An empirically derived taxonomy for personality diagnosis: bridging science and practice in conceptualizing personality

Abstract

Objective: The authors describe a system for diagnosing personality pathology that is empirically derived, clinically relevant, and practical for day-to-day use.

Method: A random national sample of psychiatrists and clinical psychologists (N=1,201) described a randomly selected current patient with any degree of personality dysfunction (from minimal to severe) using the descriptors in the Shedler-Westen Assessment Procedure–II and completed additional research forms.

Results: The authors applied factor analysis to identify naturally occurring diagnostic groupings within the patient sample. The analysis yielded 10 clinically coherent personality diagnoses organized into three higher-order clusters: internalizing, externalizing, and borderline-dysregulated. The authors selected the most highly rated descriptors to construct a diagnostic prototype for each personality syndrome. In a second, independent sample, research interviewers and patients' treating clinicians were able to diagnose the personality syndromes with high agreement and minimal comorbidity among diagnoses.

Conclusions: The empirically derived personality prototypes described here provide a framework for personality diagnosis that is both empirically based and clinically relevant.

FIGURE 1. Hierarchical Structure of Personality Diagnoses