Stability and change of DSM-III-R personality disorder dimensions in adolescents followed up 2 years after psychiatric hospitalization

Abstract

We examined the stability of DSM-III-R personality disorder dimensions in a clinical sample of adolescents. Sixty adolescent inpatients were reliably assessed with the Personality Disorder Examination (PDE) soon after admission to the Yale Psychiatric Institute, and were independently reassessed with the same instrument 2 years following discharge. PDE symptom ratings were summed to create dimensional scores for each personality disorder. To assess the dimensional stability of personality disorders, intraclass correlation coefficients (ICCs) were computed. To assess the magnitude of the difference between baseline and follow-up scores, paired t tests were used. Significant ICCs were observed for histrionic, narcissistic, dependent, obsessive-compulsive, and passive-aggressive personality disorders. Compared to baseline, dimensional scores for most personality disorders were significantly lower at follow-up—and none was significantly higher. Diagnostic stability is a key defining feature of personality disorders. We observed low-to-moderate stability for dimensional measures of personality dysfunction in adolescents—suggesting that previous reports of modest personality disorder stability in this age group cannot be attributed solely to limitations of the categorical approach to such pathology. Alternatively, our findings may be viewed as consistent with reports in the adult literature that personality disorders may improve over time, and can potentially benefit from treatment.