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The present study aims to test the hypothesis of biological hyperarousal and hyperreactivity underpinning the dysfunctional emotional processes of borderline personality disorder (BPD). Self-reported (quality and intensity of emotions) and physiological (respiratory sinus arrhythmia [RSA] and heart rate) data were collected in 14 clinical subjects with BPD and in 14 control subjects (healthy controls [HCs]), during the administration of six video clips with different emotional contents. Our findings showed a constant hyperarousal state (lower RSA) in the clinical group, supporting the hypothesis of a biological vulnerability to emotional dysregulation. BPD patients showed lower self-reported happiness in positive stimuli compared with HCs and a significant association between emotional dysregulation and physiological hyperreactivity to neutral stimuli. Our data support the hypothesis of a constant condition of physiological preparedness to threat and danger in BPD subjects. Moreover, our results highlight the influence of self-reported ability in regulating emotions in explaining BPD responses to specific emotional situations.

To evaluate the associations between Diagnostic and Statistical Manual of Mental Disorders, 5th Edition(DSM-5) Alternative Model of Personality Disorder traits and domains and categorically diagnosed narcissistic personality disorder (NPD) and borderline personality disorder (BPD), respectively, 238 inpatient and outpatient participants who were consecutively admitted to the Clinical Psychology and Psychotherapy Unit of San Raffaele Hospital in Milan, Italy, were administered the Personality Inventory for DSM-5(PID-5) and the Structured Clinical Interview for DSM-IVAxis II Personality Disorders (SCID-II). Based on SCID-II, the participants were assigned to the following groups: a) NPD (n= 49), b) BPD (n= 32), c) any other PD (n= 91), and d) no PD (n= 63). Emotional lability, separation insecurity, depressivity, impulsivity, risk taking, and hostility were significantly associated with BPD diagnosis. Attention seeking significantly discriminated participants who received an SCID-II categorical NPD diagnosis. Separation insecurity, impulsivity, distractibility, and perceptual dysregulation were the DSM-5traits that significantly discriminated BPD participants. Domain-level analyses confirmed and extended trait-level findings.

To assess how the maladaptive personality domains and facets that were included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition(DSM-5) Alternative Model of Personality Disorders relate to adult attachment styles, 480 Italian nonclinical adults were administered the Personality Inventory for DSM-5(PID-5) and the Attachment Style Questionnaire (ASQ). To evaluate the uniqueness of the associations between the PID-5 scales and the ASQ scales, the participants were also administered the Big Five Inventory (BFI). Multiple regression analyses showed that the ASQ scales significantly predicted both PID-5 domain scales and BFI scales; however, the relationships were different both qualitatively and quantitatively. With the exception of the PID-5 risk taking scale (adjusted R2= 0.02), all other PID-5 trait scales were significantly predicted by the ASQ scales, median adjusted R2value = 0.25, all ps < 0.001. Our findings suggest that the maladaptive personality domains and traits listed in the DSM-5Alternative Model of Personality Disorders show meaningful associations with adult attachment styles.

The aim of the study was to assess the reliability and the validity of the Italian translation of the Hypersensitive Narcissism Scale (HSNS) in a sample of consecutively admitted psychiatric outpatients (N= 366) and in an independent sample of non‐clinical volunteers (N= 385). In both samples, data from the HSNS had adequate internal consistency, considering its limited length. Consistent with our hypothesis, a two‐factor structure explained the HSNS item intercorrelations. Among clinical participants, the HSNS and the Narcissistic Personality Inventory (NPI) showed radically different patterns of correlations with the fourth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM‐IV) Personality Disorder diagnoses. In both samples, the HSNS and the NPI showed distinct and theoretically consistent correlations with temperament and character dimensions. As a whole, these findings seem to support the reliability and the validity of the HSNS as a measure of hypersensitive narcissism. Copyright © 2009 John Wiley & Sons, Ltd.

SummaryMultisample confirmatory factor analyses were carried out in samples of Italian university and high school students in order to assess the replicability of the factor structure in the Italian version of the Aggression Questionnaire by Buss and Perry. Item-level multiple-group component analysis confirmed Buss and Perry's 4-factor structure of the Aggression Questionnaire items in both samples. The results of multisample maximum likelihood confirmatory factor analysis of scale scores supported the hypothesis of single aggression latent dimension underlying the four Aggression Questionnaire scales, the structure of which was invariant across the two samples.

The associations between personality disorders and adult attachment dimensions were assessed in a sample of 487 consecutively admitted psychiatric subjects. Canonical correlation analysis showed that two sets of moderately correlated canonical variates explained the correlations between personality disorders and adult attachment patterns. The first and second attachment variates closely resembled the avoidance and anxiety attachment dimensions, respectively. The first personality disorder variate was mainly characterized by avoidant, depressive, paranoid, and schizotypal personality disorders, whereas dependent, histrionic, and borderline personality disorders loaded on the second canonical variate. However, these linear combinations of personality disorders were different from those obtained from principal component analysis. The results extend previous studies linking personality disorders and attachment patterns and suggest the importance of focusing on specific constellations of symptoms associated with dimensions of insecurity.

AbstractThe aim of this study was to assess the specificity of the association between temperamental vulnerability, character deficits, and Borderline personality disorder (BPD), controlling for the effects of attachment patterns. A total of 44 BPD patients were compared with 98 non-BPD patients with other cluster B Personality Disorder (PD) diagnoses, 39 patients with any cluster A or cluster C PD diagnoses, 70 patients with no PD diagnosis, and 206 nonclinical patients. All patients were administered the Temperament and Character Inventory, the Parental Bonding Instrument, and the Attachment Style Questionnaire. Multivariate and univariate tests showed that BPD patients differed significantly from all control groups on Novelty Seeking and Cooperativeness. These differences remained significant when controlling for the effect of attachment.

To assess the reliability and validity of the Wender Utah Rating Scale (WURS), 759 Italian undergraduate students were administered the Italian version of the WURS. In this sample, the WURS showed good internal consistency reliability (Cronbach alpha = .888). Both 1-week ( r= .981, P< .001) and 2-month ( r= .924, P< .001) retest reliabilities were satisfactory. The mother/subject agreement on the WURS total score was large: intraclass r= .883, P< .001. The principal component (PC) analysis showed the presence of three positively correlated first-order PCs, and one second-order PC. This PC structure of the WURS was replicated in an independent sample of 300 consecutively admitted psychiatric inpatients and outpatients. Finally, in a sample of 132 secondary school students, the WURS showed a moderate correlation with the Conners Abbreviated Parent and Teacher Questionnaire (CAPTQ): r= .307, P< .001. In this sample, the WURS total score was negatively correlated with school performance (rho = −.460, P< .001) and conduct (rho = −.293, P< .005) indexes.

The passive-aggressive (negativistic) personality disorder (PAPD) is one of the most controversial personality disorders. In order to assess DSM-IV PAPD psychometric properties and comorbidity pattern in a mixed psychiatric sample, 379 consecutively admitted in- and outpatients were administered SCID-II, Version 2.0. Confirmatory factor analysis showed that DSM-IV PAPD is a unidimensional construct with adequate internal consistency (K-R 20 = .85). A strong, specific association (odds ratio = 10.38, 95% CI = 4.83-22.30) was observed between DSM-IV PAPD and narcissistic personality disorder (NPD). Confirmatory factor analysis showed that DSM-IV PAPD should be considered as a subtype of a broader narcissistic disorder.

The evaluation of defense mechanisms represents one of the most promising fields in the psychodynamic-oriented empirical research on personality disorders (PDs). This study examines the association between DSM-IV PDs and defense mechanisms. We evaluated a sample of 50 adult outpatients seeking personality assessment and psychotherapeutic treatment. PDs have been assessed using the Structured Clinical Interview for DSM-IV Personality Disorder, version 2.0. Defense mechanisms have been evaluated by a group of trained clinical psychologists and psychiatrists (interrater reliability from .61 to .95) using Perry's Defense Mechanism Rating Scale. Our results support the hypothesis that some defense mechanisms underlie PDs and that defenses call for further attention as we assess PDs.

A meta-analysis of the published literature was performed to evaluate the common effect size (r) of the association between childhood sexual abuse (CSA) and Borderline Personality Disorder (BPD). An online search from 1980 to 1995 was used to gather published papers, coefficient was used as an effect size measure, and 21 studies were retrieved. A moderate pooled r (.279) for the association between CSA and BPD was observed. Pooled effect size estimates were also obtained for CSA parameters. No significant effect of moderators was evidenced. The results of this study did not support the hypothesis that CSA is a major psychological risk factor or a causal antecedent of BPD.

Three hundred consecutively admitted in- and outpatients were administered the Personality Diagnostic Questionnaire-4+ (PDQ-4+). The Structured Clinical Interview for DSM-IV Axis II Personality Disorders. Version 2.0 (SCIDTI) was used as the external diagnostic standard for personality disorder (PD) assessment. SCID-II was administered blind to PDQ-4+ scores. Low agreement between PDQ-4+ and SCID-II was observed for both dimensional and categorial PD evaluations. Receiver operating characteristic (ROC) analysis showed a definitively satisfactory discriminatory capability only for two PDQ-4+ PD scales (dependent, and antisocial). In agreement with previous studies, these results showed that PDQ-4+ was not a substitute for a structured diagnostic interview.

This study was designed to assess a three level model of personality impairment, as hypothesized by S. E. Hyler, in a non-clinical sample, according to the Personality Diagnostic Questionnaire (PDQ-R) total score, and the association of this three level organization with defense styles and state psycho-pathological symptoms, administering PDQ-R, Defense Style Questionnaire (DSQ-SF), and Hopkins Symptom Checklist (SCL-90) to a sample of 254 first-year medical students. Hierarchical agglomerative cluster analysis, performed on the PDQ-R total score, confirmed the three-level model. The one-way multi-variate analysis of variance showed a significant (Pillai's V = .483 p >.0001) association between levels of personality impairment, and DSQ-SF and SCL-90 scales. According to 99% Bonferroni simultaneous confidence intervals, the DSQ-SF Immature Defense and all SCL-90 scale mean scores, except So-matization and Phobic Anxiety, were significantly different in all the three levels of personality impairment. The PDQ-R proved to be quite overinclusive, with particular reference to the Paranoid subscale.

Abstract: It is well known in clinical practice that psychogenic impotence affects younger patients than organic impotence and with a more acute onset. In the present study the authors evaluated the predictive usefulness and discriminating power of the following sociodemographic and clinical variables: age, kind of onset (acute or gradual), civil status, number of partners, duration of illness. The sample was made of 133 patients suffering from erectile dysfunction for at least three months, consecutively admitted to the Multidisciplinary Centre for the Diagnosis and Treatment of Impotence of the Scientific Institute San Raffaele of Milan from May 1992 to April 1993. All patients underwent a thorough clinical and laboratory evaluation: 72 (54.5%) were psychogenic (mean age 42.611.2); 60 (45.5%) organic (mean age 56.39.8). Stepwise logistic regression model identified age and kind of onset as significant predictors of kind of impotence. According to the logistic regression classification table, sensitivity for psychogenic impotence was 778, specificity was. 750, positive predictive power was .789, and negative predictive power was .738. These results indicate that age and kind of onset proved to be significant predictors of psychogenic impotence and to have a good clinical functioning as both inclusion and exclusion criteria. These results suggest that a patient in his forties and with an acute onset of impotence should be firstly assessed from a psychological point of view; and on the opposite, a 50 year old patient with a gradual onset presents a rationale for a thorough clinical evaluation.

Interrater reliability and internal consistency of the SCID-II 2.0 was assessed in a sample of 231 consecutively admitted in-and outpatients using a pairwise interview design, with randomized rater pairing and blind interview assessment. Inter-rater reliability coefficients ranged from 48 to .98 for categorical diagnosis (Cohen κκ), and from .90 to .98 for dimensional judgements (Intraclass correlation coefficient). Internal consistency coefficients were satisfactory (.71-.94). The results suggest that the SCID-II 2.0 has adequate interrater and internal consistency reliability.

BACKGROUND AND DESIGN: The few articles published on the interactions between psychological factors and alopecia seem to yield contrasting results. To assess the relationships between alopecia, gender, Diagnostic Statistical Manual of Mental Disorders, Revised Third Edition personality disorders, and psychopathologic symptoms reactive to alopecia, we administered the Personality Disorders Questionnaire-Revised and the Symptoms Checklist-90 to a randomly selected sample of 116 outpatients with androgenetic alopecia. RESULTS: The prevalence of personality disorders in subjects with androgenetic alopecia proved to be significantly higher than the prevalence of such diagnoses in the general population. Women did not show a higher prevalence of personality disorders or more psychopathologic symptoms than men. The factor analysis demonstrated the existence of three personality profiles (F1, F2, and F3) significantly and specifically associated with the subject's gender and with the psychopathologic reactive symptoms, measured using the Symptoms Checklist-90. CONCLUSIONS: The most important factor in developing a psychopathologic reaction to alopecia seems to be the presence of a Diagnostic Statistical Manual of Mental Disorders, Revised Third Edition personality disorder and not the subject's gender.(Arch Dermatol. 1994;130:868-872)