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A comparison of two interviews for DSM-III-R personality disorders
1Dept. of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston 77550-2777.
Psychiatry Research
|April 1, 1990
Summary
This study found fair agreement between two structured interviews for personality disorder diagnoses. While depression didn't consistently alter diagnoses, dimensional scores were higher when patients were depressed, suggesting dimensional profiles may be more reliable.
Area of Science:
- Psychiatry
- Clinical Psychology
- Psychopathology
Background:
- Accurate personality disorder diagnosis is crucial for effective treatment.
- Assessing diagnostic agreement between different structured interviews is essential for clinical practice.
- Understanding the impact of comorbid conditions, such as depression, on diagnostic stability is important.
Purpose of the Study:
- To evaluate the diagnostic agreement between the Personality Disorder Examination (PDE) and the Structured Clinical Interview for DSM-III-R Personality Disorder (SCID-PD).
- To investigate the influence of a current depressive state on personality disorder diagnoses obtained via these structured interviews.
- To compare the reliability of categorical versus dimensional personality disorder assessments.
Main Methods:
- Twenty subjects diagnosed with personality disorders were interviewed using both the PDE and SCID-PD while experiencing a depressive episode.
- Eighteen subjects were reinterviewed after recovery from depression to assess the impact of the depressive state.
- Diagnostic agreement was quantified using kappa statistics for overall diagnoses, personality disorder clusters, and individual disorders.
Main Results:
- Fair overall diagnostic agreement was observed between the PDE and SCID-PD (kappa = 0.38).
- Agreement varied significantly across personality disorder clusters (kappa range: 0.08–0.83) and individual disorders (kappa range: 0.18–0.62).
- The depressive state did not consistently alter categorical diagnoses but tended to increase dimensional scores, suggesting a potential state-dependent effect.
Conclusions:
- The two structured interviews show moderate agreement in diagnosing personality disorders.
- Dimensional scoring of personality disorders may offer a more stable and reliable assessment compared to categorical diagnoses, especially in the presence of mood states like depression.
- Clinicians should consider the potential influence of depressive symptoms on personality disorder assessment and may benefit from utilizing dimensional approaches.