Comprehensive Psychiatry
Volume 50, Issue 5 , Pages 463-470 , September 2009

Factor structure and diagnostic efficiency of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for avoidant personality disorder in Hispanic men and women with substance use disorders

  • Daniel F. Becker

      Affiliations

    • Department of Psychiatry, University of California, San Francisco, CA 94143, USA
    • Corresponding Author InformationCorresponding author. Mills-Peninsula Medical Center, 1501 Trousdale Dr, Burlingame, CA 94010, USA.
  • ,
  • Luis Miguel Añez

      Affiliations

    • Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06520, USA
  • ,
  • Manuel Paris

      Affiliations

    • Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06520, USA
  • ,
  • Luis Bedregal

      Affiliations

    • Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06520, USA
  • ,
  • Carlos M. Grilo

      Affiliations

    • Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06520, USA

References 

  1. Alden LE, Laposa JM, Taylor CT, Ryder AG. Avoidant personality disorder: current status and future directions. J Personal Disord. 2002;16:1–29
  2. Ekselius L, Tillfors M, Furmark T, Fredrikson M. Personality disorders in the general population: DSM-IV and ICD-10 defined prevalence as related to sociodemographic profile. Pers Individ Dif. 2001;30:311–320
  3. Torgersen S, Kringlen E, Cramer V. The prevalence of personality disorders in a community sample. Arch Gen Psychiatry. 2001;58:590–596
  4. Alnæs R, Torgersen S. DSM-III symptom disorders (axis I) and personality disorders (axis II) in an outpatient population. Acta Psychiatr Scand. 1988;78:348–355
  5. Stuart S, Pfohl B, Battaglia M, Bellodi L, Grove W, Cadoret R. The cooccurrence of DSM-III-R personality disorders. J Personal Disord. 1998;12:302–315
  6. McGlashan TH, Grilo CM, Skodol AE, Gunderson JG, Shea MT, Morey LC, et al. The Collaborative Longitudinal Personality Disorders Study: baseline Axis I/II and II/II diagnostic co-occurrence. Acta Psychiatr Scand. 2000;102:256–264
  7. Meyer B, Carver CS. Negative childhood accounts, sensitivity, and pessimism: a study of avoidant personality disorder features in college students. J Personal Disord. 2000;14:233–248
  8. Nurnberg HG, Rifkin A, Doddi S. A systematic assessment of the comorbidity of DSM-III-R personality disorders in alcoholic outpatients. Compr Psychiatry. 1993;34:447–454
  9. Oldham JM, Skodol AE, Kellman HD, Hyler SE, Doidge N, Rosnick L, et al. Comorbidity of axis I and axis II disorders. Am J Psychiatry. 1995;152:571–578
  10. Pepper CM, Klein DN, Anderson RL, Riso LP, Ouimette PC, Lizardi H. DSM-III-R axis II comorbidity in dysthymia and major depression. Am J Psychiatry. 1995;152:239–247
  11. Grilo CM, Sanislow CA, Shea MT, Skodol AE, Stout RL, Gunderson JG, et al. Two-year prospective naturalistic study of remission from major depressive disorder as a function of personality disorder comorbidity. J Consult Clin Psychol. 2005;75:78–85
  12. Massion AO, Dyck IR, Shea MT, Phillips KA, Warshaw MG, Keller MB. Personality disorders and time to remission in generalized anxiety disorder, social phobia, and panic disorder. Arch Gen Psychiatry. 2002;59:434–440
  13. American Psychiatric Association . Diagnostic and statistical manual of mental disorders. 4th ed.. Washington, DC: APA; 1994;
  14. Millon T. Disorders of personality: DSM-III, Axis II. New York: Wiley; 1981;
  15. American Psychiatric Association . Diagnostic and statistical manual of mental disorders. 3rd ed.. Washington, DC: APA; 1980;
  16. American Psychiatric Association . Diagnostic and statistical manual of mental disorders. 3rd ed., rev.. Washington, DC: APA; 1987;
  17. Baillie AJ, Lampe LA. Avoidant personality disorder: empirical support for DSM-IV revisions. J Personal Disord. 1998;12:23–30
  18. Hummelen B, Wilberg T, Pedersen G, Karterud S. An investigation of the validity of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition avoidant personality disorder construct as a prototype category and the psychometric properties of the diagnostic criteria. Compr Psychiatry. 2006;47:376–383
  19. Grilo CM, McGlashan TH. Stability and course of personality disorders. Curr Opin Psychiatry. 1999;12:157–162
  20. Blais MA, Norman DK. A psychometric evaluation of the DSM-IV personality disorder criteria. J Personal Disord. 1997;11:168–176
  21. Blashfield RK, Livesley WJ. Metaphorical analysis of psychiatric classification as a psychological test. J Abnorm Psychol. 1991;100:262–270
  22. Widiger TA, Hurt SW, Frances A, Clarkin JF, Gilmore M. Diagnostic efficiency and DSM-III. Arch Gen Psychiatry. 1984;41:1005–1012
  23. Becker DF, Grilo CM, Edell WS, McGlashan TH. Diagnostic efficiency of borderline personality disorder criteria in hospitalized adolescents: comparison with hospitalized adults. Am J Psychiatry. 2002;159:2042–2047
  24. Blais MA, Hilsenroth MJ, Fowler JC. Diagnostic efficiency and hierarchical functioning of the DSM-IV borderline personality disorder criteria. J Nerv Ment Dis. 1999;187:167–173
  25. Faraone SV, Biederman J, Sprich-Buckminster S, Chen W, Tsuang MT. Efficiency of diagnostic criteria for attention deficit disorder: toward an empirical approach to designing and validating diagnostic algorithms. J Am Acad Child Adolesc Psychiatry. 1993;32:166–174
  26. Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas. 1960;20:37–46
  27. Baldessarini RJ, Finkelstein S, Arana GW. The predictive power of diagnostic tests and the effect of prevalence of illness. Arch Gen Psychiatry. 1983;40:569–573
  28. Milich R, Widiger TA, Landau S. Differential diagnosis of attention deficit and conduct disorders using conditional probabilities. J Consult Clin Psychol. 1987;55:762–767
  29. Waldman ID, Lilienfeld SO. Diagnostic efficiency of symptoms for oppositional defiant disorder and attention-deficit hyperactivity disorder. J Consult Clin Psychol. 1991;59:732–738
  30. Grilo CM. Factorial structure and diagnostic efficiency of DSM-IV criteria for avoidant personality disorder in patients with binge eating disorder. Behav Res Ther. 2004;42:1149–1162
  31. Nestadt G, Fang-Chi H, Samuels J, Bienvenu OJ, Reti I, Costa PT, et al. Latent structure of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition personality disorder criteria. Compr Psychiatry. 2006;47:54–62
  32. Becker DF, Grilo CM, Morey LC, Walker ML, Edell WS, McGlashan TH. Applicability of personality disorder criteria to hospitalized adolescents: evaluation of internal consistency and criterion overlap. J Am Acad Child Adolesc Psychiatry. 1999;38:200–205
  33. Farmer RF, Chapman AL. Evaluation of DSM-IV personality disorder criteria as assessed by the Structured Clinical Interview for DSM-IV Personality Disorders. Compr Psychiatry. 2002;43:285–300
  34. Grilo CM, McGlashan TH, Morey LC, Gunderson JG, Skodol AE, Shea MT, et al. Internal consistency, intercriterion overlap and diagnostic efficiency of criteria sets for DSM-IV schizotypal, borderline, avoidant and obsessive-compulsive personality disorders. Acta Psychiatr Scand. 2001;104:264–272
  35. Barzega G, Maina G, Venturello S, Bogetto F. Gender-related distribution of personality disorders in a sample of patients with panic disorder. Eur Psychiatry. 2001;16:173–179
  36. Carter JD, Joyce PR, Mulder RT, Sullivan PF, Luty SE. Gender differences in the frequency of personality disorders in depressed outpatients. J Personal Disord. 1999;13:67–74
  37. Golomb M, Fava M, Abraham M, Rosenbaum JF. Gender differences in personality disorders. Am J Psychiatry. 1995;152:579–582
  38. Grilo CM. Are there gender differences in DSM-IV personality disorders?. Compr Psychiatry. 2002;43:427–430
  39. Grilo CM, Becker DF, Walker ML, Edell WS, McGlashan TH. Gender differences in personality disorders in psychiatrically hospitalized young adults. J Nerv Ment Dis. 1996;184:754–757
  40. Grilo CM, Martino S, Walker ML, Becker DF, Edell WS, McGlashan TH. Psychiatric comorbidity differences in male and female adult psychiatric inpatients with substance use disorders. Compr Psychiatry. 1997;38:155–159
  41. Landheim AS, Bakken K, Vaglum P. Gender differences in the prevalence of symptom disorders and personality disorders among poly-substance abusers and pure alcoholics: substance abusers treated in two counties in Norway. Eur Addict Res. 2003;9:8–17
  42. Turk CL, Heimberg RG, Orsillo SM, Holt CS, Gitow A, Street LL, et al. An investigation of gender differences in social phobia. J Anxiety Disord. 1998;12:209–223
  43. Dohrenwend BP, Dohrenwend BS. Sex differences and psychiatric disorders. AJS. 1976;81:1447–1454
  44. Paris J. Gender differences in personality traits and disorders. Curr Psychiatry Rep. 2004;6:71–74
  45. Ball SA. Comparing individual therapies for personality disordered opioid dependent patients. J Personal Disord. 2007;21:305–321
  46. Fernández-Montalvo J, Landa N, López-Goñi JJ, Lorea I. Personality disorders in alcoholics: a comparative pilot study between the IPDE and the MCMI-II. Addict Behav. 2006;31:1442–1448
  47. Kranzler HR, Satel S, Apter A. Personality disorders and associated features in cocaine-dependent inpatients. Compr Psychiatry. 1994;35:335–340
  48. Schinka JA, Hughes PH, Coletti SD, Hamilton NL, Renard CG, Urmann CF, et al. Changes in personality characteristics in women treated in a therapeutic community. J Subst Abuse Treat. 1999;16:137–142
  49. Stravynski A, Lamontagne Y, Lavallée YJ. Clinical phobias and avoidant personality disorder among alcoholics admitted to an alcoholism rehabilitation setting. Can J Psychiatry. 1986;31:714–719
  50. Fals-Stewart W. Personality characteristics of substance abusers: an MCMI cluster typology of recreational drug users treated in a therapeutic community and its relationship to length of stay and outcome. J Pers Assess. 1992;59:515–527
  51. Adams GL, Dworkin RJ, Rosenberg SD. Diagnosis and pharmacotherapy issues in the care of Hispanics in the public sector. Am J Psychiatry. 1984;141:970–974
  52. Baskin D, Bluestone H, Nelson M. Ethnicity and psychiatric diagnosis. J Clin Psychol. 1981;37:529–537
  53. Karno M, Hough RL, Burnam A, Escobar JI, Timbers DM, Santana F, et al. Lifetime prevalence of specific psychiatric disorders among Mexican Americans and non-Hispanic whites in Los Angeles. Arch Gen Psychiatry. 1987;44:695–701
  54. Chavira DA, Grilo CM, Shea MT, Yen S, Gunderson JG, Morey LC, et al. Ethnicity and four personality disorders. Compr Psychiatry. 2003;44:483–491
  55. Grant BF, Hasin DS, Stinson FS, Dawson DA, Chou SP, Ruan WJ, et al. Prevalence, correlates, and disability of personality disorders in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2004;65:948–958
  56. Marsella AJ. Cross-cultural research on severe mental disorders: issues and findings. Acta Psychiatr Scand Suppl. 1988;344:7–22
  57. Sundbom E, Jacobsson L, Kullgren G, Penayo U. Personality and defenses: a cross-cultural study of psychiatric patients and healthy individuals in Nicaragua and Sweden. Psychol Rep. 1998;83:1331–1347
  58. McCrae RR, Costa PT. Personality trait structure as a human universal. Am Psychol. 1997;52:509–516
  59. Benet-Martínez V, John OP. Los Cinco Grandes across cultures and ethnic groups: multitrait multimethod analyses of the Big Five in Spanish and English. J Pers Soc Psychol. 1998;75:729–750
  60. Gibbs JT. Personality patterns of delinquent females: ethnic and sociocultural variations. J Clin Psychol. 1982;38:198–206
  61. Grilo CM, Añez LM, McGlashan TH. The Spanish-Language Version of the Diagnostic Interview for DSM-IV Personality Disorders: development and initial psychometric evaluation of diagnoses and criteria. Compr Psychiatry. 2003;44:144–161
  62. Long VO, Martinez EA. Masculinity, femininity, and Hispanic professional men's self-esteem and self-acceptance. J Psychol. 1997;131:481–488
  63. Comas-Díaz L. Cultural considerations in diagnosis. In:  Kaslow FW editors. Handbook of relational diagnosis and dysfunctional family patterns. New York: Wiley; 1996;p. 152–168
  64. Andrés-Hyman RC, Ortiz J, Añez LM, Paris M, Davidson L. Culture and clinical practice: recommendations for working with Puerto Ricans and other Latinas(os) in the United States. Prof Psychol Res Pract. 2006;37:694–701
  65. Añez LM, Paris M, Bedregal LE, Davidson L, Grilo CM. Application of cultural constructs in the care of first generation Latino clients in a community mental health setting. J Psychiatr Pract. 2005;11:221–230
  66. Añez LM, Silva MA, Paris M, Bedregal LE. Engaging Latinos through the integration of cultural values and motivational interviewing principles. Prof Psychol Res Pract. 2008;39:153–159
  67. Bender DS, Skodol AE, Dyck IR, Markowitz JC, Shea MT, Yen S, et al. Ethnicity and mental health treatment utilization by patients with personality disorders. J Consult Clin Psychol. 2007;75:992–999
  68. Bracero W. Intimidades: confianza, gender, and hierarchy in the construction of Latino-Latina therapeutic relationships. Cult Divers Ment Health. 1998;4:264–277
  69. Falicov CJ. Latino families in therapy: a guide to multicultural practice. New York: Guilford Press; 1998;
  70. Santiago-Rivera AL, Arredondo PM, Gallardo-Cooper M. Counseling Latinos and la familia. Thousand Oaks (Calif): Sage Publications; 2002;
  71. Zanarini MC, Frankenburg FR, Sickel AE, Yong L. The diagnostic interview for DSM-IV personality disorders. Belmont (Mass): McLean Hospital; 1996;
  72. Pilkonis PA, Heape CL, Ruddy J, Serrao P. Validity in the diagnosis of personality disorders: the use of the LEAD standard. Psychol Assess. 1991;3:6–54
  73. Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika. 1951;16:297–334
  74. Norusis MJ. SPSS for Windows: base system user's guide and advanced statistics, release 6.1. Chicago: SPSS; 1994;
  75. Nunnally J. Psychometric theory. New York: McGraw-Hill; 1967;
  76. Kaiser HF. A second generation little jiffy. Psychometrika. 1970;35:401–415
  77. Hattie J. Methodology review: assessing unidimensionality of tests and items. Appl Psychol Measurement. 1985;9:139–164
  78. Oldham JM, Skodol AE, Kellman HD, Hyler SE, Rosnick L, Davies M. Diagnosis of DSM-III-R personality disorders by two structured interviews: patterns of comorbidity. Am J Psychiatry. 1992;149:213–220
  79. Matano RA, Locke KD, Schwartz K. MCMI personality subtypes for male and female alcoholics. J Pers Assess. 1994;63:250–264
  80. Schneier FR, Blanco C, Antia SX, Liebowitz MR. The social anxiety spectrum. Psychiatr Clin N Am. 2002;25:757–774

 Presented in part at the 161st Annual Meeting of the American Psychiatric Association, Washington, DC, May 3-8, 2008.

PII: S0010-440X(08)00166-1

doi: 10.1016/j.comppsych.2008.10.002

Comprehensive Psychiatry
Volume 50, Issue 5 , Pages 463-470 , September 2009