Diagnostic efficiency of DSM-IV criteria for obsessive compulsive personality disorder in patients with binge eating disorder

This study examined the diagnostic efficiency of the DSM-IV criteria for obsessive compulsive personality disorder (OCPD) in patients with binge eating disorder (BED). Two hundred and eleven consecutive adult patients with axis I diagnoses of BED were reliably assessed with semi-structured diagnostic interviews. Conditional probabilities-sensitivity, specificity, positive predictive power (PPP), and negative predictive power (NPP)-were calculated for each of the eight criteria for OCPD, using the 'best-estimate' OCPD diagnosis as the standard. The diagnostic efficiencies of the OCPD criteria were variable, with three criteria failing to have predictive value (PPP<0.50). The best inclusion criterion (highest PPP) was 'Perfectionism,' which was also the overall most predictive criterion. The findings suggest ordering of the DSM-IV criteria for OCPD based on performance and call into question the utility of some criteria.     

Factorial structure and diagnostic efficiency of DSM-IV criteria for avoidant personality disorder in patients with binge eating disorder

This study examined the factorial structure and diagnostic efficiency of the DSM-IV criteria for avoidant personality disorder (AVPD). Two hundred and twenty-eight consecutive outpatients (181 females and 47 males) with a primary diagnosis of binge eating disorder were reliably assessed with diagnostic interviews. Internal consistency of AVPD criteria was good, as suggested by coefficient alpha of 0.87, the pattern of inter-item correlations (range 0.41 to 0.64), and the lack of changes in alpha if any criteria are deleted. Exploratory factor analysis revealed a one-factor solution (56% of variance) supporting the unidimensionality of the AVPD criteria. Diagnostic efficiency indices (conditional probabilities, total predictive power, and kappa coefficients) were calculated for each AVPD criterion, for the entire study group and separately by gender. Overall, the best inclusion criterion was 'fears being ridiculed,' which was also the best predictor overall. These psychometric findings did not differ by gender. The findings support certain important aspects of the AVPD diagnosis.     

DSM-IV criteria for borderline personality disorder: A critical evaluation

The present article critically examines the diagnostic criteria for borderline personality disorder (BPD) recently proposed by the DSM-IV Axis II work group (Gunderson, J. G., et al., Journal of Personality Disorders, 5, 340–352, 1991). It is concluded that some of the revisions are trivial and there is insufficient justification for others. The revisions are likely to increase the overlap between BPD and other disorders and represent an attempt to retain a categorical classification in the face of evidence that a dimensional model is more appropriate. Evidence suggests that many borderline traits are manifestations of extreme neuroticism.     

Psychopathy and the DSM-IV criteria for antisocial personality disorder

The Axis II Work Group of the Task Force on DSM-IV has expressed concern that antisocial personality disorder (APD) criteria are too long and cumbersome and that they focus on antisocial behaviors rather than personality traits central to traditional conceptions of psychopathy and to international criteria. We describe an alternative to the approach taken in the rev. 3rd ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R; American Psychiatric Association, 1987), namely, the revised Psychopathy Checklist. We also discuss the multisite APD field trials designed to evaluate and compare four criteria sets: the DSM-III-R criteria, a shortened list of these criteria, the criteria for dyssocial personality disorder from the 10th ed. of the International Classification of Diseases (World Health Organization, 1990), and a 10-item criteria set for psychopathic personality disorder derived from the revised Psychopathy Checklist.     

Perceived dysfunction of male-typed and female-typed DSM-IV personality disorder criteria

To determine whether female-typed personality disorders are associated with a different pattern of dysfunction than male-typed disorders, lay judges (N = 216) estimated the amount of social impairment, occupational impairment, and personal distress related to symptoms of personality disorders. Results for both the subset of six disorders originally rated by clinician judges in the research of Funtowicz and Widiger (1999) and for a larger set of nine disorders revealed a pattern originally reported by Funtowicz and Widiger where female-typed disorders were associated with relatively higher ratings of personal distress, whereas male-typed disorders were associated with relatively higher ratings of social (and sometimes occupational) impairment. Findings are discussed with respect to the emphasis of different forms of dysfunction for male- and female-typed disorders, lay versus clinician judgments, and directions for future research.     

Confirmatory factor analyses of DSM-IV Cluster C personality disorder criteria

Notwithstanding its research and clinical relevance, the dimensionality and validity of the DSM-IV avoidant, dependent, and obsessive-compulsive personality disorders (PDs) criteria is still a largely unexplored topic. The aim of this study was to test the factor structure for DSM-IV Cluster C PD criteria in a sample of 641 consecutively admitted outpatients. Factor analysis results suggested that avoidant, dependent, and obsessive-compulsive PDs share a common latent dimension, and supported the three-factor structure of both observer and self-report ratings of DSM-IV Cluster C PD criteria. The pattern of factor loadings, however, was different from the one expected according to the DSM-IV classification.     

The Eating Attitudes Test: development of an adapted language form for children

The purpose of this study was to determine the comparability of scores generated by two forms of the Eating Attitudes Test, the original form for adults and an adapted language form for children. Analysis of data indicated that the adapted language form of the test can be used effectively.     

Eating patterns and breakfast consumption in obese patients with binge eating disorder

This study examined eating patterns and breakfast consumption, and their relationships to weight and binge eating, in obese individuals with binge eating disorder (BED). One-hundred seventy-three consecutively evaluated men (n=46) and women (n=127) with BED were administered semi-structured interviews and self-report measures to assess the frequency of meals and snacks eaten, as well as binge eating and eating disorder features. Overall, those who consumed more frequent meals, particularly breakfast, and snacks, weighed less. Breakfast, which was eaten on a daily basis by less than half of participants (n=74; 43%), was the least frequently eaten meal of the day. Participants (n=56; 32%) who ate three meals per day weighed significantly less, and had significantly fewer binges, than participants (n=117; 68%) who did not regularly eat three meals per day. Thus, eating more frequently, having breakfast and consuming three meals every day, have potentially important clinical applications for the treatment of BED given that the effectiveness of specific interventions within treatments for BED are unknown, and that weight loss outcome for BED has been poor.     

Reliability of the Eating Disorder Examination-Questionnaire in patients with binge eating disorder

This study examined the test-retest reliability of the Eating Disorder Examination-Questionnaire (EDE-Q) in patients with binge eating disorder (BED). Short-term (mean days = 4.8; SD = 3.6) test-retest reliability of the EDE was examined in a sample of 86 patients with BED. Test-retest reliability was excellent for objective bulimic episodes (correlation = .84), but poor to unacceptable for subjective bulimic episodes and objective overeating episodes (correlations = .51 and .39, respectively). Test-retest reliabilities were good for the EDE-Q scales (correlations = .66 to .77), albeit somewhat variable for the individual EDE-Q items (.54 to .78). These findings support the reliability of the EDE-Q for patients with BED. The EDE-Q has utility for assessing the number of binge eating episodes (objective bulimic episodes) and associated features of eating disorders in patients with BED. The results for subjective bulimic episodes are consistent with previous studies in suggesting that these eating behaviors may not be reliable indicators of eating disorders for patients with BED.     

A psychometric study of DSM-IV passive-aggressive (negativistic) personality disorder criteria

The passive-aggressive (negativistic) personality disorder (PAPD) is one of the most controversial personality disorders. In order to assess DSM-IV PAPD psychometric properties and comorbidity pattern in a mixed psychiatric sample, 379 consecutively admitted in- and outpatients were administered SCID-II, Version 2.0. Confirmatory factor analysis showed that DSM-IV PAPD is a unidimensional construct with adequate internal consistency (K-R 20 = .85). A strong, specific association (odds ratio = 10.38, 95% CI = 4.83-22.30) was observed between DSM-IV PAPD and narcissistic personality disorder (NPD). Confirmatory factor analysis showed that DSM-IV PAPD should be considered as a subtype of a broader narcissistic disorder.     

The Eating Attitudes Test (EAT-26): reliability and validity in Spanish female samples

This paper focuses on the validation of the Spanish form of the Eating Attitudes Test (EAT-26; Garner, Olmsted, Bohr & Garfinkel, 1982) across two studies. Participants in Study 1 were 778 females recruited from community settings (aged 12-21). Study 2 included 86 females recruited from clinical and 86 females from community settings (aged 12-35). Results from Principal and Simultaneous Component Analyses showed a unidimensional structure of the EAT-26 item scores. Reliability analyses supported the internal consistency of the scale. Study 1 also explores the ability of the EAT-26 to discriminate between subjects with Eating Disorder (ED), Symptomatic or Asymptomatic by means of ROC analyses and using results from the Questionnaire for Eating Disorder Diagnoses (Q-EDD; Mintz, O'Halloran, Mulholland, & Schneider, 1997) as criterion. The EAT-26 demonstrated good specificity but insufficient sensitivity to detect a full or partial ED. Study 2 explores the ability of the questionnaire to discriminate between subjects with and without ED. The EAT-26 demonstrated good specificity and moderate sensitivity to detect ED. Clinical and theoretical implications of these results are discussed.     

DSM-IV criteria for generalized anxiety disorder in older adults: distinguishing the worried from the well

This study compared 36 older adults with generalized anxiety disorder (GAD), 22 older adults with subsyndromal anxiety symptoms, and 32 normal controls on criteria of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) for GAD. GAD patients reported more frequent and uncontrollable worry, somewhat different worry content, higher prevalence of most associated symptoms, and more distress or impairment than the subsyndromal group or normal controls. Individuals with subsyndromal anxiety reported more excessive, frequent, and uncontrollable worry than asymptomatic individuals, along with more sleep disturbance, fatigue, and distress or impairment. Results indicate that the key features of late-life GAD are distress and impairment, frequency and uncontrollability of worry, muscle tension, and sleep disturbance and that clinicians treating older adults with GAD should monitor and treat residual symptoms.     

Diagnosing agoraphobia in the context of panic disorder: examining the effect of DSM-IV criteria on diagnostic decision-making

A diagnostic and statistical manual (DSM)-IV diagnosis of agoraphobia in the context of panic disorder (PD) is based on three nosologically sufficient criteria: (1) avoidance, (2) use of companions, and (3) endurance of situations despite distress. Therefore, an agoraphobia diagnosis can be made across an extremely broad range of cases including when there are no avoidance behaviors (e.g., the patient endures the situation). It was hypothesized that clinicians do not weight these criteria equally and that the DSMs individual, sufficient criteria lead to poor inter-rater reliability. Clinicians (N=48) rated hypothetical patients with symptom profiles emphasizing each of these three criteria. Consistent with expectation, clinicians differentially weighted these criteria. Avoidance was relatively more apt to produce a diagnosis when only one criterion was emphasized in clinical vignettes. Inter-rater reliability was poor in instances when only one sufficient criterion was highlighted. Knowledge concerning DSM criteria resulted in a greater rate of agoraphobia endorsement, but knowledge did not account for the overall pattern of findings.     

The dimensionality of the 12-item version of the Eating Attitudes Test. Confirmatory factor analyses

The assumed three-dimensional structure of the 12-item version of the Eating Attitudes Test was examined by confirmatory factor analysis in a non-clinical sample of 224 female and 261 male adolescents in grade 8 aged 14-15 years. Alternative models were examined. Data did neither support a three-dimensional structure, nor a one-dimensional structure using twelve items. Three dimensions were supported when one and three items were omitted from the girls' and boys' analyses, respectively. A second order factor structure was supported in both genders. Conceptual and psychometric issues are discussed. A discussion of the measurement domain of the eating problem construct in non-clinicals is warranted.     

The factor structure and criterion validity of the short form of the Eating Attitudes Test.

One of the more frequently used measures of eating disorders is the 40-item Eating Attitudes Test (EAT) developed by Garner and Garfinkel (1979). Although originally designed to diagnose anorexia nervosa, the test has recently been applied to nonclinical populations also. In this study, we examined psychometric and validity data for a short version of the scale, the EAT-26. Using a sample of 809 female soldiers in their late teens, results showed that the EAT-26 is reliable, the factor structure is different from that obtained in clinical groups, and the EAT-26 is significantly correlated with body image, weight, and diet.     

Adolescent eating disorder: bulimia

Bulimia, an eating disorder, recently has emerged as a major mental health problem, especially among adolescent females. The bulimic experiences periods of compulsive binge eating followed by purges to rid the body of unwanted calories. Binges are triggered by intense emotional experiences, such as loneliness, anger, rejection, or stress. Associated features of bulimia are secretiveness, depression, drug abuse, preoccupation with body image and sexual attractiveness, and an awareness that the behavior is abnormal. The physical side effects include dental problems, inflamed esophagus, EEG abnormalities, abdominal or urinary disturbances, and changes in blood sugar level. Cognitive disturbances related to binging and purging are perfectionistic, egocentric, and distorted thinking, misconceptions about nutritional requirements, unreasonable goals and expectations, and disturbed affect. Bulimics resist treatment; however, such methods as cognitive, group, family, behavior, and drug therapy, and hospitalization appear promising.     

Cross-system concordance of personality disorder diagnoses of DSM-IV and diagnostic criteria for research of ICD-10

The aim in this study was to examine the cross-system concordance between the personality disorders (PDs) of DSM-IV and Diagnostic Criteria for Research of ICD-10 Classification of Mental and Behavioral Disorders, 10th rev. (ICD-10) PD diagnoses were made by a structured interview in a clinical psychiatric sample of 138 individuals. Both categorical and dimensional scores for each PD were established. The frequency of patients with a PD diagnosis on either classification who were also positive on the other varied from 26% for the schizoid PDs to 88% for the histrionic PDs. The chance-corrected agreement (Cohen's kappa) ranged from .37 to .94. The dimensional correlation (Pearson's r) between pairs of PD criteria sets was in the range of .79 to .98. In conclusion, when analyzed categorically, some of the PDs of DSM-IV and ICD-10-DCR were only moderately concordant. The reasons appear to be different criteria formulations and arbitrary thresholds for diagnoses. In contrast to categorical diagnoses, dimensional agreement was high, implicating similar trait-concept definitions. The least concordant pair of PD was antisocial (DSM-IV)-dissocial (ICD-10).     

An item response theory analysis of DSM-IV personality disorder criteria across younger and older age groups

Many of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV; American Psychiatric Association, 1994) personality disorder (PD) diagnostic criteria focus on a younger social and occupational context. The absence of age-appropriate criteria for older adults forces researchers and clinicians to draw conclusions based on existing criteria, which are likely inadequate. To explore which DSM-IV PD criteria contain age group measurement bias, the authors report 2 analyses of data on nearly 37,000 participants, ages 18-98 years, taken from a public data set that includes 7 of the 10 PDs (antisocial, avoidant, dependent, histrionic, obsessive-compulsive, paranoid, and schizoid). The 1st analysis revealed that older age groups tend to endorse fewer PD criteria than younger age groups. The 2nd analysis revealed that 29% of the criteria contain measurement bias. Although the latent variable structure for each PD was quite similar across younger and older age groups, some individual criteria were differentially endorsed by younger and older adults with equivalent PD pathology. The presence of measurement bias for these criteria raises questions concerning the assessment of PDs in older adults and the interpretation of existing data.     

Night-time eating in men and women with binge eating disorder

This study examined the frequency of night-time eating (NE) and its correlates in men and women with binge eating disorder (BED). Two-hundred and seven consecutively evaluated adults (45 men and 162 women) with BED were assessed with semi-structured interviews and a battery of behavioral and psychological measures. Overall, 28% (N = 58) of the participants reported NE. A significantly higher proportion of men (42%) than women (24%) reported NE. Overall, participants who reported NE had a significantly higher body mass index, but otherwise differed little from those who did not report NE. Men and women without NE differed little on behavioral and psychological measures, whereas women with NE had significantly higher levels of eating-, weight-, and shape-concerns than men with NE.