New research reveals that when using the same evaluative tools, a professional’s diagnosis of a personality disorder and an individual’s self-evaluation may be relatively similar. In fact, individuals may report more personality disorder pathology than was noted by their therapists. The study suggests concerns about invalid self-reports due to under-reporting have been overstated.

Purdue University researchers believe the findings should lessen concerns that people lack awareness of their own personality pathology. The research findings appear in the Journal of Consulting and Clinical Psychology.

Previous research suggested that clients lack awareness of their own personality pathology due to a perceived gap in agreement of the evaluation of a clinician and the patient’s own self-diagnosis.

However, the new research finds that when using the same evaluation tool set, that gap of agreement significantly decreased, and previous concerns might have been overstated.

“Research settings typically utilize diagnostic procedures that differ considerably from methods used in clinical practice,” said Dr. Douglas Samuel, associate professor of psychological sciences and lead author on the paper.

“As a result, little is known about the reliability and validity of the diagnoses assigned in routine clinical practice.”

For the study, researchers collected dimensional trait ratings from 54 therapist-client dyads within outpatient clinics. Patients provided ratings of dimensional personality disorder traits via the Personality Inventory for DSM-5, an assessment scale created by the American Psychiatric Association.

The assessment is designed to provide a broad indication of problematic personality traits, focusing on five personality trait domains, including negative affect, detachment, antagonism, disinhibition and psychoticism.

Therapists also completed the informant version of the same assessment.

“In contrast with concerns about under-reporting of personality disorder pathology, clients reported a greater pathology than their therapists on almost all traits,” Samuel said.

“These findings alleviate concerns about the validity of self-reports, but also raise questions about how and why clients (and clinicians) provide ratings. Ultimately, more work is necessary to understand how source and methods can be best integrated to arrive at the most effective personality disorders diagnoses.”

Graduate students Takakuni Suzuki, Meredith Bucher and Sarah Griffin are co-authors of the paper.

Researchers explain that although treating clinicians provide the majority of mental health diagnoses, little is known about the validity of their routine diagnoses — including the agreement with clients’ self- reports.

This is particularly notable for personality disorders (PDs) as the literature suggests weak agreement between therapists and clients. Existing research has been limited by a focus on PD categories and brief therapist-report measures.

Moreover, although self-reports of PD have been criticized for under-reporting, very few data have compared them to therapist-report in terms of mean-level.

To evaluate the limitations, researchers collected dimensional trait ratings from 54 therapist-client dyads within outpatient clinics. The clients (52 percent women, 94 percent Caucasian, 39.8 years) provided ratings of dimensional PD traits via the Personality Inventory for DSM-5 (PID-5). Likewise, therapists (72 percent female, 89 percent Caucasian) completed the Informant version of the same measure.

The results show that when employing similar evaluative measures of traits, the results were closer than observed in prior studies. In fact, mean-level comparisons indicated that individuals (clients) reported significantly higher levels of PD pathology than did their therapists.

This effect was most notable for the domain of psychoticism. From these findings, researchers conclude that when using similar evaluative tools, individuals and therapists were in much more agreement over a diagnosis than has been reported in prior studies.

Source: Purdue University