Personality disorder symptoms and marital functioning

"I'm fighting with BPD instead of my partner": A dyadic interpretative phenomenological analysis of the lived experience of couples navigating borderline personality disorder

Borderline personality disorder (BPD) is associated with romantic relationship distress and dissolution. The complex interaction between BPD and romantic relationships warrants further attention. Dyadic interviews (N = 10) were conducted to examine the experience and impact of BPD on couples' relationships. The results of interpretative phenomenological analysis consisted of two superordinate themes describing the couple experience of navigating BPD: (a) the shared experience of BPD as a relational stressor; and (b) adaptive dyadic coping in the context of BPD. Although BPD was experienced as a relational stressor, dyadic coping and shared externalization of BPD emerged as central components to adaptive couple functioning. Most couples reported that therapy was a critical external resource in their journey toward adaptively functioning in the context of BPD, both intrapersonally and interpersonally. The lived experiences of these couples provides therapists with an increased understanding of the resources that support adaptive dyadic coping with BPD.

Social anhedonia, communication, and marital satisfaction in newlywed couples

OBJECTIVE

Social anhedonia is associated with disinterest in social interactions and poor relationship functioning, yet little is known about the specific mechanisms underlying associations between social anhedonia and romantic relationship behaviors and satisfaction. We examined the links between social anhedonia, perceptions of conflict communication patterns, and marital satisfaction.

METHOD

The current research examined the role of social anhedonia on marital quality and functioning longitudinally across a year in a sample of 100 newlywed couples using an actor-partner interdependence framework.

RESULTS

Social anhedonia was negatively associated with own and partner's marital satisfaction. It was also negatively associated with constructive communication and positively associated with destructive communication. Furthermore, cross-sectional mediation analyses showed that communication patterns mediated the social anhedonia-satisfaction link.

CONCLUSIONS

Taken together, these findings suggest that social anhedonia is likely to lead to lower marital satisfaction, partly through its effect on communication between partners.

Childhood Maltreatment, Personality Pathology, and Intimate Partner Aggression

The goal of the current study was to examine the early childhood roots of adult personality pathology and intimate partner aggression in later life. Childhood maltreatment is associated with perpetration of intimate partner aggression (IPA) in adulthood, although the effect is generally only small to moderate in size. Childhood maltreatment is also linked with the Diagnostic and Statistical Manual of Mental Disorders (DSM) personality disorders (PDs) in adulthood, which in turn are correlated with IPA in adult romantic relationships. This suggests that one pathway by which childhood maltreatment leads to adult IPA is through maladaptive personality patterns. In the current analyses, data from 495 older, racially diverse adults and their romantic partners recruited from the St. Louis Personality and Aging Network (SPAN) study were used to examine whether childhood maltreatment may impact adult IPA through adult personality pathology. Findings from structural equation modeling demonstrated that for most of the 10 DSM-5 PD (Section II) constructs, there was a significant indirect effect from childhood maltreatment to IPA in later life through a latent variable of personality pathology. Our findings confirm that IPA does occur among romantic partners in later life, that it is robustly associated with personality pathology traits in later life, and that personality pathology in later life may have its roots in early neglect and maltreatment.

Impulsivity, impulsive aggression and borderline personality features among violent spouses

Objective

Spousal violence in Pakistan is under researched but still not considered as a public health problem. The current study is intended to analyze the association between multiple measures of impulsivity, impulsive aggression, and borderline personality feature among violent spouses as well as to find out the moderating role of impulsive aggression between spousal violence and borderline personality features.

Methods

A cross-sectional survey research design was used for conducting the research. The sample of 300 spouses, experiencing intimate partner relationships, was taken from different cities of the Hazara division through purposive sampling.

Results

Present study demonstrated a significant positive correlation of spousal violence with impulsivity (r = .708∗∗, P < .001), impulsive aggression (r = .176∗∗, P < .001), and borderline personality features (r = .605∗∗, P < .001), while impulsivity was negatively correlated with impulsive aggression (r = -.018, P < .01). Impulsive aggression moderates the relationship between spousal violence and borderline personality features. The results showed that male and female spouses were found equally impulsive and impulsively aggressive. Likewise, impulsivity, impulsive aggression, and borderline personality features were found significant predictors of violence F = (3, 296) = 106. 67, P < .001.

Conclusion

Current research offers some important insights and consequences for physicians and practitioners who interact with individuals who have experienced violence. These results have significant therapeutic implications for the treatment of violent couples.

Borderline Personality Traits and Romantic Relationship Dissolution

Many studies have found that borderline personality disorder (BPD) is associated with romantic relationship instability, with relationship dissolution being a recurring theme. Scant research, however, has examined the dissolution strategies and post-breakup outcomes for individuals with elevated levels of borderline traits. Findings from two studies revealed that there was an association between BPD criteria and tendency to employ less adaptive dissolution strategies when terminating a relationship. Furthermore, elevated levels of BPD traits were associated with less self-concept clarity and more unwanted pursuit of ex-partners. These findings both provide insight into how individuals with BPD traits experience relationship dissolution and suggest possible factors underlying the unstable relationship processes typically associated with borderline traits.

Dyadic Emotion Regulation in Women with Borderline Personality Disorder

Background

Emotion regulation (ER) and interpersonal dysfunction constitute key features of borderline personality disorder (BPD). Here, we tested if females with BPD show impairments in dyadic ER, that is in their support seeking and creation of closeness. We investigated if women with BPD might over-rely on their male partner by excessive support seeking and establishing of closeness, during conversations with personally and relationship-threatening topics.

Methods

Thirty couples in which the women were diagnosed with BPD and 34 healthy control (HC) couples were videotaped while discussing neutral, personally threatening, and relationship-threatening topics. Support seeking was rated by three independent raters, using a naïve observer method. The creation of closeness was rated using a continuous video-rating. Perceived emotions were assessed using self-report after each conversation.

Results

Women with BPD engaged in more support seeking than HC women, especially in more negative behaviors to elicit support, they created less closeness to their partner than HCs and reported a greater decline of positive emotions in both threatening conditions. Women with BPD displayed more fluctuations than controls between creating closeness and distance in the personally-threatening situation. They reported a larger increase in negative emotions after the relationship threatening conversation compared to female HC.

Conclusions

The present study indicates an increased demand of dyadic ER in BPD. Increased negative support seeking and less creation of closeness to the partner might reflect ineffective strategies to actually receive support from the partner.

My problem or yours? Interpersonal problems and marital quality

OBJECTIVE

Research has consistently illustrated the impact of personality on marital quality. Given the inherent dyadic nature of relationships, recent investigations have integrated spouse-rated personality to account for both spouses' perspectives. Grounded in Contemporary Integrative Interpersonal Theory, we viewed personality through an interpersonal lens and conceptualized maladaptive interpersonal functioning as interpersonal problems. The present study examined the incremental validity of spouse-rated interpersonal problems beyond self-reported interpersonal problems to predict marital quality within an expanded actor-partner interdependence model (APIM).

METHOD

Within a community sample of heterosexual, married couples (N = 110), we used expanded APIMs, integrating both self-report and spouse-rating, to test the incremental validity of spouse-perceived interpersonal problems over self-perceived interpersonal problems on marital quality through a model comparison approach. We tested for possible gender differences in effects.

RESULTS

Spouse perception, notably spouse-rated partner effects, appears to be the most frequent predictor of marital quality, and self-perception had less impact.

CONCLUSION

Given the implications marital quality has on health and well-being, intervention efforts capitalizing on acceptance of spouses' perspectives are likely to lead to greater improvements in quality and overall health.

Marital Satisfaction as a Moderator of Molecular Genetic Influences on Mental Health

The quality of one's romantic relationship is associated with mental health. Low levels of relationship quality may be a stressor that triggers a predisposition or diathesis to mental illness. Analyses were conducted to examine whether relationship quality moderated the association between polygenic risk scores (PRSs) for several mental health syndromes on phenotypic measures of those syndromes. Data were drawn from the Midlife in the United States (MIDUS) study of health and well-being. A subsample was genotyped, and PRSs were calculated. The PRS for anxiety was more strongly related to the anxiety phenotype when satisfaction was low than when satisfaction was high, providing evidence of a genetic susceptibility process between marital distress and anxiety. The expression of genetic influences on a phenotype in the presence of certain environmental stressors is complex and may depend on the specific phenotype and the methodology by which genetic influences are estimated.

Personality disorders as predictors of intimate partner violence: A meta-analysis

Despite years of research demonstrating a relation between personality pathology and intimate partner violence (IPV), no meta-analysis has been published examining how well, or poorly, all ten personality disorders (PDs) predict IPV perpetration or victimization, nor has any meta-analysis examined these relations across types of IPV. Therefore, the present study was undertaken to synthesize existing research on the effects of all ten PDs, as well as psychopathy and global PD symptoms, on physical, psychological, and sexual IPV perpetration and victimization. An initial search in PsycINFO, PubMed, and Sociological Abstracts yielded 3988 results. After duplicate and irrelevant articles were removed, 163 studies were included in the analysis, representing 189 individual samples. Analysis was conducted in R using the metafor package. Main effects analyses indicate that PDs were significantly and positively related to IPV perpetration. Results were more mixed for IPV victimization. Antisocial and borderline PDs demonstrated the most robust effect sizes across both perpetration and victimization. Moderator analyses suggested that with few exceptions, main effects were consistent across a number of sample and study characteristics. Findings may help to inform prevention and intervention efforts in clinical settings.

Pathology in Relationships

Committed, long-term romantic relationships are ubiquitous among modern society. They are one of the most important contexts for the development, maintenance, and treatment of psychopathology. In this review, I first place psychopathology within the most commonly cited theoretical model of marital satisfaction and stability and then discuss how relationship satisfaction is conceptualized and assessed in this literature. In the second half of the review, I describe the theories regarding how romantic relationships may be connected to psychopathology. Relationship distress is easily incorporated into a diathesis-stress model as an important trigger for psychopathology. Next, I review cross-sectional research, longitudinal research, and treatment efficacy research linking relationship quality and psychopathology. I provide evidence for the robustness of these effects and areas where research must expand. I finish with a summary section that synthesizes what is known about the mechanisms linking relationship distress and psychopathology.

Dispositional attachment style moderates the effects of physiological coregulation on short-term changes in attachment anxiety and avoidance

Individuals with personality disorders often experience romantic relationship dysfunction and have an insecure attachment style. Here, we examined attachment dynamics in dyadic interactions, focusing specifically on the role of physiological coregulation in state attachment processes in couples oversampled for personality pathology. A total of 121 couples completed a 10-minute discussion about an area of disagreement in their relationship and a 5-minute discussion in which they planned an event together. We used a dynamical model of heart rate changes to estimate coregulation. We found that (a) increases in state attachment avoidance were associated with contrarian coregulation (heart rate becoming misaligned with the partner's physiology) and (b) conversely, increases in state attachment anxiety were associated with dependent coregulation (heart rate becoming aligned with the partners' physiology). Dispositional attachment insecurity moderated the effects of state attachment insecurity on physiological coregulation. Whereas dispositional anxiety predicted individuals exhibiting dependent coregulation in response to state insecurity, dispositional avoidance predicted contrarian coregulation in response to state insecurity. This work provides insight into the role of physiological coregulation in attachment dynamics among couples oversampled for personality pathology, suggesting that disruptions to coregulation contribute to impaired emotion regulation during romantic conflicts. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Pathological personality, relationship satisfaction, and intimate partner aggression: Analyses using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, alternative model of personality disorder traits

Personality disorders (PDs) have been linked to lower levels of marital satisfaction and the perpetration of intimate partner aggression (IPA). Much of this work has used self-reports of PD symptoms conceptualized via the Diagnostic and Statistical Manual of Mental Disorder's (DSM) categorical approach. The current study adds to the literature by examining how marital satisfaction and IPA are associated with a dimensional assessment of PDs, specifically by conceptualizing PDs using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Section III alternative model of personality disorder. By collecting data from both partners in a sample of newlywed couples, we also leverage PD trait agreement between (a) both partner's own self-reports (similarity), (b) self- and spouse report (accuracy), and (c) self and ratings of partner (perceptual similarity), to examine couple-level predictors of relationship well-being (i.e., satisfaction and psychological/physical IPA). Data were drawn from a sample of 101 newly married couples who participated in baseline and follow-up data collection over a period of 12 months. Actor-partner interdependence analyses revealed significant self-report actor and partner effects on marital satisfaction and psychological and physical IPA; for spouse report, actor effects were more consistent than partner reports. Agreement was moderate for both similarity and accuracy, but greater agreement was related to greater relationship satisfaction, particularly at later time points. Thus, although reports of elevated personality pathology are detrimental to marital functioning, spousal agreement may protect against these effects. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Parents' Personality-Disorder Symptoms Predict Children's Symptoms of Anxiety and Depressive Disorders - a Prospective Cohort Study

Personality disorder (PD) symptomatology is characterized by interpersonal problems and emotional dysregulation, which may affect offspring of parents with PD symptoms. Notably though, studies are needed to discern (i) whether parental PDs forecast symptoms of psychiatric disorders in offspring during their childhood years and (ii) whether such prospective relations obtain after accounting for common causes (e.g., genetics, common methods). To address these issues, we followed up a community sample of Norwegian children biennially from ages 4 to 8 (n = 594), using a semi-structured psychiatric interview (PAPA/CAPA) to capture DSM-IV defined symptoms of emotional disorders. Parental symptoms of personality disorders were captured by the DSM-IV and ICD-10 Personality Questionnaire (DIP-Q), whereas depression and anxiety in caregivers were measured using the Beck Depression Inventory -II and Beck Anxiety Inventory, respectively. Upon applying a hybrid fixed and random effects method that takes into account all unmeasured time-invariant confounders, we found that: (i) Parental symptoms of DSM-IV defined Cluster A and C were related to symptoms of anxiety disorders in offspring two years later, even after accounting for children's initial levels of anxiety and parental anxiety, whereas (ii) Parental DSM-IV Cluster B predicted symptoms of depressive disorders in children, adjusted for children's initial levels of depression and parental depression. Clinical implications of the results are discussed.

Complex assessment of relationship quality within dyads

Higher quality relationships have been linked to improved outcomes; however, the measurement of relationship quality often ignores its complexity and the possibility of co-occurring positivity and negativity across different contexts. The goal of this study is to test the added benefit of including multiple dimensions, contexts, and perspectives of relationship quality from both individuals in predicting marital functioning. The Social Relationships Index assessed positive and negative dimensions of relationship quality under neutral, positive, and support-seeking contexts for 183 heterosexual married couples. Models showed that the inclusion of multiple dimensions of relationship quality across all three contexts improved prediction of marital functioning for both women and men. The use of multidimensional multicontextual relationship quality assessments is highly recommended.

Personality Pathology and Spouses' Moment-to-Moment Interpersonal Behaviors

We assessed the association of personality pathology with romantic couples' observed interpersonal behaviors. Couples engaged in four discussion tasks, after which observers used the Continuous Assessment of Interpersonal Dynamics method to continuously rate each participant's dominance and warmth over the course of each discussion. Using these ratings, we derived indices of average behaviors and changes in behaviors over the course of discussions. Generally, results indicated that the more personality pathology either spouse reported, the colder husbands were on average, and the colder they became toward their wives over time. However, personality disorder symptoms and overall interpersonal problems were largely unassociated with wives' behaviors. Results also indicated that the more dominance-related problems husbands and wives reported, the more dominantly and coldly they behaved, the more submissive or withdrawn their partners were, and the colder wives became over time; and the more warmth problems wives reported, the more dominantly, they behaved.

The Impact of Personality Disorders on Longitudinal Change in Relationship Satisfaction in Long-Term Married Couples

Personality disorders (PDs) are significantly, negatively related to marital satisfaction. We examine how maladaptive personality is related to change in marital satisfaction over time utilizing data from the St. Louis Personality and Aging Network (SPAN), a longitudinal, community-based study of personality and health in older adults. Participants were assessed at baseline for PD (self-report, informant-report, and structured interview); self- and spouse-reported relationship satisfaction assessed at baseline and five follow-ups was analyzed with latent growth curve modeling. Higher levels of PD at baseline were associated with lower self and spouse relationship satisfaction at baseline. On average, satisfaction did not change significantly over the study period, but there was significant individual variability. Higher levels of schizoid PD were protective of declines in partner's perception of satisfaction. Findings suggest that partners in long-term married unions may have adapted to the presence of their own or their spouse's level of personality pathology.

Mom-and-Pop Narcissism: The Impact of Attention Seeking and Grandiosity on Couples' Experience of the Transition to Parenthood

Various studies have demonstrated associations between personality disorders and relationship satisfaction. The authors examine the associations between attention seeking and grandiosity, both features of narcissistic personality disorder, and relationship satisfaction before and after the transition to parenthood. The authors then expand their analysis to parental satisfaction and postpartum depression (PPD). Nonclinical couples (N = 103 couples) expecting their first child completed measures of grandiosity, attention seeking, and relationship satisfaction before birth, and of relationship satisfaction, parental satisfaction, and PPD symptoms 3 months afterward. Attention seeking was associated with less parental satisfaction and more PPD symptoms, and with less prepartum relationship satisfaction for participants' partners. For men, attention seeking was also associated with prepartum relationship satisfaction. Grandiosity was associated with a decrease in relationship satisfaction after birth, although, surprisingly with fewer PPD symptoms for participants' partners. The authors discuss how these findings might be related to changes in social support and work-life balance during the transition to parenthood.

Disrupted physiological coregulation during a conflict predicts short-term discord and long-term relationship dysfunction in couples with personality pathology

Interpersonal dysfunction is a core feature of personality disorders, often affecting close relationships. Nevertheless, little is known about the moment-to-moment dynamic processes by which personality pathology contributes to dysfunctional relationships. Here, we investigated the role of physiological attunement during a conflict discussion in romantic couples oversampled for personality pathology. We hypothesized that physiological coregulation would be disrupted in individuals with personality pathology, subsequently predicting short-term discord and long-term relationship dissatisfaction. One hundred twenty-one couples completed a 10-min discussion about an area of disagreement while cardiovascular physiology and behavior were recorded. We quantified coregulation using a dynamical systems model of heart rate changes. We found that greater interpersonal problem severity was associated with more contrarian coregulation, exacerbating negative affect and interpersonal perceptions. Furthermore, the extent to which coregulation was associated with increased discord prospectively predicted relationship dissatisfaction 1 year later. Altogether, this work sheds light on a pathway by which personality pathology contributes to problems in romantic relationships. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

A comprehensive assessment of personality traits and psychosocial functioning in parents with bipolar disorder and their intimate partners

Background

Individuals with bipolar disorder (BD) often possess maladaptive traits and present with various difficulties in psychosocial functioning. However, little is known about the intimate partners of adults with bipolar disorder (BD) and how mental illnesses other than BD within couples may further complicate the picture. Such knowledge is needed to inform both couple and family interventions.

Methods

Participants were parents whose children were enrolled in a prospective study: 55 with BD and their partners, and 47 healthy control couples. All completed diagnostic interviews, and questionnaires describing personality traits, negative life events, coping skills, social support, marital adjustment and inter-partner verbal aggression. Parents with BD and healthy control parents were compared, as were the intimate partners. A series of exploratory analyses focused on the average measures within couples, with and without BD, and took account of comorbid personality disorders among those with BD and major depressive disorder among their partners.

Results

Intimate partners of adults with BD, relative to healthy control partners, presented with more mental disorders, higher neuroticism, lower extraversion, more emotion-focused coping, smaller social networks, less satisfaction with their social networks, and little, satisfying social contact. Additionally, they reported less consensus and satisfaction in their marital relationships, and engaged in more verbal aggression towards their partners. Participants with BD showed similar, more extreme, characteristics. Marital distress and verbal aggression were greatest among couples with an adult having BD and a comorbid personality disorder or a partner with major depressive disorder.

Conclusion

This study contributes to the literature by demonstrating that both parents with BD and their intimate partners exhibit high levels of mental illness, maladaptive personality traits and psychosocial difficulties, thus limiting their partners’ ability to provide support and stability in the these high risk families. Moreover, mental illnesses other than BD may contribute to marital problems within couples. Some statistical analyses, particularly those involving comorbid conditions, were under-powered in this study. As clinical implications, the current study suggests that both individuals with BD and their partners could benefit from interventions aimed at lowering emotionality and verbal aggression, and increasing social support and effective coping skills.

Big Five personality domains and relationship satisfaction: Direct effects and correlated change over time

OBJECTIVE

The Big Five Model (BFM) of personality domains is significantly related to romantic relationship outcomes, particularly marital satisfaction. Few studies to date, however, have examined the BFM domains and relationship outcomes longitudinally.

METHOD

We used latent growth curve modeling to estimate the initial levels (intercept) and the rate of change (slope) in the BFM domains and marital satisfaction and determine if change in one construct was associated with change in the other. All available data were retained from participants who remained married to the same individual, as well as early waves for participants who divorced or were widowed, in the Midlife in the United States study (N = 1,965). We expected negative associations between (a) intercepts of Neuroticism and relationship satisfaction and (b) the intercept/slope of Neuroticism with change in marital satisfaction. The other BFM domains were expected to have positive effects on change in satisfaction.

RESULTS

The results suggested that change over time in Neuroticism and Conscientiousness is detrimental to satisfaction, while initial levels of Conscientiousness may predict declining marital satisfaction.

CONCLUSIONS

Changes in Neuroticism accompany parallel changes in relationship satisfaction in a large sample of married U.S. adults, suggesting an ongoing bidirectional influence between these constructs in enduring marriages.

Romantic attachment style and borderline personality pathology: A meta-analysis

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.

Reciprocal Personality Assessment of Both Partners in a Romantic Relationship and Its Correlates to Dyadic Adjustment

This project examines the effects of self- and partner-rated personality and their reciprocal interaction between two partners. Personality in 113 young dating couples was measured with the Five-Factor Model and maladaptive personality trait model of the DSM-5. Partners completed self- and partner-reports of the NEO-FFI-3 and the Personality Inventory for DSM-5 (PID-5) as well as the self-report Dyadic Adjustment Scale (DAS). Three sets of Actor-Partner Interdependence Models (APIMs) were run to estimate actor and partner effects of self-rated personality, partner-rated personality, and of both sets of effects simultaneously in an integrated model. When self- and partner-rating models were examined separately, several significant actor and partner effects were observed. However, the strongest effects were observed in the partner-rating models. When self- and partner-rated personality were examined at the same time, most effects from the self-rating models disappeared. Furthermore, most of the effects as well as the strongest one observed were associated with an individual’s perception of their partner’s personality, particularly men’s perception of women’s personality. This study demonstrates the incremental predictive utility of individuals’ perception of their partner’s personality for explaining their own dyadic adjustment.

Symptom-level analysis of DSM-IV/DSM-5 personality pathology in later life: Hierarchical structure and predictive validity across self- and informant ratings

Dissatisfaction with the categorical model of personality disorder led to several investigations on alternative, dimensional systems. The majority of these studies were conducted at the syndrome-level where each diagnostic criterion is summed or averaged within each disorder. Studies at the symptom-level have identified symptom dimensions that define and cut across categories, but the number and nature of dimensions varies across studies. The purpose of the present study was to examine the hierarchical structure and impact of personality pathology at the symptom-level across self- and informant ratings in a large community sample of older adults (N = 1,630; ages 55 to 64). Results indicated that multiple structural patterns can be organized within a common hierarchical framework, with a general factor of maladjustment at the top, 2 broad dimensions of internalizing and externalizing pathology directly below, and progressively more specific symptom dimensions toward the bottom. Factors at each level of the hierarchy were similar across self- and informant ratings. The 4-factor model showed significant incremental validity in predicting a range of life outcomes over simpler models, while increasingly complex models incrementally but modestly improved predictive power. Several consistencies emerged between the current findings and prior factor analytic studies. The most unexpected result was the conspicuous absence of a disinhibition factor reflecting antisocial and impulsivity-related problems. This anomaly may involve the older age of our sample and the changing expression of personality pathology in later life. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Attachment styles, social behavior, and personality functioning in romantic relationships

Personality disorders (PDs) are commonly associated with romantic relationship disturbance. However, research has seldom evaluated who people with high PD severity partner with, and what explains the link between PD severity and romantic relationship disturbance. First, we examined the degree to which people match with partners with similar levels of personality and interpersonal problems. Second, we evaluated whether the relationship between PD severity and romantic relationship satisfaction would be explained by attachment styles and demand/withdraw behavior. Couples selected for high PD severity (n = 130; 260 participants) engaged in a conflict task, were assessed for PDs and attachment using semi-structured interviews, and self-reported their relationship satisfaction. Dyad members were not similar in terms of PD severity but evidenced a small degree of similarity on specific attachment styles and were moderately similar on attachment insecurity and interpersonal problems. PD severity also moderated the degree to which one person's attachment anxiety was associated with their partner's attachment avoidance. In addition, using a dyadic analytic approach, we found attachment anxiety and actor and partner withdrawal explained some of the relationship between PD severity and relationship satisfaction. Our results indicate people often have romantic partners with similar levels of attachment disturbance and interpersonal problems and that attachment styles and related behavior explains some of the association between PD severity and relationship satisfaction. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Psychoeducation with problem-solving (PEPS) therapy for adults with personality disorder: a pragmatic randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of a manualised intervention to improve social functioning

BACKGROUND

If effective, less intensive treatments for people with personality disorder have the potential to serve more people.

OBJECTIVES

To compare the clinical effectiveness and cost-effectiveness of psychoeducation with problem-solving (PEPS) therapy plus usual treatment against usual treatment alone in improving social problem-solving with adults with personality disorder.

DESIGN

Multisite two-arm, parallel-group, pragmatic randomised controlled superiority trial.

SETTING

Community mental health services in three NHS trusts in England and Wales.

PARTICIPANTS

Community-dwelling adults with any personality disorder recruited from community mental health services.

INTERVENTIONS

Up to four individual sessions of psychoeducation, a collaborative dialogue about personality disorder, followed by 12 group sessions of problem-solving therapy to help participants learn a process for solving interpersonal problems.

MAIN OUTCOME MEASURES

The primary outcome was measured by the Social Functioning Questionnaire (SFQ). Secondary outcomes were service use (general practitioner records), mood (measured via the Hospital Anxiety and Depression Scale) and client-specified three main problems rated by severity. We studied the mechanism of change using the Social Problem-Solving Inventory. Costs were identified using the Client Service Receipt Inventory and quality of life was identified by the European Quality of Life-5 Dimensions questionnaire. Research assistants blinded to treatment allocation collected follow-up information.

RESULTS

There were 739 people referred for the trial and 444 were eligible. More adverse events in the PEPS arm led to a halt to recruitment after 306 people were randomised (90% of planned sample size); 154 participants received PEPS and 152 received usual treatment. The mean age was 38 years and 67% were women. Follow-up at 72 weeks after randomisation was completed for 62% of participants in the usual-treatment arm and 73% in the PEPS arm. Intention-to-treat analyses compared individuals as randomised, regardless of treatment received or availability of 72-week follow-up SFQ data. Median attendance at psychoeducation sessions was approximately 90% and for problem-solving sessions was approximately 50%. PEPS therapy plus usual treatment was no more effective than usual treatment alone for the primary outcome [adjusted difference in means for SFQ -0.73 points, 95% confidence interval (CI) -1.83 to 0.38 points; p = 0.19], any of the secondary outcomes or social problem-solving. Over the follow-up, PEPS costs were, on average, £182 less than for usual treatment. It also resulted in 0.0148 more quality-adjusted life-years. Neither difference was statistically significant. At the National Institute for Health and Care Excellence thresholds, the intervention had a 64% likelihood of being the more cost-effective option. More adverse events, mainly incidents of self-harm, occurred in the PEPS arm, but the difference was not significant (adjusted incidence rate ratio 1.24, 95% CI 0.93 to 1.64).

LIMITATIONS

There was possible bias in adverse event recording because of dependence on self-disclosure or reporting by the clinical team. Non-completion of problem-solving sessions and non-standardisation of usual treatment were limitations.

CONCLUSIONS

We found no evidence to support the use of PEPS therapy alongside standard care for improving social functioning of adults with personality disorder living in the community.

FUTURE WORK

We aim to investigate adverse events by accessing centrally held NHS data on deaths and hospitalisation for all PEPS trial participants.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN70660936.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 52. See the NIHR Journals Library website for further project information.

Incremental Validity of Self- and Informant Report of Personality Disorders in Later Life

Research shows moderate agreement between different sources of information when assessing personality disorders (PDs) in older adults. The differences between measurement methods appear to be not only the result of measurement error, but also an indication that each source holds nonredundant information relevant to PD diagnosis. The current article examines three sources of diagnostic information (self-report, informant report, and clinical interview) and the utility of these instruments in predicting important outcomes in older adulthood. We analyzed data from 1,630 adults between the ages of 55 and 64 years participating in a longitudinal study of later life. PD symptomatology was assessed using multiple methods, which were then used to predict health, marital satisfaction, and cognitive decline. All three sources contributed significantly to the prediction of these outcomes, with important implications for the assessment of older adults in research and clinical settings.

Self- and partner-reported psychopathic traits' relations with couples' communication, marital satisfaction trajectories, and divorce in a longitudinal sample

Given that psychopathy is composed in large part by an antagonistic relational approach and is associated with many troubling interpersonally relevant outcomes, its role in romantic functioning warrants greater attention. The current study used data from a community sample of 172 newlywed couples to examine spouses' psychopathic traits in relation to their partners' psychopathic traits, observed communication, 4-year marital satisfaction trajectories, and 10-year divorce rates. Spouses reporting greater levels of psychopathic traits were married to partners reporting greater levels of psychopathic traits. Psychopathic traits were correlated cross-sectionally with more negative affect and less positive affect during conversations regarding sources of tension in the relationship. Longitudinally, hierarchical linear modeling of spouses' 4-year marital trajectories indicated that psychopathic traits generally predicted lower initial and sustained marital satisfaction for spouses and their partners over time. In addition, wives' ratings of husbands' psychopathic traits predicted declines in husbands' satisfaction over time and elevated 10-year divorce rates. These findings highlight the relationship impairment associated with psychopathic traits, indicate that this impairment is present from the beginning of couples' marital trajectories, and show that psychopathic traits predict divorce. Findings also suggest that partner-ratings of psychopathic traits provide substantial incremental validity in the prediction of marital functioning outcomes relative to self-ratings. Future research on the pathways by which psychopathic traits undermine relationship functioning over time would be valuable. (PsycINFO Database Record

Internalizing and Externalizing Symptoms and Marital Relationship Functioning: The Mediating Role of Demand-Withdraw Communication Processes

Marital outcomes are associated with internalizing and externalizing symptoms; however, the processes by which these domains are associated with marital outcomes are not well understood. This study examined how demand-withdraw (DW) couple communication accounts for the association between symptoms of mental illness and marital distress. A mediational model was tested in a sample of 100 newlywed couples to determine: (a) whether internalizing and externalizing symptoms influenced own and partner's level of DW communication, and (b) whether this communication pattern was associated with relationship outcomes, including lower marital satisfaction and presence of conflict. Results suggested that DW communication had significant effects on both partner's marital outcomes and mediated the association between externalizing symptoms (for husbands) and marital distress.

Romantic relationships and mental health

This paper reviews the research on relationships and mental health. Individuals who are more mentally healthy are more likely to select into relationships, but relationships are also demonstrably associated with mental health. The type of relationship matters - evidence suggests that more established, committed relationships, such as marriage, are associated with greater benefits than less committed unions such as cohabitation. The association between relationships and mental health is clearly bidirectional, however, stronger effects are observed when mental health is the outcome and relationships are the predictor, suggesting that the causal arrow flows more strongly from relationships to mental health than vice versa. Moreover, improving relationships improves mental health, but improving mental health does not reliably improve relationships. Our review of research corroborates the view that relationships are a keystone component of human functioning that have the potential to influence a broad array of mental health outcomes.

Assessment of social traits in married couples: Self-reports versus spouse ratings around the interpersonal circumplex

Personality traits predict the quality of intimate relationships, and as a result can be useful additions to assessments of couple functioning. For traits involving social behavior, the affiliation (i.e., warmth, friendliness vs. hostility, quarrelsomeness) and control (i.e., dominance vs. deference, submissiveness) dimensions of the interpersonal circumplex (IPC) are an alternative to the 5-factor model traits of agreeableness and extraversion, given that they may provide a more specific and relevant description of social behavior in the context of couple functioning. The couple context creates an opportunity to supplement commonly used self-reports with informant ratings. Although substantial correlations between self-reports and partner ratings of personality are well-documented, differences between these assessment modalities in levels of affiliation and control have not been examined previously. The present study of 301 middle-aged and older couples addressed this issue by comparing self-reports and spouse ratings, using parallel forms of a measure of the interpersonal circumplex derived from the NEO (Neuroticism-Extraversion-Openness) PI-R (Personality Inventory-Revised). Participants reported lower trait dominance relative to spouses' ratings, and less trait hostility. For dominance, this discrepancy was evident at all levels of marital quality, but for hostility it was particularly apparent among couples reporting low marital quality. The tendency to self-report less dominance relative to ratings by spouses was stronger among women than men. These discrepancies may be important in couple assessment and intervention. (PsycINFO Database Record

Borderline personality disorder symptoms and newlyweds' observed communication, partner characteristics, and longitudinal marital outcomes

Given borderline personality disorder's (BPD) relation with interpersonal dysfunction, there is substantial interest in understanding BPD's effect on marriage. The current study used data from a community sample of 172 newlywed couples to examine spouses' BPD symptoms in relation to their observed communication, partner BPD symptoms, 4-year marital quality trajectories, and 10-year divorce rates. BPD symptoms were correlated cross-sectionally with more negative skills during observational problem-solving and social support tasks, and spouses reporting more BPD symptoms were married to partners reporting more BPD symptoms. Longitudinally, hierarchical linear modeling of newlyweds' 4-year marital trajectories indicated that BPD symptoms predicted the intercept of marital quality for spouses and their partners, reflecting lower levels of marital satisfaction and higher levels of marital problems. BPD symptoms did not predict 10-year divorce rates. These findings highlight the chronic relationship impairment associated with BPD symptoms, indicate that distress begins early in marriage, and suggest that partners with higher levels of BPD symptoms remain in more troubled marriages.

Borderline personality disorder symptoms and newlyweds' observed communication, partner characteristics, and longitudinal marital outcomes

Given borderline personality disorder's (BPD) relation with interpersonal dysfunction, there is substantial interest in understanding BPD's effect on marriage. The current study used data from a community sample of 172 newlywed couples to examine spouses' BPD symptoms in relation to their observed communication, partner BPD symptoms, 4-year marital quality trajectories, and 10-year divorce rates. BPD symptoms were correlated cross-sectionally with more negative skills during observational problem-solving and social support tasks, and spouses reporting more BPD symptoms were married to partners reporting more BPD symptoms. Longitudinally, hierarchical linear modeling of newlyweds' 4-year marital trajectories indicated that BPD symptoms predicted the intercept of marital quality for spouses and their partners, reflecting lower levels of marital satisfaction and higher levels of marital problems. BPD symptoms did not predict 10-year divorce rates. These findings highlight the chronic relationship impairment associated with BPD symptoms, indicate that distress begins early in marriage, and suggest that partners with higher levels of BPD symptoms remain in more troubled marriages.

Borderline personality disorder and related constructs as risk factors for intimate partner violence perpetration

In this manuscript we systematically reviewed 29 articles from 2010 to 2014 that addressed the association between borderline personality disorder (BPD) and intimate partner violence (IPV) perpetration, with particular attention paid to the role of perpetrator sex. Our primary objective was to provide a summary of (1) the operationalization and measurement of BPD and IPV, (2) mechanisms of the BPD-IPV association, and (3)the current understanding of the role of perpetrator sex related to BPD and IPV. We observed three distinct operational definitions of BPD which are measured in a variety of ways. IPV measurement tends to be more consistent. Further, emotion perception, impulsivity, attachment, and substance use are proposed mechanisms to explain the BPD IPV relation. The findings regarding potential perpetrator sex differences in the BPD-IPV association are mixed. Finally, we also provide recommendations for future research and clinical practice.

Couples Therapy: Treating Selected Personality-disordered Couples Within a Dynamic Therapy Framework

Personality disordered couples present unique challenges for couples therapy. Novice therapists may feel daunted when taking on such a case, especially given the limited literature available to guide them in this specific area of therapy. Much of what is written on couples therapy is embedded in the larger body of literature on family therapy. While family therapy techniques may apply to couples therapy, this jump requires a level of understanding the novice therapist may not yet have. Additionally, the treatment focus within the body of literature on couples therapy tends to be situation-based (how to treat couples dealing with divorce, an affair, illness), neglecting how to treat couples whose dysfunction is not the product of a crisis, but rather a longstanding pattern escalated to the level of crisis. This is exactly the issue in therapy with personality disordered couples, and it is an important topic, as couples with personality pathology often do present for treatment. This article strives to present practical techniques, modeled in case vignettes, that can be applied directly to couples therapy- specifically therapy with personality disordered couples.

Personality Traits and Relationship Satisfaction in Intimate Couples: Three Perspectives on Personality

Personality traits are important predictors of relationship satisfaction. However, the majority of previous study findings are based on self–perceptions of personality. Thus, by means of the self–, partner–, and meta–perceptions of personality, the present study focused on three different perspectives on the Big Five personality traits to examine dyadic associations with relationship satisfaction of intimate couples. The study was based on the first measurement occasion of the Swiss longitudinal study ‘Co–Development in Personality: Longitudinal Approaches to Personality Development in Dyads across the Life Span’ and included data of 216 couples. The main analyses were based on Actor–Partner Interdependence Model. Three general findings emerged. First, the three personality perspectives represented related, albeit distinct, constructs, and showed incremental validity with respect to relationship satisfaction. Second, neuroticism was negatively related to relationship satisfaction, whereas agreeableness and conscientiousness were positively related to relationship satisfaction across all perspectives. Third, substantial associations between extraversion and relationship satisfaction were exclusively evident in terms of the partner– and meta–perception. The present results contribute to the literature by showing that each perspective is essential for the understanding of the role of personality for relationship satisfaction. Copyright © 2014 European Association of Personality Psychology

Personality disorder symptoms are differentially related to divorce frequency

Divorce is associated with a multitude of outcomes related to health and well-being. Data from a representative community sample (N = 1,241) of St. Louis residents (ages 55-64) were used to examine associations between personality pathology and divorce in late midlife. Symptoms of the 10 DSM-IV personality disorders were assessed with the Structured Interview for DSM-IV Personality and the Multisource Assessment of Personality Pathology (both self and informant versions). Multiple regression analyses showed Paranoid and Histrionic personality disorder symptoms to be consistently and positively associated with number of divorces across all three sources of personality assessment. Conversely, Avoidant personality disorder symptoms were negatively associated with number of divorces. The present paper provides new information about the relationship between divorce and personality pathology at a developmental stage that is understudied in both domains.

Test of a conceptual model of partner aggression among women entering substance use disorder treatment

OBJECTIVE

Despite extensive intimate partner violence (IPV) among women in substance use disorder treatment, few studies have investigated IPV risk factors within this population. Conceptual models, which have received support in other populations, propose that antisociality and generalized violence, alcohol and drug use, and relationship adjustment may be interrelated pathways that influence IPV. The purpose of this study was to test a conceptual model that integrates these individual and relationship pathways to explain IPV among women entering substance use disorder treatment.

METHOD

Women entering substance use disorder treatment (N = 277) who had a male relationship partner completed measures of the following domains about themselves and their male partners: antisociality/generalized violence, heavy alcohol use, drug use, relationship adjustment, and psychological and physical IPV.

RESULTS

Structural equation modeling analyses showed that the antisociality/generalized violence of each partner had direct and indirect effects on IPV. Each partner's antisociality/generalized violence was directly related to her or his physical IPV. Female antisociality/ generalized violence was indirectly related to female physical IPV via female drug use and female psychological IPV. Male antisociality/generalized violence was indirectly associated with male physical IPV via male drinking, relationship adjustment, and male psychological IPV. A reciprocal relationship was found between partners' psychological IPV but not physical IPV. When accounting for other individual and relational IPV predictors, male partners' physical IPV influenced women's physical IPV, but women's physical IPV did not influence their male partner's physical IPV.

CONCLUSIONS

Both partners' antisociality/generalized violence, substance use, and overall relationship adjustment are important in understanding IPV among women entering substance use disorder treatment.

Aggression in borderline personality disorder: evidence for increased risk and clinical predictors

This article aimed to systematically review the current literature regarding elevated risk of aggression in borderline personality disorder (BPD) and to review factors that differentiate aggressive from nonaggressive individuals with BPD. It has done so via a systematic review of the literature using Ovid MEDLINE and PsycINFO from 1980 to June 2010. Results indicate that BPD does not appear to be independently associated with increased risk of violence in the general population. History of childhood maltreatment, history of violence or criminality, and comorbid psychopathy or antisocial personality disorder appear to be predictors of violence in patients with BPD. This review concludes that the current evidence suggests that patients with BPD are not more violent than individuals in the general population. More studies are needed on factors that predict risk of aggression at an individual level.

Incremental validity of spouse ratings versus self-reports of personality as predictors of marital quality and behavior during marital conflict

The personality traits of neuroticism and agreeableness are consistently related to marital quality, influencing the individual's own (i.e., actor effect) and the spouse's marital quality (i.e., partner effect). However, this research has almost exclusively relied on self-reports of personality, despite the fact that spouse ratings have been found to have incremental validity over self-reports for a variety of other important outcomes. In a study of 300 middle-aged and older married couples, we examined the incremental validity of spouse ratings of neuroticism and agreeableness in predicting concurrent levels of self-reported marital quality, observations of behavior during a marital disagreement task, and depressive symptoms. Neuroticism and agreeableness had expected actor and partner effects on each of these outcomes. Spouse ratings of these traits demonstrated incremental validity in estimates of actor and partner effects on marital quality, marital behavior, and depressive symptoms. Results suggest that spouse ratings of personality may be important additions to the typical reliance on self-reports for research and clinical assessment in marriage.

Understanding general and specific connections between psychopathology and marital distress: a model based approach

Marital distress is linked to many types of mental disorders; however, no study to date has examined this link in the context of empirically based hierarchical models of psychopathology. There may be general associations between low levels of marital quality and broad groups of comorbid psychiatric disorders as well as links between marital adjustment and specific types of mental disorders. The authors examined this issue in a sample (N = 929 couples) of currently married couples from the Minnesota Twin Family Study who completed self-report measures of relationship adjustment and were also assessed for common mental disorders. Structural equation modeling indicated that (a) higher standing on latent factors of internalizing (INT) and externalizing (EXT) psychopathology was associated with lower standing on latent factors of general marital adjustment for both husbands and wives, (b) the magnitude of these effects was similar across husbands and wives, and (c) there were no residual associations between any specific mental disorder and overall relationship adjustment after controlling for the INT and EXT factors. These findings point to the utility of hierarchical models in understanding psychopathology and its correlates. Much of the link between mental disorder and marital distress operated at the level of broad spectrums of psychopathological variation (i.e., higher levels of marital distress were associated with disorder comorbidity), suggesting that the temperamental core of these spectrums contributes not only to symptoms of mental illness but to the behaviors that lead to impaired marital quality in adulthood.

Level of agreement between self and spouse in the assessment of personality pathology

Informant reports can provide important information regarding the presence of pathological personality traits, and they can serve as useful supplements to self-report instruments. Ratings from a spouse may be a particularly valuable source of personality assessment because spouses are very well acquainted with the target person, have typically known the person for a long time, and witness behaviors across a variety of situations. In the current study, self- and spouse report measures based on the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) personality disorder criteria were collected from a nonclinical sample of 82 couples (N = 164). Agreement between self- and spouse report for several pathological personality factors was significant and somewhat higher than has been found for self and peer agreement. Nevertheless, the magnitude of self-spouse agreement was still moderate in size (mean r = .36). Findings are discussed with regard to using spouse report in the assessment of personality pathology.