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Background. The categorical classification system for personality disorder (PD) has been frequently criticized and several alternative dimensional models have been proposed.Method. Antecedent, concurrent and predictive markers of construct validity were examined for three models of PDs: the Five-Factor Model (FFM), the Schedule for Nonadaptive and Adaptive Personality (SNAP) model and the DSM-IV in the Collaborative Study of Personality Disorders (CLPS) sample.Results. All models showed substantial validity across a variety of marker variables over time. Dimensional models (including dimensionalized DSM-IV) consistently outperformed the conventional categorical diagnosis in predicting external variables, such as subsequent suicidal gestures and hospitalizations. FFM facets failed to improve upon the validity of higher-order factors upon cross-validation. Data demonstrated the importance of both stable trait and dynamic psychopathological influences in predicting external criteria over time.Conclusions. The results support a dimensional representation of PDs that assesses both stable traits and dynamic processes. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to test whether borderline personality disorder is a variant of bipolar disorder by examining the rates of co-occurrence in both disorders, the effects of co-occurrence on a longitudinal course, and whether the presence of either disorder confers the risk for new onsets of the other. Method: A prospective repeated-measures design with reliable independent diagnostic measures and 4 years of follow-up was used to assess 196 patients with borderline personality disorder and 433 patients with other personality disorders. Results: Patients with borderline personality disorder had a significantly higher co-occurrence of bipolar disorder (19.4%) than did patients with other personality disorders. However, this co-occurrence did not appear to affect the subsequent course of borderline personality disorder. Although only 8.2% of the borderline personality disorder patients developed new onsets of bipolar disorder, this rate was higher than in patients with other personality disorders. Patients with other personality disorders with co-occurring bipolar disorder generally had more new onsets of borderline personality disorder (25%) than did patients with other personality disorders without co-occurring bipolar disorder (10%). Conclusions: A modest association between borderline personality disorder and bipolar disorder is reported. [ABSTRACT FROM AUTHOR]

Background. A defining feature of personality disorder (PD) is an enduring pattern of inner experience and behavior that is stable over time. Follow-up and follow-along studies have shown considerable diagnostic instability of PDs, however, even over short intervals. What, then, about personality disorder is stable? The purpose of this study was to determine the stability of impairment in psychosocial functioning in patients with four different PDs, in contrast to patients with major depressive disorder (MDD) and no PD, prospectively over a 2-year period.Method. Six hundred treatment-seeking or treated patients were recruited primarily from clinical services in four metropolitan areas of the Northeastern USA. Patients were assigned to one of five diagnostic groups: schizotypal (STPD) (n=81), borderline (BPD) (n=155), avoidant (AVPD) (n=137), or obsessive–compulsive (OCPD) (n=142) personality disorders or MDD and no PD (n=85), based on the results of semi-structured interview assessments and self-report measures. Impairment in psychosocial functioning was measured using the Longitudinal Interval Follow-up Evaluation (LIFE) at baseline and at three follow-up assessments.Results. Significant improvement in psychosocial functioning occurred in only three of seven domains of functioning and was largely the result of improvements in the MDD and no PD group. Patients with BPD or OCPD showed no improvement in functioning overall, but patients with BPD who experienced change in personality psychopathology showed some improvement in functioning. Impairment in social relationships appeared most stable in patients with PDs.Conclusion. Impairment in functioning, especially social functioning, may be an enduring component of personality disorder. [ABSTRACT FROM AUTHOR]

SUMMARY: This article addresses the design and selection of outcome methods for treatment research from a statistical perspective. Two of the major statistical and methodological issues relevant to the selection of dependent variable(s) are statistical power and social utility. Power is the paramount issue in research design. Power can be improved by measures and methods tailored to the predicted effects of treatment. These effects should vary from treatment to treatment, suggesting that no single outcome measure is suitable for all purposes. In estimating power, researchers should also consider the time-varying nature of most types of treatment effects. Given these considerations, timeline procedures have advantages because they allow the derivation of measures linked to specific treatment components. They also permit the study of time-varying effects of variables such as life stress. An analysis on the relationship between drinking and self-reported stress is presented as an illustration of how advanced statistical methods, in conjunction with carefully gathered data, can provide process data on how treatment can affect individual responses to stressors or other events. From a social utility perspective, however, having research focus on narrower and narrower slices of behavior in the search for power raises questions about the value of this research to clients and society. For dealing with this dilemma, it will be necessary to build a series of studies linking improvement in specific aspects of short-term outcome to longer term outcome and ultimately benefit to society. [ABSTRACT FROM AUTHOR]