الفهرس 
AcknowledgmentOnly 14 pages are availabe for public view
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Abstract
PDs represent a common and serious public health problem. Not only can they be detrimental to individuals’ personal and occupational life, PDs underlie the susceptibility to many psychiatric and medical health problems and invariably produce a worse outcome. They also constitute a major source of burden to the family, society at large, and various health services. The aim of the present study was to estimate the prevalence of different PDs among first grade students of the University of Alexandria and to investigate some ecological factors of the problem. Specific objectives included developing an Arabic version of the Personality Diagnostic Questionnaire-4+ (PDQ-4+) and testing its psychometric properties, assessing the different personality disorders of first year students of Alexandria University, and identifying the different personal, academic, familial, and medical variables associated with personality disorders. of the total number of students in the first grade in the University of Alexandria was included. A two-staged stratified sampling procedure with proportional allocation was conducted. Stratification was based on type of college (theoretical and practical), and gender. Total participants amounted to 1100 students, 443 males and 657 females. Participants were subjected to: 1) A predesigned self-administered questionnaire used to collect sociodemographic, academic, personal, medical and mental health-related information, as well as some intrafamilial risk factors. Parental rearing style and social support were also assessed. 2) Psychometric testing using the self-report questionnaire PDQ-4+ to assess 12 PDs. A subsample was interviewed with the clinical significance scale of the PDQ-4+ (a structured individual interview), which is recommended by the developers to overcome the problem of false positives, to test the predictive qualities of PDQ-4+ in our sample. The study yielded the following important results: • Test-retest reliability and internal consistency of the Arabic version of the PDQ-4+ was excellent, which also showed good discriminant validity. Although specificity and positive predictive value of the PDQ-4+ as a whole was more than satisfactory, some individual PD scales were not. • PDs were detected in 26.1 of the sampled students. Cluster C was the most prevalent (24.9) and cluster B the least (18.3). While avoidant PD was the commonest occurring PD (20.4), antisocial PD rated the lowest number of students (1.7). There was a considerable degree of comorbidity between PDs. • While a positive relationship between age and PDs among the sampled students was observed, no significant difference between males and females was discovered except for narcissistic and antisocial PDs, males being more personality disordered. • A family size of 5 or more presented a significant risk factor for having any PD. Similarly students whose parents were separated or divorced were 3.46 times more likely to develop any PD than those whose parents were living together. • The highest significant risk of PD among academic factors was associated with pressure from parents on their offspring to choose a particular college compared to those whose own choice was taken into consideration (OR= 6.64). whereas students with major difficulties experienced in college had a significantly higher risk of 3.15 to have any PD relative to those with no difficulties, a negative relationship was revealed between students’ level of academic achievement and having any PD. • Both smokers and current users of psychoactive substances, especially alcohol showed significant risks for having any PD compared to non-users (OR= 2.55 and 3.52, respectively). • While depression emerged to be the type of parental psychiatric problem with the strongest association with PD in the offspring (OR=3.29), parental inconsistent discipline carried the most risk for having any PD out of all parental disciplinary styles (OR=5.32) • A significantly increased risk for developing PD was detected for students who had intrafamilial conflicts, whether between the student and a member of the family (OR=3.00), between family members (OR=3.15) or both (OR=5.09), relative to those who reported no conflicts. • Mean scores for the warmth, rejection and control subscales of the parental rearing style questionnaire (EMBU), as well as family, friends, and total social support scores differed significantly between personality disordered and non-personality disordered students. • PDs significantly prevailed more among those who had a positive history of a medical, psychiatric or behavioural problem compared to those with a negative history. • Similarly students who had a positive history of physical or sexual abuse had an increased risk of having any PD (OR=2.37 and 8.08, respectively). • When all significant factors in univariate analysis were introduced, results of the stepwise logistic regression analysis revealed that 12 variables proved to be significant predictors of PD, namely: parental inconsistent discipline, sexual abuse, intrafamilial conflicts, decreased social support of friends and family, parental rejection and control, conduct disorder, smoking, lack of freedom in college selection, and history of a chronic medical illness or psychiatric problem. Results of the present work suggested the following recommendations: • The valid use of the Arabic version of PDQ-4+ as a screening instrument for screening for personality disturbance. • The necessity of initial screening for PDs among college students and the introduction of counselling services in different campuses. • Increasing the awareness of psychiatric services of the importance of the early recognition of PDs. • Primary preventive measures should be targeted at-risk children and adolescence such as those with axis I disorders or disruptive behavioural disorders, and those from high-risk families. Educational programmes for those parents should ensue. • Further longitudinal research is needed to further explore risk factors and impact of PDs, as well as the exploration of specific PDs and the interpretation of more standardized instruments. Evaluation of different prevention strategies should also be targeted.