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35 Epidemiology of DSM-Ill PDs were the most frequent and cluster A patients the least." There was highly significant demographic variation manifest across PD clusters. In the only study which investigated PD rates among those seen in a private psychiatric practice (N = 486). they were diagnosed in 39% of the patients seen.'= Borderline (9.7%) and obsessive-compulsive (8.2%) were the most frequently observed. Some studies have compared the hospital admission rates for PD over time, and they allow us to assess the impact of diagnostic changes. Mors36 has shown that in Denmark sex- and age-standardized rates of first-admitted borderlines significantly increased during the 16-year interval 197&85. There was no sex difference, but the age group 15-34 especially contributed to the increase, which was particularly remarkable in urban areas, and might be explained in terms of a change in diagnostic habits. This hypothesis received support from another analysis of Danish admissions to psychiatric institutions in the years 1975. 1980, and 1985. In those years the increase in borderline diagnosis (5% to 20%) in men paralleled a decrease in the diagnosis of psychopathy (22% to 7%):' The authors suggest that those previously diagnosed as psychopathic deviants were subsequently labelled borderlines. The shift in diagnosis was less marked for females. This same phenomenon, i.e., a change in diagnostic practice has been studied at one of the largest university-affiliated psychiatric hospitals in the USAJ8 Comparing the diagnoses given to hospitalized patients in the last five years of the DSM-II era (N = 5143) with those given in the first five years of the DSM-I11 era (N = 5771). a marked increase was found in the diagnosis of PD, together with a decrease in the diagnosis of schizophrenia, and a corresponding increase in the diagnosis of affective disorders. The percentage of patients with a diagnosis of PD (19.1% to 49.2%) increased more than twofold. The most frequent diagnostic categories employed since the introduction of the DSM-111 were atypicaUmixedlother PD (33%) and borderline (27%). Another study assessed the proportion of patients with PD among all hospitalized cases of non-psychotic mental disorders in military personnel in the US Navy from 1981-1984.39 The overall sample included 27,210 cases. Among them, 4581 (16.8%) had a PD as the primary diagnosis. In New Zealand a survey was made of all patients admitted to psychiatric hospitals over a seven year period with an ICD-9 primary diagnosis of personality disorders (N = 6447).40 Despite a decrease in the total number of admissions, the relative totals for each personality disorder remained consistent. The most common diagnosis was an unspecified
36 J. H. Reich and G. de Girolamo PD. and it accounted for 45% of the total sample. The next most wmmon was asthenic PD. In the US on a selected day in 1986, there were a total of 3893 persons under care in some in-patient psychiatric facility, with a primary diagnosis of PD. This corresponded to 2.4% of the total number of in-patients on that date.41 In the same year there were 29,910 admissions with a primary diagnosis of PD. 1.9% of all admissions. The median length of hospital stay for in-patients with a diagnosis of PD was nine days. Among all those under out-patient care on the same day, there were 81,731 or 5.9% of the total, with a diagnosis of PD. In the same year 136,903 people or 6.4% were admitted to out-patient care with a PD diagnosis. The epidemiological findings in treated samples are especially important if we bear in mind that the presence of a PD among those suffering from other mental disorders can be a major predictor of the natural history and treatment o~tcome.~ Conclusions The epidemiology of PDs has not received the same amount of attention as that of many other psychiatric disorders. In the last few years the situation has changed, and we now have data on the prevalence of PD in the community and in psychiatric facilities. Community data come primarily from three studie~l~-~~ with a total sample of about 1300 subjects from two countries, Germany and the US. There are excellent national and cross-national epidemiological data on antisocial personality disorder, based on the same diagnostic methods. There are almost no data on other PDs from countries other than Germany and the US. The lack of studies from developing countries is especially noteworthy because the role of sociocultural factors has yet to be determined. One important methodological problem is that some PDs have a very low prevalence rate. Consequently, epidemiological surveys carried out among the general population may require very large samples in order to identify a sufficient number of cases to study demographic correlates and the association of PD with other psychiatric disorders. Many of the PDs are at an early stage of construct validation. Further research should probably follow the general recommendations for validating a psychiatric disorder. These include the need to delineate a proposed disorder from other disorders. Given the overlap of the PDs, this will be a challenging task. Another criterion is external validation, and there are a number of psychological tests and behavioural indicators that
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 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 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
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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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