This chapter reviews recent (2000–2005) personality disorder (PD) research, focusing on three major domains: assessment, comorbidity, and stability. (a) Substantial evidence has accrued favoring dimensional over categorical conceptualization of PD, and the five-factor model of personality is prominent as an integrating framework. Future directions include assessing dysfunction separately from traits and learning to utilize collateral information. (b) To address the pervasiveness and extent of comorbidity, researchers have begun to move beyond studying overlapping pairs or small sets of disorders and are developing broader, more integrated common-factor models that cross the Axis I–Axis II boundary. (c) Studies of PD stability have converged on the finding that PD features include both more acute, dysfunctional behaviors that resolve in relatively short periods, and maladaptive temperamental traits that are relatively more stable—similar to normal-range personality traits—with increasing stability ...

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Assessment and Diagnosis of Personality Disorder: Perennial Issues and an Emerging Reconceptualization

Personality and psychopathology long have been viewed as related domains, but the precise nature of their relations remains unclear. Through most of the 20th century, they were studied as separate fields; within psychopathology, clinical syndromes were separated from personality disorders in 1980. This division led to the revelation of substantial overlap among disorders both within and across axes and to the joint study of normal and abnormal personality. The author reviews these literatures and proposes an integrative framework to explain personality-psychopathology relations: Three broad, innate temperament dimensions--negative affectivity, positive affectivity, and disinhibition--differentiate through both biologically and environmentally based developmental processes into a hierarchical personality trait structure and, at their extremes, are risk factors (diatheses) for psychopathology, especially given adverse life experiences (stress).

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Temperament as a unifying basis for personality and psychopathology.

A conceptual framework for transferring research to practice.

Vulnerability to Psychopathology: A Biosocial Model Marvin Zuckerman. Washington, DC: American Psychological Association. 1999, 535 pp., (hardcover). A great deal has been learned about psychopathology, but still many questions remain. One of the most important questions remaining to be answered is why people are vulnerable to the different variants of psychopathology ? Zuckerman has made this broad question the focus of his new book. It is a book that is remarkable by its scholarship. It provides a compendium of information on the history of mental disorders, and research findings on their course, diagnosis and prevalence, comorbidity, demographic features, genetic and biological characteristics, and social factors, and is punctuated by a strong biological orientation. Zuckerman indicates that his new book was written as a "logical sequel" to his previous book on the Psychobiology of Personality (Zuckerman, 1991). His book, which is divided into eight chapters, provides a review of the wealth of findings on psychopathology. The first cluster of chapters of the book deals with general considerations including diathesis-stress models (chapter 1), and diagnosis (chapter 2); the second cluster, and main body of the book (chapters 3 to 7), describes theory and research on a selected number of specific disorders, and the final concluding chapter is concerned with the prognosis of the future science of psychopathology. In the first chapter we learn that diathesis-stress theories are not monolithic but exhibit great variety. His model extends Paul Meehl's orientation to schizoprhenia to other disorders, and thus focuses on a biological diathesis and social stress (e.g., parenting) that increases risk of disorders. Zuckerman's book largely restricts the term diathesis to genetic and biological factors. As it happens, then, he questions the basis for the notion of cognitive vulnerability. His grounds for this are that the concept of a cognitive predisposition to psychopathology is not empirically well supported, and that it could simply be a "typical expression of a biological disposition" (p. 7), or other "interpersonal" and "developmental" factors (p. 197). For example, he suggests that research has not adequately demonstrated that cognitive factors predict subsequent levels of depression or other disorders, and are not simply state-manifestations of the disorders. These views are challenged by recent research of the Temple-Wisconsin depression project (e.g., Alloy, Abramson, Hogan et al., 2000). Although Zuckerman's book clearly reflects a monumental undertaking of scholarship, its review of the rapidly advancing cognitive literature on psychopathology is dated. Readers who are interested in a cognitively oriented approach to vulnerability to psychopathology will thus need to look for other references (e.g., Alloy & Riskind, in press). Along with his restriction of the concept of vulnerability to biological diathesis, Zuckerman's book pays little attention to methodological issues, and particularly to issues important for cognitively oriented researchers. Readers who are interested in such issues will have to turn to other sources, such as the excellent chapter by Alloy, Abramson, Raniere, & Dyller, (1999). …

Vulnerability to Psychopathology: A Biosocial Model

Drop-out from addiction treatment: A systematic review of risk factors

The current investigation explores the clinical utility in providing a series of enhanced clinical services to a sample of 303 cocaine-abusing clients (primarily crack smokers) relative to a standard group therapy treatment program. In addition to examining the comparative impact of six varying psychosocial treatment approaches for cocaine abuse on client retention and treatment exposure rates, an additional emphasis has been to examine the ability of fixed and dynamic client variables in predicting client outcome in this regard. No fixed (e.g., sex, income, marital status, income level, or employment status) or dynamic (e.g., recent alcohol use, antisocial personality disorder diagnoses, or motivational variables) client characteristics were useful in predicting client retention or treatment exposure rates. Program characteristics, however, or the frequency, intensity, and/or type of treatment services offered, were related to client retention and treatment exposure. Treatment exposure and retention were significantly enhanced by providing clients with more frequent and intensive group therapy, or by adding individual treatment services to a standard group therapy treatment regimen. With a population such as cocaine abusers, who typically have an extremely high treatment dropout rate, an obvious strategy is to focus efforts on engaging and retaining clients in treatment, and maximizing levels of treatment exposure. The current findings suggest that one successful approach towards enhancing psychosocial treatments for cocaine abuse is to increase the frequency, intensity, and/or types of treatment services offered.

Comparative cocaine abuse treatment strategies: enhancing client retention and treatment exposure.

Psychosocial treatments for cocaine abuse. 12-month treatment outcomes.

Substance users have high prevalence rates of disorders that encompass multiple comorbidities, as well as varied substance use and dependence patterns. Prevalence rates of DSM-III-R antisocial personality (ASP) and other comorbid disorders were investigated among a large sample of substance-dependent treatment clients participating in a national, multisite, prospective study of substance users admitted to treatment. Subjects included 7402 substance-dependent clients with an approximate demographic makeup of 66% male, 47% African American, 12% Hispanic, and average age of 32.6 years. Subjects were assessed with modules for substance dependence and for ASP, depressive, and anxiety disorders from the Composite International Diagnostic Interview and the Diagnostic Interview Schedule. Prevalence rates for substance-dependent subjects were 39.3% ASP and 13.9% lifetime Axis I disorders, and these rates differed according to drug-dependency patterns. Logistic regression was used to assess differences among seven ...

Comorbidity of Antisocial Personality and Mood Disorders among Psychoactive Substance-Dependent Treatment Clients

The purpose of this investigation was to determine if parental substance abuse places children at a higher risk regarding their own substance abuse, illegal activities, and psychological functioning. An intake assessment was conducted with 299 crack smokers currently undergoing treatment. It revealed that clients with a parental history of substance abuse were at over twice the risk for antisocial personality disorders, had been arrested significantly more times as an adult, were more likely to report illicit drug use in the past year, and had received prior treatment more often than clients without a parental history of substance abuse. Surprisingly, no relationship was observed between parental history of substance abuse and preadult behaviors including age-of-onset of drug use, childhood conduct disorders, age at first antisocial behavior, or number of arrests before age 18. Future prevention and treatment efforts with similar populations should recognize the strong influence of the family in the devel...

James W. Luckey

Papers

Comparative cocaine abuse treatment strategies: enhancing client retention and treatment exposure.

Psychosocial treatments for cocaine abuse. 12-month treatment outcomes.

Comorbidity of Antisocial Personality and Mood Disorders among Psychoactive Substance-Dependent Treatment Clients

Parental History of Substance Abuse as a Risk Factor in Predicting Crack Smokers' Substance Use, Illegal Activities, and Psychiatric Status

Individual Assessment Profile (IAP). Standardizing the assessment of substance abusers