Visual event-related potentials in schizotypal personality disorder and schizophrenia.

Schizophrenia (SZ) occurs among a spectrum of disorders with similar characteristics, including schizotypal personality disorder (SPD). Visual processing disturbances have been reported in both disorders, but it is not yet clear which processes are disturbed in both SZ and SPD, suggestive of a common endophenotype, and which appear only in SZ. In order to address this question, the authors evaluated visual event-related potentials (ERPs) elicited during a line-orientation discrimination task in control, SPD, and SZ participants. Visual ERPs allow specification of both the time course and physiological correlates of visual perception and cognition. SZ patients had smaller P100 and P300a amplitudes and prolonged P300b latency compared to the control group. SZ patients also had smaller N160, N200, P300a, and P300b amplitudes compared to the SPD group. SPD participants did not differ from control participants on any ERP measure. These data documented pervasive abnormalities in visual perception and attention in SZ but not in SPD, suggesting that these visual ERP disturbances may not represent a common endophenotype. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The heterogeneous structure of schizotypal personality disorder: Item-level factors of the schizotypal personality questionnaire and their associations with obsessive-compulsive disorder symptoms, dissociative tendencies, and normal personality.

A. Raine et al.'s (1994) 3-factor scheme is currently the most widely accepted model of schizotypal personality disorder (SPD). Factor analytic studies of the Schizotypal Personality Questionnaire (SPQ; A. Raine, 1991) subscales, which represent the 9 Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for SPD, have provided the model's primary support. The use of only 9 modeled variables, however, limits the number of factors that can be extracted. To explicate this structure more fully, the authors conducted item-level factor analyses of the SPQ in a large student sample that completed the instrument twice within a 2-week interval. The authors' analyses failed to support either the 3-factor model of SPD or the 9 existing DSM-based subscales of the SPQ. Instead, 5 replicable dimensions emerged that capture recurrent symptom pairings found in the broader SPD literature: Social Anhedonia, Unusual Beliefs and Experiences, Social Anxiety, Mistrust, and Eccentricity/Oddity. These factors are only weakly correlated with each other and show differential correlational patterns with the Big Five personality traits, dissociative tendencies, and symptoms of obsessive-compulsive disorder. Moreover, they are congruent with dimensional models of personality psychopathology. Implications for SPD in DSM-V are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emotional correlates of the different dimensions of schizotypal personality disorder.

Two studies explored which different dimensions of schizotypal personality disorder (SPD) were associated with negative affect, attention to emotions, clarity of emotions, and emotional intensity/instability. Study 1 included 247 college students, and questionnaires were used to measure SPD. Study 2 included 225 community residents, oversampling for individuals with elevated levels of SPD, and semistructured diagnostic interviews were used to measure SPD. In both studies (a) higher levels of negative affect were associated with higher levels of both cognitive-perceptual and interpersonal symptoms, (b) cognitive-perceptual disturbances were associated with greater attention to emotion, whereas interpersonal disturbances were associated with less attention to emotion, and (c) lower levels of emotional clarity were associated with higher levels of suspiciousness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dual-task information processing in schizotypal personality disorder: Evidence of impaired processing capacity.

Working memory theories heavily rely on the concept of processing resources and the their efficient deployment. Some recent work with schizophrenia-spectrum patients has suggested that many associated cognitive impairments may be reduced to deficits in working memory, possibly related to reductions in information-processing capacity resources. In this study, 38 patients with schizotypal personality disorder (SPD), 22 patients with other personality disorders, and 14 healthy comparison participants performed a dual-task processing assessment that was designed specifically for use in this type of study. Participants recalled lists of digits at their predetermined maximum digit span and performed box-checking tests, first alone and then in a dual-task format. Instructions included equal prioritization of both tasks. SPD patients had significantly shorter digit spans, and they also showed more deterioration on both tasks. Performance operating characteristics curves indicated that SPD patients' reduced performance was not due to abnormal resource allocation strategies leading to strategic failures. The authors discuss the implications of these processing capacity limitations for understanding both the signature of cognitive impairment within the schizophrenia spectrum and general abnormalities in working memory. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lateralized perceptual organization deficits on the global-local task in schizotypal personality disorder.

Right and left hemisphere contributions to perceptual organization functions were examined using a divided-attention version of the global-local task in a sample of 21 unmedicated participants diagnosed with schizotypal personality disorder (SPD) and 20 controls. The SPD participants showed an abnormal global processing advantage. When the visual angle of the hierarchical stimuli was increased from 3° to 9°, the controls showed an increasing local processing advantage, but the SPD participants continued to show an abnormal global processing advantage. These findings suggest a local processing deficit on divided-attention versions of the global-local task in schizophrenia spectrum disorders. Female SPD participants, who had less severe interpersonal deficit symptoms, showed a more abnormal global processing advantage. Hemispheric and processing resource mechanisms that might explain these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Context processing in schizotypal personality disorder: Evidence of specificity of impairment to the schizophrenia spectrum.

Working memory abnormalities, which are particularly pronounced on context processing tasks, appear relatively specific to schizophrenia spectrum illnesses compared with other psychotic disorders. However, the specificity of context processing deficits to schizotypal personality disorder (SPD), a prototype of schizophrenia, has not been studied. The authors administered 3 versions of the modified AX Continuous Performance Test and an N-back working memory test to 63 individuals with SPD and 25 with other personality disorders, as well as 42 healthy controls. For the AX Continuous Performance Test standard and degraded versions, there was a significant Trial Type × Delay × Group interaction, as SPDs made significantly more errors reflecting poor maintenance of context and fewer errors reflecting good maintenance of context. SPDs also demonstrated poor performance on the N-back, especially at the 2-back condition. Context processing errors and N-back accuracy scores were related to disorganization symptoms. These findings, which are quite similar to those previously reported in patients with schizophrenia, suggest that context processing deficits are specific to the schizophrenia spectrum and are not a reflection of overall psychopathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A dimensional model of personality disorder: Incorporating DSM Cluster A characteristics.

The authors articulate an expanded dimensional model of personality pathology to better account for symptoms of DSM-defined Cluster A personality disorders. Two hundred forty participants (98 firstdegree relatives of probands with schizophrenia or schizoaffective disorder, 92 community control participants, and 50 first-degree relatives of probands with bipolar disorder) completed a dimensional personality pathology questionnaire, a measure of schizotypal characteristics, and Chapman measures of psychosis proneness. Scales from all questionnaires were subjected to an exploratory factor analysis with varimax rotation. A 5-factor structure of personality pathology emerged from the analyses, with Peculiarity forming an additional factor to the common 4-factor structure of personality pathology (consisting of Introversion, Emotional Dysregulation, Antagonism, and Compulsivity). These results support a 5-factor dimensional model of personality pathology that better accounts for phenomena encompassed by the Cluster A personality disorders in DSM-IV-TR (4th ed., text revised; American Psychiatric Association, 2000). This study has implications for the consideration of a dimensional model of personality disorder in DSM-V by offering a more comprehensive structural model that builds on previous work in this area. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Borderline personality characteristics: A betrayal trauma approach.

Borderline Personality Disorder (BPD) has been associated with both trauma and insecure attachment styles. Betrayal Trauma Theory proposes survivors of interpersonal trauma may remain unaware of betrayal in order to maintain a necessary attachment. This preliminary study reports on the relations between self-reports of betrayal trauma experiences and borderline personality characteristics in a college sample. Using multiple regression, betrayal was significantly associated with BPD characteristics. High-betrayal trauma was the largest contributor to borderline traits and medium-betrayal trauma was also a significant predictor. However, traumas of low betrayal were not associated with BPD features. These results stand even after controlling for gender. These findings suggest betrayal may be a key, and yet heretofore unaddressed, feature of borderline personality disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gesture behavior in unmedicated schizotypal adolescents.

Schizotypal personality disorder is characterized by interpersonal and verbal communication deficits. Despite the important role of gesture in social communication, no published reports examine the use of gesture by individuals with SPD. In this study, raters code gesture from videotaped interviews of unmedicated adolescents with SPD, other personality disorders, or no Axis II disorder. Results indicate that SPD adolescents show significantly fewer gestures but do not differ from the other groups in overall rate of movement. The findings are discussed in light of brain regions involved in dysfunction, parallels to schizophrenia, and treatment implications. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Transitional relatedness and borderline personality disorder.

This study examined various aspects of transitional relatedness among individuals diagnosed as borderline or antisocial personality disorder. This study was a follow-up to an earlier report (Cooper, 1983) using the Rorschach Transitional Object Scale, which found only marginal support for Modell's clinical hypothesis that the borderline personality disorder involves a developmental arrest at the stage of the transitional object. The authors approached the concept of transitional relatedness as a series of external and internalized modes of relating including the perceptual capacity to distinguish between object and symbol on the Rorschach as well as self-reported current and past reliance on transitional objects and self-soothing activities. The study failed to provide evidence to suggest that reliance on a past or present transitional object per se is a unique or diagnostic feature of the borderline personality disorder. Particular aspects of current transitional relatedness, however, were strongly associated with borderline psychopathology. The clinical and research implications of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The construct validity of depressive personality disorder.

This study examined the construct validity of depressive personality disorder (DPD; American Psychiatric Association, 1994). Adult Psychiatric outpatients (N=900) underwent comprehensive Axis I and II evaluations and provided data on 4,768 of their 1st-degree relatives. Despite modest overlap, DPD was not redundant with any Axis I or II disorder. Participants with DPD exhibited more Axis I and Axis II comorbidity, and greater psychosocial dysfunction, than participants without DPD. Relatives of participants with DPD had higher rates of mood disorders, alcohol abuse, and antisocial personality. Results are consistent with findings of several other similar investigations. The authors argue that DPD is a valid construct and should be conceptualized as a personality disorder as opposed to a mood disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Conscientiousness and obsessive-compulsive personality disorder.

A dimensional perspective on personality disorder hypothesizes that the current diagnostic categories represent maladaptive variants of general personality traits. However, a fundamental foundation of this viewpoint is that dimensional models can adequately account for the pathology currently described by these categories. While most of the personality disorders have well established links to dimensional models that buttress this hypothesis, obsessive–compulsive personality disorder (OCPD) has obtained only inconsistent support. The current study administered multiple measures of 1) conscientiousness-related personality traits, 2) DSM–IV OCPD, and 3) specific components of OCPD (e.g., compulsivity and perfectionism) to a sample of 536 undergraduates who were oversampled for elevated OCPD scores. Six existing measures of conscientiousness-related personality traits converged strongly with each other supporting their assessment of a common trait. These measures of conscientiousness correlated highly with scales assessing specific components of OCPD, but obtained variable relationships with measures of DSM–IV OCPD. More specifically, there were differences within the conscientiousness instruments such that those designed to assess general personality functioning had small to medium relationships with OCPD, but those assessing more maladaptive variants obtained large effect sizes. These findings support the view that OCPD does represent a maladaptive variant of normal-range conscientiousness. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Co-occurrence of avoidant personality disorder and child sexual abuse predicts poor outcome in long-standing eating disorder.

Few consistent predictive factors for eating disorder have been identified across studies. In the current 5-year prospective study, the objective was to examine whether (a) personality disorder and child sexual abuse predict the course of severity of eating disorder symptoms after inpatient treatment and (b) how the predictors interact. A total of 74 patients with long-standing eating disorder and mean age of 30 years were assessed at the beginning and end of inpatient therapy and at 1-, 2-, and 5-year follow-up. A mixed model was used to examine the predictors. Avoidant personality disorder and child sexual abuse interacted in predicting high levels of eating disorder over a long-term course. These results suggest that eating disorder, avoidant personality disorder, and sequelae after child sexual abuse are potential targets for treatment that need further investigation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Narcissistic personality disorder and the DSM-V.

We address 3 issues relevant to narcissistic personality disorder (NPD) and the DSM–V. First, we argue that excluding NPD while retaining other traditional personality disorder constructs (e.g., avoidant) makes little sense given the research literature on NPD and trait narcissism and their association with clinically relevant consequences such as aggression, self-enhancement, distorted self-presentation, failed relationships, cognitive biases, and internalizing and externalizing dysregulation. Second, we argue that the DSM–V must include content (in diagnostic form or within a dimensional trait model) that allows for the assessment of both grandiose and vulnerable variants of narcissism. Finally, we suggest that any dimensional classification of personality disorder should recover all of the important component traits of narcissism and be provided with official recognition in the coding system. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Borderline personality disorder from the perspective of general personality functioning.

The authors extended previous work on the hypothesis that borderline personality disorder (BPD) can be understood as a maladaptive variant of personality traits included within the 5-factor model (FFM) of personality. In each of 3 samples, an empirically derived prototypic FFM borderline profile was correlated with individuals' FFM profiles to yield a similarity score, an FFM borderline index. Results across all samples indicated that the FFM borderline index correlated as highly with existing borderline measures as they correlated with one another, and the FFM borderline index correlated as highly with measures of dysfunction, history of childhood abuse, and parental psychopathology as did traditional measures of BPD. Findings support the hypothesis that BPD is a maladaptive variant of FFM personality traits. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emotional granularity and borderline personality disorder.

This study examined the affective dysregulation component of borderline personality disorder (BPD) from an emotional granularity perspective, which refers to the specificity in which one represents emotions. Forty-six female participants meeting criteria for BPD and 51 female control participants without BPD and Axis I pathology completed tasks that assessed the degree to which participants incorporated information about valence (pleasant–unpleasant) and arousal (calm–activated) in their semantic/conceptual representations of emotions and in using labels to represent emotional reactions. As hypothesized, participants with BPD emphasized valence more and arousal less than control participants did when using emotion terms to label their emotional reactions. Implications and future research directions are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

A controlled trial of psychodynamic psychotherapy for co-occurring borderline personality disorder and alcohol use disorder.

A randomized controlled trial was conducted to determine whether a manual-based psychodynamic treatment, labeled dynamic deconstructive psychotherapy (DDP), would be feasible and effective for individuals with co-occurring borderline personality disorder (BPD) and alcohol use disorder. Thirty participants were assessed every 3 months during a year of treatment with either DDP or treatment as usual (TAU) in the community. DDP participants showed statistically significant improvement in parasuicide behavior, alcohol misuse, institutional care, depression, dissociation, and core symptoms of BPD, and treatment retention was 67% to 73%. Although TAU participants received higher average treatment intensity, they showed only limited change during the same period. The results support the feasibility, tolerability, and efficacy of DDP for the co-occurring subgroup and highlight the need for further research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The stability of personality traits in individuals with borderline personality disorder.

Although stability and pervasive inflexibility are general criteria for Diagnostic and Statistical Manual of Mental Disorders, 4th edition (American Psychiatric Association, 1994) personality disorders (PDs), borderline PD (BPD) is characterized by instability in several domains, including interpersonal behavior, affect, and identity. The authors hypothesized that such inconsistencies notable in BPD may relate to instability at the level of the basic personality traits that are associated with this disorder. Five types of personality trait stability across 4 assessments over 6 years were compared for BPD patients (N = 130 at first interval) and patients with other PDs (N = 302). Structural stability did not differ across groups. Differential stability tended to be lower for 5-factor model (FFM) traits in the BPD group, with the strongest and most consistent effects observed for Neuroticism and Conscientiousness. Growth curve models suggested that these 2 traits also showed greater mean-level change, with Neuroticism declining faster and Conscientiousness increasing faster, in the BPD group. The BPD group was further characterized by greater individual-level instability for Neuroticism and Conscientiousness in these models. Finally, the BPD group was less stable in terms of the ipsative configuration of FFM facet-level profiles than was the other PD group over time. Results point to the importance of personality trait instability in characterizing BPD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)