Assessment of ICD-11 Personality Disorder Severity in Forensic Patients Using the Semi-structured Interview for Personality Functioning DSM-5 (STiP-5.1): Preliminary Findings.

Joost Hutsebaut,Nynke Tuin,Laura C Weekers,Erik Bulten,Jessica S P Apeldoorn

doi:10.3389/fpsyt.2021.617702

Joost Hutsebaut, Nynke Tuin + Show 3 more

Open Access

https://doi.org/10.3389/fpsyt.2021.617702

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Abstract

In forensic settings, several challenges may affect reliability of assessment of personality pathology, specifically when based upon self-report. This study investigates the Semi-Structured Interview for DSM-5 Personality Functioning (STiP-5.1) to assess level of severity of personality functioning in incarcerated patients. Thirty inpatients of three forensic psychiatric facilities completed the STiP 5.1 and additionally completed self-report questionnaires assessing symptom severity, personality functioning and traits. Staff members completed informant versions of personality functioning questionnaires. Previously assessed community (N = 18) and clinical samples (N = 80) were used as a reference. Interrater reliability and internal consistency of the STiP 5.1 were good. As expected, no associations were found between self-report and expert-ratings (STiP 5.1) of personality functioning. Remarkably, no associations were found between informant rated personality functioning and the STiP 5.1. This study confirms the discrepancies between self-report and expert-ratings in forensic settings and identifies the need to design and test assessment instruments within this context instead of generalizing findings obtained in regular mental health care samples. The STiP-5.1 may be a candidate for use in forensic samples, particularly to guide treatment planning and individual patient policy, although it remains unclear what specific information it offers above and beyond self-report and informant-report.

Highlights

Personality disorders (PDs) are severe mental disorders characterized by enduring patterns of experiencing and behaving that are markedly different from what is expected in the cultural context [1]
It is designed to meet many of the shortcomings of the categorical model, the ICD-11 focuses on the global level of severity and five trait qualifiers [3]
This study aims to investigate the feasibility of assessment of level of personality functioning using the STiP-5.1 in a sample of incarcerated patients

Summary

Introduction

Personality disorders (PDs) are severe mental disorders characterized by enduring patterns of experiencing and behaving that are markedly different from what is expected in the cultural context [1]. It is designed to meet many of the shortcomings of the categorical model, the ICD-11 focuses on the global level of severity (impairment in self- and interpersonal functioning) and five trait qualifiers [3]. This approach strongly resembles the new definition and criteria within the AMPD. Comparable to ICD-11, the AMPD defines impairments in self and interpersonal functioning (Criterion A) as the core of personality disorders, while a range of personality traits (Criterion B) determines the expression of these impairments in specific types of personality pathology [4] To assess these core impairments, i.e., Criterion A, DSM-5 introduced the Level of Personality Functioning Scale [LPFS; [5]]. The LPFS provides verbal descriptors on five levels of severity for 12 facets, assumed to express an underlying general dimension of severity

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