Classification Of Personality Disorders Research Articles

Clinical utility of the alternative model of personality disorders: A 10th year anniversary review.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5) alternative model of personality disorders (AMPD) has now been available for researchers and clinicians for a decade. The present article aims to provide a narrative review of literature on the AMPD framework with particular emphasis on its clinical utility, inclusive of clinicians' and patients' acceptability, ease of use, diagnostic accuracy, continuity with clinically familiar constructs, and proposed utility for treatment planning, case-formulation, and clinical management. The review specifically covers the utility of Criterion A (i.e., Level of Personality Functioning Scale) and Criterion B (i.e., maladaptive personality traits) in relation to common disorders of personality. By drawing on empirical studies, surveys, clinical cases, and recommendations, the current review points to various aspects of clinical utility as well as areas for improvement. One way of increasing the AMPD's feasibility for clinicians is to omit the transitional personality disorder (PD) hybrid types while retaining a purer diagnostic classification of PD severity and traits that also align with the International Classification of Diseases, Eleventh Revision (ICD-11), PD classification. This would allow for a more efficient assessment for busy practitioners working in general psychiatry and primary care while retaining the possibility of a more fine-grained elaboration of the PD diagnosis in high-resource specialist settings. Such revision could possibly be introduced in DSM-5.1 or DSM-6. We also propose that future exploration of the AMPD's clinical utility may involve its potential value for allocation of clinical resources, communication between clinicians and their patients' relatives, and utility for informing different treatment modalities. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Opportunities and challenges of new classification systems for personality disorders: Commentary on "clinical utility of the AMPD: A 10th year anniversary review".

At the time of publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition alternative model of personality disorders, skepticism regarding the clinical utility of a dimensional conceptualization of personality disorders was high including questions about its feasibility for clinicians, its reliability, predictive value, and implications for science and treatment. Following huge research activities summarized by the article of Bach and Tracy (2022), there is meanwhile convincing evidence that a dimensional classification of personality disorders that meets with high utility for clinical decision-making is accepted by clinicians and meets with patients´ needs because it can be easily connected with treatment planning oriented at functional impairments rather than diagnostic categories. Being close to mechanistic models of psychopathology, the alternative model of personality disorders provides a suitable framework to converge self- and interpersonal dysfunctioning indicated in Criterion A with (sub-)domains of the Research Domain Criteria and Hierarchical Taxonomy of Psychopathology systems and, thus, to inspire research to better understand the psychological and neurobiological mechanisms of change. (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).

Sensitive, Indifferent or Labile: Psychopathy and Emotions in Finnish Forensic Psychiatry, 1900s–1960s

Abstract Psychopathy was one of the most common diagnoses in Finnish forensic psychiatric examinations between the 1910s and 1960s. Abnormal categories of emotions such as sensitivity, indifference and the tendency to shift among different emotions or lability, were among the principal symptoms of psychopathy. This paper describes and analyses the ways in which Finnish forensic psychiatrists between the 1900s and 1930s perceived and portrayed the emotions of individuals they considered to be psychopaths, and how abnormal categories of emotions persisted until the end of the 1960s. Psychopathic categories of emotions were defined along a spectrum ranging between the extremes of sensitivity and of coldness and included volatility, which entailed rapid mood swings. Displaying either or both extremes of emotion defined psychopathy. The unifying category of abnormal emotions disappeared when the diagnosis of psychopathy ceased to exist in 1969, when it was replaced by the diagnostic category of personality disorders.

A Literature Review of Diagnostic Applicability of ICD 11 Classification of Personality Disorders in Comparison with ICD 10

IntroductionPersonality disorders are frequently encountered by all healthcare professionals and can often pose a diagnostic dilemma due to the crossover of different traits amongst the various subtypes. The ICD 10 classification comprised of succinct parameters of the 10 subtypes of personality disorders but lacked a global approach to address the complexity of the disease. The ICD 11 classification provides a more structural approach to aid in clinical diagnosis.ObjectivesA literature review of the diagnostic applicability of ICD 11 classification of personality disorders is presented in comparison with the ICD 10 classification.MethodsA retrospective analysis of the literature outlining the ICD 10 and 11 classifications of personality disorders, exploring the differences in evidence-based applications of both.ResultsThe ICD 11 classification of personality disorders supersedes the ICD 10 classification in describing the severity of the personality dysfunction in conjunction with a wide range of trait domain qualifiers, thus enabling the clinician to portray the disease dynamically. The current evidence available on the utility of the ICD 11 classification gives a promising outlook for its application in clinical settings.ConclusionsThe ICD 11 has transformed the classification of personality disorders by projecting a dimensional description of personality functioning, aiming to overcome the diagnostic deficiencies in the ICD 10 classification. The versatility offered by the application of the ICD 11 classification can be pivotal in reshaping the focus and intensity of clinical management of the disease.DisclosureNo significant relationships.

Evaluation of the factor structure of the Russian version of PID-5-BF

IntroductionTraditional categorical classifications of personality disorders (PD) have been criticized for insufficient structural and cross-cultural validity. In the DSM-5 Section III, alternative model of the PDs (AMPD), the maladaptive personality traits are divided into five domains: negative affect, detachment, antagonism, disinhibition and psychoticism. The Personality Inventory for DSM-5 Brief Form (PID-5-BF) is a 25-item self-report questionnaire that measures the severity of each of these five domains. To date, no questionnaires assessing pathological personality traits following the AMPD have been validated in Russia.ObjectivesThis study aimed to investigate the factor structure of the Russian version of PID-5-BF.MethodsFive hundred and 86 (female - 505 (86,2%), age - 18–77 years (M - 28.2, SD - 11.5)) consecutive inpatients with non-psychotic mental disorders were assessed with the Russian language version of the PID-5-BF. Exploratory structural equation modelling (ESEM) with Robust Diagonally Weighted Least Squares method of extraction and Robust Equamax rotation was performed in Factor v 11.04.02.ResultsThe results of the ESEM analysis showed good fit of the five-factor model (CFI - 0.982; TLI - 0.971; RMSEA (95% CI) - 0.036 (0.01-0.05). Most of the items had the highest factor loadings on their mother domains. However, two items showed weak loadings on their designated factors (<0.4), and attention seeking item had a primary load to (low) detachment instead of antagonism.ConclusionsThe PID-5-BF was found to be a valid and reliable tool for the evaluation of the AMPD trait domainDisclosureNo significant relationships.

High convergent validity among the five-factor model, PID-5-SF, and PiCD.

In the last 10 years, 2 instruments (the Personality Inventory for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [PID-5] and the Personality Inventory for International Classification of Diseases, 11th Revision [PiCD]) have been developed to measure the dimensional approach to personality disorders (PDs). Several studies have analyzed the relationships between both instruments and the five-factor model, although the PiCD has received less attention than the PID-5, given its more recent publication. For instance, the PiCD has never been related to the Revised NEO Personality Inventory (NEO-PI-R). The aims of the present article were to explore the convergent validity of the NEO-PI-R, a short version of the PID-5 (PID-5-SF), and the PiCD, to compare these dimensional approaches as for their ability to predict categorical PDs measured through the screening questionnaire of the International Personality Disorder Examination and to explore the nature of 2 controversial pathological domains: Psychoticism (from the PID-5-SF) and Anankastia (from the PiCD). A total of 1,565 people from the Spanish general population completed the NEO-PI-R, PID-5-SF, and PiCD. A total of 758 also filled out the International Personality Disorder Examination. Results show a high convergent validity of the five-factor model, the PID-5-SF, and the PiCD. Especially relevant from a clinical perspective is the great convergence between the 2 measures of dimensional PDs. In light of the results, the personality correlates of Psychoticism are reconsidered, and the location of Anankastia as the opposite pole of Disinhibition instead of as a separate domain, suggested by previous authors, is supported. The advantages of a dimensional approach to PDs and the practical implications for their assessment are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Predicting smoking and nicotine dependence from the DSM-5 alternative model for personality pathology.

Individuals with personality disorders (PDs) have higher morbidity and mortality than the general population, which may be due to maladaptive health behaviors such as smoking. Previous studies have examined the links between categorical PD diagnoses/personality traits and smoking/nicotine dependence, but little is known about how the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition alternative model for personality disorders relates to smoking and nicotine dependence. The current study examined this question in a sample of 500 participants using the Levels of Personality Functioning Scale to assess general personality pathology, the Personality Inventory for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition to measure specific traits, the Fagerström test for Nicotine Dependence to assess nicotine dependence, and questions about current and past smoking to assess smoking status (i.e., current, former, never). Multinomial logistic regression results demonstrated that general personality pathology (Criterion A) was not related to smoking status, and there were no reliable associations between traits (Criterion B) and smoking status. However, correlations showed that higher negative affectivity and disinhibition were related to higher levels of nicotine dependence within smokers. Findings are discussed in regard to previous findings linking personality pathology to smoking/nicotine dependence as well as the general validity of this new personality disorder diagnostic system. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Supplemental Material for Changes in the Classification of Personality Disorders: Comparing the DSM–5 Section II Personality Disorder Model to the Alternative Model for Personality Disorders Using Structured Clinical Interviews

Supplemental Material for Changes in the Classification of Personality Disorders: Comparing the DSM–5 Section II Personality Disorder Model to the Alternative Model for Personality Disorders Using Structured Clinical Interviews

Dimensional Model of Personality Disorder Incorporated Into ICD-11

Dimensional Model of Personality Disorder Incorporated Into ICD-11

The role of migration processes and cultural factors in the classification of personality disorders.

Migrants and ethnic minorities are at risk of being under- and overdiagnosed with personality disorders (PDs). A culturally informed approach to the classification of PDs guides clinicians in incorporating migration processes and cultural factors, to arrive at a reliable and valid assessment of personality pathology. In this article, we provide a tentative framework to highlight specific interactions between personality disorders, migration processes, and cultural factors. It is argued that migration processes can merely resemble personality pathology, activate certain (latent) vulnerabilities, and aggravate pre-existing personality pathology. We propose that these migration processes can include manifestations of grief about the loss of pre-migratory psychosocial and economic resources, and the struggle to attain psychosocial and economic resources in the host culture. Moreover, several cultural dimensions are outlined that can either resemble or mask personality pathology. The term "culturally masked personality disorder" is coined, to delineate clinical cases in which cultural factors are overused or misused to rationalize behavioral patterns that are consistently inflexible, distressing, or harmful to the individual and/or significant others, lead to significant impairment, and exceed the relevant cultural norms. Additionally, the role of historical trauma is addressed in the context of potential overdiagnosis of personality disorders in Indigenous persons, and the implications of misdiagnosis in migrants, ethnic minorities, and Indigenous populations are elaborated. Finally, clinical implications are discussed, outlining various diagnostic steps, including an assessment of temperament/character, developmental history, systemic/family dynamics, migration processes, cultural dimensions, and possible historical trauma.

The Establishment of a Clinic for Personality Modulation in Iran: A Novel Approach in Personality Psychiatry with a Dimensional Approach

The Establishment of a Clinic for Personality Modulation in Iran: A Novel Approach in Personality Psychiatry with a Dimensional Approach

Towards a contemporary approach for understanding personality pathology in developmental context: An integrative model

AbstractTraditional categorical approaches to classifying personality disorders are limited in important ways, leading to a shift in the field to dimensional approaches to conceptualizing personality pathology. Different areas of psychology – personality, developmental, and psychopathology – can be leveraged to understand personality pathology by examining its structure, development, and underlying mechanisms. However, an integrative model that encompasses these distinct lines of inquiry has not yet been proposed. In order to address this gap, we review the latest evidence for dimensional classification of personality disorders based on structural models of maladaptive personality traits, provide an overview of developmental theories of pathological personality, and summarize the Research Domain Criteria (RDoC) initiative, which seeks to understand underlying mechanisms of psychopathology. We conclude by proposing an integrative model of personality pathology development that aims to elucidate the developmental pathways of personality pathology and its underlying mechanisms.

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

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.

The clinical utility of the ICD-11 classification of personality disorders and related traits: A preliminary scoping review.

A diagnostic system that fails to deliver clinically useful information will not be utilized and consequently will be unable to provide valuable data for health policy and clinical decision making. Therefore, it is imperative to obtain an accurate depiction of the clinical utility of the eleventh revision of the International Classification of Diseases (ICD-11) Personality Disorder (PD) model. The current mixed-methods systematic review aimed to determine the clinical utility of the ICD-11 PD classification system. An electronic screening of six databases was conducted and resulting studies were subjected to specific exclusion criteria, which elicited eight studies of interest. Study characteristics were tabulated and methodological quality was appraised. Four studies offered strong support for the model's clinical utility, three offered some support accompanied by notable limitations and one study could only offer criticisms. Future investigation of the ICD-11 PD classification system's (a) communicative value between clinicians and their patients, and between clinicians and their patient's families; (b) ease of use; and (c) feasibility in terms of practical application is required to achieve a complete understanding of its clinical utility and ultimately bring clarity to the current ambiguous findings.

The “Lost” Personality Disorders and Their Relationships to the Alternative Model of Personality Disorders Among Older Adults

Abstract. Four personality disorders (PD) have become “lost” throughout the various editions of the DSM: Depressive, Passive-Aggressive, Sadistic, and Self-Defeating. The Alternative Model of Personality Disorders (AMPD) is a novel approach to PD classification, containing two diagnostic criteria: personality functioning and pathological personality traits. This study identifies the personality functioning and pathological personality trait features of the Lost PDs among older adults ( N = 202; Mage = 67.47 years). Results indicate that the Lost PDs related more strongly with the self-functioning domains (versus the interpersonal domains). Some pathological traits emerged in expected directions, whereas others did not, which is consistent with research on the traditional PDs. The AMPD appears to have mixed validity in capturing the Lost PDs in older adults, though overall it performed comparably well and warrants further examination.

ICD-11 Personality Disorders: Utility and Implications of the New Model.

The ICD-11 classification of personality disorders represents a paradigm shift in diagnosis. This was felt necessary because previous personality disorder classifications had major problems. These included unnecessary complexity, inconsistency with data on normal personality traits, and minimal consideration of severity despite this being shown to be the major predictor of outcome. The ICD-11 classification abolishes all categories of personality disorder except for a general description of personality disorder. This diagnosis can be further specified as “mild,” “moderate,” or “severe.” Patient behavior can be described using one or more of five personality trait domains; negative affectivity, dissociality, anankastia, detachment, and disinhibition. Clinicians may also specify a borderline pattern qualifier. The ICD-11 shows considerable alignment with the DSM-5 Alternative Model for Personality Disorders. Early evidence around the reliability and validity of the new model appear promising, although at present there is still limited specific evidence due to the model being so recently finalized. However, for the model to be successful, it needs to be embraced by clinicians and used widely in normal clinical practice.

Effects of diagnostic disclosure and varying diagnostic terminology on social attitudes to personality disorder: An experimental vignette study.

Personality disorder (PD) diagnosis is currently in flux, with the latest edition of the International Classification of Diseases proposing to overhaul PD classification. The stigma purportedly attached to PD labels is a common concern in debates about PD diagnosis. However, there is a paucity of data on the general public's attitudes to PD diagnoses. The current study used an experimental vignette method to explore (a) whether attitudes to a person displaying undesirable behavior are affected by disclosing a PD diagnosis, and (b) whether the different variants of PD diagnoses present in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and International Classification of Diseases elicit different social responses. Participants (n = 328) were recruited via an online platform and randomly assigned to read one of six vignettes. Vignettes described a person displaying socially undesirable behaviors, whose diagnosis was either withheld or defined as Borderline, Antisocial, Mild, Moderate, or Severe PD. Participants then completed a battery of measures assessing their attitudes to the vignette character. Relative to groups who were told of a PD diagnosis, diagnostically unaware participants were less likely to see the person's problems as biologically caused, expected the problems would be shorter in duration, and attributed the character more a greater degree of personal control over their conduct. Withholding a diagnosis also resulted in greater anger and social distance and less positive affect and pity. Between the conditions in which different diagnostic classifications were stated, the specific terminology used had minimal effect. Results suggest that disclosing a PD diagnosis may ameliorate negative responses to undesirable behavior, irrespective of the particular diagnostic terminology used. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A third hierarchical level of narrower traits for the Dimensional Assessment of Personality Pathology-Basic Questionnaire.

Current dimensional taxonomies of personality disorder show a stronger empirical grounding than categories, but may lack the necessary level of detail to make accurate predictions and case formulations. We need to further develop the lower levels of the hierarchy until reaching the building blocks of personality pathology. The Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ) is well-suited to this purpose due to its multilayered structure and its agreement with the official dimensional classifications. We disaggregated the 18 DAPP-BQ mid-level facets through exploratory and confirmatory factor analysis in a sample of 3233 community subjects and outpatients. We obtained a set of 72 clinically relevant, narrower subfacets, which were reliable, well-fitted to the data, and invariant between clinical and community subjects and between the sexes. This third level of abstraction increases by 4.7% the capacity to predict DSM categorical personality disorders, gives a particular advantage in capturing dependent, histrionic, paranoid, obsessive, and schizoid features and can provide the detailed information that clinical decisions demand.

ICD-11 Personality Disorders: A Psychodynamic Perspective on Personality Functioning.

The new ICD-11 introduces a fully dimensional classification of personality disorders representing a fundamental change in personality disorder diagnosis with major implications for clinical practice and research. The new system centers on the evaluation of the severity of impairment in the areas of self and interpersonal functioning. This focus on personality functioning converges with long-standing psychoanalytic/psychodynamic conceptualizations of personality pathology. In a detailed conceptual analysis and review of existing empirical data, points of convergence and notable differences between major exponents of the psychodynamic tradition—object relations theory as developed by Kernberg et al. and the Operationalized Psychodynamic Diagnosis—and the ICD-11 system are critically discussed. Personality functioning can be considered to be the current “common ground” for the assessment of personality disorders and constitutes a considerable step forward in making personality disorder diagnosis both clinically meaningful and suitable for research purposes.