Heritability of personality disorders in childhood: a preliminary investigation

Early maladaptive schema, attachment style, and parenting style in a clinical population with personality disorder and normal individuals: a discriminant analysis model

INTRODUCTION

Researchers have shown various variables' role in forming personality disorders (PD). This study aimed to assess the role of early maladaptive schema (EMS), attachment style (AS), and parenting style (PS) in discriminating between personality disorders and normal individuals.

METHODS

In this study, 78 personality disorder patients and 360 healthy volunteers aged 18-84 were selected using convenience sampling. They completed the Schema Questionnaire-Short Form (SQ-SF), Revised Adult Attachment Scale (RAAS), and Baumrind's Parenting Styles Questionnaire (PSI). Data were analyzed using discriminant analysis with IBM SPSS 25.

RESULTS

The results showed higher mean scores in all early maladaptive schema domains, insecure attachment styles, and authoritarian parenting in the personality disorder group than in the normal group. Also, discriminant analyses revealed that the function was statistically significant and could distinguish between the two groups and a compound of essential variables, disconnection, impaired autonomy, and secure attachment, respectively, discriminating two groups. Given that all components were able to distinguish between the two groups.

CONCLUSION

Therefore, intervention based on these factors early in life may help reduce the characteristics of personality disorders. Also, considering the role of these factors, treatment protocols can be prepared.

Intrapersonal dynamics of closeness versus distance: Qualities of the self-concept distinguish destructive overdependence, dysfunctional detachment, and healthy dependency

INTRODUCTION

People vary in the degree to which they affiliate with others; exaggerated efforts maintain interpersonal closeness versus distance are codified in longstanding categorical models of personality pathology, and in contemporary dimensional frameworks as well.

OBJECTIVE

To examine associations between destructive overdependence (DO), dysfuntional detachment (DD), and healthy dependency (HD) and qualities of the self-concept.

METHOD

A mixed-sex sample of 229 adults completed the Relationship Profile Test to assess DO, DD, and HD, and the Object Relations Inventory (ORI) to assess qualities of the self-concept.

RESULTS AND CONCLUSION

Analyses indicated that (1) the ORI Strong dimension was uniquely predictive of DO (inversely related); (2) ORI Warm and Nurturing were unique predictors of DD (both inversely related); and (3) ORI Nurturing and Successful were unique predictors of HD. This study illuminates key intrapersonal features of these three personality styles.

Testing the bipolar assumption of Singer-Loomis Type Deployment Inventory for Korean adults using classification and multidimensional scaling

In this study, we explored whether the Korean version of Singer Loomis Type Deployment Inventory II (K-SLTDI) captures the opposing tendencies of Jung's theory of psychological type. The types are Extroverted Sensing, Extroverted Intuition, Extroverted Feeling, Extroverted Thinking, Introverted Sensing, Introverted Intuition, Introverted Feeling, and Introverted Thinking. A nationwide online survey was conducted in South Korea. We performed multidimensional scaling and classification analyses based on 521 Korean adult profiles with eight psychological types to test the bipolarity assumption. The results showed that the Procrustes-rotated four-dimensional space successfully represented four types of opposing tendencies. Moreover, the bipolarity assumption in the four dimensions of Jungian typology was tested and compared between lower and higher psychological distress populations via cluster analysis. Lastly, we explored patterns of responses in lower and higher psychological distress populations using intersubject correlation. Both similarity analyses and classification results consistently support the theoretical considerations on the conceptualization of Jung's type in independent order that the types could be derived without bipolar assumption as Singer and Loomis expected in their Type Development Inventory. Limitations in our study include the sample being randomly selected internet users during the COVID-19 pandemic, despite excellence in the use of the internet in the general Korean population.

Dependency, Detachment, and Health-Related Behavior in Adult Primary Care Patients

This investigation examined links between three related personality styles as assessed with the Relationship Profile Test-destructive overdependence, dysfunctional detachment, and healthy dependency-and indices of health and health-related behavior in a mixed-sex (74% female) sample of 100 primary care patients with a mean age of 38.62 (SD = 12.99). Fourteen primary care physicians also participated. As hypothesized, destructive overdependence and dysfunctional detachment scores were positively correlated with number of contacts with the emergency department; healthy dependency scores were inversely related to emergency department contacts and number of overnight hospitalizations. Healthy dependency scores were associated with an array of positive health behaviors; destructive overdependence scores were negatively associated with positive health behaviors. In addition, healthy dependency scores were inversely related to physician ratings of a difficult doctor-patient relationship. These results demonstrate that destructive overdependence, dysfunctional detachment and healthy dependency scores are associated in expected ways with indices of health and health-related behavior, and help illuminate the underlying factors that contribute to comparatively poor health and variations in health service use among overdependent and detached medical patients.

Psychological assessment of parents of people diagnosed with borderline personality disorder and comparison with parents of people without psychological disorders

Background

To date, several evidence-based interventions have been created to help relatives of people with Borderline Personality Disorder (BPD), but few studies have analyzed the clinical situation of the family members. The aim of this study was twofold: (1) to explore the clinical symptomatology in a sample of parents of people diagnosed with BPD and compare them with a sample of a sample of people without a relative with a personality disorder, (2) to explore whether the parents of people diagnosed with BPD have psychopathology related to personality disorders (PD) or meet the diagnostic criteria for PD.

Method

Participants were 42 (39.6%) fathers and 64 (60.4%) were mothers and mothers (n = XX, −%) of people diagnosed with BPD, who were selected from a specialized PD unit for treatment. The sample of people without a relative with a PD was obtained from social network announcements. To test for differences between the two groups, Student’s t tests were performed for quantitative variables, and Chi-square tests were performed for categorical variables. Cohen’s d was calculated as a measure of the effect size.

Results

Parents of people with BPD showed greater depressive and anxious symptomatology, higher levels of expressed emotion, and worse quality of life than the sample of people without a relative with a personality disorder. In addition, a high percentage of the parents of people diagnosed with BPD (50%) met the diagnostic criteria for different PD.

Conclusion

Parents of people diagnosed with BPD may need psychological help in various aspects. Therapists are therefore advised to bear in mind the importance of carrying out a psychological assessment of family members and, if necessary, to offer psychological intervention. It is crucial to invite the family to be part of the treatment, since they can be part of the solution.

Clinical Trial registration: ClinicalTrials.gov ID, NCT04160871 (registered November 15, 2019).

Expanding the search for emerging mental ill health to safeguard student potential and vocational success in high school: A narrative review

AIM

Young people experiencing mental ill health are more likely than their healthy aged peers to drop out of high school. This can result in social exclusion and vocational derailment. Identifying young people at risk and taking action before an illness is established or school dropout occurs is an important goal. This study aimed to examine evidence for the risk markers and at risk mental states of the clinical staging model (stage 0-1b) and whether these risk states and early symptoms impact school participation and academic attainment.

METHOD

This narrative review assembles research from both the psychiatry and education literature. It examines stage 0 to stage 1b of the clinical staging model and links the risk states and early symptoms to evidence about the academic success of young people in high school.

RESULTS

In accordance with the clinical staging model and evidence from education literature, childhood trauma and parental mental illness can impact school engagement and academic progress. Sleep disturbance can result in academic failure. Undifferentiated depression and anxiety can increase the risk for school dropout. Subthreshold psychosis and hypomanic states are associated with functional impairment and high rates of Not in Employment, Education, or Training (NEET) but are not recognized in the education literature.

CONCLUSION

Risk markers for emerging mental ill health can be identified in education research and demonstrate an impact on a student's success in high school. Clear referral protocols need to be embedded into school life to reduce risk of progression to later stages of illness and support school participation and success.

Effects of interaction of NOS1AP gene polymorphisms and childhood abuse on paranoid personality disorder features among male violent offenders in China

BACKGROUND

Paranoid Personality Disorder (PPD) results from a complex synergy between genetic and environmental factors. Childhood abuse is one of risk factors. Nitric Oxide Synthase 1 Adaptor Protein (NOS1AP) is a candidate gene of schizophrenia, which has similar pathophysiology to PPD. This study investigated the role of NOS1AP gene polymorphisms and a history of childhood abuse in predicting PPD features among male violent offenders in the Chinese Han population.

METHOD

Four NOS1AP Single Nucleotide Polymorphisms (SNPs), rs4145621, rs3751284, rs348624 and rs6680461 were genotyped in a sample of 423 male prisoners. Participant evaluations included demographic information, measures of childhood abuse (Child Trauma Questionnaire, CTQ), and PPD features (Personality Diagnostic Questionnaire-4, PDQ-4). Participants were divided into a PPD group and non-PPD group assessed by PDQ-4.

RESULTS

Regression analysis revealed that emotional abuse, NOS1AP SNPs rs348624 and rs4145621 predicted PPD features (P < 0.05) among prison samples. Significant interactions between childhood abuse history and NOS1AP SNPs rs3751284 and rs6680461 were also observed. Individuals carrying the C allele of rs3751284 were susceptible to PPD features when exposed to higher levels of emotional neglect (P < 0.05); Individuals with the G allele of rs6680461 were susceptible to PPD features when exposed to higher levels of emotional, physical and sexual abuse (P < 0.01).

CONCLUSIONS

These results suggest that the interaction between childhood abuse and NOS1AP gene polymorphisms may have an influence on PPD features, at least in male violent offenders.

Interpersonal Problems Associated With Passive-Aggressive Personality Disorder

With a controversial history, passive-aggressive personality disorder (PAPD) was eventually removed from the latest edition of the Diagnostic and Statistical Manual for Mental Disorders. Despite its demise from diagnostic nomenclature, clinicians continue to regard it as a clinically relevant construct, and some researchers argue for its resurrection. Toward this end, it is important to empirically demonstrate the relevance of the passive-aggressive personality construct, including demonstrating its association with impaired functioning. Consistent with contemporary emphasis on interpersonal functioning in personality pathology, the current study aims to explore interpersonal problems that are associated with PAPD in a large clinical sample. Before beginning treatment, 240 patients completed assessments of personality psychopathology and interpersonal functioning. Results showed that higher levels of PAPD were significantly associated with greater level of interpersonal distress, especially regarding interpersonal problems of a vindictive nature. The findings are consistent with clinical descriptions of the core conflictual relational issues of patients with PAPD and lend some support to further considering PAPD as a valid diagnostic construct.

Severe childhood trauma and clinical and neurocognitive features in schizotypal personality disorder

OBJECTIVE

Literature suggests that childhood trauma increases vulnerability for schizophrenia-spectrum disorders, including schizotypal personality disorder (SPD). Yet, it remains unexplored whether childhood trauma predicts symptom load and the level of neurocognitive functioning in SPD.

METHOD

We included 225 individuals with SPD and 127 healthy controls. Childhood trauma was evaluated using the Childhood Trauma Questionnaire, and schizotypal traits were assessed using the Schizotypal Personality Questionnaire. Standard neurocognitive assessments covered six cognitive domains.

RESULTS

All types of reported childhood trauma were significantly associated with SPD, in a linear fashion. Severe sexual abuse showed the greatest magnitude of association with higher cognitive-perceptual load (e.g., ideas of reference, odd belief or magical thinking); severe emotional neglect was associated with interpersonal scores (e.g., excessive social anxiety, constricted affect) within the SPD group. SPD individuals who reported severe trauma showed worse cognitive functioning (i.e., working memory, verbal/visual learning and memory, as well as verbal fluency).

CONCLUSIONS

Particular severe childhood trauma types were associated with higher cognitive-perceptual and interpersonal symptoms in SPD, along with worse cognitive functioning. These findings highlight the need for clinicians to enquire about childhood trauma in SPD patients, since unaddressed early adverse experiences may carry long-term negative consequences.

A systematic review of the neurobiological underpinnings of borderline personality disorder (BPD) in childhood and adolescence

Contemporary theories for the aetiology of borderline personality disorder (BPD) take a lifespan approach asserting that inborn biological predisposition is potentiated across development by environmental risk factors. In this review, we present and critically evaluate evidence on the neurobiology of BPD in childhood and adolescence, compare this evidence to the adult literature, and contextualise within a neurodevelopmental framework. A systematic review was conducted to identify studies examining the neurobiological (i.e. genetic, structural neuroimaging, neurophysiological, and neuropsychological) correlates of BPD symptoms in children and adolescents aged 19 years or under. We identified, quality assessed, and narratively summarised 34 studies published between 1980 and June 2016. Similar to findings in adult populations, twin studies indicated moderate to high levels of heritability of BPD, and there was some evidence for gene-environment interactions. Also consistent with adult reports is that some adolescents with BPD demonstrated structural (grey and white matter) alterations in frontolimbic regions and neuropsychological abnormalities (i.e. reduced executive function and disturbances in social cognition). These findings suggest that neurobiological abnormalities observed in adult BPD may not solely be the consequence of chronic morbidity or prolonged medication use. They also provide tentative support for neurodevelopmental theories of BPD by demonstrating that neurobiological markers may be observed from childhood onwards and interact with environmental factors to increase risk of BPD in young populations. Prospective studies with a range of repeated measures are now required to elucidate the temporal unfurling of neurobiological features and further delineate the complex pathways to BPD.

Genetic and Neuroimaging Features of Personality Disorders: State of the Art

Personality disorders often act as a common denominator for many psychiatric problems, and studies on personality disorders contribute to the etiopathology, diagnosis, and treatment of many mental disorders. In recent years, increasing evidence from various studies has shown distinctive features of personality disorders, and that from genetic and neuroimaging studies has been especially valuable. Genetic studies primarily target the genes encoding neurotransmitters and enzymes in the serotoninergic and dopaminergic systems, and neuroimaging studies mainly focus on the frontal and temporal lobes as well as the limbic-paralimbic system in patients with personality disorders. Although some studies have suffered due to unclear diagnoses of personality disorders and some have included few patients for a given personality disorder, great opportunities remain for investigators to launch new ideas and technologies in the field.

Construct Validity of the Relationship Profile Test: Links With Measures of Psychopathology and Adult Attachment

This study assessed the construct validity of the Relationship Profile Test (RPT; Bornstein & Languirand, 2003 ) with a substance abuse sample. One hundred-eight substance abuse patients completed the RPT, Experiences in Close Relationships Scale-Short Form (Wei, Russell, Mallinckrodt, & Vogel, 2007 ), Personality Assessment Inventory (Morey, 1991 ), and Symptom Checklist-90-Revised (Derogatis, 1983 ). Results suggest that the RPT has good construct validity when compared against theoretically related broadband measures of personality, psychopathology, and adult attachment. Overall, health dependency was negatively related to measures of psychopathology and insecure attachment, and overdependence was positively related to measures of psychopathology and attachment anxiety. Many of the predictions regarding RPT detachment and the criterion measures were not supported. Implications of these findings are discussed.

Narcissistic personality disorder: an integrative review of recent empirical data and current definitions

Although concepts of pathological narcissism are as old as psychology and psychiatry itself, only a small number of clinical studies are based on the criteria for narcissistic personality disorder (NPD), as defined in the Diagnostic and Statistical Manuals of Mental Disorders (DSM). As a result, NPD appears to be one of the most controversially discussed nosological entities in psychiatry. Whereas the majority of empirical studies used self or other ratings of NPD criteria to address issues of reliability and validity of the diagnostic category (i.e., internal consistency, factor structure, discriminant validity), only recent research has applied experimental designs to investigate specific features of NPD (e.g., self-esteem, empathy, shame). The aim of this review is to summarize available empirical data on NPD and relate these findings to current definitions of NPD (according to the DSM-5, [1]). In order to do so, this review follows the five steps to establishing diagnostic validity proposed by Robins and Guze [2], i.e., (1) clinical description, (2) laboratory studies, (3) delimitation from other disorders, (4) family studies, and (5) follow up studies. Finally, this review suggests pathways for future research that may assist further nosological evaluation of NPD and contribute to the overall goal, the improvement of treatment for patients.

Retrospective assessment of premorbid psychopathology and cognitive impairments in bipolar disorder

The present study investigated whether premorbid psychopathological and cognitive impairment symptoms could be retrospectively identified during the childhood and adolescence of those later diagnosed with bipolar disorder (BPD). The present sample consisted of 30 adults diagnosed with BPD, 30 of their significant-others, a group-matched control group of 30 adults (without any reported psychological or cognitive disorders), and 30 of their significant-others. The adults diagnosed with BPD and the control group completed a self-report form of the retrospective version of the Coolidge Personality and Neuropsychological Inventory (CPNI-R) as they were before the age of 16 years. The significant-others reported on the adults diagnosed with BPD or upon their controls. Initial two-factor analyses of variance revealed that on a comprehensive measure of psychopathology and of cognitive impairment, those diagnosed with BPD scored significantly higher than the control group on the self-report and the significant-other forms, with large effects sizes. Overall, the overarching research hypothesis was confirmed: adults diagnosed with BPD and their significant-others could report salient prodromes during their childhood or adolescence.

Manifestations of interpersonal dependency and depressive subtypes in outpatient psychotherapy patients

The present study investigated the relationship between normative and pathological dependency and anaclitic and introjective depressive experiences among 71 patients participating in outpatient psychotherapy at a university-based psychology clinic. We examined the interrelationships among the Relationship Profile Test subscales, the Depressive Experiences Questionnaire subscales and the Outcome Questionnaire-45.2. Results indicated that destructive overdependence was positively correlated with anaclitic and introjective depression and negatively correlated with overall perceptions of mental health. Dysfunctional detachment was positively correlated with introjective depression and negatively correlated with generalized perceptions of one's own mental health. Healthy dependency was negatively correlated with introjective depression and positively correlated with mental health. These results not only support the construct validity of the Relationship Profile Test but also shed light on a link between depression, dependence and self-criticism.

Psychometric properties of a new measure to assess autism spectrum disorder in DSM-5

This article presents preliminary psychometric properties of a new 45-item scale, the Coolidge Autistic Symptoms Survey (CASS), designed to differentiate between children within the autism spectrum (including Asperger's Disorder) and purportedly normal children, in anticipation of DSM-5 changes, in which a single diagnostic category is proposed: autism spectrum disorder. The final sample (N = 72) consisted of 19 children diagnosed with Asperger's Disorder, 19 children who were considered loners by their parents (without an autism diagnosis), and 34 purportedly normal children. The CASS and the 200-item, DSM-IV-TR aligned, Coolidge Personality and Neuropsychological Inventory were completed by a parent. The CASS had excellent internal scale reliability (α= .97) and test-retest (r = .91) reliability. ANOVA revealed the CASS was able to discriminate significantly among the 3 groups of children. Further research with the CASS appears warranted.

The heritability of avoidant and dependent personality disorder assessed by personal interview and questionnaire

OBJECTIVE

Personality disorders (PDs) have been shown to be modestly heritable. Accurate heritability estimates are, however, dependent on reliable measurement methods, as measurement error deflates heritability. The aim of this study was to estimate the heritability of DSM-IV avoidant and dependent personality disorder, by including two measures of the PDs at two time points.

METHOD

Data were obtained from a population-based cohort of young adult Norwegian twins, of whom 8045 had completed a self-report questionnaire assessing PD traits. 2794 of these twins subsequently underwent a structured diagnostic interview for DSM-IV PDs. Questionnaire items predicting interview results were selected by multiple regression, and measurement models of the PDs were fitted in Mx.

RESULTS

The heritabilities of the PD factors were 0.64 for avoidant PD and 0.66 for dependent PD. No evidence of common environment, that is, environmental factors that are shared between twins and make them similar, was found. Genetic and environmental contributions to avoidant and dependent PD seemed to be the same across sexes.

CONCLUSION

The combination of both a questionnaire- and an interview assessment of avoidant and dependent PD results in substantially higher heritabilities than previously found using single-occasion interviews only.

The heritability of Cluster B personality disorders assessed both by personal interview and questionnaire

Whereas the heritability of common personality traits has been firmly established, the results of the few published studies on personality disorders (PDs) are highly divergent, with some studies finding high heredity and others very low. A problem with assessing personality disorders by means of interview is errors connected with interviewer bias. A way to overcome the problem is to use self-report questionnaires in addition to interviews. This study used both interview and questionnaire for assessing DSM-IV Cluster B personality disorders: antisocial personality disorder (APD), borderline (BPD), narcissistic (NPD), and histrionic (HPD). We assessed close to 2,800 twins from the Norwegian Institute of Public Health Twin Panel using a self-report questionnaire and, a few years later, the Structured Interview for DSM-IV Personality (SIDP-IV). Items from the self-report questionnaire that best predicted the PDs captured by the interview were then selected. Measurement models combining questionnaire and interview information were applied and were fitted using Mx. Whereas the heritability of Cluster B PDs assessed by interview was around .30, and around .40-.50 when assessed by self-report questionnaire, the heritability of the convergent latent factor, including information from both interview and self-report questionnaire was .69 for APD, .67 for BPD, .71 for NPD, and .63 for HPD. As is usually found for personality, the effect of shared-in families (familial) environment was zero. In conclusion, when both interview and self-report questionnaire are taken into account, the heritability of Cluster B PD appears to be in the upper range of previous findings for mental disorders.

Construct validity of the Schwartz Outcome Scale: validation using a 28-day inpatient chemical rehabilitation patient sample

The Schwartz Outcome Scale-10 (SOS-10) is a 10-item self-report that measures quality of life and psychological well-being. It is easy to administer and score, and past research has revealed its utility, validity, and reliability with different samples (i.e., clinical and nonclinical) and in different clinical settings (i.e., inpatient, outpatient, nonpsychiatry medical settings). The present study looks to investigate the utility of the SOS-10 in measuring psychological well-being and quality of life with the 28-day inpatient chemical dependency sample. In addition, the current study looks to investigate its ability to be used as a treatment outcome measure for chemical-dependent inpatients. The results revealed that the SOS-10 was associated with aspects of interpersonal dependency and alexithymia in predicted ways. The SOS-10 was positively associated to "Healthy Dependence" and negatively related to alexithymia and "Destructive Overdependence" and "Dysfunctional Detachment." The results also showed that the SOS-10 showed healthy change from admission to discharge and that this change was paralleled by healthy change in interpersonal dependency and alexithymia.

The Return of the Anal Character

The anal character is a central concept in the psychoanalytic theory of personality. It was originally described in the first decade of the 20th century, and quickly applied to the analysis of clinical cases, psychobiographies, and cultural phenomena. In midcentury a generation of psychoanalytically oriented psychologists found some evidence that anal traits cohere and that they are related to attitudes toward excreta. Subsequently, the concept of the anal character lost currency as studies failed to support the psychoanalytic explanation of its origins and enthusiasm for psychoanalysis dwindled. However, although the concept might seem to have met its demise, it has resurfaced under different names as a diverse assortment of characteristics that have inspired active research programs. These characteristics—authoritarianism, conscientiousness, detail focus, disgust sensitivity, hoarding, obsessive–compulsive personality disorder, perfectionism, and Type A—have a rarely remarked family resemblance that the anal character illuminates. I argue that the anal character has not so much been consigned to the scrap heap of bad ideas, but has been recycled into several smaller but better ones.

Exploring the association between emotional abuse and childhood borderline personality features: the moderating role of personality traits

Most of the extant literature on borderline personality disorder has focused on the course, consequences, and correlates of this disorder among adults. However, little is known about childhood borderline personality (BP) features, or the factors associated with the emergence of BP pathology in childhood. A greater understanding of childhood BP features and associated risk factors has important implications for the development of primary and secondary prevention programs. The goal of the present study was to examine the interrelationships among two BP-relevant traits (affective dysfunction and impulsivity), a BP-relevant environmental stressor (emotional abuse), and BP features in a sample of 225 children aged 11 to 14 years. Results provide support for the role of both trait vulnerabilities and environmental stressors in childhood BP features. Further, findings highlight the moderating role of affective dysfunction in the relationship between emotional abuse and childhood BP features.

Association between a serotonin transporter promoter polymorphism (5HTTLPR) and personality disorder traits in a community sample

BACKGROUND

The serotonin transporter (SERT) polymorphism (5HTTLPR) has been reported to be associated with several psychiatric conditions. Specific personality disorders could be intermediate factors in the known relationship between 5HTTLPR and psychiatric disorders. This is the first study to test the association between this polymorphism and dimensions of all DSM-IV personality disorders in a community sample.

METHODS

374 white participants were assessed by clinical psychologists using the International Personality Disorder Examination (IPDE). Associations between dimensions of each DSM-IV personality disorder and the long (l) and short (s) alleles of the 5HTTLPR were evaluated using non-parametric tests and regression models.

RESULTS

The s allele of the 5HTTLPR polymorphism was significantly associated with higher avoidant personality trait scores in the whole sample. Males with the s allele had a significantly lower likelihood of higher obsessive-compulsive personality disorder (OCPD) trait scores, whereas females with the s allele were likely to have higher OCPD personality trait scores.

CONCLUSION

This paper provides preliminary data on the relationship between personality disorders and the 5HTTLPR polymorphism. The relationship of the s allele and avoidant PD is consistent with findings of a nonspecific relationship of this polymorphism to anxiety and depressive disorders. Concerning the unusual sexual dimorphic result with OCPD, several hypotheses are presented. These findings need further replication, including a more detailed study of additional variants in SERT.

Associations linking parenting styles and offspring personality disorder are moderated by parental personality disorder, evidence from China

The aim of the study is to examine the association linking parenting and personality disorder controlling for parental personality disorder, and whether this association is moderated by parental PD. Data were from community-dwelling high school students aged 18 and above and their parents living in Beijing, China. A total of 181 cases and 2,605 controls were included in this study. Personality disorder in students was assessed via a two-stage approach, Personality Diagnostic Questionnaire as a screening tool and International Personality Disorder Examination as the diagnostic tool. Information about parenting was collected from students using Egna Minnen av. Betraffande Uppfostran. Negative parenting styles, e.g. rejective or over-protective parenting, were found to be associated with the occurrence of personality disorder. Conflictive parenting styles were also found to be associated with personality disorder. Generally stronger associations were found for students with parental personality disorder as compared to students without parental personality disorder. Findings from this study support the role of parenting in the occurrence of PD, especially for children with family history of personality disorder.

Reconceptualizing personality pathology in DSM-5: limitations in evidence for eliminating dependent personality disorder and other DSM-IV syndromes

The DSM-5 Personality and Personality Disorders Workgroup proposed that five DSM-IV personality disorders be eliminated as formal diagnostic categories (paranoid, schizoid, histrionic, narcissistic, and dependent), because these syndromes purportedly have low clinical utility and minimal evidence for validity. Scrutiny of studies cited in support of this proposal reveals difficulties in three areas: (1) Inadequate information regarding parameters of the literature search; (2) Mixed empirical support for proposed changes; and (3) Selective attention to certain disorders and not others. Review of validity and clinical utility data related to dependent personality disorder indicates that evidence regarding this syndrome does not differ from that of syndromes proposed for retention in DSM-5. Limitations in the research base cited by the workgroup illuminates gaps in the personality disorder literature, and may serve as a starting point for systematic research on personality pathology so that adequate empirical data are available to decide which syndromes to retain, revise, or remove in future versions of the diagnostic manual.

Preliminary psychometric properties of a measure of Karen Horney's Tridimensional theory in children and adolescents

This study established the psychometric properties of a child and adolescent version of the Horney-Coolidge Tridimensional Inventory (HCTI), which assesses psychoanalyst Karen Horney's theory of neurotic types. Parents of 302 children (ages 5 to 17 years; median age = 12.0 years) completed the new 45-item version of the HCTI and the Coolidge Personality and Neuropsychological Inventory (CPNI) about their children. The three main scales (Compliance, Aggression, and Detachment) had good internal scale reliability and excellent test-retest reliability. Principal components analysis supported Horney's three dimensions and a six-component substructure. There was also sufficient construct validity with personality disorder scales from the CPNI with the three HCTI dimensions and their six components. The implications of the findings are discussed for Horneyan theory.

Tryptophan-hydroxylase 2 haplotype association with borderline personality disorder and aggression in a sample of patients with personality disorders and healthy controls

BACKGROUND

There is a decreased serotonergic function in impulsive aggression and borderline personality disorder (BPD), and genetic association studies suggest a role of serotonergic genes in impulsive aggression and BPD. Only one study has analyzed the association between the tryptophan-hydroxylase 2 (TPH2) gene and BPD. A TPH2 "risk" haplotype has been described that is associated with anxiety, depression and suicidal behavior.

METHODS

We assessed the relationship between the previously identified "risk" haplotype at the TPH2 locus and BPD diagnosis, impulsive aggression, affective lability, and suicidal/parasuicidal behaviors, in a well-characterized clinical sample of 103 healthy controls (HCs) and 251 patients with personality disorders (109 with BPD). A logistic regression including measures of depression, affective lability and aggression scores in predicting "risk" haplotype was conducted.

RESULTS

The prevalence of the "risk" haplotype was significantly higher in patients with BPD compared to HCs. Those with the "risk" haplotype have higher aggression and affect lability scores and more suicidal/parasuicidal behaviors than those without it. In the logistic regression model, affect lability was the only significant predictor and it correctly classified 83.1% of the subjects as "risk" or "non-risk" haplotype carriers.

CONCLUSIONS

We found an association between the previously described TPH2 "risk" haplotype and BPD diagnosis, affective lability, suicidal/parasuicidal behavior, and aggression scores.

Erfassung und Klassifikation von Persönlichkeitspathologie im Jugendalter

Fragestellung: Die Frage der Diagnostik und Klassifikation von Persönlichkeitsstörungen im Jugendalter ist immer noch eine kontrovers diskutierte Thematik. Methodik: In dieser Übersichtsarbeit werden die aktuellen Forschungsbefunde zur Komorbidität und Diagnostik von Persönlichkeitsstörungen im Jugendalter sowie ihre neurobiologischen und -psychologischen Korrelate dargelegt. Ergebnisse: Aktuelle Forschungsergebnisse verweisen einerseits darauf, dass Persönlichkeitsstörungen im Jugendalter mittels der für Erwachsene entwickelten Instrumente zuverlässig erfasst werden können. Andererseits wird bemängelt, dass kein einheitliches jugendspezifisches Konzept zur Erfassung von Persönlichkeitsstörungen existiert, das eine einheitliche Grundlage für die Erforschung dieses klinisch so bedeutsamen Störungsbildes bildet. Schlussfolgerungen: Es bedarf diagnostischer und Langzeitstudien im Rahmen von Netzwerken, die Aufschluss über die Frage der Klassifizierbarkeit von Persönlichkeitsstörungen in der Adoleszenz in Abgrenzung zu anderen jugendtypischen Störungsbildern geben.

Catechol-o-methyltransferase genotype and childhood trauma may interact to impact schizotypal personality traits

We attempt to identify gene by childhood abuse interactions which predispose to the development of schizotypal traits in a familial bipolar disorder (BD) sample. Self-report measures of schizotypal personality traits (Schizotypal Personality Scale) and childhood maltreatment (Childhood Trauma Questionnaire) were administered to 222 participants from 44 families with BD. Variants of catechol-o-methyltransferase (COMT) and four other dopamine pathway-related genes: DRD4, DRD2,MAOA, and SLC6A3, were typed. BD type I (BD I) subjects scored significantly higher than their unaffected relatives on the Schizotypal Personality Scale. The val allele of the Val158 Met polymorphism of the COMT gene was associated with increased schizotypal personality trait scores in individuals exposed to higher levels of self-reported childhood trauma (p < 0.05). There was no direct effect of the val158met polymorphism on schizotypal personality traits. Further, no passive correlation between COMT genotype and childhood trauma was found. We raise the possibility that genetically-driven variation in COMT may interact with childhood trauma to contribute to the risk of developing schizotypal personality traits.

Do nightmares and generalized anxiety disorder in childhood and adolescence have a common genetic origin?

The present study investigated the prevalence and heritability of nightmares and their comorbidity with psychopathology in a sample (N = 1,318) of children, adolescents, and child and adolescent twins ranging in age from 4 to 17 years old. The prevalence of terrible nightmares was estimated to be 6.4%, which is similar to previous studies. There were marginal gender differences in this rate (7.7% for boys; 5.1% in girls), contrary to previous studies that purport higher rates for girls. There was little evidence for prevalence changes across age. Nightmares were highly heritable and attributed to an additive genetic influence (51%) and nonshared environmental effects (49%). There was little evidence for a shared genetic correlation for nightmares and generalized waking anxiety (Overanxious Disorder of Childhood). There was also a substantial and pervasive comorbid psychopathology for those parents who reported Strongly True on Item 59: My child has terrible nightmares on the 200-item parent-as-respondent, Coolidge Personality and Neuropsychological Inventory. Issues in estimating prevalence rates of nightmares were identified.

Childhood personality pathology: dimensional stability and change

Studies on the developmental course of personality disorders have suggested that adult personality disorders enclose both features with a natural plasticity over time, as well as stable components represented by underlying trait dimensions. The current study broadens this dimensional stability perspective toward an earlier developmental stage, and describes with different indices of stability the longitudinal behavior of basic childhood maladaptive trait dimensions in a community sample of 477 Flemish children. The results underscore structural, rank-order, and within-person stability for the disagreeableness, emotional instability, introversion, and compulsivity dimensions and suggest a similar maturation principle as has been proposed for adults. Individual growth curve analyses indicate that children's maladaptive trait scores generally decrease as they grow older, with a smaller decline for high-scoring individuals. Childhood maladaptive traits and general psychopathology dimensions show similar longitudinal patterns in terms of shape and change over time, supporting a spectrum conceptualization of Axis I related pathology and personality disorder precursors at young age. The implications of these findings for a developmental perspective on dimensional conceptualizations of personality disorders are discussed.

Expanding the Construct Validity of the Relationship Profile Test: Associations With Physical Health and Anaclitic and Introjective Traits

The authors examined the construct validity of the Relationship Profile Test (RPT) with respect to measures of two related constructs—physical health and well-being (functional health status), and depression-linked personality type (anaclitic vs. introjective). In Study 1, the authors administered the RPT, Depressive Experiences Questionnaire (DEQ), and Medical Outcomes Study Short Form (MOS SF-20) to 116 undergraduate students. In Study 2, the RPT, DEQ, and MOS SF-20 were administered to 110, mostly African American female, primary care outpatients. Destructive Overdependence was positively correlated with anaclitic and introjective trait scores in both samples. Dysfunctional Detachment was positively correlated with introjective scores in both samples and with anaclitic scores in the primary care sample. Healthy Dependency was negatively correlated with introjective scores in both samples and with anaclitic scores in the primary care sample. These studies support the construct validity of the RPT in ethnically diverse nonclinical and clinical samples, and extend previous findings documenting links between RPT subscale scores and scores on measures of other theoretically related constructs.

[Personality disorders in adolescence: conceptual issues and treatment approaches]

Objective of this paper is to search for answers for the question if it is justified to use the diagnosis of personality disorder already in adolescence. Recent research data confirm that the stability of basic personality traits is only gradually lower in adolescence compared to adulthood. Using the diagnostic criteria of adults there is not much of a difference concerning prevalence rate and stability in adolescence and adulthood. Meta-analyses reveal that patients with personality disorders can successfully be treated with specalized treatment programs so that personality disorders should not be viewed as life-course persistent. It is argued that an early assessment with standardized procedures can help to identify adolescents with personality disorders so that specialized treatment approaches can be started. In adulthood there is empirical evidence for the use of Dialectical-Behavior Therapy DBT, Transference Focused Psychotherapy TFP, Mentalization-based Therapy MBT and Schema-focused Psychotherapy SFT for the use in patients with personality disorders. These treatment approaches have to be adapted to the special situation of adolescents so that their use can help to prevent these early developing disorders to become chronic.

Extending extant models of the pathogenesis of borderline personality disorder to childhood borderline personality symptoms: the roles of affective dysfunction, disinhibition, and self- and emotion-regulation deficits

Although research has been conducted on the course, consequences, and correlates of borderline personality disorder (BPD), little is known about its emergence in childhood, and no studies have examined the extent to which theoretical models of the pathogenesis of BPD in adults are applicable to the correlates of borderline personality symptoms in children. The goal of this study was to examine the interrelationships between two BPD-relevant personality traits (affective dysfunction and disinhibition), self- and emotion-regulation deficits, and childhood borderline personality symptoms among 263 children aged 9 to 13. We predicted that affective dysfunction, disinhibition, and their interaction would be associated with childhood borderline personality symptoms, and that self- and emotion-regulation deficits would mediate these relationships. Results provided support for the roles of both affective dysfunction and disinhibition (in the form of sensation seeking) in childhood borderline personality symptoms, as well as their hypothesized interaction. Further, both self- and emotion-regulation deficits partially mediated the relationship between affective dysfunction and childhood borderline personality symptoms. Finally, results provided evidence of different gender-based pathways to childhood borderline personality symptoms, suggesting that models of BPD among adults are more relevant to understanding the factors associated with borderline personality symptoms among girls than boys.

The Construct Validity of Passive-Aggressive Personality Disorder

Although Passive Aggressive personality disorder (PAPD) plays an important role in many theories of personality pathology, it was consigned to the appendix of the fourth edition of the DSM. The scientific basis of this decision has been questioned, but several controversies persist regarding PAPD, including its structure, content validity, overlap with other PDs, and relations to validating variables such as personality traits, childhood experiences, and clinically relevant correlates. This study examined these facets of PAPD's construct validity in a large clinical sample. Results suggest that the construct is unidimensional, internally consistent, and reasonably stable. Furthermore, PAPD appears systematically related to borderline and narcissistic personality disorders, sets of personality traits, and childhood experiences consistent with several theoretical formulations, dysfunction, substance abuse disorders, and history of hospitalizations. Overall, results support the construct validity of PAPD.

Stability, change, and heritability of borderline personality disorder traits from adolescence to adulthood: a longitudinal twin study

Although personality disorders are best understood in the context of lifetime development, there is a paucity of work examining their longitudinal trajectory. An understanding of the expected course and the genetic and environmental contributions to these disorders is necessary for a detailed understanding of risk processes that lead to their manifestation. The current study examined the longitudinal course and heritability of borderline personality disorder (BPD) over a period of 10 years starting in adolescence (age 14) and ending in adulthood (age 24). In doing so, we built on existing research by using a large community sample of adolescent female twins, a sensitive dimensional measure of BPD traits, an extended follow-up period, and a longitudinal twin design that allowed us to investigate the heritability of BPD traits at four discrete ages spanning midadolescence to early adulthood. Results indicated that mean-level BPD traits significantly decline from adolescence to adulthood, but rank order stability remained high. BPD traits were moderately heritable at all ages, with a slight trend for increased heritability from age 14 to age 24. A genetically informed latent growth curve model indicated that both the stability and change of BPD traits are highly influenced by genetic factors and modestly by nonshared environmental factors. Our results indicate that as is the case for other personality dimensions, trait BPD declines as individuals mature from adolescence to adulthood, and that this process is influenced in part by the same genetic factors that influence BPD trait stability.

Dimensional representations of DSM-IV cluster B personality disorders in a population-based sample of Norwegian twins: a multivariate study

BACKGROUND

The personality disorders (PDs) in the 'dramatic' cluster B [antisocial (ASPD), histrionic (HPD), narcissistic (NPD) and borderline (BPD)] demonstrate co-morbidity. However, the degree to which genetic and/or environmental factors influence their co-occurrence is not known and, with the exception of ASPD, the relative impact of genetic and environmental risk factors on liability to the cluster B PDs has not been conclusively established.

METHOD

PD traits were assessed in 1386 Norwegian twin pairs between the age of 19 and 35 years using the Structured Interview for DSM-IV Personality Disorders (SIDP-IV). Using the statistical package Mx, multivariate twin models were fitted to dimensional representations of the PDs.

RESULTS

The best-fitting model, which did not include sex or shared family environment effects, included common genetic and environmental factors influencing all four dramatic PD traits, and factors influencing only ASPD and BPD. Heritability was estimated at 38% for ASPD traits, 31% for HPD traits, 24% for NPD traits and 35% for BPD traits. BPD traits had the lowest and ASPD traits the highest disorder-specific genetic variance.

CONCLUSION

The frequently observed co-morbidity between cluster B PDs results from both common genetic and environmental influences. Etiologically, cluster B has a 'substructure' in which ASPD and BPD are more closely related to each other than to the other cluster B disorders.

The case for shifting borderline personality disorder to Axis I

Through reviewing what is known about the nature, course, and heritability of borderline personality disorder (BPD), we argue for a reconceptualization of this disorder that would lead to its placement on Axis I. Borderline personality disorder is a prevalent and disabling condition, and yet the empirical research into its nature and treatment has not been commensurate with the seriousness of the illness. We not only review empirical evidence about the etiology, phenomenology, and course of the disorder in BPD but we also address fundamental misconceptions about BPD that we believe have contributed to misunderstanding and stigmatization of the disease. Finally, we suggest future directions for research that might permit the identification of core features of this disorder, with a focus on the importance of naturalistic assessments and of assessments through the course of development.

Child development and personality disorder

The evidence is surprisingly strong that even early adolescent personality disorders or elevated personality disorder symptoms have a broad range of negative effects well into adulthood, for the most part comparable to or even larger than those of Axis I disorders. Current evidence suggests that the most severe long-term prognosis is associated with borderline and schizotypal PDs and elevated symptoms. And of course, childhood conduct disorder is in a peculiar status, disappearing in adulthood to be manifest as a very severe disorder-antisocial PD-in a minority of those with the adolescent disorder.

Recent advances in the biological study of personality disorders

While it is premature to provide a simple model for the vulnerability to the development of either borderline (BPD) or schizotypal (SPD) personality disorder, it is clear that these heritable disorders lend themselves to fruitful neurobiological exploration. The most promising findings in BPD suggest that a diminished top-down control of affective responses, which is likely to relate to deceased responsiveness of specific midline regions of prefrontal cortex, may underlie the affective hyperresponsiveness in this disorder. In addition, genetic and neuroendocrine and molecular neuroimaging findings point to a role for serotonin in this affective disinhibition. Clearly SPD falls within the schizophrenia spectrum, but precisely the nature of what predicts full-blown schizophrenia as opposed to the milder symptoms of SPD is not yet clear.

Persönlichkeitsstörungen im Kindes- und Jugendalter?

Durch die Fortschritte bei der Behandlung von Persönlichkeitsstörungen im Erwachsenenalter wird die Übertragung dieser Konzepte auf das Kindes- und Jugendalter heute intensiv diskutiert. Argumente für und gegen eine Vergabe von Persönlichkeitsstörungsdiagnosen im Kindes- und Jugendalter werden diskutiert. Es werden aktuelle Erkenntnisse zur Diagnostik und dem Verlauf von Persönlichkeitsstörungen berichtet. Das Pro und Contra einer Diagnosestellung wird vor diesem Hintergrund gegenübergestellt.

Schizotypal personality: neurodevelopmental and psychosocial trajectories

Schizotypal personality research holds the promise of critically important insights into the etiology and ultimate prevention of schizophrenia. This article provides a critical overview of diagnostic, developmental, demographic, psychosocial, genetic, neurodevelopmental, psychophysiological, neurochemical, neurocognitive, brain imaging, and prevention-treatment issues pertaining to this personality disorder. It is argued that genetic and early environmental influences act in concert to alter brain structure/function throughout development, resulting in disturbances to basic cognitive and affective processes that give rise to three building blocks of schizotypy-cognitive-perceptual, interpersonal, and disorganized features. Two clinical subtypes are hypothesized: (a) neurodevelopmental schizotypy, which has its roots in genetic, prenatal, and early postnatal factors, is relatively stable, has genetic affinity to schizophrenia, and may benefit preferentially from pharmacological intervention, and (b) pseudoschizotypy, which is unrelated to schizophrenia, has its roots in psychosocial adversity, shows greater symptom fluctuations, and may be more responsive to psychosocial intervention.

Psychological and neurobehavioral comparisons of children with Asperger's Disorder versus High-Functioning Autism

This study investigated personality and neurobehavioral differences between 16 children with Asperger's Disorder, 15 children with High-Functioning Autism (HFA), and 31 controls, all ranging in age from 5-17 years, M age = 10.7 years, SD = 3.0. Parents rated their children's behaviors on a 44-item autistic symptoms survey and on the 200-item Coolidge Personality and Neuropsychological Inventory (Coolidge, Thede, Stewart, & Segal (2002a). The Coolidge Personality and Neuropsychological Inventory for Children (CPNI): Preliminary psychometric characteristics. Behavior Modification, 26, 550-566). The results indicated that the two clinical samples were significantly elevated on the Executive Function Deficits scale and Attention-Deficit/Hyperactivity Disorder (ADHD) scale compared to controls. There were more similarities than differences between the two clinical samples on the personality scales, although the Asperger's group scored significantly on the two scales with anxiety components.