Metacognition moderates the relationship of disturbances in attachment with severity of borderline personality disorder among persons in treatment of substance use disorders

ObjectivesBorderline personality disorder traits have been observed to be linked with both insecure attachment styles as well as deficits in mentalizing and metacognition. Less is known, however, about how attachment style does or does not interact with deficits in mentalizing and metacognition to create, sustain, or influence levels of borderline personality disorder traits. In this study, we examined the hypothesis that metacognitive mastery, which is the ability to use knowledge about mental states of self and others to cope with distress and solve social problems, moderates the relationship of anxious attachment style with the severity of borderline personality disorder traits.MethodsConcurrent assessments were gathered of metacognitive mastery using the Metacognitive Assessment Scale Abbreviated, anxious attachment style using the Experiences of in Close Relationships Scale, and borderline personality disorder traits using the Structured Clinical Interview for DSM-IV Axis II Disorders. Participants were 59 adults in an early phase of recovery from substance use disorders in a residential setting.ResultsMultiple regression revealed that metacognitive mastery moderated the relationship of anxious attachment style with the number of borderline personality disorder traits. A median split of the anxious attachment and metacognitive mastery scores was performed yielding 4 groups. An analysis of covariance revealed that participants with higher levels of anxious attachment and poorer metacognitive mastery had more borderline personality disorder traits did than the other groups after controlling for levels of psychopathology.ConclusionInsecure attachment may be associated with higher number of borderline personality disorder traits in the presence of deficits in metacognitive mastery. Patients with substance use and borderline personality disorder traits may benefit from treatment which addresses metacognitive mastery.     

Borderline personality disorder in male and female offenders newly committed to prison

BACKGROUND: The objective of the study was to estimate the rate of borderline personality disorder (BPD) in male and female offenders newly committed to the Iowa Department of Corrections. We also compared clinical and demographic characteristics of offenders with and without BPD. METHODS: A random sample of 220 offenders entering Iowa's prison system were evaluated by using a version of the Mini International Neuropsychiatric Interview, the BPD module of the Structured Interview for DSM-IV Personality Disorders, the Medical Outcome Survey Short Form-36 Health Survey, and the Level of Service Inventory-Revised. RESULTS: Borderline personality disorder was present in 65 (29.5%) subjects, although 93.2% had at least one Diagnostic and Statistical Manual of Mental Disorders-IV BPD trait. The percentage of women meeting criteria for BPD was more than twice that for men. Subjects with BPD were more likely than those without to be married, employed, and to have a high suicide risk score. Offenders with BPD were more likely than others to report prior mental health treatment, and to have reported high levels of interference from their mental disorder. Offenders with BPD had worse quality of life than offenders without BPD as assessed with the Medical Outcome Survey Short Form 36 Health Survey, and higher rates of mood, anxiety, psychotic, and eating disorders; antisocial personality disorder; and attention deficit hyperactivity disorder. Borderline personality disorder was also associated with higher Level of Service Inventory-Revised total scores, which indicates their having a greater risk for recidivism than nonborderline offenders. These relationships were observed after adjusting for sex, age, race/ethnicity, and presence of antisocial personality disorder. CONCLUSION: Borderline personality disorder is relatively common among both male and female offenders in prison, and is associated with substantial psychologic stress and impaired quality of life. Early recognition and treatment of BPD in prisons may be warranted.     

The co-occurrence of autistic traits and borderline personality disorder traits is associated to increased suicidal ideation in nonclinical young adults

BackgroundThe co-occurrence of Autism Spectrum Disorder (ASD) and Borderline Personality Disorder (BPD) is not rare and has been linked to increased suicidality. Despite this significant comorbidity between ASD and BPD, no study had examined the co-occurrence of autistic traits and borderline personality disorder traits in the general population. The aim of the present study was to examine the co-occurrence of autistic and borderline traits in a non-clinical sample of young adults and its influence on the levels of suicidal ideation and depressive symptomatology.ProceduresParticipants were 474 college students who completed self-report questionnaires. Data were analysed using correlation and cluster analyses.Main findingsBorderline personality traits and autistic traits were weakly correlated. However, cluster analysis yielded four groups: a low traits group, a borderline traits group, an autistic traits group, and a group characterized by high levels of both traits. Cluster analysis revealed that autistic and borderline traits can co-occur in a significant proportion of young adults. The high autistic and borderline traits group constituted 17% of the total sample and had higher level of suicidal ideation than the borderline traits group, despite similar levels of depressive symptoms.ConclusionThis result suggests that the higher suicidality observed in patients with comorbid ASD and BPD may extent to non-clinical individuals with high levels of co-occurrent autistic and borderline traits.     

Personality disorders in the community: Results from the Australian National Survey of Mental Health and Well-Being Part III

Abstract. Background: The aim of the present study was to examine in a national survey sample the risks of having a specific personality disorder (PD) and associations with gender, of having one or more physical conditions, of having one or more Axis 1 conditions, and of the severity (or degree) of disability. We also examined the association of specific PDs with having sought a consultation for health or mental health problems with a general practitioner (GP), a psychologist, or psychiatrist over the past 12 months. Method: Data were derived from the Australian National Mental Health and Well-Being Survey, conducted between May and August 1997. A stratified random sample of households was generated, from which all persons aged 18 or over were considered potential interviewees. There were 10,641 survey respondents, this representing a response rate of 78%. Each interviewee was asked 59 questions indexing specific ICD-10 PD criteria. Results: Logistic regressions identified that some specific PDs, especially borderline PD, were more strongly associated with having one or more Axis I conditions, greater mental disability and lost days of total and partial role functioning than having No PD, and that others, notably anankastic PD, were less likely to be associated with the same variables. Some specific PDs, again most notably borderline PD, were more associated than others, again most notably anankastic PD, with having sought mental health consultations from GPs, psychiatrists, and psychologists. By contrast, PD associations with gender, physical conditions, physical disability and health consultations with the three professional groups were weaker as reflected in the comparatively smaller odds ratios and were also less consistent than the pattern with the previously mentioned variables. Conclusion: The study reports findings from a nationwide survey and, as such, the data are less influenced by the selection and setting bias found in most other studies investigating these variables. The findings of the study do point to some specific PDs, such as borderline PD, being associated with greater Axis 1 psychopathology, disability and mental health consultations than others, such as anankastic PD. It appears that although anankastic PD in itself is associated with more disability than having No PD, it becomes significantly more disabling when it is associated with other comorbid PDs.     

The impact of borderline personality disorder on post-traumatic stress in the community: a study of health status, health utilization, and functioning.

This study examines impairment and health status and resource utilization among individuals with and without borderline personality disorder (BPD), all of whom had post-traumatic stress symptoms (PTSS). Using data from the community-based Piedmont Health Survey, 150 adult respondents who had experienced clinically significant PTSS during their life were identified. The Diagnostic Interview Schedule (DIS) Borderline Index was used to distinguish a subset of respondents who met criteria for BPD. Compared with adults with PTSS (n = 135), individuals with PTSS and BPD (PTSS-BPD) (n = 15) exhibited impaired health status and greater utilization of mental health services and psychotropic medications, as well as more functional impairment based on social, occupational, and early adverse life-event measures. Individuals with comorbid PTSS and BPD demonstrate greater overall impairment and usage of health care resources.     

Stress exposure and well-being: correlates of meeting criteria for bipolar disorder,borderline personality disorder,or both

Purpose

Bipolar and borderline personality disorders share similar features, are challenging to differentiate and sometimes co-occur in the same individual. This paper compares people with bipolar, borderline, both or neither, analyzing sociodemographic characteristics, lifetime exposure to stressors, and emotional, social, and physical wellbeing to illuminate differences in life experiences associated with expressing symptoms consistent with bipolar, borderline, or both.

Methods

Data were analyzed from the 2012–13 National Epidemiological Survey on Alcohol and Related Conditions (NESARC-III), N = 36,309. Survey participants were classified as bipolar (N = 488, 1.3%), borderline (N = 1758, 4.8%), both (N = 388, 1.1%), or neither (N = 33,675, 92.8%). Differences between these groups regarding demographics, adverse childhood experiences, recent stressors, lifetime trauma, psychiatric co-morbidities, and emotional, social, and physical wellbeing were assessed with the adjusted Wald F test.

Results

People with bipolar were more likely to also have borderline (44.3%) than the reverse (18.1%). People with both disorders were least advantaged socioeconomically, most exposed to stressors and traumas across the life course, and had the worst wellbeing emotionally, socially, and physically. Differences between people with both disorders vs. borderline only were smaller than between people with borderline vs. bipolar, although bipolar disorder was associated with considerable hardship relative to having neither disorder.

Conclusion

Borderline personality disorder alone or in combination with bipolar is associated with worse economic, social, and health outcomes than bipolar alone. Borderline can resolve with evidence-based treatment, and it is critical to correctly differentiate between the two conditions, so people with borderline and/or bipolar have the optimum chance for recovery.

     

The enduring effects of early-childhood adversities and troubled sleep among Canadian adults: a population-based study

ObjectiveAlthough many studies have consistently found that early-childhood adversities are important risk factors for physical and mental health problems later in adulthood, few have examined the association between early-childhood adversities and troubled sleep. The objective of this study was to examine the association between early-childhood adversities and troubled sleep among adult Canadians.MethodsData for this paper (N = 19,349) were obtained from Statistics Canada's 2012 Canadian Community Health Survey – Mental Health (CCHS-MH). Logistic regression analysis was conducted to examine the association between early childhood adversities and troubled sleep, while accounting for various sociodemographic, socioeconomic, health, and mental health factors.ResultsOf the 19,349 respondents examined, 2748 representing 14.2% had troubled sleep. Controlling for sociodemographic, socioeconomic, health, and mental health factors, it was observed that for each additional childhood adversity experienced, the odds of having troubled sleep increased by 10% (odds ratio = 1.10, p <0.001, 95% confidence interval = 1.07–1.13). In addition, psychological distress, older age, being female, being unmarried, being white, a lower annual income, chronic pain, poor perceived health, and mental health difficulties were associated with troubled sleep.ConclusionThe results of this paper provide population-based evidence for childhood adversities as a major predictor of troubled sleep in adulthood. The long-standing effects of these adversities on sleep highlight the importance of early detection, such as consistent assessment of sleep habits for children, adolescents, and adults, who have experienced childhood adversities, in health and mental health settings.     

The Burden of Agoraphobia in Worsening Quality of Life in a Community Survey in Italy

ObjectiveCurrent nosology redefined agoraphobia as an autonomous diagnosis distinct from panic disorder. We investigated the lifetime prevalence of agoraphobia, its association with other mental disorders, and its impact on the health-related quality of life (HR-QoL). MethodsCommunity survey in 2,338 randomly selected adult subjects. Participants were interviewed with the Advanced Neuropsychiatric Tools and Assessment Schedule (ANTAS), administered by clinicians. The diagnoses were based on the ICD-10 criteria. The Short-Form Health Survey (SF-12) was used to quantify HR-QoL. ResultsIn the sample, 35 subjects met the criteria for agoraphobia (1.5%), with greater prevalence among women (2.0%) than men (0.9%): odds ratio (OR) 2.23; 95% CI: 1.0-5–2. Agoraphobia was more often seen among those with (n=26; 1.1%) than without (n=9; 0.4%) panic disorder: OR=8.3; 2.9–24.4. Co-morbidity with other mental disorders was substantial. The mean score of SF-12 in people with agoraphobia was 35.2±7.8, with similar levels of HR-QoL in people with (35.3±7.9) or without (34.8±7.3) panic disorder: ANOVA: F(1;33)=0.0; p=1.00. ConclusionOne out of seventy people may suffer from agoraphobia in their lifetime. The attributable burden in terms of HR-QoL is substantial and comparable to the one observed for chronic mental disorders such as major depression, post-traumatic stress disorder, or obsessive-compulsive disorder.     

Psychological Risk Factors for Borderline Pathology in School-Age Children

ObjectiveTo determine whether children with borderline pathology have a specific pattern of psychological risk factors.MethodThe subjects were 94 school-age children in day treatment, divided into borderline (n = 41) and nonborderline (n = 53) groups using the child version of the Retrospective Diagnostic Interview for Borderlines. All children were assessed using the Child Behavior Checklist, the Schedule for Affective Disorders and Schizophrenia for School-Age Children, and the Psychosocial Questionnaire. Parental pathology was assessed by a computerized version of the Structured Clinical Interview for DSM-III-R.ResultsChildren with borderline pathology had higher rates of physical abuse, sexual abuse, severe neglect, as well as family breakdown and parental criminality. In multivariate analyses, the discriminating factors were sexual abuse and parental criminality. Borderline pathology was highly comorbid with conduct disorder, but most of these results remained significant in reanalyses comparing children with and without conduct disorder.ConclusionsBorderline pathology in children has a unique pattern of risk factors not accounted for by conduct disorder alone.     

Personality disorder prevalence and correlates in a whole of nation dataset

Purpose

The epidemiology of personality disorder is poorly understood. This study aims to describe the population in contact with mental health services with a diagnosis of personality disorder and compare service use between this group and those with a diagnosis of depression.

Methods

Investigation of a routinely collected clinical data set across New Zealand was conducted. We used data from 2008 to 2017 and 1-year data from 2016, the most complete dataset. This allowed for variation over the years and confirmation within a 1-year prevalence. These data were analysed focusing on patients with a primary diagnosis of any personality disorder and the subset with borderline personality disorder (BPD). BPD was chosen as the most common clinical personality disorder diagnosis and that most researched.

Results

8884 (2.8%) of the population in contact with mental health services carried a primary diagnosis of personality disorder. Personality diagnosis other than antisocial personality disorder (ASPD) in men and borderline personality disorder (BPD) in either gender was negligible. Rates of personality pathology increased with social deprivation and were commonest in young adults. Multi-morbidity was the norm, with internalising disorder common. Maori diagnosed with PD were over-represented both in the patient group and by population.

Conclusion

Borderline personality disorder and antisocial personality disorder are routinely diagnosed in routine clinical practice in New Zealand; however, other categorical diagnoses are not made. Patients with PD are significant users of resources in comparison to depressed patients. Resource utilisation was significantly greater in those with PD, in particular use of inpatient services compared to those with depression.

     

Comorbid physical health conditions and anxiety disorders: a population-based exploration of prevalence and health outcomes among older adults

ObjectiveThe primary objectives of this study were to examine the likelihood of anxiety disorders among respondents with common physical health conditions and to explore the associations between this comorbidity and older adults' perceived mental and physical health.MethodThe sample consisted of older adults from the Canadian Community Health Survey 1.2 (n=12,792). Trained lay interviewers assessed psychiatric disorders based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. Physical health conditions were based on self-reported diagnoses by health professionals. Multiple logistic regressions examined whether suffering from a physical health condition increased the odds of any assessed anxiety disorder (panic, agoraphobia, social phobia and posttraumatic stress disorder). Multiple linear regressions examined associations between self-rated health and comorbid physical health conditions and anxiety.ResultsAfter adjusting for confounding variables, the presence of chronically painful conditions (i.e., arthritis, back pain and migraine) and of other commonly occurring diseases (i.e., allergies, cataracts and gastrointestinal, lung and heart disease) were positively associated with anxiety. The comorbidity of anxiety with allergies, cataracts, arthritis and lung disease resulted in poorer self-rated physical and/or mental health after adjusting for confounding variables.ConclusionHealth problems in older adults are associated with increased odds of anxiety, and this comorbidity is associated with poorer self-reported health than medical problems or anxiety alone. These findings have important clinical implications for health professionals.     

Lifetime risk and correlates of incarceration in a nationally representative sample of U.S. adults with non-substance-related mental illness

Purpose

High rates of psychiatric disorders in correctional facilities have fueled widespread concern about the “criminalization of mental illness.” While the link between incarceration, substance abuse, and antisocial-personality disorder is well established, the relationship between non-substance-related psychiatric disorders and incarceration has not been thoroughly investigated. This study examines the association of mental illness, excluding substance use disorders, with risk for incarceration in US adults.

Methods

Nationally representative data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) were used to compare the proportions of respondents with lifetime incarceration among those with no lifetime history of DSM-5 disorders, or with lifetime history of mental illness, substance use disorders, dual diagnosis, and antisocial personality/conduct disorder. Logistic regression analysis was used to examine the independent association of incarceration with mental illness alone, both in comparison to and net of associations with sociodemographic and behavioral characteristics.

Results

Among adults with mental illness alone, 6.7% reported past incarceration, compared to 4.8% with no history of DSM-5 disorders, and 20–40% in other DSM-5 diagnostic groups. Sociodemographic and behavioral risk factors were more strongly associated with incarceration (c-statistics = 0.74 and 0.77, respectively), than mental illness (c-statistic = 0.56). Schizophrenia or other psychoses and borderline personality disorder were independently associated with incarceration, but with effect sizes no greater than eight other sociodemographic or behavioral risk factors.

Conclusion

A weak association of mental illness alone with incarceration was found, despite high level of public attention to “criminalization of mental illness.”

     

Adaptation psychologique de la Personnalité Limite Addictive à l’expérience cancéreuse : intérêt d’une approche intrapsychique

ObjectivesThe aim is to apprehend the psychological adjustment to cancer experience of Addictive Borderline Personality, through the evaluation of anxiety-depressive disorders and mentalisation.MethodsThe sample is made up of five subjects aged 48 to 64 years old (four men and one women with an average age of 58 years old), having a Borderline Personality Addictive Tobaccological and suffering from lung cancer. The Borderline Personality Addictive Tobaccological is verified by two semi-structured interviews diagnosis of borderline personality and tobacco addiction. A self-rating scale (Hospital and Anxiety and Depressive Scale [HAD]) assessed the anxiety-depressive disorders. HAD evaluates the severity of anxious and depressive current symptoms, among somatic patients. The mentalisation of cancer experience is apprehended through a tool of discourse analysis (Grille de l’Élaboration Verbale de l’Affect [Géva]), that measures empirically the level of verbal elaboration of affects. Geva is applied to product speech by the subject during a semi-structured interview: “cancer experience”, in which, the subject is invited to relate his journey with the illness.ResultsAll of subjects present mentalizing difficulties of lung cancer experience, showing adjustment difficulties. For two by five subjects, these difficulties are also expressed by the presence of anxiety-depressive disorders. The results shows the absence of these disorders, for the others subjects.ConclusionsThe assessment of psychological adjustment to cancer experience can not be limited only to the expertise of anxiety-depressive disorders, but requires an approach intra-psychic, such as an assessment of mentalisation, particularly in Borderline Personnality Addictive.     

Reliability of criteria for borderline personality disorder: a comparison of DSM-III and the Diagnostic Interview for Borderline Patients

The authors compared the reliability of two methods of distinguishing borderline personality disorder--DSM-III and the Diagnostic Interview for Borderline Patients. The reference group, outpatients with other personality disorders and without major axis I pathology, was more difficult to distinguish from the patients with borderline personality disorder than such groups used in previous samples. The sensitivity and specificity of the Diagnostic Interview for Borderline Patients were calculated, with DSM-III used as a criterion. The findings confirm considerable overlap between borderline and schizotypal personality disorders, more impairment in functioning in borderline patients than in those with other personality disorders, and the high reliability with which borderline personality disorder can be diagnosed.     

Trait emotional intelligence,the Big Five personality traits and isometric maximal voluntary contraction level under stress in athletes

ObjectivesThe purpose of the study was to investigate the effects of trait emotional intelligence (EI) and the Big Five personality traits on athletes’ ability to tolerate stress during isometric maximal voluntary contraction (MVC).MethodsFifty-two elite athletes with a mean age of 21.5 year (17 female) volunteered to participate. The Short Form Big Five Inventory and the Schutte Self-Report Emotional Intelligence Test measured personality and trait EI, respectively. Electromyography (EMG) determined the MVC level of the triceps surae muscle group in the absence and presence of a stressor. The mental stressor was to count downwards, repeatedly subtracting 13 from a starting value of 1000.ResultsAthletes’ MVC values were positively associated with conscientiousness and trait EI regardless of the presence or absence of a mental stressor. Two hierarchical regressions were conducted to determine whether personality traits and trait EI could predict MVC values measured during the absence and presence of mental stressor. Results show that personality traits explain variability in MVC values measured in both the absence and the presence of a mental stressor. Further, trait EI increased the model's ability to predict MVC. Personality traits combined with trait EI had stronger predictive ability for MVC values during exposure to a mental stressor.ConclusionAthletes with higher levels of conscientiousness and trait EI may be able to tolerate more stress without a decrease in performance.     

COVID-19 and Risk Factors of Anxiety and Depression in South Korea

ObjectiveThe aims of this study were to explore the prevalence of and identify predictors of anxiety and depression related to coronavirus disease of 2019 (COVID-19) in South Korea. MethodsThe analysis is based on a quota survey design and a sampling frame that permitted recruitment of a national sample of 1,014 individuals between March 17–31, 2020. Several standardized measurements were used, including GAD-7, PHQ-9, COVID-19 related fear, restrictions in deaily life, as well as sociodemographic information and physical and psychosocial needs during the pandemic. Multiple logistic regression was conducted to analyze the influence of sociodemographic factors, fear, and physical/psychosocial needs on anxiety and depression. ResultsSignificant numbers of the respondents were identifiable anxiety (19.0%) and depression group (17.5%), respectively. This indicates that the depression and anxiety prevalence rate after the COVID-19 is substantially high compared to the depression rate of 2.6% in 2020 and 2.8% in 2018 both reported in the Korea Community Health Survey and the anxiety rate of 5.7% reported in 2016 Survey of Mental Disorders in Korea. Multiple logistic regression results showed age, COVID-19 related fear, and the level of restrictions in daily as significant factors in understanding and predicting the anxiety group. Likfewise, the COVID-19 related fear, restrictions in daily life, and need for economic support were important predictors in predicting the depression group. ConclusionFindings on predictors for greater vulnerability to anxiety and depression has important implications for public mental health in the context of the COVID-19 pandemic.     

Insomnia among current and remitted common mental disorders and the association with role functioning: results from a general population study

Objective and backgroundInsomnia is a neglected topic in psychiatric epidemiological studies. Despite the fact that insomnia is a common phenomenon and usually co-occurs with mental disorders, it remains to be addressed to what extent insomnia is associated with remitted and current common mental disorders and with impaired functioning in the population, after considering a wide variety of confounders.Patients and methodsData were used from three waves of the Netherlands Mental Health Survey and Incidence Study-2 (N = 4618), a nationally representative face-to-face survey of the general population. Insomnia was assessed at the third wave with the Women's Health Initiative Insomnia Rating Scale. Mental disorders were assessed at all waves with the Composite International Diagnostic Interview version 3.0. Confounders included sociodemographic characteristics, physical health, and psychotropic medication use. Role functioning was assessed with the Medical Outcomes Study Short Form Health Survey and work loss with the World Health Organization Disability Assessment Schedule.ResultsForty-two per cent of the population reported none to mild insomnia, 35% moderate insomnia, and 23% severe insomnia. Both current and remitted anxiety disorder and current mood disorder were significantly associated with severe insomnia with adjusted odds ratios ranging from 1.8 to 3.3. Current and remitted substance use disorders were associated with moderate insomnia (adjusted OR range: 1.3–1.8). Moderate and severe insomnia were significantly associated with impaired role functioning and work loss after adjustment for confounders.ConclusionInsomnia is a prevalent problem across different categories of mental disorders, even in the remitted phase. As insomnia has a high impact on daily functioning, insomnia deserves wide clinical attention.     

Association of response rate and prevalence estimates of common mental disorders across 129 areas in a nationally representative survey of adults in Japan

Objective

To investigate the association of area response rate with prevalence estimates of mental disorders in the 2nd World Mental Health Survey (WMHJ2).

Methods

The sample of the WMHJ2 was selected from community residents in 129 areas from three regions of Japan. The surveys were conducted between 2013 and 2015, and 2450 (43.4%) responded. Mental disorders as well as three disorder classes (mood, anxiety, and substance use disorders) were identified using the WHO CIDI/DSM-IV. Response rates and 12-month and lifetime prevalences were calculated for each area. A generalized linear mixed model analysis was conducted to associate area response rate with the prevalence of mental disorders, controlling for sex, age, urbanity, and geographical region.

Results

Area response rates ranged from 0.05 to 0.80 across the 129 areas. Area response rate was not significantly associated with 12-month or lifetime prevalence of mental disorder. Lifetime prevalences of substance use disorder were significantly lower in a survey with a higher response rate than a survey of the same area with a lower response rate.

Conclusion

Response rate may not strongly affect the prevalence estimates of mental disorders in a community-based survey of the prevalence of common mental disorders during a particular time frame. However, a lower response rate could be associated with overestimation of lifetime prevalence of substance use disorder. This needs further elucidation.

     

A dimensional approach to assessing personality functioning: examining personality trait domains utilizing DSM-IV personality disorder criteria

BackgroundThis study compared a dimensional, trait domain approach to characterizing personality pathology with the traditional polythetic approach with respect to their associations with interpersonal functioning and personality traits from the five factor model.MethodsPsychiatric inpatients (N = 1476) were administered the Structured Clinical Interview for DSM-IV Axis II personality disorders. Dimensional representations of trait domains were derived from reorganizing DSM-IV criteria into personality trait domains from DSM-5 Alternative Model. Dimensional scores and personality disorder (PD) total criterion scores served as independent variables in predicting interpersonal profile clusters, as well as extraversion, agreeableness conscientiousness, neuroticism and openness from the five factor model traits.ResultsTrait domain scores and PD criteria totals were significantly correlated with submissive interpersonal style yet none proved significant in regression analyses. Avoidant and borderline PD total criteria were negatively associated with a normative interpersonal style. Combined trait domain of detachment and avoidant PD total criteria predicted a hostile/withdrawn interpersonal style. The trait domain of detachment was negatively associated with five factor traits of extroversion, whereas borderline PD total criteria were negatively associated with conscientiousness. Avoidant and borderline PD total criteria were positively associated with neuroticism.ConclusionsThe cross-cutting dimensional approach provided useful information in predicting a hostile/withdrawn interpersonal style as well as extroversion. Importantly, PD criterion scores and dimensional trait scores combined to predict this interpersonal style providing support to the alternative model of personality diagnosis in DSM-5. Clinicians are encouraged to assess dimensions of personality traits as these are related to interpersonal problems frequently encountered in psychiatric settings. While potentially useful, the dimensional approach articulated here did not yield substantial prediction of behavior.     

Overlap between borderline and schizotypal personality disorders.

Borderline personality was split into two diagnostic categories in DSM-III: borderline personality disorder (BPD) and schizotypal personality disorder (SPD). There remains a great deal of diagnostic overlap between these two categories despite modifications in DSM-III-R. This report discusses four possible hypotheses for this overlap: (1) an independent, random association; (2) artifactual overlap due to imperfections in the criteria sets; (3) a synergistic association of the two personality disorders; and (4) a manifestation of dimensional psychopathology. Empirical evidence for each of the first three hypotheses is weak and contradictory. Recent biologic and treatment studies appear to most strongly support the use of dimensional models of "borderline" and "schizotypal" personality traits.