Associations between personality disorders and cannabis use and cannabis use disorder: a population-based twin study.

BACKGROUND AND AIMS: Individual differences in DSM-IV personality disorders (PDs) are associated with increased prevalence of substance use disorders. Our aims were to determine which combination of PDs trait scores best predict cannabis use (CU) and cannabis use disorder (CUD), and to estimate the size and significance of genetic and environmental risks in PD traits shared with CU and CUD. DESIGN: Linear mixed-effects models were used to identify PD traits for inclusion in twin analyses to explore the genetic and environmental associations between the traits and cannabis use. SETTING: Cross-sectional data were obtained from Norwegian adult twins in a face-to-face interview in 1999-2004 as part of a population-based study of mental health. PARTICIPANTS: Subjects were 1419 twins (µage  = 28.2 years, range = 19-36) from the Norwegian Institute of Public Health Twin Panel with complete PD and cannabis data. MEASUREMENTS: PD traits were assessed using DSM-IV criteria. Life-time CU and CUD were based on DSM-IV abuse and dependence criteria, including withdrawal and craving. FINDINGS: After adjusting for age and sex, antisocial [ß = 0.23, 95% confidence interval (CI) = 0.19-0.28] and borderline PDs (ß = 0.20, 95% CI = 0.14-0.26) were associated strongly with CU. Antisocial (ß = 0.26, 95% CI = 0.21-0.31) and borderline PDs (ß = 0.12, 95% CI = 0.06-0.18) were also linked strongly to CUD. Genetic risks in antisocial and borderline PD traits explained 32-60% of the total variance in CU and CUD. Dependent and avoidant PDs explained 11 and 16% of the total variance in CU and CUD, respectively. CONCLUSIONS: Individual differences in the liability to cannabis use and cannabis use disorder appear to be linked to genetic risks correlated with antisocial and borderline personality disorder traits.

Personality Disorders in Primary Care: Impact on Depression Outcomes Within Collaborative Care.

BACKGROUND: Individuals with personality disorders (PDs) are high utilizers of primary care and mental health services; however, they struggle to utilize the care effectively and studies have shown a strong association between having a PD and higher impairment in social role functioning. This is especially important because PDs are highly comorbid with a wide range of other mental health disorders. The collaborative care model (CCM) for depression was developed with an emphasis on patient engagement and aimed to reduce health care utilization, while improving treatment outcomes in primary care. We hypothesized that the diagnosis of a personality disorder in primary care patients will negatively affect 6-month depression outcomes after enrollment into a CCM. METHODS: This retrospective chart review study was conducted on patients enrolled into CCM over a period of 7 years with collection of 6-month follow-up data. A total of 2826 patients were enrolled into CCM with a clinical diagnosis of depression and a baseline Patient Health Questionnaire-9 (PHQ-9) ≥10 were included in the study cohort. Using the depression database, baseline and 6-month follow-up data were obtained. Adjusted odds ratios (AORs) were determined for both remission and persistent depressive symptoms using logistic regression modeling for the 6-month PHQ-9 outcome; while retaining all the study variables. RESULTS: Of the 2826 CCM patients with depression in our study, 216 (7.6%) were found to have a PD. Patients with PD were younger (37.7 vs 42.5 years, P < .001) and more likely to be unmarried (36.1% vs 55.6%, P < .001) than patients without a PD. While age, marital status, clinical diagnosis, and Mood Disorders Questionnaire (MDQ) score were significant predictors of remission; anxiety symptoms, gender, and race were not. The presence of a PD diagnosis was associated with a 60% lower likelihood of remission at 6 months (AOR = 0.39; 95% CI 0.28-0.54). Conversely, patients without a PD were 2.5 times as likely to experience remission at 6-month remission compared to patients with PD (AOR =2.57; 95% CI 1.85-3.56). CONCLUSION: Patients with a personality disorder were more likely to have a recurrent depressive disorder diagnosis, an abnormal MDQ score, increased anxiety symptoms, and higher baseline PHQ-9 score. Patients with PD had worse CCM outcomes at 6 months with only 25.0% able to achieve remission versus 54.3% ( P < .001) without a PD. The presence of a PD with depression was associated with poor outcomes (reduced remission rates and increased persistent depressive symptoms rates) in comparison to patients without a diagnosis of PD, while treated within CCM.

Beyond passivity: Dependency as a risk factor for intimate partner violence.

Interpersonal dependency in male perpetrators of intimate partner violence (IPV) is an understudied phenomenon but one that has noteworthy clinical implications. The present investigation used meta-analytic techniques to quantify the dependency-IPV link in all extant studies examining this relationship (n of studies = 17). Studies were gathered via an extensive literature search using relevant dependency/IPV search terms in the PsychInfo, Medline and Google Scholar databases. Results revealed a small but statistically significant relationship between dependency and perpetration of IPV in men (r = 0.150, Combined Z = 4.25, p < 0.0001), with the magnitude of the dependency-IPV link becoming stronger (r = 0.365, Combined Z = 6.00, p < 0.0001) when studies using measures of dependent personality disorder symptoms were omitted. Other moderators of the dependency-IPV effect size included IPV measure, type of sample and perpetrator age. These findings illuminate the underlying dynamics and interpersonal processes involved in some instances of IPV and may aid in understanding how to identify and treat male perpetrators of domestic violence.

Indirect self-destructiveness in homosexual individuals.

OBJECTIVES: The aim of this study was to comprehensively examine the syndrome of indirect self-destructiveness in homosexual individuals. METHODS: 156 homosexual individuals (111 males, 45 females) aged 25-35 (mean age of 29.6) and 561 heterosexual individuals (400 males, 161 females) aged 24-36 (mean age of 28.2) were studied with regard to indirect self-destructiveness. The research instrument was the Polish version of the Chronic Self-Destructiveness Scale (CS-DS) including: Transgression and Risk (A1), Poor Health Maintenance (A2), Personal and Social Neglects (A3), Lack of Planfulness (A4) and Helplessness and Passiveness in the face of problems (A5). RESULTS: Homosexual individuals obtained significantly higher scores than heterosexual ones in numerous scales: Indirect Self-Destructiveness - global (general) index (p<0.001), A1-Transgression and Risk (p<0.001), A4-Lack of Planfulness (p<0.001) and A5-Helplessness, Passiveness (p=0.04) There were no significant differences in the Poor Health Maintenance scale (A2). They also achieved significantly higher scores in the subscales assessing using of psychoactive substances. Factor analysis revealed the presence of only one factor both in the group of homosexual and heterosexual individuals. CONCLUSIONS: The research results indicate that, as compared with the group of heterosexual individuals, in the group of homosexuals there occurs a worsening in psychological functioning, which may be also manifested by an increased indirect self-destructiveness index. The increased intensity of indirect self-destructiveness in homosexual individuals may be considered a manifestation of worsened psychological functioning. The homosexual individuals look after their health similarly to heterosexuals.

Alcohol-Dependent Subjects Show Different Personality Traits Compared With Subjects With Multiple Substance Dependence: Preliminary Data.

METHODS: We compared personality traits of 27 persons with multiple substance dependence with personality data of 52 alcohol-dependent persons regarding their personality traits and disorders (obtained by using SCID-II, TCI and NEO FFI). Both patient groups were free of any other mental disorder. RESULTS: In SKD-II, we found significant differences in the male group in dependent and scizotypic personality disorder. There were no significant differences in the female group, but sample was very small. We also found significant differences between alcohol-dependent and multiple substance-dependent persons in extraversion and novelty seeking. CONCLUSIONS: We detected significant differences in personality disorders evaluated by SCID-II. Temperament and character items­as evaluated by NEO FFI and TCI­showed also significant differences in personality traits. Given the limited number of subjects, the data should be regarded as preliminary until replicated in a larger sample. Nevertheless, the findings may be of clinical relevance with respect to prognosis or individualized treatment. These findings should be treated with caution until replicated.

Dependent personality disorder: a critical review.

Dependent personality disorder (DPD) has evolved from an abstract idea rooted in a historic and psychoanalytic context to a codified diagnosis in the DSM-IV-TR. This comprehensive review paper chronicles the evolution of DPD through each version of the DSM. Major topics relevant to the disorder are also investigated, including gender and cultural considerations, stability and manifestations of DPD across different developmental stages, comorbidity issues, and others. The purpose of this review is to provide a broad yet comprehensive examination of the complex angles of maladaptive dependency and to identify essential next steps in furthering our knowledge of this disorder. The paper concludes with a discussion of shortcomings in the body of research relevant to DPD, along with specific suggestions for improvement in this field of study.

Measuring IPDE-SQ personality disorder prevalence in pre-sentence and early-stage prison populations, with sub-type estimates.

Understanding the prevalence and type of personality disorder within prison systems allows for the effective targeting of resources to implement strategies to alleviate symptoms, manage behaviour and attempt to reduce re-offending. This study aimed to determine the prevalence of personality disorder (PD) traits within a local urban high-turnover adult male prison with a remand/recently sentenced population in London, UK. The International Personality Disorder Examination - Screening Questionnaire (IPDE-SQ) self-administered questionnaire (ICD-10 version) was completed by 283 prisoners (42% completion rate). 77% of respondents reached the threshold for one or more PDs. The most common PD types were Paranoid PD (44.5%), Anankastic PD (40.3%), Schizoid PD (35%) and Dissocial PD (25.8%). These results confirm and extend existing knowledge regarding the prevalence of PD in prison populations into a high-turnover, urban, remand population. The stark comparison with community samples indicates that a more equitable standard of service delivery within the criminal justice system, focussing on preventive and early intervention services, is now required.

Influence of dependent personality status on the outcome and health service costs of health anxiety.

OBJECTIVE: To assess the effect of dependent personality disturbance as an influence on the cost and clinical outcome of health anxiety. METHOD: In the course of a randomized trial of treatments for patients with high health anxiety over 12 months, we also recorded dependent personality status by two methods: the Personality Assessment Schedule (an observer-rated instrument) and the self-rated Dependent Personality Questionnaire (DPQ), the latter being administered at baseline, six months and 12 months. The two main hypotheses tested were that patients with dependent personality features would have a worse outcome and attract greater health service costs. RESULTS: Forty-nine patients took part in the trial; all had baseline dependent personality data, 44 provided health service costs, and 38 had observer-rated personality assessments. At baseline patients with any personality disorder had higher clinical ratings for health anxiety, and dependent personality disturbance, mainly in the form of personality difficulty, was associated with a worse outcome than those without dependent personalities after correction for baseline differences. The DPQ at a score of 15 successfully identified all patients with dependent personality disorder in both ICD and DSM classifications and showed a significant but relatively modest reduction in scores of 1.5 (13%) during the course of the 12-month trial. Costs in those separated by personality status showed those with dependent personality incurred 45% more health service costs than those without these personality characteristics (p = .10). No patient with dependent personality disorder dropped out of treatment compared with 6 out of 38 (16%) of those with no dependence. CONCLUSIONS: The DPQ is probably a reliable instrument for assessing dependent personality characteristics without the need for interview and its scores, unlike many ratings of personality, are stable over time. The findings may have been influenced by different responses to those treated in the trial with cognitive behaviour therapy compared with control treatment.

Homicidal behaviour among people with avoidant, dependent and obsessive-compulsive (cluster C) personality disorder.

BACKGROUND: Despite a growing forensic psychiatry literature, no previous study has examined in detail homicidal behaviour among offenders with cluster C personality disorders - the avoidant, dependent or obsessional personality disorders. AIMS: This study aims to compare homicide offenders with cluster C personality disorders with those with other personality disorders on criminal history, offender-victim relationship and post-offence reaction variables. METHODS: The sample was drawn from all Finnish homicide cases of 1996-2004 for whom a forensic psychiatric evaluation had been conducted. Data were extracted from forensic psychiatric and crime reports. RESULTS: In a nationwide sample of 593 homicide offenders, 21 had at least one cluster C personality disorder. These offenders had significantly shorter criminal histories than the others. Offender-victim relationship did not differ between the groups, but confession to the crime and feelings of remorse were more common among people with cluster C disorders. In addition, compared with other personality disorder clusters, co-morbid depression was more common. CONCLUSIONS: Cluster C personality disorders are rare, but not nonexistent, among homicide offenders. Observed differences in their backgrounds and post-offence behaviours indicate that they may have special needs.

The heritability of avoidant and dependent personality disorder assessed by personal interview and questionnaire.

OBJECTIVE: Personality disorders (PDs) have been shown to be modestly heritable. Accurate heritability estimates are, however, dependent on reliable measurement methods, as measurement error deflates heritability. The aim of this study was to estimate the heritability of DSM-IV avoidant and dependent personality disorder, by including two measures of the PDs at two time points. METHOD: Data were obtained from a population-based cohort of young adult Norwegian twins, of whom 8045 had completed a self-report questionnaire assessing PD traits. 2794 of these twins subsequently underwent a structured diagnostic interview for DSM-IV PDs. Questionnaire items predicting interview results were selected by multiple regression, and measurement models of the PDs were fitted in Mx. RESULTS: The heritabilities of the PD factors were 0.64 for avoidant PD and 0.66 for dependent PD. No evidence of common environment, that is, environmental factors that are shared between twins and make them similar, was found. Genetic and environmental contributions to avoidant and dependent PD seemed to be the same across sexes. CONCLUSION: The combination of both a questionnaire- and an interview assessment of avoidant and dependent PD results in substantially higher heritabilities than previously found using single-occasion interviews only.

Effects of personality disorder and impulsivity on emotional adaptations in prison among women offenders.

The present study sought to better understand the influence of personality disorders and impulsivity on women's ability to adapt to incarceration. We analyzed the influence of personality disorders as screened with the structured clinical interview for personality disorders, and impulsivity as assessed with the Barratt impulsivity scale on depression and anxiety, sleeping problems, and feeling afraid of being attacked in prison among a large sample of women incarcerated in a Virginia prison. Results from regression models indicated that schizotypal, borderline, avoidant and dependent personality disorders and cognitive impulsivity were significant predictors of symptoms of anxiety and depression net of demographic covariates. Women possessing a diagnosis of paranoid personality disorder were at increased odds of having difficulty sleeping in prison and borderline, dependent, and paranoid personality disorder were at increased odds of experiencing fear in prison. Women who had been in prison before were significantly less likely to experience these problems. Implications of study findings for policies and practices involving women offenders are discussed.

Separation anxiety disorder in OCD.

BACKGROUND: A history of separation anxiety disorder (SAD) is frequently reported by patients with obsessive-compulsive disorder (OCD). The purpose of this study was to determine if there are clinical differences between OCD-affected individuals with, versus without, a history of SAD. METHODS: Using data collected during the OCD Collaborative Genetic Study, we studied 470 adult OCD participants; 80 had a history of SAD, whereas 390 did not. These two groups were compared as to onset and severity of OCD, lifetime prevalence of Axis I disorders, and number of personality disorder traits. RESULTS: OCD participants with a history of SAD were significantly younger than the non-SAD group (mean, 34.2 versus 42.2 years; P<.001). They had an earlier age of onset of OCD symptoms (mean, 8.0 versus 10.5 years; P<.003) and more severe OCD, as measured by the Yale-Brown Obsessive Compulsive Scale (mean, 27.5 versus 25.0; P<.005). In addition, those with a history of SAD had a significantly greater lifetime prevalence of agoraphobia (odds ratio (OR) = 2.52, 95% confidence interval (CI) = 1.4-4.6, P<.003), panic disorder (OR = 1.84, CI = 1.03-3.3 P<.04), social phobia (OR = 1.69, CI 1.01-2.8, P<.048), after adjusting for age at interview, age at onset of OCD, and OCD severity in logistic regression models. There was a strong relationship between the number of dependent personality disorder traits and SAD (adjusted OR = 1.42, CI = 1.2-1.6, P<.001). CONCLUSIONS: A history of SAD is associated with anxiety disorders and dependent personality disorder traits in individuals with OCD.

Dependent personality disorder and physical abuse.

The aim of this study was to test the hypothesis that the likelihood of physical spousal abuse is increased in dependent personality disorder (DPD) compared to other personality disorders. The sample consisted of 305 subjects consecutively admitted to an outpatient department of legal medicine for physical abuse. Using the Structured Clinical Interview for Disorders, screen questionnaire (SCID-II-SQ), the subjects were divided into three groups: without personality disorders (WPD, N=108), with non-dependent personality disorders (NDPD, N=179) and with DPDs (DPD, N=18). First,, the three groups were compared to the rate of spouses among the perpetrators. The rate of spouses among the perpetrators was significantly different between the three groups: 44.4% of the perpetrators were the spouse for DPD subjects versus 11.2% for WPD and 20.1% for NDPD. Second, logistic regressions using the status of perpetrators (spouse or others) as dependent variable and socio-demographical variables as well as the rates of DPD, avoidant, obsessive-compulsive and borderline personality disorders as independent variables reported that these four disorders of personality were significant predictors. Moreover, the co-morbidities of DPD with avoidant, obsessive-compulsive or borderline personality disorders were higher than 50%. These results suggest first that DPD subjects are at high risk of physical abuse by their spouses and second that this relationship was found also for the two other cluster C personality disorders as well as for borderline personality disorder.

A population-based longitudinal study of risk factors for suicide attempts in major depressive disorder.

No longitudinal study has examined risk factors for future suicide attempts in major depressive disorder in a nationally representative sample. The objective of this study was to investigate baseline sociodemographic characteristics, comorbid mental disorders, specific depressive symptoms, and previous suicidal behavior as potential risk factors for suicide attempts at 3 years follow-up. Data came from the national epidemiologic survey on alcohol and related conditions (NESARC), a large nationally representative longitudinal survey of mental illness in adults [Wave 1 (2001-2002); Wave 2 (2004-2005) n=34,653]. Logistic regression examined associations between risk factors present at Wave 1 and suicide attempts at Wave 2 (n=169) among individuals with major depressive disorder at baseline assessment (n=6004). Risk factors for incident suicide attempts at Wave 2 (n=63) were identified among those with major depressive disorder at Wave 1 and no lifetime history of suicide attempts (n=5170). Results revealed specific comorbid anxiety, personality, and substance use disorders to be associated with incident suicide attempts at Wave 2. Comorbid borderline personality disorder was strongly associated with suicide attempts in all models. Several comorbid disorders were strongly associated with suicide attempts at Wave 2 even after adjusting for previous suicidal behavior, notably posttraumatic stress disorder (adjusted odds ratio (AOR)=2.20; 95% confidence interval (95% CI) 1.27-3.83) and dependent personality disorder (AOR=4.43; 95% CI 1.93-10.18). These findings suggest that mental illness comorbidity confers an increased risk of future suicide attempts in major depressive disorder that is not solely accounted for by past suicidal behavior.

Trastornos de personalidad y edad: Estudio con personas sin hogar / Personality diseases and age: A study with homeless

En este estudio se lleva a cabo una investigación sobre trastornos de personalidad en personas sin hogar y su relación con la edad. El objetivo era analizar si existe relación entre edad y trastorno de personalidad padecido por el sujeto. Para ello, se realizó un estudio ex post facto, de carácter prospectivo, con una muestra de personas sin hogar en un proceso de inserción (N=77) a las que se aplicó una entrevista semiestructurada y el Inventario Clínico Multiaxial de Millon (Millon, 1997). Los resultados muestran como el trastorno antisocial es el más presente en el global de la muestra (35,06%), siendo de mayor prevalencia en menores de 30 años (52,63%), disminuyendo su presencia conforme avanza la edad del sujeto; además, se da una alta presencia del trastorno dependiente entre los 30 y 49 años (38,46%); y el trastorno narcisista aumenta conforme lo hace la edad del sujeto, hasta alcanzar el 66% en mayores de 50 años. Por último, se analizan las implicaciones del estudio en la práctica clínica y futuras líneas de investigación(AU)

In this study, carried out a research on personality disorders in homeless people and their relationship with age. The objective was to analyze whether there is relationship between age and personality disorder suffered by the subject. To do this, a study ex post facto, future-oriented, with a sample of homeless people in a process of integration (N = 77) to which they applied a semistructured interview and Inventory Millon Clinical Multiaxial (Millon, 1997). The results show how the disorder is the most antisocial present in the overall sample (35.06%), being most prevalent in children under 30 years (52.63%), decreasing their presence disappear with the age of the subject and, there is a high incidence of the disorder dependent between 30 and 49 years (38.46%) and the narcissistic disorder increases as does the subject's age, reaching 66% in people older than 50 years. Finally, discusses implications of the study in clinical practice and future research (AU)

[Clinical personality trait differences in the maintenance of abstinence and in relapses in the treatment of smoking cessation]. / Diferencias de rasgos clínicos de personalidad en el mantenimiento de la abstinencia y recaídas en tratamiento del tabaquismo.

Clinical personality trait differences in the maintenance of abstinence and in relapses in the treatment of smoking cessation. The aim of this study is to describe and compare personality characteristics of participants who quit smoking voluntarily by means of group treatment. The assessment instrument used was the Millon Clinical Multiaxial Inventory (MCMI). It was administered to a sample of 105 persons in Málaga (Spain) in The Spanish Cancer Association (Asociación Española Contra el Cáncer). The analysis consisted of comparing two sample groups: abstinence and relapse. The results revealed a higher rate of avoidant, masochistic and negativistic clinical personality traits in the relapse group. However, people with dependent personality traits maintained abstinence. There were also differences, in the direction of more relapses, in schizotypal and borderline personality disorders. This suggests that certain personality traits could be risk factors for relapse, whereas others increase the probability of success in the process of smoking cessation.

Healthy and unhealthy dependence: implications for major depression.

OBJECTIVES: To examine the contribution of varying levels of dependency to Axis I and Axis II disorders, and to the recurrence of major depression in a graduate student sample diagnosed with a history of the disorder. METHODS: At Time 1, participants were interviewed to confirm a current or past episode of major depression along with the presence of Axis II and other current or past Axis I disorders. Various measures of dependency were administered including the Depressive Experiences Questionnaire (DEQ; Blatt, D'Afflitti, & Quinlan, 1976), the 3-Vector Dependency Inventory (3VDI; Pincus & Gurtman, 1995), and the Personal Style Inventory (PSI; Robins et al., 1994). Participants were interviewed 20 months later to determine the recurrence of a depressive episode. RESULTS: A factor analysis conducted on scale scores for each dependency measure resulted in three factors labelled 'unhealthy', 'intermediate', and 'healthy' dependence. Controlling for history of major depression, structural equation modelling found 'unhealthy' dependence to be the only predictor of recurrences of major depression and Axis II disorders, while 'healthy' dependence was related to fewer depressive symptoms. CONCLUSIONS: These results have important implications for the conceptualization of the dependency construct.

Integrated therapy for complex cases of personality disorder.

In this article, the author presents and illustrates the treatment of a patient with dependent and borderline personality disorders and other maladaptive traits using an integrated and eclectic approach tailored to the patient's psychopathology and personality. Interventions are selected where possible based on evidence of what works. However, because empirical evidence on treatment efficacy for personality disorder is limited, interventions were often selected based on a rational analysis of the most effective way to treat a given problem. The delivery of an eclectic array of interventions was integrated and coordinated through an emphasis on generic methods and on a phases of change model that targets symptoms and problems in a systematic way based on evidence of the stability of symptoms and personality.

Psychiatric comorbidity in chronic disabling occupational spinal disorders has minimal impact on functional restoration socioeconomic outcomes.

STUDY DESIGN: A prospective study conducted at a tertiary functional restoration center for patients with chronic disabling occupational spinal disorders (CDOSDs), comparing treatment outcome status 1-year posttreatment of patients with specific diagnosed psychiatric disorders to those without. OBJECTIVE: To evaluate if diagnosed psychopathology is a significant limiting factor in the successful interdisciplinary rehabilitation of CDOSD patients. SUMMARY OF BACKGROUND DATA: Research has demonstrated high prevalence rates of psychiatric disorders in patients with CDOSDs. Little is known about whether these disorders are associated with less successful treatment outcomes. METHODS: A consecutive group of CDOSD patients (n = 1323) averaging 19 months of prerehabilitation disability were evaluated for psychiatric disorders with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Patients participated in a functional restoration program. A structured clinical interview addressing work status, recurrent injury, healthcare utilization, and financial claims closure was administered 1 year after discharge. Logistic regression analyses were conducted to determine the unique contribution of the specific DSM-IV disorders that were significantly associated with the outcomes. RESULTS: Patients with panic disorder, antisocial personality disorder (PD) and dependent PD were >2 times more likely to be program noncompleters. For successful program completers, those with opioid dependence disorder (ODD) were 2.7 times less likely to return to work and 2.6 times less likely to retain work. Patients with ODD were also 2.1 times more likely to seek postrehabilitation treatment from a new provider. CONCLUSIONS: Despite intensive management of psychiatric disorders during interdisciplinary functional restoration for CDOSD, several disorders were found to be associated with less successful outcomes. Poorer work outcomes were more common with specific (and comorbid) Axis I psychiatric disorders. Opioid dependence was the single disorder associated most often with less successful outcomes. Despite these findings, the large majority of patients demonstrated successful outcomes. Depression did not independently link to less successful outcomes.

Longitudinal studies of personality disorders: four lessons from personality psychology.

The three longitudinal projects described in this special section of the Journal of Personality Disorders raise a number of intriguing questions concerning the natural history of personality disorders and offer more than their share of surprises. In addition, they underscore several valuable lessons derived from the literature on normal-range personality traits. Drawing in part from the writings of the American trait psychologist Gordon Allport, I describe four such lessons: (1) change and continuity of personality traits and disorders can and do coexist, (2) the covariation among personality traits helps to account for the "comorbidity" among personality disorders, (3) personality traits and disorders influence how individuals interpret life events, and (4) personality traits must be distinguished from behavioral adaptations to these traits. These lessons remind us that the science of personality disorders must be informed by the basic science of personality.