Classification, Assessment, and Differential Diagnosis of Personality Disorders

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Abstract
This is the first in a special series of articles on personality disorders (PDs) that will cover assessment and diagnosis, psychotherapeutic and psychopharmacologic treatments, and stability and course. In this article, the author focuses on classification, assessment, and diagnosis. He first reviews how the system used to classify PDs has evolved from DSM-I to DSM-IV and discusses the development of definitional criteria for PDs and the change from a monothetic to a polythetic approach to defining these disorders. The dimensional approach to defining personality disorders is then covered in detail, with discussions of the major dimensional models that have been proposed (e.g., three-factor model, five-factor model, circumplex model). The author then turns to techniques for assessing personality disorder and gives practical clinical guidance on how to assess a person's personality functioning (i.e., whom to interview, what to ask, special problems in the assessment of specific personality disorders). The author discusses how to distinguish personality traits from personality disorders, how to determine if the personality characteristics represent an enduring pattern, how to assess the relationship between PDs and Axis I disorders, how to evaluate comorbidity in patients with PDs, and special issues in the differential diagnosis of selected PDs. The article concludes with a discussion of how to use Axis II to record diagnostic information in the most clinically useful way.

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