Assessing Axis II Disorders by Informant Interview

Abstract

Although much of personality disorder research depends on diagnostic data obtained directly from patients, this approach has rarely been compared to interviews with knowledgeable informants. The purpose of this study was to determine the diagnostic agreement between these two assessment methods, as well as their relative contribution to the formulation of consensus diagnoses. Sixty-two psychiatric patients were assessed directly with the Structured Interview for DSM-III Personality Disorders (SIDP), and were asked to nominate an informant--either a family member or friend--to provide information about the patient in an interview with the same instrument. Informant interviews were conducted blind to patient-based information whenever feasible, and diagnostic consensus was achieved by an independent review of all available data by a senior clinician. Diagnostic agreement between patient-based and informant-based personality disorder interview was poor, confirming the findings of two previous studies. Information obtained from patients tended to be given greater weight in formulating consensus diagnoses than information provided by informants. However, about one quarter of diagnostic disagreements were resolved in favor of informant-based information. In contrast to a previous study, the inclusion of informant information did not appear to reveal greater psychopathology in patients. We conclude that supplementing direct patient interview with data provided by a knowledgeable informant appears to enhance the resolution of some personality disorder diagnoses. The utility of informant interviews may depend on an analysis of the costs and benefits of this additional degree of descriptive refinement.

The development of the childhood retrospective perfectionism questionnaire (CHIRP) in an eating disorder sample

“…The inter-rater reliability based upon the presence/absence of each individual trait was smaller than the agreement found when utilising the dimensional score. These findings are typical (Kraemer, Noda, & O'Hara, 2004), being found in previous literature investigating self-informant concordance regarding the presence of personality traits and disorders (Bernstein et al, 1997;Riso, Klein, Anderson, Ouimette, & Lizardi, 1994). Overall, the inter-rater concordance reflects an absence of self-presentation biases in the ED participants, defending the reliability of self-report data with this clinical group.…”

The Prevalence of DSM-IV Personality Disorders in Psychiatric Outpatients

“…Several studies have found poor levels of agreement between patients and informants in diagnosing personality disorders (34)(35)(36)(37). Adding information from an informant interview to the information already ascertained from patients nearly doubles the prevalence of personality disorders (38).…”

Comparison of Assessment of Personality Disorder by Patients and Informants

“…In spite of this disadvantage, self-report questionnaires represent the only method that can be routinely used [4]; their costs are low, they are free from systematic biases of interviewers, and the patient may be the best source of information on long-standing characteristics of his or her personality [5]. On the other hand, validity of patients' self-reports regarding their own personality has been questioned; it can be influenced by the patient's mood state, by his or her willingness or ability to divulge personal information and by the patient's tendency to give socially desirable responses [6]. Also, patients may not be fully aware of their effects on others, and they may have difficulties in distinguishing premorbid personality traits from current symptoms [7].…”