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Tijdschrift voor Psychiatrie 42 (2000) 6, 409 - 422

Review article

Guidelines for clinical assessment of dsm-iv personality disorders

R. Verheul, W. van den Brink, Ph. Spinhoven, R. Haringsma

background In general, clinical diagnoses of personality disorders lack sufficient reliability and validity. There is currently no consensus about the most appropriate method for the clinical assessment of dsm-iv personality disorders.
aims Guidelines for the clinical assessment of dsm-iv personality disorders are proposed.
method This systematic review of procedures for diagnosing personality disorders is based upon three criteria: reliability, validity and feasibility. The existing assessment methods are evaluated against these three criteria and, subsequently, guidelines are developed by aiming at finding an optimal balance in the extent to which the criteria are met.
results The reliability of personality disorder assessment benefits substantially from strategies towards structuring the clinical interview as well as standardizing the scoring of the diagnostic criteria. A semi-structured interview schedule fits in optimally with these requirements. To improve validity it is recommended to have available biographical data, collateral information, and an adequate operationalization of both the general and specific diagnostic criteria of Axis ii. It is advocated to enhance the feasibility through generating hypotheses based upon self-report screening, clinical impressions and (if necessary) collateral information.
conclusions Reliable and valid assessment of dsm-iv personality disorders is a complex task that requires both sufficient knowledge of dsm-iv and intensive training in the administration of a semistructured interview schedule.

keywords diagnosis, guidelines, personality disorders