title: The convergence of personality disorder diagnoses across different methods among monolingual (Spanish-speaking only) Hispanic patients in substance use treatment.
abstract: Methods for diagnosing personality disorders (PDs) within clinical settings typically diverge from those used in treatment research. Treatment groups in research studies are routinely diagnosed using semistructured interviews or self-report questionnaires, yet these methods show poor agreement with clinical diagnoses recorded in medical charts or assigned by treating clinicians, reducing the potential for evidence-based practice. Furthermore, existing research has been limited by focusing on primarily White and English-speaking participants. Our study extended prior research by comparing 4 independent methods of PD diagnosis, including self-report questionnaire, semistructured interview, chart diagnoses, and ratings by treating clinicians, within a clinical series of 130 monolingual (Spanish only) Hispanic persons (69% male; M age 37.4), in treatment for substance use. The authors examined the convergence of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) PD diagnoses across these methods. PD diagnoses appeared infrequently within medical charts but were diagnosed at higher levels by independent treating clinicians, self-report questionnaires, and semistructured interviews. Nonetheless, diagnostic concordance between clinical diagnoses and the other methods were poor (κ < .20). Convergence of PD diagnoses across diagnostic methods for Spanish-speaking Hispanic persons are comparable to other groups allaying concerns about cross-cultural application of PD diagnoses. Additionally, the results of this study echo previous research in suggesting that clinicians' PD diagnoses overlap little with self-report questionnaires or semistructured diagnostic interviews and suggest that PDs are underdiagnosed using standard diagnostic approaches. Implications for the clinical application of empirically supported research are discussed.
authors.affiliation: Department of Psychological Sciences.
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Samuel
authors.affiliation: Department of Psychiatry, Yale School of Medicine.
authors.forename: Luis M
authors.initials: LM
authors.lastname: Añez
authors.affiliation: Department of Psychiatry, Yale School of Medicine.
authors.forename: Manuel
authors.initials: M
authors.lastname: Paris
authors.affiliation: Department of Psychiatry, Yale School of Medicine.
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Grilo
mesh_terms: D000328:Adult; D003144:Communication Barriers; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D007406:Interview, Psychological / Q000592:standards*; D008297:Male; D008875:Middle Aged; D010554:Personality Disorders / Q000150:complications / Q000175:diagnosis*; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D011581:Psychological Tests / Q000592:standards*; D015203:Reproducibility of Results; D019966:Substance-Related Disorders / Q000150:complications / Q000534:rehabilitation; D011795:Surveys and Questionnaires / Q000592:standards*