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Multiple Axis-II Diagnoses of Personality Disorder

Published online by Cambridge University Press:  02 January 2018

Bridget Dolan ,
Chris Evans  and
Kingsley Norton
Bridget Dolan*
Affiliation:
Henderson Hospital, Sutton and St George's Hospital Medical School, London
Chris Evans
Affiliation:
St George's Hospital Medical School
Kingsley Norton
Affiliation:
Henderson Hospital and St George's Hospital Medical School
*
Dr Bridget Dolan, Section of Forensic Psychiatry, St George's Hospital Medical School, Tooting, London SW17 ORE
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Abstract

Background

Simultaneous diagnosis of more than one personality disorder (PD) has been termed ‘comorbidity’ or ‘co-occurrence’ implying that single diagnoses are the norm and multiple diagnoses interesting exceptions. Surveys of PD subjects in fact show 1.5–5.6 diagnoses per subject. Our study explores the hypothesis that multiple PD diagnosis is common and increases with increasingly personality disordered populations.

Method

The PDQ–R questionnaire was administered to three UK samples: referrals for specialist PD in-patient treatment (n = 275); high tariff offenders attending a probation centre (n = 57); and undergraduate students (n = 274).

Results

Means of 6.0 (95% CI 5.7–6.3), 4.0 (3. 1–5.0) and 3.4 (3.0–3.8) PDQ–R diagnoses per subject were found respectively. High rates of PD diagnosis in individual subjects suggest that multiple diagnosis is the norm rather than the exception.

Conclusions

Multiple diagnosis of PD is better construed as ‘breadth’ of psychopathology rather than comorbidity and is a function of sampling frame. High rates of multiple diagnoses question the interpretation of studies of any single PD. The graded construct of ‘breadth’ of axis–II pathology may further our understanding of PD.

Type
Papers
Information
The British Journal of Psychiatry , Volume 166 , Issue 1 , January 1995 , pp. 107 - 112
Copyright
Copyright © 1995 The Royal College of Psychiatrists 

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References

American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM–III–R). Washington, DC: APA.Google Scholar
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM-IV). Washington, DC: APA.Google Scholar
Blashfield, R. K. & Breen, M. J. (1989) Face validity of the DSM–III–R personality disorders. American Journal of Psychiatry, 146, 1575–1579.Google ScholarPubMed
Clark, L. A. (1992) Resolving taxonomic issues in personality disorders: the value of large-scale analyses of symptom data. Journal of Personality Disorder, 6, 360–376.CrossRefGoogle Scholar
Cooper, J. L., Morrison, T. L., Bioman, O. L., et al (1988) Bulimia and borderline personality disorder. International Journal of Eating Disorders, 7, 43–49.3.0.CO;2-U>CrossRefGoogle Scholar
Dowson, J. H. (1992) Assessment of DSM–III–R personality disorders by self-report questionnaire: The role of informants and a screening test for co-morbid personality disorders (STCPD). British Journal of Psychiatry, 161, 344–352.Google Scholar
Dowson, J. H. & Berrios, G. E. (1991) Factor structure of DSM–III–R personality disorders shown by self-report questionnaire. Acta Psychiatrica Scandinavica, 84, 555–560.Google Scholar
Du Fort, G. G., Newman, S. C. & Bland, R. C. (1993) Psychiatric comorbidity and treatment seeking: sources of selection bias in the study of clinical populations. Journal of Nervous and Mental Diseases, 18, 467–474.Google Scholar
Gardner, D. L. & Cowdry, R. W. (1986) Positive effects of carbamazepine on behavioral dyscontrol in borderline personality disorder. American Journal of Psychiatry, 143, 519–522.Google ScholarPubMed
Gartner, A. F., Marcus, R. M., Halmi, K. A., et al (1989) DSM–III–R personality disorders in patients with eating disorders. American Journal of Psychiatry, 146, 1585–1591.Google ScholarPubMed
Hunt, C. & Andrews, G. (1992) Measuring personality disorder: the use of self-report questionnaires. Journal of Personality Disorder, 6, 125–133.Google Scholar
Hurt, S. W., Hyler, S. E., Frances, A., et al (1984) Assessing borderline personality disorder with self-report, clinical interview, or semistructured interview. American Journal of Psychiatry, 141, 1228–1231.Google Scholar
Hyler, S. & Reider, R. O. (1987) Personality Diagnostic Questionnaire – revised. New York State Psychiatric Institute, New York.Google Scholar
Hyler, S. & Reider, R. O., Williams, J., et al (1989) A comparison of clinical and self-report diagnoses of DSM–III personality disorders in 552 patients. Comprehensive Psychiatry, 30, 170–178.Google Scholar
Hyler, S., Skodol, A. E., Kellman, H. D., et al (1990) Validity of the personality diagnostic questionnaire revised: Comparison with two structured interviews. American Journal of Psychiatry, 147, 1043–1048.Google ScholarPubMed
Hyler, S., Skodol, A. E., Oldham, J. M., et al (1992) Validity of the Personality Diagnostic Questionnaire – revised: A replication in an outpatient sample. Comprehensive Psychiatry, 33, 73–77.Google Scholar
Johnson, J. G. & Bornstein, R. F. (1992) Utility of the PDQ–R in a non-clinical population. Journal of Personality Disorder, 6, 450–457.CrossRefGoogle Scholar
Loranger, A. W. (1992) Are current self-report and interview measures adequate for epidemiological studies of personality disorders? Journal of Personality Disorder, 6, 313–325.CrossRefGoogle Scholar
Loranger, A. W., Susman, V. L., Oldham, J. M., et al (1985) Personality Disorder Examination (PDE) A Structured Interview for DSM–III Personality Disorder Diagnosis. White Plains New York, New York.Google Scholar
Mann, A., Jenkins, R., Cutting, J. C., et al (1981) The development and use of a standardised assessment of abnormal personality. Psychological Medicine, 11, 839–847.CrossRefGoogle ScholarPubMed
Nurnberg, H. G., Raskin, M., Levine, P. E., et al (1991) The comorbidity of borderline personality disorder and other DSM–III–R Axis II personality disorders. American Journal of Psychiatry, 148, 1371–1377.Google Scholar
O'Connell, R. A., Mayo, J. A. & Scuitto, M. S. (1991) PDQ–R personality disorders in bi-polar patients. Journal of Affective Disorders, 23, 217–221.Google Scholar
Oldham, J., Skodol, A. E., Kellman, H. D., et al (1991) Diagnosis of DSM–III–R personality disorders by two structured interviews: patterns of co-morbidity. American Journal of Psychiatry, 149, 213–220.Google Scholar
Perry, J. C. (1992) Problems and considerations in the valid assessment of personality disorders. American Journal of Psychiatry, 149, 1645–1653.Google ScholarPubMed
Peselow, E. D., Sanfilipo, M. P., Fieve, R. R., et al (1994) Personality traits during depression and after clinical recovery. British Journal of Psychiatry, 164, 349–354.Google Scholar
Pfohl, B., Stangl, D. & Zimmerman, M. (1982) The Structured Interview for Personality Disorders SID-O. Iowa City: University of Iowa.Google Scholar
Pollack, M. H., Otto, M. W., Rosenbaum, J. F., et al (1982) Personality disorders in patients with panic disorder: Association with childhood anxiety disorders, early trauma, comorbidity and chronicity. Comprehensive Psychiatry, 33, 78–83.CrossRefGoogle Scholar
Reich, J. (1987) Instruments measuring DSM–III and DSM–III–R personality disorders. Journal of Personality Disorders, 1, 220–240.Google Scholar
Reich, J. (1989) Update on instruments to measure DSM–III and DSM–III–R personality disorders. Journal of Nervous Mental Diseases, 177, 336–370.Google Scholar
Skodol, A. E., Oldham, J. M., Rosnick, L., et al (1991) Diagnosis of DSM–III–R personality disorders: A comparison of two structured interviews. International Journal of Methods in Psychiatric Research, 1, 13–26.Google Scholar
Spitzer, R. L., Williams, J. B. W., Gibbon, M., et al (1990) Structured Clinical Interview for DSM–III–R. Washington, DC: American Psychiatric Press.Google Scholar
Trull, T. J. & Goodwin, A. H. (1993) Relationship between mood changes and the report of personality disorder symptoms. Journal of Personality Assessment, 61, 99–111.Google Scholar
Tyrer, P. (1988) Personality Disorders: Diagnosis, Management and Course. London: Wright.Google Scholar
Tyrer, P. & Alexander, P. (1979) Classification of personality disorder. British Journal of Psychiatry, 135, 163–167.Google Scholar
Tyrer, P., Casey, P. & Ferguson, B. (1991) Personality disorder in perspective. British Journal of Psychiatry, 159, 463–471.CrossRefGoogle Scholar
Whiteley, J. S. (1980) Henderson Hospital: a community study. International Journal of Therapeutic Communities, 1, 38–57.Google Scholar
Widiger, T. A. (1991) DSM–IV reviews of personality disorders. Journal of Personality Disorder, 5, 122–134.CrossRefGoogle Scholar
Widiger, T. A., Trull, T. J., Hurt, S. W., et al (1987) A multidimensional scaling of the DSM–III personality disorders. Archives of General Psychiatry, 44, 557–563.CrossRefGoogle ScholarPubMed
Widiger, T. A. & Frances, A. (1987) Interviews and inventories for the measurement of personality disorders. Clinical Psychology Review, 7, 49–75.Google Scholar
Wonderlich, S. A., Swift, W. J., Slotnick, H. B., et al (1990) DSM–III–R personality disorders in the eating disorder subtypes. International Journal of Eating Disorders, 9, 607–616.Google Scholar
World Health Organization (1979) International Classification of Diseases 9th revision. Geneva: WHO.Google Scholar
World Health Organization (1992) The ICD–10 Classification of Mental and Behavioural Disorders. Geneva: WHO.Google Scholar
Yager, J., Landsverk, J., Edelstein, C., et al (1989) Screening for axis–II PD in women with bulimic eating disorders. Psychosomatics, 30, 255–262.Google Scholar
Yates, W. R., Sieleni, B., Reich, J., et al (1990) Comorbidity of bulimia nervosa with personality disorder. Journal Clinical Psychiatry, 50, 57–59.Google Scholar
Zimmerman, M. & Coryell, W. H. (1990) Diagnosing personality disorders in the community. Archives of General Psychiatry, 47, 527–531.Google Scholar
Zimmerman, M., Pfohl, B., Coryell, W. H., et al (1991) Major depression and personality disorder. Journal of Affective Disorders, 22, 199–210.Google Scholar
Zubenko, G. S., George, A. W., Soloff, P. H., et al (1987) Sexual practices among patients with borderline personality disorder. American Journal of Psychiatry, 144, 748–752.Google Scholar
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