Trastorno límite de la personalidad (TLP): características, etiología y tratamiento / Borderline personality disorder (BPD): features, etiology and treatment

El trastorno límite de personalidad (TLP) se ha considerado como el paradigma de trastorno severo de la personalidad. Los principales síntomas son el comportamiento suicida, la autolesión no suicida, el comportamiento agresivo y la reactividad emocional. El inicio del TLP depende de la combinación de factores genéticos y ambientales, especialmente de la vulnerabilidad biológica y la exposición a experiencias traumáticas durante la infancia. Entre sus características destacan las alteraciones en la percepción de posibles amenazas y rechazo social, las interacciones emoción-cognición y alteraciones de la cognición social, la importancia del estrés social y la mentalización. En el aspecto neurobiológico destacan alteraciones del volumen de diversas estructuras cerebrales, metabolismo cerebral, alteraciones funcionales y de la conectividad funcional. Los trastornos psiquiátricos comórbidos más frecuentes en los pacientes con TLP son ansiedad, trastornos afectivos, trastorno por déficit de atención e hiperactividad, trastorno de estrés postraumático y abuso de sustancias. En lo que se refiere al tratamiento, destacan las técnicas psicológicas, como la terapia conductual dialéctica y la EMDR, pero es frecuente la utilización de fármacos eficaces para síntomas específicos, como agresividad/hostilidad o falta de control de los impulsos

Borderline personality disorder (BPD) is considered the most severe personality disorder. Principal symptoms are suicidal behavior, non-suicidal injuries, aggressive behavior and emotional hyperreactivity. BPD onset depends of the combination of genetics and environmental factors, specially on biological vulnerability and exposition to traumatic experiences during childhood. The main features are threatened feelings, social rejection, interactions emotion-cognition and social cognition disorders, social stress and mentalization difficulties. About neurobiological aspects, we can highlight disorders in brain structures, brain metabolism, functional and functional connectivity. The most common comobird deseases in pacients with BPD are anxiety, affective disorders, attention deficit and hiperactivity disorder (ADHD), post traumatic stress disorder (PTSD) and substance abuse. According to treatment, psychological techniques are employed such as dialectical behavioral technique, EMDR. Usually, we can also associate drugs for controlling specific symptoms such as aggressivity o impulse control disabilities

Interpersonal Problems Associated With Passive-Aggressive Personality Disorder.

With a controversial history, passive-aggressive personality disorder (PAPD) was eventually removed from the latest edition of the Diagnostic and Statistical Manual for Mental Disorders. Despite its demise from diagnostic nomenclature, clinicians continue to regard it as a clinically relevant construct, and some researchers argue for its resurrection. Toward this end, it is important to empirically demonstrate the relevance of the passive-aggressive personality construct, including demonstrating its association with impaired functioning. Consistent with contemporary emphasis on interpersonal functioning in personality pathology, the current study aims to explore interpersonal problems that are associated with PAPD in a large clinical sample. Before beginning treatment, 240 patients completed assessments of personality psychopathology and interpersonal functioning. Results showed that higher levels of PAPD were significantly associated with greater level of interpersonal distress, especially regarding interpersonal problems of a vindictive nature. The findings are consistent with clinical descriptions of the core conflictual relational issues of patients with PAPD and lend some support to further considering PAPD as a valid diagnostic construct.

Accurate phenotyping: Reconciling approaches through Bayesian model averaging.

Genetic research into complex diseases is frequently hindered by a lack of clear biomarkers for phenotype ascertainment. Phenotypes for such diseases are often identified on the basis of clinically defined criteria; however such criteria may not be suitable for understanding the genetic composition of the diseases. Various statistical approaches have been proposed for phenotype definition; however our previous studies have shown that differences in phenotypes estimated using different approaches have substantial impact on subsequent analyses. Instead of obtaining results based upon a single model, we propose a new method, using Bayesian model averaging to overcome problems associated with phenotype definition. Although Bayesian model averaging has been used in other fields of research, this is the first study that uses Bayesian model averaging to reconcile phenotypes obtained using multiple models. We illustrate the new method by applying it to simulated genetic and phenotypic data for Kofendred personality disorder-an imaginary disease with several sub-types. Two separate statistical methods were used to identify clusters of individuals with distinct phenotypes: latent class analysis and grade of membership. Bayesian model averaging was then used to combine the two clusterings for the purpose of subsequent linkage analyses. We found that causative genetic loci for the disease produced higher LOD scores using model averaging than under either individual model separately. We attribute this improvement to consolidation of the cores of phenotype clusters identified using each individual method.

Comorbidity of oppositional defiant disorder and anxiety disorders in preschoolers / Comorbilidad del trastorno negativista desafiante y los trastornos de ansiedad en preescolares

BACKGROUND: The aim was to study the comorbidity of oppositional defiant disorder (ODD) and anxiety disorders (AD) among preschool children of the general population, and to assess the contribution of comorbidity to the child's functional impairment. METHOD: 622 children were assessed at the ages of 3 and 5, through a diagnostic interview. They were clustered into three diagnostic groups: only ODD, only AD and comorbid ODD+AD. RESULTS: At age 3, ODD was associated with specific phobia, OR = 4.7, 95% CI [1.4, 14.1], and at age 5, with any anxiety disorder, OR=3.9; 95% CI [1.8, 8.4]. ODD at age 3 was predictive of separation anxiety at age 5, OR=4.1; 95% CI [1.2, 14.3]. Comorbid ODD+AD cases showed a higher risk of functional impairment at school and in behavior toward others. Sex and socioeconomic status were not related to the diagnostic group. CONCLUSIONS: ODD+AD comorbidity can be identified in preschool children. Early identification of this association is needed to adequately treat the affected children

ANTECEDENTES: se analiza la comorbilidad entre el trastorno negativista desafiante (TND) y los trastornos de ansiedad (TA) en preescolares de población general, y el deterioro funcional con que se asocian. MÉTODO: 622 niños fueron evaluados a los 3 y los 5 años con una entrevista diagnóstica. Se compararon 3 grupos diagnósticos: únicamente TND, únicamente TA y comorbilidad TND+TA. RESULTADOS: a los 3 años se halló asociación entre TND y fobia específica (OR = 4.7, IC95%: 1.4÷14.1) y a los 5 años entre TND y TA, OR= 3.9; 95% IC [1.8, 8.4]. La presencia de TND a los 3 años fue predictiva de ansiedad de separación a los 5 años (OR = 4.1; IC95%: 1.2÷14.3). La comorbilidad se asoció con mayor deterioro funcional en la escuela y en el comportamiento hacia los demás. Sexo y nivel socioeconómico no se asociaron al grupo diagnóstico. CONCLUSIONES: la comorbilidad TND+TA se puede identificar en edad preescolar. Es necesaria la detección temprana de estos trastornos para el adecuado tratamiento de los niños afectados

Atypical antipsychotics in the treatment of pathological aggression in children and adolescents: literature review and clinical recommendations / Antipsicóticos atípicos no tratamento da agressividade patológica em crianças e adolescentes: revisão da literatura e recomendações clínicas

Objective: To review the literature about the use of atypical antipsychotics in the treatment of pathological aggression in children and adolescents. Method: The databases MEDLINE, SciELO, and LILACS were searched for publications in Portuguese or English from 1992 to August 2011 using the following keywords: mental disease, child, adolescent, treatment, atypical antipsychotic, aggressive behavior, aggression, and violent behavior. Results: Sixty-seven studies of good methodological quality and clinical interest and relevance were identified. Studies including children and adolescents were relatively limited, because few atypical antipsychotics have been approved by the Food and Drug Administration (FDA). All the medications included in this review (risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole and clozapine) have some effectiveness in treating aggression in children and adolescents, and choices should be based on clinical indications and side effects. Conclusions: There are few studies about the effectiveness and safety of atypical antipsychotics for the pediatric population, and further randomized controlled studies with larger groups of patients and more diagnostic categories, such as severe conduct disorder and oppositional defiant disorder, should be conducted to confirm the results reported up to date and to evaluate the impact of long-term use.

Objetivo: Realizar uma revisão sistemática da literatura científica sobre o uso de antipsicóticos atípicos (APAs) no tratamento da agressividade patológica em crianças e adolescentes. Método: Foi realizada busca eletrônica nas bases de dados MEDLINE, SciELO e LILACS, de 1992 a agosto 2011, considerando artigos publicados em língua inglesa e portuguesa. Foram utilizadas associações das seguintes expressões: mental disease, child, adolescent, treatment, atypical antipsychotic, aggressive behaviour, aggression e violent behavior. Resultados: Foram identificados 67 artigos de boa qualidade metodológica, de relevância e interesse clínico para o tema em foco. De modo geral, os estudos são relativamente limitados para esta faixa etária, resultado do fato de poucos APAs terem sido aprovados pela Food and Drug Administration (FDA). Dentre as medicações consideradas nesta revisão (risperidona, olanzapina, quetiapina, ziprazidona, aripiprazol e clozapina), todas elas podem ter alguma efetividade no tratamento da agressividade em crianças e adolescentes, ficando a escolha baseada na indicação clínica e perfil de efeitos colaterais. Conclusão: O número ainda limitado de estudos acerca da efetividade e segurança na população pediátrica demanda pesquisas futuras com grupos maiores de pacientes e com mais categorias diagnósticas (como, por exemplo, as formas graves de transtorno de conduta e transtorno desafiador de oposição), desenhadas de forma randomizada e controlada. Assim poderão ser confirmados os achados até o momento e o impacto do uso em longo prazo.

A comparison of passive-aggressive and negativistic personality disorders.

Passive-aggressive personality disorder (PAPD) has historically played an important role in clinical theorizing and was diagnosable prior to the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994), in which the construct was relabeled negativistic (NEGPD), expanded to include negative affective symptoms, and appendicized. In this study we tested the hypothesis that the expansion of PAPD to include content related to negative moods and nonspecific personality pathology compromised its discriminant validity. In an undergraduate sample (N = 1,215), a self-report measure of PAPD was only moderately related to NEGPD and showed less diagnostic overlap with other personality disorders than NEGPD. Furthermore, a conjoint factor analysis yielded a strong first factor (moodiness) that appeared less specific to passive-aggressive behavior than 3 other factors (irresponsibility, inadequacy, and contempt). We conclude that future research on this potentially important clinical construct should focus on core passive-aggressive features and abandon the negativistic content that has been added to it in successive editions of the DSM.

A randomized controlled trial of sequentially bilateral prefrontal cortex repetitive transcranial magnetic stimulation in the treatment of negative symptoms in schizophrenia.

BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) has been investigated for its treatment efficacy for the negative symptoms of schizophrenia. Previous studies have targeted the dorsolateral prefrontal cortex (DLPFC), which is associated with the pathophysiology of this disorder. Several rTMS parameters have been explored in the treatment of negative symptoms and include stimulating the left and bilateral DLPFC at several different frequencies and number of sessions. Results of such studies have been inconsistent, while high-frequency rTMS has shown greatest promise. OBJECTIVE/HYPOTHESIS: The objective of this study was to evaluate the efficacy of bilateral high-frequency rTMS in the treatment of negative symptoms in schizophrenia. It was hypothesized rTMS would alleviate negative symptoms in schizophrenia. METHODS: Twenty-five patients were enrolled in this double-blind placebo-controlled randomized trial. Bilateral 20 Hz rTMS was MRI-targeted to the DLPFC at 90% RMT administered daily for 4 weeks for a total of 20 treatments. Negative symptoms were assessed with the Scale for the Assessment of Negative Symptoms (SANS), the Positive and Negative symptom scale (PANSS), and controlling for depression as measured with the Calgary Depression Scale (CDS) at baseline, 1, 2, 3, 4, and 2 weeks after the treatment course. RESULTS: No significant group or time differences were found on negative symptoms or depressive symptoms after rTMS. Bilateral high-frequency rTMS did not alleviate negative symptoms in patients with schizophrenia. CONCLUSIONS: These findings indicate that such symptoms are unresponsive to rTMS treatment or that more optimized parameters are needed to achieve improved therapeutic efficacy.

The construct validity of passive-aggressive personality disorder.

Although Passive Aggressive personality disorder (PAPD) plays an important role in many theories of personality pathology, it was consigned to the appendix of the fourth edition of the DSM. The scientific basis of this decision has been questioned, but several controversies persist regarding PAPD, including its structure, content validity, overlap with other PDs, and relations to validating variables such as personality traits, childhood experiences, and clinically relevant correlates. This study examined these facets of PAPD's construct validity in a large clinical sample. Results suggest that the construct is unidimensional, internally consistent, and reasonably stable. Furthermore, PAPD appears systematically related to borderline and narcissistic personality disorders, sets of personality traits, and childhood experiences consistent with several theoretical formulations, dysfunction, substance abuse disorders, and history of hospitalizations. Overall, results support the construct validity of PAPD.

Adicción a la cocaína y trastornos de personalidad: un estudio con el MCMI-II / Cocaine addiction and personality disorders: a study with the MCMI-II

En este artículo se lleva a cabo un estudio de los trastornos de personalidad asociados a la adicción a la cocaína. Para ello se contó con una muestra de 60 pacientes cocainómanos, que cumplimentaron el MCMI-II antes del tratamiento, y de 50 sujetos de la población normal con las mismas características demográficas (edad, sexo y nivel socioeconómico). El 36,7% de la muestra clínica (frente al 16% de la muestra normativa) presentaba, al menos, un trastorno de personalidad. Los trastornos de mayor prevalencia entre los cocainómanos fueron el trastorno pasivo-agresivo de la personalidad y el trastorno dependiente de la personalidad (10% cada uno de ellos), seguidos del trastorno obsesivo-compulsivo y el histriónico (6,7% cada uno). Asimismo, el 15%de la muestra clínica presentaba simultáneamente dos o más trastornos. Por último, se comentan las implicaciones de este estudio para la práctica clínica y para las investigaciones futuras (AU)

This paper explores the personality disorders most commonly related to cocaine addiction. The samples used were 60 cocaine-addicted patients, who were assessed with the MCMI-II before treatment, and 50 normative participants from the general population with the same demographic features (age, sex and socioeconomic level). According to the results, 36.7% of the clinical sample (versus 16% of the normative sample) showed at least one personality disorder. The most prevalent disorders in the cocaine sample were Passive-Aggressive Personality Disorder and Dependent Personality Disorder (10% in each case), followed by Obsessive-Compulsive Personality Disorder and Histrionic Personality Disorder (6.7% each). Moreover, 15% of the clinical sample showed more than one personality disorder. Finally, the implications of this study for clinical practice and future research in this field are discussed (AU)

Passive-aggressive (negativistic) personality disorder: a population-based twin study.

The objective of this study was to investigate the familial aggregation of passive aggressive personality disorder (PAPD), and explore issues regarding PAPD raised by the DSM-IV Personality Disorder Work Group. Two thousand seven hundred and ninety-four Norwegian twins from the population-based Norwegian Institute of Public Health Twin Panel were interviewed with the Structured Interview for DSM-IV Personality (SIDP-IV). Because of the rarity of the twins meeting full diagnostic criteria for PAPD a dimensional representation of the disorder was used for the analyses. Overlap with other axis II disorders was assessed by polychoric correlations, while familial aggregation was explored by structural equation twin models. Overlap was highest with paranoid (r = 0.52) and borderline personality disorder (r = 0.53), and lowest with schizoid (r = 0.26). Significant familial aggregation was found for PAPD. The twin correlations and parameter estimates in the full model indicated genetic and shared environmental effects for females, and only shared environmental effects for males, but the prevalence of endorsed PAPD criteria in this community sample was too low to permit us to conclude with confidence regarding the relative influence of genetic and shared environmental factors on the familial aggregation of PAPD.

The relationships of antisocial behavior with attachment styles, autonomy-connectedness, and alexithymia.

The present study was aimed at investigating the relationships among attachment styles, autonomy-connectedness (self-awareness, sensitivity to others, and capacity for managing new situations), alexithymia, and antisocial behavior among 202 college students (67 men and 135 women). We were particularly interested in sex differences in the levels of these variables as well as their associations. Sex differences were expected in types of insecure attachment styles, patterns of autonomy-connectedness, and levels of self-reported antisocial and passive-aggressive behavior. All expected sex differences were indeed found. Furthermore, the model that we hypothesized was partly confirmed: For men, anxious attachment had a stronger direct and positive effect on antisocial behavior than for women, and the positive effect of anxious attachment on passive-aggressive behavior was smaller for women than for men. Interestingly, capacity for managing new situations had a main and mediating effect on antisocial behavior. Sensitivity to others appeared as a mediator between anxious attachment style and passive-aggressive behavior. Contrary to expectations, fantasizing (a component of alexithymia) had a strong, negative association with antisocial behavior. The results are discussed against the background of other recent findings concerning alexithymia and autonomy- connectedeness.

The validity of DSM-IV passive-aggressive (negativistic) personality disorder.

Passive-Aggressive (Negativistic) Personality Disorder (NEGPD), listed in Appendix B of the DSM-IV, is not an officially recognized personality disorder. Its future as a discrete disorder is uncertain (Widiger, 2003). Yet, NEGPD occupies a role in some theoretical formulations of personality pathology (Millon & Davis, 1996), and many clinicians believe that passive-aggressive traits are not adequately represented by other PDs (Westen, 1997). In this study, 1158 psychiatric outpatients were assessed for Axis I and Axis II disorders. Thirty-five (3.02%) met criteria for NEGPD. Participants with NEGPD did not differ significantly from those without NEGPD on demographic variables. The internal consistency of the DSM-IV's seven NEGPD items was 0.50. Corrected item- total correlations for the 7 criteria averaged 0.27. Participants with NEGPD had higher rates of lifetime anxiety disorders, and almost 90% had an additional PD. An exploratory factor analysis suggested a two- factor solution that accounted for 43.4% of the variance. The first factor reflected the belief that life is unfair, while the second factor seemed to reflect modes of anger expression. A confirmatory factor analysis showed that the two-factor model fit the data better than a unidimensional model. We discuss implications of these results for the future of the NEGPD diagnosis.

Is the appendix a useful appendage? An empirical examination of depressive, passive-aggressive (negativistic), sadistic, and self-defeating personality disorders.

Decisions about whether to include depressive, passive-aggressive, sadistic, and self-defeating disorders in Axis II have been made difficult by a relative dearth of data. We report the results of a study identifying potential defining features of these diagnoses and assessing their distinctiveness from other Axis II personality disorders (PDs). A national sample of experienced psychiatrists and psychologists used the SWAP-200 to describe a patient with a current axis II disorder or an appendix or deleted PD from DSM-II-R. We examined clinicians' descriptions of patients to identify their most characteristic features, and then applied an empirical clustering procedure, Q-factor analysis, to see whether versions of these disorders would emerge empirically. As currently conceptualized, only passive-aggressive PD was distinct from other PDs. When the data were subjected to Q-factor analysis, the first and largest grouping was a dysphoric (depressive) PD. A hostile-negativistic subcategory emerged that resembled passive-aggressive PD, along with a revised dependent diagnosis that included many self-defeating/masochistic features. The results suggest that a depressive or dysphoric personality may represent an internalizing spectrum of personality pathology, and that a hostile-negativistic PD may be distinct from the disorders in the text of DSM-IV. Sadistic and self-defeating PD do not appear to represent distinct disorders, although they include personality traits (sadism and revictimization) associated with distinct developmental histories.

A psychometric typology of U.K. domestic violence offenders.

A number of studies have described subtypes of domestically violent men, and the heterogeneity of domestically violent men is well established. The aim of the current study was to investigate the distribution of subtypes using psychometric measures in convicted domestically violent offenders in England. Four subtypes of offenders were identified: low pathology, borderline, narcissistic, and antisocial. These subtypes were broadly comparable with the family-only, dysphoric/borderline, and generally violent/antisocial types proposed by Holtzworth-Munroe and Stuart. The majority of the sample (60%) best fit the generally violent/antisocial profile. However, the reliance on psychometric measurement and lack of corroborative evidence from partners means that further research is necessary to test these findings.

El trastorno negativista de la personalidad y su relación con el abuso de sustancias / Negativistic personality disorder related with substance abuse

Objetivo. El trastorno negativista de la personalidad (TNP), anteriormente denominado trastorno pasivo-agresivo, es el que más controversia genera, por diversos motivos: su estatus actual (propuesto para estudio en el DSM-IV), los criterios que se proponen para definirlo, su semejanza o cercanía a otros trastornos y las diversas prevalencias halladas en poblaciones diferentes. Por otra parte, todos los estudios efectuados estiman una alta prevalencia en población adicta. Los objetivos del estudio han sido determinar en qué medida el MCMI-II se ajusta a los criterios del DSM-IV para evaluar el patrón pasivo-agresivo/negativista de la personalidad, evaluar los rasgos que subyacen al TNP y las diferencias apreciadas con otros trastornos, así como las que se dan entre los sujetos con un trastorno negativista y otros, con respecto a diversas variables observables. Método. Se aplica el cuestionario MCMI-II, el BFQ, el TCI-R y una versión de la entrevista SCID-II adaptada a los ítem del MCMI-II, y se estudia el historial clínico en una muestra de 201 sujetos que inician tratamiento por consumo de drogas. Resultados. Los ítem principales del TNP dan información sobre 5 de los 7 criterios propuestos en el DSM-IV; el estudio de los rasgos subyacentes sitúa al TNP como una modalidad atenuada del trastorno límite de la personalidad (TLP), aunque la propia estructura del MCMI-II contribuye a esta semejanza; ambos trastornos se caracterizan, usando el TCI-R, por la combinación de elevadas puntuaciones en búsqueda de novedad y evitación del daño, lo que les distingue claramente del resto de patrones, pero no entre sí, existiendo sólo una diferen cia de grado. Sin embargo, los sujetos con un TNP muestran en su historial un menor número de situaciones críticas (intentos autolíticos, mejor ajuste laboral, inexistencia de maltrato físico en el entorno familiar, etc.) respecto a los que presentan un TLP. Conclusiones. El TNP parece presentar características diferenciales que lo hacen merecedor de mayor atención en clasificaciones diagnósticas futuras, y, especialmente, en relación con las conductas adictivas que pueden encontrar explicación a partir de las características definitorias de esta determinada estructura de personalidad. El estudio de rasgos que lo asemeja al TLP es coherente con dos premisas formuladas por Millon: el TLP sería una de las modalidades descompensadas del TNP y los rasgos subyacentes, aunque comunes, no pueden explicar las diferencias entre los patrones, debido a que la configuración estructural no se atiene a la linealidad y ortogonalidad que se presupone en los rasgos

Objectives. The negativistic personality (NP), previously known as Passive-Aggressive Personality Disorder, is a matter of current discussion, due to several reasons: its current status (proposed to be studied in the DSM-IV), the criteria that are proposed to define it, its similarity or proximity to other disorders and the diverse prevalence found in different populations. On the other hand, all studies estimate a high prevalence in addict population. The objectives of the study were to determine how MCMI-II adjusts to the criteria of the DSM-IV to evaluate the NP, to evaluate the traits that underlies to the TNP and the differences appreciated with other disorders, as well as the differences between subjects with a negativistic personality and others, throughout several variables. Method. MCMI-II, BFQ, TCI-R and a version of SCID-II interview, adapted to ítems of the MCMI-II, using clinical history to obtain some variables, in a sample of 201 individuals who demand treatment for drug abuse. Results. The main items of the NP give information on 5 of the 7 criteria proposed in the DSM-IV; the study of the underlying characteristics locates the TNP as a light modality of the Borderline Personality Disorder (BPD), although the proper structure of the MCMI-II contributes to this similarity; both disorders are characterized, using the TCI-R, by the combination of high scores in Novelty Seeking and Harm Avoidance, which distinguishes them clearly of the rest of patterns, but not to each other, existing only differences in the degree. Nevertheless, the subjects with a NP show in their life history a smaller number of critic situations (self-defeating attempts, better work adjustment, nonexistence of physic mistreat in the familiar surroundings, etc) respect to those who display a BPD. Conclusions. The NP seems to display differential features that make it deserve a wider attention in future diagnostic classifications, and, specially, in relation to the addictive behaviours that can be explained from some of the characteristics of this structure of personality. The study of its traits is coherent with two premises formulated by Millon: the BPD would be one of the decompensated modalities of the NP and the underlying traits, although being common to both of them, cannot explain the differences between patterns, because this structural configuration does not rely on the linearity and ortogonality that is estimated in the traits

Características psicométricas de las versiones reducidas del cuestionario de agresividad de Buss y Perry / Psychometric properties of the reduced versions of Buss and Perry´s aggression questionnaire

El cuestionario de agresividad de Buss y Perry (1992) es una de las herramientas más ampliamente utilizadas en el estudio de la conducta agresiva. No obstante, distintas investigaciones han señalado la posibilidad de que no presente un ajuste adecuado al modelo de cuatro factores propuesto originalmente por dichos autores. Cabe señalar que la mayoría de dichos estudios fueron llevados a cabo en muestras homogéneas, formadas por estudiantes universitarios, lo cual podría explicar las dificultades para replicar la estructura factorial del cuestionario. El presente estudio analiza el ajuste a dicho modelo y la consistencia interna de este cuestionario y de dos de las versiones reducidas que se han desarrollado para solucionar los problemas detectados en el mismo. Con este fin se administró el cuestionario de agresividad a una muestra heterogénea de 237 sujetos. Los resultados indican que las tres versiones estudiadas presentan tanto un ajuste aceptable al modelo de cuatro factores como una consistencia interna adecuada

The aggression questionnaire developed by Buss and Perry (1992) has been one of the most commonly used tools in the study of aggressive behaviour. Nevertheless, several researchers have pointed out that its fit to the four-factor model originally proposed by the authors may be unsatisfactory. It is important to note that most of this studies used homogeneous samples of university undergraduates which may explain the difficulties to replicate the factorial structure of the questionnaire. Our study analyzes this fit as well as the internal consistency of the questionnaire and the two reduced versions that have been developed to solve the problems detected. With this purpose we administered the aggression questionnaire to a heterogeneous sample of 237 participants. The results show that the fit of the three analyzed versions to the four-factor model is reasonable and that their internal consistency is adequate

Edad de inicio y sintomatología como factor pronóstico en el trastorno por déficit de atención e hiperactividad (TDAH) / Age of onset and clinical picture as prognosis factors in attention deficit hyperactivity disorder (ADHD)

Objetivo: La sintomatología del Trastorno por Déficit de Atención con Hiperactividad (TDAH) puede variar en función de la edad. Se ha estudiado la relación existente entre edad y sintomatología en un grupo diagnosticado de Trastorno Déficit de Atención con Hiperactividad (TDAH), considerando las implicaciones en relación al curso clínico y pronóstico así como las diferencias y similitudes con el Trastorno de Conducta. Metodología: Se revisan 380 historias clínicas de niños de 2 a 14,6 años de edad a lo largo de un periodo de 15 años. Se establecen criterios diagnósticos y de exclusión e inclusión para el TDAH, trastorno disocial (TD) y trastorno negativista desafiante (TN/TND). Resultados: El TDAH presenta una edad de inicio temprana. La gravedad del cuadro clínico es tanto mayor cuanto mas precoz es la edad de comienzo. Los casos de mayor gravedad presentan una edad de consulta mas precoz. En ambos grupos, los casos asociados a agresividad presentan una mayor gravedad. Conclusiones: El TDAH comienza antes que el TD/TND, y se acompaña de más problemas de aprendizaje. En ambos, el comportamiento agresivo es un dato de mal pronóstico, siendo las casos de mayor gravedad los que consultan mas precozmente (AU)

A psychometric study of DSM-IV passive-aggressive (negativistic) personality disorder criteria.

The passive-aggressive (negativistic) personality disorder (PAPD) is one of the most controversial personality disorders. In order to assess DSM-IV PAPD psychometric properties and comorbidity pattern in a mixed psychiatric sample, 379 consecutively admitted in- and outpatients were administered SCID-II, Version 2.0. Confirmatory factor analysis showed that DSM-IV PAPD is a unidimensional construct with adequate internal consistency (K-R 20 = .85). A strong, specific association (odds ratio = 10.38, 95% CI = 4.83-22.30) was observed between DSM-IV PAPD and narcissistic personality disorder (NPD). Confirmatory factor analysis showed that DSM-IV PAPD should be considered as a subtype of a broader narcissistic disorder.

Passive-aggressive personality disorder: the demise of a syndrome.

This article presents an explanation and critique of the rationale for dropping passive-aggressive personality disorder (PAPD) from DSM-IV. The clinical and research literature on PAPD is reviewed along with the historical changes in definition, diagnostic criteria, and usage. PAPD can be reliably diagnosed, is fairly prevalent, and has good internal consistency. Because PAPD is no less valid than other personality disorders, and describes clinical phenomena that are unique among personality disorders, we recommend the reinstatement of PAPD in the official diagnostic nomenclature.