The SCID is a great tool but also highlights the limitations of our current personality disorder diagnostic system.
I am at a place where we regularly administer the SCID for personality disorders. One thing you will notice right away doing it is many people will flag full diagnosis for multiple personality disorders. The other thing you will notice is the actual diagnosis may or may not line up with the actual Core Issue / Assessment that is needed for these people to improve their disorders.
In having exposure to this, it is clear to me that when dealing with personality disorders, what is more important than the diagnosis itself, is recognizing the core constructs that are disabling or causing suffering to the patient, and identifying what would be the most productive treatment modality for that patient.
I'll give an example - a loosely coherent, identity diffused patient with grossly unstable emotions and poor coping skills may be diagnosed with borderline personality disorder and benefit from DBT. A coherent, identity diffused patient with frequent dissociations but mature defenses and good coping skills may also be diagnosed with borderline personality disorder but would likely not benefit from DBT, and could do better with mentalization based therapy, transference focused therapy, or psychodynamic approaches. A SCID may label the first person as borderline full, histrionic full, and OCPD traits. And the SCID may label the second person Borderline full, avoidant full, OCPD traits. Does that really help us understand the patient? not really, and it doesn't really help identifying what treatment would work best for them.
In essence, I'm saying it's more helpful to identify if a PD is likely present, then understand what are the core issues contributing. Tailor treatment to those underlying problems, not necessarily the specific PD diagnosis.
