Personality Diagnostic Questionnaire-Revised Research Articles

Personality disorders in a Dutch forensic psychiatric sample: changes with treatment

Evidence on the effectiveness of treatment for personality disorder (PD) is mixed, and there are very few data at all on outcomes for offender patients with PD. In the Netherlands there is nevertheless commitment to treating such people in specialized forensic psychiatric hospitals. The main aim was to determine the extent to which, if at all, patients detained under the Dutch TBS provision in the Dr Henri Van der Hoeven Hospital changed during inpatient treatment. The study followed a naturalistic design. On admission, the Structured Interview for DSM Personality Disorders (SIDP-R) and the Personality Diagnostic Questionnaire-Revised (PDQ-R) were used to assess DSM axis-II personality disorder pathology. After two years of intensive treatment they were reassessed using self-report questionnaires. Fifty-nine patients (54 men and five women) completed both ratings. At follow-up, group mean indicated a significant reduction in personality disorder pathology as measured by the PDQ-R. Analysis of changes in individual subjects according to a method described by Jacobson and Truax (1991) showed that almost 40% improved reliably (by more than two standard deviations) and more than one quarter of the sample improved to a reliable and clinically significant extent in personality disorder features. The findings of the study are encouraging in terms of reduction of personality disorder psychopathology. Limitations to the study design are acknowledged. Further, it is not known whether this change constitutes substantial reorganization of personality, or whether it reflects a change at a more superficial level. Further follow-up of the patients is necessary to investigate whether the positive changes remain after release from hospital.

The prevalence of borderline personality among primary care patients with chronic pain

This study was designed to explore the prevalence of borderline personality disorder among primary care patients (N=17) with various pain syndromes. All participants completed two self-report measures [Personality Diagnostic Questionnaire-Revised (PDQ-R); Self-Harm Inventory (SHI)] and a semi-structured interview [Diagnostic Interview for Borderlines (DIB)] for the assessment of borderline personality disorder. According to study measures, 8 (47.1%), 5 (29.4%), and 8 (47.1%) participants scored positively on the PDQ-R, SHI, and DIB, respectively. Nearly 25% of the sample scored positively on two measures, and 18% scored positively on all three measures. In this sample, the prevalence of BPD was substantial. Chronic pain may be a manifestation of a self-regulatory disturbance among some patients with BPD.

Obesity and borderline personality symptomatology: comparison of a psychiatric versus primary care sample.

This study explores the relationship between obesity and borderline personality symptomatology in two clinical settings: a psychiatric vs primary care setting. The body mass indices (BMI) of 48 women from a psychiatric outpatient setting and 83 women from a primary care setting were calculated. Each participant completed the borderline personality scale of the Personality Diagnostic Questionnaire-Revised (PDQ-R). While BMI and PDQ-R were moderately related in the psychiatric sample (r=0.43, P<0.01), there was a lack of association between these variables in the primary care sample (r=0.04, P>0.05). In conclusion, women's increasing body weight appears to have some degree of correlation to borderline personality symptomatology among psychiatric patients, whereas it apparently does not among primary care patients.

Perceptions of parents' health status and relationship to somatic preoccupation

Objectives: This study was designed to examine the potential relationship of family factors to somatic preoccupation. Method: A total of 116 internal medicine patients completed research booklets exploring perceptions of parents' health, childhood trauma, borderline personality symptomatology [Personality Diagnostic Questionnaire-Revised (PDQ-R)], and somatic preoccupation (Bradford Somatic Inventory). Results: Simple correlations revealed that most of the relationships between somatic preoccupation and remaining study variables were statistically significant (e.g., poor parental health status correlated to somatic preoccupation). Using path analysis, poor perception of mother's health demonstrated an indirect effect on somatic preoccupation via borderline personality symptomatology, whereas, poor perception of father's health demonstrated an indirect effect on somatic preoccupation via childhood trauma. Neither parents' health status demonstrated direct effects on somatic preoccupation. Conclusions: There appear to be parent gender differences in the mediation of the relationship between poor parental health status and somatic preoccupation in the offspring. The implications of these findings are discussed.

Patterns of self-harm behavior among women with borderline personality symptomatology: psychiatric versus primary care samples

The current study investigated differences in self-harm behavior among individuals with borderline personality symptomatology from two different clinical settings. Participants were women, between the ages of 18 and 45, from an outpatient mental health setting or a primary care setting. Each participant completed the Self-Harm Inventory (SHI) and the borderline personality scale of the Personality Diagnostic Questionnaire-Revised (PDQ-R). Using a predetermined cut-off for substantial borderline personality symptomatology on the SHI, group comparisons with χ 2 analyses indicated that “overdosed” and “hit self” were significantly more common in the mental health subsample whereas “abused laxatives” was significantly more common in the primary care subsample. Using a predetermined cut-off for borderline personality on the PDQ-R, chi-square analyses indicated that “overdosed” and “hit self” remained significantly more common in the mental health subsample. Despite these differences, there was remarkable similarity of symptoms between groups. The implications of these findings are discussed.

Personality disorders in patients in a day-treatment programme for eating disorders

The present study examined the prevalence of DSM-III-R personality disorders (PDs) and levels of depressive symptoms in patients in a day-hospital programme for eating disorders. Sixty-five patients diagnosed with anorexia nervosa and bulimia nervosa were administered the Personality Diagnostic Questionnaire Revised (PDQ-R), the Eating Disorder Inventory (EDI) and the Beck Depression Inventory (BDI). In total, 49.2 per cent of all patients had at least one PD diagnosis. No significant difference was found between patients with bulimia nervosa and anorexia nervosa. Eating Disorder patients with at least one PD had higher scores on the BDI and three EDI subscales compared to patients without a PD. In general, the prevalence of Personality Disorders in the present sample tended to be closer to results quoted by studies with eating-disordered outpatients rather than inpatients. Axis I disorders may affect personality state measures. Copyright © 2000 John Wiley & Sons, Ltd and Eating Disorders Association.

Obesity, borderline personality symptomatology, and body image among women in a psychiatric outpatient setting.

The purpose of this study was to examine the relationships among body weight, borderline personality symptomatology, and several measures of body image among women presenting for psychiatric evaluation. Forty-eight women in a university-based psychiatric outpatient clinic completed the borderline personality scale of the Personality Diagnostic Questionnaire-Revised (PDQ-R) and several measures of body image and indicated lifetime prevalence of depression histories. PDQ-R scores correlated (r = 0.44, p < 0.01) with body mass index (BMI). Also, there were significant relationships between PDQ-R scores and measures of body image even after controlling for BMI. In a psychiatric outpatient setting, borderline personality symptomatology is associated with higher body weight as well as body-image issues that are not necessarily due to larger body size.

The efficacy of the Personality Diagnostic Questionnaire-revised as a diagnostic screening instrument in an anxiety disorder group

The efficacy of the Personality Diagnostic Questionnaire - Revised (PDQ-R) as a screening instrument was examined in a sample of 137 anxious outpatients. The SCID-II was used as the criterion. The PDQ-R cut-offs were adjusted until the maximum kappa agreement for each scale was reached. The results showed that increasing the cut-offs decreased the number of false-positive diagnoses and only slightly increased the number of false-negative diagnoses. Inclusion of the PDQ-R as a screening instrument, followed by the SCID-II to verify the false-positive diagnoses appears to be a promising method for the categorical assessment of personality disorders. However, more studies are needed, using DSM-IV instruments to determine the optimal cutoffs. The following aspects should be considered as well: (1) the differences in prevalence rates of PDs, (2) the ability of the PDQ-R to differentiate between state and trait phenomena, (3) the consequences of the false-negative diagnoses and (4) the limited validity of the personality disorder definitions. Copyright (C) 1999 John Wiley Rr Sons, Ltd.

Prevalence of axis II comorbidity in bipolar patients with and without alcohol use disorders.

This study sought to determine the prevalence of comorbid personality disorder in euthymic bipolar I patients. Sixty-one outpatients were assessed using the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID II) and/or the Personality Diagnostic Questionnaire-Revised (PDQ-R). Thirty-eight percent of bipolar patients met criteria for an Axis II diagnosis based on the SCID II. Bipolar subjects with a history of comorbid alcohol use disorder were significantly more likely to have a SCID II diagnosis (52%) compared to those bipolar subjects without an alcohol use disorder history (24%). Cluster A diagnoses were significantly more common in the bipolar/alcohol use disorder group. The PDQ-R consistently overdiagnosed Axis II disorders, finding 62% of the overall bipolar group to have an Axis II diagnosis. Euthymic bipolar patients may have an increased rate of personality disorders, but much less so than previously reported in studies that did not take into account (1) current mood state, (2) comorbidity for an alcohol use disorder, and (3) instrument used for assessment of Axis II psychopathology.

Implicit and Self-Attributed Dependency Needs in Dependent and Histrionic Personality Disorders

Theorists speculate that dependent personality disorder (DPD) and histrionic personality disorder (HPD) are both associated with high levels of implicit (i.e., unconscious) dependency needs but speculate that only DPD is associated with high levels of self-attributed (i.e., conscious) dependency needs. To test this hypothesis, 444 undergraduates (236 women and 208 men) completed the Personality Diagnostic Questionnaire-Revised (PDQ-R), along with widely used measures of implicit dependency needs (the Rorschach Oral Dependency Scale; ROD), and self-attributed dependency needs (the Interpersonal Dependency Inventory; IDI). Correlational analyses and comparisons of IDI and ROD scores in participants scoring above and below the PDQ-R DPD and HPD thresholds supported theorists' speculations regarding implicit and self-attributed dependency needs in DPD and HPD. Implications of these results are discussed, and suggestions for future studies are offered.

The effect of sampling, diagnostic criteria and assessment procedures on the observed prevalence of DSM-III-R personality disorders among treated alcoholics.

OBJECTIVE. In a recent review of empirical studies on the prevalence of DSM-III-R personality disorders among substance abusers, wide ranges of prevalence rates for overall Axis II, antisocial personality disorder (APD) and borderline personality disorder (BPD) were shown. Utilizing subsamples from within a single study population, the current report explores the effect of sampling, diagnostic criteria and assessment procedures on the observed prevalence of DSM-III-R personality disorders among treated alcoholics. Personality disorders were assessed with the Personality Diagnostic Questionnaire Revised (PDQR) at two times of measurement (Time 1 n = 459; Time 2 n = 90). In addition, APD was measured with the Composite International Diagnostic Interview (CIDI; n = 587). Finally, an unselected subgroup (n = 136) was interviewed with the International Personality Disorder Examination (IPDE). There were few differences between inpatients or outpatients or between males and females. Using the IPDE, the exclusion of substance-related pathology did not affect the prevalence estimate. However, the prevalence rates according to the PDQR varied greatly across age groups. In a representative subsample (n = 109), the prevalence rates also varied greatly across assessment methods (PDQR, 52% vs IPDE, 31%). The prevalence estimate of APD according to the CIDI was related to setting, gender, age group and the applied time-frame. These findings indicate the examined factors to be necessary qualifiers of prevalence estimates and, consequently, support the use of a multiple-criteria/multimethod assessment battery in research as well as in clinical work.

DSM-III-R personality disorders in seasonal affective disorder: Change associated with depression

Forty-five patients with winter Seasonal Affective Disorder (SAD) completed the Personality Diagnostic Questionnaire-Revised (PDQ-R) in a depressed state before starting therapy (light or medication), and again 14 weeks later when the scores on the Montgomery Åsberg Depression Rating Scale (MADRS) had been reduced by an average of 74%. Prevalence and pattern of personality disorders (PDs) before treatment were similar to that found in patients with nonseasonal major depressive disorder (MDD) during a depressive episode. Number of categorical diagnoses were lower at follow-up for most PDs, but differences were not statistically significant. However, for dimensional scores (number of positive DSM-III-R criteria) significant changes were found for schizo-typal, histrionic, narcissistic, and obsessive-compulsive PD, and for total dimensional score in cluster B and total score for all PDs. These changes differ from findings in similar studies of outpatients with nonseasonal MDD. Whether this indicates a specific pattern of change for patients with SAD is discussed. Multiple regression analysis showed a significant association between changes in positive PD criteria between the depressed and nondepressed state and change in depression score. No significant relationship was found between changes in PD criteria and Global Seasonality Score (GSS), a measure reflecting the sum of ratings of seasonal variation in sleep length, social activity, mood, weight, appetite, and energy level.

Childhood abuse, alexithymia and personality disorder

I examined the relationships among childhood abuse, alexithymia, and personality disorder. Participants were 60 adults who were receiving outpatient psychotherapy. Both the participants and their therapists used the Toronto Alexithymia Scale to provide independently information concerning the client's level of alexithymia. The therapists provided information concerning DSM-III-R personality disorder diagnoses, and participants completed portions of the Personality Diagnostic Questionnaire—Revised. Information concerning childhood abuse history was obtained from the therapists. As expected, childhood abuse, alexithymia, and personality disorder were all associated with each other. The abilities to identify and communicate emotions were differentially associated with childhood abuse and personality disorder.

Patterns of personality disorder comorbidity in early-onset versus late- onset major depression

This study tested the hypothesis that in a population of adult outpatients with major depression, those with an early onset of depression would have a greater prevalence of personality disorders than those with a late onset of depression. The 404 subjects were patients participating in depression treatment studies at the Massachusetts General Hospital. They were administered the Structured Clinical Interview for DSM-III-R-Patient Version to assess the current presence of major depression and the age at onset of the initial depressive episode. The subjects were then divided into two groups: those with early onset (before 18 years of age) and those with late onset (at age 18 or later). The prevalence of personality disorders was determined through use of the physician-rated Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) and the patient-rated Personality Diagnostic Questionnaire-Revised (PDQ-R). The patients with early onset of major depression had a significantly higher prevalence of avoidant, histrionic, narcissistic, and borderline personality disorders according to the SCID-II. The PDQ-R scores indicated that avoidant, dependent, passive-aggressive, histrionic, narcissistic, borderline, and antisocial personality disorders were significantly more prevalent among the patients with early onset of major depression. Overall, the results are consistent with the view that early-onset depressive illness is distinguished from late-onset major depression by more frequent association with persistent disturbances in behaviors and attitudes.

The Effect of Fluvoxamine, Cognitive Therapy, and Placebo on Abnormal Personality Traits in 44 Patients with Panic Disorder

The authors report findings from 44 outpatients with panic disorder who completed an 8 week randomized trial of fluvox-amine (n = 17), cognitive therapy (n = 13), or placebo (n = 14). Subjects were given the Personality Diagnostic Questionnaire-Revised (PDQ-R) before and after the trial. Patients in the three treatment cells were well matched. Nearly 32% met criteria for a personality disorder at the baseline assessment, and there were no significant differences among the treatment groups. For the 3 groups combined, the total PDQ-R score had declined significantly by week 8 (p = .03). Of the 17 PDQ-R traits present in at least? of the sample, 82% showed a decline in the cognitive therapy cell, whereas 53% did not change in the fluvoxamine cell and 41% increased in the placebo cell. “Personality profiles” were created and showed that cognitive therapy was associated with the greatest reduction in abnormal traits, specifically those in the schizotypal, narcissistic, borderline, and compulsive categories. Axis II traits were relatively resistant to change with placebo or fluvoxamine. The clinical implications of the findings are discussed.

A Modwied Scoring Algorithm for the PDQ-R: Psychiatric Symptomatology and Substance Use in Adolescents with Personality Disorders

A study was conducted to investigate the extent to which adolescents diagnosed with one or more personality disorders on a self-report instrument are at an elevated risk for psychiatric symptomatology and psychoactive substance abuse. A modified version of the Personality Diagnostic Questionnaire-Revised (PDQ-R), the Revised Hopkins Symptom Checklist (SCL-90-R), and a standard retrospective substance use diary were administered to 441 undergraduate students, 181 and 166 of whom participated in 1- and 2-month follow-up sessions at which the SCL-90-R and the substance use diary were read ministered. Results were that (a) personality disorder prevalence estimates produced by the modified PDQ-R approximated those obtained by previous researchers who have administered structured clinical interviews to general community samples; and (b) individuals diagnosed with one or more personality disorders by the modified PDQ-R manifested higher levels of psychiatric symptomatology and substance use at both baseline and follow-up than did nondiagnosed subjects.

Correspondence between Students' Scores on the Millon Clinical Multiaxial Inventory-II and Personality Diagnostic Questionnaire-Revised

The relation between two measures of personality disorders was examined in a nonclinical sample of 113 college students (86 women, 27 men) who completed the Millon Clinical Multiaxial Inventory-II and the Personality Diagnostic Questionnaire-Revised. Raw scores for 10 of 11 corresponding scales on the two instruments were significantly correlated (median r = .49). Compared to Millon's inventory, the Personality Diagnostic Questionnaire-Revised designated more subjects as having eccentric personality disorders but fewer as having anxious personality disorders. The significant association between scores on the inventories suggests that they assess personality traits that vary continuously in nonclinical samples. However, the finding that they differ significantly in their assignment of clinical labels shows that they should not be used to diagnose personality disorders in nonclinical populations.

Personality Disorder Symptomatology Associated with Adolescent Depression and Substance Abuse

A study was conducted to investigate the extent to which adolescent depression and substance abuse are associated with personality disorder symptomatology. The Personality Diagnostic Questionnaire—Revised (PDQ-R), the Revised Hopkins Symptom Checklist (SCL-90-R), and a standard retrospective substance use diary were administered to 441 undergraduate students, 166 of whom completed the substance use diary at baseline, with readministrations 1 and 2 months later. Results indicated that: (1) Depressed adolescents reported significantly greater symptomatology on the PDQ-R antisocial, avoidant, borderline, paranoid, passive-aggressive, schizotypal, and composite scales than did nondepressed adolescents, even after global psychiatric symptomatology was controlled statistically. (2) Heavy users of alcohol, marijuana, and/or tobacco reported significantly greater symptomatology on the PDQ-R antisocial, borderline, and composite scales than did adolescents in a comparison group, after global psychiatric symptomatology was controlled statistically. (3) Adolescents diagnosed with personality disorders were 10 times as likely as those without personality disorders to be identified as depressed cases and were more than twice as likely as those without personality disorders to be heavy users of alcohol, marijuana, and/or tobacco.

The Relationship of Obesity to Borderline Personality Symptomatology, Self-Harm Behaviors, and Sexual Abuse in Female Subjects in a Primary-Care Medical Setting

Two groups of females in a primary-care medical setting were assessed: those 50 pounds or more overweight presenting for any medical service (n = 61) and normal-weight women presenting for PAP smears (n = 89). Subjects completed a weight history, sexual abuse questionnaire, self-harm behavior questionnaire, and the Borderline Personality Subscale of the Personality Diagnostic Questionnaire—Revised (PDQ-R). Obese subjects were also administered the Diagnostic Interview for Borderlines (DIB). The prevalence of borderline symptomatology in obese subjects was 7% on the DIB and 25% on the PDQ-R. For the entire sample (N = 194), subjects' highest weight ever and current weight were significantly positively correlated with a history of sexual abuse, endorsements of selected self-harm behaviors, and PDQ-R borderline scores.

Personality Disorder Scales for the MMPI-2: An Assessment of Psychometric Properties in a Correctional Population

This study assessed the psychometric properties of the MMPI-2 personality disorder scales in a correctional sample (N = 85). Reliability, as assessed by Cronbach's alpha, was moderate to high for the overlapping scales and comparable to the original scales from a previous study. Three components emerged from a principal components analysis that were not convergent with DSM-III-R clusters but were consistent with component structures from previous investigations. With the scales on the Personality Diagnostic Questionnaire—Revised (PDQ-R) as the criterion variables, convergent validity was supported for all scales with the exception of the Compulsive scale. Divergent validity was modest, with scales in the DSM-III-R “dramatic” cluster performing best.