Validity of the Personality Diagnostic Questionnaire-Revised: A replication in an outpatient sample
Abstract
We report a replication study of the validity of the Personality Diagnostic Questionnaire-Revised (PDQ-R) in an outpatient sample. Fifty-nine applicants for psychoanalysis at a training institute completed the PDQ-R and were diagnosed by clinicians, blind to the PDQ-R results, using the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) and the Personality Disorder Examination (PDE). The PDQ-R showed high sensitivity and moderate specificity for most axis II disorders. Although not a substitute for a structured interview because it yields many false-positives, the PDQ-R is an efficient instrument for screening outpatients with DSM-III-R personality disorders.
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Cited by (206)
The alternative model of personality disorders among the French population: Assessment with brief tools
2023, EncephaleLe modèle alternatif des troubles de la personnalité du DSM-5 se propose d’évaluer les troubles de la personnalité en fonction du niveau de fonctionnement (critère A) et des dimensions pathologiques (critères B). L’objectif de cet article est de mettre en évidence les seuils de dépistage en population non clinique de la traduction française de deux outils brefs, la LPFS-BF de Hutsebaut et Bach et le PID 5-BF de Kruger et al.
Ces questionnaires et les items de l’évaluation symptomatique transversale de niveau 1 du DSM-5 mesurant le risque de trouble de la personnalité ont été proposés à un échantillon de 433 personnes issues de la population générale. Les seuils pour lesquels ces questionnaires dépistaient les mieux des personnes à risques de troubles de la personnalité modérés et sévères ont été déterminés à partir des indicateurs classiques des courbes ROC (sensibilité, spécificité, indice de Youden, faux positifs, faux négatifs, etc.).
Un score de 24 à la LPFS-BF présente les caractéristiques suffisantes pour évaluer les critères A du MATP. Sur la base de ces résultats, une nouvelle analyse ROC montre que le PID5-BF permettrait d’évaluer les critères B.
Les résultats sont discutés au regard de la composition de l’échantillon et des données de la littérature. L’examen des qualités du PID 5-BF à évaluer les critères B du MATP nécessiterait une recherche ultérieure prenant en compte l’évaluation des différents troubles de la personnalité et non pas la seule présence d’un trouble de la personnalité.
The aim of this work was to study whether the French versions of the brief tools available to clinicians within the framework of the Alternative Model of Personality Disorders (AMPD) can account for the risks of personality disorders in the general population. Tools are available to accurately investigate either the Level of Personality Functioning (LPF) or the Pathological Personality Dimensions (PPD) which in turn allow the validation of the relevance of the AMPD for its criteria A and B. As these tools, such as Morey's Level of Personality Functioning Scale Self Rated (LPFS-SR) for Criteria A or the Personality Inventory for DSM-5 (PID5) by Krueger et al. for Criteria B, are lengthy, the question arises as to the use of the short tools derived from them.
Data was collected from a sample of 433 people recruited on a volunteer basis with a complete protocol. The sample was predominantly female (83% female, 16% male, 2 people who did not wish to report their gender) and rather young (67% were 18–24 years old). The short version, the LPFS- BF of Hutsbaut et al., which we used in this work allows, as confirmed by several works, to consider on the basis of 12 items the global level of personality functioning. In order to assess the pathological dimensions of personality (PPD), we chose the short version of the Personality Inventory for DSM 5 (PID 5 BF) by Krueger et al. and used its validated French translation that satisfies the factor composition of the original version: Negative Affectivity, Antagonism, Detachment, Disinhibition and Psychoticism. To assess the intensity of personality disorders we used the dedicated subscale (Items 19 and 20) that the DSM 5 proposes in its Cross-Cutting Symptoms Measures of Level 1, in its French translation. A score higher than 2 was our Gold Standard when we tested the metric capacity of the two questionnaires to evaluate the A Criteria and then the B Criteria of the AMPD.
The overall results (Table 1) show levels that place the group in a non-clinical level. In terms of the severity of personality disorders it can be seen that 27 % are at risk of personality disorder (PDs > 2). Comparing these two sub-groups (Table 1), we observed significant differences for all the factors studied, pointing towards a higher score for people at risk of PDs. A logistic regression analysis of the evaluation of persons at risk lead us to find that gender and age do not have a significant influence (p = 0.225 and p = 0.065 respectively) in a valid model (chi square = 157, df = 4, p < 0.001) including the overall score on the LPFS (z = 5.76, p < 0.001) and the PID 5 (z = 2.26, p < 0.001). The Area Under the Curve (AUC = 0.859) of this translation (Table 3) is consistent with the original version (AUC = 0.84). It has metrological qualities (Sn = 73.91%, Sp = 85.33%, LR+ =5.1, LR− = 0.3005) that allowed us to use a threshold of 24 as a discriminant of a risk of moderate or severe personality disorder. In addition, if we followed the AMPD and considered the threshold of 24 on the LFPS-BF to be a risk score for personality disorder, we could see (Fig. 2) that the scores on the PID 5 BF fairly well reflected the expected pattern with a large AUC (0.901). According to the AMPD, the cut-points for the dimensions that would evoke the presence of criteria B in the case of the presence of criterion A (LPFS-BF > 24) could be either a score greater than 2 for Negative Affectivity, a score greater than 0.8 for Detachment, Antagonism and Disinhibition, or a score greater than 1.2 for Psychoticism (Table 4).
The translation of the LPFS-BF that we used in this work has sufficient qualities to assess situations at risk of personality disorders when higher than 24. Its consistency was good (= 0.84), and its factor composition in two factors (Self and Interpersonal Relations) was equivalent to the original version. The use of PID5-BF could therefore be used as a complement to the screening of AMPD A criteria, with a 25 for cut-point. The evaluation of the AMPD B criteria with the PID5-BF seemed relevant in view of our results; each of the subscales seemed to be able to correctly evaluate (AUC) persons with an LPFS-BF score at risk. However, the risk thresholds need to be confirmed in further work because of the essential role that the dimensions play in the diagnosis of types of personality disorders.
Are personality disorders in bipolar patients more frequent in the US than Europe?
2022, European NeuropsychopharmacologyCitation Excerpt :If patients completed the PDQ while in a depressive state, clinician rated depression scores on the IDS-C that were acquired within 2 weeks of filling out the PDQ were used in this study. The PDQ4 evaluates 11 separate personality disorders, each of which includes five to nine statements, scored as true or false as to whether it would “describe the kind of person you are… Think about how you have tended to feel, think, act, over the past several years” (Hyler et al., 1990, 1992). The personality disorders are categorized in three clusters.
Bipolar patients in the United States (US) compared to those from the Netherlands and Germany (here abbrev. as “Europe”) have more Axis I comorbidities and more poor prognosis factors such as early onset and psychosocial adversity in childhood. We wished to examine whether these differences also extended to Axis II personality disorders (PDs).
793 outpatients with bipolar disorder diagnosed by SCID gave informed consent for participating in a prospective longitudinal follow up study with clinician ratings at each visit. They completed detailed patient questionnaires and a 99 item personality disorder inventory (PDQ-4). US versus European differences in PDs were examined in univariate analyses and then logistic regressions, controlling for severity of depression, age, gender, and other poor prognosis factors.
In the univariate analysis, 7 PDs were more prevalent in the US than in Europe, including antisocial, avoidant, borderline, depressive, histrionic, obsessive compulsive, and schizoid PDs. In the multivariate analysis, the last 4 of these PDs remained independently greater in the US than Europe.
Although limited by use of self report and other potentially confounding factors, multiple PDs were more prevalent in the US than in Europe, but these preliminary findings need to be confirmed using other methodologies. Other poor prognosis factors are prevalent in the US, including early age of onset, more childhood adversity, anxiety and substance abuse comorbidity, and more episodes and rapid cycling. The interactions among these variables in relationship to the more adverse course of illness in the US than in Europe require further study.
Relationship of comorbid personality disorders to prospective outcome in bipolar disorder
2020, Journal of Affective DisordersIntroduction There is a high incidence of Axis II personality disorders (PDs) in patients with bipolar illness, but their influence on the prospectively measured course of bipolar disorder has been less well explicated.
Methods 392 outpatients with bipolar disorder gave informed consent, completed the PDQ4 99 item personality disorder rating, and where clinically rated during at least one year of prospective naturalistic treatment. They were classified as Well on admission (N = 64) or Responders (N = 146) or Non-responders (N = 182) to treatment for at least six months.
Results Patients who were positive for PDs were very infrequently represented in the category of Well on admission. In addition, patients with borderline, depressive, and schizoid PDs were significantly more likely to be Non-responders compared to Responders upon prospective naturalistic treatment in the network.
Conclusions Patients with bipolar disorder and comorbid PDs were in general less likely to be Well from treatment in the community at network entry or to be a Responder to prospective treatment in the network. Therapeutic approaches to patients with PDs deserve specific study in an attempt to achieve a better long-term course of bipolar disorder.
Validation of a French translation of Krueger's personality inventory for DSM-5 in its brief form (PID-5 BF)
2018, EncephaleDepuis la parution du DSM-5, la conception dimensionnelle des troubles de la personnalité coexiste avec l’approche catégorielle, classique. Des outils ont été proposés pour évaluer les 5 grandes dimensions pathologiques de la personnalité à l’étude dans le DSM-5 (affectivité négative, détachement, antagonisme, désinhibition, psychotisme) dont aucun à ce jour n’a fait l’objet d’une traduction en français. L’objectif principal de ce travail est de présenter une validation en français de l’inventaire de la personnalité pour le DSM-5 de Krueger (2013) dans sa version brève (PID-5 BF). Pour ce faire, nous avons suivi la procédure classique de traduction-retraduction et présenté ce questionnaire à un échantillon non clinique (n = 216) de jeunes adultes (âge = 31,4, ET = 4,8) en l’accompagnant d’autres questionnaires traduits en français par nos soins afin d’évaluer la validité du PID-5 pour l’évaluation des troubles de la personnalité (SAPAS de Moran et al., 2003), de la souffrance psychologique et de ses différentes composantes (SCL-10 de Nguyen et al., 1983) et les relations que les dimensions de la personnalité évaluée à travers la conception du Big Five (BFI-10 de Rammstedt et John, 2007) peuvent entretenir avec l’approche dimensionnelle des troubles de la personnalité proposée à l’étude dans le DSM-5 (APA, 2013). La validité interne de notre traduction du PID-5 BF a été évaluée à travers les indices classiques de l’analyse factorielle et sa validité externe à partir des coefficients de corrélations entre les résultats obtenus au PID-5 BF et ceux aux autres échelles proposées dans le cadre de cette étude.
L’analyse factorielle permet de retrouver la répartition des 25 questions en 5 grandes dimensions proposée dans la version originale. Chacune de ces dimensions présente, avec des alphas de Cronbach supérieurs à 0,65, une consistance suffisante pour valider la consistance interne de la version française de ce questionnaire. Au plan de la validité externe, sur la base de l’étude des coefficients de corrélations de Pearson, les résultats mettent en avant que le score global de la PID-5 BF est en lien avec la souffrance psychologique (score global de la SCL-10) avec le diagnostic de trouble de la personnalité selon l’approche catégorielle classique (score de la SAPAS) et que chaque dimension de la personnalité pathologique est en lien avec l’évaluation des troubles cliniques (sous-échelles de la SCL-10) ou des dimensions de la personnalité (BFI-10). La traduction que nous proposons ici présente ainsi toutes les conditions de validité externe.
Si les résultats obtenus viennent confirmer les travaux menés avec le PID-5 dans sa version en 200 items, la question se pose cependant de sa consistance et de sa validité auprès des publics présentant de réels problèmes de santé mentale. D’autres travaux devront venir éclaircir ce problème, les questionnaires brefs que nous avons ici utilisés pouvant être proposés plus facilement que les versions longues à des publics fragilisés par la maladie ou dont les capacités d’attention et de concentration nécessitent un aménagement des conditions de leurs évaluations.
Since the publication of the DSM-5 (APA, 2013), the dimensional conception of the personality disorders is co-existing with the classical categorical paradigm. Tools have been proposed for the evaluations of five big pathological factors to be explored further according to the APA (negative affectivity, detachment, antagonism, disinhibition, psychoticism). Despite numerous works using these questionnaires (30 works in 3 years according to Al-Adjani et al., 2015), none of them have yet been translated into French. Also, the main objective of the paper is to present a French translation of the Personality Inventory for DSM -5 by Kruegger et al. (2013) in its brief form of 25 items (PID-5 BF).
To reach this goal, we have employed the classic translation-retranslation method (Vallerand, 1989) and tested the consistence and the validity of this French version among a non-clinical sample (n = 216) of young adults (age = 31.4, SD = 4.8), in joining some other questionnaires in their short forms to study the external validity of the PID-5 about the psychological distress (SCL-10, Nguyen, 1983), the categorical diagnosis of personality disorders (SAPAS, Moran et al., 2003) and the classical Big Five dimensions of the personality (BDI 10, Ramamstedt and John, 2007). The internal consistency of this translation has been studied through the classical outcomes on factor analysis for the dimensional repartitions of the items in 5 scales and Cronbach's alpha for the consistency of each found dimensions. The external validity has been explored by studying Pearson's correlations between the outcomes on each dimension of the PID-5 BF and both the clinical dimensions of SCL-10, personality dimensions of the BFI-10 or personality disorders (SAPAS).
Factor analysis led to the same repartition of the 25 items as the original versions. Each of the dimensions is consistent enough (α > .65) to be taken into account as clinically significant. The items of the French version of the PID-5 BF follow the expected repartitions in 5 dimensions, which are consistent enough. Although their mean scores are significantly not different from the outcomes found by Krueger with the PID-5 200 items among another non-clinical population (n = 264), one cannot say that is enough to ensure the external validity of our translation, for it uses neither the same tools nor sample. A comparison with a French translation of the PID-5 would be more significant. However, the external validity of the French version seems to be significant enough. Global score on the PID-5 is correlated both to the Global Severity Index of the SCL-10, which reflects global psychological distress, and SAPAS's score, which evaluates the suspicion of personality disorder. The clinical validity of the PID-5 is confirmed by the relationships between negative affectivity and anxiety or depression or antagonism and hostility, although the clinical scale of the SCL-10, with one item by dimension, is less sensitive than the complete original version in 90 items (DeRogatis, 1974). PID-5 score and domains are also correlated with the Big Five personality dimension and global score of personality disorders which led us to think that it is coherent with the evaluation of personality suffering (r = .34) and dimensions. The links between negative affectivity and neurosism (r = .48) or between desinhibition and extraversion (r = .32) or the negative correlation between psychoticism and conscientiousness (r = –0.16) are consistent with the expectations related both to the descriptions of the domains by the DSM and outcomes on the comparisons between PID-5 200 item scales and NEO-PI or BFI 45 items.
This translation offers enough consistency and validity to be used in future studies. This could lead us to either continue studying a more representative general population or testing its validity in focusing on a clinical sample where personality disorders are prevalent, such as homeless men or substance users. As soon as a French version of the PID-5 200 items is published, one can compare the outcomes on PID-5 BF and PID-5 to lead to estimations of personality disorders and pathological domains among French populations and explore personality disorders throughout a dimensional paradigm instead of syndromic perspective. One can also see whether the items that have been kept for each dimension are as saturated in the French version as in the original one. Among general populations, comparisons with clinical distress, syndromic personality disorders or dimensional aspect of personality could be done with complete versions of PID-5, Symptom Check-list, Personality Disorders Questionnaires or Big Five Inventory; therefore, the brief forms of any questionnaire could be used among any people whose psychological distress or side effects impaired their attention and concentration.
Perimenstrual exacerbation of symptoms in borderline personality disorder: Evidence from multilevel models and the Carolina Premenstrual Assessment Scoring System
2018, Psychological MedicineSelf-selection biases in psychological studies: Personality and affective disorders are prevalent among participants
2023, PLoS ONE