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Current Opinion in Psychiatry Jan 2019To provide an update of the recent studies, which have evaluated the radical changes in personality disorder classification in DSM-5 and ICD-11. (Review)
Review
PURPOSE OF REVIEW
To provide an update of the recent studies, which have evaluated the radical changes in personality disorder classification in DSM-5 and ICD-11.
RECENT FINDINGS
Although the DSM-5 Committee rejected the personality disorders Work Group proposal for personality disorder classification, the model was published in DSM-5 Section III. This Alternative Model of Personality Disorders (AMPD) has been widely adopted by the research community resulting in multiple studies evaluating its reliability and clinical utility. The ICD-11 Personality Classification has recently been accepted by the WHO and is also receiving increasing study. Both models emphasize personality disorder severity, which most studies report is consistently linked to impairment and outcome. Both models propose five descriptive domains, which appear to capture most of the current personality disorder diagnoses, and can also be linked to disease extremes of normal personality such as the Five Factor Model.
SUMMARY
The changes in DSM-5 AMPD and ICD-11 represent a significant paradigm shift in the diagnosis of personality disorders. Early research suggests that the changes may be beneficial for clinicians and researchers. The models more closely align with the large body of literature supporting dimensional models of normal personality. The severity dimensions are consistent with the large body of evidence that personality disorder severity is a strong determinant of impairment and outcome. It remains to be seen if clinicians will use the classification to plan and predict treatment for a wide range of mental disorders.
Topics: Diagnostic and Statistical Manual of Mental Disorders; Humans; International Classification of Diseases; Personality Disorders; Reproducibility of Results
PubMed: 30234525
DOI: 10.1097/YCO.0000000000000461 -
Current Opinion in Psychiatry Jan 2016Third-wave cognitive-behaviour therapies such as dialectical behaviour therapy have demonstrated effectiveness in the treatment of personality disorders, which are...
PURPOSE OF REVIEW
Third-wave cognitive-behaviour therapies such as dialectical behaviour therapy have demonstrated effectiveness in the treatment of personality disorders, which are considered difficult to treat. These therapies typically incorporate some component of mindfulness practice. The current study examines current applications and effectiveness of mindfulness to the treatment of personality disorders.
RECENT FINDINGS
The majority of evidence available focuses on borderline personality disorder, and highlights positive associations between mindfulness practice and reduced psychiatric and clinical symptoms, less emotional reactivity, and less impulsivity. Fewer studies examine the other personality disorders, though emerging case studies have applied mindfulness techniques to treatment with antisocial, avoidant, paranoid, and obsessive-compulsive personality disorders.
SUMMARY
Mindfulness is a promising clinical tool for the treatment of personality disorders, and appears to be adaptable to the unique features of different types of personality disorders. However, further empirical research with greater methodological rigour is required to clarify the effectiveness of mindfulness as a specific skill component, and to identify the underlying mechanisms that contribute to therapeutic change.
Topics: Antisocial Personality Disorder; Borderline Personality Disorder; Cognitive Behavioral Therapy; Compulsive Personality Disorder; Emotions; Humans; Impulsive Behavior; Mindfulness; Obsessive-Compulsive Disorder; Personality Disorders
PubMed: 26651010
DOI: 10.1097/YCO.0000000000000213 -
Current Opinion in Psychiatry Jan 2022This article aims to present the current picture on conceptualization, diagnosis and care provision of personality disorders (PD) in modern Russia. These issues are... (Review)
Review
PURPOSE OF REVIEW
This article aims to present the current picture on conceptualization, diagnosis and care provision of personality disorders (PD) in modern Russia. These issues are highly relevant to Russian psychiatry, which has a rich historical tradition of analysing psychopathic constitution, personality types and dynamics.
RECENT FINDINGS
This narrative review covers the main tendencies in the recent Russian academic literature devoted to PD. PD are most frequently investigated in the frames of forensic psychiatry, in which expert conclusions and assessment of the risk factors for socially dangerous behaviour are particularly important. Another area of research concerns comorbidity, since PD often affect other health conditions or are co-occurrent with other mental or behavioural problems. Specialists have also focused on the challenges of therapy in PD.
SUMMARY
Reviewed manuscripts show a pathogenic and pathoplastic role of personality factors in manifestation of other mental, behavioural or somatic disorders. Analysis of pathocharacterological profile and self-regulation processes is a major component in assessing and diagnosing PD. The principal perspectives in this particular area focus on evidence-based research of mechanisms of personality pathology and validation of targeted personalized combined therapeutic approaches.
Topics: Antisocial Personality Disorder; Comorbidity; Concept Formation; Humans; Personality Disorders; Psychiatry
PubMed: 34812739
DOI: 10.1097/YCO.0000000000000765 -
Current Opinion in Psychiatry Jan 2017To examine the validity of concept and diagnosis of personality disorder in transcultural settings using Indigenous Australian people as an example. (Review)
Review
PURPOSE OF REVIEW
To examine the validity of concept and diagnosis of personality disorder in transcultural settings using Indigenous Australian people as an example.
RECENT FINDINGS
There are significant deficits in comparative research on personality disorders across cultures. There is also a dearth of information regarding Indigenous Australians, and cultural applicability and clinical utility of the diagnosis of personality disorder in this group.
SUMMARY
The concept of culture is generally ignored when making a diagnosis of personality disorder. A valid diagnosis should incorporate what would be considered understandable and adaptive behavior in a person's culture. In Indigenous Australian culture, making diagnosis of a personality disorder is complicated by historical trauma from colonization, disruption of kinship networks, and ongoing effects of poverty and social marginalization.
Topics: Australia; Humans; Native Hawaiian or Other Pacific Islander; Personality Disorders
PubMed: 27798485
DOI: 10.1097/YCO.0000000000000293 -
Journal of Personality Disorders Apr 2020This study evaluated the Standardized Assessment of Severity of Personality Disorder (SASPD) proposed for ICD-11 and the Level of Personality Functioning Scale-Brief...
This study evaluated the Standardized Assessment of Severity of Personality Disorder (SASPD) proposed for ICD-11 and the Level of Personality Functioning Scale-Brief Form 2.0 (LPFS-BF) developed for Section III and their relationships with external correlates. We used a clinical sample ( = 150; 33% women) of 65 psychiatric outpatients and 85 incarcerated addicts, who self-reported the SASPD and the LPFS-BF. We conducted correlation and regression analyses in order to determine the relative associations of these two measures with relevant external criteria. SASPD predominantly captured externalizing and other-related problems (e.g., potential harm to others), whereas LPFS-BF predominantly captured internalizing and self-related problems (e.g., identity and distress). Generally, LPFS-BF explained more variance of the external criteria relative to SASPD. The findings seem to reflect that the ICD-11 oriented SASPD emphasizes interpersonal and aggressive features, whereas the -oriented LPFS-BF emphasizes self-pathology and distress. More conclusive findings warrant interview-rated personality functioning.
Topics: Adult; Aggression; Correctional Facilities; Defense Mechanisms; Diagnostic and Statistical Manual of Mental Disorders; Female; Humans; International Classification of Diseases; Male; Middle Aged; Outpatients; Patient Reported Outcome Measures; Personality; Personality Disorders; Personality Inventory; Psychometrics; Reproducibility of Results; Self Report; Severity of Illness Index
PubMed: 30179575
DOI: 10.1521/pedi_2018_32_393 -
Current Opinion in Psychology Aug 2020The relationship between certain personality disorders (PDs) and insomnia has been the object of few studies in recent years. Even though it is not indicated to use... (Review)
Review
The relationship between certain personality disorders (PDs) and insomnia has been the object of few studies in recent years. Even though it is not indicated to use polysomnography to diagnose insomnia, objective measures have shown sleep abnormalities in individuals with a personality disorder and insomnia. Interestingly, there is increasing evidence that emotion dysregulation is involved in a mutually aggravating relationship between Borderline Personality Disorder (BPD) and insomnia. While BPD traits are highly associated with suicide ideation and attempts, these behaviors could be potentiated or enhanced in individuals presenting sleep disturbances. Because BPD and other mental disorders are often linked with the use of medication or other substances, it is also important to review the association between substance use disorders (SUD) and insomnia. SUD can disrupt sleep and foster insomnia, which in turn might increase motivation to use substances. Insomnia has also been shown to precede (i.e., predict) SUD, and can be present during withdrawal as well. These results highlight the need to assess and treat insomnia when working with patients who present a PD or SUD.
Topics: Antisocial Personality Disorder; Borderline Personality Disorder; Humans; Personality Disorders; Sleep Initiation and Maintenance Disorders; Substance-Related Disorders
PubMed: 31778972
DOI: 10.1016/j.copsyc.2019.10.005 -
Psychological Bulletin Jul 2017Personality disorders are defined in the current psychiatric diagnostic system as pervasive, inflexible, and stable patterns of thinking, feeling, behaving, and... (Meta-Analysis)
Meta-Analysis Review
Personality disorders are defined in the current psychiatric diagnostic system as pervasive, inflexible, and stable patterns of thinking, feeling, behaving, and interacting with others. Questions regarding the validity and reliability of the current personality disorder diagnoses prompted a reconceptualization of personality pathology in the most recent edition of the psychiatric diagnostic manual, in an appendix of emerging models for future study. To evaluate the construct and discriminant validity of the current personality disorder diagnoses, we conducted a quantitative synthesis of the existing empirical research on associations between personality disorders and interpersonal functioning, defined using the interpersonal circumplex model (comprising orthogonal dimensions of agency and communion), as well as functioning in specific relationship domains (parent-child, family, peer, romantic). A comprehensive literature search yielded 127 published and unpublished studies, comprising 2,579 effect sizes. Average effect sizes from 120 separate meta-analyses, corrected for sampling error and measurement unreliability, and aggregated using a random-effects model, indicated that each personality disorder showed a distinct profile of interpersonal style consistent with its characteristic pattern of symptomatic dysfunction; specific relationship domains affected and strength of associations varied for each personality disorder. Overall, results support the construct and discriminant validity of the personality disorders in the current diagnostic manual, as well as the proposed conceptualization that disturbances in self and interpersonal functioning constitute the core of personality pathology. Importantly, however, contradicting both the current and proposed conceptualizations, there was not evidence for pervasive dysfunction across interpersonal situations and relationships. (PsycINFO Database Record
Topics: Humans; Interpersonal Relations; Personality Disorders
PubMed: 28447827
DOI: 10.1037/bul0000101 -
American Journal of Psychotherapy Mar 2023Transference-focused psychotherapy (TFP) is an empirically based, manualized psychodynamic psychotherapy that emerged as an adaptation of psychoanalytic techniques to... (Review)
Review
Transference-focused psychotherapy (TFP) is an empirically based, manualized psychodynamic psychotherapy that emerged as an adaptation of psychoanalytic techniques to meet the needs of patients with personality pathology. As it became more clearly defined through a series of treatment manuals and empirical research, TFP has also come to be considered a conceptual and technical model of therapy that can be used to introduce therapists in training to the principles of psychodynamic psychotherapy in a systematic way. Advanced levels of TFP training and practice involve an emphasis on supervision that is applied in a more structured way than traditional psychodynamic supervision, while respecting the depth and subtlety of psychoanalytic exploration. This article reviews the development of the treatment model and the supervisory process that guides the therapist to carry out TFP in accordance with its proposed mechanism of change.
Topics: Humans; Psychotherapy, Psychodynamic; Transference, Psychology; Psychotherapy; Personality Disorders; Psychoanalysis; Empirical Research; Borderline Personality Disorder
PubMed: 36353848
DOI: 10.1176/appi.psychotherapy.20220019 -
European Addiction Research 2018Substance use disorders (SUD) and personality disorders co-occur frequently. This relationship might be understood by studying schema modes (a key concept in Schema...
Substance use disorders (SUD) and personality disorders co-occur frequently. This relationship might be understood by studying schema modes (a key concept in Schema therapy), which explain the dysfunctions characterizing personality disorder patients. In the present study, we compared the schema modes and personality disorder symptoms between alcohol-dependent patients, cocaine-dependent patients and healthy controls. We found indications that specific schema modes are specific for SUD patients. However, no differences between specific subtypes of SUD patients (alcohol- vs. cocaine-dependent patients) could be found regarding schema modes. Further, it is suggested that borderline personality disorder symptoms are highly relevant for SUD patients. A first step is made in understanding the relationship between schema modes and SUD, which may contribute to the understanding of the problematic behaviour seen in patients with personality disorders and SUD (and may possibly contribute to the improvement of the treatment of this group of patients).
Topics: Adult; Alcoholism; Case-Control Studies; Cocaine-Related Disorders; Cognition; Emotions; Female; Humans; Male; Middle Aged; Personality Disorders; Personality Inventory; Psychiatric Status Rating Scales; Young Adult
PubMed: 30278456
DOI: 10.1159/000493644 -
Psychiatry Research Mar 2021Social avoidance in young patients is a clinically worrisome phenomenon that characterizes impending schizophrenia, but that also constitutes a core phenomenon in... (Review)
Review
Social avoidance in young patients is a clinically worrisome phenomenon that characterizes impending schizophrenia, but that also constitutes a core phenomenon in avoidant personality disorder (AvPD), schizoid personality disorder (ScPD), and in autism spectrum disorder (ASD). Especially in the absence of any other clinically relevant phenomena, understanding the origins of social avoidance may be one the most challenging tasks in assessing whether adolescents and young adults are at risk for developing schizophrenia. Descriptive and psychometric assessments only allow to comment on the absence or the presence of this phenomenon, but do not capture the origins and the meaning of social avoidance. Based on a narrative review, we highlight the importance of a phenomenological approach to unveil the Gestalt of social avoidance in these mental disorders, including and appraisal of the underlying mental structures and attachment styles. The phenomenological approach allows to distinguish the Gestalt of social avoidance between AvPD, ScPD, ASD, and beginning schizophrenia, to ensure correct diagnostic labelling and optimal treatment, and to avoid unwarranted stigmatization.
Topics: Adolescent; Autism Spectrum Disorder; Humans; Personality Disorders; Psychometrics; Schizoid Personality Disorder; Schizophrenia; Social Behavior; Young Adult
PubMed: 33465524
DOI: 10.1016/j.psychres.2021.113718