Structured Interview For DSM-IV Personality Research Articles

A longitudinal, population-based twin study of avoidant and obsessive-compulsive personality disorder traits from early to middle adulthood.

The phenotypic stability of avoidant personality disorder (AVPD) and obsessive-compulsive personality disorder (OCPD) has previously been found to be moderate. However, little is known about the longitudinal structure of genetic and environmental factors for these disorders separately and jointly, and to what extent genetic and environmental factors contribute to their stability. AVPD and OCPD criteria were assessed using the Structured Interview for DSM-IV Personality in 2793 young adult twins (1385 pairs, 23 singletons) from the Norwegian Institute of Public Health Twin Panel at wave 1 and 2282 (986 pairs, 310 singletons) of these on average 10 years later at wave 2. Longitudinal biometric models were fitted to AVPD and OCPD traits. For twins who participated at both time-points, the number of endorsed sub-threshold criteria for both personality disorders (PDs) decreased 31% from wave 1 to wave 2. Phenotypic correlations between waves were 0.54 and 0.37 for AVPD and OCPD, respectively. The heritability estimates of the stable PD liabilities were 0.67 for AVPD and 0.53 for OCPD. The genetic correlations were 1.00 for AVPD and 0.72 for OCPD, while the unique environmental influences correlated 0.26 and 0.23, respectively. The correlation between the stable AVPD and OCPD liabilities was 0.39 of which 63% was attributable to genetic influences. Shared environmental factors did not significantly contribute to PD variance at either waves 1 or 2. Phenotypic stability was moderate for AVPD and OCPD traits, and genetic factors contributed more than unique environmental factors to the stability both within and across phenotypes.

The Relationship between Personality Disorders and Quality of Life in Adolescent Outpatients

Abstract Background: During recent years, there has been an increasing focus on the benefits of the early detection and treatment of personality disorders in adolescents. Previous studies of adults have shown that the number of personality disorder criteria met is negatively correlated with a patient’s quality of life and general functioning. Objective: The aim of the present study was to investigate the prevalence of personality disorders, particularly with regard to the correlation between the number of personality disorder criteria fulfilled and self-perceived quality of life. Distribution according to gender and age in a clinical sample of adolescent outpatients were also considered. Method: This study included 153 adolescents between the ages of 14 and 17 years who were referred to a mental health outpatient clinic. Personality disorders were assessed using the Structured Interview for DSM-IV Personality. Quality of life was assessed using the Youth Quality of Life Instrument - Research Version, which is a 41-item questionnaire that covers broad aspects of quality of life. Axis I disorders were assessed using the Mini International Neuropsychiatric Interview. Results: Results demonstrated that 21.6% of the adolescents met the diagnostic criteria for at least one personality disorder. A relationship between the number of personality disorder criteria met and reduced quality of life was found. No significant gender differences with regard to the prevalence of each of the personality disorders were revealed. Adjustment for the presence of Axis I disorders did not appreciably affect these findings Conclusion: The present study indicates that reduced quality of life as a result of the number of personality disorder criteria met affects adolescents in much the same way that it does adults. This further emphasizes the clinical importance of including quality of life assessment as part of the general diagnostic procedures used with adolescents.

A longitudinal twin study of cluster A personality disorders.

While cluster A personality disorders (PDs) have been shown to be moderately heritable, we know little about the temporal stability of these genetic risk factors. Paranoid PD (PPD) and schizotypal PD (STPD) were assessed using the Structured Interview for DSM-IV Personality in 2793 young adult twins from the Norwegian Institute of Public Health Twin Panel at wave 1 and 2282 twins on average 10 years later at wave 2. Using the program Mx, we fitted a longitudinal latent factor model using the number of endorsed criteria for PPD and STPD. The stability over time of the criteria counts for PPD and STPD, estimated as polychoric correlations, were +0.34 and +0.40, respectively. The best-fit longitudinal model included only additive genetic and individual-specific environmental factors with parameter estimates constrained to equality across the two waves. The cross-wave genetic and individual-specific environmental correlations for a latent cluster A factor were estimated to equal +1.00 and +0.13, respectively. The cross-time correlations for genetic and environmental effects specific to the individual PDs were estimated at +1.00 and +0.16-0.20, respectively. We found that 68% and 71% of the temporal stability of PPD and STPD derived, respectively, from the effect of genetic factors. Shared genetic risk factors for two of the cluster A PDs are highly stable in adults over a 10-year period while environmental risk factors are relatively transient. Over two-thirds of the long-term stability of the common cluster A PD liability can be attributed to genetic influences.

Personality Pathology as a Risk Factor for Negative Health Perception

Previous findings suggest that self-perception of health relates to many physical health outcomes, including mortality. Many factors appear to shape health perceptions, such as personality. Little research, however, has focused on whether personality pathology may affect perceived health. This preliminary study examined the unique effects of personality pathology on health perceptions beyond those of objective health and normal personality factors. As part of an ongoing longitudinal study, the authors examined data from a representative sample (N = 697) of St. Louis residents (ages 55-64) who were identified using standard epidemiological methods. The Diagnostic Interview Schedule and the Health Status Inventory were used to collect reports of health perceptions, chronic illnesses, and physical functioning. Personality traits were measured with the revised NEO Personality Inventory, and personality disorders were assessed using the Structured Interview for DSM-IV Personality. Number of physical illnesses, physical functioning, normal personality, and personality disorders all predicted self-perception of health separately. Personality disorders also predicted health perception above and beyond objective health and personality variables. These findings elucidate the importance of personality pathology in understanding perceived health and suggest that certain patterns of pathology may be particularly detrimental to subjective health.

The Standardized Assessment of Personality—Abbreviated Scale as a screening instrument for personality disorders in substance‐dependent criminal offenders

Personality disorders (PDs) are considered to be potential predictors of treatment outcome in substance-dependent patients and potential treatment matching variables. There is a need for a brief and simple screening instrument for PDs that can be used in routine psychological assessment, especially in a treatment setting for previously substance-dependent criminal offenders, where a high prevalence of PDs is expected. This study investigated the psychometric properties of the Standardized Assessment of Personality-Abbreviated Scale (SAPAS), a commonly used screening interview for PDs, in a population of inpatient criminal offenders with a history of substance dependence. Various statistical procedures were used to establish reliability and validity measures, such as Kuder-Richardson 20, confirmative factor analysis, receiver operating characteristic analysis and multitrait multimethod matrix. The SAPAS was administered to 101 inpatient criminal offenders with a history of substance dependence at baseline. Within three weeks, participants were administered the Structured Interview for DSM-IV Personality in order to assess the presence of PDs. Results show limited evidence to make firm conclusions on the psychometric qualities of the SAPAS as a screening instrument for comorbid PDs in a substance dependence treatment setting for criminal offenders. Suggestions for improvement concerning the psychometric qualities of the SAPAS as a screening instrument for this population are noted.

The Economic Burden of Personality Disorders in Mental Health Care

Some evidence suggests that personality disorders are associated with a high economic burden due to, for example, a high demand on psychiatric, health, and social care services. However, state-of-the-art cost studies for the broad range of personality disorder diagnoses are lacking. The present study examines the direct medical costs, as well as the indirect costs, of patients seeking mental health treatment with DSM-IV personality disorders. The 1740 subjects included in this study were recruited from March 2003 to March 2006 from 6 different mental health care institutes in the Netherlands specializing in the psychotherapeutic treatment of personality disorders. The direct and indirect costs were assessed using the Trimbos and Institute for Medical Technology Assessment Questionnaire on Costs Associated with Psychiatric Illness. Personality disorders were diagnosed using the Structured Interview for DSM-IV Personality. The mean total costs of the personality disorder group in the 12 months prior to treatment were 11,126 euros per patient. Two thirds (66.5%) of these costs consisted of direct medical costs, while the remaining costs were related to productivity losses. Borderline and obsessive-compulsive personality disorders were uniquely associated with increased mean total costs. Treatment-seeking patients with personality disorders pose a high economic burden on society, a burden substantially higher than that found in, for instance, depression or generalized anxiety disorder. These high societal costs present a strong argument in favor of prioritizing effective personality disorder treatments in reimbursement decisions.

The Relationship Between Avoidant Personality Disorder and Social Phobia: A Population-Based Twin Study

The purpose of this study was to determine the sources of comorbidity for social phobia and dimensional representations of avoidant personality disorder by estimating to what extent the two disorders are influenced by common genetic and shared or unique environmental factors versus the extent to which these factors are specific to each disorder. Young adult female-female twin pairs (N=1,427) from the Norwegian Institute of Public Health Twin Panel were assessed at personal interview for avoidant personality disorder and social phobia using the Structured Interview for DSM-IV Personality and the Composite International Diagnostic Interview. Bivariate Cholesky models were fitted using the Mx statistical program. The best-fitting model included additive genetic and unique environmental factors only. Avoidant personality disorder and social phobia were influenced by the same genetic factors, whereas the environmental factors influencing the two disorders were uncorrelated. Within the limits of statistical power, these results suggest that there is a common genetic vulnerability to avoidant personality disorder and social phobia in women. An individual with high genetic liability will develop avoidant personality disorder versus social phobia entirely as a result of the environmental risk factors unique to each disorder. The results are in accordance with the hypothesis that psychobiological dimensions span the axis I and axis II disorders.

Interpersonal Aspects of Personality Disorders in Opioid-Dependent Patients: The Convergence of the ICL-R and the SIDP-IV

This study aims to establish the convergence of the empirically based Diagnostic Statistical Manual (DSM)- and theory-based interpersonal behavioral approaches to personality, in opioid-dependent patients (n = 110), with the use of the Structured Interview for DSM-IV Personality [Pfohl et al.: Structured Interview for DSM-IV PD. Iowa City, UICM, 1995] and the Interpersonal Checklist-Revised (ICL-R) [DeJong and VandenBrink: ICL-R. St. Oedenrode/NL, Novadic, 1998]. As hypothesized, based on prior research, we found the two approaches to be complementary rather than interchangeable. However, some overlap was found between the SIDP-IV dimensions and the ICL-R, mainly with rebellious/distrustful, reserved/silent and masochistic/self-effacing styles. Results indicate that drug dependence in itself is not a predictor of interpersonal style, while personality pathology is. Patients with a personality disorder (PD) perceive themselves as hostile and submissive, while patients without a PD view themselves as friendly and controlling. The SIDP-IV seems informative in classifying PDs, in addition guidelines for behavioral change, in addicted patients, were provided based on the ICL-R.

Fantasy proneness, dissociation, and DSM-IV axis II symptomatology.

Scores on the Inventory of Childhood Memories and Imaginings (S. C. Wilson & T. X. Barber, 1981) identified fantasizers and controls who were administered the Structured Interview for DSM-IV Personality (SIDP-IV; B. Pfohl, N. Blum, & M. Zimmerman, 1994) and the Dissociative Experiences Scale (DES; E. M. Bernstein & F. W. Putnam, 1986). Fantasizers had increased rates of Cluster A and B personality disorders but were equivalent to controls in Cluster C diagnoses. For both Clusters A and B, 55% of the fantasizers received clinical diagnoses. Fantasizers had significantly higher DES, DES-T (N. G. Waller, F. W. Putnam, & E. B. Carlson, 1996), and Normal Dissociative Index scores. Although nearly one half of the fantasizers' DES-T patterns were classified within the pathological dissociative taxon (N. G. Waller & C. A. Ross, 1997), none of the controls and only 10.03% of the original screening sample received this classification. Both Axis II pathology and pathological dissociation were associated with fantasy proneness.