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Am J Psychiatry 1992; 149:213-220
Copyright © 1992 by American Psychiatric Association
Diagnosis of DSM-III-R personality disorders by two structured interviews: patterns of comorbidity
JM Oldham, AE Skodol, HD Kellman, SE Hyler, L Rosnick and M Davies
Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY.
OBJECTIVE: The purpose of this study was to examine patterns of co-
occurrence of axis II disorders in a group of consecutive patients
evaluated with two contrasting structured interviews. METHOD: One hundred
of 106 consecutive applicants for long-term, inpatient treatment of severe
personality psychopathology were assessed, face-to- face, by psychiatrists
using the Structured Clinical Interview for DSM- III-R Personality
Disorders (SCID-II) and the Personality Disorder Examination (PDE). The
percent of co-occurrence of pairs of disorders diagnosed by each structured
interview separately was calculated, and significance levels were
determined by using chi-square tests of independence. Finally, odds ratios
were computed for the odds of each pair of disorders occurring together
compared with the odds for the occurrence of each disorder alone. RESULTS:
The two interview methods revealed different comorbidity patterns.
Significant covariation was found for 29 pairs of disorders diagnosed with
the PDE, compared with 12 pairs diagnosed with the SCID-II. Six pairs of
disorders covaried significantly and were associated with odds ratios
greater than 4: histrionic with borderline, histrionic with narcissistic,
narcissistic with antisocial, narcissistic with passive-aggressive,
avoidant with schizotypal, and avoidant with dependent. CONCLUSIONS:
Substantial overlap occurred among personality disorders. In this group of
patients, consistent patterns of comorbidity involving narcissistic,
avoidant, and histrionic personality disorders suggest that categorical
distinctions between them and certain other DSM-III-R personality disorders
may be illusory. The question of which of two overlapping disorders is more
valid, however, is left unanswered. For clinical purposes, a two-level
diagnostic convention is proposed.
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