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Two-Year Stability And Change Of Schizotypal, Borderline, Avoidant And Obsessive-Compulsive Personality Disorders, Carlos M. Grilo, M. Tracie Shea, Charles A. Sanislow, Andrew E. Skodol, John G. Gunderson, Robert L. Stout, Maria E. Pagano, Shirley Yen, Leslie C. Morey, Mary C. Zanarini, Thomas H. Mcglashan

Charles A. Sanislow, Ph.D.

he authors examined the stability of schizotypal (STPD), borderline (BPD), avoidant (AVPD) and obsessive-compulsive (OCPD) personality disorders (PDs) over 2 years of prospective multiwave follow-up. Six hundred thirty-three participants recruited at 4 collaborating sites who met criteria for 1 or more of the 4 PDs or for major depressive disorder (MOD) without PD were assessed with semistructured interviews at baseline, 6, 12, and 24 months. Lifetable survival analyses revealed that the PD groups had slower time to remission than the MDD group. Categorically, PD remission rates range from 50% (AVPD) to 61% (STPD) for dropping below diagnostic threshold on a …

Major Depressive Disorder And Borderline Personality Disorder Revisited: Longitudinal Interactions, John G. Gunderson, Leslie C. Morey, Robert L. Stout, Andrew E. Skodol, M. Tracie Shea, Thomas H. Mcglashan, Mary C. Zanarini, Carlos M. Grilo, Charles A. Sanislow, Shirley Yen, Maria T. Daversa, Donna S. Bender

Charles A. Sanislow, Ph.D.

BACKGROUND: This report investigates the longitudinal association of changes in major depressive disorder (MDD) and borderline personality disorder.

METHOD: A DSM-IV-diagnosed sample of 161 patients with borderline personality disorder who have been followed with repeated measures at 6, 12, 24, and 36 months are investigated to see whether those with co-occurring MDD differ at baseline and in their course. Proportional hazard regression and cross-lagged panel analyses are used to demonstrate whether changes in the course of either disorder have predictable effects on the course of the other.

RESULTS: The rate of remissions of borderline personality disorder was not affected by …

Longitudinal Diagnostic Efficiency Of Dsm-Iv Criteria For Obsessive–Compulsive Personality Disorder: A 2-Year Prospective Study, Carlos M. Grilo, Andrew E. Skodol, John G. Gunderson, Charles A. Sanislow, Robert L. Stout, M. Tracie Shea, Leslie C. Morey, Mary C. Zanarini, Donna S. Bender, Shirley Yen, Thomas H. Mcglashan

Charles A. Sanislow, Ph.D.

Objective: To examine the longitudinal diagnostic efficiency of the DSM-IV criteria for obsessive–compulsive personality disorder (OCPD).

Method: At baseline, criteria and diagnoses were determined using diagnostic interviews, and blinded assessments were performed 24 months later with 550 participants. Diagnostic efficiency indices (conditional probabilities, total predictive power, and kappa) were calculated for each criterion determined at baseline, using the independent OCPD diagnosis at follow-up as the standard.

Results: Longitudinal diagnostic efficiencies for the OCPD criteria varied; findings suggested the overall predictive utility of preoccupied with details, rigid and stubborn, and reluctant to delegate.

Conclusion: These findings suggest the predictive validity of …

The Longitudinal Relationship Of Personality Traits And Disorders, Megan B. Warner, Leslie C. Morey, John F. Finch, John G. Gunderson, Andrew E. Skodol, Charles A. Sanislow, M. Tracie Shea, Thomas H. Mcglashan, Carlos M. Grilo

Charles A. Sanislow, Ph.D.

Personality disorders are presumed to be stable because of underlying stable and maladaptive personality traits, but while previous research has demonstrated a link between personality traits and personality disorders cross-sectionally, personality disorders and personality traits have not been linked longitudinally. This study explores the extent to which relevant personality traits are stable in individuals diagnosed with 4 personality disorders (schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders) and examines the assumption that these personality disorders are stable by virtue of stable personality traits. This assumption was tested via the estimation of a series of latent longitudinal models that evaluated whether changes …

Testing An Apa Practice Guideline: Symptom-Targeted Medication Utilization For Patients With Borderline Personality Disorder, John M. Oldham, Donna S. Bender, Andrew E. Skodol, Ingrid R. Dyck, Charles A. Sanislow, Shirley Yen, Carlos M. Grilo, M. Tracie Shea, Mary C. Zanarini, John G. Gunderson, Thomas H. Mcglashan

Charles A. Sanislow, Ph.D.

BACKGROUND: The goal of this study was to test whether the use of psychotropic medication treatment for borderline personality disorder (BPD) was consistent with proposals in the recently published American Psychiatric Association's Practice Guideline for the Treatment of Patients with Borderline Personality Disorder.

METHOD: Medication utilization by patients with BPD was assessed prospectively over a 2-year period prior to the publication of the Guideline. Three BPD symptom clusters--cognitive-perceptual, affective dysregulation, and impulsive-behavioral dyscontrol--along with demographic and functioning variables were used to predict the use of five classes of medication.

RESULTS: Symptoms of impulsive-behavioral dyscontrol significantly predicted use of both neuroleptics …

Childhood Maltreatment Associated With Adult Personality Disorders: Findings From The Collaborative Longitudinal Personality Disorders Study, Cynthia L. Battle, M. Tracie Shea, Dawn M. Johnson, Caron Zlotnick, Mary C. Zanarini, Charles A. Sanislow, Andrew E. Skodol, John G. Gunderson, Carlos M. Grilo, Thomas H. Mcglashan, Leslie C. Morey

Charles A. Sanislow, Ph.D.

No abstract provided.

Borderline Personality Disorder Criteria Associated With Prospectively Observed Suicidal Behavior, Shirley Yen, M. Tracie Shea, Charles A. Sanislow, Carlos M. Grilo, Andrew E. Skodol, John G. Gunderson, Thomas H. Mcglashan, Mary C. Zanarini, Leslie C. Morey

Charles A. Sanislow, Ph.D.

OBJECTIVE: The authors prospectively examined associations between each DSM-IV borderline personality disorder criterion and suicidal behaviors.

METHOD: Borderline personality disorder diagnosis and criteria, major depressive disorder, substance use disorders, and history of childhood sexual abuse were assessed with semistructured interviews. Participants (N=621) were followed for 2 years with repeated structured evaluations that included assessments of suicidality.

RESULTS: With the self-injury criterion excluded, the borderline personality disorder criteria of affective instability, identity disturbance, and impulsivity significantly predicted suicidal behaviors. Only affective instability and childhood sexual abuse were significantly associated with suicide attempts (i.e., behavior with some intent to die).

CONCLUSIONS: Affective …

Clinical Features And Impairment In Women With Borderline Personality Disorder (Bpd) With Post-Traumatic Stress Disorder (Ptsd), Bpd Without Ptsd, And Other Personality Disorders With Ptsd, Caron Zlotnick, Dawn M. Johnson, Shirley Yen, Cynthia Battle, Charles A. Sanislow, Andrew E. Skodol, Carlos M. Grilo, Thomas H. Mcglashan, John G. Gunderson, Donna S. Bender, Mary C. Zanarini, M. Tracie Shea

Charles A. Sanislow, Ph.D.

The aims of this study were to examine differences in clinical features, impairment, and types of childhood traumas among women with borderline personality disorder (BPD), women with BPD and posttraumatic stress disorder (PTSD), and those with other personality disorders and PTSD. Using baseline data from the Collaborative Longitudinal Study of Personality Disorders, 186 women were divided into 3 groups (BPD+PTSD, BPD, PTSD), based on structured diagnostic interviews for Axis I and Axis II disorders and compared on selected clinical variables. The additional diagnosis of PTSD in borderline women did not significantly increase the degree of borderline pathology and psychiatric morbidity …

The Representation Of Four Personality Disorders By The Schedule For Nonadaptive And Adaptive Personality Dimensional Model Of Personality, Leslie C. Morey, Megan B. Warner, M. Tracie Shea, John G. Gunderson, Charles A. Sanislow, Carlos M. Grilo, Andrew E. Skodol, Thomas H. Mcglashan

Charles A. Sanislow, Ph.D.

This study examined the relationships of the Schedule for Nonadaptive and Adaptive Personality (SNAP) model of personality to 4 targeted personality disorders (PDs) in a large multisite sample of patients. Data were examined from 529 patients, who were assigned 1 of 5 primary diagnoses: borderline, schizotypal, avoidant, and obsessive–compulsive PDs and major depression without PD. Patients were administered the SNAP questionnaire and results were compared among diagnostic groups and between patient groups and nonclinical norms. Results indicated that the dimensions of the model appear to have considerable promise in differentiating normal from abnormal personality, particularly in the propensity of individuals …

Axis I And Ii Disorders As Predictors Of Prospective Suicide Attempts: Findings From The Collaborative Longitudinal Personality Disorders Study, Shirley Yen, M. Tracie Shea, Maria Pagano, Charles A. Sanislow, Carlos M. Grilo, Thomas H. Mcglashan, Andrew E. Skodol, Donna S. Bender, Mary C. Zanarini, John G. Gunderson, Leslie C. Morey

Charles A. Sanislow, Ph.D.

This study examined diagnostic predictors of prospectively observed suicide attempts in a personality disorder (PD) sample. During 2 years of follow-up, 58 participants (9%) reported at least 1 definitive suicide attempt. Predictors that were examined include 4 PD diagnoses and selected Axis I diagnoses (baseline and course). Multivariate logistic regression analyses indicated that baseline borderline personality disorder (BPD) and drug use disorders significantly predicted prospective suicide attempts. Controlling for baseline BPD diagnosis, proportional hazards analyses showed that worsening in the course of major depressive disorder (MDD) and of substance use disorders in the month preceding the attempt were also significant …

Gender Differences In Borderline Personality Disorder: Findings From The Collaborative Longitudinal Personality Disorders Study, Dawn M. Johnson, M. Tracie Shea, Shirley Yen, Cynthia L. Battle, Caron Zlotnick, Charles A. Sanislow, Carlos M. Grilo, Andrew E. Skodol, Donna S. Bender, Thomas H. Mcglashan, John G. Gunderson, Mary C. Zanarini

Charles A. Sanislow, Ph.D.

A majority of the literature on borderline personality disorder (BPD) focuses on its occurrence in women or does not specifically assess for gender differences in clinical presentations. Some studies report that men with BPD may be more likely to be diagnosed with substance use disorders, as well as paranoid, passive-aggressive, narcissistic, sadistic, and antisocial personality disorders (PDs). Additionally, women with BPD appear to be more likely to report histories of adult physical and sexual abuse and to meet diagnostic criteria for post-traumatic stress disorder (PTSD) and eating disorders. The purpose of the present study was to further examine gender differences …

Plausibility And Possible Determinants Of Sudden 'Remissions' In Borderline Patients, John G. Gunderson, Donna S. Bender, Charles A. Sanislow, Shirley Yen, Jennifer Bame Rettew, Regina Dolan-Sewell, Ingrid R. Dyck, Leslie C. Morey, Thomas H. Mcglashan, M. Tracie Shea, Andrew E. Skodol

Charles A. Sanislow, Ph.D.

THIS STUDY documents dramatic improvements in patients with borderline personality disorder (BPD) and explores their possible determinants. From a sample of the 160 carefully diagnosed borderline patients on whom prospective follow-along data was collected, a subsample of 18 was identified whose DSM-IV criteria count fell to two or fewer during the course of the first 6 months of the study and retained that improvement for the next 6 months. Follow-along data including month-by-month ratings of BPD criteria; week-by-week ratings of Axis I disorders, medication changes, and life events were then used to establish concensus ratings on four hypothesized causes: Axis …

Functional Impairment In Patients With Schizotypal, Borderline, Avoidant, And Obsessive-Compulsive Personality Disorder, Andrew E. Skodol, John G. Gunderson, Thomas H. Mcglashan, Ingrid R. Dyck, Robert L. Stout, Donna S. Bender, Carlos M. Grilo, M. Tracie Shea, Mary C. Zanarini, Leslie C. Morey, Charles A. Sanislow, John M. Oldham

Charles A. Sanislow, Ph.D.

Objective: The purpose of this study was to compare psychosocial functioning in patients with schizotypal, borderline, avoidant, or obsessive-compulsive personality disorder and patients with major depressive disorder and no personality disorder.

Method: Patients (N=668) were recruited by the four clinical sites of the Collaborative Longitudinal Personality Disorders Study. The carefully diagnosed study groups were compared on an array of domains of psychosocial functioning, as measured by the Longitudinal Interval Follow-Up Evaluation—Baseline Version and the Social Adjustment Scale.

Results: Patients with schizotypal personality disorder and borderline personality disorder were found to have significantly more impairment at work, in social relationships, and …

Confirmatory Factor Analysis Of The Dsm-Iv Criteria For Borderline Personality Disorder: Findings From The Collaborative Longitudinal Personality Disorders Study, Charles A. Sanislow, Carlos M. Grilo, Leslie C. Morey, Donna S. Bender, Andrew E. Skodol, John G. Gunderson, M. Tracie Shea, Robert L. Stout, Mary C. Zanarini, Thomas H. Mcglashan

Charles A. Sanislow, Ph.D.

Objective: This study tested the factor structure of the DSM-IV criteria for borderline personality disorder by using confirmatory methods for the analysis of covariance structures in a large group from a multisite study.

Method: A total of 668 primarily treatment-seeking subjects were reliably assessed for personality disorders by using the Diagnostic Interview for DSM-IV Personality Disorders. Associations among criteria for borderline personality disorder were examined. A confirmatory factor analysis was performed to test diagnosis as a unitary construct and to test an earlier-reported three-factor model comprising disturbed relatedness, behavioral dysregulation, and affective dysregulation. The three-factor model was subsequently tested by …

Confirmatory Factor Analysis Of Dsm-Iv Schizotypal, Borderline, Avoidant, And Obsessive-Compulsive Personality Disorders: Findings From The Collaborative Longitudinal Study Of Personality Disorders, Charles A. Sanislow, Leslie C. Morey, Carlos M. Grilo, John G. Gunderson, M. Tracie Shea, Andrew E. Skodol, Robert L. Stout, Mary C. Zanarini, Thomas H. Mcglashan

Charles A. Sanislow, Ph.D.

Objective: To test the diagnostic constructs implied by DSM-IV Axis-II personality disorders by examining relationships between different combinations of DSM-IV criteria.

Method: Confirmatory factor analysis was used to test the borderline, schizotypal, avoidant and obsessive-compulsive personality disorder constructs in a large treatment-seeking sample (N=668) from a multisite study. A model based on the three DSM-IV Axis II clusters was also tested. Both models were tested against a unitary ‘generic’ model constructed from four criteria sets combined.

Results: Goodness-of-fit for both the three-cluster and four disorder models was significantly better than the unidimensional model, and the four-disorder model was significantly better …

Internal Consistency And Intercriterion Overlap Within And Between Dsm-Iv Axis Ii Personality Disorders: Findings From The Collaborative Longitudinal Study Of Personality Disorders, Carlos M. Grilo, Thomas H. Mcglashan, Leslie C. Morey, John G. Gunderson, Andrew E. Skodol, M. Tracie Shea, Charles A. Sanislow, Mary C. Zanarini, Donna S. Bender, John M. Oldham, Ingrid Dyck, Robert L. Stout

Charles A. Sanislow, Ph.D.

Objective: To evaluate performance characteristics of DSM-IV Personality Disorders (PDs) criteria.

Method: Six hundred and sixty-eight adults recruited for the Collaborative Longitudinal Personality Disorders Study (CLPS) were assessed with diagnostic interviews.

Results: Within-category inter-relatedness was evaluated by Cronbach’s alpha and median intercriterion correlations (MIC). Cronbach’s alpha ranged from 0.47 to 0.87 (median=0.71); seven of the 10 PDs had alphas greater than 0.70. Between-category criterion overlap was evaluated by ‘inter-category’ intercriterion correlations between all PD pairs (ICMIC). ICMIC values (median=0.08) were lower than MIC values (median=0.23). Diagnostic efficiency statistics (sensitivity, specificity, positive predictive power and negative predictive power were calculated for …

Treatment Utilization By Patients With Personality Disorders, Donna S. Bender, Regina T. Dolan, Andrew E. Skodol, Charles A. Sanislow, Ingrid R. Dyck, Thomas H. Mcglashan, M. Tracie Shea, Mary C. Zanarini, John M. Oldham, John G. Gunderson

Charles A. Sanislow, Ph.D.

Objective: Utilization of mental health treatment was compared in patients with personality disorders and patients with major depressive disorder without personality disorder.

Method: Semistructured interviews were used to assess diagnosis and treatment history of 664 patients in four representative personality disorder groups—schizotypal, borderline, avoidant, and obsessive-compulsive—and in a comparison group of patients with major depressive disorder.

Results: Patients with personality disorders had more extensive histories of psychiatric outpatient, inpatient, and psychopharmacologic treatment than patients with major depressive disorder. Compared to the depression group, patients with borderline personality disorder were significantly more likely to have received every type of psychosocial treatment …

The Collaborative Longitudinal Personality Disorders Study: Reliability Of Axis I And Ii Diagnoses., Mary C. Zanarini, Andrew E. Skodol, Donna S. Bender, Regina T. Dolan, Charles A. Sanislow, Elizabeth Schaefer, Leslie C. Morey, Carlos M. Grilo, M. Tracie Shea, Thomas H. Mcglashan, John G. Gunderson

Charles A. Sanislow, Ph.D.

Both the interrater and test-retest reliability of axis I and axis II disorders were assessed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and the Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV). Fair-good median interrater K (.40-.75) were found for all axis II disorders diagnosed five times or more, except antisocial personality disorder (1.0). All of the test-retest K for axis II disorders, except for narcissistic personality disorder (1.0) and paranoid personality disorder (.39), were also found to be fair-good. Interrater and test-retest dimensional reliability figures for axis II were generally higher than those for their categorical …