Personality Disorder Not Otherwise Specified Research Articles

Personality disorder not otherwise specified heterogeneity and its implication in psychiatric residential treatment

IntroductionVilla Ratti is a therapeutic community dedicated to the treatment of Personality Disorder with a particular focus on Borderline Personality Disorder (BPD), but this diagnosis may manifest in very different clinical conditions (Bayer & Parker, 2017; Scott, 2017).Objectives Since the second most common diagnosis we encounter from referring psychiatrists is Personality Disorder Not Otherwise Specified (PDNOS) (26,4%) and this diagnosis serves sometimes as a skeleton key for complex or unclear diagnostic scenarios (Verheul & Widiger, 2004), our main goal is to investigate how the variability within this category is reflected in terms of diagnostic accuracy, different development of the therapeutic and rehabilitative course, and of different outcomes at the end of the treatment.MethodsTo reach this goal, we collected data on all patients referred with a PDNOS diagnosis and compared their treatment program. scenarios.ResultsOur data showed how a PDNOS diagnosis hid in most cases complex personality disorders and comorbidities that reflected different specific difficulties and interventions during their treatment and, consequently, resulted in different outcomes.ConclusionsOur experience led us to give additional attention to referred PDNOS diagnosis and to observe how much a clear diagnostic picture of a patient is crucial to correctly plan a treatment program and adapt local service interventions both for personality disorder and comorbidity

Demographic and Clinical Characteristics of Military Service Members Hospitalized Following a Suicide Attempt versus Suicide Ideation.

Psychiatric hospitalization for a suicide attempt (SA), rather than suicide ideation (SI) alone, is a stronger risk indicator for eventual suicide death. Yet, little is known about demographic and clinical characteristics differentiating those admitted for SA versus SI. Understanding these differences has implications for assessment and treatment. A retrospective review of electronic medical records (EMRs) was performed on service members (n = 955) admitted for SA or SI at the Walter Reed Army Medical Center between 2001–2006. Service members hospitalized for SA were younger compared to those hospitalized for SI. The proportion of women admitted for SA was significantly higher than those admitted for SI whereas their male counterparts showed the opposite pattern. Patients admitted for SA, versus SI, had significantly higher prevalence of adjustment disorder with mixed disturbance of emotion and conduct (MDEC), personality disorder not otherwise specified (PDNOS), and borderline personality disorder (BPD). Patients admitted for SI had significantly higher prevalence of adjustment disorder with depressed mood and deferred Axis II diagnosis, compared to those admitted for SA. There were no significant between-group differences in the average or median number of documented prior suicide attempts. Findings highlight the need for more standardized assessment, diagnostic decision-making, and documentation practices for all patients.

Adverse Effects of Outcome Monitoring Feedback in Patients With Personality Disorders: A Randomized Controlled Trial in Day Treatment and Inpatient Settings.

This study aimed to evaluate the differential effect of outcome monitoring feedback to therapists and to patients on outcomes in cluster B, cluster C, and personality disorder not otherwise specified (PD-NOS) patients. Day treatment patients (n = 112) and inpatients (n = 94) were randomly assigned to a feedback to therapist (FbT), feedback to therapist and patient (FbTP), or no feedback (NFb) condition. Feedback was based on weekly administrations of the Outcome Questionnaire-45 (OQ-45). In cluster B and PD-NOS patients FbTP resulted in increased OQ-45 scores during the first 6 months of therapy for not on track (NOT) patients. In cluster C patients, no adverse effects of feedback were found. These results suggest that for certain personality disorder patient groups, providing feedback during treatment may not always be beneficial, although more research is needed to further assess these effects.

Personality disorder–not otherwise specified evidence of validity and consideration for DSM-5

Personality disorder–not otherwise specified (PD-NOS) has received little study despite being a very prevalent diagnosis of personality disorder (PD). Although some studies suggest that PD-NOS is intermediate in severity between subjects with, and without, formal PD, studies examining a comprehensive set of measures and control subjects have not been reported. Nearly 800 subjects were studied with semi-structured diagnostic interviews and with a variety of measures of temperament, character, and specific dimensions of personality and behavior. The subjects were divided into healthy controls (n = 176), Axis I controls (n = 87), PD subjects (n = 344) and PD-NOS subjects (n = 177). Subjects who met General Diagnostic Criteria for Personality Disorder (GDCPD), but not criteria for any one, specific PD, were designated as PD-NOS. On nearly all measures, PD-NOS differed from Healthy and from Axis I Controls in the direction of more pathology. Although subjects meeting criteria for specific PDs appeared more pathological than PD-NOS, this was always due to severity of PD as reflected by the Structured Interview for the Diagnosis of DSM Personality 4 severity score. When compared with subjects with only one specific PD diagnosis, subjects with PD-NOS did not differ in any way. When diagnosed by GDCPD, subjects with PD-NOS are similar to subjects with specific personality disorders and differ, as expected, from Healthy and Axis I Controls on measures of psychosocial function and on various dimensions of personality and related behavior. Accordingly, PD-NOS by GDCPD is as valid a PD as any other specific PD by DSM criteria.

Dimensional Diagnosis andDSM-5

we do not know the psychometrics of such ratings, particularly if made by clinicians with variable training and skill. Zimmerman et al8 point out that these complex procedures may not even be necessary if, as in DSM-IV, one can score traits as absent, subclinical, or clinically diagnosable. While that method of scoring is a rough procedure, so are the procedures under consideration for DSM-5. By and large, dimensional scoring makes the most sense for subclinical problems, and less sense for diagnosable and severe personality disorders. Most trait measures have been validated in community populations, not in clinical settings. It remains to be seen whether describing patients as having a severe personality disorder, and then describing their traits, can do justice to the sickest patients we see. Dimensions could be most helpful with the problem of personality disorder, not otherwise specified (PD-NOS), which DSM-5 plans to call personality disorder trait-specified.9 These terms describe patients who meet overall criteria for a personality disorder but do not fit into any of the well-established categories. Zimmerman et al10 had found PD-NOS to be the most frequent diagnosis in clinical practice when systematic methods are applied, even if clinicians did not necessarily recognize the clinical picture. It would be advantageous to develop trait profiles for such cases, but severity ratings could suffer from the same problems as those described above. In summary, the findings of the present study can be viewed as showing that the emperor has no (or few) clothes. Complex scoring of the severity of psychopathology looks like a scientific procedure. But it may not be much better than what we already have.

Personality Disorder Types Proposed for DSM-5

The Personality and Personality Disorders Work Group has proposed five specific personality disorder (PD) types for DSM-5, to be rated on a dimension of fit: antisocial/psychopathic, avoidant, borderline, obsessive-compulsive, and schizotypal. Each type is identified by core impairments in personality functioning, pathological personality traits, and common symptomatic behaviors. The other DSM-IV-TR PDs and the large residual category of personality disorder not otherwise specified (PDNOS) will be represented solely by the core impairments combined with specification by individuals' unique sets of personality traits. This proposal has three main features: (1) a reduction in the number of specified types from 10 to 5; (2) description of the types in a narrative format that combines typical deficits in self and interpersonal functioning and particular configurations of traits and behaviors; and (3) a dimensional rating of the degree to which a patient matches each type. An explanation of these modifications in approach to diagnosing PD types and their justifications--including excessive co-morbidity among DSM-IV-TR PDs, limited validity for some existing types, lack of specificity in the definition of PD, instability of current PD criteria sets, and arbitrary diagnostic thresholds--are the subjects of this review.

Prevalence and Construct Validity of Personality Disorder not Otherwise Specified (PDNOS)

Personality Disorder Not Otherwise Specified (PDNOS) is one of the most frequently used Axis II diagnoses, yet explicit guidelines for its assessment are lacking. To investigate the prevalence and construct validity of various definitions of PDNOS, 1760 psychotherapy referrals were diagnosed using the Structured Interview for DSM-IV Personality Disorders (SIDP-IV). Construct validity parameters included severity of psychiatric complaints, personality symptoms, and functional impairment. Results show that PDNOS is highly prevalent in this sample (21.6% or 70.8%, depending on whether co-occurrence with formal PD is allowed). Patients with both formal PD and PDNOS have more severe problems than those with formal PD only. In terms of severity, PDNOS takes an intermediate position between formal and no PD. For mixed PD, a cut-off of 5 criteria would yield a large (12.0%) additional PD group with a similar level of functional impairment as compared to mixed PD with a cut-off of either 10 or 15 criteria. In conclusion, the high prevalence of PDNOS warrants proportional attention in science and practice. If PDNOS is retained in DSM-V, it is recommendable to develop explicit guidelines for its assessment.

Personality Disorder and Chronicity of Addiction as Independent OutcomePredictors in Alcoholism Treatment

Personality Disorder and Chronicity of Addiction as Independent OutcomePredictors in Alcoholism Treatment

Personality Disorder not Otherwise Specified: Searching for an Empirically Based Diagnostic Threshold

The purpose of this paper is to propose a method for empirically investigating diagnostic criteria for personality disorder not otherwise specified (PDNOS). From a large, nonclinical sample of military recruits and undergraduate students who were screened for personality disorders (PDs), 572 completed the Structured Interview for DSM-IV Personality. Data from the interviewed group were used to identify a diagnostic threshold for PDNOS by comparing those who did (n = 88) and did not (n = 484) qualify for a PD diagnosis. For both groups, subjective distress increased and measures of social and occupational functioning decreased as a function of the number of PD criteria met. A classification and regression tree modeling procedure was applied using self-report scores on measures of mood, anxiety, and personality traits to arrive at probabilities for predicting the presence of a PD diagnosis based on the pattern of reported traits present. These probabilities were then used to derive an empirically based diagnostic threshold for PDNOS. In this sample, the most appropriate threshold for a PDNOS diagnosis appears to be the presence of 10 PD criteria for a person who does not qualify for a diagnosis of any other specific form of PD. This definition identified 5.5% of the young adults who were interviewed in this study.

A meta-analysis of the prevalence and usage of the personality disorder not otherwise specified (PDNOS) diagnosis.

The primary aim of the current study was to determine the prevalence and usage of the diagnosis of personality disorder not otherwise specified (PDNOS). As a secondary objective, this study explores the impact of assessment method and definition of PDNOS on observed prevalence. A meta-analysis is reported of 51 studies reporting separate rates for the overall prevalence of specific personality disorders and PDNOS. The best estimate of the absolute prevalence of PDNOS in patient samples is in the range of 8 to 13% and the best estimate of the relative prevalence of PDNOS (i.e., prevalence of PDNOS divided over the overall Axis II prevalence excluding PDNOS) is in the range of 21-49%. In structured interview studies PDNOS is the third most frequently used personality disorder diagnosis, whereas in nonstructured interview studies, PDNOS is often the single most frequently used diagnosis. PDE/IPDE yielded higher PDNOS prevalences than either the SCID or SIDP. Only slightly more than half of the studies provided an operational definition of PDNOS, and the most frequently occurring definition is "mixed" personality disorder. PDNOS would perhaps be the most frequently used diagnosis if it was used in a manner consistent with its definition in DSM-IV. The clinical relevance of future classification, assessment, and research could substantially benefit from validated, explicit, and uniform guidelines for the assessment of PDNOS.

Day treatment of patients with personality disorders: experiences from a Norwegian treatment research network.

This study sought to investigate the following research questions: Are time-limited day treatment programs for patients with personality disorder (PD) effective outside resourceful university settings, and what are the overall treatment results when the program is implemented on a larger scale? Do all categories and subtypes of PDs respond favorably to such treatment? How intensive should such day treatment programs be? All patients (n = 1,244) were consecutively admitted to eight different treatment programs in the Norwegian Network of Psychotherapeutic Day Hospitals from 1993 to 2000. Altogether, 1,010 patients were diagnosed with PD. Avoidant, borderline, not otherwise specified (NOS), and paranoid PD were the most common conditions. SCID-II and MINI were used as diagnostic instruments. Outcome measures included GAF Global Assessment of Functioning, (GAF; American Psychiatric Association, 1994), SCL-90R, CIP, Quality of Life, work functioning and parasuicidal behavior, measured at admittance, discharge and 1-year follow up. The attrition rate was 24%. The number of dropouts did not improve over time. As a group, completers with PD improved significantly on all outcome variables from admittance to discharge and improvement was maintained or increased at follow up. Treatment results were best for borderline PD, cluster C patients, PD NOS and No PD, and poorer for cluster A patients. Units with a high treatment dosage did not experience better outcomes than those with a low treatment dosage (10 hours per week). Results from the University unit were not better than those from units at local hospitals or mental health centers.