Diagnosis and subtypes of adolescent antisocial personality disorder.

The present study examined the application of the Antisocial Personality Disorder (APD) diagnosis to adolescents and investigated the possibility of subtypes of APD adolescents. As part of a broader study of adolescent personality in clinically-referred patients, experienced clinicians provided personality data on a randomly selected patient in their care using the SWAP-II-A personality pathology instrument. Three hundred thirteen adolescents met adult DSM-IV diagnostic criteria for APD. To characterize adolescents with the disorder, we aggregated the data to identify the items most descriptive and distinctive of APD adolescents relative to other teenagers in the sample (N = 950). Q-factor analysis identified five personality subtypes: psychopathic-like, socially withdrawn, impulsive-histrionic, emotionally dysregulated, and attentionally dysregulated. The five subtypes differed in predictable ways on a set of external criteria related to global adaptive functioning, childhood family environment, and family history of psychiatric illness. Both the APD diagnosis and the empirically derived APD subtypes provided incremental validity over and above the DSM-IV disruptive behavior disorders in predicting global adaptive functioning, number of arrests, early-onset severe externalizing pathology, and quality of peer relationships. Although preliminary, these results provide support for the use of both APD and personality-based subtyping systems in adolescents.

Personality subtypes of suicidal adults.

Research into personality factors related to suicidality suggests substantial variability among suicide attempters. A potentially useful approach that accounts for this complexity is personality subtyping. As part of a large sample looking at personality pathology, this study used Q-factor analysis to identify subtypes of 311 adult suicide attempters using Shedler-Westen Assessment Procedure-II personality profiles. Identified subtypes included internalizing, emotionally dysregulated, dependent, hostile-isolated, psychopathic, and anxious somatizing. Subtypes differed in hypothesized ways on criterion variables that address their construct validity, including adaptive functioning, Axis I and II comorbidity, and etiology-related variables (e.g., history of abuse). Furthermore, dimensional ratings of the subtypes predicted adaptive functioning above DSM-based diagnoses and symptoms.

Questioning the coherence of histrionic personality disorder: borderline and hysterical personality subtypes in adults and adolescents.

After the introduction of histrionic personality disorder (HPD), nosologists struggled to reduce its overlap with borderline personality disorder and other PDs. We studied the coherence of HPD in adults and adolescents as part of 2 larger studies. Clinicians described a random patient with personality pathology using rigorous psychometrics, including the SWAP-II (a Q-sort that captures personality and its pathology in adults) in study 1 and the SWAP-II-A (the adolescent version) in study 2. Using DSM-IV-based measures, we identified patients who met HPD criteria with varying degrees of diagnostic confidence. Central tendencies in the SWAP-II and SWAP-II-A profiles revealed that both the most descriptive and most distinctive features of the patients included some features of HPD but also many features of borderline personality disorder. Q-factor analyses of the SWAP data yielded 3 types of patients in each of the 2 samples. The HPD diagnosis may not be sufficiently coherent or valid.

The borderline personality diagnosis in adolescents: gender differences and subtypes.

BACKGROUND: This study aimed to identify personality features characterizing adolescent girls and boys with borderline personality disorder (BPD) and to see whether meaningful patterns of heterogeneity exist among adolescents diagnosed with the disorder. METHODS: Two hundred and ninety-four randomly selected doctoral-level clinicians described adolescent patients using Axis II rating scales and the Shedler-Westen Assessment Procedure-200 for Adolescents (SWAP-200-A). We used the SWAP-200-A to provide empirically derived descriptions of female and male adolescents meeting DSM-IV criteria for BPD (who differed substantially in their profiles), and used Q-factor analysis to identify naturally occurring groupings of female patients based on shared personality features. RESULTS: The symptoms and phenomenology of adolescent girls with BPD are similar to those of adults. Adolescent boys meeting BPD criteria have a more aggressive, disruptive, antisocial presentation. Although Ns did not permit further analysis of the data on adolescent boys, Q-analysis isolated four clinically coherent subgroups of girls with BPD: high-functioning internalizing, histrionic, depressive internalizing, and angry externalizing. CONCLUSIONS: BPD in female adolescents resembles DSM-IV BPD as defined for adults. The operating characteristics of the DSM-IV criteria for adolescent boys require further investigation. Empirically derived subgroups are similar to those identified in recent research with adult females. Differences across subgroups on internalizing and externalizing Child Behavior Checklist (CBCL) scales provide preliminary data on the validity of subgroups and raise questions about the place of BPD among internalizing and externalizing spectrum disorders.

Quantifying construct validity: two simple measures.

Construct validity is one of the most central concepts in psychology. Researchers generally establish the construct validity of a measure by correlating it with a number of other measures and arguing from the pattern of correlations that the measure is associated with these variables in theoretically predictable ways. This article presents 2 simple metrics for quantifying construct validity that provide effect size estimates indicating the extent to which the observed pattem of correlations in a convergent-discriminant validity matrix matches the theoretically predicted pattern of correlations. Both measures, based on contrast analysis, provide simple estimates of validity that can be compared across studies, constructs, and measures meta-analytically, and can be implemented without the use of complex statistical procedures that may limit their accessibility.

Histrionic personality disorder and antisocial personality disorder: sex-differentiated manifestations of psychopathy?

Little is known about the etiology of histrionic personality disorder (HPD) or its relation to other personality disorders. In this study, we examined whether HPD is etiologically related to psychopathy and more specifically whether HPD and antisocial personality disorder (ASPD) are sex-typed alternative manifestations of psychopathy. In addition, based on Newman's (1987) response modulation hypothesis of psychopathy, we examined the associations between psychopathic, HPD, and ASPD features and performance on laboratory measures of passive avoidance errors and interference effects. Seventy-five live theater actors completed self-report questionnaires and two laboratory measures of response modulation, and peers completed questionnaires concerning the participants' personality disorder features. The results provided weak and inconsistent support for the hypotheses that HPD is a female-typed variant of psychopathy and that ASPD is a male-typed variant of psychopathy. Contrary to previous findings, scores on response modulation tasks were not significantly related to psychopathy, or to either HPD or ASPD. The limitations of this study and possibilities for future research in this area are outlined.

The hysterical personality disorder: a phenomenological approach.

The background of the present study is a general uncertainty as to what comprises the essence of hysterical (histrionic) personality disorder. Using phenomenological methodology, phenomena observable in the 'classic' hysterical personality are analysed, described, named, and classified according to the basic functions of human experience and behaviour. The resulting psychopathological picture of the hysterical personality facilitates a differential diagnosis that is often decidedly difficult. The phenomenon of dissociation of the mental processes is demonstrated for the various basic functions. A specific feature of the disorder is shown which generates a dissociation of contents of the personality along a conscious-preconscious-unconscious continuum. It is concluded that dissocation is, in the final analysis, the prerequisite for a compromised and partial acting out of prohibited non-integrated elements, e.g. aggression, as a coping strategy.

[Hysterical personality disorder]. / La personnalité hystérique.

The hysteric personality disorder is characterized by: 1. an intense need for affection; it is a child-like need, seeking protection and affection, making the patient subject to suggestibility and dependence, along with an erotic behaviour which is in reality associated to fear of sexuality; 2. an exaggerated and rapidly shifting expression of emotion leading to unstable, theatrical and histrionic expression of emotions giving an impression of shallowness and lack of authenticity; 3. a highly imaginative thinking pattern with flight of reality and tendency to dreaming, mythomania, memory reconstruction.

MMPI assessment of the DSM-III-R histrionic personality disorder.

This study investigated the MMPI characteristics of a group of 25 Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R]; American Psychiatric Association, 1987) histrionic personality disorder patients, contrasted with a mixed group of 57 other personality disorder patients. All patients were diagnosed by means of a semistructured interview (SCID-II; Spitzer, Williams, & Gibbon, 1987). Effects for diagnostic category were found for MMPI Scales 9 (Ma), 0 (Si) and for the HST scale, developed by Morey, Waugh, and Blashfield (1985) for the diagnosis of the histrionic personality disorder. Further analysis of the results revealed that these MMPI scales, and especially the HST scale, mainly assess a social introversion-extraversion dimension, on which histrionic inpatients can be differentiated from nonhistrionic inpatients. This study does not offer direct empirical support for the use of the HST scale as a measurement of the DSM-III-R histrionic personality disorder concept.

Dimensions of personality disorder. The DSM-III-R cluster B diagnoses.

This study describes a psychometric approach to refining descriptions of antisocial, borderline, histrionic, and narcissistic personality disorders in an attempt to achieve greater distinctiveness. We developed descriptions of each diagnosis from content analysis of the literature. Psychiatrists' ratings were used to organize the features of each diagnosis into a set of carefully defined behavioral dimensions. Self-report scales were developed to assess each dimension. Scales were administered to a general population sample (N = 274) and a sample of patients with a primary diagnosis of personality disorder (N = 133). Scales demonstrated satisfactory levels of internal consistency. Some dimensions showed a low correlation with other dimensions defining the same diagnosis. These dimensions could be eliminated without affecting reliability. The structure underlying the dimensions delineating each diagnosis was evaluated using factor analysis. For each diagnosis, the structure was highly similar in the two samples. Based on these results, specific proposals are made for redefining diagnoses.

Gender weighting of DSM-III-R personality disorder criteria.

This study explored the gender weighting of the diagnostic criteria for personality disorders. Gender weighting was defined in terms of how 33 female and 17 male nonclinicians ranked the diagnostic criteria along a male-female dimension. Although the a priori expectation was that antisocial would be the prototypically masculine personality disorder and histrionic the feminine, the subjects ranked criteria from the sadistic category as the most masculine and those from the dependent category as the most feminine. These results and the subjects' gender weighting of criteria for borderline, obsessive-compulsive, and self-defeating personality disorders are analyzed in detail.

Antisocial and related disorders in a southern community. An application of grade of membership analysis.

Symptoms of antisocial personality disorder (ASPD) and of psychiatric conditions reported to be related to ASPD were subjected to grade of membership analysis, a relatively new procedure for medical classification, to identify the pure types that would empirically emerge in the absence of prior assumptions about the clustering of those symptoms. The sample consists of 914 respondents who participated in the NIMH Epidemiologic Catchment Area Program at the North Carolina site. Symptom and diagnostic data were obtained using the Diagnostic Interview Schedule. Seven pure types emerged from the grade of membership analysis. Two pure types closely resemble the DSM-III portrait of ASPD. Two other pure types consisted of alcohol abuse/dependence symptoms and indicators of illicit drug use for recreational purposes. Only two of the symptomatic pure types were common among women. The first of these was characterized by marital instability, other domestic problems, and employment difficulties; as such this type resembles the DSM-III description of borderline and/or histrionic personality disorder. The other female pure type was characterized by multiple symptoms of depression and selected symptoms of other axis I disorders. The final pure type was characterized by an absence of psychiatric symptoms and served as a comparison group against which the symptomatic pure types were compared.

A structured interview for the DSM-III personality disorders. A preliminary report.

With few exceptions, published studies fail to indicate that the DSM-III personality disorders can be distinguished from each other with respect to etiology, prognosis, treatment response, or family history. The Structured Interview for the DSM-III Personality Disorders (SIDP) was developed to improve axis II diagnostic reliability, and hence allow validity testing of axis II. Sixty-three subjects were independently rated by two interviewers using the SIDP. The kappa coefficients for interrater agreement reached .70 or higher for histrionic, borderline, and dependent personalities. While it is impossible to separate the validity testing of the SIDP from validity testing of the DSM-III personality criteria themselves, preliminary results from 102 inpatient SIDP interviews suggest some criterion-based validity with respect to standard personality rating scales and some construct validity with respect to the dexamethasone suppression test.

[Hysterical manifestations in Black Africa. Pilot study conducted at the Neuro-Psycho-Pathology Center, Kinshasa]. / Les manifestations hystériques en Afrique Noire. Une étude-pilote menée au CNPP Kinshasa.

In a retrospective study on twenty Zairese patients, presenting a hysterical personality structure, the different forms of decompensation have been described and classified according to the DSM III criteria. Even taking into account the inconstancy of hysterical manifestations and the use of criteria not adapted to the local context, some of the described syndromes seem rather atypical. Such findings should stimulate the African psychiatry to develop its own nosographical criteria.

The validity of DSM-III borderline personality disorder. A phenomenologic, family history, treatment response, and long-term follow-up study.

To test the validity of the DSM-III diagnosis of borderline personality disorder (BPD), we examined the phenomenology, family history, treatment response, and four-to-seven-year long-term outcome of a cohort of 33 patients meeting DSM-III criteria for BPD. We found that (1) BPD could be distinguished readily from DSM-III schizophrenia; (2) BPD did not appear to represent "borderline affective disorder," although many patients displayed BPD and major affective disorder concomitantly; and (3) BPD could not be distinguished on any of the indices from histrionic and antisocial personality disorders.

Hysteroid dysphoria: an unsuccessful attempt to demonstrate its syndromal validity.

Hysteroid dysphoria has been described as a chronic illness characterized by recurrent periods of depression precipitated by a specific type of stress and associated with a histrionic personality. In addition, there are specific atypical symptoms. The authors tested the syndromal validity of this proposed category in a sample of 1,324 patients with mild depression reported on by psychiatrists in a questionnaire survey. They found 41 (3.1%) who fit a pattern consisting of the basic features of the condition. However, patients who fit this pattern were not more likely to have substantially more atypical symptoms than patients without this pattern. The authors conclude that the syndromal validity of hysteroid dysphoria is not supported.

Psychiatric diagnoses (Research Diagnostic Criteria) in symptomatic volunteers.

Symptomatic volunteers (SVs) are increasingly used as subjects for clinical research studies. A total of 362 SVs were recruited, psychiatric diagnoses were made according to Research Diagnostic Criteria (RDC), and standard symptom scale scores on the Hopkins Symptom Check list (HSCL) for the individual diagnostic categories were computed. Of these subjects, 221 were classified as having a depressive disorder (three categories), 112 as having an anxiety disorder (three categories), and 29 as having some other RDC disorder. The HSCL scale scores for the depressive- and anxiety-disorder subject groups were consistent with those for actual patient groups. There were significant differences in HSCL scores for some RDC categories within the broader depressive- or anxiety-disorder groupings. Individual RDC categories should be kept separate in reporting treatment results for depressive or anxiety disorders.

Hysteria split asunder.

The authors present the proposed DSM-III classification of the traditional hysterical disorders, i.e., disorders that suggest physical illness but in which psychological factors are judged to be of importance. The use of the DSM-III inclusion and exclusion criteria--physical mechanism explains the symptoms, symptoms are linked to psychological factors, symptom initiation is under voluntary control, and there is an obvious recognizable environmental goal--are discussed in the differential diagnosis of somatoform disorder, factitious disorder, malingering, psychological factors affecting physical condition, and undiagnosed physical illness.