What is Involved in a Personality Disorder Assessment?

Personality disorders are psychiatric conditions characterized by lifelong impairment in everyday situations due to maladaptive personality traits or structures. Unlike other types of mental illnesses, personality disorders are lifelong conditions rather than episodic impairments. Personality disorder assessment involves a thorough psychiatric history, interaction with a health care professional and, in some cases, psychological testing.

The Diagnostic and Statistical Manual (DSM-IV) is the book of guidelines mental health professionals use to diagnose mental disorders. It specifies the necessary criteria for each type of personality disorder. This criteria must be met during a personality disorder assessment in order to diagnose a person with a personality disorder.

The DSM-IV specifies that different types of mental illnesses are listed on different “axes.” Axis I is reserved for mental illnesses such as bipolar disorder, depression, or schizophrenia. Axis II is used to indicate pervasive mental disorders that have been present for a long time. Personality disorders, as well as mental retardation, are specified under Axis II.

A personality disorder assessment is very difficult because personality disorders must affect a person throughout his or her lifetime and in different situations. An extensive psychiatric history, taking into account traumatic events and everyday social functioning over a lifetime and across different situations, is necessary. Psychosocial functioning can vary widely among different individuals with personality disorders.

Co-morbidity also complicates a personality disorder assessment. Often a person with a personality disorder will also suffer from another mental illness. Some of the most common co-morbidities include substance abuse and depression.

There are several different types of personality disorders, and they are divided into clusters of similar disorders. Cluster A includes the “strange” personality disorders, disorders that are characterized by odd behavior and mannerisms. These disorders include paranoid, schizoid, and schizotypal personality disorders.

Cluster B includes personality disorders that interfere with impulse control and social functioning, such as antisocial personality disorder or borderline personality disorder. Cluster C includes personality disorders that involve excessive dependence on certain people or rituals, such as avoidant, dependent, or obsessive-compulsive personality disorder. A personality disorder assessment must specify which personality disorder is present.

A personality disorder assessment is the first step toward treatment. Psychotherapy is often the most effective and widely used treatment for personality disorders. Cognitive behavioral psychotherapy can help a person change his unhealthy thinking and adopt healthy behaviors. Interpersonal psychotherapy can build social skills and improve everyday functioning. Co-morbid disorders such as depression or substance abuse may be treated with medication or therapy.