The effect of sampling, diagnostic criteria and assessment procedures on the observed prevalence of DSM-III-R personality disorders among treated alcoholics

J Stud Alcohol. 1998 Mar;59(2):227-36. doi: 10.15288/jsa.1998.59.227.

Abstract

OBJECTIVE. In a recent review of empirical studies on the prevalence of DSM-III-R personality disorders among substance abusers, wide ranges of prevalence rates for overall Axis II, antisocial personality disorder (APD) and borderline personality disorder (BPD) were shown. Utilizing subsamples from within a single study population, the current report explores the effect of sampling, diagnostic criteria and assessment procedures on the observed prevalence of DSM-III-R personality disorders among treated alcoholics.

Method: Personality disorders were assessed with the Personality Diagnostic Questionnaire Revised (PDQR) at two times of measurement (Time 1 n = 459; Time 2 n = 90). In addition, APD was measured with the Composite International Diagnostic Interview (CIDI; n = 587). Finally, an unselected subgroup (n = 136) was interviewed with the International Personality Disorder Examination (IPDE).

Results: There were few differences between inpatients or outpatients or between males and females. Using the IPDE, the exclusion of substance-related pathology did not affect the prevalence estimate. However, the prevalence rates according to the PDQR varied greatly across age groups. In a representative subsample (n = 109), the prevalence rates also varied greatly across assessment methods (PDQR, 52% vs IPDE, 31%). The prevalence estimate of APD according to the CIDI was related to setting, gender, age group and the applied time-frame.

Conclusions: These findings indicate the examined factors to be necessary qualifiers of prevalence estimates and, consequently, support the use of a multiple-criteria/multimethod assessment battery in research as well as in clinical work.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Alcoholism / epidemiology
  • Alcoholism / psychology
  • Alcoholism / rehabilitation*
  • Antisocial Personality Disorder / diagnosis
  • Antisocial Personality Disorder / epidemiology
  • Antisocial Personality Disorder / psychology
  • Bias
  • Borderline Personality Disorder / diagnosis
  • Borderline Personality Disorder / epidemiology
  • Borderline Personality Disorder / psychology
  • Comorbidity
  • Cross-Sectional Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Patient Admission
  • Personality Disorders / diagnosis*
  • Personality Disorders / epidemiology
  • Personality Disorders / psychology
  • Psychiatric Status Rating Scales / statistics & numerical data*
  • Psychometrics
  • Reproducibility of Results
  • Treatment Outcome