[Psychopathy].
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Antisocial Personality Disorder↗
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Results for “Histrionic Personality Disorder”
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Psychological understanding and management of rhinoplasty patients.
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Body Image↗
Standardized assessment of personality disorders in obsessive-compulsive disorder.
We assessed 96 patients with obsessive-compulsive disorder for DSM-III personality disorder diagnoses with a standardized interview instrument (Structured Interview for the DSM-III Personality Disorders). Fifty patients (52%) met criteria for at least one personality disorder, with mixed, dependent, and histrionic personality disorders most frequently diagnosed. Compulsive personality disorder was diagnosed in only 6 patients (6%), 5 of whom had had onset of obsessive-compulsive symptoms before the age of 10 years, indicating that DSM-III compulsive personality disorder is not invariably a premorbid condition for the development of obsessive-compulsive disorder. Schizotypal personality disorder, at 5%, was found to be less common than in past samples, reflecting differences in either assessment methods or sampling.
Adolescent↗
Pseudoseizure "status".
Psychogenic pain, disturbances of gait and stance, sensory symptoms, dizziness, and psychogenic seizures have been found to be the most common conversion symptoms in neurology clinics. A retrospective analysis of 18 patients suffering from pseudoseizure "status" is presented in this study. All of the patients fulfilled the DSM-III-R criteria of conversion disorder. However, 5 of them had concomitant major depression, 6 suffered from bulimia nervosa, and 7 met the criteria for substance abuse. On Axis II, 10 cases of borderline personality disorder, 2 cases of antisocial personality disorder, and 3 cases of histrionic personality disorder were diagnosed. The majority of the patients had attempted suicide and other forms of self-destructive behavior. The findings suggest that patients with pseudoseizure "status" suffer from severe affective imbalances and disturbed impulse control.
Adolescent↗
"True" schizotypal personality disorder: a study of co-twins and relatives of schizophrenic probands.
OBJECTIVE: The aim of the study was to investigate the type and nature of personality disorders among biological relatives of schizophrenic probands. METHOD: A total of 176 nonschizophrenic co-twins and other first-degree relatives of schizophrenic probands were compared to 101 co-twins and first-degree relatives of probands with major depression. RESULTS: Schizotypal personality disorders were more common and histrionic personality disorders less common among the biological relatives of schizophrenic probands than among relatives of probands with major depression. A further exploration of the schizotypal criteria revealed that the so-called "negative" criteria such as odd speech, inappropriate affect, and odd behavior, as well as excessive social anxiety, were significantly more common among the relatives of schizophrenic probands. The latter criterion seems particularly important. The so-called "positive" schizotypal criteria were partly, although not statistically significantly, more common among the relatives of probands with major depression. There were only minor differences in frequencies of the negative criteria between monozygotic co-twins, dizygotic co-twins, and other first-degree relatives of schizophrenic probands. CONCLUSIONS: The present study suggests that DSM-III-R schizotypal disorder is defined by a set of criteria that partly describe a "true" schizophrenia-related personality disorder and partly features that are not specific for relatives of schizophrenic probands. Furthermore, the genetic relationship between schizophrenia and "true" schizotypal personality disorder seems weak. Excessive social anxiety may be a marker of a possible genetic link between the disorders.
Adult↗
Mnemonics for DSM-IV personality disorders.
The paper presents several mnemonics to assist clinicians in recalling DSM-IV diagnostic criteria for personality disorders. The mnemonics are acronyms, and each letter is associated with a specific criterion. Each acronym reflects a facet of the related disorder; for example, the acronym for the diagnostic criteria for paranoid personality disorder is SUSPECT, and for histrionic personality disorder it is PRAISE ME. The mnemonics have been used to teach students and residents the conceptual nature of DSM-IV disorders and to help them remember the criteria.
Humans↗
Psychiatric conditions in cosmetic surgery patients.
Beauty is important. As psychiatrists, we see the interface of beauty with mental health, self-esteem, and mental illness. As physicians who enhance cosmetic appearance, you encounter a broad spectrum of patients ranging from those with a healthy pursuit of enhanced appearance to those whose behavior is extremely maladaptive. This article provides some examples of unhealthy pursuit and how to recognize patients who may be inappropriate for cosmetic procedures. Patients with body dysmorphic disorder and narcissistic and histrionic personality disorders are suffering from psychiatric illnesses that interfere with their judgment and can lead them to make poor choices when considering cosmetic procedures. Clinicians who acquire a basic understanding of these psychiatric conditions can properly screen their patients and enhance their understanding of their patients' goals, both realistic and unrealistic, thus saving them from performing inappropriate procedures that cause frustration to both the clinician and the patient.
Histrionic Personality Disorder↗
The hysterical personality disorder: a phenomenological approach.
The background of the present study is a general uncertainty as to what comprises the essence of hysterical (histrionic) personality disorder. Using phenomenological methodology, phenomena observable in the 'classic' hysterical personality are analysed, described, named, and classified according to the basic functions of human experience and behaviour. The resulting psychopathological picture of the hysterical personality facilitates a differential diagnosis that is often decidedly difficult. The phenomenon of dissociation of the mental processes is demonstrated for the various basic functions. A specific feature of the disorder is shown which generates a dissociation of contents of the personality along a conscious-preconscious-unconscious continuum. It is concluded that dissocation is, in the final analysis, the prerequisite for a compromised and partial acting out of prohibited non-integrated elements, e.g. aggression, as a coping strategy.
Adaptation, Psychological↗
Perceptual strategies of isolation in obsessive-compulsive personality disorder.
Recent findings have shown that the Defense Mechanism Test, a serial tachistoscopic technique developed inside the percept-genetic frame of reference, discriminates neurotics from normals, neurotics from schizophrenic outpatients, and subjects with histrionic personality disorder from controls. The present research addresses another major class of Axis II pathology, comparing on the Defense Mechanism Test a group with a psychometric diagnosis of obsessive-compulsive personality disorder (n = 26) with a matched sample of noncompulsive controls. As predicted, several variants of isolation were significantly more characteristic of the compulsive group. Intellectualization, disappearance of the whole structure, whitening of the hero, and lack of recognition of the threat were the variants of isolation with the best discriminative properties. Codings of reaction formation were not linked with compulsive personality, which is congruent with the recent observation of their correspondence to the histrionic personality disorder. The findings are presented in the context of the percept-genetic literature on obsessive-compulsive defensive strategies.
Adult↗
The relationship between early life events and DSM III personality disorders.
The relationship between early childhood events and DSM III personality disorders was examined in 82 non-psychotic psychiatric outpatients. Early loss of a parent or living in a family where there was overt marital discord was associated with having a greater chance of developing DSM III Cluster B personality disorders (narcissistic, antisocial, borderline, histrionic) as adults. It was also related to an increased number suicide attempts as adults. Those patients who suffered an early loss of a parent through death had a significantly higher percentage of antisocial personality and suicide attempts as adults. Patients who as adults had a DSM III Cluster B personality disorder were significantly less likely than comparison patients to have had an early loss of a parent. This finding of a lower chance of a personality disorder if there were a loss of a parent was also significant for histrionic personality disorder when it was analyzed separately. Some theoretical implications of these findings are discussed.
Adult↗
Measures of aggression and mood changes in male weightlifters with and without androgenic anabolic steroid use.
Supraphysiologic doses of testosterone are associated with increased aggression that is hypothesized to be a function of testosterone serum concentrations, mood, and personality. The study attempted to characterize this relationship among weightlifters who were users (n = 10) and nonusers (n = 18) of anabolic steroids. Participants were interviewed using the Modified Mania Rating Scale and Hamilton Rating Scale for Depression to assess mood, the Buss-Durkee Hostility Inventory (BDHI) and Point Subtraction Aggression Paradigm (PSAP) to assess aggression, and the Personality Disorder Questionnaire (PDQ-R) to assess personality. Blood samples were obtained for the determination of total, free, and weakly bound testosterone. Comparisons of continuous variables between testosterone users and non-users were performed with a parametric (unpaired t-test) or non-parametric (Mann-Whitney) test where appropriate. Correlations with testosterone were examined separately for testosterone users and non-users, using Spearman rank correlation. The subjective (BDHI) and objective (PSAP) assessments of aggression found that supranormal testosterone concentrations were associated with increased aggression. However, the PDQ-R results suggest that this finding was confounded by the personality disorder profile of the steroid users, because steroid users demonstrated Cluster B personality disorder traits for antisocial, borderline, and histrionic personality disorder.
Adult↗
An investigation of role-taking in histrionic personalities.
Gough's theory that psychopathy stems from a deficiency in role taking, the ability to perceive and evaluate one's own behaviour as it is perceived and evaluated by others in the same culture, was tested. The Socialization scale, developed by Gough to assess role taking, was administered to a group of 20 female psychiatric patients with histrionic personality disorders, and a control group of female depressives of similar age and intelligence. Socialization scores of the histrionic personalities were significantly lower, indicating impaired role taking, and this difference was not attributable to depression of mood. The Socialization scale was a better discriminator between the groups than the scales of two other personality inventories or a test to elicit meta-impressions.
Adult↗
Diagnosing dissociative disorders in The Netherlands: a pilot study with the Structured Clinical Interview for DSM-III-R Dissociative Disorders.
OBJECTIVE: To improve the ability to diagnose dissociative disorders in The Netherlands, the authors conducted a study using a Dutch version of the Structured Clinical Interview for DSM-III-R Dissociative Disorders (SCID-D) with additional questions on childhood trauma and symptoms of borderline and histrionic personality disorders. METHOD: All interviews were audiotaped or videotaped and rated by two investigators separately. Forty-four patients (42 women and two men) participated in the study. Most of the patients had been referred for evaluation of dissociative symptoms; five had participated in a nationwide survey on incest. None of the patients had ever received a diagnosis of a dissociative disorder, and none had evidence of organic brain syndrome or mental retardation. All patients were in active treatment; 23 were being treated in an outpatient psychiatric service, 13 in an inpatient psychiatric service, and eight in private practice. Thirty-two patients had been psychiatric inpatients at least once. RESULTS: Four diagnostic groups of patients were identified: two with dissociative disorders (12 patients with multiple personality disorder and 11 with dissociative disorder not otherwise specified), one with DSM-III-R personality disorders (11 patients), and one without dissociative or personality disorders (10 patients). CONCLUSIONS: Dissociative disorders are clearly not only an American phenomenon. The diagnosis can be made outside of the United States if the symptoms are sought. The SCID-D proved to be a promising instrument.
Adolescent↗
Acutely administered haloperidol-induced pattern changes of regional cerebral blood flow in schizophrenics. Observation from subtraction of brain imaging with single photon emission computed tomography using technetium-99m hexamethyl-propyleneamine oxime.
Changes in regional cerebral blood flow in brain images with single photon emission computed tomography using technetium-99m hexamethyl-propyleneamine oxime before and after intramuscular injection of haloperidol (0.08 mg/kg) were studied in 5 medicated subjects in their twenties, consisting of 5 schizophrenics and 1 patient with histrionic personality disorder, by a subtraction method of brain images. The haloperidol injection induced two types of perfusion pattern change; in 2 of the schizophrenics, a relative hypoperfusion in the frontal lobes in the images prior to injection was converted to a relative hyperperfusion. In the other 3 schizophrenics and in the patient with histrionic personality disorder, the slight left hemispheric dominance was changed to a marked right hemispheric dominance. The results indicate that haloperidol affects perfusion patterns in schizophrenics.
Acute Disease↗
The comorbidity of multiple personality disorder and DSM-III-R axis II disorders.
Our ability to differentiate MPD from DSM-III-R Axis I disorders has become increasingly refined. Differentiation of MPD from the Axis II personality disorders is an area of more recent clinical investigation. MPD can be found comorbidity with many other psychiatric conditions. It is found in association with each of the DSM-III-R personality disorders. At the present time, however, we lack research data that define the prevalence of the comorbidity of MPD with the personality disorders. Objective study of this area is complicated by the paucity of instruments available to assess personality dimensions in the presence of a DD. In addition, the currently available personality inventories tend to overdiagnose BPD in patients with a high level of distress and acuity of symptoms. The diagnosis of a personality disorder in a patient with MPD is made on the basis of the assessment of the "whole" human being. It is based on the presence of a pervasive and relatively inflexible pattern of behaviors that reflects the individual predominant mode of being. The diagnosis of a personality disorder is not made on the basis of personality traits contained within any single alternate personality or groups of personalities. The personality disorders defined by DSM-III-R are a heterogeneous group of conditions whose individual etiologies reflect a complex interplay of constitutional, genetic, environmental, interpersonal, and psychodynamic factors. The interplay is variable and diverse between these determinants of the personality disorders and the traumatic forces that result in the development of a DD. For the Cluster A personality disorders (schizoid, schizotypal, paranoid), there is evidence supporting a relationship with specific psychotic illnesses. The combination of dissociative pathology with these personality disorders commonly results in a greater impairment of reality testing than in either condition alone. The Cluster B personality disorders (histrionic, narcissistic, borderline, antisocial) and Cluster C personality disorders (avoidant, compulsive, dependent, passive-aggressive) are believed to be primarily developmental disturbances. Comorbidity of these personality disorders with MPD involves consideration of the interaction of many developmental processes with the psychological impact of severe childhood trauma. Many MPD patients present with an apparent mixed personality profile consisting of an array of avoidant, compulsive, borderline, narcissistic, dependent, and passive-aggressive features. Although this article explores comorbidity of MPD with each of the personality disorders defined in DSM-III-R individually, it seems likely that a number of posttraumatic personality organizations can be defined that commonly coexist with MPD.(ABSTRACT TRUNCATED AT 400 WORDS)
Borderline Personality Disorder↗
How useful are clinical reports concerning the consequences of therapist-patient sex?
The harmfulness and prevalence of sex between therapist and patient are difficult to research. One reason for this is the difficult of establishing a rate of harm; general population trends cannot be established within reasonable limits. A second problem involves determining the cause of observed harm. Therapists who treat patients who have had sex with a therapist may incorrectly conclude that symptoms resulted from that inappropriate relationship, while another therapist might attribute them to childhood sexual abuse or other causes. Patients with borderline or histrionic personality disorder may be at greatest risk of therapist-patient sex. Outrage at these violations of professional ethics must be separated from assessment of symptoms. Important questions are: (1) did lasting harm result? and (2) if harm resulted, how much did the sex contribute to it? Outrage should not alter the standards of validity adopted by authors of clinical reports.
Adaptation, Psychological↗
Hypochondriacal concerns in depressed outpatients.
The relationship between hypochondriacal concerns, as assessed by the Illness Attitude Scales, and depressive symptoms was examined in a sample of 100 drug-free outpatients with major depressive disorder. These patients were treated with fluoxetine for 8 weeks, and the effect of treatment on hypochondriacal symptoms was examined. All patients were administered the Structured Clinical Interview for DSM-III-R, the Hamilton Depression Rating Scale, the Symptom Questionnaire, and the Personality Disorders Questionnaire-Revised. We found little relationship between severity of depressive symptoms and hypochondriacal concerns. Measures of anxiety, somatic symptoms, and psychological distress were more consistently related to these concerns. Similarly, patients with either histrionic personality disorder or a lifetime history of panic disorder had greater hypochondriacal concerns than patients without these diagnoses. After open treatment with fluoxetine, the degree of hypochondriacal concerns showed statistically significant decreases, which were only partly related to the degree of change in depression and anxiety severity. Our findings suggest that the presence of hypochondriacal concerns among depressed outpatients is more closely related to the presence of anxiety than depressive symptoms. The relatively small impact of an acute course of antidepressant treatment on hypochondriacal concerns in our sample suggests that these concerns may be enduring characteristics modulated only to a limited extent by short term pharmacological alterations of affective state.
Adult↗
Sex-role attitudes and clinical appraisal in psychiatry residents.
OBJECTIVE: To measure sex-role beliefs of psychiatry residents and to examine bias in clinical appraisal. METHOD: Residents (45 female, 51 male) evaluated 1 of 4 possible clinical case histories-a female or male patient with histrionic personality disorder (HPD) or antisocial personality disorder (APD)-and completed the Sex-Role Egalitarianism Scale (SRES). RESULTS: As predicted, female residents were more egalitarian than male residents (P < 0.03) according to the SRES. As expected, significantly more male than female patients received the diagnosis of APD (P < 0.00002). Although it was predicted that female patients would more often be given the HPD diagnosis than males, no significant gender differences were found. Sex of resident was not found to influence clinical behaviour significantly. CONCLUSIONS: These results highlight differential sex-role attitudes, as measured by the SRES, between female and male residents and suggest that residents' sex-role biases affect the diagnosis of APD. These results have implications for psychiatric assessment and treatment. Further understanding of these issues is critical to the development of educational tools to address sex biases in psychiatry.
Adult↗