Skip to main content

Advertisement

SpringerLink
Log in

Current issues in the assessment of personality disorders

  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

Most patients will have clinically significant maladaptive personality traits. These personality traits can substantially complicate the effective treatment of other mental disorders, and they can also be the focus of effective treatment. The assessment of personality disorders is of considerable clinical importance. However, this assessment can also be highly problematic. This article discusses the major issues in the assessment of personality disorders (eg, differentiation from other mental disorders, from normal personality functioning, and gender bias) and summarizes existing research on the convergent and discriminant validity of the semistructured interviews and self-report inventories, which have been developed to improve the reliability and validity of personality disorder assessment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 3. Washington, DC: American Psychiatric Association; 1980.

    Google Scholar 

  2. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders Text Revision, edn 4. Washington, DC: American Psychiatric Association; 2000.

    Book  Google Scholar 

  3. Dolan-Sewell RG, Krueger RF, Shea MT: Co-occurrence with syndrome disorders. In Handbook of Personality Disorders. Edited by Livesley WJ. New York: Guilford; 2001:84–104.

    Google Scholar 

  4. Perry JC, Banon E, Ianni F: Effectiveness of psychotherapy for personality disorders. Am J Psychiatry 1999, 156:1312–1321.

    PubMed  CAS  Google Scholar 

  5. Sanislow CA, McGlashan TH: Treatment outcome of personality disorders. Can J Psychiatry 1998, 43:237–250.

    PubMed  CAS  Google Scholar 

  6. Hare RD, Hart SD, Harpur TJ: Psychopathy and the DSM-IV criteria for antisocial personality disorder. J Abnorm Psychol 1991, 100:391–398.

    Article  PubMed  CAS  Google Scholar 

  7. Westen D: Divergences between clinical and research methods for assessing personality disorders: implications for research and the evolution of Axis II. Am J Psychiatry 1997, 154:895–903. This paper argues against the use of semistructured interviews and self-report inventories. The author suggests that assessments of personality disorder should be modeled on how personality disorders are diagnosed by practicing clinicians.

    PubMed  CAS  Google Scholar 

  8. Blashfield RK, Herkov MJ: Investigating clinician adherence to diagnosis by criteria: a replication of Morey and Ochoa (1989). J Pers Disord 1996, 10:219–228.

    Google Scholar 

  9. Rogers R: Diagnostic and Structured Interviewing: A Handbook for Clinical Practice, edn 2. New York: Guilford; 2001.

    Google Scholar 

  10. Garb HN: Race bias, social class bias, and gender bias in clinical judgment. Clin Psychol Sci Pract 1997, 4:99–120.

    Google Scholar 

  11. Widiger TA: Sex biases in the diagnosis of personality disorders. J Personal Disord 1998, 12:95–118.

    PubMed  CAS  Google Scholar 

  12. Millon T, Davis RD, Millon CM, et al.: Disorders of Personality: DSM-IV and Beyond. New York: Wiley; 1996.

    Google Scholar 

  13. Zimmerman M, Mattia JI: Differences between clinical and research practices in diagnosing borderline personality disorder. Am J Psychiatry 1999, 156:1570–1574. This study indicates empirically that practicing clinicians may be failing to provide accurate diagnoses of borderline personality disorder because of a failure to provide systematic and comprehensive assessments. When provided the information obtained by a semistructured interview, clinicians substantially increased the frequency of their borderline diagnoses.

    PubMed  CAS  Google Scholar 

  14. Gunderson JG, Ronningstam E, Bodkin A: The diagnostic interview for narcissistic patients. Am J Psychiatry 1990, 47:676–680.

    CAS  Google Scholar 

  15. Zanarini MC, Frankenburg FR, Chauncey DL, et al.: The Diagnostic Interview for Personality Disorders: interrater and test-retest reliability. Compr Psychiatry 1987, 28:467–480.

    Article  PubMed  CAS  Google Scholar 

  16. Hare RD: The Hare Psychopathy Checklist-Revised Manual. North Tonawanda: Multi-Health Systems; 1991.

    Google Scholar 

  17. Loranger AW: International Personality Disorder Examination (IPDE). Odessa: Psychological Assessment Resources; 1999.

    Google Scholar 

  18. Widiger TA, Mangine S, Corbitt EM, et al.: Personality Disorder Interview IV: A Semistructured Interview for the Assessment of Personality Disorders. Odessa: Psychological Assessment Resources; 1995.

    Google Scholar 

  19. Zanarini MC, Gunderson JG, Frankenburg, et al.: The Revised Diagnostic Interview for Borderlines: discriminating BPD from other axis II disorders. J Personal Disord 1989, 3:10–18.

    Google Scholar 

  20. Westen D, Shedler J: Revising and assessing axis II, part II: toward an empirically based and clinically useful classification of personality disorders. Am J Psychiatry 1999, 156:273–285.

    PubMed  CAS  Google Scholar 

  21. First MB, Gibbon M, Spitzer RL, et al.: User’s Guide for the Structured Clinical Interview for DSM-IV Axis II Personality Disorders. Washington, DC: American Psychiatric Press; 1997.

    Google Scholar 

  22. Pfohl B, Blum N, Zimmerman M: Structured Interview for DSM-IV Personality. Washington, DC: American Psychiatric Press; 1997.

    Google Scholar 

  23. Trull TJ, Widiger TA: Structured Interview for the Five-Factor Model of Personality. Odessa: Psychological Assessment Resources; 1997.

    Google Scholar 

  24. Kaye AL, Shea MT: Personality disorders, personality traits, and defense mechanisms measures. In Handbook of Psychiatric Measures. Edited by Rush AJ, Pincus HA, First, MB, et al. Washington, DC: American Psychiatric Association; 2000:713–749. The American Psychiatric Association developed an official handbook of psychiatric measures to provide authoritative guidelines to clinicians for the instruments to use for the assessment of each mental disorder. The chapter by Drs. Kaye and Shea provide the recommendations for the assessment of personality disorders, as well as a thorough description of advantages and disadvantages of each instrument.

    Google Scholar 

  25. Widiger TA: Personality disorders. In Handbook of Assessment, Treatment Planning, and Outcome. Edited by Antony MM, Barlow DH. New York: Guilford; 2002:453–480. This chapter discusses issues in the assessment of personality disorders that are of particular importance in treatment planning and outcome assessment. Dr. Widiger also provides a systematic discussion of the advantages and disadvantages of each of the predominant semistructured interviews and self-report inventories.

    Google Scholar 

  26. O’Boyle M, Self D: A comparison of two interviews for DSMIII-R personality disorders. Psychiatry Res 1990, 32:85–92.

    Article  PubMed  CAS  Google Scholar 

  27. Skodol AE, Oldham JM, Rosnick L, et al.: Diagnosis of DSMIII-R personality disorders: a comparison of two structured interviews. Int J Methods Psychiatr Res 1991, 1:13–26.

    Google Scholar 

  28. Loranger AW: Are current self-report and interview methods adequate for epidemiological studies of personality disorders? J Pers Disorders 1991, 6:313–325.

    Google Scholar 

  29. Widiger TA, Coker LA: Assessing personality disorders. In Clinical Personality Assessment: Practical Approaches, edn 2. Edited by Butcher JN. New York: Oxford University Press; 2001:407–434. This chapter provides a thorough discussion of issues in the assessment of personality disorders, as well as practical recommendations for clinical practice. Also provided is a comprehensive summary of the convergent validity coefficients among all of the semistructured interviews and self-report inventories provided in 41 previous studies.

    Google Scholar 

  30. Coolidge FL, Merwin MM: Reliability and validity of the Coolidge Axis II Inventory: a new inventory for the assessment of personality disorders. J Pers Assess 1992, 59:223–238.

    Article  PubMed  CAS  Google Scholar 

  31. Livesley WJ, Jackson D: Manual for the Dimensional Assessment of Personality Pathology Basic Questionnaire. Port Huron: Sigma Press, In press.

  32. Horowitz LM, Rosenberg SE, Baer BA, et al.: Inventory of interpersonal problems: psychometric properties and clinical applications. J Consult Clin Psychol 1988, 56:885–892.

    Article  PubMed  CAS  Google Scholar 

  33. Pincus AL, Newes SL, Dickinson KA, et al.: A comparison of three indexes to assess the dimensions of Structural Analysis of Social Behavior (SASB). J Pers Assess 1998, 70:145–170.

    Article  PubMed  CAS  Google Scholar 

  34. Millon T, Millon C, Davis R: MCMI-III Manual, edn 2. Minneapolis: National Computer Systems; 1997.

    Google Scholar 

  35. Colligan RC, Morey LC, Offord KP: MMPI/MMPI-2 personality disorder scales: contemporary norms for adults and adolescents. J Clin Psychol 1994, 50:168–200.

    Article  PubMed  CAS  Google Scholar 

  36. Somwaru DP, Ben-Porath YS: Development and reliability of MMPI-2 based personality disorder scales. Paper presented at the 30th Annual Workshop and Symposium on Recent Developments in Use of the MMPI-2 & MMPI-A; St. Petersburg Beach, FL, March 1995.

  37. Harkness AR, McNulty JL, Ben-Porath YS: The Personality Psychopathology Five (PSY-5): constructs and MMPI-2 scales. Psychol Assess 1995, 7:104–114.

    Article  Google Scholar 

  38. Costa PT, McCrae RR: Revised NEO Personality Inventory (NEO PI-R) and NEO Five-Factor Inventory (NEO-FFI) Professional Manual. Odessa, FL: Psychological Assessment Resources; 1992.

    Google Scholar 

  39. Morey LC: An Interpretive Guide to the Personality Assessment Inventory (PAI). Odessa: Psychological Assessment Resources; 1996.

    Google Scholar 

  40. Hyler SE: Personality Diagnostic Questionnaire-4 (PDQ-4) Unpublished Test. New York: New York State Psychiatric Institute; 1994.

    Google Scholar 

  41. Clark LA: Manual for the Schedule for Nonadaptive and Adaptive Personality. Minneapolis: University of Minnesota Press; 1993.

    Google Scholar 

  42. Cloninger CR, Svrakic DM, Przybeck TR: A psychobiological model of temperament and character. Arch Gen Psychiatry 1993, 50:975–990.

    PubMed  CAS  Google Scholar 

  43. Klein MH, Benjamin LS, Rosenfeld R, et al.: The Wisconsin Personality Disorders Inventory, I: development, reliability, and validity. J Personal Disord 1993, 7:285–303.

    Google Scholar 

  44. Livesley WJ: Suggestions for a framework for an empirically based classification of personality disorder. Can J Psychiatry 1998, 43:137–147.

    PubMed  CAS  Google Scholar 

  45. Widiger TA: The DSM-III-R categorical personality disorder diagnoses: a critique and an alternative. Psychol Inquiry 1993; 4:75–90.

    Article  Google Scholar 

  46. Widiger TA, Trull TJ, Clarkin JF, et al.: A description of the DSM-IV personality disorders with the five-factor model of personality. In Personality Disorders and the Five-factor Model of Personality, edn 2. Edited by Costa PT, Widiger TA. Washington, DC: American Psychological Association; 2002:89–99.

    Google Scholar 

  47. Perry JC: Problems and considerations in the valid assessment of personality disorders. Am J Psychiatry 1992, 149:1645–1653.

    PubMed  CAS  Google Scholar 

  48. Zimmerman M: Diagnosing personality disorders: a review of issues and research methods. Arch Gen Psychiatry 1994, 51:225–245.

    PubMed  CAS  Google Scholar 

  49. Hyler SE, Rieder RO, Williams JBW, et al.: A comparison of clinical and self-report diagnoses of DSM-III personality disorders in 552 patients. Compr Psychiatry 1989, 30:170–178.

    Article  PubMed  CAS  Google Scholar 

  50. Heumann KA, Morey LC: Reliability of categorical and dimensional judgments of personality disorder. Am J Psychiatry 1990, 147:498–500.

    PubMed  CAS  Google Scholar 

  51. Clark LA, Livesley WJ, Morey L: Personality disorder assessment: the challenge of construct validity. J Personal Disord 1997, 11:205–231.

    PubMed  CAS  Google Scholar 

  52. Oldham JM, Skodol AE, Kellman HD, et al.: Diagnosis of DSMIII-R personality disorders by two semistructured interviews: patterns of comorbidity. Am J Psychiatry 1992, 149:213–220.

    PubMed  CAS  Google Scholar 

  53. Bornstein RF: Reconceptualizing personality disorder diagnosis in the DSM-V: the discriminate validity challenge. Clin Psychol Sci Pract 1998, 5:333–343.

    Article  Google Scholar 

  54. Farmer RF: Issues in the assessment and conceptualization of personality disorders. Clin Psychol Rev 2000, 20:823–852. This article provides a thorough summary of issues in the assessment of personality disorders, and relates these problems to controversies in the conceptualization and diagnosis of personality disorders.

    Article  PubMed  CAS  Google Scholar 

  55. Lilienfeld SO, Waldman ID, Israel AC: A critical examination of the use of the term "comorbidity" in psychopathology research. Clin Psychol Sci Pract 1994, 1:71–83.

    Google Scholar 

  56. Morey LC, Gunderson J, Quigley BD, et al.: Dimensions and categories: the "big five" factors and the DSM personality disorders. Assessment 2000, 7:203–216.

    Article  PubMed  CAS  Google Scholar 

  57. Gunderson JG, Shea MT, Skodol AE, et al.: The Collaborative Longitudinal Personality Disorders Study, I: development, aims, design, and sample characteristics. J Person Disord 2000, 14:300–315. The Collaborative Longitudinal Personality Disorders Study has provided many influential and likely to be widely cited findings. This paper provides a good summary of the primary methodologic features of the project, including the controversial decision to use hierarchical exclusion rules when patients meet diagnostic criteria for more than one personality disorder.

    CAS  Google Scholar 

  58. Westen D, Shedler J: Revising and assessing axis II, part I: developing a clinically and empirically valid assessment method. Am J Psychiatry 1999, 156:258–272.

    PubMed  CAS  Google Scholar 

  59. Herkov MJ, Blashfield RK: Clinicians’ diagnoses of personality disorder: evidence of a hierarchical structure. J Pers Assess 1995, 65:313–321.

    Article  PubMed  CAS  Google Scholar 

  60. First MB, Spitzer RL, Williams JBW: Exclusionary principles and the comorbidity of psychiatric diagnoses: a historical review and implications for the future. In Comorbidity of Anxiety and Mood Disorders. Edited by Maser JD, Cloninger CR. Washington, DC: American Psychiatric Press; 1990:83–109.

    Google Scholar 

  61. Loranger AW, Lenzenweger MF, Gartner AF, et al.: Trait-state artifacts and the diagnosis of personality disorders. Arch Gen Psychiatry 1991, 48:720–729.

    PubMed  CAS  Google Scholar 

  62. Stuart S, Simons AD, Thase ME, et al.: Are personality disorders valid in acute major depression? J Affect Disord 1992, 24:281–290.

    Article  PubMed  CAS  Google Scholar 

  63. Piersma HL: The MCMI as a measure of DSM-III axis II diagnoses: an empirical comparison. J Clin Psychol 1987, 43:478–483.

    Article  PubMed  CAS  Google Scholar 

  64. Piersma HL: The MCMI-II as a treatment outcome measure for psychiatric inpatients. J Clin Psychol 1989, 45:87–93.

    Article  PubMed  CAS  Google Scholar 

  65. Bernstein DP, Kasapis C, Bergman A, et al.: Assessing axis II disorders by informant interview. J Personal Disord 1997, 11:158–167.

    PubMed  CAS  Google Scholar 

  66. Dreessen L, Hildebrand M, Arntz A: Patient-informant concordance on the structured clinical interview for DSM-III-R personality disorders (SCID-II). J Personal Disord 1998, 12:149–161.

    PubMed  CAS  Google Scholar 

  67. Riso LP, Klein DN, Anderson RL, et al.: Concordance between patients and informants on the Personality Disorder Examination. Am J Psychiatry 1994, 151:568–573.

    PubMed  CAS  Google Scholar 

  68. Zimmerman M, Pfohl B, Coryell W, et al.: Diagnosing personality disorders in depressed patients: a comparison of patient and informant interviews. Arch Gen Psychiatry 1988, 45:733–737.

    PubMed  CAS  Google Scholar 

  69. Oltmanns TF, Turkheimer E, Strauss ME: Peer assessment of personality traits and pathology. Assessment 1998, 5:53–65.

    Article  PubMed  CAS  Google Scholar 

  70. Funtowicz MN, Widiger TA: Sex bias in the diagnosis of personality disorders: an evaluation of the DSM-IV criteria. J Abnorm Psychol 1999, 108:195–202.

    Article  PubMed  CAS  Google Scholar 

  71. Clark LA, Watson D, Reynolds S: Diagnosis and classification of psychopathology: challenges to the current system and future directions. Ann Rev Psychol 1995, 46:121–153.

    Article  CAS  Google Scholar 

  72. Westen D, Arkowitz-Westen L: Limitations of axis II in diagnosing personality pathology in clinical practice. Am J Psychiatry 1998, 155:1767–1771.

    PubMed  CAS  Google Scholar 

  73. Frances AJ, First MB, Pincus HA: DSM-IV Guidebook. Washington, DC: American Psychiatric Press; 1995.

    Google Scholar 

  74. Bagby RM, Taylor GJ, Parker JDA: The twenty-item Toronto Alexithymia Scale II: convergent, discriminate, and concurrent validity. J Psychosom Res 1994, 38:23–32.

    Article  PubMed  CAS  Google Scholar 

  75. Hartung CM, Widiger TA: Gender differences in the diagnosis of mental disorders: conclusions and controversies of DSM-IV. Psychol Bull 1998, 123:260–278.

    Article  PubMed  CAS  Google Scholar 

  76. Kaplan M: A woman’s view of DSM-III. Am J Psychol 1983, 38:786–792.

    Article  CAS  Google Scholar 

  77. Lindsay KA, Sankis LM, Widiger TA: Gender bias in self-report personality disorder inventories. J Personal Disord 2000. 14:218–232. Many self-report inventories include items that identify the presence of adaptive functioning. These items can be useful in differential diagnosis and in addressing the tendency of some patients to deny or dissimulate. However, the results of this study indicate how these items can also result in gender-biased assessments. The authors also indicate how such items will likely be problematic for treatment outcome studies.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychology, University of Kentucky, 115 Kastle Hall, 40506, Lexington, KY, USA

    Thomas A. Widiger MD

Authors
  1. Thomas A. Widiger MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kaylynn Chaynes MA
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Widiger, T.A., Chaynes, K. Current issues in the assessment of personality disorders. Curr Psychiatry Rep 5, 28–35 (2003). https://doi.org/10.1007/s11920-003-0006-4

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11920-003-0006-4

Keywords

Search

Navigation