Assessing Criterion A in adolescents using the Semistructured Interview for Personality Functioning DSM–5.

Abstract

Accumulating evidence supports the reliability and validity of the diagnosis of personality disorders (PDs) in adolescents, but whether the current Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM–5), criteria are optimal to capture and help detect emerging PDs in this age-group remains controversial. The Level of Personality Functioning Scale (LPFS), included in the alternative model for personality disorders, may provide a more developmentally sensitive way to identify impaired personality features in young people. This study investigates the feasibility of the LPFS in adolescents by examining the psychometric properties of the Semistructured Interview for Personality Functioning DSM–5 in a clinical sample of referred adolescents (N = 84) and in a community sample (N = 12). Additionally, referred adolescents completed self-report questionnaires pertaining to symptom severity, personality functioning, and personality traits. In general, good interrater reliability and internal consistency were observed, and the associations with external variables largely followed theoretical prediction. Interestingly, and in contrast to data on adults, we found no significant associations between the LPFS scores on the one hand and traditional DSM–5 PD diagnoses in the clinical sample on the other (except for borderline PD criteria). In discussing these findings, we argue that the assessment of personality functioning may be better suited for detecting personality pathology in adolescence than the traditional Section II criteria.

Reliability, structure, and validity of module I (personality functioning) of the Structured Clinical Interview for the alternative DSM–5 model for personality disorders (SCID-5-AMPD-I).

“…Most studies have been conducted with the Semi-Structured Interview for Personality Functioning DSM-5 (STiP-5.1; Hutsebaut et al, 2017) and the Structured Clinical Interview for the AMPD-Module I (SCID-5-AMPD-I; Bender et al, 2018). Overall good to excellent interrater reliability could be demonstrated with both, the STiP-5.1 (Hutsebaut et al, 2017(Hutsebaut et al, , 2021Weekers et al, 2021;Zettl et al, 2019) and SCID-5-AMPD-I (Buer Christensen et al, 2018;Somma et al, 2020). Test-retest reliability was also good when using the SCID-5-AMPD-I, though the coefficients for a few subdomains were questionable (Buer Christensen et al, 2018).…”

“…Discriminant validity of interview-assessed personality functioning has not been formally tested so far, yet there are indications that discriminant validity may be partially present. For example, STiP-5.1 scores showed higher correlations with categorical PDs than with other categorical mental disorders in adults (Hutsebaut et al, 2017) but not in adolescents (Weekers et al, 2021). Conversely, STiP-5.1 scores showed higher correlations with personality pathology than with general psychological distress in adolescents (Weekers et al, 2021) but not in adults (Hutsebaut et al, 2017;Zettl et al, 2019).…”

“…For example, STiP-5.1 scores showed higher correlations with categorical PDs than with other categorical mental disorders in adults (Hutsebaut et al, 2017) but not in adolescents (Weekers et al, 2021). Conversely, STiP-5.1 scores showed higher correlations with personality pathology than with general psychological distress in adolescents (Weekers et al, 2021) but not in adults (Hutsebaut et al, 2017;Zettl et al, 2019). Moreover, in a SCID-5-AMPD-I study, in which personality functioning was examined as a predictor for psychosocial functioning, personality functioning showed higher associations with categorical PDs than with psychosocial functioning (Buer Christensen et al, 2020).…”

Change in the Definition of Personality Disorder in Transition to ICD-11: A Look from Clinical and Developmental Perspectives

“…Manoma, kad asmenybės funkcionavimo lygio konstruktas turi potencialo pagerinti asmenybės patologijos vertinimą paauglystėje pirmiausia dėl to, kad tiesiogiai susieja asmenybės patologiją su asmenybės procesais ir tai gali būti raidai jautresnis būdas aptikti sutrikusius asmenybės aspektus paauglystėje, kai asmenybės sutrikimas dar nėra visiškai išsiskleidęs (Weekers et al, 2020). Weekers ir kitų (2020) tyrimas atskleidė, kad asmenybės funkcionavimo lygis, vertintas pasitelkus klinikinį interviu, buvo susijęs tik su ribiniu, bet ne su kitais asmenybės sutrikimais, nustatytais naudojantis kategorinio modelio kriterijais.…”

“…Kiti tyrimai pateikia labai panašius rezultatus: visi asmenybės funkcionavimo lygio aspektai su dideliu efekto dydžiu diferencijuoja turinčius ribinį asmenybės sutrikimą ir jo neturinčius paauglius (Goth et al, 2018). Autoriai aiškina, kad asmenybės funkcionavimo lygio kriterijus jautriau nei tradiciniai kriterijai užfiksuoja asmenybės patologiją, o esminiai asmenybės patologijos aspektai raidoje pirmiausia atsiskleidžia kaip ribinio asmenybės sutrikimo požymiai (Weekers et al, 2020). Gali būti, kad ribinio asmenybės sutrikimo simptomai, tiek suaugusiųjų, tiek paauglių imtyje, atspindi bendrinį asmenybės patologijos sunkumo žymeklį, nes dauguma ribinio asmenybės sutrikimo kriterijų fiksuoja savęs suvokimo, savianalizės, tapatumo, sąryšingumo su kitais problemas (Sharp et al, 2015;Sharp et al, 2018).…”