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Yun S, Jo SH, Jeon HJ, Kim HG, Cheon EJ, Koo BH. The Complexity of Borderline Personality Disorder: Network Analysis of Personality Factors and Defense Styles in the Context of Borderline Personality Organization. Psychiatry Investig 2024; 21:672-679. [PMID: 38960445 PMCID: PMC11222081 DOI: 10.30773/pi.2024.0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/05/2024] [Accepted: 04/16/2024] [Indexed: 07/05/2024] Open
Abstract
OBJECTIVE Borderline personality disorder (BPD) is known to share characteristics with a variety of personality disorders (PDs) and exhibits diverse patterns of defense mechanisms. To enhance our understanding of BPD, it's crucial to shift our focus from traditional categorical diagnostics to the dimensional traits shared with other PDs, as the borderline personality organization (BPO) model suggests. This approach illuminates the nuanced spectrum of BPD characteristics, offering deeper insights into its complexity. While studies have investigated the comorbidity of BPD with other PDs, research exploring the relationship between various personality factors and defense mechanisms within BPD itself has been scarce. The present study was undertaken to investigate the complex interrelationships between various personality factors and defense styles in individuals diagnosed with BPD. METHODS Using a network analysis approach, data from 227 patients diagnosed with BPD were examined using the Defense Style Questionnaire and Personality Disorder Questionnaire-4+ for assessment. RESULTS Intricate connections were observed between personality factors and defense styles. Significant associations were identified between various personality factors and defense styles, with immature defense styles, such as maladaptive and image-distorting being particularly prominent in BPD in the centrality analysis. The maladaptive defense style had the highest expected influence centrality. Furthermore, the schizotypal, dependent, and narcissistic personality factors demonstrated relatively high centrality within the network. CONCLUSION Network analysis can effectively delineate the complexity of various PDs and defense styles. These findings are expected to facilitate a deeper understanding of why BPD exhibits various levels of organization and presents with heterogeneous characteristics, consistent with the perspectives proposed by the BPO.
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Affiliation(s)
- Seokho Yun
- Department of Psychiatry, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - So-Hye Jo
- Department of Psychiatry, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Hye-Jin Jeon
- Department of Psychiatry, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Hye-Geum Kim
- Department of Psychiatry, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Eun-Jin Cheon
- Department of Psychiatry, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Bon-Hoon Koo
- Department of Psychiatry, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Republic of Korea
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2
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Wibbelink CJM, Venhuizen ASSM, Grasman RPPP, Bachrach N, van den Hengel C, Hudepohl S, Kunst L, de Lange H, Louter MA, Matthijssen SJMA, Schaling A, Walhout S, Wichers KR, Arntz A. Group schema therapy for cluster-C personality disorders: A multicentre open pilot study. Clin Psychol Psychother 2023; 30:1279-1302. [PMID: 37691135 DOI: 10.1002/cpp.2903] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Group schema therapy (GST) is increasingly popular as a treatment for personality disorders (PDs), including Cluster-C PDs. Individual ST has proven to be effective for Cluster-C PD patients, while the evidence for GST is limited. This study aimed to investigate the effectiveness of GST for Cluster-C PD. Moreover, differences between the specific Cluster-C PDs (avoidant PD, dependent PD and obsessive-compulsive PD) were explored. METHODS A multicentre open trial was conducted, including 137 patients with a Cluster-C PD (avoidant PD: n = 107, dependent PD: n = 11 and obsessive-compulsive PD: n = 19). Patients received 30 weekly GST sessions with a maximum of 180 min of individual ST and five optional monthly booster sessions. Outcome measures including Cluster-C PD severity, general psychopathological symptoms, quality of life, functional impairment, happiness, PD-related beliefs, self-esteem, self-ideal discrepancy, schemas and schema modes were assessed at baseline until 2-year follow-up with semi-structured interviews and self-report measures. Change over time and differences between the specific Cluster-C PDs were analysed with mixed regression analyses. RESULTS The outcome measures showed significant improvements for all Cluster-C PDs, with medium to large effect sizes after 2 years. A treatment dropout rate of 11.7% was found. There were some indications for differences between the Cluster-C PDs in severity at baseline, change trajectories and effectiveness of GST. CONCLUSIONS This study demonstrated that GST is a promising treatment for Cluster-C PDs. The following step is a randomized controlled trial to further document the (cost-)effectiveness of GST.
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Affiliation(s)
- Carlijn J M Wibbelink
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Raoul P P P Grasman
- Department of Psychological Methods, University of Amsterdam, Amsterdam, The Netherlands
| | - Nathan Bachrach
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- GGZ Oost Brabant Helmond, Helmond, Netherlands
| | | | | | - Liselotte Kunst
- PsyQ Haarlem, Haarlem, The Netherlands
- NPI, Amsterdam, The Netherlands
| | | | - Mark A Louter
- Viersprong Institute for Studies on Personality Disorders, Rotterdam, The Netherlands
| | | | | | | | | | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
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3
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Ding X, Pan Y, Chen Y, Li Y. Association between dependency and long sleep duration among elderly people: a community-based study. Psychogeriatrics 2023; 23:789-799. [PMID: 37332148 DOI: 10.1111/psyg.12998] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/22/2023] [Accepted: 06/06/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Long sleep duration is a common sleep disorder among elderly people. Dependency increases with increasing age. This study aimed to assess the association between dependency and long sleep duration among elderly people. METHODS This study is a population-based cross-sectional study. A total of 1152 participants aged ≥ 60 years were selected from 26 locations in China by a complex multistage sampling design. Data were collected through face-to-face interviews. Sleep duration was measured using the Pittsburgh Sleep Quality Index. Dependency was assessed using Minnesota Multiphasic Personality Inventory-II. Hierarchical multiple linear regression analysis was used to evaluate the efficacy of sleep-related factors and psychological factors for sleep duration. Analysis of covariance and logistic regression analysis were performed to evaluate the association between the dependency score and sleep duration, and the strength of dependency effect on sleep duration. RESULTS A total of 1120 participants were valid for the analysis. Among them, 15.8% of participants had a dependency score ≥60 points. The results of hierarchical multiple linear regression analysis showed that sleep duration was positively associated with dependency scores. Analysis of covariance indicated a J-shaped association between dependency scores and sleep duration. The results of logistic regression analysis showed dependency was significantly associated with long sleep duration, and the odds ratio was 3.52 (95% CI, 1.87-6.63; P < 0.001). CONCLUSION Dependency was significantly associated with long sleep duration among elderly people. The results suggested that dependent intervention may be a strategy that needs urgent implementation to reduce long sleep duration among elderly people.
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Affiliation(s)
- XiWen Ding
- Department of Social Medicine, School of Public Health, Zhejiang University, Hangzhou, China
| | - YiYang Pan
- Department of Social Medicine, School of Public Health, Zhejiang University, Hangzhou, China
| | - Yuan Chen
- Department of Social Medicine, School of Public Health, Zhejiang University, Hangzhou, China
- Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Ying Li
- Department of Social Medicine, School of Public Health, Zhejiang University, Hangzhou, China
- School of medicine, Zhejiang University, Hangzhou, China
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4
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Patterns of emotional schema endorsement and personality disorder symptoms among outpatient psychotherapy clients. MOTIVATION AND EMOTION 2022. [DOI: 10.1007/s11031-022-10000-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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5
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Leboeuf I, Antoine P. Exploring the processes of connection and disconnection in imagery work in a patient with depression and dependent personality disorder. J Clin Psychol 2022. [DOI: 10.1002/jclp.23464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 11/10/2022] [Accepted: 11/13/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Isabelle Leboeuf
- Université de Lille, CNRS, UMR 9193—SCALAB—Sciences Cognitives et Sciences Affectives Lille France
| | - Pascal Antoine
- Université de Lille, CNRS, UMR 9193—SCALAB—Sciences Cognitives et Sciences Affectives Lille France
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Reis T, Gekker M, Land MGP, Mendlowicz MV, Berger W, Luz MP, Vilete L, Figueira I, Araújo AXG. The growth and development of research on personality disorders: A bibliometric study. Personal Ment Health 2022; 16:290-299. [PMID: 35182026 DOI: 10.1002/pmh.1540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/19/2022] [Accepted: 02/08/2022] [Indexed: 01/31/2023]
Abstract
This study objective was to investigate publication trends on personality disorders (PD) and to identify patterns of historical development. Publication rates were determined using the Results by Year Timeline feature of PubMed. Time series autoregressive integrated moving average models were used to analyse the publication rates for PDs in quinquennial periods beginning in 1980 and ending in 2019 and to predict the number of publications in the 2024-2029 period. More than 300 articles on antisocial and borderline PD are being published each year, and the models suggest an accelerating growth rate. Approximately 100 articles are being published on average every year on schizotypal PD, and the regression model indicates linear growth in the near future. The mean number of publications per year for obsessive-compulsive, narcissistic and avoidant PDs is in the range of 10-30 with the corresponding models indicating linear growth. Fewer than 10 articles are being published each year on dependent, paranoid, histrionic and schizoid PD, whereas dependent PD shows modest growth and paranoid PD rates tended to stability, histrionic and schizoid PD exhibit declining rates. Personality disorders are a group of conditions with diverse etiological, prognostic, therapeutic, legal, research, social and cultural implications that influence publication rates.
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Affiliation(s)
- Taylor Reis
- Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), 71 Venceslau Brás Avenue, Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil
| | - Márcio Gekker
- Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), 71 Venceslau Brás Avenue, Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil
| | - Marcelo Gerardin Poirot Land
- Clinical Medicine Graduate Medical Program I Maternal and Child Health Graduate Program, Universidade Federal do Rio de Janeiro (UFRJ), 225 Rodolpho Paulo Rocco Avenue, building F, suite 5. University City, Fundão Island, Rio de Janeiro, Rio de Janeiro, 21941-905, Brazil
| | - Mauro Vitor Mendlowicz
- Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), 71 Venceslau Brás Avenue, Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil.,Department of Psychiatry and Mental Health, Universidade Federal Fluminense (UFF), 303 Marquês de Paraná Street, second floor, Niteroi, Rio de Janeiro, 24220-000, Brazil
| | - William Berger
- Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), 71 Venceslau Brás Avenue, Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil
| | - Mariana Pires Luz
- Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), 71 Venceslau Brás Avenue, Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil
| | - Liliane Vilete
- Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), 71 Venceslau Brás Avenue, Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil
| | - Ivan Figueira
- Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), 71 Venceslau Brás Avenue, Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil
| | - Alexandre Xavier Gomes Araújo
- Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), 71 Venceslau Brás Avenue, Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil.,Department of Psychiatry and Mental Health, Universidade Federal Fluminense (UFF), 303 Marquês de Paraná Street, second floor, Niteroi, Rio de Janeiro, 24220-000, Brazil
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Li Y, Aierken A, Ding X, Pan Y, Chen Y. Dependency-associated individual, family, community, and social factors from a resilience framework among elderly people. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03670-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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8
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Aierken A, Ding X, Pan Y, Chen Y, Li Y. Association between dependency on community resources and social support among elderly people living in rural areas in China: a cross-sectional study. BMC Geriatr 2022; 22:589. [PMID: 35842579 PMCID: PMC9288718 DOI: 10.1186/s12877-022-03247-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 06/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of dependency personality disorder (DPD) is high among elderly people living in rural areas. This study aims to explore the association between dependency on community resources and social support among elderly individuals living in rural areas. METHODS A cross-sectional study was conducted in 26 locations in China. A total of 1160 participants aged ≥ 60 years were selected using a complex multistage sampling design. All data were obtained using questionnaires via face-to-face interviews. DPD was measured using the Minnesota Multiphasic Personality Inventory-II in the standardized Chinese version. Self-efficacy was assessed using the Chinese version of the General Self-Efficacy Scale. Social support was measured using the Chinese version of the questionnaires of the Older American Resources and Services scale. Community services and resources comprised 44 items. The association between DPD and levels of social support and self-efficacy was evaluated using a logistic regression model. The association between social support and self-efficacy was assessed using analysis of covariance. RESULTS Univariate analysis results showed that elderly people living in rural areas had higher DPD scores and lower levels of self-efficacy compared with those living in urban areas (P < 0.001). Logistic regression analysis showed that DPD was positively associated with the received frequencies of community health service, contracted family doctor services, and regular lectures on health knowledge among the elderly people with odd ratios of 1.58 (P < 0.001), 2.03 (P = 0.013), and 2.67 (P = 0.005), respectively. Logistic regression analysis showed significant interaction between social support and self-efficacy effect on DPD was found in the additive model (P < 0.001). CONCLUSION DPD was associated mainly with the community resources among elderly people living in rural areas. Social support and self-efficacy were commonly associated with DPD through a synergistic effect. These results suggest that DPD among elderly people may be reduced through effective social support to directly and indirectly promote the elderly's use of community resources and improve their self-efficacy.
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Affiliation(s)
- Ayizuhere Aierken
- Department of Social Medicine, School of Public Health, Zhejiang University, 866 Yu-hang-tang Road, Hangzhou, 310058, Zhejiang, China
| | - XiWen Ding
- Department of Social Medicine, School of Public Health, Zhejiang University, 866 Yu-hang-tang Road, Hangzhou, 310058, Zhejiang, China
| | - YiYang Pan
- Department of Social Medicine, School of Public Health, Zhejiang University, 866 Yu-hang-tang Road, Hangzhou, 310058, Zhejiang, China
| | - Yuan Chen
- Department of Social Medicine, School of Public Health, Zhejiang University, 866 Yu-hang-tang Road, Hangzhou, 310058, Zhejiang, China
| | - Ying Li
- Department of Social Medicine, School of Public Health, Zhejiang University, 866 Yu-hang-tang Road, Hangzhou, 310058, Zhejiang, China.
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9
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Wilmot MP, Ones DS. Agreeableness and Its Consequences: A Quantitative Review of Meta-Analytic Findings. PERSONALITY AND SOCIAL PSYCHOLOGY REVIEW 2022; 26:242-280. [DOI: 10.1177/10888683211073007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Agreeableness impacts people and real-world outcomes. In the most comprehensive quantitative review to date, we summarize results from 142 meta-analyses reporting effects for 275 variables, which represent N > 1.9 million participants from k > 3,900 studies. Arranging variables by their content and type, we use an organizational framework of 16 conceptual categories that presents a detailed account of Agreeableness’ external relations. Overall, the trait has effects in a desirable direction for 93% of variables (grand mean [Formula: see text]). We also review lower order trait evidence for 42 variables from 20 meta-analyses. Using these empirical findings, in tandem with existing theory, we synthesize eight general themes that describe Agreeableness’ characteristic functioning across variables: self-transcendence, contentment, relational investment, teamworking, work investment, lower results emphasis, social norm orientation, and social integration. We conclude by discussing potential boundary conditions of findings, contributions and limitations of our review, and future research directions.
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Affiliation(s)
| | - Deniz S. Ones
- University of Minnesota Twin Cities, Minneapolis, USA
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10
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Pan Y, Aierken A, Ding X, Chen Y, Li Y. Socioeconomic Status Association With Dependency From Objective and Subjective Assessments: A Cross-Sectional Study. Front Psychiatry 2022; 13:898686. [PMID: 35845452 PMCID: PMC9276981 DOI: 10.3389/fpsyt.2022.898686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/31/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The effect of socioeconomic status (SES) on dependency is still complex and not fully clear. The purposes of this study are to assess the association between SES and dependency personality disorder (DPD) using both objective and subjective assessments. METHODS A cross-sectional study was conducted in 27 locations in China among 1,276 general residents aged 60 years and above through a complex multistage sampling design. Data were collected using a questionnaire by well-trained investigators through face-to-face interviews. The DPD was assessed using a standardized Chinese version of the Minnesota Multiphasic Personality Inventory-II scale. Objective SES was assessed by the combination of education levels, individual income, preretirement occupation, and medical insurance. Subjective SES was measured using the MacArthur Scale. The logistic regression analysis was used to evaluate the association between objective SES and DPD. Analysis of covariance was conducted to compare the mean of DPD scores in different levels of SES. RESULTS The results of the chi-squared test showed that the levels of objective SES were associated with DPD, depression, social resources, and region. The logistic regression analysis showed a significant negative association between the levels of objective SES and DPD. The odds ratio was 1.84 (95% confidence interval, 1.07-3.18) after adjusting for important confounding factors. The analysis of covariance showed differences in the mean of DPD scores among different groups defined by different levels of SES. CONCLUSION The levels of SES were negatively associated with DPD, and subjective SES had a stronger association with DPD than objective SES. The effect of subjective SES on DPD is possibly associated with the perception of position in the social hierarchy.
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Affiliation(s)
- YiYang Pan
- Department of Social Medicine, School of Public Health, Zhejiang University, Hangzhou, China
| | - Ayizuhere Aierken
- Department of Social Medicine, School of Public Health, Zhejiang University, Hangzhou, China
| | - XiWen Ding
- Department of Social Medicine, School of Public Health, Zhejiang University, Hangzhou, China
| | - Yuan Chen
- Department of Social Medicine, School of Public Health, Zhejiang University, Hangzhou, China
| | - Ying Li
- Department of Social Medicine, School of Public Health, Zhejiang University, Hangzhou, China
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12
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Abstract
Although autism spectrum disorder (ASD) is the prototypical psychiatric disorder of social impairment, several if not most psychiatric disorders are characterized by prominent impairments in social functioning. A challenge in clinically assessing and describing social impairment is that it has been variably defined and can be difficult to measure. In this article we consider the psychiatric differential diagnosis of social impairment within the DSM-5 framework. We describe the features of social impairment in 13 DSM-5 disorders from a developmental perspective and highlight diagnostic factors that differentiate among the disorders, including the main features of social impairment, verbal communication, nonverbal communication, course of social impairment, social cognition, and key features of accompanying neuropsychiatric symptoms. We conclude by describing an approach for assessing social impairment across the lifespan.
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Heintz HL, Freedberg AL, Harper DG. Dependent Personality in Depressed Older Adults: A Case Report and Systematic Review. J Geriatr Psychiatry Neurol 2021; 34:445-453. [PMID: 32608309 DOI: 10.1177/0891988720933361] [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: 11/15/2022]
Abstract
Personality pathology in older adults is largely understudied. Here, we present a case report of an older adult who presented to an inpatient geriatric psychiatry unit with dependent personality traits in the context of chronic major depressive disorder, followed by a systematic review of the literature to identify research regarding the diagnosis and prevalence of dependent personality in depressed older adults. We identified 11 studies relevant to this topic. Synthesis of these data revealed that dependent personality is generally more common in depressed older adults compared to other personality disorders. However, studies were limited by small sample sizes and the use of assessments not validated for use in older adults. Therefore, it is difficult to draw conclusions from the available data. Potential implications for patient outcomes and health care services utilization are discussed. Our review highlights the need for larger scale research and personality assessments which are sensitive to age-related factors in order to draw evidence-based conclusions.
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Affiliation(s)
- Hannah L Heintz
- Division of Geriatric Psychiatry, 24472McLean Hospital, Belmont, MA, USA
| | - Alexis L Freedberg
- Division of Geriatric Psychiatry, 24472McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - David G Harper
- Division of Geriatric Psychiatry, 24472McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Yager J. Infective Messages: Definitions, Processes, and Implications for Trauma, Identities, Internal Conflicts, Psychotherapy, and Research. J Nerv Ment Dis 2021; 209:474-480. [PMID: 33782250 DOI: 10.1097/nmd.0000000000001321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Throughout life, individuals are bombarded by countless emotion-generating messages. Certain of these messages, for example, some insults, admonitions, rejections, challenges, or insightful declarations, can be viewed as "infective." Infective messages shock, puncture, adhere, disturb, and generate discernable host responses that assimilate, accommodate, or repel the intruding messages. Messages originating in one's own mind can stimulate psychological equivalents of autoimmune responses. Sometimes, these messages produce enduring psychological changes. Infective messages may traumatize, organize, or therapize. The aims of this article are to consider how infective messages a) relate to their messengers (vectors), structural characteristics, and recipient (host) factors; b) might contribute to trauma, personal identity formation, psychological conflicts, and emotional self-regulatory and cognitive heuristics; c) might inform the conduct of psychotherapy; and d) suggest future research. METHODS Clinical observations were augmented with selective literature reviews. These sources contributed to perspectives regarding how certain messages might become infective; contribute to trauma, complex aspects of identity formation, and inner conflict; and inform the conduct of psychotherapy. RESULTS Infective messages are commonly characterized by short, cogent communications emanating from credible sources that fall on vulnerable recipients' receptive, dispositional feeling states. These infective stimuli trigger reactive and defensive emotions and associated behaviors reflecting responses to significant threats or benefits relative to the individual's deepest needs, motivations, and values. Defensive overreactions may occur in response to messages to which individuals have been previously sensitized. Infective message contents appear to assimilate into constantly evolving, dynamic autobiographical brain maps consisting of highly specific neuronal networks that range from the brainstem through limbic structures to multiple cortical areas. Autobiographical maps built from message-injected contents may transform, akin to the incorporation of retroviruses or prions, to encode personal identities as aspects of the self. Contrasting maps may exist semi-independently of one another, continuously evolving, interacting, combining, dividing, conflicting, and contending with one another for attention. Achieving attentional awareness, such maps help structure how individuals conceptualize and communicate about their encoded traumas, diverse identities, and the conflicts among them. CONCLUSIONS AND IMPLICATIONS During psychotherapy, aftereffects of traumatizing infective messages might be detoxified by deconstructing, desensitizing, and processing messages' precise words and emotional envelopes in relation to contexts in which they were delivered, and the individual's inner dispositions at moments of impact. Carefully crafted, timely interpretations can be therapeutically infective, generating enduring positive impacts. Future studies using an assortment of approaches can test these perspectives.
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Affiliation(s)
- Joel Yager
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado
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15
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Li Y, Pan Y, Chen Y, Cui P. Important Dependency-Associated Community Resources among Elderly Individuals with a Low Level of Social Support in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052754. [PMID: 33803141 PMCID: PMC7967261 DOI: 10.3390/ijerph18052754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 03/02/2021] [Indexed: 11/16/2022]
Abstract
Background: The prevalence of dependency personality disorder is high among elderly individuals with a low level of social support. The objective of this study was to explore the dependency associated with important community resources among elderly individuals with a low level of social support from the perspective of resource demand. Methods: The population-based cross-sectional study was conducted in 22 locations in China. A total of 950 participants aged ≥60 years were selected using a complex multistage sampling design. All the data were collected using questionnaires via face-to-face interviews. The dependency was assessed using the standardized Chinese version of the Minnesota Multiphasic Personality Inventory-II. Community resources were assessed using 43 items. Logistic regression analysis was used to evaluate the association between dependency and important community resources. Results: Bivariate analysis showed that the level of social support was negatively associated with levels of income (p < 0.001) and education (p = 0.008) and was positively associated with social communication and interactions (p < 0.001). The logistic regression analysis showed that the emergency call or survival monitoring system (ECSMS) was the most important community resource that was significantly associated with the levels of dependency; the odds ratio was 2.64 (95% CI, 1.07–3.91; p = 0.031) among elderly individuals with a low level of social support. Conclusions: The levels of dependency were most significantly associated with the ECSMS among elderly individuals with a low level of social support. Our results suggest that improving the ECSMS can be the main problem in the development of community resources.
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Affiliation(s)
- Ying Li
- Correspondence: ; Tel.: +86-0571-(8820)-8590; Fax: +86-0571-(8795)-2233
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van den End A, Dekker J, Beekman ATF, Aarts I, Snoek A, Blankers M, Vriend C, van den Heuvel OA, Thomaes K. Clinical Efficacy and Cost-Effectiveness of Imagery Rescripting Only Compared to Imagery Rescripting and Schema Therapy in Adult Patients With PTSD and Comorbid Cluster C Personality Disorder: Study Design of a Randomized Controlled Trial. Front Psychiatry 2021; 12:633614. [PMID: 33868050 PMCID: PMC8044980 DOI: 10.3389/fpsyt.2021.633614] [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: 11/25/2020] [Accepted: 02/23/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Posttraumatic stress disorder (PTSD) is a serious and relatively common mental disorder causing a high burden of suffering. Whereas evidence-based treatments are available, dropout and non-response rates remain high. PTSD and Cluster C personality disorders (avoidant, dependent or obsessive-compulsive personality disorder; CPD) are highly comorbid and there is evidence for suboptimal treatment effects in this subgroup of patients. An integrated PTSD and CPD treatment may be needed to increase treatment efficacy. However, no studies directly comparing the efficacy of regular PTSD treatment and treatment tailored to PTSD and comorbid CPD are available. Whether integrated treatment is more effective than treatment focused on PTSD alone is important, since (1) no evidence-based guideline for PTSD and comorbid CPD treatment exists, and (2) treatment approaches to CPD are costly and time consuming. Present study design describes a randomized controlled trial (RCT) directly comparing trauma focused treatment with integrated trauma focused and personality focused treatment. Methods: An RCT with two parallel groups design will be used to compare the clinical efficacy and cost-effectiveness of "standalone" imagery rescripting (n = 63) with integrated imagery rescripting and schema therapy (n = 63). This trial is part of a larger research project on PTSD and personality disorders. Predictors, mediators and outcome variables are measured at regular intervals over the course of 18 months. The main outcome is PTSD severity at 12 months. Additionally, machine-learning techniques will be used to predict treatment outcome using biopsychosocial variables. Discussion: This study protocol outlines the first RCT aimed at directly comparing the clinical efficacy and cost-effectiveness of imagery rescripting and integrated imagery rescripting and schema therapy for treatment seeking adult patients with PTSD and comorbid cluster C personality pathology. Additionally, biopsychosocial variables will be used to predict treatment outcome. As such, the trial adds to the development of an empirically informed and individualized treatment indication process. Clinical Trial registration: ClinicalTrials.gov, NCT03833531.
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Affiliation(s)
- Arne van den End
- Sinai Centrum, Amstelveen, Netherlands.,Department of Psychiatry, Academic Medical Center, Location Vrije Universiteit Medical Center, Amsterdam, Netherlands
| | - Jack Dekker
- Arkin Mental Health Care, Amsterdam, Netherlands.,Faculty of Behavioural and Movement Sciences, VU University, Amsterdam, Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, Academic Medical Center, Location Vrije Universiteit Medical Center, Amsterdam, Netherlands.,GGZ inGeest, Amsterdam, Netherlands
| | - Inga Aarts
- Sinai Centrum, Amstelveen, Netherlands.,Department of Psychiatry, Academic Medical Center, Location Vrije Universiteit Medical Center, Amsterdam, Netherlands
| | - Aishah Snoek
- Sinai Centrum, Amstelveen, Netherlands.,Department of Psychiatry, Academic Medical Center, Location Vrije Universiteit Medical Center, Amsterdam, Netherlands
| | - Matthijs Blankers
- Arkin Mental Health Care, Amsterdam, Netherlands.,Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht, Netherlands
| | - Chris Vriend
- Amsterdam Neuroscience, Amsterdam University Medical Center, Location Vrije Universiteit Medical Center, Amsterdam, Netherlands.,Department of Anatomy and Neurosciences, Amsterdam University Medical Center, Location Vrije Universiteit Medical Center, Amsterdam, Netherlands
| | - Odile A van den Heuvel
- Amsterdam Neuroscience, Amsterdam University Medical Center, Location Vrije Universiteit Medical Center, Amsterdam, Netherlands.,Department of Anatomy and Neurosciences, Amsterdam University Medical Center, Location Vrije Universiteit Medical Center, Amsterdam, Netherlands
| | - Kathleen Thomaes
- Sinai Centrum, Amstelveen, Netherlands.,Department of Psychiatry, Academic Medical Center, Location Vrije Universiteit Medical Center, Amsterdam, Netherlands.,Arkin Mental Health Care, Amsterdam, Netherlands
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17
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Shao X, Wang C, Shen C, Jia Y, Wang W. Nightmare experience and personality disorder functioning styles in healthy volunteers and nightmare disorder patients. Bull Menninger Clin 2020; 84:278-294. [PMID: 33000963 DOI: 10.1521/bumc.2020.84.3.278] [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
Nightmares are prevalent in psychiatric disorders, and personality disorder features might be associated with nightmare experience, especially in nightmare disorder patients. The authors invited 219 healthy volunteers and 118 nightmare disorder patients to undergo tests of the Nightmare Experience Questionnaire (NEQ), the Parker Personality Measure (PERM), and the Plutchik-van Praag Depression Inventory. Compared to healthy volunteers, nightmare disorder patients scored significantly higher on annual nightmare frequency and NEQ Physical Effect, Negative Emotion, Meaning Interpretation, and Horrible Stimulation, and higher on PERM Paranoid, Schizotypal, Borderline, Histrionic, Narcissistic, Avoidant, and Dependent styles. Borderline, Schizotypal, and Passive-Aggressive styles in healthy volunteers and Dependent, Avoidant, Histrionic, and Paranoid in patients were significant predictors of some NEQ scales. Higher annual nightmare frequency, higher scale scores of nightmare experience and personality disorder styles, and more associations between the two were found in nightmare disorder patients, implying the need for personality-adjustment therapy for nightmare disorder.
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Affiliation(s)
- Xu Shao
- MD candidate, Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, China.,PhD candidate, Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
| | - Chu Wang
- PhD candidate, Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
| | - Chanchan Shen
- MD candidate, Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, China.,PhD candidate, Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
| | - Yanli Jia
- MSc candidate, Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
| | - Wei Wang
- Professor and chief psychiatrist, Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
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18
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Ramsay G, Jolayemi A. Personality Disorders Revisited: A Newly Proposed Mental Illness. Cureus 2020; 12:e9634. [PMID: 32923235 PMCID: PMC7478931 DOI: 10.7759/cureus.9634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/09/2020] [Indexed: 11/10/2022] Open
Abstract
Personality disorders such as dependent personality disorder (DPD), among others, have shown limited academic development in terms of a more in-depth understanding or subtypes that may exist as a mental illness or associated condition. DPD was first published as a distinct personality disorder in the Diagnostic and Statistical Manual for Mental Disorders, 3rd edition (DSM III) psychiatry manual in 1980. Since its revision in the DSM IIIR in 1987, no significant advancements have been proposed to date. This case study reported a patient with suicidal ideation and offered a new type of DPD to advance personality disorders research. The new subtype of dependent personality disorder has a few key characteristics of the traditional disorder yet reveals features that mirror nearly opposite symptom criteria, making it unique as a distinct subtype or possibly a separate personality disorder of its kind. The case study patient report proposes comorbid diagnoses of adjustment disorder and dependent personality disorder, the altruistic depressive type. Recommendations for further research were made.
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Affiliation(s)
- Glen Ramsay
- Psychiatry, Interfaith Medical Center, Brooklyn, USA
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19
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Lex C, Hautzinger M, Meyer TD. Symptoms, course of Illness, and comorbidity as predictors of expressed emotion in bipolar disorder. Psychiatry Res 2019; 276:12-17. [PMID: 30981096 DOI: 10.1016/j.psychres.2019.03.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 03/29/2019] [Accepted: 03/30/2019] [Indexed: 11/28/2022]
Abstract
High levels of expressed emotions (EE) reflect the amount of criticism and/or over-involvement in families and has been linked to relapse risk in various psychiatric disorders including bipolar disorder (BD). Less clear is which factors contribute to the development and/or maintenance of EE. Therefore, we tested whether patient characteristics, specifically clinical features and personality disorder traits in BD predicted key aspects of EE as assessed by patients and their relatives. Patients with remitted BD and their relatives were asked to complete the Family Attitude Scale (FAS) and the Perceived Criticism Measure (PCM). Patient characteristics were assessed with a variety of measures including SCID I and II. The FAS and PCM shared 25% of the variance for patients and 14% for relatives, suggesting a conceptual overlap, but they may not assess identical constructs. The number of previous mood episodes, current self-rated manic symptoms, and comorbid symptoms of Cluster C personality disorder predicted patient-rated FAS. Relative-rated FAS was only predicted by comorbid symptoms of Cluster A personality disorder. In BD, specific patient characteristics seem to be linked to key aspects of EE even when in remission. However, it might depend whether the patient, his/her relative, or a neutral observer assessed EE.
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Affiliation(s)
- Claudia Lex
- Department of Psychiatry, Villach General Hospital, Nikolaigasse 43, 9500 Villach, Austria.
| | - Martin Hautzinger
- Department of Psychology, Eberhard Karls University, Schleichstrasse 4, 72076 Tuebingen, Germany
| | - Thomas D Meyer
- McGovern Medical School, Department of Psychiatry and Behavioral Sciences, University of Texas HSC at Houston, 1941 East Road (BBSB 3118), Houston, Texas 77054, USA.
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20
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Furnham A. A Big Five facet analysis of sub-clinical dependent personality disorder (Dutifulness). Psychiatry Res 2018; 270:622-626. [PMID: 30384281 DOI: 10.1016/j.psychres.2018.10.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 10/21/2018] [Accepted: 10/21/2018] [Indexed: 11/19/2022]
Abstract
This study aimed to examine a Big Five, normal personality trait, "bright side" analysis of a sub-clinical personality disorder: Dependency Personality Disorder. Around 6000 British adults completed the NEO-PI-R which measures the Big Five personality factors at the domain and the facet level. They also completed the Hogan Development Survey (HDS) which has a measure of sub-clinical Dependency Personality Disorder called Dutiful as one of its eleven dysfunctional interpersonal tendencies. Correlation and regression results confirmed many of the associations between the Big Five domains and facets and sub-clinical Dependency. The Dutiful (Dependent) scale from the HDS was the criterion variable in all analyses. The results showed that those high on Dutiful are highly unstable Neurotic, Agreeable people who are low on Openness. They are Anxious, Compliant, Self-Conscious, Unassertive and Vulnerable. It is thus possible to assess subclinical personality disorder "dark-side" traits, like Dutifulness, in terms of normal "bright-side" traits. Limitations of the study are acknowledged.
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Affiliation(s)
- Adrian Furnham
- Norwegian Business School (BI), Nydalveien, Olso, Norway.
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21
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Abstract
PURPOSE OF REVIEW This review aims to give an overview on the current literature on sex differences in personality disorders and to highlight the potential of dimensional approaches. RECENT FINDINGS Empirical findings on sex differences in personality disorders are inconsistent and appear to be highly dependent on study settings. Current studies have mainly focused on borderline and antisocial personality disorder and the question whether these are sex-specific representations of a common substrate. In general, sexes differ in the manifestation of personality disorders as well as in comorbidities. Criticism of the established categorical model led to an additional dimensional model of personality disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Investigations on sex differences in personality disorders are sparse and mainly limited to antisocial and borderline personality disorder. The introduction of a dimensional model offers the chance to re-think the construct of "personality disorder" and thereby also opens the possibility for a better understanding of sex differences.
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22
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Ray D, Roy D, Sindhu B, Sharan P, Banerjee A. Neural Substrate of Group Mental Health: Insights from Multi-Brain Reference Frame in Functional Neuroimaging. Front Psychol 2017; 8:1627. [PMID: 29033866 PMCID: PMC5625015 DOI: 10.3389/fpsyg.2017.01627] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 09/04/2017] [Indexed: 01/09/2023] Open
Abstract
Contemporary mental health practice primarily centers around the neurobiological and psychological processes at the individual level. However, a more careful consideration of interpersonal and other group-level attributes (e.g., interpersonal relationship, mutual trust/hostility, interdependence, and cooperation) and a better grasp of their pathology can add a crucial dimension to our understanding of mental health problems. A few recent studies have delved into the interpersonal behavioral processes in the context of different psychiatric abnormalities. Neuroimaging can supplement these approaches by providing insight into the neurobiology of interpersonal functioning. Keeping this view in mind, we discuss a recently developed approach in functional neuroimaging that calls for a shift from a focus on neural information contained within brain space to a multi-brain framework exploring degree of similarity/dissimilarity of neural signals between multiple interacting brains. We hypothesize novel applications of quantitative neuroimaging markers like inter-subject correlation that might be able to evaluate the role of interpersonal attributes affecting an individual or a group. Empirical evidences of the usage of these markers in understanding the neurobiology of social interactions are provided to argue for their application in future mental health research.
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Affiliation(s)
- Dipanjan Ray
- Cognitive Brain Lab, National Brain Research Centre, Manesar, India
| | - Dipanjan Roy
- Cognitive Brain Lab, National Brain Research Centre, Manesar, India
| | - Brahmdeep Sindhu
- Department of Psychiatry, Gurgaon Civil Hospital, Gurgaon, India
| | - Pratap Sharan
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Arpan Banerjee
- Cognitive Brain Lab, National Brain Research Centre, Manesar, India
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23
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McClintock AS, McCarrick SM. An Examination of Dependent Personality Disorder in the Alternative DSM-5 Model for Personality Disorders. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2017. [DOI: 10.1007/s10862-017-9621-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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24
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Benotsch EG, Sawyer AN, Martin AM, Allen ES, Nettles CD, Richardson D, Rietmeijer CA. Dependency Traits, Relationship Power, and Health Risks in Women Receiving Sexually-Transmitted Infection Clinic Services. Behav Med 2017; 43:176-183. [PMID: 28767015 DOI: 10.1080/08964289.2017.1297291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In prior research, having traits consistent with a personality disorder has been shown to be related to substance use and high-risk sexual activity; however, few studies have examined relationships between dependency traits and health-jeopardizing behaviors. Individuals with traits consistent with dependent personality disorder may be more likely to be in a primary relationship characterized by unhealthy conditions, including physical abuse from a partner, low assertiveness in sexual situations, and partner infidelity. In addition, dependency traits may be associated with unhealthy coping (e.g., through substance use). To examine associations between dependent personality traits and these types of health-related behaviors, 198 women seeking sexually transmitted infection clinic services completed a computer-assisted assessment of dependent personality traits, substance use, unhealthy conditions in primary relationships, perceived sexual and relationship power, and sexual risk related to condom use. Dependency trait scores were correlated with the use of cocaine, heroin, and methamphetamine. Participants high in dependency traits reported low perceived power within their relationships and less say in sexual behaviors, including condom use. In a series of multivariate analyses, dependency traits significantly predicted having been hit by a partner, staying with a partner after he cheated, having sex because of threats, and fear of asking a partner to use a condom. Dependency traits were also associated with lower past condom use and lower future condom use intentions. Results suggest that dependent personality traits may place women at higher risk for physical abuse and harmful health behaviors.
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Affiliation(s)
- Eric G Benotsch
- a Department of Psychology , Virginia Commonwealth University
| | - Ashlee N Sawyer
- a Department of Psychology , Virginia Commonwealth University
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25
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Ma G, Fan H, Shen C, Wang W. Genetic and Neuroimaging Features of Personality Disorders: State of the Art. Neurosci Bull 2016; 32:286-306. [PMID: 27037690 DOI: 10.1007/s12264-016-0027-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 03/03/2016] [Indexed: 12/11/2022] Open
Abstract
Personality disorders often act as a common denominator for many psychiatric problems, and studies on personality disorders contribute to the etiopathology, diagnosis, and treatment of many mental disorders. In recent years, increasing evidence from various studies has shown distinctive features of personality disorders, and that from genetic and neuroimaging studies has been especially valuable. Genetic studies primarily target the genes encoding neurotransmitters and enzymes in the serotoninergic and dopaminergic systems, and neuroimaging studies mainly focus on the frontal and temporal lobes as well as the limbic-paralimbic system in patients with personality disorders. Although some studies have suffered due to unclear diagnoses of personality disorders and some have included few patients for a given personality disorder, great opportunities remain for investigators to launch new ideas and technologies in the field.
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Affiliation(s)
- Guorong Ma
- Department of Clinical Psychology and Psychiatry, Zhejiang University School of Medicine, Hangzhou, 310058, China.,Department of Psychology and Behavioral Sciences, Zhejiang University College of Science, Hangzhou, 310007, China
| | - Hongying Fan
- Department of Clinical Psychology and Psychiatry, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Chanchan Shen
- Department of Psychology and Behavioral Sciences, Zhejiang University College of Science, Hangzhou, 310007, China
| | - Wei Wang
- Department of Clinical Psychology and Psychiatry, Zhejiang University School of Medicine, Hangzhou, 310058, China. .,Department of Psychology and Behavioral Sciences, Zhejiang University College of Science, Hangzhou, 310007, China.
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26
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Abstract
A high rate of personality disorders (PDs) was found in individuals with Internet addiction (IA) in previous studies using clinical and limited sample sizes. The present study further made comparisons between sex and incorporated a control group to compare the frequencies of PD between individuals with IA and those without IA. Five hundred fifty-six college students (341 females) completed self-report surveys and were later given diagnostic interviews to assess for a PD diagnosis. Males with IA showed a higher frequency of narcissistic PD, whereas females with IA showed a higher frequency of borderline, narcissistic, avoidant, or dependent PD when compared with those without IA. The high rate of PD among Internet addicts may be associated with the core features of specific PD psychopathology. Sex differences in the PD frequencies among IA individuals provide indications for understanding the psychopathological characteristics of PDs in Internet addicts.
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27
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McClintock AS, Anderson T, Cranston S. Mindfulness Therapy for Maladaptive Interpersonal Dependency: A Preliminary Randomized Controlled Trial. Behav Ther 2015; 46:856-68. [PMID: 26520227 DOI: 10.1016/j.beth.2015.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 08/18/2015] [Accepted: 08/19/2015] [Indexed: 01/15/2023]
Abstract
Existing treatments for maladaptive interpersonal dependency and dependent personality disorder do not meet basic scientific standards for effectiveness. The present investigation tested the efficacy of a mindfulness-based approach: mindfulness therapy for maladaptive interpersonal dependency (MT-MID). Forty-eight participants who reported consistently high levels of maladaptive dependency (i.e., scored higher than 1 standard deviation above the mean on the Interpersonal Dependency Inventory at two separate assessments) were randomized to either 5 sessions of MT-MID or a minimal contact control. Five self-reported outcomes (mindfulness, maladaptive interpersonal dependency, helplessness, fears of negative evaluation, and excessive reassurance seeking) were assessed at pretreatment, posttreatment, and a 4-week follow-up. Intent-to-treat analyses indicated that MT-MID yielded greater improvements than the control on all 5 outcomes at posttreatment (median d=1.61) and follow-up (median d=1.51). Participants assigned to MT-MID were more likely than control participants to meet criteria for clinically significant change at posttreatment (56.5% vs. 0%) and follow-up (42.9% vs. 0%). There was also evidence that increases in mindfulness mediated the dependency-related improvements. These results provide preliminary support for the efficacy of a mindfulness-based approach for treating the symptoms of maladaptive dependency.
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28
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Gore WL, Widiger TA. Assessment of dependency by the FFDI: Comparisons to the PID-5 and maladaptive agreeableness. Personal Ment Health 2015; 9:258-76. [PMID: 26333624 DOI: 10.1002/pmh.1308] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 07/20/2015] [Accepted: 07/26/2015] [Indexed: 11/08/2022]
Abstract
The present study explores the validity of the Five Factor Dependency Inventory (FFDI), a measure of dependent personality traits from the perspective of the five factor model, examined across three separate samples and two studies. The first study examined the FFDI with respect to the traits assigned to assess dependent personality disorder (DPD) by the DSM-5 work group, two measures of DSM-IV-TR DPD and three measures of dependent traits, sampling 184 Mechanical Turk participants and 83 students (the latter oversampled for DPD features). Based on responses from an additional 137 students, the second study investigated the role of maladaptive agreeableness in dependency by examining the FFDI in relation to the interpersonal circumplex using three alternative measures. Discriminant validity was provided with respect to DSM-5 traits and the interpersonal circumplex. Incremental validity was provided with respect to the ability of the FFDI to account for variance within DPD measures beyond the variance explained by DSM-5 traits. Implications for the assessment of dependency and the proposed DSM-5 dimensional trait model are discussed.
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Affiliation(s)
- Whitney L Gore
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Thomas A Widiger
- Department of Psychology, University of Kentucky, Lexington, KY, USA
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29
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Loas G, Baelde O, Verrier A. Relationship between alexithymia and dependent personality disorder: a dimensional analysis. Psychiatry Res 2015; 225:484-8. [PMID: 25529260 DOI: 10.1016/j.psychres.2014.11.062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 10/07/2014] [Accepted: 11/30/2014] [Indexed: 01/30/2023]
Abstract
The present study had two aims and used two different samples. The first aim was to determine if alexithymia and dependent personality disorder (DPD) are distinct or overlapping constructs. The second aim was to determine the specificity and the stability of the relationship between alexithymia and DPD. The first study used exploratory principal components analysis (PCA) in a sample of 477 non-clinical subjects who completed three questionnaires measuring alexithymia (Twenty item Toronto Alexithymia Scale, i.e. TAS-20), dependent personality disorder (Dependent Personality Questionnaire, i.e. DPQ) and depression (Beck Depression Inventory-II, i.e. BDI-II). The second study used a sample of 305 subjects consecutively admitted to an outpatient department of legal medicine. The subjects completed (at admission and 3 months later) the Structured Clinical Interview for DSM-IV, screen questionnaire (SCID-II-SQ), the TAS-20 and the BDI. Multiple regressions were done. For the first study, the PCA yielded a four-factor solution with no overlap of the significant factor loadings for the items from each scale and with the factors corresponding to their respective construct. For the second study, multiple regressions showed that only avoidant personality disorder was an independent predictor of the TAS-20 scores. Alexithymia is a construct that is distinct and separate from DPD and depression. Alexithymia is not a stable feature of DPD while it is a core feature of avoidant personality disorder.
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Affiliation(s)
- Gwenolé Loas
- Department of Psychiatry, Hôpital Erasme, Université Libre de Bruxelles (ULB), Bruxelles, Belgium.
| | - Olympe Baelde
- Department of Psychiatry, Hôpital Pinel, Amiens, France
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