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

Abstract

The authors describe a system for diagnosing personality pathology that is empirically derived, clinically relevant, and practical for day-to-day use. 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. 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. The empirically derived personality prototypes described here provide a framework for personality diagnosis that is both empirically based and clinically relevant.