A Brief but Comprehensive Review of Research on the Alternative DSM-5 Model for Personality Disorders

Zimmermann, Johannes; Kerber, André; Kappelmann, Nils; Hopwood, Christopher J.; Krueger, Robert F.

doi:10.1007/s11920-019-1079-z

Cited by 249 publications

(263 citation statements)

References 312 publications

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“…Although there is now consistent evidence that dimensional PD classification systems are superior to categorical ones (e.g., Zimmermann et al, 2019), there is an ongoing debate about how to best conceptualize PD severity in a dimensional system (Widiger et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

A psychometric evaluation of the Standardized Assessment of Severity of Personality Disorder (SASPD) in nonclinical and clinical German samples.

Kappelmann¹,

Thielmann²,

Henkel³

et al. 2020

Psychological Assessment

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Personality disorders (PD) are prevalent, underdiagnosed and affect clinical trajectories of psychiatric patients. The SASPD has been developed as a screening tool for PD severity according to the dimensional model of the initial ICD-11 proposal. We show that the SASPD total score might be useful as an indicator for a heterogeneous mixture of PD features, but less as a unidimensional measure of PD severity.

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Section: Introductionmentioning

confidence: 99%

A psychometric evaluation of the Standardized Assessment of Severity of Personality Disorder (SASPD) in nonclinical and clinical German samples.

Kappelmann¹,

Thielmann²,

Henkel³

et al. 2020

Psychological Assessment

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“…The inclusion of the LPFS in the DSM-5 has given an impetus to research on the assessment of personality functioning ( 12 ), and it is to be expected that psychophysiological research will follow. According to the AMPD, emotional regulation, self-esteem regulation, and other self-regulatory capacities are closely related to interpersonal functioning, like the capacity to understand others' intentions and emotions, and the capacity to engage in close relationships.…”

Section: Introductionmentioning

confidence: 99%

The Test-Retest Reliability of Heart Rate Variability and Its Association With Personality Functioning

et al. 2020

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Background: Heart rate variability (HRV) is a widely used non-invasive index of emotion regulation ability. The main aim of our study was to investigate the relationship between HRV and level of personality functioning in a clinical sample, most of whom had a personality disorder. Our secondary aim was to examine the test-retest reliability of HRV in our sample as there is a lack of knowledge regarding the test-retest reliability in psychiatric populations. We hypothesized that trait HRV would be negatively associated with impairments of personality functioning. Method: Thirty-two adults (23 females, mean age = 27) with threshold or subthreshold personality disorders were recruited from two psychiatric outpatient clinics in Norway. Impairment of personality functioning was assessed by the first module of the Structured Clinical Interview for the DSM-5 Alternative Model for Personality Disorders (SCID-5-AMPD-I); Level of Personality Functioning Scale (LPFS). HRV was assessed during resting conditions with spontaneous breathing over three separate days. Trait HRV was calculated by averaging all three HRV assessments. The test-retest reliability of HRV was assessed using intraclass correlations. Results: Contrary to expected, a positive association between trait HRV and the LPFS Self-direction domain emerged. This was driven by positive associations between the LPFS and HRV at time point 2. Overall, the test-retest reliability of HRV was comparable to previous studies on healthy subjects. However, the reliability coefficients for the first two time points were considerably lower relative to the second and third time points. Conclusions: We propose that impairment of personality functioning may have increased the proportion of variance in HRV attributed to state relative to trait. This could explain the lower test-retest reliability for the first two time points. The increased test-retest reliability for the last two time points could reflect a habituation to the testing situation and hence, less pronounced influences of state in the second and third time points.

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“…(b) Anxiousness; (c) Separation insecurity; (d) Depressivity; (e) Impulsivity; (f) Risk taking; and (g) Hostility. Research on the AMPD BPD diagnosis has shown adequate continuity with Section II BPD diagnosis (see [24] for a summary).…”

Section: Introductionmentioning

confidence: 99%

Latent Profiles of Patients with Borderline Pathology Based on the Alternative DSM-5 Model for Personality Disorders

Gamache

Savard

Leclerc

et al. 2020

Preprint

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Background There have been multiple attempts to try to parse out heterogeneity within borderline pathology by identifying patient subtypes; thus far, these works have yielded few consistent results. Recent developments in the operationalization of borderline pathology may provide new opportunities to identify clinically and conceptually meaningful subgroups of patients. The Alternative DSM-5 Model for Personality Disorders (AMPD) offers a categorical-dimensional operationalization of Borderline personality disorder (BPD) that has yet to be tested for identification of patient subgroups. The purpose of the present study is to test whether the combination of the Criterion A elements (pertaining to level of severity) and the seven pathological traits from Criterion B that define BPD in the AMPD can yield meaningful patient profiles. Methods A total of 211 outpatients from a specialized PD treatment program (133 women, Mage = 33.66, SD = 10.97) were selected based on the presence of at least moderate borderline pathology according to cutoffs recently proposed for the Borderline Symptom List-23. Valid Criterion A (Self and Interpersonal Functioning Scale) and B (Personality Inventory for DSM-5-Short Form) self-reports were administered to measure elements and traits that define BPD in the AMPD model; these variables were used as indicators in a Latent profile analysis (LPA). Results The optimal solution generated by LPA yielded four distinct profiles: (a) Borderline traits; (b) Low borderline pathology with Impulsivity; (c) Moderate borderline pathology with Identity problems and Depressivity; and (d) Severe borderline pathology. Clinically meaningful distinctions emerged between profiles on AMPD indicators and external variables relevant to PD, especially aggression and impulsivity. Conclusions Profiles reflected both the “severity” and “style” components imbedded within Criterion A and B of the AMPD, as they were mainly distinguished by a continuum of severity but also by some meaningful qualitative differences that may have important clinical implications for treatment planning and contracting. Results also suggest that the four Criterion A elements have independent value to identify important differences in patients with borderline pathology. They also highlight that some Criterion B traits that define BPD in the AMPD may be especially important to identify subgroups of patients, mainly Impulsivity and Depressivity.

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A Brief but Comprehensive Review of Research on the Alternative DSM-5 Model for Personality Disorders

Cited by 249 publications

References 312 publications

A psychometric evaluation of the Standardized Assessment of Severity of Personality Disorder (SASPD) in nonclinical and clinical German samples.

A psychometric evaluation of the Standardized Assessment of Severity of Personality Disorder (SASPD) in nonclinical and clinical German samples.

The Test-Retest Reliability of Heart Rate Variability and Its Association With Personality Functioning

Latent Profiles of Patients with Borderline Pathology Based on the Alternative DSM-5 Model for Personality Disorders

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