Redefining personality disorder: a Jamaican perspective

objective: to characterize and assess the factor structure of phenomenological features of dsm-iv personality disorder diagnosis in jamaican patients and determine any similarities with those of traditional criteria, associations with disorder severity, and/or significant relationships between variables to inform the current debate on the relevance of established personality disorder diagnostics. methods: this was a case-control study. all the patients included were seen by one private psychiatric practice from 1974 to 2007. the study sample group (n = 351) were patients diag nosed as having a personality disorder (dsm-iv axis ii). the control group was composed of patients with dsm-iv axis i clinical disorders, who had not been diagnosed with a personality disorder, and matched exactly on gender, and closely on age, as well as socioeconomic variables. results: of the 351 individuals in the study sample group, 166 (47.3%) were male and 185 (53.7%) were female; 50 (14.2%) were white and 301 (85.8%) were black; 293 (83.5%) were born and raised in jamaica; and 202 (57.6%) were from socioeconomic classes i and ii. mean age was 33.92 (standard deviation 10.236). disaggregating the phenomenology, the conventional dsm-iv personality disorder diagnoses disappeared. factor analysis of 38 clinical phenomena identified five components: psychosis, major depression, power management problems, psychosexual issues, and physiological dependency. independent t-tests revealed patients without personality disorder had significantly higher mean scores for psychosis; both groups scored equally for depression; and those with personality disorder had significantly higher mean scores on the remaining factors. analysis of variance indicated these factors differed significantly for three levels of severity (mild, moderate, and severe). conclusions: the phenomenology clustering into three major groups suggested an axis i (clinical) diagnostic disorder of impulse control and authority and conf