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)     

Features of borderline personality disorder, perceived childhood emotional invalidation, and dysfunction within current romantic relationships.

The mechanisms through which current romantic relationship dysfunction develops in individuals with borderline personality disorder (BPD) symptoms are still unclear. One possible pathway may be childhood experiences of emotional invalidation by parents, which may result in the development of poor social problem-solving skills or cognitive responses such as splitting, which impair current romantic relationships. This study examines the relationship between features of BPD and current romantic relationship dysfunction, and demonstrates that perceived emotional invalidation by parents during childhood mediates the relationship between BPD features and current romantic relationship dysfunction. Structural equations modeling was used to test the hypothesized model in 758 young adults in an ethnically diverse community sample. The proposed model fit the data well; perceived childhood emotional invalidation partially mediated the relationship between features of BPD and romantic relationship dysfunction, even when controlling for the presence of a major depressive episode in the last year. The findings of this study suggest that individuals with features of BPD experience relationship dysfunction that cannot be accounted for by comorbid depression and that perceived childhood emotional invalidation may contribute to these problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Borderline personality disorder and personality traits: A comparison of SCID-II BPD and NEO-PI.

62 hospitalized female patients (aged 18–43 yrs) with a clinical diagnosis of borderline personality disorder (BPD) were assessed for Axis II disorders by the SCID-II and for personality traits with the NEO-Personality Inventory (NEO-PI). The predominant personality trait profile for these patients involved a very high Neuroticism score and low Agreeableness score. Five of the 8 BPD criteria had significant correlations with NEO-PI scales. The combination of BPD severity and personality traits as measured on the NEO-PI had a significant relationship to the patients' social adjustment. The utility of gathering information on both borderline personality pathology and personality traits is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between personality pathology and dysfunctional cognitions in previously depressed adults.

Multivariate and univariate regression models were used to examine the relationship between Axis II personality pathology and dysfunctional cognitions in a follow-up study of 40 formerly depressed inpatients. A dimensionalized measure of overall Axis II pathology was significantly and positively related to dysfunctional attitudes (Dysfunctional Attitudes Scale [DAS]) and maladaptive negative event attributions (Attributional Style Questionnaire–Negative Composite [ASQ-N]); the Axis II measure accounted for approximately 29% of the variance in DAS and 14% of the variance in ASQ-N, after controlling statistically for subsyndromal depressive symptoms (Beck Depression Inventory [BDI]). Axis II pathology was not significantly associated with positive event attributions, and no significant Axis II?×?BDI interaction effects were observed. A secondary canonical analysis of Axis II clusters was largely consistent with a hypothesized general personality pathology factor associated with dysfunctional cognitions, though a more specific association between Axis II Cluster C pathology and dysfunctional attitudes was also observed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depression and axis II disorders: comorbidity and relationship to cooperativeness

The diagnosis of depression and Axis II personality disorders have been found to co-occur in people, and the purpose of this paper is to examine the relationships between chronicity of depression and Axis II diagnosis. We assessed for the prevalence of two Axis II disorders, Antisocial Personality Disorder (APD) and Borderline Personality Disorder (BPD). Patients who were evaluated in a tertiary care center were diagnosed as having Chronic Major Depressive Disorder (CMDD), Dysthymic disorder (DD), or Acute Major Depressive Disorder (AMDD). We expected the prevalence of Axis II disorders to increase with increasing depression chronicity. Cloninger et al. (1993, Arch Gen Psychiatry 50:975-988; 1994) have proposed that temperament and character factors may be predictors of personality disorders. The instrument originally developed to measure these factors was the Tri-dimensional Personality Questionnaire (TPQ), which was later revised to produce the Temperament and Character Inventory (TCI). There is evidence that TCI scores help predict the presence of Axis II disorders. We hypothesized that one component of the TCI, cooperativeness, would be lower in CMDD than DD or AMDD, reflecting a relationship between Axis II disorders and chronicity of depression. From our sample, no patients had APD and there was not a significant difference between the number of patients with BPD in each of the depression groups. Furthermore, there was not a significant difference between cooperativeness scores among each of the groups. The implications of these findings are discussed.     

Depressive symptoms and close relationships during the transition to adulthood: Perspectives from dysphoric women, their best friends, and their romantic partners.

Late adolescent women's depressive symptoms and interpersonal functioning were assessed using reports from participants, their best friends, and their romantic partners. As predicted, the associations between relationship dysfunction and dysphoria were stronger in romantic relationships than in friendships. Unlike friends, romantic partners perceived dysphoric women as having poorer social skills. Romantic partners also reported providing less emotional support to dysphoric women, whereas friends reported providing more. Finally, romantic partners of dysphoric women had more Cluster A (odd-eccentric) personality disorder symptoms; these symptoms mediated the relation between women's depression and partners' nonsupportiveness. The findings suggest that dysphoric women may find themselves in emotionally nonsupportive romantic relationships because they have paired (through assortative pairing or mutual influence) with symptomatic partners. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Symptoms and traits of personality disorder: Two new methods for their assessment.

Examines the reliability and validity of 2 dimensional methods for the assessment of personality disorder symptoms and traits. In Study 1, 3 groups that varied in personality pathology level completed the Schedule for Nonadaptive and Adaptive Personality (SNAP; L. A. Clark, 1993), a self-report questionnaire that measures traits relevant to Axis II pathology. Differences among the groups, which were patterned in theoretically interesting ways, are discussed. In Study 2, 2 independent judges rated 22 clusters of Axis II symptoms in 56 state hospital inpatients based on chart information. Good interrater reliability was obtained (median coefficient?=?.71), and personality-related pathology was quite prevalent. Relations among symptom ratings, SNAP scores, and chart diagnoses were generally systematic, but anomalous findings also emerged. Implications for the dimensional assessment of personality-related pathology are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Borderline Personality Disorder Features Predict Negative Outcomes 2 Years Later.

In a sample of 351 young adults, the authors assessed whether borderline personality disorder (BPD) features prospectively predicted negative outcomes (poorer academic achievement and social maladjustment) over the subsequent 2 years, over and above gender and both Axis I and Axis II psychopathology. Borderline traits were significantly related to these outcomes, with impulsivity and affective instability the most highly associated. The present findings suggest that the impulsivity and affective instability associated with BPD leads to impairment in relating well with others, in meeting social role obligations, and in academic or occupational achievement. Therefore, these may be especially important features to target in interventions for BPD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality disorders among alcoholics and alcohol-comorbid subtypes with a Vietnam-era military sample.

Promotes the enhancement of the alcohol and psychiatric comorbidity typology by including the full range of Axis II personality disorders in addition to Axis I disorders. Data from 3,210 male Vietnam-era veterans were used to document the prevalence of personality disorders in male alcoholic Ss with and without other psychiatric comorbidity. Ss were classified into 1 of 6 groups. The results of the personality disorder scales of the MMPI demonstrate increased Axis II comorbidity in alcoholic Ss across a wide range of personality disorders compared with no-diagnosis control Ss and across alcoholic subtypes based on psychiatric comorbidity. In addition, a relationship was found between personality dysfunction and multiple comorbidity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Recurrence of MDD: A prospective study of personality pathology and cognitive distortions.

Major depressive disorder (MDD) is characterized by a high risk of recurrence, especially among individuals whose initial episode occurs during adolescence. Identifying predictors of recurrence of MDD among young samples is therefore of paramount clinical importance. Survival analytic models were used to evaluate the effects of dysfunctional cognitions and Axis II personality pathology on MDD recurrence in a sample of 130 previously, but not currently, depressed young adults. Participants were initially assessed for depression, dysfunctional attitudes, and personality pathology during their first semester in college and then reevaluated via the Longitudinal Interval Follow-up Evaluation interview every 6 months for 18 months. Baseline level of depressive symptoms significantly (HR-1.07, p = .002) predicted recurrence of MDD. In the survival analyses with baseline level of depression serving as a current mood state covariate, overall personality pathology (HR-1.04, p DSM–IV personality disorder cluster scores uniquely predicted recurrence. We discussed the theoretical, empirical, and clinical implications of these findings, and we noted the limitations of the study. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Multimethod investigation of interpersonal functioning in borderline personality disorder.

Even though interpersonal functioning is of great clinical importance for patients with borderline personality disorder (BPD), the comparative validity of different assessment methods for interpersonal dysfunction has not yet been tested. This study examined multiple methods of assessing interpersonal functioning, including self- and other-reports, clinical ratings, electronic diaries, and social cognitions in three groups of psychiatric patients (N = 138): patients with (1) BPD, (2) another personality disorder, and (3) Axis I psychopathology only. Using dominance analysis, we examined the predictive validity of each method in detecting changes in symptom distress and social functioning 6 months later. Across multiple methods, the BPD group often reported higher interpersonal dysfunction scores compared with other groups. Predictive validity results demonstrated that self-report and electronic diary ratings were the most important predictors of distress and social functioning. Our findings suggest that self-report scores and electronic diary ratings have high clinical utility, because these methods appear most sensitive to change. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Personality, Family History, and Competence in Early Adult Romantic Relationships.

The present investigation tested how well family characteristics and the personality traits assessed by the Multidimensional Personality Questionnaire (A. Tellegen, 1982) measured in late adolescence predict aspects of romantic relationships in early adulthood. Nurturant-involved parenting practices and personality traits were related to observed negative interactions and to couples' reports of relationship quality. These results from a prospective longitudinal study suggest that the origins of competence in romantic relationships can be found both in individual differences in personality (especially in negative emotionality) and in differences in developmental experiences. Discussion further develops an account of relationship success and dysfunction that integrates proximal factors, such as couple interactions, with more distal factors such as personality and socialization experiences. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Distinguishing general and specific personality disorder features and implications for substance dependence comorbidity.

Clinical and population-based samples show high comorbidity between Substance Use Disorders (SUDs) and Axis II Personality Disorders (PDs). However, Axis II disorders are frequently comorbid with each other, and existing research has generally failed to distinguish the extent to which SUD/PD comorbidity is general or specific with respect to both specific types of PDs and specific types of SUDs. We sought to determine whether ostensibly specific comorbid substance dependence-Axis II diagnoses (e.g., alcohol use dependence and borderline personality disorder) are reflective of more pervasive or general personality pathology or whether the comorbidity is specific to individual PDs. Face-to-face interview data from Wave 1 and Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions were analyzed. Participants included 34,653 adults living in households in the United States. We used hierarchical factor models to statistically partition general and specific personality disorder dimensions while simultaneously testing for specific PD-substance dependence relations. Results indicated that substance dependence-Axis II comorbidity is characterized by general (pervasive) pathology and by Cluster B PD pathology over and above the relationship to the general PD factor. Further, these relations between PD factors and substance dependence diagnoses appeared to largely account for the comorbidity among substance dependence diagnoses in the younger but not older participants. Our findings suggest that a failure to consider the general PD factor, which we interpret as reflecting interpersonal dysfunction, can lead to potential mischaracterizations of the nature of certain PD and SUD comorbidities. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Prototypic typology and the Borderline Personality Disorder.

Based on interview data from 76 18–45 yr old outpatients, the implications of a prototypic rather than a classical model of personality-disorder classification were demonstrated for DSM-III Axis II Borderline Personality Disorder (BPD). Heterogeneity of membership is described, and conditional probabilities are used to demonstrate the relative efficiency of single diagnostic criteria and combinations of criteria and the degree of overlap among BPD and other personality disorders. The conditional probability approach can be used to determine empirically the covariation of symptoms and to link the study of prototypicality to the individual patient rather than to the group. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depressive response to physostigmine challenge in borderline personality disorder patients

The purpose of this study was to examine the relationship between mood and hormonal responses to cholinergic challenge with physostigmine in order to assess cholinergic system responsiveness in borderline personality disorder (BPD) patients, other non-BPD personality disorder patients, and normal controls. Thirty-four personality disorder patients, 10 of whom met criteria for BPD and 24 of whom met criteria for other, non-borderline, personality disorders, and 11 normal controls participated in a double blind, placebo controlled physostigmine challenge paradigm. The Profile of Mood States depression subscale (POMS-D) self report measure was obtained at baseline and following the physostigmine or placebo infusions. A repeated measures ANOVA of POMS-D scores in placebo and drug conditions indicated a significantly greater depressive response in the total cohort of personality disorder patients than in the normal comparison group (p < 0.05). However, the depressive response to physostigmine was significantly greater in BPD patients, but not other personality disorder patients, compared to normal controls (p < 0.05). There was a correlation between the peak placebo-corrected depressive response to physostigmine and a group of BPD traits related to affective instability but not a group of BPD traits related to impulsivity. There was no correlation in any group between mood response to physostigmine and changes in plasma cortisol, prolactin, or growth hormone, or to nausea or other side effects following physostigmine infusion. These data suggest that there is an association between BPD and acute depressive responses to physostigmine challenge, and that the cholinergic system may be involved in the regulation of affect in Axis II disorders.     

Personality disorders predict relapse in alcoholic patients

This prospective study examines the association of DSM-III-R Axis II comorbidity with (time to) relapse since the end of treatment in a sample of 105 outpatient and 82 inpatient alcoholics. Furthermore, this study addresses the role of motivation for change, time in program, and working alliance in the mechanism underlying the association between Axis II and relapse. We found that Axis II comorbidity in alcoholics is a robust predictor of relapse following treatment, while the effect is strongest in outpatients with low motivation for change and/or short time in program. Motivation for change and time in program did not mediate the association of Axis II with relapse. We also found poor working alliance to be related to personality pathology among inpatients, and from our findings it can be hypothesised that poor working alliance is part of the mechanism underlying the observed impact of Axis II on treatment outcome in outpatients. A preliminary model of the role of personality pathology in the mechanism of relapse is proposed.     

Modeling relapse in unipolar depression: The effects of dysfunctional cognitions and personality disorders.

Survival analytic models were used to determine the effects of Axis II pathology and dysfunctional cognitions on depressive relapse in a sample of 50 depressed inpatients followed 33 to 84 months (M?=?49.9) postdischarge. In analyses based on follow-up interview measures, expected remission duration among patients without personality disorders was approximately 7.4 times longer than among patients with Axis II comorbidity. Attributional style also accounted for unique variance in the relapse model, with adaptive positive event attributions inversely related to relapse probability. Neither dysfunctional attitudes nor negative event attributions were significantly related to relapse. Dimensional Axis II Cluster B and C pathology ratings were associated with decreased survival time, whereas Cluster A pathology was associated with increased survival. Among measures obtained during index hospitalization, only the dimensional rating of Axis II pathology was significantly predictive, with a cumulative 8% decrease in expected survival for each Axis II criterion item met. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality disorder subtypes among opiate addicts in methadone maintenance.

The Millon Clinical Multiaxial Inventory was administered to 196 men and 113 women newly admitted to methadone maintenance. The distribution of participants among Axis I subtypes was no elevation (18.8%), drug-alcohol abuse only (25.2%), affective disturbance (31.7%), and psychotic symptoms(l7.2%); among Axis II subtypes it was no elevation (10.4%), narcissistic-antisocial (36.2%), dependent (16.2%), withdrawn-negativistic (12.6%), histrionic (7.4%), and severe personality disorder (8.4%). Women were more likely to be assigned to histrionic, dependent, and severe personality disorder subtypes. Proportionately more Black participants were assigned to drug-alcohol only, psychotic symptoms, narcissistic-antisocial, and severe personality disorder subtypes. The proportion retained in treatment at 18 mo was higher for withdrawn (.51) and histrionic (.33) than other Axis II subtypes (range?=?.13–.22). (PsycINFO Database Record (c) 2010 APA, all rights reserved)