The network structure of personality functioning and maladaptive traits in adolescents.

The aim of this study was to examine the psychometric properties of the Polish version of the Self and Interpersonal Functioning Scale (SIFS-PL). The scale is designed to assess Criterion A of the DSM-5 Alternative Model of Personality Disorders (AMPD) - the four core elements of personality pathology (Identity, Self-direction, Empathy, and Intimacy) from the Level of Personality Functioning (LPF) for personality disorders (PDs). Adult participants from 6 community and clinical samples (total N = 394; 83.2% female; age: M = 30.9, SD = 9.6) completed the SIFS-PL. A clinical subsample of 50 patients diagnosed with personality disorders additionally completed the Personality Inventory for DSM-5 (PID5). Confirmatory factor analysis supported a bifactor four-factor model. All items had significant loadings on both the four specific elements and an overarching general personality pathology factor. The internal consistency ranged from acceptable to good for subscales and excellent for the global scale. In terms of criterion validity, results from the clinical subgroup were consistent with previous research on the SIFS. The SIFS-PL scales effectively discriminated between community sample participants and those suffering from depression, as well as an ambulatory clinical group with personality disorders. Our findings underscore the robust psychometric properties of the Polish version of the SIFS, rendering it a promising tool for both screening and extensive research on personality disorders within contemporary dimensional models such as the AMPD and ICD-11. Its application in clinical settings can also be advocated. However, general scores and subscale scores might serve distinct purposes, warranting further investigation into their predictive validity.

Research on different aspects of mentalizing is essential for understanding the mechanisms underlying personality disorders (PDs) and for informing psychotherapy approaches, in which mentalizing is considered a key mechanism of change. This study aimed to explore whether self- and other-mentalizing, in interaction with attachment insecurity, differentially explain Criteria A (level of personality functioning) and B (maladaptive traits) of the Alternative Model for Personality Disorders in the DSM-5. Our sample consisted of 109 participants (54% female, 41% male and 5% nonbinary). We used the Structured Clinical Interview for DSM-5 Personality Disorders, a Movie for the Assessment of Social Cognition, the Reflective Functioning Questionnaire, the Experiences in Close Relationships-Revised, the Self and Interpersonal Functioning Scale and the Personality Inventory for DSM-5. Regression analyses show that self-mentalizing deficits uniquely predict both Criterion A domains (self and interpersonal functioning) and all five maladaptive traits, while other-mentalizing is relevant only to interpersonal functioning. Explained variance (adjusted R2) ranges from 55% to 18%. Additionally, mentalization moderates the relationship between insecure attachment and personality pathology (interpersonal functioning, Negative Affectivity and Detachment), mainly with greater mentalization deficits linked to more severe personality dysfunction under heightened attachment insecurity. Our findings authorize mentalizing as a crucial factor in PD, supporting the potential value of mentalization-focused interventions in addressing both the severity and the 'flavour' of PD. Notably, our findings suggest a hierarchy within self- and other-mentalizing, indicating that self- mentalizing plays a more foundational role in PD. Through a comprehensive, multimethod assessment of mentalization, this study offers a refined understanding of its role in psychopathology, providing valuable insights that could guide the development of more targeted therapeutic interventions.

The personality disorders are said to be at the vanguard in the shift to a dimensional model of classification, as exemplified in the Alternative Model of Personality (AMPD) presented in Section III of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) for emerging models and in the 11th edition of the International Classification of Diseases (ICD-11). Considered herein are some limitations and challenges. For the DSM-5 AMPD trait model, these include problematic placements, inadequate coverage, perceived complexity, and lack of cutoff points. For the DSM-5 AMPD Level of Personality Functioning (LPF), they include the complexity, the questionable presumption that the LPF defines the core of personality disorder, the presumption that the LPF identifies what is unique to the personality disorders, and the premise that the LPF is distinct from the maladaptive traits. Limitations and challenges of the ICD-11 model are the absence of lower-order facet scales and the fact that only the level of severity is required. This review suggests that the trait of depressivity belongs with negative affectivity and suspicion belongs within antagonism, that maladaptive traits from all 10 poles of the five domains should be provided, and that cutoff points based on social-occupational impairment and/or distress should be provided. The review summarizes research that questions whether the LPF represents the core of personality disorder, identifies what is unique to the personality disorders, and is distinct from maladaptive traits. Finally, the review suggests that the ICD-11 should require the assessment of the traits and include facet scales.

The Minnesota Multiphasic Personality Inventory (MMPI) instruments are frequently used to assess personality and psychopathology. Recent publications of personality disorder (PD) spectra scales for dimensionalized PD syndromes with MMPI instruments may advance PD assessment. To this end, we examined MMPI-Second Edition (2) and MMPI-2-Restructured Form (-RF) PD Spectra scales within the lens of a contemporary dimensional model of PDs, the alternative model for personality disorders (AMPD). The core dimension of PD, Criterion A of the AMPD or level of personality functioning (LPF), was characterized quantitatively within the PD Spectra scales. By sequentially factor analyzing the scales of the Severity Indices of Personality Problems (SIPP-118) to a common general factor of PD, an index of LPF external to the MMPI item pool was established. This LPF dimension was strongly represented across most PD Spectra scales. LPF variances within the PD Spectra scales were deconstructed using measures of general demoralization (RCdemoralization) and maladaptive personality traits indexed by the Personality Psychopathology-5 (PSY-5). Nuanced LPF and PD Spectra scale relationships were discerned. Dimensionalized Antisocial PD, Borderline PD, Dependent PD, and Paranoid PD showed meaningful association with LPF after demoralization, and maladaptive trait variances were removed. The examination of the MMPI-3 item pool reveals that the existing PD Spectra scale item sets are largely carried forward in the new edition of the MMPI. This suggests PD Spectra scale correlates, including LPF relationships, may be discernable in the newest edition of the MMPI, pending future study.

Level of Personality Functioning (LPF) represents the entry criterion (Criterion A) of the Alternative Model for Personality Disorders (AMPD) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). It is defined as a dimensional general severity criterion common to all personality disorders and conceptually independent of personality types or traits, and it represents maladaptive self (identity and self-direction) and interpersonal (empathy and intimacy) functioning. We review the history, measurement, and significance of LPF. We show that the inclusion of LPF in the AMPD is well justified if it is defined as a general adaptive failure of a subjective intrapsychic system needed to fulfill adult life tasks. If so defined, LPF distinguishes itself from maladaptive traits (Criterion B of the AMPD) and captures the contribution humans make as agentic authors to the interpretation and management of the self. While Criterion B maladaptive traits provide important descriptive nuance to manifestations of personality pathology, maladaptive LPF is conditional to the diagnosis of personality disorder.

The Alternative Model of Personality Disorders (AMPD), introduced in Section III of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013), was proposed as a new operationalization of personality disorders (PDs) aiming to overcome the several limitations of the traditional symptom-based model (Waugh et al., 2017; Zimmerman et al., 2019). In the AMPD, PDs are defined by two-dimensional criteria (the level of personality functioning and maladaptive personality traits), but as a hybrid model, it also allows for categorical assessment of PDs (i.e., "hybrid types") to facilitate continuity with clinical practice. The present study aimed to provide normative data for two widely used instruments assessing Criterion A (Level of Personality Functioning Scale-Self-Report; Morey, 2017) and B (Personality Inventory for DSM-5; Krueger et al., 2012) in a large populational French-Canadian sample. Regarding the categorical assessment, Gamache et al. (2022) recently tested scoring approaches for extracting the PD hybrid types from dimensional measures of the AMPD. In the present study, these approaches were used to estimate prevalence rates for these PD hybrid types in two samples. In the populational sample, results showed that prevalence rates varied from 0.2% (antisocial PDs) to 3.0% (trait-specified PDs), with an overall prevalence of 5.9% to 6.1% for any PD hybrid type. Prevalence was higher in men than in women in the populational sample, but the contrary was observed in the at-risk sample. Prevalence was higher in younger adults than in middle-aged and older adults. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Personality disorders are a major public health concern that onset during adolescence and young adulthood. There has been a recent interest in studying the role of positive psychology constructs in personality pathology. A positive psychology construct that has been tested in conjunction with normative personality traits, but not yet maladaptive personality traits, is intellectual humility (IH). Evaluating links between IH and maladaptive personality traits would advance prior research and could also inform new prevention and intervention strategies for personality pathology, as well as increase clinical applications for IH. The current study therefore aimed to examine associations between IH and the five maladaptive traits outlined in the Alternative Model of Personality Disorders from Section III of the DSM-5: negative affect, detachment, antagonism, disinhibition, and psychoticism. The sample included 897 young adults between the ages of 18–25 (79.8% female), who completed the five-factor Personality Inventory for DSM-5 and the three-factor Intellectual Humility Scale as part of a cross-sectional online study. Five hierarchical regression models were evaluated. All five maladaptive traits were significantly and inversely predicted by at least one of the three IH domains, over and above age and gender. Relative to the other maladaptive traits, antagonism had the greatest amount of variability explained (23.7%) by IH factors (compared to the 4–10% variance explained in the other traits). Clinical implications, particularly for personality disorders that involve antagonism, and future research directions are discussed.

Objective: In DSM-5, Section III, the Level of Personality Functioning (LPF) was proposed as a severity index of personality disorders (PDs), but as it reflects both trait-like (availability) and state-like (accessibility) features, of which, moreover, the relationship with the experience of patients is unclear, we critically examined LPF in patients with general psychopathology. Method: This study compared the validity of the direct Inventory of Personality Organization (IPO), and the indirect Differentiation-Relatedness Scale (DRS) LPF-measure, in relation to measures of intrapersonal and interpersonal functioning. The sample consisted of 70 inpatients with general psychopathology and no primary PDs. Associations of both measures with DSM-PDs were examined, with and without controlling for clinical distress. Results: The IPO was significantly related to age and clinical distress. When controlling for clinical distress, the IPO was still associated with cluster A (odd) and B (erratic) PD features, high levels of self-criticism, conflict in relationships and low levels of adaptive coping strategies. The DRS was only related to the schizotypical PD. Conclusions: In patients with general psychopathology, both the IPO and the DRS, appear to have limitations in measuring LPF. The IPO seems to be prone to state effects, although correlations with PDs remained significant when controlling for clinical distress. The DRS seemed to be more independent from clinical distress but was unexpectedly unrelated to features of personality pathology. DRS reflects availability, while IPO also reflects different degrees of accessibility of LPF in PDs.

The classification of personality disorders (PDs) is in transition. The shortcomings of the categorical PD diagnoses led to the development of the Alternative Model for Personality Disorders (AMPD) in Section III of the DSM–5 regarding a dimensional differentiation of severity of personality pathology. Impairments in personality functioning are defined as a general Criterion A for PD. Inspired by the AMPD, the LoPF–Q 12–18 was developed to assess Levels of Personality Functioning (LoPF) dimensionally in adolescents from 12 to 18 years old in self-report. The questionnaire shows good scale reliabilities, good construct validity by demonstrating a systematic variation with pathology in line with theory, and a valuable clinical utility. The results suggest that the LoPF–Q 12–18 questionnaire is a clinically useful instrument to assess personality pathology in young people and that the concept of personality functioning is useful in detecting and describing central impairments of PD pathology at an early stage of development.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the International Classification of Diseases (ICD-11) proposed a dimensional approach to the assessment of personality disorders (PDs). Both models dictate that the clinician first determines PD severity before assessing maladaptive traits, invoking the level of personality functioning (LPF) construct. We consider LPF a promising dimensional construct for translational research because of its clinical importance and conceptual overlap with the Research Domain Criteria (RDoC) Social Processes. We aim to identify biomarkers that co-vary with fluctuations in LPF in adulthood, ultimately to predict persistent decrease in LPF, associated with suicidality and morbidity. However, a theoretical framework to investigate stress-related oscillations in LPF is currently missing. In this article, we aim to fill this hiatus with a critical review about stress and LPF. First, we discuss acute stress and LPF. We briefly present the basics of the neurophysiological stress response and review the literature on momentary and daily fluctuations in LPF, both at a subjective and physiological level. Second, we review the effects of chronic stress on brain function and social behaviour and recapitulate the main findings from prospective cohort studies. This review underlies our suggestions for multimethod assessment of stress-related oscillations in LPF and our theoretical framework for future longitudinal studies, in particular studies using the experience sampling method (ESM).

The Alternative Model for Personality Disorders provides a dimensional framework for the conceptualization of personality disorders where Criterion A concerns the assessment of one’s level of personality functioning (LPF). This study examines the psychometric properties of the English translation of the Semi-Structured Interview for Personality Functioning (STiP-5.1) to validate this translation for the assessment of LPF in English-speaking populations; and examine whether this measure increments self-report measures of LPF and personality pathology in predicting general functioning. The sample consisted of 129 emerging adults between 18 and 25 years of age (M = 20.54, SD = 2.08) from a mixed college and clinical sample. Results support a unidimensional factor structure of the STiP-5.1, good internal consistency, and high inter-rater reliability. Construct validity was supported through associations of the STiP-5.1 with self-report measures of LPF and personality pathology. The STiP-5.1 incremented self-report measures of personality pathology in predicting functional impairment, though additional variance explained was modest. Finally, STiP-5.1 scores differentiated individuals who obtained a score at or above the clinical cutoff from those below on self-report measures of personality pathology and LPF with large effect sizes. Findings support the validity of the English translation of the STiP-5.1 for the assessment of LPF.

Both the new ICD-11 and the latest Alternative DSM-5 Model for Personality Disorders focus on self and interpersonal functioning as the central feature of personality pathology, also acknowledging that personality disorders are organized along a dimensional continuum of severity. This revised understanding is in line with long-standing psychodynamic conceptualisations of personality pathology, in particular Kernberg’s object relations model of personality organization. Despite existing evidence for the clinical utility of the derived Structured Interview of Personality Organization (STIPO-R), empirical support for the identification of clear cut-points between the different levels of personality functioning is missing. For this purpose, a total of 764 adult participants were recruited across two clinical (outpatient and inpatient) settings (n = 250) and two non-clinical (university students and general community) samples (n = 514). Results from the mixture modeling suggested the existence of five groups across the clinical and non-clinical samples that covered: healthy personality functioning, maladaptive personality rigidity, and mild, moderate, and severe levels of personality pathology. All five indicators of personality organization were found to be reliable predictors of personality pathology. Of the five STIPO-R indicators, Aggression and Moral Values had the most discriminative power for differentiating between the Mild, Moderate, and Severe personality disorder groups. Implications of these findings are discussed.

Given shifts to dimensional models of personality pathology and a growing consensus that personality disorder (PD) often onsets during adolescence, there is a need for validated measures of PD in adolescents. Level of Personality Functioning (LPF) is particularly relevant for the identification of emerging personality dysfunction in adolescents given its ability to capture developmental discontinuity as metacognitive capacities in self- and interpersonal-functioning emerge. However, no studies as of yet have validated a measure of LPF in a sample of Spanish-speaking adolescents. In addition, no study has evaluated whether LPF associates with status as victim of parental neglect vs. community adolescents. A total of 570 Spanish-speaking adolescents between the ages of 11 and 18 (n = 168 with a history of parental neglect, n = 402 from a community sample) completed the briefest form of LPF, the LPFS-BF 2.0. Results from the confirmatory factor analysis revealed adequate fit of a unidimensional model, and invariance analyses suggested measurement invariance across gender and age (early versus late adolescents). Internal consistency was adequate, and convergent validity was supported through negative correlations of the LPFS-BF 2.0 with empathy and reflective function, and positive associations with alexithymia. Contrary to expectations, total scores on the LPFS-BF 2.0 did not distinguish adolescents with a history of parental neglect and adolescents from a community sample. Overall, results support the Spanish translation of the LPFS-BF 2.0 as a valid measure for use in adolescents.

Numerous studies have demonstrated that the Alternative Model for Personality Disorders (AMPD) outperforms traditional categorical nosology (i.e., Section II) in predicting an array of salient clinical outcomes. However, despite the centrality of social-cognitive impairments in personality disorder, few studies have examined the superiority of the AMPD over Section II in predicting social-cognitive deficits. The current study addresses this gap by evaluating the incremental validity of AMPD-defined level of personality functioning (LPF) versus borderline personality features in predicting mentalizing - a social-cognitive construct proposed to underlie the development of personality disorder. Participants included 267 university students (Mage = 20.49, SD = 1.74) who completed self-report measures of LPF, borderline personality features, and two measures of mentalizing: the Reflective Functioning Questionnaire (RFQ) and the Mentalization Scale (MentS). Hierarchical regressions revealed that LPF explained additional variance in the RFQ beyond borderline features and internalizing psychopathology. Although borderline features also incremented LPF in predicting the RFQ, additional variance explained was less than half that contributed by the LPF over borderline features. LPF also incremented the variance explained in the MentS total score and subscales over and above borderline features and internalizing symptoms, whereas borderline features did not increment LPF in predicting any of the MentS variables. These results strengthen the evidence base for the superiority of the AMPD over Section II and suggest that mentalizing deficits are better captured by LPF than borderline personality disorder symptoms. Findings support the extension of mentalization-based treatment to AMPD-defined personality disorder, which should be explored in future research.

ABSTRACTInterest in the Level of Personality Functioning (LPF), defined by Criterion A of the Alternative Model for Personality Disorders (AMPD), is growing. LPF includes self‐functioning (identity, self‐direction) and interpersonal functioning (empathy, intimacy). While LPF is crucial for understanding personality dysfunction, its ability to distinguish personality disorders from other conditions remains debated. The DSM‐5 Levels of Functioning Questionnaire–Short Form (DLOPFQ‐SF) is a promising LPF measure, but further research in diverse populations is needed. This study examined the internal structure and psychopathological correlates of the DLOPFQ‐SF in an Italian nonclinical sample. Specifically, it assessed the tool's factor structure and relations with the Hierarchical Taxonomy of Psychopathology (HiTOP) and positive adjustment. A sample of 1183 Italian participants (46.2% female, mean age = 31.3 ± 14.8) completed the DLOPFQ‐SF and other self‐report measures. Exploratory and confirmatory factor analyses showed a three‐factor structure comprising Identity, Empathy, and Intimacy. Structural equation modeling (SEM) explored links between the three DLOPFQ‐SF dimensions, HiTOP dimensions (internalizing, externalizing‐antisocial, antagonism, detachment, psychoticism), and positive adjustment. In general, SEM analyses showed that higher LPF scores were associated with increased psychopathology and reduced well‐being. The three subscales demonstrated specific links to distinct psychopathological outcomes, thereby supporting the construct validity of the DLOPFQ‐SF. Despite the removal of the Self‐Direction scale, the instrument proved useful in capturing key aspects of LPF across self and interpersonal domains, reinforcing its relevance within a dimensional model of psychopathology.