[Show abstract][Hide abstract] ABSTRACT: DSM-5 offers an alternative model of personality pathology that includes 25 traits. Although personality disorders are mostly treated with psychotherapy, the correspondence between DSM-5 traits and concepts in evidence-based psychotherapy has not yet been evaluated adequately. Suitably, schema therapy was developed for treating personality disorders, and it has achieved promising evidence. The authors examined associations between DSM-5 traits and schema therapy constructs in a mixed sample of 662 adults, including 312 clinical participants. Associations were investigated in terms of factor loadings and regression coefficients in relation to five domains, followed by specific correlations among all constructs. The results indicated conceptually coherent associations, and 15 of 25 traits were strongly related to relevant schema therapy constructs. Conclusively, DSM-5 traits may be considered expressions of schema therapy constructs, which psychotherapists might take advantage of in terms of case formulation and targets of treatment. In turn, schema therapy constructs add theoretical understanding to DSM-5 traits.
Journal of Personality Disorders 08/2015; DOI:10.1521/pedi_2015_29_212 · 2.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Early Maladaptive Schemas, as measured with the Young Schema Questionnaire (YSQ), are proposed to underlie a variety of mental
health problems, in particular Personality Disorders. The latest short version of the instrument measuring all 18 schemas, the YSQ-S3, has only
been examined to a limited extent, and its associations with Personality Disorders have not yet been tested in a psychiatric setting.
We investigated psychometric properties of the Danish YSQ-S3 including its associations with Personality Disorders. A mixed Danish sample
of clinical and nonclinical participants (N = 567) completed the YSQ-S3, whereas a clinical subsample (n = 142) was also assessed with a
diagnostic interview for Personality Disorders. We performed reliability analysis, confirmatory factor analysis, regression analysis, and tested
for group differences using analysis of variance. The Danish YSQ-S3 proved to be a reliable and valid measure. Its theoretical factorial structure
was weakly but sufficiently supported. Its scales were meaningfully associated with specific Personality Disorders and discriminated between
relevant groups. We conclude that the YSQ-S3 is a psychometrically valuable instrument for the assessment of Early Maladaptive Schemas in
both clinical and research settings. Findings are discussed in relation to Personality Disorders and the Schema Therapy model.
European Journal of Psychological Assessment 07/2015; DOI:10.1027/1015-5759/a000272 · 2.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: Callous-unemotional (CU) traits have been found to index an important subgroup of antisocial youth who are at high risk for developing psychopathic personality pathology, and for becoming severe and persistent offenders. On the basis of such research findings, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, have included a “with limited prosocial emotions” specifier in the diagnostic criteria for conduct disorder to designate a subtype with high levels of CU traits. This creates the need for psychometrically sound measures for the assessment of these traits. The self-report questionnaire Inventory of Callous-Unemotional Traits (ICU) was designed to provide an efficient, reliable, and valid measure of CU traits among youth populations. Method: Eighty Danish adolescent boys between the ages of 15 to 18 years in secure institutions were assessed concurrently with the ICU, the Psychopathy Checklist: Youth Version (PCL:YV), self-report measures of aggression and empathy, and ratings of psychosocial problems. Approximately nine days later, the ICU was readministered in a subset of the sample (n = 40) to examine test-retest reliability. Results: Internal consistency was satisfactory, and test-retest reliability was excellent. Concurrent validity associations with the PCL:YV ranged from moderate to high. The ICU displayed excellent discriminative validity for identifying persons who displayed high levels of psychopathic traits. CU traits were also found to be associated with psychosocial impairments, aggression, and reduced empathy. Conclusions: Overall, these findings support the reliability; construct validity, and criterion validity of the ICU.
[Show abstract][Hide abstract] ABSTRACT: In this article, the authors provide a narrative review of the mounting evidence base on personality disorder in childhood and adolescence. Topics covered include diagnostic validity, prevalence, developmental issues, comorbidity, risk and protective factors, and treatment. Novel indicated prevention and early intervention programs for borderline personality disorder in adolescence are given special priority. To conclude, directions for future research are provided.
[Show abstract][Hide abstract] ABSTRACT: In this article we highlight the pivotal role of Dr. Theodore Millon in the founding of the International Society for the Study of Personality Disorders (ISSPD). This historical outline of Millon's contribution to the ISSPD also contains previously unpublished transcripts of his talks at ISSPD congresses based on transcripts from the first author's audio recordings throughout the years.
Journal of Personality Assessment 04/2015; DOI:10.1080/00223891.2015.1031795 · 2.01 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In this study we assessed the DSM-5 trait model in a large Danish sample (n = 1,119) with respect to reliability of the applied Danish version of the Personality Inventory for DSM-5 (PID-5) self-report form by means of internal consistency and item discrimination. In addition, we tested whether the five-factor structure of the DSM-5 trait model can be replicated in a Danish independent sample using the PID-5 self-report form. Finally, we examined the hierarchical structure of DSM-5 traits. In terms of internal consistency and item discrimination, the applied PID-5 scales were generally found reliable and functional; our data resembled the five-factor structure of previous findings, and we identified a hierarchical structure from one to five factors that was conceptually reasonable and corresponded with existing findings. These results support the new DSM-5 trait model and suggest that it can be generalized to other languages and cultures.
Journal of personality disorders 04/2015; DOI:10.1521/pedi_2015_29_187 · 3.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: Section III of the DSM-5 includes a model of twenty five pathological personality traits along with six defined personality disorder types. This model provides a means for the dimensional assessment of individuals with psychopathology as alternative to the preserved categorical approach in Section II. However, there is limited research on the associations of the pathological trait model with clinical constructs used in evidence-based psychotherapy for BPD and allied disorders. The current study examined the relations between BPD traits as defined in DSM-5 Section III and Schema Therapy Constructs (Early Maladaptive Schemas and Schema Modes). Method: A mixed sample (N=462) consisting of clinical participants (n=142; 71% BPD patients) and non-clinical participants (n=320) completed the Personality Inventory DSM-5 (PID-5), the Young Schema Questionnaire – Short form 3 (YSQ-S3), and the Schema Mode Inventory (SMI). Associations were investigated by correlating DSM-5 Section III trait-scales with scales of YSQ-S3 and SMI. Based on identified associations, constellations of early maladaptive schemas and schema modes were connected with traits of BPD as defined in the DSM-5 Section III. Results: As expected, both Early Maladaptive Schemas and Schema Modes were overall correlated with BPD traits in a conceptually meaningful way. This particularly applied for certain schemas and modes as proposed in the Schema Therapy model. Conclusion: Overall, the results suggest that the BPD traits of the DSM-5 Section III model are meaningfully associated with theoretically related concepts from the Schema Therapy Model. Possible clinical implications of this will shortly be discussed.
International Congress on Borderline Personality Disorder, Rome, Italy; 10/2014
[Show abstract][Hide abstract] ABSTRACT: The International Society for the Study of Personality Disorders (ISSPD) celebrated its 25th anniversary in September 2013 in Copenhagen and commemorated the First International Congress at the same site. The overall theme of the congress was "Bridging Personality and Psychopathology: The Person Behind the Illness." More than 400 abstracts were submitted, and the program included 8 keynote presentations, 18 invited symposia, a debate on current controversial issues in the classification of personality disorders (Fossati, Tyrer, Livesley, and Krueger), an ISSPD award lecture (Silk), a jubilee lecture (Simonsen), a young researchers' symposium (Hopwood, Sharp, and Kaess), and special lectures on the Danish philosopher Soeren Kierkegaard and the poet Hans Christian Andersen. In this article we will survey the presentations and highlight the important issues in order to underline the current trends in research and clinical interests in personality disorders. The keynote video presentations, invited symposia, and slide presentations are freely available at www.isspd2013.com.
[Show abstract][Hide abstract] ABSTRACT: Objective To compare the benefits and harms of third-wave cognitive therapy versus mentalisation-based therapy in a small sample of depressed participants.
Setting The trial was conducted at an outpatient psychiatric clinic for non-psychotic patients in Roskilde, Denmark.
Participants 44 consecutive adult participants diagnosed with major depressive disorder.
Interventions 18 weeks of third-wave cognitive therapy (n=22) versus 18 weeks of mentalisation-based treatment (n=22).
Outcomes The primary outcome was the Hamilton Rating Scale for Depression (HDRS) at end of treatment (18 weeks). Secondary outcomes were: remission (HDRS <8), Beck's Depression Inventory, Symptom Checklist 90 Revised and The WHO-Five Well-being Index 1999.
Results The trial inclusion lasted for about 2 years as planned but only 44 out of the planned 84 participants were randomised. Two mentalisation-based participants were lost to follow-up. The unadjusted analysis showed that third-wave participants compared with mentalisation-based participants did not differ significantly regarding the 18 weeks HDRS score (12.9 vs 17.0; mean difference −4.14; 95% CI −8.30 to 0.03; p=0.051). In the analysis adjusted for baseline HDRS score, the difference was favouring third-wave cognitive therapy (p=0.039). At 18 weeks, five of the third-wave participants (22.7%) were in remission versus none of the mentalisation-based participants (p=0.049). We recorded no suicide attempts or suicides during the intervention period in any of the 44 participants. No significant differences were found between the two intervention groups on the remaining secondary outcomes.
Conclusions Third-wave cognitive therapy may be more effective than mentalisation-based therapy for depressive symptoms measured on the HDRS. However, more randomised clinical trials are needed to assess the effects of third-wave cognitive therapy and mentalisation-based treatment for depression.
Trial registration number Registered with Clinical Trials government identifier: NCT01070134.
BMJ Open 08/2014; 4(8):1-12. DOI:10.1136/bmjopen-2014-004903 · 2.27 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
Caregivers of persons with first-episode psychosis (FEP) often report high levels of distress. Preventing long-term or chronic distress within the whole family is an important focus of early intervention for psychosis. However, a more comprehensive understanding of the psychological factors involved is needed.
To examine the impact of subjective appraisals and expressed emotion on caregiver distress in FEP.
Within a cross-sectional design, 154 caregivers of 99 persons with FEP in a clinical epidemiological sample completed a series of questionnaires to examine potential predictors of caregiver distress.
Thirty-seven percent of caregivers were suffering from clinically significant distress. A linear mixed model analysis found that, after controlling for caregiver socio-demographic factors, service-user symptoms and global functioning, emotional over-involvement and subjective appraisal of caregiving were significant predictors of caregiver distress.
Caregiver distress is significant in the early phase of illness, and this seems to be more related to their subjective appraisal and over-involvement, than to variations in symptoms and global functioning of the person diagnosed with FEP. This lends further support to the stress-appraisal coping model and the cognitive model of caregiving in FEP, and highlights supportive interventions aimed at handling unhelpful cognitions and behaviors.
Social Psychiatry and Psychiatric Epidemiology 07/2014; 50(3). DOI:10.1007/s00127-014-0935-8 · 2.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Aims:
The present study examined if any patient characteristics at baseline predicted depressive symptoms at 10 years and whether patients prone to depressive symptoms in the first year of treatment had a different prognosis in the following years.
A total of 299 first-episode psychosis (FEP) patients with schizophrenia spectrum disorders were assessed for depressive symptoms with PANSS depression item (g6) at baseline, and 1, 2, 5 and 10 years of follow up. At 10 years, depressive symptoms were also assessed with Calgary Depression Scale for Schizophrenia (CDSS). A PANSS g6 ≥ 4 and CDSS score ≥ 6 were used as a cut-off score for depression.
A total of 122 (41%) patients were scored as depressed at baseline, 75 (28%) at 1 year, 50 (20%) at 2 years, 33 (16%) at 5 years, and 35 (19%) at 10 years of follow up. Poor childhood social functioning and alcohol use at baseline predicted depression at 10 years of follow up. Thirty-eight patients were depressed at both baseline and 1 year follow up. This group had poorer symptomatic and functional outcome in the follow-up period compared to a group of patients with no depression in the first year of treatment.
Depressive symptoms are frequent among FEP patients at baseline but decrease after treatment because their general symptoms have been initiated. Patients with poor social functioning in childhood and alcohol use at baseline are more prone to have depressive symptoms at 10 years of follow up. Patients struggling with depressive symptoms in the first year of treatment should be identified as having poorer long-term prognosis.
Early Intervention in Psychiatry 06/2014; DOI:10.1111/eip.12163 · 1.95 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: First episode psychosis (FEP) patients have an increased risk for violence and criminal activity prior to initial treatment. However, little is known about the prevalence of criminality and acts of violence many years after implementation of treatment for a first episode psychosis. Aim: To assess the prevalence of criminal and violent behaviors during a 10-year follow-up period after the debut of a first psychosis episode, and to identify early predictors and concomitant risk factors of violent behavior. Method: A prospective design was used with comprehensive assessments of criminal behavior, drug abuse, clinical, social and treatment variables at baseline, five, and 10-year follow-up. Additionally, threatening and violent behavior was assessed at 10-year follow-up. A clinical epidemiological sample of first-episode psychosis patients (n = 178) was studied. Results: During the 10-year follow-up period, 20% of subjects had been apprehended or incarcerated. At 10-year follow-up, 15% of subjects had exposed others to threats or violence during the year before assessment. Illegal drug use at baseline and five-year follow-up, and a longer duration of psychotic symptoms were found to be predictive of violent behavior during the year preceding the 10-year follow-up. Conclusion: After treatment initiation, the overall prevalence of violence in psychotic patients drops gradually to rates close to those of the general population. However, persistent illicit drug abuse is a serious risk factor for violent behavior, even long after the start of treatment. Achieving remission early and reducing substance abuse may contribute to a lower long-term risk for violent behavior in FEP patients.
Schizophrenia Research 05/2014; 156(2). DOI:10.1016/j.schres.2014.04.010 · 3.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In first-episode psychosis, the family is considered an important part in the recovery process. This is often accompanied by significant distress, which is acknowledged in numerous studies. However, little is known about the psychological factors involved. One hundred and twenty-seven caregivers of persons with first-episode psychosis completed a series of questionnaires aimed at investigating the contribution of expressed emotion and metacognitions to caregiver distress. Linear mixed model analysis found that emotional over-involvement and metacognitions independently predicted caregiver distress. Mediation analysis using bootstrapping showed that emotional over-involvement could be seen as mediating the effect of metacognitions on distress. The current study is a first step towards understanding the role of metacognitions in caregiver distress, thus opening up for the possibility of using interventions from ‘contextual behaviour therapies’. Implications and future studies are discussed. Copyright
[Show abstract][Hide abstract] ABSTRACT: Objective:
To investigate the effects of social-skills training and a parental training program on children with ADHD as measured by the children's attachment competences.
The SOSTRA trial is a randomized, parallel-group, outcome-assessor-blinded, superiority trial evaluating 8 weeks social-skills training and parental training plus standard treatment versus standard treatment alone for 8- to 12-year old children with ADHD.
There were no significant differences in attachment competences at 6 months between the experimental (n = 25) and the control (n = 22) groups (odds ratio = 1.06, 95% confidence interval = [0.31, 3.58], p = .91). In total, 17 children (36%) changed their entry status, 1 (2%) from secure to insecure attachment, while 16 (34%) changed from insecure to secure attachment.
The experimental treatment does not seem to affect attachment competences compared with standard treatment alone. Children in the SOSTRA trial improved their attachment competences significantly at 6-month follow-up.