One-day communities for personality disorder

The U.K. Government and mental-health services have been making attempts to improve services for people with personality disorders. Sometimes these involve residential therapeutic communities but day therapeutic communities which people take part in once a week are more adaptable, local and cheaper. Researchers from the University of Liverpool studied four one-day therapeutic communities in Manchester and Liverpool between November 2005 and July 2008 looking at patients' mental health, social functioning, self-harm and use of services. The patients reported their own levels of health and were assessed by experts. The researchers found that the centres improved the patients' mental health and social functioning but made only slight improvements in their levels of self-harm and their use of services.

Barr, Wally ... [et al] - Quantitative findings from a mixed methods evaluation of once-weekly therapeutic community day services for people with personality disorder Journal of Mental Health, October 2010; 19(5): 412–421

IQ and mental-health problems

Long-term, or longitudinal, studies allow researchers to look back in time to see what factors early in people's lives are associated with them developing mental-health problems later. People who develop schizophrenia later in life tend to have lower IQs when they are younger and a team of researchers led by Annick Urfer-Parnas at Hvidovre Hospital in Denmark looked to see whether the same was true for other mental-health problems. People in Denmark take an IQ test when they are conscripted into the military at 18 and, in a sample of 28,017 people the IQ scores of the 7,486 people who went on to be hospitalised with a mental illness were compared to those of the 20,531 people who didn't. The study found that the people who went on to develop mental-health problems had significantly lower IQs than those who did not. The people with affective disorders had the highest IQ at 18 and those with personality disorders the lowest. For each mental-health problem a lower IQ was associated with an increased risk of becoming a patient.

Urfer-Parnas, A. ... [et al] - Pre-morbid IQ in mental disorders: a Danish draft-board study of 7,486 psychiatric patients Psychological Medicine April 2010, 40(4), 547-556

Narcissism in the workplace

Researchers from Florida State University have been looking into the effects of narcissism in the workplace. They asked more than 1,200 people about their managers and found that

• 31% said that their boss exaggerated their accomplishments to look good in front of others
• 27% said that their boss bragged to other people to get praise
• 25% said that their boss had an inflated view of himself or herself
• 24% said that their boss was self-centred
• 20% said that their boss would only do a favour if they were guaranteed one in return

Those people with a narcissistic boss had lower levels of job satisfaction, higher stress, were less appreciative of their work and organization, reported lower levels of effort and performance and were more prone to sadness and frustration at work. Narcissists can often end up in managerial roles as they are seen as outgoing and confident.

You can find out more about this research at

http://www.sciencedaily.com/releases/2009/08/090807120948.htm

New NICE guidelines on antisocial personality disorder

Antisocial personality disorder (ASPD) is a condition that affects a person’s thoughts, emotions and behaviour in a way that harms other people. People with ASPD are impulsive, quick to anger and can behave in an irresponsible, reckless and deceitful way. They have often grown up in broken homes with lots of rows, where parenting is harsh and inconsistent. Many people with antisocial personality disorder have a criminal conviction and are imprisoned or die prematurely as a result of reckless behaviour.

The National Institute for Clinical Excellence (NICE) published guidance on the 28th of January whic outlines how healthcare professionals can treat, manage and prevent antisocial personality disorder (ASPD).

You can download a copy of the guidelines at

http://www.nice.org.uk/media/187/2B/2009004AntisocialPersonalityDisorder.pdf

Attachment and personality disorders

Attachment styles are patterns of expectations, needs, ways of regulating one's moods and social behaviour. They are believed to stem from our relationship with our primary caregiver - usually our mother - during our first few years of life. A sensitive and consistent response to a child leads to positive models of oneself and others developing but inadequate responsiveness leads to either a negative model of oneself as undeserving of support, or others as fundamentally unreliable. People with negative models of themselves are said to suffer from attachment anxiety. They are hypersensitive to things going wrong in relationships, constantly monitor the situation for signs of abandonment and can be 'clingy.' People with negative models of others downplay the importance of relationships and try not to think about them too much - something psychologists term attachment avoidance. Researchers from New York looked at the links between attachment style and interpersonal problems in a sample of 41 people receiving outpatient treatment for a mental-health problem. They found that people with secure attachment were less likely to be dominant, vindictive, cold, socially-inhibited and non-assertive. People with attachment anxiety were more likely to be cold, vindictive, socially-inhibited and dominant, although they were also more likely to be self-sacrificing. People with attachment avoidance were more likely to be dominant.

Haggerty, Greg, Hilsenroth, Mark J. and Vala-Stewart, Rosemarie - Attachment and interpersonal distress: examining the relationship between attachment styles and interpersonal problems in a clinical population Clinical Psychology and Psychotherapy January-February 2009, 16(1), 1-9

Severe personality disorder: in, out, what's it all about?

Until relatively recently the treatment of choice for people with severe personality disorders was admission for long-term treatment in psychotherapy hospitals or therapeutic communities. However, most of these institutions have closed down and the gap has been filled by partial hospitalization and outpatient, community-based approaches. It is uncertain how these two models compare though so researchers in London contrasted a community-based programme provided by the Cassel Hospital in London with inpatient treatment at the same facility. Their study found that people in the community-based programme improved to a significantly greater degree and had a lower dropout rate than people being treated on an inpatient basis.

Chiesa, Marco, Fonagy, Peter and Gordon, John - Community-based psychodynamic treatment program for severe personality disorders: clinical description and naturalistic evaluation Journal of Psychiatric Practice January 2009, 15(1), 12-24

OCD, OCPD, OCPT and EDs - perfectionism and eating disorders

Obsessive-compulsive personality disorder (OCPD) is different from obsessive-compulsive disorder (OCD) and is defined as 'a pervasive pattern of preoccupation with orderliness, perfection, mental and interpersonal control'. OCPD is associated with eating disorders (EDs) before, during and after they develop but it can be difficult to retrospectively measure people's OCPD in childhood before they developed an ED. A team of researchers at the Institute of Psychiatry in London developed the Childhood Retrospective Perfectionism questionnaire (CHIRP) and surveyed 246 people with an eating disorder, 93 informants (close friends or family members of the people with EDs), and 89 healthy controls. The CHIRP questionnaire was found to be reliable compared to the informants' memories of the ED group as children and interviews with the ED group themselves. The participants with EDs showed more experience of childhood OCPD than the control group and the more symptoms of OCPD people had had in childhood the worse their eating disorder symptoms were.

Southgate, Laura ... [et al] - The development of the Childhood Retrospective Perfectionism questionnaire (CHIRP) in an eating disorder sample European Eating Disorders Review November-December 2008, 16(6), 451-462

Narcissism and leadership

Researchers from Ohio State University at Newark have found that in groups without leaders it is often narcissists who step into the breach. This could be worrying as narcissists tend to be self-centred, exaggerate their talents and abilities and lack empathy for others. In one study 432 undergraduate students completed personality tests, which measured narcissism and were put into groups of four. They were given a hypothetical task selecting next year's director of the student union and afterwards completed a questionnaire evaluating the leadership of themselves and other group members. Those who scored highest on one dimension of narcissism - the desire for power - were more likely to say they wanted to lead the group, were more likely to say they did lead the group discussion and were more likely to be viewed as group leaders by the other group members. In another experiment 408 students were placed in groups of four and asked to choose 15 items from a list to help them survive on a desert island. Again the narcissists were more likely to emerge as leaders of the groups although when their list was compared to a list compiled by survival experts they were no more effective at choosing the best items than other students. In a third study 153 business managers enrolled on an MBA programme were given a task of assuming the role of a school board deciding how to allocate a large donation from a fictional company. This time trained observers sat in on the group and assessed who emerged as the leaders. Once again those highest in narcissism were more likely to emerge as leaders.

You can find out more about this research at

http://psychcentral.com/news/2008/10/08/narcissistic-individuals-are-often-leaders/3087.html

Narcissism and social networking

Around 100 million people now use the social-networking site Facebook. Researchers at the University of Georgia looked into the links between people's Facebook page and their personality, and, in particular, how the content of people's pages correlated with the personality trait of narcissism. Narcissists are superficially charming people who often end up using people for their own advantage and who have difficulty in forming healthy long-term relationships. They often hurt the people around them and hurt themselves in the long run. The study administered questionnaires to nearly 130 Facebook users, analyzed the content of their pages and asked untrained strangers to view their pages and rate their impression of the owner's narcissism. The study found that the number of friends and wall posts a person had correlated with narcissism reflecting the fact that narcissists tend to have numerous but shallow relationships. The untrained observers used quantity of social interaction, attractiveness of the individual and the degree of self-promotion in their profile picture to rate people's narcissism and were fairly accurate in their judgements. Narcissists were also more likely to choose glamorous, self-promoting photos as their profile picture, whereas other people tended to choose snap shots.

You can find out more about this research at

http://psychcentral.com/news/2008/09/23/social-networking-ids-narcissism/2988.html

Screening for personality disorders in prisoners

Many prisoners have personality disorders. It is important to get an accurate picture about how many people in prisons have personality disorders as this may determine service needs and have important implications for inmate management. The presence of these disorders may also predict the behaviour of some prisoners while in custody and after release. The ideal way of diagnosing personality disorders is through a clinical interview but this can be time consuming and expensive. Researchers in the UK looked into the effectiveness of a screening tool called SCID-II by using it on 496 prisoners. They found it 'retained good internal consistency with improved discrimination between personality disorders and clinical syndromes'.

Ullrich, Simone ... [et al] - Detecting personality disorders in the prison population of England and Wales: comparing case identification using the SCID-II screen and the SCID-II clinical interview Journal of Forensic Psychiatry and Psychology September 2008, 19(3), 301-322

Personality disorders and problem gambling

The role played by personality disorders in other addictions has encouraged researchers to conduct studies into the links between personality disorders and pathological gambling. A Spanish study compared 50 pathological gamblers, 50 people being treated for other addictions and 50 other unaffected people. 32% of pathological gamblers showed a personality disorder, compared to 16% of the other addicts and 8% of the general population. The most common disorders were borderline personality (16%) followed by antisocial, narcissistic and non-specified personality disorders (8% each).

Echeburua, Enrique and Fernandez-Montalvo, Javier - Are there more personality disorders in treatment-seeking pathological gamblers than in other kinds of patients? A comparative study between the IPDE and the MCMI International Journal of Clinical and Health Psychology 2008, 8(1), 53-64

Family structure and personality disorders

Personality disorders are thought to be caused by an interaction between genes and environmental factors during the early years of development. Growing up in single-parent and stepfamilies, young motherhood, maternal depression and financial problems in childhood have all been considered as risk factors for children's mental health. A Finnish study of 1,588 young adults looked into the links between family structure and the later development of personality disorders. 7% of the participants had at least one probable or definite personality disorder. After adjusting for gender, parental social class and parental psychiatric disorder it was found that coming from a single-parent family was associated with cluster B (antisocial, borderline, histrionic and narcissistic) personality disorders while being an only child was associated with cluster A (paranoid, schizoid and schizotypal) disorders.

Kantojarvi, L. ... [et al] - Childhood family structure and personality disorders in adulthood European Psychiatry 2008, 23, 205-211

Eating disorders and personality disorders

Previous research on the links between eating disorders and personality disorders has varied greatly in its findings although there is a general understanding that personality disorders are common among eating-disorder patients. A study of 545 eating-disorder patients in Denmark found that 29.5% of them had one or more personality disorders - less than the researchers were expecting to find. Personality disorders, in particular borderline personality disorder, were more common among people with bulimia.

Godt, Kristine - Personality disorders in 545 patients with eating disorders European Eating Disorders Review March-April 2008, 16(2), 94-99