Are Premorbid Abnormal Personality Traits Associated with Behavioural and Psychological Symptoms in Dementia?

Objective: The study aims to investigate associations between behavioural and psychological symptoms of dementia (BPSD) and abnormal premorbid personality traits. Methods: Data were obtained from 217 patients with a diagnosis of probable Alzheimer’s disease. Behavioural and psychological symptoms of late-onset dementia were assessed with the Neuropsychiatric Inventory. Premorbid personality traits were assessed using the Standardised Assessment of Personality. Abnormal premorbid personality traits were categorised with Diagnostic and Statistical Manual of Mental Disorders fourth edition and International Statistical Classification of Diseases and Related Health Problems—10 diagnostic criteria for personality disorders. Results: Abnormal premorbid personality traits were associated with increased behavioural and psychological symptoms in dementia. Cluster A (solitary/paranoid) premorbid personality traits were associated with anxiety, depression and hallucinations. Cluster C (anxious/dependent) traits were associated with a syndrome of depression. Conclusions: The presence of Clusters A (solitary/paranoid) and C (anxious/dependent) abnormal premorbid personality traits seems to affect the expression of certain behavioural and psychological symptoms in dementia, depression in particular. Copyright # 2016 John Wiley & Sons, Ltd

Associations between Belief in Conspiracy Theories and the Maladaptive Personality Traits of the Personality Inventory for DSM-5

Conspiracy theories can be treated as both rational narratives of the world as well as outcomes of underlying maladaptive traits. Here, we examined associations between belief in conspiracy theories and individual differences in personality disorders. An Internet-based sample (N=259) completed measures of belief in conspiracy theories and the 25 facets of the Personality Inventory for DSM-5 (PID-5). Preliminary analyses showed no significant differences in belief in conspiracy theories across participant sex, ethnicity, and education. Regression analyses showed that the PID-5 facets of Unusual Beliefs and Experiences and, to a lesser extent, Suspiciousness, significantly predicted belief in conspiracy theories. These findings highlight a role for maladaptive personality traits in understanding belief in conspiracy theories, but require further investigation.

Effects of motive-oriented therapeutic relationship in a ten-session general psychiatric treatment of borderline personality disorder: a randomized controlled trial.

Background: Motive-oriented therapeutic relationship (MOTR) was postulated to be a particularly helpful therapeutic ingredient in the early treatment phase of patients with personality disorders, in particular with borderline personality disorder (BPD). The present randomized controlled study using an add-on design is the first study to test this assumption in a 10-session general psychiatric treatment with patients presenting with BPD on symptom reduction and therapeutic alliance. Methods: A total of 85 patients were randomized. They were either allocated to a manual-based short variant of the general psychiatric management (GPM) treatment (in 10 sessions) or to the same treatment where MOTR was deliberately added to the treatment. Treatment attrition and integrity analyses yielded satisfactory results. Results: The results of the intent-to-treat analyses suggested a global efficacy of MOTR, in the sense of an additional reduction of general problems, i.e. symptoms, interpersonal and social problems (F1, 73 = 7.25, p < 0.05). However, they also showed that MOTR did not yield an additional reduction of specific borderline symptoms. It was also shown that a stronger therapeutic alliance, as assessed by the therapist, developed in MOTR treatments compared to GPM (Z55 = 0.99, p < 0.04). Conclusions: These results suggest that adding MOTR to psychiatric and psychotherapeutic treatments of BPD is promising. Moreover, the findings shed additional light on the perspective of shortening treatments for patients presenting with BPD. © 2014 S. Karger AG, Basel.

Personality and neuropsychological factors involved in females' relational aggression

The personality and neuropsychological factors associated with relational aggression were examined in a group of30 grade 6,7, and 8 girls identified through cluster analysis as being highly, yet almost exclusively, relationally aggressive and a group of 30 nonaggressive matched controls. Parents of the students in both groups completed the Coolidge Personality and Neuropsychological Inventory (1998), a 200- item DSM-IV -TR aligned, parent-as-respondent, standardized measure of c.hildren' s psychological functioning. It was found that high levels of relational aggression, in the absence of physical and verbal aggression, were associated with symptoms of DSM-IV - TR Axis I oppositional defiant disorder and conduct disorder and a wide variety of personality traits associated with DSM-IV -TR Axis II paranoid, borderline, narcissistic, histrionic, schizotypal, and passive aggressive personality disorders. Implications of these findings for theory, practice, and further research are discussed.

Behavioural and neural correlates of emotion recognition as a function of psychopathic personality traits

Psychopathy is associated with well-known characteristics such as a lack of empathy and impulsive behaviour, but it has also been associated with impaired recognition of emotional facial expressions. The use of event-related potentials (ERPs) to examine this phenomenon could shed light on the specific time course and neural activation associated with emotion recognition processes as they relate to psychopathic traits. In the current study we examined the PI , N170, and vertex positive potential (VPP) ERP components and behavioural performance with respect to scores on the Self-Report Psychopathy (SRP-III) questionnaire. Thirty undergraduates completed two tasks, the first of which required the recognition and categorization of affective face stimuli under varying presentation conditions. Happy, angry or fearful faces were presented under with attention directed to the mouth, nose or eye region and varied stimulus exposure duration (30, 75, or 150 ms). We found that behavioural performance to be unrelated to psychopathic personality traits in all conditions, but there was a trend for the Nl70 to peak later in response to fearful and happy facial expressions for individuals high in psychopathic traits. However, the amplitude of the VPP was significantly negatively associated with psychopathic traits, but only in response to stimuli presented under a nose-level fixation. Finally, psychopathic traits were found to be associated with longer N170 latencies in response to stimuli presented under the 30 ms exposure duration. In the second task, participants were required to inhibit processing of irrelevant affective and scrambled face distractors while categorizing unrelated word stimuli as living or nonliving. Psychopathic traits were hypothesized to be positively associated with behavioural performance, as it was proposed that individuals high in psychopathic traits would be less likely to automatically attend to task-irrelevant affective distractors, facilitating word categorization. Thus, decreased interference would be reflected in smaller N170 components, indicating less neural activity associated with processing of distractor faces. We found that overall performance decreased in the presence of angry and fearful distractor faces as psychopathic traits increased. In addition, the amplitude of the N170 decreased and the latency increased in response to affective distractor faces for individuals with higher levels of psychopathic traits. Although we failed to find the predicted behavioural deficit in emotion recognition in Task 1 and facilitation effect in Task 2, the findings of increased N170 and VPP latencies in response to emotional faces are consistent wi th the proposition that abnormal emotion recognition processes may in fact be inherent to psychopathy as a continuous personality trait.

Attachment, borderline personality, and romantic relationship dysfunction

Previous studies have implicated attachment and disturbances in romantic relationships as important indicators for Borderline Personality Disorder (BPD). The current research extends our current knowledge by examining the specific associations among attachment, romantic relationship dysfunction, and BPD, above and beyond the contribution of emotional distress and nonromantic interpersonal functioning in two distinct samples. Study 1 comprised a community sample of women (N = 58) aged 25–36. Study 2 consisted of a psychiatric sample (N = 138) aged 21–60. Results from both Study 1 and Study 2 demonstrated that (1) attachment was specifically related to BPD symptoms and romantic dysfunction, (2) BPD symptoms were specifically associated with romantic dysfunction, and (3) the association between attachment and romantic dysfunction was statistically mediated by BPD symptoms. The findings support specific associations among attachment, BPD symptoms, and romantic dysfunction.

Anger, preoccupied attachment and domain disorganisation in borderline personality disorder

Emotional dysregulation and attachment insecurity have been reported in borderline personality disorder (BPD). Domain disorganization, evidenced in poor regulation of emotions and behaviors in relation to the demands of different social domains, may be a distinguishing feature of BPD. Understanding the interplay between these factors may be critical for identifying interacting processes in BPD and potential subtypes of BPD. Therefore, we examined the joint and interactive effects of anger, preoccupied attachment, and domain disorganization on BPD traits in a clinical sample of 128 psychiatric patients. The results suggest that these factors contribute to BPD both independently and in interaction, even when controlling for other personality disorder traits and Axis I symptoms. In regression analyses, the interaction between anger and domain disorganization predicted BPD traits. In recursive partitioning analyses, two possible paths to BPD were identified: high anger combined with high domain disorganization and low anger combined with preoccupied attachment. These results may suggest possible subtypes of BPD or possible mechanisms by which BPD traits are established and maintained.

Obsessive-compulsive disorder and personality disorder - Evidence from the British National Survey of Psychiatric Morbidity 2000

Background Previous studies indicate that most individuals with obsessive-compulsive disorder (OCD) have comorbid personality disorders (PDs), particularly from the anxious cluster. However, the nature and strength of this association remains unclear, as the majority of previous studies have relied heavily on clinical populations. We analysed the prevalence of screen positive personality disorder in a representative sample of adults with OCD living in private households in the UK. Methods A secondary analysis of data from the 2000 British National Survey of Psychiatric Morbidity. The prevalence of PD, as determined by the SCID-II questionnaire, was compared in participants with OCD, with other neuroses and non-neurotic controls. Within the OCD group we also analysed possible differences relating to sex and subtypes of the disorder. Results the prevalence of any screen positive PD in the OCD group (N = 108) was 74%, significantly greater than in both control groups. The most common screen positive categories were paranoid, obsessive-compulsive, avoidant, schizoid and schizotypal. Compared to participants with other neuroses, OCD cases were more likely to screen positively for paranoid, avoidant, schizotypal, dependent and narcissistic PDs. Men with OCD were more likely to screen positively for PDs in general, cluster A PDs, antisocial, obsessive-compulsive and narcissistic categories. The presence of comorbid neuroses in people with OCD had no significant effect on the prevalence of PD. Conclusions Personality pathology is highly prevalent among people with OCD who are living in the community and should be routinely assessed, as it may affect help-seeking behaviour and response to treatment.

Change mechanisms of schema-centered group psychotherapy with personality disorder patients

Background This study addressed the temporal properties of personality disorders and their treatment by schema-centered group psychotherapy. It investigated the change mechanisms of psychotherapy using a novel method by which psychotherapy can be modeled explicitly in the temporal domain. Methodology and Findings 69 patients were assigned to a specific schema-centered behavioral group psychotherapy, 26 to social skills training as a control condition. The largest diagnostic subgroups were narcissistic and borderline personality disorder. Both treatments offered 30 group sessions of 100 min duration each, at a frequency of two sessions per week. Therapy process was described by components resulting from principal component analysis of patients' session-reports that were obtained after each session. These patient-assessed components were Clarification, Bond, Rejection, and Emotional Activation. The statistical approach focused on time-lagged associations of components using time-series panel analysis. This method provided a detailed quantitative representation of therapy process. It was found that Clarification played a core role in schema-centered psychotherapy, reducing rejection and regulating the emotion of patients. This was also a change mechanism linked to therapy outcome. Conclusions/Significance The introduced process-oriented methodology allowed to highlight the mechanisms by which psychotherapeutic treatment became effective. Additionally, process models depicted the actual patterns that differentiated specific diagnostic subgroups. Time-series analysis explores Granger causality, a non-experimental approximation of causality based on temporal sequences. This methodology, resting upon naturalistic data, can explicate mechanisms of action in psychotherapy research and illustrate the temporal patterns underlying personality disorders.

Endoscopy for repeatedly ingested sharp foreign bodies in patients with borderline personality disorder: an international survey

The general guidelines on the management of ingested foreign bodies (FBs) do not address specific aspects raised by psychiatric patients, particularly in patients with borderline personality disorders (BPD) who repeatedly ingest FBs. The aim of this survey was to collect data on experience and opinions on the management of FBs in psychiatric patients with BPD and to review the relevant literature.

Effects of Motive-Oriented Therapeutic Relationship in a Ten-Session General Psychiatric Treatment of Borderline Personality Disorder: A Randomized Controlled Trial

Background: Motive-oriented therapeutic relationship (MOTR) was postulated to be a particularly helpful therapeutic ingredient in the early treatment phase of patients with personality disorders, in particular with borderline personality disorder (BPD). The present randomized controlled study using an add-on design is the first study to test this assumption in a 10-session general psychiatric treatment with patients presenting with BPD on symptom reduction and therapeutic alliance. Methods: A total of 85 patients were randomized. They were either allocated to a manual-based short variant of the general psychiatric management (GPM) treatment (in 10 sessions) or to the same treatment where MOTR was deliberately added to the treatment. Treatment attrition and integrity analyses yielded satisfactory results. Results: The results of the intent-to-treat analyses suggested a global efficacy of MOTR, in the sense of an additional reduction of general problems, i.e. symptoms, interpersonal and social problems (F 1, 73 = 7.25, p < 0.05). However, they also showed that MOTR did not yield an additional reduction of specific borderline symptoms. It was also shown that a stronger therapeutic alliance, as assessed by the therapist, developed in MOTR treatments compared to GPM (Z 55 = 0.99, p < 0.04). Conclusions: These results suggest that adding MOTR to psychiatric and psychotherapeutic treatments of BPD is promising. Moreover, the findings shed additional light on the perspective of shortening treatments for patients presenting with BPD.

Motive-Oriented Psychotherapeutic Relationship Facing a Patient Presenting with Narcissistic Personality Disorder: A Case Study

Motive-oriented therapeutic relationship (MOTHER), a prescriptive concept based on an integrative form of case formulation, the Plan Analysis (PA) method (Caspar, in: Eells (ed.), Handbook of psychotherapy case formulations, 2007), has shown to be of particular relevance for the treatment of patients presenting with personality disorders, in particular contributing to better therapeutic outcome and to a more constructive development of the therapeutic alliance over time (Kramer et al., J Nerv Ment Dis 199:244–250, 2011). Several therapy models refer to MOTHER as intervention principle with regard to borderline and Narcissistic Personality Disorder (NPD) (Sachse et al., Clarification-oriented psychotherapy of narcissistic personality disorder, 2011; Caspar and Berger, in: Dulz et al. (eds.), Handbuch der Borderline-Störungen, 2011). The present case study discusses the case of Mark, a 40-year-old patient presenting with NPD, along with anxious, depressive and anger problems. This patient underwent a seven-session long pre-therapy process, based on psychiatric and psychotherapeutic principles complemented with PA and MOTHER, in preparation for further treatment. MOTHER will be illustrated with patient–therapist verbatim from session 4 and the links between MOTHER and confrontation techniques will be discussed in the context of process-outcome hypotheses, in particular the effect of MOTHER on symptom reduction.

Exploring occasion specificity in the assessment of DSM-5 maladaptive personality traits: A latent state-trait theory analysis.

The alternative classification system for personality disorders in DSM-5 features a hierarchical model of maladaptive personality traits. This trait model comprises five broad trait domains and 25 specific trait facets that can be reliably assessed using the Personality Inventory for DSM-5 (PID-5). Although there is a steadily growing literature on the validity of the PID-5, issues of temporal stability and situational influences on test scores are currently unexplored. We addressed these issues using a sample of 611 research participants who completed the PID-5 three times, with time intervals of two months. Latent state-trait (LST) analyses for each of the 25 PID-5 trait facets showed that, on average, 79.5% of the variance was due to stable traits (i.e., consistency), and 7.7% of the variance was due to situational factors (i.e., occasion specificity). Our findings suggest that the PID-5 trait facets predominantly capture individual differences that are stable across time.

The Structure and Correlates of Self-Reported DSM-5 Maladaptive Personality Traits: Findings From Two German-Speaking Samples

The authors investigated the structure and correlates of DSM-5 maladaptive personality traits in two samples of 577 students and 212 inpatients using the German self-report form of the Personality Inventory for DSM-5. They found that (a) the factor structure of DSM-5 trait facets is largely in line with the proposed trait domains of Negative Affectivity, Detachment, Antagonism, Disinhibition, and Psychoticism; (b) all DSM-5 trait domains except Psychoticism are highly related to the respective domains of the Five-Factor Model of personality; (c) the trait facets are positively associated with a self-report measure of general personality dysfunction; and (d) the DSM-5 trait facets show differential associations with a range of self-reported DSM-IV Axis I disorders. These findings give further support to the new DSM-5 trait model and suggest that it may generalize to other languages and cul