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13 Review of diagnostic instruments also emerged: explosive (impulsive), sensitive aggressive, histrionic, asthenic, anxious, paranoid, hypochondriacal, dystbymic, and avoidant. Interrater agreement in rating the 24 amibutes on a dimensional scale is reported to be generally good, as has that for the diagnosis of a PDper se. Poor agreement, however, has been found between patients and informants, and some studies have used an arbitraq and complicated set of guidelines to determine which information to use. The 24 personality dimensions on the PAS are neither described in detail nor defined by specific criteria. They are rated according to the degree of social impairment they produce. This is a departure from DSM-III-R and ICD-10, which include subjective distress as well as social impairment in the definition of a personality disorder, although both are not required for a diagnosis. The PAS mandates social impairment and is not directly concerned with subjective distress. The assumption is that if subjective distress is high enough to be indicative of a personality disorder, then marked social impairment will be present. The PAS also follows a hierarchical system of diagnosis that identities the disorder with the greatest social impairment as the primary one. Although the PAS was not developed to assess the PDs in DSM-III-R or ICD-10, it does provide algorithms for making diagnoses in those systems. It is not known, however, whether the algorithms will identify the same cases as those interviews based on the criteria themselves. Standardized Assessment of Pe~~onality (SAP) The SAP1"s a short semisrmcmd interview developed by Pilgrim and Mann, and designed for use with a relative or close friend of a patient. It takes 10-15 minutes to administer. The informant is asked to describe the patient's personality prior to illness, and a series of probes explores specific areas of personality. Although it claims to assess PDs in the ICD-10 and DSM-III-R classification systems, it does not systematically survey the more than 100 criteria on which those two systems are based. It has had limited use so far, other than by its developers. Personality Disorder Inventories Millon Clinical Multiaxial Inventory (MCMI) The MCMI is unique in that it is based on the author's own theory of personality and psychopathology and also claims to be congruent with the
14 A. W. Loranger DSM-111-R nosology. It is not considered suitable for use with normals. The latest version (MCMI-11)" consists of 175 true-false items aggregated in 20 clinical scales. These in turn are organized into three broad categories: persistent personality features, current symptom states, and levels of pathology. Norms for the test are based on several groups of normal subjects and numerous clinical samples. They include base rate scores calculated from prevalence data. The claim that it maps the domain of DSM-111 Axis I1 has been challenged and remains to be demonstrated."-18 Although more research on this subject needs to be done, efforts so far to establish a correspondence between the MCMI and the clinical diagnosis of PDs have been di~appointing.'~-~~ Personality Diagnostic Questionnaire (PDQ-R) In its revised form the PDQ-R is a 189-item true-false questionnaire developed by Hyler and ass~ciates.~' The content is keyed to the DSM- 111-R personality disorders. One or more items are devoted to each Axis I1 criterion, and the wording is close to the criteria. For example, the borderline criterion, 'Inappropriate, intense anger or lack of control of anger,' is assessed by these two statements: 'I rarely get so angry that I lose control' (false) and 'I've often gotten into more real physical fights than most people' (true). A borderline diagnosis is given when the respondent answers at least one of the items that sample each of the five or more criteria required for the diagnosis in the DSM-111-R. As with the MCMI, studies have generally found a poor correspondence between the PDQ and personality diagnoses made by clinicians with and without semistructured inte~views.~'27 Tridimensional Personality Questionnaire (TPQ) The TPQ,28 developed by Cloninger is a 100-item self-report inventory that measures three major personality dimensions: novelty seeking, harm avoidance, and reward dependence. The inventory is based on a theoretical biosocial model that integrates neuroanatomical and neurophysiological constructs with learning styles and three personality dimensions. Normative data are based on a US sample of 1019 adults. The TPQ is available in a number of languages. Novelty seeking has four subscales: exploratoly excitability vs stoic rigidity (9 items), impulsiveness vs reflection (8 items), extravagance vs reserve (7 items), and disorderliness vs regimentation (10 items). Harm
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 14 and 15: Problems in the field of personalit
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
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63 Centres participating in IPDE fi
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P- P Table 1. Sample sizes and IPDE
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73 Results Table 3. ICD-I0 Disorder
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75 Results Table 5. Frequency of CO
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77 Results Table 8. Interrater reli
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Discussion and conclusions Armand W
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8 1 Discussion and Conclusions stab
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83 Discussion and Conclusions Repet
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Discussion and Conclusions of princ
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87 Discussion and Conclusions Frequ
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89 Discussion and Conclusions emoti
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9 1 Discussion and Conclusions inte
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93 Appendix Table A2 Persomlity dis
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95 Appendix Table A4 Personality di
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97 Appendix Table A6 Personaliry di
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99 Appendix Table SA Personaliry di
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Table A10 Personality disorder diag
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103 Appendix Table A12 Personality
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Table A13 (con?) Criterion B7 B8 1
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107 Appendix Table A13 (cont) Frequ
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109 Appendix Table A14 (cont.) Freq
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Acknowledgements 113 Manual History
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Manual History of the IPDE One of t
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116 Manual Struchlre of the IPDE Th
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118 Manual that is likely to enhanc
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120 Manual data. If examiners have
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122 Manual Scoring conventions Much
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124 Manual Recording the scores Req
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126 Manual Q. What do you do when s
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128 Manual section, if there are qu
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ICD-10 criteria and corresponding I
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132 ICD-10 criteria and correspondi
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134 IPDE ICD-10 module screening qu
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136 Screening questionnaire 47 1 lo
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I 138 IPDE ICD-10 module* interview
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140 Interview schedule 2. 0 1 2 7 0
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142 Inte~iew schedule 4. O 1 2 I N
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144 Interview schedule 6. O l Z ? 0
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146 Interview schedule 8. 0 1 2 1 0
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148 Interview schedule .10. 0 1 2 ?
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150 Interview schedule 12. 0 1 2 7
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152 lnte~iew schedule 14. 0 1 2 ? 0
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154 Interview schedule 16. 0 1 2 ?
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156 interview schedule 18. 0 1 2 ?
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158 Interview schedule 20. O 1 2 N
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164 Interview schedule *26. 0 1 2 ?
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166 lntewiew schedule 28. 0 1 2 ? 0
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170 lnte~iew schedule 32. O 1 2 7 N
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174 lntewiew schedule 36. 0 1 2 ? 0
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176 lnterv~ew schedule 38. 0 1 2 ?
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184 lnte~iew schedule 46. 0 1 2 7 0
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~ 186 Interview schedule 48. 0 1 2
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194 Interview schedule 56. 0 1 2 1
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196 Interview schedule VI. IMPULSE
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200 Interview schedule Have you eve
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202 Interview schedule 1 63. 0 1 2
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204 Intewiew schedule Rate the foll
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206 IPDE ICD-10 module handscoring
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+ 39+44=4, 208 Handscoring algorith
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210 Handscoring algorithms and summ
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IPDE ICD-10 module summary scoreshe
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224 Index paranoid 108 schizoid 108
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226 Index Personalily Assessment Sc
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