In this study, we utilized a large undergraduate sample (N = 536), oversampled for the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision [DSM-IV-TR]; American Psychiatric Association, 2000) obsessive-compulsive personality disorder (OCPD) pathology, to compare 8 self-report measures of OCPD. No prior study has compared more than 3 measures, and the results indicate that the scales had only moderate convergent validity. We also went beyond the existing literature to compare these scales to 2 external reference points: their relationships with a well-established measure of the five-factor model of personality (FFM) and clinicians' ratings of their coverage of the DSM-IV-TR criterion set. When the FFM was used as a point of comparison, the results suggest important differences among the measures with respect to their divergent representation of conscientiousness, neuroticism, and agreeableness. Additionally, an analysis of the construct coverage indicated that the measures also varied in terms of their representation of particular diagnostic criteria. For example, whereas some scales contained items distributed across the diagnostic criteria, others were concentrated more heavily on particular features of the DSM-IV-TR disorder.

ABSTRACT Individual symptoms of child psychiatric disorders have rarely been systematically examined to determine which operate best as inclusion criteria (ruling in a disorder by their presence) and which as exclusion criteria (ruling out a disorder by their absence). The past use of sensitivity and specificity statistics to validate the criteria for different diagnoses has been misleading in certain situations. These problems are particularly salient in the classification of disruptive behavior disorders (including ADHD and CD) in DMS-III-R, a polythetic diagnostic system in which any combination of a set of symptoms can be employed for diagnosis as long as the requisite number has been achieved. In this kind of "confirmatory" diagnostic system (the more symptoms, the more likely the diagnosis), symptoms that are most descriptive of a disorder (i.e., many of the children with the disorder have the symptom) may not be most efficient in the diagnosis of that disorder (i.e., many of the children with the symptoms have the disorder). In the case of attention-deficit hyperactivity disorder and conduct disorder, symptoms were identified that were associated with one specific diagnosis, but actually had greater implications for ruling out the other diagnosis. For example, the ADD symptom "doesn't listen" was found to be most useful as an exclusion criterion for a CD diagnosis. Alternatively, the polythetic DSM-III-R system is ideally suited to the application of predictive power methods. Efficient inclusion criteria can be determined from positive predictive power (PPP), and exclusion criteria can be determined by an examination of negative predictive power (NPP) rates. Item analysis of PPP and NPP rates can be used, for example, to establish the efficiency of symptoms in the differential diagnosis of ADD and CD. However, the DSM-III-R criteria for ADHD and CD address only inclusion criteria and make no provision for exclusion criteria. Until clinicians make accommodations for inclusion and exclusion criteria (i.e., until predictive power methods are employed), clinical choices for the child psychopharmacological treatment of disruptive behavior disorders will be based on sensitivity/specificity thinking and limited by our "confirmatory" diagnostic practices.

The five-factor model (FFM) of personality is obtaining construct validation, recognition, and practical consideration across a broad domain of fields, including clinical psychology, industrial-organizational psychology, and health psychology. As a result, an array of instruments have been developed and existing instruments are being modified to assess the FFM. In this article, we present an overview and critique of five such instruments (the Goldberg Big Five Markers, the revised NEO Personality Inventory, the Interpersonal Adjective Scales-Big Five, the Personality Psychopathology-Five, and the Hogan Personality Inventory), focusing in particular on their representation of the lexical FFM and their practical application.

There has been considerable controversy and research regarding sex bias in the diagnosis of personality disorders, but little has involved self-report inventories. Thus this study investigated items from the Millon Clinical Multiaxial Inventory-II (Millon, 1987), the Minnesota Multiphasic Personality Inventory (Morey, Waugh,& Blashfield, 1985), and the Personality Diagnostic Questionnaire-Revised (Hyler & Rieder, 1987). Subjects (N = 189) completed the Histrionic, Dependent, Antisocial, and Narcissistic scales from these inventories, along with the Bem Sex Role Inventory (Bem, 1974) and the Symptom Checklist-90-Revised (Derogatis, 1977). Items were considered to evidence sex or gender bias if they (a) failed to correlate with dysfunction and (b) exhibited sex or gender role differences. At least 13 items evidenced sex bias (76 items using a more liberal threshold). The majority were from Narcissistic scales; few Histrionic items evidenced sex or gender bias. Implications with respect to sex-bias assessment and item construction are discussed.

Millon (1985) presented eight criticisms of the article by Widiger, Williams, Spitzer, and Frances (1985) on the MCMI as a measure of DSM-III. This article is a brief rejoinder. The major point we wish to make is that one should be cautious in interpreting the MCMI as a measure of DSM-III disorders because there has not yet been any research published on the relationship between the MCMI and DSM-III. We believe this position has not been refuted by Millon's critique.

The debate over the validity of the Rorschach has been lengthy but unresolved. Major reasons for the lack of consensus and conclusion are the absence of agreement about, how validation research should be conducted and the failure to identify appropriate criteria for subsequent evaluation. A construct validation model for the Rorschach is presented, with guidelines for proper implementation. The difficulties in establishing the optimal relationship between theory, research design, and clinical practice arc discussed. Recommendations for a resolution of these difficulties are presented.

The antisocial, narcissistic, dependent, histrionic, and borderline personality disorders often obtain differential sex prevalence rates. One explanation has been that the diagnostic criteria for these personality disorders have different gender implications for maladaptivity (e.g., perhaps the dependent personality disorder diagnostic criteria are considered by clinicians to be more pathological for women than for men). This hypothesis was explored in two studies that obtained judgments by professional clinicians of the maladaptivity and statistical infrequency of personality disorder diagnostic criteria. Significant differences across gender were obtained for the frequency of diagnostic criteria but not for their maladaptivity. The personality disorder diagnostic criteria appear to be gender neutral with respect to their implications for maladaptivity.

Research assessing the relationship of the Five-factor model (FFM) of personality to personality disorder symptomatology has generally been consistent with theoretical expectations. Three exceptions, however, have been failures to confirm predicted associations of the NEO-Personality Inventory-Revised (NEO-PI-R) Conscientiousness scale with obsessive-compulsive personality disorder symptomatology, the NEO-PI-R Agreeableness scale with dependent symptomatology, and the NEO-PI-R Openness scale with schizotypal symptomatology. It was the hypothesis of this study that these findings might be due in part to a relative emphasis on adaptive rather than maladaptive variants of these domains of personality functioning within the NEO-PI-R. This hypothesis was tested by experimentally altering NEO-PI-R items to reverse their implications for maladaptiveness. The predicted correlations of the FFM were confirmed with the experimentally altered items in a sample of 86 adult psychiatric outpatients.

This study sought to extend previous work on the five-factor dimensional model (FFM) of personality disorder (PD) by developing more comprehensive FFM descriptions of prototypic cases. Specifically, the authors asked experts in each of the 10 DSM-IV PDs to rate the prototypic case by using all 30 facets of the FFM. Aggregating across raters of the given disorder generated a prototype for each disorder. In general, there was good agreement among experts and with previous theoretical and empirical FFM translations of DSM diagnostic criteria. Furthermore, the ability of the FFM explanation to reproduce the high comorbidity rates among PDs was demonstrated. The authors concluded that, with the possible exception of schizotypal PD, the DSM PDs can be understood from the dimensional perspective of the FFM. Future directions for research, including the use of the present prototypes to "diagnose" personality disorder, are discussed.

The present study examined Widiger and Lynam's (1998) hypothesis that psychopathy can be represented using the Five-Factor Model (FFM) of personality. Participants in the study consisted of 481 21-22-year-old men and women who are part of an ongoing longitudinal study. Psychopathy was assessed by the degree of similarity between an individual's NEO-PI-R and an expert-generated FFM psychopathy prototype. The expert-based prototype supported the account of Widiger and Lynam (1998), as did the correlations between the NEO-PI-R Psychopathy Resemblance Index (PRI) and the individual personality dimensions. The PRI was also related in predicted ways to measures of antisocial behavior, drug use, and psychopathology. The results support the contention that psychopathy can be understood as an extreme variant of common dimensions of personality, and underscore the utility of a dimensional model of personality disorders.

The Structured Interview for the Five-Factor Model (SIFFM; Trull & Widiger, 1997) is an 120-item semistructured interview that assesses both adaptive and maladaptive features of the personality traits included in the five-factor model of personality, or "Big Five." In this article, we evaluate the ability of SIFFM scores to predict personality disorder symptomatology in a sample of 232 adults (46 outpatients and 186 nonclinical college students). Personality disorder symptoms were assessed using the Personality Diagnostic Questionnaire-Revised (PDQ-R; Hyler & Rider, 1987). Results indicated that many of the predicted associations between lower-order personality traits and personality disorders were supported. Further, many of these associations held even after controlling for comorbid personality disorder symptoms. These findings may help inform conceptualizations of the personality disorders, as well as etiological theories and treatment.

PURPOSE OF REVIEW After the initial enthusiasm, the study of personality disorder seems to be at a crossroad, without clear direction. This is mainly due to overlapping categorical diagnostic criteria of personality disorders. Study samples based on these criteria are inadequate and their results questionable. RECENT FINDINGS The literature is unanimously advocating a dimensional concept of personality disorders. Four dimensions are consistently reported to underlie personality disorder symptoms. We put forward an argument that personality disorders are disorders of adaptation, not of personality per se, as extreme personality traits are not ipso facto dysfunctional. Available methods to assess maladaptation are reviewed. SUMMARY The diagnosis 'personality disorder' should be replaced by the diagnosis 'adaptation disorders'. This reflects the real nature of the disorder more accurately, and is likely to reduce the stigmatizing component of the personality disorder diagnosis as it places emphasis on positive efforts to improve adaptation. The suggested revisions of the personality disorder diagnosis and dimensional approach to these disorders are likely to advance treatment and research - we discuss these aspects in some detail.

According to DSM-IV the cluster A personality disorders include paranoid, schizoid, and schizotypal personality disorders. There exists a phenomenological similarity between the experience and behaviour of the so-called odd or eccentric personality disorders and the symptoms of schizophrenia. Evidence of common etiological factors is still the best for the schizotypal personality disorder. The cluster A personality disorders are among the less common personality disorders with a high co-occurrence. Present findings about the neurobiological substrate of the schizotypal personality disorder are discussed also taking neuropsychological results into consideration. A central prerequisite of psychotherapeutic and pharmacological treatment of cluster A personality disorders is a strong therapeutic patient relationship.

This study was designed to compare the NEO-FFI-R versus the ZKPQ-50-CC in their relationships with the fourteen MCMI-III personality disorder scales in a Spanish non-clinical sample (N = 674). Previous studies showed consistent relationships between the Five Factor Model and the DSM-IV personality disorders (PD), but there is no comparative study between both Five Factor and Zuckerman's personality models. The aim was to replicate previous results about relationships between the Big-Five and PDs using the revised short version of the NEO-PI-R, and to compare the NEO-FFI-R versus the ZKPQ-50-CC regarding the relationships with MCMI-III personality disorder scales. Results showed no sharp differences between the NEO-FFI-R and ZKPQ-50-CC scales. Each instrument explained around 30% of the PDs MCMI-III scales variance. Using conjointly the 10 personality scales from the NEO-FFI-R and ZKPQ-50-CC, the PDs accounted variance rose to 38%. Differences and similarities between both short personality questionnaires are discussed.

PURPOSE OF REVIEW Personality disorders are not usually thought of as being associated with medical comorbidity. Research shows that medical comorbidity in personality disorders is clinically important. RECENT FINDINGS In general those with personality disorders do not feel as fit as others do. Also, those with personality disorders in addition to other psychiatric disorders, such as depression and antisocial personality disorder, are likely to have more health problems than those without personality disorders. People with active borderline personality disorder have been shown to have more medical problems than those with remitted borderline personality disorder. Personality disorders can complicate the course of chronic medical illnesses. Finally, the use of psychotropic medications is not unusual in personality disorders and in itself can be associated with medical illnesses. SUMMARY Clinicians caring for people with personality disorders need to be aware of possible medical comorbidity. More research is needed.

Three sets of personality disorder scales (PD scales) can be scored for the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen,& Kaemmer, 1989). Two sets (Levitt & Gotts, 1995; Morey, Waugh,& Blashfield, 1985) are derived from the MMPI (Hathaway & McKinley, 1983), and a third set (Somwaru & Ben-Porath, 1995) is based on the MMPI-2. There is no validity research for the Levitt and Gotts scale, and limited validity research is available for the Somwaru and Ben-Porath scales. There is a large body of research suggesting that the Morey et al. scales have good to excellent convergent validity when compared to a variety of other measures of personality disorders. Since the Morey et al. scales have established validity, there is a question if additional sets of PD scales are needed. The primary purpose of this research was to determine if the PD scales developed by Levitt and Gotts and those developed by Somwaru and Ben-Porath contribute incrementally to the scales developed by Morey et al. in predicting corresponding scales on the MCMI-II (Millon, 1987). In a sample of 494 individuals evaluated at an Army medical center, a hierarchical regression analysis demonstrated that the Somwaru and Ben-Porath Borderline, Antisocial, and Schizoid PD scales and the Levitt and Gotts Narcissistic and Histrionic scales contributed significantly and meaningfully to the Morey et al. scales in predicting the corresponding MCMI-II (Millon, 1987) scale. However, only the Somwaru and Ben-Porath scales demonstrated acceptable internal consistency and convergent validity.

OBJECTIVE To present nationally representative data on the prevalence, sociodemographic correlates, and disability of 7 of the 10 DSM-IV personality disorders. METHOD The data were derived from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (N = 43,093). Diagnoses were made using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version, and associations between personality disorders and sociodemographic correlates were determined. The relationship between personality disorders and 3 emotional disability scores (Short-Form 12, version 2) was also examined. RESULTS Overall, 14.79% of adult Americans (95% CI = 14.08 to 15.50), or 30.8 million, had at least 1 personality disorder. The most prevalent personality disorder in the general population was obsessive-compulsive personality disorder, 7.88%(95% CI = 7.43 to 8.33), followed by paranoid personality disorder 4.41%(95% CI = 4.12 to 4.70), antisocial personality disorder 3.63%(95% CI = 3.34 to 3.92), schizoid personality disorder 3.13%(95% CI = 2.89 to 3.37), avoidant personality disorder 2.36%(95% CI = 2.14 to 2.58), histrionic personality disorder 1.84%(95% CI = 1.66 to 2.02), and dependent personality disorder 0.49%(95% CI = 0.40 to 0.58). The risk of avoidant, dependent, and paranoid personality disorders was significantly greater among women than men (p <.05); the risk of antisocial personality disorder was greater among men compared with women (p <.05); and no sex differences were observed in the risk of obsessive-compulsive, schizoid, or histrionic personality disorders. In general, risk factors for personality disorders included being Native American or black, being a young adult, having low socioeconomic status, and being divorced, separated, widowed, or never married. Avoidant, dependent, schizoid, paranoid, and antisocial personality disorders (p <.02 to p <.0001) were each statistically significant predictors of disability. Obsessive-compulsive personality disorder was inconsistently related to disability. In contrast, disability was not significantly different among individuals with histrionic personality disorder compared with those without the disorder. CONCLUSION Personality disorders are prevalent in the general population and are generally highly associated with disability. This study highlights the need to develop more effective and targeted prevention and intervention initiatives for personality disorders.

In this study, we examined the relationship of the MCMI-III (Millon, Davis,& Millon, 1997; Millon, Millon,& Davis, 1994) modifier indices and personality disorder scales to the validity and basic clinical scales of the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen,& Kaemmer, 1989). The MCMI-III modifier indices highly correlated with all of the MMPI-2 validity scales except for the F(p) scale. Similarly, the MCMI-III personality disorder scales strongly covaried with the MMPI-2 validity and clinical scales except for the F(p) and 5 (Mf) scales. A factor analysis with Promax rotation revealed substantial relationships between the MMPI-2 and MCMI-III. However, the MMPI-2 F(p) scale did not tend to correlate with MMPI-2 or MCMI-III scales, indicating that F(p) scale variance was largely independent of other scales. The results suggest that clinicians should consider the interrelationship between personality characteristics and dissimulation.

Personality disorders cause dysfunction over the course of adult life. A chronic course of disorder tends to be associated with an early onset, and personality disorders are preceded by precursor symptoms in childhood. Long-term outcome varies by personality disorder category: antisocial and borderline personality tend to remit with age, an improvement that is not seen in other diagnoses. The chronicity of personality disorders can usefully guide treatment planning, and psychotherapy for personality disorders can focus on rehabilitation.

The MCMI-III personality disorder scales (Millon, 1994) were empirically validated in a sample of prisoners, psychiatric inpatients, and outpatients (N = 477). The scale intercorrelations were congruent with those obtained by Millon, Davis, and Millon (1997). We conclude that our Flemish/Dutch version shows no significant differences with the original version of the MCMI-III as far as intercorrelations are concerned. Convergent validity of the MCMI-III personality disorder scales was evaluated by the correlational data between the MCMI-III personality disorder scales and the MMPI-2 clinical (Butcher, Dahlstrom, Graham, Tellegen,& Kaemmer, 1989) and personality disorder (Somwaru & Ben-Porath, 1995) scales. Improved convergence was obtained compared with previous versions of the MCMI-I. Only the compulsive MCMI-III personality disorder scale remains problematic. The scale even showed negative correlations with some of the related clinical scales and with the corresponding personality disorder scales of the MMPI-2.