John M. Oldham

VALIDITY OF THE PERSONALITY DIAGNOSTIC QUESTIONNAIRE-REVISED : A REPLICATION IN AN OUTPATIENT SAMPLE

We report a replication study of the validity of the Personality Diagnostic Questionnaire-Revised (PDQ-R) in an outpatient sample. Fifty-nine applicants for psychoanalysis at a training institute completed the PDQ-R and were diagnosed by clinicians, blind to the PDQ-R results, using the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) and the Personality Disorder Examination (PDE). The PDQ-R showed high sensitivity and moderate specificity for most axis II disorders. Although not a substitute for a structured interview because it yields many false-positives, the PDQ-R is an efficient instrument for screening outpatients with DSM-III-R personality disorders.

Proposed changes in personality and personality disorder assessment and diagnosis for DSM-5 part I: description and rationale

A major reconceptualization of personality psychopathology has been proposed for DSM-5 that identifies core impairments in personality functioning, pathological personality traits, and prominent pathological personality types. A comprehensive personality assessment consists of four components: levels of personality functioning, personality disorder types, pathological personality trait domains and facets, and general criteria for personality disorder. This four-part assessment focuses attention on identifying personality psychopathology with increasing degrees of specificity, based on a clinicians available time, information, and expertise. In Part I of this two-part article, we describe the components of the new model and present brief theoretical and empirical rationales for each. In Part II, we will illustrate the clinical application of the model with vignettes of patients with varying degrees of personality psychopathology, to show how assessments might be conducted and diagnoses reached.

Co-occurrence of mood and personality disorders: A report from the collaborative longitudinal personality disorders study (CLPS)†

The purpose of this study was to examine the relationship of subtypes and particular clinical features of mood disorders to co‐occurrence with specific personality disorders. Five hundred and seventy‐one subjects recruited for the Collaborative Longitudinal Personality Disorders Study (CLPS) were assessed with the Structured Clinical Interview for DSM‐IV Axis I Disorders (SCID‐I) and the Diagnostic Interview for DSM‐IV Personality Disorders (DIPD‐IV). Percent co‐occurrence rates for current and lifetime mood disorders with personality disorders were calculated. Logistic regression analyses examined the effects of clinical characteristics of depressive disorders (e.g., age at onset, recurrence, symptom severity, double depression, and atypical features) on personality disorder co‐occurrence. In comparison with other DSM‐IV personality disorders, avoidant, borderline, and dependent personality disorders (PDs) were most specifically associated with mood disorders, particularly depressive disorders. Severity and recurrence of major depressive disorder and comorbid dysthymic disorder predicted co‐occurrence with borderline and to a lesser extent research criteria depressive personality disorders. The results are consistent with the view that a mood disorder with an insidious onset and recurrence, chronicity, and progression in severity leads to a personality disorder diagnosis in young adults. Depression and Anxiety 10:175–182, 1999.© 1999 Wiley‐Liss, Inc.

Comorbidity of DSM‐III‐R eating disorders and personality disorders

The purpose of this study was to assess the relationship of eating disorders to personality disorders. Two hundred subjects were independently administered the Structured Clinical Interview for DSM-III-R (SCID) and the Personality Disorder Examination (PDE) face-to-face by two experienced clinicians. One hundred forty-six also completed the Personality Diagnostic Questionnaire-Revised (PDQ-R). Rates of personality disorder among patients with and without eating disorders were determined by each of the three instruments. Comorbidity between bulimia nervosa and anorexia nervosa and a conservative estimate of individual Axis II disorders was examined. Eating disorders with and without personality disorders were compared on age at onset and two measures of illness severity. Results indicate that the association, in general, between personality disorders and eating disorders varies by diagnostic method. Bulimia nervosa, however, is associated with borderline personality disorder and anorexia nervosa with avoidant personality disorder. Eating disorders with personality disorders are characterized by chronicity and low levels of functioning compared with eating disorders without personality disorders.

Patterns of anxiety and personality disorder comorbidity

The purpose of this study was to examine patterns of comorbidity of DSM-III-R anxiety disorders and personality disorders (PD). Two-hundred subjects were independently interviewed with the Structured Clinical Interview for DSM-III-R (SCID) and the Personality Disorder Examination (PDE) face-to-face by two experienced clinicians. One-hundred and forty-six also completed the Personality Diagnositc Questionnaire-Revised (PDQ-R). Rates of personality disorder among patients with and without anxiety disorders were determined by each of the three instruments. Comorbidity between panic disorder social phobia, obsessive-compulsive disorder and simple phobia and a conservative estimate of individual Axis II disorders was examined. Results indicate that panic disorder, either current or lifetime, is associated with borderline, avoidant, and dependent personality disorders: social phobia is associated with avoidant personality disorder, and obsessive-compulsive disorder is associated with obsessive-compulsive and avoidant personality disorders. Anxiety disorders with personality disorders are characterized by chronicity and lower levels of functioning compared with anxiety disorders without personality disorders.

Internal consistency, intercriterion overlap and diagnostic efficiency of criteria sets for DSM-IV schizotypal, borderline, avoidant and obsessive-compulsive personality disorders

Objective: To evaluate performance characteristics of DSM‐IV Personality Disorders (PDs) criteria.

Construct validity and factor structure of the difficulties in Emotion Regulation Scale among adults with severe mental illness

BACKGROUND The Difficulties in Emotion Regulation Scale (DERS: Gratz and Roemer, 2004) is a measure of emotion-regulation capacities with good construct validity, test-retest reliability and internal consistency. Factor analytic studies have produced mixed results, with the majority of studies supporting the original 6-factor model while several studies advance alternative 5-factor models, each of which raises questions about the psychometric validity of the Lack of Emotional Awareness factor. A limitation of prior psychometric studies on the DERS is the reliance on healthy subjects with minimal impairment in emotion regulation. The current study assesses the construct validity and latent factor structure of the DERS in a large sample of adult psychiatric inpatients with serious mental illness (SMI). METHODS Inpatients with SMI (N = 592) completed the DERS, Acceptance and Action Questionnaire (AAQ-2), Patient Health Questionnaire (PHQ-SADS), and research diagnostic interviews (SCID I/II) at admission. RESULTS DERS total scores were correlated with AAQ-2 (r = .70), PHQ-Depression (r = .45), PHQ-Anxiety (r = .44) and moderately correlated with PHQ-Somatization (r = .28). Confirmatory factor analysis indicated that five and six-factor model produced equivalent fit indices. All factors demonstrated positive correlations with the exception of difficulty engaging in goal-directed behavior and lack of emotional awareness. CONCLUSIONS The DERS is a strong measure with excellent internal consistency and good construct validity. Caution is warranted in discarding the six-factor model given the equivalence with the five-factor model, particularly in light of the body of clinical research evidence utilizing the full scale.

Proposed changes in personality and personality disorder assessment and diagnosis for DSM-5 part II: Clinical application

The four-part assessment of personality psychopathology proposed for DSM-5 focuses attention on identifying personality psychopathology with increasing degrees of specificity, based on a clinicians available time, information, and expertise. In Part I of this two-part article, we described the components of the new model and presented brief rationales for them. In Part II, we illustrate the clinical application of the model with vignettes of patients with varying degrees of personality psychopathology, selected from the DSM-IV-TR Casebook, to show how assessments might be conducted and diagnoses reached.

Clinician judgments of clinical utility: A comparison of DSM-IV-TR personality disorders and the alternative model for DSM-5 personality disorders.

This study compared the perceived clinical utility of DSM-IV-TR personality disorder diagnoses (retained in DSM-5) with the alternative model presented in DSM-5 Section III, using a national sample of clinicians applying both systems to their own patients. A sample of 337 mental health clinicians (26% psychiatrists, 63% psychologists, and 11% other professional disciplines) provided a complete assessment of all personality disorder features listed in DSM-IV-TR and DSM-5 Section III. After applying each diagnostic model, clinicians evaluated the clinical utility of that model with respect to communication with patients and with other professionals, comprehensiveness, descriptiveness, ease of use, and utility for treatment planning. These perceptions were compared across DSM-IV-TR and the 3 components of the DSM-5 Section III model, and between psychiatrists and nonpsychiatrists. Although DSM-IV-TR was seen as easy to use and useful for professional communication, in every other respect the DSM-5 Section III model was viewed as being equally or more clinically useful than DSM-IV-TR. In particular, the DSM-5 dimensional trait model was seen as more useful than DSM-IV-TR in 5 of 6 comparisons-by psychiatrists as well as other professionals. Although concerns were expressed about the clinical utility of the DSM-5 personality disorder system during its development, these criticisms were offered without data on the proposed system. The results of this study demonstrate that aside from the current familiarity of the DSM-IV-TR approach, it offers little advantage in perceived clinical utility over the DSM-5 Section III system, whereas the latter is viewed as being more useful in several respects.

Exposure to interpersonal trauma, attachment insecurity, and depression severity

BACKGROUND Exposure to traumatic events is a nonspecific risk factor for psychiatric symptoms including depression. The trauma-depression link finds support in numerous studies; however, explanatory mechanisms linking past trauma to current depressive symptoms are poorly understood. This study examines the role that attachment insecurity plays in mediating the relationship between prior exposure to trauma and current expression of depression severity. METHODS Past trauma and attachment anxiety and avoidance were assessed at baseline in a large cohort (N=705) of adults admitted to a specialized adult psychiatric hospital with typical lengths of stay ranging from 6 to 8 weeks. Depression severity was assessed at day 14 of treatment using the Beck Depression Inventory-II. RESULTS Interpersonal trauma (e.g., assaults, abuse) was correlated with depression severity, whereas exposure to impersonal trauma (e.g., natural disasters, accidents) was not. Adult attachment partially mediated the relationship between past interpersonal trauma and depression severity at day 14 among psychiatric inpatients. LIMITATIONS Measure of trauma exposure did not systematically differentiate the age of exposure or relationship to the perpetrator. Individuals scoring high on the self-report attachment measure may be prone to over-report interpersonal traumas. CONCLUSIONS Treatment of depression in traumatized patients should include an assessment of attachment insecurity and may be fruitful target for intervention.