Differential diagnosis of personality disorders by the seven-factor model of temperament and character.
We used multiaxial structured interviews and questionnaires to evaluate the ability of self-reports on seven personality dimensions to predict independent interview diagnoses of DSM-III-R personality disorders. We studied 136 consecutive adult psychiatric inpatients, excluding those with psychosis, organic mental disorders, and severe agitation. Sixty-six patients had interview diagnoses of DSM-III-R personality disorders. Most also had mood disorders. We confirmed the hypotheses that self-reports of low self-directedness and cooperativeness strongly predicted the number of personality symptoms in all interview categories, whereas the other factors distinguished among subtypes as predicted. Self-directedness and cooperativeness also predicted the presence of any personality disorder by differentiating patients varying in risk from 11% to 94%. Patients in clusters A, B, and C were differentiated by low reward dependence, high novelty seeking, and high harm avoidance, respectively. We conclude that low self-directedness and cooperativeness are core features of all personality disorders and are validly measured by the seven-factor Temperament and Character Inventory, but not the five-factor Neuroticism-Extraversion-Openness inventory. Each DSM-III-R personality disorder category is associated with a unique profile of scores in the seven-factor model, providing an efficient guide to differential diagnosis and treatment.
Svrakic
D M
DM
Department of Psychiatry, Washington University School of Medicine, St. Louis, Mo.
Whitehead
C
C
Przybeck
T R
TR
Cloninger
C R
CR
D002605:Character; D003937:Diagnosis, Differential; D005163:Factor Analysis, Statistical; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D001523:Mental Disorders / Q000145:classification / Q000175:diagnosis*; D008954:Models, Biological; D008960:Models, Psychological; D010552:Personality Assessment; D010554:Personality Disorders / Q000145:classification / Q000175:diagnosis*; D010555:Personality Inventory / Q000706:statistics & numerical data*; D011336:Probability; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011594:Psychometrics; D013694:Temperament / Q000145:classification*