Understanding Types of Clinical Interviews

Structured Clinical Interviews and Clinical Diagnostic Interviews

Fragile woman in counselling session
What is a clinical interview, what types are there, and why are these important in the diagnosis of mental health conditions?. jeangill/Getty Images

A clinical interview is a tool that helps physicians, psychologists and researchers make an accurate diagnosis of a variety of mental illnesses, such as obsessive-compulsive disorder (OCD). There are two common types: Structured clinical interviews and clinical diagnostic interviews.

Structured Clinical Interviews

The gold standard for structured clinical interviews is the Structured Clinical Interview for DSM-5, also known as SCID.

It is a semi-structured interview guide which is administered by a psychologist or other mental health professional who is familiar with the diagnostic criteria of mental health conditions.

The Purpose of the Structured Clinical Interview

Structured clinical interviews have a variety of uses, including assessing patients in order to make a diagnosis based on the Diagnostic and Statistical Manual of Mental Health Disorders, 5th Edition (DSM-5); for research to study certain groups of people who all have the same symptoms; for clinical trials; or for students who are going into the mental health field to practice in order to become better interviewers. SCIDs can also help determine if you have more than one illness. They contain standardized questions to ensure that each patient is interviewed in the same way.  

Since many of the questions concerning diagnostic criteria are subjective (in comparison, for example, to the number on a blood test which may be used to diagnose a physical disorder), a standardized guide such as this helps to make sure studies are looking at people with the same general symptoms.

In other words, it helps to make a largely subjective diagnosis a little more objective.

Types of Questions on the Structured Clinical Interview

The questions on the SCID range from asking about your family and medical history to your illnesses and current complaints, as well as the nature, severity and duration of symptoms you have experienced.

The questions get very detailed and specific, but not all questions will need answers since the SCID covers a broad range of illnesses, most of which you probably do not have. 

A SCID can take anywhere from 15 minutes to several hours to complete, depending on the severity and types of your symptoms.

Questions that you may be asked during a structured clinical interview that are specifically about OCD include:

  • What are the specific details of your obsessions and compulsions?
  • How long have you had these obsessions and compulsions?
  • How have these obsessions and compulsions affected your life?
  • Did your symptoms start after a new illness or taking a new drug?
  • Were you physically sick before you started having obsessions and/or compulsions?
  • Were you using drugs before you started having obsessions and/or compulsions?
  • How old were you when these symptoms started?

Clinical Diagnostic Interviews

Another valid way to assess and/or diagnose a mental illness is by using a clinical diagnostic interview (CDI).

CDIs are different in that they involve a conversation, or narrative, between the mental health professional and the patient instead of a list of standardized questions like the SCID has. This interview takes about two and a half hours and the mental health professional doing the interview will likely take notes as you talk. A symptom checklist might also be used along with the CDI to help the interviewer make a diagnosis. 

Types of Questions on the Clinical Diagnostic Interview

The questions on a CDI are much more broad and leave you room give details. Examples of questions are:

  • What was your childhood like?
  • What is your relationship with your mother/father/siblings like?
  • What was school like for you?
  • What sort of friendships did you have as a child?
  • What have your romantic relationships been like?
  • What is your job and how long have you done it?

Is One Type of Clinical Interview More Valid Than Another?

No. A recent study showed that both interview methods are equally valid and useful. Which method a clinician uses will likely depend on the standard at their organization and/or personal preference. 

Bottom Line on Clinical Interviews

Regardless of which interview method your therapist recommends to determine if you are coping with obsessive compulsive disorder or another mental health condition, it is extremely important that a thorough method of diagnosis such as this is used.

Too often, a mental health diagnosis is made without the help of these tools. With the information available on the Internet, people are increasingly self-diagnosing mental health conditions. And with a shortage of mental health providers (plus constraints on time and charges placed by 3td party payers), this step is sometimes inappropriately streamlined.

Considering the great effect that OCD and other mental health disorders can have on a person's life, it is imperative that these initial diagnostic interviews are not skipped over. Making a precise diagnosis is helpful in determining the type of treatments and therapies which have found to be most effective in clinical studies for that particular diagnosis. It is also very important to conduct these interviews to get a baseline as to how much the condition is interfering with your life. Progress in mental health can sometimes be slow, and is often the proverbial three steps forward and two steps back. Understanding exactly what you were coping with at the time you were diagnosed can help your therapist determine if your current therapy plan is working, or if a different approach is needed.

Sources:

Drill, R., Nakash, O., DeFife, J., and D. Westen. Assessment of Clinical Information: Comparison of the Validity of a Structured Clinical Interview (the SCID) and the Clinical Diagnostic Interview. Journal of Nervous and Mental Disorders. 2015. 203(6):459-62.

Rapp, A., Bergman, L., Piacentini, J., and J. McGuire. Evidence-Based Assessment of Obsessive-Compulsive Disorder. Journal of Central Nervous System Disease. 2016. 8:13-29.

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