Staff Observational Differences Between Depressive Disorders and Personality Disorders.

Abstract

Introduction: Distinguishing those with a personality disorder from those with major depressive disorder (MDD) can be challenging, but establishing the correct diagnosis can direct appropriate management.

Aim: To identify whether behavioural themes differ between those with personality disorders from those with MDD, and how those differences might relate to a clinical team's perception of diagnosis.

Method: An observational study identifying all inpatients presenting with symptoms of depression. At discharge, patients (n = 60) underwent a structured diagnostic interview and were grouped according to diagnosis. Qualitative data was analysed to determine whether behavioural themes differed between those with MDD and those with a personality disorder (with or without MDD).

Results: Ward staff perceptions of diagnosis aligned in all cases of personality disorder, but they also attributed that diagnosis to 54% of patients who had only MDD. Several behavioural themes were evident in those with a personality disorder but not those with MDD. Many behavioural themes were observed in both groups, and it is likely these that drove differences in diagnostic views.

Implications for practice: Certain behavioural themes may be determinants of the perception of diagnosis held by inpatient staff, and when present in acute episodes in MDD, may risk diagnostic misattribution.