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Borderline personality disorder (BPD) is characterized by considerable heterogeneity. Prior approaches to resolving heterogeneity in BPD pathology have used factor and cluster analytic as well as latent class analysis strategies. These prior studies have been atheoretical in nature, but provide an initial empirical corpus for further sub-typing efforts in BPD. A model-based taxonomy for BPD that is supported by evidence from an advanced statistical methodology would enhance investigations of BPD etiology, pathophysiology, and treatment. This study applied finite mixture modeling analysis, in a model-guided fashion, to selected dimensions of pathology within a group of well-characterized BPD patients to determine if latent groups are harbored within the disorder. Subjects with BPD (N = 90) were examined on a variety of model-relevant psychopathology dimensions. We applied finite mixture modeling to these dimensions. We then evaluated the validity of the obtained solution by reference to a variety of external measures not included in the initial mixture modeling. Three phenotypically distinct groups reside within the overall BPD category. Group-1 is characterized by low levels of antisocial, paranoid, and aggressive features. Group-2 is characterized by elevated paranoid features, whereas Group-3 is characterized by elevated antisocial and aggressive features. External correlates reveal a pattern of differences consistent with the validity of this proposed grouping structure. A theory-guided finite mixture modeling analysis supports a parsing of the BPD category into three subgroups. This proposed BPD taxonomy represents an approach to reducing heterogeneity observed among BPD patients and it may prove useful in studies seeking to understand etiologic and pathophysiologic factors as well as treatment response in BPD. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The authors examined three yearlong outpatient treatments for borderline personality disorder: dialectical behavior therapy, transference-focused psychotherapy, and a dynamic supportive treatment. METHOD: Ninety patients who were diagnosed with borderline personality disorder were randomly assigned to transference-focused psychotherapy, dialectical behavior therapy, or supportive treatment and received medication when indicated. Prior to treatment and at 4-month intervals during a 1-year period, blind raters assessed the domains of suicidal behavior, aggression, impulsivity, anxiety, depression, and social adjustment in a multiwave study design. RESULTS: Individual growth curve analysis revealed that patients in all three treatment groups showed significant positive change in depression, anxiety, global functioning, and social adjustment across 1 year of treatment. Both transference-focused psychotherapy and dialectical behavior therapy were significantly associated with improvement in suicidality. Only transference-focused psychotherapy and supportive treatment were associated with improvement in anger. Transference-focused psychotherapy and supportive treatment were each associated with improvement in facets of impulsivity. Only transference-focused psychotherapy was significantly predictive of change in irritability and verbal and direct assault. CONCLUSIONS: Patients with borderline personality disorder respond to structured treatments in an outpatient setting with change in multiple domains of outcome. A structured dynamic treatment, transference-focused psychotherapy was associated with change in multiple constructs across six domains; dialectical behavior therapy and supportive treatment were associated with fewer changes. Future research is needed to examine the specific mechanisms of change in these treatments beyond common structures. [ABSTRACT FROM AUTHOR]

The picture for the long-term prediction of schizotypic individual difference features in relation to schizotypy assessed earlier in life remains opaque. Whereas schizotypy assessed earlier in life, typically during the late teen years, has been shown to predict nonaffective psychotic illness as well as the presence of nonaffective psychotic features (Chapman et al., 1994; Lenzenweger, 2021), the presence in midlife (mid-30s) of nonpsychotic schizotypic features in those assessed for schizotypy earlier in life remains to be demonstrated. The current study, which reports on a 17-year follow-up study, addresses this void in the schizotypy literature. Seventeen years after an initial psychometric assessment for schizotypy, in a sample of emerging adults (age = 18) with no prior history of psychotic illness, Perceptual Aberration Scale scores predicted elevated schizotypal personality features, increased schizophrenia-related personality disorder features (particularly schizotypal and paranoid), and elevated schizophrenia proneness scores at age 35. This pattern of associations was maintained even after the removal of participants with a diagnosis of nonaffective psychosis. The associations also remained largely unchanged net of state anxiety levels at initial and later assessments. These results support the emergence or maintenance of schizotypic psychopathology features consistent with a model that views schizotypy as the underlying liability for schizotypic psychopathology phenotypes. The results also provide additional support for both the construct validity of the initial psychometric schizotypy measure (Perceptual Aberration Scale) as well as the validity of the psychometric high-risk paradigm. Longitudinal research remains an illuminating and informative approach to understanding the nature of schizophrenia-related psychopathology by utilizing time as an essential scientific lever. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

An extensive theoretical literature links identity pathology with deficits in mentalization, which is the ability to understand the internal mental states of self and others. However, only a few investigations have attempted to bridge theory and data by empirically testing the relation between mentalization and identity pathology, and none have done so with mentalization measured using a laboratory task. The current study investigated the association between mentalization deficits and identity pathology in a large, nonclinical sample. Participants ( N = 305) completed a self-report measure assessing identity pathology and a laboratory task assessing mentalization ability. Whereas the existing theoretical literature would argue for a robust association between identity pathology and mentalization impairment, our results revealed essentially no association between identity pathology and mentalization impairment. Moreover, we found essentially no association between identity pathology and any of a number of specific mentalization deficits in our sample. Our findings failed to provide empirical support for the clinical and theoretical literature linking mentalization and identity pathology. Given our adequate statistical power to detect even relatively small associations, we offer these findings to advance theoretical and methodological discussion in this important area. We discuss the implications of these null findings, particularly attuned to the possibility that a link between mentalization impairment and identity pathology may be more complicated than hypothesized. We also consider that these results might be related to methodological features of our study (e.g., self-report and laboratory measures; the range of mentalization impairment in our sample). (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Background: The historical concept of borderline conditions refers to the pathology on the border between neurosis and psychosis. In DSM-III the conditions were divided into specific but also somewhat overlapping diagnostic criteria for Borderline Personality Disorder (BPD) and Schizotypal Personality Disorder (SPD). This phenomenological overlap, which results in co-occurrence of the two diagnoses, remains a clinical challenge to this day., Methods: To address this issue we examined the co-occurrence of SPD and BPD according to the established DSM-IV/-5 diagnostic criteria. A literature search was conducted including studies that employed a structured interview with defined BPD and SPD criteria., Results: Studies from 20 samples were included (i.e. 15 patients, 3 community and 2 forensic samples). For patients diagnosed primarily with BPD, 1-27% also met the criteria for SPD and for patients diagnosed primarily with SPD, 5 - 33% showed co-occurrence with BPD. In the forensic samples, co-occurrence for primary BPD was 10% and 67 - 82% for primary SPD. In the community samples, co-occurrence for primary BPD was 29% and 50% for primary SPD. The pattern of co-occurrence across community samples was particularly heterogeneous., Conclusion: The identified co-occurrences for BPD and SPD were considerably sample-dependent, and samples and measurements were generally too heterogeneous for a precise meta-analysis. Forensic and community samples generally showed higher co-occurrences, but these findings were characterized by potential methodological limitations.

Indirect assessment is a useful tool in forensic evaluation, especially in cases of threat assessment. To this end, we illustrated the ability to conceptualize a complicated case (i.e., Theodore John Kaczynski) using an indirect approach, with a particular emphasis upon dimensional frameworks of personality. Raters who were unrelated to Mr. Kaczynski's case and with expertise in relevant domains were asked to study information available in the public domain about Mr. Kaczynski and provide ratings using several assessment instruments. Our aim was not to provide a professional clinical opinion, but rather engage in scholarly discourse about the utility of instruments. Mr. Kaczynski was rated to demonstrate characteristics associated with lone actor terrorists. He showed an elevation on a measure of psychosis, and raters conceptualized trauma as an important aspect of his functioning. He demonstrated impairments in detachment and psychoticism (Criterion B of the AMPD) and interpersonal functioning (Criterion A of the AMPD). Clinical conceptualizations for Mr. Kaczynski emphasized schizotypal and paranoid personality disorders. This analysis of an infamous case about which considerable data are publicly available demonstrates the ease with which indirect and multimethod assessment can be applied and integrated in forensic assessment, using modern conceptualizations of personality pathology.

Individuals with schizophrenia are at increased risk for suicide. However, much less is known about suicide risk among individuals with schizotypic features. To address this gap in the literature, the current report examines the relationship between positive schizotypy and suicide risk using five distinct samples. Each of these five studies addresses unique, but complementary, questions regarding the relationship between positive schizotypy and suicide risk. Studies 1 and 2 investigate the cross-sectional relationship between perceptual aberrations and suicidal ideation. Study 3 examines the relationship between suicidal ideation and multiple positive schizotypic features (perceptual aberrations, magical thinking, paranoia, and referential thinking). Study 4 investigates the long-term relationship between perceptual aberrations and suicide risk through a 17-year follow-up. Finally, Study 5 examines the specificity of our findings using a psychiatric control group. Results across all five studies support a relationship between suicide risk and positive schizotypy. Specifically, perceptual aberrations were associated with suicide risk both cross-sectionally and longitudinally. Results also suggest that individuals with positive schizotypic features have rates of suicidal ideation that are comparable to those with high negative affect and are significantly greater than healthy controls. Taken together, these findings establish an empirical connection between positive schizotypy and suicide risk, thus expanding the purview of the suicide risk construct. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Objective: Otto F. Kernberg pioneered the description, understanding, and treatment of pathological narcissism. Narcissism has emerged as a clinical construct of considerable interest in clinical psychology, psychiatry, and psychoanalysis and has often been featured in the literature on personality and social psychology. Considerable discussion in recent years has focused on whether levels of narcissism seen among young adults have been increasing. Nearly all of that discussion has been focused on changes in successive cohorts in normative (normal-range) expressions of narcissism. No direct prospective longitudinal study of the same individuals has assessed for pathological narcissism during college, the period that has been the specific focus of such lively debate. This study aimed to fill that gap in the literature., Methods: This multiwave, longitudinal study explored pathological narcissism during college by enrolling first-year undergraduate students (N=250) from the Longitudinal Study of Personality Disorders and by using individual growth curve (IGC) analysis. Participants were assigned to either a possible personality disorder or no personality disorder group, according to results from the International Personality Disorder Examination., Results: By the third wave of assessments, 16% of the sample received a probable or definite diagnosis of at least one axis II personality disorder. IGC analysis revealed that pathological narcissism declined across the first 4 years of college. Personality predictors of this pattern of change are also discussed., Conclusions: This study highlights the need for a fine-grained prospective study of the same participants over time to illuminate patterns of change in narcissism.

Introduction: It is argued that all personality pathology represents the final emergent product of a complex interaction of underlying neurobehavioral systems, which are reflected in personality factors, in conjunction with environmental inputs. Neurobehavioral systems manifest themselves in dispositional temperament and personality processes. Environmental inputs include, obviously, interpersonal relationships (e.g., parenting, social, and mentoring relations) as well as other factors such as abuse, neglect, and/or environmental insults (e.g., economic hardship, deprivation). Narcissistic personality disorder (NPD) is hypothesized to reflect both dispositional and environmental inputs to its pathogenesis. Temperament and personality-based theorizing regarding NPD proposes high dispositional levels of anger and related temperament features that could shape early development and subsequent NPD. Many classic theorists (e.g., Freud, Kernberg, Kohut, Miller) have also proposed that profound parenting failures are implicated in the emergence of NPD, each suggesting some failure in proper engagement and responsivity with the developing child. Such a failure in parenting can be thought of as reflecting diminished proximal process engagement with the developing child., Method: Using data from the Longitudinal Study of Personality Disorders, the present study examines both proximal process and temperament factors in relation to clinically significant NPD features from a prospective perspective., Results: Results suggest that both proximal process and temperament (notably anger) factors independently predict the level of NPD features over time., Conclusion: Both interpersonal relationships and temperament should be considered in models of etiology of NPD, it is not just one or the other., (© 2022 S. Karger AG, Basel.)

Previous research reveals that rejection sensitivity is associated with both sexual violence victimization and self-silencing behavior, yet the association among these variables has not been examined. As the foundation for this study, we propose a theoretical model that integrates these constructs. Using mediational analyses with bootstrapping, the results from a sample of 241 heterosexual college women revealed that consistent with the proposed model, self-silencing mediated the link between rejection sensitivity and reports of unwanted sexual contact and rape. The implications of the findings for the prevention of victimization/revictimization and interventions with victimized women are discussed., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Understanding resilience has expanded our knowledge of certain risk and protective factors regarding the development of different forms of psychopathology. Particularly, a focus on resilience can be used to implement interventions and to target specific behaviors in hopes of mitigating the onset of a disorder or to alleviate symptoms. Less research on resilience has been done with individuals with psychosis, particularly schizophrenia spectrum disorders. Only 1 previous study has targeted individuals assessed for schizotypy. The current study examined associations between resilience and schizotypy features, assessed using self-report measures. Specifically, we compared 3 different resilience measures, social and occupational functioning, and 3 schizotypy measures in 3 different samples: undergraduate students ( n = 878), adult community members ( n = 120), and an Amazon Mechanical Turk adult community members ( n = 329). Data analyses consisted of correlation and regression analyses, including tests for statistical moderation. Specifically, this study found negative associations between schizotypy and both psychosocial functioning and resilience. Although we predicted resilience would moderate the relations between schizotypy and psychosocial functioning, our analyses did not provide support for a moderating role for resilience. We discuss our findings in terms of understanding the relations among schizotypy, resilience, and psychosocial outcome constructs. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Long-standing theory regarding personality pathology as well as the recently proposed DSM-5 Alternative Model for Personality Disorders (AMPD) posit that self/identity problems are a hallmark feature cutting across forms of personality pathology. With emergence of the AMPD, researchers have started to focus empirical investigations on identity pathology as a transdiagnostic factor across personality pathology. The current study investigated identity pathology across indicators of personality pathology from both the current categorical perspective ( DSM-5 PD) and the dimensional perspective in the AMPD. Identity diffusion and low self-concept clarity were correlated with all PD feature scales and all maladaptive personality dimension scales. Regression analyses revealed most indicators of personality pathology were significant correlates of identity diffusion and low self-concept clarity. Borderline and Avoidant PD feature scales and Negative Affectivity and Detachment maladaptive personality dimension scales emerged as the strongest correlates of identity pathology. The role that identity pathology plays in personality pathology is highlighted.

Borderline (BPD) and schizotypal personality disorder (SPD) were introduced in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III). However, the clinical differentiation of the 2 diagnoses (e.g., psychotic-like features) was challenging for diagnostic classification and clinical management. With the introduction of the alternative model for personality disorders (AMPD) in DSM-5 Section III, a dimensional approach was proposed, which potentially holds promise for better future differentiation between BPD and SPD. The present study sought to examine the psychopathology using the AMPD model. A total of 105 patients were interviewed, 25 were excluded according to exclusion criteria, and the final sample comprised 80 patients who fulfilled the DSM-5 criteria for BPD (n = 35), SPD (n = 25), and comorbid BPD + SPD (n = 20), respectively. All patients were administered The Structured Clinical Interview for DSM-5 alternative model for personality disorders Modules I and II. One-way analysis of variance tests with planned contrasts were used. Results showed that for AMPD Criterion A, the BPD + SPD group had the most severe impairment of personality functioning, except for Identity, where the SPD group showed the most severe impairment. For AMPD Criterion B, the domain of Detachment and the facet of Eccentricity from the Psychoticism domain were most prominent for the SPD group relative to the 2 other groups. The differentiating between BPD and SPD manifestations of cognitive/perceptual disturbances does not seem resolved by the Psychoticism domain, which covers broader aspects of psychopathology. Future research should further investigate the construct of Psychoticism, especially to differentiate nonpsychotic symptoms (e.g., dissociation) and address thought disorder. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Theory of mind (ToM) impairments are well documented in schizophrenia, although it remains unclear whether these deficits exist among individuals with schizotypy. The current study sought to shed light on mixed findings in schizotypy by differentiating between various aspects of ToM, (cognitive/affective ToM and overmentalization/undermentalization). A three-group design (positive schizotypy, negative affect, and healthy control) was used to assess ToM performance on the Movie for Assessment of Social Cognition. Results indicated that the positive schizotypy group made greater intent overmentalization errors than both control groups. The schizotypy and negative affect groups made greater emotion overmentalization errors relative to healthy controls. In addition, the authors explored the relationship between ToM, schizotypal traits, and psychosocial functioning. Results demonstrated a significant positive relationship between cognitive-perceptual schizotypal traits and intent overmentalization as well as a significant positive relationship between interpersonal traits and emotion overmentalization. Finally, intent and emotion overmentalization were both related to poorer psychosocial functioning.

Determining the long-term psychosis-related outcomes of late-teen individuals characterized initially by a nonpsychotic, schizotypic feature (elevated perceptual aberrations) can further our understanding of the developmental pathways leading to schizophrenia, nonaffective psychotic conditions, and psychotic symptoms later in adulthood. Using the well-known laboratory/psychometric high-risk approach, the present study investigated the associations between nonpsychotic perceptual aberrations measured at age 18, in individuals with no prior history of psychosis, and clinical psychotic symptom outcomes 17 years later in midlife (middle 30s). Clinical assessments for hallucinations and delusions were completed for 191 adults (95% of the original sample) in the follow-up study. Elevated perceptual aberrations at age 18 predicted increased levels of hallucinations, delusions, and total psychotic symptoms in midlife as well as psychotic illness. The associations between baseline perceptual aberrations and later psychotic symptoms were not accounted for by general nonspecific psychopathology factors such as anxiety or depression present at age 18. Early detection of subtle, nonpsychotic forms of perceptual disturbance may aid in identifying individuals at increased risk for nonaffective psychosis outcomes in adulthood. Perceptual aberrations may constitute a useful endophenotype for genetic, neurobiological, and cognitive neuroscience investigations of schizophrenia liability. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Introduction: Borderline personality disorder (BPD) and schizotypal personality disorder (SPD) were introduced in DSM-III and retained in DSM-5 Section II. They often co-occur and some aspects of the clinical differentiation between the 2 diagnoses remain unclear (e.g., psychotic-like features and identity disturbance)., Methods: The present study explored if self-reported identity disturbance and psychosis proneness could discriminate between the BPD and SPD DSM-5 diagnoses. All patients were interviewed with the Schedules for Clinical Assessment in Neuropsychiatry and the Structured Clinical Interview for DSM-5 Personality Disorders, and administered the Inventory of Personality Organization, Self-Concept and Identity Measure, Schizotypal Personality Questionnaire, Perceptual Aberration Scale, and the Magical Ideation Scale., Results: A total of 105 patients were initially assessed, 26 were excluded, and the final sample (N = 79) was composed of 34 BPD patients, 25 SPD patients, and 20 patients with co-occurring SPD and BPD. The BPD group (n = 34) was first compared with the pure SPD group (n = 25), and secondly with the total group of patients diagnosed with SPD (n = 25 + 20). Logistic regression analyses indicated that primitive defenses and disorganization best differentiated the BPD and the pure SPD group, while primitive defenses and interpersonal factor along with perceptual aberrations best differentiated the BPD and the total SPD group., Conclusion: Identity disturbance did not predict the diagnostic groups, but BPD patients were characterized by primitive defenses, which are closely related to identity disturbance. Pure SPD was characterized by oddness/eccentricity, while the lack of specificity for cognitive-perceptual symptoms suggests that the positive symptoms do not differentiate BPD from SPD., (© 2021 S. Karger AG, Basel.)

(Reprinted with permission from The American Journal of Psychiatry 2020; 177:868-872)., (Copyright © 2020 by the American Psychiatric Association.)

Memorializes Armand W. Loranger (1930-2019). A preeminent authority on personality pathology, Loranger was known internationally as a scholar who transformed the diagnosis of personality disorders through the development of a systematic structured interview approach, moving the field away from decades of less reliable methods. Loranger's research reflected his broad range of clinical interests and included numerous publications on diagnosis and classification, psychopharmacology, genetics, and epidemiology, involving schizophrenia, dementia, mood disorders, and the personality disorders. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Background and Overview: The conceptualization of personality pathology, or personality disturbance, is now at a substantive crossroads. Some researchers (and clinicians) prefer a focus on the domains of personality pathology that are well-described and captured in traditional categorical diagnostic approaches that, in some instances, abut normal personality constructs. Other workers argue to move the study of personality disorder (PD) closer to personality science seeking continuous connections between PD and established dimensions of healthy-range, normal personality. Most of the latter efforts revolve around correlational and factor analytic study of phenotypic expressions of PD features and normal personality dimensions. It is notable, however, that both visions of the PD/personality interface are essentially unlinked to an understanding of shared neurobiological underpinnings (i.e., neurotransmitter-influenced neurobehavioral systems) of both personality disturbance and normal personality1. Here, we present a nontechnical, conceptual overview of our approach to this problem, advancing a neurobehavioral approach that seeks to anchor both normal personality and personality disturbance within a matrix of brain-based neurobiological systems, incorporating genetic, epigenetic, and environmental inputs. In this brief paper, we seek only to provide a necessarily cursory introduction to how we conceptualize this area and illustrate, in broad outline, our effort to characterize both personality and personality disturbance anchored in neurobehavioral systems. Our approach, which we began developing in the middle 1990s, can be juxtaposed with the more recently proposed DSM-5 Alternative Model of Personality Disorders as well as the well-established five-factor approach to PD., (© 2020 S. Karger AG, Basel.)

There is substantial evidence that patients with schizophrenia have deficits in their ability to make inferences about others' mental states. However, the findings in schizotypy are mixed. In an effort to elucidate these mixed findings, the current study evaluated self-referential theory of mind (ToM) in positive schizotypy, or the ability to make inferences about others' mental states as they apply to the self. In addition, we differentiated between 2 ToM error types: hypermentalization (excessive mental state attribution) and undermentalization (overly simplistic or lack of mental state attribution). We used a 3-group design (positive schizotypy, negative affect psychiatric control group, and healthy control group) to assess ToM performance on the hinting task (Corcoran, Mercer, & Frith, 1995) and a newly developed self-referential version of the hinting task that differentiates between ToM error types. Results demonstrated that the schizotypy group made significantly greater self-referential hypermentalization errors than both control groups. Self-referential hypermentalization was significantly related to referential thinking, aberrant salience, interpersonal schizotypic traits, and functional outcome. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Although evidence from a number of longitudinal studies indicates a marked change in narcissistic personality disorder (NPD) symptoms over time, few studies have examined other psychological systems that may be related to this change. The current study uses data from the Longitudinal Study of Personality Disorders to examine how change in NPD symptoms is related to change in normal personality trait trajectories using parallel process growth curve modeling. A total of 250 students provided information on their personality traits and NPD symptoms on 3 occasions over the course of 4 years. Results suggest that cross-sectionally, NPD symptoms are positively correlated with dominance, neuroticism, and openness. Longitudinally, however, NPD symptoms decrease in parallel with increases in conscientiousness and decreases in neuroticism. Importantly, these longitudinal relationships are not a simple replication of the cross-sectional relationships between these 2 systems. Rather, this pattern of change is consistent with trait profiles suggesting maturation in young adults and has implications for the temporal stability of NPD as a construct and the theoretical relationship between normal personality traits and personality disorder more generally. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Little is known about the connection between body modification and borderline personality disorder (BPD). This study investigated the relation between a wide range of body modification practices (piercing, tattooing, scarification, pubic hair removal, and cosmetic surgery) and BPD features, with a special focus on identity and identity dysfunction, in an adult community sample ( N = 330). Results indicated BPD features were positively correlated with total number of body modifications and breadth of body modification practices endorsed, as well as, specifically, increased piercings, tattoos, and scarifications. Furthermore, identity problems (i.e., identity diffusion and low self-concept clarity) were associated with body modifications. Implications of these findings are discussed, including their heuristic value in understanding body modification in light of its connection to BPD (and particularly identity/self-concept functions). (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Research suggests that both personality disorder (PD) and normal personality change as systems of variables (e.g., the general factor of PD), rather than as individual variables (e.g., neuroticism). Consequently, understanding PD and normal personality as multidimensional systems may yield additional insights over traditional single-variable approaches. Normal personality change has been attributed to increase across adaptive traits (i.e., the maturity principle), suggesting that shifts in the overall magnitude of construct expression plays a role in systemic change. We examined the extent to which total ipsative, system-level change was accounted for by shifts in the overall level of constructs (i.e., severity/maturity) as well as shifts in the configuration of PD and normal personality (i.e., style) across self-report and structured interview. Results demonstrated that overall change in PD and normal personality measured via self-report reflected both stylistic and severity change, whereas structured interview of PD primarily reflected shifts in profile severity. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Borderline personality disorder (BPD) is a debilitating condition with significant personal and societal costs. Throughout the history of the conceptualization of borderline pathology as a form of psychopathology, there has been debate concerning the essential attributes of this disorder, which has significant implications for its assessment and treatment. The first of this 2-part review evaluates the major approaches to conceptualizing BPD, from the traditional DSM diagnosis through the more recent Alternative Model in DSM-5, Section III, and the research domain criteria initiative of the National Institute of Mental Health that was articulated largely in response to limitations of the DSM., (Copyright © 2018 Elsevier Inc. All rights reserved.)

In part 2, the authors argue for a greater focus on a process approach to conceptualizing borderline personality disorder (BPD). The studies reviewed highlight contextual aspects of the pathology, specifically the affective and relational conditions under which BPD features become evident. The authors identify at what level in a complex social cognitive process the pathology may emerge. The implications of these findings for future model conceptualization are discussed, including the centrality of understanding BPD as an emergent phenomenon that cannot be reduced to single explanatory dimensions. The implications of these models for assessment, research, and treatment of BPD are discussed., (Copyright © 2018 Elsevier Inc. All rights reserved.)

The nature and definition of schizotypy, as the latent liability for schizophrenia capable of generating various phenotypic and endophenotypic outcomes, is reviewed. The proceedings of the 2017 meeting of the International Consortium on Schizotypy Research are included in this Special Section and they are presented as illustrations of current research work on schizotypy. The potential leverage of the schizotypy framework for schizophrenia research continues to be realized and these articles present current research efforts that explore new angles of inquiry while building upon past advances. Methodological and substantive areas of concern are highlighted and suggestions for improvement of future schizotypy research are made.

Eye contact is an essential means of nonverbal communication, providing information about attention, emotion, mental state, facial expressions, and identity/gender (Itier & Batty, 2009). Although studies suggest that patients with schizophrenia endorse direct gaze more often than controls in ambiguous gaze circumstances, gaze perception in schizotypy remains unstudied. This study investigated whether individuals with positive schizotypic features incorrectly perceive that others are looking at them and whether this is related to referential thinking and psychosocial functioning. Schizotypic individuals (n = 33) and controls (n = 29) completed a newly developed measure of gaze perception, a cone of gaze task (Gamer & Hecht, 2007). Results reveal that individuals in the schizotypy group report feeling as though they are being looked at across a wider range of angles than controls. Consistent with our hypotheses, this wider cone of gaze is associated with increased referential thinking and poorer psychosocial functioning. (PsycINFO Database Record, ((c) 2018 APA, all rights reserved).)

The most current conceptualization of personality pathology emphasizes the assessment of the severity of selected domains of functioning involving lack of accurate perceptions of self and others that are common across the personality disorder categories. Advances in our understanding of personality pathology have stimulated further development of Transference-Focused Psychotherapy (TFP) for patients with borderline personality disorder, including treatment focus on both behavior and mental representations of self and others, the trajectory of change in TFP, and the extension of TFP principles to the entire domain of personality pathology., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

In this study we used the Reading the Mind in the Eyes Test (RMET) to explore facial emotion recognition in borderline personality disorder (BPD). We also used Cyberball, a computerized task designed to mimic social ostracism, to examine the response of BPD-feature participants to social exclusion. Seventeen individuals with BPD features were compared to 16 healthy controls on RMET performance pre- and post-exclusion via Cyberball. Our results revealed a significant interaction between BPD-feature status and RMET performance in relation to neutral stimuli following a social exclusion experience. BPD participants' ability to correctly identify neutral faces significantly decreased following exclusion. This finding suggests that once an individual with BPD features experiences a social exclusion event, his or her objectivity decreases and affective valence is ascribed to stimuli previously perceived as neutral. Our results may help to explain, in part, the social instability seen in BPD.

Background: Normal and pathological narcissism have been the focus of considerable theoretical discussion and empirical research in recent years in personality psychology and psychopathology. Kernberg [1-4] has argued that there is a particularly dysfunctional and impairing variant of narcissistic disturbance known as malignant narcissism. This exploratory study sought to develop, using established assessment methods, a dimensional measure of malignant narcissism that incorporates the key features of grandiose narcissism, paranoid propensities, psychopathic features, and proclivity for a sadistic and aggressive interpersonal style. Method and Sampling: This study examined 57 subjects, diagnosed with borderline personality disorder that were treated using 3 different empirically supported treatments in a previous study [5], for possible deviance on the proposed malignant narcissism index. It also evaluated 2 important clinical domains of change in relation to malignant narcissism. To wit, it was predicted, based on Kernberg's [3, 4] clinical model, that elevated levels of malignant narcissism would be significantly associated with slower rates of improvement in both general psychosocial/psychological functioning and anxiety among treated individuals., Results: Higher levels of malignant narcissism were associated, as predicted, with slower rates of improvement in both global functioning and anxiety. The proposed malignant narcissism index was a more powerful predictor of slowed improvement in global functioning than simple narcissistic personality disorder features., Conclusions: The heuristic potential of the malignant narcissism construct is discussed and the utility of a dimensional approach to this construct is explored, especially in reference employing personality traits/processes to better understand pathological configurations and personality disturbance., (© 2018 S. Karger AG, Basel.)

The present laboratory study examined motor empathy in male and female individuals, who were either high or low on psychopathic traits, drawn from a nonclinical university population. Past findings suggest that psychopathic individuals are impaired in affective empathy, but findings on impairments in cognitive empathy are mixed. Research on motor empathy in psychopathy is scarce. The authors hypothesized that individuals high on psychopathic traits would have deficient motor empathy (similar to affective empathy) related to valenced emotion stimuli because of the automatic nature of motor empathy. Potential participants completed the Psychopathic Personality Inventory-Revised (PPI-R). Participants were chosen for the study on the basis of their PPI-R scores. All participants viewed photographic images drawn from a well-established set of stimuli (the International Affective Picture System) and were video recorded while doing so. Intensity for eight emotions (anger, contempt, disgust, fear, sad, joy, surprise, and neutral) in participants' facial expressions was measured objectively using an automated program, the Computer Expression Recognition Toolbox. Individuals high on psychopathic traits as compared with low PPI-R scorers displayed significantly less emotional congruence when viewing negative images. The study results suggest that deficits in motor empathy related to psychopathic trait levels are relatively restricted to negative emotions.

Aims: Borderline personality disorder (BPD) is characterized by self-regulation deficits, including impulsivity and affective lability. Transference-focused psychotherapy (TFP) is an evidence-based treatment proven to reduce symptoms across multiple cognitive-emotional domains in BPD. This pilot study aimed to investigate neural activation associated with, and predictive of, clinical improvement in emotional and behavioral regulation in BPD following TFP., Methods: BPD subjects (n = 10) were scanned pre- and post-TFP treatment using a within-subjects design. A disorder-specific emotional-linguistic go/no-go functional magnetic resonance imaging paradigm was used to probe the interaction between negative emotional processing and inhibitory control., Results: Analyses demonstrated significant treatment-related effects with relative increased dorsal prefrontal (dorsal anterior cingulate, dorsolateral prefrontal, and frontopolar cortices) activation, and relative decreased ventrolateral prefrontal cortex and hippocampal activation following treatment. Clinical improvement in constraint correlated positively with relative increased left dorsal anterior cingulate cortex activation. Clinical improvement in affective lability correlated positively with left posterior-medial orbitofrontal cortex/ventral striatum activation, and negatively with right amygdala/parahippocampal activation. Post-treatment improvements in constraint were predicted by pre-treatment right dorsal anterior cingulate cortex hypoactivation, and pre-treatment left posterior-medial orbitofrontal cortex/ventral striatum hypoactivation predicted improvements in affective lability., Conclusions: These preliminary findings demonstrate potential TFP-associated alterations in frontolimbic circuitry and begin to identify neural mechanisms associated with a psychodynamically oriented psychotherapy., (© 2015 The Authors. Psychiatry and Clinical Neurosciences © 2015 Japanese Society of Psychiatry and Neurology.)

Numerous studies have demonstrated that motor control deficits are characteristic of patients diagnosed with schizophrenia and those at-risk for the development of the disorder. Recent advances in the quantification of motor dysfunction have confirmed this, but these methods fail to consider an important aspect of subject performance: the qualitative nature of their psychomotor dyscontrol. We report on a novel technique used to quantify the qualitative nature of psychomotor performance and its relation to schizotypy. Control (n = 35) and schizotypic subjects (n = 47) completed a line-drawing task that yields metrics for psychomotor control and predominant frequency. Schizotypes evidenced greater psychomotor dyscontrol and lower predominant frequencies than controls. These results are interpreted as evidence of reduced visual-motor integration, self-monitoring capacity, or adherence to basic motor principles in schizotypes. The potential use of these metrics as putative endophenotypes for the liability for schizophrenia and the implications of these findings for the relationship between schizophrenia and schizotypy are discussed., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Intermittent degradation refers to transient detrimental disruptions in task performance. This phenomenon has been repeatedly observed in the performance data of patients with schizophrenia. Whether intermittent degradation is a feature of the liability for schizophrenia (i.e., schizotypy) is an open question. Further, the specificity of intermittent degradation to schizotypy has yet to be investigated. To address these questions, 92 undergraduate participants completed a battery of self-report questionnaires assessing schizotypy and psychological state variables (e.g., anxiety, depression), and their reaction times were recorded as they did so. Intermittent degradation was defined as the number of times a subject's reaction time for questionnaire items met or exceeded three standard deviations from his or her mean reaction time after controlling for each item's information processing load. Intermittent degradation scores were correlated with questionnaire scores. Our results indicate that intermittent degradation is associated with total scores on measures of positive and disorganized schizotypy, but unrelated to total scores on measures of negative schizotypy and psychological state variables. Intermittent degradation is interpreted as potentially derivative of schizotypy and a candidate endophenotypic marker worthy of continued research.

The concept of schizotypy represents a rich and complex psychopathology construct. Furthermore, the construct implies a theoretical model that has considerable utility as an organizing framework for the study of schizophrenia, schizophrenia-related psychopathology (eg, delusional disorder, psychosis-NOS (not otherwise specified), schizotypal, and paranoid personality disorder), and putative schizophrenia endophenotypes as suggested by Rado, Meehl, Gottesman, Lenzenweger, and others. The understanding (and misunderstanding) of the schizophrenia-related schizotypy model, particularly as regards clinical illness, as well as an alternative approach to the construct require vigilance in order to ensure the methodological approach continues to yield the fruit that it can in illuminating the pathogenesis of schizophrenia-related psychopathology. The articles in the Special Section in this issue of Schizophrenia Bulletin highlight methodological and theoretical issues that should be examined carefully., (© The Author 2015. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Certain Personality Disorders (PDs) have been found to be present in the prodromal phase of schizophrenia at a higher rate than other personality disorders. Although schizotypal, paranoid, and schizoid PDs are traditionally viewed as spectra for schizophrenia, research suggests that avoidant PD should be included in this group (e.g., Fogelson et al., 2007). The present study examines whether a sample of psychometrically identified schizotypes (SZT) have higher incidence of schizophrenia-spectrum PDs, as well as more symptoms of these PDs, in general, than does a matched comparison (MC) sample. Eighty-five SZT and 78 MC participants were administered the Personality Disorder Interview for DSM-IV (PDI-IV) to assess PD symptoms and diagnoses. Results indicate that the SZT group evidenced significantly more symptoms of avoidant, schizoid, paranoid, and schizotypal PDs than did the MC group. Further, there were significant differences in the incidence of these PDs between the groups., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

During World War II, the Office of Strategic Services (OSS), the forerunner of the Central Intelligence Agency, sought the assistance of clinical psychologists and psychiatrists to establish an assessment program for evaluating candidates for the OSS. The assessment team developed a novel and rigorous program to evaluate OSS candidates. It is described in Assessment of Men: Selection of Personnel for the Office of Strategic Services (OSS Assessment Staff, 1948). This study examines the sole remaining multivariate data matrix that includes all final ratings for a group of candidates (n = 133) assessed near the end of the assessment program. It applies the modern statistical methods of both exploratory and confirmatory factor analysis to this rich and highly unique data set. An exploratory factor analysis solution suggested 3 factors underlie the OSS assessment staff ratings. Confirmatory factor analysis results of multiple plausible substantive models reveal that a 3-factor model provides the best fit to these data. The 3 factors are emotional/interpersonal factors (social relations, emotional stability, security), intelligence processing (effective IQ, propaganda skills, observing and reporting), and agency/surgency (motivation, energy and initiative, leadership, physical ability). These factors are discussed in terms of their potential utility for personnel selection within the intelligence community.

A number of mixture modeling approaches assume both normality and independent observations. However, these two assumptions are at odds with the reality of many data sets, which are often characterized by an abundance of zero-valued or highly skewed observations as well as observations from biologically related (i.e., non-independent) subjects. We present here a finite mixture model with a zero-inflated Poisson regression component that may be applied to both types of data. This flexible approach allows the use of covariates to model both the Poisson mean and rate of zero inflation and can incorporate random effects to accommodate non-independent observations. We demonstrate the utility of this approach by applying these models to a candidate endophenotype for schizophrenia, but the same methods are applicable to other types of data characterized by zero inflation and non-independence., (Copyright © 2014 John Wiley & Sons, Ltd.)

Approximately two thirds of those with borderline personality disorder (BPD) who self-injure report diminished sensitivity to pain during acts of self-harm. Research on pain perception suggests that abnormalities of the motivational-affective domain likely contribute to the commonly reported hypo-analgesia evidenced in BPD. It is not that BPD individuals cannot detect or feel painful stimuli, rather their response to it seems to reflect differences in tolerance and willingness to report a stimulus as painful. Although specific processes involved with pain insensitivity have been debated in literature, the likelihood of generalized dysfunction in the somatosensory systems in BPD has not been considered. Prior BPD research has focused only on the pain submodality of somatosensation. This study assessed pain perception (nociception), basic touch (exteroception), and body sense (proprioception) somatosensory submodalities, in an effort to determine if generalized somatosensory deficits are present in BPD. Subjects diagnosed with DSM-IV BPD (n = 27) were compared with individuals who had a history of major depressive disorder with no current psychopathology (n = 20), and normal controls (n = 44), all drawn from a community setting. Individuals with BPD evidenced higher pain endurance and tolerance, but did not demonstrate generalized somatosensory deficits, as evidenced by appropriate functioning on tasks of exteroceptive and proprioceptive sensitivity. Findings are consistent with (but do not prove) a specific dysfunction in the pain-specific mechanism of sensitivity and perception in BPD, perhaps one that does not disturb the other somatosensory modalities. These data help to provide a firmer empirical basis for pain insensitivity as an endophenotype for BPD., (PsycINFO Database Record (c) 2014 APA, all rights reserved)

The endophenotype is central to modern developmental psychopathology studies. It is used in studies seeking to connect the genetic substrates of the panoply of major mental disorders with processes, tapped by laboratory and other assessment measures, in the genotype to a behavior/psychopathology pathway. Proposed originally by Gottesman and Shields (1972; Shields & Gottesman, 1973) 41 years ago, the endophenotype concept has gained widespread traction in psychopathology research since the Gottesman and Gould (2003) review. Other concepts broadly related to the endophenotype notion have also generated discussion in experimental and developmental psychopathology research. One is the intermediate phenotype, a concept proffered as a putative alternative formulation to the endophenotype. Another concept in this intellectual vein is biomarker. The terms endophenotype, intermediate phenotype, and biomarker have often been used interchangeably in the psychiatric literature, yielding conceptual confusion. However, these three terms are not fungible. The recent Research Domain Criteria proposal from the National Institute of Mental Health has emphasized selected underlying processes thought to be of developmental etiologic significance to psychopathology. These selected processes will be the focus of energetic future research efforts, many of which will make use of the endophenotype and biomarker research paradigms. In this context, the concepts of endophenotype, intermediate phenotype, and biomarker are examined critically and contrasted in terms of meaning, intention, clarity, and intellectual history. This analysis favors use of the endophenotype concept in genetically informed laboratory and neuroscience studies of psychopathology. The term intermediate phenotype is perhaps best restricted to its originally defined meaning in genetics. Biomarker is used to denote objectively measured biological antecedents or consequences of normal or pathogenic processes or a physiologic response to a therapeutic intervention.

Past research has emphasized the association between stress and the manifestation of psychotic symptoms in schizophrenia, yet relatively little is known about how environmental stressors affect cognitive processes in the illness. The present study sought to determine the effects of a loud noise stressor on a range of cognitive tasks, including spatial working memory (SWM), short-term visual memory, and sustained visual attention. Twenty-nine (29) schizotypic subjects and 45 controls performed the cognitive tasks across four waves of data collection: baseline, a noisy stress condition, and two follow-up conditions. Heart rate (BPM) was measured at each wave and subjective ratings of stress were collected in response to the loud noise stressor. Schizotypic subjects exhibited significantly greater increases in BPM during the loud, noisy stressor in comparison to controls. Additionally, schizotypic subjects' subjective ratings of stress in response to the loud noise were significantly greater than the controls' ratings. As hypothesized a priori, schizotypic subjects experienced significant decreases in SWM from baseline to the noisy stress condition in comparison to controls. Performance on non-SWM cognitive tasks did not significantly differ during the noisy stress condition and SWM performance did not significantly differ during noise-free conditions. Results from the present study highlight SWM as being particularly susceptible to loud noise stressors in a schizotypic population. Although the source of the induced impairment is not clear, one possibility is that the encoding stage of SWM was negatively affected by the loud noise., (PsycINFO Database Record (c) 2013 APA, all rights reserved.)

Avoidant personality disorder (AVPD), like other personality disorders, has historically been construed as a highly stable disorder. However, results from a number of longitudinal studies have found that the symptoms of AVPD demonstrate marked change over time. Little is known about which other psychological systems are related to this change. Although cross-sectional research suggests a strong relationship between AVPD and personality traits, no work has examined the relationship of their change trajectories. The current study sought to establish the longitudinal relationship between AVPD and basic personality traits using parallel process growth curve modeling. Parallel process growth curve modeling was applied to the trajectories of AVPD and basic personality traits from the Longitudinal Study of Personality Disorders (Lenzenweger, M. F., 2006, The longitudinal study of personality disorders: History, design considerations, and initial findings. Journal of Personality Disorders, 20, 645-670. doi:10.1521/pedi.2006.20.6.645), a naturalistic, prospective, multiwave, longitudinal study of personality disorder, temperament, and normal personality. The focus of these analyses is on the relationship between the rates of change in both AVPD symptoms and basic personality traits. AVPD symptom trajectories demonstrated significant negative relationships with the trajectories of interpersonal dominance and affiliation, and a significant positive relationship to rates of change in neuroticism. These results provide some of the first compelling evidence that trajectories of change in PD symptoms and personality traits are linked. These results have important implications for the ways in which temporal stability is conceptualized in AVPD specifically, and PD in general.

Pain perception in borderline personality disorder (BPD) may reflect abnormalities of the sensory-discriminative and/or motivational-affective domains in those patients. Although pain insensitivity has received considerable specific discussion, the likelihood of a generalized dysfunction in the somatosensory systems in BPD has not been explored. Prior BPD research has focused only on the pain submodality of somatosensation. This study assessed other prominent and basic touch and body sense somatosensory submodalities, exteroception and proprioception, respectively. Exteroception and proprioception were measured with two-point discrimination and weight discrimination tasks, respectively. A group of subjects with BPD features (n = 32) was compared with a control group (n = 29), both drawn from a nonclinical population, across objective laboratory measures of somatosensation. Results indicated that individuals with BPD features do not demonstrate generalized somatosensory deficits. Lack of group differences in these two somatosensation submodalities (particularly the exteroceptive sensitivity submodality) is consistent with (but does not prove) a dysfunction in the pain-specific mechanism of sensitivity and perception in BPD, perhaps one that does not disturb the other somatosensory modalities.

The current Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic system for Axis II disorders continues to be characterized by considerable heterogeneity and poor discriminant validity. Such problems impede accurate personality disorder (PD) diagnosis. As a result, alternative assessment tools are often used in conjunction with the DSM. One popular framework is the object relational model developed by Kernberg and his colleagues (J. F. Clarkin, M. F. Lenzenweger, F. Yeomans, K. N. Levy, & O. F. Kernberg, 2007, An object relations model of borderline pathology, Journal of Personality Disorders, Vol. 21, pp. 474-499; O. F. Kernberg, 1984, Severe Personality Disorders, New Haven, CT: Yale University Press; O. F. Kernberg & E. Caligor, 2005, A psychoanalytic theory of personality disorders, in M. F. Lenzenweger & J. F. Clarkin, Eds., Major Theories of Personality Disorder, New York, NY: Guilford Press). Drawing on this model and empirical studies thereof, the current study attempted to clarify Kernberg's (1984) PD taxonomy and identify subtypes within a sample with varying levels of personality pathology using finite mixture modeling. Subjects (N = 141) were recruited to represent a wide range of pathology. The finite mixture modeling results indicated that 3 components were harbored within the variables analyzed. Group 1 was characterized by low levels of antisocial, paranoid, and aggressive features, and Group 2 was characterized by elevated paranoid features. Group 3 revealed the highest levels across the 3 variables. The validity of the obtained solution was then evaluated by reference to a variety of external measures that supported the validity of the identified grouping structure. Findings generally appear congruent with previous research, which argued that a PD taxonomy based on paranoid, aggressive, and antisocial features is a viable supplement to current diagnostic systems. Our study suggests that Kernberg's object relational model offers a plausible substantive aid in refining PD classification., (PsycINFO Database Record (c) 2013 APA, all rights reserved.)

Although previous reports have documented mean-level declines in personality disorder (PD) symptoms over time, little is known about whether personality pathology sometimes emerges among nonsymptomatic adults, or whether rates of change differ qualitatively among symptomatic persons. Our study sought to characterize heterogeneity in the longitudinal course of PD symptoms with the goal of testing for and describing latent trajectories. Participants were 250 young adults selected into two groups using a PD screening measure: those who met diagnostic criteria for a DSM-III-R PD (PPD, n = 129), and those with few PD symptoms (NoPD, n = 121). PD symptoms were assessed three times over a 4-year study using semistructured interviews. Total PD symptom counts and symptoms of each DSM-III-R PD were analyzed using growth mixture modeling. In the NoPD group, latent trajectories were characterized by stable, minor symptoms; the rapid or gradual remission of subclinical symptoms; or the emergence of symptoms of avoidant, obsessive-compulsive, or paranoid PD. In the PPD group, three latent trajectories were evident: rapid symptom remission, slow symptom decline, or a relative absence of symptoms. Rapid remission of PD symptoms was associated with fewer comorbid disorders, lower Negative Emotionality, and greater Positive Emotionality and Constraint, whereas emergent personality dysfunction was associated with comorbid PD symptoms and lower Positive Emotionality. In most cases, symptom change for one PD was associated with concomitant changes in other PDs, depressive symptoms, and anxiety. These results indicate that the longitudinal course of PD symptoms is heterogeneous, with distinct trajectories evident for both symptomatic and nonsymptomatic individuals. The prognosis of PD symptoms may be informed by an assessment of personality and comorbid psychopathology., (2013 APA, all rights reserved)

Advances in our understanding of complex psychopathology will likely benefit from approaches to mind, brain, and behavior that seek to (a) specify those general neurobehavioral processes underpinning pathology and (b) bridge to other process-based models of psychopathology at different levels of analysis. Well-defined neurobehavioral processes (e.g., positive emotionality, negative emotionality, nonaffective constraint, fear, affiliation) and their phenotypic indicators are firmly rooted in neural substrates (Depue & Lenzenweger, 2005). Furthermore, long-studied psychodynamic psychological processes, such as identity diffusion, primitive psychological defensive functioning, and reality-testing dimensions, are important to understanding personality pathology (Kernberg & Caligor, 2005). Both theoretical perspectives view the cardinal processes involved in the determination of personality disorders (PDs) as relevant across existing PD diagnostic entities. The authors examined relationships between psychometric indicators of these two sets of processes, the neurobehavioral and the psychodynamic, in a well-characterized sample of individuals with borderline personality disorder (BPD; N = 92). In bridging these two levels of analysis, the authors found that the alienation, aggression, and absorption constructs represent important linkages to the psychodynamic processes, especially primitive psychological defenses and reality-testing impairments. These results are discussed in terms of their potential for joining these two domains of analysis--a neurobehaviorally informed view of personality and the psychodynamic--in efforts to (a) foster a process-oriented approach, (b) resolve heterogeneity, and (c) facilitate identification of endophenotypes in BPD. The heuristic value of this approach for understanding other forms of psychopathology is also discussed.