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Racial/Ethnic Differences in Psychometric Properties of Alcohol-Related Behaviors in the USA. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01379-3. [PMID: 35917062 DOI: 10.1007/s40615-022-01379-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/13/2022] [Accepted: 07/26/2022] [Indexed: 10/16/2022]
Abstract
OBJECTIVE Alcohol-related behaviors are often examined using surveys assessing participants' self-report of attitudes/actions. However, racial/ethnic differences exist in scale construction and evaluation, and surveys evaluating alcohol behaviors lack invariance across ethnic groups. These dissimilarities may be due to deep-rooted differences in ethnic classification of unhealthy substance use behaviors. METHODS We examined factor structure of "Number of days per month drank alcohol in past 12 months," "Number of days had one or more drinks in past 30 days," and "Number of days had four/five or more drinks in past 30 days," administered during the 2017 National Survey on Drug Use and Health. Factorial invariance was examined across 12- to 17-year-old White, Black/African American, Asian American, and Hispanic/Latinx boys and girls endorsing alcohol use. A multigroup confirmatory factor analysis statistically determined whether the factor structure was invariant across groups. RESULTS The alcohol scale lacked invariance across all groups, indicating racial/ethnic group identification is related to alcohol-related cognitions. CONCLUSIONS Psychometric properties of scales assessing alcohol-related behaviors generalized across racial/ethnic groups require evaluation.
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Personality Pathology and Substance Misuse in Later Life: Perspectives from Interviewer-, Self-, and Informant-Reports. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2021; 43:597-619. [DOI: 10.1007/s10862-020-09862-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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3
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Masferrer L, Mancini AD, Caparrós B. Understanding the Relationship Between Complicated Grief Symptoms and Patterns of Personality Disorders in a Substance Users' Sample: A Network Analysis Approach. Front Psychol 2020; 11:566785. [PMID: 33250810 PMCID: PMC7673378 DOI: 10.3389/fpsyg.2020.566785] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/11/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The presence of personality disorders is greatly prevalent among substance users. Personality disorders could increase vulnerability to complicated grief symptoms. Bereavement is commonly overlooked among substance users. We used network analysis to estimate the structure of relations between patterns of personality disorders and complicated grief symptoms among a bereaved substance-using population. METHODS Complicated grief and personality disorders were assessed in a sample of 196 bereaved substance users. We use the graphical least absolute shrinkage selection operator (LASSO) to compute a regularized partial correlation network revealing associations among different patterns of personality disorders and complicated grief symptoms. RESULTS In a network involving nodes for personality disorders and symptomatology of complicated grief, patterns of depressive and paranoid personality disorder showed small relationships to complicated grief symptoms. All other personality disorders showed negligible to no relationship to complicated grief symptoms. Further, in the overall network, complicated grief showed the lowest level of centrality, suggesting that it is independent of personality disorders, whereas depressive and paranoid personality disorder symptoms showed the highest centrality. CONCLUSION Network analysis can be used to understand the relationships among higher-level constructs such as disorders. We found that complicated grief is largely independent of patterns of personality disorders with the exception of depressive and paranoid. Findings have implications for assessment and appropriate treatment of complicated grief symptoms and substance use disorder.
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Affiliation(s)
- Laura Masferrer
- CAS Girona, Mental Health and Addiction Research Group, Institutd’Assistència Sanitària (IAS), Institut d’Investigació Biomèdica de Girona (IDIBGI), Girona, Spain
- Department of Psychology, University of Girona, Girona, Spain
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4
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The Interplay Between Emotional Intelligence, Tramadol Dependence, and Comorbid Personality Disorder. ADDICTIVE DISORDERS & THEIR TREATMENT 2020. [DOI: 10.1097/adt.0000000000000200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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5
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Penders KA, Peeters IG, Metsemakers JF, van Alphen SP. Personality Disorders in Older Adults: a Review of Epidemiology, Assessment, and Treatment. Curr Psychiatry Rep 2020; 22:14. [PMID: 32025914 PMCID: PMC7002365 DOI: 10.1007/s11920-020-1133-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PURPOSE OF REVIEW The aim of the paper is reviewing recent literature on the epidemiology, assessment, and treatment of personality disorders (PDs) among older adults (≥ 60 years). RECENT FINDINGS Since 2015, 12 primary empirical studies have been published addressing PDs in older adults; 3 addressing epidemiological aspects, 6 on assessment, 2 exploring both epidemiology and assessment, and 1 examining treatment. PD research in older adults is steadily growing and is predominantly focused on assessment. The studies showed that PDs were rather prevalent ranging from 10.6-14.5% in community-dwelling older adults, to 57.8% in nursing home-residing older adults. The Severity Indices of Personality Problems-Short Form, Gerontological Personality disorders Scale, and Assessment of DSM-IV Personality Disorders turned out to be promising instruments for assessing PDs in later life. Furthermore, schema therapy seems to be a feasible and effective intervention. Despite promising findings, there is an urgent need for studies addressing PDs in older adults, especially studies investigating epidemiological aspects and treatment options. Furthermore, new areas of interest arise such as PDs in other settings, and behavioral counseling.
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Affiliation(s)
- Krystle A.P. Penders
- 0000 0001 0481 6099grid.5012.6Department of Family Medicine, School CAPHRI, Care and Public Health Research Institute, Maastricht University (UM), P.O. box 616, 6200 MD Maastricht, The Netherlands ,Department of Treatment and Guidance, Envida, Maastricht, The Netherlands
| | - Inge G.P. Peeters
- 0000 0001 0481 6099grid.5012.6Department of Family Medicine, School CAPHRI, Care and Public Health Research Institute, Maastricht University (UM), P.O. box 616, 6200 MD Maastricht, The Netherlands ,0000 0004 0480 1382grid.412966.eDepartment of Integrated Care, Maastricht University Medical Centre + (MUMC+), Maastricht, The Netherlands
| | - Job F.M. Metsemakers
- 0000 0001 0481 6099grid.5012.6Department of Family Medicine, School CAPHRI, Care and Public Health Research Institute, Maastricht University (UM), P.O. box 616, 6200 MD Maastricht, The Netherlands
| | - Sebastiaan P.J. van Alphen
- 0000 0001 2290 8069grid.8767.eFaculty of Psychology & Educational Sciences, Department of Psychology, Vrije Universiteit Brussel (VUB), Brussels, Belgium ,Department of Old Age Psychiatry, Mondriaan Hospital, Heerlen-Maastricht, The Netherlands ,0000 0001 0943 3265grid.12295.3dSchool of Social and Behavioral Sciences, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
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6
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Cavicchioli M, Ramella P, Movalli M, Prudenziati F, Vassena G, Simone G, Maffei C. DSM-5 Maladaptive Personality Domains among Treatment-Seeking Individuals with Alcohol Use Disorder: The Role of Disinhibition and Negative Affectivity. Subst Use Misuse 2020; 55:1746-1758. [PMID: 32410484 DOI: 10.1080/10826084.2020.1762650] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: Dimensional models of personality and personality disorders (PDs) have been widely investigated among individuals with alcohol use disorders (AUD). Nevertheless, DSM-5 maladaptive personality domains showed mixed associations with AUD. Furthermore, no studies have explored the role of DSM-5 maladaptive personality domains on the comorbidity between AUD and different PDs. Objective(s): This study aims at investigating whether DSM-5 maladaptive personality dimensions could differentiate individuals with AUD from normative and healthy controls (HCs) subjects. The study also investigated relationships between these personality dimensions and AUD clinical features (i.e. onset, severity of concurrent substance use disorders), as well as their role in accounting for the comorbidity between AUD and PDs. Methods: This study administered the personality inventory for DSM-5 (PID-5) to 99 treatment-seeking individuals (male 68.8%; female 31.2%; age: 48.12 (14.32)) with AUD (41 AUD only; 58 AUD with PDs), comparing the participants' levels of PID-5 domains with normative data and the data from a HC sample (N = 40; male 50%; female 50%; age: 48.12 (14.32)). Results: Disinhibition and negative affectivity were relevant maladaptive personality dimensions of AUD, even when controlling for the impact of PD diagnoses. Disinhibition and negative affectivity were associated to the onset of AUD and the severity of concurrent substance use disorders. The co-occurrence of AUD and PDs is related to other two domains, namely antagonism and detachment. Conclusions: AUD is a complex psychopathological disorder in which both externalizing and internalizing aspects determine relevant clinical features.
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Affiliation(s)
- Marco Cavicchioli
- Department of Psychology, University "Vita-Salute San Raffaele", Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy
| | - Pietro Ramella
- Department of Psychology, University "Vita-Salute San Raffaele", Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy
| | - Mariagrazia Movalli
- Department of Psychology, University "Vita-Salute San Raffaele", Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy
| | - Francesca Prudenziati
- Department of Psychology, University "Vita-Salute San Raffaele", Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy
| | - Giulia Vassena
- Department of Psychology, University "Vita-Salute San Raffaele", Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy
| | - Giulia Simone
- Department of Psychology, University "Vita-Salute San Raffaele", Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy
| | - Cesare Maffei
- Department of Psychology, University "Vita-Salute San Raffaele", Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy
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7
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Abstract
In this article, we review associations between the Dark Triad of personality (narcissism, Machiavellianism, and psychopathy) and addictive behaviors, both substance-related and non-substance-related. We summarize evidence from personality and clinical research and integrate it with prevailing models of addiction. Specifically, we discuss addictive behavior in the light of affect regulation, which is likely more relevant in narcissism, as well as inhibitory deficits, a putative mechanism in psychopathy. These mechanisms can be related to central motives of the respective personality constructs, such as stabilization of self-esteem in narcissism and impulsive stimulation seeking in psychopathy. We conclude that different mechanisms might lead to similar observable behavior in narcissism and psychopathy at earlier stages of the addiction cycle, but psychopathic disinhibition might be particularly relevant at later stages. This underpins the importance of considering personality factors for the understanding and treatment of addiction.
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Affiliation(s)
- Emanuel Jauk
- Clinical Psychology and Behavioral Neuroscience, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Raoul Dieterich
- Addiction Research, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
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8
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Abstract
From a perspective broadly informed by Stress and Coping Theory, this review examined whether theoretically distinct and important dimensions of narcissism (grandiosity and vulnerability) associate with health-related stress-reactivity. Literature searches were conducted and articles were included if they contained a validated baseline assessment of narcissism, a stressor, and a within-person assessment of stress-reactivity (i.e., a baseline and post-stress assessment of a health-related psychological, biological, or behavioural process). Additionally, narcissism measures had to be systematically categorised as assessing grandiosity or vulnerability (see Grijalva, E., Newman, D. A., Tay, L., Donnellan, M. B., Harms, P. D., Robins, R. W., & Yan, T. (2015). Gender differences in narcissism: A meta-analytic review. Psychological Bulletin, 141(2), 261-310. doi: 10.1037/a0038231 ), and narcissism dimensions had to be assessed independently of other constructs. Findings were narratively synthesised within three broad dimensions of stress-reactivity (psychological, biological, and behavioural). Overall, there appear to be relatively consistent patterns that grandiosity and vulnerability are related to altered stress-reactivity. Additionally, grandiosity and vulnerability may differentially influence stress-reactivity depending on the type of stressor and/or indicator of stress-reactivity (e.g., under certain conditions, grandiosity may confer some level of resilience). This review highlights important theoretical and empirical gaps in the emerging narcissism and health literature. Furthermore, this review may help inform methodological considerations for future research, and may also point to physical health outcomes that could conceivably be affected by narcissism over time (e.g., overweight/obesity, cardiovascular disease, HIV/AIDS).
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Affiliation(s)
- Sulamunn R M Coleman
- a Department of Biobehavioral Health , The Pennsylvania State University , University Park , PA , USA
| | - Aaron L Pincus
- b Department of Psychology , The Pennsylvania State University , University Park , PA , USA
| | - Joshua M Smyth
- a Department of Biobehavioral Health , The Pennsylvania State University , University Park , PA , USA
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9
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Álvarez A, Ávila JJ, Palao DJ, Montejo ÁL. Influence of Personality Traits on the Severity of Alcohol Use Disorders. J Clin Med 2018; 7:jcm7060127. [PMID: 29843468 PMCID: PMC6025520 DOI: 10.3390/jcm7060127] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 05/18/2018] [Accepted: 05/25/2018] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Alcohol Use Disorders (AUD) are the most prevalent psychiatric diagnosis in the general population. The study of personality characteristics, using Cloninger Personality Inventory (TCI-R), allows us to know the evolution of these patients at the beginning of treatment. MATERIAL AND METHOD We conducted a cross-sectional, observational and descriptive study for 3 years with a total of 304 patients. We studied the severity of their alcohol disorder by the Alcohol Dependency Intensity Scale (EIDA), Scale of Obsessive Consumption Compulsive (OCDS) and European version of the Addiction Severity Index (EUROPASI); we studied the relationship with the personality traits of TCI-R. RESULTS AND CONCLUSIONS The personality lines influence the evolution of alcohol use disorder (AUD). People with higher scores on Reward Dependency (RD), Persistence (P), Cooperation (CO) and Autotranscendence (ST) have a better prognosis while people with higher scores on Search for Novelty (SN) and Avoidance of Damage (AD) have a worst prognosis. Women present differences in consumption in relation to men, as a consequence of their personality. Women have lower scores in Persistence (P) y Self-Transcendence (ST) which are associated with the greater severity of their addiction.
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Affiliation(s)
- Aida Álvarez
- Department of Psychiatry, Corporaciò Sanitária Parc Taulí, 08208 Sabadell, Spain.
| | - José J Ávila
- EUEF School, University of Salamanca, 37008 Salamanca, Spain.
| | - Diego J Palao
- Department of Psychiatry, Corporaciò Sanitária Parc Taulí, 08208 Sabadell, Spain.
- Centro de Investigación en Salud Mental (CIBERSAM), 28029 Madrid, Spain.
| | - Ángel L Montejo
- EUEF School, University of Salamanca, 37008 Salamanca, Spain.
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain.
- Departament of Psychiatry, University Clinical Hospital of Salamanca, 37007 Salamanca, Spain.
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10
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Roncero C, de Miguel A, Fumero A, Abad AC, Martín R, Bethencourt JM, Grau-López L, Rodríguez-Cintas L, Daigre C. Anxiety and Depression in Drug-Dependent Patients with Cluster C Personality Disorders. Front Psychiatry 2018; 9:19. [PMID: 29472875 PMCID: PMC5810269 DOI: 10.3389/fpsyt.2018.00019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 01/18/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Comorbidity between personality disorders (PD) and substance-use disorders (SUD) is one of the most common findings in the psychiatric field. The patients with Cluster C disorders present maladjustment traits often characterized by high levels of anxiety. The main aim of this study was to find evidences about higher anxiety and depression prevalence on Cluster C than others Clusters, analyzing similarities and differences within, with other Cluster A and B PD patients and patients without PD. METHOD A total of 822 substance dependent patients (ages18-78; Mean = 38.35, SD = 10.14) completed the structured clinical interview for DSM-IV Axis I and Axis II disorders, Beck Depression Inventory, and State-Trait Anxiety Inventory. RESULTS Results supported poly-consumption in Cluster C patients, being greater alcohol consumption as well as abuse of both stimulants and depressants. Anxiety and depression did not show just one pattern for all patients with SUD-Cluster C PD. There was a relation between anxiety and depression for all the groups except for the Dependent-PD. CONCLUSION Interventions should focus on aspects like depression and anxiety more than on the substance consumed.
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Affiliation(s)
- Carlos Roncero
- Psychiatric Service, University of Salamanca Health Care Complex, Institute of Biomedicine of Salamanca, University of Salamanca, Salamanca, Spain.,Addiction and Dual Diagnosis Unit, Hospital Universitari Vall d'Hebron-ASPB, Barcelona, Spain.,Psychiatry Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Adelia de Miguel
- Sciences of Health School, Universidad of La Laguna, Tenerife, Spain
| | - Ascensión Fumero
- Sciences of Health School, Universidad of La Laguna, Tenerife, Spain
| | - Alfonso C Abad
- Addiction and Dual Diagnosis Unit, Hospital Universitari Vall d'Hebron-ASPB, Barcelona, Spain.,Psychiatry Services, Hospital Universitario Vall d'Hebron, CIBERSAM, Barcelona, Spain
| | - Rita Martín
- Sciences of Health School, Universidad of La Laguna, Tenerife, Spain
| | | | - Lara Grau-López
- Addiction and Dual Diagnosis Unit, Hospital Universitari Vall d'Hebron-ASPB, Barcelona, Spain.,Psychiatry Department, Universitat Autònoma de Barcelona, Barcelona, Spain.,Psychiatry Services, Hospital Universitario Vall d'Hebron, CIBERSAM, Barcelona, Spain
| | - Laia Rodríguez-Cintas
- Addiction and Dual Diagnosis Unit, Hospital Universitari Vall d'Hebron-ASPB, Barcelona, Spain.,Psychiatry Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Constanza Daigre
- Addiction and Dual Diagnosis Unit, Hospital Universitari Vall d'Hebron-ASPB, Barcelona, Spain.,Psychiatry Department, Universitat Autònoma de Barcelona, Barcelona, Spain.,Psychiatry Services, Hospital Universitario Vall d'Hebron, CIBERSAM, Barcelona, Spain
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11
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Schückher F, Sellin T, Berglund K, Berggren U, Balldin J, Engström I, Fahlke C. The Importance of Age at Onset of Excessive Alcohol Use with Regard to Psychiatric Symptoms and Personality Characteristics. ALCOHOLISM TREATMENT QUARTERLY 2017. [DOI: 10.1080/07347324.2017.1350540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Fides Schückher
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Tabita Sellin
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Kristina Berglund
- Department of Psychology, University of Gothenburg, Göteborg, Sweden
| | - Ulf Berggren
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden
| | - Jan Balldin
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden
| | - Ingemar Engström
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Claudia Fahlke
- Department of Psychology, University of Gothenburg, Göteborg, Sweden
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12
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Risk of Suicide and Dysfunctional Patterns of Personality among Bereaved Substance Users. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14030316. [PMID: 28335530 PMCID: PMC5369152 DOI: 10.3390/ijerph14030316] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 03/12/2017] [Accepted: 03/15/2017] [Indexed: 12/04/2022]
Abstract
Background: Research has shown that suicide is a phenomenon highly present among the drug dependent population. Different studies have demonstrated an upraised level of comorbidity between personality disorders (PD) and substance use disorders (SUD). This study aimed to describe which PDs are more frequent among those patients with a risk of suicide. Methods: The study was based on a consecutive non-probabilistic convenience sample of 196 bereaved patients attended to in a Public Addiction Center in Girona (Spain). Sociodemographic data, as well as suicide and drug related characteristics were recorded. The risk of suicide was assessed with the Spanish version of “Risk of suicide”. Personality disorders were measured with the Spanish version of Millon Multiaxial Clinical Inventory. Results: The PDs more associated with the presence of risk of suicide were depressive, avoidant, schizotypal and borderline disorders. However, the histrionic, narcissistic and compulsive PDs are inversely associated with risk of suicide even though the narcissistic scale had no statistical correlation. Conclusions: The risk of suicide is a significant factor to take into account related to patients with SUD and especially with the presence of specific PDs. These findings underline the importance of diagnosing and treating rigorously patients with SUD.
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13
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Newton-Howes G, Gordon S. The recovery paradigm and distress conceptualized as personality disorder: Lack of evidence does not equate to a lack of importance. Personal Ment Health 2017; 11:33-36. [PMID: 27891764 DOI: 10.1002/pmh.1364] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/10/2016] [Accepted: 10/10/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Giles Newton-Howes
- University of Otago, Department of Psychological Medicine, Wellington, New Zealand
| | - Sarah Gordon
- University of Otago, Department of Psychological Medicine, Wellington, New Zealand
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14
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Doyle M, While D, Mok PLH, Windfuhr K, Ashcroft DM, Kontopantelis E, Chew-Graham CA, Appleby L, Shaw J, Webb RT. Suicide risk in primary care patients diagnosed with a personality disorder: a nested case control study. BMC FAMILY PRACTICE 2016; 17:106. [PMID: 27495284 PMCID: PMC4974738 DOI: 10.1186/s12875-016-0479-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 07/12/2016] [Indexed: 11/18/2022]
Abstract
Background Personality disorder (PD) is associated with elevated suicide risk, but the level of risk in primary care settings is unknown. We assessed whether PD among primary care patients is linked with a greater elevation in risk as compared with other psychiatric diagnoses, and whether the association is modified by gender, age, type of PD, and comorbid alcohol misuse. Methods Using data from the UK Clinical Practice Research Datalink, 2384 suicides were matched to 46,899 living controls by gender, age, and registered practice. Prevalence of PD, other mental disorders, and alcohol misuse was calculated for cases and controls separately and conditional logistic regression models were used to estimate exposure odds ratios. We also fitted gender interaction terms and formally tested their significance, and estimated gender age-specific effects. Results We found a 20-fold increase in suicide risk for patients with PD versus no recorded psychiatric disorder, and a four-fold increase versus all other psychiatric illnesses combined. Borderline PD and PD with comorbid alcohol misuse were associated with a 37- and 45-fold increased risk, respectively, compared with those with no psychiatric disorders. Relative risks were higher for female than for male patients with PD. Significant risks associated with PD diagnosis were identified across all age ranges, although the greatest elevations were in the younger age ranges, 16–39 years. Conclusions The large elevation in suicide risk among patients diagnosed with PD and comorbid alcohol misuse is a particular concern. GPs have a potentially key role to play in intervening with patients diagnosed with PD, particularly in the presence of comorbid alcohol misuse, which may help reduce suicide risk. This would mean working with specialist care, agreed clinical pathways and availability of services for comorbidities such as alcohol misuse, as well as opportunities for GPs to develop specific clinical skills.
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Affiliation(s)
- Michael Doyle
- Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, England. .,South West Yorkshire Partnership NHS Foundation Trust, Wakefield, England.
| | - David While
- Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, England
| | - Pearl L H Mok
- Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, England
| | - Kirsten Windfuhr
- Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, England
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School, University of Manchester, Manchester, England.,NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, University of Manchester, Manchester, England
| | - Evangelos Kontopantelis
- The Farr Institute for Health Informatics Research, University of Manchester, Manchester, England.,NIHR School for Primary Care Research, University of Manchester, Manchester, England
| | - Carolyn A Chew-Graham
- Research Institute, Primary Care and Health Sciences, Keele University, Keele, England.,West Midlands Collaboration for Leadership in Applied Health Research and Care (CLAHRC), Keele, England
| | - Louis Appleby
- Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, England
| | - Jenny Shaw
- Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, England
| | - Roger T Webb
- Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, England
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15
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Abstract
The main body of research on addiction and pathological narcissism has focused on the study of their co-occurrence by applying Diagnostic and Statistical Manual of Mental Disorders ( DSM) definitions for these clinical phenomena or by assessing trait narcissism in substance-dependent populations. Clinically informed comprehensive conceptualizations of narcissism which focus on its phenomenological range from vulnerability to grandiosity have not been applied in studying the specific narcissistic disturbances that underlie the relationship between these comorbid conditions. Aiming to examine this relationship, this study compared the presence of pathological narcissism, and more specifically narcissistic grandiosity and vulnerability, in substance-dependent individuals in treatment with individuals from the general population. Comparisons indicate that substance-dependent individuals experience significant narcissistic disturbances more likely related to vulnerability than grandiosity. Shame, rage, and self-esteem contingent upon external validation comprise the intrapsychic and interpersonal vulnerability. Implications for the clinical conceptualization of pathological narcissism as well as for substance dependence treatment interventions are discussed.
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16
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Creswell KG, Bachrach RL, Wright AGC, Pinto A, Ansell E. Predicting problematic alcohol use with the DSM-5 alternative model of personality pathology. Personal Disord 2015; 7:103-11. [PMID: 26389625 DOI: 10.1037/per0000131] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
High comorbidity between personality disorders and alcohol use disorders appears related to individual differences in underlying personality dimensions of behavioral undercontrol and affective dysregulation. However, very little is known about how the Diagnostic and Statistical Manual of Mental Disorders (5th edition; DSM-5) Section III trait model of personality pathology relates to alcohol problems or how the strength of the relationship between personality pathology and alcohol problems changes with age and across gender. The current study examined these questions in a sample of 877 participants using the General Assessment of Personality Disorder to assess general personality dysfunction, the Personality Inventory for DSM-5 to measure specific traits, and the Alcohol Use Disorder Identification Test (AUDIT) to assess problematic alcohol use. Results demonstrated that general personality pathology (Criterion A) was significantly related to problematic alcohol use after controlling for age and gender effects. Furthermore, 2 of the 5 higher-order personality trait domains (Criterion B), Antagonism and Disinhibition, remained significant predictors of problematic alcohol use after accounting for the influence of general personality pathology; however, general personality pathology no longer predicted hazardous alcohol use once Antagonism and Disinhibition were added into the model. Finally, these 2 specific traits interacted with age, such that Antagonism was a stronger predictor of AUDIT scores among older individuals and Disinhibition was a stronger predictor of alcohol problems among younger individuals. Findings support the general validity of this new personality disorder diagnostic system and suggest important age effects in the relationship between traits and problematic alcohol use. (PsycINFO Database Record
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Affiliation(s)
| | | | | | - Anthony Pinto
- Division of Psychiatry Research, Zucker Hillside Hospital, North Shore-LIJ Health System
| | - Emily Ansell
- Department of Psychiatry, Yale University School of Medicine
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Yen CH, Yeh YW, Liang CS, Ho PS, Kuo SC, Huang CC, Chen CY, Shih MC, Ma KH, Peng GS, Lu RB, Huang SY. Reduced Dopamine Transporter Availability and Neurocognitive Deficits in Male Patients with Alcohol Dependence. PLoS One 2015; 10:e0131017. [PMID: 26120847 PMCID: PMC4487997 DOI: 10.1371/journal.pone.0131017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 05/26/2015] [Indexed: 12/26/2022] Open
Abstract
Dopamine plays an important role in the development of alcohol dependence, cognitive dysfunction, and is regulated via dopamine transporter activity. Although dopamine transporter activity is critically involved in alcohol dependence, studies observing this relationship are limited. Thus the current study examined whether dopamine transporter availability is associated with developing of alcohol dependence and cognitive dysfunction. Brain imaging with 99mTc-TRODAT-1 as a ligand was used to measure dopamine transporter availability among 26 male patients with pure alcohol dependence and 22 age- and sex- matched healthy volunteers. The Wisconsin Card Sorting Test (WCST) and Tridimensional Personality Questionnaire (TPQ) were administered to assess neurocognitive functioning and personality traits, respectively. Compared to healthy controls, patients with alcohol dependence showed a significant reduction in dopamine transporter availability (p < 0.001), as well as diminished performance on the WCST (p < 0.001). Dopamine transporter availability was negatively correlated with both total and perseverative WCST errors among healthy controls, but only patients with alcohol dependence showed a positive correlation between dopamine transporter availability and a harm avoidance personality profile. Thus, reductions in dopamine transporter availability may play a pathophysiological role in the development of pure alcohol dependence, given its association with neurocognitive deficits. Moreover, personality may influence the development of pure alcohol dependence; however, additional clinical subgroups should be examined to confirm this possibility.
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Affiliation(s)
- Che-Hung Yen
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, ROC; Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Yi-Wei Yeh
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chih-Sung Liang
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, ROC; Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Pei-Shen Ho
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Shin-Chang Kuo
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, ROC; Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chang-Chih Huang
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, ROC; Department of Psychiatry, Taipei Branch, Buddhist Tzu Chi General Hospital, Taipei, Taiwan, ROC
| | - Chun-Yen Chen
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, ROC; Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Mei-Chen Shih
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Kuo-Hsing Ma
- Department of anatomy and biology, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Giia-Sheun Peng
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Ru-Band Lu
- Institute of Behavior Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC
| | - San-Yuan Huang
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, ROC; Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
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Abstract
The pervasive effect of personality disorder is often overlooked in clinical practice, both as an important moderator of mental state and physical disorders, and as a disorder that should be recognised and managed in its own right. Contemporary research has shown that maladaptive personality (when personality traits are extreme and associated with clinical distress or psychosocial impairment) is common, can be recognised early in life, evolves continuously across the lifespan, and is more plastic than previously believed. These new insights offer opportunities to intervene to support more adaptive development than before, and research shows that such intervention can be effective. Further research is needed to improve classification, assessment, and diagnosis of personality disorder across the lifespan; to understand the complex interplay between changes in personality traits and clinical presentation over time; and to promote more effective intervention at the earliest possible stage of the disorder than is done at present. Recognition of how personality disorder relates to age and developmental stage can improve care of all patients.
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Affiliation(s)
- Giles Newton-Howes
- University of Otago, Wellington, New Zealand; Imperial College, Hammersmith, London, UK.
| | | | - Andrew Chanen
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
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19
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Prakash O, Sharma N, Singh AR, Sengar KS, Chaudhury S, Ranjan JK. Personality disorder, emotional intelligence, and locus of control of patients with alcohol dependence. Ind Psychiatry J 2015; 24:40-7. [PMID: 26257482 PMCID: PMC4525430 DOI: 10.4103/0972-6748.160931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AIM To assess personality disorder (PD), emotional intelligence (EI), and locus of control of alcohol dependent (AD) patients and its comparison with normal controls. MATERIALS AND METHODS Based on purposive sampling technique, 33 AD patients were selected from the De-Addiction Ward of Ranchi Institute of Neuro-Psychiatry and Allied Sciences (RINPAS) and 33 matched normal subjects were selected from Ranchi and nearby places. Both the groups were matched on various sociodemographic parameters, that is, age, gender, and socioeconomic level. All participants were assessed with Millon Clinical Multiaxial Inventory-III, Mangal EI Inventory, and Locus of Control scale. Obtained responses were scored by using standard scoring procedures and subsequently statistically analyzed by using Chi-square test. RESULTS AD patients have more comorbid pathological personality traits and disorders in comparison to their normal counterparts. Depressive, narcissistic, and paranoid PDs were prominent among AD group; followed by schizotypal, antisocial, negativistic, dependent, schizoid, sadistic, masochistic, and borderline PD. In comparison to normal participants, AD patients were significantly deficient in almost all the areas of EI and their locus of control was externally oriented. CONCLUSION Patients with AD have significantly higher PDs, low EI, and an external orientation on the locus of control. Identification and management of these comorbid conditions are likely to improve the management and outcome of AD.
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Affiliation(s)
- Om Prakash
- Clinical Psychologist, Government Medical College and Hospital, Sector 32, Chandigarh, India
| | - Neelu Sharma
- Department of Clinical Psychology, RINPAS, Kanke, Ranchi, Jharkhand, India
| | - Amool R Singh
- Department of Clinical Psychology, RINPAS, Kanke, Ranchi, Jharkhand, India
| | - K S Sengar
- Department of Clinical Psychology, RINPAS, Kanke, Ranchi, Jharkhand, India
| | - Suprakash Chaudhury
- Department of Psychiatry, Pravara Institute of Medical Sciences (Deemed University), Rural Medical College, Ahmed Nagar, Maharashtra, India
| | - Jay Kumar Ranjan
- Department of Psychology, RBR NES PG College, Jaspur Nagar, Chhattisgarh, India
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20
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Dimaggio G. Narcissistic personality disorder and becoming old. Personal Ment Health 2014; 8:89-90. [PMID: 24399659 DOI: 10.1002/pmh.1251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 11/29/2013] [Indexed: 11/05/2022]
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Adopting Metacognitive Interpersonal Therapy to Treat Narcissistic Personality Disorder with Somatization. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2013. [DOI: 10.1007/s10879-013-9254-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Gleason MEJ, Weinstein Y, Balsis S, Oltmanns TF. The enduring impact of maladaptive personality traits on relationship quality and health in later life. J Pers 2013; 82:493-501. [PMID: 23998798 DOI: 10.1111/jopy.12068] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Over the past 5 years, the St. Louis Personality and Aging Network (SPAN) has been collecting data on personality in later life with an emphasis on maladaptive personality, social integration, and health outcomes in a representative sample of 1,630 adults aged 55-64 living in the St. Louis area. This program has confirmed the importance of considering both the normal range of personality and in particular the role of maladaptive traits in order to understand individuals' relationships, life events, and health outcomes. In the current article, we discuss the explanatory benefits of considering maladaptive traits or traits associated with personality disorders when discussing the role of personality in social and health outcomes, with an emphasis on adults in middle to later life, and integrate these findings into the greater literature.
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Oltmanns TF, Rodrigues MM, Weinstein Y, Gleason MEJ. Prevalence of Personality Disorders at Midlife in a Community Sample: Disorders and Symptoms Reflected in Interview, Self, and Informant Reports. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2013; 36:177-188. [PMID: 24954973 DOI: 10.1007/s10862-013-9389-7] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This report is concerned with the prevalence of symptoms of specific personality disorders in a representative community sample and draws attention to the importance of different sources of diagnostic information. We recruited a sample of 1,630 people between the ages of 55 and 64 to participate in a study regarding personality and health. Using careful recruitment methods, our participation rate was 43 %. Participants completed the SIDP-IV interview as well as a questionnaire (self-report MAPP). Informants completed the same questionnaire (informant MAPP), describing the participant's maladaptive personality characteristics. According to the diagnostic interview, 7 % of participants met criteria for exactly one PD, 1 % met criteria for 2 or 3 PDs, and 2 % met criteria for PD NOS (defined as 10 or more miscellaneous criteria). Avoidant and obsessive compulsive PDs were the most common types. Correlations between the three sources of information indicated significant agreement among these measurement methods, but they are not redundant. In comparison to interview and self-report data, informants reported more symptoms of personality pathology (except for avoidant PD). Symptoms of personality pathology are continuously distributed, and subthreshold features may have an important impact on health and social adjustment. In this community sample, rates of co-morbidity among PDs and the proportion of PDNOS diagnoses are substantially lower than reported from clinical samples. Future research must evaluate the validity of diagnostic thresholds and competing sources of diagnostic information in relation to important life outcomes.
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Affiliation(s)
- Thomas F Oltmanns
- Department of Psychology, Washington University in St. Louis, St. Louis, MO 63130-4899, USA
| | - Merlyn M Rodrigues
- Department of Psychology, Washington University in St. Louis, St. Louis, MO 63130-4899, USA
| | - Yana Weinstein
- Department of Psychology, University of Massachusetts - Lowell, Lowell, USA
| | - Marci E J Gleason
- Department of Human Development and Family Sciences, University of Texas in Austin, Austin, USA
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Ireland JL, Higgins P. Behavioural stimulation and sensation-seeking among prisoners: applications to substance dependency. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2013; 36:229-234. [PMID: 23623718 DOI: 10.1016/j.ijlp.2013.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Sensation-seeking among prisoners with substance dependence difficulties (drug and/or alcohol) was examined. This topic is under-researched in a prisoner sample. AIMS The aims are to examine the association between sensation-seeking, other personality variables, and substance dependency among prisoners, and to examine if sensation-seeking can be refined. METHODS Adult male prisoners (n=200) completed self-report measures examining the constructs of interest. RESULTS Sensation-seeking comprised extraversion and openness to experience. It was more appropriately described as Behavioural-Stimulation-and-Sensation-Seeking (BStim-SS). BStim-SS is related to drug and poly-substance dependency but not alcohol-only dependency. Increased impulsivity was related to all substance use dependencies. CONCLUSIONS AND IMPLICATIONS FOR PRACTISE BStim-SS presents as a valuable concept to apply to forensic populations. It captures the need for behavioural and emotional stimulation and lends support to Reward Discounting theory as valuable concept to apply across substance dependency. Implications for practise include: • A need to identify a broader concept of sensation-seeking for prisoner samples; • The recognition of differences within substance dependent samples, with impulsivity presenting differently across drug and/or alcohol dependent groups; • Recognition that concepts regularly applied to community samples need to be examined more specifically among forensic samples to ascertain validity.
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Affiliation(s)
- Jane L Ireland
- Ashworth Research Centre (ARC), Mersey Care NHS Trust and University of Central Lancashire, Preston, Lancashire, UK.
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