Evolution of personality disorder diagnosis in the Diagnostic and Statistical Manual of Mental Disorders.

This article reviews the history and evolution of the diagnosis of personality disorders according to the Diagnostic and Statistical Manual of Mental Disorders (DSM) from its first edition in 1952 through its fourth edition in 1994. The article also traces the earliest origins of personality disorders (e.g., Hippocrates) through the modern foundational works of Pritchard, Schneider, and Horney. Analysis of the changes across the editions of the DSM suggest slow but steady progress in the clarification and classification of personality disorders, although formidable challenges remain. A call for future research as to reliability and validity of personality disorders is made, and suggestions for research are offered.

Heritability and the comorbidity of attention deficit hyperactivity disorder with behavioral disorders and executive function deficits: a preliminary investigation.

The heritability and comorbidity of attention deficit hyperactivity disorder (ADHD) with conduct disorder (CD), oppositional defiant disorder (ODD), and executive function (EF) deficits were examined in 224 child twins (140 monozygotic and 84 dizygotic). The Coolidge Personality and Neuropsychological Inventory for Children (Coolidge, 1998), a standardized, 200-item, Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) aligned, parent-as-respondent inventory, assessed psychopathology. Structural equation model fitting revealed that the individual scale heritabilities were substantial: .82 for ADHD, .74 for CD, .61 for ODD, and .77 for EF deficits. The results of the multivariate twin analyses suggest that ADHD shares most of its genetic liability with CD, ODD, and EF deficits. Thus, the findings argue for a common biological risk underlying these commonly comorbid externalizing behavior problems and cognitive deficits. The residual genetic variance provides preliminary support for additional genetic influences underlying CD, ODD, and EF that are independent of ADHD.

A convergent validity study of Cloninger's Temperament and Character Inventory with the Coolidge Axis II Inventory.

This study examined the convergent validity of the Temperament and Character Inventory (TCI), a measure of four biosocial temperaments and three character dimensions with the Coolidge Axis II Inventory (CATI), a measure of 14 personality disorders. A nonclinical sample of 163 college students was given both measures, and the data were analyzed with bivariate and multivariate statistics. Hypotheses generated from the findings of Svrakic, Whitehead, Przybeck, and Cloninger (1993, Archives of General Psychiatry, 50, 991-999) were confirmed for a majority of the relationships between the two measures. The preliminary results provide qualified support for the TCI and Cloninger's biosocial theory in the assessment of personality disorders.

Heritability of personality disorders in childhood: a preliminary investigation.

The heritability of personality disorder features was investigated in 112 child (ages 4-15 years) twin pairs (70 monozygotic and 42 dizygotic pairs). Parents assessed personality disorder features using the Coolidge Personality and Neuropsychological Inventory for Children (CPNI; Coolidge, 1998) that measures 12 personality disorders according to the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (American Psychiatric Association, 1994). Structural equation model-fitting methods indicated that the median heritability coefficient for the 12 scales was .75 (ranging from .81 for the Dependent and Schizotypal Personality Disorder scales to .50 for the Paranoid and Passive-Aggressive Personality Disorder scales). These results suggest that childhood personality disorders have a substantial genetic component and that they are similar to heritability estimates of personality disorder traits in adults and counter hypotheses that only temperaments and higher-order personality disorder traits have significant genetic components (Paris, 1997).

The effects of interference on verbal learning in multiple sclerosis.

Thirty multiple sclerosis (MS) patients were compared with 30 matched (age and education) controls and were asked to learn and recall 20 target words that were placed among 24 distracter words. Targets and distracters were printed on different colored cards, and the subjects were asked to read each word aloud and recall the target words. This task was repeated four times. The MS patients recalled significantly fewer words across the four trials. A second list without distracters was presented for two trials, and there were no significant differences between the groups' recall. Subsequent recall (short delay and long delay) for List 1 revealed significantly poorer recall for the MS group and significantly poorer cued recall but not recognition memory. Retrieval processes were implicated such as source memory, or contextual stamping, rather than encoding mechanisms.

Personality disorders and coping among anxious older adults.

This study examined the interrelationships among anxiety, personality disorders, and coping strategies in anxious older adults (n = 28; age range = 55-89; mean = 66.0), nonanxious older adults (n = 100, age range = 55-79, mean = 64.6 ), and anxious younger adults (n = 132; age range = 17-30; mean = 20.2). Younger participants were college students and older participants were community-based family members of the students or recruits from local senior centers. Participants completed the Coolidge Axis II Inventory, the Coping Orientations to Problems Experienced scale, and the Brief Symptom Inventory. Results indicated that the prevalence of generalized anxiety states was relatively low and similar in both older and younger groups and dependent on measurement scale and criterion. At least one personality disorder was found in 61% of the older persons group; obsessive-compulsive, schizoid, and avoidant were the most frequently assigned personality disorders. Anxious older adults had elevated rates of dependent and avoidant personality disorder compared with nonanxious older adults. Younger anxious persons were found to have significantly greater personality dysfunction compared with older anxious persons. Finally, coping differences existed between older anxious and older nonanxious adults and between older anxious and younger anxious adults. Implications for diagnosis and treatment of anxiety in older adults were discussed.

Executive functions of the frontal lobes: psychometric properties of a self-rating scale.

This study investigated the psychometric properties of a self-rating scale designed to test the executive functions of the frontal lobes. A set of 16 items was selected, based on face validity, from the 200-item Coolidge Axis II Inventory. Cronbach scale reliability for the new scale was .72 on 1,223 purportedly normal participants. A factor analysis yielded a three-factor structure, Decision-making difficulties (8 items, 23% of the variance, scale reliability .77), Poor planning (4 items, 15% of the variance, scale reliability .63), and Task incompletion (6 items, 9% of the variance, scale reliability .66). A multivariate analysis of variance, performed on the overall scale sum and the three subscales, between 17 closed head-injured patients and a matched control group was significant. The head-injured patients scored significantly higher on the over-all measure of executive dysfunction and higher on the decision-making difficulties subscale but not on the other two subscales.

On the relationship of the five-factor personality model to personality disorders: four reservations.

McCrae and Costa since 1986 have proferred a five-factor personality model as a lingua franca among different psychometric test users, and they suggest that their operationalization of the five-factor model, the NEO Personality Inventory, may also be useful in the clinical assessment of the abnormal personality. The present study examined the inventory and its relationship to the 11 personality disorders of Axis II of DSM-III-R in a sample of 180 adults. Correlational multivariate analyses appear to indicate a limited usefulness of the five-factor model in the understanding of personality disorders, and four major objections are offered. Further research with clinical samples, other models of personality, and other measures of personality disorders are encouraged.

Beliefs about mental illness and willingness to seek help: a cross-sectional study.

Evidence indicates that older adults underutilize mental health services, but little is known empirically about the perceptions older adults have about mental illness and their attitudes about seeking professional help for psychological problems. The present study examined beliefs about mental illness and willingness to seek professional help among younger (n=96; M age=20.6 years; range=17-26 years) and older (n=79; M age=75.1 years; range=60-95 years) persons. Participants completed the Beliefs Toward Mental Illness Scale and the Willingness to Seek Help Questionnaire. Older adults had generally similar perceptions of mental illness as younger adults except that older adults were more likely to perceive the mentally ill as being embarrassing and having poor social skills. Older adults also did not report a lower willingness to seek psychological help. Correlational analyses showed that, among older adults, increases in negative attitudes about mental illness (specifically, the view that the mentally ill have poor interpersonal skills) are associated with decreases in willingness to seek psychological services. An implication is that negative stereotypes about mental illness held by some older adults could play a role in their underutilization of mental health services. Other barriers to mental health care are also discussed.

Reliability and validity of the Coolidge Axis II Inventory: a new inventory for the assessment of personality disorders.

This group of studies describes the development of a 200 item, self-report, 4-point true-false inventory (Coolidge Axis II Inventory [CATI]) to assess personality disorders according to the criteria established in the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R]; American Psychiatric Association, 1987). The 13 personality disorder scales of the CATI had a mean test-retest reliability of .90 and a median internal consistency (Cronbach's alpha) of .76. There was a 50% concordance rate with clinician's diagnosis for 24 personality disordered patients. The median concurrent validity (raw score sums) between the CATI and the Millon Clinical Multiaxial Inventory-II for the 13 personality disorder scales was .58. Preliminary studies also support the reliability and validity of Depression, Anxiety, and Brain Dysfunction scales.

Personality profiles of the morbidly obese.

Personality characteristics of 150 morbidly obese patients (100 pounds or more over ideal weight) were investigated. The patients were given the Minnesota Multiphasic Personality Inventory (MMPI) and a new, self-report personality disorder inventory. The study attempted to determine whether particular personality variables could predict success or failure at weight loss six months post-surgery. Multivariate analyses of variance revealed no significant differences on any of the personality variables when the patients were divided into "good," "fair," and "poor" success categories. Rank order MMPI scale profiles and personality disorder profiles are presented and implications discussed.

A comparison of suicidal thinking and reasons for living among younger and older adults.

A cross-sectional design was used to examine age-related differences in suicidal thinking and reasons for living among younger (n = 82; M age = 21) and older (n = 82; M age = 68) adults. Volunteers anonymously completed the Beck Scale for Suicide Ideation and the Reasons for Living Inventory. Findings indicated that older adults do not manifest suicidal ideation differently than younger adults. However, there does appear to be some age-related differences in reasons for not committing suicide. Compared to the younger group, the older group reported moral objections and child-related concerns as stronger reasons for not committing suicide. An implication is that the identification of specific reasons that deter individuals from committing suicide may be clinically useful and provide some assistance in suicide prevention efforts.

Reliability of observer ratings in the assessment of personality disorders: a preliminary study.

A 200-item, self-report personality disorder inventory (Coolidge Axis II Inventory; CATI) was administered to 52 married target subjects. Their spouses and a close friend completed a significant-other form about the targets. The mean correlation across all personality disorder scales was .51 for the targets-spouses, .36 for the targets-friends, and .41 for the spouses-friends. Twenty-eight target-spouse correlations were significant and ranged from .99 to -.40. The mean correlation for the individual 13 personality disorder scales was .46 for target-spouses and ranged from .63 for the histrionic scale to .27 for the paranoid scale. The results were interpreted as establishing a basis for significant other assessment of personality disorders.

Hemispheric asymmetries of affective processing as determined by the Minnesota Multiphasic Personality Inventory.

Patients with left hemisphere disease have been noted to be depressed while those with right hemisphere disease appear indifferent. While patients with left hemisphere disease frequently have a greater cognitive deficit, patients with right hemisphere disease have difficulty in expressing affectively intoned speech. The Minnesota Multiphasic Personality Inventory (MMPI) can demonstrate underlying affective experience and is not dependent on affectively intoned speech. The purpose of this study was to determine whether a difference in affective moods, as assessed by the MMPI, was related to laterality of lesion in patients matched for severity of cognitive and motor dysfunction. Seven of the 16 subjects with left hemisphere dysfunction and none of the eight subjects with right hemisphere dysfunction showed an elevation on the depression scale. This observation not only confirms previous clinical observations but also demonstrates that these asymmetries cannot be ascribed completely to hemisphere-related differences in cognitive deficits or expressive abilities.

WAIS profiles in mentally retarded adults.

The present study investigated WAIS indices of scatter in a sample of 83 mentally retarded adults (FIQ, means = 58). Overall subtest scatter was significantly correlated with VIQ, PIQ and FIQ. There was no significant relationship between the discrepancy score (absolute value of the difference between VIQ and PIQ), and VIQ, PIQ and FIQ. The scatter and discrepancy score means were surprisingly large. Analysis of VIQ and PIQ configuration revealed that VIQ greater than PIQ, and PIQ greater than VIQ occurred with nearly equal frequency.