Prevalence and Construct Validity of Personality Disorder Not Otherwise Specified PDNOS

1
Prevalence and Construct Validity of Personality
Disorder Not Otherwise Specified (PDNOS)

• Anna Bartak, Roel Verheul, Suzan Kara

Anna Bartak, MA VISPD P.O. Box 7 4660 AA
Halsteren The Netherlands 31 164
632200 anna.bartak_at_deviersprong.nl
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What is PDNOS?
A
B
C
Paranoid PD Schizoid PD Schizotypal PD
Antisocial PD Borderline PD Histrionic
PD Narcissistic PD
Avoidant PD Dependent PD Obsessive- Compulsive
PD
P D N O S
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History

• First introduced in DSM-III (1980)
• In clinical practice one of the most frequently
  used Axis II diagnoses
• Lack of explicit guidelines for assessment

4
Definitions

• P D N O S

Other PD (e.g., self-defeating, negativistic,
depressive PD)
Mixed PD (? 10 criteria)
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Meta-analysis(Verheul Widiger 2004)

• lt50 of studies separate rate for PDNOS
• 50 of studies provide definition
• prevalence in patient samples 8 to 13
• PDNOS
• Most frequently used PD diagnosis (clinical
  diagnosis)
• Third most frequently used PD diagnosis
  (structured interview)

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Research Questions

• Prevalence of PDNOS in a patient sample
• Prevalence of other PD
• depressive, negativistic, self-defeating PD
• Prevalence of mixed PD
• Cutoff of 10 criteria
• Construct validity
• Axis II severity
• Functional impairment (social role problems and
  interpersonal problems)

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SCEPTREStudy on Cost-Effectiveness of
Personality Disorder TREatment

• Multicenter (cost)effectiveness study
• 800 PD patients receiving various dosages of
  psychotherapy
• Outpatient
• Day hospital
• Inpatient

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Sample

• 1449 patients admitting for psychotherapy
• 62.5 female, 37.5 male
• Mean age 34 (SD10)

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Instruments

• Structured Interview for DSM-IV Personality
  Disorders (SIDP-IV)
• Dimensional Assessment of Personality Pathology
  (DAPP-BQ)
• Outcome Questionnaire (OQ-45)
• Social role
• Interpersonal functioning

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Results I
PDNOS
11
Results II
ANOVA with post-hoc LSD test plt.05
12
Results III
ANOVA with post-hoc LSD test plt.05
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Conclusion

• PDNOS is highly prevalent (22)
• PDNOS takes an intermediate position between
  formal PD and no PD
• Axis II severity and interpersonal problems
• Appendix diagnoses are similar to formal PD
• Social role problems
• Cutoff of 5 diagnostic criteria (add 12) marks
  severe impairment

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Future

• Appendix diagnoses as official categories?
• Empirical validation of cutoff for mixed PD?
• Categorical DSM-IV Axis II lacks sufficient
  coverage
• Dimensional approach could cover a broader range
  of personality pathology

www.dsm5.org
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anna.bartak_at_deviersprong.nl

• www.vispd.nl