The Dependent Personality Questionnaire (DPQ): a screening instrument for dependent personality

BACKGROUND: There are no specific instruments for rating dependent personality, although this may be an important subject in clinical practice, where knowledge of dependent personality features may influence treatment. AIMS: To develop a simple self-rating questionnaire for dependent personality features and compare the findings in two groups, one with and one without established dependent personality disorder. METHOD: An 8-item Dependent Personality Questionnaire (DPQ) was developed and its acceptability and validity tested by administration to 30 psychiatric patients, half of whom had dependent personality disorder using clinical and research data, and the other 15 (pair-matched for age and sex) having other psychiatric diagnoses (including other personality disorders) but no dependent personality features. RESULTS: The mean score on the dependent personality questionnaire (DPQ) was 13.7 in those with dependent personality disorder and 7.5 in those without such a disorder (p < .005). The DPQ was also a good predictor of the diagnosis of dependent personality disorder, with sensitivity, specificity, predicted positive, and predicted negative accuracies of 87%. CONCLUSIONS: The results suggest that the DPQ may be a suitable screening instrument for dependent personality characteristics.     

The development of the somatoform dissociation questionnaire (SDQ-5) as a screening instrument for dissociative disorders

Using cases of dissociative disorder (n=50) and other DSM-IV diagnoses (n=50), a somatoform dissociation self-report questionnaire was developed and its capacity to function as a screening device for dissociative disorders was analysed. A list of 75 items was constructed which, according to clinical experience and expert judgement, could reflect instances of somatoform dissociation. Statistical analyses revealed the 20 best discriminating items. Stepwise forward logistic analysis detected five items which, as a group, provided optimal discrimination between the two groups. At an estimated prevalence rate of dissociative disorders of 10% among psychiatric patients the sensitivity would be 94%, the specificity would be 96%, the positive predictive value would be 72%, and the negative predictive value would be 99%. Cross-validation in an independent sample (n=33/42) largely corroborated the initial findings. The SDQ-5 can be used as a brief screening device for dissociative disorders.     

Development and validation of a computerized screening test for personality disorders in DSM-III-R

The available self-report instruments designed to measure personality disorder (PD) are time-consuming to administer and/or score and can be impractical for routine clinical use. There is a need for a computerized method of personality assessment based on contemporary systems of classification. A computerized DSM-III-R-based questionnaire was developed and validated against the structured clinical interview for DSM-III-R Axis-II disorders on a sample of 60 subjects. The computerized test showed moderate validity as a diagnostic instrument (mean kappa coefficient=0.47). With adjusted cut-off scores it was valid as a screening instrument (mean sensitivity=0.87). Antisocial, borderline and avoidant PD scores were strongly correlated across measures and not subject to significant observer bias.     

Obsessive-compulsive and eating disorders: comparison of clinical and personality features

Abstract   The aim of the present study was to determine whether anorexia nervosa (AN), bulimia nervosa (BN) and obsessive-compulsive disorder (OCD) share clinical and psychopathological traits. The sample consisted of 90 female patients (30 OCD; 30 AN; 30 BN), who had been consecutively referred to the Department of Psychiatry, University Hospital of Bellvitge, Barcelona. All subjects met DSM-IV criteria for those pathologies. The assessment consisted of the Maudsley Obsessive-Compulsive Inventory (MOCI), Questionnaire of obsessive traits and personality by Vallejo, Eating Attitudes Test-40 (EAT-40), Eating Disorder Inventory (EDI), and Beck Depression Inventory (BDI). ancova tests (adjusted for age and body mass index) and multiple linear regression models based on obsessive-compulsiveness, obsessive personality traits and perfectionism, as independent variables, were applied to determine the best predictors of eating disorder severity. On ancova several significant differences were found between obsessive-compulsive and eating-disordered patients (MOCI, P  < 0.001; EAT, P  < 0.001; EDI, P  < 0.001), whereas some obsessive personality traits were not eating disorder specific. A total of 16.7% OCD patients presented a comorbid eating disorder, whereas 3.3% eating disorders patients had an OCD diagnosis. In the eating disorder group, the presence of OC symptomatology was positively associated ( r  = 0.57, P  < 0.001) with the severity of the eating disorder. The results were maintained after adjusting for comorbidity. Although some obsessive-compulsive and eating disorder patients share common traits (e.g. some personality traits especially between OCD and AN), both disorders seem to be clinically and psychopathologically different.     

The rationale, development and reliability of a new screening psychiatric instrument

Background: This paper describes the rationale, development, reliability and validity of a new screening psychiatric instrument. Method: The instrument comprises 26 items that tap the cardinal features of main psychiatric categories as defined by ICD-10 and DSM-IV. These items were adapted from various structured and semi-structured diagnostic interviews that yield ICD-10 and DSM-IV psychiatric diagnoses. After a training course, 12 trainees and the trainer rated blindly the 26 items on 45 subjects (22 with psychopathology and 23 without). Inter-rater reliability coefficient (Kappa) was estimated between trainees and the trainer on each item of the instrument. The total score on the new instrument was then correlated with the total score on the Arabic Self Reporting Questionnaire (SRQ-20) and the Arabic version of the General Health Questionnaire (GHQ) in a random sample from the general population (n=365). Logistic regression was utilised to estimate the power of the total score on the new instrument in discriminating between cases and non-cases as classified by the SRQ-20. Results: Excellent levels of agreement (Kappa > 0.80) were found for all items except for obsession (Kappa = 0.65) and for depressed mood (Kappa = 0.70). Moderate correlations were found between the total score on the new instrument and total score on SRQ-20 (r = 0.69) and the total score on the Arabic GHQ (r = 0.7). The new instrument correctly classified 89% of subjects into cases and non-cases. Conclusions: The results of this study indicate that the new instrument is a highly reliable and valid screening instrument. The authors are now investigating its test-retest reliability and its procedural validity. Accepted: 6 November 1998     

Comparison of hospital-treated personality disorders and personality disorders in a general population sample

The distribution of personality disorders (PDs) was explored in hospital-treated subjects and in a population subsample. This study forms a part of the Northern Finland 1966 Birth Cohort study. Hospital case records of psychiatric treatment periods of all cohort members (n=11,017) were reviewed and re-checked against DSM-III-R criteria. A subsample of the cohort members living in Oulu (n=1609) were invited to a two-stage psychiatric field survey with Structured Clinical Interview for DSM-III-R (SCID) as a diagnostic method. The most common PDs in hospital-treated sample were cluster B PDs (erratic). In the population subsample, cluster C PDs (anxious) formed the majority.     

Mentalization as a moderator of treatment effects: Findings from a randomized clinical trial for personality disorders

Abstract

Mentalization is the capacity to understand behavior as expressions of various mental states. It is assumed to be important for understanding the underlying psychopathology, the therapeutic process, and the outcome of therapy associated with patients with personality disorders (PDs). However, to date, empirical findings are scarce and inconsistent. This study aimed to examine whether the pre-treatment level of mentalization, operationalized as Reflective Functioning (RF), was associated with differential responses to two different treatment modalities and might predict clinical improvement. We analyzed data from a randomized clinical trial (Ullevål Personality Project). Seventy-eight patients with borderline and/or avoidant PD had been randomly assigned to either a step-down treatment program or outpatient individual psychotherapy. The step-down treatment comprised short-term day hospital treatment, followed by long-term, combined group and individual psychotherapy. RF was rated before treatment and after 36 months. Outcome measures were administered at baseline and after 8, 18, and 36 months. The moderator analyses indicated that patients with low RF levels at baseline responded better to outpatient individual psychotherapy than to the step-down treatment in terms of improvements in psychosocial functioning. Patients with medium-high RF levels responded equally well to both therapy formats. Determining which therapy format is appropriate for specific groups of patients can improve treatment efficiency. Therefore, our findings may have important clinical implications. Future research should address RF as a mediator of change.     

Characterizing eating disorders in a personality disorders sample

The presence of a comorbid eating disorder (ED) and personality disorder (PD) is associated with greater problems and poorer functioning than having an ED alone or PD alone. This pattern is also found for non-ED axis I disorders and PDs. This study aims to examine if an ED, compared to other non-ED axis I disorders, in a PD sample confers greater risks for: number and type of non-ED axis I and axis II disorders, suicide attempts and non-suicidal self-injury, and poorer psychosocial functioning. Standardized interviews were conducted on 166 females and 166 males with PDs. In females with PDs, EDs, as compared to other axis I disorders, were associated with more non-ED axis I and II disorders (particularly borderline and avoidant PD) and poorer global functioning, but not with suicide attempts or non-suicidal self-injury. In males with PDs, EDs were associated with more axis II disorders, particularly borderline PD. Given the small group of males with EDs, these results require replication. Males and females with PDs and EDs may have multiple comorbid disorders, particularly borderline PD and for females, avoidant PD that may warrant targeting in treatment.     

Dysmorphic concern symptoms and personality disorders: a clinical investigation in patients seeking cosmetic surgery

Body dysmorphic disorder (BDD) is a somatoform disorder characterized by an excessive concern with an imagined or slight defect in appearance. BDD has been particularly studied in cosmetic surgery settings. The object of the present study is to investigate the relationship between personality disorders and dysmorphic symptoms in a group of 66 patients seeking cosmetic surgery. Assessment instruments included the following: a semistructured interview for demographic and clinical characteristics; the Structured Clinical Interview for DSM-IV, the Hamilton Depression and Anxiety Rating Scales, and the Body Dysmorphic Disorder Yale - Brown Obsessive--Compulsive Scale (BDD - YBOCS). A multiple regression analysis was performed using the BDD - YBOCS score as a continuous dependent variable. The severity of dysmorphic symptoms (BDD - YBOCS score) was significantly related to two factors: the number of diagnostic criteria for schizotypal and paranoid personality disorders. The results suggest that the presence of a psychopathological reaction to imagined defects in appearance in subjects pursuing a surgical correction is associated with the severity of schizotypal and paranoid personality disorders. Preoperative assessment could help to define the clinical profile of patients in cosmetic surgery settings.     

Behind bars: personality disorders

Individuals with severe, function-impairing personality disorders comprise a large proportion of the difficult-to-manage inmates. Personality disorders are reliably diagnosable using standardized criteria (DSM-IV), and treatment options are now available. Through careful assessment, differential diagnosis, and differential therapeutic selection, clinicians have the opportunity to help these individuals gain more control over unstable affect, impulsive/ irritable aggression, and paranoid perceptual distortions. Appropriate intervention holds the possibility, if not the promise, of reduced morbidity and recidivism, and may reasonably contribute to the public safety mission of corrections and to the primary mission of clinicians, which is improved health.     

Detection of dissociative disorders in psychiatric patients by a screening instrument and a structured diagnostic interview.

OBJECTIVE AND METHOD: Diagnosis and treatment of the dissociative disorders may be delayed for many years because of difficulties in detecting patients at high risk for dissociative disorders. This study investigates the utility of the Dissociative Experiences Scale (DES), a self-report instrument for dissociative experiences, in detecting patients at high risk for dissociative disorders. The clinician-administered Structured Clinical Interview for DSM-III-R Dissociative Disorders (SCID-D) was used as the diagnostic standard, and 36 outpatients with mixed diagnoses and nine normal subjects were evaluated for the presence and absence of a dissociative disorder. DES scores were then compared. RESULTS: Results indicate that a DES cutoff score of 15-20 yields good to excellent sensitivity and specificity as a screening instrument. However, for higher cutoff points the sensitivity can be much lower. CONCLUSIONS: Thus, although the DES can be used to identify some high-risk patients, they should be further evaluated with such diagnostic instruments as the SCID-D or by in-depth clinical follow-up.     

The developmental profile: Validation of a theory-driven instrument for personality assessment

Abstract

The Developmental Profile is an instrument for personality assessment. It covers both maladaptive and adaptive characteristics. The current study examined its internal consistency and construct validity in a Dutch sample of 763 participants from various clinical and nonclinical settings. The internal consistency reliability estimates were good for the clusters of levels (adaptive, neurotic, and primitive), although not for all separate levels. Confirmatory factor analysis showed an overall good fit, with the exception of the level of primary narcissism. Furthermore, empirical evidence was found for the interpretation of a patient's Developmental Profile according to increasing levels of aggregation, with as a highest level a single maladaptivity–adaptivity scale score. This scale significantly distinguished among different patient groups.     

Evaluation of DSM-IV personality disorder criteria as assessed by the structured clinical interview for DSM-IV personality disorders

The primary objective of this research was to investigate the psychometric and diagnostic efficiency properties of DSM-IV personality disorder (PD) criteria as assessed by the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II). Logistic regression analyses were also employed to identify discriminating and nondiscriminating diagnostic criteria within specific PD categories. Results based on a community sample of 149 psychotropic medication-free persons, 58% of whom had at least one PD as determined from the SCID-II, suggest problems with the assessment and/or conceptualization of some PD categories, most notably obsessive-compulsive PD. For many PD concepts, diagnostic criteria were identified that either detracted from the overall internal consistency and diagnostic efficiency of their associated PD criteria set or failed to uniquely discriminate individuals with specific PDs from those without. Most of these findings cannot be clearly attributed to limitations associated with the method used to assess PD criteria.     

Fragile-X syndrome in North East Essex: towards systematic screening: clinical selection

ABSTRACT. A systematic screening for fragile-X syndrome, using various clinical criteria to preselect for cytogenetic testing, was performed throughout the North East Essex Health District on 1100 people attending three different local services for people with learning disability. The selection procedure used varied from a gestalt impression to head, ear and testis measurement depending on the setting. Fifty-nine males and five females who met the selection criteria went on to have chromosome studies. Of these, 23 males and one female were positive (more than 4% positive cells). They came from 19 families. Whilst the true prevalence of fragile-X syndrome is not known in the district, at a minimum , it contributed 3.2% of the institutionalized males (health authority care), 4.4% of the boys and 2.1% of the girls attending special schools for severe learning disability, 7.9% of the boys attending schools for mild learning disability (Local Education Authority), and 3.5% of men attending the two adult training centres within the district (social services). These figures compare well with the yield from reported surveys in which all individuals without a known diagnosis were tested cytogenetically.     

Narcissistic personality disorder: a clinical perspective

Narcissistic traits and narcissistic personality disorder (NPD) present specific diagnostic challenges. While they are often readily and straightforwardly identified, their presentation in some patients and the reasons for which such patients seek treatment may conceal significant narcissistic pathology. Recently, several empirical studies have confirmed that the phenotypic range of people with NPD includes individuals with insecure, shy, and hypersensitive traits with prominent internalized narcissistic features and functioning. Other studies have confirmed that internal emotional distress, interpersonal vulnerability, fear, pain, anxiety, a sense of inadequacy, and depressivity can also co-occur with narcissistic personality functioning. This paper focuses on integrating these findings into the diagnostic evaluation and initial negotiation of treatment for NPD. In patients with narcissistic traits or NPD, it is important to give attention to the two sides of character functioning, which include both self-serving and self-enhancing manifestations as well as hypersensitivity, fluctuations in self-esteem, and internal pain and fragility. This article highlights some of these seemingly incompatible clinical presentations of narcissistic traits and NPD, especially as they co-occur with depressivity and perfectionism, and it discusses implications for building a treatment alliance with a patient with such a predominant disorder of character functioning. The article also discusses the importance of retaining the NPD diagnosis as a separate type of personality disorder, with this range of features, in the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DMS-5).     

Personality and personality disorders II. The Specificity of the DAPP-model as a diagnostic system for personality disorders

The 'Dimensional Assessment of Personality Pathology - Basic Questionnaire' (DAPP) measures 18 traits to provide a systematic representation of the overall domain of personality disorders (PD). The present study investigated the relationships between DAPP personality profiles and dimensional assessments of DSM-IV PD in general population subjects (n = 156), and a sample of 220 nonpsychotic psychiatric patients (including n = 67 PD patients). Using nonmetric multidimensional scaling models the similarities between the 18 DAPP-factors and the dimensional scores of the 12 DSM-IV PD (inclusive appendix) were graphically represented in a 2-dimensional similarity-system. Here each DSM-IV PD dimension could be described by a distinct profile of DAPP-factors. Overall results support the assumption that PD can be represented by a dimensional system of personality traits with sufficient sensitivity and specificity.     

Validation of a screening instrument for post-traumatic stress disorder in a clinical sample of older adults

Objectives: To determine the diagnostic validity of the Post Traumatic Disorder Checklist (PCL) against the ‘gold standard’ of the Clinician Administered PTSD Scale (CAPS) in a clinical sample of older adults.

Methods: A cross-sectional validation study: participants were patients (65 years and over) being treated for medical and/or psychiatric conditions in a hospital setting. Participants completed the PCL, measures of mood, cognition, physical health, alcohol use and the CAPS. A receiver operating characteristics curve was constructed to determine the optimal cut-point of the PCL. Analysis of variance was used to examine clinical differences between PTSD cases, sub-threshold cases and the remainder of the sample.

Results: Using the recommended cut-point of 50, the PCL had a sensitivity of 0.40, specificity of 0.97 and positive predictive value of 0.57. However, these values changed to 0.90, 0.87 and 0.45, respectively, when the optimal cut-point of 36 was used.

Conclusion: With an adjusted cut-point the PCL is an acceptable and brief screening instrument for PTSD in older adults.