The Structured Interview of Personality Organization (STIPO): An Instrument to Assess Severity and Change of Personality Pathology

Abstract

The assessment and diagnosis of personality disorders for clinical intervention and research purposes is at crossroads. The diagnostic criteria for the personality disorders in DSM-IV TR Axis II are a listing of symptoms in search of a unifying assessment of personality dysfunction. The utilization of the diagnosis of these criteria has resulted in an advance in the reliability of personality disorders, but it has become evident that there are numerous difficulties in the personality disorder diagnoses made by the criterion-based, atheoretical approach of Axis II. The major problem involves the heterogeneity of the patient groups selected by the categorical system without any rating of severity of dysfunction. While a categorical approach to diagnosis focuses on the presence or absence of the disorder, based on a number of fulfilled criteria or symptoms, a dimensional approach also assesses the severity of symptoms or dimensions of personality pathology. As patients seen in clinical practice tend to present with different levels of severity of pathology, a dimensional approach provides the clinician with a diagnosis more reflective of the clinical picture, which also includes an assessment of strengths and deficits on each of the dimensions. The clinical usefulness of the categorical system has been seriously questioned [1]. The proposed changes in DSM-V define personality disorders as a failure to develop self-identity and capacity for adaptive interpersonal functioning, focus on the assessment on personality disorder prototypes, and provide a severity rating of personality disorder functioning. These proposed changes are congruent with the object relations view of personality pathology and call attention to the need for reliable diagnostic instruments based on psychodynamic object relations theory. In this chapter, we describe such an instrument, which provides evaluation of core dimensions of personality functioning emphasized by the DSM V Personality Disorders Task Force (www.dsm5.org)