Personality disorder in an Early Intervention Psychosis cohort: Findings from the Social Epidemiology of Psychoses in East Anglia (SEPEA) study

AIM

Personality Disorders (PD) often share clinical and phenomenological overlap with psychotic disorders, especially at onset. However, there is little research on comorbid PD among people experiencing first episode psychosis. We examined the prevalence of PD recording and its sociodemographic and clinical correlates in people accepted to Early Intervention in Psychosis (EIP) services.

METHODS

Participants were aged 16-35, accepted into 6 EIP services for suspected psychosis, as part of the Social Epidemiology of Psychoses in East Anglia (SEPEA) study. PD was recorded by clinicians according to ICD-10. Multilevel logistic regression was performed.

RESULTS

Of 798 participants, 76 people (9.5%) received a clinical diagnosis of PD, with emotionally unstable PD (75.0%, N = 57) the most common subtype. In multivariable analysis, risk factors for PD included female sex (odds ratio [OR]: 3.4; 95% CI: 2.0-5.7), absence of psychotic disorder after acceptance to EIP (OR: 3.0; 95% CI: 1.6-5.5), more severe hallucinations (OR: 1.6; 95% CI: 1.2-2.1), and lower parental SES (OR: 1.4; 95% CI: 1.1-1.8). Compared with the white British, black and minority ethnic groups were less likely to receive a PD diagnosis (OR: 0.3; 95% CI: 0.1-0.7). There was no association between PD and neighbourhood-level deprivation or population-density.

CONCLUSIONS

Recording of a PD diagnosis was three times more common amongst participants later found not to meet threshold criteria for psychotic disorder, implying phenomenological overlap at referral which highlights difficulties encountered in accurate diagnostic assessment, treatment and onward referral. People with PD experienced more individual-level, but not neighbourhood-level social disadvantage in an already disadvantaged sample.

Psychometric Properties of the Life Orientation Test-Revised in Samples of Japanese Students

The Life Orientation Test–Revised (Scheier, Carver, & Bridges, 1994) is a widely used self-report measure of optimism. The present study examined the test's psychometric properties in a Japanese cultural context. 448 Japanese university students completed a Japanese version of the Life Orientation Test–Revised along with measures of neuroticism, extraversion, and depression. Exploratory factor analysis yielded the same two factors, positively phrased optimistic items and negatively phrased pessimistic items, as Scheier and Carver reported. Internal consistency of optimism and pessimism was acceptable. Confirmatory factor analysis of the Life Orientation Test–Revised with another group of 205 Japanese university students showed the superiority of a two-factor model of optimism–pessimism. The bidimensionality was partly due to the difference in responses between positively and negatively worded items. The Japanese data provide additional psychometric support for the Life Orientation Test–Revised and enhance the generalization of prior findings on U.S. samples to Japanese samples.

Using the Megargee System among Belgian Prisoners: Cross-Cultural Prevalence of the MMPI-2 Based Types

On the basis of the Minnesota Multiphasic Personality Inventory, and later the MMPI-2, E, I. Megargee and colleagues empirically developed a classification system to enhance management and treatment of offenders throughout the criminal justice system. This preliminary study extended the application of the MMPI-2 based system for the first time to a non-U.S. prison sample and classified the MMPI-2 profiles of 1,636 male inmates from Belgian federal prisons. The typology was capable of classifying most of the subjects and all 10 Megargee types were represented. Compared to American prevalence data, types Delta and Charlie were overrepresented and type George was underrepresented. Issues that warrant further investigation are discussed.

Developmental trajectories of maladaptive perfectionism among African American adolescents

This study examined the developmental trajectories of maladaptive perfectionism over a 7-year period among African American youth living in an urban setting (N = 547). In particular, the study attempted to determine whether two maladaptive aspects of perfectionism (socially prescribed and self-critical) changed over time and could be distinguished by variables in 6th and 12th grades (Mage at study entry [first grade] was 6.22 years [SD = 0.34]). Four classes best described the developmental trajectories on both measures of maladaptive perfectionism: high, low, increasing, and decreasing. Sixth- and 12th-grade correlates, including measures of internalizing symptoms, mostly confirmed the distinctiveness of these classes. Parallel process analyses suggested that the two processes are complementary, yet distinct. Implications regarding the prevention of maladaptive perfectionism are discussed.

Do patients seeking laparoscopic adjustable gastric banding surgery differ from those seeking gastric bypass surgery? A comparison of psychological profiles across ethnic groups

BACKGROUND

Understanding presurgical psychological functioning is important in determining whether patients may benefit from psychological support before or after undergoing bariatric surgery. However, few studies have directly explored whether presurgical psychosocial profiles differ for patients presenting for different bariatric surgeries and what, if any, impact ethnic background might have. The present study compared presurgical depressive symptomatology, binge eating symptoms, and psychopathology in Caucasian and African American laparoscopic adjustable gastric banding (LAGB) and gastric bypass (RYGB) patients.

METHODS

Patients (n=272) presenting for either LAGB or RYGB surgery completed self-report measures of depressive symptomatology (BDI), binge eating symptoms (BES), and psychopathology/personality (PAI) as part of the presurgical psychological evaluation.

RESULTS

RYGB patients endorsed more depressive symptomatology, binge eating symptoms, somatic complaints, and antisocial features than LAGB patients, though higher BMI in the RYGB patients accounted for differences in binge eating symptoms. When the sample was examined by ethnic group, LAGB-RYGB differences were found only in African American, and not Caucasian, patients.

CONCLUSIONS

Psychosocial profiles appear to differ for African American patients presenting for LAGB and RYGB surgeries; however, some of these differences are accounted for by differences in presurgical BMI. Gaining a better understanding of the initial psychological characteristics of bariatric surgery candidates may improve clinicians' abilities to identify and address specific areas of concern for these patients.

Association study of catechol-O-methyltransferase Val158Met polymorphism with personality traits in japanese healthy volunteers

Catechol-O-methyltransferase (COMT) is one of the major enzymes for the degradation of catecholamines. It has been suggested that catecholaminergic neurotransmission is involved in characterization of personality. Previous studies on the association between the COMT Val158Met polymorphism and personality traits in healthy subjects have produced inconsistent results. Therefore, the relationship between this polymorphism and personality was re-examined in 478 Japanese healthy volunteers. Personality traits were assessed by the Temperament and Character inventory (TCI), and the COMT genotypes were determined by a PCR-RFLP method. in total, there were no significant differences among the Val/Val, Val/Met, and Met/Met genotypes in seven TCI dimension scores. Similarly, no significant relationship was found between the COMT genotypes and the TCI dimensions when males and females were analyzed separately. The present study thus suggests that the COMT Val158Met polymorphism is not associated with personality traits in Japanese healthy subjects.

Cross-cultural clinical judgment bias in personality disorder diagnosis by forensic psychiatrists in the UK: a case-vignette study

Previous research in the UK has suggested that cross-cultural bias in personality disorder diagnosis might partly account for the smaller proportion of Black, relative to White, patients with personality disorder in secure psychiatric hospitals. Using the case-vignette method, we investigated cross-cultural clinical judgment bias in the diagnosis of personality disorder in African Caribbean men by 220 forensic psychiatrists in the UK. In the vignette describing possible DSM-IV antisocial personality disorder, Caucasians were 2.8 times more likely to be given a diagnosis of personality disorder than African Caribbeans. Diagnosis also varied according to the ethnicity of the clinicians. No cross-cultural bias was found in the vignette describing possible DSM-IV borderline personality disorder. These findings are important in relation to recent policies for offenders and others with personality disorder, and to the current focus on delivering race equality in mental health services in the UK. Ongoing debates about the strengths and limitations of the case-vignette method are also discussed.

Epidemiological comparisons of problems and positive qualities reported by adolescents in 24 countries

In this study, the authors compared ratings of behavioral and emotional problems and positive qualities on the Youth Self-Report (T. M. Achenbach & L. A. Rescorla, 2001) by adolescents in general population samples from 24 countries (N = 27,206). For problem scales, country effect sizes (ESs) ranged from 3% to 9%, whereas those for gender and age ranged from less than 1% to 2%. Scores were significantly higher for girls than for boys on Internalizing Problems and significantly higher for boys than for girls on Externalizing Problems. Bicountry correlations for mean problem item scores averaged .69. For Total Problems, 17 of 24 countries scored within one standard deviation of the overall mean of 35.3. In the 19 countries for which parent ratings were also available, the mean of 20.5 for parent ratings was far lower than the self-report mean of 34.0 in the same 19 countries (d = 2.5). Results indicate considerable consistency across 24 countries in adolescents' self-reported problems but less consistency for positive qualities.

'Autistic' traits in non-autistic Japanese populations: relationships with personality traits and cognitive ability

We explored the relationships between 'autistic' traits as measured by the AQ (Autism-Spectrum Quotient; Baron-Cohen et al., J. Autism Develop. Disord. (2001b) 31 5) and various personality traits or cognitive ability, which usually coincide with autistic symptoms, for general populations. Results showed the AQ was associated with tendencies toward an obsessional personality as defined by the TCI (Temperament and Character Inventory), higher depression and anxiety, and higher frequency of experience of being bullied. These results parallel the patterns in autism and corroborate the validity of the AQ for general populations. Contrary to our prediction, however, there was no relationship between the AQ and cognitive ability, such as theory of mind, executive functioning, and central coherence, suggesting the AQ does not reflect autism-specific cognitive patterns in general populations.

A cultural-contextual perspective on the validity of the MMPI-2 with American Indians

This study investigated the normative validity of the MMPI-2 with two distinct American Indian tribes. Differences occurred on 8 of the 13 basic validity and clinical scales (F, 1, 4, 5, 6, 7, 8, 9) between the MMPI-2 norms and both tribal samples. Elevated MMPI-2 scores of American Indians may not only reflect the possibility of psychological distress spurred by historical oppression and present adversity, but also an expression of a divergent worldview. Considering the context of the historical and social production of knowledge about American Indians, it is argued that researchers and practitioners, when interpreting MMPI-2 results for American Indians, should seriously consider their interpretive points of reference, which may be impacted by dominant cultural belief systems.

Boundary issues and personality disorders

The author first presents an overview of the basic elements of boundary theory and clarifies the distinction between boundary crossings and boundary violations. The concepts of context dependence, power asymmetry, and fiduciary duty as they relate to boundary problems are also discussed. The intrinsic and extrinsic consequences of boundary problems are reviewed. The extrinsic consequences fall into three major categories: civil lawsuits, complaints to the board of registration, and complaints to professional societies. The author then reviews types of boundary issues that arise in relation to histrionic, dependent, antisocial, and borderline personality disorders. Countertransference issues that arise in working with patients with personality disorders are discussed, as well as cultural differences that may affect the perception of boundary problems. The article ends with a list of risk management principles and recommendations for avoiding boundary problems in the therapeutic relationship.

Neighborhood context, personality, and stressful life events as predictors of depression among African American women

The authors tested neighborhood context, negative life events, and negative affectivity as predictors of the onset of major depression among 720 African American women. Neighborhood-level economic disadvantage (e.g., percentage of residents below the poverty line) and social disorder (e.g., delinquency, drug use) predicted the onset of major depression when controlling for individual-level demographic characteristics. Neighborhood-level disadvantage/disorder interacted with negative life events, such that women who experienced recent negative life events and lived in high disadvantage/disorder neighborhoods were more likely to become depressed than were those who lived in more benign settings, both concurrently and over a 2-year period. Neighborhood disadvantage/disorder can be viewed as a vulnerability factor that increases susceptibility to depression following the experience of negative life events.

The Five-factor Personality Inventory as a measure of the Five-factor Model: Belgian, American, and Hungarian comparisons with the NEO-PI-R

The lexically based Five-Factor Personality Inventory (FFPI) was correlated with the factors and facets of the Revised NEO Personality Inventory (NEO-PI-R) in Belgian (N = 265), American (N = 116), and Hungarian (N = 320) samples. Results were similar across the three cultures. Analysis of orthogonalized FFPI factors showed that three of them--emotional stability, extraversion, and agreeableness--showed a direct correspondence to their NEO-PI-R counterparts. Autonomy, however, was not clearly related to openness, and facet analysis suggested that it might be interpreted as a dominance factor Better matches to NEO-PI-R conscientiousness and openness could be obtained by using vectors rotated 30 degrees from the FFPI positions. Raw scale scores showed similar results. Researchers should not assume that all measures of the Five-Factor Model are qualitatively similar

The structure and correlates of perfectionism in African American children

This study examined the structure and symptom correlates of perfectionism in a sample of 6th-grade, urban, African American children using the Child and Adolescent Perfectionism Scale (CAPS; Flett, Hewitt, Boucher, Davidson, & Munro, 2000). Confirmatory factor analysis showed inadequate fit of the original subscales. Exploratory factor analysis suggested 3 dimensions of perfectionism: A Socially Prescribed and a Self-Oriented-Critical factor were described as maladaptive, whereas a Self-Oriented-Striving factor was proposed as adaptive. Cross-sectional correlations among the perfectionism dimensions and symptoms of psychopathology fit well with the adaptive versus maladaptive model. In addition, Socially Prescribed Perfectionism showed a robust predictive relation to 7th-grade internalizing symptoms, especially depression, in boys. Results are discussed in the context of the cultural and socioeconomic characteristics of this African American sample and suggestions for future research are provided.

Convergent Validity of the Chinese Personality Assessment Inventory and the Minnesota Multiphasic Personality Inventory-2: Preliminary Findings With a Normative Sample

We examined the convergent validity of the Chinese Personality Assessment Inventory (CPAI; Cheung, Leung, et al., 1996), an indigenously constructed measure, by comparing its patterns of correlations with the MMPI-2 (Butcher et al., 2001). A valid sample of 147 Chinese students took both the CPAI and the MMPI-2. Results provide preliminary support for the convergence between most of the CPAI clinical scales and the relevant MMPI-2 scales. The CPAI personality scales further illustrated the patterns of personality features associated with the MMPI-2 scales in a Chinese cultural context. We discuss discrepancies in the correspondence between a number of CPAI and MMPI-2 clinical scales.

The relationships of a rationality/antiemotionality personality scale to mortalities of cancer and cardiovascular disease in a community population in Japan

OBJECTIVE

Grossarth-Maticek et al. reported that an individual's level on a rationality/antiemotionality (R/A) personality was strongly predictive of cancer, ischemic heart disease and stroke mortality. To investigate the relationships of an individual's level on the R/A personality to cancer and cardiovascular disease mortality in Japan, we conducted a population-based cohort study.

METHOD

A self-administered questionnaire was distributed to 36990 Japanese residents in September 1992. The response rate was 90.3%. Data from 13226 males and 14880 females were analyzed. Dates and causes of death through December 31, 1999 were obtained for deceased participants.

RESULTS

The results from multivariate hazard ratios (HRs) revealed that males scoring in the middle level compared to those scoring in the lower level of the R/A personality scale decreased their risk of death from cancer and cardiovascular diseases after controlling for covariates.

CONCLUSIONS

The level on the R/A personality scale may affect mortality from cancer and cardiovascular diseases differently in Japan.

Attitudes toward Arabs of Israeli children exposed to missile attacks: the role of personality functions

BACKGROUND

This study examines the attitudes toward Arabs of Israeli children who were exposed to missile attacks during the Gulf War as related to exposure, early and present functioning, and appraisal of chances for peace.

METHODS

A semi-structured interview assessed the attitudes, symptoms, defenses and prosocial behavior of 82 children who had been directly exposed to the missile attacks.

RESULTS

The attitudes were not related to the displacement of the family during the war. A very negative attitude was associated with more problems with behavior modulation during the preschool years, an increase in externalizing and posttraumatic symptoms, and more immature defenses. A balanced attitude was associated with age, fewer symptoms, more mature defenses, and more prosocial behavior.

CONCLUSION

Individual vulnerabilities in the face of traumatic experiences could lead to posttraumatic responses that may shape children's social attitudes and behaviors. The resolution of inter-group conflict requires implementation of psychotherapeutic and socio-educational interventions to transform hate and fear into empathy and hope.

The Narcissistic Personality Inventory: Applicability in a Swedish population sample

A Swedish translation of the 40-item Narcissistic Personality Inventory (NPI) was mailed to 410 participants, aged 21-61 years, randomly sampled from the Swedish general population. The participation rate was 62%. The applicability of a previously published seven-factor structure (Raskin & Terry) and a four-factor structure (Emmons) was investigated. The factor structure found in the present in the Swedish sample corresponded better with Emmons's version. Therefore the four-factor structure was chosen. Because the correspondence to Emmons's factor structure was not perfect, a revised NPI for Swedish use was constructed. The total scale score is usually used, although the Swedish NPI includes four subscales: Leadership/Power, Exhibitionism/Self-admiration. Superiority/Arrogance, and Uniqueness/Entitlement. For the total scale, the internal consistency (Cronbach's alpha) was 0.80 and the test-retest correlation was 0.93. The total scale score correlated with self-esteem as well as the interpersonal style and emotional aspects of psychopathy, supporting the validity of the scale.

Properties of the temperament and character inventory in a Chinese sample

OBJECTIVE

To determine the influence of language and culture on the temperament and character (TCI) measure in a Chinese sample.

METHOD

We translated the TCI into Mandarin and had a non-psychiatric sample of Malaysian Chinese subjects complete the TCI at baseline and at a 1-month retest, with subsets completing English or Mandarin versions alternatively or on both occasions. Analyses examine the TCI factor structure and any impact of language and culture on TCI scoring.

RESULTS

We identified age, gender, occupation and language effects on TCI scale scores. Test-retest reliability was high and not compromised by language. Scale internal consistency was also high. Factor analyses of separate sets of TCI scales corresponded strongly to the structure identified in the TCI development studies.

CONCLUSION

The results indicate that TCI is likely to have applicability to Chinese subjects, and argue against properties being constrained by the English language or by western culture.

Functioning styles of personality disorders and five-factor normal personality traits: a correlation study in Chinese students

BACKGROUND

Previous studies show that both the categorical and dimensional descriptors of personality disorders are correlated with normal personality traits. Recently, a 92-item inventory, the Parker Personality Measure (PERM) was designed as a more efficient and precise first-level assessment of personality disorders. Whether the PERM constructs are correlated with those of the five-factor models of personality needs to be clarified.

METHODS

We therefore invited 913 students from poly-technical schools and colleges in China to answer the PERM, the Five-Factor Nonverbal Personality Questionnaire (FFNPQ), and the Zuckerman-Kuhlman Personality Questionnaire (ZKPQ).

RESULTS

Most personality constructs had satisfactory internal alphas. PERM constructs were loaded with FFNPQ and ZKPQ traits clearly on four factors, which can be labelled as Dissocial, Emotional Dysregulation, Inhibition and Compulsivity, as reported previously. FFNPQ Openness to Experience, Conscientiousness and Extraversion formed another Factor, named Experience Hunting, which was not clearly covered by PERM or ZKPQ.

CONCLUSION

The PERM constructs were loaded in a predictable way on the disordered super-traits, suggesting the PERM might offer assistance measuring personality function in clinical practice.

Scores on the Eysenck Personality Questionnaire for a Sample of Children and Adolescents Receiving Psychological Treatment in Puerto Rico

Personality questionnaire scores obtained by children and adolescents ( n = 28) receiving psychological treatment at a health facility in Humacao, Puerto Rico were examined. The scores were compared with those of regular school children of the same age, of Gurabo, Puerto Rico, who were not in treatment ( n = 30). The children in treatment obtained higher scores on Psychoticism, lower scores on Extraversion, and similar scores on Neuroticism and Dissimulation by comparison with regular students.

Personality disorders associated with substance use among American and Greek adolescents

A study was conducted to investigate the association between personality disorder (PD) symptomatology and substance use among adolescents in community settings in the United States and Greece. The Structured Clinical Interview for DSM-IV Personality Disorders and the Adolescent Health Behavior Survey were completed by 37 male and 84 female adolescents, ages 15 to 18, who were recruited from an adolescent medical clinic and schools in and near New York City (n = 71) and Heraklion, Greece (n = 50). Results indicated that: (1) adolescents with PDs reported more frequent alcohol consumption during the past year than did those without PDs; (2) adolescents with borderline PD reported more cigarette smoking and heavy alcohol consumption than did those without borderline PD; (3) adolescents with antisocial PD symptomatology reported greater alcohol, cigarette, and illicit drug use than did those without antisocial PD symptomatology; and (4) although more American (30%) than Greek (4%) adolescents reported illicit substance use, differences were not observed in the prevalence of alcohol use, cigarette use, or personality disorders as a function of nationality.

Use of the MMPI-2 in American Indians: I. Comparability of the MMPI-2 Between Two Tribes and With the MMPI-2 Normative Group

The comparability of the MMPI-2 in American Indians with the MMPI-2 normative group was investigated in a sample of 535 Southwestern and 297 Plains American Indian tribal members with contrasting sociocultural and historical origins. Both American Indian tribal groups had clinically significant higher T scores (> 5 T points) on 5 validity and clinical scales, 6 content scales, and 2 supplementary scales than did the MMPI-2 normative group. There were no significant differences between the 2 tribal groups on any of the MMPI-2 clinical, content, or supplementary scales. Matching members of both tribes with persons in the MMPI-2 normative group on the basis of age, gender, and education reduced the magnitude of the differences between the 2 groups on all of these scales, although the differences in T scores still exceeded 5 T points. It appears likely that the MMPI-2 differences of these 2 American Indian groups from the normative group may reflect their adverse historical, social, and economic conditions.

Ethnic differences in prisoners. 1: criminality and psychiatric morbidity

BACKGROUND

In England and Wales, persons of African-Caribbean origin are more likely to be both imprisoned and admitted to secure hospitals.

AIMS

To estimate population-based rates of imprisonment in different ethnic groups, and compare criminal behaviour and psychiatric morbidity.

METHOD

We examined Home Office data on all persons in prison, and carried out a two-stage cross-sectional survey of 3142 remanded and sentenced, male and female, prisoners in all penal establishments in England and Wales in 1997.

RESULTS

We confirmed high rates of imprisonment for Black people and lower rates for South Asians. Different patterns of offending and lower prevalence of psychiatric morbidity were observed in Black prisoners.

CONCLUSIONS

Despite increased risks of imprisonment, African-Caribbeans show less psychiatric morbidity than White prisoners. This contrasts with the excess of African-Caribbeans in secure hospitals, an inconsistency possibly in part due to the effects of ethnic groups on admission procedures.

The structure of traits delineating personality disorder in a Chinese sample

The present study examined the factorial structure of a Chinese language version of the self-report Dimensional Assessment of Personality Pathology Questionnaire in 581 adults. Four factors were extracted (Emotional Dysregulation, Dissocial, Inhibition, and Compulsivity) that are similar to the factors extracted in the scales' normative clinical and general population samples from North America (factor comparability coefficients range from .88 to .96), supporting the idea that this trait structure is invariant across diverse populations. The internal consistency of the scales (Cronbach's alpha) was satisfactory across age and gender groups with the exception of the Intimacy Problems scale. Possible explanations for the poor internal consistency of the Intimacy Problems scale, such as cultural differences in social factors influencing marital and romantic relationships in Chinese populations, as opposed to other populations are discussed.

Correlates of retrospective early life experience with personality in young Japanese women

To examine the influence of early experiences on the development of personality. We used the Temperament and Character Inventory to assess 98 young women who had first entered a company. Different early experiences were linked, albeit weakly, to test scores. Both partial correlations and multiple regression analyses indicated that Self-directedness was higher if women reported more care of parents. Partial correlation, but not multiple regression analyses, showed that Cooperativeness was greater if women reported more care of parents and less frequent abuse. Reports of early parental loss or negative or positive early life events showed no correlation with scores on any of the Temperament and Character Inventory subscales.

Assessing the DSM-IV structure of personality disorder with a sample of Chinese psychiatric patients

The validity of the three-cluster system of personality disorders (PDs) in the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; APA, 1994) was examined in a sample of Chinese psychiatric patients (n = 227), who completed the self-report Personality Disorders Questionnaire for DSM-IV (PDQ-4; Hyler, 1994) and who were also administered the clinician-rated Personality Disorders Interview-IV (PDI-IV; Widiger, Mangine, Corbit, Ellis, & Thomas,). Using confirmatory factor analysis, a three-factor model corresponding to the DSM-IV clusters was tested and compared statistically to a one-factor model and a set of random, three-factor models. Only the clinician-rated instrument supported the DSM-IV three-cluster model, and then only when the factors were allowed to correlate. Results from the theoretically more rigorous uncorrelated model testing did not support the DSM-IV model for either assessment modality.

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

We examined the reliability, cross-instrument validity, and factor structure of Chinese adaptations of the Personality Diagnostic Questionnaire (PDQ-4+; N = 1,926) and Personality Disorders Interview (PDI-IV; N = 525) in psychiatric patients. Comparisons with data from Western countries suggest that the psychometric properties of these two instruments are comparable across cultures. Low to modest agreement between the PDQ-4+ and PDI-IV was observed for both dimensional and categorical personality disorder evaluations. When the PDI-IV was used as the diagnostic standard, the PDQ-4+ showed higher sensitivity than specificity, and higher negative predictive power than positive predictive power. Factor analyses of both instruments replicated the four-factor structure O'Connor and Dyce (1998) found in Western samples. Results suggested that conceptions and measures of DSM-IV personality disorders are cross-culturally generalizable to Chinese psychiatric populations.

Neurotic perfectionism, perceived stress, and self-esteem among Japanese men: a prospective study

The present study examined the relationship between self-report scores of neurotic perfectionism and of perceived stress and self-esteem 6 wk. later among 146 Japanese male college students. Hierarchical regression analysis indicated that scores for neurotic perfectionism accounted for statistically significant but functionally small variance (4% and 3%) in scores for perceived stress and self-esteem obtained at Time 2 (6 wk. later), after controlling for the scores for perceived stress and self-esteem at Time 1, respectively.

The course of the marriage of Elizabeth Montagu: an ambitious and talented woman without means

Based on a study of the Montagu Collection of letters housed in the Huntington Library, this article analyzes the apparent motives behind the marriage between Elizabeth and Edward Montagu and the slow but sure emergence of evidence of her growing dissatisfaction with it. It reveals the various ways in which she sought distraction from her marriage and her attempts to compensate for it. Behind her growing restlessness and frustration, there lie aspects of her character—her obsession with money, her urgent need to be constantly admired and lauded, and her need to be in control of both people and things.

Population variation in children's behavioral symptomatology

Previous anthropological studies identified significant interpopulation consistencies in the frequency and symptoms of adult depression, anxiety, and schizophrenia. Tests of the degree of variation of such behavioral phenomena across contemporary populations are significant for the study of human evolution because universality or near universality suggests specific evolved aspects of human behavior. The aim of this research was to provide a preliminary test of whether cross-cultural consistencies in symptomatology associated with some psychiatric conditions are observable in children as they are in adults. We tested for interpopulation variation in degrees (intensity and frequency) of anxiety, depression, withdrawal, and somatization symptomatology in normal samples of children. Psychometric ratings scales allowed assessment of characteristic symptomatology of each child in the different contexts of home and school. The study populations comprised 1,208 6-11-year-old children from the Paisa community in Antioquia, Colombia, and African-American, Euro-American, and Hispanic children in the United States. We found interpopulation consistencies in some aspects of child behavioral symptomatology, especially depression and withdrawal. Mean degrees of symptomatology and percentages of children with clinically significant levels of symptomatology were consistent for both across populations, in home and school contexts, and for both girls and boys. Anxiety and somatization displayed more cross-cultural variability in expression. These patterns are in accordance with current understandings of cross-cultural variability and universals of adult psychiatric symptomatology.

Are personality disorder criteria ethnically biased? A card-sort analysis

On the basis of methodology used in previous research on sex criterion bias, this study examined ethnicity criterion bias of personality disorders (PDs) defined in the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., Rev.) and included examination of sex as well as ethnicity. A card-sort analysis using undergraduate college students as sorters indicated that criteria for all of the PDs were applied disproportionately by ethnicity, resulting in particular ethnic groups receiving diagnoses for specific PDs. Criteria were sorted systematically such that diagnoses of antisocial and paranoid PDs were assigned to African Americans, schizoid PD was assigned to Asian Americans, and schizotypal PD was assigned to Native Americans. All other PDs were assigned to European Americans, whereas none of the criteria were sorted resulting in any PD diagnosis being applied to Latinos. Implications for clinicians, methodological considerations, and recommendations for future research are discussed.

Gender differences in social and interpersonal features and personality disorders among Japanese patients with obsessive-compulsive disorder

This study sought to elucidate the differential effect of gender on clinical features in 40 males and 54 females who met both DSM-III-R and DSM-IV criteria for obsessive-compulsive disorder (OCD). Males had a lower rate of marriage, and a higher rate of major impairment in social or occupational functioning, whereas females were significantly more likely to involve others in their OCD symptoms, such as reassurance-seeking. Although no significant differences were detected in the distribution of OCD symptoms, cluster A personality disorders (PDs), especially schizotypal PD, were more frequently diagnosed in males, and borderline and dependent PDs tended to be more prevalent in females. Thus, gender differences in OCD subjects were prominently observed in social or interpersonal features, which might be consistent with the differential PD pathology between males and females.

Predictions of violent and total infractions among institutionalized male juvenile offenders

Forensic practitioners in settings with institutionalized adolescent offenders are frequently responsible for the accurate classification of problematic and potentially violent youths. Methods of assessment often include traditional tests, such as the MMPI and MMPI-A, and interview-based determinations of psychopathy. In a study of residential male adolescent offenders, the MMPI-A and the Screening Version of the Psychopathy Checklist (PCL:SV) were used to predict total, violent, self-injurious, and nonviolent infractions in a treatment-oriented facility for delinquents. In predicting the overall number of infractions, the MMPI-A was superior to the PCL:SV. Psychopaths manifested a significantly higher rate of violent infractions than nonpsychopaths. Finally, ethnic differences raise serious concerns about the generalizability of the PCL:SV; differences were found in the relationship between psychopathy and infractions based on ethnicity.

MMPI-2 with Mexican psychiatric inpatients: basic and content scales

This paper presents the results of a study of the Mexican Spanish version of the MMPI-2 with a clinical sample of 233 patients who were diagnosed as having psychological disturbances or personality disorders, according to DSM-III R criteria. Inpatient scores were obtained from four psychiatric hospitals, located in Mexico City. The scores of the patients were compared with those of Mexican college students, which is the largest Mexican normative sample collected to date, consisting of 813 men and 1,137 women. Results of this study show that the MMPI-2 can accurately differentiate between normal and non-normal groups in Mexican populations and demonstrate that the inventory maintains its construct validity in this clinical sample.

Early manifestations, personality traits and pathways into care for Asian and white first-onset cases of schizophrenia

BACKGROUND

Previous studies have shown that manifestations of symptoms and premorbid personality of patients with schizophrenia differ across cultures. However, these have only been demonstrated in cultural settings apart from each other.

METHOD

We set out to compare these across different ethnic groups from a catchment area in west London. The Asian and the white group had similar inception rates of schizophrenia and we therefore decided to compare these two groups to ascertain similarities in social, demographic and personality factors and pathways into care. First-onset cases of schizophrenia were studied on a number of parameters using previously validated instruments.

RESULTS

There were more similarities than differences between the two groups. When compared with the findings of a previous multicentre study in India, London Asians, like their counterparts in India, were more likely than the London white sample to present with loss of appetite, become more religious and behave as if hearing voices. However, compared to their Indian counterparts, the onset of symptoms was more likely to be insidious and alternative sources of healing were less likely to be approached.

CONCLUSIONS

These findings are discussed in relation to the findings for white patients and recommendations made for future research.

A comparison of clinical features among Japanese eating-disordered women with obsessive-compulsive disorder

Clinical features, such as obsessive-compulsive disorder (OCD) symptoms, were investigated in Japanese women with DSM-III-R eating disorders (EDs) and concurrent OCD in comparison to age-matched women with OCD. Sixteen women with restricting anorexia nervosa (AN), 16 with bulimia nervosa (BN), and 16 with both AN and BN (BAN) showed commonality in a more elevated prevalence of OCD symptoms of symmetry and order compared with 18 OCD women. Among the personality disorders (PDs), likewise, obsessive-compulsive PD (OCPD) was more prevalent in each ED group compared with the OCD group. However, aggressive obsessions were more common in both BN and BAN subjects compared with AN subjects. Subjects with bulimic symptoms were also distinguished from AN subjects by impulsive features in behavior and personality. Thus, an elevated prevalence of aggressive obsessions along with an admixture of impulsive and compulsive features specifically characterized the clinical features of bulimic subjects with OCD.

Mexican-American male batterers on the MCMI-III

This study examined personality characteristics of Mexican-American male batterers. 60 Mexican-American male batterers (M = 33.6 yr.) in the court system in South Texas took the MCMI-III and their MCMI-III scores were compared with the scores of a community sample of 45 Mexican-American individuals (M = 30.4 yr.). The batterers frequently scored higher than the nonbatterers on the Avoidant and Passive-Aggressive scales, while nonbatterers frequently scored higher on the Histrionic scale. The batterers scored significantly higher on 18 out of 24 MCMI-III scales, while nonbatterers scored significantly higher on two scales.

Personality disorders in sociocultural perspective

Personality disorders are shaped by a social and cultural context. This principle is supported by evidence that Axis II diagnoses have a different prevalence in different societies, and that some disorders demonstrate cohort effects. Transitions from traditional to modern social structures, accompanied by social disintegration and rapid social change, could account for these phenomena. The main mechanisms of action would involve interference with family functioning and with buffering from the social community.

Comparison of the big-five factor structure across samples of Chinese and American adults

We compared the factor structure of Goldberg's (1992) 50-item Bipolar Rating Scale (50-BRS) in samples of Chinese (n = 198) and American (n = 303) students. Results confirmed the hypothesized five-factor pattern for the U.S. sample, and a simultaneous multisample confirmatory factor analysis showed that the same five-factor pattern fit the item covariances in the Chinese sample. High levels of internal consistency were found within each sample, and a high degree of congruency of corresponding item factor loadings was obtained across samples. Overall, results supported the potential utility of the Five-Factor Model and the 50-BRS for assessing personality dimensions in Chinese culture.

Avoidant personality disorder and taijin kyoufu: sociocultural implications of the WHO/ADAMHA International Study of Personality Disorders in Japan

This paper discusses the characteristics of avoidant personality disorder in a cultural context based on the Japanese concept of taijin kyoufu as well as that of DSM-III-R and DSM-IV social phobia. Sixty-six patients were given the International Personality Disorder Examination and questionnaires including the Beck Anxiety Inventory. Among the 23 DSM-III-R personality disorder patients, 8 patients were diagnosed as having avoidant personality disorder. Six of them were suffering from taijin kyoufu symptoms. Among 27 ICD personality disorder patients, 22 patients were diagnosed as having ICD anxious personality disorder. All DSM avoidant patients were included in the ICD anxious group. These findings suggest that patients with avoidant personality disorder have had a long history of difficulties and share common personality problems with a milder form of taijin kyoufu, which is conceptually different from social phobia.

Racial differences in treatment of psychiatric inpatients

OBJECTIVE

The study examined several aspects of inpatient psychiatric treatment to determine if differences existed between treatment of African-American and white patients.

METHODS

Using a structured chart review, data were collected on 76 African-American and 88 white patients consecutively admitted to an acute inpatient setting with a principal axis I diagnosis of a major mood or psychotic disorder. Racial differences in treatment were examined using analysis of variance and logistic regression to assess the effects of diagnosis and socioeconomic status.

RESULTS

Nonpsychotic African-American patients had shorter lengths of stay than white patients with similar disorders. White patients were more likely to be on one-to-one observational status. Clinicians were more likely to order urine drug screens for African-American patients with high socioeconomic status than for comparable white patients. African-American patients with schizophrenic disorders received higher neuroleptic dosages than white patients with similar diagnoses.

CONCLUSIONS

Most racial differences cited in earlier studies of psychotic patients were not found or were not statistically significant once socio-economic status and diagnosis were accounted for. However, racial differences related to the detection, phenomenology, treatment, and course of psychotic disorders and the diagnosis and management of alcohol and drug use disorders and personality disorders were found.

Toward a cultural history of the personality disorders

Psychiatric categories in general, and the personality disorders in particular, remain problematic and contested. This is no where more clearly evident than in the case of the 'antisocial' and 'histrionic' personality disorders. In part, the problem is related to the observation of differences in gender distribution. Men are more likely to be diagnosed 'antisocial' than women, and women are more likely to be diagnosed 'histrionic' than men. Confusion results partly from the suspicion that these categories may be culturally conditioned and therefore spurious as medical labels true in some 'absolute' sense. This paper argues that the antisocial and histrionic disorders have cultural histories, representing (in extreme form) values strongly congruent with familiar cultural stereotypes: the 'independent' male and the 'dependent' female. The process by which these values were delegated to men and women is examined, and then shown to be at least partly determinative of later developments in the formation of psychiatric categories.

The measurement of narcissism in Asian, Caucasian and Hispanic American women

This study compared scores on the 40-item Narcissistic Personality Inventory for 14 Asian, 58 Caucasian, and 16 Hispanic American college women. Asian American women had significantly lower narcissism scores than Caucasian American women and also scored significantly lower on four of the seven component scales. Hispanic and Caucasian women had similar scores on narcissism. These results may be based on an ethnic response set and/or the influence of cultural values present in many traditional Asian cultures which are seemingly antithetical to narcissism and include modesty, respect for authority, and the valuing of relationship over individualism. The importance of including ethnic information in research is stressed.

The measurement of narcissism in Asian, Caucasian and Hispanic American women

This study compared scores on the 40-item Narcissistic Personality Inventory for 14 Asian, 58 Caucasian, and 16 Hispanic American college women. Asian American women had significantly lower narcissism scores than Caucasian American women and also scored significantly lower on four of the seven component scales. Hispanic and Caucasian women had similar scores on narcissism. These results may be based on an ethnic response set and/or the influence of cultural values present in many traditional Asian cultures which are seemingly antithetical to narcissism and include modesty, respect for authority, and the valuing of relationship over individualism. The importance of including ethnic information in research is stressed.