A question of style: refining the dimensions of personality disorder style

Hypnotizability and Disordered Personality Styles in Cluster A Personality Disorders

AIM

Interpersonal sensitivity and mistrust are the main characteristics of cluster A personality disorders (CAPD) which might be due to the high accessibility to negative suggestions from environments. Yet the exact associations between hypnotic suggestibility and their personality disorder functioning styles remain unclear.

METHODS

We invited 36 patients with CAPD and 115 healthy volunteers to undergo the Stanford Hypnotic Susceptibility Scale: Form C (SHSS:C) and Parker Personality Measure (PERM).

RESULTS

Compared to controls; patients scored higher on PERM paranoid; schizoid; schizotypal; borderline; avoidant; and dependent styles; on the SHSS:C total and "challenge suggestions", and the passing rates of "hand lowering", "arm rigidity", "dream", and "arm immobilization". In patients, "dream" negatively predicted the schizoid; "hallucinated voice" negatively the schizotypal; "mosquito hallucination" positively the histrionic and dependent; and "arm immobilization" negatively the avoidant style.

CONCLUSIONS

Our results suggested that the insusceptibility to perceptual suggestions from others and the high control over body contribute to the paranoid attitude and interpersonal avoidance in CAPD. These findings help to understand the cause of interpersonal problems in these patients and suggest the trial of hypnotherapy for them.

EEG Markers in Emotionally Unstable Personality Disorder-A Possible Outcome Measure for Neurofeedback: A Narrative Review

Objectives. There is growing evidence for the use of biofeedback (BF) in affective disorders, dissocial personality disorder, and in children with histories of abuse. Electroencephalogram (EEG) markers could be used as neurofeedback in emotionally unstable personality disorder (EUPD) management especially for those at high risk of suicide when emotionally aroused. This narrative review investigates the evidence for EEG markers in EUPD. Methods. PRISMA guidelines were used to conduct a narrative review. A structured search method was developed and implemented in collaboration with an information specialist. Studies were identified via 3 electronic database searches of MEDLINE, Embase, and PsycINFO. A predesigned inclusion/exclusion criterion was applied to selected papers. A thematic analysis approach with 5 criteria was used. Results. From an initial long list of 5250 papers, 229 studies were identified and screened, of which 44 met at least 3 of the predesigned inclusion criteria. No research to date investigates EEG-based neurofeedback in EUPD. A number of different EEG biomarkers are identified but there is poor consistency between studies. Conclusions. The findings heterogeneity may be due to the disorder complexity and the variable EEG related parameters studied. An alternative explanation may be that there are a number of different neuromarkers, which could be clustered together with clinical symptomatology, to give new subdomains. Quantitative EEGs in particular may be helpful to identify more specific abnormalities. EEG standardization of neurofeedback protocols based on specific EEG abnormalities detected may facilitate targeted use of neurofeedback as an intervention in EUPD.

Nightmare experience and personality disorder functioning styles in healthy volunteers and nightmare disorder patients

Nightmares are prevalent in psychiatric disorders, and personality disorder features might be associated with nightmare experience, especially in nightmare disorder patients. The authors invited 219 healthy volunteers and 118 nightmare disorder patients to undergo tests of the Nightmare Experience Questionnaire (NEQ), the Parker Personality Measure (PERM), and the Plutchik-van Praag Depression Inventory. Compared to healthy volunteers, nightmare disorder patients scored significantly higher on annual nightmare frequency and NEQ Physical Effect, Negative Emotion, Meaning Interpretation, and Horrible Stimulation, and higher on PERM Paranoid, Schizotypal, Borderline, Histrionic, Narcissistic, Avoidant, and Dependent styles. Borderline, Schizotypal, and Passive-Aggressive styles in healthy volunteers and Dependent, Avoidant, Histrionic, and Paranoid in patients were significant predictors of some NEQ scales. Higher annual nightmare frequency, higher scale scores of nightmare experience and personality disorder styles, and more associations between the two were found in nightmare disorder patients, implying the need for personality-adjustment therapy for nightmare disorder.

Short form of the Zuckerman-Kuhlman-Aluja Personality Questionnaire: Its trait and facet relationships with personality disorder functioning styles in Chinese general and clinical samples

Five-factor model of personality trait measures displays predictable associations with personality disorder features in both general and clinical populations. Facet-level measures such as the Zuckerman-Kuhlman-Aluja Personality Questionnaire offer more detailed associations in these aspects. Recently, a short form of this questionnaire (ZKA-PQ/SF), with five traits and four facets under each trait, has been developed for further application of personality measures in a reasonable short time. We hypothesized that ZKA-PQ/SF displays predictable associations with personality disorder functioning styles in both general and clinical populations. We therefore in China, invited 446 healthy volunteers and 112 personality disorder patients to undergo the tests of ZKA-PQ/SF, the Parker Personality Measure (PERM) and the Plutchik-van Praag Depression Inventory. Patients scored significantly higher on all PERM styles and on ZKA-PQ/SF Neuroticism and Aggressiveness traits and some of their facets, and lower on ZKA-PQ/SF Extraversion and its facets, and on Work Energy facet of Activity. ZKA-PQ/SF traits and some facets displayed associations with PERM styles supporting previous documentation, while those trait- and facet-related associations were even more specific in patients. Our results thus support the ZKA-PQ/SF application in clinical practice to aid the psychological explanation and the diagnosis of personality disorders, at least in Chinese culture.

Hypochondriac concerns and correlates of personality styles and affective states in bipolar I and II disorders

BACKGROUND

Hypochondriac concerns are associated with the treatment-difficulty of bipolar disorder, which might be due to the personality styles and affective states.

METHODS

We invited outpatients with bipolar I disorder (BD I, n = 87), bipolar II disorder (BD II, n = 92) and healthy volunteers (n = 129) to undergo the Illness Attitude Scales and Parker Personality Measure tests, and measurements of concurrent affective states.

RESULTS

Compared to healthy volunteers, BD I and BD II patients scored significantly higher on mania, hypomania and depression. BD I and BD II patients also scored significantly higher on Symptom Effect and Treatment Seeking, and BD II patients scored higher on Patho-thanatophobia and Hypochondriacal Belief. BD II in addition scored higher on Patho-thanatophobia than BD I did. In controls, the Dependent style predicted Patho-thanatophobia and Symptom Effect, Schizoid with Hypochondriacal Belief; in BD I, Narcissistic (-) with Hypochondriacal Belief, Histrionic with Patho-thanatophobia and Hypochondriacal Belief, depression with Hypochondriacal Belief, and hypomania with Symptom Effect and Hypochondriacal Belief; in BD II, depression with Symptom Effect and Hypochondriacal Belief, mania with Symptom Effect.

CONCLUSIONS

Bipolar disorder, especially BD II, is associated with greater hypochondriac concerns, which relates to personality disorder functioning styles and concurrent affective states.

Predicting personality disorder functioning styles by the Chinese Adjective Descriptors of Personality: a preliminary trial in healthy people and personality disorder patients

BACKGROUND

Cultural and personality factors might contribute to the clinical differences of psychiatric patients all over the world including China. One cultural oriented Chinese Adjective Descriptors of Personality (CADP) designed to measure normal personality traits, might be specifically associated with different personality disorder functioning styles.

METHODS

We therefore have invited 201 healthy volunteers and 67 personality disorder patients to undergo CADP, the Parker Personality Measure (PERM), and the Plutchik-van Praag Depression Inventory (PVP) tests.

RESULTS

Patients scored significantly higher on PVP scale and all 11 PERM personality disorder functioning styles, as well as CADP Emotional and Unsocial traits. The PVP was significantly correlated with some CADP traits and PERM styles in both groups. In healthy volunteers, only one CADP trait, Unsocial, prominently predicted 11 PERM styles. By contrast in patients, CADP Intelligent predicted the PERM Narcissistic and Passive-Aggressive styles; CADP Emotional the PERM Paranoid, Borderline, and Histrionic styles; CADP Conscientious the PERM Obsessive-Compulsive style; CADP Unsocial the PERM Schizotypal, Antisocial, Narcissistic, Avoidant, Dependent, and Passive-Aggressive styles; CADP Agreeable the PERM Antisocial style.

CONCLUSION

As a preliminary study, our results demonstrated that, in personality disorder patients, all five CADP traits were specifically associated with almost all 11 personality disorder functioning styles, indicating that CADP might be used as an aid to diagnose personality disorders in China.

Predicting Personality Disorder Functioning Styles by the Five-Factor Nonverbal Personality Questionnaire in Healthy Volunteers and Personality Disorder Patients

BACKGROUND

Detecting personality disorders in the illiterate population is a challenge, but nonverbal tools measuring personality traits such as the Five-Factor Nonverbal Personality Questionnaire (FFNPQ) might help. We hypothesized that FFNPQ traits are associated with personality disorder functioning styles in a predictable way, especially in a sample of personality disorder patients.

METHODS

We therefore invited 106 personality disorder patients and 205 healthy volunteers to answer the FFNPQ and the Parker Personality Measure (PERM) which measures 11 personality disorder functioning styles.

RESULTS

Patients scored significantly higher on the FFNPQ neuroticism and conscientiousness traits and all 11 PERM styles. In both groups, the 5 FFNPQ traits displayed extensive associations with the 11 PERM styles, respectively, and the associations were more specific in patients. Associations between neuroticism, extraversion and agreeableness traits and most PERM styles were less exclusive, but conscientiousness was associated with antisocial (-) and obsessive-compulsive styles, and openness to experience with schizotypal and dependent (-) styles.

CONCLUSIONS

Our study has demonstrated correlations between FFNPQ traits and PERM styles, and implies the nonverbal measure of personality traits is capable of aiding the diagnoses of personality disorders in the illiterate population. Enlarging sample size and including the illiterate might make for more stable results.

Relationship between personality disorder functioning styles and the emotional states in bipolar I and II disorders

Background

Bipolar disorder types I (BD I) and II (BD II) behave differently in clinical manifestations, normal personality traits, responses to pharmacotherapies, biochemical backgrounds and neuroimaging activations. How the varied emotional states of BD I and II are related to the comorbid personality disorders remains to be settled.

Methods

We therefore administered the Plutchick – van Praag Depression Inventory (PVP), the Mood Disorder Questionnaire (MDQ), the Hypomanic Checklist-32 (HCL-32), and the Parker Personality Measure (PERM) in 37 patients with BD I, 34 BD II, and in 76 healthy volunteers.

Results

Compared to the healthy volunteers, patients with BD I and II scored higher on some PERM styles, PVP, MDQ and HCL-32 scales. In BD I, the PERM Borderline style predicted the PVP scale; and Antisocial predicted HCL-32. In BD II, Borderline, Dependant, Paranoid (-) and Schizoid (-) predicted PVP; Borderline predicted MDQ; Passive-Aggressive and Schizoid (-) predicted HCL-32. In controls, Borderline and Narcissistic (-) predicted PVP; Borderline and Dependant (-) predicted MDQ.

Conclusion

Besides confirming the different predictability of the 11 functioning styles of personality disorder to BD I and II, we found that the prediction was more common in BD II, which might underlie its higher risk of suicide and poorer treatment outcome.

Preliminary study of relationships between hypnotic susceptibility and personality disorder functioning styles in healthy volunteers and personality disorder patients

BACKGROUND

Hypnotic susceptibility is one of the stable characteristics of individuals, but not closely related to the personality traits such as those measured by the five-factor model in the general population. Whether it is related to the personality disorder functioning styles remains unanswered.

METHODS

In 77 patients with personality disorders and 154 healthy volunteers, we administered the Stanford Hypnotic Susceptibility Scale: Form C (SHSSC) and the Parker Personality Measure (PERM) tests.

RESULTS

Patients with personality disorders showed higher passing rates on SHSSC Dream and Posthypnotic Amnesia items. No significant correlation was found in healthy volunteers. In the patients however, SHSSC Taste hallucination (β=0.26) and Anosmia to Ammonia (β=-0.23) were significantly correlated with the PERM Borderline style; SHSSC Posthypnotic Amnesia was correlated with the PERM Schizoid style (β=0.25) but negatively the PERM Narcissistic style (β=-0.23).

CONCLUSIONS

Our results provide limited evidence that could help to understand the abnormal cognitions in personality disorders, such as their hallucination and memory distortions.

The Zuckerman-Kuhlman Personality Questionnaire predicts functioning styles of personality disorder: a trial in healthy subjects and personality-disorder patients

Normal personality traits, as measured by the Zuckerman-Kuhlman Personality Questionnaire (ZKPQ), predicted some personality disorders in a sample of healthy volunteers. Whether these predictions could be more pronounced in patients with personality disorders remains unknown. We administered the ZKPQ and the Parker Personality Measure (PERM), which describes the functioning styles of personality disorder, in 134 patients with a range of personality disorders and in 268 age-, gender- and education level-matched healthy volunteers. Cluster A patients scored lowest on Sociability, cluster B highest on Impulsive Sensation Seeking and Aggression-Hostility, cluster C1 (Avoidant and Dependent types) highest on Neuroticism-Anxiety, and cluster C2 (Obsessive-Compulsive type) highest on Activity. Most of the predictors were consistent across both the healthy and patient groups. The variances that accounted for predicting most PERM styles by the ZKPQ traits in the patient group were higher than those in the healthy group. Our results showed that the ZKPQ traits could specifically predict the PERM styles in both healthy subjects and personality-disorder patients. This result was more pronounced in the latter group. The most powerful predictions were obtained for Antisocial, Dependent, Borderline and Avoidant styles, and the weakest for the Schizotypal and Schizoid styles in the patient group.

Alexithymia and personality disorder functioning styles in paranoid schizophrenia

OBJECTIVES

Personality disorder functioning styles might contribute to the inconclusive findings about alexithymic features in schizophrenia. We therefore studied the relationship between alexithymia and personality styles in paranoid schizophrenia.

METHODS

We administered the Chinese versions of the Toronto Alexithymia Scale (TAS-20), the Parker Personality Measure (PERM), the Positive and Negative Syndrome Scale as well as the Hamilton Anxiety and Depression Scales to 60 paranoid schizophrenia patients and 60 healthy control subjects.

RESULTS

Patients scored significantly higher on the Positive and Negative Syndrome Scale, TAS 'difficulty identifying feelings' and 'difficulty describing feelings', Hamilton Depression Scale and most PERM scales. In healthy subjects, difficulty identifying feelings predicted the PERM 'dependent' style, and the Hamilton Anxiety Scale predicted difficulty identifying feelings and difficulty describing feelings. In patients, difficulty identifying feelings nonspecifically predicted all the PERM scales; by contrast, the PERM 'antisocial' style predicted difficulty identifying feelings, the 'avoidant' style predicted difficulty describing feelings, and the 'histrionic' and 'paranoid (-)' styles predicted 'externally oriented thinking'.

CONCLUSIONS

Personality disorder functioning styles - instead of anxiety, depression, psychotic symptoms or disease duration - were specifically associated with alexithymia scales in our patients, which sheds light on a cognitive-personological substrate in paranoid schizophrenia on the one hand, and calls for a longitudinal design to discover how premorbid or postacute residual personality styles contribute to the sluggish disorder on the other.

Protocol: Personality assessment as a support for referral and case-work in treatment for substance use disorders (PASRC-study)

BACKGROUND

Assessment of co-morbid personality disorders in substance use disorders may lead to important insights concerning individual patients. However, little is known about the potential value of routine personality disorder assessment in a clinical context.

METHODS

Patients are adults with past-year substance dependence seeking treatment at a centralized intake unit for substance abusers in the City of Copenhagen. A randomized controlled trial of assessment of personality disorders and individual feedback vs. a general life situation interview. Patients are followed at 3 and 6 months post-treatment

DISCUSSION

If routine personality assessment improves outcomes of substance abuse treatment, the clinical implication is to increase the use of personality disorder assessment in substance abuse treatment settings.

TRIAL REGISTRATION

Current controlled trials ISRCTN39851689.

PASSIVE EVENT-RELATED POTENTIALS BY A SINGLE TONE IN PERSONALITY DISORDERS

A cerebral P3 potential (passive P3) in response to a single tone shares similar morphology to the classical P3 elicited in the active “oddball” paradigm, but reflects passive attention. As patients with schizotypal, antisocial, and borderline personality disorders show reduced amplitude and prolonged latency of classical P3, it is reasonable to expect that these patients might show an abnormal passive P3. We tested whether the single tone elicited event-related potentials (ERPs) in 205 patients with personality disorders and in 30 healthy volunteers. Their Axis I symptoms of depression and anxiety were measured by Zung's Self-rating Depression Scale and Self-rating Anxiety Scale (1965, 1971). Both schizoid and paranoid groups showed significantly reduced P3 amplitude. In addition, the schizoid group showed significantly shortened N1 latency and enhanced N2 amplitude. Most patient groups except schizoids scored higher on the Depression or Anxiety scales, or both, but the ERP findings were not correlated with the Axis I symptoms in any given group alone. The abnormal negative components implied a higher vigilance or cortical arousal level in the schizoid patients, while the reduced P3 amplitude indicated a poorer passive attention in both schizoid and paranoid patients.

Mismatch negativity in paranoid, schizotypal, and antisocial personality disorders

AIMS

The mismatch negativity (MMN) to frequency deviant tones has yielded conflicting results in patients with schizophrenia. This might be because Axis I schizophrenia overlaps with Axis II diagnoses such as paranoid or schizotypal personality disorders. This study was designed to address this issue.

METHODS

We evaluated the auditory MMN to frequency deviance in 17 patients with paranoid, 15 schizotypal, and 16 antisocial personality disorders. These were compared to 25 healthy subjects.

RESULTS

N1 to both deviant and standard tones was shorter in the paranoid group when compared to healthy controls. MMN latencies were shorter at Fz, Cz, and Pz in the paranoid group when compared to healthy controls, schizotypal, and antisocial groups. MMN amplitudes were higher at Fz and Cz in the schizotypal and antisocial groups when compared to healthy controls and the paranoid group.

CONCLUSIONS

Patients with paranoid personality disorder had faster automatic detection of auditory stimuli and of their change, but normal inhibition of irrelevant stimuli. By contrast, patients with schizotypal and antisocial personality disorders had normal discrimination of the auditory stimuli, but might have a deficit in inhibition on irrelevant stimuli. Our results might help differentiate these personality types, and clarify some MMN findings in schizophrenia.

Measuring disordered personality functioning: to love and to work reprised

OBJECTIVE

Current limitations to diagnosing and measuring the personality disorders encouraged a set of studies seeking to provide an alternate approach to modeling and measuring disordered personality function.

METHOD

A large set of self-reported descriptors of disordered personality function were factor analyzed in a sample of patients with clinician-diagnosed personality dysfunction, generating 11 lower-order and two higher-order constructs. Subjects and non-clinical controls also completed a measure of personality styles underpinning formalized personality disorder groupings. Properties of the refined self-report (SR) measure were assessed in an independent sample of patients with a clinically diagnosed personality disorder.

RESULTS

Limitations in 'cooperativeness' and 'coping' formed the higher-order constructs defining disordered personality function, with these constructs relevant to all personality styles. Analyses of SR, corroborative witness (CW) and clinician-rated data in an independent sample supported measuring disordered personality function by our derived 20-item SR measure, and exposed limitations to clinician-based assessment.

CONCLUSION

Study findings build to a multi-axial strategy for measuring personality disorder, involving separate dimensional assessment of both disordered personality function and of personality style.

Studying personality characteristics in bipolar depressed subjects: how comparator group selection can dictate results

OBJECTIVE

To examine the extent to which identification of any distinct personality characteristics in bipolar subjects are influenced by selection of the comparison diagnostic group.

METHOD

Scores were compared on several general measures of personality style and, additionally, the prevalence of disordered personality functioning was examined in a sample of 198 non-psychotic depressed subjects, 39 with bipolar depression and 159 with unipolar depression.

RESULTS

When the bipolar subjects were separately compared with unipolar subjects, and to sub-sets of those with clinically and DSM-IV defined melancholic and non-melancholic depression, quite differing results were suggested. In essence, clinically-defined melancholic subjects had the least personality psychopathology in comparison with the non-melancholic and bipolar subjects.

CONCLUSION

Whether subjects with bipolar disorder have any distinct personality characteristics or over-represented co-morbid personality disorders remains quite unclear when reference is made to the literature. We suggest that inconsistencies across studies may reflect choice and representation of depressive sub-types within the unipolar comparator group.

Functioning styles of personality disorders and five-factor normal personality traits: a correlation study in Chinese students

BACKGROUND

Previous studies show that both the categorical and dimensional descriptors of personality disorders are correlated with normal personality traits. Recently, a 92-item inventory, the Parker Personality Measure (PERM) was designed as a more efficient and precise first-level assessment of personality disorders. Whether the PERM constructs are correlated with those of the five-factor models of personality needs to be clarified.

METHODS

We therefore invited 913 students from poly-technical schools and colleges in China to answer the PERM, the Five-Factor Nonverbal Personality Questionnaire (FFNPQ), and the Zuckerman-Kuhlman Personality Questionnaire (ZKPQ).

RESULTS

Most personality constructs had satisfactory internal alphas. PERM constructs were loaded with FFNPQ and ZKPQ traits clearly on four factors, which can be labelled as Dissocial, Emotional Dysregulation, Inhibition and Compulsivity, as reported previously. FFNPQ Openness to Experience, Conscientiousness and Extraversion formed another Factor, named Experience Hunting, which was not clearly covered by PERM or ZKPQ.

CONCLUSION

The PERM constructs were loaded in a predictable way on the disordered super-traits, suggesting the PERM might offer assistance measuring personality function in clinical practice.