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Psychodynamic Psychiatry 2021Recent advances in the understanding of personality pathology have contributed to an emphasis on the core of personality pathology as deficits in self-functioning and...
Recent advances in the understanding of personality pathology have contributed to an emphasis on the core of personality pathology as deficits in self-functioning and interpersonal functioning at different levels of severity that must be assessed for clinical intervention. In concert with these conceptual and empirical advances, transference-focused psychotherapy (TFP), an empirically supported psychodynamic treatment for borderline personality disorder, has been in constant development with extensive clinical use. This article describes an object relations model for conceptualizing and assessing levels of personality organization, a transdiagnostic approach to personality pathology, and related treatment modifications, thus expanding the utilization of TFP beyond borderline personality disorder to the full range of personality dysfunction. The core of this treatment approach is a sequential interpretive process between patient and therapist. This process takes place within the context of a structured treatment frame tailored to the unique individual with problems in self-functioning and interpersonal functioning in his/her particular environment.
Topics: Borderline Personality Disorder; Female; Humans; Male; Object Attachment; Personality Disorders; Psychotherapy; Transference, Psychology
PubMed: 34061652
DOI: 10.1521/pdps.2021.49.2.188 -
Current Psychiatry Reports Jul 2019We review recent empirical investigations about two core processes subtending impairments in interpersonal functioning and, more precisely, cooperative behaviors in... (Review)
Review
PURPOSE OF REVIEW
We review recent empirical investigations about two core processes subtending impairments in interpersonal functioning and, more precisely, cooperative behaviors in personality disorders: Trust toward others and rejection sensitivity. The main contributions are about borderline and narcissistic personality disorders but we report a little evidence about other personality disorders too (i.e., avoidant, antisocial, and paranoid personality disorders).
RECENT FINDINGS
Regarding borderline personality disorder, a misinterpretation of situations as threatening seems to be relevant for both trust and rejection sensitivity. With specific regard to narcissistic personality disorder, results suggest rejection sensitivity and distrust to be plausible risk factors for aggressive outbursts. Empirical findings display specific patterns of disturbances in rejection sensitivity and trust dynamics across different personality disorders. Nonetheless, further studies on personality disorders other than borderline or narcissistic personality disorder are needed. A deeper understanding may provide insight for better clinical management of such impairments among patients with personality disorders.
Topics: Antisocial Personality Disorder; Borderline Personality Disorder; Humans; Interpersonal Relations; Narcissism; Personality Disorders; Rejection, Psychology; Trust
PubMed: 31264030
DOI: 10.1007/s11920-019-1059-3 -
Current Opinion in Psychology Jun 2018Personality disorders impair social, occupational, leisure, and global functioning more than a significant disorder such as major depressive disorder. Impairment is... (Review)
Review
Personality disorders impair social, occupational, leisure, and global functioning more than a significant disorder such as major depressive disorder. Impairment is found in clinical and community populations. Impairment is independent of co-occurring other mental disorders. Impairment is more stable over time than are the diagnoses themselves. Personality traits are also impairing and may be more predictive of outcomes over time, but a hybrid of personality disorder features and normal range personality traits may be the most predictive model. A general, 'transdiagnostic,' self-other severity factor may be important for understanding the relationship of personality pathology and psychosocial functioning over time. The Alternative DSM-5 Model for Personality Disorders may be useful for the study of psychosocial functioning in individuals with personality pathology.
Topics: Comorbidity; Depressive Disorder, Major; Diagnostic and Statistical Manual of Mental Disorders; Humans; Models, Psychological; Personality Disorders; Psychiatric Status Rating Scales
PubMed: 28961463
DOI: 10.1016/j.copsyc.2017.09.006 -
Journal of Personality Disorders Jun 2021Health and social care professionals are more likely to hold negative attitudes towards people with a diagnosis of personality disorder than toward people with other... (Review)
Review
Health and social care professionals are more likely to hold negative attitudes towards people with a diagnosis of personality disorder than toward people with other mental health diagnoses. Negative attitudes have also been found to adversely impact care and service provision. This review sought to systemically evaluate training aimed at improving professional attitudes towards people with a diagnosis of personality disorder. Electronic databases PsychINFO, PubMed, Embase, Web of Science, and ProQuest were searched, and 19 articles were identified. Results show that training is effective and that improvements tend to be maintained. The results suggest that (1) co-production with people with personal experience of a personality disorder diagnosis, (2) communicating a psychological model to participants, and (3) teaching participants clinical skills for use in their work improve effectiveness. Further research in the form of randomized controlled trials that use validated measures and follow-up participants for at least 6 months is needed.
Topics: Attitude of Health Personnel; Clinical Competence; Health Knowledge, Attitudes, Practice; Humans; Personality Disorders; Social Support
PubMed: 31682190
DOI: 10.1521/pedi_2019_33_458 -
Assessment Jan 2024The purpose of this article is to provide a description and discussion of the evidence-based assessment of personality disorder. Considered herein is the assessment of...
The purpose of this article is to provide a description and discussion of the evidence-based assessment of personality disorder. Considered herein is the assessment of the Section II personality disorders included within the fifth edition of the American Psychiatric Association's (APA) (5th ed., text rev.; -5-TR), within Section III of -5-TR, and within the 11th edition of the World Health Organization's International Classification of Diseases (WHO). The recommendation for an evidence-based assessment is for a multimethod approach: first administer a self-report inventory to alert the clinician to maladaptive personality functioning that might not have otherwise been anticipated, followed by a semi-structured interview to verify the personality disorder's presence. The validity of this multimethod strategy can be improved further by considering the impact of other disorders on the assessment, documenting temporal stability, and establishing a compelling, empirical basis for cutoff points.
Topics: Humans; Personality Disorders; Personality; Diagnostic and Statistical Manual of Mental Disorders; Personality Assessment; Self Report; Personality Inventory
PubMed: 37231676
DOI: 10.1177/10731911231176461 -
Child Abuse & Neglect Jun 2023Parental pathology may affect parenting capacity and is deemed a risk factor for child maltreatment. Especially parental personality disorder (PD) can significantly... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Parental pathology may affect parenting capacity and is deemed a risk factor for child maltreatment. Especially parental personality disorder (PD) can significantly burden the relationship and interaction between parents and their children.
OBJECTIVE
This meta-analytic review aims to summarize and quantify the influence of parental PD on the occurrence / the risk of child maltreatment.
PARTICIPANTS AND SETTING
Studies had to meet the following inclusion criteria: They had to analyze a sample of parents with a diagnosed PD and the occurrence / risk of maltreating their children. To be included in the narrative synthesis and/or meta-analysis, they had to be case-control, cross-sectional, or longitudinal studies. Literature research was conducted in the databases Web of Science, Psychinfo, and Google Scholar up to January 2023.
METHODS
First, studies were analyzed on a narrative level, and eligible studies for the meta-analysis were identified. Studies were grouped according to the diagnosed PDs. Five different groups were included: borderline PD, antisocial PD, narcissistic PD, nondifferentiated PDs, and Cluster B PDs. Three different random-effects meta-analyses were computed (borderline PD, antisocial PD, Cluster B PDs). Meta-analyses were controlled for publication bias and different covariates (e.g., study quality, sample size).
RESULTS
After screening 41 full texts, 17 studies were included in the narrative synthesis, out of which 14 samples from 11 studies were included in the meta-analysis. Analysis of borderline PD showed an association with the occurrence / risk of child maltreatment (OR = 8.08; 95 % CI [2.51, 25.93]). However, after taking into account possible publication bias, this association was no longer significant. We found a significant and stable association between antisocial PD and the occurrence of / risk of child maltreatment (OR = 4.92; 95 % CI [3.26, 7.43]). Analysis of Cluster B PDs (antisocial, borderline, histrionic, narcissistic) revealed a significant overall association (OR = 4.23; 95 % CI [2.75, 6.5]), indicating that the presence of Cluster B PDs in parents significantly increases the occurrence of / the risk of child maltreatment.
CONCLUSIONS
Analyses indicated a significant association between of Cluster B PDs, and specifically between antisocial and borderline PD, with the occurrence of / the risk of child maltreatment. However, methodological limitations have to be taken into account, because results for borderline PD were no longer significant after controlling for possible publication bias. Moreover, the number of studies included was rather small, and results showed a substantial amount of heterogeneity.
OTHER
This work was not supported by any funding.
Topics: Humans; Child; Cross-Sectional Studies; Personality Disorders; Borderline Personality Disorder; Antisocial Personality Disorder; Child Abuse; Parents
PubMed: 37060689
DOI: 10.1016/j.chiabu.2023.106148 -
Current Psychiatry Reports Apr 2016Children suffering from attention deficit hyperactivity disorder (ADHD) may remit until adulthood. But, more than 60-80% have persisting ADHD symptoms. ADHD as an early... (Review)
Review
Children suffering from attention deficit hyperactivity disorder (ADHD) may remit until adulthood. But, more than 60-80% have persisting ADHD symptoms. ADHD as an early manifesting neurodevelopmental disorder is considered a major risk factor for the development of comorbid psychiatric disorders in later life. Particularly, personality disorders are oftentimes observed in adult patients suffering from ADHD. If ADHD and personality disorders share common etiological mechanisms and/or if ADHD as a severely impairing condition influences psychological functioning and learning and leads to unfavorable learning histories is unclear. The development of inflexible and dysfunctional beliefs on the basis of real and perceived impairments or otherness due to the core symptoms of ADHD is intuitively plausible. Such beliefs are a known cause for the development of personality disorders. But, why some personality disorders are more frequently found in ADHD patients as for example antisocial and borderline personality disorder remains subject of debate. Because of the high prevalence of ADHD and the high impact of personality disorders on daily functioning, it is important to take them into account when treating patients with ADHD. Research on the developmental trajectories leading to personality disorders in adult ADHD patients might open the door for targeted interventions to prevent impairing comorbid clinical pictures.
Topics: Adult; Antisocial Personality Disorder; Attention Deficit Disorder with Hyperactivity; Borderline Personality Disorder; Comorbidity; Humans; Personality Disorders; Prevalence; Risk Factors
PubMed: 26893231
DOI: 10.1007/s11920-016-0675-4 -
Journal of Personality Disorders Jun 2017Many argue that current categorical personality disorder (PD) classification systems should be more dimensional and consider personality traits. The present study...
Many argue that current categorical personality disorder (PD) classification systems should be more dimensional and consider personality traits. The present study examined whether a brief PD screening tool, the Standardized Assessment of Personality: Abbreviated Scale (SAPAS) primarily screened for traits of low emotional stability, low extraversion, and low agreeableness, rather than PD per se. A general community sample (n = 237) completed the SAPAS, a personality trait measure, and the International Personality Disorder Examination (IPDE) screening questionnaire. Regressions showed that the SAPAS provided substantial incremental validity over personality trait scores in predicting total IPDE scores, indicating that the SAPAS captures variance unique to PD, rather than just extremes of general disposition. The SAPAS is an empirically valid rapid PD screen for nonclinical populations, correctly identifying 78% of individuals who screen positively for PD on the IPDE. However, the SAPAS was not effective for screening antisocial PD, limiting its utility in forensic settings.
Topics: Adolescent; Adult; Aged; Female; Humans; Male; Middle Aged; Personality Disorders; Personality Tests; Surveys and Questionnaires; Young Adult
PubMed: 27387058
DOI: 10.1521/pedi_2016_30_259 -
Current Opinion in Psychiatry Sep 2019It is not uncommon for clinicians to label patients' complaints as 'psychogenic' when they present with symptoms that are difficult to understand. This article reviews... (Review)
Review
PURPOSE OF REVIEW
It is not uncommon for clinicians to label patients' complaints as 'psychogenic' when they present with symptoms that are difficult to understand. This article reviews recent reports about the comorbidity of personality disorders and nonpsychiatric medical problems, which call into question the adequacy of the mind-body dichotomy in medicine.
RECENT FINDINGS
The strong association of any personality disorders with poor health in cross-sectional and community-based studies is now confirmed by personality disorder predicting future deterioration in longitudinal studies. Borderline personality disorder has been studied most frequently, but recent data suggest that severity of any personality disorder is associated with poor and worsening health.
SUMMARY
Personality disorder is associated with the full range of physical, mental, and social disorders. Greater attention to the common features of personality disorders, which are crucial for the self-regulation of behavior, would facilitate more effective health promotion and disease prevention across all medical specialties, thereby helping to relieve the burdens of chronic common diseases.
Topics: Chronic Disease; Comorbidity; Humans; Personality Disorders; Psychophysiology
PubMed: 31219842
DOI: 10.1097/YCO.0000000000000536 -
The Journal of Nervous and Mental... Nov 2023This review offers a critique of recent attempts to reconceptualize some cases of borderline personality disorder (BPD) within the newer diagnosis of complex... (Review)
Review
This review offers a critique of recent attempts to reconceptualize some cases of borderline personality disorder (BPD) within the newer diagnosis of complex posttraumatic stress disorder (CPTSD). The CPTSD construct focuses on the role of childhood trauma in shaping relational problems in adulthood, difficulties that have been previously seen as features of a personality disorder. The CPTSD model fails to consider the role of heritable personality traits, as well as a broader range of psychosocial risk factors. This review proposes that a biopsychosocial model of BPD is more comprehensive, taking into account a wider range of risk factors, while viewing BPD as rooted in gene-environment interactions. In this model, heritable traits are amplified by an adverse psychosocial environment. One can acknowledge the role of trauma as a risk factor without assuming that it fully accounts for the development of personality pathology.
Topics: Humans; Stress Disorders, Post-Traumatic; Borderline Personality Disorder; Models, Biopsychosocial; Personality Disorders; Psychiatric Status Rating Scales
PubMed: 37890024
DOI: 10.1097/NMD.0000000000001722