Semi Structured Clinical Interviews

Over the past 3 decades, numerous structured and semi-structured diagnostic interviews have been created to assist with the differential diagnosis of all standard Axis II personality disorders and all major Axis I clinical syndromes. During such an interview, diagnostic criteria are comprehensively assessed through a consistently applied set of questions and responses that are coded in a replicable fashion. Structured and semi-structured interviews have become widely used in clinical, research, and training applications often serving as the gold standard for diagnosis in these settings. These interviews are an important development in the mental health field because, when used appropriately, they provide a standardized, scientific, systematic, comprehensive, and quantitative approach to the evaluation of mental disorders (Segal, Coolidge, O'Riley, & Heinz, 2006). This has served to enhance diagnostic reliability and validity, especially for the personality disorders (Segal et al., 2006).

The major interviews that focus on a wide range of personality disorders include the Structured Interview for DSM-IV Personality, the International Personality Disorder Examination, the Structured Clinical Interview for DSM-IV Axis II Personality Disorders, the Personality Disorder Inventory-IV, and the Diagnostic Interview for DSM-IV Personality Disorders. These measures are all closely aligned with the DSM-IV system and have a semi-structured format, which means that although the initial questions for each personality disorder criteria are specified and asked verbatim to the respondent, the clinician has substantial latitude to follow up on responses. For example, the interviewer may modify existing questions and even devise new questions to more accurately rate the diagnostic criteria. Due to the semi-structured format of these interviews (in contrast to a fully structured format), clinical experience and knowledge of psychopathology are required for competent administration; lay professionals cannot administer them (for further information about diverse structured interview approaches, the interested reader is referred to a comprehensive text by Rogers, 2001).

Next, we describe each Axis II instrument and conclude with some thoughts about their application with older adults. Personality disorders covered by the current version of each instrument are presented in Table 9.2.

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