Personality Disorders and Attachment Trauma in Adolescent Patients with Psychiatric Disorders

This study examined how personality disorders (PD) differ with respect to gender, attachment status and traumatic childhood experiences in adolescent psychiatric inpatients. In particular, we investigated attachment-related traumatic material underlying adolescent PD. Our sample consisted of 175 inpatient adolescents aged 14 to 18 years (77% female, Mage = 15.13, SD = 1.35; 23% male, Mage =14.85, SD = 1.41). Thirty-nine patients (22%) fulfilled the diagnostic criteria for a PD according to the SCID-II PD: 51% avoidant, 13% obsessive-compulsive, 13% antisocial, 19% borderline, 2% paranoid and 2% histrionic. In the total sample, eighty-three (47%) of our inpatients were classified with an unresolved attachment status using the Adult Attachment Projective Picture System (AAP). We did not find any significant gender differences for patients with and without a PD. Our results revealed a higher percentage of unresolved attachment status in patients with a PD. The in-depth analysis of the total sample showed that patients with a PD demonstrated more traumatic material in their attachment interviews indicating a greater severity of attachment trauma. Furthermore, patients with a PD reported higher scores on emotional and physical neglect. Intervention strategies targeting traumatic attachment-related themes might be useful to treat adolescents with PD.

Do you have to be mad to believe in conspiracy theories? Personality disorders and conspiracy theories

This study explored the relationship between belief in conspiracy theories and the personality disorders. A sample of 475 British adults, aged around 30 years, completed measures of Belief in Conspiracy Theories (CTs) and the Personality Disorders (PDs), as well as the SAPAS, a short intelligence test and two self-evaluations. Belief in CTs was correlated with nearly all PDs, as well as the three established higher order clusters (A: odd and eccentric; B: dramatic and emotional; C: anxious). A series of stepwise multiple regressions were computed. A final regression showed five of the variables (education, intelligence, Cluster A, B, and C) were significant, which indicated that less well-educated and less intelligent participants, scoring higher on two PD clusters (Cluster A and B) but lower on Cluster C, believed more in the CTs. Implications of the study for understanding the origin of CTs is discussed. Limitations of the study, particularly the sample and measures used, are acknowledged.

Vulnerable and dominant: Bright and dark side personality traits and values of individuals in organized crime in Denmark

In this paper, we build on a robust literature on push and pull factors to focus on the personality traits and values of individuals involved in organized crime. We distinguish organized crime from other kinds of criminal activity and recruit a unique sample of non-incarcerated individuals verified by the Danish National Police to be involved in organized crime. We use comprehensive standardized psychological assessments of their big five personality traits, maladaptive dark traits and core values and drivers to compare them to an adult norm group. Danish individuals involved in organized crime are much less emotionally stable (d = 1.84), ambitious and self-confident (d = 1.50), agreeable (d = 0.87) and conscientious (d = 0.65) than the norm group. At the same time, they have substantially higher scores on all but one of the 11 dark traits (Cohen's d ranging from 0.39 to 3.10). They are characterized by a high need for security (d = 1.14) as well as material (d = 0.96) and financial success (d = 0.81). While these patterns fit results previously found in the criminological literature, a latent class analysis reveals two separate groups. A subset of one third of our sample had somewhat less depressed scores on the big five and more moderate scores on the dark traits, indicating more adaptive personality structures. We consider this novel finding in terms of potential exits from a milieu of organized crime.

Validity and Reliability of the Urdu Version of the McLean Screening Instrument for Borderline Personality Disorder

Introduction: Although the translation and the validation of the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) are performed in various languages and samples, no study has established the validity and reliability of the Urdu version of MSI-BPD in individuals with cardiac problems. Materials and Methods: The Urdu version of the MSI-BPD was prepared through the standard back-translation method. The translation and adaption were completed in four steps: forward translation, adaption and translation, back translation and committee approach, and cross-language validation. The sample, selected through the purposive sampling method, comprised of 150 adults with cardiac problems (men = 75 and women = 75), with an age range of 23-78 years (M = 55, SD = 10.6). The Cronbach alpha reliability and factorial validity of the MSI-BPD were assessed through confirmatory factor analysis (CFA) and Pearson correlation analyses. Internal consistency and test-retest reliability (at 2 weeks' interval) were used to evaluate the reliability. Statistical analyses were performed, using SPSS (version 22) and Structural Equation Modeling (SEM) software. Results: Preliminary analysis revealed that the overall instrument had good internal consistency (Urdu MSI-BPD α = 0.79; English MSI-BPD α = 0.77) as well as test-retest correlation coefficients for 15 days (r = 0.94). Conclusions: Findings suggested that the MSI-BPD, with important limitations, can be used as an effective preliminary screening tool to measure BPD in Urdu-speaking adults with cardiac problems. Further validations should be conducted to make the translated version of the MSI-BPD an appropriate tool to screen BPD in hospitals and mental health care settings.

Anger and cluster B personality traits and the conversion from unipolar depression to bipolar disorder

INTRODUCTION

Feelings of anger and irritability are prominent symptoms of bipolar disorder (BD) that may occur during hypomanic, depressive and, especially, during mixed mood states. We aimed to determine whether such constructs are associated with the conversion to BD in subjects with a history of unipolar depression.

METHODS

Data were derived from the depressed participants of Netherlands Study of Depression and Anxiety with 9 years of follow-up. Hypomania was ascertained using the Composite International Diagnostic Interview at 2, 4, 6, and 9 years follow-up. Cross-sectionally, we studied the association between prevalent hypomania and anger related constructs with the "Spielberger Trait Anger subscale," the "Anger Attacks" questionnaire, the cluster B personality traits part of the "Personality Disorder Questionnaire," and "aggression reactivity." Prospectively, we studied whether aggression reactivity predicted incident hypomania using Cox regression analyses.

RESULTS

Cross-sectionally, the bipolar conversion group (n = 77) had significantly higher scores of trait anger and aggression reactivity, as well as a higher prevalence on "anger attacks," "antisocial traits," and "borderline traits" compared to current (n = 349) as well as remitted (n = 1159) depressive patients. In prospective analyses in 1744 participants, aggression reactivity predicted incident hypomania (n = 28), with a multivariate-adjusted hazard ratio of 1.4 (95% confidence interval: 1.02-1.93; p = .037).

CONCLUSION

Anger is a risk factor for conversion from unipolar depression to BD. In addition, patients who converted to BD showed on average more anger, agitation and irritability than people with a history of unipolar depression who had not converted.

Efecto De La Personalidad Sobre El Recobro De Actos Violentos En Testigos

En el campo de investigación en psicología del testimonio se ha estudiado el efecto de múltiples factores psicológicos sobre la cantidad de detalles, la reproducción de conversaciones y las falsas memorias en el recobro de eventos autobiográficos. El objetivo de esta investigación es identificar el efecto de la personalidad sobre el recobro de testigos presenciales de actos con violencia verbal y no verbal. Participaron 40 estudiantes de psicología divididos en cuatro grupos en términos de sus puntuaciones altas en los estilos de personalidad histriónica (Grupo 1), esquizoide (Grupo 2), obsesiva-compulsiva (Grupo 3), y un grupo control con puntuaciones promedio en dichos estilos (Grupo 4). Mediante una situación experimental se presentó a los participantes un video con contenido de violencia verbal o física; posteriormente se realizó una tarea de recobro libre y se evaluó la cantidad de detalles, la reproducción de conversaciones y las falsas memorias. Los resultados mostraron que los participantes del Grupo 1 evidenciaron recobros pobres en detalles, con deficiente precisión en la reproducción de conversaciones y ausencia de falsas memorias, mientras que los participantes de los grupos 2 y 3 recobraron la información con mayor cantidad de detalles y mayor precisión en la reproducción de conversaciones, aunque el Grupo 3 obtuvo la mayor cantidad de falsas memorias. Estos hallazgos son discutidos en términos de la relación entre la forma en que se recobra la información en los procesos de Memoria Autobiográfica en escenarios jurídicos, y que hay otros constructos asociados como la personalidad y la emoción que pueden influir en el testimonio. Palabras Clave: Psicología del testimonio, recobro, personalidad, memoria autobiográfica, testimonio, contenido violento.

Computerized Adaptive Testing for Schizotypal Personality Disorder: Detecting Individuals at Risk

As schizotypal personality disorder (SPD) increasingly prevails in the general population, a rapid and comprehensive measurement instrument is imperative to screen individuals at risk for SPD. To address this issue, we aimed to develop a computerized adaptive testing for SPD (CAT-SPD) using a non-clinical Chinese sample (N = 999), consisting of a calibration sample (N₁ = 497) and a validation sample (N₂ = 502). The item pool of SPD was constructed from several widely used SPD scales and statistical analyses based on the item response theory (IRT) via a calibration sample using a graded response model (GRM). Finally, 90 items, which measured at least one symptom of diagnostic criteria of SPD in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and had local independence, good item fit, high slope, and no differential item functioning (DIF), composed the final item pool for the CAT-SPD. In addition, a simulated CAT was conducted in an independent validation sample to assess the performance of the CAT-SPD. Results showed that the CAT-SPD not only had acceptable reliability, validity, and predictive utility but also had shorter but efficient assessment of SPD which can save significant time and reduce the test burden of individuals with less information loss.

Atypical social reward anticipation as a transdiagnostic characteristic of psychopathology: A meta-analytic review and critical evaluation of current evidence

Several psychopathologies (e.g. schizophrenia spectrum conditions, autism spectrum disorders) are characterised by atypical interpersonal and social behaviour, and there is increasing evidence to suggest this atypical social behaviour is related to adjusted behavioural and neural anticipation of social rewards. This review brings together social reward anticipation research in psychopathology (k = 42) and examines the extent to which atypical social reward anticipation is a transdiagnostic characteristic. Meta-analyses of anticipatory reaction times revealed that, in comparison to healthy controls, attention-deficit/hyperactivity disorder, autism spectrum disorder, and schizophrenia spectrum conditions are associated with significantly reduced behavioural anticipation of social rewards. The pooled meta-analysis of anticipatory reaction times found that the full clinical sample demonstrated significant social reward hypoanticipation in comparison to the healthy control group with a medium effect size. A narrative synthesis of meta-analytically ineligible behavioural data, self-report data, and neuroimaging studies complemented the results of the meta-analysis, but also indicated that bipolar disorder, eating disorders, and sexual addiction disorders may be associated with social reward hyperanticipation. The evaluation of existing evidence suggests that future research should better account for factors that affect reward anticipation (e.g. gender, psychotropic medication) and highlights the importance of using stimuli other than happy faces as social rewards.

Unresolved Attachment Mediates the Relationship Between Childhood Trauma and Impaired Personality Functioning in Adolescence

The present study investigates the mediating effect of attachment trauma on the relationship between childhood maltreatment and personality functioning in 199 adolescents (12-18 years) using a novel approach of an in-depth analysis of attachment-related traumatic contents during an attachment interview (AAP). Our findings demonstrate that adolescents with a high amount of traumatic attachment-related material show a lower resilience when facing traumatic childhood experiences, resulting in a greater severity of personality dysfunction. In particular, the associations between emotional abuse and neglect and the domains of identity, empathy, self-direction, and intimacy were mediated by the severity of attachment trauma. These results advance our understanding of the different nuances of attachment-related traumatic material and how they might shape personality structure in an adolescent age group.

Barriers to care for adolescents with borderline personality disorder

Intervention for borderline personality disorder (BPD) in adolescence is crucial as early onset of the disorder predicts more severe course, and intervention 'late' in the course of the disorder is associated with more negative outcomes. In spite of this, access to services is poor. This is because several unique barriers to accessing care exist for adolescents with BPD. In this article we highlight key barriers to care for adolescents with BPD utilizing a conceptual model for understanding health care access that emphasizes the interaction between patient and health care system characteristics. We conclude with proposed recommendations to address these identified barriers.

Procedures to Develop a Computerized Adaptive Testing to Advance the Measurement of Narcissistic Personality

Narcissistic personality (NP) has recently attracted a great deal of attention. In this study, we mainly investigated the feasibility and effectiveness of using computerized adaptive testing (CAT) to measure NP (CAT-NP). The CAT in this study was simulated by the responses of several NP questionnaires of 1,013 university students as if their responses were collected adaptively. The item bank (85 items) that met the requirements of the psychometric properties of Item Response Theory (IRT) was first established, and then the CAT dynamically selected items according to the estimates of current trait level until the prespecified measurement precision is achieved. Finally, the efficiency and validity of the CAT were verified. The results showed that the proposed CAT-NP had reasonable reliability, validity, predictive utility, and high correlation. In addition, the CAT-NP could significantly save item usage without losing measurement accuracy, which greatly improves the test efficiency. The advantages and limitations of CAT in measuring NP and other psychological tests are discussed in the final section.

Borderline personality disorder: part 1 – assessment and diagnosis

General adult psychiatrists are largely responsible for the care of patients with personality disorders in community and in-patient settings, and this can be associated with diagnostic and management challenges. In the first of two articles focusing specifically on borderline personality disorder (BPD), we summarise the core clinical features of the disorder and discuss appropriate diagnostic practice.

Borderline Personality Features in Inpatients with Bipolar Disorder: Impact on Course and Machine Learning Model Use to Predict Rapid Readmission

BACKGROUND

Earlier research indicated that nearly 20% of patients diagnosed with either bipolar disorder (BD) or borderline personality disorder (BPD) also met criteria for the other diagnosis. Yet limited data are available concerning the potential impact of co-occurring BPD and/or BPD features on the course or outcome in patients with BD. Therefore, this study examined this comorbidity utilizing the standardized Borderline Personality Questionnaire (BPQ).

METHODS

This study involved 714 adult patients with a primary diagnosis of BD per DSM-IV criteria who were admitted to the psychiatric unit at an academic hospital in Houston, TX between July 2013 and July 2018. All patients completed the BPQ within 72 hours of admission. Statistical analysis was used to detect correlations between severity of BD, length of stay (LOS), and scores on the BPQ. A machine learning model was constructed to predict the parameters affecting patients' readmission rates within 30 days.

RESULTS

Analysis revealed that the severity of certain BPD traits at baseline was associated with mood state and outcome measured by LOS. Inpatients with BD who were admitted during acute depressive episodes had significantly higher mean scores on 7 of the 9 BPQ subscales (P<0.05) compared with those admitted during acute manic episodes. Inpatients with BD with greater BPQ scores on 4 of the 9 BPQ subscales had significantly shorter LOS than those with lower BPQ scores (P<0.05). The machine learning model identified 6 variables as predictors for likelihood of 30-day readmission with a high sensitivity (83%), specificity (77%), and area under the receiver operating characteristic curve of 86%.

CONCLUSIONS

Although preliminary, these results suggest that inpatients with BD who have higher levels of BPD features were more likely to have depressive rather than manic symptoms, fewer psychotic symptoms, and a shorter LOS. Moreover, machine learning models may be particularly valuable in identifying patients with BD who are at the highest risk for adverse consequences including rapid readmission.

Convergent and Discriminant Validity of the Five Factor Form and the Sliderbar Inventory

Existing measures of the five factor model (FFM) of personality are generally, if not exclusively, unipolar in their assessment of maladaptive variants of the FFM domains. However, two recently developed measures, the Five Factor Form (FFF) and the Sliderbar Inventory (SI), include items that assess for maladaptive variants at both poles of each item. This structure is unique among existing measures of personality and personality disorder, although there is a historical, infrequently used Stone Personality Trait Schema (SPTS) that had also included this item structure. To facilitate an exploration of their convergent and discriminant validity, the SI and SPTS items were reorganized into FFM scales. The convergent and discriminant validity of the FFF, SI-FFM, and SPTS-FFM scales was considered in a sample of 450 adults with current or a history of mental health treatment. The FFF, SI-FFM, and SPTS-FFM were also compared with respect to their relationship with FFM domains. Finally, the FFF items and SI-FFM scales were tested with respect to their relationship with measures of maladaptive variants of both high and low agreeableness and conscientiousness. The implications of the results are discussed with respect to the assessment of maladaptive personality functioning, and suggestions for future research are provided.

A Big Five facet analysis of sub-clinical narcissism: understanding boldness in terms of well-known personality traits

This study aimed to examine a Big Five 'bright-side' analysis of a sub-clinical personality disorder, i.e. narcissism. A total of 6957 British adults completed the NEO-PI-R, which measures the Big Five Personality factors at the domain and the facet level, as well as the Hogan Development Survey (HDS), which has a measure of Narcissism called Bold as one of its dysfunctional interpersonal tendencies. Correlation and regression results confirmed many of the associations between the Big Five domains and facets (NEO-PI-R) and sub-clinical narcissism. The Bold (Narcissism) scale from the HDS was the criterion variable in all analyses. Bold individuals are disagreeable extraverts with very low scores on facet Modesty but moderately high scores on Assertiveness, Competence and Achievement Striving. The study confirmed work using different population groups and different measures.