Level Of Personality Functioning Scale Research Articles

Integrating personality functioning in brief psychotherapy for substance use disorders: a case study

A large treatment gap exists for substance use disorders (SUDs) in India. Among other factors, personality vulnerabilities are widely implicated in the initiation and maintenance of SUDs leading to poor outcomes. Available brief interventions do not adequately address this. Longer term therapies are resource intensive and therefore difficult to incorporate in tertiary care settings due to poor treatment provider-patient ratio. Further, trait-based and categorical models have limited application in brief psychotherapies. Core pathology seen across personality disorders such as the impairments in self and interpersonal functioning present as modifiable characteristic adaptations of more stable personality structures. Therefore, the present article attempts to explore the possibility of integrating the personality functioning model as proposed by the alternative model of personality disorders (AMPD) in the DSM-5, within brief psychotherapies for SUDs. Modifications to the routine treatment structure, assessment, formulation and content are suggested with a focus on personality functioning. The clinical utility of the level of personality functioning scale (LPFS) is also demonstrated using a brief case illustration. Further research is required to explore the feasibility and effectiveness of utilizing a personality functioning model among patients with SUDs in India.

Comparing the new concept of impairment in personality functioning with borderline personality disorder: differential psychosocial and psychopathological correlates in a clinical adolescent sample.

Borderline personality disorder (BPD) is an established diagnosis in adolescence with high comorbidity and psychosocial impairment. With the introduction of the alternative model for personality disorders in DSM-5 (AMPD), personality functioning is operationalized using the Level of Personality Functioning Scale (LPFS), which has been shown to be associated with severity of personality pathology. The present study aimed at examining differential psychopathological and psychosocial correlates of LPFS and BPD. A total of 526 adolescent in- and outpatients were interviewed with the STiP-5.1 (LPFS) and the SCID-II. Mixed linear regression was used to investigate the associations between the two interviews with measures of psychopathology and psychosocial impairment. 11.4% met the diagnostic threshold of both interviews, 16.1% only of the LPFS, and 64.1% were below the diagnostic threshold in both interviews (no PD). The BPD only group was larger than expected-8.4% of patients who met criteria for BPD did not fulfill criteria for significant impairment in the LPFS. The highest burden was found in individuals concurrently showing significant impairment in LPFS and fulfilling BPD diagnosis (LPFS + BPD). Differences between the LPFS only group and the BPD only group were found in risk behavior and traumatic experiences, with higher prevalence in the BPD group. Findings confirm the high psychopathological burden and psychosocial impairment associated with both BPD and LPFS. Those exceeding the diagnostic threshold of LPFS in combination with a BPD diagnosis are characterized by greatest disability. Not all adolescents fulfilling formal BPD diagnosis showed a clinically significant impairment in LPFS, which may refer to a distinct diagnostic group.

Personality disorders: the impact of severity on societal costs.

Personality disorders (PDs) are associated with high levels of societal costs. However, previous research has found limited or no evidence of unique contributions of individual PD categories on the overall level of societal costs. Recent research supports the validity of PD as a dimensional construct, and PD severity may be a better predictor of societal costs than specific PD categories. The aim of this study was to explore if PD severity could predict the level of societal costs among treatment-seeking patients with PDs, while controlling for the impact of comorbid mental health and substance use disorders. Four different severity indicators were explored: the number of PDs, the total number of PD criteria, the number of BPD criteria, and the Level of Personality Functioning Scale (LPFS) from the alternative model in DSM-5. Participants (n = 798/794) were retrieved from the quality register of the Norwegian Network for Personality Disorders for the period 2017-2020. Societal costs were assessed using a structured interview covering the six-month period prior to assessment. Diagnoses and diagnostic criteria were determined using a semi-structured diagnostic interview (SCID-5-PD and M.I.N.I), and the LPFS was assessed by the LPFS-Brief Form 2.0 (LPFS-BF 2.0) questionnaire. Statistics included multiple regression analyses. None of the severity indicators were significant predictors of overall societal costs among treatment-seeking patients, and effect sizes were small.

Interrater reliability of criterion A of the alternative model for personality disorder (Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition-Section III): A meta-analysis.

The alternative model for personality disorder (AMPD) is currently included in Section III of the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5). This review sought to summarize the literature concerning the interrater reliability (IRR) of the AMPD. Despite high heterogeneity, meta-analysis provided tentative support for the IRR of Criterion A of the AMPD, with pooled intraclass correlation coefficients (ICCs) for the Level of Personality Functioning Scale (LPFS) and its domains falling above DSM acceptability levels. Subgroup analysis of the LPFS suggested IRR scores could be improved by using a specific AMPD Structured Clinical Interview (SCI). Further research should in particular consider the IRR of Criterion B elements of the AMPD and overall PD diagnosis, where insufficient data were available to draw conclusions in the present study. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Associations between different measures of personality pathology and resting-state autonomic function among adolescents.

Borderline personality disorder (BPD) has been associated with a reduced functional flexibility of the autonomic nervous system (ANS), indexed by decreased vagally mediated heart rate variability (vmHRV). Employing a comprehensive Section II-based assessment approach and a partial Section III-based assessment approach (including Criterion A of the alternative model of personality disorders [AMPD]), the present study investigates how different conceptualizations of personality disorders (PDs) according to the Diagnostic and Statistical Manual for Mental Disorders, 5th edition relate to ANS function. Using the BPD section of the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II, a Section II-based assessment approach) and the Semistructured Interview for Personality Functioning DSM-5 (STiP-5.1, a Section III-based assessment approach), we conducted linear regression analyses to examine how categorical (BPD diagnosis) and dimensional (severity and domain) measures of PD are associated with ANS activity among adolescent psychiatric patients (N = 147, Mage = 15.25 years). Replicating earlier findings, analyses revealed a statistically significant positive association between the SCID-II measures of BPD and heart rate (HR), b = 0.43, t(59) = 3.57, p = .001, f = .57, as well as a statistically significant negative association between the SCID-II measures of BPD and vmHRV, b = -0.34, t(59) = -2.74, p = .008, f = .47. Neither the STiP-5.1 total score nor the subscales of the Level of Personality Functioning Scale (LPFS) were associated with HR or vmHRV. The present findings indicate that the SCID-II may capture features of PD that are more informative of variance in physiological function than the STiP-5.1. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Utility of the Level of Personality Functioning Scale in Maternal Samples: A Brief Report

Maternal personality plays a role in how a mother parents her children and adolescents. Current trait-based measures of personality are acceptable for use in maternal samples, but the presence or absence of given personality traits might not be enough to describe how personality relates to parenting. The Level of Personality Functioning Scale (LPFS) could serve as a solution, as it was designed to capture level of dysfunction in personality without being reliant on specific personality traits. Research, however, has yet to demonstrate the LPFS as a useful measure of personality in maternal samples, thus the goal of this study. A sample of 123 mothers reported on behavioral problems in their adolescent-aged children and their own personality using both a trait-based measure and the LPFS. Our data showed that maternal reports on the LPFS were associated with maternal perceptions of adolescent behavioral problems, in addition to being an acceptable measure of personality in our maternal sample. We also provide support for incremental validity of the LPFS in our sample, as the LPFS uniquely predicted maternal perceptions of adolescent behavioral problems even after controlling for maternal personality traits. Our results are discussed in light of the limitations of the extant work on maternal personality and add to the literature by demonstrating that the LPFS is an acceptable and ubiquitous measure of personality in maternal samples.

Investigation of the role of personality traits and emotion regulation on personality functioning in patients with depression/anxiety disorder.

The relationship between the dimensional assessment of personality and difficulties in emotion regulation has yet to be made clear. The present study aimed to investigate the role of personality traits and emotion regulation on personality functioning. Difficulties in Emotion Regulation Scale (DERS), Beck Anxiety Inventory, Beck Depression Inventory, Personality Inventory for DSM-5 (PID-5) and Level of Personality Functioning Scale (LPFS) were rated for 220 patients with depression and/or anxiety disorder diagnosis and 100 healthy controls. Stepwise regression analyses (SRA) were used to find potential predictors of personality functioning, and generalized linear analyses (GLA) were used to find mediators between the traits and personality functioning. SRA results in the clinical group showed that higher depression, antagonism, difficulties in impulse control and difficulties in awareness predicted higher levels of dysfunction in personality. According to GLA results in the clinical group, the impulse subscale of DERS partially mediated the relationship between antagonism and level of impairment in personality functioning. Our results indicate that certain emotion regulation styles and personality traits play an important role in predicting personality functioning in the clinical sample of depression and anxiety patients. Future studies should focus on specific emotion dysregulation strategies and broaden the dimensional personality literature in different samples.

Multinational evaluation of the measurement invariance of the Level of Personality Functioning Scale-brief form 2.0: Comparison of student and community samples across seven countries.

The Diagnostic and Statistical Manual of Mental Disorders-fifth Edition's (DSM-5) Level of Personality Functioning Scale (LPFS) was introduced as a dimensional rating of impairments in self- and interpersonal functioning, and the LPFS-Brief Form (LPFS-BF) was the first published corresponding self-report. The updated LPFS-BF 2.0 has been translated into several languages and international research supports many of the instrument's psychometric properties; however, its measurement invariance has only been evaluated across a few countries. This study expands previous studies as an introductory step in a global evaluation of the LPFS-BF 2.0s measurement invariance. Archival data (N = 5,618, 57% female) from seven countries (Canada, Chile, Denmark, Germany, Italy, United Arab Emirates, United States of America) were used for this study. Participants were recruited from both community (n = 4,677) and student (n = 941) populations. After confirming adequate model fit separately in the community and student samples, we evaluated a series of increasingly stringent model comparisons to test three aspects of measurement invariance (configural, metric, scalar) and then examined latent mean differences across countries. Full scalar invariance was supported in the community sample and partial scalar invariance was supported in the student sample. Evaluation of latent mean differences revealed multiple significant differences. Overall, the LPFS-BF 2.0 appears to assess self- and interpersonal functioning impairment similarly across the included countries. Findings are discussed through the lenses of the cultures from which participants were recruited, as well as in the context of alternative explanations. Limitations, plans for future research, and implications for both research and clinical practice are offered. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Criterion A: Level of personality functioning in the alternative DSM-5 model for personality disorders.

Criterion A, as represented by Level of Personality Functioning (LPF), offers a means by which to conceptualize the core impairment in self and interpersonal functioning that distinguishes personality disorder (PD) from other forms of psychopathology. One of the most widely cited criticisms of the current Section II in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition categorical diagnostic system is the high level of comorbidity among the categorical PD diagnoses. The Section III alternative Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition model for PDs (AMPD) addresses this problem by assessing the commonalities of the PDs using a single severity continuum, represented in the AMPD by the Level of Personality Functioning Scale (LPFS), which comprises both self and interpersonal pathology. Since its initial introduction, the LPFS has generated an expansive literature base and has also seen significant advancements in its measurement, including both semistructured and self-report methods. Such studies have generally demonstrated that the LPFS can be rated reliably, across both experienced and inexperienced raters, and demonstrates strong validity as evidenced by associations with relevant criterion variables and demonstrations of predictive and clinical utility. This review offers a brief history of the conceptualization and development of Criterion A and the LPFS, describes the major advancements in its measurement, and provides a summary of the status of the empirical literature regarding Criterion A's structure, reliability, and validity. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Is the alternative model for personality disorders able to capture avoidant personality disorder according to Section II of the DSM-5? A systematic review.

This review aims at examining the continuity between the categorical model for personality disorders (PDs) as defined by Section II of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and the alternative model for personality disorders (AMPD) with respect to Section II avoidant personality disorder (AvPD). Because the Criterion A of the AMPD, that is, the Level of Personality Functioning Scale (LPFS), is a prerequisite for a PD diagnosis, only studies assessing the LPFS were included, whether or not the Criterion B, that is, pathological personality traits, were assessed as well. A total of 13 studies met the inclusion criteria, with 6 studies comprising community/undergraduate samples and 7 studies comprising clinical samples. Weighted correlation between global LPFS and AvPD was .39 (rw = .55 for community/undergraduate studies; rw =.17 for clinical studies). When AvPD-specific impairment was evaluated, that is, impairment of personality functioning characterizing AvPD in the AMPD, correlations were substantially larger. In studies using regression analyses, the Criterion B appeared to have incremental utility in predicting the presence of Section II AvPD. To capture Section II AvPD in a sufficient degree by the AMPD, it might be necessary to use an AvPD-specific impairment questionnaire. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

How Much Training Do We Need? Assessing the Validity and Interrater Reliability of the PDM-2’s Psychodiagnostic Chart among Less Experienced Clinicians

The Psychodynamic Diagnostic Manual – Second Edition (PDM-2) has emerging evidence supporting its clinical utility, yet one of the main limitations remains the conjecture that considerable training and experience is required. It also remains unclear how the PDM-2 framework compares with current DSM measures of personality pathology such as the Level of Personality Functioning Scale (LPFS). The aim of the present study is to examine these issues by testing whether less clinically experienced second year doctoral psychology students are able to reliably assess patients’ level of personality pathology using the PDM-2’s Psychodiagnostic Chart (PDC-2), and to investigate the convergence between the PDC-2 and the LPFS. Results showed adequate inter-rater reliability for both of the main PDC-2 axes, with 52% of the variance for the overall personality organization (P-Axis) rating, and 29% of the overall M-Axis score being due to rater consensus. Reliability of individual ratings ranged from fair to excellent for the overall scores on both axes (ICC = 0.59 to .90). Results also showed that student evaluations were valid, with the latter’s assessment of the patients’ level of personality organization converging both with the experts’ rating of the PDC-2 as well as the LPFS. Implications for clinical training are discussed.

Trading Patients: Applying the Alternative Model for Personality Disorders to Two Cases of DSM-5 Borderline Personality Disorder Over Time and Across Therapists.

The DSM-5 Alternative Model for Personality Disorders (AMPD) dimensionally defines personality pathology using severity of dysfunction and maladaptive style. As the empirical literature on the clinical utility of the AMPD grows, there is a need to examine changes in diagnostic profiles and personality expression in treatment over time. Assessing these changes in individuals diagnosed with borderline personality disorder (BPD) is complicated by the tendency for patients to cycle through multiple therapists over the course of treatment leaving the potential for muddled diagnostic clarity and disjointed case conceptualizations. Following patient trajectories across therapists offers a unique opportunity to examine the AMPD’s sensitivity to and utility for capturing personality stability and change over time for patients with BPD. This article demonstrates the utility of the AMPD for two clinical cases in three distinct ways: (i) highlighting heterogeneity in BPD between patients, (ii) comparing improvements in personality severity and style over time, and (iii) elucidating profile change across therapist ratings. We present two patients diagnosed with DSM-5 Section II BPD, crossing between two therapists over the course of 3 years of psychodynamic psychotherapy. Treating clinicians rated patients for their respective treatment phases using the Level of Personality Functioning Scale (LPFS), capturing severity, and the Personality Inventory for the DSM-5 (PID-5), capturing style. AMPD diagnostic profiles differentiated patients with BPD in both severity and style, and captured within-patient change beyond within-therapist response bias. Results indicated greater improvements in personality severity while personality style remained more stable. Implications for the patients’ treatment progress and associated challenges are discussed, as are considerations for the utility of the AMPD in therapy.

The Incremental Utility of Criteria A and B of the DSM-5 Alternative Model for Personality Disorders for Predicting DSM-IV/DSM-5 Section II Personality Disorders

The DSM-5 Alternative Model for Personality Disorders (AMPD) includes two main criteria: moderate or greater impairment in personality functioning (Criterion A) and the presence of one or more pathological personality traits (Criterion B). The aim of the study was to investigate the incremental utility of Criteria A and B for predicting DSM-5 Section II personality disorders (PD). The sample (N = 317) consisted of three well-defined groups: non-clinical participants (n = 35), psychiatric patients with PD (n = 193), and without PD (n = 83). All were assessed using the Structured Clinical Interview for the DSM-5 Alternative Model for Personality Disorders Module I (SCID-5-AMPD-I): Level of Personality Functioning Scale (LPFS), and the Personality Inventory for DSM-5 (PID-5). Logistic regression analyses showed that the SCID-5-AMPD-I could predict the presence of PDs in general, and the three specific PDs that were investigated (i.e., Antisocial, Borderline, and Avoidant PDs). The PID-5 domains enhanced prediction of the specific PDs, but not the presence of PDs in general, when entered in the second step. Our results support the AMPD model: Criterion A predicted the presence of DSM-5 Section II PDs in general, whereas measures of Criterion B incremented prediction of Antisocial, Borderline, and Avoidant PDs.

Dimensional Model of Personality Disorder Incorporated Into ICD-11

Dimensional Model of Personality Disorder Incorporated Into ICD-11

Assessment of personality functioning in ICD-11 posttraumatic stress disorder and complex posttraumatic stress disorder.

The newly added diagnosis complex posttraumatic stress disorder (CPTSD) in the 11th edition of the International Classification of Diseases (ICD-11) includes a domain of disturbances in self-organization (DSO), in addition to PTSD. The DSO construct appears to have definitional overlap with the dimensional personality pathology severity measure, personality functioning. This study investigated the association between personality functioning and ICD-11 CPTSD, and the associations between DSO clusters and personality functioning domains. The sample comprised 83 outpatients with ICD-11 PTSD or CPTSD. Personality functioning was operationalized with the Level of Personality Functioning Scale (LPFS) and assessed with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Alternative Model for Personality Disorders, Module I. Results showed an average level of moderate impairment in personality functioning (i.e., Identity, Self-Direction, Empathy, and Intimacy) for the whole sample. However, the levels of impairment in personality functioning were significantly more severe in patients with ICD-11 CPTSD, compared with patients with PTSD. Furthermore, the results revealed strong significant positive associations between the personality functioning domains and the DSO symptom clusters, except for the LPFS Identity domain and the DSO Affective Dysregulation cluster. Contrary to expectations, we found a significant positive association between the PTSD symptom cluster Avoidance and the LPFS domains Identity, Self-Direction, and Intimacy. Furthermore, higher levels of impairment in the Identity and Intimacy domain were associated with an increase in DSO symptom severity. New development in assessment of personality functioning may assist clinicians in differential diagnosis of PTSD and CPTSD. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Examining the Structure and Validity of Self-Report Measures of DSM-5 Alternative Model for Personality Disorders Criterion A.

The Level of Personality Functioning Scale (LPFS) operationalizes Criterion A of the DSM-5 Alternative Model for Personality Disorders. Despite progress in LPFS measurement development and validation, there is a lack of research, and some disagreement, concerning structural, convergent, and incremental validity of LPFS self-report measures. The present study aimed to compare the LPFS Self-Report, LPFS Self-Report of Criterion A, and LPFS Brief Form. Internal structure was assessed through principal component analyses, factor analyses, and bifactor analyses of unidimensionality. Associations with both pathological and basic personality characteristics among the LPFS measures were explored. Incremental validity of LPFS severity in predicting pathological personality outcomes controlling for basic personality traits, and the reverse, were examined. Results suggest a unidimensional structure robustly associated with other pathological personality assessments. LPFS severity and basic personality traits mutually offered unique explanatory power. We discuss the implications of assessing personality pathology using LPFS self-report measures.

Assessing Criterion A in adolescents using the Semistructured Interview for Personality Functioning DSM–5.

Accumulating evidence supports the reliability and validity of the diagnosis of personality disorders (PDs) in adolescents, but whether the current Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), criteria are optimal to capture and help detect emerging PDs in this age-group remains controversial. The Level of Personality Functioning Scale (LPFS), included in the alternative model for personality disorders, may provide a more developmentally sensitive way to identify impaired personality features in young people. This study investigates the feasibility of the LPFS in adolescents by examining the psychometric properties of the Semistructured Interview for Personality Functioning DSM-5 in a clinical sample of referred adolescents (N = 84) and in a community sample (N = 12). Additionally, referred adolescents completed self-report questionnaires pertaining to symptom severity, personality functioning, and personality traits. In general, good interrater reliability and internal consistency were observed, and the associations with external variables largely followed theoretical prediction. Interestingly, and in contrast to data on adults, we found no significant associations between the LPFS scores on the one hand and traditional DSM-5 PD diagnoses in the clinical sample on the other (except for borderline PD criteria). In discussing these findings, we argue that the assessment of personality functioning may be better suited for detecting personality pathology in adolescence than the traditional Section II criteria. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Development and initial evaluation of the ICD-11 personality disorder severity scale: PDS-ICD-11.

No measure has formally been developed to assess the published ICD-11 model of Personality Disorder (PD) severity. We therefore set out to develop and evaluate the 14-item Personality Disorder Severity ICD-11 (PDS-ICD-11) scale. A representative U.S. community sample (N = 428; 50.9% women) and a New Zealand mental health sample (N = 87; 61.5% women) completed the PDS-ICD-11 scale along with a series of established PD and impairment measures. Item response theory supported the unidimensionality of PDS-ICD-11 (median item loading of 0.68) and indicated that a PDS-ICD-11 score of 17.5 may serve as a benchmark for pronounced dysfunction. Correlation and regression analyses supported both criterion validity and incremental validity in predicting impairment and PD symptoms. The PDS-ICD-11 was particularly associated with measures of Level of Personality Functioning Scale (LPFS), Global PD severity, and Borderline PD symptom score. A comparison between clinical individuals diagnosed with an ICD-11 PD vs. no PD supported diagnostic validity. This initial construction study suggests that the PDS-ICD-11 constitutes a promising instrument that provides a quick impression of the severity of personality dysfunction according to the official ICD-11 PD guidelines. Clearly, more research is needed to corroborate its validity and utility. The PDS-ICD-11 scale is provided as online supporting information.

How does level of personality functioning inform clinical management and treatment? Implications for ICD-11 classification of personality disorder severity.

The International Classification of Diseases, 11th Edition (ICD-11) classifies personality disturbance according to levels of severity. This article reviews the literature on levels of personality functioning in relation to clinical management and treatment, and proposes how these findings apply to the ICD-11 classification of personality disorders. Findings were primarily derived from studies using the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) Level of Personality Functioning Scale (LPFS), Kernberg's Level of Personality Organization, and the general P-factor of personality disorder. Severity of personality dysfunction is related to treatment outcome, risk of dropout, therapeutic alliance, readiness for treatment, risk of harm to self or others, risk of dissociation and psychotic-like breaks, coherence in narrative identity, reflective functioning, and epistemic trust. The overall level of personality disorder severity indicates risk of negative outcomes and may be used as decision tool for 'personalized medicine' and required treatment intensity (e.g., strength of alliance and the need for establishing epistemic trust). Beyond the ICD-11 guidelines for determining personality disorder severity, these implications also apply to practitioners using comparable frameworks such as the DSM-5 LPFS and Kernberg's Level of Personality Organization. Future research should focus on the interaction of severity with trait qualifiers in relation to clinical management.

A Psychometric Analysis of the Structured Clinical Interview for the DSM-5 Alternative Model for Personality Disorders Module I (SCID-5-AMPD-I): Level of Personality Functioning Scale.

The current study aims to examine the psychometric properties of the Structured Clinical Interview for the DSM-5 Alternative Model for Personality Disorders Module I (SCID-5-AMPD-I) assessing the Level of Personality Functioning Scale (LPFS) in a heterogeneous sample of 282 nonpsychotic patients. Latent variable models were used to investigate the dimensionality of the LPFS. The results indicate that the LPFS, as assessed by the SCID-5-AMPD-I, can be considered as a unidimensional construct that can be measured reliably across a wide range of the latent trait. Threshold parameters for the 12 indicators of the LPFS increased gradually over the latent scale, indicating that the five LPFS levels were ordered as predicted by the model. In general, the increase of threshold parameters was relatively small for the shift from Level 2 to Level 3. A better distinction among the different severity levels might be obtained by fine-tuning the interview guidelines or the Level 2 indicators themselves.