Formal Assessment of PD

The psychological community has several measures to assess for PDs; however, not all measures provide accurate information that can be therapeuti-cally relevant for the patient with co-occurring disorders. Beck, Freeman, Davis, and Associates (2004) suggest a number of measures.

The most practical assessment tools for therapists are self-report questionnaires, because they tend to capture more information about the patient. The Millon Clinical Multiaxial Inventory-III (MCMI-III; Millon, Millon, & Davis, 1994) and the Personality Diagnostic Questionnaire— Revised (PDQ-R; Hyler & Rieder, 1987) assess personality disorders as they relate to DSM-IV-TR. The Personality Belief Questionnaire (PBQ; Beck & Beck, 1991) and the Schema Questionnaire (SQ; Young & Brown, 1994) focus more on the cognitive aspects typically associated with patients with PDs.

Another category of assessment tools is the structured and non-structured clinical interviews. The following structured interviews have shown good reliability and validity, and continue to be widely used: Structured Clinical Interview for DSM-IV (SCID-II; First, Spitzer, Gibbon, & Williams, 1995), the Personality Disorder Examination—Revised (PDE-R; Loranger, Susman, Oldham, & Russakoff, 1987), and the Structured Interview for DSM-IV Personality Disorders (SIDP-R; Pfohl, Blum, Zimmerman, & Stangl, 1989).

The use of nonstructured interviews that are not prompted by a series of predetermined questions can be useful in assessing PDs. However, they require that the therapist have knowledge and expertise of not only DSM-IV-TR criteria but also DSM-IV-TR prevalence and comorbidity data (American Psychiatric Association, 2000). Clinical experience is a must for the therapist to derive enough of information from the subject to ascertain an accurate clinical picture of the patient to determine the presence of a PD (Beck et al., 2004). The interview must involve questions about the "pervasiveness, persistence, and level of impairment" of the problems, then finally questions about belief systems, thoughts, assumptions, and behaviors (Beck, Freeman, Davis, & Associates, 2004).

A useful screening tool is the Freeman Quick Score (FQS; 2006). This scale identifies the existence of a PD, but does not specify the disorder. The specific disorder is then screened with any of the previously mentioned scales for specificity.

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