A Proposed Classification of ICD-11 Severity Degrees of Personality Pathology Using the Self and Interpersonal Functioning Scale

Abstract

Background: The 11th version of the World Health Organization's International Classification of Diseases (ICD-11) has adopted a dimensional approach to personality disorder (PD) nosology. Notably, it includes an assessment of PD degree of severity, which can be classified according to five categories. To date, there is no gold standard measure for assessing degree of PD severity based on the ICD-11 model, and there are no empirically-based anchor points to delineate the proposed categories. With the operationalization of PD degrees of severity in the ICD-11 PD model now being closely aligned with Criterion A of the DSM-5 Alternative Model for Personality Disorders (AMPD), sharing a focus on self and interpersonal dysfunction, self-report instruments developed for the latter model might prove useful as screening tools to determine degrees of severity in the former.Methods: The Self and Interpersonal Functioning Scale, a brief validated self-report questionnaire originally designed to assess level of personality pathology according to the AMPD framework, was used to derive anchor points to delineate the five severity degrees from the ICD-11 PD model. Data from five clinical and non-clinical samples (total N = 2,240) allowed identifying anchor points for classification, based on Receiver Operating Characteristic curve analysis, Latent Class Analysis, and data distribution statistics. Categories were validated using multiple indices pertaining to externalizing and internalizing symptoms relevant to PD.Results: Analyses yielded the following anchor points for PD degrees of severity: No PD = 0–1.04; Personality Difficulty = 1.05–1.29; Mild PD = 1.30–1.89; Moderate PD = 1.90–2.49; and Severe PD = 2.50 and above. A clear gradient of severity across the five categories was observed in all samples. A high number of significant contrasts among PD categories were also observed on external variables, consistent with the ICD-11 PD degree of severity operationalization.Conclusions: The present study provides potentially useful guidelines to determine severity of personality pathology based on the ICD-11 model. The use of a brief self-report questionnaire as a screening tool for assessing PD degrees of severity should be seen as a time-efficient support for clinical decision and treatment planning.

Kişilik Bozukluklarında ICD-11 ve DSM-5 Alternatif Modelin Karşılaştırmalı İncelenmesi

“…While the DSM-5, published by the American Psychiatric Association, starts the process of evaluating personality disorder under these four headings under the alternative model, these four areas are also covered with broader explanations in the ICD-11 guide published by the World Health Organization. In this respect, it can be said that the two guidelines display a common approach, focusing on identity and interpersonal functionality in understanding personality (Bach et al 2017, Gamache et al 2021. Both the ICD-11 PD section and DSM-5 PD AM allow researchers and clinicians to provide clearer diagnostic profiles in various combinations.…”

Criteria A and B of the Alternative DSM-5 Model for Personality Disorders (AMPD) Capture Borderline Personality Features Among Adolescents

“…Finally, the use of ICD-11 requires assessment tools. Some studies have shown that measures originally developed for Criterion A in the AMPD can be reliably used to classify the severity of PD in the ICD-11 ( 55 ). In light of these results, the operationalization of personality functioning used in the current study, the Level of Personality Functioning Questionnaire for adolescents (LoPF-Q 12–18), uniquely captures adolescents' (borderline) personality difficulties ( 17 , 18 ), and might be considered a proxy measure for PD severity in the ICD-11.…”

Integrative Dimensional Personality Inventory for ICD-11: Development and Evaluation in the Peruvian Correctional Setting

“…(3) Finally, studies that consider the validation of a measure of Criterion A (level of personality functioning) in the Alternative Model of Personality Disorders of the DSM-5-TR (DSM-5 AMPD; American Psychiatric Association, 2022), taking as criterion the severity of personality dysfunction proposed in the ICD-11, include the Self and Interpersonal Functioning Scale (SIFS; Gamache et al, 2021), the Semi-Structured Interview for Personality Functioning DSM-5 (STiP 5.1; Hutsebaut et al, 2021), and the Level of Personality Functioning Questionnaire Screener (LoPF-Q Screener; Zimmermann et al, 2022).…”