Anticipation and Delivery of a Personality Disorder Diagnosis in Psychiatry

ABSTRACT A personality disorder (PD) diagnosis can be considered by a patient to be stigmatizing. This presents interactional challenges for the clinician who makes the diagnosis and communicates it to the patient.Through an analysis of video-recorded clinical interviews of PD patients, we explore the anticipation and delivery of the diagnosis in psychiatry. The method of the study is conversation analysis (CA). The diagnostic evaluation process of each patient extends over a number of clinical interviews. At the beginning of the process, the clinicians speak about the personality disorder diagnosis in an anticipatory manner. At the end of the process, they eventually communicate it to the patients. This analysis focuses on the interactional practices used by psychiatrists to help a patient “save face” when mentioning the (prospective) diagnosis. We demonstrate that both the avoidance and corrective practices of face work occur in the data. Even with these prartices, the delivery of the diagnosis to the patent can lead to conflict. We conclude that, in extended diagnostic evaluation processes, the preparatory work by the clinician is important to secure patient participation.The data for this analysis are in Finnish.