An Invisible College View of the DSM-5 Personality Disorder ClassificationBlashfield, Roger K.; Reynolds, Shannon M.
2012 Journal of Personality Disorders
doi: 10.1521/pedi.2012.26.6.821pmid: 23281666
The DSM-5 Personality and Personality Disorders Work Group released the final proposed changes for the upcoming manual in May 2012. The proposal, located at www.dsm5.org , included a hybrid dimensional/categorical method of diagnosing personality disorders. This brief article examines the reference section of the DSM-5 personality disorder proposal rationale (American Psychiatric Association, 2012). The authors counted the number of authors and the coauthorships; coauthorship patterns were then examined and diagramed. The data suggested that a group of researchers involved with the Collaborative Longitudinal Personality Disorders Study (CLPS) were central to the hybrid classification created by the DSM-5 work group.
The Heritability of Cluster B Personality Disorders Assessed Both by Personal Interview and QuestionnaireTorgersen, Svenn; Myers, John; Reichborn-Kjennerud, Ted; Røysamb, Espen; Kubarych, Thomas S.; Kendler, Kenneth S.
2012 Journal of Personality Disorders
doi: 10.1521/pedi.2012.26.6.848pmid: 23281671
Whereas the heritability of common personality traits has been firmly established, the results of the few published studies on personality disorders (PDs) are highly divergent, with some studies finding high heredity and others very low. A problem with assessing personality disorders by means of interview is errors connected with interviewer bias. A way to overcome the problem is to use self-report questionnaires in addition to interviews. This study used both interview and questionnaire for assessing DSM-IV Cluster B personality disorders: antisocial personality disorder (APD), borderline (BPD), narcissistic (NPD), and histrionic (HPD). We assessed close to 2,800 twins from the Norwegian Institute of Public Health Twin Panel using a self-report questionnaire and, a few years later, the Structured Interview for DSM-IV Personality (SIDP-IV). Items from the self-report questionnaire that best predicted the PDs captured by the interview were then selected. Measurement models combining questionnaire and interview information were applied and were fitted using Mx. Whereas the heritability of Cluster B PDs assessed by interview was around .30, and around .40–.50 when assessed by self-report questionnaire, the heritability of the convergent latent factor, including information from both interview and self-report questionnaire was .69 for APD, .67 for BPD, .71 for NPD, and .63 for HPD. As is usually found for personality, the effect of shared-in families (familial) environment was zero. In conclusion, when both interview and self-report questionnaire are taken into account, the heritability of Cluster B PD appears to be in the upper range of previous findings for mental disorders.
Borderline Personality Traits and Substance Use: Genetic Factors Underlie the Association With Smoking and Ever Use of Cannabis, but Not With High Alcohol ConsumptionDistel, Marijn A.; Trull, Tim J.; de Moor, Marleen M. H.; Vink, Jacqueline M.; Geels, Lot M.; van Beek, Jenny H. D. A.; Bartels, Meike; Willemsen, Gonneke; Thiery, Evert; Derom, Catherine A.; Neale, Michael C.; Boomsma, Dorret I.
2012 Journal of Personality Disorders
doi: 10.1521/pedi.2012.26.6.867pmid: 23281672
Borderline personality disorder (BPD) and substance use disorders often co-occur. Both disorders are heritable and family studies showed that there are familial factors that increase the risk for BPD as well as substance use/abuse. This is the first study that investigates whether the association of borderline personality traits (BPT) with substance use reflects an underlying genetic vulnerability or nongenetic familial influences. To this end we analyzed data of 5,638 Dutch and Belgian twins aged between 21–50 years from 3,567 families. Significant associations between BPT and high alcohol consumption ( r = .192), regular smoking ( r = .299), and ever use of cannabis ( r = .254) were found. Bivariate genetic analyses showed that the associations of BPT and substance use had different etiologies. For regular smoking and for ever use of cannabis, the correlation with BPT was explained by common genetic factors. Interestingly, for high alcohol consumption and BPT the association was explained by unique environmental factors that influence both traits rather than common genetic factors.
An Empirical Examination of Gunderson's Proposed Revision of the Diagnostic Algorithm for Borderline Personality DisorderZimmerman, Mark; Dalrymple, Kristy; Young, Diane; Chelminski, Iwona; Martinez, Jennifer
2012 Journal of Personality Disorders
doi: 10.1521/pedi.2012.26.6.880pmid: 23281673
Gunderson (2010) recently offered a sharp criticism of the draft proposal for diagnosing personality disorders in DSM-5. Based on a review of phenomenological, factor analytic, social psychology, family, neurobiological, and treatment studies of borderline personality disorder (BPD), he proposed an alternative revision of the BPD criteria. One of the suggested changes was a modification of the DSM-IV diagnostic algorithm. Gunderson did not, however, provide any data on the impact this new diagnostic algorithm would have on the prevalence of BPD, or the validity of this alternative approach compared to the DSM-IV algorithm. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project we administered semi-structured diagnostic interviews to 3,081 psychiatric outpatients and examined diagnostic concordance between DSM-IV and Gunderson's proposal, and whether there is incremental validity in Gunderson's diagnostic approach. The results did not indicate that the alternative diagnostic algorithm improved validity, and, depending on the threshold used, could result in false negative diagnoses.
An Empirical Evaluation of the Structure of DSM-IV Personality Disorders in a Nationally Representative Sample: Results of Confirmatory Factor Analysis in the National Epidemiologic Survey on Alcohol and Related Conditions Waves 1 and 2Cox, Brian J.; Clara, Ian P.; Worobec, Lydia M.; Grant, Bridget F.
2012 Journal of Personality Disorders
doi: 10.1521/pedi.2012.26.6.890pmid: 23281674
Individual personality disorders (PD) are grouped into three clusters in the DSM-IV (A, B, and C). There is very little empirical evidence available concerning the validity of this model in the general population. The current study included all 10 of the DSM-IV PD assessed in Wave 1 and Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Confirmatory factor analysis was used to evaluate three plausible models of the structure of Axis II personality disorders (the current hierarchical DSM-IV three-factor model in which individual PD are believed to load on their assigned clusters, which in turn load onto a single Axis II factor; a general single-factor model; and three independent factors). Each of these models was tested in both the total and also separately for gender. The higher order DSM-IV model demonstrated good fit to the data on a number of goodness-of-fit indices. The results for this model were very similar across genders. A model of PD based on the current DSM-IV hierarchical conceptualization of a higher order classification scheme received strong empirical support through confirmatory factor analysis using a number of goodness-of-fit indices in a nationally representative sample. Other models involving broad, higher order personality domains such as neuroticism in relation to personality disorders have yet to be tested in epidemiologic surveys and represent an important avenue for future research.
Exploring the Interface of Neurobehaviorally Linked Personality Dimensions and Personality Organization in Borderline Personality Disorder: The Multidimensional Personality Questionnaire and Inventory of Personality OrganizationLenzenweger, Mark F.; McClough, Joel F.; Clarkin, John F.; Kernberg, Otto F.
2012 Journal of Personality Disorders
doi: 10.1521/pedi.2012.26.6.902pmid: 23281675
Advances in our understanding of complex psychopathology will likely benefit from approaches to mind, brain, and behavior that seek to (a) specify those general neurobehavioral processes underpinning pathology and (b) bridge to other process-based models of psychopathology at different levels of analysis. Well-defined neurobehavioral processes (e.g., positive emotionality, negative emotionality, nonaffective constraint, fear, affiliation) and their phenotypic indicators are firmly rooted in neural substrates (Depue & Lenzenweger, 2005). Furthermore, long-studied psychodynamic psychological processes, such as identity diffusion, primitive psychological defensive functioning, and reality-testing dimensions, are important to understanding personality pathology (Kernberg & Caligor, 2005). Both theoretical perspectives view the cardinal processes involved in the determination of personality disorders (PDs) as relevant across existing PD diagnostic entities. The authors examined relationships between psychometric indicators of these two sets of processes, the neurobehavioral and the psychodynamic, in a well-characterized sample of individuals with borderline personality disorder (BPD; N = 92). In bridging these two levels of analysis, the authors found that the alienation, aggression, and absorption constructs represent important linkages to the psychodynamic processes, especially primitive psychological defenses and reality-testing impairments. These results are discussed in terms of their potential for joining these two domains of analysis—a neurobehaviorally informed view of personality and the psychodynamic—in efforts to (a) foster a process-oriented approach, (b) resolve heterogeneity, and (c) facilitate identification of endophenotypes in BPD. The heuristic value of this approach for understanding other forms of psychopathology is also discussed.
Schizoid Personality DisorderSiever, Larry J.; Triebwasser, Joseph; Chemerinski, Eran; Roussos, Panos
2012 Journal of Personality Disorders
doi: 10.1521/pedi.2012.26.6.919pmid: 23281676
Schizoid personality disorder (ScPD) is one of the “odd cluster” or “cluster A” personality disorders in DSM-IV. In the present article, the authors review information pertaining to the psychometric characteristics of ScPD as gleaned from a search of relevant publications as well as from databases of personality disorder study groups. Comparatively little evidence exists for the validity and reliability of ScPD as a separate, multifaceted personality disorder. Some authors, moreover, have contended that the group of patients termed “schizoid” actually fall into two distinct groups—an “affect constricted” group, who might better be subsumed within schizotypal personality disorder, and a “seclusive” group, who might better be subsumed within avoidant personality disorder. The research-based justification for retaining ScPD as an independent diagnosis is sufficiently sparse for it to seem reasonable to remove ScPD from the list of personality disorders in DSM-V , and instead to invite clinicians to code for schizoid traits using a dimensional model.
What Does Sadness Mean to BPD Patients?Briand-Malenfant, Rachel; Lecours, Serge; Deschenaux, Emilie
2012 Journal of Personality Disorders
doi: 10.1521/pedi.2012.26.6.939pmid: 23281678
Dysphoria is a core feature of Borderline Personality Disorder. Although a few studies have examined the nature of dysphoria in those patients, no research has focused on their experience of sadness. Considering the adaptive value of this emotion, an understanding of how BPD patients experience sadness is relevant to treatment. We conducted a qualitative analysis of the narratives of seven individuals with a diagnosis of BPD that have participated in a semi-structured interview describing sadness experiences in a relational context. Fourteen episodes were analyzed jointly by two doctoral students following Interpretative Phenomenological Analysis principles. Five themes were found: (1) aggression, (2) relationship broken off by the other, (3) undifferentiated negative affect, (4) self being defective, and (5) overwhelming experience. Surprisingly, sadness in a relational context was not associated with a representation of loss. The results suggest instead that sadness in those episodes is a non-mentalized experience that should not be conceptualized as sadness proper.
“Mad or Bad?”: Burden on Caregivers of Patients With Personality DisordersBauer, Rita; Döring, Antje; Schmidt, Tanja; Spießl, Hermann
2012 Journal of Personality Disorders
doi: 10.1521/pedi.2012.26.6.956pmid: 23281679
The burden on caregivers of patients with personality disorders is often greatly underestimated or completely disregarded. Possibilities for caregiver support have rarely been assessed. Thirty interviews were conducted with caregivers of such patients to assess illness-related burden. Responses were analyzed with a mixed method of qualitative and quantitative analysis in a sequential design. Patient and caregiver data, including sociodemographic and disease-related variables, were evaluated with regression analysis and regression trees. Caregiver statements ( n = 404) were summarized into 44 global statements. The most frequent global statements were worries about the burden on other family members (70.0%), poor cooperation with clinical centers and other institutions (60.0%), financial burden (56.7%), worry about the patient's future (53.3%), and dissatisfaction with the patient's treatment and rehabilitation (53.3%). Linear regression and regression tree analysis identified predictors for more burdened caregivers. Caregivers of patients with personality disorders experience a variety of burdens, some disorder specific. Yet these caregivers often receive little attention or support.