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Reliability and cultural applicability of the Greek version of the International Personality Disorders Examination.

BACKGROUND: The International Personality Disorders Examination (IPDE) constitutes the proposal of the WHO for the reliable diagnosis of personality disorders (PD). The IPDE assesses pathological personality and is compatible both with DSM-IV and ICD-10 diagnosis. However it is important to test the reliability and cultural applicability of different IPDE translations. METHODS: Thirty-one patients (12 male and 19 female) aged 35.25 +/- 11.08 years, took part in the study. Three examiners applied the interview (23 interviews of two and 8 interviews of 3 examiners, that is 47 pairs of interviews and 70 single interviews). The phi coefficient was used to test categorical diagnosis agreement and the Pearson Product Moment correlation coefficient to test agreement concerning the number of criteria met. RESULTS: Translation and back-translation did not reveal specific problems. Results suggested that reliability of the Greek translation is good. However, socio-cultural factors (family coherence, work environment etc) could affect the application of some of the IPDE items in Greece. The diagnosis of any PD was highly reliable with phi >0.92. However, diagnosis of non-specific PD was not reliable at all (phi close to 0) suggesting that this is a true residual category. Diagnosis of specific PDs were highly reliable with the exception of schizoid PD. Diagnosis of antisocial and Borderline PDs were perfectly reliable with phi equal to 1.00. CONCLUSIONS: The Greek translation of the IPDE is a reliable instrument for the assessment of personality disorder but cultural variation may limit its applicability in international comparisons.

Adult↗

A developmental perspective on personality disorders: lessons from research on normal personality development in childhood and adolescence.

Recent work on normal personality development in children and adolescents points to several conclusions that are relevant for understanding personality pathology. First, child temperament and adult personality traits share many features in common. Second, youths' individual differences can be described in terms of the Big Five personality traits observed in adults; an integrative taxonomy of individual differences in childhood and adolescence is articulated in this article. Third, personality is already moderately stable by the preschool years, but considerable personality change occurs well into the adult years. Taken together, these findings suggest that childhood personality functioning can and should be integrated into developmental research and applied work on personality disorders.

Adolescent↗

Criminal Behavior Associated with Pathological Gambling.

The influence of addictive gambling behavior on criminal behavior was examined in this study. A sample of pathological gamblers from in- and outpatient treatment centers and self-help groups (n = 300) and a sample of high and low frequency gamblers from the general population and army (n = 274) completed a comprehensive questionnaire which assessed social attachment, personality, pathological gambling and criminal behavior variables. The causal analysis of a Lisrel Model leads to the following results: addictive gambling behavior is an important criminogenic factor. This predisposing factor alone cannot sufficiently explain criminal behavior associated with pathological gambling. Personality variables also directly influence the intensity of criminal behavior. Social attachment variables have only an indirect effect. As far as property offenses are concerned, it was found that the direct causal effect of addiction behavior is greater than that of personality.

Journal Article↗

Stability and change in personality disorder features: the Longitudinal Study of Personality Disorders.

BACKGROUND: There exists no empirical literature documenting the long-term longitudinal stability of personality pathology comparable to that available for normal personality. A number of test-retest studies have usefully established the short-term reliability of Axis II measures. However, the test-retest design is methodologically inadequate for resolving issues related to the long-term stability of personality disorder (PD). This prospective longitudinal study evaluated the stability of PD features in multiwave perspective. METHODS: Subjects (N = 250) drawn from a nonclinical university population were examined for PD features at 3 different time points using the International Personality Disorders Examination (IPDE) and the Millon Clinical Multiaxial Inventory II (MCMI-II) during a study period of 4 years. RESULTS: Features of PD displayed considerable evidence of stability for individual differences and group means, at the dimensional level of analysis, on both the IPDE and the MCMI-II. Both measures revealed modest declines in PD features over time; however, the observed changes were associated with relatively small effect sizes. CONCLUSION: Features of PD, viewed from a dimensional perspective, seem to be relatively stable in terms of individual differences and group means based on both clinical interview and self-administered PD assessments.

Analysis of Variance↗

The stability of the MCMI-II for psychiatric inpatients.

The MCMI-II (Millon, 1987) has been introduced recently as a successor to the MCMI-I (Millon, 1983). Because numerous revisions have been made in the MCMI-II, it will need to be cross-validated as an instrument distinct from the MCMI-I. The purposes of this study were to: (1) cross-validate the test-retest stabilities for MCMI-II personality and symptom scales; and (2) compare and contrast the MCMI-II and MCMI-I in regard to scale stability. The MCMI-II was administered to 98 psychiatric inpatients at admission and discharge. Results were generally consistent with the data reported by Millon (1987), in that the basic personality scales evidenced the greatest stability, the pathological personality scales somewhat lower stability, and the symptom scales the least stability. Compared to the MCMI-I, test-retest coefficients were generally higher for the MCMI-II.

Adult↗

Personality constellations in patients with a history of childhood sexual abuse.

Although childhood sexual abuse (CSA) appears to have an impact on personality, it does not affect all survivors the same way. The goal of this study was to identify common personality patterns in women with a history of CSA. A national sample of randomly selected psychologists and psychiatrists described 74 adult female patients with a history of CSA and a comparison group of 74 without CSA using the Shedler-Westen Assessment Procedure-200 (SWAP-200), a Q-sort procedure for assessing personality pathology. Q-factor analysis identified four personality constellations among abuse survivors: Internalizing Dysregulated, High Functioning Internalizing, Externalizing Dysregulated, and Dependent. The four groups differed on diagnostic, adaptive functioning, and developmental history variables, providing initial support for the validity of this classification. The data have potential methodological and treatment implications.

Adult↗

Age and sex distribution of DSM-III personality cluster traits in a community population.

DSM-III pathological personality cluster traits were measured on a community sample of 235 people. Traits in the schizoid cluster (schizoid, schizotypal, and paranoid) showed no change with age while traits in the dramatic cluster (antisocial, narcissistic, borderline, and histrionic) and to some extent the anxious cluster (avoidant, dependent, compulsive, and passive/aggressive) showed similar significant associations with age. This pattern was a reverse "J" shaped curve, with mean number of traits declining from younger to older groups and a slight upturn in the oldest age group (60 years plus). Women aged 31 to 40 years had a higher mean number of traits than their male counterparts, with a corresponding increase in impairment. The highest levels of personality traits in men were found at ages 18 to 30, while in women the 31 to 40 year group was highest.

Adolescent↗

Is alexithymia a risk factor for unexplained physical symptoms in general medical outpatients?

OBJECTIVE: Alexithymia is presumed to play an important predisposing role in the pathogenesis of medically unexplained physical symptoms. However, no research on alexithymia has been done among general medical outpatients who present with medically unexplained physical symptoms as their main problem and in which anxiety and depression have been considered as possible confounding factors. This study investigated whether patients with medically unexplained physical symptoms are more alexithymic than those with explained symptoms and whether, in patients with unexplained symptoms, alexithymia is associated with subjective health experience and use of medical services. METHODS: We conducted a cross-sectional study among patients attending an internal medicine outpatient clinic. All patients were given a standardized interview and completed a number of questionnaires. RESULTS: After complete physical examinations, 169 of 321 patients had unexplained physical symptoms according to two independent raters. Patients with medically unexplained symptoms more often had a mental disorder, but overall they were not more alexithymic. In patients with unexplained physical symptoms, alexithymia was not associated with subjective health experience or use of medical services. However, patients with both unexplained symptoms and a mental disorder who also denied any possible connection between emotional problems and their physical symptoms did have more alexithymic traits. CONCLUSIONS: In the majority of patients with medically unexplained physical symptoms, alexithymia does not play a role of clinical significance. Patients with unexplained physical symptoms are heterogeneous with respect to psychiatric syndrome pathology and probably also with respect to personality pathology.

Adult↗

An examination of the relationship between personality patterns and symptom/mood patterns.

Relationships between various personality styles measured by the basic and pathological personality scales of the Millon Clinical Multiaxial Inventory (MCMI) and mood or symptom states measured by the Profile of Mood State scales were examined. The MCMI personality scale-POMS symptom/mood scale relationships found in this study are compared with MCMI personality scale-MMPI and SCL-90 symptom/mood scale relationships reported in the MCMI manual. Consistent associations of moderate strength were found between: (a) the MCMI Compulsive-Conforming and Passive-Aggressive (Negativistic) scales (negative and positive associations, respectively) and various measures of depression, anxiety and hostility; (b) the MCMI Avoidant, Schizotypal and Borderline-Cycloid scales and various measures of depression and anxiety; (c) the MCMI Schizoid-Asocial scale and various measures of depression; and (d) the Histrionic-Gregarious scale and various measures of high energy-activity. These MCMI personality scale-symptom/mood scale relationships are generally consistent both with the underlying theory of personality and psychopathology upon which the MCMI is based and with the personality-symptom scale relationships found within the MCMI.

Alcoholism↗

Childhood sexual, physical, and psychological abuse and their relationship to comorbid psychopathology in bulimia nervosa.

We examined the relationship between childhood sexual, physical, psychological, and "multiple" abuse (i.e., abuse in more than one form) and comorbid Axis I and personality psychopathology among women with a lifetime history of bulimia nervosa (BN group; n =s 80) and a control group of noneating-disordered women (n = 40). Subjects were recruited primarily by newspaper advertisement. They participated in structured clinical interviews for diagnosis of Axis I and personality pathology, and they completed child abuse questionnaires in the interview setting. At odds with prediction, child abuse in various forms was not associated with the presence of lifetime comorbid Axis I disorders in general (i.e., 1 or more) or disorder classes in particular (mood, alcohol/substance use, anxiety) among BN subjects, although sexual, psychological, and multiple abuse were associated with the diagnosis of a higher total number of Axis I conditions. A history of psychological and multiple abuse (but not physical or sexual abuse alone) among BN subjects was strongly associated with the presence of personality disorder diagnoses, especially those in the "anxious-fearful" cluster (Cluster C). Finally, we found that when a personality disorder was present in addition to the Axis I conditions in question, significant relationships emerged between abuse and Axis I pathology, particularly for psychological and multiple abuse. In general, control group findings were in accord with BN group findings, indicating that our findings were not specific to eating-disordered women. Our results suggest that childhood abuse, particularly psychological abuse and abuse in multiple forms, increase the likelihood of lifetime comorbid Axis I disorders and personality pathology among bulimic patients. Eating-disordered women with a history of child abuse may thus represent a subgroup of patients requiring especially intensive intervention.

Adolescent↗

Emotional reliance and social loss: effects on depressive symptomatology.

A reactive form of dependence has been proposed to occur when a person is undergoing a period of substantial stress and change. The present study assessed 114 psychiatric inpatients categorized according to the presence or absence of social loss and their level of emotional reliance on others. Both emotional reliance and social loss were related to a variety of depressive symptoms. A significant interaction was observed between emotional reliance and social loss on depression severity as measured by the Beck Depression Inventory (BDI). In general, subjects high in emotional reliance but experiencing no social loss displayed higher levels of depression than emotionally reliant subjects who had undergone a social loss. Patients reporting high emotional reliance on others, in the aftermath of a social loss, may be reacting to the loss and suffer from less-severe and less-chronic pathology. Subjects reporting excessive emotional reliance in the absence of any precipitating exit event may be displaying more of a trait-like pathology. Personality disorder pathology should occur with such frequency and intensity so it can be observed even when obvious eliciting stimuli are absent.

Adaptation, Psychological↗

Psychotherapy for the personality disorders: working with traits.

Empirical research confirms clinical impressions that personality disorders are difficult to treat in psychotherapy. Personality pathology interferes with the therapeutic process, largely due to problems in alliance formation. Future models of treatment need to be built on a broader theory of the etiology of the personality disorders. These conditions are best understood as pathological amplifications of normal personality traits. The temporal stability of personality disorders can be accounted for by the genetic influence on these traits. Treatment involves helping patients to develop more adaptive ways of using their underlying traits.

Adaptation, Psychological↗

Genetic and environmental contributions to dimensions of personality disorder.

OBJECTIVE: The authors estimated the heritability of the basic dimensions of personality disorder and the relative proportions of the variance attributable to genetic and environmental sources. METHOD: The subjects were 175 volunteer twin pairs (90 monozygotic and 85 dizygotic) from the general population. Each twin completed the Dimensional Assessment of Personality Pathology, a questionnaire that assesses 18 dimensions of personality disorder. The questionnaire was developed on the basis of factor analytic studies that identified a stable structure underlying personality disorders in clinical and nonclinical subjects. Structural equation model-fitting methods were used to estimate the influence of additive genetic, common environmental, and unique environmental effects. RESULTS: The estimates of broad heritability ranged from 0%, for conduct problems, to 64%, for narcissism. Behaviors associated with submissiveness and attachment problems had low heritability. For most dimensions, the best-fitting model was one that specified additive genetic and unique environmental effects. CONCLUSIONS: These results are similar to those reported for normal personality and suggest a continuity between normal and disordered personality.

Adolescent↗

Dimensional personality traits and the prediction of DSM-IV personality disorder symptom counts in a nonclinical sample.

The third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III; APA, 1980) set forth a categorical system of personality psychopathology that is composed of discrete personality disorders (PDs), each with a distinct set of diagnostic criteria. Although this system is widely accepted and highly influential, alternative dimensional approaches to capturing personality psychopathology have been proposed. Three dimensional models of personality have garnered particular attention-the Five-Factor Model (FFM; Costa & McCrae, 1992), the Seven-Factor Psychobiological Model of Temperament and Character (Seven-Factor Model; Cloninger, Svrakic, & Przybeck, 1993); and the 18-factor model of personality pathology (18-factor model; Livesley, 1986). Although the personality traits from each of these models has been examined in relation to the ten personality disorders in the DSM-IV, no study has examined the comparative and incremental validity of these models in predicting PD symptoms for these ten disorders. Using self-report instruments that measure these models and the ten DSM-IV PDs, correlation and linear regression analyses indicate that traits from all three models had statistically significant associations with PD symptom counts. Hierarchical regressions revealed that the 18-factor model had incremental predictive validity over the FFM and Seven-Fac-tor Model in predicting symptom counts for all ten DSM-IV PDs. The FFM had incremental predictive validity over the Seven-Factor Model model for all ten disorders and the Seven-Factor was able to add incremental predictive validity over the 18-factor model for five of the ten PDs and for eight of the ten disorders relative to the FFM.

Adolescent↗

Personality prototypes in eating disorders based on the Big Five model.

A three factor model of personality pathology was investigated in a clinical sample of 335 female eating disordered patients. Cluster analysis of the Big Five NEO-FFI scales (Costa & McCrae, 1992) yielded three distinct personality profiles, which were consistent with previous studies: (1) a resilient/high functioning cluster with no clinical elevations on the NEO-FFI scales; (2) an undercontrolled/emotionally dysregulated cluster with elevated scores on the Neuroticism scale and low scores on Conscientiousness and Agreeableness; (3) an overcontrolled/constricted cluster showing high scores on Neuroticism and Conscientiousness and low scores on Openness to Experience. Comparing the three personality prototypes with respect to Axis I and Axis II disorders,resilients reported systematically less clinical and personality problems than both undercontrollers and overcontrollers. Compared to the latter, undercontrollers showed more impulsive personality features and behaviors. Finally, cluster membership was not clearly associated with eating disorder subtypes, suggesting that there is considerable variance in personality features and/or pathology within the various eating disorder categories.

Adolescent↗

[Course of an adolescent diagnosed as schizophrenic: uncertainty].

This paper reports the case of a female patient hospitalized twice at a twelve-year interval in the same department. During the first hospitalization at the age of fifteen clinical findings and results of projective tests had led to consider schizophrenia. The patient had been entered upon a Sakel cure. Twelve years later, this twenty-seven-year-old patient has no symptoms pointing to schizophrenia. Her mental organization and the nature of the relationships she establishes with others rather suggest pathologic personality organizations which are now better known, especially narcissic pathology. While the answers to projective tests performed at a twelve-year interval are very similar, the interpretation of these tests no longer focuses upon the same issues. This observation is especially interesting as an illustration of the developments which have taken place in the psychopathological approach and as material for an a posteriori discussion of the Sakel cure which has now been practically abandoned. Lastly, this observation clearly shows that strict focusing upon the diagnostic neurosis-psychosis alternative is an oversimplification. From this viewpoint, the wide field of conditions designated as "borderline" has led to more dynamic discussions and more subtle therapeutic choices.

Adult↗

Multivariate modelling and the Defence Mechanism Test: a comparative study of defensive structures in borderline, other personality disorders and schizophrenic disorder.

The study aims at discerning discriminating patterns in the perceptual responses according to the projective percept-genetic method Defence Mechanism Test (DMT) among 45 subjects with the diagnoses borderline personality disorder (BPD), other personality disorders (OPD), schizophrenic disorder (SD) and a non-patient group. The overall results show that, by means of partial least squares (PLS) discriminant analysis of 130 DMT variables, it is possible to separate these groups. Patients with a BPD or a SD diagnosis and the non-patient group are clearly separated, whereas the OPD group shows a less homogeneous pattern. The findings support both the validity of the DMT as a method to measure personality features and the psychodynamic validity of BPD. The most characteristic properties of the BPD group are responses of emotional expressions, especially introaggression and frequent distortions of the stimulus picture. Regarding the SD/OPD group, a pattern of high threshold values for perception emerges as a discriminating feature as well as different variants of introjection. The non-patients are characterized by very few DMT distortions and consequently show a good reality orientation. The conclusion is that the DMT and the PLS discriminant analysis are powerful methods in the assessment of personality pathology.

Borderline Personality Disorder↗

Personality dysfunction among somatizing patients.

To examine the nature and extent of personality dysfunction related to somatization, the authors administered the Structured Interview for DSM-IV Personality and the NEO Five-Factor Inventory to a series of somatizing and nonsomatizing patients in a general medicine clinic. A greater percentage of somatizers met criteria for one or more DSM-IV personality disorders, especially obsessive-compulsive disorder, than did control patients. Somatizers also differed from control patients with respect to self-defeating, depressive, and negativistic personality traits and scored higher on the dimension of neuroticism and lower on the dimension of agreeableness. In addition, initial and facultative somatizers showed more personality pathology than true somatizers. These findings suggest that certain personality disorders and traits contribute to somatization by way of increased symptom reporting and care-seeking behavior.

Adult↗