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Jacobsson P, Hopwood CJ, Krueger RF, Söderpalm B, Nilsson T. Conceptualizing adult ADHD with the DSM alternative model of personality disorder. Personal Ment Health 2024. [PMID: 39239863 DOI: 10.1002/pmh.1632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 07/11/2024] [Accepted: 07/22/2024] [Indexed: 09/07/2024]
Abstract
Personality traits and personality disorders are related to ADHD and indicate dysfunction in clinical populations. The goals of this study were to examine how the DSM-5 Alternative Model of Personality Disorder (AMPD) a) indicates the presence of ADHD and b) communicates information about dysfunction over and above ADHD diagnosis. A sample of 330 adult psychiatric patients with and without ADHD (60% female; mean age 33 years) were assessed for ADHD symptoms, personality impairment, maladaptive personality traits, and functional life impairment domains. The maladaptive personality domain Disinhibition and particularly the lower order facet of Distractibility distinguished between individuals with psychiatric difficulties with and without ADHD. Distractibility is strongly related to the ADHD symptom dimension Inattentiveness, and Antagonism to Hyperactivity/impulsivity. General personality impairment augmented ADHD diagnosis in predicting life impairments. The AMPD has utility in ADHD assessments for diagnosis and prognosis.
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Affiliation(s)
- Peter Jacobsson
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sektionskansliet: Blå Stråket 15, vån 3, SU/Sahlgrenska University Hospital, Gothenburg, Sweden
- Region Halland, Varberg, Sweden
| | | | - Robert F Krueger
- Department of Psychology, N414 Elliott Hall, 75 East River, Parkway, University of Minnesota, Minneapolis, MN, USA
| | - Bo Söderpalm
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sektionskansliet: Blå Stråket 15, vån 3, SU/Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thomas Nilsson
- Centre for Ethics, Law and Mental Health (CELAM), Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Forensic Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
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2
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Kwak S, Kwon J. General and distinct correspondence between personality disorder and interpersonal functioning. Acta Psychol (Amst) 2024; 249:104454. [PMID: 39153317 DOI: 10.1016/j.actpsy.2024.104454] [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: 02/20/2024] [Revised: 06/27/2024] [Accepted: 08/06/2024] [Indexed: 08/19/2024] Open
Abstract
The alternative model of personality disorders (AMPD) in DSM-5 includes interpersonal dysfunction as a core construct as a global severity dimension. However, it is less known how various interpersonal characteristics contribute to both general and distinct dimensions of personality dysfunction. In participants from community sources, we obtained responses to Levels of Personality Functioning Scale-Self Report (LPFS-SR), maladaptive traits (PID-5-BF), and social relationship patterns, including those related to close relationships and quantitative measures of network size. Canonical correlation analysis mapped conjoint associations between two sets of variables (personality scales and social relationship) and identified three distinct modes of correlation as significant. The first canonical pattern represented global dysfunction and was associated with utilitarianism, short-termed, weaker strengths, and smaller network sizes. The second canonical correlation represented externalizing traits and was associated with a larger number of relationships, higher utilitarianism, and short-term relationships with a close significant other. The third canonical correlation represented a detached, unemotional, and callous personality which corresponded with weaker relationship strength with both the mother and a close significant other. Our findings suggest that interpersonal functioning corresponding to personality dysfunction can be distinguished into both common and specific characteristics and further highlight the importance of characterizing distinct patterns within close relationships.
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Affiliation(s)
- Seyul Kwak
- Department of Psychology, Pusan National University, Busan, Republic of Korea.
| | - Jieun Kwon
- Department of Psychology, Pusan National University, Busan, Republic of Korea
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3
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Wyssen A, Lerch S, Reichl C, Mürner-Lavanchy I, Sigrist C, Schär S, Cavelti M, Koenig J, Kaess M. Comparing the new concept of impairment in personality functioning with borderline personality disorder: differential psychosocial and psychopathological correlates in a clinical adolescent sample. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02555-y. [PMID: 39150466 DOI: 10.1007/s00787-024-02555-y] [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: 03/11/2023] [Accepted: 08/05/2024] [Indexed: 08/17/2024]
Abstract
Borderline personality disorder (BPD) is an established diagnosis in adolescence with high comorbidity and psychosocial impairment. With the introduction of the alternative model for personality disorders in DSM-5 (AMPD), personality functioning is operationalized using the Level of Personality Functioning Scale (LPFS), which has been shown to be associated with severity of personality pathology. The present study aimed at examining differential psychopathological and psychosocial correlates of LPFS and BPD. A total of 526 adolescent in- and outpatients were interviewed with the STiP-5.1 (LPFS) and the SCID-II. Mixed linear regression was used to investigate the associations between the two interviews with measures of psychopathology and psychosocial impairment. 11.4% met the diagnostic threshold of both interviews, 16.1% only of the LPFS, and 64.1% were below the diagnostic threshold in both interviews (no PD). The BPD only group was larger than expected-8.4% of patients who met criteria for BPD did not fulfill criteria for significant impairment in the LPFS. The highest burden was found in individuals concurrently showing significant impairment in LPFS and fulfilling BPD diagnosis (LPFS + BPD). Differences between the LPFS only group and the BPD only group were found in risk behavior and traumatic experiences, with higher prevalence in the BPD group. Findings confirm the high psychopathological burden and psychosocial impairment associated with both BPD and LPFS. Those exceeding the diagnostic threshold of LPFS in combination with a BPD diagnosis are characterized by greatest disability. Not all adolescents fulfilling formal BPD diagnosis showed a clinically significant impairment in LPFS, which may refer to a distinct diagnostic group.
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Affiliation(s)
- Andrea Wyssen
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Stefan Lerch
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Corinna Reichl
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Ines Mürner-Lavanchy
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christine Sigrist
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Selina Schär
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Marialuisa Cavelti
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.
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García LF, Gutiérrez F, García O, Aluja A. The Alternative Model of Personality Disorders: Assessment, Convergent and Discriminant Validity, and a Look to the Future. Annu Rev Clin Psychol 2024; 20:431-455. [PMID: 38211624 DOI: 10.1146/annurev-clinpsy-081122-010709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
The Alternative Model of Personality Disorders (AMPD) is a dimensional, empirically based diagnostic system developed to overcome the serious limitations of traditional categories. We review the mounting evidence on its convergent and discriminant validity, with an incursion into the less-studied ICD-11 system. In the literature, the AMPD's Pathological Trait Model (Criterion B) shows excellent convergence with normal personality traits, and it could be useful as an organizing framework for mental disorders. In contrast, Personality Functioning (Criterion A) cannot be distinguished from personality traits, lacks both discriminant and incremental validity, and has a shaky theoretical background. We offer some suggestions with a view to the future. These include removing Criterion A, using the real-life consequences of traits as indicators of severity, delving into the dynamic mechanisms underlying traits, and furthering the integration of currently disengaged psychological paradigms that can shape a sounder clinical science.
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Affiliation(s)
- Luis F García
- Department of Biological and Health Psychology, Universidad Autónoma de Madrid, Madrid, Spain;
- Institute of Biomedical Research of Lleida Dr. Pifarré Foundation, Lleida, Catalonia, Spain
| | - Fernando Gutiérrez
- Personality Disorder Unit, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
- Institut d'Investigacions Biomèdiques August Pi Sunyer, Barcelona, Catalonia, Spain
| | - Oscar García
- Institute of Biomedical Research of Lleida Dr. Pifarré Foundation, Lleida, Catalonia, Spain
- Department of Psychology, European University of Madrid, Madrid, Spain
| | - Anton Aluja
- Institute of Biomedical Research of Lleida Dr. Pifarré Foundation, Lleida, Catalonia, Spain
- Department of Psychology, University of Lleida, Lleida, Catalonia, Spain
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Pires R, Henriques-Calado J, Sousa Ferreira A, Gama Marques J, Ribeiro Moreira A, Barata BC, Paulino M, Morey L, Gonçalves B. The Portuguese version of the self-report form of the DSM-5 Level of Personality Functioning Scale (LPFS-SR) in a community and clinical sample. PLoS One 2024; 19:e0300706. [PMID: 38935649 PMCID: PMC11210752 DOI: 10.1371/journal.pone.0300706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 03/04/2024] [Indexed: 06/29/2024] Open
Abstract
The Level of Personality Functioning Scale-Self-Report (LPFS-SR) operationalizes Criterion A of the DSM-5 Alternative Model for Personality Disorders. The current study aimed 1) to examine the internal consistency of the Portuguese version of the LPFS-SR in a community sample and a clinical sample, 2) to compare non-clinical participants (N = 282, Mage = 48.01, SD = 10.87) with two samples of clinical participants, one composed of patients with a personality disorder diagnosis (PD sample, n = 40, Mage = 46.18, SD = 13.59) and the other of patients with other psychiatric diagnoses (OD sample, n = 148, Mage = 49.49, SD = 11.88), with respect to LPFS-SR dimensions and total score, 3) to examine the capacity of the LPFS-SR to discriminate between samples through the ROC curve analyses, and 4) to examine the factor structure of the Portuguese version of the LPFS-SR. The Portuguese version of the LPFS-SR revealed adequate internal consistency results, akin to the original data, in the community and clinical samples. The community sample differed significantly from both clinical samples in all the LPFS-SR dimensions and total score. The ROC curve analysis indicated an optimal cut-off for the total score of 272.00, corresponding to a sensitivity of 75% and a specificity of 89%, in the PD vs. community samples. The LPFS-SR total score discriminative capacity between the PD and OD samples was lower, albeit also significant (area-under-the-curve of .63; p = .027; 95% CI: .52-.74). The current study provided evidence of the LPFS-SR's unidimensionality in both community and clinical samples. Although this study has limitations, its findings contribute to a deeper understanding of the LPFS-SR construct, as well as to its cross-cultural validation.
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Affiliation(s)
- Rute Pires
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisboa, Portugal
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisboa, Portugal
| | - Joana Henriques-Calado
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisboa, Portugal
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisboa, Portugal
| | - Ana Sousa Ferreira
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisboa, Portugal
- Instituto Universitário de Lisboa—Business Research Unit (BRU-IUL), Lisboa, Portugal
| | - João Gama Marques
- Clínica Universitária de Psiquiatra e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Consulta de Esquizofrenia Resistente, Hospital Júlio de Matos, Centro Hospitalar Psiquiátrico de Lisboa, Lisboa, Portugal
| | - Ana Ribeiro Moreira
- Centro Hospitalar de Lisboa Ocidental, Hospital de Egas Moniz, Lisboa, Portugal
| | - Bernardo C. Barata
- Departamento de Psiquiatria e Saúde Mental, Centro Hospitalar Barreiro Montijo, Barreiro, Portugal
| | - Marco Paulino
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisboa, Portugal
- Clínica Universitária de Psiquiatra e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Leslie Morey
- Texas A&M University: College Station, TX, United States of America
| | - Bruno Gonçalves
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisboa, Portugal
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisboa, Portugal
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Balzen KM, Kerr S, Gecha T, Hutsebaut J, Berghuis H, Sharp C. First Psychometric Evaluation of the English Version of the Semi-Structured Interview for Personality Functioning (STiP-5.1). J Pers Assess 2024:1-11. [PMID: 38934551 DOI: 10.1080/00223891.2024.2365325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024]
Abstract
The Alternative Model for Personality Disorders provides a dimensional framework for the conceptualization of personality disorders where Criterion A concerns the assessment of one's level of personality functioning (LPF). This study examines the psychometric properties of the English translation of the Semi-Structured Interview for Personality Functioning (STiP-5.1) to validate this translation for the assessment of LPF in English-speaking populations; and examine whether this measure increments self-report measures of LPF and personality pathology in predicting general functioning. The sample consisted of 129 emerging adults between 18 and 25 years of age (M = 20.54, SD = 2.08) from a mixed college and clinical sample. Results support a unidimensional factor structure of the STiP-5.1, good internal consistency, and high inter-rater reliability. Construct validity was supported through associations of the STiP-5.1 with self-report measures of LPF and personality pathology. The STiP-5.1 incremented self-report measures of personality pathology in predicting functional impairment, though additional variance explained was modest. Finally, STiP-5.1 scores differentiated individuals who obtained a score at or above the clinical cutoff from those below on self-report measures of personality pathology and LPF with large effect sizes. Findings support the validity of the English translation of the STiP-5.1 for the assessment of LPF.
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Affiliation(s)
| | - Sophie Kerr
- Department of Psychology, University of Houston
| | - Tess Gecha
- Department of Psychology, University of Houston
| | - Joost Hutsebaut
- Department of Medical and Clinical Psychology, Center of Research on Psychological disorders and Somatic diseases (CoRPS), Tilburg, The Netherlands
| | - Han Berghuis
- Arkin Mental Heath, NPI Centre for Personality Disorders, Amersfoort, The Netherlands
| | - Carla Sharp
- Department of Psychology, University of Houston
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Vittori A, Petrucci E, Cascella M, Bignami EG, Simonini A, Sollecchia G, Fiore G, Vergallo A, Marinangeli F, Pedone R. Maladaptive personality traits are associated with burnout risk in Italian anesthesiologists and intensivists: a secondary analysis from a cross-sectional study. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2024; 4:36. [PMID: 38907360 PMCID: PMC11193186 DOI: 10.1186/s44158-024-00171-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 05/27/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Burnout is a maladaptive response to chronic stress, particularly prevalent among clinicians. Anesthesiologists are at risk of burnout, but the role of maladaptive traits in their vulnerability to burnout remains understudied. METHODS A secondary analysis was performed on data from the Italian Association of Hospital Anesthesiologists, Pain Medicine Specialists, Critical Care, and Emergency (AAROI-EMAC) physicians. The survey included demographic data, burnout assessment using the Maslach Burnout Inventory (MBI) and subscales (emotional exhaustion, MBI-EE; depersonalization, MBI-DP; personal accomplishment, MBI-PA), and evaluation of personality disorders (PDs) based on DSM-IV (Diagnostic and Statistical Manual of Mental Disorders Fourth Edition) criteria using the assessment of DSM-IV PDs (ADP-IV). We investigated the aggregated scores of maladaptive personality traits as predictor variables of burnout. Subsequently, the components of personality traits were individually assessed. RESULTS Out of 310 respondents, 300 (96.77%) provided complete information. The maladaptive personality traits global score was associated with the MBI-EE and MBI-DP components. There was a significant negative correlation with the MBI-PA component. Significant positive correlations were found between the MBI-EE subscale and the paranoid (r = 0.42), borderline (r = 0.39), and dependent (r = 0.39) maladaptive personality traits. MBI-DP was significantly associated with the passive-aggressive (r = 0.35), borderline (r = 0.33), and avoidant (r = 0.32) traits. Moreover, MBI-PA was negatively associated with dependent (r = - 0.26) and avoidant (r = - 0.25) maladaptive personality features. CONCLUSIONS There is a significant association between different maladaptive personality traits and the risk of experiencing burnout among anesthesiologists. This underscores the importance of understanding and addressing personality traits in healthcare professionals to promote their well-being and prevent this serious emotional, mental, and physical exhaustion state.
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Affiliation(s)
- Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, 00165, Rome, Italy
| | - Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L'Aquila, 67100, L'Aquila, Italy
| | - Marco Cascella
- Unit of Anesthesiology, Intensive Care Medicine, and Pain Medicine, Department of Anesthesia and Critical Care, Department of Medicine, Surgery, and Dentistry, University of Salerno, 84082, Baronissi (Salerno), Italy.
| | - Elena Giovanna Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, 43121, Parma, Italy
| | - Alessandro Simonini
- Pediatric Anesthesia and Intensive Care Unit AOU Delle Marche, Salesi Children's Hospital, 60121, Ancona, Italy
| | - Giacomo Sollecchia
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L'Aquila, 67100, L'Aquila, Italy
| | - Gilberto Fiore
- Department of Anesthesia and Intensive Care, Hospital of Santa Croce Di Moncalieri, 10024, Turin, Italy
| | - Alessandro Vergallo
- Department of Anesthesia and Intensive Care, Spedali Civili Di Brescia, 25121, Brescia, Italy
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L'Aquila, 67100, L'Aquila, Italy
| | - Roberto Pedone
- Department of Psychology, University of Campania Luigi Vanvitelli, 8100, Caserta, Italy
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8
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Hopwood CJ. Personality Functioning, Problems in Living, and Personality Traits. J Pers Assess 2024:1-16. [PMID: 38700238 DOI: 10.1080/00223891.2024.2345880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/12/2024] [Indexed: 05/05/2024]
Abstract
The publication of the Alternative Model of Personality Disorder (AMPD) was a signpost achievement in the personality assessment. However, research on the AMPD has generally not led to either a deeper understanding of personality disorder or personality assessment or new ideas about how to provide better care for people with personality disorder diagnoses. A significant portion of research has focused on narrow issues and appears to be driven in part by ideological differences between scholars who prefer Criterion A (personality functioning) or Criterion B (maladaptive traits). I trace these issues to ambiguity about the concept of personality functioning as defined in the AMPD and its conceptual distinction from personality traits and problems in living. In this paper, I reground these concepts in coherent and distinct definitions, elaborate upon the implications of their differences, and show how these differences can help clarify and reorient AMPD research to focus on generating clinically useful models for personality pathology and personality assessment.
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Thomson M, Cavelti M, Lerch S, Koenig J, Reichl C, Mürner-Lavanchy I, Wyssen A, Kaess M. Clinical profiles of adolescent personality pathology: a latent structure examination of the Semi-Structured Interview for Personality Functioning DSM-5 (STiP-5.1) in a help-seeking sample. Borderline Personal Disord Emot Dysregul 2024; 11:9. [PMID: 38589974 PMCID: PMC11003081 DOI: 10.1186/s40479-024-00252-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/25/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Despite the introduction of dimensional conceptualisations of personality functioning in the latest classification systems, such as Criterion A of the Alternative Model of Personality Disorders in the DSM-5, heterogeneous clinical presentation of personality pathology remains a challenge. Relatedly, the latent structure of personality pathology as assessed by the Semi-Structured Interview for Personality Functioning DSM-5 (STiP-5.1) has not yet been comprehensively examined in adolescents. Therefore, this study aimed to examine the latent structure of the STiP-5.1, and, based on those findings, to describe any unique clinical profiles that might emerge. METHODS The final sample comprised 502 participants aged 11-18 years consecutively recruited from a specialised personality disorder outpatient service, as well as general day clinic and inpatient wards at the University Hospital University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Bern, Switzerland. Participants were assessed using the STiP-5.1, as well as a battery of other psychological measures by clinical psychologists or trained doctoral students. Variations of Factor Analysis, Latent Class Analysis and Factor Mixture Models (FMM) were applied to the STiP-5.1 to determine the most appropriate structure. RESULTS The best fitting model was an FMM comprising four-classes and two factors (corresponding to self- and interpersonal-functioning). The classes differed in both overall severity of personality functioning impairment, and in their scores and clinical relevance on each element of the STiP-5.1. When compared to the overall sample, classes differed in their unique clinical presentation: class 1 had low impairment, class 2 had impairments primarily in self-functioning with high depressivity, class 3 had mixed levels of impairment with emerging problems in identity and empathy, and class 4 had severe overall personality functioning impairment. CONCLUSIONS A complex model incorporating both dimensional and categorical components most adequately describes the latent structure of the STiP-5.1 in our adolescent sample. We conclude that Criterion A provides clinically useful information beyond severity (as a dimensional continuum) alone, and that the hybrid model found for personality functioning in our sample warrants further attention. Findings can help to parse out clinical heterogeneity in personality pathology in adolescents, and help to inform early identification and intervention efforts.
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Affiliation(s)
- Madelyn Thomson
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Marialuisa Cavelti
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Stefan Lerch
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Corinna Reichl
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Ines Mürner-Lavanchy
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Andrea Wyssen
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
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10
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Biberdzic M, Sowislo JF, Cain N, Meehan KB, Preti E, Di Pierro R, Caligor E, Clarkin JF. Establishing Levels of Personality Functioning Using the Structured Interview of Personality Organization (STIPO-R): a Latent Profile Analysis. J Pers Assess 2024:1-13. [PMID: 38563480 DOI: 10.1080/00223891.2024.2330502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 02/17/2024] [Indexed: 04/04/2024]
Abstract
Both the new ICD-11 and the latest Alternative DSM-5 Model for Personality Disorders focus on self and interpersonal functioning as the central feature of personality pathology, also acknowledging that personality disorders are organized along a dimensional continuum of severity. This revised understanding is in line with long-standing psychodynamic conceptualisations of personality pathology, in particular Kernberg's object relations model of personality organization. Despite existing evidence for the clinical utility of the derived Structured Interview of Personality Organization (STIPO-R), empirical support for the identification of clear cut-points between the different levels of personality functioning is missing. For this purpose, a total of 764 adult participants were recruited across two clinical (outpatient and inpatient) settings (n = 250) and two non-clinical (university students and general community) samples (n = 514). Results from the mixture modeling suggested the existence of five groups across the clinical and non-clinical samples that covered: healthy personality functioning, maladaptive personality rigidity, and mild, moderate, and severe levels of personality pathology. All five indicators of personality organization were found to be reliable predictors of personality pathology. Of the five STIPO-R indicators, Aggression and Moral Values had the most discriminative power for differentiating between the Mild, Moderate, and Severe personality disorder groups. Implications of these findings are discussed.
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Affiliation(s)
- Marko Biberdzic
- Department of Psychology, Bishop's University, Sherbrooke, QC, Canada
| | - Julia F Sowislo
- Personality Disorders Institute and Department of Psychiatry, Weill Medical College of Cornell University, New York, New York
| | - Nicole Cain
- Personality Disorders Institute and Department of Psychiatry, Weill Medical College of Cornell University, New York, New York
- Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, New Jersey, USA
| | - Kevin B Meehan
- Personality Disorders Institute and Department of Psychiatry, Weill Medical College of Cornell University, New York, New York
- Department of Psychology, Long Island University, Brooklyn, New York, USA
| | - Emanuele Preti
- Department of Psychology, University of Milan-Bicocca, Milan, Italy
| | | | - Eve Caligor
- Personality Disorders Institute and Department of Psychiatry, Weill Medical College of Cornell University, New York, New York
- Department of Psychiatry, Vagelos College of Physicians and Surgeons of Columbia University, New York, New York, USA
| | - John F Clarkin
- Personality Disorders Institute and Department of Psychiatry, Weill Medical College of Cornell University, New York, New York
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11
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Kim YR, Lee YH. The Dimensional Conceptualization of Personality Disorders: Personality Organization, Personality Functioning, and Personality Disorders. J Pers Disord 2024; 38:105-125. [PMID: 38592910 DOI: 10.1521/pedi.2024.38.2.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
Over the past several decades, significant criticism of the categorical classification system for personality disorders has highlighted the need to transition to a dimensional classification system. This study reviewed key issues involved in the potential conversion of the diagnostic system of personality disorders from a categorical to a dimensional model. The result suggests that Kernberg's concept of personality organization can be used to indicate the overall severity of personality pathology.
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Affiliation(s)
- Young Ran Kim
- From Institute of Psychoanalytic Training and Research, New York, New York
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Clark LA, Ro E, Nuzum H, Vanderbleek EN, Allen X. Personality disorder coverage, prevalence, and convergence: do the DSM-5's two models of personality disorder identify the same patients? Psychol Med 2024:1-12. [PMID: 38501282 DOI: 10.1017/s0033291724000357] [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: 03/20/2024]
Abstract
BACKGROUND Research on the Alternative DSM-5 Model for Personality Disorders (AMPD) in DSM-5's Section-III has demonstrated acceptable interrater reliability, a largely consistent latent structure, substantial correlations with theoretically and clinically relevant measures, and evidence for incremental concurrent and predictive validity after controlling for DSM-5's Section II categorical personality disorders (PDs). However, the AMPD is not yet widely used clinically. One clinician concern may be caseness - that the new model will diagnose a different set of PD patients from that with which they are familiar. The primary aim of this study is to determine whether this concern is valid, by testing how well the two models converge in terms of prevalence and coverage. METHOD Participants were 305 psychiatric outpatients and 302 community residents not currently in mental-health treatment who scored above threshold on the Iowa Personality Disorder Screen (Langbehn et al., ). Participants were administered a semi-structured interview for DSM-5 PD, which was scored for both Section II and III PDs. RESULTS Convergence across the two PD models was variable for specific PDs, Good when specific PDs were aggregated, and Very Good for 'any PD.' CONCLUSIONS Results provide strong evidence that the AMPD yields the same overall prevalence of PD as the current model and, further, identifies largely the same overall population. It also addresses well-known problems of the current model, is more consistent with the ICD-11 PD model, and provides more complete, individualized characterizations of persons with PD, thereby offering multiple reasons for its implementation in clinical settings.
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Affiliation(s)
- Lee Anna Clark
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Eunyoe Ro
- Department of Psychology, Southern Illinois University Edwardsville, Edwardsville, IL, USA
| | - Hallie Nuzum
- Veterans Affairs Puget Sound Health Care System, Seattle Division, Seattle, WA, USA
| | | | - Xia Allen
- And Still We Rise, LLC, Boston, MA, USA
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Natoli AP, Rodriguez CM. A new performance-based measure of personality functioning impairment: development and preliminary evaluation of reliability and validity. DISCOVER MENTAL HEALTH 2024; 4:6. [PMID: 38388840 PMCID: PMC10884381 DOI: 10.1007/s44192-024-00059-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/31/2024] [Indexed: 02/24/2024]
Abstract
Personality functioning impairment is at the center of many dimensional models of personality. Available measures of personality functioning impairment are limited to self-report, clinician-/informant-rated, and interview methods. Although researchers have begun investigating established performance-based instruments' potential for assessing personality functioning impairment, administration and scoring of these instruments is complex and the latent variables they measure diverge from personality functioning impairment as described in the ICD-11 and the Alternative Model for Personality Disorders (AMPD) of the DSM. We address this absence by developing and psychometrically evaluating the Level of Personality Functioning Scale-Questionnaire-based Implicit Association Test (LPFS-qIAT). The LPFS-qIAT's psychometric properties were evaluated across four studies, producing initial evidence supporting the new instrument's reliability as well as its convergent, discriminant, and criterion-related validity. As the first performance-based measure of personality functioning impairment that aligns with the AMPD and, to a degree the ICD-11, that is easily administered, scored, and interpreted, the LPFS-qIAT shows potential to become a valuable tool in both research and clinical practice.
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Affiliation(s)
- Adam P Natoli
- Department of Psychology and Philosophy, Sam Houston State University, Huntsville, TX, USA.
| | - Chloe M Rodriguez
- Department of Psychology and Philosophy, Sam Houston State University, Huntsville, TX, USA
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Sellbom M, Brown TA, Bach B. Development and psychometric evaluation of the Personality Disorder Severity ICD-11 (PDS-ICD-11) Clinician-Rating Form. Personal Ment Health 2024; 18:60-68. [PMID: 37941508 DOI: 10.1002/pmh.1596] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/17/2023] [Accepted: 10/16/2023] [Indexed: 11/10/2023]
Abstract
No clinician-rating tool has formally been developed to assess the ICD-11 model of personality disorder (PD) severity. We therefore developed and evaluated the 14-item personality disorder Severity ICD-11 (PDS-ICD-11) Clinician-Rating Form. A combined sample of 195 patients was rated by mental health professionals or clinical research assistants in New Zealand using the PDS-ICD-11 Clinician-Rating Form. Responses were subjected to item-response theory analysis and confirmatory factor analysis. In a subsample, we examined interrater reliability and convergence with self- and informant-reported measures of personality impairment, dysfunction in various psychopathology domains, and traditional PD symptoms. Item-response theory and confirmatory factor analyses supported the item functioning and unidimensionality, respectively, of the PDS-ICD-11 Clinician-Rating Form. The interrater reliability was very promising (intraclass correlation coefficient = 0.94, p < 0.001). PDS-ICD-11 Clinician-Rating Form scores were associated with established measures of personality dysfunction at large effect sizes. This initial development study suggests that the PDS-ICD-11 Clinician-Rating Form constitutes a psychometrically sound instrument that provides a clinically based impression of the severity of personality dysfunction according to the official ICD-11 description. More research is needed to corroborate its validity and utility, and a structured interview is warranted for diagnostic purposes. The final PDS-ICD-11 Clinician-Rating Form is included as online supporting information.
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Affiliation(s)
- Martin Sellbom
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Tiffany A Brown
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Bo Bach
- Psychiatric Research Unit, Center for Personality Disorder Research, Region Zealand, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
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Volkert J, Ilagan GS, Iliakis EA, Ren B, Schröder-Pfeifer P, Choi-Kain LW. What predicts psychosocial functioning in borderline personality disorder? Investigating the association with reflective functioning. Psychol Psychother 2024. [PMID: 38214456 DOI: 10.1111/papt.12516] [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: 02/10/2023] [Revised: 11/21/2023] [Accepted: 12/18/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVES The aim of this study was to investigate factors associated with functioning in participants with and without borderline personality disorder (BPD). In particular, we were interested whether mentalizing and related social cognitive capacities, as factors of internal functioning, are important in predicting psychosocial functioning, in addition to other psychopathological and sociodemographic factors. METHOD This is a cross-sectional study with N = 53 right-handed females with and without BPD, without significant differences in age, IQ, and socioeconomic status, who completed semi-structured diagnostic and self-report measures of social cognition. Mentalizing was assessed using the Reflective Functioning Scale based on transcribed Adult Attachment Interviews. A regularized regression with the elastic net penalty was deployed to investigate whether mentalizing and social cognition predict psychosocial functioning. RESULTS Borderline personality disorder symptom severity, sexual abuse trauma, and social and socio-economic factors ranked as the most important variables in predicting psychosocial functioning, while reflective functioning (RF) was somewhat less important in the prediction, social cognitive functioning and sociodemographic variables were least important. CONCLUSIONS Borderline personality disorder symptom severity was most important in determining functional impairment, alongside trauma related to sexual abuse as well as social and socio-economic factors. These findings verify that BPD symptoms themselves most robustly predict functional impairment, followed by history of sexual abuse, then contextual factors (e.g. housing, financial, physical health), and then RF. These results lend marginal support to the conceptualization that mentalizing may enhance psychosocial functioning by facilitating social learning, but emphasize symptom reduction and stabilization of life context as key intervention targets.
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Affiliation(s)
- Jana Volkert
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Ulm, Ulm, Germany
| | | | - Evan A Iliakis
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Boyu Ren
- Laboratory for Psychiatric Biostatistics, McLean Hospital, Belmont, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Paul Schröder-Pfeifer
- Institute for Psychosocial Prevention, University of Heidelberg, Heidelberg, Germany
| | - Lois W Choi-Kain
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Gunderson Personality Disorders Institute, McLean Hospital, Belmont, Massachusetts, USA
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Emery LT, Evans CM, Dimitrova J, O'Keefe C, Simms LJ. Understanding the association between normal and maladaptive personality traits: Replication and extension of Morey et al. (2020). J Pers 2023. [PMID: 38014708 DOI: 10.1111/jopy.12904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/08/2023] [Accepted: 11/05/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND/OBJECTIVE The Alternative Model for Personality Disorders (AMPD) within the DSM-5 includes separable components representing general personality dysfunction (Criterion A) and maladaptive personality traits (Criterion B). Some critique Criterion A for accounting for little incremental variance in PD beyond Criterion B. However, Morey et al. (2020) hypothesized that personality dysfunction is a key mechanism through which normal-range traits account for the maladaptive component of personality traits, justifying its inclusion. We sought to replicate and extend this work in a psychiatric sample with mixed methods. METHOD In total, 152 participants recruited from mental health clinics completed multiple measures of personality dysfunction and normal-range and maladaptive traits. RESULTS Replication was only partially achieved. The degree of incremental prediction of maladaptive traits and the extent to which personality dysfunction explained the relations between normal-range and maladaptive traits varied significantly across traits, and those effects that reached significance were small in magnitude. Removing variance due to personality dysfunction reduced intercorrelations among maladaptive traits by only a small amount. CONCLUSION Counter to Morey et al. (2020), our results failed to support maladaptive traits as composites of normal-range traits and personality dysfunction, suggesting that other methods of distinguishing personality pathology severity and style are needed.
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Affiliation(s)
- Leah T Emery
- Department of Psychology, University at Buffalo, Buffalo, New York, USA
| | - Chloe M Evans
- Department of Psychology, University at Buffalo, Buffalo, New York, USA
| | - Julia Dimitrova
- Department of Psychology, University at Buffalo, Buffalo, New York, USA
| | - Courtney O'Keefe
- Department of Psychology, University at Buffalo, Buffalo, New York, USA
| | - Leonard J Simms
- Department of Psychology, University at Buffalo, Buffalo, New York, USA
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Knapen S, Swildens WE, Mensink W, Hoogendoorn A, Hutsebaut J, Beekman ATF. The development and psychometric evaluation of the Questionnaire Epistemic Trust (QET): A self-report assessment of epistemic trust. Clin Psychol Psychother 2023. [PMID: 37947067 DOI: 10.1002/cpp.2930] [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: 05/24/2023] [Revised: 10/15/2023] [Accepted: 10/16/2023] [Indexed: 11/12/2023]
Abstract
Epistemic trust (ET) refers to the predisposition to trust information as authentic, trustworthy and relevant to the self. Epistemic distrust - resulting from early adversity - may interfere with openness to social learning within the therapeutic encounter, reducing the ability to benefit from treatment. The self-report Questionnaire Epistemic Trust (QET) is a newly developed instrument that aims to assess ET. This study presents the first results on the psychometric properties of the QET in both a community and a clinical sample. Our findings indicate that the QET is composed of four meaningful subscales with good to excellent internal consistency. The QET shows relevant associations with related constructs like personality functioning, symptom distress and quality of life. QET scores clearly distinguish between a clinical and community sample and are associated with the quality of the therapeutic alliance. The QET provides a promising, brief and user-friendly instrument that could be used for a range of clinical and research purposes. Future studies with larger samples are needed to strengthen construct validity and to investigate the value of the QET to predict differential treatment responses or to study mechanisms of change.
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Affiliation(s)
- Saskia Knapen
- Altrecht Mental Health Care, Utrecht, Amsterdam UMC, Amsterdam, The Netherlands
| | - Wilma E Swildens
- Altrecht Mental Health Care, Utrecht, Inholland University of Applied Sciences, Amsterdam, The Netherlands
| | - Wendy Mensink
- Altrecht Mental Health Care, Utrecht, The Netherlands
| | - Adriaan Hoogendoorn
- Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Joost Hutsebaut
- Tilburg University and Viersprong Institute for the Study on Personality Disorders, Halsteren, The Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, the Netherlands
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Williams R, Chiesa M, Moselli M, Frattini C, Casini M, Fonagy P. The relationship between mood disorders, personality disorder and suicidality in adolescence: does general personality disturbance play a significant role in predicting suicidal behavior? Borderline Personal Disord Emot Dysregul 2023; 10:32. [PMID: 37907967 PMCID: PMC10619325 DOI: 10.1186/s40479-023-00238-9] [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: 04/07/2023] [Accepted: 10/04/2023] [Indexed: 11/02/2023] Open
Abstract
INTRODUCTION Current research points to the importance personality pathology and Major Depression e as relevant psycopathological risk factors for understanding suicidal risk in adolescence. Literature has mainly focused on the role of BPD, however current orientations in personality pathological functioning suggest that BPD may be the representative of a general personality disturbance, a factor of vulnerability underlying diverse psychopathological variants and aspects of maladaptive functioning. However, recent studies seem to have neglected the contributions that other specific personality disorders and personality pathology as a general factor of vulnerability for suicidality; and only marginally investigated the interaction of personality disorder (PD) as an overall diagnosis and individual PDs and major depression (MDD). In this paper, the independent and cumulative effects of MDD and DSM-IV PDs on suicidal risk are investigated in a sample of adolescents observed in a longitudinal window of observation ranging from three months preceding the assessment to a six-month follow up period of clinical monitoring. METHODS A sample of 118 adolescents (mean age = 15.48 ± 1.14) referred for assessment and treatment on account of suicidal ideation or behavior were administered the CSSRS, SCID II, Kiddie-SADS at admission at inpatient and outpatient Units. All subjects included in the study had reported suicidal ideation or suicide attempts at the C-SSRS; The CSSRS was applied again to all patients who reported further suicidal episodes during the six-months follow-up period of clinical monitoring. Dimensional diagnoses of PDs was obtained by summing the number of criteria met by each subject at SCID-%-PD 5, In order, to test the significance of the associations between the variables chosen as predictors (categorical and dimensional PDs and MD diagnosis), and the suicidal outcomes variables suicide attempts, number of suicide attempts and potential lethality of suicide attempt, non-parametric bivariate correlations, logistic regression models and mixed-effects Poisson regression were performed PD. RESULTS The categorical and dimensional diagnosis of PD showed to be a significant risk factors for suicide attempt and their recurrence, independently of BPD, that anyway was confirmed to be a specific significant risk factor for suicidal behaviors. Furthermore, PD assessed at a categorical and dimensional level and Major Depression exert an influence on suicidal behaviors and their lethality both as independent and cumulative risk factors. LIMITATIONS Besides incorporating dimensional thinking into our approach to assessing psychopathology, our study still relied on traditionally defined assessment of PD. Future studies should include AMPD-defined personality pathology in adolescence to truly represent dimensional thinking. CONCLUSION These results point to the importance of early identification of the level of severity of personality pathology at large and its co-occurrence with Major Depression for the management of suicidal risk in adolescence.
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Affiliation(s)
- Riccardo Williams
- Department of Dynamic and Clinical Psychology and Health Studies, Faculty of Medicine and Psychology, "Sapienza" - University of Rome, Rome, Italy.
| | - Marco Chiesa
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Marta Moselli
- Department of Dynamic and Clinical Psychology and Health Studies, Faculty of Medicine and Psychology, "Sapienza" - University of Rome, Rome, Italy
| | - Camillla Frattini
- Department of Dynamic and Clinical Psychology and Health Studies, Faculty of Medicine and Psychology, "Sapienza" - University of Rome, Rome, Italy
| | - MariaPia Casini
- Section of Child and Adolescent Neuro-Psychiatry, "Sapienza" - University of Rome, Rome, Italy
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Katar KS, Örsel S, Gündoğmuş AG. Investigation of the role of personality traits and emotion regulation on personality functioning in patients with depression/anxiety disorder. Personal Ment Health 2023; 17:232-245. [PMID: 36693422 DOI: 10.1002/pmh.1577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/10/2022] [Accepted: 01/09/2023] [Indexed: 01/26/2023]
Abstract
The relationship between the dimensional assessment of personality and difficulties in emotion regulation has yet to be made clear. The present study aimed to investigate the role of personality traits and emotion regulation on personality functioning. Difficulties in Emotion Regulation Scale (DERS), Beck Anxiety Inventory, Beck Depression Inventory, Personality Inventory for DSM-5 (PID-5) and Level of Personality Functioning Scale (LPFS) were rated for 220 patients with depression and/or anxiety disorder diagnosis and 100 healthy controls. Stepwise regression analyses (SRA) were used to find potential predictors of personality functioning, and generalized linear analyses (GLA) were used to find mediators between the traits and personality functioning. SRA results in the clinical group showed that higher depression, antagonism, difficulties in impulse control and difficulties in awareness predicted higher levels of dysfunction in personality. According to GLA results in the clinical group, the impulse subscale of DERS partially mediated the relationship between antagonism and level of impairment in personality functioning. Our results indicate that certain emotion regulation styles and personality traits play an important role in predicting personality functioning in the clinical sample of depression and anxiety patients. Future studies should focus on specific emotion dysregulation strategies and broaden the dimensional personality literature in different samples.
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Affiliation(s)
- Kübra Sezer Katar
- University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Sibel Örsel
- University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Ayse Gökçen Gündoğmuş
- University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
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Frowijn I, Masthoff E, Bogaerts S. Predictive validity on clinical item-level of the HKT-R divided into clinical patient classes. BMC Psychiatry 2023; 23:502. [PMID: 37438815 DOI: 10.1186/s12888-023-04994-4] [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: 02/13/2023] [Accepted: 07/02/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Because of the heterogeneity of forensic groups, latent class analysis (LCA) can allow for the formation of stronger homogeneous patient classes, which can improve the predictive validity of forensic risk assessment tools, such as the Historical Clinical Future - Revised (HKT-R), which was used in this study. In particular, dynamic clinical risk and protective items are important in treatment and are obligatory assessed annually for every forensic patient with a TBS measure in the Netherlands. Therefore, this study investigated the predictive validity of the HKT-R at clinical item-level per patient class. METHOD A cohort of 332 forensic patients, who were discharged from highly secured Forensic Psychiatric Centers/Clinics (FPCs) in the Netherlands between 2004 and 2008, was followed. LCA was performed to cluster this group of patients based on psychopathology and criminal offenses. The predictive validity of the HKT-R clinical items by class was assessed with official reconviction data two and five years after discharge as outcome measure. RESULTS Four classes were identified. The predictive validity of the HKT-R clinical items showed differences between and within classes on admission or discharge, and for predicting violent reoffending after two or five years after discharge. DISCUSSION Different risk/protective factors of the HKT-R may play a role for different subgroups of patients. Therefore, this heterogeneity should be considered for any measure or intervention.
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Affiliation(s)
- Iris Frowijn
- Department of Developmental Psychology, Tilburg University, Tilburg, the Netherlands.
- Fivoor Science and Treatment Innovation (FARID), Rotterdam, the Netherlands.
| | - Erik Masthoff
- Department of Developmental Psychology, Tilburg University, Tilburg, the Netherlands
- Fivoor Science and Treatment Innovation (FARID), Rotterdam, the Netherlands
| | - Stefan Bogaerts
- Department of Developmental Psychology, Tilburg University, Tilburg, the Netherlands
- Fivoor Science and Treatment Innovation (FARID), Rotterdam, the Netherlands
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James R, Daukantaité D, Nilsson M. A validation of the Swedish self-concept and Identity Measure (SCIM) and its association with mental health problems. Heliyon 2023; 9:e18151. [PMID: 37519721 PMCID: PMC10372226 DOI: 10.1016/j.heliyon.2023.e18151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 06/20/2023] [Accepted: 07/10/2023] [Indexed: 08/01/2023] Open
Abstract
Pathological disturbance to one's identity is closely linked with mental illness and in particular personality disorders. Current measures of identity pathology within clinical research are nevertheless inconsistently used and present with substantial limitations such as disproportionate focus on adolescence. The Self-Concept and Identity Measure (SCIM) identifies pathological and non-pathological identity disturbance by implementing a measurement for clinical components of identity, as well as introducing the Lack of Identity concept. This study thus explores the psychometric properties (factor structure, internal consistency, and criterion validity) of the Swedish SCIM in a large sample of Swedish university students (N = 1500). Model fit indices for the three-dimension model of identity pathology consisting of consolidated-, disturbed-, and lack of identity subscales were deemed acceptable and the Swedish SCIM scores correlated with measures of psychopathology in the expected direction, together concluding that the Swedish SCIM was satisfactorily valid and reliable. The results further reveal a significant positive correlation between identity pathology and non-suicidal self-injury, two concepts that co-occur in psychopathologies, such as borderline personality disorder, but have not yet been studied in a Western population with this tool. The potential clinical use of this translated dimensional tool needs to be tested in a Swedish clinical population, however, we conclude that it already offers insight into the complexities of identity functioning and correlations with clinical symptoms.
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Affiliation(s)
- Rosie James
- Faculty of Medicine at Lund University, Sweden
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Sweden
| | | | - Magnus Nilsson
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Sweden
- Clinical Psychiatric Research Centre, Region Skåne, Lund, Sweden
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Rosenblau G, Frolichs K, Korn CW. A neuro-computational social learning framework to facilitate transdiagnostic classification and treatment across psychiatric disorders. Neurosci Biobehav Rev 2023; 149:105181. [PMID: 37062494 PMCID: PMC10236440 DOI: 10.1016/j.neubiorev.2023.105181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 03/14/2023] [Accepted: 04/13/2023] [Indexed: 04/18/2023]
Abstract
Social deficits are among the core and most striking psychiatric symptoms, present in most psychiatric disorders. Here, we introduce a novel social learning framework, which consists of neuro-computational models that combine reinforcement learning with various types of social knowledge structures. We outline how this social learning framework can help specify and quantify social psychopathology across disorders and provide an overview of the brain regions that may be involved in this type of social learning. We highlight how this framework can specify commonalities and differences in the social psychopathology of individuals with autism spectrum disorder (ASD), personality disorders (PD), and major depressive disorder (MDD) and improve treatments on an individual basis. We conjecture that individuals with psychiatric disorders rely on rigid social knowledge representations when learning about others, albeit the nature of their rigidity and the behavioral consequences can greatly differ. While non-clinical cohorts tend to efficiently adapt social knowledge representations to relevant environmental constraints, psychiatric cohorts may rigidly stick to their preconceived notions or overly coarse knowledge representations during learning.
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Affiliation(s)
- Gabriela Rosenblau
- Department of Psychological and Brain Sciences, George Washington University, Washington DC, USA; Autism and Neurodevelopmental Disorders Institute, George Washington University, Washington DC, USA.
| | - Koen Frolichs
- Section Social Neuroscience, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany; Institute for Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph W Korn
- Section Social Neuroscience, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany; Institute for Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Monaghan C, Bizumic B. Dimensional models of personality disorders: Challenges and opportunities. Front Psychiatry 2023; 14:1098452. [PMID: 36960458 PMCID: PMC10028270 DOI: 10.3389/fpsyt.2023.1098452] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/03/2023] [Indexed: 03/09/2023] Open
Abstract
Categorical models of personality disorders have been beneficial throughout psychiatric history, providing a mechanism for organizing and communicating research and treatment. However, the view that individuals with personality disorders are qualitatively distinct from the general population is no longer tenable. This perspective has amassed steady criticism, ranging from inconsequential to irreconcilable. In response, stronger evidence has been accumulated in support of a dimensional perspective that unifies normal and pathological personality on underlying trait continua. Contemporary nosology has largely shifted toward this dimensional perspective, yet broader adoption within public lexicon and routine clinical practice appears slow. This review focuses on challenges and the related opportunities of moving toward dimensional models in personality disorder research and practice. First, we highlight the need for ongoing development of a broader array of measurement methods, ideally facilitating multimethod assessments that reduce biases associated with any single methodology. These efforts should also include measurement across both poles of each trait, intensive longitudinal studies, and more deeply considering social desirability. Second, wider communication and training in dimensional approaches is needed for individuals working in mental health. This will require clear demonstrations of incremental treatment efficacy and structured public health rebates. Third, we should embrace cultural and geographic diversity, and investigate how unifying humanity may reduce the stigma and shame currently generated by arbitrarily labeling an individual's personality as normal or abnormal. This review aims to organize ongoing research efforts toward broader and routine usage of dimensional perspectives within research and clinical spaces.
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Affiliation(s)
- Conal Monaghan
- Research School of Psychology, Australian National University, Canberra, ACT, Australia
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Pires R, Henriques-Calado J, Sousa Ferreira A, Gama Marques J, Ribeiro Moreira A, Barata BC, Paulino M, Gonçalves B. Bridging the ICD11 and the DSM-5 personality disorders classification systems: The role of the PID5BF + M. Front Psychiatry 2023; 14:1004895. [PMID: 36937719 PMCID: PMC10017429 DOI: 10.3389/fpsyt.2023.1004895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 02/06/2023] [Indexed: 03/06/2023] Open
Abstract
Introduction In both the ICD-11 Classification of Personality Disorders and the DSM-5 Alternative Model of Personality Disorders (AMPD) personality disorders (PD) are characterized by impairments in self- and interpersonal functioning which distinguish the various levels of dysfunction. Moreover, pathological traits are used by these classification systems to define the stylistic expression of personality dysfunction. Negative affectivity, detachment, antagonism/dissociality, and disinhibition feature as trait domains in each of these models. However, there are also differences between the two models, namely, in the psychoticism domain, which does not feature as a personality trait domain in the ICD-11, and in the anankastia domain, corresponding to compulsivity in the DSM-5, which was removed from the final AMPD model. Furthermore, facets are acknowledged by the DSM-5 within each trait domain, while this does not occur in the ICD-11. In view of the similarity between these classification systems, their harmonization would be beneficial for the clinical profession. With this goal in mind, the PID5BF + M, an algorithm that assesses the DSM-5 and ICD-11 six trait domains and 18 facets, was developed and has proven to adequately characterize the ICD-11 trait domains by means of DSM-5 trait facets. Methods The current study compares a community sample (N = 280, M age = 48.01, 53.2% females) with a PD sample (N = 131, M age = 42.66, 45.0% females) along with the PID5BF + M, the LPFS-SR and the PID-5. Given that the PID5BF + M total can be seen as a measure of the level of personality dysfunction, strong relations between the PID5BF + M total and the LPFS-SR total are expected. Strong relations between the trait specifiers measured by the PID5BF + M and the PID-5 are also expected. Finally, the community and clinical samples are expected to differentiate by means of the dimensions assessed through the three afore-mentioned measures. The Spearman rank-order correlation coefficient was used to measure the strength and direction of associations between the PID5BF + M total and the LPFS-SR total and between the PID5BF + M and the PID-5 traits. Group differences were explored using the Mann-Whitney U test for independent samples. Results As expected, there were strong, significant, and positive relations between the measures. Furthermore, higher scores were observed in all the variables for the PD group against the community group. Discussion Although this study has limitations, its findings sustain that the PID5BF + M has potential to assess the severity of personality disfunction and to characterize the stylistic features of PD as they are conceived by both the ICD-11 and the DSM-5. Although more research is needed regarding the convergent validity of the PID5BF + M, this new test contributes to the harmonization of both systems and to parsimony in the assessment of PD, which is the main objective of clinical practice.
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Affiliation(s)
- Rute Pires
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisbon, Portugal
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisbon, Portugal
| | - Joana Henriques-Calado
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisbon, Portugal
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisbon, Portugal
| | - Ana Sousa Ferreira
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisbon, Portugal
- Instituto Universitário de Lisboa - Business Research Unit (BRU-IUL), Lisbon, Portugal
| | - João Gama Marques
- Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, Lisbon, Portugal
- Consulta de Esquizofrenia Resistente, Hospital Júlio de Matos, Centro Hospitalar Psiquiátrico de Lisboa, Lisbon, Portugal
| | - Ana Ribeiro Moreira
- Centro Hospitalar de Lisboa Ocidental, Hospital de Egas Moniz, Lisbon, Portugal
| | - Bernardo C. Barata
- Departamento de Psiquiatria e Saúde Mental, Centro Hospitalar Barreiro Montijo, Av. Movimento das Forças Armadas, Barreiro, Portugal
| | - Marco Paulino
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisbon, Portugal
- Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, Lisbon, Portugal
| | - Bruno Gonçalves
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisbon, Portugal
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisbon, Portugal
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Personality Pathology and Functional Impairment in Patients With Hypochondriasis. J Acad Consult Liaison Psychiatry 2023; 64:28-34. [PMID: 35964912 DOI: 10.1016/j.jaclp.2022.08.001] [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: 03/17/2022] [Revised: 07/16/2022] [Accepted: 08/08/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Research indicates substantial co-occurance of personality pathology and hypochondriasis, which both involve significant psychosocial impairment. OBJECTIVE This study sought to investigate the role of personality pathology for explaining functional impairment in patients with hypochondriasis, while accounting for the influence of health anxiety severity. METHODS Patients diagnosed with hypochondriasis (N = 84; 60% women) were administered interview- and self-report instruments for personality pathology, health anxiety severity, and functional impairment (general, social, and physical): The Structured Clinical Interview for DSM-IV Axis II (SCID-II), the Personality Inventory for DSM-5 (PID-5), the Short Health Anxiety Inventory (SHAI), the 36-item Short Form health survey (SF-36), and the Global Assessment of Functioning (GAF). Hierarchical regression analyses were performed with boot-strapping (1000 samples). RESULTS Findings overall showed that personality pathology incrementally explained functional impairment over the influence of health anxiety severity. More specifically, findings revealed that the incremental effect of PID-5 trait dimensions was substantially larger than the SCID-II personality disorder criterion-count. Functional impairment was specifically associated with SCID-II symptoms of Avoidant Personality disorder and dependent personality disorder as well as PID-5 trait domains of negative affectivity, detachment, and psychoticism. CONCLUSIONS The findings highlight the potential significance of personality pathology for understanding and clinical management of functional impairment in patients with hypochondriasis. The personality features that best explained functional impairment were avoidant personality disorder and dependent personality disorder and, in particular, DSM-5 and the International Classification of Diseases, 11th revision personality trait domains of negative affectivity, detachment, and psychoticism.
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Aafjes-van Doorn K, Kealy D, Ehrenthal JC, Ogrodniczuk JS, Joyce AS, Weber R. The Relationship Between Patients' Personality Traits, the Alliance, and Change in Interpersonal Distress in Intensive Group Treatment for Personality Dysfunction. J Pers Disord 2022; 36:731-748. [PMID: 36454157 DOI: 10.1521/pedi.2022.36.6.731] [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: 12/05/2022]
Abstract
This study examined patients' personality traits as operationalized by the five-factor model in relation to early alliance and reduction of interpersonal distress through an intensive group treatment program for personality dysfunction. A sample of 79 consecutively admitted psychiatric outpatients with personality dysfunction who attended an 18-week intensive group treatment program completed the NEO Five-Factor Inventory at pretreatment, the Inventory of Interpersonal Problems at pre- and posttreatment, and the Edmonton Therapeutic Alliance Scale, a measure of the therapeutic alliance with the program therapist, at Session 5. Results indicated that patients who were relatively extraverted tended to rate the alliance with their program therapist higher and subsequently reported more improvement of interpersonal distress. The presence of a personality disorder did not moderate this mediation. Patients' extraversion likely promotes a bonding with the therapist and facilitates the interpersonal group work necessary for improvement. Assessing patients' level of extraversion before starting intensive group treatment might indicate which intervention strategies could be useful with that patient within the program frame.
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Affiliation(s)
| | - David Kealy
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | | | - John S Ogrodniczuk
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Anthony S Joyce
- Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Rainer Weber
- Clinic for Psychosomatics and Psychotherapy, University of Cologne, Germany
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Simon J, Bach B. Organization of Clinician-Rated Personality Disorder Types According to ICD-11 Severity of Personality Dysfunction. Psychodyn Psychiatry 2022; 50:672-688. [PMID: 36476023 DOI: 10.1521/pdps.2022.50.4.672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective: The International Classification of Diseases, 11th edition (ICD-11) model of personality disorders (PD) allows clinicians to classify personality dysfunction according to four levels of severity. This approach is partially inspired by Kernberg's levels of personality organization, in which various PD types are organized according to their level of severity. This study sought to investigate whether the established ICD-10 PD categories can be organized according to the four levels of ICD-11 PD severity, and to what extent this organization aligns with Kernberg's four levels of personality organization. Method: A sample of 247 patients were rated by their mental health professionals according to ICD-10 PD categories and ICD-11 PD severity levels. Results: The frequencies of ICD-10 PDs on the different ICD-11 PD severity levels were generally found to be consistent with Kernberg's model. Accordingly, borderline and antisocial PDs predominantly occurred at the most severe levels, whereas anankastic, avoidant, and dependent PDs typically occurred at the milder levels. Only paranoid and histrionic PDs were less consistent with Kernberg's model. Conclusions: The findings indicate that the new ICD-11 PD severity dimension largely aligns with Kernberg's model of personality functioning with respect to the organization of PD types. Clinicians may therefore conceptualize familiar PD types in terms of their ICD-11 PD severity and vice versa.
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Affiliation(s)
- Jonatan Simon
- Psychology student at the Faculty of Health Sciences, University of Southern Denmark at the time of writing; he is currently a clinical psychologist at Region Zealand Mental Health Services
| | - Bo Bach
- Senior Research Associate at the Psychiatric Research Unit, Center for Personality Disorder Research (CPDR), Mental Health Services, Region Zealand, Denmark and Associate Professor at the University of Southern Denmark
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Oitsalu ML, Kreegipuu M, Hutsebaut J. Psychometric evaluation of the Estonian version of the Semi-structured Interview for Personality Functioning DSM-5 (STiP-5.1). Borderline Personal Disord Emot Dysregul 2022; 9:28. [PMID: 36451191 PMCID: PMC9714151 DOI: 10.1186/s40479-022-00197-7] [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: 06/03/2022] [Accepted: 09/02/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The DSM-5 Alternative Model for Personality Disorders introduced a dimensional perspective on personality disorders. The model assesses functioning in four domains: Identity, Self-Direction, Empathy, and Intimacy. This study evaluates the psychometric properties of the Semi-Structured Interview for Personality Functioning DSM-5 (STiP-5.1) in Estonian. METHOD The sample consists of 131 participants: 58 from the general population and 73 from a mixed clinical sample that is further divided into a mood and anxiety disorder sample and personality disorder sample. All participants completed the STiP-5.1 interview and the Level of Personality Functioning Scale-Brief Form (LPFS-BF 2.0). RESULTS The Estonian STiP-5.1 interview has good internal consistency (McDonald's ω between .94-.98) and high convergent validity (correlations with LPFS-BF 2.0 above .7). Interview scores successfully differentiated the general population from the mixed clinical sample (Cohen's d = 2.68), as well as patients with personality disorder from those without (Cohen's d = 1.76). The LPFS-BF 2.0 total score differentiates the general population sample from the mixed clinical sample (Cohen's d = 1.99) but not the personality disorder sample from other clinical sample participants. CONCLUSIONS The properties of the Estonian STiP-5.1 replicate those of other languages, and empirically support a unified personality functioning dimension that can be meaningfully thought of as reflecting impairments in self and interpersonal functioning. Findings of this study will be discussed in the light of the ongoing debate on the dimensionality of personality pathology and the use of self-report versus interview measures for assessing personality pathology.
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Affiliation(s)
- Maarja-Liisa Oitsalu
- Department of Psychology, University of Tallinn, Tallinn, Estonia.
- North Estonia Medical Centre, Psychiatric Clinic, Tallinn, Estonia.
| | - Maie Kreegipuu
- Viljandi Hospital, Psychiatric Clinic, Jämejala, Estonia
| | - Joost Hutsebaut
- Viersprong Institute for Studies On Personality Disorders, Halsteren, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
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An exploratory study of associations between the ICD-11 personality disorder model and eating pathology. J Eat Disord 2022; 10:130. [PMID: 36045403 PMCID: PMC9429753 DOI: 10.1186/s40337-022-00658-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 08/24/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Recently, the International Classification of Diseases 11th Revision (ICD-11) has introduced a paradigm shift in personality disorder conceptualization. The novel ICD-11 personality disorder model comprises a dimensional assessment of personality dysfunction and five maladaptive personality trait domains. Maladaptive personality plays a central role in eating pathology. Yet, relations between the ICD-11 personality disorder model and eating pathology are, to date, unclear. Thus, this study aimed to explore the bivariate, incremental, and interactive associations of the ICD-11 personality disorder model components with eating pathology domains. METHODS A predominantly female (85%) sample of 888 German-speaking community adults completed validated self-report measures of personality dysfunction, the ICD-11 personality trait domains, and five eating pathology domains (drive for thinness, bulimia, body dissatisfaction, orthorexia, binge eating). Bivariate and hierarchical regressions models were used to investigate bivariate, incremental, and interactive relations between the ICD-11 personality disorder model components and eating pathology. RESULTS Personality dysfunction and the ICD-11 personality trait domains showed statistically significant bivariate relations with eating pathology. Additionally, personality dysfunction and most ICD-11 personality trait domains displayed incremental links with eating pathology. Finally, the relations of the ICD-11 personality trait domains with eating pathology were largely independent of the severity of personality dysfunction. CONCLUSIONS This study indicated that all ICD-11 personality disorder model components are uniquely linked to eating pathology. Beyond maladaptive personality trait domains, the strong and incremental relations of personality dysfunction with eating pathology have potential implications for theory building. Further research using longitudinal designs is needed to evaluate causal links between the ICD-11 personality disorder model components and eating pathology.
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Maerz J, Buchheim A, Rabl L, Riedl D, Viviani R, Labek K. The interplay of Criterion A of the Alternative Model for Personality Disorders, mentalization and resilience during the COVID-19 pandemic. Front Psychol 2022; 13:928540. [PMID: 35959052 PMCID: PMC9358045 DOI: 10.3389/fpsyg.2022.928540] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/04/2022] [Indexed: 01/07/2023] Open
Abstract
Background and aims The COVID-19 pandemic has been accompanied by a worsening of mental health levels in some, while others manage to adapt or recover relatively quickly. Transdiagnostic factors such as personality functioning are thought to be involved in determining mental health outcomes. The present study focused on two constructs of personality functioning, Criterion A of the Alternative Model for Personality Disorders (AMPD, DSM-5) and mentalization, as predictors of depressive symptoms and life satisfaction during the COVID-19 pandemic. A second focus of the study was to examine whether this relationship was mediated by resilience. Methods Linear regression analyses were used to examine the relationship between personality functioning measured by Criterion A (AMPD, DSM-5) and mentalizing abilities as predictors, and depression and life satisfaction as mental health outcomes. To assess the hypothesis that this relationship is mediated by resilience a structural equation modeling approach was conducted. Data from N = 316 individuals from the general population were collected. Results Linear regression models revealed highly significant associations between Criterion A/mentalization and both outcome measures. Structural equation models showed a significant partial mediation by resilience of these relationships. Conclusion Our results support the hypothesis that mentalizing serves as a protective function by promoting resilience to the impact of stress and threats. Criterion A and mentalization performed similarly as predictors of mental health outcomes, providing empirically overlapping operationalizations of personality functioning. This finding emphasizes the importance of personality functioning in positive and negative mental health outcomes. Furthermore, our results are consistent with a mediating role of resilience.
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Affiliation(s)
- Jeff Maerz
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Anna Buchheim
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Luna Rabl
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - David Riedl
- University Hospital of Psychiatry II, Medical University Innsbruck, Innsbruck, Austria
| | - Roberto Viviani
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
- Department of Psychiatry and Psychotherapy III, University of Ulm, Ulm, Germany
| | - Karin Labek
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
- *Correspondence: Karin Labek,
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Constantinou MP, Frueh BC, Fowler JC, Allen JG, Madan A, Oldham JM, Fonagy P. Predicting depression outcomes throughout inpatient treatment using the general and specific personality disorder factors. Psychol Med 2022; 52:1838-1846. [PMID: 33028440 DOI: 10.1017/s003329172000361x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Clinical intuition suggests that personality disorders hinder the treatment of depression, but research findings are mixed. One reason for this might be the way in which current assessment measures conflate general aspects of personality disorders, such as overall severity, with specific aspects, such as stylistic tendencies. The goal of this study was to clarify the unique contributions of the general and specific aspects of personality disorders to depression outcomes. METHODS Patients admitted to the Menninger Clinic, Houston, between 2012 and 2015 (N = 2352) were followed over a 6-8-week course of multimodal inpatient treatment. Personality disorder symptoms were assessed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th edition Axis II Personality Screening Questionnaire at admission, and depression severity was assessed using the Patient Health Questionnaire-9 every fortnight. General and specific personality disorder factors estimated with a confirmatory bifactor model were used to predict latent growth curves of depression scores in a structural equation model. RESULTS The general factor predicted higher initial depression scores but not different rates of change. By contrast, the specific borderline factor predicted slower rates of decline in depression scores, while the specific antisocial factor predicted a U shaped pattern of change. CONCLUSIONS Personality disorder symptoms are best represented by a general factor that reflects overall personality disorder severity, and specific factors that reflect unique personality styles. The general factor predicts overall depression severity while specific factors predict poorer prognosis which may be masked in prior studies that do not separate the two.
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Affiliation(s)
- Matthew P Constantinou
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - B Christopher Frueh
- Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX, USA
- Department of Psychology, University of Hawaii, Hilo, HI, USA
| | - J Christopher Fowler
- Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX, USA
- Houston Methodist Hospital, Houston, TX, USA
| | - Jon G Allen
- Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Alok Madan
- Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX, USA
- Houston Methodist Hospital, Houston, TX, USA
| | - John M Oldham
- Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- The Menninger Clinic, Houston, TX, USA
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- The Menninger Clinic, Houston, TX, USA
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Waszczuk MA, Hopwood CJ, Luft BJ, Morey LC, Perlman G, Ruggero CJ, Skodol AE, Kotov R. The prognostic utility of personality traits versus past psychiatric diagnoses: Predicting future mental health and functioning. Clin Psychol Sci 2022; 10:734-751. [PMID: 35967764 PMCID: PMC9366938 DOI: 10.1177/21677026211056596] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Past psychiatric diagnoses are central to patient case formulation and prognosis. Recently, alternative classification models such as the Hierarchical Taxonomy of Psychopathology (HiTOP) proposed to assess traits to predict clinically-relevant outcomes. The current study directly compared personality traits and past diagnoses as predictors of future mental health and functioning in three independent, prospective samples. Regression analyses found that personality traits significantly predicted future first onsets of psychiatric disorders (ΔR2=06-.15), symptom chronicity (ΔR2=.03-.06), and functioning (ΔR2=.02-.07), beyond past and current psychiatric diagnoses. Conversely, past psychiatric diagnoses did not provide an incremental prediction of outcomes when personality traits and other concurrent predictors were already included in the model. Overall, personality traits predicted a variety of outcomes in diverse settings, beyond diagnoses. Past diagnoses were generally not informative about future outcomes when personality was considered. Together, these findings support the added value of personality traits assessment in case formulation, consistent with HiTOP model.
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Affiliation(s)
- Monika A Waszczuk
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL
- Department of Psychiatry, Stony Brook University, Stony Brook, NY
| | | | - Benjamin J Luft
- Department of Medicine, Stony Brook University, Stony Brook, NY
| | - Leslie C Morey
- Department of Psychology, Texas A&M University, College Station, TX
| | - Greg Perlman
- Department of Psychiatry, Stony Brook University, Stony Brook, NY
| | | | | | - Roman Kotov
- Department of Psychiatry, Stony Brook University, Stony Brook, NY
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Biberdzic M, Grenyer BFS. How Much Training Do We Need? Assessing the Validity and Interrater Reliability of the PDM-2's Psychodiagnostic Chart among Less Experienced Clinicians. J Pers Assess 2022; 105:436-444. [PMID: 35771210 DOI: 10.1080/00223891.2022.2086133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The Psychodynamic Diagnostic Manual - Second Edition (PDM-2) has emerging evidence supporting its clinical utility, yet one of the main limitations remains the conjecture that considerable training and experience is required. It also remains unclear how the PDM-2 framework compares with current DSM measures of personality pathology such as the Level of Personality Functioning Scale (LPFS). The aim of the present study is to examine these issues by testing whether less clinically experienced second year doctoral psychology students are able to reliably assess patients' level of personality pathology using the PDM-2's Psychodiagnostic Chart (PDC-2), and to investigate the convergence between the PDC-2 and the LPFS. Results showed adequate inter-rater reliability for both of the main PDC-2 axes, with 52% of the variance for the overall personality organization (P-Axis) rating, and 29% of the overall M-Axis score being due to rater consensus. Reliability of individual ratings ranged from fair to excellent for the overall scores on both axes (ICC = 0.59 to .90). Results also showed that student evaluations were valid, with the latter's assessment of the patients' level of personality organization converging both with the experts' rating of the PDC-2 as well as the LPFS. Implications for clinical training are discussed.
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Affiliation(s)
- Marko Biberdzic
- School of Psychology Illawarra Health and Medical Research Institute, University of Wollongong
| | - Brin F S Grenyer
- School of Psychology Illawarra Health and Medical Research Institute, University of Wollongong
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Ringwald WR, Hallquist MN, Dombrovski AY, Wright AG. Transdiagnostic Associations With Interpersonal and Affective Variability in Borderline Personality Pathology. J Pers Disord 2022; 36:320-338. [PMID: 35647774 PMCID: PMC9830454 DOI: 10.1521/pedi.2022.36.3.320] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Emotional and behavioral variability are unifying characteristics of borderline personality disorder (BPD). Ambulatory assessment (AA) has been used to quantify this variability in terms of the categorical BPD diagnosis, but evidence suggests that BPD instead reflects general personality pathology. This study aimed to clarify the conceptualization of BPD by mapping indices of variability in affect, interpersonal behavior, and perceptions of others onto general and specific dimensions of personality pathology. A sample of participants who met diagnostic criteria for BPD (n = 129) and healthy controls (n = 47) reported on their daily interactions during a 21-day AA protocol. Multilevel SEM was used to examine associations between shared and specific variance in maladaptive traits with dynamic patterns of functioning. The authors found that variability is an indicator of shared trait variance and Negative Affectivity, not any other specific traits, reinforcing the idea that BPD is best understood as general personality pathology.
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Affiliation(s)
| | - Michael N. Hallquist
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill
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Bliton CF, Roche MJ, Pincus AL, Dueber D. Examining the Structure and Validity of Self-Report Measures of DSM-5 Alternative Model for Personality Disorders Criterion A. J Pers Disord 2022; 36:157-182. [PMID: 34287067 DOI: 10.1521/pedi_2021_35_531] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The Level of Personality Functioning Scale (LPFS) operationalizes Criterion A of the DSM-5 Alternative Model for Personality Disorders. Despite progress in LPFS measurement development and validation, there is a lack of research, and some disagreement, concerning structural, convergent, and incremental validity of LPFS self-report measures. The present study aimed to compare the LPFS Self-Report, LPFS Self-Report of Criterion A, and LPFS Brief Form. Internal structure was assessed through principal component analyses, factor analyses, and bifactor analyses of unidimensionality. Associations with both pathological and basic personality characteristics among the LPFS measures were explored. Incremental validity of LPFS severity in predicting pathological personality outcomes controlling for basic personality traits, and the reverse, were examined. Results suggest a unidimensional structure robustly associated with other pathological personality assessments. LPFS severity and basic personality traits mutually offered unique explanatory power. We discuss the implications of assessing personality pathology using LPFS self-report measures.
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Affiliation(s)
- Chloe F Bliton
- Department of Psychology, Pennsylvania State University, University Park, Pennsylvania
| | - Michael J Roche
- Department of Psychology, West Chester University, West Chester, Pennsylvania
| | - Aaron L Pincus
- Department of Psychology, Pennsylvania State University, University Park, Pennsylvania
| | - David Dueber
- Department of Educational, School, and Counseling Psychology, University of Kentucky, Lexington, Kentucky
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Hallion LS, Wright AGC, Joormann J, Kusmierski SN, Coutanche MN, Caulfield MK. A five-factor model of perseverative thought. JOURNAL OF PSYCHOPATHOLOGY AND CLINICAL SCIENCE 2022; 131:235-252. [PMID: 35230863 PMCID: PMC9439587 DOI: 10.1037/abn0000737] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Like diagnostic status, clinically relevant thought remains overwhelmingly conceptualized in terms of discrete categories (e.g., worry, rumination, obsessions). However, definitions can vary widely. The area of perseverative thought (or clinically relevant thought more broadly) would benefit substantially from a consensus-based, empirically grounded taxonomy similar to the Hierarchical Taxonomy of Psychopathology (Kotov et al., 2017) or the Big Five for personality. This article addresses three major barriers to establishing such a taxonomy: (a) a lack of research explicitly comparing categorical (subtype) versus dimensional models, (b) primary reliance on between-person measures rather than modeling at the level of the thought (within person), and (c) insufficient emphasis on replication and refinement. Participants included an unselected crowdsourced sample (790 observations from 286 participants) and an independent anxious-depressed replication sample (808 observations from 277 participants). Participants made dimensional ratings for three idiographic clinically relevant thoughts on a range of features. Multilevel latent class analysis and multilevel exploratory factor analysis were applied to identify and extract natural patterns of covariation among features at the level of the thought, controlling for person-level tendencies. A consistent five-dimension solution emerged across both samples and reliably outperformed the best-fitting categorical solution in terms of fit, replicability, and explanatory power. Identified dimensions were dyscontrol, self-focus, valence, interpersonal, and uncertainty. Findings support a five-factor latent structure of perseverative thought. Theoretical, empirical, and clinical implications and future directions are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | - Marc N. Coutanche
- Department of Psychology, University of Pittsburgh
- Learning Research and Development Center, University of Pittsburgh
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37
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Veenstra MS, van Dijk SDM, Bouman R, van Alphen SPJB, van Asselt ADIT, van den Brink RHS, Voshaar RCO. Impact of personality functioning and pathological traits on mental wellbeing of older patients with personality disorders. BMC Psychiatry 2022; 22:214. [PMID: 35331179 PMCID: PMC8944148 DOI: 10.1186/s12888-022-03857-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/15/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Although personality disorders are common and consequential, they are largely ignored in geriatric mental healthcare. We examined the relative contributions of different aspects of personality disorders and comorbid mental disorders to the impairment of mental wellbeing in older adults. METHODS Baseline data were used of 138 patients who participated in a randomized controlled trial on schema therapy for geriatric mental health outpatients with a full or subthreshold cluster B or C personality disorder. Personality was assessed according to both the categorical and dimensional model of DSM-5. Aspects of mental wellbeing assessed were; psychological distress, positive mental health, subjective health, and life satisfaction. The current study uses baseline data of the RCT to examine the associations between different aspects of personality pathology and mental wellbeing by multivariate regression analysis, controlling for age, sex, level of education, and number of chronic somatic illnesses. RESULTS The vast majority of patients (79.0%) had one or more mental disorders in addition to personality disorder. Personality pathology was responsible for the core of the mental health burden experienced by patients, and negated the influence of co-occurring mental disorders when entered subsequently in multivariate analysis. Personality dimensions proved to be highly predictive of mental wellbeing, and this contrasted with absence of influence of personality disorder diagnosis. Although the personality functioning dimensions - and in particular Identity integration (large effect size with partial eta-squared = 0.36) - were the primary predictors of mental wellbeing, personality trait dimensions added significant predictive value to that (Disinhibition 0.25 and Negative affect 0.24). CONCLUSIONS Personality disorders seriously affect the mental wellbeing of patients, and this overshadows the impact of comorbid mental disorders. In particular personality functioning and pathological traits of the Alternative Model of Personality Disorders (AMPD) of DSM-5 contribute to this impact on mental wellbeing. Alertness for and treatment of personality disorders in geriatric mental healthcare seems warranted.
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Affiliation(s)
- Martine S. Veenstra
- grid.4494.d0000 0000 9558 4598Department of Psychiatry, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, the Netherlands
| | - Silvia D. M. van Dijk
- grid.4494.d0000 0000 9558 4598Department of Psychiatry, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, the Netherlands
| | - Renske Bouman
- grid.4494.d0000 0000 9558 4598Department of Psychiatry, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, the Netherlands
| | | | - Antoinette D. I. Thea van Asselt
- grid.4494.d0000 0000 9558 4598Department of Epidemiology and Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Rob H. S. van den Brink
- grid.4494.d0000 0000 9558 4598Department of Psychiatry, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, the Netherlands
| | - Richard C. Oude Voshaar
- grid.4494.d0000 0000 9558 4598Department of Psychiatry, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, the Netherlands
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Gutiérrez F, Aluja A, Rodríguez C, Gárriz M, Peri JM, Gallart S, Calvo N, Ferrer M, Gutiérrez-Zotes A, Soler J, Pascual JC. Severity in the ICD-11 personality disorder model: Evaluation in a Spanish mixed sample. Front Psychiatry 2022; 13:1015489. [PMID: 36699492 PMCID: PMC9868964 DOI: 10.3389/fpsyt.2022.1015489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/16/2022] [Indexed: 01/12/2023] Open
Abstract
Severity is the main component of the ICD-11 personality disorder (PD) classification, but pertinent instruments have only recently been developed. We analyzed the psychometric properties of the ICD-11 Personality Disorder Severity scale (PDS-ICD-11) in a mixed sample of 726 community and clinical subjects. We also examined how the different components of the ICD-11 PD system -five trait domains, the borderline pattern specifier, and severity, all of them measured through self-reports- are interconnected and operate together. PDS-ICD-11 properties were adequate and similar to those of the original instrument. However, regressions and factor analyses showed a considerable overlap of severity with the five personality domains and the borderline specifier (72.6%). Bifactor modeling resulted in a general factor of PD (g-PD) that was not equivalent to severity nor improved criterion validity. The whole ICD-11 PD system, i.e., five personality domains, borderline, and severity, explained an average of 43.6% of variance of external measures of well-being, disability, and clinical problems, with severity contributing 4.8%. Suggestions to further improve the ICD-11 PD taxonomy include remodeling the present definition of severity to give more weight to the real-life consequences of traits.
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Affiliation(s)
- Fernando Gutiérrez
- Institute of Neuroscience, Hospital Clínic of Barcelona, Barcelona, Spain.,Institut d'Investigacións Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Anton Aluja
- Lleida Institute for Biomedical Research Dr. Pifarré Foundation, Lleida, Spain.,Department of Psychology, University of Lleida, Lleida, Spain
| | - Claudia Rodríguez
- Institute of Neuroscience, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Miguel Gárriz
- Neuropsychiatry and Drug Addiction Institute, Parc de Salut Mar, Barcelona, Spain
| | - Josep M Peri
- Institute of Neuroscience, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Salvador Gallart
- Department of Psychiatry, Mental Health, and Addiction, GSS-Hospital Santa Maria, Lleida, Spain
| | - Natalia Calvo
- Department of Psychiatry, Vall d'Hebron University Hospital, Barcelona, Spain.,Network Centre for Biomedical Research in Mental Health (CIBERSAM), Barcelona, Spain.,Psychiatry and Legal Medicine Department, Autonomous University of Barcelona, Barcelona, Spain
| | - Marc Ferrer
- Department of Psychiatry, Vall d'Hebron University Hospital, Barcelona, Spain.,Network Centre for Biomedical Research in Mental Health (CIBERSAM), Barcelona, Spain.,Psychiatry and Legal Medicine Department, Autonomous University of Barcelona, Barcelona, Spain
| | - Alfonso Gutiérrez-Zotes
- Network Centre for Biomedical Research in Mental Health (CIBERSAM), Barcelona, Spain.,Pere Virgili Health Research Institute (IISPV), CERCA, Reus, Spain.,Pere Mata Psychiatric University Hospital, Reus, Spain
| | - Joaquim Soler
- Psychiatry and Legal Medicine Department, Autonomous University of Barcelona, Barcelona, Spain.,Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Juan Carlos Pascual
- Psychiatry and Legal Medicine Department, Autonomous University of Barcelona, Barcelona, Spain.,Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Fischer-Kern M, Tmej A, Naderer A, Zimmermann J, Nolte T. Failure to resolve loss and compromised mentalizing in female inpatients with major depressive disorder. Attach Hum Dev 2021; 24:503-524. [PMID: 34952561 DOI: 10.1080/14616734.2021.2015794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Attachment and mentalizing are central concepts in research on the etiology, course, and treatment of depression. The goal of this cross-sectional study was to clarify the unique value of these constructs in characterizing the presence, severity, and chronicity of depression. We examined 50 female inpatients suffering from Major Depressive Disorder (MDD) in comparison to 47 matched healthy controls regarding their attachment states of mind, mentalizing capacities, and clinical variables indicating depression severity and chronicity (e.g. illness duration, number of hospitalizations). In the group of depressed patients, unresolved attachment with regard to loss was significantly overrepresented. Dimensionally, patients were more disorganized and more insecure, whereas there was no difference on the dismissing-preoccupied dimension between the two groups. Mentalizing was significantly lower in patients than in healthy controls. Logistic regression analysis revealed attachment insecurity, mentalizing deficits, and unresolved loss to be incrementally relevant to predict MDD. Correlations with clinical parameters in the group of depressed patients showed positive associations between mentalizing deficits, attachment insecurity, and variables indicating illness chronicity. Our findings highlight the relevance of the inability to resolve or reappraise loss experiences in depressive states.
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Affiliation(s)
- Melitta Fischer-Kern
- Department of Psychoanalysis and Psychotherapy, Medical University Vienna, Vienna, Austria
| | - Anna Tmej
- Department of Psychoanalysis and Psychotherapy, Medical University Vienna, Vienna, Austria
| | - Andrea Naderer
- Department of Psychoanalysis and Psychotherapy, Medical University Vienna, Vienna, Austria
| | | | - Tobias Nolte
- University College London, Welcome Centre for Human Neuroimaging, Institute of Neurology, London, UK.,Anna Freud National Centre for Children and Families, UK
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40
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Barkauskienė R, Gaudiešiūtė E, Skabeikytė G. Change in the Definition of Personality Disorder in Transition to ICD-11: A Look from Clinical and Developmental Perspectives. PSICHOLOGIJA 2021. [DOI: 10.15388/psichol.2021.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The recent body of research reveals fundamental limitations to the categorical concept of a personality disorder that has led researchers to adopt a new personality disorder concept. During the last decade DSM-5 and ICD-11 diagnostic classifications have accepted the dimensional view towards personality pathology. Despite the differences between the two classifications, the joint aspect of both models is the construct of Levels of personality functioning. The construct of personality functioning involves personality (dys)function in the self and interpersonal domains. This two-step conceptualization includes (a) impairments of self and interpersonal functioning, indicating general signs and severity of personality disorder, and (b) pathological personality traits, reflecting ‘stylistic’ differences in the expression of personality disorder. The new conceptualization of personality disorder reflects the innovative multi-theoretical integration of known, empirically-based personality assessment paradigms. The relationship between personality functioning and interpersonal, psychodynamic, and personological paradigms provides the theoretical integrity and empirically-based structure necessary to understand the overall severity of personality pathology. Many methods (interviews, self-assessment scales, and questionnaires) have already been developed for the assessment of personality functioning, and their development will be encouraged by the ICD-11 classification established in 2022. At present, only one instrument has been developed in Lithuania for assessing the level of personality functioning in young people aged 12–18 (Barkauskienė & Skabeikytė, 2020). The empirical data about the validity of this construct and its capability to differentiate between the normal and impaired personality in adults and adolescents provide promising results, but are still accumulating. Research suggests that adolescence is a stage in development when personality pathology can fully unfold and be validly confirmed, which opens up opportunities for early intervention. Although the dimensional personality disorder model needs to further prove its importance, there is already evidence that it is less stigmatizing and returns psychology and personality into the concept of a personality disorder. This review presents changes in the conceptualization of personality disorders by discussing them from both clinical and developmental perspectives and highlighting the results of key research in recent years.
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41
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Bach B, Brown TA, Mulder RT, Newton-Howes G, Simonsen E, Sellbom M. Development and initial evaluation of the ICD-11 personality disorder severity scale: PDS-ICD-11. Personal Ment Health 2021; 15:223-236. [PMID: 34002530 DOI: 10.1002/pmh.1510] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/23/2021] [Indexed: 11/07/2022]
Abstract
AIM No measure has formally been developed to assess the published ICD-11 model of Personality Disorder (PD) severity. We therefore set out to develop and evaluate the 14-item Personality Disorder Severity ICD-11 (PDS-ICD-11) scale. METHOD A representative U.S. community sample (N = 428; 50.9% women) and a New Zealand mental health sample (N = 87; 61.5% women) completed the PDS-ICD-11 scale along with a series of established PD and impairment measures. RESULTS Item response theory supported the unidimensionality of PDS-ICD-11 (median item loading of 0.68) and indicated that a PDS-ICD-11 score of 17.5 may serve as a benchmark for pronounced dysfunction. Correlation and regression analyses supported both criterion validity and incremental validity in predicting impairment and PD symptoms. The PDS-ICD-11 was particularly associated with measures of Level of Personality Functioning Scale (LPFS), Global PD severity, and Borderline PD symptom score. A comparison between clinical individuals diagnosed with an ICD-11 PD vs. no PD supported diagnostic validity. CONCLUSION This initial construction study suggests that the PDS-ICD-11 constitutes a promising instrument that provides a quick impression of the severity of personality dysfunction according to the official ICD-11 PD guidelines. Clearly, more research is needed to corroborate its validity and utility. The PDS-ICD-11 scale is provided as online supporting information.
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Affiliation(s)
- Bo Bach
- Psychiatric Research Unit, Center for Personality Disorder Research, Region Zealand, Slagelse, Denmark
| | - Tiffany A Brown
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Roger T Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Giles Newton-Howes
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Erik Simonsen
- Psychiatric Research Unit, Center for Personality Disorder Research, Region Zealand, Slagelse, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Martin Sellbom
- Department of Psychology, University of Otago, Dunedin, New Zealand
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42
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Nazari A, Huprich SK, Hemmati A, Rezaei F. The Construct Validity of the ICD-11 Severity of Personality Dysfunction Under Scrutiny of Object-Relations Theory. Front Psychiatry 2021; 12:648427. [PMID: 34366910 PMCID: PMC8340676 DOI: 10.3389/fpsyt.2021.648427] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 04/06/2021] [Indexed: 11/26/2022] Open
Abstract
The current classification of personality disorder in ICD-11 includes a description of personality functioning, derived from a number of theoretical paradigms, but most notably consistent with the psychodynamic approach. Concurrently, an object-relations model of personality functioning in a dimensional assessment of severity is provided in the Structured Interview of Personality Organization-Revised (STIPO-R). To date, there are no published measures of International Classification of Diseases-11 (ICD-11) personality severity, though the construct is very comparable to the concepts assessed in the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) levels of personality functioning concept, which is measured by the Level of Personality Functioning Scale-Self-Report (LPFS-SR). This study examined the validity of ICD-11 personality functioning, as measured by the LPFS-SR, by evaluating its associations with the STIPO-R in Kurdistan region. The samples included 231 University students and 419 inpatient participants across four hospitals (267 with a diagnosed personality disorder). All the components of LPFS-SR and STIPO-R were positively and significantly intercorrelated. The components of each measure discriminated PD and non-PD patients from a University, non-clinical group adequately. Despite slightly better performance of the STIPO-R in this discrimination, the measures had a high congruence in predicting personality dysfunction. Overall, the findings of the present study support the validity of ICD-11 construct for evaluating personality functioning.
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Affiliation(s)
- Amin Nazari
- Department of Psychology, University of Kurdistan, Sanandaj, Iran
| | - Steven K. Huprich
- Department of Psychology, University of Detroit Mercy, Detroit, MI, United States
- Department of Psychiatry and Behavioral Sciences, College of Human Medicine, Michigan State University, Lansing, MI, United States
| | - Azad Hemmati
- Department of Psychology, University of Kurdistan, Sanandaj, Iran
| | - Farzin Rezaei
- Neurosciences Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
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43
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Clark LA, Corona-Espinosa A, Khoo S, Kotelnikova Y, Levin-Aspenson HF, Serapio-García G, Watson D. Preliminary Scales for ICD-11 Personality Disorder: Self and Interpersonal Dysfunction Plus Five Personality Disorder Trait Domains. Front Psychol 2021; 12:668724. [PMID: 34322060 PMCID: PMC8311289 DOI: 10.3389/fpsyg.2021.668724] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/17/2021] [Indexed: 12/17/2022] Open
Abstract
The ICD-11 personality disorder model is the first fully dimensional assessment of personality pathology. It consists of a personality disorder (PD) dysfunction-severity dimension, which encompasses both self- and interpersonal dysfunction, and six optional qualifiers for five prominent personality traits-Negative Affectivity (NA), Detachment (DET), Dissociality (DSL), Disinhibition (DSN), and Anankastia (ANK)-plus a borderline pattern that is defined by the criteria of DSM-IV borderline PD. This article reports on the development of a new self-report measure to assess self- and interpersonal dysfunction and the five trait qualifiers. It is the first comprehensive measure of the ICD-11 PD model in that (a) it is the only one to include both PD dysfunction-severity as well as trait scales and because (b) it is based on the Clinical Description and Diagnostic Guidelines, which are more detailed than the "statistical" model description that is currently on the ICD-11 website. The authors wrote 992 items and then reduced the pool to 300 items by eliminating redundancy and selecting the consensus best few items for each subconstruct. Data were collected using an online sample of 383 Prolific workers. Using exploratory factor analysis, seven domain scales were developed, each of which contained two to four scales assessing components of the domain. These preliminary scales' psychometrics were excellent, as were the domains' and their components' convergent and discriminant validity, with a few generally minor exceptions. Structural analyses at the component level revealed a three-factor structure consisting of two moderately correlated Internalizing factors, one centered on Self Dysfunction with two NA components and a DSN component (Distractibility) and the other on Interpersonal Dysfunction with DET and ANK components; as well as an Externalizing factor with DSL and a DSN component (Reckless Impulsivity) that was uncorrelated with the other two factors. Two aspects of the results in particular are striking: (1) ANK was not the opposite end of a DSN dimension, but rather contributed to an Internalizing Interpersonal Dysfunction dimension and (2) DSN had both an Internalizing and an Externalizing component. Implications of the findings and study limitations are discussed.
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Affiliation(s)
- Lee Anna Clark
- Department of Psychology, University of Notre Dame, Notre Dame, IN, United States
| | | | - Shereen Khoo
- Department of Psychology, University of Notre Dame, Notre Dame, IN, United States
| | - Yuliya Kotelnikova
- Department of Psychology, University of Notre Dame, Notre Dame, IN, United States
| | | | - Greg Serapio-García
- Department of Psychology, University of Notre Dame, Notre Dame, IN, United States
| | - David Watson
- Department of Psychology, University of Notre Dame, Notre Dame, IN, United States
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44
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Auty KM, Farrington DP, Coid JW. Intergenerational transmission of personality disorder: general or disorder-specific? PSYCHOLOGY CRIME & LAW 2021. [DOI: 10.1080/1068316x.2021.1941014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
| | | | - Jeremy W. Coid
- West China Brain Research Centre, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
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45
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Salgó E, Bajzát B, Unoka Z. Schema modes and their associations with emotion regulation, mindfulness, and self-compassion among patients with personality disorders. Borderline Personal Disord Emot Dysregul 2021; 8:19. [PMID: 34112254 PMCID: PMC8194201 DOI: 10.1186/s40479-021-00160-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/21/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The current study's goal was to examine the multivariate patterns of associations between schema modes and emotion regulation mechanisms in personality disorders. Schema modes are either integrated or dissociative states of mind, including intense emotional states, efforts to regulate emotions, or self-reflective evaluative thought processes. Exploring the multivariate patterns of a shared relationship between schema modes and emotion regulation strategies may lead to a better understanding of their associations and a deeper understanding of the latent personality profiles that organize their associations in a mixed personality disorder sample. METHODS Patients who have personality disorders (N = 263) filled out five different self-report questionnaires, out of which four measured adaptive and maladaptive emotion-regulation strategies (Cognitive Emotion Regulation Questionnaire, Difficulty of Emotion Regulation Scale, Five Factor Mindfulness Questionnaire, Self-Compassion Scale), and the fifth one assessed schema modes (Schema Mode Inventory). We conducted canonical correlation analysis in order to measure the multivariate patterns of associations between the 26 emotion regulation and the 14 schema mode subscales. RESULTS We found strong multivariate associations between schema modes and emotion regulation strategies. Collectively, the full model based on all canonical variate pairs was statistically significant using the Wilks's Λ = .01 criterion, F (364,2804.4) = 3.5, p < .001. The first two canonical variate pairs yielded interpretable squared canonical correlation (Rc2) effect sizes of 74.7% and 55.8%, respectively. The first canonical variate pair represents a general personality pathology variable with a stronger weight on internalization than externalization, and bipolarity in terms of adaptive vs. non-adaptive characteristics. We labeled this variate pair "Adaptive/Non-Adaptive." The second canonical variate pair, labeled "Externalizing", represents externalizing schema modes and emotion regulation strategies. CONCLUSION Using a multivariate approach (CCA), we identified two independent patterns of multivariate associations between maladaptive schema modes and emotion regulation strategies. The Adaptive/Non-Adaptive general personality pathology profile and the Externalizing personality pathology profile may lead to a deeper understanding of personality disorders and help psychotherapists in their conceptualization in order to design the most appropriate interventions.
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Affiliation(s)
- Ella Salgó
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Bettina Bajzát
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Zsolt Unoka
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary.
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46
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Bach B, Eikenaes IUM. Transdiagnostic conceptualization of social avoidance through the lens of personality functioning and traits. J Clin Psychol 2021; 77:1249-1258. [PMID: 34003505 DOI: 10.1002/jclp.23160] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 04/10/2021] [Accepted: 04/12/2021] [Indexed: 11/12/2022]
Abstract
This commentary seeks to highlight how social avoidance is portrayed in the six presented case-reports from the perspective of self- and interpersonal functioning as well as stylistic trait features of negative affectivity (e.g., anxiousness and shame) and detachment (e.g., social withdrawal and emotional restriction). This approach to avoidance and social isolation will subsequently be generalized to a range of mental disorders where such features play a significant role. We propose that self and interpersonal functioning along with traits of negative affectivity and detachment may serve as a transdiagnostic framework for describing features of avoidance and social isolation across different treatment models, traditions, and disorders. We specifically assume that future developments of the promising treatment approaches presented in the current collection of case reports may benefit from such a "shared" framework for conceptualizing and treating self- and interpersonal problems related to avoidance and social isolation.
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Affiliation(s)
- Bo Bach
- Psychiatric Research Unit, Center for Personality Disorder Research (CPDR), Mental Health Services, Slagelse, Region Zealand, Denmark
| | - Ingeborg Ulltveit-Moe Eikenaes
- National Advisory Unit for Personality Psychiatry, Section for Personality Psychiatry and Specialized Treatments, Division of Mental Health and Addiction, Department for National and Regional Functions, Oslo University Hospital, Oslo, Norway
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47
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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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Rossi G, Weekers LC, Hutsebaut J. Resilient, undercontrolled, and overcontrolled personality types based upon DSM-5 maladaptive personality traits. Heliyon 2021; 7:e06938. [PMID: 34027157 PMCID: PMC8121662 DOI: 10.1016/j.heliyon.2021.e06938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 04/01/2021] [Accepted: 04/23/2021] [Indexed: 11/15/2022] Open
Abstract
We explored the clinical relevance of resilient, overcontrolled and undercontrolled personality types based upon DSM-5 maladaptive personality traits. We examined if these prototypes could be differentiated in terms of personality functioning, and internalizing and externalizing pathology. Self-report questionnaires and structured interviews were administered to 192 adult patients referred to a mental health care center specialized in assessment and treatment of personality disorders. Through cluster analysis we identified a resilient type with no elevation on maladaptive trait domains and showing better personality functioning and less pathology than the overcontrolled and undercontrolled types. Furthermore, the overcontrolled type had elevated Negative Affectivity and a higher prevalence of mood disorders, whereas the undercontrolled type had elevations on all maladaptive traits, with the exception of Disinhibition, and higher rates of narcissistic and borderline personality disorders. Given the differences in psychopathology between the types, identifying these types may inform treatment focus. Also, in line with a stepped care model, compared to overcontrollers, resilient types may need less intensive treatment and undercontrollers may need more intensive treatment.
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Affiliation(s)
- Gina Rossi
- Vrije Universiteit Brussel (VUB), Department Psychology, Personality and Psychopathology Research Group, Brussels, Belgium
| | - Laura C. Weekers
- Viersprong Institute for Studies on Personality Disorders, Halsteren, the Netherlands
| | - Joost Hutsebaut
- Viersprong Institute for Studies on Personality Disorders, Halsteren, the Netherlands
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Pires R, Henriques-Calado J, Sousa Ferreira A, Bach B, Paulino M, Gama Marques J, Ribeiro Moreira A, Grácio J, Gonçalves B. The Utility of ICD-11 and DSM-5 Traits for Differentiating Patients With Personality Disorders From Other Clinical Groups. Front Psychiatry 2021; 12:633882. [PMID: 33935831 PMCID: PMC8085522 DOI: 10.3389/fpsyt.2021.633882] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 02/26/2021] [Indexed: 11/13/2022] Open
Abstract
The ICD-11 Classification of Personality Disorders delineates five trait domain qualifiers (i.e., negative affectivity, detachment, dissociality, disinhibition, and anankastia), whereas the DSM-5 Alternative Model of Personality Disorders also delineates a separate domain of psychoticism. These six combined traits not only characterize individual stylistic features, but also the severity of their maladaptive expressions. It was, therefore, the aim of this study to investigate the utility of ICD-11 and DSM-5 trait domains to differentiate patients with personality disorders (PD) from patients with other mental disorders (non-PD). The Personality Inventory for DSM-5 Brief Form Plus (PID5BF+M) was administered to a sample of patients diagnosed with a personality disorder (N = 124, M age = 42.21, 42.7% females) along with a sample of patients diagnosed with other mental disorders (N = 335, M age = 44.83, 46.6% females). Group differences were explored using the independent sample t test or the Mann-Whitney U test for independent samples, and discriminant factor analysis was used to maximize group differences for each trait domain and facet score. The PD group showed significantly higher scores for the total PID5BF+M composite score, for the trait domains of negative affectivity, antagonism/dissociality, and disinhibition and for the trait facets of emotional lability, manipulativeness, deceitfulness, and impulsivity. The trait domains of disinhibition, negative affectivity, and antagonism/dissociality as well as the trait facets of impulsivity, deceitfulness, emotional lability, and manipulativeness were the best discriminators between PD and non-PD patients. The global PID5BF+M composite score was also one of the best discriminators supporting its potential as a global severity index for detecting personality dysfunction. Finally, high scores in three or more of the 18 PID5BF+M facets suggested the possible presence of a PD diagnosis. Despite some limitations, our findings suggest that the ICD-11 and DSM-5 traits have the potential to specifically describe the stylistic features that characterize individuals with PD, including the severity of their maladaptive expressions.
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Affiliation(s)
- Rute Pires
- Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal
| | - Joana Henriques-Calado
- Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal
| | - Ana Sousa Ferreira
- Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal
- Instituto Universitário de Lisboa - Business Research Unit (BRU-IUL), Lisbon, Portugal
| | - Bo Bach
- Center for Personality Disorder Research, Psychiatric Research Unit, Slagelse, Denmark
| | - Marco Paulino
- Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - João Gama Marques
- Clínica de Psiquiatria Geral e Transcultural, Hospital Júlio de Matos, Centro Hospitalar Psiquiátrico de Lisboa, Lisbon, Portugal
- Clínica Universitária de Psiquiatra e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Ana Ribeiro Moreira
- Centro Hospitalar de Lisboa Ocidental, Hospital de Egas Moniz, Lisbon, Portugal
| | - Jaime Grácio
- Champalimaud Clinical Centre, Champalimaud Centre for the Unknown, Champalimaud Foundation, Lisbon, Portugal
- Champalimaud Research, Champalimaud Centre for the Unknown, Champalimaud Foundation, Lisbon, Portugal
- NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Bruno Gonçalves
- Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal
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Reynolds CJ, Vest N, Tragesser SL. Borderline Personality Disorder Features and Risk for Prescription Opioid Misuse in a Chronic Pain Sample: Roles for Identity Disturbances and Impulsivity. J Pers Disord 2021; 35:270-287. [PMID: 31609188 DOI: 10.1521/pedi_2019_33_440] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Although borderline personality disorder (BPD) is associated with both chronic pain and substance abuse, little research examines how BPD features in chronic pain patients may constitute a risk factor for misuse of prescription opioids, and no prior research has examined which particular component(s) of BPD might put chronic pain patients at risk-an oversight that undermines prevention and treatment of such problematic opioid use. In a cross-sectional study of patients in treatment for chronic pain (N = 147), BPD features were associated with several measures of prescription opioid misuse, even controlling for pain severity and interference. Specifically, the identity disturbances and self-harmful impulsivity facets of BPD were most consistently associated with opioid misuse, and exploratory analyses suggested that these factors may be interactive in their effects. Together, these results suggest that BPD features-especially unstable identity and self-harmful impulsivity-play a unique role in problematic prescription opioid use in chronic pain settings.
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Affiliation(s)
- Caleb J Reynolds
- Washington State University, Pullman.,Florida State University, Tallahassee
| | - Noel Vest
- Washington State University, Pullman
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