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Lorentzen HS, Bårdsen PM, Thimm JC. Reliability and validity of the Personality Disorder Severity ICD-11 (PDS-ICD-11) scale and the Revised Personality Assessment Questionnaire for ICD-11 (PAQ-11R) in a Norwegian community sample. Personal Ment Health 2024. [PMID: 39049719 DOI: 10.1002/pmh.1630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 06/25/2024] [Accepted: 07/07/2024] [Indexed: 07/27/2024]
Abstract
In the ICD-11, a new model for the diagnosis of personality disorders is included, consisting of an assessment of the severity of personality impairment as well as an optional evaluation of pathological personality traits. This study aimed to examine the reliability, structural validity, and convergent and discriminant validity of the Norwegian versions of the Personality Disorder Severity ICD-11 (PDS-ICD-11) scale for the assessment of personality disorder severity and the Revised Personality Assessment Questionnaire for ICD-11 (PAQ-11R) for the assessment of the ICD-11 pathological personality traits in a Norwegian community sample. The sample consisted of 295 participants (75.9% female) with a mean age of 30.0 years (SD = 10.7 years). The participants answered the PDS-ICD-11, PAQ-11R, Level of Personality Functioning Scale-Brief Form 2.0 (LPFS-BF 2.0), and the Personality Inventory for DSM-5-Brief Form Plus Modified (PID5BF + M). The Norwegian PDS-ICD-11 showed good reliability. Support for a unidimensional model and a high convergent correlation with the LPFS-BF 2.0 was found. The reliability analysis of the Norwegian PAQ-11R scales yielded mixed findings with suboptimal reliability estimates for the PAQ-11R detachment, disinhibition, and dissociality scales. Analyzing the structure of the PAQ-11R items, four factors emerged (negative affectivity, detachment, disinhibition, and anankastia). The PAQ-11R scales showed good convergent and, overall, adequate discriminant validity with the PID5BF + M scales. The findings support the use of the PDS-ICD-11 for assessing severity in the ICD-11 PD model in Norway. The Norwegian PAQ-11R appears to be a useful screening tool for the ICD-11 PD trait domains.
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Affiliation(s)
| | | | - Jens C Thimm
- Department of Psychology, UiT The Arctic University of Norway, Tromsø, Norway
- Centre for Crisis Psychology, University of Bergen, Bergen, Norway
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Šimunović Filipčić I, Jakšić N, Levaj S, Ćopo M, Vuksan-Ćusa Z, Mikulić FL, Grah M, Skočić Hanžek M, Šagud M, Filipčić I, Marčinko D. Physical multimorbidity in psychiatric patients with personality disorders: Insights within the ICD-11 framework. Gen Hosp Psychiatry 2024; 89:16-22. [PMID: 38704972 DOI: 10.1016/j.genhosppsych.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/29/2024] [Accepted: 04/29/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE Recent research has revealed poor physical health among individuals with personality disorders (PDs). We aimed to compare chronic physical illnesses (CPI) and chronic physical multimorbidity (CPM) prevalence between the general population (GEP) and PD patients, and to explore the relationship between CPM and various aspects of PD, predominantly within the ICD-11 framework. METHODS This cross-sectional study included 126 PD patients and 126 matched controls from the GEP. Patients were evaluated for the ICD-11 PD severity and maladaptive personality domains, subjective emptiness, and reflective functioning. CPI was assessed using a standardized self-report questionnaire. RESULTS PD patients had a higher mean number of CPIs (2.05 vs. 1.02) and a more frequent CPM occurrence (49.2% vs. 26.2%) compared to the matched controls (p < .001). The ICD-11 PD severity (OR = 1.143, p = .007) and maladaptive domain Negative affectivity (OR = 4.845, p = .002), and poor reflective functioning (OR = 1.694, p = .007) were significant predictors of CPM, independent of sociodemographic, clinical and lifestyle factors. Negative affectivity showed the most robust effect on CPM, while smoking did not significantly mediate these relationships. CONCLUSION Our study found increased CPM burden in PD patients and a link between CPM and various PD aspects under the ICD-11 framework, highlighting the need for more integrated healthcare.
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Affiliation(s)
- Ivona Šimunović Filipčić
- Department of Psychiatry and Psychological Medicine, University Hospital Center Zagreb, Zagreb, Croatia; Faculty of Dental Medicine and Health Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.
| | - Nenad Jakšić
- Department of Psychiatry and Psychological Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - Sarah Levaj
- Department of Psychiatry and Psychological Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - Marija Ćopo
- Neuropsychiatric Hospital "Dr. Ivan Barbot", Croatia
| | | | | | - Majda Grah
- Faculty of Dental Medicine and Health Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; University Psychiatric Clinic Sveti Ivan, Zagreb, Croatia; University of Applied Health Science, Zagreb, Croatia
| | - Milena Skočić Hanžek
- Department of Psychiatry and Psychological Medicine, University Hospital Center Zagreb, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Marina Šagud
- Department of Psychiatry and Psychological Medicine, University Hospital Center Zagreb, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Igor Filipčić
- Faculty of Dental Medicine and Health Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; University Psychiatric Clinic Sveti Ivan, Zagreb, Croatia; University of Applied Health Science, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Darko Marčinko
- Department of Psychiatry and Psychological Medicine, University Hospital Center Zagreb, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia
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Crawford MJ, Leeson VC, Evans R, Goulden N, Weaver T, Trumm A, Barrett BM, Khun-Thompson F, Pandya SP, Saunders KE, Lamph G, Woods D, Smith H, Greenall T, Nicklin V, Barnicot K. Clinical effectiveness and cost-effectiveness of Structured Psychological Support for people with probable personality disorder in mental health services in England: study protocol for a randomised controlled trial. BMJ Open 2024; 14:e086593. [PMID: 38925701 PMCID: PMC11202761 DOI: 10.1136/bmjopen-2024-086593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION Evidence-based psychological treatments for people with personality disorder usually involve attending group-based sessions over many months. Low-intensity psychological interventions of less than 6 months duration have been developed, but their clinical effectiveness and cost-effectiveness are unclear. METHODS AND ANALYSIS This is a multicentre, randomised, parallel-group, researcher-masked, superiority trial. Study participants will be aged 18 and over, have probable personality disorder and be treated by mental health staff in seven centres in England. We will exclude people who are: unwilling or unable to provide written informed consent, have a coexisting organic or psychotic mental disorder, or are already receiving psychological treatment for personality disorder or on a waiting list for such treatment. In the intervention group, participants will be offered up to 10 individual sessions of Structured Psychological Support. In the control group, participants will be offered treatment as usual plus a single session of personalised crisis planning. The primary outcome is social functioning measured over 12 months using total score on the Work and Social Adjustment Scale (WSAS). Secondary outcomes include mental health, suicidal behaviour, health-related quality of life, patient-rated global improvement and satisfaction, and resource use and costs. The primary analysis will compare WSAS scores across the 12-month period using a general linear mixed model adjusting for baseline scores, allocation group and study centre on an intention-to-treat basis. In a parallel process evaluation, we will analyse qualitative data from interviews with study participants, clinical staff and researchers to examine mechanisms of impact and contextual factors. ETHICS AND DISSEMINATION The study complies with the Helsinki Declaration II and is approved by the London-Bromley Research Ethics Committee (IRAS ID 315951). Study findings will be published in an open access peer-reviewed journal; and disseminated at national and international conferences. TRIAL REGISTRATION NUMBER ISRCTN13918289.
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Affiliation(s)
| | | | | | | | - Tim Weaver
- Department of Mental Health & Social Work, Middlesex University, London, UK
| | - Aile Trumm
- Department of Mental Health & Social Work, Middlesex University, London, UK
| | | | | | | | | | - Gary Lamph
- School of Nursing and Midwifery, Keele University, Keele, UK
| | - David Woods
- Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Harriet Smith
- Avon and Wiltshire Mental Health Partnership NHS Trust, Bath, UK
| | - Toby Greenall
- Lincolnshire Community Health Services NHS Trust, Lincoln, UK
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Pan B, Wang W. Practical implications of ICD-11 personality disorder classifications. BMC Psychiatry 2024; 24:191. [PMID: 38454364 PMCID: PMC10921591 DOI: 10.1186/s12888-024-05640-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 02/26/2024] [Indexed: 03/09/2024] Open
Abstract
Personality disorders (PDs) are associated with an inferior quality of life, poor health, and premature mortality, leading to heavy clinical, familial, and societal burdens. The International Classification of Diseases-11 (ICD-11) makes a thorough, dramatic paradigm shift from the categorical to dimensional diagnosis of PD and expands the application into adolescence. We have reviewed the recent literature on practical implications, and severity and trait measures of ICD-11 defined PDs, by comparing with the alternative model of personality disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), by mentioning the relevance in forensic and social concerns, and by referencing the developmental implication of life span, especially in adolescence. Study results strongly support the dimensional utility of ICD-11 PD diagnosis and application in adolescence which warrants early detection and intervention. More evidence-based research is needed along the ICD-11 PD application, such as its social relevance, measurement simplification, and longitudinal design of lifespan observation and treatment.
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Affiliation(s)
- Bing Pan
- Department of Psychiatry, Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Wei Wang
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway.
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5
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King JD, Cheng S, Fok MLY, Pappa S, Munjiza J. Interventions to improve the sleep quality of adults with personality disorder: A systematic review. Personal Ment Health 2024; 18:19-31. [PMID: 37674476 DOI: 10.1002/pmh.1591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/18/2023] [Accepted: 08/14/2023] [Indexed: 09/08/2023]
Abstract
Poor quality sleep is common for people who have a diagnosis of personality disorder (PD). Core cognitive and behavioral features of PD may cause and perpetuate poor sleep, but to date, no review has collated the evidence on the efficacy of interventions to improve sleep quality for people with PD. Structured searches for interventional studies among adults with PD and reporting validated measures of sleep quality were conducted up to November 2022 in multiple databases. Single-case reports were excluded. Study quality was assessed with standardized risk of bias tools. Unreported data was sought systematically from authors. This review was pre-registered with an international prospective register of systematic reviews (PROSPERO) (CRD42021282105). Of the 3503 identified studies, nine met inclusion criteria, representing a range of psychological, pharmaceutical, and other interventions and outcome measures. Meta-analytic methods were not feasible because of the serious risk of bias in all studies, and results were therefore synthesized narratively. There is limited and low-quality evidence of the effects of a variety of interventions to improve the sleep quality of people living with PD. Further research might consider specifically including people diagnosed with PD in trials of sleep interventions and using sleep outcome measures in trials of established PD treatments.
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Affiliation(s)
- Jacob D King
- Central and North West London NHS Foundation Trust, London, UK
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
| | - Shee Cheng
- Central and North West London NHS Foundation Trust, London, UK
| | | | - Sofia Pappa
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
- West London NHS Trust, Southhall, UK
| | - Jasna Munjiza
- Central and North West London NHS Foundation Trust, London, UK
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
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6
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Widiger TA, Hines A, Crego C. Evidence-Based Assessment of Personality Disorder. Assessment 2024; 31:191-198. [PMID: 37231676 DOI: 10.1177/10731911231176461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The purpose of this article is to provide a description and discussion of the evidence-based assessment of personality disorder. Considered herein is the assessment of the Section II personality disorders included within the fifth edition of the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.; DSM-5-TR), within Section III of DSM-5-TR, and within the 11th edition of the World Health Organization's International Classification of Diseases (WHO). The recommendation for an evidence-based assessment is for a multimethod approach: first administer a self-report inventory to alert the clinician to maladaptive personality functioning that might not have otherwise been anticipated, followed by a semi-structured interview to verify the personality disorder's presence. The validity of this multimethod strategy can be improved further by considering the impact of other disorders on the assessment, documenting temporal stability, and establishing a compelling, empirical basis for cutoff points.
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Hualparuca-Olivera L, Caycho-Rodríguez T, Torales J, Ramos-Campos D. Convergence between the dimensional PD models of ICD-11 and DSM-5: a meta-analytic approach. Front Psychiatry 2023; 14:1325583. [PMID: 38098639 PMCID: PMC10719945 DOI: 10.3389/fpsyt.2023.1325583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 11/10/2023] [Indexed: 12/17/2023] Open
Abstract
In the current diagnostic systems, the International Classification of Diseases-11th rev. (ICD-11) and the Diagnostic and Statistical Manual of Mental Disorders-5th ed. (DSM-5), the evaluation and diagnosis of personality disorder (PD) aim at dimensional examination of the severity of its dysfunction and the stylistic features that accompany it. Since their implementation, or even before, several measures have been developed to assess PD severity and traits in both models. Thus, convergent validity metrics have been reported with various PD measures; however, the convergence of the same constructs included in the measures of these two models remains undefined. The objective of the present review was to examine whether there is a sufficient relationship between PD measures of the ICD-11 and DSM-5 AMPD in the general population. For this meta-analytic review, systematic searches were conducted in Web of Science, PubMed, Scopus, and Google Scholar. We included studies that reported Pearson's r correlations without restrictions on language, age, sex, setting, type of sample, or informant of the measures. We excluded associations with anankastia, psychoticism or the borderline pattern because they were not comparable between one dimensional model and the other. We examined the quality of the evidence with the JBI Critical Appraisal Checklist for Analytical Cross Sectional Studies, and performed the random effects meta-analysis with the 'meta' package of the RStudio software. Of the 5,629 results returned by the search, 16 studies were eligible; and showed moderate quality. The risk of bias was manifested by not specifying the details of the sample, the recruitment environment, and the identification and control of confounding factors. Thirteen studies provided two or more correlations resulting in a total of 54 studies for meta-analysis. The overall effect size estimate (correlation) was moderate for the overall model (r = 0.62, 95% CI [0.57, 0.67], p < 0.0001, I2 = 97.6%). For the subgroup of associations, ICD-11 severity model and DSM-5 AMPD severity model, the correlation was also moderate (k = 10, r = 0.57, 95% CI [0.48; 0.66]; I2 = 92.9%); as for the subgroup of associations, ICD-11 traits model and DSM-5 AMPD traits model (k = 44, r = 0.63, 95% CI [0.57; 0.69], I2 = 97.9%). The convergent validity between measures of PD severity and traits between one diagnostic system and another has been demonstrated in this review and they can probably be used interchangeably because they also measure the same constructs. Future research can address the limitations of this study and review the evidence for the discriminant validity of these measures.
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Affiliation(s)
| | | | - Julio Torales
- Department of Medical Psychology, School of Medical Sciences, Universidad Nacional de Asunción, San Lorenzo, Paraguay
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8
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White A, Hudson A. Questions arising from the application of the ICD-11 diagnoses of complex post traumatic stress disorder and personality disorder. Int J Psychiatry Clin Pract 2023; 27:301-307. [PMID: 36579422 DOI: 10.1080/13651501.2022.2158109] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 11/16/2022] [Accepted: 12/09/2022] [Indexed: 12/30/2022]
Abstract
There is an overlap between the International Classification of Diseases for Mortality and Morbidity Statistics- 11th Revision (ICD-11) diagnoses of complex post-traumatic stress disorder (CPTSD) and personality disorder. When the latter is comorbid with post-traumatic stress disorder (PTSD), this may allow for a false positive CPTSD diagnosis. This fact has both clinical implications and throws into relief theoretical questions about the ontology of trauma and personality disorder-related pathology. These questions are presented as a call for further research.
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Affiliation(s)
- Andrew White
- Principal Clinical Psychologist, Structured Clinical Management Lead, South West London and St George's NHS Trust, Springfield University Hospital, London, UK
| | - Anna Hudson
- Assistant Psychologist, Cambridgeshire and Peterborough NHS Foundation Trust, Adult Locality Mental Health Team, Cambridge, UK
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9
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Sellbom M, Chiasson PM, Brown TA, Bach B. Examining the construct validity of the Personality Assessment Questionnaire for ICD-11 (PAQ-11) personality trait domains in a community sample. Personal Ment Health 2023; 17:197-207. [PMID: 36527327 DOI: 10.1002/pmh.1573] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 11/21/2022] [Accepted: 11/27/2022] [Indexed: 12/23/2022]
Abstract
The ICD-11 has a new diagnostic system for personality disorder, which includes five optional trait specifiers to characterize the diagnosed pathology. The current study evaluated the internal structure and construct validity of the Personality Assessment Questionnaire for ICD-11 (PAQ-11) personality trait domains in a US population-representative community sample. An exploratory factor analysis revealed the support for a four-factor model underlying the 17 PAQ-11 items, reflecting four of the five ICD-11 trait domains (Negative Affectivity, Detachment, Disinhibition and Anankastia). Moreover, correlation analyses revealed that the PAQ-11 domain scale scores were associated, as expected, with their counterparts from two other ICD-11 trait domain measures, as well as with traditional personality disorder scores. More broadly, the results raised questions about the structural integrity of the Dissociality domain scale, and the discriminant validity of the Disinhibition and Anankastia scales. The overall conclusion was nevertheless promising with respect to the PAQ-11 serving as a brief screening measure for the ICD-11 trait domains.
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Affiliation(s)
- Martin Sellbom
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Payton M Chiasson
- Department of Psychology, University of Florida, Gainesville, Florida, USA
| | - Tiffany A Brown
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Bo Bach
- Psychiatric Research Unit, Center for Personality Disorder Research, Region Zealand, Slagelse, Denmark
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10
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Levin-Aspenson HF, Khoo S, Stanton K, King B, Zimmerman M. A Bridge Between DSM-5 Section II Personality Disorder Criteria and ICD-11 Personality Disorder Trait Domains. J Pers Disord 2023; 37:317-336. [PMID: 37367819 DOI: 10.1521/pedi.2023.37.3.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
The organization of personality pathology into trait domains (vs. specific disorders) in ICD-11 represents an important shift in personality disorder (PD) nosology. However, to facilitate clinical implementation, a bridge is needed between this system and the DSM-5 Section II system familiar to many researchers and clinicians. In this study, individual DSM-5 PD criteria were assigned to ICD-11 trait domains based on the published Clinical Descriptions and Diagnostic Requirements. This scoring scheme was examined empirically alongside DSM-5 PD dimensions (using SIDP ratings from the MIDAS project; N = 2,147 outpatients) in terms of descriptive properties and relations with psychosocial morbidity and functioning. Most PD criteria could be matched to at least one ICD-11 trait domain, indicating considerable cross-system continuity. However, points of incongruity are noteworthy for research and clinical applications. Results provide key information for bridging categorical and dimensional frameworks, indicating that the shift toward trait-based PD models need not be as disruptive as feared.
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Affiliation(s)
- Holly F Levin-Aspenson
- Department of Psychiatry and Human Behavior, Brown University School of Medicine, and Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island
- Department of Psychology, University of North Texas, Denton, Texas
| | - Shereen Khoo
- Department of Psychiatry and Human Behavior, Brown University School of Medicine, and Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island
| | - Kasey Stanton
- Department of Psychology, University of Wyoming, Laramie, Wyoming
| | - Brittany King
- Department of Psychiatry and Human Behavior, Brown University School of Medicine, and Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island
| | - Mark Zimmerman
- Department of Psychiatry and Human Behavior, Brown University School of Medicine, and Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island
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11
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Damovsky F, Zettl M, Zimmermann J, Herbold W, Curtius T, Bücker S, Taubner S, Volkert J. [The Personality Inventory for ICD-11 (PiCD): Reliability and Validity of the German Version in a Clinical and Non-Clinical Sample]. Psychother Psychosom Med Psychol 2023; 73:62-69. [PMID: 36055254 DOI: 10.1055/a-1826-1888] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The 11th version of the International Statistical Classification of Diseases and Related Health Problems (ICD-11) marks a paradigm shift in the diagnosis of personality disorders: In the near future, their classification will no longer be categorical, but dimensional along the severity of personality impairments and optionally regarding the presence of maladaptive personality traits. This study examines the reliability and validity of the German version of the Personality Inventory for ICD-11 (PiCD), a questionnaire designed to assess ICD-11 maladaptive personality domains, in a clinical and nonclinical sample (N=939). The factor structure of the PiCD was examined using Exploratory Factor Analysis (EFA) and showed a tendency for a four-factor model (Negative Affectivity, Dissociality, Detachment, and a bipolar factor Disinhibition-Anankastia). The subscales of the PiCD demonstrated acceptable to excellent reliability coefficients with Cronbach's α (0.79 - 0.89) and McDonald's ω (0.76 - 0.90). Convergent and discriminant validity were examined in conjunction with other questionnaires and were found to be satisfactory. The results suggest that the German version of the PiCD is a reliable and largely valid measurement instrument for assessing ICD-11 maladaptive personality traits. However, further research on factor structure, appropriate cut-off as well as norm values is needed.
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Affiliation(s)
- Florian Damovsky
- Institut für Psychosoziale Prävention, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Max Zettl
- Institut für Psychosoziale Prävention, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | | | - Willy Herbold
- Asklepios Fachklinikum, Asklepios Fachklinikum, Göttingen, Germany
| | - Theresa Curtius
- Department Psychologie, MSB Medical School Berlin GmbH, Berlin, Germany
| | - Susanne Bücker
- Arbeitseinheit Psychologische Methodenlehre, Ruhr-Universität Bochum, Bochum, Germany
| | - Svenja Taubner
- Institut für Psychosoziale Prävention, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Jana Volkert
- Department Psychologie, MSB Medical School Berlin GmbH, Berlin, Germany
- Institut für Psychosoziale Prävention, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
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Simon J, Lambrecht B, Bach B. Cross-walking personality disorder types to ICD-11 trait domains: An overview of current findings. Front Psychiatry 2023; 14:1175425. [PMID: 37091704 PMCID: PMC10116048 DOI: 10.3389/fpsyt.2023.1175425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/16/2023] [Indexed: 04/25/2023] Open
Abstract
The ICD-11 has adopted a classification of Personality Disorders (PD) that abolishes the established categorical PD types in favor of global severity classification with specification of individual trait domains. To facilitate and guide this profound transition, an overview of current research on empirical associations between established PD types and ICD-11 trait domains seems warranted. We identified a total of 9 relevant studies from 2018 to 2022, which were based on both clinical and community samples from U.S., China, Brazil, Denmark, Spain, Korea, and Canada. The patterns of associations with ICD-11 trait domains were systematically synthesized and portrayed for each PD type. Findings overall showed expected and conceptually meaningful associations between categorical PD types and ICD-11 trait domains, with only few deviations. Based on these findings, we propose a cross-walk for translating categorical PD types into ICD-11 trait domains. More research is needed in order to further guide continuity and translation between ICD-10 and ICD-11 PD classification in mental healthcare, including facet-level ICD-11 trait information. Moreover, the nine reviewed studies only relied on self-reported ICD-11 trait domains, which should be expanded with clinician-rated trait domains in future research. Finally, future research should also take ICD-11's essential PD severity classification into account.
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Affiliation(s)
- Jonatan Simon
- Center for Personality Disorder Research (CPDR), Psychiatric Research Unit, Region Zealand, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Bastian Lambrecht
- Center for Personality Disorder Research (CPDR), Psychiatric Research Unit, Region Zealand, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Bo Bach
- Center for Personality Disorder Research (CPDR), Psychiatric Research Unit, Region Zealand, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- *Correspondence: Bo Bach,
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Bach B, Mulder R. Clinical Implications of ICD-11 for Diagnosing and Treating Personality Disorders. Curr Psychiatry Rep 2022; 24:553-563. [PMID: 36001221 DOI: 10.1007/s11920-022-01364-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/10/2022] [Indexed: 01/29/2023]
Abstract
PURPOSE OF REVIEW The International Classification of Diseases 11th revision (ICD-11) introduced a new approach to personality disorders and related traits. This paper reviews recent literature on the assessment of ICD-11 personality disorders and implications for clinical diagnosis, decision-making, and treatment. RECENT FINDINGS We reviewed findings on two measures developed for the ICD-11 model of personality dysfunction and six inventories for the ICD-11 trait specifiers. The psychometric qualities of these tools are promising, and they allow for both rapid screening and fine-grained assessment. Implications for clinical diagnosis and treatment of personality disorders are reviewed including utility for forensic practice. Based on evidence and our experience, we provide some recommendations for severity- and trait-informed interventions. Initial evidence supports the available instruments for assessing ICD-11 personality disorders. More research is needed including development of clinician-rating forms and diagnostic interviews as well as treatment protocols and trials based on the new ICD-11 classification.
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Affiliation(s)
- Bo Bach
- Center for Personality Disorder Research (CPDR), Psychiatric Research Unit, Region Zealand Psychiatry, Fælledvej 6, Bygning 3, 4200, Slagelse, Denmark. .,Department of Psychology, University of Southern Denmark, Odense, Denmark.
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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Aluja A, Sorrel MA, García LF, García O, Gutierrez F. Factor Convergence and Predictive Analysis of the Five Factor and Alternative Five Factor Personality Models with the Five-Factor Personality Inventory for ICD-11 (FFICD). J Pers Disord 2022; 36:296-319. [PMID: 35647769 DOI: 10.1521/pedi_2021_35_542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The authors analyze and compare the factor convergence and predictive power of the Revised NEO Personality Inventory (NEO-PI-R) and the Zuckerman-Kuhlman-Aluja Personality Questionnaire (ZKA-PQ/SF) with respect to the Five-Factor Personality Inventory for ICD-11 (FFiCD). A total of 803 White Spanish subjects were analyzed. All the personality domains had significant predictive power with regard to the FFiCD except NEO Openness. The explained variance of the personality domains with respect to FFiCD Negative Affectivity (71% and 77%) and Detachment (56% and 56%) were similar for NEO-PI-R and ZKA-PQ/SF, respectively, but the NEO-PI-R accounted for greater variance for FFiCD Anankastia, Dissociality, and Disinhibition. The FFiCD facets of Rashness, Thrill- Seeking (Disinhibition), and Unassertiveness (Detachment) were located in factors other than those theoretically expected. The authors conclude that normal personality measured by the NEO-PI-R and the ZKA-PQ/SF contribute, in a differential but complementary way, to knowledge of the maladaptive personality measured by the FFiCD.
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Affiliation(s)
- Anton Aluja
- Lleida Institute for Biomedical Research Dr. Pifarré Foundation (IRBLleida), Lleida, Catalonia, Spain.,University of Lleida, Lleida, Catalonia, Spain
| | | | - Luis F García
- Lleida Institute for Biomedical Research Dr. Pifarré Foundation (IRBLleida), Lleida, Catalonia, Spain.,Faculty of Psychology, Autonomous University of Madrid, Madrid, Spain
| | | | - Fernando Gutierrez
- Personality Disorder Unit, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
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15
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Aluja A, Sorrel MA, García LF, García O, Gutierrez F, Gutierrez F. Factor Convergence and Predictive Analysis of the Five Factor and Alternative Five Factor Personality Models With the Five-Factor Personality Inventory for ICD-11 (FFiCD). J Pers Disord 2022; 36:296-319. [PMID: 34985333 DOI: 10.1521/pedi_2012_35_542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The authors analyze and compare the factor convergence and predictive power of the Revised NEO Personality Inventory (NEO-PI-R) and the Zuckerman-Kuhlman-Aluja Personality Questionnaire (ZKA-PQ/SF) with respect to the Five-Factor Personality Inventory for ICD-11 (FFiCD). A total of 803 White Spanish subjects were analyzed. All the personality domains had significant predictive power with regard to the FFiCD except NEO Openness. The explained variance of the personality domains with respect to FFiCD Negative Affectivity (71% and 77%) and Detachment (56% and 56%) were similar for NEO-PI-R and ZKA-PQ/SF, respectively, but the NEO-PI-R accounted for greater variance for FFiCD Anankastia, Dissociality, and Disinhibition. The FFiCD facets of Rashness, Thrill- Seeking (Disinhibition), and Unassertiveness (Detachment) were located in factors other than those theoretically expected. The authors conclude that normal personality measured by the NEO-PI-R and the ZKA-PQ/SF contribute, in a differential but complementary way, to knowledge of the maladaptive personality measured by the FFiCD.
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Affiliation(s)
- Anton Aluja
- Lleida Institute for Biomedical Research Dr. Pifarré Foundation (IRBLleida), Lleida, Catalonia, Spain.,University of Lleida, Lleida, Catalonia, Spain
| | | | - Luis F García
- Lleida Institute for Biomedical Research Dr. Pifarré Foundation (IRBLleida), Lleida, Catalonia, Spain.,Faculty of Psychology, Autonomous University of Madrid, Madrid, Spain
| | | | - Fernando Gutierrez
- Personality Disorder Unit, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Fernando Gutierrez
- Personality Disorder Unit, Institute of Neuroscience, Hospital Clinic de Barcelona, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
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16
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Bangash A. Late life personality disorders: Problems in assessment and management. Personal Ment Health 2022; 16:155-159. [PMID: 35304826 DOI: 10.1002/pmh.1542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 03/08/2022] [Accepted: 03/11/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Ayesha Bangash
- South West Yorkshire Partnership NHS Foundation Trust, Old Age Psychiatry, The Dales, Calderdale Royal Hospital, Halifax, UK
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17
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Jha M, Barrett B, Brewin C, Bowker G, Harwood N, Jalil I, Crawford M, Phull J, Allen K, Duggan C, Yang M, Tyrer P. Matching ICD-11 personality status to clinical management in a community team-The Boston (UK) Personality Project: Study protocol. Personal Ment Health 2022; 16:130-137. [PMID: 35474611 DOI: 10.1002/pmh.1544] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/02/2022] [Accepted: 04/05/2022] [Indexed: 01/19/2023]
Abstract
Epidemiological studies show 30% to 50% of all patients in community mental health teams have personality disorders. These are normally comorbid with other psychiatric disorders, often as Galenic syndromes, and are seldom identified. In the Boston (UK) Personality Project all patients under a community health service in Boston in Lincolnshire will be asked to agree to have their personality status assessed using scales recording the new ICD-11 classification, together with clinical ratings, social function and satisfaction. A control group of 100 patients from an adjacent service of similar demographics (Spalding) will also have similar ratings but no personality assessments. Changes in clinical status, social function and service satisfaction will be made after 6 and 12 months in both groups. The patients in the Boston group will be offered matched interventions using a stepped care approach for both the severity of disorder and its domain structure. These interventions will include shorter versions of existing psychological treatments, environmental therapies including nidotherapy, adaptive and acceptance models, drug reduction and social prescribing. Full costs of psychiatric care will be measured in both groups. The main hypothesis is that greater awareness of personality function will lead to better clinical outcomes and satisfaction.
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Affiliation(s)
- Mithilesh Jha
- Lincolnshire Partnership NHS Foundation Trust, St George's, Lincoln, UK
| | | | - Chris Brewin
- Department of Psychology, University College Hospital, London, UK
| | - Geoff Bowker
- Lincolnshire Partnership NHS Foundation Trust, St George's, Lincoln, UK
| | - Nick Harwood
- Lincolnshire Partnership NHS Foundation Trust, St George's, Lincoln, UK
| | - Iram Jalil
- Lincolnshire Partnership NHS Foundation Trust, St George's, Lincoln, UK
| | - Mike Crawford
- Division of Psychiatry, Commonwealth Building, Imperial College, London, UK
| | - Jaspreet Phull
- Lincolnshire Partnership NHS Foundation Trust, St George's, Lincoln, UK
| | - Katherine Allen
- Birmingham and Solihull Mental Health Foundation Trust, Uffculme Centre, Birmingham, UK
| | | | - Min Yang
- West China School of Public Health, Sichuan University, Chengdu, China.,Faculty of Health, Art and Design, Swinburne, University of Technology, Melbourne, Sydney, Australia
| | - Peter Tyrer
- Lincolnshire Partnership NHS Foundation Trust, St George's, Lincoln, UK.,Kings Health Economics, King's College London, London, UK
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19
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Bach B, Kramer U, Doering S, di Giacomo E, Hutsebaut J, Kaera A, De Panfilis C, Schmahl C, Swales M, Taubner S, Renneberg B. The ICD-11 classification of personality disorders: a European perspective on challenges and opportunities. Borderline Personal Disord Emot Dysregul 2022; 9:12. [PMID: 35361271 PMCID: PMC8973542 DOI: 10.1186/s40479-022-00182-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/11/2022] [Indexed: 12/05/2022] Open
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.
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Affiliation(s)
- Bo Bach
- Center for Personality Disorder Research, Slagelse Psychiatric Hospital, Region Zealand, Slagelse, Denmark
| | - Ueli Kramer
- Institute of Psychotherapy/General Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Stephan Doering
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Ester di Giacomo
- School of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | - Joost Hutsebaut
- Viersprong Institute for Studies on Personality Disorders, Halsteren, Netherlands
| | - Andres Kaera
- Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | - Chiara De Panfilis
- Unit of Neuroscience, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | | | - Svenja Taubner
- Institute for Psychosocial Prevention, University Heidelberg, Heidelberg, Germany
| | - Babette Renneberg
- Clinical Psychology and Psychotherapy, Freie Universität, Habelschwerdter Allee 45, 14195, Berlin, Germany.
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20
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Duggan C, Tyrer P. Specialist teams as constituted are unsatisfactory for treating people with personality disorders. BJPsych Bull 2022; 46:100-102. [PMID: 34247690 PMCID: PMC9074156 DOI: 10.1192/bjb.2021.69] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/07/2021] [Accepted: 06/22/2021] [Indexed: 12/21/2022] Open
Abstract
It is now becoming standard practice in most advanced economies to provide specialist services for those with personality disorder. Such services, almost exclusively, provide complex well-structured psychological interventions lasting many months for a small number of those with borderline personality disorder pathology. The evidence suggests that these treatments are effective but they can only be provided for a small number of people. However, in every area the numbers of patients with significant personality disorder far exceeds those that are treated, and most of these have other personality disorders. It is argued that the current service system is not working efficiently and should be replaced by one that provides resources and expertise within community teams with some external advice from specialists but no transfer of responsibility to a designated team.
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Affiliation(s)
| | - Peter Tyrer
- Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
- Imperial College,London, UK
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21
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Bach B, Somma A, Keeley JW. Editorial: Entering the Brave New World of ICD-11 Personality Disorder Diagnosis. Front Psychiatry 2021; 12:793133. [PMID: 34867566 PMCID: PMC8636038 DOI: 10.3389/fpsyt.2021.793133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 10/21/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Bo Bach
- Center for Personality Disorder Research (CPDR), Psychiatric Research Unit, Slagelse Psychiatric Hospital, Slagelse, Denmark
| | - Antonella Somma
- School of Psychology, Vita-Salute San Raffaele University, Milan, Italy
| | - Jared W. Keeley
- Psychology Department, Virginia Commonwealth University, Richmond, VA, United States
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22
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Tyrer P, Yang M, Tyrer H, Crawford M. Is social function a good proxy measure of personality disorder? Personal Ment Health 2021; 15:261-272. [PMID: 33998774 DOI: 10.1002/pmh.1513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/23/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Personality assessment may be helped by proxy measures. AIMS To examine the assessment of social functioning in relationship to personality disorder. METHOD Secondary analysis of data from three clinical studies, following deliberate self-harm (n = 460), cognitive behaviour therapy for health anxiety (n = 444) and a 30-year follow-up of 200 anxious/depressed patients. Social function and personality were assessed using the Social Functioning Questionnaire (SFQ) and the Personality Assessment Schedule, with its ICD-11 modification. A 5-item short version of the SFQ, the Short Social Functioning Questionnaire (SSFQ), was also developed. The SFQ score in the first two studies (area under curve [AUC] 0.64 and 0.65) partly predicted personality status; in the third study, this achieved close agreement (AUC SFQ 0.85 [95% CI 0.8-0.9]; AUC SSFQ 0.84 [95% CI 0.78-0.89]). In all studies, social function deteriorated linearly with increasing personality pathology. Cut-off points of 4 on the SSFQ and 7 on the SFQ had high sensitivity (SSFQ 82%-90%; SFQ 82%-83%) and acceptable specificity (SSFQ 66%-75%; SFQ 69%-75%) in identifying personality disorder in the third study. CONCLUSIONS Social functioning recorded in either a 5-item or 8-item self-rating is a useful proxy measure of personality disturbance and may be the core of disorder.
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Affiliation(s)
- Peter Tyrer
- Centre for Psychiatry, Imperial College London, London, UK
| | - Min Yang
- School of Public Health, West China Medical Center of Sichuan University, Chengdu, China.,Faculty of Health, Art and Design, Swinburne University of Technology, Melbourne, Australia
| | - Helen Tyrer
- Centre for Psychiatry, Imperial College London, London, UK
| | - Mike Crawford
- Centre for Psychiatry, Imperial College London, London, UK
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23
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Tracy M, Tiliopoulos N, Sharpe L, Bach B. The clinical utility of the ICD-11 classification of personality disorders and related traits: A preliminary scoping review. Aust N Z J Psychiatry 2021; 55:849-862. [PMID: 34144646 DOI: 10.1177/00048674211025607] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES A diagnostic system that fails to deliver clinically useful information will not be utilized and consequently will be unable to provide valuable data for health policy and clinical decision making. Therefore, it is imperative to obtain an accurate depiction of the clinical utility of the eleventh revision of the International Classification of Diseases (ICD-11) Personality Disorder (PD) model. The current mixed-methods systematic review aimed to determine the clinical utility of the ICD-11 PD classification system. METHOD An electronic screening of six databases was conducted and resulting studies were subjected to specific exclusion criteria, which elicited eight studies of interest. Study characteristics were tabulated and methodological quality was appraised. RESULTS Four studies offered strong support for the model's clinical utility, three offered some support accompanied by notable limitations and one study could only offer criticisms. CONCLUSION Future investigation of the ICD-11 PD classification system's (a) communicative value between clinicians and their patients, and between clinicians and their patient's families; (b) ease of use; and (c) feasibility in terms of practical application is required to achieve a complete understanding of its clinical utility and ultimately bring clarity to the current ambiguous findings.
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Affiliation(s)
- Mikaela Tracy
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | | | - Louise Sharpe
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Bo Bach
- Centre of Excellence on Personality Disorder, Psykiatrien i Region Sjalland, Slagelse, Denmark
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24
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Clark LA, Corona-Espinosa A, Khoo S, Kotelnikova Y, Levin-Aspenson HF, Serapio-García G, Watson D. Preliminary Scales for ICD-11 Personality Disorder: Self and Interpersonal Dysfunction Plus Five Personality Disorder Trait Domains. Front Psychol 2021; 12:668724. [PMID: 34322060 PMCID: PMC8311289 DOI: 10.3389/fpsyg.2021.668724] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/17/2021] [Indexed: 12/17/2022] Open
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.
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Affiliation(s)
- Lee Anna Clark
- Department of Psychology, University of Notre Dame, Notre Dame, IN, United States
| | | | - Shereen Khoo
- Department of Psychology, University of Notre Dame, Notre Dame, IN, United States
| | - Yuliya Kotelnikova
- Department of Psychology, University of Notre Dame, Notre Dame, IN, United States
| | | | - Greg Serapio-García
- Department of Psychology, University of Notre Dame, Notre Dame, IN, United States
| | - David Watson
- Department of Psychology, University of Notre Dame, Notre Dame, IN, United States
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25
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Hemmati A, Rahmani F, Bach B. The ICD-11 Personality Disorder Trait Model Fits the Kurdish Population Better Than the DSM-5 Trait Model. Front Psychiatry 2021; 12:635813. [PMID: 33859581 PMCID: PMC8042144 DOI: 10.3389/fpsyt.2021.635813] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/08/2021] [Indexed: 11/13/2022] Open
Abstract
The ICD-11 Classification of Personality Disorders and the DSM-5 Alternative Model of Personality Disorders (AMPD) operate with trait domains that contribute to the individual expression of personality disturbance (i.e., negative affectivity, detachment, dissociality, disinhibition, anankastia, and psychoticism). To date, these trait frameworks have not been investigated sufficiently in Middle Eastern cultures. Thus, the present study explored the structure of the ICD-11 and AMPD personality disorder (PD) trait domains in a large mixed sample from the Kurdistan zone of Iran. The ICD-11 and AMPD trait domains were operationalized using empirically supported algorithms for the Personality Inventory for DSM-5 (PID-5). The PID-5 was administered to a large mixed sample (N = 3,196) composed of 2,678 community and 518 clinical participants. Structural validity was investigated using Exploratory Factor Analysis (EFA), whereas differential construct validity was explored by comparing clinical and community scores. Model fit and the expected factor structure were deemed appropriate for the ICD-11 trait model, but less adequate for the DSM-5 trait model (i.e., disinhibition did not emerge as a separate factor). All domain and facet scores showed significant differences between clinical and community subsamples with moderate to large effects, mostly for disinhibition and dissociality/antagonism while least for anankastia. The findings of the present study may suggest that the ICD-11 trait model is more cross-culturally fitting than the DSM-5 AMPD trait model, at least with respect to a large mixed sample from the region of Kurdistan. Accordingly, there is evidence for using PID-5 data for WHO ICD-11 purposes in this part of the World.
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Affiliation(s)
- Azad Hemmati
- Department of Psychology, University of Kurdistan, Sanandaj, Iran
| | - Fateh Rahmani
- Department of Psychology, University of Kurdistan, Sanandaj, Iran
| | - Bo Bach
- Psychiatric Research Unit, Center for Personality Disorder Research, Region Zealand Psychiatry, Slagelse, Denmark
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26
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Simms LJ. Consensus building and clinical translation: The path to an impactful and evidence-based personality disorder classification system. Personal Ment Health 2021; 15:3-7. [PMID: 33624442 DOI: 10.1002/pmh.1504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Leonard J Simms
- Department of Psychology, University at Buffalo, Buffalo, New York, USA
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27
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Gecaite-Stonciene J, Lochner C, Marincowitz C, Fineberg NA, Stein DJ. Obsessive-Compulsive (Anankastic) Personality Disorder in the ICD-11: A Scoping Review. Front Psychiatry 2021; 12:646030. [PMID: 33796036 PMCID: PMC8007778 DOI: 10.3389/fpsyt.2021.646030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/19/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction: With the shift from a categorical to a dimensional model, ICD-11 has made substantial changes to the diagnosis of personality disorders (PDs), including obsessive-compulsive (anankastic) personality disorder (OCPD). The ICD-11 PD model proposes a single diagnosis of PD with specifications regarding severity and domains. However, a systematic overview of ICD-11 anankastia is lacking. In this review we address the reformulation of the OCPD diagnosis in the ICD-11, and draw comparisons with the DSM-5, with a particular focus on diagnostic validity and clinical utility. We hypothesized that the ICD-11 PD model provides a diagnostically valid and clinically useful approach to OCPD, with specific emphasis on the anankastia domain as the primary trait qualifier. Methods: Literature published from 2010 to 2020 was systematically searched using the PubMed/MEDLINE, PsychInfo, Cochrane, and Web of Sciences search engines, in order to find all articles that addressed ICD-11 anankastia. Relevant articles were collated, and themes of these articles subsequently extracted. Results: Out of the 264 publications identified, 19 articles were included in this review. Four themes were identified, namely (a) overlap of DSM-5 OCPD with the ICD-11 PD model, (b) the factorial structure of the ICD-11 PD model with respect to the anankastia domain, (c) the clinical utility of the ICD-11 PD model, and (d) comparison of the ICD-11 PD model of anankastia with the DSM-5 alternative model for OCPD. Conclusions: The ICD-11 anankastia domain overlaps with DSM-5 OCPD traits, and the factor analyses of the ICD-11 PD model further support the diagnostic validity of this domain. There is some support for the clinical utility of the ICD-11 PD model of anankastia but further studies are needed, including of its relationship to obsessive-compulsive and related disorders.
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Affiliation(s)
- Julija Gecaite-Stonciene
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania
| | - Christine Lochner
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Clara Marincowitz
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Naomi A Fineberg
- National Obsessive Compulsive Disorders Specialist Service, Hertfordshire Partnership University National Health Service Foundation Trust, University of Hertfordshire, Hatfield, United Kingdom
| | - Dan J Stein
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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28
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Anderson JL, Sellbom M. Assessing ICD-11 personality trait domain qualifiers with the MMPI-2-RF. J Clin Psychol 2020; 77:1090-1105. [PMID: 33320342 DOI: 10.1002/jclp.23099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 10/23/2020] [Accepted: 11/29/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The current study examined the utility of the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) in assessing ICD-11 personality psychopathology trait domain qualifiers. METHOD Using a community sample (N = 217) weighted for externalizing dysfunction, this study evaluated the convergence between ICD-11 trait domains as measured by the personality inventory for DSM-5 (PID-5) with hypothesized MMPI-2-RF scales. Particular emphasis was placed on evaluating the convergence between the ICD-11 trait domain qualifiers and the MMPI-2-RF personality psychopathology-5 (PSY-5) scales, as the latter are meant to represent broadband domains of personality pathology. RESULTS Correlation and regression analyses demonstrated expected associations between ICD-11 domains and conceptually expected MMPI-2-RF scales, with some minor exceptions. Notably, the Anankastia domain showed associations with scales assessing negative affect, but did not show expected negative associations with scales related to disinhibition. CONCLUSIONS The findings generally supported the use of the MMPI-2-RF in assessing individual expressions of personality dysfunction from the ICD-11 trait domain qualifier perspective.
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Affiliation(s)
- Jaime L Anderson
- Department of Psychology and Philosophy, Sam Houston State University, Huntsville, Texas, USA
| | - Martin Sellbom
- Department of Psychology, University of Otago, Dunedin, New Zealand
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