title: Personality and cognitive vulnerability in remitted recurrently depressed patients.
abstract: BACKGROUND
  Personality disorders (PDs) have been associated with a poor prognosis of Major Depressive Disorder (MDD). The aim of the current study was to examine cognitive vulnerability (i.e., dysfunctional beliefs, extremity of beliefs, cognitive reactivity, and rumination) that might contribute to this poor prognosis of patients with PD comorbidity.
  
  
  METHODS
  309 outpatients with remitted recurrent MDD (SCID-I; HAM-D17 ≤ 10) were included within two comparable RCTs and were assessed at baseline with the Personality Diagnostic Questionnaire-4(+) (PDQ-4(+)), the Dysfunctional Attitude Scale Version-A (DAS-A), the Leiden Index of Depression Sensitivity (LEIDS), the Ruminative Response Scale (RRS), and the Inventory of Depressive Symptomatology-Self Report (IDS-SR).
  
  
  RESULTS
  We found an indication that the PD prevalence was 49.5% in this remitted recurrently depressed sample. Having a PD (and higher levels of personality pathology) was associated with dysfunctional beliefs, cognitive reactivity, and rumination. Extreme 'black and white thinking' on the DAS was not associated with personality pathology. Brooding was only associated with a Cluster C classification (t(308) = 4.03, p < .001) and with avoidant PD specifically (t(308) = 4.82, p < .001), while surprisingly not with obsessive-compulsive PD.
  
  
  CONCLUSIONS
  PDs were assessed by questionnaire and the analyses were cross-sectional in nature.
  
  
  CONCLUSIONS
  Being the first study to examine cognitive reactivity and rumination in patients with PD and remitted MDD, we demonstrated that even after controlling for depressive symptomatology, dysfunctional beliefs, cognitive reactivity, and rumination were associated with personality pathology. Rumination might be a pathway to relapse for patients with avoidant PD. Replication of our findings concerning cognitive vulnerability and specific PDs is necessary.
authors.affiliation: Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands.
authors.forename: Gerard D
authors.initials: GD
authors.lastname: van Rijsbergen
authors.affiliation: Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands.
authors.forename: Gemma D
authors.initials: GD
authors.lastname: Kok
authors.affiliation: Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands.
authors.forename: Hermien J
authors.initials: HJ
authors.lastname: Elgersma
authors.affiliation: Vanderbilt University, Department of Psychology, Nashville, TN, United States.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Hollon
authors.affiliation: Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands; Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands. Electronic address: C.L.H.Bockting@rug.nl.
authors.forename: Claudi L H
authors.initials: CL
authors.lastname: Bockting
mesh_terms: D001290:Attitude; D003071:Cognition; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003469:Culture; D003865:Major Depressive Disorder / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010554:Personality Disorders / Q000453:epidemiology / Q000523:psychology*; D010555:Personality Inventory; D015995:Prevalence
keywords: Cognitive reactivity; Dysfunctional belief; Major Depressive Disorder; Personality disorder; Relapse; Rumination