Nicholas J S Day, Michelle L Townsend, Brin F S Grenyer
Pathological narcissism is marked by deficits in psychosocial functioning. Difficulties in relationships include instances of aggression, devaluation and control; however, few studies have examined these relationships from the perspective of partners and family members. We studied participants who were in relationships with relatives high in narcissistic traits (N = 436; current romantic partners [57.3%]; former romantic partners [21.1%]; family members [15.4%]). Participant responses were analysed thematically, and their underlying mental health problems were also measured. Thematic analysis of participant responses indicated themes of abuse from the relative with narcissism (physical, verbal, emotional and sexual) as well as the relative imposing challenging financial and sexual behaviours. There were complex interpersonal themes of mutual idealization but also devaluation. In response, participants reported high levels of anxiety, depression, self-aggression, sickness and somatic concerns. Further, participants expressed overt outward hostility towards their relative with narcissism, but also dependency strivings and frustrated dependency themes. Partners and their relative with narcissism appeared locked into interpersonal and intrapersonal dynamic conflicts. Clinical implications include specific attendance to alliance issues, dependency themes, and a focus on limit setting to establish personal safety.
{"title":"Pathological narcissism: An analysis of interpersonal dysfunction within intimate relationships.","authors":"Nicholas J S Day, Michelle L Townsend, Brin F S Grenyer","doi":"10.1002/pmh.1532","DOIUrl":"https://doi.org/10.1002/pmh.1532","url":null,"abstract":"<p><p>Pathological narcissism is marked by deficits in psychosocial functioning. Difficulties in relationships include instances of aggression, devaluation and control; however, few studies have examined these relationships from the perspective of partners and family members. We studied participants who were in relationships with relatives high in narcissistic traits (N = 436; current romantic partners [57.3%]; former romantic partners [21.1%]; family members [15.4%]). Participant responses were analysed thematically, and their underlying mental health problems were also measured. Thematic analysis of participant responses indicated themes of abuse from the relative with narcissism (physical, verbal, emotional and sexual) as well as the relative imposing challenging financial and sexual behaviours. There were complex interpersonal themes of mutual idealization but also devaluation. In response, participants reported high levels of anxiety, depression, self-aggression, sickness and somatic concerns. Further, participants expressed overt outward hostility towards their relative with narcissism, but also dependency strivings and frustrated dependency themes. Partners and their relative with narcissism appeared locked into interpersonal and intrapersonal dynamic conflicts. Clinical implications include specific attendance to alliance issues, dependency themes, and a focus on limit setting to establish personal safety.</p>","PeriodicalId":46871,"journal":{"name":"Personality and Mental Health","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e7/25/PMH-16-.PMC9541508.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10621046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-08-01Epub Date: 2021-12-05DOI: 10.1002/pmh.1533
Susan Simpson, Fatima Azam, SiennaMarisa Brown, Anastasia Hronis, Robert Brockman
A significant proportion of those with eating disorders (EDs) do not respond to first-line treatments. This systematic review was conducted to identify whether personality disorders (PDs)/traits predict or moderate ED treatment outcomes and whether these outcomes were differentially influenced by ED or PD diagnostic subtypes, or treatment approach. A comprehensive systematic literature search was conducted using the PRISMA guidelines. A total of seven randomised controlled trials (RCTs) plus four follow-up studies were reviewed investigating the impact of PD and PD traits on treatment outcomes for EDs. The majority indicated that PD had some impact on treatment outcomes. Outcome measures and time-point measurements varied across studies. Included studies suggested that bulimia nervosa treatment outcomes were not hindered by co-morbidity of borderline PD; however, psychiatric impairment remained high at post-treatment and follow-up. Cluster C PDs were found to negatively impact treatment outcomes for binge ED and attrition rates for anorexia nervosa. Included studies suggested that interventions that addressed aspects of personality pathology showed greater main effects for ED treatment outcomes. There is an urgent need for future RCTs on ED treatments to include routine measures of core personality features to allow their impacts to be more thoroughly examined and for psychotherapies to be tailored accordingly.
{"title":"The impact of personality disorders and personality traits on psychotherapy treatment outcome of eating disorders: A systematic review.","authors":"Susan Simpson, Fatima Azam, SiennaMarisa Brown, Anastasia Hronis, Robert Brockman","doi":"10.1002/pmh.1533","DOIUrl":"https://doi.org/10.1002/pmh.1533","url":null,"abstract":"<p><p>A significant proportion of those with eating disorders (EDs) do not respond to first-line treatments. This systematic review was conducted to identify whether personality disorders (PDs)/traits predict or moderate ED treatment outcomes and whether these outcomes were differentially influenced by ED or PD diagnostic subtypes, or treatment approach. A comprehensive systematic literature search was conducted using the PRISMA guidelines. A total of seven randomised controlled trials (RCTs) plus four follow-up studies were reviewed investigating the impact of PD and PD traits on treatment outcomes for EDs. The majority indicated that PD had some impact on treatment outcomes. Outcome measures and time-point measurements varied across studies. Included studies suggested that bulimia nervosa treatment outcomes were not hindered by co-morbidity of borderline PD; however, psychiatric impairment remained high at post-treatment and follow-up. Cluster C PDs were found to negatively impact treatment outcomes for binge ED and attrition rates for anorexia nervosa. Included studies suggested that interventions that addressed aspects of personality pathology showed greater main effects for ED treatment outcomes. There is an urgent need for future RCTs on ED treatments to include routine measures of core personality features to allow their impacts to be more thoroughly examined and for psychotherapies to be tailored accordingly.</p>","PeriodicalId":46871,"journal":{"name":"Personality and Mental Health","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39961030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-08-01Epub Date: 2022-01-26DOI: 10.1002/pmh.1538
Donald W Black, Nancee Blum, Jeff Allen
Differential response to the Systems Training for Emotional Predictability and Problem Solving (STEPPS) program was compared in subgroups identified through latent class analysis (LCA). STEPPS is an evidence-based group treatment program for patients with borderline personality disorder (BPD). A reanalysis of data was conducted using data from a 20-week randomized controlled trial and 1-year follow-up. Subjects (n = 164) with DSM-IV BPD were assessed for comorbid Axis I and II disorders and selected clinical variables. Severity was assessed using the Zanarini Rating Scale for BPD (ZAN-BPD) and the Borderline Evaluation of Severity Over Time (BEST). Three- and four-class models were identified with the four-class model having the better fit. The latter included a high severity (HS) class (26%), an affective instability/substance abuse (AISA) class (16%), an empty/dissociation/identity disturbance (EDID) class (27%), and a low severity (LS) class (30%). High impulsiveness predicted membership in the HS class. Improvement was determined using a linear mixed-effects model. Those most likely to benefit were those in the HS group characterized by high symptom severity, Axis I and II comorbidity, problem relationships, abandonment fears, and intense anger. This work should help further efforts to match patients with treatments based on sociodemographic, diagnostic, and other illness characteristics.
通过潜在类分析(LCA)确定亚组,比较了对情绪可预测性和问题解决系统训练(STEPPS)计划的差异反应。STEPPS是一项针对边缘型人格障碍(BPD)患者的循证团体治疗方案。对20周随机对照试验和1年随访的数据进行再分析。对患有DSM-IV BPD的受试者(n = 164)进行共病I和II轴疾病和选定的临床变量评估。使用扎纳里尼BPD评定量表(Zanarini Rating Scale for BPD, ZAN-BPD)和严重程度随时间的边界评估(BEST)来评估严重程度。确定了三、四类模型,其中四类模型拟合效果较好。后者包括高严重性(HS)类(26%)、情感不稳定/药物滥用(AISA)类(16%)、空虚/分离/身份障碍(EDID)类(27%)和低严重性(LS)类(30%)。高冲动性预示着高中班的成员资格。使用线性混合效应模型确定改善程度。最有可能受益的是那些具有高症状严重程度、轴I和轴II合并症、问题关系、遗弃恐惧和强烈愤怒的HS组。这项工作将有助于进一步根据社会人口学、诊断和其他疾病特征为患者匹配治疗方案。
{"title":"Factor structure of borderline personality disorder and response to Systems Training for Emotional Predictability and Problem Solving.","authors":"Donald W Black, Nancee Blum, Jeff Allen","doi":"10.1002/pmh.1538","DOIUrl":"https://doi.org/10.1002/pmh.1538","url":null,"abstract":"<p><p>Differential response to the Systems Training for Emotional Predictability and Problem Solving (STEPPS) program was compared in subgroups identified through latent class analysis (LCA). STEPPS is an evidence-based group treatment program for patients with borderline personality disorder (BPD). A reanalysis of data was conducted using data from a 20-week randomized controlled trial and 1-year follow-up. Subjects (n = 164) with DSM-IV BPD were assessed for comorbid Axis I and II disorders and selected clinical variables. Severity was assessed using the Zanarini Rating Scale for BPD (ZAN-BPD) and the Borderline Evaluation of Severity Over Time (BEST). Three- and four-class models were identified with the four-class model having the better fit. The latter included a high severity (HS) class (26%), an affective instability/substance abuse (AISA) class (16%), an empty/dissociation/identity disturbance (EDID) class (27%), and a low severity (LS) class (30%). High impulsiveness predicted membership in the HS class. Improvement was determined using a linear mixed-effects model. Those most likely to benefit were those in the HS group characterized by high symptom severity, Axis I and II comorbidity, problem relationships, abandonment fears, and intense anger. This work should help further efforts to match patients with treatments based on sociodemographic, diagnostic, and other illness characteristics.</p>","PeriodicalId":46871,"journal":{"name":"Personality and Mental Health","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39738048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-08-01Epub Date: 2021-12-14DOI: 10.1002/pmh.1534
Kiana Cano, Eric Sumlin, Carla Sharp
Although borderline symptoms show a normative decline throughout adulthood, severe psychosocial impairment often remains. Identifying personality pathology in college-age students may help prevent "adaptive failure" that can occur during the critical period of development from puberty through the late 20s and thus reduce impairment later in life. The aims of the current study were to estimate the prevalence of borderline personality disorder (BPD) in a diverse college sample, determine which symptoms confer the greatest relative risk of screening positive for BPD and examine the utility of the Personality Inventory for DSM-5 brief form (PID-5-BF) in identifying BPD. Participants were 1456 undergraduate students, and 312 individuals (21.4% of the sample) screened positive for BPD. Chronic feelings of emptiness conferred the greatest relative risk of any symptom; students who endorsed this symptom were 15 times more likely to screen positive for BPD than those who did not. Scales and composite scores of the PID-5-BF demonstrated diagnostic accuracy ranging from sufficient to excellent. The current study contributes to literature concerning best practices in screening for personality pathology in young adults. Results suggest that chronic feelings of emptiness are significant for detecting at-risk students and implications for the use of the PID-5-BF are discussed.
{"title":"Screening for borderline personality pathology on college campuses.","authors":"Kiana Cano, Eric Sumlin, Carla Sharp","doi":"10.1002/pmh.1534","DOIUrl":"https://doi.org/10.1002/pmh.1534","url":null,"abstract":"<p><p>Although borderline symptoms show a normative decline throughout adulthood, severe psychosocial impairment often remains. Identifying personality pathology in college-age students may help prevent \"adaptive failure\" that can occur during the critical period of development from puberty through the late 20s and thus reduce impairment later in life. The aims of the current study were to estimate the prevalence of borderline personality disorder (BPD) in a diverse college sample, determine which symptoms confer the greatest relative risk of screening positive for BPD and examine the utility of the Personality Inventory for DSM-5 brief form (PID-5-BF) in identifying BPD. Participants were 1456 undergraduate students, and 312 individuals (21.4% of the sample) screened positive for BPD. Chronic feelings of emptiness conferred the greatest relative risk of any symptom; students who endorsed this symptom were 15 times more likely to screen positive for BPD than those who did not. Scales and composite scores of the PID-5-BF demonstrated diagnostic accuracy ranging from sufficient to excellent. The current study contributes to literature concerning best practices in screening for personality pathology in young adults. Results suggest that chronic feelings of emptiness are significant for detecting at-risk students and implications for the use of the PID-5-BF are discussed.</p>","PeriodicalId":46871,"journal":{"name":"Personality and Mental Health","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39604471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-21DOI: 10.1093/med:psych/9780199384426.001.0001
Erol Ekiz, S. V. van Alphen, M. Ouwens, Jamie Van de Paar, A. Videler
Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a group treatment program for patients with borderline personality disorder (BPD). The program was intended to be highly accessible, both for patients and therapists. During STEPPS, patients are taught emotion regulation and behavior management skills. This systematic review synthesizes the current empirical status of STEPPS, focusing on research designs, quality of studies, target groups, protocols, and outcome. We selected 20 studies, with three randomized controlled trials. Patients with BPD, subthreshold BPD, and patients with BPD and comorbid antisocial personality disorder were investigated. One study was conducted in adolescents. There were no studies in older adults. Results demonstrated STEPPS to be associated with reduced BPD symptoms, improved quality of life, decreased depressive symptoms, and decreased negative affectivity. Mixed results were found for impulsivity and suicidal behaviors. STEPPS has both been studied as an add-on therapy to patients' ongoing treatment, and, with the addition of individual STEPPS sessions, as a stand-alone treatment. High attrition rates were found in patients attending STEPPS, complicating the generalizability of the results. Although the evidence for STEPPS is promising, further research is needed before firm conclusions can be drawn. Recommendations for future research are discussed.
{"title":"Systems Training for Emotional Predictability and Problem Solving for borderline personality disorder: A systematic review.","authors":"Erol Ekiz, S. V. van Alphen, M. Ouwens, Jamie Van de Paar, A. Videler","doi":"10.1093/med:psych/9780199384426.001.0001","DOIUrl":"https://doi.org/10.1093/med:psych/9780199384426.001.0001","url":null,"abstract":"Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a group treatment program for patients with borderline personality disorder (BPD). The program was intended to be highly accessible, both for patients and therapists. During STEPPS, patients are taught emotion regulation and behavior management skills. This systematic review synthesizes the current empirical status of STEPPS, focusing on research designs, quality of studies, target groups, protocols, and outcome. We selected 20 studies, with three randomized controlled trials. Patients with BPD, subthreshold BPD, and patients with BPD and comorbid antisocial personality disorder were investigated. One study was conducted in adolescents. There were no studies in older adults. Results demonstrated STEPPS to be associated with reduced BPD symptoms, improved quality of life, decreased depressive symptoms, and decreased negative affectivity. Mixed results were found for impulsivity and suicidal behaviors. STEPPS has both been studied as an add-on therapy to patients' ongoing treatment, and, with the addition of individual STEPPS sessions, as a stand-alone treatment. High attrition rates were found in patients attending STEPPS, complicating the generalizability of the results. Although the evidence for STEPPS is promising, further research is needed before firm conclusions can be drawn. Recommendations for future research are discussed.","PeriodicalId":46871,"journal":{"name":"Personality and Mental Health","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2022-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43182510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Great progress has been made in furthering our understanding of the long-term course of personality pathology. However, our knowledge about the long-term outcomes of personality disorder, thus far, is based on a polythetic and categorical definition of personality disorder. This special issue brings together a set of papers reporting on the results of the 30-year prospective study, the Nottingham Study of Neurotic Disorder, in addition to presenting a study protocol for a future study, the Boston (UK) Personality Project, and results from a study of lived experience of individuals who have been in treatment for personality challenges. Together, these papers highlight the value in viewing personality pathology not as a categorically defined disorder, but as a severity criterion related to functioning. This special issue paves the way for considering how to further refine and conceptualize the general severity criterion common to all manifestations (types) of personality disorder.
{"title":"New data toward fulfilling the promise of the ICD-11 severity criterion.","authors":"C. Sharp","doi":"10.1002/pmh.1549","DOIUrl":"https://doi.org/10.1002/pmh.1549","url":null,"abstract":"Great progress has been made in furthering our understanding of the long-term course of personality pathology. However, our knowledge about the long-term outcomes of personality disorder, thus far, is based on a polythetic and categorical definition of personality disorder. This special issue brings together a set of papers reporting on the results of the 30-year prospective study, the Nottingham Study of Neurotic Disorder, in addition to presenting a study protocol for a future study, the Boston (UK) Personality Project, and results from a study of lived experience of individuals who have been in treatment for personality challenges. Together, these papers highlight the value in viewing personality pathology not as a categorically defined disorder, but as a severity criterion related to functioning. This special issue paves the way for considering how to further refine and conceptualize the general severity criterion common to all manifestations (types) of personality disorder.","PeriodicalId":46871,"journal":{"name":"Personality and Mental Health","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44365682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01Epub Date: 2022-01-03DOI: 10.1002/pmh.1535
Peter Tyrer, Helen Tyrer, Min Yang
We compared the drug treatments and health service contacts of anxious and depressed patients separated by personality disturbance in 200 patients over 30 years. Contact details with health professionals at 5, 12 and 30 years were recorded and analysed by multilevel models at all time points. Over 30 years, patients with dependent and anankastic personality disturbance and cothymia (the general neurotic syndrome) were 2.27 times more likely to receive selective serotonin reuptake inhibitors (SSRIs) and new antidepressants (95% confidence interval [CI]: 1.22-4.24), particularly paroxetine, and were 1.6 weeks (95% CI: 1.2-2.3) longer on the drug than those without the syndrome. Similar results with SSRIs and new antidepressants in patients with personality disorder fell short of significance after adjusting for age, sex and DSM status. Most patients had a DSM diagnosis at follow-up points, and these had increased psychological treatment, psychiatric admissions, multiple drugs, SSRIs and new antidepressants. At later follow-up, most drug treatments decreased apart from psychological treatment, SSRIs and new antidepressants, and baseline personality disorder had little impact on treatment histories compared with others. We conclude that the (Galenic) general neurotic syndrome is associated with greater use of treatments in the long term, showing that combined personality and symptomatic pathology overcomes that of personality disorder alone.
{"title":"Relationships between treatments received in the Nottingham Study of Neurotic Disorder over 30 years and personality status.","authors":"Peter Tyrer, Helen Tyrer, Min Yang","doi":"10.1002/pmh.1535","DOIUrl":"https://doi.org/10.1002/pmh.1535","url":null,"abstract":"<p><p>We compared the drug treatments and health service contacts of anxious and depressed patients separated by personality disturbance in 200 patients over 30 years. Contact details with health professionals at 5, 12 and 30 years were recorded and analysed by multilevel models at all time points. Over 30 years, patients with dependent and anankastic personality disturbance and cothymia (the general neurotic syndrome) were 2.27 times more likely to receive selective serotonin reuptake inhibitors (SSRIs) and new antidepressants (95% confidence interval [CI]: 1.22-4.24), particularly paroxetine, and were 1.6 weeks (95% CI: 1.2-2.3) longer on the drug than those without the syndrome. Similar results with SSRIs and new antidepressants in patients with personality disorder fell short of significance after adjusting for age, sex and DSM status. Most patients had a DSM diagnosis at follow-up points, and these had increased psychological treatment, psychiatric admissions, multiple drugs, SSRIs and new antidepressants. At later follow-up, most drug treatments decreased apart from psychological treatment, SSRIs and new antidepressants, and baseline personality disorder had little impact on treatment histories compared with others. We conclude that the (Galenic) general neurotic syndrome is associated with greater use of treatments in the long term, showing that combined personality and symptomatic pathology overcomes that of personality disorder alone.</p>","PeriodicalId":46871,"journal":{"name":"Personality and Mental Health","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39783800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Although personality strengths are assessed frequently in occupational and managerial settings and in children, they have been less used in studies of personality disorder. The aim of this study is to examine the impact of a measure of personality strengths derived from the comprehensive version of the Personality Assessment Schedule (CPAS) (i.e., positive and reinforcing traits) on clinical symptoms and functioning. Eighty‐nine patients with anxiety and depression seen at the 30‐year follow‐up point in a cohort study (Nottingham Study of Neurotic Disorder) were administered the Comprehensive version of the PAS (CPAS). A factor analysis of the results determined the main groupings and their impact on long‐term outcomes as well as their association with change of outcomes over 30 years. Five positive factors (strengths), forceful considerateness, emotional toughness, cautiousness, independence and discernment accounted for 67.2% of the variance using both Varimax and Promax rotations. Low positive scores were strongly associated with suicide attempts, moderate/severe personality disorder, cothymia (mixed anxiety‐depression), greater symptomatology and poor social function. High scores were protective of serious pathology and particularly effective in inhibiting suicidal behaviour. The promotion of personality strengths may be of value in preventing suicidal behaviour and helping pro‐social change in those with personality disturbance.
{"title":"The recording of personality strengths: An analysis of the impact of positive personality features on the long‐term outcome of common mental disorders","authors":"Min Yang, P. Tyrer, H. Tyrer","doi":"10.1002/pmh.1548","DOIUrl":"https://doi.org/10.1002/pmh.1548","url":null,"abstract":"Abstract Although personality strengths are assessed frequently in occupational and managerial settings and in children, they have been less used in studies of personality disorder. The aim of this study is to examine the impact of a measure of personality strengths derived from the comprehensive version of the Personality Assessment Schedule (CPAS) (i.e., positive and reinforcing traits) on clinical symptoms and functioning. Eighty‐nine patients with anxiety and depression seen at the 30‐year follow‐up point in a cohort study (Nottingham Study of Neurotic Disorder) were administered the Comprehensive version of the PAS (CPAS). A factor analysis of the results determined the main groupings and their impact on long‐term outcomes as well as their association with change of outcomes over 30 years. Five positive factors (strengths), forceful considerateness, emotional toughness, cautiousness, independence and discernment accounted for 67.2% of the variance using both Varimax and Promax rotations. Low positive scores were strongly associated with suicide attempts, moderate/severe personality disorder, cothymia (mixed anxiety‐depression), greater symptomatology and poor social function. High scores were protective of serious pathology and particularly effective in inhibiting suicidal behaviour. The promotion of personality strengths may be of value in preventing suicidal behaviour and helping pro‐social change in those with personality disturbance.","PeriodicalId":46871,"journal":{"name":"Personality and Mental Health","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44907893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01Epub Date: 2022-05-10DOI: 10.1002/pmh.1547
Brin F S Grenyer, Michelle L Townsend, Kate Lewis, Nicholas Day
Although recovery from borderline personality disorder (BPD) is common, not all individuals improve over time. This study sought to examine the features that contribute to response or non-response for individuals at different stages of recovery from BPD over a longitudinal follow-up. Participants were individuals with a diagnosis of BPD that were followed up after 1 year of receiving psychological treatment. There were no significant differences between participants at intake across key indices; however, at 1-year follow-up, two groups were distinguishable as either 'functioning well' (n = 23) or 'functioning poorly' (n = 25) based on symptomatology and functional impairment. Participant qualitative responses were analysed thematically and via Leximancer content analysis. Thematic analysis indicated three key themes: (1) love of self and others, (2) making a contribution through work and study and (3) stability in daily life. Participants who were 'functioning well' described meaningful relationships with others, enjoyment in vocation, and described less frequent or manageable life crises. The 'functioning poorly' group described relationship conflicts, vocational challenges, feelings of aimlessness and purposelessness, instability in daily living and frequent crises. Leximancer content analysis visually depicted these divergent thematic nomological networks. Corroborating quantitative analyses indicated significant differences between these groups for social, occupational and symptom profiles. These findings highlight the centrality of achieving the capacity to 'love and work' in fostering a sense of personal recovery. Treatments may need specific focus on these factors, as they appeared to reinforce symptomatic trajectories of either improvement or poor non-response to therapy.
{"title":"To love and work: A longitudinal study of everyday life factors in recovery from borderline personality disorder.","authors":"Brin F S Grenyer, Michelle L Townsend, Kate Lewis, Nicholas Day","doi":"10.1002/pmh.1547","DOIUrl":"10.1002/pmh.1547","url":null,"abstract":"<p><p>Although recovery from borderline personality disorder (BPD) is common, not all individuals improve over time. This study sought to examine the features that contribute to response or non-response for individuals at different stages of recovery from BPD over a longitudinal follow-up. Participants were individuals with a diagnosis of BPD that were followed up after 1 year of receiving psychological treatment. There were no significant differences between participants at intake across key indices; however, at 1-year follow-up, two groups were distinguishable as either 'functioning well' (n = 23) or 'functioning poorly' (n = 25) based on symptomatology and functional impairment. Participant qualitative responses were analysed thematically and via Leximancer content analysis. Thematic analysis indicated three key themes: (1) love of self and others, (2) making a contribution through work and study and (3) stability in daily life. Participants who were 'functioning well' described meaningful relationships with others, enjoyment in vocation, and described less frequent or manageable life crises. The 'functioning poorly' group described relationship conflicts, vocational challenges, feelings of aimlessness and purposelessness, instability in daily living and frequent crises. Leximancer content analysis visually depicted these divergent thematic nomological networks. Corroborating quantitative analyses indicated significant differences between these groups for social, occupational and symptom profiles. These findings highlight the centrality of achieving the capacity to 'love and work' in fostering a sense of personal recovery. Treatments may need specific focus on these factors, as they appeared to reinforce symptomatic trajectories of either improvement or poor non-response to therapy.</p>","PeriodicalId":46871,"journal":{"name":"Personality and Mental Health","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9287094/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48048329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01Epub Date: 2022-04-01DOI: 10.1002/pmh.1543
Peter Tyrer, Helen Tyrer, Min Yang
Two hundred ten patients with anxiety and depressive disorders were followed up over 30 years. Personality status was assessed at baseline using the Personality Assessment Schedule (PAS), an instrument that classifies personality disorder in a similar way to the new ICD-11 classification. Assessments of suicidal behaviour were made at 5, 12 and 30 years and suicidal thoughts at 12 and 30 years and analysed by personality status, clinical diagnosis and scores on the General Neurotic Syndrome Scale, a combined diagnosis of mixed anxiety depression and personality dysfunction. Suicide attempts were most frequent in the first 5 years of the study and reduced over time. Baseline personality status was the best predictor of suicide attempts at 5 years (no personality disorder 29.3%, personality disorder 51.6%, p = 0.006), and at 12 years (no personality disorder 11.9%, personality disorder 25.7%, p = 0.042), but no important differences were found at 30 years, when comorbid mental state disorder was the strongest predictor (p < 0.001). Similar but less marked findings were found for the general neurotic syndrome. It is concluded that the presence of personality disorder is a robust predictor of suicidal behaviour in the shorter term but in the long-term comorbid pathology is a better predictor.
{"title":"The influence of personality disorder in predicting suicidal behaviour in common mental disorders: A 30-year study.","authors":"Peter Tyrer, Helen Tyrer, Min Yang","doi":"10.1002/pmh.1543","DOIUrl":"10.1002/pmh.1543","url":null,"abstract":"<p><p>Two hundred ten patients with anxiety and depressive disorders were followed up over 30 years. Personality status was assessed at baseline using the Personality Assessment Schedule (PAS), an instrument that classifies personality disorder in a similar way to the new ICD-11 classification. Assessments of suicidal behaviour were made at 5, 12 and 30 years and suicidal thoughts at 12 and 30 years and analysed by personality status, clinical diagnosis and scores on the General Neurotic Syndrome Scale, a combined diagnosis of mixed anxiety depression and personality dysfunction. Suicide attempts were most frequent in the first 5 years of the study and reduced over time. Baseline personality status was the best predictor of suicide attempts at 5 years (no personality disorder 29.3%, personality disorder 51.6%, p = 0.006), and at 12 years (no personality disorder 11.9%, personality disorder 25.7%, p = 0.042), but no important differences were found at 30 years, when comorbid mental state disorder was the strongest predictor (p < 0.001). Similar but less marked findings were found for the general neurotic syndrome. It is concluded that the presence of personality disorder is a robust predictor of suicidal behaviour in the shorter term but in the long-term comorbid pathology is a better predictor.</p>","PeriodicalId":46871,"journal":{"name":"Personality and Mental Health","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9285912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46000511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}