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Psychiatry Research Oct 2023Prevalence rates and correlates of personality disorders (PD) are relevant to health care policy and planning.
INTRODUCTION
Prevalence rates and correlates of personality disorders (PD) are relevant to health care policy and planning.
OBJECTIVES
To present normative data for self-reported ICD-11 personality disorder (PD) features including tentative cut-off scores and prevalence rates for severity levels along with psychosocial correlates.
METHODS
The Personality Disorder Severity ICD-11 (PDS-ICD-11) scale and criterion measures of impairment were administered to a social-demographically stratified sample of Danish citizens (N = 8,941) of which 3,044 delivered complete data. Item-Response Theory (IRT) was employed to indicate cut-offs based on standard deviations from the latent mean.
RESULTS
The unidimensionality of the PDS-ICD-11 score was supported and IRT analysis suggested norm-based thresholds at latent severity levels. Expected associations with criterion measures were found.
CONCLUSION
The normative data portray ICD-11 PD features in the general population and allow for interpretation of PDS-ICD-11 scores (e.g., scores of 12, 16, and 19 may indicate mild, moderate, and severe dysfunction), which may inform health care policy and planning. A total weighted prevalence of 6.9 % of the Danish general population is estimated to have clinically significant personality dysfunction, proportionally composed of Mild (4.8 %), Moderate (1.2 %), and Severe (0.9 %) levels. Future research should corroborate these findings using relevant clinical samples and methods.
Topics: Humans; Prevalence; International Classification of Diseases; Personality Disorders; Self Report; Personality; Denmark
PubMed: 37748238
DOI: 10.1016/j.psychres.2023.115484 -
PloS One 2018Grandiose narcissism has been associated with poor ability to understand one's own mental states and the mental states of others. In particular, two manifestations of...
BACKGROUND
Grandiose narcissism has been associated with poor ability to understand one's own mental states and the mental states of others. In particular, two manifestations of Narcissistic Personality Disorder (NPD) can be explained by poor mindreading abilities: absence of symptomatic subjective distress and lack of empathy.
METHODS
We conducted two studies to investigate the relationships between mindreading capacity, symptomatic subjective distress and narcissistic personality. In the first study (N = 246), we compared mindreading capacities and symptomatic distress in three outpatient samples: narcissistic patients (NPD); patients with other Personality Disorders (PD); patients without PD. In the second study (N = 1357), we explored the relationships between symptomatic distress, mindreading and specific NPD criteria.
RESULTS
In the first study, the NPD patients showed poorer mindreading than the patients without PD and comparable to patients with other PDs. Symptomatic subjective distress in the narcissistic group was less severe than in the other PDs group and comparable to the group without PDs. However, no relationship emerged between mindreading and symptomatic subjective distress. In the second study, taking the clinical sample as a whole, symptomatic distress appeared negatively linked to grandiosity traits, while mindreading scores were negatively linked to empathy.
CONCLUSIONS
NPD showed specific mindreading impairments. However, mindreading capacity did not appear to be directly connected with subjective distress, but did appear to be connected with specific aspects of narcissistic pathology.
Topics: Adolescent; Adult; Affective Symptoms; Aged; Female; Humans; Interview, Psychological; Male; Metacognition; Middle Aged; Personality Disorders; Psychiatric Status Rating Scales; Self Concept; Severity of Illness Index; Social Perception; Stress, Psychological; Theory of Mind; Young Adult
PubMed: 30110368
DOI: 10.1371/journal.pone.0201216 -
BMC Psychiatry May 2019The main objectives of the mobile Psychiatric Emergency Services (PES) in the Netherlands are to assess the presence of a mental disorder, to estimate risk to self or... (Observational Study)
Observational Study
BACKGROUND
The main objectives of the mobile Psychiatric Emergency Services (PES) in the Netherlands are to assess the presence of a mental disorder, to estimate risk to self or others, and to initiate continuity of care, including psychiatric hospital admission. The aim of this study was to assess the associations between the level of suicidality and risk of voluntary or involuntary admission in patients with and without a personality disorder who were presented to mobile PES.
METHODS
Observational data were obtained in three areas of the Netherlands from 2007 to 2016. In total, we included 71,707 contacts of patients aged 18 to 65 years. The outcome variable was voluntary or involuntary psychiatric admission. Suicide risk and personality disorder were assessed by PES-clinicians. Multivariable regression analysis was used to explore associations between suicide risk, personality disorder, and voluntary or involuntary admission.
RESULTS
Independently of the level of suicide risk, suicidal patients diagnosed with personality disorder were less likely to be admitted voluntarily than those without such a diagnosis (admission rate .37 versus .46 respectively). However, when the level of suicide risk was moderate or high, those with a personality disorder who were admitted involuntarily had the same probability of involuntary admission as those without such a disorder.
CONCLUSIONS
While the probability of voluntary admission was lower in those diagnosed with a personality disorder, independent of the level of suicidality, the probability of involuntary admission was only lower in those whose risk of suicide was low. Future longitudinal studies should investigate the associations between (involuntary) admission and course of suicidality in personality disorder.
Topics: Adolescent; Adult; Aged; Commitment of Mentally Ill; Emergency Services, Psychiatric; Female; Hospitalization; Humans; Longitudinal Studies; Male; Middle Aged; Netherlands; Patient Admission; Personality Disorders; Suicidal Ideation; Suicide; Young Adult
PubMed: 31122268
DOI: 10.1186/s12888-019-2145-0 -
Current Psychiatry Reports Jul 2021Childhood trauma is an important risk factor for the development of personality disorders (PDs), yet most research has been devoted to categorical models of personality... (Review)
Review
PURPOSE OF REVIEW
Childhood trauma is an important risk factor for the development of personality disorders (PDs), yet most research has been devoted to categorical models of personality pathology. Considering the introduction of a dimensional PD model with ICD-11, we review current findings related to various forms of childhood trauma, and PDs, operationalized in the form of personality functioning and maladaptive traits. We focus on the magnitude of associations and examine specific relationships between emotional and physical trauma with areas of personality functioning and single traits.
RECENT FINDINGS
Two studies showed a strong association between childhood trauma and personality dysfunction. Seven studies, including clinical and forensic samples, demonstrated heterogeneous associations between various forms of childhood trauma and maladaptive traits. Overall, four studies indicated a slightly stronger association between personality dysfunction, maladaptive trait expression, and higher levels of emotional trauma than for physical or sexual trauma. Regarding specific trait domains and childhood trauma, most studies yielded the strongest associations for either psychoticism or detachment. Research on childhood trauma and dimensional PD models (i.e., personality functioning and traits) has the potential to contribute to a better understanding of their complex relationship. However, high intercorrelations among different types of childhood trauma, areas of personality functioning, and trait domains increase the difficulty of disentangling single effects. More research is needed including clinical and non-Western samples, especially considering the upcoming ICD-11 classification.
Topics: Diagnostic and Statistical Manual of Mental Disorders; Humans; International Classification of Diseases; Personality; Personality Disorders; Personality Inventory
PubMed: 34279729
DOI: 10.1007/s11920-021-01265-5 -
Current Opinion in Psychiatry Jan 2008To review the most recent literature on the relationship between personality disorders and violent behavior. The review does not aim to address the issue of a possible... (Review)
Review
PURPOSE OF REVIEW
To review the most recent literature on the relationship between personality disorders and violent behavior. The review does not aim to address the issue of a possible etiological connection between previously being the victim of violent acts and later developing a personality disorder.
RECENT FINDINGS
Recent data suggest that personality disorders, especially antisocial and borderline, are strongly related to the manifestation of violent acts. Substance abuse is another strong factor which could act either independently or additively. Biological factors seem to constitute a risk factor for violent behavior independently of personality. Although intelligence does not seem to be related to violence, some patients may manifest specific cognitive deficits. The ethical and legal questions posed by the above correlations are difficult to answer, and research has not yet provided enough data on this issue.
SUMMARY
The most recent data support the relationship between antisocial personality and violence, especially when substance abuse is also present, although the presence of confounding factors in the diagnostic criteria suggest caution in the interpretation of the literature.
Topics: Adolescent; Adult; Antisocial Personality Disorder; Borderline Personality Disorder; Child; Comorbidity; Cross-Sectional Studies; Domestic Violence; Female; Homicide; Humans; Male; Personality Disorders; Risk Factors; Sex Factors; Sex Offenses; Violence
PubMed: 18281846
DOI: 10.1097/YCO.0b013e3282f31137 -
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 -
PloS One 2020Depression is a common illness with substantial economic consequences for society and a great burden for affected individuals. About 30% of patients with depression do...
OBJECTIVES
Depression is a common illness with substantial economic consequences for society and a great burden for affected individuals. About 30% of patients with depression do not respond to repeated treatments. Psychiatric comorbidity is known to affect duration, recurrence and treatment outcome of depression. However, there is a lack of knowledge on the extent to which psychiatric comorbidity is identified in the clinical setting for depressed patients in secondary psychiatric care. Therefore, the aim of this study was to compare the agreement between traditional diagnostic assessment (TDA) and a structured and comprehensive diagnostic procedure (SCDP) for identification of personality and anxiety disorder comorbidity in depressed patients in secondary psychiatric care.
METHODS
274 patients aged 18-77 were referred from four secondary psychiatric care clinics in Sweden during 2012-2017. ICD-10 diagnoses according to TDA (mostly unstructured by psychiatric specialist and residents in psychiatry), were retrieved from medical records and compared to diagnoses resulting from the SCDP in the study. This included the Mini International Neuropsychiatric Interview, the Structured Interview for DSM Axis II Personality Disorders and semi-structured questions on psychosocial circumstances, life-events, psychiatric symptoms, psychiatric treatments, substance use, and suicidal and self-harm behaviour. The assessment was carried out by psychiatric specialists or by residents in psychiatry with at least three years of psychiatric training.
RESULTS
SCDP identified personality disorder comorbidity in 43% of the patients compared to 11% in TDA (p<0,0001). Anxiety disorder comorbidity was identified in 58% with SCDP compared to 12% with TDA (p<0,0001).
CONCLUSIONS
Important psychiatric comorbidity seems to be unrecognized in depressive patients when using TDA, which is routine in secondary psychiatric care. Comorbidities are better identified using the proposed model involving structured and semi-structured interviews together with clinical evaluations by clinical experts.
Topics: Adolescent; Adult; Aged; Anxiety Disorders; Comorbidity; Depressive Disorder; Diagnostic and Statistical Manual of Mental Disorders; Female; Humans; International Classification of Diseases; Interview, Psychological; Male; Middle Aged; Personality Disorders; Psychiatric Status Rating Scales; Psychiatry; Psychotherapy; Secondary Care; Sweden; Young Adult
PubMed: 31895938
DOI: 10.1371/journal.pone.0227364 -
Psychiatria Danubina Mar 2019This paper presents an integrative model of personality and personality disorder which incorporates psychoanalytic concepts with modern neuroscience. In addition, a...
This paper presents an integrative model of personality and personality disorder which incorporates psychoanalytic concepts with modern neuroscience. In addition, a dynamic, personalized, and context - and time-sensitive diagnosis of personality disorder is introduced. The authors cogently argue that all clinical variants of personality disorder share the same common deficit: fragmented basic units of experience at the nonconscious core of the mind (aka "partial object relations"). The fragmentation propagates through mental faculties (thought, motivation, emotion), as they self-organize into subsystems of personality, e.g., one's sense of self, identity, character, moral values, rendering them polarized into extreme and thus adaptively suboptimal. The syndrome of personality disorder arises as a nonconscious compensatory maneuver of the fragmented mind to organize itself through a defensive but unrealistic self-image (e.g., narcissistic, schizoid, antisocial, etc.), giving rise to a host of unique symptoms. Symptomatic pharmacotherapy of personality disorder is best organized around four empirically derived domains of symptoms, shared by all variants to a variable degree: i) mood and anxiety dysregulation; ii) impulsivity, aggression, and behavior dyscontrol; iii) emotional disinterest and detachment; and iv) cognitive distortions and brief reactive psychoses. Pharmacotherapy targeting the above domains is nonspecific, as medications affect multiple domains simultaneously. Modest empirical evidence and considerable clinical benefits continue to support the use of medications in the overall symptomatic treatment of personality disorder.
Topics: Antisocial Personality Disorder; Humans; Impulsive Behavior; Models, Psychological; Narcissism; Personality Disorders; Psychotherapy
PubMed: 30948684
DOI: 10.24869/psyd.2019.2 -
Turk Psikiyatri Dergisi = Turkish... 2022To review and summarize data on the prevalence of overall personality disorder extracted from SCID-II (Structured Clinical Interview for DSM-III Axis II Disorders)... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To review and summarize data on the prevalence of overall personality disorder extracted from SCID-II (Structured Clinical Interview for DSM-III Axis II Disorders) studies conducted in Turkey with samples consisting of mental health consumers, and also to elaborate on the level and sources of heterogeneity.
METHOD
MEDLINE, WOS, PsycINFO, ScienceDirect databases as well as the Turkish Psychiatric Database have been systematically searched. Relevant studies conducted with samples composed of psychiatric inpatients or outpatients receiving psychiatric treatment were included. The diagnostic rate of any personality disorder was regarded as the valid indicator of the overall personality disorder prevalence; therefore, papers presenting data not conducive to this goal were excluded.
RESULTS
A total of 311 papers were identified, and 55 studies were included in the qualitative synthesis. Following a critical appraisal of the quality of the data involving point prevalence rates ranging from 20% to 100%, we decided to include 35 studies in the quantitative synthesis. A random-effects meta-analysis followed by a subgroup analysis yielded a summary estimate of 52% [46 - 58%] for the prevalence of overall personality disorder. A high level of overall heterogeneity 84.8 % [80.0 - 88.4] was found to persist in each diagnostic subgroup with a particular primary diagnosis.
CONCLUSION
The prevalence estimates derived from the meta-analysis of the SCID-II studies conducted in Turkey support the notion that personality disorder is present in nearly half of the mental health service consumers. That the level of heterogeneity across studies originating from Turkey alone was as high as those observed in previous reviews covering studies originating from various countries suggests that the very source of such heterogeneity might be questionable validity and reliability of SCID-II diagnoses.
Topics: Humans; Personality Disorders; Prevalence; Psychiatry; Reproducibility of Results; Turkey
PubMed: 35730512
DOI: 10.5080/u26104 -
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