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Doe Ring

Doe Ring

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Published by: euronetit on May 12, 2011
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Validation of the “Assessment of DSM-IV PersonalityDisorders (ADP-IV)” Questionnaire
1
 Stephan Doering
, Daniela Renn
4
, Stefan Höfer 
4
, Gerhard Rumpold
4
, Ulrike Smrekar 
4
, Nicola Janecke
4
, Dieter S. Schatz
4
, Chris Schotte
5
, Dirk DeDoncker 
5
, and Gerhard Schüßler 
4
 
Summary
Objectives:
The “Assessment of DSM-IV Personality Disorders (ADP-IV)” represents a 94-item questionnaire that allows for a categorical and dimensional assessment of the DSM-IV personality disorders.
Methods:
Psychometric properties of the German ADP-IV were investigated in 400 psychotherapy outpatients and a community sample of 385 persons. The SCID-II interviewand a standardised expert consensus rating were employed for the assessment of concurrentvalidity.
Results:
The ADP-IV showed satisfactory reliability; the median Cronbach´s
α
for thesubscales was .76 (range .65 - .87), the median retest reliability .79 (range .37 - .88). Factor analysis revealed an 11-factor solution that explained 49.4% of the variance. The mediancorrelation of the dimensional ADP-IV subscale scores with the SCID-II and the expertconsensus ratings were .51 (range: 34 - .72) and .44 (range: .27 - .62), respectively. Thekappas for the chance corrected agreement of categorical ADP-IV diagnoses with the SCID-IIdiagnoses and the expert ratings were .35 and .29 for any personality disorder and a median of .37 and .30 for the specific personality disorders.
Conclusions:
The ADP-IV shows satisfactory reliability and a validity that is comparable and partly superior to other self-rating instruments. The advantages of the instrument are its brevity, the inclusion of distress ratings, and the dimensional scoring that allows for theconstruction of detailed profiles of personality pathology. Moreover it is freely available inthe internet (download:http://zmkweb.uni-muenster.de/einrichtungen/proth/dienstleistungen/  psycho/diag/index.html
 
).
Keywords
Personality disorders - diagnosis - questionnaire - Reliability - validity
 
1
This study was supported by a grant of the ”Jubiläumsfonds der Österreichischen Nationalbank“, project # 9141.
2
University of Muenster, Germany, Department of Prosthodontics
3
University of Muenster, Germany, Department of Psychosomatics and Psychotherapy
4
Innsbruck Medical University, Austria, Clinical Department of Psychological Medicine and Psychotherapy
5
University Hospital Antwerp (UZA), Belgium, Department of Psychiatry
 
 
1
1. Introduction
The assessment of personality disorders represents one of the most challenging issues in psychiatry (Leibing & Doering 2006; Schüßler et al. 2006). The current conceptualization andclassification of personality disorders in the DSM-IV has been criticised for its lack of empirical basis (Westen & Shedler 1999; Widiger & Sanderson 1995). Especially thecategorical approach of the DSM-IV axis II (Saß et al. 2003) and ICD-10 (Dilling et al. 2004)has been opposed, because the dichotomization of continuous variables (the diagnosticcriteria) into present/absent, is neither theoretically nor statistically sensible (Leibing et al. in press; Westen & Shedler 1999; Widiger & Sanderson 1995; Wöller & Tress 2005). As aconsequence, the categorical approach fails to cover personality pathology of patients whoseek and need treatment, but do not fall within one of the categories, because they do not fulfilenough diagnostic criteria of one and the same personality disorder (Westen & Shedler 1999;Heuft et al. 2005). Moreover, comorbid pathological personality traits of other categories thanthe diagnosed one are not being described by the current DSM-IV classification.In 1991 Widiger made the proposal to assess the DSM-III-R personality disorder categorieson a dimensional basis. In his model six levels are provided for a rating of each personalitydisorder on the basis of the number of present diagnostic criteria. The rating of each of the personality disorders results in a profile of personality pathology, which provides importantadditional information without demanding too much effort from the diagnostician.In addition to these conceptual issues, the construction of instruments for the measurement of  personality disorders represents a major problem. Since the introduction of the DSM-IIIdiagnostic criteria for personality disorders the reliability of these diagnoses has benefited to agreat deal (Perry 1992), but the validity of the assessment remains a major problem. In 1983Spitzer stated that an expert consensus rating on the basis of all available data represents the“gold standard” for a valid diagnosis of a personality disorder (
L
ongitudinal
E
xperts using
A
ll
D
ata, LEAD). As a consequence, diagnostic instruments have to prove their externalvalidity in comparison to LEAD diagnosis on the basis of the corresponding classification, i.e.DSM-IV. A number of interviews have been presented, that showed acceptable validity, e.g.,the “Structured Clinical Interview for DSM-IV, Axis II (SCID-II)” (Fydrich et al. 1997) andthe “International Personality Disorder Examination (IPDE)” (Loranger et al. 1994).However, these interviews have to be learned in extensive training courses and they are quitetime consuming. Thus, the assessment of personality disorders by means of questionnairesrepresents a widely used alternative for everyday clinical use. These self-rating instrumentsare easily applicable and cost saving, but they tend to show unacceptably low validity.A number of questionnaires for the assessment of personality disorders have been published.The “Personality Diagnostic Questionnaire” (PDQ; Hyler & Rieder 1987; Hyler et al. 1988;Hyler 1994) is the only one of these that has been translated into German and validated in asmall sample of 60 patients (Bronisch et al. 1993). This questionnaire represents a 99-itemtrue-false questionnaire that yields personality disorder diagnoses consistent with DSM-IVcriteria and reveals categorical diagnoses, only. The SCID-II interview manual (Fydrich et al.1997) contains a 94-item true/ false screening questionnaire. Two more self-ratinginstruments for the assessment of personality disorders have not yet been published in a
 
 
2German translation: The “Millon Multiaxial Inventory” (MCMI, Millon 1977; MCMI-III,Millon et al. 1994) and the “Wisconsin Personality Disorders Inventory” (WISPI, Klein et al.1993), that has been derived from Lorna S. Benjamin´s (1993) interpersonal theory. Thedisadvantage of both instruments lies in the high number of items.In 1998 a new self-rating instrument was presented by Schotte et al., that was designed toovercome the limitations of the categorical assessment of personality disorders while adheringto the DSM-IV criteria: The ”Assessment of DSM-IV Personality Disorders” (ADP-IV).Similar to the SCID-II screening questionnaire each of the 94 diagnostic criteria of the DSM-IV is addressed by one question, but the rating is not a dichotomous one, but a dimensionalone by means of a 7-point scale. Moreover, an assessment of distress caused by the positivelyrated personality trait is provided. In accordance with Widiger´s model the ADP-IV allows for a categorical and a dimensional diagnosis of DSM-IV personality disorders.In this study the German translation of the ADP-IV was validated on 400 psychotherapyoutpatients and a community sample of 385 persons. The aims of the study were theevaluation of: (1) Internal consistency and factor analysis of the ADP-IV items, (2)assessment of retest reliability, and (3) concurrent validity with the SCID-II interview and anexpert consensus rating.
2. Method 2.1 Subjects
At the psychotherapy outpatient unit of the Clinical Department of Medical Psychology andPsychotherapy, Innsbruck Medical University, Austria, 643 outpatients were asked to participate in the study. Four hundred (62.2%) gave informed consent and were included intothe investigation. Inclusion criteria were: Age
18 years, sufficient knowledge of Germanlanguage. Exclusion criteria were: Cognitive impairment, acute psychotic disorder, and severeaffective disorder. All patients completed the ADP-IV questionnaire, in 210 patientsadditionally a SCID-II interview was conducted. In addition, a representative sample of the population of the Austrian county of Tyrol, consisting of 385 persons was assessed by meansof the ADP-IV questionnaire. Out of these 41 completed the questionnaire for a second timeafter a period of four weeks. This sample corresponds to the community of Tyrol with regardto age, gender, and education (data fromhttp://www.statistik.at
 
).
2.2 Instruments Assessment of DSM-IV Personality Disorders (ADP-IV) questionnaire
The self assessment instrument consists of 94 items that correspond to the diagnostic criteriafor personality disorders of the DSM-IV (see Figure 1 for translated sample items). Each trait-item has to be assessed on a seven point scale. If the rating is 5 or above, an additionaldistress rating on a three point scale from 1 to 3 has to be answered (response format seeFigure 1).

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