Personality Disorder in Adhd Part 1: Assessment of Personality Disorder in Adult Adhd Using Data from a Clinical trial of Oros Methylphenidate

Abstract

Background

Comorbidity of personality disorder (PD) and attention-deficit/hyperactivity disorder (ADHD) has been suggested in several reports. However, assessment of PD is problematic, and studies have overrelied on baseline evaluations.

Methods

Forty-seven patients entered a double-blind trial of osmotic release oral system (OROS) methylphenidate (MPH). Patients were assessed at baseline with the Wisconsin Personality Inventory IV (WISPI-IV) and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). Following the study, all information—including tests, family reports, and extended clinical observations—produced a final PD diagnosis. Three post hoc categories were created: PD-negative (no PD), PD-positive (1 PD), and PD-plus (2 or more PDs).

Results

Twenty-one (45%) patients had a PD on the final assessment vs 62% using SCID-II and 33% using WISPI-IV; final PD diagnosis revealed 9% cluster A, 17% cluster B, and 28% cluster C. Twenty-one percent of patients experienced multiple disorders. Using a weighted kappa, the number of PDs on the final assessment correlated with the WISPI-IV (κ =.53; P > .001) and the SCID-II (κ =.70; P < .001). However the SCID-II overidentified and the WISPI-IV underidentified PD.

Conclusion

Almost all PDs were represented in this sample, and past emphasis on cluster B appears unwarranted. Although the SCID-II and WISPI-IV had limited success in identifying specific PDs, they were more successful in identifying the number of PDs present in each patient. The small sample makes these findings preliminary.

Keywords

ADHD adult personality disorder Wisconsin Personality Inventory-IV (WISPI-IV)SCID-II

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