Skip to main content
×
Home

Concordance between personality disorder assessment methods

  • G. Nestadt (a1), C. Di (a2), J. F. Samuels (a1), Y.-J. Cheng (a3), O. J. Bienvenu (a1), I. M. Reti (a1), P. Costa (a4), W. W. Eaton (a5) and K. Bandeen-Roche (a6)...
Abstract
Background

Studies have criticized the low level of agreement between the various methods of personality disorder (PD) assessment. This is an important issue for research and clinical purposes.

Method

Seven hundred and forty-two participants in the Hopkins Epidemiology of Personality Disorders Study (HEPS) were assessed on two occasions using the Personality Disorder Schedule (PDS) and the International Personality Disorder Examination (IPDE). The concordance between the two diagnostic methods for all DSM-IV PDs was assessed using standard methods and also two item response analytic approaches designed to take account of measurement error: a latent trait-based approach and a generalized estimating equations (GEE)-based approach, with post-hoc adjustment.

Results

Raw criteria counts, using the intraclass correlation coefficient (ICC), κ and odds ratio (OR), showed poor concordance. The more refined statistical methods showed a moderate to moderately high level of concordance between the methods for most PDs studied. Overall, the PDS produced lower prevalences of traits but higher precision of measurement than the IPDE. Specific criteria within each PD showed varying endorsement thresholds and precision for ascertaining the disorder.

Conclusions

Concordance in the raw measurement of the individual PD criteria between the two clinical methods is lacking. However, based on two statistical methods that adjust for differential endorsement thresholds and measurement error in the assessments, we deduce that the PD constructs themselves can be measured with a moderate degree of confidence regardless of the clinical approach used. This may suggest that the individual criteria for each PD are, in and of themselves, less specific for diagnosis, but as a group the criteria for each PD usefully identify specific PD constructs.

Copyright
Corresponding author
*Address for correspondence: Dr G. Nestadt, Department of Psychiatry and Behavioral Sciences, Johns Hopkins Hospital, Meyer 113, 600 N. Wolfe Street, Baltimore, MD 21287, USA. (Email: gnestadt@jhmi.edu)
References
Hide All
Anthony JC, Folstein M, Romanoski AJ, Von Korff MR, Nestadt GR, Chahal R, Merchant A, Brown CH, Shapiro S, Kramer M, Gruenberg EM (1985). Comparison of the lay Diagnostic Interview Schedule and a standardized psychiatric diagnosis. Experience in eastern Baltimore. Archives of General Psychiatry 42, 667675.
APA (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn (DSM-IV). American Psychiatric Association: Washington, DC.
Digby PGN (1983). Approximating the tetrachoric correlation coefficient. Biometrics 39, 753757.
Eaton WW, Anthony JC, Romanoski A, Tien A, Gallo J, Cai G, Neufeld K, Schlaepfer T, Laugharne J, Chen LS (1998). Onset and recovery from panic disorder in the Baltimore ECA follow-up. British Journal of Psychiatry 173, 501507.
Heagerty PJ, Zeger SL (2000). Multivariate continuation ratio models: connections and caveats. Biometrics 56, 719732.
Huang GH, Bandeen-Roche K, Rubin GS (2002). Building marginal models for multiple ordinal measurements. Applied Statistics 51, 3757.
Loranger AW, Sartorius N, Andreoli A, Berger P, Buchheim P, Channabasavanna SM, Coid B, Dahl A, Diekstra RFW, Ferguson B, Jacobsberg LB, Mombour W, Pull C, Ono Y, Regier DA (1994). The International Personality Disorder Examination. Archives of General Psychiatry 51, 215224.
Lord FM (1980). Applications of Item Response Theory to Practical Testing Problems. Lawrence Erlbaum: Hillsdale, NJ.
Nestadt G, Di C, Samuels JF, Bienvenu OJ, Reti IM, Costa P, Eaton WW, Bandeen-Roche K (2010). The stability of DSM personality disorders over twelve to eighteen years. Journal of Psychiatric Research 44, 17.
Perry JC (1992). Problems and considerations in the valid assessment of personality disorders. American Journal of Psychiatry 149, 16451653.
Romanoski AJ, Nestadt G, Chahal R, Merchant A, Folstein MF, Gruenberg EM, McHugh PR (1998). Interobserver reliability of a ‘Standardized Psychiatric Examination’ (SPE) for case ascertainment (DSM-III). Journal of Nervous and Mental Disorders 176, 6371.
Samuels J, Eaton WW, Bienvenu OJ 3rd, Brown CH, Costa PT Jr., Nestadt G (2002). Prevalence and correlates of personality disorders in a community sample. British Journal of Psychiatry 180, 536542.
Samuels JF, Nestadt G, Romanoski AJ, Folstein MF, McHugh PR (1994). DSM-III personality disorders in the community. American Journal of Psychiatry 151, 10551062.
Zeger SL, Liang KY (1986). Longitudinal data analysis for discrete and continuous outcomes. Biometrics 42, 121130.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Metrics

Full text views

Total number of HTML views: 2
Total number of PDF views: 22 *
Loading metrics...

Abstract views

Total abstract views: 183 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 22nd November 2017. This data will be updated every 24 hours.