Development and initial evaluation of the ICD-11 personality disorder severity scale: PDS-ICD-11.
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.
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TL;DR: The 11th revision of the World Health Organization (WHO) International Classification of Diseases (ICD-11) includes a fundamentally new approach to personality disorders (PD) which is expected to be implemented first in European countries before other WHO member states as discussed by the authors .
Abstract: The 11th revision of the World Health Organization (WHO) International Classification of Diseases (ICD-11) includes a fundamentally new approach to Personality Disorders (PD). ICD-11 is expected to be implemented first in European countries before other WHO member states. The present paper provides an overview of this new ICD-11 model including PD severity classification, trait domain specifiers, and the additional borderline pattern specifier. We discuss the perceived challenges and opportunities of using the ICD-11 approach with particular focus on its continuity and discontinuity with familiar PD categories such as avoidant PD and narcissistic PD. The advent of the ICD-11 PD classification involves major changes for health care workers, researchers, administrators, and service providers as well as patients and families involved. The anticipated challenges and opportunities are put forward in terms of specific unanswered questions. It is our hope that these questions will stimulate further research and discussion among researchers and clinicians in the coming years.
27 citations
TL;DR: In this article, the authors developed a self-report measure to assess self-and interpersonal dysfunction and the five personality traits qualifiers in the ICD-11 personality disorder model, which is based on the Clinical Description and Diagnostic Guidelines.
Abstract: The ICD-11 personality disorder model is the first fully dimensional assessment of personality pathology. It consists of a personality disorder (PD) dysfunction-severity dimension, which encompasses both self- and interpersonal dysfunction, and six optional qualifiers for five prominent personality traits-Negative Affectivity (NA), Detachment (DET), Dissociality (DSL), Disinhibition (DSN), and Anankastia (ANK)-plus a borderline pattern that is defined by the criteria of DSM-IV borderline PD. This article reports on the development of a new self-report measure to assess self- and interpersonal dysfunction and the five trait qualifiers. It is the first comprehensive measure of the ICD-11 PD model in that (a) it is the only one to include both PD dysfunction-severity as well as trait scales and because (b) it is based on the Clinical Description and Diagnostic Guidelines, which are more detailed than the "statistical" model description that is currently on the ICD-11 website. The authors wrote 992 items and then reduced the pool to 300 items by eliminating redundancy and selecting the consensus best few items for each subconstruct. Data were collected using an online sample of 383 Prolific workers. Using exploratory factor analysis, seven domain scales were developed, each of which contained two to four scales assessing components of the domain. These preliminary scales' psychometrics were excellent, as were the domains' and their components' convergent and discriminant validity, with a few generally minor exceptions. Structural analyses at the component level revealed a three-factor structure consisting of two moderately correlated Internalizing factors, one centered on Self Dysfunction with two NA components and a DSN component (Distractibility) and the other on Interpersonal Dysfunction with DET and ANK components; as well as an Externalizing factor with DSL and a DSN component (Reckless Impulsivity) that was uncorrelated with the other two factors. Two aspects of the results in particular are striking: (1) ANK was not the opposite end of a DSN dimension, but rather contributed to an Internalizing Interpersonal Dysfunction dimension and (2) DSN had both an Internalizing and an Externalizing component. Implications of the findings and study limitations are discussed.
19 citations
TL;DR: In this paper , the authors evaluated the psychometric properties of the Semi-Structured Interview for Personality Functioning DSM-5 (STiP-5.1) in Estonian.
Abstract: Abstract Background The DSM-5 Alternative Model for Personality Disorders introduced a dimensional perspective on personality disorders. The model assesses functioning in four domains: Identity, Self-Direction, Empathy, and Intimacy. This study evaluates the psychometric properties of the Semi-Structured Interview for Personality Functioning DSM-5 (STiP-5.1) in Estonian. Method The sample consists of 131 participants: 58 from the general population and 73 from a mixed clinical sample that is further divided into a mood and anxiety disorder sample and personality disorder sample. All participants completed the STiP-5.1 interview and the Level of Personality Functioning Scale–Brief Form (LPFS-BF 2.0). Results The Estonian STiP-5.1 interview has good internal consistency (McDonald's ω between .94–.98) and high convergent validity (correlations with LPFS-BF 2.0 above .7). Interview scores successfully differentiated the general population from the mixed clinical sample (Cohen’s d = 2.68), as well as patients with personality disorder from those without (Cohen’s d = 1.76). The LPFS-BF 2.0 total score differentiates the general population sample from the mixed clinical sample (Cohen’s d = 1.99) but not the personality disorder sample from other clinical sample participants. Conclusions The properties of the Estonian STiP-5.1 replicate those of other languages, and empirically support a unified personality functioning dimension that can be meaningfully thought of as reflecting impairments in self and interpersonal functioning. Findings of this study will be discussed in the light of the ongoing debate on the dimensionality of personality pathology and the use of self-report versus interview measures for assessing personality pathology.
5 citations
TL;DR: In this article, the authors highlight how social avoidance is portrayed in case-reports from the perspective of self-and interpersonal functioning as well as stylistic trait features of negative affectivity (e.g., anxiousness and shame) and detachment.
Abstract: This commentary seeks to highlight how social avoidance is portrayed in the six presented case-reports from the perspective of self- and interpersonal functioning as well as stylistic trait features of negative affectivity (e.g., anxiousness and shame) and detachment (e.g., social withdrawal and emotional restriction). This approach to avoidance and social isolation will subsequently be generalized to a range of mental disorders where such features play a significant role. We propose that self and interpersonal functioning along with traits of negative affectivity and detachment may serve as a transdiagnostic framework for describing features of avoidance and social isolation across different treatment models, traditions, and disorders. We specifically assume that future developments of the promising treatment approaches presented in the current collection of case reports may benefit from such a "shared" framework for conceptualizing and treating self- and interpersonal problems related to avoidance and social isolation.
4 citations
TL;DR: In this article , the effect of childhood traumas explained 34% of the variance in internalizing symptoms while controlling for the influence of age and gender, and maladaptive traits accounted for 78% of this effect, which was predominantly exerted through the domains of negative affectivity, detachment, and psychoticism.
Abstract: Research supports a strong relationship between childhood maltreatment and internalizing psychopathology (e.g., anxiety and depression), and features of personality are assumed to explain some of this relationship. In this study, we proposed a model in which maladaptive traits mediate the effect of childhood trauma history on internalizing symptoms in adult individuals. A mixed sample (N = 462) composed of 142 psychiatric patients and 320 community‐dwelling individuals completed the Childhood Trauma Questionnaire (CTQ), the Personality Inventory for DSM‐5 (PID‐5), and the Symptom Checklist (SCL‐27) for internalizing psychopathology. The effect of childhood traumas explained 34% of the variance in internalizing symptoms while controlling for the influence of age and gender. The traits accounted for 78% of this effect, which was predominantly exerted through the domains of Negative Affectivity, Detachment, and Psychoticism, and specifically through the facets of Depressivity, Suspiciousness, Anxiousness, Perceptual Dysregulation, and Distractibility. This finding provides preliminary support for the proposed model indicating that the aforementioned maladaptive trait domains potentially function as mediating links by which childhood traumas are translated into internalizing symptoms in adulthood. However, these findings must be interpreted with caution due to the cross‐sectional and retrospective mono‐method design of this study. Clinical implications are discussed in relation to transdiagnostic treatment and the potential value of specifying trait domain specifiers in ICD‐11 and DSM‐5 models of personality disorders.
4 citations
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TL;DR: This transmutability of the validation matrix argues for the comparisons within the heteromethod block as the most generally relevant validation data, and illustrates the potential interchangeability of trait and method components.
Abstract: Content Memory (Learning Ability) As Comprehension 82 Vocabulary Cs .30 ( ) .23 .31 ( ) .31 .31 .35 ( ) .29 .48 .35 .38 ( ) .30 .40 .47 .58 .48 ( ) As judged against these latter values, comprehension (.48) and vocabulary (.47), but not memory (.31), show some specific validity. This transmutability of the validation matrix argues for the comparisons within the heteromethod block as the most generally relevant validation data, and illustrates the potential interchangeability of trait and method components. Some of the correlations in Chi's (1937) prodigious study of halo effect in ratings are appropriate to a multitrait-multimethod matrix in which each rater might be regarded as representing a different method. While the published report does not make these available in detail because it employs averaged values, it is apparent from a comparison of his Tables IV and VIII that the ratings generally failed to meet the requirement that ratings of the same trait by different raters should correlate higher than ratings of different traits by the same rater. Validity is shown to the extent that of the correlations in the heteromethod block, those in the validity diagonal are higher than the average heteromethod-heterotrait values. A conspicuously unsuccessful multitrait-multimethod matrix is provided by Campbell (1953, 1956) for rating of the leadership behavior of officers by themselves and by their subordinates. Only one of 11 variables (Recognition Behavior) met the requirement of providing a validity diagonal value higher than any of the heterotrait-heteromethod values, that validity being .29. For none of the variables were the validities higher than heterotrait-monomethod values. A study of attitudes toward authority and nonauthority figures by Burwen and Campbell (1957) contains a complex multitrait-multimethod matrix, one symmetrical excerpt from which is shown in Table 6. Method variance was strong for most of the procedures in this study. Where validity was found, it was primarily at the level of validity diagonal values higher than heterotrait-heteromethod values. As illustrated in Table 6, attitude toward father showed this kind of validity, as did attitude toward peers to a lesser degree. Attitude toward boss showed no validity. There was no evidence of a generalized attitude toward authority which would include father and boss, although such values as the VALIDATION BY THE MULTITRAIT-MULTIMETHOD MATRIX
15,795 citations
TL;DR: This article reviewed the literature on such tests, pointed out some statistics that should be avoided, and presented a variety of techniques that can be used safely with medium to large samples, and several illustrative numerical examples are provided.
Abstract: In a variety of situations in psychological research, it is desirable to be able to make statistical comparisons between correlation coefficients measured on the same individuals. For example, an experimenter may wish to assess whether two predictors correlate equally with a criterion variable. In another situation, the experimenter may wish to test the hypothesis that an entire matrix of correlations has remained stable over time. The present article reviews the literature on such tests, points out some statistics that should be avoided, and presents a variety of techniques that can be used safely with medium to large samples. Several illustrative numerical examples are provided.
4,245 citations
TL;DR: In this article, the constructs of intelligence and ego-resiliency are discussed and the personality implications of "pure intelligence" and "pure egoresilience" were identified.
Abstract: The constructs of intelligence and ego-resiliency are discussed. The personality implications of "pure intelligence" and "pure ego-resilience" were identified. Intelligence (IQ) was indexed by the Wechsler Adult Intelligence Scale-Revised and ego-resiliency by an inventory scale. Residual scores measuring "pure intelligence" and "pure ego-resilience" were correlated with the items of the observer-based California Q-sort, used to describe participants. Persons relatively high on ego-resilience tend to be more competent and comfortable in the "fuzzier" interpersonal world; persons defined primary by raw IQ tend to be effective in the "clearer" world of structured work but tend also to be uneasy with affect and less able to realize satisfying human connections. Gender differences exist in the relations of ego-resilience and intelligence and in their adaptive relevance.
1,541 citations
TL;DR: Personality disorders were found to be prevalent, with avoidant, schizoid, and paranoid PDs more common, and borderline PD less common than what is usually reported.
Abstract: Background To our knowledge, no previous studies of personality disorders (PDs) in a large representative sample of the common population have been conducted. Methods A representative sample of 2053 individuals between the ages of 18 and 65 years in Oslo, the capital of Norway, was studied from 1994 to 1997. Information about PDs was obtained by means of the Structured Interview for DSM-III-R Personality Disorders, in conjunction with an interview recording demographic data. The subjects were interviewed primarily at home, but in some instances, also at the clinic. Results The prevalence of PDs was 13.4% (SE, 0.7). The prevalence rates (SEs) for specific PDs, irrespective of whether a person had 1 or more PD, were: paranoid, 2.4% (0.3); schizoid, 1.7% (1.6); schizotypal, 0.6% (0.2); antisocial, 0.7% (0.2); sadistic, 0.2% (0.1); borderline, 0.7% (0.2); histrionic, 2.0% (0.3); narcissistic, 0.8; (0.2); avoidant, 5.0% (0.5); dependent, 1.5% (0.3); obsessive-compulsive: 2.0% (0.3); passive-aggressive, 1.7% (0.3); self-defeating, 0.8%, (0.2). The prevalence of PDs was highest among subjects with only a high school education or less, and living without a partner in the center of the city. Conclusions Personality disorders were found to be prevalent, with avoidant, schizoid, and paranoid PDs more common, and borderline PD less common than what is usually reported. Personality disorders tend to be more frequent among single individuals from the lower socioeconomic classes in the center of the city. It is impossible to determine what is cause and what is consequence from a cross-sectional study.
1,147 citations
TL;DR: Patients with schizotypal personality disorder and borderline personality disorder were found to have significantly more impairment at work, in social relationships, and at leisure than patients with obsessive-compulsive personality disorder or major depressive disorder; patients with avoidant Personality disorder were intermediate.
Abstract: Objective: The purpose of this study was to compare psychosocial functioning in patients with schizotypal, borderline, avoidant, or obsessive-compulsive personality disorder and patients with major depressive disorder and no personality disorder. Method: Patients (N=668) were recruited by the four clinical sites of the Collaborative Longitudinal Personality Disorders Study. The carefully diagnosed study groups were compared on an array of domains of psychosocial functioning, as measured by the Longitudinal Interval Follow-Up Evaluation—Baseline Version and the Social Adjustment Scale. Results: Patients with schizotypal personality disorder and borderline personality disorder were found to have significantly more impairment at work, in social relationships, and at leisure than patients with obsessive-compulsive personality disorder or major depressive disorder; patients with avoidant personality disorder were intermediate. These differences were found across assessment modalities and remained significant after covarying for demographic differences and comorbid axis I psychopathology. Conclusions: Personality disorders are a significant source of psychiatric morbidity, accounting for more impairment in functioning than major depressive disorder alone.
635 citations