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[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↗

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↗

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↗

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↗

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↗

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↗

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↗

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↗

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↗

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↗

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↗

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↗

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↗

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↗

The classification of disturbed personality functioning in early adolescence.

This study describes disturbed personality functioning in early adolescence. A non-clinical sample of 63 thirteen year olds underwent a semi-structured psychiatric interview as part of a longitudinal study investigating the relationship between competence in personality functioning and development. The presence of personality disturbance was determined by two psychiatrists who rated the adolescents on a personality functions scale. The raters then described the type of disturbance using Axis II of DSM-III as a guideline. Forty-six percent of the sample were found to have some degree of disturbed personality functioning. Of these, over one-half fell into a cluster comprised of avoidant, dependent, compulsive, or passive-aggressive types, while another third were characterized by antisocial tendencies. Severity of disturbance was not related to type of disturbance. Ratings of behaviour by teachers and parents supported the division of subjects with personality dysfunction into two broad groups: an anxious, fearful, "quiet" cluster; and a group of more "acting out", disturbing individuals. However, parents and teachers could not distinguish the "quiet" group from teenagers who were free of disturbed personality functioning. These data indicate that it is possible to classify a segment of a non-clinical population of young adolescents who had personality dysfunction using Axis II of DSM-III as a guideline. Furthermore, such a group of teenagers is not homogeneous. They distribute themselves into internalizing and externalizing clusters.

Adolescent↗

Negative and positive components of psychological masculinity and femininity and their relationships to self-reports of neurotic and acting out behaviors.

Negatively valued masculinity (M-) and femininity (F-) personality scales were developed to supplement the positively valued Masculinity (M+) and Femininity (F+) scales of the Personal Attributes Questionnaire (PAQ; Spence & Helmreich). M- consisted of traits that had been judged to be (a) more typical of males than females, (b) undesirable in both sexes, and (c ) agentic or instrumental in content. Two F- scales were developed, both containing stereotypically feminine, undesirable traits, one set of traits referring to communionlike characteristics (Fc-) and the other to verbal passive-aggressive qualities (FVA-). Significant sex differences in the predicted direction were found on all scales. In both sexes, low and typically nonsignificant correlations were found between parallel positive and negative scales, but highly significant negative correlations were found between positive and negative cross-sex scales. These findings provide additional evidence for the multidimentionslity of masculinity and femininity. Scores on a self-esteem measure were positively correlated with M+ and F+, uncorrelated with M-, and negatively correlated with the F- scales. Different patterns of scores were associated with two types of problem behaviors. In both sexes, neuroticism was most highly correlated (in a negative direction) with M+, and acting out behavoir was most strongly correlated (in a positive direction) with M-. The next highest correlation in both instances was with FVA-.

Acting Out↗