Cluster A personality pathology in social anxiety disorder: A comparison with panic disorder

Abstract

Background: Social anxiety disorder (SAD) has been associated with cluster A personality disorder (PD) traits, mainly paranoid and schizoid traits. Aim: The aim of the study was to further investigate cluster A personality pathology in patients with SAD. Methods: Self-reported PD traits were investigated in a clinical sample of 161 participants with SAD and in a clinical comparison group of 145 participants with panic disorder with or without agoraphobia (PAD). Results: A diagnosis of SAD was associated with more paranoid and schizotypal PD traits, and an association between depression and personality pathology could indicate a state-effect of depression on PD traits. Conclusions: Patients with SAD had more cluster A personality pathology than patients with PAD, with the most solid indication for paranoid personality pathology.     

Comorbid personality disorders and their impact on severe dissociative experiences in Mexican patients with borderline personality disorder

Abstract

Objective: To identify personality disorders comorbid with borderline personality disorder (BPD) that may confer greater risk for the presence of severe dissociative experiences.

Method: Three hundred and one outpatients with a primary diagnosis of BPD were evaluated using the Structured Clinical Interview for DSM-IV Axis II personality disorders, the Borderline Evaluation of Severity Over Time (BEST) and the Dissociative Experiences Scale (DES).

Results: The most frequent personality disorders comorbid to BPD were paranoid (83.2%, n?=?263) and depressive (81.3%, n?=?257). The mean BEST and DES total score were 43.3 (SD?=?11.4, range 15–69) and 28.6 (SD?=?19.8, range 0–98), respectively. We categorized the sample into patients with and without severe dissociative experiences (41% were positive). A logistic regression model revealed that Schizotypal, Obsessive-compulsive and Antisocial personality disorders conferred greater risk for the presence of severe dissociative experiences.

Discussion: Our results suggest that a large proportion of patients with BPD present a high rate of severe dissociative experiences and that some clinical factors such as personality comorbidity confer greater risk for severe dissociation, which is related to greater dysfunction and suffering, as well as a worse progression of the BPD.     

Association between a serotonin transporter promoter polymorphism (5HTTLPR) and personality disorder traits in a community sample

Background

The serotonin transporter (SERT) polymorphism (5HTTLPR) has been reported to be associated with several psychiatric conditions. Specific personality disorders could be intermediate factors in the known relationship between 5HTTLPR and psychiatric disorders. This is the first study to test the association between this polymorphism and dimensions of all DSM-IV personality disorders in a community sample.

Methods

374 white participants were assessed by clinical psychologists using the International Personality Disorder Examination (IPDE). Associations between dimensions of each DSM-IV personality disorder and the long (l) and short (s) alleles of the 5HTTLPR were evaluated using non-parametric tests and regression models.

Results

The s allele of the 5HTTLPR polymorphism was significantly associated with higher avoidant personality trait scores in the whole sample. Males with the s allele had a significantly lower likelihood of higher obsessive-compulsive personality disorder (OCPD) trait scores, whereas females with the s allele were likely to have higher OCPD personality trait scores.

Conclusion

This paper provides preliminary data on the relationship between personality disorders and the 5HTTLPR polymorphism. The relationship of the s allele and avoidant PD is consistent with findings of a nonspecific relationship of this polymorphism to anxiety and depressive disorders. Concerning the unusual sexual dimorphic result with OCPD, several hypotheses are presented. These findings need further replication, including a more detailed study of additional variants in SERT.     

The heritability of avoidant and dependent personality disorder assessed by personal interview and questionnaire

Gjerde LC, Czajkowski N, Røysamb E, Ørstavik RE, Knudsen GP, Østby K, Torgersen S, Myers J, Kendler KS, Reichborn‐Kjennerud T. The heritability of avoidant and dependent personality disorder assessed by personal interview and questionnaire. Objective: Personality disorders (PDs) have been shown to be modestly heritable. Accurate heritability estimates are, however, dependent on reliable measurement methods, as measurement error deflates heritability. The aim of this study was to estimate the heritability of DSM‐IV avoidant and dependent personality disorder, by including two measures of the PDs at two time points. Method: Data were obtained from a population‐based cohort of young adult Norwegian twins, of whom 8045 had completed a self‐report questionnaire assessing PD traits. 2794 of these twins subsequently underwent a structured diagnostic interview for DSM‐IV PDs. Questionnaire items predicting interview results were selected by multiple regression, and measurement models of the PDs were fitted in Mx. Results: The heritabilities of the PD factors were 0.64 for avoidant PD and 0.66 for dependent PD. No evidence of common environment, that is, environmental factors that are shared between twins and make them similar, was found. Genetic and environmental contributions to avoidant and dependent PD seemed to be the same across sexes. Conclusion: The combination of both a questionnaire‐ and an interview assessment of avoidant and dependent PD results in substantially higher heritabilities than previously found using single‐occasion interviews only.     

A retrospective study of separation in the development of adult avoidant personality disorder

This retrospective study investigated experiences of separation and perceptions of early relations with parents and peers by patients diagnosed as having avoidant personality disorder. The main hypothesis of our study was that patients diagnosed as having avoidant personality disorder would report more actual separations and more pathogenic parenting than normal control subjects. This hypothesis was not supported. The main features differentiating patients from normals were: perceptions of a encouraging home climate, and less demonstrations of love and pride in the child on the part of the parents.     

Psychotic reactivity in borderline personality disorder

Glaser J‐P, Van Os J, Thewissen V, Myin‐Germeys I. Psychotic reactivity in borderline personality disorder. Objective: To investigate the stress relatedness and paranoia specificity of psychosis in borderline personality disorder (BPD). Method: Fifty‐six borderline patients, 38 patients with cluster C personality disorder, 81 patients with psychotic disorder and 49 healthy controls were studied with the experience sampling method (a structured diary technique) to assess: i) appraised subjective stress and ii) intensity of psychotic experiences. Results: All patient groups experienced significantly more increases in psychotic experiences in relation to daily life stress than healthy controls, borderline patients displaying the strongest reactivity. Borderline patients, moreover, reported significantly more hallucinatory reactivity than healthy controls and subjects with cluster C personality disorder. Paranoid reactivity to daily life stress did not differ between the patient groups. Conclusion: These results are the first to ecologically validate stress‐related psychosis in BPD. However, psychotic reactivity was not limited to expression of paranoia but involved a broader range of psychotic experiences including hallucinations.     

Interacting mechanisms of impulsivity in bipolar disorder and antisocial personality disorder

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.     

Bipolar obsessive-compulsive disorder and personality disorders

OBJECTIVES: Relatively few systematic data exist on the clinical impact of bipolar comorbidity in obsessive-compulsive disorder (OCD) and no studies have investigated the influence of such a comorbidity on the prevalence and pattern of Axis II comorbidity. The aim of the present study was to explore the comorbidity of personality disorders in a group of patients with OCD and comorbid bipolar disorder (BD). METHODS: The sample consisted of 204 subjects with a principal diagnosis of OCD (DSM-IV) and a Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score>or=16 recruited from all patients consecutively referred to the Anxiety and Mood Disorders Unit, Department of Neuroscience, University of Turin over a period of 5 years (January 1998-December 2002). Diagnostic evaluation and Axis I comorbidities were collected by means of the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Personality status was assessed by using the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II). Socio-demographic and clinical features (including Axis II comorbidities) were compared between OCD patients with and without a lifetime comorbidity of BD. RESULTS: A total of 21 patients with OCD (10.3%) met DSM-IV criteria for a lifetime BD diagnosis: 4 (2.0%) with BD type I and 17 (8.3%) with BD type II. Those without a BD diagnosis showed significantly higher rates of male gender, sexual and hoarding obsessions, repeating compulsions and lifetime comorbid substance use disorders, when compared with patients with BD/OCD. With regard to personality disorders, those with BD/OCD showed higher prevalence rates of Cluster A (42.9% versus 21.3%; p=0.027) and Cluster B (57.1% versus 29.0%; p=0.009) personality disorders. Narcissistic and antisocial personality disorders were more frequent in BD/OCD. CONCLUSIONS: Our results point towards clinically relevant effects of comorbid BD on the personality profiles of OCD patients, with higher rates of narcissistic and antisocial personality disorders in BD/OCD patients.     

Pain sensitivity is reduced in borderline personality disorder,but not in posttraumatic stress disorder and bulimia nervosa

Background. Several studies revealed reduced pain sensitivity in patients suffering from borderline personality disorder (BPD) under baseline and stress conditions. To establish whether these findings are specific for BPD, we compared pain thresholds in patients with BPD, posttraumatic stress disorder (PTSD), bulimia nervosa, and healthy controls. Methods. The study included 76 female subjects: 16 patients with BPD, 16 patients with PTSD, 20 patients with bulimia nervosa and 24 healthy controls. Heat and cold pain thresholds were assessed under baseline and stress conditions, using a contact thermode. Mental stress was induced by the Paced Auditory Serial Addition Task. Results. Under baseline conditions, pain thresholds in patients with BPD were significantly higher compared to healthy controls. Patients with PTSD and bulimia nervosa did not show significant differences in pain thresholds compared to healthy controls. Under stress conditions, the difference between BPD patients and healthy controls became even more prominent, whereas the results in the other patient groups remained insignificant. Conclusions. Our results support the hypothesis that reduced pain sensitivity is a prominent feature of BPD, which may differentiate this disorder from other stress-related psychiatric conditions.     

Ecologically valid support for the link between cognitive and psychosocial functioning in bipolar disorder

Prior research into the link between cognitive and psychosocial functioning in bipolar disorder has examined primarily asymptomatic patients, has measured these domains concurrently, and has failed to establish convergent validity in the assessment of psychosocial dysfunction. The present study examines the relation between cognitive and psychosocial functioning at the time of discharge from hospitalization for acute mood disturbance. We obtained measures of psychosocial functioning that were both close and distant to the time of neuropsychological testing; the former from the discharging psychiatrists, and the latter from reports of formally recognized disability status, determined by persons wholly unrelated to the present research. Sixty-three patients with bipolar I disorder, hospitalized for acute mood disturbance, completed a neuropsychological test battery 24 to 48 h prior to discharge. We compared patients with versus without formal disability status on the Global Assessment of Functioning (GAF) scale and on scores of neuropsychological tests. We also tested associations between GAF scores and cognitive test scores. Results supported the convergent validity in the measurement of psychosocial disability, underscored the robust connection between cognitive and psychosocial impairment, and highlighted the presence of this connection during an important clinical state — time of discharge from psychiatric hospitalization.     

共病边缘型人格障碍的双相情感障碍患者认知功能状况

背景 双相情感障碍与边缘型人格障碍（BPD）共病率高,共病患者认知功能受损更严重。目的 探讨是否共病BPD的双相情感障碍患者认知功能的差异,为临床诊疗提供参考。方法 采用简单随机抽样,选取2021年4月-2022年4月在河北医科大学第一医院治疗的共病BPD的双相情感障碍患者60例（共病组）,其中双相抑郁患者33例,双相躁狂患者27例。同时选取双相情感障碍患者60例（未共病组）,其中双相抑郁35例,双相躁狂25例。采用中文版神经心理状态测验（RBANS）和Stroop色词测验评估患者的认知功能。结果 共病组RBANS中的即刻记忆、视觉广度、言语功能和总评分均低于未共病组,差异均有统计学意义（t=-2.356、-2.138、-3.306、-2.729,P<0.05或0.01）,Stroop色词测验中的单字时间、单色时间、双字时间和双色时间均长于未共病组,差异均有统计学意义（t=4.808、3.341、5.249、5.167,P均<0.01）。共病BPD的双相抑郁患者RBANS中的即刻记忆、视觉广度、言语功能和总评分均低于未共病BPD的双相抑郁患者（t=-2.446、-2.407、-2.231、-2.078,P均<0.05）,Stroop色词测验中的单字时间、单色时间、双字时间和双色时间均长于未共病组（t=3.652、3.035、4.406、5.016,P均<0.01）。共病组双相躁狂患者RBANS中的言语功能和总评分均高于未共病组（t=-2.777、-2.347,P<0.05或0.01）,Stroop色词测验中的单字时间、单色时间、双字时间和双色时间均长于未共病组（t=3.600、2.658、2.943、4.337,P<0.05或0.01）。结论 相较于未共病BPD的双相情感障碍患者,共病BPD的双相情感障碍患者认知功能受损更严重。     

Comorbidity between obsessive-compulsive disorder (OCD) and personality disorders

The aims of the present study were to examine the frequency of personality disorders in 36 patients with obsessive-compulsive disorder (OCD), and to investigate whether patients with a coexisting personality disorder could be characterized by certain personality traits assessed by means of the Karolinska Scales of Personality (KSP). In total, 27 (75%) of the OCD patients fulfilled the DSM-III-R criteria for a personality disorder, and 13 patients (36%) had an obsessive-compulsive personality disorder. Subjects with a comorbid personality disorder had significantly higher scores on most of the KSP scales, including all anxiety scales, as well as scales measuring indirect aggression, irritability, guilt and detachment, whereas subjects without personality disorders did not differ significantly from healthy controls with regard to personality traits.     

Variants of premorbid personality and personality disorder: a taxonomic model of their relationships

From a biographical analysis of approximately 500 case records of patients with various kinds of mental state (in particular mood, anxiety and schizophrenic) disorders, a typology of premorbid personality variants was derived. It comprises three “affective types” dominating in patients with major affective disorders and three “neurotoid types” prevailing in other, above all anxity and schizophrenic, disorders. These types were operationalized so that they could be assessed by means of diagnostically “blind”rating of biographical case reports or of interview protocols concerning the premorbid development of clinically remitted patients. The material for the present analysis consisted of ratings regarding 120 subjects (100 patients and 20 healthy controls) who had been interviewed within a project primarily aiming at the development of a novel assessment tool, the Biographical Personality Interview (BPI). This data was used for constructing a comprehensive taxonomic model of premorbid personality variants and their relationships to personality disorders. The intercorrelation of type-scores representing the six premorbid personality types suggests a circular order of these types, opposing the “neurotoid types” on one side to the “affective types” on the other side of the circle (circumplex) along a dimension of mental abnormality vs. normality. Two types, the (“neurotoid”) nervous, tense type, and the (“affective”) manic type are contrasted with the (“affective”) melancholic and the (“neurotoid”) anxious, insecure types along an orthogonal dimension of rather changeable vs. rather constant habitual behaviour. This order is confirmed by the correlation of type-scores with factor scores of the two main dimensions ob BPI-item scores. It is also concordant with the correlation of type-scores and scores on questionnaire scales of personality. Personality disorders as maladapted extreme variants of personality can be located outside the circle according to their similarity or dissimilarity with the six premorbid personality types. They are necessarily distributed almost exclusively along the “neurotoid” side of the circumplex. This two-dimensional model of variants of premorbid personality and personality disorders is in basic agreement with models derived from dimensions of personality in mentally healthy subjects and with findings concerning the comorbidity among personality disorders. Further empirical studies are required for choosing or developing the most appropriate model of the relationships between personality variants and personality disorders. Received: 8 March 2000 / Accepted: 31 May 2000     

Psychological distress and functional impairment in patients with personality disorders

The study is aimed at investigating the impact of a personality disorder (PD) diagnosis, in terms of functional impairment and subjective distress, in order to better understand the burden of this diagnosis and its implications. Among the 462 consecutive psychiatric patients diagnosed with the DSM structured interview for Axis I, II and V diagnoses, almost 60% had PD. Patients with PD displayed considerable vulnerability and suffering in many domains, including finances and interpersonal relationships. Despite the educational and occupational similarities of PD patients and non-PD patients, the PD patients had more problems maintaining permanent job positions. They also had more symptomatic suffering and concerns about health than non-PD patients. Generally, the results were in line with findings in the literature but more thoroughly captured the challenges that PD patients face in various areas of life. Awareness of the frequent comorbidity of PD with Axis I disorders seems crucial in developing future treatment plans with an emphasis on psychosocial rehabilitation, vocational training and social support.     

Perception of early parenting by patients diagnosed avoidant personality disorder: a test of the overprotection hypothesis

The perceptions of their parents by patients diagnosed avoidant personality disorder (DSM-III) and matched normal subjects were compared. The overprotection hypothesis proposed by Parker was not found to predict the perceptions of patients diagnosed avoidant personality disorder. Social introversion in patients was found to be related to perceptions of their parents as shaming, guilt-engendering and intolerant.     

The effects of comorbid personality disorders on cognitive behavioral treatment for panic disorder

The present study investigated the influence of personality pathology assessed both dimensionally and categorically on acute clinical response to group cognitive-behavioral treatment in a large sample of panic disorder patients (N = 173) meeting DSMIII-R criteria for panic disorder with or without agoraphobia. Nearly one-third of the sample met for one or more personality disorders, with the majority meeting for a Cluster C diagnosis. Patients with one or more comorbid personality disorders displayed higher baseline and higher post treatment scores across multiple indices of panic disorder severity compared to those without personality disorders. After controlling for panic disorder severity at baseline, the presence of both Cluster C and Cluster A Pers-Ds predicted a poorer outcome, whereas when assessed dimensionally, only Cluster C symptoms predicted a poorer treatment response. However, the influence of personality pathology was modest relative to that of baseline panic disorder severity.     

Interactions between bipolar disorder and antisocial personality disorder in trait impulsivity and severity of illness

Swann AC, Lijffijt M, Lane SD, Steinberg JL, Moeller FG. Interactions between bipolar disorder and antisocial personality disorder in trait impulsivity and severity of illness. Objective: We investigated trait impulsivity in bipolar disorder and antisocial personality disorder (ASPD) with respect to severity and course of illness. Method: Subjects included 78 controls, 34 ASPD, 61 bipolar disorder without Axis II disorder, and 24 bipolar disorder with ASPD, by Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (DSM‐IV) (SCID‐I and ‐II). Data were analyzed using general linear model and probit analysis. Results: Barratt Impulsiveness Scale (BIS‐11) scores were higher in ASPD (effect sizes 0.5–0.8) or bipolar disorder (effect size 1.45) than in controls. Subjects with both had more suicide attempts and previous episodes than bipolar disorder alone, and more substance‐use disorders and suicide attempts than ASPD alone. BIS‐11 scores were not related to severity of crimes. Conclusion: Impulsivity was higher in bipolar disorder with or without ASPD than in ASPD alone, and higher in ASPD than in controls. Adverse effects of bipolar disorder in ASPD, but not of ASPD in bipolar disorder, were accounted for by increased impulsivity.     

Longitudinal outcome in patients with bipolar disorder assessed by life-charting is influenced by DSM-IV personality disorder symptoms

Objectives:  Few studies have examined the question of how personality features impact outcome in bipolar disorder (BD), though results from extant work and studies in major depressive disorder suggest that personality features are important in predicting outcome. The primary purpose of this paper was to examine the impact of DSM-IV personality disorder symptoms on long-term clinical outcome in BD.
Methods:  The study used a 'life-charting' approach in which 87 BD patients were followed regularly and treated according to published guidelines. Outcome was determined by examining symptoms over the most recent year of follow-up and personality symptoms were assessed with the Structured Clinical Interview for DSM-IV (SCID-II) instrument at entry into the life-charting study.
Results:  Patients with better outcomes had fewer personality disorder symptoms in seven out of 10 disorder categories and Cluster A personality disorder symptoms best distinguished euthymic and symptomatic patients.
Conclusions:  These results raise important questions about the mechanisms linking personality pathology and outcome in BD, and argue that conceptual models concerning personality pathology and BD need to be further developed. Treatment implications of our results, such as need for psychosocial interventions and treatment algorithms, are also described.     

Axis II comorbidity of borderline personality disorder: description of 6-year course and prediction to time-to-remission

OBJECTIVE: The purpose of this study was to compare the axis II comorbidity of 202 patients whose borderline personality disorder (BPD) remitted over 6 years of prospective follow-up to that of 88 whose BPD never remitted. METHOD: The axis II comorbidity of 290 patients meeting both DIB-R and DSM-III-R criteria for BPD was assessed at baseline using a semistructured interview of demonstrated reliability. Over 96% of surviving patients were reinterviewed about their co-occurring axis II disorders blind to all previously collected information at three distinct follow-up waves: 2-, 4-, and 6-year follow-up. RESULTS: Both remitted and non-remitted borderline patients experienced declining rates of most types of axis II disorders over time. However, the rates of avoidant, dependent, and self-defeating personality disorders remained high among non-remitted borderline patients. Additionally, the absence of these three disorders was found to be significantly correlated with a borderline patient's likelihood-of-remission and time-to-remission; self-defeating personality disorder by a factor of 4, dependent personality disorder by a factor of 3 1/2, and avoidant personality disorder by a factor of almost 2. CONCLUSION: The results of this study suggest that axis II disorders co-occur less commonly with BPD over time, particularly for remitted borderline patients. They also suggest that anxious cluster disorders are the axis II disorders which most impede symptomatic remission from BPD.