Search

Based on the Baltimore Epidemiologic Catchment Area (ECA) follow-up survey, we examined relationships between dimensions of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) personality disorders and both subjective and objective memory functioning in a community population. Our study subjects consisted of 736 individuals from the ECA follow-up study of the original Baltimore ECA cohort, conducted between 1993 and 1996 and available for assessment in the Hopkins Epidemiology Study of Personality Disorders from 1997 to 1999. Subjects were assessed for DSM-IV personality disorders using a semi-structured instrument, the International Personality Disorder Examination, and were asked about a subjective appraisal of memory. Verbal memory function, including immediate recall, delayed recall, and recognition, were also evaluated. Multiple linear regression analyses were used to determine associations between personality dimensions of DSM-IV Axis II traits and subjective and objective memory functioning. Scores on schizoid and schizotypal personality dimensions were associated with subjective and objective memory dysfunction, both with and without adjustment for Axis I disorders. Borderline, antisocial, avoidant, and dependent personality disorder scores were associated with subjective memory impairment only, both with and without adjustment for Axis I disorders. This study suggests that subjective feelings of memory impairment and/or objective memory dysfunction are associated with specific personality disorder dimensions., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Background: Studies have criticized the low level of agreement between the various methods of personality disorder (PD) assessment. This is an important issue for research and clinical purposes., Method: Seven hundred and forty-two participants in the Hopkins Epidemiology of Personality Disorders Study (HEPS) were assessed on two occasions using the Personality Disorder Schedule (PDS) and the International Personality Disorder Examination (IPDE). The concordance between the two diagnostic methods for all DSM-IV PDs was assessed using standard methods and also two item response analytic approaches designed to take account of measurement error: a latent trait-based approach and a generalized estimating equations (GEE)-based approach, with post-hoc adjustment., Results: Raw criteria counts, using the intraclass correlation coefficient (ICC), κ and odds ratio (OR), showed poor concordance. The more refined statistical methods showed a moderate to moderately high level of concordance between the methods for most PDs studied. Overall, the PDS produced lower prevalences of traits but higher precision of measurement than the IPDE. Specific criteria within each PD showed varying endorsement thresholds and precision for ascertaining the disorder., Conclusions: Concordance in the raw measurement of the individual PD criteria between the two clinical methods is lacking. However, based on two statistical methods that adjust for differential endorsement thresholds and measurement error in the assessments, we deduce that the PD constructs themselves can be measured with a moderate degree of confidence regardless of the clinical approach used. This may suggest that the individual criteria for each PD are, in and of themselves, less specific for diagnosis, but as a group the criteria for each PD usefully identify specific PD constructs.

Background: The serotonin transporter (SERT) polymorphism (5HTTLPR) has been reported to be associated with several psychiatric conditions. Specific personality disorders could be intermediate factors in the known relationship between 5HTTLPR and psychiatric disorders. This is the first study to test the association between this polymorphism and dimensions of all DSM-IV personality disorders in a community sample., Methods: 374 white participants were assessed by clinical psychologists using the International Personality Disorder Examination (IPDE). Associations between dimensions of each DSM-IV personality disorder and the long (l) and short (s) alleles of the 5HTTLPR were evaluated using non-parametric tests and regression models., Results: The s allele of the 5HTTLPR polymorphism was significantly associated with higher avoidant personality trait scores in the whole sample. Males with the s allele had a significantly lower likelihood of higher obsessive-compulsive personality disorder (OCPD) trait scores, whereas females with the s allele were likely to have higher OCPD personality trait scores., Conclusion: This paper provides preliminary data on the relationship between personality disorders and the 5HTTLPR polymorphism. The relationship of the s allele and avoidant PD is consistent with findings of a nonspecific relationship of this polymorphism to anxiety and depressive disorders. Concerning the unusual sexual dimorphic result with OCPD, several hypotheses are presented. These findings need further replication, including a more detailed study of additional variants in SERT., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Background: Over the past several decades, the relationship between personality traits and heart disease has interested clinicians and researchers alike., Objective: The authors investigated personality disorders (PDs) and PD dimensional traits as prospective risk factors for incident cardiovascular disease (CVD) in the Baltimore Epidemiologic Catchment Area (ECA) follow-up study., Method: In 1981, 244 community residents were examined for DSM-III PDs, and PD dimensional traits and were followed for incident CVD by 2004., Results: Logistic-regression models with or without adjustment for potential confounders revealed that Cluster B PD and PD dimensional traits at baseline were consistently associated with increased risk of incident CVD by 2004. Post-hoc analysis also revealed that Cluster B PD and traits also predict CVD mortality., Conclusion: Cluster B PDs and dimensional traits may be independent risk factors for incident CVD in the community.

Background: Stability of personality disorders is assumed in most nomenclatures; however, the evidence for this is limited and inconsistent. The aim of this study is to investigate the stability of DSM-III personality disorders in a community sample of eastern Baltimore residents unselected for treatment., Methods: Two hundred ninety four participants were examined on two occasions by psychiatrists using the same standardized examination twelve to eighteen years apart. All the DSM-III criteria for personality disorders were assessed. Item-response analysis was adapted into two approaches to assess the agreement between the personality measures on the two occasions. The first approach estimated stability in the underlying disorder, correcting for error in trait measurement, and the second approach estimated stability in the measured disorder, without correcting for item unreliability., Results: Five of the ten personality disorders exhibited moderate stability in individuals: antisocial, avoidant, borderline, histrionic, and schizotypal. Associated estimated ICCs for stability of underlying disorder over time ranged between approximately 0.4 and 0.7-0.8. A sixth disorder, OCPD, exhibited appreciable stability with estimated ICC of approximately 0.2-0.3. Dependent, narcissistic, paranoid, and schizoid disorders were not demonstrably stable., Conclusions: The findings suggest that six of the DSM personality disorder constructs themselves are stable, but that specific traits within the DSM categories are both of lesser importance than the constructs themselves and require additional specification.

Determining how personality disorder traits and panic disorder and/or agoraphobia relate longitudinally is an important step in developing a comprehensive understanding of the etiology of panic/agoraphobia. In 1981, a probabilistic sample of adult (> or =18 years old) residents of east Baltimore were assessed for Axis I symptoms and disorders using the Diagnostic Interview Schedule (DIS); psychiatrists reevaluated a subsample of these participants and made Axis I diagnoses, as well as ratings of individual Diagnostic and Statistical Manual of Mental Disorders, Third Edition personality disorder traits. Of the participants psychiatrists examined in 1981, 432 were assessed again in 1993 to 1996 using the DIS. Excluding participants who had baseline panic attacks or panic-like spells from the risk groups, baseline timidity (avoidant, dependent, and related traits) predicted first-onset DIS panic disorder or agoraphobia over the follow-up period. These results suggest that avoidant and dependent personality traits are predisposing factors, or at least markers of risk, for panic disorder and agoraphobia-not simply epiphenomena.

This study compared the latent structure of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition personality disorders (PDs) with the 5-factor model (FFM) of general personality dimensions. The subjects in the study were 742 community-residing individuals who participated in the Hopkins Epidemiology of Personality Disorders Study. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition PD traits were assessed by psychologists using the International Personality Disorder Examination, and PD dimensions were derived previously using dichotomous factor analysis. The Revised NEO Personality Inventory, a measure of the FFM, was administered to all subjects. The relationship between the 2 sets of personality-related constructs was examined using a construct validity framework and also using Pearson correlation coefficients, multiple linear regression models, and spline regression models. The 5 PD factors each exhibited small to moderate correlations with several NEO dimensions; together, the NEO domain and facet scores explained a fifth to a third of the variance in PD dimensions. Examples of nonlinear relationships between the personality dimensions were identified. There is a modest correspondence between the PD dimensions and FFM traits, and the traits of FFM only partially explain the variance of the PDs. Dimensional measures of general personality may be a suitable alternative to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Whether additional maladaptive traits would better define the domain of PDs remains an important objective for future research.

Aims: This study investigated the internal construct validity of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) personality disorders and explored alternative models to characterize the personality disorder traits. The relationship between the obtained personality disorder dimensions and measures of functioning and disability was examined., Methods: The subjects in the study were 742 community-residing individuals who participated in the Hopkins Epidemiology of Personality Disorders Study. The presence of DSM-IV personality disorder traits was assessed by psychologists using the International Personality Disorder Examination (IPDE). Confirmatory factor analysis was performed on all the IPDE criteria for each of the 10 personality disorders using the Mplus program. Exploratory factor analysis of all personality disorder traits was completed using the same program. Factor scores were correlated with subjects' GAF ratings and number of missed days from work for physical and psychological reasons., Results: A single underlying factor was found for the IPDE item criteria of avoidant and dependent personality disorder, with less evidence for the other 8 personality disorders. Five factors were retained as the dimensional accounting for the personality disorder criteria. These factors were named compulsive, neurotic avoidant, aloof, impulsive callous, and egocentric. Of the five factors, 4 were associated with evidence of diminished functioning., Conclusions: The IPDE pathological personality traits did not empirically cluster according to the current DSM-IV axis II diagnostic system but instead defined 5 relatively independent PD symptom dimensions that were related to functional impairments.

Background: Little is known about the long-term outcome of personality disorder traits. The purpose of this study was to investigate, in a community-residing population, the longitudinal relationship between psychiatrist-assessed personality disorder scores and global functioning 13-18 years later., Method: A stratified random sample of residents of east Baltimore were examined by psychiatrists in 1981 and asssessed for DSM-III personality disorders using a semi-structured instrument, the Standardized Psychiatric Examination. A total of 292 persons were re-examined by different psychiatrists during 1994-1999 using the Schedules for the Assessment of Neuropsychiatry (SCAN). After completion of the SCAN, the subjects' functional status was evaluated using the Global Assessment of Functioning (GAF). The relationships between personality dimensions and follow-up GAF scores were evaluated using linear regression models., Results: All of the personality disorder scales measured in 1981 were inversely related to functioning 13-18 years later, with the exception of narcissistic and compulsive scales. After controlling for Axis I disorders diagnosed contemporaneously with GAF assessment, schizoid, antisocial, borderline, histrionic, and avoidant personality disorder scores significantly predicted GAF scores., Conclusions: Most dimensions of DSM-III personality disorder traits were significantly associated with global functioning after an interval of 15 years. However, only schizoid, antisocial, borderline, histrionic, and avoidant personality disorder traits had long-term effects on functioning when Axis I disorders at follow-up were controlled. This suggests that the functional effect of the other personality disorder traits may be mediated through their relationship with Axis I disorders. Future research is needed using more specific and sensitive outcome measures.

Previous studies have implicated antisocial personality disorder in criminal behavior, but little is known about the association between "normal" personality dimensions and arrest. We investigated the relationships between these personality dimensions and prior arrest in a sample of adults participating in a longitudinal epidemiological study. Between 1993 and 1999, psychiatrists re-examined subjects who were originally interviewed in Baltimore in 1981 as part of the Epidemiologic Catchment Area study; the psychiatrists diagnosed axis I and axis II disorders according to DSM-IV criteria. A total of 611 subjects also completed the Revised NEO Personality Inventory (NEO-PI-R), which assesses five broad factors and 30 facets of normal personality. History of criminal arrest in Maryland in the period 1981 to 1993 was determined from the state criminal justice database. Student's t test and logistic regression were used to evaluate relationships between NEO personality scores and prior arrest. Controlling for demographic characteristics, alcohol or drug use disorders, and DSM-IV personality disorder scores, the odds of prior arrest increased with scores on angry hostility, impulsiveness, and excitement-seeking dimensions. Prior arrest was inversely related to scores on trust, straightforwardness, compliance, modesty, dutifulness, and deliberation dimensions. The results suggest that specific dimensions of normal personality are related to criminal arrest in the community.

There is a considerable literature linking aspects of experienced parenting to later personality disorders. Because dimensionally measured personality disorders are associated with variations in normal personality traits, it is important to understand the contribution of parenting experienced in childhood to later normal personality traits. In this report, 742 community-based individuals, subjects from the Hopkins Epidemiology of Personality Disorders Study, were assessed for normal personality traits, as measured by the Revised NEO Personality Inventory (NEO-PI-R) and the Temperament and Character Inventory (TCI), and for parental behavior experienced as children, as measured by the Parental Bonding Instrument (PBI). The PBI dimensions were significantly, but moderately, correlate with measures of normal personality, the strongest associations being with the NEO-PI-R factors, neuroticism and conscientiousness, and with the TCI factors, self-directedness and harm avoidance. Subjects who reported lower parental care and higher parental intrusiveness were more likely to be higher in neuroticism, lower in conscientiousness, lower in self-directedness, and higher in harm avoidance. Also, trends emerged suggesting both parent-specific and gender-specific differences in the relationship between the PBI dimensions and normal adult personality traits. As variations in normal personality traits are associated with dimensionally measured personality disorders, it is conceivable that the role of parenting in later personality disorder may be mediated by associations between parenting and normal personality traits.

Background: Knowledge of the prevalence and correlates of personality disorders in the community is important for identifying treatment needs and for provision of psychiatric services., Aims: To estimate the prevalence of personality disorders in a community sample and to identify demographic subgroups with especially high prevalence., Method: Clinical psychologists used the International Personality Disorder Examination to assess DSM-IV and ICD-10 personality disorders in a sample of 742 subjects, ages 34-94 years, residing in Baltimore, Maryland. Logistic regression was used to evaluate the association between demographic characteristics and DSM-IV personality disorder clusters., Results: The estimated overall prevalence of DSM-IV personality disorders was 9%. Cluster A disorders were most prevalent in men who had never married. Cluster B disorders were most prevalent in young men without a high school degree, and cluster C disorders in high school graduates who had never married., Conclusions: Approximately 9% of this community sample has a DSM-IV personality disorder. Personality disorders are over-represented in certain demographic subgroups of the community.

High comorbidity among anxiety and depressive conditions is a consistent but not well-understood finding. The current study examines how normal personality traits relate to this comorbidity. In the Baltimore Epidemiologic Catchment Area Follow-up Study, psychiatrists administered the full Schedules for Clinical Assessment in Neuropsychiatry to 320 subjects, all of whom completed the Revised NEO Personality Inventory. The disorders of interest were simple phobia, social phobia, agoraphobia, panic disorder, and major depression. Analyses were carried out with second-order generalized estimating equations. The unadjusted summary odds ratio (SOR - or weighted mean odds ratio) for all five disorders was 1.72 (95% confidence interval=1.21-2.46). Neuroticism, introversion, younger age, and female gender were all significant predictors of prevalence of disorders. After adjustment for the relationships between these personality and demographic predictors and prevalence, the association among disorders was much weaker (SOR=1.11, 95% CI=0.79-1.56). However, subjects with high extraversion had a SOR 213% as high (95% CI=102-444%) as those with low extraversion (1.60 vs. 0.75). Therefore, neuroticism and introversion are associated with increased comorbidity due to relationships in common with the prevalence of the different disorders. In contrast, extraversion is associated with increased comorbidity per se.

The object of this study is to assess the internal validity of DSM-III personality constructs and to explore whether the constituent elements are better explained by an alternate internally coherent classification. A two-stage stratified random sample of subjects identified at the Baltimore site of the Epidemiologic Catchment Area (ECA) program were examined by psychiatrists for DSM-III personality attributes using a semistructured instrument. Dichotomous factor analysis was used in the confirmatory mode to test whether a single factor explained each of the 11 DSM-III personality disorders. This approach rejected a single explanatory factor for all but compulsive personality disorder. Exploratory factor analysis showed that these DSM-III personality features are parsimoniously described by a five-factor model. These factors are warmth, animation, timidity, trust, and scrupulousness.