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Carlos M. Grilo - One of the best experts on this subject based on the ideXlab platform.
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Psychiatric, behavioral, and attitudinal correlates of avoidant and Obsessive-Compulsive Personality pathology in patients with binge-eating Disorder
Comprehensive psychiatry, 2010Co-Authors: Daniel F. Becker, Robin M. Masheb, Marney A. White, Carlos M. GriloAbstract:Abstract Objective We examined correlates of avoidant and Obsessive-Compulsive Personality pathology—with respect to psychiatric comorbidity, eating Disorder psychopathology, and associated psychologic factors—in patients with binge-eating Disorder (BED). Method Three hundred forty-seven treatment-seeking patients who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), research criteria for BED were reliably assessed with semistructured interviews to evaluate DSM-IV Axis I Disorders, Personality Disorders, and behavioral and attitudinal features of eating Disorder psychopathology. Results Fifteen percent of subjects had avoidant Personality Disorder features, 12% had Obsessive-Compulsive Personality Disorder features, 8% had features of both Disorders, and 66% had features of neither. These groups differed significantly in the frequencies of depressive and anxiety Disorders, as well as on measures of psychologic functioning (negative/depressive affect and self-esteem) and eating Disorder attitudes (shape and weight concerns). There were no group differences on measures of eating behaviors. The avoidant and Obsessive-Compulsive groups had more psychiatric comorbidity than the group without these Personality features but less than the combined group. The group without these features scored significantly lower than all other groups on negative/depressive affect and significantly higher than the avoidant and combined groups on self-esteem. The combined group had the greatest severity on shape and weight concerns. Conclusions Avoidant and Obsessive-Compulsive Personality features are common in patients with BED. Among BED patients, these forms of Personality psychopathology—separately and in combination—are associated with clinically meaningful diagnostic, psychologic, and attitudinal differences. These findings have implications for the psychopathologic relationship between BED and Personality psychopathology and may also have implications for assessment and treatment.
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structure of diagnostic and statistical manual of mental Disorders fourth edition criteria for obsessive compulsive Personality Disorder in patients with binge eating Disorder
The Canadian Journal of Psychiatry, 2008Co-Authors: Emily B Ansell, Anthony Pinto, Maria Orlando Edelen, Carlos M. GriloAbstract:OCPD is a relatively understudied Personality Disorder despite the highest prevalence rate (7.9%) of all Personality Disorders in community based studies,1 one of the highest rates (8.7%) in outpatient groups,2 and higher prevalence rates in patients with eating Disorders.3 A controlled study4 reported OCPD as significantly more common in patients with BED, than in a comparison group of general psychiatric outpatients (14%, compared with 6%). Despite the high prevalence of OCPD, little empirical attention has been given to the validity and structure of the OCPD construct as outlined in DSM-IV.5 The DSM-IV assumes a unidimensional structure for each of the Personality Disorder diagnoses. However, clinical views and the limited empirical literature suggest that a multifactorial approach may offer a better understanding of the construct.6 Theoretical underpinnings of OCPD highlight deliberateness and effortfulness,7 control over self and environment,8 and interpersonal rigidity characterized by a demanding and uncompromising stance9 that frequently results in interpersonal conflict.10 Prior examinations suggest that OCPD is a heterogeneous construct encompassing domains of interpersonal control and perfectionism.5,6,11,12 The 2 exploratory examinations of factor structure in OCPD to date revealed 2- and 3-factor solutions that conform to this assertion. Baer12 reported a 2-factor solution with loadings of perfectionism and rigidity on separate factors based on examination of DSM-III OCPD in a homogenous obsessive–compulsive Disorder patient group. Grilo,6 in the sole exploratory factor-analytic study of DSM-IV OCPD criteria, reported a 3-factor structure of OCPD in a homogeneous BED patient group in which perfectionism, rigidity, and miserliness factors were identified. The third factor had poor internal reliability leading Grilo6 to question its use. Table 1 summarizes the 1-, 2-, and 3-factor models. For the purpose of this study, Baer’s12 2 factors were extrapolated to DSM-IV criteria. Table 1 The 2- and 3-factor models of OCPD The aim of our study was to test competing models of OCPD by performing a confirmatory factor analysis on DSM-IV OCPD criteria obtained using a reliably administered semi-structured diagnostic interview given to a consecutive series of patients with BED. A confirmatory factor analysis allowed for a more definitive test of the proposed factors and comparison of model fit. We followed the recruitment and assessment methods applied in Grilo’s6 exploratory study to obtain a homogeneous patient study group with current BED, given the high prevalence of cooccurring OCPD4 and previous research highlighting aspects of OCPD as a potential vulnerability factor in eating Disorders.3,11,13 Identifying the underlying structure of DSM-IV Personality Disorders may assist researchers in understanding the maladaptive Personality constructs that contribute to Personality pathology and offers a potential avenue for integrating current models of Personality Disorders with dimensional approaches. This is particularly relevant given recent debate over dimensional models of Personality Disorder14 and the proposition that additional, undetermined, maladaptive traits may better define the Personality Disorder constructs.15,16
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clarifying the convergence between obsessive compulsive Personality Disorder criteria and obsessive compulsive Disorder
Journal of Personality Disorders, 2006Co-Authors: Jane L Eisen, Tracie M Shea, Robert L Stout, Carlos M. Grilo, Shirley Yen, Meredith E Coles, Maria E Pagano, Steven A RasmussenAbstract:In this study we examined the convergence between Obsessive-Compulsive Personality Disorder (OCPD) criteria and Obsessive-Compulsive Disorder (OCD). Baseline assessments of 629 participants of the Collaborative Longitudinal Personality Disorders Study were used to examine the associations between OCPD criteria and diagnoses of OCD. Three of the eight OCPD criteria—hoarding, perfectionism, and preoccupation with details—were significantly more frequent in subjects with OCD (n = 89) than in subjects without OCD (n = 540). Logistic regressions were used to predict the probability of each OCPD criterion as a function of Axis I diagnoses (OCD, additional anxiety Disorders, and major depressive Disorder). Associations between OCD and these three OCPD criteria remained significant in the logistic regressions, showing unique associations with OCD and odds ratios ranging from 2.71 to 2.99. In addition, other anxiety Disorders and major depressive Disorder showed few associations with specific OCPD criteria. This study suggests variability in the strength of the relationships between specific OCPD criteria and OCD. The findings also support a unique relationship between OCPD symptoms and OCD, compared to other anxiety Disorders or major depression. Future efforts to explore the link between Axis I and Axis II Disorders may be enriched by conducting analyses at the symptom level.
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stability of functional impairment in patients with schizotypal borderline avoidant or obsessive compulsive Personality Disorder over two years
Psychological Medicine, 2005Co-Authors: Andrew E. Skodol, Donna S Bender, Tracie M Shea, Robert L Stout, Leslie C. Morey, John G. Gunderson, Charles A. Sanislow, Shirley Yen, Maria E Pagano, Carlos M. GriloAbstract:Background. A defining feature of Personality Disorder (PD) is an enduring pattern of inner experience and behavior that is stable over time. Follow-up and follow-along studies have shown considerable diagnostic instability of PDs, however, even over short intervals. What, then, about Personality Disorder is stable ? The purpose of this study was to determine the stability of impair- ment in psychosocial functioning in patients with four different PDs, in contrast to patients with major depressive Disorder (MDD) and no PD, prospectively over a 2-year period. Method. Six hundred treatment-seeking or treated patients were recruited primarily from clinical services in four metropolitan areas of the Northeastern USA. Patients were assigned to one of five diagnostic groups : schizotypal (STPD) (n=81), borderline (BPD) (n=155), avoidant (AVPD) (n=137), or Obsessive-Compulsive (OCPD) (n=142) Personality Disorders or MDD and no PD (n=85), based on the results of semi-structured interview assessments and self-report measures. Impairment in psychosocial functioning was measured using the Longitudinal Interval Follow-up Evaluation (LIFE) at baseline and at three follow-up assessments. Results. Significant improvement in psychosocial functioning occurred in only three of seven domains of functioning and was largely the result of improvements in the MDD and no PD group. Patients with BPD or OCPD showed no improvement in functioning overall, but patients with BPD who experienced change in Personality psychopathology showed some improvement in functioning. Impairment in social relationships appeared most stable in patients with PDs. Conclusion. Impairment in functioning, especially social functioning, may be an enduring component of Personality Disorder.
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Two-Year Prevalence and Stability of Individual DSM-IV Criteria for Schizotypal, Borderline, Avoidant, and Obsessive-Compulsive Personality Disorders: Toward a Hybrid Model of Axis II Disorders
The American journal of psychiatry, 2005Co-Authors: Thomas H. Mcglashan, Mary C Zanarini, Leslie C. Morey, John G. Gunderson, Andrew E. Skodol, Carlos M. Grilo, M. Tracie Shea, Elizabeth Ralevski, Donna S BenderAbstract:OBJECTIVE: This study tracked the individual criteria of four DSM-IV Personality Disorders—borderline, schizotypal, avoidant, and Obsessive-Compulsive Personality Disorders—and how they change over 2 years. METHOD: This clinical sample of patients with Personality Disorders was derived from the Collaborative Longitudinal Personality Disorders Study and included all participants with borderline, schizotypal, avoidant, or Obsessive-Compulsive Personality Disorder for whom complete 24-month blind follow-up assessments were obtained (N=474). The authors identified and rank-ordered criteria for each of the four Personality Disorders by their variation in prevalence and changeability (remission) over time. RESULTS: The most prevalent and least changeable criteria over 2 years were paranoid ideation and unusual experiences for schizotypal Personality Disorder, affective instability and anger for borderline Personality Disorder, feeling inadequate and feeling socially inept for avoidant Personality Disorder, and ...
Andrew E. Skodol - One of the best experts on this subject based on the ideXlab platform.
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Comparison of Attachment Styles in Borderline Personality Disorder and Obsessive-Compulsive Personality Disorder
The Psychiatric quarterly, 2006Co-Authors: Cindy J. Aaronson, Donna S Bender, Andrew E. Skodol, John G. GundersonAbstract:The intense, unstable interpersonal relationships characteristic of patients with borderline Personality Disorder (BPD) are thought to represent insecure attachment. The Reciprocal Attachment Questionnaire was used to compare the attachment styles of patients with BPD to the styles of patients with a contrasting Personality Disorder, Obsessive-Compulsive Personality Disorder (OCPD). The results showed that patients with BPD were more likely to exhibit angry withdrawal and compulsive care-seeking attachment patterns. Patients with BPD also scored higher on the dimensions of lack of availability of the attachment figure, feared loss of the attachment figure, lack of use of the attachment figure, and separation protest. The findings may be relevant for understanding the core interpersonal psychopathology of BPD and for managing therapeutic relationships with these patients.
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stability of functional impairment in patients with schizotypal borderline avoidant or obsessive compulsive Personality Disorder over two years
Psychological Medicine, 2005Co-Authors: Andrew E. Skodol, Donna S Bender, Tracie M Shea, Robert L Stout, Leslie C. Morey, John G. Gunderson, Charles A. Sanislow, Shirley Yen, Maria E Pagano, Carlos M. GriloAbstract:Background. A defining feature of Personality Disorder (PD) is an enduring pattern of inner experience and behavior that is stable over time. Follow-up and follow-along studies have shown considerable diagnostic instability of PDs, however, even over short intervals. What, then, about Personality Disorder is stable ? The purpose of this study was to determine the stability of impair- ment in psychosocial functioning in patients with four different PDs, in contrast to patients with major depressive Disorder (MDD) and no PD, prospectively over a 2-year period. Method. Six hundred treatment-seeking or treated patients were recruited primarily from clinical services in four metropolitan areas of the Northeastern USA. Patients were assigned to one of five diagnostic groups : schizotypal (STPD) (n=81), borderline (BPD) (n=155), avoidant (AVPD) (n=137), or Obsessive-Compulsive (OCPD) (n=142) Personality Disorders or MDD and no PD (n=85), based on the results of semi-structured interview assessments and self-report measures. Impairment in psychosocial functioning was measured using the Longitudinal Interval Follow-up Evaluation (LIFE) at baseline and at three follow-up assessments. Results. Significant improvement in psychosocial functioning occurred in only three of seven domains of functioning and was largely the result of improvements in the MDD and no PD group. Patients with BPD or OCPD showed no improvement in functioning overall, but patients with BPD who experienced change in Personality psychopathology showed some improvement in functioning. Impairment in social relationships appeared most stable in patients with PDs. Conclusion. Impairment in functioning, especially social functioning, may be an enduring component of Personality Disorder.
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Two-Year Prevalence and Stability of Individual DSM-IV Criteria for Schizotypal, Borderline, Avoidant, and Obsessive-Compulsive Personality Disorders: Toward a Hybrid Model of Axis II Disorders
The American journal of psychiatry, 2005Co-Authors: Thomas H. Mcglashan, Mary C Zanarini, Leslie C. Morey, John G. Gunderson, Andrew E. Skodol, Carlos M. Grilo, M. Tracie Shea, Elizabeth Ralevski, Donna S BenderAbstract:OBJECTIVE: This study tracked the individual criteria of four DSM-IV Personality Disorders—borderline, schizotypal, avoidant, and Obsessive-Compulsive Personality Disorders—and how they change over 2 years. METHOD: This clinical sample of patients with Personality Disorders was derived from the Collaborative Longitudinal Personality Disorders Study and included all participants with borderline, schizotypal, avoidant, or Obsessive-Compulsive Personality Disorder for whom complete 24-month blind follow-up assessments were obtained (N=474). The authors identified and rank-ordered criteria for each of the four Personality Disorders by their variation in prevalence and changeability (remission) over time. RESULTS: The most prevalent and least changeable criteria over 2 years were paranoid ideation and unusual experiences for schizotypal Personality Disorder, affective instability and anger for borderline Personality Disorder, feeling inadequate and feeling socially inept for avoidant Personality Disorder, and ...
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longitudinal diagnostic efficiency of dsm iv criteria for obsessive compulsive Personality Disorder a 2 year prospective study
Acta Psychiatrica Scandinavica, 2004Co-Authors: Carlos M. Grilo, Donna S Bender, Mary C Zanarini, Robert L Stout, Leslie C. Morey, John G. Gunderson, Andrew E. Skodol, M. T. Shea, Shirley YenAbstract:Objective: To examine the longitudinal diagnostic efficiency of the DSM-IV criteria for obsessive–compulsive Personality Disorder (OCPD). Method: At baseline, criteria and diagnoses were determined using diagnostic interviews, and blinded assessments were performed 24 months later with 550 participants. Diagnostic efficiency indices (conditional probabilities, total predictive power, and kappa) were calculated for each criterion determined at baseline, using the independent OCPD diagnosis at follow-up as the standard. Results: Longitudinal diagnostic efficiencies for the OCPD criteria varied; findings suggested the overall predictive utility of ‘preoccupied with details’, ‘rigid and stubborn’, and ‘reluctant to delegate’. Conclusion: These findings suggest the predictive validity of three cognitive-interpersonal OCPD criteria.
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the representation of borderline avoidant obsessive compulsive and schizotypal Personality Disorders by the five factor model
Journal of Personality Disorders, 2002Co-Authors: Leslie C. Morey, Tracie M Shea, Robert L Stout, John G. Gunderson, Andrew E. Skodol, Thomas H. Mcglashan, Brian D Quigley, Mary C ZanariniAbstract:This study evaluated the accuracy of hypothesized relationships of the five-factor model of Personality to four targeted Personality Disorders in a large multisite sample of patients. Data were gathered from 668 patients, who were assigned to one of five study cells: Borderline, Schizotypal, Avoidant, and Obsessive-Compulsive Personality Disorder, and a Major Depression without Personality Disorder comparison group. Patients were administered a questionnaire designed to assess the domains and facets of the five-factor model and results were compared among diagnostic groups and between patients and community norms. Although many relationships between Personality traits and Disorders were obtained, the magnitude of the relationships varied greatly as a function of the comparison group involved. In general, the differences between the Personality Disorder patients and community norms were far larger than the differences between the specific Personality Disorder groups. Also, for avoidant Personality, it appeared that statistical interactions between Personality factors are needed to better differentiate it from other Personality Disorder groups. The four Personality Disorder groups studied could each be distinguished from community norms on the Personality dimensions of the five-factor model. However, differentiating among the four groups proved more difficult, as each shared the configuration of high Neuroticism, low Agreeableness, and low Conscientiousness. It does not appear that these Disorders represent extremes of different Personality dimensions, but rather each appears to be a variant of the same extreme configuration. Differences between Personality Disorders may reflect diverse interactions among the dimensions, rather than differences on single dimensions.
Leslie C. Morey - One of the best experts on this subject based on the ideXlab platform.
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stability of functional impairment in patients with schizotypal borderline avoidant or obsessive compulsive Personality Disorder over two years
Psychological Medicine, 2005Co-Authors: Andrew E. Skodol, Donna S Bender, Tracie M Shea, Robert L Stout, Leslie C. Morey, John G. Gunderson, Charles A. Sanislow, Shirley Yen, Maria E Pagano, Carlos M. GriloAbstract:Background. A defining feature of Personality Disorder (PD) is an enduring pattern of inner experience and behavior that is stable over time. Follow-up and follow-along studies have shown considerable diagnostic instability of PDs, however, even over short intervals. What, then, about Personality Disorder is stable ? The purpose of this study was to determine the stability of impair- ment in psychosocial functioning in patients with four different PDs, in contrast to patients with major depressive Disorder (MDD) and no PD, prospectively over a 2-year period. Method. Six hundred treatment-seeking or treated patients were recruited primarily from clinical services in four metropolitan areas of the Northeastern USA. Patients were assigned to one of five diagnostic groups : schizotypal (STPD) (n=81), borderline (BPD) (n=155), avoidant (AVPD) (n=137), or Obsessive-Compulsive (OCPD) (n=142) Personality Disorders or MDD and no PD (n=85), based on the results of semi-structured interview assessments and self-report measures. Impairment in psychosocial functioning was measured using the Longitudinal Interval Follow-up Evaluation (LIFE) at baseline and at three follow-up assessments. Results. Significant improvement in psychosocial functioning occurred in only three of seven domains of functioning and was largely the result of improvements in the MDD and no PD group. Patients with BPD or OCPD showed no improvement in functioning overall, but patients with BPD who experienced change in Personality psychopathology showed some improvement in functioning. Impairment in social relationships appeared most stable in patients with PDs. Conclusion. Impairment in functioning, especially social functioning, may be an enduring component of Personality Disorder.
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Two-Year Prevalence and Stability of Individual DSM-IV Criteria for Schizotypal, Borderline, Avoidant, and Obsessive-Compulsive Personality Disorders: Toward a Hybrid Model of Axis II Disorders
The American journal of psychiatry, 2005Co-Authors: Thomas H. Mcglashan, Mary C Zanarini, Leslie C. Morey, John G. Gunderson, Andrew E. Skodol, Carlos M. Grilo, M. Tracie Shea, Elizabeth Ralevski, Donna S BenderAbstract:OBJECTIVE: This study tracked the individual criteria of four DSM-IV Personality Disorders—borderline, schizotypal, avoidant, and Obsessive-Compulsive Personality Disorders—and how they change over 2 years. METHOD: This clinical sample of patients with Personality Disorders was derived from the Collaborative Longitudinal Personality Disorders Study and included all participants with borderline, schizotypal, avoidant, or Obsessive-Compulsive Personality Disorder for whom complete 24-month blind follow-up assessments were obtained (N=474). The authors identified and rank-ordered criteria for each of the four Personality Disorders by their variation in prevalence and changeability (remission) over time. RESULTS: The most prevalent and least changeable criteria over 2 years were paranoid ideation and unusual experiences for schizotypal Personality Disorder, affective instability and anger for borderline Personality Disorder, feeling inadequate and feeling socially inept for avoidant Personality Disorder, and ...
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longitudinal diagnostic efficiency of dsm iv criteria for obsessive compulsive Personality Disorder a 2 year prospective study
Acta Psychiatrica Scandinavica, 2004Co-Authors: Carlos M. Grilo, Donna S Bender, Mary C Zanarini, Robert L Stout, Leslie C. Morey, John G. Gunderson, Andrew E. Skodol, M. T. Shea, Shirley YenAbstract:Objective: To examine the longitudinal diagnostic efficiency of the DSM-IV criteria for obsessive–compulsive Personality Disorder (OCPD). Method: At baseline, criteria and diagnoses were determined using diagnostic interviews, and blinded assessments were performed 24 months later with 550 participants. Diagnostic efficiency indices (conditional probabilities, total predictive power, and kappa) were calculated for each criterion determined at baseline, using the independent OCPD diagnosis at follow-up as the standard. Results: Longitudinal diagnostic efficiencies for the OCPD criteria varied; findings suggested the overall predictive utility of ‘preoccupied with details’, ‘rigid and stubborn’, and ‘reluctant to delegate’. Conclusion: These findings suggest the predictive validity of three cognitive-interpersonal OCPD criteria.
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the representation of borderline avoidant obsessive compulsive and schizotypal Personality Disorders by the five factor model
Journal of Personality Disorders, 2002Co-Authors: Leslie C. Morey, Tracie M Shea, Robert L Stout, John G. Gunderson, Andrew E. Skodol, Thomas H. Mcglashan, Brian D Quigley, Mary C ZanariniAbstract:This study evaluated the accuracy of hypothesized relationships of the five-factor model of Personality to four targeted Personality Disorders in a large multisite sample of patients. Data were gathered from 668 patients, who were assigned to one of five study cells: Borderline, Schizotypal, Avoidant, and Obsessive-Compulsive Personality Disorder, and a Major Depression without Personality Disorder comparison group. Patients were administered a questionnaire designed to assess the domains and facets of the five-factor model and results were compared among diagnostic groups and between patients and community norms. Although many relationships between Personality traits and Disorders were obtained, the magnitude of the relationships varied greatly as a function of the comparison group involved. In general, the differences between the Personality Disorder patients and community norms were far larger than the differences between the specific Personality Disorder groups. Also, for avoidant Personality, it appeared that statistical interactions between Personality factors are needed to better differentiate it from other Personality Disorder groups. The four Personality Disorder groups studied could each be distinguished from community norms on the Personality dimensions of the five-factor model. However, differentiating among the four groups proved more difficult, as each shared the configuration of high Neuroticism, low Agreeableness, and low Conscientiousness. It does not appear that these Disorders represent extremes of different Personality dimensions, but rather each appears to be a variant of the same extreme configuration. Differences between Personality Disorders may reflect diverse interactions among the dimensions, rather than differences on single dimensions.
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functional impairment in patients with schizotypal borderline avoidant or obsessive compulsive Personality Disorder
American Journal of Psychiatry, 2002Co-Authors: Andrew E. Skodol, Donna S Bender, Ingrid R Dyck, Tracie M Shea, Mary C Zanarini, Robert L Stout, John G. Gunderson, Thomas H. Mcglashan, Carlos M. Grilo, Leslie C. MoreyAbstract:Objective: The purpose of this study was to compare psychosocial functioning in patients with schizotypal, borderline, avoidant, or Obsessive-Compulsive Personality Disorder and patients with major depressive Disorder and no Personality Disorder. Method: Patients (N=668) were recruited by the four clinical sites of the Collaborative Longitudinal Personality Disorders Study. The carefully diagnosed study groups were compared on an array of domains of psychosocial functioning, as measured by the Longitudinal Interval Follow-Up Evaluation—Baseline Version and the Social Adjustment Scale. Results: Patients with schizotypal Personality Disorder and borderline Personality Disorder were found to have significantly more impairment at work, in social relationships, and at leisure than patients with Obsessive-Compulsive Personality Disorder or major depressive Disorder; patients with avoidant Personality Disorder were intermediate. These differences were found across assessment modalities and remained significant after covarying for demographic differences and comorbid axis I psychopathology. Conclusions: Personality Disorders are a significant source of psychiatric morbidity, accounting for more impairment in functioning than major depressive Disorder alone.
John G. Gunderson - One of the best experts on this subject based on the ideXlab platform.
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Comparison of Attachment Styles in Borderline Personality Disorder and Obsessive-Compulsive Personality Disorder
The Psychiatric quarterly, 2006Co-Authors: Cindy J. Aaronson, Donna S Bender, Andrew E. Skodol, John G. GundersonAbstract:The intense, unstable interpersonal relationships characteristic of patients with borderline Personality Disorder (BPD) are thought to represent insecure attachment. The Reciprocal Attachment Questionnaire was used to compare the attachment styles of patients with BPD to the styles of patients with a contrasting Personality Disorder, Obsessive-Compulsive Personality Disorder (OCPD). The results showed that patients with BPD were more likely to exhibit angry withdrawal and compulsive care-seeking attachment patterns. Patients with BPD also scored higher on the dimensions of lack of availability of the attachment figure, feared loss of the attachment figure, lack of use of the attachment figure, and separation protest. The findings may be relevant for understanding the core interpersonal psychopathology of BPD and for managing therapeutic relationships with these patients.
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stability of functional impairment in patients with schizotypal borderline avoidant or obsessive compulsive Personality Disorder over two years
Psychological Medicine, 2005Co-Authors: Andrew E. Skodol, Donna S Bender, Tracie M Shea, Robert L Stout, Leslie C. Morey, John G. Gunderson, Charles A. Sanislow, Shirley Yen, Maria E Pagano, Carlos M. GriloAbstract:Background. A defining feature of Personality Disorder (PD) is an enduring pattern of inner experience and behavior that is stable over time. Follow-up and follow-along studies have shown considerable diagnostic instability of PDs, however, even over short intervals. What, then, about Personality Disorder is stable ? The purpose of this study was to determine the stability of impair- ment in psychosocial functioning in patients with four different PDs, in contrast to patients with major depressive Disorder (MDD) and no PD, prospectively over a 2-year period. Method. Six hundred treatment-seeking or treated patients were recruited primarily from clinical services in four metropolitan areas of the Northeastern USA. Patients were assigned to one of five diagnostic groups : schizotypal (STPD) (n=81), borderline (BPD) (n=155), avoidant (AVPD) (n=137), or Obsessive-Compulsive (OCPD) (n=142) Personality Disorders or MDD and no PD (n=85), based on the results of semi-structured interview assessments and self-report measures. Impairment in psychosocial functioning was measured using the Longitudinal Interval Follow-up Evaluation (LIFE) at baseline and at three follow-up assessments. Results. Significant improvement in psychosocial functioning occurred in only three of seven domains of functioning and was largely the result of improvements in the MDD and no PD group. Patients with BPD or OCPD showed no improvement in functioning overall, but patients with BPD who experienced change in Personality psychopathology showed some improvement in functioning. Impairment in social relationships appeared most stable in patients with PDs. Conclusion. Impairment in functioning, especially social functioning, may be an enduring component of Personality Disorder.
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Two-Year Prevalence and Stability of Individual DSM-IV Criteria for Schizotypal, Borderline, Avoidant, and Obsessive-Compulsive Personality Disorders: Toward a Hybrid Model of Axis II Disorders
The American journal of psychiatry, 2005Co-Authors: Thomas H. Mcglashan, Mary C Zanarini, Leslie C. Morey, John G. Gunderson, Andrew E. Skodol, Carlos M. Grilo, M. Tracie Shea, Elizabeth Ralevski, Donna S BenderAbstract:OBJECTIVE: This study tracked the individual criteria of four DSM-IV Personality Disorders—borderline, schizotypal, avoidant, and Obsessive-Compulsive Personality Disorders—and how they change over 2 years. METHOD: This clinical sample of patients with Personality Disorders was derived from the Collaborative Longitudinal Personality Disorders Study and included all participants with borderline, schizotypal, avoidant, or Obsessive-Compulsive Personality Disorder for whom complete 24-month blind follow-up assessments were obtained (N=474). The authors identified and rank-ordered criteria for each of the four Personality Disorders by their variation in prevalence and changeability (remission) over time. RESULTS: The most prevalent and least changeable criteria over 2 years were paranoid ideation and unusual experiences for schizotypal Personality Disorder, affective instability and anger for borderline Personality Disorder, feeling inadequate and feeling socially inept for avoidant Personality Disorder, and ...
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longitudinal diagnostic efficiency of dsm iv criteria for obsessive compulsive Personality Disorder a 2 year prospective study
Acta Psychiatrica Scandinavica, 2004Co-Authors: Carlos M. Grilo, Donna S Bender, Mary C Zanarini, Robert L Stout, Leslie C. Morey, John G. Gunderson, Andrew E. Skodol, M. T. Shea, Shirley YenAbstract:Objective: To examine the longitudinal diagnostic efficiency of the DSM-IV criteria for obsessive–compulsive Personality Disorder (OCPD). Method: At baseline, criteria and diagnoses were determined using diagnostic interviews, and blinded assessments were performed 24 months later with 550 participants. Diagnostic efficiency indices (conditional probabilities, total predictive power, and kappa) were calculated for each criterion determined at baseline, using the independent OCPD diagnosis at follow-up as the standard. Results: Longitudinal diagnostic efficiencies for the OCPD criteria varied; findings suggested the overall predictive utility of ‘preoccupied with details’, ‘rigid and stubborn’, and ‘reluctant to delegate’. Conclusion: These findings suggest the predictive validity of three cognitive-interpersonal OCPD criteria.
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the representation of borderline avoidant obsessive compulsive and schizotypal Personality Disorders by the five factor model
Journal of Personality Disorders, 2002Co-Authors: Leslie C. Morey, Tracie M Shea, Robert L Stout, John G. Gunderson, Andrew E. Skodol, Thomas H. Mcglashan, Brian D Quigley, Mary C ZanariniAbstract:This study evaluated the accuracy of hypothesized relationships of the five-factor model of Personality to four targeted Personality Disorders in a large multisite sample of patients. Data were gathered from 668 patients, who were assigned to one of five study cells: Borderline, Schizotypal, Avoidant, and Obsessive-Compulsive Personality Disorder, and a Major Depression without Personality Disorder comparison group. Patients were administered a questionnaire designed to assess the domains and facets of the five-factor model and results were compared among diagnostic groups and between patients and community norms. Although many relationships between Personality traits and Disorders were obtained, the magnitude of the relationships varied greatly as a function of the comparison group involved. In general, the differences between the Personality Disorder patients and community norms were far larger than the differences between the specific Personality Disorder groups. Also, for avoidant Personality, it appeared that statistical interactions between Personality factors are needed to better differentiate it from other Personality Disorder groups. The four Personality Disorder groups studied could each be distinguished from community norms on the Personality dimensions of the five-factor model. However, differentiating among the four groups proved more difficult, as each shared the configuration of high Neuroticism, low Agreeableness, and low Conscientiousness. It does not appear that these Disorders represent extremes of different Personality dimensions, but rather each appears to be a variant of the same extreme configuration. Differences between Personality Disorders may reflect diverse interactions among the dimensions, rather than differences on single dimensions.
Mary C Zanarini - One of the best experts on this subject based on the ideXlab platform.
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Two-Year Prevalence and Stability of Individual DSM-IV Criteria for Schizotypal, Borderline, Avoidant, and Obsessive-Compulsive Personality Disorders: Toward a Hybrid Model of Axis II Disorders
The American journal of psychiatry, 2005Co-Authors: Thomas H. Mcglashan, Mary C Zanarini, Leslie C. Morey, John G. Gunderson, Andrew E. Skodol, Carlos M. Grilo, M. Tracie Shea, Elizabeth Ralevski, Donna S BenderAbstract:OBJECTIVE: This study tracked the individual criteria of four DSM-IV Personality Disorders—borderline, schizotypal, avoidant, and Obsessive-Compulsive Personality Disorders—and how they change over 2 years. METHOD: This clinical sample of patients with Personality Disorders was derived from the Collaborative Longitudinal Personality Disorders Study and included all participants with borderline, schizotypal, avoidant, or Obsessive-Compulsive Personality Disorder for whom complete 24-month blind follow-up assessments were obtained (N=474). The authors identified and rank-ordered criteria for each of the four Personality Disorders by their variation in prevalence and changeability (remission) over time. RESULTS: The most prevalent and least changeable criteria over 2 years were paranoid ideation and unusual experiences for schizotypal Personality Disorder, affective instability and anger for borderline Personality Disorder, feeling inadequate and feeling socially inept for avoidant Personality Disorder, and ...
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longitudinal diagnostic efficiency of dsm iv criteria for obsessive compulsive Personality Disorder a 2 year prospective study
Acta Psychiatrica Scandinavica, 2004Co-Authors: Carlos M. Grilo, Donna S Bender, Mary C Zanarini, Robert L Stout, Leslie C. Morey, John G. Gunderson, Andrew E. Skodol, M. T. Shea, Shirley YenAbstract:Objective: To examine the longitudinal diagnostic efficiency of the DSM-IV criteria for obsessive–compulsive Personality Disorder (OCPD). Method: At baseline, criteria and diagnoses were determined using diagnostic interviews, and blinded assessments were performed 24 months later with 550 participants. Diagnostic efficiency indices (conditional probabilities, total predictive power, and kappa) were calculated for each criterion determined at baseline, using the independent OCPD diagnosis at follow-up as the standard. Results: Longitudinal diagnostic efficiencies for the OCPD criteria varied; findings suggested the overall predictive utility of ‘preoccupied with details’, ‘rigid and stubborn’, and ‘reluctant to delegate’. Conclusion: These findings suggest the predictive validity of three cognitive-interpersonal OCPD criteria.
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the representation of borderline avoidant obsessive compulsive and schizotypal Personality Disorders by the five factor model
Journal of Personality Disorders, 2002Co-Authors: Leslie C. Morey, Tracie M Shea, Robert L Stout, John G. Gunderson, Andrew E. Skodol, Thomas H. Mcglashan, Brian D Quigley, Mary C ZanariniAbstract:This study evaluated the accuracy of hypothesized relationships of the five-factor model of Personality to four targeted Personality Disorders in a large multisite sample of patients. Data were gathered from 668 patients, who were assigned to one of five study cells: Borderline, Schizotypal, Avoidant, and Obsessive-Compulsive Personality Disorder, and a Major Depression without Personality Disorder comparison group. Patients were administered a questionnaire designed to assess the domains and facets of the five-factor model and results were compared among diagnostic groups and between patients and community norms. Although many relationships between Personality traits and Disorders were obtained, the magnitude of the relationships varied greatly as a function of the comparison group involved. In general, the differences between the Personality Disorder patients and community norms were far larger than the differences between the specific Personality Disorder groups. Also, for avoidant Personality, it appeared that statistical interactions between Personality factors are needed to better differentiate it from other Personality Disorder groups. The four Personality Disorder groups studied could each be distinguished from community norms on the Personality dimensions of the five-factor model. However, differentiating among the four groups proved more difficult, as each shared the configuration of high Neuroticism, low Agreeableness, and low Conscientiousness. It does not appear that these Disorders represent extremes of different Personality dimensions, but rather each appears to be a variant of the same extreme configuration. Differences between Personality Disorders may reflect diverse interactions among the dimensions, rather than differences on single dimensions.
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functional impairment in patients with schizotypal borderline avoidant or obsessive compulsive Personality Disorder
American Journal of Psychiatry, 2002Co-Authors: Andrew E. Skodol, Donna S Bender, Ingrid R Dyck, Tracie M Shea, Mary C Zanarini, Robert L Stout, John G. Gunderson, Thomas H. Mcglashan, Carlos M. Grilo, Leslie C. MoreyAbstract:Objective: The purpose of this study was to compare psychosocial functioning in patients with schizotypal, borderline, avoidant, or Obsessive-Compulsive Personality Disorder and patients with major depressive Disorder and no Personality Disorder. Method: Patients (N=668) were recruited by the four clinical sites of the Collaborative Longitudinal Personality Disorders Study. The carefully diagnosed study groups were compared on an array of domains of psychosocial functioning, as measured by the Longitudinal Interval Follow-Up Evaluation—Baseline Version and the Social Adjustment Scale. Results: Patients with schizotypal Personality Disorder and borderline Personality Disorder were found to have significantly more impairment at work, in social relationships, and at leisure than patients with Obsessive-Compulsive Personality Disorder or major depressive Disorder; patients with avoidant Personality Disorder were intermediate. These differences were found across assessment modalities and remained significant after covarying for demographic differences and comorbid axis I psychopathology. Conclusions: Personality Disorders are a significant source of psychiatric morbidity, accounting for more impairment in functioning than major depressive Disorder alone.
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confirmatory factor analysis of dsm iv borderline schizotypal avoidant and obsessive compulsive Personality Disorders findings from the collaborative longitudinal Personality Disorders study
Acta Psychiatrica Scandinavica, 2002Co-Authors: Charles A. Sanislow, Tracie M Shea, Mary C Zanarini, Robert L Stout, Leslie C. Morey, John G. Gunderson, Andrew E. Skodol, Carlos M. Grilo, Thomas H. McglashanAbstract:Objective: To test the diagnostic constructs implied by DSM-IV Axis-II Personality Disorders by examining relationships between different combinations of DSM-IV criteria. Method: Confirmatory factor analysis was used to test the borderline, schizotypal, avoidant and Obsessive-Compulsive Personality Disorder constructs in a large treatment-seeking sample (N=668) from a multisite study. A model based on the three DSM-IV Axis II clusters was also tested. Both models were tested against a unitary ‘generic’ model constructed from four criteria sets combined. Results: Goodness-of-fit for both the three-cluster and four Disorder models was significantly better than the unidimensional model, and the four-Disorder model was significantly better than the three-cluster model. Results were replicated using data from 2-year follow-up obtained by interviewers blind to original Axis II diagnoses at baseline. Conclusion: Support is provided for the DSM-IV Disorder-level classification for schizotypal, borderline, avoidant and Obsessive-Compulsive Personality Disorders in a treatment-seeking sample.
