Elsevier

Comprehensive Psychiatry

Volume 55, Issue 8, November 2014, Pages 1900-1905
Comprehensive Psychiatry

Comparison of personality beliefs between depressed patients and healthy controls

https://doi.org/10.1016/j.comppsych.2014.07.020Get rights and content

Abstract

Introduction

According to the cognitive model, the common mechanism underlying all psychological disorders is distorted or dysfunctional thoughts that affect mood and behaviors. Dysfunctional thoughts predispose an individual to depression and are among the processes that form the basis of personality traits. Elucidating the personality beliefs associated with depression and dysfunctional thoughts is important to understanding and treating depression. The aim of the present study is to determine whether depressed patients exhibited pathological personality beliefs compared with healthy controls. Furthermore, we investigated which personality beliefs were more common among such depressed patients.

Methods

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 diagnosed with major depressive disorder according to The Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) diagnostic criteria were included in the study. Additionally, 70 healthy controls matched for age, marital status, and education were included in the study. The Sociodemographic Data Form and Personality Belief Questionnaire-Short form (PBQ-SF) were administered to the participants.

Results

A comparison of the depression group with the healthy controls revealed higher scores in dependent, passive–aggressive, obsessive–compulsive, antisocial, histrionic, paranoid, borderline, and avoidant personality subscales in the depressive group.

Conclusions

These results suggest that personality beliefs at the pathological level are more common in depressive patients and that the detection of these beliefs would be useful for predicting the prognosis of the disease and determining appropriate treatment methods.

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)

  • S. Strack

    Handbook of personology and psychopathology

    (2005)
  • R.M. Bagby et al.

    Personality and depression

    Can J Psychiatry

    (2008)
  • G. Parke et al.

    Predictors of 1-year outcome in depression

    Aust N Z J Psychiatry

    (2000)
  • G. Newton-Howes et al.

    Personality disorder and the outcome of depression: meta-analysis of published studies

    Br J Psychiatry

    (2006)
  • M. De Bolle et al.

    Does personality disorder co-morbidity ımpact treatment outcome for patients with major depression?: a multi-level analysis

    J Pers Disord

    (2011)
  • Cited by (4)

    • Dysfunctional personality disorder beliefs and lifetime suicide attempts among psychiatrically hospitalized military personnel

      2018, Comprehensive Psychiatry
      Citation Excerpt :

      Mean scores on obsessive-compulsive, avoidant, schizoid, and paranoid scales in the current study are similar to mean scores of outpatients diagnosed with corresponding PDs in the U.S. [27] and inpatients diagnosed with major depressive disorder (MDD) in Turkey [35]. Military inpatients in the current study scored lower than U.S. outpatients diagnosed with dependent and narcissistic PDs on corresponding PBQ-SF scales [27] and scored lower than Turkish inpatients diagnosed with MDD on passive-aggressive, dependent, antisocial, histrionic, and narcissistic scales [35]. Those with multiple suicide attempts versus single attempts or no attempts, had higher scores of borderline and histrionic PD dysfunctional beliefs.

    • Memory performance of patients with major depression in an everyday life situation

      2017, Psychiatry Research
      Citation Excerpt :

      In particular in our everyday life paradigm (but not in real life) the participants were aware of being tested and of being watched and evaluated by the examiner. This awareness may have influenced their performance (“Hawthorne Effect”; McCambridge et al., 2014), especially as depressed patients are particularly sensitive to the expectations and demands of their environment (Yucens et al., 2014). Generally, depressive patients‘ test performance depends on two important factors (Beblo, 2016): (1) motivation as well as (2) ruminative thoughts that are known to impair cognitive performance (Young et al., 2012).

    View full text