Severity Of Personality Dysfunction Research Articles

Relationship between patient and therapist counter transference in transference and non-transference practices

The importance of therapists' emotional reactions, or Counter Transference (CT), in the therapeutic process has received attention in recent studies. The communication potential of CT has been highlighted by the systematic correlations these researchers have found between therapists' CT and numerous patient variables. To better understand the function of Transference Work (TW) in psychodynamic therapy and how it relates to therapist cognitive treatment (CT), we conducted a Randomized Controlled Trial (RCT). New study data has shown a consistent link among therapists' emotional response and Counter Transference (CT) in treatment, as well as a number of patient variables, illuminating the collaborative potential of CT. We looked into whether patient pretreatment interpersonal issues, the severity of personality dysfunction and the urge for psychodynamic therapy were associated with the therapist's transference work (TW) used in psychodynamic treatment in a Randomized Controlled Experiment (RCT) evaluating the role of TW. The second thing we looked at was whether or not the therapists employed TW in their sessions regarding these relationships. 100 outpatients received psychodynamic counseling (with or without TW). The Feelings Word Checklist-68 (FWC-68) was used to gauge their therapists' post-session emotional responses (CT). Patient characteristics differently predicted four FWC-68 subscales: insufficient, self-assured, extricate, and benevolent feelings. The level of pathology associated with PD. was connected with therapists in the non-TW group feeling less competent, according to some relationships that relied on the treatment situation. Patients' treatment desire was correlated with less troubling CT sentiments, including insufficient and distracted CT plus felt more self-assured CT. Depends on whether psychologists use transfer work in psychodynamic therapy, patient characteristics predict therapists' emotional Counter Transference in different ways.

Organization of Clinician-Rated Personality Disorder Types According to ICD-11 Severity of Personality Dysfunction.

Objective: The International Classification of Diseases, 11th edition (ICD-11) model of personality disorders (PD) allows clinicians to classify personality dysfunction according to four levels of severity. This approach is partially inspired by Kernberg's levels of personality organization, in which various PD types are organized according to their level of severity. This study sought to investigate whether the established ICD-10 PD categories can be organized according to the four levels of ICD-11 PD severity, and to what extent this organization aligns with Kernberg's four levels of personality organization. Method: A sample of 247 patients were rated by their mental health professionals according to ICD-10 PD categories and ICD-11 PD severity levels. Results: The frequencies of ICD-10 PDs on the different ICD-11 PD severity levels were generally found to be consistent with Kernberg's model. Accordingly, borderline and antisocial PDs predominantly occurred at the most severe levels, whereas anankastic, avoidant, and dependent PDs typically occurred at the milder levels. Only paranoid and histrionic PDs were less consistent with Kernberg's model. Conclusions: The findings indicate that the new ICD-11 PD severity dimension largely aligns with Kernberg's model of personality functioning with respect to the organization of PD types. Clinicians may therefore conceptualize familiar PD types in terms of their ICD-11 PD severity and vice versa.

The Inventory of Personality Organization: A valid instrument to detect the severity of personality dysfunction.

In the eleventh revision of the International Classification of Diseases (ICD-11), the severity of personality dysfunction became the central dimension of personality disorder's (PDs) definition, besides the trait domain qualifiers. Personality functioning, also known as personality organization (PO), is becoming an increasingly important concept in administering, predicting, and measuring severity and nature of personality disturbance. Otto Kernberg and his team developed several tools to measure personality impairment. The Inventory of Personality Organization (IPO) is a self-report rating scale for the measurement of PO. Aim of this study was to identify severity groups according to the level of PO and to explore their validity. A clinical sample of 118 patients was recruited from a 4-weeks in-patient cognitive psychotherapy program. Beside the IPO, Structured Clinical Interview for the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, (DSM-IV.) Axis I and II, Symptom Check List-90 (SCL-90), State-Trait Anger Expression Inventory and Dissociative Experience scale (DES). Two types of analyses were conducted: a person-centered (latent profile) analysis and various variable-centered tests to confirm the factor structure of IPO and calculate group differences. The three-factor (CFI = 0.990, TLI = 0.990, RMSEA = 0.022, SRMR = 0.089) and the five-factor (CFI = 0.995, TLI = 0.995, RMSEA = 0.014, SRMR = 0.090) models of the IPO was supported. Latent class analysis identified three subgroups of PO: "Well-integrated," "Moderately integrated," and "Disintegrated" classes. There were no significant differences between the three classes in the number of Axis 1 diagnoses (p = 0.354; η2 = 0.01). Group differences in the number of PDs, the number of PD symptoms as well as in the presence of borderline and depressive PD were significant (all p < 0.001; V = 0.35-0.42; η2 = 0.15-0.26). Persons with more severe PO problem level had higher rates of psychopathological symptoms, state and trait anger, and dissociative characteristics (all p < 0.001; η2 = 0.13-0.36). The IPO can be an appropriate instrument to measure the severity of personality disorganization and to classify participants along a continuum of severity in this regard. Our results present further evidence that the severity of personality dysfunction, the central dimension of the ICD-11 and the Alternative Model for PDs is detectable with an instrument, the IPO, that was initially developed to detect the disturbances in PO.

Comparing Measures of Criterion A to Better Understand Incremental Validity in the Alternative Model of Personality Disorders.

The Alternative Model of Personality Disorders distinguishes between the severity of personality dysfunction (Criterion A) and individual differences in personality disorder expression (Criterion B). Several Criterion A measures exist, but few studies have compared these measures with each other. Moreover, debates about whether the constructs of Criteria A and B are redundant (i.e., weak incremental validity) should be framed around how different Criterion A measures perform relative to others. This study of 204 undergraduate students evaluated multiple measures of Criterion A. These measures were strongly correlated with Criterion B, but evidenced incremental validity (39% of outcomes, 5% average additional variance explained) with outcomes of psychopathology and interpersonal impairments, and less consistent incremental validity with suicidality, aggression, and mental health utilization. We discuss how these results inform the construct of Criterion A relative to Criterion B and evaluate strengths/weaknesses of Criterion A measures.

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.

The trait-type dialectic: Construct validity, clinical utility, and the diagnostic process.

The current debate regarding how best to conceptualize, operationalize, and assess personality pathology is often framed as a choice between categorical ("type") and dimensional ("trait") models, but when viewed from the perspective of the diagnostician, these two approaches actually have much in common. It is not possible to assign symptom ratings in any categorical personality disorder framework without first evaluating the severity of each symptom on a continuum, nor to implement dimensional personality disorder assessments in clinical settings without using thresholds that demarcate the presence of personality pathology, or severity of personality dysfunction. Although recent discussions of these two frameworks have focused primarily on issues regarding construct validity (and to a lesser extent, clinical utility), it is important to consider the impact of the diagnostic process as well. When considered within this broader context, the advantages and limitations of each perspective are illuminated, and it becomes clear that the categorical and dimensional frameworks represent an evolving dialectic that will continue into the future, as new and better models alter the focus of these debates. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Personality Constructs and Paradigms in the Alternative DSM-5 Model of Personality Disorder

ABSTRACTThe DSM–5 Section III alternative model for personality disorders (AMPD) is a personality disorder (PD) nosology based on severity of personality dysfunction and pathological traits. We examined the degree to which the personality constructs identified by McAdams and Pals (2006; dispositional traits, characteristic adaptations, narrative identity) and the paradigms of personality assessment described by Wiggins (2003; psychodynamic, interpersonal, personological, multivariate, empirical) are represented within the AMPD. Nine raters expert with the AMPD and personality evaluated elements of Criterion A and the 25 trait facets of Criterion B for presence of type and degree of personality constructs and paradigms, as well as level of inference. Criterion B showed higher rater agreement compared to Criterion A. Criteria A and B reflect different configurations of construct, paradigm, and level of inference. The characteristic adaptation construct and interpersonal paradigm were strongly reflected in both Criteria A and B. The psychodynamic and personological paradigms and the narrative identity construct were highly correlated, and the multivariate, empirical, and dispositional traits variables were highly correlated. Results illustrate differential conceptual emphases as well as areas of overlap with Criteria A and B. This characterization highlights that PD nosology rests on personality theory and suggests implications for integrative PD assessment.

Assessing the Level of Structural Integration Using Operationalized Psychodynamic Diagnosis (OPD): Implications for DSM–5

A key ingredient in the current proposal of the DSM–5 Work Group on Personality and Personality Disorders is the assessment of overall severity of impairment in personality functioning: the Levels of Personality Functioning Scale (LPFS). The aim of this article is to contribute a conceptual and empirical discussion of the LPFS from the perspective of the Operationalized Psychodynamic Diagnosis (OPD) system (OPD Task Force, 2008). First, we introduce the OPD Levels of Structural Integration Axis (OPD–LSIA), a measure of individual differences in severity of personality dysfunction that is rooted in psychodynamic theory. We show that the OPD–LSIA is reliable, valid, and highly associated with observer ratings of personality disorders. In the second part, we present results from an OPD expert consensus study exploring potential limitations of the current LPFS item set from the perspective of the OPD–LSIA. We conclude with highlighting implications for future revisions of the DSM–5 proposal.

Late Luteal Phase Dysphoric Disorder: Relationship to Personality Disorders

Forty–two women seeking a diagnostic evaluation for premenstrual syndrome provided daily symptom ratings for two or more menstrual cycles. The Personality Diagnostic Questionnaire–Revised (PDQ–R) was completed in the follicular phase; 10 women also completed the PDQ–R in the luteal phase of the same menstrual cycle. The follicular PDQ–Rs indicated a high prevalence of personality dysfunction. Although follicular personality dysfunction was correlated with severity of premenstrual symptoms, personality dysfunction was not significantly associated with the diagnosis of either premenstrual syndrome (PMS) or late luteal phase dysphoric disorder (LLPDD). There was no significant change in the severity of personality dysfunction across the menstrual cycle regardless of the diagnosis of either PMS or LLPDD.