DIVERGENCES BETWEEN CLINICAL AND RESEARCH METHODS FOR ASSESSING PERSONALITY-DISORDERS - IMPLICATIONS FOR RESEARCH AND THE EVOLUTION OF AXIS-II

Objective: The purpose of this study was to examine the extent to whic h instruments for assessing axis II diverge from clinical diagnostic p rocesses. Method: Subjects in the first study were 52 clinicians with experience in assessment and treatment of patients with personality di sorders, who were surveyed about the methods they use in clinical prac tice to make diagnoses and other aspects of the diagnostic process. A second study replicated the major findings with a random national samp le of 1,901 experienced psychiatrists and psychologists. Results: Wher eas current instruments rely primarily on direct questions derived fro m DSM-IV, clinicians of every theoretical persuasion found direct ques tions useful for assessing axis I disorders but only marginally so for axis II. They made axis II diagnoses, instead by listening to patient s describe interpersonal interactions and observing their behavior wit h the interviewer. In contrast to findings with current research instr uments, most patients with personality disorders in clinical practice receive only one axis II diagnosis, and if they receive more than one, one is considered primary. Clinicians reported treating a substantial number of patients for enduring personality patterns that current axi s II instruments do not assess, many of which meet neither axis I nor axis II criteria, notably problems with relatedness, work, self-esteem , and chronic subclinical depressive traits. Conclusions: Measures of axis II were constructed by using a model derived from axis I instrume nts that diverges from clinical diagnostic procedures in a way that ma y be problematic for the assessment of personality disorders and the d evelopment of a more clinically and empirically sound taxonomy.