Structured Clinical Interview For DSM-III-R Personality Disorders Research Articles

Personality disorders in patients with eating disorders in Japan.

We assessed the prevalence of personality disorders (PD) using the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) in 36 patients with restricting anorexia nervosa, 30 patients with anorexia nervosa and bulimia nervosa, and 42 patients with bulimia nervosa. Of the 108 patients, 51% met the criteria for at least one PD. The patients with PD had more severe clinical features in terms of bulimic behaviors, concurrent depressive, anxious, and obsessive-compulsive symptoms, and psychopathology related to eating disorders compared to the patients without any PD. The patients with PD, especially borderline PD, also had more severe global functioning and greater numbers of suicidal attempts and hospital admissions. We compare these results with those reported in the Western world and discuss them cross-culturally.

Personality disorders in patients with eating disorders in Japan

We assessed the prevalence of personality disorders (PD) using the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) in 36 patients with restricting anorexia nervosa, 30 patients with anorexia nervosa and bulimia nervosa, and 42 patients with bulimia nervosa. Of the 108 patients, 51% met the criteria for at least one PD. The patients with PD had more severe clinical features in terms of bulimic behaviors, concurrent depressive, anxious, and obsessive-compulsive symptoms, and psychopathology related to eating disorders compared to the patients without any PD. The patients with PD, especially borderline PD, also had more severe global functioning and greater numbers of suicidal attempts and hospital admissions. We compare these results with those reported in the Western world and discuss them cross-culturally. © 1998 John Wiley & Sons, Inc. Int J Eat Disord 23: 399–408, 1998.

Comorbidity of personality disorders with bipolar mood disorders

The aim of the study was to assess the prevalence of personality disorders in a group of outpatients with bipolar I disorder. The Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) was administered to 90 bipolar outpatients who met the DSM-III-R criteria and 58 control subjects. Of the patients and controls, 47.7% and 15.5%, respectively, had at least one personality disorder. At least one personality disorder in clusters A, S, and C and obsessive-compulsive, paranoid, histrionic, and borderline personality disorders were significantly more prevalent in bipolars. Suicide attempts were more frequent in patients with a history of personality disorder.

Self and informant ratings of SCID‐II personality disorder items for nonreferred college women: Effects of item and participant characteristics

Examined the relationship between self- and informant-ratings on Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) items. Seventy-five female undergraduate student volunteers and their roommates also completed the Brief Symptom Inventory, Rubin's Liking Scale, and the Marlowe–Crowne Social Desirability Scale. Self-rating scores on personality disorder items were significantly higher than informant-ratings on five personality disorder scales. Participants and informants endorsed more personality disorder items rated higher on social desirability. No relationship was found between subjectivity of personality disorder scales and differences between self- and informant-ratings. Participants with higher needs for positive self-presentation rated themselves lower on nine personality disorder scales. A higher level of liking for roommates was associated with lower informant ratings for six personality disorder scales. © 1997 John Wiley & Sons, Inc. J Clin Psychol 53: 523–533, 1997.

Personality disorders do not influence the results of cognitive and behavior therapy for obsessive compulsive disorder

This study examined whether categorical or dimensional personality disorder variables affected treatment outcome in a sample of 52 patients with obsessive compulsive disorder who followed a standardized cognitive behavior therapy program. Treatment consisted of 12 weekly sessions and was completed by 43 patients. The Structured Clinical Interview for DSM-III-R personality disorders (SCID-II) was taken before the start of treatment by an independent rater. The treatment outcome measures included questionnaires and a Behavioral Assessment Test. Measurements were taken before and after treatment, and at 1 and 6 month follow-up tests. After the first follow-up test, further treatment was provided if clinically indicated. Neither categorical, nor dimensional personality disorder variables affected treatment outcome significantly. The inclusion of drop-outs in the analyses, did not change these results. Therefore, patients with obsessive compulsive disorder and concomitant personality disorder pathology should not be excluded from cognitive or behavior therapy for their obsessive compulsive complaints. Attributing therapy failure to concomitant Axis II pathology should be approached with caution.

Validity of DSM-III-R diagnosis by psychological autopsy: a comparison with clinician ante-mortem diagnosis.

Psychological autopsies are an important research tool in establishing risk factors associated with suicide. We report the results of a validity study comparing psychological autopsy-generated DSM-III-R diagnoses in suicides and non-suicides with chart diagnoses generated by clinicians who had treated the subjects prior to death. The Structured Clinical Interview for DSM-III-R Disorders (SCID-P) and the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) were used to make independent post-mortem diagnoses. Comparison of research diagnoses with clinician ante-mortem diagnoses generated kappa coefficients of 0.85 for Axis I diagnoses and 0.65 for Axis II conditions. These kappa coefficients compare favourably with direct patient interview reliability studies. This provides evidence for the validity of the psychological autopsy as a method of determining psychiatric diagnosis.

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 Tridimensional Personality Questionnaire as an Instrument for Screening Personality Disorders: Use in Patients with Generalized Anxiety Disorder

Forty-eight patients with generalized anxiety disorder (GAD) were administered the Tridimensional Personality Questionnaire (TPQ), and then they were interviewed by the means of the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II). Agreement between the two instruments about absence of personality disorder (PD) was found in 30 patients. There were only 3 patients who were diagnosed with a PD on the basis of the TPQ scores but did not receive a SCID-II diagnosis of PD. The TPQ appears to have high sensitivity in detecting personality disorders (PDs) among GAD patients and it might be a useful screening instrument for PDs in patients with anxiety disorders in general. The paper also compares results of the two approaches to PD assessment in GAD patients: dimensional, as embodied in the TPQ; and categorical, as represented by the SCID-II and DSM-III-R.

Twelve-month test-retest reliability of the structured clinical interview for dsm-iii-r personality disorders in cocaine-dependent patients

This study examined 12-month test-retest reliability of the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) in cocaine-dependent patients. Thirty-one patients completed the SCID-II during the second week of hospitalization for cocaine dependence, and again 12 months later. In both interviews, patients were asked to answer questions about their personality during the several years preceding admission to the hospital. Test-retest reliability, as measured by κ, was relatively poor at .46. However, reliability of negative diagnoses (the absence of a disorder at both time points) was higher than reliability of positive diagnoses (the presence of a disorder at both time points). Reasons for the difficulty in attaining long-term test-retest reliability of axis II diagnoses in cocaine-dependent patients are discussed.

A Comparison of the Structured Clinical Interview for DSM-III-R and Clinical Diagnoses

The relationship between diagnoses generated by the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID) and by nonstructured psychiatric interviews was examined. The purposes were to evaluate which DSM-III-R diagnoses were most reliably chosen, and to compare diagnostic practices between two clinical sites. Diagnoses generated by researchers using the patient version of the SCID and by psychiatric interviews were compared for 100 patients. The participants had been randomly assigned to one of two acute treatment sites within the same institution, as part of a larger study of an alternative to inpatient hospitalization. Overall reliability between the SCID and the clinicians, as determined by weighted Kappa, was poor. There was considerable variability among the major diagnostic categories, with higher agreement for schizophrenia and bipolar disorder than for others. The agreement for schizoaffective disorder was extremely low. There were also significant differences in the patterns of diagnosis between the two sites. The patient version of the SCID appears to produce results that are very different from clinical practice, which, in turn, may be influenced strongly by location.

The Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II). Part II: Multi-Site Test-Retest Reliability Study

A test-retest reliability study of the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) was conducted on 284 subjects in four psychiatric patient sites and two nonpsychiatric patient sites. For the patient sites, kappas ranged from .24 for obsessive—compulsive personality disorder to .74 for histrionic personality disorder, with an overall weighted kappa of .53. For the nonpatients, however, agreement was considerably lower, with an overall weighted kappa of .38. Mean duration of administration time was 36 minutes. Results of this study and other studies using the SCID-II suggest that the reliability and validity of the SCID-II are comparable with other instruments that diagnose Axis II disorders of the Diagnostic and Statistical Manual of Mental Disorders, but this new instrument has the advantage of a shorter time of administration.

Gender differences in personality disorders.

The aim of this study was to assess gender differences in personality disorders. Since heterogeneity of axis I diagnoses could introduce variability in the assessment of axis II diagnoses, the authors studied a group of patients with a primary diagnosis of major depression. A total of 316 patients were evaluated with the Personality Diagnostic Questionnaire--Revised, a self-rating measure, or the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II), a clinician-rated instrument, or both. Axis II disorders were assessed with the Personality Diagnostic Questionnaire--Revised for 288 patients with major depression. The SCID-II was administered to 117 subjects, with an additional 95 subjects receiving the SCID-II for cluster B diagnoses only. The mean 17-item Hamilton Depression Rating Scale scores for 108 men (mean age = 39.28 years) and 208 women (mean age = 39.11) were 19.0 (SD = 3.8) and 19.6 (SD = 6.9), respectively. Men were significantly more likely than women to meet criteria for narcissistic, antisocial, and obsessive-compulsive personality disorders as measured by the Personality Diagnostic Questionnaire--Revised and for narcissistic and obsessive-compulsive personality disorders as measured by the SCID-II. These findings are consistent with those of previous studies showing a greater prevalence of antisocial and narcissistic personality disorders in men. In contrast with other investigations, however, neither the Personality Diagnostic Questionnaire--Revised nor the SCID-II revealed a higher prevalence of any personality disorder in women.

The Diagnosis of Personality Disorder With a Modified Version of the SCID-II in A Spanish Clinical Sample

The Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) questionnaire and interview were translated into Spanish and extended in order to cover all DSM-III Axis II diagnosis. Other modifications included rewording some of the items of the questionnaire to improve reliability, extending the response scale to five levels, and clarifying scoring criteria of the interview. Sixty psychiatric patients were given the questionnaire and thereafter interviewed by two psychiatrists. Agreement ranged from ? = 0.37 for schizotypal, to ? = 1.00 for avoidant personality disorder. Kappa for the presence versus absence of disorder was 0.85. Forty eight patients had a positive diagnosis according to the questionnaire, but only 25 were confirmed in the interview. Positive predictive values were poor to fair from 0.25 for a prevalence of 0.20 to 0.63 for a prevalence of 0.15.

Personality disorders in cocaine dependence

To assess the relationship between cocaine dependence and personality disorders, we administered the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) to 50 patients who were hospitalized for cocaine dependence. We modified the SCID-II so that patients were asked to indicate whether personality traits (if present) occurred during periods of drug use, abstinence, or both. Thirty-seven patients (74%) received at least one axis II diagnosis; 69% of these diagnoses were present both during periods of drug use and abstinence. Only one patient received a diagnosis during periods of drug use alone. These findings suggest that personality disorder diagnoses in cocaine-dependent patients remain relatively stable regardless of current drug use patterns. These data support clinicians' addressing these maladaptive personality traits as part of treatment for cocaine dependence.

Validity of the Personality Diagnostic Questionnaire-Revised: A replication in an outpatient sample

We report a replication study of the validity of the Personality Diagnostic Questionnaire-Revised (PDQ-R) in an outpatient sample. Fifty-nine applicants for psychoanalysis at a training institute completed the PDQ-R and were diagnosed by clinicians, blind to the PDQ-R results, using the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) and the Personality Disorder Examination (PDE). The PDQ-R showed high sensitivity and moderate specificity for most axis II disorders. Although not a substitute for a structured interview because it yields many false-positives, the PDQ-R is an efficient instrument for screening outpatients with DSM-III-R personality disorders.

Diagnosis of DSM-III-R personality disorders by two structured interviews: patterns of comorbidity

The purpose of this study was to examine patterns of co-occurrence of axis II disorders in a group of consecutive patients evaluated with two contrasting structured interviews. One hundred of 106 consecutive applicants for long-term, inpatient treatment of severe personality psychopathology were assessed, face-to-face, by psychiatrists using the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) and the Personality Disorder Examination (PDE). The percent of co-occurrence of pairs of disorders diagnosed by each structured interview separately was calculated, and significance levels were determined by using chi-square tests of independence. Finally, odds ratios were computed for the odds of each pair of disorders occurring together compared with the odds for the occurrence of each disorder alone. The two interview methods revealed different comorbidity patterns. Significant covariation was found for 29 pairs of disorders diagnosed with the PDE, compared with 12 pairs diagnosed with the SCID-II. Six pairs of disorders covaried significantly and were associated with odds ratios greater than 4: histrionic with borderline, histrionic with narcissistic, narcissistic with antisocial, narcissistic with passive-aggressive, avoidant with schizotypal, and avoidant with dependent. Substantial overlap occurred among personality disorders. In this group of patients, consistent patterns of comorbidity involving narcissistic, avoidant, and histrionic personality disorders suggest that categorical distinctions between them and certain other DSM-III-R personality disorders may be illusory. The question of which of two overlapping disorders is more valid, however, is left unanswered. For clinical purposes, a two-level diagnostic convention is proposed.

DSM-III-R personality disorders in eating-disorder subtypes

The authors interviewed 46 eating-disordered individuals with the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) to assess the prevalence of personality disorders in four eating disorder subtypes. The findings suggest that eating disorder subtypes vary in prevalence of concurrent personality disorder diagnoses. Obsessive-compulsive personality disorder was common in restricting anorexics, but not bulimic anorexics. Normal-weight bulimia was associated with histrionic personality disorder. Regardless of eating-disorder subtype, self-reported depression was highest in individuals meeting criteria for borderline and dependent personality disorder.