Comparison of personality beliefs between depressed patients and healthy controls
Introduction
The cognitive theory of depression is a bio-psycho-social model in which biological, environmental, cognitive, and behavioral factors can play a role in the occurrence and persistence of depression [1]. According to Beck's theory, cognitive errors were important in depression, but deeper cognitive structures are also believed to make a contribution to triggering depression [2]. Beck proposed that three different cognitive levels interact with each other and lead to depression. Negative automatic thoughts are at the surface level of cognition. Beliefs, dysfunctional attitudes, and personal rules are deeper cognitive structures. Core beliefs conceptualized as thoughts, attitudes, and negative information processing are at the deepest levels of cognition [3], [4].
A basic characteristic of the cognitive theory of personality disorders is the emphasis placed on the role of dysfunctional beliefs. According to this theory, each personality disorder has a characteristic group of dysfunctional beliefs. The behavioral pattern in different personality disorders appears as overt symptoms of underlying cognitive structures [5]. Dysfunctional beliefs are the central component of cognitive case formulation in the therapy and the main target of the intervention [6]. If dysfunctional beliefs are identified correctly, these beliefs reflect cognitive themes indicating the developmental history of the patient, compensatory strategies, and dysfunctional reactions toward existing conditions [7]. With the therapist and patient working together to identify and modify these beliefs, improvements can be observed in many areas of functionality. These cognitive features seem to be primary focus and mechanism of change in cognitive interventions in personality disorders [8].
Elucidating personality traits associated with depression and possible consequences of this association has been the focus of numerous empirical studies to better understand and treat depression. Depressed patients have been found to have higher rates of personality disorders compared with non-depressed individuals. Studies have reported different rates of comorbidities ranging from 15% to 95%, depending on methodological differences between the studies in terms of sample size, follow-up period, and evaluation methods [9].
Many studies have shown that patients with personality disorders and comorbid depression respond poorly to psychotherapy and drug therapies compared with depressed patients without personality disorders [10]. Psychiatrists must prepare appropriate treatment plans for depressed patients with personality disorders. As per American Psychological Association (APA) guidelines about the treatment of depression, the treatment must primarily focus on depression; psychotherapeutic and combined pharmacotherapeutic approaches may be attempted with success if the symptoms of a personality disorder persist after the symptoms of depression are relieved. Indeed, the response of patients with a personality disorder to antidepressant therapy has been found to be lower compared with patients without personality disorders, in terms of social functioning and residual depressive symptoms [11]. The presence of a personality disorder impairs compliance with treatment and the establishment of psychotherapeutic relationships and also increases the risk of depressive episodes and prolongs the time necessary to achieve remission [12].
In light of these studies, personality traits or disorders comorbid with depression are considered to play an important role in the evaluation and selection of treatment approaches [13]. Cognitive therapy is a commonly used treatment approach that has been shown to efficiently treat depression. The determination of personality beliefs and personality disorders in a depressed patient during the course of cognitive therapy could contribute to the selection and efficiency of cognitive interventions.
The aim of the present study is to determine the personality beliefs of patients diagnosed with major depressive disorder and the differences exhibited by various personality beliefs. To this end, the personality beliefs of patients diagnosed with major depressive disorders according to Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria and age-matched healthy controls showing similar features were compared using the scales that measure personality traits in different cognitive domains. We hypothesize that patients with major depressive disorders would more frequently exhibit dysfunctional beliefs.
Section snippets
Sample
A total of 70 patients, who were admitted to the Department of Psychiatry at Ankara Diskapi Yildirim Beyazit Training and Research Hospital (Ankara, Turkey) and who were diagnosed with major depressive disorder according to DSM-IV diagnostic criteria were included in the study. Additionally, 70 healthy controls with similar sociodemographic features were included in the study. The subjects in the study and the control groups were informed of the study objectives and methods, and consent was
Results
The mean age of the patients in the depression group was 35.68 ± 10.52 years and 41.65 ± 17.20 years in the control group. There was no statistically significant difference between the groups in terms of mean age. There were 14 males (20%) and 56 females (80%) in the depression group and 14 males (20%) and 56 (80%) females in the control group. The distribution of gender was equal between the two groups. The demographic features of the groups are comparatively presented in Table 1.
A comparison of the
Discussion
The relationship between depression and personality disorders is important from a clinical, therapeutic, and prognostic perspective. The aim of the present study is to show that patients diagnosed with depression more commonly exhibit personality beliefs at the pathological level compared with healthy controls and to identify these personality beliefs using the PBQ.
In clinical practice, the PBQ-SF, which reveals the clusters of specific beliefs corresponding to specific personality diagnosis
Conclusions and recommendations
We found that the patients in the depressed group had higher scores in the dependent, passive–aggressive, obsessive–compulsive, antisocial, histrionic, paranoid, borderline, and avoidant personality subscales compared with the control group; there was no significant difference between the groups in terms of their score in the narcissistic and schizoid personality subscales.
It would not be appropriate to diagnose personality disorder in patients with depression and then state that it is improper
Acknowledgment
We thank the anonymous reviewers for their valuable comments. We express our deepest gratitude to all of the patients and the healthy subjects for being part of this study.
References (30)
- et al.
The distinction between unipolar and bipolar depression: a cognitive theory perspective
Compr Psychiatry
(2013) - et al.
The effectiveness of cognitive behavioral therapy for personality disorders
Psychiatr Clin North Am
(2010) - et al.
Comorbidity of personality disorders and unipolar major depression: a review
J Affect Disord
(1996) - et al.
Personality disorders in bipolar and depressive disorders
J Affect Disord
(2001) - et al.
Co-occurrence of 12-month mood and anxiety disorders and personality disorders in the US: results from the National Epidemiologic Survey on Alcohol and Related Conditions
J Psychiatr Res
(2005) Depresyon
(2009)- et al.
The comparison of cognitive distorsions among patients with depression, dysthymia, remitted depression and healthy control group
Anadolu Psikiyatri Derg
(2012) Depression: clinical, experimental, and theoretical aspects
(1967)- et al.
Cognitive therapy of personality disorders
(1990) Complex cognitive therapy treatment for personality disorder patients
Bull Menninger Clin
(1998)
Handbook of personology and psychopathology
Personality and depression
Can J Psychiatry
Predictors of 1-year outcome in depression
Aust N Z J Psychiatry
Personality disorder and the outcome of depression: meta-analysis of published studies
Br J Psychiatry
Does personality disorder co-morbidity ımpact treatment outcome for patients with major depression?: a multi-level analysis
J Pers Disord
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