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15 - Categorical Assessment of Personality Disorders: Considerations of Reliability and Validity

from Part IV - Assessment

Published online by Cambridge University Press:  24 February 2020

By
Janine D. Flory
Edited by
Carl W. Lejuez  and
Kim L. Gratz
Carl W. Lejuez
Affiliation:
University of Kansas
Kim L. Gratz
Affiliation:
University of Toledo, Ohio
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Summary

The revision of the Diagnostic and Statistical Manual, Fourth Edition (DSM-IV-TR) to DSM-5 provided the opportunity to shift the paradigm for diagnosing personality disorders (PDs) from a polythetic, categorical approach to a dimensional methodology. Although initial and in-progress descriptions of the plans to revise the diagnostic criteria for PDs suggested that there would be an extensive revision, the changes to DSM ultimately reflected a conservative approach. The categorical approach was retained without substantial revision other than to remove the PDs from a separate diagnostic axis. In effect, this decision set the agenda for research and clinical practice for PDs for years to come, with a continued reliance on polythetic categories to define PDs. This chapter provides a broad overview of existing methods for assessment of categorical PDs including the use of self-report scales and structured or semi-structured interviews. The point-of-view presented in this chapter is not that Present/Absent categories are the gold standard for diagnosis, but that they represent current practice in clinical care and (some) research. The major focus will be to evaluate validity and reliability characteristics of these methods. A summary statement that includes recommendations for future research is presented.

Keywords

diagnosisDSM-5categorical assessmentreliabilityvalidity
Type
Chapter
Information
The Cambridge Handbook of Personality Disorders , pp. 356 - 364
Publisher: Cambridge University Press
Print publication year: 2020

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References

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed., Text Revision). Washington, DC: American Psychiatric Association.Google Scholar
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.Google Scholar
Bender, D., Skodol, A. E., First, M. B., & Oldham, J. M. (2018). Structured Clinical Interview for the DSM-5 Alternative Model for Personality Disorders: Module I. Washington, DC: American Psychiatric Press.Google Scholar
Benjet, C., Borges, G., & Medina-Mora, M. E. (2008). DSM-IV personality disorders in Mexico: Results from a general population survey. Revista Brasileira de Psiquiatria, 30(3), 227–234.Google Scholar
Buer Christensen, T., Paap, M. C. S., Arnesen, M., Koritzinsky, K., Nysaeter, T. E., Eikenaes, I., … Hummelen, B. (2018). Interrater reliability of the Structured Clinical Interview for the DSM-5 Alternative Model of Personality Disorders Module I: Level of Personality Functioning Scale. Journal of Personality Assessment, 100(6), 630–641.CrossRefGoogle ScholarPubMed
Butcher, J. N., Graham, J. R., Ben-Porath, Y. S., Tellegen, A., Dahlstrom, W. G., & Kaemmer, B. (2001). Minnesota Multiphasic Personality Inventory–2. Minneapolis: University of Minnesota Press.Google Scholar
Clark, L. A. (1993). Manual for the Schedule for Nonadaptive and Adaptive Personality (SNAP). Minneapolis: University of Minnesota Press.Google Scholar
Clark, L. A. (2007). Assessment and diagnosis of personality disorder: Perennial issues and an emerging reconceptualization. Annual Review of Psychology, 58, 227–257.CrossRefGoogle Scholar
Cohen, P., Crawford, T. N., Johnson, J. G., & Kasen, S. (2005). The children in the community study of developmental course of personality disorder. Journal of Personality Disorders, 19(5), 466–486.Google Scholar
Costa, P. T., & McCrae, R. R. (1992). Revised NEO Personality Inventory (NEO-PI-R) and NEO Five Factor Inventory (NEO-FFI) Professional Manual. Odessa, FL: Psychological Assessment Resources.Google Scholar
Damen, K. F., De Jong, C. A., & Van der Kroft, P. J. (2004). Interrater reliability of the structured interview for DSM-IV personality in an opioid-dependent patient sample. European Addiction Research, 10(3), 99–104.Google Scholar
Ekselius, L., Lindstrom, E., von Knorring, L., Bodlund, O., & Kullgren, G. (1994). SCID II interviews and the SCID Screen questionnaire as diagnostic tools for personality disorders in DSM-III-R. Acta Psychiatrica Scandivavica, 90(2), 120–123.CrossRefGoogle ScholarPubMed
First, M. B., Bell, C. C., Cuthbert, B., Krystal, J. H., Malison, R., Offord, D. R., Reiss, D., Shea, T., Widiger, T, & Wisner, K. L. (2002). Personality disorders and relational disorders: A research agenda for addressing crucial gaps in DSM. In Kupfer, D. J, First, M. B, & Regier, D. A. (Eds.), A Research Agenda for DSM-V (pp. 123–199). Washington, DC: American Psychiatric Press.Google Scholar
First, M. B., Gibbon, M., Spitzer, R. L., Williams, J. B. W., & Benjamin, L. S. (1997). Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). Washington, DC: American Psychiatric Press.Google Scholar
First, M. B., Skodol, A. E., Bender, D. S., & Oldham, J. M. (2018). User’s Guide for the SCID-5-AMPD: Structured Clinical Interview for the DSM-5 Alternative Model for Personality Disorders. Arlington, VA: American Psychiatric Association.Google Scholar
First, M. B., Williams, J. B. W., Benjamin, L. S., & Spitzer, R. L. (2016). Structured Clinical Interview for DSM-5 (SCID-5): User’s Guide. Arlington, VA: American Psychiatric Association.Google Scholar
Forbes, D., Creamer, M., & Biddle, D. (2001). The validity of the PTSD checklist as a measure of symptomatic change in combat-related PTSD. Behaviour Research and Therapy, 39(8), 977–986.CrossRefGoogle ScholarPubMed
Grant, B. F., Dawson, D. A., Stinson, F. S., Chou, P. S., Kay, W., & Pickering, R. (2003). The Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV (AUDADIS-IV): Reliability of alcohol consumption, tobacco use, family history of depression and psychiatric diagnostic modules in a general population sample. Drug and Alcohol Dependence, 71(1), 7–16.Google Scholar
Grant, B. F., Hasin, D. S., Stinson, F. S., Dawson, D. A., Chou, S. P., Ruan, W. J., & Pickering, R. P. (2004). Prevalence, correlates, and disability of personality disorders in the United States: Results from the national epidemiologic survey on alcohol and related conditions. Journal of Clinical Psychiatry, 65(7), 948–958.Google Scholar
Gunderson, J. G. (2013). Seeking clarity for future revisions of the personality disorders in DSM-5. Personality Disorders: Theory, Research, and Treatment, 4(4), 368–376.CrossRefGoogle ScholarPubMed
Gunderson, J. G., Shea, M. T., Skodol, A. E., McGlashan, T. H., Morey, L. C., Stout, R. L., … Keller, M. B. (2000). The Collaborative Longitudinal Personality Disorders Study: Development, aims, design, and sample characteristics. Journal of Personality Disorders, 14(4), 300–315.Google Scholar
Hasin, D. S., & Grant, B. F. (2015). The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 1 and 2: Review and summary of findings. Social Psychiatry and Psychiatric Epidemiology, 50(11), 1609–1640.Google Scholar
Haslam, N., Holland, E., & Kuppens, P. (2012). Categories versus dimensions in personality and psychopathology: A quantitative review of taxometric research. Psychological Medicine, 42(5), 903–920.CrossRefGoogle ScholarPubMed
Helzer, J. E., Kraemer, H. C., & Krueger, R. F. (2006). The feasibility and need for dimensional psychiatric diagnoses. Psychological Medicine, 36(12), 1671–1680.Google Scholar
Herpertz, S. C., Huprich, S. K., Bohus, M., Chanen, A., Goodman, M., Mehlum, L., … Sharp, C. (2017). The challenge of transforming the diagnostic system of personality disorders. Journal of Personality Disorders, 31(5), 577–589.Google Scholar
Hopwood, C. J., Kotov, R., Krueger, R. F., Watson, D., Widiger, T. A., Althoff, R. R., … Zimmermann, J. (2018). The time has come for dimensional personality disorder diagnosis. Personality and Mental Health, 12(1), 82–86.CrossRefGoogle ScholarPubMed
Jacobsberg, L., Perry, S., & Frances, A. (1995). Diagnostic agreement between the SCID-II screening questionnaire and the Personality Disorder Examination. Journal of Personality Assessment, 65(3), 428–433.Google Scholar
Jane, J. S., Pagan, J. L., Turkheimer, E., Fiedler, E. R., & Oltmanns, T. F. (2006). The interrater reliability of the Structured Interview for DSM-IV Personality. Comprehensive Psychiatry, 47(5), 368–375.CrossRefGoogle ScholarPubMed
Johnson, J. G., Cohen, P., Kasen, S., Skodol, A. E., & Oldham, J. M. (2008). Cumulative prevalence of personality disorders between adolescence and adulthood. Acta Psychiatrica Scandinavica, 118(5), 410–413.Google Scholar
Kendell, R., & Jablensky, A. (2003). Distinguishing between the validity and utility of psychiatric diagnoses. American Journal of Psychiatry, 160(1), 4–12.CrossRefGoogle ScholarPubMed
Kranzler, H. R., Kadden, R. M., Babor, T. F., & Rounsaville, B. J. (1994). Longitudinal, expert, all data procedure for psychiatric diagnosis in patients with psychoactive substance use disorders. Journal of Nervous and Mental Disease, 182(5), 277–283.Google Scholar
Krueger, R. F. (2013). Personality disorders are the vanguard of the post-DSM-5.0 era. Personality Disorders: Theory, Research, and Treatment, 4(4), 355–362.Google Scholar
Lenzenweger, M. F., Lane, M. C., Loranger, A. W., & Kessler, R. C. (2007). DSM-IV personality disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 62(6), 553–564.Google Scholar
Loranger, A. W., Lenzenweger, M. F., Gartner, A. F., Susman, V. L., Herzig, J., Zammit, G. K., … Young, R. C. (1991). Trait-state artifacts and the diagnosis of personality disorders. Archives of General Psychiatry, 48(8), 720–728.CrossRefGoogle ScholarPubMed
Loranger, A. W., Sartorius, N., Andreoli, A., Berger, P., Buchheim, P., Channabasavanna, S. M., … Regier, D. A. (1994). The International Personality Disorder Examination: The World Health Organization/Alcohol, Drug Abuse, and Mental Health Administration international pilot study of personality disorders. Archives of General Psychiatry, 51(3), 215–224.CrossRefGoogle ScholarPubMed
McGilloway, A., Hall, R. E., Lee, T., & Bhui, K. S. (2010). A systematic review of personality disorder, race and ethnicity: prevalence, aetiology and treatment. BMC Psychiatry, 10, 33.Google Scholar
Miller, J. D., Few, L. R., & Widiger, T. A. (2012). Assessment of personality disorders and related traits: Bridging DSM-IV-TR and DSM-5. In Widiger, T. A. (Ed.), The Oxford Handbook of Personality Disorders (pp. 108–140). New York: Oxford University Press.Google Scholar
Millon, T., Millon, C., & Davis, R. (1997). MCMI-III Manual (2nd ed.). Minneapolis: National Computer Systems.Google Scholar
Monson, C. M., Gradus, J. L., Young-Xu, Y., Schnurr, P. P., Price, J. L., & Schumm, J. A. (2008). Change in posttraumatic stress disorder symptoms: Do clinicians and patients agree? Psychological Assessment, 20(2), 131–138.CrossRefGoogle ScholarPubMed
Morey, L. C., Benson, K. T., Busch, A. J., & Skodol, A. E. (2015). Personality disorders in DSM-5: Emerging research on the alternative model. Current Psychiatry Reports, 17(4), 558.Google Scholar
Nussbaum, D., & Rogers, R. (1992). Screening psychiatric patients for Axis II disorders. Canadian Journal of Psychiatry, 37(9), 658–660.CrossRefGoogle ScholarPubMed
O’Boyle, M., & Self, D. (1990). A comparison of two interviews for DSM-III-R personality disorders. Psychiatry Research, 32(1), 85–92.CrossRefGoogle ScholarPubMed
O’Connor, B. P. (2002). The search for dimensional structure differences between normality and abnormality: A statistical review of published data on personality and psychopathology. Journal of Personality and Social Psychology, 83(4), 962–982.Google Scholar
Pfohl, B. (1995). Structured Interview for DSM-IV Personality (SIDP-IV). Iowa City, IA: University of Iowa College of Medicine.Google Scholar
Pfohl, B., Blum, N., Zimmerman, M., & Stangl, D. (1989). Structured Interview for DSM-III-R Personality: SIDP-R. Iowa City, IA: University of Iowa.Google Scholar
Pfohl, B., Stangl, D., & Zimmerman, M. (1983). Structured Interview for DSM-III Personality (SIDP). Iowa City, IA: University of Iowa Hospitals and Clinics.Google Scholar
Pilkonis, P. A., Heape, C. L., Proietti, J. M., Clark, S. W., McDavid, J. D., & Pitts, T. E. (1995). The reliability and validity of two structured diagnostic interviews for personality disorders. Archives of General Psychiatry, 52(12), 1025–1033.Google Scholar
Pilkonis, P. A., Heape, C. L., Ruddy, J., & Serrao, P. S. (1991). Validity in the diagnosis of personality disorders: The use of the LEAD standard. Psychological Assessment, 3, 46–54.Google Scholar
Samuel, D. B., Hopwood, C. J., Ansell, E. B., Morey, L. C., Sanislow, C. A., Markowitz, J. C., … Grilo, C. M. (2011). Comparing the temporal stability of self-report and interview assessed personality disorder. Journal of Abnormal Psychology, 120(3), 670–680.CrossRefGoogle ScholarPubMed
Skodol, A. E., Morey, L. C., Bender, D. S., & Oldham, J. M. (2013). The ironic fate of the personality disorders in DSM-5. Personality Disorders: Theory, Research, and Treatment, 4(4), 342–349.CrossRefGoogle ScholarPubMed
Somma, A., Fossati, A., Terrinoni, A., Williams, R., Ardizzone, I., Fantini, F., … Ferrara, M. (2016). Reliability and clinical usefulness of the personality inventory for DSM-5 in clinically referred adolescents: A preliminary report in a sample of Italian inpatients. Comprehensive Psychiatry, 70, 141–151.Google Scholar
Strickland, C. M., Hopwood, C. J., Bornovalova, M. A., Rojas, E. C., Krueger, R. F., & Patrick, C. J. (2019). Categorical and dimensional conceptions of personality pathology in DSM-5: Toward a model-based synthesis. Journal of Personality Disorders, 33(2), 185–213.CrossRefGoogle Scholar
Torgersen, S., Czajkowski, N., Jacobson, K., Reichborn-Kjennerud, T., Roysamb, E., Neale, M. C., & Kendler, K. S. (2008). Dimensional representations of DSM-IV cluster B personality disorders in a population-based sample of Norwegian twins: A multivariate study. Psychological Medicine, 38(11), 1617–1625.Google Scholar
Trull, T. J., Jahng, S., Tomko, R. L., Wood, P. K., & Sher, K. J. (2010). Revised NESARC personality disorder diagnoses: Gender, prevalence, and comorbidity with substance dependence disorders. Journal of Personality Disorders, 24(4), 412–426.Google Scholar
Tyrer, P., Crawford, M., & Mulder, R. (2011). Reclassifying personality disorders. Lancet, 377(9780), 1814–1815.Google Scholar
Widiger, T. A. (2013). A postmortem and future look at the personality disorders in DSM-5. Personality Disorders: Theory, Research, and Treatment, 4(4), 382–387.Google Scholar
Widiger, T. A., & Costa, P. T. jr. (2012). Integrating normal and abnormal personality structure: The Five-Factor Model. Journal of Personality, 80(6), 1471–1506.CrossRefGoogle ScholarPubMed
Widiger, T. A., & Trull, T. J. (2007). Plate tectonics in the classification of personality disorder: Shifting to a dimensional model. American Psychologist, 62(2), 71–83.Google Scholar
Zanarini, M. C., Frankenburg, F. R., Chauncey, D. L., & Gunderson, J. G. (1987). The Diagnostic Interview for Personality Disorders: Interrater and test-retest reliability. Comprehensive Psychiatry, 28(6), 467–480.Google Scholar
Zanarini, M. C., Frankenburg, F. R., Sickel, A. E., & Yong, L. (1996). The Diagnostic Interview for DSM Personality Disorders (DIPD). Belmont, MA: McLean Hospital.Google Scholar
Zanarini, M. C., Skodol, A. E., Bender, D., Dolan, R., Sanislow, C., Schaefer, E., … Gunderson, J. G. (2000). The Collaborative Longitudinal Personality Disorders Study: Reliability of axis I and II diagnoses. Journal of Personality Disorders, 14(4), 291–299.CrossRefGoogle Scholar

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