1
|
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.
Collapse
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
| |
Collapse
|
2
|
Khazaie H, Rezaei F, Faridmarandi B, Zakiei A, Jananeh M, Mahdavi S, Nazari A, Komasi S. The sensitivity of the ICD-11 trait model to the symptoms of clinical disorders in young adults. Personal Ment Health 2024. [PMID: 38741371 DOI: 10.1002/pmh.1618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 02/25/2024] [Accepted: 04/28/2024] [Indexed: 05/16/2024]
Abstract
Hierarchical psychopathology contributes to providing a broader picture of the links between emerging personality structures such as the DSM-5/ICD-11 trait models and clinical disorders. The present study aimed to predict the specific and general clinical symptoms by the less studied constructs of the ICD-11 model (negative affectivity, detachment, dissociality, disinhibition, and anankastia). Data from 642 young adults from Iran (63% female, 18-34 years) were collected by three mental symptom scales and the Personality Inventory for DSM-5 (PID-5), which was recently used to harmonize the constructs of the DSM-5 and ICD-11 trait models. Multiple linear regressions showed that the ICD-11 model significantly predicted both the specific clinical symptoms (ranging from R2 = 0.15 to 0.40) and the general factor of clinical symptoms extracted by exploratory factor analysis (R2 = 0.40, all p < 0.001). Negative affectivity was the strongest construct correlated with both the specific symptoms (ranging from β = 0.36 to 0.69) and the general symptom factor (β = 0.59, all p < 0.001). Because the ICD-11 trait model is a practical structure related to the clinical psychopathology in young adults, screening for maladaptive traits can help clinicians in case formulation for diagnosis and treatment.
Collapse
Affiliation(s)
- Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Farzin Rezaei
- Roozbeh Hospital, Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Behrooz Faridmarandi
- Department of Neuroscience and Psychopathology Research, Mind GPS Institute, Kermanshah, Iran
| | - Ali Zakiei
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Minoo Jananeh
- Department of Neuroscience and Psychopathology Research, Mind GPS Institute, Kermanshah, Iran
| | - Sahar Mahdavi
- Department of Neuroscience and Psychopathology Research, Mind GPS Institute, Kermanshah, Iran
| | - Amin Nazari
- Department of Psychology, University of Kurdistan, Sanandaj, Iran
| | - Saeid Komasi
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Department of Neuroscience and Psychopathology Research, Mind GPS Institute, Kermanshah, Iran
| |
Collapse
|
3
|
Vaysi A, Nazarpour P, Kiani Z, Maleki M, Hamzehei M, Amianto F, Sellbom M, Komasi S. Replicability of the five-factor structure of DSM-5 and ICD-11 trait systems and their associations with binge eating and bipolar spectrum psychopathology. Personal Ment Health 2024; 18:122-137. [PMID: 38031321 DOI: 10.1002/pmh.1600] [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: 08/17/2023] [Revised: 10/21/2023] [Accepted: 11/09/2023] [Indexed: 12/01/2023]
Abstract
Since the research on contemporary personality models-and psychopathology-mainly originate from the Western world, we aimed to test the factorial structure of two trait systems assessed with the Personality Inventory for DSM-5 (PID-5) in a non-Western sample and to compare the extracted models' relative associations with binge eating disorder (BED) and bipolar spectrum disorder (BSD) symptoms. A community sample (N = 516; 72% female) was administered the PID-5, which can operationalize both the DSM-5 and ICD-11 systems. The factor structures of both systems were tested using exploratory structural equation modeling (ESEM). The congruence coefficients of all factor loadings with international studies were calculated. The Binge Eating Scale (BES), Bipolar Spectrum Diagnostic Scale (BSDS), and Hypomania Checklist-32-Revised (HCL-32) were used to measure the criterion variables. Linear regression models were used for comparing the DSM-5 and ICD-11 systems in predicting the BED and BSD. The findings supported five-factor solutions for both trait systems. Both systems significantly predicted dimensional measures of both BED and BSD (all p < 0.001). The present findings support an acceptable five-factor structure for both personality systems in the non-Western sample. Different algorithms of maladaptive domains on both systems are related to binge eating and bipolar spectrum psychopathology.
Collapse
Affiliation(s)
- Anis Vaysi
- Department of Neuroscience and Psychopathology Research, Mind GPS Institute, Kermanshah, Iran
| | - Parisa Nazarpour
- Department of Neuroscience and Psychopathology Research, Mind GPS Institute, Kermanshah, Iran
| | - Zhaleh Kiani
- Department of Neuroscience and Psychopathology Research, Mind GPS Institute, Kermanshah, Iran
| | - Mahtab Maleki
- Department of Neuroscience and Psychopathology Research, Mind GPS Institute, Kermanshah, Iran
| | - Maryam Hamzehei
- Department of Neuroscience and Psychopathology Research, Mind GPS Institute, Kermanshah, Iran
| | - Federico Amianto
- Department of Neurosciences, Psychiatry Section, Regional Pilot Centre for Eating Disorders, University of Torino, Torino, Italy
| | - Martin Sellbom
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Saeid Komasi
- Department of Neuroscience and Psychopathology Research, Mind GPS Institute, Kermanshah, Iran
| |
Collapse
|
4
|
Pan B, Wang W. Practical implications of ICD-11 personality disorder classifications. BMC Psychiatry 2024; 24:191. [PMID: 38454364 PMCID: PMC10921591 DOI: 10.1186/s12888-024-05640-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 02/26/2024] [Indexed: 03/09/2024] Open
Abstract
Personality disorders (PDs) are associated with an inferior quality of life, poor health, and premature mortality, leading to heavy clinical, familial, and societal burdens. The International Classification of Diseases-11 (ICD-11) makes a thorough, dramatic paradigm shift from the categorical to dimensional diagnosis of PD and expands the application into adolescence. We have reviewed the recent literature on practical implications, and severity and trait measures of ICD-11 defined PDs, by comparing with the alternative model of personality disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), by mentioning the relevance in forensic and social concerns, and by referencing the developmental implication of life span, especially in adolescence. Study results strongly support the dimensional utility of ICD-11 PD diagnosis and application in adolescence which warrants early detection and intervention. More evidence-based research is needed along the ICD-11 PD application, such as its social relevance, measurement simplification, and longitudinal design of lifespan observation and treatment.
Collapse
Affiliation(s)
- Bing Pan
- Department of Psychiatry, Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Wei Wang
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway.
| |
Collapse
|
5
|
Somma A, Keeley JW, Bach B. Editorial: Community series in ICD-11 personality disorders: utility and implications of the new model, volume II. Front Psychiatry 2023; 14:1199703. [PMID: 37283709 PMCID: PMC10240050 DOI: 10.3389/fpsyt.2023.1199703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/02/2023] [Indexed: 06/08/2023] Open
Affiliation(s)
- Antonella Somma
- School of Psychology, Vita-Salute San Raffaele University, Milan, Italy
- Clinical Psychology and Psychotherapy Unit, IRCCS San Raffaele Turro Hospital, Milan, Italy
| | - Jared W. Keeley
- Psychology Department, Virginia Commonwealth University, Richmond, VA, United States
| | - Bo Bach
- Center for Personality Disorder Research (CPDR), Psychiatric Research Unit, Slagelse Psychiatric Hospital, Slagelse, Denmark
| |
Collapse
|
6
|
Pešić D, Lečić-Toševski D, Kalanj M, Ristić I, Vuković O, Pejušković B. Analysis of the Relationship between Higher-Order Factor Structure of Personality Disorders and the Five-Factor Model of Personality. Brain Sci 2023; 13:brainsci13040605. [PMID: 37190570 DOI: 10.3390/brainsci13040605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/23/2023] [Accepted: 03/29/2023] [Indexed: 04/05/2023] Open
Abstract
The growing body of evidence on the dimensional classification of personality disorders (PD) has resulted in its acceptance in the ICD-11 classification, which abolished categories and retains only a general description of PD. Specifying the type of PD is optional, and the suggested domains represent maladaptive variants of the five-factor model of personality (FFM). The aim of our study was to explore the existence of a joint structure between maladaptive and normal personality traits, and to investigate how these structures are integrated. The study included 223 patients who had been diagnosed with PD and completed the Structured Clinical Interview for DSM-5 Personality Disorders and the NEO Personality Inventory-Revised (NEO-PI-R). To determine the degree of overlap between PD domains and NEO PI–R scales, a canonical analysis of covariance was conducted. Our findings showed a relationship between the internalizing PD spectrum (consisting of avoidant, dependent, and borderline traits with detached and anankastic traits) and high neuroticism, low conscientiousness, and moderately low agreeableness and extroversion, suggesting the existence of a broad personality disorder factor. However, the internalizing dimensions exhibited a more pronounced effect within this construct. Furthermore, we identified a second function that demonstrated a link between the externalizing PD spectrum (including narcissistic, histrionic, and antisocial traits) and high extraversion, high openness, and low agreeableness, suggesting the existence of an externalizing factor. Overall, our findings provide evidence for a joint structure of maladaptive and normal personality traits in a sample of personality disorders and emphasize the importance of integrating the FFM model in PD evaluation in clinical practice, suggesting that differentiating between major subgroups could assist in adjusting therapeutic approaches.
Collapse
Affiliation(s)
- Danilo Pešić
- Clinic for Children and Adolescence, Institute of Mental Health, 11000 Belgrade, Serbia
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | | | - Marko Kalanj
- Clinic for Children and Adolescence, Institute of Mental Health, 11000 Belgrade, Serbia
| | - Ivan Ristić
- Clinical Department for Psychotic Disorders, Institute of Mental Health, 11000 Belgrade, Serbia
| | - Olivera Vuković
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Department for Research and Education, Institute of Mental Health, 11000 Belgrade, Serbia
| | - Bojana Pejušković
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Clinical Department for Crisis intervention and Affective Disorders, Head, Institute of Mental Health, 11000 Belgrade, Serbia
| |
Collapse
|
7
|
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.
Collapse
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,
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Skimina E, Strus W, Cieciuch J, Topolewska-Siedzik E. How Many and What Mechanisms Are Needed to Explain Self-Regulatory Functions in Personality Dynamics: Towards a Model Based on the Circumplex of Personality Metatraits. J Pers 2022. [PMID: 35451067 DOI: 10.1111/jopy.12722] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 04/13/2022] [Accepted: 04/15/2022] [Indexed: 11/28/2022]
Abstract
We propose a model of basic self-regulatory mechanisms that integrates descriptive-structural and dynamic-explanatory approaches to personality. Using a structural way of thinking and based on a structural model of personality (the Circumplex of Personality Metatraits) we deduced two orthogonal (distinct) but interactive mechanisms: (a) Impulse Control responsible for controlling automatically activated impulses, urges, and affective reactions and (b) Self-Motivation responsible for regulating intentions in goal-oriented behaviors. Their operation depends on both situational and dispositional factors and optimal functioning of both mechanisms is needed for effective regulation of behavior. People can also be characterized by relatively stable levels of Impulse Control and Self-Motivation as dispositions, which depend on temperamental predispositions but can develop incoherently with them due to the impact of environmental factors. Combinations of Impulse Control and Self-Motivation as dispositions result in personality types, which differ in their adaptiveness. Importantly, Impulse Control and Self-Motivation mechanisms reveal substantial similarities to other self-regulatory constructs described in the literature, particularly those included in Block and Block's, as well as Kuhl's theories. The contribution of our paper may serve as an example of how to apply the descriptive-structural approach to develop a dynamic-explanatory model of personality.
Collapse
Affiliation(s)
- Ewa Skimina
- Institute of Psychology, Cardinal Stefan Wyszyński University in Warsaw, Poland
| | - Włodzimierz Strus
- Institute of Psychology, Cardinal Stefan Wyszyński University in Warsaw, Poland
| | - Jan Cieciuch
- Institute of Psychology, Cardinal Stefan Wyszyński University in Warsaw, Poland.,URPP Social Networks, University of Zurich, Switzerland
| | | |
Collapse
|
10
|
Cieciuch J, Strus W. Toward a Model of Personality Competencies Underlying Social and Emotional Skills: Insight From the Circumplex of Personality Metatraits. Front Psychol 2021; 12:711323. [PMID: 34867590 PMCID: PMC8636011 DOI: 10.3389/fpsyg.2021.711323] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 10/04/2021] [Indexed: 11/20/2022] Open
Abstract
In recent years, there has been a growing interest in social and emotional skills (SES) both in the scientific literature and in social practice. The paper presents an overview of the ways of understanding what SES are and the catalogs thereof. There are some attempts in the literature to organize these catalogs within the Big Five traits that for a long time was claimed to be the most sound model of basic orthogonal dimensions of personality. However, further research on personality structure revealed that two metatraits can be found above the Big Five traits. These two metatraits form the basis of the Two Factor Model of personality, which was later developed into the Circumplex of Personality Metatraits. It turned out that in certain aspects models based on metatraits have a greater theoretical potential than those based on the Big Five traits. The paper presents a proposal for describing SES from the perspective of the Circumplex of Personality Metatraits rather than the Big Five. In this framework, we distinguish the concept of personality competences that underlie and organize many specific SES and identify the core personality competencies on the basis of the Circumplex of Personality Metatraits model.
Collapse
Affiliation(s)
- Jan Cieciuch
- Institute of Psychology, Cardinal Stefan Wyszyński University in Warsaw, Warsaw, Poland
- URPP Social Networks, University of Zurich, Zurich, Switzerland
| | - Włodzimierz Strus
- Institute of Psychology, Cardinal Stefan Wyszyński University in Warsaw, Warsaw, Poland
| |
Collapse
|