R. Michael Bagby

Objective: Despite evidence of significant symptom heterogeneity and excessive diagnostic comorbidity, many contend that borderline personality disorder (BPD) is unidimensional, an assumption that rests primarily on results from factor analytic investigations of BPD symptom criteria. We note several limitations in the literature and argue that the symptom structure of BPD can be best clarified by using both factor analytic techniques and examining the BPD symptom dimensions in relation to external criteria (that is, personality traits). Our goals were to: examine if the symptoms of BPD are best conceptualized as unidimensional or multidimensional, and determine the extent to which personality traits account for any symptom dimensions that underlie BPD. Method: All published structural models of the BPD symptom criteria were identified and tested for statistical fit using confirmatory factor analysis in a sample of 373 patients who had completed the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders-Axis II Personality Questionnaire BPD scale. Dimensions from the best fitting model were examined in relation to traits from the Five-Factor Model (FFM) and the Personality Psychopathology Five (PSY-5) using correlational and regression analyses. Results: Sanislow's 3-factor model, containing affect dysregulation, behavioural dysregulation, and disturbed relations symptom dimensions, provided the best fit; the unidimensional model produced the worst. The symptom dimensions of the 3-factor model were differentiable from one another and had unique associations with the FFM and PSY-5 personality traits. Conclusion: BPD is a multidimensional construct.

The objective of the current investigation was to examine the prevalence of pathological gambling (PG) in a psychiatric sample with a history of mood disorder, and the concurrent and longitudinal association of PG and mood disorder symptoms according to retrospective report. A total of 275 (100 male, 175 female) psychiatric outpatients in Ontario, Canada, with a lifetime diagnosis of a depressive (n = 138) or bipolar disorder (n = 137), completed the Canadian Problem Gambling Index, South Oaks Gambling Screen and Longitudinal Interval Follow-up Evaluation. Correlational and cross-lagged panel analyses evaluated the relation between PG and mood disorder symptom course. The prevalence of PG was elevated within patients with a mood disorder; there was no difference across diagnosis. Concurrent PG and mood disorder symptoms were positively correlated; however, longitudinal analyses revealed no evidence for an association between PG and mood disorder symptoms when symptom stability was taken into account. Despite the elevated prevalence of PG within mood disorders, and the concurrent association between PG and mood disorder symptoms, no direct association was found between these types of pathology. Prospective designs and intervening variables are required to advance understanding of the etiological associations between these disorders.

Impulsivity has been implicated in the development of pathological gambling (PG); sensation seeking and urgency in particular have predicted gambling pathology in undergraduate and psychiatric samples. In light of the relevance of both depressed and elevated mood to impulsivity and gambling, the components of impulsivity associated with PG across mood disorders warrants investigation. The aim of the current investigation was to examine the association between impulsivity and gambling pathology severity across depressive versus bipolar disorders. A total of 275 participants with lifetime depressive or bipolar disorder completed measures of impulsivity and gambling. Urgency was consistently associated with gambling pathology indicators; lack of perseverance was specifically associated with gambling pathology within participants with depressive disorders. Reckless action during negative mood is associated with gambling pathology across mood disorders, whereas difficulty remaining focused is associated with PG solely within depressive disorders. Impulsivity and affective comorbidity may inform current understanding of PG.

Background: Clinicians and researchers have questioned whether participants in randomized control trials (RCTs) are representative of patients in the broader clinical population. Method: We compared the demographic, clinical, and personality characteristics of patients (N=256) with major depressive disorder (MDD) receiving antidepressant medication or interpersonal therapy as part of an RCT investigation (n=105) versus in a clinic (n=151). The RCT and clinic protocols were identical with the exception of recruitment procedures (advertisement versus physician referral) and assignment to treatment (randomized versus nonrandomized). Results: No significant differences emerged between the RCT participants and clinic patients for sex, age, marital status, and education. Overall, clinic patients were no more severely depressed compared to RCT participants; there was, however, a significant interaction effect. Response rates were significantly higher for RCT participants versus clinic patients. Those participating in the RCT scored significantly higher on a personality scale assessing preference for novel experiences compared to those in the clinic. Conclusions: Differences in clinical and personality variables between those receiving treatment for MDD as part of an RCT versus in a clinic exist; however, the clinical significance of these differences remains in question, as these variables were unrelated to treatment outcome. Depression and Anxiety, 2009.

Background: Although empirical support for the efficacy of cognitive behavioural therapy (CBT) as a treatment for major depressive disorder (MDD) is well established, its mechanism of action is uncertain. In this investigation, we examined evidence for the cognitive mediational model in a randomized control trial involving CBT, interpersonal therapy (IPT) and pharmacotherapy (PHT) in patients with MDD.Method: One hundred and thirty participants diagnosed with MDD were treated with CBT, IPT or PHT. Participants completed the Hamilton Depression Rating Scale, Beck Depression Inventory – II and Dysfunctional Attitudes Scale prior to and following treatment.Results: The cognitive mediational model, in which dysfunctional attitudes are proposed to mediate depressive symptom reduction in response to treatment, provided a good fit to the data when contrasting CBT v. IPT, with results supporting a mediational role for dysfunctional attitude change in depressive symptom reduction. The complication model, in which dysfunctional attitudes are proposed to be a consequence of depressive symptom reduction, provided a good fit to the data when contrasting CBT v. PHT, with results supporting a mediational role for depressive symptom reduction in dysfunctional attitude change.Conclusions: There was no evidence for a mediational role for dysfunctional attitude change in IPT. Changes in dysfunctional attitudes accompanied both CBT and PHT; however, empirical evidence suggests that the role of attitudes in treatment outcome may differ between these two treatments.

Objective: Effective treatments for major depressive disorder exist, yet some patients fail to respond, or achieve only partial response. One approach to optimizing treatment success is to identify which patients are more likely to respond best to which treatments. The objective of this investigation was to determine if patient personality characteristics are predictive of response to either cognitive-behavioural therapy (CBT) or pharmacotherapy (PHT).Method: Depressed patients completed the Revised NEO Personality Inventory, which measures the higher-order domain and lower-order facet traits of the Five-Factor Model of Personality, and were randomized to receive either CBT or PHT.Result: Four personality traits—the higher-order domain neuroticism and 3 lower-order facet traits: trust, straightforwardness, and tendermindedness—were able to distinguish a differential response rate to CBT, compared with PHT.Conclusion: The assessment of patient dimensional personality traits can assist in the selection and optimization of treatment response for depressed patients.Objectif: Il existe des traitements efficaces du trouble dépressif majeur et pourtant, des patients ne réussissent pas à y répondre, ou n'y répondent que partiellement. Une approche en vue d'optimiser la réussite du traitement consiste à identifier quels patients sont plus susceptibles de mieux répondre à quels traitements. L'objectif de cette recherche était de déterminer si les caractéristiques de la personnalité des patients prédisent la réponse à soit la thérapie cognitivo-comportementale (TCC) soit la pharmacothérapie (PHT).

The current study reviews and reexamines the association between pathological gambling and personality disorders (PDs). To date, the majority of investigations have examined the prevalence of PDs in a single group of treatment-seeking pathological gamblers (PGs); very few of these studies included a comparison group, and even fewer compared PGs to nonpathological gamblers who, in contrast to nongamblers, resemble PGs in their attraction to and engagement in gambling behavior. The current study included a sample composed of nontreatment-seeking pathological gamblers and a comparison group of nonpathological gamblers (NPGs); these participants completed a self-report instrument (SCID-II/PQ) and were administered a structured clinical interview SCID-II) designed to assess PDs. Compared to the SCID-II, the SCIDII/PQ produced significantly higher PD prevalence rate estimates and symptom endorsements. Although the pattern of specific PD prevalence and symptom endorsement varied somewhat across the instruments, PGs consistently displayed significantly higher levels of borderline PD than NPGs; this pattern endured even after controlling for Axis I disorders and overlap among Axis II PDs.

The five‐factor model of personality (FFM), derived from personality trait psychology, is increasingly used to describe personality disorders (PDs). Critics have argued, however, that the personality traits of the FFM fail to capture adequately the full range of personality psychopathology. In this investigation, the personality domains of the personality psychopathology five (PSY‐5), an alternative model designed specifically to assess pathological traits, were compared to the domain traits from the FFM in the prediction of the PD symptom counts. The personality traits from both dimensional models were assessed in a sample of 138 psychiatric patients with the Minnesota Multiphasic Personality Inventory‐2 (MMPI‐2) and the revised NEO personality inventory (NEO PI‐R), respectively. Both instruments significantly predicted all 10 PD symptoms and contributed on average an additional 10% of the variance beyond that predicted by the other instrument. Whereas the MMPI‐2 PSY‐5 scales were comparatively better predictors of paranoid, schizotypal, narcissistic and antisocial PD symptom counts, the NEO PI‐R domain scales outperformed the MMPI‐2 PSY‐5 scales in the prediction of borderline, avoidant and dependent PD symptom counts. Copyright © 2008 John Wiley & Sons, Ltd.

The authors examined the relationship between self‐criticism, dependency, and treatment outcome for 102 participants who met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM‐IV‐TR; American Psychiatric Association, 2000) criteria for major depressive disorder. The participants were randomly assigned to receive either cognitive–behavioral therapy (CBT), interpersonal therapy (IPT), or pharmacotherapy with clinical management (PHT‐CM) and completed the Depressive Experiences Questionnaire (Blatt, D'Affilitti, & Quinlan, 1976), a measure of self‐criticism and dependency, as part of a broader research protocol. Regression analyses indicated that among individuals in IPT, self‐criticism predicted poorer treatment outcome based on depressive symptom severity measured using the 17‐item Hamilton Rating Scale for Depression (Hamilton, 1960, 1967). In addition, there were trends toward dependency predicting worse treatment response in CBT and self‐criticism predicting better treatment response in PHT‐CM. © 2008 Wiley Periodicals, Inc. J Clin Psychol 64: 231–244, 2008.