Prototype Personality Diagnosis in Clinical Practice: A Viable Alternative for DSM-V and ICD-11

• Type of Material: Article
• Authors: Drew Westen, Emory University; Jared DeFife, Emory University; Bekh Bradley-Davino, Emory University; Mark J. Hilsenroth, Adelphi University
• Language: English
• Date: 2010-12
• Publisher: American Psychological Association
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2010, American Psychological Association
• Title of Journal or Parent Work: Professional Psychology: Research And Practice
• ISSN: 0735-7028
• Volume: 41
• Issue: 6
• Start Page: 482
• End Page: 487
• Grant/Funding Information: Preparation of this article was supported in part by NIMH grants MH62377, MH62378, and MH078100.
• Keywords: ICD-11; personality disorders; DSM-V; prototype reliability; Prototype diagnosis
• Research Categories: Psychology, Clinical

Abstract

Several studies suggest that a prototype matching approach yields diagnoses of comparable validity to the more complex diagnostic algorithms outlined in DSM-IV. Furthermore, clinicians prefer prototype diagnosis of personality disorders (PDs) to the current categorical diagnostic system or alternative dimensional methods. An important extension of this work is to investigate the degree to which clinicians are able to make prototype diagnoses reliably. The aim of this study is to assess the inter-rater reliability of a prototype matching approach to personality diagnosis in clinical practice. Using prototypes derived empirically in prior research, outpatient clinicians diagnosed patients’ personality after an initial evaluation period. External evaluators independently diagnosed the same patients after watching videotapes of the same clinical hours. Inter-rater reliability for prototype diagnosis was high, with a median r = .72. Cross-correlations between disorders were low, with a median r = .01. Clinicians and clinically trained independent observers can assess complex personality constellations with high reliability using a simple prototype matching procedure, even with prototypes that are relatively unfamiliar to them. In light of its demonstrated reliability, efficiency, and versatility, prototype diagnosis appears to be a viable system for DSM-V and ICD-11 with exceptional utility for research and clinical practice.