Evaluation of DSM-IV personality disorder criteria as assessed by the structured clinical interview for DSM-IV personality disorders

The factor structure of the DSM-III-R personality disorders: an evaluation of competing models

Confirmatory factor analysis was used to test a series of competing models to determine the best way to characterize the factor structure of the DSM-III-R personality disorder scores. Data were collected from 301 clients with a primary diagnosis of anxiety disorder. The Structured Clinical Interview for DSM-III-R (SCID) was used to determine Axis I and Axis II diagnoses, and adequate to good reliability was obtained for the number of criteria met for a given personality disorder. Several factor models were tested, including a single-factor model, a three-factor model based on the DSM grouping of odd, dramatic, and anxious personality disorders, and a four-factor model based on normal personality theories. Only the DSM three-factor model received strong and unequivocal support.

Factorial structure and diagnostic efficiency of DSM-IV criteria for avoidant personality disorder in patients with binge eating disorder

This study examined the factorial structure and diagnostic efficiency of the DSM-IV criteria for avoidant personality disorder (AVPD). Two hundred and twenty-eight consecutive outpatients (181 females and 47 males) with a primary diagnosis of binge eating disorder were reliably assessed with diagnostic interviews. Internal consistency of AVPD criteria was good, as suggested by coefficient alpha of 0.87, the pattern of inter-item correlations (range 0.41 to 0.64), and the lack of changes in alpha if any criteria are deleted. Exploratory factor analysis revealed a one-factor solution (56% of variance) supporting the unidimensionality of the AVPD criteria. Diagnostic efficiency indices (conditional probabilities, total predictive power, and kappa coefficients) were calculated for each AVPD criterion, for the entire study group and separately by gender. Overall, the best inclusion criterion was 'fears being ridiculed,' which was also the best predictor overall. These psychometric findings did not differ by gender. The findings support certain important aspects of the AVPD diagnosis.

Mood patterns and variations associated with personality disorder pathology

This study examined mood and mood variation in relation to varying forms and degrees of personality disorder (PD) pathology. Mood experiences of 98 psychotropic medication-free individuals were repeatedly assessed over a 4-day period. Persons with PDs (n = 57) generally displayed neutral to moderately positive moods; however, overall mood valence was less positive when compared to those without PDs (n = 41). Mood ratings demonstrated moderate covariations with anxious-fearful (A-F) PD traits but little or no association with erratic-emotional-dramatic (E-D) and odd-eccentric (O-E) PD traits once common variance among PD dimensions was removed. For PD diagnostic categories, the presence of avoidant and/or depressive PDs was most strongly associated with negative mood. When dimensional scores based on specific PD trait features were considered, avoidant, depressive, borderline, passive-aggressive, obsessive-compulsive, dependent, paranoid, and schizoid PD traits demonstrated the most reliable associations with negative mood. Apart from borderline PD features, traits associated with other E-D cluster PDs displayed little or no associations with mood quality. Consistent with previous research, mood variability emerged as an internally consistent and stable individual difference variable. Mood variability, however, was not generally associated with PD diagnostic categories or traits. Implications of this study's findings are considered in relation to the conceptual modeling of PDs.

Longitudinal diagnostic efficiency of DSM-IV criteria for obsessive-compulsive personality disorder: a 2-year prospective study

OBJECTIVE

To examine the longitudinal diagnostic efficiency of the DSM-IV criteria for obsessive-compulsive personality disorder (OCPD).

METHOD

At baseline, criteria and diagnoses were determined using diagnostic interviews, and blinded assessments were performed 24 months later with 550 participants. Diagnostic efficiency indices (conditional probabilities, total predictive power, and kappa) were calculated for each criterion determined at baseline, using the independent OCPD diagnosis at follow-up as the standard.

RESULTS

Longitudinal diagnostic efficiencies for the OCPD criteria varied; findings suggested the overall predictive utility of 'preoccupied with details', 'rigid and stubborn', and 'reluctant to delegate'.

CONCLUSION

These findings suggest the predictive validity of three cognitive-interpersonal OCPD criteria.

Diagnostic efficiency of DSM-IV criteria for obsessive compulsive personality disorder in patients with binge eating disorder

This study examined the diagnostic efficiency of the DSM-IV criteria for obsessive compulsive personality disorder (OCPD) in patients with binge eating disorder (BED). Two hundred and eleven consecutive adult patients with axis I diagnoses of BED were reliably assessed with semi-structured diagnostic interviews. Conditional probabilities-sensitivity, specificity, positive predictive power (PPP), and negative predictive power (NPP)-were calculated for each of the eight criteria for OCPD, using the 'best-estimate' OCPD diagnosis as the standard. The diagnostic efficiencies of the OCPD criteria were variable, with three criteria failing to have predictive value (PPP<0.50). The best inclusion criterion (highest PPP) was 'Perfectionism,' which was also the overall most predictive criterion. The findings suggest ordering of the DSM-IV criteria for OCPD based on performance and call into question the utility of some criteria.