Psychology Commons^™

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 …

The Natural Course Of Bulimia Nervosa And Eating Disorder Not Otherwise Specified Is Not Influenced By Personality Disorders, Carlos M. Grilo, Charles A. Sanislow, M. Tracie Shea, Andrew E. Skodol, Robert L. Stout, Maria E. Pagano, Shirley Yen, Thomas H. Mcglashan

Charles A. Sanislow, Ph.D.

Objective: To examine prospectively the natural course of bulimia nervosa (BN) and eating disorder not otherwise specified (EDNOS) and to test the effects of personality disorder (PD) comorbidity on the outcomes.

Method: Ninety-two female patients with current BN (N ¼ 23) or EDNOS (N ¼ 69) were evaluated at baseline enrollment in the Collaborative Longitudinal Personality Disorders Study (CLPS). Eating disorders (EDs) were assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders. Personality disorders (PDs) were assessed with the Diagnostic Interview for DSM-IV PD (DIPD-IV). The course of BN and EDNOS was assessed with the Longitudinal Interval Follow-up …

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 …

Do Eating Disorders Co-Occur With Personality Disorders? Comparison Groups Matter., Carlos M. Grilo, Charles A. Sanislow, Andrew E. Skodol, John G. Gunderson, Robert L. Stout, M. Tracie Shea, Mary C. Zanarini, Donna S. Bender, Leslie C. Morey, Ingrid R. Dyck, Thomas H. Mcglashan

Charles A. Sanislow, Ph.D.

OBJECTIVE: To assess and compare lifetime rates of occurrence of eating disorders (ED) with four Axis II personality disorders (PD) and with major depressive disorder (MDD) without PD. The eating disorders met criteria outlined in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

METHOD: Six hundred sixty-eight patients recruited for the Collaborative Longitudinal Personality Disorders Study (CLPS) were reliably assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders and the Diagnostic Interview for DSM-IV Personality Disorders. The distribution of ED diagnoses was compared among four PD study groups (schizotypal, borderline, avoidant, obsessive-compulsive) and …

Representations Of Therapists By Patients With Personality Disorders, Donna S. Bender, Barry A. Farber, Charles A. Sanislow, Ingrid R. Dyck, Jesse D. Geller, Andrew E. Skodol

Charles A. Sanislow, Ph.D.

The purpose of this study was to investigate attributes of mental representations of therapists by patients with specific personality disorders (PDs), schizotypal (STPD), borderline (BPD), avoidant (AVPD), and obsessive-compulsive (OCPD), and a comparison group with Major Depressive Disorder and no PD (MDD). The Therapist Representation Inventory-II (TRI) measured characteristics of participants' extra-session thoughts about their therapists. Results showed that patients with STPD had the highest level of mental involvement with therapy outside the session, missing their therapists and wishing for friendship, while also feeling aggressive or negative. Patients with BPD exhibited the most difficulty in creating a benign image of …

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 …

Substance Or Style? An Investigation Of The Neo-Pi-R Validity Scales, Leslie C. Morey, Brian D. Quigley, Charles A. Sanislow, Andrew E. Skodol, Thomas H. Mcglashan, M. Tracie Shea, Robert L. Stout, Mary C. Zanarini, John G. Gunderson

Charles A. Sanislow, Ph.D.

The Revised NEO Personality Inventory (NEO-PI-R; Costa & McCrae, 1992b) has been criticized for the absence of validity scales designed to detect response distortion. Recently, validity scales were developed from the items of the NEO-PI-R (Schinka, Kinder, & Kremer, 1997) and several studies have used a variety of methods to test their use. However, it is controversial whether these scales are measuring something that is substantive (such as psychopathology or its absence) or stylistic (which might be effortful distortion or less conscious processes such as lack of insight). In this study, we used a multimethod-multitrait approach to examine the validity …

Traumatic Exposure And Posttraumatic Stress Disorder In Borderline, Schizotypal, Avoidant, And Obsessive-Compulsive Personality Disorders: Findings From The Collaborative Longitudinal Personality Disorders Study, Shirley Yen, M. Tracie Shea, Cynthia L. Battle, Dawn M. Johnson, Caron Zlotnick, Regina Dolan-Sewell, Andrew E. Skodol, Carlos M. Grilo, John G. Gunderson, Charles A. Sanislow, Mary C. Zanarini, Donna S. Bender, Jennifer B. Rettew, Thomas H. Mcglashan

Charles A. Sanislow, Ph.D.

The association between trauma and personality disorders (PDs), while receiving much attention and debate, has not been comprehensively examined for multiple types of trauma and PDs. The authors examined data from a multisite study of four PD groups: schizotypal, borderline (BPD), avoidant, and obsessive-compulsive, and a major depression comparison group. Rates of traumatic exposure to specific types of trauma, age of first trauma onset, and rates of posttraumatic stress disorder are compared. Results indicate that BPD participants reported the highest rate of traumatic exposure (particularly to sexual traumas, including childhood sexual abuse), the highest rate of posttraumatic stress disorder, and …

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 …

Schizophrenia: A Critical Examination, Charles A. Sanislow, Robert C. Carson

Charles A. Sanislow, Ph.D.

No abstract provided.

Factor Analysis Of The Dsm-Iii-R Borderline Personality Disorder Criteria In Psychiatric Inpatients, Charles A. Sanislow, Carlos M. Grilo, Thomas H. Mcglashan

Charles A. Sanislow, Ph.D.

Objective: The goal of this study was to examine the factor structure of the DSM-III-R criteria for borderline personality disorder in young adult psychiatric inpatients.

Method: The authors assessed 141 acutely ill inpatients with the Personality Disorder Examination, a semistructured diagnostic interview for DSM-III-R personality disorders. They used correlational analyses to examine the associations among the different criteria for borderline personality disorder and performed an exploratory factor analysis.

Results: Cronbach’s coefficient alpha for the borderline personality disorder criteria was 0.69. A principal components factor analysis with a varimax rotation accounted for 57.2% of the variance and revealed three homogeneous factors. …

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 …