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Hörberg N, Kouros I, Ekselius L, Ramklint M. Beyond Symptoms - A Cross-Sectional Study Exploring Functioning in Psychiatric Outpatients. Psychiatry 2024:1-19. [PMID: 39258895 DOI: 10.1080/00332747.2024.2395754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2024]
Abstract
OBJECTIVE This study aimed to explore factors influencing functioning in psychiatric outpatients, both separately and in combination. The primary objectives were to determine predictors of functioning, assess their significance in a combined analysis, and quantify their collective predictive power. METHOD A sample of 137 psychiatric outpatients diagnosed with bipolar disorder, borderline personality disorder, or attention deficit hyperactivity disorder (ADHD) participated in this cross-sectional study, undergoing semi-structured diagnostic interviews for psychiatric and personality disorders. Participants also completed assessments of current functioning, personality traits (temperament and character), attachment style, and childhood trauma. Linear regression models were employed to analyse the relationships between these factors and level of functioning. RESULTS The majority of temperament and character traits and attachment dimensions, as well as having a personality disorder, predicted impaired functioning, but comorbidity and childhood trauma did not. When all variables were taken into account in a multiple regression analysis, only the temperament and character traits Harm Avoidance and Self-directedness remained significantly predictive (p = .006 and .003, respectively). These two factors explain about one-third of the variance. CONCLUSIONS Personality traits-more specifically, the temperament trait Harm Avoidance and the character trait Self-directedness-are strong predictors of functioning among psychiatric outpatients. Interestingly, when accounting for these factors, traditionally associated variables, such as attachment, comorbidity, and childhood trauma, lost their significance as predictors. These findings underscore the pivotal role of specific personality traits in understanding and predicting the functioning of psychiatric patients.
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Emami M, Moghadasin M, Mastour H, Tayebi A. Early maladaptive schema, attachment style, and parenting style in a clinical population with personality disorder and normal individuals: a discriminant analysis model. BMC Psychol 2024; 12:78. [PMID: 38360823 PMCID: PMC10870430 DOI: 10.1186/s40359-024-01564-5] [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: 08/28/2023] [Accepted: 01/29/2024] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION Researchers have shown various variables' role in forming personality disorders (PD). This study aimed to assess the role of early maladaptive schema (EMS), attachment style (AS), and parenting style (PS) in discriminating between personality disorders and normal individuals. METHODS In this study, 78 personality disorder patients and 360 healthy volunteers aged 18-84 were selected using convenience sampling. They completed the Schema Questionnaire-Short Form (SQ-SF), Revised Adult Attachment Scale (RAAS), and Baumrind's Parenting Styles Questionnaire (PSI). Data were analyzed using discriminant analysis with IBM SPSS 25. RESULTS The results showed higher mean scores in all early maladaptive schema domains, insecure attachment styles, and authoritarian parenting in the personality disorder group than in the normal group. Also, discriminant analyses revealed that the function was statistically significant and could distinguish between the two groups and a compound of essential variables, disconnection, impaired autonomy, and secure attachment, respectively, discriminating two groups. Given that all components were able to distinguish between the two groups. CONCLUSION Therefore, intervention based on these factors early in life may help reduce the characteristics of personality disorders. Also, considering the role of these factors, treatment protocols can be prepared.
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Affiliation(s)
- Maryam Emami
- Department of Clinical Psychology, Faculty of Psychology and Educational Sciences, Kharazmi University, Tehran, Iran
| | - Maryam Moghadasin
- Department of Clinical Psychology, Faculty of Psychology and Educational Sciences, Kharazmi University, Tehran, Iran.
| | - Haniye Mastour
- Department of Medical Education, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Afshin Tayebi
- Department of Psychology, Faculty of Psychology, Islamic Azad University, Karaj, Iran
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Szabo G, Szigeti F J, Sipos M, Varbiro S, Gonda X. Affective temperaments show stronger association with infertility treatment success compared to somatic factors, highlighting the role of personality focused interventions. Sci Rep 2023; 13:21956. [PMID: 38081851 PMCID: PMC10713532 DOI: 10.1038/s41598-023-47969-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
Infertility has a multifactorial background, where, besides somatic factors, psychological contributors also play a role in development and outcome. While affective temperaments have been associated with development, course, and outcome as well as treatment success in various somatic conditions, their association with infertility and its treatment has not been investigated so far. The purpose of our retrospective cohort study was to evaluate the influence of affective temperaments on fertility treatment outcomes. Among 578 women who underwent infertility treatment in an Assisted Reproduction Centre in Budapest, Hungary, treatment success, detailed medical history, and demographic parameters were recorded, and the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Auto-questionnaire (TEMPS-A) was administered. Possible predictors of assisted reproduction outcome were analyzed using multivariate logistic regression models, followed by a receiver operating curve (ROC) analysis in order to define ideal affective temperament cut-off values for clinical applicability. Aside from age, BMI, and previous miscarriage, cyclothymic scores > 4 (OR = 0.51 CI 0.35-0.74, p < 0.001), depressive scores > 9 (OR = 0.59 CI 0.4-0.87, p = 0.009) and anxious scores > 9 (OR = 0.45 CI 0.31-0.66, p < 0.001) significantly decreased the odds of clinical pregnancy by 49%, 41% and 55%, respectively. Irritable and hyperthymic temperaments, as well as other somatic and socio-economic factors had no effect on infertility treatment outcomes. The results suggest that affective temperaments may be related to the outcome of infertility treatments. Thus, screening for affective temperaments may help identify high-risk patient groups and offer patient-tailored treatment, which may increase the chances of a successful pregnancy and live birth for women undergoing IVF treatment.
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Affiliation(s)
- Georgina Szabo
- Doctoral School of Mental Health Sciences, Semmelweis University, Budapest, Hungary
| | - Judit Szigeti F
- Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary
| | - Miklos Sipos
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Szabolcs Varbiro
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Xenia Gonda
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary.
- NAP3.0-SE Neuropsychopharmacology Research Group, Hungarian Brain Research Program, Semmelweis University, Gyulai Pál Street 2, 1085, Budapest, Hungary.
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Pad RA, Okut H, Zackula R, Macaluso M, Huprich SK. Understanding the relationship between personality pathology and attachment style in the context of the DSM-5 Alternative Model of Personality Disorders. Personal Ment Health 2022; 16:163-179. [PMID: 34608765 DOI: 10.1002/pmh.1530] [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: 01/10/2021] [Revised: 07/01/2021] [Accepted: 09/02/2021] [Indexed: 11/07/2022]
Abstract
This study utilizes the two different criteria of the DSM-5 Alternative Model of Personality Disorder Assessment to evaluate the relationship between attachment style and personality pathology. One-hundred forty patients from a combined sample of psychiatric and internal medicine clinics were given a survey composed of the DSM-5 Levels of Personality Functioning Questionnaire (DLOPFQ), the Personality Inventory for DSM-5-Brief Form (PID-5-BF), and the Relationship Questionnaire (RQ). Analysis of variance indicated that attachment styles were differentiated across all four the DLOPFQ scales and the Detachment trait domain. Elastic net regression modeling with bootstrap was used to assess the strength of the level of personality functioning dimensions and trait domains in the prediction of attachment style, both independently and interactively while accounting for multicollinearity. This study offers readers insight to a novel statistical approach to model building that addresses two issues among psychiatric data: high correlation and small sample size.
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Affiliation(s)
- Rachel A Pad
- Department of Psychology, University of Detroit Mercy, Detroit, Michigan, USA
| | - Hayrettin Okut
- Department of Psychiatry and Behavioral Science, University of Kansas School of Medicine, Wichita, Kansas, USA
| | - Rosey Zackula
- Department of Psychiatry and Behavioral Science, University of Kansas School of Medicine, Wichita, Kansas, USA
| | - Matthew Macaluso
- Department of Psychiatry and Behavioral Neurobiology, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Steven K Huprich
- Department of Psychology, University of Detroit Mercy, Detroit, Michigan, USA.,Department of Psychiatry and Behavioral Science, University of Kansas School of Medicine, Wichita, Kansas, USA.,Department of Psychiatry, Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
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Smith MS, South SC. Call to arms: Research directions to substantiate a unified model of attachment and personality pathology. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2021. [DOI: 10.1111/spc3.12644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Madison Shea Smith
- Department of Psychological Sciences Purdue University West Lafayette Indiana USA
| | - Susan C. South
- Department of Psychological Sciences Purdue University West Lafayette Indiana USA
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Boldrini T, Mancinelli E, Erbuto D, Lingiardi V, Muzi L, Pompili M, Ducci G, Salcuni S, Tanzilli A, Venturini P, Giovanardi G. Affective temperaments and depressive symptoms: The mediating role of attachment. J Affect Disord 2021; 293:476-483. [PMID: 34256209 DOI: 10.1016/j.jad.2021.06.026] [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] [Received: 02/02/2021] [Revised: 06/12/2021] [Accepted: 06/15/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Studies showed that affective temperaments and attachment are associated with depressive symptoms, and that they bi-directionally influence each-other. The aim of this study is to explore mechanisms underlying the relationship between the affective temperaments (i.e., depressive, cyclothymic, irritable, hyperthymic and anxious), interview-based attachment, and depressive symptoms. METHODS A sample of 61 adolescents and young adults outpatients were asked to complete the Temperament Evaluation of Memphis, Pisa, and San Diego Autoquestionnaire (TEMPS-A) and the Hamilton Rating Scale for Depression (HAM-D). Attachment was assessed through the Adult Attachment Interview (AAI) and employing a dimensional approach to obtain continuous measures. Mediation models were performed with the affective temperaments as predictor, depressive symptoms as the criterion variable, and attachment dimensions as mediators. RESULTS Findings showed significant direct effects between all the affective temperaments and depressive symptoms. Only the cyclothymic (β = 0.22; SE = 0.1; 95% IC = 0.05, 0.42) and irritable (β = 0.21; SE = 0.09; 95% IC = 0.04, 0.4) temperaments showed an indirect effect on depressive symptoms through secure-insecure attachment. Dismissing attachment did not predict either the affective temperaments nor depressive symptoms. Preoccupied attachment significantly predicts depressive symptoms and, when controlling for it, the hyperthymic temperament no longer directly associates with depressive symptoms. LIMITATIONS The cross-sectional study design limit conclusion about causation and directionality. CONCLUSIONS Secure attachment could be a protective factor for depressive symptoms for individuals with a cyclothymic or irritable temperament. Differently, the hyperthymic temperament loses its protective role toward depressive symptoms when accounting for preoccupied attachment.
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Affiliation(s)
- Tommaso Boldrini
- Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy.
| | - Elisa Mancinelli
- Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy
| | - Denise Erbuto
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Laura Muzi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Ducci
- Mental Health Department, ASL Roma 1, S.Spirito Hospital, Rome, Italy.
| | - Silvia Salcuni
- Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy
| | - Annalisa Tanzilli
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Paola Venturini
- European Network of Psychodynamic Psychiatry, Rome, Italy; Department of Psychiatry, ASL Roma 1, Rome, Italy
| | - Guido Giovanardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
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Nakash O, Nagar M, Razon L, Westen D. Association Between Attachment Patterns and Personality Disorders: A Multimethod Multi-Informant Study Using a Clinical Sample. J Nerv Ment Dis 2021; 209:386-394. [PMID: 33625070 DOI: 10.1097/nmd.0000000000001310] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT We investigated the association between personality disorders (PDs) and attachment patterns, and examined the construct validity of attachment patterns against adaptive functioning. We used a multimeasure multi-informant approach, which allowed us to disentangle the effects of the methods and to examine the utility of the various methods for measuring these constructs. The participants included 80 clinicians and 170 clinical outpatients, recruited via convenience sampling. Results showed that secure attachment was positively associated with adaptive functioning, whereas insecure patterns were negatively associated with adaptive functioning. Both categorical and dimensional PD diagnoses were associated with insecure attachment patterns. However, after controlling for comorbidity among the PD diagnoses, only some findings remained significant, most notably the association between borderline PD and the clinicians' assessment of preoccupied and incoherent/disorganized attachment, and the patients' self-reported attachment anxiety. Our findings underscore the importance of controlling for comorbidity in examining the associations between attachment patterns and PDs.
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Affiliation(s)
| | | | - Liat Razon
- Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC), Herzliya, Israel
| | - Drew Westen
- Department of Psychology and Psychiatry, Emory University, Atlanta, Georgia
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Ben-Gal Dahan A, Mikulincer M. Attachment and task persistence: attachment orientations, perception of teacher's responsiveness, and adolescents' persistence in academic tasks. Attach Hum Dev 2020; 23:665-686. [PMID: 33371804 DOI: 10.1080/14616734.2020.1865425] [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: 10/22/2022]
Abstract
The goal of the two studies reported here was to examine the contribution of adolescents' attachment orientations (anxiety, avoidance) and their perception of teacher's responsiveness to persistence in academic tasks. In Study 1 (N = 160), we assessed self-reports of persistence in schoolwork. In Study 2 (N = 240), we manipulated the symbolic presence of participants' teacher (teacher priming) and assessed their actual persistence in a cognitive task. Across the two studies, attachment anxiety was associated with decreased persistence, and the perception of teacher as a responsive figure contributed to heightened persistence and buffered the detrimental effects of attachment anxiety. Study 2's findings also showed that the beneficial effects of perceived teacher's responsiveness on actual task persistence were found only when the teacher was made contextually salient but not when the teacher was not salient. We discussed the dispositional and contextual sources of attachment security that contribute to task persistence.
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Affiliation(s)
- Anat Ben-Gal Dahan
- Department of Education, The Mofet Institute and Tel Hai College, Tel Hai, Israel
| | - Mario Mikulincer
- School of Psychology, Interdisciplinary Center (IDC) Herzliya, Herzliya, Israel
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Barel E, Mizrachi Y, Nachmani M. Quantifying the Predictive Role of Temperament Dimensions and Attachment Styles on the Five Factor Model of Personality. Behav Sci (Basel) 2020; 10:bs10100145. [PMID: 32987781 PMCID: PMC7598700 DOI: 10.3390/bs10100145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/07/2020] [Accepted: 09/22/2020] [Indexed: 12/23/2022] Open
Abstract
Background: The present study investigated the role of temperament and attachment security in predicting individual differences in the five factor personality traits among adults. As previous studies suggested the potential moderating role of attachment in the association between temperament and personality traits, the present study sought to examine an interactionist model combining attachment and temperament in explaining individual differences in personality traits. Methods: A sample of 1871 participants (1151 women and 719 men) completed self-report measures of adult attachment style (the Relationships Questionnaire—RQ), temperament dimension (the Fisher Temperament Inventory—FTI), and personality domain (the Five Factor Model—FFM). Results: Partial correlational analyses revealed associations between attachment security and each of the five domains of the FFM, and few associations between some temperament dimensions and several domains of the FFM. Moderated regression analyses showed that attachment security moderated the associations between temperament dimensions and the Agreeableness domain of the FFM. Among secure individuals, those with higher scores on the Curious/Energetic, Cautious/Social Norm Compliant and Prosocial/Empathetic scales exhibited higher Agreeableness scores, whereas among insecure individuals, those with higher scores on the Analytic/Tough-minded scale exhibited lower scores on the Agreeableness scale. Conclusion: Overall, the current study provides evidence in support of the substantive role of social-environmental factors (Adult Attachment) as a moderating element bridging temperament-related personality elements and a number of their FFM manifestations.
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Affiliation(s)
- Efrat Barel
- Department of Behavioral Sciences, The Max Stern Academic College of Emek Yezreel, Emek Yezreel 19300, Israel
- Correspondence:
| | - Yonathan Mizrachi
- Departments of Sociology and Anthropology, The Max Stern Academic College of Emek Yezreel, Emek Yezreel 19300, Israel & The Laboratory for AI, Machine Learning, Business & Data Analytics (LAMBDA), Tel-Aviv University, Tel Aviv 6997801, Israel;
| | - Maayan Nachmani
- Department of Psychology, The Max Stern Academic College of Emek Yezreel, Emek Yezreel 19300, Israel;
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Marzola E, Porliod A, Panero M, De-Bacco C, Abbate-Daga G. Affective temperaments and eating psychopathology in anorexia nervosa: Which role for anxious and depressive traits? J Affect Disord 2020; 266:374-380. [PMID: 32056902 DOI: 10.1016/j.jad.2020.01.142] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/09/2019] [Accepted: 01/25/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Anorexia nervosa (AN) is a severe mental illness. Personality traits and comorbidity with affective and anxiety disorders are key-aspects of its pathogenesis but little attention has been paid so far to affective temperaments in AN. Also, childhood anxiety is proposed to impact on AN clinical severity. Therefore, we aimed to investigate if affective temperaments could be related to AN eating psychopathology also clarifying if those with low versus high scores on depressive and anxious temperaments could differ in AN clinical current and lifetime severity. METHODS One-hundred and forty-seven inpatients with AN were consecutively recruited. All participants completed: Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Autoquestionnaire, Eating Disorder Examination Questionnaire, State Trait Anxiety Inventory, Beck Depression Inventory. Clinical data were collected upon admission. RESULTS Regression models showed that all affective temperaments were associated with eating psychopathology (eating restraint and eating, shape, and weight concerns); however, when controlling for confounders, only the anxious temperament remained significant. Also, those patients with higher scores on depressive and anxious temperaments reported higher current and lowest lifetime body mass index (BMI). LIMITATIONS Only inpatients were recruited; self-report assessments were used and follow-up data are lacking. CONCLUSIONS Results from this study support the association between affective (anxious in particular) temperament traits and the presence of altered eating psychopathology in AN. Also, higher traits of depressive and anxious temperaments reported higher current and lowest lifetime BMI. Should these findings be confirmed, the assessment of the anxious temperament could fruitfully inform prevention and treatment interventions for AN.
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Affiliation(s)
- Enrica Marzola
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy.
| | - Alain Porliod
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy.
| | - Matteo Panero
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy.
| | - Carlotta De-Bacco
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy.
| | - Giovanni Abbate-Daga
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy.
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Garland J, Miller S. Borderline personality disorder: part 1 – assessment and diagnosis. BJPSYCH ADVANCES 2020. [DOI: 10.1192/bja.2019.76] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
SUMMARYGeneral adult psychiatrists are largely responsible for the care of patients with personality disorders in community and in-patient settings, and this can be associated with diagnostic and management challenges. In the first of two articles focusing specifically on borderline personality disorder (BPD), we summarise the core clinical features of the disorder and discuss appropriate diagnostic practice.
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Smith M, South S. Romantic attachment style and borderline personality pathology: A meta-analysis. Clin Psychol Rev 2019; 75:101781. [PMID: 31918217 DOI: 10.1016/j.cpr.2019.101781] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 09/13/2019] [Accepted: 10/15/2019] [Indexed: 12/24/2022]
Abstract
Borderline Personality Disorder (BPD) implies profound impairment in interpersonal relationships, particularly romantic relationships (Daley, Burge, & Hammen, 2000). Insecure attachment bears striking resemblance to BPD traits in both empirical and theoretical work (Levy, Johnson, Clouthier, Scala, & Temes, 2015) and may be particularly suited for understanding the BPD-related deficits in romantic functioning. Despite several qualitative reviews concluding that secure attachment is disrupted in those with BPD traits, no consensus has emerged regarding the form of this disruption (Levy et al., 2015), with most reviews focusing on whether BPD is best captured as high levels of attachment anxiety or attachment avoidance. The purpose of the current review is to provide a quantitative synthesis of the strength and direction of the associations between attachment insecurity and BPD traits. Searches on PsycINFO and Pubmed resulted in 27 effect sizes that measured BPD and adult romantic attachment on the two primary dimensions of anxiety and avoidance (Fraley, Waller, & Brennan, 2000). Results demonstrated that attachment anxiety correlates most strongly with BPD traits (r = 0.48); however, attachment avoidance also evinced a significant effect (r = 0.30). Findings from regression analyses indicate that attachment anxiety and avoidance interact, suggesting a particularly strong relationship between attachment disorganization and BPD traits.
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Affiliation(s)
- Madison Smith
- Psychological Sciences, Purdue University, 703 3rd Street, West Lafayette, IN, United States of America.
| | - Susan South
- Psychological Sciences, Purdue University, 703 3rd Street, West Lafayette, IN, United States of America.
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Abstract
BACKGROUND Among risk factors for suicidal behavior, there is growing interest in associations with stable affective temperament types, particularly based on assessment with the TEMPS-A self-rating scale. AIM As research on this topic has not been reviewed systematically, we synthesized relevant, reported research findings. METHODS Systematic searching identified peer-reviewed reports pertaining to associations of suicidal behavior or ideation with affective temperament types evaluated with TEMPS-A. We summarized available findings and applied quantitative meta-analytic methods to compare scale scores in suicidal versus nonsuicidal subjects. RESULTS In 21 of 23 TEMPS-A studies meeting inclusion criteria, anxious, cyclothymic, depressive, or irritable temperament scores were significantly higher with previous or recent suicide attempts or ideation in both psychiatric and general population samples compared to nonsuicidal controls, whereas hyperthymic temperament scores were lower in 9 of 11 reports. These findings were synthesized by random-effects meta-analyses of standardized mean differences in TEMPS-A temperament scores in suicidal versus nonsuicidal subjects. Associations ranked: depressive ≥ irritable > cyclothymic > anxious > hyperthymic (negative). CONCLUSIONS Affective temperaments, especially depressive and irritable, were strongly associated with suicidal risk, whereas hyperthymic temperament appeared to be protective.
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Abstract
Avoidant personality disorder (AVPD) is a relatively common disorder that is associated with significant distress, impairment, and disability. It is a chronic disorder with an early age at onset and a lifelong impact. Yet it is underrecognized and poorly studied. Little is known regarding the most effective treatment. The impetus for research into this condition has waxed and waned, possibly due to concerns regarding its distinctiveness from other disorders, especially social anxiety disorder (SAD), schizoid personality disorder, and dependent personality disorder. The prevailing paradigm subscribes to the "severity continuum hypothesis", in which AVPD is viewed essentially as a severe variant of SAD. However, areas of discontinuity have been described, and there is support for retaining AVPD as a distinct diagnostic category. Recent research has focused on the phenomenology of AVPD, factors of possible etiological significance such as early parenting experiences, attachment style, temperament, and cognitive processing. Self-concept, avoidant behavior, early attachments, and attachment style may represent points of difference from SAD that also have relevance to treatment. Additional areas of research not focused specifically on AVPD, including the literature on social cognition as it relates to attachment and personality style, report findings that are promising for future research aimed at better delineating AVPD and informing treatment.
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Affiliation(s)
- Lisa Lampe
- Discipline of Psychiatry, University of Newcastle, Newcastle, NSW, Australia
| | - Gin S Malhi
- Discipline of Psychiatry, University of Sydney, Sydney, NSW, Australia
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15
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Contextual determinants of psychopathology. The singularity of attachment as a predictor of mental dysfunction. Psychiatry Res 2018; 261:338-343. [PMID: 29334658 DOI: 10.1016/j.psychres.2018.01.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 11/20/2017] [Accepted: 01/07/2018] [Indexed: 01/10/2023]
Abstract
The general aim of this research is to evaluate the singular weight of attachment relationships in psychopathology, to determine the point to which these relationships cannot be subsumed by other variables that are famously related to attachment, such as experience of stressful life events, social support, and coping styles. 172 people treated in mental health centers provided data related to these four aspects and about manifestations of psychopathology. Multiple linear regression analyses determined that 51% of the variance in the level of symptomatology is explained with six variables: two related to adult attachment (fear of rejection and abandonment in romantic relationships, and the degree of similarity to the fearful prototype), one related to social support (family appreciation), one to life events (overall perceived stress), and two to coping style (cognitive restructuring and social withdrawal). Fear of rejection was the variable accounting for the most variance. The findings suggest that adult attachment is a non-redundant individual factor associated with manifestations of psychological dysfunction and highlight the desirability of taking attachment history into account in clinical practice.
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Keefe JR, Derubeis RJ. Changing character: A narrative review of personality change in psychotherapies for personality disorder. Psychother Res 2018; 29:752-769. [DOI: 10.1080/10503307.2018.1425930] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- John R. Keefe
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert J. Derubeis
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
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Hengartner MP. The Evolutionary Life History Model of Externalizing Personality: Bridging Human and Animal Personality Science to Connect Ultimate and Proximate Mechanisms Underlying Aggressive Dominance, Hostility, and Impulsive Sensation Seeking. REVIEW OF GENERAL PSYCHOLOGY 2017. [DOI: 10.1037/gpr0000127] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The present work proposes an evolutionary model of externalizing personality that defines variation in this broad psychobiological phenotype resulting from genetic influences and a conditional adaptation to high-risk environments with high extrinsic morbidity-mortality. Due to shared selection pressure, externalizing personality is coadapted to fast life history strategies and maximizes inclusive fitness under adverse environmental conditions by governing the major trade-offs between reproductive versus somatic functions, current versus future reproduction, and mating versus parenting efforts. According to this model, externalizing personality is a regulatory device at the interface between the individual and its environment that is mediated by 2 overlapping psychobiological systems, that is, the attachment and the stress-response system. The attachment system coordinates interpersonal behavior and intimacy in close relationships and the stress-response system regulates the responsivity to environmental challenge and both physiological and behavioral reactions to stress. These proximate mechanisms allow for the integration of neuroendocrinological processes underlying interindividual differences in externalizing personality. Hereinafter I further discuss the model's major implications for personality psychology, psychiatry, and public health policy.
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Marzola E, Fassino S, Amianto F, Abbate-Daga G. Affective temperaments in anorexia nervosa: The relevance of depressive and anxious traits. J Affect Disord 2017; 218:23-29. [PMID: 28456073 DOI: 10.1016/j.jad.2017.04.054] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 04/09/2017] [Accepted: 04/24/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Affective temperaments have been so far understudied in anorexia nervosa (AN) despite the relevance of personality and both affective and anxious comorbidity with regard to vulnerability, course, and outcome of this deadly disorder. METHODS Ninety-eight female inpatients diagnosed with AN and 131 healthy controls (HCs) were enrolled in this study and completed the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A) in addition to assessments of eating psychopathology, depression, and anxiety. RESULTS AN patients and HCs differed in all affective temperaments. The diagnostic subtypes of AN differed as well with binge-purging individuals being more cyclothymic and anxious than those with restricting-type AN. TEMPS-A scores correlated with body mass index and eating psychopathology but not with duration of illness. Concerning comorbidity, grater scores on the depressive and lower scores on the hyperthymic temperaments were found in depressed patients. Those who had either an anxious or irritable temperament were significantly more diagnosed with an anxious disorder than those who did not show this temperament. When logistic regression was performed, high depressive/low hyperthymic and high irritable/anxious traits resulted to be associated with depressive and anxious comorbidity, respectively, independently of confounding factors. LIMITATIONS Cross-sectional design, some patients on medications, few baseline clinical differences between diagnostic subtypes, no other personality assessments. CONCLUSIONS An affective continuum strongly associated with mood and anxious comorbidity emerged in AN. Such an evaluation could have several research and clinical implications given the need of improving treatment individualization and early interventions for such a complex disorder.
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Affiliation(s)
- Enrica Marzola
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Secondo Fassino
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Federico Amianto
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Giovanni Abbate-Daga
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy.
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Abstract
Selective relationships and attachments are central to human health and well-being, both in current societies and during the course of evolution. The presence or absence of social bonds has consequences across the lifespan. The neurobiology of attachment is grounded in neuroendocrine substrates that are shared with reproduction and survival. Experimental studies of species, such as sheep or prairie voles, capable of showing selective social behaviors toward offspring or partners, have provided empirical evidence for the role of oxytocin and vasopressin in the formation of selective attachments. Developmental exposure to social experiences and to peptides, including oxytocin and vasopressin, also can "retune" the nervous system, altering thresholds for sociality, emotion regulation, and aggression. Without oxytocin and without the ability to form attachments the human brain as we know it could not exist. Knowledge of the neurobiology of attachment, and especially the role of oxytocin, also has implications for understanding both healthy behavior and treating mental disorders.
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Affiliation(s)
- C Sue Carter
- Director, Kinsey Institute, Rudy Professor of Biology, Indiana University, Bloomington
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Kaščáková N, Husárová D, Hašto J, Kolarčik P, Šolcová IP, Gecková AM, Tavel P. Validation of a 16-Item Short Form of the Czech Version of the Experiences in Close Relationships Revised Questionnaire in a Representative Sample. Psychol Rep 2016; 119:804-825. [PMID: 27620689 DOI: 10.1177/0033294116667725] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to create a shorter Czech version (ECR-R-16) of the Revised Experiences in Close Relationships (ECR-R) questionnaire and to assess its psychometric properties. Data from a representative sample of the Czech population from 15 to 90 years old (N = 1000, M age = 46.0 years, SD = 17.3) were collected using a face-to-face structured interview in 2014. The developed short form of the Czech version of the ECR-R showed good internal consistency (alphas varied from .84 to .90), and both exploratory and confirmatory factor analyses replicated the two-dimensional model. The results also demonstrated concurrent validity with measures of neuroticism, self-esteem, and positive and negative affect. People living with a partner and people with higher educational levels had significantly lower Avoidance scores than people living alone and people with lower educational levels. It was concluded that the ECR-R-16 questionnaire has good psychometric properties and is a valid assessment method in the Czech cultural context, suitable for research and clinical studies, when the shorter form of a measure is desirable.
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Affiliation(s)
- Natália Kaščáková
- Olomouc University Social and Health Institute, Palacky University in Olomouc, Czech Republic; Psychiatric Clinic, Bratislava, Slovak Republic
| | - Daniela Husárová
- Department of Health Psychology, Faculty of Medicine, P.J. Safarik University in Kosice, Slovak Republic
| | - Jozef Hašto
- Olomouc University Social and Health Institute, Palacky University in Olomouc, Czech Republic; Psychiatric Clinic, Bratislava, Slovak Republic
| | - Peter Kolarčik
- Olomouc University Social and Health Institute, Palacky University in Olomouc, Czech Republic; Department of Health Psychology, Faculty of Medicine, P.J. Safarik University in Kosice, Slovak Republic
| | - Iva Poláčková Šolcová
- Institute of Psychology of the Academy of Sciences of the Czech Republic, Czech Republic
| | - Andrea Madarasová Gecková
- Olomouc University Social and Health Institute, Palacky University in Olomouc, Czech Republic; Department of Health Psychology, Faculty of Medicine, P.J. Safarik University in Kosice, Slovak Republic
| | - Peter Tavel
- Olomouc University Social and Health Institute, Palacky University in Olomouc, Czech Republic
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Cohen LJ, Tanis T, Ardalan F, Yaseen Z, Galynker I. Maladaptive interpersonal schemas as sensitive and specific markers of borderline personality disorder among psychiatric inpatients. Psychiatry Res 2016; 242:395-403. [PMID: 27394052 DOI: 10.1016/j.psychres.2016.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 06/06/2016] [Accepted: 06/09/2016] [Indexed: 11/15/2022]
Abstract
Diagnostic criteria for borderline personality disorder (BPD) and mood and psychotic disorders characterized by major mood episodes (i.e., major depressive, bipolar and schizoaffective disorder) share marked overlap in symptom presentation, complicating differential diagnosis. The current study tests the hypothesis that maladaptive interpersonal schemas (MIS) are characteristic of BPD, but not of the major mood disorders. One hundred psychiatric inpatients were assessed by SCID I, SCID II and the Young Schema Questionnaire (YSQ-S2). Logistic regression analyses tested the association between MIS (measured by the YSQ-S2) and BPD, bipolar, major depressive and schizoaffective disorder. Receiver operator characteristic (ROC) curve analyses assessed the sensitivity and specificity of MIS as a marker of BPD. After covariation for comorbidity with each of the 3 mood disorders, BPD was robustly associated with 4 out of 5 schema domains. In contrast, only one of fifteen regression analyses demonstrated a significant association between any mood disorder and schema domain after covariation for comorbid BPD. ROC analyses of the 5 schema domains suggested Disconnection/Rejection had the greatest power for identification of BPD cases. These data support the specific role of maladaptive interpersonal schemas in BPD and potentially contribute to greater conceptual clarity about the distinction between BPD and the major mood disorders.
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Affiliation(s)
- Lisa J Cohen
- Department of Psychiatry, Mount Sinai Beth Israel, 1st Avenue & East 16th Street, New York, NY 10003, United States.
| | - Thachell Tanis
- Department of Psychiatry, Mount Sinai Beth Israel, 1st Avenue & East 16th Street, New York, NY 10003, United States
| | - Firouz Ardalan
- Department of Psychiatry, Mount Sinai Beth Israel, 1st Avenue & East 16th Street, New York, NY 10003, United States
| | - Zimri Yaseen
- Department of Psychiatry, Mount Sinai Beth Israel, 1st Avenue & East 16th Street, New York, NY 10003, United States
| | - Igor Galynker
- Department of Psychiatry, Mount Sinai Beth Israel, 1st Avenue & East 16th Street, New York, NY 10003, United States
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Skala K, Riegler A, Erfurth A, Völkl-Kernstock S, Lesch OM, Walter H. The connection of temperament with ADHD occurrence and persistence into adulthood - An investigation in 18 year old males. J Affect Disord 2016; 198:72-7. [PMID: 27011362 DOI: 10.1016/j.jad.2016.03.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 02/22/2016] [Accepted: 03/11/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND This study intended to determine whether certain traits of temperament are associated with former and current ADHD symptomatology in a non-clinical sample of 18 year old males. METHODS We performed a cross sectional descriptive study of 3280 men during the examination for military service. The investigation included a socio-demographic questionnaire, screening for substance abuse, temperament (TEMPS-M), past (WURS) and current (ADHD symptom checklist) ADHD symptomatology. RESULTS We found a correlation of cyclothymic (p<.001), irritable (p<.001) and anxious (p<.05) temperament with occurrence and severity of past and present ADHD symptomatology. No significant correlation has been detected for hyperthymic and depressive temperament. Judged retrospectively, ADHD symptoms were strongly consistent over time. LIMITATIONS The sample consists of men only. These had to be fit enough to be enlisted for military service; men with severe mental or physical disorders were thus excluded. Furthermore, the cross-sectional study design does not allow making conclusions about the temporal relationships between ADHD symptoms and substance misuse. CONCLUSIONS These results indicate that a temperament based approach towards those affected by ADHD might be useful. Subtyping ADHD by integrating temperament profiles in diagnosis and treatment of the disorder could help explain some of the heterogeneity of the disease.
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Affiliation(s)
- K Skala
- University of Vienna, Department of Child and Adolescent Psychiatry, Austria.
| | - A Riegler
- Otto Wagner Spital, Department of Psychiatry IV, Austria
| | - A Erfurth
- Otto Wagner Spital, Department of Psychiatry IV, Austria
| | - S Völkl-Kernstock
- University of Vienna, Department of Child and Adolescent Psychiatry, Austria
| | - O M Lesch
- University of Vienna, Department of Psychiatry, Austria
| | - H Walter
- University of Vienna, Department of Psychiatry, Austria
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Lang A, Papp B, Gonda X, Dome P, Rihmer Z. Dimensions of adult attachment are significantly associated with specific affective temperament constellations in a Hungarian university sample. J Affect Disord 2016; 191:78-81. [PMID: 26655115 DOI: 10.1016/j.jad.2015.11.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 11/11/2015] [Accepted: 11/15/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Related to emotion regulation and mental health, adult attachment and affective temperaments are relevant research topics of contemporary psychiatry and clinical psychology. However, to date, only one study investigated the relationship between these two constructs. Thus, we aimed to further reveal adult attachment's association with affective temperaments. METHODS Affective temperament and adult attachment dimensions of 1469 Hungarian university students were assessed with self-report measures (Temperament Evaluation of Memphis, Pisa and San Diego autoquestionnaire and Experiences in Close Relationships Scale, respectively). Age and measured variables were compared between genders with ANOVAs. Associations between attachment dimensions and affective temperaments were examined with Pearson's correlations and partial correlations; the moderation effect of age and gender on these relationships was tested with PROCESS macro. Using Fisher r-to-z transformation, we also compared our results with the findings of the previous study. Cohen's ds were used to report effect size and Cronbach's alphas were computed as indices of internal reliability. RESULTS Significant correlations were found between attachment dimensions and affective temperaments. Correlations were especially robust between attachment anxiety and depressive, cyclothymic and anxious temperaments. Contrasted with the results of the previous study, hyperthymic temperament was negatively related to attachment avoidance and anxious temperament was significantly more strongly correlated with attachment anxiety in our study. LIMITATIONS We used a previous version of the adult attachment measure. Our sample differed from the target sample in several ways. Participants were not screened for mental disorders. CONCLUSIONS Findings highlight that adult attachment dimensions are significantly associated with affective temperaments.
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Affiliation(s)
- Andras Lang
- Institute of Psychology, University of Pecs, Ifjusag str. 6., H-7624 Pecs, Hungary.
| | - Barbara Papp
- Doctoral School of Psychology, University of Pecs, Ifjusag str. 6., H-7624 Pecs, Hungary
| | - Xenia Gonda
- Department of Clinical and Theoretical Mental Health, Semmelweis University, Kutvolgyi str. 4., H-1125 Budapest, Hungary; National Institute of Psychiatry and Addictions, Laboratory for Suicide Research and Prevention, Lehel str. 59, H-1135 Budapest, Hungary; MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Hungarian Academy of Sciences, Nagyvarad sq. 4., H-1089 Budapest, Hungary
| | - Peter Dome
- Department of Clinical and Theoretical Mental Health, Semmelweis University, Kutvolgyi str. 4., H-1125 Budapest, Hungary; National Institute of Psychiatry and Addictions, Laboratory for Suicide Research and Prevention, Lehel str. 59, H-1135 Budapest, Hungary
| | - Zoltan Rihmer
- Department of Clinical and Theoretical Mental Health, Semmelweis University, Kutvolgyi str. 4., H-1125 Budapest, Hungary; National Institute of Psychiatry and Addictions, Laboratory for Suicide Research and Prevention, Lehel str. 59, H-1135 Budapest, Hungary
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Avoidant personality disorder as a social anxiety phenotype: risk factors, associations and treatment. Curr Opin Psychiatry 2016; 29:64-9. [PMID: 26651009 DOI: 10.1097/yco.0000000000000211] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This article identifies research trends and synthesizes information from recent studies of avoidant personality disorder (AVPD). RECENT FINDINGS AVPD and social anxiety disorder (SAD) share genetic vulnerability, but may have distinct environmental risk factors that shape qualitative differences. Negative self-concept, shame proneness, and interpersonal hypersensitivity are characteristic of AVPD and may be predisposed to by heritable traits of high negative affectivity and low positive affectivity, and experiences of neglectful or emotionless parents. The interpersonal difficulties of AVPD may be associated with both anxious and avoidant attachment. Most individuals with AVPD do not also meet criteria for SAD. SUMMARY Integrative treatments incorporating cognitive behavioral strategies effective in SAD but also targeting shame aversion and avoidance may be most helpful for AVPD. Therapy adapted to both anxious attachment, associated with heightened interpersonal sensitivity and distress, and avoidant attachment, associated with experiential avoidance, may be optimal, though this is yet to be tested. Effective treatment of AVPD may enhance the outcome of comorbid conditions. More research is needed which compares three social anxiety groups (SAD alone, AVPD alone, and SAD plus AVPD) to further explore these disorders which are highly related, but which may have differences that are clinically relevant for individuals.
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25
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MacDonald K, Sciolla AF, Folsom D, Bazzo D, Searles C, Moutier C, Thomas ML, Borton K, Norcross B. Individual risk factors for physician boundary violations: the role of attachment style, childhood trauma and maladaptive beliefs. Gen Hosp Psychiatry 2015; 37:489-96. [PMID: 26554082 DOI: 10.1016/j.genhosppsych.2015.06.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The assessment and remediation of boundary-challenged healthcare professionals is enhanced through examination of individual risk factors. We assessed three such factors--attachment style, childhood trauma and maladaptive beliefs--in 100 attendees (mostly physicians) of a CME professional boundaries course. We propose a theoretical model which draws a causal arc from childhood maltreatment through insecure attachment and maladaptive beliefs to elevated risk for boundary violations. METHODS We administered the Experiences in Close Relationship Questionnaire (ECR-R), Childhood Trauma Questionnaire (CTQ), and Young Schema Questionnaire (YSQ) to 100 healthcare professionals (mostly physicians) attending a CME course on professional boundaries. Experts rated participant autobiographies to determine attachment style and early adversities. Correlations and relationships among self- and expert ratings and between different risk factors were examined. RESULTS Five percent of participants reported CTQ total scores in the moderate to severe range; eleven percent reported moderate to severe emotional neglect or emotional abuse. Average attachment anxiety and attachment avoidance were low, and more than half of participants were rated “secure” by experts. Childhood maltreatment was correlated with attachment anxiety and avoidance and predicted expert-rated insecure attachment and maladaptive beliefs. CONCLUSION Our findings support a potential link between childhood adversity and boundary difficulties, partly mediated by insecure attachment and early maladaptive beliefs. Furthermore, these results suggest that boundary education programs and professional wellness programs may be enhanced with a focus on sequelae of childhood maltreatment, attachment and common maladaptive thinking patterns.
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26
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Hengartner MP, von Wyl A, Tanis T, Halmi W, Galynker I, Cohen LJ. Severity of personality disorders and domains of general personality dysfunction related to attachment. Personal Ment Health 2015; 9:195-207. [PMID: 26033749 DOI: 10.1002/pmh.1297] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 02/27/2015] [Accepted: 04/29/2015] [Indexed: 02/02/2023]
Abstract
This is the first study to link attachment to both severity of total DSM-IV personality disorder (PD) traits and domains of general personality dysfunction, using a sample of 72 inpatients from New York City. We assessed a measure of global PD severity and the core domains of personality functioning using the severity indices of personality problems (SIPP-118). Attachment was measured with the experience in close relationships-revised (ECR-R) and the relationship style questionnaire (RSQ). Global PD severity correlated most strongly with attachment anxiety (r = 0.65). Regression of the SIPP-118 domains on attachment produced models that accounted for a substantial proportion of variance in those scales (R(2) ranging from 28.2 to 54.2%). SIPP-118 relational capacities were the strongest predictor of ECR-R avoidance (β = -0.88) and anxiety (β = -0.58), as well as RSQ secure (β = 0.53) and fearful (β = -0.65). In conclusion, insecure attachment strongly related to the severity of global PD traits and specifically to relational capacities, which are a higher-order domain of general personality dysfunction. These findings provide further evidence that interpersonal problems are at the core of PDs and that attachment could constitute an important mediator of the social dysfunction in persons with personality pathology.
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Affiliation(s)
- Michael P Hengartner
- School of Applied Psychology, Zurich University of Applied Sciences (ZHAW), Zurich, Switzerland
| | - Agnes von Wyl
- School of Applied Psychology, Zurich University of Applied Sciences (ZHAW), Zurich, Switzerland
| | - Thachell Tanis
- Icahn School of Medicine, Mount Sinai Beth Israel Medical Center, New York City, NY, USA
| | | | - Igor Galynker
- Icahn School of Medicine, Mount Sinai Beth Israel Medical Center, New York City, NY, USA
| | - Lisa J Cohen
- Icahn School of Medicine, Mount Sinai Beth Israel Medical Center, New York City, NY, USA
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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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Individual risk factors for physician boundary violations: the role of attachment style, childhood trauma and maladaptive beliefs. Gen Hosp Psychiatry 2015; 37:81-8. [PMID: 25440724 DOI: 10.1016/j.genhosppsych.2014.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 08/20/2014] [Accepted: 09/01/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The assessment and remediation of boundary-challenged health care professionals is enhanced through examination of individual risk factors. We assessed three such factors - attachment style, childhood trauma and maladaptive beliefs - in 100 attendees (mostly physicians) of a continuing medical education (CME) professional boundaries course. We propose a theoretical model that draws a causal arc from childhood maltreatment through insecure attachment and maladaptive beliefs to elevated risk for boundary violations. METHODS We administered the Experiences in Close Relationships Questionnaire Revised (ECR-R), Childhood Trauma Questionnaire (CTQ) and Young Schema Questionnaire (YSQ) to 100 health care professionals attending a CME course on professional boundaries. Experts rated participant autobiographies to determine attachment style and early adversities. Correlations and relationships between self-ratings and expert ratings and among different risk factors were examined. RESULTS One fifth of participants reported moderate to severe childhood abuse; sixty percent reported moderate to severe emotional neglect. Despite this, average attachment anxiety and attachment avoidance were low, and more than half of participants were rated "secure" by experts. Childhood maltreatment was correlated with attachment anxiety and avoidance and predicted expert-rated insecure attachment and maladaptive beliefs. CONCLUSIONS Our findings support a potential link between childhood adversity and boundary difficulties, partly mediated by insecure attachment and early maladaptive beliefs. Furthermore, these results suggest that boundary education programs and professional wellness programs may be enhanced with a focus on sequelae of childhood maltreatment, attachment and common maladaptive thinking patterns.
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29
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Weinstein L, Perez-Rodriguez MM, Siever L. Personality disorders, attachment and psychodynamic psychotherapy. Psychopathology 2014; 47:425-36. [PMID: 25376756 DOI: 10.1159/000366135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 07/24/2014] [Indexed: 01/10/2023]
Abstract
While attachment has been a fruitful and critical concept in understanding enduring individual templates for interpersonal relationships, it does not have a well-understood relationship to personality disorders, where impairment of interpersonal functioning is paramount. Despite the recognition that attachment disturbances do not simply reflect nonoptimal caretaking environments, the relationship of underlying temperamental factors to these environmental insults has not been fully explored. In this paper we provide an alternate model for the role of neurobiological temperamental factors, including brain circuitry and neuropeptide modulation, in mediating social cognition and the internalization and maintenance of attachment patterns. The implications of these altered attachment patterns on personality disorders and their neurobiological and environmental roots for psychoanalytically based treatment models designed to ameliorate difficulties in interpersonal functioning through the medium of increased access to mature forms of mentalization is discussed.
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Affiliation(s)
- Lissa Weinstein
- Doctoral Program in Clinical Psychology, City College of New York and Graduate Center, New York, N.Y., USA
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