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Fanti E, Di Sarno M, Di Pierro R. In search of hidden threats: A scoping review on paranoid presentations in personality disorders. Clin Psychol Psychother 2023; 30:1215-1233. [PMID: 37727949 DOI: 10.1002/cpp.2913] [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: 03/13/2023] [Revised: 07/25/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023]
Abstract
Recent diagnostic developments suggest that paranoia is a transdiagnostic characteristic common to several personality disorders rather than a personality disorder per se. Nonetheless, empirical literature fails to provide comprehensive and univocal findings on whether and how paranoid presentations relate to different personality disorders. In the present scoping review, we map the empirical literature on paranoid presentations in personality disorders, considering the entire spectrum of paranoid manifestations (i.e., the paranoia hierarchy). In selecting original quantitative studies on paranoid presentations in personality-disordered patients, we screened 4,433 records in PsycArticles, PsycInfo and PUBMED. We eventually included 47 eligible studies in the review. Our synthesis indicates consistent empirical evidence of a wide range of paranoid presentations in Paranoid, Schizotypal and Borderline personality disorders. Conversely, little empirical literature exists on paranoid presentations in other personality disorders. Preliminary findings suggest broad-severity paranoid presentations, ranging from milder to severe forms, in Paranoid, Schizotypal and Borderline personality disorders. There is also some evidence of milder forms of paranoia in Avoidant, Antisocial and Narcissistic personality disorders. Conversely, there is poor evidence of paranoid presentations in Schizoid, Histrionic, Dependent or Obsessive-compulsive personality disorders. Research gaps and recommendations for improving empirical research on paranoid presentations in personality disorders are discussed.
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Affiliation(s)
- Erika Fanti
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Marco Di Sarno
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
- Personality Disorder Lab (PDLab), Milan-Parma, Italy
| | - Rossella Di Pierro
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
- Personality Disorder Lab (PDLab), Milan-Parma, Italy
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Henriques-Calado J, Pires R, Paulino M, Gama Marques J, Gonçalves B. Psychotic spectrum features in borderline and bipolar disorders within the scope of the DSM-5 section III personality traits: a case control study. Borderline Personal Disord Emot Dysregul 2023; 10:2. [PMID: 36647173 PMCID: PMC9841700 DOI: 10.1186/s40479-022-00205-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/14/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Psychotic spectrum features in borderline personality disorder (PD) are a long-standing phenomenon, but remarkably, to date, they have not been the focus of many empirical studies. Moreover, the comparative studies that acknowledge their links to affective psychoses are even more scarce. Likewise, the contributions of empirical research on the DSM-5 dimensional approach to this topic are also uncommon. This study seeks to identify the best set of pathological personality traits and/or symptoms that are predictors of psychotic features (psychoticism and ideation paranoid symptoms) in borderline PD and in bipolar disorder, based on the framework of the DSM-5 section III personality traits. METHODS A cross-sectional study of two clinical samples: 1) Borderline PD group of 63 participants; 2) Bipolar disorder group of 65 participants. Self-reported assessment: Personality Inventory for DSM-5 (PID-5); Brief Symptom Inventory (BSI). A series of linear and logistic regression analyses were computed. RESULTS Overall, the data emerging as common predictors are detachment, negative affectivity, psychoticism, depressivity, grandiosity, suspiciousness and interpersonal sensitivity symptoms. Borderline PD has the highest score in BSI paranoid ideation which emerges as its discriminating trait (Nagelkerke R2 = .58): cognitive and perceptual dysregulation (OR: 13.02), restricted affectivity (OR: 12.09), withdrawal (OR: 11.70), anhedonia (OR: 10.98) and emotional lability (OR: 6.69). CONCLUSIONS Besides the commonality that appears to overlap both disorders with a psychosis superspectrum, the patterns of the pathological personality-symptoms underlying the psychotic features appear to reinforce a position between schizophrenia and bipolar disorders that borderline PD may occupy, highlighting the possibility of its intersection with schizoaffective/psychosis spectra. The pathological personality nature of the psychotic features emerges as a potential comprehensive trait of the phenomenological dimensions.
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Affiliation(s)
- Joana Henriques-Calado
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013, Lisboa, Portugal. .,CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013, Lisboa, Portugal.
| | - Rute Pires
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013, Lisboa, Portugal.,CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013, Lisboa, Portugal
| | - Marco Paulino
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013, Lisboa, Portugal.,Clínica Universitária de Psiquiatra e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal
| | - João Gama Marques
- Clínica Universitária de Psiquiatra e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal.,Consulta de Esquizofrenia Resistente, Hospital Júlio de Matos, Centro Hospitalar Psiquiátrico de Lisboa, Avenida do Brasil, 53, 1749-002, Lisboa, Portugal
| | - Bruno Gonçalves
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013, Lisboa, Portugal.,CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013, Lisboa, Portugal
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