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Australasian Psychiatry : Bulletin of... Dec 2021To outline overlap and boundaries between ICD-11 definitions of complex post-traumatic stress disorder (C-PTSD) and personality disorder (PD) and propose guiding...
OBJECTIVE
To outline overlap and boundaries between ICD-11 definitions of complex post-traumatic stress disorder (C-PTSD) and personality disorder (PD) and propose guiding principles that may assist practitioners in assigning one or both of the two diagnoses.
CONCLUSIONS
The ICD-11 definitions for C-PTSD and PD are substantially comparable in terms of self- and interpersonal problems, and childhood trauma may be at the root of both disorders. The ICD-11 formally recognizes this overlap and allows the assignment of both diagnoses at the same time. The C-PTSD diagnosis essentially differs from a PD diagnosis by requiring a history of trauma and PTSD symptoms. Moreover, C-PTSD typically involves stable and persistent patterns of negative self-perception while emphasizing avoidant interpersonal patterns. In comparison, the PD diagnosis may differ from C-PTSD by allowing an unstable or internally contradictory sense of self, which may involve both overly negative and overly positive self-views. When the diagnostic requirements for both C-PTSD and PD are met, only the C-PTSD diagnosis should be assigned, unless the PD diagnosis may contribute with clinically useful information that is not sufficiently covered by the C-PTSD diagnosis. The outlined similarities and boundaries must be further corroborated by future empirical studies.
Topics: Adverse Childhood Experiences; Humans; International Classification of Diseases; Personality Disorders; Stress Disorders, Post-Traumatic
PubMed: 33993748
DOI: 10.1177/10398562211014212 -
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 -
Scandinavian Journal of Psychology Dec 2021According to the literature, avoidant personality disorder (APD) is often overlooked in research on personality disorders. In the present study, patients with APD were...
According to the literature, avoidant personality disorder (APD) is often overlooked in research on personality disorders. In the present study, patients with APD were compared to patients with borderline personality disorder (BPD) with respect to emotional dysfunction. Emotional dysfunction was operationalized through the Affect Integration Inventory. Sixty-one patients receiving treatment at specialized outpatient hospital facilities for either BPD (n = 25) or APD (n = 36) (Diagnostic and Statistical Manual of Mental Disorders, fifth edition) were included in a cross-sectional study. Supporting our expectations of no difference in the global capacity for affect integration between groups, the estimated difference was 0.00 (95% confidence interval [CI] [-0.53, 0.53]). On the other hand, the expected increased dysfunction in APD regarding Expression could not be confirmed. Furthermore, problems with specific affects distinguished the groups; integration of Interest was worse in APD (p = 0.01), whereas integration of Jealousy was worse in BPD (p = 0.04). In terms of prototypical modes of experiencing affects, APD was characterized by decreased access to the motivational properties of Interest (p < 0.01), while BPD was more driven by Interest (p < 0.01), Anger (p < 0.01), and Jealousy (p = 0.01). In conclusion, even though the two disorders are characterized by similar overall levels of emotional dysfunction, they differ systematically and predictably regarding specific affects and modes of experiencing. These findings carry implications for the understanding of emotional dysfunction in APD and BPD, suggesting specific areas of emotional dysfunction that could be targeted in tailored psychotherapeutic interventions.
Topics: Borderline Personality Disorder; Cross-Sectional Studies; Diagnostic and Statistical Manual of Mental Disorders; Humans; Personality Disorders
PubMed: 34523729
DOI: 10.1111/sjop.12771 -
American Journal of Psychotherapy Jan 2022Recent meta-analyses suggest that many patients with borderline personality disorder have a history of complex trauma. Although trauma is central in mentalization-based... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
Recent meta-analyses suggest that many patients with borderline personality disorder have a history of complex trauma. Although trauma is central in mentalization-based approaches to the understanding of borderline personality disorder, surprisingly little is known about the effects of trauma on outcomes of mentalization-based treatment (MBT). This article investigates the prevalence and impact of childhood trauma among patients with borderline personality disorder participating in a randomized controlled trial (RCT) comparing day hospital MBT (MBT-DH) and intensive outpatient MBT (MBT-IOP).
METHODS
All 114 patients from the original multicenter RCT in the Netherlands were included in this study. Childhood trauma was assessed at baseline (with the Childhood Trauma Questionnaire), and its impact on symptom severity, interpersonal functioning, and borderline pathology was investigated through multilevel modeling for 36 months after the start of treatment.
RESULTS
Childhood trauma was common among patients with borderline personality disorder referred to MBT, with more than 85% meeting cutoff criteria for substantial childhood trauma. Childhood trauma had little impact on outcomes of either MBT-DH or MBT-IOP in terms of improved borderline personality disorder features or interpersonal functioning. However, patients with substantial childhood trauma seemed to improve more rapidly with MBT-DH, as compared with MBT-IOP, in terms of symptom severity. In addition, patients with a history of emotional neglect showed more rapid changes in symptoms of borderline personality disorder with MBT-DH compared with MBT-IOP.
CONCLUSIONS
Findings are discussed in the context of a social communicative approach to borderline personality disorder, with a focus on the need to address trauma in MBT.
Topics: Borderline Personality Disorder; Humans; Mentalization; Mentalization-Based Therapy; Treatment Outcome
PubMed: 35099263
DOI: 10.1176/appi.psychotherapy.20210027 -
The Australian and New Zealand Journal... Jul 2023The , 11th edition includes a new personality disorder diagnosis, in light of growing concerns of the categorical personality disorder diagnoses. The purpose of the...
OBJECTIVES
The , 11th edition includes a new personality disorder diagnosis, in light of growing concerns of the categorical personality disorder diagnoses. The purpose of the current study was to examine the reliability and validity of the severity dimension of the new , 11th edition diagnosis, through multi-method assessment.
METHOD
In a community mental health sample ( = 311), we examined the interrater reliability of the severity diagnosis and evaluated the diagnosis against self-report measures of dimensional personality pathology and psychopathology constructs and traditional categorical and informant-report measures.
RESULTS
Intraclass correlations indicated 'excellent' reliability of the diagnostic ratings. Large associations were observed between the , 11th edition clinician diagnosis and overall impairment measures. Generally, the , 11th edition clinician diagnosis exhibited largest associations with measures of internalising dysfunction, and more variable associations with interpersonal and externalising impairment. The , 11th edition clinician diagnosis showed a large association with borderline personality disorder symptom scores and moderate associations with Paranoid, Schizoid and Avoidant personality disorder scores. Similar patterns emerged of the associations between the , 11th edition personality disorder diagnosis with self-report and informant-report measures, although the associations were larger with self-report measures.
CONCLUSION
These findings provide promising initial evidence for the reliability and validity of the new , 11th edition personality disorder diagnosis, indicating that the new conceptualisation of personality disorders may address issues within the categorical model.
Topics: Humans; International Classification of Diseases; Reproducibility of Results; Diagnostic and Statistical Manual of Mental Disorders; Personality Disorders; Personality
PubMed: 36384302
DOI: 10.1177/00048674221136457 -
Journal of Psychopathology and Clinical... May 2022A discordant twin design was utilized to examine the potentially causal effects of childhood trauma (CT; i.e., emotional abuse, physical abuse, sexual abuse, and...
A discordant twin design was utilized to examine the potentially causal effects of childhood trauma (CT; i.e., emotional abuse, physical abuse, sexual abuse, and witnessing violence) on borderline personality disorder traits (BPD traits) in early adulthood. The participants were 2,808 twins between 17 and 23 years from the Oslo University Adolescent and Young Adult Twin Project. BPD traits were assessed by the Structured Interview for Personality (SIDP-IV), and CT was assessed using the Childhood Trauma Interview (CTI). BPD traits (h² = .50) and CT (h² = .33-.69) were both found to be moderately heritable. Small but statistically significant associations between CT and BPD traits were found in the total sample. After controlling for shared environmental and genetic factors in the discordant twin pairs, the analyses showed little to no evidence for causal effects of CT on BPD traits. The results indicated that the associations between CT and BPD traits stem from common genetic influences. These findings are inconsistent with the widely held assumption that CT causes the development of BPD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Topics: Adolescent; Adult; Adverse Childhood Experiences; Borderline Personality Disorder; Diagnostic and Statistical Manual of Mental Disorders; Diseases in Twins; Humans; Personality Disorders; Young Adult
PubMed: 35377676
DOI: 10.1037/abn0000755 -
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 -
Clinical Psychology & Psychotherapy Mar 2023Narcissistic personality disorder (NPD) and the manic and hypomanic episodes found in the bipolar disorders are characterized by grandiosity. It is possible that this... (Review)
Review
Narcissistic personality disorder (NPD) and the manic and hypomanic episodes found in the bipolar disorders are characterized by grandiosity. It is possible that this shared grandiosity is a 'homologous structure' or reflects a superficial similarity between two disparate conditions. It is, however, possible that NPD and the bipolar disorders are more closely related than implied by their segregation into the separate superordinate categories of personality disorders and mood disorders. Whereas narcissism is considered to be a life-course, stable trait and the bipolar disorders are characterized by episodes of mania and depression, there is considerable research indicating that narcissism may be linked to mood instability (including depression) and bipolar disorder may have a pervasive personality component (i.e., hypomanic personality). Utilizing dimensional models of psychopathology, the current review examined the evidence linking narcissism and the bipolar disorders and suggests that considerable overlap may exist in the domains associated with reward-seeking, harm avoidance and social functioning.
Topics: Humans; Bipolar Disorder; Narcissism; Personality Disorders; Mood Disorders; Psychopathology
PubMed: 36308069
DOI: 10.1002/cpp.2796 -
BMC Psychiatry Mar 2024Personality disorders (PDs) are associated with an inferior quality of life, poor health, and premature mortality, leading to heavy clinical, familial, and societal... (Review)
Review
Personality disorders (PDs) are associated with an inferior quality of life, poor health, and premature mortality, leading to heavy clinical, familial, and societal burdens. The International Classification of Diseases-11 (ICD-11) makes a thorough, dramatic paradigm shift from the categorical to dimensional diagnosis of PD and expands the application into adolescence. We have reviewed the recent literature on practical implications, and severity and trait measures of ICD-11 defined PDs, by comparing with the alternative model of personality disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), by mentioning the relevance in forensic and social concerns, and by referencing the developmental implication of life span, especially in adolescence. Study results strongly support the dimensional utility of ICD-11 PD diagnosis and application in adolescence which warrants early detection and intervention. More evidence-based research is needed along the ICD-11 PD application, such as its social relevance, measurement simplification, and longitudinal design of lifespan observation and treatment.
Topics: Adolescent; Humans; International Classification of Diseases; Quality of Life; Personality Disorders; Diagnostic and Statistical Manual of Mental Disorders; Mortality, Premature; Personality
PubMed: 38454364
DOI: 10.1186/s12888-024-05640-3