Introduction: Dimensional models of personality disorders (PD) in the DSM-5 and ICD-11 share a focus on impairments in self and interpersonal functioning to represent the general features and severity of PD. This new perspective has led to the development of numerous measures for assessing individual differences in PD severity. While this improves choices for researchers and practitioners, it also poses the challenge of an increasing lack of standardization. Objective: The aim of this study is to establish a common metric across 6 widely used self-report measures of PD severity using item response theory models. Methods: 849 participants completed a survey including the Inventory of Personality Organization-16-item version (IPO-16), the Level of Personality Functioning Scale-Brief Form 2.0, the Level of Personality Functioning Scale-Self-Report, the Operationalized Psychodynamic Diagnosis-Structure Questionnaire Short Form, the Personality Inventory for DSM-5-Brief Form Plus and the Standardized Assessment of Severity of Personality Disorder (SASPD). We fitted exploratory multidimensional graded response models and used bifactor rotation to extract a general factor across measures. Factor scores were linked to representative T scores using data from a representative survey of 2,502 participants who completed the IPO-16. Results: When using bifactor rotation in a 7-factor model, all items loaded positively on the general factor, and the general factor explained 65.5% of the common variance. With the exception of the SASPD, all measures provided highly discriminating items (factor loadings > 0.70) for measuring the general factor and reached an acceptable reliability (> 0.80) across a wide range of the latent continuum. We constructed a crosswalk table linking total scores of the 6 measures to each other and to representative T scores. Conclusions: Our results suggest that 6 different self-report measures of the severity of PD capture a strong common factor and can therefore be scaled along a single latent continuum. Our results may facilitate instrument-independent assessment of severity of PD and increase comparability across studies.

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ObjectivesFew studies outside United Kingdom have documented effects of mentalization-based treatment (MBT) for patients with borderline personality disorder (BPD). This study aimed to investigate outcomes for BPD patients treated in an MBT programme in a Norwegian specialist treatment unit and compare benefits of the implemented MBT with the unit's former psychodynamic treatment programme.DesignA naturalistic, longitudinal, comparison of treatment effects for BPD patients before and after transition to MBT.MethodsThe sample consisted of 345 BPD patients treated in the period 1993–2013. Before 2008, patients were admitted to a psychodynamic treatment programme (n = 281), after 2008 patients received MBT (n = 64). Symptom distress, interpersonal problems, and global functioning were assessed repeatedly throughout the treatment. Suicidal/self-harming acts, hospital admissions, medication, and occupational status were assessed at the start and end of treatment. Therapists' competence and adherence to MBT was rated and found satisfactory. The statistical method for longitudinal analyses was mixed models.ResultsBPD patients in MBT and in the former psychodynamic treatment programme had comparable baseline severity and impairments of functioning. BPD patients in MBT had a remarkably low drop-out rate (2%), significantly lower than the former treatment. Improvements of symptom distress, interpersonal, global and occupational functioning were significantly greater for MBT patients. Large reductions in suicidal/self-harming acts, hospital admissions, and use of medication were evident in the course of both treatments.ConclusionsThe study confirms the effectiveness of MBT for BPD patients and indicates greater clinical benefits than in traditional psychodynamic treatment programmes.Practitioner pointsMBT is an effective treatment for patients with BPD.MBT can successfully be implemented in therapeutic settings outside United Kingdom and may be more beneficial than psychodynamic treatment programmes for BPD patients.

The study evaluated the quality of the DSM-IV obsessive-compulsive personality disorder (OCPD) construct as a prototype category. A sample of 2237 patients from the Norwegian Network of Psychotherapeutic Day Hospitals was examined by a variety of psychometric analyses. A high number of OCPD patients (77%) had co-occurrent PDs, but only the co-occurrence with paranoid was significantly higher than expected. Exploratory factor analysis of the PD criteria indicated that OCPD consists of 2 dimensions. The first dimension, perfectionism, was constituted by OCPD criteria only and was significantly related to obsessive-compulsive disorder. The second dimension, aggressiveness, included 2 OCPD criteria, reluctance to delegate and stubbornness, but was also defined by criteria from paranoid, antisocial, and borderline PD. Confirmatory factor analysis of the OCPD criteria indicated a poor fit of both a unitary model and a 3-dimensional model. Overall, the OCPD criteria had poor psychometric properties. Although it seems that the quality of the DSM-IV OCPD as a prototype construct is insufficient, it may be improved by deleting the criteria hoarding behavior and miserliness. Alternative criteria could be related to problems in close relationships involving the need for predictability. Such revisions may add a third dimension to the 2 dimensions of perfectionism and aggressiveness.

Avoidant personality disorder (APD) and social phobia (SP) are closely related, such that they are suggested to represent different severity levels of one social anxiety disorder. This cross-sectional study aimed to compare patients with APD to patients with SP, with particular focus on personality dysfunction. Ninety-one adult patients were examined by diagnostic interviews and self-report measures, including the Index of Self-Esteem and the Severity Indices of Personality Problems. Patients were categorized in three groups; SP without APD (n = 20), APD without SP (n = 15), and APD with SP (n = 56). Compared to patients with SP without APD, patients with APD reported more symptom disorders, psychosocial problems, criteria of personality disorders, and personality dysfunction regarding self-esteem, identity and relational problems. These results indicate that APD involves more severe and broader areas of personality dysfunction than SP, supporting the conceptualization of APD as a personality disorder as proposed for DSM-5.

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The Alternative Model for Personality Disorders (AMPD) in the Diagnostic and Statistical Manual of Mental Disorders (DSM), fifth edition (DSM-5), defines personality functioning by assessment of impairment in Identity and Self-direction (Self-component) and in Empathy and Intimacy (Interpersonal). These four domains constitute the Level of Personality Functioning Scale (LPFS), a trans-diagnostic measure of PD severity. The association between the LPFS and psychosocial impairment based on other previously established psychosocial functioning instruments has not been reported. A total of 317 individuals, including a representative clinical sample of 282 patients (192 with a PD diagnosis), was evaluated with the Structured Clinical Interview for the DSM-5 AMPD (SCID-5-AMPD) Module I. Self-reported impairment was measured by the Work and Social Adjustment Scale (WSAS) and social and occupational impairment was assessed by the functioning score of Global Assessment of Functioning scale (GAF-F). WSAS and GAF-F both correlated significantly with mean LPFS scores and the sum of DSM-IV PD criteria. For both measures, the mean LPFS was a stronger predictor for psychosocial impairment than the sum of DSM-IV PD criteria. Within the LPFS, the Self component was a better predictor than the Interpersonal component for both WSAS and GAF-F. For the four domains the results diverged, with Identity as the strongest predictor by far for WSAS. Empathy was the only significant predictor for impairment evaluated by GAF-F, but its contribution to variance was not substantial.

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) presents an alternative model for personality disorders in which severity of personality pathology is evaluated by the Level of Personality Functioning Scale (LPFS). The Structured Interview for the DSM-5 Alternative Model for Personality Disorders, Module I (SCID-5-AMPD I) is a new tool for LPFS assessment, but its interrater reliability (IRR) has not yet been tested. Here we examined the reliability of the Norwegian translation of the SCID-5-AMPD I, applying two different designs: IRR assessment based on ratings of 17 video-recorded SCID-5-AMPD I interviews by five raters; and test-retest IRR based on interviews of 33 patients administered by two different raters within a short interval. For the video-based investigation, intraclass correlation coefficient (ICC) values ranged from .77 to .94 for subdomains, .89 to .95 for domains, and .96 for total LPFS. For the test-retest investigation, ICC ranged from .24 to .72 for subdomains, .59 to .90 for domains, and .75 for total LPFS. The test-retest study revealed questionable reliability estimates for some subdomains. However, overall the level of personality functioning was measured with a sufficient degree of IRR when assessed by the SCID-5-AMPD I.