MIDAS Project Publication Abstracts

Objective: A recent study reported that clinicians are less inclined than researchers to use direct questions in ascertaining the presence of personality disorders (PDs), and raised questions about the validity of research on PDs in which diagnoses are based on semi-structured diagnostic interviews. No studies have directly compared research and clinical approaches towards making PD diagnoses. The goal of the present study was to examine the influence of assessment method on the diagnosis of borderline PD. Methods: Borderline PD diagnoses derived from structured and unstructured clinical interviews were compared in two groups of psychiatric outpatients seen in the same practice setting. Five hundred individuals presenting for an intake appointment to a general adult psychiatric practice underwent a routine unstructured clinical interview. Subsequent to the completion of the first study the method of conducting diagnostic evaluations was changed and 409 individuals were interviewed with the borderline PD section of the Structured Interview for DSM-IV Personality (SIDP-IV). Results: In the structured interview cohort, individuals were significantly more often diagnosed with borderline PD than individuals in the clinical cohort. When the information from the SIDP-IV was presented to the clinicians, borderline PD was much more likely to be diagnosed clinically. Conclusions: The method used to assess borderline PD greatly impacts on the frequency by which it is diagnosed. Without the benefit of detailed information from a semi-structured diagnostic interview, clinicians rarely diagnose borderline PD during a routine intake diagnostic evaluation. Providing the results of a semi-structured interview to clinicians changes their behavior in that borderline PD is much more frequently diagnosed. This is inconsistent with the view that PD diagnoses based on semi-structured interviews are not viewed as valid by clinicians.

Back