Identifying personality disorders: Towards the development of a clinical screening instrument

The study objective was to identify a set of personality disorder (PD) crit eria from the DSM PD diagnostic sets that can be used to detect subjects wi th an increased likelihood of having a PD diagnosis. In a series of outpati ents evaluated systematically in two waves for every criteria item for 12 D SM-III-R PDs, stepwise logistic regression identified 45 criteria as discri minative for their specific PDs, which are selected for further analysis to assess their ability to discriminate for any PD. Receiver operating charac teristic (ROC) analysis is used to evaluate their discriminative power in a n independent conjoined sample (N = 1,342) from six centers that assessed e very PD criteria item by structured instrument (Structured Clinical Intervi ew for DSM-III-R PDs [SCID-II], Personality Disorder Examination [PDE], and Structured Interview for DSM-III-R PDs [SIDP-R]). The cutoff that maximize s information gain is used to determine the diagnostic threshold (DT). Init ially, 15 of 45 criteria are identified, At the 0.43 PD prevalence, a DT of 2 or more of the 15 PD criteria across samples is optimal. The maximum inf ormation gain (MIG) is .42 bits, and the AUR is 0.94 +/- .007. Other perfor mance indices at this cutoff are .90 sensitivity, .84 specificity, .81 posi tive predictive power (PPP), .91 negative predictive power (NPP), and .86 h it rate (HR). Taken collectively, the 15 PD criteria selected by the data r eduction techniques suggest a narrowed set to be assessed in screening for the presence or absence of any PD with comparable or better psychometric pr operties than other tests routinely used for diagnosing medical and psychia tric disorders. If specific PD categorization is needed, a second-step comp rehensive assessment should follow. Copyright (C) 2000 by W.B. Saunders Com pany.