Behavioral and molecular genetic contributions to a dimensional classification of personality disorder

The problem of overcontrol: Perfectionism, emotional inhibition, and personality disorders

BACKGROUND AND AIMS

Some individuals with Personality Disorders (PD), particularly of a non-Borderline type, present with difficulties relating to over-control of cognitions, emotion and behavior, perfectionistic traits, and impaired social interactions. The current study sought to evaluate the strength of association, and interactions of both emotional inhibition and perfectionism in PD's, after controlling for symptoms and interpersonal problems.

METHOD

We recruited a sample of 578 treatment seeking outpatients. Diagnosis of PD was made with the SCID-II. Individual's completed measures of perfectionism (Frost-MPS), Emotional Inhibition (EIS), Depression (BDI-II), Anxiety (STAI-Y), Global symptoms (SCL-90-R), and interpersonal problems (IIP-32).

RESULTS

Perfectionism was related to interpersonal problems, to the majority of PD symptomatology and to PD severity via number of SCID-II criteria met. Emotional inhibition was linked to symptoms and interpersonal problems as well as with avoidant, dependent, depressive and paranoid PDs; and with overall PD Severity. Inhibition and perfectionism were correlated with each other. Both variables predicted PD above and beyond other variables assessed. Mediation modeling demonstrated that the effect of emotional inhibition on PD severity was fully mediated by perfectionism and interpersonal problems.

CONCLUSIONS

Psychological mechanisms of overcontrol are a maintaining factor in many PDs. Both perfectionism and emotional inhibition impact on a broad range of PDs and there is an urgent need for research into these processes, and to adapt psychological interventions to consider these factors.

Genetic and Environmental Structure of DSM-IV Criteria for Antisocial Personality Disorder: A Twin Study

Results from previous studies on DSM-IV and DSM-5 Antisocial Personality Disorder (ASPD) have suggested that the construct is etiologically multidimensional. To our knowledge, however, the structure of genetic and environmental influences in ASPD has not been examined using an appropriate range of biometric models and diagnostic interviews. The 7 ASPD criteria (section A) were assessed in a population-based sample of 2794 Norwegian twins by a structured interview for DSM-IV personality disorders. Exploratory analyses were conducted at the phenotypic level. Multivariate biometric models, including both independent and common pathways, were compared. A single phenotypic factor was found, and the best-fitting biometric model was a single-factor common pathway model, with common-factor heritability of 51% (95% CI 40-67%). In other words, both genetic and environmental correlations between the ASPD criteria could be accounted for by a single common latent variable. The findings support the validity of ASPD as a unidimensional diagnostic construct.

Emotional dysregulation and trauma predicting psychopathy dimensions in female and male juvenile offenders

BACKGROUND

Psychopathy is a specific syndrome that predicts future violent and aggressive behavior in adults. Studies in youth and adults have demonstrated a strong association between early traumatic incidents and later dissocial behavior. Moreover, the impact of personality pathology and emotional dysregulation on aggressive and violent behavior is well established. However, few studies have addressed the relationship between early traumatization and psychopathic traits in adolescents.

METHOD

The present study examined associations between both general dimensions of personality pathology and early traumatic experiences and the dimensions of psychopathy in 170 male and 171 female adolescent detainees.

RESULTS

Analyses revealed associations between physical abuse, emotional dysregulation and psychopathic traits in delinquent boys but not in delinquent girls.

CONCLUSION

Hypothesized relationships between trauma, personality pathology could only be confirmed in the lifestyle and antisocial, but not in the core affective and interpersonal facets of psychopathy.

The Relationship Between Psychopathology and a Hierarchical Model of Normal Personality Traits: Evidence From a Psychiatric Patient Sample

Shifts in the conceptualization of psychopathology have favored a dimensional approach, with the five-factor model (FFM) playing a prominent role in this research. However, reservations about the utility of the FFM in differentiating disorders have risen. In the current investigation, a "bottom-up" analytical method was used to ascertain the hierarchical structure of personality, with investigation of the specificity of the traits in categorizing diagnostic categories across an expanded array of psychiatric disorders. Following earlier investigations, which used a hierarchical structural approach, this study presents new results relating to the differentiation of several forms of psychopathology not included in these earlier analyses--bipolar disorder, psychotic disorders, problem gambling, posttraumatic stress disorder, and somatoform disorders--across distinct levels of a personality hierarchy based on the FFM. These results bolster the argument for the use of FFM personality traits in characterizing and differentiating psychiatric diagnostic groups.

An item response theory integration of normal and abnormal personality scales

The Diagnostic and Statistical Manual of Mental Disorders (DSM–IV–TR) currently conceptualizes personality disorders (PDs) as categorical syndromes that are distinct from normal personality. However, an alternative dimensional viewpoint is that PDs are maladaptive expressions of general personality traits. The dimensional perspective postulates that personality pathology exists at a more extreme level of the latent trait than does general personality. This hypothesis was examined using item response theory analyses comparing scales from two personality pathology instruments—the Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ; Livesley & Jackson, in press) and the Schedule for Nonadaptive and Adaptive Personality (SNAP; Clark, 1993; Clark, Simms, Wu, & Casillas, in press)—with scales from an instrument designed to assess normal range personality, the NEO Personality Inventory–Revised (NEO PI-R; Costa & McCrae, 1992). The results indicate that respective scales from these instruments assess shared latent constructs, with the NEO PI-R providing more information at the lower (normal) range and the DAPP-BQ and SNAP providing more information at the higher (abnormal) range. Nevertheless, the results also demonstrated substantial overlap in coverage. Implications of the findings are discussed with respect to the study and development of items that would provide specific discriminations along underlying trait continua.

Stabilität von Persönlichkeitspathologie bei jugendlichen Delinquenten

In dieser Follow-up-Studie wurde die Stabilität dimensional erfasster Persönlichkeitspathologie in einer Stichprobe ehemals inhaftierter weiblicher und männlicher Jugendlicher nach Ablauf von anderthalb Jahren untersucht. Es wurden 71 weibliche und männliche Jugendliche aus einer Kohorte vormals Inhaftierter im Mittel 17,1 Monate nach der Ersterhebung mit dem Dimensional Assessment of Personality Pathology- Basic Questionnaire (DAPP-BQ) nachuntersucht. Zur Klärung der Frage einer signifikanten Mittelwertsveränderung über die beiden Erhebungszeitpunkte hinweg wurde eine univariate Varianzanalyse mit Messwiederholung und zudem Rangkorrelationen berechnet. Die Ausprägungen für die DAPP-Subskalen Kognitive Verzerrung, Affektive Labilität, Argwohn, Unsichere Bindung, Reizsuche und Hartherzigkeit erwiesen sich als stabil. Demgegenüber waren signifikante Mittelwertsveränderungen bezüglich Identitätsprobleme, Oppositionalität, Selbstschädigung und Verhaltensprobleme auszumachen. Die vorliegenden Resultate entsprachen Ergebnissen mehrerer aktueller longitudinaler Studien. Als instabil erwiesen sich von anderen Autoren als „dysfunktionales Verhalten“ beschriebene persönlichkeitspathologische Merkmale, wohingegen stabilere Resultate für Persönlichkeitstraits (z. B. affektive Labilität und Hartherzigkeit) vorlagen. Diese Ergebnisse verweisen darauf, dass sich auch in einer Hochrisikopopulation delinquenter Jugendlicher das Konstrukt Persönlichkeit aus stabilen und instabilen Anteilen zusammensetzt. Die Auswirkungen auf die klinische Praxis werden diskutiert.

Borderline personality disorder features and mate retention tactics

The purpose of the present study was to examine the association between features of borderline personality disorder (BPD) and mate retention tactics as a means of examining an evolutionary perspective on the association between BPD features and interpersonal problems and violence in romantic relationships. Two-hundred twenty-five college student participants completed the Personality Assessment Inventory for Borderlines (PAI-BOR; Morey, 1991) and the Mate Retention Inventory-Short Form (MRI-SF; Buss, Shackelford, & McKibbin, 2008) embedded within other measures. There was a strong association between BPD features and cost-inflicting mate retention tactics, including the specific tactics of vigilance, punishing mate's infidelity threat, intrasexual threats, and sexual inducements for both men and women. There were also gender-specific associations for additional tactics. These results contribute to our understanding of problems in romantic relationships among men and women with BPD features, including violence, and to our understanding of impulsive sexual behavior among individuals with BPD features by showing how these behaviors are used as extreme, maladaptive attempts at mate retention.

Persönlichkeitsstörungen im Jugendalter

Ziel dieses Beitrags ist es, die aktuelle Kontroverse zum Thema Persönlichkeitsstörungen im Jugendalter darzustellen und für den deutschsprachigen Raum Trends sowie Perspektiven in Forschung und Praxis seit 2009 zu skizzieren. Dazu wurden vor allem Publikationen aus der Kinder- und Jugendpsychiatrie und der Klinischen Kinderpsychologie neben wissenschaftlichen Beiträgen des 32. Kongresses der Deutschen Gesellschaft für Kinder- und Jugendpsychiatrie gesichtet. Aktuelle Forschungsergebnisse verweisen darauf, dass Persönlichkeitsstörungen im Jugendalter mittels der für Erwachsene entwickelten Instrumente zuverlässig erfasst werden können und diagnostiziert werden sollten. Zugleich fehlt es noch an spezifischen Instrumenten, welche die Besonderheiten von Persönlichkeitsstörungen im Jugendalter abbilden und von Adoleszenzkrisen differenzieren können. Die Prävalenz von Persönlichkeitsstörungen scheint im Jugendalter höher als im Erwachsenenalter zu liegen. Eine Subform der antisozialen Persönlichkeitsstörung, die auch bei Jugendlichen zu finden ist, stellt die Psychopathy dar. Insgesamt wird deutlich, dass es noch weiterer diagnostischer Langzeitstudien bedarf, um zu klären, unter welchen Bedingungen Persönlichkeitsstörungen manifest werden, welche Faktoren ihren Verlauf beeinflussen und wie sie sich durch Interventionen verändern lassen.

Self-report methodology is insufficient for improving the assessment and classification of Axis II personality disorders

Current approaches to the assessment and classification of personality disorders (PDs) rely almost exclusively on self-report methodology. In this paper, we document the many difficulties with self-reports, including limitations in their accuracy, the confounding effect of mood state, and problems with the selection and retention of factors in factor analytic approaches to self-report questionnaires. We also discuss the role of implicit processes in self-reports, with special attention directed to the phenomenon of priming and its effect on outcome. To rectify these issues, we suggest a transtheoretical, multimethod, multimodal approach to personality pathology assessment and diagnosis, which utilizes the richness of prototypes and empirical findings on PD categories and pathologies.

The hierarchical structure of the Dimensional Assessment of Personality Pathology (DAPP-BQ)

Hierarchical personality models have the potential to identify common and specific components of DSM-IV personality disorders (PDs), and may offer a solution for the re-tooling of personality pathology in future versions of the DSM. In this paper, we examined the hierarchical structure of the Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ; Livesley & Jackson, 2009) and the capacity of various trait components at different levels to predict DSM-IV PD symptoms. Participants were 275 psychiatric outpatients and 365 undergraduate students. Goldberg's (2006) bass-ackwards method was used to investigate the hierarchical structure of the DAPP-BQ. The predictive capacity of hierarchy components was assessed. We found that Level 5 of the hierarchy enhanced the capacity of the DAPP-BQ for predicting DSM PD symptoms beyond a four-factor structure, particularly for borderline PD.

Clinician's judgments of the utility of the DSM-IV and five-factor models for personality disordered patients

The purpose of the current study was to examine the clinical utility of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 2000) and the Five Factor Model of personality disorder (FFM; Widiger, Costa, & McCrae, 2002) in describing personality pathology. In the current study, practicing psychologists described one or two of their personality disordered patients in terms of the FFM and DSM models. In some instances, the patient was someone who met the criteria for one of the 10 DSM-IV personality disorders; in others, the patient was someone who received a diagnosis of personality disorder, not otherwise specified. Participants then rated each model on six aspects of clinical utility. The current study found that the FFM was consistently rated higher than the DSM model in terms of four of the six aspects of clinical utility. Across both cases, the clinicians rated the FFM as significantly more useful with respect to its ability to provide a global description of the individual's personality, to communicate information to clients, and to encompass all of the individual's important personality difficulties.

A multivariate perspective on schizotypy and familial association with schizophrenia: a review

Although generally accepted that schizotypal personality disorder diagnosis is more prevalent among relatives of individuals with schizophrenia and may be associated with genetic liability to schizophrenia, it seems likely that this diagnosis is itself heterogeneous and thus perhaps not as useful in identifying genes that affect schizophrenia risk (i.e. endophenotypes) as it could be. In contrast, symptoms and dimensions of schizotypal personality disorder may be more etiologically homogeneous, and thus more useful in genetic studies. The current review evaluated and consolidated evidence to date regarding specific symptoms and dimensions of schizotypal personality disorder among non-psychotic relatives of schizophrenia patients. Comparisons were made with relatives of affective disorder patients and non-psychiatric controls. Findings indicate strong support for elevation of social-interpersonal schizotypal symptoms among relatives of schizophrenia patients versus other groups along with moderate specificity. Results suggest only a small elevation of cognitive-perceptual and disorganized symptoms in relatives of schizophrenia patients and results for disorganized symptoms were inconsistent across studies. Thus, evidence to date supports further investigation of genetic associations between symptoms of schizotypal personality disorder and schizophrenia, and suggests that social-interpersonal symptoms may be particularly promising in genetic analyses of schizophrenia.

Integrating normal and abnormal personality structure: a proposal for DSM-V

The personality disorders section of the American Psychiatric Association's fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) is currently being developed. The purpose of the current paper is to encourage the authors of DSM-V to integrate normal and abnormal personality structure within a common, integrative model, and to suggest that the optimal choice for such an integration would be the five-factor model (FFM) of general personality structure. A proposal for the classification of personality disorder from the perspective of the FFM is provided. Discussed as well are implications and issues associated with an FFM of personality disorder, including validity, coverage, feasibility, clinical utility, and treatment implications.

Endophenotypes and the diagnosis of personality disorders

It has been suggested that psychiatric diagnosis should come to depend on endophenotypes, in order to define more precisely the mechanisms behind mental disorders. This construct is associated with the assumption that mental processes can be reduced to activity at a neuronal level. The approach has had a strong influence on the conceptual basis of proposals for DSM-5, but could be consistent either with categorical or dimensional diagnosis. However, application of endophenotypes to personality disorders is unlikely for the foreseeable future, given an insufficient knowledge of etiology and pathogenesis.

Familial aggregation of personality disorder: epidemiological evidence from high school students 18 years and older in Beijing, China

BACKGROUND

There has been evidence from Western countries of the familial aggregation of personality disorder (PD) in clinical populations. Nonetheless, it is not clear if the results apply to nonclinical population or non-Western countries. The aim of this study is to provide evidence about the familial aggregation of PD using an epidemiological sample of high school students and their parents in Beijing, China.

METHOD

A sample of high school students (at least 18 years old) and their parents was drawn by stratified cluster sampling. Personality disorder in students was assessed via a two-stage approach, Personality Diagnostic Questionnaire (PDQ) as a screening tool and International Personality Disorder Examination as the diagnostic tool. Parents completed the PDQ. Univariate and multivariate analyses were used to address the familial aggregation of PD.

RESULTS

Students' PDQ scores were correlated with parents' PDQ scores. Parents of PD students scored higher in PDQ and were more likely to be PD cases than controls' parents (adjusted odds ratio, 6.4-18.8).

LIMITATIONS

Student controls and parents are only assessed by PDQ-4.

CONCLUSION

Obvious familial aggregation of PD was observed in this study. Psychiatrists may consider asking about family history when diagnosing PD.

A unifying perspective on personality pathology across the life span: developmental considerations for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders

Proposed changes in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) include replacing current personality disorder (PD) categories on Axis II with a taxonomy of dimensional maladaptive personality traits. Most of the work on dimensional models of personality pathology, and on personality disorders per se, has been conducted on young and middle-aged adult populations. Numerous questions remain regarding the applicability and limitations of applying various PD models to early and later life. In the present paper, we provide an overview of such dimensional models and review current proposals for conceptualizing PDs in DSM-V. Next, we extensively review existing evidence on the development, measurement, and manifestation of personality pathology in early and later life focusing on those issues deemed most relevant for informing DSM-V. Finally, we present overall conclusions regarding the need to incorporate developmental issues in conceptualizing PDs in DSM-V and highlight the advantages of a dimensional model in unifying PD perspectives across the life span.

Childhood antecedents of personality disorder: an alternative perspective

One of the fundamental limitations of the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition, Text Revision (DSM-IV-TR) categorical model of personality disorder classification has been the lack of a strong scientific foundation, including an understanding of childhood antecedents. The DSM-IV-TR personality disorders, however, do appear to be well understood as maladaptive variants of the domains and facets of the general personality structure as conceptualized within the five-factor model (FFM). Integrating the classification of personality disorder with the FFM brings to an understanding of the personality disorders a considerable body of scientific research on childhood antecedents. The temperaments and traits of childhood do appear to be antecedent to the FFM of adult personality structure, and these temperament and traits of childhood and adolescence are the likely antecedents for adult personality disorder, providing further support for the conceptualization of the adult personality disorders as maladaptive variants of the domains and facets of the FFM. Conceptualizing personality disorders in terms of the FFM thereby provides a basis for integrating the classification of abnormal and normal personality functioning across the life span.

Revising the personality disorder diagnostic criteria for the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-V): consider the later life context

The categorical measurement approach implemented by the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) personality disorder (PD) diagnostic system is theoretically and pragmatically limited. As a result, many prominent psychologists now advocate for a shift away from this approach in favor of more conceptually sound dimensional measurement. This shift is expected to improve the psychometric properties of the personality disorder (PD) diagnostic system and make it more useful for clinicians and researchers. The current article suggests that despite the probable benefits of such a change, several limitations will remain if the new diagnostic system does not closely consider the context of later life. A failure to address the unique challenges associated with the assessment of personality in older adults likely will result in the continued limited validity, reliability, and utility of the Diagnostic and Statistical Manual of Mental Disorders (DSM) system for this growing population. This article discusses these limitations and their possible implications.

What should become of depressive personality disorder in DSM-V?

Depressive personality disorder (DPD) has been under consideration for inclusion in the Diagnostic and Statistical Manual of Mental Disorders for many years. The wealth of empirical studies on the validity of DPD has raised many questions about the validity of the DPD construct and its measures. This article specifically reviews studies on the validity of that construct and how it is measured. Although the evidence supports the idea that DPD is a viable diagnostic category, there remain significant challenges to its assessment. These findings are discussed in the context of some potential changes that may occur in the classification and diagnosis of personality disorders in DSM-V.

Structures of personality and their relevance to psychopathology: II. Further articulation of a comprehensive unified trait structure

There is increasing agreement that the current categorical system of personality disorders (PDs) in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 2000) should be replaced by a trait dimensional scheme in DSM-V. In particular, the consensus appears to be converging on a hierarchical Big Four model. The broad factors that form the apex of this hierarchy are essentially maladaptive variants of the Big Five traits of normal personality, minus Openness. We argue that this Big Four model is incomplete, however, in that it fails to model characteristics related to the "odd or eccentric" Cluster A PDs adequately. We report the results of three studies that examine these odd, eccentric characteristics in relation to basic dimensions of normal and abnormal personality. The results of these studies establish the existence of an Oddity factor that is (a) broader than the Cluster A traits and (b) distinct from Openness and the other Big Five dimensions. Consequently, its addition yields an alternative five-factor model of personality pathology (considering only abnormal traits) and an expanded, integrated Big Six taxonomy that subsumes both normal and abnormal personality characteristics.

Research trends and directions in the study of personality disorder

An examination of current research trends needs to consider both the prerequisites for research and the specific research directions needed to arrive at a more systematic understanding of the etiology, development, course, and treatment of personality disorder. Important prerequisites are improved phenotypes and more sophisticated research designs to explicate mechanisms specific to the various patterns of personality disorder. Specific research themes with promise are systematic studies of gene-environment interplay, investigations of biological substrates, and longitudinal studies capable of generating information on how the different domains of personality pathology change over time. There also needs to be a new generation of treatment research that is less concerned with comparing the outcome of treatments that often seem modest in effects and limited in scope and more concerned with identifying the most effective treatment methods for each domain of psychopathology. Along with these developments it is also important that research pays more attention to how the integrative processes within personality become dysfunctional in personality disorder.

Genetics of personality disorders

This review of the literature on genetic contributions to the etiology of personality disorders broadly follows the DSM classification, and begins by evaluating the current evidence for genetic influences on the DSM axis II disorders. One of the most exciting directions in psychiatric genetics is the rapidly developing field of molecular genetic studies aiming to identify specific genes correlated with psychiatric phenotypes. Personality disorders, like most other psychiatric diagnostic categories, are etiologically complex, which implies that they are influenced by several genes and several environmental factors. The interplay between genes and the environment is a field that is receiving increasing attention and is addressed both in relation to quantitative and molecular methods.

Psychopathy as a clinical and empirical construct

In this review, we focus on two major influences on current conceptualizations of psychopathy: one clinical, with its origins largely in the early case studies of Cleckley, and the other empirical, the result of widespread use of the Hare Psychopathy Checklist-Revised (PCL-R) for assessment purposes. Some investigators assert that the PCL-R, ostensibly based on Cleckley's work, has "drifted" from the construct described in his Clinical Profile. We evaluate this profile, note its basis in an unrepresentative sample of patients, and suggest that its literal and uncritical acceptance by the research community has become problematical. We also argue that the idea of construct "drift" is irrelevant to current conceptualizations of psychopathy, which are better informed by the extensive empirical research on the integration of structural, genetic, developmental, personality, and neurobiological research findings than by rigid adherence to early clinical formulations. We offer some suggestions for future research on psychopathy.

Depressive personality disorder, dysthymia, and their relationship to perfectionism

This paper reports the results of two studies in a nonclinical (n=105) and primary care outpatient sample (n=110), in which Depressive Personality Disorder (DPD), Dysthymia, and depression were assessed for their distinctive relationship with perfectionism. Results from both studies found that self-reported DPD, Dysthymia, and depressive symptoms were all intercorrelated, and that DPD, Dysthymia, and depressive symptoms were correlated with three dimensions of perfectionism-Concern over Mistakes, Doubts about Actions, and Parental Criticism. In the nonclinical sample, variance in measures of DPD was predicted by measures of perfectionism after controlling for depression and Dysthymia symptoms. A similar pattern of findings was observed in the primary care sample. This relationship with perfectionism did not occur when Dysthymia or depressive symptoms were predicted. Nevertheless, much of the variance in measures of DPD, Dysthymia, and depressive symptoms is associated with each other and not perfectionism. It is concluded that a common factor or set of factors underlies these disorders, but that DPD may be more strongly related to perfectionism than Dysthymia and depression. As a common factor(s) is identified, measures of DPD and Dysthymia may be refined, thereby increasing the discriminant validity of their measures.

The Behavioral Genetics of Personality Disorder

Behavioral genetics research has opened a new window on understanding personality disorder. The earliest studies were focused on establishing the relative contributions of genes and the environment in these disorders. Although these studies provided solid evidence of the importance of genetic and environmental influences on personality disorder and showed that all aspects of personality disorder are subject to genetic influence, heritability studies are limited because they are not helpful in explicating causal mechanisms. More recent research has focused on the relative contributions of the covariation of personality disorder diagnoses and traits, which allows one to examine etiological relationships. These developments are leading to major changes in ideas about what constitutes the environment and nature of the interplay between genes and environment. The present review examines major themes in this growing body of research in the context of current issues in the personality disorders.

Implications of fMRI and genetics for the law and the routine practice of forensic psychiatry

This review outlines recent neurobiological findings in humans relevant for the practice of law and forensic psychiatry. We focus on offenders with antisocial personality disorder and on sex offenders. In addition, the impact of risk polymorphisms in monoamine oxidase A (MAO-A), previously related to violence in interaction with the environment, on brain structure and function and on personality traits in healthy persons are presented. While increasing knowledge of functional and structural alterations provides a better understanding of the neurobiological underpinnings of delinquent behaviour, antisocial and violent behaviour arises from a complex pattern of biological, psychological, social and situational factors, precluding a stance of simple biological reductionism. Rather, optimal integration of neurobiological findings requires cooperation among many disciplines such as medicine, criminology, sociology, psychology, politics and neuroscience.

Psychometric characteristics of Cloninger's criteria for personality disorder in a population of French prisoners

Cloninger has proposed a new procedure to assess personality disorders on the basis of his model of temperament and character. We explored the psychometric characteristics of this instrument in 560 male prisoners, using factor analyses. Results showed that the 20 items relating to the general personality criteria have acceptable internal consistency and that the three-factor structure of the temperament items used to subtype personality disorder are correctly identified by a maximum likelihood factor analysis model with varimax rotation. Overall, 32% of prisoners had a personality disorder according to this model, and it was possible to subtype 68% of these. This new diagnostic procedure for personality disorder seemed to have satisfactory basic psychometric characteristics but further study is required to explore the concurrent validity and the reliability of this instrument.

An overview of issues related to categorical and dimensional models of personality disorder assessment

Despite long-standing efforts to improve the current diagnostic system for Axis II, problems remain with the categorical conceptualization of personality disorders (PDs). Due in part to these problems, interest has developed in dimensional models of PD classification. In this article, we discuss four issues relevant to categorical vs. dimensional assessment of PDs: (a) problems with self-reports in PD patients, (b) methodological issues in behavioral and clinician assessment of PDs, (c) challenges that arise when dimensional models are applied to patient and nonpatient samples, and (d) clinical implications of categorical and dimensional PD models. We suggest that researchers and clinicians address these concerns to avoid implementing a new PD assessment model that-although different from the current system-would otherwise remain fraught with difficulties.

A Psychoanalytic Clinician Looks at Diagnostic Labels and Diagnostic Classification Systems

As psychoanalytic clinicians, we do not believe that assessment should be diagnosis based. However, we are supportive of attempts to create a diagnostic classification system that reflects something essential about human nature and also serves clinical purposes. In this article, we present a psychoanalytic diagnostic scheme that combines a more descriptive characterological diagnosis with a more structural level of personality organization diagnosis. The scheme is applied to a clinical case and then we discuss it in terms of the functions such a scheme provides for assessment.

Assessment and diagnosis of personality disorder: perennial issues and an emerging reconceptualization

This chapter reviews recent (2000-2005) personality disorder (PD) research, focusing on three major domains: assessment, comorbidity, and stability. (a) Substantial evidence has accrued favoring dimensional over categorical conceptualization of PD, and the five-factor model of personality is prominent as an integrating framework. Future directions include assessing dysfunction separately from traits and learning to utilize collateral information. (b) To address the pervasiveness and extent of comorbidity, researchers have begun to move beyond studying overlapping pairs or small sets of disorders and are developing broader, more integrated common-factor models that cross the Axis I-Axis II boundary. (c) Studies of PD stability have converged on the finding that PD features include both more acute, dysfunctional behaviors that resolve in relatively short periods, and maladaptive temperamental traits that are relatively more stable-similar to normal-range personality traits-with increasing stability until after 50 years of age. A new model for assessing PD-and perhaps all psychopathology-emerges from integrating these interrelated reconceptualizations.

Personality disorder research agenda for the DSM-V

The American Psychiatric Association is sponsoring a series of international conferences to set a research agenda for the development of the next edition of the diagnostic manual. The first conference in this series, "Dimensional Models of Personality Disorder: Etiology, Pathology, Phenomenology, and Treatment," was devoted to reviewing the existing research and setting a future research agenda that would be most effective in leading the field toward a dimensional classification of personality disorder. The purpose of this article, authored by the Steering Committee of this conference, was to provide a summary of the conference papers and their recommendations for research. Covered herein are the reviews and recommendations concerning alternative dimensional models of personality disorder, behavioral genetics and gene mapping, neurobiological mechanisms, childhood antecedents, cross-cultural issues, Axes I and II continuity, coverage and cutoff points for diagnosis, and clinical utility.