|
| | |
|
Am J Psychiatry 1997; 154:895-903
Copyright © 1997 by American Psychiatric Association
Divergences between clinical and research methods for assessing personality disorders: implications for research and the evolution of axis II
D Westen
Department of Psychiatry, Harvard Medical School, Boston, MA, USA. dw@wjh.harvard.edu
OBJECTIVE: The purpose of this study was to examine the extent to which
instruments for assessing axis II diverge from clinical diagnostic
processes. METHOD: Subjects in the first study were 52 clinicians with
experience in assessment and treatment of patients with personality
disorders, who were surveyed about the methods they use in clinical
practice to make diagnoses and other aspects of the diagnostic process. A
second study replicated the major findings with a random national sample of
1,901 experienced psychiatrists and psychologists. RESULTS: Whereas current
instruments rely primarily on direct questions derived from DSM-IV,
clinicians of every theoretical persuasion found direct questions useful
for assessing axis I disorders but only marginally so for axis II. They
made axis II diagnoses, instead, by listening to patients describe
interpersonal interactions and observing their behavior with the
interviewer. In contrast to findings with current research instruments,
most patients with personality disorders in clinical practice receive only
one axis II diagnosis, and if they receive more than one, one is considered
primary. Clinicians reported treating a substantial number of patients for
enduring personality patterns that current axis II instruments do not
assess, many of which meet neither axis I nor axis II criteria, notably
problems with relatedness, work, self-esteem, and chronic subclinical
depressive traits. CONCLUSIONS: Measurements of axis II were constructed by
using a model derived from axis I instruments that diverges from clinical
diagnostic procedures in a way that may be problematic for the assessment
of personality disorders and the development of a more clinically and
empirically sound taxonomy.
This article has been cited by other articles:
|
|
|
|
 
G. Newton-Howes, P. Tyrer, and T. Weaver
Social Functioning of Patients With Personality Disorder in Secondary Care
Psychiatr Serv,
September 1, 2008;
59(9):
1033 - 1037.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Westen, J. Shedler, and R. Bradley
A Prototype Approach to Personality Disorder Diagnosis
Am J Psychiatry,
May 1, 2006;
163(5):
846 - 856.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Zimmerman, L. Rothschild, and I. Chelminski
The Prevalence of DSM-IV Personality Disorders in Psychiatric Outpatients
Am J Psychiatry,
October 1, 2005;
162(10):
1911 - 1918.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. M. Oldham
Personality Disorders
Focus,
July 1, 2005;
3(3):
372 - 382.
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. THOMPSON-BRENNER and D. WESTEN
Personality subtypes in eating disorders: validation of a classification in a naturalistic sample
The British Journal of Psychiatry,
June 1, 2005;
186(6):
516 - 524.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. W. Bateman and P. Tyrer
Services for personality disorder: organisation for inclusion
Advan. Psychiatr. Treat.,
November 1, 2004;
10(6):
425 - 433.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Shedler and D. Westen
Dimensions of Personality Pathology: An Alternative to the Five-Factor Model
Am J Psychiatry,
October 1, 2004;
161(10):
1743 - 1754.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Tyrer, J. Morgan, and D. Cicchetti
The Dependent Personality Questionnaire (DPQ): A Screening Instrument for Dependent Personality
International Journal of Social Psychiatry,
March 1, 2004;
50(1):
10 - 17.
[Abstract]
[PDF]
|
|
|
|
|
|
|
D. F. Becker, C. M. Grilo, W. S. Edell, and T. H. McGlashan
Diagnostic Efficiency of Borderline Personality Disorder Criteria in Hospitalized Adolescents: Comparison With Hospitalized Adults
Am J Psychiatry,
December 1, 2002;
159(12):
2042 - 2047.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. Doidge, B. Simon, L. Brauer, D. C. Grant, M. First, J. Brunshaw, W. J. Lancee, A. Stevens, J. M. Oldham, and P. Mosher
Psychoanalytic Patients in the U.S., Canada, and Australia: I. DSM-III-R Disorders, Indications, Previous Treatment, Medications, and Length of Treatment
J Am Psychoanal Assoc,
June 1, 2002;
50(2):
575 - 614.
[Abstract]
[PDF]
|
|
|
|
|
|
|
N. Doidge, B. Simon, W. J. Lancee, M. First, J. Brunshaw, L. Brauer, D. C. Grant, A. Stevens, J. M. Oldham, and P. Mosher
Psychoanalytic Patients in the U.S., Canada, and Australia: II. A DSM-III-R Validation Study
J Am Psychoanal Assoc,
June 1, 2002;
50(2):
615 - 627.
[Abstract]
[PDF]
|
|
|
|
|
|
|
G. A. Bonanno, N. P. Field, A. Kovacevic, and S. Kaltman
Self-Enhancement as a Buffer Against Extreme Adversity: Civil War in Bosnia and Traumatic Loss in the United States
Pers Soc Psychol Bull,
February 1, 2002;
28(2):
184 - 196.
[Abstract]
[PDF]
|
|
|
|
|
|
|
M. J. HILSENROTH, S. J. ACKERMAN, M. D. BLAGYS, and J. L. PRICE
Dr. Hilsenroth and Colleagues Reply
Am J Psychiatry,
November 1, 2001;
158(11):
1936 - 1937.
[Full Text]
|
|
|
|
|
|
|
P. Tyrer
Personality disorder
The British Journal of Psychiatry,
July 1, 2001;
179(1):
81 - 84.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Westen and J. Harnden-Fischer
Personality Profiles in Eating Disorders: Rethinking the Distinction Between Axis I and Axis II
Am J Psychiatry,
April 1, 2001;
158(4):
547 - 562.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
D. WESTEN
Diagnosing Personality Disorders
Am J Psychiatry,
February 1, 2001;
158(2):
324- - 325.
[Full Text]
|
|
|
|
|
|
|
J. HILL, H. FUDGE, R. HARRINGTON, A. PICKLES, and M. RUTTER
Complementary approaches to the assessment of personality disorder: The Personality Assessment Schedule and Adult Personality Functioning Assessment compared
The British Journal of Psychiatry,
May 1, 2000;
176(5):
434 - 438.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. E. Agronin and G. Maletta
Personality Disorders in Late Life: Understanding and Overcoming the Gap in Research
Am J Geriatr Psychiatry,
February 1, 2000;
8(1):
4 - 18.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
M. Zimmerman and J. I. Mattia
Differences Between Clinical and Research Practices in Diagnosing Borderline Personality Disorder
Am J Psychiatry,
October 1, 1999;
156(10):
1570 - 1574.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
M. KAPLAN
"Monk" Requesting Castration
Am J Psychiatry,
June 1, 1999;
156(6):
984 - 984.
[Full Text]
|
|
|
|
|
|
|
D. Westen and J. Shedler
Revising and Assessing Axis II, Part I: Developing a Clinically and Empirically Valid Assessment Method
Am J Psychiatry,
February 1, 1999;
156(2):
258 - 272.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
D. Westen and J. Shedler
Revising and Assessing Axis II, Part II: Toward an Empirically Based and Clinically Useful Classification of Personality Disorders
Am J Psychiatry,
February 1, 1999;
156(2):
273 - 285.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
J. Shedler and D. Westen
Refining the Measurement of Axis II: A Q-Sort Procedure for Assessing Personality Pathology
Assessment,
December 1, 1998;
5(4):
333 - 353.
[Abstract]
|
|
|
|
|
|
|
D. Westen and L. Arkowitz-Westen
Limitations of Axis II in Diagnosing Personality Pathology in Clinical Practice
Am J Psychiatry,
December 1, 1998;
155(12):
1767 - 1771.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
M. J. HOROWITZ
Sex-related differences in depressed alcoholics.
Am J Psychiatry,
October 1, 1998;
155(10):
1464 - 1465.
[Full Text]
|
|
|
|
|
|
|
T. Ferro, D. N. Klein, J. E. Schwartz, K. L. Kasch, and J. B. Leader
30-Month Stability of Personality Disorder Diagnoses in Depressed Outpatients
Am J Psychiatry,
May 1, 1998;
155(5):
653 - 659.
[Abstract]
[Full Text]
|
|
|
Get information about faster international access.
Privacy Policy
Copyright © 1997
American Psychiatric Association.
All rights reserved.
Home
| Search
| Current Issue
| Past Issues
| Subscribe
| All APPI Journals
| Help
| Contact Us
|
