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Personality disorders are long-standing and pervasive patterns of behavior that impede the individual's functioning and lead to significant distress in performing everyday activities with others (American Psychiatric Association, 1994). As these are chronic conditions that are present from an early age the patient does not perceive that the problems in their lives are a result of their behavior. Often people with these disorders are referred for psychological assessment or treatment at the bequest of persons close to them such as family members or employers. Personality disorders are not easy to diagnose for several other reasons. First, the assessment process does not allow a clinician ample time to spend with a patient to get a sense of the chronic pathology related to characterological dysfunction and other diagnoses such as mood or anxiety disorders are made. Second, individuals with personality disorders are often very good at hiding their pathology in the short-term, thus biasing informant information. Third, some personality questionnaires tend to over-pathologize symptoms and interpretation of these instruments must be carefully and systematically undertaken. Fifth, the diagnostic criteria for personality disorders as set down by the DSM-IV-TR have considerable overlap and this can lead to confusion on the part of the clinician as to exactly what diagnosis to consider. Finally, personality disorders are serious diagnoses that can create serious distress or harm if the diagnosis is disclosed to the family, friends, physicians, or employers of the patient. Therefore great care and empathetic consideration are crucial when considering diagnosing a personality disorder (Kaplan and Sadock, 2007).
Borderline personality disorder is represented clinically by symptoms that consist of a persistent pattern of instability in emotional regulation, impulse control, personal relationships, and self-image (Lieb, Zanarini, Schmahl, Linehan, & Bohus, 2004). These patients often feel barren emotionally, may have a very poor self-concept, and experience difficulty regulating their emotions and behaviors. When borderline patients initially arrive for assessment or treatment the preliminary referral question may be related to depression, problems with anger management, or other relationship issues. Clinicians often have to recognize the need for a more comprehensive assessment of the patient's presenting issues. The preferred method of assessing personality disorders is a semi-structured interview (Lopez, 1989; Rogers, 2003). However, clinicians also may find semi-structured interviews too lengthy to complete and Widiger (2003) suggests that it is more efficient to administer a self-report inventory prior to the interview in order to give the clinician a guideline as to what types of presenting symptoms the patient is exhibiting. The clinician can then to use that information to guide the interview process. Moreover, Widiger also notes that the major self-report inventories have validity scales which can alert the clinician to response sets, biases, and other distortions that can affect the validity of the assessment. Another benefit to administering a self-report inventory prior to the interview is that it can potentially reveal complaints/symptoms that might be overlooked as a result of false expectations (e.g., failing to notice potential borderline traits in male patients).
A possible difficulty in administering a self-report inventory prior to the interview could be the potential for creating a conformation bias in the interview. Confirmation biases occur when clinicians look only to find what they anticipate that they will find based on previous expectations or knowledge about the client (Lopez, 1989). Therefore, the best self-report inventory to administer prior to an interview would be one that is designed to screen for a wide variety of problems and allow for the clinician to assess for potential fabrications. The MMPI-2 provides good discriminant validity in the diagnosis of personality disorders and would be the ideal choice for the initial part of the assessment for a suspected borderline client (Trull, 1991). In addition, Trull ascertained that the MMPI-2 scale configurations with elevations on scales 2, 4, and 8 had good discriminant validity when identifying borderline patients from a variety of other clinical groups, but offers information about a variety of other potential problems and diagnostic concerns. Morey and Zanarini (2000) also found the MMPI-2 to be useful in assessing and diagnosing the symptoms in borderline personality disorder based on a subscale of MMPI-2 items defined earlier. They also preferred the use of the MMPI-2 over the MCMI-III as it was believed that the MCMI-III had a tendency to over-pathologize symptoms and produced too many false positive diagnoses. In addition, the MMPI-2 also allows for the assessment of potential psychotic-like symptoms, delusional behaviors, depressive symptoms, and emotional difficulties that are often observed in more severe cases of…[continue]
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