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Structured Clinical Interview for DSM-IV (SCID)

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DOI: 10.1007/978-981-287-087-2_80-1

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S
Structured Clinical Interview
for DSM-IV (SCID)
Deborah R. Glasofer1,2, Amanda J. Brown1,2 and
Melissa Riegel2
1
Department of Psychiatry, Columbia University
College of Physicians and Surgeons, New York,
NY, USA
2
Division of Clinical Therapeutics, New York
State Psychiatric Institute, New York, NY, USA
Definition
The Structured Clinical Interview for Diagnostic
and Statistical Manual of Mental Disorders
(DSM; SCID) is a widely used semi-structured
interview intended to determine whether an indi-
vidual meets criteria for any DSM disorder. The
most recent versions of this measure parallel
DSM-IV (American Psychiatric Association
1994) Axis I and II diagnoses (SCID-IV; First
et al. 2002a) and DSM-5 (American Psychiatric
Association 2013) diagnoses (SCID-5; First
et al. 2015).
Historical Background
Development
The SCID was developed and piloted in the years
following the publication of the DSM-III
(c. 1980; Spitzer et al. 1992). Directly linked to
# Springer Science+Business Media Singapore 2015
T. Wade (ed.), Encyclopedia of Feeding and Eating Disorders,
DOI 10.1007/978-981-287-087-2_80-1
the existing diagnostic criteria, the measure
offers a way for clinicians to adhere to a set
format while tailoring probes to the patient’s
understanding, asking additional questions to
clarify differential diagnosis, and evaluating
whether the description of a symptom offered
by the patient aligns with the intent of the diag-
nostic criterion. The SCID has consistently
included modules that reflect the range of cur-
rently recognized psychiatric diagnoses, includ-
ing eating disorders.
The SCID can be used for multiple purposes:
as part of intake procedures in clinical, forensic,
or research evaluations; to select a study popula-
tion; to describe a study population in terms of
current and past psychiatric diagnoses; and to
teach or improve the diagnostic interviewing
skills of mental health professionals. Given
these varied uses, different versions of the
SCID-IV are available for researchers (First
et al. 2002a), for clinicians (First et al. 1996),
and for use with community samples (First
et al. 2002b). Research, clinician, and clinical
trial versions of the SCID-5 became available as
of 2015 (http://www.appi.org/pages/scid-5.
aspx).
Overall Content
The SCID assesses both current and lifetime
diagnoses and prompts the interviewer to docu-
ment age of illness onset and to rate current
illness severity.
2 Structured Clinical Interview for DSM-IV (SCID)
The interview begins with an overview section
in which basic demographic information is
obtained and the chief complaint is established.
The patient is then prompted to describe the his-
tory of present illness, past episodes of psychiat-
ric disturbance, treatment history, and current
functioning.
Following this section of open-ended
questioning, the interviewer proceeds to the
diagnostic modules, where questions related to
diagnostic criteria are asked in a close-ended
(i.e., yes/no) fashion. Specific follow-up ques-
tions are then asked to allow the patient to elab-
orate on or clarify initial responses. As described
by the authors of the original SCID interview,
“A fundamental principle of the SCID is that,
although the interviewer is asking one or more
structured questions about each diagnostic crite-
rion, the ratings are of the criteria, and not nec-
essarily the answers to the questions. If the
interviewer suspects that a particular symptom
is present, he or she does not allow a subject’s
denial of the symptom to go unchallenged”
(Spitzer et al. 1992).
Questions are grouped by diagnosis and
criteria. Within each diagnosis, if a required cri-
terion or series of criteria is not met, the inter-
viewer is instructed to skip the remaining
questions for that diagnosis. Thus, items of no
diagnostic significance for a particular case are
passed over. This approach allows the inter-
viewer to make diagnoses as the interview
progresses.
The SCID-IV for Axis I includes modules
assessing mood disorders, psychotic disorders,
substance use disorders, anxiety disorders,
somatoform disorders, eating disorders, and cur-
rent adjustment disorder. The SCID-5 for Axis
I covers mood disorders, psychotic disorders,
substance use disorders, anxiety disorders,
obsessive-compulsive and related disorders,
sleep-wake disorders, feeding and eating disor-
ders, somatic symptom and related disorders,
externalizing disorders, and trauma- and
stressor-related disorders. Interviewers are per-
mitted to skip modules that may not be necessary
or relevant for their purposes.
Current Knowledge
Feeding and Eating Disorder Content
Consistent with DSM-IV eating disorder diag-
nostic structure, the SCID-IV eating disorder sec-
tion assesses the presence of symptoms required
for a diagnosis of anorexia nervosa, bulimia
nervosa, and binge eating disorder.
The SCID-5 assesses the diagnostic criteria for
four eating disorder diagnoses recognized in the
latest iteration of the DSM: anorexia nervosa,
bulimia nervosa, binge eating disorder, and
other specified feeding and eating disorders
(OSFED; e.g., atypical anorexia nervosa, purging
disorder).
The SCID-5 contains an optional module to
assess avoidant-restrictive food intake disorder
(ARFID) but does not assess pica or rumination
disorder.
Administration and Scoring
To conduct the SCID, interviewers read manda-
tory probes that include suggested follow-up
items designed to evaluate a specific diagnostic
criterion. The SCID uses a decision tree approach
(i.e., extensive skip logic) that prompts the inter-
viewer to skip subsequent questions, or whole
diagnostic sections, when sufficient criteria are
not met to warrant further questioning.
Scoring the SCID occurs in stages as the inter-
view proceeds. It can typically be done in a few
minutes by the interviewer after administration of
each module.
Ideally, the SCID is completed by an inter-
viewer with sufficient clinical knowledge to com-
plete a thorough diagnostic evaluation in the
absence of a structured interview (First
et al. 2008). However, those with less knowledge
or experience can administer the SCID provided
they receive appropriate training, have been
observed by a qualified interviewer, and receive
supervision in which their questions can be
answered by an experienced clinician. With ade-
quate training, excellent inter-rater reliability can
be achieved regardless of the interviewer’s level
of experience (Ventura et al. 1998).
Information about the SCID and related train-
ing DVDs can be found at http://www.scid5.org/
Structured Clinical Interview for DSM-IV (SCID)
or by contacting the authors at scid5@columbia.
edu. The SCID-5 must be purchased through the
American Psychiatric Publishing Inc.’s website:
http://www.appi.org/products/structured-clinical-
interview-for-dsm-5-scid-5. Pricing is based on
the intended use of the measure.
Psychometrics
The reliability of the SCID has been assessed
using one of two methods: by comparing two or
more independent ratings of a single interview or
by having the same patient interviewed by inde-
pendent raters at two different time points. The
first method has typically led to higher reliability
scores (kappa values of 0.60–1.0), as all raters
hear the same story and are aware of the inter-
viewer’s decisions regarding skips and follow-up
questions. Reliability is generally weaker when
using the second method (kappa values of
0.40–0.85), as patients may provide different
responses to the same questions at different time
points. Two independent studies have found fair
to good test-retest reliability of eating disorder
diagnoses in patient samples, and one study has
found good to excellent inter-rater reliability for
anorexia nervosa and bulimia nervosa diagnoses
in a patient sample. For a listing of specific stud-
ies, see http://www.scid4.org/. Reliability and
validity data for the SCID-5 has not been
published to date.
The validity of the SCID has been assessed by
comparing diagnoses assigned on the basis of the
interview to those given by expert diagnosticians
using data collected over time. Several studies
have demonstrated superior validity of the SCID
over standard clinical intake interviews (for spe-
cific studies, see http://www.scid4.org/). No stud-
ies have reported the validity of eating disorder
diagnoses based on the SCID-5.
Strengths and Limitations
The SCID has several strengths, including
(1) generating diagnoses based on DSM criteria;
(2) strong empirical support for its reliability,
although additional data will be needed for the
DSM-5 version; and (3) an eating disorder
3
module that can be administered and scored rel-
atively quickly.
There are also two key improvements from the
SCID-IV to the SCID-5.
First, specific questions to establish impairment
have been added to the OSFED section. These
include questions assessing how eating symp-
toms have affected functioning in relation-
ships, at work or school, and at home, as well
as the degree to which the individual is both-
ered by the symptoms. This information helps
the interviewer to distinguish between an eat-
ing disorder and non-eating disorder diagno-
sis, using the impairment and distress
guidelines provided in the DSM-5 definition
of a mental disorder (American Psychiatric
Association 2013, p. 20).
Second, guidance on assigning severity catego-
ries for anorexia nervosa (based on a table of
adult heights and weights for each severity
category) and bulimia nervosa (based on fre-
quency of compensatory behaviors) has also
been included in the updated version.
In general, limitations of the SCID include its
cost and its extensive skip logic, which can result
in the potential loss of meaningful clinical infor-
mation that might be of interest to clinicians or
researchers. The duration of the interview is highly
variable and typically dependent on the number of
modules administered and the number of symp-
toms endorsed. The assessment of an uncompli-
cated problem may take as little as 20 min, while
cases with a high degree or diagnostic complexity
or comorbidity can take as long as 2 h.
The SCID-5 has several specific limitations
with regard to diagnostic information captured.
Although it assesses the presence of an eating
disorder, it does not ask about feeding disorder
symptoms (i.e., pica, rumination disorder) and
does not attempt to determine with precision the
individual’s BMI or the particular frequencies of
a range of behavioral disturbances such as objec-
tive and subjective binge eating episodes. Also,
because the ARFID module is optional and there-
fore may not be routinely administered, limited
data will be collected to enhance understanding
4 Structured Clinical Interview for DSM-IV (SCID)
of this nascent diagnostic category. Finally, the
options available for designating other specified
feeding and eating disorder diagnoses include a
list of possible clinical presentations but lack
prompts to guide the interviewer.
Future Directions
A psychometric update of the SCID using the
newest version is warranted, as is cross-
validation of the SCID-5 with other feeding and
eating disorder-specific semi-structured inter-
view measures such as the Eating Disorder
Assessment for DSM-5 (feeding and eating dis-
orders) and the Eating Disorder Examination
(eating disorders only), as well as questionnaire
measures (e.g., Eating Disorder Diagnostic
Scale). Researchers and clinicians alike might
also benefit from the development of an elec-
tronic application of the SCID-5, which could
automate the extensive skip rule logic.
Cross-References
▶ Assessment Burden
▶ Choosing an Instrument/Method
▶ Eating Disorder Assessment for DSM-5
▶ Eating Disorder Diagnostic Scale
▶ Eating Disorder Examination
▶ Purpose of Assessment
▶ Severity Dimensions
▶ Thresholds for Clinical Significance
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References and Further Reading
American Psychiatric Association. (2013). Diagnostic
and statistical manual of mental disorders (5th ed.).
Arlington, VA: American Psychiatric Publishing.
First, M. B., Spitzer, R. L., Gibbon, M., & Williams,
J. B. W. (1996). Structured clinical interview for
DSM-IV axis I disorders, clinician version
(SCID-CV). Washington, DC: American Psychiatric
Press.
First, M. B., Spitzer, R. L., Gibbon, M., & Williams,
J. B. W. (2002a). Structured clinical interview for
DSM-IV-TR axis I disorders, research version, patient
edition. (SCID-I/P). New York: Biometrics Research,
New York State Psychiatric Institute.
First, M. B., Spitzer, R. L., Gibbon, M., & Williams,
J. B. W. (2002b). Structured clinical interview for
DSM-IV-TR axis I disorders, research version,
non-patient edition. (SCID-I/NP). New York: New
York State Psychiatric Institute.
First, M. B., Spitzer, R. L., Gibbon, M., & Williams,
J. B. W. (2008). Structured clinical interview for
DSM-IV axis I disorders (SCID-I). In A. J. Rush,
M. B. First, & D. Blacker (Eds.), Handbook of psychi-
atric measures. Washington, DC: American Psychiat-
ric Publishing.
First, M. B., Williams, J. B. W., Karg, R. S., & Spitzer,
R. L. (2015). Structured clinical interview for DSM-5-
research version (SCID-5 for DSM-5, research ver-
sion; SCID-5-RV, version 1.0.0). Arlington: American
Psychiatric Association.
Spitzer, R. L., Williams, J. B. W., Gibbon, M., & First,
M. B. (1992). The structured clinical interview for
DSM-III-R (SCID) I: History, rationale, and descrip-
tion. Archives of General Psychiatry, 49(8), 624–629.
Structured Clinical Interview for DSM Disorders (SCID).
Resource document. www.scid5.org/index.html.
Accessed 22 Apr 2015.
Ventura, J., Liberman, R. P., Green, M. F., Shaner, A., &
Mintz, J. (1998). Training and quality assurance with
the structured clinical interview for DSM-IV (SCID-I/
P). Psychiatry Research, 79(2), 163–173.