The Construct Validity of the ICD-11 Severity of Personality Dysfunction Under Scrutiny of Object-Relations Theory.

Amin Nazari,Azad Hemmati,Farzin Rezaei,Steven K Huprich

doi:10.3389/fpsyt.2021.648427

Abstract

The current classification of personality disorder in ICD-11 includes a description of personality functioning, derived from a number of theoretical paradigms, but most notably consistent with the psychodynamic approach. Concurrently, an object-relations model of personality functioning in a dimensional assessment of severity is provided in the Structured Interview of Personality Organization-Revised (STIPO-R). To date, there are no published measures of International Classification of Diseases-11 (ICD-11) personality severity, though the construct is very comparable to the concepts assessed in the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) levels of personality functioning concept, which is measured by the Level of Personality Functioning Scale-Self-Report (LPFS-SR). This study examined the validity of ICD-11 personality functioning, as measured by the LPFS-SR, by evaluating its associations with the STIPO-R in Kurdistan region. The samples included 231 University students and 419 inpatient participants across four hospitals (267 with a diagnosed personality disorder). All the components of LPFS-SR and STIPO-R were positively and significantly intercorrelated. The components of each measure discriminated PD and non-PD patients from a University, non-clinical group adequately. Despite slightly better performance of the STIPO-R in this discrimination, the measures had a high congruence in predicting personality dysfunction. Overall, the findings of the present study support the validity of ICD-11 construct for evaluating personality functioning.

Highlights

Personality disorder includes impairments in functioning of aspects of the self, and problems in interpersonal functioning [1]
The inter-component correlations for Structured Interview of Personality Organization-Revised (STIPO-R) varies from 0.42 to 0.71, while the inter-component correlates for the Level of Personality Functioning Scale-Self-Report (LPFS-SR) were 0.83 to 0.88
These high inter-component correlations for the Level of Personality Functioning Scale-Self-Report (LPFS)-SR dimensions are indicative of the unitary nature of the LPFS-SR [42]

Summary

Introduction

Personality disorder includes impairments in functioning of aspects of the self (i.e., identity, accuracy of self-view, self-worth, self-direction), and problems in interpersonal functioning (e.g., parent–child, romantic relationships, school/work, family, friendships, peer contexts) [1]. The level of severity of personality disorder was recently incorporated into International Classification of Diseases (ICD-11) as a means of classifying personality functioning and assigning patients a personality disorder diagnosis [2]. The level of personality functioning has been derived from multiple frameworks [2, 3], including psychodynamic, interpersonal, and personological. These three paradigms have consistently stressed the dynamics of the intrapersonal and interpersonal [3]. The International Classification of Diseases-10 (ICD-10) and the Diagnostic and Statistical Manual of Mental DisordersIV (DSM-IV) had no account of severity of dysfunction [4]. By including severity in the conceptualization and diagnosis of personality disorder, studies have found that researchers and clinicians have more adequate prediction and prognosis in the assessment of personality disorder [5, 6, 9, 11]

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Discussion

Conclusion