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Leslie C. Morey - One of the best experts on this subject based on the ideXlab platform.
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Relating DSM-5 section II and section III Personality Disorder diagnostic classification systems to treatment planning.
Comprehensive Psychiatry, 2016Co-Authors: Leslie C. Morey, Kathryn T. BensonAbstract:Abstract Background Beginning with DSM-III, the inclusion of a “Personality” axis was designed to encourage awareness of Personality Disorders and the treatment-related implications of individual differences, but since that time there is little accumulated evidence that the Personality Disorder categories provide substantial treatment-related guidance. The DSM-5 Personality and Personality Disorders Work Group sought to develop an Alternative Model for Personality Disorder, and this study examined whether this model is more closely related to clinicians' decision-making processes than the traditional categorical Personality Disorder diagnoses. Procedures A national sample of 337 clinicians provided complete Personality Disorder diagnostic information and several treatment-related clinical judgments about one of their patients. Findings The dimensional concepts of the DSM-5 Alternative Model for Personality Disorders demonstrated stronger relationships than categorical DSM-IV/DSM-5 Section II diagnoses to 10 of 11 clinical judgments regarding differential treatment planning, optimal treatment intensity, and long-term prognosis. Conclusions The constructs of the DSM-5 Alternative Model for Personality Disorders may provide more clinically useful information for treatment planning than the official categorical Personality Disorder diagnostic system retained in DSM-5 Section II.
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Course of Personality Disorder
The Oxford Handbook of Personality Disorders, 2012Co-Authors: Leslie C. Morey, Justin K. MeyerAbstract:The purpose of this chapter is to provide an overview of the course of Personality Disorders. The chapter begins with a discussion of general conceptual and methodological issues in the study of the temporal stability and course of Personality Disorder; more specifically, dimensional versus categorical models of classification and developmental issues. This is followed by a summary and discussion of four contemporary longitudinal studies; in particular, the Children in the Community Study (Cohen, Crawford, Johnson, & Kasen, 2005), the Longitudinal Study of Personality Disorders (Lenzenweger, 1999), the McLean Study of Adult Development (Zanarini, Frankenburg, Hennen, Reich, & Silk, 2005), and the Collaborative Longitudinal Personality Disorders Study (CLPS; Skodol, Gunderson et al., 2005). With respect to the CLPS, specific attention is given to the findings concerning stability of categorical diagnoses, dimensional features, functional impairment, and component traits. The chapter concludes with a discussion of the implications of these findings for the diagnosis and conceptualization of Personality Disorder, as well as suggestions for future research.
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Personality Disorder types proposed for dsm 5
Journal of Personality Disorders, 2011Co-Authors: Andrew E Skodol, Lee Anna Clark, Leslie C. Morey, John M Oldham, Donna S Bender, Robert F Krueger, Renato D Alarcon, Roel Verheul, Carl C Bell, Larry J. SieverAbstract:The Personality and Personality Disorders Work Group has proposed five specific Personality Disorder (PD) types for DSM-5, to be rated on a dimension of fit: antisocial/psychopathic, avoidant, borderline, obsessive-compulsive, and schizotypal. Each type is identified by core impairments in Personality functioning, pathological Personality traits, and common symptomatic behaviors. The other DSM-IV-TR PDs and the large residual category of Personality Disorder not otherwise specified (PDNOS) will be represented solely by the core impairments combined with specification by individuals' unique sets of Personality traits. This proposal has three main features: (1) a reduction in the number of specified types from 10 to 5; (2) description of the types in a narrative format that combines typical deficits in self and interpersonal functioning and particular configurations of traits and behaviors; and (3) a dimensional rating of the degree to which a patient matches each type. An explanation of these modifications...
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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, John G. Gunderson, Thomas H Mcglashan, Ingrid R Dyck, Robert L Stout, Donna S Bender, Carlos M Grilo, Tracie M Shea, Mary C Zanarini, 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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Personality Disorder 3 Treatment of Personality Disorder
2020Co-Authors: Anthony Bateman, John G. Gunderson, Roger T. MulderAbstract:The evidence base for the eff ective treatment of Personality Disorders is insuffi cient. Most of the existing evidence on Personality Disorder is for the treatment of borderline Personality Disorder, but even this is limited by the small sample sizes and short follow-up in clinical trials, the wide range of core outcome measures used by studies, and poor control of coexisting psychopathology. Psychological or psychosocial intervention is recommended as the primary treatment for borderline Personality Disorder and pharmacotherapy is only advised as an adjunctive treatment. The amount of research about the underlying, abnormal, psychological or biological processes leading to the manifestation of a Disordered Personality is increasing, which could lead to more eff ective interventions. The synergistic or antagonistic interaction of psychotherapies and drugs for treating Personality Disorder should be studied in conjunction with their mechanisms of change throughout the development of each.
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treatment of Personality Disorder
The Lancet, 2015Co-Authors: Anthony Bateman, John G. Gunderson, Roger T. MulderAbstract:Summary The evidence base for the effective treatment of Personality Disorders is insufficient. Most of the existing evidence on Personality Disorder is for the treatment of borderline Personality Disorder, but even this is limited by the small sample sizes and short follow-up in clinical trials, the wide range of core outcome measures used by studies, and poor control of coexisting psychopathology. Psychological or psychosocial intervention is recommended as the primary treatment for borderline Personality Disorder and pharmacotherapy is only advised as an adjunctive treatment. The amount of research about the underlying, abnormal, psychological or biological processes leading to the manifestation of a Disordered Personality is increasing, which could lead to more effective interventions. The synergistic or antagonistic interaction of psychotherapies and drugs for treating Personality Disorder should be studied in conjunction with their mechanisms of change throughout the development of each.
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borderline Personality Disorder ontogeny of a diagnosis
FOCUS, 2010Co-Authors: John G. GundersonAbstract:Objective:The purpose of this article is to describe the development of the borderline Personality Disorder diagnosis, highlighting both the obstacles encountered and the associated achievements. Method:On the basis of a review of the literature, the author provides a chronological account of the borderline construct in psychiatry, summarizing progress in decade-long intervals. Results:Borderline Personality Disorder has moved from being a psychoanalytic colloquialism for untreatable neurotics to becoming a valid diagnosis with significant heritability and with specific and effective psychotherapeutic treatments. Nonetheless, patients with this Disorder pose a major public health problem while they themselves remain highly stigmatized and largely neglected. Conclusions:Despite remarkable changes in our knowledge about borderline Personality Disorder, increased awareness involving much more education and research is still needed. Psychiatric institutions, professional organizations, public policies, and re...
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borderline Personality Disorder ontogeny of a diagnosis
American Journal of Psychiatry, 2009Co-Authors: John G. GundersonAbstract:Objective: The purpose of this article is to describe the development of the borderline Personality Disorder diagnosis, highlighting both the obstacles encountered and the associated achievements. Method: On the basis of a review of the literature, the author provides a chronological account of the borderline construct in psychiatry, summarizing progress in decade-long intervals. Results: Borderline Personality Disorder has moved from being a psychoanalytic colloquialism for untreatable neurotics to becoming a valid diagnosis with significant heritability and with specific and effective psychotherapeutic treatments. Nonetheless, patients with this Disorder pose a major public health problem while they themselves remain highly stigmatized and largely neglected. Conclusions: Despite remarkable changes in our knowledge about borderline Personality Disorder, increased awareness involving much more education and research is still needed. Psychiatric institutions, professional organizations, public policies, an...
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the interface between borderline Personality Disorder and bipolar spectrum Disorders
Comprehensive Psychiatry, 2007Co-Authors: Joel Paris, John G. Gunderson, Igor WeinbergAbstract:Objective: This review examines whether borderline Personality Disorder (BPD) should be considered part of the bipolar spectrum. Methods: A literature review examined studies of co-occurrence, phenomenology, family prevalence, medication response, longitudinal course, and etiology. Results: Borderline Personality Disorder and bipolar Disorder co-occur, but their relationship is not consistent or specific. There are overlaps but important differences in phenomenology and in medication response. Family studies suggest clear distinctions, and it is unusual for BPD to evolve into bipolar Disorder. Research is insufficient to establish whether these Disorders have a common etiology. Conclusions: Existing data fail to support the conclusion that BPD and bipolar Disorders exist on a spectrum but allows for the possibility of partially overlapping etiologies.
Larry J. Siever - One of the best experts on this subject based on the ideXlab platform.
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Schizoid Personality Disorder.
Journal of Personality Disorders, 2012Co-Authors: Joseph Triebwasser, Eran Chemerinski, Panos Roussos, Larry J. SieverAbstract:Schizoid Personality Disorder (ScPD) is one of the “odd cluster” or “cluster A” Personality Disorders in DSM-IV. In the present article, the authors review information pertaining to the psychometric characteristics of ScPD as gleaned from a search of relevant publications as well as from databases of Personality Disorder study groups. Comparatively little evidence exists for the validity and reliability of ScPD as a separate, multifaceted Personality Disorder. Some authors, moreover, have contended that the group of patients termed “schizoid” actually fall into two distinct groups—an “affect constricted” group, who might better be subsumed within schizotypal Personality Disorder, and a “seclusive” group, who might better be subsumed within avoidant Personality Disorder. The research-based justification for retaining ScPD as an independent diagnosis is sufficiently sparse for it to seem reasonable to remove ScPD from the list of Personality Disorders in DSM-V, and instead to invite clinicians to code for s...
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Personality Disorder types proposed for dsm 5
Journal of Personality Disorders, 2011Co-Authors: Andrew E Skodol, Lee Anna Clark, Leslie C. Morey, John M Oldham, Donna S Bender, Robert F Krueger, Renato D Alarcon, Roel Verheul, Carl C Bell, Larry J. SieverAbstract:The Personality and Personality Disorders Work Group has proposed five specific Personality Disorder (PD) types for DSM-5, to be rated on a dimension of fit: antisocial/psychopathic, avoidant, borderline, obsessive-compulsive, and schizotypal. Each type is identified by core impairments in Personality functioning, pathological Personality traits, and common symptomatic behaviors. The other DSM-IV-TR PDs and the large residual category of Personality Disorder not otherwise specified (PDNOS) will be represented solely by the core impairments combined with specification by individuals' unique sets of Personality traits. This proposal has three main features: (1) a reduction in the number of specified types from 10 to 5; (2) description of the types in a narrative format that combines typical deficits in self and interpersonal functioning and particular configurations of traits and behaviors; and (3) a dimensional rating of the degree to which a patient matches each type. An explanation of these modifications...
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the interpersonal dimension of borderline Personality Disorder toward a neuropeptide model
American Journal of Psychiatry, 2010Co-Authors: Barbara Stanley, Larry J. SieverAbstract:AbstractBorderline Personality Disorder is characterized by affective instability, impulsivity, identity diffusion, and interpersonal dysfunction. Perceived rejection and loss often serve as triggers to impulsive, suicidal, and self-injurious behavior, affective reactivity, and angry outbursts, suggesting that the attachment and affiliative system may be implicated in the Disorder. Neuropeptides, including the opioids, oxytocin, and vasopressin, serve a crucial role in the regulation of affiliative behaviors and thus may be altered in borderline Personality Disorder. While clinical data are limited, the authors propose alternative neuropeptide models of borderline Personality Disorder and review relevant preclinical research supporting the role of altered neuropeptide function in this Disorder in the hope of stimulating more basic research and the development of new treatment approaches.
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characterizing affective instability in borderline Personality Disorder
American Journal of Psychiatry, 2002Co-Authors: Harold W Koenigsberg, Jeremy M. Silverman, Philip D Harvey, Vivian Mitropoulou, James Schmeidler, Marianne Goodman, Michael Serby, Frances Schopick, Larry J. SieverAbstract:OBJECTIVE: This study sought to understand affective instability among patients with borderline Personality Disorder by examining the degree of instability in six affective domains. The authors also examined the subjective intensity with which moods are experienced and the association between instability and intensity of affect. METHOD: In a group of 152 patients with Personality Disorders, subjective affective intensity and six dimensions of affective instability were measured. The mean scores for lability and intensity for each affective domain for patients with borderline Personality Disorder were compared with those of patients with other Personality Disorders through analyses that controlled for other axis I affective Disorders, age, and sex. RESULTS: Greater lability in terms of anger and anxiety and oscillation between depression and anxiety, but not in terms of oscillation between depression and elation, was associated with borderline Personality Disorder. Contrary to expectation, the experience o...
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Depressive response to physostigmine challenge in borderline Personality Disorder patients.
Neuropsychopharmacology, 1997Co-Authors: Bonnie J Steinberg, Jeremy M. Silverman, Vivian Mitropoulou, Michael Serby, Robert L. Trestman, Coccaro Ef, Susan Weston, Marie L. Devegvar, Larry J. SieverAbstract:The purpose of this study was to examine the relationship between mood and hormonal responses to cholinergic challenge with physostigmine in order to assess cholinergic system responsiveness in borderline Personality Disorder (BPD) patients, other non-BPD Personality Disorder patients, and normal controls. Thirty-four Personality Disorder patients, 10 of whom met criteria for BPD and 24 of whom met criteria for other, non-borderline, Personality Disorders, and 11 normal controls participated in a double blind, placebo controlled physostigmine challenge paradigm. The Profile of Mood States depression subscale (POMS-D) self report measure was obtained at baseline and following the physostigmine or placebo infusions. A repeated measures ANOVA of POMS-D scores in placebo and drug conditions indicated a significantly greater depressive response in the total cohort of Personality Disorder patients than in the normal comparison group (p < 0.05). However, the depressive response to physostigmine was significantly greater in BPD patients, but not other Personality Disorder patients, compared to normal controls (p < 0.05). There was a correlation between the peak placebo-corrected depressive response to physostigmine and a group of BPD traits related to affective instability but not a group of BPD traits related to impulsivity. There was no correlation in any group between mood response to physostigmine and changes in plasma cortisol, prolactin, or growth hormone, or to nausea or other side effects following physostigmine infusion. These data suggest that there is an association between BPD and acute depressive responses to physostigmine challenge, and that the cholinergic system may be involved in the regulation of affect in Axis II Disorders.
Andrew E Skodol - One of the best experts on this subject based on the ideXlab platform.
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Personality Disorder types proposed for dsm 5
Journal of Personality Disorders, 2011Co-Authors: Andrew E Skodol, Lee Anna Clark, Leslie C. Morey, John M Oldham, Donna S Bender, Robert F Krueger, Renato D Alarcon, Roel Verheul, Carl C Bell, Larry J. SieverAbstract:The Personality and Personality Disorders Work Group has proposed five specific Personality Disorder (PD) types for DSM-5, to be rated on a dimension of fit: antisocial/psychopathic, avoidant, borderline, obsessive-compulsive, and schizotypal. Each type is identified by core impairments in Personality functioning, pathological Personality traits, and common symptomatic behaviors. The other DSM-IV-TR PDs and the large residual category of Personality Disorder not otherwise specified (PDNOS) will be represented solely by the core impairments combined with specification by individuals' unique sets of Personality traits. This proposal has three main features: (1) a reduction in the number of specified types from 10 to 5; (2) description of the types in a narrative format that combines typical deficits in self and interpersonal functioning and particular configurations of traits and behaviors; and (3) a dimensional rating of the degree to which a patient matches each type. An explanation of these modifications...
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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, John G. Gunderson, Thomas H Mcglashan, Ingrid R Dyck, Robert L Stout, Donna S Bender, Carlos M Grilo, Tracie M Shea, Mary C Zanarini, 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.
Mary C Zanarini - One of the best experts on this subject based on the ideXlab platform.
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prediction of the 10 year course of borderline Personality Disorder
American Journal of Psychiatry, 2006Co-Authors: Mary C Zanarini, Frances R Frankenburg, John Hennen, Bradford D Reich, Kenneth R SilkAbstract:Objective: The purpose of this study was to determine the most clinically relevant baseline predictors of time to remission for patients with borderline Personality Disorder. Method: A total of 290 inpatients meeting criteria for both the Revised Diagnostic Interview for Borderlines and DSM-III-R for borderline Personality Disorder were assessed during their index admission with a series of semistructured interviews and self-report measures. Diagnostic status was reassessed at five contiguous 2-year time periods. Discrete survival analytic methods, which controlled for baseline severity of borderline psychopathology and time, were used to estimate hazard ratios. Results: Eighty-eight percent of the patients with borderline Personality Disorder studied achieved remission. In terms of time to remission, 39.3% of the 242 patients who experienced a remission of their Disorder first remitted by their 2-year follow-up, an additional 22.3% first remitted by their 4-year follow-up, an additional 21.9% by their 6-...
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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, John G. Gunderson, Thomas H Mcglashan, Ingrid R Dyck, Robert L Stout, Donna S Bender, Carlos M Grilo, Tracie M Shea, Mary C Zanarini, 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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axis i comorbidity of borderline Personality Disorder
American Journal of Psychiatry, 1998Co-Authors: Mary C Zanarini, Frances R Frankenburg, Elyse Dubo, Amy Sickel, Anjana Trikha, Alexandra Levin, Victoria ReynoldsAbstract:Objective:The purpose of this study was to assess the lifetime rates of occurrence of a full range of DSM-III-R axis I Disorders in a group of patients with criteria-defined borderline Personality Disorder and comparison subjects with other Personality Disorders. Method:The axis I comorbidity of 504 inpatients with Personality Disorders was assessed by interviewers who were blind to clinical diagnosis and who used a semistructured research interview of demonstrated reliability.Results:Four new findings emerged from this study. First, anxiety Disorders were found to be almost as common among borderline patients (N=379) as mood Disorders but far more discriminating from axis II comparison subjects (N=125). Second, posttraumatic stress Disorder (PTSD) was found to be a common but not universal comorbid Disorder among borderline patients, a finding inconsistent with the view that borderline Personality Disorder is actually a form of chronic PTSD. Third, male and female borderline patients were found to differ...
