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The utility of the DSM personality disorder (PD) system remains a concern. The strategy employed represents one approach designed to evaluate and improve the diagnostic efficiency of the SCID-II PDs. Using a sample of 203 patients, SCID-II PD items-based on the criterion sets of the 10 DSM-IV PDs-were evaluated with respect to (a) convergent validity; (b) divergent validity; (c) relation to general personality traits; and (d) association with functional impairment. Only Borderline PD items were satisfactory on all four evaluation criteria. Histrionic and Obsessive-Compulsive PD items met criteria for convergent and divergent validity and relation to personality dimensions of the Five-Factor Model of Personality (FFM) but were not related to functional impairment, suggesting they might be reconsidered as disorders. Schizotypal PD items met three of the four criteria but showed no relation to FFM dimensions, suggesting that it may be a candidate for reassignment to Axis I.
The flaws of the DSM PD system are well known and include excessive within-disorder diagnostic heterogeneity, poor reliability and validity, high rates of between disorder diagnostic overlap (both Axis I and II), poor relation to impairment, and failure to capture the full domain of personality psychopathology (Widiger, 1997; Widiger & Frances, 2002). Previous investigators have examined the coherence of the traits within each PD criterion set as well as overlap with other PD criteria (Blais, Hilsenroth, & Castlebury, 1997; Blais & Norman, 1997; Grilo et al., 2001; Maffei et al., 1997; McGlashan et al., 2000). These studies provided information on which individual PD traits contribute significantly to the overall diagnostic inclusion criteria, revealing that many individual PD traits lack utility. We believe that these earlier studies left unexamined two important issues-the relation of PD traits to general personality trait dimensions and the association of PD traits with functional impairment.
Overall, internal consistency and inter-rater reliability of the DSM-IV personality disorder criteria meet or exceed standard cut-offs (Blais & Norman, 1997; Blais et al., 1997; Maffei et al., 1997). The major concern is instead with co-morbidity across diagnoses. Blais and colleagues (Blais & Norman, 1997; Blais et al., 1997) reported several significant correlations between individual DSM-IV PD criteria and nonparent scales indicating a lack of discriminant validity. McGlashan and colleagues (2000) found that despite high retest and inter-rater...