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Abstract
This review of the descriptive literature on borderline patients indicates that accounts of such patients vary depending upon who is describing them, in what context, how the samples are selected, and what data are collected. The authors identify six features that provide a rational means for diagnosing borderline patients during an initial interview: the presence of intense affect, usually depressive or hostile; a history of impulsive behavior; a certain social adaptiveness; brief psychotic experiences; loose thinking in unstructured situations; and relationships that vacillate between transient superficiality and intense dependency. Reliable identification of these patients will permit better treatment planning and clinical research. Reprinted from Am J Psychiatry 1975; 132:1-10, with permission from American Psychiatric Association Publishing. Copyright © 1975.
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Attitudes of Mental Health Staff Toward Patients With Borderline Personality Disorder: An Italian Cross-Sectional Multisite Study. J Pers Disord 2021; 35:41-56. [PMID: 30785861 DOI: 10.1521/pedi_2019_33_421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Negative attitudes toward borderline personality disorder (BPD) can present a barrier to those seeking care. We explored caring attitudes toward BPD among 860 mental health professionals, including psychiatrists, psychologists, social health educators, nurses, and social workers. The results showed that social workers and nurses scored significantly lower on caring attitudes than psychiatrists, social health educators, and psychologists. Our analysis showed that the more BPD patients treated in the past year, more years of experience in mental health, and having prior BPD training were positively associated with caring attitudes scores. For all professional subgroups, except for social health educators, the caring attitudes score is higher in those who have had prior BPD training, and for professionals with low and medium level of experience in mental health. This result shows that training on BPD should target less experienced clinicians and those professional groups who had less opportunity to receive such education.
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A Clinical Trial of a Psychoeducation Group Intervention for Patients With Borderline Personality Disorder. J Clin Psychiatry 2019; 81. [PMID: 31917907 DOI: 10.4088/jcp.19m12753] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 04/01/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The objective of this study was to assess the impact of a 6-session psychoeducational group (PEG) intervention for borderline personality disorder (BPD) in an underserved community-based outpatient setting. METHODS The study was conducted between July 2015 and January 2017. Of 96 outpatients who met DSM-IV criteria for BPD, the first 48 received the experimental treatment, whereas the next 48 were assigned to a wait list. All received non-intensive treatment as usual. The primary outcome measure, the Zanarini Rating Scale for DSM-IV Borderline Personality Disorder (ZAN-BPD), was administered at baseline, at the end of treatment, and 2 months after the end of treatment. RESULTS The PEG intervention was associated with a significant improvement on all sectors of BPD (P < .001). Improvements were greater for the PEG on all sectors except impulsivity. Benefits remained stable during 2-month follow-up. The PEG intervention had a large effect size (Cohen d = -1.16), whereas the wait list effect size was small (Cohen d = -0.18). The between-arms effect size was 0.80 after treatment and 0.90 at follow-up. With full response defined as a decrease of ≥ 50% from baseline in ZAN-BPD total score, 22 patients (46%) in the psychoeducation group and 3 (6%) in the wait list group were considered full responders. CONCLUSIONS This study shows that a PEG intervention can be an effective treatment for patients with BPD. The overall cost benefits of group interventions and the the applicability of a PEG intervention to underserved patients demonstrate its potential to address significant public health needs.
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Abstract
The authors review four theories that propose different conceptualizations of borderline personality disorder's (BPD) core psychopathology: excess aggression, emotional dysregulation, failed mentalization, and interpersonal hypersensitivity. The theories are compared in their ability to explain BPD's coaggregation of four usually distinct sectors of psychopathology, their high overlap with other disorders, their ability to distinguish BPD from other disorders, their integration of heritability, and their clinical applicability. The aims of this review are to increase awareness of these theories, to stimulate improved theories, and to f ster testable hypotheses so that research can advance our knowledge about BPD's core.
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Abstract
Ueli Kramer has assembled an eclectic and original set of articles on mechanisms of change in the treatment of borderline personality disorder. They largely focus on patient variables. Several authors make the point that developmentally based variables may have more predictive power than symptom-based variables. Several other articles illustrate that changes occur early in treatments and studying their mechanisms is a promising approach that could have longer term significance. These articles document the variety of research methodologies that can be used to study mechanisms of change and the potential clinical significance of doing this. For showing the field the potential of such research, we owe Dr. Kramer our gratitude.
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Functional outcomes in community-based adults with borderline personality disorder. J Psychiatr Res 2017; 89:105-114. [PMID: 28213169 PMCID: PMC5483330 DOI: 10.1016/j.jpsychires.2017.01.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 11/21/2016] [Accepted: 01/19/2017] [Indexed: 12/13/2022]
Abstract
Many individuals in clinical samples with borderline personality disorder (BPD) experience high levels of functional impairment. However, little is known about the levels of functional impairment experienced by individuals with BPD in the general community. To address this issue, we compared overall and domain-specific (educational/occupational; social; recreational) functioning in a sample of community-based individuals with BPD (n = 164); community-based individuals without BPD (n = 901); and clinically-ascertained individuals with BPD (n = 61). BPD diagnoses and functional outcomes were based on well-accepted, semi-structured interviews. Community-based individuals with BPD were significantly less likely to experience good overall functioning (steady, consistent employment and ≥1 good relationship) compared to community-based individuals without BPD (BPD: 47.4%; Non- BPD: 74.5%; risk difference -27.1%; p < 0.001), even when compared directly to their own non-BPD siblings (risk difference -35.5%; p < 0.001). Community-based individuals with BPD versus those without BPD did not differ significantly on most domain-specific outcomes, but the former group experienced poorer educational/occupational performance and lower quality relationships with parents, partners, and friends. However, community-based individuals with BPD were significantly more likely to experience good overall functioning than clinically-based individuals with BPD (risk difference -35.2%; p < 0.001), with the latter group more likely to experience reduced employment status, very poor quality relationships with partners, and social isolation. In conclusion, community-based individuals with BPD experienced marked functional impairment, especially in the social domain, but were less likely to experience the more extreme occupational and social impairments seen among patients with BPD.
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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] [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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The Effect of Attending Good Psychiatric Management (GPM) Workshops on Attitudes Toward Patients With Borderline Personality Disorder. J Pers Disord 2016; 30:567-76. [PMID: 26111249 PMCID: PMC4691210 DOI: 10.1521/pedi_2015_29_206] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The effect that attending a 1-day workshop on Good Psychiatric Management (GPM) had on attitudes about borderline personality disorder (BPD) was assessed among 297 clinicians. Change was recorded by comparing before and after scores on a 9-item survey previously developed to assess the effects of workshops on Systems Training for Emotional Predictability and Problem Solving (STEPPS). Participants reported decreased inclination to avoid borderline patients, dislike of borderline patients, and belief that BPD's prognosis is hopeless, as well as increased feeling of competence, belief that borderline patients have low self-esteem, feeling of being able to make a positive difference, and belief that effective psychotherapies exist. Less clinical experience was related to an increased feeling of competence and belief that borderline patients have low self-esteem. These findings were compared to those from the STEPPS workshop. This assessment demonstrates GPM's potential for training clinicians to meet population-wide needs related to borderline personality disorder.
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The Emergence of a Generalist Model to Meet Public Health Needs for Patients With Borderline Personality Disorder. Am J Psychiatry 2016; 173:452-8. [PMID: 27133405 DOI: 10.1176/appi.ajp.2015.15070885] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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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] [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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Abstract
General psychiatric management for patients with borderline personality disorder was devised to be an outpatient intervention that could be readily learned and easily delivered by independent community mental health professionals. To disseminate the approach, Drs. Gunderson and Links developed the Handbook of Good Psychiatric Management for Borderline Personality Disorder (Gunderson & Links, ) that presented the basics of the approach, videos to illustrate the appropriate clinical skills, and case examples to practice adherence to the approach. Unfortunately, the inclusion of "psychiatric" in the treatment's name may discourage psychologists and other mental health professionals from using this therapy. In this article, we review the basic principles and approaches related to general psychiatric management. With a case example, we illustrate how psychologists can use all the general psychiatric management principles for their patients with BPD, except medications and, as a result, provide and deliver this approach effectively.
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Abstract
BACKGROUND Individuals with borderline personality disorder (BPD) frequently display co-morbid mental disorders. These disorders include 'internalizing' disorders (such as major depressive disorder and anxiety disorders) and 'externalizing' disorders (such as substance use disorders and antisocial personality disorder). It is hypothesized that these disorders may arise from latent 'internalizing' and 'externalizing' liability factors. Factor analytic studies suggest that internalizing and externalizing factors both contribute to BPD, but the extent to which such contributions are familial is unknown. METHOD Participants were 368 probands (132 with BPD; 134 without BPD; and 102 with major depressive disorder) and 885 siblings and parents of probands. Participants were administered the Diagnostic Interview for DSM-IV Personality Disorders, the Revised Diagnostic Interview for Borderlines, and the Structured Clinical Interview for DSM-IV. RESULTS On confirmatory factor analysis of within-person associations of disorders, BPD loaded moderately on internalizing (factor loading 0.53, S.E. = 0.10, p < 0.001) and externalizing latent variables (0.48, S.E. = 0.10, p < 0.001). Within-family associations were assessed using structural equation models of familial and non-familial factors for BPD, internalizing disorders, and externalizing disorders. In a Cholesky decomposition model, 84% (S.E. = 17%, p < 0.001) of the association of BPD with internalizing and externalizing factors was accounted for by familial contributions. CONCLUSIONS Familial internalizing and externalizing liability factors are both associated with, and therefore may mutually contribute to, BPD. These familial contributions account largely for the pattern of co-morbidity between BPD and internalizing and externalizing disorders.
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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] [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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Abstract
Borderline personality disorder (BPD) and its core Diagnostic and Statistical Manual of Mental Disorders (DSM) factor-analytically derived phenotypes aggregate in families. To potentially inform future conceptualizations of BPD, this study examined the familial aggregation and co-aggregation with BPD of 3 additional candidate phenotypes for BPD psychopathology: anxiousness, aggressiveness, and cognitive dysregulation. Participants included 347 probands (126 with BPD, 128 without BPD, and 93 with major depressive disorder) and 814 parents and siblings of probands. All participants completed diagnostic assessments and scales assessing the candidate phenotypes. The familial aggregation of phenotypes (correlation of level of phenotype between family members), the familial co-aggregation of phenotypes with BPD (correlation of phenotype with BPD between family members), and the within-individual correlation of phenotypes with BPD were assessed. All 3 candidate phenotypes showed high levels of familial aggregation (rs = .14 - .53, ps < .001), the magnitudes of which were comparable with DSM-based core sectors of psychopathology. Anxiousness and cognitive dysregulation showed strong within-individual associations with BPD (rs = .55 and .46, respectively; ps < .001) and substantial familial co-aggregation with BPD (rs = .12 and .13, respectively; ps ≤ .002). In contrast, aggressiveness showed a weak within-individual association with BPD (r = .11, p = .12) and little familial co-aggregation with BPD (r = .05, p = .21). These findings suggest that anxiousness and cognitive dysregulation are promising phenotypes for BPD psychopathology that move beyond factor-analytically based conceptualizations. In contrast, aggressiveness was only weakly related to BPD, suggesting that this phenotype may not represent an essential feature of this disorder.
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Approaches to psychotherapy for borderline personality: Demonstrations by four master clinicians. ACTA ACUST UNITED AC 2014; 5:108-16. [DOI: 10.1037/per0000055] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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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] [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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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] [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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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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Seeking clarity for future revisions of the personality disorders in DSM-5. ACTA ACUST UNITED AC 2013; 4:368-76. [DOI: 10.1037/per0000026] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Commentary on "Personality traits and the classification of mental disorders: toward a more complete integration in DSM-5 and an empirical model of psychopathology". Personal Disord 2012; 1:119-22. [PMID: 22448622 DOI: 10.1037/a0019974] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This article develops the larger theme that the fundamental quantitatively developed architecture of personality provides a sound base for classifying all areas of psychopathology and, more specifically, should underlie the current effort to revise the classification of personality disorders (PDs) in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). My commentary is organized around what I perceive to be four significant problems with the proposed change to a trait-based system: (1) unfamiliarity to clinicians (and possibly unfeasibility), (2) lack of clinical utility, (3) the preliminary quality of the science upon which the proposed change is based, and (4) harmful effects on the diagnosis of borderline personality disorder (BPD).
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Abstract
BACKGROUND Several conceptual models have been considered for the assessment of personality pathology in DSM-5. This study sought to extend our previous findings to compare the long-term predictive validity of three such models: the five-factor model (FFM), the schedule for nonadaptive and adaptive personality (SNAP), and DSM-IV personality disorders (PDs). METHOD An inception cohort from the Collaborative Longitudinal Personality Disorder Study (CLPS) was followed for 10 years. Baseline data were used to predict long-term outcomes, including functioning, Axis I psychopathology, and medication use. RESULTS Each model was significantly valid, predicting a host of important clinical outcomes. Lower-order elements of the FFM system were not more valid than higher-order factors, and DSM-IV diagnostic categories were less valid than dimensional symptom counts. Approaches that integrate normative traits and personality pathology proved to be most predictive, as the SNAP, a system that integrates normal and pathological traits, generally showed the largest validity coefficients overall, and the DSM-IV PD syndromes and FFM traits tended to provide substantial incremental information relative to one another. CONCLUSIONS DSM-5 PD assessment should involve an integration of personality traits with characteristic features of PDs.
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"Psychometric characteristics and clinical correlates of NEO-PI-R fearless dominance and impulsive antisociality in the Collaborative Longitudinal Personality Disorders Study": Correction to Witt et al. (2010). Psychol Assess 2011. [DOI: 10.1037/a0025502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Self-harm subscale of the Schedule for Nonadaptive and Adaptive Personality (SNAP): predicting suicide attempts over 8 years of follow-up. J Clin Psychiatry 2011; 72:1522-8. [PMID: 21294991 PMCID: PMC3710127 DOI: 10.4088/jcp.09m05583blu] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Accepted: 04/27/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We examined the predictive power of the self-harm subscale of the Schedule for Nonadaptive and Adaptive Personality (SNAP) to identify suicide attempters in the Collaborative Longitudinal Study of Personality Disorders (CLPS). METHOD The SNAP, a self-report personality inventory, was administered to 733 CLPS participants at baseline, of whom 701 (96%) had at least 6 months of follow-up data. Cox proportional hazards regression analyses were performed to examine the SNAP-self-harm subscale (SNAP-SH) in predicting the 129 suicide attempters over 8 years of follow-up. Possible moderators of prediction were examined, including borderline personality disorder, major depressive disorder (MDD), and substance use disorder. We also compared baseline administration of the SNAP-SH to subsequent administrations more proximal to the suicide attempt, and to a higher-order SNAP-negative temperament (SNAP-NT) subscale. Receiver operating characteristic analyses were conducted using suicide attempts (n = 58) over the first year of follow-up to provide reference points for sensitivity and specificity. RESULTS The SNAP-SH demonstrated good predictive power for suicide attempts (hazard ratio = 1.28, P < .001) and appeared relatively consistent across borderline personality disorder, MDD, and substance use disorder diagnoses. Using more proximal scores did not increase predictive power. The SNAP-SH compared favorably to the predictive power of the higher-order SNAP-NT. Receiver operating characteristic analyses indicate several cutoff scores on the SNAP-SH that yield moderate to high sensitivity and specificity for predicting suicide attempts over the first year of follow-up. CONCLUSIONS The SNAP-SH may be a useful screening instrument for risk of suicide attempts in nonpsychotic psychiatric patients.
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Pathological personality traits among patients with absent, current, and remitted substance use disorders. Addict Behav 2011; 36:1087-90. [PMID: 21782347 DOI: 10.1016/j.addbeh.2011.06.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 01/17/2011] [Accepted: 06/15/2011] [Indexed: 11/26/2022]
Abstract
Personality traits may provide underlying risk factors for and/or sequelae to substance use disorders (SUDs). In this study Schedule for Nonadaptive and Adaptive Personality (SNAP) traits were compared in a clinical sample (N=704, age 18-45) with current, past, or no historical alcohol or non-alcohol substance use disorders (AUD and NASUD) as assessed by DSM-IV semi-structured interview. Results corroborated previous research in showing associations of negative temperament and disinhibition to SUD, highlighting the importance of these traits for indicating substance use proclivity or the chronic effects of substance use. Certain traits (manipulativeness, self-harm, disinhibition, and impulsivity for AUD, and disinhibition and exhibitionism for NASUD) were higher among individuals with current relative to past diagnoses, perhaps indicating concurrent effects of substance abuse on personality. The positive temperament characteristics detachment and entitlement distinguished AUDs and NASUDs, respectively, perhaps clarifying why this higher order trait tends to show limited relations to SUD generally. These findings suggest the importance of systematically integrating pathological and normative traits in reference to substance-related diagnosis.
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Abstract
CONTEXT The familiality of borderline personality disorder (BPD) and its sectors of psychopathology are incompletely understood. OBJECTIVES To assess the familial aggregation of BPD and its 4 major sectors (affective, interpersonal, behavioral, and cognitive) and test whether the relationship of the familial and nonfamilial associations among these sectors can be accounted for by a latent BPD construct. DESIGN Family study, with direct interviews of probands and relatives. SETTING A psychiatric hospital (McLean Hospital) and the Boston-area community. PARTICIPANTS A total of 368 probands (132 with BPD, 134 without BPD, and 102 with major depressive disorder) and 885 siblings and parents of probands. MAIN ASSESSMENTS: The Diagnostic Interview for DSM-IV Personality Disorders and the Revised Diagnostic Interview for Borderlines (DIB-R) were used to assess borderline psychopathology, and the Structured Clinical Interview for DSM-IV was used to assess major depressive disorder. RESULTS Borderline personality disorder meeting both DSM-IV and DIB-R criteria showed substantial familial aggregation for BPD in individuals with a family member with BPD vs those without a family member with BPD, using proband-relative pairs (risk ratio, 2.9; 95% confidence interval, 1.5-5.5) as well as using all pairs of family members (3.9; 1.7-9.0). All 4 sectors of BPD psychopathology aggregated significantly in families, using both DSM-IV and DIB-R definitions (correlation of traits among all pairs of family members ranged from 0.07 to 0.27), with the affective and interpersonal sectors showing the highest levels; however, the level of familial aggregation of BPD was higher than that of the individual sectors. The relationship among the sectors was best explained by a common pathway model in which the sectors represent manifestations of a latent BPD construct. CONCLUSIONS Familial factors contribute to BPD and its sectors of psychopathology. Borderline personality disorder may arise from a unitary liability that finds expression in its sectors of psychopathology.
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Abstract
Despite a general consensus that dimensional models are superior to the categorical representations of personality disorders in DSM-IV, proposals for how to depict personality pathology dimensions vary substantially. One important question involves how to separate clinical severity from the style of expression through which personality pathology manifests. This study empirically distinguished stylistic elements of personality pathology symptoms from the overall severity of personality disorder in a large, longitudinally assessed clinical sample (N = 605). Data suggest that generalized severity is the most important single predictor of current and prospective dysfunction, but that stylistic elements also indicate specific areas of difficulty. Normative personality traits tend to relate to the general propensity for personality pathology, but not stylistic elements of personality disorders. Overall, findings support a three-stage diagnostic strategy involving a global rating of personality disorder severity, ratings of parsimonious and discriminant valid stylistic elements of personality disorder, and ratings of normative personality traits.
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Abstract
BACKGROUND This study prospectively examined the natural clinical course of six anxiety disorders over 7 years of follow-up in individuals with personality disorders (PDs) and/or major depressive disorder. Rates of remission, relapse, new episode onset and chronicity of anxiety disorders were examined for specific associations with PDs. METHOD Participants were 499 patients with anxiety disorders in the Collaborative Longitudinal Personality Disorders Study, who were assessed with structured interviews for psychiatric disorders at yearly intervals throughout 7 years of follow-up. These data were used to determine probabilities of changes in disorder status for social phobia (SP), generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), panic disorder and panic disorder with agoraphobia. RESULTS Estimated remission rates for anxiety disorders in this study group ranged from 73% to 94%. For those patients who remitted from an anxiety disorder, relapse rates ranged from 34% to 67%. Rates for new episode onsets of anxiety disorders ranged from 3% to 17%. Specific PDs demonstrated associations with remission, relapse, new episode onsets and chronicity of anxiety disorders. Associations were identified between schizotypal PD with course of SP, PTSD and GAD; avoidant PD with course of SP and OCD; obsessive-compulsive PD with course of GAD, OCD, and agoraphobia; and borderline PD with course of OCD, GAD and panic with agoraphobia. CONCLUSIONS Findings suggest that specific PD diagnoses have negative prognostic significance for the course of anxiety disorders underscoring the importance of assessing and considering PD diagnoses in patients with anxiety disorders.
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Ten-year course of borderline personality disorder: psychopathology and function from the Collaborative Longitudinal Personality Disorders study. ACTA ACUST UNITED AC 2011; 68:827-37. [PMID: 21464343 DOI: 10.1001/archgenpsychiatry.2011.37] [Citation(s) in RCA: 439] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Borderline personality disorder (BPD) is traditionally considered chronic and intractable. OBJECTIVE To compare the course of BPD's psychopathology and social function with that of other personality disorders and with major depressive disorder (MDD) over 10 years. DESIGN A collaborative study of treatment-seeking, 18- to 45-year-old patients followed up with standardized, reliable, and repeated measures of diagnostic remission and relapse and of both global social functioning and subtypes of social functioning. SETTING Nineteen clinical settings (hospital and outpatient) in 4 northeastern US cities. PARTICIPANTS Three study groups, including 175 patients with BPD, 312 with cluster C personality disorders, and 95 with MDD but no personality disorder. MAIN OUTCOME MEASURES The Diagnostic Interview for DSM-IV Personality Disorders and its follow-along version (the Diagnostic Interview for DSM-IV Personality Disorders-Follow-Along Version) were used to diagnose personality disorders and assess changes in them. The Structured Clinical Interview for DSM-IV Axis I Disorders and the Longitudinal Interval Follow-up Evaluation were used to diagnose MDD and assess changes in MDD and in social function. RESULTS Eighty-five percent of patients with BPD remitted. Remission of BPD was slower than for MDD (P < .001) and minimally slower than for other personality disorders (P < .03). Twelve percent of patients with BPD relapsed, a rate less frequent and slower than for patients with MDD (P < .001) and other personality disorders (P = .008). All BPD criteria declined at similar rates. Social function scores showed severe impairment with only modest albeit statistically significant improvement; patients with BPD remained persistently more dysfunctional than the other 2 groups (P < .001). Reductions in criteria predicted subsequent improvements in DSM-IV Axis V Global Assessment of Functioning scores (P < .001). CONCLUSIONS The 10-year course of BPD is characterized by high rates of remission, low rates of relapse, and severe and persistent impairment in social functioning. These results inform expectations of patients, families, and clinicians and document the severe public health burden of this disorder.
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Psychometric characteristics and clinical correlates of NEO-PI-R fearless dominance and impulsive antisociality in the Collaborative Longitudinal Personality Disorders Study. Psychol Assess 2011; 22:559-68. [PMID: 20822268 DOI: 10.1037/a0019617] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study evaluates the validity of derived measures of the psychopathic personality traits of Fearless Dominance and Impulsive Antisociality from the NEO Personality Inventory-Revised (NEO-PI-R; Costa & McCrae, 1992) using data from the Collaborative Longitudinal Personality Disorders Study (baseline N = 733). These 3 issues were examined: (a) the stability of the measures over a 10-year interval, (b) their criterion-related validity, and (c) their incremental validity relative to an alternative NEO-PI-R profile-rating approach for assessing psychopathy. NEO-PI-R Fearless Dominance and Impulsive Antisociality scales were relatively stable across 10 years and demonstrated differential associations with measures of personality pathology and psychopathology generally consistent with past research and theoretical considerations. Moreover, these measures demonstrated an appreciable degree of incremental validity over the NEO-PI-R profile-rating approach.
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Personality disorders predict relapse after remission from an episode of major depressive disorder: a 6-year prospective study. J Clin Psychiatry 2010; 71:1629-35. [PMID: 20584514 PMCID: PMC4615714 DOI: 10.4088/jcp.08m04200gre] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Accepted: 07/10/2009] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To examine prospectively the course of major depressive disorder (MDD) and to test for the moderating effects of personality disorder (PD) comorbidity on relapse after remission from an episode of MDD. METHOD Participants were 303 patients (196 women and 107 men) with current DSM-IV-diagnosed MDD at baseline enrollment in the Collaborative Longitudinal Personality Disorders Study. Major depressive disorder and Axis I psychiatric disorders were assessed with the Structured Clinical Interview for DSM-IV, and Axis II PDs were assessed with the Diagnostic Interview for DSM-IV Personality Disorders. The course of MDD was assessed with the Longitudinal Interval Follow-up Evaluation at 6 and 12 months and then yearly through 6 years. Survival analyses were used to analyze time to remission and time to relapse. The study was conducted from July 1996 to June 2005. RESULTS Of 303 patients, 260 (86%) remitted from MDD; life table survival analyses revealed that patients with MDD who had PDs at baseline had significantly longer time to remission from MDD than patients without PDs. Among the 260 patients whose MDD remitted, 183 (70%) relapsed. Patients with MDD with PDs-specifically those with borderline and obsessive-compulsive PDs-at baseline had significantly shorter time to relapse than patients with MDD without PDs. Cox proportional hazards regression analyses revealed that the presence of PDs at baseline (hazard ratio = 1.5) and recurrent-type MDD (hazard ratio = 2.2), but not sex (hazard ratio = 1.03) or dysthymic disorder (hazard ratio = 0.97), significantly predicted time to relapse. CONCLUSIONS Personality disorders at baseline were robust predictors prospectively of accelerated relapse after remission from an episode of MDD. Personality disorders at baseline significantly moderated eventual time to relapse in MDD among patients who remitted from an episode of MDD, even when controlling for other potential negative prognostic predictors.
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Abstract
The changes in the borderline personality disorder (BPD) diagnosis proposed by the DSM-V personality disorder work group involve radical changes in format (prototype and dimensions) and descriptive characteristics (traits). Changes of this magnitude will create an unwelcome and potentially harmful discontinuity with the definition that has guided BPD research and the development of disorder-specific therapies. This paper offers an alternative proposal that was developed in collaboration with clinical and research leaders. It includes modification of existing criteria, use of a diagnostic algorithm based on phenotypes, and giving BPD a hierarchical relationship vis-à-vis other personality disorders. These changes are incremental, diminish overlap and heterogeneity, sustain clinical and research development, and will improve utilization.
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Ethnicity in trauma and psychiatric disorders: findings from the collaborative longitudinal study of personality disorders. J Clin Psychol 2010; 66:583-98. [PMID: 20455250 DOI: 10.1002/jclp.20686] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The study's aims are to explore ethnic differences in rates of adverse childhood experiences and lifetime traumatic events and in rates of psychiatric disorders for patients exposed to similar traumas. Rates of these events and rates of major depressive disorder, posttraumatic stress, substance use, and borderline personality disorders were compared among 506 non-Hispanic Whites (N-HW), 108 Latina(o)s, and 94 African Americans (AA) participating in the Collaborative Longitudinal Personality Disorder Study. We found that Whites reported higher rates of neglect than African Americans and Latina(o)s, higher rates of verbal/emotional abuse than African Americans, and higher rates of accidents and injuries/feared serious injury than Latina(o)s. African Americans had higher rates of seeing someone injured/killed than Whites. No significant interaction was observed between adverse events and ethnicity for mental disorders.
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Abstract
OBJECTIVE The authors sought to determine whether personality disorders diagnosed during a depressive episode have long-term outcomes more typical of those of other patients with personality disorders or those of patients with noncomorbid major depression. METHOD The authors used 6-year outcome data collected from the multisite Collaborative Longitudinal Personality Disorders Study (CLPS). Diagnoses and personality measures gathered from the study cohort at the index assessment using interview and self-report methods were associated with symptomatic, functional, and personality measures at 6-year follow-up. Of 668 patients initially recruited to the CLPS, 522 were followed for 6 years. All participants had either a DSM-IV diagnosis of one of four personality disorders (borderline, schizotypal, obsessive-compulsive, or avoidant) or a DSM-IV diagnosis of major depressive disorder with no accompanying personality disorder. RESULTS Six-year outcomes for patients with comorbid personality disorder and major depressive disorder at the index evaluation were similar to those of patients with pure personality disorder and significantly worse than those of patients with pure major depressive disorder. Stability estimates of personality traits were similar for personality disorder patients with and without major depressive disorder at the index evaluation. CONCLUSIONS These results suggest that personality disorder diagnoses established during depressive episodes are a valid reflection of personality pathology rather than an artifact of depressive mood.
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An experimental investigation of emotional reactivity and delayed emotional recovery in borderline personality disorder: the role of shame. Compr Psychiatry 2010; 51:275-85. [PMID: 20399337 DOI: 10.1016/j.comppsych.2009.08.005] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2009] [Revised: 07/15/2009] [Accepted: 08/05/2009] [Indexed: 10/20/2022] Open
Abstract
Despite the emphasis on emotional reactivity and delayed emotional recovery in prominent theoretical accounts of borderline personality disorder (BPD), research in this area remains limited. This study sought to extend extant research by examining emotional reactivity (and recovery following emotional arousal) to 2 laboratory stressors (one general, and the other involving negative evaluation) and exploring the impact of these stressors on subjective responding across the specific emotions of anxiety, irritability, hostility, and shame. We hypothesized that outpatients with BPD (compared to outpatients without a personality disorder; non-PD) would demonstrate heightened subjective emotional reactivity to both stressors, as well as a delayed return to baseline levels of emotional arousal. Results provide evidence for context- and emotion-specific reactivity in BPD. Specifically, BPD participants (compared to non-PD participants) evidenced heightened reactivity to the negative evaluation but not the general stressor. Furthermore, results provide support for shame-specific reactivity in BPD, with BPD participants (vs non-PD participants) evidencing a significantly different pattern of change in shame (but not in reported anxiety, irritability, or hostility) across the course of the study. Specifically, not only did BPD participants report higher levels of shame in response to the negative evaluation, their levels of shame remained elevated following this stressor (through the post-recovery period at the end of the study). Findings suggest the importance of continuing to examine emotional reactivity in BPD within specific contexts and across distinct emotions, rather than at the general trait level.
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The stability of personality traits in individuals with borderline personality disorder. JOURNAL OF ABNORMAL PSYCHOLOGY 2010; 118:806-15. [PMID: 19899850 DOI: 10.1037/a0016954] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Although stability and pervasive inflexibility are general criteria for Diagnostic and Statistical Manual of Mental Disorders, 4th edition (American Psychiatric Association, 1994) personality disorders (PDs), borderline PD (BPD) is characterized by instability in several domains, including interpersonal behavior, affect, and identity. The authors hypothesized that such inconsistencies notable in BPD may relate to instability at the level of the basic personality traits that are associated with this disorder. Five types of personality trait stability across 4 assessments over 6 years were compared for BPD patients (N = 130 at first interval) and patients with other PDs (N = 302). Structural stability did not differ across groups. Differential stability tended to be lower for 5-factor model (FFM) traits in the BPD group, with the strongest and most consistent effects observed for Neuroticism and Conscientiousness. Growth curve models suggested that these 2 traits also showed greater mean-level change, with Neuroticism declining faster and Conscientiousness increasing faster, in the BPD group. The BPD group was further characterized by greater individual-level instability for Neuroticism and Conscientiousness in these models. Finally, the BPD group was less stable in terms of the ipsative configuration of FFM facet-level profiles than was the other PD group over time. Results point to the importance of personality trait instability in characterizing BPD.
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Personality disorders and mood disorders: perspectives on diagnosis and classification from studies of longitudinal course and familial associations. J Pers Disord 2010; 24:83-108. [PMID: 20205500 PMCID: PMC6540749 DOI: 10.1521/pedi.2010.24.1.83] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The results of three rigorous studies of the naturalistic course of personality disorders indicate the following: (1) personality psychopathology improves over time at unexpectedly significant rates; (2) particular maladaptive personality traits are more stable than personality disorder diagnoses; (3) although personality psychopathology improves, residual effects are usually seen in the form of persistent functional impairment and ongoing Axis I psychopathology; and (4) improvement in personality psychopathology may eventually be associated with reduction in ongoing personal and social burden. A comparison of the longitudinal stability of personality disorders and mood disorders does not support a clear distinction between them based on differential stability of either psychopathology (at least based on remission rates) or functional impairment. Differences may yet emerge with respect to relapse rates over the longer term. Both types of disorders may share some common underlying vulnerabilities best conceptualized in term of personality traits. A group of promising, though methodologically flawed, family studies suggest familiality of at least BPD among the personality disorders and the coaggregation of BPD and depressive disorders (but not bipolar disorders) that may contribute to their frequent co-occurrence. Again, underlying personality traits may prove to be more heritable than either type of disorder.
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Borderline Personality Disorder: Ontogeny of a Diagnosis. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2010. [DOI: 10.1176/foc.8.2.foc230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Trajectories of PTSD and Substance Use Disorders in a Longitudinal Study of Personality Disorders. PSYCHOLOGICAL TRAUMA : THEORY, RESEARCH, PRACTICE AND POLICY 2009; 1:269-281. [PMID: 26366249 PMCID: PMC4567043 DOI: 10.1037/a0017831] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study investigated the co-occurrence of posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) in a sample (N = 668) recruited for personality disorders and followed longitudinally as part of the Collaborative Longitudinal Personality Disorders Study. The study both examined rates of co-occurring disorders at baseline and temporal relationships between PTSD and substance use disorders over 4 years. Subjects with a lifetime history of PTSD at baseline had significantly higher rates of SUDs (both alcohol and drug) than subjects without PTSD. Latent class growth analysis, a relatively novel approach used to analyze trajectories and identify homogeneous subgroups of participant on the basis of probabilities of PTSD and SUD over time, identified 6 classes, which were compared with respect to a set of functioning and personality variables. The most consistent differences were observed between the group that displayed low probabilities of both SUD and PTSD and the group that displayed high probabilities of both.
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The convergent and discriminant validity of five-factor traits: current and prospective social, work, and recreational dysfunction. J Pers Disord 2009; 23:466-76. [PMID: 19817628 PMCID: PMC2859436 DOI: 10.1521/pedi.2009.23.5.466] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The convergent and discriminant validity of Five Factor Model (FFM) personality traits with concurrent and prospective social, work, and recreational dysfunction was assessed in a large, longitudinal clinical sample. Consistent with five factor theoretical expectations, neuroticism is broadly related to dysfunction across domains; extraversion is primarily related to social and recreational dysfunction; openness to recreational dysfunction; agreeableness to social dysfunction; and conscientiousness to work dysfunction. Findings support five factor theory and the clinical assessment of normative personality traits.
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Abstract
OBJECTIVE To examine higher order personality factors of negative affectivity (NA) and disinhibition (DIS), as well as lower order facets of impulsivity, as prospective predictors of suicide attempts in a predominantly personality disordered sample. METHOD Data were analyzed from 701 participants of the Collaborative Longitudinal Personality Disorders Study with available follow-up data for up to 7 years. Cox proportional hazards regression analyses was used to examine NA and DIS, and facets of impulsivity (e.g. urgency, lack of perseverance, lack of premeditation and sensation seeking), as prospective predictors of suicide attempts. RESULTS NA, DIS and all facets of impulsivity except for sensation seeking were significant in univariate analyses. In multivariate models which included sex, childhood sexual abuse, course of major depressive disorder and substance use disorders, only NA and lack of premeditation remained significant in predicting suicide attempts. DIS and the remaining impulsivity facets were not significant. CONCLUSION NA emerged as a stronger and more robust predictor of suicide attempts than DIS and impulsivity, and warrants greater attention in suicide risk assessment. Distinguishing between facets of impulsivity is important for clinical risk assessment.
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MESH Headings
- Adaptation, Psychological
- Adolescent
- Adult
- Comorbidity
- Depressive Disorder, Major/diagnosis
- Depressive Disorder, Major/epidemiology
- Depressive Disorder, Major/psychology
- Diagnostic and Statistical Manual of Mental Disorders
- Disruptive, Impulse Control, and Conduct Disorders/diagnosis
- Disruptive, Impulse Control, and Conduct Disorders/epidemiology
- Disruptive, Impulse Control, and Conduct Disorders/psychology
- Female
- Follow-Up Studies
- Humans
- Male
- Middle Aged
- Patient Acceptance of Health Care/statistics & numerical data
- Personality Disorders/diagnosis
- Personality Disorders/epidemiology
- Personality Disorders/psychology
- Predictive Value of Tests
- Prevalence
- Prospective Studies
- Severity of Illness Index
- Substance-Related Disorders/diagnosis
- Substance-Related Disorders/epidemiology
- Suicide, Attempted/psychology
- Suicide, Attempted/statistics & numerical data
- Young Adult
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Ten-year stability and latent structure of the DSM-IV schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders. JOURNAL OF ABNORMAL PSYCHOLOGY 2009; 118:507-19. [PMID: 19685948 PMCID: PMC6445274 DOI: 10.1037/a0016478] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Evaluation of the validity of personality disorder (PD) diagnostic constructs is important for the impending revision of the Diagnostic and Statistical Manual of Mental Disorders. Prior factor analytic studies have tested these constructs in cross-sectional studies, and models have been replicated longitudinally, but no study has tested a constrained longitudinal model. The authors examined 4 PDs in the Collaborative Longitudinal Personality Disorders study (schizotypal, borderline, avoidant, and obsessive-compulsive) over 7 time points (baseline, 6 months, 1 year, 2 years, 4 years, 6 years, and 10 years). Data for 2-, 4-, 6- and 10-year assessments were obtained in semistructured interviews by raters blind to prior PD diagnoses at each assessment. The latent structure of the 4 constructs was differentiated during the initial time points but became less differentiated over time as the mean levels of the constructs dropped and stability increased. Obsessive-compulsive PD became more correlated with schizotypal and borderline PD than with avoidant PD. The higher correlation among the constructs in later years may reflect greater shared base of pathology for chronic personality disorders.
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The construct validity of rule-breaking and aggression in an adult clinical sample. J Psychiatr Res 2009; 43:803-8. [PMID: 18789456 PMCID: PMC2696696 DOI: 10.1016/j.jpsychires.2008.07.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2008] [Revised: 07/28/2008] [Accepted: 07/31/2008] [Indexed: 11/20/2022]
Abstract
Previous research has demonstrated that aggression (AGG) and non-aggressive rule-breaking (RB) represent elements of antisocial behavior with different etiological mechanisms and associations to personality and psychopathology. However, these constructs have not been investigated in an adult clinical sample. In the current study, interview and self-report derived AGG and RB were associated with personality traits and disorders as well as functioning across several domains, family history, concurrent psychopathology, and prospective behaviors. Both AGG and RB were similarly related to disagreeableness. RB was uniquely related to low conscientiousness, cluster B personality disorders, functioning, problems in childhood, suicide risk, arrests, and substance use disorders. AGG (+) and RB (-) were differentially related to obsessive-compulsive personality disorder and conscientiousness. Gender moderation effects were limited. It was concluded that AGG and RB represent separable components of antisocial behavior with differential and clinically meaningful correlates in an adult clinical sample.
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Abstract
OBJECTIVE The purpose of this article is to describe the development of the borderline personality disorder diagnosis, highlighting both the obstacles encountered and the associated achievements. METHOD On the basis of a review of the literature, the author provides a chronological account of the borderline construct in psychiatry, summarizing progress in decade-long intervals. RESULTS Borderline personality disorder has moved from being a psychoanalytic colloquialism for untreatable neurotics to becoming a valid diagnosis with significant heritability and with specific and effective psychotherapeutic treatments. Nonetheless, patients with this disorder pose a major public health problem while they themselves remain highly stigmatized and largely neglected. CONCLUSIONS Despite remarkable changes in our knowledge about borderline personality disorder, increased awareness involving much more education and research is still needed. Psychiatric institutions, professional organizations, public policies, and reimbursement agencies need to prioritize this need.
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Abstract
OBJECTIVE It is commonly believed that some features of borderline personality disorder (BPD) improve as individuals reach their late 30s and 40s. This study examined age-related change in borderline criteria and functional impairment, testing the hypothesis that older age would be associated with relatively more improvement than younger age. METHOD A total of 216 male and female participants with BPD were followed prospectively with yearly assessments over 6 years. RESULTS Participants showed similar rates of improvement in borderline features regardless of age. A significant age by study year interaction showed functioning in older subjects to reverse direction and begin to decline in the latter part of the follow-up, in contrast to younger subjects who maintained or continued improvement over the 6 years. Despite the decline, functioning for the older subjects was comparable with or slightly better at year 6 than at year 1. CONCLUSION Improvement in borderline features is not specific to the late 30s and 40s. There may be a reversal of improvement in functioning in some borderline patients in this older-age range.
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