Research Paper: Personality Disorders Are Long-Standing

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[. . .] By identifying the constellation of presenting problems unique to the individual, the MMPI-2 would allow for assisting the clinician in diagnosing and visualizing what potential courses of remediation might be beneficial in the case of the particular patient in question.

The MMPI-2 is a structured self-report personality inventory. Some borderline patients are able to perform well in structured tests, but have been observed to perform more poorly on unstructured portions of tests, an observation also found in patients with psychotic disorders (Berg, 1983). It would also be useful to use a projective measure to provide further support for a personality diagnosis vs. A diagnosis of an Axis I or other personality disorder. The Rorschach test has been found to have good discriminative ability when distinguishing between the thought disorders displayed by borderline patients, neurotics, and psychotic patients. For example, Singer and Larson (1981) noted that when borderline subjects are administered the Rorschach the quality of responses to the cards declined as the test progressed. In a three-group comparison a discriminant-function analysis they correctly classified most of the borderline subjects from acute and chronic schizophrenic subjects. The decline in response quality and periodic problems reasoning were used to distinguish the borderline sample's Rorschach records from those of psychotics and others. Peters and Nunno (1996) found that aspects of the color cards were found to be highly effective in differentiating a previously diagnosed borderline subjects from a schizophrenic group. They were also able to correlate Rorschach responses with MMPI-2 scales to determine specific profile characteristics shared by both protocols to help identify borderline subjects.

Weiner (1999) made an excellent case for using both the Rorschach and the MMPI-2 for diagnostic purposes. Subjects will respond to these two instruments using different quantities of conscious awareness when considering the possible significance of their answer. Because of its unstructured nature the Rorschach is less susceptible than the MMPI-2 to impression management. Therefore the Rorschach results compliment the results of MMPI-2 findings to enrich the clinical assessment. This can be especially important when subjects present with efforts to fake MMPI-2 results that provide unreliable information. These profiles can often be found in defensive patients and the Rorschach provides incremental validity in personality assessment. Thus, the Rorschach and the MMPI-2 scales would work well together when used to assist in the final diagnosis of borderline personality disorder.

While not necessary for the diagnosis of borderline personality disorder, it is often useful to understand the patient's intellectual functioning, especially in patients with more severe pathology or odd and confusing presentations of symptoms. The WAIS-IV could provide useful information as to the patient's intellectual strengths, weaknesses, and problem solving capabilities. There is research indicating that people with borderline personality may present with cognitive difficulties compared to controls, but identification of these difficulties is not definitive in diagnosing of the disorder (O'Leary, Brouwers, Gardner, & Cowdry, 1991). Nonetheless, the inclusion of the WAIS-IV could identify potential cognitive issues that could be useful when conceptualizing the patient's overall current level of functioning and assist in any treatment planning.

References

American Psychiatric Association. (1994). Diagnostic and Statistical Manual

of Mental Disorders (4th ed.). Washington, DC: Author.

Berg M. (1983). Borderline psychopathology as displayed on psychological tests.

Journal of Personality Assessment, 47, (2), 120-133.

Kaplan, B.J. And Sadock, V.A. (2007). Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry. (Tenth Edition). Philadelphia: Lippincott Williams and Wilkins.

Lieb, K., Zanarini, M., Schmahl, C., Linehan, M., & Bohus, M. (2004). Borderline personality disorder. The Lancet, 364, (9432), 453-461.

Lopez, S.R. (1989). Patient variable biases in clinical judgment: Conceptual overview and methodological considerations. Psychological Bulletin, 106, (2), 184-203.

Morey, L.C., & Zanarini, M.C. (2000). Borderline personality: Traits and disorder.

Journal of Abnormal Psychology, 109, 733 -- 737.

O'Leary, K.M., Brouwers, P., Gardner, D.L., & Cowdry, R.W. (1991). Neuropsychological testing of patients with borderline personality disorder. American Journal of Psychiatry, 148, 106-111.

Peters, J.E. & Nunno, V.J. (1996). Measuring the effect of the Rorschach Color Cards (VIII-X) on perceptual accuracy and special scores in differentiating borderline from schizophrenic protocols. Journal of Clinical Psychology, 52, (5), 581 -- 588.

Rogers, R. (2003). Standardizing DSM -- IV diagnoses: The clinical applications of structured interviews. Journal of Personality Assessment, 81, 220 -- 225.

Singer, M.T. & Larson, D.G. (1981). Borderline personality and the Rorschach test. Archives of General Psychiatry, 38, (6), 693-698.

Trull, T.J. (1999). Discriminant validity of the MMPI for borderline personality disorder. Psychological Assessment, 3, (2), 232-238.

Weiner I.B. (1999). What the Rorschach can… [END OF PREVIEW]

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