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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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Aydın-Seyrek T, Gandur T, Turgut N, Kunt DA, Dereboy F. Reliability of the ICD-11 personality disorder severity ratings and diagnosis. Personal Ment Health 2024. [PMID: 38973511 DOI: 10.1002/pmh.1629] [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: 02/05/2024] [Revised: 05/08/2024] [Accepted: 06/15/2024] [Indexed: 07/09/2024]
Abstract
The present study aimed to investigate the interrater reliability of the dichotomous and dimensional personality disorder (PD) diagnoses based on the overall severity assessment on a rating form consisting of 18 anchored items encompassing diagnostic requirements of the International Classification of Diseases 11th Revision (ICD-11). We also aimed to examine the extent of consistency within the diagnostic requirements grouped under the domains of self- and interpersonal functioning, specific manifestations of personality dysfunction, and distress and impairment in psychosocial functioning. Our data involved a total of 184 inter-ratings of 46 consenting patients by the same set of four clinicians. The chance-corrected agreement levels were estimated at intraclass correlation coefficient (ICC) = 0.89 for the overall severity composite, ICC = 0.83 for the dimensional PD diagnosis and Fleiss' kappa = 0.77 for the dichotomous PD diagnosis. Internal consistency analysis of the overall severity composite and the domain composites revealed Cronbach's alpha coefficients approaching or exceeding 0.90 level. Our findings suggest that the diagnostic requirements listed in the ICD-11 and related documents for the severity determination in PD compose an internally consistent set. With the guidance of a rating form comprised of anchored items covering this set, competency-level clinicians are likely to perform reliable evaluations of the severity of personality disturbance, and dimensional and dichotomous PD diagnoses. The development of semi-structured interviews that would further facilitate the task of inspecting and rating each diagnostic requirement reliably will possibly enhance the implementation of the ICD-11 classification for PD around the world.
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Affiliation(s)
| | - Tarık Gandur
- Department of Psychology, Faculty of Economics, Administrative and Social Sciences, Fenerbahçe University, İstanbul, Turkey
| | | | | | - Ferhan Dereboy
- Faculty of Medicine, Adnan Menderes University, Aydın, Turkey
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Balzen KM, Kerr S, Gecha T, Hutsebaut J, Berghuis H, Sharp C. First Psychometric Evaluation of the English Version of the Semi-Structured Interview for Personality Functioning (STiP-5.1). J Pers Assess 2024:1-11. [PMID: 38934551 DOI: 10.1080/00223891.2024.2365325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024]
Abstract
The Alternative Model for Personality Disorders provides a dimensional framework for the conceptualization of personality disorders where Criterion A concerns the assessment of one's level of personality functioning (LPF). This study examines the psychometric properties of the English translation of the Semi-Structured Interview for Personality Functioning (STiP-5.1) to validate this translation for the assessment of LPF in English-speaking populations; and examine whether this measure increments self-report measures of LPF and personality pathology in predicting general functioning. The sample consisted of 129 emerging adults between 18 and 25 years of age (M = 20.54, SD = 2.08) from a mixed college and clinical sample. Results support a unidimensional factor structure of the STiP-5.1, good internal consistency, and high inter-rater reliability. Construct validity was supported through associations of the STiP-5.1 with self-report measures of LPF and personality pathology. The STiP-5.1 incremented self-report measures of personality pathology in predicting functional impairment, though additional variance explained was modest. Finally, STiP-5.1 scores differentiated individuals who obtained a score at or above the clinical cutoff from those below on self-report measures of personality pathology and LPF with large effect sizes. Findings support the validity of the English translation of the STiP-5.1 for the assessment of LPF.
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Affiliation(s)
| | - Sophie Kerr
- Department of Psychology, University of Houston
| | - Tess Gecha
- Department of Psychology, University of Houston
| | - Joost Hutsebaut
- Department of Medical and Clinical Psychology, Center of Research on Psychological disorders and Somatic diseases (CoRPS), Tilburg, The Netherlands
| | - Han Berghuis
- Arkin Mental Heath, NPI Centre for Personality Disorders, Amersfoort, The Netherlands
| | - Carla Sharp
- Department of Psychology, University of Houston
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Sellbom M, Brown TA, Bach B. Development and psychometric evaluation of the Personality Disorder Severity ICD-11 (PDS-ICD-11) Clinician-Rating Form. Personal Ment Health 2024; 18:60-68. [PMID: 37941508 DOI: 10.1002/pmh.1596] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/17/2023] [Accepted: 10/16/2023] [Indexed: 11/10/2023]
Abstract
No clinician-rating tool has formally been developed to assess the ICD-11 model of personality disorder (PD) severity. We therefore developed and evaluated the 14-item personality disorder Severity ICD-11 (PDS-ICD-11) Clinician-Rating Form. A combined sample of 195 patients was rated by mental health professionals or clinical research assistants in New Zealand using the PDS-ICD-11 Clinician-Rating Form. Responses were subjected to item-response theory analysis and confirmatory factor analysis. In a subsample, we examined interrater reliability and convergence with self- and informant-reported measures of personality impairment, dysfunction in various psychopathology domains, and traditional PD symptoms. Item-response theory and confirmatory factor analyses supported the item functioning and unidimensionality, respectively, of the PDS-ICD-11 Clinician-Rating Form. The interrater reliability was very promising (intraclass correlation coefficient = 0.94, p < 0.001). PDS-ICD-11 Clinician-Rating Form scores were associated with established measures of personality dysfunction at large effect sizes. This initial development study suggests that the PDS-ICD-11 Clinician-Rating Form constitutes a psychometrically sound instrument that provides a clinically based impression of the severity of personality dysfunction according to the official ICD-11 description. More research is needed to corroborate its validity and utility, and a structured interview is warranted for diagnostic purposes. The final PDS-ICD-11 Clinician-Rating Form is included as online supporting information.
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Affiliation(s)
- Martin Sellbom
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - 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
- Department of Psychology, University of Southern Denmark, Odense, Denmark
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Hualparuca-Olivera L, Caycho-Rodríguez T, Torales J, Ramos-Campos D. Convergence between the dimensional PD models of ICD-11 and DSM-5: a meta-analytic approach. Front Psychiatry 2023; 14:1325583. [PMID: 38098639 PMCID: PMC10719945 DOI: 10.3389/fpsyt.2023.1325583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 11/10/2023] [Indexed: 12/17/2023] Open
Abstract
In the current diagnostic systems, the International Classification of Diseases-11th rev. (ICD-11) and the Diagnostic and Statistical Manual of Mental Disorders-5th ed. (DSM-5), the evaluation and diagnosis of personality disorder (PD) aim at dimensional examination of the severity of its dysfunction and the stylistic features that accompany it. Since their implementation, or even before, several measures have been developed to assess PD severity and traits in both models. Thus, convergent validity metrics have been reported with various PD measures; however, the convergence of the same constructs included in the measures of these two models remains undefined. The objective of the present review was to examine whether there is a sufficient relationship between PD measures of the ICD-11 and DSM-5 AMPD in the general population. For this meta-analytic review, systematic searches were conducted in Web of Science, PubMed, Scopus, and Google Scholar. We included studies that reported Pearson's r correlations without restrictions on language, age, sex, setting, type of sample, or informant of the measures. We excluded associations with anankastia, psychoticism or the borderline pattern because they were not comparable between one dimensional model and the other. We examined the quality of the evidence with the JBI Critical Appraisal Checklist for Analytical Cross Sectional Studies, and performed the random effects meta-analysis with the 'meta' package of the RStudio software. Of the 5,629 results returned by the search, 16 studies were eligible; and showed moderate quality. The risk of bias was manifested by not specifying the details of the sample, the recruitment environment, and the identification and control of confounding factors. Thirteen studies provided two or more correlations resulting in a total of 54 studies for meta-analysis. The overall effect size estimate (correlation) was moderate for the overall model (r = 0.62, 95% CI [0.57, 0.67], p < 0.0001, I2 = 97.6%). For the subgroup of associations, ICD-11 severity model and DSM-5 AMPD severity model, the correlation was also moderate (k = 10, r = 0.57, 95% CI [0.48; 0.66]; I2 = 92.9%); as for the subgroup of associations, ICD-11 traits model and DSM-5 AMPD traits model (k = 44, r = 0.63, 95% CI [0.57; 0.69], I2 = 97.9%). The convergent validity between measures of PD severity and traits between one diagnostic system and another has been demonstrated in this review and they can probably be used interchangeably because they also measure the same constructs. Future research can address the limitations of this study and review the evidence for the discriminant validity of these measures.
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Affiliation(s)
| | | | - Julio Torales
- Department of Medical Psychology, School of Medical Sciences, Universidad Nacional de Asunción, San Lorenzo, Paraguay
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Gutiérrez F, Aluja A, Rodríguez C, Gárriz M, Peri JM, Gallart S, Calvo N, Ferrer M, Gutiérrez-Zotes A, Soler J, Pascual JC. Severity in the ICD-11 personality disorder model: Evaluation in a Spanish mixed sample. Front Psychiatry 2022; 13:1015489. [PMID: 36699492 PMCID: PMC9868964 DOI: 10.3389/fpsyt.2022.1015489] [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: 08/09/2022] [Accepted: 12/16/2022] [Indexed: 01/12/2023] Open
Abstract
Severity is the main component of the ICD-11 personality disorder (PD) classification, but pertinent instruments have only recently been developed. We analyzed the psychometric properties of the ICD-11 Personality Disorder Severity scale (PDS-ICD-11) in a mixed sample of 726 community and clinical subjects. We also examined how the different components of the ICD-11 PD system -five trait domains, the borderline pattern specifier, and severity, all of them measured through self-reports- are interconnected and operate together. PDS-ICD-11 properties were adequate and similar to those of the original instrument. However, regressions and factor analyses showed a considerable overlap of severity with the five personality domains and the borderline specifier (72.6%). Bifactor modeling resulted in a general factor of PD (g-PD) that was not equivalent to severity nor improved criterion validity. The whole ICD-11 PD system, i.e., five personality domains, borderline, and severity, explained an average of 43.6% of variance of external measures of well-being, disability, and clinical problems, with severity contributing 4.8%. Suggestions to further improve the ICD-11 PD taxonomy include remodeling the present definition of severity to give more weight to the real-life consequences of traits.
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Affiliation(s)
- Fernando Gutiérrez
- Institute of Neuroscience, Hospital Clínic of Barcelona, Barcelona, Spain.,Institut d'Investigacións Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Anton Aluja
- Lleida Institute for Biomedical Research Dr. Pifarré Foundation, Lleida, Spain.,Department of Psychology, University of Lleida, Lleida, Spain
| | - Claudia Rodríguez
- Institute of Neuroscience, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Miguel Gárriz
- Neuropsychiatry and Drug Addiction Institute, Parc de Salut Mar, Barcelona, Spain
| | - Josep M Peri
- Institute of Neuroscience, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Salvador Gallart
- Department of Psychiatry, Mental Health, and Addiction, GSS-Hospital Santa Maria, Lleida, Spain
| | - Natalia Calvo
- Department of Psychiatry, Vall d'Hebron University Hospital, Barcelona, Spain.,Network Centre for Biomedical Research in Mental Health (CIBERSAM), Barcelona, Spain.,Psychiatry and Legal Medicine Department, Autonomous University of Barcelona, Barcelona, Spain
| | - Marc Ferrer
- Department of Psychiatry, Vall d'Hebron University Hospital, Barcelona, Spain.,Network Centre for Biomedical Research in Mental Health (CIBERSAM), Barcelona, Spain.,Psychiatry and Legal Medicine Department, Autonomous University of Barcelona, Barcelona, Spain
| | - Alfonso Gutiérrez-Zotes
- Network Centre for Biomedical Research in Mental Health (CIBERSAM), Barcelona, Spain.,Pere Virgili Health Research Institute (IISPV), CERCA, Reus, Spain.,Pere Mata Psychiatric University Hospital, Reus, Spain
| | - Joaquim Soler
- Psychiatry and Legal Medicine Department, Autonomous University of Barcelona, Barcelona, Spain.,Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Juan Carlos Pascual
- Psychiatry and Legal Medicine Department, Autonomous University of Barcelona, Barcelona, Spain.,Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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