Personality disorders最新文献

Traditional personality disorders (PDs; e.g., Diagnostic and Statistical Manual of Mental Disorders, fifth edition [DSM-5] Section II PDs), as well as dimensional traits (e.g., alternative model for PD [AMPD]), offer unique advantages in personality pathology assessment. However, very little is known about how these systems compare in predicting observable behavior. This study compares self-report ratings of PD symptoms (i.e., Structured Clinical Interview for DSM-IV PD) with self-reports of AMPD traits (i.e., Personality Inventory for DSM-5) in predicting clinical outcomes, 1 year later, via three different methods: (a) naturalistically observed psychosocial functioning (i.e., electronically activated recorder [EAR]), (b) informant-reported interpersonal functioning (i.e., Inventory of Interpersonal Problems-32), and (c) self-reported suicidality (SI), depression, anxiety, and substance use symptoms (i.e., Psychiatric Diagnostic Screening Questionnaire). Data were analyzed from 72 individuals in current or recent psychiatric treatment meeting diagnosis for at least one PD. Results showed that DSM Section II PD and AMPD ratings yielded meaningful and comparable predictions of naturalistically observed EAR variables and informant-rated interpersonal functioning. The AMPD appeared to offer slight advantages in the prediction of EAR-observed negative affect, hostile words, and informant-rated interpersonal functioning, with clearer advantages at the facet level. Overall, these results provide tentative evidence that both DSM Section II PD and AMPD systems show meaningful links with clinical outcomes measured via multiple methods 1 year later, but with clearer advantages for the AMPD at the facet level. Moreover, results show that the EAR is a viable method for capturing naturalistically observed clinically meaningful, in vivo behavior of individuals exhibiting maladaptive personality patterns. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

In 2022, PDs: Theory, Research, and Treatment published a 10-year retrospective on the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), Section III, Alternative Model for PDs (AMPD; American Psychiatric Association, 2013). The articles of the 10-year retrospective provided evidence in support of the validity, reliability, and clinical utility of the AMPD. Specifically, it provided evidence in support of the unidimensional factor structure of the LPF and the five-dimensional structure of the pathological trait domains. In addition, evidence in support of the construct validity of the LPF in its association with psychiatric severity, functional outcomes, traditional PDs, cognitive, emotional, and contextual correlates, and other indices of maladaptive self- and interpersonal functioning was provided. Despite this evidence, a significant gap has since been identified related to how the American Psychiatric Association (APA) decides to accept proposed revisions to diagnostic criteria. The goal of the current special issue is to address this gap. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Borderline personality disorder (BPD) is defined by the presence of at least five of nine symptoms in Section II of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition. In the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, Section III Alternative Model of Personality Disorders (AMPD), BPD is defined by deficits in self and/or interpersonal functioning (Criterion A), elevated negative affectivity, and elevated antagonism and/or disinhibition (Criterion B). However, it is unclear if these definitions describe the same people and if the AMPD criteria explain unique variability in treatment outcomes in this population. In a treatment-seeking sample of adult participants diagnosed with BPD according to Section II criteria (n = 65, M_age = 27.60, 70.8% female, 76.9% White), we found a majority (66.2%) would have also received the diagnosis based on AMPD criteria. Those meeting AMPD criteria reported more severe Section II BPD symptoms than those who did not, ps < .02, ds > 0.60, and the presence or severity of Section II fears of abandonment and inappropriate anger uniquely predicted AMPD BPD diagnoses, ps < .03, ORs ≥ 2.31. Changes in AMPD dimensions explained 34% of the variability in change in work/social adjustment (p = .13) and quality of life (p = .22), respectively, over and above changes in Section II symptoms during a novel cognitive-behavioral treatment for BPD. These results suggest that AMPD criteria capture a more severe subset of BPD than Section II criteria and may be important predictors of treatment outcomes. We discuss the potential trade-offs of this shift in diagnosis. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The alternative model of personality disorders (AMPD) traits were designed to maintain continuity with the Section II personality disorder (PD) diagnoses by retaining the same clinical information. Whether the AMPD traits achieve this is not well established. Prior work testing incremental validity of AMPD traits and Section II diagnoses is limited by the fact each model was measured by a different instrument or rater, making it unclear whether discrepancies are due to the constructs or methods. Here, we compare the incremental validity of AMPD traits versus Section II PDs assessed by the same instrument and rater. Participants (N = 311, 50% received past-year mental health treatment) completed a clinical interview, baseline self-reports, and 14-day ambulatory assessment protocol. Interviewers rated AMPD domains, facets, and Section II criteria from the same interview (Structured Interview for DSM-IV Personality). We used hierarchical regression models to evaluate the variance predicted in 17 clinically relevant cross-sectional and momentary variables by the AMPD traits and Section II PDs. Incremental R² showed that Section II PDs account for little variance in outcomes over and above the AMPD domains/facets, whereas the AMPD facets were generally more predictive of outcomes than the Section II PDs. Results add novel evidence that dimensional PD traits-not a particular assessment method-are equivalent or superior to PD categories for predicting social, emotional, and behavioral functioning. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Our cross-sectional study provides a head-to-head comparison of Section II and Section III of Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) diagnostic models of personality disorders (PDs) in identifying significant personality correlates of psychiatric hospitalization (PH). PH is an indicator of a breakdown in one's existing ability to manage mental crisis. The sample was recruited from psychiatric clinical services (N = 60) as well as universities and the local community (N = 49). We used the Structured Clinical Interview for DSM-5 PD (SCID-5-PD) for Section II DSM-5 diagnosis, the Self and Interpersonal Functioning Scale (SIFS) for Criterion A and the Personality Inventory for DSM-5 (PID-5) for Criterion B. Separate logistic regressions analyses showed high discriminative utility for all diagnostic models: the number of Section II diagnosis, level of personality functioning, and five maladaptive traits (AUC between .89 and .97). Binomial logistic regression with a forward stepwise procedure showed that Section II number of diagnoses revealed incremental utility over Criteria A and B in distinguishing between individuals experiencing a mental health crisis requiring PH and those not requiring immediate intervention. We conclude that each diagnostic model, when considered individually, exhibits a high degree of discriminatory performance. However, employing all these models concurrently for identifying personality correlates of PH proves impractical. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

In this study, we compare the incremental predictive capacities of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) Section II personality disorders (SII-PDs) with Section III trait domains of the Alternative Model of Personality Disorders (AMPD) in a psychiatric outpatient sample (N = 185). To this end, a series of hierarchical regression analyses was conducted in which the 10 SII-PDs and the five AMPD trait domains served as the predictor variables and five areas of clinical dysfunction as the criterion variables. Two models for each criterion were tested. In Model A, the 10 PDs were entered as a block, followed by the block entry of trait domains; in Model B, the block entry of these predictors was reversed. As the AMPD was designed to address the shortcomings of the SII-PDs, it was hypothesized that the AMPD trait domains would show greater predictive capacity vis-à-vis the latter by (a) explaining more overall variance for each criterion variables when entered first into the model versus when SII-PDs was entered first and (b) explaining more incremental variance than SII-PDs when block was entered second. These hypotheses were partially supported. Overall, the AMPD trait domains predicted more variance than SII-PDs and demonstrated better model fit and more predictive power for three of the criterion variables. Similarly, the AMPD domains predicted a significant but modest incremental increase in variance over that of the SII-PDs for three of the criterion variables. We conclude that more work needs to be done to improve the AMPD, particularly in the assessment of externalizing psychopathology as it relates to clinical dysfunction. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Complex posttraumatic stress disorder (CPTSD) is characterized in the International Classification of Diseases-11 by affect dysregulation, negative self-concept, and relationship impairments, symptoms also presented in borderline personality disorder (BPD). Some research shows CPTSD as a distinct disorder, others as a subgroup or a replacement for BPD. No review currently amalgamates the findings on whether CPTSD presents too similarly to BPD to be a standalone disorder. This article systematically reviewed similarities and differences in symptom presentations of the two disorders. Six databases were searched (PsycINFO, EMBASE, PubMed, Web of Science, PsycEXTRA, and Open Access Theses and Dissertations) and identified papers were summarized narratively. The majority of studies found distinct profiles for CPTSD and BPD. One study found no differences between the constructs; however, this used a population without severe trauma. CPTSD and BPD can present comorbidly, these individuals will have likely experienced earlier and more frequent interpersonal trauma and display greater functional impairment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Borderline personality disorder (BPD) is a debilitating disorder characterized by deficits in social connectedness, which is a multifaceted construct with structural (i.e., the number, diversity, or frequency of social relationships), functional (i.e., the actual or perceived resources relationships provide), and quality (i.e., the positive and negative aspects of social relationships) elements (Holt-Lunstad, 2018). However, the literature is sparse and lacks integration regarding which specific elements of social connectedness are deficient in BPD and why. This systematic review synthesized the literature on the bidirectional relationship of social connectedness and BPD. Electronic searches of three databases (i.e., PsycInfo, PsycArticles, and PubMed) identified 1,962 articles which underwent title and abstract screening and, if potentially eligible, full-text review. Sixty two articles met the eligibility criteria and underwent data extraction and risk of bias assessment. Cross-sectional research supported associations between BPD and problems in structural, functional, and quality social connectedness, with most research underscoring deficits in quality social connectedness. Preliminary longitudinal research suggested that BPD pathology predicts problems across these domains, but little to no research exists testing the reverse direction. Although people with BPD may not have difficulties forming relationships, they exhibit a range of problems within those relationships. BPD may elicit such problems in social connectedness, but it is unclear whether such issues reciprocally exacerbate and elicit BPD, and longitudinal research investigating such directionality is needed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Borderline personality disorder (BPD) is a serious mental disorder, which has been linked to a number of negative outcomes in adolescents and adults. BPD is generally linked to more severe impairments in personality functioning. The (differential) association of specific BPD symptoms with severity level, however, has not been explored yet. The present study explores the relationship between all nine BPD symptoms and impairments in personality functioning in adolescents using a cross-sectional design. A total of 116 treatment-seeking adolescents were administered semistructured interviews for DSM-IV Axis I and Axis II disorders and the semistructured interview for personality functioning DSM-5 (STiP-5.1). Furthermore, the potential association of symptom disorders, and more specifically mood disorders, with level of personality functioning was assessed. Together, the nine BPD criteria were significantly related to STiP-5.1 total score, even when controlling for the presence of a mood disorder. However, when taking the effect of number of symptom disorders and the other BPD symptoms into account, only the presence of recurrent self-harm and/or suicidal behavior and intense anger, were associated with a higher level of impairment in personality functioning. These findings emphasize the diagnostic importance of repeated self-harm and suicidality and provide additional evidence for the value of using BPD criteria to easily identify teenagers at risk. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Personality disorders (PDs) are characterized by problems with identity and self-direction. Since the recent dimensional PD models of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) and the International Statistical Classification of Diseases and Related Health Problems, 11th edition, the role of identity and self-direction in personality pathology has been made explicitly by including these problems in a general personality pathology criterion. This criterion reflects impairment in personality functioning (IPF), which is assessed on a continuum to determine the severity of personality pathology. The present study aimed to psychometrically evaluate the Five-Item Screening Scale for Personality Disorders (FISSPD; Skodol et al., 2011), a short screener for IPF, in a Dutch-speaking clinical sample of 820 adults. This screener mainly taps into self-related impairment, with four items measuring self-related impairment and one item measuring interpersonal impairment. The factor structure, scale reliability, measurement invariance (across sex, age, and patients with vs. without PD), and convergent validity were investigated. The Dutch FISSPD showed a unidimensional structure and good scale reliability. Scalar measurement invariance was established across sex, age (patients below vs. above age 40), and patients with versus without PD. The Dutch FISSPD was significantly related to identity and all DSM-IV/5 Section-II PD symptoms. The present study indicates that the Dutch FISSPD has potential as a reliable and valid screener for personality pathology in adult patients. (PsycInfo Database Record (c) 2024 APA, all rights reserved).