Attachment representations in mothers, fathers, adolescents, and clinical groups: A meta-analytic search for normative data.

This meta-analysis on 33 studies, including more than 2,000 Adult Attachment Interview (AAI) classifications, presents distributions of AAI classifications in samples of nonclinical fathers and mothers, in adolescents, in samples from different cultures, and in clinical groups. Fathers, adolescents, and participants from different countries show about the same distribution of AAI classifications as nonclinical mothers do. The distribution of nonclinical mothers is as follows: 24% dismissing, 58% autonomous, and 18% preoccupied mothers. About 19% of the nonclinical mothers are unresolved with respect to loss or trauma of other kinds. Mothers from low socioeconomic status show more often dismissing attachment representations and unresolved loss or trauma. Autonomous women and autonomous men are more often married to each other than can be expected by chance, and the same goes for unresolved men and women. Clinical participants show highly deviating distributions of AAI classifications, with a strong overrepresentation of insecure attachment representations, but systematic relations between clinical diagnosis and type of insecurity are absent. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stability of attachment representations: The transition to marriage.

This study examined the stability of adult attachment representations across the transition to marriage. One hundred fifty-seven couples were assessed using the Adult Attachment Interview (AAI; C. George, N. Kaplan, & M. Main, 1985), the Current Relationship Interview (J. A. Crowell & G. Owens, 1996), and measures describing relationship functioning and life events 3 months prior to their weddings and 18 months into their marriages. The authors tested the hypotheses that attachment classifications are stable and that change is related to experiences in the relationship and/or life events; 78% of the sample received the same primary AAI classification (secure, preoccupied, and dismissing) at both times. Change was toward increased security and was associated with feelings and cognitions about the relationship. Only 46% of participants initially classified as unresolved retained the classification. Stability of the unresolved classification was associated with stressful life events and relationship aggression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Borderline personality disorder symptoms as predictors of 4-year romantic relationship dysfunction in young women: Addresing issues of specificity.

The relationships between romantic relationship dysfunction and symptoms of borderline personality disorder (BPD), other personality disorders, and depression were examined prospectively in a community sample of 142 late adolescent women. Although BPD symptoms predicted 4-year romantic dysfunction (romantic chronic stress, conflicts, partner satisfaction, abuse, and unwanted pregnancy), the associations were not unique to BPD. Instead, relationship dysfunction was better predicted by a cumulative index of non-BPD Axis II pathology. Depression did not predict outcomes uniquely when Axis II symptoms were included, except in the case of unplanned pregnancy. The results suggest that although BPD is associated with relationship dysfunction, the effect is a more general phenomenon applying rather broadly to Axis II pathology. The results also highlight the importance of subclinical psychopathology in the construction of early intimate relationships. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

DSM-III-R personality disorders in a mood and anxiety disorders clinic: prevalence, comorbidity, and clinical correlates

This study examined the prevalence, comorbidity, and clinical correlates of personality disorders in an outpatient sample (N = 352) with anxiety and depression. Subjects were diagnosed using the Structured Clinical Interview for DSM-III-R (SCID) on Axes I and II, and they also completed interview and self-report measures of symptoms. Subjects with a personality disorder were less likely to be married, more likely to be single or divorced, had lower family incomes, had more severe symptoms of both anxiety and depression, and had a greater number of lifetime Axis I diagnoses. Subjects with dysthymic and bipolar disorders were more likely, and subjects with panic disorder uncomplicated by agoraphobia were less likely to have a personality disorder compared to the rest of the sample. The most prevalent personality disorders were Avoidant, Obsessive-Compulsive, Paranoid, and Borderline. Paranoid co-occurred with Narcissistic, and Borderline co-occurred with Histrionic personality disorder significantly more often than chance and base rates would predict.     

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.     

Comorbid psychopathology in binge eating disorder: Relation to eating disorder severity at baseline and following treatment.

Individuals with binge eating disorder (BED) have high rates of comorbid psychopathology, yet little is known about the relation of comorbidity to eating disorder features or response to treatment. These issues were examined among 162 BED patients participating in a psychotherapy trial. Axis I psychopathology was not significantly related to baseline eating disorder severity, as measured by the Structured Clinical Interview for DSM-III-R (SCID-I and SCID-II) and the Eating Disorder Examination. However, presence of Axis II psychopathology was significantly related to more severe binge eating and eating disorder psychopathology at baseline. Although overall presence of Axis II psychopathology did not predict treatment outcome, presence of Cluster B personality disorders predicted significantly higher levels of binge eating at 1 year following treatment. Results suggest the need to consider Cluster B disorders when designing treatments for BED. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality disorders and features in social phobia and panic disorder.

The hypothesis that there is a specific relationship between social phobia (SP) and avoidant personality disorder (APD) was investigated. Using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) Personality Disorders, 32 patients with SP and 85 patients with panic disorder (PD) for the presence of personality disorders were screened. Avoidant features were found significantly more often in SP than in PD, although the diagnosis of APD could not be established significantly more often. On the item level, APD Criterion 6 (fears being embarrassed) discriminated the strongest. Social phobics appeared to be more disturbed on Axis II than PD patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The joint structure of DSM-IV Axis I and Axis II disorders.

The Diagnostic and Statistical Manual (4th ed. [DSM–IV]; American Psychiatric Association, 1994) distinction between clinical disorders on Axis I and personality disorders on Axis II has become increasingly controversial. Although substantial comorbidity between axes has been demonstrated, the structure of the liability factors underlying these two groups of disorders is poorly understood. The aim of this study was to determine the latent factor structure of a broad set of common Axis I disorders and all Axis II personality disorders and thereby to identify clusters of disorders and account for comorbidity within and between axes. Data were collected in Norway, through a population-based interview study (N = 2,794 young adult twins). Axis I and Axis II disorders were assessed with the Composite International Diagnostic Interview (CIDI) and the Structured Interview for DSM–IV Personality (SIDP–IV), respectively. Exploratory and confirmatory factor analyses were used to investigate the underlying structure of 25 disorders. A four-factor model fit the data well, suggesting a distinction between clinical and personality disorders as well as a distinction between broad groups of internalizing and externalizing disorders. The location of some disorders was not consistent with the DSM–IV classification; antisocial personality disorder belonged primarily to the Axis I externalizing spectrum, dysthymia appeared as a personality disorder, and borderline personality disorder appeared in an interspectral position. The findings have implications for a meta-structure for the DSM. (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)     

Psychiatric comorbidity in women with binge eating disorder: Prevalence rates from a non-treatment-seeking sample.

This study provides estimates of comorbid psychiatric disorders in women with binge eating disorder (BED). Sixty-one BED and 60 control participants, who were recruited from the community, completed the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) Axis I and Axis II disorders and self-report measures of eating and general psychiatric symptomatology. Regarding psychiatric diagnoses, women with BED had higher lifetime prevalence rates for major depression. any Axis I disorder, and any Axis II disorder relative to controls. BED women also evidenced greater eating and psychiatric symptomatology than did controls. Results suggest that the prevalence of comorbid psychiatric disorders in BED may be lower than previously indicated by clinical studies. (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)     

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)     

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.     

Change in attachment patterns and reflective function in a randomized control trial of transference-focused psychotherapy for borderline personality disorder.

Changes in attachment organization and reflective function (RF) were assessed as putative mechanisms of change in 1 of 3 year-long psychotherapy treatments for patients with borderline personality disorder (BPD). Ninety patients reliably diagnosed with BPD were randomized to transference-focused psychotherapy (TFP), dialectical behavior therapy, or a modified psychodynamic supportive psychotherapy. Attachment organization was assessed with the Adult Attachment Interview and the RF coding scale. After 12 months of treatment, participants showed a significant increase in the number classified secure with respect to attachment state of mind for TFP but not for the other 2 treatments. Significant changes in narrative coherence and RF were found as a function of treatment, with TFP showing increases in both constructs during treatment. No changes in resolution of loss or trauma were observed across treatments. Findings suggest that 1 year of intensive TFP can increase patients' narrative coherence and RF. Future research should establish the relationship between these 2 constructs and relevant psychopathology, identify treatment components responsible for effecting these changes, and examine the long-term outcome of these changes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mothers' representations of their relationships with their toddlers: Links to adult attachment and observed mothering.

Mothers (N?=?125) and their firstborn sons were studied over an 11-month period to examine relations between mothers' representations of their relationships with their children (measured at 15 months by using the Parent Development Interview [PDI]), adult representations of attachment (measured at 12 months by using the Adult Attachment Interview [AAI]), and observed mothering (measured at 15 and 21 months). Results indicate (a) that mothers classified as autonomous on the AAI scored highest on the joy-pleasure/coherence dimension of the PDI and mothers classified as dismissing on the AAI scored highest on the anger dimension of the PDI and (b) that mothers scoring higher on the joy-pleasure/coherence dimension of the PDI engaged in less negative and more positive mothering. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social phobia: Axis I and II correlates.

The presence of Axis I and Axis II disorders in 71 social phobic patients was examined. Generalized anxiety disorder was the common secondary Axis I disorder, followed by simple phobia. Avoidant personality disorder and obsessive-compulsive personality disorder were the most common Axis II diagnoses, and 88% of the sample exhibited features of these 2 personality styles. Ss with additional Axis I diagnoses were more anxious and depressed than those with no additional Axis I disorder. Social phobics with additional Axis II disorders were more depressed but not more anxious than those with no Axis II diagnosis. Furthermore, those with an additional Axis I disorder had higher scores on measures of neuroticism, interpersonal sensitivity, and agoraphobia. The prevalence and impact of additional Axis I and II disorders on the etiology, maintenance, and treatment outcome for persons with social phobia are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevalence of personality disorders among patients with anxiety disorders

Outpatients with a principal diagnosis of an anxiety disorder (n = 347) were administered the Structured Clinical Interview for DSM-III-R/Axis II Disorders (SCID-II) during their intake evaluation. At least one personality disorder was found in 35% of these patients. Patients with social phobia (61%) and generalized anxiety disorder (49%) were most often diagnosed with a personality disorder. Patients with simple phobia were rarely diagnosed with a personality disorder (12%). The most commonly diagnosed personality disorders were from the "anxious/fearful" cluster (27% received at least one diagnosis from cluster C), most notably avoidant and obsessive-compulsive personality. Our findings suggest that personality disorders, in general, are less prevalent among anxious patients than among depressive patients.