Steven E. Hyler

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.

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.

DSM-III personality diagnosis in bulimia

Abstract The authors report the results of a systematic examination of DSM-III personality disorder in 24 normal-weight subjects with bulimia. Using a self-report personality questionnaire as a guide to a comprehensive personality interview, two psychiatrists reached a consensus personality diagnosis. The majority of subjects met criteria for one or more DSM-III personality disorders. Fifteen of 24 subjects showed pathology in the Histrionic/Borderline spectrum and seven showed predominant Compulsive/Avoidant pathology. These findings did not correlate to RDC diagnosis or eating behavior. The authors conclude that individuals with bulimia are heterogeneous with regards to their Axis II diagnoses and that these differences may have implications for treatment response.

Factor Analysis of the DSM-III Personality Disorder Clusters: A Replication

The authors describe the replication of Kass et al.s study where a factor analysis of scaled ratings of DSM-III personality disorders yielded groupings similar to those described in DSM-III. In this replication the authors used scaled ratings from a nationwide sample of psychiatrists on 358 patients. The authors conclude that this replication lends additional support for the DSM-III (now DSM-III-R) approach towards grouping personality disorders into three (or four) clusters.

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.

DSM-III at the cinema: Madness in the movies

Abstract A kaleidoscopic view of commercial film and television depiction of mental disorders is presented. Films portraying various types of mental disorder, from psychoses through personality disorders, are identified and examined in terms of DSM-III diagnostic criteria. It is concluded that although few generalizations can be made, a surprisingly large number of films are reasonably accurate in their representations of various disorders, and some may even be considered prototypal in their portrayal of the mentally ill.

Legal and ethical challenges in telepsychiatry.

Telepsychiatry in the 21st century poses a wide range of legal and ethical challenges. The authors review issues related to licensure, credentialing, privacy, security, confidentiality, informed consent, and professional liability in the use of telepsychiatry services and illustrate the discussion with hypothetical clinical vignettes. It is clear that there will be a need in the immediate future to create legal instruments as well as formal professional ethical guidelines for the practice of telepsychiatry.

Teaching psychiatry? Let hollywood help! : suicide in the cinema

Commercial films on videotape may be helpful in teaching medical students and residents about psychiatry. Recommendations are made on the use of specific films to illustrate various aspects of suicide, including depression, posttraumatic stress disorder, adolescent pressures and suicide, suicide gesture vs. suicide attempt, and the spiritual and philosophical aspects of suicide. In the Appendix, the authors list several dozen films depicting suicide that might be used for teaching purposes.

Screening for Axis II Personality Disorders in Women with Bulimic Eating Disorders

The Personality Diagnostic Questionnaire (PDQ) was completed by 628 eating-disordered women: 300 with normal-weight bulimia, 15 with anorexia nervosa with bulimic features, and 313 with subdiagnostic eating disorders. Three-quarters (75%) of subjects with normal-weight bulimia had personality disorder diagnoses, compared with 50% of those with subdiagnostic eating disorders. The average number of separate PDQ diagnoses was 2.7 for the normal-weight bulimia group, 2.5 for the group with anorexia nervosa with bulimic traits, and 1.5 for the subdiagnostic group. The most common PDQ diagnoses were schizotypal, histrionic, and borderline disorders, but avoidant and dependent personality features also occurred. Personality disturbances may be common in patients with eating disorders.

Clinical implications of Axis I-Axis II interactions.

Abstract The DSM-III multiaxial approach to diagnosis encourages the clinician to distinguish state (Axis I) from trait (Axis II) features of mental disorders. However, in many cases the differentiation is by no means clear-cut and the correlation between particular clinical syndromes and personality disorders suggest that they may interact in complicated ways. The authors present three cases illustrating typical diagnostic and treatment difficulties encountered when there is an admixture of Axis I and Axis II psychopathology.