This document summarizes principles of assessing personality disorders. It discusses different assessment approaches like categorical, dimensional, and idiographic. It describes several assessment instruments like self-report inventories, semi-structured interviews, and projective tests. It provides examples of specific instruments and discusses their strengths and limitations. Overall, the document conveys that while personality disorders can be assessed, there is a lack of consensus on the best methods and further standardization is needed.
4. Differences
• AXIS-I DISORDERS
• TEMPORARY
• REACTIVE
• DOMINATED BY Sxs
THAN BEHAVIOR.
• DIAG.—MSE
• MAY DVP.INTO OTHER
DISORDERS.
AXIS-II DISORDERS
--PERMANENT
--GENERATIVE
--BEHAVIOR
&RELATIONSHIP
B/W OTHERS
--DIAG-LONGTERM
FUNCTION
--STABLE
5. GENERAL DIAGNOSTIC
CRITERIA(ICD-10&DSM-IV)
• A) Enduring pattern of inner experience
that deviates from culture.Manifest in 2 or
more
• 1) cognition.
• 2) affectivity.
• 3) I.P. functioning
• 4) impulse control.
6. GENERAL DIAGNOSTIC
CRITERIA(ICD-10&DSM-IV)
• B) Pattern inflexible & pervasive across
social & personal situation
• C) Pattern leads to impairment in socio-
occupational or imp. areas of functioning.
• D) Pattern is stable & long standing &
onset to adolescence or early childhood.
• E) Pattern is not better accounted for as
manifestation of another axis-I disorder.
8. IDIOGRAPHIC
• Based on clinical grounds & case history.
• Focus on individual.
• Provide multifaceted description of
personal attributes & behaviors.
• Weakness being subjectivity.
10. Drawbacks
• “Danger of losing the human person in
everyday life.”— Allport ,1937.
• “Measure a bit of everything & not enough
of anything to give dependable &
quantifiable samples of personality.”----
--MacFarlane & Turddenham, 1951.
11. Categorical classification
• Followed by ICD-10 & DSM-IV
• Preferred –ease of communication &
efficiency
• Rx plan in dual(triple) diagnosis(axes-I+II
disorders ),.
• Decision making in forensic psychiatry.
12. Categorical classification
• Current gold standard for large number of
international comparisons and official
statistics.
• Ex: epidemiological surveys.
13. • Research studies in P.D. show
evidence that DIMENSIONAL
system of classifying is more valid
& reliable.---
----Clark et al 1995.
----Livesley et al 1994.
14. Reasons being--
• Dimensional view may be truer to the
fundamental nature of PDs as categorical
views impose an arbitrary distinctions that
may misrepresent a seamless state of
affairs.
• Categorical view may reduce researchers
capacity to assess correlates of PD &
severity related information.
• Categorical --–high degree of co-morbidity
& spurious representation
15. • In short
• “Categorical classification view PDs
as black & white in it’s structural
assumption , is oversimplifying &
falsely precise in it’s dichomatization
& uneconomical in it’s
diagnostics applications.”
---Nick Haslam,2003.
16. Dimensional classification ---
argues PD as extreme variant that
fall in a continuum with normal
personality.
• Meta analytic review by Lisa M Saulsman
et al. 2004, concludes
• PD’s conceptualized better by dimensional
classification in few disorders.
Contd…
17. • Dimensional ---offer practical
utility,relevant to majority of PDs.
• Related in meaningful & predictable way.
• Neuroticism & agreeableness are
dimensions across PD
• Extraversion & to certain extent
conscientiousness are unique to certain pd
categories.
18. • Combined CATEGORICAL-
DIMENSIONAL approach to
conceptualize & Rx PD may be more
valuable & preserve the integrity of both
classificatory systems.
---Lisa M Saulsman et al,2004.
19. Instruments to assess PD
• To assess individual traits, collection of
traits, constellations of traits.
• Methods---
• 1) Self-report inventories.(SRI)
• 2) Semi-structured interviews.(SSI)
• 3) Projective techniques.
20. SELF-REPORT INVENTORIES-SRI
• Consist of written statements or questions
ex: true-false, agree-disagree,etc.
• Most popular method
• Less expensive, less time.
• Easy to administer
• Vast samples.
• High inter-site reliabilty due to high degree
of structure.
21. • DISADVANTAGES.
• Being in differences in
1) Item analyses-content misrepresented due
to variety of methods & phrasing.
2) Gender,ethnic& cultural differences.
3) Individual differences.
4) Response distortion-person not
understanding or unwill or impaired to
accurate response.
SELF-REPORT INVENTORIES-SRI
22. SELF-REPORT INVENTORIES-SRI
• 16 personality factors questionnaire-
T/F,self-report,16 dimensions+4 second
order factors.
• IOWA personality disorder screen, Y/N,
5 min.,11 screening instruments.
• Millon clinical multi-axial inventory,MCMI,
DSM-IIIR,175 questions,20-30 min.
• PDQ-R152 questions,30 min.
23. Contd-SRI.
• Schedule for normal & abnormal
personality disorders,SNAP.—106
questions, 10 min.
• Tri-dimensional personality questionnaire
,100 questions,20-30 min.
• Wisconsin personality inventory ,360
questions,20 min.
24. Projective tests.
• Consists of relatively ambiguous stimuli or
prompts, responses to which are open-ended
to project unconscious conflicts, impulses,
needs or wishes.( Instructions to score &
interpret.)
25. Contd..projective tests
• Rorschach ink-blot test—10 stimulus cards –
ink-blots,5-chromatic.
• Thematic apperception test—30 stimulus
cards- ambiguous IP situations.
• Sentence completion test—part of sentence.
• Draw a person test.
26. Contd..projective tests
• Approach lacks empirical support of the
cognitive-perceptual scoring systems &
may encourage a return to less reliable
& subjective interpretations.
27. Unstructured interviews.
• Popular methods.
• Rely on training, expertise,
conscientiousness of interviewer .
• Prone for false assumptions,
attribution errors, misleading
expectations.
28. SEMI-STRUCTURED INTERVIEWS-
SSI
• Requires professional judgment &
discretion in administering & score.
• Responsibility of an interviewer to assess
personality trait & not just record
responses.
• Follow-up questions must be sensitive &
responsive to mood state, defensiveness &
self-awareness of the person.
29. Contd…ssi
• Ensures each trait is assessed in a
consistent fashion.
• Systematic biases in clinical assessments
are easily identified & corrected with
explicit nature of ssi.
30. SSI—EXAMPLES:-
• Diagnostic interview for p.d. (DIPD)-
Zanarini-101Q,60-120 min.
• International Personality disorder
examination-IPDE-Loranger et al.-157Q,
150 min.
• Personality assessment schedule-PAS-Tyrer
et al-24Q, 60min.
31. SSI…CONTd..
• Personality interview questions-
II,Widiger-375Q, 60-120 min.
• Standardized assessment of
personality,Mann et al.,10-15min.
• Structured clinical interview for DSM-
IIIR PD—SCID-II, Spitzer& Williams,
120 Q ,60-90min.
• SIPD---Pfohl etal.,136Q,90min.
32. Kappa(k)statistic
• --Cohen
• Corrects chance agreement by taking the
base rates into account to calculate what
proportion of maximum possible chance-
corrected rate of agreement.
• =>1—(minus)chance rate of agreement/ (divides)
max. possible rate of chance-corrected
agreement
33. k statistic
• To determine the level of diagnostic
agreement b/w 2 interviewers or 2
instruments.
• Values >0.75---excellent agreement
• 0.41-0.74--- fair-good ”
• <0.40---poor agreement
34. Personality assessment schedule.
• Tyrer & Alexander,1976.
• 25-40 minutes, trained clinical
interviewer,administer to pt. / or informant.
• Identifies personality traits &scored on 8-
point scale.
• 24 dimensions of personality assessed.
• 5 main personality classes derived,revised
to 13 classes.
36. ipde
• Screening questionnaire--self
administered-3 or more + to interview
for that pd.
• Traits + for at least 5 yrs & some manifest
in last 1yr & 1 criterion before age 25.
• Also provides option for late onset pd.
• Requires training & clinical experience for
diagnosis.
37. Reliability of IPDE
Kappa statistic DSM-IIIR ICD-10
DEFINITE PD 0.57 0.65
Probable or
definite PD
O.73 0.77
Inter-rater
reliability for
dimensional
score
0.79 – 0.94 0.86– 0.93
38. Strengths of IPDE
• Medium to high inter-rater agreement &
temporal reliability for categorical &
dimensional scores.
• Detailed training manual for instructions &
scoring algorithms
• Dual coverage of DSM-IV & ICD-10
39. Strengths of IPDE
• Measures dimensional scores which
provide information about accentuation
normal traits below the threshold for pd.
• Availability in several languages across
countries & cross culturally.
40. Structured clinical interview for
DSM-IIIR PD{SCID-II}
• Spitzer et al., 30-45 min.
• Assessment for 11 DSM-IIIR PDs.
• Categorical or dimensional personality
assessment.
• Self-report screening questionnaire –y/n.
41. SCID-II
• Negative questions followed up when in
doubt.
• Can be rated using alternative sources
(observed behavior, records, informants)
• Score 0---3
• Manual available
42. SCID-II
• RELIABILITY—k—0.53—patients,
• 0.31 for non-patients
• Format is not disorder based but is in
primary format.
• Lack of thematically organized format
limits examiner’s choices.
43. Structured interview for DSM-IV
Personality Disorder. {SIPD-IV}
• Pfohl et al 1995.
• Administered by trained psychologist or
psychiatrist.
• 107Q,16 areas of personality functions
• 4 levels of severity, 60-90min.
• Drawback--Little data, no screening
questionnaire.
44. Standardized assessment of
personality.
• Mann et al,1981.
• Uses informants.
• 15-20min.
• Suitable as a screening instrument as it is
sensitive & not very specific.
45. Personality disorder interview-
IV(personality interview Q--PIQ)
• Widiger et al.,1995.
• Semi-structured, 94 criteria.
• Also assess dimensionally.
• Reliability kappa—0.65.
• May be used by lay interviewers with
manual, training required.
• No self report Questions,less no.of studies.
46. Instruments for diagnosis of
personality dimensionally
• Questionnaires –
• Eysenck inventory questionnaire-EPI,EPQ.
• Karolinska scales of personality-KSP
• Karolinska psychodynamic profile-KPP
• Personality assessment inventory-PAI
• Schedule for normal & abnormal personality-
SNAP
• Dimensional assessment of personality pathology-
basic questionnaire-DAPP-BQ
47. Interview schedule—
dimensionally
• Personality assessment schedule-PAS
• Personality disorder interview-PDI-IV
• Structured interview of DSM-IV PD-
SIDPIV
• ADD-IV—Dutch instrument
• More likely new to be added.
48. conclusions across
studies…Ziemmerman,1994
• 1) Reliability of unstandardized clinical
evaluations is poor to fair.
• 2) Joint-interview inter-rater reliability is
generally good-excellent –if used by
developers, unclear if otherwise.
• 3) Test-retest reliability co-efficient-- lower
if interval is greater by couple of wks.
49. conclusions across
studies…Ziemmerman,1994
• 4) Effect of study design on reliability
probably varies by PD.
• 5) Pt.’s & informants differ in personality
description-insufficient data for validity
comparison & cost-effectiveness
• 6) Variability among PD instruments in
terms of extent of coverage.
50. conclusions across
studies…Ziemmerman,1994
• 7) Comparing instruments have poor
diagnostic concordance.
• 8) Self-report personality inventories &
semi-structured interviews are biased by
acute state.
• 9) When personality changes, time frame
focus can over or under diagnose PD.
51. CONCLUSION
PD can be assessed & classified with some
degree of success. However, there are too
many assessment schedules in the
diagnostic kitchen & it is not surprising that
the cook gets confused & often cannot
produce right recipe. We urgently need
some international consensus in both
classification & assessment if we are to
realize some gains we have made in past yrs
