Introduction The DSM-5 Alternative Model of Personality Disorders (AMPD) and the ICD-11 classification of personality disorders (PD) are largely commensurate and, when combined, they delineate 6 trait domains: negative affectivity, detachment, antagonism/dissociality, disinhibition, anankastia, and psychoticism. Objective The present study evaluated the international validity of a brief 36-item patient-report measure that portrays all 6 domains simultaneously including 18 primary subfacets. Methods We developed and employed a modified version of the Personality Inventory for DSM-5 - Brief Form Plus (PID5BF+). A total of 16,327 individuals were included, 2,347 of whom were patients. The expected 6-factor structure of facets was initially investigated in samples from Denmark (n = 584), Germany (n = 1,271), and the USA (n = 605) and subsequently replicated in both patient- and community samples from Italy, France, Switzerland, Belgium, Norway, Portugal, Spain, Poland, Czech Republic, the USA, and Brazil. Associations with interview-rated DSM-5 PD categories were also investigated. Results Findings generally supported the empirical soundness and international robustness of the 6 domains including meaningful associations with familiar interview-rated PD types. Conclusions The modified PID5BF+ may be employed internationally by clinicians and researchers for brief and reliable assessment of the 6 combined DSM-5 and ICD-11 domains, including 18 primary subfacets. This 6-domain framework may inform a future nosology for DSM-5.1 that is more reasonably aligned with the authoritative ICD-11 codes than the current DSM-5 AMPD model. The 36-item modified PID5BF+ scoring key is provided in online supplementary Appendix A see www.karger.com/doi/10.1159/000507589 (for all online suppl. material).

International Assessment of DSM-5 and ICD-11 Personality Disorder Traits: Toward a Common Nosology in DSM-5.1

The Alternative Model for Personality Disorders (AMPD) in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, Section III, presents a new approach to conceptualizing personality psychopathology and diagnosing personality disorders. The Personality Inventory for DSM-5 (PID-5) was designed to measure Criterion B of the AMPD and is composed of 25 lower-order facet trait scales that form 5 higher-order domain trait scales. Although the PID-5 has mostly adequate to strong psychometric qualities, the lower-order factor structure of PID-5 facet scales has shown considerable variability across studies, and several PID-5 facets scales show evidence of interstitiality-the cross-loading of facets onto more than 1 domain. This interstitiality is neither unexpected nor especially problematic because complex models of personality have traits that are by nature interstitial. What is problematic, however, is that the factor loadings of these interstitial facets vary across samples, suggesting that some PID-5 facet scales are likely susceptible to sampling error and sampling variability. Moreover, the magnitude of some cross-loadings in some studies is substantive (i.e., ≥ .30). The objective of the current study was to conduct a meta-analysis of the internal structure of the PID-5 to offset potential variability associated with sampling error and gain a clearer picture of the lower-order structure of PID-5 facet scales. This was accomplished using weighted mean factor loadings of the PID-5 facet scales across 14 independent samples (N = 14,743). Results supported that the level of interstitiality decreased when multiple samples were combined, and a clearer picture of the internal structure of the PID-5 facet scales emerged. (PsycINFO Database Record

A meta-analysis of the five-factor internal structure of the Personality Inventory for DSM–5.

While Diagnostic and Statistical Manual of Mental Disorders-Fifth edition (DSM-5) Section III and ICD-11 (International Classification of Diseases 11th-Revision) both allow for dimensional assessment of personality pathology, the models differ in the definition of maladaptive traits. In this study, we pursued the goal of developing a short and reliable assessment for maladaptive traits, which is compatible with both models, using the item pool of the Personality Inventory for DSM-5 (PID-5). To this aim, we applied ant colony optimization algorithms in English- and German-speaking samples comprising a total N of 2,927. This procedure yielded a 34-item measure with a hierarchical latent structure including six maladaptive trait domains and 17 trait facets, the "Personality Inventory for DSM-5, Brief Form Plus" (PID5BF+). While latent structure, reliability, and criterion validity were ascertained in the original and in two separate validation samples (n = 849, n = 493) and the measure was able to discriminate personality disorders from other diagnoses in a clinical subsample, results suggest further modifications for capturing ICD-11 Anankastia.

https://journals.sagepub.com/doi/pdf/10.1177/1073191120971848

Development of a Short and ICD-11 Compatible Measure for DSM-5 Maladaptive Personality Traits Using Ant Colony Optimization Algorithms.

Introduction: Dimensional models of personality disorders (PD) in the DSM-5 and ICD-11 share a focus on impairments in self and interpersonal functioning to represent the general features and severity of PD. This new perspective has led to the development of numerous measures for assessing individual differences in PD severity. While this improves choices for researchers and practitioners, it also poses the challenge of an increasing lack of standardization. Objective: The aim of this study is to establish a common metric across 6 widely used self-report measures of PD severity using item response theory models. Methods: 849 participants completed a survey including the Inventory of Personality Organization – 16-item version (IPO-16), the Level of Personality Functioning Scale – Brief Form 2.0, the Level of Personality Functioning Scale – Self-Report, the Operationalized Psychodynamic Diagnosis – Structure Questionnaire Short Form, the Personality Inventory for DSM-5 – Brief Form Plus and the Standardized Assessment of Severity of Personality Disorder (SASPD). We fitted exploratory multidimensional graded response models and used bifactor rotation to extract a general factor across measures. Factor scores were linked to representative T scores using data from a representative survey of 2,502 participants who completed the IPO-16. Results: When using bifactor rotation in a 7-factor model, all items loaded positively on the general factor, and the general factor explained 65.5% of the common variance. With the exception of the SASPD, all measures provided highly discriminating items (factor loadings >0.70) for measuring the general factor and reached an acceptable reliability (>0.80) across a wide range of the latent continuum. We constructed a crosswalk table linking total scores of the 6 measures to each other and to representative T scores. Conclusions: Our results suggest that 6 different self-report measures of the severity of PD capture a strong common factor and can therefore be scaled along a single latent continuum. Our results may facilitate instrument-independent assessment of severity of PD and increase comparability across studies.

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A Common Metric for Self-Reported Severity of Personality Disorder

Authoritative classification systems for psychopathology such as the DSM and ICD are shifting toward more dimensional approaches in the field of personality disorders (PDs). In this paper, we provide a brief overview of the dimensionally oriented DSM-5 alternative model of PDs (AMPD). Since its publication in 2013, the AMPD has inspired a substantial number of studies, underlining its generative influence on the field. Generally speaking, this literature illustrates both the reliability and validity of the constructs delineated in the AMPD. The literature also illustrates empirical challenges to the conceptual clarity of the AMPD, such as evidence of substantial correlations between indices of personality functioning (criterion A in the AMPD) and maladaptive personality traits (criterion B in the AMPD). Key future directions pertain to linking the AMPD literature with applied efforts to improve the lives of persons who suffer from PDs, and surmounting challenges germane to the evolution of the DSM itself.

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An Overview of the DSM-5 Alternative Model of Personality Disorders

Both the Alternative DSM-5 Model for Personality Disorders (AMPD) and the chapter on personality disorders (PD) in the recent version of ICD-11 embody a shift from a categorical to a dimensional paradigm for the classification of PD. We describe these new models, summarize available measures, and provide a comprehensive review of research on the AMPD. A total of 237 publications on severity (criterion A) and maladaptive traits (criterion B) of the AMPD indicate (a) acceptable interrater reliability, (b) largely consistent latent structures, (c) substantial convergence with a range of theoretically and clinically relevant external measures, and (d) some evidence for incremental validity when controlling for categorical PD diagnoses. However, measures of criterion A and B are highly correlated, which poses conceptual challenges. The AMPD has stimulated extensive research with promising findings. We highlight open questions and provide recommendations for future research.

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A Brief but Comprehensive Review of Research on the Alternative DSM-5 Model for Personality Disorders.

Major depressive disorder represents (MDD) a major cause of disability and disease burden. Beside antidepressant medication, psychotherapy is a key approach of treatment. Schema therapy has been shown to be effective in the treatment of psychiatric disorders, especially personality disorders, in a variety of settings and patient groups. Nevertheless, there is no evidence on its effectiveness for MDD in an inpatient nor day clinic setting and little is known about the factors that drive treatment response in such a target group. In the current protocol, we outline OPTIMA (OPtimized Treatment Identification at the MAx Planck Institute): a single-center randomized controlled trial of schema therapy as a treatment approach for MDD in an inpatient and day clinic setting. Over the course of 7 weeks, we compare schema therapy with cognitive behavioral therapy and individual supportive therapy, conducted in individual and group sessions and with no restrictions regarding concurrent antidepressant medication, thus approximating real-life treatment conditions. N = 300 depressed patients are included. All study therapists undergo a specific training and supervision and therapy adherence is assessed. Primary outcome is depressive symptom severity as self-assessment (Beck Depression Inventory-II) and secondary outcomes are clinical ratings of MDD (Montgomery-Asberg Depression Rating Scale), recovery rates after 7 weeks according to the Munich-Composite International Diagnostic Interview, general psychopathology (Brief Symptom Inventory), global functioning (World Health Organization Disability Assessment Schedule), and clinical parameters such as dropout rates. Further parameters on a behavioral, cognitive, psychophysiological, and biological level are measured before, during and after treatment and in 2 follow-up assessments after 6 and 24 months after end of treatment. To our knowledge, the OPTIMA-Trial is the first to investigate the effectiveness of schema therapy as a treatment approach of MDD, to investigate mechanisms of change, and explore predictors of treatment response in an inpatient and day clinic setting by using such a wide range of parameters. Insights from OPTIMA will allow more integrative approaches of psychotherapy of MDD. Especially, the identification of intervention-specific markers of treatment response can improve evidence-based clinical decision for individualizing treatment. Identifier on 
clinicaltrials.gov

: 
NCT03287362

; September, 12, 2017

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Schema therapy versus cognitive behavioral therapy versus individual supportive therapy for depression in an inpatient and day clinic setting: study protocol of the OPTIMA-RCT.

The Standardized Assessment of Severity of Personality Disorder (SASPD) is a 9-item self-report screening instrument and was developed to assess personality disorder (PD) severity according to the initial proposal of ICD-11. Our aim was to investigate the psychometric properties of the German version of the SASPD in nonclinical and clinical samples. A total of 1,991 participants (N = 888 from nonclinical and N = 1,103 from clinical samples) provided ratings on the SASPD as well as other measures of psychopathology and personality. We examined the SASPD regarding its factor structure, internal consistency, and construct validity. A unidimensional structure of the SASPD provided inadequate model fit, whereas a 3-factor solution provided good fit in both the nonclinical and clinical samples. Internal consistency of the SASPD total score was acceptable in the clinical and nonclinical samples based on this multifactorial model. In terms of convergent validity, SASPD scores correlated fairly with other measures of PD severity across samples. Discriminant validity with measures of general symptom distress and measures of (normal) personality traits was mixed. In addition, the SASPD scores predicted levels of PD severity above and beyond a measure of symptom distress. The SASPD captures some theoretically expected features of PD severity. However, the multidimensional structure and limited convergent and discriminant validity may hamper future usage of the SASPD as a short screening tool of PD severity according to ICD-11. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

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A Psychometric Evaluation of the Standardized Assessment of Severity of Personality Disorder (SASPD) in Nonclinical and Clinical German Samples

BACKGROUND
Advancements in the treatment of depression are pivotal due to high levels of non-response and relapse. This study evaluated the role of personality pathology in the treatment of depression by testing whether maladaptive personality traits (1) predict changes in depression over treatment or vice versa, (2) change themselves over treatment, (3) change differentially depending on treatment with schema therapy (ST) or cognitive behavioural therapy (CBT), and (4) moderate the effectiveness of these treatments.


METHODS
We included 193 depressed inpatients (53.4% women, Mage = 42.9, SD = 13.4) participating in an assessor-blind randomized clinical trial and receiving a 7-week course of ST or CBT. The research questions were addressed using multiple indicator latent change score models as well as multigroup structural equation models implemented in EffectLiteR.


RESULTS
Maladaptive traits did not predict changes in depressive symptoms at post-treatment, or vice versa. However, maladaptive trait domains decreased over treatment (standardized Δμ range: -0.38 to -0.89), irrespective of treatment with ST or CBT. Maladaptive traits at baseline did not moderate the effectiveness of these treatments.


CONCLUSIONS
Self-reported maladaptive personality traits can change during treatment of depression, but may have limited prognostic or prescriptive value, at least in the context of ST or CBT. These results need to be replicated using follow-up data, larger and more diverse samples, and informant-rated measures of personality pathology.

Katharina Rek

Papers

A Brief but Comprehensive Review of Research on the Alternative DSM-5 Model for Personality Disorders.

Schema therapy versus cognitive behavioral therapy versus individual supportive therapy for depression in an inpatient and day clinic setting: study protocol of the OPTIMA-RCT.

A Psychometric Evaluation of the Standardized Assessment of Severity of Personality Disorder (SASPD) in Nonclinical and Clinical German Samples

Evaluating the role of maladaptive personality traits in schema therapy and cognitive behavioural therapy for depression.