Differentiating avoidant and depressive personality disorders

The purpose of this study was to test a priori predictions about the way in which avoidant personality disorder (APD) can be differentiated from depressive personality disorder (DPD) in a clinical population. Psychiatric outpatients were administered two measures of DPD, including the SCID-II for other DSM-IV Axis II personality disorders, along with criterion measures upon which the two disorders would be differentiated. APD was found to be most strongly associated with state and trait measures of anxiety, while DPD was most strongly associated with state and trait measures of hostility. Individuals with DPD had higher mean scores on measures of hostility than those without DPD, and individuals with APD had higher mean scores on measures of anxiety than those without APD. However, DPD measures were also significantly correlated with state and trait measures of anxiety and APD with measures of depressive symptoms. Furthermore, anxiety was found to be higher in some groups of individuals with DPD than those with APD. It is concluded that the level of hostility in this DPD population appears to be an important symptom by which to differentiate the two disorders and that a reconsideration of including DPD criterion #4 -- prone to brooding and worrying -- may be justified. Furthermore, the SCID-II interview may be better at differentiating DPD and APD than a self-report measure of DPD.     

Divergent ethical perspectives on the duty-to-warn principle with HIV patients

This article presents the case of an HIV-positive client who reported having sexual relations with an unknowing partner. The issue raised is whether the therapist was required to warn the unknowing partner, similar to the Tarasoff mandate that is imposed on therapists. The case is analyzed from an ethical framework similar to that presented by Beauchamp and Childress (1994). Two opinions are presented, each leading to different conclusions about whether the therapist should inform the unknowing partner. It is concluded that although such analysis is valuable in aiding the therapist in his or her decision-making process, no clear professional standard for the management of the problem is evident.     

Should self-defeating personality disorder be revisited in the DSM?

Self-defeating personality disorder (SDPD) was proposed for consideration in the DSM-III-R, but was eventually removed from the manual because of the lack of evidence to support its validity. Yet, after DSM-IV was published, some studies suggested that SDPD may be a viable diagnosis. The purpose of this study was to evaluate SDPD's viability as a diagnostic category. Consequently, SDPD's internal consistency, comorbidity with other Axis I and II disorders, association with psychosocial impairment, and its ability to predict overall impairment in past, current, and global levels of functioning beyond other personality disorder symptomatology was assessed in 1,200 psychiatric evaluated with the Structured Clinical Interview for DSM-IV Personality (Pfohl, Blum, & Zimmerman, 1997). Cronbach's alpha for SDPD criteria was 0.61, and item-total correlations ranged between 0.22-0.38. There was substantial comorbidity of SDPD with depressive, avoidant, and borderline personality disorders, as well as major depression and anxiety disorders. The SDPD group did not significantly differ from psychiatric controls on multiple measures of psychosocial impairment, global functioning, and suicidality. SDPD did not meaningfully add to the prediction of impairment above and beyond other measures of Axis II pathology. It is concluded that the data do not support the reliability, validity, and utility of the SDPD diagnosis.     

Do DSM-5 personality disorder proposals meet criteria for clinical utility?

The Work Group for the DSM-5 personality disorders has submitted their proposal to the professional community. In this paper, we consider the proposal in light of its ability to meet criteria for clinical utility as proposed by First and colleagues (2004). While the Work Group's proposal has addressed some of these concerns, we conclude that there remain several unanswered problems with how the proposal will improve the clinical utility of personality disorders section of the DSM-5. Though these concerns can be addressed to some extent in the field trials, it is incumbent upon the Work Group and clinical researchers to attend carefully to these issues so that shortcomings of previous diagnostic manuals are not repeated in the future.     

Evaluating NEO Personality Inventory-Revised profiles in veterans with personality disorders

Fifty-one psychiatric, veteran outpatients were assessed for personality disorders on the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II; First, Gibbon, Spitzer, Williams, & Benjamin, 1997a) and were also administered the NEO Personality Inventory-Revised (NEO-PI-R; Costa & McCrae, 1992). Results were compared to Trull and Widiger's (1997) hypotheses about the profiles of such patients and similar past studies. Correlations between NEO-PI-R facets and SCID-II personality disorder symptom clusters generally occurred in the expected direction. Facets hypothesized to be associated with a given personality disorder were able to predict variance in their respective SCID-II personality disorder scores for seven of ten personality disorders. In general, results support the facet-level conceptualizations of these disorders, except for Obsessive-Compulsive Personality Disorder.     

Construct validity of the relationship profile test: three-year retest reliability and links with core personality traits, object relations, and interpersonal problems

The Relationship Profile Test (RPT; Bornstein & Languirand, 2003) is a 30-item self-report measure of destructive overdependence, dysfunctional detachment, and healthy dependency. Previous research has shown that the 3 RPT subscales have adequate internal consistency, good retest reliability over 23 and 85 weeks, and good convergent and discriminant validity with respect to measures of attachment style, relatedness, gender role, self-concept, alexithymia, locus of control, need for approval, and life satisfaction. In this investigation, we assessed the 3-year retest reliability of RPT scores in a northeastern liberal arts college student sample (Study 1) and evaluated the convergent and discriminant validity of RPT scores in a southern university sample (Study 2). Results generally supported the long-term stability and convergent and discriminant validity of RPT scores but also pointed to some limitations of the measure. We discuss implications of these results and describe future research directions.     

Psychometric evaluation of the depressive personality disorder inventory

The purpose of this study was to evaluate the psychometric properties of the Depressive Personality Disorder Inventory (DPDI; Huprich, Margrett, Barthelemy, & Fine, 1996). The DPDI was found to have strong internal consistency in both an undergraduate and a veteran, psychiatric outpatient population. The DPDI had significant, positive correlations with other measures of depressive personality, supporting its convergent validity. These relationships remained even after controlling for state-like depression, suggesting that the DPDI has incremental validity. The DPDI also significantly predicted scores on measures of interpersonal loss, even after controlling for state-like depression, suggesting that the DPDI has good construct validity. In support of discriminant validity, the DPDI was more correlated with another measure of depressive personality than it was with measures of other personality disorders. Finally, the DPDI had strong diagnostic efficiency statistics: (a) Sensitivity = .82, (b) Specificity = .80, (c) Positive Predictive Power = .75, (d) Negative Predictive Power = .86, and (e) Overall Diagnostic Power = .81. It appears that the DPDI has good psychometric properties.