Face validity of the DSM-III-R personality disorders

Article Abstract:

The Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R) contains standard guidelines and criteria for diagnosing mental and emotional disorders. More often than not, a patient will meet the criteria for more than one personality disorder. There are many correlations between the personality disorders diagnosed with the DSM. This overlap may be higher with the revised edition of the DSM than earlier versions. In this study, 29 psychiatrists and 32 psychologists were given a list of the 142 diagnostic criteria and the 13 personality disorders diagnosed by the DSM-III-R. They were asked to code each criterion according to the disorder it was associated with, to learn which criteria clinicians associate with each diagnostic category. Only 52 of the 142 criteria were assigned to the correct disorders by at least 80 percent of the clinicians, and 10 criteria were consistently assigned to the wrong disorder. Another 27 criteria were misassigned by at least half of the clinicians. Overall, these clinicians correctly assigned two-thirds of the 142 criteria to their correct diagnosis. They found no significant difference in ratings between psychologists and psychiatrists. Three pairs of disorders had high levels of overlap; avoidant/dependent, histrionic/narcissistic, and paranoid/schizotypal. The histrionic, obsessive-compulsive and passive-aggressive criteria also had high overlap with the narcissistic category, suggesting that narcissism is a significant general component of other disorders. The histrionic and avoidant disorders had a low level of criteria recognition, suggesting the need for redefinition by the DSM. Clinicians also generally failed to recognize poor parental and work behavior as criteria for antisocial personality disorder.

Criticism and interpretation, Diagnostic and Statistical Manual of Mental Disorders (Book)

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Diagnosing personality disorders in recent-onset schizophrenia

Article Abstract:

Several personality characteristics have been identified that have been associated with the development of schizophrenia. Among these are schizoid, paranoid and borderline personality disorders. The validity of the hypothesis that there is an association between these personality types and the development of schizophrenia has been questioned. To further investigate this relationship, the prevalence of personality disorders was examined in a sample of patients with recent-onset schizophrenia. The Structured Interview for DSM-III Personality (SIDP) and the Millon Clinical Multiaxial Inventory (MCMI-I) were used to assess 40 patients recently diagnosed with schizophrenia. Both the personality characteristics of the subjects and reliability of the two tests for diagnosis were compared and analyzed. The results of the SIDP indicated that 58 percent of the subjects had a personality disorder; the MCMI-I indicated that 70 percent of the subjects had at least one personality disorder. According to the SIDP, the most frequently observed personality disorders were antisocial, borderline, and schizotypal disorders. The MCMI-I indicated that dependent, narcissistic, and avoidant personality disorders were the most common among these subjects. Agreement was found when the trait scores obtained for these subjects by each test were compared, but the assignment of diagnosis based on the results of the tests did not agree. This supports the contention that diagnosis of schizophrenia based on personality types other than schizoid is not reliable. Possible explanations for the different findings of these two instruments are discussed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Testing, Schizophrenia

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The family resemblance hypothesis applied to psychiatric classification

Article Abstract:

An alternative method of classifying personality disorders has recently been advocated. The new method establishes clusters of features for each category of disorder. The more features a patient possesses, the more closely the patient fits the category. Previous studies have had mixed results in applying this method to the classification of psychiatric disorders. The method was evaluated by examining the relationship between agreement among different diagnosticians and the number of features in prototypes of personality disorder cases. It was concluded that closeness of fit to a category indeed increases with the number of characteristics the patient shares with the category. However, it was not true that closeness of fit declined with increases in the number of additional patient features not in the category.

Identification and classification, Psychology, Pathological, Psychopathology, Categorization (Psychology)

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