Anticipation and Delivery of a Personality Disorder Diagnosis in Psychiatry

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 anticipa-
tion 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 anticipa-
tory 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