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Day NJS, Green A, Denmeade G, Bach B, Grenyer BFS. Narcissistic personality disorder in the ICD-11: Severity and trait profiles of grandiosity and vulnerability. J Clin Psychol 2024; 80:1917-1936. [PMID: 38742471 DOI: 10.1002/jclp.23701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 04/28/2024] [Accepted: 04/30/2024] [Indexed: 05/16/2024]
Abstract
Modern diagnostic and classification frameworks such as the ICD-11 and DSM-5-AMPD have adopted a dimensional approach to diagnosing personality disorder using a dual "severity" and "trait" model. As narcissistic personality has historically struggled to be adequately captured in dominant diagnostic systems, this study investigated the utility of the new ICD-11 framework in capturing diverse narcissistic expressions. Participants were mental health clinicians (N = 180, 67% female, age = 38.9), who completed ratings of ICD-11 personality severity, trait domains and a clinical reflection for two hypothetical case vignettes reflecting either prototypical "grandiose" or "vulnerable" narcissism. The majority of clinicians (82%) endorsed a diagnosis of personality disorder for both grandiose and vulnerable vignettes. Discriminant elements of personality impairment included rigid, unrealistically positive self-view, low empathy and high conflict with others for grandiosity, and incoherent identity, low self-esteem and hypervigilant, avoidant relations with others for vulnerability. Regarding trait profile, grandiose narcissism was predominately dissocial whereas vulnerable narcissism was primarily associated with negative affectivity and detachment. Qualitative responses highlight distinct clinical themes for each presentation. These findings suggest that clinicians using the ICD-11 framework are able to identify common core elements of personality dysfunction in grandiose and vulnerable narcissism while also recognizing their distinctive differences.
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Affiliation(s)
- Nicholas J S Day
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Ava Green
- Department of Psychology, City, University of London, London, UK
| | - Georgia Denmeade
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Bo Bach
- Psychiatric Research Unit, Mental Health Services, Center for Personality Disorder Research, Region Zealand, Denmark
| | - Brin F S Grenyer
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
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2
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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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3
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Khazaie H, Rezaei F, Faridmarandi B, Zakiei A, Jananeh M, Mahdavi S, Nazari A, Komasi S. The sensitivity of the ICD-11 trait model to the symptoms of clinical disorders in young adults. Personal Ment Health 2024. [PMID: 38741371 DOI: 10.1002/pmh.1618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 02/25/2024] [Accepted: 04/28/2024] [Indexed: 05/16/2024]
Abstract
Hierarchical psychopathology contributes to providing a broader picture of the links between emerging personality structures such as the DSM-5/ICD-11 trait models and clinical disorders. The present study aimed to predict the specific and general clinical symptoms by the less studied constructs of the ICD-11 model (negative affectivity, detachment, dissociality, disinhibition, and anankastia). Data from 642 young adults from Iran (63% female, 18-34 years) were collected by three mental symptom scales and the Personality Inventory for DSM-5 (PID-5), which was recently used to harmonize the constructs of the DSM-5 and ICD-11 trait models. Multiple linear regressions showed that the ICD-11 model significantly predicted both the specific clinical symptoms (ranging from R2 = 0.15 to 0.40) and the general factor of clinical symptoms extracted by exploratory factor analysis (R2 = 0.40, all p < 0.001). Negative affectivity was the strongest construct correlated with both the specific symptoms (ranging from β = 0.36 to 0.69) and the general symptom factor (β = 0.59, all p < 0.001). Because the ICD-11 trait model is a practical structure related to the clinical psychopathology in young adults, screening for maladaptive traits can help clinicians in case formulation for diagnosis and treatment.
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Affiliation(s)
- Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Farzin Rezaei
- Roozbeh Hospital, Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Behrooz Faridmarandi
- Department of Neuroscience and Psychopathology Research, Mind GPS Institute, Kermanshah, Iran
| | - Ali Zakiei
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Minoo Jananeh
- Department of Neuroscience and Psychopathology Research, Mind GPS Institute, Kermanshah, Iran
| | - Sahar Mahdavi
- Department of Neuroscience and Psychopathology Research, Mind GPS Institute, Kermanshah, Iran
| | - Amin Nazari
- Department of Psychology, University of Kurdistan, Sanandaj, Iran
| | - Saeid Komasi
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Department of Neuroscience and Psychopathology Research, Mind GPS Institute, Kermanshah, Iran
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Biberdzic M, Sowislo JF, Cain N, Meehan KB, Preti E, Di Pierro R, Caligor E, Clarkin JF. Establishing Levels of Personality Functioning Using the Structured Interview of Personality Organization (STIPO-R): a Latent Profile Analysis. J Pers Assess 2024:1-13. [PMID: 38563480 DOI: 10.1080/00223891.2024.2330502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 02/17/2024] [Indexed: 04/04/2024]
Abstract
Both the new ICD-11 and the latest Alternative DSM-5 Model for Personality Disorders focus on self and interpersonal functioning as the central feature of personality pathology, also acknowledging that personality disorders are organized along a dimensional continuum of severity. This revised understanding is in line with long-standing psychodynamic conceptualisations of personality pathology, in particular Kernberg's object relations model of personality organization. Despite existing evidence for the clinical utility of the derived Structured Interview of Personality Organization (STIPO-R), empirical support for the identification of clear cut-points between the different levels of personality functioning is missing. For this purpose, a total of 764 adult participants were recruited across two clinical (outpatient and inpatient) settings (n = 250) and two non-clinical (university students and general community) samples (n = 514). Results from the mixture modeling suggested the existence of five groups across the clinical and non-clinical samples that covered: healthy personality functioning, maladaptive personality rigidity, and mild, moderate, and severe levels of personality pathology. All five indicators of personality organization were found to be reliable predictors of personality pathology. Of the five STIPO-R indicators, Aggression and Moral Values had the most discriminative power for differentiating between the Mild, Moderate, and Severe personality disorder groups. Implications of these findings are discussed.
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Affiliation(s)
- Marko Biberdzic
- Department of Psychology, Bishop's University, Sherbrooke, QC, Canada
| | - Julia F Sowislo
- Personality Disorders Institute and Department of Psychiatry, Weill Medical College of Cornell University, New York, New York
| | - Nicole Cain
- Personality Disorders Institute and Department of Psychiatry, Weill Medical College of Cornell University, New York, New York
- Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, New Jersey, USA
| | - Kevin B Meehan
- Personality Disorders Institute and Department of Psychiatry, Weill Medical College of Cornell University, New York, New York
- Department of Psychology, Long Island University, Brooklyn, New York, USA
| | - Emanuele Preti
- Department of Psychology, University of Milan-Bicocca, Milan, Italy
| | | | - Eve Caligor
- Personality Disorders Institute and Department of Psychiatry, Weill Medical College of Cornell University, New York, New York
- Department of Psychiatry, Vagelos College of Physicians and Surgeons of Columbia University, New York, New York, USA
| | - John F Clarkin
- Personality Disorders Institute and Department of Psychiatry, Weill Medical College of Cornell University, New York, New York
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5
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Mirjat MH, Kamran M, Ashraf H, Akhtar H, Lalwani AK. A Case Report of Primary Derealization Disorder: Diagnostic and Treatment Challenges in a Pakistani Healthcare Setting. Cureus 2024; 16:e55419. [PMID: 38567226 PMCID: PMC10985512 DOI: 10.7759/cureus.55419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2024] [Indexed: 04/04/2024] Open
Abstract
Depersonalization and derealization symptoms are often transient. Recurrent and persistent symptoms can result in a diagnosis of depersonalization/derealization disorder (DDD). Here, we reported a case of a 24-year-old adult male whose presentation was consistent with primary derealization disorder only. He was referred with his consent by an ophthalmologist and neurologist for psychiatric opinion for the complaints of blackish discoloration of his vision for the last two years and feeling of unreality towards his surroundings for the last one and a half years in the absence of any comorbid physical illness and mental disorder. The patient was treated with fluoxetine, Lamotrigine, and psychotherapy, but there was only some improvement reported in his distress; however, primary complaints remained unchanged.
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Affiliation(s)
| | - Maham Kamran
- Orthopedics, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Hadiqa Ashraf
- Internal Medicine, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Hareem Akhtar
- Psychiatry and Behavioural Sciences, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Aasish K Lalwani
- Psychiatry and Behavioural Sciences, Jinnah Postgraduate Medical Centre, Karachi, PAK
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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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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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Brown TA, Sellbom M, Bach B, Newton-Howes G. New Zealand (Aotearoa) clinicians' perspectives on the utility of the ICD-11 personality disorder diagnosis. Personal Ment Health 2023; 17:282-291. [PMID: 36890116 DOI: 10.1002/pmh.1582] [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: 11/27/2022] [Revised: 12/19/2022] [Accepted: 02/16/2023] [Indexed: 03/10/2023]
Abstract
The ICD-11 has now taken effect and includes a new dimensional personality disorder (PD) diagnosis. The current study aimed to examine Aotearoa/New Zealand practitioners' perceptions of the clinical utility of the new PD system. A sample of 124 psychologists and psychiatrists completed a survey, applying the DSM-5 and ICD-11 PD diagnostic systems to a current patient, and completed clinical utility metrics on the DSM-5 and ICD-11 models. Additional open-ended questions further elicited clinicians' perceptions of the strengths, weaknesses and potential application issues of the ICD-11 PD diagnosis, and these responses were analysed through thematic analysis. Overall, the ICD-11 system was rated higher than the DSM-5 on all six clinical metrics, with no significant difference between psychologists' and psychiatrists' ratings. Five themes emerged: appreciation for an alternative to DSM-5, structural barriers preventing ICD-11 PD implementation, personal barriers to ICD-11 implementation, diagnoses viewed as low utility, clinician preference for formulation and cultural safety considerations for implementation of ICD-11 PD in Aotearoa/NZ. Overall, clinicians had positive opinions of the clinical utility of the ICD-11 PD diagnosis, although expressed some concerns about its implementation. The study expands upon initial evidence that mental health practitioners have generally positive perceptions of the ICD-11 PDs' clinical utility.
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Affiliation(s)
| | | | - Bo Bach
- Centre for Personality Disorder Research, Slagelse Psychiatric Hospital, Slagelse, Denmark
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Tracy M, Sharpe L, Bach B, Tiliopoulos N. Connecting DSM-5 and ICD-11 trait domains with schema therapy and dialectical behavior therapy constructs. Personal Ment Health 2023; 17:208-219. [PMID: 36575608 DOI: 10.1002/pmh.1574] [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: 02/09/2022] [Revised: 10/23/2022] [Accepted: 11/30/2022] [Indexed: 12/29/2022]
Abstract
The DSM-5 Section III alternative model of personality disorder (AMPD) and the International Classification of Diseases - 11th Edition's (ICD-11) personality disorder classification allow clinicians to identify individual trait domains in which people score highly. However, how these domains relate to constructs associated with efficacious treatment approaches is unclear. The current study aimed to determine whether constructs from two evidence-based treatments (schema therapy [ST] and dialectical behavior therapy [DBT]) were associated with maladaptive personality traits in a way consistent with underlying theories. We examined associations between ST constructs, DBT skill use and maladaptive coping styles, and personality traits in a sample of 525 adults. Bivariate intercorrelations and a series of multiple regression analyses were conducted to investigate the associations. As hypothesized, maladaptive coping was strongly associated with all trait domains. Surprisingly, poor DBT-skill use was only associated with negative affectivity, detachment, and disinhibition trait domains. Specific schema domains were associated with each personality trait domain, supporting trait domain-schema domain specificity. The current study highlights the potential clinical utility of the AMPD and ICD-11 trait models and ultimately contributes to the dearth of evidence on their likely usefulness for treatment selection, planning, and applications.
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Affiliation(s)
- Mikaela Tracy
- School of Psychology, Faculty of Science, The University of Sydney, Camperdown, New South Wales, Australia
| | - Louise Sharpe
- School of Psychology, Faculty of Science, The University of Sydney, Camperdown, New South Wales, Australia
| | - Bo Bach
- Center for Personality Disorder Research (CPDR), Psychiatric Research Unit, Mental Health Services, Region Zealand, Denmark
| | - Niko Tiliopoulos
- School of Psychology, Faculty of Science, The University of Sydney, Camperdown, New South Wales, Australia
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Cano K, Sharp C. A Consumer Perspective on Personality Diagnostic Systems: One Size Does Not Fit All. J Pers Disord 2023; 37:263-284. [PMID: 37367823 DOI: 10.1521/pedi.2023.37.3.263] [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
Although providers and patients may largely agree on what is essential to clinically useful assessment and diagnosis, patients have a unique voice and contribute additional information to our conceptualization of clinical utility. The current study evaluated the clinical utility of three diagnostic models (Section II categorial, Section III hybrid, and the original ICD-11 dimensional) from the consumer/user perspective. Participants included 703 undergraduate students and 154 family members or individuals with borderline personality disorder. Participants rated mock diagnostic reports on six indices of clinical utility. Results indicated that undergraduates favored categorical reports over the original ICD-11 dimensional reports on three of six indices but rated categorical and hybrid reports as essentially equivalent. In the patient/family sample, participants favored the hybrid or categorical model on all indices. Our findings speak to the value of a clear diagnostic label and suggest that future iterations of the DSM adopting a hybrid or dimensional model should have a continued focus on simplicity in communication.
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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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12
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Hualparuca-Olivera L, Caycho-Rodríguez T. Diagnostic accuracy of severity measures of ICD-11 and DSM-5 personality disorder: clarifying the clinical landscape with the most up-to-date evidence. Front Psychiatry 2023; 14:1209679. [PMID: 37324826 PMCID: PMC10265646 DOI: 10.3389/fpsyt.2023.1209679] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/15/2023] [Indexed: 06/17/2023] Open
Abstract
With the implementation of new dimensional models of personality disorder (PD) in the DSM-5 and ICD-11, several investigators have developed and evaluated the psychometric properties of measures of severity. The diagnostic accuracy of these measures, an important cross-cultural metric that falls between validity and clinical utility, remains unclear. This study aimed to analyze and synthesize the diagnostic performance of the measures designed for both models. For this purpose, searches were carried out using three databases: Scopus, PubMed, and Web of Science. Studies that presented sensitivity and specificity parameters for cut-off points were selected. There were no restrictions on the age and gender of the participants nor on the reference standard used or the settings. Study quality and synthesis were assessed using QUADAS-2 and MetaDTA software, respectively. Twelve studies were eligible covering self-reported and clinician-rated measures based on the ICD-11 and DSM-5 PD severity models. A total of 66.7% of the studies showed a risk of bias in more than 2 domains. The 10th and 12th studies provided additional metrics, resulting in a total of 21 studies for evidence synthesis. Adequate overall sensitivity and specificity (Se = 0.84, Sp = 0.69) of these measures were obtained; however, the cross-cultural performance of specific cut-off points could not be assessed due to the paucity of studies on the same measure. Evidence suggests that patient selection processes should mainly be improved (avoid case-control design), use adequate reference standards, and avoid only reporting metrics for the optimal cut-off point.
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Somma A, Keeley JW, Bach B. Editorial: Community series in ICD-11 personality disorders: utility and implications of the new model, volume II. Front Psychiatry 2023; 14:1199703. [PMID: 37283709 PMCID: PMC10240050 DOI: 10.3389/fpsyt.2023.1199703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/02/2023] [Indexed: 06/08/2023] Open
Affiliation(s)
- Antonella Somma
- School of Psychology, Vita-Salute San Raffaele University, Milan, Italy
- Clinical Psychology and Psychotherapy Unit, IRCCS San Raffaele Turro Hospital, Milan, Italy
| | - Jared W. Keeley
- Psychology Department, Virginia Commonwealth University, Richmond, VA, United States
| | - Bo Bach
- Center for Personality Disorder Research (CPDR), Psychiatric Research Unit, Slagelse Psychiatric Hospital, Slagelse, Denmark
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14
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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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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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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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