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Yalch MM, Snyder K, Hujing CL, Torres AN. Influence of Betrayal Trauma on Schizotypal Personality Pathology. J Trauma Dissociation 2024; 25:366-378. [PMID: 36050931 DOI: 10.1080/15299732.2022.2120153] [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: 03/19/2022] [Accepted: 08/12/2022] [Indexed: 10/14/2022]
Abstract
Schizotypal personality pathology (SZP) is a persistent and debilitating problem for a substantial number of people. Research on SZP has typically emphasized its biological and more specifically genetic origins. However, recent research has highlighted the potential influence of trauma on SZP. This research is promising, although it has thus far focused primarily on type of trauma (e.g., different types of abuse vs. neglect in childhood) rather than who perpetrated the trauma. Previous studies on both personality pathology in general and psychotic-spectrum experiences characteristic of SZP in particular have highlighted the influence of trauma perpetrated by someone with whom the trauma survivor was close (i.e., betrayal trauma), although this has not yet been examined with respect to SZP specifically. In this study we examined this, evaluating the influence of trauma with varying degrees of betrayal on SZP in a sample of adults (N = 364) using structural equation modeling. Results suggest that interpersonal trauma in general was associated with higher levels of SZP. Findings further indicate that for women but not men, trauma with a high degree of betrayal was uniquely associated with SZP. These results underscore the potential role of trauma in SZP and have implications for future research on and intervention with people with high levels of SZP.
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Affiliation(s)
- Matthew M Yalch
- Department of Psychology, Palo Alto University, Palo Alto, California, USA
| | - Kaitlin Snyder
- Department of Psychology, Palo Alto University, Palo Alto, California, USA
| | - Christine L Hujing
- Department of Psychology, Palo Alto University, Palo Alto, California, USA
| | - Alicia N Torres
- Department of Psychology, Palo Alto University, Palo Alto, California, USA
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2
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Schorer L, Ross T, Fontao M. [Patient Factors in Offender Treatment: Personality, Therapy Motivation and Outcome]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2024; 92:170-185. [PMID: 35948024 DOI: 10.1055/a-1872-9220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Using a systematic literature review according to the PRISMA criteria, patient factors of offenders were related to forensic outcomes. Searches were conducted in the PsycInfo and PSYNDEX databases; further relevant studies were taken from the bibliographies of studies that met the selection criteria. Only quantitative empirical studies for the period 1990-2021 were included. Findings from 31 studies on patient factors (personality, therapy motivation, therapy expectation, satisfaction with therapy) are reported. Patient factors could not always be consistently associated with outcomes. The clearest correlations were found between the expression of anti- or dissocial personality traits and/or psychopathy and (negative) therapy outcomes. Traits usually associated with antisocial developments (impulsivity, anger, rage, hostility) in some cases also correlated negatively with therapeutically desirable outcomes. Patient motivation for therapy should generally have a positive impact on the likelihood of successful forensic therapies, but not all relevant studies pointed in this direction. No studies were identified on the relationships between therapy expectancy or satisfaction and outcome. Based on general psychotherapy research, we suggest that offender therapy could benefit from broader approaches to studying therapy effectiveness.
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Affiliation(s)
- Leila Schorer
- Fachbereich Psychologie, Universität Konstanz, Konstanz, Germany
| | - Thomas Ross
- Klinik für Forensische Psychiatrie und Psychotherapie, Zentrum für Psychiatrie Reichenau, Reichenau, Germany
- Medizinische Fakultät, Universität Ulm, Ulm, Germany
| | - Maria Fontao
- Fachbereich Psychologie, Universität Konstanz, Konstanz, Germany
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3
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Gander M, Buchheim A, Sevecke K. Personality Disorders and Attachment Trauma in Adolescent Patients with Psychiatric Disorders. Res Child Adolesc Psychopathol 2024; 52:457-471. [PMID: 37889355 PMCID: PMC10896792 DOI: 10.1007/s10802-023-01141-1] [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] [Accepted: 10/09/2023] [Indexed: 10/28/2023]
Abstract
This study examined how personality disorders (PD) differ with respect to gender, attachment status and traumatic childhood experiences in adolescent psychiatric inpatients. In particular, we investigated attachment-related traumatic material underlying adolescent PD. Our sample consisted of 175 inpatient adolescents aged 14 to 18 years (77% female, Mage = 15.13, SD = 1.35; 23% male, Mage =14.85, SD = 1.41). Thirty-nine patients (22%) fulfilled the diagnostic criteria for a PD according to the SCID-II PD: 51% avoidant, 13% obsessive-compulsive, 13% antisocial, 19% borderline, 2% paranoid and 2% histrionic. In the total sample, eighty-three (47%) of our inpatients were classified with an unresolved attachment status using the Adult Attachment Projective Picture System (AAP). We did not find any significant gender differences for patients with and without a PD. Our results revealed a higher percentage of unresolved attachment status in patients with a PD. The in-depth analysis of the total sample showed that patients with a PD demonstrated more traumatic material in their attachment interviews indicating a greater severity of attachment trauma. Furthermore, patients with a PD reported higher scores on emotional and physical neglect. Intervention strategies targeting traumatic attachment-related themes might be useful to treat adolescents with PD.
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Affiliation(s)
- Manuela Gander
- Institute of Psychology, University of Innsbruck, Universitätsstrasse 5-7, Innsbruck, 6020, Austria.
- Department of Child and Adolescent Psychiatry, Tirol Kliniken, Milserstrasse 10, 6060 Hall in Tirol, Tirol, Austria.
| | - Anna Buchheim
- Institute of Psychology, University of Innsbruck, Universitätsstrasse 5-7, Innsbruck, 6020, Austria
| | - Kathrin Sevecke
- Department of Child and Adolescent Psychiatry, Tirol Kliniken, Milserstrasse 10, 6060 Hall in Tirol, Tirol, Austria
- Department of Child and Adolescent Psychiatry, Medical University of Innsbruck, Innsbruck, 6020, Austria
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4
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d’Huart D, Seker S, Bürgin D, Birkhölzer M, Boonmann C, Schmid M, Schmeck K, Bach B. Key insights from studies on the stability of personality disorders in different age groups. Front Psychiatry 2023; 14:1109336. [PMID: 37398598 PMCID: PMC10309036 DOI: 10.3389/fpsyt.2023.1109336] [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: 11/27/2022] [Accepted: 05/25/2023] [Indexed: 07/04/2023] Open
Abstract
While for decades, temporal stability has been conceived as a defining feature of personality disorders (PDs), cumulative findings appear to question the stability of PDs and PD symptoms over time. However, stability itself is a complex notion and findings are highly heterogenous. Building upon a literature search from a systematic review and meta-analysis, this narrative review aims to capture key findings in order to provide critical implications, both for clinical practice and future research. Taken together, this narrative review revealed that unlike previous assumptions, stability estimates in adolescence are comparable to stability estimates in adulthood and PDs and PD symptoms are not that stable. The extent of stability itself depends yet on various conceptual, methodological, environmental, and genetic factors. While findings were thus highly heterogenous, they all seem to converge in a notable trend towards symptomatic remission, except for high-risk-samples. This challenges the current understanding of PDs in terms of disorders and symptoms and argues instead in favor of the AMPD and ICD-11 reintroducing the idea of self and interpersonal functioning as the core feature of PDs.
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Affiliation(s)
- Delfine d’Huart
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel, Basel, Switzerland
| | - Süheyla Seker
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel, Basel, Switzerland
| | - David Bürgin
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel, Basel, Switzerland
- Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
| | - Marc Birkhölzer
- Department of Forensic Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, Basel, Switzerland
| | - Cyril Boonmann
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel, Basel, Switzerland
- Department of Forensic Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, Basel, Switzerland
- LUMC Curium—Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, Netherlands
| | - Marc Schmid
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel, Basel, Switzerland
| | - Klaus Schmeck
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel, Basel, Switzerland
| | - Bo Bach
- Center of Excellence on Personality Disorder, Psychiatric Research Unit, Region Zealand, Slagelse Psychiatric Hospital, Slagelse, Denmark
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5
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d'Huart D, Seker S, Bürgin D, Birkhölzer M, Boonmann C, Schmid M, Schmeck K. The stability of personality disorders and personality disorder criteria: A systematic review and meta-analysis. Clin Psychol Rev 2023; 102:102284. [PMID: 37116251 DOI: 10.1016/j.cpr.2023.102284] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 01/29/2023] [Accepted: 04/20/2023] [Indexed: 04/30/2023]
Abstract
The aim of this systematic review and meta-analysis was to investigate the diagnostic, the dimensional mean-level, and rank-order stability of personality disorders (PDs) and PD criteria over time. EMBASE, PsycInfo, PubMed, and Web of Science were searched for peer-reviewed studies published in either English, German, or French between the first publication of the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980 and December 20, 2022. Inclusion criteria were a prospective longitudinal study design, assessing the stability of PDs or PD criteria over at least two measurement occasions at least one month apart, and using the same assessment at baseline and follow-up. Effect sizes included proportion of enduring cases (i.e., diagnostic stability), test-retest correlations (i.e., dimensional rank-order stability), and within-group standardized mean differences (i.e., dimensional mean-level stability), based on the first and last available measurement occasion. From an initial pool of 1473 studies, 40 were included in our analyses, covering 38,432 participants. 56.7% maintained the diagnosis of any PD, and 45.2% maintained the diagnosis of borderline PD over time. Findings on the dimensional mean-level stability indicate that most PD criteria significantly decreased from baseline to follow-up, except for antisocial, obsessive-compulsive, and schizoid PD criteria. Findings on the dimensional rank-order stability suggested moderate estimates, except for antisocial PD criteria, which were found to be high. Findings indicated that both PDs and PD criteria were only moderately stable, although between study heterogeneity was high, and stability itself depended on several methodological factors.
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Affiliation(s)
- Delfine d'Huart
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel, Basel, Switzerland. Delfine.d'
| | - Süheyla Seker
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel, Basel, Switzerland
| | - David Bürgin
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel, Basel, Switzerland; Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
| | - Marc Birkhölzer
- Department of Forensic Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, Basel, Switzerland
| | - Cyril Boonmann
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel, Basel, Switzerland; Department of Forensic Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, Basel, Switzerland; LUMC Curium - Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
| | - Marc Schmid
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel, Basel, Switzerland
| | - Klaus Schmeck
- Department of Clinical Research, Medical Faculty, University of Basel, Basel, Switzerland
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6
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Stricker J, Jakob L, Köhler D, Pietrowsky R. Six-month stability and predictive validity of the personality inventory for ICD-11. BMC Psychol 2022; 10:270. [PMID: 36384683 PMCID: PMC9670366 DOI: 10.1186/s40359-022-00979-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/09/2022] [Indexed: 11/17/2022] Open
Abstract
Background The International Classification of Diseases 11th Revision (ICD-11) personality disorder model comprises, among other elements, five maladaptive personality trait domains (negative affectivity, detachment, dissociality, disinhibition, anankastia). Recently, the personality inventory for ICD-11 (PiCD) has emerged as one of the most widely used measures of these ICD-11 personality trait domains. Methods The current study contributed to the validation of the PiCD validation by exploring its stability and predictive links with psychological distress over 6 months in a sample of 206 German community adults. Results The PiCD trait domain scales displayed strong differential (all r ≥ .80) and absolute stability (all |d| ≤ .09). Additionally, PiCD negative affectivity predicted depression, anxiety, and stress, and PiCD detachment predicted depression over 6 months beyond baseline. Conclusion In sum, this study demonstrated the stability of the PiCD trait domain scores, supporting their utility for capturing relatively stable traits as described in the ICD-11. Additionally, we provided the first evidence for the predictive validity of some of the PiCD trait domain scores. Supplementary Information The online version contains supplementary material available at 10.1186/s40359-022-00979-2.
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Zilcha-Mano S, Solomonov N, Posner JE, Roose SP, Rutherford BR. Proof of Concept of the Contribution of the Interaction between Trait-like and State-like Effects in Identifying Individual-Specific Mechanisms of Action in Biological Psychiatry. J Pers Med 2022; 12:1197. [PMID: 35893291 PMCID: PMC9332605 DOI: 10.3390/jpm12081197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/29/2022] [Accepted: 07/08/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Identifying individual-specific mechanisms of action may facilitate progress toward precision medicine. Most studies seeking to identify mechanisms of action collapse together two distinct components: pre-treatment trait-like characteristics differentiating between individuals and state-like characteristics changing within each individual over the course of treatment. We suggest a conceptual framework highlighting the importance of studying interactions between trait-like and state-like components in the development of moderated mediation models that can guide personalized targeted interventions. Methods: To facilitate implementation of this framework, two empirical demonstrations are presented from a recent clinical trial and neuroimaging study. The first examines limbic reactivity during an emotional face task; the second concerns striatal activation in a monetary reward task. Results: In both tasks, considering the interaction between trait-like and state-like components predicted treatment outcome more robustly than did the trait-like or state-like components examined individually. Conclusions: These findings suggest that the extent to which state-like modulation of neural activations can serve as a potential treatment target depends on the pre-treatment, trait-like levels of activation in these regions. Thus, the interaction between trait-like and state-like components can serve as a promising path to the development of personalized interventions within a precision medicine framework in which mechanisms of action are individual-specific.
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Affiliation(s)
- Sigal Zilcha-Mano
- Department of Psychology, University of Haifa, Mount Carmel, Haifa 31905, Israel
| | - Nili Solomonov
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, White Plains, NY 10605, USA;
| | - Jonathan E. Posner
- New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, New York, NY 10032, USA; (J.E.P.); (S.P.R.); (B.R.R.)
| | - Steven P. Roose
- New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, New York, NY 10032, USA; (J.E.P.); (S.P.R.); (B.R.R.)
| | - Bret R. Rutherford
- New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, New York, NY 10032, USA; (J.E.P.); (S.P.R.); (B.R.R.)
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8
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Vásquez-Echeverría A, Alvarez-Nuñez L, Gonzalez M, Loose T, Rudnitzky F. Role of parenting practices, mother’s personality and depressive symptoms in early child development. Infant Behav Dev 2022; 67:101701. [DOI: 10.1016/j.infbeh.2022.101701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 12/30/2021] [Accepted: 02/06/2022] [Indexed: 11/30/2022]
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9
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d’Huart D, Steppan M, Seker S, Bürgin D, Boonmann C, Birkhölzer M, Jenkel N, Fegert JM, Schmid M, Schmeck K. Prevalence and 10-Year Stability of Personality Disorders From Adolescence to Young Adulthood in a High-Risk Sample. Front Psychiatry 2022; 13:840678. [PMID: 35401274 PMCID: PMC8987201 DOI: 10.3389/fpsyt.2022.840678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background With the implementation of the 11th edition of the International Classification of Diseases (ICD-11) in early 2022, there will be a radical change in the framework and process for diagnosing personality disorders (PDs), indicating a transition from the categorical to the dimensional model. Despite increasing evidence that PDs are not as stable as previously assumed, the long-term stability of PDs remains under major debate. The aim of the current paper was to investigate the categorical and dimensional mean-level and rank-order stability of PDs from adolescence into young adulthood in a high-risk sample. Methods In total, 115 young adults with a history of residential child welfare and juvenile-justice placements in Switzerland were included in the current study. PDs were assessed at baseline and at a 10-year follow-up. On a categorical level, mean-level stability was assessed through the proportion of enduring cases from baseline to follow-up. Rank-order stability was assessed through Cohen's κ and tetrachoric correlation coefficients. On a dimensional level, the magnitude of change between the PD trait scores at baseline and at follow-up was measured by Cohen's d. Rank-order stability was assessed through Spearman's ρ. Results The prevalence rate for any PD was 20.0% at baseline and 30.4% at follow-up. The most frequently diagnosed disorders were antisocial, borderline, and obsessive-compulsive PDs, both at baseline and at follow-up. On a categorical level, the mean-level stability of any PD was only moderate, and the mean-level stability of specific PDs was low, except of schizoid PD. Likewise, the rank-order stability of any PD category was moderate, while ranging from low to high for individual PD diagnoses. On a dimensional level, scores increased significantly for most PDs, except for histrionic traits, which decreased significantly from baseline to follow-up. Effect sizes were generally low. The rank-order stability for dimensional scores ranged from low to moderate. Conclusion The findings indicate low to moderate stability of Pds and Pd traits from adolescence to adulthood, which supports the growing evidence that categorical diagnoses of Pds are quite unstable. This in turn, emphasizes the use of the upcoming ICD-11 that Acknowledgments Pds to be only "relatively" stable.
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Affiliation(s)
- Delfine d’Huart
- Department of Child and Adolescent Psychiatric Research, University Psychiatric Clinics Basel, Basel, Switzerland
| | - Martin Steppan
- Division of Developmental and Personality Psychology, University of Basel, Basel, Switzerland
| | - Süheyla Seker
- Department of Child and Adolescent Psychiatric Research, University Psychiatric Clinics Basel, Basel, Switzerland
| | - David Bürgin
- Department of Child and Adolescent Psychiatric Research, University Psychiatric Clinics Basel, Basel, Switzerland
- Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
| | - Cyril Boonmann
- Department of Child and Adolescent Psychiatric Research, University Psychiatric Clinics Basel, Basel, Switzerland
- Department of Forensic Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, Basel, Switzerland
| | - Marc Birkhölzer
- Department of Forensic Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, Basel, Switzerland
| | - Nils Jenkel
- Department of Child and Adolescent Psychiatric Research, University Psychiatric Clinics Basel, Basel, Switzerland
| | - Jörg M. Fegert
- Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
| | - Marc Schmid
- Department of Child and Adolescent Psychiatric Research, University Psychiatric Clinics Basel, Basel, Switzerland
| | - Klaus Schmeck
- Department of Child and Adolescent Psychiatric Research, University Psychiatric Clinics Basel, Basel, Switzerland
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Garner AR, Blocher N, Tierney D, Baumgardner M, Watson A, Romero G, Skadberg R, Younginer T, Waugh MH. Applying the DSM-5 Alternative Model of Personality Disorders and the Shedler-Westen Assessment Procedure to the Classic Case of "Madeline G.": Novice and Expert Rater Convergences and Divergence. Front Psychol 2022; 13:794616. [PMID: 35242078 PMCID: PMC8885620 DOI: 10.3389/fpsyg.2022.794616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
Prior research supports the learnability of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition Alternative Model of Personality Disorders (AMPD). However, researchers have yet to compare novice ratings on the AMPD's Level of Personality Functioning Scale and the 25 pathological personality traits with expert ratings. Furthermore, the AMPD has yet to be examined with the idiographic Shedler-Westen Assessment Procedure (SWAP). We compared the aggregated AMPD clinical profile of a group of psychology doctoral students who learned the AMPD to high levels of reliability to that of an expert rater using the crucible of the classical case of "Madeline G." Examination of AMPD and SWAP ratings of "Madeline G." revealed excellent overall concordance but suggests that novice raters tend to perceive lower levels of personality impairment.
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Affiliation(s)
- Alisa R Garner
- Department of Psychology, University of Tennessee-Knoxville, Knoxville, TN, United States
| | - Natalie Blocher
- Department of Psychology, University of Tennessee-Knoxville, Knoxville, TN, United States
| | - David Tierney
- Department of Psychology, University of Tennessee-Knoxville, Knoxville, TN, United States
| | - Megan Baumgardner
- Department of Psychology, University of Tennessee-Knoxville, Knoxville, TN, United States
| | - Alayna Watson
- Department of Psychology, University of Tennessee-Knoxville, Knoxville, TN, United States
| | - Gloria Romero
- Department of Psychology, University of Tennessee-Knoxville, Knoxville, TN, United States
| | - Rebecca Skadberg
- Department of Psychology, University of Tennessee-Knoxville, Knoxville, TN, United States
| | - Taylor Younginer
- Department of Psychology, University of Tennessee-Knoxville, Knoxville, TN, United States
| | - Mark H Waugh
- Department of Psychology, University of Tennessee-Knoxville, Knoxville, TN, United States.,Oak Ridge National Laboratory, Oak Ridge, TN, United States
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11
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The Validation of a Five-Item Screening Scale for Personality Disorders in Dutch-Speaking Community Adolescents and Adults. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2022. [DOI: 10.1007/s10862-022-09951-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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12
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Hopwood CJ, Schwaba T, Wright AGC, Bleidorn W, Zanarini MC. Longitudinal associations between borderline personality disorder and five-factor model traits over 24 years. EUROPEAN JOURNAL OF PERSONALITY 2021. [DOI: 10.1177/08902070211012918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Are five-factor traits and borderline personality symptoms the same features with different names? The existing literature offers reasons to think they are the same and reasons to think they are different. We examined longitudinal associations between these variables in a sample of patients assessed 12 times over 24 years using latent curve models with structured residuals. Mean trajectories for all variables were in the direction of symptom reduction/personality maturation and could be parsed into an initial, rapid improvement phase and a subsequent, gradual improvement phase. We found robust between-person associations among intercepts and long-term slopes of traits and symptoms. Specifically, higher levels of neuroticism as well as lower levels of extraversion, agreeableness, and conscientiousness were associated with higher levels of borderline personality symptoms, and changes in these traits were correlated with reduction in symptoms over time. Associations among time-structured residuals allowed for examinations of within-person deflections from these general trends at briefer (two year) intervals. All variables exhibited robust within-person carry-over effects. Other within-person effects were more specific to certain traits. These results suggest that, despite their distinct theoretical and methodological bases, normal trait and psychiatric diagnostic approaches largely converged on a similar conception of borderline personality.
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13
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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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14
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Dotterer HL, Beltz AM, Foster KT, Simms LJ, Wright AGC. Personalized models of personality disorders: using a temporal network method to understand symptomatology and daily functioning in a clinical sample. Psychol Med 2020; 50:2397-2405. [PMID: 31597579 DOI: 10.1017/s0033291719002563] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND An ongoing challenge in understanding and treating personality disorders (PDs) is a significant heterogeneity in disorder expression, stemming from variability in underlying dynamic processes. These processes are commonly discussed in clinical settings, but are rarely empirically studied due to their personalized, temporal nature. The goal of the current study was to combine intensive longitudinal data collection with person-specific temporal network models to produce individualized symptom-level structures of personality pathology. These structures were then linked to traditional PD diagnoses and stress (to index daily functioning). METHODS Using about 100 daily assessments of internalizing and externalizing domains underlying PDs (i.e. negative affect, detachment, impulsivity, hostility), a temporal network mapping approach (i.e. group iterative multiple model estimation) was used to create person-specific networks of the temporal relations among domains for 91 individuals (62.6% female) with a PD. Network characteristics were then associated with traditional PD symptomatology (controlling for mean domain levels) and with daily variation in clinically-relevant phenomena (i.e. stress). RESULTS Features of the person-specific networks predicted paranoid, borderline, narcissistic, and obsessive-PD symptom counts above average levels of the domains, in ways that align with clinical conceptualizations. They also predicted between-person variation in stress across days. CONCLUSIONS Relations among behavioral domains thought to underlie heterogeneity in PDs were indeed associated with traditional diagnostic constructs and with daily functioning (i.e. stress) in person-specific networks. Findings highlight the importance of leveraging data and models that capture person-specific, dynamic processes, and suggest that person-specific networks may have implications for precision medicine.
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Affiliation(s)
| | - Adriene M Beltz
- Department of Psychology, University of Michigan, Ann Arbor, USA
| | | | - Leonard J Simms
- Department of Psychology, University at Buffalo, Buffalo, USA
| | - Aidan G C Wright
- Department of Psychology, University of Pittsburgh, Pittsburgh, USA
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15
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DeYoung CG, Chmielewski M, Clark LA, Condon DM, Kotov R, Krueger RF, Lynam DR, Markon KE, Miller JD, Mullins-Sweatt SN, Samuel DB, Sellbom M, South SC, Thomas KM, Watson D, Watts AL, Widiger TA, Wright AGC. The distinction between symptoms and traits in the Hierarchical Taxonomy of Psychopathology (HiTOP). J Pers 2020; 90:20-33. [PMID: 32978977 DOI: 10.1111/jopy.12593] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/10/2020] [Accepted: 09/13/2020] [Indexed: 12/11/2022]
Abstract
The Hierarchical Taxonomy of Psychopathology (HiTOP) is an empirically and quantitatively derived dimensional classification system designed to describe the features of psychopathology and, ultimately, to replace categorical nosologies. Among the constructs that HiTOP organizes are "symptom components" and "maladaptive traits," but past HiTOP publications have not fully explicated the distinction between symptoms and traits. We propose working definitions of symptoms and traits and explore challenges, exceptions, and remaining questions. Specifically, we propose that the only systematic difference between symptoms and traits in HiTOP is one of time frame. Maladaptive traits are dispositional constructs that describe persistent tendencies to manifest features of psychopathology, whereas symptoms are features of psychopathology as they are manifest during any specific time period (from moments to days to months). This has the consequence that almost every HiTOP dimension, at any level of the hierarchy, can be assessed as either a trait or a symptom dimension, by adjusting the framing of the assessment. We discuss the implications of these definitions for causal models of the relations between symptoms and traits and for distinctions between psychopathology, normal personality variation, and dysfunction.
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Affiliation(s)
- Colin G DeYoung
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | | | - Lee Anna Clark
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - David M Condon
- Department of Psychology, University of Oregon, Eugene, OR, USA
| | - Roman Kotov
- Department of Psychiatry and Behavioral Health, State University of New York, Stony Brook, NY, USA
| | - Robert F Krueger
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Donald R Lynam
- Department of Psychology, Purdue University, West Lafayette, IN, USA
| | | | - Joshua D Miller
- Department of Psychology, University of Georgia, Athens, GA, USA
| | | | - Douglas B Samuel
- Department of Psychology, Purdue University, West Lafayette, IN, USA
| | - Martin Sellbom
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Susan C South
- Department of Psychology, Purdue University, West Lafayette, IN, USA
| | | | - David Watson
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Ashley L Watts
- Department of Psychology, University of Missouri, Columbia, MO, USA
| | - Thomas A Widiger
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Aidan G C Wright
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
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16
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Hamlat EJ, Young JF, Hankin BL. Developmental Course of Personality Disorder Traits in Childhood and Adolescence. J Pers Disord 2020; 34:25-43. [PMID: 31084556 PMCID: PMC6980182 DOI: 10.1521/pedi_2019_33_433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Developmental patterns of personality pathology traits are not well delineated from childhood through late adolescence. In the present study, participants (N = 675, 56% female) were recruited to create three cohorts of third (n = 205), sixth (n = 248), and ninth (n = 222) graders to form an accelerated longitudinal cohort design. We assessed six PD (avoidant, dependent, histrionic, narcissistic, borderline, schizotypal) traits based on DSM-IV trait diagnostic conceptualizations via parent report at baseline, 18 months, and 36 months. According to parent report, mean levels of avoidant, dependent, histrionic, narcissistic, borderline, and schizotypal traits all declined for both boys and girls. The changes in dependent and histrionic traits were of medium effect size, and the changes in avoidant, narcissistic, borderline, and schizotypal traits were of small effect size. Over the 3 years of the study, the traits of each PD also demonstrated moderate to high rank-order stability.
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Affiliation(s)
| | - Jami F. Young
- Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine
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17
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Morey LC, Good EW, Hopwood CJ. Global personality dysfunction and the relationship of pathological and normal trait domains in the DSM-5 alternative model for personality disorders. J Pers 2020; 90:34-46. [PMID: 32422689 DOI: 10.1111/jopy.12560] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The DSM-5 Alternative Model of Personality Disorders distinguishes core personality dysfunction common to all personality pathology from maladaptive traits that delineate specific variants of disorder. Previous research shows the convergence between maladaptive and normal range trait domains as well as substantial correlations between maladaptive traits and core dysfunctions, leading some to conclude that personality traits and dysfunction are redundant. This study sought to examine the potential utility of the concept of core dysfunctions as a means of clarifying the nature of the relationship between maladaptive and normal-range traits. METHOD Three nonclinical samples (n = 178, 307, and 1,008) were evaluated for personality dysfunction, maladaptive traits, and normal-range traits using different measures. RESULTS Results indicated that: (1) normal trait domains and core dysfunction contribute independently to understanding maladaptive traits; (2) the correlation of a normal trait domain with its putative maladaptive equivalent is consistently accounted for in part by core dysfunction; and (3) the multitrait multimethod matrices of normal and maladaptive personality trait domains demonstrate appreciable discriminant validity problems that are clarified by a consideration of core dysfunction. CONCLUSION These results suggest that maladaptive traits reflect the distinguishable contributions of core personality dysfunction (problems) and normal-range personality traits (person).
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Affiliation(s)
- Leslie C Morey
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, USA
| | - Evan W Good
- Department of Psychology, Michigan State University, East Lansing, MI, USA
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18
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Bleidorn W, Hopwood CJ, Back MD, Denissen JJ, Hennecke M, Jokela M, Kandler C, Lucas RE, Luhmann M, Orth U, Roberts BW, Wagner J, Wrzus C, Zimmermann J. Longitudinal Experience–Wide Association Studies—A Framework for Studying Personality Change. EUROPEAN JOURNAL OF PERSONALITY 2020. [DOI: 10.1002/per.2247] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The importance of personality for predicting life outcomes in the domains of love, work, and health is well established, as is evidence that personality traits, while relatively stable, can change. However, little is known about the sources and processes that drive changes in personality traits and how such changes might impact important life outcomes. In this paper, we make the case that the research paradigms and methodological approaches commonly used in personality psychology need to be revised to advance our understanding of the sources and processes of personality change. We propose Longitudinal Experience–Wide Association Studies as a framework for studying personality change that can address the limitations of current methods, and we discuss strategies for overcoming some of the challenges associated with Longitudinal Experience–Wide Association Studies. © 2020 European Association of Personality Psychology
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Affiliation(s)
- Wiebke Bleidorn
- Department of Psychology, University of California, Davis, Davis, CA USA
| | | | - Mitja D. Back
- Department of Psychology, University of Münster, Münster, Germany
| | - Jaap J.A. Denissen
- Department of Developmental Psychology, Tilburg University, Tilburg, The Netherlands
| | - Marie Hennecke
- Department of Psychology, University of Siegen, Siegen, Germany
| | - Markus Jokela
- Department of Psychology, University of Helsinki, Helsinki, Finland
| | | | - Richard E. Lucas
- Department of Psychology, Michigan State University, East Lansing, MI USA
| | - Maike Luhmann
- Department of Psychological Methods, Ruhr University Bochum, Bochum, Germany
| | - Ulrich Orth
- Department of Psychology, University of Bern, Bern, Switzerland
| | - Brent W. Roberts
- Department of Psychology, University of Illinois, Urbana-Champaign, IL USA
| | - Jenny Wagner
- Fakultat fur Psychologie und Bewegungswissenschaft, University of Hamburg, Hamburg, Germany
| | - Cornelia Wrzus
- Department of Psychology, University of Heidelberg, Heidelberg, Germany
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19
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Hale AC, Nelson SM, Reckow J, Spencer RJ. Validation and extension of personality disorder spectra scales from MMPI‐2‐RF items. J Clin Psychol 2020; 76:1754-1774. [DOI: 10.1002/jclp.22953] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Andrew C. Hale
- Department of Physical Medicine and RehabilitationUniversity of Michigan Ann Arbor Michigan
- VA Center for Clinical Management ResearchHealth Services Research and Development Ann Arbor Michigan
| | - Sharon M. Nelson
- Mental Health ServiceVA Ann Arbor Healthcare System Ann Arbor Michigan
- Department of PsychologyEastern Michigan University Ypsilanti Michigan
| | - Jaclyn Reckow
- Mental Health ServiceVA Ann Arbor Healthcare System Ann Arbor Michigan
- Mercy Health Saint Mary'sHauenstein Neurosciences Grand Rapids Michigan
| | - Robert J. Spencer
- Mental Health ServiceVA Ann Arbor Healthcare System Ann Arbor Michigan
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20
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Leal I, Silva SB, Ramos MM, Pedreira M, Ramos VS, Pires P. Assessing Personality Disorders in Adolescence: A Validation Study of the IPOP-A. ADOLESCENT PSYCHIATRY 2020. [DOI: 10.2174/2210676609666181204144136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
The need to develop clinical and empirically-based tools for
assessing personality development in adolescence led to the proposal of the IPOP-A
(Ammaniti, Fontana, Kernberg, Clarkin, & Clarkin, 2011), a semi-structured interview for
adolescents that aims to differentiate personality organization processes from characteristics
that may reflect a personality disorder.
Objective and Methods:
This research aimed to evaluate the adaptation of the IPOP-A to the
Portuguese population, attending to its diagnostic properties and its discriminant validity by
comparing a clinical group with a nonclinical one. A total sample of 44 adolescents from 13
to 18 years old has taken part in this study, 22 of whom had a previous personality disorder
diagnosis. The content of the interviews was transcribed and codified according to the
coding manual.
Results:
Acceptable internal consistency values across the dimensions of the IPOP-A are
found and statistically significant differences are revealed between the clinical group and
nonclinical group, with the clinical group revealing values that suggest higher impairment in
the dimensions of the personality functioning in comparison with the nonclinical one.
Conclusion:
Our study supports that the Portuguese version of the IPOP-A can be
considered a valid instrument to identify adolescents with a personality disorder.
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Affiliation(s)
- Isabel Leal
- William James Center for Research, ISPA – Instituto Universitário, Lisboa, Portugal
| | | | - Maria Meireles Ramos
- William James Center for Research, ISPA – Instituto Universitário, Lisboa, Portugal
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21
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Weber R, Ehrenthal JC, Pförtner TK, Albus C, Stosch C. Die schönste Zeit des Lebens? ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2020. [DOI: 10.1026/1616-3443/a000573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund. Trotz der gesundheitspolitischen Relevanz ist die Datenlage zu psychischen Erkrankungen und Belastungen von Studierenden in Deutschland im internationalen Vergleich eher schmal. Bestehende Untersuchungen mit größeren Stichproben leiden entweder an methodischen Problemen in der Erfassung von psychischen Störungen oder sind wenig kontrolliert. Fragestellungen: Um einen Überblick über das Ausmaß psychischer Symptome von Studierenden zu bekommen, wurden in einem Screening-Ansatz die Studierenden der Universität zu Köln im Rahmen einer Online-Befragung befragt. Zusätzlich zu den störungsbezogenen Ergebnissen wurden Daten zur Inanspruchnahme von Hilfeleistungen und studienrelevante Informationen und dem Vorliegen des Verdachts einer Persönlichkeitsstörung erfasst. Methodik. 44 299 Studierende der Universität zu Köln wurden zu einer Online-Befragung zum Thema Studieren mit psychischen Belastungen und Erkrankungen eingeladen. Zum Erfassen psychischer Beschwerden und Erkrankungen wurden der Patient-Health-Questionnaire (PHQ-D) und ein Screeningfragebogen für Persönlichkeitsstörungen (Persönlichkeitsstörungs-Screening Kurzform [PSS-K]), eingesetzt. Ergebnisse. Die Rücklaufquote der Befragung lag bei 11.18 % ( N = 4 952; bereinigte Rücklaufquote: N = 4 894; 11,04 %). Bei 53.6 % der Studierenden ( N = 2 657) zeigte sich mindestens ein syndromales Störungsbild (PHQ-D). Der Verdacht auf eine Störung der Persönlichkeitsentwicklung stellt sich bei 14.5 % der Respondentinnen und Respondenten ( N = 708). Schlussfolgerung. Die Ergebnisse bestätigen, dass psychische Belastungen unter Studierenden weit verbreitet sind. Neben behandlungsbedürftigen psychischen Störungen findet sich ein nicht geringer Prozentsatz subklinischer Zustände. Präventions- und Interventionsansätze sollten auf unterschiedliche Schweregrade der Belastung abgestimmt sein. Weiterhin stellen psychische Beschwerden einen Risikofaktor für Studienabbruchgedanken dar.
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Affiliation(s)
- Rainer Weber
- Klinik für Psychosomatik und Psychotherapie, Universitätsklinikum Köln
| | | | - Timo Kolja Pförtner
- Institut für Medizinsoziologie, Versorgungsforschung und Rehabilitationswissenschaft, Universität zu Köln
| | - Christian Albus
- Klinik für Psychosomatik und Psychotherapie, Universitätsklinikum Köln
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22
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Wang J, Chen Z, Sun W, Zheng Y, Hui L, Liu X, Wang J, Wu H, Qiao Y, Zhang T. A Strategy to Address High Comorbidity of Personality Disorders in a Chinese Population: A Principal and Subordinate Diagnostic Model. Psychiatry 2019; 82:272-282. [PMID: 31017559 DOI: 10.1080/00332747.2019.1600218] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Multiple and overlapping diagnoses of personality disorders (PDs) have been a major obstacle in clinical practice and research. This study aims to investigate the comorbidity of PDs in a sample of a high-risk clinical population. We propose a diagnostic model to address this critical issue. Methods: The sample population included 982 PD patients. The PD diagnoses were concluded based on self-reported and face-to-face interviews. To address the issue of overlapping PD diagnoses, we defined the criteria for clinically distinguishing principal and subordinate PDs, and determined the frequency of each condition. Results: Diagnostic overlap among PDs was quite common across all categories. Of all 982 PD patients, 436 (44.4%) met the criteria for more than one PD. In terms of specific PD diagnoses, the comorbidity rate of each PD was nearly 47.1-74.7%. The principal and subordinate PDs were distinguished accordingly. Avoidant, obsessive-compulsive, and borderline PD remain the most prevalent types of principal PD in this clinical population. Conclusions: The principal/subordinate model may be one strategy of resolving the issue of PD comorbidity in Chinese clinical settings.
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23
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Conway CC, Boudreaux M, Oltmanns TF. Dynamic associations between borderline personality disorder and stressful life events over five years in older adults. Personal Disord 2018; 9:521-529. [PMID: 29461847 PMCID: PMC6098988 DOI: 10.1037/per0000281] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The time course of borderline personality disorder (BPD) is far more variable than traditionally assumed. Shifting environmental conditions are theorized to account, at least in part, for fluctuations in symptom presentation over time. In the present study, we evaluated the reciprocal influences of stressful life events and borderline pathology in a representative community sample of 1,630 older adults assessed 3 times over 5 years. An autoregressive cross-lagged model revealed strong, but imperfect, stability in symptoms of BPD over the study time frame. After adjusting for this continuity in BPD, the prospective effect of life stress on borderline pathology was virtually nil, contrary to expectations. On the other hand, borderline pathology was prospectively related to subsequent dependent event (i.e., stressors to which individuals may have contributed), but not independent event (i.e., fateful stressors), exposure. This pattern of associations was consistent with a stress generation effect. We conclude that stressful life events do not substantially redirect the trajectory of BPD in older adults, possibly owing to inertia of borderline pathology at this developmental stage. Instead, symptoms of BPD seem to promote stress exposure, thereby setting the stage for continued social impairment and comorbid psychiatric problems. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
| | - Michael Boudreaux
- Department of Psychological and Brain Sciences, Washington University in St. Louis, MO, USA
| | - Thomas F. Oltmanns
- Department of Psychological and Brain Sciences, Washington University in St. Louis, MO, USA
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24
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Hopwood CJ. Interpersonal Dynamics in Personality and Personality Disorders. EUROPEAN JOURNAL OF PERSONALITY 2018. [DOI: 10.1002/per.2155] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Clinical and basic personality psychologists interact less than they should, given their similar interests. In clinical personality psychology, available evidence supports a transition from the current categorical system to a hierarchical trait scheme for diagnosing the stable features of personality disorder. However, trait models do not capture the dynamic aspects of personality disorders as they have been described in the clinical literature, and thus miss a clinically critical feature of personality pathology. In contrast, basic personality psychologists have coalesced around a consensual structure of individual differences and become increasingly interested in the dynamic processes that underlie and contextualize traits. But trait psychology models are not sufficiently specific to characterize dynamic personality processes. In this paper, I filter clinical descriptions of personality disorders through the lens of interpersonal theory to specify a recursive within–situation interpersonal pattern of motives, affects, behaviours, and perceptions that could contribute to the stable between–situation patterns of maladaptive behaviour of historical interest to both basic and clinical personality psychologists. I suggest that this interpersonal model adds specificity to recent proposals regarding processes in the basic personality literature and has significant potential to advance research on personality dynamics. © 2018 European Association of Personality Psychology
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25
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Woods WC, Edershile EA, Wright AGC, Lenzenweger MF. Illuminating ipsative change in personality disorder and normal personality: A multimethod examination from a prospective longitudinal perspective. Personal Disord 2018; 10:80-86. [PMID: 30010375 DOI: 10.1037/per0000302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Research suggests that both personality disorder (PD) and normal personality change as systems of variables (e.g., the general factor of PD), rather than as individual variables (e.g., neuroticism). Consequently, understanding PD and normal personality as multidimensional systems may yield additional insights over traditional single-variable approaches. Normal personality change has been attributed to increase across adaptive traits (i.e., the maturity principle), suggesting that shifts in the overall magnitude of construct expression plays a role in systemic change. We examined the extent to which total ipsative, system-level change was accounted for by shifts in the overall level of constructs (i.e., severity/maturity) as well as shifts in the configuration of PD and normal personality (i.e., style) across self-report and structured interview. Results demonstrated that overall change in PD and normal personality measured via self-report reflected both stylistic and severity change, whereas structured interview of PD primarily reflected shifts in profile severity. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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26
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Conway CC, Hopwood CJ, Morey LC, Skodol AE. Borderline personality disorder is equally trait-like and state-like over ten years in adult psychiatric patients. JOURNAL OF ABNORMAL PSYCHOLOGY 2018; 127:590-601. [PMID: 29952598 DOI: 10.1037/abn0000364] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Borderline personality disorder (PD) has historically been cast as an unabating condition. Longitudinal data, however, support a more variable time course marked by remission and relapse. In the present study, we tested the possibility that borderline PD has both stable (i.e., consistently present across time and situation, as modern diagnostic systems stipulate) and dynamic (i.e., episodic and situational) elements. Participants were 668 patients from the Collaborative Longitudinal Personality Disorders Study who were administered semistructured diagnostic interviews 5 times over a decade. Trait-state-occasion modeling dissected borderline pathology into time-invariant (i.e., trait) and time-varying (i.e., state) components. Contradicting traditional views of PD intransigence, less than half of borderline PD variability (approximately 45%) was time-invariant (i.e., perfectly stable) over the study timeframe. Furthermore, we found that the time-invariant component of borderline pathology, which we termed borderline proneness, was very closely related (r = .81) to a previously validated Five Factor Model trait composite of borderline features. Moreover, the trait versus state components showed a clear pattern of discriminant validity in relation to several putative causal agents for borderline PD (i.e., environmental pathogens, temperament dimensions). We conclude that borderline pathology contains a stable core and sizable situational components, and that both elements relate systematically to normative personality dimensions and known risk factors. These findings have key implications for etiological research, prognosis, and treatment for borderline PD. (PsycINFO Database Record
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27
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Reardon KW, Mercadante EJ, Tackett JL. The assessment of personality disorder: methodological, developmental, and contextual considerations. Curr Opin Psychol 2018; 21:39-43. [PMID: 28963890 DOI: 10.1016/j.copsyc.2017.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/05/2017] [Accepted: 09/06/2017] [Indexed: 10/18/2022]
Abstract
The reliable and valid assessment of personality disorders (PDs) faces several challenges in different domains. In particular, the variety of methods, settings, and informants relevant for PD assessment raises questions about best practices. Additionally, issues surrounding assessment across the lifespan, including youth and the elderly, further complicate PD assessment. We review these issues here and point toward future directions in PD assessment, with an emphasis on the utility of dimensional PD assessment.
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Affiliation(s)
- Kathleen W Reardon
- Northwestern University, Department of Psychology, 2029 Sheridan Rd, Evanston, IL 60208, USA.
| | - Eric J Mercadante
- Northwestern University, Department of Psychology, 2029 Sheridan Rd, Evanston, IL 60208, USA
| | - Jennifer L Tackett
- Northwestern University, Department of Psychology, 2029 Sheridan Rd, Evanston, IL 60208, USA
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28
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Conway CC, Zinbarg RE, Mineka S, Craske MG. Core dimensions of anxiety and depression change independently during adolescence. JOURNAL OF ABNORMAL PSYCHOLOGY 2018; 126:160-172. [PMID: 28192011 DOI: 10.1037/abn0000222] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The developmental trajectories of emotional disorder symptoms during adolescence remain elusive, owing in part to a shortage of intensive longitudinal data. In the present study, we charted the temporal course of the tripartite model of anxiety and depression-which posits an overarching negative affect dimension and specific anhedonia and anxious arousal dimensions-over adolescence and emerging adulthood to construct a developmental map of the core dimensions of emotional disorders. We recruited 604 high school juniors, overselecting those at high risk for emotional disorders, and assessed the tripartite symptom domains 5 times annually. Latent curve modeling revealed that negative affect and anxious arousal declined over follow up, whereas anhedonia did not. Moreover, the correlation in rate of change varied across pairs of symptom domains. Change in negative affect was moderately correlated with change in anxious arousal, but change in anhedonia was not significantly related to change in any other domain. Symptom trajectories, and the pattern of covariation among trajectories, were equivalent across gender and comorbidity status. We discuss implications of these findings for developmental models of anxiety and depression, as well as transdiagnostic frameworks for emotional disorders. (PsycINFO Database Record
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Affiliation(s)
| | | | - Susan Mineka
- Department of Psychology, Northwestern University
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29
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Akee R, Copeland W, Costello EJ, Simeonova E. How Does Household Income Affect Child Personality Traits and Behaviors? THE AMERICAN ECONOMIC REVIEW 2018; 108:775-827. [PMID: 29568124 PMCID: PMC5860688 DOI: 10.1257/aer.20160133] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
We examine the effects of a quasi-experimental unconditional household income transfer on child emotional and behavioral health and personality traits. Using longitudinal data, we find that there are large beneficial effects on children's emotional and behavioral health and personality traits during adolescence. We find evidence that these effects are most pronounced for children who start out with the lowest initial endowments. The income intervention also results in improvements in parental relationships which we interpret as a potential mechanism behind our findings.
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Affiliation(s)
- Randall Akee
- UCLA Department of Public Policy, 3250 Public Affairs Building, Los Angeles, CA 90095
| | - William Copeland
- Center for Developmental Epidemiology, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 3454, Durham, NC 27710
| | - E Jane Costello
- Center for Developmental Epidemiology, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 3454, Durham, NC 27710
| | - Emilia Simeonova
- The Johns Hopkins Carey Business School, 100 International Drive, Baltimore, MD 21202
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Keefe JR, Derubeis RJ. Changing character: A narrative review of personality change in psychotherapies for personality disorder. Psychother Res 2018; 29:752-769. [DOI: 10.1080/10503307.2018.1425930] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- John R. Keefe
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert J. Derubeis
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
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Shrout PE, Stadler G, Lane SP, McClure MJ, Jackson GL, Clavél FD, Iida M, Gleason MEJ, Xu JH, Bolger N. Initial elevation bias in subjective reports. Proc Natl Acad Sci U S A 2018; 115:E15-E23. [PMID: 29255039 PMCID: PMC5776801 DOI: 10.1073/pnas.1712277115] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
People's reports of their thoughts, feelings, and behaviors are used in many fields of biomedical and social science. When these states have been studied over time, researchers have often observed an unpredicted and puzzling decrease with repeated assessment. When noted, this pattern has been called an "attenuation effect," suggesting that the effect is due to bias in later reports. However, the pattern could also be consistent with an initial elevation bias. We present systematic, experimental investigations of this effect in four field studies (study 1: n = 870; study 2: n = 246; study 3: n = 870; study 4: n = 141). Findings show clear support for an initial elevation bias rather than a later decline. This bias is larger for reports of internal states than for behaviors and for negative mental states and physical symptoms than for positive states. We encourage increased awareness and investigation of this initial elevation bias in all research using subjective reports.
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Affiliation(s)
- Patrick E Shrout
- Department of Psychology, New York University, New York, NY 10003;
| | - Gertraud Stadler
- Aberdeen Health Psychology Group, Department of Applied Health Sciences, University of Aberdeen, Aberdeen, AB25 2ZD, Scotland, United Kingdom
| | - Sean P Lane
- Department of Psychological Sciences, Purdue University, West Lafayette, IN 47906
| | - M Joy McClure
- Gordon F. Derner School of Psychology, Adelphi University, Garden City, NY 11530
| | - Grace L Jackson
- Department of Psychology, University of California, Los Angeles, CA 90095
| | | | - Masumi Iida
- T. Denny Sanford School of Social and Family Dynamics, Arizona State University, Tempe, AZ 85287
| | - Marci E J Gleason
- Department of Human Development and Family Science, The University of Texas at Austin, Austin, TX 78712
| | - Joy H Xu
- Department of Psychology, New York University, New York, NY 10003
| | - Niall Bolger
- Department of Psychology, Columbia University, New York, NY 10027
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A compromise solution between overlapping and overlooking DSM personality disorders in Chinese psychiatric practice. Soc Psychiatry Psychiatr Epidemiol 2018; 53:99-106. [PMID: 28956087 DOI: 10.1007/s00127-017-1444-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 09/22/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study aimed to examine the overlaps between the Diagnostic and Statistical Manual-5 (DSM-5) Personality Disorders (PDs) in a high-risk clinical population and to explore a transitional model for implementing DSM-5 PDs. METHOD A sample population of 982 outpatients with at least one diagnosed PD was selected from 3,075 outpatients of the Shanghai Mental Health Center. The diagnostic process comprised of a personality diagnostic questionnaire and a structured clinical interview. RESULTS 685 (22.3%) patients were diagnosed with at least one of six PDs (antisocial, avoidant, borderline, narcissistic, obsessive-compulsive, and schizotypal) under the alternative DSM-5 model for personality disorders proposed in Section III of the DSM-5. Nearly 20.3% of the subjects with PD met criteria for at least two PDs (of the 685 PD patients/6 PD model). Cluster and principal component analyses suggest a transitional model for the 7 specific PD categories (among the 722 PD patients, the overlapping rate was 24.1%) will be more appropriate for PD diagnosis in China. CONCLUSIONS Using the simplified PD categories in the alternative DSM-5 model for personality disorders will reduce the overlaps in PD diagnoses in Chinese psychiatric practice, and should be preferred over the DSM-5 PD diagnostic system.
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Hengartner MP. The Evolutionary Life History Model of Externalizing Personality: Bridging Human and Animal Personality Science to Connect Ultimate and Proximate Mechanisms Underlying Aggressive Dominance, Hostility, and Impulsive Sensation Seeking. REVIEW OF GENERAL PSYCHOLOGY 2017. [DOI: 10.1037/gpr0000127] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The present work proposes an evolutionary model of externalizing personality that defines variation in this broad psychobiological phenotype resulting from genetic influences and a conditional adaptation to high-risk environments with high extrinsic morbidity-mortality. Due to shared selection pressure, externalizing personality is coadapted to fast life history strategies and maximizes inclusive fitness under adverse environmental conditions by governing the major trade-offs between reproductive versus somatic functions, current versus future reproduction, and mating versus parenting efforts. According to this model, externalizing personality is a regulatory device at the interface between the individual and its environment that is mediated by 2 overlapping psychobiological systems, that is, the attachment and the stress-response system. The attachment system coordinates interpersonal behavior and intimacy in close relationships and the stress-response system regulates the responsivity to environmental challenge and both physiological and behavioral reactions to stress. These proximate mechanisms allow for the integration of neuroendocrinological processes underlying interindividual differences in externalizing personality. Hereinafter I further discuss the model's major implications for personality psychology, psychiatry, and public health policy.
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Hopwood CJ, Bleidorn W. Stability and change in personality and personality disorders. Curr Opin Psychol 2017; 21:6-10. [PMID: 28923391 DOI: 10.1016/j.copsyc.2017.08.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/26/2017] [Accepted: 08/29/2017] [Indexed: 10/18/2022]
Abstract
In this paper, we review recent findings related to stability and change in personality and personality disorder. Estimates of stability vary depending on a number of methodological and substantive factors. These factors include the type of stability being examined, the type of construct being assessed, the method being used to assess personality, how participants are sampled, and developmental trends in personality stability and change. We describe current evidence about personality stability with respect to each of these factors. We conclude that current gaps in the literature can be filled by more carefully attending to factors that impact estimates of stability and change, and provide recommendations about how future research can fill those gaps.
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Reichborn-Kjennerud T, Krueger RF, Ystrom E, Torvik FA, Rosenström TH, Aggen SH, South SC, Neale MC, Knudsen GP, Kendler KS, Czajkowski NO. Do DSM-5 Section II personality disorders and Section III personality trait domains reflect the same genetic and environmental risk factors? Psychol Med 2017; 47:2205-2215. [PMID: 28414014 DOI: 10.1017/s0033291717000824] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND DSM-5 includes two conceptualizations of personality disorders (PDs). The classification in Section II is identical to the one found in DSM-IV, and includes 10 categorical PDs. The Alternative Model (Section III) includes criteria for dimensional measures of maladaptive personality traits organized into five domains. The degree to which the two conceptualizations reflect the same etiological factors is not known. METHODS We use data from a large population-based sample of adult twins from the Norwegian Institute of Public Health Twin Panel on interview-based DSM-IV PDs and a short self-report inventory that indexes the five domains of the DSM-5 Alternative Model plus a domain explicitly targeting compulsivity. Schizotypal, Paranoid, Antisocial, Borderline, Avoidant, and Obsessive-compulsive PDs were assessed at the same time as the maladaptive personality traits and 10 years previously. Schizoid, Histrionic, Narcissistic, and Dependent PDs were only assessed at the first interview. Biometric models were used to estimate overlap in genetic and environmental risk factors. RESULTS When measured concurrently, there was 100% genetic overlap between the maladaptive trait domains and Paranoid, Schizotypal, Antisocial, Borderline, and Avoidant PDs. For OCPD, 43% of the genetic variance was shared with the domains. Genetic correlations between the individual domains and PDs ranged from +0.21 to +0.91. CONCLUSION The pathological personality trait domains, which are part of the Alternative Model for classification of PDs in DSM-5 Section III, appears to tap, at an aggregate level, the same genetic risk factors as the DSM-5 Section II classification for most of the PDs.
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Affiliation(s)
| | - R F Krueger
- Department of Psychology,University of Minnesota,Minneapolis,MN,USA
| | - E Ystrom
- Department of Mental Disorders,Norwegian Institute of Public Health,Oslo,Norway
| | - F A Torvik
- Department of Mental Disorders,Norwegian Institute of Public Health,Oslo,Norway
| | - T H Rosenström
- Department of Mental Disorders,Norwegian Institute of Public Health,Oslo,Norway
| | - S H Aggen
- Virginia Institute for Psychiatric and Behavioral Genetics,Richmond,VA,USA
| | - S C South
- Department of Psychological Sciences,Purdue University,IN,USA
| | - M C Neale
- Virginia Institute for Psychiatric and Behavioral Genetics,Richmond,VA,USA
| | - G P Knudsen
- Department of Mental Disorders,Norwegian Institute of Public Health,Oslo,Norway
| | - K S Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics,Richmond,VA,USA
| | - N O Czajkowski
- Department of Mental Disorders,Norwegian Institute of Public Health,Oslo,Norway
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Conway CC, Hipwell AE, Stepp SD. Seven-Year Course of Borderline Personality Disorder Features: Borderline Pathology Is as Unstable as Depression during Adolescence. Clin Psychol Sci 2017; 5:742-749. [PMID: 28920008 DOI: 10.1177/2167702617691546] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Borderline personality disorder (PD) historically is construed as an unremitting condition with poor prognosis. The present study takes a new approach to examining stability and change in borderline PD by explaining symptom expression in terms of an unchanging foundation-termed borderline proneness-on one hand, and transitory influences on the other. We monitored borderline PD symptoms annually in a large sample of high-risk adolescent girls (N = 2,450) from ages 14 to 20. Trait-state-occasion modeling revealed that just over half (52-57%) of borderline PD symptom variation was attributable to fixed borderline proneness, whereas the remainder was subject to change across yearly measurement occasions. This degree of stability was no larger than the corresponding estimate for depression, a condition known for its variable course. Our results indicate that, contrary to its reputation, borderline pathology is not set in stone, and it fluctuates in response to situational influences.
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Affiliation(s)
| | - Alison E Hipwell
- Department of Psychiatry, University of Pittsburgh School of Medicine, PA, USA
| | - Stephanie D Stepp
- Department of Psychiatry, University of Pittsburgh School of Medicine, PA, USA
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Swart S, Wildschut M, Draijer N, Langeland W, Smit JH. The clinical course of trauma-related disorders and personality disorders: study protocol of two-year follow-up based on structured interviews. BMC Psychiatry 2017; 17:173. [PMID: 28486966 PMCID: PMC5424424 DOI: 10.1186/s12888-017-1339-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 04/30/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Trauma-related disorders and personality disorders are prevalent in survivors of chronic childhood trauma and neglect. Both conditions have serious consequences for patients, their families, society and public health and a high risk of development of chronicity. However, information on the long term course trajectories is lacking and predictors of course outcome in survivors of chronic childhood traumatization are unknown. The first aim of the current study is to identify two-year course trajectories of pathology in patients with trauma-related disorders and personality disorders. The second aim is to examine predictors of the course, including demographics, clinical characteristics and comorbidities. METHODS/DESIGN The study is a naturalistic two-year follow-up of 150 patients consecutively admitted to the trauma treatment program and the personality disorder treatment program respectively at GGZ Friesland, a regular Dutch mental health care center. The only exclusion criterion is insufficient mastery of the Dutch language. Participants will be assessed after 2 years of treatment through measures that have been completed at baseline, including structured clinical interviews to measure childhood histories of trauma and neglect, (symptoms of) trauma-related disorders and personality disorders, and psychological questionnaire measures (e.g., general psychopathology, depressive symptoms and personality features). In addition, participants will complete an evaluation questionnaire to assess medication prescribed and treatment (s) received outside GGZ Friesland between baseline and follow-up. Information about (psychological and pharmacological) treatment received at GGZ Friesland during the follow-up period will be collected from patient files. DISCUSSION This study provides insight in the two-year course of (comorbid) trauma-related disorders and personality disorders. Identifying predictors of the course of trauma-related and personality disorders will allow to differentiate clinical profiles and will offer indicators for treatment.
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Affiliation(s)
- Sanne Swart
- GGZ Friesland, Borniastraat 34b, Leeuwarden, 8934 AD the Netherlands
| | - Marleen Wildschut
- GGZ Friesland, Borniastraat 34b, Leeuwarden, 8934 AD the Netherlands
| | - Nel Draijer
- Department of Psychiatry and EMGO Institute, Vrije University Medical Center/GGZinGeest, Amsterdam, the Netherlands
- Department of Research, GGZinGeest, Amsterdam, the Netherlands
| | | | - Jan H. Smit
- Department of Psychiatry and EMGO Institute, Vrije University Medical Center/GGZinGeest, Amsterdam, the Netherlands
- Department of Research, GGZinGeest, Amsterdam, the Netherlands
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Waugh MH, Hopwood CJ, Krueger RF, Morey LC, Pincus AL, Wright AGC. Psychological Assessment with the DSM-5 Alternative Model for Personality Disorders: Tradition and Innovation. PROFESSIONAL PSYCHOLOGY-RESEARCH AND PRACTICE 2017; 48:79-89. [PMID: 28450760 PMCID: PMC5403154 DOI: 10.1037/pro0000071] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) Section III Alternative Model for Personality Disorders (AMPD; APA, 2013) represents an innovative system for simultaneous psychiatric classification and psychological assessment of personality disorders (PD). The AMPD combines major paradigms of personality assessment and provides an original, heuristic, flexible, and practical framework that enriches clinical thinking and practice. Origins, emerging research, and clinical application of the AMPD for diagnosis and psychological assessment are reviewed. The AMPD integrates assessment and research traditions, facilitates case conceptualization, is easy to learn and use, and assists in providing patient feedback. New as well as existing tests and psychometric methods may be used to operationalize the AMPD for clinical assessments.
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Affiliation(s)
- Mark H Waugh
- Private Practice, Oak Ridge, Tennessee, Oak Ridge National Laboratory, & University of Tennessee
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Zimmermann J, Mayer A, Leising D, Krieger T, grosse Holtforth M, Pretsch J. Exploring Occasion Specificity in the Assessment of DSM-5 Maladaptive Personality Traits. EUROPEAN JOURNAL OF PSYCHOLOGICAL ASSESSMENT 2017. [DOI: 10.1027/1015-5759/a000271] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. The alternative classification system for personality disorders in DSM-5 features a hierarchical model of maladaptive personality traits. This trait model comprises five broad trait domains and 25 specific trait facets that can be reliably assessed using the Personality Inventory for DSM-5 (PID-5). Although there is a steadily growing literature on the validity of the PID-5, issues of temporal stability and situational influences on test scores are currently unexplored. We addressed these issues using a sample of 611 research participants who completed the PID-5 three times, with time intervals of 2 months. Latent state-trait (LST) analyses for each of the 25 PID-5 trait facets showed that, on average, 79.5% of the variance was due to stable traits (i.e., consistency), and 7.7% of the variance was due to situational factors (i.e., occasion specificity). Our findings suggest that the PID-5 trait facets predominantly capture individual differences that are stable across time.
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Affiliation(s)
| | - Axel Mayer
- Department of Data Analysis, Ghent University, Belgium
| | - Daniel Leising
- Department of Psychology, Technische Universität Dresden, Germany
| | - Tobias Krieger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Switzerland
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Hengartner MP, Lehmann SN. Why Psychiatric Research Must Abandon Traditional Diagnostic Classification and Adopt a Fully Dimensional Scope: Two Solutions to a Persistent Problem. Front Psychiatry 2017; 8:101. [PMID: 28638352 PMCID: PMC5461269 DOI: 10.3389/fpsyt.2017.00101] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Michael P Hengartner
- Department of Applied Psychology, Zurich University of Applied Sciences, Zurich, Switzerland
| | - Sandrine N Lehmann
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Zurich, Switzerland
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Wright AGC, Hopwood CJ, Skodol AE, Morey LC. Longitudinal validation of general and specific structural features of personality pathology. JOURNAL OF ABNORMAL PSYCHOLOGY 2016; 125:1120-1134. [PMID: 27819472 PMCID: PMC5119768 DOI: 10.1037/abn0000165] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Theorists have long argued that personality disorder (PD) is best understood in terms of general impairments shared across the disorders as well as more specific instantiations of pathology. A model based on this theoretical structure was proposed as part of the DSM-5 revision process. However, only recently has this structure been subjected to formal quantitative evaluation, with little in the way of validation efforts via external correlates or prospective longitudinal prediction. We used the Collaborative Longitudinal Study of Personality Disorders dataset to: (a) estimate structural models that parse general from specific variance in personality disorder features, (b) examine patterns of growth in general and specific features over the course of 10 years, and (c) establish concurrent and dynamic longitudinal associations in PD features and a host of external validators including basic personality traits and psychosocial functioning scales. We found that general PD exhibited much lower absolute stability and was most strongly related to broad markers of psychosocial functioning, concurrently and longitudinally, whereas specific features had much higher mean stability and exhibited more circumscribed associations with functioning. However, both general and specific factors showed recognizable associations with normative and pathological traits. These results can inform efforts to refine the conceptualization and diagnosis of personality pathology. (PsycINFO Database Record
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Symptom- and personality disorder changes in intensive short-term dynamic residential treatment for treatment-resistant anxiety and depressive disorders. Acta Neuropsychiatr 2016; 28:257-71. [PMID: 26916592 DOI: 10.1017/neu.2016.5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The study investigated the effectiveness of an 8-week intensive residential treatment programme based on principles from intensive short-term dynamic psychotherapy for patients with known treatment-resistant anxiety- and/or depressive disorders (mainly with comorbid personality disorders). METHODS Patients (N=95) with prior repeated treatment failure were included. Changes in self-reported target complaints, symptom severity, and overall interpersonal problems have been presented for these patients in two previous articles. We now expand upon the existing knowledge by presenting novel data from a number of important observer-based and self-reported outcome domains (diagnostic changes on Axis I and II, changes in overall personality dysfunction, disorder complexity, medication use, health care utilisation, and occupational activity). RESULTS There were pervasive and significant improvements on all measures during treatment, which were maintained or further improved during follow-up. Fourteen months after the end of treatment, 46.26% of patients had recovered in terms of Axis I pathology, 63.79% had recovered in terms of Axis II pathology, 71.18% had returned to work, and there was a 28.62% reduction in regular use of psychotropic medications. Health care utilisation was reduced by 65.55%, and there were large improvements in disorder complexity and levels of personality dysfunction. CONCLUSION The treatment programme was highly effective for patients with common and complex treatment-resistant mental disorders. Results are encouraging for the relatively large number of patients who tend not to benefit from standard formats of treatment for debilitating psychological problems.
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Wright AGC, Simms LJ. Stability and fluctuation of personality disorder features in daily life. JOURNAL OF ABNORMAL PSYCHOLOGY 2016; 125:641-56. [PMID: 27196437 PMCID: PMC4925296 DOI: 10.1037/abn0000169] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Very little is known about the daily stability and fluctuation of personality pathology. To address this gap in knowledge, we investigated the naturalistic manifestation of personality pathology over the course of 100 days. A group of individuals (N = 101) diagnosed with any personality disorder (PD) completed a daily diary study over 100 consecutive days (Mdn = 94 days, range = 33-101 days). Participants completed daily ratings of 30 manifestations of personality pathology. Patterns of stability and variability over the course of the study were then examined. Results indicated that individual PD manifestations and domains of PD manifestations were variable across days and differed widely in their frequency. Additionally, individual averages and level of variability in PD domains were highly stable across months, individual averages of PD domains were predicted by baseline dispositional ratings of PD traits with a high degree of specificity, and daily variability PD domains was associated with elevated levels of PD traits. This pattern of findings suggests that dynamic processes of symptom exacerbation and diminution that are stable in mean level and variability in expression over time characterizes personality pathology. Further, dispositional ratings are significant predictors of average daily expression of PD features. (PsycINFO Database Record
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Affiliation(s)
| | - Leonard J Simms
- Department of Psychology, University at Buffalo, State University of New York
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Morey LC, Benson KT. Relating DSM-5 section II and section III personality disorder diagnostic classification systems to treatment planning. Compr Psychiatry 2016; 68:48-55. [PMID: 27234182 DOI: 10.1016/j.comppsych.2016.03.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 03/16/2016] [Accepted: 03/24/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Beginning with DSM-III, the inclusion of a "personality" axis was designed to encourage awareness of personality disorders and the treatment-related implications of individual differences, but since that time there is little accumulated evidence that the personality disorder categories provide substantial treatment-related guidance. The DSM-5 Personality and Personality Disorders Work Group sought to develop an Alternative Model for personality disorder, and this study examined whether this model is more closely related to clinicians' decision-making processes than the traditional categorical personality disorder diagnoses. PROCEDURES A national sample of 337 clinicians provided complete personality disorder diagnostic information and several treatment-related clinical judgments about one of their patients. FINDINGS The dimensional concepts of the DSM-5 Alternative Model for personality disorders demonstrated stronger relationships than categorical DSM-IV/DSM-5 Section II diagnoses to 10 of 11 clinical judgments regarding differential treatment planning, optimal treatment intensity, and long-term prognosis. CONCLUSIONS The constructs of the DSM-5 Alternative Model for personality disorders may provide more clinically useful information for treatment planning than the official categorical personality disorder diagnostic system retained in DSM-5 Section II.
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Wright AG, Zalewski M, Hallquist MN, Hipwell AE, Stepp SD. Developmental Trajectories of Borderline Personality Disorder Symptoms and Psychosocial Functioning in Adolescence. J Pers Disord 2016; 30:351-72. [PMID: 26067158 PMCID: PMC4676743 DOI: 10.1521/pedi_2015_29_200] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In recent years, major gains toward understanding the emergence of borderline personality disorder (BPD) pathology, which is typically first noted during adolescence, have been made. Simultaneously, a profound shift has occurred in the adult personality pathology literature, in which empirical evidence rebuts the idea that personality disorders (PDs) are intractable disorders that do not develop or otherwise change over time, and therefore cannot be treated. The present study addresses a gap in our understanding of within-person change in BPD symptoms across adolescence and contributes to the limited literature on outcomes associated with adolescent BPD. Using an at-risk community sample of girls (N = 2,450), the authors used bivariate latent growth curve models to analyze the codevelopment of BPD symptoms with eight domains of psychosocial functioning (e.g., academic achievement, social skills, sexual behavior) across ages 14-17. Findings revealed moderate to strong effect sizes for the associations between BPD symptoms and every domain of psychosocial functioning, suggesting that the development of BPD was coupled with poorer outcomes across development. Controlling for depression and conduct disorder features revealed unique associations between BPD and self-perception, social skills, and sexual behavior. These results highlight the increased need for extending advancements in the adult PD literature to research on PDs in adolescence, and for greater recognition of adolescent BPD in clinical settings.
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Bo S, Bach B, Mortensen EL, Simonsen E. Reliability and Hierarchical Structure of DSM-5 Pathological Traits in a Danish Mixed Sample. J Pers Disord 2016; 30:112-29. [PMID: 25905735 DOI: 10.1521/pedi_2015_29_187] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In this study we assessed the DSM-5 trait model in a large Danish sample (n = 1,119) with respect to reliability of the applied Danish version of the Personality Inventory for DSM-5 (PID-5) self-report form by means of internal consistency and item discrimination. In addition, we tested whether the five-factor structure of the DSM-5 trait model can be replicated in a Danish independent sample using the PID-5 self-report form. Finally, we examined the hierarchical structure of DSM-5 traits. In terms of internal consistency and item discrimination, the applied PID-5 scales were generally found reliable and functional; our data resembled the five-factor structure of previous findings, and we identified a hierarchical structure from one to five factors that was conceptually reasonable and corresponded with existing findings. These results support the new DSM-5 trait model and suggest that it can be generalized to other languages and cultures.
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Affiliation(s)
- Sune Bo
- Psychiatric Research Unit, Region Zealand, Denmark
| | - Bo Bach
- Psychiatric Clinic Slagelse, Region Zealand, Denmark
| | - Erik Lykke Mortensen
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Denmark
| | - Erik Simonsen
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, and Psychiatric Research Unit, Region Zealand, Denmark
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Torvik FA, Welander-Vatn A, Ystrom E, Knudsen GP, Czajkowski N, Kendler KS, Reichborn-Kjennerud T. Longitudinal associations between social anxiety disorder and avoidant personality disorder: A twin study. JOURNAL OF ABNORMAL PSYCHOLOGY 2016; 125:114-124. [PMID: 26569037 PMCID: PMC4701609 DOI: 10.1037/abn0000124] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Social anxiety disorder (SAD) and avoidant personality disorder (AvPD) are frequently co-occurring psychiatric disorders with symptomatology related to fear of social situations. It is uncertain to what degree the 2 disorders reflect the same genetic and environmental risk factors. The current study addresses the stability and co-occurrence of SAD and AvPD, the factor structure of the diagnostic criteria, and genetic and environmental factors underlying the disorders at 2 time points. SAD and AvPD were assessed in 1,761 young adult female twins at baseline and 1,471 of these approximately 10 years later. Biometric models were fitted to dimensional representations of SAD and AvPD. SAD and AvPD were moderately and approximately equally stable from young to middle adulthood, with increasing co-occurrence driven by environmental factors. At the first wave, approximately 1 in 3 individuals with AvPD had SAD, increasing to 1 in 2 at follow-up. The diagnostic criteria for SAD and AvPD had a two-factor structure with low cross-loadings. The relationship between SAD and AvPD was best accounted for by a model with separate, although highly correlated (r = .76), and highly heritable (.66 and .71) risk factors for each disorder. Their genetic and environmental components correlated .84 and .59, respectively. The finding of partially distinct risk factors indicates qualitative differences in the etiology of SAD and AvPD. Genetic factors represented the strongest time-invariant influences, whereas environmental factors were most important at the specific points in time.
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Affiliation(s)
- Fartein Ask Torvik
- Department of Genetics, Environment and Mental Health, Norwegian Institute of Public Health
| | - Audun Welander-Vatn
- Department of Genetics, Environment and Mental Health, Norwegian Institute of Public Health
| | - Eivind Ystrom
- Department of Genetics, Environment and Mental Health, Norwegian Institute of Public Health
| | - Gun Peggy Knudsen
- Department of Genetics, Environment and Mental Health, Norwegian Institute of Public Health
| | - Nikolai Czajkowski
- Department of Genetics, Environment and Mental Health, Norwegian Institute of Public Health
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Dépistage des troubles de la personnalité avec la version française du Personality Diagnostic Questionnaire-4+ dans une population psychiatrique : une étude préliminaire. ANNALES MEDICO-PSYCHOLOGIQUES 2016. [DOI: 10.1016/j.amp.2014.10.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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50
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Gjerde LC, Czajkowski N, Røysamb E, Ystrom E, Tambs K, Aggen SH, Ørstavik RE, Kendler KS, Reichborn-Kjennerud T, Knudsen GP. A longitudinal, population-based twin study of avoidant and obsessive-compulsive personality disorder traits from early to middle adulthood. Psychol Med 2015; 45:3539-3548. [PMID: 26273730 PMCID: PMC4623996 DOI: 10.1017/s0033291715001440] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The phenotypic stability of avoidant personality disorder (AVPD) and obsessive-compulsive personality disorder (OCPD) has previously been found to be moderate. However, little is known about the longitudinal structure of genetic and environmental factors for these disorders separately and jointly, and to what extent genetic and environmental factors contribute to their stability. METHOD AVPD and OCPD criteria were assessed using the Structured Interview for DSM-IV Personality in 2793 young adult twins (1385 pairs, 23 singletons) from the Norwegian Institute of Public Health Twin Panel at wave 1 and 2282 (986 pairs, 310 singletons) of these on average 10 years later at wave 2. Longitudinal biometric models were fitted to AVPD and OCPD traits. RESULTS For twins who participated at both time-points, the number of endorsed sub-threshold criteria for both personality disorders (PDs) decreased 31% from wave 1 to wave 2. Phenotypic correlations between waves were 0.54 and 0.37 for AVPD and OCPD, respectively. The heritability estimates of the stable PD liabilities were 0.67 for AVPD and 0.53 for OCPD. The genetic correlations were 1.00 for AVPD and 0.72 for OCPD, while the unique environmental influences correlated 0.26 and 0.23, respectively. The correlation between the stable AVPD and OCPD liabilities was 0.39 of which 63% was attributable to genetic influences. Shared environmental factors did not significantly contribute to PD variance at either waves 1 or 2. CONCLUSION Phenotypic stability was moderate for AVPD and OCPD traits, and genetic factors contributed more than unique environmental factors to the stability both within and across phenotypes.
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Affiliation(s)
- L. C. Gjerde
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - N. Czajkowski
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - E. Røysamb
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - E. Ystrom
- Department of Psychology, University of Oslo, Oslo, Norway
| | - K. Tambs
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - S. H. Aggen
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
- Departments of Psychiatry and Human Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - R. E. Ørstavik
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - K. S. Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
- Departments of Psychiatry and Human Genetics, Virginia Commonwealth University, Richmond, VA, USA
- Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - T. Reichborn-Kjennerud
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
- Institute of Psychiatry, University of Oslo, Oslo, Norway
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - G. P. Knudsen
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
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