Critical developments in the assessment of personality disorder

Abstract

BackgroundThe assessment of personality disorder is currently inaccurate, largely unreliable, frequently wrong and in need of improvement.AimsTo describe the errors inherent in the current systems and to indicate recent ways of improving personality assessment.MethodHistorical review, description of recent developments, including temporal stability, and of studies using document-derived assessment.ResultsStudies of interrater agreement and accuracy of diagnosis in complex patients with independently established personality status using document-derived assessment (PAS–DOC) with a four personality cluster classification, showed very good agreement between raters for the flamboyant cluster B group of personalities, generally good agreement for the anxious/dependent cluster C group and inhibited (obsessional) cluster D group, but only fair agreement for the withdrawn cluster A group. Overall diagnostic accuracy was 71%.ConclusionsPersonality function or diathesis, a fluctuating state, is a better description than personality disorder. The best form of assessment is one that uses longitudinal repeated measures using a four-dimensional system.