Current issues in the assessment of personality disorders

Studies of personality disorders: past, present, and future in recognition of ISSPD's 25th anniversary

The past 25 years have shown major advances in the studies of personality disorders. This collaborative article by the presidents, past and present, of ISSPD reflects on the progress within several significant areas of studies, i.e., assessment, neuroscience, treatment, prevention, advocacy, and mental health policy.

Five-factor model personality disorder prototypes in a community sample: self- and informant-reports predicting interview-based DSM diagnoses

The need for an empirically validated, dimensional system of personality disorders is becoming increasingly apparent. While a number of systems have been investigated in this regard, the five-factor model of personality has demonstrated the ability to adequately capture personality pathology. In particular, the personality disorder prototypes developed by Lynam and Widiger (2001) have been tested in a number of samples. The goal of the present study is to extend this literature by validating the prototypes in a large, representative community sample of later middle-aged adults using both self and informant reports. We found that the prototypes largely work well in this age group. Schizoid, Borderline, Histrionic, Narcissistic, and Avoidant personality disorders demonstrate good convergent validity, with a particularly strong pattern of discriminant validity for the latter four. Informant-reported prototypes show similar patterns to self reports for all analyses. This demonstrates that informants are not succumbing to halo representations of the participants, but are rather describing participants in nuanced ways. It is important that informant reports add significant predictive validity for Schizoid, Antisocial, Borderline, Histrionic, and Narcissistic personality disorders. Implications of our results and directions for future research are discussed.

Relationship between personality disorder symptoms and temperament in the young male general population of South Korea

The aim of the present study was to identify the characteristics of temperament and character in personality disorder symptoms in the young male general population. A total of 585 male subjects from the same community were included in the study (mean age, 19.06 +/- 0.26 years). There was no difference in socioeconomic and educational background. Subjects completed the Personality Disorder Questionnaire-IV+ (PDQ-IV+) and Temperament and Character Inventory (TCI). There were unique correlations between each personality disorder symptom and four temperament profiles. When classification was done through three cluster symptoms by DSM-IV, cluster A symptoms were most strongly associated with low reward dependence (r = -0.46), cluster B with high novelty seeking (r = 0.33), and cluster C with high harm avoidance (r = 0.47). The character dimension, self-directedness was the most powerful predictor of the presence of any personality disorders. In homogenous male general population, unique combinations were found between temperament and each personality disorders. Although the subjects were relatively young and therefore their characters had not yet fully matured, character played an important role in the presence of personality disorder. Temperament can be used to differentiate the personality symptoms and characters used to predict the presence of personality disorder.

Temperament and character in patients with borderline personality disorder taking gender and comorbidity into account

This study examined correlations of borderline personality disorder (BPD) symptoms with scales from Cloninger's psychobiological model taking gender and psychiatric comorbidity into consideration. Inpatients with BPD (n = 202) were compared to several control groups including psychiatrically healthy persons (n = 327), subjects with affective disorders (n = 46), alcohol use disorders (n = 47), cluster C personality disorders (n = 23) and antisocial personality disorder (n = 25). The results indicate that only males with BPD presented an 'explosive' temperament suggested by Cloninger, with simultaneously high levels of novelty seeking and harm avoidance. In contrast, women with BPD were characterized by high levels of harm avoidance, but not novelty seeking. Regarding temperament and character dimensions our analyses suggest that patients with BPD could be characterized, in particular, by a combination of high harm avoidance and very low self-directedness. The specific temperament configuration of BPD postulated by Cloninger's psychobiological model could only partially be supported. The results provide support for the importance of controlling for gender effects when investigating the applicability of dimensional models with respect to personality disorders.

Social workers' ratings of comorbid personality disorders in substance abusers

Clinical diagnoses of personality disorders have been discredited in the literature. However, the artificial dichotomization of dimensions, along with the constraint of having to select only one or a few diagnoses, may have limited the ability of clinical judgment to converge with other clinician's judgments, or with relevant external criteria. Assessment with a dimensional approach to personality disorders may provide improved agreement. In this study, substance abusers were rated by two different staff members involved in their treatment. Inter-rater agreement was moderately high for paranoid, schizotypal, antisocial, and borderline personality disorder, and high-moderate discriminant validity was found for all personality disorders except schizoid and obsessive-compulsive personality disorder.