The British Journal of Psychiatry (2007) 190: s51-s59. doi: 10.1192/bjp.190.5.s51
© 2007 The Royal College of Psychiatrists
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Critical developments in the assessment of personality disorder

Peter Tyrer, MD and Natalie Coombs, MSc

Department of Psychological Medicine, Imperial College, Charing Cross Campus, London, UK

Fatema Ibrahimi, MRCPsych

St Mary's Psychiatric Training Scheme, London, UK

Anand Mathilakath, MRCPsych

West London Psychiatric Training Scheme, London, UK

Priya Bajaj, MRCPsych

St Mary's Psychiatric Training Scheme, London, UK

Maja Ranger, MRCPsych and Bharti Rao, MSc

Department of Psychological Medicine, Imperial College, Charing Cross Campus, London, UK

Raana Din, MRCPsych

St Mary's Psychiatric Training Scheme, London, UK

Correspondence: Professor Peter Tyrer, Department of Psychological Medicine, Imperial College, St Dunstan's Road, London W6 8RP, UK. Email: p.tyrer{at}imperial.ac.uk

Declaration of interest P.T. is Editor of the British Journal of Psychiatry, but had no part in the assessment of this manuscript for publication

Background The assessment of personality disorder is currently inaccurate, largely unreliable, frequently wrong and in need of improvement.

Aims To describe the errors inherent in the current systems and to indicate recent ways of improving personality assessment.

Method Historical review, description of recent developments, including temporal stability, and of studies using document-derived assessment.

Results Studies of interrater agreement and accuracy of diagnosis in complex patients with independently established personality status using document-derived assessment (PAS-DOC) with a four personality cluster classification, showed very good agreement between raters for the flamboyant cluster B group of personalities, generally good agreement for the anxious/dependent cluster C group and inhibited (obsessional) cluster D group, but only fair agreement for the withdrawn cluster A group. Overall diagnostic accuracy was 71%.

Conclusions Personality function or diathesis, a fluctuating state, is a better description than personality disorder. The best form of assessment is one that uses longitudinal repeated measures using a four-dimensional system.




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