Personality disorders最新文献

Borderline personality disorder (BPD) diagnoses reliably predict worse mental health treatment outcomes. It is unknown whether multidimensional models of psychopathology, increasingly viewed as viable alternatives to traditional diagnostic systems, can match BPD's predictive power in clinical settings. In a sample of 2,625 partial hospital patients, we compared BPD with internalizing and harmful substance use dimensions as predictors of treatment success, defined by improvement in symptom severity, functional impairment, and quality of life. On a bivariate level, BPD features were moderately related to posttreatment functional impairment (r = .28) and quality of life (r = -.24), but not self-rated symptom improvement (r = .04). When adjusting for internalizing and harmful substance use, however, BPD features had very little unique predictive power. Instead, the internalizing spectrum was the strongest, most consistent predictor of symptom and functional improvement. This pattern of effects suggests that broad dimensions of psychopathology, particularly internalizing, capture much of BPD's prognostic utility in a partial hospital setting. We advise more attention to how the traditional BPD diagnosis compares to broad psychopathology dimensions in terms of clinical utility. This study's data, analysis code, and materials are posted at https://osf.io/wpy7e. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Obsessive-compulsive personality disorder (OCPD) is commonly comorbid with major depressive disorder, and their comorbidity is associated with worsened outcomes and treatment refraction. Radically open dialectical behavior therapy (RO DBT) is a novel transdiagnostic psychosocial intervention. RO DBT targets OCPD-related traits (e.g., maladaptive perfectionism, inflexibility) and has been theorized as an OCPD treatment. This study examined RO DBT efficacy for treatment-refractory depression (TRD), with and without comorbid OCPD. RefraMED was a multisite randomized controlled trial of treatment as usual (TAU) versus RO DBT + TAU for TRD (N = 250). In this secondary data analysis, linear regression predicted 7-month (end of treatment) and 12-month (follow-up) symptoms, controlling for baseline symptoms. Three models examined: (a) outcomes for participants with OCPD (n = 117) comparing RO DBT + TAU and TAU, (b) outcomes among participants receiving RO DBT (n = 162) comparing OCPD and no OCPD, and (c) OCPD diagnosis moderating treatment effects for all participants (N = 250). At 12 months, participants with OCPD had significantly improved emotional approach coping (emotion recognition and communication) and psychological flexibility in RO DBT + TAU (vs. TAU alone; false discovery rate-adjusted ps = .008), with no significant differences observed for depression or interpersonal functioning. OCPD presence did not predict any outcomes within the RO DBT group, nor moderate the effect of treatment on outcomes, suggesting treatment effects were not significantly inhibited by OCPD presence. In conclusion, RO DBT shows promise as a potential evidence-based treatment for OCPD, particularly when comorbid with TRD. Treatment effects were equivalent for those with and without OCPD. Moreover, RO DBT may be particularly beneficial for improving emotional approach coping and flexibility. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Due to conflicting evidence regarding gender-specific prevalence of borderline personality disorder (BPD), this systematic review aims to evaluate its occurrence in men within the general population to inform more responsive approaches in assessment and treatment. A systematic search was conducted in MEDLINE, PubMed, PsycINFO, PsycARTICLES, Embase, and Web of Science for English-language publications between 1980 and 2023. Inclusion criteria included peer-reviewed studies reporting original prevalence data for BPD in men in the general population. Study quality was assessed using Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, and data were synthesized using quantitative methods including meta-analysis. Eleven studies met the inclusion criteria (N = 2,027,764). Results indicated that the prevalence of BPD in men in the general population varied based on measurement method. Seven studies using clinical interviews reported a pooled prevalence of 0.9% and a men-to-women ratio of 43:100. In contrast, four studies using self-report measurements revealed a pooled prevalence of 8.1% and a men-to-women ratio of 73:100. The prevalence also differed according to sampling methods, participants age, as well as cultural and economic factors. This review suggests that BPD prevalence in men appears to vary according to multiple factors, with men meeting diagnostic criteria less frequently than women in the general population. The variations of prevalence may be influenced by gender bias in diagnostic criteria and clinical practice, as well as methodological and environmental factors. Future research should focus on refining measurement tools and improving clinical practice to better capture gender-specific and age-related manifestations of BPD, particularly across diverse cultural and economic contexts. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Distress tolerance (DT) is thought to be a transdiagnostic risk factor for psychopathology, especially borderline (BPD) and antisocial personality disorders (ASPD). However, most of the studies documenting the relationship of DT with BPD and ASPD have been cross-sectional, with few examining basic longitudinal patterns of change or interrelationships of these constructs. The present study examined longitudinal patterns of change and prospective reciprocal associations of DT with BPD and ASPD-related pathological personality traits (PPTs) in an adult clinical sample (N = 354) receiving inpatient treatment for substance use disorders and then reintegrating into the community across five time points (baseline, posttreatment, 1-, 3-, and 6-month follow-up). Results indicated high rank-order stability for DT and all PPTs, with significant mean level changes between baseline and follow-ups. Eleven bivariate random intercept cross-lagged panel models were fitted for the association of DT with PPTs. Within-person autoregressive effects were generally nonsignificant during treatment up until the posttreatment period but became significant during the community follow-up for both PPTs and DT. Within-person cross-lagged effects were generally nonsignificant, with only four brief and isolated reciprocal associations observed across disinhibition- and antagonism-related PPT models. Significant concurrent associations were replicated at both the within-person and between-person levels. These findings add to the limited literature on the longitudinal dynamics of DT and PPTs in clinical populations. They also underscore the potential value of targeting DT in interventions aimed at reducing emotional and behavioral dysregulation during the transition from treatment to community settings. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Given that people with borderline personality disorder (BPD) features are vulnerable to emotion dysregulation, they might be particularly sensitive to the emotional impacts of poor sleep quality and low sleep quantity. In the present study, we evaluated whether BPD features moderate the relationship between daily sleep, measured objectively (total sleep time [TST]) and subjectively (perceived sleep quality), and self-reports of positive and negative affect (NA). A sample of 83 cohabitating couples (n = 166) were recruited for a 3-week daily diary study. Participants completed a BPD symptom measure at baseline, a perceived sleep quality assessment each morning, and a daily emotion assessment each evening. TST was assessed daily using a FitBit activity monitor. Mixed-model regression analyses revealed a significant interaction between subjective sleep quality and overall BPD features in predicting daily levels of NA, even after statistical control of depression. Participants with higher BPD features exhibited greater NA on days when they reported worse sleep quality, as compared to participants with lower BPD features. Secondary analyses showed that this interaction seemed to be particularly impactful for anger, but not anxiety or sadness. In contrast, there was no significant interaction effect between BPD features and objectively assessed TST in predicting daily emotion. These results suggest that the emotional impact of poor subjective sleep quality might be more pronounced for those with BPD features. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Despite the availability of effective treatments for personality disorders (PDs), recovery rates are modest. A better understanding is therefore needed of what patients, significant others and therapists consider to be impediments to PD treatment. We used concept mapping to create a conceptual framework of factors that impede PD treatment. The perspectives of patients, significant others, and therapists with respect to impediments were collected in brainstorm sessions and then formulated as statements by an expert team. The participants subsequently prioritized and sorted these statements prior to analysis with multidimensional scaling and grouping on a two-dimensional concept map using hierarchical cluster analyses. Fifty-four statements were defined and assigned to 11 clusters that were grouped in five metaclusters: (a) lack of trust in the therapeutic relationship, (b) perceived therapist incompetence (c) shortcomings in the mental health care system, (d) patient-related conflicting factors, and (e) insufficient involvement of significant others. This study provides a conceptual framework of factors that are perceived to impede PD treatment. Our findings potentially contribute to an awareness of impediments in clinical practice and suggest that therapists should actively inquire about the expectations, needs, and treatment difficulties of patients and their significant others. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

The Alternative DSM-5 Model for Personality Disorders and ICD-11 adopt a dimensional approach to personality disorders, defining them in terms of impairments in self-related (identity, self-direction) and interpersonal (empathy, intimacy) personality functions. This study examined the clinical utility of a clinician-rated global evaluation of personality functioning based on the Level of Personality Functioning Scale (LPFS). A total of 346 German mental health professionals provided LPFS ratings for 1,403 patients, stratified by 38 diagnostic categories, including, but not limited to, personality disorders. Clinicians reported on each patient's treatment outcome, recommended optimal treatment components for each patient, and provided their perspective on the clinical utility of the LPFS and its potential risk of stigmatizing patients. On average, clinicians rated the LPFS as "very useful," its applicability as "rather easy," and the risk of patient stigmatization as "rather low." Logistic and ordinal Bayesian multilevel models indicated meaningful associations between LPFS ratings and clinical judgments, highlighting its effectiveness in conveying clinical impressions. Greater impairments in personality functioning were associated with poorer clinician-rated treatment outcome and poorer prognosis. In addition, associations with optimal treatment components yielded a nuanced pattern, with clinicians typically recommending short-term outpatient psychotherapy for patients with mild impairments, long-term psychotherapy for patients with moderate to severe impairments, and intensive care interventions (e.g., outreach care, assisted living) for those with extreme impairments. The results indicate that German mental health professionals consider the LPFS to be a clinically useful concept and that it may be valuable in organizing and communicating information about patients. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Suicide is a leading cause of death worldwide and is often empirically examined in relation to internalizing psychiatric constructs, such as depression, but less commonly in relation to externalizing disorders. The purpose of this preregistered meta-analysis was to explore the relations between suicide-related variables (i.e., ideation, attempts, and self-harm) and psychopathy-a maladaptive personality construct falling under the externalizing umbrella. The results showed small-to-moderate associations between total psychopathy scores and suicidal ideation (r = .19), behavior (r = .12), and self-harm (r = .20). Psychopathy subscales and factor scores varied widely in their correlations with suicide-related variables, highlighting the utility of assessing psychopathy using a more nuanced, trait-based approach. Potential mechanisms underlying these relations and clinical implications of the findings are discussed. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Measures of psychopathic personality traits have been utilized in a variety of settings and are often weighed heavily in decision-making. Though there is evidence of testing bias in marginalized groups, no evaluation of potential bias has been conducted for bias among sexual orientation minorities. This study utilized a slope-intercept bias approach to evaluate the testing bias of three self-report psychopathy measures: the Triarchic Psychopathy Measure, the Comprehensive Assessment of Psychopathic Personality-Self-Report, and the Levenson Self-Report Psychopathy Scale. Broadly, the current findings suggest psychopathy measures predominantly overpredict personality psychopathology and related impairment in sexual minorities, especially detachment, and disinhibition. Reassuringly, although some measures and scales had significantly overpredicted antisocial behaviors, none of these differences reached a threshold of clinically meaningful implications. Nonetheless, the risk of both testing and clinician bias should continue to be assessed in sexual minority persons and other diverse groups to ensure equitable evaluations. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Contemporary models conceptualize personality disorder (PD) as a combination of personality dysfunction and pathological personality traits. However, some perspectives suggest that pathological traits, along with functional impairment, may be sufficient indicators of PD. This study builds on previous research by investigating whether identity disturbance, defined as impaired coherence, inconsistency, and discontinuity in the sense of self, contributes to pathological personality trait scores beyond basic five-factor personality traits. Additionally, it examines whether the associations between pathological personality trait domains, PD diagnosis, and functional impairment remain when controlling for identity disturbance and basic personality traits. The study included two samples: 776 community individuals (344 with a psychiatric history) and 77 psychiatric patients diagnosed with PD. Structural equation models with latent factors indicated that pathological personality trait domains can be described as a combination of variance from basic personality traits and to a lesser extent identity disturbance. When identity disturbance was controlled for, however, pathological trait domains no longer differentiated individuals with PD from community participants with psychiatric histories. Furthermore, individual pathological trait domains did not demonstrate incremental validity in predicting functional impairment beyond the contributions of basic personality traits and identity disturbance. (PsycInfo Database Record (c) 2025 APA, all rights reserved).