The new Dysfunctional Personality Model of the Anxiety Matrix (DPM-AM): “Neurotic Personality Disorder” (NPD)

Abstract

Background and objectives: According to the PICI model, second edition, the personality disorders of the neurotic area are six (anxious, phobic, obsessive, somatic, avoidant, and manic) and the diagnosis of the psychopathological disorder is determined on the basis of the persistence of certain dysfunctional traits present in the personality framework. However, on the basis of clinical experience and through the application of IPM/PICI, Deca, PDM, PHEM, and PPP-DNA models (including PF-SPEM and NDAM), it was found that all the disorders of the neurotic area had in common the anxiety traits and that the symptoms of the six different disorders were often present in comorbidity. This assumption led to the hypothesis that there was a different and better way to group them into a single, all-encompassing category: “neurotic personality disorder”. This research aims to demonstrate whether or not the use of this hypothetical new nosographic construct is useful. Materials and methods: Individual clinical interview, consisting of the amnestic collection and administration of the PICI-2TA (Perrotta Integrative Clinical Interviews, version 2-TA), PAD-Q (Perrotta Affective Dependency Questionnaire), PSM-1 (Perrotta Sexual Matrix) and PDM-Q (Perrotta Defence Mechanisms Questionnaire), to each group of population. Result: Of the selected sample of 326 subjects, 318 were eligible because they met the inclusive criteria. The three male groups, subdivided by age (18-36, 37-54, 55-72), completely resolved their neurotic symptoms in 86.7% (13/15), 87.5% (7/8) and 60% (3/5), for a partial total of 78.1% (23/28), while the remaining 21.9% (5/28) declared to have benefited from the PPP-DNA protocol with an attenuation of at least 50% of their neurotic symptoms. The three female groups, subdivided according to age (18-36, 37-54, 55-72), completely resolved their neurotic symptoms in 93.3% (154/165), 95% (57/60), and 92.3% (60/65), for a partial total of 93.5% (271/290), while the remaining 6.5% (19/290) declared to have benefited from the PPP-DNA protocol with at least a 50% attenuation of their neurotic symptoms. Conclusion: The PPP-DNA protocol is effective for 85.8% (with a greater prevalence of effectiveness in the female population) in the resolution of neurotic symptoms of anxious, phobic, somatic, avoidant, obsessive, and manic nature, both with the previous wording and with the new nosographic hypothesis “neurotic personality disorder”, as it does not represent a new psychopathological construct but only a different way of grouping disorders of cluster A (neurotic) to avoid that the absorptions do not take into account important dysfunctional traits that are instead at the base of those disorders and therefore does not affect in any case the exact diagnosis of the dysfunctional personality profile.

Perrotta Integrative Clinical Interviews‐3 (PICI‐3): Development, regulation, updation, and validation of the psychometric instrument for the identification of functional and dysfunctional personality traits and diagnosis of psychopathological disorders, for children (8–10 years), preadolescents (11–13 years), adolescents (14–18 years), adults (19–69 years), and elders (70–90 years)

“…The category inhibited from uninhibited is definitively separated, in attachment, thus becoming 19 categories and no longer 18 (previously, category No. 13 was separated into “13a” and “13b,” as was the case for narcissism in PICI‐TA‐3). Completion of either section A or section B depends on registry age, and one automatically excludes completion of the other. The concluding diagnosis of dysfunctionality, for both PICI‐TA‐3 and PICI‐C‐3, is structured based on the highest score of dysfunctional traits found, per single category (25 for PICI‐TA‐3 and 19 for PICI‐C‐3). The concept of egosyntonic personality disorders is mitigated by the model underlying the PICI, and therefore the possible presence of a patient's egosyntonicity concerning his or her symptoms is discernible only when the psychopathological impairment is severe (>7/9 dysfunctional traits), while in all other cases, it is possible to witness egodystonic patients, concerning their symptoms, while still having values relevant to the diagnosis of personality disorder. The neurotic area of disorders includes six specificities, but they should be treated as if they were a unitary disorder 25 (referred to as “neurotic personality disorder”). The complexity of the psychopathological diagnosis of borderline and bipolar disorder must be addressed during therapy and mediated by the responses obtained during psychotherapy, as manic and depressive traits induce the activation of both bipolar and borderline traits, as they are common. Indeed: in the bipolar patient, there is a marked tendency toward emotional and mood instability, which is more rigid than that of the borderline and is enriched by irrational beliefs taken to extremes, between depressive and manic episodes representing the patient's two main modes (albeit with four different possible sub‐hypotheses), however, depressive episodes are common to depressive disorder, while manic episodes are common to borderline disorder and some psychotic activations; in the borderline patient, there is a greater and more pronounced tendency toward impulsivity and aggression, with more emotional and affective fluctuations (as it is a relationship disorder), sudden and rapid, and depressive and manic episodes that are shorter and more circumscribed in the relevant timeframe than in the bipolar.…”

“… The concept of egosyntonic personality disorders is mitigated by the model underlying the PICI, and therefore the possible presence of a patient's egosyntonicity concerning his or her symptoms is discernible only when the psychopathological impairment is severe (>7/9 dysfunctional traits), while in all other cases, it is possible to witness egodystonic patients, concerning their symptoms, while still having values relevant to the diagnosis of personality disorder. The neurotic area of disorders includes six specificities, but they should be treated as if they were a unitary disorder 25 (referred to as “neurotic personality disorder”). The complexity of the psychopathological diagnosis of borderline and bipolar disorder must be addressed during therapy and mediated by the responses obtained during psychotherapy, as manic and depressive traits induce the activation of both bipolar and borderline traits, as they are common.…”

“…The neurotic area of disorders includes six specificities, but they should be treated as if they were a unitary disorder 25 (referred to as “neurotic personality disorder”).…”

“…The dedicated test for children (PICI‐2C) remained unchanged, while the second version of the test (PICI‐2TA) 24 was modeled by making the following changes: The concept of ego synchrony of personality disorders is mitigated by the model underlying the PICI, and therefore the possible presence of ego synchrony in the patient concerning his or her symptoms is discernible only when the psychopathological impairment is severe (>7/9 dysfunctional traits), while in all other cases, it is possible to witness egodystonic patients, concerning their symptoms, while still having values relevant to the diagnosis of personality disorder. Although six different personality disorders are distinguished in the test, the psychopathological classes afferent to the neurotic area must be treated as if they were a unitary disorder 25 (referred to as “ neurotic personality disorder, NPD ”) (Supporting information 3). For the child population, the same structure can be applied, however, considering it simply as “neurotic disorder.” The complexity of the psychopathological diagnosis of borderline disorder and bipolar disorder must be addressed during therapy and mediated by the responses obtained during psychotherapy, since manic and depressive traits induce the activation of bipolar and borderline traits, as they are common.…”

“…Although six different personality disorders are distinguished in the test, the psychopathological classes afferent to the neurotic area must be treated as if they were a unitary disorder 25 (referred to as “ neurotic personality disorder, NPD ”) (Supporting information 3 ). For the child population, the same structure can be applied, however, considering it simply as “neurotic disorder.”…”