Personality disorders as maladaptive, extreme variants of normal personality: borderline personality disorder and neuroticism in a substance using sample

Pathological personality in relation to multiple domains of quality of life and impairment: Evidence for the specific relevance of the maladaptive poles of major trait domains

The current study examined whether personality domains have nonmonotonic relationships with functional outcomes, specifically in relation to quality of life and impairment. Four samples were utilized, which were drawn from the United States and Germany. Personality trait domains were measured via the IPIP-NEO and PID-5; quality of life (QoL) was measured with the WHOQOL-BREF, and impairment was measured using the WHODAS-2.0. The PID-5 was analyzed in all four samples. Two-line testing, which fits two spline regression lines separated at a break point, was conducted to evaluate potential nonmonotonicity of the relationship between personality traits and quality of life. Overall, results demonstrated little support for nonmonotonic relationships in the PID-5 and IPIP-NEO dimensions. Rather, our results indicate that there is one clear pathological pole of major domains of personality that is associated with lower quality of life and increased impairment. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Comparison of executive functions in individuals with high and low levels of schizotypal trait

The dimensional approach to Schizotypal Personality Disorder (SPD) indicates that SPD includes a constellation of maladaptive personality traits on a continuum with general personality functioning. This study aimed to compare executive functions (EFs) in low and high-level schizotypal individuals. Using a convenient sampling method, we recruited 120 individuals, from which 30 individuals with high schizotypal trait levels (fourth quartile) and 30 participants with lower schizotypal trait levels (first quartile) were selected based on their scores on the schizotypal personality disorder questionnaire. Then, participants from the two groups were administered the Corsi Block-Tapping Test (CBTT), Wisconsin Card Sorting Test (WCST), and Continuance Performance Test (CPT). The results indicated individuals with higher schizotypy trait levels performed significantly poorer in tasks measuring working-visual-spatial memory, cognitive flexibility, sustained attention, and response inhibition. This pattern of results indicated that EF dysfunctions in individuals with higher schizotypy trait levels would cause significant disturbances in multiple areas of life. The practical implications of the findings are further discussed.

The Synergistic Effects of Neuroticism and Extraversion on Suicidal Ideation, Single Attempts, and Multiple Attempts in an Inpatient Sample

The current study sought to investigate the differential risk/protective factors of neuroticism and extraversion among individuals with only suicide ideation, those with a single suicide attempt, and those with multiple attempts. We hypothesized that extraversion would moderate the relation between neuroticism and suicide attempts (single and multiple) but not ideation. Patients in a private facility (N = 3343) completed measures assessing suicide history and general personality traits. Four moderation analyses were conducted with extraversion moderating the relationship between neuroticism and suicide ideation, single attempt (compared to zero attempts), and multiple attempts (compared to zero attempts and to single attempts). Extraversion moderated neuroticism only when comparing individuals with multiple suicide attempts to those with no attempts. Individuals who were low in both neuroticism and extraversion had higher levels of attempts than individuals with low neuroticism and high extraversion, highlighting the importance of considering biological predispositions as risk factors for suicide.

Where are the active ingredients for borderline personality disorder? The importance of heightened triggers, two arguments for traits, and two arguments for Criterion A

We are grateful that insightful experts took the time to comment on our article, and we find their comments both elucidating and advancing. In response to the commentaries, we consider 3 possible locations for the active ingredients producing borderline personality disorder symptoms. First, we offer a more optimistic case that the active ingredients may be in Personality Inventory for DSM-5 traits because of the important role of heightened trigger frequency in accounting for elevated symptoms (with some caveats). Second, we support the commenters' arguments that active ingredients may be in dysfunction in the self and in relationships, as in Criterion A. Third, we offer an argument that the active ingredients may be in normal traits, but that the conception and measurement of normal traits need to be updated in light of the connection between normal traits and personality disorders. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Do normal personality traits connect to the dynamic processes of psychopathology?

The purpose of this article is to reveal whether traits can predict the core processes constituting borderline personality disorder (BPD). A large sample, including many with BPD, completed personality questionnaires and reported trigger and symptom experiences 5 times per day for 2 weeks. Multilevel modeling revealed first that symptoms were strongly contingent upon concurrent triggers and that BPD's association to symptoms was largely due to this contingency. Second, personality traits predicted all components of this process: trigger experiences, symptom intensity, and the contingency of the symptoms on triggers. However, normal personality traits only partially accounted for the heightened experience of triggers, elevated symptoms, and magnified reactivity to triggers among those with BPD. Thus, normal personality traits are capable of explaining the dynamic processes characteristic of clinical disorders, meaning that normal traits can elucidate even complex dynamic clinical processes. However, traits appear to only partially contain the active ingredients responsible for the core process in BPD. Aspects of the disorder other than traits may account for the heightened trigger experience, elevated symptom intensity, and magnified reactivity to triggers in those with BPD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Reliability and validity of the Hungarian version of the Personality Inventory for DSM-5 (PID-5)

Objectives and methods

In order to assess the internal consistency, fit indexes, test-retest reliability, and validity of the Personality Inventory for the DSM-5 (PID-5) and its associations with age, gender, and education, 471 non-clinical (69,6% female; mean age: 37,63) and 314 clinical participants (69,7% female, mean age: 37,41) were administered the Hungarian translation of the PID-5, as well as the SCL-90-R and the SCID-II Personality Questionnaire.

Results

We found that; (a) temporal consistency of the Hungarian PID-5 was confirmed by one-month test-retest reliability analysis, (b) validity of the PID-5 instrument is acceptable in the clinical and the non-clinical sample as well, based on significant correlations with SCID-II and SCL-90-R, (c) PID-5 facets’ and domains’ associations with gender, age, and level of education are in accordance with previous findings.

Conclusion

These findings support that the Hungarian PID-5 is a reliable and valid instrument for both clinical and non-clinical populations.

Psychometric properties of the Persian version of short-form five factor borderline inventory (FFBI-SF)

BACKGROUND

The Five-Factor Borderline Inventory-Short Form (FFBI-SF) is a self-report measure developed to assess traits of Borderline Personality Disorder (BPD) from the perspective of the Five-Factor Model of general personality. This study was designed to examine the factor structure, internal consistency, and convergent/discriminant validity of the Persian FFBI-SF in a sample of Iranian university students.

METHODS

A total of 641 university students (M-age = 28.04, SD = 8.21, 66.7% women) completed the online forms of the FFBI-SF, PID-5-BF, and Mini IPIP.

RESULTS

Confirmatory factor analysis supported the original and modified (without item 47) twelve-factor models. Also, Cronbach's alpha (α) for the FFBI-SF scores ranged from unacceptable to excellent ranges. However, when relying on MIC values to measure internal consistency, the FFBI-SF Total and subscale scores demonstrated adequate internal consistency. Finally, the FFBI Total and subscale scores showed the expected relations with other personality measures scores (e.g., Neuroticism, Antagonism, and Conscientiousness), which supports the validity of the interpretation of the FFBI-SF scores.

CONCLUSIONS

The findings indicated that FFBI-SF is a useful tool with sound psychometric properties for assessing BPD traits in Iranian students and may spark research in other Iranian settings (e.g., community and clinical samples).

Development and initial evaluation of the ICD-11 personality disorder severity scale: PDS-ICD-11

AIM

No measure has formally been developed to assess the published ICD-11 model of Personality Disorder (PD) severity. We therefore set out to develop and evaluate the 14-item Personality Disorder Severity ICD-11 (PDS-ICD-11) scale.

METHOD

A representative U.S. community sample (N = 428; 50.9% women) and a New Zealand mental health sample (N = 87; 61.5% women) completed the PDS-ICD-11 scale along with a series of established PD and impairment measures.

RESULTS

Item response theory supported the unidimensionality of PDS-ICD-11 (median item loading of 0.68) and indicated that a PDS-ICD-11 score of 17.5 may serve as a benchmark for pronounced dysfunction. Correlation and regression analyses supported both criterion validity and incremental validity in predicting impairment and PD symptoms. The PDS-ICD-11 was particularly associated with measures of Level of Personality Functioning Scale (LPFS), Global PD severity, and Borderline PD symptom score. A comparison between clinical individuals diagnosed with an ICD-11 PD vs. no PD supported diagnostic validity.

CONCLUSION

This initial construction study suggests that the PDS-ICD-11 constitutes a promising instrument that provides a quick impression of the severity of personality dysfunction according to the official ICD-11 PD guidelines. Clearly, more research is needed to corroborate its validity and utility. The PDS-ICD-11 scale is provided as online supporting information.

Longitudinal associations between borderline personality disorder and five-factor model traits over 24 years

Are five-factor traits and borderline personality symptoms the same features with different names? The existing literature offers reasons to think they are the same and reasons to think they are different. We examined longitudinal associations between these variables in a sample of patients assessed 12 times over 24 years using latent curve models with structured residuals. Mean trajectories for all variables were in the direction of symptom reduction/personality maturation and could be parsed into an initial, rapid improvement phase and a subsequent, gradual improvement phase. We found robust between-person associations among intercepts and long-term slopes of traits and symptoms. Specifically, higher levels of neuroticism as well as lower levels of extraversion, agreeableness, and conscientiousness were associated with higher levels of borderline personality symptoms, and changes in these traits were correlated with reduction in symptoms over time. Associations among time-structured residuals allowed for examinations of within-person deflections from these general trends at briefer (two year) intervals. All variables exhibited robust within-person carry-over effects. Other within-person effects were more specific to certain traits. These results suggest that, despite their distinct theoretical and methodological bases, normal trait and psychiatric diagnostic approaches largely converged on a similar conception of borderline personality.

A response surface analysis investigation of the effects of (mis)alignment between interpersonal values and efficacies on interpersonal problems

OBJECTIVE

In this study we examined whether discrepancies between interpersonal values and interpersonal efficacies are associated with distress, and provide a framework through which similar questions regarding intrapersonal alignment may be investigated.

METHOD

Using interpersonal circumplex scales, we assessed interpersonal values and efficacies in two large samples (undergraduate N = 1,453, community N = 1,099) and used response surface analysis to model the alignment of these variables and their association with interpersonal distress.

RESULTS

We found that there were significant positive relationships between larger mismatches and greater distress. We also found that extremity in both matches and mismatches predicted more distress. At a more specific level, people who valued warmth but reported low efficacy for warm behavior reported problems related to being too cold to others.

CONCLUSION

This study highlights the value of elaborating within-person discrepancies across personality levels, provides a model for doing so organized around the interpersonal circumplex, and specifies connections between value-efficacy discrepancies and interpersonal distress.

Parents' Personality-Disorder Symptoms Predict Children's Symptoms of Anxiety and Depressive Disorders - a Prospective Cohort Study

Personality disorder (PD) symptomatology is characterized by interpersonal problems and emotional dysregulation, which may affect offspring of parents with PD symptoms. Notably though, studies are needed to discern (i) whether parental PDs forecast symptoms of psychiatric disorders in offspring during their childhood years and (ii) whether such prospective relations obtain after accounting for common causes (e.g., genetics, common methods). To address these issues, we followed up a community sample of Norwegian children biennially from ages 4 to 8 (n = 594), using a semi-structured psychiatric interview (PAPA/CAPA) to capture DSM-IV defined symptoms of emotional disorders. Parental symptoms of personality disorders were captured by the DSM-IV and ICD-10 Personality Questionnaire (DIP-Q), whereas depression and anxiety in caregivers were measured using the Beck Depression Inventory -II and Beck Anxiety Inventory, respectively. Upon applying a hybrid fixed and random effects method that takes into account all unmeasured time-invariant confounders, we found that: (i) Parental symptoms of DSM-IV defined Cluster A and C were related to symptoms of anxiety disorders in offspring two years later, even after accounting for children's initial levels of anxiety and parental anxiety, whereas (ii) Parental DSM-IV Cluster B predicted symptoms of depressive disorders in children, adjusted for children's initial levels of depression and parental depression. Clinical implications of the results are discussed.

The Roles of Emotion Regulation Difficulties and Impulsivity in the Associations between Borderline Personality Disorder Symptoms and Frequency of Nonprescription Sedative Use and Prescription Sedative/Opioid Misuse

Despite evidence of a strong relationship between BPD and substance use problems in general, little research has examined the associations of BPD symptoms with the misuse of sedatives or opioids, and no studies have explored possible factors that may underlie these associations. Thus, this study examined the relationships of BPD symptoms (i.e., the number of BPD criteria with threshold ratings on a diagnostic interview) to nonprescription sedative use, nonprescription opioid use, and prescription sedative/opioid misuse among 194 patients with alcohol and/or cocaine dependence in a residential substance use disorder treatment facility, as well as the roles of two theoretically-relevant factors in these relationships: emotion regulation (ER) difficulties and impulsivity facets. We found significant positive associations between BPD symptoms and nonprescription sedative use, nonprescription opioid use, and prescription sedative/opioid misuse. We also found significant positive indirect relationships of BPD symptoms to nonprescription sedative use through ER difficulties, ab = .04, 95% CI [.003, .09], and to prescription sedative/opioid misuse through two facets of impulsivity: lack of perseverance, ab = .05, 95% CI [.01, .11], and negative urgency, ab = .03, 95% CI [.002, .07]. Findings highlight the differential relevance of ER difficulties and impulsivity dimensions to the relationships of BPD symptoms to nonprescription sedative use and prescription sedative/opioid misuse, respectively, among patients with alcohol and/or cocaine dependence.

Clinical, personality, and neurodevelopmental phenotypes in borderline personality disorder: a family study

BACKGROUND

Borderline personality disorder (BPD) is characterized by a heterogeneous clinical phenotype that emerges from interactions among genetic, biological, neurodevelopmental, and psychosocial factors. In the present family study, we evaluated the familial aggregation of key clinical, personality, and neurodevelopmental phenotypes in probands with BPD (n = 103), first-degree biological relatives (n = 74; 43% without a history of psychiatric disorder), and non-psychiatric controls (n = 99).

METHODS

Participants were assessed on DSM-IV psychiatric diagnoses, symptom dimensions of emotion dysregulation and impulsivity, 'big five' personality traits, and neurodevelopmental characteristics, as part of a larger family study on neurocognitive, biological, and genetic markers in BPD.

RESULTS

The most common psychiatric diagnoses in probands and relatives were major depression, substance use disorders, post-traumatic stress disorder, anxiety disorders, and avoidant personality disorder. There was evidence of familial aggregation for specific dimensions of impulsivity and emotion dysregulation, and the big five traits neuroticism and conscientiousness. Both probands and relatives reported an elevated neurodevelopmental history of attentional and behavioral difficulties.

CONCLUSIONS

These results support the validity of negative affectivity- and impulse-spectrum phenotypes associated with BPD and its familial risk. Further research is needed to investigate the aggregation of neurocognitive, neural and genetic factors in families with BPD and their associations with core phenotypes underlying the disorder.

Trait neuroticism and emotion neurocircuitry: Functional magnetic resonance imaging evidence for a failure in emotion regulation

Though theory suggests that individual differences in neuroticism (a tendency to experience negative emotions) would be associated with altered functioning of the amygdala (which has been linked with emotionality and emotion dysregulation in childhood, adolescence, and adulthood), results of functional neuroimaging studies have been contradictory and inconclusive. We aimed to clarify the relationship between neuroticism and three hypothesized neural markers derived from functional magnetic resonance imaging during negative emotion face processing: amygdala activation, amygdala habituation, and amygdala-prefrontal connectivity, each of which plays an important role in the experience and regulation of emotions. We used general linear models to examine the relationship between trait neuroticism and the hypothesized neural markers in a large sample of over 500 young adults. Although neuroticism was not significantly associated with magnitude of amygdala activation or amygdala habituation, it was associated with amygdala-ventromedial prefrontal cortex connectivity, which has been implicated in emotion regulation. Results suggest that trait neuroticism may represent a failure in top-down control and regulation of emotional reactions, rather than overactive emotion generation processes, per se. These findings suggest that neuroticism, which has been associated with increased rates of transdiagnostic psychopathology, may represent a failure in the inhibitory neurocircuitry associated with emotion regulation.

Perspective Change and Personality State Variability: An Argument for the Role of Self-Awareness and an Outlook on Bidirectionality (Commentary on Wundrack et al., 2018)

In a recent article, Wundrack et al. (2018) put forward an elaborate and intriguing hypothesis on enhanced perspective-taking (Theory of Mind) ability as a consequence of higher personality state variability. While there is evidence in favor of this hypothesis, the clinical examples of bipolar disorder and borderline personality disorder, as highlighted by the authors, demonstrate that a high state variability can also be accompanied by a lower perspective-taking ability (as commonly observed in these disorders). We suggest that only those state changes which are initiated on a voluntary basis and are accompanied by self-awareness go along with a higher perspective-taking ability. Introducing self-awareness as a moderating factor might help explain seemingly conflicting findings related to the hypothesis proposed in the target article. Moreover, we argue that the direction of causality proposed in the target article is not the only conceivable one, and perspective-taking ability could also be a cause, not just a consequence, of personality state variability. Finally, we provide suggestions on how these hypotheses could be tested in future studies.

Borderline Personality Disorder: Associations Between Dimensional Personality Profiles and Self-Destructive Behaviors

Ongoing research is shifting towards a dimensional understanding of borderline personality disorder (BPD). Aim of this study was to identify personality profiles in BPD that are predictive of self-destructive behaviors. Personality traits were assessed (n = 130) according to the five-factor model of personality (i.e., Neuroticism, Extraversion, Openness to Experience, Agreeableness, Conscientiousness) and an additional factor called Risk Preference. Self-destructive behavior parameters such as non-suicidal self-injury (NSSI) and other borderline typical dyscontrolled behaviors (e.g., drug abuse) were assessed by self-report measures. Canonical correlation analyses demonstrated that Neuroticism, Extraversion, and Conscientiousness are predictors of NSSI. Further, Neuroticism, Agreeableness, and Risk Preference were associated with dyscontrolled behaviors. Our results add further support on personality-relevant self-destructive behaviors in BPD. A combined diagnostic assessment could offer clinically meaningful insights about the causes of self-destruction in BPD to expand current therapeutic repertoires.

Neuroticism and suicide in a general population cohort: results from the UK Biobank Project

BACKGROUND

Neuroticism has often been linked to suicidal thoughts and behaviour.

AIMS

To examine whether neuroticism is associated with suicide deaths after adjusting for known risks.

METHOD

UK Biobank participants (n = 389 365) were assessed for neuroticism as well as social, demographic and health-related variables at study entry and followed for up to 10 years. Suicide risk was modelled using Cox regression stratified by gender.

RESULTS

Neuroticism increased the risk of suicide in both men (hazard ratio (HR) = 1.15, 95% CI 1.09-1.22) and women (HR = 1.16, 95% CI 1.06-1.27). In a subsample who were assessed for mood disorders, neuroticism remained a significant predictor for women (HR 1.25, 95% CI 1.03-1.51) but not for men.

CONCLUSIONS

Screening and therapeutic interventions for neuroticism may be important for early suicide prevention.

DECLARATION OF INTEREST

None.

Relationships between self-reported childhood traumatic experiences, attachment style, neuroticism and features of borderline personality disorders in patients with mood disorders

BACKGROUND

Co-occurring borderline personality disorder (BPD) features have a marked impact on treatment of patients with mood disorders. Overall, high neuroticism, childhood traumatic experiences (TEs) and insecure attachment are plausible aetiological factors for BPD. However, their relationship with BPD features specifically among patients with mood disorders remains unclear. We investigated these relationships among unipolar and bipolar mood disorder patients.

METHODS

As part of the Helsinki University Psychiatric Consortium study, the McLean Screening Instrument (MSI), the Experiences in Close Relationships-Revised (ECR-R), the Short Five (S5) and the Trauma and Distress Scale (TADS) were filled in by patients with mood disorders (n=282) in psychiatric care. Correlation coefficients between total scores of scales and their dimensions were estimated, and multivariate regression (MRA) and mediation analyses were conducted.

RESULTS

Spearman's correlations were strong (rho=0.58; p<0.001) between total scores of MSI and S5 Neuroticism and moderate (rho=0.42; p<0.001) between MSI and TADS as well as between MSI and ECR-R Attachment Anxiety. In MRA, young age, S5 Neuroticism and TADS predicted scores of MSI (p<0.001). ECR-R Attachment Anxiety mediated 33% (CI=17-53%) of the relationships between TADS and MSI.

LIMITATIONS

Cross-sectional questionnaire study.

CONCLUSIONS

We found moderately strong correlations between self-reported BPD features and concurrent high neuroticism, reported childhood traumatic experiences and Attachment Anxiety also among patients with mood disorders. Independent predictors for BPD features include young age, frequency of childhood traumatic experiences and high neuroticism. Insecure attachment may partially mediate the relationship between childhood traumatic experiences and borderline features among mood disorder patients.

Personality disorders and the DSM-5: Scientific and extra-scientific factors in the maintenance of the status quo

OBJECTIVE

The aim of this study was to review and discuss the evidence for dimensional classification of personality disorders and the historical and sociological bases of psychiatric nosology and research.

METHOD

Categorical and dimensional conceptualisations of personality disorder are reviewed, with a focus on the Diagnostic and Statistical Manual of Mental Disorders-system's categorisation and the Five-Factor Model of personality. This frames the events leading up to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, personality disorder debacle, where the implementation of a hybrid model was blocked in a last-minute intervention by the American Psychiatric Association Board of Trustees. Explanations for these events are discussed, including the existence of invisible colleges of researchers and the fear of risking a 'scientific revolution' in psychiatry.

RESULTS

A failure to recognise extra-scientific factors at work in classification of mental illness can have a profound and long-lasting influence on psychiatric nosology. In the end it was not scientific factors that led to the failure of the hybrid model of personality disorders, but opposing forces within the mental health community in general and the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Task Force in particular.

CONCLUSION

Substantial evidence has accrued over the past decades in support of a dimensional model of personality disorders. The events surrounding the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Personality and Personality Disorders Work Group show the difficulties in reconciling two different worldviews with a hybrid model. They also indicate the future of a psychiatric nosology that will be increasingly concerned with dimensional classification of mental illness. As such, the road is paved for more substantial changes to personality disorder classification in the International Classification of Diseases, 11th Revision, in 2017.

Capturing the DSM-5 Alternative Personality Disorder Model Traits in the Five-Factor Model's Nomological Net

Several studies have shown structural and statistical similarities between the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) alternative personality disorder model and the Five-Factor Model (FFM). However, no study to date has evaluated the nomological network similarities between the two models. The relations of the Revised NEO Personality Inventory (NEO PI-R) and the Personality Inventory for DSM-5 (PID-5) with relevant criterion variables were examined in a sample of 336 undergraduate students (M_age  = 19.4; 59.8% female). The resulting profiles for each instrument were statistically compared for similarity. Four of the five domains of the two models have highly similar nomological networks, with the exception being FFM Openness to Experience and PID-5 Psychoticism. Further probing of that pair suggested that the NEO PI-R domain scores obscured meaningful similarity between PID-5 Psychoticism and specific aspects and lower-order facets of Openness. The results support the notion that the DSM-5 alternative personality disorder model trait domains represent variants of the FFM domains. Similarities of Openness and Psychoticism domains were supported when the lower-order aspects and facets of Openness domain were considered. The findings support the view that the DSM-5 trait model represents an instantiation of the FFM.

Predicting Personality Disorder Functioning Styles by the Five-Factor Nonverbal Personality Questionnaire in Healthy Volunteers and Personality Disorder Patients

BACKGROUND

Detecting personality disorders in the illiterate population is a challenge, but nonverbal tools measuring personality traits such as the Five-Factor Nonverbal Personality Questionnaire (FFNPQ) might help. We hypothesized that FFNPQ traits are associated with personality disorder functioning styles in a predictable way, especially in a sample of personality disorder patients.

METHODS

We therefore invited 106 personality disorder patients and 205 healthy volunteers to answer the FFNPQ and the Parker Personality Measure (PERM) which measures 11 personality disorder functioning styles.

RESULTS

Patients scored significantly higher on the FFNPQ neuroticism and conscientiousness traits and all 11 PERM styles. In both groups, the 5 FFNPQ traits displayed extensive associations with the 11 PERM styles, respectively, and the associations were more specific in patients. Associations between neuroticism, extraversion and agreeableness traits and most PERM styles were less exclusive, but conscientiousness was associated with antisocial (-) and obsessive-compulsive styles, and openness to experience with schizotypal and dependent (-) styles.

CONCLUSIONS

Our study has demonstrated correlations between FFNPQ traits and PERM styles, and implies the nonverbal measure of personality traits is capable of aiding the diagnoses of personality disorders in the illiterate population. Enlarging sample size and including the illiterate might make for more stable results.

Exploring the relation between childhood trauma, temperamental traits and mindfulness in borderline personality disorder

BACKGROUND

Deficits in mindfulness-related capacities have been described in borderline personality disorder (BPD). However, little research has been conducted to explore which factors could explain these deficits. This study assesses the relationship between temperamental traits and childhood maltreatment with mindfulness in BPD.

METHODS

A total of 100 individuals diagnosed with BPD participated in the study. Childhood maltreatment was assessed using the Childhood Trauma Questionnaire (CTQ-SF), temperamental traits were assessed using the Zuckerman-Khulman Personality Questionnaire (ZKPQ), and mindfulness capabilities were evaluated with the Five Facet Mindfulness Questionnaire (FFMQ).

RESULTS

Hierarchical regression analyses were performed including only those CTQ-SF and ZKPQ subscales that showed simultaneous significant correlations with mindfulness facets. Results indicated that neuroticism and sexual abuse were predictors of acting with awareness; and neuroticism, impulsiveness and sexual abuse were significant predictors of non-judging. Temperamental traits did not have a moderator effect on the relationship between childhood sexual abuse and mindfulness facets.

CONCLUSIONS

These results provide preliminary evidence for the effects of temperamental traits and childhood trauma on mindfulness capabilities in BPD individuals. Further studies are needed to better clarify the impact of childhood traumatic experiences on mindfulness capabilities and to determine the causal relations between these variables.

Clinical utility of the DSM-5 alternative model of personality disorders: six cases from practice

In Section III, Emerging Measures and Models, DSM-5 presents an Alternative Model of Personality Disorders, which is an empirically based model of personality pathology measured with the Level of Personality Functioning Scale (LPFS) and the Personality Inventory for DSM-5 (PID-5). These novel instruments assess level of personality impairment and pathological traits. Objective. A number of studies have supported the psychometric qualities of the LPFS and the PID-5, but the utility of these instruments in clinical assessment and treatment has not been extensively evaluated. The goal of this study was to evaluate the clinical utility of this alternative model of personality disorders. Method. We administered the LPFS and the PID-5 to psychiatric outpatients diagnosed with personality disorders and other nonpsychotic disorders. The personality profiles of six characteristic patients were inspected (involving a comparison of presenting problems, history, and diagnoses) and used to formulate treatment considerations. We also considered 6 specific personality disorder types that could be derived from the profiles as defined in the DSM-5 Section III criteria. Results. Using the LPFS and PID-5, we were able to characterize the 6 cases in a meaningful and useful manner with regard to understanding and treatment of the individual patient and to match the cases with 6 relevant personality disorder types. Implications for ease of use, communication, and psychotherapy are discussed. Conclusion. Our evaluation generally supported the utility for clinical purposes of the Alternative Model for Personality Disorders in Section III of the DSM-5, although it also identified some areas for refinement. (Journal of Psychiatric Practice 2015;21:3-25).

Associations between changes in normal personality traits and borderline personality disorder symptoms over 16 years

There has been significant movement toward conceptualizing borderline personality disorder (BPD) with normal personality traits. However, 1 critical assumption underlying this transition, that longitudinal trajectories of BPD symptoms and normal traits track together, has not been tested. We evaluated the prospective longitudinal associations of changes in Five-Factor Model traits and BPD symptoms over the course of 16 years using parallel process latent growth curve models in 362 patients with BPD (n = 290) or other PDs (n = 72). Moderate to strong cross-sectional and longitudinal associations were observed between BPD symptoms and Neuroticism, Extraversion, Agreeableness, and Conscientiousness. This study is the first to demonstrate a longitudinal link between changes in BPD symptoms and changes in traits over an extended interval in a clinical sample. These findings imply that changes in BPD symptoms occur in concert with changes in normal traits, and support the proposed transition to conceptualizing BPD, at least in part, with trait dimensions.

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.

Dimensional models of personality: the five-factor model and the DSM-5

It is evident that the classification of personality disorder is shifting toward a dimensional trait model and, more specifically, the five-factor model (FFM). The purpose of this paper is to provide an overview of the FFM of personality disorder. It will begin with a description of this dimensional model of normal and abnormal personality functioning, followed by a comparison with a proposal for future revisions to DSM-5 and a discussion of its potential advantages as an integrative hierarchical model of normal and abnormal personality structure.

First principles of Hamiltonian medicine

We introduce the field of Hamiltonian medicine, which centres on the roles of genetic relatedness in human health and disease. Hamiltonian medicine represents the application of basic social-evolution theory, for interactions involving kinship, to core issues in medicine such as pathogens, cancer, optimal growth and mental illness. It encompasses three domains, which involve conflict and cooperation between: (i) microbes or cancer cells, within humans, (ii) genes expressed in humans, (iii) human individuals. A set of six core principles, based on these domains and their interfaces, serves to conceptually organize the field, and contextualize illustrative examples. The primary usefulness of Hamiltonian medicine is that, like Darwinian medicine more generally, it provides novel insights into what data will be productive to collect, to address important clinical and public health problems. Our synthesis of this nascent field is intended predominantly for evolutionary and behavioural biologists who aspire to address questions directly relevant to human health and disease.

Dimensional models of personality: the five-factor model and the DSM-5

It is evident that the classification of personality disorder is shifting toward a dimensional trait model and, more specifically, the five-factor model (FFM). The purpose of this paper is to provide an overview of the FFM of personality disorder. It will begin with a description of this dimensional model of normal and abnormal personality functioning, followed by a comparison with a proposal for future revisions to DSM-5 and a discussion of its potential advantages as an integrative hierarchical model of normal and abnormal personality structure.