The application of an etiological model of personality disorders to problem gambling

Problem gambling is a significant mental health problem that creates a multitude of intrapersonal, interpersonal, and social difficulties. Recent empirical evidence suggests that personality disorders, and in particular borderline personality disorder (BPD), are commonly co-morbid with problem gambling. Despite this finding there has been very little research examining overlapping factors between these two disorders. The aim of this review is to summarise the literature exploring the relationship between problem gambling and personality disorders. The co-morbidity of personality disorders, particularly BPD, is reviewed and the characteristics of problem gamblers with co-morbid personality disordersare explored. An etiological model from the more advanced BPD literature—the biosocial developmental model of BPD—is used to review the similarities between problem gambling and BPD across four domains: early parent–child interactions, emotion regulation, co-morbid psychopathology and negative outcomes. It was concluded that personality disorders, in particular BPD are commonly co-morbid among problem gamblers and the presence of a personality disorder complicates the clinical picture. Furthermore BPD and problem gambling share similarities across the biosocial developmental model of BPD.Therefore clinicians working with problem gamblers should incorporate routine screening for personality disorders and pay careful attention to the therapeutic alliance, client motivations and therapeutic boundaries. Furthermore adjustments to therapy structure, goals and outcomes may be required. Directions for future research include further research into the applicability of the biosocial developmental model of BPD to problemgambling.

Vulnerable dark triad personality facets are associated with religious fundamentalist tendencies

BACKGROUND: This study explores the possibility that religious fundamentalism (RF) may be linked to deficits in personality structure, which is in contrast to the general assumption that religiosity and spirituality are positively related to mature personality development. SAMPLING AND METHODS: To test this hypothesis, 327 (232 female) college students completed the Multidimensional Inventory for Religious/Spiritual Well-Being together with the Innsbrucker Religious Fundamentalism Scale. In addition, the 'vulnerable dark triad' of personality ('vulnerable narcissism', subscale of the Pathological Narcissism Inventory; 'secondary psychopathy', subscale of Levenson's Self-Report Psychopathy Scale; 'borderline personality', of the Borderline Personality Inventory) was assessed. RESULTS: In general, the relation between spirituality and healthy personality functioning was confirmed. In addition to greatly overlapping with 'general religiosity' (p < 0.001), RF was also relevantly predicted by narcissistic ('hiding the self') and borderline ('primitive defenses') personality facets (p < 0.05 for both). CONCLUSIONS: Based on these preliminary data, we conclude that specific structural deficits in personality might lead to more rigorous variants of religious/spiritual beliefs such as RF. Further research in clinical surroundings as well as in religious extremist groups is recommended.

Subjective well-being maintenance

This thesis research examined the relationship between SWB and depression in the context of homeostasis theory. Results provide support for homeostasis as the SWB maintenance mechanism and strong support for conceptualising depression as a loss of SWB. Remarkable, results also indicate that some SWB measures outperform depression inventories in detecting depression. The portfolio uses attachment theory as a conceptual framework for understanding the contribution of attachment relationships to the development of borderline and antisocial personality pathology in children and adolescents. Four case studies are presented in illustration.

Non-retinal light stimulation and the human biological clock

Since 1998, debate has occurred over whether light synchronises the human biological clock through the visual system only, or if the light penetrating our skin is also influential. This thesis provides definitive, debate ending, evidence that skin exposure to even intensely bright light has no impact on circadian timing. The portfolio presents a review of the literature regarding the efficacy of dialectical behavior therapy as a treatment for borderline personality disorder, a summary of the proposed mechanisms of action on the various treatment components, and a description of the clinical application of the four 'skills training modules' via the use of four case study examples.

Dialectical behavior therapy in community mental health settings : an evaluation

Borderline personality disorder causes extreme and enduring suffering. Dialectical Behavior Therapy is a psychological intervention that has been developed to treat the disorder. Two studies were conducted to test the effectiveness of the treatment. Results showed that borderline personality disorder can be treated effectively in the public mental health system. The portfolio presents four case studies to examine the notion that Cognitive Behavior Therapy (CBT) is efficacious in the treatment of anxiety as a comorbid condition.

A proof of concept for using brief Dialectical Behavior Therapy as a treatment for problem gambling

Fourteen ‘treatment resistant’ problem gamblers received 9 weeks of Dialectical Behavior Therapy (DBT) at specialist problem gambling services delivered in Melbourne, Australia. This study is the first to investigate the effectiveness of a brief DBT treatment for problem gambling, with a focus on measuring change in the four DBT process skills (mindfulness, distress tolerance, emotion dysregulation, and negative relationships). Although there were no statistically significant improvements in measures of gambling behaviour, 83% of participants were abstinent or reduced their gambling expenditure pre- to post-treatment. Participants also reported statistically and clinically significant improvements in psychological distress,  mindfulness, and distress tolerance. Moreover, there were no increases in alcohol or substance use. These results are discussed in the context of focusing on a single DBT process skill, and the benefits of using group-based approaches.

Bipolar disorder: a troubled diagnosis

Bipolar disorder is indeed a troubled diagnosis. Conceived from manic-depressive illness, bipolar disorder is a much narrower concept by virtue of the emphasis placed in modern psychiatric taxonomy on polarity rather than recurrence of mood episodes. At first, this "new diagnosis" floundered and received little attention, but once it established itself, it steadily gained interest throughout the "decade of the brain." By the beginning of the new millennium bipolar disorder was perfectly poised for a phenomenal expansion. Its rapid growth led to a proliferation of bipolar subtypes, each of which quickly gained disorder status, wrongly insinuating a disease entity. Prompted by the recent launch of DSM-5 and the imminent arrival of ICD-11, questions are being asked about this complex diagnosis, which has been so problematic, especially in children. This chapter discusses the evolution of bipolar disorder, in the hope that an understanding of its origins will shed light on why it remains such a troublesome diagnosis.

Subtypes of psychopathy : proposed differences between narcissistic, borderline, sadistic and antisocial psychopaths

Atascadero State Hospital (ASH) is a maximum-security forensic hospital that houses male patients with a wide range of psychiatric diagnoses. Psychopaths at this institution appear to be a heterogeneous group of individuals who, while sharing core personality characteristics, manifest substantial variability in their behavior. Identifying subtypes within this clinical classification can have implications for patient treatment and management, as well as for the safety of the staff who work with them and for the communities to which they will eventually return. Several means of identifying subtypes have been proposed in the literature, and potential subgroups have been identified. Clinical observations at ASH have suggested 4 possible subtypes of psychopathy: narcissistic, borderline, sadistic, and antisocial. Issues related to the conceptualization of psychopathy are addressed, recognizing that additional data are needed to understand the observed variations in cases of psychopathy.

The association between parental personality patterns and internalising and externalising behaviour problems in children and adolescents

Background:  This study investigated the relationship between parental personality patterns and internalising and externalising behaviour problems in a clinically referred sample of children (aged 4–8) and adolescents (aged 12–18).

Methods:  Data from families involved in two clinical trials in Victoria, Australia were analysed (n = 59). Families were administered the Millons Clinical Multiaxial Inventory—III (MCMI-III) which reports personality patterns consistent with Axis II disorder and an Achenbach measure of mental health as appropriate to child's age (Child Behavior Checklist (CBCL), Youth Self-Report (YSR), or Adult Self-Report (ASR)). Relationships between internalising and externalising behaviour problems, and parental personality patterns were examined via correlation and regression analyses.

Results:  The study found a positive correlation between parental borderline, paranoid, and avoidant personality patterns, and child and adolescent externalising behaviour problems. The relationships were generally stronger for adolescents than for children. However, no relationship was observed between parental personality patterns and internalising behaviour problems.

Conclusions:  These findings underline the importance of clinical assessment of the family ecology as a whole—including the interaction between parental personality patterns and child and adolescent behaviour and emotional problems. These findings contribute to the understanding of developmental risk factors for child and adolescent mental health and the transmission of psychopathology across generations.

The prevalence of comorbid personality disorders in treatment-seeking problem gamblers: a systematic review and meta-analysis

The aim of this study was to systematically review and meta-analyze the prevalence of comorbid personality disorders among treatment-seeking problem gamblers. Almost one half (47.9%) of problem gamblers displayed comorbid personality disorders. They were most likely to display Cluster B disorders (17.6%), with smaller proportions reporting Cluster C disorders (12.6%) and Cluster A disorders (6.1%). The most prevalent personality disorders were narcissistic (16.6%), antisocial (14.0%), avoidant (13.4%), obsessive-compulsive (13.4%), and borderline (13.1%) personality disorders. Sensitivity analyses suggested that these prevalence estimates were robust to the inclusion of clinical trials and self-selected samples. Although there was significant variability in reported rates, subgroup analyses revealed no significant differences in estimates of antisocial personality disorder according to problem gambling severity, measure of comorbidity employed, and study jurisdiction. The findings highlight the need for gambling treatment services to conduct routine screening and assessment of co-occurring personality disorders and to provide treatment approaches that adequately address these comorbid conditions.

The prevalence, age distribution and comorbidity of personality disorders in Australian women

OBJECTIVE: We aimed to describe the prevalence and age distribution of personality disorders and their comorbidity with other psychiatric disorders in an age-stratified sample of Australian women aged ⩾25 years. METHODS: Individual personality disorders (paranoid, schizoid, schizotypal, histrionic, narcissistic, borderline, antisocial, avoidant, dependent, obsessive-compulsive), lifetime mood, anxiety, eating and substance misuse disorders were diagnosed utilising validated semi-structured clinical interviews (Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Non-patient Edition and Structured Clinical Interview for DSM-IV Axis II Personality Disorders). The prevalence of personality disorders and Clusters were determined from the study population (n = 768), and standardised to the Australian population using the 2011 Australian Bureau of Statistics census data. Prevalence by age and the association with mood, anxiety, eating and substance misuse disorders was also examined. RESULTS: The overall prevalence of personality disorders in women was 21.8% (95% confidence interval [CI]: 18.7, 24.9). Cluster C personality disorders (17.5%, 95% CI: 16.0, 18.9) were more common than Cluster A (5.3%, 95% CI: 3.5, 7.0) and Cluster B personality disorders (3.2%, 95% CI: 1.8, 4.6). Of the individual personality disorders, obsessive-compulsive (10.3%, 95% CI: 8.0, 12.6), avoidant (9.3%, 95% CI: 7.1, 11.5), paranoid (3.9%, 95% CI: 3.1, 4.7) and borderline (2.7%, 95% CI: 1.4, 4.0) were among the most prevalent. The prevalence of other personality disorders was low (⩽1.7%). Being younger (25-34 years) was predictive of having any personality disorder (odds ratio: 2.36, 95% CI: 1.18, 4.74), as was being middle-aged (odds ratio: 2.41, 95% CI: 1.23, 4.72). Among the strongest predictors of having any personality disorder was having a lifetime history of psychiatric disorders (odds ratio: 4.29, 95% CI: 2.90, 6.33). Mood and anxiety disorders were the most common comorbid lifetime psychiatric disorders. CONCLUSIONS: Approximately one in five women was identified with a personality disorder, emphasising that personality disorders are relatively common in the population. A more thorough understanding of the distribution of personality disorders and psychiatric comorbidity in the general population is crucial to assist allocation of health care resources to individuals living with these disorders.

The role of personality in leadership: an application of the five-factor model in the Australian military

This study investigated the relation between the five-factor model (FFM) of personality trait domains and leadership effectiveness. Ninety-nine Australian Army commissioned officers completed the NEO Personality Inventory-Revised (NEO-PI-R; Costa & McCrae, 1992) and were rated by their superior officer on the Australian Army annual leadership effectiveness evaluation schedule. Participants indicated whether they had been selected to attend a leadership promotion course at the Army Command and Staff College, widely regarded within the Army as indicative of an officer's effectiveness. It was hypothesized that leadership effectiveness would be predicted by the personality trait domains of high Conscientiousness, Openness, Agreeableness, and Extraversion and by low Neuroticism. High Conscientiousness and low Extraversion scores predicted high leadership effectiveness and the likelihood of attending the leadership promotion course. High Openness scores also predicted the likelihood of attending the promotion course. The results support the utility of the FFM in exploring the role of personality in leadership effectiveness among military leaders.

Personality and responses to appetitive and aversive stimuli: the joint influence of behavioural approach and behavioural inhibition systems

Gray’s reinforcement sensitivity theory (RST) posits two separable neurological systems involved in the regulation of personality and behaviour. The behavioural approach and inhibition systems facilitate the expression of appetitive (impulsive-sensation seeking traits) and aversive motivation (anxiety traits), respectively. Inconsistent findings regarding associations between measures of personality and behavioural responses to appetitive and aversive stimuli has led to a modification of RST including the notion that, rather than separable as first hypothesised, the two systems jointly influence behaviour. The current study was designed to investigate this proposal with an additional focus on the role of reinforcement expectancies. Seventy-eight participants completed two questionnaire measures of BIS/BAS activity (EPQ-R, SPSRQ) and two behavioural measures (Q-TASK, Card Arranging Reward Responsivity Objective Task). Findings were in general consistent with the original separable systems approach, however they also showed that aversive responses were highest in high BAS/high BIS individuals, thus suggesting an interactive account of BIS/BAS processes. Further, stronger positive correlations between self-report BAS traits and behavioural reward responsiveness were found for participants who perceived the task as more rewarding than initially expected. Discussion focuses on the role of reward expectancies and on the issue regarding separable vs. joint BIS/BAS systems.