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 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.

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.

Assessment of Pathological Traits in DSM-5 Personality Disorders By the DAPP-BQ: How Do These Traits Relate to the Six Personality Disorder Types of the Alternative Model?

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
Keyword(s):  
Personality Disorder ◽  
Personality Disorders ◽  
Alternative Model ◽  
Psychiatric Patients ◽  
Personality Pathology ◽  
Personality Functioning ◽  
Dsm 5 ◽  
Criterion A ◽  
Dsm Iv ◽  
Dimensional Assessment

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.

An Emotional Neglect–Personality Disorder Approach: Quantifying a Dimensional Transdiagnostic Model of Trauma-Related and Personality Disorders

2020 ◽  
Vol 34 (2) ◽  
pp. 250-261 ◽  
Author(s):  
Marleen Wildschut ◽  
Sanne Swart ◽  
Willemien Langeland ◽  
Jan H. Smit ◽  
Nel Draijer
Keyword(s):  
Personality Disorder ◽  
Personality Disorders ◽  
Personality Pathology ◽  
Parental Warmth ◽  
Emotional Neglect ◽  
Dimensional Model ◽  
Personality Functioning ◽  
Retrospective Reports ◽  
Proposed Model ◽  
Transdiagnostic Model

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.

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

2021 ◽  
Vol 12 ◽  
Author(s):  
Amin Nazari ◽  
Steven K. Huprich ◽  
Azad Hemmati ◽  
Farzin Rezaei
Keyword(s):  
Personality Disorder ◽  
Object Relations ◽  
International Classification Of Diseases ◽  
Structured Interview ◽  
Self Report ◽  
Clinical Group ◽  
Object Relations Theory ◽  
Personality Functioning ◽  
Personality Dysfunction

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.

scholarly journals The Relationship between Affect Integration and Psychopathology in Patients with Personality Disorder: A Cross-Sectional Study

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 627
Author(s):  
Christina Frederiksen ◽  
Ole André Solbakken ◽  
Rasmus Wentzer Licht ◽  
Carsten René Jørgensen ◽  
Maria Rodrigo-Domingo ◽  
...  
Keyword(s):  
Personality Disorder ◽  
Personality Disorders ◽  
Interpersonal Problems ◽  
Symptom Distress ◽  
Central Component ◽  
Psychotherapeutic Treatment ◽  
Cross Sectional ◽  
Personality Functioning ◽  
Emotional Dysfunction ◽  
The Relationship

Background and Objectives: Emotional dysfunction is considered a key component in personality disorders; however, only few studies have examined the relationship between the two. In this study, emotional dysfunction was operationalized through the Affect Integration Inventory, and the aim was to examine the relationships between the level of affect integration and the levels of symptom distress, interpersonal problems, and personality functioning in patients diagnosed with personality disorder according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition. Materials and Methods: Within a hospital-based psychiatric outpatient setting, 87 patients with personality disorder referred for treatment were identified for assessment with the Affect Integration Inventory and other measures (e.g., the Symptom Checklist-90, Revised, the Inventory of Interpersonal Problems 64 circumplex version, and the Severity Indices of Personality Problems). Results: The analyses revealed that problems with affect integration were strongly and statistically significantly correlated with high levels of symptom distress, interpersonal problems, and maladaptive personality functioning. Additionally, low scores on the Affect Integration Inventory regarding discrete affects were associated with distinct and differentiated patterns of interpersonal problems. Conclusion: Taken together, emotional dysfunction, as measured by the Affect Integration Inventory, appeared to be a central component of the pathological self-organization associated with personality disorder. These findings have several implications for the understanding and psychotherapeutic treatment of personality pathology. Furthermore, they highlight the importance of considering the integration of discrete affects and their specific contributions in the conceptualization and treatment of emotional dysfunction in patients with personality disorders.

scholarly journals Three Dimensional Approaches to Personality Disorders: a Review on Personality Functioning, Personality Structure, and Personality Organization

2021 ◽  
Vol 23 (7) ◽  
Author(s):  
Susanne Hörz-Sagstetter ◽  
Ludwig Ohse ◽  
Leonie Kampe
Keyword(s):  
Personality Disorders ◽  
Empirical Studies ◽  
Three Dimensional ◽  
Personality Pathology ◽  
Personality Structure ◽  
Assessment Instruments ◽  
Personality Organization ◽  
Personality Functioning ◽  
Clinical Observations ◽  
Categorical Classification

Abstract Purpose of Review The concept of personality functioning (Alternative DSM-5 Model of Personality Disorders) has led to increased interest in dimensional personality disorder diagnosis. While differing markedly from the current categorical classification, it is closely related to the psychodynamic concepts of personality structure and personality organization. In this review, the three dimensional approaches, their underlying models, and common instruments are introduced, and empirical studies on similarities and differences between the concepts and the categorical classification are summarized. Additionally, a case example illustrates the clinical application. Recent Findings Numerous studies demonstrate the broad empirical basis, validated assessment instruments and clinical usefulness of the dimensional concepts. Their advantages compared to the categorical approach, but also the respective differences, have been demonstrated empirically, in line with clinical observations. Summary Evidence supports the three dimensional concepts, which share conceptual overlap, but also entail unique aspects of personality pathology, respectively.

Transference-Focused Psychotherapy for Pathological Narcissism and Narcissistic Personality Disorder (TFP-N)

2021 ◽  
Vol 49 (2) ◽  
pp. 244-272
Author(s):  
Diana Diamond ◽  
Frank Yeomans ◽  
John R. Keefe
Keyword(s):  
Personality Disorder ◽  
Sense Of Self ◽  
Assessment Process ◽  
Narcissistic Personality Disorder ◽  
Object Relations Theory ◽  
Pathological Narcissism ◽  
Personality Functioning ◽  
Therapeutic Interaction ◽  
Narcissistic Personality ◽  
Transference Focused Psychotherapy

In this article, we provide an overview of transference-focused psychotherapy for patients with pathological narcissism and narcissistic personality disorder (TFP-N). In TFP-N we have modified and refined the tactics and techniques of TFP, an evidence-based treatment for borderline personality disorder, to meet the specific challenges of working with patients with narcissistic personality pathology whose retreat from reality into an illusory grandiosity makes them particularly difficult to engage in treatment. We first describe a model of narcissistic pathology based on considerations of psychological structure stemming from object relations theory. This model provides a unifying understanding of the core structure of narcissistic pathology, the pathological grandiose self, that underlies the impairments in self and interpersonal functioning of those with narcissistic pathology across the levels of personality organization (from high functioning to borderline to malignant). We then delineate the clinical process of working with patients with pathological narcissism and narcissistic personality disorder. Starting with the assessment process, using a detailed clinical example, we guide the reader through the progression of TFP-N as it helps the patient move from the distorted, unintegrated sense of self underlying the narcissistic presentation to the more integrated, realistic sense of self that characterizes healthier personality functioning. In TFP-N the focus on the disturbed interpersonal patterns of relating in the here and now of the therapeutic interaction is the vehicle to diminish grandiosity and improve relatedness, thereby effecting enduring changes in mental representation and real-world functioning.

ICD-11 and DSM-5 personality trait domains capture categorical personality disorders: Finding a common ground

2017 ◽  
Vol 52 (5) ◽  
pp. 425-434 ◽  
Author(s):  
Bo Bach ◽  
Martin Sellbom ◽  
Mathias Skjernov ◽  
Erik Simonsen
Keyword(s):  
Personality Disorder ◽  
Mental Disorders ◽  
Personality Disorders ◽  
International Classification Of Diseases ◽  
International Classification ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Classification Of Diseases ◽  
Domain Models

Objective: The five personality disorder trait domains in the proposed International Classification of Diseases, 11th edition and the Diagnostic and Statistical Manual of Mental Disorders, 5th edition are comparable in terms of Negative Affectivity, Detachment, Antagonism/Dissociality and Disinhibition. However, the International Classification of Diseases, 11th edition model includes a separate domain of Anankastia, whereas the Diagnostic and Statistical Manual of Mental Disorders, 5th edition model includes an additional domain of Psychoticism. This study examined associations of International Classification of Diseases, 11th edition and Diagnostic and Statistical Manual of Mental Disorders, 5th edition trait domains, simultaneously, with categorical personality disorders. Method: Psychiatric outpatients ( N = 226) were administered the Structured Clinical Interview for DSM-IV Axis II Personality Disorders Interview and the Personality Inventory for DSM-5. International Classification of Diseases, 11th edition and Diagnostic and Statistical Manual of Mental Disorders, 5th edition trait domain scores were obtained using pertinent scoring algorithms for the Personality Inventory for DSM-5. Associations between categorical personality disorders and trait domains were examined using correlation and multiple regression analyses. Results: Both the International Classification of Diseases, 11th edition and the Diagnostic and Statistical Manual of Mental Disorders, 5th edition domain models showed relevant continuity with categorical personality disorders and captured a substantial amount of their information. As expected, the International Classification of Diseases, 11th edition model was superior in capturing obsessive–compulsive personality disorder, whereas the Diagnostic and Statistical Manual of Mental Disorders, 5th edition model was superior in capturing schizotypal personality disorder. Conclusion: These preliminary findings suggest that little information is ‘lost’ in a transition to trait domain models and potentially adds to narrowing the gap between Diagnostic and Statistical Manual of Mental Disorders, 5th edition and the proposed International Classification of Diseases, 11th edition model. Accordingly, the International Classification of Diseases, 11th edition and Diagnostic and Statistical Manual of Mental Disorders, 5th edition domain models may be used to delineate one another as well as features of familiar categorical personality disorder types. A preliminary category-to-domain ‘cross walk’ is provided in the article.

Kernberg's Object-Relations Theory and the Group Psychotherapy of Psychosis

1994 ◽  
Vol 27 (4) ◽  
pp. 419-432 ◽  
Author(s):  
Charles F.A. Milders
Keyword(s):  
Object Relations ◽  
Personality Disorders ◽  
Group Process ◽  
Psychotic Disorders ◽  
Personality Pathology ◽  
Object Relations Theory ◽  
Individual Group ◽  
Psychotherapeutic Process ◽  
Psychic Process ◽  
The Individual

The application of object-relations theory to the psychotherapy of severe personality disorders owes much to the writings of Otto Kernberg. According to Kernberg, object-relations theory facilitates analysis of the psychotherapeutic process and the clarification of personality pathology. It is a concept that integrates theories of psychic process in the individual, group process and the organization of the clinical setting, and has found general support among Dutch (group) psychotherapists treating patients with borderline and psychotic disorders. However, the scope of object-relations theory is seldom addressed. When object-relations theory is separated from clinical psychiatry it can be overvalued as a universal explanatory model.

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