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Background: Cluster B personality disorders (PDs) are considered some of the most severe mental health conditions. Scarce evidence exists about the real-world utilization of psychotropics for cluster B PD individuals. Objective: We aimed to uncover trends and patterns of psychotropic medication use among individuals diagnosed with cluster B PD in the year before and after their diagnosis and to identify factors associated with medication use in a large cohort of individuals newly diagnosed with cluster B PDs. Methods: We conducted a population-based observational study using Quebec's health services register. We identified Quebec residents aged ≥14 years and insured with the provincial drug plan with a first diagnosis of cluster B PD recorded between April 1, 2002, and March 31, 2019. Cluster B PD was defined with ICD-9/10 diagnostic codes. We retrieved all claims for the main psychotropic medication classes: antipsychotics, antidepressants, anxiolytics, mood stabilizers, and attention-deficit/hyperactivity disorder (ADHD) medications. We calculated the proportion of individuals exposed to these medication classes and analyzed trends over the years using robust Poisson regression models, adjusting for potential confounders. We used robust Poisson regression to identify factors associated with medication class use. Results: We identified 87,778 new cases of cluster B PD, with a mean age of 44.5 years; 57.5% were women. Most frequent psychiatric comorbidities in the five years before cluster B PD diagnosis were depression (50.9%), anxiety (49.7%), and psychotic disorders (37.5%). Most individuals (71.0%) received at least one psychotropic during the year before cluster B PD diagnosis, and 78.5% received at least one of these medications in the subsequent year. The proportion of users increased after the diagnosis for antidepressants (51.6-54.7%), antipsychotics (35.9-45.2%), mood stabilizers (14.8-17.0%), and ADHD medications (5.1-5.9%), and remained relatively stable for anxiolytics (41.4-41.7%). Trends over time showed statistically significant increased use of antipsychotics and ADHD medications, decreased use of anxiolytics and mood stabilizers, and a stable use of antidepressants. Conclusion: Psychotropic medication use is highly prevalent among cluster B PD individuals. We observed an increase in medication use in the months following the diagnosis, particularly for antipsychotics, antidepressants, and mood stabilizers.
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Borderline personality disorder (BPD) is one of the most diagnosed disorders in clinical settings. Besides the fully diagnosed disorder, borderline personality traits (BPT) are quite common in the general population. Prior studies have investigated the neural correlates of BPD but not of BPT. This paper investigates the neural correlates of BPT in a subclinical population using a supervised machine learning method known as Kernel Ridge Regression (KRR) to build predictive models. Additionally, we want to determine whether the same brain areas involved in BPD are also involved in subclinical BPT. Recent attempts to characterize the specific role of resting state-derived macro networks in BPD have highlighted the role of the default mode network. However, it is not known if this extends to the subclinical population. Finally, we wanted to test the hypothesis that the same circuitry that predicts BPT can also predict histrionic personality traits. Histrionic personality is sometimes considered a milder form of BPD, and making a differential diagnosis between the two may be difficult. For the first time KRR was applied to structural images of 135 individuals to predict BPT, based on the whole brain, on a circuit previously found to correctly classify BPD, and on the five macro-networks. At a whole brain level, results show that frontal and parietal regions, as well as the Heschl's area, the thalamus, the cingulum, and the insula, are able to predict borderline traits. BPT predictions increase when considering only the regions limited to the brain circuit derived from a study on BPD, confirming a certain overlap in brain structure between subclinical and clinical samples. Of all the five macro networks, only the DMN successfully predicts BPD, confirming previous observations on its role in the BPD. Histrionic traits could not be predicted by the BPT circuit. The results have implications for the diagnosis of BPD and a dimensional model of personality.
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Transtorno da Personalidade Borderline , Humanos , Transtorno da Personalidade Borderline/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Personalidade , Tálamo , FenótipoRESUMO
Histrionic personality disorder (HPD) is a common and problematic form of personality pathology involving excessive attention-seeking, often through overly sexualized means. Much of the research on HPD has involved the association between HPD characteristics and basic temperament traits. Given the sometimes hypersexualized presentation of HPD, another potential influence on HPD characteristics may be exposure to sexual assault. However, there is little research on the association between sexual assault and HPD in general or with respect to temperament traits in particular. In this study, we examine the relative associations of sexual assault and temperament traits with the cognitive characteristics of HPD in a large sample of college students (N = 965) using a Bayesian approach to the analysis of covariance. Results suggest that sexual assault is associated with HPD cognitive characteristics over and above the robust influence of temperament traits. The study findings have implications for future research on and clinical intervention with people with HPD.
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Delitos Sexuais , Temperamento , Humanos , Teorema de Bayes , Transtorno da Personalidade Histriônica/psicologia , Personalidade , Cognição , Inventário de PersonalidadeRESUMO
OBJECTIVE: Histrionic personality disorder (HPD) with a lifetime prevalence rate of 1.8% is an under-researched psychiatric diagnosis. The present study therefore aimed to investigate both the processes and outcomes of psychotherapy for HPD in a non-controlled study. METHODS: A total of 159 patients diagnosed with HPD were recruited and received clarification-oriented psychotherapy. Sessions 15, 20, and 25 were video-recorded and analysed using the Process-Content-Relationship Scale. Therapy outcome was assessed with symptom measures at intake and discharge. Hierarchical linear modelling was applied to estimate the changes in the psychotherapeutic outcome and associations with patient and therapist process developments. RESULTS: Improvements in relationship processes of patients and therapists were systematically related to outcome while only partial relationships were found on the levels of process and content. CONCLUSION: The present study represents the first systematic insight into core changes in patients with HPD undergoing psychotherapy.
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Transtorno da Personalidade Histriônica , Psicoterapia , Humanos , Transtorno da Personalidade Histriônica/diagnóstico , Transtorno da Personalidade Histriônica/psicologia , Resultado do TratamentoRESUMO
Histrionic personality pathology is among the most common forms of personality pathology, although little is known about its potential risk factors. One possible factor that may influence histrionic personality pathology is childhood trauma, most notably sexual abuse and physical/emotional neglect. However, there is little research on how these and other forms of childhood trauma may influence histrionic personality pathology relative to each other. To address this, in this study we examined the relative effects of different forms of child abuse and neglect on histrionic personality pathology in a sample of women and men from Amazon's Mechanical Turk (N = 399) using a Bayesian approach to structural equation modeling. Results suggest that child sexual abuse is the strongest predictor of histrionic personality pathology in adulthood. However, this differs between women and men such that physical neglect also predicts histrionic personality pathology for women, whereas physical and emotional abuse as well as emotional neglect predict histrionic personality pathology for men. These findings provide insight into the developmental precursors to histrionic personality pathology and have implications for research on and clinical intervention with people exhibiting histrionic personality pathology.
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Maus-Tratos Infantis , Masculino , Criança , Humanos , Feminino , Adulto , Teorema de Bayes , Inquéritos e Questionários , Maus-Tratos Infantis/psicologia , Personalidade , Transtornos da Personalidade/psicologiaRESUMO
Oral finasteride represented a breakthrough for treatment of male pattern hair loss (MPHL), with clinical studies having demonstrated high efficacy of treatment and a favorable safety profile. And yet, fertility issues, malignancy, and postfinasteride syndrome have been concerns of users and prescribers of the drug. Pre-existing mental health disorder may put patients at an increased risk of nocebo, while the prevalence of personality disorders in subjects with MPHL is known to be higher than in the general population, specifically histrionic personality disorder. We devised a system for patient selection and risk assessment, including fertility issues, regular PSA determinations, and specific mental health assessment. For those who choose regular prostate cancer screening, the use of finasteride meaningfully reduces the risk of prostate cancer. While gynecomastia is a known, rare adverse effect of finasteride, so far, studies support the view that exposure to finasteride is not associated with male breast cancer risk. Patient understanding and involvement are central to optimal treatment selection and active patient role in treatment.
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This research was conducted to highlight the utility of considering clinical psychology concepts in judgment and decision research. Our overarching thesis is that the judgments and choices people make may often be influenced by clinically relevant phenomena, and that understanding these relationships can, in a reciprocal fashion, help advance our understanding of judgment and decision making as well as specific clinical diagnoses and proclivities. We focused on histrionic personality disorder and conducted four studies that show that histrionic symptomology predicts preferences and choices that facilitate grabbing others' attention, even when such choices cost more money, and are at the expense of giving up more tangible features. In addition to demonstrating a new implication of the histrionic personality, we provide insight into the process underlying this tendency and discuss implications for mental health service providers.
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Julgamento , Psicologia Clínica , Atenção , Tomada de Decisões , HumanosRESUMO
Hysteria is one of the oldest and best known clinical terms. Its history reveals the extent to which pathological entities, some more than others, are the fruit of successive conceptions of experts, themselves undoubtedly influenced by the prevailing currents of thought of their time. From its uterine origin to its psychogenic etiology, here is the history of hysteria and its controversies. A history that belongs to that of medicine, neurology, psychiatry, psychology and psychoanalysis.
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Neurologia , Psiquiatria , Psicanálise , História do Século XIX , Humanos , Histeria , PsicoterapiaRESUMO
BACKGROUND: The main research objective was to translate and evaluate the Polish version of the As-If-Scale (AIS) as well as to test the measurement invariance of the Polish and the original (German) versions of the tool, and to analyze the differences in histrionic self-presentation style among Poles and Germans. The AIS consists of 8 items for the subjective assessment of the histrionic self-presentation style which involves behaviors such as playing roles, imitating people or even engaging others in performing small role-plays, and is seen as an individual difference phenomenon. PARTICIPANTS AND PROCEDURE: The psychometric properties of the Polish version were tested in two samples with a total of 762 participants. RESULTS: The article presents the factor structure and reliability of the scale. In addition, the AIS was correlated with measures of the Big Five personality traits, pragmatism and gelotophobia to provide initial validation. Measurement invariance was tested using data collected in this study (Polish sample) and existing and previously published data (German sample). CONCLUSIONS: Overall, the results provide support for the reliability of the scale as its properties are similar to those of the German version. The findings also allow one to make broader cross-cultural comparisons of the histrionic self-presentation style, which includes various types of behavior and is often associated with humor.
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BACKGROUND: Increased violent events happen in the general hospitals in China and yet non-psychiatric departments do not have tools for violence-tendency screening. METHODS: The current study developed and evaluated two Inpatient Psychological Experience Questionnaires (IPEQs) for the screening of violence-related six mental health disorders: (Inpatient Psychological Experience Questionnaire-1 (IPEQ-1): anxiety, depression and suicidality; Inpatient Psychological Experience Questionnaire-2 (IPEQ-2): paranoid personality disorder, emotionally unstable personality disorder and histrionic personality disorder). Two initial IPEQs (IPEQ-1: 37 items and IPEQ-2: 30 items) were developed and assessed by domain experts. Then 1210 inpatients were recruited and divided into three groups (160, 450 and 600 samples, respectively) for IPEQs item selection and evaluation. During the two-stage item selection, three statistical methods including Pearson's correlation coefficient, exploratory factor analysis and item response theory were applied. For the item evaluation, Cronbach's alpha coefficient, test-retest reliability, criterion-related validity and construct validity of the final questionnaires were measured. RESULTS: Twelve items were selected for each IPEQs. Cronbach's alpha coefficients were 0.91 and 0.78 for IPEQ-1 and IPEQ-2, respectively. Test-retest replication ratios were 0.95 and 0.87 for IPEQ-1 and IPEQ-2, respectively. Correlation coefficients between different disorders and their related-tools scores were [0.51, 0.44] and [0.40, 0.44] for IPEQ-1 and IPEQ-2, respectively and were significant (P < 0.01). Confirmatory factor analysis supported the validity of the final IPEQs (P < 0.05), and the model fit index met the criterion generally. CONCLUSION: The IPEQs developed in this study could be effective and easy-to-use tools for screening inpatients with violence-intendancy in non-psychosomatic departments.
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Transtornos de Ansiedade/diagnóstico , Transtorno Depressivo/diagnóstico , Transtornos da Personalidade/diagnóstico , Inquéritos e Questionários/normas , Violência/prevenção & controle , Adulto , China , Análise Fatorial , Feminino , Humanos , Pacientes Internados/psicologia , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Qualidade de Vida , Reprodutibilidade dos TestesRESUMO
Largely overlooked in the literature, this study investigated factors influencing women's use of sexual coercion. Specifically, pornography use and personality disorder traits linked with poor impulse control, emotional regulation, and superior sense of sexual desirability were considered. Women (N = 142) aged 16-53 years (M = 24.23, SD = 7.06) were recruited from community and student populations. Participants completed the Narcissistic and Histrionic subscales of the Personality Diagnostic Questionnaire-4, in addition to the Cyber-Pornography Use Inventory to explore the influence of their pornography use (interest, efforts to engage with pornography, and compulsivity) on their use of sexual coercion. This was measured using four subscales of the Postrefusal Sexual Persistence Scale: nonverbal sexual arousal, emotional manipulation and deception, exploitation of the intoxicated, and use of physical force or threats. Multiple regression analyses revealed that pornography use, narcissistic traits, and histrionic traits significantly predicted the use of nonverbal sexual arousal, emotional manipulation and deception, and exploitation of the intoxicated. Effort to engage with pornography was a significant individual predictor of nonverbal sexual arousal and emotional manipulation and deception, while histrionic traits were a significant individual predictor of exploitation of the intoxicated. Findings were discussed in relation to existing sexual coercion literature and potential future research.
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Literatura Erótica/psicologia , Transtorno da Personalidade Histriônica/prevenção & controle , Transtorno da Personalidade Histriônica/psicologia , Narcisismo , Adolescente , Adulto , Coerção , Feminino , Humanos , Pessoa de Meia-Idade , Comportamento Sexual/psicologia , Inquéritos e Questionários , Adulto JovemRESUMO
Post-finasteride syndrome (PFS) has been claimed to occur in men who have taken oral finasteride to treat either hair loss or benign prostatic hyperplasia, independent of age, dosage, or indication. By definition, the condition is characterized by sexual dysfunction, somatic symptoms, and psychological disorders that persist after cessation of finasteride treatment. As yet, the condition is not recognized by the medical community, although individuals who suffer from PFS present with relatively homogenous symptoms. The concept of PFS has emerged from reports of non-dermatologists, neuroendocrinological research and reflections, and uncontrolled studies of low quality and with a strong bias selection, while a significant nocebo effect among patients informed about possible side effects of finasteride is recognized. There are no predictive factors for the risk of development of PFS. Nevertheless, it has been suggested that a patient history of preexisting mental health disorder, particularly depression, may put patients at an increased risk. We report the first case of PFS in a long-standing (over 20 years) dermatotrichological practice with frequent finasteride prescription observed in a 25-year-old male following dutasteride treatment for male androgenetic alopecia. There was circumstantial evidence that PFS may represent a delusional disorder of the somatic type, possibly on a background of a histrionic personality disorder, which would explain the refractoriness of the condition and a high degree of suggestibility.
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Episodios de enfermedad psicógena masiva han ocurrido en entornos sociales diferentes, en todo el mundo, a lo largo de la historia de la humanidad. Cada vez los profesionales de la salud participan más en su atención y solución. Este trabajo presenta tres "casos" catalogados como tales, que el autor tuvo la oportunidad de asistir. Se realizan comentarios en cada uno de ellos y se actualizan conceptos sobre esta condición, que se expresa por los más variados síntomas en un grupo de personas ante un estrés intenso por supuestas amenazas, aunque no exista una razón física o ambiental para que se enfermen. Genera marcada tensión tanto en pacientes como en facultativos y en el público. Los médicos, y el personal sanitario en general, deben estar preparados para su adecuado diagnóstico y conducta a seguir.
Episodes of massive psychogenic disease have occurred in different social contexts, worldwide, throughout history. Every time health professionals participate more in their attention and solution. This work presents three ¨cases¨ classified as such, which the author had the opportunity to attend. There are, in this work comments, about each of them and concepts about this condition are updated; which is expressed by the most varied symptoms in a group of people facing intense stress due to supposed threatening even though there is no physical or environmental reason to get sick. It generates a marked tension in patients and doctors so as in the general public. Doctors and sanitary personnel should be prepared for its adequate diagnosis and conduct to follow.
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Humanos , Transtorno da Personalidade Histriônica/diagnóstico , Transtorno da Personalidade Histriônica/psicologia , Transtorno da Personalidade Histriônica/epidemiologiaRESUMO
Previous studies that aimed to support emotion recognition deficits and alexithymia in B cluster personality disorders have mainly focused on borderline personality disorder (BPD), and resulted in mixed findings. In our study we examine emotion recognition and alexithymia in patients with histrionic (HPD), narcissistic (NPD) and borderline (BPD) personality disorders compared to each other and healthy controls. Furthermore, the possibility is investigated that it is not the type of PD but the severity of psychopathology which predicts the severity of emotion recognition deficits and alexithymia. Patients with HPD, NPD, BPD and healthy controls (Nâ¯=â¯20 for each group) were examined by using the Ekman 60 Faces Test (FEEST) and the Toronto Alexithymia Scale (TAS-20). To measure the extent and severity of psychopathology, the Symptom-Checklist-90 Revised (SCL-90-R) was used. Patient groups performed significantly worse compared to healthy controls on the Ekman test and TAS-20, while we found no significant differences among patient groups in emotion recognition and alexithymia. Furthermore, higher scores on the SCL-90-R predicted poorer emotion recognition performance and higher alexithymic features. The empirical data supports the conclusion that the severity of psychopathology plays an important role in predicting emotion recognition deficits and alexithymia in borderline, narcissistic, and histrionic personality disorders.
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Sintomas Afetivos/fisiopatologia , Transtorno da Personalidade Borderline/fisiopatologia , Expressão Facial , Reconhecimento Facial/fisiologia , Transtorno da Personalidade Histriônica/fisiopatologia , Narcisismo , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Caso Clínico Paciente María R.A., 28 años, Escolaridad básica en programa diferencial, dueña de casa, Casada, 9 años de matrimonio. Su pareja tiene 62 años. Actualmente vive con esposo e hijo de 2 años, en Maipú. Durante 2016, María consultó en distintos servicios de urgencia, recibiendo distintos diagnósticos: Conversión, Síndrome conversivo. Se ingresa en Urgencia con diagnóstico: Síndrome Psicótico lúcido. Paciente en cama, sin movimientos espontáneos, con rigidez, mirada fija, deshidratada, no acepta alimentarse, negativista, no establece contacto visual, no responde preguntas simples, sin embargo, en forma espontánea puede permanecer hablando, dando cuenta de contenidos delirantes. El día de su ingreso a sector se inició terapia Electro convulsiva, y completó 5 sesiones. Tras la primera sesión paciente evoluciona favorablemente, se levanta de la cama, solicita agua, es capaz de comer. Síntomas psicóticos ceden tras la tercera sesión, señalando además no recordar nada de lo ocurrido. En entrevista de evolución paciente vigil, orientada TE, actitud parcialmente cooperadora. En cuanto a las psicosis histéricas en sí, es una psicosis aguda, de rápida curación cuando se las trata adecuadamente y Bleuler habla de los llamados estados crepusculares histéricos. La duda diagnóstica es entre un trastorno disociativo tipo psicosis histérica o bien un trastorno psicótico agudo, refiriéndose a trastornos de presunto origen disociativo con sintomatología que podríamos denominar pseudopsicótica. La CIE-10 clasifica las psicosis agudas no afectivas, como Trastornos psicóticos agudos y transitorios (TPAT), (Acute and Transient Psychotic Disorders (ATPD) en inglés), comparten las características comunes de inicio agudo dentro de dos semanas, y la presencia de síntomas psicóticos típicos. La descripción de TPAT fue influenciada por los conceptos de psicosis cicloide, bouffée délirante y psicosis reactiva. No es sorprendente, por lo tanto, que los ATPD de la CIE-10 (al menos diagnósticamente) sean un heterogéneo grupo de trastornos. Tanto los sistemas CIE como DSM se basan en síntomas, y descuentan los aspectos "no empíricos" del diagnóstico, que pueden constituir el «fenómeno" esencia de un trastorno psicótico. Actualmente, no existe una categoría de diagnóstico para definir individuos que están experimentando tal psicopatología y tienen un riesgo significativamente mayor de desarrollar esquizofrenia u otro desorden psicótico. Trastorno histriónico de la personalidad (HPD), como argumento aquí, no es una patología mental real; más bien, "histriónico" se refiere a un rasgo o grupo de rasgos de personalidad que podría conducir a algún otro trastorno mental.
Clinical case. Patient María R.A., 28 years old, Basic schooling in differential program, housewife, Married, 9 years of marriage. His partner is 62 years old. Currently lives with husband and 2 year old son in Maipú. During 2016, Maria consulted in different emergency services, receiving different diagnoses: Conversion and conversion syndrome. Urgency is entered with diagnosis: Syndrome Psychotic lucid. Patient in bed, without spontaneous movements, with rigidity, stare, dehydrated, does not accept to feed, negativist, does not establish visual contact, does not answer simple questions, however, spontaneously can remain talking, giving account of delusional contents. On the day of his admission to the sector, Electro Convulsive therapy was started, and he completed 5 sessions. After the first patient session he progresses favorably, gets up from bed, requests water, is able to eat. Psychotic symptoms give way after the third session, noting also not remember anything of what happened. In an evolution interview, vigil patient , oriented TE, partially cooperative attitude. As for hysterical psychoses per se, it is an acute, rapidly healing psychosis when properly treated and Bleuler speaks of so-called hysterical crepuscular states. The diagnostic doubt is between a dissociative disorder type hysterical psychosis or an acute psychotic disorder. referring to disorders of presumed dissociative origin with symptomatology that we could call pseudopsychotic. The ICD-10 classifies acute non-affective psychoses, as Acute and Transient Psychotic Disorders (ATPD), share the common characteristics of acute onset within two weeks, and the presence of typical psychotic symptoms. The description of ATPD was influenced by the concepts of cycloid psychosis, bouffée délirante and reactive psychosis. It is not surprising, therefore, that the ATPD of the ICD-10 (at least diagnostically) is a heterogeneous group of disorders. Both CIE and DSM systems are based on symptoms and discount the "non-empirical" aspects of diagnosis, which may constitute the "phenomenon" essence of a psychotic disorder. Currently, there is no diagnostic category to define individuals who are experiencing such psychopathology and have a significantly increased risk of developing schizophrenia or other psychotic disorder. Histrionic Personality Disorder (HPD), as an argument here, is not a real mental pathology; rather, "histrionic" refers to a trait or group of personality traits that could lead to some other mental disorder.
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Humanos , Feminino , Adulto , Transtornos Psicóticos/diagnóstico , Transtorno da Personalidade Histriônica/diagnóstico , Doença Aguda , HisteriaRESUMO
Previous research has shown that humor and self-presentation are linked in several ways. With regard to individual differences, it turned out that gelotophilia (the joy of being laughed at) and katagelasticism (the joy of laughing at others) are substantially associated with the histrionic self-presentation style that is characterized by performing explicit As-If-behaviors (e.g., irony, parodying others) in everyday interactions. By contrast, gelotophobia (the fear of being laughed at) shows a negative correlation with histrionic self-presentation. In order to further contribute to the nomological network, we have explored whether the three dispositions toward ridicule and laughter as well as histrionic self-presentation are related to humor creation abilities. In doing so, we have assessed the four constructs in a study with 337 participants that also completed the Cartoon Punch line Production Test (CPPT, Köhler and Ruch, 1993, unpublished). In the CPPT, subjects were asked to generate as many funny punch lines as possible for six caption-removed cartoons. The created punch lines were then analyzed with regard to quantitative (e.g., number of punch lines) and qualitative (e.g., wittiness of the punch lines and overall wittiness of the person as evaluated by three independent raters) humor creation abilities. Results show that both gelotophilia and histrionic self-presentation were positively correlated with quantitative and qualitative humor creation abilities. By contrast, gelotophobia showed slightly negative and katagelasticism no associations with the assessed humor creation abilities. These findings especially apply to the subgroup of participants that created punch lines for each of the six cartoons and partly replicate and extend the results of a previous study by Ruch et al. (2009). Altogether, the results of our study show that individual differences in humor-related traits are associated with the quantity and quality of humorous punch lines. It is argued that behavior-related or performative humor creation tasks should be considered in addition to the CPPT in order to open up new avenues that can cross-fertilize research on individual differences in humor and self-presentation.
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OBJECTIVE: Both normative personality and DSM-IV personality disorders have been found to be heritable. However, there is limited knowledge about the extent to which the genetic and environmental influences underlying DSM personality disorders are shared with those of normative personality. The aims of this study were to assess the phenotypic similarity between normative and pathological personality and to investigate the extent to which genetic and environmental influences underlying individual differences in normative personality account for symptom variance across DSM-IV personality disorders. METHOD: A large population-based sample of adult twins was assessed for DSM-IV personality disorder criteria with structured interviews at two waves spanning a 10-year interval. At the second assessment, participants also completed the Big Five Inventory, a self-report instrument assessing the five-factor normative personality model. The proportion of genetic and environmental liabilities unique to the individual personality disorder measures, and hence not shared with the five Big Five Inventory domains, were estimated by means of multivariate Cholesky twin decompositions. RESULTS: The median percentage of genetic liability to the 10 DSM-IV personality disorders assessed at wave 1 that was not shared with the Big Five domains was 64%, whereas for the six personality disorders that were assessed concurrently at wave 2, the median was 39%. Conversely, the median proportions of unique environmental liability in the personality disorders for wave 1 and wave 2 were 97% and 96%, respectively. CONCLUSIONS: The results indicate that a moderate-to-sizable proportion of the genetic influence underlying DSM-IV personality disorders is not shared with the domain constructs of the Big Five model of normative personality. Caution should be exercised in assuming that normative personality measures can serve as proxies for DSM personality disorders when investigating the etiology of these disorders.
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Doenças em Gêmeos/genética , Transtornos da Personalidade/genética , Personalidade/genética , Adulto , Manual Diagnóstico e Estatístico de Transtornos Mentais , Doenças em Gêmeos/psicologia , Estudos de Associação Genética , Predisposição Genética para Doença/genética , Humanos , Masculino , Transtornos da Personalidade/diagnóstico , Transtornos da Personalidade/psicologia , Inventário de Personalidade , Gêmeos Dizigóticos/genética , Gêmeos Dizigóticos/psicologia , Gêmeos Monozigóticos/genética , Gêmeos Monozigóticos/psicologiaRESUMO
Previous research has shown that antisocial, borderline, narcissistic and histrionic personality disorders, also known as the Cluster B personality disorders in the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5), are commonly raised in lawsuits. Cluster B disorders are characterized by problems with emotion regulation, impulsivity and interpersonal conflicts. Without question, individuals diagnosed with a Cluster B disorder possess traits that make them more susceptible to becoming involved in litigation; however, to date there has been no research on how the disorders interact with the judicial system. This study surveyed litigant success of Cluster B personality disorders in United States federal and state case law. Results showed that both criminal and civil litigants tended to be unsuccessful in their cases. Overall, this study demonstrated that court opinions can provide a window into the psychology of trial litigants and how personality can affect trial outcomes.
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BACKGROUND: Evidence concerning the determinants of vaginismus (V), in particular medical conditions, is inconclusive. AIM: To investigate, in a cohort of subjects consulting for female sexual dysfunction, whether there is a difference in medical and psychosocial parameters between women with V and women with other sexual complaints. METHODS: A series of 255 women attending our clinic for female sexual dysfunction was consecutively recruited. V was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria. Lifelong and acquired V cases were included. OUTCOMES: Patients underwent a structured interview and physical, gynecologic, laboratory, and clitoral ultrasound examinations; they completed the Female Sexual Function Index (FSFI), the Middlesex Hospital Questionnaire, the Female Sexual Distress Scale-Revised (FSDS), and the Body Uneasiness Test. RESULTS: V was diagnosed in 20 patients (7.8%). Women with V were significantly younger than the rest of the sample (P < .05). No differences were found for traditional risk factors such as a history of sexual abuse, relational parameters, or gynecologic diseases or for newly investigated parameters (ie, neurologic, hormonal, and metabolic alterations). Women with V showed significantly higher histrionic-hysterical symptoms and traits (as detected by MHQ-H score; P < .05) compared with subjects with other sexual complaints. When the scores of all MHQ subscales were simultaneously introduced in a logistic model, the association between V and MHQ-H score was confirmed (P = .013). Women with V also showed higher FSFI pain and FSDS total scores, even after adjusting for age (P < .05). In an age-adjusted model, FSDS total score increased as a function of the years of duration of V (P = .032) but not as a function of its severity. All observations were confirmed in a case-control study (ratio = 1:3). CLINICAL IMPLICATIONS: Our data demonstrate that some novel contributors of V should be investigated, namely histrionic-hysterical traits. This psychological comorbidity could offer valuable insights for intervention and managing complications. STRENGTHS AND LIMITATIONS: This is the first study to assess the role of many metabolic and hormonal parameters as potential determinants of V. The main limitation is its exploratory and cross-sectional nature; our data need to be confirmed in larger, more systematic analyses. CONCLUSION: V was associated with histrionic-hysterical traits, FSFI pain domain, and sex-related distress. A history of abuse, relational parameters, gynecologic diseases, and hormonal and metabolic alterations do not seem to play a role in the development of V. Maseroli E, Scavello I, Cipriani S, et al. Psychobiological Correlates of Vaginismus: An Exploratory Analysis. J Sex Med 2017;14:1392-1402.