There has been increased recognition of the clinical importance of personality disorders (PDs) in both psychiatric and medical samples and related efforts to develop better methods of case identification. Sufficient progress has been made to propose a comparative test of screeners currently available: the Iowa Personality Disorder Screen, the self-directedness scale from the Temperament and Character Inventory (TCI), and the scales for PDs developed from the Inventory of Interpersonal Problems (lIP). To maximize their scientific value, these tests should include both crossvalidation in psychiatric samples and an examination of their operating characteristics in samples where the base rate of PDs is likely to be lower. We propose a 2- stage assessment methodology for these purposes. Stage I is the completion of all three screening instruments and stage 2 is a more intensive clinical assessment with stratified, randomly selected subsamples of subjects identified by the different screeners.
The specific aims of the work are: (1) To crossvalidate the initial results from our IIP PD screening scales in a new psychiatric sample and to investigate the comparative utility of the other screening tools now available; (2) To extend the work into samples with lower base rates of PDs: a medical sample with diabetes and a community sample ascertained from University of Pittsburgh sources; and (3) To examine the predictive validity or PD diagnosis by the different methods over a 6- month follow-up period. The outcomes of interest will be both personal outcomes (psychiatric status, medical status, symptomatology, role functioning) and social outcomes (use of treatment services). Our hypothesis is that there will be the same rank ordering of outcomes in both areas in all three samples: subjects with cluster B (dramatic, expressive, externalizing) PDs will have the poorest personal outcomes and require the most treatment services, followed by subjects with cluster C (anxious, fearful, internalizing) PDs, followed by subjects without PDs, who will have the best personal outcomes while requiring the fewest services.
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