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19 Epidemiology of DSM-Ill PDs in community samples, and used assessment instruments specific for PD."'They will be briefly reviewed separately. In a random sample of 200 people selected from urban and mm1 communities and assessed with the Personality Assessment Schedule (PAS), a PD was found in 26 subjects (13%)? Explosive PD was the most common type. There were no differences between urban and rural samples, or between men and women among the 16 (8%) identified as psychiatric cases on the Resent State Examination (PSE), more than half of whom also had a PD. Social functioning was worse in those with PD than in those with a normal personality, with no significant differences among the different categories of PD. Maier et al.1° surveyed an unscreened sample of 109 families for lifetime diagnoses of both Axis I disorders and PD. Among 447 subjects who were personally interviewed with the Schedule for Affective Disorders and Schizophrenia-Lifetime Version (SADS-L) and the Structured Clinical Interview for DSM-III-R (SCID-U), they found rates of PD comparable to the other studies. The rate among males was 9.9% and among females 10.5%, and it was higher in younger than in older subjects. Significant associations between current Axis I disorders and PD were observed, in particular anxiety disorders with avoidant PD. and affective disorders with borderline PD. In a community sample of 235 adults surveyed with a self-administered instrument, the Personality Diagnostic Questionnaire (PDQ), 26 were diagnosed as having a PD. yielding an age-adjusted prevalence of 11.1%." A history of alcohol abuse, poor employment, and marital problems was more common in the group with PDs. The age and sex distribution of the DSM-111 personality cluster traits was also assessed." Traits in the schizoid cluster were not associated with age, while those in the dramatic and the anxious clusters were. Women aged 31 to 40 and men aged 18 to 30 had the highest rate of PDs. Women aged 31 to 40 had a higher mean number of traits than their male counterpm, and also a corresponding increase in impairment. In a study by Zimmerman and Coryell, 697 relatives of psychiatric patients and healthy controls who were interviewed with the Structured Interview for Personality Disorders (SIPD) also took the PDQ.12 More had a PD according to the interview than the questionnaire (13.5% vs 10.33%). Schizotypal, histrionic, antisocial and passive-aggressive were the most frequent diagnoses from the SIDP, while dependent PD and multiple diagnoses were more frequent using the PDQ. One conclusion from this study that is especially relevant to the present review, is that
20 1. H. Reich and G. de Girolamo questionnaire and interview assessments of PD generally show a poor concordance. Therefore, the type of assessment can strongly affect the rate of a disorder. To summarize, although different investigators have used different instmments and populations, the prevalence of PD ranged from 10.3% to 13.5%. a highly consistent prevalence rate of PD in the community. The rate seems to vary with age. with a slight decrease in older age-groups. Urban populations and lower socioeconomic groups showed higher rates. Although the sex ratio is different for specific types of PD. the overall rates of PD are about equal for the two sexes. Community epidemiological studies of specified personality disorders Table 1 lists the prevalence rates for specific PDs. The majority of the estimates come From three st~dies.l~,~~~~ In addition, data on the prevalence of some specified PDs have been reported by Baron et al.,14 who assessed 750 first-degree relatives of chronic schizophrenics (n = 376) and normal control probands (n = 374). They administered the subjects the SADS, the Schedule for Interviewing Borderlines (SIB) and additional items to diagnose other specific PDs, for which the two interview schedules did not provide adequate coverage. Paranoid Reich er al.15 and Zimmerman and C~ryell'~ have found comparable rates, ranging from 0.4% to 0.8%. while Maier et ~1.'~ found slightly higher rates, 1.8%. Baron et al.I4 found a significantly higher rate of paranoid PD among relatives of schizophrenic probands (7.3%) than among relatives of control probands (2.7%). This disorder seems to be more frequent among the members of the lower social classes. Schizoid Maier et a1.,I0 Reich et al..IS and Zimmennan and Coryelllz reported rates ranging from 0.4% to 0.9%. Baron er al.I4 reported a rate of 1.6% among relatives of schizophrenic probands and to no cases among relatives of control probands. Reich et al." and Zimmerman and C~ryell'~ reported rates of 3.0% and 5.6% respectively, while Maier er al.l0 found a substantially lower rate
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 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
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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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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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