Attitudes, Clinical Practices, and Perceived Advocacy Needs of Professionals With Interests in Personality Disorders

Experts in personality disorders (PDs) generally prefer dimensional diagnostic systems to categorical ones, but less is known about experts' attitudes toward personality pathology diagnoses in adolescents, and little is known about public health shortfalls and advocacy needs and how these might differ geographically. To fill these gaps, the International Society for the Study of Personality Disorders surveyed 248 professionals with interests in PDs about their attitudes toward different diagnostic systems for adults and adolescents, their PD-related clinical practices, and perceived advocacy needs in their area. Results suggested that dimensional diagnostic systems are preferable to categorical and that skepticism about personality pathology in adolescents may not be warranted. The most pressing advocacy need was the increased availability of PD-related services, but many other needs were identified. Results provide a blueprint for advocacy and suggest ways that professional societies can collaborate with public health bodies to expand the reach of PD expertise and services.

Measurement Invariance Between Genders on Two Measures of Borderline Personality Disorder

Gender bias in the diagnosis and assessment of borderline personality disorder (BPD) has been the subject of much controversy in the psychological research literature. Evidence regarding differential prevalence rates and diagnostic rates in clinical settings between genders has been mixed, and measurement bias is one potential explanation for these mixed findings. A total of 340 participants were recruited from a Midwestern university and four outpatient community mental health clinics. They were administered two structured clinical interviews for BPD that were then evaluated for measurement invariance. Both the SCID-II BPD scale and the PDI-IV BPD scale were found to be measurement invariant between genders. No significant differences were found on the SCID-II BPD scale in diagnosis or overall number of criteria endorsed. However, in the rates of endorsement of individual criteria, differences were found in the unstable relationships item.

The Impact of Theoretical Orientation and Training on Preference for Diagnostic Models of Personality Pathology

The role of theoretical orientation in determining preference for different methods of diagnosis has been largely unexplored. The goal of the present study was to explore ratings of the usefulness of 4 diagnostic methods after applying them to a patient: prototype ratings derived from the SWAP-II, the DSM-5 Section III specific personality disorders, the DSM-5 Section III trait model, and prototype ratings derived from the Psychodynamic Diagnostic Manual (PDM). Three hundred and twenty-nine trainees in APA-accredited doctoral programs and internships rated one of their current patients with each of the 4 diagnostic methods. Individuals who classified their theoretical orientation as "cognitive- behavioral" displayed a significantly greater preference for the proposed DSM-5 personality disorder prototypes when compared to individuals who classified their orientation as "psychodynamic/psychoanalytic," while individuals who considered themselves psychodynamic or psychoanalytic rated the PDM as significantly more useful than those who considered themselves cognitive-behavioral. Individuals who classified their graduate program as a PsyD program were also more likely to rate the DSM-5 Section III and PDM models as more useful diagnostic methods than individuals who classified their graduate program as a PhD program. Implications and future directions will be discussed.

Retrospective reports of attachment disruptions, parental abuse and neglect mediate the relationship between pathological narcissism and self-esteem

Studies have shown a direct relationship between pathological narcissism and self-esteem; however, there have not been many studies that have empirically tested which theoretically relevant variables mediate this relationship. In the present study, we evaluated how self-reported, early negative childhood experiences with parental figures mediate the relationship between pathological narcissism and self-esteem. Four-hundred eight-five undergraduates from a Midwestern university retrospectively assessed their experiences of parental attachment and bonding, as well as their levels of pathological narcissism and current self-esteem. There was a significant correlation among all pathological narcissism subscales and self-esteem, except for the Exploitativeness subscale. Self-esteem was negatively correlated with all negative childhood experiences on the Childhood Trauma Questionnaire (CTQ) and was positively correlated with positive childhood experiences on the Parental Attachment Questionnaire (PAQ). The parental relationship quality was negatively associated with all but one Pathological Narcissism Inventory subscale, as was the PAQ total score. Lastly, emotional neglect on the CTQ significantly mediated the relationship between several pathological narcissism subscales and self-esteem. When investigating parental attachment and parental bonding, the quality of the relationship with the parent was a significant mediator between pathological narcissism and self-esteem. These findings demonstrate the importance of understanding the adverse effects of parental abuse and neglect on healthy development of the self and self-esteem. Clinical implications of these findings are discussed.

New directions for an old construct: Depressive personality research in the DSM-5 era

The DSM-5 Personality and Personality Disorders Work Group has suggested that the DSM-IV depressive personality disorder (DPD) construct be assessed within a proposed set of trait domains, which include anxiousness, depressivity, and anhedonia, and that the diagnostic category itself be removed from the DSM-5. A review of studies on DPD has demonstrated many challenges and limitations to DPD research, despite strong evidence of its validity and clinical utility. Nevertheless, there remains much interest in how a depressive personality construct fits into a dimensionalized framework of assessing psychopathology. In this paper, I offer three major research directions that can help advance our understanding of the depressive personality construct. These directions can inform researchers and clinicians how depressive personality fits within broad trait dimensions of classification, as well as the internal psychological processes, dynamics and content that characterize this type of psychopathology.

Manifestations of interpersonal dependency and depressive subtypes in outpatient psychotherapy patients

The present study investigated the relationship between normative and pathological dependency and anaclitic and introjective depressive experiences among 71 patients participating in outpatient psychotherapy at a university-based psychology clinic. We examined the interrelationships among the Relationship Profile Test subscales, the Depressive Experiences Questionnaire subscales and the Outcome Questionnaire-45.2. Results indicated that destructive overdependence was positively correlated with anaclitic and introjective depression and negatively correlated with overall perceptions of mental health. Dysfunctional detachment was positively correlated with introjective depression and negatively correlated with generalized perceptions of one's own mental health. Healthy dependency was negatively correlated with introjective depression and positively correlated with mental health. These results not only support the construct validity of the Relationship Profile Test but also shed light on a link between depression, dependence and self-criticism.

Proposals for DSM-5: introduction to special section of Journal of Personality Disorders

On February 10, 2010, the official proposals for the personality disorders section of the fifth edition of the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-5) were posted (see www.dsm5.org ). The posting by the DSM-5 Personality and Personality Disorders Work Group has been helpful in informing the field of the possible changes that may occur with DSM-5. Their presence allows for and encourages persons to provide their suggestions and concerns. The extent of the proposals is considerable. As expressed on the website, "the work group recommends a major reconceptualization of personality psychopathology" (Skodol, 2010, "Reformulation of personality disorders in DSM-5," para. 1). The proposals have generated some controversy. The Journal of Personality Disorders has always sought to be a participant in the crucial debates in our field. The purpose of this special issue is to provide members of the Work Group the opportunity to further articulate the rationale for the proposals, and to provide others an opportunity to articulate their concerns. Copies of this special issue were distributed to interested persons when the complete set of final papers were received (October of 2010).

Baroreflex responses to the stress of severe hemorrhage in the rat

In two groups of anesthetized (sodium pentobarbital), mature Sprague-Dawley rats, 1) aged 2 years and weighing 300-400 grams, 2) aged 6 months weighing 200-300 grams, baroreflex-induced circulatory responses to pressor (graded doses phenylephrine) and depressor (graded doses nitroglycerine) agents were compared to those occurring during progressive hemorrhage in the same animals. Graded withdrawals of blood from the femoral artery elicited progressive hypotension accompanied by bradycardia rather than expected tachycardia. Graded doses of phenylephrine (2.5 ug to 40 ug bolus, via femoral vein) regularly induced elevations in arterial blood pressure with associated reflex bradycardia. Similarly graded doses of nitroglycerine induced a marked decline in arterial blood pressure, without expected tachycardia. As hypotension became more severe (during hemorrhage), atrioventricular conduction slowed and A-V block developed, resulting in statistically greater slowing in ventricular than in atrial excitation and contractile cycles. Heart failure during hemorrhage in the rat is characterized sequentially by severe bradycardia, depressed atrial contractile force, impaired conduction and A-V block, terminating in ventricular, atrial, and finally, in pacemaker failure. Baroreceptor reflexes were blunted or even absent in both young and old animals during induced hypotension.