Two-Year Stability and Change of Schizotypal, Borderline, Avoidant, and Obsessive-Compulsive Personality Disorders.

The authors examined the stability of schizotypal (STPD), borderline (BPD), avoidant (AVPD) and obsessive-compulsive (OCPD) personality disorders (PDs) over 2 years of prospective multiwave follow-up. Six hundred thirty-three participants recruited at 4 collaborating sites who met criteria for 1 or more of the 4 PDs or for major depressive disorder (MOD) without PD were assessed with semistructured interviews at baseline, 6, 12, and 24 months. Lifetable survival analyses revealed that the PD groups had slower time to remission than the MDD group. Categorically, PD remission rates range from 50% (AVPD) to 61% (STPD) for dropping below diagnostic threshold on a blind 24-month reassessment but range from 23% (STPD) to 38% (OCPD) for a more stringent definition of improvement. Dimensionally, these findings suggest that PDs may be characterized by maladaptive trait constellations that are stable in their structure (individual differences) but can change in severity or expression over time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Visual event-related potentials in schizotypal personality disorder and schizophrenia.

Schizophrenia (SZ) occurs among a spectrum of disorders with similar characteristics, including schizotypal personality disorder (SPD). Visual processing disturbances have been reported in both disorders, but it is not yet clear which processes are disturbed in both SZ and SPD, suggestive of a common endophenotype, and which appear only in SZ. In order to address this question, the authors evaluated visual event-related potentials (ERPs) elicited during a line-orientation discrimination task in control, SPD, and SZ participants. Visual ERPs allow specification of both the time course and physiological correlates of visual perception and cognition. SZ patients had smaller P100 and P300a amplitudes and prolonged P300b latency compared to the control group. SZ patients also had smaller N160, N200, P300a, and P300b amplitudes compared to the SPD group. SPD participants did not differ from control participants on any ERP measure. These data documented pervasive abnormalities in visual perception and attention in SZ but not in SPD, suggesting that these visual ERP disturbances may not represent a common endophenotype. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dimensions of internalized object relations in borderline and schizophrenic patients.

This paper explores two dimensions of internalized object relations in borderline and schizophrenic patients using Rorschach scales. A thematic and a structural Rorschach measure of object relations is applied to the Rorschachs of two borderline groups (an infantile personality group and an obsessive-paranoid group) and a schizophrenic group. The findings suggest the value of both a multidimensional definition of internalized object relations and the use of such an approach to clarifying the diagnostic concept of borderline personality disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gesture behavior in unmedicated schizotypal adolescents.

Schizotypal personality disorder is characterized by interpersonal and verbal communication deficits. Despite the important role of gesture in social communication, no published reports examine the use of gesture by individuals with SPD. In this study, raters code gesture from videotaped interviews of unmedicated adolescents with SPD, other personality disorders, or no Axis II disorder. Results indicate that SPD adolescents show significantly fewer gestures but do not differ from the other groups in overall rate of movement. The findings are discussed in light of brain regions involved in dysfunction, parallels to schizophrenia, and treatment implications. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Context processing in schizotypal personality disorder: Evidence of specificity of impairment to the schizophrenia spectrum.

Working memory abnormalities, which are particularly pronounced on context processing tasks, appear relatively specific to schizophrenia spectrum illnesses compared with other psychotic disorders. However, the specificity of context processing deficits to schizotypal personality disorder (SPD), a prototype of schizophrenia, has not been studied. The authors administered 3 versions of the modified AX Continuous Performance Test and an N-back working memory test to 63 individuals with SPD and 25 with other personality disorders, as well as 42 healthy controls. For the AX Continuous Performance Test standard and degraded versions, there was a significant Trial Type × Delay × Group interaction, as SPDs made significantly more errors reflecting poor maintenance of context and fewer errors reflecting good maintenance of context. SPDs also demonstrated poor performance on the N-back, especially at the 2-back condition. Context processing errors and N-back accuracy scores were related to disorganization symptoms. These findings, which are quite similar to those previously reported in patients with schizophrenia, suggest that context processing deficits are specific to the schizophrenia spectrum and are not a reflection of overall psychopathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological trauma and schizotypal personality disorder.

Two studies examined the relation between psychological trauma and schizotypal symptoms. In Study 1, in which 1,510 adults completed telephone interviews, both childhood maltreatment and the experience of an injury or life-threatening event were significantly associated with schizotypal symptoms. In Study 2, in which 303 adults (oversampled for having elevated levels of schizotypal symptoms) completed extensive in-person assessments, both childhood maltreatment and meeting posttraumatic stress disorder (PTSD) Criterion A were significantly associated with schizotypal symptoms. The links between schizotypal symptoms and at least some forms of psychological trauma could not be fully accounted for by shared variance with antisocial and borderline personality disorders, absorption/dissociation, PTSD symptom severity, family history of psychotic disorder, or signs of neurodevelopmental disturbance (as indexed by minor physical anomalies and inconsistent hand use). Schizotypal symptoms were more strongly associated with childhood maltreatment among men than among women, whereas schizotypal symptoms were more strongly associated with PTSD Criterion A among women than among men. Finally, among men, the association between childhood maltreatment and schizotypal symptoms was moderated by signs of neurodevelopmental disturbance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dual-task information processing in schizotypal personality disorder: Evidence of impaired processing capacity.

Working memory theories heavily rely on the concept of processing resources and the their efficient deployment. Some recent work with schizophrenia-spectrum patients has suggested that many associated cognitive impairments may be reduced to deficits in working memory, possibly related to reductions in information-processing capacity resources. In this study, 38 patients with schizotypal personality disorder (SPD), 22 patients with other personality disorders, and 14 healthy comparison participants performed a dual-task processing assessment that was designed specifically for use in this type of study. Participants recalled lists of digits at their predetermined maximum digit span and performed box-checking tests, first alone and then in a dual-task format. Instructions included equal prioritization of both tasks. SPD patients had significantly shorter digit spans, and they also showed more deterioration on both tasks. Performance operating characteristics curves indicated that SPD patients' reduced performance was not due to abnormal resource allocation strategies leading to strategic failures. The authors discuss the implications of these processing capacity limitations for understanding both the signature of cognitive impairment within the schizophrenia spectrum and general abnormalities in working memory. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Transitional relatedness and borderline personality disorder.

This study examined various aspects of transitional relatedness among individuals diagnosed as borderline or antisocial personality disorder. This study was a follow-up to an earlier report (Cooper, 1983) using the Rorschach Transitional Object Scale, which found only marginal support for Modell's clinical hypothesis that the borderline personality disorder involves a developmental arrest at the stage of the transitional object. The authors approached the concept of transitional relatedness as a series of external and internalized modes of relating including the perceptual capacity to distinguish between object and symbol on the Rorschach as well as self-reported current and past reliance on transitional objects and self-soothing activities. The study failed to provide evidence to suggest that reliance on a past or present transitional object per se is a unique or diagnostic feature of the borderline personality disorder. Particular aspects of current transitional relatedness, however, were strongly associated with borderline psychopathology. The clinical and research implications of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correction to Kornblum et al. (1999).

Reports an error in The effects of irrelevant stimuli: 1. The time course of stimulus–stimulus and stimulus–response consistency effects with Stroop-like stimuli, Simon-like tasks, and their factorial combinations by Sylvan Kornblum, Gregory T. Stevens, Anthony Whipple and Jean Requin (Journal of Experimental Psychology: Human Perception and Performance, 1999[Jun], Vol 25[3], 688-714). A key reference for coauthor Gregory T. Stevens’s PhD dissertation was omitted and appears in the correction. (The following abstract of the original article appeared in record 1999-13929-008.) The effects of Simon- and Stroop-like stimuli are examined in isolation and in factorial combinations with different delays between the presentation of the irrelevant and the relevant stimuli. The effects of irrelevant stimuli have different time courses depending on whether they overlap with the relevant stimulus (stimulus-stimulus overlap, Dimensional Overlap [DO] Type 4) or with the response (stimulus-response overlap, DO Type 3). A new, computational, parallel distributed processing (PDP)-type model, DO'97, is presented that is based on the original DO model (S. Kornblum, 1994; S. Kornblum, T. Hasbroucq, & A. Osman, 1990), and it postulates a nonmonotone irrelevant stimulus activation function in addition to 2 temporally ordered, serial, nonindependent stages: a stimulus processing stage and a response production stage. DO'97 is able to simulate the temporal dynamic characteristics of the processes, with good fits to the empirical data of this study and other published studies, at the level of means, variances, and distributional plots. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Comprehensive Object Relations Profile: A preliminary report.

This article reports a study of a newly created instrument designed specifically for the measurement of object relations concepts. The Comprehensive Object Relations Profile (CORP) is a semistructured projective test that asks the subject to respond to specific questions regarding interpersonal vignettes. Each question is designed to tap a particular dimension of object relationships. Three dimensions are measured: object constancy, object integration, and empathy. Validity was assessed by a comparison of three diagnostic groups: schizophrenics, borderlines, and neurotics. Reliability was measured by the interjudge method. The results indicated that the CORP significantly differentiated the three diagnostic groups in the expected direction and that the CORP is a highly reliable instrument. The implications of these results were drawn for both the usefulness of the CORP and the validity of object relations concepts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ten-year stability and latent structure of the DSM–IV schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders.

Evaluation of the validity of personality disorder (PD) diagnostic constructs is important for the impending revision of the Diagnostic and Statistical Manual of Mental Disorders. Prior factor analytic studies have tested these constructs in cross-sectional studies, and models have been replicated longitudinally, but no study has tested a constrained longitudinal model. The authors examined 4 PDs in the Collaborative Longitudinal Personality Disorders study (schizotypal, borderline, avoidant, and obsessive-compulsive) over 7 time points (baseline, 6 months, 1 year, 2 years, 4 years, 6 years, and 10 years). Data for 2-, 4-, 6- and 10-year assessments were obtained in semistructured interviews by raters blind to prior PD diagnoses at each assessment. The latent structure of the 4 constructs was differentiated during the initial time points but became less differentiated over time as the mean levels of the constructs dropped and stability increased. Obsessive-compulsive PD became more correlated with schizotypal and borderline PD than with avoidant PD. The higher correlation among the constructs in later years may reflect greater shared base of pathology for chronic personality disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Associations in the Course of Personality Disorders and Axis I Disorders Over Time.

In this study, the authors examined time-varying associations between schizotypal (STPD), borderline (BPD), avoidant (AVPD), or obsessive-compulsive (OCPD) personality disorders and co-occurring Axis I disorders in 544 adult participants from the Collaborative Longitudinal Personality Disorders Study. The authors tested predictions of specific longitudinal associations derived from a model of crosscutting psychobiological dimensions (L. J. Siever & K. L. Davis, 1991) with participants with the relevant Axis I disorders. The authors assessed participants at baseline and at 6-, 12-, and 24-month follow-up evaluations. BPD showed significant longitudinal associations with major depressive disorder and posttraumatic stress disorder. AVPD was significantly associated with anxiety disorders (specifically social phobia and obsessive-compulsive disorder). Two of the four personality disorders under examination (STPD and OCPD) showed little or no association with Axis I disorders. (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)     

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)     

A controlled trial of psychodynamic psychotherapy for co-occurring borderline personality disorder and alcohol use disorder.

A randomized controlled trial was conducted to determine whether a manual-based psychodynamic treatment, labeled dynamic deconstructive psychotherapy (DDP), would be feasible and effective for individuals with co-occurring borderline personality disorder (BPD) and alcohol use disorder. Thirty participants were assessed every 3 months during a year of treatment with either DDP or treatment as usual (TAU) in the community. DDP participants showed statistically significant improvement in parasuicide behavior, alcohol misuse, institutional care, depression, dissociation, and core symptoms of BPD, and treatment retention was 67% to 73%. Although TAU participants received higher average treatment intensity, they showed only limited change during the same period. The results support the feasibility, tolerability, and efficacy of DDP for the co-occurring subgroup and highlight the need for further research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Taxometric Study of Borderline Personality Disorder.

Taxometric methodology was used to determine whether borderline personality disorder (BPD) represents a taxon that is categorically distinct from normal personality or whether it falls on a dimensional continuum with normality. Two taxometric procedures were used with a sample of 1,389 outpatients assessed for BPD symptoms by semistructured interview. The procedures indicated that BPD does not represent a latent category. Implications are drawn for the conceptualization and etiology of BPD, and for the categorical versus dimensional status of personality disorders in general. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A dimensional model of personality disorder: Incorporating DSM Cluster A characteristics.

The authors articulate an expanded dimensional model of personality pathology to better account for symptoms of DSM-defined Cluster A personality disorders. Two hundred forty participants (98 firstdegree relatives of probands with schizophrenia or schizoaffective disorder, 92 community control participants, and 50 first-degree relatives of probands with bipolar disorder) completed a dimensional personality pathology questionnaire, a measure of schizotypal characteristics, and Chapman measures of psychosis proneness. Scales from all questionnaires were subjected to an exploratory factor analysis with varimax rotation. A 5-factor structure of personality pathology emerged from the analyses, with Peculiarity forming an additional factor to the common 4-factor structure of personality pathology (consisting of Introversion, Emotional Dysregulation, Antagonism, and Compulsivity). These results support a 5-factor dimensional model of personality pathology that better accounts for phenomena encompassed by the Cluster A personality disorders in DSM-IV-TR (4th ed., text revised; American Psychiatric Association, 2000). This study has implications for the consideration of a dimensional model of personality disorder in DSM-V by offering a more comprehensive structural model that builds on previous work in this area. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correction to Schut et al. (2005).

Reports an error in "Therapist Interpretation, Patient-Therapist Interpersonal Process, and Outcome in Psychodynamic Psychotherapy for Avoidant Personality Disorder" by Alexander J. Schut, Louis G. Castonguay, Kelly M. Flanagan, Alissa S. Yamasaki, Jacques P. Barber, Jamie D. Bedics and Tracey L. Smith (Psychotherapy: Theory, Research, Practice, Training, 2005 Win, Vol 42(4), 494-511). The correct legend for Figure 1 on page 500 should read as follows: Figure 1. The SASB circumplex model, cluster version, interpersonal surfaces. Adapted from Benjamin (1993), Interpersonal diagnosis and treatment of personality disorders. New York: Guilford Press, copyright Guilford Press, and from: Benjamin (1987), Use of the SASB dimensional model to develop treatment plans for personality disorders, I: Narcissism. Journal of Personality Disorders, 1, 43-70, copyright Guilford Press. (The following abstract of the original article appeared in record 2006-03309-008.) The authors examined the link between interpretive techniques, the therapeutic relationship, and outcome in psychodynamic psychotherapy. Two independent teams of judges each coded one early session from patients diagnosed with avoidant personality disorder. Results revealed (a) an inverse association between concentration of interpretation and favorable patient outcome; (b) that small amounts of disaffiliative patient-therapist transactions before, during, and after interpretations were reliably or meaningfully associated with negative patient change; and (c) concentration of interpretation was positively associated with disaffiliative therapy process before and during interpretation and negatively associated with affiliative patient responses to interpretation. The results suggest that therapists who persisted with interpretations had more hostile interactions with patients and had patients who reacted with less warmth than therapists who used interpretations more judiciously. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Context-Processing Deficits in Schizotypal Personality Disorder.

Research suggests that schizotypal personality disorder (SPD) is a part of the spectrum of schizophrenia-related illnesses. This article hypothesizes that a deficit in the representation and maintenance of context is a core cognitive disturbance in schizophrenia and that SPD individuals should demonstrate context-processing deficits. To test this hypothesis, the authors administered 3 versions of their AX-CPT task, designed to assess context processing, to 35 healthy controls and 26 individuals with DSM-IV SPD. They also administered working memory and selective attention tasks. SPD individuals displayed context representation deficits similar to those found in schizophrenia but did not show the same additional deficits in context maintenance. Context processing was strongly associated with working memory and selective attention performance in the SPD individuals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)