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Hualparuca-Olivera L, Caycho-Rodríguez T, Torales J, Ramos-Vera C, Ramos-Campos D, Córdova-Gónzales L, Bach B. Internal consistency of measures for ICD-11 personality disorder severity and traits: A systematic review and meta-analysis. Personal Ment Health 2024. [PMID: 39086213 DOI: 10.1002/pmh.1631] [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: 04/25/2024] [Revised: 06/13/2024] [Accepted: 07/15/2024] [Indexed: 08/02/2024]
Abstract
A number of measures and scales have been developed for the ICD-11 personality disorder (PD) diagnosis, including severity and trait dimensions. The present systematic review and meta-analysis sought to evaluate the internal consistency of these measures across different populations and cultures. A systematic search was conducted across four databases where relevant studies were subjected to explicit eligibility criteria resulting in 49 included studies and 370 effect sizes. Study characteristics were tabulated, their methodological quality was evaluated, and findings were synthesized using random effects meta-analysis. Findings overall indicated that measures of ICD-11 PD severity and trait domains have adequate levels of internal consistency (α/ω = 0.82, 95% CI [0.81; 0.83], I2 = 97.3%). Aspects such as sample, country, language, format, and measured construct were significant sources of variation. Additional meta-analyses revealed that some measures performed better than others for certain dimensions. Internal consistency was overall supported across ICD-11 measures of severity and trait domains. Future research should further investigate the interrater reliability, test-retest reliability and stability, and alignment with interview-based PD diagnoses.
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Affiliation(s)
| | | | - Julio Torales
- Department of Medical Psychology, School of Medical Sciences, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | | | | | - Luis Córdova-Gónzales
- Escuela Universitaria de PostGrado, Universidad Nacional Federico Villarreal, Lima, Peru
| | - Bo Bach
- Psychiatric Research Unit, Center for Personality Disorder Research, Region Zealand, Slagelse, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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2
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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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3
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Rossi G, van Alphen SPJ, Videler AC, Diaz-Batanero C. Can personality disorder be accurately assessed in older age? A differential item functioning analysis of ICD-11 inventories. Int J Geriatr Psychiatry 2024; 39:e6075. [PMID: 38459700 DOI: 10.1002/gps.6075] [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: 11/24/2023] [Accepted: 03/03/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVES The contested categorical personality disorder (PD) criteria are not well suited to inform PD diagnoses in older adults. Yet, the classification of PDs is undergoing a critical transition phase with a paradigm shift to a dimensional approach for diagnosing PDs. No special attention was given to the expression of PDs in older age when the dimensional ICD-11 model was developed. Given that PDs are highly prevalent in older adults, there is an urgent need to examine if ICD-11 related instruments are able to adequately assess for PDs in older adults. METHODS The age-neutrality of ICD-11 measures was examined in a sample of 208 Dutch community-dwelling adults (N = 208, M age = 54.96, SD = 21.65), matched on sex into 104 younger (age range 18-64) and 104 older (age range 65-93) adults. An instrument is considered not to be age-neutral if a collective large level of differential item functioning (DIF) exists in a group of items of an instrument (i.e., 25% or more with DIF). We therefore set out to detect possible DIF in the following ICD-11 self-report measures: the Standardized Assessment of Severity of Personality Disorder (SASPD), the Personality Inventory for ICD-11 (PiCD), and the Borderline Pattern Scale (BPS). RESULTS DIF analyses using a non-parametric odds ratio approach demonstrated that SASPD, PiCD, and BPS were age-neutral with less than 25% of items showing DIF. Yet, impact of DIF at scale level, examined by way of differential test functioning (DTF), indicated a DTF effect on the SASPD total score. CONCLUSIONS These results of age-neutrality of the PiCD and BPS are promising for measuring ICD-11 traits and the borderline pattern. Yet, the age-neutral measurement of PD severity requires further research. With a rapidly aging population, its accurate assessment across the entire adult life span, including older age, is a prerequisite for an adequate detection of PDs.
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Affiliation(s)
- Gina Rossi
- Personality and Psychopathology Research Group (PEPS), Department of Psychology, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Sebastiaan P J van Alphen
- Personality and Psychopathology Research Group (PEPS), Department of Psychology, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Clinical Centre of Excellence for Older Adults with Personality Disorders, Mondriaan Mental Health Centre, Heerlen-Maastricht, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Arjan C Videler
- PersonaCura, Clinical Centre of Excellence for Personality and Developmental Disorders in Older Adults, Tilburg, The Netherlands
- Tranzo, Scientific Centre for Care and Wellbeing of the Tilburg School of Social and Behavioral Sciences of Tilburg University, Tilburg, The Netherlands
| | - Carmen Diaz-Batanero
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
- Research Center for Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain
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4
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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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5
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Torres-Rosado L, Lozano OM, Sanchez-Garcia M, Fernández-Calderón F, Diaz-Batanero C. Operational definitions and measurement of externalizing behavior problems: An integrative review including research models and clinical diagnostic systems. World J Psychiatry 2023; 13:278-297. [PMID: 37383280 PMCID: PMC10294133 DOI: 10.5498/wjp.v13.i6.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/04/2023] [Accepted: 04/20/2023] [Indexed: 06/19/2023] Open
Abstract
Measurement of externalizing disorders such as antisocial disorders, attention-deficit/hyperactivity disorder or borderline disorder have relevant implications for the daily lives of people with these disorders. While the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD) have provided the diagnostic framework for decades, recent dimensional frameworks question the categorical approach of psychopathology, inherent in traditional nosotaxies. Tests and instruments develop under the DSM or ICD framework preferentially adopt this categorical approach, providing diagnostic labels. In contrast, dimensional measurement instruments provide an individualized profile for the domains that comprise the externalizing spectrum, but are less widely used in practice. Current paper aims to review the operational definitions of externalizing disorders defined under these different frameworks, revise the different measurement alternatives existing, and provide an integrative operational definition. First, an analysis of the operational definition of externalizing disorders among the DSM/ICD diagnostic systems and the recent Hierarchical Taxonomy of Psychopathology (HiTOP) model is carried out. Then, in order to analyze the coverage of operational definitions found, a description of measurement instruments among each conceptualization is provided. Three phases in the development of the ICD and DSM diagnosis systems can be observed with direct implications for measurement. ICD and DSM versions have progressively introduced systematicity, providing more detailed descriptions of diagnostic criteria and categories that ease the measurement instrument development. However, it is questioned whether the DSM/ICD systems adequately modelize externalizing disorders, and therefore their measurement. More recent theoretical approaches, such as the HiTOP model seek to overcome some of the criticism raised towards the classification systems. Nevertheless, several issues concerning this model raise mesasurement challenges. A revision of the instruments underneath each approach shows incomplete coverage of externalizing disorders among the existing instruments. Efforts to bring nosotaxies together with other theoretical models of psychopathology and personality are still needed. The integrative operational definition of externalizing disorders provided may help to gather clinical practice and research.
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Affiliation(s)
- Lidia Torres-Rosado
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva 21071, Spain
| | - Oscar M Lozano
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva 21071, Spain
- Research Center for Natural Resources, Health and Environment, University of Huelva, Huelva 21071, Spain
| | - Manuel Sanchez-Garcia
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva 21071, Spain
- Research Center for Natural Resources, Health and Environment, University of Huelva, Huelva 21071, Spain
| | - Fermín Fernández-Calderón
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva 21071, Spain
- Research Center for Natural Resources, Health and Environment, University of Huelva, Huelva 21071, Spain
| | - Carmen Diaz-Batanero
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva 21071, Spain
- Research Center for Natural Resources, Health and Environment, University of Huelva, Huelva 21071, Spain
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6
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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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7
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Maladaptive Conscientiousness is Still Conscientiousness. JOURNAL OF RESEARCH IN PERSONALITY 2022. [DOI: 10.1016/j.jrp.2022.104334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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8
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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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9
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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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10
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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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11
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Sundar SP, Bhola P. Dimensional Personality Traits and Non-suicidal Self Injury Among Emerging Adults: The Mediating Role of Mentalization. PSYCHOLOGICAL STUDIES 2022. [DOI: 10.1007/s12646-022-00663-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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12
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Brown TA, Sellbom M. Associations Between MMPI-3 Scale Scores and the DSM-5 AMPD and ICD-11 Dimensional Personality Traits. Assessment 2022; 30:943-958. [PMID: 35144481 DOI: 10.1177/10731911221075724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The current study aimed to examine the associations between Minnesota Multiphasic Personality Inventory-3 (MMPI-3) scales and the dimensional personality traits contained within the ICD-11 Personality Disorder diagnosis and DSM-5 Alternative Model for Personality Disorders (AMPD) models. The sample consisted of 489 undergraduate students, with dimensional personality traits operationalized via the Comprehensive Assessment of Traits relevant to Personality Disorder (CAT-PD). A priori hypotheses were generated for which MMPI-3 scales would be most associated with each personality trait domain, as well as individual CAT-PD scales. Zero-order correlations and regression analyses were used to examine associations between a set of hypothesized MMPI-3 scale scores and CAT-PD scale scores. The results showed a pattern of meaningful correlations supporting the majority of hypotheses. Moreover, most hypothesized scales also incremented one another in regression models predicting hypothesized PD scale scores. These findings indicate that the MMPI-3 is well situated to aid clinicians in the assessment of personality trait dysfunction from a dimensional perspective.
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13
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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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14
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Strus W, Łakuta P, Cieciuch J. Anankastia or Psychoticism? Which One Is Better Suited for the Fifth Trait in the Pathological Big Five: Insight From the Circumplex of Personality Metatraits Perspective. Front Psychiatry 2021; 12:648386. [PMID: 34721093 PMCID: PMC8551367 DOI: 10.3389/fpsyt.2021.648386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 09/14/2021] [Indexed: 11/13/2022] Open
Abstract
Both the ICD-11 and the DSM-5 (Section III) classification systems introduced dimensional models of personality disorders, with five broad domains called the Pathological Big Five. Nevertheless, despite large congruence between the two models, there are also substantial differences between them, with the most evident being the conceptualization of the fifth dimension: Anankastia in the ICD-11 vs. Psychoticism in the DSM-5. The current paper seeks an answer to the question of which domain is structurally better justified as the fifth trait in the dimensional model of personality disorders. For this purpose, we provided both a conceptual and empirical comparison of the ICD-11 and the DSM-5 models, adopting the Circumplex of Personality Metatraits-a comprehensive model of personality structure built on the basis of the higher-order factors of the Big Five-as a reference framework. Two studies were conducted: the first on a sample of 242 adults (52.9% female; M age = 30.63, SD age = 11.82 years), and the second on a sample of 355 adults (50.1% female; M age = 29.97, SD age = 12.26 years) from the non-clinical population. The Personality Inventory for ICD-11 (PiCD), the Personality Inventory for DSM-5 (PID-5), and the Circumplex of Personality Metatraits Questionnaire-Short Form (CPM-Q-SF) were administered in both studies, together with the PID-5BF+M algorithm for measuring a common (ICD-11 + DSM-5) six-domain model. Obtained empirical findings generally support our conceptual considerations that the ICD-11 model more comprehensively covered the area of personality pathology than the DSM-5 model, with Anankastia revealed as a more specific domain of personality disorders as well as more cohesively located within the overall personality structure, in comparison to Psychoticism. Moreover, the results corroborated the bipolar relations of Anankastia vs. Disinhibition domains. These results also correspond with the pattern of relationships found in reference to the Big Five domains of normal personality, which were also included in the current research. All our findings were discussed in the context of suggestions for the content and conceptualization of pathological personality traits that flow from the CPM as a comprehensive model of personality structure including both pathological and normal poles of personality dimensions.
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Affiliation(s)
- Włodzimierz Strus
- Institute of Psychology, Cardinal Stefan Wyszyński University in Warsaw, Warsaw, Poland
| | - Patryk Łakuta
- Institute of Psychology, Cardinal Stefan Wyszyński University in Warsaw, Warsaw, Poland
| | - Jan Cieciuch
- Institute of Psychology, Cardinal Stefan Wyszyński University in Warsaw, Warsaw, Poland
- University Research Priority Program Social Networks, University of Zurich, Zurich, Switzerland
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15
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Zhang W, Wang M, Yu M, Wang J. The Hierarchical Structure and Predictive Validity of the Personality Inventory for DSM-5 in Chinese Nonclinical Adolescents. Assessment 2021; 29:1559-1575. [PMID: 34134544 DOI: 10.1177/10731911211022835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To evaluate the factor structure, reliability, and validity of the Personality Inventory for DSM-5 (PID-5) in Chinese nonclinical adolescents, a total of 1,442 Chinese middle school youths (Mage = 14.85, girls = 52.4%) were recruited in the present study. All the participants completed the full-length 220-item PID-5. Some participants (n = 1,003) were administered adolescents' social adjustment as a criterion measure at the same time and 236 participants took part in longitudinal assessment of the PID-5 and adolescents' social adjustment 6 months later. First, exploratory structural equation modeling analyses supported a six-factor structure of the PID-5 in our present sample. Second, Negative Affectivity, Detachment, Antagonistic, and Disinhibition domains had positive correlations with negative social adjustment, and negative correlations with positive social adjustment concurrently and longitudinally, with the exception of Constraint and Psychoticism. Third, Cronbach's alpha for the PID-5 traits ranged from .57 to .91 in the full sample. The 6-month test-retest reliability by indexes of interclass correlation coefficient showed poor to good stability. As a whole, our findings provided preliminary evidence of the PID-5 as a reliable and valid measure of adolescents' maladaptive personality traits in mainland China.
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Affiliation(s)
| | | | - Meng Yu
- Sun Yat-sen University, Guangzhou, Guangdong, China
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16
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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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17
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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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18
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Abstract
PURPOSE OF REVIEW The International Classification of Diseases 11th Revision (ICD-11) officially adopted a dimensional system of personality disorder that was a paradigm shift for the classification of personality disorders. The purpose of this article is to review the growing amount of research on one component of that system - the personality trait domain model. Importantly, several self-report measures have been developed to measure the ICD-11 domains and have been subjected to initial validation through examination of their factor structure, multimethod use, convergent and discriminant validity with other prominent dimensional personality models (such as the Five-Factor Model), and criterion validity for important life outcomes. RECENT FINDINGS Studies indicate the ICD-11 domains align with the Five-Factor Model and prior influential models of dimensional personality traits, as expected, and thus rest on an impressive body of empirical research. They also capture large amounts of variance included in the ICD-10/Diagnostic and Statistical Manual of Mental Disorders, 5th Edition Section II personality disorders. SUMMARY Together these findings support the construct validity of the ICD-11 trait domains. However, continued validation research is necessary, as well as research on how to implement these domains into clinical practice, and research on the more specific facet-level of the trait domains - although the ICD-11 model is only officially at the domain-level.
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Affiliation(s)
- Joshua R Oltmanns
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, New York, USA
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19
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Kerber A, Schultze M, Müller S, Rühling RM, Wright AGC, Spitzer C, Krueger RF, Knaevelsrud C, Zimmermann J. Development of a Short and ICD-11 Compatible Measure for DSM-5 Maladaptive Personality Traits Using Ant Colony Optimization Algorithms. Assessment 2020; 29:467-487. [PMID: 33371717 PMCID: PMC8866743 DOI: 10.1177/1073191120971848] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
While Diagnostic and Statistical Manual of Mental Disorders–Fifth
edition (DSM-5) Section III and ICD-11
(International Classification of Diseases 11th–Revision) both allow for
dimensional assessment of personality pathology, the models differ in the
definition of maladaptive traits. In this study, we pursued the goal of
developing a short and reliable assessment for maladaptive traits, which is
compatible with both models, using the item pool of the Personality Inventory
for DSM-5 (PID-5). To this aim, we applied ant colony
optimization algorithms in English- and German-speaking samples comprising a
total N of 2,927. This procedure yielded a 34-item measure with a hierarchical
latent structure including six maladaptive trait domains and 17 trait facets,
the “Personality Inventory for DSM-5, Brief Form Plus”
(PID5BF+). While latent structure, reliability, and criterion validity were
ascertained in the original and in two separate validation samples
(n = 849, n = 493) and the measure was
able to discriminate personality disorders from other diagnoses in a clinical
subsample, results suggest further modifications for capturing ICD-11
Anankastia.
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20
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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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21
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Gutiérrez F, Aluja A, Ruiz J, García LF, Gárriz M, Gutiérrez-Zotes A, Gallardo-Pujol D, Navarro-Haro MV, Alabèrnia-Segura M, Mestre-Pintó JI, Torrens M, Peri JM, Sureda B, Soler J, Pascual JC, Vall G, Calvo N, Ferrer M, Oltmanns JR, Widiger TA. Personality Disorders in the ICD-11: Spanish Validation of the PiCD and the SASPD in a Mixed Community and Clinical Sample. Assessment 2020; 28:759-772. [PMID: 32583685 PMCID: PMC7961637 DOI: 10.1177/1073191120936357] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The International Classification of Diseases–11th revision (ICD-11) classification of personality disorders is the official diagnostic system that is used all over the world, and it has recently been renewed. However, as yet very few data are available on its performance. This study examines the Personality Inventory for ICD-11 (PiCD), which assesses the personality domains of the system, and the Standardized Assessment of Severity of Personality Disorder (SASPD), which determines severity. The Spanish versions of the questionnaires were administered to a community (n = 2,522) and a clinical sample (n = 797). Internal consistency was adequate in the PiCD (α = .75 to .84) but less so in the SASPD (α = .64 and .73). Factor analyses suggested a unidimensional or bidimensional structure for severity, while revealing that the personality trait qualifiers are organized into four factors: negative affectivity, detachment, dissociality, and a bipolar domain of disinhibition–anankastia. The mutual relationships between traits and severity were analyzed, as well as the ability of the whole system to identify clinical subjects. Although further improvements are required, the results generally support the use of the PiCD and the SASPD and help substantiate the new ICD-11 taxonomy that underlies them.
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Affiliation(s)
| | - Anton Aluja
- University of Lleida, Lleida, Spain.,Biomedical Research Institute of Lleida, Lleida, Spain
| | - José Ruiz
- University of Barcelona, Barcelona, Spain
| | - Luis F García
- Biomedical Research Institute of Lleida, Lleida, Spain.,Autonomous University of Madrid, Madrid, Spain
| | - Miguel Gárriz
- Institut de Neuropsiquiatria i Addiccions, Barcelona, Spain
| | | | - David Gallardo-Pujol
- University of Barcelona, Barcelona, Spain.,Institute of Neurosciences, Barcelona, Spain
| | - Maria V Navarro-Haro
- University of Zaragoza, Zaragoza, Spain.,Aragón Health Research Institute, Zaragoza, Spain
| | | | - Joan Ignasi Mestre-Pintó
- IMIM Hospital del Mar Medical Research Institute, Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain
| | - Marta Torrens
- IMIM Hospital del Mar Medical Research Institute, Barcelona, Spain.,Universitat Autònoma de Barcelona, Spain
| | | | | | - Joaquim Soler
- Universitat Autònoma de Barcelona, Spain.,Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Juan Carlos Pascual
- Universitat Autònoma de Barcelona, Spain.,Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Gemma Vall
- Biomedical Research Institute of Lleida, Lleida, Spain.,GSS-Hospital Santa Maria, Lleida, Spain
| | - Natalia Calvo
- Universitat Autònoma de Barcelona, Spain.,Vall d'Hebron University Hospital, Barcelona, Spain
| | - Marc Ferrer
- Universitat Autònoma de Barcelona, Spain.,Vall d'Hebron University Hospital, Barcelona, Spain
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