Comparing the Personality Disorder Interview for DSM–IV (PDI–IV) and SCID–II Borderline Personality Disorder Scales: An Item–Response Theory Analysis

One-hundred sixty-nine psychiatric outpatients and 171undergraduate students were assessed with the Personality Disorder Interview–IV (PDI–IV; Widiger, Mangine, Corbitt, Ellis, & Thomas, 1995) and the Structured Clinical Interview for DSM–IV Axis II disorders (SCID–II; First, Gibbon, Spitzer, Williams, & Benjamin, 1997) for borderline personality disorder (BPD). Eighty individuals met PDI–IV BPD criteria, whereas 34 met SCID–II BPD criteria. Dimensional ratings of both measures were highly intercorrelated (rs = .78, .75), and item-level interrater reliability fell in the good to excellent range. An item–response theory analysis was performed to investigate whether properties of the items from each interview could help understand these differences. The limited agreement seemed to be explained by differences in the response options across the two interviews. We found that suicidal behavior was among the most discriminating criteria on both instruments, whereas dissociation and difficulty controlling anger had the 2 lowest alpha parameter values. Finally, those meeting BPD criteria on both interviews had higher levels of anxiety, depression, and more impairments in object relations than those meeting criteria on just the PDI–IV. These findings suggest that the choice of measure has a notable effect on the obtained diagnostic prevalence and the level of BPD severity that is detected.     

Psychodynamic Conceptualization and Treatment of Suicidal Patients

This paper discusses psychodynamic perspectives to the conceptualization and treatment of suicidal patients. A review of psychoanalytic and psychodynamic conceptualizations is provided, along with representative case examples of these phenomena. Empirical studies are also reviewed, noting how recent research provides some meaningful insight into the object relations of suicidal patients. Finally, treatment issues are discussed, including comments about transference, dreams, and countertransference. It is concluded that a psychodynamic model is of value when treating patients with suicidal ideation and impulses.     

Beyond dysfunction and threshold-based classification: a multidimensional model of personality disorder diagnosis

An alternative dimensional model of personality disorder (PD) diagnosis that addresses several difficulties inherent in the current DSM conceptualization of PDs (excessive PD overlap and comorbidity, use of arbitrary thresholds to distinguish normal from pathological personality functioning, failure to capture variations in the adaptative value of PD symptoms, and inattention to the impact of situational influences on PD-related behaviors) is outlined. The model uses a set of diagnostician-friendly strategies to render PD diagnosis in three steps: (1) the diagnostician assigns every patient a single dimensional rating of overall level of personality dysfunction on a 50-point continuum; (2) the diagnostician assigns separate intensity and impairment ratings for each PD dimension (e.g., narcissism, avoidance, dependency); and (3) the diagnostician lists any personality traits-including PD-related traits-that enhance adaptation and functioning (e.g., histrionic theatricality, obsessive attention to detail). Advantages of the proposed model for clinicians and clinical researchers are discussed.     

Convergent and discriminant validity of three measures of depressive personality disorder

Sixty-eight outpatients from a veterans' administration psychiatry clinic and community mental health center were assessed with 3 measures of depressive personality disorder (DPD)-the Diagnostic Interview for Depressive Personality Disorder (Gunderson, Phillips, Triebwasser, & Hirschfeld, 1994), the Depressive Personality Disorder Inventory (Huprich, Margrett, Barthelemy, & Fine, 1996), and the Structured Clinical Interview for DSM-IV Axis II Disorders (First, Gibbon, Spitzer, Williams, & Benjamin, 1997a)-to evaluate their convergent and discriminant validity. Evidence supporting the measures' validity was mixed. The rate of convergence of depressive personality diagnoses across 3 measures was less than optimal, but the degree of intercorrelation among the measures was strong. Although depressive personality scores had moderate levels of intercorrelations with other personality disorders, the degree of intercorrelation decreased substantially after controlling for depressive symptoms. I conclude that further work is needed to strengthen the validity of measures of DPD.     

An overview of issues related to categorical and dimensional models of personality disorder assessment

Despite long-standing efforts to improve the current diagnostic system for Axis II, problems remain with the categorical conceptualization of personality disorders (PDs). Due in part to these problems, interest has developed in dimensional models of PD classification. In this article, we discuss four issues relevant to categorical vs. dimensional assessment of PDs: (a) problems with self-reports in PD patients, (b) methodological issues in behavioral and clinician assessment of PDs, (c) challenges that arise when dimensional models are applied to patient and nonpatient samples, and (d) clinical implications of categorical and dimensional PD models. We suggest that researchers and clinicians address these concerns to avoid implementing a new PD assessment model that-although different from the current system-would otherwise remain fraught with difficulties.     

Construct Validity of the Relationship Profile Test: Correlates of Overdependence,Detachment, and Healthy Dependency in Low Income Urban Women Seeking Medical Services

Four categories of paintings (N = 200), done by schizophrenic patients, art students, and education students were rated by judges (N = 13) as to whether the painter was schizophrenic or normal. There was significant agreement in correctly identifying paintings, but the percent correct, greater than chance, was only 9.99%. Judges did best on paintings with “human content.” Intelligence scores were related to correct identification of two paintings, while art experience related to proportion was judged schizophrenic for all four paintings. Stepwise regression analysis suggested that intelligence scores were artifactually related to painting scores but art experience was not.     

Affect regulation and Depressive Personality Disorder

Depressive Personality Disorder (DPD) has been under consideration for inclusion in the Diagnostic and Statistical Manual of Mental Disorders since 1994; yet, few studies have been published that test whether those with DPD have affective experiences that are characterized exclusively by depression and negative affect. One hundred ninety-seven undergraduate students were interviewed for DPD and Borderline Personality Disorder with the Personality Disorder Interview for DSM-IV (Widiger, Mangine, Corbitt, Ellis, & Thomas, 1995), in order to control for frequently co-occurring BPD which is characterized by affective lability. Participants also were administered measures of affective lability, affective intensity, anxious and depressive states, and more trait-like manifestations of depression, anxiety, and anger. Results indicate that those with DPD may be described as having a mood state characterized by transitions from a baseline neutral mood to one of anxiety, with their experiences being more prominently depressed and dysphoric. They also have tendencies toward angry hostility, though they may not report frequent shifts from a baseline neutral mood to anger. Those with DPD also report intense, frequent experiences of depression and dysphoria, with many shifts between depression and anxiety.