A Common Metric for Self-Reported Severity of Personality Disorder
TL;DR: In this paper, a common metric across 6 widely used self-report measures of personality disorder severity using item response theory models is established, which may facilitate instrument-independent assessment of severity of personality disorders and increase comparability across studies.
Abstract: 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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TL;DR: While latent structure, reliability, and criterion validity were ascertained in the original and in two separate validation samples, results suggest further modifications for capturing ICD-11 Anankastia.
Abstract: 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.
46 citations
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...This is in line with Zimmermann et al. (2020) who demonstrated that PID5BF+ total scores can be used as an indicator of PD severity....
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TL;DR: In this paper, the authors developed and evaluated the 14-item Personality Disorder Severity ICD-11 (PDS-ICD-11) scale and found that a score of 17.5 may serve as a benchmark for pronounced dysfunction.
Abstract: Aim No measure has formally been developed to assess the published ICD-11 model of Personality Disorder (PD) severity. We therefore set out to develop and evaluate the 14-item Personality Disorder Severity ICD-11 (PDS-ICD-11) scale. Method A representative U.S. community sample (N = 428; 50.9% women) and a New Zealand mental health sample (N = 87; 61.5% women) completed the PDS-ICD-11 scale along with a series of established PD and impairment measures. Results Item response theory supported the unidimensionality of PDS-ICD-11 (median item loading of 0.68) and indicated that a PDS-ICD-11 score of 17.5 may serve as a benchmark for pronounced dysfunction. Correlation and regression analyses supported both criterion validity and incremental validity in predicting impairment and PD symptoms. The PDS-ICD-11 was particularly associated with measures of Level of Personality Functioning Scale (LPFS), Global PD severity, and Borderline PD symptom score. A comparison between clinical individuals diagnosed with an ICD-11 PD vs. no PD supported diagnostic validity. Conclusion This initial construction study suggests that the PDS-ICD-11 constitutes a promising instrument that provides a quick impression of the severity of personality dysfunction according to the official ICD-11 PD guidelines. Clearly, more research is needed to corroborate its validity and utility. The PDS-ICD-11 scale is provided as online supporting information.
32 citations
TL;DR: The Reflective Functioning Questionnaire (RFQ) is an 8-item self-report measure of reflective functioning that is presumed to capture individual differences in hypo- and hyper-mentalizing.
Abstract: The Reflective Functioning Questionnaire (RFQ) is an 8-item self-report measure of reflective functioning that is presumed to capture individual differences in hypo- and hypermentalizing. Despite its broad acceptance by the field, we argue that the validity of the measure is not well-established. The current research elaborates on problems of the RFQ related to its item content, scoring procedure, dimensionality, and associations with psychopathology. We tested these considerations across three large clinical and non-clinical samples from Germany and the US (total N = 2289). In a first study, we found that the RFQ may assess a single latent dimension related to hypomentalizing but is rather unlikely to capture maladaptive forms of hypermentalizing. Moreover, the RFQ exhibited very strong associations with measures of personality pathology, while associations with measures of symptom distress were less strong. In a second preregistered study focused on convergent and discriminant validity, however, a commonality analysis indicated that associations with indicators of personality pathology are inflated because some of the RFQ items tap into emotional lability and impulsivity rather than mentalizing. Our findings demonstrate limitations of the RFQ. We discuss key challenges in assessing mentalizing via self-report.
24 citations
TL;DR: The new ICD-11 system as discussed by the authors introduces a fully dimensional classification of personality disorders representing a fundamental change in personality disorder diagnosis with major implications for clinical practice and research, which converges with long-standing psychoanalytic/psychodynamic conceptualizations of personality pathology.
Abstract: The new ICD-11 introduces a fully dimensional classification of personality disorders representing a fundamental change in personality disorder diagnosis with major implications for clinical practice and research. The new system centers on the evaluation of the severity of impairment in the areas of self and interpersonal functioning. This focus on personality functioning converges with long-standing psychoanalytic/psychodynamic conceptualizations of personality pathology. In a detailed conceptual analysis and review of existing empirical data, points of convergence and notable differences between major exponents of the psychodynamic tradition – object relations theory as developed by Kernberg and colleagues and the Operationalized Psychodynamic Diagnosis – and the ICD-11 system are critically discussed. Personality functioning can be considered to be the current “common ground” for the assessment of personality disorders and constitutes a considerable step forward in making personality disorder diagnosis both clinically meaningful and suitable for research purposes.
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TL;DR: Copyright (©) 1999–2012 R Foundation for Statistical Computing; permission is granted to make and distribute verbatim copies of this manual provided the copyright notice and permission notice are preserved on all copies.
Abstract: Copyright (©) 1999–2012 R Foundation for Statistical Computing. Permission is granted to make and distribute verbatim copies of this manual provided the copyright notice and this permission notice are preserved on all copies. Permission is granted to copy and distribute modified versions of this manual under the conditions for verbatim copying, provided that the entire resulting derived work is distributed under the terms of a permission notice identical to this one. Permission is granted to copy and distribute translations of this manual into another language, under the above conditions for modified versions, except that this permission notice may be stated in a translation approved by the R Core Team.
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TL;DR: In this article, the adequacy of the conventional cutoff criteria and several new alternatives for various fit indexes used to evaluate model fit in practice were examined, and the results suggest that, for the ML method, a cutoff value close to.95 for TLI, BL89, CFI, RNI, and G...
Abstract: This article examines the adequacy of the “rules of thumb” conventional cutoff criteria and several new alternatives for various fit indexes used to evaluate model fit in practice. Using a 2‐index presentation strategy, which includes using the maximum likelihood (ML)‐based standardized root mean squared residual (SRMR) and supplementing it with either Tucker‐Lewis Index (TLI), Bollen's (1989) Fit Index (BL89), Relative Noncentrality Index (RNI), Comparative Fit Index (CFI), Gamma Hat, McDonald's Centrality Index (Mc), or root mean squared error of approximation (RMSEA), various combinations of cutoff values from selected ranges of cutoff criteria for the ML‐based SRMR and a given supplemental fit index were used to calculate rejection rates for various types of true‐population and misspecified models; that is, models with misspecified factor covariance(s) and models with misspecified factor loading(s). The results suggest that, for the ML method, a cutoff value close to .95 for TLI, BL89, CFI, RNI, and G...
76,383 citations
Journal Article•
TL;DR: Diagnostic and statistical manual of mental disorders (DSM-5) was translated by psychiatrists and psychologists, mainly from the University psychiatric hospital Vrapce and published by the Naklada Slap publisher.
Abstract: Title: Diagnostic and statistical manual of mental disorders (DSM-5) Author: American Psychiatric Association Editors of Croatian Edition: Vlado Jukic, Goran Arbanas ISBN: 978-953-191-787-2 Publisher: Naklada Slap, Jastrebarsko, Croatia Number of pages: 936Diagnostic and statistical manual of mental disorders is a national classification, but since its third edition it became a worldwide used manual. [1] It has been published by the American Psychiatric Association and two years ago the fifth edition was released. [2] Croatian was among the first languages this book was translated to. [3] DSM-5 was translated by psychiatrists and psychologists, mainly from the University psychiatric hospital Vrapce and published by the Naklada Slap publisher.DSM has always been more publicly debated than the other main classification - the International Classification of Diseases (ICD). [4] The same happened with this fifth edition. Even before it was released, numerous individuals, organizations, groups and associations were publicly speaking about the classification, new diagnostic entities and changing criteria. [5]Although there is a tendency of authors of both DSM and ICD to synchronize these two classifications and to make them more harmonized with each new edition, there are several differences among them. While ICD covers all the diseases, disorders and reasons for making a contact with the health system, DSM covers "only" mental disorders. Other disorders (medical conditions, as they are named in DSM-5) are not included, except in situations when they lead to a development of a mental disorder. The other main difference is that DSM is more operational zed, and gives criteria for each of the disorders, listing how many criteria have to be met to make a diagnosis of a particular disorder, and what excluding criteria are.Due to the fact that it is used all around the globe and since it has become the most used psychiatric manual, it is sometimes said that DSM is a "psychiatric Bible". [6]Some critics of DSM say that it stigmatizes people and that in each edition it includes more diagnostic entities. It is true that in each edition of DSM there are more disorders listed, but this is due to the fact that medicine is a developing area and new insights are made every year, so some disorders are separated into different subtypes or subgroups and different new diagnoses, giving the impression more behaviour are being pathologized. The intention of the authors was to make more homogenous groups. But, the truth is that, compared with ICD, it is more difficult to get a diagnosis in DSM, than in ICD, with the same clinical presentation. [7] DSM requires functional impairment or distress to pathologize behaviour, while in ICD this criterion is not present in every case.During the process of developing DSM-5 there was an open public discussion. [2] For over a year any person was able to participate in the discussion about future criteria, inclusion or exclusion of diagnostic entities from DSM. More than 21000 letters was sent to the authors. This was the unprecedented way of developing a classification that ICD now tries to follow in preparation of its 11th edition.As a direct consequence of such an open and wide discussion, some new disorders were included (e.g. hoarding disorder), some were excluded even though they were included during the proposal period (e.g. hypersexual disorders), some were heavily debated (e.g. narcissistic personality disorder). [8-10]As previously mentioned, DSM and ICD systems try to harmonize more. There were more non-American authors included in DSM-5 than ever before and some of the experts in the field were in the task force of DSM-5 and ICD-11. [2, 11]What is new in DSM-5, compared to DSM-IV. The organization of the chapters has been changed, so now the flow of the disorders follow life cycle. The book starts with neurodevelopmental disorders, followed by schizophrenia, bipolar and depressive disorders, and closing with neurocognitive disorders. …
15,478 citations
TL;DR: In this article, the authors considered the problem of estimating latent ability using the entire response pattern of free-response items, first in the general case and then in the case where the items are scored in a graded way, especially when the thinking process required for solving each item is assumed to be homogeneous.
Abstract: Estimation of latent ability using the entire response pattern of free-response items is discussed, first in the general case and then in the case where the items are scored in a graded way, especially when the thinking process required for solving each item is assumed to be homogeneous.
The maximum likelihood estimator, the Bayes modal estimator, and the Bayes estimator obtained by using the mean-square error multiplied by the density function of the latent variate as the loss function are taken as our estimators. Sufficient conditions for the existence of a unique maximum likelihood estimator and a unique Bayes modal estimator are formulated with respect to an individual item rather than with respect to a whole set of items, which are useful especially in the situation where we are free to choose optimal items for a particular examinee out of the item library in which a sufficient number of items are stored with reliable quality controls.
Advantages of the present methods are investigated by comparing them with those which make use of conventional dichotomous items or test scores, theoretically as well as empirically, in terms of the amounts of information, the standard errors of estimators, and the mean-square errors of estimators. The utility of the Bayes modal estimator as a computational compromise for the Bayes estimator is also discussed and observed. The relationship between the formula for the item characteristic function and the philosophy of scoring is observed with respect to dichotomous items.
3,031 citations
TL;DR: A plot of the difference against the average of the standard and new measurements is unlikely to mislead in this way and is shown theoretically and by a practical example.
2,248 citations