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Who is 'who' in dissociation?: A plea for psychodynamics in a time of trauma.

Contemporary theories of dissociation and trauma for the most part have evolved outside of psychoanalysis. Psychoanalytic writings have also been regarded as being in opposition to trauma-based notions of human psychopathology. The specific psychoanalytic contribution--the emphasis on unconscious conflict and meaning--is for the most part excluded from the discourse on dissociation, often resulting in a 'mechanic' conceptualisation of trauma. In this paper, based on clinical material, the author argues in favour of including conflict, unconscious intention and personal meaning in understanding the kind of dissociation we see in cases of multiple personality pathology. Textual analysis of letters written to the analyst illustrates how events of abuse are defensively elaborated. The author demonstrates that patterns of affect regulation and dominant object-relational strategies can be captured through analysis of the discourse structure. She focuses on how an organised character pattern, revealed mainly through narrative style and the analyst's countertransference, serves protective purposes as well as wish-fulfillment. She argues that dissociation in the form of multiple personalities may imply an active, strategic agent.

Adult↗

The relationship of suicide attempts, borderline personality traits, and major depressive disorder in a veteran outpatient population.

BACKGROUND: Suicide attempts have been associated to both Major Depression and Borderline Personality Disorder. This report hypothesized that there would be significant clinical differences between psychiatric outpatients with Major Depression, Major Depression with a history of a suicide attempt (but low Borderline traits) and Major Depression high levels of Borderline personality traits. METHODS: Male psychiatric outpatients who had Major Depression were divided into three groups: No suicide attempts and low Borderline traits (Depression), suicide and low Borderline traits (Suicide) and high Borderline traits (Borderline traits.) A screened control group was also used (Controls). Standardized measures of Axis I and Axis II variables were gathered by trained interviewers. RESULTS: "Suicide" had significantly higher levels of anxiety and depression than all other groups. "Borderline traits" had higher levels of pathological personality traits and familial Generalized Anxiety Disorder (GAD) than all other groups. CONCLUSIONS AND CLINICAL RELEVANCE: The Suicide group appears to identify a group that is more symptomatically severe in Axis I symptoms than other Major Depression groups. Different Major Depression groups may require different treatments. The association between Borderline and GAD warrants further research. LIMITATIONS: This study used male veterans in middle age. The usual cautions about generalizing findings to other demographic groups apply.

Adult↗

Creativity and psychopathology. A study of 291 world-famous men.

BACKGROUND: This investigation sought to determine the prevalences of various psychopathologies in outstandingly creative individuals, and to test a hypothesis that the high prevalence of mental abnormalities reported in prominent living creative persons would not be found in those who had achieved and retained world status. METHOD: The family background, physical health, personality, psychosexuality and mental health of 291 famous men in science, thought, politics, and art were investigated. The membership of the six series of scientists and inventors, thinkers and scholars, statesmen and national leaders, painters and sculptors, composers, and of novelists and playwrights was determined by the availability of sufficiently adequate biographies. Extracted data were transformed into diagnoses in accordance with DSM-III-R criteria, when appropriate. RESULTS: All excelled not only by virtue of their abilities and originality, but also of their drive, perseverance, industry, and meticulousness. With a few exceptions, these men were emotionally warm, with a gift for friendship and sociability. Most had unusual personality characteristics and, in addition, minor 'neurotic' abnormalities were probably more common than in the general population. Severe personality deviations were unduly frequent only in the case of visual artists and writers. Functional psychoses were probably less frequent than psychiatric epidemiology would suggest, and they were entirely restricted to the affective varieties. Among other functional disorders, only depressive conditions, alcoholism, and, less reliably, psychosexual problems were more prevalent than expected in some professional categories, but strikingly so in writers. CONCLUSIONS: Similar findings have been reported for living artists and writers, and this suggests that certain pathological personality characteristics, as well as tendencies towards depression and alcoholism, are causally linked to some kinds of valuable creativity.

Creativity↗

Borderline personality disorder characteristics in young adults with recurrent mood disorders: a comparison of bipolar and unipolar depression.

BACKGROUND: In young adults it can be difficult to differentiate between an early bipolar illness and borderline personality disorder. There are considerable areas of clinical overlap between cyclothymic temperament, bipolar-spectrum disorders and borderline characteristics. The aim of this study was to measure borderline characteristics in young adults during an index depressive episode and to compare three diagnostic groups: DSM-IV bipolar affective disorder (BPAD); bipolar spectrum disorder (BSD); and DSM-IV recurrent major depressive disorder (MDD). METHODS: Eighty-seven young adults with a current episode of major depression and at least one previous episode of depression were recruited from consecutive referrals to a psychiatric clinic. Diagnoses were based on the Structured Clinical Interview for DSM-IV (SCID-1) and recently proposed structured diagnostic criteria for BSD. All patients also completed the borderline questions from the screening questionnaire of the International Personality Disorders Examination (IPDE). RESULTS: Diagnostically, the cohort of 87 patients divided into three groups: 14 with BPAD; 27 with BSD; and 46 with MDD. None of the subjects fulfilled DSM-IV or ICD-10 diagnostic criteria for personality disorder and all three groups were well matched in terms of age, gender distribution, ethnicity, socioeconomic and educational status, age at onset of illness, and severity of index depressive episode. Both of the bipolar-depressed groups reported significantly higher median levels of borderline characteristics than the MDD group (p<0.0001). Three of the borderline characteristics emerged as potentially useful in differentiating bipolar depression from unipolar depression: 'I've never threatened suicide or injured myself on purpose' (sensitivity=0.93; positive predictive value [PPV]=56.7); 'I have tantrums or angry outbursts' (sensitivity 0.66; PPV=65.6%); and 'Giving in to some of my urges gets me into trouble' (sensitivity=0.76; PPV=59.6%). LIMITATIONS: All of the subjects were recruited from a university health service clinic and as such are unlikely to be representative of patients from more diverse socio-economic backgrounds. No structured diagnostic assessment of personality disorder was administered. The diagnostic criteria for BSD are not yet fully validated. CONCLUSIONS: Young adults with bipolar depression exhibit significantly higher levels of borderline personality pathology than those with unipolar depression. Those borderline screening questions that reflect cyclothymic characteristics or depressive mixed states may be of practical use to clinicians in helping to differentiate between bipolar depression and unipolar depression in young adults.

Adult↗

Heterosexual male perpetrators of childhood sexual abuse: a preliminary neuropsychiatric model.

This paper presents data from a series of preliminary neuropsychiatric studies, including neuropsychological, personality, sexual history, plethysmographic and neuroimaging investigations, on a sample of 22 male, heterosexual, nonexclusive pedophiles and 24 demographically similar healthy controls. A psychobiological model of pedophilia is proposed, positing that early childhood sexual abuse leads to neurodevelopmental abnormalities in the temporal regions mediating sexual arousal and erotic discrimination and the frontal regions mediating the cognitive aspects of sexual desire and behavioral inhibition. In this way, pedophiles develop deviant pedophilic arousal. Subsequently, if there is comorbid personality pathology, specifically sociopathy and cognitive distortions, there will be failure to inhibit pedophilic behavior.

Adolescent↗

A dynamic assessment of offender risk, needs, and strengths in a sample of pre-release general offenders.

Static, dynamic, and protective factors have been identified as three focal domains significantly related to offender recidivism. However, few measures include comprehensive and inclusive assessment of these variables. The Inventory of Offender Risk, Needs, and Strengths (IORNS) was developed to fill a void in the assessment of risk and needs for offenders. The current study examines the reliability and initial validity of the IORNS in a sample of pre-release offenders assessed for risk and treatment need. Results indicate moderate to high levels of internal consistency and identical IORNS scale results across race, and that the IORNS indexes, scales, and subscales display good convergent validity with self-report and interview measures of static risk, dynamic risk, antisocial behavior, psychopathy, personality pathology, substance abuse, depression, and anxiety. Initial predictive validity examination of the IORNS indicates that several of the indexes, scales, and subscales were able to differentiate offenders who were sent back to prison for half-way house rule violations from those who did not violate rules.

Adolescent↗

[Prevalence of serious mental pathology in the city of San Luis].

OBJECTIVE: This work includes part of the results of the first epidemiological research on mental health held at San Luis City, aimed to estimate adult prevalence rate of mental pathology on San Luis' adult population. It has also been considered the prevalent kind of disorders. In both cases, it has been taken into account five domains of independent variables, due to sociodemographic characteristics: sex, age, educational level, occupational level, and residence zone. METHODS: The methodology is based on the epidemiological descriptive and transversal model. The assessment instrument, the Millon Clinical Multiaxial Inventory-II, was administrated to a representative adult sample, designed by a probabilistic sample methodology. RESULTS: The clinical measurement of Personality Pathology Scales and Sever Clinical Syndromes Scales showed a prevalence rate of 25,69% of serious mental pathology in general population, which is higher in women, 27,13%; than in men, 24,19%. In accordance to independent variables, there is a higher prevalence in elderly people, although there is no correlation with the number of symptoms; there is a lower prevalence among people with more years of education, with a relative correlation with number of symptoms-; and some professions showed higher scores than others, also with a relative correlation with number of symptoms. Considering the kind of mental disorders, there was a high prevalence of paranoid disorder and of alucinatory disorder, both in the women and men's samples. CONCLUSIONS: Finally, we found that the prevalence rates of serious mental pathology in San Luis population are similar to those obtained by previous studies in Argentina.

Adolescent↗

Clinical experience with patients suffering from hyperemesis gravidarum (severe nausea and vomiting during pregnancy): thoughts about subtyping of patients, treatment and counseling models.

The medical and psychological treatment of hyperemesis gravidarum (HG) is generally acknowledged as being difficult. It is also recognized that the somatic changes during pregnancy play a role in the process of HG and that psychosocial factors are of particular importance. The following issues have been studied: psychosocial stressors; personality disorders; coping mechanisms and stress tolerance. The reviewed studies mention many different causes of HG. Some produce symptoms in certain women and some will not. As a result of clinical experience and observation during several years treating women with HG from a broad social, cultural and ethnic background in a large inner-city general hospital, we have been able to identify several subgroups of HG patients according to personality pathology, psychiatric symptoms and psychosocial stress factors. Accurate assessment is necessary in order to be able to tailor the interventions to the characteristics and needs of the individual patient. For the various subgroups different treatment strategies are recommended.

Adaptation, Psychological↗

Peer assessment of personality traits and pathology in female college students.

Assessment procedures for personality disorders (PDs) typically rely on self-reports, even though some people with PDs may be unable to view themselves realistically or are unwilling to report socially undesirable traits. Close associates may provide important information regarding the presence of PD traits. Peer nomination is a reliable and valid assessment procedure that can be adapted to the study of PDs for research purposes. This study focused on characteristic features that define narcissistic, dependent, and obsessive-compulsive PDs using information collected from both self and others in a nonclinical sample of women. It was designed to identify specific areas of agreement and discrepancy between self-report and peer assessment in the measurement of characteristic features of these disorders.

Adult↗

Antisocial personality disorder and TC treatment outcomes.

There is a belief that persons diagnosed with antisocial personality disorder (APD) do not respond well to treatment, but the existing research has not supported this hypothesis. This study examined the relationship of APD to therapeutic community (TC) treatment outcomes. A total of 275 men and women were randomly assigned to two TCs. It was hypothesized that clients diagnosed with APD via the Millon Clinical Multiaxial Inventory (MCMI-II) would have poorer treatment outcomes than those with no APD. The MCMI-II was used to diagnose APD because of its focus in underlying pathological personality traits, as opposed to strict behavioral criteria as used in the Diagnostic and Statistical Manual of Mental Disorders classifications for APD; this hypothesis was not supported. Logistic regression analyses indicated that an MCMI-II diagnosis of APD was unrelated to treatment outcomes. Treatment completion was the most important factor in reducing recent drug use and post-discharge arrests. The results indicate that persons diagnosed with APD, with histories of substantial drug abuse and criminality, can benefit from TC treatment with aftercare in the community or at the very least, do as well as those with no APD. In light of the high prevalence rates of APD in substance-abusing populations, future research should continue to explore the many issues surrounding the diagnosis of APD, as well as its relationship to treatment outcomes.

Adult↗

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↗

Correlations between the Hand Test Pathology score and Personality Assessment Inventory scales for pain clinic patients.

Pearson correlations between the Hand Test Pathology (PATH) score and Personality Assessment Inventory scales produced a cluster of relationships characteristic of an antisocial orientation. Likewise, PATH significantly differentiated between a "P" (Pathology) group flagged by a high Negative Impression score on the inventory, and an "N" (Normal) group of 100 pain patients. It was suggested that the interpretive simplicity of Hand Test scores renders the scores amenable to further correlational studies involving the inventory.

Adult↗

Personality and family functioning in families of depressed patients.

In this cross-sectional study, the authors attempted to identify correlates of family functioning in 86 couples with a depressed member during the acute phase of the patient's depression. Demographic variables, psychiatric status, and personality traits of both the patient and spouse were investigated as potential predictors of family functioning. Regression analyses indicated that lower levels of personality pathology in the patient, higher levels of patient conscientiousness, and less psychological distress in the spouse were associated with healthier family functioning. Future research implications and clinical importance of these findings are discussed.

Adaptation, Psychological↗

Personality traits and striatal dopamine synthesis capacity in healthy subjects.

OBJECTIVE: Neuroimaging and genetic studies suggest that individual differences in the brain dopaminergic system contribute to the normal variability of human personality (e.g., social detachment and novelty seeking). The authors studied whether presynaptic dopamine function is also associated with personality traits. METHOD: Presynaptic dopamine synthesis capacity in the brain was measured with positron emission tomography and [(18)F]fluorodopa in 33 healthy adults, and personality traits were assessed with the Karolinska Scales of Personality. Associations were studied by using a linear regression model controlling for the effects of age and gender on both variables. RESULTS: High scores on two of the anxiety-related personality scales, somatic anxiety and muscular tension, and on one aggressivity-related scale, irritability, were significantly associated with low [(18)F]fluorodopa uptake in the caudate. No statistically significant associations were observed between [(18)F]fluorodopa uptake and the detachment scale or scales related to novelty-seeking behavior (impulsiveness and monotony avoidance). CONCLUSIONS: The results suggest a role for the dopaminergic system in the regulation of anxiety in healthy subjects. Together with previous studies, they also indicate differential involvement of various components of the dopaminergic system in normal and pathological personality traits.

Adult↗

The effect of temperament and character on response to selective serotonin reuptake inhibitors in panic disorder.

OBJECTIVE: In this prospective study, temperament and character were evaluated in patients with panic disorder (PD), before 1 year of medication therapy, to verify whether these factors influenced the outcome of treatment. METHOD: Seventy-one PD patients were evaluated with the SCID-IV, the Temperament and Character Inventory (TCI), the SCL-90, the Ham-A and the Ham-D. Patients were treated with pharmacotherapy and were evaluated monthly over 1 year. RESULTS: Before treatment, non-remitted patients showed higher levels of harm avoidance (HA) and lower levels of persistence (P), self-directedness (SD) and cooperativeness (C), whereas remitted patients showed only higher levels of HA. After controlling the effect of the confounding variables, the likelihood to achieve remission was positively related to SD score (OR = 1.12; P = 0.002), particularly 'self-acceptance' SD dimension (OR = 1.30; P = 0.02). CONCLUSIONS: Our data suggest that in PD: i) the evaluation of personality, using the Cloninger's model, confirms the presence of personality pathology as one predictor of non-response to treatment; ii) in patients with low SD a combination of medication and cognitive-behaviour therapy should be the most effective treatment.

Adult↗

Obsessive-compulsive disorder and personality disorder: evidence from the British National Survey of Psychiatric Morbidity 2000.

BACKGROUND: Previous studies indicate that most individuals with obsessive-compulsive disorder (OCD) have comorbid personality disorders (PDs), particularly from the anxious cluster. However, the nature and strength of this association remains unclear, as the majority of previous studies have relied heavily on clinical populations. We analysed the prevalence of screen positive personality disorder in a representative sample of adults with OCD living in private households in the UK. METHODS: A secondary analysis of data from the 2000 British National Survey of Psychiatric Morbidity. The prevalence of PD, as determined by the SCID-II questionnaire, was compared in participants with OCD, with other neuroses and non-neurotic controls. Within the OCD group we also analysed possible differences relating to sex and subtypes of the disorder. RESULTS: The prevalence of any screen positive PD in the OCD group (N=108) was 74%, significantly greater than in both control groups. The most common screen positive categories were paranoid, obsessive-compulsive, avoidant, schizoid and schizotypal. Compared to participants with other neuroses, OCD cases were more likely to screen positively for paranoid, avoidant, schizotypal, dependent and narcissistic PDs. Men with OCD were more likely to screen positively for PDs in general, cluster A PDs, antisocial, obsessive-compulsive and narcissistic categories. The presence of comorbid neuroses in people with OCD had no significant effect on the prevalence of PD. CONCLUSIONS: Personality pathology is highly prevalent among people with OCD who are living in the community and should be routinely assessed, as it may affect help-seeking behaviour and response to treatment.

Adolescent↗

Dimensions and categories: the "big five" factors and the DSM personality disorders.

The five-factor model of personality, which has been widely studied in personality psychology, has been hypothesized to have specific relevance for DSM-defined personality disorders. To evaluate hypothesized relationships of the five-factor model of personality to personality disorders, 144 patients with personality disorders (diagnosed via a structured interview) completed an inventory to assess the five-factor model. Results indicated that the majority of the personality disorders can be differentiated in theoretically predictable ways using the five-factor model of personality. However, while the personality disorders as a whole appear to be differentiable from normal personality functioning on the five factors, the patterns are quite similar across the disorders, a finding that may provide some insight into the general nature of personality pathology but may also suggest problems with discriminant validity. Third, it does not appear that considering disorders as special combinations of features (as might be expected in some categorical models) is more informative than considering them as the sum of certain features (as might be expected in a dimensional model).

Adolescent↗

Childhood and adulthood abuse in bulimic and nonbulimic women: prevalences and psychological correlates.

OBJECTIVE: We evaluated associations between childhood physical and sexual abuse in bulimic women and eating disturbances, psychiatric symptoms, and likelihood of later abuse in adulthood. METHOD: Fifty-one bulimics and 25 normal eaters participated in this study. Semistructured interviews and self-report measures were used to assess eating symptoms, comorbid psychiatric disturbances, personality pathology, and childhood and adulthood abuse. RESULTS: Compared with the normal eaters, bulimic women reported higher levels of childhood abuse. Although bulimic women showed more psychopathology than nonbulimic women, there was a correspondence between the presence and severity of abuse and the severity of concurrent psychopathologic symptoms. Results linked dissociation and submissiveness to most severe forms of abuse. Abuse in adulthood was almost always preceded by earlier abuse during childhood. DISCUSSION: Our findings suggest an association between certain psychopathologic traits and the likelihood of abuse (especially when occurring both in childhood and adulthood). Observed associations could implicate causal effects of childhood abuse on personality development, influences of personality traits in heightening the risk of abuse, or both.

Adolescent↗