Narcissism in the Rorschach revisited: Some reflections on empirical data.

This study investigates the extent to which the Rorschach was able to identify accurately pathological expressions of narcissism according to the methodological recommendations offered by T. Nezworski and J. Wood (1995) . Ninety-one patients who were found to meet DSM-IV criteria for an Axis II disorder (Cluster A personality disorders/&=/&10; antisocial/&=/&20, borderline/&=/&25, histrionic/&=/&5, narcissistic [NPD]/&=/&15; Cluster C personality disorders/&=/&16) and 50 nonclinical participants were compared on 5 Rorschach variables: reflection, pair, personalization, idealization, and the egocentricity index. The results of this study indicate that selected Rorschach variables can be used effectively to differentiate NPD patients from a nonclinical sample and from Cluster A, Cluster C, and other Cluster B personality disorders. Also, the reflection and idealization variables were found to be empirically related to DSM-IV diagnostic criteria for NPD and a self-report measure of NPD. Finally, these 2 variables could be used for classification purposes in ways that were clinically meaningful in the diagnosis of NPD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rorschach and MMPI-2 indices of early psychotherapy termination.

This study was an investigation of the differences between 97 patients who had prematurely terminated psychotherapy (M?=?1 session) and 81 who had participated in individual psychotherapy for at least 6 months and 24 sessions (M?=?18 months/72 sessions) on selected Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and Rorschach variables. None of the between-group comparisons using the MMPI-2 proved to be significant. However, a multivariate analysis of variance of 9 Rorschach variables in 3 conceptual categories, (1) interpersonal relatedness, (2) psychological resources versus resource demand, and (3) level of psychopathology, proved to be significant at p?=?.008. The Rorschach scores from the interpersonal-relational category proved to be the most robust in differentiating the 2 groups. The theoretical implications of interpersonal variables are discussed in relation to the termination and continuation of patients in psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of free radical production and scavengers on occlusion-reperfusion induced arrhythmias

The DSM-IV section of the DSM-IV and ICD-10 Personality Questionnaire (DIP-Q) was used to screen for personality disorders in 448 subjects from three clinical samples (general and forensic psychiatric patients and candidates for psychotherapy) and a sample of 139 healthy volunteers. Differences between the samples with regard to patterns of personality pathology in relation to concurrent Axis I disorders and sociodemographic variables were analysed. The prevalence of personality disorders according to DIP-Q was 14% among the healthy volunteers, compared to 59% in the general psychiatric sample, 68% in the forensic psychiatric sample and up to 90% among psychotherapy candidates. Moreover, from a dimensional perspective (i.e. the number of fulfilled Axis II criteria), all clinical groups differed significantly from the control group in all specified personality dimensions and clusters. Dimensional DIP-Q cluster scores also discriminated significantly between the three clinical samples. Unexpectedly, the odds ratio for an Axis II disorder was nearly five times higher among psychotherapy applicants than among general psychiatric patients, independent of concomitant Axis I disorders, gender or age. The strongest association between DIP-Q score and Axis I disorders was found for depressive disorders, which more than doubled the odds ratio for a personality disorder diagnosis. This association could result from high true comorbidity, but could also be due to the fact that a concomitant depressive state can increase self-reported personality difficulties. The high prevalence among psychotherapy candidates may to some extent reflect help-seeking exaggeration of problems. These are aspects to consider when using the DIP-Q, which overall appears to discriminate well between different samples.     

Latent structure analysis of DSM-IV borderline personality disorder criteria

The aim of this study was to evaluate the structure of DSM-IV borderline personality disorder (BPD) criteria. The study group consisted of 564 consecutively admitted inpatients and outpatients. BPD criteria discriminatory power was tested by using corrected item-to-total and item-to-diagnosis correlations. Weighted least-squares (WLS) confirmatory factor analysis (CFA) was used to assess the fit of DSM-IV BPD unidimensional model. The categorical model of BPD was tested by exploratory latent class analysis (LCA). Item analysis suggested a hierarchy in BPD criteria discriminatory power, even if with different rank order with respect to the DSM-IV model. CFA showed a unifactorial structure with congeneric items as the best fitting model for DSM-IV BPD criteria (chi2 = 18.89, df= 27, P > .87). LCA showed evidence for three latent classes; heterogeneity was observed only among subjects falling below DSM-IV diagnostic threshold for BPD. These results support the categorical model of BPD, even if with several differences with respect to DSM-IV.     

Preliminary relationships between adherence and outcome in dynamic deconstructive psychotherapy.

This study examined adherence to specific psychotherapeutic techniques as a predictor of outcome in dynamic deconstructive psychotherapy (DDP), a new psychodynamic therapy for treatment-resistant clients with borderline personality disorder (BPD). Ten clients dually diagnosed with BPD and alcohol use disorders underwent 12 months of DDP. Outcome indexes included measures of borderline symptoms, depression, dissociation, social support, alcohol misuse, parasuicide, and institutional care. Independent raters coded videorecorded sessions on adherence to DDP techniques, using a scale developed for this study, as well as therapeutic alliance and standard cognitive–behavioral and psychodynamic techniques. The adherence instrument demonstrated excellent interrater and test–retest reliability. Adherence to DDP techniques was positively related to improvement in BPD symptoms (ρ = .64) and most secondary outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treating co-occurring Axis I disorders in recurrently suicidal women with borderline personality disorder: A 2-year randomized trial of dialectical behavior therapy versus community treatment by experts.

This study evaluated whether dialectical behavior therapy (DBT) was more efficacious than treatment by nonbehavioral psychotherapy experts in reducing co-occurring Axis I disorders among suicidal individuals with borderline personality disorder (BPD). Women with BPD and recent and repeated suicidal and/or self-injurious behavior (n = 101) were randomly assigned to 1 year of DBT or community treatment by experts (CTBE), plus 1 year of follow-up assessment. For substance dependence disorders (SDD), DBT patients were more likely to achieve full remission, spent more time in partial remission, spent less time meeting full criteria, and reported more drug- and alcohol-abstinent days than did CTBE patients. These findings suggest that improvements in co-occurring SDD among suicidal BPD patients are specific to DBT and cannot be attributed to general factors associated with nonbehavioral expert psychotherapy. Further, group differences in SDD remission were not explained by either psychotropic medication usage or changes in BPD criterion behaviors. DBT and CTBE did not significantly differ in the reduction of anxiety disorders, eating disorders, or major depressive disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of Cluster C personality disorders on outcomes of contrasting brief psychotherapies for depression.

Twenty-seven of 114 depressed clients, stratified for severity of depression, obtained a Diagnostic and Statistical Manual of Mental Disorders (3rd ed.; DSM-III; American Psychiatric Association, 1980) diagnosis of Cluster C personality disorder, that is, avoidant, obsessive-compulsive or dependent personality disorder (PD clients), whereas the remaining 87 did not (non-personality-disorder [NPD] clients). All clients completed either 8 or 16 sessions of cognitive-behavioral (CB) or psychodynamic-interpersonal (PI) psychotherapy. On most measures, PD clients began with more severe symptomatology than NPD clients. Among those who received PI therapy, PD clients maintained this difference posttreatment and at 1-year follow-up. Among those who received CB therapy, posttreatment differences between PD and NPD groups were not significant. Treatment length did not influence outcome for PD clients. PD clients whose depression was also relatively severe showed significantly less improvement after treatment than either PD clients with less severe depression or NPD clients. (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)     

Effects of impression management and self-deception on the predictive validity of personality constructs.

This study tests whether 2 types of response distortion (self-deception and impression management) affect the predictive validity of 2 of the "Big 5" personality dimensions, conscientiousness and emotional stability, in 2 applicant samples of long-haul semitruck drivers (n?=?147 and n?=?139). As hypothesized, conscientiousness (p?=?–.26 and –.26) and emotional stability (p?=?–.23 and –.21 ) were valid predictors of voluntary turnover in the 2 samples. Also as hypothesized, conscientiousness was a valid predictor of supervisory ratings of performance (p?=?.41 and .39 ) in the 2 samples. Although not hypothesized, emotional stability was also significantly related to supervisor ratings of performance (p?=?.23 and .27). Results from structural equations modeling indicated that applicants did distort their scores on both personality dimensions and the distortion occurred both through self-deception and impression management; however, neither type of distortion attenuated the predictive validities of either personality construct. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diagnostic Efficiency of DSM-IV Criteria for Borderline Personality Disorder: An Evaluation in Hispanic Men and Women With Substance Use Disorders.

This study examined diagnostic efficiency of Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), criteria for borderline personality disorder (BPD). One hundred thirty monolingual Hispanic adults (90 men, 40 women) at an outpatient psychiatric and substance abuse clinic were assessed with the Spanish-Language Version of the Diagnostic Interview for DSM-IV Personality Disorders (C. M. Grilo, L. M. Anez, & T. H. McGlashan, 2003). The BPD diagnosis was determined by the best-estimate method. Diagnostic efficiency indices were calculated for all BPD criteria, for the entire study group, and separately by gender. Overall, the best exclusion criterion was affective instability, whereas suicidality or self-injury was the best inclusion criterion and the best predictor overall. These findings did not differ by gender, are similar to those reported elsewhere in the literature, and have implications for the refinement of diagnostic systems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Safety and tolerability of intravenous cibenzoline for acute termination of spontaneous sustained ventricular tachycardia. Cibenzoline and spontaneous VT

OBJECTIVE: To examine the rate of persistence of borderline personality disorder (BPD), the existence of concomitant personality disorders on follow-up, and the predictors of outcome in patients who met criteria for BPD compared with patients with borderline features who failed to meet all of the criteria. METHOD: This prospective cohort study reassessed subjects for BPD diagnosis and cooccurring personality pathology at 7 years follow-up. Initial measures of borderline and comorbid personality psychopathology were used to predict levels of borderline or other personality disorder psychopathology at follow-up. RESULTS: Of the 57 subjects who initially met the criteria for BPD, 30 (52.6%) were found to have remitted BPD, and 27 (47.4%) were characterized as having persistent BPD. The remitted group met significantly fewer comorbid personality disorder diagnoses than the persistent group (mean = 0.8, mean = 3.5 respectively; P < 0.05). Results also indicated that the initial level of borderline psychopathology was predictive of borderline psychopathology at follow-up, which explained 17% of the variance. CONCLUSIONS: This prospective follow-up study found that almost 50% of former inpatients with BPD continue to test positive for BPD at 7 years follow-up, and these persistent BPD patients also had significantly more comorbid personality psychopathology. Borderline psychopathology at follow-up was primarily predicted by the level of borderline psychopathology recorded at the initial assessment.     

Paths of influence of divorce on preschool children's psychosocial adjustment.

This study examined the direct and indirect influences of parental divorce on preschool children's psychosocial adjustment through its effect on maternal strain, family socioeconomic status, the quality of the family's interpersonal relationships, and mother–child interaction. Participants included 198 married (n?=?99) and divorced (n?=?99), predominantly White, lower- to middle-income families with preschool children. Analyses using structural equation modeling (SEM) indicate that family structure and processes in combination most strongly influenced child outcomes. Specifically, the effects of divorce on children's adjustment were mediated by maternal strain and the quality of mother–child interaction. The goodness-of-fit indices (.90 to .94), root mean square error of approximation index (.03), and nonsignificant chi-square (p?=?.12) indicated a good fit for the generated structural equation model. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The comorbidity of alcoholism and personality disorders in a clinical population: Prevalence and relation to alcohol typology variables.

This study assessed prevalence rates and overlap among Diagnostic and Statistical Manual of Mental Disorders ( 3rd ed., revised; DSM-III—R; American Psychiatric Association, 1987) personality disorders in a multisite sample of 366 substance abusers in treatment. In addition, the relation of antisocial personality disorder (APD), borderline personality disorder (BPD), and paranoid personality disorder (PPD) to alcohol typology variables was examined. Structured diagnostic interviews and other measures were administered to participants at least 14 days after entry into treatment. Results indicated high prevalence rates for APD and non-APD disorders. There was extensive overlap between Axis I disorders and personality disorders, and among personality disorders themselves. APD, BPD, and PPD were linked to more severe symptomatology of alcoholism and other clinical problems. However, only APD and BPD satisfied subtyping criteria, after controlling for other comorbidity. Implications for classifying alcoholics by comorbid disorders are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Criterion-related validity of the Psychopathic Personality Inventory in a prison sample.

The Psychopathic Personality Inventory (PPI; S. 0. Lilienfeld & B. P. Andrews, 1996), a self-report measure of psychopathic personality features, and R. D. Hare's (1991) Psychopathy Checklist–Revised (PCL–R) were administered to adult youthful offender prison inmates (N?=?50). As hypothesized, PPI scores were significantly correlated with scores on the PCL–R, providing evidence of concurrent validity for the PPI. Moreover, unlike existing self-report psychopathy measures, the PPI showed a moderate and positive correlation with PCL–R Factor 1 (i.e., the core personality traits of psychopathy). Discriminant function analysis using the optimal PPI total score value to predict PCL–R classifications of psychopath (n?=?10) and nonpsychopath (n?=?40) resulted in accurate classification of 86% of the cases (sensitivity?=?.50, specificity?=?.95). Results are discussed in terms of the relative merits of these 2 measures of psychopathy and the validation of the PPI for clinical use. (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)     

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)     

Unlike any other procedure

The paper presents several mnemonics to assist clinicians in recalling DSM-IV diagnostic criteria for personality disorders. The mnemonics are acronyms, and each letter is associated with a specific criterion. Each acronym reflects a facet of the related disorder; for example, the acronym for the diagnostic criteria for paranoid personality disorder is SUSPECT, and for histrionic personality disorder it is PRAISE ME. The mnemonics have been used to teach students and residents the conceptual nature of DSM-IV disorders and to help them remember the criteria.     

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.