scholarly journals Change in the Definition of Personality Disorder in Transition to ICD-11: A Look from Clinical and Developmental Perspectives

Psichologija ◽  
2021 ◽  
Vol 65 ◽  
pp. 8-21
Author(s):  
Rasa Barkauskienė ◽  
Elena Gaudiešiūtė ◽  
Gabrielė Skabeikytė

The recent body of research reveals fundamental limitations to the categorical concept of a personality disorder that has led researchers to adopt a new personality disorder concept. During the last decade DSM-5 and ICD-11 diagnostic classifications have accepted the dimensional view towards personality pathology. Despite the differences between the two classifications, the joint aspect of both models is the construct of Levels of personality functioning. The construct of personality functioning involves personality (dys)function in the self and interpersonal domains. This two-step conceptualization includes (a) impairments of self and interpersonal functioning, indicating general signs and severity of personality disorder, and (b) pathological personality traits, reflecting ‘stylistic’ differences in the expression of personality disorder. The new conceptualization of personality disorder reflects the innovative multi-theoretical integration of known, empirically-based personality assessment paradigms. The relationship between personality functioning and interpersonal, psychodynamic, and personological paradigms provides the theoretical integrity and empirically-based structure necessary to understand the overall severity of personality pathology. Many methods (interviews, self-assessment scales, and questionnaires) have already been developed for the assessment of personality functioning, and their development will be encouraged by the ICD-11 classification established in 2022. At present, only one instrument has been developed in Lithuania for assessing the level of personality functioning in young people aged 12–18 (Barkauskienė & Skabeikytė, 2020). The empirical data about the validity of this construct and its capability to differentiate between the normal and impaired personality in adults and adolescents provide promising results, but are still accumulating. Research suggests that adolescence is a stage in development when personality pathology can fully unfold and be validly confirmed, which opens up opportunities for early intervention. Although the dimensional personality disorder model needs to further prove its importance, there is already evidence that it is less stigmatizing and returns psychology and personality into the concept of a personality disorder. This review presents changes in the conceptualization of personality disorders by discussing them from both clinical and developmental perspectives and highlighting the results of key research in recent years.

2017 ◽  
Author(s):  
Christopher James Hopwood ◽  
Evan Good ◽  
Leslie C. Morey

Validation of the Levels of Personality Functioning Scale - Self-Report. Results suggest that the measure has a robust single dimension and that it correlates in a very general manner with a wide range of maladaptive personality variables, consistent with its purpose as a measure of non-specific personality pathology.


2018 ◽  
Author(s):  
Chelsea Sleep ◽  
Joanna Lamkin ◽  
Donald Lynam ◽  
William Keith Campbell ◽  
Josh Miller

Mixed findings exist as to whether personality pathology involves a critical lack of awareness and insight. Research questions about insight and awareness in personality pathology are typically assessed via comparing self and informant reports of traits. However, recent studies have measured insight by asking individuals to evaluate additional questions about impairment and desire to change. The present study uses a variety of approaches to examine these issues including investigations of convergence between self and informant reports (N = 197 dyads; correlations and comparisons of means) of personality psychopathology, desired trait levels, and perceptions of impairment. Convergence was observed between levels of self- and informant-reported traits, desired traits, and impairment. However, individuals rated themselves higher on pathological trait levels and impairment than did their informants. Furthermore, individuals with relatively higher pathological traits desired higher levels of these traits (but lower than their actual scores) than individuals with lower scores; on the actual measurement scale, however, these higher scorers rated their desired level below the neutral point. Overall, individuals with pathological personality traits possess a reasonable degree of insight into their actual trait levels and associated impairment.


2000 ◽  
Vol 176 (5) ◽  
pp. 434-439 ◽  
Author(s):  
Jonathan Hill ◽  
Hazel Fudge ◽  
Richard Harrington ◽  
Andrew Pickles ◽  
Michael Rutter

BackgroundCurrent concepts and measures of personality disorder are in many respects unsatisfactory.AimsTo establish agreement between two contrasting measures of personality disorder, and to compare subject–informant agreement on each. To examine the extent to which trait abnormality can be separated from interpersonal and social role dysfunction.MethodFifty-six subjects and their closest informants were interviewed and rated independently. Personality functioning was assessed using a modified Personality Assessment Schedule (M–PAS), and the Adult Personality Functioning Assessment (APFA).ResultsSubject–informant agreement on the M–PAS was moderately good, and agreement between the M–PAS and the APFA, across and within subjects and informants, was comparable to that for the M–PAS. This was equally the case when M–PAS trait plus impairment scores and trait abnormality scores were used.ConclusionsThe M–PAS and the APFA are probably assessing similar constructs. Trait abnormalities occur predominantly in an interpersonal context and could be assessed within that context.


2021 ◽  
Vol 12 ◽  
Author(s):  
Victor Blüml ◽  
Stephan Doering

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.


Author(s):  
Andrew E. Skodol ◽  
Leslie C. Morey

This chapter describes the emergence of dimensional models for the classification and diagnosis of personality pathology. Broad personality traits underlie the meta-structure of psychopathology in general and describe the myriad manifestations of personality disorders (PDs) specifically. Domains of personality functioning distinguish personality styles from PD, and PD from other types of psychopathology, and represent the important construct of severity in personality pathology. This chapter describes the alternative Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) model for personality disorder (AMPD) and the five-factor model of personality (FFM) by which it was inspired. It summarizes the development and longitudinal course of personality traits, personality functioning, and PD; the relationship of personality and PD with physical health and psychosocial impairment; and the clinical utility of dimensional diagnostic approaches. Finally, it illustrates how traditional DSM subtypes of PD can be rendered according to impairments in personality functioning and pathological personality traits in a ‘hybrid’ dimensional–categorical model.


Author(s):  
Andrew E. Skodol

A new hybrid dimensional-categorical model for personality and personality disorder assessment and diagnosis has been proposed for DSM-5 field testing. The justifications for the proposed modifications in approach to diagnosing personality disorders include lack of specificity in the DSM-IV-TR definition of personality disorder, inadequate representation of personality disorder severity and arbitrary thresholds for diagnosis, excessive comorbidity among personality disorders, limited validity for some existing types, heterogeneity within types, and instability of current personality disorder criteria sets. This chapter reviews the development of the revised personality assessment model, including summaries of literature reviews, experiences in workshops, comments from the field, and published critiques. The next major step in the development of the DSM-5 personality assessment and diagnosis model will be the DSM-5 field trials. Further revisions are anticipated.


2019 ◽  
Vol 33 (1) ◽  
pp. 49-70 ◽  
Author(s):  
Han Berghuis ◽  
Theo J. M. Ingenhoven ◽  
Paul T. van der Heijden ◽  
Gina M. P. Rossi ◽  
Chris K. W. Schotte

The six personality disorder (PD) types in DSM-5 section III are intended to resemble their DSM-IV/DSM-5 section II PD counterparts, but are now described by the level of personality functioning (criterion A) and an assigned trait profile (criterion B). However, concerns have been raised about the validity of these PD types. The present study examined the continuity between the DSM-IV/DSM-5 section II PDs and the corresponding trait profiles of the six DSM-5 section III PDs in a sample of 350 Dutch psychiatric patients. Facets of the Dimensional Assessment of Personality Pathology—Basic Questionnaire (DAPP-BQ) were presumed as representations (proxies) of the DSM-5 section III traits. Correlational patterns between the DAPP-BQ and the six PDs were consistent with previous research between DAPP-BQ and DSM-IV PDs. Moreover, DAPP-BQ proxies were able to predict the six selected PDs. However, the assigned trait profile for each PD didn't fully match the corresponding PD.


2020 ◽  
Vol 34 (2) ◽  
pp. 250-261 ◽  
Author(s):  
Marleen Wildschut ◽  
Sanne Swart ◽  
Willemien Langeland ◽  
Jan H. Smit ◽  
Nel Draijer

Are personality disorders (PDs) associated with emotional neglect? Draijer (2003) developed a dimensional model of trauma-related disorders and PD. The first dimension consists of the severity of the trauma endured. The second dimension consists of emotional neglect, which is assumed to be related primarily to personality pathology. In this article, we investigate whether an association between retrospective reports of emotional neglect and the presence and severity of PD exists. A sample of 150 patients was systematically assessed. Results indicate that there is little evidence to support a link between emotional neglect and problematic personality functioning at the disorder level; however, there might be a link between emotional neglect and problematic personality functioning in a dimensional way. Findings indicate a relationship between lack of parental warmth and problematic personality functioning, supporting the existence of the emotional neglectaxis of the proposed model in a dimensional framework of viewing personality pathology.


2017 ◽  
Vol 33 (3) ◽  
pp. 158-165
Author(s):  
Natalia Calvo ◽  
Naia Sáez-Francàs ◽  
Sergi Valero ◽  
Jesús Castro-Marrero ◽  
José Alegre Martín ◽  
...  

Abstract. The study examines the relationship between a categorical and a dimensional personality assessment instrument in patients with Chronic Fatigue Syndrome (CFS). A total of 162 CFS patients were included in the study (91.4% women; mean age 47.5 years). All subjects completed the Spanish versions of the Personality Diagnostic Questionnaire-4+ (PDQ-4+) and the Temperament and Character Inventory-Revised (TCI-R). Results: 78 (48.1%) of the patients presented a Personality Disorder (PD), the most frequent being Cluster C, specifically Obsessive-compulsive disorder, followed by Avoidant disorder. PDs showed a specific pattern of correlation with temperament scales. All PD clusters correlated positively with Harm Avoidance and Self-Transcendence, and negatively with Reward Dependence, Self-Directedness, and Cooperativeness. In a logistic regression analysis, Self-Directedness and Cooperativeness predicted PD presence. The findings are consistent with previous studies in non-CFS samples and suggest that the combination of the Temperament and Character dimensions (low Self-Directedness and Cooperativeness and high Harm Avoidance and Self-Transcendence) correlates with PD severity, and that Self-Directedness and Cooperativeness are associated with PD presence in CFS patients. The integration of these two perspectives expands the current comprehension of personality pathology in CFS patients.


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