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Background On the way toward an agreed dimensional taxonomy for personality disorders (PD), several pivotal questions remain unresolved. We need to know which dimensions produce problems and in what domains of life; whether impairment can be found at one or both extremes of each dimension; and whether, as is increasingly advocated, some dimensions measure personality functioning whereas others reflect style. Method To gain this understanding, we administered the Temperament and Character Inventory to a sample of 862 consecutively attended outpatients, mainly with PDs (61.2%). Using regression analysis, we examined the ability of personality to predict 39 variables from the Life Outcome Questionnaire concerning career, relationships, and mental health. Results Persistence stood out as the most important dimension regarding career success, with 24.2% of explained variance on average. Self-directedness was the best predictor of social functioning (21.1%), and harm avoidance regarding clinical problems (34.2%). Interpersonal dimensions such as reward dependence and cooperativeness were mostly inconsequential. In general, dimensions were detrimental only in one of their poles. Conclusions Although personality explains 9.4% of life problems overall, dimensions believed to measure functioning (character) were not better predictors than those measuring style (temperament). The notion that PD diagnoses can be built upon the concept of “personality functioning” is unsupported.

Personality variation is increasingly thought to have an adaptive function. This is less clear for personality disorders (PDs)—extreme variants of personality that cause harm in most aspects of life. However, the possibility that PDs may be maintained in the population because of their advantages for fitness has been not convincingly tested. In a sample of 959 outpatients, we examined whether, and how, sexual selection acts on the seven main dimensions of personality pathology, taking into account mating success, reproductive success, and the mediating role of status. We find that, to varying extents, all personality dimensions are under sexual selection. Far from being predominantly purifying, selective forces push traits in diverging, often pathological, directions. These pressures differ moderately between the sexes. Sexual selection largely acts in males through the acquisition of wealth, and through the duration (rather than the number) of mates. This gives a reproductive advantage to males high in persistence–compulsivity. Conversely, because of the decoupling between the number of mates and offspring, the promiscuous strategy of psychopaths is not so successful. Negative emotionality, the most clinically detrimental trait, is slightly deleterious in males but is positively selected in females, which can help to preserve variation. The general picture is that at least some PDs form part of high-risk alternative strategies, although a sole evolutionary mechanism is unlikely to apply to all traits. An evolutionary perspective on PDs can provide a better understanding of their nature and causes than we have achieved to date by considering them as illnesses.

Most taxonomies of coping have been built as if coping strategies were unrelated to all other aspects of personality. However, the evidence suggests some overlaps, and it may be that basic personality axes such as constraint, fearfulness or affiliation constitute a meaningful organizing principle for coping. In a sample of 499 outpatients, we examined the ability of the Temperament and Character Inventory to predict the fifteen coping strategies measured by the COPE. We also studied the joint structure of personality dimensions and coping. Engagement strategies were mainly enacted by subjects with low fear, high self-efficacy and high persistence, whereas roughly the opposite was true for Disengagement. Help-seeking strategies were exclusively aligned with affiliation dimensions. Our results clarify the empirical structure of coping strategies, and locate them within the broader and better-known space of personality axes.

Introduction and objectives Heart transplantation (HT) is a potentially life-saving procedure for people with terminal cardiac disease. In the last decades researchers of HT programs have attempted to identify the existence of psychosocial factors that might influence the clinical outcome before and after the transplantation. The main objective of this study was to describe epidemiological, psychiatric and psychological features of a large sample of HT candidates. Methods Cross-sectional, observational and descriptive study. A psychiatric and psychological assessment of 125 adult patients was performed at the moment of being included in the HT waiting list, between 2006 and 2012. The assessment consisted in: Clinical, epidemiological and psychosocial form; Spanish version of Hospital Anxiety and Depression Scale; Structured Clinical Interview for DSM-IV axis I disorders; Coping questionnaire (COPE); Five Factors Inventory Revised (NEO-FFI-R); Apgar-Family questionnaire and the Multidimensional Health Locus of Control scale. Results Axis I diagnoses were present in a 30.4% of patients. COPE showed that this group of patients used most frequently engagement strategies. Personality factors profile of NEO-FFI-R were similar to general population and locus of control scale also presented similar scores compared with other chronic diagnostic groups. Statistically significant associations were found between personality factors and COPE scales/dimensions and psychopathology, mainly neuroticism and disengagement. Conclusions This is the first study to assess systematically psychosocial factors in a large sample of HT candidates. We have found that around one third of these patients have a psychiatric disorder. Neuroticism and disengagement coping styles can serve as markers of emotional distress.

Extreme personality traits in humans often have detrimental life consequences, so they have long been supposed to be diseases. However, many other species display personality variants that are maintained due to their fitness advantages; in this case, they are construed as strategies. To examine the fitness costs and benefits of pathological personality traits in humans, we measured features of the A (socially odd, distrustful), B (incentive-seeking, selfish) and C (fearful, inhibited) clusters with the Personality Diagnostic Questionnaire-4 + (PDQ-4 +) in a sample of 738 outpatients. Fitness relevant parameters like mating success, reproductive output, self preservation, and access to status were assessed with the Life Outcome Questionnaire. No fitness advantages were found for high-A subjects. In contrast, high-B subjects tripled low-B subjects with regard to mating success and had 39% more offspring. Further, high-C subjects outperformed low-C subjects in attaining status and avoiding risks. These findings help explain the commonness of some extreme personality traits in humans, and suggest that they should be seen as evolutionary strategies rather than as diseases.

To assess the influence of the pain locus of control on return to work in fibromyalgia patients.Ninety-eight fibromyalgia patients on sick leave were enrolled in a multidisciplinary treatment program and were followed up for 12 months post-discharge. Treatment was considered successful at discharge in the case of patients who returned to work and unsuccessful in patients who remained sick listed. Treatment was considered successful during follow-up in patients who remained at work for at least the last 6 months of follow-up. Patients who took sick leave again and those lost to follow-up were considered failures. Logistic regression methods were used to define the best predictive models of treatment failure.Fifty-eight patients were considered treatment successes at discharge and 50 at 12-month follow-up. The subscale Fate from the Multidimensional Health Locus of Control-Pain Scale and the Health Assessment Questionnaire predicted treatment failure at discharge (-2lnR=57.79; chi-square=74.74; df=2; P.001). The predictive model of treatment failure at 12-month follow-up was unspecific.Fibromyalgia patients undergoing a multidisciplinary treatment who were least likely to return to work at discharge were those with a pain locus of control characterized by more negative expectations about pain progression and a high perceived functional disability.

Serious problems persist concerning the conceptualization and measurement of the coping construct. This study examines the properties and factor structure of the COPE questionnaire, one of the most widely used instruments to measure coping, in a sample of 471 patients. A series of exploratory factor procedures are applied at the item- and scale-level, and the resulting solutions are tested both by their congruence with previously published structures and by confirmatory techniques. Our finding of three robust, generalizable, and parsimonious second-order dimensions—Engagement, Disengagement, and Help-Seeking—challenges the original structure. The results are discussed from an evolutionary perspective, on the assumption that the recognition of coping as the activation of vestigial defenses may make a substantial contribution to clarifying its functions and organization.

La fibromialgia (FM) es una enfermedad cronica y compleja que provoca dolores extensos que pueden llegar a ser invalidantes, y afecta a la esfera biologica, psicologica y social del paciente. La FM es un problema de salud dada su elevada prevalencia y morbilidad, su alto indice de frecuentacion y el elevado consumo de recursos sanitarios que provoca 1 . El Pla de Salut de Catalunya 1996-1998 ya recoge este problema, fruto del cual se elaboraron unos Criterios Comunes Minimos para la Atencion de Enfermos con Fibromialgia. Debido a la evolucion de los conocimientos que ha acontecido en los ultimos anos y a la confirmacion de su alta prevalencia y morbilidad, se ha constituido un grupo de trabajo multidisciplinario con la voluntad de redactar un documento orientativo, a modo de guia de practica clinica, que estructure y homogeneice los conceptos y actitudes que se pueden aplicar a estos pacientes.

Fundamento Algunos autores han postulado una division entre un patron de alteracionpredominantemente “cortical” para la demencia tipo Alzheimer y un patron de alteracion mas“subcortical” para la demencia vascular. El principal objetivo de este trabajo fue identificar unpatron de deterioro cognitivo neuropsicologico que discriminase el tipo de demencia en fases oestadios iniciales. Metodo Se compararon dos grupos de pacientes: uno con demencia, leve, tipo Alzheimer (DTA,n = 30) y otro con demencia vascular (DV, n = 30), administrando una bateria de tests neuropsicologicos.La bateria estaba compuesta por los siguientes tests: Orientacion Temporal (Bentonet al); Vocabulario, Semejanzas, Digitos, Clave y Kohs (WAIS); el test de Forma-Color deWeigl; el test del Trazo (A y B) (HRNB); el Tapping (McQuarrie); la Memoria Logica, MemoriaVisual y Aprendizaje Asociativo (WMS), y Memoria Diferida (Russell). Los dos grupos eran similaresen edad y caracteristicas socioculturales. Se compararon a traves de la nota z y su significacionestadistica con el test de Mann-Whitney y se realizo un analisis discriminante exploratoriopara clasificar a los pacientes en los dos grupos. Resultados En general, los resultados fueron mas pobres en el grupo DTA, no detectandose diferenciassignificativas en los tests neuropsicologicos, aunque en algunos casos (Memoria VisualInmediata y Cubos de Kohs) casi se alcanzo la significacion. A traves del analisis discriminanteexploratorio, se clasificaron correctamente un 67% de sujetos del grupo DTA y un 70%del grupo DV. Conclusiones En los estadios iniciales de las demencias es dificil diferenciar entre un patronde deficit cortical en la DTA y un patron de deficit subcortical en la DV. Cuando se usan testsneuropsicologicos complejos los rendimientos dependen de la coordinacion de multiples sistemasrelacionados. Estos hallazgos estan de acuerdo con los modelos holisticos de las funcionescorticales superiores.

Se realiza un estudio clinico en 94 pacientes afectados de blushing a los que se les realizo una simpatectomia toracica endoscopica bilateral. Todos los pacientes fueron visitados por un equipo multidisciplinario (dermatologo, psicologo y cirujano toracico) e informados detalladamente de los efectos secundarios y las expectativas de la intervencion. Los resultados a corto y medio plazo han sido excelentes: un 90,4% mostro un alto indice de satisfaccion; en el resto, el efecto fue solo parcial en un 7,5%, y un 2,1% de los pacientes considero la intervencion insatisfactoria; el aumento de la sudacion en otras areas del cuerpo se produjo en el 75,5% de los pacientes, pero solo en el 3,2% fue grave.