Four methods of how to assess and diagnose personality disorders have received much attention within the literature: the Shedler-Westen Assessment Procedure (Shedler & Westen, 1998), the DSM-5 Section III Personality Disorders section (APA, 2011), the DSM-5 Section III trait model (APA, 2013), and the Psychodynamic Diagnostic Manual (PDM; PDM Task Force, 2006) descriptions of 15 personality disorders. Given that much of the debate has been driven by clinician concerns, it is important to consider clinical utility when evaluating the usefulness of each method. The present study compares the 4 models on ratings of several dimensions of clinical utility provided by 329 graduate student clinicians and psychology interns from across the United States. Findings suggest that participants rated the DSM-5 trait model significantly higher in most clinical utility domains. Additionally, qualitative analyses of the open-ended responses provided by participants indicated that each method had strengths and weaknesses. Most notably, participants commented positively on the PDM's level of comprehensiveness and appreciated the SWAP-II's inclusion of a health category, despite the ease of use not being as highly rated for these methods. (PsycINFO Database Record

Many studies have determined that the traits of emotional dysregulation, negative affect, and impulsivity are the strongest predictors of borderline personality disorder (BPD). Although psychodynamic, empirically supported BPD treatments (i.e., transference-focused, mentalization based) focus upon changing the internal representations of self and other, no studies have simultaneously evaluated the contribution of object relations in relation to these traits in predicting BPD symptoms. This study sought to determine the combined effects of emotional dysregulation, negative affect, impulsivity, and object relations in the prediction of BPD through the use of mediation modeling in 4 a priori hypothesized relationships among these variables. One hundred sixty-nine psychiatric outpatients and 171 undergraduate students were evaluated with self-reported trait and object relations measures and were administered 2 semistructured diagnostic interviews for BPD. Although all trait and object relations measures were correlated with BPD symptoms, the best fitting model was one in which object relations partially mediated the relationship of negative affect and impulsivity with BPD symptoms. Direct effects of the traits were also observed in mediation. Self-reported object relational quality had more of an effect on the prediction of BPD than previously recognized within a trait-framework, thus further supporting the model explicated in psychodynamic and relationally based treatments for BPD. (PsycINFO Database Record

The role of theoretical orientation in determining preference for different methods of diagnosis has been largely unexplored. The goal of the present study was to explore ratings of the usefulness of 4 diagnostic methods after applying them to a patient: prototype ratings derived from the SWAP-II, the DSM-5 Section III specific personality disorders, the DSM-5 Section III trait model, and prototype ratings derived from the Psychodynamic Diagnostic Manual (PDM). Three hundred and twenty-nine trainees in APA-accredited doctoral programs and internships rated one of their current patients with each of the 4 diagnostic methods. Individuals who classified their theoretical orientation as “cognitive- behavioral” displayed a significantly greater preference for the proposed DSM-5 personality disorder prototypes when compared to individuals who classified their orientation as “psychodynamic/psychoanalytic,” while individuals who considered themselves psychodynamic or psychoanalytic rated the PDM as significantly more useful than those who considered themselves cognitive-behavioral. Individuals who classified their graduate program as a PsyD program were also more likely to rate the DSM-5 Section III and PDM models as more useful diagnostic methods than individuals who classified their graduate program as a PhD program. Implications and future directions will be discussed.

One-hundred sixty-nine psychiatric outpatients and 171 undergraduate students were assessed with the Personality Disorder Interview-IV (PDI-IV; Widiger, Mangine, Corbitt, Ellis, & Thomas, 1995) and the Structured Clinical Interview for DSM-IV Axis II disorders (SCID-II; First, Gibbon, Spitzer, Williams, & Benjamin, 1997) for borderline personality disorder (BPD). Eighty individuals met PDI-IV BPD criteria, whereas 34 met SCID-II BPD criteria. Dimensional ratings of both measures were highly intercorrelated (rs = .78, .75), and item-level interrater reliability fell in the good to excellent range. An item-response theory analysis was performed to investigate whether properties of the items from each interview could help understand these differences. The limited agreement seemed to be explained by differences in the response options across the two interviews. We found that suicidal behavior was among the most discriminating criteria on both instruments, whereas dissociation and difficulty controlling anger had the 2 lowest alpha parameter values. Finally, those meeting BPD criteria on both interviews had higher levels of anxiety, depression, and more impairments in object relations than those meeting criteria on just the PDI-IV. These findings suggest that the choice of measure has a notable effect on the obtained diagnostic prevalence and the level of BPD severity that is detected.

Gender bias in the diagnosis and assessment of borderline personality disorder (BPD) has been the subject of much controversy in the psychological research literature. Evidence regarding differential prevalence rates and diagnostic rates in clinical settings between genders has been mixed, and measurement bias is one potential explanation for these mixed findings. A total of 340 participants were recruited from a Midwestern university and four outpatient community mental health clinics. They were administered two structured clinical interviews for BPD that were then evaluated for measurement invariance. Both the SCID-II BPD scale and the PDI-IV BPD scale were found to be measurement invariant between genders. No significant differences were found on the SCID-II BPD scale in diagnosis or overall number of criteria endorsed. However, in the rates of endorsement of individual criteria, differences were found in the unstable relationships item.