title: Shakatani: the phenomenology of personality disorder in Jamaican patients.
abstract: OBJECTIVE
  To examine the distribution and clinically significant patterns of the phenomenology of a cohort of Jamaican patients with a Diagnostic and Statistical Manual of Mental Disorders (DSM) Axis II diagnosis of personality disorder and to clarify the conventional diagnostic deficiencies of DSM-based personality disorder categories.
  
  
  METHODS
  In a case-control study from the naturalistic clinical setting of a private psychiatric practice in Kingston, Jamaica, between 1974 and 2007, the phenomenology of a cohort of 351 patients with an Axis II DSM diagnosis of personality disorder is qualitatively described and quantitatively compared with that of a control group of patients with an Axis I DSM clinical diagnosis, matched for age, gender and socio-economic class.
  
  
  RESULTS
  There were 166 males (47.3%); 238 (67.8%) of the patients were between age 18 and 39 years. Ethnically, 325 (92.6%) were Black, 10 (2.8%) White and 16 (4.6%) Other. The majority of patients (20.7%) had a DSM-IV diagnosis of dependent personality disorder. Patients with an Axis II diagnosis were significantly more likely to display symptoms of a 'clinical triad' of power management, dependency and psychosexual issues. Qualitative analysis of the phenomenological symptoms of personality disorder diagnosed patients suggests aetiological interconnections based on early childhood experiences as explained by object relations and attachment theories.
  
  
  CONCLUSIONS
  The phenomenological approach to personality disorder may be a viable replacement for the four-cluster classification of DSM-IV in a Jamaican population with the clinical triad called Shakatani, derived from the Swahili words shaka (problem) and tani (power). This phenomenological approach may provide more clinical utility to practitioners.
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: 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
authors.affiliation: Caribbean Institute of Mental Health and Substance Abuse (CARIMENSA), Faculty of Medical Sciences, The University of the West Indies, Kingston 7, Jamaica.
authors.forename: V
authors.initials: V
authors.lastname: Paisley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D007563:Jamaica / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010554:Personality Disorders / Q000145:classification* / Q000453:epidemiology / Q000523:psychology