1
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Peters JR, Crowe ML, Morgan T, Zimmerman M, Sharp C, Grilo CM, Sanislow CA, Shea MT, Zanarini MC, McGlashan TH, Morey LC, Skodol AE, Yen S. Borderline personality disorder symptom networks across adolescent and adult clinical samples: examining symptom centrality and replicability. Psychol Med 2023; 53:2946-2953. [PMID: 35094733 PMCID: PMC9339041 DOI: 10.1017/s0033291721004931] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/22/2021] [Accepted: 11/09/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Numerous theories posit different core features to borderline personality disorder (BPD). Recent advances in network analysis provide a method of examining the relative centrality of BPD symptoms, as well as examine the replicability of findings across samples. Additionally, despite the increase in research supporting the validity of BPD in adolescents, clinicians are reluctant to diagnose BPD in adolescents. Establishing the replicability of the syndrome across adolescents and adults informs clinical practice and research. This study examined the stability of BPD symptom networks and centrality of symptoms across samples varying in age and clinical characteristics. METHODS Cross-sectional analyses of BPD symptoms from semi-structured diagnostic interviews from the Collaborative Longitudinal Study of Personality Disorders (CLPS), the Methods to Improve Diagnostic Assessment and Service (MIDAS) study, and an adolescent clinical sample. Network attributes, including edge (partial association) strength and node (symptom) expected influence, were compared. RESULTS The three networks were largely similar and strongly correlated. Affective instability and identity disturbance emerged as relatively central symptoms across the three samples, and relationship difficulties across adult networks. Differences in network attributes were more evident between networks varying both in age and in BPD symptom severity level. CONCLUSIONS Findings highlight the relative importance of affective, identity, and relationship symptoms, consistent with several leading theories of BPD. The network structure of BPD symptoms appears generally replicable across multiple large samples including adolescents and adults, providing further support for the validity of the diagnosis across these developmental phases.
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Affiliation(s)
| | - Michael L. Crowe
- Alpert Medical School of Brown University, Providence, USA
- VA Boston Healthcare System, Boston, USA
| | - Theresa Morgan
- Butler Hospital, Alpert Medical School of Brown University, Providence, USA
| | - Mark Zimmerman
- Rhode Island Hospital, Alpert Medical School of Brown University, Providence, USA
| | | | | | | | - M. Tracie Shea
- Alpert Medical School of Brown University, Providence, USA
| | | | | | | | | | - Shirley Yen
- Alpert Medical School of Brown University, Providence, USA
- Beth Israel Deaconess Medical Center, Massachusetts Mental Health Center, Harvard Medical School, Boston, USA
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2
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Müller S, Hopwood CJ, Skodol AE, Morey LC, Oltmanns TF, Benecke C, Zimmermann J. Exploring the predictive validity of personality disorder criteria. Personal Disord 2023; 14:309-320. [PMID: 36729499 DOI: 10.1037/per0000609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We tested the predictive validity of personality disorder (PD) indicators at different levels of aggregation, ranging from general PD severity to PD syndrome scales to individual PD criteria. We compared the predictive validity of models on these levels based on interview data on all 78 DSM-IV PD criteria, by using 19 outcome scales in three different samples (N = 651, N = 552, and N = 1,277). We hypothesized that criteria of personality pathology yield a significant increase in predictive validity compared with scales that are aggregated at the syndrome- or general severity-level. We assessed out of sample performance of predictive models in a repeated cross-validation design using regularized linear regression and regression forest algorithms. We observed no significant difference in predictive performance between models trained at the item-level and models trained on scale-level data. We further tested the predictive performance of the trained linear models across samples on outcome measures shared between samples and inspected models for criteria-level information they relied on to make predictions. Our results suggest that little predictive variance is lost when interview items assessing DSM-IV PD criteria are aggregated to dimensional PD scales. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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3
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Nysaeter TE, Hummelen B, Christensen TB, Eikenaes IUM, Selvik SG, Pedersen G, Bender DS, Skodol AE, Paap MCS. The Incremental Utility of Criteria A and B of the DSM-5 Alternative Model for Personality Disorders for Predicting DSM-IV/DSM-5 Section II Personality Disorders. J Pers Assess 2023; 105:111-120. [PMID: 35285763 DOI: 10.1080/00223891.2022.2039166] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The DSM-5 Alternative Model for Personality Disorders (AMPD) includes two main criteria: moderate or greater impairment in personality functioning (Criterion A) and the presence of one or more pathological personality traits (Criterion B). The aim of the study was to investigate the incremental utility of Criteria A and B for predicting DSM-5 Section II personality disorders (PD). The sample (N = 317) consisted of three well-defined groups: non-clinical participants (n = 35), psychiatric patients with PD (n = 193), and without PD (n = 83). All were assessed using the Structured Clinical Interview for the DSM-5 Alternative Model for Personality Disorders Module I (SCID-5-AMPD-I): Level of Personality Functioning Scale (LPFS), and the Personality Inventory for DSM-5 (PID-5). Logistic regression analyses showed that the SCID-5-AMPD-I could predict the presence of PDs in general, and the three specific PDs that were investigated (i.e., Antisocial, Borderline, and Avoidant PDs). The PID-5 domains enhanced prediction of the specific PDs, but not the presence of PDs in general, when entered in the second step. Our results support the AMPD model: Criterion A predicted the presence of DSM-5 Section II PDs in general, whereas measures of Criterion B incremented prediction of Antisocial, Borderline, and Avoidant PDs.
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Affiliation(s)
| | - Benjamin Hummelen
- Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | | | - Ingeborg Ulltveit-Moe Eikenaes
- National Advisory Unit for Personality Psychiatry (NAPP), Oslo university Hospital, Oslo, Norway.,Division of Mental Health and Addiction Treatment, Vestfold Hospital Trust, Tønsberg, Norway
| | | | - Geir Pedersen
- The Norwegian Centre of Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Section for Personality Psychiatry and Specialized Treatments, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Donna S Bender
- Division of Computer Science and Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Andrew E Skodol
- Department of Psychiatry, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Muirne C S Paap
- Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Department of Child and Family Welfare, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
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4
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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: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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5
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Kotov R, Cicero DC, Conway CC, DeYoung CG, Dombrovski A, Eaton NR, First MB, Forbes MK, Hyman SE, Jonas KG, Krueger RF, Latzman RD, Li JJ, Nelson BD, Regier DA, Rodriguez-Seijas C, Ruggero CJ, Simms LJ, Skodol AE, Waldman ID, Waszczuk MA, Watson D, Widiger TA, Wilson S, Wright AGC. The Hierarchical Taxonomy of Psychopathology (HiTOP) in psychiatric practice and research. Psychol Med 2022; 52:1666-1678. [PMID: 35650658 DOI: 10.1017/s0033291722001301] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The Hierarchical Taxonomy of Psychopathology (HiTOP) has emerged out of the quantitative approach to psychiatric nosology. This approach identifies psychopathology constructs based on patterns of co-variation among signs and symptoms. The initial HiTOP model, which was published in 2017, is based on a large literature that spans decades of research. HiTOP is a living model that undergoes revision as new data become available. Here we discuss advantages and practical considerations of using this system in psychiatric practice and research. We especially highlight limitations of HiTOP and ongoing efforts to address them. We describe differences and similarities between HiTOP and existing diagnostic systems. Next, we review the types of evidence that informed development of HiTOP, including populations in which it has been studied and data on its validity. The paper also describes how HiTOP can facilitate research on genetic and environmental causes of psychopathology as well as the search for neurobiologic mechanisms and novel treatments. Furthermore, we consider implications for public health programs and prevention of mental disorders. We also review data on clinical utility and illustrate clinical application of HiTOP. Importantly, the model is based on measures and practices that are already used widely in clinical settings. HiTOP offers a way to organize and formalize these techniques. This model already can contribute to progress in psychiatry and complement traditional nosologies. Moreover, HiTOP seeks to facilitate research on linkages between phenotypes and biological processes, which may enable construction of a system that encompasses both biomarkers and precise clinical description.
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Affiliation(s)
- Roman Kotov
- Stony Brook University, Stony Brook, New York, USA
| | | | | | | | | | | | - Michael B First
- Columbia University College of Physicians and Surgeons, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | | | - Steven E Hyman
- Stanley Center for Psychiatric Research at the Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA
| | | | | | | | - James J Li
- University of Wisconsin-Madison, Madison, Wisconsin, USA
| | | | - Darrel A Regier
- Uniformed Services University, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | | | | | | | - Andrew E Skodol
- University of Arizona College of Medicine, Tucson, Arizona, USA
| | | | - Monika A Waszczuk
- Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | | | | | - Sylia Wilson
- University of Minnesota, Minneapolis, Minnesota, USA
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6
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Morey LC, McCredie MN, Bender DS, Skodol AE. Criterion A: Level of personality functioning in the alternative DSM–5 model for personality disorders. Personal Disord 2022; 13:305-315. [DOI: 10.1037/per0000551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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7
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Ruchensky JR, Donnellan MB, Hopwood CJ, Edens JF, Skodol AE, Morey LC. A Comparison of Two Five-Factor Model Operationalizations of the Triarchic Model of Psychopathy in a Clinical Sample. Assessment 2021; 29:1496-1506. [PMID: 34096359 DOI: 10.1177/10731911211006186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Structural models of personality traits, particularly the five-factor model (FFM), continue to inform ongoing debates regarding what personality attributes and trait domains are central to psychopathy. A growing body of literature has linked the constructs of the triarchic model of psychopathy (boldness, meanness, disinhibition) to the FFM. Recently, researchers developed both item and regression-based measures of the triarchic model of psychopathy using the NEO Personality Inventory-Revised-a popular measure of the FFM. The current study examines the correlates of these two FFM-derived operationalizations of the triarchic model using data from the Collaborative Longitudinal Personality Disorders Study. The two approaches had strong convergent validity coefficients and similar patterns of criterion-related validity coefficients. Meanness related to greater personality pathology characterized by exploitation of others and poor attachment, whereas disinhibition related to indicators of greater negative affect and poor behavioral constraint. Boldness related to reduced negative affect and greater narcissistic personality traits. Although the item and regression-based approaches showed similar patterns of associations with criterion-variables, the item-based approach has some practical and psychometric advantages over the regression-based approach given strong correlations between the meanness and disinhibition scores from the regression approach.
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8
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Yen S, Peters JR, Nishar S, Grilo CM, Sanislow CA, Shea MT, Zanarini MC, McGlashan TH, Morey LC, Skodol AE. Association of Borderline Personality Disorder Criteria With Suicide Attempts: Findings From the Collaborative Longitudinal Study of Personality Disorders Over 10 Years of Follow-up. JAMA Psychiatry 2021; 78:187-194. [PMID: 33206138 PMCID: PMC7675214 DOI: 10.1001/jamapsychiatry.2020.3598] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Borderline personality disorder (BPD) has been identified as a strong risk factor for suicidal behavior, including suicide attempts. Delineating specific features that increase risk could inform interventions. OBJECTIVE To examine factors associated with prospectively observed suicide attempts among participants in the Collaborative Longitudinal Study of Personality Disorders (CLPS), over 10 years of follow-up, with a focus on BPD and BPD criteria. DESIGN, SETTING, AND PARTICIPANTS The CLPS is a multisite, naturalistic, prospective study of adult participants with 4 personality disorders (PDs) and a comparison group of adults with major depressive disorder and minimal PD features. Participants were all treatment-seeking and recruited from inpatient, partial, and outpatient treatment settings across New York, New York, Boston, Massachusetts, New Haven, Connecticut, and Providence, Rhode Island. A total of 733 participants were recruited at baseline, with 701 completing at least 1 follow-up assessment. The cohorts were recruited from September 1996 through April 1998 and September 2001 through August 2002. Data for this study using this follow-up sample (N = 701) were analyzed between March 2019 and August 2020. MAIN OUTCOMES AND MEASURES Participants were assessed annually using semistructured diagnostic interviews and a variety of self-report measures for up to 10 years. Multiple logistic regression analyses were used to examine baseline demographic and clinical risk factors, including BPD and individual BPD criteria, of suicide attempt assessed over 10 years of prospective follow-up. RESULTS Of the 701 participants, 447 (64%) identified as female, 488 (70%) as White, 527 (75%) as single, 433 (62%) were unemployed, and 512 (73%) reported at least some college education. Of all disorders, BPD emerged as the most robust factor associated with prospectively observed suicide attempt(s) (odds ratio [OR], 4.18; 95% CI, 2.68-6.52), even after controlling for significant demographic (sex, employment, and education) and clinical (childhood sexual abuse, alcohol use disorder, substance use disorder, and posttraumatic stress disorder) factors. Among BPD criteria, identity disturbance (OR, 2.21; 95% CI, 1.37-3.56), chronic feelings of emptiness (OR, 1.63; 95% CI, 1.03-2.57), and frantic efforts to avoid abandonment (OR, 1.93; 95% CI, 1.17-3.16) emerged as significant independent factors associated with suicide attempt(s) over follow-up, when covarying for other significant factors and BPD criteria. CONCLUSIONS AND RELEVANCE In the multisite, longitudinal study of adults with personality disorders, identity disturbance, chronic feelings of emptiness, and frantic efforts to avoid abandonment were significantly associated with suicide attempts. Identity disturbance, chronic feelings of emptiness, and frantic efforts to avoid abandonment may be clinically overlooked features of BPD in context of suicide risk assessment. In light of the high rates of BPD diagnostic remission, our findings suggest that these criteria should be independently assessed and targeted for further study as suicide risk factors.
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Affiliation(s)
- Shirley Yen
- Beth Israel Deaconess Medical Center, Massachusetts Mental Health Center, Harvard Medical School, Boston, Massachusetts,Alpert Medical School, Brown University, Providence, Rhode Island
| | | | - Shivani Nishar
- Alpert Medical School, Brown University, Providence, Rhode Island
| | | | | | - M. Tracie Shea
- Alpert Medical School, Brown University, Providence, Rhode Island,Providence Veterans Affairs Medical Center, Providence, Rhode Island
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9
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Buer Christensen T, Hummelen B, Paap MCS, Eikenaes I, Selvik SG, Kvarstein E, Pedersen G, Bender DS, Skodol AE, Nysæter TE. Evaluation of Diagnostic Thresholds for Criterion A in the Alternative DSM-5 Model for Personality Disorders. J Pers Disord 2020; 34:40-61. [PMID: 31682197 DOI: 10.1521/pedi_2019_33_455] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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) of the Alternative DSM-5 Model for Personality Disorders (AMPD) was formulated to assess the presence and severity of personality disorders (PDs). Moderate impairment (Level 2) in personality functioning, as measured by the LPFS, was incorporated into the AMPD as a diagnostic threshold for PD in Criterion A of the general criteria, as well as for the "any two areas present" rule for assigning a specific PD diagnosis. This study represents the first evaluation of the diagnostic decision rules for Criterion A, in a clinical sample (N = 282). The results indicate that an overall diagnostic threshold for PDs should be used with caution because it may not identify all DSM-IV PDs. The "any two areas present" rule proved to be a reasonable alternative, although this finding should be interpreted with caution because the LPFS does not measure the disorder-specific A criteria.
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Affiliation(s)
| | - Benjamin Hummelen
- Department of Personality Psychiatry, Clinic Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Department of Research and Development, Clinic Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Muirne C S Paap
- Department of Research and Development, Clinic Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Department of Special Needs, Education, and Youth Care, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Ingeborg Eikenaes
- Department of Personality Psychiatry, Division of Mental Health and Addiction Treatment, Vestfold Hospital Trust, Tonsberg, Norway
| | - Sara Germans Selvik
- Department of Psychiatry, Hospital Namsos, Namsos, Norway.,Department of Mental Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Elfrida Kvarstein
- Department of Personality Psychiatry, Clinic Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Geir Pedersen
- Department of Personality Psychiatry, Clinic Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,NORMENT, KG Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Donna S Bender
- Department of Psychiatry and Behavioral Sciences and Counseling and Psychological Services, Tulane University, New Orleans, Louisiana
| | - Andrew E Skodol
- Department of Psychiatry, University of Arizona College of Medicine, Tucson, Arizona
| | - Tor Erik Nysæter
- Department of Mental Health, Sorlandet Hospital, Arendal, Norway
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10
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Ruggero CJ, Kotov R, Hopwood CJ, First M, Clark LA, Skodol AE, Mullins-Sweatt SN, Patrick CJ, Bach B, Cicero DC, Docherty A, Simms LJ, Bagby RM, Krueger RF, Callahan JL, Chmielewski M, Conway CC, De Clercq B, Dornbach-Bender A, Eaton NR, Forbes MK, Forbush KT, Haltigan JD, Miller JD, Morey LC, Patalay P, Regier DA, Reininghaus U, Shackman AJ, Waszczuk MA, Watson D, Wright AGC, Zimmermann J. Integrating the Hierarchical Taxonomy of Psychopathology (HiTOP) into clinical practice. J Consult Clin Psychol 2020; 87:1069-1084. [PMID: 31724426 DOI: 10.1037/ccp0000452] [Citation(s) in RCA: 118] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Diagnosis is a cornerstone of clinical practice for mental health care providers, yet traditional diagnostic systems have well-known shortcomings, including inadequate reliability, high comorbidity, and marked within-diagnosis heterogeneity. The Hierarchical Taxonomy of Psychopathology (HiTOP) is a data-driven, hierarchically based alternative to traditional classifications that conceptualizes psychopathology as a set of dimensions organized into increasingly broad, transdiagnostic spectra. Prior work has shown that using a dimensional approach improves reliability and validity, but translating a model like HiTOP into a workable system that is useful for health care providers remains a major challenge. METHOD The present work outlines the HiTOP model and describes the core principles to guide its integration into clinical practice. RESULTS Potential advantages and limitations of the HiTOP model for clinical utility are reviewed, including with respect to case conceptualization and treatment planning. A HiTOP approach to practice is illustrated and contrasted with an approach based on traditional nosology. Common barriers to using HiTOP in real-world health care settings and solutions to these barriers are discussed. CONCLUSIONS HiTOP represents a viable alternative to classifying mental illness that can be integrated into practice today, although research is needed to further establish its utility. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | - Roman Kotov
- Department of Psychiatry, Stony Brook University
| | | | - Michael First
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University
| | | | | | | | | | - Bo Bach
- Psychiatric Research Unit, Slagelse Psychiatric Hospital
| | | | | | - Leonard J Simms
- Department of Psychology, University at Buffalo, The State University of New York
| | - R Michael Bagby
- Departments of Psychology and Psychiatry, University of Toronto
| | | | | | | | | | - Barbara De Clercq
- Department of Developmental, Personality, and Social Psychology, Ghent University
| | | | | | - Miriam K Forbes
- Centre for Emotional Health, Department of Psychology, Macquarie University
| | | | | | | | | | - Praveetha Patalay
- Centre for Longitudinal Studies and MRC Unit for Lifelong Health and Ageing, University College London
| | - Darrel A Regier
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University
| | | | | | | | - David Watson
- Department of Psychology, University of Notre Dame
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11
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Buer Christensen T, Eikenaes I, Hummelen B, Pedersen G, Nysæter TE, Bender DS, Skodol AE, Selvik SG. Level of personality functioning as a predictor of psychosocial functioning-Concurrent validity of criterion A. Personal Disord 2019; 11:79-90. [PMID: 31580097 DOI: 10.1037/per0000352] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The alternative model for personality disorders (AMPD) in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), defines personality functioning by assessment of impairment in Identity and Self-direction (Self component) and in Empathy and Intimacy (Interpersonal). These four domains constitute the Level of Personality Functioning Scale, a trans-diagnostic measure of PD severity. The association between the Level of Personality Functioning Scale and psychosocial impairment based on other previously established psychosocial functioning instruments has not been reported. A total of 317 individuals, including a representative clinical sample of 282 patients (192 with a personality disorder [PD] diagnosis), was evaluated with the Structured Clinical Interview for the DSM-5 AMPD Module I. Self-reported impairment was measured by the Work and Social Adjustment Scale (WSAS), and social and occupational impairment was assessed by the functioning score of the Global Assessment of Functioning scale (GAF-F). WSAS and GAF-F both correlated significantly with mean LPFS scores and the sum of DSM-IV PD criteria. For both measures, the mean LPFS was a stronger predictor for psychosocial impairment than the sum of DSM-IV PD criteria. Within the LPFS, the Self component was a better predictor than the Interpersonal component for both WSAS and GAF-F. For the four domains, the results diverged, with Identity as the strongest predictor by far for WSAS. Empathy was the only significant predictor for impairment evaluated by GAF-F, but its contribution to variance was not substantial. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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12
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Conway CC, Forbes MK, Forbush KT, Fried EI, Hallquist MN, Kotov R, Mullins-Sweatt SN, Shackman AJ, Skodol AE, South SC, Sunderland M, Waszczuk MA, Zald DH, Afzali MH, Bornovalova MA, Carragher N, Docherty AR, Jonas KG, Krueger RF, Patalay P, Pincus AL, Tackett JL, Reininghaus U, Waldman ID, Wright AG, Zimmermann J, Bach B, Bagby RM, Chmielewski M, Cicero DC, Clark LA, Dalgleish T, DeYoung CG, Hopwood CJ, Ivanova MY, Latzman RD, Patrick CJ, Ruggero CJ, Samuel DB, Watson D, Eaton NR. A Hierarchical Taxonomy of Psychopathology Can Transform Mental Health Research. Perspect Psychol Sci 2019; 14:419-436. [PMID: 30844330 PMCID: PMC6497550 DOI: 10.1177/1745691618810696] [Citation(s) in RCA: 183] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
For more than a century, research on psychopathology has focused on categorical diagnoses. Although this work has produced major discoveries, growing evidence points to the superiority of a dimensional approach to the science of mental illness. Here we outline one such dimensional system-the Hierarchical Taxonomy of Psychopathology (HiTOP)-that is based on empirical patterns of co-occurrence among psychological symptoms. We highlight key ways in which this framework can advance mental-health research, and we provide some heuristics for using HiTOP to test theories of psychopathology. We then review emerging evidence that supports the value of a hierarchical, dimensional model of mental illness across diverse research areas in psychological science. These new data suggest that the HiTOP system has the potential to accelerate and improve research on mental-health problems as well as efforts to more effectively assess, prevent, and treat mental illness.
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Affiliation(s)
- Christopher C. Conway
- Department of Psychological Sciences, College of William & Mary, Williamsburg, VA, USA
| | - Miriam K. Forbes
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | | | - Eiko I. Fried
- Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Michael N. Hallquist
- Department of Psychology, The Pennsylvania State University, State College, PA, USA
| | - Roman Kotov
- Department of Psychiatry, State University of New York, Stony Brook, NY, USA
| | | | - Alexander J. Shackman
- Department of Psychology and Neuroscience and Cognitive Science Program, University of Maryland, College Park, MD, USA
| | - Andrew E. Skodol
- Department of Psychiatry, University of Arizona, Tucson, AZ, USA
| | - Susan C. South
- Purdue University, Department of Psychological Sciences, West Lafayette, IN, USA
| | - Matthew Sunderland
- NHMRC Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Monika A. Waszczuk
- Department of Psychiatry, State University of New York, Stony Brook, NY, USA
| | - David H. Zald
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | | | | | - Natacha Carragher
- Medical Education and Student Office, Faculty of Medicine, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Anna R. Docherty
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
| | - Katherine G. Jonas
- Department of Psychiatry, State University of New York, Stony Brook, NY, USA
| | - Robert F. Krueger
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Praveetha Patalay
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Aaron L. Pincus
- Department of Psychology, The Pennsylvania State University, State College, PA, USA
| | | | - Ulrich Reininghaus
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, The Netherlands
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | | | - Aidan G.C. Wright
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Bo Bach
- Psychiatric Research Unit, Slagelse Psychiatric Hospital, Slagelse, Denmark
| | - R. Michael Bagby
- Departments of Psychology and Psychiatry, University of Toronto, Toronto, Canada
| | | | - David C. Cicero
- Department of Psychology, University of Hawaii at Manoa, HI, USA
| | - Lee Anna Clark
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK
| | - Colin G. DeYoung
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | | | - Masha Y. Ivanova
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Robert D. Latzman
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | | | - Camilo J. Ruggero
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Douglas B. Samuel
- Purdue University, Department of Psychological Sciences, West Lafayette, IN, USA
| | - David Watson
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Nicholas R. Eaton
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
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13
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Mulay AL, Waugh MH, Fillauer JP, Bender DS, Bram A, Cain NM, Caligor E, Forbes MK, Goodrich LB, Kamphuis JH, Keeley JW, Krueger RF, Kurtz JE, Jacobsson P, Lewis KC, Rossi GMP, Ridenour JM, Roche M, Sellbom M, Sharp C, Skodol AE. Borderline personality disorder diagnosis in a new key. Borderline Personal Disord Emot Dysregul 2019; 6:18. [PMID: 31827801 PMCID: PMC6886204 DOI: 10.1186/s40479-019-0116-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 11/07/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Conceptualizations of personality disorders (PD) are increasingly moving towards dimensional approaches. The definition and assessment of borderline personality disorder (BPD) in regard to changes in nosology are of great importance to theory and practice as well as consumers. We studied empirical connections between the traditional DSM-5 diagnostic criteria for BPD and Criteria A and B of the Alternative Model for Personality Disorders (AMPD). METHOD Raters of varied professional backgrounds possessing substantial knowledge of PDs (N = 20) characterized BPD criteria with the four domains of the Level of Personality Functioning Scale (LPFS) and 25 pathological personality trait facets. Mean AMPD values of each BPD criterion were used to support a nosological cross-walk of the individual BPD criteria and study various combinations of BPD criteria in their AMPD translation. The grand mean AMPD profile generated from the experts was compared to published BPD prototypes that used AMPD trait ratings and the DSM-5-III hybrid categorical-dimensional algorithm for BPD. Divergent comparisons with DSM-5-III algorithms for other PDs and other published PD prototypes were also examined. RESULTS Inter-rater reliability analyses showed generally robust agreement. The AMPD profile for BPD criteria rated by individual BPD criteria was not isomorphic with whole-person ratings of BPD, although they were highly correlated. Various AMPD profiles for BPD were generated from theoretically relevant but differing configurations of BPD criteria. These AMPD profiles were highly correlated and showed meaningful divergence from non-BPD DSM-5-III algorithms and other PD prototypes. CONCLUSIONS Results show that traditional DSM BPD diagnosis reflects a common core of PD severity, largely composed of LPFS and the pathological traits of anxiousness, depressively, emotional lability, and impulsivity. Results confirm the traditional DSM criterion-based BPD diagnosis can be reliably cross-walked with the full AMPD scheme, and both approaches share substantial construct overlap. This relative equivalence suggests the vast clinical and research literatures associated with BPD may be brought forward with DSM-5-III diagnosis of BPD.
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Affiliation(s)
- Abby L Mulay
- 1Medical University of South Carolina, 29C Leinbach Drive, Charleston, SC 29407 USA
| | - Mark H Waugh
- 2Oak Ridge National Laboratory (ORNL) & University of Tennessee Knoxville, Knoxville, TN 37996 USA
| | | | - Donna S Bender
- 4Tulane University, 6823 St. Charles Ave., Bldg. 92, New Orleans, LA 70118 USA
| | | | - Nicole M Cain
- 6Rutgers University, Graduate School of Applied and Professional Psychology, 152 Frelinghuysen Rd, Piscataway, NJ 08854-8020 USA
| | - Eve Caligor
- 7Columbia University, 1501 Riverside Drive, New York, NY 10032 USA
| | - Miriam K Forbes
- 8Macquarie University, Balaclava Rd., Macquarie Park, NSW 2109 Australia
| | | | - Jan H Kamphuis
- 10University of Amsterdam (UvA), Nieuwe Achtergracht, 129B, 1001 NK Amsterdam, Netherlands
| | - Jared W Keeley
- 11Virginia Commonwealth University, 806 West Franklin Street, Box 842018, Richmond, VA 23284-2018 USA
| | - Robert F Krueger
- 12University of Minnesota, 101 Pleasant St SE, Minneapolis, MN 55455 USA
| | - John E Kurtz
- 13Villanova University, 800 Lancaster Avenue, Villanova, PA 19085 USA
| | - Peter Jacobsson
- 14Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Katie C Lewis
- 15Austen Riggs Center, 25 Main Street, P.O. Box 962, Stockbridge, MA 01262 USA
| | - Gina M P Rossi
- 16Department of Psychology, Personality and Psychopathology Research group Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Jeremy M Ridenour
- 15Austen Riggs Center, 25 Main Street, P.O. Box 962, Stockbridge, MA 01262 USA
| | - Michael Roche
- 17Penn State Altoona, 3000 Ivyside Park, Altoona, PA 16601 USA
| | - Martin Sellbom
- 18University of Otago, PO Box 56, Dunedin, 9054 New Zealand
| | - Carla Sharp
- 19University of Houston, 3695 Cullen Boulevard Room 126, Houston, TX 77204-5022 USA
| | - Andrew E Skodol
- 20University of Arizona, 1501 N. Campbell Avenue, PO Box 245017, Tucson, AZ 85724 USA
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14
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Buer Christensen T, Paap MCS, Arnesen M, Koritzinsky K, Nysaeter TE, Eikenaes I, Germans Selvik S, Walther K, Torgersen S, Bender DS, Skodol AE, Kvarstein E, Pedersen G, Hummelen B. Interrater Reliability of the Structured Clinical Interview for the DSM–5 Alternative Model of Personality Disorders Module i: Level of Personality Functioning Scale. J Pers Assess 2018; 100:630-641. [DOI: 10.1080/00223891.2018.1483377] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - Muirne C. S. Paap
- Department of Special Needs, Education, and Youth Care, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
| | | | | | | | - Ingeborg Eikenaes
- Department of Personality Psychiatry, Division of Mental Health and Addiction Treatment, Vestfold Hospital Trust, Vestfold, Norway
| | - Sara Germans Selvik
- Department of Psychiatry, Hospital Namsos, Namsos, Norway
- Department of Mental Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Kristoffer Walther
- Department of Personality Psychiatry, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | | | - Donna S. Bender
- Department of Psychiatry and Behavioral Sciences and Counseling and Psychological Services, Tulane University
| | - Andrew E. Skodol
- 9Department of Psychiatry, University of Arizona College of Medicine, Oslo University Hospital, Oslo, Norway
| | - Elfrida Kvarstein
- Department of Personality Psychiatry, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Geir Pedersen
- Department of Personality Psychiatry, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- NORMENT, KG Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Benjamin Hummelen
- Department of Personality Psychiatry, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Department of Research and Development, Clinic Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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15
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Affiliation(s)
- Andrew E Skodol
- From the Department of Psychiatry, University of Arizona College of Medicine, Tucson
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16
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Conway CC, Hopwood CJ, Morey LC, Skodol AE. Borderline personality disorder is equally trait-like and state-like over ten years in adult psychiatric patients. J Abnorm Psychol 2018; 127:590-601. [PMID: 29952598 DOI: 10.1037/abn0000364] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Borderline personality disorder (PD) has historically been cast as an unabating condition. Longitudinal data, however, support a more variable time course marked by remission and relapse. In the present study, we tested the possibility that borderline PD has both stable (i.e., consistently present across time and situation, as modern diagnostic systems stipulate) and dynamic (i.e., episodic and situational) elements. Participants were 668 patients from the Collaborative Longitudinal Personality Disorders Study who were administered semistructured diagnostic interviews 5 times over a decade. Trait-state-occasion modeling dissected borderline pathology into time-invariant (i.e., trait) and time-varying (i.e., state) components. Contradicting traditional views of PD intransigence, less than half of borderline PD variability (approximately 45%) was time-invariant (i.e., perfectly stable) over the study timeframe. Furthermore, we found that the time-invariant component of borderline pathology, which we termed borderline proneness, was very closely related (r = .81) to a previously validated Five Factor Model trait composite of borderline features. Moreover, the trait versus state components showed a clear pattern of discriminant validity in relation to several putative causal agents for borderline PD (i.e., environmental pathogens, temperament dimensions). We conclude that borderline pathology contains a stable core and sizable situational components, and that both elements relate systematically to normative personality dimensions and known risk factors. These findings have key implications for etiological research, prognosis, and treatment for borderline PD. (PsycINFO Database Record
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17
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Affiliation(s)
- Christopher C Conway
- From the Department of Psychology, College of William & Mary, Williamsburg, Va.; the Department of Psychology, Northwestern University, Evanston, Ill.; and the Department of Psychiatry, University of Arizona, Tucson
| | - Jennifer L Tackett
- From the Department of Psychology, College of William & Mary, Williamsburg, Va.; the Department of Psychology, Northwestern University, Evanston, Ill.; and the Department of Psychiatry, University of Arizona, Tucson
| | - Andrew E Skodol
- From the Department of Psychology, College of William & Mary, Williamsburg, Va.; the Department of Psychology, Northwestern University, Evanston, Ill.; and the Department of Psychiatry, University of Arizona, Tucson
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18
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Skodol AE. Impact of personality pathology on psychosocial functioning. Curr Opin Psychol 2017; 21:33-38. [PMID: 28961463 DOI: 10.1016/j.copsyc.2017.09.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 09/04/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022]
Abstract
Personality disorders impair social, occupational, leisure, and global functioning more than a significant disorder such as major depressive disorder. Impairment is found in clinical and community populations. Impairment is independent of co-occurring other mental disorders. Impairment is more stable over time than are the diagnoses themselves. Personality traits are also impairing and may be more predictive of outcomes over time, but a hybrid of personality disorder features and normal range personality traits may be the most predictive model. A general, 'transdiagnostic,' self-other severity factor may be important for understanding the relationship of personality pathology and psychosocial functioning over time. The Alternative DSM-5 Model for Personality Disorders may be useful for the study of psychosocial functioning in individuals with personality pathology.
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Affiliation(s)
- Andrew E Skodol
- University of Arizona College of Medicine, USA; Columbia University College of Physicians and Surgeons, USA.
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19
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Kotov R, Krueger RF, Watson D, Achenbach TM, Althoff RR, Bagby RM, Brown TA, Carpenter WT, Caspi A, Clark LA, Eaton NR, Forbes MK, Forbush KT, Goldberg D, Hasin D, Hyman SE, Ivanova MY, Lynam DR, Markon K, Miller JD, Moffitt TE, Morey LC, Mullins-Sweatt SN, Ormel J, Patrick CJ, Regier DA, Rescorla L, Ruggero CJ, Samuel DB, Sellbom M, Simms LJ, Skodol AE, Slade T, South SC, Tackett JL, Waldman ID, Waszczuk MA, Widiger TA, Wright AGC, Zimmerman M. The Hierarchical Taxonomy of Psychopathology (HiTOP): A dimensional alternative to traditional nosologies. Journal of Abnormal Psychology 2017; 126:454-477. [DOI: 10.1037/abn0000258] [Citation(s) in RCA: 1221] [Impact Index Per Article: 174.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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20
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Wright AGC, Hopwood CJ, Skodol AE, Morey LC. Longitudinal validation of general and specific structural features of personality pathology. J Abnorm Psychol 2016; 125:1120-1134. [PMID: 27819472 PMCID: PMC5119768 DOI: 10.1037/abn0000165] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Theorists have long argued that personality disorder (PD) is best understood in terms of general impairments shared across the disorders as well as more specific instantiations of pathology. A model based on this theoretical structure was proposed as part of the DSM-5 revision process. However, only recently has this structure been subjected to formal quantitative evaluation, with little in the way of validation efforts via external correlates or prospective longitudinal prediction. We used the Collaborative Longitudinal Study of Personality Disorders dataset to: (a) estimate structural models that parse general from specific variance in personality disorder features, (b) examine patterns of growth in general and specific features over the course of 10 years, and (c) establish concurrent and dynamic longitudinal associations in PD features and a host of external validators including basic personality traits and psychosocial functioning scales. We found that general PD exhibited much lower absolute stability and was most strongly related to broad markers of psychosocial functioning, concurrently and longitudinally, whereas specific features had much higher mean stability and exhibited more circumscribed associations with functioning. However, both general and specific factors showed recognizable associations with normative and pathological traits. These results can inform efforts to refine the conceptualization and diagnosis of personality pathology. (PsycINFO Database Record
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21
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Timoney LR, Walsh Z, Shea MT, Yen S, Ansell EB, Grilo CM, McGlashan TH, Stout RL, Bender DS, Skodol AE, Sanislow CA, Morey LC, Gunderson JG. Personality and life events in a personality disorder sample. Personal Disord 2016; 8:376-382. [PMID: 27797543 DOI: 10.1037/per0000214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Individuals with a personality disorder (PD) tend to experience more negative life events (NLEs) than positive life events (PLEs). In community samples, the Five Factor Model of personality (FFM) predicts both positive and negative life events. The present research examined whether FFM normal personality traits were associated with positive and negative life events among individuals with 1 of 4 PDs: avoidant, borderline, schizotypal, and obsessive-compulsive, and tested whether associations between the FFM of personality and PLEs and NLEs were similar across the 4 PD groups and a control group. Among aggregated PDs, neuroticism was positively associated with NLEs, whereas extraversion, openness to experience, and conscientiousness were positively associated with PLEs. Comparisons of each PD group to a control group of individuals with a major depressive disorder indicated that the FFM traits operated similarly across clinical samples with and without PD. Our findings indicate that normal personality traits can be used to help understand the lives of individuals with PD. (PsycINFO Database Record
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Affiliation(s)
| | - Zach Walsh
- Department of Psychology, University of British Columbia
| | - M Tracie Shea
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School
| | - Shirley Yen
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School
| | - Emily B Ansell
- Department of Psychiatry, Yale University School of Medicine
| | - Carlos M Grilo
- Department of Psychiatry and Department of Psychology, Yale University School of Medicine
| | | | - Robert L Stout
- Decision Sciences Institute, Pacific Institute for Research and Evaluation
| | | | - Andrew E Skodol
- Department of Psychiatry, University of Arizona College of Medicine
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22
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Affiliation(s)
- Andrew E Skodol
- Department of Psychiatry, University of Arizona College of Medicine, Tucson, AZ, USA; Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
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23
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Elliott JC, Stohl M, Wall MM, Keyes KM, Skodol AE, Eaton NR, Shmulewitz D, Goodwin RD, Grant BF, Hasin DS. Childhood maltreatment, personality disorders and 3-year persistence of adult alcohol and nicotine dependence in a national sample. Addiction 2016; 111:913-23. [PMID: 26714255 PMCID: PMC4826838 DOI: 10.1111/add.13292] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 06/11/2015] [Accepted: 12/17/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Persistent cases of alcohol and nicotine dependence are associated with considerable morbidity and mortality, and are predicted by childhood maltreatment and personality disorders. Our aim was to test whether personality disorders (individually or conjointly) mediate the relationship between childhood maltreatment and the persistence of dependence. DESIGN Personality disorders, modeled dimensionally, were tested as mediators of the relationship between childhood maltreatment and the 3-year persistence of alcohol and nicotine dependence in participants in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) who had current alcohol and nicotine dependence in their baseline interview. Individual personality disorders were assessed in separate models. Then, those that were significant were examined jointly in multiple mediator models to determine their total and unique effects. SETTING A large, nationally representative US survey. PARTICIPANTS Participants ≥ 18 years who completed baseline and 3-year follow-up NESARC interviews who had baseline alcohol dependence (n = 1172; 68% male) or nicotine dependence (n = 4017; 52.9% male). MEASUREMENTS Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS-IV) measures of childhood maltreatment, personality disorders and alcohol/nicotine dependence. FINDINGS Individual models indicated that many personality disorders mediated the relationship between childhood maltreatment and the 3-year persistence of alcohol and nicotine dependence (each explaining 6-46% of the total effect, Ps < 0.05). In multiple mediator models, borderline and antisocial symptoms remained significant mediators, each explaining 20-37% of the total effect (Ps < 0.01). CONCLUSIONS Personality disorder symptoms (especially borderline and antisocial) help explain the association between childhood maltreatment and persistent alcohol and nicotine dependence.
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Affiliation(s)
- Jennifer C. Elliott
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA,New York State Psychiatric Institute, New York, New York, USA,Department of Psychiatry, Columbia University Medical Center, New York, New York, USA
| | - Malka Stohl
- New York State Psychiatric Institute, New York, New York, USA
| | - Melanie M. Wall
- New York State Psychiatric Institute, New York, New York, USA,Department of Psychiatry, Columbia University Medical Center, New York, New York, USA,Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Katherine M. Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Andrew E. Skodol
- Department of Psychiatry, Columbia University Medical Center, New York, New York, USA,Department of Psychiatry, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Nicholas R. Eaton
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| | - Dvora Shmulewitz
- New York State Psychiatric Institute, New York, New York, USA,Department of Psychiatry, Columbia University Medical Center, New York, New York, USA
| | - Renee D. Goodwin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA,Department of Psychology, Queens College and The Graduate Center, City University of New York (CUNY), Queens, New York, USA
| | - Bridget F. Grant
- Laboratory of Epidemiology and Biometry, National Institute of Alcohol Abuse and Alcoholism, Rockville, Maryland, USA
| | - Deborah S. Hasin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA,New York State Psychiatric Institute, New York, New York, USA,Department of Psychiatry, Columbia University Medical Center, New York, New York, USA
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Abstract
BACKGROUND The DSM-5 Personality and Personality Disorders Work Group formulated a hybrid dimensional/categorical model that represented personality disorders as combinations of core impairments in personality functioning with specific configurations of problematic personality traits. Specific clusters of traits were selected to serve as indicators for six DSM categorical diagnoses to be retained in this system - antisocial, avoidant, borderline, narcissistic, obsessive-compulsive and schizotypal personality disorders. The goal of the current study was to describe the empirical relationships between the DSM-5 section III pathological traits and DSM-IV/DSM-5 section II personality disorder diagnoses. METHOD Data were obtained from a sample of 337 clinicians, each of whom rated one of his or her patients on all aspects of the DSM-IV and DSM-5 proposed alternative model. Regression models were constructed to examine trait-disorder relationships, and the incremental validity of core personality dysfunctions (i.e. criterion A features for each disorder) was examined in combination with the specified trait clusters. RESULTS Findings suggested that the trait assignments specified by the Work Group tended to be substantially associated with corresponding DSM-IV concepts, and the criterion A features provided additional diagnostic information in all but one instance. CONCLUSIONS Although the DSM-5 section III alternative model provided a substantially different taxonomic structure for personality disorders, the associations between this new approach and the traditional personality disorder concepts in DSM-5 section II make it possible to render traditional personality disorder concepts using alternative model traits in combination with core impairments in personality functioning.
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Affiliation(s)
- L C Morey
- Department of Psychology,Texas A&M University,College Station,TX,USA
| | - K T Benson
- Department of Psychology,Texas A&M University,College Station,TX,USA
| | - A E Skodol
- Department of Psychiatry,University of Arizona College of Medicine,Phoenix,AZ,USA
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25
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Abstract
BACKGROUND The DSM-5 Personality and Personality Disorders Work Group formulated a hybrid dimensional/categorical model that represented personality disorders as combinations of core impairments in personality functioning with specific configurations of problematic personality traits. Specific clusters of traits were selected to serve as indicators for six DSM categorical diagnoses to be retained in this system - antisocial, avoidant, borderline, narcissistic, obsessive-compulsive and schizotypal personality disorders. The goal of the current study was to describe the empirical relationships between the DSM-5 section III pathological traits and DSM-IV/DSM-5 section II personality disorder diagnoses. METHOD Data were obtained from a sample of 337 clinicians, each of whom rated one of his or her patients on all aspects of the DSM-IV and DSM-5 proposed alternative model. Regression models were constructed to examine trait-disorder relationships, and the incremental validity of core personality dysfunctions (i.e. criterion A features for each disorder) was examined in combination with the specified trait clusters. RESULTS Findings suggested that the trait assignments specified by the Work Group tended to be substantially associated with corresponding DSM-IV concepts, and the criterion A features provided additional diagnostic information in all but one instance. CONCLUSIONS Although the DSM-5 section III alternative model provided a substantially different taxonomic structure for personality disorders, the associations between this new approach and the traditional personality disorder concepts in DSM-5 section II make it possible to render traditional personality disorder concepts using alternative model traits in combination with core impairments in personality functioning.
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Affiliation(s)
- L C Morey
- Department of Psychology,Texas A&M University,College Station,TX,USA
| | - K T Benson
- Department of Psychology,Texas A&M University,College Station,TX,USA
| | - A E Skodol
- Department of Psychiatry,University of Arizona College of Medicine,Phoenix,AZ,USA
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27
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Keuroghlian AS, Gunderson JG, Pagano ME, Markowitz JC, Ansell EB, Shea MT, Morey LC, Sanislow C, Grilo CM, Stout RL, Zanarini MC, McGlashan TH, Skodol AE. Interactions of borderline personality disorder and anxiety disorders over 10 years. J Clin Psychiatry 2015; 76:1529-34. [PMID: 26114336 DOI: 10.4088/jcp.14m09748] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 02/11/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This report examines the relationship of DSM-IV borderline personality disorder (BPD) to anxiety disorders using data on the reciprocal effects of improvement or worsening of BPD and anxiety disorders over the course of 10 years. METHOD We reliably and prospectively assessed borderline patients (n = 164) with DSM-IV-defined co-occurring generalized anxiety disorder (GAD; n = 42), panic disorder with agoraphobia (n = 39), panic disorder without agoraphobia (n= 36), social phobia (n = 48), obsessive-compulsive disorder (OCD; n = 36), and posttraumatic stress disorder (PTSD; n = 88) annually over a period of 10 years between 1997 and 2009. We used proportional hazards regression analyses to assess the effects of monthly improvement or worsening of BPD and anxiety disorders on each other's remission and relapse the following month. RESULTS BPD improvement significantly predicted remission of GAD (hazard ratio [HR] = 0.65, P <.05) and PTSD (HR = 0.57, P < .05), whereas BPD worsening significantly predicted social phobia relapse (HR = 1.87, P < .05). The course of anxiety disorders did not predict BPD remission or relapse, except that worsening PTSD significantly predicted BPD relapse (HR = 1.90, P < .05). CONCLUSION BPD negatively affects the course of GAD, social phobia, and PTSD. In contrast, the anxiety disorders, aside from PTSD, had little effect on BPD course. For GAD and social phobia, whose course BPD unidirectionally influences, we suggest prioritizing treatment for BPD, whereas BPD should be treated concurrently with panic disorders, OCD, or PTSD. We discuss state/trait issues in the context of our findings.
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28
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Morey LC, Skodol AE, Oldham JM. Clinician judgments of clinical utility: A comparison of DSM-IV-TR personality disorders and the alternative model for DSM-5 personality disorders. J Abnorm Psychol 2015; 123:398-405. [PMID: 24886013 DOI: 10.1037/a0036481] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study compared the perceived clinical utility of DSM-IV-TR personality disorder diagnoses (retained in DSM-5) with the alternative model presented in DSM-5 Section III, using a national sample of clinicians applying both systems to their own patients. A sample of 337 mental health clinicians (26% psychiatrists, 63% psychologists, and 11% other professional disciplines) provided a complete assessment of all personality disorder features listed in DSM-IV-TR and DSM-5 Section III. After applying each diagnostic model, clinicians evaluated the clinical utility of that model with respect to communication with patients and with other professionals, comprehensiveness, descriptiveness, ease of use, and utility for treatment planning. These perceptions were compared across DSM-IV-TR and the 3 components of the DSM-5 Section III model, and between psychiatrists and nonpsychiatrists. Although DSM-IV-TR was seen as easy to use and useful for professional communication, in every other respect the DSM-5 Section III model was viewed as being equally or more clinically useful than DSM-IV-TR. In particular, the DSM-5 dimensional trait model was seen as more useful than DSM-IV-TR in 5 of 6 comparisons-by psychiatrists as well as other professionals. Although concerns were expressed about the clinical utility of the DSM-5 personality disorder system during its development, these criticisms were offered without data on the proposed system. The results of this study demonstrate that aside from the current familiarity of the DSM-IV-TR approach, it offers little advantage in perceived clinical utility over the DSM-5 Section III system, whereas the latter is viewed as being more useful in several respects.
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Affiliation(s)
- Andrew E Skodol
- From the Department of Psychiatry, University of Arizona College of Medicine, Tucson; the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York; the Department of Psychology, Texas A&M University, College Station; the Department of Psychiatry and Behavioral Sciences and Counseling and Psychological Services, Tulane University, New Orleans; the Menninger Clinic, Houston; and the Department of Psychiatry, Baylor College of Medicine, Houston
| | - Leslie C Morey
- From the Department of Psychiatry, University of Arizona College of Medicine, Tucson; the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York; the Department of Psychology, Texas A&M University, College Station; the Department of Psychiatry and Behavioral Sciences and Counseling and Psychological Services, Tulane University, New Orleans; the Menninger Clinic, Houston; and the Department of Psychiatry, Baylor College of Medicine, Houston
| | - Donna S Bender
- From the Department of Psychiatry, University of Arizona College of Medicine, Tucson; the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York; the Department of Psychology, Texas A&M University, College Station; the Department of Psychiatry and Behavioral Sciences and Counseling and Psychological Services, Tulane University, New Orleans; the Menninger Clinic, Houston; and the Department of Psychiatry, Baylor College of Medicine, Houston
| | - John M Oldham
- From the Department of Psychiatry, University of Arizona College of Medicine, Tucson; the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York; the Department of Psychology, Texas A&M University, College Station; the Department of Psychiatry and Behavioral Sciences and Counseling and Psychological Services, Tulane University, New Orleans; the Menninger Clinic, Houston; and the Department of Psychiatry, Baylor College of Medicine, Houston
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Abstract
An "Alternative DSM-5 Model for Personality Disorders" was published in Sect. III of DSM-5, while the identical categories and criteria from DSM-IV for the personality disorders (PDs) are in Sect. II. Given strong shifts from categorical diagnoses toward dimensional representations in psychiatry, how did the PDs end up "stuck in neutral," with the flawed DSM-IV model perpetuated? This article reviews factors that influenced the development of the new model and data to encourage and facilitate its use by clinicians. These include recognizing 1) a dimensional structure for psychopathology for which personality may be foundational; 2) a consensus on the structure of normal and abnormal personality; 3) the clinical significance of personality; 4) PD-specific severity required to establish disorder; 5) disruption, discontinuity, and perceived clinical utility of the Alternative Model may not be problems; and 6) a way forward involving collaborative research on neurobiological and psychosocial processes, treatment planning, and outcomes.
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Affiliation(s)
- Andrew E Skodol
- Department of Psychiatry, University of Arizona College of Medicine, Tucson, AZ, USA,
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Skodol AE, Geier T, Grant BF, Hasin DS. Personality disorders and the persistence of anxiety disorders in a nationally representative sample. Depress Anxiety 2014; 31:721-8. [PMID: 24995387 DOI: 10.1002/da.22287] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 05/20/2014] [Accepted: 05/27/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Among individuals with anxiety disorders, comorbid personality disorders (PDs) increase cross-sectional symptom severity and decrease functioning. Little is known, however, about how PDs influence the course of anxiety disorders over time. The purpose of this study was to examine the effect of PDs on the persistence of four anxiety disorders in a nationally representative sample in the United States. METHODS Two waves of data were collected on 34,653 participants, 3 years apart. At both waves, participants were evaluated for generalized anxiety disorder (GAD), social and specific phobias, and panic disorder. Predictors of persistence included all DSM-IV PDs. Control variables included demographics, comorbid PDs, age at onset of the anxiety disorder, number of prior episodes, duration of the current episode, treatment history, and cardinal symptoms of exclusionary diagnoses for each anxiety disorder. RESULTS Any PD, two or more PDs, borderline PD, schizotypal PD, mean number of PD criteria met, and mean number of PDs diagnosed predicted the persistence of all four anxiety disorders. Narcissistic PD predicted persistence of GAD and panic disorder. Schizoid and avoidant PDs also predicted persistence of GAD. Finally, avoidant PD predicted persistence of social phobia. Particular patterns of cross-cluster PD comorbidity were strong predictors of the persistence of individual anxiety disorders as well. CONCLUSIONS In this national sample, a variety of PDs robustly predicted the persistence of anxiety disorders over 3 years, consistent with the results of recent prospective clinical studies. Personality psychopathology should be assessed and addressed in treatment for all patients with anxiety disorders.
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Affiliation(s)
- Andrew E Skodol
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York; New York State Psychiatric Institute, New York, New York; Department of Psychiatry, University of Arizona College of Medicine, Tucson, Arizona
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Gunderson JG, Stout RL, Shea MT, Grilo CM, Markowitz JC, Morey LC, Sanislow C, Yen S, Zanarini MC, Keuroghlian AS, McGlashan TH, Skodol AE. Interactions of borderline personality disorder and mood disorders over 10 years. J Clin Psychiatry 2014; 75:829-34. [PMID: 25007118 DOI: 10.4088/jcp.13m08972] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 04/23/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To examine the relationship of borderline personality disorder (BPD) to mood disorders by using data from the Collaborative Longitudinal Personality Disorders Study on the reciprocal interactions of BPD with both depressive and bipolar disorders over the course of 10 years. METHOD The study included 223 BPD patients with DSM-IV-defined co-occurring major depressive disorder (MDD) (n = 161), bipolar I disorder (n = 34), and bipolar II disorder (n = 28) who were reliably and prospectively assessed over a period of 10 years between 1997 and 2009. Proportional hazards regression analyses were used to assess the effects of improvement or worsening of BPD and mood disorders on each disorder's time to remission and time to relapse. RESULTS Borderline personality disorder and MDD had strong and statistically significant reciprocal effects, delaying each disorder's time to remission (BPD's effect on MDD, P = .0004; MDD's effect on BPD, P = .0002) and accelerating time to relapse (BPD's effect on MDD, P = .0410; MDD's effect on BPD, P = .0011), whereas BPD and the bipolar disorders were largely independent disorders except that bipolar II lengthened BPD's time to remission (P = .0085). CONCLUSIONS Borderline personality disorder and MDD interactions suggest overlap in their psychopathologies and argue for prioritizing the treatment of BPD. Borderline personality disorder and bipolar disorders appear to be independent disorders, underscoring the need to provide appropriate treatment for each.
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Elliott JC, Stohl M, Wall MM, Keyes KM, Goodwin RD, Skodol AE, Krueger RF, Grant BF, Hasin D. The risk for persistent adult alcohol and nicotine dependence: the role of childhood maltreatment. Addiction 2014; 109:842-50. [PMID: 24401044 PMCID: PMC3984602 DOI: 10.1111/add.12477] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 08/19/2013] [Accepted: 12/31/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Alcohol and nicotine dependence are associated with considerable morbidity and mortality, especially when cases are persistent. The risk for alcohol and nicotine dependence is increased by childhood maltreatment. However, the influence of childhood maltreatment on dependence course is unknown, and is evaluated in the current study. DESIGN Physical, sexual and emotional abuse, and physical and emotional neglect, were evaluated as predictors of persistent alcohol and nicotine dependence over 3 years of follow-up, with and without control for other childhood adversities. SETTING National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). PARTICIPANTS NESARC participants completing baseline and follow-up who met criteria at baseline for past-year alcohol dependence (n = 1172) and nicotine dependence (n = 4017). MEASUREMENTS Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS) measures of alcohol/nicotine dependence, childhood maltreatment and other adverse childhood experiences (e.g. parental divorce). FINDINGS Controlling for demographics only, physical, sexual and emotional abuse and physical neglect predicted 3-year persistence of alcohol dependence [adjusted odds ratio (AOR) = 1.50-2.99; 95% CI = 1.04-4.68] and nicotine dependence (AOR = 1.37-1.74; 95% CI = 1.13-2.11). With other childhood adversities also controlled, maltreatment types remained predictive for alcohol persistence (AOR = 1.53-3.02; 95% CI = 1.07-4.71) and nicotine persistence (AOR = 1.35-1.72; 95% CI = 1.11-2.09). Further, a greater number of maltreatment types incrementally influenced persistence risk (AOR = 1.19-1.36; 95% CI = 1.11-1.56). CONCLUSIONS A history of childhood maltreatment predicts persistent adult alcohol and nicotine dependence. This association, robust to control for other childhood adversities, suggests that maltreatment (rather than a generally difficult childhood) affects the course of dependence.
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Affiliation(s)
- Jennifer C. Elliott
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Malka Stohl
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Melanie M. Wall
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA,New York State Psychiatric Institute, New York, New York, USA,Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Katherine M. Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Renee D. Goodwin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA,Department of Psychology, Queens College and The Graduate Center, City University of New York (CUNY), Queens, New York, USA
| | - Andrew E. Skodol
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA,Department of Psychiatry, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Robert F. Krueger
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Bridget F. Grant
- Laboratory of Epidemiology and Biometry, National Institute of Alcohol Abuse and Alcoholism, Rockville, Maryland, USA
| | - Deborah Hasin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA,Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA,New York State Psychiatric Institute, New York, New York, USA
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Morey LC, Krueger RF, Skodol AE. The hierarchical structure of clinician ratings of proposed DSM-5 pathological personality traits. J Abnorm Psychol 2014; 122:836-41. [PMID: 24016020 DOI: 10.1037/a0034003] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Preliminary explorations of the trait model for personality disorders provided in Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) Section III suggest that the factor structure of proposed traits includes 5 higher order factors that resemble other dimensional trait models of personality. These prior investigations have been based on self-reported data obtained from personality questionnaires, as has much of the research literature from which such trait models have evolved. However, the DSM-5 itself involves judgments made by clinicians about their patients. Thus, it is important to examine whether this factor structure identified in recent studies can also be found in clinician rating data. This study examined the hierarchical structure of the 25 proposed DSM-5 traits in patient ratings provided by a sample of 337 mental health professionals. Exploratory factor analysis revealed a hierarchical structure that resembled previously reported trait structures. As with a prior investigation by Wright et al. (2012), the various solutions estimated in the hierarchy of the DSM-5 traits resembled existing models of common mental disorders, temperament, and personality pathology.
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Skodol AE. Commentary: Assessing personality disorder in adolescents from the perspective of DSM‐5. Clinical Psychology: Science and Practice 2014. [DOI: 10.1111/cpsp.12058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Waxman R, Fenton MC, Skodol AE, Grant BF, Hasin D. Childhood maltreatment and personality disorders in the USA: specificity of effects and the impact of gender. Personal Ment Health 2014; 8:30-41. [PMID: 24532553 PMCID: PMC3927226 DOI: 10.1002/pmh.1239] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 04/12/2013] [Accepted: 06/18/2013] [Indexed: 11/05/2022]
Abstract
Childhood maltreatment increases the risk for adult personality disorders (PDs), but several PDs or maltreatment types co-occur. Specificity of maltreatment-personality associations is poorly understood. Using a representative US population sample, we identified specific associations between maltreatment types (sexual, physical and emotional abuse and physical and emotional neglect) and PDs after controlling for basic demographics, parental psychopathology, co-occurring maltreatment types and comorbid PD. We then examined interactions of gender and maltreatment in predicting PDs. Each maltreatment type significantly predicted three-four PDs. Borderline and schizotypal PDs were most strongly predicted by sexual abuse, antisocial by physical abuse and avoidant and schizoid by emotional neglect. Specific vulnerabilities differ by gender; maltreated boys may respond with attention seeking and girls with social withdrawal. Findings highlight the importance of evaluating all forms of maltreatment even when they co-occur and can inform development of interventions to prevent personality pathology in at-risk children.
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Affiliation(s)
- Rachel Waxman
- New York State Psychiatric Institute, New York, NY, 10032, USA
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Walsh Z, Shea MT, Yen S, Ansell EB, Grilo CM, McGlashan TH, Stout RL, Bender DS, Skodol AE, Sanislow CA, Morey LC, Gunderson JG. Socioeconomic-status and mental health in a personality disorder sample: the importance of neighborhood factors. J Pers Disord 2013; 27:820-31. [PMID: 22984860 PMCID: PMC4628287 DOI: 10.1521/pedi_2012_26_061] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This cross-sectional study examined the associations between neighborhood-level socioeconomic-status (NSES), and psychosocial functioning and personality pathology among 335 adults drawn from the Collaborative Longitudinal Personality Disorders Study. Participants belonged to four personality disorder (PD) diagnostic groups: Avoidant, Borderline, Schizotypal, and Obsessive Compulsive. Global functioning, social adjustment, and PD symptoms were assessed following a minimum two-year period of residential stability. Residence in higherrisk neighborhoods was associated with more PD symptoms and lower levels of functioning and social adjustment. These relationships were consistent after controlling for individual-level socioeconomic-status and ethnicity; however, the positive association between neighborhood-level socio-economic risk and PD symptoms was evident only at higher levels of individual-level socio-economic risk. Our findings identify NSES as a candidate for explaining some of the variability in symptoms and functioning among PD individuals.
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Affiliation(s)
- Zach Walsh
- Centre for the Advancement of Psychological Science and Law, University of British Columbia
| | - M. Tracie Shea
- Department of Veterans Affairs and Brown University Alpert Medical School
| | | | | | | | | | | | - Donna S. Bender
- Institute for Mental Health Research and Columbia University
| | - Andrew E. Skodol
- The Sunbelt Collaborative, Tucson, Arizona, and University of Arizona College of Medicine
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Zimmermann J, Benecke C, Bender DS, Skodol AE, Schauenburg H, Cierpka M, Leising D. AssessingDSM–5Level of Personality Functioning From Videotaped Clinical Interviews: A Pilot Study With Untrained and Clinically Inexperienced Students. J Pers Assess 2013; 96:397-409. [DOI: 10.1080/00223891.2013.852563] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Thomas KM, Hopwood CJ, Donnellan MB, Wright AGC, Sanislow CA, McDevitt-Murphy ME, Ansell EB, Grilo CM, McGlashan TH, Shea MT, Markowitz JC, Skodol AE, Zanarini MC, Morey LC. Personality heterogeneity in PTSD: distinct temperament and interpersonal typologies. Psychol Assess 2013; 26:23-34. [PMID: 24015858 DOI: 10.1037/a0034318] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Researchers examining personality typologies of posttraumatic stress disorder (PTSD) have consistently identified 3 groups: low pathology, internalizing, and externalizing. These groups have been found to predict functional severity and psychiatric comorbidity. In this study, we employed Latent Profile Analysis to compare this previously established typology, grounded in temperament traits (negative emotionality; positive emotionality; constraint), to a novel typology rooted in interpersonal traits (dominance; warmth) in a sample of individuals with PTSD (n = 155). Using Schedule for Nonadaptive and Adaptive Personality (SNAP) traits to create latent profiles, the 3-group temperament model was replicated. Using Interpersonal Circumplex (IPC) traits to create latent profiles, we identified a 4-group solution with groups varying in interpersonal style. These models were nonredundant, indicating that the depiction of personality variability in PTSD depends on how personality is assessed. Whereas the temperament model was more effective for distinguishing individuals based on distress and comorbid disorders, the interpersonal model was more effective for predicting the chronicity of PTSD over the 10 year course of the study. We discuss the potential for integrating these complementary temperament and interpersonal typologies in the clinical assessment of PTSD.
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Affiliation(s)
| | | | | | | | | | | | - Emily B Ansell
- Department of Psychiatry, Yale University School of Medicine
| | - Carlos M Grilo
- Department of Psychiatry, Yale University School of Medicine
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Skodol AE, Krueger RF. Can the classification of personality disorders be based on behavior genetics? A comment on South and DeYoung (2013). Personal Disord 2013; 4:286-8. [PMID: 23914995 DOI: 10.1037/per0000003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Comments on the article by S. C. South and N. J. DeYoung (see record 2012-01744-001). This commentary examines how behavior genetic research can be used to inform the revision of personality disorders (PDs) during the transition from DSM-IV to DSM-5. Although supportive of the proposal put forth by the work group that extreme personality traits need to be distinguished from personality disorder by the presence of disorganization in personality structure and function, South and DeYoung note the absence of behavior genetics data on the levels of personality functioning and the new general criteria for personality disorder that incorporate impairment in personality functioning as the "A criterion." They also note, however, that literature supporting this type of definition with its focus on aspects of self-concept and interpersonal relations is rapidly growing.
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Affiliation(s)
- Andrew E Skodol
- Department of Psychiatry, University of Arizona College of Medicine, Phoenix, AZ 85016, USA.
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Affiliation(s)
- John M Oldham
- The Menninger Clinic, Houston, TX; Baylor College of Medicine, Houston, TX.
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Abstract
BACKGROUND Dimensional models of co-morbidity have the potential to improve the conceptualization of mental disorders in research and clinical work, yet little is known about how relatively uncommon disorders may fit with more common disorders. The present study estimated the meta-structure of psychopathology in the US general population focusing on the placement of five under-studied disorders sharing features of thought disorder: paranoid, schizoid, avoidant and schizotypal personality disorders, and manic episodes as well as bipolar disorder. METHOD Data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions, a face-to-face interview of 34 653 non-institutionalized adults in the US general population. The meta-structure of 16 DSM-IV Axis I and Axis II psychiatric disorders, as assessed by the Alcohol Use Disorder and Associated Disabilities Interview Schedule DSM-IV version (AUDADIS-IV), was examined using exploratory and confirmatory factor analysis. RESULTS We document an empirically derived thought disorder factor that is a subdomain of the internalizing dimension, characterized by schizoid, paranoid, schizotypal and avoidant personality disorders as well as manic episodes. Manic episodes exhibit notable associations with both the distress subdomain of the internalizing dimension as well as the thought disorder subdomain. The structure was replicated for bipolar disorder (I or II) in place of manic episodes. CONCLUSIONS As our understanding of psychopathological meta-structure expands, incorporation of disorders characterized by detachment and psychoticism grows increasingly important. Disorders characterized by detachment and psychoticism may be well conceptualized, organized and measured as a subdimension of the internalizing spectrum of disorders. Manic episodes and bipolar disorder exhibit substantial co-morbidity across both distress and thought disorder domains of the internalizing dimension. Clinically, these results underscore the potential utility of conceptualizing patient treatment needs using an approach targeting psychopathological systems underlying meta-structural classification rubrics.
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Affiliation(s)
- K M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
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Samuel DB, Sanislow CA, Hopwood CJ, Shea MT, Skodol AE, Morey LC, Ansell EB, Markowitz JC, Zanarini MC, Grilo CM. Convergent and incremental predictive validity of clinician, self-report, and structured interview diagnoses for personality disorders over 5 years. J Consult Clin Psychol 2013; 81:650-659. [PMID: 23647282 PMCID: PMC4030440 DOI: 10.1037/a0032813] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Research has demonstrated poor agreement between clinician-assigned personality disorder (PD) diagnoses and those generated by self-report questionnaires and semistructured diagnostic interviews. No research has compared prospectively the predictive validity of these methods. We investigated the convergence of these 3 diagnostic methods and tested their relative and incremental validity in predicting independent, multimethod assessments of psychosocial functioning performed prospectively over 5 years. METHOD Participants were 320 patients in the Collaborative Longitudinal Personality Disorders Study diagnosed with PDs by therapist, self-report, and semistructured interview at baseline. We examined the relative incremental validity of therapists' naturalistic ratings relative to these other diagnostic methods for predicting psychosocial functioning at 5-year follow-up. RESULTS Hierarchical linear regression analyses revealed that both the self-report questionnaire and semistructured interview PD diagnoses had significant incremental predictive validity over the PD diagnoses assigned by a treating clinician. Although, in some cases, the clinicians' ratings for individual PDs did have validity for predicting subsequent functioning, they did not generally provide incremental prediction beyond the other methods. These findings remained robust in a series of analyses restricted to a subsample of therapist ratings based on clinical contact of 1 year or greater. CONCLUSIONS These results from a large clinical sample echo previous research documenting limited agreement between clinicians' naturalistic PD diagnoses and those from self-report and semistructured interview methods. They extend prior work by providing the first evidence about the relative predictive validity of these different methods. Our findings challenge the validity of naturalistic PD diagnoses and suggest the use of structured diagnostic instruments.
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Abstract
The criteria for personality disorders in Section II of DSM-5 have not changed from those in DSM-IV. Therefore, the diagnosis of Section II narcissistic personality disorder (NPD) will perpetuate all of the well-enumerated shortcomings associated with the diagnosis since DSM-III. In this article, we will briefly review problems associated with Section II NPD and then discuss the evolution of a new model of personality disorder and the place in the model of pathological narcissism and NPD. The new model was intended to be the official approach to the diagnosis of personality pathology in DSM-5, but was ultimately placed as an alternative in Section III for further study. The new model is a categorical-dimensional hybrid based on the assessment of core elements of personality functioning and of pathological personality traits. The specific criteria for NPD were intended to rectify some of the shortcomings of the DSM-IV representation by acknowledging both grandiose and vulnerable aspects, overt and covert presentations, and the dimensionality of narcissism. In addition, criteria were assigned and diagnostic thresholds set based on empirical data. The Section III representation of narcissistic phenomena using dimensions of self and interpersonal functioning and relevant traits offers a significant improvement over Section II NPD.
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Affiliation(s)
- Andrew E Skodol
- Department of Psychiatry, University of Arizona College of Medicine
| | - Donna S Bender
- Department of Psychiatry, University of Arizona College of Medicine
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Hopwood CJ, Donnellan MB, Ackerman RA, Thomas KM, Morey LC, Skodol AE. The Validity of the Personality Diagnostic Questionnaire–4 Narcissistic Personality Disorder Scale for Assessing Pathological Grandiosity. J Pers Assess 2013; 95:274-83. [DOI: 10.1080/00223891.2012.732637] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Alegria AA, Blanco C, Petry NM, Skodol AE, Liu SM, Grant B, Hasin D. Sex differences in antisocial personality disorder: results from the National Epidemiological Survey on Alcohol and Related Conditions. Personal Disord 2013; 4:214-22. [PMID: 23544428 DOI: 10.1037/a0031681] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite the 3:1 prevalence ratio of men versus women with Antisocial Personality Disorder (ASPD), research on sex differences on correlates of ASPD in the general population is scarce. The purpose of this study was to examine sex differences in childhood and adult adverse events, lifetime psychiatric comorbidity, and clinical correlates of DSM-IV ASPD. The sample included 819 men and 407 women with DSM-IV ASPD diagnosis. Data were derived from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) (N = 43,093). Compared to men, women with ASPD reported more frequent childhood emotional neglect (AOR = 2.25; 95% CI: 1.52-3.34) and sexual abuse (AOR = 4.20; 95% CI: 2.78-6.35), any parent-related adverse event during childhood (e.g., parental substance use disorder) (AOR = 2.47; 95% CI: 1.60-3.82), and adverse events during adulthood (AOR = 4.20; 95% CI: 2.78-6.35). Although women with ASPD present less violent antisocial behaviors and higher rates of aggressiveness and irritability (OR = 0.46; 95% CI: 0.31-0.67), they have higher rates of victimization, greater impairment, and lower social support. Our findings suggest increased mental health needs in women with ASPD, meriting development of different treatment programs for women and men.
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Boisseau CL, Yen S, Markowitz JC, Grilo CM, Sanislow CA, Shea MT, Zanarini MC, Skodol AE, Gunderson JG, Morey LC, McGlashan TH. Individuals with single versus multiple suicide attempts over 10years of prospective follow-up. Compr Psychiatry 2013; 54:238-42. [PMID: 22995448 PMCID: PMC3541431 DOI: 10.1016/j.comppsych.2012.07.062] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 07/13/2012] [Accepted: 07/23/2012] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND The study attempted to identify characteristics that differentiate multiple suicide attempters from single attempters in individuals with personality disorders (PDs) and/or major depression. METHOD Participants were 431 participants enrolled in the Collaborative Longitudinal Study of Personality Disorders from July 1996 to June 2008. Suicide attempts were assessed with the Longitudinal Interval Follow-up Evaluation at 6 and 12months, then yearly through 10years. Logistic regression was used to compare single attempters to multiple attempters on Axis I and II psychiatric disorders and personality trait variables. RESULTS Twenty-one percent of participants attempted suicide during the 10years of observation, with 39 (9.0%) reporting a single suicide attempt and 54 (12.5%) reporting multiple suicide attempts. Although no significant differences in were found in baseline Axis I disorders, multiple attempters were significantly more likely to meet criteria for borderline personality disorder and to have higher impulsivity scores than single attempters. CONCLUSION These results underscore the importance of considering both personality disorders and traits in the assessment of suicidality.
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Affiliation(s)
- Christina L. Boisseau
- Department of Psychiatry and Human Behavior, Warren Alpert Brown Medical School, Providence, Rhode Island,Butler Hospital, Providence, Rhode Island
| | - Shirley Yen
- Department of Psychiatry and Human Behavior, Warren Alpert Brown Medical School, Providence, Rhode Island
| | - John C. Markowitz
- New York State Psychiatric Institute, College of Physicians and Surgeons, Columbia University
| | | | | | - M. Tracie Shea
- Department of Psychiatry and Human Behavior, Warren Alpert Brown Medical School, Providence, Rhode Island,Veterans Affairs Medical Center, Providence, Rhode Island
| | - Mary C. Zanarini
- Department of Psychiatry, McLean Hospital and Harvard Medical School, Belmont, Massachusetts
| | - Andrew E. Skodol
- Sunbelt Collaborative and the University of Arizona College of Medicine, Tucson
| | - John G. Gunderson
- Department of Psychiatry, McLean Hospital and Harvard Medical School, Belmont, Massachusetts
| | - Leslie C. Morey
- Department of Psychology, Texas A&M University, College Station
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Hopwood CJ, Morey LC, Donnellan MB, Samuel DB, Grilo CM, McGlashan TH, Shea MT, Zanarini MC, Gunderson JG, Skodol AE. Ten-year rank-order stability of personality traits and disorders in a clinical sample. J Pers 2013; 81:335-44. [PMID: 22812532 DOI: 10.1111/j.1467-6494.2012.00801.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study compares the 10-year retest stability of normal traits, pathological traits, and personality disorder dimensions in a clinical sample. METHOD Ten-year rank-order stability estimates for the Revised NEO Personality Inventory, Schedule for Nonadaptive and Adaptive Personality, and Diagnostic Interview for DSM-IV Personality Disorders were evaluated before and after correcting for test-retest dependability and internal consistency in a clinical sample (N = 266). RESULTS Dependability-corrected stability estimates were generally in the range of.60-.90 for traits and.25-.65 for personality disorders. CONCLUSIONS The relatively lower stability of personality disorder symptoms may indicate important differences between pathological behaviors and relatively more stable self-attributed traits and imply that a full understanding of personality and personality pathology needs to take both traits and symptoms into account. The five-factor theory distinction between basic tendencies and characteristic adaptations provides a theoretical framework for the separation of traits and disorders in terms of stability in which traits reflect basic tendencies that are stable and pervasive across situations, whereas personality disorder symptoms reflect characteristic maladaptations that are a function of both basic tendencies and environmental dynamics.
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Affiliation(s)
- Christopher J Hopwood
- Psychology Department, Michigan State University Psychological Clinic, Psychology Building, 316 Physics-Room 107A, East Lansing, MI 48824, USA.
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Skodol AE, Krueger RF, Bender DS, Morey LC, Clark LA, Bell CC, Alarcon RD, Siever LJ, Oldham JM. Personality Disorders in DSM-5 Section III. FOC 2013. [DOI: 10.1176/appi.focus.11.2.187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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