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Adamis D, Kasianenko D, Usman M, Saleem F, Wrigley M, Gavin B, McNicholas F. Prevalence of Personality Disorders in Adults With Attention Deficit Hyperactivity Disorder (ADHD). J Atten Disord 2023; 27:658-668. [PMID: 36927130 DOI: 10.1177/10870547231161531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE To estimate the prevalence of PDs according to Millon's evolution-based model among adult ADHD outpatients. METHOD Cross-sectional study of consecutive patients referred to an adult ADHD clinic. PDs were evaluated with Millon Clinical Multiaxial Inventory-III (MCMI-III). RESULTS One-hundred-eighty-one participants had valid MCMI-III, of whom147 were diagnosed with ADHD. Mean age: 32.97, SD:11.56, females: 74 (50.3%). Among the 147 participants with ADHD, 29 (19.7%) did not meet criteria for any PD, 43 (29.3%) met the criteria for one PD, 34 (23.1%) for two PDs and the rest three or more. Most common PD was Dependent (n = 58) followed by Depressive (n = 45). Inattentive sub-type was associated with dependent PD, while combined type with antisocial, negativistic (passive/aggressive) and sadistic PD. CONCLUSION Particular personality profiles were more common with different ADHD subtypes. Given the developmental origins of PD, further research may help identify possible links with childhood difficulties.
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Affiliation(s)
| | | | | | | | - Margo Wrigley
- National Clinical Programme for Adult ADHD, Dublin, Ireland
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2
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Jacobsson P, Hopwood CJ, Söderpalm B, Nilsson T. Adult ADHD and emerging models of maladaptive personality: a meta-analytic review. BMC Psychiatry 2021; 21:282. [PMID: 34074265 PMCID: PMC8170979 DOI: 10.1186/s12888-021-03284-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/13/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND ADHD is a highly consequential disorder that is estimated to affect 2.5% of the adult population. Emerging models of psychopathology posit that disorders like ADHD can be usefully situated within general models of individual differences in personality, such as those recently implemented in the DSM and ICD for the diagnosis of personality disorder. Previous research and systematic reviews have linked adult ADHD to the personality traits Conscientious Inhibition and Negative Emotionality. However, there have been some inconsistencies in the literature and research embedding ADHD-personality connections in the DSM-5 and ICD-11 personality disorder models has been limited. The goal of this paper was to systematically review associations between adult ADHD and personality traits, organized within a maladaptive five factor framework. METHOD A comprehensive literature search yielded 13 papers whose effects were meta-analyzed. RESULTS Results supported associations between ADHD and low Conscientious Inhibition and high Negative Emotionality. However, interesting patterns of variability were observed, potentially related to issues such as instrumentation and facet variation. CONCLUSION Results support the clinical application of personality assessment for suggesting risk for ADHD symptoms, and point to important directions for further research.
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Affiliation(s)
- Peter Jacobsson
- The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden. .,Psychiatry Halland, Region Halland, Sweden.
| | - Christopher J. Hopwood
- Psychiatry Halland, Region Halland, Sweden ,grid.27860.3b0000 0004 1936 9684University of California, Davis, USA
| | - Bo Söderpalm
- grid.8761.80000 0000 9919 9582The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Thomas Nilsson
- Psychiatry Halland, Region Halland, Sweden ,grid.8761.80000 0000 9919 9582Department of Forensic Psychiatry, National Board of Forensic Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Hanley C, Saleem F, Graffeo I, McCarthy G, Gavin B, McNicholas F, Adamis D. Association of Wender Utah Rating Scale (WURS)-61 items with clinical psychiatric diagnosis in adulthood. Ir J Med Sci 2021; 191:327-335. [PMID: 33665779 DOI: 10.1007/s11845-021-02574-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 02/26/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The Wender Utah Rating Scale (WURS) is a widely used retrospective scale in adults presenting for ADHD evaluations which features items relating to childhood symptoms. AIMS The aim of this study is to establish if certain childhood symptoms (including ADHD) as identified by the WURS-61 are associated with specific mental health disorders in adulthood. METHODS Case-control study of N=630 attending Adult Mental Health Services (AMHS) and a control group without mental disorders (N=96). RESULTS The mean age of the participants was 39.81 (SD 12.94) of which 387 (53.3%) were females. There were no significant differences between cases and controls in terms of age (t= 1.829, df 724, p=.068) and gender (x2=1.123, df 1, p=.289). Exploratory factor analysis of WURS-61 reveals 5 factors. Using factor scores and after cross-tabulation, we found that: The presence of childhood impulsivity, emotional lability and distress in addition to inattention/disorganisation were significantly associated with adult ADHD diagnosis (F90). WURS items which suggests childhood conduct problems were associated with a number of adult diagnoses, when present either on its own (psychoactive substance use, or when present in combination with childhood impulsivity, emotional lability and distress (personality disorders). CONCLUSION There is an association between certain childhood behaviours and risk for later development of personality disorders, and psychoactive substance use. There is overlap of childhood symptoms to those who later diagnosed in adulthood with ADHD, personality disorders, and substance abuse.
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Affiliation(s)
- Cliodhna Hanley
- Sligo Mental Health Services, Clarion Rd, Sligo, Ireland.,University College Dublin, Dublin, Ireland
| | - Faisal Saleem
- Sligo Mental Health Services, Clarion Rd, Sligo, Ireland
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Kerber A, Schultze M, Müller S, Rühling RM, Wright AGC, Spitzer C, Krueger RF, Knaevelsrud C, Zimmermann J. Development of a Short and ICD-11 Compatible Measure for DSM-5 Maladaptive Personality Traits Using Ant Colony Optimization Algorithms. Assessment 2020; 29:467-487. [PMID: 33371717 PMCID: PMC8866743 DOI: 10.1177/1073191120971848] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
While Diagnostic and Statistical Manual of Mental Disorders–Fifth
edition (DSM-5) Section III and ICD-11
(International Classification of Diseases 11th–Revision) both allow for
dimensional assessment of personality pathology, the models differ in the
definition of maladaptive traits. In this study, we pursued the goal of
developing a short and reliable assessment for maladaptive traits, which is
compatible with both models, using the item pool of the Personality Inventory
for DSM-5 (PID-5). To this aim, we applied ant colony
optimization algorithms in English- and German-speaking samples comprising a
total N of 2,927. This procedure yielded a 34-item measure with a hierarchical
latent structure including six maladaptive trait domains and 17 trait facets,
the “Personality Inventory for DSM-5, Brief Form Plus”
(PID5BF+). While latent structure, reliability, and criterion validity were
ascertained in the original and in two separate validation samples
(n = 849, n = 493) and the measure was
able to discriminate personality disorders from other diagnoses in a clinical
subsample, results suggest further modifications for capturing ICD-11
Anankastia.
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Sellbom M, Carragher N, Sunderland M, Calear AL, Batterham PJ. The role of maladaptive personality domains across multiple levels of the HiTOP structure. Personal Ment Health 2020; 14:30-50. [PMID: 31397079 DOI: 10.1002/pmh.1461] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 06/05/2019] [Accepted: 06/10/2019] [Indexed: 11/11/2022]
Abstract
This study aimed to examine associations between maladaptive personality traits and psychopathology from the perspective of the hierarchical taxonomy of psychopathology (HiTOP). We tested hierarchical structural models to further validate a portion of the structural components of HiTOP. We also tested a priori personality and psychopathology associations with three levels of the HiTOP hierarchy: general psychopathology, spectra and syndromes/disorders. We used a large sample from the general Australian population who completed a large set of personality and psychopathology inventories online. Confirmatory factor analyses indicated that internalizing, externalizing and thought dysfunction spectra emerged structurally, as expected per HiTOP, but also revealed that obsessive-compulsive disorder loaded on both internalizing and thought dysfunction and attention deficit hyperactivity disorder on both externalizing and internalizing. Furthermore, results indicated that almost all personality and psychopathology hypotheses were supported, although trait antagonism did not predict externalizing to the degree initially expected. Implications for personality and psychopathology are discussed. © 2019 John Wiley & Sons, Ltd.
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Affiliation(s)
- Martin Sellbom
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Natacha Carragher
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Matthew Sunderland
- NHMRC Centre of Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Alison L Calear
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
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Richter M, Spangenberg H, Ramklint M, Ramirez A. The clinical relevance of asking young psychiatric patients about childhood ADHD symptoms. Nord J Psychiatry 2020; 74:23-29. [PMID: 31556784 DOI: 10.1080/08039488.2019.1667427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Aim: The aim of this study was to explore the relevance of asking young psychiatric patients about childhood symptoms of attention deficit hyperactivity disorder (ADHD).Method: A total of 180 young adults (18-25 years of age) from a general psychiatric out-patient clinic in Uppsala filled in the Child and Adolescent Psychiatric Screening Inventory-Retrospect (CAPSI-R) as part of the diagnostic procedure. The study population was divided into groups based on number and subtype of reported ADHD symptoms, inattention (IN) or hyperactivity/impulsivity (HI). The clinical characteristics associated with different symptoms of ADHD were explored.Results: The groups with five or more self-reported ADHD childhood symptoms, of either IN or HI, had more psychiatric comorbid conditions, a significantly higher co-occurrence of substance use disorders and personality disorders, and experienced more psychosocial and environmental problems.Conclusion: High level of self-reported ADHD childhood symptoms in young psychiatric patients identified a group more burdened with psychiatric comorbid conditions and more psychosocial problems. This group should be offered a thorough diagnostic assessment of ADHD.
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Affiliation(s)
- M Richter
- Psychiatry, Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - H Spangenberg
- Psychiatry, Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - M Ramklint
- Psychiatry, Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - A Ramirez
- Psychiatry, Department of Neuroscience, Uppsala University, Uppsala, Sweden
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Zimmermann J, Kerber A, Rek K, Hopwood CJ, Krueger RF. A Brief but Comprehensive Review of Research on the Alternative DSM-5 Model for Personality Disorders. Curr Psychiatry Rep 2019; 21:92. [PMID: 31410586 DOI: 10.1007/s11920-019-1079-z] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Both the Alternative DSM-5 Model for Personality Disorders (AMPD) and the chapter on personality disorders (PD) in the recent version of ICD-11 embody a shift from a categorical to a dimensional paradigm for the classification of PD. We describe these new models, summarize available measures, and provide a comprehensive review of research on the AMPD. RECENT FINDINGS A total of 237 publications on severity (criterion A) and maladaptive traits (criterion B) of the AMPD indicate (a) acceptable interrater reliability, (b) largely consistent latent structures, (c) substantial convergence with a range of theoretically and clinically relevant external measures, and (d) some evidence for incremental validity when controlling for categorical PD diagnoses. However, measures of criterion A and B are highly correlated, which poses conceptual challenges. The AMPD has stimulated extensive research with promising findings. We highlight open questions and provide recommendations for future research.
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Affiliation(s)
- Johannes Zimmermann
- Department of Psychology, University of Kassel, Holländische Str. 36-38, 34127, Kassel, Germany.
| | | | - Katharina Rek
- Max-Planck-Institut für Psychiatrie, Munich, Germany
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Weiner L, Perroud N, Weibel S. Attention Deficit Hyperactivity Disorder And Borderline Personality Disorder In Adults: A Review Of Their Links And Risks. Neuropsychiatr Dis Treat 2019; 15:3115-3129. [PMID: 31806978 PMCID: PMC6850677 DOI: 10.2147/ndt.s192871] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 10/23/2019] [Indexed: 12/12/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) and borderline personality disorder (BPD) are particularly common disorders, that are highly comorbid in adult populations. The symptomatic overlap between adult ADHD and BPD includes impulsivity, emotional dysregulation and interpersonal impairment, which makes the differential diagnosis difficult. Our review aims at focusing on recent data on the comorbid ADHD+BPD form, as well as the risk factors involved in the emergence of the two disorders. While adult ADHD and BPD share some genetic and temperamental risk factors, adult ADHD is characterized by more severe trait-impulsivity compared to non-comorbid BPD; BPD patients display more severe trait-emotion regulation symptoms compared to non-comorbid ADHD. Patients with the comorbid ADHD+BPD form have severe symptoms in both dimensions. Early-life exposure to adverse events is a shared risk factor for the development of ADHD and BPD, but type and timing of adversity seem to play a differential role in the development of BPD and ADHD symptoms. Age of onset used to be a discriminative diagnostic criterion between ADHD, an early-onset neurodevelopmental disorder, and BPD, a late-onset psychological disorder. However, this distinction has been recently called into question, increasing the need for more research aiming at delineating the disorders from a developmental and clinical standpoint. Clinicians should carefully consider the comorbidity, and consider ADHD and BPD dimensionally, in order to provide more effective patient management. This might improve early preventive interventions, and treatment for comorbid conditions in adulthood.
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Affiliation(s)
- Luisa Weiner
- Department of Psychiatry, University Hospital of Strasbourg, Strasbourg, France.,Laboratoire De Psychologie Des Cognitions, University of Strasbourg, Strasbourg, France
| | - Nader Perroud
- Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland.,Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sébastien Weibel
- Department of Psychiatry, University Hospital of Strasbourg, Strasbourg, France.,Inserm U1114, Strasbourg, France
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Calamia M, Hill BD, Musso MW, Pella RD, Gouvier WD. Factor structure and clinical correlates of the 61-item Wender Utah Rating Scale (WURS). ACTA ACUST UNITED AC 2018; 10:177-188. [PMID: 29427262 DOI: 10.1007/s12402-018-0251-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 02/02/2018] [Indexed: 12/14/2022]
Abstract
The objective of this study was to assess the factor structure and clinical correlates of a 61-item version of the Wender Utah Rating Scale (WURS), a self-report retrospective measure of childhood problems, experiences, and behavior used in ADHD assessment. Given the currently mostly widely used form of the WURS was derived via a criterion-keyed approach, the study aimed to use latent variable modeling of the 61-item WURS to potentially identify more and more homogeneous set of items reflecting current conceptualizations of ADHD symptoms. Exploratory structural equation modeling was used to generate factor scores which were then correlated with neuropsychological measures of intelligence and executive attention as well as a broad measure of personality and emotional functioning. Support for a modified five-factor model was found: ADHD, disruptive mood and behavior, negative affectivity, social confidence, and academic problems. The ADHD factor differed somewhat from the traditional 25-item WURS short form largely through weaker associations with several measures of personality and psychopathology. This study identified a factor more aligned with DSM-5 conceptualization of ADHD as well as measures of other types of childhood characteristics and symptoms which may prove useful for both research and clinical practice.
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Affiliation(s)
| | | | - Mandi W Musso
- Our Lady of the Lake Regional Medical Center, Baton Rouge, LA, USA
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