IPDE - Extranet Systems - World Health Organization

More documents

Recommendations

Info

Problems in the field of personality disorders Alv A. Dahl and Antonio Andreoli When the World Health OrganizationAJS Alcohol, Drug Abuse and Mental Health Administration (WHOIADAMHA) decided to conduct the International Pilot Study of Personality Disorders (IPSPD), they entered one of the most controversial fields of mental disorders. Many psychiatrists have doubted the validity of personality disorders (PDs) and their diagnostic reliability has been found to be very low. Theories of their etiology have implicated constitution, genes, brain abnormalities, bad morals, poor environment, and disturbed psychological development. There are no generally accepted treatments for PDs, and their long-term outcome is often unknown. Since the introduction of DSM-I11 in 1980, however, empirical studies of PDs have flourished. The research has brought into focus many of the problems related to PDs. This chapter will describe some of them, and try to place the IPSPD and IPDE (International Personality Disorder Examination) within that context. Basic descriptions of personality Throughout history attempts have been made to identify the basic dimensions or categories that best define the essential similarities and differences among people. Hippocrates identified four basic temperaments based on the balance of the body fluids. The phrenologists stated that they were able to identify personality characteristics through the contour variations of the skull. Kretschmer and Sheldon described personality feanxes based on physique, and believed that these personality types predisposed to the major mental disorders. In 1908 Heyman and Wiersma statistically analyzed the personality traits of a great number of ordinary people, and they found that personality could be described by three orihogonal factors. The study of basic personality dimensions was later promoted by Eysenck who identified three dimensions called neuroticism, extraversion, and psychoticism. Personality psychologists later expanded these to five dimensions ('the big five'), adding conscientiousness and agreeableness.'
4 A. A. Dahl and A. Andreoli Psychoanalysis introduced a general theory of personality develop ment based on the solution of phase-specific drive conflicts during childhood. From this emerged the oral, anal, and phallic-genital personality types. As psychoanalysis progressed from a focus on drive conflicts to tbe study of ego functions, object relations, and self-development, a more interpersonal view was taken to describe conflicts and defects in personality functioning. For example, various interpersonal wishes and fears characterize the personality types described by Smith Benjamim2 Recently, a basic separation of temperament and character was proposed by Cloninger et al..' who stated that descriptive data about individual behaviour were insufficient to permit strong preferences among alternative ways of summarizing personality traits. They proposed a general psychobiological model of personality based on three temperamental and four character dimensions. Deviant personalities, psychopathies, and personality disorders The problems in describing normal personality raise the fundamental question of what the difference is between normal and abnormal personality. Disorders of personality were described in the nineteenth century, along with such concepts as character, constitution, temperament, and self.4 Pinel. in 1801, described personalities that were deviant in their emotions. Prichard, in 1835, identified patients who violated social nonns as having 'moral insanity'. He raised the fundamental question, still very important in forensic psychiatry, of whether deviant personalities are mad or bad. In 1873, Koch described personality deviance in several domains as 'psychopathic inferiorities', thereby embracing the view of More1 that those with deviant personalities are inferior to normal people. The moralistic attitude towards deviant personalities was based on this assumption, and a derogatory view of patients with PD is still quite common. From the very beginning PD was debated as a nosological entity, because of moral judgements about unacceptable personality traits, problems of their delimitation with normality, and the lack of guilt and remorse in many such patients. Because individuals with PD often did not consider themselves mentally ill, their diagnosis was less reliable than it was for many other mental disorders. SchneiderJ proposed the view that personality traits are continuously distributed, the extreme deviations of a trait being pathological, if the individual or society suffered because of them. His 10 types of PD illustrate the fundamental arbihariness of categorical classification of abnormal
Page 2 and 3: Until recently, the standardization
Page 4 and 5: Assessment and diagnosis of persona
Page 6 and 7: Contents Contributors Preface Annan
Page 8 and 9: Contributors Dr Antonio Andreoli Ho
Page 10 and 11: Preface One of the major goals of t
Page 12 and 13: ... Xlll Acknowledgements The IPDE
Page 16 and 17: 5 Problems in the field of PD perso
Page 18 and 19: 7 Problems in the field of PD In DS
Page 20 and 21: 9 Problems in the field of PD cultu
Page 22 and 23: 11 Review of diagnostic instruments
Page 30 and 31: 19 Epidemiology of DSM-Ill PDs in c
Page 32 and 33: Table l. Prevalence rates of specif
Page 35 and 36: 24 1. H. Reich and G. de Girolamo (
Page 37 and 38: 26 .- 5 2 0 W C .- 0 P g F ? g e Q
Page 39 and 40: 28 J. H. Reich and G. de Girolarno
Page 41 and 42: Table 3. Prevalence rates ofpersona
Page 44 and 45: Pfohl etal.. l986 (67) Pilgrim & Ma
Page 46 and 47: 35 Epidemiology of DSM-Ill PDs were
Page 48 and 49: 37 Epidemiology of DSM-Ill PDs migh
Page 50 and 51: 39 Epidemiology of DSM-Ill PDs 23 R
Page 52 and 53: 4 1 Epidemiology of DSM-Ill PDs 55
Page 54 and 55: 43 International personality disord
Page 56 and 57: I 45 IPDE iner what he is actually
Page 58 and 59: 47 IPDE Sample of IPDE item The que
Page 60 and 61: 49 IPDE dimensional scores are not
Page 62 and 63: 1 9 IPDE considerable training and
Page 64 and 65:
53 Experiences with IPDE The invest
Page 66 and 67:
55 Experiences with IPDE passive ag
Page 68 and 69:
57 Field Trial
Page 70 and 71:
59 Sampling, inte~iewers, interview
Page 72 and 73:
Description of centres participatin
Page 74 and 75:
63 Centres participating in IPDE fi
Page 76 and 77:
Page 78 and 79:
Page 80 and 81:
Page 82 and 83:
P- P Table 1. Sample sizes and IPDE
Page 84 and 85:
73 Results Table 3. ICD-I0 Disorder
Page 86 and 87:
75 Results Table 5. Frequency of CO
Page 88 and 89:
77 Results Table 8. Interrater reli
Page 90 and 91:
Discussion and conclusions Armand W
Page 92 and 93:
8 1 Discussion and Conclusions stab
Page 94 and 95:
83 Discussion and Conclusions Repet
Page 96 and 97:
Discussion and Conclusions of princ
Page 98 and 99:
87 Discussion and Conclusions Frequ
Page 100 and 101:
89 Discussion and Conclusions emoti
Page 102 and 103:
9 1 Discussion and Conclusions inte
Page 104 and 105:
93 Appendix Table A2 Persomlity dis
Page 106 and 107:
95 Appendix Table A4 Personality di
Page 108 and 109:
97 Appendix Table A6 Personaliry di
Page 110 and 111:
99 Appendix Table SA Personaliry di
Page 112 and 113:
Table A10 Personality disorder diag
Page 114 and 115:
103 Appendix Table A12 Personality
Page 116 and 117:
Table A13 (con?) Criterion B7 B8 1
Page 118 and 119:
107 Appendix Table A13 (cont) Frequ
Page 120 and 121:
109 Appendix Table A14 (cont.) Freq
Page 122 and 123:
Acknowledgements 113 Manual History
Page 124 and 125:
Manual History of the IPDE One of t
Page 126 and 127:
116 Manual Struchlre of the IPDE Th
Page 128 and 129:
118 Manual that is likely to enhanc
Page 130 and 131:
120 Manual data. If examiners have
Page 132 and 133:
122 Manual Scoring conventions Much
Page 134 and 135:
124 Manual Recording the scores Req
Page 136 and 137:
126 Manual Q. What do you do when s
Page 138 and 139:
128 Manual section, if there are qu
Page 140 and 141:
ICD-10 criteria and corresponding I
Page 142 and 143:
132 ICD-10 criteria and correspondi
Page 144 and 145:
134 IPDE ICD-10 module screening qu
Page 146 and 147:
136 Screening questionnaire 47 1 lo
Page 148 and 149:
I 138 IPDE ICD-10 module* interview
Page 150 and 151:
140 Interview schedule 2. 0 1 2 7 0
Page 152 and 153:
142 Inte~iew schedule 4. O 1 2 I N
Page 154 and 155:
144 Interview schedule 6. O l Z ? 0
Page 156 and 157:
146 Interview schedule 8. 0 1 2 1 0
Page 158 and 159:
148 Interview schedule .10. 0 1 2 ?
Page 160 and 161:
150 Interview schedule 12. 0 1 2 7
Page 162 and 163:
152 lnte~iew schedule 14. 0 1 2 ? 0
Page 164 and 165:
154 Interview schedule 16. 0 1 2 ?
Page 166 and 167:
156 interview schedule 18. 0 1 2 ?
Page 168 and 169:
158 Interview schedule 20. O 1 2 N
Page 170 and 171:
Page 172 and 173:
Page 174 and 175:
164 Interview schedule *26. 0 1 2 ?
Page 176 and 177:
166 lntewiew schedule 28. 0 1 2 ? 0
Page 178 and 179:
Page 180 and 181:
170 lnte~iew schedule 32. O 1 2 7 N
Page 182 and 183:
Page 184 and 185:
174 lntewiew schedule 36. 0 1 2 ? 0
Page 186 and 187:
176 lnterv~ew schedule 38. 0 1 2 ?
Page 188 and 189:
Page 190 and 191:
Page 192 and 193:
Page 194 and 195:
184 lnte~iew schedule 46. 0 1 2 7 0
Page 196 and 197:
~ 186 Interview schedule 48. 0 1 2
Page 198 and 199:
Page 200 and 201:
Page 202 and 203:
Page 204 and 205:
194 Interview schedule 56. 0 1 2 1
Page 206 and 207:
196 Interview schedule VI. IMPULSE
Page 208 and 209:
Page 210 and 211:
200 Interview schedule Have you eve
Page 212 and 213:
202 Interview schedule 1 63. 0 1 2
Page 214 and 215:
204 Intewiew schedule Rate the foll
Page 216 and 217:
206 IPDE ICD-10 module handscoring
Page 218 and 219:
+ 39+44=4, 208 Handscoring algorith
Page 220 and 221:
210 Handscoring algorithms and summ
Page 222 and 223:
Page 224 and 225:
Page 226 and 227:
Page 228 and 229:
Page 230 and 231:
Page 232 and 233:
IPDE ICD-10 module summary scoreshe
Page 234 and 235:
224 Index paranoid 108 schizoid 108
Page 236 and 237:
226 Index Personalily Assessment Sc
show all

IPDE - Extranet Systems - World Health Organization

Create successful ePaper yourself

Delete template?

Save as template?