Prevalence of personality disorders using two diagnostic systems in psychiatric outpatients in Shanghai, China: A comparison of uni-axial and multi-axial formulation

Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, 600 South Wanping Road, Shanghai, 200030, People's Republic of China.
Social Psychiatry (Impact Factor: 2.54). 12/2011; 47(9):1409-17. DOI: 10.1007/s00127-011-0445-x
Source: PubMed


To compare multi-axial (DSM-IV) with uni-axial diagnostic system (CCMD-3, Chinese Classification and Diagnostic Criteria of Mental Disorders) as diagnostic methods to determine the prevalence of personality disorders (PDs) in Chinese psychiatric outpatients.
3,075 outpatients were randomly sampled from clinical settings in China. CCMD-3 PDs were evaluated as per routine psychiatric practice. DSM-IV PDs were assessed using both self-reported questionnaire and structured clinical interview.
The prevalence estimate for any type of PD in the total sample is 31.93% as reflected in the DSM-IV. This figure is nearly 110 times as large as the prevalence estimate for the CCMD-3. Only 9 outpatients were diagnosed with PD based on the CCMD-3. Amongst the 10 forms of DSM-IV PDs, avoidant (8.1%), obsessive-compulsive (7.6%), paranoid (6.0%), and borderline (5.8%) PDs were the most prevalent subtypes. This study found that PDs are commonly associated with the following: (i) the younger aged; (ii) single marital status; (iii) those who were not raised by their parents; (iv) introverted personalities; (v) first-time seekers of psycho-counseling treatment; and (vi) patients with co-morbid mood or anxiety disorders.
PDs are easily overlooked when the diagnosis is made based on the CCMD-3 uni-axial diagnostic system. However, it was found that personality pathology is common in the Chinese psychiatric community when using the DSM-IV classification system. Existing evidence suggest, at least indirectly, that there are important benefits of moving towards a multi-axial diagnostic approach in psychiatric practice.

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    • "41 La pré valence de chaque trouble de la personnalité est variable, 42 notamment en fonction des outils utilisé s et de caracté ristiques 43 dé mographiques. Elle se situe entre 1 % et 18 % en population 44 gé né rale [7] [34] [36] et peut dé passer les 40 % lorsqu'il s'agit de 45 patients ambulatoires ou hospitalisé s [10] [34]. Né anmoins, les taux 46 de pré valence d'au moins un trouble de la personnalité sont 47 nettement supé rieurs (aux alentours de 80 %) [8] [15] [33]. "
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    ABSTRACT: Background: We choose to examine the Personality Diagnostic Questionnaire-4+ (PDQ-4+), considered as one of the most used and representative measure for personality disorders as they are referenced in the DSM-IV. The PDQ-4+ is a self-report questionnaire assessing the ten personality disorders and the two additional personality disorders derived from the DSM-IV. Participants must answer by True or False to the 99 items, each item represents a personality disorder’ criteria. Few researches have pointed out the psychometric properties of the original version of the PDQ-4+. Validating studies on the French version have been rarely conducted and only among students and teenagers. Clinical samples have been laid aside. Objective: Considering the importance of the assessment of personality disorders, the aim of the present study was to evaluate the main psychometric properties of the French version of the PDQ-4+ as a screening tool for borderline, antisocial, schizotypal, schizoid, obsessional-compulsive, narcissistic, histrionic, paranoid, dependent and avoidant personality disorders, in a psychiatric population. Materials and methods: A sample of 137 French psychiatric patients completed the French versions of the Structured Interview for DSM-IV Personality disorder-IV (SIDP-IV) and the PDQ-4+. Convergent validity, sensibility, specificity, positive and negative predictive values, and internal consistency have been evaluated. Results: The level of agreement between the PDQ-4+ and the SIDP-IV was very low for the majority of personality disorders and low for the dependent personality disorder. The sensitivity was high for antisocial and borderline personality disorders and moderate or low for the other. Only dependent (0.44) and borderline (0.39) personality disorders had a moderate predictive positive value, associated with a high negative predictive value (0.82 and 0.79). The other personality disorders had a low positive predictive value (ranged from 0.00 to 0.28) and a high negative predictive value (ranged from 0.76 to 1.00). The specificity was high for five disorders and moderate for the other. Internal consistency of the PDQ-4+ and its subscales was unsatisfying. Correlation coefficients between each PDQ-4+ subscales were low or moderate. Conclusions: As other self-report measure, the PDQ-4+ screened more personality disorders than the clinical interview. Besides, even if the two diagnostic methods evaluated more borderline and avoidant personality disorders, level of agreements for each personality disorder were generally low, in concordance with previous studies. Only dependent personality disorder emerged with low agreement, moderate specificity and positive predictive value, and high sensitivity and negative predictive value. The influence of the cut-off scores on these results could be raised. The internal consistency for each personality disorders was unsatisfying and lower than other French and international validating studies. The psychometric properties of the French version of the PDQ-4+ were overall unsatisfying. This tool allows a large screening of personality disorders and thus only appears as a useful method to screen a global personality disturbance.
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    • "Furthermore, early experience of neglect may have more impact on cluster A PDs (schizoid and paranoid PD), which reveals that the characteristic of unwarranted mistrust or indifferent to society is formed probably by being neglected by family and society in early life. There are some controversies in the classification of PDs, one of which is the high co-morbidity rates among various PDs as reported by previous studies reported [34] [64] "
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    ABSTRACT: To determine the lifetime prevalence and diverse profiles of types of childhood maltreatment (CM) in a high-risk clinical sample using standardized assessment tools (Child Trauma Questionnaire, CTQ) in China, Shanghai, 2090 subjects were sampled from the Shanghai Mental Health Centre. Personality disorder (PD) was assessed using the Personality Diagnostic Questionnaire (PDQ-4+) and subjects were interviewed using the Structured Clinical Interview (SCID-II). CTQ was used to assess CM in five domains (emotional abuse, EA; physical abuse, PA; sexual abuse, SA; emotional neglect, EN; and physical neglect, PN). The prevalence estimate of EA in the sample is 22.2%, followed by 17.8% of PA, and 12.5% of SA. The prevalence estimate was more frequent in PN (65.0%) and in EN (34.0%) than in childhood abuse (EA, PA and SA). It seems that males reported more PA and females reported more SA, the older subjects reported more neglect and the younger subjects reported more abuse. There was a higher prevalence of EA and SA in borderline PD patients (44.4%, 22.5%), PA in antisocial PD patients (38.9%). Multi-PD patients reported more forms of CM in childhood. Additionally, factor analysis of CTQ items confirmed factorial validity by identifying a five-factor structure that explained 50% of the total variance. These findings support the view that prevalence of CM was commonly experienced in clinical population during their childhood, especially for subjects with PDs. Factorial validity in PN needs to be further improved, and can in part be culturally explained.
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    ABSTRACT: In order to explore age-related differences in personality pathology between psychotic disorder (PSD) and mood and/or anxiety disorder (MAD) among psychiatric outpatients, 2,354 subjects were sampled randomly from outpatients in Shanghai and divided into two groups: PSD (N = 951) and MAD (N = 1403). Dimensional scores for personality disorder (PD) traits were assessed by using a self-reported personality diagnostic questionnaire (PDQ4+). Significant age differences were observed in most of the PD traits in MAD patients. Cluster B and C PD traits displayed an apparent decrease with age in MAD group, but such decline trend was not evident in PSD group. In both groups, the decline of self-reported Cluster A PD traits were less visible than the other clusters. Age-related mellowing of some PD traits such as "dramatic, erratic, anxious" occurred primarily in MAD patients; however the same traits in PSD patients appear to be less resistant to aging. Besides, "old eccentric" PD traits in both MAD and PSD patients seem to be maintained and less modified by aging.
    The International Journal of Psychiatry in Medicine 01/2012; 44(3):241-55. DOI:10.2190/PM.44.3.e · 0.89 Impact Factor
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