Evaluating Stable and Situational Expressions of Passive-Aggressive Personality Disorder: A Multimethod Experience Sampling Case Study.

Passive-aggressive (PA) personality traits have received increasing attention in the research literature and are known to interfere with treatment engagement and recovery. Theoretical disagreements about PA, combined with its omission from the DSM-5, have left open many questions regarding its dynamic structure and temporal stability. Our goal in the present case study was to use a multimethod, experience sampling assessment framework for a single research subject enrolled in long-term residential treatment who exhibited significant PA traits to provide a complex portrait of daily interpersonal behaviors and experiences across a range of contexts. We review data gathered over a year of residential treatment to identify changes in self and interpersonal functioning and to deepen our understanding of the dynamic motivational structure of PA over time. Our findings expand understanding of both PA dynamics and provide support for integrating multimethod assessment into routine clinical practice.

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.

Negativismo, ansiedad y retraimiento social como predictores de la sintomatología del déficit de atención con Hiperactividad / Negativity, anxiety and social withdrawal as predictors of symptoms of attention deficit hyperactivity disorder

Se analiza la capacidad predictora de la ansiedad, la socialización, la autoestima y el negativismo respecto a los déficit de atención e hiperactividad, considerando en primer lugar, población normal y, posteriormente, individuos con sospecha de déficit de atención con hiperactividad (TDAH). Han participado 259 niños (M=13,05; DT=1,92) y 241 niñas (M=12,90; DT=2,04). Se han diferenciado dos grupos a partir de la información aportada por los profesores a través de la "Escala para la evaluación del TDAH" (ADHD Rating Scale-IV; DuPaul, Power, Anastopoulos y Reid, 1998). Los resultados muestran índices de varianza explicada entre el 33,5%, F(6, 349)= 30,854; p= 0,008, de la puntuación en inatención y el 45,2%, F(3,102)= 29,901; p= 0,008, en sintomatología combinada. Destacan síntomas de negativismo, ansiedad estado y retraimiento social, como las variables más relevantes con tendencia a incrementar las puntuaciones en inatención e impulsividad. La autoestima escolar y consideración con los demás resultan las principales variables moderadoras de la sintomatología hiperactiva

Predictive ability of anxiety, socialization, self-esteem and negativism for attentional deficiencies and hyperactivity was analyzed, considering firstly a normal population and then individuals with suspected attentiondeficit/ hyperactivity disorder (ADHD). 259 children (M= 13.05, SD= 1.92) and 241 girls (M= 12.90, SD= 2.04) have participated in this study. Two groups have been differentiated from the information provided by teachers through the ADHD Rating Scale-IV (DuPaul, Power, Anastopoulos y Reid, 1998). The results show variance explained rates between 33.5%, F(6, 349)= 30.854, p= 008, inattention score and 45.2%, F(3,102)= 29.901, p= .008, combined symptoms. Symptoms of negativism, state anxiety and social withdrawal stand out, as the most relevant variables that tend to increase scores on inattention and impulsivity. The school esteem and consideration to others are the main moderating variables of overactive symptoms

Attainment and stability of sustained symptomatic remission and recovery among patients with borderline personality disorder and axis II comparison subjects: a 16-year prospective follow-up study.

OBJECTIVE: The purposes of this study were to determine time to attainment of symptom remission and to recovery lasting 2, 4, 6, or 8 years among patients with borderline personality disorder and comparison subjects with other personality disorders and to determine the stability of these outcomes. METHOD: A total of 290 inpatients with borderline personality disorder and 72 comparison subjects with other axis II disorders were assessed during their index admission using a series of semistructured interviews, which were administered again at eight successive 2-year follow-up sessions. For inclusion in the study, patients with borderline personality disorder had to meet criteria for both the Revised Diagnostic Interview for Borderlines and DSM-III-R. RESULTS: Borderline patients were significantly slower to achieve remission or recovery (which involved good social and vocational functioning as well as symptomatic remission) than axis II comparison subjects. However, by the time of the 16-year follow-up assessment, both groups had achieved similarly high rates of remission (range for borderline patients: 78%-99%; range for axis II comparison subjects: 97%-99%) but not recovery (40%-60% compared with 75%-85%). In contrast, symptomatic recurrence and loss of recovery occurred more rapidly and at substantially higher rates among borderline patients than axis II comparison subjects (recurrence: 10%-36% compared with 4%-7%; loss of recovery: 20%-44% compared with 9%-28%). CONCLUSIONS: Our results suggest that sustained symptomatic remission is substantially more common than sustained recovery from borderline personality disorder and that sustained remissions and recoveries are substantially more difficult for individuals with borderline personality disorder to attain and maintain than for individuals with other forms of personality disorder.

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.

Readiness to change, partner violence subtypes, and treatment outcomes among men in treatment for partner assault.

Men court-mandated to attend a batterer's intervention program (BIP) were evaluated to determine whether pre-BIP readiness to change and the presence of partner violence subtypes predicted BIP completion, criminal recidivism, and postadjudication partner violence 6 months post-BIP. Of the 199 subject sample, 40% did not complete BIP. Four readiness-to-change clusters were found, with most men (76%) reporting change-resistant stages-of-change profiles. The partner violence typology reported by Holtzworth-Munroe et al. (2000) was supported with clustering into four subtypes: family only (FO), low-level antisocial (LLA), borderline/dysphoric (BD), and generally violent/antisocial (GVA). BIP completion was predicted by violence subtype (with BD and GVA more likely to drop out) but not by pre-BIP readiness to change. Men rearrested scored higher on the precontemplative stage of change and were more likely to be in the BD and GVA subtypes. Implications for counseling strategies are discussed.

[Effectiveness of outpatient treatment for alcoholism - impact of personality disorders on course of treatment]. / Die Bedeutung von Persönlichkeitsstörungen für den Therapieverlauf einer ambulanten Alkoholentwöhnungstherapie.

Personality disorders (PS) frequently exist as comorbid disorder in alcoholism. However, the impact of comorbid personality disorder on the treatment and course of alcoholism still remains unclear. On that background, the present study on the efficacy of an intensive out-patient therapy for alcohol-dependents investigated the influence of comorbid personality disorder on the relapse and dropout rate during the treatment phase in 102 patients. Personality disorders were assessed with the SCID-II (DSM-IV). On a descriptive level results indicate that comorbidity with negativistic personality disorder and Cluster B PS may adversely affect the course of treatment. Statistical analyses, however, revealed that the observed differences in the type or number of personality disorders between patients with or without relapse resp. between patients with or without dropout failed to reach statistical significance. Thus, we conclude that the relevance of comorbid personality disorder on the course of alcoholism may be overestimated. The present results indicate that patients with comorbid personality disorder can be successfully integrated into a high-structured outpatient therapy.

Premeditated assaults on young boys by a man with spina bifida and hydrocephalus--a cognitive-behavioural approach to treatment.

This paper describes the case of a 25-year-old man with spina bifida and hydrocephalus, who had at least a ten-year history of physically assaulting young boys. Anti-social behaviour is reported as comparatively rare in people with this disability, and the case study illustrates how psychological assessment and treatment techniques were successfully applied. Information from his personal history plus a functional analysis of the assaults suggested that a combination of existing psychological difficulties and learning experiences contributed to the development of his behaviour. A behavioural model of the psychological mechanisms underlying the behaviour was suggested and treatment objectives defined. Cognitive and behavioural treatment techniques were adapted where necessary, with a good outcome. A gap in services for physically handicapped people with behavioural problems is noted and briefly discussed.

Treatment outlines for avoidant, dependent and passive-aggressive personality disorders. The Quality Assurance Project.

Treatment outlines for avoidant, dependent and passive-aggressive personality disorders were developed by having nominated experts consider their own views in the light of the treatment literature and the responses of practising psychiatrists. The experts recommend that long-term psychotherapy is the treatment of choice and that a considerable component of the outcome will be related to the therapeutic relationship. Assessment, general approaches to treatment, and strategies in psychodynamic management are outlined in some detail. For those individuals for whom long-term therapy is not available or appropriate, other therapies, such as cognitive behavioural therapy, can be promising.

[Passive-aggressive personality and dependent personality-- current status of the question]. / Personnalité passive-agressive et personnalité dépendante--état actuel de la question.

The author makes a critical review of the literature concerning dependent and passive-aggressive personalities. After putting them in a historic perspective, he presents the various etiologic hypotheses. Special attention is given to the clinical and therapeutic aspects. The author concludes that despite the supposed high incidence of these two personality disorders, the reliability of the diagnoses and the natural history of the disorders remain to be explored in a prospective and systematic manner, before definite conclusions can be drawn regarding therapy.

Passive-aggressive personality disorder. Treatment implications of a clinical typology.

Patients with passive-aggressive personality disorder or personality traits represent a very difficult group on which surprisingly little is written. The authors delineate four patterns of passive-aggressive behavior that pose different problems in learning and adaptation. These are the anxiety-inhibited, environmentally inhibited (masochistic), and resentful-vindictive patients and patients inhibited by existential choice. All four types meet the DSM-III criteria for passive-aggressive personality disorder; they may also occur as significant personality traits apart from the fully developed personality disorder. The difficulties that these patients present are the same for clinicians of every theoretical perspective. Using one treatment approach, assertiveness training, the authors offer specific suggestions in the treatment of each type of passive-aggressive patient. These suggestions should aid the clinicians in avoiding premature termination, and fostering both a positive therapeutic alliance and a successful treatment outcome.