Personality Assessment in the Diagnostic Manuals: On Mindfulness, Multiple Methods, and Test Score Discontinuities

Abstract

Recent controversies have illuminated the strengths and limitations of different frameworks for conceptualizing personality pathology (e.g., trait perspectives, categorical models), and stimulated debate regarding how best to diagnose personality disorders (PDs) in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.), and in other diagnostic systems (i.e., the International Classification of Diseases, the Psychodynamic Diagnostic Manual). In this article I argue that regardless of how PDs are conceptualized and which diagnostic system is employed, multimethod assessment must play a central role in PD diagnosis. By complementing self-reports with evidence from other domains (e.g., performance-based tests), a broader range of psychological processes are engaged in the patient, and the impact of self-perception and self-presentation biases can be better understood. By providing the assessor with evidence drawn from multiple modalities, some of which provide converging patterns and some of which yield divergent results, a multimethod assessment compels the assessor to engage this evidence more deeply. The mindful processing that ensues can help minimize the deleterious impact of naturally occurring information processing bias and distortion on the part of the clinician (e.g., heuristics, attribution errors), bringing greater clarity to the synthesis and integration of assessment data.

Notes

¹ One might argue that PD screening questionnaires and diagnostic interviews are in fact assessment tools—and technically they might be—but there is an important distinction to be made between the structure of an instrument and the goals of that instrument. Structurally PD questionnaires and interviews do indeed resemble other psychological assessment tools (Rogers, 2003), and must meet acceptable criteria for retest reliability, and convergent and discriminant validity (Widiger & Samuel, 2005). Despite these similarities, these two types of instruments differ with respect to their central purpose: PD questionnaires and interviews are designed to quantify symptoms and syndromes, whereas assessment tools like the Rorschach Inkblot Method (Rorschach, 1921/1942) and Minnesota Multiphasic Personality Inventory–2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) are designed to tap implicit and self-attributed needs, motives, attitudes, beliefs, and affect states.

² This is not meant to imply that self-reports are unaffected by processes outside awareness. On the contrary, research has demonstrated that self-reports are influenced by implicit affective responses, unintended priming effects, and other subtle factors that are, for the most part, beyond the respondent's conscious control (see Huprich et al., 2011). With this in mind, however, it is clear that self-reports are more strongly influenced than performance-based tests by conscious, controlled processes, and that performance-based test responses are more strongly influenced by processes that are less accessible to awareness and deliberate, conscious control.