Staff Observational Differences Between Depressive Disorders and Personality Disorders

Distinguishing those with a personality disorder from those with major depressive disorder (MDD) can be challenging, but establishing the correct diagnosis can direct appropriate management.

To identify whether behavioural themes differ between those with personality disorders from those with MDD, and how those differences might relate to a clinical team's perception of diagnosis.

An observational study identifying all inpatients presenting with symptoms of depression. At discharge, patients (n = 60) underwent a structured diagnostic interview and were grouped according to diagnosis. Qualitative data was analysed to determine whether behavioural themes differed between those with MDD and those with a personality disorder (with or without MDD).

Ward staff perceptions of diagnosis aligned in all cases of personality disorder, but they also attributed that diagnosis to 54% of patients who had only MDD. Several behavioural themes were evident in those with a personality disorder but not those with MDD. Many behavioural themes were observed in both groups, and it is likely these that drove differences in diagnostic views.

Certain behavioural themes may be determinants of the perception of diagnosis held by inpatient staff, and when present in acute episodes in MDD, may risk diagnostic misattribution.