Criteria Combinations in the Personality Disorders: Challenges Associated with a Polythetic Diagnostic System

Abstract

Converging research on the diagnostic criteria for personality disorders (PDs) reveals that most criteria have different psychometric properties. This finding is inconsistent with the DSM-IV-TR PD diagnostic system, which weights each criterion equally. The purpose of the current study was to examine the potential effects of using equal weights for differentially-functioning criteria. Using data from over 2,100 outpatients, response patterns to the diagnostic criteria for nine PDs were analyzed and scored within an item response theory (IRT) framework. Results indicated that combinations that included the same number of endorsed criteria (the same "raw score") yielded differing estimates of PD traits, depending on which criteria were met. Moreover, trait estimates from subthreshold criteria combinations often overlapped with diagnostic combinations (i.e., at threshold or higher), indicating that there were subthreshold combinations of criteria that indicated as much or more PD traits than some combinations at the diagnostic threshold. These results suggest that counting the number of criteria an individual meets provides only a coarse estimation of their PD trait level. Suggestions for the improved measurement of polythetically-defined mental disorders are discussed.