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Lin Y, Guo Z, Zhou Y, Wei Y, Xu L, Tang X, Wang Z, Hu Y, Wang J, Mei Y, Wu H, Luo Y, Zhang T. Distribution of self-reported borderline personality disorder traits symptoms in a large-scale clinical population. Front Psychiatry 2024; 15:1424966. [PMID: 38988741 PMCID: PMC11234847 DOI: 10.3389/fpsyt.2024.1424966] [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: 04/29/2024] [Accepted: 06/06/2024] [Indexed: 07/12/2024] Open
Abstract
Introduction Borderline Personality Disorder (BPD) traits play a crucial role in the prognosis of psychiatric disorders, as well as in assessing risks associated with negativity and impulsivity. However, there is a lack of data regarding the distribution characteristics of BPD traits and symptoms within clinical populations. Methods A total of 3015 participants (1321 males, 1694 females) were consecutively sampled from outpatients at the psychiatric and psycho-counseling clinics at the Shanghai Mental Health Center. BPD symptoms were assessed using a self-reported personality diagnostic questionnaire. Having BPD traits is defined as having five or more positive items in self-reported BPD characteristics. Participants were stratified into male and female groups, age groups, and diagnostic groups (schizophrenia, mood disorders, anxiety disorders). Exploratory factor analysis using principal components analysis was conducted. Three factors were identified: "F1: Affective Instability and Impulsivity", "F2: Interpersonal Unstable and Extreme Reactions", and "F3: Identity Disturbance". Results Among 3015 participants, 45.9% of the patients self-reported BPD traits. Comparing of male and female patients, there was no statistically significant difference in the occurrence rate of BPD traits (χ2 = 1.835, p=0.176). However, in terms of symptoms, female patients reported more symptoms than male patients. Female patients also exhibited more pronounced features on F2 compared to male patients (t =-1.972, p=0.049). There is a general decrease in BPD traits, symptoms, and factors with increasing age. Specifically, the proportion of positive BPD traits is approximately halved before the age of 30 and decreases to around one-third after the age of 30. BPD traits were most common in the Mood Disorders group at 55.7%, followed by the Anxiety Disorders group at 44.4%, and Schizophrenia group at 41.5% (χ2 = 38.084, p<0.001). Discussion Our study revealed the pervasive presence of BPD traits and symptoms among psychiatric outpatients, exhibiting distinctive distributions across gender, age, and diagnostic categories. These findings emphasize the significance of identifying and addressing BPD pathology in the clinical care of psychiatric outpatients.
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Affiliation(s)
- Yong Lin
- Department of Psychiatry, Kangci Hospital of Jiaxing, Tongxiang, Zhejiang, China
| | - ZiLei Guo
- Department of Psychiatry, Kangci Hospital of Jiaxing, Tongxiang, Zhejiang, China
| | - Yong Zhou
- Department of Psychiatry, Kangci Hospital of Jiaxing, Tongxiang, Zhejiang, China
| | - YanYan Wei
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - LiHua Xu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - XiaoChen Tang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Zixuan Wang
- Department of Psychology, Shanghai Xinlianxin Psychological Counseling Center, Shanghai, China
| | - YeGang Hu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - JiJun Wang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Yi Mei
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - HaiSu Wu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - YanLi Luo
- Department of Psychological Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - TianHong Zhang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
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Leichsenring F, Fonagy P, Heim N, Kernberg OF, Leweke F, Luyten P, Salzer S, Spitzer C, Steinert C. Borderline personality disorder: a comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies. World Psychiatry 2024; 23:4-25. [PMID: 38214629 PMCID: PMC10786009 DOI: 10.1002/wps.21156] [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: 01/13/2024] Open
Abstract
Borderline personality disorder (BPD) was introduced in the DSM-III in 1980. From the DSM-III to the DSM-5, no major changes have occurred in its defining criteria. The disorder is characterized by instability of self-image, interpersonal relationships and affects. Further symptoms include impulsivity, intense anger, feelings of emptiness, strong abandonment fears, suicidal or self-mutilation behavior, and transient stress-related paranoid ideation or severe dissociative symptoms. There is evidence that BPD can be reliably diagnosed and differentiated from other mental disorders by semi-structured interviews. The disorder is associated with considerable functional impairment, intensive treatment utilization, and high societal costs. The risk of self-mutilation and suicide is high. In the general adult population, the lifetime prevalence of BPD has been reported to be from 0.7 to 2.7%, while its prevalence is about 12% in outpatient and 22% in inpatient psychiatric services. BPD is significantly associated with other mental disorders, including depressive disorders, substance use disorders, post-traumatic stress disorder, attention-deficit/hyperactivity disorder, bipolar disorder, bulimia nervosa, and other personality disorders. There is convincing evidence to suggest that the interaction between genetic factors and adverse childhood experiences plays a central role in the etiology of BPD. In spite of considerable research, the neurobiological underpinnings of the disorder remain to be clarified. Psychotherapy is the treatment of choice for BPD. Various approaches have been empirically supported in randomized controlled trials, including dialectical behavior therapy, mentalization-based therapy, transference-focused therapy, and schema therapy. No approach has proved to be superior to others. Compared to treatment as usual, psychotherapy has proved to be more efficacious, with effect sizes between 0.50 and 0.65 with regard to core BPD symptom severity. However, almost half of the patients do not respond sufficiently to psychotherapy, and further research in this area is warranted. It is not clear whether some patients may benefit more from one psychotherapeutic approach than from others. No evidence is available consistently showing that any psychoactive medication is efficacious for the core features of BPD. For discrete and severe comorbid anxiety or depressive symptoms or psychotic-like features, pharmacotherapy may be useful. Early diagnosis and treatment of BPD can reduce individual suffering and societal costs. However, more high-quality studies are required, in both adolescents and adults. This review provides a comprehensive update of the BPD diagnosis and clinical characterization, risk factors, neurobiology, cognition, and management. It also discusses the current controversies concerning the disorder, and highlights the areas in which further research is needed.
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Affiliation(s)
- Falk Leichsenring
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
- Department of Psychosomatics and Psychotherapy, University of Rostock, Rostock, Germany
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Nikolas Heim
- International Psychoanalytic University, Berlin, Germany
| | - Otto F Kernberg
- Personality Disorders Institute, Weill Cornell Medical College, New York, NY, USA
| | - Frank Leweke
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
| | - Patrick Luyten
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - Simone Salzer
- International Psychoanalytic University, Berlin, Germany
| | - Carsten Spitzer
- Department of Psychosomatics and Psychotherapy, University of Rostock, Rostock, Germany
| | - Christiane Steinert
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
- International Psychoanalytic University, Berlin, Germany
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Lindell-Innes R, Phillips-Hughes AL, Bartsch D, Galletly C, Ludbrook C. Attitudes of psychiatry trainees towards patients with borderline personality disorder: Does the stigma begin during training? Personal Ment Health 2023; 17:387-395. [PMID: 37211385 DOI: 10.1002/pmh.1587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 04/24/2023] [Accepted: 05/03/2023] [Indexed: 05/23/2023]
Abstract
Research suggests there is a widespread stigma among clinicians towards patients with borderline personality disorder (BPD) and that this contributes to poor treatment outcomes. Given the influence of learning environments in shaping perceptions, this study investigated the attitude of South Australian psychiatry trainees towards patients with BPD. A questionnaire was distributed to 89 South Australian doctors, from both The Adelaide Prevocational Psychiatry Program (TAPPP) and psychiatry trainees of The Royal Australian and New Zealand College of Psychiatrists (RANZCP). This questionnaire investigated the domains of treatment optimism, clinician attitude and empathy towards patients with BPD. Results indicated that psychiatry trainees near the end of training scored significantly lower across all domains, indicating a more negative perception of patients with BPD, when compared to early- and mid-stage trainees. This study identifies a need to understand why trainees closer to qualifying as psychiatrists have increased stigma towards patients with BPD. Improved education and training surrounding patients with BPD is warranted to reduce negative stigma and improve clinical outcomes.
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Affiliation(s)
- Rhea Lindell-Innes
- Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
- Adelaide University, Adelaide, South Australia, Australia
| | | | - Dianna Bartsch
- Adelaide University, Adelaide, South Australia, Australia
- Borderline Personality Disorder Collaborative, Unley, South Australia, Australia
| | - Cherrie Galletly
- Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
- Discipline of Psychiatry, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Cathy Ludbrook
- Borderline Personality Disorder Collaborative, Unley, South Australia, Australia
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Goldbach RE, Neukel C, Panizza A, Reinken A, Krause-Utz A. Differentiating between intrapsychic symptoms and behavioral expressions of borderline personality disorder in relation to childhood emotional maltreatment and emotion dysregulation: an exploratory investigation. Eur J Psychotraumatol 2023; 14:2263317. [PMID: 37846822 PMCID: PMC10583625 DOI: 10.1080/20008066.2023.2263317] [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: 03/08/2023] [Accepted: 08/11/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Borderline personality disorder (BPD) is a severe mental disorder, characterized by pronounced instability in emotions, self-image, and interpersonal relationships. Experiences of childhood maltreatment are among the risk factors for BPD. While self-damaging and aggressive acts often occur, not every person with the disorder shows markedly dysregulated behaviour. Internalized symptoms, such as shame, loneliness, and self-disgust tend to be more pervasive and persist after clinical remission. OBJECTIVE Here we investigated associations between BPD symptom severity, childhood maltreatment, and emotion regulation difficulties. We further explored if the Borderline Symptom List (BSL) could potentially be used to differentiate between internalized symptoms (intrapsychic strain) and externalized symptoms (dysregulated behaviours) in future research. METHOD 187 women with at least mild BPD symptoms (65% having a diagnosis of BPD) completed the BSL 23 including its 11-item supplement (BSL-S), the Childhood Trauma Questionnaire (CTQ), and Difficulties in Emotion Regulation Scale (DERS). Participants further underwent a semi-structured clinical interview to assess BPD criteria (International Personality Disorder Examination, IPDE). Multivariate models and regression-based bootstrapping analyses were performed to test direct and indirect effects. RESULTS Childhood trauma severity, especially emotional abuse, positively predicted BPD symptom severity. A significant indirect effect through emotion regulation difficulties was found (k2=.56). When exploring associations with BPD criteria (IPDE), the BSL-23 mean significantly correlated with separation anxiety, identity and mood problems, chronic emptiness, suicidal ideation, and dissociation, while the BSL-S correlated with self-harming impulsive behaviour and anger outbursts. CONCLUSIONS Findings complement previous research, highlighting the role of childhood maltreatment and emotion regulation difficulties in BPD. While our findings need to be seen as preliminary and interpreted with caution, they suggest that the BSL may be used to differentiate between internalized symptoms and behavioural expressions of BPD in future research. Such a distinction might help to deepen the understanding of this complex heterogenous disorder.
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Affiliation(s)
- Roosmarijn E. Goldbach
- Department of Psychology, Faculty of Social and Behavioral Sciences, Leiden University, the Netherlands
| | - Corinne Neukel
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Germany
| | - Angelika Panizza
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Aischa Reinken
- Department of Psychology, Faculty of Social and Behavioral Sciences, Leiden University, the Netherlands
| | - Annegret Krause-Utz
- Department of Psychology, Faculty of Social and Behavioral Sciences, Leiden University, the Netherlands
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5
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Bach B, Simonsen E, Kongerslev MT, Bo S, Hastrup LH, Simonsen S, Sellbom M. ICD-11 personality disorder features in the danish general population: Cut-offs and prevalence rates for severity levels. Psychiatry Res 2023; 328:115484. [PMID: 37748238 DOI: 10.1016/j.psychres.2023.115484] [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: 07/22/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION Prevalence rates and correlates of personality disorders (PD) are relevant to health care policy and planning. OBJECTIVES To present normative data for self-reported ICD-11 personality disorder (PD) features including tentative cut-off scores and prevalence rates for severity levels along with psychosocial correlates. METHODS The Personality Disorder Severity ICD-11 (PDS-ICD-11) scale and criterion measures of impairment were administered to a social-demographically stratified sample of Danish citizens (N = 8,941) of which 3,044 delivered complete data. Item-Response Theory (IRT) was employed to indicate cut-offs based on standard deviations from the latent mean. RESULTS The unidimensionality of the PDS-ICD-11 score was supported and IRT analysis suggested norm-based thresholds at latent severity levels. Expected associations with criterion measures were found. CONCLUSION The normative data portray ICD-11 PD features in the general population and allow for interpretation of PDS-ICD-11 scores (e.g., scores of 12, 16, and 19 may indicate mild, moderate, and severe dysfunction), which may inform health care policy and planning. A total weighted prevalence of 6.9 % of the Danish general population is estimated to have clinically significant personality dysfunction, proportionally composed of Mild (4.8 %), Moderate (1.2 %), and Severe (0.9 %) levels. Future research should corroborate these findings using relevant clinical samples and methods.
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Affiliation(s)
- Bo Bach
- Psychiatric Research Unit, Center for Personality Disorder Research, Region Zealand, Denmark; University of Copenhagen, Denmark.
| | - Erik Simonsen
- Psychiatric Research Unit, Center for Personality Disorder Research, Region Zealand, Denmark; University of Copenhagen, Denmark
| | - Mickey T Kongerslev
- Psychiatric Research Unit, Center for Personality Disorder Research, Region Zealand, Denmark; University of Southern Denmark, Odense, Denmark
| | - Sune Bo
- University of Copenhagen, Denmark; Mental Health Services, Region Southern Denmark, Svendborg, Denmark
| | - Lene H Hastrup
- Psychiatric Research Unit, Center for Personality Disorder Research, Region Zealand, Denmark; University of Southern Denmark, Odense, Denmark
| | - Sebastian Simonsen
- University of Copenhagen, Denmark; Stolpegaard Psychotherapy Centre, Capital Region, Denmark
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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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Tyrer P, Tyrer H, Yang M. The influence of personality disorder in predicting suicidal behaviour in common mental disorders: A 30-year study. Personal Ment Health 2022; 16:111-119. [PMID: 35362264 PMCID: PMC9285912 DOI: 10.1002/pmh.1543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/31/2022] [Accepted: 03/15/2022] [Indexed: 12/29/2022]
Abstract
Two hundred ten patients with anxiety and depressive disorders were followed up over 30 years. Personality status was assessed at baseline using the Personality Assessment Schedule (PAS), an instrument that classifies personality disorder in a similar way to the new ICD-11 classification. Assessments of suicidal behaviour were made at 5, 12 and 30 years and suicidal thoughts at 12 and 30 years and analysed by personality status, clinical diagnosis and scores on the General Neurotic Syndrome Scale, a combined diagnosis of mixed anxiety depression and personality dysfunction. Suicide attempts were most frequent in the first 5 years of the study and reduced over time. Baseline personality status was the best predictor of suicide attempts at 5 years (no personality disorder 29.3%, personality disorder 51.6%, p = 0.006), and at 12 years (no personality disorder 11.9%, personality disorder 25.7%, p = 0.042), but no important differences were found at 30 years, when comorbid mental state disorder was the strongest predictor (p < 0.001). Similar but less marked findings were found for the general neurotic syndrome. It is concluded that the presence of personality disorder is a robust predictor of suicidal behaviour in the shorter term but in the long-term comorbid pathology is a better predictor.
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Affiliation(s)
- Peter Tyrer
- Division of PsychiatryImperial CollegeLondonUK
- Lincolnshire Partnership NHS Foundation TrustLincolnUK
| | - Helen Tyrer
- Division of PsychiatryImperial CollegeLondonUK
| | - Min Yang
- West China School of Public HealthSichuan UniversityChengduChina
- Faculty of Health, Art and DesignSwinburne University of TechnologyMelbourneAustralia
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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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Barkauskienė R, Gaudiešiūtė E, Adler A, Gervinskaitė-Paulaitienė L, Laurinavičius A, Skabeikytė-Norkienė G. Criteria A and B of the Alternative DSM-5 Model for Personality Disorders (AMPD) Capture Borderline Personality Features Among Adolescents. Front Psychiatry 2022; 13:828301. [PMID: 35479485 PMCID: PMC9035636 DOI: 10.3389/fpsyt.2022.828301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/23/2022] [Indexed: 11/30/2022] Open
Abstract
The recent development of a dimensional view toward personality disorder opens up the field of personality research based on the constructs of personality functioning (Criterion A) and maladaptive personality traits (Criterion B) as core components of personality pathology. However, little is known about the roles of these aspects in relation to borderline personality features during adolescence. The current study aimed at exploring the associations of Criterion A and B and their contribution in predicting borderline personality features in adolescence. A sample of 568 adolescents aged 11-17 (M = 14.38, SD = 1.57; 42.4% males) from different backgrounds (community-based, psychiatric inpatients, and youth forensic care) completed a set of questionnaires among which were measures of personality functioning, maladaptive personality traits, and borderline personality features. The findings reveal that Criterion A and B are strongly interrelated and both are significant in predicting borderline personality features in adolescents. Further, the results showed the incremental value of Criterion A beyond the level of underlying psychopathology and maladaptive personality traits suggesting the distinctive function of Criterion A to capture the features of borderline personality. These findings extend the knowledge about the dimensional aspects of personality pathology in adolescence. The implications in relation to the new personality disorder model in the ICD-11 are highlighted.
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Affiliation(s)
| | | | - Asta Adler
- Institute of Psychology, Vilnius University, Vilnius, Lithuania
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11
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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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12
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Bach B, Brown TA, Mulder RT, Newton-Howes G, Simonsen E, Sellbom M. Development and initial evaluation of the ICD-11 personality disorder severity scale: PDS-ICD-11. Personal Ment Health 2021; 15:223-236. [PMID: 34002530 DOI: 10.1002/pmh.1510] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/23/2021] [Indexed: 11/07/2022]
Abstract
AIM No measure has formally been developed to assess the published ICD-11 model of Personality Disorder (PD) severity. We therefore set out to develop and evaluate the 14-item Personality Disorder Severity ICD-11 (PDS-ICD-11) scale. METHOD A representative U.S. community sample (N = 428; 50.9% women) and a New Zealand mental health sample (N = 87; 61.5% women) completed the PDS-ICD-11 scale along with a series of established PD and impairment measures. RESULTS Item response theory supported the unidimensionality of PDS-ICD-11 (median item loading of 0.68) and indicated that a PDS-ICD-11 score of 17.5 may serve as a benchmark for pronounced dysfunction. Correlation and regression analyses supported both criterion validity and incremental validity in predicting impairment and PD symptoms. The PDS-ICD-11 was particularly associated with measures of Level of Personality Functioning Scale (LPFS), Global PD severity, and Borderline PD symptom score. A comparison between clinical individuals diagnosed with an ICD-11 PD vs. no PD supported diagnostic validity. CONCLUSION This initial construction study suggests that the PDS-ICD-11 constitutes a promising instrument that provides a quick impression of the severity of personality dysfunction according to the official ICD-11 PD guidelines. Clearly, more research is needed to corroborate its validity and utility. The PDS-ICD-11 scale is provided as online supporting information.
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Affiliation(s)
- Bo Bach
- Psychiatric Research Unit, Center for Personality Disorder Research, Region Zealand, Slagelse, Denmark
| | - Tiffany A Brown
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Roger T Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Giles Newton-Howes
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Erik Simonsen
- Psychiatric Research Unit, Center for Personality Disorder Research, Region Zealand, Slagelse, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Martin Sellbom
- Department of Psychology, University of Otago, Dunedin, New Zealand
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Mulder RT. ICD-11 Personality Disorders: Utility and Implications of the New Model. Front Psychiatry 2021; 12:655548. [PMID: 34040555 PMCID: PMC8141634 DOI: 10.3389/fpsyt.2021.655548] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/19/2021] [Indexed: 11/17/2022] Open
Abstract
The ICD-11 classification of personality disorders represents a paradigm shift in diagnosis. This was felt necessary because previous personality disorder classifications had major problems. These included unnecessary complexity, inconsistency with data on normal personality traits, and minimal consideration of severity despite this being shown to be the major predictor of outcome. The ICD-11 classification abolishes all categories of personality disorder except for a general description of personality disorder. This diagnosis can be further specified as "mild," "moderate," or "severe." Patient behavior can be described using one or more of five personality trait domains; negative affectivity, dissociality, anankastia, detachment, and disinhibition. Clinicians may also specify a borderline pattern qualifier. The ICD-11 shows considerable alignment with the DSM-5 Alternative Model for Personality Disorders. Early evidence around the reliability and validity of the new model appear promising, although at present there is still limited specific evidence due to the model being so recently finalized. However, for the model to be successful, it needs to be embraced by clinicians and used widely in normal clinical practice.
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Affiliation(s)
- Roger T Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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