Level Of Personality Functioning Scale Research Articles

The Test-Retest Reliability of Heart Rate Variability and Its Association With Personality Functioning.

Background: Heart rate variability (HRV) is a widely used non-invasive index of emotion regulation ability. The main aim of our study was to investigate the relationship between HRV and level of personality functioning in a clinical sample, most of whom had a personality disorder. Our secondary aim was to examine the test-retest reliability of HRV in our sample as there is a lack of knowledge regarding the test-retest reliability in psychiatric populations. We hypothesized that trait HRV would be negatively associated with impairments of personality functioning.Method: Thirty-two adults (23 females, mean age = 27) with threshold or subthreshold personality disorders were recruited from two psychiatric outpatient clinics in Norway. Impairment of personality functioning was assessed by the first module of the Structured Clinical Interview for the DSM-5 Alternative Model for Personality Disorders (SCID-5-AMPD-I); Level of Personality Functioning Scale (LPFS). HRV was assessed during resting conditions with spontaneous breathing over three separate days. Trait HRV was calculated by averaging all three HRV assessments. The test-retest reliability of HRV was assessed using intraclass correlations.Results: Contrary to expected, a positive association between trait HRV and the LPFS Self-direction domain emerged. This was driven by positive associations between the LPFS and HRV at time point 2. Overall, the test-retest reliability of HRV was comparable to previous studies on healthy subjects. However, the reliability coefficients for the first two time points were considerably lower relative to the second and third time points.Conclusions: We propose that impairment of personality functioning may have increased the proportion of variance in HRV attributed to state relative to trait. This could explain the lower test-retest reliability for the first two time points. The increased test-retest reliability for the last two time points could reflect a habituation to the testing situation and hence, less pronounced influences of state in the second and third time points.

Mentalization and criterion a of the alternative model for personality disorders: Results from a clinical and nonclinical sample.

Criterion A of the alternative model for the classification of personality disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), introduced the Level of Personality Functioning Scale (LPFS), a dimensional model for the assessment of impairments in self and interpersonal functioning. The LPFS was developed based on a review of different measures of personality functioning, such as the Reflective Functioning Scale, a measure of mentalizing. This study investigated the empirical overlap between the LPFS and mentalization. The study sample included adult inpatients (n = 55) with a mental disorder and a healthy adult control group (n = 55). All participants were examined regarding the LPFS using the Semistructured Interview for Personality Functioning DSM-5; mentalizing was assessed with the Brief Reflective Functioning Interview and coded with the Reflective Functioning Scale. We used structural equation modeling to investigate the relationship between LPFS domains and mentalization. Correlation analysis was used to examine the agreement between interview-rated LPFS and self-report measures of personality dysfunction. All domains of the LPFS were significantly related to mentalizing. Interview-rated LPFS was significantly associated with self-reported personality dysfunction. The findings support the notion that the LPFS and mentalization share a strong conceptual and operational overlap by demonstrating that both constructs are empirically interrelated. The results yield further support for the validity of the LPFS as a dimensional model for the assessment of personality disorder severity. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The Level of Personality Functioning Scale Applied to Clinical Material From the Structured Interview of Personality Organization (STIPO): Utility in Detecting Personality Pathology.

The Alternative Model for Personality Disorders states that personality pathology involves significant impairment in personality functioning that can be assessed using the Level of Personality Functioning Scale (LPFS). However, the ability of the LPFS to capture impairments typical of personality pathology, rather than of general psychopathology, is still unclear. The authors applied a 12-item version of the LPFS to clinical interviews (i.e., the Structured Interview of Personality Organization [STIPO]) to test whether differences in levels of impairment in domains related to both self- and interpersonal functioning can be detected among patients with personality disorders (n = 33), psychiatric outpatients (n = 30), and nonclinical controls (n = 30). Results show that the 12-item version of the LPFS scored using clinical material gathered through STIPO interviews captures impairments in identity, self-direction, and empathy uniquely linked to personality pathology. However, impairments in intimacy do not differentiate between patients with and without personality disorders.

Borderline personality disorder diagnosis in a new key

BackgroundConceptualizations of personality disorders (PD) are increasingly moving towards dimensional approaches. The definition and assessment of borderline personality disorder (BPD) in regard to changes in nosology are of great importance to theory and practice as well as consumers. We studied empirical connections between the traditional DSM-5 diagnostic criteria for BPD and Criteria A and B of the Alternative Model for Personality Disorders (AMPD).MethodRaters of varied professional backgrounds possessing substantial knowledge of PDs (N = 20) characterized BPD criteria with the four domains of the Level of Personality Functioning Scale (LPFS) and 25 pathological personality trait facets. Mean AMPD values of each BPD criterion were used to support a nosological cross-walk of the individual BPD criteria and study various combinations of BPD criteria in their AMPD translation. The grand mean AMPD profile generated from the experts was compared to published BPD prototypes that used AMPD trait ratings and the DSM-5-III hybrid categorical-dimensional algorithm for BPD. Divergent comparisons with DSM-5-III algorithms for other PDs and other published PD prototypes were also examined.ResultsInter-rater reliability analyses showed generally robust agreement. The AMPD profile for BPD criteria rated by individual BPD criteria was not isomorphic with whole-person ratings of BPD, although they were highly correlated. Various AMPD profiles for BPD were generated from theoretically relevant but differing configurations of BPD criteria. These AMPD profiles were highly correlated and showed meaningful divergence from non-BPD DSM-5-III algorithms and other PD prototypes.ConclusionsResults show that traditional DSM BPD diagnosis reflects a common core of PD severity, largely composed of LPFS and the pathological traits of anxiousness, depressively, emotional lability, and impulsivity. Results confirm the traditional DSM criterion-based BPD diagnosis can be reliably cross-walked with the full AMPD scheme, and both approaches share substantial construct overlap. This relative equivalence suggests the vast clinical and research literatures associated with BPD may be brought forward with DSM-5-III diagnosis of BPD.

Evaluation of Diagnostic Thresholds for Criterion A in the Alternative DSM-5 Model for Personality Disorders.

The Level of Personality Functioning Scale (LPFS) of the Alternative DSM-5 Model for Personality Disorders (AMPD) was formulated to assess the presence and severity of personality disorders (PDs). Moderate impairment (Level 2) in personality functioning, as measured by the LPFS, was incorporated into the AMPD as a diagnostic threshold for PD in Criterion A of the general criteria, as well as for the "any two areas present" rule for assigning a specific PD diagnosis. This study represents the first evaluation of the diagnostic decision rules for Criterion A, in a clinical sample (N = 282). The results indicate that an overall diagnostic threshold for PDs should be used with caution because it may not identify all DSM-IV PDs. The "any two areas present" rule proved to be a reasonable alternative, although this finding should be interpreted with caution because the LPFS does not measure the disorder-specific A criteria.

Examining criterion a: DSM-5 level of personality functioning as assessed through life story interviews.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition alternative model for personality disorders offers a two-part definition of personality pathology, separating personality functioning from traits. The Level of Personality Functioning Scale (LPFS) from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition alternative model for personality disorders encapsulates the personality functioning criterion, and several methods have been used to assess it. Previous interview rating methods have overlapped with an assessment of personality traits and symptoms, biasing the assessment of functioning, and recently developed self-report instruments rely on the participant's awareness of their personality pathology. The purpose of the current analyses was to examine the reliability and validity of LPFS ratings based on open-ended, nondiagnostic interviews. The sample consisted of 162 community-dwelling, older adult participants from the St. Louis Personality and Aging Network. Undergraduate students rated video recordings of Life Story Interviews, using a 12-item version of the LPFS. One-way random, average measures intraclass correlation coefficient for the total LPFS was .80. A principal components analysis indicated that a single underlying dimension could characterize the LPFS. Component scores derived from this analysis demonstrated theoretically consistent associations with both normal-range and maladaptive personality traits. The component scores also contributed small but significant variance to the prediction of personality disorder symptoms, health, and functional outcomes over and above personality traits. These findings support the reliability and validity of the LPFS as assessed using Life Story Interviews and suggest that personality functioning ratings may have utility in predicting clinically relevant outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Comparison of the Structured DSM–5 Clinical Interview for the Level of Personality Functioning Scale With the Structured Interview of Personality Organization

In Section III of DSM–5, the Level of Personality Functioning Scale (LPFS), a component of the DSM–5 Alternative Model for Personality Disorders (AMPD), offers a dimensional approach to the assessment of personality pathology. Similar to the psychoanalytic concept of personality organization developed by Kernberg (1984), personality disorders are assessed not only by categorical diagnoses, but also by measuring impairment of personality functioning. In this study we empirically investigate the convergence between two instruments examining personality functioning, the Structured Clinical Interview for the DSM–5 Alternative Model for Personality Disorders Module I (SCID-AMPD) and the Structured Interview of Personality Organization (STIPO). For this goal, correlations between both the overall scores of the two instruments as well as between the corresponding domain scale scores were examined. In addition, the relationship between interview ratings and clinical criteria quantifying the severity of the disorder (suicide attempts, frequency of psychiatric hospitalization, ICD–10 diagnoses) were analyzed. Based on videotaped assessments of 30 psychotherapeutic in- and outpatients with both instruments, significant correlations between overall scores and domain scales of the two interviews were found. Moreover, the ratings from both interviews showed high correlations with criteria of clinical severity.

Introduction to the Special Series on the Personality Functioning Component of the Alternative DSM–5 Model for Personality Disorders

The Alternative DSM–5 Model for Personality Disorders (AMPD; American Psychiatric Association, 2013) was created to remedy the previously well-explicated limitations of the categorical DSM–IV personality disorders. The AMPD combines dimensional assessments of personality functioning (Criterion A) and traits (Criterion B), which can be used independently or together, and serve as the basis for defining six categorical disorder options. The Criterion A Level of Personality Functioning Scale (LPFS) defines a continuum characterized by the four elements of identity, self-direction, empathy, and intimacy. Empirical work related to the LPFS has been growing, and this Journal of Personality Assessment special series features reports from a variety of research groups around the world. These studies provide contributions for better understanding the reliability, validity, and utility of the LPFS, as well as describing new measures that have been created to investigate personality functioning.

Interrater Reliability of the Structured Clinical Interview for the DSM–5 Alternative Model of Personality Disorders Module i: Level of Personality Functioning Scale

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) presents an alternative model for personality disorders in which severity of personality pathology is evaluated by the Level of Personality Functioning Scale (LPFS). The Structured Interview for the DSM–5 Alternative Model for Personality Disorders, Module I (SCID–5–AMPD I) is a new tool for LPFS assessment, but its interrater reliability (IRR) has not yet been tested. Here we examined the reliability of the Norwegian translation of the SCID–5–AMPD I, applying two different designs: IRR assessment based on ratings of 17 video-recorded SCID–5–AMPD I interviews by five raters; and test–retest IRR based on interviews of 33 patients administered by two different raters within a short interval. For the video-based investigation, intraclass correlation coefficient (ICC) values ranged from .77 to .94 for subdomains, .89 to .95 for domains, and .96 for total LPFS. For the test–retest investigation, ICC ranged from .24 to .72 for subdomains, .59 to .90 for domains, and .75 for total LPFS. The test–retest study revealed questionable reliability estimates for some subdomains. However, overall the level of personality functioning was measured with a sufficient degree of IRR when assessed by the SCID–5–AMPD I.

Expanding the Validity of the Level of Personality Functioning Scale Observer Report and Self-Report Versions Across Psychodynamic and Interpersonal Paradigms

ABSTRACTThe Level of Personality Functioning Scale (LPFS) operationalizes Criterion A of the DSM–5 alternative model for personality disorders. Yet, research on this measure has been slow to accumulate and questions remain regarding its reliability and validity. This study examined the LPFS observer-rated (OR) and self-report (SRA) versions of Criterion A in a sample of 240 students who provided psychological life history data and a variety of self-report measures. The results suggested the LPFS OR could be reliably coded, and the LPFS OR and LPFS SRA were significantly associated with outcome variables across psychodynamic and interpersonal paradigms. We discuss the implications of assessing personality dysfunction using the LPFS and the importance of expanding the research base for the AMPD model.

Examining the Interpersonal Nature of Criterion A of the DSM–5 Section III Alternative Model for Personality Disorders Using Bootstrapped Confidence Intervals for the Interpersonal Circumplex

ABSTRACTCriterion A of the alternative model of personality disorders (AMPD) involves the assessment of impairments in self and self in relation to other functioning and can be assessed using the Level of Personality Functioning Scale (LPFS). This study uses responses to a self-report version of the LPFS (AMPD–CAS) from 248 college students to examine the interpersonal implications of AMPD personality impairments using the interpersonal circumplex (IPC) as a nomological net. Results suggest that AMPD–CAS self-impairments are related to problems of low communion and interpersonal distress and do not appear to tap expected interpersonal problems of low agency. Additionally, AMPD–CAS identity is specifically associated with sensitivity to control, suggesting that individuals with diffuse identity find it aversive and intrusive when others take the lead. AMPD–CAS self in relation to other impairments are related to being too argumentative and suspicious of others, having difficulty connecting and caring for others, and finding others' affection and reliance aversive. Both self and self in relation to other AMPD–CAS impairments are related to interpersonal distress and misanthropy, suggesting they tap pathological aspects of personality functioning. These findings represent a first step toward fully examining the interpersonal nature of Criterion A impairments and provides preliminary evidence for the construct validity of AMPD–CAS scores.

Using the Structured Interview of Personality Organization for DSM–5 Level of Personality Functioning Rating Performed by Inexperienced Raters

ABSTRACTWe argue that clinical information related to an object-relations model of personality pathology can be used by untrained and clinically inexperienced students to rate personality-disordered patients on the Level of Personality Functioning Scale (LPFS). To do so, 73 clinically inexperienced undergraduate students were asked to assess personality functioning of 10 female inpatients using the LPFS from audio recordings of the Structured Interview of Personality Organization (STIPO). LPFS ratings showed acceptable interrater reliability. Moreover, LPFS ratings were significantly associated with external measures of severity of personality pathology (number of DSM–IV–TR personality disorders) as assessed by experienced clinicians. Finally, the students' ratings were also associated with the level of personality organization as measured by experienced clinicians using the STIPO. Our findings confirm that untrained raters can reliably assess personality pathology by rating the LPFS based on material from the STIPO. Implications related to the use of the STIPO as a tool for the assessment of personality pathology according to the DSM–5 Alternative model are discussed.

Effects of personality functioning on the global functioning of patients with bipolar disorder I

Due to the comorbidity of personality traits or disorders and BD, the present study investigated the extent to which the global functioning of patients with BD would be affected by personality functioning. This study included 100 subsequent patients who had been diagnosed with BD-I, and were in the remission phase. Global functioning was assessed with the Bipolar Disorder Functioning Questionnaire (BDFQ) and the Level of Personality Functioning Scale (LPFS) was conducted following psychodynamic-oriented semi-structured interviews to assess the level of personality functioning. Hierarchical linear regression models were conducted. After controlling other variables, the predictability of LPFS components on global functionality was assessed. Global functioning was negatively correlated with subsyndromal depressive symptoms, the presence of a psychiatric comorbidity, alcohol/substance use disorders, the side effects of medication, poor social support, and an impaired level of personality functioning. Finally, a decrease in the level of personality functioning predicted impaired global functioning. The present study demonstrated that the level of personality functioning had a significant impact on global functioning during the euthymic period of BD. Therefore, the assessment of the level of personality functioning in patients with BD will aid in better understanding this population and in the design of long-term treatment plans.

Application of the DSM-5 Level of Personality Functioning Scale by Lay Raters.

One concern that has been expressed with the Alternative Model for Personality Disorders (AMPD) presented in DSM-5 is that the description of characteristic impairments in personality function uses concepts requiring considerable experience and clinical inference to apply. To examine this question, the individual indicators included in the AMPD's Level of Personality Functioning Scale (LPFS) that describes these core impairments were abstracted as individual items, and then rated on a target acquaintance by 194 undergraduate college students with minimal training in personality disorder and no training in the AMPD. Results indicated that the LPFS indicators were highly internally consistent as rated in this sample, and that the degree of discrimination between groups corresponded very well with the putative level of severity represented for each indicator in the LPFS. These findings support the contention that using the LPFS might not require any particular clinical experience or training.

Clinical utility of the DSM-5 alternative model of personality disorders: six cases from practice.

In Section III, Emerging Measures and Models, DSM-5 presents an Alternative Model of Personality Disorders, which is an empirically based model of personality pathology measured with the Level of Personality Functioning Scale (LPFS) and the Personality Inventory for DSM-5 (PID-5). These novel instruments assess level of personality impairment and pathological traits. Objective. A number of studies have supported the psychometric qualities of the LPFS and the PID-5, but the utility of these instruments in clinical assessment and treatment has not been extensively evaluated. The goal of this study was to evaluate the clinical utility of this alternative model of personality disorders. Method. We administered the LPFS and the PID-5 to psychiatric outpatients diagnosed with personality disorders and other nonpsychotic disorders. The personality profiles of six characteristic patients were inspected (involving a comparison of presenting problems, history, and diagnoses) and used to formulate treatment considerations. We also considered 6 specific personality disorder types that could be derived from the profiles as defined in the DSM-5 Section III criteria. Results. Using the LPFS and PID-5, we were able to characterize the 6 cases in a meaningful and useful manner with regard to understanding and treatment of the individual patient and to match the cases with 6 relevant personality disorder types. Implications for ease of use, communication, and psychotherapy are discussed. Conclusion. Our evaluation generally supported the utility for clinical purposes of the Alternative Model for Personality Disorders in Section III of the DSM-5, although it also identified some areas for refinement. (Journal of Psychiatric Practice 2015;21:3-25).

Assessing DSM–5 Level of Personality Functioning From Videotaped Clinical Interviews: A Pilot Study With Untrained and Clinically Inexperienced Students

Several authors have raised the concern that the DSM–5 Level of Personality Functioning Scale (LPFS) is relatively complex and theory laden, and thus might put high requirements on raters. We addressed this concern by having 22 untrained and clinically inexperienced students assess the personality functioning of 10 female psychotherapy inpatients from videotaped clinical interviews, using a multi-item version of the LPFS. Individual raters’ LPFS total scores showed acceptable interrater reliability, and were significantly associated with 2 distinct expert-rated measures of the severity of personality pathology. These findings suggest that, contrary to the previously mentioned concerns, successfully applying the LPFS to clinical cases might require neither extensive clinical experience nor training.

The role of identity in the DSM-5 classification of personality disorders.

In the revised Diagnostic and Statistical Manual DSM-5 the definition of personality disorder diagnoses has not been changed from that in the DSM-IV-TR. However, an alternative model for diagnosing personality disorders where the construct “identity” has been integrated as a central diagnostic criterion for personality disorders has been placed in section III of the manual. The alternative model’s hybrid nature leads to the simultaneous use of diagnoses and the newly developed “Level of Personality Functioning-Scale” (a dimensional tool to define the severity of the disorder). Pathological personality traits are assessed in five broad domains which are divided into 25 trait facets. With this dimensional approach, the new classification system gives, both clinicians and researchers, the opportunity to describe the patient in much more detail than previously possible. The relevance of identity problems in assessing and understanding personality pathology is illustrated using the new classification system applied in two case examples of adolescents with a severe personality disorder.