Concordance between two personality disorder instruments with psychiatric inpatients

Eighty-two psychiatric inpatients received axis II diagnoses on the Millon Clinical Multiaxial Inventory (MCMI-1)--a self-report instrument--and the Structured Interview for DSM-III Personality (SIDP). Those two instruments were then compared in terms of personality disorder categories and trait-scores (dimensions). Essentially, with the exception of the borderline category, concordance between the two instruments was poor on all scales. Bayesian statistics confirmed the obtained results. The adequacy of the MCMI-I as an index of DSM-III personality disorders is questioned.     

Frequency of DSM-III personality disorders in patients with panic disorder: comparison with psychiatric and normal control subjects

Three clinical populations--panic disorder (n = 88), randomly selected outpatients (n = 82), and normal control subjects (n = 40)--were compared on three standardized DSM-III personality disorder instruments, the Structured Interview for DSM-III Personality Disorders (SIDP), the Millon Clinical Multiaxial Inventory (MCMI), and the Personality Diagnostic Questionnaire (PDQ). Significant differences were consistently found in presence of "any" personality disorder and DSM-III Cluster C (there were always more disorders in the outpatients). Logistic regression analysis revealed the important determinants predicting personality disorders, and therefore of differences between groups, were state depression, age, lifetime history of alcohol abuse, and presence of panic disorder.     

Diagnosing personality disorders in recent-onset schizophrenia

The present study aimed to determine the prevalence of personality disorders (PDs) and personality disorder traits in 40 recent-onset schizophrenic patients, to establish the degree of concordance between the Structured Interview for DSM-III Personality Disorders (SIDP) and the Million Multiaxial Clinical Inventory (MCMI-I), and to examine the interrater reliabilities for the diagnosis of SIDP disorders and traits. During their recovery phase, patients underwent the SIDP and completed the MCMI-I, a self-report inventory. Results showed that 57% of all patients had PDs according to the SIDP. The most common PDs were antisocial, borderline, and schizotypal, whereas the most common according to the MCMI-I were dependent, narcissistic, and avoidant. Both instruments indicated that multiple PD diagnoses were common. Paranoid and schizotypal traits were found to be ubiquitous across instruments. The level of agreements between the two instruments was poor on diagnostic assignment but better when trait scores were considered.     

Diagnosing personality disorders in the community. A comparison of self-report and interview measures

The rapidly expanding empirical study of personality disorders is the result of the publication of operational diagnostic criteria in DSM-III and the development of instruments to assess these criteria. Few researchers have examined the comparability of measures of personality disorders, and to our knowledge there are no studies of the factors associated with discordance between measures. In the present study, 697 relatives of psychiatric patients and healthy controls were interviewed with the Structured Interview for Personality Disorders (SIDP) and completed the Personality Disorders Questionnaire (PDQ). Significantly more individuals had a personality disorder according to the SIDP; however, multiple personality disorders were more frequently diagnosed on the PDQ. Schizotypal, compulsive, dependent, and borderline personality disorders were significantly more frequently diagnosed by the PDQ, whereas the SIDP more frequently diagnosed antisocial and passive-aggressive personality disorder. The corresponding dimensional scores of the two measures were all significantly correlated; however, the concordance for categorical diagnoses was poor. Discrepancies between the PDQ and the SIPD dimensional scores were significantly associated with current level of depressive symptoms and PDQ lie scale scores.     

Empirical determination of thresholds for case identification: Validation of the Personality Diagnostic Questionnaire-Revised

The Personality Diagnostic Questionnaire-Revised (PDQ-R) was sent to first-degree relatives of major psychotic patients for identification of DSM-III-R personality disorders (PDs). Responses to the PDQ-R were interpreted both literally and empirically, and compared with the Structured Interview for DSM-III PDs (SIDP) as the standard. For literal interpretation, symptoms reported were counted directly for case identification using fixed DSM-III-R thresholds. The empirical approach adjusted the threshold for case identification to maximize concordance with the SIDP. Comparison of the two methods showed that using empirically determined thresholds in some scales gives better concordance with the SIDP. For the dependent and histrionic PD scales, the improvements were statistically significant. The area under the receiver operating characteristic (ROC) curve was computed for each PDQ-R scale to summarize its discriminatory capability across all thresholds. Areas under the ROC curve indicated that the schizoid, schizotypal, borderline, dependent, passive-aggressive, and histrionic PD scales in the PDQ-R have better discriminatory qualities than other PDQ-R scales.     

Dependent personality disorder associated with phobic avoidance in patients with panic disorder

Eighty-eight panic disorder patients were divided into three groups according to the extent of their phobic avoidance (none, limited, or extensive). These groups were compared on three personality disorder instruments: the Structured Interview for DSM-III Personality Disorders, the Personality Diagnostic Questionnaire, and the Millon Clinical Multiaxial Inventory. Phobic patients were found to have significantly more dependent personality disorder and DSM-III third-cluster personality disorders than nonphobic patients. A subgroup of patients with social phobic symptoms was found to resemble the rest of the phobic group in terms of personality.     

DSM-III symptom disorders (Axis I) and personality disorders (Axis II) in an outpatient population

Type and prevalence of Axis I and Axis II disorders (DSM-III) were assessed in a sample of 298 consecutive psychiatric outpatients. The instruments used were SCID and SIDP. About half of the Axis I diagnoses consisted of different subgroups of depression. Most patients had more than one diagnosis, anxiety being the second most common disorder. Eighty one percent of the subjects met the criteria for a personality disorder diagnosis; half of them obtained more than one Axis II diagnosis. Personality disorder was more common among men than among women. Avoidant and dependent personality disorders constituted the most frequent diagnoses.     

Prognostic validity of self-report and interview measures of personality disorder in depressed inpatients

Presence of personality disorders was assessed with the Structured Interview for the DSM-III Personality Disorders (SIDP) in a series of 78 nonpsychotic inpatients with major depression. Measures of severity of depression were administered at admission, at discharge, and 6 months after admission. Outcome for the depression was especially poor in patients meeting criteria for multiple personality disorders from multiple DSM-III clusters. A subgroup of 38 patients received both the SIDP interview and a self-report measure of personality disorder, the Personality Diagnostic Questionnaire. Depressed inpatients who met more than the median number of personality disorder criteria by either measure were approximately half as likely to show improvement at discharge and at 6-month follow-up than were patients with less than the median number of criteria.     

The effects of changing axis II diagnostic criteria.

This study examined whether changes in diagnostic criteria from the DSM-III to the DSM-III for personality disorders (PDs) had the intended effects. Seventy-two subjects at the University of Iowa from three research studies and one clinical sample were administered two structured interviews (the Structured Interview for DSM-III Personality [SIDP] and the revised SIDP [SIDP-R]) to assess DSM-III and DSM-III-R criteria. Major changes in rates of diagnoses were observed between the DSM-III and DSM-III-R criteria with kappas for agreement ranging between -.025 and .571. As expected, the switch from monothetic to polythetic definitions had an effect on which patients were assigned a given diagnosis. However, not all of the other revisions associated with the DSM-III-R had the intended effects. For instance, the frequency of the diagnosis of schizoid PD did not increase, nor did the overlap between borderline and histrionic PDs decrease. In addition, there was an unintended increase in the rate of paranoid PD. An analysis of individual criteria showed how small, apparently minor changes in the wording of criteria can sometimes have major effects on which patients received a diagnosis of PD.     

Personality disorders in recent-onset bipolar disorder

The frequency and types of DSM-III personality disorders (PDs) were investigated in a sample of 26 recent-onset bipolar-disordered (BD) patients. Results showed that 62% of BD patients had PDs according to the Structured Interview for DSM-III Personality Disorders (SIDP). The most frequently diagnosed PDs were the histrionic, borderline, passive-aggressive, and antisocial categories. A comparison between the BD patients and a sample of 35 recent-onset schizophrenic patients showed significant differences for two PDs. Schizotypal PD was more frequently diagnosed in the schizophrenic group, while the BD group had a higher frequency of histrionic PD.     

Diagnosis of personality disorders by the Millon Clinical Multiaxial Inventory

The diagnostic efficiency of the Millon Clinical Multiaxial Inventory (MCMI) was examined with regard to the diagnosis of DSM-III axis II personality disorders by practicing psychiatrists. The MCMI displayed fairly good sensitivity but poor specificity and predictive power regarding the diagnosis of any personality disorder. Two possible explanations were offered: a) axis I psychopathology inflates scores on the MCMI personality disorder scales and causes an overdiagnosis of personality disorders by the test; or b) there is an under-recognition of axis II personality disorders (especially in the context of obvious axis I psychopathology) by the average practicing clinician.     

Personality and personality disorders among patients with major depression in combination with dysthymic or cyclothymic disorders

Personality traits and personality disorders in 298 consecutive outpatients with pure major depression, major depression with dysthymic or cyclothymic disorder, pure dysthymic or cyclothymic disorder and other disorders were investigated. Patients with dysthymic or cyclothymic disorders alone or in combination with major depression showed more self-doubt, insecurity, sensitivity, compliance, rigidity and emotional instability. They were more schizoid, schizotypal, borderline and avoidant according to MCMI and had a higher prevalence of DSM-III Axis II diagnoses, and more borderline, avoidant, and passive-aggressive personality disorders, as measured by SIDP. All in all, dramatic and anxious clusters of personality disorders were more frequent among patients with dysthymic-cyclothymic disorders in addition to major depression than among patients with major depression only. The findings elucidated the close connection between the more chronic affective disorders and the personality disorders, irrespective of any concomitant diagnosis of major depression.     

The diagnostic interview for personality disorders: Interrater and test-retest reliability

The Diagnostic Interview for Personality Disorders (DIPD) is a semistructured interview of 252 questions that encompasses all 11 Axis II disorders described in the DSM-III. Its interrater reliability was assessed using a sample of 43 patients and its test-retest reliability was assessed using a separate sample of 54 patients. Adequate kappas were obtained in both situations for all disorders except schizoid personality disorder, which was never diagnosed. Interrater coefficients ranged from .52 to 1.0, with nine in the excellent range (κ > .75). Test-retest coefficients ranged from .46 to .85, with four in the excellent range. These results compara very favorably to those achieved using the other two Axis II interviews that have appeared in the literature, the Structured Interview for the DSM-III Personality Disorders (SIDP) and the Personality Disorder Examination (PDE).     

Personality and response to tricyclic antidepressants in depressed patients

Several studies have shown that disturbances of personality are poor predictors of response to antidepressants. None of these studies, however, has used personality measures similar to the DSM-III. We evaluated the relationship between antidepressant response and personality scores obtained on the Millon Clinical Multiaxial Inventory, which provides personality measures congruent with DSM-III. Personality features such as assertiveness, independence, and competitiveness distinguished responders from nonresponders. However, the frequency of personality disorder diagnoses did not differ between responders and nonresponders.     

Diagnosing personality disorders in psychiatric inpatients

This study investigated assumptions made by DSM-III and DSM-III-R regarding Axis I-Axis II associations and sex differences for the 11 personality disorders (PD). A total of 112 patients formed 4 Axis I diagnostic groups: recent-onset schizophrenia (n = 35); recent-onset mania (n = 26); unipolar affective disorder (n = 30); and a mixed diagnostic group (n = 21). The prevalence of PD was determined using the Structured Interview for DSM-III Personality Disorders (SIDP). Schizophrenia was associated with antisocial PD and schizotypal PD; manic disorder was associated with histrionic PD; and unipolar affective disorder was associated with borderline, dependent and avoidant PD. Some of these results were consistent with DSM-III/DSM-III-R postulates. However, there was little support for the DSM-III/DSM-III-R statements on sex differences in the prevalence of PD, except for antisocial PD. The implications of the results for DSM-III/DSM-III-R assumptions are discussed.     

Update on instruments to measure DSM-III and DSM-III-R personality disorders

In the last 2 years, researchers have revised personality instruments to encompass the DSM-III-R criteria for personality disorders. More recent, innovative instruments undergoing validity work include a self-report instrument that rederives DSM-III personality categories from dimensional measures, a self-report designed to be used in conjunction with a diagnostic interview, an interview designed to be given by trained lay people, and a family history measure of the DSM-III personality disorder clusters. The modifications of older instruments and those instruments more recently developed are described. Clearly instruments require additional validity testing and better test-retest reliability. Discrepancies between different measurement instruments also need to be addressed.     

The structure of personality disorders in DSM-III.

In DSM-III it is proposed that there are 11 personality disorders (PDs) that fall into 3 superordinate clusters: cluster A, labelled the odd or eccentric; cluster B, labelled the emotional, dramatic or erratic; and cluster C, described as the anxious or fearful. To check this proposal, data were obtained from a sample of 112 state hospital psychiatric inpatients via the Structured Interview for DSM-III Personality (SIDP). Various statistical techniques were applied to the data, ranging from the least constrained method of multidimensional scaling to the most constrained and statistically rigorous approach of confirmatory factor analysis. In the latter approach, the models suggested by the various statistical approaches were contrasted directly. A 3-cluster solution was accepted as the best representation of the data, although PD membership of the 3 clusters varied in some ways from those suggested by DSM-III. An exploratory correlation analysis showed that many of the items were more strongly correlated with PDs other than the ones specified by DSM-III, but generally items clustered within the 3 superordinate clusters. This issue deserves further investigation.     

Relations between mood disorders and personality. Recent data]

In the field of studies of links between mood disorders and personality, the need to study only completely remitted patients has been demonstrated recently. Indeed, the clinically depressed state strongly influences the assessment of some personality traits in a more pathological direction (for instance for emotional stability, extraversion, interpersonal dependency, ego strength). The studies concerning unipolar depression have been mainly made according to two methodological approaches which results are relatively consistent. The first one uses batteries of standard self-report personality inventories such as the Hirschfeld and Klerman battery which includes the Guilford-Zimmerman Temperament Survey, the Interpersonal Dependency Inventory, the shortened version of the Lazare-Klerman-Armor Personality Inventory and two subscales of the MMPI. This approach shows that compared to normal population, recovered depressive, have less emotional strength more interpersonal dependency and a more introverted personality. The second approach uses diagnostic criteria of personality disorders according to DSM III. The clinical evaluation can be performed with the help of the Structured Interview for DSM III Personality Disorders (SIDP) or with of the help the Millon Clinical Multiaxial Inventory (MCMI), a self rated questionnaire. The most frequent personality disorder among recovered unipolar patients is dependent personality, followed by the avoidant and histrionic personalities and lastly the schizo?d, schizotypal, borderline, compulsive and passive-aggressive personalities. But the interpretation of all these results must be cautious given that a recent study dealing with premorbid personality invites one to consider that not only depression influences personality assessment during illness, but also that depression may result in personality change after recovery. Few studies are available concerning bipolar patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

A comparison of three measures for the diagnosis of borderline personality disorder

Three instruments for diagnosing borderline personality disorder were administered to 22 outpatients. There was poor concordance among the indexes for the identification of the disorder, and more than half of the sample received more than two DSM-III axis II diagnoses.     

Sex distribution of DSM-III personality disorders in psychiatric outpatients

The author determined the sex distribution of 170 outpatients with a DSM-III diagnosis of personality disorder measured by standardized instruments and compared his findings with DSM-III predictions. They confirmed the prediction of more women diagnosed as having histrionic personality disorder and more men diagnosed as having paranoid, compulsive, and antisocial personality disorders. The predicted excess of women diagnosed as having borderline and dependent personality disorders was not confirmed.