Personality disorders in parasuicide

To examine the prevalence of personality disorders in a representative sample of patients admitted to inpatient care after a parasuicide, 64 consecutive patients were investigated with structured interviews for DSM-IV personality disorders and clinical interviews for Axis I disorders and suicidal behaviour. We found a borderline personality disorder (BPD) as principal diagnosis in 55% of the subjects and some other personality disorder (OPD) in an additional 23%. Multiple Axis II disorders were significantly more common in the BPD group, in which 71% met criteria for three or more personality disorders, compared with 7% in the OPD group. In the BPD group 20% did not have a concomitant Axis I disorder, whereas this was very uncommon in the other groups. A relatively large proportion (34%) in the BPD group used other parasuicide methods than drug intoxication, whereas in the other groups this was rare. The mean number of previous parasuicidal acts was significantly higher in the BPD group, in which 57% had three or more previous parasuicides, and a high proportion (60%) also had repeated a parasuicidal act within the last year. In the BPD group 69% had ongoing outpatient treatment. Only 25% of these outpatients had a borderline personality disorder reported in the hospital records, suggesting that the personality disorder might go undiagnosed. The study gives support to the importance of a focused and structured personality disorder diagnosis in customizing treatment for the person with a recent parasuicide.     

Personality disorders in psychiatry

Psychiatric patients with personality disorders are among the most difficult because of the counter-transferential strain they put on clinicians and the paucity of specific treatment. The author develops the point that personality disorders are not diseases as implied in Axis I disorders, but social illness syndromes which depict systemic problems in which clinicians can be engulfed and entrapped. The difficult patient does not exist in isolation, a victim of his own drives and psyche, but rather is a specific socio-cultural actor living and emerging from a particular environmental context. Personality disorders are considered to be interpersonal patterns in which a person's debilitating behaviour elicits complementary behaviour that reinforces the original behaviour. Within a systems perspective, there is not a disordered personality so much as a disordering system of relationships. As with families and society, healers too become involved in the vicious cycle of personality disorders if they fail to see the manipulative interpersonal devices used by these patients. If clinicians accept too naively the lay person's simplistic belief that personality disorders are diseases to be treated by psychiatrists, they run the risk of fostering inappropriate passivity in patients in the face of life demands. Overindulgence and angry rejection are the two major pitfalls often seen in clinical practice. The approach proposed here may seem conterintuitive in laying stress on the need to actively resist the temptation to take over responsibility for a patient's life. There is a difference between a behaviour that a patient's illness (Axis I disorder) prevents him from controlling and an impulsive deliberate behaviour stemming from character pathology. It is a logical error to deal with personality disorders in the same manner and with the same conceptual terminology as for depressive and psychotic disorders. Principles of management are detailed and can be summarized as a kind firmness to bring back patients to take on their own responsibilities.     

Personality disorders in late life

There is growing empiric evidence to suggest that a large number of elderly patients who have chronic depression frequently have comorbid personality disorders as well. In addition, contrary to commonly held clinical beliefs, a recent meta-analysis suggests that rates of personality disorders among older adults are essentially equivalent to that of younger groups. Although understudied, personality-disordered elderly patients have been shown to be less responsive to mental health interventions, and personality dysfunction may be one of the most relevant factors to account for when examining late-life depression remission and relapse. The paper considers briefly the notion of personality and personality disorders in late-life, examines prevalence rates including a recent meta-analysis, explores relevant issues associated with treatment, and discusses new developments in treatment.     

Personality disorders in old age

Little has been written on the subject of diagnosable personality disorders in old age. The evidence suggests that while most personality domains remain stable over several decades, those individuals whose personality disorders brought them to clinical or forensic attention tend to mellow with age. During old age itself a variety of hitherto submerged and newly emergent abnormalities of personality may present     

Personality in frontal lobe disorders

Personality changes in frontal lobe disorders are easy to recognize, but their evolution can be hard to predict. Both focal lesions and diffuse neurodegenerative processes may produce personality change based on interruption of prefrontal cortex or subcortical structures that comprise the frontal-subcortical circuits. Observed changes in personality have been classified by behavioral neurologists into three frontal-subcortical circuit syndromes, yet a given patient may defy this classification system by manifesting only selective features of one or more syndromes simultaneously, based on the neuroanatomic distribution of pathology. The orbitofrontal syndrome is the most well known and consists of major antisocial behaviors such as disinhibition, emotional lability, and impulsivity. In some cases, changes are severe enough to lead to new onset of criminality. Apathy and amotivational state lie at the other end of the personality change spectrum. Many psychologic instruments can measure the degree of change in personality, but none of them can be used to extrapolate a patient’s ability to function at home or at large in society. The psychopathy checklist by Hare may predict risk of violence but has been validated only for use in criminal populations.     

Personality and anxiety disorders

Personality traits and most anxiety disorders are strongly related. In this article, we review existing evidence for ways in which personality traits may relate to anxiety disorders: 1) as predisposing factors, 2) as consequences, 3) as results of common etiologies, and 4) as pathoplastic factors. Based on current information, we conclude the following: 1) Personality traits such as high neuroticism, low extraversion, and personality disorder traits (particularly those from Cluster C) are at least markers of risk for certain anxiety disorders; 2) Remission from panic disorder is generally associated with partial “normalization” of personality traits; 3) Anxiety disorders in early life may influence personality development; 4) Anxiety disorders and personality traits are usefully thought of as spectra of common genetic etiologies; and 5) Extremes of personality traits indicate greater dysfunction in patients with anxiety disorders.     

Personality disorders and violence

PURPOSE OF REVIEW: To review the most recent literature on the relationship between personality disorders and violent behavior. The review does not aim to address the issue of a possible etiological connection between previously being the victim of violent acts and later developing a personality disorder. RECENT FINDINGS: Recent data suggest that personality disorders, especially antisocial and borderline, are strongly related to the manifestation of violent acts. Substance abuse is another strong factor which could act either independently or additively. Biological factors seem to constitute a risk factor for violent behavior independently of personality. Although intelligence does not seem to be related to violence, some patients may manifest specific cognitive deficits. The ethical and legal questions posed by the above correlations are difficult to answer, and research has not yet provided enough data on this issue. SUMMARY: The most recent data support the relationship between antisocial personality and violence, especially when substance abuse is also present, although the presence of confounding factors in the diagnostic criteria suggest caution in the interpretation of the literature.     

Repetition of parasuicide —ICD-10 personality disorders and adversity

Patients with a history of previous parasuicide were compared to those who had made their first attempt. A scale for suicidal ideation derived from the Scaled Version of the General Health Questionnaire was completed by patients. ICD-10 personality disorder diagnoses were derived from the Standardized Assessment of Personality which was administered to knowledgeable informants. Logistic regression showed that unemployment, increasing severity of suicidal ideation, previous psychiatric treatment and borderline personality disorder increased the risk of reports of previous parasuicide. Anankastic personality disorder decreased the risk of reports of previous parasuicide. Unemployment and specific personality disorders have independent risks for repetition of parasuicide. Specific ICD-10 personality disorders may increase or decrease the risk for repetition of parasuicide.     

Personality traits and disorders in obsessive-compulsives

The Personality Diagnostic Questionnaire (PDQ) was completed by significant others for 26 obsessive-compulsive disorder (OCD) patients. Personality traits and diagnoses were scored. Profiles indicated that only one patient met criteria for compulsive personality, whereas one quarter to one third of the sample met criteria for avoidant, histrionic, schizotypal, and dependent personality disorders. High mean percentages on traits scores were found for avoidant and dependent traits, as well as for passive-aggressive and compulsive ones. Patients with more personality traits provoked more negative familial reactions and were less socially adjusted, but they did not have more OCD symptoms at pretest. Personality diagnoses did not predict behavioral treatment outcome. High dependent personality trait scores were related to better post-test gains, whereas passive-aggressive ones were associated with poorer long-term benefits. Results are discussed in light of recent reports of personality disorder in OCD and in other anxiety disorder patients. Methodological concerns are delineated.     

Personality disorders in the public sector

Using a clinical data base for New York state hospitals, the authors examined the prevalence of DSM-III axis II personality disorders in state hospital patients and explored the patterns of comorbidity between axis I and axis II disorders. They found that 11 percent of the patients received a diagnosis of personality disorder and that these patients were more likely than other patients to have a primary diagnosis of schizoaffective disorder, major affective disorder, dysthymia, and substance use disorder other than alcoholism. Comparison of state hospital data with data from nonstate facilities showed different patterns of coexisting primary diagnoses and personality disorders and a much higher frequency of borderline personality disorder in nonstate patients. Based on the low percentage of state hospital patients diagnosed as having personality disorders, the authors conclude that axis II disorders are underreported in state facilities.     

Personality disorders in recent-onset bipolar disorder

The frequency and types of DSM-III personality disorders (PDs) were investigated in a sample of 26 recent-onset bipolar-disordered (BD) patients. Results showed that 62% of BD patients had PDs according to the Structured Interview for DSM-III Personality Disorders (SIDP). The most frequently diagnosed PDs were the histrionic, borderline, passive-aggressive, and antisocial categories. A comparison between the BD patients and a sample of 35 recent-onset schizophrenic patients showed significant differences for two PDs. Schizotypal PD was more frequently diagnosed in the schizophrenic group, while the BD group had a higher frequency of histrionic PD.     

Personality in men with eating disorders

OBJECTIVE: This study compares personality variables of men with eating disorders to women with eating disorders. METHOD: Data were obtained from an international study of the genetics of eating disorders. Forty-two male participants were age-band matched at 1:2 ratio to females from the same study. Personality features were compared between males and females controlling for diagnostic subgroup. RESULTS: Males with eating disorders appear to be slightly less at risk for perfectionism, harm avoidance, reward dependence, and cooperativeness than females. Few differences were found when diagnostic subgroup was considered. CONCLUSION: Observed differences in personality variables may help explain the difference in incidence and prevalence of eating disorders in men and women.