Anger and Emotion Regulation Associated With Borderline and Antisocial Personality Features Within a Correctional Sample.

Although diagnostically distinct, research indicates that antisocial personality disorder (ASPD) and borderline personality disorder (BPD) share common features, including anger impulses and emotion dysregulation. It is unclear, however, how these variables are expressed and experienced differentially. The current study sought to examine independent associations of forms of anger expression and emotion dysregulation among a sample of incarcerated males. Participants were 30 males incarcerated in a county jail who completed self-report measures of BPD and ASPD features, emotion dysregulation, and anger. Results revealed that when controlling for the co-occurrence of the other disorder, anger expression and emotion dysregulation were significantly associated with BPD. Difficulties engaging in goal-directed behavior were significantly associated with ASPD. BPD may confer unique clinical challenges among incarcerated samples.

Emotion regulation accounts for associations between mindfulness and depression across and within diagnostic categories.

BACKGROUND: Previous research shows that mindfulness and emotion regulation (ER) are highly related to each other. Preliminary evidence in small clinical populations show that ER may partially account for the relationship between mindfulness and depressive symptoms. The present study aimed to investigate which diagnostic categories were associated with depressive symptoms after controlling for ER in a heterogeneous sample of treatment-seeking patients. METHODS: A large sample of psychiatric outpatients (N = 911) completed the Structured Clinical Interview for DSM-IV (SCID), Five Facet Mindfulness Questionnaire (FFMQ), Difficulties in Emotion Regulation Scale (DERS), and Clinically Useful Depression Outcome Scale (CUDOS). Partial correlations were conducted to evaluate to what degree the relationship between depression scores and facets of mindfulness were accounted for by ER scores. RESULTS: When controlling for baseline mindfulness, the relationship between emotion dysregulation and depression symptoms remained significant for all data points; however, when controlling for baseline emotion dysregulation, the association between mindfulness and depression was not significant in the majority of cases. Nonjudging was most resistant to this result. CONCLUSIONS: Although mindfulness is negatively associated with depressive symptoms, this association may be better accounted for by emotion dysregulation.

Should childhood conduct disorder be necessary to diagnose antisocial personality disorder in adults?

BACKGROUND: Antisocial personality disorder (ASPD) is the only DSM personality disorder that requires a diagnosis of conduct disorder (CD) during childhood. Previous research comparing adults diagnosed with ASPD with adults who meet all ASPD criteria except for a history of CD (referred to in this study as adult antisocial syndrome [AAS]) have reported mixed results. This study sought to clarify the differences among adults with ASPD, adults with AAS, and a large psychiatric outpatient control group. METHODS: A series of semi-structured interviews were conducted with 2,691 psychiatric outpatients. We compared groups on demographic variables, psychiatric comorbidity, symptom presentation, parental history, and psychosocial morbidity. RESULTS: Significant differences were found among ASPD, AAS, and controls in regard to demographic variables, comorbidity, symptom presentation, and parental history. The ASPD and AAS groups were similarly impaired with respect to global functioning, occupational and social functioning, and suicidality. CONCLUSIONS: Findings suggest that by including a history of CD in ASPD criteria, our diagnostic system excludes an important group of later-onset patients who also require attention and resources. Implications, limitations, and future directions are discussed.

Validity of the DSM-5 anxious distress specifier for major depressive disorder.

BACKGROUND: DSM-5 introduced the anxious distress specifier in recognition of the clinical significance of anxiety in depressed patients. Recent studies that supported the validity of the specifier did not use measures that were designed to assess the criteria of the specifier but instead approximated the DSM-5 criteria from scales that were part of an existing data base. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we examined the validity of the specifier diagnosed with a semistructured interview. METHODS: Two hundred sixty patients with a principal diagnosis of major depressive disorder were evaluated with semistructured diagnostic interviews. The patients were rated on clinician rating scales of depression, anxiety and irritability, and completed self-report measures. RESULTS: Approximately three-quarters of the depressed patients met the criteria for the anxious distress specifier. Patients with anxious distress had a higher frequency of anxiety disorders, particularly panic disorder and generalized anxiety disorder, as well as higher scores on measures of anxiety, depression, and anger. The patients meeting the anxious distress subtype reported higher rates of drug use disorders, poorer functioning during the week before the evaluation, and poorer coping ability compared to the patients who did not meet the anxious distress specifier. Moreover, anxious distress was associated with poorer functioning and coping after controlling for the presence of an anxiety disorder. CONCLUSIONS: The results of the present study indicate that anxious distress is common in depressed patients and support the validity of the DSM-5 anxious distress specifier.

Reliability and validity of a self-report scale for daily assessments of the severity of depressive symptoms.

To evaluate the efficacy of rapidly effective treatments for depression it is necessary to use measures that are designed to assess symptom severity over short intervals. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we modified our previously published depression scale and examined the reliability and validity of a daily version of the Clinically Useful Depression Outcome Scale (CUDOS-D). One thousand one hundred and fifteen patients presenting for treatment of DSM-IV/DSM-5 major depressive disorder (MDD) to a partial hospital program completed the CUDOS-D as part of their initial paperwork and on a daily basis thereafter. Test-retest reliability was examined in 50 patients who completed the CUDOS-D twice on the same day. A subset of 69 patients were interviewed by a trained diagnostic rater who administered the 17-item Hamilton Depression Rating Scale (HAMD) at baseline and on the day of discharge. The CUDOS-D had high internal consistency (Cronbach's alpha at intake = 0.82; Cronbach's alpha at follow-up = 0.93) and test-retest reliability (r = 0.91 and 0.98 at intake and follow-up, respectively), and was more highly correlated with another measure of depressive than nondepressive symptoms. CUDOS-D scores progressively declined during the course of treatment, and scores on each successive day were significantly lower than the preceding day. The change in CUDOS-D scores was significantly correlated with a change in HAMD scores (r = 0.65, p < 0.001). A large effect size was found for both measures (CUDOS-D: d = 1.63; HAMD: d = 1.56). In a large sample of partial hospital patients, the CUDOS-D was a reliable and valid measure of the DSM-5 symptoms of MDD assessed on a daily basis.

Does diagnosing a patient with borderline personality disorder negatively impact patient satisfaction with the initial diagnostic evaluation?

BACKGROUND: Research has found that clinicians have less sympathetic attitudes and behave less empathically toward patients with borderline personality disorder (BPD). Anecdotal conversations with clinicians and trainees reveal that some have a reluctance to tell their patients that they have BPD due to a concern that these patients will react badly. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we examined whether diagnosing BPD resulted in lower satisfaction with the initial evaluation. METHODS: One thousand ninety-three patients presenting to the Rhode Island Hospital partial hospital program completed the Clinically Useful Patient Satisfaction Scale (CUPSS), a reliable and valid measure of satisfaction with the initial evaluation. The usual clinical practice in our program is to discuss with the patients their diagnoses. RESULTS: Approximately one-sixth of the patients were diagnosed with BPD (15.6%, n = 171). There were no significant differences in satisfaction ratings on the 16 items of the CUPSS between patients with and without BPD. CONCLUSIONS: There was no evidence that diagnosing BPD was associated with reduced satisfaction with the initial diagnostic evaluation. Approaches toward making the diagnosis of BPD also are discussed.

Relationship Between the DSM-5 Anxious Distress Specifier and the Hamilton Depression Rating Scale Anxiety/Somatization Factor.

We examined the association between the Hamilton Depression Scale (HAMD) approach to classifying depressed patients into anxious and nonanxious subgroups and the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) anxious distress specifier subtyping. Two hundred two depressed patients were interviewed with semistructured diagnostic interviews. Patients were rated on the 17-item HAMD and the Hamilton Anxiety Rating Scale and completed the Clinically Useful Anxiety Outcome Scale. Both approaches toward identifying anxiety in depressed patients resulted in most of the patients meeting the anxiety subtype. Both subtyping methods were significantly correlated with clinician-rated and self-report measures of anxiety, and scores on the anxiety scales were higher in the patients who met the anxious subtype. However, DSM-5 anxious distress subtyping was only marginally associated with the HAMD anxiety/somatization factor subtyping approach (k = 0.21), and dimensional scores were only moderately correlated (r = 0.50). These findings indicate that the DSM-5 and HAMD approaches toward identifying an anxious subtype of depression are not interchangeable.

Measuring anxiety in depressed patients: A comparison of the Hamilton anxiety rating scale and the DSM-5 Anxious Distress Specifier Interview.

DSM-5 included criteria for an anxious distress specifier for major depressive disorder (MDD). In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project we examined whether a measure of the specifier, the DSM-5 Anxious Distress Specifier Interview (DADSI), was as valid as the Hamilton Anxiety Scale (HAMA) as a measure of the severity of anxiety in depressed patients. Two hundred three psychiatric patients with MDD were interviewed by trained diagnostic raters who administered the Structured Clinical Interview for DSM-IV (SCID) supplemented with questions to rate the DADSI, HAMA, and Hamilton Depression Rating Scale (HAMD). The patients completed self-report measures of depression, anxiety, and irritability. Sensitivity to change was examined in 30 patients. The DADSI and HAMA were significantly correlated (r = 0.60, p < 0.001). Both the DADSI and HAMA were more highly correlated with measures of anxiety than with measures of the other symptom domains. The HAMD was significantly more highly correlated with the HAMA than with the DADSI. For each anxiety disorder, patients with the disorder scored significantly higher on both the DADSI and HAMA than did patients with no current anxiety disorder. A large effect size of treatment was found for both measures (DADSI: d = 1.48; HAMA: d = 1.37). Both the DADSI and HAMA were valid measures of anxiety severity in depressed patients, though the HAMA was more highly confounded with measures of depression than the DADSI. The DADSI is briefer than the HAMA, and may be more feasible to use in clinical practice.

Reliability and validity of the DSM-5 Anxious Distress Specifier Interview.

BACKGROUND: To acknowledge the clinical significance of anxiety in depressed patients, DSM-5 included an anxious distress specifier for major depressive disorder (MDD). In the present report we describe the reliability and validity of a semi-structured interview assessing the features of the anxious distress specifier. Our goal was to develop an instrument that could be used for both diagnostic and outcome measurement purposes. METHODS: One hundred seventy-three psychiatric patients with MDD were interviewed by a trained diagnostic rater who administered the Structured Clinical Interview for DSM-IV (SCID) supplemented with questions from the DSM-5 Anxious Distress Specifier Interview (DADSI). Inter-rater (n=25) and test-retest (n=25) reliability of the DADSI was examined in separate groups of patients. The patients were rated on clinician rating scales of depression, anxiety and irritability, and patients completed self-report measures of these constructs. Sensitivity to change was examined in 16 patients. RESULTS: Approximately three-quarters of the depressed patients met the criteria for the anxious distress specifier (78.0%, n=135). The DADSI had excellent joint-interview reliability and good test-retest reliability. DADSI total scores were more highly correlated with other clinician-rated and self-report measures of anxiety than with measures of depression and anger. DADSI scores were significantly higher in depressed outpatients with a current anxiety disorder than depressed patients without a comorbid anxiety disorder. The DADSI was sensitive to improvement. CONCLUSION: The DADSI is a reliable and valid measure of the presence of the DSM-5 anxious distress specifier for MDD as well as the severity of the features of the specifier.