Temporal Coherence of Criteria for Four Personality Disorders

Morey, Leslie C.; Skodol, Andrew E.; Grilo, Carlos M.; Sanislow, Charles A.; Zanarini, Mary C.; Shea, M. Tracie; Gunderson, John G.; McGlashan, Thomas H.

doi:10.1521/pedi.18.4.394.40351

Cited by 4 publications

(1 citation statement)

References 6 publications

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“…It also aimed to study the validity of DSM-IV definitions of these PDs and compare the ability of three general models of personality to predict outcome. 17 Subjects were 668 treatment-seeking adults. 18 Two years after intake, 50% of those with an initial diagnosis of AVPD continued to meet criteria; after adjusting for interrater reliability, a κ coefficient of 0.53 was estimated.…”

Section: Demographic Symptom and Disability Correlates Of Avpdmentioning

confidence: 99%

Avoidant personality disorder: current insights

Lampe¹,

Malhi²

2018

PRBM

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Avoidant personality disorder (AVPD) is a relatively common disorder that is associated with significant distress, impairment, and disability. It is a chronic disorder with an early age at onset and a lifelong impact. Yet it is underrecognized and poorly studied. Little is known regarding the most effective treatment. The impetus for research into this condition has waxed and waned, possibly due to concerns regarding its distinctiveness from other disorders, especially social anxiety disorder (SAD), schizoid personality disorder, and dependent personality disorder. The prevailing paradigm subscribes to the “severity continuum hypothesis”, in which AVPD is viewed essentially as a severe variant of SAD. However, areas of discontinuity have been described, and there is support for retaining AVPD as a distinct diagnostic category. Recent research has focused on the phenomenology of AVPD, factors of possible etiological significance such as early parenting experiences, attachment style, temperament, and cognitive processing. Self-concept, avoidant behavior, early attachments, and attachment style may represent points of difference from SAD that also have relevance to treatment. Additional areas of research not focused specifically on AVPD, including the literature on social cognition as it relates to attachment and personality style, report findings that are promising for future research aimed at better delineating AVPD and informing treatment.

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Section: Demographic Symptom and Disability Correlates Of Avpdmentioning

confidence: 99%

Avoidant personality disorder: current insights

Lampe¹,

Malhi²

2018

PRBM

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Two-Year Prevalence and Stability of Individual DSM-IV Criteria for Schizotypal, Borderline, Avoidant, and Obsessive-Compulsive Personality Disorders: Toward a Hybrid Model of Axis II Disorders

McGlashan

Grilo²,

Sanislow³

et al. 2005

AJP

Self Cite

374

193

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Objective-This study tracked the individual criteria of four DSM-IV personality disordersborderline, schizotypal, avoidant, and obsessive-compulsive personality disorders-and how they change over 2 years.Method-This clinical sample of patients with personality disorders was derived from the Collaborative Longitudinal Personality Disorders Study and included all participants with borderline, schizotypal, avoidant, or obsessive-compulsive personality disorder for whom complete 24-month blind follow-up assessments were obtained (N=474). The authors identified and rank-ordered criteria for each of the four personality disorders by their variation in prevalence and changeability (remission) over time.Results-The most prevalent and least changeable criteria over 2 years were paranoid ideation and unusual experiences for schizotypal personality disorder, affective instability and anger for borderline personality disorder, feeling inadequate and feeling socially inept for avoidant personality disorder, and rigidity and problems delegating for obsessive-compulsive personality disorder. The least prevalent and most changeable criteria were odd behavior and constricted affect for schizotypal personality disorder, self-injury and behaviors defending against abandonment for borderline personality disorder, avoiding jobs that are interpersonal and avoiding potentially embarrassing situations for avoidant personality disorder, and miserly behaviors and strict moral behaviors for obsessive-compulsive personality disorder.Conclusions-These patterns highlight that within personality disorders the relatively fixed criteria are more trait-like and attitudinal, whereas the relatively intermittent criteria are more behavioral and reactive. These patterns suggest that personality disorders are hybrids of traits and symptomatic behaviors and that the interaction of these elements over time helps determine diagnostic stability. These patterns may also inform criterion selection for DSM-V. This article examines the individual criteria of four DSM-IV personality disorders: schizotypal, borderline, avoidant, and obsessive-compulsive. For each disorder we track how each criterion varies over a 2-year period, compared with every other criterion. We do this to rank-order them in terms of their prevalence and changeability or variance within their personality disorder categories, thus providing clues as to the presence and character of underlying dimensions or phenotypes as well as providing data about the centrality and importance of each criterion for future iterations of personality disorder nosology.The individual criteria for the DSM-IV axis II personality disorders were first articulated in DSM-III. The criteria for borderline personality disorder largely emerged from a burgeoning clinical literature on the disorder (1-5) and from a discriminant function analysis of data from patients judged by clinicians to have borderline personality disorder, compared with samples of patients with other disorders, including schizophrenia and d...

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Guideline Watch: Practice Guideline for the Treatment of Patients With Borderline Personality Disorder

Oldham¹

2005

FOC

155

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Since the 2001 publication of APA's Practice Guideline for the Treatment of Patients With Borderline Personality Disorder (1), more studies have been published on borderline personality disorder (BPD) than on any other personality disorder (2, 3). New analyses of the validity of the DSM-IV-TR criteria-defined construct of BPD have been published, new data on the prevalence of BPD are available, risk factors for and biological characteristics of BPD are being elucidated, and new studies on the treatment of BPD have been carried out. This guideline watch highlights the most important of these developments. DEFINITION, DIAGNOSTIC STABILITY, AND LONGITUDINAL COURSE Definition With an eye toward DSM-V, careful examination of axis II is occurring. This has, in part, included comparing the relative merits of categorical systems such as DSM-IV-TR and dimensional systems such as the five-factor model (4). This debate is as yet unresolved. However, recent studies have analyzed the nine DSM-IV criteria that define BPD and have concluded that, as defined, BPD appears to reflect a statistically coherent construct (5, 6). Utilization of a polythetic system requiring five out of nine criteria to make a categorical BPD diagnosis inevitably results in extensive heterogeneity within and between BPD populations being treated The American Psychiatric Association (APA) practice guidelines are developed by expert work groups using an explicit methodology that includes rigorous review of available evidence, broad peer review of iterative drafts, and formal approval by the APA Assembly and Board of Trustees. APA practice guidelines are intended to assist psychiatrists in clinical decision making. They are not intended to be a standard of care. The ultimate judgment regarding a particular clinical procedure or treatment plan must be made by the psychiatrist in light of the clinical data presented by the patient and the diagnostic and treatment options available. Guideline watches summarize significant developments in practice since publication of an APA practice guideline. Watches may be authored and reviewed by experts associated with the original guideline development effort and are approved for publication by APA's Executive Committee on Practice Guidelines. Thus, watches represent opinion of the authors and approval of the Executive Committee but not policy of the APA. This guideline watch was published in March 2005.

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Temporal Coherence of Criteria for Four Personality Disorders

Cited by 4 publications

References 6 publications

Avoidant personality disorder: current insights

Avoidant personality disorder: current insights

Two-Year Prevalence and Stability of Individual DSM-IV Criteria for Schizotypal, Borderline, Avoidant, and Obsessive-Compulsive Personality Disorders: Toward a Hybrid Model of Axis II Disorders

Guideline Watch: Practice Guideline for the Treatment of Patients With Borderline Personality Disorder

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