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Assessment Tools for Personality Disorders

Below we comment on specific aspects of assessment that are most relevant to the person with suspected personality disorder. The methods with which health care professionals assess an individual for personality traits and disorders encompass a wide range of techniques, which invariably reflect professional background and agenda. Ideally, the assessment would bring together evidence from all disciplines, using interview, structured assessment tools, observation and third-party information to corroborate facts and findings. There are pitfalls associated with an overreliance on mentally thumbing through the criteria of diagnostic tools such as DSM-IV  or ICD-10  following a non-specific interview or basic assessment, similarly through a reliance on self report.

Self-report measures

Self-report measures that look to measure personality correlate with mood state and irrelevant things, which leads to questions as to how reliable or valid self-report measures are. Self report as a stand-alone assessment can miss subtleties, particularly in measuring criminality. Such tests may be further affected by a general lack of insight and deceit. Despite many self-report measures being developed only three have an adequate body of psychometric data. One such tool is the MCMI-III. Fortified and refined to align itself with the framework of the DSM-IV, the MCMI-III is a 175-item clinical assessment tool with profiles based on 24 clinical scales, designed only for the purpose of diagnostic screening and clinical assessment for adults who have eighthgrade reading abilities. Despite the well reported validity and reliability of self-report measures such as the MCMI-III in diagnosing traits and disorders of personality, the differences in the constructs of psychopathy and anti-social personality disorder as defined within DSM-IV results in their use not being recommended in the assessment of psychopathy.

Observation

Observation is an under-utilized assessment method that can be highly effective in identifying both personality traits and coping styles. It may be controlled or uncontrolled depending largely on whether they are prearranged or unplanned observations of ongoing behaviours. Similarly, these may be recorded freehand or through using a structured response sheet to monitor what is seen and heard. Self observation, that is the maintaining of thought or behaviour diaries, can offer a useful insight into the individual’s perception of themselves. As with self-report measures of any kind, important cognitions can be shrouded in what the individual may think we want to hear. This is in itself an important tool and can give the assessor a valuable insight in to how the person views themselves, others and the world around them. Aiken suggests that in order to be truly valid, observations should be objective and unobtrusive, which may be difficult to achieve when working within the psychiatric setting where patients are aware that they are being observed. There are further difficulties in attempting to be objective while the majority of the professional’s time is taken up in getting to know the individual. It is questionable how objective the nurse can be with regard to observation while he or she is within a therapeutic relationship with the individual. Observation is not merely a tool for watching but a valuable tool for engagement. Whether the observations are formal or informal they offer the clinician a way in, and the individual a chance to understand and participate fully in their care.

Interview

Personality assessment via interview is perhaps the most popular method of choice by clinicians. It may provide the interviewer with a rich source of information, such as, •the nature of the individual’s problems (including duration, severity and manifestation); •the coping ability of the individual, triggers, and protective factors; •what has worked in the past, and what strategies may be useful for the future. The assessor must guard against using the assessment interview as an ‘easy way out’. That is, a quick interview in the comfort of an office is no substitute for a comprehensive assessment covering all fields in order to back up, quantify and indeed qualify information gathered and received. The interviewer should be friendly but neutral, avoid prying yet show interest. The interview should demonstrate that its sole purpose is to understand not only the difficulties experienced but also the individual themselves. It should, therefore, reflect their perspective, countered against observations, written reports and self-report tests. The style of interview should be somewhat directive, using a high proportion of open questions and reflection.

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