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Šimunović Filipčić I, Jakšić N, Levaj S, Ćopo M, Vuksan-Ćusa Z, Mikulić FL, Grah M, Skočić Hanžek M, Šagud M, Filipčić I, Marčinko D. Physical multimorbidity in psychiatric patients with personality disorders: Insights within the ICD-11 framework. Gen Hosp Psychiatry 2024; 89:16-22. [PMID: 38704972 DOI: 10.1016/j.genhosppsych.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/29/2024] [Accepted: 04/29/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE Recent research has revealed poor physical health among individuals with personality disorders (PDs). We aimed to compare chronic physical illnesses (CPI) and chronic physical multimorbidity (CPM) prevalence between the general population (GEP) and PD patients, and to explore the relationship between CPM and various aspects of PD, predominantly within the ICD-11 framework. METHODS This cross-sectional study included 126 PD patients and 126 matched controls from the GEP. Patients were evaluated for the ICD-11 PD severity and maladaptive personality domains, subjective emptiness, and reflective functioning. CPI was assessed using a standardized self-report questionnaire. RESULTS PD patients had a higher mean number of CPIs (2.05 vs. 1.02) and a more frequent CPM occurrence (49.2% vs. 26.2%) compared to the matched controls (p < .001). The ICD-11 PD severity (OR = 1.143, p = .007) and maladaptive domain Negative affectivity (OR = 4.845, p = .002), and poor reflective functioning (OR = 1.694, p = .007) were significant predictors of CPM, independent of sociodemographic, clinical and lifestyle factors. Negative affectivity showed the most robust effect on CPM, while smoking did not significantly mediate these relationships. CONCLUSION Our study found increased CPM burden in PD patients and a link between CPM and various PD aspects under the ICD-11 framework, highlighting the need for more integrated healthcare.
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Affiliation(s)
- Ivona Šimunović Filipčić
- Department of Psychiatry and Psychological Medicine, University Hospital Center Zagreb, Zagreb, Croatia; Faculty of Dental Medicine and Health Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.
| | - Nenad Jakšić
- Department of Psychiatry and Psychological Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - Sarah Levaj
- Department of Psychiatry and Psychological Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - Marija Ćopo
- Neuropsychiatric Hospital "Dr. Ivan Barbot", Croatia
| | | | | | - Majda Grah
- Faculty of Dental Medicine and Health Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; University Psychiatric Clinic Sveti Ivan, Zagreb, Croatia; University of Applied Health Science, Zagreb, Croatia
| | - Milena Skočić Hanžek
- Department of Psychiatry and Psychological Medicine, University Hospital Center Zagreb, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Marina Šagud
- Department of Psychiatry and Psychological Medicine, University Hospital Center Zagreb, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Igor Filipčić
- Faculty of Dental Medicine and Health Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; University Psychiatric Clinic Sveti Ivan, Zagreb, Croatia; University of Applied Health Science, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Darko Marčinko
- Department of Psychiatry and Psychological Medicine, University Hospital Center Zagreb, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia
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Links PS, Aslam H, Brodeur J. Assessing and managing patients with borderline personality disorder requesting medical assistance in dying. Front Psychiatry 2024; 15:1364621. [PMID: 38919634 PMCID: PMC11196780 DOI: 10.3389/fpsyt.2024.1364621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 06/03/2024] [Indexed: 06/27/2024] Open
Abstract
Background When physician assisted dying (referred to as Medical Assistance in Dying or MAiD in this article) is available for individuals with mental disorders as the sole underlying medical condition (MD-SUMC), patients with borderline personality disorder (BPD) frequently request MAiD. Psychiatrists and other clinicians must be prepared to evaluate and manage these requests. Objectives The purposes of this paper are to define when patients with BPD should be considered to have an irremediable, treatment resistant disorder and provide clinicians with an approach to assess and manage their patients with BPD making requests for MAiD. Methods This perspective paper developed the authors' viewpoint by using a published, authoritative definition of irremediability and including noteworthy systematic and/or meta-analytic reviews related to the assessment of irremediability. Results The clinician must be aware of the eligibility requirements for granting MAiD in their jurisdiction so that they can appropriately prepare themselves and their patients for the assessment process. The appraisal of the intolerability of the specific person's suffering comes from having an extensive dialogue with the patient; however, the assessment of whether the patient has irremediable BPD should be more objectively and reliably determined. A systematic approach to the assessment of irremediability of BPD is reviewed in the context of the disorder's severity, treatment resistance and irreversibility. Conclusion In addition to characterizing irremediability, this paper also addresses the evaluation and management of suicide risk for patients with BPD undergoing the MAiD assessment process.
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Affiliation(s)
- Paul S. Links
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Hira Aslam
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jonah Brodeur
- Department of Family Medicine, University of Toronto, Toronto, ON, Canada
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Nance M, Stetsiv K, McNamara IA, Carpenter RW, Hepp J. Acute, Chronic, and Everyday Physical Pain in Borderline Personality Disorder. Curr Psychiatry Rep 2024; 26:240-248. [PMID: 38598062 PMCID: PMC11082044 DOI: 10.1007/s11920-024-01498-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2024] [Indexed: 04/11/2024]
Abstract
PURPOSE OF REVIEW Physical pain is an underrecognized area of dysregulation among those with borderline personality disorder (BPD). Disturbances are observed within the experience of acute, chronic, and everyday physical pain experiences for people with BPD. We aimed to synthesize research findings on multiple areas of dysregulation in BPD in order to highlight potential mechanisms underlying the association between BPD and physical pain dysregulation. RECENT FINDINGS Potential biological mechanisms include altered neural responses to painful stimuli within cognitive-affective regions of the brain, as well as potentially low basal levels of endogenous opioids. Emotion dysregulation broadly mediates dysregulation of physical pain. Certain psychological experiences may attenuate acute physical pain, such as dissociation, whereas others, such as negative affect, may exacerbate it. Social challenges between patients with BPD and healthcare providers may hinder appropriate treatment of chronic pain. Dysregulated physical pain is common in BPD and important in shaping health outcomes including elevated BPD symptoms, chronic pain conditions, and risk for problematic substance use.
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Affiliation(s)
- Melissa Nance
- Department of Psychological Sciences, University of Missouri, St. Louis, St. Louis, USA
| | - Khrystyna Stetsiv
- Department of Psychological Sciences, University of Missouri, St. Louis, St. Louis, USA
| | - Ian A McNamara
- Department of Psychological Sciences, University of Missouri, St. Louis, St. Louis, USA
| | - Ryan W Carpenter
- Department of Psychological Sciences, University of Missouri, St. Louis, St. Louis, USA
| | - Johanna Hepp
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, J5, 68159, Mannheim, Germany.
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Álvarez-Tomás I, Soler J, Schmidt C, Pascual JC. Physical health, primary care utilization and long-term quality of life in borderline personality disorder: A 10-year follow-up study in a Spanish sample. J Psychosom Res 2024; 179:111623. [PMID: 38422718 DOI: 10.1016/j.jpsychores.2024.111623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/21/2024] [Accepted: 02/21/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE We aimed to study physical health and primary care utilization in the long-term course of borderline personality disorder (BPD) and their impact on quality of life (QOL) in a Spanish clinical sample. METHODS This study is part of a longitudinal study following a clinical cohort with BPD. A total of 41 participants were re-evaluated at 10-year follow-up, when current medical conditions, primary care utilization, and quality of life were assessed. Comparative population data were extracted from the Catalan Health Survey ESCA. RESULTS 68% of BPD patients reported physical health problems, and 32% informed of multiple medical illnesses at follow-up. Higher rates of musculoskeletal disorders and frequent use of general practitioner (GP) consultations were reported by BPD patients compared to the general population. Differences in physical health and use of primary care services between remitted and non-remitted BPD patients were not significant. BPD remission was independently associated with better long-term QOL. Comorbid somatic diseases worsened the long-term QOL of non-remitted BPD patients. CONCLUSION Chronic somatic conditions are prevalent in people with BPD and interact negatively with persistent BPD pathology, worsening their QOL in the long-term. Health care strategies in the assistance of long-lasting BPD patients are recommended.
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Affiliation(s)
| | - Joaquim Soler
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica- Sant Pau (IIB-SANT PAU), Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Spain.
| | - Carlos Schmidt
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica- Sant Pau (IIB-SANT PAU), Barcelona, Spain
| | - Juan C Pascual
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica- Sant Pau (IIB-SANT PAU), Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, Spain
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Muñoz-Negro JE, Gutiérrez B, Rivera M, Molina E, González Díaz M, Jabalera Ruz P, Cervilla JA. An epidemiological survey on personality disorder in Andalusia (the PISMA-ep PD study). Int J Soc Psychiatry 2024; 70:209-217. [PMID: 37840279 DOI: 10.1177/00207640231204216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
BACKGROUND Despite a significant clinical and social burden, there is a relative scarcity of epidemiological studies on Personality Disorder (PD). AIM To determine the current prevalence of PD and the psychosocial correlates associated with this in the Andalusian population. METHOD We carried out a cross-sectional population mental-health survey in Andalusia, southern Spain. Thus, 4,518 randomly selected participants were interviewed following sampling using different standard stratification levels. We used the Spanish version of the SAPAS to estimate PD prevalence. In addition, a full battery of other instruments was utilized to explore global functionality, childhood abuse, maltreatment, threatening life events, personality traits (neuroticism, impulsivity and paranoia), medical and psychiatric comorbidities, family history of psychological problems and other potential risk factors for PD. RESULTS PD prevalence (10.8%; 95% CI [9.8, 11.7]) and ran two different multivariate models for PD. We obtained the highest PD prevalence in those affected by any mental disorder plus those reporting having suffered childhood abuse, particularly sexual abuse. Additional potential risk factors or correlates of PD identified were: younger age, lower levels of functioning, less social support, poorer general health, having suffered maltreatment, threatening life events, higher suicidal risk scores and higher levels of both neuroticism and impulsivity. CONCLUSIONS This study reports PD prevalence and risk correlates in consonance with similar findings reported in other Western populations. However, longitudinal studies are needed to elicit a more thorough group of prospective determinants of PD.
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Affiliation(s)
| | - Blanca Gutiérrez
- Departament of Psychiatry, University of Granada, Spain
- Institute of Neurosciences, Biomedical Research Centre, University of Granada, Spain
- Instituto de Investigación Biosanitaria ibs Granada, Spain
| | - Margarita Rivera
- Institute of Neurosciences, Biomedical Research Centre, University of Granada, Spain
- Instituto de Investigación Biosanitaria ibs Granada, Spain
- Department of Biochemistry and Molecular Biology II, Faculty of Pharmacy, University of Granada, Spain
| | - Esther Molina
- Institute of Neurosciences, Biomedical Research Centre, University of Granada, Spain
- Instituto de Investigación Biosanitaria ibs Granada, Spain
- Department of Nursing, Faculty of Health Sciences, University of Granada, Spain
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Hastrup LH, Jennum P, Ibsen R, Kjellberg J, Simonsen E. Borderline personality disorder and the diagnostic co-occurrence of mental health disorders and somatic diseases: A controlled prospective national register-based study. Acta Psychiatr Scand 2024; 149:124-132. [PMID: 38072006 DOI: 10.1111/acps.13642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/27/2023] [Accepted: 11/20/2023] [Indexed: 01/16/2024]
Abstract
OBJECTIVE Information on borderline personality disorder (BPD) and its comorbidities is often limited to concentrate on a few diagnoses. The aim of the study was to use national register data to investigate all diagnostic co-occurring mental health disorders and somatic diseases 3 years before and after initial BPD diagnosis compared with a matched control group. METHOD The study was a register-based cohort of 2756 patients with incident BPD (ICD F60.3) and 11,024 matched controls, during 2002-2016. Comorbidity data were classified into main disease groups, in accordance with the World Health Organization ICD-10 criteria. RESULTS Almost half the patients had been diagnosed with mental and behavioral disorders before the BPD diagnosis as compared to 3% in the control group. Further, the co-occurrence of diseases due to external causes of morbidity, including injury, self-harm, and poisoning were more represented in the BPD group before diagnosis as compared to the control group. In addition, co-occurring morbidity related to diseases in the circulatory, the respiratory, the digestive, the musculoskeletal, and the genitourinary system was more represented in the BPD group. After diagnosis, the proportion of patients with co-occurring morbidity increased further in all main disease groups in the BPD group. As many as 87% of patients had mental and behavioral co-occurring morbidity and 15% nervous diseases as compared with 3% and 4%, respectively, in the control group. Also, comorbidities related to external causes of morbidity, including for example, injury and self-harm were more represented in the BPD group. The BPD group had more somatic co-occurring morbidity, especially digestive, respiratory, circulatory, and endocrine diseases. Finally, the mortality over 12 years was statistically significantly higher in people with BPD than in the control group. CONCLUSION Patients with BPD have higher odds for multiple physical health conditions and co-occurrence of mental health disorders.
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Affiliation(s)
- L H Hastrup
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark
- Danish Centre for Health Economics (DaCHE), University of Southern Denmark, Odense, Denmark
| | - P Jennum
- Faculty of Health Sciences, Danish Center for Sleep Medicine, Neurophysiology Clinic, University of Copenhagen, Copenhagen, Denmark
| | | | - J Kjellberg
- Danish Center for Social Science Research (VIVE), Copenhagen, Denmark
| | - E Simonsen
- Mental Health Service East, Psychiatry Region Zealand, Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Mattingley S, Youssef GJ, Graeme L, Sloan E, Manning V, Hall K. Negative urgency, distress tolerance, and symptoms of substance use, eating, and borderline personality disorders in treatment-seeking young people. J Clin Psychol 2024; 80:261-278. [PMID: 37597248 DOI: 10.1002/jclp.23579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 04/24/2023] [Accepted: 07/23/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVE Negative urgency (NU) and distress tolerance (DT) are two similar yet distinct constructs with putative transdiagnostic relevance, particularly across psychopathology characterized by impulsivity (e.g., substance use disorders [SUD], eating disorders featuring binging and/or purging ED-B/P, and borderline personality disorder [BPD]). Yet, there remains a lack of research into NU and DT across SUD, ED-B/P, and BPD symptomatology in clinical populations. The present study sought to elucidate the transdiagnostic utility of NU and DT across impulsive-type psychology by examining the unique and interactive roles of NU and DT across SUD, ED-B/P, and BPD symptomatology within a treatment-seeking sample of young people. METHOD Participants (N = 385; 62.3% female; aged 16-25 years) were recruited from youth health services across Melbourne, Australia. Participants completed an online survey including self-report measures of NU and DT as well as SUD, ED-B/P, and BPD symptoms. Mixed effects logistic regression was used to explore unique and interactive associations of NU and DT with symptoms. RESULTS Both NU (adjusted odds ratio [ORadj ] = 1.22; 95% confidence interval [CI] = [1.16, 1.28]) and global DT (ORadj = 0.59; 95% CI = [0.47, 0.74]) uniquely predicted symptoms. However, associations with global DT and most of its components differed across psychopathology types. No significant interactions between NU and DT in predicting symptoms were found. CONCLUSIONS These results support the transdiagnostic utility of NU across SUD, ED-B/P, and BPD, while suggesting the role of DT across these disorders is more nuanced. These findings have important implications for NU and DT as potential intervention targets.
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Affiliation(s)
- Sophie Mattingley
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - George J Youssef
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Centre of Drug Use, Addictive and Antisocial Behavior Research, Deakin University, Geelong, Victoria, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Liam Graeme
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Elise Sloan
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Victoria Manning
- Monash Addiction Research Centre (MARC), Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
- Turning Point, Eastern Health, Richmond, Victoria, Australia
| | - Kate Hall
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Centre of Drug Use, Addictive and Antisocial Behavior Research, Deakin University, Geelong, Victoria, Australia
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Stone LE, Segal DL. Associations between physical health and the alternative model of personality disorders: A cross-sectional age study. Personal Ment Health 2023; 17:220-231. [PMID: 36670518 DOI: 10.1002/pmh.1576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 12/29/2022] [Accepted: 01/02/2023] [Indexed: 01/22/2023]
Abstract
The Alternative Model of Personality Disorders (AMPD) is a relatively new dimensional model of personality disorders (PDs) that assesses two diagnostic constructs: personality functioning and pathological personality traits. Thus far, research on the AMPD among older adults has been limited, but the research that does exist suggests limited generalizability to the unique biopsychosocial context of later life. To further examine the applicability of the AMPD to older adults, the purpose of this study was to examine relationships between the AMPD's two constructs with perceived physical health status among younger and older adult samples. Older adults (n = 222) and younger adults (n = 215) completed the Short Form-36 (SF-36), Levels of Personality Functioning Scale-Self-Report (LPFS-SR), and Personality Inventory for DSM-5-Brief Form (PID-5-BF). Correlations and Fisher's z-tests revealed significantly stronger relationships between the SF-36 with the LPFS-SR and PID-5-BF domains for older adults than younger adults. Additionally, age group significantly moderated the relationships between personality functioning and pathological personality traits and health. The stronger relationships between health and the AMPD's constructs for older adults suggest meaningful overlap between negative health outcomes and PD pathology. Future research should further investigate specific mechanisms in which personality pathology negatively impacts health in older adults.
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Affiliation(s)
- Lisa E Stone
- Department of Psychology, University of Colorado at Colorado Springs, Colorado Springs, Colorado, USA
| | - Daniel L Segal
- Department of Psychology, University of Colorado at Colorado Springs, Colorado Springs, Colorado, USA
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Trivedi RB, Rossi FS, Javier SJ, Greene L, Singer SJ, Vanneman ME, Goldstein M, Zulman DM. Association Between Mental Health Conditions and Outpatient Care Fragmentation: a National Study of Older High-Risk Veterans. J Gen Intern Med 2022; 37:4071-4079. [PMID: 35869316 PMCID: PMC9708986 DOI: 10.1007/s11606-022-07705-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 06/16/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Healthcare fragmentation may lead to adverse consequences and may be amplified among older, sicker patients with mental health (MH) conditions. OBJECTIVE To determine whether older Veterans with MH conditions have more fragmented outpatient non-MH care, compared with older Veterans with no MH conditions. DESIGN Retrospective cohort study using FY2014 Veterans Health Administration (VHA) administrative data linked to Medicare data. PARTICIPANTS 125,481 VHA patients ≥ 65 years old who were continuously enrolled in Medicare Fee-for-Service Parts A and B and were at high risk for hospitalization. MAIN OUTCOME AND MEASURES The main outcome was non-MH care fragmentation as measured by (1) non-MH provider count and (2) Usual Provider of Care (UPC), the proportion of care with the most frequently seen non-MH provider. We tested the association between no vs. any MH conditions and outcomes using Poisson regression and fractional regression with logit link, respectively. We also compared Veterans with no MH condition with each MH condition and combinations of MH conditions, adjusting for sociodemographics, comorbidities, and drive-time to VHA specialty care. KEY RESULTS In total, 47.3% had at least one MH condition. Compared to those without MH conditions, Veterans with MH conditions had less fragmented care, with fewer non-MH providers (IRR = 0.96; 95% CI: 0.96-0.96) and more concentrated care with their usual provider (OR = 1.08 for a higher UPC; 95% CI: 1.07, 1.09) in adjusted models. Secondary analyses showed that those with individual MH conditions (e.g., depression) had fewer non-MH providers (IRR range: 0.86-0.98) and more concentrated care (OR range: 1.04-1.20). A similar pattern was observed when examining combinations of MH conditions (IRR range: 0.80-0.90; OR range: 1.16-1.30). CONCLUSIONS Contrary to expectations, having a MH condition was associated with less fragmented non-MH care among older, high-risk Veterans. Further research will determine if this is due to different needs, underuse, or appropriate use of healthcare.
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Affiliation(s)
- Ranak B Trivedi
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Ci2i Bldg 324 B-134, 795 Willow Rd MPD-152, Menlo Park, CA, 94025, USA.
- Division of Public Mental Health and Population Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.
| | - Fernanda S Rossi
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Ci2i Bldg 324 B-134, 795 Willow Rd MPD-152, Menlo Park, CA, 94025, USA
- Center for Primary Care and Outcomes Research (PCOR), Stanford University School of Medicine, Stanford, CA, USA
| | - Sarah J Javier
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Ci2i Bldg 324 B-134, 795 Willow Rd MPD-152, Menlo Park, CA, 94025, USA
- Center for Primary Care and Outcomes Research (PCOR), Stanford University School of Medicine, Stanford, CA, USA
| | - Liberty Greene
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Ci2i Bldg 324 B-134, 795 Willow Rd MPD-152, Menlo Park, CA, 94025, USA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Sara J Singer
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Megan E Vanneman
- Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS), VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Mary Goldstein
- Center for Primary Care and Outcomes Research (PCOR), Stanford University School of Medicine, Stanford, CA, USA
- Office of Geriatrics and Extended Care, Department of Veterans Affairs, Washington, DC, USA
| | - Donna M Zulman
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Ci2i Bldg 324 B-134, 795 Willow Rd MPD-152, Menlo Park, CA, 94025, USA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
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10
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Muacevic A, Adler JR, Alnajdi SA, Alamri AA, Shuqdar R. Mental Health Workers' Knowledge and Attitude Towards Borderline Personality Disorder: A Saudi Multicenter Study. Cureus 2022; 14:e31938. [PMID: 36582557 PMCID: PMC9794184 DOI: 10.7759/cureus.31938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2022] [Indexed: 11/28/2022] Open
Abstract
Background Borderline personality disorder (BPD) is a mental illness characterized by emotional instability. Its prevalence can be as high as 1.8% among the general population. Poor knowledge and negative perceptions of the disorder by mental health workers (MHWs) can affect patients' care and their help-seeking behavior. This study aims to explore MHW's knowledge and attitudes toward BPD. Method A cross-sectional study was conducted on MHWs across the five regions of Saudi Arabia (SA) using a questionnaire that assessed knowledge, attitude, and training regarding BPD. Results Data collected from 1028 MHWs showed a good knowledge level. Superior knowledge was observed among females, residents in the central region, physicians, those who received specific BPD training, and MHWs who had more experience and frequent interactions with BPD patients. Participants had moderate to high levels of perceived knowledge and confidence regarding the identification, assessment, and management of BPD patients. Undergraduate training programs were the most reported source of information on the disorder. While 66% of participants admitted that they find dealing with BPD patients more difficult and thought patient management was inadequate, 71% were willing to attend further BPD training. Conclusion MHWs in SA have moderate knowledge of but negative perceptions of BPD; specific training is needed to improve the care provided for BPD patients.
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11
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Yan R, Ringwald WR, Hernandez JV, Kehl M, Bae SW, Dey AK, Low C, Wright AGC, Doryab A. Exploratory Machine Learning Modeling of Adaptive and Maladaptive Personality Traits from Passively Sensed Behavior. FUTURE GENERATIONS COMPUTER SYSTEMS : FGCS 2022; 132:266-281. [PMID: 35342213 PMCID: PMC8951872 DOI: 10.1016/j.future.2022.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Continuous passive sensing of daily behavior from mobile devices has the potential to identify behavioral patterns associated with different aspects of human characteristics. This paper presents novel analytic approaches to extract and understand these behavioral patterns and their impact on predicting adaptive and maladaptive personality traits. Our machine learning analysis extends previous research by showing that both adaptive and maladaptive traits are associated with passively sensed behavior providing initial evidence for the utility of this type of data to study personality and its pathology. The analysis also suggests directions for future confirmatory studies into the underlying behavior patterns that link adaptive and maladaptive variants consistent with contemporary models of personality pathology.
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Affiliation(s)
- Runze Yan
- School of Engineering and Applied Science, University of Virginia, United States
| | | | - Julio Vega Hernandez
- Mobile Sensing + Health Institute, Center for Behavioral Health, Media, and Technology, University of Pittsburgh, United States
| | - Madeline Kehl
- Department of Psychology, University of Pittsburgh, United States
| | - Sang Won Bae
- School of Systems and Enterprises, Stevens Institute of Technology, United States
| | - Anind K Dey
- Information School, University of Washington, United States
| | - Carissa Low
- Mobile Sensing + Health Institute, Center for Behavioral Health, Media, and Technology, University of Pittsburgh, United States
| | - Aidan G C Wright
- Department of Psychology, University of Pittsburgh, United States
| | - Afsaneh Doryab
- School of Engineering and Applied Science, University of Virginia, United States
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12
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Wibbelink CJM, Arntz A, Grasman RPPP, Sinnaeve R, Boog M, Bremer OMC, Dek ECP, Alkan SG, James C, Koppeschaar AM, Kramer L, Ploegmakers M, Schaling A, Smits FI, Kamphuis JH. Towards optimal treatment selection for borderline personality disorder patients (BOOTS): a study protocol for a multicenter randomized clinical trial comparing schema therapy and dialectical behavior therapy. BMC Psychiatry 2022; 22:89. [PMID: 35123450 PMCID: PMC8817780 DOI: 10.1186/s12888-021-03670-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/21/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Specialized evidence-based treatments have been developed and evaluated for borderline personality disorder (BPD), including Dialectical Behavior Therapy (DBT) and Schema Therapy (ST). Individual differences in treatment response to both ST and DBT have been observed across studies, but the factors driving these differences are largely unknown. Understanding which treatment works best for whom and why remain central issues in psychotherapy research. The aim of the present study is to improve treatment response of DBT and ST for BPD patients by a) identifying patient characteristics that predict (differential) treatment response (i.e., treatment selection) and b) understanding how both treatments lead to change (i.e., mechanisms of change). Moreover, the clinical effectiveness and cost-effectiveness of DBT and ST will be evaluated. METHODS The BOOTS trial is a multicenter randomized clinical trial conducted in a routine clinical setting in several outpatient clinics in the Netherlands. We aim to recruit 200 participants, to be randomized to DBT or ST. Patients receive a combined program of individual and group sessions for a maximum duration of 25 months. Data are collected at baseline until three-year follow-up. Candidate predictors of (differential) treatment response have been selected based on the literature, a patient representative of the Borderline Foundation of the Netherlands, and semi-structured interviews among 18 expert clinicians. In addition, BPD-treatment-specific (ST: beliefs and schema modes; DBT: emotion regulation and skills use), BPD-treatment-generic (therapeutic environment characterized by genuineness, safety, and equality), and non-specific (attachment and therapeutic alliance) mechanisms of change are assessed. The primary outcome measure is change in BPD manifestations. Secondary outcome measures include functioning, additional self-reported symptoms, and well-being. DISCUSSION The current study contributes to the optimization of treatments for BPD patients by extending our knowledge on "Which treatment - DBT or ST - works the best for which BPD patient, and why?", which is likely to yield important benefits for both BPD patients (e.g., prevention of overtreatment and potential harm of treatments) and society (e.g., increased economic productivity of patients and efficient use of treatments). TRIAL REGISTRATION Netherlands Trial Register, NL7699 , registered 25/04/2019 - retrospectively registered.
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Affiliation(s)
- Carlijn J. M. Wibbelink
- grid.7177.60000000084992262Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, Amsterdam, 1018 WS the Netherlands
| | - Arnoud Arntz
- grid.7177.60000000084992262Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, Amsterdam, 1018 WS the Netherlands
| | - Raoul P. P. P. Grasman
- grid.7177.60000000084992262Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, Amsterdam, 1018 WS the Netherlands
| | - Roland Sinnaeve
- grid.5596.f0000 0001 0668 7884Department of Neurosciences, Mind Body Research, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Michiel Boog
- grid.491189.cDepartment of Addiction and Personality, Antes Mental Health Care, Max Euwelaan 1, Rotterdam, 3062 MA the Netherlands ,grid.6906.90000000092621349Institute of Psychology, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, 3000 DR the Netherlands
| | - Odile M. C. Bremer
- grid.491093.60000 0004 0378 2028Arkin Mental Health, NPI Institute for Personality Disorders, Domselaerstraat 128, Amsterdam, 1093 MB the Netherlands
| | - Eliane C. P. Dek
- grid.491389.ePsyQ Personality Disorders Rotterdam-Kralingen, Max Euwelaan 70, Rotterdam, 3062 MA the Netherlands
| | | | - Chrissy James
- grid.420193.d0000 0004 0546 0540Department of Personality Disorders, Outpatient Clinic De Nieuwe Valerius, GGZ inGeest, Amstelveenseweg 589, Amsterdam, 1082 JC the Netherlands
| | | | - Linda Kramer
- grid.491220.c0000 0004 1771 2151GGZ Noord-Holland-Noord, Stationsplein 138, 1703 WC Heerhugowaard, the Netherlands
| | - Maria Ploegmakers
- grid.491369.00000 0004 0466 1666Pro Persona, Siependaallaan 3, Tiel, 4003 LE the Netherlands
| | - Arita Schaling
- grid.491369.00000 0004 0466 1666Pro Persona, Willy Brandtlaan 20, Ede, 6716 RR the Netherlands
| | - Faye I. Smits
- grid.468622.c0000 0004 0501 8787GGZ Rivierduinen, Sandifortdreef 19, Leiden, 2333 ZZ the Netherlands
| | - Jan H. Kamphuis
- grid.7177.60000000084992262Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, Amsterdam, 1018 WS the Netherlands
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13
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Cruitt PJ, Hill PL, Oltmanns TF. Personality pathology predicts increased informant-reported, but not performance-based, cognitive decline: Findings from two samples. Personal Disord 2022; 13:30-40. [PMID: 33507791 PMCID: PMC8475501 DOI: 10.1037/per0000434] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Research on the relationship between normal-range personality and cognitive aging has demonstrated consistent, modest effects. The current investigation increases our understanding of unhealthy cognitive aging by testing whether personality disorders (PDs), specifically borderline, avoidant, and obsessive-compulsive PDs, show prospective associations with the onset of cognitive problems. Interpersonal stressful life events and social support were expected to mediate these relationships. The current investigation used data from 2 longitudinal studies of older adulthood: the Alzheimer's disease Research Center cohort (ADRC, N = 434, Mage = 69.95, 56% women) and the St. Louis Personality and Aging Network study (SPAN, N = 1,058, Mage = 65.92, 54% women). The ADRC study administered a battery of neuropsychological tests to assess cognitive ability/memory. Borderline PD was measured with a composite from the NEO Five-Factor Inventory. The SPAN study administered self-, informant, and interview measures of the three PDs; a free-recall task; and an informant report measure of cognitive problems. Borderline PD features exhibited cross-sectional correlations with memory (ADRC: r = -.11; SPAN: all rs = -.08), general cognitive ability (ADRC: r = -.11), and informant-reported cognitive problems (rs ranged from .15 to .39). Most importantly, borderline PD features predicted an increase in informant-reported cognitive problems in SPAN participants (standardized bs = .13 and .15) over a 2-year period, but they did not predict a deterioration in the performance-based cognitive measures in either study. Avoidant and obsessive-compulsive PDs exhibited little association with cognitive aging. Neither interpersonal variable mediated any of these effects. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Patrick J. Cruitt
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO.,Psychology Doctoral Internship Program, Minneapolis VA Health Care System, Minneapolis, MN
| | - Patrick L. Hill
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO
| | - Thomas F. Oltmanns
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO
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14
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Sen P, Barnicot K, Podder P, Dasgupta I, Gormley M. Exploring the prevalence of personality disorder and the feasibility of using the SAPAS as a screening tool for personality disorder in an emergency department in India. MEDICINE, SCIENCE, AND THE LAW 2022; 62:8-16. [PMID: 34018857 DOI: 10.1177/00258024211011387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Personality disorders (PD) lead to frequent emergency department (ED) visits. Existing studies have evaluated high-risk ED populations in Western settings. PD screening tools, such as the Standardized Assessment of Personality - Abbreviated Scale (SAPAS), have thus far only been validated in Western populations. AIMS This study aimed to establish the screened prevalence of PD, and to evaluate the performance of the SAPAS as a screening tool within an ED setting in India. METHODS The study took place in the ED of a private multi-speciality hospital in Kolkata, India. All attendees were approached during two days per week over three months, except those who were medically unfit to participate. The SAPAS and the International Personality Disorder Examination (IPDE) were translated into Bengali and then used as screening tools for PD and as the reference standard for PD diagnosis. RESULTS Out of 120 ED attendees approached, 97 participated (48 men and 49 women), of whom 24% met the criteria for a diagnosis of PD. A cut-off score of 4 on the SAPAS provided the best trade-off between sensitivity and specificity for detecting PD. CONCLUSION The prevalence of PD was similar to Western samples, and the SAPAS showed promise for use in a non-Western setting.
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Affiliation(s)
- Piyal Sen
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- Elysium Healthcare, UK
| | - Kirsten Barnicot
- Centre for Psychiatry, Imperial College London, UK
- Central and North West London NHS Foundation Trust, UK
| | | | - Indraneel Dasgupta
- Department of Emergency Medicine, Peerless Hospital and B.K. Roy Research Centre, India
- Royal College of Emergency Medicine, UK
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15
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Quirk SE, Koivumaa-Honkanen H, Honkanen RJ, Mohebbi M, Kavanagh BE, Heikkinen J, Williams LJ. Associations between personality and musculoskeletal disorders in the general population: A systematic review protocol. Front Psychiatry 2022; 13:1079162. [PMID: 36762294 PMCID: PMC9905843 DOI: 10.3389/fpsyt.2022.1079162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/30/2022] [Indexed: 01/26/2023] Open
Abstract
There is growing evidence of the comorbidity between personality disorder (PD) and musculoskeletal disorders (MSDs). However, there are no systematic reviews including critical appraisal and meta-analyses that identify, evaluate, and synthesize the available evidence on these associations. Therefore, we present here a protocol of the methodology to undertake a systematic review, with the objective to evaluate associations between PD and MSDs in epidemiological population-based studies. A systematic review of observational studies will be conducted. A complete search strategy will be developed in consultation with a health librarian. To identify peer-reviewed literature, the search will be translated for, and implemented in Medline Complete, CINAHL Complete, and PsycINFO via the EBSCOhost platform from 1990 to the present. Gray literature will be identified. Studies will be eligible if they examine general population participants aged 15 years and over. Associations of interest are the presence of threshold or positive screen according to the DSM-V/5 (groupings: any, Clusters A, B, C, specific PD) or ICD-10 for PD in relation to arthritis, back/neck conditions, fibromyalgia, osteopenia/osteoporosis, and/or "any" of these MSDs. Data extraction and critical appraisal will be conducted in line with the Joanna Briggs Institute (JBI) guidance for systematic reviews of etiology and risk. The results from all studies will be presented in tables, text, and figures. A descriptive synthesis will present the characteristics of included studies, critical appraisal results, and descriptions of the main findings. Where appropriate, meta-analyses will be performed. If heterogeneity (e.g., I 2 = 50%) is detected, subgroup/sensitivity analysis may be used to explore the possible sources. The systematic review does not require ethics approval. The proposed systematic review will strengthen the evidence base on what is known regarding associations between PD and MSDs by identifying, evaluating, and synthesizing the findings of existing observational studies including meta-analyses, where appropriate.
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Affiliation(s)
- Shae E Quirk
- School of Medicine, Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia.,Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland.,Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Heli Koivumaa-Honkanen
- Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland.,Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Mental Health and Wellbeing Center, Kuopio University Hospital, Kuopio, Finland
| | - Risto J Honkanen
- Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland.,Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Mohammadreza Mohebbi
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Bianca E Kavanagh
- School of Medicine, Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
| | - Jeremi Heikkinen
- Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland.,Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Lana J Williams
- School of Medicine, Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia.,Barwon Health, University Hospital Geelong, Geelong, VIC, Australia
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16
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Quirk SE, Koivumaa-Honkanen H, Kavanagh BE, Honkanen RJ, Heikkinen J, Williams LJ. Exploring the comorbidity between personality and musculoskeletal disorders among adults: A scoping review. Front Psychiatry 2022; 13:1079106. [PMID: 36819943 PMCID: PMC9932280 DOI: 10.3389/fpsyt.2022.1079106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/20/2022] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION There is growing awareness of the comorbidity between mental and musculoskeletal disorders (MSDs) and their associated burden. We aimed to explore what is known regarding the existing epidemiological clinical-and population- based literature on the comorbidity between personality disorders (PDs) and MSDs specifically. In addition, we aimed to investigate their associated burden by examining a range of outcomes including morbidity/mortality, patient- and clinical-reported outcomes, work-related outcomes, hospital admissions, and financial costs. Finally, we sought to identify gaps in the literature and provide recommendations for further research. METHODS Studies with participants 15 years of age were eligible. Categorical PDs/features (DSM-III/IV/5 or ICD 9/10), identified by a health care professional, medical records, diagnostic interviews, or self-administered questionnaires. The definitions/groupings of MSDs were guided by the ICD-10 including conditions of the back, joints, and soft tissue, and disorders of bone density and structure. Published peer-reviewed and gray literature were considered. Eligible study designs were cohort, case-control, and cross-sectional studies, and existing reviews of observational studies. Identification and selection of articles, data extraction and the presentation of the results was conducted according to the Joanna Briggs Institute methodological guidance and the PRISMA extension for scoping reviews. RESULTS In total, 57 articles were eligible including 10 reviews and 47 individual studies. Across clinical and population settings, we detected evidence of comorbidity between PDs and chronic back/neck/spine conditions, arthritis, and fibromyalgia, and emerging evidence of associations between PDs and reduced bone mineral density. In terms of knowledge gaps, the burden associated with PDs and MSDs is poorly understood, as is their underlying mechanisms. DISCUSSION This scoping review might prompt further research into PDs and MSDs as separate groups of disorders, along with their comorbidity and the mechanisms that may link them. SYSTEMATIC REVIEW REGISTRATION https://osf.io/mxbr2/registrations.
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Affiliation(s)
- Shae E Quirk
- School of Medicine, Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia.,Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland.,Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Heli Koivumaa-Honkanen
- Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland.,Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Mental Health and Wellbeing Center, Kuopio University Hospital, Kuopio, Finland
| | - Bianca E Kavanagh
- School of Medicine, Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
| | - Risto J Honkanen
- Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland.,Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jeremi Heikkinen
- Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland.,Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Lana J Williams
- School of Medicine, Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia.,Barwon Health, University Hospital Geelong, Geelong, VIC, Australia
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Halberstadt AL, Skrzynski CJ, Wright AG, Creswell KG. Predicting smoking and nicotine dependence from the DSM-5 alternative model for personality pathology. Personal Disord 2022; 13:84-95. [PMID: 33705195 PMCID: PMC8916785 DOI: 10.1037/per0000487] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Individuals with personality disorders (PDs) have higher morbidity and mortality than the general population, which may be due to maladaptive health behaviors such as smoking. Previous studies have examined the links between categorical PD diagnoses/personality traits and smoking/nicotine dependence, but little is known about how the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition alternative model for personality disorders relates to smoking and nicotine dependence. The current study examined this question in a sample of 500 participants using the Levels of Personality Functioning Scale to assess general personality pathology, the Personality Inventory for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition to measure specific traits, the Fagerström test for Nicotine Dependence to assess nicotine dependence, and questions about current and past smoking to assess smoking status (i.e., current, former, never). Multinomial logistic regression results demonstrated that general personality pathology (Criterion A) was not related to smoking status, and there were no reliable associations between traits (Criterion B) and smoking status. However, correlations showed that higher negative affectivity and disinhibition were related to higher levels of nicotine dependence within smokers. Findings are discussed in regard to previous findings linking personality pathology to smoking/nicotine dependence as well as the general validity of this new personality disorder diagnostic system. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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18
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Oltmanns JR, Widiger TA. Five-Factor Model Personality Disorder Traits, Health Behaviors, Health Perceptions, and Insomnia Symptoms in Older Adults. J Pers Disord 2021; 35:801-S10. [PMID: 33779278 DOI: 10.1521/pedi_2021_35_506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Personality traits predict physical health outcomes, including health behaviors, disease, and mortality. Maladaptive traits of personality disorders may predict even more variance in physical health indicators. Dimensional models of maladaptive personality traits are replacing categorical models of personality disorder, and the Five-Factor Model of personality disorder (FFMPD) is a useful dimensional model of maladaptive traits. However, there has been little work investigating the criterion validity of the FFMPD. The present study serves as a broad initial overview of the FFMPD scales in the prediction of health behaviors, heath perceptions, and insomnia symptoms across two time points in a representative community sample of older adults (N = 1,060). Findings indicate that the FFMPD scales explain a significant amount of variance in the physical health variables across time. Exploratory analyses indicate that the FFMPD traits have incremental validity over covariates, normal-range personality traits, and personality disorder criteria.
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Galli F, Scotto L, Ravenda S, Zampino MG, Pravettoni G, Mazzocco K. Personality Factors in Colorectal Cancer: A Systematic Review. Front Psychol 2021; 12:590320. [PMID: 34803785 PMCID: PMC8595914 DOI: 10.3389/fpsyg.2021.590320] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 10/06/2021] [Indexed: 12/12/2022] Open
Abstract
Background: The role of personality in cancer incidence and development has been studied for a long time. As colorectal cancer (CRC) is one of the most prevalent cancer types and linked with lifestyle habits, it is important to better understand its psychological correlates, in order to design a more specific prevention and intervention plan. The aim of this systematic review is to analyze all the studies investigating the role of personality in CRC incidence. Methods: All studies on CRC and personality up to November 2020 were scrutinized according to the Cochrane Collaboration and the PRISMA statements. Selected studies were additionally evaluated for the Risk of Bias according to the Newcastle-Ottawa Scale (NOS). Results: Eight studies met the inclusion criteria and were eventually included in this review. Two main constructs have been identified as potential contributors of CRC incidence: emotional regulation (anger) and relational style (egoism). Conclusion: Strong conclusions regarding the influence of personality traits on the incidence of CRC are not possible, because of the small number and the heterogeneity of the selected studies. Further research is needed to understand the complexity of personality and its role in the incidence of CRC and the interaction with other valuable risk factors.
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Affiliation(s)
- Federica Galli
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, IRCCS, Milan, Italy
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Ludovica Scotto
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, IRCCS, Milan, Italy
| | - Simona Ravenda
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IRCCS, Milan, Italy
| | - Maria Giulia Zampino
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IRCCS, Milan, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Ketti Mazzocco
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Brudey C. Personality Disorders in Older Age. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2021; 19:303-307. [PMID: 34690596 DOI: 10.1176/appi.focus.20210007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Personality disorders are among the most common mental disorders in older age and are associated with a range of negative outcomes in physical and emotional health as well as in interpersonal functioning. Several screening tools have been validated with older patients and can aid in diagnosis. The presence of a personality disorder is associated with increased risk of cognitive decline, and cognitive disorders may mimic personality disorders. As a result, an evaluation of cognitive function is an essential part of assessing for a personality disorder. Emerging evidence points to the promise of dialectical behavioral therapy and schema therapy for older patients with personality disorders. Second-generation antipsychotics and mood stabilizers have been found to be effective for some personality disorders in the general adult population, but no such studies have been conducted with older adults.
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21
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Shields AN, Oltmanns TF, Boudreaux MJ, Paul SE, Bogdan R, Tackett JL. The Impact of Personality Pathology Across Three Generations: Evidence from the St. Louis Personality and Intergenerational Network Study. Clin Psychol Sci 2021; 9:900-918. [PMID: 35433118 PMCID: PMC9009746 DOI: 10.1177/2167702621989665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
Personality disorder (PD) symptoms in a parent generation may confer risk for problems in future generations, but intergenerational transmission has not been studied beyond parent-child effects. We examined the generational transfer of risk associated with PDs using structural models of grandparent personality pathology and grandchild psychopathology among 180 adults (M age =66.9), 218 of their children (M age =41.2), and 337 of their grandchildren (M age =10.5). We found evidence for general and heterotypic domain-specific transmission. Specifically, broad grandparent personality pathology was associated with broad grandchild psychopathology (B=.15, 95% CI [-.01, .31]); at the domain level, grandparent internalizing personality pathology was associated with grandchild externalizing psychopathology (B =.06, 95% CI [.01, .12]). Neither association was significantly mediated by parental personality pathology. These findings indicate that personality pathology in one generation confers risk for psychopathology across subsequent generations. Such intergenerational transmission operates across broad, rather than specific (i.e., individual disorder) psychopathology domains.
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Affiliation(s)
| | - Thomas F. Oltmanns
- Department of Psychological and Brain Sciences, Washington University in St. Louis
| | | | - Sarah E. Paul
- Department of Psychological and Brain Sciences, Washington University in St. Louis
| | - Ryan Bogdan
- Department of Psychological and Brain Sciences, Washington University in St. Louis
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22
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Mendo-Cullell M, Arenas-Pijoan L, Forné C, Fernández-Oñate D, Ruiz de Cortázar-Gracia N, Facal C, Torrent A, Palacios R, Pifarré J, Batalla I. A pilot study of the efficacy of an adventure therapy programme on borderline personality disorder: A pragmatic controlled clinical trial. Personal Ment Health 2021; 15:159-172. [PMID: 33569869 DOI: 10.1002/pmh.1505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 01/26/2021] [Accepted: 01/31/2021] [Indexed: 11/06/2022]
Abstract
Adventure therapy (AT) is a therapeutic intervention that has demonstrated effectiveness in different populations, but there are no studies on this therapy in borderline personality disorder (BPD). The objective of this study was to assess the response to AT in comparison with treatment as usual (based on cognitive-behavioural therapy) in patients with BPD. Regarding the comparison of the differences post-therapy-pre-therapy between both groups, some metabolic variables improved more in the AT group, with medium-large effect sizes. Almost all psychometric variables evolved better in the AT group, with negligible effects. AT could be considered in BPD treatment because it results in healthier lifestyle habits and increases functionality and quality of life in patients who are prone to self-destruction. © 2021 John Wiley & Sons, Ltd.
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Affiliation(s)
| | | | - Carles Forné
- Department of Basic Medical Sciences, University of Lleida, Lleida, Spain
| | - David Fernández-Oñate
- Psychiatry Service, University Hospital Santa Maria, Lleida, Spain.,Asociación Experientia: Terapia a través de la aventura, Barcelona, Spain
| | | | - Carmen Facal
- Psychiatry Service, University Hospital Santa Maria, Lleida, Spain
| | - Aurora Torrent
- Psychiatry Service, University Hospital Santa Maria, Lleida, Spain
| | - Roberto Palacios
- Psychiatry Service, University Hospital Santa Maria, Lleida, Spain
| | - Josep Pifarré
- Psychiatry Service, University Hospital Santa Maria, Lleida, Spain.,Institute for Biomedical Research in Lleida Dr. Pifarré Foundation (IRBLleida), Lleida, Spain.,Department of Medicine, Faculty of Medicine, University of Lleida, Lleida, Spain.,Sant Joan de Deu Terres de Lleida, Lleida, Spain
| | - Iolanda Batalla
- Psychiatry Service, University Hospital Santa Maria, Lleida, Spain.,Asociación Experientia: Terapia a través de la aventura, Barcelona, Spain.,Institute for Biomedical Research in Lleida Dr. Pifarré Foundation (IRBLleida), Lleida, Spain.,Department of Medicine, Faculty of Medicine, University of Lleida, Lleida, Spain
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23
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Quirk SE, Koivumaa-Honkanen H, Honkanen R, Heikkinen J, Kavanagh BE, Williams LJ. Exploring the comorbidity of musculoskeletal and personality disorders among adults: a scoping review protocol. Syst Rev 2021; 10:182. [PMID: 34148544 PMCID: PMC8215781 DOI: 10.1186/s13643-021-01721-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 05/28/2021] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND Separately, mental and musculoskeletal disorders (MSDs) are prevalent across the life course and are leading contributors to disability worldwide. While people with personality disorder (PD) have been shown to have an increased risk of certain physical health comorbidities-associations with MSDs have not been thoroughly explored. The proposed scoping review aims to explore the existing clinical- and population-based literature on the comorbidity of PD and MSDs among adults ≥ 18 years and the burden associated with their comorbidity, identify knowledge gaps on this topic, and propose recommendations for future research. METHODS This protocol describes the methodology to undertake the scoping review. It is guided by Arksey and O'Malley's framework and the extensions recommended by the Joanna Briggs Institute. A comprehensive search strategy will be used to identify relevant articles, which will be underpinned by Population, Concept, and Context (PCC) inclusion criteria. One author will perform the search and two authors will independently screen titles/abstracts followed by a full-text review for articles considered relevant. The supervising author will confirm the final selection of articles to be included. One author will extract relevant information from the articles using a predetermined charting form, while a second will perform validation of all information entered. DISCUSSION Information will be synthesised to inform a discussion of what is known regarding associations between PD and MSDs, and the burden associated with their comorbidity in different contexts, with future research directions proposed. SYSTEMATIC REVIEW REGISTRATION This protocol is registered in Open Science Framework Registries ( https://osf.io/mxbr2/ ).
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Affiliation(s)
- Shae E Quirk
- Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Victoria, Australia.,Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland.,Institute of Clinical Medicine, Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio, Finland
| | - Heli Koivumaa-Honkanen
- Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland.,Institute of Clinical Medicine, Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio, Finland.,Mental Health and Wellbeing Center, Kuopio University Hospital, Kuopio, Finland
| | - Risto Honkanen
- Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland.,Institute of Clinical Medicine, Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio, Finland
| | - Jeremi Heikkinen
- Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland.,Institute of Clinical Medicine, Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio, Finland
| | - Bianca E Kavanagh
- Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Victoria, Australia
| | - Lana J Williams
- Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Victoria, Australia. .,University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia.
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Cook JA, Burke-Miller JK, Razzano LA, Steigman PJ, Jonikas JA, Santos A. Serious mental illness, other mental health disorders, and outpatient health care as predictors of 30-day readmissions following medical hospitalization. Gen Hosp Psychiatry 2021; 70:10-17. [PMID: 33639449 DOI: 10.1016/j.genhosppsych.2021.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Prior research has not addressed whether both serious mental illness (SMI) and other mental health (OMH) disorders affect the likelihood of 30-day readmissions after medical hospitalizations, or whether post-discharge use of outpatient medical, mental health, and pharmacy services is associated with readmission likelihood. METHODS Using the Truven Health Analytics MarketScan® Medicaid Multi-State Database, we studied 43,817 Medicaid beneficiaries, age 18-64, following discharge from medical hospitalizations in 2011. Logistic regression models compared all-cause, 30-day readmissions among those with SMI, OMH, and no psychiatric diagnosis, and examined associations of 30-day outpatient service use with 30-day readmissions. RESULTS Thirty-day readmission rates were 15.9% (SMI), 13.8% (OMH), and 11.7% (no mental illness). In multivariable analysis, compared to patients without mental illness, odds of readmission were greater for those with SMI (aOR = 1.43, 95%CI:1.32-1.51) and OMH (aOR = 1.21, 95%CI:1.12-1.30), and lower among those using outpatient mental health services (aOR = 0.50, 95%CI: 0.44-0.56). CONCLUSION The adult Medicaid population disproportionately includes patients with SMI and OMH disorders, both of which were found to be associated with 30-day hospital readmissions. Receiving outpatient mental health services after hospital discharge may be protective against readmission following medical hospitalizations, suggesting the need for further research on these topics.
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Affiliation(s)
- Judith A Cook
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA.
| | - Jane K Burke-Miller
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Lisa A Razzano
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Pamela J Steigman
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Jessica A Jonikas
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Alberto Santos
- Department of Psychiatry, Fetter Health Care Network, Charleston, SC, USA
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25
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Ohse L, Burian R, Hahn E, Burian H, Ta TMT, Diefenbacher A, Böge K. Process-outcome associations in an interdisciplinary treatment for chronic pain and comorbid mental disorders based on Acceptance and Commitment Therapy. PAIN MEDICINE 2021; 22:2615-2626. [PMID: 33755159 DOI: 10.1093/pm/pnab102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Numerous studies support the effectiveness of Acceptance and Commitment Therapy (ACT) for chronic pain, yet little research has been conducted about its underlying mechanisms of change, especially regarding patients with comorbid mental disorders. The present investigation addressed this issue by examining associations of processes targeted by ACT (pain acceptance, mindfulness, psychological flexibility) and clinical outcomes (pain intensity, somatic symptoms, physical health, mental health, depression, general anxiety). SUBJECTS Participants were 109 patients who attended an ACT-based interdisciplinary treatment program for chronic pain and comorbid mental disorders in a routine care psychiatric day hospital. METHODS Pre- to post-treatment differences in processes and outcomes were examined with Wilcoxon signed-rank tests and effect size r. Associations between changes in processes and changes in outcomes were analyzed with correlation and multiple regression analyses. RESULTS Pre- to post-treatment effect sizes were mostly moderate to large (r between |0.21| and |0.62|). Associations between changes in processes and changes in outcomes were moderate to large for both, bivariate correlations (r between |0.30| and |0.54|) and shared variances accounting for all three processes combined (R2 between 0.21 and 0.29). CONCLUSION The present investigation suggests that changes in pain acceptance, mindfulness and psychological flexibility are meaningfully associated with changes in clinical outcomes. It provides evidence on particular process-outcome associations that had not been investigated in this way before. The focus on comorbid mental disorders informs clinicians about a population of chronic pain patients that often has a severe course of illness and has seldom been studied.
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Affiliation(s)
- Ludwig Ohse
- Department of Psychiatry, Psychotherapy and Psychosomatics, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Herzbergstraße 79, 10365, Berlin, Germany.,Psychologische Hochschule Berlin, Am Köllnischen Park 2, 10179, Berlin, Germany
| | - Ronald Burian
- Department of Psychiatry, Psychotherapy and Psychosomatics, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Herzbergstraße 79, 10365, Berlin, Germany
| | - Eric Hahn
- Department of Psychiatry, Psychotherapy and Psychosomatics, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Herzbergstraße 79, 10365, Berlin, Germany.,Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Hannah Burian
- Department of Psychiatry, Psychotherapy and Psychosomatics, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Herzbergstraße 79, 10365, Berlin, Germany
| | - Thi Minh Tam Ta
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Albert Diefenbacher
- Department of Psychiatry, Psychotherapy and Psychosomatics, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Herzbergstraße 79, 10365, Berlin, Germany.,Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Kerem Böge
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
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Sinnaeve R, Vaessen T, van Diest I, Myin-Germeys I, van den Bosch LMC, Vrieze E, Kamphuis JH, Claes S. Investigating the stress-related fluctuations of level of personality functioning: A critical review and agenda for future research. Clin Psychol Psychother 2021; 28:1181-1193. [PMID: 33590556 DOI: 10.1002/cpp.2566] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 01/28/2021] [Indexed: 12/14/2022]
Abstract
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the International Classification of Diseases (ICD-11) proposed a dimensional approach to the assessment of personality disorders (PDs). Both models dictate that the clinician first determines PD severity before assessing maladaptive traits, invoking the level of personality functioning (LPF) construct. We consider LPF a promising dimensional construct for translational research because of its clinical importance and conceptual overlap with the Research Domain Criteria (RDoC) Social Processes. We aim to identify biomarkers that co-vary with fluctuations in LPF in adulthood, ultimately to predict persistent decrease in LPF, associated with suicidality and morbidity. However, a theoretical framework to investigate stress-related oscillations in LPF is currently missing. In this article, we aim to fill this hiatus with a critical review about stress and LPF. First, we discuss acute stress and LPF. We briefly present the basics of the neurophysiological stress response and review the literature on momentary and daily fluctuations in LPF, both at a subjective and physiological level. Second, we review the effects of chronic stress on brain function and social behaviour and recapitulate the main findings from prospective cohort studies. This review underlies our suggestions for multimethod assessment of stress-related oscillations in LPF and our theoretical framework for future longitudinal studies, in particular studies using the experience sampling method (ESM).
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Affiliation(s)
- Roland Sinnaeve
- University Psychiatric Center KU Leuven, Kortenberg, Belgium.,Department of Neurosciences, Mind Body Research, KU Leuven, Leuven, Belgium
| | - Thomas Vaessen
- Department of Neurosciences, Mind Body Research, KU Leuven, Leuven, Belgium.,Department of Neurosciences, Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Ilse van Diest
- Faculty of Psychology and Educational Sciences, Health Psychology Research Group, KU Leuven, Leuven, Belgium
| | - Inez Myin-Germeys
- Department of Neurosciences, Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | | | - Elske Vrieze
- University Psychiatric Center KU Leuven, Kortenberg, Belgium.,Department of Neurosciences, Mind Body Research, KU Leuven, Leuven, Belgium
| | - Jan Henk Kamphuis
- Faculty of Social and Behavioural Sciences, Programme group Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Stephan Claes
- University Psychiatric Center KU Leuven, Kortenberg, Belgium.,Department of Neurosciences, Mind Body Research, KU Leuven, Leuven, Belgium
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27
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Johnson BN, Lumley MA, Cheavens JS, McKernan LC. Exploring the links among borderline personality disorder symptoms, trauma, and pain in patients with chronic pain disorders. J Psychosom Res 2020; 135:110164. [PMID: 32569851 PMCID: PMC7422088 DOI: 10.1016/j.jpsychores.2020.110164] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/30/2020] [Accepted: 05/31/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Chronic pain and borderline personality disorder (BPD) are commonly comorbid and jointly associated with increased symptoms of both disorders and clinical and functional impairment. Little is known, however, about specific links between these disorders. In a cross-sectional study of patients with chronic pain, we compared participants high or low on BPD symptoms on patterns of pain experience and types of child and adult traumas. METHODS Adults (N = 181) with chronic pain completed self-reports of pain severity, dimensions of pain experiencing, body coverage of pain, and clinical indicators of central sensitization (i.e., chronic hypersensitivity of the central nervous system), as well as measures of child and adult physical abuse, sexual abuse, trauma, and neglect. Participants also completed the McLean Screening Instrument for BPD. RESULTS Participants with clinically significant BPD symptoms (n = 32) reported more childhood sexual trauma, punishment, and neglect, as well as adult physical/sexual trauma, than those without elevated BPD symptoms. Among participants with clinically significant BPD symptoms, affective pain and central sensitization were elevated, potentially explained by heightened negative affect in BPD. CONCLUSION BPD symptoms are associated with increased clinical severity among patients with chronic pain as well as a unique manifestation of pain experiencing (i.e., increased affective pain and central sensitization in particular). Childhood trauma of all types is associated with chronic pain and BPD co-occurrence. Researchers and clinicians should assess for BPD in people with chronic pain to enhance conceptual models of the transaction between these disorders and to improve clinical care.
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28
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Collins A, Barnicot K, Sen P. A Systematic Review and Meta-Analysis of Personality Disorder Prevalence and Patient Outcomes in Emergency Departments. J Pers Disord 2020; 34:324-347. [PMID: 30307832 DOI: 10.1521/pedi_2018_32_400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The objectives of this study were to perform a systematic review and meta-analysis of studies reporting prevalence of personality disorders (PDs) in emergency departments (EDs) and evaluate the effect of comorbid PDs on clinical outcomes. A systematic search of five databases along with manual searching and expert consultation was performed. A quality appraisal was conducted. A total of 29 articles were included. Prevalence of PDs in ED attendees varied depending on presenting complaint, Q(4) = 577.5, p < .01, with meta-analytic prevalence rates of suicide and self-harm at 35% and 22%, respectively. The assessment method had a significant effect on prevalence rates, Q(3) = 17.36, p < .01. Comorbid PD was a risk factor for repeating presenting complaint, subsequent ED return, and hospitalization. Better identification of PDs using screening tools in EDs could improve patient management and clinical outcomes. Future research should focus on PD prevalence in unselected ED populations using validated diagnostic interviews.
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Affiliation(s)
| | - Kirsten Barnicot
- Centre for Psychiatry, Department of Medicine, Imperial College London, UK
| | - Piyal Sen
- Department of Forensic and Neurodevelopmental Sciences, King's College, London, and Elysium Healthcare, Milton Keynes, UK
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29
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Barber TA, Ringwald WR, Wright AG, Manuck SB. Borderline personality disorder traits associate with midlife cardiometabolic risk. Personal Disord 2020; 11:151-156. [PMID: 31647268 PMCID: PMC7047517 DOI: 10.1037/per0000373] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
There is growing interest in relationships between borderline personality disorder (BPD) pathology and physical health outcomes. Diagnostic BPD and BPD-related traits, for instance, have been shown to associate with self-reported cardiovascular disease and various cardiometabolic risk factors. However, potential confounding of these associations by comorbid depression, which itself contributes to risk for heart disease, remains unresolved, and previous research is limited by nearly uniform reliance on self-reported health status. In the present study, we examine the association of BPD traits and contemporaneously assessed depressive mood with instrumented measures of cardiometabolic risk in a midlife community sample (N = 1,295). BPD pathology was measured using dimensional, multi-informant trait measures; depressive symptomology was self-reported; and cardiometabolic risk was indexed via multiple indicators of insulin resistance, adiposity, dyslipidemia, and blood pressure. Structural equation modeling was used to estimate the effects of BPD traits and depressive symptoms on aggregated cardiometabolic risk, adjusting for their shared variance. Results showed both BPD features and depressive symptomatology related to the extent of cardiometabolic risk; when examined simultaneously, only BPD associated independently with risk indicators. In further supporting a link between BPD pathology and cardiovascular disease risk, these findings warrant future work to elucidate intervening behavioral and biological mechanisms. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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30
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Williams LJ, Quirk SE, Koivumaa-Honkanen H, Honkanen R, Pasco JA, Stuart AL, Kavanagh BE, Heikkinen J, Berk M. Personality Disorder and Physical Health Comorbidities: A Link With Bone Health? Front Psychiatry 2020; 11:602342. [PMID: 33363487 PMCID: PMC7752862 DOI: 10.3389/fpsyt.2020.602342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/05/2020] [Indexed: 11/17/2022] Open
Abstract
We examined whether personality disorders (PDs) (any, cluster A/B/C) were associated with bone mineral density (BMD) in a population-based sample of Australian women (n = 696). Personality and mood disorders were assessed using semi-structured diagnostic interviews. BMD was measured at the spine, hip, and total body using dual-energy x-ray absorptiometry (GE-Lunar Prodigy). Anthropometrics, medication use, physical conditions, and lifestyle factors were documented. The association between PDs (any, cluster A/B/C) and BMD (spine/hip/total body) was examined with multiple linear regression models. The best models were identified by backward elimination including age, weight, physical activity, smoking status, alcohol consumption, dietary calcium intake, mood disorders, physical multimorbidity, socioeconomic status, and medications affecting bone. The variables were retained in the model if p < 0.05. All potential interactions in final models were tested. Those with cluster A PD, compared to those without, had 6.7% lower hip BMD [age, weight adjusted mean 0.853 (95% CI 0.803-0.903) vs. 0.910 (95% CI 0.901-0.919) g/cm2, p = 0.027] and 3.4% lower total body BMD [age, weight, smoking, alcohol, calcium adjusted mean 1.102 (95% CI 1.064-1.140) vs. 1.139 (95% CI 1.128-1.150) g/cm2, p = 0.056]. No associations were observed between cluster B/C PDs and hip/total body BMD or between any of the PD clusters and spine BMD. To our knowledge, this study is the first to investigate the bone health of women with PD in a population-based sample. Given the paucity of literature, replication and longitudinal research including the examination of underlying mechanisms and sex differences are warranted.
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Affiliation(s)
- Lana J Williams
- Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, VIC, Australia.,University Hospital Geelong, Barwon Health, Geelong, VIC, Australia
| | - Shae E Quirk
- Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, VIC, Australia.,Institute of Clinical Medicine/Psychiatry, University of Eastern Finland, Kuopio, Finland.,Kuopio Musculoskeletal Research Unit, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Heli Koivumaa-Honkanen
- Institute of Clinical Medicine/Psychiatry, University of Eastern Finland, Kuopio, Finland.,Kuopio Musculoskeletal Research Unit, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Departments of Psychiatry, South-Savonia Hospital District, Mikkeli, Finland.,Departments of Psychiatry, North Karelia Central Hospital, Joensuu, Finland.,Departments of Psychiatry, SOTE, Iisalmi, Finland.,Department of Psychiatry, Oulu University Hospital, Oulu, Finland
| | - Risto Honkanen
- Institute of Clinical Medicine/Psychiatry, University of Eastern Finland, Kuopio, Finland.,Kuopio Musculoskeletal Research Unit, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Psychiatry, Oulu University Hospital, Oulu, Finland
| | - Julie A Pasco
- Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, VIC, Australia.,University Hospital Geelong, Barwon Health, Geelong, VIC, Australia.,Department of Medicine-Western Health, The University of Melbourne, St. Albans, VIC, Australia
| | - Amanda L Stuart
- Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, VIC, Australia
| | - Bianca E Kavanagh
- Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, VIC, Australia
| | - Jeremi Heikkinen
- Institute of Clinical Medicine/Psychiatry, University of Eastern Finland, Kuopio, Finland.,Kuopio Musculoskeletal Research Unit, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Michael Berk
- Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, VIC, Australia.,University Hospital Geelong, Barwon Health, Geelong, VIC, Australia.,Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia.,Orygen the National Center of Excellence in Youth Mental Health, Center for Youth Mental Health, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
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31
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Rosario M, Espinosa A, Gagnon G, Talhouk L, Neff B. Associations among parental and romantic attachment, personality disorder symptoms, and physical health. J Health Psychol 2019; 26:1609-1624. [PMID: 31789584 DOI: 10.1177/1359105319890027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The relations of parental and romantic attachment with physical health symptoms and the mediating role of personality disorder symptoms in those relations were examined in an online survey of US young adults. Latent class analysis identified two groups: occasionally sick and healthier. Insecure attachment was related to being occasionally sick and to personality disorder symptoms (poor reality testing, primitive defenses, and diffused identity). Primitive defenses/identity diffusion mediated relations between insecure parental attachment and physical symptoms. Maternal and paternal attachment each provided unique information about these relations. Romantic attachment was not associated with physical symptoms after adjusting for parental attachment and personality disorder symptoms.
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Affiliation(s)
- Margaret Rosario
- The City College, The City University of New York, USA.,The Graduate Center, The City University of New York, USA
| | | | - Gregory Gagnon
- The Graduate Center, The City University of New York, USA
| | - Leila Talhouk
- The City College, The City University of New York, USA
| | - Brian Neff
- The City College, The City University of New York, USA
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Cruitt PJ, Oltmanns TF. Unemployment and the Relationship between Borderline Personality Pathology and Health. JOURNAL OF RESEARCH IN PERSONALITY 2019; 82:103863. [PMID: 32863466 PMCID: PMC7448725 DOI: 10.1016/j.jrp.2019.103863] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Evidence suggests that employment may buffer against the negative health outcomes associated with borderline personality disorder (BPD). The purpose of the current analyses was to examine unemployment and the BPD-health relationship prospectively. Participants were 1,536 older adults in a longitudinal study of health and aging, with repeated measures of physical health, depressive symptoms, and life satisfaction. We measured BPD features using multiple sources at baseline, and used principal components analysis to obtain latent scores. Multilevel models indicated that unemployment experiences did not moderate the prospective relationship between BPD features and physical health or life satisfaction, but did strengthen the positive relationship between BPD features and depressive symptoms. These findings provide insight into mechanisms of recovery for individuals with BPD.
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Affiliation(s)
- Patrick J Cruitt
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO
| | - Thomas F Oltmanns
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO
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33
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Foyston Z, Taylor C, Freestone M. "Who needs secure services for personality disorder?" Results of an expert Delphi study with professional staff. BMC Psychiatry 2019; 19:280. [PMID: 31506071 PMCID: PMC6734324 DOI: 10.1186/s12888-019-2268-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/30/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Personality Disorder (PD) is an enduring, multi-faceted mental disorder, associated with adverse health effects, difficulties with interpersonal relationships and in some cases increased risk to others. A limited number of dedicated forensic mental health services are available for serious offenders with severe personality disorder. The recent Offender Personality Disorder (OPD) strategy aims to ensure that most such offenders are treated in prison rather than secure psychiatric services, except in highly complex cases where this is not possible. While the strategy sets out very broad criteria relating to this, greater clarity is needed to support decisions about appropriate transfer and hence enhance public protection. This study explored which characteristics professional experts associate with appropriate transfer from prison to forensic mental health services for high-risk offenders with PD. METHOD A modified Delphi survey distributed through an online survey system was conducted in two-rounds with a group of professional experts recruited from forensic mental healthcare; criminal justice and specialist commissioning. RESULTS Fifty-one (56%) respondents completed stage one of the Delphi and 34 (61%) of these completed stage two. Consensus was reached for a total of 22 items indicating complexity, including co-morbid mental illness, high level of risk, lack of progress in prison and high motivation for treatment. A preliminary checklist for these factors was developed. Panel members consistently emphasised the importance of the individual's presenting need, the overall clinical picture and formulation in their free text responses. CONCLUSIONS Professionals face a complex picture when making decisions regarding suitability for hospital admission for high-risk male offenders with PD, with varied opinions amongst professional experts as to priorities for intervention and a focus on individual needs through formulation. It was, nevertheless, possible to condense these views into a set of consistent variables that can be used to highlight the need for transfer into hospital-based treatment services.
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Affiliation(s)
- Zoe Foyston
- grid.498924.aManchester University NHS Foundation Trust, Manchester, UK
| | - Celia Taylor
- 0000 0004 0426 7183grid.450709.fEast London NHS Foundation Trust, London, UK
| | - Mark Freestone
- Centre for Psychiatry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
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Abstract
PURPOSE OF REVIEW It is not uncommon for clinicians to label patients' complaints as 'psychogenic' when they present with symptoms that are difficult to understand. This article reviews recent reports about the comorbidity of personality disorders and nonpsychiatric medical problems, which call into question the adequacy of the mind-body dichotomy in medicine. RECENT FINDINGS The strong association of any personality disorders with poor health in cross-sectional and community-based studies is now confirmed by personality disorder predicting future deterioration in longitudinal studies. Borderline personality disorder has been studied most frequently, but recent data suggest that severity of any personality disorder is associated with poor and worsening health. SUMMARY Personality disorder is associated with the full range of physical, mental, and social disorders. Greater attention to the common features of personality disorders, which are crucial for the self-regulation of behavior, would facilitate more effective health promotion and disease prevention across all medical specialties, thereby helping to relieve the burdens of chronic common diseases.
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35
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Holzer KJ, Huang J. Physical health-related quality of life among older adults with personality disorders. Aging Ment Health 2019; 23:1031-1040. [PMID: 29749747 DOI: 10.1080/13607863.2018.1468412] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Objectives: Personality Disorders (PDs) are associated with a multitude of negative consequences. The negative PD effects on health can be even more burdensome for older adults given the physical and social functioning changes that occur with age; however, the majority of research examining the influence of PDs focuses on younger adults. The present study seeks to investigate the relationship between PDs and physical health-related quality of life (PHRQoL) in adults over the age of 50. Methods: Data for 16,884 adults ages 50 and older from the 2001-2002 National Epidemiological Survey on Alcohol and Related Conditions (NESARC) were analyzed. Multiple linear regression models were analyzed to investigate the relationships of seven PDs and participants' PHRQoL. Results: All PDs except histrionic and avoidant PD had statistically significant negative associations with PHRQoL scores, indicating that respondents diagnosed with PDs were expected to have lower PHRQoL than those without PDs, after controlling for sociodemographic characteristics. When psychosocial covariates were added to the model, only dependent, obsessive-compulsive and paranoid PDs were significantly related to PHRQoL score. Conclusions: For adults ages 50 and older, a diagnosis of PD was weakly associated with lower PHRQoL scores for three PDs, however this is unlikely to be a causal association. The strength of the relationship between PDs and PHRQoL varies by type of PD. Given the higher rates of functional and social changes that occur with age, future research should focus on potential causes of worse physical health among older adults with PDs.
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Affiliation(s)
- Katherine J Holzer
- a School of Social Work, College for Public Health and Social Justice , Saint Louis University , St. Louis , MO , United States
| | - Jin Huang
- a School of Social Work, College for Public Health and Social Justice , Saint Louis University , St. Louis , MO , United States
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Abstract
Several studies of the prevalence of borderline personality disorder in community and clinical settings have been carried out to date. Although results vary according to sampling method and assessment method, median point prevalence is roughly 1%, with higher or lower rates in certain community subpopulations. In clinical settings, the prevalence is around 10% to 12% in outpatient psychiatric clinics and 20% to 22% among inpatient clinics. Further research is needed to identify the prevalence and correlates of borderline personality disorder in other clinical settings (eg, primary care) and to investigate the impact of demographic variables on borderline personality disorder prevalence.
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Schmaling KB, Fales JL. The association between borderline personality disorder and somatoform disorders: A systematic review and meta-analysis. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2018. [DOI: 10.1111/cpsp.12244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Karen B. Schmaling
- Department of Psychology; Washington State University; Vancouver Washington
| | - Jessica L. Fales
- Department of Psychology; Washington State University; Vancouver Washington
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38
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Dixon-Gordon KL, Berghoff CR, McDermott MJ. Borderline Personality Disorder Symptoms and Pain in College Students: The Role of Emotional Suppression. J Pers Disord 2018; 32:277-288. [PMID: 28604278 DOI: 10.1521/pedi_2017_31_300] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Borderline personality disorder (BPD) is associated with higher rates of pain conditions and greater pain impairment. Past research implicates emotional suppression in acute pain tolerance; thus, emotional suppression may contribute to pain interference among those with high BPD features. Participants were 89 university students who completed measures of BPD features, and complied with 2-week daily diary procedures assessing suppression of emotional thoughts associated with social and nonsocial stressors, distress, pain severity, and interference. Multilevel models revealed a BPD × Suppression × Distress interaction, such that suppression in response to social (but not nonsocial) stressors in the context of high distress was related to pain interference when controlling for pain severity among those with high, but not low, BPD features. These findings suggest. that suppression of emotionally relevant thoughts in response to high distress may contribute to the functional impairment from pain among those with high BPD symptoms.
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Affiliation(s)
- Katherine L Dixon-Gordon
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Christopher R Berghoff
- Department of Psychiatry and Human Behavior, University of Mississippi, Medical Center, Jackson, Mississippi
| | - Michael J McDermott
- Department of Psychology, University of Louisiana, Lafayette, Lafayette, Louisiana
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39
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Tan RY, Grigg J, Kulkarni J. Borderline personality disorder and polycystic ovary syndrome: A review of the literature. Aust N Z J Psychiatry 2018; 52:117-128. [PMID: 28891300 DOI: 10.1177/0004867417730650] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE This review examines the existing evidence for the relationship between borderline personality disorder and polycystic ovary syndrome, and to identify commonalities in etiological mechanisms of borderline personality disorder and polycystic ovary syndrome that might explain the relationship between these seemingly disparate disorders. METHODS A search of Medline, EMBASE and Cochrane Central was undertaken on 5 December 2016 to identify studies investigating women with borderline personality disorder and polycystic ovary syndrome (or symptoms and markers specific to polycystic ovary syndrome). RESULTS Nine studies were identified, including three cross-sectional studies investigating symptoms of polycystic ovary syndrome in women with borderline personality disorder, two cross-sectional and one cohort study examining the prevalence of psychiatric diagnoses in women with polycystic ovary syndrome and three case reports of comorbid borderline personality disorder and polycystic ovary syndrome. CONCLUSION Overall, the literature shows women with borderline personality disorder to have higher than expected serum androgen levels and incidence of polycystic ovaries, which can be key features of polycystic ovary syndrome. However, this research is still in its infancy, which limits our understanding of this potential comorbid phenomenon. Given the emerging anecdotal and empirical evidence to date, a theoretical discussion of the potential psychoneuroendocrinological mechanism underlying the borderline personality disorder and polycystic ovary syndrome comorbidity is provided. Further rigorous studies using standardized diagnostic criteria for polycystic ovary syndrome are warranted. Specifically, the use of prospective controlled cohort studies may be able to determine the causality and temporality of observed comorbid borderline personality disorder and polycystic ovary syndrome.
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Affiliation(s)
- Raelene Ym Tan
- 1 Monash Alfred Psychiatry Research Centre (MAPrc), Melbourne, VIC, Australia.,2 Monash University, Melbourne, VIC, Australia
| | - Jasmin Grigg
- 1 Monash Alfred Psychiatry Research Centre (MAPrc), Melbourne, VIC, Australia
| | - Jayashri Kulkarni
- 1 Monash Alfred Psychiatry Research Centre (MAPrc), Melbourne, VIC, Australia
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40
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Cruitt PJ, Boudreaux MJ, Jackson JJ, Oltmanns TF. Borderline personality pathology and physical health: The role of employment. Personal Disord 2018; 9:73-80. [PMID: 27657166 PMCID: PMC5311027 DOI: 10.1037/per0000211] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Borderline personality disorder (BPD) is associated with negative physical health outcomes. Clinical case studies suggest that employment status may buffer against the negative effects of BPD on physical health. The goal of the current study was to examine the interaction between BPD features and employment status in predicting subjective perceptions of physical health. We hypothesized that employment status would moderate the relationship between BPD features and physical health, such that individuals who are employed would exhibit a weaker negative relationship between BPD features and self- and informant ratings of physical health. We investigated this question using data from a community sample of 1,630 middle-aged to older adults participating in the St. Louis Personality and Aging Network, an ongoing study of personality, health, and aging. Results indicated that employment status and BPD features were significant predictors of both self- and informant ratings of physical health. Confirming our hypothesis, the interaction term contributed to a significant increase in the proportion of explained variance, suggesting that employment is associated with a weaker negative relationship between BPD features and physical health. These findings highlight the importance of examining occupational functioning in the long-term course of BPD and offer avenues for further research into moderators of the relationship between BPD features and physical health. (PsycINFO Database Record
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Affiliation(s)
- Patrick J Cruitt
- Department of Psychological and Brain Sciences, Washington University in St. Louis
| | - Michael J Boudreaux
- Department of Psychological and Brain Sciences, Washington University in St. Louis
| | - Joshua J Jackson
- Department of Psychological and Brain Sciences, Washington University in St. Louis
| | - Thomas F Oltmanns
- Department of Psychological and Brain Sciences, Washington University in St. Louis
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41
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Husni ME, Merola JF, Davin S. The psychosocial burden of psoriatic arthritis. Semin Arthritis Rheum 2017; 47:351-360. [DOI: 10.1016/j.semarthrit.2017.05.010] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 05/09/2017] [Accepted: 05/19/2017] [Indexed: 01/01/2023]
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42
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Cruitt PJ, Oltmanns TF. Age-related outcomes associated with personality pathology in later life. Curr Opin Psychol 2017; 21:89-93. [PMID: 29073530 DOI: 10.1016/j.copsyc.2017.09.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 09/27/2017] [Accepted: 09/28/2017] [Indexed: 11/28/2022]
Abstract
Methodological advances enable the latest research on personality pathology in later life to turn toward understanding the role personality pathology plays in age-related outcomes. Despite indications that some features of personality disorders fade in later life, a prevalence rate of approximately 10 percent has been established for adults aged 50 or older. Personality disorder features have been linked to suicidal ideation, poorer physical health, and cognitive decline in later life. Given these associations, the literature on treatment of personality disorders in this age group is surprisingly scant. Future research needs to address this lack in order to provide guidelines for the use of the DSM-5 Alternative Model for Personality Disorders with older adults.
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Affiliation(s)
- Patrick J Cruitt
- From the Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA.
| | - Thomas F Oltmanns
- From the Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
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43
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Eaton NR, Greene AL. Personality disorders: community prevalence and socio-demographic correlates. Curr Opin Psychol 2017; 21:28-32. [PMID: 28961462 DOI: 10.1016/j.copsyc.2017.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 09/04/2017] [Accepted: 09/05/2017] [Indexed: 11/29/2022]
Abstract
Multiple studies have reported community prevalence rates of personality disorders (PDs), but these studies differed in terms of diagnostic criteria, assessment instruments, communities sampled, and size, producing widely ranging estimates. We take a meta-analytic approach to characterizing PD community prevalence rates by comparing results from two reviews that pooled previous studies. Overall, particular PD rates are low in community samples, but the presence of any PD is relatively high, with approximately one person in seven experiencing personality psychopathology. High congruence of prevalence estimates, but low rank-order agreement of rates, was observed. We discuss how the presence of PD is associated with socio-demographic correlates such as gender, race/ethnicity, and age and highlight areas for further study.
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Affiliation(s)
- Nicholas R Eaton
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA.
| | - Ashley L Greene
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
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44
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Dixon-Gordon KL, Conkey LC, Whalen DJ. Recent advances in understanding physical health problems in personality disorders. Curr Opin Psychol 2017; 21:1-5. [PMID: 28915400 DOI: 10.1016/j.copsyc.2017.08.036] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 08/28/2017] [Accepted: 08/29/2017] [Indexed: 11/16/2022]
Abstract
Personality disorders are associated with a range of adverse health outcomes, contributing to the high healthcare utilization seen in patients with these disorders. A growing literature supports a robust association of personality disorders and health problems. The primary aim of this article is to summarize the most recent research documenting the associations between personality disorders and health conditions. Extending past reviews, we discuss the association of personality disorders with chronic physical illnesses, sleep disturbances, pain conditions, and obesity. We provide recommendations for future research in this area.
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Affiliation(s)
- Katherine L Dixon-Gordon
- University of Massachusetts Amherst, Department of Psychological and Brain Sciences, 135 Hicks Way, Amherst, MA 01003, USA.
| | - Lindsey C Conkey
- University of Massachusetts Amherst, Department of Psychological and Brain Sciences, 135 Hicks Way, Amherst, MA 01003, USA
| | - Diana J Whalen
- Washington University School of Medicine, Department of Psychiatry, Box 8511, St. Louis, MO 63110, USA
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45
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Gratz KL, Weiss NH, McDermott MJ, Dilillo D, Messman-Moore T, Tull MT. Emotion Dysregulation Mediates the Relation Between Borderline Personality Disorder Symptoms and Later Physical Health Symptoms. J Pers Disord 2017; 31:433-448. [PMID: 27322577 PMCID: PMC5472518 DOI: 10.1521/pedi_2016_30_252] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Despite evidence of a relation between borderline personality disorder (BPD) pathology and physical health problems, the mechanisms underlying this relation remain unclear. Given evidence that emotion dysregulation may affect physical health by altering physiological functioning, one mechanism that warrants examination is emotion dysregulation. This study examined BPD symptoms as a prospective predictor of physical health symptoms 8 months later and the mediating role of emotion dysregulation in this relation. Participants completed three assessments over an 8-month period, including a BPD diagnostic interview. Results of analyses examining baseline predictors of later physical health symptoms revealed a significant unique association between baseline BPD symptom severity and physical health symptoms 8 months later, above and beyond baseline physical health symptoms, depression and anxiety symptoms, and emotion dysregulation. Moreover, structural equation modeling revealed a significant indirect relation of BPD symptoms at Wave 1 to physical health symptoms at Wave 3 through emotion dysregulation at Wave 2.
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Affiliation(s)
- Kim L Gratz
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi
| | - Nicole H Weiss
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Michael J McDermott
- Department of Psychology, University of Louisiana at Lafayette, Lafayette, Louisiana
| | - David Dilillo
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska
| | | | - Matthew T Tull
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi
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46
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Yeung JWK, Zhang Z, Kim TY. Volunteering and health benefits in general adults: cumulative effects and forms. BMC Public Health 2017; 18:8. [PMID: 28693551 PMCID: PMC5504679 DOI: 10.1186/s12889-017-4561-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 07/03/2017] [Indexed: 11/12/2022] Open
Abstract
Background Although the health benefits of volunteering have been well documented, no research has examined its cumulative effects according to other-oriented and self-oriented volunteering on multiple health outcomes in the general adult public. This study examined other-oriented and self-oriented volunteering in cumulative contribution to health outcomes (mental and physical health, life satisfaction, social well-being and depression). Methods Data were drawn from the Survey of Texas Adults 2004, which contains a statewide population-based sample of adults (n = 1504). Multivariate linear regression and Wald test of parameters equivalence constraint were used to test the relationships. Results Both forms of volunteering were significantly related to better health outcomes (odds ratios = 3.66% to 11.11%), except the effect of self-oriented volunteering on depression. Other-oriented volunteering was found to have better health benefits than did self-volunteering. Conclusion Volunteering should be promoted by public health, education and policy practitioners as a kind of healthy lifestyle, especially for the social subgroups of elders, ethnic minorities, those with little education, single people, and unemployed people, who generally have poorer health and less participation in volunteering.
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Affiliation(s)
- Jerf W K Yeung
- Department of Applied Social Sciences, City University of Hong Kong, Kowloon, Hong Kong.
| | - Zhuoni Zhang
- Department of Applied Social Sciences, City University of Hong Kong, Kowloon, Hong Kong
| | - Tae Yeun Kim
- Department of Applied Social Sciences, City University of Hong Kong, Kowloon, Hong Kong
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47
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Angstman KB, Seshadri A, Marcelin A, Gonzalez CA, Garrison GM, Allen JS. Personality Disorders in Primary Care: Impact on Depression Outcomes Within Collaborative Care. J Prim Care Community Health 2017; 8:233-238. [PMID: 28613090 PMCID: PMC5932731 DOI: 10.1177/2150131917714929] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background:Individuals with personality disorders (PDs) are high utilizers of primary care and mental health services; however, they struggle to utilize the care effectively and studies have shown a strong association between having a PD and higher impairment in social role functioning. This is especially important because PDs are highly comorbid with a wide range of other mental health disorders. The collaborative care model (CCM) for depression was developed with an emphasis on patient engagement and aimed to reduce health care utilization, while improving treatment outcomes in primary care. We hypothesized that the diagnosis of a personality disorder in primary care patients will negatively affect 6-month depression outcomes after enrollment into a CCM. Methods: This retrospective chart review study was conducted on patients enrolled into CCM over a period of 7 years with collection of 6-month follow-up data. A total of 2826 patients were enrolled into CCM with a clinical diagnosis of depression and a baseline Patient Health Questionnaire–9 (PHQ-9) ≥10 were included in the study cohort. Using the depression database, baseline and 6-month follow-up data were obtained. Adjusted odds ratios (AORs) were determined for both remission and persistent depressive symptoms using logistic regression modeling for the 6-month PHQ-9 outcome; while retaining all the study variables. Results: Of the 2826 CCM patients with depression in our study, 216 (7.6%) were found to have a PD. Patients with PD were younger (37.7 vs 42.5 years, P < .001) and more likely to be unmarried (36.1% vs 55.6%, P < .001) than patients without a PD. While age, marital status, clinical diagnosis, and Mood Disorders Questionnaire (MDQ) score were significant predictors of remission; anxiety symptoms, gender, and race were not. The presence of a PD diagnosis was associated with a 60% lower likelihood of remission at 6 months (AOR = 0.39; 95% CI 0.28-0.54). Conversely, patients without a PD were 2.5 times as likely to experience remission at 6-month remission compared to patients with PD (AOR =2.57; 95% CI 1.85-3.56). Conclusion: Patients with a personality disorder were more likely to have a recurrent depressive disorder diagnosis, an abnormal MDQ score, increased anxiety symptoms, and higher baseline PHQ-9 score. Patients with PD had worse CCM outcomes at 6 months with only 25.0% able to achieve remission versus 54.3% (P < .001) without a PD. The presence of a PD with depression was associated with poor outcomes (reduced remission rates and increased persistent depressive symptoms rates) in comparison to patients without a diagnosis of PD, while treated within CCM.
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48
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Cruitt PJ, Oltmanns TF. Incremental Validity of Self- and Informant Report of Personality Disorders in Later Life. Assessment 2017; 25:324-335. [DOI: 10.1177/1073191117706020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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49
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Riddle M, Meeks T, Alvarez C, Dubovsky A. When personality is the problem: Managing patients with difficult personalities on the acute care unit. J Hosp Med 2016; 11:873-878. [PMID: 27610608 DOI: 10.1002/jhm.2643] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 07/07/2016] [Accepted: 07/18/2016] [Indexed: 11/06/2022]
Abstract
Personality disorders are pervasive patterns of maladaptive behaviors, thoughts, and emotions that often go unrecognized and can wreak havoc in the patient's interpersonal life. These inflexible patterns of managing the world can be disruptive when an individual is admitted to the hospital, causing distress for both the patient who lacks the skills to deal with the expectations of the hospital environment and the treatment team who can feel ill equipped to manage such behavior. Having a personality disorder has implications for an individual's healthcare outcomes; those with a personality disorder have a life expectancy nearly 2 decades shorter than the general population for a multitude of reasons, among them trouble interacting with the healthcare system. Although a diagnosis of a specific personality disorder may be difficult to make on an acute care unit, identification of dysfunctional personality structures can provide opportunity for better management of an individual patient's medical and psychological needs. This review focuses on the identification of these individuals in the acute care setting and provides an overview of evidence-based behavioral and pharmacological interventions. Journal of Hospital Medicine 2015;11:873-878. © 2015 Society of Hospital Medicine.
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Affiliation(s)
- Megan Riddle
- Psychiatry Residency Program, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Timothy Meeks
- Department of Clinical Education, Harborview Medical Center, Seattle, Washington
| | - Carrol Alvarez
- Department of Clinical Education, Harborview Medical Center, Seattle, Washington
| | - Amelia Dubovsky
- Psychiatry Residency Program, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
- Department of Clinical Education, Harborview Medical Center, Seattle, Washington
- Department of Psychiatry and Behavioral Sciences, University of Washington and Harborview Medical Center, Seattle, Washington
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50
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Cailhol L, Francois M, Thalamas C, Garrido C, Birmes P, Pourcel L, Lapeyre-Mestre M, Paris J. Is borderline personality disorder only a mental health problem? Personal Ment Health 2016; 10:328-336. [PMID: 27735136 DOI: 10.1002/pmh.1350] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 06/28/2016] [Accepted: 08/24/2016] [Indexed: 11/07/2022]
Abstract
Patients with borderline personality disorder (BPD) have been shown to have increased rates of the use of medical services. The objective of this multicentre study was to compare the utilization of physical health services by patients with severe BPD (n = 36) with that of two control groups: one with other personality disorders (PDs) (n = 38) and one with matched subjects randomly selected from the general population (n = 165). Information was drawn from an insurance database collected over a 5-year period. The results showed that the BPD group had a higher mean number of medication prescriptions (377.3 vs. 97.4, p < 0.001), general medical consultations (34.4 vs. 13.2, p < 0.05) and days of medical or surgical hospitalization (10.2 vs. 1.9, p = 0.03). However, there were no significant differences between the groups with BPD and other PDs. The annual health-care cost for each BPD patient is estimated to be 12 761 euros, of which 17.6% is due to somatic care. In the BPD group, co-morbidity for narcissistic PD (NPD) contributed to the overall use of medications and hospitalization use. Combined with other data, this exploratory study shows that BPD is a medical burden and not just a psychiatric one. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Lionel Cailhol
- Psychiatrie, Saint Jérôme, Saint-Jérôme, Quebec, Canada.
| | | | | | | | | | | | | | - Joel Paris
- Psychiatry, Institute of Community and Family Psychiatry, Montreal, Quebec, Canada
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