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Hualparuca-Olivera L, Caycho-Rodríguez T, Torales J, Ramos-Vera C, Ramos-Campos D, Córdova-Gónzales L, Bach B. Internal consistency of measures for ICD-11 personality disorder severity and traits: A systematic review and meta-analysis. Personal Ment Health 2024. [PMID: 39086213 DOI: 10.1002/pmh.1631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 06/13/2024] [Accepted: 07/15/2024] [Indexed: 08/02/2024]
Abstract
A number of measures and scales have been developed for the ICD-11 personality disorder (PD) diagnosis, including severity and trait dimensions. The present systematic review and meta-analysis sought to evaluate the internal consistency of these measures across different populations and cultures. A systematic search was conducted across four databases where relevant studies were subjected to explicit eligibility criteria resulting in 49 included studies and 370 effect sizes. Study characteristics were tabulated, their methodological quality was evaluated, and findings were synthesized using random effects meta-analysis. Findings overall indicated that measures of ICD-11 PD severity and trait domains have adequate levels of internal consistency (α/ω = 0.82, 95% CI [0.81; 0.83], I2 = 97.3%). Aspects such as sample, country, language, format, and measured construct were significant sources of variation. Additional meta-analyses revealed that some measures performed better than others for certain dimensions. Internal consistency was overall supported across ICD-11 measures of severity and trait domains. Future research should further investigate the interrater reliability, test-retest reliability and stability, and alignment with interview-based PD diagnoses.
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Affiliation(s)
| | | | - Julio Torales
- Department of Medical Psychology, School of Medical Sciences, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | | | | | - Luis Córdova-Gónzales
- Escuela Universitaria de PostGrado, Universidad Nacional Federico Villarreal, Lima, Peru
| | - Bo Bach
- Psychiatric Research Unit, Center for Personality Disorder Research, Region Zealand, Slagelse, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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Pires R, Henriques-Calado J, Sousa Ferreira A, Gama Marques J, Ribeiro Moreira A, Barata BC, Paulino M, Gonçalves B. Bridging the ICD11 and the DSM-5 personality disorders classification systems: The role of the PID5BF + M. Front Psychiatry 2023; 14:1004895. [PMID: 36937719 PMCID: PMC10017429 DOI: 10.3389/fpsyt.2023.1004895] [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: 07/27/2022] [Accepted: 02/06/2023] [Indexed: 03/06/2023] Open
Abstract
Introduction In both the ICD-11 Classification of Personality Disorders and the DSM-5 Alternative Model of Personality Disorders (AMPD) personality disorders (PD) are characterized by impairments in self- and interpersonal functioning which distinguish the various levels of dysfunction. Moreover, pathological traits are used by these classification systems to define the stylistic expression of personality dysfunction. Negative affectivity, detachment, antagonism/dissociality, and disinhibition feature as trait domains in each of these models. However, there are also differences between the two models, namely, in the psychoticism domain, which does not feature as a personality trait domain in the ICD-11, and in the anankastia domain, corresponding to compulsivity in the DSM-5, which was removed from the final AMPD model. Furthermore, facets are acknowledged by the DSM-5 within each trait domain, while this does not occur in the ICD-11. In view of the similarity between these classification systems, their harmonization would be beneficial for the clinical profession. With this goal in mind, the PID5BF + M, an algorithm that assesses the DSM-5 and ICD-11 six trait domains and 18 facets, was developed and has proven to adequately characterize the ICD-11 trait domains by means of DSM-5 trait facets. Methods The current study compares a community sample (N = 280, M age = 48.01, 53.2% females) with a PD sample (N = 131, M age = 42.66, 45.0% females) along with the PID5BF + M, the LPFS-SR and the PID-5. Given that the PID5BF + M total can be seen as a measure of the level of personality dysfunction, strong relations between the PID5BF + M total and the LPFS-SR total are expected. Strong relations between the trait specifiers measured by the PID5BF + M and the PID-5 are also expected. Finally, the community and clinical samples are expected to differentiate by means of the dimensions assessed through the three afore-mentioned measures. The Spearman rank-order correlation coefficient was used to measure the strength and direction of associations between the PID5BF + M total and the LPFS-SR total and between the PID5BF + M and the PID-5 traits. Group differences were explored using the Mann-Whitney U test for independent samples. Results As expected, there were strong, significant, and positive relations between the measures. Furthermore, higher scores were observed in all the variables for the PD group against the community group. Discussion Although this study has limitations, its findings sustain that the PID5BF + M has potential to assess the severity of personality disfunction and to characterize the stylistic features of PD as they are conceived by both the ICD-11 and the DSM-5. Although more research is needed regarding the convergent validity of the PID5BF + M, this new test contributes to the harmonization of both systems and to parsimony in the assessment of PD, which is the main objective of clinical practice.
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Affiliation(s)
- Rute Pires
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisbon, Portugal
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisbon, Portugal
| | - Joana Henriques-Calado
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisbon, Portugal
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisbon, Portugal
| | - Ana Sousa Ferreira
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisbon, Portugal
- Instituto Universitário de Lisboa - Business Research Unit (BRU-IUL), Lisbon, Portugal
| | - João Gama Marques
- Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, Lisbon, Portugal
- Consulta de Esquizofrenia Resistente, Hospital Júlio de Matos, Centro Hospitalar Psiquiátrico de Lisboa, Lisbon, Portugal
| | - Ana Ribeiro Moreira
- Centro Hospitalar de Lisboa Ocidental, Hospital de Egas Moniz, Lisbon, Portugal
| | - Bernardo C. Barata
- Departamento de Psiquiatria e Saúde Mental, Centro Hospitalar Barreiro Montijo, Av. Movimento das Forças Armadas, Barreiro, Portugal
| | - Marco Paulino
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisbon, Portugal
- Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, Lisbon, Portugal
| | - Bruno Gonçalves
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisbon, Portugal
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisbon, Portugal
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Simon J, Lambrecht B, Bach B. Cross-walking personality disorder types to ICD-11 trait domains: An overview of current findings. Front Psychiatry 2023; 14:1175425. [PMID: 37091704 PMCID: PMC10116048 DOI: 10.3389/fpsyt.2023.1175425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/16/2023] [Indexed: 04/25/2023] Open
Abstract
The ICD-11 has adopted a classification of Personality Disorders (PD) that abolishes the established categorical PD types in favor of global severity classification with specification of individual trait domains. To facilitate and guide this profound transition, an overview of current research on empirical associations between established PD types and ICD-11 trait domains seems warranted. We identified a total of 9 relevant studies from 2018 to 2022, which were based on both clinical and community samples from U.S., China, Brazil, Denmark, Spain, Korea, and Canada. The patterns of associations with ICD-11 trait domains were systematically synthesized and portrayed for each PD type. Findings overall showed expected and conceptually meaningful associations between categorical PD types and ICD-11 trait domains, with only few deviations. Based on these findings, we propose a cross-walk for translating categorical PD types into ICD-11 trait domains. More research is needed in order to further guide continuity and translation between ICD-10 and ICD-11 PD classification in mental healthcare, including facet-level ICD-11 trait information. Moreover, the nine reviewed studies only relied on self-reported ICD-11 trait domains, which should be expanded with clinician-rated trait domains in future research. Finally, future research should also take ICD-11's essential PD severity classification into account.
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Affiliation(s)
- Jonatan Simon
- Center for Personality Disorder Research (CPDR), Psychiatric Research Unit, Region Zealand, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Bastian Lambrecht
- Center for Personality Disorder Research (CPDR), Psychiatric Research Unit, Region Zealand, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Bo Bach
- Center for Personality Disorder Research (CPDR), Psychiatric Research Unit, Region Zealand, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- *Correspondence: Bo Bach,
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Bach B, Mulder R. Clinical Implications of ICD-11 for Diagnosing and Treating Personality Disorders. Curr Psychiatry Rep 2022; 24:553-563. [PMID: 36001221 DOI: 10.1007/s11920-022-01364-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/10/2022] [Indexed: 01/29/2023]
Abstract
PURPOSE OF REVIEW The International Classification of Diseases 11th revision (ICD-11) introduced a new approach to personality disorders and related traits. This paper reviews recent literature on the assessment of ICD-11 personality disorders and implications for clinical diagnosis, decision-making, and treatment. RECENT FINDINGS We reviewed findings on two measures developed for the ICD-11 model of personality dysfunction and six inventories for the ICD-11 trait specifiers. The psychometric qualities of these tools are promising, and they allow for both rapid screening and fine-grained assessment. Implications for clinical diagnosis and treatment of personality disorders are reviewed including utility for forensic practice. Based on evidence and our experience, we provide some recommendations for severity- and trait-informed interventions. Initial evidence supports the available instruments for assessing ICD-11 personality disorders. More research is needed including development of clinician-rating forms and diagnostic interviews as well as treatment protocols and trials based on the new ICD-11 classification.
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Affiliation(s)
- Bo Bach
- Center for Personality Disorder Research (CPDR), Psychiatric Research Unit, Region Zealand Psychiatry, Fælledvej 6, Bygning 3, 4200, Slagelse, Denmark. .,Department of Psychology, University of Southern Denmark, Odense, Denmark.
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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Riegel KD, Schlosserova L, Zbornik TS. Self-reported narcissistic traits in patients with addiction through the lens of the ICD-11 model for personality disorders. Front Psychiatry 2022; 13:1041480. [PMID: 36506455 PMCID: PMC9732545 DOI: 10.3389/fpsyt.2022.1041480] [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: 09/11/2022] [Accepted: 11/08/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND There is a presumption that pathological narcissism, or narcissistic personality disorder per se, can be considered a precursor to addiction. Although the ICD-11 model does not distinguish specific personality disorders, narcissistic psychopathology should be captured through personality trait qualifiers. OBJECTIVES To verify the capacity of the ICD-11 model in the detection of narcissistic psychopathology in patients with addiction; to test its discrimination capacity, convergent validity, and specificity toward the gender and the type of addiction. MATERIALS AND METHODS Two samples were employed in the study. Sample 1 (n = 421) consisted of patients with addiction; Sample 2 (n = 567) consisted of general population volunteers. Age range was 18-75 years and a battery of self-assessment questionnaires containing Personality Inventory for DSM-5-Brief Form Plus Modified; Triarchic Psychopathy Measure; Hypersensitive Narcissism Scale; and Level of Personality Functioning Scale-Self-Report was administered by pencil-and-paper method. RESULTS The following was confirmed: (1) capacity of the ICD-11 model in relation to capture narcissistic pathology; (2) the differentiation capacity between the clinical and non-clinical population; (3) gender specificity in relation to grandiose and vulnerable narcissism; (4) the connection between the overall degree of impairment in personality functioning and most of trait qualifiers; (5) certain specifics of patients with addiction in relation to the type of addiction. CONCLUSION Results support the empirical and clinical relevance of the ICD-11 model in capturing narcissistic pathology in addicted patients. Clinical implications concerning assessment and treatment in addiction settings, and certain limits regarding the Anankastia domain are discussed.
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Affiliation(s)
- Karel D Riegel
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Lucia Schlosserova
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Tadeas S Zbornik
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia
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