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

Abstract

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.

Prevalence of Personality Disorders at Midlife in a Community Sample: Disorders and Symptoms Reflected in Interview, Self, and Informant Reports

“…We defined PDNOS as the presence of ten or more miscellaneous criteria across all of the PDs without meeting the specific threshold for a diagnosis of any one type of PD (Pagan et al 2005; Verheul and Widiger 2004). In Table 2, we present the number of males and females in the sample who qualified for each personality disorder, as well as the number who fell one criterion short.…”

The interrater reliability of the Structured Interview for DSM-IV Personality

“…The SIDP-IV does not assess for PD not otherwise specified (PDNOS) because no empirical criteria or agreed upon assessment method currently exists in the DSM-IV. However, a recent set of analyses conducted in our laboratory suggested that individuals who meet at least 10 DSM-IV PD criteria without meeting criteria for any 1 PD demonstrate comparable distress and impairment as those who meet criteria for at least 1 PD [22]. We applied this standard to the interview data for the 433 Air Force recruits and found that additional 24 recruits (5.5% of the interviewed sample) qualified for a diagnosis of PDNOS.…”

“…Perfectionism was encouraged in this setting, so military recruits probably thought that it was acceptable to admit to possessing these traits. Because the SIDP-IV does not assess for PDNOS, we applied an empirically derived threshold of 10 PD criteria for diagnosing this disorder in our sample [22]. This method identified 24 (5.5%) recruits as potentially deserving a diagnosis of PDNOS, which makes PDNOS the second most common PD diagnosis behind obsessivecompulsive PD.…”

Effectiveness of Psychotherapy in Personality Disorders Not Otherwise Specified: A Comparison of Different Treatment Modalities

“…A diagnosis of PDNOS can be obtained in two ways: (1) meeting the diagnostic criteria for an appendix PD (DSM‐IV‐TR depressive or negativistic PD, DSM‐III‐R self‐defeating PD) but not for any specific cluster PD, or (2) meeting the criteria for a mixed PD: meeting 10 or more diagnostic criteria of various PDs but not for any specific PD. The definition of mixed PD in the current study is in agreement with some earlier studies (Pagan, Oltmanns, Whitmore, & Turkheimer, ; Wilberg et al ., ) but not with other studies in which a cut‐off of only five criteria was suggested (Coccaro, Nayyer, & McCloskey, ; Verheul et al ., ). Since in clinical practice mostly 10 or more criteria have to be met, we chose to use this definition.…”