Controversy in Personality Disorder Assessment

1. Controversy in Personality Disorder Assessment As evidenced by Borderline Personality Disorder

2. What is a Personality Disorder? • Definition of a PD from DSM description

3. How are Personality Disorders Measured? • FFM (Widiger and Lowe article) • MMPI • DSM (Give specific Criteria) • Rorschach • Which is the most effective way to assess personality and personality disorder?

4. Personality Disorder Controversy • Just as with any DSM diagnosis, there is much controversy over Personality Disorders and the ways in which they are understood, assessed, and treated.

5. Problems in Personality Disorder Assessment • Many assessment measures rely on self-report, which can prove problematic. (Huprich and Ganellen) • Terminology is that of abstract constructs, and the patient may not understand the terms, or may not understand them in the same way the clinician does • All patients may intentionally or unconsciously misrepresent themselves in self-reports, but this is especially problematic when working with Personality disordered individuals who may not have an accurate self-concept, and may not think their personality is disordered

6. Problems in Personality Disorder Assessment • Similarly, reports from others connected to the patient may not be trustworthy, either. • Agreement problems between informants • Understanding of concepts and terminology • Reporter’s own personality pathology might interfere

7. Categorical vs. Dimensional Approach to Understanding • Huprich and Bornstein • Widiger and Lowe define the types of disorders for which DSM style categorical approach works best, and how PDs don’t fit into this model. • Bernstein ‘07 looks ahead to PDs in the DSM-V • 74% of PD experts prefer a categorical approach

8. Methodological Issues • Problems with patient vs. non-patient samples (Huprich and Bornstein ‘07) • Most measures look at behavior not at the underlying psychological constructs, which can each get at different presentations of a disorder (Shedler&Westen) • Most do not take clinical expertise into account (Shedler & Westen)

9. Treatment • Treatment of personality disorder can vary greatly depending on the theoretical orientation used

10. Stability • Of diagnoses over time • This is one that we didn’t have outlined on the blackboard, but is it worth looking at?

11. Borderline Personality Disorder • General features of BLPD

12. Assessment of Borderline Personality Disorder • Self and other reports likely to be flawed because how can we be sure that client/informer and clinician agree on what is “extreme,” etc. • Self-concept is flawed with BLPD • Problems in assessing suicidality as imminent as it may be with BLPD

13. BLPD as dimensional, not categorical • Taxometric analysis shows that BLPD is better conceptualized as a continuous entity, not a latent category. • Bernstein ‘07 says that experts on PD want to do away with the term “Borderline” in the DSM-V • Only 31% want to see it kept

14. Gender and Ethical Bias • Delphin article

15. How to effectively treat • DBT and CBT from a CB perspective • What treatment from a developmental/attachment, or analytic perspective? • Medication from a biological perspective