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1.
J Nerv Ment Dis ; 205(9): 685-691, 2017 09.
Article in English | MEDLINE | ID: mdl-28682982

ABSTRACT

The present study examines changes in defense maturity from mid to late life using data from an over 70-year longitudinal study. A sample of 72 men was followed beginning in late adolescence. Participants' childhoods were coded for emotional warmth. Defense mechanisms were coded by independent raters using the Q-Sort of Defenses (, Ego mechanisms of defense: A guide for clinicians and researchers 217-233) based on interview data gathered at approximately ages 52 and 75. We examined psychosocial correlates of defenses at midlife, late life, and changes in defense from mid to late life. Overall, defenses grew more adaptive from midlife to late life. However, results differed on the basis of the emotional warmth experienced in the participants' childhoods. In midlife, men who experienced warm childhoods used more adaptive (mature) defenses; yet by late life, this difference in defensive maturity had disappeared. Men who experienced less childhood warmth were more likely to show an increase in adaptive defenses during the period from mid to late life.


Subject(s)
Adaptation, Psychological/physiology , Defense Mechanisms , Family Relations/psychology , Human Development/physiology , Social Adjustment , Adolescent , Aged , Humans , Longitudinal Studies , Male , Middle Aged
2.
Compr Psychiatry ; 72: 97-105, 2017 01.
Article in English | MEDLINE | ID: mdl-27776275

ABSTRACT

OBJECTIVE: Identifying adaptive ways to cope with extreme stress is essential to promoting long-term health. Memory systems are highly sensitive to stress, and combat exposure during war has been shown to have deleterious effects on cognitive processes, such as memory, decades later. No studies have examined coping styles used by combat veterans and associations with later-life cognitive functioning. Defenses are coping mechanisms that manage difficult memories and feelings, with some more closely related to memory processes (e.g., suppression, repression). Utilizing a longitudinal database, we assessed how reliance on certain defense mechanisms after World War II combat exposure could affect cognitive health 60years later. METHOD: Data spanning 75years were available on 71 men who had post-war assessment of combat exposure, defense mechanism ratings (ages 19-50), and late-life neuropsychological testing. Interaction models of combat exposure with defenses predicting late-life memory were examined. RESULTS: In bivariate analyses, greater reliance on suppression correlated with worse memory performance (r=-0.30, p=.01), but greater reliance on repression did not. Greater reliance on suppression strengthened the link between combat exposure and worse memory in late life (R2=0.24, p<.001). In contrast, greater reliance on repression attenuated the link between combat exposure and poorer late-life memory (R2=0.19, p<.001). CONCLUSIONS: Results suggest that coping styles may affect the relationship between early-adult stress and late-life cognition. Findings highlight the importance of understanding how coping styles may impact cognitive functioning as people move through adult life.


Subject(s)
Adaptation, Psychological , Combat Disorders/psychology , Mental Recall , Stress Disorders, Post-Traumatic/psychology , Veterans/psychology , Adult , Combat Disorders/diagnosis , Combat Disorders/epidemiology , Emotions , Humans , Longitudinal Studies , Male , Memory , Neuropsychological Tests , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/epidemiology , Warfare
3.
Infant Ment Health J ; 38(1): 150-165, 2017 01.
Article in English | MEDLINE | ID: mdl-28004406

ABSTRACT

The expression of physical aggression is normative in early child development; it peaks in the second year of life, with steep declines for most children by the third and fourth years as children learn alternatives to aggression. Some children, however, fail to demonstrate declines in aggressive acts, and many of these are boys. The current review uses a dynamic systems (DS) approach to identify early individual and contextual factors that may dynamically influence trajectories of aggression as a characteristic way of engaging within communities and relationships. Within the DS framework, we focus on the parent-infant relationship as central to the development of adaptive emotion-regulation capacities of the infant and young child. Biological sex differences that may influence this early relationship are highlighted, as is the influence of contextual processes such as family violence. Clinical implications suggested by both the empirical and theoretical literatures are then described.


Subject(s)
Aggression , Child Development , Socialization , Family/psychology , Humans , Infant , Infant, Newborn , Male , Models, Psychological , Sex Characteristics
4.
Bull Menninger Clin ; 80(2): 97-130, 2016.
Article in English | MEDLINE | ID: mdl-27294585

ABSTRACT

In an attempt to find variables that would discriminate between creativity and psychopathology on the Rorschach, Rorschach data from two groups were compared. The first group was an inpatient sample of creative individuals who also carried a diagnosis of psychosis. The second was a group of creative writers. Both groups were engaged in intensive psychoanalytic psychotherapy. Comparing the most creative versus the least creative of the protocols in each group showed that more creative engagement was characterized by a higher response rate and greater and more idisosyncratic elaboration. Differences also emerged between groups: Whereas the inpatient sample relied more heavily on ideational coping, the writers relied more heavily on affective resources.


Subject(s)
Creativity , Psychotic Disorders/diagnosis , Affect , Female , Humans , Male , Psychotic Disorders/psychology , Rorschach Test
5.
Dev Psychol ; 52(3): 496-508, 2016 Mar.
Article in English | MEDLINE | ID: mdl-26551530

ABSTRACT

Erikson's (1950) model of adult psychosocial development outlines the significance of successful involvement within one's relationships, work, and community for healthy aging. He theorized that the consequences of not meeting developmental challenges included stagnation and emotional despair. Drawing on this model, the present study uses prospective longitudinal data to examine how the quality of assessed Eriksonian psychosocial development in midlife relates to late-life cognitive and emotional functioning. In particular we were interested to see whether late-life depression mediated the relationship between Eriksonian development and specific domains of cognitive functioning (i.e., executive functioning and memory). Participants were 159 men from the over-75 year longitudinal Study of Adult Development. The sample was comprised of men from both higher and lower socioeconomic strata. Eriksonian psychosocial development was coded from men's narrative responses to interviews between the ages of 30-47 (Vaillant & Milofsky, 1980). In late life (ages 75-85) men completed a performance-based neuropsychological assessment measuring global cognitive status, executive functioning, and memory. In addition depressive symptomatology was assessed using the Geriatric Depression Scale. Our results indicated that higher midlife Eriksonian psychosocial development was associated with stronger global cognitive functioning and executive functioning, and lower levels of depression 3 to 4 decades later. There was no significant association between Eriksonian development and late-life memory. Late-life depression mediated the relationship between Eriksonian development and both global cognition and executive functioning. All of these results controlled for highest level of education and adolescent intelligence. Findings have important implications for understanding the lasting benefits of psychosocial engagement in mid-adulthood for late-life cognitive and emotional health. In addition, it may be that less successful psychosocial development increases levels of depression making individuals more vulnerable to specific areas of cognitive decline.


Subject(s)
Aging/psychology , Cognition , Emotions , Human Development , Mental Health , Aged , Aged, 80 and over , Depression/epidemiology , Depression/psychology , Executive Function , Humans , Male , Neuropsychological Tests , Prospective Studies
7.
Infant Ment Health J ; 36(3): 262-74, 2015.
Article in English | MEDLINE | ID: mdl-25931380

ABSTRACT

"Ghosts in the nursery." "Visitors from the unremembered past." Fraiberg, Adelson, and Shapiro's (1975) words convey the relational "intruders" that they perceived while working with mothers and infants. A mother's unresolved past is a driving force within the treatment of mother-infant dyads. Working with these families, the therapist strives to process and metabolize the distress of the dyad while enabling the mother to contain the infant more fully. This article proposes that Fraiberg et al.'s metaphor may be newly elaborated utilizing Bion's (1962) original theoretical conceptualization of the "container and contained." He posited that an infant projects distressing affective states upon the mother, who contains the experience, transforms the feelings, and then enables the infant to reintroject a more tolerable experience. This lays the foundation for the relational experience of being known by another and facilitates the infant's development of self-knowledge and emotional regulation. We utilize Fraiberg et al.'s original case material to identify ways in which ghosts in the nursery disrupt the processes of the container and contained. Bion's ideas may help enrich our understanding of how the therapeutic relationship enables cycles of containment, transitioning the material "ghosts" from being contained by the infant to being contained by the therapist, and to ultimately being transformed so that the mother can reattribute them to the past.


Subject(s)
Child Abuse/psychology , Child Abuse/therapy , Mother-Child Relations/psychology , Mothers/psychology , Psychotherapy/methods , Child Development , Humans , Infant , Object Attachment
8.
J Am Acad Child Adolesc Psychiatry ; 53(5): 528-49, 2014 May.
Article in English | MEDLINE | ID: mdl-24745953

ABSTRACT

OBJECTIVE: This study describes an empirically derived approach to diagnosing adolescent personality pathology that is clinically relevant and empirically grounded. METHOD: A random national sample of psychiatrists and clinical psychologists (N = 950) described a randomly selected adolescent patient (aged 13-18 years, stratified by age and gender) in their care using the Shedler-Westen Assessment Procedure-II-A for Adolescents (SWAP-II-A) and several additional questionnaires. RESULTS: We applied a form of factor analysis to identify naturally occurring personality groupings within the patient sample. The analysis yielded 10 clinically coherent adolescent personality descriptions organized into 3 higher-order clusters (internalizing, externalizing, and borderline-dysregulated). We also obtained a higher-order personality strengths factor. These factors and clusters strongly resembled but were not identical to factors similarly identified in adult patients. In a second, independent sample from an intensive day treatment facility, 2 clinicians (the patients' treating clinician and the medical director) independently completed the SWAP-II-A, the Child Behavior Checklist (CBCL), and a measure of adaptive functioning. Two additional clinicians, blinded to the data from the first 2 clinicians, independently rated patients' ward behavior using a validated measure of interpersonal behavior. Clinicians diagnosed the personality syndromes with high agreement and minimal comorbidity among diagnoses, and SWAP-II-A descriptions strongly correlated in expected ways with the CBCL, adaptive functioning, and ward ratings. CONCLUSION: The results support the importance of personality diagnosis in adolescents and provide an approach to diagnosing adolescent personality that is empirically based and clinically useful.


Subject(s)
Empirical Research , Personality Disorders/classification , Personality Disorders/diagnosis , Adolescent , Female , Humans , Male , Personality Assessment/statistics & numerical data , Personality Disorders/psychology , Psychometrics/statistics & numerical data , Reproducibility of Results , Surveys and Questionnaires , United States
9.
J Nerv Ment Dis ; 202(4): 333-45, 2014 Apr.
Article in English | MEDLINE | ID: mdl-24647212

ABSTRACT

Consistent with attachment theory and a developmental psychopathology framework, a growing body of research suggests that traumatic parental separations may lead to unique pathways of personality adaptation and maladaptation. The present study both examined personality characteristics and identified personality subtypes of adolescents with histories of traumatic separations. Randomly selected psychologists and psychiatrists provided data on 236 adolescents with histories of traumatic separations using a personality pathology instrument designed for use by clinically experienced observers, the Shedler-Westen Assessment Procedure. Using a Q factor analysis, five distinct personality subtypes were identified as follows: internalizing/avoidant, psychopathic, resilient, impulsive dysregulated, and immature dysregulated. Initial support for the validity of the subtypes was established on the basis of axis I and axis II pathology, adaptive functioning, developmental history, and family history variables. The personality subtypes demonstrated substantial incremental validity in predicting adaptive functioning, above and beyond demographic variables and histories of other traumatic experiences.


Subject(s)
Adaptation, Psychological/physiology , Anxiety, Separation/psychology , Life Change Events , Parent-Child Relations , Personality Disorders/classification , Personality/classification , Adolescent , Age Factors , Child , Child, Preschool , Female , Humans , Infant , Male , Personality Disorders/diagnosis , Personality Disorders/etiology , Predictive Value of Tests , Psychiatric Status Rating Scales , Reproducibility of Results , Sex Factors
10.
J Pers Assess ; 96(3): 339-49, 2014.
Article in English | MEDLINE | ID: mdl-23980745

ABSTRACT

There has been surprisingly little research into the stimulus properties of the Thematic Apperception Test Cards (TAT; Murray, 1943). This study used the Social Cognition and Object Relations Scale-Global Rating Method (SCORS-G; Stein, Hilsenroth, Slavin-Mulford, & Pinsker, 2011 ; Westen, 1995 ) to explore the stimulus properties of select TAT cards in a clinical sample. The SCORS-G is a theoretically based and empirically validated measure of object relations that has widely been used in TAT research. A sample of 80 patients referred for psychological assessment at a large Northeastern hospital were administered the TAT (Cards 1, 2, 3BM, 4, 13MF, 12M, and 14) as part of their assessment battery. Trained raters scored the narratives using the SCORS-G. The SCORS-G ratings were analyzed to determine the nature and degree of object representation "pull" both across and within the TAT cards. The results showed that Cards 3BM and 13MF exhibited the greatest card pull for negative pathological object representations, and Card 2 displayed the highest card pull for adaptive and mature object representations. Both clinical and research related implications are discussed.


Subject(s)
Mental Disorders/diagnosis , Psychometrics/methods , Thematic Apperception Test/standards , Adult , Female , Humans , Male , Middle Aged , Outpatients/psychology , Psychometrics/instrumentation
11.
Pers Individ Dif ; 55(2): 85-89, 2013 Jul 01.
Article in English | MEDLINE | ID: mdl-24031102

ABSTRACT

A growing body of research suggests that personality characteristics relate to physical health; however, this relation ship has primarily been tested in cross-sectional studies that have not followed the participants into old age. The present study utilizes data from a 70-year longitudinal study to prospectively examine the relationship between the adaptive defense mechanisms in midlife and objectively assessed physical health in late life. In addition to examining the direct effect, we test whether social support mediates this relation ship. The sample consisted of 90 men who were followed for over seven decades beginning in late adolescence. Health ratings from medical records were made at three time points (ages 70, 75, and 80). Defense mechanisms were coded from narratives by trained independent raters (Vaillant, Bond, & Vaillant, 1986). Independent raters assessed social supports between ages 50 and 70. More adaptive defenses in midlife were associated with better physical health at all three time points in late life. These relationships were partially mediated by social support. Findings are consistent with the theory that defense maturity is important for building social relationships, which in turn contribute to better late-life physical health. Psychological interventions aimed at improving these domains may be beneficial for physical health.

12.
Psychol Assess ; 25(2): 606-17, 2013 Jun.
Article in English | MEDLINE | ID: mdl-23458082

ABSTRACT

Research over the last decade has been promising in terms of the incremental utility of psychometric tools in predicting important clinical outcomes, such as mental health service utilization and inpatient psychiatric hospitalization. The purpose of this study was to develop and validate a new Level of Care Index (LOCI) from the Personality Assessment Inventory (PAI). Logistic regression was initially used in a development sample (n = 253) of psychiatric patients to identify unique PAI indicators associated with inpatient (n = 75) as opposed to outpatient (n = 178) status. Five PAI variables were ultimately retained (Suicidal Ideation, Antisocial Personality-Stimulus Seeking, Paranoia-Persecution, Negative Impression Management, and Depression-Affective) and were then aggregated into a single LOCI and independently evaluated in a second validation sample (n = 252). Results indicated the LOCI effectively differentiated inpatients from outpatients after controlling for demographic variables and was significantly associated with both internalizing and externalizing risk factors for psychiatric admission (range of ds = 0.46 for history of arrests to 0.88 for history of suicidal ideation). The LOCI was additionally found to be meaningfully associated with measures of normal personality, performance-based tests of psychological functioning, and measures of neurocognitive (executive) functioning. The clinical implications of these findings and potential utility of the LOCI are discussed.


Subject(s)
Mental Disorders/diagnosis , Personality Assessment/standards , Personality Inventory/standards , Psychiatric Status Rating Scales/standards , Psychometrics/instrumentation , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Inpatients/psychology , Male , Middle Aged , New England , Outpatients/psychology , Pilot Projects , Young Adult
13.
Psychotherapy (Chic) ; 50(1): 110-8, 2013 Mar.
Article in English | MEDLINE | ID: mdl-23505987

ABSTRACT

Depression is among the most prevalent and burdensome psychiatric disorders in the United States (Kessler et al., Achieves of General Psychiatry 62:617-627, 2005). There is substantial empirical support regarding efficacy of pharmacotherapy, psychotherapy, and combined treatment (both pharmacotherapy and psychotherapy) for treating depression. However, far less is known about the effectiveness of these treatments for real-world patients treated within routine clinical care settings (Cahill et al., The British Journal of Clinical Psychology 49:421-453, 2010). This study seeks to explore the effectiveness of treatment as usual (TAU) for depression in a large cohort of psychiatric outpatients receiving psychotherapy, pharmacotherapy, or combined treatment within an academic medical center. Initial and follow-up self-report assessments were analyzed for 1,322 patients receiving treatment for depression. Using these data, we determined treatment effect sizes, rates of reliable improvement (and deterioration), and rates of clinically significant improvement for psychotherapy, pharmacotherapy, and combined care. On average, all treatments produced significant improvement with effect sizes surpassing our no-treatment benchmark. No significant between-group (treatment) differences in self-report outcomes were found. The rates of reliable change were similar for all treatment groups consistent with past research. The present findings support the effectiveness of psychotherapy, pharmacotherapy, and combined treatment as routinely provided within a large academic medical center for the treatment of real-world patients suffering with depression.


Subject(s)
Antidepressive Agents/therapeutic use , Depressive Disorder, Major/therapy , Dysthymic Disorder/therapy , Psychotherapy/methods , Academic Medical Centers , Adult , Ambulatory Care , Cohort Studies , Combined Modality Therapy , Couples Therapy , Depressive Disorder, Major/diagnosis , Depressive Disorder, Major/psychology , Dysthymic Disorder/diagnosis , Dysthymic Disorder/psychology , Family Therapy , Female , Follow-Up Studies , Humans , Male , Middle Aged , Outcome and Process Assessment, Health Care , Psychotherapy, Group , Surveys and Questionnaires , Treatment Outcome
14.
J Pers Assess ; 95(4): 432-4, 2013.
Article in English | MEDLINE | ID: mdl-23437922

ABSTRACT

This brief report explores the external correlates of 2 higher order structures of the Personality Assessment Inventory (PAI; Morey, 1991, 2007); Hoelzle and Meyer's (2009a, 2009b) PAI Components and Hopwood and Moser's (2011) Internalizing and Externalizing Dimensions. Scores from these higher order structures were correlated with life-event data including education, marital status, employment, suicide attempts, psychiatric hospitalizations, trauma, medical problems, hallucinations, paranoid ideation, drug abuse, alcohol abuse, and arrest. Although some differences were noted, the results showed that both Hoelzle and Meyer's Components and Hopwood and Moser's Dimensions were meaningfully correlated with a wide range of life outcomes in a conceptually consistent manner. Overall, these findings provide support for the utility of these higher order variables.


Subject(s)
Mental Disorders/psychology , Personality , Adult , Educational Status , Employment , Female , Humans , Male , Personality Assessment , Psychometrics , Suicide, Attempted
15.
Bull Menninger Clin ; 77(1): 70-93, 2013.
Article in English | MEDLINE | ID: mdl-23428172

ABSTRACT

Psychoanalytic theories suggest that color perception on the Rorschach relates to affective modulation. However, this idea has minimal empirical support. Using a clinical sample, the authors explored the cognitive and clinical correlates of Rorschach color determinants and differences among four affective modulation subtypes: Controlled, Balanced, Under-Controlled, and Flooded. Subtypes were differentiated by measures of affective regulation, reality testing/confusion, and personality traits. Initial support for the relationship of chromatic color response styles and affective modulation was found.


Subject(s)
Affect , Anxiety Disorders/psychology , Bipolar Disorder/psychology , Color Perception , Depressive Disorder/psychology , Psychotic Disorders/psychology , Adolescent , Adult , Aged , Color , Female , Humans , Male , Middle Aged , Rorschach Test , Young Adult
16.
Compr Psychiatry ; 54(4): 326-33, 2013 May.
Article in English | MEDLINE | ID: mdl-23219361

ABSTRACT

The revisions proposed for the DSM-5 would greatly alter how personality pathology is conceptualized, assessed, and diagnosed. One aspect of the proposed changes, elimination of four current personality disorders, has raised considerable controversy. The present study attempts to inform this debate by exploring clinicians' views of the structure of Personality Disorders using the current diagnostic system, the DSM-IV. An exploratory factor analysis was conducted on the DSM-IV Personality Disorder criteria using clinician ratings for 280 patients. The factor analysis revealed eight clear and meaningful factors. The eight factors contained all six personality disorders proposed for retention in DSM-5 but also contained clear representations of two disorders (Paranoid and Schizoid) identified for removal from the system. These conditions appear to have clinical utility and their removal may have unintended negative consequences in clinical practice. Dependent and Avoidant criteria also merged to form a new construct with interesting clinical implications. These findings provide new insights into the complex typologies clinicians employ when applying the DSM-IV system to personality disordered patients. Lastly we argue that successful refinement of clinically significant constructs, like diagnostic systems, requires a balanced appraisal of evidence for clinical utility as well as external and internal validity.


Subject(s)
Diagnostic and Statistical Manual of Mental Disorders , Personality Disorders/diagnosis , Checklist , Factor Analysis, Statistical , Humans , Psychometrics , Surveys and Questionnaires
17.
World Psychiatry ; 11(3): 172-80, 2012 Oct.
Article in English | MEDLINE | ID: mdl-23024677

ABSTRACT

This article describes a system for diagnosing mood disorders that is empirically derived and designed for its clinical utility in everyday practice. A random national sample of psychiatrists and clinical psychologists described a randomly selected current patient with a measure designed for clinically experienced informants, the Mood Disorder Diagnostic Questionnaire (MDDQ), and completed additional research forms. We applied factor analysis to the MDDQ to identify naturally occurring diagnostic groupings within the patient sample. The analysis yielded three clinically distinct mood disorder dimensions or spectra, consistent with the major mood disturbances included in the DSM and ICD over successive editions (major depression, dysthymia, and mania), along with a suicide risk index. Diagnostic criteria were determined strictly empirically. Initial data using diagnostic efficiency statistics supported the accuracy of the dimensions in discriminating DSM-IV diagnoses; regression analyses supported the discriminant validity of the MDDQ scales; and correlational analysis demonstrated coherent patterns of association with family history of mood disorders and functional outcomes, supporting validity. Perhaps most importantly, the MDDQ diagnostic scales demonstrated incremental validity in predicting adaptive functioning and psychiatric history over and above DSM-IV diagnosis. The empirically derived syndromes can be used to diagnose mood syndromes dimensionally without complex diagnostic algorithms or can be combined into diagnostic prototypes that eliminate the need for ever-expanding categories of mood disorders that are clinically unwieldy.

18.
J Pers Assess ; 94(6): 593-600, 2012.
Article in English | MEDLINE | ID: mdl-22571412

ABSTRACT

This study contributes to the ongoing construct validation of the personality assessment inventory (PAI; Morey, 1991 , 2007 ) by identifying nontest life-event correlates of the PAI full scales and subscales in a sample of psychiatric patients. The life-event data used in this study included education, marital status, and employment, as well as a history of suicide attempts, psychiatric hospitalizations, trauma, medical problems, hallucinations, paranoid ideation, drug abuse, alcohol abuse, and arrest. Correlations were calculated to explore the convergent and discriminant validity of the PAI scales relative to the life-event data. The results showed that the majority of the PAI scales (11 of 13) had meaningful correlations with at least 1 life-event variable. The PAI BOR scale had the greatest number of correlations and was associated with 8 life-event variables. In contrast, the PAI ANX and MAN scales had no correlations above a predetermined threshold (r ≥ .21). These findings add to the growing body of empirical correlates of the PAI and generally provide support for the construct validity of the PAI scales.


Subject(s)
Mental Disorders/diagnosis , Mental Disorders/psychology , Personality Assessment/statistics & numerical data , Personality Inventory/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Life Change Events , Male , Middle Aged , Psychometrics/statistics & numerical data , Reproducibility of Results , Statistics as Topic , Young Adult
19.
J Clin Psychol ; 67(12): 1259-82, 2011 Dec.
Article in English | MEDLINE | ID: mdl-22072534

ABSTRACT

OBJECTIVES: This study examined personality characteristics and identified personality subtypes of adults with childhood histories of traumatic separations from a parent. Previous work from attachment theory and developmental psychopathology suggests that distinct developmental trajectories might lead to different styles of personality adaptation after an attachment disruption. design: Randomly selected psychologists and psychiatrists provided data on 203 adults with histories of traumatic separations using a personality pathology instrument designed for use by clinically experienced observers, the Shedler-Westen Assessment Procedure (SWAP-II). RESULTS: Using a Q-factor analysis, 5 distinct personality subtypes were identified: internalizing/avoidant, psychopathic, emotionally dysregulated, hostile/paranoid, and resilient. Initial support for the validity of the subtypes was established, based on Axis I and Axis II pathology, adaptive functioning, developmental history, and family history variables. CONCLUSIONS: Both therapeutic interventions and case formulation might be strengthened by considering an individual's personality features and match to one of the identified subtypes.


Subject(s)
Life Change Events , Personality Disorders/epidemiology , Reactive Attachment Disorder/epidemiology , Adolescent , Adult , Case-Control Studies , Child , Child, Preschool , Comorbidity , Cross-Sectional Studies , Emotions , Female , Humans , Infant , Male , Mental Disorders/epidemiology , Personality Development , United States/epidemiology
20.
J Pers Disord ; 25(3): 305-20, 2011 Jun.
Article in English | MEDLINE | ID: mdl-21699393

ABSTRACT

Despite a general consensus that dimensional models are superior to the categorical representations of personality disorders in DSM-IV, proposals for how to depict personality pathology dimensions vary substantially. One important question involves how to separate clinical severity from the style of expression through which personality pathology manifests. This study empirically distinguished stylistic elements of personality pathology symptoms from the overall severity of personality disorder in a large, longitudinally assessed clinical sample (N = 605). Data suggest that generalized severity is the most important single predictor of current and prospective dysfunction, but that stylistic elements also indicate specific areas of difficulty. Normative personality traits tend to relate to the general propensity for personality pathology, but not stylistic elements of personality disorders. Overall, findings support a three-stage diagnostic strategy involving a global rating of personality disorder severity, ratings of parsimonious and discriminant valid stylistic elements of personality disorder, and ratings of normative personality traits.


Subject(s)
Personality Assessment/standards , Personality Disorders/diagnosis , Personality Disorders/psychology , Severity of Illness Index , Adult , Diagnostic and Statistical Manual of Mental Disorders , Female , Humans , Longitudinal Studies , Male , Middle Aged , Psychiatric Status Rating Scales/standards , Psychometrics , Surveys and Questionnaires , Young Adult
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