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Huprich SK. Personality-driven depression: The case for malignant self-regard (and depressive personalities). J Clin Psychol 2019; 75:834-845. [PMID: 30768792 DOI: 10.1002/jclp.22760] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Many patients with chronic depression are not well-treated. In part, this is due to the underlying personality dynamics that maintain the depressive experience are ignored. In this paper, I describe the concept of malignant self-regard, a derivative of the depressive personality. I describe briefly its origins in the clinical and empirical literature and focus upon the presentation of a case of a patient who displays a prototypic manifestation of malignant self-regard. I offer some ideas for how to manage such patients, with a focus on countertransference experiences that can be used to inform treatment.
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Affiliation(s)
- Steven K Huprich
- Department of Psychology, University of Detroit Mercy, Detroit, Michigan
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Jiménez-Maldonado ME, Gallardo-Moreno GB, Villaseñor-Cabrera T, González-Garrido AA. [Dysthymia in the Clinical Context]. ACTA ACUST UNITED AC 2013; 42:212-8. [PMID: 26572816 DOI: 10.1016/s0034-7450(13)70008-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 11/12/2012] [Indexed: 11/26/2022]
Abstract
Dysthymia is defined as a chronic mood disorder that persists for at least two years in adults, and one year in adolescents and children. According to DSM IV-TR, Dysthymia is classified into two subtypes: early-onset, when it begins before 21 years-old, and late onset Dysthymia, when it starts after this age. Before age 21, symptoms of conduct disorder, attention deficit disorder and hyperactivity with a few vegetative symptoms are usually present. It is important to distinguish it from other types of depression, as earlier as possible. This would allow providing these patients with the appropriate treatment to attenuate the impact of symptoms, such as poor awareness of self-mood, negative thinking, low self-esteem, and low energy for social and family activities, which progressively deteriorate their life quality. The etiology of Dysthymia is complex and multifactorial, given the various biological, psychological and social factors involved. Several hypotheses attempt to explain the etiology of Dysthymia, highlighting the genetic hypothesis, which also includes environmental factors, and an aminergic hypothesis suggesting a deficiency in serotonin, norepinephrine and dopamine in the central nervous system. From our point of view, dysthymia cannot be conceived as a simple mild depressive disorder. It is a distinct entity, characterized by a chronic depressive disorder which could persist throughout life, with important repercussions on the life quality of both patients and families.
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Affiliation(s)
- Miriam E Jiménez-Maldonado
- O.P.D. Hospital Civil Fray Antonio Alcalde, Guadalajara, México; Departamento de Neurociencias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, México
| | - Geisa B Gallardo-Moreno
- Departamento de Neurociencias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, México; Instituto de Neurociencias, Centro Universitario de Ciencias Biológicas y Agropecuarias, Universidad de Guadalajara, México
| | - Teresita Villaseñor-Cabrera
- O.P.D. Hospital Civil Fray Antonio Alcalde, Guadalajara, México; Departamento de Neurociencias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, México.
| | - Andrés A González-Garrido
- O.P.D. Hospital Civil Fray Antonio Alcalde, Guadalajara, México; Instituto de Neurociencias, Centro Universitario de Ciencias Biológicas y Agropecuarias, Universidad de Guadalajara, México
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Irastorza LJ, Rojano P, Gonzalez-Salvador T, Cotobal J, Leira M, Rojas C, Rubio G, Rodríguez-Rieiro C, Bellon JM, Alvarez M, Rodríguez C, Arango C. Psychometric properties of the Spanish version of the diagnostic interview for depressive personality. Eur Psychiatry 2012; 27:582-90. [PMID: 21296561 DOI: 10.1016/j.eurpsy.2010.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 11/15/2010] [Accepted: 11/16/2010] [Indexed: 10/18/2022] Open
Abstract
The aim of this study was to evaluate the reliability and validity of the Spanish-language version of the diagnostic interview for depressive personality (DIDP). The DIDP was administered to 328 consecutive outpatients and the test-retest and inter-rater reliability were assessed. Factor analysis was used in search of factors capable of explaining the scale and a cutoff point was established. The DIDP scales showed adequate Cronbach's α values and acceptable test-retest and inter-rater reliability coefficients. Convergent and discriminant validity were explored, the latter with respect to avoidant and borderline personality disorders. The results of the factor analysis were consistent with the four-factor structure of the DIDP scales. The receiver operating characteristic (ROC) analysis revealed the area under the curve to be 0.848. We found 30 to be a good cutoff point, with a sensitivity of 74.5% and a specificity of 78.5%. The DIDP proved to be a reliable and valid instrument for assessing depressive personality disorder, at least among our outpatients. The psychometric properties of the DIDP support its clinical usefulness in assessing depressive personality.
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Affiliation(s)
- L J Irastorza
- Mental Health Centre, Arganda del Rey, Hospital Virgen de la Torre, 28500 Madrid, Spain.
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Chamberlain J, Huprich SK. The depressive personality disorder inventory and current depressive symptoms: implications for the assessment of depressive personality. J Pers Disord 2011; 25:668-80. [PMID: 22023303 DOI: 10.1521/pedi.2011.25.5.668] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The Depressive Personality Disorder Inventory (DPDI; Huprich, Margrett, Barthelemy, & Fine, 1996; see Appendix) was created to assess Depressive Personality Disorder in clinical and nonclinical samples. Since its creation, the DPDI has been used in multiple studies, and the psychometric properties of the measure have generally supported its reliability, convergent validity, and construct validity; however, evidence for the measure's discriminant validity has been mixed. Specifically, the DPDI tends to correlate highly with measures of current depressive symptoms, which limits its efficacy in differentiating current depressive symptoms from a depressive personality structure. A principal components analysis of 362 individuals who completed both the DPDI and Beck Depression Inventory (BDI-II; Beck, Steer, & Brown, 1996) found that 49% of the variance was accounted for in two components. Seven items from the DPDI loaded more strongly on the first component composed of many BDI-II items. These items were removed in order to create a measure believed to assess DPD without the confounding influence of current depressive symptomology. Principal components analysis of the revised measure yielded three components, accounting for 46% of the variance. The revised DPDI was used to calculate convergent, discriminant, and construct validity coefficients from measures used in former studies. Virtually no improvement in the validity coefficients was observed. It is concluded that assessing DPD via self-report is limited in its utility.
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Huprich SK, Schmitt T, Zimmerman M, Chelminski I. Combining self-defeating and depressive personality symptoms into one construct. Psychopathology 2011; 44:303-13. [PMID: 21659792 DOI: 10.1159/000323608] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Accepted: 12/13/2010] [Indexed: 11/19/2022]
Abstract
In the history of the DSM, two disorders have been proposed for consideration that shared much in common - self-defeating personality disorder (SDPD) and depressive personality disorder (DPD). In a previous paper, it was reported that SDPD (n = 34) and DPD (n = 240) shared a diagnostic overlap of 70%. It was concluded that SDPD could not be empirically supported as a diagnostic category. In this paper, the overlap of the two disorders was explored further in this same sample (n = 1,200) of psychiatric outpatients. We found that symptoms of the two disorders were positively correlated. Confirmatory factor analysis (CFA) provided strong support for a model with two distinct, but very highly correlated constructs. Based on the hypothesis that SDPD and DPD are separate but related, a second-order CFA factor was fit to the data to further examine the strong association between the two disorders. Taken collectively, it is concluded that DPD and SDPD are components of the same construct, and that the current DPD and SDPD diagnoses as proposed in the DSM are actually subtypes of a common personality pathology (i.e. a second-order factor).
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Affiliation(s)
- Steven K Huprich
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI 48197, USA.
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Miller JD, Tant A, Bagby RM. Depressive Personality Disorder: A Comparison of Three Self-Report Measures. Assessment 2009; 17:230-40. [DOI: 10.1177/1073191109356537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Depressive personality disorder (DPD) was included in the appendix of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition ( DSM-IV) for further study. Questions abound regarding this disorder in terms of its distinctiveness from extant diagnostic constructs and clinical significance.This study examines the interrelations between three assessments of DPD and their relations to pathological personality traits and disorders in a sample of undergraduates ( N = 182). The DPD indices evinced adequate convergence with each other (mean r = .60) and similar pathological personality profiles. The authors also tested the incremental validity of the DPD scores in relation to psychological functioning, after controlling for depressive symptoms and the DSM-IV personality disorders (PDs). The DPD scores manifested limited incremental validity, mainly in the form of predicting lower levels of positive affectivity. Our results suggest that this is not specific to DPD, however, as the official PDs also manifested limited incremental validity.
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Affiliation(s)
| | - Adam Tant
- University of Georgia, Athens, GA, USA
| | - R. Michael Bagby
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada, University of Toronto, Toronto, Ontario, Canada
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Maddux RE, Riso LP, Klein DN, Markowitz JC, Rothbaum BO, Arnow BA, Manber R, Blalock JA, Keitner GI, Thase ME. Select comorbid personality disorders and the treatment of chronic depression with nefazodone, targeted psychotherapy, or their combination. J Affect Disord 2009; 117:174-9. [PMID: 19217168 DOI: 10.1016/j.jad.2009.01.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Revised: 12/31/2008] [Accepted: 01/04/2009] [Indexed: 12/01/2022]
Abstract
BACKGROUND Individuals with chronic depression respond poorly to both medication and psychotherapy. The reasons for the poorer response, however, remain unclear. One potential factor is the presence of comorbid Axis II personality disorders (PDs), which occur at high rates among these patients. METHODS This study examines the moderating influence of co-occurring PDs, primarily in cluster C, among 681 chronically depressed adult outpatients who were randomly assigned to 12 weeks of treatment with nefazodone, a specialized psychotherapy for chronic depression, or their combination. RESULTS At baseline, 50.4% (n=343) of patients met criteria for one or more Axis II disorders. Following 12 weeks of treatment, patients with comorbid PDs had statistically lower depression scores (M=12.2, SD=+9.2) than patients without comorbid PDs (M=13.5, SD=+8.7). There was no differential impact of a comorbid PD on responsiveness to medication versus psychotherapy. The results did not change when the data were analyzed using an intent-to-treat sample or when individual personality disorders were examined separately. LIMITATIONS Patients with severe borderline, antisocial, and schizotypal PDs were excluded from study entry; therefore, these data primarily apply to patients with cluster C PDs and may not generalize to other Axis II conditions. CONCLUSIONS Comorbid Axis II disorders did not negatively affect treatment outcome and did not differentially affect response to psychotherapy versus medication. Treatment formulations for chronically depressed patients with certain PDs may not need to differ from treatment formulations of chronically depressed patients without co-occurring PDs.
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Abstract
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.
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Affiliation(s)
- Steven K Huprich
- Department of Psychology, Eastern Michigan University, 501 Mark Jefferson, Ypsilanti, MI 48197, USA.
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Sprock J, Fredendall L. Comparison of prototypic cases of depressive personality disorder and dysthymic disorder. J Clin Psychol 2008; 64:1293-317; discussion 1318-22. [PMID: 18825775 DOI: 10.1002/jclp.20538] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although depressive personality disorder (DPD) was included in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 1994) appendix as a proposed category needing further research, there are concerns that it overlaps excessively with dysthymic disorder (DD). The purpose of this investigation was to identify the characteristic features of representative patients with DPD and patients with DD, and to determine whether they could be distinguished by their symptoms. Two matched samples of psychologists (n=57, n=48) identified a prototypic patient with DPD or DD, provided demographic and treatment information about the patient, and rated the patient's symptoms on a series of mood and personality disorder symptoms taken from the DSM-IV and the literature. When composite descriptions were constructed using the highest rated symptoms, there was considerable overlap in symptoms of identified DPD and DD patients. The DSM-IV research criteria for DPD provided the best description of the DPD patients; however, there was a high degree of correlation between DPD and DD criteria sets. There was also considerable comorbidity, with the majority of the patients in both groups meeting criteria for DPD and DD. However, there was a significant difference in comorbid diagnoses (and other differences in family history, outcome, and treatment history that failed to reach the more stringent level of statistical significance, i.e., p<.001) suggesting that there may be some important differences between DPD and DD. Nevertheless, the symptom ratings imply blurred boundaries between DPD and DD, suggesting the need for clearer differentiation between the two disorders or the need to adopt an alternative model of classification.
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Affiliation(s)
- June Sprock
- Psychology Department, Indiana State University, Terre Haute, IN 47809, USA.
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Huprich SK, Porcerelli J, Keaschuk R, Binienda J, Engle B. Depressive personality disorder, dysthymia, and their relationship to perfectionism. Depress Anxiety 2008; 25:207-17. [PMID: 17352379 DOI: 10.1002/da.20290] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Steven K Huprich
- Department of Psychology, Eastern Michigan University, Ypsilanti, Michigan 48197, USA.
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Bagby RM, Psych C, Quilty LC, Ryder AC. Personality and depression. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2008; 53:14-25. [PMID: 18286868 DOI: 10.1177/070674370805300104] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the implications of the association between personality and depression for the understanding, assessment, and treatment of major depression. METHOD A broad range of peer-reviewed manuscripts relevant to personality and depression was reviewed. Particular emphasis was placed on etiology, stability, diagnosis, and treatment implications. RESULTS Personality features in depressed samples reliably differ from those of healthy samples. The associations between personality and depression are consistent with a variety of causal models; these models can best be compared through longitudinal research. Research demonstrates that attention to personality features can be useful in diagnosis and treatment. Indeed, personality information has been on the forefront of recent efforts to advance the current diagnostic classification system. Moreover, personality dimensions have shown recent promise in the prediction of differential treatment outcome. For example, neuroticism is associated with preferential response to pharmacotherapy rather than psychotherapy. CONCLUSIONS Consideration of personality features is crucial to the understanding and management of major depression.
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Affiliation(s)
- R Michael Bagby
- Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario.
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Ryder AG, Schuller DR, Bagby RM. Depressive personality and dysthymia: evaluating symptom and syndrome overlap. J Affect Disord 2006; 91:217-27. [PMID: 16487600 DOI: 10.1016/j.jad.2006.01.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2005] [Revised: 12/19/2005] [Accepted: 01/06/2006] [Indexed: 10/25/2022]
Abstract
BACKGROUND Depressive Personality (DP) is being evaluated for future inclusion in DSM. One recurring issue has been conceptual and empirical redundancy with Dysthymia (i.e., Dysthymic Disorder; DD). METHODS The symptom and syndrome overlap of DP and DD were tested in a clinical sample (N = 125) using both self-report and clinician ratings. RESULTS Confirmatory factor analyses of the DP and DD symptoms indicated that models which separate these two syndromes had a better fit than a model in which all symptoms were classified together, particularly for the clinician-rated data. At the same time, the syndromes were highly correlated. Binary diagnostic analysis showed that over 80% of the individuals meeting criteria for DP also met criteria for DD. As predicted, the best fit was obtained when the 'psychological' symptoms of DD-- low self-esteem and feelings of hopelessness-- were allowed to be part of both syndromes, and 82% of patients who met criteria for both DP and DD endorsed these two symptoms. LIMITATIONS Clinical ratings rather than structured diagnostic interviews were used. As well, some models required modification to improve fit. CONCLUSIONS Depressive personality traits can be empirically separated from DD symptoms, but including DP as a categorical diagnosis would lead to a high degree of diagnostic overlap. Much of this overlap is due to sharing psychological features in common. Revisions in the diagnostic system should find a way to incorporate depressive personality traits without insisting that they be diagnosed in a categorical manner.
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Affiliation(s)
- Andrew G Ryder
- Department of Psychology, PY 153-2, Concordia University, 7141 rue Sherbrooke O., Montréal, Québec Canada, H4B 1R6.
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Huprich SK, Porcerelli J, Binienda J, Karana D. Functional health status and its relationship to depressive personality disorder, dysthymia, and major depression: preliminary findings. Depress Anxiety 2006; 22:168-76. [PMID: 16189815 DOI: 10.1002/da.20116] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Controversy continues on the extent to which depressive personality disorder (DPD) and dysthymic disorder (DYST) may be differentiated. Although affective disorders often are accompanied by changes in functional health status, to date no study has examined how functional health associated with affective disorders may assist in differentiating the two disorders. In this study, we hypothesized that measures of DPD would have fewer correlations with functional health status than would measures of DYST and major depressive disorder (MDD). African American women (n=110) completed questionnaires that assessed for depressive disorders, somatic concerns, and physical health. Measures of DPD, DYST, and MDD were all significantly correlated with functional health status. When symptoms of MDD were controlled, DYST was more associated with functional health status than was a DSM-IV measure of DPD, although a self-report measure of DPD--the Depressive Personality Disorder Inventory [DPDI; Huprich et al., 1996: J Clin Psychol 52:152-159]--remained significantly correlated with functional health status. When symptoms of DYST were controlled, DSM-IV symptoms of DPD were not strongly associated with functional health status, although measures of MDD and the DPDI were correlated with functional health status. We concluded that despite the overlap in depressive symptoms and functional health status, DPD may be less associated with functional health status in a primary care population than DYST and MDD. Implications for the assessment of DPD are provided.
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Affiliation(s)
- Steven K Huprich
- Department of Psychology, Eastern Michigan University, Ypsilanti, Michigan 48197, USA.
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Saulsman LM, Coall DA, Nathan PR. The association between depressive personality and treatment outcome for depression following a group cognitive–behavioral intervention. J Clin Psychol 2006; 62:1181-96. [PMID: 16688713 DOI: 10.1002/jclp.20278] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The present study investigated the association of depressive personality traits to treatment outcome for depression. One hundred and nineteen patients with a primary diagnosis of major depression were divided into high- and low-depressive personality groups, and depression symptomatology was assessed pre- and postparticipation in a standardized group cognitive-behavioral intervention. Analyses revealed poorer pre-state and end-state functioning for the high-depressive personality group. However, rate of improvement pre- to posttreatment was comparable between the two groups. Subsequent multiple regression analyses revealed that when controlling for pretreatment depression severity, depressive personality was not a predictor of depression treatment outcome. Within the methodological parameters of the current study, depressive personality traits were not associated with a poorer response to cognitive-behavioral treatment for depression.
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Affiliation(s)
- Lisa M Saulsman
- Centre for Clinical Interventions, Northbridge, WA 6003, Australia.
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Markowitz JC, Skodol AE, Petkova E, Xie H, Cheng J, Hellerstein DJ, Gunderson JG, Sanislow CA, Grilo CM, McGlashan TH. Longitudinal comparison of depressive personality disorder and dysthymic disorder. Compr Psychiatry 2005; 46:239-45. [PMID: 16175753 DOI: 10.1016/j.comppsych.2004.09.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Few studies have compared the related diagnostic constructs of depressive personality disorder (DPD) and dysthymic disorder (DD). The authors attempted to replicate findings of Klein and Shih in longitudinally followed patients with personality disorder or major depressive disorder (MDD) in the Collaborative Longitudinal Personality Disorders Study. METHODS Subjects (N = 665) were evaluated at baseline and over 2 years (n = 546) by reliably trained clinical interviewers using semistructured interviews and self-report personality questionnaires. RESULTS Only 44 subjects (24.6% of 179 DPD and 49.4% of 89 early-onset dysthymic subjects) met criteria for both disorders at baseline. Depressive personality disorder was associated with increased comorbidity of some axis I anxiety disorders and other axis II diagnoses, particularly avoidant (71.5%) and borderline (55.9%) personality disorders. Depressive personality disorder was associated with low positive and high negative affectivity on dimensional measures of temperament. Depressive personality disorder subjects had lower likelihood of remission of baseline MDD at 2-year follow-up, whereas DD subjects did not. The DPD diagnosis appeared unstable over 2 years of follow-up, as only 31% (n = 47) of 154 subjects who had DPD at baseline and also had follow-up assessment met criteria on blind retesting. LIMITATIONS Results from this sample may not generalize to other populations. CONCLUSIONS Depressive personality disorder and dysthymic disorder appear to be related but differ in diagnostic constructs. Its moderating effect on MDD and predicted relationship to measures of temperament support the validity of DPD, but its diagnostic instability raises questions about its course, utility, and measurement.
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Affiliation(s)
- John C Markowitz
- New York State Psychiatric Institute and Columbia University, New York, NY 10032, USA.
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Huprich SK. Convergent and Discriminant Validity of Three Measures of Depressive Personality Disorder. J Pers Assess 2004; 82:321-8. [PMID: 15151808 DOI: 10.1207/s15327752jpa8203_08] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Sixty-eight outpatients from a veterans' administration psychiatry clinic and community mental health center were assessed with 3 measures of depressive personality disorder (DPD)-the Diagnostic Interview for Depressive Personality Disorder (Gunderson, Phillips, Triebwasser, & Hirschfeld, 1994), the Depressive Personality Disorder Inventory (Huprich, Margrett, Barthelemy, & Fine, 1996), and the Structured Clinical Interview for DSM-IV Axis II Disorders (First, Gibbon, Spitzer, Williams, & Benjamin, 1997a)-to evaluate their convergent and discriminant validity. Evidence supporting the measures' validity was mixed. The rate of convergence of depressive personality diagnoses across 3 measures was less than optimal, but the degree of intercorrelation among the measures was strong. Although depressive personality scores had moderate levels of intercorrelations with other personality disorders, the degree of intercorrelation decreased substantially after controlling for depressive symptoms. I conclude that further work is needed to strengthen the validity of measures of DPD.
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Affiliation(s)
- Steven K Huprich
- Department of Psychology and Neuroscience, Baylor University, Waco, Texas 76798-7334, USA.
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Abstract
Research into the relationship between depression and personality disorder is compromised by a number of methodologic factors, including differing concepts of personality disorder, the validity of a personality disorder diagnosis, the effect of mood on diagnosis, and the overlap between some personality disorder symptoms and mood symptoms. Personality pathology is common in patients with personality disorder. Reasons for this include a "scar" effect of chronic low mood on attitudes and behaviors, as well as possible risk factors via certain personality traits. The negative effect of comorbid personality disorder on treatment outcome in depressed patients may be less than previously believed. Possible reasons include treatment bias in non-controlled trials and the increasing use of selective serotonin reuptake inhibitors rather than tricyclic antidepressants. Many personality traits and disorders may be part of the psychopathology of depression and share a common origin.
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Affiliation(s)
- Roger T Mulder
- Department of Psychological Medicine, Christchurch School of Medicine, PO Box 4345, Christchurch, New Zealand.
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Abstract
In this paper, we review the empirical publications from the 1990s on the assessment of object relations (OR). Twelve different measures are referenced. Major findings of studies, conclusions, and evaluations of each measure are provided. In general, it was found that the most recent empirical literature has compared OR across diagnostic groups or evaluated therapy process and outcome by the quality of one's OR. Current strengths and limitations of the extant OR literature are provided, along with methodological recommendations to expand the utility and validity of OR assessment.
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Affiliation(s)
- Steven K Huprich
- Department of Psychology and Neuroscience, Baylor University, PO Box 97334, Waco, TX 76798-7334, USA.
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Abstract
The purpose of this study was to evaluate Widiger, Trull, Clarkin, Sanderson, and Costa's (1994) facet-level predictions about depressive personality disorder, thereby evaluating the validity of the depressive personality disorder construct. A sample of 67 patients was collected from two treatment facilities. Participants completed three different measures of depressive personality disorder and the NEO-PI-R (Costa & McCrae, 1992). All measures of depressive personality disorder were significantly correlated with three of the four predicted facets: Anxiety, Depression, and Self-Consciousness. All three measures were significantly correlated with the Vulnerability, Warmth, Gregariousness, Assertiveness, Positive Emotions, Actions, Trusts, and Achievement Striving facets. A series of regression analyses was performed. Two of the predicted facets--Self-Consciousness and Tendermindedness--were able to uniquely account for variance in all three measures of depressive personality across most analyses. However, there was a lack of specificity across other facets in predicting the depressive personality disorder. A facet-level understanding of depressive personality disorder appears to be empirically justified, and the validity of the depressive personality disorder further supported. Additional work is needed on improving the measurement of depressive personality disorder.
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Affiliation(s)
- Steven K Huprich
- Department of Psychology and Neuroscience, Baylor University, Waco, TX 76798-7334, USA.
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Shahar G, Blatt SJ, Zuroff DC, Pilkonis PA. Role of perfectionism and personality disorder features in response to brief treatment for depression. J Consult Clin Psychol 2003; 71:629-33. [PMID: 12795586 DOI: 10.1037/0022-006x.71.3.629] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Using data from the Treatment of Depression Collaborative Research Program (TDCRP), the authors compared the role of patients' perfectionism and features of personality disorder (PD) in the outcome of brief treatment for depression. Data were extracted as to patients' intake levels of symptoms; perfectionism; and PD features, measured as continuous variables, as well as their symptoms at termination; their contribution to the therapeutic alliance; and their satisfaction with social relations. Poorer therapeutic outcome was demonstrated for patients with elevated levels of perfectionism and odd-eccentric and depressive PD features. Patients' contribution to therapeutic alliance and satisfaction with social relations were predicted by perfectionism but not by PD features. Results highlight the central role played by patients' personality in the course of brief treatment for depression.
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Affiliation(s)
- Golan Shahar
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06511, USA.
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21
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Abstract
Depressive personality disorder (DPD), which has a long tradition in psychiatry, currently resides in Appendix B ("Disorders for Further Study") of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. After a brief outline of this history, the authors review empirical research on DPD using the Robins and Guze criteria (discussed later) for diagnostic and clinical validity as a framework. Although DPD has unique features, the authors argue that this diagnosis can largely be subsumed under dysthymic disorder. As a result of diagnostic confusion, and of the small amount of research conducted in this area, recommendations for the assessment and treatment of DPD are necessarily speculative. The authors conclude that if personality disorders are maintained as categoric constructs, DPD may best be understood as a subtype of dysthymic disorder. A more radical solution would be to conceptualize DPD, along with the other personality disorders, as extreme positions along dimensional continua.
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Affiliation(s)
- R Michael Bagby
- Research Section on Personality and Psychopathology, Centre for Addiction and Mental Health, University of Toronto, 250 College Street, Ontario M5T 1R8, Canada.
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Huprich SK. Depressive personality and its relationship to depressed mood, interpersonal loss, negative parental perceptions, and perfectionism. J Nerv Ment Dis 2003; 191:73-9. [PMID: 12586959 DOI: 10.1097/01.nmd.0000050935.15349.44] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Eighty veteran psychiatric outpatients were evaluated for depressive personality disorder on the Depressive Personality Disorder Inventory (DPDI). It was predicted that those classified with depressive personality would report higher levels of interpersonal loss, negative perceptions of their parents, and higher levels of perfectionism than psychiatric control subjects. Nine of the 12 measures of these variables were significantly greater in those with depressive personality compared with psychiatric control subjects. When statelike depression was controlled for, seven of the nine variables still significantly differed between the two groups. Hierarchical regression analysis and discriminant function analysis found that these variables predicted 9% of the variance in the DPDI above and beyond statelike depression, and that a combination of these variables correctly classified 91% of the depressive personalities and 88% of the psychiatric control subjects. It is concluded that, as hypothesized, depressive personality disorder is associated with loss, negative parental perceptions, and perfectionism, and that these relationships are not accounted for exclusively by a depressed mood.
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Affiliation(s)
- Steven K Huprich
- Department of Psychology and Neuroscience, Baylor University, P.O. Box 97334, Waco, Texas 76798-7334, USA
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24
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Abstract
The purpose of this study was to evaluate the psychometric properties of the Depressive Personality Disorder Inventory (DPDI; Huprich, Margrett, Barthelemy, & Fine, 1996). The DPDI was found to have strong internal consistency in both an undergraduate and a veteran, psychiatric outpatient population. The DPDI had significant, positive correlations with other measures of depressive personality, supporting its convergent validity. These relationships remained even after controlling for state-like depression, suggesting that the DPDI has incremental validity. The DPDI also significantly predicted scores on measures of interpersonal loss, even after controlling for state-like depression, suggesting that the DPDI has good construct validity. In support of discriminant validity, the DPDI was more correlated with another measure of depressive personality than it was with measures of other personality disorders. Finally, the DPDI had strong diagnostic efficiency statistics: (a) Sensitivity = .82, (b) Specificity = .80, (c) Positive Predictive Power = .75, (d) Negative Predictive Power = .86, and (e) Overall Diagnostic Power = .81. It appears that the DPDI has good psychometric properties.
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Affiliation(s)
- Steven K Huprich
- Department of Psychology and Neuroscience, Baylor University, P.O. Box 97334, Waco, TX 76798-7334, USA.
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25
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Abstract
Some general recommendations can be made, collected from these subjective descriptions of personality types. Because determining an accurate psychiatric diagnosis is not the internist's aim, it is better for him or her to have a stance that generalizes to all patients, which can be refined as personality characteristics emerge. Tolerate the patient's affect (such as anger or anxiety), being firm and kind, rather than punitive or overinvested. Accept dependency and vulnerability. Accept and respect the underlying coping style. Understand that the patient's personality style is the best (and usually only) way he or she knows to have a relationship, including a relationship with the physician. Understand that personality traits additionally may have a function (e.g., to guard against anxiety or depression). Recognize that personality traits do not come in pure form. One personality trait is likely to blend into or overlap with other traits. Identify and treat any underlying symptom disorder, such as anxiety, depression, irritability, or thought disorder. Educate the patient clearly (and without patronizing) about medical illness. Document what was explained to the patient and how the patient responded, including dispassionate observations about behavior and emotional expression. Appreciate the patient's possible attachment to medical symptoms. Avoid arguments with patients who make unreasonable demands. Make timely judgments about whether or not to accede to a demand. When in doubt about a patient's honesty, give the patient the benefit of the doubt. Do not worry about being used because all patients use their physicians to some extent. Go to the limits of your tolerance for a patient's personality, but know your limits and refer to a colleague when you cannot work with the patient. Terminate an interaction and get help if there is a risk (or fear) of violence. Given the time it takes to manage the relationship and the psychiatric elements of treatment, a referral to a psychiatrist or other mental health professional often is wise if the patient will accept it. Include the mental health professional as part of the medical team. Although these various recommendations have been emphasized in connection with certain personality types, one can be flexible about their application in a variety of patients. It is important also to reiterate the limits of subjective descriptions. It is rare to find any of the aforementioned subjective descriptions in unmodified form; characteristics of more than one personality type usually appear in the same person. The descriptions are composites that provide a starting point for the physician. The physician should edit the composites based on experience with real patients. This article has described human characteristics and rough guidelines for helpful human responses and possible pharmacologic interventions. So equipped, the primary care physician may find it less troubling and more interesting to face the wide variation in human character.
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Affiliation(s)
- M C Miller
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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Sprock J, Crosby JP, Nielsen BA. Effects of sex and sex roles on the perceived maladaptiveness of DSM-IV personality disorder symptoms. J Pers Disord 2001; 15:41-59. [PMID: 11236814 DOI: 10.1521/pedi.15.1.41.18648] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study investigated the influence of sex on the perceived maladaptiveness of DSM-IV personality disorder criteria based on previous findings that inconsistency of symptoms with sex roles affects the perception of personality disorder symptoms. The effects of rater characteristics (i.e., sex, sex role) were also examined. A total of 161 undergraduates (65 men, 96 women) rated the diagnostic criteria according to how maladaptive they were for males (male condition), females (female condition), or without regard to sex (neutral condition that served as a baseline) using a 7-point scale. Participants' sex role was determined using the Bem Sex Role (1981a) Inventory. Dependent and depressive personality disorder criteria (trend for borderline) were rated more maladaptive for females than males, whereas obsessive-compulsive personality disorder criteria were rated more maladaptive for males than females. Participant sex and sex role had little or no significant effects on the ratings. Results are compared with those of previous research. Methodological issues and implications for the diagnosis of personality disorders are discussed.
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Affiliation(s)
- J Sprock
- Department of Psychology, Indiana State University, Terry Haute 47809, USA.
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Ryder AG, Bagby RM, Dion KL. Chronic, low-grade depression in a nonclinical sample: depressive personality or dysthymia? J Pers Disord 2001; 15:84-93. [PMID: 11236817 DOI: 10.1521/pedi.15.1.84.18641] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Depressive personality disorder (DPD) is being considered for inclusion in future editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM). However, there is substantial conceptual and empirical overlap between DPD and dysthymic disorder (Dysthymia) criteria, suggesting that these two constructs may not be distinct. Confirmatory factor analysis of the DPD traits and dysthymia symptoms in a large, nonclinical sample (N = 368) indicated that a two-factor model was a better fit than a one-factor model. However, binary diagnostic analysis revealed that over half of the individuals meeting criteria for DPD also met criteria for dysthymia and that the best-fitting model allowed the psychological symptoms of dysthymia to load on both DPD and dysthymia latent factors. All of the individuals with DPD alone failed to meet criteria for dysthymia because they did not report chronic depressed mood. Our results suggest that although DPD is not synonymous with Dysthymia, it may be a milder subtype.
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Affiliation(s)
- A G Ryder
- Department of Psychology, University of British Columbia, Vancouver.
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28
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Bagby RM, Ryder AG. Personality and the affective disorders: past efforts, current models, and future directions. Curr Psychiatry Rep 2000; 2:465-72. [PMID: 11122997 DOI: 10.1007/s11920-000-0004-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The existence of a relation between personality and the affective disorders has long been observed but with little agreement as to how it can best be described. This paper reviews attempts to address this issue, beginning with an examination of subaffective personality types. The personality dimensions of two major predominant theories, the Five Factor Model of Personality and the Seven Factor Dimensional Psychobiological Model of Temperament and Character, and the relation of these dimensions with bipolar disorder and unipolar depression is also examined. Throughout, the state-versus-trait issue is explored, and the last section is a critical reexamination of this continuing controversy. The overall objective is to search for commonalities in past and present models, and to deal with ongoing concerns, in order to point the way for future research in the field.
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Affiliation(s)
- R M Bagby
- Section on Personality and Psychopathology, Centre for Addiction and Mental Health, Clarke Site, 250 College Street, Toronto, Ontario, M5T 1R8, Canada.
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