Structured Clinical Interview for DSM-IV
Structured Clinical Interview for DSM-IV
The Structured Clinical Interview for DSM-IV (SCID) is the generic term for a series of psychological assessment instruments used by clinicians and researchers to make diagnoses of mental disorders listed in the Diagnostic and Statistical Manual, Fourth Edition (DSM-IV)of the American Psychiatric Association.
The SCID is designed to help clinicians and researchers consistently and accurately diagnose mental disorders and to avoid making a premature diagnosis based on insufficient data or preconceived notions. The SCID uses a standard set of questions that are asked in patient interviews. Based on the answers to these questions, a diagnosis is made. A previous version of the SCID was available for use with the DSM-III.
There are two parts to the SCID. The choice of which part is administered depends on what general type of disorder is suspected in the patient. The SCID-I is designed for use by clinicians to accurately and consistently diagnose 37 of the most frequently seen DSM-IV Axis I clinical disorders. The disorders fall into the following categories:
- disorders usually first diagnosed in infancy, childhood, or adolescence (excluding mental retardation)
- delirium, dementia, and amnestic and other cognitive disorders
- mental disorders due to a general medical condition
- substance-related disorders
- schizophrenia and other psychotic disorders
- mood disorders
- anxiety disorders
- somatoform disorders
- factitious disorders
- dissociative disorders
- sexual and gender identity disorders
- eating disorders
- sleep disorders
- impulse-control disorders not elsewhere classified
- adjustment disorders
- other conditions that may be a focus of clinical attention
The SCID-II is designed to measure disorders that are part of Axis II (personality disorders ) of the DSM-IV.These are:
- paranoid personality disorder
- schizoid personality disorder
- schizotypal personality disorder
- antisocial personality disorder
- borderline personality disorder
- histrionic personality disorder
- narcissistic personality disorder
- avoidant personality disorder dependent personality disorder
- obsessive-compulsive personality disorder
- personality disorder not otherwise specified
In addition, the SCID-II is designed to diagnose depressive personality disorder, passive-aggressive personality disorder, and dependent personality disorder. Neither the SCID-I nor the SCID-II diagnoses disorders included on Axis III (general medical conditions) or Axis IV (psychosocial and environmental problems) of the DSM-IV.
The SCID has been translated or is in the process of being translated into numerous other languages. These include Danish, Dutch, French, German, Greek, Hebrew, Italian, Portuguese, Romanian, Russian, Spanish, Swedish, and Turkish. Depending on the complexity of the patient’s psychiatric history and his or her ability to clearly describe episodes and symptoms, it takes approximately one to two hours to complete the SCID-I and 30 minutes to an hour to complete the SCID-II. These times tend to be shorter than for other comprehensive assessment instruments of this type.
A version of the SCID for use with children—the KID-SCID—is being developed. This version includes most of the disorders included on the SCID-I and SCID-II as well as many childhood disorders, including disruptive behavior disorders and separation anxiety disorders. Future development of the KID-SCID will include eating disorders and Tourette’s disorder.
Reliability —The degree to which a psychological test or assessment instrument consistently measures what it is intended to measure.
Structured interview —An interview technique that attempts to increase the reliability of data collection between interviewers by using a standardized, predetermined set of questions or topics.
Validity —The degree to which a psychological test or assessment instrument accurately measures what it is intended to measure.
When determining whether or not a psychological assessment instrument such as the SCID is useful for the purpose for which it is designed, two factors should be considered: the instrument’s reliability and its validity. Reliability is the ability of the assessment instrument to consistently measure the idea or concept it has been designed to measure. Validity is the ability of the instrument to accurately measure what it is intended to measure. Unless a test is reliable, it cannot be valid.
Research studies investigating the reliability of the SCID-I and the SCID-II have shown wide variation in the reliability of the SCID, ranging from poor to good. This may be due to factors such as the varying designs of research studies, training of the individuals administering the SCID, and types of disorders represented in those interviewed.
To determine the validity of assessment instruments such as the SCID, researchers typically look at the agreement between diagnoses made using the instrument and diagnoses using an objective standard. Unfortunately, such an objective standard for mental disorders has yet to be developed. However, given the fact that the reliability of the SCID is not consistent, the validity of the instrument must also be called into question.
While the SCID is used in many diagnostic situations, it is not the only assessment instrument available. Other instruments include the Personality Disorder Examination, Structured Clinical Interview for DSM-IV Personality, Diagnostic Interview for Personality Disorders, Brief Psychiatric Rating Scale, Composite International Diagnostic Interview, and Present State Examination. Researchers and clinicians should choose which assessment instrument to use based on what they are trying to measure and the comparative strengths and weaknesses of the instruments. It should be noted, however, that the lack of objective standards against which to measure validity affects the veracity of the results from all of these instruments, and the problems attendant with using human interviewers affect all interview techniques.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed., Text rev. Washington D.C.: American Psychiatric Association, 2000.
Benjamin, Lorna Smith, and Michael B. First. Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II), User’s Guide. Arlington, VA: American Psychiatric Publishing, 1997.
First, Michael B., Robert L. Spitzer, Miriam Gibbon, and Janet B. W. Williams. Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Clinician Version, User’s Guide. Arlington, VA: American Psychiatric Publishing, 1997.
VandenBos, Gary R., ed. APA Dictionary of Psychology. Washington D.C.: American Psychological Association, 2006.
Rodebaugh, Thomas L., Dianne L. Chambless, Babette Renneberg, and Thomas Fydrich. “The Factor Structure of the DSM-III-R Personality Disorders: An Evaluation of Competing Models.” International Journal of Methods in Psychiatric Research 14.1 (2005): 43–55.
Smith, Douglas C., Diane L. Huber, and James A. Hall. “Psychometric Evaluation of the Structured Clinical Interview for DSM-IV Childhood Diagnoses (KID-SCID).” Journal of Human Behavior in the Social Environment 11.3–4 (2005): 1–21.
Ruth A. Wienclaw, PhD