Development of antisocial personality disorder in detained youths: The predictive value of mental disorders.

Antisocial personality disorder (APD) is a serious public and mental health concern. Understanding how well conduct disorder (CD) and other mental disorders predict the development of APD among youths involved in the juvenile justice system is critical for prevention. The authors used a stratified random sample of 1,112 detained youths to examine the development of APD at a 3-year follow-up interview. Nearly one fifth of male juvenile detainees later developed APD; approximately one quarter of male juvenile detainees with CD at baseline later developed APD. Significantly more males than females developed APD; no differences were found by race/ethnicity. Having 5 or more symptoms of CD, dysthymia, alcohol use disorder, or generalized anxiety disorder was significantly associated with developing modified APD (M-APD; APD without the CD requirement). Some disorders were strong predictors of APD; however, none were adequate screeners for identifying which detainees would later develop M-APD. The findings of this study have implications for interventions and further research in developmental psychopathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychoanalysis with avoidant personality disorder: A systematic case study.

This case study of process and outcome is based upon data obtained during a 5-year psychoanalysis of an adult male with avoidant personality disorder (AVPD). To date, no known systematic case studies, effectiveness studies, or randomized control trials exist for psychoanalysis in the treatment of AVPD. In this study, self-reported symptoms and observer-rated personality disorder (PD), global functioning, object relations, and psychological health were gathered at intake, after each year of treatment, and at 1-year follow-up. Process data was gathered to determine the extent to which the treatment adhered to prototypes of psychodynamic, cognitive-behavioral, and interpersonal therapy. Results indicated that the patient achieved clinically significant reductions in PD, symptom severity, and relational pathology. Gains were maintained at 1-year follow-up. The treatment significantly adhered to psychodynamic principles throughout, with some use of cognitive-behavioral and interpersonal principles in the third year of treatment. These findings warrant further investigation of psychoanalysis for AVPD and demonstrate the usefulness of assessing multiple domains of patient functioning and treatment process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nontraumatic pathways to borderline personality disorder.

Clinicians who treat borderline personality disorder (BPD) generally assume that this disorder is caused by childhood abuse. This assumption is strongly supported in the BPD literature, which indicates that the majority of individuals with BPD have suffered emotional, physical, and sexual abuse. What is often missed or simply ignored in discussions of BPD is that this same body of research also suggests that a significant minority of borderline individuals have not suffered childhood abuse. This article reviewed the literature on the prevalence of childhood abuse and BPD, offered a number of hypotheses about nontraumatic pathways to BPD, and briefly considered treatment implications for nontraumatized BPD individuals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Childhood abuse, body image disturbance, and eating disorders

Studies have suggested that women who experience child sexual abuse are at risk for developing symptoms related to anorexia nervosa and bulimia. The purpose of the present study was to examine the relationships among childhood sexual and physical abuse, body image disturbance, and eating disorder symptomatology. Of 670 female college students screened for childhood abuse, 29 sexually abused, 32 physically abused, and 29 nonabused women completed measures of eating disorder symptoms, psychological factors thought to be related to eating disorders, and body image distortion. Contrary to previous reports, there was no evidence that child sexual or physical abuse was associated with the development of body image disturbance. Furthermore, the results did not support the hypothesis that child sexual and physical abuse are related to eating disorder symptomatology. It is suggested that subjects who are victims of child sexual abuse and who are receiving psychotherapy manifest higher rates of a number of different types of psychopathology, including eating disorders.     

Structural relations between borderline personality disorder features and putative etiological correlates.

This study assessed the structural relations between borderline personality disorder (BPD) features and purported etiological correlates. Approximately 5,000 18-year-old nonclinical young adults were screened for BPD features, and 2 cohorts of participants (total N?=?421; approximately one half of whom endorsed significant borderline features) completed the laboratory phase of the study. Measures included self-report and interview-based assessments of BPD psychopathology, personality, psychopathology in biological parents, and childhood physical and sexual abuse. Significant relations between BPD features and purported etiological correlates of BPD were found. A multivariate model that included parental psychopathology, childhood abuse, and personality factors provided an adequate fit to the data and supported the contention that the personality traits disinhibition and negative affectivity underlie BPD features. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinician bias in the diagnosis of posttraumatic stress disorder and borderline personality disorder.

[Correction Notice: An erratum for this article was reported in Vol 2(2) of Psychological Trauma: Theory, Research, Practice, and Policy (see record 2010-12181-005). In this article, the copyright attribution is incorrect. The article is in the public domain.] A sample of volunteers from a group of randomly selected psychologists in New York State (N = 119) provided a primary diagnosis and rule-out diagnoses for a case vignette that included balanced criteria for borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD) in a mail survey. Vignettes portrayed a male or a female client, and history of childhood sexual abuse was presented either first or last. Results indicated that cognitive–behavioral therapy (CBT) clinicians were more likely to diagnose PTSD than BPD or other disorders, and psychodynamic clinicians were more likely to diagnose BPD or other disorders than PTSD. An anchoring effect (i.e., evidence that one regards initial information as an anchor that may or may not be adjusted upon exposure to subsequent information) of abuse history presentation was found. Findings did not support a patient or clinician gender bias. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Clinician bias in the diagnosis of posttraumatic stress disorder and borderline personality disorder": Correction to Woodward et al. (2009).

Reports an error in "Clinician bias in the diagnosis of posttraumatic stress disorder and borderline personality disorder" by Halley E. Woodward, Casey T. Taft, Richard A. Gordon and Laura A. Meis (Psychological Trauma: Theory, Research, Practice, and Policy, 2009[Dec], Vol 1[4], 282-290). In this article, the copyright attribution is incorrect. The article is in the public domain. (The following abstract of the original article appeared in record 2009-23661-003.) A sample of volunteers from a group of randomly selected psychologists in New York State (N = 119) provided a primary diagnosis and rule-out diagnoses for a case vignette that included balanced criteria for borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD) in a mail survey. Vignettes portrayed a male or a female client, and history of childhood sexual abuse was presented either first or last. Results indicated that cognitive–behavioral therapy (CBT) clinicians were more likely to diagnose PTSD than BPD or other disorders, and psychodynamic clinicians were more likely to diagnose BPD or other disorders than PTSD. An anchoring effect (i.e., evidence that one regards initial information as an anchor that may or may not be adjusted upon exposure to subsequent information) of abuse history presentation was found. Findings did not support a patient or clinician gender bias. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Looking for the disorder in conduct disorder.

Besides their well-known externalizing behavior, children with conduct disorder (CD) often have additional impairments outside the criteria for the CD diagnosis. In a 5-year study of 984 treated children (ages 5–17 years), those with CD had an average of 2.2 primary diagnoses. Children with CD showed the worst problem and impairment scores in comparison with 11 common diagnoses. Compared with other treated children, children with CD achieved worse scores on 14 of 15 syndromes, including internalizing problems such as withdrawal and major depression. The average child with CD had larger relapse scores in the 1.5- to 3-year period after admission to treatment. This pattern, pervasive at intake and chronic in course, resembles a global disability more than a circumscribed problem managed with a narrow range of treatments specific to it. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Examination of predictors and moderators for self-help treatments of binge-eating disorder.

Predictors and moderators of outcomes were examined in 75 overweight patients with binge-eating disorder (BED) who participated in a randomized clinical trial of guided self-help treatments. Age variables, psychiatric and personality disorder comorbidity, and clinical characteristics were tested as predictors and moderators of treatment outcomes. Current age and age of BED onset did not predict outcomes. Key dimensional outcomes (binge frequency, eating psychopathology, and negative affect) were predominately predicted, but not moderated, by their respective pretreatment levels. Presence of personality disorders, particularly Cluster C, predicted both posttreatment negative affect and eating disorder psychopathology. Negative affect, but not major depressive disorder, predicted attrition, posttreatment negative affect, and eating disorder psychopathology. Despite the prognostic significance of these findings for dimensional outcomes, none of the variables tested were predictive of binge remission (i.e., a categorical outcome). No moderator effects were found. The present study found poorer prognosis for patients with negative affect and personality disorders, suggesting that treatment outcomes may be enhanced by attending to the cognitive and personality styles of these patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Borderline personality traits and disorder: Predicting prospective patient functioning.

Objective: Decisions about the composition of personality assessment in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–V) will be heavily influenced by the clinical utility of candidate constructs. In this study, we addressed 1 aspect of clinical utility by testing the incremental validity of 5-factor model (FFM) personality traits and borderline personality disorder (BPD) symptoms for predicting prospective patient functioning. Method: FFM personality traits and BPD features were correlated with one another and predicted 2-, 4-, 6-, 8-, and 10-year psychosocial functioning scores for 362 patients with personality disorders. Results: Traits and symptom domains related significantly and pervasively to one another and to prospective functioning. FFM extraversion and agreeableness tended to be most incrementally predictive of psychosocial functioning across all intervals; cognitive and impulse action features of BPD features incremented FFM traits in some models. Conclusions: These data suggest that BPD symptoms and personality traits are important long-term indicators of clinical functioning that both overlap with and increment one another in clinical predictions. Results support the integration of personality traits and disorders in DSM–V. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The construct validity of depressive personality disorder.

This study examined the construct validity of depressive personality disorder (DPD; American Psychiatric Association, 1994). Adult Psychiatric outpatients (N=900) underwent comprehensive Axis I and II evaluations and provided data on 4,768 of their 1st-degree relatives. Despite modest overlap, DPD was not redundant with any Axis I or II disorder. Participants with DPD exhibited more Axis I and Axis II comorbidity, and greater psychosocial dysfunction, than participants without DPD. Relatives of participants with DPD had higher rates of mood disorders, alcohol abuse, and antisocial personality. Results are consistent with findings of several other similar investigations. The authors argue that DPD is a valid construct and should be conceptualized as a personality disorder as opposed to a mood disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Axis I and Axis II disorders as predictors of prospective suicide attempts: Findings from the Collaborative Longitudinal Personality Disorders Study.

[Correction Notice: An erratum for this article was reported in Vol 113(2) of Journal of Abnormal Psychology (see record 2007-16710-001). On p. 378, the values in the "95% CI" column of Table 1 are incorrect. The correct values are given in the far right column of the table provided in the erratum.] This study examined diagnostic predictors of prospectively observed suicide attempts in a personality disorder (PD) sample. During 2 years of follow-up, 58 participants (9%) reported at least 1 definitive suicide attempt. Predictors that were examined include 4 PD diagnoses and selected Axis I diagnoses (baseline and course). Multivariate logistic regression analyses indicated that baseline borderline personality disorder (BPD) and drug use disorders significantly predicted prospective suicide attempts. Controlling for baseline BPD diagnosis, proportional hazards analyses showed that worsening in the course of major depressive disorder (MDD) and of substance use disorders in the month preceding the attempt were also significant predictors. Therefore, among individuals diagnosed with PDs, exacerbation of Axis I conditions, particularly MDD and substance use, heightens risk for a suicide attempt. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Binge eating disorder: treatment outcome over a 6-year course

Little is known about the long-term course of binge eating disorder (BED). The aim of the study was to assess the 3- and 6-year course and outcome of 68 consecutively treated females with BED. Their mean age was 29.3 years and they were assessed longitudinally at four timepoints: (1) beginning of therapy; (2) end of therapy; (3) 3-year follow-up; and (4) 6-year follow-up. Self rating as well as expert ratings were used for assessment. Symptoms of specific eating disorder as well as general psychopathology were measured. The general pattern of results over time was as follows: substantial improvement during therapy; slight (in most cases nonsignificant) decline during the first 3 years after the end of treatment, and further improvement and stabilization in years 4, 5, and 6 after the end of treatment. At the 6-year follow-up, the majority showed no major DSM-IV eating disorder, 5.9% had BED, 7.4% had shifted to bulimia nervosa (purging type) (DSM-IV), 7.4% were classified as ED-NOS, and one patient died. Based on an operationalized global outcome score for the complete sample, 57.4% had good outcome, 35.3% intermediate outcome, 5.9% poor outcome, and one person (1.4%) died. BED and BNP patients showed very similar intermediate and long-term course in self ratings as well as expert ratings.     

Two-Year Prospective Naturalistic Study of Remission From Major Depressive Disorder as a Function of Personality Disorder Comorbidity.

In this study, the authors examined prospectively the 24-month natural course of remission from major depressive disorder (MDD) as a function of personality disorder (PD) comorbidity. In 302 participants (196 women, 106 men), psychiatric and PDs were assessed at baseline with diagnostic interviews, and the course of MDD was assessed with the Longitudinal Interval Follow-Up Evaluation at 6-, 12-, and 24-month follow-ups. Survival analyses revealed an overall 24-month remission rate of 73.5% for MDD that differed little by gender. Participants with MDD who had certain forms of coexisting PD psychopathology (schizotypal, borderline, or avoidant) as their primary PD diagnoses had a significantly longer time to remission from MDD than did patients with MDD without any PD. These PDs emerged as robust predictors of slowed remission from MDD even when controlling for other negative prognostic predictors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Borderline personality disorder from the perspective of general personality functioning.

The authors extended previous work on the hypothesis that borderline personality disorder (BPD) can be understood as a maladaptive variant of personality traits included within the 5-factor model (FFM) of personality. In each of 3 samples, an empirically derived prototypic FFM borderline profile was correlated with individuals' FFM profiles to yield a similarity score, an FFM borderline index. Results across all samples indicated that the FFM borderline index correlated as highly with existing borderline measures as they correlated with one another, and the FFM borderline index correlated as highly with measures of dysfunction, history of childhood abuse, and parental psychopathology as did traditional measures of BPD. Findings support the hypothesis that BPD is a maladaptive variant of FFM personality traits. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Axis I and Axis II disorders as predictors of prospective suicide attempts: Findings from the Collaborative Longitudinal Personality Disorders Study": Correction to Yen et al (2003).

Reports an error in "Axis I and Axis II disorders as predictors of prospective suicide attempts: Findings from the Collaborative Longitudinal Personality Disorders Study" by Shirley Yen, Tracie Shea, Maria Pagano, Charles A. Sanislow, Carlos M. Grilo, Thomas H. McGlashan, Andrew E. Skodol, Donna S. Bender, Mary C. Zanarini, John G. Gunderson and Leslie C. Morey (Journal of Abnormal Psychology, 2003[Aug], Vol 112[3], 375-381). On p. 378, the values in the "95% CI" column of Table 1 are incorrect. The correct values are given in the far right column of the table provided in the erratum. (The following abstract of the original article appeared in record 2003-05990-006.) This study examined diagnostic predictors of prospectively observed suicide attempts in a personality disorder (PD) sample. During 2 years of follow-up, 58 participants (9%) reported at least 1 definitive suicide attempt. Predictors that were examined include 4 PD diagnoses and selected Axis I diagnoses (baseline and course). Multivariate logistic regression analyses indicated that baseline borderline personality disorder (BPD) and drug use disorders significantly predicted prospective suicide attempts. Controlling for baseline BPD diagnosis, proportional hazards analyses showed that worsening in the course of major depressive disorder (MDD) and of substance use disorders in the month preceding the attempt were also significant predictors. Therefore, among individuals diagnosed with PDs, exacerbation of Axis I conditions, particularly MDD and substance use, heightens risk for a suicide attempt. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Handbook of treatment for eating disorders.

Reviews the book, Handbook of treatment for eating disorders (2nd ed.) edited by David M. Garner and Paul E. Garfinkel (see record 1997-08478-000). In this book, the editors state that their primary goal is to present treatment approaches in sufficient detail that clinicians can conduct therapy of these disorders. A strong research base undergirds each chapter, filled with extensive case illustration and practical approaches, directed toward the practicing clinician. With new as well as revised chapters, this book consists of five major sections. The first, "The Context for Treatment," describes the history of eating disorders, focusing on Anorexia Nervosa and Bulimia Nervosa. The second, and most coherent, section focuses on cognitive-behavioral and educational approaches. A conglomeration of approaches based on other theoretical perspectives appears in the third section, entitled "Psychodynamic, Feminist, and Family Approaches." In the fourth section, issues around inpatient, partial hospitalization, and drug therapies are reviewed. A final, catch-all section covers special topics, including comorbid histories and conditions (sexual abuse, substance abuse, and medical issues), diagnostic concerns (personality disorders), alternative treatments (group, self-help), treatment dilemmas (treatment refusal in anorexia nervosa), age considerations (prepubertal eating disorders), and binge-eating disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of relationship functioning for patients with bipolar disorder and their partners.

Previous investigations have examined family functioning, including marital functioning, as an important predictor of the course of bipolar disorder, but limited research exists identifying the factors that influence relationship functioning in patients with bipolar disorder. In the current study, 56 patients with bipolar disorder and their partners were assessed for Axis II pathology, general family functioning, and relationship distress. Patient mood symptoms and Axis II pathology variables were examined as predictors of general relationship functioning (Family Assessment Device, McMaster Clinical Rating Scale, and Dyadic Adjustment Scale) in regression models. Analyses indicated that patients' depressive symptomatology was associated with patient ratings of general family functioning and couple functioning, while patients' manic symptoms were associated with partners' ratings of the romantic relationship. Partners' total Axis II pathology, but not patients' Axis II pathology, was associated with patient and partner perception of the couple's relationship. These findings highlight the importance of mood and personality pathology to relationship functioning, and represent one of the first investigations to verify the impact of personality pathology on patients' and partners' perceptions of relationship functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maternal depression and early positive parenting predict future conduct problems in young children with attention-deficit/hyperactivity disorder.

Children with attention-deficit/hyperactivity disorder (ADHD) are at risk for adverse outcomes such as substance abuse and criminality, particularly if they develop conduct problems. Little is known about early predictors of the developmental course of conduct problems among children with ADHD, however. Parental psychopathology and parenting were assessed in 108 children who first met Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for ADHD at 4-7 years old. When demographic variables and baseline ADHD and conduct problems were controlled, maternal depression predicted conduct problems 2-8 years following the initial assessment, whereas positive parenting during the structured parent- child interaction task predicted fewer future conduct problems. These findings suggest that maternal depression is a risk factor, whereas early positive parenting is a protective factor, for the developmental course of conduct problems among children with ADHD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sexual abuse and bulimia: response to inpatient treatment and preliminary outcome

The purpose of this study was to explore the clinical impact of child sex abuse on bulimic patients. Specifically, differences in treatment response and preliminary treatment outcome between hospitalized bulimic patients with and without a reported history of sexual abuse were examined. The patients were evaluated for past history of alleged sexual abuse by investigator-based interview and ratings of severity of sexual abuse were made. Assessments of mood, eating disordered-related attitudes, and eating behaviors were conducted at the start of treatment, weekly during treatment, and three months post discharge. Sixty-one per cent (45) of the 74 patients enrolled in the study reported a history of child sexual abuse. The majority of such events constituted serious and very serious abuse by this study's criteria. The abused subjects exhibited higher levels of depression, anxiety, and eating disordered attitudes at each assessment point relative to nonabused subjects. In addition, abused subjects were more likely to be re-hospitalized in the 3 month post-discharge period. Significant differences in the extent of actual bulimic behaviors were not detected. Both the abused and nonabused bulimic patients demonstrated significant reductions in psychiatric symptomatology from pretreatment to posttreatment, and from posttreatment to follow-up. Contrary to prediction, differences in symptomatology between the very serious, serious, and least serious abused groups were not detected. Results suggest that bulimic patients with reported histories of sexual abuse can be effectively engaged in a conventional eating disorder treatment program, but that such abuse may place patients at a disadvantage owing to higher levels of pretreatment symptom severity. Findings suggest that extended and/or more specific intervention may be warranted for the abused bulimic patient.