The Validity of a Personality Disorder Diagnosis for People with an Intellectual Disability

Background It has long been appreciated that people with intellectual disabilities experience mental health problems. Studies into the prevalence of personality disorder in the population of people with an intellectual disability indicate significant variations, which have no clear explanation. Method Work on personality disorder and personality is reviewed. Results This article will outline some of the reasons for the variations in the reported prevalence figures including the impact of diagnostic overshadowing, problems inherent within the diagnostic classification systems and instruments that have a significant impact upon the reliability of a diagnosis. It will also argue that there are some fundamental issues relating to the validity of the construct of personality disorder and its application to the population of people with intellectual disabilities. The article notes that the model of personality, which in itself is not without critics, is derived from research on the general population and has not been integrated with personality research conducted within the population of people with an intellectual disability. Conclusion It is suggested that the current diagnostic systems need to be reviewed in the context of an existing evidence base from within the field of intellectual disabilities. There are grounds to be cautious with the current diagnostic process and to question its clinical utility. Furthermore, diagnosis may only serve as an intermediate step and as part of a more detailed nomothetic approach.     

老年抑郁症病人述情障碍和人格特征的研究

目的探讨老年抑郁症病人的述情障碍和人格特征及两者间的关系。方法采用多伦多述情障碍量表（TAS）及明尼苏达多相个性调查问卷（MMPI）,分别对60例老年抑郁症病人（研究组）及60例健康者（对照组）测评,分析老年抑郁症病人的述情障碍和人格特征及两者间的关系。结果研究组TAS总分及因子Ⅰ、Ⅱ、Ⅳ评分均高于对照组,因子Ⅲ评分低于对照组,差异均具有显著性（t=-2.392~8.809,P〈0.05）;其MMPI各临床量表中疑病、抑郁、癔症、精神病态、偏执、精神衰弱T分值均高于对照组,男性-女性化平均T分值低于对照组,差异均具有显著性（t=2.952~10.854,P〈0.05）;研究组TAS因子Ⅰ评分与抑郁、精神病态、偏执、精神衰弱T分值均呈正相关,因子Ⅳ评分与抑郁T分值呈负相关（r=-0.340~0.487,P〈0.05）。结论老年抑郁症病人有一定的人格基础,存在明显的述情障碍,并且两者密切相关。     

Cluster A personality disorders: considering the 'odd-eccentric' in psychiatric nursing

Psychiatric nurses are familiar with the concept of personality disorder because of their contact with persons with the most common personality disorder in clinical settings - borderline type, who frequently engage mental health services. Perhaps it is this familiarity that has focused research and clinical attention on borderline personality disorder compared with the other personality disorders. The significance of cluster A personality disorders for nursing is multifaceted because of their severity, prevalence, inaccurate diagnosis, poor response to treatment, and similarities to axis I diagnoses. Despite this, literature reviews have established that relatively few studies have focused on the treatment of the cluster A personality disorders - paranoid, schizotypal, and schizoid - resulting in a dearth of evidence-based interventions for this group of clients. A discussion of these disorders in the context of personality disorder and their individual characteristics demonstrates the distinctive and challenging engagement techniques required by psychiatric nurses to provide effective treatment and care. It is also strongly indicated that the discipline of psychiatric nursing has not yet begun to address the care of persons with cluster A personality disorders.