Assessment of Criterion A.
TL;DR: The importance of multi-informant multi-method assessment of, and a longitudinal perspective on PD pathology and the importance of standardized inclusion of PD individuals in studies to increase the significance of research findings are underlined.
Abstract: The diagnostic concept of Personality Disorder (PD) is changing. A dimensional PD concept that focuses on severity of impairment of personality functioning was introduced in the DSM 5 Section III in 2013 and is adopted by the upcoming ICD-11 in a similar manner. Several reliable, valid and useful instruments to assess personality functioning (Criterion A) either as self-report, expert rating or clinical interview were developed in the past years. This article gives a latest state-of-the-art overview of these measures. It underlines the importance of multi-informant multi-method assessment of, and a longitudinal perspective on PD pathology and the importance of standardized inclusion of PD individuals in studies to increase the significance of research findings.
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TL;DR: The concept of personality functioning (Alternative DSM-5 Model of Personality Disorders) has led to increased interest in dimensional personality disorder diagnosis as discussed by the authors, while differing markedly from the current categorical classification, it is closely related to the psychodynamic concepts of personality structure and personality organization.
Abstract: The concept of personality functioning (Alternative DSM-5 Model of Personality Disorders) has led to increased interest in dimensional personality disorder diagnosis. While differing markedly from the current categorical classification, it is closely related to the psychodynamic concepts of personality structure and personality organization. In this review, the three dimensional approaches, their underlying models, and common instruments are introduced, and empirical studies on similarities and differences between the concepts and the categorical classification are summarized. Additionally, a case example illustrates the clinical application. Numerous studies demonstrate the broad empirical basis, validated assessment instruments and clinical usefulness of the dimensional concepts. Their advantages compared to the categorical approach, but also the respective differences, have been demonstrated empirically, in line with clinical observations. Evidence supports the three dimensional concepts, which share conceptual overlap, but also entail unique aspects of personality pathology, respectively.
15 citations
TL;DR: In this article , the authors investigate the categorical and dimensional mean-level and rank-order stability of personality disorders from adolescence into young adulthood in a high-risk sample, which supports the growing evidence that categorical diagnoses of Pds are quite unstable.
Abstract: Background With the implementation of the 11th edition of the International Classification of Diseases (ICD-11) in early 2022, there will be a radical change in the framework and process for diagnosing personality disorders (PDs), indicating a transition from the categorical to the dimensional model. Despite increasing evidence that PDs are not as stable as previously assumed, the long-term stability of PDs remains under major debate. The aim of the current paper was to investigate the categorical and dimensional mean-level and rank-order stability of PDs from adolescence into young adulthood in a high-risk sample. Methods In total, 115 young adults with a history of residential child welfare and juvenile-justice placements in Switzerland were included in the current study. PDs were assessed at baseline and at a 10-year follow-up. On a categorical level, mean-level stability was assessed through the proportion of enduring cases from baseline to follow-up. Rank-order stability was assessed through Cohen’s κ and tetrachoric correlation coefficients. On a dimensional level, the magnitude of change between the PD trait scores at baseline and at follow-up was measured by Cohen’s d. Rank-order stability was assessed through Spearman’s ρ. Results The prevalence rate for any PD was 20.0% at baseline and 30.4% at follow-up. The most frequently diagnosed disorders were antisocial, borderline, and obsessive-compulsive PDs, both at baseline and at follow-up. On a categorical level, the mean-level stability of any PD was only moderate, and the mean-level stability of specific PDs was low, except of schizoid PD. Likewise, the rank-order stability of any PD category was moderate, while ranging from low to high for individual PD diagnoses. On a dimensional level, scores increased significantly for most PDs, except for histrionic traits, which decreased significantly from baseline to follow-up. Effect sizes were generally low. The rank-order stability for dimensional scores ranged from low to moderate. Conclusion The findings indicate low to moderate stability of Pds and Pd traits from adolescence to adulthood, which supports the growing evidence that categorical diagnoses of Pds are quite unstable. This in turn, emphasizes the use of the upcoming ICD-11 that Acknowledgments Pds to be only “relatively” stable.
7 citations
TL;DR: In this paper, the authors examined the validity of ICD-11 personality functioning, as measured by the Level of Personality Functioning Scale-Self-Report (LPFS-SR), by evaluating its associations with the Structured Interview of Personality Organization-Revised (STIPO-R) in Kurdistan region.
Abstract: The current classification of personality disorder in ICD-11 includes a description of personality functioning, derived from a number of theoretical paradigms, but most notably consistent with the psychodynamic approach. Concurrently, an object-relations model of personality functioning in a dimensional assessment of severity is provided in the Structured Interview of Personality Organization-Revised (STIPO-R). To date, there are no published measures of International Classification of Diseases-11 (ICD-11) personality severity, though the construct is very comparable to the concepts assessed in the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) levels of personality functioning concept, which is measured by the Level of Personality Functioning Scale-Self-Report (LPFS-SR). This study examined the validity of ICD-11 personality functioning, as measured by the LPFS-SR, by evaluating its associations with the STIPO-R in Kurdistan region. The samples included 231 University students and 419 inpatient participants across four hospitals (267 with a diagnosed personality disorder). All the components of LPFS-SR and STIPO-R were positively and significantly intercorrelated. The components of each measure discriminated PD and non-PD patients from a University, non-clinical group adequately. Despite slightly better performance of the STIPO-R in this discrimination, the measures had a high congruence in predicting personality dysfunction. Overall, the findings of the present study support the validity of ICD-11 construct for evaluating personality functioning.
6 citations
TL;DR: In this article , the authors investigated the factorial structure of the LoPF-Q 12-18 (Levels of Personality Functioning Questionnaire) and developed a short version to meet the need of efficient screening for personality disorder in clinical and research applications.
Abstract: The LoPF-Q 12-18 (Levels of Personality Functioning Questionnaire) was designed for clinical use and to promote early detection of personality disorder (PD). It is a self-report measure with 97 items to assess personality functioning in adolescents from 12 years up. It operationalizes the dimensional concept of personality disorder (PD) severity used in the Alternative DSM-5 Model for Personality Disorders and the ICD-11. In this study, we investigated the factorial structure of the LoPF-Q 12-18. Additionally, a short version was developed to meet the need of efficient screening for PD in clinical and research applications. To investigate the factorial structure, several confirmatory factor analysis models were compared. A bifactor model with a strong general factor and four specific factors showed the best nominal fit (CFI = .91, RMSEA = .04, SRMR = .07). The short version was derived using the ant colony optimization algorithm. This procedure resulted in a 20-item version with excellent fit for a hierarchical model with four first order factors to represent the domains and a secondary higher order factor to represent personality functioning (CFI = .98, RMSEA = .05, SRMR = .04). Clinical validity (effect size d= 3.1 between PD patients and controls) and clinical utility (cutoff >= 36 providing 87.5% specificity and 80.2% sensitivity) for detecting patients with PD were high for the short version. Both, the long and short LoPF-Q 12-18 version are ready to be used for research and diagnostic purposes.
5 citations
TL;DR: In this article , the authors investigated the factorial structure of the LoPF-Q 12-18 (Levels of Personality Functioning Questionnaire) and developed a short version to meet the need of efficient screening for personality disorder in clinical and research applications.
Abstract: The LoPF-Q 12–18 (Levels of Personality Functioning Questionnaire) was designed for clinical use and to promote early detection of personality disorder (PD). It is a self-report measure with 97 items to assess personality functioning in adolescents from 12 years up. It operationalizes the dimensional concept of personality disorder (PD) severity used in the Alternative DSM-5 Model for Personality Disorders and the ICD-11. In this study, we investigated the factorial structure of the LoPF-Q 12–18. Additionally, a short version was developed to meet the need of efficient screening for PD in clinical and research applications. To investigate the factorial structure, several confirmatory factor analysis models were compared. A bifactor model with a strong general factor and four specific factors showed the best nominal fit (CFI = .91, RMSEA = .04, SRMR = .07). The short version was derived using the ant colony optimization algorithm. This procedure resulted in a 20-item version with excellent fit for a hierarchical model with four first order factors to represent the domains and a secondary higher order factor to represent personality functioning (CFI = .98, RMSEA = .05, SRMR = .04). Clinical validity (effect size d = 3.1 between PD patients and controls) and clinical utility (cutoff ≥ 36 providing 87.5% specificity and 80.2% sensitivity) for detecting patients with PD were high for the short version. Both, the long and short LoPF-Q 12–18 version are ready to be used for research and diagnostic purposes.
4 citations
References
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11 Jun 2013
113,134 citations
TL;DR: The weight of empirical evidence has led the DSM-5 and the UK and Australian national treatment guidelines to “legitimize” the diagnosis of BPD prior to age 18 and the “first wave” of evidence-based treatments has demonstrated that structured treatments for BPD in young people are effective.
208 citations
TL;DR: Preliminary reliability and validity data is provided for a measure that directly corresponds to core personality pathology as operationalized in the AMPD, and items representing the 4 subcomponents of personality dysfunction were found to manifest high degrees of internal consistency.
Abstract: The DSM-5 presents an Alternative Model for Personality Disorder (AMPD) recommending the assessment of impairments in core personality functions as well as clinically relevant personality traits. Although a self-report assessment instrument has been provided corresponding to the trait model proposed in the AMPD, no comparable instrument provides a direct assessment of the specific indicators of core personality functions described in that model. The goal of this paper is to provide preliminary reliability and validity data for a measure that directly corresponds to core personality pathology as operationalized in the AMPD. Self-report questions were generated to capture each diagnostic indicator provided in the Level of Personality Functioning Scale, a clinician rating guide provided in the AMPD that describes characteristic impairments in identity, self-direction, empathy, and intimacy at 5 different levels of personality functioning. These questions were administered to a community sample of 306 participants, with the resulting scale examined for internal consistency, unidimensionality, and concurrent validity with 4 other self-report measures of global personality dysfunction. Items representing the 4 subcomponents of personality dysfunction were found to manifest high degrees of internal consistency, and were highly related to each other, supporting the AMPD contention that these core dysfunctions reflect a single dimension of personality dysfunction. Correlations with concurrent validity measures were large, with associations at the global level of dysfunction often exceeding .80. The developed instrument is reprinted in the supplementary materials, with the goal of encouraging additional refinement and development by other investigators as part of the call for additional research on the AMPD. (PsycINFO Database Record
158 citations
TL;DR: Both the Alternative DSM-5 Model for Personality Disorders 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.
Abstract: 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.
145 citations
TL;DR: The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) Section III Alternative Model for Personality Disorders (AMPD) represents an innovative system for simultaneous psychiatric classification and psychological assessment of personality disorders.
Abstract: The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) Section III Alternative Model for Personality Disorders (AMPD; APA, 2013) represents an innovative system for simultaneous psychiatric classification and psychological assessment of personality disorders (PD). The AMPD combines major paradigms of personality assessment and provides an original, heuristic, flexible, and practical framework that enriches clinical thinking and practice. Origins, emerging research, and clinical application of the AMPD for diagnosis and psychological assessment are reviewed. The AMPD integrates assessment and research traditions, facilitates case conceptualization, is easy to learn and use, and assists in providing patient feedback. New as well as existing tests and psychometric methods may be used to operationalize the AMPD for clinical assessments.
105 citations