Am J Psychiatry 161:1350-1365, August 2004
© 2004 American Psychiatric Association
Refining Personality Disorder Diagnosis: Integrating Science and Practice
Jonathan Shedler, Ph.D., and
Drew Westen, Ph.D.
OBJECTIVE: Personality disorder researchers are currently evaluating a range of potential solutions to problems with the DSM-IV diagnostic categories. This article proposes changes to the diagnostic categories and criteria based on empirical findings from a national sample of patients with personality disorder diagnoses. METHOD: The Shedler-Westen Assessment Procedure (SWAP-200) is a personality assessment tool designed to capture the richness and complexity of clinical personality descriptions while providing reliable and quantifiable data. A national sample of experienced psychiatrists and psychologists used the SWAP-200 to describe either their conceptions (prototypes) of personality disorders (N=267) or current patients with personality disorder diagnoses (N=530). RESULTS: Clinicians" conceptions of personality disorders and their descriptions of actual patients overlapped with the DSM descriptions but also differed in systematic ways. Their descriptions were clinically richer than the DSM descriptions and placed greater emphasis on patients" mental life or inner experience. The study identifies potential diagnostic criteria that may be more defining of personality syndromes than some of the current DSM criteria. CONCLUSIONS: Diagnostic criterion sets should be expanded to better address the multiple domains of functioning inherent in the concept of personality and should more explicitly address patients’ mental life or inner experience. The authors offer recommendations for revision of the diagnostic categories and criteria and also propose a prototype matching approach to personality disorder diagnosis that may overcome limitations inherent in the current diagnostic system.
This article has been cited by other articles:
|
|
|
|
 
B. M. Rottman, W.-k. Ahn, C. A. Sanislow, and N. S. Kim
Can Clinicians Recognize DSM-IV Personality Disorders From Five-Factor Model Descriptions of Patient Cases?
Am J Psychiatry,
April 1, 2009;
166(4):
427 - 433.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. D. Newman-Norlund, S. Ganesh, H. T. v. Schie, E. R. A. De Bruijn, and H. Bekkering
Self-identification and empathy modulate error-related brain activity during the observation of penalty shots between friend and foe
Soc Cogn Affect Neurosci,
March 1, 2009;
4(1):
10 - 22.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Russ, J. Shedler, R. Bradley, and D. Westen
Refining the Construct of Narcissistic Personality Disorder: Diagnostic Criteria and Subtypes
Am J Psychiatry,
November 1, 2008;
165(11):
1473 - 1481.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. G. Haskins and J. A. Silva
Asperger's Disorder and Criminal Behavior: Forensic-Psychiatric Considerations
J Am Acad Psychiatry Law,
September 1, 2006;
34(3):
374 - 384.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. T. Hauser
Studying Psychoanalysis: Asking and Answering the Hard Questions
J Am Psychoanal Assoc,
June 1, 2006;
54(2):
561 - 569.
[PDF]
|
|
|
|
|
|
|
S. J. Blatt, J. Corveleyn, and P. Luyten
Minding the Gap Between Positivism and Hermeneutics in Psychoanalytic Research
J Am Psychoanal Assoc,
June 1, 2006;
54(2):
571 - 610.
[Abstract]
[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]
|
|
|
|
|
|
|
B. Haskins and J. A. Silva
J Am Acad Psychiatry Law,
September 1, 2005;
33(3):
417 - 418.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. M. Oldham
Personality Disorders
Focus,
July 1, 2005;
3(3):
372 - 382.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Zittel Conklin and D. Westen
Borderline Personality Disorder in Clinical Practice
Am J Psychiatry,
May 1, 2005;
162(5):
867 - 875.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. M. PENA-ANDREU, A. FONTALBA, M. CARRERA, J. L. MARTINEZ, and M. I. RODRIGUEZ
Refining the Personality Disorder Diagnosis
Am J Psychiatry,
May 1, 2005;
162(5):
1030 - 1031.
[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]
|
|
|
Get information about faster international access.
Privacy Policy
Copyright © 2004
American Psychiatric Association.
All rights reserved.
Home
| Search
| Current Issue
| Past Issues
| Subscribe
| All APPI Journals
| Help
| Contact Us
|
