Assessing Adolescent Personality Disorders With the Shedler-Westen Assessment Procedure for Adolescents

Clinical Psychology: Science and Practice

Volumn 20, Issue 4, 2013, Pages 393-407

  Defife, Jared A ^a   Malone, Johanna C ^b   Dilallo, John ^c   Westen, Drew ^d  

^a EMORY UNIVERSITY SCHOOL OF MEDICINE   (United States)

^b MASSACHUSETTS GENERAL HOSPITAL   (United States)

^c NEW YORK UNIVERSITY SCHOOL OF MEDICINE   (United States)

^d EMORY UNIVERSITY   (United States)

Author keywords

Adolescent personality disorders; Diagnosis and classification; Dimensional diagnosis; Personality pathology; Shedler Westen Assessment Procedure Adolescent version

Indexed keywords

EID: 84889639682     PISSN: 09695893     EISSN: 14682850     Source Type: Journal    
DOI: 10.1111/cpsp.12049     Document Type: Article

References (90)

1. Achenbach, T. (1991a). Manual for the Child Behavior Checklist/4-18 and 1991 profile. Burlington, VT: Department of Psychiatry, University of Vermont.
2. Achenbach, T. (1991b). Manual for the teacher's report form and 1991 profile. Burlington, VT: Department of Psychiatry, University of Vermont.
3. Achenbach, T. (1991c). Manual for the youth self-report. Burlington, VT: Department of Psychiatry, University of Vermont.
4. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.
5. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
6. Becker, D. F., Grilo, C. M., Morey, L. C., Walker, M. L., Edell, W. S., & McGlashan, T. H. (1999). Applicability of personality disorder criteria to hospitalized adolescents: Evaluation of internal consistency and criterion overlap. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 200-205. doi:10.1097/00004583-199902000-00020
7. Bernstein, D. P., Cohen, P., Velez, C. N., Scwab-Stone, M., Seiver, L. J., & Shinsato, L. (1993). Prevalence and stability of DSM-II-R personality disorders in a community based survey of adolescents. American Journal of Psychiatry, 150, 1237-1243.
8. Blackburn, R., & Glasgow, D. V. (2006). Manual for the Chart of Interpersonal Reactions in Closed Living Environments (CIRCLE). Unpublished manuscript, University of Liverpool.
9. Blackburn, R., & Renwick, S. J. (1996). Rating scales for measuring the interpersonal circle in forensic psychiatric patients. Psychological Assessment, 8, 76-84. doi:10.1037/1040-3590.8.1.76
10. Blagov, P. S., Bi, W., Shedler, J., & Westen, D. (2012). The Shedler-Westen Assessment Procedure (SWAP): Evaluating psychometric questions about its reliability, validity, and impact of its fixed score distribution. Assessment, 19, 370-382. doi:10.1177/1073191112436667
11. Blagov, P., & Westen, D. (2008). Questioning the coherence of histrionic personality disorder: Borderline and hysterical personality subtypes in adults and adolescents. Journal of Nervous and Mental Disease, 196, 785-797. doi:10.1097/NMD.0b013e31818b502d
12. Blais, M., & Norman, D. (1997). A psychometric evaluation of the DSM-IV personality disorder criteria. Journal of Personality Disorders, 11, 168-176. doi:10.1521/pedi.1997.11.2.168
13. Bornovalova, M. A., Hicks, B. M., Iacono, W. G., & McGue, M. (2009). Stability, change, and heritability of borderline personality disorder traits from adolescence to adulthood: A longitudinal twin study. Development and Psychopathology, 21, 1335-1353. doi:10.1017/S0954579409990186
14. Box, G. E. P., & Cox, D. R. (1964). Analysis of transformations. Journal of the Royal Statistical Society, Series B, 26, 211-252.
15. Clark, L. A. (2009). Stability and change in personality disorder. Current Directions in Psychological Science, 18(1), 27-31. doi:10.1111/j.1467-8721.2009.01600.x
16. Clifton, A., Turkheimer, E., & Oltmanns, T. F. (2003). Self and peer perspectives on pathological personality traits and interpersonal problems. Unpublished manuscript, University of Virginia.
17. Colligan, R., Osborne, D., & Offord, K. (1980). Linear transformation and the interpretation of MMPI T-scores. Journal of Clinical Psychology, 36, 162-165. doi:10.1002/1097-4679(198001)36:1%3c162:AID-JCLP2270360117%3e3.0.CO;2-E
18. Colligan, R., Osborne, D., & Offord, K. (1984). Normalized transformations and the interpretation of MMPI T-scores: A reply to Hsu. Journal of Consulting and Clinical Psychology, 52, 824-826. doi:10.1037/0022-006X.52.5.824
19. Crawford, T., & Cohen, P. (2008). Comorbid Axis I and Axis II disorders in early adolescence: Outcomes 20 years later. Archives of General Psychiatry, 65, 641-648. doi:10.1001/archpsyc.65.6.641
20. Daley, S. E., Rizzo, C. J., & Gunderson, B. H. (2006). The longitudinal relation between personality disorder symptoms and depression in adolescence: The mediating role of interpersonal stress. Journal of Personality Disorders, 20, 352-368. doi:10.1521/pedi.2006.20.4.352
21. DeFife, J. A., Drill, R., Nakash, O., & Westen, D. (2010). Agreement between clinician and patient ratings of adaptive functioning and developmental history. American Journal of Psychiatry, 167, 1472-1478. doi:10.1176/appi.ajp.2010.09101489
22. DeFife, J. A., Goldberg, M. G., & Westen, D. (in press). Dimensional assessment of self and interpersonal functioning in adolescents: Implications for DSM-5's general definition of personality disorder. Journal of Personality Disorders. doi:10.1521/pedi_2013_27_085
23. DeFife, J. A., & Westen, D. (2012). Empirically-informed clinical interviewing for personality disorders. In R. Levy, J. Ablon, & H. Kächele (Eds.), Psychodynamic psychotherapy research: Evidence-based practice and practice-based evidence (pp. 553-569). New York, NY: Springer. doi:10.1007/978-1-60761-792-1_31
24. DiLallo, J. D., Jones, M., & Westen, D. (2009). Personality subtypes in disruptive adolescent males. Journal of Nervous and Mental Disease, 197, 15-23. doi:10.1097/NMD.0b013e318192770c
25. Donnellan, M. B., Conger, R. D., & Burzette, R. G. (2007). Personality development from late adolescence to young adulthood: Differential stability, normative maturity, and evidence for the maturity-stability hypothesis. Journal of Personality, 75, 237-264. doi:10.1111/j.1467-6494.2007.00438.x
26. Durrett, C., & Westen, D. (2005). The structure of Axis II pathology in adolescents: A cluster- and factor-analytic investigation. Journal of Personality Disorders, 19, 440-461, doi:10.1521/pedi.2005.19.4.440
27. Dutra, L., Campbell, L., & Westen, D. (2004). Quantifying clinical judgment in the assessment of adolescent psychopathology: Reliability, validity, and factor structure of the Child Behavior Checklist for Clinician-Report. Journal of Clinical Psychology, 60, 65-85. doi:10.1002/jclp.10234
28. Fischer, J. E., Bachmann, L. M., & Jaeschke, R. (2003). A readers' guide to the interpretation of diagnostic test properties: Clinical example of sepsis. Intensive Care Medicine, 29, 1043-1051. doi:10.1007/s00134-003-1761-8
29. Hemphill, J. (2003). Interpreting the magnitudes of correlation coefficients. American Psychologist, 58, 78-79. doi:10.1037/0003-066X.58.1.78
30. Hilsenroth, M. J., Ackerman, S. J., Blagys, M. D., Baumann, B. D., Baity, M. R., Smith, S. R., . Holdwick, D.J. (2000). Reliability and validity of DSM-IV Axis V. American Journal of Psychiatry, 157, 1858-1863. doi:10.1176/appi.ajp.157.11.1858
31. Hinrichs, J., DeFife, J. A., & Westen, D. (2011). Personality subtypes in adolescent and adult children of alcoholics: A two-part study. Journal of Nervous and Mental Disease, 199, 487-498. doi:10.1097/NMD.0b013e3182214268
32. Hinshaw, S. P., & Cicchetti, D. (2000). Stigma and mental disorder: Conceptions of illness, public attitudes, personal disclosure, and social policy. Development and Psychopathology, 12, 555-598. doi:10.1017/S0954579400004028
33. Hsu, L. M. (1984). MMPI T scores: Linear versus normalized. Journal of Consulting and Clinical Psychology, 52, 821-823. doi:10.1037/0022-006x.52.5.821
34. Jones, A. (2005). An examination of three sets of MMPI-2 personality disorder scales. Journal of Personality Disorders, 19, 370-385. doi:10.1521/pedi.2005.19.4.370
35. Kagan, J. (2007). A trio of concerns. Perspectives on Psychological Science, 2, 361-376. doi:10.1111/j.1745-6916.2007.00049.x
36. Klein, D. N., Ouimette, P. C., Kelly, H. S., Ferro, T., & Riso, L. P. (1994). Test-retest reliability of team consensus best-estimate diagnoses of Axis I and II disorders in a family study. American Journal of Psychiatry, 151, 1043-1047.
37. Klonsky, E. D., Oltmanns, T. F., & Turkheimer, E. (2002). Informant-reports of personality disorder: Relation to self-reports and future research directions. Clinical Psychology: Science and Practice, 9, 300-311. doi:10.1093/clipsy.9.3.300
38. Krueger, R. F. (2005). Continuity of Axes I and II: Toward a unified model of personality, personality disorders, and clinical disorders. Journal of Personality Disorders, 19, 233-261. doi:10.1521/pedi.2005.19.3.233
39. Krueger, R. F., Eaton, N. R., Clark, L. A., Watson, D., Markon, K. E., Derringer, J., . Livesley, W. J. (2011). Deriving an empirical structure of personality pathology for DSM-5. Journal of Personality Disorders, 25, 170-191. doi:10.1521/pedi.2011.25.2.170
40. Krueger, R. F., & Markon, K. E. (2011). A dimensional-spectrum model of psychopathology: Progress and opportunities. Archives of General Psychiatry, 68, 10-11. doi:10.1001/archgenpsychiatry.2010.188
41. Krueger, R. F., Watson, D., & Barlow, D. H. (2005). Introduction to the special section: Toward a dimensionally based taxonomy of psychopathology. Journal of Abnormal Psychology, 114, 491-493. doi:10.1037/0021-843X.114.4.491
42. Leary, T. (1957). Interpersonal diagnosis of personality: A functional theory and methodology for personality evaluation. New York, NY: Ronald Press.
43. Levy, K. N., Becker, D. F., Grilo, C. M., Mattanah, J., Garnet, K. E., Quinlan, D. M., . McGlashan, T.H. (1999). Concurrent and predictive validity of the personality disorder diagnosis in adolescent patients. American Journal of Psychiatry, 156, 1522-1528.
44. Lynam, D. R., & Widiger, T. A. (2001). Using the five-factor model to represent the DSM-IV personality disorders: An expert consensus approach. Journal of Abnormal Psychology, 110, 401-412. doi:10.1037/0021-843X.110.3.401
45. Marin-Avellan, L., McGauley, G., Campbell, C., & Fonagy, P. (2005). Using the SWAP-200 in a personality-disordered forensic population: Is it valid, reliable and useful? Journal of Criminal Behaviour and Mental Health, 15, 28-45. doi:10.1002/cbm.35
46. Mattanah, J. J., Becker, D. F., Levy, K. N., Edell, W. S., & McGlashan, T. H. (1995). Diagnostic stability in adolescents followed up 2 years after hospitalization. American Journal of Psychiatry, 152, 889-894.
47. McGue, M., Bacon, S., & Lykken, D. T. (1993). Personality stability and change in early adulthood: A behavioral genetic analysis. Developmental Psychology, 29, 96-109. doi:10.1037/0012-1649.29.1.96
48. Miller, J. D., Bagby, R. M., Pilkonis, P. A., Reynolds, S. K., & Lynam, D. R. (2005). A simplified technique for scoring DSM-IV personality disorders with the five-factor model. Assessment, 12, 404-415. doi:10.1177/1073191105280987
49. Millon, T., & Davis, R. (1997). Millon Clinical Multiaxial Inventory-III. Minneapolis, MN: National Computer Systems.
50. Morey, L. C. (1988). Personality disorders in DSM-III and DSM-III-R: Convergence, coverage, and internal consistency. American Journal of Psychiatry, 145, 573-577.
51. Morey, L. C., Waugh, M. H., & Blashfield, R. K. (1985). MMPI scales for DSM-III personality disorders: Their derivation and correlates. Journal of Personality Assessment, 49, 245-251. doi:10.1207/s15327752jpa4903_5
52. Nakash-Eisikovits, O., Dutra, L., & Westen, D. (2002). Relationship between attachment patterns and personality pathology in adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 1111-1123. doi:10.1097/00004583-200209000-00012
53. Oldham, J. M., & Skodol, A. E. (2000). Charting the future of Axis II. Journal of Personality Disorders, 14, 17-29. doi:10.1521/pedi.2000.14.1.17
54. Oldham, J., Skodol, A., Kellman, H., Hyler, S., Rosnick, L., & Davies, M. (1992). Diagnosis of DSM-III-R personality disorders by two structured interviews: Patterns of comorbidity. American Journal of Psychiatry, 149, 213-220.
55. Patricia, C. (2008). Child development and personality disorder. Psychiatric Clinics of North America, 31, 477-493. doi:10.1016/j.psc.2008.03.005
56. Pilkonis, P. A., Heape, C. L., Ruddy, J., & Serrao, P. (1991). Validity in the diagnosis of personality disorders: The use of the LEAD standard. Psychological Assessment, 31, 46-54. doi:10.1037/1040-3590.3.1.46
57. Powers, A. D., & Westen, D. (2011). Personality subtypes in adolescents with panic disorder. Clinical Child Psychology and Psychiatry, 16, 551-565. doi:10.1177/1359104510387572
58. Roberts, B. W., Caspi, A., & Moffitt, T. E. (2001). The kids are alright: Growth and stability in personality development from adolescence to adulthood. Journal of Personality and Social Psychology, 81, 670-683. doi:10.1037/0022-3514.81.4.670
59. Roberts, B. W., & DelVecchio, W. F. (2000). The rank-order consistency of personality traits from childhood to old age: A quantitative review of longitudinal studies. Psychological Bulletin, 126, 3-25. doi:10.1037/0033-2909.126.1.3
60. Robins, R. W., Tracy, J. L., & Sherman, J. W. (2007). What kinds of methods do personality psychologists use? In R. W. Robins, R. C. Fraley, & R. F. Krueger (Eds.), Handbook of research methods in personality psychology (pp. 673-678). London, UK: Guilford Press.
61. Rottman, B., Ahn, W., Sanislow, C., & Kim, N. (2009). Can clinicians recognize DSM-IV personality disorders from five-factor model descriptions of patient cases? American Journal of Psychiatry, 166, 427-433. doi:10.1176/appi.ajp.2008.08070972
62. Schwarz, N. (1999). Self-reports: How the questions shape the answers. American Psychologist, 54, 93-105. doi:10.1037/0003-066X.54.2.93
63. Shedler, J., Beck, A., Fonagy, P., Gabbard, G., Gunderson, J., Kernberg, O., . Westen, D. (2010). Personality disorders in DSM-5. American Journal of Psychiatry, 167, 1026-1028. doi:10.1176/appi.ajp.2010.10050746
64. Shedler, J., & Westen, D. (2004a). Dimensions of personality pathology: An alternative to the five factor model. American Journal of Psychiatry, 161, 1743-1754. doi:10.1176/appi.ajp.161.10.1743
65. Shedler, J., & Westen, D. (2004b). Refining personality disorder diagnoses: Integrating science and practice. American Journal of Psychiatry, 161, 1350-1365. doi:10.1176/appi.ajp.161.8.1350
66. Shedler, J., & Westen, D. (2007). The Shedler-Westen Assessment Procedure (SWAP): Making personality diagnosis clinically meaningful. Journal of Personality Assessment, 89(1), 41-55. doi:10.1080/00223890701357092
67. Skodol, A. W. E., Johnson, J. G., Cohen, P., Sneed, J. R., & Crawford, T. N. (2007). Personality disorder and impaired functioning from adolescence to adulthood. British Journal of Psychiatry, 190, 415-420. doi:10.1192/bjp.bp.105.019364
68. Spitzer, R., First, M., Shedler, J., Westen, D., & Skodol, A. (2008). Clinical utility of five dimensional systems for personality diagnosis: A "consumer preference" study. Journal of Nervous and Mental Disease, 196, 356-374. doi:10.1097/NMD.0b013e3181710950
69. Vazire, S. (2006). Informant reports: A cheap, fast, and easy method for personality assessment. Journal of Research in Personality, 40, 472-481. doi:10.1016/j.jrp.2005.03.003
70. Waller, N. (2011). Choosing a scale for SWAP-II factor scores: The relative merits of linear, normalized, and uniform T-scores. Unpublished manuscript, University of Minnesota.
71. Westen, D. (2012). Prototype diagnosis of psychiatric symptoms. World Psychiatry, 11(1), 16-21. doi:10.1016/j.wpsyc.2012.01.004
72. Westen, D., Betan, E., & DeFife, J. A. (2011). Identity disturbance in adolescents: Associations with borderline personality disorder. Development and Psychopathology, 23, 305-313. doi:10.1017/S0954579410000817
73. Westen, D., Dutra, L., & Shedler, J. (2005). Assessing adolescent personality pathology: Quantifying clinical judgment. British Journal of Psychiatry, 186, 227-238. doi:10.1192/bjp.186.3.227
74. Westen, D., Gabbard, G. O., & Blagov, P. (2006). Back to the future: Personality structure as a context for psychopathology. In R. F. Krueger & J. L. Tackett (Eds.), Personality and psychopathology (pp. 335-384). New York, NY: Guilford Press.
75. Westen, D., & Muderrisoglu, S. (2003). Reliability and validity of personality disorder assessment using a systematic clinical interview: Evaluating an alternative to structured interviews. Journal of Personality Disorders, 17, 350-368. doi:10.1521/pedi.17.4.351.23967
76. Westen, D., & Muderrisoglu, S. (2006). Clinical assessment of pathological personality traits. American Journal of Psychiatry, 163, 1285-1287. doi:10.1176/appi.ajp.163.7.1285
77. Westen, D., Muderrisoglu, S., Fowler, C., Shedler, J., & Koren, D. (1997). Affect regulation and affective experience: Individual differences, group differences, and measurement using a Q-sort procedure. Journal of Consulting and Clinical Psychology, 65, 429-439. doi:10.1037/0022-006X.65.3.429
78. Westen, D., Nakash, O., Thomas, C., & Bradley, R. (2006). Clinical assessment of attachment patterns and personality disorder in adolescents and adults. Journal of Consulting and Clinical Psychology, 74, 1065-1085. doi:10.1037/0022-006X.74.6.1065
79. Westen, D., & Shedler, J. (1999a). Revising and assessing Axis II, Part 1: Developing a clinically and empirically valid assessment method. American Journal of Psychiatry, 156, 258-272.
80. Westen, D., & Shedler, J. (1999b). Revising and assessing Axis II, Part 2: Toward an empirically based and clinically useful classification of personality disorders. American Journal of Psychiatry, 156, 273-285.
81. Westen, D., & Shedler, J. (2000). A prototype matching approach to diagnosing personality disorders toward DSM-V. Journal of Personality Disorders, 14, 109-126. doi:10.1521/pedi.2000.14.2.109
82. Westen, D., & Shedler, J. (2007). Personality diagnosis with the Shedler-Westen Assessment Procedure (SWAP): Integrating clinical and statistical measurement and prediction. Journal of Abnormal Psychology, 116, 810-822. doi:10.1037/0021-843X.116.4.810
83. Westen, D., Shedler, J., & Bradley, R. (2006). A prototype approach to personality disorder diagnosis. American Journal of Psychiatry, 163, 846-856. doi:10.1176/appi.ajp.163.5.846
84. Westen, D., Shedler, J., Bradley, B., & DeFife, J. A. (2012). An empirically-derived taxonomy for personality diagnosis: Bridging science and practice in conceptualizing personality. American Journal of Psychiatry, 169, 273-284. doi:10.1176/appi.ajp.2011.11020274
85. Westen, D., Shedler, J., Durrett, C., Glass, S., & Martens, A. (2003). Personality diagnosis in adolescence: DSM-IV Axis II diagnoses and an empirically derived alternative. American Journal of Psychiatry, 160, 952-966. doi:10.1176/appi.ajp.160.5.952
86. Westen, D., Waller, N., Shedler, J., & Blagov, P. S. (in press). Dimensions of personality and personality pathology: Factor structure of the Shedler-Westen Assessment Procedure-II (SWAP-II). Journal of Personality Disorders. doi: 10.1521/pedi_2012_26_059.
87. Widiger, T. A. (2005). A dimensional model of personality disorder. Current Opinion in Psychiatry, 18(1), 41-43.
88. Widiger, T. A., & Samuel, D. B. (2005). Evidence-based assessment of personality disorders. Psychological Assessment, 17, 278-287. doi:10.1037/1040-3590.17.3.278
89. Zimmerman, M., Chelminski, I., Young, D., Dalrymple, K., & Martinez, J. (2011). Does DSM-IV already capture the dimensional nature of personality disorders? Journal of Clinical Psychiatry, 72, 1333-1339. doi:10.4088/JCP.11 m06974
90. Zimmerman, M., Rothschild, L., & Chelminski, I. (2005). The prevalence of DSM-IV personality disorders in psychiatric outpatients. American Journal of Psychiatry, 162, 1911-1918. doi:10.1176/appi.ajp.162.10.1911