Tool May Help Diagnose Personality Disorders: SWAP-200-A to Be Released by Next Spring. (Shedler-Western Assessment Procedure)

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ROME -- A new psychiatric assessment tool that is being developed could change the way adolescent personality disorders are diagnosed and classified.

The Shedler-Westen Assessment Procedure 200-item Q-sort for Adolescents (SWAP-200-A) to be released by early next spring, may provide a more clinically useful and accurate diagnosis than the standard DSM-IV Axis II assessment, said Drew Westen, Ph.D., at a meeting of the International Society of Adolescent Psychiatry Dr. Westen helped developed the tool.

The SWAP-200-A Q-sort uses 200 questions that describe an adolescent's functional behavior on a numerical scale: A "1" rating means the patient does not exhibit this behavior, while a "7" rating indicates that she typifies that behavior.

After the sorting process, the tool generates a comprehensive description of the patient and the extent to which the patient matches six empirically derived prototypes: emotionally dysregulated, avoidant-constrictive, antisocial-psychopathic, narcissistic, histrionic, or inhibited self-critical.

Axis II does predict external correlates such as school performance, arrests, and psychiatric hospitalizations, but it lacks the sensitivity to diagnose many aspects of personality, he said. "Axis II measures don't predict each other well, and they don't predict clinician diagnosis," said Dr. Westen, a professor of psychology and psychiatry at Emory University, Atlanta.

Because it categorizes symptoms and personality disorders as either present or absent, Axis II doesn't allow clinicians to describe patterns that may still require treatment but aren't severe enough to warrant a personality disorder diagnosis. And, Dr. Westen said, the Axis II measurements are derived from an adult population; no one really knows how much they apply to adolescents, because no one really knows when their personalities achieve adult dimension. …

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