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Conjaerts JAP, Videler AC, Schepman R, Elfeddali I, Rosowsky E, van Alphen SPJ. Clinical Staging for Personality Disorders in Older Adults. J Geriatr Psychiatry Neurol 2024:8919887241254467. [PMID: 38809516 DOI: 10.1177/08919887241254467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
OBJECTIVE This scientific research aimed to investigate the feasibility of implementing a clinical staging (CS) model for personality disorders (PDs) in older adults. The CS model could provide valuable insights into the life course of personality pathology, prognosis, and treatment decisions for PDs in older adults. METHODS/DESIGN The study employed an international Delphi methodology with three rounds and involved 21 experts. RESULTS Consensus was achieved on 12 out of 17 statements, confirming the viability of a CS model for PDs in older adults. The proposed model incorporates the Alternative Model for PDs, criterion A, and integrates life course information, distinguishing between chronic PD, re-emergent PD, late-onset PD, and past PD. CONCLUSION The findings suggest that international experts support the implementation of a CS model for PDs in older adults, considering both the severity of personality functioning and the retrospective life course of PD expression.
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Affiliation(s)
- Jeroen A P Conjaerts
- Clinical Center of Excellence for Personality Disorders in Older Adults, Mondriaan Mental Health Center, Heerlen-Maastricht, The Netherlands
| | - Arjan C Videler
- Clinical Center of Excellence of Personality Disorders and Developmental Disorders in Older Adults, GGz Breburg Mental Health Center, PersonaCura, Tilburg, The Netherlands
- Tranzo department, Tilburg University, Tilburg, The Netherlands
- Clinical Centre of Excellence Body Mind and Health, GGz Breburg Mental Health Center, Tilburg, The Netherlands
| | - Roel Schepman
- Clinical Center of Excellence of Personality Disorders and Developmental Disorders in Older Adults, GGz Breburg Mental Health Center, PersonaCura, Tilburg, The Netherlands
| | - Iman Elfeddali
- Clinical Center of Excellence of Personality Disorders and Developmental Disorders in Older Adults, GGz Breburg Mental Health Center, PersonaCura, Tilburg, The Netherlands
- Tranzo department, Tilburg University, Tilburg, The Netherlands
- Clinical Centre of Excellence Body Mind and Health, GGz Breburg Mental Health Center, Tilburg, The Netherlands
| | - Erlene Rosowsky
- Department of Clinical Psychology William James College, Newton, MA, USA
| | - Sebastiaan P J van Alphen
- Clinical Center of Excellence for Personality Disorders in Older Adults, Mondriaan Mental Health Center, Heerlen-Maastricht, The Netherlands
- Personality and Psychopathology Research Group (PEPS), Department of Psychology (PE), Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Hopwood CJ. Personality Functioning, Problems in Living, and Personality Traits. J Pers Assess 2024:1-16. [PMID: 38700238 DOI: 10.1080/00223891.2024.2345880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/12/2024] [Indexed: 05/05/2024]
Abstract
The publication of the Alternative Model of Personality Disorder (AMPD) was a signpost achievement in the personality assessment. However, research on the AMPD has generally not led to either a deeper understanding of personality disorder or personality assessment or new ideas about how to provide better care for people with personality disorder diagnoses. A significant portion of research has focused on narrow issues and appears to be driven in part by ideological differences between scholars who prefer Criterion A (personality functioning) or Criterion B (maladaptive traits). I trace these issues to ambiguity about the concept of personality functioning as defined in the AMPD and its conceptual distinction from personality traits and problems in living. In this paper, I reground these concepts in coherent and distinct definitions, elaborate upon the implications of their differences, and show how these differences can help clarify and reorient AMPD research to focus on generating clinically useful models for personality pathology and personality assessment.
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Rufino SM, Hudson NW, Briskin JL. Volitional Change in Pathological Traits: Can People Change Their Maladaptive Traits? PERSONALITY AND SOCIAL PSYCHOLOGY BULLETIN 2024:1461672241235737. [PMID: 38491843 DOI: 10.1177/01461672241235737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
Abstract
Research suggests people want to change their normative personality traits-and they can volitionally do so. However, studies have not yet addressed volitional change in pathological personality. Consequently, the current study examined (a) people's desires to change pathological traits, (b) whether these change goals predict subsequent trait change, (c) whether this withstands controlling normative traits, and (d) the extent to which pathological trait change predicts relevant outcomes. College students (N = 463) self-reported their pathological traits weekly for up to 16 weeks. People with elevated pathological traits generally desired to decrease these traits. Furthermore, goals to change negative affectivity and disinhibition predicted corresponding trait change. Thus, people want to reduce their pathological traits-and they may be able to do so for some traits.
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Hanegraaf L, Paton B, Hohwy J, Verdejo-Garcia A. Combining novel trait and neurocognitive frameworks to parse heterogeneity in borderline personality disorder. J Pers 2023; 91:1344-1363. [PMID: 36650906 DOI: 10.1111/jopy.12811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 12/02/2022] [Accepted: 01/12/2023] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Borderline Personality Disorder (BPD) diagnosis comprises several constellations of trait, neurocognitive, and psychosocial alterations. Dimensional models of psychopathology provide new opportunities to parse heterogeneity and create a stronger interface between individual characterization and psychosocial outcomes. However, dimensional models have focused on either traits or neurocognitive features, lacking integration to capture the multifaceted nature of BPD. METHOD We assessed 100 participants with BPD using a combination of tools stemming from trait (Alternative Model for Personality Disorders) and neurocognitive models (Research Domain Criteria; RDoC) to examine if trait-derived subgroups display distinctive social-processing and psychosocial profiles. We used two complementary analytical approaches: person-centered (k-means clustering) and construct-based (multiple factor analysis). RESULTS Our person-centered approach identified four subgroups with separable internalizing, detached, externalizing, and low psychopathology trait profiles. These profiles revealed distinctive patterns of affiliation, emotion recognition and mentalization performance in RDoC tasks, and psychosocial measures of quality of life and social connectedness. RDoC-based measures showed close construct proximity with negative affectivity, disinhibition, and antagonism trait domains, relative to the detachment domain, which had close proximity with self-knowledge. CONCLUSIONS Altogether, findings support consilience between trait-based and neurobiological frameworks and suggest that trait models are useful to parse BPD heterogeneity leading to unique social functioning profiles.
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Affiliation(s)
- Lauren Hanegraaf
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Bryan Paton
- School of Psychological Sciences, College of Engineering, Science and Environment, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Jakob Hohwy
- Cognition and Philosophy Lab, Philosophy Department, Monash University, Clayton, Victoria, Australia
| | - Antonio Verdejo-Garcia
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
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5
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Ghanbari S, Asgarizadeh A, Vahidi E, Seyed Mousavi PS, Omidghaemi M. Emotion dysregulation as mediator between mentalizing capacity and affective states: An exploratory study. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2023; 2:e124. [PMID: 38867841 PMCID: PMC11114384 DOI: 10.1002/pcn5.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 06/25/2023] [Accepted: 07/05/2023] [Indexed: 06/14/2024]
Abstract
Aim We intended to elucidate the relationship between mentalizing capacity and affective states by investigating the mediatory role of emotion dysregulation. Methods A sample of nonclinical Iranian adults (N = 445) completed a battery of online self-report measures comprising the Positive and Negative Affect Schedule (PANAS), Mentalization Scale (MentS), and Difficulties in Emotion Regulation Scale (DERS). Results Correlational analyses demonstrated that self- and other-related mentalizing were significantly and inversely associated with emotion dysregulation, which in turn was strongly linked with positive and negative affects. Using structural equation modeling, the results delineated emotion dysregulation as a mediator between self- and other-related mentalizing and affective states, predicting higher negative and lower positive affects. However, motivation to mentalize failed to predict positive affects and only contributed to lower negative affects directly. Conclusion Mentalizing capacity was found to be indirectly linked with affective states through emotion dysregulation; hence, along with the previously substantiated association between emotion dysregulation and affective states and the partially established relationship between mentalizing capacity and affective states, we propose mentalizing incapacity to be at fault in the development of affective difficulties.
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Affiliation(s)
- Saeed Ghanbari
- Faculty of Education and PsychologyShahid Beheshti UniversityTehranIran
| | - Ahmad Asgarizadeh
- Faculty of Education and PsychologyShahid Beheshti UniversityTehranIran
| | - Elahe Vahidi
- Faculty of Education and PsychologyShahid Beheshti UniversityTehranIran
| | | | - Maryam Omidghaemi
- Faculty of Education and PsychologyShahid Beheshti UniversityTehranIran
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Monaghan C, Bizumic B. Dimensional models of personality disorders: Challenges and opportunities. Front Psychiatry 2023; 14:1098452. [PMID: 36960458 PMCID: PMC10028270 DOI: 10.3389/fpsyt.2023.1098452] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/03/2023] [Indexed: 03/09/2023] Open
Abstract
Categorical models of personality disorders have been beneficial throughout psychiatric history, providing a mechanism for organizing and communicating research and treatment. However, the view that individuals with personality disorders are qualitatively distinct from the general population is no longer tenable. This perspective has amassed steady criticism, ranging from inconsequential to irreconcilable. In response, stronger evidence has been accumulated in support of a dimensional perspective that unifies normal and pathological personality on underlying trait continua. Contemporary nosology has largely shifted toward this dimensional perspective, yet broader adoption within public lexicon and routine clinical practice appears slow. This review focuses on challenges and the related opportunities of moving toward dimensional models in personality disorder research and practice. First, we highlight the need for ongoing development of a broader array of measurement methods, ideally facilitating multimethod assessments that reduce biases associated with any single methodology. These efforts should also include measurement across both poles of each trait, intensive longitudinal studies, and more deeply considering social desirability. Second, wider communication and training in dimensional approaches is needed for individuals working in mental health. This will require clear demonstrations of incremental treatment efficacy and structured public health rebates. Third, we should embrace cultural and geographic diversity, and investigate how unifying humanity may reduce the stigma and shame currently generated by arbitrarily labeling an individual's personality as normal or abnormal. This review aims to organize ongoing research efforts toward broader and routine usage of dimensional perspectives within research and clinical spaces.
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Affiliation(s)
- Conal Monaghan
- Research School of Psychology, Australian National University, Canberra, ACT, Australia
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Cheli S, Cavalletti V, Lysaker PH, Dimaggio G, Petrocchi N, Chiarello F, Enzo C, Velicogna F, Mancini F, Goldzweig G. A pilot randomized controlled trial comparing a novel compassion and metacognition approach for schizotypal personality disorder with a combination of cognitive therapy and psychopharmacological treatment. BMC Psychiatry 2023; 23:113. [PMID: 36803673 PMCID: PMC9942388 DOI: 10.1186/s12888-023-04610-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 02/13/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Schizotypal personality disorder is characterized by a pervasive pattern of maladaptive behavior that has been associated with the liability for schizophrenia. Little is known about effective psychosocial interventions. This pilot non-inferiority randomized controlled trial aimed to compare a novel form of psychotherapy tailored for this disorder and a combination of cognitive therapy and psychopharmacological treatment. The former treatment - namely, Evolutionary Systems Therapy for Schizotypy-integrated evolutionary, metacognitively oriented, and compassion focused approaches. METHODS Thirty-three participants were assessed for eligibility, twenty-four randomized on a 1:1 ratio, nineteen included in the final analysis. The treatments lasted 6 months (24 sessions). The primary outcome was change across nine measurements in personality pathology, the secondary outcomes were remission from diagnosis and pre-post changes in general symptomatology and metacognition. RESULTS Primary outcome suggested a non-inferiority of the experimental treatment in respect to control condition. Secondary outcomes reported mixed results. There was no significant difference in terms of remission, but experimental treatment showed a larger reduction of general symptomatology (η2 = 0.558) and a larger increase in metacognition (η2 = 0.734). CONCLUSIONS This pilot study reported promising results about the effectiveness of the proposed novel approach. A confirmatory trial on large sample size is needed to provide evidence about relative effectiveness of the two treatment conditions. TRIAL REGISTRATION ClinicalTrials.gov; NCT04764708; Registration day 21/02/2021.
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Affiliation(s)
- Simone Cheli
- School of Human Health Sciences, University of Florence, Florence, Italy. .,Center for Psychology and Health (Centro Di Psicologia e Psicoterapia), Tages Charity (Tages Onlus), Via Della Torretta 14, 50137, Florence, Italy.
| | - Veronica Cavalletti
- Center for Psychology and Health (Centro Di Psicologia e Psicoterapia), Tages Charity (Tages Onlus), Via Della Torretta 14, 50137 Florence, Italy
| | - Paul H. Lysaker
- grid.280828.80000 0000 9681 3540Department of Psychiatry, Richard L Roudebush VA Medical Center, Indianapolis, USA ,grid.257413.60000 0001 2287 3919Department of Psychiatry, Indiana University School of Medicine, Indianapolis, USA
| | - Giancarlo Dimaggio
- grid.512576.20000 0004 7475 2686Centro Di Terapia Metacognitiva Interpersonale, Rome, Italy
| | - Nicola Petrocchi
- grid.449441.80000 0004 1789 8806John Cabot University, Rome, Italy
| | - Francesca Chiarello
- Center for Psychology and Health (Centro Di Psicologia e Psicoterapia), Tages Charity (Tages Onlus), Via Della Torretta 14, 50137 Florence, Italy
| | - Consuelo Enzo
- Center for Psychology and Health (Centro Di Psicologia e Psicoterapia), Tages Charity (Tages Onlus), Via Della Torretta 14, 50137 Florence, Italy
| | - Francesco Velicogna
- Center for Psychology and Health (Centro Di Psicologia e Psicoterapia), Tages Charity (Tages Onlus), Via Della Torretta 14, 50137 Florence, Italy
| | - Francesco Mancini
- grid.440899.80000 0004 1780 761XGuglielmo Marconi University, Rome, Italy
| | - Gil Goldzweig
- grid.430432.20000 0004 0604 7651The Academic College of Tel Aviv Yaffo, Tel Aviv, Israel
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Yalch MM, Ceroni DB, Dehart RM. Influence of Child Abuse and Neglect on Histrionic Personality Pathology. J Trauma Dissociation 2023; 24:111-124. [PMID: 36053041 DOI: 10.1080/15299732.2022.2119458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Histrionic personality pathology is among the most common forms of personality pathology, although little is known about its potential risk factors. One possible factor that may influence histrionic personality pathology is childhood trauma, most notably sexual abuse and physical/emotional neglect. However, there is little research on how these and other forms of childhood trauma may influence histrionic personality pathology relative to each other. To address this, in this study we examined the relative effects of different forms of child abuse and neglect on histrionic personality pathology in a sample of women and men from Amazon's Mechanical Turk (N = 399) using a Bayesian approach to structural equation modeling. Results suggest that child sexual abuse is the strongest predictor of histrionic personality pathology in adulthood. However, this differs between women and men such that physical neglect also predicts histrionic personality pathology for women, whereas physical and emotional abuse as well as emotional neglect predict histrionic personality pathology for men. These findings provide insight into the developmental precursors to histrionic personality pathology and have implications for research on and clinical intervention with people exhibiting histrionic personality pathology.
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Affiliation(s)
- Matthew M Yalch
- Department of Psychology, Palo Alto University, Palo Alto, California, USA
| | - Dominic B Ceroni
- Department of Psychology, Palo Alto University, Palo Alto, California, USA
| | - Ryanne M Dehart
- Department of Psychology, Palo Alto University, Palo Alto, California, USA
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Allison S, Bastiampillai T, Looi JC, Mulder R. Adolescent borderline personality disorder: Does early intervention 'bend the curve'? Australas Psychiatry 2022; 30:698-700. [PMID: 35514042 DOI: 10.1177/10398562221092311] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The Global Alliance for Prevention and Early Intervention for Borderline Personality Disorder (BPD) proposed a major change for youth mental health services. The Alliance recommended that early detection and specialised treatment for youth BPD becomes a major focus of their clinical activities. Since structured psychotherapies for BPD are complex and lengthy, this proposal has significant implications for youth policy, planning and resource allocation. Our commentary addresses whether BPD is diagnosable and treatable in youth, and whether early intervention results in longer-term benefits. CONCLUSION People diagnosed with BPD are highly heterogeneous and experience high levels of comorbidity. The low quality of the evidence for the treatment of BPD in adolescence limits our ability to develop evidence-based guidelines. Accordingly, there is no clear case for BPD early intervention as a major component of youth mental health services. The introduction of ICD-11 classification system may facilitate further empirical studies of personality disorders in adolescence and emerging adulthood.
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Affiliation(s)
- Stephen Allison
- College of Medicine and Public Health, 1065Flinders University, Adelaide, SA, Australia; and Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Tarun Bastiampillai
- College of Medicine and Public Health, 1065Flinders University, Adelaide, SA, Australia; Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and Department of Psychiatry, Monash University, Melbourne, VIC, Australia
| | - Jeffrey Cl Looi
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and Academic Unit of Psychiatry and Addiction Medicine, Canberra Hospital, 104822The Australian National University Medical School, Canberra, ACT, Australia
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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Müller S, Wendt LP, Schicktanz P, Hopwood CJ, Zimmermann J. Development and Validation of a German Interpersonal Sensitivities Circumplex (ISC-G). EUROPEAN JOURNAL OF PSYCHOLOGICAL ASSESSMENT 2022. [DOI: 10.1027/1015-5759/a000737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Abstract. The Interpersonal Sensitivities Circumplex (ISC) assesses individual differences in sensitivities to aversive interpersonal behaviors. In this research (total N = 1,519), we developed and validated a German adaptation of the ISC (ISC-G) and extended the nomological net of interpersonal sensitivity as a construct. Using the structural summary method, we investigated associations with self- and informant reports of adaptive (interpersonal) personality traits as well as self-reported personality functioning, maladaptive personality traits, childhood trauma, and hypersensitivity. Replicating and extending previous findings with the ISC, the present research sheds light on the interplay between different personality traits and the perception of others’ interpersonal behavior. Results suggested that individuals report experiencing interpersonal behavior opposite to their own self-description in terms of agency and communion as aversive. This oppositional pattern was most pronounced for antagonistic vs. agreeable traits/behaviors. We discuss these results in the context of research on personality pathology.
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Affiliation(s)
- Sascha Müller
- Department of Psychology, University of Kassel, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Rostock University Medical Center, University of Rostock, Germany
| | - Leon P. Wendt
- Department of Psychology, University of Kassel, Germany
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11
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Choi-Kain LW, Sahin Z, Traynor J. Borderline Personality Disorder: Updates in a Postpandemic World. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2022; 20:337-352. [PMID: 37200886 PMCID: PMC10187392 DOI: 10.1176/appi.focus.20220057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Progress in understanding borderline personality disorder has unfolded in the last decade, landing in a new COVID-19-influenced world. Borderline personality disorder is now firmly established as a valid diagnosis, distinct from its co-occurring mood, anxiety, trauma-related, and behavioral disorders. Further, it is also understood as a reflection of general personality dysfunction, capturing essential features shared among all personality disorders. Neuroimaging research, representing the vast neurobiological advances made in the last decade, illustrates that the disorder shares frontolimbic dysfunction with many psychiatric diagnoses but has a distinct signature of interpersonal and emotional hypersensitivity. This signature is the conceptual basis of the psychotherapies and clinical management approaches proven effective for the disorder. Medications remain adjunctive and are contraindicated by some guidelines internationally. Less invasive brain-based therapeutics show promise. The most significant change in the treatment landscape is a focus on briefer, less intensive formats of generalist management. Shorter variants of therapies, such as dialectical behavior therapy and mentalization-based treatment, are in the process of being shown to be adequately effective. Earlier intervention and greater emphasis on functional improvement are needed to more effectively curb the disabilities and risks of borderline personality disorder for patients and their families. Remote interventions show promise in broadening access to care.
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Affiliation(s)
- Lois W Choi-Kain
- Gunderson Personality Research Institute, McLean Hospital, Belmont, Massachusetts, and Faculty of Medicine, Harvard Medical School, Boston
| | - Zeynep Sahin
- Gunderson Personality Research Institute, McLean Hospital, Belmont, Massachusetts, and Faculty of Medicine, Harvard Medical School, Boston
| | - Jenna Traynor
- Gunderson Personality Research Institute, McLean Hospital, Belmont, Massachusetts, and Faculty of Medicine, Harvard Medical School, Boston
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12
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Maerz J, Buchheim A, Rabl L, Riedl D, Viviani R, Labek K. The interplay of Criterion A of the Alternative Model for Personality Disorders, mentalization and resilience during the COVID-19 pandemic. Front Psychol 2022; 13:928540. [PMID: 35959052 PMCID: PMC9358045 DOI: 10.3389/fpsyg.2022.928540] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/04/2022] [Indexed: 01/07/2023] Open
Abstract
Background and aims The COVID-19 pandemic has been accompanied by a worsening of mental health levels in some, while others manage to adapt or recover relatively quickly. Transdiagnostic factors such as personality functioning are thought to be involved in determining mental health outcomes. The present study focused on two constructs of personality functioning, Criterion A of the Alternative Model for Personality Disorders (AMPD, DSM-5) and mentalization, as predictors of depressive symptoms and life satisfaction during the COVID-19 pandemic. A second focus of the study was to examine whether this relationship was mediated by resilience. Methods Linear regression analyses were used to examine the relationship between personality functioning measured by Criterion A (AMPD, DSM-5) and mentalizing abilities as predictors, and depression and life satisfaction as mental health outcomes. To assess the hypothesis that this relationship is mediated by resilience a structural equation modeling approach was conducted. Data from N = 316 individuals from the general population were collected. Results Linear regression models revealed highly significant associations between Criterion A/mentalization and both outcome measures. Structural equation models showed a significant partial mediation by resilience of these relationships. Conclusion Our results support the hypothesis that mentalizing serves as a protective function by promoting resilience to the impact of stress and threats. Criterion A and mentalization performed similarly as predictors of mental health outcomes, providing empirically overlapping operationalizations of personality functioning. This finding emphasizes the importance of personality functioning in positive and negative mental health outcomes. Furthermore, our results are consistent with a mediating role of resilience.
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Affiliation(s)
- Jeff Maerz
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Anna Buchheim
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Luna Rabl
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - David Riedl
- University Hospital of Psychiatry II, Medical University Innsbruck, Innsbruck, Austria
| | - Roberto Viviani
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
- Department of Psychiatry and Psychotherapy III, University of Ulm, Ulm, Germany
| | - Karin Labek
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
- *Correspondence: Karin Labek,
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13
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Wallick A, Ward RN, Levendosky AA, Brown LM, Yalch MM. Incremental Influence of Betrayal Trauma and Personality Traits on PTSD Symptoms. J Trauma Dissociation 2022; 23:356-365. [PMID: 34651565 DOI: 10.1080/15299732.2021.1989119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Symptoms of posttraumatic stress disorder (PTSD) are common reactions to trauma. One factor that influences the manifestation of PTSD symptoms is the type of trauma experienced. Traumas perpetrated by someone on whom the trauma survivor trusts and relies on for support (i.e., betrayal traumas) are especially predictive of PTSD symptoms. However, the degree to which this is true differs somewhat across men and women. Another factor that influences PTSD symptoms is personality, which is most often operationalized in terms of discrete personality traits. Among these traits, Neuroticism (the tendency to experience negative affect) is linked to a wide range of psychological dysfunction in general and to PTSD symptoms in particular. However, there is little research on how trauma type and personality differentially influence PTSD symptoms. To address this gap, in this study we examined the incremental effects of traumas with varying degrees of betrayal and personality traits on PTSD symptoms in a sample of college students (N = 276) using a Bayesian approach to multiple regression. Results suggest that Neuroticism and trauma at all levels of betrayal were associated with higher levels of PTSD symptoms, although this differed across sex. These results are consistent with previous research that identifies Neuroticism as a risk factor for a wide range of mental health problems and clarifies earlier findings on betrayal trauma.
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Affiliation(s)
- Amanda Wallick
- Department of Psychology, Palo Alto University, Palo Alto, California, United States
| | - Rachel N Ward
- Department of Psychology, Palo Alto University, Palo Alto, California, United States
| | - Alytia A Levendosky
- Department of Psychology, Michigan State University, East Lansing, Minnesota, United States
| | - Lisa M Brown
- Department of Psychology, Palo Alto University, Palo Alto, California, United States.,Department of Psychology, Stanford University, Palo Alto, United States
| | - Matthew M Yalch
- Department of Psychology, Palo Alto University, Palo Alto, California, United States
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14
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Yalch MM, Watters KN, Gallagher AR. Influence of Personality Traits on Post-Traumatic Cognitions of Sexual Assault. J Trauma Dissociation 2022; 23:416-431. [PMID: 34641762 DOI: 10.1080/15299732.2021.1989121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Sexual assault is a common form of trauma that is associated with psychological distress for many people who experience it. One factor that influences the degree to which sexual assault survivors exhibit distress is the cognitions they form related to the assault in its aftermath. The more times the assault happens, the more disruptive are the post-traumatic cognitions, although both the frequency of sexual assault and nature of post-traumatic cognitions differ by gender. Another factor that may influence post-traumatic cognitions is personality, which emerging research suggests has an influence on post-traumatic response in general and post-traumatic cognitions in particular. However, there is little research on the influence of personality on post-traumatic cognitions related to sexual assault specifically. In this study, we examine the association between personality traits (Agreeableness, Conscientiousness, Extraversion, Neuroticism, and Openness) and post-traumatic cognitions of sexual assault in a sample of sexual assault survivors recruited from Amazon's Mechanical Turk (N = 303) using a Bayesian approach to multiple regression. Results suggest that although the influence of traits varied depending on the post-traumatic cognition under analysis and the sex of the sexual assault survivor, Neuroticism was the primary predictor of post-traumatic cognitions over and above sexual assault frequency, although this applied more for men than for women. Study findings clarify previous research on the role of personality traits in post-traumatic response and suggest directions for future research and clinical intervention.
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Affiliation(s)
- Matthew M Yalch
- Department of Psychology, Palo Alto University, Palo Alto, California
| | | | - Alana R Gallagher
- Department of Psychology, Palo Alto University, Palo Alto, California
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15
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Ringwald WR, Hallquist MN, Dombrovski AY, Wright AG. Transdiagnostic Associations With Interpersonal and Affective Variability in Borderline Personality Pathology. J Pers Disord 2022; 36:320-338. [PMID: 35647774 PMCID: PMC9830454 DOI: 10.1521/pedi.2022.36.3.320] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Emotional and behavioral variability are unifying characteristics of borderline personality disorder (BPD). Ambulatory assessment (AA) has been used to quantify this variability in terms of the categorical BPD diagnosis, but evidence suggests that BPD instead reflects general personality pathology. This study aimed to clarify the conceptualization of BPD by mapping indices of variability in affect, interpersonal behavior, and perceptions of others onto general and specific dimensions of personality pathology. A sample of participants who met diagnostic criteria for BPD (n = 129) and healthy controls (n = 47) reported on their daily interactions during a 21-day AA protocol. Multilevel SEM was used to examine associations between shared and specific variance in maladaptive traits with dynamic patterns of functioning. The authors found that variability is an indicator of shared trait variance and Negative Affectivity, not any other specific traits, reinforcing the idea that BPD is best understood as general personality pathology.
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Affiliation(s)
| | - Michael N. Hallquist
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill
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16
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Bliton CF, Roche MJ, Pincus AL, Dueber D. Examining the Structure and Validity of Self-Report Measures of DSM-5 Alternative Model for Personality Disorders Criterion A. J Pers Disord 2022; 36:157-182. [PMID: 34287067 DOI: 10.1521/pedi_2021_35_531] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The Level of Personality Functioning Scale (LPFS) operationalizes Criterion A of the DSM-5 Alternative Model for Personality Disorders. Despite progress in LPFS measurement development and validation, there is a lack of research, and some disagreement, concerning structural, convergent, and incremental validity of LPFS self-report measures. The present study aimed to compare the LPFS Self-Report, LPFS Self-Report of Criterion A, and LPFS Brief Form. Internal structure was assessed through principal component analyses, factor analyses, and bifactor analyses of unidimensionality. Associations with both pathological and basic personality characteristics among the LPFS measures were explored. Incremental validity of LPFS severity in predicting pathological personality outcomes controlling for basic personality traits, and the reverse, were examined. Results suggest a unidimensional structure robustly associated with other pathological personality assessments. LPFS severity and basic personality traits mutually offered unique explanatory power. We discuss the implications of assessing personality pathology using LPFS self-report measures.
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Affiliation(s)
- Chloe F Bliton
- Department of Psychology, Pennsylvania State University, University Park, Pennsylvania
| | - Michael J Roche
- Department of Psychology, West Chester University, West Chester, Pennsylvania
| | - Aaron L Pincus
- Department of Psychology, Pennsylvania State University, University Park, Pennsylvania
| | - David Dueber
- Department of Educational, School, and Counseling Psychology, University of Kentucky, Lexington, Kentucky
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17
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Ruchensky JR, Dowgwillo EA, Kelley SE, Massey C, Slavin-Mulford J, Richardson LA, Blais MA, Stein MB. Exploring the Alternative Model for Personality Disorders Using SCORS-G Ratings on Thematic Apperception Test Narratives. J Pers Disord 2022; 36:201-216. [PMID: 34427493 DOI: 10.1521/pedi_2021_35_535] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The Alternative Model for Personality Disorders (AMPD) in Section III of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013) conceptualizes personality pathology as a combination of impairment (Criterion A) and traits (Criterion B). One measure used to develop Criterion A was the Social Cognition and Object Relations Scale - Global Rating Method (SCORS-G), which is a multidimensional, object-relational clinician-rated measure of personality functioning. Although there are conceptual links between the AMPD and SCORS-G dimensions, there exists no research examining the relationship. To address this, we examined associations between the SCORS-G dimensions and measures of the AMPD constructs in a large, archival dataset of outpatients and inpatients. More pathological scores on SCORS-G dimensions reflecting self- and interpersonal functioning were associated with greater pathological traits and impairment. Overall, results support further investigation into SCORS-G as a useful measure in AMPD research and assessment.
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Affiliation(s)
| | | | - Shannon E Kelley
- Clinical Psychology Department, William James College, Newton, Massachusetts
| | - Christina Massey
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Laura A Richardson
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mark A Blais
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Michelle B Stein
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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18
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Veenstra MS, van Dijk SDM, Bouman R, van Alphen SPJB, van Asselt ADIT, van den Brink RHS, Voshaar RCO. Impact of personality functioning and pathological traits on mental wellbeing of older patients with personality disorders. BMC Psychiatry 2022; 22:214. [PMID: 35331179 PMCID: PMC8944148 DOI: 10.1186/s12888-022-03857-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/15/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Although personality disorders are common and consequential, they are largely ignored in geriatric mental healthcare. We examined the relative contributions of different aspects of personality disorders and comorbid mental disorders to the impairment of mental wellbeing in older adults. METHODS Baseline data were used of 138 patients who participated in a randomized controlled trial on schema therapy for geriatric mental health outpatients with a full or subthreshold cluster B or C personality disorder. Personality was assessed according to both the categorical and dimensional model of DSM-5. Aspects of mental wellbeing assessed were; psychological distress, positive mental health, subjective health, and life satisfaction. The current study uses baseline data of the RCT to examine the associations between different aspects of personality pathology and mental wellbeing by multivariate regression analysis, controlling for age, sex, level of education, and number of chronic somatic illnesses. RESULTS The vast majority of patients (79.0%) had one or more mental disorders in addition to personality disorder. Personality pathology was responsible for the core of the mental health burden experienced by patients, and negated the influence of co-occurring mental disorders when entered subsequently in multivariate analysis. Personality dimensions proved to be highly predictive of mental wellbeing, and this contrasted with absence of influence of personality disorder diagnosis. Although the personality functioning dimensions - and in particular Identity integration (large effect size with partial eta-squared = 0.36) - were the primary predictors of mental wellbeing, personality trait dimensions added significant predictive value to that (Disinhibition 0.25 and Negative affect 0.24). CONCLUSIONS Personality disorders seriously affect the mental wellbeing of patients, and this overshadows the impact of comorbid mental disorders. In particular personality functioning and pathological traits of the Alternative Model of Personality Disorders (AMPD) of DSM-5 contribute to this impact on mental wellbeing. Alertness for and treatment of personality disorders in geriatric mental healthcare seems warranted.
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Affiliation(s)
- Martine S. Veenstra
- grid.4494.d0000 0000 9558 4598Department of Psychiatry, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, the Netherlands
| | - Silvia D. M. van Dijk
- grid.4494.d0000 0000 9558 4598Department of Psychiatry, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, the Netherlands
| | - Renske Bouman
- grid.4494.d0000 0000 9558 4598Department of Psychiatry, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, the Netherlands
| | | | - Antoinette D. I. Thea van Asselt
- grid.4494.d0000 0000 9558 4598Department of Epidemiology and Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Rob H. S. van den Brink
- grid.4494.d0000 0000 9558 4598Department of Psychiatry, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, the Netherlands
| | - Richard C. Oude Voshaar
- grid.4494.d0000 0000 9558 4598Department of Psychiatry, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, the Netherlands
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19
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Bliton CF, Rosenstein LK, Pincus AL. Trading Patients: Applying the Alternative Model for Personality Disorders to Two Cases of DSM-5 Borderline Personality Disorder Over Time and Across Therapists. Front Psychol 2022; 13:794624. [PMID: 35237208 PMCID: PMC8884405 DOI: 10.3389/fpsyg.2022.794624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/03/2022] [Indexed: 11/16/2022] Open
Abstract
The DSM-5 Alternative Model for Personality Disorders (AMPD) dimensionally defines personality pathology using severity of dysfunction and maladaptive style. As the empirical literature on the clinical utility of the AMPD grows, there is a need to examine changes in diagnostic profiles and personality expression in treatment over time. Assessing these changes in individuals diagnosed with borderline personality disorder (BPD) is complicated by the tendency for patients to cycle through multiple therapists over the course of treatment leaving the potential for muddled diagnostic clarity and disjointed case conceptualizations. Following patient trajectories across therapists offers a unique opportunity to examine the AMPD’s sensitivity to and utility for capturing personality stability and change over time for patients with BPD. This article demonstrates the utility of the AMPD for two clinical cases in three distinct ways: (i) highlighting heterogeneity in BPD between patients, (ii) comparing improvements in personality severity and style over time, and (iii) elucidating profile change across therapist ratings. We present two patients diagnosed with DSM-5 Section II BPD, crossing between two therapists over the course of 3 years of psychodynamic psychotherapy. Treating clinicians rated patients for their respective treatment phases using the Level of Personality Functioning Scale (LPFS), capturing severity, and the Personality Inventory for the DSM-5 (PID-5), capturing style. AMPD diagnostic profiles differentiated patients with BPD in both severity and style, and captured within-patient change beyond within-therapist response bias. Results indicated greater improvements in personality severity while personality style remained more stable. Implications for the patients’ treatment progress and associated challenges are discussed, as are considerations for the utility of the AMPD in therapy.
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Affiliation(s)
- Chloe F Bliton
- Department of Psychology, The Pennsylvania State University, University Park, PA, United States
| | - Lia K Rosenstein
- Department of Psychology, The Pennsylvania State University, University Park, PA, United States
| | - Aaron L Pincus
- Department of Psychology, The Pennsylvania State University, University Park, PA, United States
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20
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Cheli S, Lam WWT, Estapé T, Winterling J, Bahcivan O, Andritsch E, Weis J, Centeno I, Serpentini S, Farkas C, Wengström Y, Fioretto L, Baider L, Lam CCL, Goldzweig G. Risk perception, treatment adherence, and personality during COVID-19 pandemic: An international study on cancer patients. Psychooncology 2022; 31:46-53. [PMID: 34314560 PMCID: PMC8420575 DOI: 10.1002/pon.5775] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/06/2021] [Accepted: 07/22/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To explore the role of personality traits in moderating the relation between COVID-19 risk perception and treatment adherence, and between risk perception and psychosocial distress in patients diagnosed with cancer. METHODS An online survey (n = 1281) was conducted worldwide in seven countries (Austria, Germany, Hong Kong, Italy, Spain, Sweden, and Turkey). Inclusion criteria were to be 18 years of age or older, have received a cancer diagnosis, and be in treatment or follow-up. A few moderated regression models were performed with both personality traits and Hierarchical Taxonomy of Psychopathology super-spectra as moderators. RESULTS Detachment, negative affectivity, psychoticism and all the super-spectra significantly moderated the relation between coronavirus risk perception and psychosocial distress, after the adjusting effect of confidence in safeguards. Only negative affectivity moderated the association between coronavirus risk perception and treatment adherence. CONCLUSIONS Personality traits may foster the understanding of how a patient might adjust to cancer treatment and, more generically, to highly stressful events such as the COVID-19 pandemic. Further research is needed to confirm the results in different cancer stages and types.
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Affiliation(s)
- Simone Cheli
- School of Human Health SciencesUniversity of FlorenceFlorenceItaly
- Center for Psychology and HealthTages CharityFlorenceItaly
| | - Wendy W. T. Lam
- Faculty of MedicineSchool of Public HealthJockey Club Institute of Cancer CareThe University of Hong KongHong KongChina
| | | | - Jeanette Winterling
- Comprehensive Cancer CentreKarolinska University HospitalStockholmSweden
- Department of Neurobiology, Care Sciences and SocietyDivision of NursingKarolinska InstitutetStockholmSweden
| | | | | | - Joachim Weis
- Medical Faculty Comprehensive Cancer CenterUniversity Clinic CentreFreiburgGermany
| | - Isabel Centeno
- Fundación Elisabeth Kübler‐RossSan Pedro Garza GarcíaMexico
| | | | | | - Yvonne Wengström
- Comprehensive Cancer CentreKarolinska University HospitalStockholmSweden
- Department of Neurobiology, Care Sciences and SocietyDivision of NursingKarolinska InstitutetStockholmSweden
| | | | - Lea Baider
- Assuta Medical CenterOncology InstituteTel‐AvivIsrael
| | - Cherry C. L. Lam
- Faculty of MedicineSchool of Public HealthJockey Club Institute of Cancer CareThe University of Hong KongHong KongChina
| | - Gil Goldzweig
- The Academic College of Tel Aviv–YaffoTel‐AvivIsrael
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21
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Mariotti EC, Waugh MH, McClain CM, Beevers LG, Clemence AJ, Lewis KC, Miller R, Mulay AL, Ridenour JM, Huprich SK, Pitman SR, Meehan KB. Assessing Self-Definition and Relatedness in Level of Personality Functioning. J Pers Disord 2021; 35:857-880. [PMID: 33764821 DOI: 10.1521/pedi_2021_35_516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The two polarities model (TPM) of personality organizes psychological assessment and psychotherapy and connects to personality disorder diagnosis using the DSM-5 Alternative Model for Personality Disorders (AMPD). The authors developed scales assessing the TPM from an existing self-report measure for level of personality functioning (LPF), a core component of the AMPD. Iterative content analyses of the LPF measure yielded scales for Autonomy and Communion corresponding to dimensions of the TPM. The scales were refined via internal consistency analyses using a measure of psychological attachment and studied in development and validation samples. Associations with relevant external criteria were explored in a series of multiple regressions. The new content-based LPF scales were illustrated with a case vignette. Although the new Autonomy/Communion scales await further validation prior to clinical use, initial evidence suggests that they may bridge the nomological nets of the TPM and AMPD and potentially offer clinical utility in assessment and treatment planning.
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Affiliation(s)
| | - Mark H Waugh
- University of Tennessee, Knoxville.,Oak Ridge National Laboratory, Oak Ridge, Tennessee
| | | | | | | | | | - Racheli Miller
- Center for Compassion Focused Therapy, New York, New York
| | - Abby L Mulay
- Medical University of South Carolina, Charleston, South Carolina
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22
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Konjusha A, Hopwood CJ, Price AL, Masuhr O, Zimmermann J. Investigating the Transdiagnostic Value of Subjective Emptiness. J Pers Disord 2021; 35:788-800. [PMID: 33661017 DOI: 10.1521/pedi_2021_35_510] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
It is common for people with mental health problems to report feelings of emptiness. However, the association of subjective emptiness with specific disorders and its unique role within dimensional taxonomies of personality pathology is not well understood. The present study assesses the transdiagnostic value of subjective emptiness using a recently developed self-report measure in a mixed sample of 157 participants. The authors investigated the associations of emptiness with clinically relevant variables, including borderline personality disorder symptoms, depression, anxiety, suicidal ideation, and suicide attempts. Subjective emptiness showed strong positive relationships with all criteria. Regression models controlling for impairments of personality functioning, maladaptive personality traits, and current symptom distress supported the incremental validity of emptiness for specific disorder constructs and suicidality. These findings indicate that emptiness represents a facet of psychopathology that can be particularly useful for the classification of mental disorders, and in particular internalizing disorders involving self-dysfunction and detachment.
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Affiliation(s)
| | | | | | - Oliver Masuhr
- Asklepios Fachklinikum Tiefenbrunn, Rosdorf, Germany
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23
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Affiliation(s)
- Roger Mulder
- Department of Psychological MedicineUniversity of OtagoChristchurchNew Zealand
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24
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Luo X, Hopwood CJ, Good EW, Turchan JE, Thomas KM, Levendosky AA. Using Interpersonal Dimensions of Personality and Personality Pathology to Examine Momentary and Idiographic Patterns of Alliance Rupture. Front Psychol 2021; 12:711109. [PMID: 34484067 PMCID: PMC8415308 DOI: 10.3389/fpsyg.2021.711109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/22/2021] [Indexed: 11/17/2022] Open
Abstract
The Alternative Model of Personality Disorders (AMPD) integrates several theoretical models of personality functioning, including interpersonal theory. The interpersonal circumplex dimensions of warmth and dominance can be conceptualized as traits similar to those in AMPD Criterion B, but interpersonal theory also offers dynamic hypotheses about how these variables that change from moment to moment, which help to operationalize some of the processes alluded to in AMPD Criterion A. In the psychotherapy literature, dynamic interpersonal behaviors are thought to be critical for identifying therapeutic alliance ruptures, yet few studies have examined moment-to-moment interpersonal behaviors that are associated with alliance ruptures at an idiographic level. The current study examined the concurrent and cross-lagged relationships between interpersonal behaviors and alliance ruptures within each session in the famous Gloria films ("Three Approaches to Psychotherapy"). Interpersonal behaviors (warmth and dominance) as well as alliance ruptures (i.e., withdrawal and confrontation) were calculated at half minute intervals for each dyad. We identified distinct interpersonal patterns associated with alliance ruptures for each session: Gloria (patient)'s warmth was positively related with withdrawal ruptures concurrently in the session with Carl Rogers; Gloria's dominance and coldness were related with increased confrontation ruptures in the session with Fritz Perls concurrently, while her coldness was also predicted by confrontation ruptures at previous moments; lastly, both Gloria's dominance and Albert Ellis's submissiveness were positively related with withdrawal ruptures. These interpersonal patterns demonstrated the promise of using AMPD dimensions to conceptualize momentary interpersonal processes related to therapy ruptures, as well as the clinical importance of attuning to repetitive, dyad-specific interpersonal cues of ruptures within each session.
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Affiliation(s)
- Xiaochen Luo
- Department of Counseling Psychology, Santa Clara University, Santa Clara, CA, United States
| | | | - Evan W. Good
- Department of Psychology, Michigan State University, East Lansing, MI, United States
| | - Joshua E. Turchan
- Department of Psychology, Michigan State University, East Lansing, MI, United States
- Counseling & Psychiatric Services, Michigan State University, East Lansing, MI, United States
| | | | - Alytia A. Levendosky
- Department of Psychology, Michigan State University, East Lansing, MI, United States
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25
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Hörz-Sagstetter S, Ohse L, Kampe L. Three Dimensional Approaches to Personality Disorders: a Review on Personality Functioning, Personality Structure, and Personality Organization. Curr Psychiatry Rep 2021; 23:45. [PMID: 34181116 PMCID: PMC8238706 DOI: 10.1007/s11920-021-01250-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW The concept of personality functioning (Alternative DSM-5 Model of Personality Disorders) has led to increased interest in dimensional personality disorder diagnosis. While differing markedly from the current categorical classification, it is closely related to the psychodynamic concepts of personality structure and personality organization. In this review, the three dimensional approaches, their underlying models, and common instruments are introduced, and empirical studies on similarities and differences between the concepts and the categorical classification are summarized. Additionally, a case example illustrates the clinical application. RECENT FINDINGS Numerous studies demonstrate the broad empirical basis, validated assessment instruments and clinical usefulness of the dimensional concepts. Their advantages compared to the categorical approach, but also the respective differences, have been demonstrated empirically, in line with clinical observations. Evidence supports the three dimensional concepts, which share conceptual overlap, but also entail unique aspects of personality pathology, respectively.
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Affiliation(s)
| | - Ludwig Ohse
- Psychologische Hochschule Berlin (PHB), Am Köllnischen Park 2, 10179, Berlin, Germany
| | - Leonie Kampe
- Psychologische Hochschule Berlin (PHB), Am Köllnischen Park 2, 10179, Berlin, Germany
- Zentrum für Psychosoziale Medizin, Klinikum Itzehoe, Germany
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26
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Jacobsson P, Hopwood CJ, Söderpalm B, Nilsson T. Adult ADHD and emerging models of maladaptive personality: a meta-analytic review. BMC Psychiatry 2021; 21:282. [PMID: 34074265 PMCID: PMC8170979 DOI: 10.1186/s12888-021-03284-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/13/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND ADHD is a highly consequential disorder that is estimated to affect 2.5% of the adult population. Emerging models of psychopathology posit that disorders like ADHD can be usefully situated within general models of individual differences in personality, such as those recently implemented in the DSM and ICD for the diagnosis of personality disorder. Previous research and systematic reviews have linked adult ADHD to the personality traits Conscientious Inhibition and Negative Emotionality. However, there have been some inconsistencies in the literature and research embedding ADHD-personality connections in the DSM-5 and ICD-11 personality disorder models has been limited. The goal of this paper was to systematically review associations between adult ADHD and personality traits, organized within a maladaptive five factor framework. METHOD A comprehensive literature search yielded 13 papers whose effects were meta-analyzed. RESULTS Results supported associations between ADHD and low Conscientious Inhibition and high Negative Emotionality. However, interesting patterns of variability were observed, potentially related to issues such as instrumentation and facet variation. CONCLUSION Results support the clinical application of personality assessment for suggesting risk for ADHD symptoms, and point to important directions for further research.
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Affiliation(s)
- Peter Jacobsson
- The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden. .,Psychiatry Halland, Region Halland, Sweden.
| | - Christopher J. Hopwood
- Psychiatry Halland, Region Halland, Sweden ,grid.27860.3b0000 0004 1936 9684University of California, Davis, USA
| | - Bo Söderpalm
- grid.8761.80000 0000 9919 9582The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Thomas Nilsson
- Psychiatry Halland, Region Halland, Sweden ,grid.8761.80000 0000 9919 9582Department of Forensic Psychiatry, National Board of Forensic Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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27
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Clark LA. Livesley's lament on classifying personality pathology: A commentary. Personal Ment Health 2021; 15:26-31. [PMID: 33336513 DOI: 10.1002/pmh.1501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 11/21/2020] [Accepted: 11/23/2020] [Indexed: 01/16/2023]
Abstract
This commentary on Livesley's paper in this special issue on International Classification of Diseases (ICD)-11's personality disorder (PD) section addresses each of four issues that Livesley claims are impeding progress towards an evidence-based system for the classification of personality pathology. I focus my commentary on the third issue, but also comment briefly on the others. Regarding, first, the complexity of personality pathology and, second, problematic assumptions about the nature of personality pathology, I contend that Livesley's comments are accurate, but omit that the fundamental impediment is the refusal of the Diagnostic and Statistical Manual of Mental Disorders (DSM) establishment to allow the official classification to reflect the reality of personality pathology that he describes, in contrast to its acceptance in the ICD-11. In response to Livesley's third claim that a viable alternative to categorical diagnosis is not available, I take issue with various aspects of his assertions and develop arguments that the ICD-11 PD model provides a useful, although admittedly imperfect, system. Finally, I agree with Livesley that the revision processes for official classifications are conservative and open to non-scientific influences, but maintain that whereas the Diagnostic and Statistical Manual of Mental Disorders establishment held fast to the status quo, the ICD-11 PD Working Group made considerable progress towards a valid PD diagnostic system. © 2020 John Wiley & Sons, Ltd.
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Affiliation(s)
- Lee Anna Clark
- Department of Psychology, University of Notre Dame, Notre Dame, Indiana, USA
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28
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DSM-5 personality traits and cognitive risks for depression, anxiety, and obsessive-compulsive symptoms. PERSONALITY AND INDIVIDUAL DIFFERENCES 2021. [DOI: 10.1016/j.paid.2020.110041] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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29
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Zettl M, Akin Z, Back S, Taubner S, Goth K, Zehetmair C, Nikendei C, Bertsch K. Identity Development and Maladaptive Personality Traits in Young Refugees and First- and Second-Generation Migrants. Front Psychiatry 2021; 12:798152. [PMID: 35126207 PMCID: PMC8813733 DOI: 10.3389/fpsyt.2021.798152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/21/2021] [Indexed: 11/13/2022] Open
Abstract
Refugees are often exposed to a variety of stressors and traumatic events, posing a significant risk for the development of mental disorders. Young refugees may be particularly at risk because adverse life events affect identity formation, a developmental task that is typically expected in adolescence and emerging adulthood. Trauma and cultural changes may alter identity development, potentially leading to identity diffusion, a core concept of personality disorders. However, previous research on personality pathology among refugees is scarce. In this study, we examine identity development and maladaptive personality traits in young refugees and migrants. Refugees from 22 countries of origin were recruited in a German reception center (n = 120) and a group of adults with a migration background in first- or second generation was obtained via web-based recruitment (n = 281). Identity development was measured using the Assessment of Identity Development in Adolescence - Short Form. Maladaptive personality traits were assessed with the Personality Inventory for DSM-5-Brief Form. Group differences between refugees and migrants regarding identity development and trait expression were investigated using t-tests. The relationship between the two measures and their corresponding subscales was examined by means of correlation analyses. Refugees reported significantly higher levels of identity diffusion, negative affectivity, detachment, antagonism, and disinhibition compared to migrants. No significant differences were found for psychoticism. Correlation analyses revealed low to moderate positive associations between identity diffusion and maladaptive trait expression. Possible implications for early phase of resettlement, preventive psychiatric care and further research questions are discussed.
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Affiliation(s)
- Max Zettl
- Center for Psychosocial Medicine, Institute for Psychosocial Prevention, Medical Faculty, University Hospital Heidelberg, Heidelberg, Germany
| | - Zeynep Akin
- Department of Psychology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Sarah Back
- Department of Psychology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Svenja Taubner
- Center for Psychosocial Medicine, Institute for Psychosocial Prevention, Medical Faculty, University Hospital Heidelberg, Heidelberg, Germany
| | - Kirstin Goth
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Clinics (UPK), Basel, Switzerland
| | - Catharina Zehetmair
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Katja Bertsch
- Department of Psychology, Ludwig-Maximilians-University Munich, Munich, Germany.,Department of General Psychiatry, Medical Faculty, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
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30
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Bastiaens T, Smits D, Claes L. Case Report: Pathological Personality Traits Through the Lens of the ICD-11 Trait Qualifiers and the DSM-5 Section III Trait Model: Two Patients Illustrating the Clinical Utility of a Combined View. Front Psychiatry 2021; 12:627119. [PMID: 33767640 PMCID: PMC7985332 DOI: 10.3389/fpsyt.2021.627119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 02/11/2021] [Indexed: 11/17/2022] Open
Abstract
We report on two individuals presenting for treatment as part of everyday clinical practice, comparing their pathological personality traits through the lens of the ICD-11 trait qualifiers and the DSM-5 Section III personality trait model. We compare higher order pathological personality domains and lower order pathological personality trait facets of patient M (diagnosed with borderline personality traits according to DSM-5 Section II), and patient L (diagnosed with obsessive-compulsive personality traits according to DSM-5 Section II) with normative data and with each other. Findings highlight the clinical utility of a ICD-11/DSM-5 combined view, including: (1) the Disinhibition/Anankastia personality domain distinction as advocated in the ICD-11 model, (2) the Psychoticism personality domain as conceptualized in the DSM-5 Section III personality trait model, as well as (3) the use of lower order personality trait facets within each higher order personality domain.
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Affiliation(s)
- Tim Bastiaens
- Department of Diagnostics, University Psychiatric Center KU Leuven, Kortenberg, Belgium
| | - Dirk Smits
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.,Department of Research and Project Management, Odisee University College, Brussels, Belgium
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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31
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How does level of personality functioning inform clinical management and treatment? Implications for ICD-11 classification of personality disorder severity. Curr Opin Psychiatry 2021; 34:54-63. [PMID: 33252430 DOI: 10.1097/yco.0000000000000658] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW The International Classification of Diseases, 11th Edition (ICD-11) classifies personality disturbance according to levels of severity. This article reviews the literature on levels of personality functioning in relation to clinical management and treatment, and proposes how these findings apply to the ICD-11 classification of personality disorders. RECENT FINDINGS Findings were primarily derived from studies using the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) Level of Personality Functioning Scale (LPFS), Kernberg's Level of Personality Organization, and the general P-factor of personality disorder. Severity of personality dysfunction is related to treatment outcome, risk of dropout, therapeutic alliance, readiness for treatment, risk of harm to self or others, risk of dissociation and psychotic-like breaks, coherence in narrative identity, reflective functioning, and epistemic trust. SUMMARY The overall level of personality disorder severity indicates risk of negative outcomes and may be used as decision tool for 'personalized medicine' and required treatment intensity (e.g., strength of alliance and the need for establishing epistemic trust). Beyond the ICD-11 guidelines for determining personality disorder severity, these implications also apply to practitioners using comparable frameworks such as the DSM-5 LPFS and Kernberg's Level of Personality Organization. Future research should focus on the interaction of severity with trait qualifiers in relation to clinical management.
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32
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Kerber A, Schultze M, Müller S, Rühling RM, Wright AGC, Spitzer C, Krueger RF, Knaevelsrud C, Zimmermann J. Development of a Short and ICD-11 Compatible Measure for DSM-5 Maladaptive Personality Traits Using Ant Colony Optimization Algorithms. Assessment 2020; 29:467-487. [PMID: 33371717 PMCID: PMC8866743 DOI: 10.1177/1073191120971848] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
While Diagnostic and Statistical Manual of Mental Disorders–Fifth
edition (DSM-5) Section III and ICD-11
(International Classification of Diseases 11th–Revision) both allow for
dimensional assessment of personality pathology, the models differ in the
definition of maladaptive traits. In this study, we pursued the goal of
developing a short and reliable assessment for maladaptive traits, which is
compatible with both models, using the item pool of the Personality Inventory
for DSM-5 (PID-5). To this aim, we applied ant colony
optimization algorithms in English- and German-speaking samples comprising a
total N of 2,927. This procedure yielded a 34-item measure with a hierarchical
latent structure including six maladaptive trait domains and 17 trait facets,
the “Personality Inventory for DSM-5, Brief Form Plus”
(PID5BF+). While latent structure, reliability, and criterion validity were
ascertained in the original and in two separate validation samples
(n = 849, n = 493) and the measure was
able to discriminate personality disorders from other diagnoses in a clinical
subsample, results suggest further modifications for capturing ICD-11
Anankastia.
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33
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Sauer-Zavala S, Southward MW, Semcho SA. Integrating and differentiating personality and psychopathology in cognitive behavioral therapy. J Pers 2020; 90:89-102. [PMID: 33070346 DOI: 10.1111/jopy.12602] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/09/2020] [Indexed: 12/23/2022]
Abstract
A large body of literature supports the strong association between personality features and psychopathology. This research has, however, had little influence on day-to-day therapeutic practice, particularly in cognitive behavioral approaches that have traditionally focused on addressing the symptoms of categorically defined diagnoses. Indeed, there are few CBT protocols aimed at altering the personality features. Recently, however, the CBT literature has displayed an increased focus on identifying alternative higher-order, dimensional mechanisms that may underscore the development and maintenance of broad classes of psychopathology (e.g., aversive reactivity to emotions, reward sensitivity, and performance expectancies). There is ample evidence linking these processes to DSM disorder severity; however, they may also represent a functional link between the personality domains and the disorder symptoms organized beneath them. The functional mechanisms through which an individual's personality confers risk for psychopathology may be naturally amenable to cognitive behavioral elements, and targeting these processes in treatment has the potential to address both disorder symptoms and underlying personality vulnerabilities. Thus, the identification of intermediate functional mechanisms may help bridge the gap between personality science and clinical practice.
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Affiliation(s)
| | | | - Stephen A Semcho
- Department of Psychology, University of Kentucky, Lexington, KY, USA
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34
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Yalch MM, Rickman SRM, Good EW, Levendosky AA. Influence of personality traits on college women's appraisals of intimate partner violence. J Trauma Dissociation 2020; 21:574-584. [PMID: 32369426 DOI: 10.1080/15299732.2020.1760411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Intimate partner violence (IPV) is a common traumatic stressor for young adult women and results in a number of problems for those who experience it. The appraisals women make of IPV influence the degree of distress they experience in the aftermath of IPV. Research suggests that personality traits may influence IPV appraisals, although there are relatively few studies of this. In this study, we examine the association between Five Factor Model personality traits (i.e., Agreeableness, Conscientiousness, Extraversion, Neuroticism, and Openness) and appraisals of IPV in a sample of young adult women in college who experienced IPV (N = 241) using a Bayesian approach to multiple regression. Results suggest that Agreeableness, Extraversion, and Neuroticism predicted different styles of appraisals over and above the effect of IPV severity. Study findings clarify previous research on the role of personality traits in the response to IPV and suggest directions for future research.
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Affiliation(s)
- Matthew M Yalch
- Department of Psychology, Palo Alto University , Palo Alto, California, USA
| | - Sloane R M Rickman
- Department of Psychology, Palo Alto University , Palo Alto, California, USA
| | - Evan W Good
- Department of Psychology, Michigan State University , East Lansing, USA
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35
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Krueger RF, Hobbs KA. An Overview of the DSM-5 Alternative Model of Personality Disorders. Psychopathology 2020; 53:126-132. [PMID: 32645701 PMCID: PMC7529724 DOI: 10.1159/000508538] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 05/06/2020] [Indexed: 12/15/2022]
Abstract
Authoritative classification systems for psychopathology such as the DSM and ICD are shifting toward more dimensional approaches in the field of personality disorders (PDs). In this paper, we provide a brief overview of the dimensionally oriented DSM-5 alternative model of PDs (AMPD). Since its publication in 2013, the AMPD has inspired a substantial number of studies, underlining its generative influence on the field. Generally speaking, this literature illustrates both the reliability and validity of the constructs delineated in the AMPD. The literature also illustrates empirical challenges to the conceptual clarity of the AMPD, such as evidence of substantial correlations between indices of personality functioning (criterion A in the AMPD) and maladaptive personality traits (criterion B in the AMPD). Key future directions pertain to linking the AMPD literature with applied efforts to improve the lives of persons who suffer from PDs, and surmounting challenges germane to the evolution of the DSM itself.
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Affiliation(s)
- Robert F Krueger
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota, USA,
| | - Kelsey A Hobbs
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota, USA
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36
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Stefana A, Bulgari V, Youngstrom EA, Dakanalis A, Bordin C, Hopwood CJ. Patient personality and psychotherapist reactions in individual psychotherapy setting: a systematic review. Clin Psychol Psychother 2020; 27:697-713. [PMID: 32251550 DOI: 10.1002/cpp.2455] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/17/2020] [Accepted: 04/01/2020] [Indexed: 11/06/2022]
Abstract
Despite the importance of psychotherapists' subjective experiencse working with patients with mental issues, little is known about the relationship between therapists' emotional reactions and patients' personality problems. The present study is a systematic review of quantitative research on the association between patients' personality pathology and psychotherapists' emotional, cognitive and behavioural reactions in individual psychotherapy setting. A systematic database search (from January 1980 to August 2019) supplemented by manual searches of references and citations identified seven relevant studies. Significant and consistent relationships were found between therapist reactions and specific personality traits or disorders. In general, odd and eccentric patients tend to evoke feelings of distance and disconnection; emotionally dysregulated patients tend to evoke anxiety and incompetence, and anxious and withdrawn patients tend to evoke sympathy and concern. However, the relatively small sample of studies and methodological inconsistencies across studies limit firm conclusions and suggest the need for more systematic research. Findings from this review indicate that patients who share the same personality disorder or symptoms tend to evoke specific and similar cognitive, emotional and behavioural reactions in their therapists. This suggests that therapists overall reactions toward patients may be source of valuable diagnostic information.
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Affiliation(s)
- Alberto Stefana
- Department of Clinical and Experimental Sciences, University of Brescia. Viale Europa, Brescia, Italy
| | - Viola Bulgari
- Area di Psichiatria, IRCCS Centro S Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Eric A Youngstrom
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
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Papamalis FE, Kalyva E, Teare MD, Meier PS. The role of personality functioning in drug misuse treatment engagement. Addiction 2020; 115:726-739. [PMID: 31779050 DOI: 10.1111/add.14872] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/11/2019] [Accepted: 10/23/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND AIM Personality functioning is predictive of drug misuse and relapse, yet little is known about the role of personality in engagement with the treatment process. This study aimed to estimate the extent to which broad- and facet-level characteristic adaptations contribute to or hinder treatment engagement, while controlling for psychosocial indicators. DESIGN Multi-site cross-sectional survey. SETTING In-patient treatment units covering 80% of residential treatment entries in Greece. PARTICIPANTS A total of 338 service users, 287 (84.9%) male, 51 (15.1%) female, average age 33.4 years. MEASUREMENTS Expressions of personality functioning (characteristic adaptations) were assessed using the Severity Indices of Personality Problems (SIPP-118). Treatment engagement was measured using the Client Evaluation of Self and Treatment, in-patient version (CEST). FINDINGS Dysfunctional levels of relational capacities predicted counselling rapport [β = 1.50, 95% confidence interval (CI) = 0.326-2.69, P = 0.013], treatment participation (β = 2.09, 95% CI = 1.15-3.11, P < 0.001) and treatment satisfaction (β = 1.65, 95% CI = 0.735-2.57, P < 0.001). Counselling rapport was also predicted by dysfunctional levels in self-control (β = 1.78, 95% CI = 0.899-2.67, P < 0.001), self-reflective functioning at the facet-level (β = 2.24, 95% CI = 1.01-3.46, P < 0.001) and aggression regulation (β = 1.43, 95% CI = 0.438-2.42, P = 0.005). Dysfunctional levels on social concordance (β = -1.90, 95% CI = -2.87 to -0.941, P = 0.001), emotional regulation (β = 1.90, 95% CI = 0.87-2.92, P < 0.001) and intimacy (β = 2.04, 95% CI = 1.31-3.05, P < 0.001) were significant predictors of treatment participation. Treatment readiness and desire for help predicted treatment engagement. CONCLUSIONS In people attending substance use treatment services, maladaptive interpersonal patterns and relational intimacy, emotional dysregulation and impulse control may be associated with low levels of counselling rapport and treatment participation. Low frustration tolerance and aggressive impulses also appeared to predict low participation.
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Affiliation(s)
| | - Efrosini Kalyva
- Child and Adolescent Research and Development Centre, Thessaloniki, Greece
| | - M Dawn Teare
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Petra S Meier
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Mullins-Sweatt SN, Hopwood CJ, Chmielewski M, Meyer NA, Min J, Helle AC, Walgren MD. Treatment of personality pathology through the lens of the hierarchical taxonomy of psychopathology: Developing a research agenda. Personal Ment Health 2020; 14:123-141. [PMID: 31364820 PMCID: PMC7053295 DOI: 10.1002/pmh.1464] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 06/24/2019] [Accepted: 06/28/2019] [Indexed: 12/19/2022]
Abstract
Despite the emphasis on evidence-based treatment for psychological disorders, to date, there has been limited research examining treatment for nine of the 10 categorical personality disorders in DSM-5 Section 2. This is perhaps not surprising given the complex heterogeneity and co-morbidity within personality pathology. The hierarchical taxonomy of psychopathology (HiTOP) was proposed to address limitations within the traditional categorical model of the diagnostic system. Within this system are five spectra: detachment, antagonistic externalizing, disinhibited externalizing, thought disorder and internalizing. These foundational personality traits potentially have direct and specific treatment implications. The purpose of this paper is to highlight potential psychotherapeutic and pharmacological treatment recommendations within the personality spectra. Additionally, we outline the advantages of considering the personality science found within dimensional models of psychopathology in clinical assessment and intervention to aid in treatment planning. © 2019 John Wiley & Sons, Ltd.
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Affiliation(s)
| | | | | | - Neil A Meyer
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Jiwon Min
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Ashley C Helle
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - Maggie D Walgren
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
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39
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Widiger TA, McCabe GA. The Alternative Model of Personality Disorders (AMPD) from the Perspective of the Five-Factor Model. Psychopathology 2020; 53:149-156. [PMID: 32526758 DOI: 10.1159/000507378] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/19/2020] [Indexed: 11/19/2022]
Abstract
The fifth edition of the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders(DSM-5; American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington: American Psychiatric Association; 2013) includes an Alternative Model of Personality Disorders (AMPD). The AMPD includes two components: the Criterion A level of personality functioning (i.e., impairments or deficits in the sense of self and interpersonal relatedness) and the Criterion B five-domain maladaptive trait model. The purpose of the current paper is to discuss the AMPD from the perspective of the Five-Factor Model (FFM) of general personality structure. The conclusion of this review is that both the Criterion A self-other deficits and the Criterion B traits can be understood as maladaptive variants of the FFM.
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Affiliation(s)
- Thomas A Widiger
- Department of Psychology, University of Kentucky, Lexington, Kentucky, USA,
| | - Gillian A McCabe
- Department of Psychology, University of Kentucky, Lexington, Kentucky, USA
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40
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Pincus AL, Cain NM, Halberstadt AL. Importance of Self and Other in Defining Personality Pathology. Psychopathology 2020; 53:133-140. [PMID: 32114579 DOI: 10.1159/000506313] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 01/31/2020] [Indexed: 11/19/2022]
Abstract
Criteria A of the DSM-5 Alternative Model for Personality Disorders (AMPD) defines personality pathology in terms of impairments in "self" (identity, self-direction) and "interpersonal" (empathy, intimacy) functioning. Articulated as a set of dynamic regulatory and relational processes that are stratified in the Level of Personality Functioning Scale, these impairments involve how individuals think and feel about themselves and others and how they relate to others. Defining personality pathology in terms of regulatory and relational processes involving self and other, and distinguishing severity of personality pathology from individual differences in its expression (Criteria B), offers the AMPD several advantages. First, it distinguishes the nature and severity of personality pathology from other forms of psychopathology. Second, it allows the AMPD to integrate personality structure and personality processes. Third, it is highly suitable for synthesis with the Contemporary Integrative Interpersonal Theory of personality. Finally, beyond the interpersonal perspective, it facilitates even broader theoretical and treatment integration.
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Affiliation(s)
- Aaron L Pincus
- Department of Psychology, Pennsylvania State University, University Park, Pennsylvania, USA,
| | - Nicole M Cain
- Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, New Jersey, USA
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41
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Rodriguez-Seijas C, Ruggero C, Eaton NR, Krueger RF. The DSM-5 Alternative Model for Personality Disorders and Clinical Treatment: a Review. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s40501-019-00187-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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42
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Zimmermann J, Kerber A, Rek K, Hopwood CJ, Krueger RF. A Brief but Comprehensive Review of Research on the Alternative DSM-5 Model for Personality Disorders. Curr Psychiatry Rep 2019; 21:92. [PMID: 31410586 DOI: 10.1007/s11920-019-1079-z] [Citation(s) in RCA: 147] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Both the Alternative DSM-5 Model for Personality Disorders (AMPD) and the chapter on personality disorders (PD) in the recent version of ICD-11 embody a shift from a categorical to a dimensional paradigm for the classification of PD. We describe these new models, summarize available measures, and provide a comprehensive review of research on the AMPD. RECENT FINDINGS A total of 237 publications on severity (criterion A) and maladaptive traits (criterion B) of the AMPD indicate (a) acceptable interrater reliability, (b) largely consistent latent structures, (c) substantial convergence with a range of theoretically and clinically relevant external measures, and (d) some evidence for incremental validity when controlling for categorical PD diagnoses. However, measures of criterion A and B are highly correlated, which poses conceptual challenges. The AMPD has stimulated extensive research with promising findings. We highlight open questions and provide recommendations for future research.
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Affiliation(s)
- Johannes Zimmermann
- Department of Psychology, University of Kassel, Holländische Str. 36-38, 34127, Kassel, Germany.
| | | | - Katharina Rek
- Max-Planck-Institut für Psychiatrie, Munich, Germany
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43
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Steen A, Berghuis H, Braam AW. Lack of meaning, purpose and direction in life in personality disorder: A comparative quantitative approach using Livesley's General Assessment of Personality Disorder. Personal Ment Health 2019; 13:144-154. [PMID: 31050190 DOI: 10.1002/pmh.1446] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 02/22/2019] [Accepted: 03/24/2019] [Indexed: 12/21/2022]
Abstract
Meaning in life is a motivational force and an existential theme for many people. The concept of meaning comprises purpose, comprehension and mattering. According to the Section III model of personality disorder (DSM-5), lack of meaning, purpose and direction in life is part of personality dysfunction. The present study aimed to determine the association between personality disorder (PD), personality dysfunction and 'lack of meaning, purpose and direction' as a distinct facet of personality dysfunction, using Livesley's self-report questionnaire-the General Assessment of Personality Disorder. This comparative quantitative study showed significant differences in lack of meaning, purpose and direction between a group of patients with PD (n = 126, PD with depression n = 51 and PD without depression n = 75), a group of non-PD patients (n = 76, with depression n = 27 and without depression n = 49) and a control group (n = 444). The PD groups had similar scores as the non-PD patients with depression. Lack of meaning was significantly associated with 'difficulty setting and attaining goals' in all groups, with 'lack of affiliative relationships' in the PD groups and 'sense of inner emptiness' in the PD group without depression and in controls. © 2019 John Wiley & Sons, Ltd.
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Affiliation(s)
- A Steen
- Centre for Psychotherapy, GGz Centraal, Zwaluw & Enk, Ermelo, The Netherlands.,Department of Human Chaplaincy Studies for a Plural Society, University of Humanistic Studies, Utrecht, The Netherlands
| | - H Berghuis
- Centre for Psychotherapy, Pro Persona, Lunteren, The Netherlands
| | - A W Braam
- Department of Human Chaplaincy Studies for a Plural Society, University of Humanistic Studies, Utrecht, The Netherlands.,Department of Emergency Psychiatry and Department of Residency Training, Altrecht Mental Health Care, Utrecht, The Netherlands
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44
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Weekers LC, Hutsebaut J, Kamphuis JH. The Level of Personality Functioning Scale-Brief Form 2.0: Update of a brief instrument for assessing level of personality functioning. Personal Ment Health 2019; 13:3-14. [PMID: 30230242 DOI: 10.1002/pmh.1434] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 08/13/2018] [Accepted: 08/15/2018] [Indexed: 01/30/2023]
Abstract
Section III of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) introduced the alternative model of personality disorders that includes assessing levels of personality functioning. Here, we describe the development, preliminary psychometric evaluation and sensitivity to change of a revised brief self-report questionnaire, the Level of Personality Functioning Scale-Brief Form 2.0 (LPFS-BF 2.0). Patients (N = 201) referred to a specialized centre for the assessment and treatment of personality disorders completed the LPFS-BF 2.0, the Brief Symptom Inventory and the Severity Indices of Personality Problems Short Form and were administered the Structured Clinical Interview for DSM-IV Axis I and Axis II Disorders. Internal structure and aspects of construct validity were examined. A subsample of 39 patients also completed the questionnaires after 3 months of inpatient treatment. Confirmatory factor analyses demonstrated better fit for a two-factor solution (interpretable as self-functioning and interpersonal functioning) than for a unidimensional model, though acceptable model fit was evident only after two post hoc modifications. The LPFS-BF 2.0 demonstrated satisfactory internal consistency and promising construct validity. Sensitivity to change after 3 months of treatment was high. The LPFS-BF 2.0 constitutes a short, user-friendly instrument that provides a quick impression of the severity of personality pathology. © 2018 John Wiley & Sons, Ltd.
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Affiliation(s)
- Laura C Weekers
- Viersprong Institute for Studies on Personality Disorders, Halsteren, The Netherlands
| | - Joost Hutsebaut
- Viersprong Institute for Studies on Personality Disorders, Halsteren, The Netherlands
| | - Jan H Kamphuis
- Viersprong Institute for Studies on Personality Disorders, Halsteren, The Netherlands.,Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
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Abstract
PURPOSE OF REVIEW Schema therapy conceptualizes personality disorders in terms of modes and underlying schemas. This article reviews the literature on schema therapy conceptualization of personality disorder functioning and traits, and proposes how these findings apply to novel personality disorder classification in ICD-11 and the DSM-5 Alternative Model of Personality Disorders (AMPD). RECENT FINDINGS Maladaptive schemas and modes are generally associated with personality dysfunction and traits in conceptually coherent ways. The healthy adult mode, a transdiagnostic core concept in schema therapy, corresponds to the ICD-11 and DSM-5-AMPD features of core personality functioning. Modes and underlying schemas substantially overlap with specific ICD-11 and DSM-5-AMPD traits, which denote individual themes and styles of personality dysfunction. SUMMARY The dimensional personality disorder framework in ICD-11 and DSM-5-AMPD is largely compatible with the schema therapy model. The ICD-11 and DSM-5-AMPD provide a scientifically derived and theory-free framework for all practitioners, which may be connected to clinical theory of schema therapy in a coherent manner. Level of personality functioning can be conceptualized as healthy adult functioning (e.g. sense of identity, self-worth, emotion regulation, intimacy, and fulfillment), which inform intensity of treatment. Trait qualifiers can be conceptualized by associated modes (e.g., compliant surrender) and underlying schemas (e.g. abandonment), which inform focus and style of treatment.
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46
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Herbold W. Strukturbezogene Behandlungspfade bei Persönlichkeitsstörungen. PSYCHOTHERAPEUT 2018. [DOI: 10.1007/s00278-018-0325-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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47
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