Am J Psychiatry 1994; 151:560-567
Copyright © 1994 by American Psychiatric Association
Validity of self-defeating personality disorder
AE Skodol, JM Oldham, PE Gallaher and S Bezirganian
Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York.
OBJECTIVE: The purpose of this study was to assess the validity of DSM-
III-R self-defeating personality disorder. METHOD: Applicants for inpatient
treatment of personality disorders (N = 100) or psychoanalysis (N = 100)
were independently evaluated face to face by experienced clinicians using
the Structured Clinical Interview for DSM- III-R and the Personality
Disorder Examination. Internal consistency; agreement between assessments;
diagnostic efficiency of criteria; prevalence; sex ratio; comorbidity with
axis I and II disorders; and relationship to education, current employment,
and selection for psychoanalytically oriented treatment were examined.
RESULTS: The internal consistency of the criteria set and the agreement
between psychiatric assessments of self-defeating personality disorder were
fair. The most discriminating criteria were those referring to a) choices
leading to disappointment, failure, or mistreatment and b) rejection of
opportunities for pleasure. A consensus diagnosis of self- defeating
personality disorder was more common than all but three other axis II
disorders. The sex ratio of the subjects with this diagnosis was not
significantly different from the sex ratio of the entire subject group or
of patients with other personality disorders. Significant comorbidity with
borderline and dependent personality disorders and with current mood
disorders was found. Patients with self- defeating personality disorder
resembled patients with other personality disorders in educational
attainment and treatment assignment. They were more likely to be employed.
CONCLUSIONS: These data lend little support to the validity of
self-defeating personality disorder as a separate personality disorder
category.
