Comparison of Assessment of Personality Disorder by Patients and Informants

Abstract

The present study evaluated the pathology of personality disorder in a group of 8 nonpatient volunteers and 32 psychiatric in- and outpatients, most of them suffering from substance abuse disorder. The patient self-reports were compared with the reports by 2 informants for each proband. All probands and informants completed the Structured Interview for DSM-III-R Axis II Personality Questionnaire. Patient self-reports and informant reports yielded the same number of diagnoses. The diagnostic agreement between the three sets of data was generally poor; however, the concordance was slightly better between both groups of informants than between patients and informants: Median κ were 0.13 for patients versus parents, 0.14 for patients versus brothers/sisters and 0.29 for parents versus brothers/sisters. Patient and informant evaluations represent two different assessment approaches of the personality, and a complete agreement is not to be expected.

Associations between informant ratings of personality disorder traits, self‐reports of personality, and directly observed behavior

“…Therefore, depression levels do not point toward augmented Axis I pathology in our sample. Overall, the intraclass correlations (ICCs) of agreement among nominated informants were all relatively modest but in the statistically significant range (.21 up to .39) and similar to coefficients reported in clinical samples (Coolidge, Burns, & Mooney, ; Modestin & Puhan, ; Oltmanns & Strauss, ; see also Oltmanns & Turkheimer, ). Figure gives a detailed overview of agreement scores across MAPP subscales divided by gender.…”

“…A more accurate and reliable description of PD traits, therefore, might be obtained on the basis of multiple informant reports from acquaintances, friends, and family (Kaurin, Egloff, Stringaris, & Wessa, ; Klonsky, Oltmanns, & Turkheimer, ; Westen & Shedler, ). Second, people with PDs are often incapable of viewing themselves in realistic terms and are naïve to the consequences of their behavior for other people, which may be why informants report more PD traits than the targets themselves (e.g., Ferro & Klein, ; Mann et al, ; Modestin & Puhan, ; Peselow, Sanfilipo, & Fieve, ; Peselow, Sanfilipo, Fieve, & Gulbenkian, ; Zimmermann, Pfohl, Coryell, Stangl, & Corenthal, ).…”

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).…”

Psychological Autopsy Studies as Diagnostic Tools: Are They Methodologically Flawed?

“…However, the questions to be answered to assign such a diagnosis are even harder for others to answer reliably than the ones for Axis I diagnoses described above (e.g., Kelly & Mann, 1996). Besides, studies from other fields have shown low agreement between self- and informant reports on symptoms for personality disorders (e.g., Klonsky, Oltmanns, & Turheimer, 2002; Modestin & Puhan, 2000). Consequently, some authors have not assigned personality disorders in their PA study “because of the difficulty of assessing post mortem the severity, distress, and impairment due to the criteria traits” (Apter et al, 1993, p. 139).…”