Personality Studies
Andrew E. Skodol, M.D., Director
Donna S. Bender, Ph.D., Research
Scientist IV
The Department of Personality Studies conducts research on personality traits and disorders in collaboration with investigators from other research departments at Psychiatric Institute and other university Departments of Psychiatry. Personality disorders are increasingly being recognized in their own right as important contributors to substantial functional impairment and high treatment utilization. Evidence has also accumulated attesting to their negative prognostic effects on a variety of other mental disorders.
In 2000, members of the Department of Personality Studies obtained competing continuation funding for a fifth year of an NIMH-funded Collaborative Longitudinal Study of Personality Disorders (CLPS). Other collaborative sites include McLean Hospital (Harvard University) in Belmont, Massachusetts; Butler Hospital (Brown University) in Providence, Rhode Island; Yale Psychiatric Institute (Yale University) in New Haven, Connecticut; and the Department of Psychology of Texas A&M University in College Station, Texas. The CLPS has recruited 668 treatment-seeking or treated subjects with one of four representative personality disorders (schizotypal, N=86; borderline, N=175; avoidant, N=157; and obsessive compulsive, N=153) or with major depressive disorder and no personality disorder (N=97). As of the end of the year, the majority of subjects had been followed via four separate follow-up assessments over three years.
Several significant observations have been made. 1) Personality disorders can be assessed with the same degree of diagnostic reliability as other mental disorders by well-trained clinical interviewers using semi-structured interviews. 2) Particular characteristics of Axis I mental disorders appear to be most associated with personality disorder comorbidity; specifically, mood disorders with insidious onsets and recurrence, chronicity, and progression in severity may be related to a personality disorder diagnosis in young adults. 3) Severe personality disorders (e.g., schizotypal and borderline) are associated with more impairment in social and occupational functioning than is an impairing Axis I disorder, such as major depressive disorder. 4) Patients with severe personality disorders, such as borderline personality disorder, have more extensive histories of psychiatric outpatient, inpatient, and psychopharmacologic treatment than patients with major depressive disorder. 5) Personality disorder diagnoses, as exemplified by DSM-IV criteria sets, may not be as stable over time as their generally accepted definitions imply. Between 19% (schizotypal) and 38% (obsessive compulsive) of patients with personality disorders experience significant periods of symptomatic "remission" over a one-year follow-up and only 34% (schizotypal) to 56% (avoidant) have manifestations sufficient to meet full diagnostic criteria every month for a 12-month period. 6) Normal personality traits, such as those represented by the Five-Factor Model (FFM) of personality, and functional impairments associated with personality disorders appear to be more stable over time than are the diagnostic criteria of DSM-IV personality disorders.
A four-year, funded continuation of the CLPS was recommended by an NIMH review committee in 2000, which would bring the study a continuous period of funding of nine years and extend the follow-up period for all subjects to at least seven years.
Dr. Skodol is the Principal Investigator of the New York State Psychiatric Institute site of the CLPS study and is chair of the study's scientific component subcommittee on social functioning and Axis I disorders. Dr. John Oldham is Co-Principal Investigator and responsible for medication usage patterns on the part of the subjects. These data are helping to inform the effort, led by Dr. Oldham, to develop practice guidelines for borderline personality disorder on the part of the American Psychiatric Association. Dr. Donna Bender is in charge of the ongoing implementation of the CLPS protocol at the NYSPI site and is also monitoring the use of psychosocial treatments across the multisite study and working to understand intrapsychic and psychosocial factors that affect treatment utilization and compliance, resistance to treatment, and drop-out.
In addition to his functions as Principal Investigator on the Collaborative Longitudinal Study, Dr. Skodol has been collaborating with Dr. Patricia Cohen and her colleagues in the Department of the Epidemiology of Mental Disorders on her Children in the Community longitudinal study of the risks for and course of psychopathology from childhood to adulthood. Specifically, Dr. Skodol has worked with Dr. Stephanie Kasen and Dr. Jeffrey Johnson in their efforts to understand the complex interplay between personality disorder symptomatology and other major mental disorders from childhood on. This work also examines antecedents and outcomes associated with adolescent personality psychopathology. Dr. Cohen's study and the CLPS share several similar goals, although the samples and their ages are different, but complementary.
In January, 2000, Dr. Skodol was appointed
to the position of Deputy Director at Psychiatric Institute. He has continued,
however, to direct the Department of Personality Studies. Year 2000 was
a busy year as he attempted to juggle the needs of the Department of Personality
Studies with the needs of research at NYSPI, in general, and to fulfill
his responsibilities to both.
Dr. Andrew Skodol and Dr. Donna Bender