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Psychodynamic Psychiatry 2021Transference-focused psychotherapy (TFP), developed and studied as an extended individual psychotherapy for patients with borderline personality disorder (BPD), rests on... (Review)
Review
Transference-focused psychotherapy (TFP), developed and studied as an extended individual psychotherapy for patients with borderline personality disorder (BPD), rests on a rich theoretical foundation informed by psychoanalytic object relations theory. "Applied TFP" is a developing initiative using TFP principles in multiple clinical situations other than the standard extended individual psychotherapy, which has been empirically validated and is detailed in the TFP treatment manual. The growing application of TFP principles in innovative, overlapping ways has been focused primarily in three spheres: (1) the integration of TFP principles in pluralistic theoretical approaches to treatment of patients with personality disorder pathology; (2) the use of TFP elements in multiple teaching situations as part of curricula for trainees and practicing clinicians, and (3) the employment of TFP theory and interventions in settings across a continuum of patient acuity, tailored for patients with varying diagnoses. The use of TFP principles in the situations described directly addresses needs emerging in particular contexts that reflect specific requirements of clinician practice and training and of broader public health missions.
Topics: Borderline Personality Disorder; Humans; Object Attachment; Personality Disorders; Psychotherapy; Transference, Psychology
PubMed: 34061650
DOI: 10.1521/pdps.2021.49.2.273 -
Social Psychiatry and Psychiatric... Apr 2021The epidemiology of personality disorder is poorly understood. This study aims to describe the population in contact with mental health services with a diagnosis of...
PURPOSE
The epidemiology of personality disorder is poorly understood. This study aims to describe the population in contact with mental health services with a diagnosis of personality disorder and compare service use between this group and those with a diagnosis of depression.
METHODS
Investigation of a routinely collected clinical data set across New Zealand was conducted. We used data from 2008 to 2017 and 1-year data from 2016, the most complete dataset. This allowed for variation over the years and confirmation within a 1-year prevalence. These data were analysed focusing on patients with a primary diagnosis of any personality disorder and the subset with borderline personality disorder (BPD). BPD was chosen as the most common clinical personality disorder diagnosis and that most researched.
RESULTS
8884 (2.8%) of the population in contact with mental health services carried a primary diagnosis of personality disorder. Personality diagnosis other than antisocial personality disorder (ASPD) in men and borderline personality disorder (BPD) in either gender was negligible. Rates of personality pathology increased with social deprivation and were commonest in young adults. Multi-morbidity was the norm, with internalising disorder common. Maori diagnosed with PD were over-represented both in the patient group and by population.
CONCLUSION
Borderline personality disorder and antisocial personality disorder are routinely diagnosed in routine clinical practice in New Zealand; however, other categorical diagnoses are not made. Patients with PD are significant users of resources in comparison to depressed patients. Resource utilisation was significantly greater in those with PD, in particular use of inpatient services compared to those with depression.
Topics: Antisocial Personality Disorder; Borderline Personality Disorder; Humans; Male; New Zealand; Personality; Personality Disorders; Prevalence; Young Adult
PubMed: 32394007
DOI: 10.1007/s00127-020-01876-y -
Current Psychiatry Reports Nov 2023Despite significant negative outcomes, the co-occurrence of personality disorders (PDs) and substance use disorders (SUDs) continues to be underrecognized, and the... (Review)
Review
PURPOSE OF REVIEW
Despite significant negative outcomes, the co-occurrence of personality disorders (PDs) and substance use disorders (SUDs) continues to be underrecognized, and the mechanisms contributing to this co-occurrence remain unclear. This review summarizes recent work on PD-SUD co-occurrence, with a focus on borderline and antisocial PDs, general substance use patterns among those with PDs, and the association of personality traits with SUDs.
RECENT FINDINGS
The prevalence of co-occurring PD-SUD is generally high, with estimates ranging depending on the type of PD and SUD, the population assessed, and the sampling methods and measures used. Current theoretical explanations for co-occurrence include shared etiology and predisposition models, with research highlighting the importance of transactional processes. Potential underlying mechanisms include personality traits and transdiagnostic characteristics. Recent research has increased focus on substances besides alcohol, dimensional models of personality pathology, and transactional explanations of co-occurrence, but more research is needed to disentangle the nuanced PD-SUD relationship.
Topics: Humans; Comorbidity; Personality Disorders; Substance-Related Disorders; Personality; Prevalence
PubMed: 37787897
DOI: 10.1007/s11920-023-01452-6 -
Psychiatria Danubina Dec 2022Sex-related disturbance including sexual dreams contributes to psychiatric disorders, but whether personality disorder functioning styles are linked with sexual dreams...
BACKGROUND
Sex-related disturbance including sexual dreams contributes to psychiatric disorders, but whether personality disorder functioning styles are linked with sexual dreams especially in frequent dreamers remains unsettled SUBJECTS AND METHODS: One hundred and seventy one healthy volunteers (controls) and 81 frequent sexual dreamers (fsDreamers) were invited to answer the Sexual Dream Experience Questionnaire (SDEQ) and the Parker Personality Measure (PERM).
RESULTS
Compared to controls, fsDreamers scored significantly higher on SDEQ Joyfulness, Familiarity, Bizarreness and the annual frequency, and on all PERM styles except Schizoid and Obsessive-Compulsive. Sexual dream contents were associated with Borderline, Histrionic and Narcissistic styles in controls, and with Paranoid, Schizotypal, Borderline, Histrionic, Avoidant, and Passive-Aggressive styles in fsDreamers.
CONCLUSIONS
Personality involvement in etiology of sexual dreams has been illustrated by the elevated sexual experience and personality disorder functioning style scores and their prominent inter-correlations, especially in frequent sexual dreamers.
Topics: Humans; Personality Disorders; Personality; Sexual Behavior; Happiness; Surveys and Questionnaires
PubMed: 36752253
DOI: No ID Found -
Personality Disorders Jan 2023Tests of statistical interactions (or tests of moderation effects) in personality disorder research are a common way for researchers to examine nuanced hypotheses...
Tests of statistical interactions (or tests of moderation effects) in personality disorder research are a common way for researchers to examine nuanced hypotheses relevant to personality pathology. However, the nature of statistical interactions makes them difficult to reliably detect in many research scenarios. The present study used a flexible, simulation-based approach to estimate statistical power to detect trait-by-trait interactions common to psychopathy research using the Triarchic model of Psychopathy and the Psychopathic Personality Inventory. Our results show that even above-average sample sizes in these literatures (e.g., = 428) provide inadequate power to reliably detect trait-by-trait interactions, and the sample sizes needed to detect interaction effect sizes in realistic scenarios are extremely large, ranging from 1,300 to 5,200. The implications for trait-by-trait interactions in psychopathy are discussed, as well as how the present findings might generalize to other areas of personality disorder research. We provide recommendations for how to design research studies that can provide informative tests of interactions in personality disorder research, but also highlight that a more realistic option is to abandon the traditional approach when testing for interaction effects and adopt alternative approaches that may be more productive. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Topics: Humans; Personality Inventory; Personality Disorders; Antisocial Personality Disorder; Personality; Phenotype
PubMed: 35737564
DOI: 10.1037/per0000582 -
Acta Psychiatrica Scandinavica Dec 2023Psychotic-like experiences (PLE) have been associated with the subsequent emergence of psychotic disorders as well as several other domains of psychopathology. In this...
INTRODUCTION
Psychotic-like experiences (PLE) have been associated with the subsequent emergence of psychotic disorders as well as several other domains of psychopathology. In this twin study, we estimated the genetic and environmental correlations between PLE and 10 personality disorders (PD).
METHODS
Diagnoses of 10 PDs according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and PLE from the Composite International Diagnostic Interview (CIDI) were retrieved for 2793 young adult twins from the Norwegian Twin Registry. Risk for having a PD and PLEs was modeled using item response theory. Biometric twin models were fitted to estimate the genetic and environmental correlations between PDs and PLEs. Co-twin control analysis was performed to estimate additional within-family risk for PLEs when having a PD.
RESULTS
Phenotypic overlap between PDs and PLEs ranged from 14% to 44% in males and from 11% to 39% in females, with the highest overlap for borderline PD in both sexes. In general, we found higher genetic correlations (r = 0.14-0.72) than environmental correlations (r = 0.06-0.28) between PDs and PLEs. The highest genetic correlations between PLE and PDs were found for borderline (r = 0.72), paranoid (r = 0.56), schizotypal (r = 0.56) and antisocial PD (r = 0.49).
CONCLUSION
We found that the co-occurrence between PDs and PLE is the best explained by shared genetic determinants, with minor contributions from environmental factors. Interestingly, borderline PD was highly genetically correlated with PLE, warranting molecular genetic studies of this association.
Topics: Male; Female; Humans; Young Adult; Risk Factors; Personality Disorders; Twins; Borderline Personality Disorder; Psychotic Disorders; Diagnostic and Statistical Manual of Mental Disorders
PubMed: 37497694
DOI: 10.1111/acps.13596 -
Journal of Personality Disorders Jun 2023Change in treatment of narcissistic personality disorder (NPD) has been considered difficult to attain. Aspects of narcissistic pathology, including interpersonal...
Change in treatment of narcissistic personality disorder (NPD) has been considered difficult to attain. Aspects of narcissistic pathology, including interpersonal enhancement, avoidance, aggressivity, and control, have contributed to challenges in forming a therapeutic alliance and pursuing treatment towards attainable goals for change and remission. This study, based on a qualitative review of therapists' case reports of individual psychotherapy with eight patients diagnosed with NPD, is the first to identify and explore patterns, processes, and indicators of change in pathological narcissism. All patients showed significant improvement in personality and life functioning, including engagement in work or education and long-term close relationships, with remission of the NPD diagnosis. The process of change was gradual, with some noticeable changes occurring in specific life contexts. Additional factors indicating and contributing to change included patients' motivation and commitment to psychotherapy, reflective ability, emotion regulation, sense of agency, and interpersonal and social engagement.
Topics: Humans; Personality Disorders; Personality; Psychotherapy; Narcissism; Therapeutic Alliance
PubMed: 37367820
DOI: 10.1521/pedi.2023.37.3.337 -
Current Opinion in Psychiatry Jan 2021This review explores recent literature on the applicability of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) and International... (Review)
Review
PURPOSE OF REVIEW
This review explores recent literature on the applicability of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) and International Classification of Disease, 11th Revision (ICD-11) personality disorder classification systems across countries and cultural contexts.
RECENT FINDINGS
Several studies examining the cultural validity and utility of DSM-5 and ICD-11 personality disorder have been conducted in a number of language and cultural groups that are different from those in which the tools were originally developed. These studies, using quantitative methods, have largely supported the applicability of the new dimensional and trait approaches to classifying personal disorders. Studies qualitatively exploring the views of service users and clinicians on the development or operationalization of DSM-5 and ICD-11 personality disorder report that a lay summary of diagnostic constructs thatreflect concern about language of diagnostic criteria as well the lived experience of service users would be found useful. Clinicians found the dimensional system of ICD-11 slightly more useful than the categorical system of ICD-10 on several utility scales, but the studies on ICD-11 have been much less in view of its latter appearance.
SUMMARY
DSM-5 and ICD-11 personality disorder have shown a preliminary evidence of improved utility across cultures. More studies, including those reflecting the views of service users, are needed to confirm this early observation across many more cultural and linguistic groups.
Topics: Algeria; Brazil; Cross-Cultural Comparison; Diagnostic and Statistical Manual of Mental Disorders; Europe; Humans; International Classification of Diseases; Personality; Personality Disorders; Research Design; Singapore; United States
PubMed: 33044250
DOI: 10.1097/YCO.0000000000000659 -
European Child & Adolescent Psychiatry Sep 2023Acquiring age-appropriate social skills, arguably a major prerequisite for favorable psychosocial development in children, is targeted in a range of interventions....
Acquiring age-appropriate social skills, arguably a major prerequisite for favorable psychosocial development in children, is targeted in a range of interventions. Hence, identifying factors that limit this acquisition may inform preventative and treatment efforts. Personality disorders are characterized by pervasive and enduring dysfunctional interpersonal functioning, including parenting, and could thus entail risk for offspring in not developing adaptive interpersonal skills. However, no study has tested this possibility. A representative sample drawn from two birth cohorts of Norwegian 4-year-olds (n = 956) and their parents was followed up at ages 6, 8, and 10 years. Parents' personality disorder symptoms were measured dimensionally with the DSM-IV and ICD-10 Personality Questionnaire, and children's social skills were evaluated by the Social Skills Rating System. A difference-in-difference approach was applied to adjust for all unmeasured time-invariant confounders, and parental symptoms of depression and anxiety were entered as covariates. Increased Cluster B symptoms in parents of children aged 4 to 6 years predicted decreased social skill development in offspring (B = -0.97, 95% CI -1.58, -0.37, p = 0.002). On a more granular level, increased symptoms of borderline (B = -0.39, CI -0.65, -0.12, p = 0.004), histrionic (B = -0.55, CI -0.99, -0.11, p = 0.018), and avoidant (B = -0.46, CI-0.79, -0.13, p = 0.006) personality disorders in parents predicted decreased social skill development in offspring. Subclinical levels of borderline, histrionic and avoidant personality disorders in parents may impair the development of social skills in offspring. Successfully treating these personality problems or considering them when providing services to children may facilitate children's acquisition of social skills.
Topics: Child; Humans; Child, Preschool; Social Skills; Prospective Studies; Child of Impaired Parents; Parents; Personality Disorders
PubMed: 35235044
DOI: 10.1007/s00787-022-01965-0 -
The Australian and New Zealand Journal... Mar 2022Persistence is said to be a feature of personality disorder, but there are few long-term prospective studies of the condition. A total of 200 patients with anxiety and... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Persistence is said to be a feature of personality disorder, but there are few long-term prospective studies of the condition. A total of 200 patients with anxiety and depressive disorders involved in a randomised controlled trial initiated in 1983 had full personality status assessed at baseline. We repeated assessment of personality status on three subsequent occasions over 30 years.
METHODS
Personality status was recorded using methods derived from the Personality Assessment Schedule, which has algorithms for allocating Diagnostic and Statistical Manual of Mental Disorders (DSM) and the 11th International Classification of Diseases (ICD-11) categories. The category and severity of personality diagnosis were recorded at baseline in the randomised patients with DSM-III anxiety and depressive diagnoses. The same methods of assessing personality status was repeated at 2, 12 and 30 years after baseline.
RESULTS
Using the ICD-11 system, 47% of patients, mainly those with no personality disturbance at baseline, retained their personality status; of the others 16.8% improved and 20.4% worsened to more severe disorder. In DSM-III diagnosed patients, those diagnosed as Cluster A and Cluster C increased in frequency (from 14% to 40%, p < 0.001, and 21.5% to 36%, p < 0.001, respectively) over follow-up, while those with Cluster B showed little change in frequency (22% to 18%, p = 0.197).
CONCLUSION
In this population of patients with common mental disorders, personality status showed many changes over time, inconsistent with the view that personality disorder is a persistent or stable condition. The increase in diagnoses within the Cluster A and C groups suggests personality disorder generally increases in frequency as people age.
Topics: Cohort Studies; Diagnostic and Statistical Manual of Mental Disorders; Humans; Neurotic Disorders; Personality; Personality Disorders; Prospective Studies
PubMed: 34250845
DOI: 10.1177/00048674211025624