|
1
|
Leichsenring F, Fonagy P, Heim N, Kernberg OF, Leweke F, Luyten P, Salzer S, Spitzer C, Steinert C. Borderline personality disorder: a comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies. World Psychiatry 2024; 23:4-25. [PMID: 38214629 PMCID: PMC10786009 DOI: 10.1002/wps.21156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Abstract
Borderline personality disorder (BPD) was introduced in the DSM-III in 1980. From the DSM-III to the DSM-5, no major changes have occurred in its defining criteria. The disorder is characterized by instability of self-image, interpersonal relationships and affects. Further symptoms include impulsivity, intense anger, feelings of emptiness, strong abandonment fears, suicidal or self-mutilation behavior, and transient stress-related paranoid ideation or severe dissociative symptoms. There is evidence that BPD can be reliably diagnosed and differentiated from other mental disorders by semi-structured interviews. The disorder is associated with considerable functional impairment, intensive treatment utilization, and high societal costs. The risk of self-mutilation and suicide is high. In the general adult population, the lifetime prevalence of BPD has been reported to be from 0.7 to 2.7%, while its prevalence is about 12% in outpatient and 22% in inpatient psychiatric services. BPD is significantly associated with other mental disorders, including depressive disorders, substance use disorders, post-traumatic stress disorder, attention-deficit/hyperactivity disorder, bipolar disorder, bulimia nervosa, and other personality disorders. There is convincing evidence to suggest that the interaction between genetic factors and adverse childhood experiences plays a central role in the etiology of BPD. In spite of considerable research, the neurobiological underpinnings of the disorder remain to be clarified. Psychotherapy is the treatment of choice for BPD. Various approaches have been empirically supported in randomized controlled trials, including dialectical behavior therapy, mentalization-based therapy, transference-focused therapy, and schema therapy. No approach has proved to be superior to others. Compared to treatment as usual, psychotherapy has proved to be more efficacious, with effect sizes between 0.50 and 0.65 with regard to core BPD symptom severity. However, almost half of the patients do not respond sufficiently to psychotherapy, and further research in this area is warranted. It is not clear whether some patients may benefit more from one psychotherapeutic approach than from others. No evidence is available consistently showing that any psychoactive medication is efficacious for the core features of BPD. For discrete and severe comorbid anxiety or depressive symptoms or psychotic-like features, pharmacotherapy may be useful. Early diagnosis and treatment of BPD can reduce individual suffering and societal costs. However, more high-quality studies are required, in both adolescents and adults. This review provides a comprehensive update of the BPD diagnosis and clinical characterization, risk factors, neurobiology, cognition, and management. It also discusses the current controversies concerning the disorder, and highlights the areas in which further research is needed.
Collapse
Affiliation(s)
- Falk Leichsenring
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
- Department of Psychosomatics and Psychotherapy, University of Rostock, Rostock, Germany
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Nikolas Heim
- International Psychoanalytic University, Berlin, Germany
| | - Otto F Kernberg
- Personality Disorders Institute, Weill Cornell Medical College, New York, NY, USA
| | - Frank Leweke
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
| | - Patrick Luyten
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - Simone Salzer
- International Psychoanalytic University, Berlin, Germany
| | - Carsten Spitzer
- Department of Psychosomatics and Psychotherapy, University of Rostock, Rostock, Germany
| | - Christiane Steinert
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
- International Psychoanalytic University, Berlin, Germany
| |
Collapse
|
|
2
|
Southward MW, Howard KP, Christensen Pacella KA, Cheavens JS. Protective factors in borderline personality disorder: A multi-study analysis of conscientiousness, distress tolerance, and self-compassion. J Affect Disord 2023; 338:589-598. [PMID: 37392944 PMCID: PMC10528710 DOI: 10.1016/j.jad.2023.06.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 06/16/2023] [Accepted: 06/28/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Despite a growing literature characterizing risk factors associated with the development and maintenance of borderline personality disorder (BPD), substantially less is known about potentially protective factors in BPD. METHODS In a sample of online (N = 272) participants with likely BPD, major depressive disorder (MDD), or no disorder (ND) and an independent sample of in-person (N = 90) participants diagnosed with BPD, MDD, or ND, we tested the cross-sectional and longitudinal associations among BPD features and three putatively protective personality, cognitive, and affective-behavioral factors: conscientiousness, self-compassion, and distress tolerance. RESULTS Only conscientiousness was significantly lower in BPD than MDD (ds: .67-.73) across both studies and more strongly related to BPD features (rs: -.68 to -.59) than MDD symptoms (rs: -.49 to -.43) in dimensional analyses across both studies. However, in a multiple regression analysis including all three factors in Study 1, only self-compassion predicted decreases in BPD features (β = -.28) and MDD symptoms (β = -.21) over one month. LIMITATIONS Study 1 participants completed all measures online and exhibited some differential attrition at one month follow-up. Study 2 participants were all diagnosed by one trained assessor and the smaller sample size limited our power to detect effects. CONCLUSIONS Low conscientiousness may be most strongly related to BPD, whereas self-compassion may be a prospective transdiagnostic protective factor.
Collapse
Affiliation(s)
| | - Kristen P Howard
- Division of Mental Health, Milwaukee VA Medical Center, United States of America; Division of General Internal Medicine, Medical College of Wisconsin, United States of America
| | | | - Jennifer S Cheavens
- Department of Psychology, The Ohio State University, United States of America
| |
Collapse
|
|
3
|
Kang W, Steffens F, Pineda S, Widuch K, Malvaso A. Personality traits and dimensions of mental health. Sci Rep 2023; 13:7091. [PMID: 37127723 PMCID: PMC10151354 DOI: 10.1038/s41598-023-33996-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/22/2023] [Indexed: 05/03/2023] Open
Abstract
Individuals are different in a relatively constant pattern of thoughts, feeling, and behaviors, which are called personality traits. Mental health is a condition of well-being in which people may reach their full potential and deal effectively with stress, work efficiently, and contribute to their communities. Indeed, the link between personality and mental health as indicated by the 12-item version of the general health questionnaires (GHQ-12) has been well-established according to evidence found by decades of research. However, the GHQ-12 comprises many questions asking about different dimensions of mental health. It is unclear how personality traits relate to these dimensions of mental health. In this paper, we try to address this question. We analyzed data from 12,007 participants from the British Household Panel Study (BHPS) using a confirmatory factor analysis (CFA) and generalized linear models. We replicated the factor structure of GHQ-12 labeled as GHQ-12A (social dysfunction & anhedonia; 6 items), GHQ-12B (depression & anxiety; 4 items), and GHQ-12C (loss of confidence; 2 items). Moreover, Neuroticism was positively related to all dimensions of mental health issues, Extraversion was negatively related to GHQ-12A (social dysfunction & anhedonia) and GHQ-12B (depression & anxiety), Agreeableness and Conscientiousness were negatively related to GHQ-12A (social dysfunction & anhedonia) and GHQ-12C (loss of confidence), and Openness was negatively related to GHQ-12B (depression & anxiety). These results contribute to theories including the predisposition/vulnerability model, complication/scar model, pathoplasty/exacerbation model, and the spectrum model, which propose that personality traits are linked to mental health and explained possible reasons. Psychologists may use results from this study to identify individuals who may be at high risk of developing various non-psychiatric mental health issues and intervene to avoid negative outcomes.
Collapse
Affiliation(s)
- Weixi Kang
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Department of Medicine, Hammersmith Hospital, Imperial College London, 3rd floor Burlington Danes Building, Du Cane Road, London, W12 0NN, UK.
| | | | - Sònia Pineda
- TecnoCampus, Pompeu Fabra University, Barcelona, Spain
| | | | - Antonio Malvaso
- Department of Brain and Behavioral Sciences, National Neurological Institute, IRCCS "C. Mondino" Foundation, Pavia, Italy
- University of Pavia, Pavia, Italy
| |
Collapse
|
|
4
|
Stanghellini G. Homo dissipans: Excess and Expenditure as Keys for Understanding the Borderline Condition? Psychopathology 2023; 56:478-491. [PMID: 36889295 DOI: 10.1159/000529130] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/09/2023] [Indexed: 03/10/2023]
Abstract
This paper sheds light on some aspects of what contemporary clinical theory calls "borderline" condition providing a description of a key figure of late-modern culture that I will call Homo dissipans (from Latin dissipatio, -onis = scattering, dispersion). Homo dissipans is the opposite of Homo œconomicus, the form that "narcissism" takes on in contemporary "achievement society," solely concerned with rational action aimed to utility and production. In order to define Homo dissipans, I follow French philosopher, anthropologist, and novelist Georges Bataille's descriptions of two core phenomena: "excess" and "expenditure." The former can be defined as a surplus of energy that according to Bataille characterizes human existence, animated by a general movement of exudation and dilapidation and an inexhaustible drive to "pour out" of oneself, especially outside the limits of composure and reasonableness. The latter is an ethical attitude which gives its approval to excess and to its metamorphic and destructive power. The Homo dissipans' credo is to profitlessly dissipate the surplus of energy, escape into a world of pure intensities in which all forms - including identity - dissolve and surrender themselves to transformation. I argue that Bataille's ideas about "dissipation" can help us reconsider two features attributed to borderline personality disorder which have been extensively described and sometimes stigmatized - "identity diffusion" and "stable instability" - and to better recognize, understand, and make sense of their phenomenology in the clinical context.
Collapse
Affiliation(s)
- Giovanni Stanghellini
- Department of Health Sciences, University of Florence, Florence, Italy
- Centro de Estudios de Fenomenologìa y Psiquiatrìa, 'Diego Portales' University, Santiago, Chile
| |
Collapse
|
|
5
|
Abstract
IMPORTANCE Borderline personality disorder (BPD) affects approximately 0.7% to 2.7% of adults in the US. The disorder is associated with considerable social and vocational impairments and greater use of medical services. OBSERVATIONS Borderline personality disorder is characterized by sudden shifts in identity, interpersonal relationships, and affect, as well as by impulsive behavior, periodic intense anger, feelings of emptiness, suicidal behavior, self-mutilation, transient, stress-related paranoid ideation, and severe dissociative symptoms (eg, experience of unreality of one's self or surroundings). Borderline personality disorder is typically diagnosed by a mental health specialist using semistructured interviews. Most people with BPD have coexisting mental disorders such as mood disorders (ie, major depression or bipolar disorder) (83%), anxiety disorders (85%), or substance use disorders (78%). The etiology of BPD is related to both genetic factors and adverse childhood experiences, such as sexual and physical abuse. Psychotherapy is the treatment of choice for BPD. Psychotherapy such as dialectical behavior therapy and psychodynamic therapy reduce symptom severity more than usual care, with medium effect sizes (standardized mean difference) between -0.60 and -0.65. There is no evidence that any psychoactive medication consistently improves core symptoms of BPD. For discrete and severe comorbid mental disorders, eg, major depression, pharmacotherapy such as the selective serotonin reuptake inhibitors escitalopram, sertraline, or fluoxetine may be prescribed. For short-term treatment of acute crisis in BPD, consisting of suicidal behavior or ideation, extreme anxiety, psychotic episodes, or other extreme behavior likely to endanger a patient or others, crisis management is required, which may include prescription of low-potency antipsychotics (eg, quetiapine) or off-label use of sedative antihistamines (eg, promethazine). These drugs are preferred over benzodiazepines such as diazepam or lorazepam. CONCLUSIONS AND RELEVANCE Borderline personality disorder affects approximately 0.7% to 2.7% of adults and is associated with functional impairment and greater use of medical services. Psychotherapy with dialectical behavior therapy and psychodynamic therapy are first-line therapies for BPD, while psychoactive medications do not improve the primary symptoms of BPD.
Collapse
Affiliation(s)
- Falk Leichsenring
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
- Department of Psychosomatics and Psychotherapy, University of Rostock, Rostock, Germany
| | - Nikolas Heim
- International Psychoanalytic University, Berlin, Germany
| | - Frank Leweke
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
| | - Carsten Spitzer
- Department of Psychosomatics and Psychotherapy, University of Rostock, Rostock, Germany
| | - Christiane Steinert
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
- International Psychoanalytic University, Berlin, Germany
| | - Otto F Kernberg
- Weill Cornell Medical College, Personality Disorders Institute, New York, New York
| |
Collapse
|
|
6
|
Hopwood CJ, Schwaba T, Wright AGC, Bleidorn W, Zanarini MC. Longitudinal associations between borderline personality disorder and five-factor model traits over 24 years. EUROPEAN JOURNAL OF PERSONALITY 2021. [DOI: 10.1177/08902070211012918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Are five-factor traits and borderline personality symptoms the same features with different names? The existing literature offers reasons to think they are the same and reasons to think they are different. We examined longitudinal associations between these variables in a sample of patients assessed 12 times over 24 years using latent curve models with structured residuals. Mean trajectories for all variables were in the direction of symptom reduction/personality maturation and could be parsed into an initial, rapid improvement phase and a subsequent, gradual improvement phase. We found robust between-person associations among intercepts and long-term slopes of traits and symptoms. Specifically, higher levels of neuroticism as well as lower levels of extraversion, agreeableness, and conscientiousness were associated with higher levels of borderline personality symptoms, and changes in these traits were correlated with reduction in symptoms over time. Associations among time-structured residuals allowed for examinations of within-person deflections from these general trends at briefer (two year) intervals. All variables exhibited robust within-person carry-over effects. Other within-person effects were more specific to certain traits. These results suggest that, despite their distinct theoretical and methodological bases, normal trait and psychiatric diagnostic approaches largely converged on a similar conception of borderline personality.
Collapse
|
|
7
|
Zanarini MC, Temes CM, Magni LR, Aguirre BA, Hein KE, Goodman M. Risk Factors for Borderline Personality Disorder in Adolescents. J Pers Disord 2020; 34:17-24. [PMID: 30920936 PMCID: PMC7584111 DOI: 10.1521/pedi_2019_33_425] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The objective of this study was to assess the association between variables reflecting childhood adversity, protective childhood experiences, and the five-factor model of personality and BPD in adolescents. Two groups of adolescents were studied: 104 met criteria for BPD and 60 were psychiatrically healthy. Adverse and protective childhood experiences were assessed using a semistructured interview. The five-factor model of personality was assessed using the NEO-FFI. Eight of nine variables indicating severity of abuse and neglect, positive childhood relationships, childhood competence, and the personality factors studied were found to be significant bivariate risk factors for adolescent BPD. However, in a multivariate model, severity of neglect, higher levels of neuroticism, and lower levels of childhood competence were found to be the best risk factor model. Taken together, the results of this study suggest that all three types of risk factors studied are significantly associated with BPD in adolescents.
Collapse
Affiliation(s)
- Mary C. Zanarini
- McLean Hospital, Belmont, Massachusetts, and Harvard Medical School, Boston, Massachusetts
| | - Christina M. Temes
- McLean Hospital, Belmont, Massachusetts, and Harvard Medical School, Boston, Massachusetts
| | - Laura R. Magni
- Unit of Psychiatry, IRCCS S. Giovanni di Dio, Fatebenefratelli, Brescia, Italy
| | - Blaise A. Aguirre
- McLean Hospital, Belmont, Massachusetts, and Harvard Medical School, Boston, Massachusetts
| | | | - Marianne Goodman
- James J. Peters Veterans Affairs Medical Center, Bronx, New York, and Icahn School of Medicine at Mt. Sinai, New York, New York
| |
Collapse
|
|
8
|
Hopwood CJ. Interpersonal Dynamics in Personality and Personality Disorders. EUROPEAN JOURNAL OF PERSONALITY 2018. [DOI: 10.1002/per.2155] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Clinical and basic personality psychologists interact less than they should, given their similar interests. In clinical personality psychology, available evidence supports a transition from the current categorical system to a hierarchical trait scheme for diagnosing the stable features of personality disorder. However, trait models do not capture the dynamic aspects of personality disorders as they have been described in the clinical literature, and thus miss a clinically critical feature of personality pathology. In contrast, basic personality psychologists have coalesced around a consensual structure of individual differences and become increasingly interested in the dynamic processes that underlie and contextualize traits. But trait psychology models are not sufficiently specific to characterize dynamic personality processes. In this paper, I filter clinical descriptions of personality disorders through the lens of interpersonal theory to specify a recursive within–situation interpersonal pattern of motives, affects, behaviours, and perceptions that could contribute to the stable between–situation patterns of maladaptive behaviour of historical interest to both basic and clinical personality psychologists. I suggest that this interpersonal model adds specificity to recent proposals regarding processes in the basic personality literature and has significant potential to advance research on personality dynamics. © 2018 European Association of Personality Psychology
Collapse
|
|
9
|
Giourou E, Skokou M, Andrew SP, Alexopoulou K, Gourzis P, Jelastopulu E. Complex posttraumatic stress disorder: The need to consolidate a distinct clinical syndrome or to reevaluate features of psychiatric disorders following interpersonal trauma? World J Psychiatry 2018; 8:12-19. [PMID: 29568727 PMCID: PMC5862650 DOI: 10.5498/wjp.v8.i1.12] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 12/29/2017] [Accepted: 02/05/2018] [Indexed: 02/05/2023] Open
Abstract
Complex posttraumatic stress disorder (Complex PTSD) has been recently proposed as a distinct clinical entity in the WHO International Classification of Diseases, 11th version, due to be published, two decades after its first initiation. It is described as an enhanced version of the current definition of PTSD, with clinical features of PTSD plus three additional clusters of symptoms namely emotional dysregulation, negative self-cognitions and interpersonal hardship, thus resembling the clinical features commonly encountered in borderline personality disorder (BPD). Complex PTSD is related to complex trauma which is defined by its threatening and entrapping context, generally interpersonal in nature. In this manuscript, we review the current findings related to traumatic events predisposing the above-mentioned disorders as well as the biological correlates surrounding them, along with their clinical features. Furthermore, we suggest that besides the present distinct clinical diagnoses (PTSD; Complex PTSD; BPD), there is a cluster of these comorbid disorders, that follow a continuum of trauma and biological severity on a spectrum of common or similar clinical features and should be treated as such. More studies are needed to confirm or reject this hypothesis, particularly in clinical terms and how they correlate to clinical entities’ biological background, endorsing a shift from the phenomenologically only classification of psychiatric disorders towards a more biologically validated classification.
Collapse
Affiliation(s)
- Evangelia Giourou
- Department of Psychiatry, School of Medicine, University of Patras, Rio Patras 26500, Greece
- Department of Public Health, School of Medicine, University of Patras, Rio Patras 26500, Greece
| | - Maria Skokou
- Department of Psychiatry, School of Medicine, University of Patras, Rio Patras 26500, Greece
| | - Stuart P Andrew
- Specialist Care Team Limited, Lancashire LA4 4AY, United Kingdom
| | | | - Philippos Gourzis
- Department of Psychiatry, School of Medicine, University of Patras, Rio Patras 26500, Greece
| | - Eleni Jelastopulu
- Department of Public Health, School of Medicine, University of Patras, Rio Patras 26500, Greece
| |
Collapse
|
|
10
|
Ninomiya T, Oshita H, Kawano Y, Goto C, Matsuhashi M, Masuda K, Takita F, Izumi T, Inoue A, Higuma H, Kanehisa M, Akiyoshi J. Reduced white matter integrity in borderline personality disorder: A diffusion tensor imaging study. J Affect Disord 2018; 225:723-732. [PMID: 28922736 DOI: 10.1016/j.jad.2017.09.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 08/30/2017] [Accepted: 09/07/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Borderline personality disorder (BPD) has a pervasive pattern of instability in interpersonal relationships, self-image, and emotions. BPD may be linked to an abnormal brain anatomy, but little is known about possible impairments of the white matter microstructure in BPD or their relationship with impulsivity or risky behaviors. The aims of the present study were to explore the relationship between BPD and diffusion tensor imaging (DTI) parameters and psychological tests. METHODS We evaluated 35 un-medicated BPD patients in a medication-free state and 50 healthy controls (HCs). We performed DTI tractography in BPD patients and HCs. The Childhood Trauma Questionnaire (CTQ), Profile of Mood State (POMS), State-Trait Anxiety Inventory (STAI), Beck Depression Inventory (BDI), Social Adaptation Self-Evaluation Scale (SASS), and Depression and Anxiety Cognition Scale (DACS) were administered to BPD patients and HCs. RESULTS A tract-based spatial statistics (TBSS) revealed that the BPD group had three clusters with a significantly lower axial diffusivity (AD) than the HC group: one located mainly in the cingulum and the other mainly in the inferior front-occipital fasciculus and inferior longitudinal fasciculus. Regarding the AD values, one cluster correlated negatively and significantly with POMS (Depression) and it was located in the cingulum, while another cluster correlated positively and significantly with DACS (Future Denial) and it was located in the inferior front-occipital fasciculus (IFOF). LIMITATIONS The small sample size of this study prevents us from forming any definitive conclusions, meaning that more studies are needed to confirm our findings. We are unable to generalize our findings to include other ethnic groups. CONCLUSIONS Our results suggested that hypo-metabolism in a front-limbic network dysfunction is characterized by the cingulum and a front-occipital network dysfunction characterized by the occipital lobe, while an occipital-temporal network dysfunction characterized by the inferior longitudinal fasciculus.
Collapse
Affiliation(s)
- Taiga Ninomiya
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Harumi Oshita
- Department of Applied Linguistics, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | | | - Chiharu Goto
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Mai Matsuhashi
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Koji Masuda
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Fuku Takita
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Toshihiko Izumi
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Ayako Inoue
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Haruka Higuma
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Masayuki Kanehisa
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan
| | - Jotaro Akiyoshi
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Hasama-Machi, Oita 879-5593, Japan.
| |
Collapse
|
|
11
|
Frías Á, Palma C, Solves L, Martínez B, Salvador A. Differential symptomatology and functioning in borderline personality disorder across age groups. Psychiatry Res 2017; 258:44-50. [PMID: 28985552 DOI: 10.1016/j.psychres.2017.09.081] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 09/24/2017] [Accepted: 09/26/2017] [Indexed: 10/18/2022]
Abstract
There is increasing research aimed at addressing whether patients with borderline personality disorder (BPD) may exhibit variations in symptomatology and functioning according to their chronological age. The current study consisted of 169 outpatients diagnosed with BPD, who were divided into four age groups as follows: 16-25 years (n = 41), 26-35 years (n = 43), 36-45 years (n = 45), and 46 and more years (n = 40). Age groups were compared for symptomatology, normal personality traits, psychiatric comorbidities, functioning, and treatment-related features. The younger group had significantly higher levels of physical/verbal aggression and suicide attempts relative to the older group. Conversely, the older group had significantly greater severity of somatization, depression, and anxiety symptoms. In addition, the older group showed significantly greater functional impairment overall and across physical/psychological domains, specifically when compared to the younger group. Overall, these findings may suggest that age-related symptoms should be considered when diagnosing BPD. Also, functional impairments should be the target interventions for older BPD patients.
Collapse
Affiliation(s)
- Álvaro Frías
- Facultad de Psicologia, Ciencias de la Educación y el Deporte Blanquerna, University of Ramon-Llull, Barcelona, Spain; Consorci Sanitari del Maresme, Department of Psychiatry, Hospital of Mataró, Mataró, Spain.
| | - Carol Palma
- Facultad de Psicologia, Ciencias de la Educación y el Deporte Blanquerna, University of Ramon-Llull, Barcelona, Spain; Consorci Sanitari del Maresme, Department of Psychiatry, Hospital of Mataró, Mataró, Spain
| | - Laia Solves
- Consorci Sanitari del Maresme, Department of Psychiatry, Hospital of Mataró, Mataró, Spain
| | - Bárbara Martínez
- Consorci Sanitari del Maresme, Department of Psychiatry, Hospital of Mataró, Mataró, Spain
| | - Ana Salvador
- Facultad de Psicologia, Ciencias de la Educación y el Deporte Blanquerna, University of Ramon-Llull, Barcelona, Spain; Consorci Sanitari del Maresme, Department of Psychiatry, Hospital of Mataró, Mataró, Spain
| |
Collapse
|
|
12
|
Alvarez-Tomás I, Soler J, Bados A, Martín-Blanco A, Elices M, Carmona C, Bauzà J, Pascual JC. Long-Term Course of Borderline Personality Disorder: A Prospective 10-Year Follow-Up Study. J Pers Disord 2017; 31:590-605. [PMID: 27749187 DOI: 10.1521/pedi_2016_30_269] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of this prospective study was to expand previously reported evidence on the 10-year clinical and functional course of borderline personality disorder (BPD) in a Spanish sample. Participants diagnosed with BPD were assessed at baseline and at 10-year follow-up to evaluate BPD symptomatology and other relevant clinical measures, suicidal behavior, dimensional personality traits, Axis I and II comorbidity, use of mental health resources, and psychosocial functioning. At the 10-year follow up, significant improvements were observed on BPD domains, suicidal behavior, and other clinical measures. Neuroticism, impulsiveness, and aggression-hostility features trended toward normalization, whereas activity and sociability were impaired over time. Comorbidity with Axis I and personality disorders remained high. Social functioning and occupational functioning were largely unchanged. These findings confirm the tendency toward a symptomatic remission of BPD over the long term with regard to symptom criteria and characteristic dimensional traits. However, psychosocial functioning remains impaired.
Collapse
Affiliation(s)
- Irene Alvarez-Tomás
- Department of Clinical Psychology and Psychobiology, section of Personality, Assessment, and Psychological Treatments, Faculty of Psychology, Universitat de Barcelona (UB), Spain
| | - Joaquim Soler
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red de Salud Mental (CIBER-SAM), Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), and Psychiatry and Legal Medicine and Clinical Psychology and Health Departments, Universitat Autònoma de Barcelona, Spain
| | - Arturo Bados
- Department of Clinical Psychology and Psychobiology, section of Personality, Assessment, and Psychological Treatments, Faculty of Psychology, Universitat de Barcelona (UB), Spain
| | - Ana Martín-Blanco
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red de Salud Mental (CIBER-SAM), Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), and Psychiatry and Legal Medicine and Clinical Psychology and Health Departments, Universitat Autònoma de Barcelona, Spain
| | - Matilde Elices
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red de Salud Mental (CIBER-SAM), Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), and Psychiatry and Legal Medicine and Clinical Psychology and Health Departments, Universitat Autònoma de Barcelona, Spain
| | - Cristina Carmona
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red de Salud Mental (CIBER-SAM), Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), and Psychiatry and Legal Medicine and Clinical Psychology and Health Departments, Universitat Autònoma de Barcelona, Spain
| | - Joana Bauzà
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red de Salud Mental (CIBER-SAM), Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), and Psychiatry and Legal Medicine and Clinical Psychology and Health Departments, Universitat Autònoma de Barcelona, Spain
| | - Juan Carlos Pascual
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red de Salud Mental (CIBER-SAM), Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), and Psychiatry and Legal Medicine and Clinical Psychology and Health Departments, Universitat Autònoma de Barcelona, Spain
| |
Collapse
|
|
13
|
Borderline personality features, interpersonal correlates, and blood pressure response to social stressors: Implications for cardiovascular risk. PERSONALITY AND INDIVIDUAL DIFFERENCES 2017; 113:38-47. [DOI: 10.1016/j.paid.2017.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
|
|
14
|
Wrzus C, Roberts BW. Processes of Personality Development in Adulthood: The TESSERA Framework. PERSONALITY AND SOCIAL PSYCHOLOGY REVIEW 2016; 21:253-277. [PMID: 27260302 DOI: 10.1177/1088868316652279] [Citation(s) in RCA: 158] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The current article presents a theoretical framework of the short- and long-term processes underlying personality development throughout adulthood. The newly developed TESSERA framework posits that long-term personality development occurs due to repeated short-term, situational processes. These short-term processes can be generalized as recursive sequence of Triggering situations, Expectancy, States/State expressions, and Reactions (TESSERA). Reflective and associative processes on TESSERA sequences can lead to personality development (i.e., continuity and lasting changes in explicit and implicit personality characteristics and behavioral patterns). We illustrate how the TESSERA framework facilitates a more comprehensive understanding of normative and differential personality development at various ages during the life span. The TESSERA framework extends previous theories by explicitly linking short- and long-term processes of personality development, by addressing different manifestations of personality, and by being applicable to different personality characteristics, for example, behavioral traits, motivational orientations, or life narratives.
Collapse
|
|
15
|
Amini M, Pourshahbaz A, Mohammadkhani P, Ardakani MRK, Lotfi M, Ramezani MA. The relationship between five-factor model and diagnostic and statistical manual of mental disorder-fifth edition personality traits on patients with antisocial personality disorder. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2015; 20:470-6. [PMID: 26487876 PMCID: PMC4590202 DOI: 10.4103/1735-1995.163970] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background: Despite the fact that new criteria of antisocial personality disorder (ASPD) in diagnostic and statistical manual of mental disorders-fifth edition (DSM-5) were resulted from five-factor model (FFM), there is a small amount of studies that investigate the relations between proposed personality traits and FFM. Also, cross-cultural study in this field continuously would be needed. The aim of the present study was to evaluate the relation between the FFM and DSM-5 ASPD pathological traits. Materials and Methods: This study was a cross-sectional study design. The participants consisted of 122 individuals with ASPD that selected from prisoners (73.0%), outpatients (18.0%), and inpatients (9.0%). They were recruited from Tehran Prisoners, and Clinical Psychology and Psychiatry Clinics of Razi and Taleghani Hospitals, Tehran, Iran, since 2013-2014. The Sample was selected based on judgmental sampling. The structured clinical interview for DSM-IV axis II disorders-Personality Questionnaire, NEO-Personality Inventory-Revised, and DSM-5 personality trait rating form were used to diagnosis and assessment of personality disorder. Pearson correlation has been used for data analysis. All statistical analyses were performed using the SPSS 16 software. Results: The results indicate that neuroticism (N) has positive significant relationship with hostility (r = 0.33, P < 0.01), manipulativeness (r = 0.25, P < 0.01), deceitfulness (r =.23, P < 0.01), impulsivity (r = 0.20, P < 0.05), and negative relation with risk taking (r = −0.23, P < 0.01). Also, there was significant relationship between extraversion (E) with manipulativeness (r = 0.28, P < 0.01) and deceitfulness (r = 0.32, P < 0.01). Agreeableness and conscientiousness have negative significant relation with DSM-5 traits. In addition, results showed that there is positive significant relationship between FFM and DSM-5 personality traits with DSM-fourth edition-text revision (DSM-IV-TR) ASPD symptoms (P < 0.01). Conclusion: Except manipulativeness, deceitfulness, and callousness, there is positively significant relationship between DSM-5 ASPD traits and DSM-IV-TR ASPD symptoms. The present study helps to understand the adequacy of dimensional approach to evaluation of ASPD pathology, specifically on Iranian sample.
Collapse
Affiliation(s)
- Mahdi Amini
- Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Abbas Pourshahbaz
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation, Tehran, Iran
| | - Parvaneh Mohammadkhani
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation, Tehran, Iran
| | | | - Mozhgan Lotfi
- Mental Health Research Center, Tehran Institute of Psychiatry, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | | |
Collapse
|
|
16
|
Levallius J, Rydén G, Norring C. Maturation in patients with borderline personality disorder. Psychiatry Res 2015; 228:950-2. [PMID: 26106055 DOI: 10.1016/j.psychres.2015.05.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 03/05/2015] [Accepted: 05/05/2015] [Indexed: 11/29/2022]
Abstract
Patients with borderline personality disorder have a characteristic and extreme personality associated with psychopathology. The aim was to investigate personality change in relation to suicidality following treatment. 21 patients were assessed before and after psychotherapy on personality (NEO PI-R) and suicidality (SUAS). At follow-up, Neuroticism and Conscientiousness normalized along with six lower-order facets; Depression, Impulsiveness, Competence, Achievement Striving, Self-Discipline and Deliberation. Thirteen patients showed a positive personality development paralleled by a lesser degree of suicidality.
Collapse
Affiliation(s)
- Johanna Levallius
- Center for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institutet, Norra Stationsgatan 69, 11364 Stockholm, Sweden.
| | - Göran Rydén
- Center for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institutet, Norra Stationsgatan 69, 11364 Stockholm, Sweden
| | - Claes Norring
- Center for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institutet, Norra Stationsgatan 69, 11364 Stockholm, Sweden
| |
Collapse
|
|
17
|
Schienle A, Wabnegger A, Schöngassner F, Leutgeb V. Effects of personal space intrusion in affective contexts: an fMRI investigation with women suffering from borderline personality disorder. Soc Cogn Affect Neurosci 2015; 10:1424-8. [PMID: 25809402 DOI: 10.1093/scan/nsv034] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 03/19/2015] [Indexed: 02/03/2023] Open
Abstract
The amygdala and the parietal cortex play a key role in the neural representation of personal space. Although the concept of personal space is clinically very relevant for borderline personality disorder (BPD), especially in affective contexts, it has not been investigated thus far with functional magnetic resonance imaging (fMRI). In this fMRI study, 25 female BPD patients and 25 healthy women were exposed to photos of angry, disgusted and neutral facial expressions. All stimuli were once shown as still photos, and once were zoomed-in in order to simulate intrusion into one's own personal space. Approaching faces generally provoked activation of the amygdala and the somatosensory cortex. BPD patients showed an increased activation within both regions, but only toward approaching disgusted faces. Their amygdala activation in this specific condition positively correlated with self-disgust scores. Moreover, the clinical group indicated an enhanced personal distance preference, which was associated with parietal activation. The present study revealed altered personal space processing of BPD patients, especially in situations that relate to social contexts involving disgust. Future studies should focus on the temporal stability of personal space processing during the natural course of BPD as well as during therapy.
Collapse
Affiliation(s)
- Anne Schienle
- Clinical Psychology, University of Graz, BioTechMedGraz, Graz, Austria
| | - Albert Wabnegger
- Clinical Psychology, University of Graz, BioTechMedGraz, Graz, Austria
| | | | - Verena Leutgeb
- Clinical Psychology, University of Graz, BioTechMedGraz, Graz, Austria
| |
Collapse
|
|
18
|
Yalch MM, Hopwood CJ, Zanarini MC. Hyperbolic Temperament as a Distinguishing Feature Between Borderline Personality Disorder and Mood Dysregulation. BORDERLINE PERSONALITY AND MOOD DISORDERS 2015:119-132. [DOI: 10.1007/978-1-4939-1314-5_7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
|
|
19
|
Lee CK, Corte C, Stein KF, Park CG, Finnegan L, McCreary LL. Prospective effects of possible selves on alcohol consumption in adolescents. Res Nurs Health 2014; 38:71-81. [PMID: 25545451 DOI: 10.1002/nur.21641] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2014] [Indexed: 11/11/2022]
Abstract
Possible selves, cognitions about the self that reflect hopes, fears, and expectations for the future, are reliable predictors of health risk behaviors but have not been explored as predictors of adolescents' alcohol use. In a secondary analysis of data from 137 adolescents, we examined the influence of possible selves assessed in eighth grade on alcohol consumption (yes/no and level of use) in ninth grade. Having a most important feared possible self related to academics in eighth grade predicted alcohol abstinence in ninth grade. Among those who reported alcohol use, having many hoped-for possible selves and a most important hoped-for possible self related to academics in eighth grade predicted lower level of alcohol consumption in ninth grade. Interventions that foster the personal relevance and importance of academics and lead to the development of hoped-for possible selves may reduce adolescents' alcohol consumption.
Collapse
Affiliation(s)
- Chia-Kuei Lee
- School of Nursing, University of Rochester, 601 Elmwood Avenue, Box SON, Rochester, NY, 14642
| | | | | | | | | | | |
Collapse
|
|
20
|
Hasler G, Hopwood CJ, Jacob GA, Brändle LS, Schulte-Vels T. Patient-reported outcomes in borderline personality disorder. DIALOGUES IN CLINICAL NEUROSCIENCE 2014. [PMID: 25152662 PMCID: PMC4140517 DOI: 10.31887/dcns.2014.16.2/ghasler] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Patient-reported outcome (PRO) refers to measures that emphasize the subjective view of patients about their health-related conditions and behaviors. Typically, PROs include self-report questionnaires and clinical interviews. Defining PROs for borderline personality disorder (BPD) is particularly challenging given the disorder's high symptomatic heterogeneity, high comorbidity with other psychiatric conditions, highly fluctuating symptoms, weak correlations between symptoms and functional outcomes, and lack of valid and reliable experimental measures to complement self-report data. Here, we provide an overview of currently used BPD outcome measures and discuss them from clinical, psychometric, experimental, and patient perspectives. In addition, we review the most promising leads to improve BPD PROs, including the DSM-5 Section III, the Recovery Approach, Ecological Momentary Assessments, and novel experimental measures of social functioning that are associated with functional and social outcomes.
Collapse
Affiliation(s)
- Gregor Hasler
- Psychiatric University Hospital, University of Bern, Bern, Switzerland
| | | | | | - Laura S Brändle
- Psychiatric University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Schulte-Vels
- Department of Psychiatry and Psychotherapy, University Hospital, Zurich, Switzerland
| |
Collapse
|
|
21
|
Wright AGC, Hallquist MN, Beeney JE, Pilkonis PA. Borderline personality pathology and the stability of interpersonal problems. JOURNAL OF ABNORMAL PSYCHOLOGY 2014; 122:1094-100. [PMID: 24364612 DOI: 10.1037/a0034658] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Features of borderline personality disorder (BPD) are associated with the presence and severity of interpersonal problems. At the same time, individuals with BPD are heterogeneous with regard to the types of interpersonal problems they display. BPD is also associated with temporal instability in various domains (e.g., affective lability), and this characteristic raises questions about whether BPD is associated with changes in the expression of interpersonal dysfunction over time, which may contribute to the observed heterogeneity. The focus of the present study was to evaluate the relationship between BPD features and the stability of interpersonal problems over the course of 1 year. Participants (N = 150) were assessed for borderline personality pathology at baseline and also completed the Inventory of Interpersonal Problems-Circumplex Scales at baseline and every 3 months over the course of a year. Baseline BPD was used to predict structured (i.e., latent growth trajectories) and unstructured (i.e., mean square of successive differences) change parameters in generalized interpersonal distress, agentic problems, and communal problems across assessment waves. Baseline BPD predicted individual means in generalized distress and unstructured change (i.e., instability) in agentic and communal problems across the year. Baseline BPD was not predictive, however, of structured change (i.e., linear change trajectories) for any aspect of interpersonal problems. These findings support the conclusion that interpersonal dysfunction in borderline pathology is stable in its severity but unstable in the style of its manifestation.
Collapse
|
|
22
|
Sauer-Zavala S, Barlow DH. The case for borderline personality disorder as an emotional disorder: Implications for treatment. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/cpsp.12063] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
|
23
|
Stephan Y, Sutin AR, Terracciano A. Physical activity and personality development across adulthood and old age: Evidence from two longitudinal studies. JOURNAL OF RESEARCH IN PERSONALITY 2014. [DOI: 10.1016/j.jrp.2013.12.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
|
24
|
Hopwood CJ, Zanarini MC. Five-factor trait instability in borderline relative to other personality disorders. Personal Disord 2013; 1:58-66. [PMID: 22121460 DOI: 10.1037/a0018230] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Borderline personality disorder (BPD) is related to five-factor model (FFM) traits and can be characterized as involving psychological and behavioral instability. A previous study comparing the FFM trait stability across individuals with borderline and other personality disorders found that the BPD group tended to have lower stability, particularly on neuroticism and conscientiousness and the overall configuration of FFM profiles over 6 years, suggesting that associated psychological and behavioral variability may be due to trait variability. The current study was designed to test the degree to which these findings replicate in another sample using different diagnostic and trait measures and extending the measurement period to 10 years. Results are consistent with previous findings in showing lower differential (rank-order) stability on conscientiousness, greater mean-level decreases on neuroticism, lower individual-level stability on conscientiousness, and lower ipsative stability of trait profile configurations among those with BPD. However, unlike the previous study, no differences were observed for differential or individual-level neuroticism or mean-level conscientiousness. Overall, findings show that the instability characteristic of BPD extends into typically stable personality traits, and that it does so with some specificity in terms of which traits are affected and how instability manifests.
Collapse
Affiliation(s)
- Christopher J Hopwood
- Department of Psychology, Michigan State University, East Lansing, MI 48824-1116, USA.
| | | |
Collapse
|
|
25
|
Affiliation(s)
- Leslie C. Morey
- Department of Psychology, Texas A&M University, College Station, Texas 77843;
| | | |
Collapse
|
|
26
|
Vachon DD, Lynam DR, Widiger TA, Miller JD, McCrae RR, Costa PT. Basic Traits Predict the Prevalence of Personality Disorder Across the Life Span. Psychol Sci 2013; 24:698-705. [DOI: 10.1177/0956797612460249] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Personality disorders (PDs) may be better understood in terms of dimensions of general personality functioning rather than as discrete categorical conditions. Personality-trait descriptions of PDs are robust across methods and settings, and PD assessments based on trait measures show good construct validity. The study reported here extends research showing that basic traits (e.g., impulsiveness, warmth, straightforwardness, modesty, and deliberation) can re-create the epidemiological characteristics associated with PDs. Specifically, we used normative changes in absolute trait levels to simulate age-related differences in the prevalence of psychopathy in a forensic setting. Results demonstrated that trait information predicts the rate of decline for psychopathy over the life span; discriminates the decline of psychopathy from that of a similar disorder, antisocial PD; and accurately predicts the differential decline of subfactors of psychopathy. These findings suggest that basic traits provide a parsimonious account of PD prevalence across the life span.
Collapse
Affiliation(s)
| | | | | | | | - Robert R. McCrae
- Laboratory of Personality and Cognition, National Institutes of Health
| | - Paul T. Costa
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University
| |
Collapse
|
|
27
|
Wright AGC, Pincus AL, Lenzenweger MF. Interpersonal development, stability, and change in early adulthood. J Pers 2013; 80:1339-72. [PMID: 22224462 DOI: 10.1111/j.1467-6494.2012.00761.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The goal of this research was to explore the development of the interpersonal system mapped by the interpersonal circumplex in early adulthood (ages 18-22). This study uses the Longitudinal Study of Personality Disorders sample (N = 250; 53% female). Participants completed the Revised Interpersonal Adjective Scales (Wiggins, Trapnell, & Phillips, 1988) in their freshman, sophomore, and senior years of college. Estimates of structural, rank-order, mean, individual, and ipsative stability were calculated for the broad interpersonal dimensions of Dominance and Affiliation and also the lower order octant scales. Additionally, the interpersonal profile parameters of differentiation and prototypicality were calculated at each wave and explored longitudinally and also used as predictors of interpersonal stability. We found excellent structural and high rank-order and ipsative stability in the interpersonal scales over this time period. Mean increases on the Affiliation axis, but not on the Dominace axis, were found to mask differential rates of change among the octant scales, along with significant individual variation in the rates of change. Interpersonal differentiation and prototypicality were related to higher stability in overall interpersonal style. Results point to evidence of both stability and nuanced change, illuminating some of the features of the structural variables that can be derived from interpersonal circumplex profiles.
Collapse
|
|
28
|
Hopwood CJ, Morey LC, Donnellan MB, Samuel DB, Grilo CM, McGlashan TH, Shea MT, Zanarini MC, Gunderson JG, Skodol AE. Ten-year rank-order stability of personality traits and disorders in a clinical sample. J Pers 2013; 81:335-44. [PMID: 22812532 DOI: 10.1111/j.1467-6494.2012.00801.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study compares the 10-year retest stability of normal traits, pathological traits, and personality disorder dimensions in a clinical sample. METHOD Ten-year rank-order stability estimates for the Revised NEO Personality Inventory, Schedule for Nonadaptive and Adaptive Personality, and Diagnostic Interview for DSM-IV Personality Disorders were evaluated before and after correcting for test-retest dependability and internal consistency in a clinical sample (N = 266). RESULTS Dependability-corrected stability estimates were generally in the range of.60-.90 for traits and.25-.65 for personality disorders. CONCLUSIONS The relatively lower stability of personality disorder symptoms may indicate important differences between pathological behaviors and relatively more stable self-attributed traits and imply that a full understanding of personality and personality pathology needs to take both traits and symptoms into account. The five-factor theory distinction between basic tendencies and characteristic adaptations provides a theoretical framework for the separation of traits and disorders in terms of stability in which traits reflect basic tendencies that are stable and pervasive across situations, whereas personality disorder symptoms reflect characteristic maladaptations that are a function of both basic tendencies and environmental dynamics.
Collapse
Affiliation(s)
- Christopher J Hopwood
- Psychology Department, Michigan State University Psychological Clinic, Psychology Building, 316 Physics-Room 107A, East Lansing, MI 48824, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
29
|
Krischer MK, Pukrop R, Halstenberg A, Lehmkuhl G, Sevecke K. Stabilität von Persönlichkeitspathologie bei jugendlichen Delinquenten. KINDHEIT UND ENTWICKLUNG 2012. [DOI: 10.1026/0942-5403/a000081] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
In dieser Follow-up-Studie wurde die Stabilität dimensional erfasster Persönlichkeitspathologie in einer Stichprobe ehemals inhaftierter weiblicher und männlicher Jugendlicher nach Ablauf von anderthalb Jahren untersucht. Es wurden 71 weibliche und männliche Jugendliche aus einer Kohorte vormals Inhaftierter im Mittel 17,1 Monate nach der Ersterhebung mit dem Dimensional Assessment of Personality Pathology- Basic Questionnaire (DAPP-BQ) nachuntersucht. Zur Klärung der Frage einer signifikanten Mittelwertsveränderung über die beiden Erhebungszeitpunkte hinweg wurde eine univariate Varianzanalyse mit Messwiederholung und zudem Rangkorrelationen berechnet. Die Ausprägungen für die DAPP-Subskalen Kognitive Verzerrung, Affektive Labilität, Argwohn, Unsichere Bindung, Reizsuche und Hartherzigkeit erwiesen sich als stabil. Demgegenüber waren signifikante Mittelwertsveränderungen bezüglich Identitätsprobleme, Oppositionalität, Selbstschädigung und Verhaltensprobleme auszumachen. Die vorliegenden Resultate entsprachen Ergebnissen mehrerer aktueller longitudinaler Studien. Als instabil erwiesen sich von anderen Autoren als „dysfunktionales Verhalten“ beschriebene persönlichkeitspathologische Merkmale, wohingegen stabilere Resultate für Persönlichkeitstraits (z. B. affektive Labilität und Hartherzigkeit) vorlagen. Diese Ergebnisse verweisen darauf, dass sich auch in einer Hochrisikopopulation delinquenter Jugendlicher das Konstrukt Persönlichkeit aus stabilen und instabilen Anteilen zusammensetzt. Die Auswirkungen auf die klinische Praxis werden diskutiert.
Collapse
Affiliation(s)
- Maya K. Krischer
- Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters der Universität zu Köln
| | - Ralf Pukrop
- Klinik für Psychiatrie und Psychotherapie der Universität zu Köln
| | - Alina Halstenberg
- Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters der Universität zu Köln
| | - Gerd Lehmkuhl
- Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters der Universität zu Köln
| | - Kathrin Sevecke
- Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters der Universität zu Köln
| |
Collapse
|
|
30
|
Bresin K, Robinson MD, Ode S, Leth-Steensen C. Driven, distracted, or both? A performance-based ex-Gaussian analysis of individual differences in anxiety. J Pers 2012; 79:875-904. [PMID: 21204841 DOI: 10.1111/j.1467-6494.2010.00709.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Since the inception of the empirical study of personality, and even before it, individual differences in anxiety and distress have been viewed as key predictors of behavioral performance. Yet such literatures have always entertained 2 perspectives, one contending that anxious individuals are "driven" and the other contending that anxious individuals are "distracted." The present 3 studies (total N=289) sought to reconcile such discrepant views according to an ex-Gaussian parsing of reaction time performance tendencies in basic cognitive tasks. As hypothesized, a particular pattern marked by faster responding on the preponderance of trials (in terms of the ex-Gaussian μ parameter) in combination with slower responding on other trials (in terms of the ex-Gaussian τ parameter) was predictive of higher levels of anxiety. Implications for understanding neuroticism, distress, the anxiety-performance interface, and cognitive models of personality processes are discussed.
Collapse
Affiliation(s)
- Konrad Bresin
- Psychology Department, North Dakota State University, Fargo, ND 58108-6050, USA.
| | | | | | | |
Collapse
|
|
31
|
Wright AGC, Pincus AL, Lenzenweger MF. Development of personality and the remission and onset of personality pathology. J Pers Soc Psychol 2011; 101:1351-8. [PMID: 21967009 DOI: 10.1037/a0025557] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The current study used the Longitudinal Study of Personality Disorders data set (Lenzenweger, 1999) to examine the development of personality traits in the context of the remission and onset of personality disorder (PD) symptoms. Despite high levels of stability, past research on the development of basic personality traits has also found a mean trend toward increased maturity and that individuals vary in their trajectories of trait development. Research on PD change has shown a similar pattern. We employed individual growth curve modeling to examine the relationship between personality trait development and PD symptom course. We found that both are indeed related and that remission in PD symptoms is associated with patterns of trait development associated with more rapid maturity. In contrast, deviating from the mean of trait development either through no change (i.e., stagnation) or change in the opposite direction (i.e., regression) was associated with developing PD symptoms over the course of the study.
Collapse
Affiliation(s)
- Aidan G C Wright
- Department of Psychology, The Pennsylvania State University, USA
| | | | | |
Collapse
|
|
32
|
Hopwood CJ, Donnellan MB, Blonigen DM, Krueger RF, McGue M, Iacono WG, Burt SA. Genetic and environmental influences on personality trait stability and growth during the transition to adulthood: a three-wave longitudinal study. J Pers Soc Psychol 2011; 100:545-56. [PMID: 21244174 DOI: 10.1037/a0022409] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
During the transition to adulthood individuals typically settle into adult roles in love and work. This transition also involves significant changes in personality traits that are generally in the direction of greater maturity and increased stability. Competing hypotheses have been offered to account for these personality changes: The intrinsic maturation hypothesis suggests that change trajectories are endogenous, whereas the life-course hypothesis suggests that these changes occur because of transactions with the social environment. This study investigated the patterns and origins of personality trait changes from ages 17 to 29 using 3 waves of Multidimensional Personality Questionnaire data provided by twins. Results suggest that (a) trait changes were more profound in the first relative to the second half of the transition to adulthood; (b) traits tend to become more stable during the second half of this transition, with all the traits yielding retest correlations between .74 and .78; (c) Negative Affectivity declined over time, and Constraint increased over time; minimal change was observed on agentic or communal aspects of Positive Emotionality; and (d) both genetic and nonshared environmental factors accounted for personality changes. Overall, these genetically informed results support a life-course perspective on personality development during the transition to adulthood.
Collapse
Affiliation(s)
- Christopher J Hopwood
- Department of Psychology, Michigan State University, East Lansing, MI 48824-1116, USA.
| | | | | | | | | | | | | |
Collapse
|
|
33
|
|
|
34
|
Abstract
Recent research findings have contributed to an improved understanding and treatment of borderline personality disorder. This disorder is characterised by severe functional impairments, a high risk of suicide, a negative effect on the course of depressive disorders, extensive use of treatment, and high costs to society. The course of this disorder is less stable than expected for personality disorders. The causes are not yet clear, but genetic factors and adverse life events seem to interact to lead to the disorder. Neurobiological research suggests that abnormalities in the frontolimbic networks are associated with many of the symptoms. Data for the effectiveness of pharmacotherapy vary and evidence is not yet robust. Specific forms of psychotherapy seem to be beneficial for at least some of the problems frequently reported in patients with borderline personality disorder. At present, there is no evidence to suggest that one specific form of psychotherapy is more effective than another. Further research is needed on the diagnosis, neurobiology, and treatment of borderline personality disorder.
Collapse
Affiliation(s)
- Falk Leichsenring
- Department of Psychosomatics and Psychotherapy, University of Giessen, Germany.
| | | | | | | | | |
Collapse
|
|
35
|
Hopwood CJ, Morey LC, Ansell EB, Grilo CM, Sanislow CA, McGlashan TH, Markowitz JC, Gunderson JG, Yen S, Shea MT, Skodol AE. The convergent and discriminant validity of five-factor traits: current and prospective social, work, and recreational dysfunction. J Pers Disord 2009; 23:466-76. [PMID: 19817628 PMCID: PMC2859436 DOI: 10.1521/pedi.2009.23.5.466] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The convergent and discriminant validity of Five Factor Model (FFM) personality traits with concurrent and prospective social, work, and recreational dysfunction was assessed in a large, longitudinal clinical sample. Consistent with five factor theoretical expectations, neuroticism is broadly related to dysfunction across domains; extraversion is primarily related to social and recreational dysfunction; openness to recreational dysfunction; agreeableness to social dysfunction; and conscientiousness to work dysfunction. Findings support five factor theory and the clinical assessment of normative personality traits.
Collapse
|