The cross-cultural validity of posttraumatic stress disorder: implications for DSM-5

Background: There is considerable debate about the cross‐cultural applicability of the posttraumatic stress disorder (PTSD) category as currently specified. Concerns include the possible status of PTSD as a Western culture‐bound disorder and the validity of individual items and criteria thresholds. This review examines various types of cross‐cultural validity of the PTSD criteria as defined in DSM‐IV‐TR, and presents options and preliminary recommendations to be considered for DSM‐5. Methods: Searches were conducted of the mental health literature, particularly since 1994, regarding cultural‐, race‐, or ethnicity‐related factors that might limit the universal applicability of the diagnostic criteria of PTSD in DSM‐IV‐TR and the possible criteria for DSM‐5. Results: Substantial evidence of the cross‐cultural validity of PTSD was found. However, evidence of cross‐cultural variability in certain areas suggests the need for further research: the relative salience of avoidance/numbing symptoms, the role of the interpretation of trauma‐caused symptoms in shaping symptomatology, and the prevalence of somatic symptoms. This review also indicates the need to modify certain criteria, such as the items on distressing dreams and on foreshortened future, to increase their cross‐cultural applicability. Text additions are suggested to increase the applicability of the manual across cultural contexts: specifying that cultural syndromes—such as those indicated in the DSM‐IV‐TR Glossary—may be a prominent part of the trauma response in certain cultures, and that those syndromes may influence PTSD symptom salience and comorbidity. Conclusions: The DSM‐IV‐TR PTSD category demonstrates various types of validity. Criteria modification and textual clarifications are suggested to further improve its cross‐cultural applicability. Depression and Anxiety, 2011. © 2010 Wiley‐Liss, 1Inc.     

Validation of the PTSD screening cartoon test “Darryl” in a Danish clinical sample of children and adolescents

The current study examined the reliability and validity of a Danish adaptation of “Darryl”, a cartoon‐based measure of DSM‐IV symptoms of post‐traumatic stress disorder (PTSD) in a sample of Danish children and adolescents. Exposure to potentially traumatizing events, PTSD symptoms and diagnostic status were assessed in 65 children between the ages of 7 and 17 years old. Participants were recruited from a crisis centre for battered women and a school for children with emotional and behavioural problems. The study revealed that Darryl has good internal consistency for the overall scale and adequate reliability for each DSM‐IV symptom cluster. Scores from Darryl were significantly correlated with the Clinician Administered PTSD Scale for Children and Adolescents (CAPS‐CA) scores and receiver operating characteristic (ROC) analysis showed that it could significantly predict the presence of a PTSD diagnosis according to the CAPS‐CA. In comparison to the CAPS‐CA, Darryl has comparable psychometric properties and assesses PTSD symptoms in a developmentally appropriate manner. Furthermore, Darryl is quick to administer and was easier for the children in this sample to comprehend than the more traditional measure of PTSD. Overall, Darryl is an effective instrument for screening children at risk of a PTSD diagnosis. The relatively high specificity suggests that screening positive for PTSD using Darryl merits further diagnostic assessment. Copyright © 2016 John Wiley & Sons, Ltd.     

Clinical value of DSM IV and DSM 5 criteria for diagnosing the most prevalent somatoform disorders in patients with medically unexplained physical symptoms (MUPS)

ObjectiveThis study aimed (1) to describe frequencies of DSM IV somatisation disorder, undifferentiated somatoform disorder and pain disorder versus DSM 5 somatic symptom disorder (SSD) in a multi-setting population of patients with medically unexplained physical symptoms (MUPS), (2) to investigate differences in sociodemographic and (psycho)pathological characteristics between these diagnostic groups and (3) to explore the clinical relevance of the distinction between mild and moderate DSM 5 SSD.MethodsWe used baseline data of a cohort of 325 MUPS patients. Measurements included questionnaires about symptom severity, physical functioning, anxiety, depression, health anxiety and illness perceptions. These questionnaires were used as proxy measures for operationalization of DSM IV and DSM 5 diagnostic criteria.Results92.9% of participants fulfilled criteria of a DSM IV somatoform disorder, while 45.5% fulfilled criteria of DSM 5 SSD. Participants fulfilling criteria of DSM 5 SSD suffered from more severe symptoms than those only fulfilling criteria of a DSM IV somatoform disorder(mean PHQ-15 score of 13.98 (SD 5.17) versus 11.23 (SD 4.71), P-value < 0.001). Furthermore their level of physical functioning was significantly lower. Compared to patients with mild SSD, patients with moderate SSD suffered from significantly lower physical functioning and higher levels of depression.ConclusionWithin a population of MUPS patients DSM 5 SSD criteria are more restrictive than DSM IV criteria for somatoform disorders. They are associated with higher symptom severity and lower physical functioning. However, further specification of the positive psychological criteria of DSM 5 SSD may improve utility in research and practice.     

Measurement non‐invariance of DSM‐IV narcissistic personality disorder criteria across age and sex in a population‐based sample of Norwegian twins

We investigated measurement non‐invariance of DSM‐IV narcissistic personality disorder (NPD) criteria across age and sex in a population‐based cohort sample of 2794 Norwegian twins. Age had a statistically significant effect on the factor mean for NPD. Sex had a statistically significant effect on the factor mean and variance. Controlling for these factor level effects, item‐level analysis indicated that the criteria were functioning differently across age and sex. After correcting for measurement differences at the item level, the latent factor mean effect for age was no longer statistically significant. The mean difference for sex remained statistically significant after correcting for item threshold effects. The results indicate that DSM‐IV NPD criteria perform differently in males and females and across age. Differences in diagnostic rates across groups may not be valid without correcting for measurement non‐invariance.     

PTSD in children and adolescents: toward an empirically based algorithma

In considering potential revisions for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐V), describing developmental influences on symptomatic expression is a high priority. This review presents a number of options and preliminary recommendations to be considered for DSM‐V. Research conducted in the past 15 years is reviewed that pertains to expressions of posttraumatic stress disorder (PTSD) symptoms in preschool and school age children and in adolescents. This research has attempted to determine the usefulness of the DSM‐IV criteria for PTSD in children and adolescents. Based on the studies of preschool children, evidence supports two sets of suggestions: first, we suggest that developmental manifestations are warranted in A‐D criteria of PTSD; and second, we suggest that a developmental preschool PTSD subtype is warranted that lowers the C threshold from three to one symptom. For school‐age children and young adolescents, the evidence is more limited. Nevertheless, there is also evidence suggesting that modifications in PTSD criteria A–D, including fewer Cluster C symptoms, may facilitate accurate diagnosis in this age group. Depression and Anxiety, 2011.© 2010 Wiley‐Liss, Inc.     

Assessing the performance of the short screening scale for post‐traumatic stress disorder in a large nationally‐representative survey

The performance of the short screening scale for the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM‐IV) post‐traumatic stress disorder (PTSD), has not been assessed in an independent general population sample, although it has been used in epidemiological as well as clinical research. In this report we evaluate the short screening scale in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a population‐based survey of US household and group quarter residents. DSM‐IV PTSD was assessed via symptom questions in the Alcohol Use Disorder and Associated Disabilities Interview Schedule‐DSM‐IV (AUDADIS‐IV) version. Sensitivity, specificity, positive and negative predictive value, and percent correctly classified were calculated, using the interview‐based diagnosis as the standard. Replicating findings from the initial report, a score of four or more on the short screening scale identifies cases of PTSD with sensitivity of 78%, specificity of 97%, positive predictive value of 75%, and negative predictive value of 98%. The percentage of correctly classified respondents was 96%. The findings support the utility of the seven‐item scale for screening PTSD in clinical and general population samples.     

Screening for trauma‐related symptoms via a smartphone app: The validity of Smart Assessment on your Mobile in referred police officers

To facilitate easily accessible screening for trauma‐related symptoms, a web‐based application called Smart Assessment on your Mobile (SAM) was developed. In this study, we examined whether SAM was able to accurately identify posttraumatic stress disorder (PTSD) and depression in adults. Eighty‐nine referred police officers completed SAM, containing the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders (DSM)‐5 (PCL‐5) and the Depression Anxiety and Stress Scale (DASS‐21), on their own device prior to a diagnostic interview where the Clinician‐Administered PTSD Scale for DSM‐5 (CAPS‐5) and Structured Clinical Interview for DSM‐IV (SCID‐I/P) were administered. Results showed a substantial agreement between SAM and the diagnostic interview in the assessment of PTSD and depression. An optimal trade‐off between sensitivity (89%) and specificity (68%) levels was found at a cut‐off score of 31 on the PTSD Checklist for DSM‐5 (area under the curve = 0.845, 95% CI [0.765, 0.925], diagnostic odds ratio = 15.97). This is one of the first studies to support the validity and reliability of a mobile screener following trauma. SAM may facilitate screening for trauma‐related symptoms on a large scale and could be a first step in a stepped‐care model for trauma survivors to help identify individuals who need further diagnostics and care.     

Agoraphobia: a review of the diagnostic classificatory position and criteria

The status of agoraphobia (AG) as an independent diagnostic category is reviewed and preliminary options and recommendations for the fifth edition of The Diagnostic and Statistical Manual (DSM‐V) are presented. The review concentrates on epidemiology, psychopathology, neurobiology, vulnerability and risk factors, clinical course and outcome, and correlates and consequences of AG since 1990. Differences and similarities across conventions and criteria of DSM and ICD‐10 are considered. Three core questions are addressed. First, what is the evidence for AG as a diagnosis independent of panic disorder? Second, should AG be conceptualized as a subordinate form of panic disorder (PD) as currently stipulated in DSM‐IV‐TR? Third, is there evidence for modifying or changing the current diagnostic criteria? We come to the conclusion that AG should be conceptualized as an independent disorder with more specific criteria rather than a subordinate, residual form of PD as currently stipulated in DSM‐IV‐TR. Among other issues, this conclusion was based on psychometric evaluations of the construct, epidemiological investigations which show that AG can exist independently of panic disorder, and the impact of agoraphobic avoidance upon clinical course and outcome. However, evidence from basic and clinic validation studies remains incomplete and partly contradictory. The apparent advantages of a more straightforward, simpler classification without implicit hierarchies and insufficiently supported differential diagnostic considerations, plus the option for improved further research, led to favoring the separate diagnostic criteria for AG as a diagnosis independent of panic disorder. Depression and Anxiety, 2010. © 2010 Wiley‐Liss, Inc.     

Application of item response theory to achieve cross‐cultural comparability of occupational stress measurement

Our objective was to examine cross‐cultural comparability of standard scales of the Effort–Reward Imbalance occupational stress scales by item response theory (IRT) analyses. Data were from 20,256 Japanese employees, 1464 Dutch nurses and nurses' aides, 2128 representative employees from post‐communist countries, 963 Swedish representative employees, 421 Chinese female employees, 10,175 employees of the French national gas and electric company and 734 Spanish railroad employees, sanitary personnel and telephone operators. The IRT likelihood ratio model was used for differential item functioning (DIF) and differential test functioning (DTF) analyses. Despite the existence of DIF, most comparisons did not show discernible differences in the relations between Effort–Reward total score and level of the underlying trait across cultural groups. In the case that DTF was suspected, excluding an item with significant DIF improved the comparability. The full cross‐cultural comparability of Effort–Reward Imbalance scores can be achieved with the help of IRT analysis. Copyright © 2009 John Wiley & Sons, Ltd.     

Evaluation of the DSM‐IV and ICD‐10 criteria for depressive disorders in a community population in Japan using item response theory

The DSM‐IV and ICD‐10 are both operational diagnostic systems that classify known psychological disorders according to the number of criteria symptoms. Certain discrepancies between the criteria exist and may lead to some inconsistencies in psychiatric research. The purpose of this study was to investigate these differences in the assessment of depression with item response theory (IRT) analyses. The World Mental Health‐Japan (WMHJ) Survey is an epidemiological survey of the general population in Japan. We analyzed data from the WMHJ completed by 353 respondents who had either depressive mood or diminished interest. A two‐parameter logistic model was used to evaluate the characteristics of the symptoms of the DSM‐IV and ICD‐10. IRT analyses revealed that the symptoms about psychomotor activity, worthlessness and self‐reproach were more informative and suggestive of greater severity, while the symptoms about dietary habits were less informative. IRT analyses also revealed that the ICD‐10 seems more sensitive to the mild range of the depression spectrum compared to the DSM‐IV. Although there were some variations in severity among respondents, most of the respondents diagnosed with a severe or moderate depressive episode according to the ICD‐10 were also diagnosed with a major depressive episode according to the DSM‐IV.     

Trauma exposure and posttraumatic reactions in a community sample of Bedouin members of the Israel Defense Forces

Background: Limited available data indicate that minorities in military service face heightened risks for traumatic exposure and more severe posttraumatic reactions. This study explored traumatic exposure and impact on mental and physical health, functioning, and medical services utilization in a previously unstudied ethnic minority group of Bedouins enlisted in the Israeli Defense Forces. Methods: Participants were 317 community‐based Bedouin servicemen recruited through community outreach efforts. Axis I psychiatric diagnoses were determined by the Structured Clinical Interview for DSM‐IV Disorders; posttraumatic symptoms were measured with the Screen for Posttraumatic Stress Symptoms; and depression and anxiety symptoms were assessed by the Hopkins Symptom Checklist ?25 (HSCL‐25) Arabic version. Functional impairment and health service utilization were measured by a self‐report questionnaire. Results: Use of a stringent definition of trauma, restricted to experiences involving physical presence at the scene of the event, revealed that 75% of respondents reported potentially traumatizing events. Cap of these nearly 20% were diagnosed with posttraumatic stress disorder (PTSD), which was mostly co‐morbid with depression, alcohol abuse, or both. In spite of the widespread trauma exposure in this community, only those trauma‐exposed men who developed PTSD experienced extensive impact on their health, as indicated by associations with poor health status, physician‐diagnosed medical conditions, health‐related impairment in daily functioning, and frequent use of primary or specialty care services. Mental health services were typically not utilized. Conclusions: Detection of PTSD among Bedouin servicemen necessitates deliberate diagnostic efforts within primary care settings. Depression and Anxiety 25:700–707, 2008. © 2008 Wiley‐Liss, Inc.     

Obsessive–compulsive disorder: a review of the diagnostic criteria and possible subtypes and dimensional specifiers for DSM‐V

Background: Since the publication of the DSM‐IV in 1994, research on obsessive–compulsive disorder (OCD) has continued to expand. It is timely to reconsider the nosology of this disorder, assessing whether changes to diagnostic criteria as well as subtypes and specifiers may improve diagnostic validity and clinical utility. Methods: The existing criteria were evaluated. Key issues were identified. Electronic databases of PubMed, ScienceDirect, and PsycINFO were searched for relevant studies. Results: This review presents a number of options and preliminary recommendations to be considered for DSM‐V. These include: (1) clarifying and simplifying the definition of obsessions and compulsions (criterion A); (2) possibly deleting the requirement that people recognize that their obsessions or compulsions are excessive or unreasonable (criterion B); (3) rethinking the clinical significance criterion (criterion C) and, in the interim, possibly adjusting what is considered “time‐consuming” for OCD; (4) listing additional disorders to help with the differential diagnosis (criterion D); (5) rethinking the medical exclusion criterion (criterion E) and clarifying what is meant by a “general medical condition”; (6) revising the specifiers (i.e., clarifying that OCD can involve a range of insight, in addition to “poor insight,” and adding “tic‐related OCD”); and (7) highlighting in the DSM‐V text important clinical features of OCD that are not currently mentioned in the criteria (e.g., the major symptom dimensions). Conclusions: A number of changes to the existing diagnostic criteria for OCD are proposed. These proposed criteria may change as the DSM‐V process progresses. Depression and Anxiety, 2010. © 2010 Wiley‐Liss, Inc.     

Improvement of the quality of the DSM‐IV diagnostic definitions through computerized algorithms using macros in SPSS and SAS language

This work addresses methodological and conceptual issues related to the translation of the DSM‐IV diagnoses from verbal language into formal language through computerized algorithms, with the aim of guaranteeing its quality. A great number of biases can affect this process, so the main difficulties connected with each phase are outlined, proposals to standardize the process are advanced, and practical solutions to avoid errors in the formal diagnostic definitions are presented. The steps followed are: (a) classification of the disorders in seven different groups depending on the diagnostic structure they have in the taxonomy; (b) the creation of macros in SPSS and SAS languages that express formally the structures/groups identified; (c) elaboration of 162 macro calls, specifying formally all the particular diagnostic conditions for each DSM‐IV disorder; and (d) checking the correct functioning of the formal definitions proposed in a test data file (that has also been created in this work). Moreover, because the standardization of the process that creates the diagnoses in programming language requires the homogenization of the variable names and the codification formats, we have produced a proposal compatible with the verbal language for identifying, through letters and numbers, all the DSM‐IV criteria. The main contribution of this work consists of facilitating computerized and universal algorithms for obtaining automatically any DSM‐IV diagnosis in three categories (present, absent and not evaluable due to the lack of information) starting from a vector that includes all the criteria for that disorder. This study will also contribute to endowing the classification system most used in psychopathology (DSM‐IV) with greater methodological rigour. Copyright © 2000 Whurr Publishers Ltd.     

Low serum HDL‐cholesterol levels are associated with long symptom duration in patients with major depressive disorder

Aims: The purpose of the present study was to examine whether the association between depression and the serum high‐density lipoprotein cholesterol (HDL‐C) is modified by symptom duration. Methods: Depressed patients (n = 88) and an age‐ and sex‐matched group of healthy general population controls (n = 88) underwent a Structured Clinical Interview for DSM‐IV (SCID), and depressed participants reported the duration of their symptoms. The serum levels of total cholesterol (TC), HDL‐C, low‐density lipoprotein cholesterol (LDL‐C), triglycerides (TG) and non‐HDL, and the ratios of LDL‐C/HDL and TC/HDL‐C were assessed. Results: Major depressive disorder (MDD) subjects with a long symptom duration (≥3 years) had lower levels of HDL‐C compared with healthy controls or MDD subjects with a symptom duration <3 years. The likelihood for long symptom duration doubled for each 0.5‐mmol/L decrease in HDL‐C levels in regression models adjusted for age, gender, marital status, overweight, symptom severity, alcohol consumption, smoking, physical exercise, medication use, and non‐HDL‐C (P < 0.05). Conclusions: These findings suggest that a low serum HDL‐C level, a risk factor for coronary heart disease, is specifically associated with long‐term depressive symptomatology.     

Culture and the anxiety disorders: recommendations for DSM‐V

Background: The anxiety disorders specified in the fourth edition, text revision, of The Diagnostic and Statistical Manual (DSM‐IV‐TR) are identified universally in human societies, and also show substantial cultural particularities in prevalence and symptomatology. Possible explanations for the observed epidemiological variability include lack of measurement equivalence, true differences in prevalence, and limited validity or precision of diagnostic criteria. One central question is whether, through inadvertent “over‐specification” of disorders, the post‐DSM‐III nosology has missed related but somewhat different presentations of the same disorder because they do not exactly fit specified criteria sets. This review canvases the mental health literature for evidence of cross‐cultural limitations in DSM‐IV‐TR anxiety disorder criteria. Methods: Searches were conducted of the mental health literature, particularly since 1994, regarding cultural or race/ethnicity‐related factors that might limit the universal applicability of the diagnostic criteria for six anxiety disorders. Results: Possible mismatches between the DSM criteria and the local phenomenology of the disorder in specific cultural contexts were found for three anxiety disorders in particular. These involve the unexpectedness and 10‐minute crescendo criteria in Panic Disorder; the definition of social anxiety and social reference group in Social Anxiety Disorder; and the priority given to psychological symptoms of worry in Generalized Anxiety Disorder. Limited evidence was found throughout, particularly in terms of neurobiological markers, genetic risk factors, treatment response, and other DSM‐V validators that could help clarify the cross‐cultural applicability of criteria. Conclusions: On the basis of the available data, options and preliminary recommendations for DSM‐V are put forth that should be further evaluated and tested. Depression and Anxiety, 2010© 2009 Wiley‐Liss, Inc.     

Efficacy of interpersonal therapy‐group format adapted to post‐traumatic stress disorder: an open‐label add‐on trial

Background: Post‐traumatic stress disorder (PTSD) is a highly prevalent condition, yet available treatments demonstrate only modest efficacy. Exposure therapies, considered by many to be the “gold‐standard” therapy for PTSD, are poorly tolerated by many patients and show high attrition. We evaluated interpersonal therapy, in a group format, adapted to PTSD (IPT‐G PTSD), as an adjunctive treatment for patients who failed to respond to conventional psychopharmacological treatment. Methods: Research participants included 40 patients who sought treatment through a program on violence in the department of psychiatry of Federal University of São Paulo (UNIFESP). They had received conventional psychopharmacological treatment for at least 12 weeks and failed to have an adequate clinical response. After signing an informed consent, approved earlier by the UNIFESP Ethics Review Board, they received a semi‐structured diagnostic interview (SCID‐I), administered by a trained mental health worker, to confirm the presence of a PTSD diagnosis according to DSM‐IV criteria. Other instruments were administered, and patients completed out self‐report instruments at baseline, and endpoint to evaluate clinical outcomes. Results: Thirty‐three patients completed the trial, but all had at least one second outcome evaluation. There were significant improvements on all measures, with large effect sizes. Conclusions: IPT‐G PTSD was effective not only in decreasing symptoms of PTSD, but also in decreasing symptoms of anxiety and depression. It led to significant improvements in social adjustment and quality of life. It was well tolerated and there were few dropouts. Our results are very preliminary; they need further confirmation through randomized controlled clinical trials. Depression and Anxiety, 2010. © 2009 Wiley‐Liss, Inc.     

Mapping the manuals of madness: Comparing the ICD‐10 and DSM‐IV‐TR using a network approach

The International Classification of Diseases and Related Health Problems (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM) represent dominant approaches to diagnosis of mental disorders. However, it is unclear how these alternative systems relate to each other when taking into account the symptoms that make up the disorders. This study uses a network approach to investigate the overlap in structure between diagnostic networks pertaining to ICD‐10 and DSM‐IV‐TR. Networks are constructed by representing individual symptoms as nodes, and connecting nodes whenever the corresponding symptoms feature as diagnostic criteria for the same mental disorder. Results indicate that, relative to the DSM‐IV‐TR network, the ICD‐10 network contains (a) more nodes, (b) lower level of clustering, and (c) a higher level of connectivity. Both networks show features of a small world, and have similar (of “the same”) high centrality nodes. Comparison to empirical data indicates that the DSM‐IV‐TR network structure follows comorbidity rates more closely than the ICD‐10 network structure. We conclude that, despite their apparent likeness, ICD‐10 and DSM‐IV‐TR harbour important structural differences, and that both may be improved by matching diagnostic categories more closely to empirically determined network structures. Copyright © 2016 John Wiley & Sons, Ltd.     

Gender Differences in Depressive Symptoms in Thai Individuals with Depressed Mood and/or Anhedonia: A Differential Item Functioning Approach

This study used the item response theory-based log-likelihood-ratio technique for differential item functioning (IRT-LR DIF) to determine gender differences in seven add-on major depressive episode criteria in Thai people living in community. Of a population of 17,480 Thai people living in community, 322 men (3.79%) and 487 women (5.63%) currently were of depressed mood and/or anhedonia. Of seven symptoms, only cognitive deficit had a statistically significant DIF (G ² of 7.3, df?=?2, p?=?0.007; Benjamini-Hochberg adjusted p?=?0.049). The uniform DIF suggested that men had a significantly but marginally lower threshold value for endorsing cognitive deficit than women (threshold difference?=??0.25). While the discrimination parameters of this cognitive symptom were greater than 2.0 (men?=?2.10 and women?=?2.29), their difference was as low as ?0.19. Most depressed symp-toms have similar criterion functioning in both genders. However, Thai men may be more likely to have a cognitive deficit than their female counterparts.     

Identifying bipolar disorders in individuals with intellectual disability

Objective The aim of the present study was to characterize adults with intellectual disability (ID) and concomitant clinical diagnoses of bipolar disorder (BPD), and determine whether DSM‐IV criteria would distinguish individuals with BPD from patients with other psychiatric diagnoses. Methods A retrospective chart review was done of a convenience sample of adult patients seen over a 3‐year period in a specialty clinic for adults with ID and psychiatric disorders. The DSM‐IV criteria were used to differentiate individuals with clinical symptoms of BPD from groups of patients with other mood or thought disorders with behavioural symptoms which frequently overlap those of BPD. Behavioural symptoms were also catalogued and used to distinguish the diagnostic groups. Results Subjects with clinical symptoms of BPD had significantly more DSM‐IV mood‐related and non‐mood‐related symptoms, as well as functional impairments, compared to individuals with major depression, depression with psychosis or schizophrenia/psychosis NOS (not otherwise specified). Likewise, behavioural profiles of the BPD group of patients differed significantly from patients in the other three groups. Conclusions Bipolar disorder can be readily recognized and distinguished from other behavioural and psychiatric diagnoses in individuals with ID, and DSM‐IV criteria can be useful in the diagnosis of BPD.