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1.
Gerald Nestadt Chongzhi Di O.J. Bienvenu P. Costa Karen Bandeen-Roche 《Journal of psychiatric research》2010,44(1):1-7
Background
Stability of personality disorders is assumed in most nomenclatures; however, the evidence for this is limited and inconsistent. The aim of this study is to investigate the stability of DSM-III personality disorders in a community sample of eastern Baltimore residents unselected for treatment.Methods
Two hundred ninety four participants were examined on two occasions by psychiatrists using the same standardized examination twelve to eighteen years apart. All the DSM-III criteria for personality disorders were assessed. Item-response analysis was adapted into two approaches to assess the agreement between the personality measures on the two occasions. The first approach estimated stability in the underlying disorder, correcting for error in trait measurement, and the second approach estimated stability in the measured disorder, without correcting for item unreliability.Results
Five of the ten personality disorders exhibited moderate stability in individuals: antisocial, avoidant, borderline, histrionic, and schizotypal. Associated estimated ICCs for stability of underlying disorder over time ranged between approximately 0.4 and 0.7-0.8. A sixth disorder, OCPD, exhibited appreciable stability with estimated ICC of approximately 0.2-0.3. Dependent, narcissistic, paranoid, and schizoid disorders were not demonstrably stable.Conclusions
The findings suggest that six of the DSM personality disorder constructs themselves are stable, but that specific traits within the DSM categories are both of lesser importance than the constructs themselves and require additional specification. 相似文献2.
Howard Steiger Jodie Richardson Norbert Schmitz Ridha Joober Mimi Israel Kenneth R. Bruce Lise Gauvin Cathy Dandurand Annelie Anestin 《Journal of psychiatric research》2009,43(13):1086-290
Context
Efforts to classify eating-disordered individuals based on concurrent personality traits have consistently converged on a typology encompassing “over-regulated”, “dysregulated”, and “low psychopathology” subgroups. In various populations, evidence has associated personality variations of an “over-regulated/dysregulated” type with differences on serotonin-system indices, and specifically, with different loadings of serotonin transporter promoter regulatory region polymorphism (5HTTLPR) genotypes and alleles. We explored the extent to which an empirical, trait-defined typology of eating-disordered individuals coincided systematically with variations in 5HTTLPR, assayed using biallelic and triallelic models.Method
We tested 185 women with a DSM-IV eating disorder (108 with Bulimia Nervosa, 17 Anorexia Nervosa, and 60 an Eating Disorder Not Otherwise Specified) and 93 with no eating disorder on measures reflecting psychopathological traits and 5HTTLPR (biallelic and triallelic) genotypes and alleles.Results
The highest-function, triallelic (LA/LA) genotype occurred significantly more frequently among eating-disordered individuals than among controls. However, a more fine-grained analysis suggested that this association was attributable to the fact that, among eating-disordered participants, those displaying an “Inhibited/Compulsive” profile (derived using latent class analysis) were more likely than those of a “Dissocial/Impulsive” or a “Low Psychopathology” group to carry the triallelic 5HTTLPR gain-of-function LA allele and to be LA/LA homozygotes.Discussion
This study’s empirically derived classes coincide with interpretable differences on genetic indices—associating an “Inhibited/Compulsive” group with 5HTTLPR gain-of-function genotypes (and alleles) that have elsewhere been linked to trait compulsivity. The findings, furthermore, suggest that 5HTTLPR, by influencing personality-trait manifestations may, in turn, influence eating-disorder risk and symptom expression. 相似文献3.
Objective
We examined correlates of avoidant and obsessive-compulsive personality pathology—with respect to psychiatric comorbidity, eating disorder psychopathology, and associated psychologic factors—in patients with binge-eating disorder (BED).Method
Three hundred forty-seven treatment-seeking patients who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), research criteria for BED were reliably assessed with semistructured interviews to evaluate DSM-IV Axis I disorders, personality disorders, and behavioral and attitudinal features of eating disorder psychopathology.Results
Fifteen percent of subjects had avoidant personality disorder features, 12% had obsessive-compulsive personality disorder features, 8% had features of both disorders, and 66% had features of neither. These groups differed significantly in the frequencies of depressive and anxiety disorders, as well as on measures of psychologic functioning (negative/depressive affect and self-esteem) and eating disorder attitudes (shape and weight concerns). There were no group differences on measures of eating behaviors. The avoidant and obsessive-compulsive groups had more psychiatric comorbidity than the group without these personality features but less than the combined group. The group without these features scored significantly lower than all other groups on negative/depressive affect and significantly higher than the avoidant and combined groups on self-esteem. The combined group had the greatest severity on shape and weight concerns.Conclusions
Avoidant and obsessive-compulsive personality features are common in patients with BED. Among BED patients, these forms of personality psychopathology—separately and in combination—are associated with clinically meaningful diagnostic, psychologic, and attitudinal differences. These findings have implications for the psychopathologic relationship between BED and personality psychopathology and may also have implications for assessment and treatment. 相似文献4.
Introduction
There is a paucity of empirical information pertaining to the association between personality disorders and cigarette smoking. The present study examined whether, and to what degree, personality disorders are associated with cigarette smoking; investigated the specificity of any observed smoking-personality disorder association; and the role of mood/anxiety disorders, substance use, and nicotine dependence in those relations.Methods
Data were drawn from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC), a nationally representative sample of 43,083 adults in the United States.Results
Results indicated a substantial percentage of those with personality disorders are nicotine dependent. Interestingly, the association between dependent, avoidant, histrionic, schizoid and paranoid personality disorders as well as former dependent smoking was partially explained by co-occurring mood/anxiety disorders, and adjusting for such clinical conditions appeared to generally attenuate the strength of many other associations. Finally, the association between personality disorders and smoking appears to differ by specific personality disorder, with some of the strongest relations being evident for antisocial personality disorder.Discussion
These novel empirical findings are discussed in relation to the relevance of cigarette smoking among those with personality disorders. 相似文献5.
Lochner C Serebro P van der Merwe L Hemmings S Kinnear C Seedat S Stein DJ 《Progress in neuro-psychopharmacology & biological psychiatry》2011,35(4):1087-1092
Introduction
Comorbid obsessive-compulsive personality disorder (OCPD) is well-described in obsessive-compulsive disorder (OCD). It remains unclear, however, whether OCPD in OCD represents a distinct subtype of OCD or whether it is simply a marker of severity in OCD.Materials and methods
The aim of this study was to compare a large sample of OCD subjects (n = 403) with and without OCPD on a range of demographic, clinical and genetic characteristics to evaluate whether comorbid OCPD in OCD represents a distinct subtype of OCD, or is a marker of severity.Results
Our findings suggest that OCD with and without OCPD are similar in terms of gender distribution and age at onset of OC symptoms. Compared to OCD − OCPD (n = 267, 66%), those with OCD + OCPD (n = 136, 34%) are more likely to present with the OC symptom dimensions which reflect the diagnostic criteria for OCPD (e.g. hoarding), and have significantly greater OCD severity, comorbidity, functional impairment, and poorer insight. Furthermore there are no differences in distribution of gene variants, or response to treatment in the two groups.Conclusion
The majority of our findings suggest that in OCD, patients with OCPD do not have a highly distinctive phenomenological or genetic profile, but rather that OCPD represents a marker of severity. 相似文献6.
Nestadt G Hsu FC Samuels J Bienvenu OJ Reti I Costa PT Eaton WW 《Comprehensive psychiatry》2006,47(1):54-62
Aims
This study investigated the internal construct validity of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) personality disorders and explored alternative models to characterize the personality disorder traits. The relationship between the obtained personality disorder dimensions and measures of functioning and disability was examined.Methods
The subjects in the study were 742 community-residing individuals who participated in the Hopkins Epidemiology of Personality Disorders Study. The presence of DSM-IV personality disorder traits was assessed by psychologists using the International Personality Disorder Examination (IPDE). Confirmatory factor analysis was performed on all the IPDE criteria for each of the 10 personality disorders using the Mplus program. Exploratory factor analysis of all personality disorder traits was completed using the same program. Factor scores were correlated with subjects' GAF ratings and number of missed days from work for physical and psychological reasons.Results
A single underlying factor was found for the IPDE item criteria of avoidant and dependent personality disorder, with less evidence for the other 8 personality disorders. Five factors were retained as the dimensional accounting for the personality disorder criteria. These factors were named compulsive, neurotic avoidant, aloof, impulsive callous, and egocentric. Of the five factors, 4 were associated with evidence of diminished functioning.Conclusions
The IPDE pathological personality traits did not empirically cluster according to the current DSM-IV axis II diagnostic system but instead defined 5 relatively independent PD symptom dimensions that were related to functional impairments. 相似文献7.
Background
While it is well known that personality disorders are associated with trauma exposure and PTSD, limited nationally representative data are available on DSM-IV personality disorders that co-occur with posttraumatic stress disorder (PTSD) and partial PTSD.Methods
Face-to-face interviews were conducted with 34,653 adults participating in the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. Logistic regression analyses controlling for sociodemographics and additional psychiatric comorbidity evaluated associations of PTSD and partial PTSD with personality disorders.Results
Prevalence rates of lifetime PTSD and partial PTSD were 6.4% and 6.6%, respectively. After adjustment for sociodemographic characteristics and additional psychiatric comorbidity, respondents with full PTSD were more likely than trauma controls to meet criteria for schizotypal, narcissistic, and borderline personality disorders (ORs = 2.1-2.5); and respondents with partial PTSD were more likely than trauma controls to meet diagnostic criteria for borderline (OR = 2.0), schizotypal (OR = 1.8), and narcissistic (OR = 1.6) PDs. Women with PTSD were more likely than controls to have obsessive-compulsive PD. Women with partial PTSD were more likely than controls to have antisocial PD; and men with partial PTSD were less likely than women with partial PTSD to have avoidant PD.Conclusions
PTSD and partial PTSD are associated with borderline, schizotypal, and narcissistic personality disorders. Modestly higher rates of obsessive-compulsive PD were observed among women with full PTSD, and of antisocial PD among women with partial PTSD. 相似文献8.
Joachime Courjaret Christiaan K.W. Schotte Herlindis Wijnants Paul Cosyns 《Journal of psychosomatic research》2009,66(1):13-20
Objective
Personality is an important factor in the research of the chronic fatigue syndrome (CFS). Although some studies report a high rate of personality disorders—around the 40% level—in samples of patients with CFS, the generalizability of these findings can be questioned. The present study evaluates the prevalence of Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) personality disorders in a sample of female CFS patients and in two control groups.Method
The ADP-IV questionnaire (Assessment of DSM Personality Disorders IV) was used to assess the DSM-IV-TR personality disorders at a dimensional and categorical level in a sample of 50 female CFS patients and in two matched control samples of Flemish civilians (n=50) and psychiatric patients (n=50).Results
The results indicate a striking lack of statistical significant differences between the CFS sample and the Flemish control group at the level of dimensional Trait scores, number of criteria, and prevalence rates of personality disorder diagnoses. Unsurprisingly, higher scores at these levels were obtained within the psychiatric sample. The prevalence of an Axis II disorder was 12% in the Flemish and CFS samples, whereas the psychiatric sample obtained a prevalence of 54%.Conclusion
The prominent absence of any significant difference in personality disorder characteristics between the female Flemish general population and the CFS samples seems to suggest only a minor etiological role for personality pathology, as defined by the DSM-IV Axis II, within CFS. 相似文献9.
Abigail Powers 《Comprehensive psychiatry》2009,50(2):164
Objective
This study examined personality subtypes of adults diagnosed with panic disorder (PD).Methods
As part of a National Institute of Mental Health-funded study on personality in a clinical population, randomly selected psychologists and psychiatrists used a Q-sort instrument to describe 96 adults diagnosed with PD.Results
Q-factor analysis yielded 4 personality subtypes: high functioning, emotionally dysregulated, inhibited/avoidant, and somatizing. Within the sample, the subtypes differed on Axis I and II pathology, adaptive functioning, and developmental and family history variables. Personality constellations in the sample showed substantial incremental validity in predicting adaptive functioning and treatment response above and beyond the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I diagnoses.Conclusions
These distinctions may elucidate the high rates of comorbidity among patients with PD and are important in understanding treatment choice and outcome. 相似文献10.
Objective
Parenting and family dynamics influence the emergence, development, and maintenance of eating disorders (EDs). Although family interventions are relevant for therapeutic programs, knowledge of the relationship between parental personality traits and the eating psychopathology of daughters is scarce. This study explored the personality and psychopathology of women with EDs and correlated them with parental personality traits.Method
The personality and eating psychopathology traits of 38 restricter anorectics, 30 bingeing/purging anorectics, 37 bulimics, and their parents' personality traits (87 fathers and 97 mothers) were measured with the Temperament and Character Inventory, the Clinical Global Impression Scale, the Eating Disorders Inventory-2, and the Beck Depression Inventory. The results were compared with matched controls (54 women, 50 fathers, 54 mothers). Personality and psychopathology were correlated with multiple regression.Results
Women with ED displayed high harm avoidance and low self-directedness, whereas restricter anorectic women had high persistence. Low persistence was common in fathers of daughters across all EDs. Fathers of restricter anorectics were highly harm avoidant. Fathers of both anorectic subtypes and mothers of bulimic women displayed low self-directedness. Parental personality traits were linearly correlated with their daughter's personality and psychopathology, but the correlation differed among EDs.Conclusion
Parents of eating-disordered participants displayed personality characteristics that differed from controls and, among ED subgroups, these differences were related to their daughter's personality and psychopathology. The linear correlation did not fully explain the relationship of the parental personality traits to the presence of their daughter's ED, suggesting that a more complex personality-based family dynamic is involved. A Temperament and Character Inventory profile of the entire family may be used in the planning of family treatment. 相似文献11.
Swann AC Lijffijt M Lane SD Steinberg JL Moeller FG 《Journal of psychiatric research》2011,45(11):1477-1482
Background
Bipolar disorder and antisocial personality disorder (ASPD) overlap in clinical characteristics and behavioral consequences. Impulsivity is prominent in both, but there is little information on how specific mechanisms of impulsivity differentiate, bridge, or underlie the disorders.Methods
Subjects, all males, were controls (n = 46), bipolar disorder without cluster B personality disorder (n = 21), ASPD without bipolar disorder (n = 50), and bipolar disorder with ASPD (n = 16). Impulsivity measures were the Immediate Memory Task (IMT), a continuous performance test of response inhibition measuring ability to evaluate a stimulus before responding, and the Two-Choice Impulsivity Paradigm (TCIP), a choice between smaller-sooner and larger-later reward. Data were analyzed using general linear models analysis.Results
Subjects with bipolar disorder had fewer IMT correct detections and slower reaction times than controls. Reaction times were faster with combined diagnoses than in bipolar disorder alone. TCIP responding in either diagnosis alone resembled controls, but was more impulsive in combined disorders. These differences persisted after correction for age and education, which had significant independent effects. In combined ASPD and bipolar disorder, increased reaction speed, impulsive response bias, and reward-delay impulsivity occurred independent of substance-use disorder history.Conclusions
Impulsivity was increased in the combined disorders over either disorder alone. Results were consistent with at least partially distinct mechanisms of impulsivity in ASPD and bipolar disorder. Compensatory mechanisms for impulsivity in uncomplicated ASPD or bipolar disorder appear to be compromised or lost when the disorders are combined. 相似文献12.
J. Korkeila T. OksanenM. Virtanen P. SaloH. Nabi J. PenttiJ. Vahtera M. Kivimäki 《European psychiatry》2011,26(1):18-22
Objective
Risk of retirement from work before statutory retirement age among employees with personality disorders is unknown.Method
We used diagnoses of awarded medical rehabilitations and hospitalisations to select two clinical cohorts from a population of 151,618 employees: participants in rehabilitation (total N = 1942, 233 personality disorder, 419 anxiety disorder and 1290 depression cases) and hospitalised patients (N = 1333, 354, 126 and 853, respectively). Early retirement from work was tracked through national registers during a period of 5 years. Cox proportional hazard models were used to examine the association of diagnostic groups with risk of early retirement.Results
In models adjusted for age, sex and socioeconomic position, the relative risk of early retirement for patients with personality disorders was 3.5-fold (95% CI 2.1 to 5.8) in the rehabilitation cohort and 2.3-fold (95% CI 1.6 to 3.5) in the hospital cohort compared with anxiety disorders. The corresponding hazard ratios of early retirement for personality disorders compared with depressive disorders were 1.1 (95% CI 0.8-1.5) and 1.7 (95% CI 1.4-2.1), respectively.Conclusions
Personality disorders increase the risk of early retirement at least to an equal extent as depression and more than twice that of anxiety disorders. 相似文献13.
E. Perrier F. Pompei G. Ruberto E. Vassos D. Collier S. Frangou 《European psychiatry》2011,26(3):135-137
Background
The polymorphism rs1006737 within the CACNA1C gene is associated with increased risk for bipolar disorder (BD) and variations in brain morphology and function of subcortical regions. Here we sought to investigate the influence of CACNA1C polymorphism on key subcortical brain structures implicated in the pathophysiology of BD.Methods
Structural magnetic resonance imaging scans were acquired from 41 euthymic patients with BD and 40 healthy controls, who were also genotyped for the CACNA1C rs1006737 polymorphism. The effect of diagnosis, genotype and their interaction was examined in predefined volumes of interest in the basal ganglia, hypothalamus and amygdala extracted using SPM5.Results
Carriers of the CACNA1C rs1006737 risk allele showed increased grey matter density in the right amygdala and right hypothalamus irrespective of diagnosis. An interaction between genotype and diagnosis was observed in the left putamen which was smaller in BD patients carrying the risk allele than in healthy controls.Conclusions
: The CACNA1C rs1006737 polymorphism influences anatomical variation within subcortical regions involved in emotional processing. 相似文献14.
Purpose
The study investigated crucial aspects of the construct validity of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) histrionic personality disorder (HPD) category.Material and methods
The study included 2289 patients from the Norwegian Network of Psychotherapeutic Day Hospitals. Construct validity was assessed by means of prevalence, comorbidity with other personality disorders, internal consistency among HPD criteria, severity indices, as well as factor analyses.Results
The prevalence of HPD was very low (0.4 %). The comorbidity was high, especially with borderline, narcissistic, and dependent personality disorders. The internal consistency was low. The criteria seemed to form 2 separate clusters: the first contained exhibitionistic and attention-seeking traits and the other contained impressionistic traits.Conclusion
The results indicated poor construct validity of the HPD category. Different options for the future of the category are discussed. The authors suggest the HPD category to be deleted from the DSM system. However, the clinical phenomena of exhibitionism and attention-seeking, which are the dominant personality features of HPD, should be preserved in an exhibitionistic subtype of narcissism. 相似文献15.
16.
Craig Johnston Martin J. Dorahy Terry Bayles 《Journal of behavior therapy and experimental psychiatry》2009,40(2):248-255
Objective
To examine the relationship between dysfunctional schema modes, childhood trauma and dissociation in borderline personality disorder (BPD).Method
30 BPD patients completed the Wessex Dissociation Scale (WDS), Childhood Trauma Questionnaire (CTQ), General Health Questionnaire (GHQ), and Schema Mode Questionnaire (SMQ).Results
The ‘Angry and Impulsive Child’ and ‘Abandoned and Abused Child’ modes uniquely predicted dissociation scores. Childhood trauma did not predict dissociation scores.Conclusions
Findings support the schema mode model of BPD [Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: A practitioners guide. London: Guilford Press] and its emphasis on the role of dissociation. Clinically they support the emphasis on the identification and integration of dysfunctional parts of the personality in working with individuals diagnosed with BPD. 相似文献17.
J.D. Miller A. Pham-Scottez J.-P. Rolland F. De Fruyt 《Annales médico-psychologiques》2008,166(6):418-426
Introduction
Widespread and long-standing dissatisfaction with the current DSM-IV diagnostic system for the personality disorders (PDs) revolves around five specific issues: use of a dichotomous, categorical model; extremely high rates of comorbidity within the PDs, as well as with Axis I disorders; excessive heterogeneity within the PDs; nonempirically derived diagnostic cut-offs and limited coverage of the personality pathology seen by clinicians. Many critics have suggested that the personality pathology might be better characterized using a dimensional trait model of general or pathological personality. Much research documents support relations between the PDs and the five-factor model of personality (FFM), a prominent model of general personality functioning. Recent research has examined the ability of FFM trait configurations to assess the DSM-IV PDs. Initial work focused on matching individual FFM profiles to prototypical PD profiles derived from expert ratings. Although this initial work showed that these FFM-assessed PDs performed like explicit PD assessments, the prototype matching approach was deemed cumbersome and a simpler, alternative count technique derived from the expert profiles was developed. The FFM PD counts sum the facets rated as being particularly prototypic (high or low) of a PD.The current study
The current study tests the FFM PD counts by examining their convergent and discriminant validity correlations with explicit measures of DSM-IV PD symptomatology in two clinical samples (one French; one Belgian). In addition, “receiver operator characteristics” (ROC) analyses are used to provide information on the clinical utility of the FFM PD counts.Method
The French clinical sample consisted of 100 female inpatients hospitalized for treatment of an eating disorder, whereas the Belgian clinical sample consisted of 130 psychiatric inpatients (47% women) with diverse presenting problems. Translated versions of the NEO PI-R were used to assess the FFM in each sample and to generate the FFM PD counts. DSM-IV PD symptom counts and diagnoses were obtained via structured interview in the French sample and via self-reports in the Belgian sample.Results
In the French sample, convergent validity correlations between the FFM PD counts and DSM symptom counts ranged from 0.20 to 0.65 with a median r of 0.47. In the Belgian sample, these correlations ranged from 0.17 to 0.61 with a median r of 0.45. For the French sample, the median discriminant correlations for each FFM PD ranged from −0.23 to 0.35; for the Belgian sample they ranged from −0.13 to 0.28. Finally, ROC analyses were conducted for the PDs in which 10 or more individuals met the DSM diagnosis. ROC analyses provide “areas under the curve” (AUC), as well as other diagnostic efficiency statistics. An AUC of 0.50 indicates that the FFM PD count is no better at distinguishing between those with and without a given PD diagnosis than chance. AUCs were significant for all PDs examined except for the OCPD, ranging from 0.57 to 0.94 with a mean of 0.75. Average diagnostic efficiency statistics were also generally good.Discussion
The FFM PD counts adequately assess the majority of extant DSM PDs. With the recent development of normative data and scoring sheets, these FFM counts can be applied in most clinical settings. Importantly, FFM data can be used flexibly with a focus either on the role of specific domains and facets or on specific trait configurations. Additionally, there are theoretical benefits to conceiving of PDs as constellations of FFM trait. Comorbidity is to be expected to the degree that the PDs include the same traits. The FFM PD counts are inherently dimensional, representing approximations to a prototype; thus, concerns surrounding the PDs as categories are rendered inert. Using the FFM to conceptualize the PDs allows basic research on personality to inform research on the etiology, course and treatment of the PDs. 相似文献18.
David J. Hellerstein Andrew E. Skodol Eva Petkova Hui Xie John C. Markowitz Shirley Yen Carlos Grilo Thomas H. McGlashan 《Comprehensive psychiatry》2010,51(5):449
Objective
The goal of our study was to investigate the impact of dysthymic disorder (DD), a form of chronic depression, on naturalistic outcome in individuals with personality disorders (PDs).Method
The Collaborative Longitudinal Personality Disorders Study is a cohort initially including 573 subjects with 4 targeted PDs (borderline, avoidant, schizotypal, and obsessive-compulsive) and 95 subjects with major depression but no PD. At baseline, 115 subjects were diagnosed with coexisting DD, of whom 109 (94.8%) were PD subjects. Regression analyses were performed to predict 3 classes of broad clinical outcome after 2 years of prospective follow-up. We hypothesized that DD diagnosis at baseline would be associated with worse outcome on (1) persistence of a PD diagnosis, (2) impairment in psychosocial functioning (as measured by the Longitudinal Interval Follow-up Evaluation), and (3) crisis-related treatment utilization.Results
Baseline DD diagnosis was associated with persistence of PD diagnosis at 2 years, particularly for borderline and avoidant PDs. It was associated with worse outcome on global social adjustment, life satisfaction, recreation, and friendships, but not employment or relationship with spouse. Contrary to expectation, DD did not increase suicide attempts, emergency room visits, or psychiatric hospitalizations.Conclusions
Comorbidity of DD is associated with persistence of PD diagnosis and with worse outcome on many, but not all, measures of psychosocial functioning. 相似文献19.
Background
Antisocial personality disorder (ASPD) and psychopathy are different diagnostic constructs. It is unclear whether they are separate clinical syndromes or whether psychopathy is a severe form of ASPD.Methods
A representative sample of 496 prisoners in England and Wales was interviewed in the second phase of a survey carried out in 1997 using the Schedules for Clinical Assessment in Neuropsychiatry, the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis II personality disorders, and the Psychopathy Checklist-Revised.Results
Among those 18 years and older (n = 470), 211 (44.9%) received a diagnosis of ASPD, of whom 67 (31.8%) were classified as psychopaths, indicated by Psychopathy Checklist-Revised scores of 25 and above. Symptoms of ASPD and psychopathy both demonstrated low diagnostic contrast when comparing subgroups of ASPD above and below the cutoff for psychopathy. There were no differences in demography, Axis I comorbidity, and treatment-seeking behavior. Psychopathic individuals with ASPD demonstrated comorbid schizoid and narcissistic personality disorder, more severe conduct disorder and adult antisocial symptoms, and more violent convictions.Conclusions
Psychopathy and ASPD are not separate diagnostic entities, but psychopathic ASPD is a more severe form than ASPD alone with greater risk of violence. Dimensional scores of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition personality disorders (other than ASPD) may be helpful in identifying this specific subgroup. 相似文献20.