Refining personality disorder diagnosis: integrating science and practice

Area of Science:

• Psychiatry and Clinical Psychology
• Mental Health Diagnostics

Background:

• Current diagnostic categories for personality disorders face challenges.
• Empirical data from a national sample of patients is used to propose improvements.

Purpose of the Study:

• To propose revisions to personality disorder diagnostic categories and criteria.
• To address limitations in the current Diagnostic and Statistical Manual of Mental Disorders (DSM) system.

Main Methods:

• Utilized the Shedler-Westen Assessment Procedure (SWAP-200) for personality assessment.
• Collected data from psychiatrists and psychologists describing personality disorder prototypes (N=267) and patients (N=530).

Main Results:

• Clinician descriptions of personality disorders and patients showed overlap with, but also systematic differences from, DSM criteria.
• Patient descriptions were richer, emphasizing inner experience more than DSM criteria.
• Identified potential new diagnostic criteria more representative of personality syndromes.

Conclusions:

• Diagnostic criteria should be expanded to include multiple domains of functioning and patients' inner experiences.
• Recommendations are made for revising diagnostic categories and criteria.
• A prototype matching approach is proposed to enhance personality disorder diagnosis.