A view of personality disorder from the colonial periphery.

OBJECTIVE: To examine the history of personality disorder in the context of contemporary post-colonial Jamaican society. METHODS: The literature outlining the development and classification of personality disorder is reviewed. The social, psychiatric and epidemiological studies of personality disorder in Jamaica are presented. RESULTS: A categorical classification system of personality disorder has been in use by the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM) from the mid 20th century. Challenging that approach is the Minnesota Multiphasic Personality Inventory (MMPI), which represents the dimensional method, which views pathology as a continuum from normal personality traits. Both systems suffer from an absence of cultural flexibility, an absence of a a system of severity, and a lack of treatment specificity, which foster misdiagnosis while making treatment planning difficult and unreliable. The proposed DSM-5 attempts to integrate a prototypematching system and identification of personality traits promises disappointing outcomes. The University of the West Indies, Section of Psychiatry, proposes a phenomenological nosological approach, advocating an alternate DSM Axis I category called Shakatani derived from Swahili shaka (problem), tani (power), and developing a 38-item Jamaica Personality Disorder Inventory (JPDI) screening questionnaire for diagnosing this condition. The epidemiological results using this instrument are reviewed, and the Jamaican print, broadcast and social media responses to this research in Jamaica are described. CONCLUSIONS: The heritage of slavery and colonial oppression in Jamaica has resulted in maladaptive personality disorders that have led to extremely high rates of homicide, violence and transgressive behaviour.

The creation and validation of the Jamaica Personality Disorder Inventory.

OBJECTIVE: To describe the creation and validation of the Jamaica Personality Disorder Inventory (JPDI) screening questionnaire. METHOD: Using the phenomenological triad of power management, dependency and psychosexual issues, drafts of the JPDI were piloted on patients from psychiatric and medical wards. The JPDI consisted of 38 close-ended, yes/no questions. Validation was conducted in a sample of 200 patients, using the International Personality Disorder Examination-Screening Instrument (IPDE-S), the Brief Screen for Depression and consultant psychiatrists' Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) personality disorder interview. Construct validity was assessed through principal component factor analysis; Spearman correlation was used to assess criterion-related and discriminant validity; Cronbach's alpha was used to assess reliability of the entire scale as well as the resulting factors. The Multitrait Multimethod Matrix (MTMM) was used to assess discriminant and construct validity. RESULTS: Factor analysis revealed eight clusters consisting of 30 of the 38 questions, which had close congruence with the clinical triad. Cronbach's alpha for the entire scale was α = 0.79, ranging from a high 0.70 to 0.82 to low 0.63 to 0.45. The JPDI exhibited a sensitivity of 95.06% and a specificity of 67.71%. Significant correlation of scores for the JPDI and IPDE-S (r = 0.432, p = 0.000) and the JPDI and the DSM IV-TR diagnosis (r = 0.598, p = 0.000) established concurrent validity for the JPDI. Correlations (r = 0.293, p = 0.000) suggested that the JPDI possessed predictive validity. The complete sample matrix of the MTMM provided evidence of both convergent and discriminant validity, and thereby, construct validity. CONCLUSION: The JPDI demonstrated reliability, and criterion-related and discriminant validity.

Shakatani: the phenomenology of personality disorder in Jamaican patients.

OBJECTIVE: To examine the distribution and clinically significant patterns of the phenomenology of a cohort of Jamaican patients with a Diagnostic and Statistical Manual of Mental Disorders (DSM) Axis II diagnosis of personality disorder and to clarify the conventional diagnostic deficiencies of DSM-based personality disorder categories. METHODS: In a case-control study from the naturalistic clinical setting of a private psychiatric practice in Kingston, Jamaica, between 1974 and 2007, the phenomenology of a cohort of 351 patients with an Axis II DSM diagnosis of personality disorder is qualitatively described and quantitatively compared with that of a control group of patients with an Axis I DSM clinical diagnosis, matched for age, gender and socio-economic class. RESULTS: There were 166 males (47.3%); 238 (67.8%) of the patients were between age 18 and 39 years. Ethnically, 325 (92.6%) were Black, 10 (2.8%) White and 16 (4.6%) Other. The majority of patients (20.7%) had a DSM-IV diagnosis of dependent personality disorder. Patients with an Axis II diagnosis were significantly more likely to display symptoms of a 'clinical triad' of power management, dependency and psychosexual issues. Qualitative analysis of the phenomenological symptoms of personality disorder diagnosed patients suggests aetiological interconnections based on early childhood experiences as explained by object relations and attachment theories. CONCLUSIONS: The phenomenological approach to personality disorder may be a viable replacement for the four-cluster classification of DSM-IV in a Jamaican population with the clinical triad called Shakatani, derived from the Swahili words shaka (problem) and tani (power). This phenomenological approach may provide more clinical utility to practitioners.

Correlates of conflict, power and authority management, aggression and impulse control in the Jamaican population.

OBJECTIVE: The object of this study is to establish the correlates of the phenomenology of conflict and power management in the Jamaican population. METHODS: A total of 1506 adult individuals were sampled from 2150 households using a stratified sampling method and assessed using the 12 questions of the Jamaica Personality Disorder Inventory (JPDI) on the phenomenology of conflict and power management that are grouped into the psychological features of aggressive social behaviour, unlawful behaviour, socially unacceptable behaviour and financial transgressive behaviour. The database of responses to the demographic and JPDI questionnaires was created and analysed using the Statistical Package for the Social Sciences (SPSS) version 17. RESULTS: Of the national population sampled, 69.1% denied having any phenomenological symptoms of abnormal power management relations while 30.9% of the population admitted to having some degree of conflict and power management, ranging from mild (10.3%), to moderate (17.1), or severe (3.5%). There were 46.55% of the population which had problems with aggressive social behaviour, 9.33% had problems with unlawful behaviour, 9.58% had problems with unacceptable social behaviour and 37.74% had problems with financial transgressive behaviour. Significant gender and socio-economic class patterns for conflict and power management were revealed. This pattern of conflict and power management behaviour is critical in understanding the distinction between normal and abnormal expression of these emotions and actions. CONCLUSION: Nearly one-third of the sample population ` studied reported problems with conflict, abnormal power and authority management, impulse control and serious aggressive and transgressive behaviour.

The psychological correlates of dependency in the Jamaican population.

OBJECTIVE: To establish the prevalence of psychological dependency in the Jamaican society in order to examine the relationship between the psychological correlates of dependency and socio-political dependency in this post-colonial country. METHODS: A total of 1506 adult individuals were sampled from 2150 households using a stratified sampling method and assessed using the 17 questions of the Jamaica Personality Disorder Inventory (JPDI) on the phenomenology of dependency that are grouped into the psychological features of physiological dependency, financial dependency, and psychological dependency. The database of responses to the demographic and JPDI questionnaires was created and analysed using the Statistical Package for the Social Sciences (SPSS) version 17. RESULTS: Of the national population sampled, 77.1% denied having any of these phenomenological symptoms of dependence while 22.63% of the population admitted to having some phenomenology of dependency, ranging from mild (5.6%), to moderate (12.1), or severe (4.9%). Substance use (physiological dependency) responders accounted for 21.23%, financial dependency responders for 43.45%, and psychological dependency responders for 15.96%. Significant gender and socio-economic class patterns of dependency were revealed. This substantial swathe of the Jamaican population acknowledged their own dependency and behavioural withdrawal response to physical or emotional loss in their life, and reported having dependency problems in managing their financial and monetary affairs. CONCLUSIONS: Three-quarters of the Jamaican responders of this survey ostensibly are free of the phenomenology of dependency while a more vulnerable one-quarter has insight that they are still locked in a struggle for psychological independence. The political and economic relations between psychological dependency and socio-political dependency are discussed.

Correlates of psychosexual issues in the Jamaican population.

OBJECTIVE: To examine the relationship between the psychopathological correlates of psychosexual phenomena in post-colonial Jamaica. METHODS: A total of 1506 adult individuals were sampled from 2150 households using a stratified sampling method and assessed with the Jamaica Personality Disorder Inventory (JPDI). Responses to the seven questions on the psychological features of homosexual practices, sexual practices and dysfunction were tabulated and analysed using the Statistical Package for the Social Sciences (SPSS) version 17. RESULTS: Of the sample, 79.38% denied having phenomenological symptoms of psychosexual phenomena while 20.33% of the population admitted to having some degree of heterosexual and homosexual phenomena, ranging from mild (5.13%), to moderate (11.40), or severe (3.80%). Sixteen (1.06%) responders described homosexual practices in their lives, and 53 (3.52%) described thinking frequently about homosexual experiences in their subjective psychic lives. Significantly more (p > 0.001) male responders (348, 23.11%) had difficulty being sexually faithful to one person at a time than females (122, 8.10%). The lower class cohort members (348, 23.11%) were more likely to have had multiple sexual relationships over the previous 12 months than socio-economic class (SEC) 1-3 responders (54, 3.58%) and were more likely (681, 45.21%) to fantasize about sexual relationships with persons other than their partners (p < 0.001) than SEC 1-3 responders (94, 6.24%). CONCLUSION: Significant levels of multiple sexual partnerships and feelings of infidelity in a swathe of Jamaican people reveal underlying psychosexual anxiety and guilt, poor impulse control and difficulties with partner intimacy. This psychopathology is correlated to concomitant high-risk public health sexual behaviour such as teenage pregnancy, sexually transmitted diseases (STDs) and HIV/AIDS existing in the Jamaican society.

Prevalence and correlates of personality disorder in the Jamaican population.

OBJECTIVE: To identify the prevalence and correlates of personality disorder in a representative sample of the Jamaican population using the Jamaica Personality Disorder Inventory (JPDI). METHOD: A four-stage stratified random sampling method was used to obtain a representative population sample consisting of 1506 Jamaicans, M:F = 727 (48.3%):779 (51.7%), ages 18-64 years. A demographic questionnaire and the JPDI were administered to all participants. RESULTS: Two-fifths of the population (41.4%) scored above the scale's cut-point indicating a diagnosis of personality disorder with the level of severity ranging from mild to severe. Persons with personality disorder were significantly more likely to be single (63%), male (60%), between the ages 18 and 44 years (77%) and of a lower socio-economic status (65%) (p < 0.50 to p < 0.001). CONCLUSION: This is the only population study of personality disorder recorded in the English-speaking Caribbean. This suggests a high risk of behavioural dysfunction in the Jamaican population, having significant implications in light of the country's high rate of crime and violence. The findings highlight the need to develop effective and targeted prevention and intervention measures.

Personality disorder in convicted Jamaican murderers.

OBJECTIVE: To establish the aetiology and historical prevalence of personality disorder in violent homicidal men in Jamaica. METHODS: Examination and analysis of primary data from the psychosocial case study interviews of 36 convicted murderers from the Jamaican Government Barnett Commission of Enquiry in 1976. The disaggregated social and clinical data were analysed using a Chi-square statistical analysis. RESULTS: The mean age at time of arrest for the male convicted murderers was 24.26 ± 8.48 years. Twenty-three (66%) of the subjects had loving relationships with mothers, particularly in those men reared in the rural areas. Twenty-one (59%) cases showed marked paternal rejection and absence of integrated family life. Twenty-four (69%) of the cases experienced severe parental disciplinary methods, and two-thirds were illiterate or barely literate. Twenty-nine (83%) were from very poor socio-economic conditions. Thirty (86%) of all the murder victims were adult males. There were significant differences between the urban reared murderers (URM) and rural reared murderers (RRM). Sixteen (94%) of the victims of the URM ensued from robbery and police confrontation, while 13 (72%) of the victims of the RRM resulted from domestic disputes (p < 0.00). Seventeen (49%) of the men had normal personalities; 18 (51%) were diagnosed as having antisocial and inadequate personalities. Diagnosis of primary data using Diagnostic and Statistical Manual of Mental Disorders fourth edition, text revision (DSM-IV-TR) criteria revealed 23 (66%) men with Antisocial Personality Disorder (APD). There were significantly more APD in the URM than the RRM (p < 0.01). CONCLUSIONS: Antisocial personality disorder as an aetiological precursor of homicidal violence represents a major public health problem in contemporary Jamaica.

The prevalence of personality disorder in a psychiatric and substance abuse population in Jamaica.

OBJECTIVE: To determine the prevalence of personality disorders in patients admitted to the psychiatric wards of the University Hospital of the West Indies (UHWI). METHOD: Patients (n = 100) sequentially admitted to the psychiatric wards of the UHWI were assessed for personality disorder using the gold standard of a consultant assessment using the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM IV-TR) diagnostic criteria for personality disorder, the International Personality Disorder Examination Screening questionnaire (IPDE-S), and the Jamaica Personality Disorder Inventory (JPDI). RESULTS: The three assessment instruments identified a prevalence of personality disorder in the cohort of patients of 51% consultant DSM-IV-TR assessment, 57% JPDI and 86% IPDE-S. The prevalence rate identified by the IPDE-S was significantly higher that the local instruments used (p < 0.000). CONCLUSIONS: The prevalence of personality disorder assessed by the JPDI and the consultant DSM IV-TR instruments in Jamaica is comparable to the prevalence rate of studies in other countries in a similar population.

The prevalence of personality disorder in a general medical hospital population in Jamaica.

OBJECTIVE: To determine the prevalence of personality disorders in patients admitted to the general medical wards of the University Hospital of the West Indies (UHWI). METHOD: Patients (n = 100) sequentially admitted to the general medical wards of the UHWI were assessed for the diagnosis of personality disorder using the gold standard of a consultant assessment based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM IV-TR) diagnostic criteria for personality disorder, the International Personality Disorder Examination Screening questionnaire (IPDE-S) and the Jamaica Personality Disorder Inventory (JPDI). RESULTS: The three assessment instruments identified a prevalence of personality disorder in the cohort of patients of 21% consultant DSM IV-TR assessment, 28% JPDI and 70% IPDE-S. The prevalence rate identified by the IPDE-S was significantly higher than the local instruments used (p < 0.000). CONCLUSIONS: The prevalence of personality disorder assessed by the JPDI and the IPDE-S and the consultant DSM IV-TR instruments in Jamaica is significantly higher than the prevalence rate of studies in other countries.

The prevalence of personality disorder in a psychiatric and substance abuse population in Jamaica / Prevalencia de los trastornos de la personalidad en una población psiquiátrica y adicta al abuso de sustancias en Jamaica

OBJECTIVE: To determine the prevalence of personality disorders in patients admitted to the psychiatric wards of the University Hospital of the West Indies (UHWI). METHOD: Patients (n = 100) sequentially admitted to the psychiatric wards of the UHWI were assessed for personality disorder using the gold standard of a consultant assessment using the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM IV-TR) diagnostic criteria for personality disorder, the International Personality Disorder Examination Screening questionnaire (IPDE-S), and the Jamaica Personality Disorder Inventory (JPDI). RESULTS: The three assessment instruments identified a prevalence of personality disorder in the cohort of patients of 51% consultant DSM-IV-TR assessment, 57% JPDI and 86% IPDE-S. The prevalence rate identified by the IPDE-S was significantly higher that the local instruments used (p < 0.000). CONCLUSIONS: The prevalence of personality disorder assessed by the JPDI and the consultant DSM IVTR instruments in Jamaica is comparable to the prevalence rate of studies in other countries in a similar population.

OBJETIVO: Determinar la prevalencia de los trastornos de la personalidad en pacientes ingresados en las salas de psiquiatría del Hospital Universitario de West Indies (HUWI). MÉTODO: Los pacientes (n = 100) secuencialmente ingresados a las salas de psiquiatría del UHWI, fueron evaluados en relación con trastornos de personalidad, utilizando los criterios de diagnóstico del estándar de oro de la evaluación consultante con el Manual Diagnóstico y Estadístico de los Trastornos Mentales, cuarta edición revisada (DSM-IV-TR), el cuestionario de tamizaje del Examen Internacional de Trastornos de la Personalidad (IPDE-S), y el Inventario de Trastornos de la Personalidad en Jamaica (JPDI). RESULTADOS: Los tres instrumentos de evaluación identificaron una prevalencia de trastornos de personalidad en la cohorte de pacientes como sigue: 51% en la evaluación del consultante del DSMIV- TR, 57% en el JPDI, y 86% en el IPDE-S. La tasa de prevalencia identificada por el IPDE-S fue significativamente mayor que la de los instrumentos locales (p < 0.000). CONCLUSIONES: La prevalencia del trastorno de personalidad evaluado por el JPDI y los instrumentos de consultante de DSM IV-TR en Jamaica, es comparable a la tasa de prevalencia de estudios en otros países en una población similar.

The psychological correlates of dependency in the Jamaican population / Correlatos psicológicos de la dependencia en la población Jamaicana

OBJECTIVE: To establish the prevalence of psychological dependency in the Jamaican society in order to examine the relationship between the psychological correlates of dependency and socio-political dependency in this post-colonial country. METHODS: A total of 1506 adult individuals were sampled from 2150 households using a stratified sampling method and assessed using the 17 questions of the Jamaica Personality Disorder Inventory (JPDI) on the phenomenology of dependency that are grouped into the psychological features of physiological dependency, financial dependency, and psychological dependency. The database of responses to the demographic and JPDI questionnaires was created and analysed using the Statistical Package for the Social Sciences (SPSS) version 17. RESULTS: Of the national population sampled, 77.1% denied having any of these phenomenological symptoms of dependence while 22.63% of the population admitted to having some phenomenology of dependency, ranging from mild (5.6%), to moderate (12.1), or severe (4.9%). Substance use (physiological dependency) responders accounted for 21.23%, financial dependency responders for 43.45%, and psychological dependency responders for 15.96%. Significant gender and socio-economic class patterns of dependency were revealed. This substantial swathe of the Jamaican population acknowledged their own dependency and behavioural withdrawal response to physical or emotional loss in their life, and reported having dependency problems in managing their financial and monetary affairs. CONCLUSIONS: Three-quarters of the Jamaican responders of this survey ostensibly are free of the phenomenology of dependency while a more vulnerable one-quarter has insight that they are still locked in a struggle for psychological independence. The political and economic relations between psychological dependency and socio-political dependency are discussed.

OBJETIVO: Establecer la prevalencia de la dependencia psicológica en la sociedad jamaicana para examinar la relación entre los correlatos psicológicos de dependencia y la dependencia sociopolítica en este país postcolonial. MÉTODOS: Un total de 1506 individuos adultos fueron tomados como muestras a partir de 2150 hogares, usando un método de muestreo estratificado. Los individuos fueron posteriormente evaluados usando las 17 preguntas del Inventario de Trastornos de Personalidad en Jamaica (JPDI) sobre la fenomenología de la dependencia, las cuales se agrupan como características psicológicas de la dependencia fisiológica, dependencia económica y dependencia psicológica. La base de datos de respuestas a los cuestionarios de demografía y JPDI fue creada y analizada utilizando el Paquete Estadístico para la Ciencias Sociales (SPSS) versión 17. RESULTADOS: El 77.1% de la población nacional muestreada negó tener ninguno de estos síntomas fenomenológicos de la dependencia, mientras que al 22.63% de la población admitió tener una fenomenología de la dependencia, que fluctúa de valores leves (5.6%) a moderados (12.1) o severos (4.9%). Los encuestados del uso de sustancias (dependencia fisiológica) representaron el 21.23%; los encuestados de dependencia financiera representaron el 43.45%; y los encuestados de la dependencia psicológica fueron el 15.96%. Se pusieron de manifiesto de forma significativa patrones de género y de clase socio-económica. Esta franja sustancial de la población jamaicana reconoció su propia dependencia y respuesta de aislamiento conductual ante la pérdida física o emocional en su vida, y reportó haber tenido problemas de dependencia en el manejo de sus asuntos financieros y monetarios. CONCLUSIONES: Tres cuartas partes de los respondedores jamaicanos de esta encuesta aparentemente están libres de la fenomenología de la dependencia, mientras que una cuarta parte más vulnerable tiene la percepción de que aún están atrapados en una lucha por la independencia psicológica. Se discuten las relaciones políticas y económicas entre la dependencia psicológica y la dependencia sociopolítica.

Personality disorder in convicted Jamaican murderers / Trastornos de personalidad en asesinos Jamaicanos convictos

OBJECTIVE: To establish the aetiology and historical prevalance of personality disorder in violent homicidal men in Jamaica. METHODS: Examination and analysis of primary data from the psychosocial case study interviews of 36 convicted murderers from the Jamaican Government Barnett Commission of Enquiry in 1976. The disaggregated social and clinical data were analysed using a Chi-square statistical analysis RESULTS: The mean age at time of arrest for the male convicted murderers was 24.26 ± 8.48 years. Twenty-three (66%) of the subjects had loving relationships with mothers, particularly in those men reared in the rural areas. Twenty-one (59%) cases showed marked paternal rejection and absence of integrated family life. Twenty-four (69%) of the cases experienced severe parental disciplinary methods, and two-thirds were illiterate or barely literate. Twenty-nine (83%) were from very poor socio-economic conditions. Thirty (86%) of all the murder victims were adult males. There were significant differences between the urban reared murderers (URM) and rural reared murderers (RRM). Sixteen (94%) of the victims of the URM ensued from robbery and police confrontation, while 13 (72%) of the victims of the RRM resulted from domestic disputes (p < 0.00). Seventeen (49%) of the men had normal personalities; 18 (51%) were diagnosed as having antisocial and inadequate personalities. Diagnosis of primary data using Diagnostic and Statistical Manual of Mental Disorders fourth edition, text revision (DSM-IV-TR) criteria revealed 23 (66%) men with Antisocial Personality Disorder (APD). There were significantly more APD in the URM than the RRM (p < 0.01). CONCLUSIONS: Antisocial personality disorder as an aetiological precursor of homicidal violence represents a major public health problem in contemporary Jamaica.

OBJETIVO: Establecer la etiología y la prevalencia histórica de los trastornos de personalidad en hombres violentos homicidas en Jamaica. MÉTODOS: Examen y análisis de los datos principales de las entrevistas de casos de estudio psicosociales de 36 asesinos convictos, tomadas de la Comisión de Investigación Barnett del Gobierno de Jamaica en 1976. Los datos clínicos y sociales desagregados se analizaron mediante un análisis estadístico chicuadrado. RESULTADOS: La edad promedio al momento del arresto de los asesinos convictos fue 24.26 ± 8.48 años. Veintitrés (66%) de los sujetos tenían relaciones afectuosas con las madres, especialmente aquellos hombres criados en las zonas rurales. Veintiún casos (59%) mostraron un marcado rechazo paternal y ausencia de vida familiar integrada. Veinticuatro (69%) de los casos experimentaron severos métodos disciplinarios por parte de los padres, y dos tercios eran analfabetos o apenas sabían leer y escribir. Veintinueve (83%) tenían muy malas condiciones socio-económicas. Treinta (86%) de todas las víctimas de los asesinatos eran varones adultos. Hubo diferencias significativas entre los asesinos criados en áreas urbanas (abreviado en inglés, URM) y los asesinos criados en áreas rurales (en inglés, RRM). Dieciséis (94%) de las víctimas de los asesinos provenientes de zonas urbanas (URM) fueron consecuencia de robos y confrontación con la policía, mientras que 13 (72%) de las víctimas de los asesinos de zonas rurales (RRM) fueron resultado de disputas domésticas (p < 0.00). Diecisiete (49%) de los hombres tenían personalidades normales; 18 (51%) fueron diagnosticados con personalidad antisocial e inadecuada. El diagnóstico a partir de datos primarios mediante criterios de DSM-IV-TR reveló 23 hombres (66%) con Trastorno de Personalidad Antisocial (TPA). Hubo significativamente más TPA entre los URM que entre los RRM (p < 0.01). CONCLUSIONES: El trastorno de personalidad antisocial como precursor etiológico de la violencia homicida representa un problema importante de salud pública en la Jamaica actual.

The prevalence of personality disorder in a general medical hospital population in Jamaica / Prevalencia de los trastornos de personalidad en una población del hospital de medicina general de Jamaica

OBJECTIVE: To determine the prevalence of personality disorders in patients admitted to the general medical wards of the University Hospital of the West Indies (UHWI). METHOD: Patients (n = 100) sequentially admitted to the general medical wards of the UHWI were assessed for the diagnosis of personality disorder using the gold standard of a consultant assessment based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM IV-TR) diagnostic criteria for personality disorder, the International Personality Disorder Examination Screening questionnaire (IPDE-S) and the Jamaica Personality Disorder Inventory (JPDI). RESULTS: The three assessment instruments identified a prevalence of personality disorder in the cohort of patients of 21% consultant DSM IV-TR assessment, 28% JPDI and 70% IPDE-S. The prevalence rate identified by the IPDE-S was significantly higher that the local instruments used (p < 0.000). CONCLUSIONS: The prevalence of personality disorder assessed by the JPDI and the IPDE-S and the consultant DSM IV-TR instruments in Jamaica is significantly higher than the prevalence rate of studies in other countries.

OBJETIVO: Determinar la prevalencia de los trastornos de personalidad en los pacientes ingresados en las salas de medicina general del Hospital Universitario de West Indies (HUWI). MÉTODO: Pacientes (n = 100) secuencialmente ingresados en las salas de medicina general del UHWI fueron sometidos a una evaluación encaminada a diagnosticar trastornos de personalidad. Para la misma se utilizó el método estándar de referencia usado en las evaluaciones realizadas por los consultores. Dicho método se basa en los criterios diagnósticos para los trastornos de personalidad, tomados de la cuarta edición revisada del Manual diagnóstico y estadístico de los trastornos mentales (DSM IV-TR), el cuestionario de tamizaje del Examen Internacional de los trastornos de la personalidad (IPDE-S), y el Inventario de los trastornos de la personalidad en Jamaica (JPDI). RESULTADOS: Los tres instrumentos de evaluación identificaron una prevalencia de los trastornos de la personalidad en la cohorte de pacientes, de 21% con la evaluación DSM IV-TR de los consultores, 28% con el JPDI, y 70% con el tamizaje del IPDE-S. La tasa de prevalencia identificada por el IPDE-S, fue significativamente mayor que la de los instrumentos locales usados (p < 0.000). CONCLUSIONES: La prevalencia de los trastornos de la personalidad, evaluada por el inventario JPDI y el tamizaje del IPDE-S, así como por los instrumentos DSM IV-TR de los consultores en Jamaica, es significativamente mayor que la tasa de prevalencia en los estudios de otros países.

A view of personality disorder from the colonial periphery / Una perspectiva de los trastornos de personalidad desde la periferia colonial

OBJECTIVE: To examine the history of personality disorder in the context of contemporary post-colonial Jamaican society. METHODS: The literature outlining the development and classification of personality disorder is reviewed. The social, psychiatric and epidemiological studies of personality disorder in Jamaica are presented. RESULTS: A categorical classification system of personality disorder has been in use by the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM) from the mid 20th century. Challenging that approach is the Minnesota Multiphasic Personality Inventory (MMPI), which represents the dimensional method, which views pathology as a continuum from normal personality traits. Both systems suffer from an absence of cultural flexibility, an absence of a system of severity, and a lack of treatment specificity, which foster misdiagnosis while making treatment planning difficult and unreliable. The proposed DSM-5 attempts to integrate a prototypematching system and identification of personality traits promises disappointing outcomes. The University of the West Indies, Section of Psychiatry, proposes a phenomenological nosological approach, advocating an alternate DSM Axis I category called Shakatani derived from Swahili shaka (problem), tani (power), and developing a 38-item Jamaica Personality Disorder Inventory (JPDI) screening questionnaire for diagnosing this condition. The epidemiological results using this instrument are reviewed, and the Jamaican print, broadcast and social media responses to this research in Jamaica are described. CONCLUSIONS: The heritage of slavery and colonial oppression in Jamaica has resulted in maladaptive personality disorders that have led to extremely high rates of homicide, violence and transgressive behaviour.

OBJETIVO: Examinar la historia de los trastornos de la personalidad en el contexto de la sociedad jamaicana postcolonial contemporánea. MÉTODOS: Se examina la literatura que bosqueja el desarrollo y la clasificación de los trastornos de la personalidad. Se presentan estudios sociales, psiquiátricos y epidemiológicos de los trastornos de personalidad en Jamaica. RESULTADOS: Un sistema de clasificación por categorías de los trastornos de la personalidad ha formado parte de la Clasificación Internacional de Enfermedades (CIE) y el Diagnóstico y Manual Estadístico de los Trastornos Mentales (DSM) desde mediados del siglo 20. Un reto a tal enfoque, lo hallamos en el Inventario Multifásico de Personalidad de Minnesota (MMPI, por sus siglas en inglés: Minnesota Multiphasic Personality Inventory). El MMPI representa un método dimensional, que considera la patología como un continuo que parte de rasgos de la personalidad normal. Ambos sistemas sufren de falta de flexibilidad cultural, ausencia de un sistema de severidad, y falta de especificidad con respecto al tratamiento. Tales faltas promueven un diagnóstico erróneo, a la par que hacen que la planificación del tratamiento sea difícil y poco confiable. El DSM-5 que se propone, constituye un intento por integrar un sistema de pareamiento de prototipos, y la identificación de rasgos de personalidad augura resultados decepcionantes. El Departamento de Psiquiatría de la Universidad de West Indies propone un enfoque fenomenológico nosológico, que aboga por una categoría alternativa del Eje I del DSM, denominada Shakatani, derivada del Swahili shaka (problema), tani (poder), y el desarrollo de un Inventario de Trastornos de la Personalidad en Jamaica (JPDI), consistente en un cuestionario de tamizaje de 38 ítems destinados a diagnosticar esta condición. Se revisan los resultados epidemiológicos que utilizan este instrumento, y se describen las respuestas dadas a esta investigación por los medios sociales, la televisión, la radio y la prensa escrita de Jamaica, CONCLUSIONES: La herencia de la esclavitud y la opresión colonial en Jamaica ha traído como resultado trastornos de personalidad por inadaptación, los cuales a su vez han llevado a tasas extremadamente altas de homicidios, violencia y conducta transgresora.

The creation and validation of the Jamaica personality disorder inventory / Creación y validación del inventario de trastornos de la personalidad en Jamaica

OBJECTIVE: To describe the creation and validation of the Jamaica Personality Disorder Inventory (JPDI) screening questionnaire. METHOD: Using the phenomenological triad of power management, dependency and psychosexual issues, drafts of the JPDI were piloted on patients from psychiatric and medical wards. The JPDI consisted of 38 close-ended, yes/no questions. Validation was conducted in a sample of 200 patients, using the International Personality Disorder Examination-Screening Instrument (IPDE-S), the Brief Screen for Depression and consultant psychiatrists' Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) personality disorder interview. Construct validity was assessed through principal component factor analysis; Spearman correlation was used to assess criterionrelated and discriminant validity; Cronbach's alpha was used to assess reliability of the entire scale as well as the resulting factors. The Multitrait Multimethod Matrix (MTMM) was used to assess discriminant and construct validity. RESULTS: Factor analysis revealed eight clusters consisting of 30 of the 38 questions, which had close congruence with the clinical triad. Cronbach's alpha for the entire scale was α = 0.79, ranging from a high 0.70 to 0.82 to low 0.63 to 0.45. The JPDI exhibited a sensitivity of 95.06% and a specificity of 67.71%. Significant correlation of scores for the JPDI and IPDE-S (r = 0.432, p = 0.000) and the JPDI and the DSM IV-TR diagnosis (r = 0.598, p = 0.000) established concurrent validity for the JPDI. Correlations (r = 0.293, p = 0.000) suggested that the JPDI possessed predictive validity. The complete sample matrix of the MTMM provided evidence of both convergent and discriminant validity, and thereby, construct validity. CONCLUSION: The JPDI demonstrated reliability, and criterion-related and discriminant validity.

OBJETIVO: Describir la creación y validación del cuestionario de tamizaje del Inventario de Trastornos de la Personalidad en Jamaica (JPDI). MÉTODO: Usando la tríada fenomenológica de manejo del poder, dependencia y problemas psicosexuales, se realizaron pruebas pilotos usando versiones p rovisionales del JPDI con pacientes de salas médicas y psiquiátricas. El JPDI constaba de 38 preguntas cerradas, del tipo que requieren sí o no. La validación se realizó con una muestra de 200 pacientes, usando el Instrumento de Tamizaje del Examen Internacional de los Trastornos de Personalidad (IPDE-S), la Prueba Breve para la Depresión, y el Manual Diagnóstico y Estadístico de los Trastornos Mentales, cuarta edición (DSM-IV) de los psiquiatras consultantes, para entrevistas de trastornos de personalidad. La validez de constructo se evaluó a través de análisis factorial de componentes principales. El coeficiente de correlación de Spearman se utilizó para evaluar la validez de criterio y la validez discriminante. El coeficiente Alfa de Cronbach fue utilizado para evaluar la fiabilidad de toda la escala, así como los factores resultantes. La matriz multirasgo-multimétodo (MTMM) fue utilizada para evaluar la validez de constructo y la validez discriminante. RESULTADOS: El análisis factorial reveló ocho clústeres que constaban de 30 de las 38 preguntas, las cuales presentaban una estrecha congruencia con la tríada clínica. El Alfa de Cronbach para toda la escala fue α = 0.79, fluctuando desde valores altos de 0.70 a 0.82 hasta valores bajos de 0.63 a 0.45. El inventario JPDI mostró una sensibilidad de 95.06% y una especificidad de 67.71%. La correlación significativa de las puntuaciones para el JPDI y el IPDE-S (r = 0.432, p = 0.000) y el JPDI y el diagnóstico de DSM IV-TR (r = 0.598, p = 0.000) estableció una validez concurrente para el JPDI. Las correlaciones (r = 0.293, p = 0.000) sugirieron que el JPDI poseía validez predictiva. La matriz completa de la muestra de la MTMM proporcionó evidencia tanto de la validez discriminante como de la validez convergente, y por ende, de la validez de constructo. CONCLUSIÓN: El inventario JPDI demostró fiabilidad, así como validez de criterio y validez discriminante.

Shakatani: the phenomenology of personality disorder in Jamaican patients / Shakatani: la fenomenología del trastorno de personalidad en pacientes Jamaicanos

OBJECTIVE: To examine the distribution and clinically significant patterns of the phenomenology of a cohort of Jamaican patients with a Diagnostic and Statistical Manual of Mental Disorders (DSM) Axis II diagnosis of personality disorder and to clarify the conventional diagnostic deficiencies of DSMbased personality disorder categories. METHODS: In a case-control study from the naturalistic clinical setting of a private psychiatric practice in Kingston, Jamaica, between 1974 and 2007, the phenomenology of a cohort of 351 patients with an Axis II DSM diagnosis of personality disorder is qualitatively described and quantitatively compared with that of a control group of patients with an Axis I DSM clinical diagnosis, matched for age, gender and socio-economic class. RESULTS: There were 166 males (47.3%); 238 (67.8%) of the patients were between age 18 and 39 years. Ethnically, 325 (92.6%) were Black, 10 (2.8%) White and 16 (4.6%) Other. The majority of patients (20.7%) had a DSM-IV diagnosis of dependent personality disorder. Patients with an Axis II diagnosis were significantly more likely to display symptoms of a 'clinical triad' of power management, dependency and psychosexual issues. Qualitative analysis of the phenomenological symptoms of personality disorder diagnosed patients suggests aetiological interconnections based on early childhood experiences as explained by object relations and attachment theories. CONCLUSIONS: The phenomenological approach to personality disorder may be a viable replacement for the four-cluster classification of DSM-IV in a Jamaican population with the clinical triad called Shakatani, derived from the Swahili words shaka (problem) and tani (power). This phenomenological approach may provide more clinical utility to practitioners.

OBJETIVO: Examinar la distribución y los patrones clínicamente significativos de la fenomenología de una cohorte de pacientes jamaicanos con diagnóstico de trastornos de personalidad de eje II según el Manual Estadístico Diagnóstico (DSM), y aclarar las deficiencias diagnósticas convencionales de categorías de trastorno de la personalidad basadas en DSM. MÉTODOS: Se describe cualitativamente la fenomenología de una cohorte de 351 pacientes con diagnóstico de trastorno de la personalidad de eje II DSM, en un estudio de caso control a partir de un contexto clínico naturalista en una práctica psiquiátrica privada de Kingston, Jamaica, entre 1974 y 2007. Dicha fenomenología fue comparada cuantitativamente con la de un grupo control de pacientes con un diagnóstico clínico de eje I DSM, pareados por edad, género y clase socio-económica. RESULTADOS: Hubo 166 varones (47.3%); 238 (67.8%) de los pacientes tenían entre edades entre 18 y 39 años. Étnicamente, 325 (92.6%) eran negros, 10 (2.8%) blancos, y 16 (4.6%) étnicamente diversos. La mayoría de los pacientes (20,7%) tenía un diagnóstico DSM-IV de trastorno de personalidad dependiente. Los pacientes con un diagnóstico de eje II tuvieron significativamente más probabilidades de mostrar síntomas de una 'tríada clínica' de manejo del poder, dependencia y problemas psicosexuales. El análisis cualitativo de los síntomas fenomenológicos de los pacientes diagnosticados con trastorno de personalidad, sugiere interconexiones etiológicas basadas en experiencias de la niñez temprana, tal cual lo explican la teoría de la relación de objetos y la teoría del apego. CONCLUSIONES: El enfoque fenomenológico de los trastornos de personalidad puede ser un substituto viable para la clasificación de cuatro clústeres de DSM-IV en una población jamaicana con la tríada clínica denominada Shakatani, término derivado de las palabras Swahili shaka (problema) y tani ("poder"). Este enfoque fenomenológico puede ofrecer mayor utilidad clínica a los profesionales.

Correlates of conflict, power and authority management, aggression and impulse control in the Jamaican population / Correlatos de conflicto, poder y manejo de la autoridad, agresividad y control de los impulsos en la población Jamaicana

OBJECTIVE: The object of this study is to establish the correlates of the phenomenology of conflict and power management in the Jamaican population. METHODS: A total of 1506 adult individuals were sampled from 2150 households using a stratified sampling method and assessed using the 12 questions of the Jamaica Personality Disorder Inventory (JPDI) on the phenomenology of conflict and power management that are grouped into the psychological features of aggressive social behaviour, unlawful behaviour, socially unacceptable behaviour and financial transgressive behaviour. The database of responses to the demographic and JPDI questionnaires was created and analysed using the Statistical Package for the Social Sciences (SPSS) version 17. RESULTS: Of the national population sampled, 69.1% denied having any phenomenological symptoms of abnormal power management relations while 30.9% of the population admitted to having some degree of conflict and power management, ranging from mild (10.3%), to moderate (17.1), or severe (3.5%). There were 46.55% of the population which had problems with aggressive social behaviour, 9.33% had problems with unlawful behaviour, 9.58% had problems with unacceptable social behaviour and 37.74% had problems with financial transgressive behaviour. Significant gender and socio-economic class patterns for conflict and power management were revealed. This pattern of conflict and power management behaviour is critical in understanding the distinction between normal and abnormal expression of these emotions and actions. CONCLUSION: Nearly one-third of the sample population studied reported problems with conflict, abnormal power and authority management, impulse control and serious aggressive and transgressive behaviour.

OBJETIVO: El objeto de este estudio es establecer los correlatos de la fenomenología del manejo de conflicto y poder en la población jamaicana. MÉTODOS: Se tomaron muestras de un total de 1506 individuos adultos de 2150 hogares, usando un método de muestreo estratificado, y se evaluaron usando las 12 preguntas del Inventario de Trastornos de la Personalidad en Jamaica (JPDI) sobre la fenomenología del manejo del conflicto y el poder, clasificadas como características psicológicas del comportamiento social agresivo, comportamiento ilícito, comportamiento socialmente inaceptable, y conducta financiera transgresora. La base de datos de respuestas a los cuestionarios de demografía y JPDI, fue creada y analizada utilizando el Paquete Estadístico para Ciencias Sociales (SPSS) versión 17. RESULTADOS: El 69.1% de la población nacional muestreada negó tener síntoma fenomenológico alguno de relaciones de poder anormal, mientras que el 30.9% de la población admitía haber tenido algún grado de manejo de conflicto y poder, fluctuando de leve (10.3%) a moderado (17.1), o severo (3.5%). Hubo 46.55% de la población con problemas de comportamiento social agresivo, 9.33% tuvo problemas de comportamiento ilegal, 9.58% tenían problemas de comportamiento social inaceptable, y 37.74% tuvo problemas de comportamiento financiero transgresor. Se pusieron de manifiesto de forma significativa patrones de género y clase socioeconómica con respecto al manejo de conflicto y poder. Este patrón de comportamiento de manejo de conflicto y poder es un factor crítico para entender la distinción entre la expresión normal y anormal de estas emociones y acciones. CONCLUSIÓN: Casi un tercio de la población de la muestra estudiada reportó problemas con el manejo de conflicto, poder anormal y autoridad, control de impulsos, y serio comportamiento agresivo y transgresor.

Correlates of psychosexual issues in the Jamaican population / Correlatos de problemas psicosexuales en la población Jamaicana

OBJECTIVE: To examine the relationship between the psychopathological correlates of psychosexual phenomena in post-colonial Jamaica. METHODS: A total of 1506 adult individuals were sampled from 2150 households using a stratified sampling method and assessed with the Jamaica Personality Disorder Inventory (JPDI). Responses to the seven questions on the psychological features of homosexual practices, sexual practices and dysfunction were tabulated and analysed using the Statistical Package for the Social Sciences (SPSS) version 17. RESULTS: Of the sample, 79.38% denied having phenomenological symptoms of psychosexual phenomena while 20.33% of the population admitted to having some degree of heterosexual and homosexual phenomena, ranging from mild (5.13%), to moderate (11.40), or severe (3.80%). Sixteen (1.06%) responders described homosexual practices in their lives, and 53 (3.52%) described thinking frequently about homosexual experiences in their subjective psychic lives. Significantly more (p > 0.001) male responders (348, 23.11%) had difficulty being sexually faithful to one person at a time than females (122, 8.10%). The lower class cohort members (348, 23.11%) were more likely to have had multiple sexual relationships over the previous 12 months than socio-economic class (SEC) 1-3 responders (54, 3.58%) and were more likely (681, 45.21%) to fantasize about sexual relationships with persons other than their partners (p < 0.001) than SEC 1-3 responders (94, 6.24%). CONCLUSION: Significant levels of multiple sexual partnerships and feelings of infidelity in a swathe of Jamaican people reveal underlying psychosexual anxiety and guilt, poor impulse control and difficulties with partner intimacy. This psychopathology is correlated to concomitant high-risk public health sexual behaviour such as teenage pregnancy, sexually transmitted diseases (STDs) and HIV/AIDS existing in the Jamaican society.

OBJETIVO: Examinar la relación entre los correlatos psicopatológicos de los fenómenos psicosexuales en la Jamaica postcolonial. MÉTODOS: Un total de 1506 individuos adultos fueron tomados como muestras a partir de 2150 hogares, usando un método de muestreo estratificado, y evaluados mediante el Inventario de Trastornos de la Personalidad de Jamaica (JPDI). Las respuestas a las siete preguntas sobre las características psicológicas de las prácticas homosexuales, las prácticas sexuales, y la disfunción, fueron tabuladas y analizadas mediante el Paquete Estadístico para las Ciencias Sociales (SPSS) versión 17. RESULTADOS: De la muestra, 79.38% negó tener síntomas fenomenológicos de fenómenos psicosexuales, mientras que el 20.33% de la población admitió haber tenido algún grado de fenómenos heterosexuales y homosexuales, desde leves (5.13%) a moderados (11.40) o severos (3.80%). Once encuestados (0.73%) reportaron prácticas homosexuales en sus vidas, y 53 (3.52%) reportaron pensar con frecuencia acerca de experiencias homosexuales en su vida psíquica subjetiva. Significativamente más encuestados varones (p > 0.001) (348, 23.11%) tuvieron dificultades para ser fieles sexualmente a una persona alguna vez, en comparación con las hembras (122, 8.10%). Los miembros de la cohorte de clase baja (348, 23.11%) eran más propensos a tener múltiples relaciones sexuales en los 12 meses anteriores (3.58%), y tuvieron una mayor probabilidad (681, 45.21%) de tener fantasías acerca de relaciones sexuales con personas que no eran sus parejas (p < 0.001) en comparación con los encuestados de SEC 1-3 (94, 6.24%). CONCLUSIÓN: Los niveles significativos de las relaciones sexuales múltiples y los sentimientos de la infidelidad en un sector del pueblo jamaicano, revelan ansiedad psicosexual subyacente y sentimientos de culpa, control de impulsos pobre, y dificultades con la intimidad de la pareja. Esta psicopatología está correlacionada con comportamientos sexuales concomitantes de alto riesgo en la salud pública, tales como el embarazo adolescente, las enfermedades de transmisión sexual (ETS), y el VIH/SIDA, existentes en la sociedad jamaicana.

Prevalence and correlates of personality disorder in the Jamaican population / Prevalencia y correlatos de los trastornos de personalidad en la población Jamaicana

OBJECTIVE: To identify the prevalence and correlates of personality disorder in a representative sample of the Jamaican population using the Jamaica Personality Disorder Inventory (JPDI). METHOD: A four-stage stratified random sampling method was used to obtain a representative population sample consisting of 1506 Jamaicans, M:F = 727 (48.3%):779 (51.7%), ages 18−64 years. A demographic questionnaire and the JPDI were administered to all participants. RESULTS: Two-fifths of the population (41.4%) scored above the scale's cut-point indicating a diagnosis of personality disorder with the level of severity ranging from mild to severe. Persons with personality disorder were significantly more likely to be single (63%), male (60%), between the ages 18 and 44 years (77%) and of a lower socio-economic status (65%) (p < 0.50 to p < 0.001). CONCLUSION: This is the only population study of personality disorder recorded in the English-speaking Caribbean. This suggests a high risk of behavioural dysfunction in the Jamaican population, having significant implications in light of the country's high rate of crime and violence. The findings highlight the need to develop effective and targeted prevention and intervention measures.

OBJETIVO: Identificar la prevalencia y los correlatos del trastorno de la personalidad en una muestra representativa de la población Jamaica, usando el Inventario de los Trastornos de la Personalidad en Jamaica (JPDI). MÉTODO: Se usó un método de muestreo aleatorio estratificado en cuatro etapas, con el propósito de obtener una muestra poblacional representativa, formada por 1506 Jamaicanos, V:H = 727 (48.3%):779 (51.7%), edades 18−64 años. Se aplicó un cuestionario demográfico y el inventario JPDI a todos los participantes. RESULTADOS: Dos quintas partes de la población (41.4%) alcanzaron puntuaciones por encima del valor límite de la escala, lo cual indica un diagnóstico de trastorno de la personalidad con un nivel de severidad que varía de leve a grave. Las personas con trastorno de personalidad presentaron una probabilidad significativamente más alta de ser solteros (63%), hombres (60%), tener edades entre los 18 y 44 años (77%), y ser de una condición socio-económica más baja (65%) (p < 0,50 hasta p < 0.001). CONCLUSIÓN: Este es el único estudio poblacional de trastornos de personalidad registrado en el Caribe anglófono. Esto sugiere un alto riesgo de disfunción conductual en la población jamaicana, lo cual tiene importantes implicaciones a la luz de la alta tasa de crimen y violencia en el país. Los hallazgos destacan la necesidad de desarrollar medidas de prevención e intervención y encaminada a objetos específicos.