scholarly journals Diagnosis and classification of personality disorder: difficulties, their resolution and implications for practice

2010 ◽  
Vol 16 (5) ◽  
pp. 388-396 ◽  
Author(s):  
Jaydip Sarkar ◽  
Conor Duggan
Keyword(s):  
Personality Disorder ◽  
Personality Disorders ◽  
Integrated Approach ◽  
Personality Pathology ◽  
Icd 10 ◽  
Diagnosis And Classification ◽  
Axis I ◽  
Dsm Iv ◽  
Current Systems

SummaryThere are many difficulties associated with the diagnostic guidelines for personality disorder in the current international classificatory systems such as ICD–10 and DSM–IV. These lead not only to significant overlap with DSM Axis I disorders, resulting in high rates of diagnoses of comorbidities and multiple personality disorders, but also to lack of adequate capture of core personality pathology. The current classifications are also unhelpful in treatment selection, presumably the prime reason for assessing individuals in the first place. In this article we highlight various deficits and inadequacies related to the nosology of the current systems and suggest some strategies for dealing with these. We offer an integrated model of assessing and diagnosing personality disorders. We attempt to demonstrate how using a more integrated approach minimises or even eliminates some of the key problems highlighted in the current systems.

Diagnosis and classification of personality disorders

2012 ◽  
pp. 855-860
Author(s):  
James Reich ◽  
Giovanni de Girolamo
Keyword(s):  
Personality Disorder ◽  
Personality Disorders ◽  
Assessment Methods ◽  
Icd 10 ◽  
Diagnosis And Classification ◽  
Dsm Iv ◽  
Similarities And Differences ◽  
Different Cultures

There has been considerable interest in the study of personality and personality disorder (PD) since early times and in many different cultures. This chapter covers definitions of personality disorders, ICD and DSM classifications of personality disorders, similarities and differences between ICD-10 and DSM-IV, recent changes in the conceptualization of DSM personality disorders, categorical versus dimensional styles of classification, and assessment methods for personality disorders.

A comparison of DSM-III-R and ICD-10 personality disorder criteria in an out-patient population

1996 ◽  
Vol 26 (1) ◽  
pp. 151-160 ◽  
Author(s):  
G. Sara ◽  
P. Raven ◽  
A. Mann
Keyword(s):  
Personality Disorder ◽  
Personality Disorders ◽  
Diagnostic Criteria ◽  
Equivalent Form ◽  
Primary Diagnosis ◽  
Individual Personality ◽  
Diagnostic Threshold ◽  
Icd 10 ◽  
Dsm Iv

SynopsisThis study reports the results of a comparison of DSM-III-R and ICD-10 personality disorder criteria by application of both sets of criteria to the same group of patients. Despite the clinical relevance of these disorders and the need for reliable diagnostic criteria, such a comparison has not previously been reported. DSM-III-R and ICD-10 have converged in their classification of personality disorders, but some important differences between the two systems remain. Personality disorder diagnoses from both systems were obtained in 52 out-patients, using the Standardized Assessment of Personality (SAP), a brief, informant-based interview which yields diagnoses in both DSM-III-R and ICD-10. For individual personality disorder diagnoses, agreement between systems was limited. Thirty-four subjects received a personality disorder diagnosis that had an equivalent form in both systems, but only 10 subjects (29%) received the same primary diagnosis in each system. There was a difference in rate of diagnosis, with ICD-10 making significantly more personality disorder diagnoses. The lower diagnostic threshold of the ICD-10 contributed most of this effect. Further modifications in ICD-10 Diagnostic Criteria for Research (DCR) and DSM-IV to the personality disorder category have been considered. The omission in DSM-IV of three categories unique to that system and the raising of the threshold in ICD-10 DCR, do seem to have been helpful in promoting convergence.

scholarly journals Comparison of alternative models for personality disorders, II: 6-, 8- and 10-year follow-up

2011 ◽  
Vol 42 (8) ◽  
pp. 1705-1713 ◽  
Author(s):  
L. C. Morey ◽  
C. J. Hopwood ◽  
J. C. Markowitz ◽  
J. G. Gunderson ◽  
C. M. Grilo ◽  
...  
Keyword(s):  
Personality Disorders ◽  
Factor Model ◽  
Five Factor Model ◽  
Personality Pathology ◽  
Diagnostic Categories ◽  
Dsm 5 ◽  
Axis I ◽  
Dsm Iv ◽  
Characteristic Features

BackgroundSeveral conceptual models have been considered for the assessment of personality pathology in DSM-5. This study sought to extend our previous findings to compare the long-term predictive validity of three such models: the Five-Factor Model (FFM), the Schedule for Nonadaptive and Adaptive Personality (SNAP), and DSM-IV personality disorders (PDs).MethodAn inception cohort from the Collaborative Longitudinal Personality Disorder Study (CLPS) was followed for 10 years. Baseline data were used to predict long-term outcomes, including functioning, Axis I psychopathology, and medication use.ResultsEach model was significantly valid, predicting a host of important clinical outcomes. Lower-order elements of the FFM system were not more valid than higher-order factors, and DSM-IV diagnostic categories were less valid than dimensional symptom counts. Approaches that integrate normative traits and personality pathology proved to be most predictive, as the SNAP, a system that integrates normal and pathological traits, generally showed the largest validity coefficients overall, and the DSM-IV PD syndromes and FFM traits tended to provide substantial incremental information relative to one another.ConclusionsDSM-5 PD assessment should involve an integration of personality traits with characteristic features of PDs.

Childhood antecedents of personality disorder: An alternative perspective

2009 ◽  
Vol 21 (3) ◽  
pp. 771-791 ◽  
Author(s):  
Thomas A. Widiger ◽  
Barbara De Clercq ◽  
Filip De Fruyt
Keyword(s):  
Personality Disorder ◽  
Personality Disorders ◽  
Factor Model ◽  
Five Factor Model ◽  
Personality Structure ◽  
Childhood And Adolescence ◽  
Adult Personality ◽  
Dsm Iv ◽  
Childhood Antecedents

AbstractOne of the fundamental limitations of theDiagnostic and Statistical Manual of Mental Disorders—Fourth Edition, Text Revision(DSM-IV-TR) categorical model of personality disorder classification has been the lack of a strong scientific foundation, including an understanding of childhood antecedents. TheDSM-IV-TRpersonality disorders, however, do appear to be well understood as maladaptive variants of the domains and facets of the general personality structure as conceptualized within the five-factor model (FFM). Integrating the classification of personality disorder with the FFM brings to an understanding of the personality disorders a considerable body of scientific research on childhood antecedents. The temperaments and traits of childhood do appear to be antecedent to the FFM of adult personality structure, and these temperament and traits of childhood and adolescence are the likely antecedents for adult personality disorder, providing further support for the conceptualization of the adult personality disorders as maladaptive variants of the domains and facets of the FFM. Conceptualizing personality disorders in terms of the FFM thereby provides a basis for integrating the classification of abnormal and normal personality functioning across the life span.

scholarly journals Prevalence and correlates of personality disorders in a community sample

2002 ◽  
Vol 180 (06) ◽  
pp. 536-542 ◽  
Author(s):  
Jack Samuels ◽  
William W. Eaton ◽  
O. Joseph Bienvenu ◽  
Clayton H. Brown ◽  
Paul T. Costa ◽  
...  
Keyword(s):  
High School ◽  
Personality Disorder ◽  
Personality Disorders ◽  
Community Sample ◽  
Treatment Needs ◽  
Never Married ◽  
High School Degree ◽  
Icd 10 ◽  
Dsm Iv ◽  
Demographic Subgroups

Background Knowledge of the prevalence and correlates of personality disorders in the community is important for identifying treatment needs and for provision of psychiatric services. Aims To estimate the prevalence of personality disorders in a community sample and to identify demographic subgroups with especially high prevalence. Method Clinical psychologists used the International Personality Disorder Examination to assess DSM-IV and ICD-10 personality disorders in a sample of 742 subjects, ages 34–94 years, residing in Baltimore, Maryland. Logistic regression was used to evaluate the association between demographic characteristics and DSM - IV personality disorder clusters. Results The estimated overall prevalence of DSM - IV personality disorders was 9%. Cluster A disorders were most prevalent in men who had never married. Cluster B disorders were most prevalent in young men without a high school degree, and cluster C disorders in high school graduates who had never married. Conclusions Approximately 9% of this community sample has a DSM-IV personality disorder. Personality disorders are over-represented in certain demographic subgroups of the community

Gender-related distribution of personality disorders in a sample of patients with panic disorder

2001 ◽  
Vol 16 (3) ◽  
pp. 173-179 ◽  
Author(s):  
G. Barzega ◽  
G. Maina ◽  
S. Venturello ◽  
F. Bogetto
Keyword(s):  
Personality Disorder ◽  
Panic Disorder ◽  
Personality Disorders ◽  
Structured Interview ◽  
Dependent Personality Disorder ◽  
Dependent Personality ◽  
Co Morbidity ◽  
Related Distribution ◽  
Axis I ◽  
Dsm Iv

SummaryObjectiveWe examined gender differences in the frequency of DSM-IV personality disorder diagnoses in a sample of patients with a diagnosis of panic disorder (PD).MethodOne hundred and eighty-four outpatients with a principal diagnosis of PD (DSM-IV) were enrolled. All patients were evaluated with a semi-structured interview to collect demographic and clinical data and to generate Axis I and Axis II diagnoses in accordance with DSM-IV criteria.ResultsMales were significantly more likely than females to meet diagnoses for schizoid and borderline personality disorder. Compared to males, females predominated in histrionic and cluster C diagnoses, particularly dependent personality disorder diagnoses. A significant interaction was found between female sex and agoraphobia on personality disorder (PD) distribution.ConclusionsMale PD patients seem to be characterized by more severe personality disorders, while female PD patients, particularly with co-morbid agoraphobia, have higher co-morbidity rates with personality disorders belonging to the ‘anxious-fearful cluster’.

CS04-03 - New developments in the classification of personality disorders

2011 ◽  
Vol 26 (S2) ◽  
pp. 1780-1780
Author(s):  
E. Simonsen
Keyword(s):  
Personality Disorders ◽  
Psychiatric Patients ◽  
Normal Population ◽  
Scientific Basis ◽  
Personality Pathology ◽  
Clinical Validity ◽  
New Developments ◽  
Functional Deficits ◽  
Dsm Iv

Personality disorders are regarded as being among the more important categories within the DSM-IV diagnostic nomenclature, because they have the unique distinction of being placed on a separate diagnostic axis. However, empirical data have pointed out a number of disadvantages and concerns with the categorical system: excessive co-occurrence, inadequate coverage, heterogeneity within diagnoses, arbitrary and unstable diagnostic boundaries and inadequate scientific basis.Alternative dimensional approaches have been considered. There is a surprising consistency over the number and descriptions of the main factors or dimensions both in normal population and among psychiatric patients, at least the following four: an externalizing factor aggression (antagonism), an internalizing anxious-emotional unstable second factor, an inhibited and constraint third factor and fourth factor of compulsivity and perfectionism. Beside this, severity of functional deficits, a number of trait domains and disturbances of self and identity are considered to be included as additional descriptors of personality pathology. It is proposed that only 5 or 6 of the current categories with highest clinical validity will be kept in the system. The aim is to maximize clinical utility, but the current suggestions seem to be too complex for the average clinician to follow.

scholarly journals Sexual dysfunction: classification and assessment

2013 ◽  
Vol 19 (1) ◽  
pp. 48-55 ◽  
Author(s):  
Dinesh Bhugra ◽  
Gabriele Colombini
Keyword(s):  
Sexual Dysfunction ◽  
Sexual Dysfunctions ◽  
Success Rates ◽  
Medical Interventions ◽  
Assessment And Treatment ◽  
Icd 10 ◽  
Diagnosis And Classification ◽  
Dsm Iv

SummarySexual dysfunction is one of the most common psychiatric disorders, but it is often ignored in assessment. It can be primary or secondary (a result of psychiatric disorder or medication). Success rates in managing sexual dysfunction are relatively high, with good response to psychological and medical interventions. In ICD-10 and DSM-IV-TR, sexual dysfunctions are broadly classified on the basis of the stages of sexual activity, from arousal to orgasm. There are major similarities between ICD and DSM in diagnosis and classification of sexual dysfunction, but both systems raise challenges. These include definitions of what is ‘normal’ and how abnormality is defined. In this article, we describe the role of the two systems and possible amendments that might help researchers and clinicians. We also present key principles for the assessment and treatment of people who experience sexual dysfunction. We consider problems that need to be managed in engaging and in the therapeutic alliance.

DSM-IV and ICD-10 personality disorders: a comparison of a self-report questionnaire (DIP-Q) with a structured interview

1998 ◽  
Vol 13 (5) ◽  
pp. 246-253 ◽  
Author(s):  
H Ottosson ◽  
O Bodlund ◽  
L Ekselius ◽  
M Grann ◽  
L von Knorring ◽  
...  
Keyword(s):  
Personality Disorder ◽  
Healthy Volunteers ◽  
Personality Disorders ◽  
Intraclass Correlation ◽  
Structured Interview ◽  
Epidemiological Studies ◽  
Self Report ◽  
Expert Interview ◽  
Icd 10 ◽  
Dsm Iv

SummaryObjectiveDiagnosing personality disorders according to structured expert interviews is time-consuming and costly. For epidemiological studies, self-report instruments have several advantages. The DSM-IV and ICD-10 personality questionnaire (DIP-Q) is a selfreport questionnaire constructed to identify personality disorder according to DSM-IV and ICD-10.MethodsThe DIP-Q is validated vs a structured expert interview in a clinical sample of 138 individuals. In addition, prevalence rates yielded by DIP-Q among 136 healthy volunteers are assessed and compared to expected prevalence.ResultsFor DSM-IV the agreement for any personality disorder as measured by Cohen's Kappa was 0.61 and 0.56 for ICD-10. Overall sensitivity for any personality disorder was for DSM-IV 0.84 and for ICD-10 0.85. However, specificity was lower: 0.77 and 0.70, respectively. When dimensional scores between self-report and interview for each personality disorder were compared, the intraclass correlation for the DSMIV entities was 0.37–0.87 and for the ICD-10 entities 0.33–0.73. Among healthy volunteers the base rate of personality disorders was found to be 14%.ConclusionsDIP-Q can be used as a screening instrument for personality disorders according to DSM-IV and ICD-10. Self-report questionnaires such as DIP-Q will probably play an increasingly important role in future epidemiological studies.

scholarly journals DSM-IV personality disorders in Mexico: results from a general population survey

2008 ◽  
Vol 30 (3) ◽  
pp. 227-234 ◽  
Author(s):  
Corina Benjet ◽  
Guilherme Borges ◽  
Maria Elena Medina-Mora
Keyword(s):  
Personality Disorder ◽  
Personality Disorders ◽  
Multiple Imputation ◽  
Adult Population ◽  
The United States ◽  
Imputation Method ◽  
Axis I Disorders ◽  
Axis I ◽  
Dsm Iv ◽  
Multiple Imputation Method

OBJECTIVE: This paper reports the first population estimates of prevalence and correlates of personality disorders in the Mexican population. METHOD: Personality disorders screening questions from the International Personality Disorder Examination were administered to a representative sample of the Mexican urban adult population (n = 2,362) as part of the Mexican National Comorbidity Survey, validated with clinical evaluations conducted in the United States. A multiple imputation method was then implemented to estimate prevalence and correlates of personality disorder in the Mexican sample. RESULTS: Multiple imputation method prevalence estimates were 4.6% Cluster A, 1.6% Cluster B, 2.4% Cluster C, and 6.1% any personality disorder. All personality disorders clusters were significantly comorbid with DSM-IV Axis I disorders. One in every five persons with an Axis I disorder in Mexico is likely to have a comorbid personality disorder, and almost half of those with a personality disorder are likely to have an Axis I disorder. CONCLUSIONS: Modest associations of personality disorders with impairment and strong associations with treatment utilization were largely accounted for by Axis I comorbidity suggesting that the public health significance of personality disorders lies in their comorbidity with, and perhaps effects upon, Axis I disorders rather than their direct effects on functioning and help seeking.

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