Interview with Informants

As an adjunct to interviews with the patient, collateral interviews with people who know the patient well may be enlightening. Informants may be spouses, children, other family members, health care providers, or professionals from the patient's living setting (e.g., assisted living or nursing home staff). Individuals who have regular contact with the patient can offer a unique perspective because they see the patient in varied social contexts and, in some cases, they may have known the patient for many years and can speak about lifelong patterns of behavior, the longitudinal course of the disorder, and degree of social impairment in the patient. Thus, informants can provide valuable diagnostic data (especially longitudinal observations) that can help resolve the state/trait distinction about specific criterion behaviors. Often, it is advisable to interview the patient and the close informant conjointly. Rather than hearing about troublesome interactions from the patient or the informant, the clinician can directly observe the interactional patterns in the consulting room, and this can be enlightening. As an example, in an individual interview, one of our older male patients came across as aggressive and angry. During a conjoint interview with his wife, however, the patient appeared more docile and timorous and was deferential to his wife during the meeting. Because personality disorder symptoms can ebb and flow over time and can be amplified or dampened when certain people are around (e.g., the patient's spouse or children; Mroczek, Hurt, & Berman, 1999), assessment of the patient in multiple contexts and across different occasions is necessary.

Another advantage of collateral interviews is that patients with personality disorders tend to lack insight into their own maladaptive personality traits (Paris, 2003) and distort facts about their strengths and limitations. Personality-disordered patients are typically unaware of having a mental illness, whereas significant others are often acutely aware of the patient's problems. It is common that the patient's self-report of the problem may not match the report from others, and as such, clinicians must evaluate all sources of data to make their own judgments. A final advantage to interviewing significant others is that the patient's level of social support can be evaluated and, if appropriate, significant others may be involved in the treatment process.

In cases where it is unclear from the clinical and/or collateral interview if the patient has significant features of a personality disorder, or in cases where it is probable that the patient has significant personality dysfunction but it is not clear which specific personality disorder might be present, further assessment using standardized measures is advisable.

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