Integration of the ICD-11 and DSM-5 Dimensional Systems for Personality Disorders Into a Unified Taxonomy With Non-overlapping Traits.

Fernando Gutiérrez,Miguel Gárriz,Laura Ruiz,Marc Ferrer,Marc Ferrer,Natalia Calvo,Josep M Peri,Gemma Vall,Gemma Vall,Bárbara Sureda,Estela Arqué,Jaume Condomines

doi:10.3389/fpsyt.2021.591934

Abstract

The promise of replacing the diagnostic categories of personality disorder with a better-grounded system has been only partially met. We still need to understand whether our main dimensional taxonomies, those of the International Classification of Diseases, 11th Revision (ICD-11) and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), are the same or different, and elucidate whether a unified structure is possible. We also need truly independent pathological domains, as they have shown unacceptable overlap so far. To inquire into these points, the Personality Inventory for DSM-5 (PID-5) and the Personality Inventory for ICD-11 (PiCD) were administered to 677 outpatients. Disattenuated correlation coefficients between 0.84 and 0.93 revealed that both systems share four analogous traits: negative affectivity, detachment, dissociality/antagonism, and disinhibition. These traits proved scalar equivalence too, such that scores in the two questionnaires are roughly interchangeable. These four domains plus psychoticism formed a theoretically consistent and well-fitted five-factor structure, but they overlapped considerably, thereby reducing discriminant validity. Only after the extraction of a general personality disorder factor (g-PD) through bifactor analysis, we could attain a comprehensive model bearing mutually independent traits.

Highlights

Despite being increasingly close to a scientifically based personality disorder (PD) classification, we still do not have a unique, generally accepted, and unproblematic dimensional substitute for the traditional categories [1, 2]
We examined the relationships between the ICD-11 and DSM5 systems for PD as measured through the Personality Inventory for ICD-11 (PiCD) and PID5-SF questionnaires in 677 outpatients
We found that both systems share four basic constructs of personality pathology: negative affectivity, detachment, dissociality/antagonism, and disinhibition/anankastia

Summary

INTRODUCTION

Despite being increasingly close to a scientifically based personality disorder (PD) classification, we still do not have a unique, generally accepted, and unproblematic dimensional substitute for the traditional categories [1, 2]. Attempts have been made to capture the ICD-11 domains from the more broadly studied Personality Inventory for DSM-5 (PID-5) [7, 8], and the resulting factors confirmed the presumption that both models are commensurate These studies did not take psychoticism into account, as it does not form part of the ICD-11 classification, and their design did not allow testing a common structure for the AMPD and the ICD-11. Nor has exploratory structural equation modeling (ESEM) [19, 20] been hitherto applied to the common structure of the PiCD and the PID-5, though it has been to DSM-based algorithms [7, 8] This method is strongly recommended instead of the more usual exploratory (EFA) and confirmatory (CFA) approaches, as it relaxes some unreal constraints such as zero cross-loadings, which are unlikely to be fulfilled by personality structures [20]. We examined in a sample of 677 outpatients, the extent to which both systems are similar or different, and how a unified and maximally comprehensive taxonomic system, comprising non-overlapping pathological traits, should look like

MATERIALS AND METHODS

DISCUSSION

ETHICS STATEMENT