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Am J Psychiatry 1996; 153:1593-1597
Copyright © 1996 by American Psychiatric Association
Establishing the severity of personality disorder
P Tyrer and T Johnson
Department of Psychiatry, Imperial College School of Medicine at St. Mary's, London, U.K.
OBJECTIVE: The authors developed a simplified method of rating the severity
of personality disorder. METHOD: The new rating method is based on four
levels of severity: no personality disorder, personality difficulty, simple
personality disorder, and diffuse personality disorder. The new method was
applied to different diagnostic systems and was then compared with an old
rating system based on six severity levels. Data were derived from a
longitudinal study in which 163 patients with anxiety and depressive
disorders had initial assessments of personality status and were followed
up over 2 years. Ratings of psychiatric symptoms were made by using the
Comprehensive Psychopathological Rating Scale over this period. The results
were analyzed with special attention to linear and quadratic trends.
RESULTS: The new system was clinically useful in separating patients'
initial assessments and outcomes. Patients with no personality disorder had
the lowest initial symptom scores and the best outcomes, and those with
diffuse personality disorder had the highest initial levels of symptoms and
improved least over the 2 years. When the patients were separated by the
old classification system, 72% of the variation between groups was
accounted for by linear and quadratic trends; the comparable percentage was
97% when the patients were categorized by the new system. CONCLUSIONS: The
new system of rating severity of personality disturbance is an improvement
on existing methods and allows ratings to be made easily from DSM-IV and
ICD-10.
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