The cross-cultural generalizability of Axis-II constructs: an evaluation of two personality disorder assessment instruments in the People's Republic of China

The relationship between depressive mood and non-suicidal self-injury among secondary vocational school students: the moderating role of borderline personality disorder tendencies

Background

Non-suicidal self-injury (NSSI) has become an important public health issue of global concern, often occurring in adolescents, and depressive mood is closely related to NSSI. In addition, NSSI is considered a symptom of borderline personality disorder. It has been found that adolescents in secondary vocational schools are more vulnerable to behavior and emotional disorders than those in general high schools. This study investigated the risk factors associated with NSSI affecting secondary vocational school students and analyzed the role of borderline personality disorder tendencies in promoting the occurrence of NSSI among students with depressive moods.

Methods

A total of 1,848 Chinese secondary vocational students completed a self-report questionnaire. The homemade NSSI behavior questionnaire, Patient Health Questionnaire-9 and Personality Diagnostic Questionnaire-4 were used in this survey. Binary logistic regression and PROCESS software analysis were used to explore the influencing factors associated with NSSI and to test for moderating effects.

Results

Female (OR = 3.412, 95% CI 2.301-5.060), drinking history (OR = 2.007, 95% CI 1.383-2.911), history of suicidal death exposure (OR = 3.161, 95% CI 1.999-4.999), depressive mood (OR = 2.436, 95% CI 1.668-3.558) and borderline personality disorder tendencies (OR = 2.558, 95% CI = 1.764-3.711) were independent risk factors for NSSI. Borderline personality disorder tendencies (B = 0.047, p = 0.000) moderated the relationship between depressive mood and NSSI. The stronger the borderline personality tendencies, the more NSSI behavior occurred when they were depressive.

Conclusions

Borderline personality disorder tendencies in secondary vocational school adolescents significantly enhance the association of depressive mood with NSSI. There is a moderating role for borderline personality disorder tendencies in depressive mood and NSSI.

Prevalence, Clinical Features, and Psychological Characteristics of Dissociative Subtype of Posttraumatic Stress Disorder in Chinese Prisoners

This study aimed to examine prevalence, clinical symptoms, and psychological characteristics of D-PTSD in a sample of Chinese prisoners with probable PTSD. A total of 1458 male prisoners were recruited from a large prison in Guangdong, China. Participants completed self-administrated questionnaires that assessed PTSD and dissociative symptoms, psychopathology, emotion regulation, emotional expressivity, social pleasure, traumatic events, and social support. According to DSM-5 criteria, participants were classified into four groups: D-PTSD, PTSD only, derealization/depersonalization (DD) only, and neither. The proportions of D-PTSD, PTSD only, DD only and neither were 2.5%, 4.7%, 2.4%, and 92.2%, respectively. PTSD symptoms and emotion regulation difficulties were distinguishing for the four groups: PTSD symptoms declined gradually in the order of D-PTSD, PTSD only, DD only, and neither, while emotion regulation difficulties declined in an order from D-PTSD, DD only, and PTSD only to neither, all ps < .001. D-PTSD and DD only had higher depressive and dissociative symptoms than PTSD only and the neither groups, all ps < .001. D-PTSD also had more borderline personality symptoms, emotion regulation difficulties, and more negative emotional expressivity than PTSD only and DD only, all ps < .05. Logistic regressions indicated that D-PTSD reported lower social support compared to PTSD only (OR = 0.95, p < .01), DD only (OR = 0.96, p < .05) and neither (OR = 0.93, p < .001). D-PTSD is common in probable PTSD in prisoners and is associated with complex clinical presentations as well as emotional processing. Social support is an important protective factor of D-PTSD.

Impaired sustained attention in groups at high risk for antisocial personality disorder: A contingent negative variation and standardized low-resolution tomographic analysis study

Objective

This study aimed to explore the characteristics of contingent negative variation (CNV) in groups at high risk for antisocial personality disorder.

Materials and methods

A classic CNV paradigm was used to compare the characteristics of attention maintenance among a group of individuals with conduct disorder (CD group; n = 27), a group of individuals with antisocial personality traits (AP; n = 29), a group of individuals with conduct disorder and antisocial personality traits (CD + AP group; n = 25), and a group of healthy controls (CG group; n = 30), to examine the characteristics of the amplitude and latency of CNV in different processing stages.

Results

Results of the event-related potential analysis were as follows: The mean amplitude analysis between 500 and 1,000 ms revealed that the mean CNV amplitudes in the CD + AP group (-1.388 ± 0.449 μV, P < 0.001) were significantly lower than that in the CG group (-4.937 ± 0.409 μV). The mean amplitude analysis between 1,000 and 1,500 ms revealed that the mean CNV amplitude in the CD + AP group (-0.931 ± 0.646 μV) was significantly lower than that in the CG group (4.809 ± 0.589 μV, P < 0.001). The mean amplitude analysis between 1,500 and 2,000 ms revealed that the mean CNV amplitude in the CG group (3.121 ± 0.725 μV) was significantly higher than that in the CD + AP group (-0.277 ± 0.795 μV, P = 0.012), whereas the mean CNV amplitude in the CD + AP group was not significantly different in the AP group (P = 0.168) and CD group (P > 0.05). Source localization results indicated altered activity in frontal-temporal regions.

Conclusion

The CNV amplitude characteristics in the CD + AP group and AP group were more consistent and fluctuated around the baseline, indicating the absence of attention maintenance resulted in impairments in attention allocation and motor preparation in the CD + AP group and AP group.

Key factors selection on adolescents with non-suicidal self-injury: A support vector machine based approach

Comparing a family structure to a company, one can often think of parents as leaders and adolescents as employees. Stressful family environments and anxiety levels, depression levels, personality disorders, emotional regulation difficulties, and childhood trauma may all contribute to non-suicidal self-injury (NSSI) behaviors. We presented a support vector machine (SVM) based method for discovering the key factors among mazy candidates that affected NSSI in adolescents. Using SVM as the base learner, and the binary dragonfly algorithm was used to find the feature combination that minimized the objective function, which took into account both the prediction error and the number of selected variables. Unlike univariate model analysis, we used a multivariate model to explore the risk factors, which better revealed the interactions between factors. Our research showed that adolescent education level, anxiety and depression level, borderline and avoidant personality traits, as well as emotional abuse and physical neglect in childhood, were associated with mood disorders in adolescents. Furthermore, gender, adolescent education level, physical abuse in childhood, non-acceptance of emotional responses, as well as paranoid, borderline, and histrionic personality traits, were associated with an increased risk of NSSI. These findings can help us make better use of artificial intelligence technology to extract potential factors leading to NSSI in adolescents from massive data, and provide theoretical support for the prevention and intervention of NSSI in adolescents.

Childhood emotional abuse and motor impulsiveness among male violent inmates with antisocial personality disorder

This study aimed to explore the relationship among childhood maltreatment, impulsiveness and antisocial personality through a questionnaire survey of violent male inmates. We found that the scores of inmates with Antisocial Personality Disorder (ASPD) in Childhood Trauma Questionnaire-28 item Short Form (CTQ-SF) and Barratt Impulsive Scale-11 (BIS-11) were higher than those in the Non-Antisocial personality group, and there was a significant correlation between the scores of CTQ-SF and BIS-11. We found that the interaction between impulsivity and childhood abuse predicts ASPD levels. Moreover, motor and non-planning impulsiveness played important roles in the observed differences in antisocial personality scores among the inmates who had experienced childhood maltreatment; motor impulsiveness was mainly related to emotional abuse, physical abuse, and sexual abuse, while non-planning impulsiveness was mainly related to emotional neglect and physical neglect. These findings suggest that identifying and providing timely intervention for inmates with high impulsiveness who experienced maltreatment in childhood may also contribute to the prevention of violent behavior and to better prison management.

Identity and Personality Pathology: A Convergence Across the DSM-5 Personality Disorder Model and the Alternative Model for Personality Disorders

Long-standing theory regarding personality pathology as well as the recently proposed DSM-5 Alternative Model for Personality Disorders (AMPD) posit that self/identity problems are a hallmark feature cutting across forms of personality pathology. With emergence of the AMPD, researchers have started to focus empirical investigations on identity pathology as a transdiagnostic factor across personality pathology. The current study investigated identity pathology across indicators of personality pathology from both the current categorical perspective (DSM-5 PD) and the dimensional perspective in the AMPD. Identity diffusion and low self-concept clarity were correlated with all PD feature scales and all maladaptive personality dimension scales. Regression analyses revealed most indicators of personality pathology were significant correlates of identity diffusion and low self-concept clarity. Borderline and Avoidant PD feature scales and Negative Affectivity and Detachment maladaptive personality dimension scales emerged as the strongest correlates of identity pathology. The role that identity pathology plays in personality pathology is highlighted.

Avoidant Personality Disorder Symptoms and Cardiovascular Reactivity to Psychological Stress Tasks With Increasing Cognitive Demands

Abstract. This study aimed to investigate whether and how avoidant personality disorder symptoms are related to cardiovascular reactivity to stress tasks with different levels of cognitive demands. The revised Chinese edition of the avoidant personality disorder subscale of Personality Diagnosed Questionnaire-4+ (PDQ-4+) was administered to 222 undergraduate students randomly assigned to psychological stress tasks (i.e., mental arithmetic tasks) with low, moderate, or high cognitive demands (manipulated by task difficulty), during which their physiological data were continuously collected. Results showed that avoidant personality disorder symptoms and cognitive demands of tasks interactively predicted systolic blood pressure (SBP) and diastolic blood pressure (DBP) reactivity. In specific, avoidant personality disorder symptoms were not associated with SBP reactivity under the low- and moderate-demand conditions and DBP reactivity under the low-demand condition but were associated with blunted SBP reactivity under the high-demand condition and blunted DBP reactivity under the moderate- and high-demand conditions. These findings indicate that the association between avoidant personality disorder symptoms and cardiovascular reactivity to psychological stress is contingent on the cognitive demands of tasks, which have potential implications for physical health.

Specific type of childhood trauma and borderline personality disorder in Chinese patients

Background

Childhood maltreatment (CM) is a known risk factor for the development of mental disorders. An extensive body of literature about CM and mental health has been developed in wealthy countries, but information about this connection is lacking in developing countries including China.

Aims

To explore the possible relationship between specific types of CM and borderline personality disorder (BPD) in patients with mental disorders in China.

Methods

A survey was conducted in 2006, involving over 3,402 Chinese individuals aged 18-60 years who were randomly selected from the outpatients in the Shanghai Mental Health Center. The patients were screened with the Personality Diagnostic Questionnaire and CM was assessed using the Childhood Trauma Questionnaire. The final sample comprised 178 patients with BPD, 178 patients with other personality disorders (PDs), and 178 patients without PDs.

Results

In Chinese patients, compared to other PDs, patients with BPDs are more likely to have experienced CM. Emotional maltreatment (emotional abuse and neglect) was the strongest predictor of BPD. Female gender and sexual abuse are significant predictors of the self-harm/suicidal risk of BPD patients.

Conclusion

This is a pioneering study conducted on a large set of Chinese clinical samples with paired controls to establish and compare the associations between specific CM and BPD. Further studies in this field are necessary to elucidate the mechanism of how various types of childhood trauma have influenced PDs.

The remediating effect of Attention Bias Modification on aggression in young offenders with antisocial tendency: A randomized controlled trial

BACKGROUND AND OBJECTIVES

An attention bias toward hostile stimuli is associated with an increased risk of aggressive behavior. Thus, reducing hostile attention bias may help to reduce aggression in young offenders. We evaluated the remediating effects of Attention Bias Modification (ABM) on hostile attention bias and aggressive behavior in Chinese male young offenders with antisocial tendencies.

METHODS

Institutionalized male young offenders (ages 16-18) were recruited and randomly assigned to ABM (n = 28), placebo (n = 28), or waiting list (n = 28). The ABM group received four weeks of training using visual search of emotional faces; the placebo group underwent similar training using visual search of neutral objects. Before and after treatment, aggressive behavior, attention bias toward positive stimuli and hostile stimuli were assessed.

RESULTS

Linear mixed models and hierarchical multiple regression analyses showed that the intervention effect of ABM was moderated by participants' initial attention bias. Young offenders with a high level of initial hostile attention bias, or with a low level of initial positive attention bias, benefitted most from ABM.

LIMITATIONS

The small sample size impedes investigation of the mechanism of the intervention's effects. Further research can determine whether the current results can be extrapolated to the population of female young offenders.

CONCLUSION

The results of the present study suggest that ABM is helpful for young offenders who show the greatest bias toward hostile stimuli and away from positive stimuli. These findings highlight the importance of matching the intervention and the participant.

TRIAL REGISTRATION

osf.io/vj5rk.

The role of migration processes and cultural factors in the classification of personality disorders

Migrants and ethnic minorities are at risk of being under- and overdiagnosed with personality disorders (PDs). A culturally informed approach to the classification of PDs guides clinicians in incorporating migration processes and cultural factors, to arrive at a reliable and valid assessment of personality pathology. In this article, we provide a tentative framework to highlight specific interactions between personality disorders, migration processes, and cultural factors. It is argued that migration processes can merely resemble personality pathology, activate certain (latent) vulnerabilities, and aggravate pre-existing personality pathology. We propose that these migration processes can include manifestations of grief about the loss of pre-migratory psychosocial and economic resources, and the struggle to attain psychosocial and economic resources in the host culture. Moreover, several cultural dimensions are outlined that can either resemble or mask personality pathology. The term "culturally masked personality disorder" is coined, to delineate clinical cases in which cultural factors are overused or misused to rationalize behavioral patterns that are consistently inflexible, distressing, or harmful to the individual and/or significant others, lead to significant impairment, and exceed the relevant cultural norms. Additionally, the role of historical trauma is addressed in the context of potential overdiagnosis of personality disorders in Indigenous persons, and the implications of misdiagnosis in migrants, ethnic minorities, and Indigenous populations are elaborated. Finally, clinical implications are discussed, outlining various diagnostic steps, including an assessment of temperament/character, developmental history, systemic/family dynamics, migration processes, cultural dimensions, and possible historical trauma.

Comparing English-Language and Chinese-Language Assessment of DSM-5 Personality Disorders and Interpersonal Problems in Chinese Bilingual Speakers

A review of the literature on Chinese translations of Western self-report personality disorder assessment measures indicates the need to empirically evaluate the validity of assessing Western personality disorder constructs in Chinese language and culture. The current study presents a novel approach to examining this critical question in cross-cultural clinical assessment science and practice. One hundred and ninety-nine (199) Mandarin Chinese and English bilingual participants (92 males and 107 females) provided both English and Chinese self-report ratings on the Inventory of Interpersonal Problems - Short Circumplex (IIP-SC) and The Personality Diagnostic Questionnaire - 4+ (PDQ-4+). The similarities and differences in associations between Diagnostic and Statistical Manual of Mental Disorders-5th edition (DSM-5) personality disorders and interpersonal problems assessed across languages were examined. The structural summary method (SSM) for circumplex data and a bootstrapping methodology were used to compute confidence intervals around SSM parameters to analyze and compare the interpersonal problems profiles for each personality disorder scale (e.g. narcissistic) derived from English-language and Chinese-language data. The current study found highly similar interpersonal profiles for personality disorder scales assessed in English and Chinese, suggesting Western DSM-5 personality disorder constructs generally emphasize the same interpersonal problems in Chinese language and culture. The method employed in this study also has implications for understanding whether translated measures capture the same personality constructs.

Attentional variability and avoidance of hostile stimuli decrease aggression in Chinese male juvenile delinquents

BACKGROUND

As a prominent issue worldwide, juveniles' aggressive and violent crimes have attracted much interest in recent years. Based on the social information processing model, the present study aimed to evaluate the Chinese male juvenile delinquents' attention bias towards hostile stimuli from both static and dynamic perspectives. Additionally, the predictive effect of attention bias on aggressive behavior and the moderating effect of group (juvenile delinquents and the controls with no criminal history) were also investigated.

METHODS

The hostile attention bias and aggressive behavior of 76 juvenile delinquents (M_age = 17.5 years, SD = 0.59 years) and 67 controls (M_age = 18.3 years, SD = 0.73 years) were measured with the emotional dot-probe task, emotional Stroop task, and the Chinese version of the Buss & Perry aggression questionnaire, respectively.

RESULTS

The results showed that compared with controls, juvenile delinquents showed more attention biases towards hostile faces and words, and demonstrated higher levels of physical aggression and anger. Furthermore, the type of participants moderated the relationship between hostile attention bias and aggressive behavior. For juvenile delinquents, attention bias away from hostile stimuli and attention variability negatively predicted anger, while for controls, attention variability positively predicted self-directed aggression.

CONCLUSION

Attentional variability and avoidance of hostile stimuli are expected to reduce the aggressive level of Chinese male juvenile delinquents. The relationship between attention bias and aggression should be further considered and applied in the clinical practice.

Insomnia partially mediates the relationship between pathological personality traits and depression: a case-control study

Background and Objective

Personality disorders are frequently associated with insomnia and depression, but little is known about the inter-relationships among these variables. Therefore, this study examined these inter-relationships and the possible mediating effect of insomnia on the association between specific personality pathologies and depression severity.

Methods

There were 138 study participants, including 69 individuals with depression and 69 healthy controls. The main variables were measured by the Hamilton Depression Rating Scale-24 (HAMD-24), Athens Sleep Insomnia Scale (AIS), and the Personality Diagnostic Questionnaire (PDQ-4+). Multivariate linear regression and mediation analysis were conducted.

Results

With the exception of the antisocial personality score, all the PDQ-4+ scores and AIS scores were significantly higher in the depression group than in the healthy control group (p < 0.001). In the total sample, all personality pathology scores (p < 0.001), except the antisocial personality score, had significant positive correlations with the AIS scores and HAMD-24 scores, and the AIS scores and HAMD-24 scores were positively correlated (r = 0.620, p < 0.001). Regression analysis revealed that borderline personality, passive-aggressive personality, and insomnia positively predicted the severity of depression, after adjusting for sociodemographic covariates, and that insomnia partially mediated the associations of borderline personality and passive-aggressive personality with depression severity.

Conclusions

Borderline personality, passive-aggressive personality, and insomnia tend to increase the severity of depression, and the effect of borderline and passive-aggressive personality on depression severity may be partially mediated by insomnia. This is the first study to report these findings in a Chinese sample, and they may help researchers to understand the pathways from specific personality pathologies to the psychopathology of depression better, which should be useful for designing interventions to relieve depression severity, as the impact of specific personality pathology and insomnia should be considered.

Personality inventory for DSM-5 brief form(PID-5-BF) in Chinese students and patients: evaluating the five-factor model and a culturally informed six-factor model

BACKGROUND

The Personality Inventory for DSM-5 Brief Form (PID-5-BF) is a 25-item measuring tool evaluating maladaptive personality traits for the diagnosis of personality disorders(PDs). As a promising scale, its impressive psychometric properties have been verified in some countries, however, there have been no studies about the utility of the PID-5-BF in Chinese settings. The current study aimed to explore the maladaptive personality factor model which was culturally adapted to China and to examine psychometric properties of the PID-5-BF among Chinese undergraduate students and clinical patients.

METHODS

Seven thousand one hundred fifty-five undergraduate students and 451 clinical patients completed the Chinese version of the PID-5-BF. Two hundered twenty-eight students were chosen randomly for test-retest reliability at a 4-week interval. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted to discover the most suitable factor structure in China, measurement invariance(MI), internal consistency, and external validity were also calculated.

RESULTS

The theoretical five-factor model was acceptable, but the exploratory six-factor model was more applicable in both samples (Undergraduate sample: CFI = 0.905, TLI = 0.888, RMSEA = 0.044, SRMR = 0.039; Clinical sample: CFI = 0.904, TLI = 0.886, RMSEA = 0.047, SRMR = 0.060). In the Chinese six-factor model, the Negative Affect domain was divided into two factors and the new factor was named "Interpersonal Relationships", which was in line with the Big-Six Personality model in Chinese. Measurement invariance across non-clinical and clinical sample was established (configural, weak, strong MI, and partial strict MI). Aside from acceptable internal consistency (Undergraduate sample: alpha = 0.84, MIC = 0.21; Clinical sample: alpha = 0.86, MIC = 0.19) and test-retest reliability(0.73), the correlation between the 25-item PID-5-BF and the 220-item PID-5 was significant(p < 0.01). The six PDs measured by Personality diagnostic questionnaire-4+ (PDQ-4+) were associated with and predicted by expected domains of PID-5-BF.

CONCLUSIONS

Both the theoretical five-factor model and the exploratory six-factor model of the PID-5-BF were acceptable to the Chinese population. The five-factor model could allow for comparison and integration with other work on the original theoretical model. However, the Chinese six-factor structure may be more culturally informed in East Asian settings. In sum, the PID-5-BF is a convenient and useful screening tool for personality disorders.

The CDA-BPD: retrofitting a traditional borderline personality questionnaire under the cognitive diagnosis model framework

To obtain rich information about the cognitive diagnosis of borderline personality disorder (BPD), this study attempted to retrofit a traditional borderline personality questionnaire so that the improved assessment (called CDA-BPD) could provide more diagnostic information. The retrofitting processes included the following steps: (1) applied an cognitive diagnosis model to analyze the psychometric characteristics of the traditional questionnaire; (2) under the guidance of cognitive diagnosis assessment (CDA), high-quality items were chosen to develop the CDA-BPD and tested on 1,097 subjects; (3) the quality of the CDA-BPD was evaluated; (4) the structure of the CDA-BPD was analyzed. Results indicated that: (1) the CDA-BPD had acceptable reliability and validity; (2) the CDA-BPD had sensitivity of 0.985 and specificity of 0.853 with area under curve (AUC) = 0.956; (3) the two structural factors of the traditional questionnaire were confirmed in the CDA-BPD; χ2 was 83.01 with df = 26, p < .0001, comparative fit index (CFI) = 0.97, root mean square error of approximation (RMSEA) = 0.045. It was concluded that the practice of retrofitting a traditional borderline personality assessment for cognitive diagnostic purpose was feasible. Most importantly, under the cognitive diagnosis model framework, CDA-BPD could simultaneously provide general-level information and the detailed symptom criteria-level information about the posterior probability of satisfying each symptom criterion in the Diagnostic and Statistical Manual of Mental Disorders (5th edition; DSM-5; American Psychiatric Association, 2013 ) for each individual, which gave further insight into tailoring individual-specific treatments for borderline personality disorder.

Procedures to Develop a Computerized Adaptive Testing to Advance the Measurement of Narcissistic Personality

Narcissistic personality (NP) has recently attracted a great deal of attention. In this study, we mainly investigated the feasibility and effectiveness of using computerized adaptive testing (CAT) to measure NP (CAT-NP). The CAT in this study was simulated by the responses of several NP questionnaires of 1,013 university students as if their responses were collected adaptively. The item bank (85 items) that met the requirements of the psychometric properties of Item Response Theory (IRT) was first established, and then the CAT dynamically selected items according to the estimates of current trait level until the prespecified measurement precision is achieved. Finally, the efficiency and validity of the CAT were verified. The results showed that the proposed CAT-NP had reasonable reliability, validity, predictive utility, and high correlation. In addition, the CAT-NP could significantly save item usage without losing measurement accuracy, which greatly improves the test efficiency. The advantages and limitations of CAT in measuring NP and other psychological tests are discussed in the final section.

A diagnostic classification version of Schizotypal Personality Questionnaire using diagnostic classification models

OBJECTIVE

To obtain more precise and rich information from the measurements for schizotypal personality disorder (SPD), a cutting-edge psychometric theory called diagnostic classification models (DCMs) was first employed in the present study to develop a diagnostic classification version of the Schizotypal Personality Questionnaire (DC-SPQ) based on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders.

METHODS

Under the framework of DCMs, 980 college students were recruited to calibrate item parameters of the Schizotypal Personality Questionnaire. Items that fit the psychometric characteristic would be selected to compose the DC-SPQ, prior to an analysis of its indexes.

RESULTS

Results showed that the DC-SPQ had high reliability and validity in both the classical test theory and DCMs, in addition to showing a sensitivity of 0.921 and a specificity of 0.841 with area under receiver operating characteristic curve = 0.936. Meanwhile, the four-factor model proposed adequately fits with the data. More importantly, the DC-SPQ provides not only the general-level information similar to traditional questionnaires but also the symptom-level information with the posterior probability, which provides an insight into delivering the individual-specific intervention that is tailor made to schizotypal personality disorder.

CONCLUSIONS

This study demonstrates that the DC-SPQ is very valuable for psychometric detection in that it can clarify the symptom being measured and provide more reasonable estimates.

Construct Validity of the McLean Screening Instrument for Borderline Personality Disorder in Two Singaporean Samples

This study examined the construct validity of the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) in a consecutive sample of adult psychiatric patients (n = 128) and a separate sample of undergraduate students (n = 289) in Singapore. Participants were administered the MSI-BPD and other measures assessing related symptoms of BPD. Patients were also administered a semistructured interview by interviewers blind to their MSI-BPD scores. Confirmatory factor analyses revealed a unique three-factor solution, consisting of affect dysregulation, self-disturbances, and behavioral and interpersonal dysregulation. In both samples, the MSI-BPD demonstrated good internal consistency and convergent validity. The measure also showed good discriminant validity and predictive accuracy (AUC = .82), with an optimal cut-off score of 7.5. Overall, the findings suggest that BPD is a valid and coherent clinical construct in Singapore, and point to the need to further clarify the presentation and etiology of BPD in this cultural context.

Electrophysiological Characteristics in Depressive Personality Disorder: An Event-Related Potential Study

This study aimed to investigate the neurophysiological characteristics of young people with depressive personality disorder using event-related potentials (ERP). To explore the effects of visual-emotional words on ERP, mainly N350, we recruited 19 individuals with a depressive personality disorder and 10 healthy controls. ERP were recorded while the subjects took decisions on target words that were classified into three categories: emotionally positive, negative, and neutral. The ERP signals were then separately averaged according to the subjects' classifications. Data analysis showed that the amplitude of N350 was larger in response to positive and negative words than to neutral words. The latency of N350 was longer in negative words, in contrast with positive and neutral words. However, no difference was found between the two groups. These results suggest that neurophysiological characteristics of young people with a depressive personality disorder in visual-emotional word processing have not yet been influenced by their personality traits. To some extent, N350 reflected semantic processes and was not sensitive to participants' mood state.

Co-Morbidity of DSM-IV Personality Disorder in Major Depressive Disorder Among Psychiatric Outpatients in China: A Further Analysis of an Epidemiologic Survey in a Clinical Population

Introduction: It is common that personality disorder (PD) co-occurs with major depressive disorder (MDD). In the current literature, there is a dearth of information on the co-occurrence of PD and MDD among Chinese population. Materials and Methods: 609 individuals were randomly sampled from outpatients diagnosed as MDD in Shanghai Mental Health Center. Co-morbidity of PDs was assessed using the Personality Diagnostic Questionnaire Fourth Edition Plus (PDQ-4+) and eligible subjects were interviewed with the Structured Clinical Interview for DSM-IV Axis II (SCID-II). The score of PDQ-4+ and the rate of SCID-II PD between subjects diagnosed with MDD and those with anxiety disorders (AD) were compared. Results: Two hundred fifty-eight outpatients (42.36%) with MDD were recognized to possess at least one criterion of diagnosis for PD, according to the DSM-IV. The most prevalent PD was depressive PD (14.61%), followed by avoidant (11.49%) and borderline (11.49%) PD. Cluster C PDs (anxious and panic PD) were the most common PD types (12.12%) when compared to other clusters. Compared to patients with AD, individuals with MDD were significantly more likely to have paranoid PD (6.6% vs. 3.3%, p = 0.011), borderline PD (11.5% vs. 3.7%, p = 0.000), passive-aggressive PD (5.6% vs. 2.4%, p = 0.007), and depressive PD (14.6% vs. 7.8%, p = 0.000). Discussion: The finding indicates that there is a high prevalence of PD among patients with MDD. More significant co-morbidity rates of PDs in MDD have been found when compared with AD. Further studies for the longitudinal impact of the PD-MDD co-morbidity are in need.

Borderline personality disorder: an adaptation of the Taiwan short version of the screening inventory into Brazilian Portuguese

Objective The current study presents the translation and adaptation of the 20-item Taiwan version of the Borderline Personality Inventory (BPI) into Brazilian Portuguese (BPI-P). Methods After translation and back-translation, the Brazilian Portuguese version was administered to three samples: patients with borderline personality disorder, psychiatric patients with comorbid substance use disorder and volunteers with no reported mental disorders. Results Significant differences between groups for borderline scores (analysis of variance [ANOVA], F = 52.923, p = 0.01) were found but there were no significant correlations between scores for borderline personality disorder and alcohol or nicotine dependence. The BPI-P had satisfactory validity for borderline personality disorder, even when anxiety and depression were present, with an area under the receiver operating characteristic curve of 0.931 at a cutoff point of 14. Conclusion This study provides support for the potential utility of the BPI-P as a screening instrument for clinical practice in Portuguese speaking countries, including outpatients with alcohol and nicotine use disorders in early or sustained remission.

Cultural Aspects in Symptomatology, Assessment, and Treatment of Personality Disorders

PURPOSE OF REVIEW

This review discusses cultural trends, challenges, and approaches to assessment and treatment of personality traits and disorders. Specific focus include current developments in the Asian, Italian, Iranian, and Australian societies, as well as the process of acculturation, following moves between cultures with the impact on healthy and disordered personality function.

RECENT FINDINGS

Each culture with its specific history, dimensions, values, and practices influences and gears the individual and family or group in unique ways that affect personality functioning. Similarly, each culture provides means of protection and assimilation as well as norms for acceptance and denunciations of specific behaviors and personality traits. The diagnosis of personality disorders and their treatment need to take into consideration the individual in the context of the culture and society in which they live. Core personality problems, especially emotion dysregulation and interpersonal functioning are specifically influenced by cultural norms and context.

A compromise solution between overlapping and overlooking DSM personality disorders in Chinese psychiatric practice

OBJECTIVE

This study aimed to examine the overlaps between the Diagnostic and Statistical Manual-5 (DSM-5) Personality Disorders (PDs) in a high-risk clinical population and to explore a transitional model for implementing DSM-5 PDs.

METHOD

A sample population of 982 outpatients with at least one diagnosed PD was selected from 3,075 outpatients of the Shanghai Mental Health Center. The diagnostic process comprised of a personality diagnostic questionnaire and a structured clinical interview.

RESULTS

685 (22.3%) patients were diagnosed with at least one of six PDs (antisocial, avoidant, borderline, narcissistic, obsessive-compulsive, and schizotypal) under the alternative DSM-5 model for personality disorders proposed in Section III of the DSM-5. Nearly 20.3% of the subjects with PD met criteria for at least two PDs (of the 685 PD patients/6 PD model). Cluster and principal component analyses suggest a transitional model for the 7 specific PD categories (among the 722 PD patients, the overlapping rate was 24.1%) will be more appropriate for PD diagnosis in China.

CONCLUSIONS

Using the simplified PD categories in the alternative DSM-5 model for personality disorders will reduce the overlaps in PD diagnoses in Chinese psychiatric practice, and should be preferred over the DSM-5 PD diagnostic system.

Diagnostic Concordance Between Categorical and Dimensional Instruments to Assess Personality Disorder in Chronic Fatigue Syndrome

Abstract. The study examines the relationship between a categorical and a dimensional personality assessment instrument in patients with Chronic Fatigue Syndrome (CFS). A total of 162 CFS patients were included in the study (91.4% women; mean age 47.5 years). All subjects completed the Spanish versions of the Personality Diagnostic Questionnaire-4+ (PDQ-4+) and the Temperament and Character Inventory-Revised (TCI-R). Results: 78 (48.1%) of the patients presented a Personality Disorder (PD), the most frequent being Cluster C, specifically Obsessive-compulsive disorder, followed by Avoidant disorder. PDs showed a specific pattern of correlation with temperament scales. All PD clusters correlated positively with Harm Avoidance and Self-Transcendence, and negatively with Reward Dependence, Self-Directedness, and Cooperativeness. In a logistic regression analysis, Self-Directedness and Cooperativeness predicted PD presence. The findings are consistent with previous studies in non-CFS samples and suggest that the combination of the Temperament and Character dimensions (low Self-Directedness and Cooperativeness and high Harm Avoidance and Self-Transcendence) correlates with PD severity, and that Self-Directedness and Cooperativeness are associated with PD presence in CFS patients. The integration of these two perspectives expands the current comprehension of personality pathology in CFS patients.

Prevalence of Personality Disorders in a General Population Among Men and Women

The aim of the present study is to establish the prevalence of personality disorders (PDs) in a healthy (nonclinical) Polish population, to examine sex difference in PDs, and to show the structure of clusters which PDs form with regard to men and women. A large sample of 1460 individuals of age between 18 and 65 years was examined. The Structured Clinical Interview for Axis II was used to obtain information on PDs, the Mini International Neuropsychiatric Interview to obtain information on other disorders, and an interview to record demographic data. Results show that approximately 9% of the sample had at least one PD (the overall rate is 8.9%) and rates on sex differences in PDs are similar to other European and North American countries. The most prevalent PDs are obsessive-compulsive (9.6%), narcissistic (7%), and borderline (7%). Results show the considerable comorbidity of PDs which means that about 9% of the adult population have at least one PD and in fact they display features of many specific PDs. A factor analysis revealed that 12 PDs form different clusters in men and women.

Cross-cultural bias in the diagnosis of borderline personality disorder

Borderline personality disorder (BPD) is an internationally recognized disorder, although it is slightly varied in its nosology in the International Classification of Diseases, 10th Revision (ICD-10), the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), and the Chinese Classification of Mental Disorders (CCMD). While it is recognized by genetic and neurobiological patterns, instability of affect, impaired interpersonal relationships, and unstable sense of self, its manifestation is extremely varied based on environmental factors, particularly culture. Several studies of the manifestation of BPD between and across countries, particularly in immigrant populations, identify variations in symptom prevalence based on culture. These findings reveal a need for more unified dimensional-based categorization of BPD to reduce cross-cultural bias and improve identification.

Factor structure and psychometric evaluation of the Connor-Davidson resilience scale in a new employee population of China

BACKGROUND

In order to find a suitable instrument to evaluate psychological resilience in Chinese new employee population, we intended to propose a possible factorial structure of Connor-Davidson Resilience Scale (CD-RISC). Furthermore, we administered to explore its reliability and validity in the present population.

METHODS

Participants were derived from the male new employees who had started working in the last 2-3 months from 12 machinery factories across 8 different provinces of China. Chinese version of CD-RISC was used to assess the resilience of the study participants. Exploratory factor analysis (EFA) was conducted to assess the possible factor structure, and confirmatory factor analysis (CFA) was used to determine which factor structure was the most suitable among the present study sample.

RESULTS

The present 4-factor model (tolerance for stress, tenacity, and goal orientation; adaptability and acceptance of change; optimism and sense of security; and trust in one's instinct) of CD-RISC showed good internal consistency, concurrent validity and consistent structure validity, and had presented better data fit than the original 5-factor and the Chinese 3-factor patterns. Each of the present 4-factor structure and the total score of CD-RISC were negatively and significantly associated with Global Severity Index T score and Personality Diagnostic Questionnaire-4+ score.

CONCLUSIONS

The measure of resilience is useful in screening high-risk employees who are vulnerable to stress. Optimal and tailored interventions can be further applied to avoid potential adverse events in this population. Longitudinal research should be required to determine whether aging and long-term health events can change the nature of resilience.

Aberrant functional brain connectome in people with antisocial personality disorder

Antisocial personality disorder (ASPD) is characterised by a disregard for social obligations and callous unconcern for the feelings of others. Studies have demonstrated that ASPD is associated with abnormalities in brain regions and aberrant functional connectivity. In this paper, topological organisation was examined in resting-state fMRI data obtained from 32 ASPD patients and 32 non-ASPD controls. The frequency-dependent functional networks were constructed using wavelet-based correlations over 90 brain regions. The topology of the functional networks of ASPD subjects was analysed via graph theoretical analysis. Furthermore, the abnormal functional connectivity was determined with a network-based statistic (NBS) approach. Our results revealed that, compared with the controls, the ASPD patients exhibited altered topological configuration of the functional connectome in the frequency interval of 0.016–0.031 Hz, as indicated by the increased clustering coefficient and decreased betweenness centrality in the medial superior frontal gyrus, precentral gyrus, Rolandic operculum, superior parietal gyrus, angular gyrus, and middle temporal pole. In addition, the ASPD patients showed increased functional connectivity mainly located in the default-mode network. The present study reveals an aberrant topological organisation of the functional brain network in individuals with ASPD. Our findings provide novel insight into the neuropathological mechanisms of ASPD.

Screening results correlating to personality disorder traits in a new employee population of People's Republic of China

BACKGROUND

Adaptation to a new environment may have an uncertain influence on young employees, whose values are still being formed during early adulthood. To understand the current mental status and further improve the mental health level of the new employee population of People's Republic of China, we conducted a cross-sectional study to screen the prevalence and correlates of personality disorder (PD) traits in this population.

METHODS

This study included all male participants who were new employees (those who had started working in approximately the last three months) from 12 machinery factories in People's Republic of China. The Personality Diagnostic Questionnaire-4+ was used to evaluate the mental status of all participants. The Connor-Davidson Resilience Scale was used to assess the resilience of the study participants.

RESULTS

A total of 3,960 male participants were included in the analysis. The mean age of the study participants was 18.7±1.5 years. The mean values of all PD subtypes were scored from 0.74 to 2.90, with a total of 16.85. Of all 10 PD traits, obsessive-compulsive, histrionic, and narcissistic scored the highest. PD traits scored significantly higher among participants who had higher education levels, came from a single-parent (divorced or separated) family, were raised in a neglectful parental rearing pattern, were the only child of the family, were living in city areas, or had a lower family income. All subtype PD traits were significantly and negatively correlated with resilience.

CONCLUSION

Education level, single-parent family, parental rearing pattern, only-child status, living place, and family income may influence the development of PD traits. Additional high-quality studies are needed to learn more about the mental health status of new employees. Optimal interventions are warranted to avoid potential adverse events in this population.

Neurological soft signs in adolescents with borderline personality traits

OBJECTIVE

This study investigated the prevalence and severity of neurological soft signs (NSS), and their relationships with borderline personality (BP) traits in adolescents.

METHODS

Eighty-nine adolescents with BP traits (BP-trait group), and 89 adolescents without traits of any personality disorder (control group), were recruited in China. BP traits were diagnosed by the BPD subscale of the Personality Diagnostic Questionnaire for the DSM-IV (PDQ-4+). The soft sign subscales of the Cambridge Neurological Inventory were administered to all participants. The group differences in prevalence of soft signs and in NSS scores were analyzed, as well as the associations between the NSS scale and borderline personality traits.

RESULTS

Five soft signs were significantly more frequent in adolescents with BP traits. A total of 59.6% of adolescents with BP traits exhibited at least 1 NSS, whereas only 34.8% of adolescents without BP traits did (p < 0.01). A total of 42.7% of adolescents in the BP-trait group exhibited at least 2 NSS, while only 16.9% of adolescents without BP traits did (p < 0.001). Moreover, adolescents with BP traits showed more sensory integration, disinhibition, total neurological soft signs, left-side soft signs, and right-side soft signs, than adolescents without BP traits. Sensory integration and disinhibition were positively associated with BP traits.

CONCLUSION

These findings suggest that adolescents with BP traits may have a nonfocal abnormality of the central nervous system.

Personality disorders as an expression of the dimensional polarity in personality development in late adulthood women

Relationships between Axis II personality disorders and Sidney Blatt constructs of dependency and self-criticism were explored in a late adulthood women sample. The sample consisted of 102 women (M = 72.07 years of age, SD = 7.04) who were administered two measures, the Personality Diagnostic Questionnaire-4+ and the Depressive Experiences Questionnaire. The histrionic, dependent, and obsessive-compulsive personality disorder scales are shown to be significant predictors of dependency, and the narcissistic, borderline, and avoidant scales are significant predictors of self-criticism. The application of a dimensional interpersonal approach to psychopathology is discussed.

Comparing the Personality Disorder Interview for DSM-IV (PDI-IV) and SCID-II borderline personality disorder scales: an item-response theory analysis

One-hundred sixty-nine psychiatric outpatients and 171 undergraduate students were assessed with the Personality Disorder Interview-IV (PDI-IV; Widiger, Mangine, Corbitt, Ellis, & Thomas, 1995) and the Structured Clinical Interview for DSM-IV Axis II disorders (SCID-II; First, Gibbon, Spitzer, Williams, & Benjamin, 1997) for borderline personality disorder (BPD). Eighty individuals met PDI-IV BPD criteria, whereas 34 met SCID-II BPD criteria. Dimensional ratings of both measures were highly intercorrelated (rs = .78, .75), and item-level interrater reliability fell in the good to excellent range. An item-response theory analysis was performed to investigate whether properties of the items from each interview could help understand these differences. The limited agreement seemed to be explained by differences in the response options across the two interviews. We found that suicidal behavior was among the most discriminating criteria on both instruments, whereas dissociation and difficulty controlling anger had the 2 lowest alpha parameter values. Finally, those meeting BPD criteria on both interviews had higher levels of anxiety, depression, and more impairments in object relations than those meeting criteria on just the PDI-IV. These findings suggest that the choice of measure has a notable effect on the obtained diagnostic prevalence and the level of BPD severity that is detected.

Five-factor model personality domains in the prediction of Axis II personality disorders: an exploratory study in late adulthood women non-clinical sample

Relationships between Axis II personality disorders (DSM-IV) and the five-factor model were explored in a non-clinical sample of late adulthood women. The sample consists of 90 women (M = 72.29 years of age, standard deviation = 7.10), who were administered with two measures, the NEO-FFI and the Personality Diagnostic Questionnaire-4+. Some personality disorders scales such as paranoid, schizotypal, borderline and dependent demonstrate a differentiated pattern of five-factor model domain predictors. Low agreeableness predicted schizoid, narcissistic and antisocial; histrionic, obsessive-compulsive and negativistic were predicted by high neuroticism and low agreeableness; high neuroticism and low extraversion, in turn, predicted dependent and depressive scales. Also, two clusters of personality disorders are identified, one associated with low agreeableness and another with low agreeableness and high neuroticism. This study suggest that some traits become maladaptive personality traits, and correspond more closely to psychopathology, when they become opposite to what would be expected in line with studies in normal late adulthood development.

Personality disorders in Asians: summary, and a call for cultural research

Epidemiological studies show relatively low rates of personality disorder (PD) in Asian-origin samples, but these low rates may result from a lack of understanding about what constitutes PD in Asian cultural contexts. Research on etiology, assessment, and treatment has rarely been extended to incorporate ways in which culture might shape PDs in general, let alone among Asians in particular. PDs did not officially change in DSM-5, but an alternative dimensional system may help link the Asian PD literature to non-clinical personality research. Personality and culture are deeply intertwined, and the research literature on Asian PDs - and on PDs more generally - would benefit greatly from more research unpacking the cultural mechanisms of variation.

Suicide in the absence of mental disorder? A review of psychological autopsy studies across countries

BACKGROUND

While numerous past reviews of psychological autopsy (PA) studies have examined the relationship between mental disorder and suicide, there has been little systematic investigation of suicide occurring in the absence of any identifiable psychiatric condition.

AIM

This article reviews available literature on the topic by considering Axis I, sub-threshold, mild disorders and personality disorders.

METHOD

We conducted a systematic review of PA studies from 2000 onwards. Studies included in the review had to clearly describe the proportion of suicide cases without a classifiable mental disorder or sub-threshold condition.

RESULTS

Up to 66.7% of suicide cases remained without diagnosis in those studies that only examined Axis I disorders (n = 14). Approximately 37.1% of suicide cases had no psychiatric condition in research papers that assessed personality and Axis I disorders (n = 9), and 37% of suicides had no Axis I, sub-threshold/mild conditions (n = 6). In general, areas in China and India had a higher proportion of suicides without a diagnosis than studies based in Europe, North America or Canada.

CONCLUSION

Variation in the proportion of suicide cases without a psychiatric condition may reflect cultural specificities in the conceptualization and diagnosis of mental disorder, as well as methodological and design-related differences between studies.

Exploring trait assessment of samples, persons, and cultures

I present a very broad overview of what I have learned about personality trait assessment at different levels and offer some views on future directions for research and clinical practice. I review some basic principles of scale development and argue that internal consistency has been overemphasized; more attention to retest reliability is needed. Because protocol validity is crucial for individual assessment and because validity scales have limited utility, I urge combining assessments from multiple informants, and I present some statistical tools for that purpose. As culture-level traits, I discuss ethos, national character stereotypes, and aggregated personality traits, and summarize evidence for the validity of the latter. Our understanding of trait profiles of cultures is limited, but it can guide future exploration.

Screening cluster A and cluster B personality disorders in Chinese high school students

BACKGROUND

Personality disorders (PDs) during adolescence may, in addition to increasing risk for violent behaviors and suicide, also increase risk for elevated PD traits in adulthood. The aim of this study was to explore the prevalence of Cluster A and Cluster B PD traits and their relationships to demographic variables in Chinese high school students.

METHODS

A cohort of 3,552 students from eight high schools completed the Personality Diagnostic Questionnaire-4+ (PDQ-4+) and MacArthur Scale of Subjective Social Status-youth version (SSSy) questionnaires.

RESULTS

Boys scored higher than girls on the paranoid, schizotypal, antisocial, and narcissistic PDs. Freshmen and sophomores scored higher than juniors on schizoid, borderline, and antisocial PDs. Children in single-child families scored higher than nonsingletons on the paranoid and antisocial PDs. Students from single-parent households scored higher than students from double-parent households on the schizotypal and antisocial PDs, and students with remarried parents scored higher than students from double-parent households on the borderline and antisocial PDs. Students who had low perception of social status in the society ladder scored higher than those with a high perceived status on the schizoid and borderline PDs, but scored lower on the histrionic PD; students with a low subjective social status in the school community ladder scored higher scores than those with a high perceived status on the paranoid, schizoid, borderline, and antisocial PDs, but scored lower on the histrionic PD.

CONCLUSIONS

Gender, grade, family structure, and subjective social status may affect the development of PDs. Longitudinal studies and studies of the full scope of PDs are needed to fully elucidate the impact of demographic variables on PD prevalence rates in adolescence and adulthood.

Prevalence of personality disorders using two diagnostic systems in psychiatric outpatients in Shanghai, China: a comparison of uni-axial and multi-axial formulation

OBJECTIVE

To compare multi-axial (DSM-IV) with uni-axial diagnostic system (CCMD-3, Chinese Classification and Diagnostic Criteria of Mental Disorders) as diagnostic methods to determine the prevalence of personality disorders (PDs) in Chinese psychiatric outpatients.

METHOD

3,075 outpatients were randomly sampled from clinical settings in China. CCMD-3 PDs were evaluated as per routine psychiatric practice. DSM-IV PDs were assessed using both self-reported questionnaire and structured clinical interview.

RESULTS

The prevalence estimate for any type of PD in the total sample is 31.93% as reflected in the DSM-IV. This figure is nearly 110 times as large as the prevalence estimate for the CCMD-3. Only 9 outpatients were diagnosed with PD based on the CCMD-3. Amongst the 10 forms of DSM-IV PDs, avoidant (8.1%), obsessive-compulsive (7.6%), paranoid (6.0%), and borderline (5.8%) PDs were the most prevalent subtypes. This study found that PDs are commonly associated with the following: (i) the younger aged; (ii) single marital status; (iii) those who were not raised by their parents; (iv) introverted personalities; (v) first-time seekers of psycho-counseling treatment; and (vi) patients with co-morbid mood or anxiety disorders.

CONCLUSIONS

PDs are easily overlooked when the diagnosis is made based on the CCMD-3 uni-axial diagnostic system. However, it was found that personality pathology is common in the Chinese psychiatric community when using the DSM-IV classification system. Existing evidence suggest, at least indirectly, that there are important benefits of moving towards a multi-axial diagnostic approach in psychiatric practice.

Are DSM-IV-TR borderline personality disorder, ICD-10 emotionally unstable personality disorder, and CCMD-III impulsive personality disorder analogous diagnostic categories across psychiatric nomenclatures?

This study examined the validity of the borderline construct which encompasses diagnostic criteria from the DSM-IV-TR Borderline Personality Disorder (BPD), ICD-10 Emotionally Unstable Personality Disorder (EUPD), and CCMD-III Impulsive Personality Disorder (IPD) in a sample of 1,419 Chinese psychiatric patients. Participants completed the Chinese Personality Disorder Inventory and the Chinese Personality Assessment Inventory-2 assessing various disordered personality features. Adequate internal consistency was found for the borderline construct (α = .83). Exploratory factor analysis revealed two components: (1) affective and cognitive disturbances, and (2) impulse dysregulation, which were replicated by confirmatory factor analysis. Item analysis indicated that the various borderline criteria displayed similar levels of diagnostic efficiency, which does not support the elimination of fear of abandonment and transient psychotic features from the EUPD and IPD criteria set. Findings of this study suggest that BPD, EUPD, and IPD may represent analogous diagnostic categories across classification systems.

Role of childhood traumatic experience in personality disorders in China

BACKGROUND

There has been no large-scale examination of the association between types of childhood abuse and personality disorders (PDs) in China using standardized assessment tools and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. Hence, this study aimed to explore the relationship between retrospective reports of various types of childhood maltreatments and current DSM-IV PDs in a clinical population in China, Shanghai.

METHOD

One thousand four hundred two subjects were randomly sampled from the Shanghai Psychological Counselling Centre. PDs were assessed using the Personality Diagnostic Questionnaire, Fourth Edition Plus. Participants were also interviewed using the Structured Clinical Interview for DSM-IV axis II. The Child Trauma Questionnaire (CTQ) was used to assess childhood maltreatment in 5 domains (emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect).

RESULTS

According to Pearson correlations, childhood maltreatment had a strong association with most PDs. Subsequently, using partial correlations, significant relationships were also demonstrated between cluster B PDs and all the traumatic factors except physical neglect. A strongest positive correlation was found between cluster B PD and CTQ total scores (r = .312, P < .01). Using the Kruskal-Wallis rank sum test, significant differences in 4 groups of subjects (clusters A, B, and C PD and non-PD) in terms of emotional abuse (χ(2) = 34.864, P < .01), physical abuse (χ(2) = 14.996, P < .05), sex abuse (χ(2) = 9.211, P < .05), and emotional neglect (χ(2) = 17.987, P < .01) were found. Stepwise regression analysis indicated that emotional abuse and emotional neglect were predictive for clusters A and B PD, and sexual abuse was highly predictive for cluster B PD; only emotional neglect was predictive for cluster C PD.

CONCLUSION

Early traumatic experiences are strongly related to the development of PDs. The effects of childhood maltreatment in the 3 clusters of PDs are different. Childhood trauma has the most significant impact on cluster B PD.

Frequency of borderline personality disorder among psychiatric outpatients in Shanghai

The objective of this study was to investigate the frequency, clinical characteristics, and comorbidity of borderline personality disorder (BPD) among psychiatric outpatients in two clinics at Shanghai Mental Health Center. A cross-sectional investigation was conducted. From 3,075 outpatients screened using the Personality Diagnostic Questionnaire-IV+, 2,284 patients positive for a personality disorder were assessed using the Structured Clinical Interview for DSM-IV Personality Disorders. The frequency of BPD among the psychiatric outpatients was 5.8%, with a frequency of 3.5% among males and 7.5% among females (p < .01). BPD was found to have extensive comorbidity with Axis I and II disorders. This study proves that BPD does occur in China. The detected frequency among outpatients is lower than that reported in North America.

Age and remission of personality pathology in the psychotic disorders compared to mood and/or anxiety disorders

In order to explore age-related differences in personality pathology between psychotic disorder (PSD) and mood and/or anxiety disorder (MAD) among psychiatric outpatients, 2,354 subjects were sampled randomly from outpatients in Shanghai and divided into two groups: PSD (N = 951) and MAD (N = 1403). Dimensional scores for personality disorder (PD) traits were assessed by using a self-reported personality diagnostic questionnaire (PDQ4+). Significant age differences were observed in most of the PD traits in MAD patients. Cluster B and C PD traits displayed an apparent decrease with age in MAD group, but such decline trend was not evident in PSD group. In both groups, the decline of self-reported Cluster A PD traits were less visible than the other clusters. Age-related mellowing of some PD traits such as "dramatic, erratic, anxious" occurred primarily in MAD patients; however the same traits in PSD patients appear to be less resistant to aging. Besides, "old eccentric" PD traits in both MAD and PSD patients seem to be maintained and less modified by aging.

Early maladaptive schemas and personality disorder symptoms: An examination in a non-clinical sample

OBJECTIVE

This study aimed to examine the overall and specific relationship between early maladaptive schemas (EMSs) and personality disorder (PD) symptoms in a non-clinical sample.

DESIGN

While a notable previous study has examined the relationship between EMSs and PD symptoms after statistically controlling for gender and within-cluster PD symptoms, they did not control for comorbid axis I and inter-cluster PD symptoms. Hence, we redressed this methodological problem by statistically controlling for these conditions in a series of multiple regressions.

METHODS

In a sample of 178 non-clinical participants, we obtained self-reports of PD symptoms, depression, anxiety, eating disorder, and EMSs.

RESULTS

Results of a series of multiple regressions found that EMSs significantly predicted all PD symptoms apart from borderline and antisocial PDs and our hypotheses were largely consistent with hypotheses for cluster A and C PDs. We also found that specific EMSs differentially predicted PD subtypes even after controlling for other PD symptoms, depression, anxiety, and eating disorder symptoms.

CONCLUSION

This study supports the contention that PDs are related to EMSs and there are specific relationships between particular EMSs and particular PDs.