Iowa Personality Disorder Screen Research Articles

Personality disorder coverage, prevalence, and convergence: do the DSM-5's two models of personality disorder identify the same patients?

Research on the Alternative DSM-5 Model for Personality Disorders (AMPD) in DSM-5's Section-III has demonstrated acceptable interrater reliability, a largely consistent latent structure, substantial correlations with theoretically and clinically relevant measures, and evidence for incremental concurrent and predictive validity after controlling for DSM-5's Section II categorical personality disorders (PDs). However, the AMPD is not yet widely used clinically. One clinician concern may be caseness - that the new model will diagnose a different set of PD patients from that with which they are familiar. The primary aim of this study is to determine whether this concern is valid, by testing how well the two models converge in terms of prevalence and coverage. Participants were 305 psychiatric outpatients and 302 community residents not currently in mental-health treatment who scored above threshold on the Iowa Personality Disorder Screen (Langbehn et al., ). Participants were administered a semi-structured interview for DSM-5 PD, which was scored for both Section II and III PDs. Convergence across the two PD models was variable for specific PDs, Good when specific PDs were aggregated, and Very Good for 'any PD.' Results provide strong evidence that the AMPD yields the same overall prevalence of PD as the current model and, further, identifies largely the same overall population. It also addresses well-known problems of the current model, is more consistent with the ICD-11 PD model, and provides more complete, individualized characterizations of persons with PD, thereby offering multiple reasons for its implementation in clinical settings.

Management of Psychiatric Disorders in Patients with Stroke and Traumatic Brain Injury.

Management of Psychiatric Disorders in Patients with Stroke and Traumatic Brain Injury.

The Iowa Personality Disorder Screen: A validation study in a psychiatric population that receives long-term group psychotherapy for personality related problems.

Personality disorder (PD) is common among psychiatric patients, and diagnosing such disorders is of great importance for the choice of treatment. Diagnosing PD is a demanding and time-consuming process. The utilities of several PD screening instruments have been studied in different populations, but not in a population who receives long-term group psychotherapy. In the current study, we investigate the predictive properties of the Iowa Personality Disorder Screen (IPDS) in a sample of 694 psychiatric outpatients with and without PD who were admitted for psychodynamic long-term group therapy from 2012 to 2014. The definitive, reference diagnoses were defined according to the SCID-II, by which 484 patients (68%) warranted a PD diagnosis. The IPDS correctly classified 67.4 percent of all participants. Sensitivity (0.75) and specificity (0.51) were lower than in previous validation studies of IPDS. We discuss possible explanations related to the general concept of PD and, more specifically, to our study sample. Because of the weaker predictive properties of IPDS, we advise caution in use of the IPDS in similar clinical settings. Copyright © 2018 John Wiley & Sons, Ltd.

Testing relationships between DSM-5 Section III maladaptive traits and measures of self and interpersonal impairment in Italian community dwelling adults.

In order to study the relationships between DSM-5 Section III maladaptive personality traits and personality dysfunction, 312 Italian community dwelling adults completed the Italian translations of the Personality Inventory for DSM-5 (PID-5) and the Measure of Disordered Personality Functioning Scale (MDPF); participants were also administered the Iowa Personality Disorder Screen (IPDS). Consistent with previous findings, 22 (88.0%) PID-5 maladaptive trait scales showed moderate and significant correlations with MDPF Non Coping (median r value = .32), and Non Cooperativeness, (median r value = .24) scales. Regression analyses showed that PID-5 trait scales explained roughly 59% and 35% of the variance in MDPF Non Coping and Non Cooperativeness scales, respectively. PID-5 traits were significantly associated also with the IPDS total score, adjusted R2 = .45, p < .001. As a whole, our data seemed to indicate that the wide majority of the PID-5 scales showed significant relationships of at least moderate size with a self-report measure of personality dysfunction, lending further support to the criterion validity of the PID-5. (PsycINFO Database Record

A Head-to-Head Comparison of the Personality Inventory for DSM-5 (PID-5) With the Personality Diagnostic Questionnaire-4 (PDQ-4) in Predicting the General Level of Personality Pathology Among Community Dwelling Subjects.

In order to evaluate if measures of DSM-5 Alternative PD Model domains predicted interview-based scores of general personality pathology when compared to self-report measures of DSM-IV Axis II/DSM-5 Section II PD criteria, 300 Italian community adults were administered the Iowa Personality Disorder Screen (IPDS) interview, the Personality Inventory for DSM-5 (PID-5), and the Personality Diagnostic Questionnaire-4+ (PDQ-4+). Multiple regression analyses showed that the five PID-5 domain scales collectively explained an adequate rate of the variance of the IPDS interview total score. This result was slightly lower than the amount of variance in the IPDS total score explained by the 10 PDQ-4+ scales. The PID-5 traits scales performed better than the PDQ-4+, although the difference was marginal. Hierarchical regression analyses revealed that the PID-5 domain and trait scales provided a moderate, but significant increase in the prediction of the general level of personality pathology above and beyond the PDQ-4+ scales.

Screening for personality disorder in drug and alcohol dependence

Comorbidity of personality disorders in addiction is common, and there is a need for efficient detection methods. This study describes the use of two quick screening instruments: the self-reported versions of the Iowa Personality Disorder Screen (IPDS-SR) and the Standardised Assessment of Personality Abbreviated Scale (SAPAS-SR). The sample included 53 inpatients dependent on alcohol and/or drugs, with a 42% prevalence of any DSM-IV personality disorder. The Personality Assessment Schedule (PAS) was used as gold standard. Receiver-Operant-Characteristic (ROC) was used for analysis. The Area Under the Curve for the IPDS-SR was 0.84 (95% CI 0.72–0.93) and for the SAPAS-SR was 0.82 (95% CI 0.70–0.93). An IPDS-SR score of 5 or more correctly classified 77.4% of patients, with a sensitivity of 86.4% and a specificity of 71%. A SAPAS-SR score of 4 or more correctly classified 73.6% of patients, with a sensitivity of 81.8% and a specificity of 67.7%. Both instruments were quick, easy to administer, and acceptable to use by this population. They can be implemented in routine clinical practice in busy substance misuse departments. However further research into the implications of positive screenings is required.

The Psychometric Properties of the Iowa Personality Disorder Screen in Methadone-Maintained Patients: An Initial Investigation

The psychometric properties of the Iowa Personality Disorder Screen (IPDS) were examined in 150 methadone-maintained patients who completed measures of demographic, psychopathology, substance use, pain, and methadone maintenance treatment (MMT) characteristics. An exploratory factor analysis revealed a two-factor solution that explained 45% of the scale variance. The first factor captured internalizing tendencies, such as inhibition and hypersensitivity to others. The second factor comprised externalizing tendencies, such as impulsivity and insensitivity to others. The IPDS item subsets, derived factors, and the total score were significantly related to race/ethnicity but not sex. The effects of race/ethnicity were controlled statistically when the IPDS was compared to other measures of psychopathology, self-reported substance use, pain variables, and MMT characteristics. In general, the IPDS appears to be reliable and valid for use with methadone-maintained patients. The two-factor structure found in this study may have clinical utility and merits further investigation in other MMT samples.

Results of the Search for Personality Disorder Screening Tools

To examine the characteristics, validity, posttest probabilities, and screening capabilities of 8 different instruments used to predict personality disorders. Screening instruments were examined in 3 prospective, observational, test-development studies in 3 random samples of Dutch psychiatric outpatients, using the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II) as the "gold standard." The studies were performed from March 2004 to March 2005 (study 1: N = 195, mean age = 32.7 years), October 2006 to January 2007 (study 2: N = 79, mean age = 34.3 years), and January 2008 to October 2009 (study 3: N = 102, mean age = 33.7 years). The following 8 assessment instruments were examined: 3 short questionnaires (a self-report form of the Standardized Assessment of Personality-Abbreviated Scale [SAPAS-SR], the self-report Iowa Personality Disorder Screen [IPDS], and a short self-report version of the SCID-II [S-SCID-II]); 2 longer questionnaires (the self-report SCID-II Personality Questionnaire [SCID-II-PQ] and the NEO Five-Factor Inventory [NEO-FFI]); 1 short semistructured interview (the Quick Personality Assessment Schedule [PAS-Q]); and 2 informant-based interviews (the Standardized Assessment of Personality [SAP] and the Standardized Assessment of Personality-Abbreviated Scale for Informants [SAPAS-INF]). The SCID-II rate of identification of personality disorders in the 3 studies was between 48.1% and 64.1%. The SAPAS-SR, the IPDS, and the PAS-Q had the best sensitivity (83%, 77%, and 80%, respectively) and specificity (80%, 85%, and 82%, respectively). Moreover, these 3 instruments correctly classified the largest number of patients. Using the SAPAS-SR, the IPDS, or the PAS-Q raises the odds from 50% to between 80% and 84% that a patient in a psychiatric outpatient population will receive a personality disorder diagnosis. The results provide evidence for the usefulness of the SAPAS-SR, IPDS, and PAS-Q instruments for personality disorder screening. Because the PAS-Q takes a longer time and requires qualified personnel to administer it, we recommend use of the SAPAS-SR or the self-report version of the IPDS.

Avoidant personality problems—their association with somatic and mental health, lifestyle, and social network. A community-based study

AimThe aim of the study was to explore the associations between the presence of avoidant personality problems (APPs) and 5 areas of impairment: demography, somatic issues, mental health, lifestyle, and social issues. MethodsAvoidant personality problem was defined by confirmation of the 2 avoidant personality disorder items of the Iowa Personality Disorder Screen and and the Social Phobia Inventory (SPIN) short version (MINI-SPIN) screening assessment for generalized social anxiety disorder sum score of 6 or more. The questionnaires were administered in a Norwegian population survey (the Oslo Health Study-HUBRO). Cases consisted of 280 individuals with APP and 5 randomly selected controls without APP (n = 1400). ResultsThe APP group more frequently reported living alone, lower level of education, and lower income than controls. Poor self-rated health, presence of somatic disease, muscular pain, frequent use of analgesics, and visits at a general practitioner were significantly more common in the APP group than among controls. The APP group had significantly higher proportion of caseness of mental distress, low general self-efficacy, and insomnia, and this result held up in multivariate analyses. The APP group showed statistically significant higher proportions of physical inactivity, obesity, daily smoking, and alcohol problems compared with controls. As for social impairment, a significantly higher proportion of the APP group reported “not having enough good friends,” “high powerlessness,” and low community activism, and the 2 former variables held up in multivariate analyses. ConclusionIn this population-based study, we found that high levels of APP, defined closely to avoidant personality disorder, were significantly associated with demographic, somatic, and mental impairment; low general self-efficacy; and insomnia affecting work ability. In addition, APP showed associations with negative lifestyle, alcohol problems, and social impairment reporting lack of good friends and lack of empowerment. Avoidant personality problem is associated with clinically significant impairment in several areas, which underlines the importance of recognizing these problems in primary health care.

A cross-sectional testing of The Iowa Personality Disorder Screen in a psychiatric outpatient setting

BackgroundPatients suspected of personality disorders (PDs) by general practitioners are frequently referred to psychiatric outpatient clinics (POCs). In that setting an effective screening instrument for PDs would be helpful due to resource constraints. This study evaluates the properties of The Iowa Personality Disorder Screen (IPDS) as a screening instrument for PDs at a POC.MethodsIn a cross-sectional design 145 patients filled in the IPDS and were examined with the SCID-II interview as reference. Various case-findings properties were tested, interference of socio-demographic and other psychopathology were investigated by logistic regression and relationships of the IPDS and the concept of PDs were studied by a latent variable path analysis.ResultsWe found that socio-demographic and psychopathological factors hardly disturbed the IPDS as screening instrument. With a cut-off ≥4 the 11 items IPDS version had sensitivity 0.77 and specificity 0.71. A brief 5 items version showed sensitivity 0.82 and specificity 0.74 with cut-off ≥ 2. With exception for one item, the IPDS variables loaded adequately on their respective first order variables, and the five first order variables loaded in general adequately on their second order variable.ConclusionOur results support the IPDS as a useful screening instrument for PDs present or absent in the POC setting.

P02-423 - How to choose the best screening instrument for personality disorder for your specific practice

IntroductionPersonality disorders (PD) are common in psychiatric services and can adversely affect the management and outcome of mental illnesses. Therefore assessment of the personality is an essential part of initial psychiatric examination. To diagnose a PD takes time and competence. A screening instrument in the diagnostic phase can be a solution.AimThe goal of the study was to provide clinicians a powerful screening tool for personality disorders that is ‘quick and dirty’.MethodNine screening instruments were studied in a prospective, observational, test development study with a random sample of Dutch psychiatric outpatients, using the SCID-II as the gold standard. There were three short questionnaires (Standardized Assessment of Personality- Abbreviated Scale (SAPAS), Iowa Personality Disorder Screen (IPDS), Short version of the SCID-II), three longer questionnaires (the SCID-II Personality Questionnaire, the NEO Five-Factor Inventory (NEO-FFI), Inventory of Interpersonal Problems (IIP-PD/C;) one short semi structured interview (Quick Personality Assessment Schedule (PAS-Q.) and two informant interviews (Standardised Assessment of personality (SAP), the Standardized Assessment of Personality- Abbreviated Scale for informants (SAPAS-INF)) involved.ResultsThe three short questionnaires and the semi structured interview were very useful for determining the presence/absence of PD. The other instruments can be used in particular situations for example to determine a specific PD or if the patient is not able to accomplish the test.ConclusionBefore deciding which screening instrument for PD is the best for your practice, you have to consider psychometric values as well as practical circumstances.

The Iowa Personality Disorder Screen

The internal consistency, test-retest reliability, and predictive validity of the Iowa Personality Disorder Screen (IPDS) as a screening instrument for personality disorders (PDs) were studied in 195 Dutch psychiatric outpatients, using the SCID-II as the gold standard. All patients completed a self-administered version of the IPDS. Internal consistency was moderate (0.64), and the test-retest reliability was good (0.87). According to the SCID-II, 97 patients (50%) had at least one personality disorder (PD). The IPDS correctly classified 81.0 percent of all participants in the category PD present/absent. The sensitivity and specificity were 77% and 88%, respectively. Positive and negative predictive values were 83% and 79%. Test-retest reliability after a 2-week interval was 0.87. These results are comparable with those reported in earlier studies with respect to the interview version of the IPDS and more promising than previously reported results obtained with a self-report version of the IPDS. Therefore, it is concluded that a self-report version of the IPDS may be useful as a screening measure for determining the presence/absence of PD in a population of psychiatric outpatients.

Personality problems are considerably associated with somatic morbidity and health care utilisation

Purpose To explore the associations between the presence of personality problems and somatic morbidity and health care utilisation. Methods The Iowa Personality Disorder Screen was administered in order to identify persons with personality problems in a Norwegian population survey (the Oslo Health Study – HUBRO). Cases consisted of 369 individuals, 30, 40 and 45 years of age with personality problems matched on age and gender with five controls each. Data on somatic morbidity and health care utilisation were collected by questionnaires. Results The cases more frequently reported persistent muscular pain, asthma, fibromyalgia and alcohol problems than the controls. They also more often used nonprescribed analgesics and antidepressants. The cases more frequently had consulted a general practitioner (GP) in the last 12 months, less frequently got referral to somatic specialist care and were less satisfied with their last visit to a GP. Conclusion In this population based study, personality problems in young adults based on DSM-IV personality disorder criteria were associated with increased occurrence of somatic morbidity and primary health care utilisation. The relevance for GP to take personality problems into account during consultations is underlined and a method for doing so is suggested.

Screening for Personality Disorders

A brief but valid self-report measure to screen for personality disorders (PDs) would be a valuable tool in making decisions about further assessment and in planning optimal treatments. In psychiatric and nonpsychiatric samples, we compared the validity of three screening measures: the PD scales from the Inventory of Interpersonal Problems, a self-report version of the Iowa Personality Disorder Screen, and the selfdirectedness scale of the Temperament and Character Inventory. Despite their different theoretical origins, the screeners were highly correlated in a range from .71 to .77. As a result, the use of multiple screeners was not a significant improvement over any individual screener, and no single screener stood out as clearly superior to the others. Each performed modestly in predicting the presence of any PD diagnosis in both the psychiatric and nonpsychiatric groups. Performance was best when predicting a more severe PD diagnosis in the psychiatric sample. The results also highlight the potential value of multiple assessments when relying on self-reports.

Diagnostic efficiency of the Iowa personality disorder screen items in a nonclinical sample.

The diagnostic efficiency of the 11-item Iowa Personality Disorder Screen (IPDS; Langbehn et al., 1999) was evaluated in a nonclinical sample of young adults, 35% of whom met DSM-III-R criteria for a personality disorder, in a retrospective analysis of SIDP-R data. Results indicated that two IPDS item sets (i.e., combinations of items) produced hit rates of more than 80% along with good sensitivity, specificity, positive predictive power, and negative predictive power. Combined with the findings of Langbehn et al. (1999), these results suggest that the IPDS may be useful as a screening measure for personality disorder in both clinical and nonclinical populations.

The Iowa Personality Disorder Screen: development and preliminary validation of a brief screening interview.

The length and expense of comprehensive personality disorder interviews makes them unwieldy for routine use. A brief but sensitive screen could eliminate administration of longer instruments in many instances. We describe the development of the Iowa Personality Disorder Screen (IPDS)--a mini-structured interview which can be completed in less than 5 minutes. Retrospective analyses using 1,203 SIDP-R interviews suggested that the IPDS items should provide good sensitivity and specificity. We present results from a prospective validation study, using a mixed group of 52 nonpsychotic inpatients and outpatients who were diagnosed using the SIDP-IV. Blind administration of the IPDS yielded excellent sensitivity (92%) and good specificity (79%), using a subset of five screening items. Addition of two more items leads to an estimated sensitivity of 79% and specificity of 86%. The IPDS shows promise as a quick personality disorder screen for use in research settings or standard clinical interviews.