Structured Interview for Dsmiv Personality

The Structured Interview for DSM-IV Personality (SIDP-IV; Pfohl, Blum, & Zimmerman, 1997) covers 14 DSM-IV Axis II diagnoses, including the 10 standard personality disorders, Mixed Personality Disorder, as well as Self-Defeating, Depressive, and Negativistic Personality Disorders. Pfohl et al. (1997) recommend that prior to administering the SIDP-IV, a full evaluation of episodic clinical disorders is required. Interestingly, the SIDP-IV does not cover personality problems on a disorder-by-disorder basis. Rather, DSM-IV personality disorder criteria are reflected in items that are grouped according to 10 "topical sections" that reflect a different dimension of personality functioning, and these include: interests and activities, work style, close relationships, social relationships, emotions, observational criteria, self-perception, perception of others, stress and anger, and social conformity (Pfohl et al., 1997). It should be noted that these categories are not scored or rated. Rather, they reflect broad areas of personal functioning under which personality disorder items can logically be subsumed.

For the most part, each SIDP-IV question corresponds to a unique DSM-IV Axis II criterion. An attractive feature of the instrument is that the specific DSM-IV criterion associated with each question is provided for interviewers to easily see and reference. All questions are typically administered to the patient and there are no skip-out options. Most questions are conversational in tone and open ended to encourage respondents to talk about their usual behaviors and long-term functioning. Respondents are specifically instructed to focus on their typical or habitual behavior when answering each question, and they are prompted to "remember what you are like when you are your usual self." Based on the responses, each criterion is rated on a scale with four anchor points. A rating of "0" indicates that the criterion was not present, "1" corresponds to a subthreshold level where there is some evidence of the trait but it is not sufficiently prominent, "2" refers to the criterion being present for most of the past 5 years, and "3" signifies a strongly present and debilitating level. The SIDP-IV requires that a trait be prominent for most of the last 5 years to be considered a part of the respondent's personality. This 5-year rule helps ensure that the particular personality characteristic is stable and of a long duration as required by the General Diagnostic Criteria for a Personality Disorder described in DSM-IV.

A strong point of the organizational format by personality dimensions (rather than by disorders) is that data for specific diagnoses are minimized until final ratings have been collated on the summary sheet. This feature can potentially reduce interviewer biases, such as the halo effect or changing thresholds, if it is obvious that a patient needs to meet one additional criteria to make the diagnosis. Chart records and collateral information from those who know the patient well (when available) can be considered in the ratings of items, and final ratings are made after all sources of information are considered. Ratings are then transcribed onto a summary sheet that lists each criterion organized by personality disorder, and formal diagnoses are assigned. As required by the DSM, diagnoses are made only if the minimum number of criteria (or threshold) has been met for that particular disorder.

Minimum qualifications for competent administration consist of an interviewer with an undergraduate degree in the social sciences and 6 months experience with diagnostic interviewing. Moreover, 1 additional month of specialized training and practice with the SIDP is required to become a competent interviewer (Pfohl et al., 1997). Administrators are required to possess an understanding of manifest psychopathology and the typical presentation and course of Axis I and II disorders. Training tapes and workshop information are available from the instrument authors. Overall, 60 to 90 minutes are needed for the patient interview, 20 minutes for interview of significant informants, and approximately 20 minutes to fill out the summary score sheet.

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