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The utility of the DSM personality disorder (PD) system remains a con-
cern. The strategy employed represents one approach designed to eval-
uate 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 diver-
gent validity and relation to personality dimensions of the Five-Factor
Model of Personality (FFM) but were not related to functional impair-
ment, 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 rela-
tion to impairment, and failure to capture the full domain of personality
psychopathology (Widiger, 1997; Widiger & Frances, 2002). Previous in-
vestigators have examined the coherence of the traits within each PD crite-
rion set as well as overlap with other PD criteria (Blais, Hilsenroth, & Cas-
tlebury, 1997; Blais & Norman, 1997; Grilo et al., 2001; Maffei et al., 1997;
McGlashan et al., 2000). These studies provided information on which in-
dividual PD traits contribute significantly to the overall diagnostic inclu-
From Concordia University (A. G. R.); National Institute of Aging (P. T. C.); and Centre for
Addiction and Mental Health, University of Toronto (R. M. B.).
Address correspondence to R. Michael Bagby, Ph.D., C. Psych., Centre for Addiction and
Mental Health, Clarke Site, 250 College Street, Toronto, Ontario, Canada M5T 1R8; E-mail:
michael_bagby@camh.net
626
EVALUATION OF THE SCID-II 627
sion criteria, revealing that many individual PD traits lack utility. We be-
lieve that these earlier studies left unexamined two important issues—the
relation of PD traits to general personality trait dimensions and the associ-
ation 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 & Nor-
man, 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 reliability for diagnoses of Schizotypal,
Borderline, Avoidant, and Obsessive-Compulsive obtained using multiple
interview measures, each of these diagnoses was on average co-morbid
with 1.4 other PD diagnoses. Skodol and colleagues (2005) report, mean-
while, that the personality dimensions underlying the PDs have more clini-
cal validity than do the the PDs themselves, especially including a much
greater degree of temporal stability. A steadily increasing number of re-
ports by personality and PD researchers suggest that the problematic PD
categories should ultimately be replaced by dimensional alternatives (e.g.,
Clark, Livesley, & Morey, 1997; Ryder, Bagby, & Schuller, 2002; Skodol et
al., 1999).
There is considerable evidence that the DSM-IV PD traits have a struc-
ture mostly compatible with the Five-Factor Model (FFM), suggesting that
PD traits may be pathological variants of core personality features (Bagby
et al., 1999; Costa & Widiger, 2002; Saulsman & Page, 2004; Widiger,
2005). From a clinical perspective, the FFM can be used to describe ade-
quately the characteristic features of individual PDs (Lynam & Widiger,
2001). Warner and colleagues (2004) demonstrated that most of the stabil-
ity observed for individual PDs over a two year interval is accounted for by
FFM traits associated with individual PDs. Establishing the relation be-
tween PDs and personality dimensions is important, as the traits that
compose the FFM were derived in nonpathological populations and thus
are not conflated with Axis I psychopathology. Although previous studies
have looked at the relation between PDs and the FFM, this study considers
whether each constituent PD trait can be said to relate in some way to the
broad domain of personality. Instances in which PD traits are not linked
to the FFM will require future investigation to determine whether our un-
derstanding of personality requires broadening to include additional con-
tent, or whether certain PD traits are better seen as Axis I psychopath-
ology.
Perhaps the cardinal attribute of a PD criterion is its association with
overall impairment, an aspect of clinical utility. According to the DSM-IV,
the assignment of a PD diagnosis is predicated on the assumption that
each of the traits in the criterion set is related to significant impairment.
PD traits that are not related to impairment may well represent important
628 RYDER, COSTA, AND BAGBY
METHOD
PARTICIPANTS
EVALUATION CRITERIA
III, symptoms were correlated with the 30 facets of the NEO-PI-R. Symp-
toms that correlated significantly (Bonferroni corrected (.05/30), p < .002)
with one or more facets were considered adequately related to the universe
of general personality traits. Finally, for Criterion IV, symptoms were cor-
related with the GAF ratings. Significant correlations were considered to
show adequate evidence of a relation with functional impairment.
APPENDIX
SCID-II-Q Self-Report Question (PD trait) I II III IV
Paranoid Personality
41. Do you often have to keep an eye out to stop people
from using you or hurting you? 1 0 0 0
42. Do you spend a lot of time wondering if you can trust
your friends or the people that you work with? 1 1 0 0
43. Do you find that it is best not to let other people know
much about you because they will use it against you? 1 1 1 0
44. Do you often detect hidden threats or insults in
things people say or do? 1 0 1 0
45. Are you the kind of person who holds grudges or
takes a long time to forgive people who have insulted
or slighted you? 0 0 0 0
46. Are there many people you can’t forgive because they
did or said something to you a long time ago? 1 0 1 1
47. Do you often get angry or lash out when someone crit-
icizes or insults you in some way? 0 0 1 0
48. Have you often suspected that your spouse or partner
has been unfaithful? 0 1 0 0
Ratio: Number of traits meeting criterion to
overall number of traits 5/8 3/8 4/8 1/8
Percentage of traits meeting criterion 62.5% 37.5% 50.0% 12.5%
Schizoid Personality
58. Are there very few people that you’re really close to
outside of your immediate family? 1 0 0 1
60. Is it NOT important to you whether you have any
close relationships?
61. Would you almost always rather do things alone than
with other people? 1 1 1 0
62. Could you be content without ever being sexually in-
volved with anyone? 1 1 0 0
63. Are there really very few things that give you plea-
sure? 1 1 1 1
64. Does it NOT matter to you what people think of you? 1 1 0 0
65. Do you find that nothing makes you very happy or
very sad? 1 0 0 1
Ratio: Number of traits meeting criterion to
overall number of traits 7/7 5/7 2/7 3/7
Percentage of traits meeting criterion 100% 71.4% 28.6% 42.9%
Schizotypal Personality
49. When you are out in public and see people talking, do
you often feel that they are talking about you? 1 1 0 1
50. Do you often get the feeling that things that have no
special meaning to most people are really meant to
give you a message? 1 0 0 0
51. When you are around people, do you often get the
feeling that you are being watched or stared at? 1 1 0 1
52. Have you ever felt that you could make things happen
just by making a wish or thinking about them? 0 0 0 0
53. Have you had personal experiences with the super-
natural? 1 1 0 0
54. Do you believe that you have a “sixth sense” that
allows you to know and predict things that others
can’t? 0 1 0 0
55. Does it seem that objects or shadows are really people
or animals or that noises are actually people’s voices? 1 1 0 0
56. Have you had the sense that some person of force is
around you, even though you cannot see anyone? 1 0 1 0
57. Do you often see auras or energy fields around
people? 0 0 0 0
58. Are there very few people that you’re really close to
outside of your immediate family? 0 0 0 1
EVALUATION OF THE SCID-II 633
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