[Epidemiological aspects of personality disorders in older adults]. / Persoonlijkheidsstoornissen bij ouderen: Epidemiologische aspecten.

Despite growing clinical attention to personality disorders in older adults (≥ 55 yrs.), empirical research addressing personality pathology in late life is scarce. Given the ageing of the population globally, scientific knowledge in this area is of vital importance. This article gives an overview of the epidemiological aspects of personality disorders in older adults, such as prevalence, the course and the impact on various domains of functioning.

[Standardized assessment of personality disorders in older adults: State-of-the-art.] / Gestandaardiseerd meten van persoonlijkheids­stoornissen bij ouderen.

The double ageing evolution in Europe is a tremendous challenge for health care. Older adults with a personality disorder place an additional burden: they have more somatic and psychiatric co-morbidity than those without a personality disorder. Moreover, they experience less quality of life than individuals without personality disorders. This is in sharp contrast to the dearth of empirical research concerning the construct of personality disorders in later life, the very limited amount of available diagnostic tools, criteria of classification systems like DSM not being attuned to the elderly context and the lack of age-neutrality of popular instruments to measure personality disorders. Therefore, in the Netherlands and Belgium a start was made to develop and validate age-specific instruments and to examine the applicability of the alternative dimensional-hybrid DSM-5 classification of personality disorders in older adults. These recent developments and how to apply them for a personalized assessment in older adults will be discussed. Finally, we advise a phased test-based diagnostic approach in which the above-mentioned instruments, combined with measures of adaptive features or more specific tests, can contribute to an assessment optimizing the balance between restricting the load for the older patient and still being sufficiently comprehensive to result in a personalized approach of the diagnostic process.

[The Cognitive Model for Behavioural Interventions for older adults with neurocognitive disorders and co-morbid maladaptive personality traits]. / Mediatieve behandeling bij mensen met zowel neuro­cognitieve stoornissen als persoonlijkheids­problematiek.

The starting point of this study is that comorbid maladaptive personality traits (CMPT) influence behavioral and psychological symptoms of dementia (BPSD). The purpose of this study was to develop and investigate the feasibility of the Cognitive Model for Behavioral Interventions (CoMBI). Forty patients with BPSD and CMPT from two geriatric psychiatric departments were treated with CoMBI. Feasibility was assessed through patient flow, compliance to, and acceptability of the treatment for family members and psychiatric nurses. CMPT was assessed using informant-based questionnaires. Change in BPSD was assessed using pre- and posttests. To determine differences in BPSD, Wilcoxon signed rank tests were conducted and effect sizes were computed. Of 312 patients admitted to the geriatric psychiatric wards, 138 patients were found eligible. 64 (46.4%) patients were discharged from the wards before or shortly after the pretest, in 28 (20.3%) cases CoMBI could not be not applied. Eventually, forty (29.0%) patients were included for analysis. Wilcoxon signed rank tests demonstrated a significant decrease of BPSD with medium (r=0.45) to large (r=0.56) effect sizes. CoMBI is highly feasible for treating challenging behavior in patients with BPSD and CMPT. CoMBI is associated with a significant decrease of challenging behaviors regardless of etiology.

Borderline personality disorder diagnosis in a new key.

BACKGROUND: Conceptualizations of personality disorders (PD) are increasingly moving towards dimensional approaches. The definition and assessment of borderline personality disorder (BPD) in regard to changes in nosology are of great importance to theory and practice as well as consumers. We studied empirical connections between the traditional DSM-5 diagnostic criteria for BPD and Criteria A and B of the Alternative Model for Personality Disorders (AMPD). METHOD: Raters of varied professional backgrounds possessing substantial knowledge of PDs (N = 20) characterized BPD criteria with the four domains of the Level of Personality Functioning Scale (LPFS) and 25 pathological personality trait facets. Mean AMPD values of each BPD criterion were used to support a nosological cross-walk of the individual BPD criteria and study various combinations of BPD criteria in their AMPD translation. The grand mean AMPD profile generated from the experts was compared to published BPD prototypes that used AMPD trait ratings and the DSM-5-III hybrid categorical-dimensional algorithm for BPD. Divergent comparisons with DSM-5-III algorithms for other PDs and other published PD prototypes were also examined. RESULTS: Inter-rater reliability analyses showed generally robust agreement. The AMPD profile for BPD criteria rated by individual BPD criteria was not isomorphic with whole-person ratings of BPD, although they were highly correlated. Various AMPD profiles for BPD were generated from theoretically relevant but differing configurations of BPD criteria. These AMPD profiles were highly correlated and showed meaningful divergence from non-BPD DSM-5-III algorithms and other PD prototypes. CONCLUSIONS: Results show that traditional DSM BPD diagnosis reflects a common core of PD severity, largely composed of LPFS and the pathological traits of anxiousness, depressively, emotional lability, and impulsivity. Results confirm the traditional DSM criterion-based BPD diagnosis can be reliably cross-walked with the full AMPD scheme, and both approaches share substantial construct overlap. This relative equivalence suggests the vast clinical and research literatures associated with BPD may be brought forward with DSM-5-III diagnosis of BPD.

Assessment of Pathological Traits in DSM-5 Personality Disorders By the DAPP-BQ: How Do These Traits Relate to the Six Personality Disorder Types of the Alternative Model?

The six personality disorder (PD) types in DSM-5 section III are intended to resemble their DSM-IV/DSM-5 section II PD counterparts, but are now described by the level of personality functioning (criterion A) and an assigned trait profile (criterion B). However, concerns have been raised about the validity of these PD types. The present study examined the continuity between the DSM-IV/DSM-5 section II PDs and the corresponding trait profiles of the six DSM-5 section III PDs in a sample of 350 Dutch psychiatric patients. Facets of the Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ) were presumed as representations (proxies) of the DSM-5 section III traits. Correlational patterns between the DAPP-BQ and the six PDs were consistent with previous research between DAPP-BQ and DSM-IV PDs. Moreover, DAPP-BQ proxies were able to predict the six selected PDs. However, the assigned trait profile for each PD didn't fully match the corresponding PD.

[Concordance and added value of informant- versus self-report in personality assessment: a systematic review]. / Concordantie en meerwaarde van informant- versus zelfrapportage bij persoonlijkheids­diagnostiek: een systematische review.

INTRODUCTION: Both in personality assessment and scientific research, self-report questionnaires are frequently used, yet the use of informant-report is increasing. The aim of this systematic review is to address the concordance and added value of informant- versus self-report in measuring personality pathology in (older) adults. METHOD: A systematic search has been carried out for relevant literature published between 2000 and 2018, via the databases Scopus, PsychINFO and PubMED. Also the reference lists of included articles have been checked, resulting in an inclusion of 46 studies. RESULTS: The concordance between informant- and self-report appears to be only moderate, but highest when the relationship is characterized by interpersonal intimacy (such as between partners). The concordance between informants is somewhat better than between informant- and self -reports. Informants have an added value over self-report in the context of externalizing personality traits and interpersonal functioning. In addition, they appear to be a better predictor for health, adaptability and professional functioning. Self-report on the other hand captures intrapsychic characteristics more thoroughly. CONCLUSION: In personality assessment, informant- and self-reports could be complementary. However, empirical research among older adults is almost uncharted territory and deserves more attention.

[Cognitive model for behavioural interventions for personality disorders in older adults: a nursing approach]. / Mediatietherapie bij ouderen met een persoonlijkheidsstoornis: Een verpleegkundige benadering.

Behavioural counselling by nurses can enhance quality of life in elderly with a personality disorder. Although nurses have a crucial role in day-to-day treatment, there is a lack of evidence-based approaches. Based on the cognitive therapy, the treatment protocol Cognitive Model for Behavioural Interventions (CoMBI) provides an alternative nursing approach for personality disorders.

Personality and psychopathology: mapping the MMPI-2-RF on Cloninger's psychobiological model of personality.

This study investigates the relationship between the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) and the Temperament and Character Inventory (TCI) in a combined data set (N = 491) of patients with a broad range of psychiatric disorders (n = 286) as well as alcohol use disorder (n = 205). We examined bivariate correlations between both measures. The MMPI-2-RF scales relate to the TCI dimensions as was hypothesized, and relationships between both measurements were largely similar for psychiatric patients and alcohol-dependent patients. Theoretical and clinical implications are considered.

Integrating psychopathology and personality disorders conceptualized by the MMPI-2-RF and the MCMI-III: a structural validity study.

The Minnesota Multiphasic Personality Inventory-2-Restructured Form (Ben-Porath & Tellegen, 2008 ) Restructured Clinical scales and Higher Order scales were linked to the Millon Clinical Multiaxial Inventory-III (Millon, Millon, Davis, & Grossman, 2009 ) personality disorder scales and clinical syndrome scales in a Flemish/Dutch sample of psychiatric inpatients and outpatients, substance abuse patients, correctional inmates, and forensic psychiatric patients (N = 968). Structural validity of psychopathology and personality disorders as conceptualized by both instruments was investigated by means of principal component analysis. Results reveal a higher order structure with 4 dimensions (internalizing disorders, externalizing disorders, paranoid ideation/thought disturbance, and pathological introversion) that parallels earlier research on pathological personality dimensions as well as research linking pathological personality traits with mental disorders. Theoretical and clinical implications are considered.