Personality Disorders in the Literature

To the Editor: Roger K. Blashfield, Ph.D., and Vincent Intoccia, B.A. (1), reviewed data from MEDLINE searches from 1966 to 1995 and concluded that, unlike published works on schizophrenia, Alzheimer’s disease, and posttraumatic stress disorder (PTSD), the literature on personality disorders has had only modest expansion. They further concluded that the growth rate actually dropped with the publication of DSM-III. Although the authors were somewhat vague regarding the specific methods by which the MEDLINE data were compiled, they may not be aware that the journal pool from which MEDLINE incorporates articles is continually changing. As a former chairman of the National Library of Medicine’s Literature Selection Technical Review Committee (which reviews and makes recommendation to the National Library of Medicine regarding which journals should be included in Index Medicus), I participated in the review of literally hundreds of journals and could see how the choice of which journals are included can shape a field. It is entirely possible that the journals that typically include personality disorders were systematically dropped from Index Medicus and those with a focus in other areas (e.g., schizophrenia, PTSD) were added. As such, the change in bibliographic entries could be a function more of a change in the journals that contributed to the denominator of articles in the database than a change in the actual number of published articles regarding personality disorders. Thus, the authors would need to track changes in the journals included in MEDLINE from 1960 to 1995 to assess the validity of their conclusions. They may also want to assess whether these findings generalize to bibliographic databases that are more inclusive of the behavioral science literature (e.g., PsychLIT).

Of course, if researchers and clinicians do not have access to journals containing articles regarding personality disorders, then the impact of research in this area may be like a tree falling in a forest with no one there to hear it.