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Results for “PERSONALITY, PATHOLOGICAL”

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PubMed1991

Effect of personality disorders on outcome of treatment.

Although many clinicians have long believed that personality pathology may interfere with the effectiveness of treatment of axis I disorders, until recently there were no empirical studies on the subject. This report reviews the recent literature with regard to the following questions: a) Does personality pathology predict negative outcome of treatment for axis I disorders? b) If so, are there specific personality traits or disorders that account for such a negative outcome? The literature review reveals a robust finding that patients with personality pathology have a poorer response to treatment of axis I disorders than those without such pathology. Specific axis I disorders reported on include DSM-III major depression, panic disorder, and obsessive-compulsive disorder. Both inpatients and outpatients have been studied. There is too little literature to determine whether certain pathological personality traits are especially important, but there is enough to provide methodological guidance for future studies. Such studies should use standardized measures of personality and outcome, should match personality and nonpersonality groups on severity of the axis I disorder, and should be certain that axis I diagnoses are not confounded by axis II symptoms.

Ambulatory Care↗

PubMed2001

Factorial structure of the German version of the dimensional assessment of personality pathology-basic questionnaire in clinical and nonclinical samples.

The Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ) assesses 18 traits to provide a systematic representation of the overall domain of personality disorders. We tested the cross-cultural stability of the prediction that four higher-order factors (Emotional Dysregulation, Dissocial Behavior, Inhibitedness, and Compulsivity) underlie the 18 basic traits. A total of 81 patients who were primarily treated for an Axis II personality disorder and N = 166 healthy control patients completed the German version of the DAPP-BQ. Results clearly confirmed cross-cultural stability of the postulated four-factor structure in both samples, accounting for 74.7% (clinical sample), and 65.7% (nonclinical sample) of the total variance. All four higher-order factors showed specific correlational relationships with dimensional assessments of DSM-IV personality disorders.

Adult↗

PubMed2003

Personality disorder symptoms in adolescence: a five-factor model perspective.

The five-factor model has been widely used to describe adaptive and maladaptive functioning in adulthood. However, less is known about the structure and developmental antecedents of personality pathology and personality disorders. In the present study, we examined the validity of the most recent DSM-IV predictions (Widiger, Trull, Clarkin, Sanderson, & Costa, 2002) in a sample of 419 non-clinical adolescents and explored the validity of the unique FFM facetvariances (using the NEO PI-R) to predict disorder symptoms (using the ADP-IV). Our results demonstrate a largely similar correlation and regression pattern between adult and adolescent data, indicating that adaptive and maladaptive trait-descriptive systems relate across a more extended developmental span than has been demonstrated before.

Adolescent↗

PubMed2007

Dimensional models of personality disorder: Diagnostic and Statistical Manual of Mental Disorders Fifth Edition and beyond.

PURPOSE OF REVIEW: We describe several dimensional models of personality disorders and highlight future directions for the integration of dimensional approaches in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). This review is timely and relevant, given the upcoming revision of DSM (DSM-V). RECENT FINDINGS: Research has identified four common higher order factors that could be used to characterize personality pathology. Evidence supports the inclusion of this dimensional representation of personality disorders in DSM-V, possibly as an adjunct to the traditional categorical classification scheme. A dimensional approach would ameliorate many of the problems associated with the categorical approach. Issues that still need to be addressed are on how to integrate these dimensions into the current classification system in a way that they will be accepted by clinicians and psychopathologists. The clinical utility of the dimensional models must be demonstrated, and the development of a method that combines trait elevations and impairment associated with personality pathology is needed in order to define personality disorder from a dimensional perspective. SUMMARY: Although there may be some initial resistance to the incorporation of the dimensional models in the future diagnostic manuals, researchers and clinicians are expected to benefit from the more reliable and valid portrayal of personality pathology.

Diagnosis, Differential↗

PubMed2006

Toward a model of self pathology underlying personality disorders: narratives, metacognition, interpersonal cycles and decision-making processes.

If we want to explain the links between the various and heterogeneous elements--symptoms, dysfunctional forms of behavior and poor social functioning--making up personality disorders, we need model a self pathology that portrays dysfunctions, the links among them, and how their interactions maintain disorders over time. In our view, the most likely elements of self pathology are: a. problematic contents (thoughts and emotions)--experienced subjectively as states of mind and organized in the form of narratives; b. shortfalls in the ability, termed meta-cognition, to reflect on mental states, both of oneself and of others; c. pathogenic interpersonal schemas; and d. maladaptive decision-making processes. These elements get altered in the various personality disorders and interact to form typical pathological organizations. This article seeks to describe a model of self pathology in personality disorders and discuss its current scientific status based on a literature review that spans several disciplines. The model is illustrated with an example of how the pathogenic elements can interact to form personality disorder. Lastly, the limitations and advantages of the model are discussed.

Defense Mechanisms↗

PubMed1998

Axis II pathology in outpatients with dissociative identity disorder.

Forty-two outpatients with dissociative identity disorder (DID) and 16 outpatients with dissociative disorder not otherwise specified (DDNOS) were administered the Millon Clinical Multiaxial Inventory-II (MCMI-II), the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), and the Dissociative Experiences Scale (DES). DID patients manifested severe personality pathology (BR > 84) on a mean of 4.0 MCMI-II scales: avoidant (76%), self-defeating (68%), borderline (53%), and passive-aggressive (45%). DDNOS cases had severe personality pathology on fewer MCMI-II scales (mean = 1.69): avoidant (50%) and self-defeating (31%). The DID and DDNOS groups differed in their scores on the DES (means = 54.9 vs. 25.9), the PK-PTSD scale of the MMPI-2 (means = 33.6 vs. 21.7), and in the incidence of severe borderline pathology (53% vs. 6%). These data on personality pathology in DID patients are virtually identical to those of seven previous studies of personality pathology in chronic PTSD patients (i.e., avoidant, self-defeating, borderline, and passive-aggressive). Such robust convergence of findings supports the construct validity of DID as a form of posttraumatic disorder and suggests that there is a quite predictable personologic core to the clinical picture of severely traumatized individuals.

Adult↗

PubMed1988

A failure to find empirical support for Beardslee and Vaillant's prediction about alcoholism.

Recent studies have proposed that the personality pathology in alcoholics is probably a result, not a cause, of alcohol intake. Thus, 19 male alcoholic veterans were assessed to determine whether there was a positive correlation between personality pathology and lifetime amount of absolute alcohol consumed. A multiple regression analysis of the data showed that there was no evidence for a statistically significant positive correlation between the lifetime amount of absolute alcohol consumed and personality pathology. The only statistically significant correlation found was a negative correlation between personality pathology and age, a finding consistent with some other recent studies.

Adult↗

PubMed2000

Personality disorder traits, family environment, and alcohol misuse: a multivariate behavioural genetic analysis.

AIMS: This study seeks to estimate the extent to which a common genetic and environmental basis is shared between (i) traits delineating specific aspects of antisocial personality and alcohol misuse, and (ii) childhood family environments, traits delineating broad domains of personality pathology and alcohol misuse. DESIGN: Postal survey data were collected from monozygotic and dizygotic twin pairs. SETTING: Twin pairs were recruited from Vancouver, British Columbia and London, Ontario, Canada using newspaper advertisements, media stories and twin clubs. PARTICIPANTS: Data obtained from 324 monozygotic and 335 dizygotic twin pairs were used to estimate the extent to which traits delineating specific antisocial personality traits and alcohol misuse shared a common genetic and environmental aetiology. Data from 81 monozygotic and 74 dizygotic twin pairs were used to estimate the degree to which traits delineating personality pathology, childhood family environment and alcohol misuse shared a common aetiology. MEASUREMENTS: Current alcohol misuse and personality pathology were measured using scales contained in the self-report Dimensional Assessment of Personality Pathology. Perceptions of childhood family environment were measured using the self-report Family Environment Scale. FINDINGS: Multivariate genetic analyses showed that a subset of traits delineating components of antisocial personality (i.e. grandiosity, attention-seeking, failure to adopt social norms, interpersonal violence and juvenile antisocial behaviours) are influenced by genetic factors in common to alcohol misuse. Genetically based perceptions of childhood family environment had little relationship with alcohol misuse. CONCLUSIONS: Heritable personality factors that influence the perception of childhood family environment play only a small role in the liability to alcohol misuse. Instead, liability to alcohol misuse is related to genetic factors common a specific subset of antisocial personality traits describing conduct problems, narcissistic and stimulus-seeking behaviour.

Adolescent↗

PubMed1996

Axis II comorbidity and developmental adversity in bulimia nervosa.

Using data from 61 bulimic patients, we evaluated associations among axis II disturbances, psychopathological traits, eating symptoms, and adverse developmental experiences (e.g., childhood sexual and physical abuse). Findings showed likelihood of childhood abuse to increase markedly in function of comorbid personality pathology. In addition, comorbid borderline personality disorder was found to be a better predictor of object-relations disturbances, primitive defenses, and hostility than developmental adversity was. Although marked trait disturbances were strongly associated with borderline personality disorder (more than with severity of childhood adversity), the converse seemed true of severity of bulimic symptoms (i.e., comorbid personality disorder had no predictive effects, whereas developmental variables had inconsistent effects). Bulimic and general psychopathological symptoms, thus, seemed to have intriguingly independent determinants. We interpret these findings as showing that the observed association between developmental adversity and bulimic syndromes may, in large part, be attributable to comorbid personality pathology.

Adult↗

PubMedDate not supplied

[Dimensions of personality disorders and neurophysiological correlates].

INTRODUCTION: To objective is to identify the factorial structure underlying personality disorders, using clinical and personality measures, and to check whether the resulting structure is valid and theoretically comprehensible, using neurocognitive and psychophysiological measures for establishing possible differences between the factors. METHOD: From the data obtained with the scales MCMI-II and BFQ administered to a sample of 87 subjects diagnosed as a case of any clinical category of DSM-IV personality disorders, and 17 normal controls, we carried out first-order and second-order factor analyses. RESULTS: Five first-order factors (designated as aggressive personality, personality with social deficit, non-pathological personality, obsessive personality and non-assertive personality) and three second-order factors (non-pathological/obsessive personality) were found. CONCLUSIONS: On studying the second-order factors in relation to neurocognitive and psychophysiological measures, it was found that socially-inhibited and non-assertive personalities (factor 1) are characterized by specific neuropsychological deficits in sustained attention; that aggressive personalities (factor 2) are characterized by impulsiveness and deficit in concepts formation; and that in non-pathological personalities with obsessive traits (factor 3), as obsessiveness increases, subjects present less efficacy in sustained attention tasks and greater psychogalvanic response to stress.

Adult↗

PubMedDate not supplied

Mood patterns and variations associated with personality disorder pathology.

This study examined mood and mood variation in relation to varying forms and degrees of personality disorder (PD) pathology. Mood experiences of 98 psychotropic medication-free individuals were repeatedly assessed over a 4-day period. Persons with PDs (n = 57) generally displayed neutral to moderately positive moods; however, overall mood valence was less positive when compared to those without PDs (n = 41). Mood ratings demonstrated moderate covariations with anxious-fearful (A-F) PD traits but little or no association with erratic-emotional-dramatic (E-D) and odd-eccentric (O-E) PD traits once common variance among PD dimensions was removed. For PD diagnostic categories, the presence of avoidant and/or depressive PDs was most strongly associated with negative mood. When dimensional scores based on specific PD trait features were considered, avoidant, depressive, borderline, passive-aggressive, obsessive-compulsive, dependent, paranoid, and schizoid PD traits demonstrated the most reliable associations with negative mood. Apart from borderline PD features, traits associated with other E-D cluster PDs displayed little or no associations with mood quality. Consistent with previous research, mood variability emerged as an internally consistent and stable individual difference variable. Mood variability, however, was not generally associated with PD diagnostic categories or traits. Implications of this study's findings are considered in relation to the conceptual modeling of PDs.

Adult↗

PubMed1990

[Initial experience with the Ilizarov apparatus in orthopedic and traumatological pathology].

Personal experience of 4 years with the use of Ilizarov's apparatus is reported. The apparatus has been utilised on a routine basis in the treatment of complex fractures, in pseudarthrosis and in hypometrias. On the whole, the results obtained were positive, confirming the value of the apparatus and its ductility in the treatment of complex lesions of the skeleton.

Adolescent↗

PubMed2006

The dimensional assessment of personality in pathologic and social gamblers: the role of novelty seeking and self-transcendence.

OBJECTIVE: A few personality traits are characteristic of pathologic gamblers (PGs), but it is not clear if and how their personality profile differs from that of non-pathologic gamblers (non-PGs). METHODS: Sixty-five non-clinical subjects, differentiated into non-PGs and PGs with the means of the South Oak Gambling Screen (SOGS) and Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition-Text Revision (DSM-IV-TR) criteria, were administered with the Temperament and Character Inventory; their values were compared with those of control subjects (CS). RESULTS: Novelty seeking (NS) and self-transcendence (ST) values were higher whereas self-directedness and cooperativeness values were lower in PGs with respect to both non-PGs and CS. A positive correlation was noted between SOGS score and NS (r = 0.40) and ST (r = 0.50) values, as well as a significant positive dependence between SOGS score and a family history of gambling (t = 2.816; P = .007). The subsamples of PGs reporting a parental involvement in gambling showed higher NS than the remaining PGs. CONCLUSIONS: Specific temperamental and character dimensions, especially NS and ST, differentiated PGs from both non-PGs and CS; the identification of a personality profile at risk for problem gambling may represent an important predictor of outcome and constitute a possible target for specific treatment approaches.

Adolescent↗

PubMed1976

[Pathologic hypochondriacal personality development (conditions of formation, clinical variants, type of course)].

The paper deals with some results of a complex somato-psycho-neurological study of 51 patients with a pathological hypochondriacal personality development which led to a stable restriction or a complete loss of working capacity. The author indicates a complex pathogenesis of this disorder: a low level of socio-working adaptation and psychopathic traits in the premorbid personality; psycho-traumatizing situation due to an underestimation by the physicians of the severity of the somato-neurological disorder which in some cases is supplemented by an unfavourable family situation.

Humans↗

PubMed2003

Assessing personality disorders using a systematic clinical interview: evaluation of an alternative to structured interviews.

The aim of this study was to assess interrater reliability and provide initial data bearing on the validity of a method of assessing personality disorders (PDs) that does not presume that patients can accurately self-report personality pathology. In a sample of 24 outpatients, two clinician-judges independently applied the Shedler-Westen Assessment Procedure-200 (SWAP-200; Westen & Shedler, 1999a, 2000), a 200-item Q-sort procedure for assessing personality pathology, to data from the Clinical Diagnostic Interview (Westen, 2002), a systematic clinical interview that mirrors and standardizes methods used by experienced clinicians to diagnose personality. In 16 of the 24 cases, the treating clinician also independently described the patient using the SWAP-200 Q-sort, based on longitudinal knowledge of the patient over the course of treatment, blind to the interview data. Interrater reliability was uniformly high, with median correlations between interviewers at r > .80. Interviewer-treating clinician correlations were also high, with median convergent validity coefficients at r > .80. Diagnostic overlap (discriminant validity) was moderate for dimensional DSM-IV diagnoses, reflecting extensive comorbidity among disorders, but minimal for empirically derived diagnoses identified in prior research. Treating clinicians' dimensional PD diagnoses using this method also strongly predicted interviewer-rated measures of adaptive functioning. The findings provide preliminary support for the reliability and validity of an alternative to structured interviews for diagnosing personality pathology, and suggest that the way to improve validity of personality diagnosis may not be to minimize clinical inference but to quantify it using psychometric instruments.

Adult↗

PubMed2001

Personality profiles in eating disorders: rethinking the distinction between axis I and axis II.

OBJECTIVE: Like other DSM-IV axis I syndromes, eating disorders are diagnosed without respect to personality, which is coded on axis II. The authors assessed the utility of segregating eating disorders and personality pathology and examined the extent to which personality patterns account for meaningful variation within axis I eating disorder diagnoses. METHOD: One hundred three experienced psychiatrists and psychologists used a Q-sort procedure (the Shedler-Westen Assessment Procedure-200) that assesses personality and personality pathology to describe a patient they were currently treating for bulimia or anorexia. Data were subjected to a cluster-analytic procedure (Q-analysis) to determine whether patients clustered into coherent groupings on the basis of their personality profiles. Categorical and dimensional personality diagnoses were then used to predict measures relevant to adaptation and etiology, controlling for axis I diagnosis. RESULTS: Three categories of patients emerged: a high-functioning/perfectionistic group, a constricted/overcontrolled group, and an emotionally dysregulated/undercontrolled group. This categorization demonstrated substantial incremental validity beyond axis I diagnosis in predicting eating disorder symptoms, adaptive functioning (Global Assessment of Functioning scores and history of psychiatric hospitalization), and etiological variables (sexual abuse history). CONCLUSIONS: Axis I symptoms are a useful component, but only one component, in the accurate diagnosis of eating disorders. Classifying patients with eating disorders by eating symptoms alone groups together patients with anorexic symptoms who are high functioning and self-critical with those who are highly disturbed, constricted, and avoidant, and groups together patients with bulimic symptoms who are high functioning and self-critical with those who are highly disturbed, impulsive, and emotionally dysregulated. These distinctions may be relevant to etiology, prognosis, and treatment.

Adult↗

PubMed2004

A "little five" lexically based perspective on personality disorder symptoms in adolescence.

Recently, De Clercq and De Fruyt (2003) examined the relation between adaptive and maladaptive personality functioning in adolescence, using adult measures to describe adolescent personality and personality pathology, i.e., that is the NEOPI-R (Costa & McCrae, 1992) and the ADP-IV (Schotte & De Doncker, 1994) respectively. The present study extends this work, administering a lexically based and age-specific measure of adaptive personality, i.e., that is the Hierarchical Personality Inventory for Children (HiPIC; Mervielde & De Fruyt, 1999), to 454 nonclinical adolescents. Results largely replicated across adult FFM versus lexically derived and age-specific measures, although HiPIC domains explained a larger proportion of disorder variance, with Benevolence and Conscientiousness especially demonstrating less descriptive specificity. Lexically derived facets were further helpful to achieve greater disorder-descriptive specificity. Finally, adolescent personality pathology, when operationalized using Axis II criteria, showed more overlap in adolescence than in adults. It is concluded that future studies should focus on age-specific taxonomies and measures to assess personality pathology in adolescence.

Adaptation, Psychological↗

PubMed1999

Diagnostic change and personality stability following functional restoration treatment in chronic low back pain patients.

This study examined personality pathology in a group of patients with chronic low back pain (CLBP) using both diagnostic interviews and dimensional self-report instruments. A group of CLBP patients (N = 125) was assessed before functional restoration treatment and compared with a matched normal comparison group (N = 75). The CLBP group evidenced broad personality pathology in all assessment modes pretreatment relative to the normal comparison sample. In addition, two subsamples of CLBP patients (n = 49 and n = 56) were assessed after treatment. Reductions in personality pathology between pre- and posttreatment assessments were more pronounced for diagnostic interview than dimensional self-report assessments. These results are discussed in the context of personality assessment and CLBP.

Adolescent↗