Papers by Fernando Gutiérrez
Psicothema, 2013
The Personality Diagnostic Questionnaire-4+ (PDQ-4+) is composed of a self-report and an intervie... more The Personality Diagnostic Questionnaire-4+ (PDQ-4+) is composed of a self-report and an interview, the Clinical Significance Scale, but no studies have reported joint findings. This study is the first to examine the diagnostic agreement between the Spanish version of the PDQ-4+ self-report and its corresponding interview. The sample comprised 235 psychiatric outpatients who were assessed with both instruments. The interview reduced to one half the number of diagnoses provided by self-report (83.4% to 38.3%; mean number of diagnoses 3.29 to .62). Diagnostic agreement was between fair and moderate (mean kappa .45 for PDQ-4+ total score). Findings suggest the utility of jointly administering the PDQ-4+ and its Clinical Significance Scale to screen for the presence or absence of personality disorders (PDs). Modifications in the diagnostic cut-offs for individual PDs and the PDQ-4+ total score may improve the efficacy of the instrument.
Journal of Research in Personality, 2007
Serious problems persist concerning the conceptualization and measurement of the coping construct... more Serious problems persist concerning the conceptualization and measurement of the coping construct. This study examines the properties and factor structure of the COPE questionnaire, one of the most widely used instruments to measure coping, in a sample of ...
Journal of Personality Disorders, 2008
Given that the DSM taxonomy of personality disorders is flawed by severe classificatory problems,... more Given that the DSM taxonomy of personality disorders is flawed by severe classificatory problems, the development of alternative classificatory systems, such as the Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ), has now become a priority. This study examined the internal consistency, second-order factor structure, and criterion validity of a Spanish translation of the DAPP-BQ in two samples: subjects with personality disorder (n = 155) and subjects from the general population (n = 300). Alpha coefficients ranged satisfactorily from .75 to .93. Four second-order factors of Emotional Dysregulation, Dissocial Behavior, Inhibitedness, and Compulsivity were obtained, which were replicable between samples and identical to those reported in the literature. Finally, disordered subjects scored significantly higher than normal subjects on 17 of the 18 DAPP-BQ traits. Some pending issues in the construction of an alternative taxonomy of personality disorders are discussed. The DSM Axis II is still the most widely used taxonomy for the description and classification of personality disorders. Nonetheless, it is generally agreed that this model is inadequate for classificatory purposes, due to severe drawbacks in two main areas. First, the true nature of personality traits (whether normal or pathological) is not categorical but dimensional, and imposing arbitrary dichotomies produces both substantial information loss and classificatory problems (Clark, Livesley, & Morey, 1997; First
Comprehensive Psychiatry, 2008
We still lack operative and theoretically founded definitions of what a personality disorder (PD)... more We still lack operative and theoretically founded definitions of what a personality disorder (PD) is, as well as empirically validated and feasible instruments to measure the disorder construct. The Temperament and Character Inventory (TCI) is the only personality instrument that explicitly distinguishes personality style and disordered functioning. Here, we seek to (1) confirm in a clinical sample that the character dimensions of the TCI capture a general construct of PD across all specific PD subtypes, (2) determine whether such core features can be used to detect the presence of PD, and (3) analyze whether such detection is affected by the presence and severity of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Axis I symptoms. Two hundred five anxious/depressed outpatients were evaluated with the Structural Clinical Interview for DSM-IV Axis I and II Disorders. Assessment also included the TCI, the Hamilton rating scales for depression and anxiety, and the Panic and Agoraphobia Scale. Sixty-one patients (29.8%) were diagnosed as having a DSM-IV PD. Self-directedness and Cooperativeness, but no other TCI dimensions, predicted the presence of PD (Nagelkerke R 2 = 0.35-0.45) and had a moderate diagnostic utility (κ = 0.47-0.58) when Axis I symptoms were absent or mild. However, accuracy decreased in anxious or depressed patients. Our study supports the hypothesis of a disorder construct that is not related to the intensity of any specific PD subtype but which is common to all PDs. This construct relies largely on internal representations of the self revealing ineffectiveness and uncooperativeness.
Acta Psychiatrica Scandinavica, 2001
... Correspondence: Dr Fernando Gutiérrez, Institut Clínic de Psiquiatria i Psicologia, Hospital ... more ... Correspondence: Dr Fernando Gutiérrez, Institut Clínic de Psiquiatria i Psicologia, Hospital Clínicde Barcelona, Villarroel ... factor analyses were performed at the subscale level using the principal-components method and Promax targeted rotations using the SAS v. 6.12 ...
Genes, Brain and Behavior, 2008
Brain-derived neurotrophic factor (BDNF) signaling pathways have been shown to be essential for o... more Brain-derived neurotrophic factor (BDNF) signaling pathways have been shown to be essential for opioid-induced plasticity. We conducted an exploratory study to evaluate BDNF variability in opioid addict responders and nonresponders to methadone maintenance treatment (MMT). We analyzed 21 single nucleotide polymorphisms (SNPs) across the BDNF genomic region. Responders and nonresponders were classified by means of illicit opioid consumption detected in random urinalysis. Patients were assessed by a structured interview (Psychiatric Research Interview for Substance and Mental Disorders (PRISM)-DSM-IV) and personality was evaluated by the Cloninger's Temperament and Character Inventory. No clinical, environmental and treatment characteristics were different between the groups, except for the Cooperativeness dimension (P < 0.001). Haplotype block analysis showed a low-frequency (2.7%) haplotype (13 SNPs) in block 1, which was more frequent in the nonresponder group than in the responder group (4/42 vs. 1/135; P corrected 5 0.023). Fine mapping in block 1 allows us to identify a haplotype subset formed by only six SNPs (rs7127507, rs1967554, rs11030118, rs988748, rs2030324 and rs11030119) associated with differential response to MMT (global P sim 5 0.011). Carriers of the CCGCCG haplotype had an increased risk of poorer response, even after adjusting for Cooperativeness score (OR 5 20.25 95% CI 1.46-280.50, P 5 0.025). These preliminary results might suggest the involvement of BDNF as a factor to be taken into account in the response to MMT independently of personality traits, environmental cues, methadone dosage and psychiatric comorbidity.
Personality Disorders: Theory, Research, and Treatment, 2019
Although normal personality traits change gradually with age, personality disorders have been rep... more Although normal personality traits change gradually with age, personality disorders have been reported to remit rapidly and completely in little more than 10 years. Such a benign prognosis is surprising and may be due in part to the combined use of categorical diagnoses, seriously ill patients, and longitudinal designs in the existing literature. This study examines, for the first time, the development of personality pathology across a life span by means of dimensional models, represented by the Dimensional Assessment of Personality Pathology-Basic Questionnaire and the Personality Inventory for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. We draw upon a cross-sectional design and four large clinical and community samples to avoid previous biases. We found that personality pathology declined by around 0.5 SD overall from age 20 to 60, though with noticeable differences between domains: Dissocial behavior and antagonism decreased by between two thirds and 1 SD; compulsivity increased at the same rate; disinhibition, negative affect, and psychoticism dropped by 0.5 SD; and detachment remained stable or rose slightly. In short, the changes in many clinically important traits are modest, occur at a slow pace, and roughly parallel the maturation effect found for normal personality traits. The resulting picture of personality disorder development is not as optimistic as previous studies would have us believe. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Comprehensive Psychiatry, 2016
On the way toward an agreed dimensional taxonomy for personality disorders (PD), several pivotal ... more On the way toward an agreed dimensional taxonomy for personality disorders (PD), several pivotal questions remain unresolved. We need to know which dimensions produce problems and in what domains of life; whether impairment can be found at one or both extremes of each dimension; and whether, as is increasingly advocated, some dimensions measure personality functioning whereas others reflect style. To gain this understanding, we administered the Temperament and Character Inventory to a sample of 862 consecutively attended outpatients, mainly with PDs (61.2%). Using regression analysis, we examined the ability of personality to predict 39 variables from the Life Outcome Questionnaire concerning career, relationships, and mental health. Persistence stood out as the most important dimension regarding career success, with 24.2% of explained variance on average. Self-directedness was the best predictor of social functioning (21.1%), and harm avoidance regarding clinical problems (34.2%). Interpersonal dimensions such as reward dependence and cooperativeness were mostly inconsequential. In general, dimensions were detrimental only in one of their poles. Although personality explains 9.4% of life problems overall, dimensions believed to measure functioning (character) were not better predictors than those measuring style (temperament). The notion that PD diagnoses can be built upon the concept of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;personality functioning&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; is unsupported.
Personality and Individual Differences, 2015
Most taxonomies of coping have been built as if coping strategies were unrelated to all other asp... more Most taxonomies of coping have been built as if coping strategies were unrelated to all other aspects of personality. However, the evidence suggests some overlaps, and it may be that basic personality axes such as constraint, fearfulness or affiliation constitute a meaningful organizing principle for coping. In a sample of 499 outpatients, we examined the ability of the Temperament and Character Inventory to predict the fifteen coping strategies measured by the COPE. We also studied the joint structure of personality dimensions and coping. Engagement strategies were mainly enacted by subjects with low fear, high self-efficacy and high persistence, whereas roughly the opposite was true for Disengagement. Help-seeking strategies were exclusively aligned with affiliation dimensions. Our results clarify the empirical structure of coping strategies, and locate them within the broader and better-known space of personality axes.
Psychiatry Research, 2013
The aim of this study was to evaluate personality in transsexuals. The Temperament and Character ... more The aim of this study was to evaluate personality in transsexuals. The Temperament and Character Inventory (TCI) profiles of 166 male-to-female (MF) and 88 female-to-male (FM) transsexuals were compared with those of a control group of males and females. MF and FM transsexuals scored significantly lower than males and females in RD4 (more independent) and C3 (more self-centeredness). MF transsexuals scored higher than males and females in HA4 (more fatigable), ST and ST3 (more spiritual acceptance), and lower in C5 (more opportunistic); moreover, they showed higher scores than males in RD1 (more sentimental) and lower than females in C (less cooperativeness). FM transsexuals scored lower than females in HA2 (more daring and confident), RD (less sentimental), and C5 (more opportunistic). Compared with FM, MF transsexuals scored higher on HA2 (more fearful), RD, RD1 (more sentimental), ST, ST2 and ST3 (more spiritual). All these differences were less than half a standard deviation except for C3. Data show that transsexuals and controls display a similar personality profile, even though there are some differential personality traits. Moreover, the personality profile of transsexuals was closer to the profile of subjects who shared their gender identity than those who shared their anatomical sex.
Journal of Clinical Psychology, 2010
This study assessed the ability of the Symptom Checklist-Revised (SCL-90-R) to discriminate betwe... more This study assessed the ability of the Symptom Checklist-Revised (SCL-90-R) to discriminate between two groups of fibromyalgia patients (those who were about to begin a treatment including the explicit aim of returning to work and those who were initiating a legal procedure to obtain permanent disability compensation) and two groups of healthy volunteers (medical students and psychology graduates), who were asked to produce a symptomatic resemblance to a chronic pain disorder. Logistic regression analyses were applied to the SCL-90-R subscales and individual probabilistic indices of simulation were calculated. Results showed that the SCL-90-R was able to discriminate between healthy subjects and both groups of patients with a high sensitivity and specificity. The individual indices of simulation, which might be more useful in clinical practice than the comparison of the SCL-90-R profiles, also showed an appropriate level of accuracy.
Current Opinion in Psychiatry, 2014
Durability has traditionally been considered to be a defining feature of personality disorders, b... more Durability has traditionally been considered to be a defining feature of personality disorders, but recent studies have challenged this notion. We review the most recent findings on the stability and course of personality pathology. Personality disorders seem to remit more often and faster than previously thought, and their relapse rate is low. However, the recent optimism regarding these disorders is mitigated by the existence of highly heterogeneous trajectories among patients and traits, the identification of certain methodological shortcomings, and the maintenance of psychosocial impairment long after symptomatic relief. The causes of personality improvement are largely unknown, but involve intermingled genetic and environmental effects. Recent follow-up studies of patients with personality pathology are changing orthodox conceptions of their inevitably negative prognosis. The current taxonomies must be reviewed and future research should be integrated with adjacent fields. Treatments need to target the enduring real-life hardships of these patients, apart from their acute symptoms.
Comprehensive Psychiatry, 2011
Background: Prevalence and clinical correlates of depersonalization symptoms have been associated... more Background: Prevalence and clinical correlates of depersonalization symptoms have been associated with panic disorder. Personality traits might increase the likelihood of experiencing depersonalization symptoms or depersonalization disorder in panic patients. Aims: The objectives of this study are to establish the prevalence of depersonalization symptoms during the panic attack and in depersonalization disorder and to examine the personality factors associated with the presence of depersonalization in patients with panic disorder. Methods: The sample comprised 104 consecutive adult outpatients with panic disorder, diagnosed according to the Semistructured Clinical Interview for DSM-IV (Axis I/II disorders). Participants were assessed with the Cambridge Depersonalization Scales, the Temperament and Character Inventory, and the Panic and Agoraphobia Scale. Results: Forty-eight percent of the sample had depersonalization symptoms during the panic attack, whereas 20% of patients had a depersonalization disorder. Women presented more depersonalization disorders than did men (P = .036). Patients with panic disorder with depersonalization disorder had a more severe panic disorder (P = .002). Logistic regression analysis showed that self-transcendence trait (odds ratio, 1.089; 95% confidence interval, 1.021-1.162; P = .010) and severity of panic (odds ratio, 1.056; 95% confidence interval, 1.005-1.110; P = .032) were independently associated with depersonalization disorder. Conclusions: A high prevalence of depersonalization symptoms and depersonalization disorder was confirmed in patients with panic disorder, supporting a dosage effect model for understanding depersonalization pathology. Self-transcendence trait and severity of panic disorder were reported as risk factors for depersonalization disorder.
Comprehensive Psychiatry, 2014
Despite general support for dimensional models of personality disorder, it is currently unclear w... more Despite general support for dimensional models of personality disorder, it is currently unclear which, and how many, dimensions a taxonomy of this kind should include. In an attempt to obtain an empirically-based, comprehensive, and usable structure of personality, three instruments-The Temperament and Character Inventory-Revised (TCI-R), the Personality Diagnostic Questionnaire-4 + (PDQ-4 +), and the Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ)were administered to 960 outpatients and their scales factor-analyzed following a bass ackwards approach. The resulting hierarchical structure was interpretable and replicable across gender and methods up to seven factors. This structure highlights coincidences among current dimensional models and clarifies their apparent divergences, and thus helps to delineate the unified taxonomy of normal and abnormal personality that the field requires.
General Hospital Psychiatry, 2013
The objectives were to compare the personality of fibromyalgia (FM) patients with other chronic p... more The objectives were to compare the personality of fibromyalgia (FM) patients with other chronic painful and nonpainful disorders considering the confusion due to psychopathology and to assess the clustering of FM patients according to their personality profile. Methods: Differences in the NEO Five-Factor Inventory between FM, non-FM chronic pain and drug-resistant epileptic patients were assessed including the confounding effect of demographics and psychopathological status by multivariate regression analysis. Clustering of FM patients was assessed by two-step cluster analysis. Differences in clinical severity and psychosocial problems between subgroups and their outcome 6 months after multidisciplinary treatment were assessed. Results: The final sample comprised 874 patients. Once the effect of confounding variables was considered, clinically nonsignificant differences in personality were observed between groups. FM patients could, however, be grouped into two clusters. Cluster 1 was characterized by higher neuroticism and lower extraversion and showed a worse pretreatment clinical state including more psychosocial problems. In spite of having reached a wider general improvement at 6-month follow-up, Cluster 1 patients remained more anxious and depressed. Conclusions: Identifying personality-based subgroups of FM might allow implementing specific preventive strategies. FM treatment might be optimized by increasing medication compliance, improving therapeutic alliance and testing different therapeutic options and treatment sequencing for each personality subgroup.
INTRODUCTION: The Personality Diagnostic Questionnaire is one of the most frequently used instrum... more INTRODUCTION: The Personality Diagnostic Questionnaire is one of the most frequently used instruments for diagnosing personality disorders (PD). Its last version (PDQ-4+) combines the easy applicability of a questionnaire with the control of state symptoms interference of an interview. The aim of this paper is to present preliminary results on the Spanish version of the PDQ-4+. METHOD: 159 psychiatric outpatients were assessed using the questionnaire of PDQ-4+. Among them, a sample of 47 were also evaluated using the short interview of clinical significance that completed the PDQ-4+. RESULTS: Results obtained were very similar to that from previous research, indicating similar psychometric properties of the PDQ-4+ Spanish version, to English, Italian, Chinese and Norway versions. In general, the internal consistency was acceptable; the obsessive-compulsive PD scale showing the lowest Cronbach's alpha. The high prevalence of PD obtained with the PDQ-4+ questionnaire was dramatica...
Actas espanolas de psiquiatria, 2018
INTRODUCTION Personality Disorders (PD) are highly prevalent among Chronic Fatigue Syndrome (CFS)... more INTRODUCTION Personality Disorders (PD) are highly prevalent among Chronic Fatigue Syndrome (CFS) patients, but studies based on the DSM-5 are still scarce. Validated instruments have not yet been specifically used in CFS patients. Therefore, our aim was to analyze the differences in personality facets and domains profiles among CFS patients with and without a PD using the Personality Inventory for DSM-5 (PID-5). Additionally, we analyzed the ability of this instrument to predict PD in a sample of CFS patients. This instrument is validated for PDs, but not for CFS. METHODS All of the 84 CFS patients were evaluated through a clinical interview and underwent psychopathological evaluation with the SCID I and SCID II. Dimensional personality facets and domains were evaluated with the PID-5, according to DSM-5. RESULTS In our sample, 54 (64%) of the patients fulfilled the criteria of a PD. The most significant facets in CFS with PD in comparison to those patients without a PD were Separa...
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Papers by Fernando Gutiérrez