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Thomson M, Cavelti M, Lerch S, Koenig J, Reichl C, Mürner-Lavanchy I, Wyssen A, Kaess M. Clinical profiles of adolescent personality pathology: a latent structure examination of the Semi-Structured Interview for Personality Functioning DSM-5 (STiP-5.1) in a help-seeking sample. Borderline Personal Disord Emot Dysregul 2024; 11:9. [PMID: 38589974 PMCID: PMC11003081 DOI: 10.1186/s40479-024-00252-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/25/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Despite the introduction of dimensional conceptualisations of personality functioning in the latest classification systems, such as Criterion A of the Alternative Model of Personality Disorders in the DSM-5, heterogeneous clinical presentation of personality pathology remains a challenge. Relatedly, the latent structure of personality pathology as assessed by the Semi-Structured Interview for Personality Functioning DSM-5 (STiP-5.1) has not yet been comprehensively examined in adolescents. Therefore, this study aimed to examine the latent structure of the STiP-5.1, and, based on those findings, to describe any unique clinical profiles that might emerge. METHODS The final sample comprised 502 participants aged 11-18 years consecutively recruited from a specialised personality disorder outpatient service, as well as general day clinic and inpatient wards at the University Hospital University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Bern, Switzerland. Participants were assessed using the STiP-5.1, as well as a battery of other psychological measures by clinical psychologists or trained doctoral students. Variations of Factor Analysis, Latent Class Analysis and Factor Mixture Models (FMM) were applied to the STiP-5.1 to determine the most appropriate structure. RESULTS The best fitting model was an FMM comprising four-classes and two factors (corresponding to self- and interpersonal-functioning). The classes differed in both overall severity of personality functioning impairment, and in their scores and clinical relevance on each element of the STiP-5.1. When compared to the overall sample, classes differed in their unique clinical presentation: class 1 had low impairment, class 2 had impairments primarily in self-functioning with high depressivity, class 3 had mixed levels of impairment with emerging problems in identity and empathy, and class 4 had severe overall personality functioning impairment. CONCLUSIONS A complex model incorporating both dimensional and categorical components most adequately describes the latent structure of the STiP-5.1 in our adolescent sample. We conclude that Criterion A provides clinically useful information beyond severity (as a dimensional continuum) alone, and that the hybrid model found for personality functioning in our sample warrants further attention. Findings can help to parse out clinical heterogeneity in personality pathology in adolescents, and help to inform early identification and intervention efforts.
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Affiliation(s)
- Madelyn Thomson
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Marialuisa Cavelti
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Stefan Lerch
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Corinna Reichl
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Ines Mürner-Lavanchy
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Andrea Wyssen
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
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Hopwood CJ, Morey LC, Markon KE. What is a psychopathology dimension? Clin Psychol Rev 2023; 106:102356. [PMID: 37926058 DOI: 10.1016/j.cpr.2023.102356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/06/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023]
Abstract
Coherence in the science and practice of mental health assessment depends upon a tight connection between psychopathology concepts that are used and the way those concepts are operationalized and defined. In contrast, the use of the same word to mean more than one thing contributes to incoherence, inefficiency, and confusion. In this paper, we review three possible meanings of the word "dimension" as it relates to the assessment of psychopathology and describe how the indiscriminate use of this word has caused confusion in the general context of the transition to a more evidence-based approach to mental health diagnosis. We attempt to disambiguate the term "dimension" by demarcating three concepts that can be distinguished based on different empirical standards: continuous variables, unidimensional dimensions, and distinct dimensions.
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Carreiras D, Cunha M, Sharp C, Castilho P. The Clinical Interview for Borderline Personality Disorder for Adolescents (CI-BOR-A): Development, acceptability and expert panel evaluation. Personal Ment Health 2023; 17:377-386. [PMID: 37183381 DOI: 10.1002/pmh.1586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/02/2023] [Accepted: 05/01/2023] [Indexed: 05/16/2023]
Abstract
Borderline personality disorder (BPD) is a severe mental disorder with marked impulsivity, instability, emotional dysregulation and self-harm. These features tend to develop over time and can be identified in adolescence. Early diagnosis is the first step to prevent the development of these features to a personality disorder. The purpose of this study was to develop the Clinical Interview for BPD for Adolescents (CI-BOR-A), a new instrument based on a sound clinical interview for BPD in youth (CI-BPD). We tested its acceptability with 43 adolescents and its content validity with the quantitative and qualitative evaluation of 23 experts in mental health. The CI-BOR-A is a hybrid semi-structured interview that considers both categorical and dimensional approaches of personality disorders of DSM-5-TR, including 16 items, decision tables for diagnosis, and an appendix to explore self-harm history further. Adolescents accepted the interview, and none refused to complete the assessment. The expert panel considered the interview relevant, clear, accurate and complete. Important feedback was provided in terms of structure and content to improve the CI-BOR-A quality. In general, the CI-BOR-A is a rigorous interview to assess BPD in adolescents and adds an important contribution to early detection in clinical and community settings.
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Affiliation(s)
- Diogo Carreiras
- Faculty of Psychology and Educational Sciences, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), University of Coimbra, Coimbra, Portugal
- Miguel Torga Higher Institute, Coimbra, Portugal
| | - Marina Cunha
- Faculty of Psychology and Educational Sciences, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), University of Coimbra, Coimbra, Portugal
- Miguel Torga Higher Institute, Coimbra, Portugal
| | | | - Paula Castilho
- Faculty of Psychology and Educational Sciences, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), University of Coimbra, Coimbra, Portugal
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Williams R, Chiesa M, Moselli M, Frattini C, Casini M, Fonagy P. The relationship between mood disorders, personality disorder and suicidality in adolescence: does general personality disturbance play a significant role in predicting suicidal behavior? Borderline Personal Disord Emot Dysregul 2023; 10:32. [PMID: 37907967 PMCID: PMC10619325 DOI: 10.1186/s40479-023-00238-9] [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: 04/07/2023] [Accepted: 10/04/2023] [Indexed: 11/02/2023] Open
Abstract
INTRODUCTION Current research points to the importance personality pathology and Major Depression e as relevant psycopathological risk factors for understanding suicidal risk in adolescence. Literature has mainly focused on the role of BPD, however current orientations in personality pathological functioning suggest that BPD may be the representative of a general personality disturbance, a factor of vulnerability underlying diverse psychopathological variants and aspects of maladaptive functioning. However, recent studies seem to have neglected the contributions that other specific personality disorders and personality pathology as a general factor of vulnerability for suicidality; and only marginally investigated the interaction of personality disorder (PD) as an overall diagnosis and individual PDs and major depression (MDD). In this paper, the independent and cumulative effects of MDD and DSM-IV PDs on suicidal risk are investigated in a sample of adolescents observed in a longitudinal window of observation ranging from three months preceding the assessment to a six-month follow up period of clinical monitoring. METHODS A sample of 118 adolescents (mean age = 15.48 ± 1.14) referred for assessment and treatment on account of suicidal ideation or behavior were administered the CSSRS, SCID II, Kiddie-SADS at admission at inpatient and outpatient Units. All subjects included in the study had reported suicidal ideation or suicide attempts at the C-SSRS; The CSSRS was applied again to all patients who reported further suicidal episodes during the six-months follow-up period of clinical monitoring. Dimensional diagnoses of PDs was obtained by summing the number of criteria met by each subject at SCID-%-PD 5, In order, to test the significance of the associations between the variables chosen as predictors (categorical and dimensional PDs and MD diagnosis), and the suicidal outcomes variables suicide attempts, number of suicide attempts and potential lethality of suicide attempt, non-parametric bivariate correlations, logistic regression models and mixed-effects Poisson regression were performed PD. RESULTS The categorical and dimensional diagnosis of PD showed to be a significant risk factors for suicide attempt and their recurrence, independently of BPD, that anyway was confirmed to be a specific significant risk factor for suicidal behaviors. Furthermore, PD assessed at a categorical and dimensional level and Major Depression exert an influence on suicidal behaviors and their lethality both as independent and cumulative risk factors. LIMITATIONS Besides incorporating dimensional thinking into our approach to assessing psychopathology, our study still relied on traditionally defined assessment of PD. Future studies should include AMPD-defined personality pathology in adolescence to truly represent dimensional thinking. CONCLUSION These results point to the importance of early identification of the level of severity of personality pathology at large and its co-occurrence with Major Depression for the management of suicidal risk in adolescence.
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Affiliation(s)
- Riccardo Williams
- Department of Dynamic and Clinical Psychology and Health Studies, Faculty of Medicine and Psychology, "Sapienza" - University of Rome, Rome, Italy.
| | - Marco Chiesa
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Marta Moselli
- Department of Dynamic and Clinical Psychology and Health Studies, Faculty of Medicine and Psychology, "Sapienza" - University of Rome, Rome, Italy
| | - Camillla Frattini
- Department of Dynamic and Clinical Psychology and Health Studies, Faculty of Medicine and Psychology, "Sapienza" - University of Rome, Rome, Italy
| | - MariaPia Casini
- Section of Child and Adolescent Neuro-Psychiatry, "Sapienza" - University of Rome, Rome, Italy
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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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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Rosenblau G, Frolichs K, Korn CW. A neuro-computational social learning framework to facilitate transdiagnostic classification and treatment across psychiatric disorders. Neurosci Biobehav Rev 2023; 149:105181. [PMID: 37062494 PMCID: PMC10236440 DOI: 10.1016/j.neubiorev.2023.105181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 03/14/2023] [Accepted: 04/13/2023] [Indexed: 04/18/2023]
Abstract
Social deficits are among the core and most striking psychiatric symptoms, present in most psychiatric disorders. Here, we introduce a novel social learning framework, which consists of neuro-computational models that combine reinforcement learning with various types of social knowledge structures. We outline how this social learning framework can help specify and quantify social psychopathology across disorders and provide an overview of the brain regions that may be involved in this type of social learning. We highlight how this framework can specify commonalities and differences in the social psychopathology of individuals with autism spectrum disorder (ASD), personality disorders (PD), and major depressive disorder (MDD) and improve treatments on an individual basis. We conjecture that individuals with psychiatric disorders rely on rigid social knowledge representations when learning about others, albeit the nature of their rigidity and the behavioral consequences can greatly differ. While non-clinical cohorts tend to efficiently adapt social knowledge representations to relevant environmental constraints, psychiatric cohorts may rigidly stick to their preconceived notions or overly coarse knowledge representations during learning.
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Affiliation(s)
- Gabriela Rosenblau
- Department of Psychological and Brain Sciences, George Washington University, Washington DC, USA; Autism and Neurodevelopmental Disorders Institute, George Washington University, Washington DC, USA.
| | - Koen Frolichs
- Section Social Neuroscience, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany; Institute for Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph W Korn
- Section Social Neuroscience, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany; Institute for Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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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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8
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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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Monaghan C, Bizumic B. Dimensional models of personality disorders: Challenges and opportunities. Front Psychiatry 2023; 14:1098452. [PMID: 36960458 PMCID: PMC10028270 DOI: 10.3389/fpsyt.2023.1098452] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/03/2023] [Indexed: 03/09/2023] Open
Abstract
Categorical models of personality disorders have been beneficial throughout psychiatric history, providing a mechanism for organizing and communicating research and treatment. However, the view that individuals with personality disorders are qualitatively distinct from the general population is no longer tenable. This perspective has amassed steady criticism, ranging from inconsequential to irreconcilable. In response, stronger evidence has been accumulated in support of a dimensional perspective that unifies normal and pathological personality on underlying trait continua. Contemporary nosology has largely shifted toward this dimensional perspective, yet broader adoption within public lexicon and routine clinical practice appears slow. This review focuses on challenges and the related opportunities of moving toward dimensional models in personality disorder research and practice. First, we highlight the need for ongoing development of a broader array of measurement methods, ideally facilitating multimethod assessments that reduce biases associated with any single methodology. These efforts should also include measurement across both poles of each trait, intensive longitudinal studies, and more deeply considering social desirability. Second, wider communication and training in dimensional approaches is needed for individuals working in mental health. This will require clear demonstrations of incremental treatment efficacy and structured public health rebates. Third, we should embrace cultural and geographic diversity, and investigate how unifying humanity may reduce the stigma and shame currently generated by arbitrarily labeling an individual's personality as normal or abnormal. This review aims to organize ongoing research efforts toward broader and routine usage of dimensional perspectives within research and clinical spaces.
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Affiliation(s)
- Conal Monaghan
- Research School of Psychology, Australian National University, Canberra, ACT, Australia
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Ellison WD, Huprich S, Behn A, Goodman M, Kerr S, Levy KN, Nelson SM, Sharp C. Attitudes, Clinical Practices, and Perceived Advocacy Needs of Professionals With Interests in Personality Disorders. J Pers Disord 2023; 37:1-15. [PMID: 36723421 DOI: 10.1521/pedi.2023.37.1.1] [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: 02/02/2023]
Abstract
Experts in personality disorders (PDs) generally prefer dimensional diagnostic systems to categorical ones, but less is known about experts' attitudes toward personality pathology diagnoses in adolescents, and little is known about public health shortfalls and advocacy needs and how these might differ geographically. To fill these gaps, the International Society for the Study of Personality Disorders surveyed 248 professionals with interests in PDs about their attitudes toward different diagnostic systems for adults and adolescents, their PD-related clinical practices, and perceived advocacy needs in their area. Results suggested that dimensional diagnostic systems are preferable to categorical and that skepticism about personality pathology in adolescents may not be warranted. The most pressing advocacy need was the increased availability of PD-related services, but many other needs were identified. Results provide a blueprint for advocacy and suggest ways that professional societies can collaborate with public health bodies to expand the reach of PD expertise and services.
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Affiliation(s)
| | - Steven Huprich
- Department of Psychology, University of Detroit Mercy, Detroit, Michigan
| | - Alex Behn
- School of Psychology, Pontificia Universidad Católica de Chile and Millennium Institute for Research in Depression and Personality, Santiago, Chile
| | - Marianne Goodman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Bronx, New York
| | - Sophie Kerr
- Department of Psychology, University of Houston, Houston, Texas
| | - Kenneth N Levy
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania
| | - Sharon M Nelson
- Serious Mental Illness Treatment, Resource, and Evaluation Center, Veterans Health Administration, Ann Arbor, Michigan
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston, Texas
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Kaess M, Bürger A. Persönlichkeitsstörung im Jugendalter. KINDHEIT UND ENTWICKLUNG 2023. [DOI: 10.1026/0942-5403/a000397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Zusammenfassung: Die kategoriale Klassifikation der Persönlichkeitsstörungen (PS) wurde im letzten Jahrzehnt durch eine „Perspektive der Lebensspanne“ mit zunehmend dimensionaler Sichtweise abgelöst. Für den Kinder- und Jugendbereich ist maßgeblich, dass die PS als Ergebnis dieses Prozesses als Erkrankungen angesehen werden, welche die gesamte Lebensspanne betreffen können. Diese Neuerung bereitet den Weg zu einer möglichen Frühbehandlung und ggf. sogar Prävention der PS bei Kindern und Jugendlichen. Im klinischen Alltag jedoch wird die Vergabe von PS in dieser Altersgruppe bis heute oft als kritisch angesehen. Das Themenheft möchte einen Beitrag zur Aufklärung über PS im Jugendalter leisten. Ziel ist es, dass die Vergabe von PS nicht als eine Stigmatisierung junger Menschen angesehen wird, sondern vielmehr als Chance schwerwiegende Entwicklungsverläufe früh zu erkennen und zielgerichtet zu verhindern oder zu behandeln. Der Fokus der Beiträge des Themenheftes liegt dabei auf der Borderline-Persönlichkeitsstörung (BPS) im Jugendalter.
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Affiliation(s)
- Michael Kaess
- Universitätsklinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universität Bern, Schweiz
- Klinik für Kinder- und Jugendpsychiatrie, Zentrum für psychosoziale Medizin, Universitätsklinikum Heidelberg, Deutschland
| | - Arne Bürger
- Zentrum für Psychische Gesundheit, Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Würzburg, Deutschland
- Deutsches Zentrum für Präventionsforschung und Psychische Gesundheit, Universität Würzburg, Deutschland
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12
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Bürger A, Kaess M. Die Borderline-Persönlichkeitsstörung im Jugendalter. KINDHEIT UND ENTWICKLUNG 2023. [DOI: 10.1026/0942-5403/a000407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Zusammenfassung: Die Borderline-Persönlichkeitsstörung (BPS) ist eine schwere psychische Erkrankung, die durch hohe Morbidität und Mortalität gekennzeichnet ist sowie mit einem niedrigen psychosozialen Funktionsniveau einhergeht. Die BPS zeigt sich oft mit Beginn der frühen Adoleszenz (ab dem 12. Lebensjahr). Neben repetitiver Selbstverletzung und Suizidalität bestehen häufig sowohl Symptome internalisierender (Depression und Angst) als auch externalisierender Störungen (Hyperaktivität und Substanzkonsum). Daher kommt einer differentialdiagnostischen Abklärung und der Diagnosestellung mit dem Ziel der Frühintervention im klinischen Alltag eine besondere Rolle zu. Die Psychotherapie stellt bei der BPS eine äußerst wirksame Behandlungsmethode dar, Belege für die Wirksamkeit von pharmakologischen Intervention fehlen. Der Schlüssel zu einer Verbesserung der Versorgung für Jugendliche mit BPS liegt in einer Generierung von Wissen zu Vorläufersymptomen sowie einer evidenzbasierten, stadienspezifischen Behandlung (frühe Behandlung bereits subklinischer BPS mit Behandlungsintensität abgestuft nach dem Schweregrad). Dieser Übersichtsartikel beleuchtet den aktuellen Stand der Forschung und gibt Empfehlungen für die therapeutische Arbeit in der klinischen Praxis.
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Affiliation(s)
- Arne Bürger
- Zentrum für Psychische Gesundheit, Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Würzburg, Deutschland
- Deutsches Zentrum für Präventionsforschung und Psychische Gesundheit, Universität Würzburg, Deutschland
| | - Michael Kaess
- Universitätsklinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universität Bern, Schweiz
- Klinik für Kinder- und Jugendpsychiatrie, Zentrum für psychosoziale Medizin, Universitätsklinikum Heidelberg, Deutschland
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13
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Benzi IMA, Fontana A, Barone L, Preti E, Parolin L, Ensink K. Emerging personality in adolescence: developmental trajectories, internalizing and externalizing problems, and the role of mentalizing abilities. J Adolesc 2022; 95:537-552. [PMID: 36564966 DOI: 10.1002/jad.12134] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Identifying longitudinal trajectories of emerging personality (EP) is crucial to highlight developmental patterns that might foster personality pathology in adolescence and early adulthood. Research on the exacerbation of personality pathology in adolescence identifies the significant contribution of internalizing and externalizing problems and suggests the importance of considering aspects such as mentalization, while accounting for gender differences. METHODS In our study, we adopted a mixed-model approach to (1) explore longitudinally EP (Adolescent Personality Structure Questionnaire; APS-Q) over 12 months in a sample of adolescents (N = 178, 62% females, mAGE = 15.04, SD = 1.27), accounting for gender effects. Moreover, (2) we assessed the longitudinal effect of internalizing and externalizing problems (Youth Self-Report; YSR-112) on EP. Finally, (3) we addressed the moderating role of mentalization (Movie Assessment for Social Cognition; MASC) in this developmental pathway. RESULTS Results highlighted a two-way pattern of EP. No changes were found in the level of difficulties in Self-acceptance, Investments and Goals, and Relationships with family dimensions. However, significant changes were found in personality functioning in the dimensions of Sense of Self, Aggression, and Relationships with friends. More, changes in difficulties in Sexuality emerged only in females. Also, gender differences emerged in the level of severity of EP. In addition, Internalizing and Externalizing problems differentially predicted difficulties in personality dimensions. Finally, mentalizing features moderated the relationship between Internalizing problems and Sense of Self and Internalizing problems and Self-acceptance, respectively. CONCLUSIONS Our contribution aligns with recent developmental models of personality pathology, suggesting that different personality dimensions develop at different paces. More, it highlights the predictive power of externalizing and internalizing problems on difficulties in personality dimensions. Finally, it advances the discussion on the contribution of mentalizing abilities to EP.
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Affiliation(s)
| | - Andrea Fontana
- Department of Human Science, LUMSA University, Rome, Italy
| | - Lavinia Barone
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Emanuele Preti
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Laura Parolin
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Karin Ensink
- Department of Psychology, Laval University, Quebec, Canada
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14
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Personality Disorder Diagnoses in ICD-11: Transforming Conceptualisations and Practice. CLINICAL PSYCHOLOGY IN EUROPE 2022; 4:e9635. [PMID: 36760321 PMCID: PMC9881116 DOI: 10.32872/cpe.9635] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 09/19/2022] [Indexed: 12/23/2022] Open
Abstract
Background Until the advent of the ICD-11, classification of personality disorders was based on categorical prototypes with a long history. These prototypes, whilst familiar, were not based in the science of personality. Prototypical classifications were also complex to administer in non-specialist settings requiring knowledge of many signs and symptoms. Method This article introduces the new structure of ICD-11 for personality disorders, describing the different severity levels and trait domain specifiers. Case studies illustrate the main aspects of the classification. Results The new ICD-11 system acknowledges the fundamentally dimensional nature of personality and its disturbances whilst requiring clinicians to make categorical decisions on the presence or absence of personality disorder and severity (mild, moderate or severe). The connection between normal personality functioning and personality disorder is established by identifying five trait domain specifiers to describe the pattern of a person's personality disturbance (negative affectivity, detachment, dissociality, disinhibition, and anankastia) that connect to the Big 5 personality traits established in the broader study of personality. Conclusions Whilst new assessment measures have been and are in development, the success of the new system will rely on clinicians and researchers embracing the new system to conceptualise and describe personality disturbances and to utilise the classification in the investigation of treatment outcome.
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15
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Peters EM, Yates K, DeVylder J, Lodhi RJ, Kelleher I. Understanding the inverse relationship between age and psychotic symptoms: The role of borderline personality traits. Acta Psychiatr Scand 2022; 146:484-491. [PMID: 35821578 DOI: 10.1111/acps.13475] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/31/2022] [Accepted: 07/09/2022] [Indexed: 01/29/2023]
Abstract
OBJECTIVE There is a well-established inverse relationship between age and positive psychotic symptoms, both in patients with psychotic disorders and in general population samples with psychotic experiences. The reason for this inverse relationship is unclear. We hypothesized that life-course developmental changes in borderline personality traits, which also typically decline with age, might explain the inverse relationship between age and positive psychotic symptoms. METHODS We tested this hypothesis with data from 19,980 adults who completed 2000, 2007, and 2014 UK Adult Psychiatric Morbidity Survey studies. Hallucinations and delusions were assessed with the Psychosis Screening Questionnaire. Borderline features were assessed with the Structured Clinical Interview for DSM-IV Axis II Personality Disorders Screening Questionnaire. Logistic regression models with effect decompositions were used to conduct the analyses. RESULTS As expected, age was negatively associated with hallucinations and delusions. These effects were wholly or mostly reduced after controlling for borderline features. Similar results were found in a subgroup of participants with a probable psychotic disorder. Repeating the analysis with a broad index of psychopathology severity instead of borderline features did not produce comparable results. Borderline factor scores reflecting identity/relationship disturbance, mood instability/anger, and self-harm/suicidality were created, all of which appeared to explain part of the inverse relationship between age and psychotic experiences. CONCLUSION Declining borderline traits throughout adulthood may account for the reduced prevalence of positive psychotic symptoms in both clinical and non-clinical populations. Future research might evaluate the impact of treatments that target borderline traits on positive psychotic symptoms.
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Affiliation(s)
- Evyn M Peters
- Department of Psychiatry, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kathryn Yates
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jordan DeVylder
- Graduate School of Social Service, Fordham University, New York, New York, USA
| | - Rohit J Lodhi
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, Ottawa, Ontario, Canada
| | - Ian Kelleher
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland.,Lucena Clinic, St John of God Hospitaller Services, Dublin, Ireland
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16
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Maladaptive Conscientiousness is Still Conscientiousness. JOURNAL OF RESEARCH IN PERSONALITY 2022. [DOI: 10.1016/j.jrp.2022.104334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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17
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Suess H, Wiegand-Grefe S, Adema B, Daubmann A, Kilian R, Zapf A, Winter SM, Lambert M, Wegscheider K, Busmann M. Clinical Trial Data: Both Parents Having Psychiatric Symptoms as Risk Factor for Children's Mental Illness. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1697. [PMID: 36360425 PMCID: PMC9688718 DOI: 10.3390/children9111697] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 10/30/2022] [Accepted: 11/01/2022] [Indexed: 01/07/2024]
Abstract
Children of mentally ill parents represent a particularly vulnerable risk group for the development of mental illness. This study examines whether there is a predictive association between children's psychiatric symptomatology and (1) the clinical diagnosis according to the International Statistical Classification of Diseases and Related Health Problems (ICD-10) of their mentally ill parent as well as (2) to families both parents showing psychiatric symptoms. The study is part of the multicenter controlled trial project "Children of Mentally Ill Parents" (CHIMPS). For this purpose, the psychiatric symptomatology of the mentally ill parent (N = 196) and his or her partner (N = 134) as well as the psychiatric symptomatology of their children aged 4 to 18 years (N = 290) was measured using clinical rated ICD-10-diagnosis, self-rated Brief Symptom Inventory (BSI), and Child Behavior Checklist (CBCL). Using multilevel analyses, the severity of the parental psychiatric symptomatology (BSI) was identified as a significant predictor of children's psychiatric symptomatology (CBCL). Children of parents with a personality disorder (ICD-10) were not more affected than children of parents with another ICD-10-diagnosis. However, children with two parents showing psychiatric symptoms (CBCL) were significantly more affected than children with one mentally ill parent. The results of this study support the well-known view that parental mental illness is a risk factor for children's psychiatric symptoms. Therefore, increased support, especially in high-risk families, both parents having psychiatric symptoms, is highly necessary and should be implemented in the future psychotherapeutic family care.
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Affiliation(s)
- Hannah Suess
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Silke Wiegand-Grefe
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Bonnie Adema
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Anne Daubmann
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Reinhold Kilian
- Department of Psychiatry and Psychotherapy II, Ulm University at Bezirkskrankenhaus Guenzburg, 89312 Guenzburg, Germany
| | - Antonia Zapf
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Sibylle M. Winter
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Martin Lambert
- Department of Adult Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Mareike Busmann
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
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18
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Reis T, Gekker M, Land MGP, Mendlowicz MV, Berger W, Luz MP, Vilete L, Figueira I, Araújo AXG. The growth and development of research on personality disorders: A bibliometric study. Personal Ment Health 2022; 16:290-299. [PMID: 35182026 DOI: 10.1002/pmh.1540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/19/2022] [Accepted: 02/08/2022] [Indexed: 01/31/2023]
Abstract
This study objective was to investigate publication trends on personality disorders (PD) and to identify patterns of historical development. Publication rates were determined using the Results by Year Timeline feature of PubMed. Time series autoregressive integrated moving average models were used to analyse the publication rates for PDs in quinquennial periods beginning in 1980 and ending in 2019 and to predict the number of publications in the 2024-2029 period. More than 300 articles on antisocial and borderline PD are being published each year, and the models suggest an accelerating growth rate. Approximately 100 articles are being published on average every year on schizotypal PD, and the regression model indicates linear growth in the near future. The mean number of publications per year for obsessive-compulsive, narcissistic and avoidant PDs is in the range of 10-30 with the corresponding models indicating linear growth. Fewer than 10 articles are being published each year on dependent, paranoid, histrionic and schizoid PD, whereas dependent PD shows modest growth and paranoid PD rates tended to stability, histrionic and schizoid PD exhibit declining rates. Personality disorders are a group of conditions with diverse etiological, prognostic, therapeutic, legal, research, social and cultural implications that influence publication rates.
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Affiliation(s)
- Taylor Reis
- Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), 71 Venceslau Brás Avenue, Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil
| | - Márcio Gekker
- Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), 71 Venceslau Brás Avenue, Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil
| | - Marcelo Gerardin Poirot Land
- Clinical Medicine Graduate Medical Program I Maternal and Child Health Graduate Program, Universidade Federal do Rio de Janeiro (UFRJ), 225 Rodolpho Paulo Rocco Avenue, building F, suite 5. University City, Fundão Island, Rio de Janeiro, Rio de Janeiro, 21941-905, Brazil
| | - Mauro Vitor Mendlowicz
- Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), 71 Venceslau Brás Avenue, Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil.,Department of Psychiatry and Mental Health, Universidade Federal Fluminense (UFF), 303 Marquês de Paraná Street, second floor, Niteroi, Rio de Janeiro, 24220-000, Brazil
| | - William Berger
- Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), 71 Venceslau Brás Avenue, Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil
| | - Mariana Pires Luz
- Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), 71 Venceslau Brás Avenue, Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil
| | - Liliane Vilete
- Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), 71 Venceslau Brás Avenue, Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil
| | - Ivan Figueira
- Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), 71 Venceslau Brás Avenue, Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil
| | - Alexandre Xavier Gomes Araújo
- Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), 71 Venceslau Brás Avenue, Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil.,Department of Psychiatry and Mental Health, Universidade Federal Fluminense (UFF), 303 Marquês de Paraná Street, second floor, Niteroi, Rio de Janeiro, 24220-000, Brazil
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19
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Ueltzhöffer K, Roth C, Neukel C, Bertsch K, Nüssel F, Herpertz SC. Do I care for you or for me? Processing of protected and non-protected moral values in subjects with extreme scores on the Dark Triad. Eur Arch Psychiatry Clin Neurosci 2022; 273:367-377. [PMID: 36208316 PMCID: PMC9547089 DOI: 10.1007/s00406-022-01489-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 08/29/2022] [Indexed: 11/03/2022]
Abstract
Protected moral values facilitate empathic concern for others, who are exposed to an existential threat, so that one spontaneously helps without taking into account utilitarian cost-benefit considerations. Subjects scoring high on the "Dark Triad" machiavellism, psychopathy, and narcissism are prone to ignore such appeals for selfless help. Until now, data on moral processing and moral decision-making following requests for altruistic help, which directly contrast appeals to protected and non-protected values in subjects with high and low scores on Dark Triad traits, have been missing. In this pilot study 25 healthy subjects with high and 27 with low Dark Triad scores participated in this functional magnetic resonance imaging study. We used a script-driven imagery paradigm to directly contrast requests for selfless help appealing to protected versus non-protected, negotiable moral values. Appeals to protected versus non-protected moral values elicited stronger activations in a large network including insula, amygdala, supramarginal gyrus, and dorsolateral prefrontal cortex. Non-protected values evoked stronger activation in superior frontal sulcus, occipito-temporal junction, and posterior cingulate cortex. During decision-making, high-scorers on the Dark Triad showed increased activations in the superior parietal lobule, precuneus, and intraparietal sulcus. Behaviorally, protected versus non-protected values strongly reduced the reliance on personal cost-benefit calculations in low-scorers, while high-scorers continued to rely on utilitarian deliberations. Data suggest that appeals to protected versus non-protected values activate distinct brain regions associated with strong moral emotions, other-directed cognition, and rule-based decision-making processes. High-scorers display an increased reliance on cost-benefit calculations, which persists even when protected values are threatened.
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Affiliation(s)
- Kai Ueltzhöffer
- grid.7700.00000 0001 2190 4373Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Voßstraße 2, 69115 Heidelberg, Germany ,grid.83440.3b0000000121901201The Wellcome Centre for Human Neuroimaging, University College London, London, WC1N 3AR UK
| | - Corinna Roth
- grid.7700.00000 0001 2190 4373Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Voßstraße 2, 69115 Heidelberg, Germany
| | - Corinne Neukel
- grid.7700.00000 0001 2190 4373Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Voßstraße 2, 69115 Heidelberg, Germany
| | - Katja Bertsch
- grid.7700.00000 0001 2190 4373Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Voßstraße 2, 69115 Heidelberg, Germany ,grid.5252.00000 0004 1936 973XInstitute of Clinical Psychology and Psychotherapy, LMU München, 80802 Munich, Germany
| | - Friederike Nüssel
- grid.7700.00000 0001 2190 4373German Cancer Center, Heidelberg University, 69117 Heidelberg, Germany
| | - Sabine C. Herpertz
- grid.7700.00000 0001 2190 4373Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Voßstraße 2, 69115 Heidelberg, Germany
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20
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Felsenheimer AK, Kieckhäfer C, Rapp AM. Irony detection in patients with borderline personality disorder: an experimental study examining schizotypal traits, response biases and empathy. Borderline Personal Disord Emot Dysregul 2022; 9:24. [PMID: 36192806 PMCID: PMC9531442 DOI: 10.1186/s40479-022-00194-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/15/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In verbal irony we often convey meanings that oppose the literal words. To look behind these words, we need to integrate perspectives of ourselves, others, and their beliefs about us. Although patients with borderline personality disorder (BPD) experience problems in social cognition and schizotypal symptoms, research on irony comprehension mainly focused on the schizophrenic spectrum. Accounting for possible negative biases in BPD, the current study examined the detection of praising and critical irony in a text messaging interface. METHODS The cross-sectional study included 30 patients and 30 matched controls, who completed measures of cognitive and affective empathy (Interpersonal Reactivity Index, IRI), schizotypal (Schizotypal Personality Questionnaire; SPQ), and borderline symptoms (Borderline Symptom List; BSL-23) and the irony detection task. The irony task contained critical and praising remarks embedded in text messages. Asking for literality (ironic vs. literal) and intention ratings (critical to praising) of the stimuli, it allowed to analyze the sensitivity of literality detection as well as implicit and explicit response biases in a signal detection framework. RESULTS Borderline symptoms explained lower sensitivity for the detection of literal and ironic statements across groups. Whereas HC showed a negativity bias when implicitly asked about the literalness of the statement, patients with BPD perceived praising utterances as less praising when explicitly asked about their perceived intention. Neither empathy nor schizotypy explained outcomes beyond borderline symptoms. CONCLUSIONS This was the first study to show lower detection of verbal irony in patients with BPD. While patients were less biased when asked about the literality of a statement, they perceived praising remarks as less positive on explicit measurements. The results highlight the importance of congruent, transparent communication in promoting epistemic trust in individuals with BPD.
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Affiliation(s)
- Anne Katrin Felsenheimer
- Department of Psychiatry and Psychotherapy, University of Tübingen, 72076, Tübingen, Germany.
- Max Planck School of Cognition , Max Planck Institut for Human Cognitive and Brain Sciences , Leipzig, Germany.
| | - Carolin Kieckhäfer
- LVR Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Alexander Michael Rapp
- Department of Psychiatry and Psychotherapy, University of Tübingen, 72076, Tübingen, Germany
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21
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Smith MM, McCabe GA, Widiger TA. Experimental Manipulation of the BFI-2, IPIP-NEO-120, and the IPC-5. Assessment 2022:10731911221107622. [PMID: 35815395 DOI: 10.1177/10731911221107622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Research assessing the relationship of the five-factor model (FFM) to personality disorder symptomatology has generally been confirmatory, with three exceptions. The exceptions have been failures to confirm associations of conscientiousness with the obsessive-compulsive personality disorder, agreeableness with dependent, and openness with schizotypal. Haigler and Widiger demonstrated empirically years ago that this was occurring because the predominant FFM measure at that time, the NEO Personality Inventory-Revised, does not include a sufficient representation of maladaptive variants of the respective FFM personality trait domains. Research since their study has continued to fail to confirm the FFM hypotheses, using other measures of the FFM. The current study extended the work of Haigler and Widiger by considering three additional FFM measures, the Big Five Inventory-2 (BFI-2), the International Item Pool-NEO-120 (IPIP-NEO-120), and the Inventory of Personal Characteristics-5 (IPC-5). Data were obtained from a community sample of adults with experience of mental health treatment. The results confirmed an improvement in the FFM-personality disorder relationships when the experimentally manipulated versions of the BFI-2, IPIP-NEO-120, and IPC-5 were used. The implications of the findings for existing and future FFM-personality disorder research are discussed.
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22
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Abstract
Malignant self-regard (MSR) is a self-representation that encompasses the shared features of depressive personality disorder, masochistic/self-defeating personality disorder, depressive-masochistic personality, and vulnerable narcissism. In this review we begin by describing the construct's historical precursors, which begin in early psychoanalytic/dynamic theory, and then trace its development across iterations of the Diagnostic and Statistical Manual of Mental Disorders. Special attention is paid to differentiating MSR from vulnerable narcissism. We then consider MSR's place within transdiagnostic, transtheoretical, and dimensional models of personality pathology. We focus heavily on MSR's impact on various personality systems (e.g., thought and affect systems) and also on overall personality functioning. The empirical research on MSR in relation to these systems is thoroughly reviewed and largely supports its psychometric properties and clinical significance. We suggest that MSR may map onto the distress subfactor in the hierarchical taxonomy of psychopathology (HiTOP) and that MSR seems to occupy the shared internalizing space across the neurotic and borderline level of personality organization in Kernberg's model of personality disorders. We also identify four major directions for future research: the possible benefits of self-defeating tendencies that involve pathological narcissism and self-esteem; MSR's relationship to overall health and well-being; depressive states and MSR severity; and how MSR fits within the Alternative Model for Personality Disorders and the personality disorder framework of the International Classification of Diseases.
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23
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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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Gutiérrez F, Vicente E, Aluja A, Peri JM, Gutiérrez-Zotes A, Baillés E, Edo Villamón S, Ruipérez Rodríguez MÁ, Meliá de Alba A, Vall G, Gallardo-Pujol D. A third hierarchical level of narrower traits for the Dimensional Assessment of Personality Pathology-Basic Questionnaire. Personal Ment Health 2021; 15:239-251. [PMID: 33871181 DOI: 10.1002/pmh.1511] [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: 10/23/2020] [Revised: 03/28/2021] [Accepted: 03/29/2021] [Indexed: 11/10/2022]
Abstract
Current dimensional taxonomies of personality disorder show a stronger empirical grounding than categories, but may lack the necessary level of detail to make accurate predictions and case formulations. We need to further develop the lower levels of the hierarchy until reaching the building blocks of personality pathology. The Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ) is well-suited to this purpose due to its multilayered structure and its agreement with the official dimensional classifications. We disaggregated the 18 DAPP-BQ mid-level facets through exploratory and confirmatory factor analysis in a sample of 3233 community subjects and outpatients. We obtained a set of 72 clinically relevant, narrower subfacets, which were reliable, well-fitted to the data, and invariant between clinical and community subjects and between the sexes. This third level of abstraction increases by 4.7% the capacity to predict DSM categorical personality disorders, gives a particular advantage in capturing dependent, histrionic, paranoid, obsessive, and schizoid features and can provide the detailed information that clinical decisions demand.
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Affiliation(s)
- Fernando Gutiérrez
- Personality Disorder Unit, Institute of Neuroscience, Hospital Clinic of Barcelona, Barcelona, Spain.,IDIBAPS, Barcelona, Spain
| | - Enrique Vicente
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain.,Psychiatry and Psychology Service, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Anton Aluja
- Department of Psychology, University of Lleida, Lleida, Spain.,Lleida Institute for Biomedical Research Dr. Pifarré Foundation, Lleida, Spain
| | - Josep M Peri
- Clinical and Health Psychology Unit, Institute of Neuroscience, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Alfonso Gutiérrez-Zotes
- Pere Virgili Health Research Institute (IISPV), Tarragona, Spain.,Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
| | - Eva Baillés
- Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
| | - Silvia Edo Villamón
- Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Castellón de la Plana, Spain
| | | | - Amanda Meliá de Alba
- Higher Institute of Psychological Studies (ISEP), Valencia, Spain.,CEDINSALUD, Valencia, Spain
| | - Gemma Vall
- Lleida Institute for Biomedical Research Dr. Pifarré Foundation, Lleida, Spain.,Department of Psychiatry, Mental Health, and Addiction, GSS-Hospital Santa María, Lleida, Spain
| | - David Gallardo-Pujol
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain.,Institute of Neurosciences (UBNeuro), Barcelona, Spain
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Ronningstam E, Simonsen E, Chanen A, Herpertz SC, Huprich S, Newton-Howes G, Behn A, Doering S, Zanarini MC, Sharp C, Oldham J. ISSPD: Past, Present, and Future. J Pers Disord 2021:1-18. [PMID: 34491079 DOI: 10.1521/pedi.2021.35.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Tracy M, Tiliopoulos N, Sharpe L, Bach B. The clinical utility of the ICD-11 classification of personality disorders and related traits: A preliminary scoping review. Aust N Z J Psychiatry 2021; 55:849-862. [PMID: 34144646 DOI: 10.1177/00048674211025607] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES A diagnostic system that fails to deliver clinically useful information will not be utilized and consequently will be unable to provide valuable data for health policy and clinical decision making. Therefore, it is imperative to obtain an accurate depiction of the clinical utility of the eleventh revision of the International Classification of Diseases (ICD-11) Personality Disorder (PD) model. The current mixed-methods systematic review aimed to determine the clinical utility of the ICD-11 PD classification system. METHOD An electronic screening of six databases was conducted and resulting studies were subjected to specific exclusion criteria, which elicited eight studies of interest. Study characteristics were tabulated and methodological quality was appraised. RESULTS Four studies offered strong support for the model's clinical utility, three offered some support accompanied by notable limitations and one study could only offer criticisms. CONCLUSION Future investigation of the ICD-11 PD classification system's (a) communicative value between clinicians and their patients, and between clinicians and their patient's families; (b) ease of use; and (c) feasibility in terms of practical application is required to achieve a complete understanding of its clinical utility and ultimately bring clarity to the current ambiguous findings.
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Affiliation(s)
- Mikaela Tracy
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | | | - Louise Sharpe
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Bo Bach
- Centre of Excellence on Personality Disorder, Psykiatrien i Region Sjalland, Slagelse, Denmark
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27
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Brown TA, Sellbom M. Associations between MMPI-3 scale scores and the DSM-5 personality disorders. J Clin Psychol 2021; 77:2943-2964. [PMID: 34342003 DOI: 10.1002/jclp.23230] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/24/2021] [Accepted: 07/17/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The current study examined associations between Minnesota Multiphasic Personality Inventory-3 (MMPI-3) scales and self-reported DSM-5 Section II personality disorder (PD) symptoms. A priori hypotheses were generated for which MMPI-3 scales would be most highly associated with each PD. METHODS We used a large sample (n = 489) of university students, who completed the MMPI-3 and two established self-report measures of personality disorders. RESULTS The results were generally consistent with theoretical expectations and previous research utilizing the MMPI-2-RF. Specifically, most hypothesized MMPI-3 scales exhibited meaningful associations with relevant PD variables, although there were some notable exceptions. The regression models revealed significant predictors for each PD which were generally consistent with expectations and previous research. CONCLUSIONS Overall, the MMPI-3 appears well situated to cover a range of DSM-5 Section II PD-related psychopathology, and three of the new MMPI-3 scales appear to have added utility for assessing personality pathology.
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Affiliation(s)
- Tiffany A Brown
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Martin Sellbom
- Department of Psychology, University of Otago, Dunedin, New Zealand
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28
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Quirk SE, Koivumaa-Honkanen H, Honkanen R, Heikkinen J, Kavanagh BE, Williams LJ. Exploring the comorbidity of musculoskeletal and personality disorders among adults: a scoping review protocol. Syst Rev 2021; 10:182. [PMID: 34148544 PMCID: PMC8215781 DOI: 10.1186/s13643-021-01721-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 05/28/2021] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND Separately, mental and musculoskeletal disorders (MSDs) are prevalent across the life course and are leading contributors to disability worldwide. While people with personality disorder (PD) have been shown to have an increased risk of certain physical health comorbidities-associations with MSDs have not been thoroughly explored. The proposed scoping review aims to explore the existing clinical- and population-based literature on the comorbidity of PD and MSDs among adults ≥ 18 years and the burden associated with their comorbidity, identify knowledge gaps on this topic, and propose recommendations for future research. METHODS This protocol describes the methodology to undertake the scoping review. It is guided by Arksey and O'Malley's framework and the extensions recommended by the Joanna Briggs Institute. A comprehensive search strategy will be used to identify relevant articles, which will be underpinned by Population, Concept, and Context (PCC) inclusion criteria. One author will perform the search and two authors will independently screen titles/abstracts followed by a full-text review for articles considered relevant. The supervising author will confirm the final selection of articles to be included. One author will extract relevant information from the articles using a predetermined charting form, while a second will perform validation of all information entered. DISCUSSION Information will be synthesised to inform a discussion of what is known regarding associations between PD and MSDs, and the burden associated with their comorbidity in different contexts, with future research directions proposed. SYSTEMATIC REVIEW REGISTRATION This protocol is registered in Open Science Framework Registries ( https://osf.io/mxbr2/ ).
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Affiliation(s)
- Shae E Quirk
- Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Victoria, Australia.,Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland.,Institute of Clinical Medicine, Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio, Finland
| | - Heli Koivumaa-Honkanen
- Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland.,Institute of Clinical Medicine, Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio, Finland.,Mental Health and Wellbeing Center, Kuopio University Hospital, Kuopio, Finland
| | - Risto Honkanen
- Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland.,Institute of Clinical Medicine, Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio, Finland
| | - Jeremi Heikkinen
- Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland.,Institute of Clinical Medicine, Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio, Finland
| | - Bianca E Kavanagh
- Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Victoria, Australia
| | - Lana J Williams
- Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Victoria, Australia. .,University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia.
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29
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Euler S, Nolte T, Constantinou M, Griem J, Montague PR, Fonagy P. Interpersonal Problems in Borderline Personality Disorder: Associations With Mentalizing, Emotion Regulation, and Impulsiveness. J Pers Disord 2021; 35:177-193. [PMID: 30920937 DOI: 10.1521/pedi_2019_33_427] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Interpersonal problems are a core symptom of borderline personality disorder (BPD). This study investigated the relationship between emotion dysregulation, impulsiveness, and impaired mentalizing in the context of predicting interpersonal problems in BPD. A total of 210 patients with BPD completed the Difficulties in Emotion Regulation Scale (DERS), Barratt Impulsiveness Scale (BIS-11), Reflective Functioning Questionnaire (RFQ), and Inventory of Interpersonal Problems (IIP-32). The authors conducted three path models, with either mentalizing, emotion regulation, or impulsiveness as the exogenous variable. Emotion dysregulation and attentional impulsiveness predicted interpersonal problems directly, whereas hypomentalizing predicted interpersonal problems only indirectly throughout emotion dysregulation and attentional impulsiveness. The results suggest that these domains contribute significantly to interpersonal problems in BPD. Moreover, hypomentalizing might affect on interpersonal problems via its effect on impulsiveness and emotion regulation. The authors argue that focusing on emotion regulation and mentalizing in BPD treatments might have interlinked beneficial effects on interpersonal problems.
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Affiliation(s)
- Sebastian Euler
- Department of Psychiatry, University of Basel, Basel, Switzerland, Department of Consultation Psychiatry and Psychosomatics, University Hospital of Zürich, Zürich, Switzerland, and University College London, London, UK
| | - Tobias Nolte
- Research Department of Clinical, Educational and Health Psychology, University College London.,Wellcome Centre for Human Neuroimaging, University College London
| | - Matthew Constantinou
- Research Department of Clinical, Educational and Health Psychology, University College London
| | - Julia Griem
- Research Department of Clinical, Educational and Health Psychology, University College London
| | - P Read Montague
- Fralin Biomedical Research Institute and Department of Physics, Virginia Tech Carilion Research Institute, Roanoke, Virginia.,Wellcome Centre for Human Neuroimaging, University College London
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London
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30
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Personality Disorders and Their Relation to Treatment Outcomes in Cognitive Behavioural Therapy for Depression: A Systematic Review and Meta-analysis. COGNITIVE THERAPY AND RESEARCH 2021. [DOI: 10.1007/s10608-021-10203-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Abstract
Background
Previous reviews indicate that depressed patients with a comorbid personality disorder (PD) tend to benefit less from psychotherapies for depression and thus personality pathology needs to be the primary focus of treatment. This review specifically focused on studies of Cognitive Behavioural Therapy (CBT) for depression examining the influence of comorbid PD on post-treatment depression outcomes.
Methods
This was a systematic review and meta-analysis of studies identified through PubMed, PsychINFO, Web of Science, and Scopus. A review protocol was pre-registered in the PROSPERO database (CRD42019128590).
Results
Eleven eligible studies (N = 769) were included in a narrative synthesis, and ten (N = 690) provided sufficient data for inclusion in random effects meta-analysis. All studies were rated as having “low” or “moderate” risk of bias and there was no significant evidence of publication bias. A small pooled effect size indicated that patients with PD had marginally higher depression severity after CBT compared to patients without PD (g = 0.26, [95% CI: 0.10, 0.43], p = .002), but the effect was not significant in controlled trials (p = .075), studies with low risk of bias (p = .107) and studies that adjusted for intake severity (p = .827). Furthermore, PD cases showed symptomatic improvements across studies, particularly those with longer treatment durations (16–20 sessions).
Conclusions
The apparent effect of PD on depression outcomes is likely explained by higher intake severity rather than treatment resistance. Excluding these patients from evidence-based care for depression is unjustified, and adequately lengthy CBT should be routinely offered.
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Blüml V, Doering S. ICD-11 Personality Disorders: A Psychodynamic Perspective on Personality Functioning. Front Psychiatry 2021; 12:654026. [PMID: 33935839 PMCID: PMC8085265 DOI: 10.3389/fpsyt.2021.654026] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/22/2021] [Indexed: 11/13/2022] Open
Abstract
The new ICD-11 introduces a fully dimensional classification of personality disorders representing a fundamental change in personality disorder diagnosis with major implications for clinical practice and research. The new system centers on the evaluation of the severity of impairment in the areas of self and interpersonal functioning. This focus on personality functioning converges with long-standing psychoanalytic/psychodynamic conceptualizations of personality pathology. In a detailed conceptual analysis and review of existing empirical data, points of convergence and notable differences between major exponents of the psychodynamic tradition-object relations theory as developed by Kernberg et al. and the Operationalized Psychodynamic Diagnosis-and the ICD-11 system are critically discussed. Personality functioning can be considered to be the current "common ground" for the assessment of personality disorders and constitutes a considerable step forward in making personality disorder diagnosis both clinically meaningful and suitable for research purposes.
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Affiliation(s)
- Victor Blüml
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Stephan Doering
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
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32
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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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33
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Gecaite-Stonciene J, Lochner C, Marincowitz C, Fineberg NA, Stein DJ. Obsessive-Compulsive (Anankastic) Personality Disorder in the ICD-11: A Scoping Review. Front Psychiatry 2021; 12:646030. [PMID: 33796036 PMCID: PMC8007778 DOI: 10.3389/fpsyt.2021.646030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/19/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction: With the shift from a categorical to a dimensional model, ICD-11 has made substantial changes to the diagnosis of personality disorders (PDs), including obsessive-compulsive (anankastic) personality disorder (OCPD). The ICD-11 PD model proposes a single diagnosis of PD with specifications regarding severity and domains. However, a systematic overview of ICD-11 anankastia is lacking. In this review we address the reformulation of the OCPD diagnosis in the ICD-11, and draw comparisons with the DSM-5, with a particular focus on diagnostic validity and clinical utility. We hypothesized that the ICD-11 PD model provides a diagnostically valid and clinically useful approach to OCPD, with specific emphasis on the anankastia domain as the primary trait qualifier. Methods: Literature published from 2010 to 2020 was systematically searched using the PubMed/MEDLINE, PsychInfo, Cochrane, and Web of Sciences search engines, in order to find all articles that addressed ICD-11 anankastia. Relevant articles were collated, and themes of these articles subsequently extracted. Results: Out of the 264 publications identified, 19 articles were included in this review. Four themes were identified, namely (a) overlap of DSM-5 OCPD with the ICD-11 PD model, (b) the factorial structure of the ICD-11 PD model with respect to the anankastia domain, (c) the clinical utility of the ICD-11 PD model, and (d) comparison of the ICD-11 PD model of anankastia with the DSM-5 alternative model for OCPD. Conclusions: The ICD-11 anankastia domain overlaps with DSM-5 OCPD traits, and the factor analyses of the ICD-11 PD model further support the diagnostic validity of this domain. There is some support for the clinical utility of the ICD-11 PD model of anankastia but further studies are needed, including of its relationship to obsessive-compulsive and related disorders.
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Affiliation(s)
- Julija Gecaite-Stonciene
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania
| | - Christine Lochner
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Clara Marincowitz
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Naomi A Fineberg
- National Obsessive Compulsive Disorders Specialist Service, Hertfordshire Partnership University National Health Service Foundation Trust, University of Hertfordshire, Hatfield, United Kingdom
| | - Dan J Stein
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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34
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Gamache D, Savard C, Leclerc P, Payant M, Berthelot N, Côté A, Faucher J, Lampron M, Lemieux R, Mayrand K, Nolin MC, Tremblay M. A Proposed Classification of ICD-11 Severity Degrees of Personality Pathology Using the Self and Interpersonal Functioning Scale. Front Psychiatry 2021; 12:628057. [PMID: 33815167 PMCID: PMC8012561 DOI: 10.3389/fpsyt.2021.628057] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/19/2021] [Indexed: 01/07/2023] Open
Abstract
Background: The 11th version of the World Health Organization's International Classification of Diseases (ICD-11) has adopted a dimensional approach to personality disorder (PD) nosology. Notably, it includes an assessment of PD degree of severity, which can be classified according to five categories. To date, there is no gold standard measure for assessing degree of PD severity based on the ICD-11 model, and there are no empirically-based anchor points to delineate the proposed categories. With the operationalization of PD degrees of severity in the ICD-11 PD model now being closely aligned with Criterion A of the DSM-5 Alternative Model for Personality Disorders (AMPD), sharing a focus on self and interpersonal dysfunction, self-report instruments developed for the latter model might prove useful as screening tools to determine degrees of severity in the former. Methods: The Self and Interpersonal Functioning Scale, a brief validated self-report questionnaire originally designed to assess level of personality pathology according to the AMPD framework, was used to derive anchor points to delineate the five severity degrees from the ICD-11 PD model. Data from five clinical and non-clinical samples (total N = 2,240) allowed identifying anchor points for classification, based on Receiver Operating Characteristic curve analysis, Latent Class Analysis, and data distribution statistics. Categories were validated using multiple indices pertaining to externalizing and internalizing symptoms relevant to PD. Results: Analyses yielded the following anchor points for PD degrees of severity: No PD = 0-1.04; Personality Difficulty = 1.05-1.29; Mild PD = 1.30-1.89; Moderate PD = 1.90-2.49; and Severe PD = 2.50 and above. A clear gradient of severity across the five categories was observed in all samples. A high number of significant contrasts among PD categories were also observed on external variables, consistent with the ICD-11 PD degree of severity operationalization. Conclusions: The present study provides potentially useful guidelines to determine severity of personality pathology based on the ICD-11 model. The use of a brief self-report questionnaire as a screening tool for assessing PD degrees of severity should be seen as a time-efficient support for clinical decision and treatment planning.
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Affiliation(s)
- Dominick Gamache
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Claudia Savard
- Department of Educational Fundamentals and Practices, Université Laval, Quebec City, QC, Canada
| | - Philippe Leclerc
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Maude Payant
- Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada
| | - Nicolas Berthelot
- Department of Nursing Sciences, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Alexandre Côté
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Jonathan Faucher
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | | | - Roxanne Lemieux
- Department of Nursing Sciences, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Kristel Mayrand
- School of Psychology, Université Laval, Quebec City, QC, Canada
| | - Marie-Chloé Nolin
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Marc Tremblay
- Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, QC, Canada
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35
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Gutiérrez F, Ruiz J, Peri JM, Gárriz M, Vall G, Cavero M. Toward an Integrated Model of Pathological Personality Traits: Common Hierarchical Structure of the PID-5 and the DAPP-BQ. J Pers Disord 2020; 34:25-39. [PMID: 31210573 DOI: 10.1521/pedi_2019_33_431] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A dimensional classification seems to be the next move in the personality disorders field. However, it is not clear whether there is one dimensional model or many, or whether the currently available dimensional instruments measure the same traits. To help clarify these issues, the authors administered the Personality Inventory for DSM-5 (PID-5) and the Dimensional Assessment of Personality Pathology (DAPP-BQ) to 414 psychiatric outpatients. Factor analyses showed that a common hierarchical structure underlies both instruments, even if each one measures slightly different aspects of it. Disattenuated correlations indicated that, at the lower order level, two thirds of the PID-5 and DAPP-BQ facets measure essentially the same traits, although the pairings were not exactly as predicted. Among higher order domains, only PID Negative Affectivity and Detachment converged unambiguously with DAPP Emotional Dysregulation and Inhibition. Overall, the PID-5 and the DAPP-BQ reflect, with small divergences, one and the same structure of pathological personality traits.
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Affiliation(s)
- Fernando Gutiérrez
- Personality Disorder Unit, Institute of Neuroscience, Hospital Clínic de Barcelona, Spain, and Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - José Ruiz
- Department of Clinical Psychology and Psychobiology, Section of Personality, Assessment and Psychological Treatments, University of Barcelona, Spain
| | | | - Miguel Gárriz
- CSMA La Mina, Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona, Spain
| | - Gemma Vall
- Department of Psychiatry, Mental Health, and Addiction, GSS-Hospital Santa Maria, Lleida, and IRB (Institut de Recerca Biomèdica), Lleida, Spain
| | - Myriam Cavero
- Institute of Neuroscience, Hospital Clínic de Barcelona, Spain
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36
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Morey LC, Hopwood CJ. Brief Report: Expert Preferences for Categorical, Dimensional, and Mixed/Hybrid Approaches to Personality Disorder Diagnosis. J Pers Disord 2020; 34:124-131. [PMID: 30650000 DOI: 10.1521/pedi_2019_33_398] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The authors asked 361 personality disorder experts to rank order their preferences for a categorical, dimensional, or mixed/hybrid approach to personality disorder diagnosis in manuals such as the DSM and ICD. Respondents reported a general preference for the mixed/hybrid approach over a purely dimensional approach, and a clear preference against a categorical model. Although there were some statistically significant differences in the rates across training background, age, and gender, this overall pattern of preferences held across these factors. Preferences were notably similar to those reported by Bernstein et al. (2007) prior to the beginnings of deliberations on DSM-5 that ultimately led to a hybrid model. Results are informative for discussions regarding how to classify personality disorders in diagnostic manuals.
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37
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Thompson KN, Jackson H, Cavelti M, Betts J, McCutcheon L, Jovev M, Chanen AM. Number of Borderline Personality Disorder Criteria and Depression Predict Poor Functioning and Quality of Life in Outpatient Youth. J Pers Disord 2020; 34:785-798. [PMID: 30689518 DOI: 10.1521/pedi_2019_33_411] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study aimed to investigate which factors contribute to poor functioning and poor quality of life in youth (aged 15-25 years) with borderline personality disorder (BPD), and whether the number of BPD criteria might be an independent predictor of these outcomes. A sample of 499 help-seeking outpatient youth, aged 15-25 years, was assessed. Stepwise multiple regression analyses showed that the number of BPD criteria was the best predictor of poor functioning, followed by number of mental health visits in the past month, female sex, and a current diagnosis of depression. Current depression was the best predictor of Assessment of Quality of Life utility score, followed by the number of BPD criteria. These findings underscore the clinical significance of DSM-IV BPD features (even when subthreshold for a categorical diagnosis) in youth and their effects upon social and occupational functioning and quality of life early in the course of BPD.
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Affiliation(s)
- Katherine N Thompson
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Henry Jackson
- School of Psychological Sciences, The University of Melbourne, Australia
| | - Marialuisa Cavelti
- Centre for Youth Mental Health, The University of Melbourne, Australia.,School of Psychological Sciences, The University of Melbourne, Australia.,University Hospital of Psychiatry and Psychotherapy Bern, Switzerland
| | - Jennifer Betts
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Australia
| | | | - Martina Jovev
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Australia.,Orygen Youth Health, Australia
| | - Andrew M Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Australia.,Orygen Youth Health, Australia
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38
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Hopwood CJ, Krueger RF, Watson D, Widiger TA, Althoff RR, Ansell EB, Bach B, Bagby RM, Blais MA, Bornovalova MA, Chmielewski M, Cicero DC, Conway C, De Clerq B, De Fruyt F, Docherty AR, Eaton NR, Edens JF, Forbes MK, Forbush KT, Hengartner MP, Ivanova MY, Leising D, Lukowitsky MR, Lynam DR, Markon KE, Miller JD, Morey LC, Mullins-Sweatt SN, Ormel J, Patrick CJ, Pincus AL, Ruggero C, Samuel DB, Sellbom M, Tackett JL, Thomas KM, Trull TJ, Vachon DD, Waldman ID, Waszczuk MA, Waugh MH, Wright AGC, Yalch MM, Zald DH, Zimmermann J. Commentary on "The Challenge of Transforming the Diagnostic System of Personality Disorders". J Pers Disord 2020; 34:1-4. [PMID: 30802176 DOI: 10.1521/pedi_2019_33_00] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
| | | | | | | | | | | | - Bo Bach
- Region Zealand Psychiatry, Denmark
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39
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Mulder RT, Horwood LJ, Tyrer P. The borderline pattern descriptor in the International Classification of Diseases, 11th Revision: A redundant addition to classification. Aust N Z J Psychiatry 2020; 54:1095-1100. [PMID: 32900208 DOI: 10.1177/0004867420951608] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The International Classification of Diseases, 11th Revision classification of personality disorder removes all categories of disorder in favour of a single diagnostic spectrum extending from no personality dysfunction to severe personality disorder. Following concerns from some clinicians and Personality Disorder Societies, it was subsequently agreed to include a borderline pattern descriptor as a qualifier of the main diagnosis. We explore the value of this additional descriptor by examining personality data in patients with major depression. METHOD We examined personality data obtained using the Structured Clinical Interview for Personality Disorder-II in 606 patients enrolled in five randomised controlled trials of depression. The Structured Clinical Interview for Personality Disorder-II uses the Diagnostic and Statistical Manual of Mental Disorders categorical system, which includes borderline personality disorder. The International Classification of Diseases, 11th Revision classification has five domain traits. Each of the Diagnostic and Statistical Manual of Mental Disorders personality disorder symptoms or behaviours from Structured Clinical Interview for Personality Disorder-II was reordered into the five domains independently by two assessors. The relationship between the two systems was examined by tabular and correlational analysis. RESULTS The findings showed that the symptoms of borderline personality disorder were associated with greater severity of personality disturbance in the International Classification of Diseases, 11th Revision classification (p < 0.0001) and were associated primarily with the Negative Affective, Dissocial and Disinhibited domains. There was only a weak association with the other two domains, Anankastia and Detachment. CONCLUSION The addition of a borderline pattern descriptor is likely to add little to the International Classification of Diseases, 11th Revision classification of personality disorder. Its features are well represented within the severity/domain structure, which allows for more fine-grained description of the personality features that constitute the borderline concept.
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Affiliation(s)
- Roger T Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - L John Horwood
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Peter Tyrer
- Division of Psychiatry, Department of Brain Sciences, Imperial College, London, UK
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40
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Campbell K, Clarke KA, Massey D, Lakeman R. Borderline Personality Disorder: To diagnose or not to diagnose? That is the question. Int J Ment Health Nurs 2020; 29:972-981. [PMID: 32426937 DOI: 10.1111/inm.12737] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 12/11/2022]
Abstract
There is considerable controversy around psychiatric diagnosis generally and personality disorders specifically. Since its conception, borderline personality disorder has been controversial because of the stigma associated with the diagnosis and the therapeutic nihilism held by practitioners who encounter people with this high prevalence problem in acute settings. This paper reviews the history of the diagnosis of BPD and summarizes some of the controversy surrounding the categorical nature of diagnosis. Both the DSM 5 and ICD-11 will be discussed; however, for the purposes of this paper, the DSM 5 will take the primary focus due to greater cultural significance. Recent developments in the treatment of borderline personality disorder suggest that it is a highly treatable condition and that full clinical recovery is possible. This paper formulates an argument that despite problems with psychiatric diagnosis that are unlikely to be resolved soon, a diagnosis should be made with an accompanying formulation to enable people to receive timely and effective treatment to enable personal and clinical recovery.
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Affiliation(s)
- Katrina Campbell
- School of Nursing, Midwifery and Paramedicine, Faculty of Science, Health, Education and Engineering University of the Sunshine Coast, Sippy Downs, Queensland, Australia.,School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, Virginia, Queensland, Australia
| | - Karen-Ann Clarke
- School of Nursing, Midwifery and Paramedicine, Faculty of Science, Health, Education and Engineering University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Deb Massey
- School of Health sciences, Southern Cross University, Lismore, New South Wales, Australia
| | - Richard Lakeman
- School of Health sciences, Southern Cross University, Lismore, New South Wales, Australia
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41
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Baltzersen ÅL. Moving forward: closing the gap between research and practice for young people with BPD. Curr Opin Psychol 2020; 37:77-81. [PMID: 32916475 DOI: 10.1016/j.copsyc.2020.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/06/2020] [Accepted: 08/09/2020] [Indexed: 10/23/2022]
Abstract
The study of personality disorders has come a long way, and this is characterized by the optimism prevalent within the community dedicated to its study. Outside this community - delays in intervention, ostracism, and ignorance remain common place. With a significant burden of disease and high costs at individual, social, and societal levels there is an urgent need to translate research into practice. Proposed solutions include educating the workforce to improve attitudes and developing more sustainable treatment alternatives. This paper brings forward a user perspective on the need to close the gap between what we know from research and what is done in policy and clinical practice.
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Affiliation(s)
- Åse-Line Baltzersen
- Norwegian National Advisory Unit for Personality Psychiatry, Clinic Mental Health and Addiction, Oslo University Hospital, Norway.
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42
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Schmeck K, Birkhölzer M. [The classification of personality disorders in ICD-11]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2020; 49:480-485. [PMID: 32783587 DOI: 10.1024/1422-4917/a000747] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The classification of personality disorders in ICD-11 Abstract. In ICD-11, the classification of personality disorders (PD) is no longer categorical but dimensional, along a spectrum defined by the severity of the disorder. The definition of PD is based on the level of impairment of self-directed and interpersonal personality functioning. Only one general diagnostic category "Personality Disorder" remains (ICD-11 Code 6D10). All distinct PD diagnoses from ICD-10 are missing, with the exception of Borderline PD, which can be classified with a "trait qualifier." The type of PD is characterized by specific patterns of five maladaptive personality traits. From the perspective of child and adolescent psychiatry, the most important change from ICD-10 to ICD-11 is the removal of an age limit, meaning PDs can be diagnosed across the lifespan.
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Affiliation(s)
- Klaus Schmeck
- Kinder- und Jugendpsychiatrische Forschungsabteilung, Universitäre Psychiatrische Kliniken (UPK) der Universität Basel
| | - Marc Birkhölzer
- Kinder- und Jugendpsychiatrische Forschungsabteilung, Universitäre Psychiatrische Kliniken (UPK) der Universität Basel
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43
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Gutiérrez F, Aluja A, Ruiz J, García LF, Gárriz M, Gutiérrez-Zotes A, Gallardo-Pujol D, Navarro-Haro MV, Alabèrnia-Segura M, Mestre-Pintó JI, Torrens M, Peri JM, Sureda B, Soler J, Pascual JC, Vall G, Calvo N, Ferrer M, Oltmanns JR, Widiger TA. Personality Disorders in the ICD-11: Spanish Validation of the PiCD and the SASPD in a Mixed Community and Clinical Sample. Assessment 2020; 28:759-772. [PMID: 32583685 PMCID: PMC7961637 DOI: 10.1177/1073191120936357] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The International Classification of Diseases–11th revision (ICD-11) classification of personality disorders is the official diagnostic system that is used all over the world, and it has recently been renewed. However, as yet very few data are available on its performance. This study examines the Personality Inventory for ICD-11 (PiCD), which assesses the personality domains of the system, and the Standardized Assessment of Severity of Personality Disorder (SASPD), which determines severity. The Spanish versions of the questionnaires were administered to a community (n = 2,522) and a clinical sample (n = 797). Internal consistency was adequate in the PiCD (α = .75 to .84) but less so in the SASPD (α = .64 and .73). Factor analyses suggested a unidimensional or bidimensional structure for severity, while revealing that the personality trait qualifiers are organized into four factors: negative affectivity, detachment, dissociality, and a bipolar domain of disinhibition–anankastia. The mutual relationships between traits and severity were analyzed, as well as the ability of the whole system to identify clinical subjects. Although further improvements are required, the results generally support the use of the PiCD and the SASPD and help substantiate the new ICD-11 taxonomy that underlies them.
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Affiliation(s)
| | - Anton Aluja
- University of Lleida, Lleida, Spain.,Biomedical Research Institute of Lleida, Lleida, Spain
| | - José Ruiz
- University of Barcelona, Barcelona, Spain
| | - Luis F García
- Biomedical Research Institute of Lleida, Lleida, Spain.,Autonomous University of Madrid, Madrid, Spain
| | - Miguel Gárriz
- Institut de Neuropsiquiatria i Addiccions, Barcelona, Spain
| | | | - David Gallardo-Pujol
- University of Barcelona, Barcelona, Spain.,Institute of Neurosciences, Barcelona, Spain
| | - Maria V Navarro-Haro
- University of Zaragoza, Zaragoza, Spain.,Aragón Health Research Institute, Zaragoza, Spain
| | | | - Joan Ignasi Mestre-Pintó
- IMIM Hospital del Mar Medical Research Institute, Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain
| | - Marta Torrens
- IMIM Hospital del Mar Medical Research Institute, Barcelona, Spain.,Universitat Autònoma de Barcelona, Spain
| | | | | | - Joaquim Soler
- Universitat Autònoma de Barcelona, Spain.,Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Juan Carlos Pascual
- Universitat Autònoma de Barcelona, Spain.,Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Gemma Vall
- Biomedical Research Institute of Lleida, Lleida, Spain.,GSS-Hospital Santa Maria, Lleida, Spain
| | - Natalia Calvo
- Universitat Autònoma de Barcelona, Spain.,Vall d'Hebron University Hospital, Barcelona, Spain
| | - Marc Ferrer
- Universitat Autònoma de Barcelona, Spain.,Vall d'Hebron University Hospital, Barcelona, Spain
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44
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Huprich SK. Personality Disorders in the ICD-11: Opportunities and Challenges for Advancing the Diagnosis of Personality Pathology. Curr Psychiatry Rep 2020; 22:40. [PMID: 32519211 DOI: 10.1007/s11920-020-01161-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE OF REVIEW The International Classification of Diseases-11th edition (ICD-11) is poised to make a dramatic change in the diagnosis of personality disorders by introducing a fully dimensionalized framework. In this paper, the history of this process is reviewed, along with international efforts taken to address some underlying concerns with this transition. Recent studies of this framework are also reviewed. RECENT FINDINGS Studies have concluded that the ICD-11 proposal is supported; however, there are a number of methodological limitations to these studies, including the utilization of measures that are not directly derived from the ICD-11 description of levels of personality severity and trait domains. There is a clear need for additional studies with measures that directly reflect the ICD-11 description of personality disorders. While there are some potentially positive effects of moving toward the dimensional model, there are a number of concerns remaining about the clinical utility of moving in this way.
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Affiliation(s)
- Steven K Huprich
- Department of Psychology, University of Detroit Mercy, 4001 W. McNichols Road, Detroit, MI, 48221, USA. .,Michigan State University College of Human Medicine, East Lansing, MI, USA.
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45
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Winsper C, Bilgin A, Thompson A, Marwaha S, Chanen AM, Singh SP, Wang A, Furtado V. The prevalence of personality disorders in the community: a global systematic review and meta-analysis. Br J Psychiatry 2020; 216:69-78. [PMID: 31298170 DOI: 10.1192/bjp.2019.166] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Personality disorders are now internationally recognised as a mental health priority. Nevertheless, there are no systematic reviews examining the global prevalence of personality disorders. AIMS To calculate the worldwide prevalence of personality disorders and examine whether rates vary between high-income countries and low- and middle-income countries (LMICs). METHOD We systematically searched PsycINFO, MEDLINE, EMBASE and PubMed from January 1980 to May 2018 to identify articles reporting personality disorder prevalence rates in community populations (PROSPERO registration number: CRD42017065094). RESULTS A total of 46 studies (from 21 different countries spanning 6 continents) satisfied inclusion criteria. The worldwide pooled prevalence of any personality disorder was 7.8% (95% CI 6.1-9.5). Rates were greater in high-income countries (9.6%, 95% CI 7.9-11.3%) compared with LMICs (4.3%, 95% CI 2.6-6.1%). In univariate meta-regressions, significant heterogeneity was partly attributable to study design (two-stage v. one-stage assessment), county income (high-income countries v. LMICs) and interview administration (clinician v. trained graduate). In multiple meta-regression analysis, study design remained a significant predictor of heterogeneity. Global rates of cluster A, B and C personality disorders were 3.8% (95% CI 3.2, 4.4%), 2.8% (1.6, 3.7%) and 5.0% (4.2, 5.9%). CONCLUSIONS Personality disorders are prevalent globally. Nevertheless, pooled prevalence rates should be interpreted with caution due to high levels of heterogeneity. More large-scale studies with standardised methodologies are now needed to increase our understanding of population needs and regional variations.
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Affiliation(s)
- Catherine Winsper
- Grant Writer and Honorary Research Fellow, Centre for Mental Health and Wellbeing Research, Warwick Medical School, University of Warwick; and Research and Innovation Department, Caludon Centre, Coventry and Warwickshire Partnership Trust, UK
| | - Ayten Bilgin
- Psychology Department, Istanbul Medeniyet University, Turkey
| | - Andrew Thompson
- Principal Research Fellow, Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Australia; and Warwick Medical School, University of Warwick, UK
| | - Steven Marwaha
- Professor of Psychiatry, Institute for Mental Health, Birmingham University; and the Barberry, National Centre for Mental Health, UK
| | - Andrew M Chanen
- Professorial Fellow and Head of Personality Disorder Research, Orygen, The National Centre of Excellence in Youth Mental Health; and Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Swaran P Singh
- Professor and Director of the Centre for Mental Health and Wellbeing Research, Centre for Mental Health and Wellbeing Research, University of Warwick, UK
| | - Ariel Wang
- PhD student, Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, UK
| | - Vivek Furtado
- Associate Clinical Professor of Forensic Psychiatry, Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, UK
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46
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Wright AGC, Kaurin A. Integrating Structure and Function in Conceptualizing and Assessing Pathological Traits. Psychopathology 2020; 53:189-197. [PMID: 32375147 DOI: 10.1159/000507590] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/27/2020] [Indexed: 11/19/2022]
Abstract
The Diagnostic and Statistical Manual of Mental Disorders' (5th Edition) Alternative Model of Personality Disorders includes a dimensional trait model to describe individual differences in the manifestation of personality pathology. Empirically derived quantitative trait models of psychopathology address many of the structural problems of classical diagnostic schemes (e.g., nonbinary distributions, excessive comorbidity, and diagnostic heterogeneity). However, they are largely based on the structure of individual differences in the manifestation of psychopathology. In contrast, clinical theories of personality disorder, which are the foundation of intervention efforts, are based on the function of maladaptive behavior. This distinction is akin to the difference between morphology and physiology in the broader biological sciences. A structure-function divide in the focus of empirical and clinical work contributes to a lack of integration and difficulties with translation. Here we discuss this tension and argue for the need to bridge this divide and adopt research efforts that integrate structure and function of personality traits. Specifically, we suggest that between-person structure identifies the principal domains of functioning, but to understand dysfunction personality must be conceptualized and studied as an ensemble of contextualized dynamic processes.
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Affiliation(s)
- Aidan G C Wright
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA,
| | - Aleksandra Kaurin
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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47
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Krueger RF, Hobbs KA. An Overview of the DSM-5 Alternative Model of Personality Disorders. Psychopathology 2020; 53:126-132. [PMID: 32645701 PMCID: PMC7529724 DOI: 10.1159/000508538] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 05/06/2020] [Indexed: 12/15/2022]
Abstract
Authoritative classification systems for psychopathology such as the DSM and ICD are shifting toward more dimensional approaches in the field of personality disorders (PDs). In this paper, we provide a brief overview of the dimensionally oriented DSM-5 alternative model of PDs (AMPD). Since its publication in 2013, the AMPD has inspired a substantial number of studies, underlining its generative influence on the field. Generally speaking, this literature illustrates both the reliability and validity of the constructs delineated in the AMPD. The literature also illustrates empirical challenges to the conceptual clarity of the AMPD, such as evidence of substantial correlations between indices of personality functioning (criterion A in the AMPD) and maladaptive personality traits (criterion B in the AMPD). Key future directions pertain to linking the AMPD literature with applied efforts to improve the lives of persons who suffer from PDs, and surmounting challenges germane to the evolution of the DSM itself.
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Affiliation(s)
- Robert F Krueger
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota, USA,
| | - Kelsey A Hobbs
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota, USA
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48
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Zimmermann J, Kerber A, Rek K, Hopwood CJ, Krueger RF. A Brief but Comprehensive Review of Research on the Alternative DSM-5 Model for Personality Disorders. Curr Psychiatry Rep 2019; 21:92. [PMID: 31410586 DOI: 10.1007/s11920-019-1079-z] [Citation(s) in RCA: 138] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Both the Alternative DSM-5 Model for Personality Disorders (AMPD) and the chapter on personality disorders (PD) in the recent version of ICD-11 embody a shift from a categorical to a dimensional paradigm for the classification of PD. We describe these new models, summarize available measures, and provide a comprehensive review of research on the AMPD. RECENT FINDINGS A total of 237 publications on severity (criterion A) and maladaptive traits (criterion B) of the AMPD indicate (a) acceptable interrater reliability, (b) largely consistent latent structures, (c) substantial convergence with a range of theoretically and clinically relevant external measures, and (d) some evidence for incremental validity when controlling for categorical PD diagnoses. However, measures of criterion A and B are highly correlated, which poses conceptual challenges. The AMPD has stimulated extensive research with promising findings. We highlight open questions and provide recommendations for future research.
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Affiliation(s)
- Johannes Zimmermann
- Department of Psychology, University of Kassel, Holländische Str. 36-38, 34127, Kassel, Germany.
| | | | - Katharina Rek
- Max-Planck-Institut für Psychiatrie, Munich, Germany
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49
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Oltmanns JR, Widiger TA. Evaluating the assessment of the ICD-11 personality disorder diagnostic system. Psychol Assess 2019; 31:674-684. [PMID: 30628821 PMCID: PMC6488396 DOI: 10.1037/pas0000693] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Proposed for the ICD-11 is a dimensional model of personality disorder that, if approved, would be a paradigm shift in the conceptualization of personality disorder. The proposal consists of a general severity rating, 5 maladaptive personality trait domains, and a borderline pattern qualifier. The general severity rating can be assessed by the Standardized Assessment of Severity of Personality Disorder (SASPD), the trait domains by the Personality Inventory for ICD-11 (PiCD), and the borderline pattern by the Borderline Pattern Scale (BPS), which is developed in the present study. To date, no study has examined the relations among all 3 components, due in part to the absence of direct measures for each component (until recently). The current study develops and provides initial validation evidence for the BPS, and examines the relations among the BPS, SASPD, and PiCD. Also considered is their relationship with the 5-factor model of general personality as well as with 2 other measures of personality disorder severity (including the DSM-5 Level of Personality Functioning Scale [LPFS]). Further, an alternative trait-based coding of the DSM-5 LPFS is examined (modeled after the ICD-11 SASPD), suggesting that its coverage of diverse maladaptivity may not be because it assesses the core of personality disorder, but rather because it has items specific to the different domains of personality. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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50
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Beyond trait reductionism: Implications of network structures for dimensional models of psychopathology. Behav Brain Sci 2019; 42:e4. [PMID: 30940244 DOI: 10.1017/s0140525x18001243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Borsboom et al. discuss the implications of network structures for neurobiology-based reductionism, but inherent in the network approach is that dimensional models of psychopathology are untenable as well. Insofar as mental disorders are complex dynamic constellations of symptoms, the "trait reductionism" of dimensional psychopathology frameworks suffers from the same limitations as neurobiological reductionism.
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