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[Psychopathological phenomena and personality disorders (the issue of dynamic aspects of psychopathologies)].

An analysis of the interaction between pathocharacterological and psychopathological (affective, anxious-phobic and hysterical) phenomena within "borderline psychiatry" (reactions, phases, development) gives evidence to the existence of 2 clinically heterogeneous variations of comorbid interactions. The first variation: primary psychopathological syndromes manifesting without any significant correlation with personality disorders and transform into pathocharacterological ones (neurotic, postreactive) personality development by means of "amalgamating" mechanism. The second variation: secondary (in regard to personality disorders) psychopathological phenomena forming on the basis of constitutional personality traits by means of "splitting off" mechanism and are defined as personality disorders with predisposition to manifest positive psychopathological symptomatology. Formation of isolated obsessive and dissociative disorders within the structure of "basic" pathocharacterological phenomena (variation 2) predicts a future absence of growing severity of personality disorders (i.e. a dynamics traditionally defined as the development--variation 1) and stabilization of psychopathic traits with features of compensation of the latter. The possibilities of pathological dynamics in psychopathic personality with a "splitting off" of the isolated psychopathological syndromes exhausted; for decades neither growing severity of personality disorders, nor an exacerbation of those psychopathological complexes which provided a primary base for manifestation of positive symptomatology may be observed.

Adult↗

Predicting personality pathology among adult patients with substance use disorders: effects of childhood maltreatment.

The purpose of this study was to examine predictive relationships between types of childhood maltreatment and personality disorders in a substance-abusing population. Three hundred thirty-nine drug- or alcohol-dependent patients completed a reliable and valid retrospective measure of childhood trauma, the CTQ, and a self-report inventory that assesses the entire range of DSM-III-R personality disorders, the PDQ-R. As a preliminary step, factor analyses were used to group personality disorders into the three DSM-III-R Axis II clusters (Clusters A, B, and C), although some diagnostic subclusters were also found. Structural equation modeling analyses revealed several significant paths between types of maltreatment and personality disorder clusters (and subclusters). Physical abuse and physical neglect were related to a subcluster of "psychopathic" personality disorders consisting of childhood and adult antisocial personality traits and sadistic traits. Emotional abuse emerged as a broad risk factor for personality disorders in Clusters A, B, and C. Emotional neglect was related to the traits of schizoid personality disorder, which formed its own subcluster. Finally, sexual abuse, which had been expected to predict borderline personality disorder traits, was unrelated to any personality disorder cluster. These findings support the view that child maltreatment contributes to the high prevalence of co-morbid personality disorders in addicted populations.

Adult↗

Convergence and divergence among self-report psychopathy measures: a personality-based approach.

The study examined, in a sample of 346 undergraduates, the convergence and divergence of three self-report measures of psychopathy; the Psychopathic Personality Inventory (Lillienfeld & Andrews, 1996), the Self-Report Psychopathy scale (Hare, Harpur, & Hemphill, 1989), and the Five Factor Psychopathy Index (Miller, Lynam, Widiger, & Leukefeld, 2001). Measures demonstrated strong convergence at the total score level, but weak convergence at the factor level. Correlations with domains and facets of the NEO Personality Inventory-Revised (Costa & McCrae, 1992) provided personality parsings of each measure. Across measures, psychopathy was composed of low Agreeableness, low Conscientiousness and a blend of high and low facets of Neuroticism and Extraversion. Divergence among subscales was due to differences in personality characteristics assessed. Additionally, the potential moderating effects of sex were also examined, but very few were identified. Implications of these results and future directions are discussed.

Adult↗

Violent behaviour by psychiatric patients.

There is no substantial body of evidence to prove that psychiatric patients as a group are more violent than the general population. In determining whether violence is exhibited, the underlying personality of the individual is far more important than the psychiatric illness from which he suffers. Individuals with psychopathic personalities, those who abuse or are dependent on alcohol drugs, and those with pronounced paranoid or sadistic traits may be characterized by aggressive and violent behaviour. There is at present no reliable method of predicting if or when an individual patient will exhibit assaultive behaviour. Psychiatric hospitals, especially in the UK, are characterized more by frequent petty violence than by serious violence. Victims of assaults by patients are often related or known to them an interact with them on a personal level; they may also play a considerable role consciously or otherwise in instigating the assault.

Alcohol Drinking↗

The childhood-onset neuropsychiatric background to adulthood psychopathic traits and personality disorders.

Childhood conduct disorder (CD) and adult psychopathic traits according to the Psychopathy Checklist Revised (PCL-R) were the closest psychiatric covariates to repeated violent crimes and aggression among offenders under forensic psychiatric investigation in Sweden. As psychopathy is not included in the present psychiatric diagnostic systems, we compared total and factor PCL-R scores to Axis I disorders, including childhood-onset neuropsychiatric disorders, and to Axis II personality disorders, to establish the convergence of psychopathic traits with other psychiatric diagnoses, and to identify possible unique features. Psychopathic traits were positively correlated with bipolar mood disorder and negatively with unipolar depression. The total PCL-R scores as well as the Factor 2 (unemotionality) and Factor 3 (behavioral dyscontrol) scores were significantly correlated with attention-deficit/hyperactivity disorder, Asperger's syndrome/high-functioning autistic traits, CD, substance abuse, and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Cluster B personality disorders. The interpersonal Factor 1 showed none of these correlations and may capture features that are specific to psychopathy, distinguishing core psychopathy from other diagnostic definitions.

Adolescent↗

Cluster analysis of a forensic population with antisocial personality disorder regarding PCL-R scores: differentiation of two patterns of criminal profiles.

Fifty six cases of a forensic population were submitted to a cluster analysis to observe the aglomerative behavior in relation to the total scores of the items comprising the PCL-R Psychopathy Checklist Revised [R.D. Hare, Manual for the Hare Psychopathy Checklist-Revised, Multi-Health System, Toronto, 1991]. The analysis indicated two independent types of antisocial personality disorders, not identified in the PCL-R in its standardized form, one of them being strongly associated with criminal conduct and the other with psychopathic personality. Such clusters were stable when the analysis was replicated with other hierarchical algorithms, and also, they were independently extracted via the k-means method without having previously fixed the value for k. One of the clusters concentrated the PCL-R highest scores, indicating that it is the prototypical psychopathic character determinant.

Adolescent↗

Convergent and discriminant validity of psychopathy factors assessed via self-report: a comparison of three instruments.

Psychopathy has been conceptualized as a personality disorder with distinctive interpersonal-affective and behavioral deviance features. The authors examine correlates of the factors of the Psychopathic Personality Inventory (PPI), Self-Report Psychopathy-II (SRP-II) scale, and Antisocial Process Screening Device (APSD) to understand similarities and differences among the constructs embodied in these instruments. PPI Fearless Dominance and SRP-II Factor 1 were negatively related to most personality disorder symptoms and were both predicted by high Dominance and low Neuroticism. In addition, PPI Fearless Dominance correlated positively with antisocial personality features, although SRP-II Factor 1 did not. In contrast, PPI Impulsive Antisociality, SRP-II Factor 2, and both APSD factors correlated with antisocial personality features and symptoms of nearly all personality disorders, and were predicted by low Love. Results suggest ways in which the measurement of the constructs in each instrument may be improved.

Adolescent↗

[How to recognize personality disorders in general medicine].

DEFINITION: The psychological traits characteristic of an individual define that person's personality. A personality disorder is considered to exist when it causes the person or his/her family or friends to suffer. Personality disorders are often associated with a state of depression, aggravating or prolonging it. FUNDAMENTAL ASPECTS: Histrionic, paranoid, obsessional and psychopathic personalities are the most well known types of personality disorders, but dependent and borderline personalities should not be overlooked. Cognitive and behavioral therapies are particularly useful in this field of health care.

Depressive Disorder↗

[Paranoid states in the dynamics of psychopathies].

A total of 46 psychopathic personalities from 30 to 55 years of age were studied. Of them 40 subjects were examined by follow-up checkings. Under psychotraumatizing situations these patients demonstrated acute paranoiac syndromes the content of which was characterized by monotopical delusional ideas. The formation of such acute paranoiac reactions was determined by abnormal personality structures and by individual pathogenic psychotraumatizing situations. The paper contains a description of the psycho-pathological traits of acute paranoiac states in psychopaths and their impact on the general development of psychopathy.

Adult↗

Psychopathy and the DSM-IV criteria for antisocial personality disorder.

The Axis II Work Group of the Task Force on DSM-IV has expressed concern that antisocial personality disorder (APD) criteria are too long and cumbersome and that they focus on antisocial behaviors rather than personality traits central to traditional conceptions of psychopathy and to international criteria. We describe an alternative to the approach taken in the rev. 3rd ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R; American Psychiatric Association, 1987), namely, the revised Psychopathy Checklist. We also discuss the multisite APD field trials designed to evaluate and compare four criteria sets: the DSM-III-R criteria, a shortened list of these criteria, the criteria for dyssocial personality disorder from the 10th ed. of the International Classification of Diseases (World Health Organization, 1990), and a 10-item criteria set for psychopathic personality disorder derived from the revised Psychopathy Checklist.

Antisocial Personality Disorder↗

Handedness and psychopathy.

OBJECTIVES: The current study investigated whether psychopathic persons exhibit a pattern of motor dominance that differs from the left-hemisphere dominance that characterizes the majority of the population. BACKGROUND: Research with cognitive tasks suggests that psychopathy may be associated with an atypical pattern of cerebral organization characterized by either left-hemisphere dysfunction or decreased hemispheric asymmetry. However, studies that evaluate motor dominance in psychopathy have provided mixed results. METHOD: The handedness of 420 adult male inmates at a county jail was assessed using a scale developed by Chapman and Chapman as part of their participation in ongoing research. RESULTS: Psychopaths reported reduced right-hand dominance, which cannot be accounted for by differences in age, intelligence, or race. CONCLUSIONS: Psychopathy is associated with an increased proportion of mixed-handedness relative to that seen in nonpsychopathic persons. This finding is consistent with theory and research suggesting anomalous cerebral asymmetry in psychopathic offenders.

Adolescent↗

Estimating facets of psychopathy from normal personality traits: a step toward community epidemiological investigations.

In three samples consisting of community and undergraduate men and women and incarcerated men, we examined the criterion validity of two distinct factors of psychopathy embodied in the Psychopathic Personality Inventory (PPI) as indexed by primary trait scales from the Multidimensional Personality Questionnaire (MPQ). Consistent with the PPI factors themselves, MPQ-estimated PPI-I related negatively with internalizing disorder symptoms and fearfulness and positively with thrill and adventure seeking, sociability, activity, and narcissism. MPQ-estimated PPI-II was associated negatively with socialization and positively with externalizing disorder symptoms, impulsivity, disinhibition and boredom susceptibility, and trait anxiety and negative emotionality. Additionally, PPI-I was selectively related to the interpersonal facet of Factor 1 of the Psychopathy Checklist-Revised (PCL-R), whereas PPI-II was related preferentially to Factor 2 of the PCL-R.

Adolescent↗

Intimate partner aggression reporting concordance and correlates of agreement among men with alcohol use disorders and their female partners.

This study examined relationship aggression reporting concordance among 303 men with alcohol use disorders and their female partners enrolled in couples-based alcohol abuse treatment. Agreement for physical and psychological aggression was generally consistent with, or higher than, concordance rates reported among other populations. Men's antisocial personality disorder characteristics were the strongest predictor of higher concordance for male- and female-perpetrated aggression. Higher alcohol problem severity, poorer relationship adjustment, and higher psychopathic personality features were associated with better concordance in some analyses. Women reported experiencing more physical aggression than men reported perpetrating, and women reported perpetrating more psychological aggression than men reported experiencing. Findings highlight the importance of obtaining aggression reports from both partners and the need for research investigating methods for improving concordance.

Adjustment Disorders↗

Non-incarcerated psychopaths: why we need to know more about the psychopaths who live amongst us.

On 1 November 2000, Robert Stewart, aged 20, was jailed for life for bludgeoning to death his Asian cellmate, Zahid Mubarek, aged 19 years because 'he felt like it'. During the court hearing the term 'psychopathic personality' was used in relation to Stewart and, following this and other similar cases, the average man or woman could be forgiven for believing that psychopathy is inextricably linked with dangerousness and criminality. In the light of the Government consultation paper entitled Managing Dangerous People with Personality Disorder. Proposals for Policy Development and the Government White Paper Reforming the Mental Health Act -- Part II: High-risk patients, this article proposes that whilst studies conducted with incarcerated psychopaths will continue to increase our knowledge and understanding of criminality, non-incarcerated psychopaths have an arguably equal potential to illuminate our understanding of the emotional difficulties, such as lack of empathy and lack of conscience, which underlie psychopathy and which lead to offending behaviour. Although a range of obstacles have hindered progress in this field of study, this paper proposes that developing an understanding of the nature of the emotional difficulties of the psychopath, unconfounded by criminality, has the potential to make a valuable contribution to the field of child psychiatry in ways which have implications for mental health nurses and society as a whole. It theorizes that if the psychological constructs which underlie psychopathy were better understood, children who display those emotional difficulties could be more accurately identified and strategies be generated which carry the ultimate aim of minimizing the risk of those children developing the offending behaviour associated with psychopathy.

Adult↗

Emotional processing in personality disorder.

In the field of personality disorders, borderline and antisocial types are associated with emotional dysfunctioning. In borderline personality disorder (BPD), the hypothesis of emotional hyperresponsiveness can be supported by several experimental studies that suggest highly intensive and slowly subsiding emotions to primed and non-primed stimuli, as well as by data showing biased information, which processes in the context of emotions. In addition, the first neuroimaging data suggest that limbic hypersensitivity is a neurofunctional correlate of emotional vulnerability in BPD. In antisocial psychopathic personality disorder, data confirm the theory of emotional detachment, subsuming fearlessness, and, beyond that, emotional indifference to appetitive stimuli. Because of a fundamental dysfunction in the amygdala, psychopathic individuals appear to use alternative cognitive operations of processing affective material to compensate for the absence of appropriate limbic input, which normally provides prompt information about the affective characteristics of stimuli.

Adolescent↗

Views of the downward extension: comparing the Youth Version of the Psychopathy Checklist with the Youth Psychopathic traits Inventory.

Increasing interest in "juvenile psychopathy" has been met with scholarly debate about the validity of directly extending the adult construct of psychopathic personality disorder to youth. To inform this debate, this study of 160 serious adolescent offenders compared two alternative, adult-based conceptualizations of juvenile psychopathy: that of the Psychopathy Checklist: Youth Version (PCL:YV) and the self-report Youth Psychopathic traits Inventory (YPI). The results indicate that these two conceptualizations overlap only partially, with the YPI focusing more tightly on core interpersonal and affective features than the PCL:YV. Each conceptualization is reliable and predicts different forms of short-term institutional misbehavior. However, only the YPI possesses a theoretically coherent, inverse association with anxiety. Despite this promise, these conceptualizations of psychopathy are less strongly associated with one another than they are with psychosocial markers of developmental maturity. This raises questions about their divergent validity and ability to identify a disorder that will remain stable during the transition from adolescence into adulthood. Implications for future longitudinal research on the validity, manifestations, and course of juvenile psychopathy are discussed.

Adolescent↗

[Consensus, hedonism: the characteristics of new family and their consequences for the development of children].

Over the last three decades, the marital family model described by Durkheim at the end of the nineteenth century has undergone numerous changes, e.g. questioning about the principle of authority, women emancipation, occurrence of the "new fathers", the growing influence of the media on the daily life of families, the less frequent and most precious child (due to the reduced number of children per family),... Through clinical, psychoanalytical and developmental models we, here, analyze these changes together with their impact on child. Historical and sociological approaches also allowed us to examine some of the effects induced by consensus and hedonism, the new familial parameters, on the child's life and development. The modern family being classically founded upon duty (central value) and the principle of authority to settle relationships between individuals, its main features are opposed to those of the contemporary family. The latter, which started to emerge over the sixties, is characterized by both the prevalence of parent-child relationships symmetrization and the emergence of the search for immediate pleasure. The change from parental authority to consensus as a principle ruling the relationships within families leads to many consequences later noticed through changes in the construction of the child's psyche along his development and in the relationships dynamics. Authority imposes on child to submit to the parents-mediatized requirements of the society and implies a change in impulses through the setting of Superego agencies and Ego Ideal, which (both ?) represent taboos and social ideals in the psyche. When consensus is at the center of the family, and according to concrete meetings with the other offered by the thousand and one situations met in the daily life, the aims and satisfaction modalities of the child's impulses will evolve into a relation often based on either strength or seduction. As a result, the settlement of classical instances will be affected. It will result in. Considering hedonism as the central value in child education leads one to support the pleasure principle and contributes to making more difficult the switching to the reality principle. The couple " I want, I don't want" is at the origin of most behaviors, and then further leads to the development of the assertive agency, "I do what I want, and thus I am". The libidinal excitation is, therefore, little restricted and reinforced by the media-based environment. The child's Superego is built on the concrete practices of his parents, but not on their Superego, whereas the Ideal of Ego is poorly socialized and driven towards the ideal Ego, early narcissist formation with the signs of child megalomania. Due to these early years of life throughout which the pleasure principle has been favored by their environment, the children are not prepared for life with its restrictions and unavoidable frustrations possibly experienced as persecutions. In the same way, when they have to meet the requirements of life in community, eg the discipline imposed within a college, these rules are more and more often felt by a pupil as unfair, arbitrary persecutions sometimes related to his own personality, "the teacher doesn't like me" of course, it is all the more legitimate to rebel against them as the charter of the pupils' rights, posted up in the school, has been read through very quickly by the teenagers. This mechanism takes one back to the archaically perception of environment by the very young child and to the projection developed by S. Freud in his description of the building "Ego-pure pleasure", (moi-plaisir purifie) (The Ego and the id, 1920). The opposed mechanism is expressed through an experience of shame felt by the subject when he is unable to satisfy, not the requests of his own impulses, but the social group's requirements. From the libidinal point of view, advertisements stimulate one's desires, incite one to consume and are at the origin of consumer needs. As a consequence, there is a resonance between the individual pleasure principle and the promotion of hedonism suggested by the society. The modern children have their mastery of impulse motions hampered by this phenomenon. The temporality of , new children " in new families sounds centered on the present, which is made of moments of eternity, always restarted (cyclic time of the first ages of life) ; it overrides historical time with a start, an end and references to intergeneration difference and filiations. This prevalence of present offers few support to neurotic defenses, with predictable problems in social interactions due to an inability to manage the tensions issued from the time discrepancies between one and his alter ego. Tran cultural studies have shown that to any social and cultural organization corresponds one or several basic personalities; among them, modem society has exuded the standard neurotic personality characterized by an ample mental space, a strict modulation of behaviors governed by the representations play and spreading out in Le théâtre du Je (The I theatre, Mac Dougall, 1982), a conflict between desire and internalized taboo, and the problematic of transgression and guilt. The modern family produces different personality structures. This led us to assume new basic personalities as follows, and to envision some psychopathological consequences: The passive dependent personality with an extreme narcissist fragility and at high risks of depressive disorders; The perverse-anarchistic personality characterized by subjects unable to feel guilty, taking at the best advantage of others to achieve his own ends thanks to his grasping of social situations and to his own seduction, lacking of true empathy; The slightly-psychopathic personality: these subjects can integrate well, but for a short time, in a social structure. They need to frequently find a new job, move in another place or country. Their relationships with others are always disrupted and changing for they can be involved in only short commitments. They are very susceptible to immediate gratifications.

Adult↗