Impulsivity mediates the association between borderline personality pathology and body mass index.

Borderline personality disorder (BPD) is associated with obesity, a major risk factor for a number of chronic illnesses (e.g., cardiovascular disease). We examined whether impulsivity and affective instability mediate the association between BPD pathology and body mass index (BMI). Participants were a community sample of adults ages 55-64 and their informants. The Structured Interview for DSM-IV Personality measured BPD symptoms and the Revised NEO Personality Inventory measured self- and informant-report impulsivity and affective instability. Mediation analyses demonstrated that only higher self-report impulsivity significantly mediated the association between greater BPD pathology and higher BMI. A subsequent model revealed that higher scores on the impulsiveness (lack of inhibitory control) and deliberation (planning) facets of impulsivity mediated the BPD-BMI association, with impulsiveness exerting a stronger mediation effect than deliberation. Obesity interventions that improve inhibitory control may be most effective for individuals with BPD pathology.

The differential effects of child abuse and posttraumatic stress disorder on schizotypal personality disorder.

OBJECTIVE: Previous findings suggest a relation between trauma exposure and risk for schizotypal personality disorder (SPD). However, the reasons for this relationship are not well understood. Some research suggests that exposure to trauma, particularly early trauma and child abuse, as well as posttraumatic stress disorder (PTSD) may play a role. METHODS: We examined subjects (n = 541) recruited from the primary care clinics of an urban public hospital as part of an National Institute of Mental Health-funded study of trauma-related risk and resilience. We evaluated childhood abuse with the Childhood Trauma Questionnaire and the Early Trauma Inventory and SPD with the Schedule for Nonadaptive and Adaptive Personality. We assessed for lifetime PTSD using the Clinician-Administered PTSD Scale. RESULTS: We found that of the 3 forms of abuse analyzed (emotional, physical, and sexual), only emotional abuse significantly predicted SPD (P < .001, R = 0.28) when all 3 abuse types were simultaneously entered into a regression model. Lifetime PTSD symptoms also significantly predicted SPD (P < .001, R = 0.26). Posttraumatic stress disorder was specifically predictive of 4 of the 8 SPD symptoms (P ≤ .001): excessive social anxiety, a lack of close friends or confidants, unusual perceptual experiences, and eccentric behavior or appearance. Using a Sobel test, we also found a partial mediation effect of PTSD on the relation between emotional abuse and SPD (z = 3.45, P < .001). CONCLUSIONS: These findings point to the important influence of emotional abuse on SPD and suggest that PTSD symptoms may provide a link between damaging childhood experiences and SPD symptoms in traumatized adults.

Borderline personality pathology and chronic health problems in later adulthood: the mediating role of obesity.

Borderline personality disorder (BPD) is associated with many negative physical health outcomes, including increased risk for serious chronic diseases such as diabetes, heart disease, and arthritis. BPD is also linked with obesity, a condition that is strongly related to many of the same physical health problems. Although research has shown that BPD is related to these physical conditions, there is limited evidence of whether body mass mediates the relation between BPD and serious physical health problems. The present study examined the associations among BPD features, body mass index (BMI), and six major physical health problems in an epidemiologically based sample (n = 1051) of Saint Louis residents, ages 55-64. Using interviewer-, self-, and informant-report of personality pathology, we found that BPD features were significantly related to reported presence of heart disease, arthritis, and obesity. BMI was also significantly related to heart disease and arthritis. Sobel mediation models showed that BMI fully mediated the relation between BPD features and arthritis. These results suggest that borderline pathology is an important risk factor for serious health problems in later adulthood. Obesity appears to be one pathway that leads to more health problems among individuals with BPD symptoms and may be a useful starting point when thinking about future intervention strategies.

Personality pathology as a risk factor for negative health perception.

Previous findings suggest that self-perception of health relates to many physical health outcomes, including mortality. Many factors appear to shape health perceptions, such as personality. Little research, however, has focused on whether personality pathology may affect perceived health. This preliminary study examined the unique effects of personality pathology on health perceptions beyond those of objective health and normal personality factors. As part of an ongoing longitudinal study, the authors examined data from a representative sample (N = 697) of St. Louis residents (ages 55-64) who were identified using standard epidemiological methods. The Diagnostic Interview Schedule and the Health Status Inventory were used to collect reports of health perceptions, chronic illnesses, and physical functioning. Personality traits were measured with the revised NEO Personality Inventory, and personality disorders were assessed using the Structured Interview for DSM-IV Personality. Number of physical illnesses, physical functioning, normal personality, and personality disorders all predicted self-perception of health separately. Personality disorders also predicted health perception above and beyond objective health and personality variables. These findings elucidate the importance of personality pathology in understanding perceived health and suggest that certain patterns of pathology may be particularly detrimental to subjective health.

Symptoms of borderline personality disorder predict interpersonal (but not independent) stressful life events in a community sample of older adults.

Individuals with borderline personality disorder (BPD) often experience stressful life events at a higher frequency than those without BPD. It is less clear what specific types of events are involved in this effect, and it has not been determined whether some features of BPD are more important than others in accounting for this effect. The latter issue is important in light of the heterogeneous nature of this diagnostic construct. These issues were examined in a large, representative community sample of men and women, ages 55-64. Ten Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev., DSM-IV-TR, Washington, DC, American Psychiatric Association, 2000) personality disorders were assessed at baseline using the Structured Interview for DSM-IV Personality: SIDP-IV (B. Pfohl, N. Blum, & M. Zimmerman, 1997, Washington, DC, American Psychiatric Press). Life events were measured at three sequential assessments following baseline at 6-month (N = 1,294), 12-month (N = 1,070), and 18-month (N = 837) follow-ups. Stressful life events were identified using a self-report questionnaire (LTE-Q; List of Threatening Experiences Questionnaire: A subset of prescribed life events with considerable long-term contextual threat by T. Brugha, C. Bebbington, P. Tennant, and J. Hurry, 1985, Psychological Medicine, Vol. 15, pp. 189-194.) followed by a telephone interview. Only borderline personality pathology was related to an increase in the frequency of interpersonal stressful life events. Three specific symptoms of BPD were largely responsible for this connection: unstable interpersonal relationships, impulsivity, and chronic feelings of emptiness (negative association). Symptoms of avoidant and schizoid personality disorders were associated with a reduced number of stressful life events that are considered to be outside a person's control (e.g., serious illness, injury, or death of a loved one). None of the personality disorders predicted an increase in the number of stressful financial events (e.g., major financial crisis). These findings suggest that, as individuals approach later life, certain features of BPD continue to serve as important risk factors for stressful life events of an interpersonal nature.

Personality disorders and physical health: a longitudinal examination of physical functioning, healthcare utilization, and health-related behaviors in middle-aged adults.

Personality disorders (PDs) have significant, long-term effects in many areas, including physical health outcomes such as increased risk for chronic disease and mortality. Although research has documented this detrimental impact in relation to long-term physical health, no one has explored the more immediate influence of disordered personality on aspects of physical functioning, such as pain level, or health-related behaviors, such as medication use. The present study examined the unique effects of PD features on physical functioning, medical resource utilization, and prescription medication use to determine potential risk associated with PDs. We studied an epidemiologically-based sample (N = 608) of Saint Louis residents (ages 55-64) over two time points (6 months apart). We found that disordered personality was significantly predictive of worse physical functioning, role limitations, fatigue, and pain at both time points, even when current health problems, the presence of depression, and health behaviors (i.e., smoking, drinking, exercise) were controlled. PD features were also predictive of increased healthcare utilization and medication use at follow-up. These results suggest that the presence of disordered personality may be an important risk factor for worse functioning, regardless of actual health status.

The enduring impact of borderline personality pathology: risk for threatening life events in later middle-age.

Both neuroticism and borderline personality disorder (BPD) are associated with increased frequency of stressful life events in young adults. It is not clear, however, whether this effect extends to later life because BPD is apparently diminished in frequency and severity when people reach middle adulthood. This issue was examined in a representative, community sample of men and women between the ages of 55 and 64 (N = 1,234). Ten DSM-IV PDs and neuroticism were assessed at baseline using a semistructured interview (SIDP-IV) and questionnaire (NEO-PI-R). Life events were measured 6 months later with a self-report questionnaire (LTE-Q) followed by a telephone interview. BPD features and neuroticism predicted increased frequency of life events, based on both self and interviewer-adjusted reports of negative life events. Avoidant and paranoid PD features predicted decreased frequency of negative life events. Approximately 42% of events reported on the LTE-Q were discounted following the telephone interview; higher scores on BPD symptoms were associated with more adjustments to self-report of threatening experiences. These findings indicate that symptoms of BPD and neuroticism continue to have a harmful impact on the lives of older adults.

Personality subtypes in adolescents with panic disorder.

This study examined personality subtypes of adolescents diagnosed with Panic Disorder (PD). As part of an NIMH-funded study of adolescent personality and its relation to psychopathology, randomly selected experienced licensed psychologists and psychiatrists used a Q-sort instrument to describe adolescents in their care, of whom 57 had been diagnosed with PD. Q-factor analysis yielded three personality subtypes: High Functioning/Dysphoric, Emotionally Dysregulated, and Avoidant. The subtypes differed on axis I and II pathology, adaptive functioning, and developmental and family history variables. Personality constellations showed substantial incremental validity in predicting adaptive functioning above and beyond DSM-IV axis I diagnoses. The results resemble subtypes recently identified in adults and suggest that adolescents who present with panic symptoms are a heterogeneous group, whose personality needs to be considered in understanding and helping them clinically.

Personality constellations in incarcerated psychopathic men.

Advances in the operationalization of psychopathy have led to an increased understanding of the boundaries, structure, and nomological network of this construct, although significant questions remain. The empirical identification of replicable and theoretically meaningful psychopathy subtypes may help to improve the classification and diagnosis of this condition. We conducted a classification study of 91 incarcerated men who met conventional criteria for high levels of psychopathy using the Psychopathy Checklist-Revised. We expanded on the methodology of previous research on psychopathy subtypes by utilizing a comprehensive personality assessment instrument and a prototype matching approach to classification. The analyses revealed a primary (narcissistic) subtype and a secondary (hostile and dysregulated) subtype that were broadly consistent with the previous literature. External validation analyses, statistical controls, and incremental validity analyses provided substantial support for the primary and secondary subtypes.