Psychologists, Heal Thyselves

One professor’s challenge to his profession

Mental health professionals are well aware of the fact that there is often a discrepancy between what people say and what they do. So why do they rely on patients’ responses to questionnaires as the foundation for most classifications in their field’s authoritative reference, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)?

That’s the question Robert Bornstein, Ph.D., professor in the Gordon F. Derner School of Psychology, has been asking for close to 20 years, most recently in an address, “What We Say and What We Do,” that he delivered as president of the Society for Personality Assessment.

“Psychology has developed an unhealthy reliance on self-report,” Dr. Bornstein explained. “Between 60 to 80 percent of the personality disorder symptom criteria in the DSM are based exclusively on questionnaires, which is a big problem. Self-reports bear little resemblance to what people do; in fact, they tend to correlate with actual behavior very modestly—at about .20 to .30 in most studies.”

But while the lack of accuracy would seem to make patients’ responses worthless, Dr. Bornstein says that is not necessarily the case. Self-reports are an excellent measure of how people perceive and present themselves—although they must be supplemented with objective information to develop more accurate classifications and deeper understandings, especially in the area of personality disorders like narcissism.

Dr. Bornstein argues that DSM assessments, which serve as a guide to treatments and have an impact on reimbursements for healthcare providers, should also incorporate detailed observations by professionals and others who know the patients well. And he calls for continued research into issues surrounding self-reports, particularly the psychological processes that occur when people choose their answers to questionnaires.

Will the profession address Dr. Bornstein’s concerns about the overreliance on self-reports? “It’s a tough problem to combat,” he said. “People in the field always say, ‘That’s a really good point,’ then move on. No one is willing to get into the ring to fight about it.”