample.

Adolescent↗
PubMed2002

Traumatic exposure and posttraumatic stress disorder in borderline, schizotypal, avoidant, and obsessive-compulsive personality disorders: findings from the collaborative longitudinal personality disorders study.

The association between trauma and personality disorders (PDs), while receiving much attention and debate, has not been comprehensively examined for multiple types of trauma and PDs. The authors examined data from a multisite study of four PD groups: schizotypal, borderline (BPD), avoidant, and obsessive-compulsive, and a major depression comparison group. Rates of traumatic exposure to specific types of trauma, age of first trauma onset, and rates of posttraumatic stress disorder are compared. Results indicate that BPD participants reported the highest rate of traumatic exposure (particularly to sexual traumas, including childhood sexual abuse), the highest rate of posttraumatic stress disorder, and youngest age of first traumatic event. Those with the more severe PDs (schizotypal, BPD) reported more types of traumatic exposure and higher rates of being physically attacked (childhood and adult) when compared to other groups. These results suggest a specific relationship between BPD and sexual trauma (childhood and adult) that does not exist among other PDs. In addition, they support an association between severity of PD and severity of traumatic exposure, as indicated by earlier trauma onset, trauma of an assaultive and personal nature, and more types of traumatic events.

Adolescent↗
PubMed2002

Short-term diagnostic stability of schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders.

OBJECTIVE: Personality disorders are defined as enduring patterns of maladaptive behaviors and traits that are stable over time. This study prospectively examined the stability of four personality disorders (schizotypal, borderline, avoidant, and obsessive-compulsive) over a 1-year follow-up period. METHOD: Subjects (N=668) were recruited from multiple clinical settings at four collaborating institutions. Subjects met criteria for one or more of the four personality disorders or were part of a comparison group of subjects with major depressive disorder and no personality disorder. Diagnoses were established by using semistructured interviews. Follow-up assessments, conducted 6 and 12 months after the baseline assessment, included monthly ratings of all criteria for the four personality disorders and weekly ratings of the course of major depressive disorder. The current report is based on 621 subjects with complete data through 12 months of the follow-up period. RESULTS: Significantly more subjects in each personality disorder group remained at diagnostic threshold throughout the 12 months of the follow-up period than did those in the major depressive disorder group. A continuous measure of number of criteria met was highly correlated across the three assessments. The majority of personality disorder subjects, however, did not consistently remain at diagnostic threshold, and the mean number of criteria met decreased significantly for each group. CONCLUSIONS: Individual differences in personality disorder features appear to be highly stable, although the number of criteria present decreases over time. Personality disorders may be characterized by stable trait constellations that fluctuate in degree of maladaptive expression.

Adaptation, Psychological↗
PubMed2002

Functional impairment in patients with schizotypal, borderline, avoidant, or obsessive-compulsive personality disorder.

OBJECTIVE: The purpose of this study was to compare psychosocial functioning in patients with schizotypal, borderline, avoidant, or obsessive-compulsive personality disorder and patients with major depressive disorder and no personality disorder. METHOD: Patients (N=668) were recruited by the four clinical sites of the Collaborative Longitudinal Personality Disorders Study. The carefully diagnosed study groups were compared on an array of domains of psychosocial functioning, as measured by the Longitudinal Interval Follow-Up Evaluation--Baseline Version and the Social Adjustment Scale. RESULTS: Patients with schizotypal personality disorder and borderline personality disorder were found to have significantly more impairment at work, in social relationships, and at leisure than patients with obsessive-compulsive personality disorder or major depressive disorder; patients with avoidant personality disorder were intermediate. These differences were found across assessment modalities and remained significant after covarying for demographic differences and comorbid axis I psychopathology. CONCLUSIONS: Personality disorders are a significant source of psychiatric morbidity, accounting for more impairment in functioning than major depressive disorder alone.

Activities of Daily Living↗
PubMed2002

Confirmatory factor analysis of DSM-IV criteria for borderline personality disorder: findings from the collaborative longitudinal personality disorders study.

OBJECTIVE: This study tested the factor structure of the DSM-IV criteria for borderline personality disorder by using confirmatory methods for the analysis of covariance structures in a large group from a multisite study. METHOD: A total of 668 primarily treatment-seeking subjects were reliably assessed for personality disorders by using the Diagnostic Interview for DSM-IV Personality Disorders. Associations among criteria for borderline personality disorder were examined. A confirmatory factor analysis was performed to test diagnosis as a unitary construct and to test an earlier-reported three-factor model comprising disturbed relatedness, behavioral dysregulation, and affective dysregulation. The three-factor model was subsequently tested by using a subset (N=498) of the study group that was reassessed 2 years later by independent evaluators who were blind to original diagnoses. RESULTS: Internal consistency of the borderline personality disorder diagnosis was adequate for both baseline and follow-up assessments. A confirmatory factor analysis model testing the borderline personality disorder diagnosis as a unitary construct provided good fit, and the three-factor model offered a significantly better fit for the baseline assessment. The three-factor model was replicated with the 2-year follow-up data. CONCLUSIONS: The diagnostic criteria for borderline personality disorder appear to reflect a statistically coherent construct. Three homogeneous components were supported empirically, lending conceptual clarity to different classes of the criteria for borderline personality disorder.

Adolescent↗
PubMed2002

Substance or style? An investigation of the NEO-PI-R validity scales.

The Revised NEO Personality Inventory (NEO-PI-R; Costa & McCrae, 1992b) has been criticized for the absence of validity scales designed to detect response distortion. Recently, validity scales were developed from the items of the NEO-PI-R (Schinka, Kinder, & Kremer, 1997) and several studies have used a variety of methods to test their use. However, it is controversial whether these scales are measuring something that is substantive (such as psychopathology or its absence) or stylistic (which might be effortful distortion or less conscious processes such as lack of insight). In this study, we used a multimethod-multitrait approach to examine the validity of these scales in a clinical sample of 668 participants diagnosed with personality disorders or major depression. Using various indicators of both stylistic and substantive variance, confirmatory factor analyses (CFA) suggested that these validity scales measure something that may be conceptually distinct from, yet highly related to, substantive variance in responding.

Adolescent↗
PubMed2002

The representation of borderline, avoidant, obsessive-compulsive, and schizotypal personality disorders by the five-factor model.

This study evaluated the accuracy of hypothesized relationships of the five-factor model of personality to four targeted personality disorders in a large multisite sample of patients. Data were gathered from 668 patients, who were assigned to one of five study cells: Borderline, Schizotypal, Avoidant, and Obsessive-Compulsive Personality Disorder, and a Major Depression without personality disorder comparison group. Patients were administered a questionnaire designed to assess the domains and facets of the five-factor model and results were compared among diagnostic groups and between patients and community norms. Although many relationships between personality traits and disorders were obtained, the magnitude of the relationships varied greatly as a function of the comparison group involved. In general, the differences between the personality disorder patients and community norms were far larger than the differences between the specific personality disorder groups. Also, for avoidant personality, it appeared that statistical interactions between personality factors are needed to better differentiate it from other personality disorder groups. The four personality disorder groups studied could each be distinguished from community norms on the personality dimensions of the five-factor model. However, differentiating among the four groups proved more difficult, as each shared the configuration of high Neuroticism, low Agreeableness, and low Conscientiousness. It does not appear that these disorders represent extremes of different personality dimensions, but rather each appears to be a variant of the same extreme configuration. Differences between personality disorders may reflect diverse interactions among the dimensions, rather than differences on single dimensions.

Adult↗
PubMedDate not supplied

Psychosocial impairment and recurrence of major depression.

Major depressive disorder is often marked by multiple recurrences. Unfortunately, it is difficult to predict specifically which patients will suffer a recurrence. This study examined whether psychosocial impairment is a risk factor for recurrence. A total of 290 subjects with unipolar major depressive disorder according to Research Diagnostic Criteria (RDC) were prospectively followed for up to 15 years as part of the Collaborative Depression Study (CDS), a multicenter longitudinal observational study of the mood disorders. Follow-up data on course of illness and psychosocial functioning were collected with the Longitudinal Interval Follow-up Evaluation (LIFE). The association of psychosocial impairment with recurrence of major depression was examined with mixed-effects logistic regression. The mean (SD) score for psychosocial functioning during recovery from an episode of major depression was 9.0 (2.7), with a possible range of 4 (no impairment) to 20 (severe impairment). For euthymic subjects who recovered from an episode of major depression, elevated psychosocial impairment was significantly associated with subsequent recurrence of major depression, with an odds ratio of 1.12 (95% confidence interval [CI], 1.06 to 1.19). The odds ratio of 1.12 indicates that for each 1-point increase in the functional impairment score, the risk of recurrence increases by about 12%. In patients who have recovered from an episode of major depression, the presence of psychosocial impairment may help identify who is at increased risk of recurrence.

Adolescent↗
PubMedDate not supplied

Social and health functioning in female primary care patients with post-traumatic stress disorder with and without comorbid substance abuse.

The present study examined whether post-traumatic stress disorder (PTSD) and comorbid substance use disorder (SUD) is associated with greater social and health morbidity than PTSD without SUD in a sample of female primary care patients. Participants were administered diagnostic interviews and assessed for work productivity, quality of interpersonal relationships, and degree of health functioning. No significant differences were found between the women with current PTSD and a comorbid lifetime substance use disorder (N = 56) and those with current PTSD and no lifetime substance use disorders (N = 60) in degree of work productivity, interpersonal functioning, and overall well-being and health, as well as number of lifetime medical illnesses. These findings suggest that the presence of comorbid SUD may not explain the level of social and health difficulties associated with the dual diagnosis of PTSD and SUD.

Adult↗
PubMedDate not supplied

Gender differences in borderline personality disorder: findings from the Collaborative Longitudinal Personality Disorders Study.

A majority of the literature on borderline personality disorder (BPD) focuses on its occurrence in women or does not specifically assess for gender differences in clinical presentations. Some studies report that men with BPD may be more likely to be diagnosed with substance use disorders, as well as paranoid, passive-aggressive, narcissistic, sadistic, and antisocial personality disorders (PDs). Additionally, women with BPD appear to be more likely to report histories of adult physical and sexual abuse and to meet diagnostic criteria for post-traumatic stress disorder (PTSD) and eating disorders. The purpose of the present study was to further examine gender differences in BPD. Using baseline data from the Collaborative Longitudinal Personality Disorders Study (CLPS), men and women who met criteria for BPD were compared on current axis I and II disorders, BPD diagnostic criteria, childhood trauma histories, psychosocial functioning, temperament, and personality traits. Men with BPD were more likely to present with substance use disorders, and with schizotypal, narcissistic, and antisocial PDs, while women with BPD were more likely to present with PTSD, eating disorders, and the BPD criterion of identity disturbance. Generally speaking, women and men with BPD displayed more similarities than differences in clinical presentations. The differences that did emerge are consistent with those found in epidemiological studies of psychopathology and therefore do not appear unique to BPD. Additionally, many gender differences traditionally found in epidemiological samples did not emerge in BPD subjects. For example, no difference was found in rates of major depressive disorder, a condition that is more prevalent in females. Thus, BPD pathology may be a prevailing characterization that can attenuate usual gender-based distinctions.

Adolescent↗
PubMedDate not supplied

Ethnicity and four personality disorders.

The current study examined the relationship between ethnicity and DSM-IV personality disorders. The distribution of four personality disorders--borderline (BPD), schizotypal (STPD), avoidant (AVPD), and obsessive-compulsive (OCPD)--along with their criteria sets, were compared across three ethnic groups (Caucasians, African Americans, and Hispanics) using both a clinician-administered diagnostic interview and a self-report instrument. Participants were 554 patients drawn from the Collaborative Longitudinal Personality Disorders Study (CLPS) who comprised these three ethnic groups and met personality disorder criteria based on reliably administered semistructured interviews. Chi-square analyses revealed disproportionately higher rates of BPD in Hispanic than in Caucasian and African American participants and higher rates of STPD among African Americans when compared to Caucasians. Self-report data reflected similar patterns. The findings suggest that in treatment-seeking samples, Caucasians, Hispanics, and African Americans may present with different patterns of personality pathology. The factors contributing to these differences warrant further investigation.

Adolescent↗