title: Is the appendix a useful appendage? An empirical examination of depressive, passive-aggressive (negativistic), sadistic, and self-defeating personality disorders.
abstract: Decisions about whether to include depressive, passive-aggressive, sadistic, and self-defeating disorders in Axis II have been made difficult by a relative dearth of data. We report the results of a study identifying potential defining features of these diagnoses and assessing their distinctiveness from other Axis II personality disorders (PDs). A national sample of experienced psychiatrists and psychologists used the SWAP-200 to describe a patient with a current axis II disorder or an appendix or deleted PD from DSM-II-R. We examined clinicians' descriptions of patients to identify their most characteristic features, and then applied an empirical clustering procedure, Q-factor analysis, to see whether versions of these disorders would emerge empirically. As currently conceptualized, only passive-aggressive PD was distinct from other PDs. When the data were subjected to Q-factor analysis, the first and largest grouping was a dysphoric (depressive) PD. A hostile-negativistic subcategory emerged that resembled passive-aggressive PD, along with a revised dependent diagnosis that included many self-defeating/masochistic features. The results suggest that a depressive or dysphoric personality may represent an internalizing spectrum of personality pathology, and that a hostile-negativistic PD may be distinct from the disorders in the text of DSM-IV. Sadistic and self-defeating PD do not appear to represent distinct disorders, although they include personality traits (sadism and revictimization) associated with distinct developmental histories.
authors.affiliation: Department of Psychology, Emory University, Atlanta, GA 30322, USA. rbradl2@emory.edu
authors.forename: Rebekah
authors.initials: R
authors.lastname: Bradley
authors.forename: Jonathan
authors.initials: J
authors.lastname: Shedler
authors.forename: Drew
authors.initials: D
authors.lastname: Westen
mesh_terms: D003863:Depression / Q000145:classification / Q000175:diagnosis; D003937:Diagnosis, Differential; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005163:Factor Analysis, Statistical; D006801:Humans; D010324:Passive-Aggressive Personality Disorder / Q000145:classification / Q000175:diagnosis; D010552:Personality Assessment / Q000592:standards*; D010554:Personality Disorders / Q000145:classification* / Q000175:diagnosis* / Q000523:psychology; D011570:Psychiatry / Q000379:methods; D011586:Psychology, Clinical / Q000379:methods*; D011594:Psychometrics; D015203:Reproducibility of Results; D012448:Sadism / Q000145:classification / Q000175:diagnosis; D016728:Self-Injurious Behavior / Q000145:classification / Q000175:diagnosis; D009626:Terminology as Topic