Hi Annette - Yes, I would certainly think that at least some PDs could serve as
predispositions/diatheses that lead certain individuals to react more strongly
than others to some potentially stressful stimuli - although I'm unaware of any
evidence along these lines in the PTSD literature per se. For example,
individuals with certain PDs, such as borderline, dependent, or avoidant
personality disorders, tend to be notoriously stress reactive, and could react
more strongly to a potentially traumatic situation than do other individuals. I
also suspect that the nature of the statistical interaction might depend on the
nature of the stressor, e.g., whether it is largely interpersonal in nature as
opposed, for example, to a natural or human-made disaster.
Re: Beth's question, by definition PDs are historical diagnoses: they
require a longstanding history of maladaptive personality traits dating back to
adolescence or at least early adulthood. If the individual's personality was
not markedly abnormal prior to the PTSD-producing stressor, then a (correct) PD
diagnosis would be unlikely (although there is debate about whether a traumatic
stressor can sometimes permanently alter personality, which might in some cases
warrant a diagnosis of a personality disorder if it the changes occurred fairly
early in life and were enduring). Traditionally, to diagnose personality
disorders, one needs the "three Ps": the condition must be pathological
(impairing of real-life functioning, causing distress), pervasive
(cross-situationally consistent), and persistent (temporally consistent). As
one might imagine, however, there is fuzziness in ascertaining all three of
these dimensions, which helps to explain why the inter-rater reliability of
personality disorders has (with a few exceptions, like antisocial personality
disorder) been among the lowest of any conditions in the DSM.
I would assume that PTSD can sometimes be misdiagnosed as a PD if the
clinician is lazy, rushed, or sloppy, and doesn't bother to establish the
longitudinal history in sufficient detail. Alternatively, PTSD can be
misdiagnosed as a PD because of state-trait artifacts: if the individual is
currently very anxious, depressed, or both, he or she may mis-recall
longstanding traits as more pathological than they actually were.
...Scott
Scott O. Lilienfeld, Ph.D.
Professor
Editor, Scientific Review of Mental Health Practice
Department of Psychology, Room 473 Psychology and Interdisciplinary Sciences
(PAIS)
Emory University
36 Eagle Row
Atlanta, Georgia 30322
[email protected]
(404) 727-1125
Psychology Today Blog:
http://www.psychologytoday.com/blog/the-skeptical-psychologist
50 Great Myths of Popular Psychology:
http://www.wiley.com/WileyCDA/WileyTitle/productCd-140513111X.html
Scientific American Mind: Facts and Fictions in Mental Health Column:
http://www.scientificamerican.com/sciammind/
The Master in the Art of Living makes little distinction between his work and
his play,
his labor and his leisure, his mind and his body, his education and his
recreation,
his love and his intellectual passions. He hardly knows which is which.
He simply pursues his vision of excellence in whatever he does,
leaving others to decide whether he is working or playing.
To him - he is always doing both.
- Zen Buddhist text
(slightly modified)
-----Original Message-----
From: Annette Taylor [mailto:[email protected]]
Sent: Monday, August 16, 2010 11:54 AM
To: Teaching in the Psychological Sciences (TIPS)
Subject: RE: [tips] Personality disorder or PTSD?
As a nonclinician here is my question:
Are PDs something a person might be predisposed to, such that a stressor, such
as deployment--whether or not in combat because even those not in actual combat
are in a constant tension of potential attack--could be a trigger to develop
the underlying predisposition to something that had not as yet manifested
itself? I'm thinking of the analogy to the diathesis-stress model for
schizophrenia; or even for some folks who develop anxiety and/or depressive
disorders, it seems that an environmental trigger can bring the disorder to
bloom.
Annette
Annette Kujawski Taylor, Ph. D.
Professor, Psychological Sciences
University of San Diego
5998 Alcala Park
San Diego, CA 92110
[email protected]
________________________________________
From: Dr. Bob Wildblood [[email protected]]
Sent: Monday, August 16, 2010 5:22 AM
To: Teaching in the Psychological Sciences (TIPS)
Subject: Re: [tips] Personality disorder or PTSD?
Beth Benoit wrote:
> It seems to me that this kind of debate is at the
> heart of psychology: Is it a personality disorder
> or is it the result of stress?
Again, just from my experience of a number of years in private practice,
several of which I worked with veterans who had been given a psychiatric
diagnosis and were eligible for treatment for these disorders, and also having
served in the military and gone through their psychological evaluation upon
reporting to boot camp, I would have to say first that it would be nearly
impossible to diagnosis an individual with a personality disorder ("...an
enduring patter of inner experience and behavior that deviates markedly from
the expectations of the individual's culture, is pervasive and inflexible, has
an onset in adolescence or early adulthood, is stable over time, and leads to
distress and impairment." DSM-IV-TR) in the amount of time that they do the
evaluations, since PDs are not often easily diagnosed in the first visit to a
psychologist.
This would suggest that that diagnosis on discharge would be nearly impossible
to be considered legitimate. PTSD, on the other hand can often be done
relatively quickly after a person has been subjected to an actual or perceived
life-threatening experience.
The statement in the article, "A congressional inquiry is under way to
determine whether the Army is relying on a different designation - referred to
as an 'adjustment disorder' - to dismiss soldiers." Again, according to
DSM-IV-TR, and adjustment disorder "is a psychological response to an
identifiable stressor or stressors that results in the development of
clinically significant emotional or emotional symptoms." This diagnosis,
although it should be differentiated from a true PTSD, seems to be a more
legitimate diagnosis for many troops returning from a battle situation, and
neither diagnosis should be considered to be a "pre-existing" condition. It's
much easier to deal with someone who has lost a limb or who has suffered
traumatic brain injury, than someone who has suffered severe psychological
trauma from the horror of war.
Historically, the government has always had difficulty resolving the problem of
the promises it makes to those who they are trying to enlist and the reality of
the way they deal with returning veterans. Our history in regard to this issue
goes back to WWI. This will continue to be a problem so long as we don't
figure in the cost of treating those individuals who will need care after
serving in the military who have been damaged or disabled, and include these
costs in military appropriation bills.
.
Robert W. Wildblood, PhD
Adjunct Psychology Faculty
Germanna Community College
[email protected]
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