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17 Review of diagnostic instruments 22 Repko, G.R. & Cooper, R. TIK diagnosis of personality disorder: A comparison of MMPl profile, Millon Inventory, and clinical judgment. Jouml of Clinical Psychology. 1985; 41: 867. 23 Hyler, S.E. & Rieder. R.O. PDQ-R Personalify Quesrwnnaire. New York: New YorkState Psychiatric Institute, July 15,1986. 24 Hun. S.W., Hyler, S.E., Frances. A. et al. Assessing borderline personality disorder with self-report, clinical interview or semismctured interview. Amrican JoumnlofPsychiatry, 1984; 141: 1228. 25 Hyler. S.E., Rieder, R.O.. Williams, J.B.W. et al. A comparison of clinical and self-report diagnoses of DSM-U1 personality disorders in 552 patients. Comprehensive Psychiatry, 1989; 30: 170. 26 Pfohl, B., Ban'ash, l., True, B. & Alexander. B. Failure of two Axis I measures to predict medication noncompliance among hypertensive patients. Jouml of Perso~lify Disorders, 1989; 3: 45. 27 Dubro, A.. Wetzler, S. & Kahn. M.W. A comparison of three self-report questionnaires for the diagnosis of DSM-111 personality disorders. Journal of Perso~lity Disorders. 1988; 2: 256. 28 Cloninger, C.R. A systematic method for clinical description and classification of personality variants. Archives of General Psychiatry, 1987: 44: 573-88. 29 Cloninger, C.R., Svmkic, D.M. & Przybeck, T.R. A psychobiological model of temperament and character. Archives of General Psychiatry, 1993; 50: 975-90. 30 Svrakic, D.M., Whitehead. C.. Pnybcck. T.R. & Cloninger, C.R. Differential diagnosis of personality disorders by the seven-factor model of temperament and character. Archives of GeneralPsychiatry. 1993: 50: 991-99.
Epidemiology of DSM-Ill personality disorders in the community and in clinical populations lames H. Reich and Giovanni de Girolamo Although the early Greek philosophers wondered about the influence of personality on health, it is only recently that the epidemiology of personality disorders (PDs) has begun to be scientifically investigated. This is because we have now developed a number of standardized instruments to assess personality and PD in an empirical fashion. The first comprehensive epidemiologic reviews in the English language have only been published since the mid-1980~.'~ The need for the epidemiological investigation of PD seems justified for several reasons: firstly, as seen in the most recent epidemiological surveys, PDs are frequent and have been found in different countries and sociocultural settings: secondly, PDs can seriously impair the life of the affected individual and can be highly disruptive to societies, communities. and families; thirdly, personality status is often a major predictive variable in determining the outcome of psychiatric disorders and the response to ~eatment.~.~ In this chapter we review the main epidemiological literature on PDs up to the end of 1993, focusing mainly on studies employing DSM-ILI or DSM-111-related measures of personality. Firstly community prevalence studies of PD will be reviewed. We then look at the prevalence of individual PDs in the community. Finally, we consider PDs in psychiatric populations. Many of the DSM-111 categories of PD have counterparts in the ICD-I0 classification; however, when this chapter was being written, there were no studies yet which directly employed ICD-10 criteria. For those interested in the literature prior to DSM-I11 and ICD-10. Nengebauer et al.' reviewed 20 epidemiological psychiatric studies carried out in Europe and North America since 1950. They found an average prevalence rate for PD of 7%. However, their estimate included alcoholism and drug abuse among the PDs. A few years later Pemy and Vaillant8 suggested that between 5 and 15% of the adult population can be expected to manifest PDs. Four recently published studies ascertained the prevalence rate of PD
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
Page 74 and 75: 63 Centres participating in IPDE fi
Page 76 and 77: 65 Centres participating in IPDE fi
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67 Centres participating in IPDE fi
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69 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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148 Interview schedule .10. 0 1 2 ?
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150 Interview schedule 12. 0 1 2 7
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158 Interview schedule 20. O 1 2 N
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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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