Dimensional models and neurobiology of personality disorders

1999 ◽  
Vol 11 (1) ◽  
pp. 1-4
Author(s):  
W. van den Brink
Keyword(s):  
Personality Disorders ◽  
Personality Pathology ◽  
Diagnostic Model ◽  
Axis Ii ◽  
Statistical Procedures ◽  
Statistical Studies ◽  
Chronic Disorders ◽  
Theoretical Considerations ◽  
Exclusive Choice

SUMMARYSince the introduction of a separate axis in DSM-III (1980), the validity of the categorical nature of the classification of personality disorders has been seriously questioned. Subsequently, a number of multidimensional alternatives have been proposed based on statistical procedures or theoretical considerations. At the same time, the study of the neurobiological underpinnings of personality and personality disorders has created a better understanding of etiological and pathogenetic processes responsible for these chronic disorders. The findings of these studies corroborate some of the major findings of statistical studies regarding the nature of the frequent comorbidity of axis II disorders. In the discussion, a mixed, two-tier diagnostic model is proposed to serve both scientific and clinical aims without the disadvantages of an exclusive choice for either categorical or dimensional approaches to the classification of personality pathology.

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

2021 ◽  
pp. 1-10
Author(s):  
Melody R. Altschuler ◽  
Robert F. Krueger
Keyword(s):  
Personality Disorders ◽  
Personality Pathology ◽  
Integrative Model ◽  
Research Domain Criteria ◽  
Developmental Context ◽  
Dimensional Classification ◽  
Developmental Theories ◽  
Underlying Mechanisms ◽  
Research Domain

Abstract Traditional 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.

CS04-03 - New developments in the classification of personality disorders

2011 ◽  
Vol 26 (S2) ◽  
pp. 1780-1780
Author(s):  
E. Simonsen
Keyword(s):  
Personality Disorders ◽  
Psychiatric Patients ◽  
Normal Population ◽  
Scientific Basis ◽  
Personality Pathology ◽  
Clinical Validity ◽  
New Developments ◽  
Functional Deficits ◽  
Dsm Iv

Personality disorders are regarded as being among the more important categories within the DSM-IV diagnostic nomenclature, because they have the unique distinction of being placed on a separate diagnostic axis. However, empirical data have pointed out a number of disadvantages and concerns with the categorical system: excessive co-occurrence, inadequate coverage, heterogeneity within diagnoses, arbitrary and unstable diagnostic boundaries and inadequate scientific basis.Alternative dimensional approaches have been considered. There is a surprising consistency over the number and descriptions of the main factors or dimensions both in normal population and among psychiatric patients, at least the following four: an externalizing factor aggression (antagonism), an internalizing anxious-emotional unstable second factor, an inhibited and constraint third factor and fourth factor of compulsivity and perfectionism. Beside this, severity of functional deficits, a number of trait domains and disturbances of self and identity are considered to be included as additional descriptors of personality pathology. It is proposed that only 5 or 6 of the current categories with highest clinical validity will be kept in the system. The aim is to maximize clinical utility, but the current suggestions seem to be too complex for the average clinician to follow.

scholarly journals Countertransference feelings and personality disorders: A psychometric evaluation of a brief version of the Feeling Word Checklist (FWC-BV)

2020 ◽  
Author(s):  
Randi Breivik ◽  
Theresa Wilberg ◽  
Julie Evensen ◽  
Jan Ivar Røssberg ◽  
Hanne Sofie Dahl ◽  
...  
Keyword(s):  
Factor Analysis ◽  
Psychometric Properties ◽  
Personality Disorders ◽  
Psychometric Evaluation ◽  
Self Report ◽  
Personality Pathology ◽  
Axis Ii ◽  
Working Alliance Inventory ◽  
Dsm Iv ◽  
Coefficient Omega

Abstract Background The Feeling Word Checklist (FWC) is a self-report questionnaire designed to assess therapists’ countertransference (CT) feelings. The primary aim of the study was to evaluate the psychometric properties of a brief, 12-item version of the Feeling Word Checklist (FWC-BV). The second aim was to validate the factor structure by examining the associations between the FWC-BV factors, patients’ personality pathology and therapeutic alliance (TA). Methods Therapists at 13 different outpatient units within the Norwegian Network of Personality Disorders participated, and the study includes therapies for a large sample of patients ( N =2425) with personality pathology. Over a period of 2.5 years, therapists completed the FWC-BV for each patient in therapy every 6 months. Statistical methods included exploratory (EFA) and confirmatory (CFA) factor analysis. Internal consistency was estimated using Mc Donald’s coefficient Omega (ω t ). The Structured Clinical Interview for DSM-IV – Axis II (SCID II) and Mini International Neuropsychiatric Interview (MINI) were used as diagnostic instruments, and patient-rated TA was assessed using the Working Alliance Inventory (WAI-SR). Results Factor analyses revealed three clinically meaningful factors: Inadequate , Idealised and Confident . These factors had acceptable psychometric properties. Most notably, a number of borderline PD criteria correlated positively with the factors Inadequate and Idealised , and negatively with the factor Confident . All the factors correlated significantly with at least one of the WAI-SR subscales Conclusions The FWC-BV measures three clinically meaningful aspects of therapists’ CT feelings. This brief version of the FWC seems satisfactory for use in further research and in clinical contexts. Keywords: Countertransference, Feeling Word Checklist, factor analysis, personality disorder, psychometrics

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

2021 ◽  
pp. 136346152110364
Author(s):  
Ardalan Najjarkakhaki ◽  
Samrad Ghane
Keyword(s):  
Personality Disorders ◽  
Ethnic Minorities ◽  
Historical Trauma ◽  
Cultural Factors ◽  
Cultural Dimensions ◽  
Economic Resources ◽  
Personality Pathology ◽  
Indigenous Populations

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.

scholarly journals Diagnosis and classification of personality disorder: difficulties, their resolution and implications for practice

2010 ◽  
Vol 16 (5) ◽  
pp. 388-396 ◽  
Author(s):  
Jaydip Sarkar ◽  
Conor Duggan
Keyword(s):  
Personality Disorder ◽  
Personality Disorders ◽  
Integrated Approach ◽  
Personality Pathology ◽  
Icd 10 ◽  
Diagnosis And Classification ◽  
Axis I ◽  
Dsm Iv ◽  
Current Systems

SummaryThere are many difficulties associated with the diagnostic guidelines for personality disorder in the current international classificatory systems such as ICD–10 and DSM–IV. These lead not only to significant overlap with DSM Axis I disorders, resulting in high rates of diagnoses of comorbidities and multiple personality disorders, but also to lack of adequate capture of core personality pathology. The current classifications are also unhelpful in treatment selection, presumably the prime reason for assessing individuals in the first place. In this article we highlight various deficits and inadequacies related to the nosology of the current systems and suggest some strategies for dealing with these. We offer an integrated model of assessing and diagnosing personality disorders. We attempt to demonstrate how using a more integrated approach minimises or even eliminates some of the key problems highlighted in the current systems.

scholarly journals ICD-11 Personality Disorders: A Psychodynamic Perspective on Personality Functioning

2021 ◽  
Vol 12 ◽  
Author(s):  
Victor Blüml ◽  
Stephan Doering
Keyword(s):  
Personality Disorder ◽  
Personality Disorders ◽  
Conceptual Analysis ◽  
Common Ground ◽  
Personality Pathology ◽  
Object Relations Theory ◽  
Personality Functioning ◽  
Dimensional Classification ◽  
Data Points

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.

scholarly journals Countertransference feelings and personality disorders: A psychometric evaluation of a brief version of the Feeling Word Checklist (FWC-12)

2019 ◽  
Author(s):  
Randi Breivik ◽  
Theresa Wilberg ◽  
Julie Evensen ◽  
Jan Ivar Røssberg ◽  
Hanne Sofie Dahl ◽  
...  
Keyword(s):  
Factor Analysis ◽  
Personality Disorder ◽  
Psychometric Properties ◽  
Personality Disorders ◽  
Psychometric Evaluation ◽  
Self Report ◽  
Personality Pathology ◽  
Axis Ii ◽  
Working Alliance Inventory ◽  
Dsm Iv

Abstract Background The Feeling Word Checklist (FWC) is a self-report questionnaire designed to measure therapists’ countertransference (CT) feelings. The primary aim of the study was to evaluate the psychometric properties of a brief version of the Feeling Word Checklist comprising twelve feeling words (FWC-12). The second aim was to validate the factor structure by examining the associations between the FWC-12 factors, patients’ personality pathology and therapeutic alliance (TA). Methods Therapists at 13 different outpatient units within the Norwegian Network of Personality Disorders completed the FWC-12 every 6 months during the course of treating a patient with a personality disorder (PD), over a period of up to 2.5 years. A large sample of patients with personality pathology participated in the study. The data were analysed with exploratory (EFA) and confirmatory (CFA) factor analysis. Internal consistency was estimated using Cronbach’s alpha. The Structured Clinical Interview for DSM-IV – Axis II (SCID II) and Mini International Neuropsychiatric Interview (MINI) were used as diagnostic instruments, and patient-rated TA was assessed using the Working Alliance Inventory (WAI-SR). Results Factor analyses revealed three clinically meaningful factors: Inadequate, Idealised and Confident. These factors had acceptable psychometric properties. Most notably, a number of borderline PD criteria correlated positively with the factors Inadequate and Idealised, and negatively with the factor Confident. All the factors correlated significantly with at least one of the WAI-SR subscales. Conclusions The FWC-12 measures three clinically meaningful aspects of therapists’ CT feelings. This brief version of the FWC seems satisfactory for use in further research and in clinical contexts. Keywords: Countertransference, Feeling Word Checklist, factor analysis, personality disorder, psychometrics

scholarly journals A perspective on the current issues in the DSM-5 classification of personality disorders

2013 ◽  
Vol 15 (2) ◽  
pp. 131-132 ◽  
Keyword(s):  
Personality Disorders ◽  
Task Force ◽  
Diagnostic Procedures ◽  
General Definition ◽  
Axis Ii ◽  
Dsm 5 ◽  
Dsm Iv ◽  
New Criteria ◽  
Better Than

David Kupfer chaired the DSM-5 Task Force, and Andrew Skodol the working group, on personality disorders. Various initial propositions were posted on the Internet in 2010 for comment and discussion: new general definition, new criteria, new diagnostic procedures, reduction in the number of categories, and dimensional representation. Following numerous criticisms, the Task Force's final decisions were made public on December 1, 2012. Personality disorders now figure alongside other mental disorders, because of the deletion of Axis II. The methodology concerning personality traits is in a third section to promote new studies. The new proposed hybrid system has not, to date, proven better than the categories of the DSM-IV. These various decisions are commented upon.

scholarly journals Countertransference feelings and personality disorders: A psychometric evaluation of a brief version of the Feeling Word Checklist (FWC-BV)

2020 ◽  
Author(s):  
Randi Breivik ◽  
Theresa Wilberg ◽  
Julie Evensen ◽  
Jan Ivar Røssberg ◽  
Hanne Sofie Dahl ◽  
...  
Keyword(s):  
Factor Analysis ◽  
Personality Disorder ◽  
Psychometric Properties ◽  
Personality Disorders ◽  
Psychometric Evaluation ◽  
Self Report ◽  
Personality Pathology ◽  
Axis Ii ◽  
Working Alliance Inventory ◽  
Coefficient Omega

Abstract Background The Feeling Word Checklist (FWC) is a self-report questionnaire designed to measure therapists’ countertransference (CT) feelings. The primary aim of the study was to evaluate the psychometric properties of a brief version of the Feeling Word Checklist (FWC-BV) comprising 12 feeling words. The second aim was to validate the factor structure by examining the associations between the FWC-BV factors, patients’ personality pathology and therapeutic alliance (TA). Methods Therapists at 13 different outpatient units within the Norwegian Network of Personality Disorders completed the FWC-BV every 6 months during the course of treating a patient with a personality disorder (PD), over a period of 2.5 years. A large sample of patients (N=2425) with personality pathology participated in the study. The data were analysed with exploratory (EFA) and confirmatory (CFA) factor analysis. Internal consistency was estimated using Mc Donald’s coefficient Omega (ωt). The Structured Clinical Interview for DSM-IV – Axis II (SCID II) and Mini International Neuropsychiatric Interview (MINI) were used as diagnostic instruments, and patient-rated TA was assessed using the Working Alliance Inventory (WAI-SR). Results Factor analyses revealed three clinically meaningful factors: Inadequate, Idealised and Confident. These factors had acceptable psychometric properties. Most notably, a number of borderline PD criteria correlated positively with the factors Inadequate and Idealised, and negatively with the factor Confident. All the factors correlated significantly with at least one of the WAI-SR subscales Conclusions The FWC-BV measures three clinically meaningful aspects of therapists’ CT feelings. This brief version of the FWC seems satisfactory for use in further research and in clinical contexts. Keywords: Countertransference, Feeling Word Checklist, factor analysis, personality disorder, psychometrics

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