1
|
Hofman S, Hafkemeijer L, de Jongh A, Starrenburg A, Slotema K. Trauma-focused EMDR for Personality disorders among Outpatients (TEMPO): study protocol for a multi-centre, single-blind, randomized controlled trial. Trials 2022; 23:196. [PMID: 35246228 PMCID: PMC8896281 DOI: 10.1186/s13063-022-06082-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 02/03/2022] [Indexed: 12/02/2022] Open
Abstract
Background Existing recommended treatment options for personality disorders (PDs) are extensive and costly. There is emerging evidence indicating that trauma-focused treatment using eye movement desensitization and reprocessing (EMDR) therapy aimed at resolving memories of individuals’ adverse events can be beneficial for this target group within a relatively short time frame. The primary purpose of the present study is to determine the effectiveness of EMDR therapy versus waiting list in reducing PD symptom severity. Furthermore, the effects of EMDR therapy on trauma symptom severity, loss of diagnosis, personal functioning, quality of life, and mental health outcomes will be determined. In addition, the cost-effectiveness of EMDR therapy in the treatment of PDs is investigated. Moreover, predictors of treatment success, symptom deterioration and treatment discontinuation will be assessed. Lastly, experiences with EMDR therapy will be explored. Method In total, 159 patients with a PD will be included in a large multicentre single-blind randomized controlled trial. The Structured Clinical Interview for DSM-5 Personality Disorders will be used to determine the presence of a PD. Participants will be allocated to either a treatment condition with EMDR therapy (ten biweekly 90-min sessions) or a waiting list. Three months after potential treatment with EMDR therapy, patients can receive treatment as usual for their PD. All participants are subject to single-blinded baseline, post-intervention and 3-, 6- and 12-month follow-up assessments. The primary outcome measures are the Assessment of DSM-IV Personality Disorders and the Clinician-Administered PTSD Scale for DSM-5. For cost-effectiveness, the Treatment Inventory of Costs in Patients with psychiatric disorders, EuroQol-5D-3L, and the Mental Health Quality of Life Questionnaire will be administered. The PTSD Checklist for DSM-5, Brief State Paranoia Checklist and Difficulties in Emotion Regulation Scale will be used to further index trauma symptom severity. Type of trauma is identified at baseline with the Childhood Trauma Questionnaire-SF and Life Events Checklist for the DSM-5. Personal functioning and health outcome are assessed with the Level of Personality Functioning Scale-BF 2.0, Outcome Questionnaire-45 and Mental Health Quality of Life Questionnaire. Experiences with EMDR therapy of patients in the EMDR therapy condition are explored with a semi-structured interview at post-intervention. Discussion It is expected that the results of this study will contribute to knowledge about the effectiveness, and cost-effectiveness of trauma-focused treatment using EMDR therapy in individuals diagnosed with a PD. Follow-up data provide documentation of long-term effects of EMDR therapy on various outcome variables, most importantly the reduction of PD symptom severity and loss of diagnoses. Trial registration Netherlands Trial Register NL9078. Registered on 31 November 2020
Collapse
Affiliation(s)
- Simon Hofman
- Department of Personality Disorders, Parnassia Psychiatric Institute, Lijnbaan 4, 2512VA, The Hague, The Netherlands
| | | | - Ad de Jongh
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands.,Research Department, PSYTREC, Bilthoven, The Netherlands.,School of Health Sciences, Salford University, Manchester, UK.,Institute of Health and Society, University of Worcester, Worcester, UK.,School of Psychology, Queen's University Belfast, Belfast, Northern Ireland
| | | | - Karin Slotema
- Department of Personality Disorders, Parnassia Psychiatric Institute, Lijnbaan 4, 2512VA, The Hague, The Netherlands. .,Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| |
Collapse
|
2
|
Hsu CW, Wang LJ, Lin PY, Hung CF, Yang YH, Chen YM, Kao HY. Differences in Psychiatric Comorbidities and Gender Distribution among Three Clusters of Personality Disorders: A Nationwide Population-Based Study. J Clin Med 2021; 10:jcm10153294. [PMID: 34362081 PMCID: PMC8347782 DOI: 10.3390/jcm10153294] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/23/2021] [Accepted: 07/23/2021] [Indexed: 12/03/2022] Open
Abstract
Personality disorders (PDs) are grouped into clusters A, B, and C. However, whether the three clusters of PDs have differences in comorbid mental disorders or gender distribution is still lacking sufficient evidence. We aim to investigate the distribution pattern across the three clusters of PDs with a population-based cohort study. This study used the Taiwan national database between 1995 and 2013 to examine the data of patients with cluster A PDs, cluster B PDs, or cluster C PDs. We compared the differences of psychiatric comorbidities classified in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition across the three clusters of PDs. Moreover, we formed gender subgroups of the three PDs to observe the discrepancy between male and female. Among the 9845 patients, those with cluster A PDs had the highest proportion of neurodevelopmental disorders, schizophrenia and neurocognitive disorders, those with cluster B PDs demonstrated the largest percentage of bipolar disorders, trauma and stressor disorders, feeding and eating disorders, and substance and addictive disorders, and those with cluster C PDs had the greatest proportion of depressive disorders, anxiety disorders, obsessive–compulsive disorders, somatic symptom disorders, and sleep–wake disorders. The gender subgroups revealed significant male predominance in neurodevelopmental disorders and female predominance in sleep–wake disorders across all three clusters of PDs. Our findings support that some psychiatric comorbidities are more prevalent in specified cluster PDs and that gender differences exist across the three clusters of PDs. These results are an important reference for clinicians who are developing services that target real-world patients with PDs.
Collapse
Affiliation(s)
- Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (C.-W.H.); (P.-Y.L.); (C.-F.H.)
- Department of Computer Science and Information Engineering, National Cheng Kung University, Tainan 70101, Taiwan
| | - Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan;
| | - Pao-Yen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (C.-W.H.); (P.-Y.L.); (C.-F.H.)
- Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
| | - Chi-Fa Hung
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (C.-W.H.); (P.-Y.L.); (C.-F.H.)
- College of Humanities and Social Sciences, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan
| | - Yao-Hsu Yang
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi County 613016, Taiwan;
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi County 613016, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 333323, Taiwan
| | - Yu-Ming Chen
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (C.-W.H.); (P.-Y.L.); (C.-F.H.)
- Correspondence: (Y.-M.C.); (H.-Y.K.); Tel.: +886-7-7317123 (ext. 8753) (Y.-M.C.); +886-6-2757575 (ext. 62546) (H.-Y.K.); Fax: +886-7-7326817 (Y.-M.C.); +886-6-2747076 (H.-Y.K.)
| | - Hung-Yu Kao
- Department of Computer Science and Information Engineering, National Cheng Kung University, Tainan 70101, Taiwan
- Correspondence: (Y.-M.C.); (H.-Y.K.); Tel.: +886-7-7317123 (ext. 8753) (Y.-M.C.); +886-6-2757575 (ext. 62546) (H.-Y.K.); Fax: +886-7-7326817 (Y.-M.C.); +886-6-2747076 (H.-Y.K.)
| |
Collapse
|
3
|
Cohen AS, Couture SM, Blanchard JJ. Social anhedonia and clinical outcomes in early adulthood: A three-year follow-up study within a community sample. Schizophr Res 2020; 223:213-219. [PMID: 32792232 PMCID: PMC7704724 DOI: 10.1016/j.schres.2020.07.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 06/25/2020] [Accepted: 07/27/2020] [Indexed: 11/17/2022]
Abstract
Social anhedonia has been employed in psychometric high risk studies to identify putative schizotypes. The current study reports three-year longitudinal results from a community study of social anhedonia: the Maryland Longitudinal Study of Schizotypy (MLSS). The initial recruitment for the MLSS involved mailed questionnaire screening of 2434 18-year olds. Baseline and three-year follow-up laboratory assessments were subsequently conducted with individuals identified as being high in social anhedonia (N = 79) and a comparison sample (N = 79). Across the assessments both groups showed maturational improvement on all clinical symptom measures with declining symptom severity at the follow-up compared to baseline and there were no group differences in personality disorder diagnoses at follow-up. However, compared to the control group, over the three-year follow-up individuals in the social anhedonia group were found to have elevated schizophrenia-spectrum personality disorder (Cluster A) characteristics, greater negative symptom characteristics, and lower global functioning. The social anhedonia group also had lower educational attainment, higher unemployment, and higher rates of mental health service utilization than did the control group. Within the social anhedonia group, social support and family relationships were cross-sectionally related to symptom severity at follow-up, although social support and family variables from baseline were not predictive of clinical symptom outcomes at follow-up. Results indicate that social anhedonia is associated with persistent schizophrenia-spectrum symptoms and functional impairment in early adulthood.
Collapse
Affiliation(s)
- Alex S Cohen
- Louisiana State University, United States of America
| | | | | |
Collapse
|
4
|
Abstract
PURPOSE OF REVIEW We review recent research concerning the diagnosis and treatment of borderline personality disorder (BPD) in young people. We examine evidence for the need to define an appropriate age for detection, and the suitability of current classification methods and treatment. RECENT FINDINGS Evidence supports early detection and intervention for subsyndromal borderline pathology or categorical BPD across an extended developmental period. A range of structured treatments are effective for BPD in young people, although the role of treatment components in successful outcomes is unclear. Substantial evidence suggests that a stronger focus on functional outcomes, especially social and vocational outcomes, is warranted. Effective treatments for BPD are rarely available internationally. There is a need to assess whether less complex interventions might be developed that are scalable across health systems. A clinical staging model should be considered, addressing clinical distress and co-occurring psychopathology, as well as diagnosis.
Collapse
|
5
|
Kongerslev MT, Chanen AM, Simonsen E. Personality Disorder in Childhood and Adolescence comes of Age: a Review of the Current Evidence and Prospects for Future Research. Scand J Child Adolesc Psychiatr Psychol 2015. [DOI: 10.21307/sjcapp-2015-004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
6
|
Hallquist MN, Lenzenweger MF. Identifying latent trajectories of personality disorder symptom change: growth mixture modeling in the longitudinal study of personality disorders. JOURNAL OF ABNORMAL PSYCHOLOGY 2012; 122:138-55. [PMID: 23231459 DOI: 10.1037/a0030060] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although previous reports have documented mean-level declines in personality disorder (PD) symptoms over time, little is known about whether personality pathology sometimes emerges among nonsymptomatic adults, or whether rates of change differ qualitatively among symptomatic persons. Our study sought to characterize heterogeneity in the longitudinal course of PD symptoms with the goal of testing for and describing latent trajectories. Participants were 250 young adults selected into two groups using a PD screening measure: those who met diagnostic criteria for a DSM-III-R PD (PPD, n = 129), and those with few PD symptoms (NoPD, n = 121). PD symptoms were assessed three times over a 4-year study using semistructured interviews. Total PD symptom counts and symptoms of each DSM-III-R PD were analyzed using growth mixture modeling. In the NoPD group, latent trajectories were characterized by stable, minor symptoms; the rapid or gradual remission of subclinical symptoms; or the emergence of symptoms of avoidant, obsessive-compulsive, or paranoid PD. In the PPD group, three latent trajectories were evident: rapid symptom remission, slow symptom decline, or a relative absence of symptoms. Rapid remission of PD symptoms was associated with fewer comorbid disorders, lower Negative Emotionality, and greater Positive Emotionality and Constraint, whereas emergent personality dysfunction was associated with comorbid PD symptoms and lower Positive Emotionality. In most cases, symptom change for one PD was associated with concomitant changes in other PDs, depressive symptoms, and anxiety. These results indicate that the longitudinal course of PD symptoms is heterogeneous, with distinct trajectories evident for both symptomatic and nonsymptomatic individuals. The prognosis of PD symptoms may be informed by an assessment of personality and comorbid psychopathology.
Collapse
|
7
|
Gutiérrez F, Vall G, Peri JM, Baillés E, Ferraz L, Gárriz M, Caseras X. Personality disorder features through the life course. J Pers Disord 2012; 26:763-74. [PMID: 23013344 DOI: 10.1521/pedi.2012.26.5.763] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Personality Disorders have proved to be more fluid through the life course than previously thought. However, because analyses have usually been undertaken at the level of diagnostic categories, relevant findings may be obscured. An examination at the criteria level could bypass arbitrary aggregations of heterogeneous traits and thus offer more accurate information. To this end, we administered the Personality Diagnostic Questionnaire-4+ (PDQ-4+) to 1,477 patients aged 15 to 82. Nine of 12 disorders declined to some extent over the lifespan, but the evolution of individual criteria diverged within categories. At this level, 45 of 93 criteria showed age-related decreases, whereas only seven presented increases. A clearer picture is offered of the PD traits that change and those that remain stable. Thus, pathological features are not only more fluid, but developmentally more heterogeneous than previously believed.
Collapse
Affiliation(s)
- Fernando Gutiérrez
- Servei Psicologia Clínica, Institut Clínic Neurociències, Hospital Clínic de Barcelona, Villarroel 170, 08036 Barcelona, Spain.
| | | | | | | | | | | | | |
Collapse
|
8
|
Kasen S, Cohen P, Chen H. Developmental course of impulsivity and capability from age 10 to age 25 as related to trajectory of suicide attempt in a community cohort. Suicide Life Threat Behav 2011; 41:180-92. [PMID: 21342218 PMCID: PMC3082462 DOI: 10.1111/j.1943-278x.2011.00017.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Hierarchical linear models were used to examine trajectories of impulsivity and capability between ages 10 and 25 in relation to suicide attempt in 770 youths followed longitudinally: intercepts were set at age 17. The impulsivity measure assessed features of urgency (e.g., poor control, quick provocation, and disregard for external constraints); the capability measure assessed aspects of self-esteem and mastery. Compared to nonattempters, attempters reported significantly higher impulsivity levels with less age-related decline, and significantly lower capability levels with less age-related increase. Independent of other risks, suicide attempt was related significantly to higher impulsivity between ages 10 and 25, especially during the younger years, and lower capability. Implications of those findings for further suicidal behavior and preventive/intervention efforts are discussed.
Collapse
Affiliation(s)
- Stephanie Kasen
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
| | - Patricia Cohen
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Henian Chen
- Winthrop University Hospital, Stony Brook University School of Medicine, Stony Brook, NY, USA
| |
Collapse
|
9
|
Skodol AE, Shea MT, Yen S, White CN, Gunderson JG. Personality disorders and mood disorders: perspectives on diagnosis and classification from studies of longitudinal course and familial associations. J Pers Disord 2010; 24:83-108. [PMID: 20205500 PMCID: PMC6540749 DOI: 10.1521/pedi.2010.24.1.83] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The results of three rigorous studies of the naturalistic course of personality disorders indicate the following: (1) personality psychopathology improves over time at unexpectedly significant rates; (2) particular maladaptive personality traits are more stable than personality disorder diagnoses; (3) although personality psychopathology improves, residual effects are usually seen in the form of persistent functional impairment and ongoing Axis I psychopathology; and (4) improvement in personality psychopathology may eventually be associated with reduction in ongoing personal and social burden. A comparison of the longitudinal stability of personality disorders and mood disorders does not support a clear distinction between them based on differential stability of either psychopathology (at least based on remission rates) or functional impairment. Differences may yet emerge with respect to relapse rates over the longer term. Both types of disorders may share some common underlying vulnerabilities best conceptualized in term of personality traits. A group of promising, though methodologically flawed, family studies suggest familiality of at least BPD among the personality disorders and the coaggregation of BPD and depressive disorders (but not bipolar disorders) that may contribute to their frequent co-occurrence. Again, underlying personality traits may prove to be more heritable than either type of disorder.
Collapse
Affiliation(s)
| | - M. Tracie Shea
- Department of Psychiatry and Human Behavior, Alpert Brown Medical School
| | - Shirley Yen
- Department of Psychiatry and Human Behavior, Alpert Brown Medical School
| | - Candace N. White
- Department of Psychiatry and Human Behavior, Alpert Brown Medical School
| | - John G. Gunderson
- Department of Psychiatry, McLean Hospital and Harvard Medical School
| |
Collapse
|
10
|
A unifying perspective on personality pathology across the life span: developmental considerations for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. Dev Psychopathol 2009; 21:687-713. [PMID: 19583880 DOI: 10.1017/s095457940900039x] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Proposed changes in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) include replacing current personality disorder (PD) categories on Axis II with a taxonomy of dimensional maladaptive personality traits. Most of the work on dimensional models of personality pathology, and on personality disorders per se, has been conducted on young and middle-aged adult populations. Numerous questions remain regarding the applicability and limitations of applying various PD models to early and later life. In the present paper, we provide an overview of such dimensional models and review current proposals for conceptualizing PDs in DSM-V. Next, we extensively review existing evidence on the development, measurement, and manifestation of personality pathology in early and later life focusing on those issues deemed most relevant for informing DSM-V. Finally, we present overall conclusions regarding the need to incorporate developmental issues in conceptualizing PDs in DSM-V and highlight the advantages of a dimensional model in unifying PD perspectives across the life span.
Collapse
|
11
|
Emmerson LC, Miller SL, Blanchard JJ. Behavioral signs of schizoidia and schizotypy in the biological parents of social anhedonics. Behav Modif 2009; 33:452-73. [PMID: 19436072 PMCID: PMC2849114 DOI: 10.1177/0145445509336431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A community sample of 88 putative schizotypes (48 social anhedonics, 40 controls), aged 18 to 19 years, and their biological parents (42 mothers of social anhedonics, 37 mothers of controls; 24 fathers of social anhedonics, 20 fathers of controls) receive videotaped diagnostic evaluations that serve as the basis for ratings of behavioral signs of schizoidia and schizotypy. Proband social anhedonics exhibit more atypical interpersonal behaviors characteristic of schizoid and schizotypal personality disorders than controls. Mothers of social anhedonics display more atypical interpersonal behaviors characteristic of schizotypal personality disorder than mothers of controls. In contrast, clinical symptom ratings of schizotypy do not differentiate mothers of social anhedonics from mothers of controls. Meaningful, though not statistically significant, effects are observed for behavioral sign ratings in the smaller sample of fathers of social anhedonics. Results provide preliminary support for the familiality of atypical interpersonal behavior in social anhedonics.
Collapse
|
12
|
Chen H, Cohen P, Johnson JG, Kasen S. Psychiatric disorders during adolescence and relationships with peers from age 17 to age 27. Soc Psychiatry Psychiatr Epidemiol 2009; 44:223-30. [PMID: 18670727 DOI: 10.1007/s00127-008-0421-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2007] [Accepted: 07/09/2008] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate normative patterns of peer relationships from ages 17 to 27, and to examine the impact of adolescent psychiatric disorders on peer relationships. METHOD Psychiatric disorders were measured at a mean age 16 years. At mean age 29, 200 participants completed detailed narrative interviews about their transition to adulthood. Monthly contact and conflict with peers were described in narratives covering ages 17-27. RESULTS Adolescent psychiatric disorders did not predict the frequency of peer contact in the young adult period. However, adolescent disruptive disorders predicted greater peer conflict regardless of contact frequency. Adolescents with major depressive or substance abuse disorders and subsequent high frequency of peer contact reported elevated peer conflict during the transition to adulthood. In contrast, among study participants with frequent peer contact during this period, those with adolescent anxiety disorders reported less peer conflict than did those without such a diagnostic history. CONCLUSIONS Adolescents with major depressive, disruptive, and substance abuse disorders may be at risk for long-term negative peer relationships, whereas those with anxiety disorders may subsequently avoid peer conflict.
Collapse
Affiliation(s)
- Henian Chen
- Division of Epidemiology, New York State Psychiatric Institute, New York, NY, USA.
| | | | | | | |
Collapse
|
13
|
Abstract
The notion of personality disorders (PDs) as stable disorders has persisted despite traditional follow-up studies showing that fewer than 50% of patients diagnosed with PDs retained these diagnoses over time. Because these studies had methodological limitations, four more rigorous large-scale studies of the naturalistic course of PDs have been conducted. The results indicate (1) personality psychopathology improves over time at unexpectedly significant rates; (2) maladaptive personality traits are more stable than PD diagnoses; (3) although personality psychopathology improves, residual effects can be seen in the form of persistent functional impairment, continuing behavioral problems, reduced future quality of life, and ongoing Axis I psychopathology; (4) improvement in personality psychopathology may eventually be associated with reduction in ongoing personal and social burden.
Collapse
Affiliation(s)
- Andrew E Skodol
- Institute for Mental Health Research, 3300 N. Central Avenue, Suite 2380, Phoenix, AZ 85012, USA.
| |
Collapse
|
14
|
Abstract
The evidence is surprisingly strong that even early adolescent personality disorders or elevated personality disorder symptoms have a broad range of negative effects well into adulthood, for the most part comparable to or even larger than those of Axis I disorders. Current evidence suggests that the most severe long-term prognosis is associated with borderline and schizotypal PDs and elevated symptoms. And of course, childhood conduct disorder is in a peculiar status, disappearing in adulthood to be manifest as a very severe disorder-antisocial PD-in a minority of those with the adolescent disorder.
Collapse
Affiliation(s)
- Patricia Cohen
- Columbia University College of Physicians & Surgeons and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| |
Collapse
|
15
|
Kasen S, Cohen P, Skodol AE, First MB, Johnson JG, Brook JS, Oldham JM. Comorbid personality disorder and treatment use in a community sample of youths: a 20-year follow-up. Acta Psychiatr Scand 2007; 115:56-65. [PMID: 17201867 DOI: 10.1111/j.1600-0447.2006.00842.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The impact of comorbid personality disorder (PD) on subsequent treatment and psychotropic drug use was examined in a representative sample of over 700 individuals. METHOD Axis I disorders and PD were assessed by self- and mother-report at mean ages 13 and 22 years, and by self-report at mean age 33. Mothers reported treatment use by participants before mean age 33; participants reported treatment and psychotropic drug use at mean age 33. RESULTS Individuals with multiple axis I disorders without PD, axis I disorder-PD comorbidity, and single disorders were compared simultaneously to individuals not diagnosed. Overall, odds of subsequent and past year treatment or psychotropic drug use or both were highest when PD co-occurred with a mood, an anxiety, a disruptive, or a substance use disorder. CONCLUSION Co-occurring personality pathology may contribute to elevated mental health service use, including use of psychotropic drugs, among young adults in the community.
Collapse
Affiliation(s)
- S Kasen
- Department of Psychiatry, Columbia University, New York, NY, USA.
| | | | | | | | | | | | | |
Collapse
|
16
|
Chen H, Cohen P. Using individual growth model to analyze the change in quality of life from adolescence to adulthood. Health Qual Life Outcomes 2006; 4:10. [PMID: 16504035 PMCID: PMC1397823 DOI: 10.1186/1477-7525-4-10] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2005] [Accepted: 02/21/2006] [Indexed: 12/01/2022] Open
Abstract
Background The individual growth model is a relatively new statistical technique now widely used to examine the unique trajectories of individuals and groups in repeated measures data. This technique is increasingly used to analyze the changes over time in quality of life (QOL) data. This study examines the change from adolescence to adulthood in physical health as an aspect of QOL as an illustration of the use of this analytic method. Methods Employing data from the Children in the Community (CIC) study, a prospective longitudinal investigation, physical health was assessed at mean ages 16, 22, and 33 in 752 persons born between 1965 and 1975. Results The analyses using individual growth models show a linear decline in average physical health from age 10 to age 40. Males reported better physical health and declined less per year on average. Time-varying psychiatric disorders accounted for 8.6% of the explained variation in mean physical health, and 6.7% of the explained variation in linear change in physical health. Those with such a disorder reported lower mean physical health and a more rapid decline with age than those without a current psychiatric disorder. The use of SAS PROC MIXED, including syntax and interpretation of output are provided. Applications of these models including statistical assumptions, centering issues and cohort effects are discussed. Conclusion This paper highlights the usefulness of the individual growth model in modeling longitudinal change in QOL variables.
Collapse
Affiliation(s)
- Henian Chen
- Epidemiology of Mental Disorders, New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Patricia Cohen
- Epidemiology of Mental Disorders, New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| |
Collapse
|