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Concordance between personality disorder assessment methods

Published online by Cambridge University Press:  24 August 2011

G. Nestadt ,
C. Di ,
J. F. Samuels ,
Y.-J. Cheng ,
O. J. Bienvenu ,
I. M. Reti ,
P. Costa ,
W. W. Eaton  and
K. Bandeen-Roche
G. Nestadt*
Affiliation:
Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
C. Di
Affiliation:
Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
J. F. Samuels
Affiliation:
Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
Y.-J. Cheng
Affiliation:
Institute of Statistics, National Tsing Hua University, Hsin-Chu, Taiwan
O. J. Bienvenu
Affiliation:
Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
I. M. Reti
Affiliation:
Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
P. Costa
Affiliation:
Gerontology Research Center, National Institute on Aging, Baltimore, MD, USA
W. W. Eaton
Affiliation:
Department of Mental Hygiene, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
K. Bandeen-Roche
Affiliation:
Department of Biostatistics, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
*
*Address for correspondence: Dr G. Nestadt, Department of Psychiatry and Behavioral Sciences, Johns Hopkins Hospital, Meyer 113, 600 N. Wolfe Street, Baltimore, MD 21287, USA. (Email: [email protected])
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Abstract

Background

Studies have criticized the low level of agreement between the various methods of personality disorder (PD) assessment. This is an important issue for research and clinical purposes.

Method

Seven hundred and forty-two participants in the Hopkins Epidemiology of Personality Disorders Study (HEPS) were assessed on two occasions using the Personality Disorder Schedule (PDS) and the International Personality Disorder Examination (IPDE). The concordance between the two diagnostic methods for all DSM-IV PDs was assessed using standard methods and also two item response analytic approaches designed to take account of measurement error: a latent trait-based approach and a generalized estimating equations (GEE)-based approach, with post-hoc adjustment.

Results

Raw criteria counts, using the intraclass correlation coefficient (ICC), κ and odds ratio (OR), showed poor concordance. The more refined statistical methods showed a moderate to moderately high level of concordance between the methods for most PDs studied. Overall, the PDS produced lower prevalences of traits but higher precision of measurement than the IPDE. Specific criteria within each PD showed varying endorsement thresholds and precision for ascertaining the disorder.

Conclusions

Concordance in the raw measurement of the individual PD criteria between the two clinical methods is lacking. However, based on two statistical methods that adjust for differential endorsement thresholds and measurement error in the assessments, we deduce that the PD constructs themselves can be measured with a moderate degree of confidence regardless of the clinical approach used. This may suggest that the individual criteria for each PD are, in and of themselves, less specific for diagnosis, but as a group the criteria for each PD usefully identify specific PD constructs.

Keywords

Concordance (measurement)personalitypersonality disorders
Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 3 , March 2012 , pp. 657 - 667
Copyright
Copyright © Cambridge University Press 2011

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