European Journal of Psychology and Educational Studies

ORIGINAL ARTICLE
Year
: 2014  |  Volume : 1  |  Issue : 1  |  Page : 22--29

Prevalence of personality disorders symptoms among male high school students in Isfahan, Iran


Asghar Aghaei, Mohsen Golparvar 
 Department of Psychology, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran

Correspondence Address:
Asghar Aghaei
Department of Psychology, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan
Iran

Abstract

Introduction: This research was conducted to examine the prevalence and variety of different personality disorders (paranoid, schizoid, schizotypal, antisocial, borderline, histrionic, narcissistic, avoidant, dependent, obsessive-compulsive) among high school boys in Isfahan (Iran). Materials and Methods: Total 375 subjects were randomly selected from 46,340 high school boy students as the sample group. Multi-stage sampling was used. Individual − family characteristics«SQ» questionnaire and structured interview on the basis of the checklist of personality disorder symptoms as mentioned in DSM-IV were administered to them. The face validity of the checklist was verified. Concurrent validity was also assigned by examining the correlation patterns between the checklist and MCMI-II; correlation coefficient was equal to 0.3 to 0.6 for 10 personality disorders. The reliability of the checklist, which was determined by using the test-retest method with an interval of four weeks, was 0.63 to 0.8. The primary 10 questions concern the prevalence of personality disorders such as paranoid, schizoid, schizotypal, antisocial, borderline, histrionic, narcissistic, avoidant, dependent and obsessive-compulsive among high school boy students in Isfahan. Result: Data analysis revealed the following results: paranoid, 5.9 percent; schizoid, 6.7 percent; schizotypal, 1.3 percent; antisocial, 6.9 percent; borderline, 8 percent; histrionic, 6.4 percent; narcissistic, 6.1 percent; dependent, 4 percent and obsessive-compulsive, 9.9 percent. Discussion and Conclusions: It is suggested that according to the self-reporting done by the students concerning the existence of personality disorder symptoms presented in DSM-IV, families and school consultants should be trained so that they can identify and evaluate the personality disorder symptoms. It is also suggested that a longitudinal study must be conducted to determine the stability and reliability of the symptoms.



How to cite this article:
Aghaei A, Golparvar M. Prevalence of personality disorders symptoms among male high school students in Isfahan, Iran.Eur J Psychol Educ Studies 2014;1:22-29


How to cite this URL:
Aghaei A, Golparvar M. Prevalence of personality disorders symptoms among male high school students in Isfahan, Iran. Eur J Psychol Educ Studies [serial online] 2014 [cited 2019 Sep 23 ];1:22-29
Available from: http://www.ejpes.org/text.asp?2014/1/1/22/150271


Full Text

 Introduction



Personality includes those personality characteristics that manifest stable conduct patterns and consists of recognition, feelings and overt conduct. [1],[2] Sometimes, these patterns and conducts go out of order and are contradictory, and as a result the individual's personality has been disordered. [3],[4] Personality disorders have been historically controversial. Theories concerning these disorders have been a mixture of some general ones in which other psychological disorders had also been included. [5],[6],[7],[8] Yet, in recent decades classification such as Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) [9] and classification of mental and behavioral disorders (ICD-10) [10] have been to some extent informative concerning the concept of personality disorders. Although there have been criticisms concerning these classifications, most experts believe that in the absence of sufficient information in connection with various dimensions of personality disorders, they are still reliable. [11] DSM-IV [9] has asserted that personality disorders usually start during childhood and adolescence and can be detected among young people if personality disorders are stable and prevalent through developmental stages. [9] Of course, some experts in the field have stated that despite this, the essence of personality disorders in children and adolescents (in particular because of the existence of disorders in young people) have remained a doubtful issue. [12],[13] Moreover, although these terms are used for young people in clinics, [8],[9],[10],[11],[12],[13],[14] , their meanings and reliability have remained unclear in this very same group of people. [15],[16]

 Personality Disorders in Adolescents



Some studies or long scales have been conducted concerning the reliability of the diagnosis of personality disorders. [17] In a longitudinal study on adolescents in Toronto, DSM-III-R was used to evaluate 72 participants from a sample of a population aged 13, 16 and 18. Researchers in this study found that personality disorders in adolescents were associated with high levels of distress and mental disturbances. [17] Likewise, several researchers showed that adolescents with personality disorders have social impairment, educational problems, contacts with the police and difficulties at work, a result similar to that of other researches. [18],[19],[20],[21],[22] A review of the literature indicates that in recent years, research on personality disorders has increased using clinical samples. [23],[24] Most of these studies have largely concentrated on borderline personalities [25] or have secondarily dealt with personality disorders in comparison with other disorders. [26],[27] These studies have shown that personality disorders in adolescents were associated with high levels of depression, anxiety, anger, dissociation, cognitive distortions and impairment, low self-concept, suicide, low response to treatment, personal attributes like sensation-seeking, aggressiveness, bad-temperedness, low self-confidence and hopelessness. [28] The above-mentioned and other studies have also revealed that personality disorders in adolescents are similar to adults as far as their incidence and patterns are concerned. [29],[30]

Researchers believe, on the basis of these findings, that it is possible to determine personality disorders in adolescents according to diagnostic reliability of criteria. [31] Researchers like Mattanah et al. [32] and Bernstein et al. [18] have observed that the stability of personality disorder symptoms in adolescents prevail for one or two months and may not be stable for longer than that. In summation, according to warnings given in some studies, recognition of personality disorders in hospitalized adolescents has acceptable concurrent validity but the predictive validity of these recognitions is mingled with many complex factors. [31],[32],[33] The prevalence of personality disorders in adolescents and adults has been the concern of many studies. However, it should be mentioned that most of these studies have generally referred to the prevalence of personality disorders and they have not dealt with individual symptoms. For example, Wissman [34] estimated the general prevalence of personality disorders from 10 to 13 percent on the basis of Epidemics Foundations and Personality Disorders Diagnostic Criteria in DSM-III. Levy et al. [31] also reported the prevalence of personality disorders among adolescents under study as follows: 86 people (equal to 61 percent out of 142 young patients) had at least one personality disorder. Borderline cases were the maximum (71 people) and schizoid and obsessive-compulsive cases were the least (two people each). However, this study was limited to clinical and psychiatric populations and the results cannot be generalized to the general population.

Johnson et al. [35] in a study based on the relationship between personality disorders and criminal and aggressive conduct in adolescents and early adulthood period, evaluated 77 adolescents as the sample group from the population together with their mothers in the years 1983, 1985, 1986, 1991 and 1993, by using structured interview on the basis of personality disorder symptoms as in DSM-III-R and DSM-III. The results of this study showed 3.3 percent of adolescents as paranoid, 1.1 percent as schizoids, 1.7 percent as schizotypal, 2.4 percent as borderline cases, 2.5 percent as narcissistic, 3.1 percent as dependent, and 1.1 percent as obsessive-compulsive cases. Among 103 adolescents with personality disorders, 51 had only one personality disorder while 52 had two or more disorders. Yet, adolescents with personality disorder groups A and B (paranoid, schizoid, schizotypal, antisocial, borderline and narcissistic) committed more antisocial, aggressive and criminal behavior in comparison to adolescents with group C personality disorders (histrionic, dependent and obsessive-compulsive).

The antisocial personality disorder was not taken into account in this study because the adolescents under study were below 18. It is worth mentioning here that according to American Psychiatry Association (1994), only antisocial personality disorder under the age of 18 cannot be diagnostic; other disorders can be detected in case their symptoms are stable. However, studies on adult personality disorders are stronger compared to that of adolescents. For example, Miller et al. [5],[25] declared the prevalence of personality disorders on the basis of personality questionnaire as: Paranoid, 0.4 to 0.9 percent; borderline, 1.3 to 3.6 percent; histrionic, 2.2 to 2.7 percent; narcissistic, 0.4; avoidant, 0.0 to 0.4 percent; dependent, 5.1 to 6.7 percent; obsessive-compulsive, 4 to 6.4 percent; and passive-aggressive, 0.0 to 0.4 percent. [5]

Torgersen et al. [36] studied 2,053 men and women in Oslo, the capital of Norway, and reported the general prevalence of personality disorders as 13.4. The frequency of each personality disorder being: Paranoid, 2.4 percent; schizoid, 1.7 percent; schizotypal, 0.6 percent; antisocial 0.7 percent; sadistic, 0.2 percent; borderline, 0.7 percent; histrionic, 2 percent; narcissistic, 0.8 percent; avoidant, 5 percent; dependent, 1.5 percent; obsessive-compulsive, 2 percent; passive-aggressive, 1.7 percent; and self-defeating, 0.8 percent. The subjects in this study aged 18 to 65. The prevalence ratios indicate that the results are not unanimous in different studies. Most of the studies have specified a clear range for each personality disorder. The differences between the prevalence indices may lie in differences between cultures, instruments and populations. Yet, it should always be remembered that the clear symptoms to distinguish personality disorders should prevail at least for one year. This means that determination of personality disorder cannot be established just because symptoms exist.

The present research surveys the frequency and variety of personality disorder symptoms on the basis of the criteria in DSM-IV and it does not intend to decisively diagnose the disorders. However, the presence of personality disorder symptoms should be alarming for the future of the society. [29] Hence, it is necessary, in the case of the presence of symptoms, to investigate further and to begin treatment. The current classifications regarding personality disorders are DSM-IV and ICD-10 that have been reformed since time to time. The main criterion for the present study is the 10 personality disorders mentioned in DSM-IV, which are classified into groups A, B and C. Group A includes paranoid, schizoids and schizotypal who show elective behavior. Group B includes antisocial, borderline, histrionic and narcissistic who demonstrate unstable, emotional behavior, and group C includes avoidant, dependent and obsessive-compulsive disorders. [9] The people with these disorders are usually in a state of panic and fear. The main aim of this research is to determine the level of frequency and prevalence of personality disorder symptoms, namely, paranoid, schizoid, schizotypal, antisocial, borderline, histrionic, narcissistic, avoidant, dependent and obsessive-compulsive among male high school students in Isfahan.

 Research Questions



How frequent are personality disorders such as paranoid, schizoid, schizotypal, antisocial, histrionic, narcissistic, avoidant, dependent and obsessive-compulsive among male high school students in Isfahan observed?

 Materials and Methods



Participants

Since this research concerns the frequency and prevalence of personality disorders (paranoid, schizoid, schizotypal, antisocial, borderline, histrionic, narcissistic, avoidant, dependent and obsessive-compulsive), the research method is a survey or epidemiology. Statistical population of the current research was all high school male students in Isfahan from the population. They are 46,340 high school students between 16 and 19 years of age. The sampling in this research has been based on the proportion criterion formula developed by Krejcie and Morgan [37] with N = 46,340, a = 0.05 and Z = 1.96, and frequency proportion for personality disorders were based on maximum P = 0.3 and a = 0.7. Since all the three grades in the high school participated in research, the number of subjects were 125 each, and so a total of 375. Multi-stage sampling was used as follows: In the first phase, nine high schools were randomly sampled out of 90 high schools and art schools for boys in Isfahan. In the second phase, three high schools were sampled for each grade. And in the third and final phase, one class was sampled and interviewed.

Measurements

Structured Interview

In order to survey the personality disorder symptoms, a checklist was provided using the criteria presented in DSM-IV, prepared by the American Psychiatry Association. [9] The checklist was prepared the following way: First, the criterion for each personality disorder was changed to a question. Then, the questions were surveyed and controlled for full correspondence with the criteria. The concurrent validity of checklist was also determined by examining the correlation coefficient between the current research checklist and Millon Clinical Multiaxial Inventory. [38],[39] In this regard, correlation coefficient range was 0.3 to 0.6 (P < 0.01). The reliability of the checklist ranged from 0.64 to 0.8 using the test-retest method at an interval of four weeks. After assigning each class in each high school, individual and family data were obtained using individual − family questionnaire. Then, the existence of each personality disorder was sought by asking the students to answer the questions in the checklist in the form of a "Yes" or "No". After that the symptoms were presented to the students one by one and the answers were recorded.

Individual − Family characteristics' questionnaire

In order to gather individual data concerning age, average and the number of fails in studies, and family characteristics like age, education and occupation of parents, the individual − family questionnaire was prepared and administered.

Data analysis

Generally, one question was developed for each personality disorder. The questions concern the frequency of disorder symptoms of paranoid, schizoid, schizotypal, antisocial, borderline, histrionic, narcissistic, avoidant, dependent and obsessive-compulsive. The data collected were analyzed in the form of frequency distribution tables and percentages.

 Results



Q1. How frequent is "paranoid" personality disorder symptoms among high school male students in Isfahan?

In [Table 1], the frequencies and their percentages are presented on the basis of at least four symptoms and more for high school male students.{Table 1}

[Table 1] shows that 94.1 percent of the students had less than four symptoms, whereas 5.9 percent had at least four symptoms and more. Hence, since the presence of four symptoms and more is required to determine paranoid personality disorders, it can be concluded that the frequency of paranoid personality disorders symptoms has been 5.9 as displayed by male students in three grades.

Q2. How frequent is "schizoid" personality disorder symptoms among high school male students in Isfahan?

In [Table 2], frequency of schizoid is presented on the basis of less than four symptoms and at least four symptoms and more for male students.{Table 2}

The data presented in [Table 2] indicate that 93.6 percent of male students had less than four symptoms concerning schizoid personality disorder, whereas 6.4 percent of the rest had four symptoms and more. Accordingly, it can be concluded that the frequency of schizoid personality disorders symptoms among boy students has been 6.4 percent.

Q3. How frequent is the "schizotypal" personality disorder symptoms among high school male students in Isfahan?

In [Table 3], the frequency and percentage of the symptoms are presented on the basis of less than five symptoms and at least five symptoms and more.{Table 3}

The numerical data presented in [Table 3] suggest that 98.7 percent of the students have less than five symptoms related to schizotypal personality disorder, whereas 1.3 percent had at least five symptoms and more. Accordingly, it can be concluded that, only on the basis of symptoms, the frequency of schizotypal has been 1.3.

Q4: How frequent is "antisocial" personality disorder symptoms among high school male students in Isfahan?

[Table 4] presents the frequencies and the percentage of antisocial personality disorder on the basis of less than three symptoms and at least three symptoms and more.{Table 4}

[Table 4] indicates that 93.1 percent of high school male students displayed less than three symptoms, while 6.9 percent displayed three symptoms and more from among all the symptoms presented for antisocial disorder. On the basis of the data, it can be concluded that the general prevalence and frequency of antisocial personality disorder symptoms has been 6.9.

Q5. How frequent is "borderline" personality disorder among symptoms among high school male students in Isfahan?

[Table 5] illustrates the frequencies and percentage of the symptoms on the basis of less than five symptoms and at least five symptoms and more.{Table 5}

[Table 5] indicates that 92 percent of male students under study had less than five symptoms concerning borderline personality disorder and the rest 8 percent (about 30) reported at least five symptoms and more. Accordingly, it can be concluded that on the basis of symptoms, 8 percent of high school male students displayed symptoms of borderline personality disorder.

Q6: How frequent is "narcissistic" personality disorder symptoms among high school male students in Isfahan?

[Table 6] illustrates the frequency of the symptoms of narcissistic personality disorder on the basis of at least five symptoms and more, and less than five symptoms.{Table 6}

[Table 6] shows that 93.9 percent of high school male students reported less than five symptoms concerning narcissistic personality disorder and 6.1 percent had at least five symptoms and more. Accordingly, it can be concluded that, on the basis of symptoms the prevalence of this personality disorder is 6.1 percent among the male students.

Q7. How frequent is "histrionic" personality disorder symptoms among high school male students in Isfahan?

[Table 7] illustrates the frequencies and percentages of this personality disorder on the basis of less than five symptoms and at least five symptoms more for high school male students.{Table 7}

On the basis of the data presented in [Table 7], 93.6 percent of high school male students had less than five symptoms, whereas 6.4 percent had at least five symptoms and more. Accordingly, it can be said that the frequency of the histrionic personality disorder symptoms had been 6.4 among the male students.

Q8: How frequent is the "avoidant" personality disorder symptoms among high school male students in Isfahan?

[Table 8] illustrates the frequencies and percentages of avoidant personality disorders symptoms on the basis of less than four symptoms and at least four symptoms and more.{Table 8}

[Table 8] shows 89.9 percent of high school male students reported less than four symptoms, whereas 10.1 percent had at least four symptoms and more. Accordingly, on the basis of symptoms, the frequency of this disorder had been 10.1 percent.

Q9. How frequent is "dependent" personality disorder symptoms among high school male students in Isfahan?

[Table 9] illustrates the frequencies and percentages of dependent personality disorder symptoms based on less than five symptoms and at least five symptoms and more.{Table 9}

[Table 9] indicates that 96 percent of high school male students in Isfahan reported less than five symptoms, while 4 percent had at least five symptoms and more. Accordingly, it can be concluded that on the basis of symptoms, the frequency of this disorder has been 4 percent among high school male students in Isfahan.

Q10: How frequent are "obsessive-compulsive" personality disorder symptoms among high school male students in Isfahan?

[Table 10] illustrates the frequencies and percentages of obsessive-compulsive personality disorder on the basis of less than four symptoms and four symptoms and more.{Table 10}

[Table 10] shows that 90.1 percent of high school male students in Isfahan reported less than four symptoms concerning obsessive-compulsive personality disorder and 9.9 percent had at least four symptoms and more. Accordingly, it can be concluded that the frequency of the symptoms of this personality disorder has been 9.9 among high school male students under study.

 Discussion



The results of the current investigation [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9] and [Table 10] present the frequencies of different personality disorder symptoms on the basis of the presence of symptoms. Different researchers have reported different rates of frequencies for personality disorders among adult and adolescent population. [18],[19],[20],[21],[22] For example, Torgersen et al. [36] reported 2.4 percent of paranoid personality disorder among male and female adults in Norway. Other personality disorders have been reported between 4 and 5 percent. Concerning previous studies, it should be mentioned that these studies have been done on adults and stability of the symptoms have been taken into account at least for one year. A review of the findings of this research revealed that the frequencies of personality disorder symptoms fluctuate from 1.3 to 10.1 and apparently the reported percentages are higher than similar foreign researches. [23],[24],[25],[26],[27],[28],[29],[30] Partly, this difference might be due to the fact that this research has been conducted on the basis of the presence of symptoms during interviews with students and not during the whole year, and this has caused the figures to rise in comparison with other researches. [3],[4],[5],[6],[27],[28],[29],[30],[31],[32],[33],[34],[35],[36],[37],[38],[39],[40]

A review of the researches on adolescent populations like Johnson et al's study [35] shows the frequencies of different personality disorders to be: Paranoid, 3.3 percent; schizotypal, 1.1 percent; schizoid, 1.7 percent; antisocial, 6.9 percent; narcissistic, 6.1 percent; avoidant, 10.1 percent; dependent, 4 percent; and obsessive-compulsive, 9.9 percent. A comparison between this study and Johnson et al's [35] study reveals that most of the frequencies in our study are higher. Johnson et al's [35] study has been a longitudinal one whose stability of symptoms via interviewing with adolescents and their families has been surveyed for at least one year. However on the other hand, it seems that some students in this study reported their symptoms on the basis of sporadic occurrences and not permanent ones. Hence, naturally, higher percentages have been reported. However, this research did not aim at the prevalence of personality disorders but on their symptoms.

Researchers like Bernstein et al. [18] have reported that personality disorder symptoms may be stable for one or two months but they change over time. But since Kasen et al. [29] believe that it is possible to rely on diagnosing personality disorders in adolescents, the findings of this research are open for comments. Recent researches have clarified the situation a bit, though it has been gloomy for the past decade. In previous attempts in this regard, Kernberg in 1978 and Robson [5] presented concisely the possibility of diagnosing personality disorders in adolescent clinical populations. [5] However, the findings of this research try to cope with the idea of the researchers who believe that it is possible to diagnose personality disorders in adolescents. American Psychiatry Association [9] has asserted in its fourth general DSM-IV concerning personality disorders that the symptoms of disorders appear in adolescence and their crucial determination would only be possible through one year stability of symptoms in interaction with social and life affairs.

This assertion coincides with the findings of this research in the sense that although the exact and crucial diagnosis of personality disorders may not be possible because of indeterminacy of the stability of symptoms, at least the findings show that personality disorder symptoms like paranoid, schizoid, schizotypal, antisocial, borderline, histrionic, narcissistic, avoidant, dependent and obsessive-compulsive can be logically detected and stressed in adolescence. It should be generally remembered that adolescence is a period in one's life, which is associated with profound changes in social, mental and personality dimensions. However, some adolescents may find it difficult to pass through this phase because of a variety of reasons, including mental health, [29] though the belief that all adolescents pass through this phase with disorders and harm has been challenged. This perspective is very important and it must be considered while commenting on all research findings.

 Conclusion, Limitations and Suggestions



Lack of research concerning the diversity of personality disorder symptoms in adolescents has been the main impetus in conducting this research. However, it should be noted that the sample randomized for this research included non-clinical high school boys in Isfahan, which were different from clinical samples or known adolescents with personality problems; [35] hence, in comparison with other researchers, the findings must be carefully dealt with. The most important suggestion this research can make is that similar studies must be done in the course of one year to determine the diagnosis of personality disorders among adolescents. At the same time, the partial frequency of all personality disorder symptoms among adolescents warns us to deal seriously with adolescents' problems. Most researchers like Kasen et al. [29] exclusively believe that most personality problems in youth can be treated and prevented once they are attended to. The righteousness of this assertion would be possible through performing research plans that would deal with the effectiveness of different meditational processes of treatment and prevention.

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