Identity disturbance in personality disorders.

We explored identity disturbance and some of its correlates and antecedents in patients with personality disorder (PD) pathology. A group of inpatients who all were diagnosed as PD on self-reports were divided as those with (28 patients) and without (62 patients) identity disturbance on the basis of the DSM-III-R borderline PD identity item criterion. The division of the patients was tested and found to be valid. Both groups were compared with each other. Seventy-five percent of patients with and 34% of patients without identity disturbance received the definite interview diagnosis of PD. The syndrome of identity disturbance was encountered in basically all PD types. In contrast, half of all patients with PD presented no identity disturbance. Identity disturbance did not predispose to specific axis I disorders and suicidal behavior, and it was not correlated convincingly with childhood traumatic experiences and parental bonding scores. The results neither support the DSM conceptualization of identity disturbance as an exclusive characteristic of borderline PD, nor the Kernberg's concept of identity disturbance as an essential of borderline personality organization which should be found in almost all PD types.

Possible antecedents of DSM-III-R personality disorders.

In order to extend our knowledge of the effects of environmental influences upon personality disorder (PD) pathology, childhood traumatic events and parental bonding were studied in 90 PD in-patients of both sexes. Childhood traumatic experiences (primarily physical and/or sexual abuse) and parental bonding dimensions were correlated with PD pathology depending on PD type and cluster. Important differences were found between the sexes. The quality of the paternal relationship (high control, low care) was significantly associated with PD pathology in men, whereas childhood traumatic experiences and the quality of maternal parenting were associated with PD pathology in women. The study of traumatic events such as childhood abuse has recently been the focus of considerable attention. More emphasis in empirical research needs to be given to parental relationships, especially in the case of men.

Possible correlates of DSM-III-R personality disorders.

An association between personality disorder (PD) pathology, including symptoms of all PD types and Axis I disorders, and suicidal behaviour was studied in a series of 90 non-schizophrenic, non-bipolar in-patients of both sexes without mental retardation or organic brain syndrome. All of these patients, who scored positively on the SCID-II-PQ, were interviewed with the PDE and SCID-P, and with the Structured interview for the study of childhood trauma provided with supplementary items reflecting suicidal behaviour. Mood disorders were found to be significantly correlated with cluster C pathology (PD pathology always being expressed by dimensional PDE scores) and eating disorders were significantly correlated with cluster B pathology in women. Psychoactive substance use disorders were mainly correlated with cluster B pathology and anxiety disorders with cluster C pathology in both sexes. Suicidal behaviour was correlated with PD pathology of all clusters in women, but not in men. In women a strong correlation was found between suicidal behaviour and history of childhood trauma, especially sexual abuse. The results of this study indicate that there is some specificity with regard to the Axis I/Axis II association, more so in relation to PD clusters than in relation to the individual PD types. However, the relationships between PD pathology and Axis I disorders and suicidal behaviour are complex, and they differ between the sexes.