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PERSONALITY DISORDERS DIAGNOSIS |
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Diagnosis of personality disorders is
complicated by the fact that persons suffering from them rarely seek
help until they are in serious trouble or until their families (or
the law) pressure them to get treatment. The reason for this
slowness is that the problematic traits are so deeply entrenched
that they seem normal (ego-syntonic) to the patient. Diagnosis of a
personality disorder depends in part on the patient's age. Although
personality disorders originate during the childhood years, they are
considered adult disorders. Some patients, in fact, are not
diagnosed until late in life because their symptoms had been
modified by the demands of their job or by marriage. After
retirement or the spouse's death, however, these patients'
personality disorders become fully apparent. In general, however, if
the onset of the patient's problem is in mid- or late-life, the
doctor will rule out substance abuse or personality change caused by
medical or neurological problems before considering the diagnosis of
a personality disorder. It is unusual for people to develop
personality disorders "out of the blue" in mid-life. There are no tests that can provide a definitive diagnosis of personality disorder. Most doctors will evaluate a patient on the basis of several sources of information collected over a period of time in order to determine how long the patient has been having difficulties, how many areas of life are affected, and how severe the dysfunction is. These sources of information may include: Interviews The doctor may schedule two or three interviews with the patient, spaced over several weeks or months, in order to rule out an adjustment disorder caused by job loss, bereavement, or a similar problem. An office interview allows the doctor to form an impression of the patient's overall personality as well as obtaining information about his or her occupation and family. During the interview, the doctor will note the patient's appearance, tone of voice, body language, eye contact, and other important non-verbal signals, as well as the content of the conversation. In some cases, the doctor may contact other people (family members, employers, close friends) who know the patient well in order to assess the accuracy of the patient's perception of his or her difficulties. It is quite common for people with personality disorders to have distorted views of their situations, or to be unaware of the impact of their behavior on others. Psychologic testing Doctors use psychologic testing to help in the diagnosis of a personality disorder. Most of these tests require interpretation by a professional with specialized training. Doctors usually refer patients to a clinical psychologist for this type of test. Personality inventories Personality inventories are tests with true/false or yes/no answers that can be used to compare the patient's scores with those of people with known personality distortions. The single most commonly used test of this type is the Minnesota Multiphasic Personality Inventory, or MMPI. Another test that is often used is the Millon Clinical Multiaxial Inventory, or MCMI. Projective tests Projective tests are unstructured. Unstructured means that instead of giving one-word answers to questions, the patient is asked to talk at some length about a picture that the psychologist has shown him or her, or to supply an ending for the beginning of a story. Projective tests allow the clinician to assess the patient's patterns of thinking, fantasies, worries or anxieties, moral concerns, values, and habits. Common projective tests include the Rorschach, in which the patient responds to a set of ten inkblots; and the Thematic Apperception Test (TAT), in which the patient is shown drawings of people in different situations and then tells a story about the picture. |
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| PERSONALITY DISORDERS RELATED ITEMS | ||
