Patient and clinician agreement on personality using the SWAP-200

The Shedler Westen Assessment Procedure (SWAP-200; Westen & Shedler, 1999a) is a clinician-rated assessment providing descriptions of personality disorder prototypes using a Q-sort procedure. This study aims to investigate the degree to which there is agreement between patients' and clinicians' accounts of personality pathology on a modified version of the SWAP-200 using Bland Altman analysis with the data from 23 clinician-patient pairs. Poor agreement was found between clinicians and patients on personality prototypes. Even the best agreement found between patients and clinicians on the avoidant prototype was poor--the patients' ratings were up to 43.5 per cent below and 32.9 per cent above the clinicians' ratings. This is an unacceptable degree of variation. The difference between the clinician and patient ratings are large when expressed as a percentage of the possible scores (as obtained on the clinician rating scale). The patient ratings vary between being 40.8 to 91.1% below the clinician ratings, and 32.9 to 99.7% above the clinician ratings.