An exploratory study of associations between the ICD-11 personality disorder model and eating pathology

Abstract

Background Recently, the International Classification of Diseases 11th Revision (ICD-11) has introduced a paradigm shift in personality disorder conceptualization. The novel ICD-11 personality disorder model comprises a dimensional assessment of personality dysfunction and five maladaptive personality trait domains. Maladaptive personality plays a central role in eating pathology. Yet, relations between the ICD-11 personality disorder model and eating pathology are, to date, unclear. Thus, this study aimed to explore the bivariate, incremental, and interactive associations of the ICD-11 personality disorder model components with eating pathology domains. Methods A predominantly female (85%) sample of 888 German-speaking community adults completed validated self-report measures of personality dysfunction, the ICD-11 personality trait domains, and five eating pathology domains (drive for thinness, bulimia, body dissatisfaction, orthorexia, binge eating). Bivariate and hierarchical regressions models were used to investigate bivariate, incremental, and interactive relations between the ICD-11 personality disorder model components and eating pathology. Results Personality dysfunction and the ICD-11 personality trait domains showed statistically significant bivariate relations with eating pathology. Additionally, personality dysfunction and most ICD-11 personality trait domains displayed incremental links with eating pathology. Finally, the relations of the ICD-11 personality trait domains with eating pathology were largely independent of the severity of personality dysfunction. Conclusions This study indicated that all ICD-11 personality disorder model components are uniquely linked to eating pathology. Beyond maladaptive personality trait domains, the strong and incremental relations of personality dysfunction with eating pathology have potential implications for theory building. Further research using longitudinal designs is needed to evaluate causal links between the ICD-11 personality disorder model components and eating pathology.

Replicability of the five‐factor structure of DSM‐5 and ICD‐11 trait systems and their associations with binge eating and bipolar spectrum psychopathology

“…Some facets of the DSM‐5 model, such as Distractibility and Impulsivity, which were expected to load strongly on the Disinhibition factor, loaded more strongly on the Negative Affectivity factor. Several studies have shown a relationship between the disinhibited features and both the BED and BSD (Hays & Roberts, 2008; Jen et al, 2013; Komasi et al, 2023; Shi et al, 2022; Sparding et al, 2017; Stricker et al, 2022).…”

“…So far, several studies tried to report the association between the DSM‐5 and the ICD‐11 domains and all personality disorders according to the used classifications by previous versions of the manuals (Al‐Dajani et al, 2016; Fang et al, 2021; Fossati et al, 2013; Fossati et al, 2016). However, the transdiagnostic personality domains proposed by both systems may apply not only to the assessment of personality pathology but to other mental disorders as well (Hong & Tan, 2021; Komasi et al, 2023; Sellbom et al, 2020; Stricker et al, 2022). For example, the antagonistic and disinhibited externalizing spectra of the Hierarchical Taxonomy of Psychopathology (HiTOP) cover several personality disorders and substance‐related disorders, whereas the internalizing spectrum (linked to Negative Affectivity) covers a wide range of mental disorders, including anxiety, sexual, eating, and affective disorders (Kotov et al, 2017).…”

“…Although many studies have examined the associations between various mental disorders and maladaptive domains of the DSM‐5 trait model (Bastiaens et al, 2019; Fossati et al, 2013; Hong & Tan, 2021; Komasi et al, 2023; Zimmermann et al, 2019), fewer have been devoted to the associations between mental disorders and the ICD‐11 trait model (Bach et al, 2018; Stricker et al, 2022). The findings of these studies addressed some associations between domains of the trait systems and both personality and clinical disorders (Bach et al, 2018; Fossati et al, 2013; Komasi et al, 2023; Stricker et al, 2022); however, to our knowledge, none of these studies comparing these two trait systems to predict BED and BSD. In addition, a few studies have attempted to report associations between psychopathology structure and maladaptive personality traits.…”

“…A few studies address the overlap between maladaptive traits and BED or BSD (Gilmartin et al, 2023; Komasi et al, 2023). Some reports have also shown that some domains of the DSM‐5 (Negative Affectivity, Disinhibition, and Psychoticism) and the ICD‐11 (Negative Affectivity and Disinhibition) systems are significantly related to the symptoms of BED and BSD (Komasi et al, 2023; Sellbom et al, 2022; Stricker et al, 2022). Although these studies provide early evidence for further understanding of the links between both the personality systems and the psychopathology of binge eating and bipolar spectrum, there are two major limitations.…”