The Convergence of Personality Disorder Diagnoses across Different Methods among Monolingual (Spanish-speaking-only) Hispanic Patients in Substance Use Treatment

摘要

Methods for diagnosing personality disorders (PDs) within clinical settings typically diverge from those employed in treatment research. Treatment groups in research studies are routinely diagnosed using semi-structured 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 four independent methods of PD diagnosis, including self-report questionnaire, semi-structured interview, chart diagnoses, and ratings by treating clinicians, within a clinical series of 130 monolingual (Spanish-only) Hispanics (69% male; mean age 37.4), in treatment for substance use. We examined the convergence of the 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 semi-structured 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 Hispanics are comparable to other groups allaying concerns about cross cultural application of PD diagnoses. Additionally, our results echo previous research in suggesting that clinicians’ PD diagnoses overlap little with self-report questionnaires or semi-structured diagnostic interviews and suggest that PDs are under-diagnosed using standard diagnostic approaches. Implications for the clinical application of empirically supported research are discussed.