Personality Studies
Andrew E. Skodol, M.D., Director
Donna S. Bender, Ph.D., Research Scientist IV
John C. Markowitz, M.D., Research Psychiatrist II
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 important contributors to impairment in
social and occupational functioning and high mental health treatment
utilization. Evidence also attests to their negative prognostic effects on a
variety of other mental disorders.
In 2001, Dr. Andrew Skodol received a 4-year renewal of his NIMH-funded
Collaborative Longitudinal Study of Personality Disorders (CLPS). Other
collaborative sites include McLean Hospital (Harvard University) in Belmont, MA;
Butler Hospital (Brown University) in Providence, RI; Yale Psychiatric Research
(Yale University) in New Haven, CT; and the Department of Psychology of Texas
A&M University in College Station, TX. 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 five separate follow-up assessments over four years. The goal of the CLPS is
to investigate the stability of personality psychopathology and associated
functioning over time, in order to describe the clinical course and to
understand the determinants of prognosis.
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
18% (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
diagnoses of DSM-IV personality disorders themselves. The newly funded
continuation of the CLPS will 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 PI of the New York State Psychiatric Institute site of the
CLPS and is Chair of the study’s Publications Committee and its scientific
component subcommittee on social functioning and Axis I disorders. Dr. John
Oldham is Co-PI and is responsible for the study of medication usage patterns on
the part of the subjects. These data helped to inform the effort, led by Dr.
Oldham, to develop practice guidelines for borderline personality disorder on
the part of the American Psychiatric Association, which were published in
October 2001. 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. Dr. John Markowitz joined the Department
of Personality Studies in 2001. One of the developers of Interpersonal
Psychotherapy (IPT). Dr. Markowitz will be introducing a psychotherapy research
and treatment initiative in the Department for patients with personality
disorders.
In addition to his functions as PI 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 and are complementary, although the samples
and their ages are different.
Dr. Skodol has continued as Deputy Director at Psychiatric Institute, while also
directing the Department of Personality Studies.