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Personality Disorders Nov 2022Criterion B of the alternative model of personality disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), outlines maladaptive...
Criterion B of the alternative model of personality disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), outlines maladaptive trait dimensions that characterize personality disorders. Emerging evidence from bifactor confirmatory factor analyses suggest these traits are related at a higher order level by a general factor of personality disorder (g-PD). Further, emerging evidence points to traits most closely related to borderline personality disorder as underpinnings of g-PD. Further investigation is required to better understand the shared basis of personality disorder, with attention to the reliability and validity of g-PD. The g-PD theory was examined in a clinical (n = 242), and community sample (n = 252) of adults, using a brief form of the Personality Inventory for DSM-5 (PID-5). Structural analyses supported a correlated 6-factor model and a bifactor solution, validating the g-PD structure. Reliability indices supported the unidimensionality, reliability, and replicability of the g-PD factor. The strongest loading and most unidimensional items on the g-PD factors were from the Negative Affectivity and Disinhibition trait domains, partially replicating the trait profile of borderline personality disorder traits. In validity analyses, the nomological network of the general and specific factors were examined. g-PD was more strongly correlated with internalizing measures and impairment than specific factors, but specific factors were more strongly correlated with thought disorder and externalizing measures than g-PD. Our results support the nature and reliability of a general factor characterized by Negative Affectivity and Disinhibition unifying personality disorder traits in a brief form of the PID-5. Implications for the alternative model of personality disorder, PID-5, and g-PD theory are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Topics: Adult; Humans; Reproducibility of Results; Personality Disorders; Personality Inventory; Diagnostic and Statistical Manual of Mental Disorders; Factor Analysis, Statistical; Personality
PubMed: 34928694
DOI: 10.1037/per0000539 -
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 -
Behavioral Sciences & the Law Mar 2022Individuals with borderline personality disorder (BPD) or antisocial personality disorder (ASPD) are overrepresented in forensic settings. Yet, despite the burden these... (Review)
Review
Individuals with borderline personality disorder (BPD) or antisocial personality disorder (ASPD) are overrepresented in forensic settings. Yet, despite the burden these disorders place on healthcare and criminal justice systems, there remains a lack of evidence-based pharmacological treatments. Epidemiological data have shown that comorbid cannabis use disorders are common in BPD and ASPD. ∆ -Tetrahydrocannabinol, the primary psychoactive constituent of cannabis, is an exogenous cannabinoid that stimulates the endocannabinoid system (ECS). Hence, an investigation of the ECS in these conditions is warranted. This scoping review screened 105 records and summarized the extant research on the ECS in ASPD (n = 69) and BPD (n = 61) participants. Preliminary results suggest that alterations of the ECS may be present in these disorders. Although research examining the ECS in personality disorders is still in its infancy, more research is warranted given initial positive findings.
Topics: Antisocial Personality Disorder; Borderline Personality Disorder; Comorbidity; Endocannabinoids; Humans; Substance-Related Disorders
PubMed: 35575169
DOI: 10.1002/bsl.2576 -
Personality Disorders May 2021Antisocial (ASPD) and borderline (BPD) personality disorders (PDs) are associated with increased risk for substance use. They are "specific" risk factors among PDs in...
Antisocial (ASPD) and borderline (BPD) personality disorders (PDs) are associated with increased risk for substance use. They are "specific" risk factors among PDs in that they withstand adjusting for the other PDs, whereas the reverse does not hold. Specificity is a classic sign of causation. This empirical work addresses 3 further problems that can undermine causal inferences in personality and substance-use research: hierarchical nature of etiologic factors in psychiatry, imperfectly operationalized PD criteria, and possible genetic or environmental confounding, as seen in lack of "etiologic continuity." We used exploratory structural equation bifactor modeling and biometric models to mitigate these problems. The participants were Norwegian adult twins of ages 19-36 years ( = 2,801). Criteria for PDs were assessed using a structured interview. General substance-use risk was indicated by World Health Organization Composite International Diagnostic Interviewed alcohol use disorder and illicit drug use, and by self-reported regular smoking. A general risk factor for all criteria of both ASPD and BPD was the strongest individual correlate of general substance use and showed etiologic continuity, though just 3 specific PD criteria could predict substance use to the same extent. The findings indicate that a broad latent factor for both ASPD and BPD may be a specific and a genetically and environmentally unconfounded risk factor for substance use. Substance-use treatment research might benefit from attending to transdiagnostic models of ASPD, BPD, and related behavioral disinhibition. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Topics: Adult; Antisocial Personality Disorder; Borderline Personality Disorder; Diagnostic and Statistical Manual of Mental Disorders; Humans; Norway; Smoking; Substance-Related Disorders; Young Adult
PubMed: 32584092
DOI: 10.1037/per0000404 -
Psychology and Psychotherapy Mar 2020The general objective of this article is to study the unclear and overlapping relationship between social anxiety disorder (SAD) and avoidant personality disorder (AvPD)...
OBJECTIVES
The general objective of this article is to study the unclear and overlapping relationship between social anxiety disorder (SAD) and avoidant personality disorder (AvPD) from an interpersonal perspective. The first specific objective is to compare the disorders with regard to interpersonal problems and general symptom distress. The second specific objective is to examine interpersonal subgroups and pathoplasticity.
DESIGN
In a cross-sectional design, patients from an outpatient psychotherapy clinic diagnosed with social anxiety disorder (SAD, n = 299), avoidant personality disorder (AvPD, n = 180), or the comorbid condition of both disorders (AvPD + SAD, n = 29) were assessed before treatment.
METHODS
Patients filled out the Inventory of Interpersonal Problems (IIP-64) and the Symptom Checklist-Revised (SCL-R-90) before treatment.
RESULTS AND CONCLUSIONS
From an interpersonal perspective, the relationship between the diagnostic groups is well described by the severity continuum hypothesis, with similar interpersonal problems related to Nonassertiveness and lower levels of general interpersonal stress in the SAD group compared to the two AvPD groups. However, other differences in severity do not fit the severity continuum hypothesis, as there are no differences in severity on the global severity index, and, moreover, the SAD group has the most severe problems on the SCL-90 phobic anxiety scale. Interpersonal pathoplasticity is not found in the diagnostic groups or in the full sample. However, three interpersonal subgroups are identified in the full sample, designated as Nonassertive, Friendly-submissive, and Cold-submissive. Implications for treatment are discussed.
PRACTITIONER POINTS
SAD is characterized by a lower level of interpersonal distress compared to AvPD, but the two disorders are similar in having Nonassertiveness as their general interpersonal problem. Contrary to expectation, SAD and AvPD did not differ in general level of symptom severity, and patients with SAD reported more problems with phobic anxiety than AvPD patients did. When understanding SAD and AvPD as different conceptualizations of the same disorder and analysing all patients together, three distinct interpersonal subgroups emerge, which can be identified as Nonassertive, Friendly-submissive, and Cold-submissive.
Topics: Adult; Anxiety; Cross-Sectional Studies; Denmark; Fear; Female; Humans; Male; Object Attachment; Personality Disorders; Phobia, Social; Psychiatric Status Rating Scales; Young Adult
PubMed: 30656823
DOI: 10.1111/papt.12214 -
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 -
Current Opinion in Psychology Feb 2021Despite global consensus regarding the early detection of personality disorder, current approaches to early intervention have failed to deliver for the majority of young... (Review)
Review
Despite global consensus regarding the early detection of personality disorder, current approaches to early intervention have failed to deliver for the majority of young people. This only serves to reinforce the enduring effects of personality disorder on functioning, mental and physical health, resulting in a reduction of quality of life and life expectancy. Here, we describe five significant challenges facing prevention and early intervention for personality disorder: identification, access to treatment, research translation, innovation and functional recovery. These challenges highlight the need for early intervention to shift from niche programmes in specialist services for a select few young people to become established in mainstream primary care and specialist youth mental health services.
Topics: Adolescent; Early Diagnosis; Humans; Personality Disorders; Quality of Life
PubMed: 33513519
DOI: 10.1016/j.copsyc.2020.12.005 -
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 -
Annual Review of Clinical Psychology May 2021Level of Personality Functioning (LPF) represents the entry criterion (Criterion A) of the Alternative Model for Personality Disorders (AMPD) in the fifth edition of the... (Review)
Review
Level of Personality Functioning (LPF) represents the entry criterion (Criterion A) of the Alternative Model for Personality Disorders (AMPD) in the fifth edition of the (DSM-5). It is defined as a dimensional general severity criterion common to all personality disorders and conceptually independent of personality types or traits, and it represents maladaptive self (identity and self-direction) and interpersonal (empathy and intimacy) functioning. We review the history, measurement, and significance of LPF. We show that the inclusion of LPF in the AMPD is well justified if it is defined as a general adaptive failure of a subjective intrapsychic system needed to fulfill adult life tasks. If so defined, LPF distinguishes itself from maladaptive traits (Criterion B of the AMPD) and captures the contribution humans make as agentic authors to the interpretation and management of the self. While Criterion B maladaptive traits provide important descriptive nuance to manifestations of personality pathology, maladaptive LPF is conditional to the diagnosis of personality disorder.
Topics: Adult; Diagnostic and Statistical Manual of Mental Disorders; Humans; Personality; Personality Disorders
PubMed: 33306924
DOI: 10.1146/annurev-clinpsy-081219-105402 -
Personality Disorders Jan 2023We critique the general state of methodological rigor in contemporary personality pathology research, focusing on challenges in study design, assessment, and data... (Review)
Review
We critique the general state of methodological rigor in contemporary personality pathology research, focusing on challenges in study design, assessment, and data analysis resulting from two pervasive problems: comorbidity and heterogeneity. To inform our understanding of this literature, we examined every article published in the two main specialty journals for personality pathology research- and the -in the 18-month period from January 2020 to June 2021 (a total of 23 issues and 197 articles). Our review of this database indicated that only three forms of personality pathology have generated substantial attention in the recent literature: borderline personality disorder (featured in 93 articles), psychopathy/antisocial personality disorder (39 articles), and narcissism/narcissistic personality disorder (28 articles), so we highlight them in our review. We discuss comorbidity-related problems that arise from group-based designs and recommend instead that researchers assess multiple forms of psychopathology as continuous dimensions. We offer separate recommendations for addressing heterogeneity in diagnosis- versus trait-based studies. For the former, we recommend that researchers (a) use measures that permit criterion-level analyses and (b) routinely report criterion-level results. For the latter, we emphasize the importance of examining specific traits when measures are known to be highly heterogeneous/multidimensional. Finally, we encourage researchers to work toward a truly comprehensive trait dimensional model of personality pathology. We suggest that this might include expanding the current alternative model of personality disorders to include additional content related to borderline features, psychopathy, and narcissism. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Topics: Humans; Personality Disorders; Personality; Comorbidity; Antisocial Personality Disorder; Psychopathology
PubMed: 36848072
DOI: 10.1037/per0000586