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Neumann E, Rohmann E, Sattel H. The 10-Item Short Form of the German Experiences in Close Relationships Scale (ECR-G-10)-Model Fit, Reliability, and Validity. Behav Sci (Basel) 2023; 13:935. [PMID: 37998682 PMCID: PMC10669102 DOI: 10.3390/bs13110935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/03/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023] Open
Abstract
The aim of the present work was the development and validation of a short form of the Experiences in Close Relationship Scale (ECR) in German. Three studies were conducted. In study 1, the best items for the short form were selected from the item pool of the original version based on ant colony optimization (ACO), a recently developed probabilistic approach. Data from three samples collected at a university, an online portal, and a psychosomatic clinic with a total of 1470 participants were analyzed. A 10-item solution resulted, measuring avoidance and anxiety with five items each. This solution showed a good model fit and acceptable reliability in all three samples. The two new short scales were independent of each other. In study 2, the 10-item solution was validated by correlating the new short scales with external criteria. Data from previous studies that included student, community, and clinical samples were reanalyzed. Both short scales showed expected correlations with measures of romantic relationships, personality, psychopathology, and childhood trauma, indicating convergent and discriminant validity. The significant correlations were moderate to strong. In study 3, the selected ten items alone and several content-related scales were presented online to 277 participants, most of them students. The good results in terms of model fit, reliability, and validity observed in studies 1 and 2 could be replicated here. The new short form, called ECR-G-10, allows the measurement of attachment avoidance and anxiety in an economic way in research and clinical practice.
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Affiliation(s)
- Eva Neumann
- Department of Psychosomatic Medicine and Psychotherapy, LVR University Hospital Düsseldorf, Heinrich Heine University, 40629 Düsseldorf, Germany
| | - Elke Rohmann
- Department of Social Psychology, Faculty of Psychology, Ruhr University, 447801 Bochum, Germany;
| | - Heribert Sattel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar, Technical University, 81675 Munich, Germany;
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van den Heuvel BB, Dekker JJM, Daniëls M, Van HL, Peen J, Bosmans J, Arntz A, Huibers MJH. G-FORCE: the effectiveness of group psychotherapy for Cluster-C personality disorders: protocol of a pragmatic RCT comparing psychodynamic and two forms of schema group therapy. Trials 2023; 24:300. [PMID: 37120550 PMCID: PMC10149026 DOI: 10.1186/s13063-023-07309-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 04/11/2023] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND Cluster-C personality disorders (PDs), characterized by a high level of fear and anxiety, are related to high levels of distress, societal dysfunctioning and chronicity of various mental health disorders. Evidence for the optimal treatment is extremely scarce. Nevertheless, the need to treat these patients is eminent. In clinical practice, group therapy is one of the frequently offered approaches, with two important frameworks: schema therapy and psychodynamic therapy. These two frameworks suggest different mechanisms of change, but until now, this has not yet been explored. The purpose of the present G-FORCE trial is to find evidence on the differential (cost)effectiveness of two forms of schema group therapy and psychodynamic group therapy in the routine clinical setting of an outpatient clinic and to investigate the underlying working mechanisms and predictors of outcome of these therapies. METHODS In this mono-centre pragmatic randomized clinical trial, 290 patients with Cluster-C PDs or other specified PD with predominantly Cluster-C traits, will be randomized to one of three treatment conditions: group schema therapy for Cluster-C (GST-C, 1 year), schema-focused group therapy (SFGT, 1.5 year) or psychodynamic group therapy (PG, 2 years). Randomization will be pre-stratified on the type of PD. Change in severity of PD (APD-IV) over 24 months will be the primary outcome measure. Secondary outcome measures are personality functioning, psychiatric symptoms and quality of life. Potential predictors and mediators are selected and measured repeatedly. Also, a cost-effectiveness study will be performed, primarily based on a societal perspective, using both clinical effects and quality-adjusted life years. The time-points of assessment are at baseline, start of treatment and after 1, 3, 6, 9, 12, 18, 24 and 36 months. DISCUSSION This study is designed to evaluate the effectiveness and cost-effectiveness of three formats of group psychotherapy for Cluster-C PDs. Additionally, predictors, procedure and process variables are analysed to investigate the working mechanisms of the therapies. This is the first large RCT on group therapy for Cluster-C PDs and will contribute improving the care of this neglected patient group. The absence of a control group can be considered as a limitation. TRIAL REGISTRATION CCMO, NL72826.029.20 . Registered on 31 August 2020, first participant included on 18 October 2020.
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Affiliation(s)
| | | | - M Daniëls
- Arkin Mental Health Care, Amsterdam, the Netherlands
| | | | - Jaap Peen
- Arkin Mental Health Care, Amsterdam, the Netherlands
| | - Judith Bosmans
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Arnoud Arntz
- Universiteit Van Amsterdam, Amsterdam, the Netherlands
| | - Marcus J H Huibers
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
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Daniëls M, Van HL, van den Heuvel B, Dekker JJM, Peen J, Bosmans J, Arntz A, Huibers MJH. Individual psychotherapy for cluster-C personality disorders: protocol of a pragmatic RCT comparing short-term psychodynamic supportive psychotherapy, affect phobia therapy and schema therapy (I-FORCE). Trials 2023; 24:260. [PMID: 37020251 PMCID: PMC10077625 DOI: 10.1186/s13063-023-07136-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 02/04/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Cluster-C personality disorders (PDs) are highly prevalent in clinical practice and are associated with unfavourable outcome and chronicity of all common mental health disorders (e.g. depression and anxiety disorders). Although several forms of individual psychotherapy are commonly offered in clinical practice for this population, evidence for differential effectiveness of different forms of psychotherapy is lacking. Also, very little is known about the underlying working mechanisms of these psychotherapies. Finding evidence on the differential (cost)-effectiveness for this group of patients and the working mechanisms of change is important to improve the quality of care for this vulnerable group of patients. OBJECTIVE In this study, we will compare the differential (cost)-effectiveness of three individual psychotherapies: short-term psychodynamic supportive psychotherapy (SPSP), affect phobia therapy (APT) and schema therapy (ST). Although these psychotherapies are commonly used in clinical practice, evidence for the Cluster-C PDs is limited. Additionally, we will investigate predictive factors, non-specific and therapy-specific mediators. METHODS This is a mono-centre randomized clinical trial with three parallel groups: (1) SPSP, (2) APT, (3) ST. Randomization on patient level will be pre-stratified according to type of PD. The total study population to be included consists of 264 patients with Cluster-C PDs or other specified PD with mainly Cluster-C traits, aged 18-65 years, seeking treatment at NPI, a Dutch mental health care institute specialized in PDs. SPSP, APT and ST (50 sessions per treatment) are offered twice a week in sessions of 50 min for the first 4 to 5 months. After that, session frequency decreases to once a week. All treatments have a maximum duration of 1 year. Change in the severity of the PD (ADP-IV) will be the primary outcome measure. Secondary outcome measures are personality functioning, psychiatric symptoms and quality of life. Several potential mediators, predictors and moderators of outcome are also assessed. The effectiveness study is complemented with a cost-effectiveness/utility study, using both clinical effects and quality-adjusted life-years, and primarily based on a societal approach. Assessments will take place at baseline, start of treatment and at 1, 3, 6, 9, 12, 18, 24 and 36 months. DISCUSSION This is the first study comparing psychodynamic treatment to schema therapy for Cluster-C PDs. The naturalistic design enhances the clinical validity of the outcome. A limitation is the lack of a control group for ethical reasons. TRIAL REGISTRATION NL72823.029.20 [Registry ID: CCMO]. Registered on 31 August 2020. First participant included on 23 October 2020.
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Affiliation(s)
| | | | | | - Jack J M Dekker
- Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands
| | - Jaap Peen
- Arkin Mental Health Care, Amsterdam, The Netherlands
| | - Judith Bosmans
- Department of Health Sciences, Faculty of Science, VU University Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Marcus J H Huibers
- Arkin Mental Health Care, Amsterdam, The Netherlands
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
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Meulemeester CD, Lowyck B, Boets B, van der Donck S, Verhaest Y, Luyten P. "Feeling Invisible": Individuals With Borderline Personality Disorder Underestimate the Transparency of Their Emotions. J Pers Disord 2023; 37:213-232. [PMID: 37002937 DOI: 10.1521/pedi.2023.37.2.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
The present study investigated transparency estimation, that is, the ability to estimate how observable one's emotions are, in patients diagnosed with borderline personality disorder (BPD) (n = 35) and healthy controls (HCs; n = 35). Participants watched emotionally evocative video clips and estimated the transparency of their own emotional experience while watching the clip. Facial expression coding software (FaceReader) quantified their objective transparency. BPD patients felt significantly less transparent than HCs, but there were no differences in objective transparency. BPD patients tended to underestimate the transparency of their emotions compared to HCs, who in turn overestimated their transparency. This suggests that BPD patients expect that others will not know how they feel, irrespective of how observable their emotions actually are. We link these findings to low emotional awareness and a history of emotional invalidation in BPD, and we discuss their impact on BPD patients' social functioning.
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Affiliation(s)
| | - Benedicte Lowyck
- University Psychiatric Hospital UPC KU Leuven, Campus Kortenberg, and Department of Neurosciences, Faculty of Medicine, KU Leuven, Belgium
| | - Bart Boets
- Center for Developmental Psychiatry, Department of Neurosciences, KU Leuven, Belgium
| | | | - Yannic Verhaest
- University Psychiatric Hospital UPC KU Leuven, Campus Kortenberg, and Department of Neurosciences, Faculty of Medicine, KU Leuven, Belgium
| | - Patrick Luyten
- Faculty of Psychology and Educational Sciences, KU Leuven, Belgium
- Research Department of Clinical, Educational and Health Psychology, University College London, United Kingdom
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Fartacek C, Kunrath S, Aichhorn W, Plöderl M. Therapeutic alliance and change in suicide ideation among psychiatric inpatients at risk for suicide. J Affect Disord 2023; 323:793-798. [PMID: 36529412 DOI: 10.1016/j.jad.2022.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 09/14/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Therapeutic alliance is thought to be essential in the treatment of suicidality. Surprisingly, studies about the association between therapeutic alliance and change in suicide ideation over the course of treatment are sparse and reported inconsistent results. Furthermore, theoretically important moderators were rarely explored empirically. METHODS We investigated the association between therapeutic alliance and change in suicide ideation (difference between intake and discharge), unadjusted and adjusted for potential confounding variables (diagnoses, sociodemographics etc.) in a sample of 351 inpatients treated in a psychiatric department specialized in crisis intervention and suicide prevention. We also explored if the association was moderated by suicide ideation at intake, history of suicide attempts, and borderline personality disorder (BPD). We ran sensitivity analyses for different diagnostic subgroups, history of suicide attempts, and a quantitative measure of BPD symptoms. RESULTS We found a moderate association between therapeutic alliance and change in suicide ideation (r = 0.30, p < 0.01). This association remained robust after accounting for potentially confounding variables. Suicide ideation at intake, history of suicide attempts, and BPD were not statistically significant moderators. Sensitivity analyses led to similar results. LIMITATIONS Therapeutic alliance was assessed only at the end of treatment and causality cannot be inferred from our study method. CONCLUSIONS Therapeutic alliance was a robust correlate of improvement in suicide ideation among psychiatric inpatients at risk for suicide, independent from diagnostic groups and other patient characteristics. Our results support the crucial role of therapeutic alliance in the treatment of patients at risk for suicide.
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Affiliation(s)
- Clemens Fartacek
- Department for Inpatient Psychotherapy and Crisis Intervention, University Clinic for Psychiatry, Psychotherapy, and Psychosomatics, Paracelsus Medical University, Salzburg, Austria; Department of Clinical Psychology, University Clinic for Psychiatry, Psychotherapy, and Psychosomatics, Paracelsus Medical University, Salzburg, Austria; Institute of Synergetics and Psychotherapy Research, University Clinic of Psychiatry, Psychotherapy and Psychosomatics, Paracelsus Medical University, Salzburg, Austria.
| | - Sabine Kunrath
- California Institute for Telecommunications and Information Technology (Calit2), Irvine, CA, USA
| | - Wolfgang Aichhorn
- Institute of Synergetics and Psychotherapy Research, University Clinic of Psychiatry, Psychotherapy and Psychosomatics, Paracelsus Medical University, Salzburg, Austria
| | - Martin Plöderl
- Department for Inpatient Psychotherapy and Crisis Intervention, University Clinic for Psychiatry, Psychotherapy, and Psychosomatics, Paracelsus Medical University, Salzburg, Austria; Department of Clinical Psychology, University Clinic for Psychiatry, Psychotherapy, and Psychosomatics, Paracelsus Medical University, Salzburg, Austria
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Abstract
Malignant self-regard (MSR) is a self-representation that encompasses the shared features of depressive personality disorder, masochistic/self-defeating personality disorder, depressive-masochistic personality, and vulnerable narcissism. In this review we begin by describing the construct's historical precursors, which begin in early psychoanalytic/dynamic theory, and then trace its development across iterations of the Diagnostic and Statistical Manual of Mental Disorders. Special attention is paid to differentiating MSR from vulnerable narcissism. We then consider MSR's place within transdiagnostic, transtheoretical, and dimensional models of personality pathology. We focus heavily on MSR's impact on various personality systems (e.g., thought and affect systems) and also on overall personality functioning. The empirical research on MSR in relation to these systems is thoroughly reviewed and largely supports its psychometric properties and clinical significance. We suggest that MSR may map onto the distress subfactor in the hierarchical taxonomy of psychopathology (HiTOP) and that MSR seems to occupy the shared internalizing space across the neurotic and borderline level of personality organization in Kernberg's model of personality disorders. We also identify four major directions for future research: the possible benefits of self-defeating tendencies that involve pathological narcissism and self-esteem; MSR's relationship to overall health and well-being; depressive states and MSR severity; and how MSR fits within the Alternative Model for Personality Disorders and the personality disorder framework of the International Classification of Diseases.
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The Validation of a Five-Item Screening Scale for Personality Disorders in Dutch-Speaking Community Adolescents and Adults. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2022. [DOI: 10.1007/s10862-022-09951-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Houben M, Mestdagh M, Dejonckheere E, Obbels J, Sienaert P, van Roy J, Kuppens P. The Statistical Specificity of Emotion Dynamics in Borderline Personality Disorder. J Pers Disord 2021; 35:819-840. [PMID: 34124950 DOI: 10.1521/pedi_2021_35_509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Persons with borderline personality disorder (BPD) experience heightened emotional instability. Different components underlie instability, and the relation between instability and well-being could be confounded by average emotionality and within-person standard deviation across emotional states, reflecting variability. Therefore, the goal was to examine which pattern of emotion dynamics parsimoniously captures the emotional trajectories of persons with BPD. Forty persons with BPD, 38 clinical controls in a major depressive episode, and 40 healthy controls rated the intensity of their emotions 10 times a day for 1 week. After correction for differences in average emotionality, persons with BPD showed heightened emotional instability compared to both control groups. When additionally correcting for emotional variability, the authors found that instability indices did not differ between groups anymore. This shows that persons with BPD differ from control groups in the magnitude of emotional deviations from the emotional baseline, and not necessarily in the degree of abruptness of these deviations.
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Affiliation(s)
| | | | | | - Jasmien Obbels
- University Psychiatric Center KU Leuven, Leuven, Belgium
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Pedone R, Barbarulo AM, Colle L, Semerari A, Grimaldi P. Metacognition Mediates the Relationship Between Maladaptive Personality Traits and Levels of Personality Functioning: A General Investigation on a Nonclinical Sample. J Nerv Ment Dis 2021; 209:353-361. [PMID: 33600122 DOI: 10.1097/nmd.0000000000001304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT The impaired ability to reflect on one's own state of mind and that of others (called metacognition or mentalization) is a central feature of personality disorders (PDs). Metacognition involves different specific abilities, which can be selectively impaired with different PDs and personality maladaptive traits. Moreover, research in the field of PDs has indicated that personality features and metacognitive abilities are associated with the severity of personality pathologies. In this study, we tested a mediation model of the interactions between these variables on predicting levels of personality functioning in a sample of adults taken from the general population (N = 775). Results showed that the relationship between personality traits and personality functioning is partially mediated by metacognitive abilities. These findings support the hypothesis that metacognition plays a significant role in predicting the levels of impairment in personality functioning. These findings have several clinical implications.
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Affiliation(s)
| | | | - Livia Colle
- Department of Psychology, Center of Cognitive Science, University of Turin, Turin
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Raj N, Verthein U, Grundmann J, Lotzin A, Hiller P, Schulte B, Driessen M, Hillemacher T, Scherbaum N, Schäfer M, Schneider B, Schäfer I. Internalizing and externalizing subtypes in female patients with co-occurring post-traumatic stress disorder and substance use disorders. J Subst Abuse Treat 2020; 121:108198. [PMID: 33357607 DOI: 10.1016/j.jsat.2020.108198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/10/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Research has described subtypes with more internalizing and more externalizing symptoms in samples of patients with post-traumatic stress disorder (PTSD) and samples of patients with substance use disorders (SUD). OBJECTIVE This study sought to examine the respective subtypes in female PTSD-SUD patients and potential relationships with substance use characteristics. METHODS We performed a latent class analysis (LCA) in 343 adult female participants of a multisite therapy trial on PTSD and SUD. We derived externalizing symptoms from the Assessment of DSM-IV Personality Disorders (ADP-IV) questionnaire. We assessed internalization using the Symptom Checklist-27 (SCL-27) and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). We collected substance use-related information using the Addiction Severity Index-Lite (ASI-lite). RESULTS LCA suggested four latent classes including an externalizing (10.8%), a moderately internalizing class (31.0%), and a highly internalizing class (22.0%), as well as a class with a low severity of psychological symptoms (36.3%). Externalizing participants used more substances than any other class, while the duration of substance use did not differ between groups. Regular use started at a significantly younger age among the members of the highly internalizing subgroup compared to the moderately internalizing and low severity participants, but at an older age compared to the externalizing group members. CONCLUSIONS The finding of two internalizing subgroups along with an externalizing and a low severity class emphasizes the heterogeneity and complexity of populations with PTSD and SUD. This heterogeneity bears implications for research among this group of patients, but also for their treatment, especially considering our results on differences in substance use.
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Affiliation(s)
- Naily Raj
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Uwe Verthein
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | - Johanna Grundmann
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | - Annett Lotzin
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | - Philipp Hiller
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | - Bernd Schulte
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | - Martin Driessen
- Department of Psychiatry and Psychotherapy Bethel, Ev. Klinikum Bielefeld, Burgsteig 13, 33617 Bielefeld, Germany.
| | - Thomas Hillemacher
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany; Department of Psychiatry and Psychotherapy, Paracelsus University Nuremberg, Prof.-Ernst-Nathan-Str. 1, 90419 Nürnberg, Germany.
| | - Norbert Scherbaum
- LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Duisburg-Essen, Virchowstrasse 174, 45147 Essen, Germany.
| | - Martin Schäfer
- Department of Psychiatry, Psychosomatics and Addiction Medicine, Evang. Kliniken Essen-Mitte, Henricistrasse 92, 45136 Essen, Germany.
| | - Barbara Schneider
- Department of Addictive Disorders, Psychiatry and Psychotherapy, LVR-Klinik Cologne, Wilhelm-Griesinger-Strasse 23, 51109 Cologne, Germany.
| | - Ingo Schäfer
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
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Hengartner M, Ajdacic-Gross V, Rodgers S, Müller M, Rössler W. Childhood adversity in association with personality disorder dimensions: New findings in an old debate. Eur Psychiatry 2020; 28:476-82. [PMID: 23835016 DOI: 10.1016/j.eurpsy.2013.04.004] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 01/23/2013] [Accepted: 04/18/2013] [Indexed: 01/22/2023] Open
Abstract
AbstractBackgroundVarious studies have reported a positive relationship between child maltreatment and personality disorders (PDs). However, few studies included all DSM-IV PDs and even fewer adjusted for other forms of childhood adversity, e.g. bullying or family problems.MethodWe analyzed questionnaires completed by 512 participants of the ZInEP epidemiology survey, a comprehensive psychiatric survey of the general population in Zurich, Switzerland. Associations between childhood adversity and PDs were analyzed bivariately via simple regression analyses and multivariately via multiple path analysis.ResultsThe bivariate analyses revealed that all PD dimensions were significantly related to various forms of family and school problems as well as child abuse. In contrast, according to the multivariate analysis only school problems and emotional abuse were associated with various PDs. Poverty was uniquely associated with schizotypal PD, conflicts with parents with obsessive-compulsive PD, physical abuse with antisocial PD, and physical neglect with narcissistic PD. Sexual abuse was statistically significantly associated with schizotypal and borderline PD, but corresponding effect sizes were small.ConclusionChildhood adversity has a serious impact on PDs. Bullying and violence in schools and emotional abuse appear to be more salient markers of general personality pathology than other forms of childhood adversity. Associations with sexual abuse were negligible when adjusted for other forms of adversity.
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Thoroman B, Salmon P, Goode N. Evaluation of construct and criterion-referenced validity of a systems-thinking based near miss reporting form. ERGONOMICS 2020; 63:210-224. [PMID: 31738666 DOI: 10.1080/00140139.2019.1694707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 11/12/2019] [Indexed: 06/10/2023]
Abstract
The validity of methods is an ongoing issue in ergonomics. Inconsistent definitions and approaches to evaluation exacerbate this challenge. In this study, the construct and criterion-referenced validity of a new near miss reporting form was evaluated to determine the extent to which it comprehensively captures near miss incidents and is aligned with the systems thinking approach to accident causation. Interview data were used as the reference standard in the evaluation. Using signal detection theory (SDT), a high average hit rate (HR), predictive value (PV) and sensitivity index (SI) were found, with an almost perfect ranking for the index of concordance. The findings show that the reporting form has strong construct and criterion-referenced validity. It is proposed that the approach used in this study could be used by researchers and practitioners when testing the validity of incident data collection tools. Practitioner summary: The validity of methods is a key issue in ergonomics. In this study, we test the validity of a near miss reporting form using interview data as a standard. This approach could be used by practitioners when testing the validity of other ergonomics methods.
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Affiliation(s)
- Brian Thoroman
- Faculty of Arts and Business, Centre for Human Factors and Sociotechnical Systems, University of the Sunshine Coast, Maroochydore, Australia
| | - Paul Salmon
- Faculty of Arts and Business, Centre for Human Factors and Sociotechnical Systems, University of the Sunshine Coast, Maroochydore, Australia
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Yakın D, Grasman R, Arntz A. Schema modes as a common mechanism of change in personality pathology and functioning: Results from a randomized controlled trial. Behav Res Ther 2020; 126:103553. [PMID: 32018065 DOI: 10.1016/j.brat.2020.103553] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 12/29/2019] [Accepted: 01/13/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE We aimed to empirically test whether schema modes are central to the change process in schema therapy, clarification-oriented psychotherapy, and treatment as usual, i.e., predictive of personality pathology, and global and social-occupational functioning. METHOD A multicenter randomized controlled trial was conducted (N = 139 men, N = 181 women) over the course of three years. Repeated assessments of schema modes, personality disorder (PD) severity and functioning (controlled for concurrent PD-pathology) were analyzed using a multilevel autoregressive model. Variables were person-centered to ensure that within-person changes were analyzed. Through a process of backward elimination, the schema modes predictive of the dependent variable (i.e., PD-severity and functioning) at a later point in time were identified while controlling for concurrent dependent variable levels. Bidirectionality was tested by assessing whether dependent variables predicted later schema modes. RESULTS The Healthy Adult, Vulnerable Child, Impulsive Child, and Avoidant Protector predicted later personality pathology, with no bidirectionality observed for the first two. The Healthy Adult and Self-Aggrandizer predicted functioning at a later point in time, with no bidirectionality for Self-Aggrandizer. There was no moderation by treatment type for PD symptomatology, except for Self-Aggrandizer, which predicted functioning only in schema therapy. CONCLUSIONS The Healthy Adult and Vulnerable Child are central to the change process and appear to reflect common mechanisms of change. The Self-Aggrandizer might reflect a change mechanism specific for schema therapy. Our findings support the recent emphasis on these modes in schema therapy.
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Affiliation(s)
- Duygu Yakın
- Department of Clinical Psychology, University of Amsterdam, the Netherlands
| | - Raoul Grasman
- Department of Psychological Methods, University of Amsterdam, the Netherlands
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, the Netherlands.
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[Personality and therapy motivation of child sexual offenders]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2019; 64:350-364. [PMID: 30829173 DOI: 10.13109/zptm.2018.64.4.350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Personality and therapy motivation of child sexual offenders Objective: This pilot study examined the interrelationship between pathological narcissism, impaired personality organization, sexual delinquency, and therapy motivation from a psychoanalytic perspective in a sample of child sexual offenders. METHOD 42 forensic outpatients who had committed child sexual offenses completed a set of self-reports (PNI, IPO-16, ADP-IV, FPTM). RESULTS We found a positive correlation between pathological narcissism and impairment of personality organization. Though the levels of vulnerable narcissism were above average, no pathology of personality organization was present in this sample. Results also did not reveal a negative correlation between the severity of personality impairment and therapy motivation. The sample showed diverging results regarding correlations between narcissism and facets of therapy motivation: Higher levels of narcissism were associated with increased feelings of suffering but also denial of any need for help. CONCLUSIONS In this sample, a restrictive diagnosis of narcissistic personality disorders according toDSMand ICD criteria seems to underestimate their prevalence. The construct of therapy motivation should be adjusted to outpatient forensic treatment.
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15
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Beck JG, Woodward MJ, Pickover AM, Lipinski AJ, Dodson TS, Tran HN. Does a history of childhood abuse moderate the association between symptoms of posttraumatic stress disorder and borderline personality disorder in survivors of intimate partner violence? J Clin Psychol 2019; 75:1114-1128. [PMID: 30742703 DOI: 10.1002/jclp.22756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 11/20/2018] [Accepted: 01/17/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This study examined whether a history of childhood abuse (CA) strengthened the association between borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD) in the aftermath of intimate partner violence (IPV). This hypothesis arises from clinical literature but has not been examined empirically. We predicted that a history of CA would enhance associations between BPD features and PTSD symptoms. METHOD Dimensional assessment of both PTSD and BPD was made in a sample of 211 women who sought mental health services following IPV. Two analyses were conducted using clinician-assessed DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th ed.) PTSD symptoms: (a) total score and (b) symptom clusters. RESULTS Using path analysis, results indicated significant associations between BPD features and PTSD symptoms, but no significant interaction between BPD and CA in either analysis. CONCLUSIONS Results are discussed given current understanding of comorbidities involving PTSD, with particular attention to potential implications for clinical practice. Areas for future research are proposed.
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Affiliation(s)
- J Gayle Beck
- Department of Psychology, The University of Memphis, Memphis, Tennessee
| | - Matthew J Woodward
- Department of Psychological Sciences, Western Kentucky University, Bowling Green, Kentucky
| | - Alison M Pickover
- Department of Psychology, The University of Memphis, Memphis, Tennessee
| | | | - Thomas S Dodson
- Department of Psychology, The University of Memphis, Memphis, Tennessee
| | - Han N Tran
- Department of Psychology, The University of Memphis, Memphis, Tennessee
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16
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Berghuis H, Ingenhoven TJM, Heijden PTVD, Rossi GMP, Schotte CKW. Assessment of Pathological Traits in DSM-5 Personality Disorders By the DAPP-BQ: How Do These Traits Relate to the Six Personality Disorder Types of the Alternative Model? J Pers Disord 2019; 33:49-70. [PMID: 29120278 DOI: 10.1521/pedi_2017_31_329] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The six personality disorder (PD) types in DSM-5 section III are intended to resemble their DSM-IV/DSM-5 section II PD counterparts, but are now described by the level of personality functioning (criterion A) and an assigned trait profile (criterion B). However, concerns have been raised about the validity of these PD types. The present study examined the continuity between the DSM-IV/DSM-5 section II PDs and the corresponding trait profiles of the six DSM-5 section III PDs in a sample of 350 Dutch psychiatric patients. Facets of the Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ) were presumed as representations (proxies) of the DSM-5 section III traits. Correlational patterns between the DAPP-BQ and the six PDs were consistent with previous research between DAPP-BQ and DSM-IV PDs. Moreover, DAPP-BQ proxies were able to predict the six selected PDs. However, the assigned trait profile for each PD didn't fully match the corresponding PD.
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Affiliation(s)
- Han Berghuis
- Centre for Psychotherapy, Pro Persona, Lunteren, The Netherlands
| | | | - Paul T van der Heijden
- Centre for Adolescent Psychiatry, Reinier van Arkel, 's-Hertogenbosch, The Netherlands and Radboud University, Nijmegen, The Netherlands
| | | | - Chris K W Schotte
- Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Universitair Ziekenhuis Brussel, Brussels, Belgium
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17
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Gidzgier P, Grundmann J, Lotzin A, Hiller P, Schneider B, Driessen M, Schaefer M, Scherbaum N, Hillemacher T, Schäfer I. The dissociative subtype of PTSD in women with substance use disorders: Exploring symptom and exposure profiles. J Subst Abuse Treat 2019; 99:73-79. [PMID: 30797397 DOI: 10.1016/j.jsat.2019.01.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 12/23/2018] [Accepted: 01/03/2019] [Indexed: 12/15/2022]
Abstract
The dissociative subtype of posttraumatic stress disorder (PTSD) was officially introduced in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In accordance with this new classification, prior studies using Latent Class Analysis (LCA) empirically identified a subgroup of patients that were characterized by a high severity of dissociative symptoms. Despite the high prevalence of PTSD in patients with substance use disorders (SUD), however, no LCA studies on the dissociative subtype of PTSD exist in this population so far. Therefore, the current study aimed to identify subgroups of patients with different symptom and exposure profiles in patients with SUD and PTSD. It was assumed that one symptom and exposure profile could be identified that would be characterized by higher dissociative symptoms, higher additional psychopathology and a higher burden of childhood trauma, as compared to other subgroups. In N = 258 female patients with SUD and PTSD, clinical characteristics of dissociative symptoms, PTSD severity, borderline personality disorder (BPD), depression, childhood trauma and substance abuse were assessed. To identify symptom and exposure profiles, Latent Class Analysis was applied. A three-class solution indicated the best model fit to our data. One class was characterized by a high probability of dissociative symptoms (D-PTSD class), whereas the other two classes were characterized by lower probabilities of dissociative symptoms. The D-PTSD class encompassed 18.7% of the patients. In accordance with our hypothesis, the D-PTSD class showed higher probabilities of PTSD severity, borderline personality disorder symptoms, depressive symptoms, childhood emotional and sexual abuse, childhood emotional neglect, and drug abuse. Our results indicate that the dissociative subtype of PTSD could also be identified in a sample of female patients with SUD. Patients with SUD and PTSD characterized by the dissociative subtype showed more severe psychopathological symptoms than the remaining patients, indicating enhanced clinical needs for this vulnerable group.
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Affiliation(s)
- Piotr Gidzgier
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | - Johanna Grundmann
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | - Annett Lotzin
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | - Philipp Hiller
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | - Barbara Schneider
- Department of Addictive Disorders and Psychiatry, LVR-Klinik Cologne, Wilhelm-Griesinger-Strasse 23, 51109 Cologne, Germany.
| | - Martin Driessen
- Department of Psychiatry and Psychotherapy Bethel, Ev. Krankenhaus Bielefeld, Burgsteig 13, 33617 Bielefeld, Germany.
| | - Martin Schaefer
- Department of Psychiatry, Psychotherapy, Psychosomatic and Addiction Medicine, Kliniken Essen-Mitte, Henricistrasse 92, 45136 Essen, Germany.
| | - Norbert Scherbaum
- LVR-Hospital Essen, Department of Addictive Behaviour and Addiction Medicine, Medical Faculty, University of Duisburg-Essen, Virchowstrasse 174, 45147 Essen, Germany.
| | - Thomas Hillemacher
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1D, 30625 Hannover, Germany; Department of Psychiatry and Psychotherapy, Paracelsus Medical University Nuremberg, Prof.-Ernst-Nathan-Str. 1, 90419 Nuremberg, Germany.
| | - Ingo Schäfer
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
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18
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Pedone R, Huprich SK, Nelson SM, Cosenza M, Carcione A, Nicolò G, Semerari A, Colle L. Expanding the validity of the malignant self-regard construct in an Italian general population sample. Psychiatry Res 2018; 270:688-697. [PMID: 30384290 DOI: 10.1016/j.psychres.2018.10.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 10/23/2018] [Accepted: 10/23/2018] [Indexed: 10/28/2022]
Abstract
Malignant self-regard (MSR) was proposed as a particular type of self-structure that may account for similarities among a set of clinically relevant Personality Disorders (PDs) such as masochistic/self-defeating and depressive PDs that yet have failed to be adequately represented in the diagnostic manuals. The investigation on the MSR may provide a better framework upon which to understand the nature of these personality types and their discrimination from related constructs. The present study examines the psychometric properties of the Italian adaptation of the Malignant Self-Regard Questionnaire (MSRQ). Reliability and validity indicators are determined in a large sample of adults from general population (n = 2574). The measure was found to be reliable and valid, given its correlations with measures of depressive personality, negative affectivity, self-defeating, and vulnerably narcissistic personalities. MSR also can be meaningfully differentiated from a nomological network of related constructs, including sadness rumination, depression, neuroticism, extraversion, and grandiose narcissism. These findings suggest that MSR may be a personality component which includes a negativistic self-representation, vulnerability and hypersensitivity to judgment, sometimes compensated by perfectionistic tendencies. As a whole, results seem to support the reliability and the validity of the Italian adaptation of the MSRQ as a measure of the MSR.
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Affiliation(s)
- Roberto Pedone
- Deparment of Psychology, University of Campania "Luigi Vanvitelli", Italy.
| | | | - Sharon M Nelson
- Department of Psychology, Eastern Michigan University, Ypsilanti, USA
| | - Marina Cosenza
- Deparment of Psychology, University of Campania "Luigi Vanvitelli", Italy
| | | | | | | | - Livia Colle
- Department of Psychology, University of Turin, Italy
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Dimensional Pathological Personality Predicting Personality Disorders: Comparison of the DAPP-BQ and PID-5 Shortened Versions in a Spanish Community Sample. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2018. [DOI: 10.1007/s10862-018-9706-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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20
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Sleuwaegen E, Claes L, Luyckx K, Wilderjans T, Berens A, Sabbe B. Do treatment outcomes differ after 3 months DBT inpatient treatment based on borderline personality disorder subtypes? Personal Ment Health 2018; 12:321-333. [PMID: 30152591 DOI: 10.1002/pmh.1430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 07/09/2018] [Accepted: 07/18/2018] [Indexed: 11/11/2022]
Abstract
Heterogeneity in borderline personality disorder (BPD) drives the search for BPD subtypes to optimize the assessment and treatment of these patients. Therefore, the aims of the present study were (1) to replicate previously identified BPD subtypes based on reactive and regulative temperament; (2) to compare them on symptomatology and coping; and (3) to investigate whether these subtypes show different treatment responses after 3 months of inpatient dialectical behaviour therapy (DBT). A total of 145 BPD inpatients were assessed by means of measures of temperament, symptomatology and coping. Through model-based clustering on the Behavioural Inhibition and Behavioural Activation Scales (BISBAS) and Effortful Control Scale (ECS), we identified three BPD subtypes: an Emotional/Disinhibited subtype (15%, high BAS and low ECS); a Low Anxiety subtype (41%, low BIS) and an Inhibited subtype (44%, low BAS). After 3 months of DBT, 75 patients completed the measures for a second time. Repeated measure ANOVAs demonstrated a general improvement on all symptoms and coping strategies. In addition, the BPD subtypes showed trajectory differences in clinical and borderline specific symptomatology and dissociation. These findings indicate that BPD subtypes based on temperament demonstrate different treatment responses, which can contribute to the search of more BPD subtype tailored treatment interventions. © 2018 John Wiley & Sons, Ltd.
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Affiliation(s)
- Ellen Sleuwaegen
- University Department of Psychiatry, Campus Psychiatric Hospital Duffel, Duffel, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Laurence Claes
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Koen Luyckx
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Tom Wilderjans
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.,Research Group of Methodology and Statistics, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Ann Berens
- University Department of Psychiatry, Campus Psychiatric Hospital Duffel, Duffel, Belgium
| | - Bernard Sabbe
- University Department of Psychiatry, Campus Psychiatric Hospital Duffel, Duffel, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Widiger TA, Bach B, Chmielewski M, Clark LA, DeYoung C, Hopwood CJ, Kotov R, Krueger RF, Miller JD, Morey LC, Mullins-Sweatt SN, Patrick CJ, Pincus AL, Samuel DB, Sellbom M, South SC, Tackett JL, Watson D, Waugh MH, Wright AGC, Zimmermann J, Bagby RM, Cicero DC, Conway CC, De Clercq B, Docherty AR, Eaton NR, Forbush KT, Haltigan JD, Ivanova MY, Latzman RD, Lynam DR, Markon KE, Reininghaus U, Thomas KM. Criterion A of the AMPD in HiTOP. J Pers Assess 2018; 101:345-355. [PMID: 29746190 DOI: 10.1080/00223891.2018.1465431] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The categorical model of personality disorder classification in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM-5]; American Psychiatric Association, 2013 ) is highly and fundamentally problematic. Proposed for DSM-5 and provided within Section III (for Emerging Measures and Models) was the Alternative Model of Personality Disorder (AMPD) classification, consisting of Criterion A (self-interpersonal deficits) and Criterion B (maladaptive personality traits). A proposed alternative to the DSM-5 more generally is an empirically based dimensional organization of psychopathology identified as the Hierarchical Taxonomy of Psychopathology (HiTOP; Kotov et al., 2017 ). HiTOP currently includes, at the highest level, a general factor of psychopathology. Further down are the five domains of detachment, antagonistic externalizing, disinhibited externalizing, thought disorder, and internalizing (along with a provisional sixth somatoform dimension) that align with Criterion B. The purpose of this article is to discuss the potential inclusion and placement of the self-interpersonal deficits of the DSM-5 Section III Criterion A within HiTOP.
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Affiliation(s)
| | - Bo Bach
- b Psychiatric Research Unit, Slagelse Psychiatric Hospital , Slagelse , Denmark
| | | | | | - Colin DeYoung
- e Department of Psychology , University of Minnesota
| | | | - Roman Kotov
- g Department of Psychiatry , Stony Brook University
| | | | | | | | | | | | - Aaron L Pincus
- l Department of Psychology , Pennsylvania State University
| | | | - Martin Sellbom
- n Department of Psychology , University of Otago , Dunedin , New Zealand
| | - Susan C South
- m Department of Psychological Sciences , Purdue University
| | | | - David Watson
- d Department of Psychology , University of Notre Dame
| | - Mark H Waugh
- p Department of Psychology , University of Tennessee
| | | | | | - R Michael Bagby
- s Departments of Psychology and Psychiatry , University of Toronto , Toronto , Canada
| | - David C Cicero
- t Department of Psychology , University of Hawaii at Manoa
| | | | - Barbara De Clercq
- v Department of Developmental, Personality, and Social Psychology Ghent University , Ghent , Belgium
| | | | | | | | - J D Haltigan
- z Department of Psychiatry , University of Toronto , Toronto , Canada
| | | | | | - Donald R Lynam
- m Department of Psychological Sciences , Purdue University
| | | | - Ulrich Reininghaus
- ad Department of Psychiatry and Psychology , Masstricht University , Maastricht , The Netherlands , and Institute of Psychiatry, Psychology, and Neuroscience, King's College , London
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Houben M, Claes L, Sleuwaegen E, Berens A, Vansteelandt K. Emotional reactivity to appraisals in patients with a borderline personality disorder: a daily life study. Borderline Personal Disord Emot Dysregul 2018; 5:18. [PMID: 30459949 PMCID: PMC6234606 DOI: 10.1186/s40479-018-0095-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 10/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emotional instability, consisting of patterns of strong emotional changes over time, has consistently been demonstrated in daily life of patients with a borderline personality disorder (BPD). Yet, little empirical work has examined emotional changes that occur specifically in response to emotional triggers in daily life, so-called emotional reactivity. The goal of this study was to examine emotional reactivity in response to general emotional appraisals (i.e. goal congruence or valence, goal relevance or importance, and emotion-focused coping potential) and BPD-specific evaluations (trust and disappointment in self and others) in daily life of inpatients with BPD. METHODS Thirty inpatients with BPD and 28 healthy controls participated in an experience sampling study and repeatedly rated the intensity of their current emotions, emotional appraisals, and evaluations of trust and disappointment in self and others. RESULTS Results showed that the BPD group exhibited stronger emotional reactivity in terms of negative affect than healthy controls, however only in response to disappointment in someone else. BPD patients also showed weaker reactivity in positive affect in response to the appraised importance of a situation; the more a situation was appraised as important, the higher the subsequent positive affect for healthy controls only, not the patient group. CONCLUSIONS These findings show that appraisals can trigger strong emotional reactions in BPD patients, and suggest that altered emotional reactivity might be a potential underlying process of emotional instability in the daily life.
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Affiliation(s)
- Marlies Houben
- 1Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, Box 3713, 3000 Leuven, Belgium
| | - Laurence Claes
- 1Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, Box 3713, 3000 Leuven, Belgium.,2Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Ellen Sleuwaegen
- 2Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.,3University Department of Psychiatry, Campus Psychiatric Hospital Duffel, Stationsstraat 22c, 2570 Duffel, Belgium
| | - Ann Berens
- 3University Department of Psychiatry, Campus Psychiatric Hospital Duffel, Stationsstraat 22c, 2570 Duffel, Belgium
| | - Kristof Vansteelandt
- 4KU Leuven, University Psychiatric Center KU Leuven, Leuvensesteenweg 517, 3070 Kortenberg, Belgium
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Grauvogl A, Pelzer B, Radder V, van Lankveld J. Associations Between Personality Disorder Characteristics, Psychological Symptoms, and Sexual Functioning in Young Women. J Sex Med 2017; 15:192-200. [PMID: 29276043 DOI: 10.1016/j.jsxm.2017.11.222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/23/2017] [Accepted: 11/28/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Recently, the etiology of sexual dysfunctions in women has been approached from different angles. In clinical practice and in previous studies, it has been observed that women with sexual problems experience anxiety problems and express more rigid and perfectionistic personality traits than women without these problems. AIM To investigate whether personality disorder characteristics according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) and psychological symptoms are associated with sexual problems in women. METHODS 188 women 18 to 25 years old participated in this cross-sectional study. Questionnaires measuring sexual functioning (Female Sexual Function Index), personality disorder characteristics (Assessment of DSM-IV-TR Personality Disorders Questionnaire), and psychological symptoms (Brief Symptom Inventory and Center for Epidemiological Studies Depression Scale) were used. OUTCOME The main outcome measure used was sexual functioning assessed by self-report. RESULTS Results, using analysis of variance, indicated that women with sexual problems report significantly more cluster A (specifically schizoid) and C (specifically avoidant and obsessive-compulsive) personality disorder characteristics than women without sexual problems. Furthermore, using multiple regression analyses, higher cluster A (specifically schizoid) and lower cluster B (specifically borderline and antisocial) personality disorder characteristics indicated lower levels of sexual functioning. Psychological symptoms partly mediated the effect of cluster A personality disorder characteristics on sexual functioning. CLINICAL IMPLICATIONS The results of this study indicate that clinical practice should extend its scope by focusing more on improving adaptive personality characteristics, such as extraversion and individualism seen in cluster B personality characteristics, and decreasing the perfectionistic, introvert, and self-doubting characteristics seen in cluster C personality characteristics. STRENGTHS AND LIMITATIONS Because of the correlational design and use of self-report measures, causal relations cannot be established between personality disorder characteristics and sexual functioning. CONCLUSION Overall, the results indicate that personality disorder characteristics can play an important associative role in the development and maintenance of sexual functioning problems in women. Grauvogl A, Pelzer B, Radder V, van Lankveld J. Associations Between Personality Disorder Characteristics, Psychological Symptoms, and Sexual Functioning in Young Women. J Sex Med 2018;15:192-200.
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Affiliation(s)
- Andrea Grauvogl
- Faculty of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, the Netherlands.
| | - Britt Pelzer
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Veerle Radder
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Jacques van Lankveld
- Faculty of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, the Netherlands
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Crego C, Widiger TA. The Conceptualization and Assessment of Schizotypal Traits: A Comparison of the FFSI and PID-5. J Pers Disord 2017; 31:606-623. [PMID: 27749186 DOI: 10.1521/pedi_2016_30_270] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of the present study was to compare the cognitive and perceptual aberration scales from the Five-Factor Schizotypal Inventory (FFSI; Edmundson, Lynam, Miller, Gore, & Widiger, 2011) and the Personality Inventory for DSM-5 (Krueger, Derringer, Markon, Watson, & Skodol,, 2012), as well as to address more generally the validity of the FFSI as a measure of both schizotypal personality traits and the FFM. Two independent samples were obtained, including 259 college students (55 of whom were preselected with elevated scores on a measure of schizotypal personality disorder [STPD]) and 346 adult MTurk participants (43% of whom had been or were currently in mental health treatment). Administered were the FFSI, the PID-5 Psychoticism scales, and alternative measures of general personality, openness, STPD, and schizotypal cognitive-perceptual aberrations. The results of the study are discussed with respect to the validity of the FFSI and PID-5 schizotypal cognitive and perception scales.
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Affiliation(s)
| | - Thomas A Widiger
- Department of Psychology, University of Kentucky, Lexington, Kentucky
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Sleuwaegen E, Houben M, Claes L, Berens A, Sabbe B. The relationship between non-suicidal self-injury and alexithymia in borderline personality disorder: "Actions instead of words". Compr Psychiatry 2017. [PMID: 28646684 DOI: 10.1016/j.comppsych.2017.06.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Borderline personality disorder (BPD) is a serious mental illness that centers on the inability to effectively regulate emotions. A large amount of BPD patients engage in non-suicidal self-injury (NSSI). Given the NSSI contributes to serious health risks, it is important to know why some BPD patients engage in NSSI and others do not. A possible associated factor of NSSI in BPD may be alexithymia, which reflects difficulties in identifying and communicating feelings. Therefore the aim of the present study was to investigate whether NSSI was associated with alexithymia and whether this association still stood when controlling for gender and depression. METHODS The current study explored the relationship between NSSI and alexithymia in 185 BPD patients by means of the Self-Injury Questionnaire-Treatment Related and the Toronto Alexithymia Scale-20 (TAS). RESULTS Of the 185 BPD inpatients, 82.7% reported life-time NSSI, of whom 52.9% were still engaging in current NSSI; and 71.3% scored in the alexithymic range (cut-off score≥61). Current NSSI was significantly associated with TAS-total. Additionally, when considering the separate TAS subscales Difficulties Describing Feelings (DDF), Difficulties Identifying Feelings (DIF) and Externally Oriented Thinking (EOT), only DDF was significantly associated with NSSI, even after controlling for gender and depression. CONCLUSION These results suggest that NSSI in BPD patients is associated with alexithymia. More specific, difficulties describing feelings can lead to NSSI, independently of the depressive status of the BPD patient. The implications for clinical treatment of self-injurious BPD patients will be discussed.
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Affiliation(s)
- Ellen Sleuwaegen
- University Department of Psychiatry, Campus Psychiatric Hospital, Duffel, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
| | - Marlies Houben
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Laurence Claes
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Ann Berens
- University Department of Psychiatry, Campus Psychiatric Hospital, Duffel, Belgium
| | - Bernard Sabbe
- University Department of Psychiatry, Campus Psychiatric Hospital, Duffel, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Vansteelandt K, Houben M, Claes L, Berens A, Sleuwaegen E, Sienaert P, Kuppens P. The affect stabilization function of nonsuicidal self injury in Borderline Personality Disorder: An Ecological Momentary Assessment study. Behav Res Ther 2017; 92:41-50. [PMID: 28257980 DOI: 10.1016/j.brat.2017.02.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 02/08/2017] [Accepted: 02/15/2017] [Indexed: 10/20/2022]
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de Weerd BJ, van Dijk MK, van der Linden JN, Roelen CAM, Verbraak MJPM. The effectiveness of a convergence dialogue meeting with the employer in promoting return to work as part of the cognitive-behavioural treatment of common mental disorders: A randomized controlled trial. Work 2017; 54:647-55. [PMID: 27286071 DOI: 10.3233/wor-162307] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Dialogue between supervisor and employee is of great importance for occupational rehabilitation. OBJECTIVE To evaluate the effectiveness of a convergence dialogue meeting (CDM) of employee, therapist and supervisor aimed at facilitating return to work (RTW) as part of cognitive-behavioural treatment. METHODS Randomized controlled trial including 60 employees sick-listed with common mental disorders and referred for specialized mental healthcare. Employees were randomly allocated either to an intervention group (n = 31) receiving work-focused cognitive-behavioural therapy plus CDM or a control group (n = 29) receiving work-focused cognitive-behavioural therapy without CDM. RESULTS The time to first RTW was 12 days shorter (p = 0.334) in the intervention group, although full (i.e., at equal earnings as before reporting sick) RTW took 41 days longer (p = 0.122) than the control group. The odds of full RTW at the end of treatment were only 7% higher (p = 0.910) in the intervention group as compared to the control group. CONCLUSIONS CDM did not significantly reduce the time to RTW. We recommend that therapists who are trained on CDM focus on barriers and solutions for RTW.
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Affiliation(s)
| | | | | | | | - Marc J P M Verbraak
- Radboud Centre Social Sciences, Radboud University and Pro Persona, Nijmegen, The Netherlands
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Sleuwaegen E, Claes L, Luyckx K, Berens A, Vogels C, Sabbe B. Subtypes in borderline patients based on reactive and regulative temperament. PERSONALITY AND INDIVIDUAL DIFFERENCES 2017. [DOI: 10.1016/j.paid.2016.11.065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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DSM-5 section III personality traits and section II personality disorders in a Flemish community sample. Psychiatry Res 2016; 238:290-298. [PMID: 27086247 DOI: 10.1016/j.psychres.2016.02.056] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 01/12/2016] [Accepted: 02/22/2016] [Indexed: 11/24/2022]
Abstract
The Personality Inventory for DSM-5 (PID-5; Krueger et al., 2012) is a dimensional self-report questionnaire designed to measure personality pathology according to the criterion B of the DSM-5 Section III personality model. In the current issue of DSM, this dimensional Section III personality model co-exists with the Section II categorical personality model derived from DSM-IV-TR. Therefore, investigation of the inter-relatedness of both models across populations and languages is warranted. In this study, we first examined the factor structure and reliability of the PID-5 in a Flemish community sample (N=509) by means of exploratory structural equation modeling and alpha coefficients. Next, we investigated the predictive ability of section III personality traits in relation to section II personality disorders through correlations and stepwise regression analyses. Results revealed a five factor solution for the PID-5, with adequate reliability of the facet scales. The variance in Section II personality disorders could be predicted by their theoretically comprising Section III personality traits, but additional Section III personality traits augmented this prediction. Based on current results, we discuss the Section II personality disorder conceptualization and the Section III personality disorder operationalization.
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Gore WL, Widiger TA. Assessment of dependency by the FFDI: Comparisons to the PID-5 and maladaptive agreeableness. Personal Ment Health 2015; 9:258-76. [PMID: 26333624 DOI: 10.1002/pmh.1308] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 07/20/2015] [Accepted: 07/26/2015] [Indexed: 11/08/2022]
Abstract
The present study explores the validity of the Five Factor Dependency Inventory (FFDI), a measure of dependent personality traits from the perspective of the five factor model, examined across three separate samples and two studies. The first study examined the FFDI with respect to the traits assigned to assess dependent personality disorder (DPD) by the DSM-5 work group, two measures of DSM-IV-TR DPD and three measures of dependent traits, sampling 184 Mechanical Turk participants and 83 students (the latter oversampled for DPD features). Based on responses from an additional 137 students, the second study investigated the role of maladaptive agreeableness in dependency by examining the FFDI in relation to the interpersonal circumplex using three alternative measures. Discriminant validity was provided with respect to DSM-5 traits and the interpersonal circumplex. Incremental validity was provided with respect to the ability of the FFDI to account for variance within DPD measures beyond the variance explained by DSM-5 traits. Implications for the assessment of dependency and the proposed DSM-5 dimensional trait model are discussed.
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Affiliation(s)
- Whitney L Gore
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Thomas A Widiger
- Department of Psychology, University of Kentucky, Lexington, KY, USA
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31
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Van den Broeck K, Pieters G, Claes L, Berens A, Raes F. Overgeneral autobiographical memory predicts higher prospective levels of depressive symptoms and intrusions in borderline patients. Memory 2015; 24:1302-10. [PMID: 26494540 DOI: 10.1080/09658211.2015.1102938] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Overgeneral memory (OGM), the tendency to retrieve categories of events from autobiographical memory instead of single events, is found to be a reliable predictor for future mood disturbances and post-traumatic symptom severity. Patients with borderline personality disorder (BPD) often report co-morbid episodes of major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). Therefore, we investigated whether OGM would predict depression severity and (post-traumatic) stress symptoms in BPD patients. At admission (N = 54) and at six-month follow-up (N ≥ 31), BPD patients completed the Structured Clinical Interview for DSM-IV Disorders, the Assessment of DSM-IV Personality Disorders, the Autobiographical Memory Test, the Beck Depression Inventory-2nd edition (BDI-II), and the Impact of Event Scale. OGM at baseline predicted (a) higher levels of depressive symptoms at follow-up and (b) more intrusions related to a stressful event over and above baseline levels of borderline symptoms, depressive symptoms, and intrusions, respectively. No association was found between memory specificity and event-related avoidance at follow-up. Despite previous findings suggesting that OGM in BPD is less robust than in MDD and PTSD, our results suggest that memory specificity in BPD patients may have some relevance for the course of depressive and stress symptomatology in BPD.
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Affiliation(s)
- Kris Van den Broeck
- a Faculty of Psychology and Educational Sciences , University of Leuven , Leuven , Belgium.,b University Psychiatric Centre KU Leuven , Kortenberg , Belgium
| | - Guido Pieters
- a Faculty of Psychology and Educational Sciences , University of Leuven , Leuven , Belgium.,b University Psychiatric Centre KU Leuven , Kortenberg , Belgium
| | - Laurence Claes
- a Faculty of Psychology and Educational Sciences , University of Leuven , Leuven , Belgium
| | - Ann Berens
- c Psychiatric Hospital Duffel , Duffel , Belgium
| | - Filip Raes
- a Faculty of Psychology and Educational Sciences , University of Leuven , Leuven , Belgium
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32
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Conway CC, Hammen C, Brennan PA. Adolescent precursors of adult borderline personality pathology in a high-risk community sample. J Pers Disord 2015; 29:316-33. [PMID: 25248011 PMCID: PMC5653280 DOI: 10.1521/pedi_2014_28_158] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Longitudinal studies of the exact environmental conditions and personal attributes contributing to the development of borderline personality disorder (BPD) are rare. Furthermore, existing research typically examines risk factors in isolation, limiting our knowledge of the relative effect sizes of different risk factors and how they act in concert to bring about borderline personality pathology. The present study investigated the prospective effects of diverse acute and chronic stressors, proband psychopathology, and maternal psychopathology on BPD features in a high-risk community sample (N = 700) of youth followed from mid-adolescence to young adulthood. Multivariate analyses revealed significant effects of maternal externalizing disorder history, offspring internalizing disorder history, family stressors, and school-related stressors on BPD risk. Contrary to expectations, no interactions between chronically stressful environmental conditions and personal characteristics in predicting borderline personality features were detected. Implications of these findings for etiological theories of BPD and early screening efforts are discussed.
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Affiliation(s)
- Christopher C. Conway
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Constance Hammen
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
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Debast I, Rossi G, van Alphen SPJ, van Alphen SPJB, Pauwels E, Claes L, Dierckx E, Peuskens H, Santens E, Schotte CKW. Age Neutrality of Categorically and Dimensionally Measured DSM-5 Section II Personality Disorder Symptoms. J Pers Assess 2015; 97:321-9. [PMID: 25833657 DOI: 10.1080/00223891.2015.1021814] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Studies on the face validity of DSM-5 Section II categorical personality disorder (PD) symptoms indicate a bias against older adults. To extend these results, this article explores whether categorically and dimensionally scored PD symptoms of DSM-5 Section II, as measured in the Assessment of DSM-IV Personality Disorders (ADP-IV; Schotte & de Doncker, 1994), corroborate potential age bias across younger (aged 18-34), middle-aged (35-59 years), and older adults (aged 60-75). Differential item functioning (DIF) analyses, following a classical test theory approach, showed that 2 of the 79 symptoms were measured differently across 3 age groups when categorically assessed, and 4 when dimensionally measured. Nevertheless, subsequent differential test functioning analyses supported a low aggregated impact of DIF on the dimensional scales, justifying mean-level comparisons across age groups. Generalizability of the results is discussed in light of methodological issues concerning the research of age neutrality of PD symptoms, including the employed measurement instrument, PD symptom measurement approach, and sample and age range used to describe older adults.
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Affiliation(s)
- Inge Debast
- a Department of Clinical and Lifespan Psychology , Vrije Universiteit Brussel , Belgium
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The impact of comorbid depression on recovery from personality disorders and improvements in psychosocial functioning: Results from a randomized controlled trial. Behav Res Ther 2014; 63:55-62. [DOI: 10.1016/j.brat.2014.09.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 09/03/2014] [Accepted: 09/15/2014] [Indexed: 11/18/2022]
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Turner BJ, Claes L, Wilderjans TF, Pauwels E, Dierckx E, Chapman AL, Schoevaerts K. Personality profiles in Eating Disorders: further evidence of the clinical utility of examining subtypes based on temperament. Psychiatry Res 2014; 219:157-65. [PMID: 24878298 DOI: 10.1016/j.psychres.2014.04.036] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 02/17/2014] [Accepted: 04/22/2014] [Indexed: 12/27/2022]
Abstract
Despite recent modifications to the DSM-V diagnostic criteria for Eating Disorders (ED; American Psychiatric Association, 2013), sources of variability in the clinical presentation of ED patients remain poorly understood. Consistent with previous research that has used underlying personality dimensions to identify distinct subgroups of ED patients, the present study examined (1) whether we could identify clinically meaningful subgroups of patients based on temperamental factors including Behavioral Inhibition (BIS), Behavioral Activation (BAS) and Effortful Control (EC), and (2) whether the identified subgroups would also differ with respect to ED, Axis-I and Axis-II psychopathology. One hundred and forty five ED inpatients participated in this study. Results of a k-means analysis identified three distinct groups of patients: an Overcontrolled/Inhibited group (n=53), an Undercontrolled/Dysregulated group (n=58) and a Resilient group (n=34). Further, group comparisons revealed that patients in the Undercontrolled/Dysregulated group demonstrated more severe symptoms of bulimia, hostility and Cluster B Personality Disorders compared to the other groups, while patients in the Resilient group demonstrated the least severe psychopathology. These findings have important implications for understanding how individual differences in personality may impact patterns of ED symptoms and co-occurring psychopathology in patients with ED.
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Affiliation(s)
| | | | | | - Els Pauwels
- Katholieke Universiteit Leuven, Leuven, Belgium; Alexian Brothers Psychiatric Hospital, Tienen, Belgium
| | - Eva Dierckx
- Alexian Brothers Psychiatric Hospital, Tienen, Belgium; Vrije Universiteit Brussel, Brussels, Belgium
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Hengartner MP, Ajdacic-Gross V, Rodgers S, Müller M, Haker H, Rössler W. Fluid intelligence and empathy in association with personality disorder trait-scores: exploring the link. Eur Arch Psychiatry Clin Neurosci 2014; 264:441-8. [PMID: 24022591 DOI: 10.1007/s00406-013-0441-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 08/24/2013] [Indexed: 10/26/2022]
Abstract
There is some evidence that fluid intelligence as well as empathy may be significantly related to personality disorders (PDs). To our knowledge, no study has addressed those issues simultaneously in all 10 DSM PDs in a sample of the general population. We analysed data from 196 participants aged 20–41 from the Epidemiology Survey of the Zurich Programme for Sustainable Development of Mental Health Services (ZInEP), a comprehensive psychiatric survey in the general population of Zurich, Switzerland. We assessed the digit symbol-coding test (DSCT), the “reading the mind in the eyes” test (RMET) and the interpersonal reactivity index (IRI). Both measures of cognitive empathy (i.e. RMET and IRI perspective taking) were not related to any PD trait-score. The total PD trait-score was significantly associated with low scores on DSCT and IRI empathic concern and high scores on IRI personal distress, which indicates a dose–response relationship in those measures. DSCT was particularly related to borderline PD, IRI empathic concern to schizoid and narcissistic PDs, and IRI personal distress to avoidant PD. The proportion of variance explained in the total PD trait-score accounted for by DSCT, IRI empathic concern and IRI personal distress was 2.6, 2.3 and 13.3 %, respectively. Symptomatology and severity of PDs are related to low fluid intelligence and reduced emotional empathy as characterized by low empathic concern and high personal distress towards emotional expressions of others. Further research is needed that examines the association between cognitive empathy and personality pathology as well as potential clinical applications.
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de Haan HA, van der Palen J, Wijdeveld TGM, Buitelaar JK, De Jong CAJ. Alexithymia in patients with substance use disorders: state or trait? Psychiatry Res 2014; 216:137-45. [PMID: 24534122 DOI: 10.1016/j.psychres.2013.12.047] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 07/25/2013] [Accepted: 12/29/2013] [Indexed: 01/12/2023]
Abstract
Previous research on substance use disorders (SUD) has yielded conflicting results concerning whether alexithymia is a state or trait, raising the question of how alexithymia should be addressed in the treatment of SUD-patients. The absolute and relative stabilities of alexithymia were assessed using the Toronto Alexithymia Scale (TAS-20) and its subscales. In total, 101 patients with SUD were assessed twice during a 3-week inpatient detoxification period while controlling for withdrawal symptoms and personality disorder traits. The relative stability of the total TAS-20 and subscales was moderate to high but showed remarkable differences between baseline low, moderate, and high alexithymic patients. A small reduction in the mean levels of the total TAS-20 scores and those of one subscale revealed the absence of absolute stability. The levels of alexithymia were unrelated to changes in withdrawal symptoms, including anxiety- and depression-like symptoms. The differences between low, moderate, and high alexithymic patients in terms of the change in alexithymia scores between baseline and follow-up indicated a strong regression to the mean. The findings suggest that alexithymia in SUD patients as measured using the TAS-20 is both a state and trait phenomenon and does not appear to be related to changes in anxiety- and depression-like symptoms.
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Affiliation(s)
- Hein A de Haan
- Tactus Addiction Treatment, 7400 AD Deventer, The Netherlands; Nijmegen Institute for Scientist-Practitioners in Addiction, 6500 HE Nijmegen, The Netherlands.
| | - Job van der Palen
- Department of Research Methodology, Measurement and Data Analysis, University of Twente, 7500 AE Enschede, The Netherlands; Medical School Twente, Medisch Spectrum Twente, 7513 ER Enschede, The Netherlands
| | - Toon G M Wijdeveld
- Nijmegen Institute for Scientist-Practitioners in Addiction, 6500 HE Nijmegen, The Netherlands
| | - Jan K Buitelaar
- Radboud University Nijmegen Medical Centre, Department of Cognitive Neuroscience, Nijmegen, The Netherlands
| | - Cor A J De Jong
- Nijmegen Institute for Scientist-Practitioners in Addiction, 6500 HE Nijmegen, The Netherlands
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Hengartner MP, Ajdacic-Gross V, Rodgers S, Müller M, Rössler W. The joint structure of normal and pathological personality: further evidence for a dimensional model. Compr Psychiatry 2014; 55:667-74. [PMID: 24314825 DOI: 10.1016/j.comppsych.2013.10.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 09/09/2013] [Accepted: 10/20/2013] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The literature proposes a joint structure of normal and pathological personality with higher-order factors mainly based on the five-factor model of personality (FFM). The purpose of the present study was to examine the joint structure of the FFM and the DSM-IV personality disorders (PDs) and to discuss this structure with regard to higher-order domains commonly reported in the literature. METHODS We applied a canonical correlation analysis, a series of principal component analyses with oblique Promax rotation and a bi-factor analysis with Geomin rotation on 511 subjects of the general population of Zurich, Switzerland, using data from the ZInEP Epidemiology Survey. RESULTS The 5 FFM traits and the 10 DSM-IV PD dimensions shared 77% of total variance. Component extraction tests pointed towards a two- and three-component solution. The two-component solution comprised a first component with strong positive loadings on neuroticism and all 10 PD dimensions and a second component with strong negative loadings on extraversion and openness and positive loadings on schizoid and avoidant PDs. The three-component solution added a third component with strong positive loadings on conscientiousness and agreeableness and a negative loading on antisocial PD. The bi-factor model provided evidence for 1 general personality dysfunction factor related to neuroticism and 5 group factors, although the interpretability of the latter was limited. CONCLUSIONS Normal and pathological personality domains are not isomorphic or superposable, although they share a substantial proportion of variance. The two and three higher-order domains extracted in the present study correspond well to equivalent factor-solutions reported in the literature. Moreover, these superordinate factors can consistently be integrated within a hierarchical structure of alternative four- and five-factor models. The top of the hierarchy presumably constitutes a general personality dysfunction factor which is closely related to neuroticism.
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Affiliation(s)
- Michael P Hengartner
- University of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics.
| | | | - Stephanie Rodgers
- University of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics
| | - Mario Müller
- University of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics
| | - Wulf Rössler
- University of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics; Collegium Helveticum, a Joint Research Institute between the University of Zurich and the Swiss Federal Institute of Technology, Zurich, Switzerland
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De Fruyt F, De Clercq B. Antecedents of Personality Disorder in Childhood and Adolescence: Toward an Integrative Developmental Model. Annu Rev Clin Psychol 2014; 10:449-76. [DOI: 10.1146/annurev-clinpsy-032813-153634] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Filip De Fruyt
- Department of Developmental, Personality and Social Psychology, Ghent University, B-9000 Ghent, Belgium; ,
| | - Barbara De Clercq
- Department of Developmental, Personality and Social Psychology, Ghent University, B-9000 Ghent, Belgium; ,
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Rodgers S, Grosse Holtforth M, Müller M, Hengartner MP, Rössler W, Ajdacic-Gross V. Symptom-based subtypes of depression and their psychosocial correlates: a person-centered approach focusing on the influence of sex. J Affect Disord 2014; 156:92-103. [PMID: 24373526 DOI: 10.1016/j.jad.2013.11.021] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Revised: 11/27/2013] [Accepted: 11/29/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Reducing the complexity of major depressive disorder by symptom-based subtypes constitutes the basis of more specific treatments. To date, few studies have empirically derived symptom subtypes separated by sex, although the impact of sex has been widely accepted in depression research. METHODS The community-based sample included 373 males and 443 females from the Zurich Program for Sustainable Development of Mental Health Services (ZInEP) manifesting depressive symptoms in the past 12 months. Latent Class Analysis (LCA) was performed separately by sex to extract sex-related depression subtypes. The subtypes were characterized by psychosocial characteristics. RESULTS Three similar subtypes were found in both sexes: a severe typical subtype (males: 22.8%; females: 35.7%), a severe atypical subtype (males: 17.4%; females: 22.6%), and a moderate subtype (males: 25.2%; females: 41.8%). In males, two additional subgroups were identified: a severe irritable/angry-rejection sensitive (IARS) subtype (30%) comprising the largest group, and a small psychomotor retarded subtype (4%). Males belonging to the severe typical subtype exhibited the lowest masculine gender role orientation, while females of the typical subtype showed more anxiety disorders. The severe atypical subtype was associated with eating disorders in both sexes and with alcohol/drug abuse/dependence in females. In contrast, alcohol/drug abuse/dependence was associated with the severe IARS subtype in males. LIMITATIONS The study had a cross-sectional design, allowing for no causal inferences. CONCLUSIONS This study contributes to a better understanding of sex-related depression subtypes, which can be well distinguished on the basis of symptom profiles. This provides the base for future research investigating the etiopathogenesis and effective treatment of the heterogeneous depression disorder.
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Affiliation(s)
- Stephanie Rodgers
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Switzerland.
| | - Martin Grosse Holtforth
- Department of Psychology, University of Zurich, and Department of Psychology, University of Bern, Switzerland
| | - Mario Müller
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Switzerland
| | - Michael P Hengartner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Switzerland
| | - Wulf Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Switzerland; Collegium Helveticum, University of Zurich and Swiss Federal Institute of Technology, Zurich, Switzerland; Institute of Psychiatry, Laboratory of Neuroscience (LIM 27), University of Sao Paulo, Brazil
| | - Vladeta Ajdacic-Gross
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Switzerland
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Interpersonal functioning deficits in association with DSM-IV personality disorder dimensions. Soc Psychiatry Psychiatr Epidemiol 2014; 49:317-25. [PMID: 23674198 DOI: 10.1007/s00127-013-0707-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 05/02/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE According to DSM, interpersonal functioning deficits are a main criterion for the general definition of personality disorders (PDs), but some PD diagnoses do not appear to be related to impaired interpersonal functioning. Social deficits have rarely been studied in all PD dimensions to date. METHODS We analyzed 511 adults aged 20-41 years from the general population of the canton of Zurich, Switzerland, using data from the Epidemiology Survey of the Zurich Programme for Sustainable Development of Mental Health Services (ZInEP). PD dimensions were measured with a questionnaire and indicators of interpersonal functioning with a semi-structured interview. Associations were analyzed with generalized linear models. RESULTS All PD dimensions were significantly associated with various indicators of interpersonal functioning deficits, such as distress and conflicts in friendships and partnership, feeling lonely, few close friends, and reduced social support. Schizotypal and borderline PD were relatively strongly associated with distress in friendships when compared with other PD dimensions. Furthermore, both dimensions were significantly related to all indicators of interpersonal functioning deficits. CONCLUSIONS Subjects scoring high on any PD dimension reported considerable deficits in interpersonal functioning as characterized by a solitary lifestyle, conflictual and distressful social relations, and lack of social support. All DSM-IV PDs are associated with poor interpersonal functioning, but there is some evidence that schizotypal and borderline symptomatology affects deficits in social interactions even more profoundly and pervasively than other PD dimensions.
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Hengartner MP, Müller M, Rodgers S, Rössler W, Ajdacic-Gross V. Occupational functioning and work impairment in association with personality disorder trait-scores. Soc Psychiatry Psychiatr Epidemiol 2014; 49:327-35. [PMID: 23835577 DOI: 10.1007/s00127-013-0739-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 06/28/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE According to the DSM, functional impairment is a main criterion for the general definition of personality disorders (PDs), but research suggests that some PDs might not be related to impaired functioning. Occupational functioning has rarely been examined in all ten DSM PDs. METHODS We analysed 511 adults aged 20-41 years from the general population of the canton of Zurich, Switzerland, using data from the Epidemiology Survey of the Zurich Programme for Sustainable Development of Mental Health Services. All PDs were assessed with dimensional trait-scores and associations with indicators of occupational functioning were analysed with generalised linear models. RESULTS Each PD revealed at least a weak association with some form of occupational impairment. Most PDs, especially from cluster A and B, were significantly related to occupational dysfunction, in particular low education level, conflicts in the workplace, dismissal or demotion, and unemployment. In contrast, obsessive-compulsive PD was mostly unrelated to occupational functioning. A total personality pathology dose-response relationship was observed for low education level, conflicts in the workplace, dismissal or demotion, and unemployment. CONCLUSIONS Impairment in occupational functioning is an important aspect particularly of cluster A and B PDs. Assuming that functional impairment is a predictor of illness severity, we advocate that clinicians should carefully explore indicators of occupational functioning in the diagnosis, prognosis, and treatment of PDs. The findings discussed herein have implications for general treatment, interventions in the work environment, or re-integration of patients into the labour force.
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Affiliation(s)
- Michael P Hengartner
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, PO Box 1930, 8021, Zurich, Switzerland,
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Manning W, Gayle Beck J. The role of psychological processes in estimates of stuttering severity. JOURNAL OF FLUENCY DISORDERS 2013; 38:356-367. [PMID: 24331243 DOI: 10.1016/j.jfludis.2013.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 07/23/2013] [Accepted: 08/08/2013] [Indexed: 06/03/2023]
Abstract
PURPOSE To examine the associations of trait anxiety (STAI), social anxiety (SIAS), depression (BDI-II), and personality features (ADP-IV) with three measures of stuttering severity: %SS, Stuttering Severity, Instrument, and the Overall Assessment of the Speaker's Experience of Stuttering. METHOD Fifty adults with a history of stuttering served as participants. Participant scores on trait, anxiety, social anxiety, depression, and personality features were entered into a regression analysis, with the criterion variables (DVs) being: %SS, SSI-3, OASES total score. In order to explore the OASES, further, each of the four OASES subscales were also examined. A separate regression was conducted for, each dependent variable. RESULTS The OASES total score model was significant (p<.0001) and revealed that social anxiety and, trait anxiety were the only significant predictors, with medium effect sizes noted for both variables. In contrast, percent syllables stuttered and the SSI were not significantly associated with psychological, variables, suggesting that anxiety may not always be related to overt indicators of stuttering. Depression and personality dysfunction were not significantly associated with any measure of, stuttering severity. CONCLUSION Anxiety in the form of social and trait anxiety are significantly associated with stuttering, severity as indicated by the OASES. Traditional procedures for assigning severity ratings to individuals, who stutter based on percent syllables stuttered and the Stuttering Severity Instrument are not, significantly related to psychological processes central to the stuttering experience. Depression and, personality characteristics do not meaningfully account for stuttering. EDUCATIONAL OBJECTIVES The reader will be able to: (a) differentiate forms of anxiety that are likely to be associated with stuttering (b) understand the importance of determining features of stuttering that go beyond the obvious, surface characteristics of stuttering frequency, and (c) discuss the important clinical and theoretical implications for understanding the degree of psychological dysfunction that is likely to be characteristic of those who stutter.
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Affiliation(s)
- Walter Manning
- School of Communication Sciences and Disorders, The University of Memphis, Memphis, TN, United States.
| | - J Gayle Beck
- Department of Psychology, The University of Memphis, Memphis, TN, United States
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Can protective factors moderate the detrimental effects of child maltreatment on personality functioning? J Psychiatr Res 2013; 47:1180-6. [PMID: 23743134 DOI: 10.1016/j.jpsychires.2013.05.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 04/23/2013] [Accepted: 05/08/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to examine whether, and if so, to what extent, education and coping strategies may reduce the detrimental effects of childhood maltreatment on personality functioning. METHODS We assessed dimensional trait-scores of all 10 DSM-IV personality disorders (PDs), childhood maltreatment, education and three coping styles in 511 subjects of the general population of Zurich, Switzerland, using data from the ZInEP Epidemiology Survey. RESULTS Childhood maltreatment was associated with all 10 PDs. Low education was related to antisocial, borderline and histrionic PD. Low emotion-focused coping was associated with paranoid, schizoid, borderline, avoidant, and obsessive-compulsive PD. Low problem-focused coping was related to schizoid PD and high problem-focused coping to histrionic PD. High dysfunctional coping was significantly related to all 10 PD dimensions. Obsessive-compulsive trait scores were significantly lower in maltreated subjects with high emotion-focused coping. Antisocial, borderline and narcissistic trait scores were significantly higher in maltreated subjects with high dysfunctional coping. CONCLUSION Education and adaptive coping may have a protective effect on PD symptomatology. Promotion of adaptive coping and suppression of dysfunctional coping may additionally reduce PD symptoms specifically in maltreated subjects. Those findings have important clinical implications. Longitudinal research is needed to address questions of causality and to evaluate potential effects of treatment and intervention.
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Van den Broeck J, Rossi G, De Clercq B, Dierckx E, Bastiaansen L. Validation of the FFM PD count technique for screening personality pathology in later middle-aged and older adults. Aging Ment Health 2013; 17:180-8. [PMID: 22913535 DOI: 10.1080/13607863.2012.717258] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Research on the applicability of the five factor model (FFM) to capture personality pathology coincided with the development of a FFM personality disorder (PD) count technique, which has been validated in adolescent, young, and middle-aged samples. This study extends the literature by validating this technique in an older sample. Five alternative FFM PD counts based upon the Revised NEO Personality Inventory (NEO PI-R) are computed and evaluated in terms of both convergent and divergent validity with the Assessment of DSM-IV Personality Disorders Questionnaire (shortly ADP-IV; DSM-IV, Diagnostic and Statistical Manual of Mental Disorders - Fourth edition). For the best working count for each PD normative data are presented, from which cut-off scores are derived. The validity of these cut-offs and their usefulness as a screening tool is tested against both a categorical (i.e., the DSM-IV - Text Revision), and a dimensional (i.e., the Dimensional Assessment of Personality Pathology; DAPP) measure of personality pathology. All but the Antisocial and Obsessive-Compulsive counts exhibited adequate convergent and divergent validity, supporting the use of this method in older adults. Using the ADP-IV and the DAPP - Short Form as validation criteria, results corroborate the use of the FFM PD count technique to screen for PDs in older adults, in particular for the Paranoid, Borderline, Histrionic, Avoidant, and Dependent PDs. Given the age-neutrality of the NEO PI-R and the considerable lack of valid personality assessment tools, current findings appear to be promising for the assessment of pathology in older adults.
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Affiliation(s)
- Joke Van den Broeck
- Department of Clinical and Lifespan Psychology, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium.
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Manning W, Beck JG. Personality dysfunction in adults who stutter: another look. JOURNAL OF FLUENCY DISORDERS 2013; 38:184-92. [PMID: 23773670 DOI: 10.1016/j.jfludis.2013.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 02/11/2013] [Accepted: 02/13/2013] [Indexed: 05/13/2023]
Abstract
PURPOSE Given reports of the frequent occurrence of personality disorders (PD) among individuals who stutter, this investigation was designed to determine the presence of personality disorders (PD) for individuals seeking treatment for stuttering, using a different self-report measure. METHOD The sample included 50 adults who were undergoing treatment for stuttering. The participants also completed a self-report measure (Assessment of the DSM-IV Personality Disorders, ADP-IV) that is known to have good differential validity in the assessment of personality disorders as well as good convergent validity with a structured interview administered by a skilled mental health professional. RESULTS Four participants met threshold values for one personality disorder (PD) and one participant met criteria for two personality disorders. The remaining 45 participants (90%) did not meet criteria for a PD. CONCLUSION Rates of observed PDs in this sample approximated rates that have been observed in general community samples using structured clinical interviews and trained interviewers. Related reports which have claimed high levels of personality disorders among adults who stutter appear to be inflated by the use of self-report devices that overestimate the occurrence and co-morbidity of these conditions. Implications for the treatment of adults who stutter are discussed. EDUCATIONAL OBJECTIVES The reader will be able to (a) summarize two basic perspectives of how individuals who stutter are influenced by the possibility of personality dysfunction (b) describe the factors that influence the detection of personality dysfunction using self-report procedures, discuss the important (c) theoretical and (d) clinical implications of accurately identifying personality dysfunction for adults who stutter.
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Affiliation(s)
- Walter Manning
- School of Communication Sciences and Disorders, The University of Memphis, Memphis, TN 38105, USA.
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De Clercq B, De Fruyt F. A Five-Factor Model framework for understanding childhood personality disorder antecedents. J Pers 2013; 80:1533-63. [PMID: 22320207 DOI: 10.1111/j.1467-6494.2012.00778.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The present contribution reviews evidence that supports the relevance of childhood antecedents of personality disorders, and advocates that the validity of a Five-Factor Model framework for describing general trait differences in childhood can be extended towards the field of developmental personality difficulties. In addition, we suggest that several traditional childhood Axis I conditions include a substantial trait component that may be responsible for the recurring finding that childhood Axis I disorders are predictive for adult Axis II disorders. Given the valuable information provided by a trait assessment, we further propose to integrate dimensional personality and personality pathology measures as standard tools in mental health assessments at a young age.
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Affiliation(s)
- Barbara De Clercq
- Department of Developmental, Personality and Social Psychology, Ghent University, Gent, Belgium.
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Vansteelandt K, Claes L, Muehlenkamp J, De Cuyper K, Lemmens J, Probst M, Vanderlinden J, Pieters G. Variability in Affective Activation Predicts Non-suicidal Self-injury in Eating Disorders. EUROPEAN EATING DISORDERS REVIEW 2012; 21:143-7. [DOI: 10.1002/erv.2220] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Jennifer Muehlenkamp
- Department of Psychology; University of Wisconsin-Eau Claire; Eau Claire; WI 54702-4004; USA
| | | | - Jos Lemmens
- University Psychiatric Center KU Leuven-Campus Kortenberg; Belgium
| | | | | | - Guido Pieters
- University Psychiatric Center KU Leuven-Campus Kortenberg; Belgium
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Spinhoven P, Bamelis L, Haringsma R, Molendijk M, Arntz A. Consistency of reporting sexual and physical abuse during psychological treatment of personality disorder: an explorative study. J Behav Ther Exp Psychiatry 2012. [PMID: 23200431 DOI: 10.1016/j.jbtep.2011.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The objective of this study was to assess the prevalence of decreasing, consistent and increasing reports of sexual and physical abuse after 12 months of long-term psychological treatment of personality disorders, to investigate demographic and clinical characteristics predictive of inconsistency of reporting abuse, and to explore whether autobiographical memory may account for this inconsistency. In 229 clinical participants with an SCID II diagnosed personality disorder, 180 (78.6%) reported the same instances of invasive sexual and/or physical abuse on a trauma questionnaire (SPAQ) at baseline and follow-up, 25 (10.9%) decreased and 24 (10.4%) increased their abuse reports. Consistency of reporting abuse did not differ between schema-focused therapy, clarification-oriented psychotherapy and treatment-as-usual. Current depressive episode (SCID-I) and decreased capacity to produce specific negative memories on the Autobiographical Memory Test were characteristic of decreasing abuse reporters, while increasing abuse reporters showed higher levels of Cluster A personality pathology (in particular schizotypal traits) on the Assessment of DSM-IV Personality Disorders (ADP-IV). These results suggest that even in treatment procedures directed at exploring someone's personal past with abuse-related imagery consistency of reporting abuse is quite stable. However, certain clinical characteristics may make some persons more likely to change their trauma reports. Moreover, reduced negative memory specificity may represent an avoidant strategy associated with no longer reporting instances of abuse.
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Affiliation(s)
- Philip Spinhoven
- Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands.
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Prevalence of DSM-IV Personality Disorders in Patients with Chronic Fatigue Syndrome: A Controlled Study. Int J Behav Med 2012; 20:219-28. [DOI: 10.1007/s12529-012-9273-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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