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A compromise solution between overlapping and overlooking DSM personality disorders in Chinese psychiatric practice

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Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Objective

This study aimed to examine the overlaps between the Diagnostic and Statistical Manual-5 (DSM-5) Personality Disorders (PDs) in a high-risk clinical population and to explore a transitional model for implementing DSM-5 PDs.

Method

A sample population of 982 outpatients with at least one diagnosed PD was selected from 3,075 outpatients of the Shanghai Mental Health Center. The diagnostic process comprised of a personality diagnostic questionnaire and a structured clinical interview.

Results

685 (22.3%) patients were diagnosed with at least one of six PDs (antisocial, avoidant, borderline, narcissistic, obsessive–compulsive, and schizotypal) under the alternative DSM-5 model for personality disorders proposed in Section III of the DSM-5. Nearly 20.3% of the subjects with PD met criteria for at least two PDs (of the 685 PD patients/6 PD model). Cluster and principal component analyses suggest a transitional model for the 7 specific PD categories (among the 722 PD patients, the overlapping rate was 24.1%) will be more appropriate for PD diagnosis in China.

Conclusions

Using the simplified PD categories in the alternative DSM-5 model for personality disorders will reduce the overlaps in PD diagnoses in Chinese psychiatric practice, and should be preferred over the DSM-5 PD diagnostic system.

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Acknowledgements

This study was supported by National Natural Science Foundation of China (81671329, 81671332), Ministry of Science and Technology of China (2016YFC1306803), Shanghai Science and Technology Committee (15411967200), Shanghai Shenkang Hospital Development Center (16CR2015A, 16CR3016A), Shanghai Key Laboratory of Psychotic Disorders (13dz2260500), Division of early psychosis (2013-YJTSZK-05), Shanghai Jiao Tong University Foundation (14JCRY04, YG2014MS40), Shanghai Mental Health Center Foundation (2016-FX-01). It was also supported by SHSMU-ION Research Center for Brain Disorders (2015NKX001), Program of Shanghai Academic Research Leader (16XD1402400).

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Author notes

  1. SuoYu Zhu, TianHong Zhang contributed equally to this work.

Authors and Affiliations

  1. Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, 600 South Wanping Road, Shanghai, 200030, People’s Republic of China

    SuoYu Zhu, TianHong Zhang, ChengQing Yang, YanYan Wei, LiHua Xu, JunJie Wang, XiaoHua Liu, KaiDa Jiang, ZePing Xiao, Hui Zhou & JiJun Wang

  2. Department of Psychiatry, Huashan Hospital, Fudan University, Shanghai, 200021, China

    SuoYu Zhu

  3. Clinical Psychology, James Cook University, Singapore, 387380, Singapore

    Annabelle Chow

  4. Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, People’s Republic of China

    TianHong Zhang & JiJun Wang

  5. Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai, People’s Republic of China

    JiJun Wang

  6. Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China

    TianHong Zhang & JiJun Wang

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  1. SuoYu Zhu
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Correspondence to TianHong Zhang, Hui Zhou or JiJun Wang.

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Zhu, S., Zhang, T., Yang, C. et al. A compromise solution between overlapping and overlooking DSM personality disorders in Chinese psychiatric practice. Soc Psychiatry Psychiatr Epidemiol 53, 99–106 (2018). https://doi.org/10.1007/s00127-017-1444-3

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  • DOI: https://doi.org/10.1007/s00127-017-1444-3

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