Predicting personality pathology among adult patients with substance use disorders: effects of childhood maltreatment

The purpose of this study was to examine predictive relationships between types of childhood maltreatment and personality disorders in a substance-abusing population. Three hundred thirty-nine drug- or alcohol-dependent patients completed a reliable and valid retrospective measure of childhood trauma, the CTQ, and a self-report inventory that assesses the entire range of DSM-III-R personality disorders, the PDQ-R. As a preliminary step, factor analyses were used to group personality disorders into the three DSM-III-R Axis II clusters (Clusters A, B, and C), although some diagnostic subclusters were also found. Structural equation modeling analyses revealed several significant paths between types of maltreatment and personality disorder clusters (and subclusters). Physical abuse and physical neglect were related to a subcluster of "psychopathic" personality disorders consisting of childhood and adult antisocial personality traits and sadistic traits. Emotional abuse emerged as a broad risk factor for personality disorders in Clusters A, B, and C. Emotional neglect was related to the traits of schizoid personality disorder, which formed its own subcluster. Finally, sexual abuse, which had been expected to predict borderline personality disorder traits, was unrelated to any personality disorder cluster. These findings support the view that child maltreatment contributes to the high prevalence of co-morbid personality disorders in addicted populations.     

A cooperative randomized controlled study of adjuvant chemoendocrine therapy for breast cancer in Japan

Social competence in subjects at risk for schizophrenia and affective disorder and in normal-comparison subjects was examined in childhood and adolescence. Based on interviews with the parents of the subjects and with the children and adolescents themselves, subjects at risk for schizophrenia had poorer overall social competence than subjects at risk for affective disorder and comparison subjects in early adolescence and adolescence but not in childhood. In analyses of specific aspects of social competence, the adolescents at risk for schizophrenia had significantly poorer peer relationships and decreased hobbies/interests than the adolescents at risk for affective disorder and the normal-comparison adolescents. With respect to school adjustment, however, the two groups of adolescent offspring of parents with psychiatric disorders had significantly poorer adjustment than the comparison adolescents but did not differ from each other on this measure. These results suggest that various aspects of poor social competence may precede the onset of schizophrenia and play an important role in its development.     

Risk factors for onset and persistence of psychosis

Clinical practice, training and evaluation of treatment in the functional psychoses continues to be carried out mostly along the traditional line of separation by diagnostic entity. However, the combined evidence from research on risk factors for onset and for persistence of psychotic illness indicates quantitative, but not qualitative, differences between categories of schizophrenia and affective psychosis. "Developmental" factors, such as childhood dysfunction, increased cerebral ventricle size and familial morbid risk of schizophrenia operate preferentially, though not specifically, at that end of the psychopathological spectrum characterised by a preponderance of negative features. On the other hand, "social" factors, such as ethnic group, adverse life events and familial morbid risk of affective disorder have a larger impact at the end associated with predominance of affective features. Heterogeneity in the functional psychoses may thus be best conceived as two discrete effects operating at different ends of a continuous psychopathological spectrum. The use of highly reliable but arbitrary diagnostic categories may introduce serious bias in aetiological and treatment research. Evidence supporting the validity of a model of shared risk factors for continuous characteristics needs to be further elaborated and incorporated into our concepts of psychotic illness.     

Big Five dimensions and ADHD symptoms: Links between personality traits and clinical symptoms.

Attention-deficit/hyperactivity disorder (ADHD) in adulthood is conceptualized as originating in childhood. Despite considerable theoretical interest, little is known about how ADHD symptoms relate to normal personality traits in adults. In 6 studies, the Big Five personality dimensions were related to ADHD symptoms that adults both recalled from childhood and reported concurrently (total N=1,620). Substantial effects emerged that were replicated across samples. First, the ADHD symptom cluster of inattention-disorganization was substantially related to low Conscientiousness and, to a lesser extent, Neuroticism. Second, ADHD symptom clusters of hyperactivity-impulsivity and oppositional childhood and adult behaviors were associated with low Agreeableness. Results were replicated with self-reports and observer reports of personality in community and clinical samples. Findings support theoretical connections between personality traits and ADHD symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dynamics of childhood and adolescent personality traits and adolescent drug use.

Examined the relative impact of childhood and adolescent personality/behavioral attributes on the adolescent's stage of drug use. Mothers of 356 youngsters were interviewed concerning their child's personality, behavior, development and childrearing techniques, family structure, family health, and demographics when the child was 5–20 yrs of age (Time 1 [T1]) and again when the child was 13–18 yrs old (Time 2 [T2]). Adolescents also completed a self-report questionnaire concerning their personalities, behavior, and drug use at T2. As hypothesized, findings support a mediational model as best depicting the interrelation of the domains of childhood and adolescent personality and stage of drug use. Childhood personality attributes were related to adolescent personality attributes, which in turn were related to adolescents' stage of drug use. Across-time personality correlations suggested that substantial continuity exists in personality traits. However, there was also some evidence for the malleability of these traits. Results suggest the positive effects of protective (i.e., nondrug-conducive) personality traits in children can be weakened by the presence of risk factors during adolescence, leading to higher T2 drug stage, and that the negative impact of childhood risk personality traits can be ameliorated by protective personality traits during adolescence, resulting in lower drug stage. (48 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of histamine in platelet aggregation by physiological and immunological stimuli

This paper reviews the current state of the debate on the relationship between mental disorder and violent behaviour. Starting from the discussion of methodological approaches to assessing a possible association, the most important studies carried out on the issue in recent years are discussed. Their results concur in supporting the assumption that there is a moderate but reliable association between mental disorder and violence. However, this does not imply that people with mental illness are generally more likely to commit violent acts than members of the general population. An elevated risk of violent behaviour is only evident for specific psychiatric diagnoses and for particular symptom constellations. For schizophrenia and other psychotic disorders, a significant increase in the likelihood to commit violent acts is reported. Substance use disorder and antisocial personality disorder, however, represent a markedly higher risk for violent behaviour. The article further discusses possible determinant of violent behaviour such as psychotic symptoms and comorbidity with substance abuse, and considers who is at particular risk of becoming a target of violent acts.     

An examination of gender and racial differences among Missouri insanity acquittees

This study examines gender and racial differences among Missouri insanity acquittees, which included 42 African American females, 279 African American males, 63 Caucasian females, and 458 Caucasian males. Significant differences across the four groups were not found in age, current marital status, a diagnosis of borderline intellectual functioning/mental retardation, committing crimes of assault and burglary, and whether insanity acquittees ever received conditional releases to reside in the community. Some variations across the four gender/race categories were related to race (diagnoses of schizophrenia, mood disorders, and other Axis I diagnoses), but variations were more frequently related to gender (whether ever married; diagnoses of substance abuse, sexual disorders, antisocial personality disorder, borderline personality disorder, and any personality disorder; committing crimes of murder, sexual offenses, and serious offenses; and current residential status). African American males were identified as being an at-risk population. They were the most likely to have a schizophrenia diagnosis, a substance abuse diagnosis, an antisocial personality disorder diagnosis, and to be hospitalized on the survey date. Implications for treatment and future research are explored.     

Collagens in intestinal smooth muscles

Most of the research and clinical reports concerning borderline personality disorder (BPD) come from highly developed countries. Although BPD can also be diagnosed in developing societies, it is likely that this form of pathology is more prevalent in North America and Europe. However, the personality traits and psychological risk factors underlying borderline personality may also be found in individuals from developing countries. The hypothesis of this paper is that social protective factors suppress the development of these traits into diagnosable personality disorders. This process is illustrated by cases in which borderline pathology emerged only after immigration.     

Genetics of personality disorders: Perspectives from personality and psychopathology research.

Although the field is young, studies pertinent to genetic hypotheses have accumulated for several personality disorders. Genetic links to personality disorders from the domains of normal personality and Axis I disorders are reviewed. Evidence of a link to schizophrenia is clearest for schizotypal and less conclusive for paranoid and schizoid personality disorders. A genetic association between borderline personality disorder and affective disorders has not been clearly supported, but there may be a subtype genetically linked to affective disorders. Evidence of genetic influence is mixed for obsessive-compulsive personality disorder. In general, greater attention to dimensional phenotypic measures and multivariate designs can yield more definitive answers regarding the correct subtyping and probable etiology of personality disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Dutch famine and schizophrenia spectrum disorders

In the Dutch Hunger Winter at the end of World War II a combination of circumstances created the conditions of a natural experiment. Unlike other famines, the Dutch famine struck at a precisely circumscribed time and place, and in a society able to document the timing and severity of the nutritional deprivation as well as the effects on fertility and health. Because the Dutch maintained comprehensive military and health records, it was possible to compare the incidence of neurodevelopmental disorders in adulthood for birth cohorts exposed versus those unexposed to prenatal famine. We have conducted several studies guided by the hypothesis that prenatal micronutrient deficiencies can cause neurodevelopmental schizophrenia or related personality disorders. In this paper we shall summarize our previous work and combine the outcome data of the different studies. Early prenatal famine was found to be specifically and robustly associated with each of three conditions: (1) congenital anomalies of the central nervous system, (2) schizophrenia, and (3) schizophrenia spectrum personality disorders. We found that the greatest increase in the risk of schizophrenia spectrum disorder- schizophrenia plus spectrum personality disorder- occurred among males born in the famine cities in December 1945 (relative risk = 2.7; 95% confidence interval = 1.5-5.1). Persons born in December 1945 were generally conceived at the absolute peak of the famine (March-April 1945). In the hope that the associations we have found may offer clues to the aetiology of schizophrenia, we are currently tracing and examining the cases of schizophrenia after prenatal exposure to famine.     

Familial prevalence and coaggregation of schizotypy indicators: A multitrait family study.

Schizophrenic probands (n?=?17), their 1st-degree relatives (n?=?61), and medically and psychiatrically screened normal control Ss (n?=?18) were studied with structured interviews for Diagnostic and Statistical Manual of Mental Disorders (DSM-III) Axis I disorders and schizotypal personality disorder, questionnaire measures of schizotypy, measures of smooth-pursuit eye movement dysfunction, and attention dysfunction. Schizophrenic Ss scored abnormally on essentially all measures. Relatives differed significantly from control Ss on most measures. Correlational analyses indicate that many characteristics tested in these measures run together in families. The data are consistent with the hypothesis that a single vulnerability dimension or typology, presumably in part genetically transmitted, may account for phenotypically distinct abnormalities. These traits, taken together, may have joint usefulness for identifying persons with a predisposition to schizophrenia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Children at high risk for schizophrenia: Parent and offspring perceptions of family relationships.

The current investigation examined family relationships prior to the onset of psychopathology in a sample at high risk for schizophrenia. The theory underlying this investigation is that individuals with schizophrenia and schizotypal personality disorders (SPD) share a similar genetic predisposition to schizophrenia; environmental factors determine whether the full schizophrenic syndrome develops. In previous studies we have concentrated on biological and environmental factors that differentiate schizophrenics from schizotypals. In this study, the results demonstrated that the family relationships of high-risk offspring who later developed schizophrenia were perceived to be significantly less satisfactory than the family relationships of high-risk offspring who were later diagnosed as having SPD or no mental illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neuroimaging in child and adolescent neuropsychiatric disorders

OBJECTIVE: To review the major findings and pathophysiological implications of imaging studies of neuropsychiatric disorders that onset in childhood or adolescence. METHOD: More than 200 neuroimaging studies were selected for review from Medline searches if the studies concerned developmental neuropsychiatric disorders such as autism, fragile X syndrome, Down syndrome, schizophrenia, obsessive-compulsive disorder, Tourette's syndrome, attention-deficit hyperactivity disorder, and dyslexia. RESULTS: Disordered central nervous system development may produce evidence of cortical neuronal migration abnormalities in autism, smaller cortical structures in Down syndrome, frontal lobe deficits and larger basal ganglia in schizophrenia, hypoplastic basal ganglia in Tourette's syndrome, aberrancies of the planum temporale in dyslexia, and hypoplastic cerebellar structures in numerous developmental disorders. Normal cerebral asymmetries appear to be disrupted in a number of disorders, including schizophrenia, Tourette's syndrome, attention deficit disorder, and dyslexia. CONCLUSIONS: Neuroimaging data regarding pathological central nervous system development in childhood are still sparse, and many of the findings in developmental disorders of childhood onset concern the study of adult subjects with those disorders. Nevertheless, imaging modalities previously used only in adults are with increasing frequency being applied to the study of children, which will likely continue to contribute to the understanding of pathological brain structure and function throughout childhood and to the improved treatment of these disorders.     

Personality and mortality risk across the life span: The importance of conscientiousness as a biopsychosocial attribute.

Objective: This study addressed whether personality in childhood and personality in adulthood are independent predictors of mortality risk and the extent to which behavioral and other psychosocial factors can explain observed relationships between personality and mortality risk. Design: This was a prospective longitudinal cohort study of 1,253 male and female Californians over 7 decades (1930-2000). Proportional hazards regressions were the principal analyses. Main Outcome Measures: Mortality risk (in the form of relative hazards) was the primary outcome. Additional tests of mediators and moderators ascertained whether associations between personality and mortality risk remained significant when psychosocial and behavioral variables were statistically controlled. Results: The findings, including a new 14-year additional follow-up in old age, revealed that conscientiousness, measured independently in childhood and adulthood, predicted mortality risk across the full life span. The link from childhood remained robust when adult conscientiousness and certain behavioral variables were controlled. Psychosocial and behavioral variables partly explained the adult conscientiousness-longevity association. Conclusion: The findings demonstrate the utility and complexity of modern personality concepts in understanding health and point to conscientiousness as a key underexplored area for future biopsychosocial studies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mechanisms by which childhood personality traits influence adult health status: Educational attainment and healthy behaviors.

Objective: The purpose of this study was to test a life span health behavior model in which educational attainment and health behaviors (eating habits, smoking, and physical activity) were hypothesized as mechanisms to account for relations between teacher ratings of childhood personality traits and self-reported health status at midlife. Design: The model was tested on 1,054 members of the Hawaii Personality and Health cohort, which is a population-based cohort participating in a longitudinal study of personality and health spanning 40 years from childhood to midlife. Outcome: Childhood Agreeableness, Conscientiousness, and Intellect-Imagination influenced adult health status indirectly through educational attainment, healthy eating habits, and smoking. Several direct effects of childhood traits on health behaviors and health status were also observed. Conclusion: The model extends past associations found between personality traits and health behaviors or health status by identifying a life-course pathway based on the health behavior model through which early childhood traits influence adult health status. The additional direct effects of personality traits indicate that health behavior mechanisms may not provide a complete account of relations between personality and health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Longitudinal Relationship of Personality Traits and Disorders.

Personality disorders are presumed to be stable because of underlying stable and maladaptive personality traits, but while previous research has demonstrated a link between personality traits and personality disorders cross-sectionally, personality disorders and personality traits have not been linked longitudinally. This study explores the extent to which relevant personality traits are stable in individuals diagnosed with 4 personality disorders (schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders) and examines the assumption that these personality disorders are stable by virtue of stable personality traits. This assumption was tested via the estimation of a series of latent longitudinal models that evaluated whether changes in relevant personality traits lead to subsequent changes in personality disorders. In addition to offering large consistency estimates for personality traits and personality disorders, the results demonstrate significant cross-lagged relationships between trait change and later disorder change for 3 of the 4 personality disorders studied. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment implications of past trauma in borderline personality disorder

Recent research and clinical experience have shown childhood trauma to be common in the histories of patients with borderline personality disorder. This article reviews the association between borderline personality disorder and early trauma, and how an awareness of the role of trauma may improve the treatment of patients with this disorder. Particularly when early trauma is in the form of childhood abuse, clinicians may be better able to understand the difficulties these patients experience in relational skills, affect tolerance, behavioral control, self-identity, and self-worth. Clinicians may be able to facilitate a stronger therapeutic alliance through acknowledgement of the patient's victimization and empathy with the effects of early trauma on the patient's life. Reframing the patient's experience as a consequence of childhood trauma is essential, especially when making traditional interventions such as interpretation and confrontation. The role of trauma in the development of borderline personality disorder suggests the need for modification of models of individual, family, and group psychotherapies that may allow more productive and successful treatment.     

Antisocial personality disorder, conduct disorder, and substance abuse in schizophrenia.

The validity of subtypes based on antisocial personality disorder (APD) or childhood conduct disorder without adult APD (CD only) in patients with schizophrenia (or schizoaffective disorder) and a substance use disorder (abuse or dependence) was examined. APD patients scored lower on personality measures related to socialization and higher on antisocial bebavior, psychopathy, and aggression. APD patients also reported higher rates of aggression and legal problems. APD, and to a lesser extent CD only, was associated with more severe psychiatric symptoms, an earlier age of onset of substance abuse, more severe symptoms of substance abuse, and a stronger family history of substance abuse and psychiatric hospitalization. The findings suggest that schizophrenia patients with APD represent a high-risk subgroup vulnerable to more severe substance abuse, psychiatric impairment, aggression, and legal problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality differences predict health-risk behaviors in young adulthood: evidence from a longitudinal study

In a longitudinal study of a birth cohort, the authors identified youth involved in each of 4 different health-risk behaviors at age 21: alcohol dependence, violent crime, unsafe sex, and dangerous driving habits. At age 18, the Multidimensional Personality Questionnaire (MPQ) was used to assess 10 distinct personality traits. At age 3, observational measures were used to classify children into distinct temperament groups. Results showed that a similar constellation of adolescent personality traits, with developmental origins in childhood, is linked to different health-risk behaviors at 21. Associations between the same personality traits and different health-risk behaviors were not an artifact of the same people engaging in different health-risk behaviors; rather, these associations implicated the same personality type in different but related behaviors. In planning campaigns, health professionals may need to design programs that appeal to the unique psychological makeup of persons most at risk for health-risk behaviors.