Personality disorders最新文献

Despite research indicating that exerting dominance and control is characteristic of psychopathy, no research has examined the role that feelings of and desire for power plays in psychopathy-related aggression. Borrowing from various literatures and novel conceptualizations, we investigated the contributions of feeling powerful and/or desiring power and distinct psychopathy facets in explaining aggression manifested in different forms (i.e., physical, verbal, indirect) across 4 samples. Results from regression analyses within each sample and a meta-analysis across the samples indicated that the impulsive facet of psychopathy was generally related to multiple forms of aggression, and the unique variance in the affective facet was primarily related to physical aggression across samples. In contrast, the unique variance of the interpersonal facet showed a primary relationship with indirect aggression (e.g., relational, passive). Desiring power made unique contributions in relation to multiple forms of aggression, whereas feeling powerful was generally unrelated and/or negatively related to aggression. In sum, the unique variance in the psychopathy facets showed fairly specialized relationships with forms of aggression, and desire for power may be an independent explanatory construct for multiple forms of aggression proneness. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Psychopathy is a collection of personality traits and behaviors that are associated with costly personal, interpersonal, and societal outcomes. The nature of this construct has been widely debated across decades of literature, and such debates have produced a multitude of instruments for the measurement of psychopathy. These measures include self-reports and clinical interviews, yet little work has examined the degree to which measurements of psychopathy may differ across these modalities and whether such potential differences may impact the associations commonly found with psychopathy (e.g., impulsivity). To this end, we applied psychometric network and item response theory analyses to data obtained from the interview-based Psychopathy Checklist: Screening Version and the Levenson Self-Report of Psychopathy in the same sample. Our results revealed similarities and differences across measurement modalities. Regarding the Psychopathy Checklist: Screening Version, Factor 2 items were more important to the psychopathy construct (i.e., the most central and contributed more information than Factor 1 items), whereas Factor 1 items were more important to the Levenson Self-Report of Psychopathy. Factor 1 items were positively linked with Positive Urgency and were either negatively associated or not associated with Negative Urgency. In contrast, Factor 2 items were positively linked with Negative Urgency in both networks. Our analyses also revealed that dishonesty and irresponsibility served as the primary bridges connecting the factors of psychopathy in both networks. We make suggestions for improving the assessment of psychopathy by implementing self-report and interview measures that allow scores to be compared directly. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Standardized Assessment of Personality-Abbreviated Scale (SAPAS) has been used extensively to screen for personality disorders (PD), including adolescents. Yet, it is unclear how well the SAPAS performs in screening for impairment in personality functioning (IPF), Criterion A of the alternative Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition model for PD (AMPD) in adolescent samples. We examined the performance of the SAPAS in detecting IPF at a diagnostic threshold for PD in the AMPD. A consecutive clinical sample of adolescents in Bern, Switzerland (N = 293), were first administered the SAPAS, then the Semistructured Interview for Personality Functioning Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (STiP-5.1). A receiver operating characteristic (ROC) analysis was used to determine the diagnostic accuracy of the SAPAS in relation to the STiP-5.1. ROC regression analyses were conducted to determine if other variables moderated the discriminant performance of the SAPAS. Internal consistency of the SAPAS was low (α = .54) and overall discriminatory accuracy was moderate (area under the curve = .73). The optimum cut-off point was 5, with the best balance of sensitivity and specificity (63.22 and 69.90, respectively), correctly classifying 67.92% of participants. Agreement between the SAPAS and the STiP-5.1 using this cut-off was low (κ = .30). Age yielded statistically significant effects on the discriminant performance of the SAPAS-performance improving among older adolescents. Findings suggest that the SAPAS may not be the optimal method of screening for Criterion A IPF among adolescents in clinical settings but might also be more suited to Criterion B. Our findings call for a developmentally adapted screener for early detection of PD represented by IPF in adolescents. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Borderline personality disorder (BPD) has a negative impact on the onset and course of anxiety disorders. However, even though many people with anxiety disorders only have some BPD symptoms, little is known about the impact of BPD symptoms on anxiety disorders. This study examines the impact of BPD symptoms on the onset and persistence of anxiety disorders over a 3-year follow-up in the general population. Longitudinal data from the Netherlands Mental Health Survey and Incidence study were used (N = 4,618). BPD symptoms were assessed using the International Personality Examination, and anxiety disorders and other mental disorders were assessed with the Composite International Diagnostic Interview. Logistic regression analyses were performed, adjusting for a wide range of potential confounders such as childhood abuse and mood disorders. In all, 72.1% of the participants reported no BPD symptoms, 24.0% reported one to two symptoms, 3.1% reported three to four symptoms, and 0.8% reported ≥ 5 symptoms. There was a clear dose-response relation, with more BPD symptoms being associated with a higher risk for onset and persistence of anxiety disorders (both p for trend < .001). Even one to two BPD symptoms significantly impacted the onset (odds ratio = 3.32, 95% confidence interval [1.68, 6.54]) and persistence (odds ratio = 3.12, 95% confidence interval [1.01, 9.64]). Results appeared to be independent of multiple potential confounders. Even a low number of BPD symptoms impact the onset and persistence of anxiety disorders. Targeting these symptoms may improve the outcome of anxiety disorders. Future research should study the effect of various interventions for people with anxiety disorders and BPD symptoms. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Case formulation is a central tool for psychotherapists, which helps them tailor psychotherapy to the individual patient, particularly for treatments for complex and multilayered clinical problems, such as personality disorders (Kramer, 2019). Case formulation methodologies are still underutilized in psychotherapy research in the prediction of therapy processes. The present study included N = 60 patients with borderline personality disorder undergoing a brief treatment using an individualized treatment component (n = 31), as compared with a standard brief treatment (n = 29; Kramer et al., 2014). For each patient (in both groups as post hoc analysis based on videos), we performed a Plan analysis case formulation (Caspar, 2019): the idiographic information from the formulation was translated into quantitative scores (on a Likert-type scale) assessing patient's interactional agreeableness (vs. antagonism; Zufferey et al., 2019). We modeled the session-by-session predictions of the progression of the therapeutic alliance-rated by the patient and the therapist-over the course of treatment, as a function of interactional agreeableness, the individualization of treatment, as well as their interaction with the session number. Patients with high levels of agreeableness have a significant increase in their alliance assessment over time. Treatment based on the case formulation predicted session-by-session increase of the therapeutic alliance as rated by the therapists. This study was the first to explore intra- and interindividual dynamics of the therapeutic alliance in relationship with idiographic information extracted from case formulations. The results may help understand relationship struggles at the beginning of therapy for complex clinical problems, such as borderline personality disorder. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The study examined the measurement invariance (configural, metric, scalar, and residual) of the Personality Inventory for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Brief Form (PID-5-BF; Krueger et al., 2013) across gender for the theorized Five-Factor oblique model. A large group of adults (N = 502), with ages ranging from 18 to 67 years, from the Australian general community completed the PID-5-BF. When the Δχ² test was applied, multiple-group confirmatory factor analysis supported configural invariance and full metric and residual invariance. For scalar invariance, at least seven items (constituting 13 thresholds) across the different dimensions lacked invariance for one or more of its thresholds. In addition, controlling all these noninvariance thresholds, women had higher latent mean scores for Negative Affect, and men had higher scores for Antagonism and Disinhibition. When the Δcomparative fit index (ΔCFI) test was applied, the findings also supported the configural invariance model and the full metric and residual invariance models. With the exception of one threshold, all the other thresholds were also invariant. The psychometric and practical implications of the findings are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

We tested the predictive validity of personality disorder (PD) indicators at different levels of aggregation, ranging from general PD severity to PD syndrome scales to individual PD criteria. We compared the predictive validity of models on these levels based on interview data on all 78 DSM-IV PD criteria, by using 19 outcome scales in three different samples (N = 651, N = 552, and N = 1,277). We hypothesized that criteria of personality pathology yield a significant increase in predictive validity compared with scales that are aggregated at the syndrome- or general severity-level. We assessed out of sample performance of predictive models in a repeated cross-validation design using regularized linear regression and regression forest algorithms. We observed no significant difference in predictive performance between models trained at the item-level and models trained on scale-level data. We further tested the predictive performance of the trained linear models across samples on outcome measures shared between samples and inspected models for criteria-level information they relied on to make predictions. Our results suggest that little predictive variance is lost when interview items assessing DSM-IV PD criteria are aggregated to dimensional PD scales. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The inclusion of the borderline pattern in the International Classification of Diseases, 11th Revision (ICD-11) dimensional classification of personality disorders (PDs) has caused controversy. Unease about leaving out these clinically challenging patients seems to conflict with the need of an evidence-based and credible diagnostic system. However, the accommodation of borderline within the new diagnostic system has not yet been studied in depth. To this end, we examine in a sample of 1799 general population and clinical subjects the joint structure of the five initial ICD-11 domains and the borderline pattern. Regression and item-level factor analyses reveal that borderline criteria do not form a separate construct and are indissociable from negative affectivity. Furthermore, borderline adds nothing to the remaining domains when it comes to predict PD severity. The borderline pattern appears as largely superfluous and even misguiding, unless their criteria are properly integrated within the structure of personality pathology. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

People with personality disorders (PDs) are often admitted to psychiatric emergency services due to the frequent repetition of acute crises. This study drew on the ICD diagnostic records of 2,634 individuals with PDs who were admitted to a specialized inpatient psychiatric crisis unit over a 6-year period. Multiple logistic regressions and survival regressions were performed to examine whether PD categories, gender, and other individual, interpersonal, and precipitating factors were associated with readmission and time-to-readmission. The results showed a 16.1% readmission rate. Of these, 99.5% of readmissions occurred within 4 years following the first admission. Gender was the main factor associated with both readmission and time-to-readmission: while men were readmitted faster, more women in total were readmitted for a second psychiatric emergency hospitalization. Findings also indicated that readmission rate and time-to-readmission differed following the category of PD: readmission rate in a ratio of 1-2 (from 8% to 10% for dissocial and paranoid PD up to 19%-21% for impulsive and borderline PD), and time-to-readmission in a ratio of 1-5 (from 1 month for anankastic and dependent, to 5 months for impulsive, histrionic and anxious-avoidant PD). Limitations of this naturalistic study include a lack of self-reported measures and generalizability to less specialized emergency settings. Future research should include a prospective longitudinal design using standardized scalable measurement tools to improve the completeness and accuracy of the data concerning the psychological processes involved in risk and time-to-readmission after brief hospitalizations in emergency psychiatry. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Empirical evidence documents disparities in the diagnosis of severe forms of psychopathology among racial/ethnic minority persons. However, research on diagnostic differences in personality disorders is equivocal: Some suggest higher prevalence of personality disorders among racial/ethnic minority persons, whereas other results suggest the opposite. The goal of the current study was to investigate (a) differences in the diagnosis of borderline personality disorder (BPD) in a mostly cisgender, heterosexual sample among racial/ethnic minority patients compared with non-Hispanic White patients and (b) whether any observed differences were attributable to differences in underlying maladaptive personality domains. Using data from partial hospital patients (N = 2,657), we found few differences in the diagnosis of BPD based on racial/ethnic group membership. We also conducted measurement invariance analyses of the Personality Inventory for DSM-5-Brief Form (PID-5-BF), finding evidence of invariance across White and non-White participants in these data. Any instances of diagnostic disparity were explained by group differences in maladaptive personality domains. These results provide context to the extant literature documenting mixed results about racial/ethnic differences in prevalence of personality disorders. In addition, they suggest relative specificity in BPD diagnostic bias related to sexual minority populations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).