Borderline, where are you? A psychometric approach to the personality domains in the International Classification of Diseases, 11th Revision (ICD-11).

The inclusion of the borderline pattern in the International Classification of Diseases, 11th Revision (ICD-11) dimensional classification of personality disorders (PDs) has caused controversy. Unease about leaving out these clinically challenging patients seems to conflict with the need of an evidence-based and credible diagnostic system. However, the accommodation of borderline within the new diagnostic system has not yet been studied in depth. To this end, we examine in a sample of 1799 general population and clinical subjects the joint structure of the five initial ICD-11 domains and the borderline pattern. Regression and item-level factor analyses reveal that borderline criteria do not form a separate construct and are indissociable from negative affectivity. Furthermore, borderline adds nothing to the remaining domains when it comes to predict PD severity. The borderline pattern appears as largely superfluous and even misguiding, unless their criteria are properly integrated within the structure of personality pathology. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Psychiatric and Psychosocial Characteristics of a Cohort of Spanish Individuals Attending Genetic Counseling Due to Risk for Genetically Conditioned Dementia.

Background: Predictive genetic tests are presently effective over several medical conditions, increasing the demand among patients and healthy individuals. Considering the psychological burden suspected familial dementia may carry on individuals, assessing personality, coping strategies, and mental health could aid clinicians in findings the appropriate time for delivering genetic test results and predict compliance regarding genetic counseling and expectations towards the genetic condition depending on the outcome. Objective: To describe the psychiatric, psychological, and coping characteristics of a sample of Spanish individuals at risk of familial dementia before genetic test results were given. Methods: We included 54 first degree relatives of patients diagnosed with Alzheimer's disease, lobar frontotemporal degeneration, or prion diseases. The NEO-FFI-R, COPE, and HADS tests evaluated personality, coping strategies, and psychological distress, respectively. Results: Anxiety and depression were below the cut-off point for mild severity. Conscientiousness and Agreeableness were the most preponderant personality factors, while Neuroticism was the least. Positive reinterpretation and Acceptance were the most frequent coping strategies, and Denial and Alcohol and drug use were the least used. Ongoing medical pathologies increased depression, while psychiatric disorders worsened psychological distress. Conclusion: Contrary to our expectations, PICOGEN candidates showed psychological distress and personality traits within normative ranges, and the use of problem-focused coping strategies prevailed over avoidance coping strategies. Nevertheless, clinicians should pay particular attention to individuals attending genetic counseling who are women, aged, and present an ongoing psychiatric disorder and psychiatric history at inclusion to ensure their mental health and adherence throughout the process.

A Double-Track Pathway to Fast Strategy in Humans and Its Personality Correlates.

The fast-slow paradigm of life history (LH) focuses on how individuals grow, mate, and reproduce at different paces. This paradigm can contribute substantially to the field of personality and individual differences provided that it is more strictly based on evolutionary biology than it has been so far. Our study tested the existence of a fast-slow continuum underlying indicators of reproductive effort-offspring output, age at first reproduction, number and stability of sexual partners-in 1,043 outpatients with healthy to severely disordered personalities. Two axes emerged reflecting a double-track pathway to fast strategy, based on restricted and unrestricted sociosexual strategies. When rotated, the fast-slow and sociosexuality axes turned out to be independent. Contrary to expectations, neither somatic effort-investment in status, material resources, social capital, and maintenance/survival-was aligned with reproductive effort, nor a clear tradeoff between current and future reproduction was evident. Finally, we examined the association of LH axes with seven high-order personality pathology traits: negative emotionality, impulsivity, antagonism, persistence-compulsivity, subordination, and psychoticism. Persistent and disinhibited subjects appeared as fast-restricted and fast-unrestricted strategists, respectively, whereas asocial subjects were slow strategists. Associations of LH traits with each other and with personality are far more complex than usually assumed in evolutionary psychology.

Patients Undergoing Bariatric Surgery: a Special Risk Group for Lifestyle, Emotional and Behavioral Adaptations During the COVID-19 Lockdown. Lessons from the First Wave.

OBJECTIVES: To determine how the COVID-19 lockdown influenced the lifestyle, eating behavior, use of substances, mental health, and weight in patients who had undergone bariatric surgery (BS) and explore the self-perception of one's own health and fears related to COVID-19. METHODS: We performed a cross-sectional exploratory study in obesity patients who had undergone BS surgery > 1 year previously in a university hospital. Assessment was performed 40 days after initiating lockdown and included 2 periods: from April 24 until May 8 and during the initial de-escalation period: from May 9 until 22, 2020. A structured telephone interview and an online survey were administered. RESULTS: One hundred eighty-eight patients were interviewed; 156 also responded to the online survey (77% females, mean age 53.46 ± 10.48 years, mean follow-up 5.71 ± 4.30 years). Dietary habits were affected in 72% of the participants, with 15% reporting better diet planning; 83.5% reported having more sedentary behaviors; 27% and 36% showed depression and anxiety, respectively; and 45% of participants reported bad sleep quality. In relation to changes in the use of any substance, the use increased in the majority of patients who were previously users. Self-perception of one's own health and fears related to COVID-19 were only moderate. Finally, emotional eating and time since BS were statistically significant risk factors for predicting weight gain. CONCLUSIONS: Lockdown during COVID-19 pandemic negatively influenced the lifestyle, mental health, substance use, and weight in BS patients. These alterations were somewhat similar to those observed in the general population but more severe and with important clinical implications.

Severity in the ICD-11 personality disorder model: Evaluation in a Spanish mixed sample.

Severity is the main component of the ICD-11 personality disorder (PD) classification, but pertinent instruments have only recently been developed. We analyzed the psychometric properties of the ICD-11 Personality Disorder Severity scale (PDS-ICD-11) in a mixed sample of 726 community and clinical subjects. We also examined how the different components of the ICD-11 PD system -five trait domains, the borderline pattern specifier, and severity, all of them measured through self-reports- are interconnected and operate together. PDS-ICD-11 properties were adequate and similar to those of the original instrument. However, regressions and factor analyses showed a considerable overlap of severity with the five personality domains and the borderline specifier (72.6%). Bifactor modeling resulted in a general factor of PD (g-PD) that was not equivalent to severity nor improved criterion validity. The whole ICD-11 PD system, i.e., five personality domains, borderline, and severity, explained an average of 43.6% of variance of external measures of well-being, disability, and clinical problems, with severity contributing 4.8%. Suggestions to further improve the ICD-11 PD taxonomy include remodeling the present definition of severity to give more weight to the real-life consequences of traits.

Integration of the ICD-11 and DSM-5 Dimensional Systems for Personality Disorders Into a Unified Taxonomy With Non-overlapping Traits.

The promise of replacing the diagnostic categories of personality disorder with a better-grounded system has been only partially met. We still need to understand whether our main dimensional taxonomies, those of the International Classification of Diseases, 11th Revision (ICD-11) and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), are the same or different, and elucidate whether a unified structure is possible. We also need truly independent pathological domains, as they have shown unacceptable overlap so far. To inquire into these points, the Personality Inventory for DSM-5 (PID-5) and the Personality Inventory for ICD-11 (PiCD) were administered to 677 outpatients. Disattenuated correlation coefficients between 0.84 and 0.93 revealed that both systems share four analogous traits: negative affectivity, detachment, dissociality/antagonism, and disinhibition. These traits proved scalar equivalence too, such that scores in the two questionnaires are roughly interchangeable. These four domains plus psychoticism formed a theoretically consistent and well-fitted five-factor structure, but they overlapped considerably, thereby reducing discriminant validity. Only after the extraction of a general personality disorder factor (g-PD) through bifactor analysis, we could attain a comprehensive model bearing mutually independent traits.

A third hierarchical level of narrower traits for the Dimensional Assessment of Personality Pathology-Basic Questionnaire.

Current dimensional taxonomies of personality disorder show a stronger empirical grounding than categories, but may lack the necessary level of detail to make accurate predictions and case formulations. We need to further develop the lower levels of the hierarchy until reaching the building blocks of personality pathology. The Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ) is well-suited to this purpose due to its multilayered structure and its agreement with the official dimensional classifications. We disaggregated the 18 DAPP-BQ mid-level facets through exploratory and confirmatory factor analysis in a sample of 3233 community subjects and outpatients. We obtained a set of 72 clinically relevant, narrower subfacets, which were reliable, well-fitted to the data, and invariant between clinical and community subjects and between the sexes. This third level of abstraction increases by 4.7% the capacity to predict DSM categorical personality disorders, gives a particular advantage in capturing dependent, histrionic, paranoid, obsessive, and schizoid features and can provide the detailed information that clinical decisions demand.

Alternative DSM-5 Model for Personality Disorders Through the Lens of an Empirical Network Model.

The Alternative Model for Personality Disorders defined in Diagnostic and Statistical Manual of Mental Disorders-Fifth edition (DSM-5) has recently attracted considerable interest in empirical research, with different hypotheses being proposed to explain the discordant results shown in previous research. Empirical network analysis has begun to be applied for complementing the study of psychopathological phenomena according to a new perspective. This article applies this analysis to personality facets measured in a sample of 626 patients with mental disorders and a 1,034 normative sample, using the Personality Inventory for DSM-5. The results reveal five substructures partially equivalent to domains defined in the DSM-5. Discordant facets (suspiciousness, hostility, rigid perfectionism, attention seeking, and restricted affectivity) play the role of connectors between substructures. Invariance between clinical and community networks was found except for the connection between unusual beliefs and perceptual dysregulation (stronger in the clinical sample). Considering the strength centrality index, anxiousness, emotional lability, and depressivity can be highlighted for their relative importance within both clinical and normative networks.

Personality Disorders in the ICD-11: Spanish Validation of the PiCD and the SASPD in a Mixed Community and Clinical Sample.

The International Classification of Diseases-11th revision (ICD-11) classification of personality disorders is the official diagnostic system that is used all over the world, and it has recently been renewed. However, as yet very few data are available on its performance. This study examines the Personality Inventory for ICD-11 (PiCD), which assesses the personality domains of the system, and the Standardized Assessment of Severity of Personality Disorder (SASPD), which determines severity. The Spanish versions of the questionnaires were administered to a community (n = 2,522) and a clinical sample (n = 797). Internal consistency was adequate in the PiCD (α = .75 to .84) but less so in the SASPD (α = .64 and .73). Factor analyses suggested a unidimensional or bidimensional structure for severity, while revealing that the personality trait qualifiers are organized into four factors: negative affectivity, detachment, dissociality, and a bipolar domain of disinhibition-anankastia. The mutual relationships between traits and severity were analyzed, as well as the ability of the whole system to identify clinical subjects. Although further improvements are required, the results generally support the use of the PiCD and the SASPD and help substantiate the new ICD-11 taxonomy that underlies them.

The General Criteria for Personality Disorders Assessed by Interview: Do They Still Have a Role to Play?

On the path to developing dimensional models of personality disorder (PD), we are at risk of leaving key diagnostic aspects behind. The general criteria for PD may be important ones because they reflect the defining aspects of personality pathology: long duration, independence from psychopathological states, and harmfulness. We assessed these criteria by interview in a sample of 362 psychiatric outpatients after administering the Personality Diagnostic Questionnaire-4+. The result was a 42.5% fall in self-reported endorsements, due to misinterpretations (11.5%), short duration of traits or contamination by state psychopathology (9.8%), and traits being non-harmful (21.2%). However, not all personality traits and disorders underwent correction to the same extent, and ultimately, the interview did not improve the prediction of clinical variables. These findings raise doubts about the practical relevance of the general criteria for PD and support the role of self-report questionnaires for diagnostic purposes.

Personality Disorders Are Not as We Thought: Hierarchical Factor Structure at the Criterion Level.

The use of personality disorder (PD) categories persists, despite the evidence against them. An often overlooked reason for this is the fact that the true structure underlying the Diagnostic and Statistical Manual of Mental Disorders (DSM) taxonomy is still unknown: We cannot be certain which disorders are valid, and which ones are arbitrary mixtures of heterogeneous traits. To address this gap, we factor analyzed the Personality Diagnostic Questionnaire (PDQ-4+; Hyler, 1994 ) at the criterion level in a mixed clinical and nonclinical sample of 2,519 individuals. The resulting structure was more similar to current dimensional taxonomies than to the DSM classification at all hierarchical levels. Whereas paranoid and antisocial PDs-and to a lesser extent avoidant, dependent, depressive, and schizoid PDs-were fairly homogeneous, all other disorders turned out to be combinations of 2 or 3 unrelated dimensions. Our results strongly support the structure of empirically based dimensional taxonomies and relocate DSM criteria within this emerging framework, thus contributing to preserving much of the knowledge accumulated to date.

Psychometric Properties of the Spanish PID-5 in a Clinical and a Community Sample.

The Personality Inventory for DSM-5 (PID-5) measures the trait part (Criterion B) of the alternative model for personality disorders proposed in Section III of DSM-5. Although its psychometric properties have proven adequate thus far, evidence is limited in other languages and in clinical samples. The Spanish PID-5 was examined in two samples comprising 446 clinical and 1,036 community subjects. Facet scales showed good internal consistency in both samples (median α = .86 and .79) and were unidimensional under exploratory and confirmatory approaches. They were also able to distinguish between clinical and community subjects with a mean standardized difference of z = 0.81. All facets except for Risk Taking were unipolar, such that the upper poles indicated pathology and the lower poles reflected normality, rather than the opposite pole of abnormality. The entire PID-5 hierarchical structure, from one to five factors, was confirmed in both samples with Tucker's congruence coefficients over .95.

How temperament and character affect our career, relationships, and mental health.

BACKGROUND: On the way toward an agreed dimensional taxonomy for personality disorders (PD), several pivotal questions remain unresolved. We need to know which dimensions produce problems and in what domains of life; whether impairment can be found at one or both extremes of each dimension; and whether, as is increasingly advocated, some dimensions measure personality functioning whereas others reflect style. METHOD: To gain this understanding, we administered the Temperament and Character Inventory to a sample of 862 consecutively attended outpatients, mainly with PDs (61.2%). Using regression analysis, we examined the ability of personality to predict 39 variables from the Life Outcome Questionnaire concerning career, relationships, and mental health. RESULTS: Persistence stood out as the most important dimension regarding career success, with 24.2% of explained variance on average. Self-directedness was the best predictor of social functioning (21.1%), and harm avoidance regarding clinical problems (34.2%). Interpersonal dimensions such as reward dependence and cooperativeness were mostly inconsequential. In general, dimensions were detrimental only in one of their poles. CONCLUSIONS: Although personality explains 9.4% of life problems overall, dimensions believed to measure functioning (character) were not better predictors than those measuring style (temperament). The notion that PD diagnoses can be built upon the concept of "personality functioning" is unsupported.

Seven basic dimensions of personality pathology and their clinical consequences: Are all personalities equally harmful?

OBJECTIVES: Dimensional pathology models are increasingly being accepted for the assessment of disordered personalities, but their ability to predict negative outcomes is yet to be studied. We examine the relative clinical impact of seven basic dimensions of personality pathology through their associations with a wide range of clinical outcomes. METHODS: A sample of 960 outpatients was assessed through a 7-factor model integrating the Cloninger, the Livesley, and the DSM taxonomies. Thirty-six indicators of clinical outcome covering three areas - dissatisfaction, functional difficulties, and clinical severity - were also assessed. The unique contribution of each personality dimension to clinical outcome was estimated through multiple regressions. RESULTS: Overall, personality dimensions explained 17.6% of the variance of clinical outcome, but varied substantially in terms of their unique contributions. Negative Emotionality had the greatest impact in all areas, contributing 43.9% of the explained variance. The remaining dimensions led to idiosyncratic patterns of clinical outcomes but had a comparatively minor clinical impact. A certain effect was also found for combinations of dimensions such as Negative Emotionality × Impulsive Sensation Seeking, but most interactions were clinically irrelevant. CONCLUSIONS: Our findings suggest that the most relevant dimensions of personality pathology are associated with very different clinical consequences and levels of harmfulness. PRACTITIONER POINTS: The relative clinical impact of seven basic dimensions of personality pathology is examined. Negative Emotionality (Neuroticism) is 6-14 times as harmful as other pathological dimensions. The remaining dimensions and their interactions have very specific and comparatively minor clinical consequences. LIMITATIONS: We examine only a handful of clinical outcomes. Our results may not be generalizable to other clinical or life outcomes. Our variables are self-reported and hence susceptible to bias. Our design does not allow us to establish causal relationships between personality and clinical outcomes.

A hierarchical model of normal and abnormal personality up to seven factors.

Despite general support for dimensional models of personality disorder, it is currently unclear which, and how many, dimensions a taxonomy of this kind should include. In an attempt to obtain an empirically-based, comprehensive, and usable structure of personality, three instruments - The Temperament and Character Inventory-Revised (TCI-R), the Personality Diagnostic Questionnaire-4+(PDQ-4+), and the Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ) - were administered to 960 outpatients and their scales factor-analyzed following a bass ackwards approach. The resulting hierarchical structure was interpretable and replicable across gender and methods up to seven factors. This structure highlights coincidences among current dimensional models and clarifies their apparent divergences, and thus helps to delineate the unified taxonomy of normal and abnormal personality that the field requires.

Evaluación de psicopatología, afrontamiento y apoyo familiar en el cumplimiento de pautas médicas en los 12 meses posteriores a un trasplante cardiaco / Assessment of psychopathology, coping strategies and family support in compliance with medical regimen in the 12 months after heart transplantation

Introducción y objetivos: La falta de cumplimiento de las pautas médicas es uno de los factores de mayor riesgo de morbimortalidad en pacientes trasplantados de corazón. El objetivo del presente trabajo es evaluar la influencia en el cumplimiento de pautas médicas, en pacientes sometidos a trasplante cardiaco, de determinados factores psicosociales como son la presencia de patología psiquiátrica previa al trasplante y las estrategias de afrontamiento y el soporte familiar medidos a los 12 meses. Métodos: Estudio prospectivo observacional que evalúa, a lo largo de 16 meses, 22 sujetos incluidos en un programa de trasplante cardiaco. Se realizó una evaluación pretrasplante y otra al año del trasplante. La valoración recogía los antecedentes clínicos y sociodemográficos, la medición de clínica depresiva y ansiosa, una entrevista psiquiátrica estructurada, las estrategias de afrontamiento, un cuestionario de función familiar y un instrumento propio diseñado para cuantificar el cumplimiento de pautas médicas. Resultados: El 27% de los pacientes mostraron un trastorno psiquiátrico en la evaluación pretrasplante. Las estrategias de afrontamiento más utilizadas fueron las de aceptación y reinterpretación positiva. El análisis de correlación mostró que a menor soporte familiar y a mayor utilización de estrategias de afrontamiento interpersonales se produce un mayor incumplimiento. No se encontró correlación entre patología psiquiátrica y el cumplimiento de pautas. El porcentaje global de incumplimiento fue del 36,6%. Conclusiones: Podemos señalar que el apoyo familiar es un factor que se asocia al cumplimiento de pautas médicas en pacientes con trasplante cardiaco y que, pese a recibir un soporte adecuado, el porcentaje global de incumplimiento de pautas es elevado (AU)

Introduction and objectives: Failure of compliance with the medical regimen is one of the major risk factors associated with morbidity and mortality in heart transplantation patients. The aim of this study is to evaluate the influence of some psychosocial factors, such as the presence of pre-transplant psychiatric disorders, and coping strategies and family support measured after 12 months, in the compliance with the medical regimen in cardiac transplantation patients. Methods: A prospective observational study was conducted over a period of 16 months to evaluate 22 subjects included in a heart transplantation program. Patients were assessed in the pre-transplant period and one year after transplantation. The evaluation collected medical history and sociodemographic data, clinical measurement of depression and anxiety, a structured psychiatric interview, coping strategies, family function questionnaire, and a tool designed to measure the compliance with the medical regimen. Results: More than one-quarter (27%) of patients had a psychiatric disorder in the pre-transplant evaluation. The most frequently used coping strategies were acceptance and positive re-interpretation. Correlation analysis showed that there is a greater non-compliance with less family support and greater use of interpersonal coping strategies. No correlation was found between psychiatric conditions and compliance with guidelines. The overall percentage of non-compliance was 36.6%. Conclusions: It has been shown that family support is an important factor associated with compliance with the medical regimen in patients with cardiac transplantation and, despite receiving adequate support, there is a high rate of non-compliance (AU)

Emotional reactions to predictive testing in Alzheimer's disease and other inherited dementias.

This work describes the reasons and emotional responses of healthy descendants after counseling for presenilin mutations in early-onset familial Alzheimer's disease (EOFAD), tau mutations in familial frontotemporal dementia (FTD), and prion mutations in fatal familial insomnia (FFI). A multidisciplinary protocol following Huntington's disease counseling guidelines and a post-test follow-up program were developed to counsel healthy descendants of affected families. The psychological consequences, anxiety levels, and depression status were assessed through validated scales before and after disclosing the information. Nine people from three different families, one with EOFAD, another with FTD, and the other with FFI came for counseling. Their main reason for testing was to initiate early treatment in the future. Disclosing the information decreased anxiety in two carriers, increased it temporarily in one, and had no effect in another. All noncarriers felt relieved. Overall, after a mean of 30 months of follow-up, no negative psychological reactions were observed. All participants positively valued the program. Although preliminary, our observations suggest that predictive testing in EOFAD, FTD, and FFI is safe and may be of benefit when performed with a delicate approach under strict pretest counseling protocols and post-test follow-up programs. The emotional reactions were similar, although the diseases, their phenotype, and mutation characteristics were different.

Perfil del inventario multifísico de personalidad minnesota-2 (mmpi-2) en transexuales / Profile of the minnesota multiphase personality interventory-2 (mmpi-2) in transsexuals

Objetivo: Evaluar el grado de psicopatología en pacientestransexuales, y determinar las diferencias en funcióndel género (transexuales de hombre-a-mujer y de mujera-hombre).Sujetos y Método: Se administró el Inventario Multifásicode Personalidad Minnesota-2 (MMPI-2) a 100 pacientesdiagnosticados de transexualismo o trastorno de laidentidad de género (ICD-10, DSM-IV TR,). Los pacientesfueron agrupados en función del género en 70 transexualesde hombre-a-mujer (H-M) y 30 de mujer-a-hombre (MH).Resultados: Las puntuaciones T medias de todas lasescalas se encontraron dentro del rango de normalidadexcepto la escala de Masculinidad-feminidad (T=65 parael grupo hombre-a-mujer y T=66 para el grupo mujer-ahombre).No se encontraron diferencias significativas enfunción del género ni en las puntaciones medias T decada escala, ni en el porcentaje de pacientes con puntuacionesT>=65.Conclusiones: Los resultados sugieren que 1. los pacientestransexuales candidatos a reasignación sexual enconjunto se encuentran libres de psicopatología y 2. nose encuentran diferencias en el grado de psicopatologíaentre los grupos hombre-a-mujer y mujer-a-hombre. Esteestudio por lo tanto no apoya la hipótesis de que eltransexual en proceso de reasignacion sexual presentealteraciones emocionales relevantes

Objective: To evaluate the degree of psychopathologyamong male-to-female and female-to-male transsexuals.Method: Minnesota Multiphasic Personality Inventory-2(MMPI-2) were administered to 100 sex change applicantswho had been diagnosed as transsexualism accordingICD-10 and DSM-IV TR (70 transsexuals male-to-femaleand 30 female-to-male).Results: Mean T scores from the MMPI-2 were within thenormal range except for the Masculinity-feminity scale(T=65 for the M-F group and T= 66 for the F-M group).Male-to-female transsexuals did not differ significantly inmean T scores nor in the percentage of patients with T>=65from the female-to-male transsexual group.Conclusions: Results support the view that 1) transsexualscandidates to sex reassignment were notably free ofpsychopathology, and 2) male-to-female versus femaleto-male did not differ in degree of psychophatology. Thus,the study reject the hypothesis that transsexuals in processof sex reassignment suffer major emotional disturbances