Biometrics Research
Robert L. Spitzer, M.D., Chief of Psychiatric Research
Janet B.W. Williams, D.S.W., Deputy Chief and Research Scientist VI
Michael B. First, M.D., Psychiatrist: (Research) I
Miriam Gibbon, M.S.W., Research Scientist IV
Problems with the current DSM-IV categorical (present vs. absent) approach to the classification of personality disorders have long been recognized by clinicians and researchers. These include marked comorbidity among the personality disorders, arbitrary distinction between normal personality, personality traits and personality disorder; and limited coverage (the most commonly diagnosed personality disorder is the residual diagnosis of personality disorder not otherwise specified).
An alternative to the categorical approach is to use dimensional systems in which the severity of a number of dimensions or domains is noted for each patient without any arbitrary cutoff indicating the presence of a disorder. Although the many advantages of a dimensional approach to personal disorder classification were recognized by the DSM-IV Personality Work Group, lack of consensus regarding any particular system and a lack of data supporting clinical utility and acceptability prevented a dimensional approach from being adopted.
Drs. Spitzer and First, collaborating with Dr. Andrew Skodol, have initiated a study that compares the clinical utility of four dimensional systems: a dimensional implementation of the DSM-IV categorical system (Skodol and Oldham), the Five Factor Model (Widiger, et al), a Stepwise Psychobiological Classification (Cloninger), and a Prototype Matching Approach (Westen and Shedler). Clinicians (psychiatrists and psychologists) interested in personality diagnosis are being recruited to participate in the study by completing forms on which they will assess one of their patients with the four dimensional systems. They will then make ratings tapping different aspects of clinical utility (e.g., coverage, helpful in focusing psychotherapy).
With Dr. Crisanto Diez-Quevdo, Dr. Spitzer has completed a study that evaluated the validity of a Spanish version of the Patient Health Questionnaire (PHQ) in a large sample (N=1003) of general medical patients in Spain. Subjects completed the PHQ, the Beck Depression Inventory and measures of functional impairment, disability days, use of health care including length of hospital stay. A total of 416 (42%) of the inpatients had a PHW diagnosis. There was good agreement between an independent mental health evaluation and the PHQ diagnosis. Patients with a mental disorder had more functional impairment, disability days and a longer hospital stay than patients without a PHQ diagnosis. The conclusion is that the Spanish PHQ has comparable validity to the original English version in primary care patients.
Collaborations
Dr. Williams continued her role as senior co-investigator in the Center for Hispanic Mental Health Studies at the Fordham University Graduate School of Social Service, where she is a Visiting Professor. She joined the Editorial Board of the Social Workers’ Desk Reference, and agreed to serve as Consulting Editor on the journal Social Work Research, and as an editorial board member of a new journal entitled Brief Treatment and Crisis Intervention. She continues to work with a collaborative group of academics, industry representatives, and the government on a task force to standardize the administration of the Hamilton Depression Rating Scale.