Clinical Diagnosis and SCID-II Assessment of DSM-III-R Personality Disorders

Abstract

Aim: To assess the diagnostic concordance of SCID-II and clinicians' estimation of DSM-III-R personality disorders of substance abusers. Method: Clinical diagnoses of substance abusers in inpatient treatment were compared with SCID-II diagnoses (N = 138). Findings: The overall prevalence of personality disorder was 79% for clinical diagnosis and 80% for SCID-II diagnosis. Substantial agreement was found for borderline personality disorder, and moderate agreement was found for presence of any personality disorder, and antisocial personality disorder. All other disorders had slight to fair agreement. Antisocial personality disorder was overdiagnosed by clinical diagnosis but schizotypal, obsessive-compulsive, passive-aggressive, and masochistic personality disorders were reported more often by SCID-II. Selecting only the primary clinical diagnosis and omitting additional clinical diagnoses, reduced agreement with SCID-II diagnoses. Implications: Clinical diagnosis and structured interviews are not interchangeable, and produce somewhat different profiles of diagnoses for a group of substance abusers, but the two methods for diagnosing personality disorders converge for the two most common personality disorders in substance abusers. Rare and less-known diagnoses tend to be underreported whereas common and well-known disorders tend to be slightly overdiagnosed by clinical diagnosis as compared with a semistructured interview, especially if only one clinical diagnosis is noted.