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Release: June 10, 1999

UI researchers develop efficient personality disorder screen

IOWA CITY, Iowa -- The diagnosis of personality disorders usually involves a lengthy and expensive interview, making it unwieldy for routine use. However, a brief yet sensitive test developed by University of Iowa Health Care researchers shows promise as a quick and effective substitute.

Personality disorder screens are used in both research and clinical settings to determine whether people have lifelong personality traits that cause persistent or recurrent problems in their personal, social or occupational lives. The Iowa Personality Disorder Screen (IPDS) is an interview of up to 19 questions and covers 11 different symptoms that seem to be at the core of personality disorders. The IPDS takes only five minutes to administer, in marked contrast to much longer, comprehensive interviews that consist of more than 100 questions and take hours to complete.

"We hope the screen will allow for more efficient diagnosis of personality disorders in both psychiatric research and day-to-day psychiatric practice," said Douglas R. Langbehn, M.D., Ph.D., UI assistant professor of psychiatry and one of the study's lead investigators. "The longer tests aren't practical to use with every patient or research subject. The IPDS takes only about five minutes to conduct. It can help researchers or clinical caregivers pick out people who may need more careful assessment with the longer, established tests."

Langbehn said the current "gold standards" for diagnosing personality problems are detailed interviews that must be conducted by specially trained interviewers. One of these comprehensive tests was developed by Bruce M. Pfohl, M.D., UI professor of psychiatry and the other lead investigator. Eight other researchers also contributed to the project. The team analyzed 1,203 comprehensive personality interviews conducted at the UI and five other institutions in the United States, Canada and Italy to determine which questions among hundreds would best screen for personality disorders.

"The most important questions that emerged focused on social avoidance and anxiety," Langbehn said. "These seem to be common underlying problems for most people with personality disorders."

The team tested the effectiveness of the IPDS questions by conducting telephone interviews with 52 patients who originally had been diagnosed using one of the longer, face-to-face screens. The validation interviews showed that five of the questions are particularly effective at indicating whether a person is likely to have a personality disorder.

Some of the IPDS questions are, "Do you generally feel nervous or anxious around people?" and, "Do you avoid situations where you have to meet new people?" Langbehn cautioned that not everyone who answers an isolated question positively has a personality disorder.

Personality disorders are long-term problems. They include such conditions as borderline personality disorder, in which a person has an unstable perception of the world and self and may experience many moods — anger, depression or euphoria — over the course of one day.

"We hope that having an efficient screen will help others conduct more research involving these psychiatric disorders," Langbehn said. The UI team will use the brief screen in a future study, and the University of Missouri plans to use it in a study on the psychiatric problems and needs of people who are HIV positive. The screen is also being considered for inclusion in a large national survey that periodically estimates the frequency of various health problems in Americans.

"We don't yet know how well the screen works in general community settings," Langbehn said. "Primary care physicians and nurse practitioners — for whom psychiatry is not a specialty — sometimes have trouble identifying psychiatric problems in patients. But we hope this short screen, which should be easy to include in the clinical setting, will help non-specialists identify people who have a high probability of having a personality disorder. The information could help health care professionals carry out further assessment or make appropriate referrals."

The IPDS findings were published in the spring issue of the Journal of Personality Disorders. The study was supported in part by a Psychiatry Epidemiology and Biometry Training Grant from the National Institutes of Mental Health. The University of Minnesota Press provided a grant that allowed reimbursement to study subjects.