Assessment and classificationPractical assessment of personality disorder
Section snippets
The importance of assessing personality disorder
There are sound reasons why psychiatrists should take an interest and be properly trained in the assessment of personality disorder. First, many Axis I conditions co-occur with one or more personality disorders, with the latter usually having a detrimental effect on the outcome of the former.1, 2 Second, personality disorders are prevalent conditions3 and are recognized as having considerable morbidity as well as an increase in mortality.4, 5 Belatedly, this recognition has led to an
Potential difficulties
Despite this recognition many psychiatrists are uncomfortable in assessing and diagnosing personality disorder as they feel ill-equipped to do so. They are also rightly concerned about the potential stigma attached to making such a diagnosis, particularly if subsequently there is nothing constructive to be offered. However, as with any other medical condition, a failure to be clear on the diagnosis of the condition inevitably makes the subsequent management of the condition difficult. Doctors
Approaches to the assessment of personality disorder
Broadly, personality disorder assessment can be grouped into three types: clinical interview; self-report inventory; and semi-structured interview.
Clinical interview: although assessing personality disorder by clinical interview is believed to be highly unreliable, this need not necessarily be the case provided that the practitioner focuses on the two key areas of personality disturbance, namely in occupational and interpersonal functioning. For this to be a meaningful inquiry, however, the
A suggested practical approach
It could be argued that training in at least one semi-structured personality assessment instrument is essential for all psychiatrists. Whilst it is recognized that the application of a full semi-structured interview might not be practicable or desirable in every situation, having specific training in one of these instruments adds significantly to the clinician’s diagnostic armoury. By having a good understanding of the specific criteria of each personality disorder and the ways in which these
From assessment to treatment
An assessment using (or at least informed by) a semi-structured instrument also has benefits that carry over into treatment. By systematically enquiring into cognitive, emotional, behavioural and social deficits a collaborative dialogue can be established which will enable the production of a problem-list derived from the patient’s answers. Facets of the patient’s psychopathology that may interfere with treatment or lead to therapeutic ruptures can also be anticipated, and if appropriate used
Conclusions
Despite the relative lack of knowledge (in comparison with most Axis I disorders) regarding the treatment and outcome of personality disorders a proper diagnostic assessment of personality disorders is essential in planning and delivering interventions to most appropriately meet the patient’s needs. Knowledge of their specific psychopathology will allow likely problems to be anticipated, prioritized and hopefully resolved. It could be argued that such an assessment should be informed by a
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