Showing papers in "Personality Disorders: Theory, Research, and Treatment in 2014"

On the structure of personality disorder traits: conjoint analyses of the CAT-PD, PID-5, and NEO-PI-3 trait models.

Abstract: The current study examines the relations among contemporary models of pathological and normal range personality traits. Specifically, we report on (a) conjoint exploratory factor analyses of the Computerized Adaptive Test of Personality Disorder static form (CAT-PD-SF) with the Personality Inventory for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition and NEO Personality Inventory-3 First Half, and (b) unfolding hierarchical analyses of the three measures in a large general psychiatric outpatient sample (n = 628; 64% Female). A five-factor solution provided conceptually coherent alignment among the CAT-PD-SF, PID-5, and NEO-PI-3FH scales. Hierarchical solutions suggested that higher-order factors bear strong resemblance to dimensions that emerge from structural models of psychopathology (e.g., Internalizing and Externalizing spectra). These results demonstrate that the CAT-PD-SF adheres to the consensual structure of broad trait domains at the five-factor level. Additionally, patterns of scale loadings further inform questions of structure and bipolarity of facet and domain level constructs. Finally, hierarchical analyses strengthen the argument for using broad dimensions that span normative and pathological functioning to scaffold a quantitatively derived phenotypic structure of psychopathology to orient future research on explanatory, etiological, and maintenance mechanisms.

Narcissistic Grandiosity and Narcissistic Vulnerability in Psychotherapy

Abstract: This article briefly summarizes the empirical and clinical literature underlying a contemporary clinical model of pathological narcissism. Unlike the DSM Narcissistic Personality Disorder (NPD), this clinical model identifies and differentiates between two phenotypic themes of dysfunction—narcissistic grandiosity and narcissistic vulnerability—that can be expressed both overtly and covertly in patients’ ways of thinking, feeling, behaving, and participating in treatment. Clinical recognition that narcissistic patients can and often do present for psychotherapy in vulnerable states of depression, anxiety, shame, and even suicidality increases the likelihood of accurate diagnosis and effective treatment planning. This article provides case examples derived from psychotherapies with narcissistic patients to demonstrate how narcissistic grandiosity and narcissistic vulnerability concurrently present in patients who seek treatment.

Prospective associations between features of borderline personality disorder, emotion dysregulation, and aggression.

Abstract: Difficulties with emotion regulation and behavioral instability, including impulsive aggression, are seen as core dimensions underlying borderline personality disorder (BPD). Although both BPD and antisocial personality disorder (ASPD) are associated with impulsivity and aggressive behavior, difficulties regulating emotions may be associated uniquely with BPD and may explain distinctive associations between BPD and aggression. This study was designed to examine the unique prospective associations between BPD symptoms at baseline, difficulties with emotion regulation and trait impulsivity, and psychological and physical aggression (both perpetration and victimization) over the course of a year after controlling for ASPD symptoms in a mixed clinical and community sample of adults (N = 150). Results of a multivariate path analysis demonstrated that associations between BPD symptoms at baseline and later psychological and physical aggression were fully mediated by difficulties with emotion regulation. Although BPD symptoms also predicted trait impulsivity, impulsivity did not predict aggression after controlling for emotion dysregulation. ASPD symptoms were directly associated with physical assault perpetration and victimization but were not associated with emotion dysregulation, impulsivity, or psychological aggression. These findings suggest that although both BPD and ASPD are associated with aggressive behaviors, associations between BPD symptoms and aggression are mediated uniquely by difficulties regulating emotions.

Empathy in narcissistic personality disorder: from clinical and empirical perspectives.

Abstract: Narcissistic personality disorder (NPD) is associated with an assortment of characteristics that undermine interpersonal functioning. A lack of empathy is often cited as the primary distinguishing feature of NPD. However, clinical presentations of NPD suggest that empathy is not simply deficient in these individuals, but dysfunctional and subject to a diverse set of motivational and situational factors. Consistent with this presentation, research illustrates that empathy is multidimensional, involving 2 distinct emotional and cognitive processes associated with a capacity to respectively understand and respond to others’ mental and affective states. The goal of this practice review is to bridge the gap between our psychobiological understanding of empathy and its clinical manifestations in NPD. We present 3 case studies highlighting the variability in empathic functioning in people with NPD. Additionally, we summarize the literature on empathy and NPD, which largely associates this disorder with deficient emotional empathy, and dysfunctional rather than deficient cognitive empathy. Because this research is limited, we also present empathy-based findings for related syndromes (borderline and psychopathy). Given the complexity of narcissism and empathy, we propose that multiple relationships can exist between these constructs. Ultimately, by recognizing the multifaceted relationship between empathy and narcissism, and moving away from an all or nothing belief that those with NPD simply lack empathy, therapists may better understand narcissistic patients’ behavior and motivational structure.

Examining the factor structure and convergent and discriminant validity of the Levenson self-report psychopathy scale: is the two-factor model the best fitting model?

Abstract: The Levenson, Kiehl, and Fitzpatrick (1995) Self-Report Psychopathy Scale (LSRP) was introduced in the mid-1990s as a brief measure of psychopathy and has since gained considerable popularity. Despite its attractiveness as a brief psychopathy tool, the LSRP has received limited research regarding its factor structure and convergent and discriminant validity. The present study examined the construct validity of the LSRP, testing both its factor structure and the convergent and discriminant validity. Using a community sample of 1,257 undergraduates (869 females; 378 males), we tested whether a 1-, 2-, or 3-factor model best fit the data and examined the links between the resultant factor structures and external correlates. Confirmatory factor analysis (CFA) findings revealed a 3-factor model best matched the data, followed by an adequate-fitting original 2-factor model. Next, comparisons were made regarding the convergent and discriminant validity of the competing 2- and 3-factor models. Findings showed the LSRP traditional primary and secondary factors had meaningful relations with extratest variables such as neuroticism, stress tolerance, and lack of empathy. The 3-factor model showed particular problems with the Callousness scale. These findings underscore the importance of examining not only CFA fit statistics but also convergent and discriminant validity when testing factor structure models. The current findings suggest that the 2-factor model might still be the best way to interpret the LSRP.

Psychopathy, DSM-5, and a caution.

Abstract: Recently developed models of psychopathy include such traits as fearlessness, boldness, and invulnerability. Section III of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes as well a psychopathy specifier that is modeled after these traits. The purpose of the current study was to test empirically the convergent and discriminant validity of the Psychopathic Personality Inventory-Revised (PPI-R), the Triarchic Psychopathy Measure (TriPM), the Elemental Psychopathy Assessment (EPA), and the Personality Inventory for DSM-5 (PID-5) with respect to their relationship to one another, with traditional measures of psychopathy and antisocial personality disorder, and with a measure of the 5-factor model. Participants were 2 samples of community adults (280 and 196) who indicated that they have engaged in criminal activities. The results indicated good convergent and discriminant validity for the PPI-R, TriPM, EPA, and the PID-5 psychopathy specifiers, as well as relationships with a measure of the 5 factor model that were quite distinct from the relationships obtained for traditional measures of antisocial personality disorder and psychopathy. However, concerns are raised with respect to a reliance on reverse-coded items for the assessment of components of psychopathy.

An 11-item measure to assess borderline traits in adolescents: refinement of the BPFSC using IRT.

Abstract: Despite historical concerns about the validity of the construct of borderline personality disorder (BPD) in adolescence, there is now general consensus that BPD in adolescence constitutes a valid and reliable diagnosis. Yet the development and refinement of measures to assess borderline traits in adolescents is in its infancy. Moreover, brief and easy-to-administer measures of borderline traits for use in large-scale studies do not exist. The aim of the current study was to evaluate the Borderline Personality Features Scale for Children (BPFSC; Crick, Murray-Close, & Woods, 2005) and develop a short version of the BPFSC through the use of item response theory (IRT) methods. BPFSC data from a community sample of 964 adolescents (mean age = 15.1 years, SD = .79; 55.9% female) were used to examine the factor structure of the BPFSC. The hypothesized 4-factor structure was not supported. The unidimensional IRT analysis showed instances of local dependence among item pairs and item responses that were not strongly related to the underlying construct. As a consequence, items were eliminated, creating a unidimensional 11-item brief BPFSC (the BPFSC-11). Next, evidence of construct validity of scores based on the shortened version was evaluated using a different sample of 371 inpatient adolescents. We demonstrated similar indices of construct validity as observed for the BPFSC total score with the BPFSC-11 scores and found evidence for good criterion validity. Use of the BPFSC-11 in clinical settings will reduce the burden on respondents without loss of information.

EEG Asymmetry in Borderline Personality Disorder and Depression Following Rejection

Abstract: Borderline personality disorder (BPD) and major depressive disorder (MDD) share numerous features, including dysphoric affect, irritability, suicidality, and a heightened sensitivity to perceived interpersonal rejection. However, these disorders are associated with divergent profiles of reactivity to rejection: Individuals with MDD are more likely to respond with withdrawal and isolation, and those with BPD appear to respond with increased approach behaviors and greater hostility. Potential mechanisms underlying these divergent patterns of response have not been elaborated. The goal of the present study was to assess whether prefrontal cortical asymmetry is associated with these behavioral profiles. EEG alpha activity was recorded at baseline and after individuals with BPD, MDD and healthy controls (HCs) participated in a rejection task. Although no differences were found at baseline, results demonstrated that following rejection, individuals with BPD showed greater left cortical activation, consistent with approach motivation, whereas those with MDD showed greater right cortical activation, consistent with withdrawal motivation. HCs evidenced a more balanced cortical profile, as hypothesized. Although BPD and MDD are highly comorbid, are easily confused, and are phenomenologically similar in a number of ways, individuals with these two disorders respond in very different ways to perceived rejection.

A closer look at the lower-order structure of the Personality Inventory for DSM-5: Comparison with the Five-Factor Model.

Abstract: The Personality Inventory for DSM-5 (PID-5) was developed as a measure of the maladaptive personality trait model included within Section III of the DSM-5. Although preliminary findings have suggested the PID-5 has a five-factor structure that overlaps considerably with the Five-Factor Model (FFM) at the higher order level, there has been much less attention on the specific locations of the 25 lower-order traits. Joint exploratory factor analysis of the PID-5 traits and the 30 facets of the NEO-PI-R were used to determine the lower-order structure of the PID-5. Results indicated the PID-5's domain-level structure closely resembled the FFM. We also explored the placement of several lower-order facets that have not loaded consistently in previous studies. Overall, these results indicate that the PID-5 shares a common structure with the FFM and clarify the placement of some interstitial facets. More research investigating the lower-order facets is needed to determine how they fit into the hierarchical structure and explicate their relationships to existing measures of pathological traits.

Distinct variants of extreme psychopathic individuals in society at large: evidence from a population-based sample.

Abstract: This study used model-based cluster analysis to identify subtypes of men who scored high in overall psychopathy (i.e., ≥ 95th percentile on the Triarchic Psychopathy Measure; n = 193) from a larger sample evaluated for service in the Finnish military (N= 4043). Cluster variates consisted of scores on distinct facets of psychopathy together with a measure of negative affectivity. The best-fitting model specified two clusters, representing ‘primary’ (n = 110) and ‘secondary’ psychopathy (n = 83) groups. Compared to a low-psychopathy comparison group (n = 1878), both psychopathy subgroups showed markedly elevated levels of externalizing symptoms and criminal behavior. Secondary psychopathic participants also reported high levels of internalizing problems including anxiousness, depression, and somatization, and scored higher on the disinhibition facet of psychopathy relative to the primary group. By contrast, primary psychopathic individuals reported fewer internalizing problems than either the secondary psychopathy or comparison groups and scored higher on the boldness facet of psychopathy. Primary psychopathic participants also had higher rates of violent crimes than the secondary psychopaths. Implications for conceptualizing and studying psychopathy in non-forensic populations are discussed.

Three-pronged assessment and diagnosis of personality disorder and its consequences: Personality functioning, pathological traits, and psychosocial disability.

Abstract: The alternative dimensional model of personality disorder (PD) in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5; American Psychiatric Association, 2013), Section III, has two main criteria: Impairment in personality functioning and one or more pathological personality traits. The former is defined as disturbances in self functioning (viz., identity, self-direction), and/or interpersonal functioning (viz., empathy, intimacy). Distinguishing personality functioning and traits is important conceptually, because simply having extreme traits is not necessarily pathological. However, adding personality functioning to PD diagnosis represents an empirical challenge, because the constructs overlap conceptually. Further, there is debate regarding whether diagnosis of mental disorder requires either distress or disability, concepts that also overlap with maladaptive-range personality traits and personality dysfunction. We investigated interrelations among these constructs using multiple self-report measures of each domain in a mixed community-patient sample (N = 402). We examined the structures of functioning (psychosocial disability and personality), and personality traits, first independently, then jointly. The disability/functioning measures yielded the three dimensions we have found previously (Ro & Clark, 2013). Trait measures had a hierarchical structure which, at the five-factor level, reflected neuroticism/negative affectivity (N/NA), (low) sociability, disinhibition, (dis)agreeableness, and rigid goal engagement. When all measures were co-factored, a hierarchical structure again emerged which, at the five-factor level, included (1) internalizing (N/NA and self-pathology vs. quality-of-life/satisfaction), (2) externalizing (social/interpersonal dysfunction, low sociability, and disagreeableness), (3) disinhibition, (4) poor basic functioning, and (5) rigid goal engagement. Results are discussed in terms of developing an integrated PD diagnostic model.

Comparing the factor structure of the Wisconsin Schizotypy Scales and the Schizotypal Personality Questionnaire

Abstract: Schizotypy is a multidimensional construct that captures the expression of schizophrenic symptoms and impairment from subclinical levels to full-blown psychosis. The present study examined the comparability of the factor structure of 2 leading psychometric measures of schizotypy: the Wisconsin Schizotypy Scales (WSS) and the Schizotypal Personality Questionnaire (SPQ). Both the SPQ and WSS purportedly capture the multidimensional structure of schizotypy; however, whether they are measuring comparable factors has not been empirically demonstrated. This study provided support for a 2-factor model with positive and negative factors underlying the WSS; however, contrary to previous findings, the best fit for the SPQ was for a 4-factor model using confirmatory factor analysis, and a 2-factor model using exploratory factor analysis. The WSS factors were relatively distinct, whereas those underlying the SPQ showed high overlap. The WSS positive and SPQ cognitive-perceptual factors appeared to tap comparable constructs. However, the WSS negative and SPQ interpersonal factors appeared to tap somewhat different constructs based on their correlation and their patterns of associations with other schizotypy dimensions and the Five-Factor Model—suggesting that the SPQ interpersonal factor may not adequately tap negative or deficit schizotypy. Although the SPQ offers the advantage over the WSS of having a disorganization factor, it is not clear that this SPQ factor is actually distinct from positive schizotypy. Existing measures should be used with caution and new measures based on a priori theories are necessary to further understand the factor structure of schizotypy.

Shame-related functions of and motivations for self-injurious behavior.

Abstract: Drawing on the self-injury and self-conscious emotion literatures, this study examined the functions of and motivations for self-injury in 67 women, 25 of whom had a history of nonsuicidal self-injury (NSSI). Specifically, the present study tested whether women with a history of NSSI engaged in such behavior in order to reduce shame, in particular, and whether shame-related constructs represent important motivational factors for NSSI. To do so, participants completed (a) self-reports of NSSI functions and relevant personality dimensions (e.g., shame-proneness; shame aversion); and (b) a pain-inducing laboratory task with assessments of state emotions pre- and post-task. Elevations in aversion to general negative affect were associated with presence (vs. absence) of an NSSI history. However, consistent with a role for shame in NSSI, among women with an NSSI history, endorsement of shame regulation functions was positively associated with the frequency of NSSI. Moreover, elevations in shame-proneness were associated with more frequent NSSI, even after taking relevant, broader personality dimensions (e.g., proneness to general negative affect) into account. Finally, following the laboratory task, women with and without an NSSI history experienced reductions in state shame. Future directions for and clinical implications of the present research are discussed.

Attachment and mentalization in female patients with comorbid narcissistic and borderline personality disorder.

Abstract: We investigated attachment representations and the capacity for mentalization in a sample of adult female borderline patients with and without comorbid narcissistic personality disorder (NPD). Participants were 22 borderline patients diagnosed with comorbid NPD (NPD/BPD) and 129 BPD patients without NPD (BPD) from 2 randomized clinical trials. Attachment and mentalization were assessed on the Adult Attachment Interview (AAI; George, Kaplan, & Main, 1996). Results showed that as expected, compared with the BPD group, the NPD/BPD group was significantly more likely to be categorized as either dismissing or cannot classify on the AAI, whereas the BPD group was more likely to be classified as either preoccupied or unresolved for loss and abuse than was the NPD/BPD group. Both groups of patients scored low on mentalizing, and there were no significant differences between the groups, indicating that both NPD/BPD and BPD individuals showed deficits in this capacity. The clinical implications of the group differences in AAI classification are discussed with a focus on how understanding the attachment representations of NPD/BPD patients helps to illuminate their complex, contradictory mental states.

Shame and borderline personality features: the potential mediating role of anger and anger rumination.

Abstract: Two prominent emotions in borderline personality disorder (BPD) are shame and anger. Rumination has been demonstrated to occur in response to shame and to escalate anger, and rumination, particularly anger rumination, has been shown to predict BPD symptoms. The present study tested a structural equation model in which shame leads to the features of BPD via increased anger and anger rumination. A sample of 823 undergraduates completed self-report measures of shame, trait-level anger, anger rumination, and BPD features. The hypothesized model of shame to anger and anger rumination to BPD features was largely supported. Bootstrapping was used to establish significant indirect effects from both situational and global forms of shame via anger rumination to BPD features, and from global shame via anger to most BPD features. The alternative hypothesis that anger and anger rumination contribute to BPD features via increased shame was also examined, with no significant indirect effects found. Recognizing this function of anger and anger rumination may be important in understanding the relationship between shame-proneness and BPD features and may have implications for treatment. Further research into determining other ways individuals maladaptively respond to shame, and understanding the functions of anger and anger rumination, is recommended.

Schizotypal Personality Questionnaire-Brief Revised: psychometric replication and extension.

Abstract: The psychometric screening and detection of schizotypy through the use of concise self-report assessment instruments such as the Schizotypal Personality Questionnaire-Brief Revised (SPQ-BR; Cohen, Matthews, Najolia, & Brown, 2010) enables an expeditious identification of individuals at putatively elevated risk to develop schizophrenia-spectrum disorders. Using 2 large, culturally diverse, independent samples, this study expanded the psychometric evaluation of this instrument by presenting a series of confirmatory factor analyses; reviewing internal consistency reliabilities; and evaluating the construct validity of the scale by way of examining group differences in SPQ-BR scores between individuals with and without self-reported family histories of schizophrenia. The results indicate a 2-tier factor solution of the measure and indicate strong internal reliability for the scale. Findings regarding construct validity of the SPQ-BR are more variable with the Cognitive-Perceptual Deficits superordinate factor receiving the strongest evidentiary support. Limitations of this study and directions for future research are discussed.

Narcissistic personality disorder in DSM-5.

Abstract: The criteria for personality disorders in Section II of DSM-5 have not changed from those in DSM-IV. Therefore, the diagnosis of Section II narcissistic personality disorder (NPD) will perpetuate all of the well-enumerated shortcomings associated with the diagnosis since DSM-III. In this article, we will briefly review problems associated with Section II NPD and then discuss the evolution of a new model of personality disorder and the place in the model of pathological narcissism and NPD. The new model was intended to be the official approach to the diagnosis of personality pathology in DSM-5, but was ultimately placed as an alternative in Section III for further study. The new model is a categorical-dimensional hybrid based on the assessment of core elements of personality functioning and of pathological personality traits. The specific criteria for NPD were intended to rectify some of the shortcomings of the DSM-IV representation by acknowledging both grandiose and vulnerable aspects, overt and covert presentations, and the dimensionality of narcissism. In addition, criteria were assigned and diagnostic thresholds set based on empirical data. The Section III representation of narcissistic phenomena using dimensions of self and interpersonal functioning and relevant traits offers a significant improvement over Section II NPD.

Perceptual biases in facial emotion recognition in borderline personality disorder.

Abstract: Individuals with borderline personality disorder (BPD) have biases in facial emotion recognition, which may underlie many of the core features of this disorder. Although they are known to misperceive specific prototypic expressions of emotion (i.e., those displayed at full emotional intensity), patients with this disorder may also show biases in their perceptions of emotions that are expressed at lower levels of emotional intensity. Females with BPD (n = 31) and IQ- and demographically matched nonpsychiatric controls (n = 28) completed a task assessing the recognition of neutral as well as happy and sad facial expressions at mild, moderate, and prototypic emotional intensities. Whereas patients with BPD were more likely than controls to ascribe an emotion to a neutral facial expression, they did not consistently attribute a more negative or positive valence to these faces as compared with controls. Patients were also more likely to perceive mildly sad facial expressions as more intensely sad, and this finding could not be attributed to depressed mood. The results of this study suggest that perceptions of even subtle expressions of negative affect in faces may be subjectively magnified by individuals with BPD, although there was no consistent evidence for a negative perceptual bias for faces displaying a neutral expression. These biases in facial emotion perception for patients with BPD may contribute to difficulties understanding others' emotional states and to problems engaging effectively in social interactions.

The relationship between emotion regulation difficulties and psychopathic personality characteristics.

Abstract: The factors of psychopathy assessment tools diverge in their relationships with numerous problematic behaviors and psychological disorders. Emotion dysregulation is a pathological process argued to cut across diagnoses, and may be important in better understanding these divergent associations. This study sought to clarify psychopathy's association with emotion regulation difficulties. It was predicted that the Fearless Dominance and Self-Centered Impulsivity factors of the Psychopathic Personality Inventory-Revised would demonstrate differential relationships with a multidimensional conceptualization of emotion regulation difficulties. Ninety-one male undergraduate students and 28 male court-mandated anger management participants completed self-report questionnaires measuring emotion regulation difficulties and psychopathic personality characteristics. Hierarchical regression analyses indicated that emotion regulation difficulties were negatively associated with Fearless Dominance psychopathic traits, but positively associated with Self-Centered Impulsivity and global psychopathic traits. In addition, emotion regulation difficulties explained incremental variance in psychopathic traits over and above negative affect alone. These findings may have clinical implications for the etiology and treatment of psychopathic personality disorder.

The Role of Emotion Regulation in the Relations Between Psychopathy Factors and Impulsive and Premeditated Aggression

Abstract: Given the high rates of aggressive behavior among highly psychopathic individuals, much research has sought to clarify the nature of the relation between psychopathy and aggression. The present study examined relations between Fearless Dominance (PPI FD), Self-Centered Impulsivity (PPI SCI), and Coldheartedness (PPI CH) Factors of the Psychopathic Personality Inventory (PPI; Lilienfeld & Andrews, 1996) and aggression dimensions (premeditated and impulsive aggression) in a sample of substance users receiving inpatient treatment. At the univariate level, PPI FD traits were significantly and positively related to premeditated aggression, but were not significantly related to impulsive aggression. PPI SCI traits were positively related to both forms of aggression, whereas PPI CH was not significantly related to either aggression dimension. Emotion regulation difficulties, as measured by the Difficulties with Emotion Regulation Scale (DERS; Gratz & Roemer, 2004), were negatively related to PPI FD traits, positively related to PPI SCI traits, and negatively related to PPI CH traits. Both PPI SCI and PPI FD traits exerted significant indirect effects on impulsive aggression through the DERS. In contrast, the DERS did not mediate the relations between psychopathic traits and premeditated aggression. Results provide a more nuanced understanding of the psychopathy-aggression relations and suggest that difficulties with emotion regulation may be an important mediator of the relations between psychopathy factors and impulsive aggression.

The Protective Role of Attachment Security for Adolescent Borderline Personality Disorder Features via Enhanced Positive Emotion Regulation Strategies

Abstract: While studies have documented significant associations between insecure attachment, emotion dysregulation, and borderline personality disorder (BPD) features, no research to date has empirically delineated the specific mechanisms by which these constructs are related. The present study brings together 2 lines of research that have hitherto separately examined attachment disturbance and emotion dysregulation as they respectively manifest in the pathogenesis of BPD, and explores the complex relations between the 2 well-established correlates of borderline traits in a clinical sample of adolescents (N = 228). We examined the adolescents' use of positive and negative emotion regulation strategies, along with their maternal and paternal attachment security. Results indicated that positive and negative emotion regulation strategies were differentially implicated in the link between attachment insecurity and BPD features. Attachment security functioned as a buffer against adolescent BPD by enhancing positive emotion regulation strategies, while negative emotion regulation strategies served to dilute the protective effect of attachment and positive regulation strategies, culminating in clinically significant levels of borderline traits. Findings are discussed with regard to interventions in the developmental trajectory of BPD as it unfolds during adolescence.

Personality × hormone interactions in adolescent externalizing psychopathology.

Abstract: The “dual-hormone” hypothesis predicts that testosterone and cortisol will jointly regulate aggressive and socially dominant behavior in children and adults (e.g., Mehta & Josephs, 2010). The present study extends research on the dual-hormone hypothesis by testing the interaction between testosterone, cortisol, and personality disorder (PD) traits in predicting externalizing problems in a community sample of adolescent males and females. Participants were 106 youth from the community, ranging in age from 13–18 (Mage 16.01 years, SDage 1.29), and their parents. Parents and youth provided ratings on an omnibus measure of personality pathology and externalizing problems. Youth provided saliva samples via passive drool from which testosterone and cortisol levels were obtained. Robust moderation of the joint effects of testosterone and cortisol on parent-reported externalizing problems was found for both higher-order PD traits associated with externalizing psychopathology (Disagreeableness and Emotional Instability). Higher testosterone was associated with externalizing outcomes, but only when cortisol was low, and only among youth with high levels of Disagreeableness and Emotional Instability. These findings provide the first evidence for the dual-hormone hypothesis in a mixed-sex sample of community adolescents, but importantly offer novel evidence for the importance of personality traits. Examination of the joint regulation of externalizing problems by testosterone and cortisol in the context of adolescent personality may help to clarify inconsistent main effects of testosterone and cortisol on clinical externalizing phenotypes.

Gender, psychopathy factors, and intimate partner violence

Abstract: The present study sheds light on relationships between distinct psychopathic traits and perpetration of intimate partner violence (IPV) in women versus men. Men and women with recent drug and/or violence histories (N = 250) were assessed for psychopathic traits using the Psychopathy Checklist: Screening Version and for their and their partner's use of IPV with the Revised Conflict Tactics Scale. The first goal was to examine the moderating role of gender in psychopathy factor relationships to IPV. Although both the interpersonal-affective traits (Factor1) and the impulsive-antisocial traits (Factor 2) of psychopathy were related to higher frequency of IPV perpetration, the relationship between Factor 1 and IPV was stronger in men. Our second goal examined the moderating role of psychopathy traits in the relationship between partner's perpetration of IPV and participant perpetration (mutual violence) in the 2 genders. Relationships between partner- and self-IPV were similar at both low and high levels of Factor 1 in men, although the partner- and self-IPV relationship was significantly stronger among women at low relative to high levels of Factor 1. The relationship between partner- and self-IPV was stronger at high levels of Factor 2 in men, whereas Factor 2 did not moderate mutual violence in women. These results indicate that relationships between psychopathy factors and IPV differ by gender, with psychopathy generally exacerbating IPV perpetration in men and Factor 1 traits playing a unique role in mutual violence in women. These findings add to the literature on female psychopathy and have important implications for future research on gender and IPV. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

Psychopathy variants: empirical evidence supporting a subtyping model in a community sample.

Abstract: Psychopathy is a personality construct typically related to deficits in interpersonal and affective functioning and antisocial behavior. Currently, the majority of research focuses on the omnibus construct of psychopathy as it applies to criminal populations. However, theories of psychopathy and empirical evidence suggest that there may be different variants of psychopathy and diverse expressions of psychopathic traits across individuals. Thus, there is a need to consider psychopathy in terms of subtypes and across more broadly defined populations. The present study used model-based cluster analysis and garnered support for the differentiation of primary and secondary subtypes in a college sample. Analysis yielded 6 clusters, 2 of which demonstrated the expected patterns of traits indexed by theories of primary and secondary psychopathy; the factors of psychopathy, anxiety, borderline personality traits, aggression, and affect, all differentiated the subtypes. Overall, the results provide continued support for the existence of psychopathy variants in college samples, initial empirical support for model of psychopathy, and aid in the understanding of psychopathy subtypes.

An examination of the perceptions of social network characteristics associated with grandiose and vulnerable narcissism.

Abstract: Two dimensions of narcissism exist, grandiose and vulnerable, which are thought to be associated with distinctly different patterns of interpersonal behavior. Social network analysis is a way of quantifying and analyzing interpersonal interactions that may prove useful for characterizing the networks associated with these narcissism dimensions. In the current study, participants (N = 148) completed scales assessing both narcissism dimensions and a measure of the five-factor model of personality. Egocentric network information about participants' 30 closest friends and family members (i.e., "alters") was also obtained. Both narcissism dimensions were characterized by negative perceptions of the individuals who comprise one's social networks, and many of these relations were mediated by individuals' higher levels of antagonism. Grandiose narcissism also interacted with alter centrality (i.e., importance to the network) such that individuals low on grandiose narcissism were less likely to perceive central alters in a negative light and were more attuned to central alters than were individuals high on grandiose narcissism. Overall, both narcissism dimensions were associated with perceiving one's overall social environment negatively because of the high levels of antagonism that characterize both narcissism dimensions. Individuals high on grandiose narcissism, however, appear to be more insensitive to the relative importance of individuals in their social networks.

Predictors of treatment response to an adjunctive emotion regulation group therapy for deliberate self-harm among women with borderline personality disorder.

Abstract: Despite evidence for the efficacy of several treatments for deliberate self-harm (DSH) within borderline personality disorder (BPD), predictors of response to these treatments remain unknown. This study examined baseline demographic, clinical, and diagnostic predictors of treatment response to an adjunctive emotion regulation group therapy (ERGT) for DSH among women with BPD. A recent RCT provided evidence for the efficacy of this ERGT (relative to a treatment-as-usual only waitlist condition). Participants in this study include the full intent-to-treat sample who began ERGT (across treatment and waitlist conditions; n = 51). Baseline diagnostic and clinical data were collected at the initial assessment, and outcome measures of DSH and self-destructive behaviors, emotion dysregulation/avoidance, and BPD symptoms (among others) were administered at pretreatment, posttreatment, and 3- and 9-months posttreatment. Notably, both demographic variables and characteristics of participants' ongoing therapy in the community had minimal impact on treatment response. However, several indicators of greater severity in domains relevant to this ERGT (i.e., baseline emotion dysregulation and BPD criteria, lifetime and recent DSH, and past-year hospitalization and suicide attempts) predicted better responses during treatment and follow-up across the primary targets of treatment. Likewise, several co-occurring disorders (i.e., social phobia, panic disorder, and a cluster B personality disorder) predicted greater improvements in BPD symptoms during treatment or follow-up. Finally, although co-occurring generalized anxiety disorder, posttraumatic stress disorder, and cluster A and C personality disorders were associated with poorer treatment response during follow-up, most of these effects reflected a lack of continued improvements during this period (vs. worsening of symptoms).

Modernity and narcissistic personality disorder.

Abstract: Narcissistic personality disorder (NPD) is a trait-based disorder that can be understood as a pathological amplification of narcissistic traits. While temperamental vulnerability and psychological adversity are risk factors for NPD, sociocultural factors are also important. This review hypothesizes that increases in narcissistic traits and cultural narcissism could be associated with changes in the prevalence of NPD. These shifts seem to be a relatively recent phenomenon, driven by social changes associated with modernity. While the main treatment for NPD remains psychotherapy, that form of treatment is itself a product of modernity and individualism. The hypothesis is presented that psychological treatment, unless modified to address the specific problems associated with NPD, could run the risk of supporting narcissism.

Affective behavior during mother-daughter conflict and borderline personality disorder severity across adolescence.

Abstract: Developmental theories of borderline personality disorder (BPD) posit that transactions between child characteristics and adverse environments, especially those in the context of the parent-child relationship, shape and maintain symptoms of the disorder over time. However, very little empirical work has investigated the role of parenting and parent-child transactions that may predict BPD severity over time. We examined maternal and dyadic affective behaviors during a mother-adolescent conflict discussion task as predictors of the course of BPD severity scores across 3 years in a diverse, at-risk sample of girls (N = 74) oversampled for affective instability and their biological mothers. Adolescent girls completed a structured conflict discussion task with their mothers at age 16. Girls' self-reported BPD severity scores were assessed annually from ages 15 to 17. Mother-adolescent interactions were coded using a global rating system of maternal and dyadic affective behaviors. Results from multilevel linear mixed models indicated that positive maternal affective behavior (i.e., supportive/validating behavior, communication skills, autonomy-promoting behavior, and positive affect) and positive dyadic affective behaviors (i.e., satisfaction and positive escalation) were associated with decreases in girls' BPD severity scores over time. Dyadic negative escalation was associated with higher overall levels of BPD severity scores, but negative maternal affective behavior (i.e., negative affect, dominance, conflict, and denial) was not. These findings suggest that the mother-daughter context is an important protective factor in shaping the course of BPD severity scores during adolescence and may be valuable in assessment, intervention, and prevention efforts.

Stability and change in distress tolerance and its prospective relationship with borderline personality features: a short-term longitudinal study.

Abstract: Distress tolerance (DT), or the ability to withstand psychological distress, has been proposed as a mechanism underlying multiple forms of psychopathology. However, research on DT is limited in several areas. First, stability and change of DT over time has never been assessed in adults. Second, it is unclear whether alternative conceptualizations of DT yield differences in longitudinal stability and change. Third, gender differences in DT have yet to be examined in nonclinical adult samples. And fourth, longitudinal predictive utility of DT has not been adequately assessed. The purpose of this study was to investigate these 3 questions using data collected at 3 time points over a 6-month period, examining borderline personality disorder (BPD) features as an outcome. Using 3 different measures of DT, results indicated that there is no mean level change in DT. Similarly, there was moderate rank-order stability in DT and no significant individual level change across measures. These findings suggest that DT is similar to other stable, trait-like constructs, as has been previously theorized. Next, a series of cross-lagged panel models revealed that although DT had a cross-sectional relationship with BPD features across all time points, DT did not predict BPD traits longitudinally. These findings have implications for treatments for BPD.

Somatosensory processing and borderline personality disorder: Pain perception and a signal detection analysis of proprioception and exteroceptive sensitivity.

Abstract: Approximately two thirds of those with borderline personality disorder (BPD) who self-injure report diminished sensitivity to pain during acts of self-harm Research on pain perception suggests that abnormalities of the motivational-affective domain likely contribute to the commonly reported hypo-analgesia evidenced in BPD It is not that BPD individuals cannot detect or feel painful stimuli, rather their response to it seems to reflect differences in tolerance and willingness to report a stimulus as painful Although specific processes involved with pain insensitivity have been debated in literature, the likelihood of generalized dysfunction in the somatosensory systems in BPD has not been considered Prior BPD research has focused only on the pain submodality of somatosensation This study assessed pain perception (nociception), basic touch (exteroception), and body sense (proprioception) somatosensory submodalities, in an effort to determine if generalized somatosensory deficits are present in BPD Subjects diagnosed with DSM-IV BPD (n = 27) were compared with individuals who had a history of major depressive disorder with no current psychopathology (n = 20), and normal controls (n = 44), all drawn from a community setting Individuals with BPD evidenced higher pain endurance and tolerance, but did not demonstrate generalized somatosensory deficits, as evidenced by appropriate functioning on tasks of exteroceptive and proprioceptive sensitivity Findings are consistent with (but do not prove) a specific dysfunction in the pain-specific mechanism of sensitivity and perception in BPD, perhaps one that does not disturb the other somatosensory modalities These data help to provide a firmer empirical basis for pain insensitivity as an endophenotype for BPD