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Results for “Passive-Aggressive Personality Disorder”

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PubMed1992

Diagnosis of DSM-III-R personality disorders by two structured interviews: patterns of comorbidity.

OBJECTIVE: The purpose of this study was to examine patterns of co-occurrence of axis II disorders in a group of consecutive patients evaluated with two contrasting structured interviews. METHOD: One hundred of 106 consecutive applicants for long-term, inpatient treatment of severe personality psychopathology were assessed, face-to-face, by psychiatrists using the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) and the Personality Disorder Examination (PDE). The percent of co-occurrence of pairs of disorders diagnosed by each structured interview separately was calculated, and significance levels were determined by using chi-square tests of independence. Finally, odds ratios were computed for the odds of each pair of disorders occurring together compared with the odds for the occurrence of each disorder alone. RESULTS: The two interview methods revealed different comorbidity patterns. Significant covariation was found for 29 pairs of disorders diagnosed with the PDE, compared with 12 pairs diagnosed with the SCID-II. Six pairs of disorders covaried significantly and were associated with odds ratios greater than 4: histrionic with borderline, histrionic with narcissistic, narcissistic with antisocial, narcissistic with passive-aggressive, avoidant with schizotypal, and avoidant with dependent. CONCLUSIONS: Substantial overlap occurred among personality disorders. In this group of patients, consistent patterns of comorbidity involving narcissistic, avoidant, and histrionic personality disorders suggest that categorical distinctions between them and certain other DSM-III-R personality disorders may be illusory. The question of which of two overlapping disorders is more valid, however, is left unanswered. For clinical purposes, a two-level diagnostic convention is proposed.

Comorbidity↗

PubMed1990

An examination of defense style in parents who abuse children.

The study aimed to determine the predominant defense style in parents who abuse their children, at least as determined by a new defense style questionnaire. The scores of 32 parents who had physically abused their young children and had been assessed after court proceedings were compared with a normal population sample and with patients with anxiety disorders who were equally symptomatic. Parents who had abused their children identified themselves as being particularly likely to use projection, displacement, passive-aggressiveness denial, and splitting to a degree greater than normal persons or patients with anxiety disorders. We would caution that, although the differences remained after statistical control of age and sex differences, a firm conclusion that such defenses are germane to child abuse will have to await replication of these findings with a study using a control group of young parents who do not abuse their children matched for social class and family structure.

Adult↗

PubMedDate not supplied

Personality disorders in recent-onset bipolar disorder.

The frequency and types of DSM-III personality disorders (PDs) were investigated in a sample of 26 recent-onset bipolar-disordered (BD) patients. Results showed that 62% of BD patients had PDs according to the Structured Interview for DSM-III Personality Disorders (SIDP). The most frequently diagnosed PDs were the histrionic, borderline, passive-aggressive, and antisocial categories. A comparison between the BD patients and a sample of 35 recent-onset schizophrenic patients showed significant differences for two PDs. Schizotypal PD was more frequently diagnosed in the schizophrenic group, while the BD group had a higher frequency of histrionic PD.

Bipolar Disorder↗

PubMed1989

Comorbidity of bulimia nervosa and personality disorder.

Thirty patients meeting DSM-III-R criteria for bulimia nervosa with at least three bingeing episodes a week were compared with 30 age- and sex-matched controls on DSM-III personality measures. The bulimic patients were more likely to display cluster B (histrionic, narcissistic, antisocial, and borderline) personality abnormalities (odds ratio 15.0) and cluster C (avoidant, dependent, compulsive, and passive-aggressive) personality abnormalities (odds ratio 4.3) than were the community controls. This study supports the finding that personality disorder is a possible risk factor for bulimia.

Borderline Personality Disorder↗

PubMed1992

MCMI-II diagnosis of borderline personality disorder: base rates versus prototypic items.

The Millon Clinical Multiaxial Inventory-II (MCMI-II) profiles of 26 psychiatric inpatients diagnosed as having borderline personality disorders were compared with profiles of 42 patients with no personality disorders. The borderline group scored significantly higher on the following scales: Disclosure (X), Debasement (Z), Passive-Aggressive (8A), Self-Defeating (8B), Borderline (C), and Major Depression (CC). Differences approaching significance were also found on substance abuse measures: the Alcohol Dependence (B) scale and Drug Dependence (T) scale. These findings are consistent with criteria established in the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R]; American Psychiatric Association, 1987) and the results of other studies utilizing the MCMI-II. In addition, diagnostic efficiency of Scale C was assessed at various cutoff points defined by either base rate (BR) scores or the number of prototypic items endorsed. The greatest efficiency was found when a cutoff of seven or more prototypic items was utilized, with nearly 80% of the patients correctly classified. Results are discussed in terms of their relevance for further research.

Adult↗

PubMedDate not supplied

[Relations between mood disorders and personality. Recent data].

In the field of studies of links between mood disorders and personality, the need to study only completely remitted patients has been demonstrated recently. Indeed, the clinically depressed state strongly influences the assessment of some personality traits in a more pathological direction (for instance for emotional stability, extraversion, interpersonal dependency, ego strength). The studies concerning unipolar depression have been mainly made according to two methodological approaches which results are relatively consistent. The first one uses batteries of standard self-report personality inventories such as the Hirschfeld and Klerman battery which includes the Guilford-Zimmerman Temperament Survey, the Interpersonal Dependency Inventory, the shortened version of the Lazare-Klerman-Armor Personality Inventory and two subscales of the MMPI. This approach shows that compared to normal population, recovered depressive, have less emotional strength more interpersonal dependency and a more introverted personality. The second approach uses diagnostic criteria of personality disorders according to DSM III. The clinical evaluation can be performed with the help of the Structured Interview for DSM III Personality Disorders (SIDP) or with of the help the Millon Clinical Multiaxial Inventory (MCMI), a self rated questionnaire. The most frequent personality disorder among recovered unipolar patients is dependent personality, followed by the avoidant and histrionic personalities and lastly the schizoïd, schizotypal, borderline, compulsive and passive-aggressive personalities. But the interpretation of all these results must be cautious given that a recent study dealing with premorbid personality invites one to consider that not only depression influences personality assessment during illness, but also that depression may result in personality change after recovery. Few studies are available concerning bipolar patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Depressive Disorder↗

PubMed1990

Adapted character styles of Vietnam veterans with Posttraumatic Stress Disorder.

A total of 189 male Vietnam veterans who were admitted to a specialized inpatient treatment program were evaluated using the Millon Clinical Multiphasic Personality Inventory to assess character styles. The veterans were assessed for Posttraumatic Stress Disorder by using a subscale of the Minnesota Multiphasic Personality Inventory (MMPI) and 72% of the patients were classified as having Posttraumatic Stress Disorder. The character styles of passive-aggressive, schizoid, avoidant, and borderline were significantly associated with these patients. The most common 2-point profile was passive-aggressive and avoidant (8-2 or 2-8) and was significantly related to the diagnosis. While drug and alcohol abuse were common problem areas for the entire sample, the profile of patients with Posttraumatic Stress was different from those of substance abusers. These results indicate that treating Vietnam veterans with this disorder requires adopting strategies which include a character style focus as well as a symptom focus.

Adaptation, Psychological↗

PubMed1991

Treatment outcomes of Vietnam veterans with Posttraumatic Stress Disorder.

This study examined changes on the Millon Clinical Multiaxial Inventory for 45 Vietnam veterans who completed a specialized inpatient treatment program. The average length of stay for these veterans was 140 days. Patients' scores on the Millon decreased on 12 of the 20 scales and increased on 8, and their Posttraumatic Stress Disorder-related symptoms of anxiety and dysthymia decreased significantly. Posttraumatic Stress Disorder-related character styles, schizoid, avoidant, and passive-aggressive, also showed significant decreases.

Combat Disorders↗

PubMed1991

The relationship between personality type and style of alcohol use.

Two hundred fifty male, alcoholic VA inpatients were administered the Millon Clinical Multiaxial Inventory (MCMI) and the Alcohol Use Inventory (AUI). A cluster analysis, based on the scales of the MCMI, yielded three clusters: Cluster 1 was the smallest and was described by the least overall psychopathology. Cluster 2 had significant elevations on Antisocial, Narcissistic, Paranoid, Drug and Alcohol Abuse scales. Cluster 3 was the largest and had significant elevations on Avoidant, Schizoid, Dependent, Passive-Aggressive, Anxiety, Dysthymia, and Alcohol Abuse scales.

Adult↗

PubMed1990

Profile clusters of the MCMI-II personality disorder scales.

An analysis was conducted to identify the major personality disorder score profiles to be found in the Millon Clinical Multiaxial Inventory II. Application of Ward's agglomerative hierarchical procedure to two subsamples of psychiatric patients (n = 83 for each) yielded four replicated subgroups. A subsequent K-means nonhierarchical approach confirmed four of the Ward clusters. Three subgroups can be characterized as (a) Antisocial, Aggressive (Sadistic), and Passive-Aggressive; (b) Avoidant, Schizoid, and Self-Defeating, and (c) Schizoid, Dependent, and Compulsive. A fourth sizable group is comprised of patients with flat profiles.

Adjustment Disorders↗

PubMed1992

Accuracy of MCMI classification of angry and psychotic black and white patients.

This study compared the ability of the MCMI personality scales to accurately predict anger and psychosis in White (n = 778) and Black (n = 272) psychiatric inpatients. Race-adjusted norms (Millon, 1984) were used to compute patients' scale scores. The MCMI successfully predicted anger and psychosis for both races (p less than .001). No difference was found in accuracy of prediction between Whites and Blacks (p greater than .40). In addition, the scales important for prediction were similar for Whites and Blacks. The Passive-Aggressive Scale best predicted anger, whereas the Avoidant Scale best predicted psychosis. The results suggest that the MCMI does predict accurately two important characteristics with both Black and White patients, but some racial bias remains.

Black or African American↗

PubMed1990

Utility of the MCMI-II in assessing suicide risk.

The MCMI-II profiles of 40 psychiatric inpatients admitted for suicidal ideation and 40 patients admitted for a suicide attempt were compared. Subjects in each group were matched on sex, history of previous attempts, and other demographic variables. While the results indicate very few differences between the MCMI-II profiles of these two groups of patients, suicide attemptors scored significantly higher on Scale Y (Desirability), which suggests greater tendencies toward denial of problem areas. Patients with suicidal ideation yielded a mean profile with elevations on Scale 2 (Avoidant), 8A (Passive-Aggressive), 8B (Self-Defeating), C (Borderline), D (Dysthymia), and Z (Debasement). These results are discussed in terms of a stress-vulnerability model of suicidal behavior with suggestions made for expanding on the findings in future studies.

Adult↗

PubMedDate not supplied

DSM-III-R narcissistic personality disorder evaluated by patients' and informants' self-report questionnaires: relationships with other personality disorders and a sense of entitlement as an indicator of narcissism.

Modified versions of the revised Personality Diagnostic Questionnaire (PDQ-R) for DSM-III-R personality disorders (PDs) were completed by 60 patients and their informants. Patients' ratings gave a mean number of 4.5 PDs per subject and narcissistic (NAR) PD in 42%. Informants' ratings gave NAR PD in 38%. For patients and informants, NAR PD scores (i.e., the number of positive NAR PD criteria for each subject) were significantly correlated with histrionic (HIS) and borderline (BOR) PD scores and with scores of some PDs outside DSM-III-R's "cluster B." Also, there were significant correlations between patients' and informants' NAR PD scores and between NAR PD scores and total number of positive criteria (i.e., for all 13 PDs) for patients and informants. For patients' ratings, there were significant associations between NAR PD and HIS, BOR, and passive-aggressive (PAG) PDs and, for informants' ratings, between NAR and HIS PDs. There was no significant association between patients' and informants' diagnoses of NAR PD. Grandiosity, the most characteristic feature of narcissism, is related to NAR PD criteria 3 through 6. The patients' evaluation of criterion 6 (i.e., "Has a sense of entitlement ...") shows satisfactory item-total correlation and endorsement frequency, together with "fair to good" reliability when patients' and informants' ratings are compared (kappa = 0.62). The identification of a sense of entitlement by the patient may be a relatively reliable and valid indicator of narcissism.

Adult↗

PubMed1989

An empirical study of defense mechanisms. I. Clinical interview and life vignette ratings.

The Defense Mechanism Rating Scales (DMRS) measure the use of defense mechanisms based on clinical interview or life vignette data. Using nonprofessional raters observing videotaped psychodynamic interviews of individuals with personality and affective disorders, the median intraclass interrater reliability (IR) of the defense scales was .36 but was .57 for group consensus ratings and .74 when related defenses were grouped into defense summary scales. When follow-up data on life vignettes were rated, the median interrater IR was .55 for those defenses occurring at least 5% of the time and .66 for the defense summary scales. In relation to follow-up data, so-called immature defenses (denial, projection, acting out, hypochondriasis, passive-aggression) were associated with higher levels of symptoms, poorer global functioning, and higher proportion of time impaired in psychosocial role functioning. Borderline defenses (splitting, projective identification) displayed a similar pattern. Among narcissistic and neurotic defenses, only devaluation was associated with poorer functioning, whereas intellectualization was associated with higher functioning. Finally, action and borderline defenses demonstrated significant correlations across methods and across time (video vs life vignettes), whereas obsessional, disavowal, and narcissistic defenses showed nonsignificant trends. Overall, these results support the model of a hierarchy of defenses.

Adolescent↗

PubMedDate not supplied

The use of the MCMI in the personality assessment of head-injured adults.

MCMI (Millon Clinical Multiaxial Inventory) profiles of 79 head-injured patients were compared with self-report of personality change following head injury. Mean MCMI scale scores were highest on Scales D (Dysthymia), A (Anxiety), 6 (Antisocial), H (Somatoform), 5 (Narcissistic) and 7 (Compulsive). Taking only high-point codes above an adjusted base-rate score of 75, the sample showed most frequent elevations on A (Anxiety), D (Dysthymia), H (Somatoform), 5 (Narcissistic), 6 (Antisocial-Aggressive) and 8 (Passive-Aggressive), in order of cumulative frequency. Personality trait scales and clinical scales were compared with self-report of personality changes. Elevated personality trait scales correlated with self-reports of dysfunction and so did clinical scale elevations. There was no relationship between the number of elevated scales and severity of head injury, nor between the number of elevated scales and interval after head injury.

Adolescent↗

PubMed1988

Clinical applications of the MCMI: the 1-2-3-8 codetype.

The MCMI profiles of 131 psychiatric inpatients were examined to identify 1-2-3-8 codetypes on the basic personality scales, which reflect a schizoid, avoidant, dependent, and passive-aggressive blend of personality traits. Approximately 25% of the inpatient sample obtained the 1-2-3-8 codetype. Analyses of the diagnoses and clinical records of these patients suggest that this profile reflects an affect/mood disturbance with prominent depressive features and suicidal ideation/attempt prior to admission. This investigation serves mainly as a stimulus for research questions that should be addressed in order to increase the range of clinical applications of the MCMI and the body of empirical literature that can support the utility of this assessment device.

Female↗

PubMed1989

Emotional indicators in the human figure drawings of hearing-impaired children: a small sample validation study.

The use of human figure drawings as projective personality assessment techniques is a well-established practice among psychological service providers to hearing-impaired children yet few studies have shown these techniques to be valid indicators of emotional functioning in any population. The purpose of the present work is to establish concurrent validity for the Koppitz scoring technique in a sample of 7- to 12-year old hearing-impaired students. Results indicate that the Koppitz technique shows a positive correlation with emotional status as measured on the Stress Response Scale. The Koppitz technique is especially sensitive to impulsive and passive-aggressive types of response modes.

Child↗

PubMed1990

Personality status: changes through adolescence.

1. Forty-two percent of a nonclinical sample of urban 18 year olds displayed some degree of personality dysfunction. This rate of disturbance is similar to a previously reported rate for 13 year olds, but higher than the prevalence rate for 16 year olds. Thus, early and late adolescence seem to represent "at risk periods" for the genesis of character pathology. 2. In late adolescence, the form of this disturbance is as follows: 40% fall into a histrionic, borderline, narcissistic cluster, whereas nearly 30% demonstrate an atypical or mixed picture. This differs markedly from the distribution of dysfunction in earlier subphases. 3. Thirty-eight percent of the disturbed sample showed evidence of dysfunction at all three subphases (early, middle, and late), whereas 62% fluctuated in or out of disturbance at one subphase or another. 4. There was a notable lack of consistency with respect to type of personality dysfunction from both a group and individual perspective, except for paranoid, schizoid, and schizotypal disturbance. This particular cluster retained both group and individual stability from age 13 to 18. 5. Two trends were evident however: teenagers who initially presented as avoidant, dependent, compulsive, or passive-aggressive seemed to grow out of their dysfunction. By age 18, hardly any of the original subjects remained in this cluster, and most had become clear. Secondly, most of the adolescents identified as antisocial in early or middle adolescence migrated into the histrionic, narcissistic, borderline cluster in late adolescence. This latter group showed a steady increase throughout the time span studied, suggesting the importance of developmental factors.

Adolescent↗