IPDE - Extranet Systems - World Health Organization

119 Limitations of the IPDE
are frantically seeking help, or who are dissatisfied with their treatment
or the amount of attention they are receiving. It may also be a reflection
of certain personality traits. Although subjects may also feign waits or
behaviour, particularly in compensation cases and some forensic and
military situations, the IPDE discourages this by requiring documentation
with convincing examples, anecdotes, and descriptions.
Patients in a dysphoric state may have a selective recall or distorted
perception of some of their behaviour. They may also confuse normal
and abnormal personality traits with the symptoms of a mental disorder.
There is evidence' that the PDE was resistant to changes in the symp
toms of anxiety and depression that occurred during the course of treatment,
when those symptoms were of mild to moderate severity. This is
not to imply that some clinical states, particularly those accompanied by
severe symptoms, do not invalidate the assessment of personality.
Additional research is required on this important subject. When possible,
some investigators may wish to postpone the assessment until the symptoms
of other mental disorders have remitted.
In ordinary clinical practice, a family member or close friend is often
used as an additional source of information to offset the limitations of the
self-repon method. We have experimented with various procedures for
augmenting the subject's responses on the IPDE with data from other
sources. Failure to acknowledge a behaviour, particularly one that is
especially frowned upon by others, is sometimes followed on the IPDE
by such inquiries as, 'Have people told you that you're like that?'
Affirmative replies are then pursued with the question, "Why do you
think they've said that?" This approach can only be used selectively. If it
were adopted in all situations where a behaviour has been denied, it
would undermine the rapport between subject and examiner.
We have also hied a parallel form of the interview in which an informant
was asked viltually the same questions about the patient. There
were often discrepancies, and it was not always obvious who had provided
the more valid information. It proved difficult to formulate a set of
practical guidelines that stipulate the source that should be used in scaring
a particular criterion. The problem is a complicated one, and a satisfactory
resolution awaits the availability of more empirical dam on the
subject. Future studies may help identify those criteria that tend to pmduce
discrepancies, and the characteristics of suhjects and informants
that might be used to determine the preferred source of information.
Meanwhile, we have adopted a practical, provisional solution to the
informant pmblem. The IPDE has a second scoring column for informant