title: A view of personality disorder from the colonial periphery.
abstract: OBJECTIVE
  To examine the history of personality disorder in the context of contemporary post-colonial Jamaican society.
  
  
  METHODS
  The literature outlining the development and classification of personality disorder is reviewed. The social, psychiatric and epidemiological studies of personality disorder in Jamaica are presented.
  
  
  RESULTS
  A categorical classification system of personality disorder has been in use by the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM) from the mid 20th century. Challenging that approach is the Minnesota Multiphasic Personality Inventory (MMPI), which represents the dimensional method, which views pathology as a continuum from normal personality traits. Both systems suffer from an absence of cultural flexibility, an absence of a a system of severity, and a lack of treatment specificity, which foster misdiagnosis while making treatment planning difficult and unreliable. The proposed DSM-5 attempts to integrate a prototypematching system and identification of personality traits promises disappointing outcomes. The University of the West Indies, Section of Psychiatry, proposes a phenomenological nosological approach, advocating an alternate DSM Axis I category called Shakatani derived from Swahili shaka (problem), tani (power), and developing a 38-item Jamaica Personality Disorder Inventory (JPDI) screening questionnaire for diagnosing this condition. The epidemiological results using this instrument are reviewed, and the Jamaican print, broadcast and social media responses to this research in Jamaica are described.
  
  
  CONCLUSIONS
  The heritage of slavery and colonial oppression in Jamaica has resulted in maladaptive personality disorders that have led to extremely high rates of homicide, violence and transgressive behaviour.
authors.affiliation: Caribbean Institute of Mental Health and Substance Abuse (CARIMENSA) Faculty of Medical Sciences, The University of the West Indies, Kingston 7, Jamaica. frederick.hickling@uwimona.edu.jm; fred@fredhickling.com.
authors.forename: F W
authors.initials: FW
authors.lastname: Hickling
authors.affiliation: Department of Community Health and Psychiatry, The University of the West Indies, Kingston 7, Jamaica and South East Regional Health Authority, Kingston and St Andrew Public Health Service, 1 Marescaux Road, Kingston 5, Jamaica.
authors.forename: G
authors.initials: G
authors.lastname: Walcott
mesh_terms: D039721:Diagnostic and Statistical Manual of Mental Disorders; D063947:Enslavement; D006801:Humans; D007563:Jamaica / Q000453:epidemiology; D010554:Personality Disorders / Q000145:classification* / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology; D010555:Personality Inventory; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors