Development and initial evaluation of the ICD‐11 personality disorder severity scale: PDS‐ICD‐11

Abstract

Aim No measure has formally been developed to assess the published ICD‐11 model of Personality Disorder (PD) severity. We therefore set out to develop and evaluate the 14‐item Personality Disorder Severity ICD‐11 (PDS‐ICD‐11) scale. Method A representative U.S. community sample (N = 428; 50.9% women) and a New Zealand mental health sample (N = 87; 61.5% women) completed the PDS‐ICD‐11 scale along with a series of established PD and impairment measures. Results Item response theory supported the unidimensionality of PDS‐ICD‐11 (median item loading of 0.68) and indicated that a PDS‐ICD‐11 score of 17.5 may serve as a benchmark for pronounced dysfunction. Correlation and regression analyses supported both criterion validity and incremental validity in predicting impairment and PD symptoms. The PDS‐ICD‐11 was particularly associated with measures of Level of Personality Functioning Scale (LPFS), Global PD severity, and Borderline PD symptom score. A comparison between clinical individuals diagnosed with an ICD‐11 PD vs. no PD supported diagnostic validity. Conclusion This initial construction study suggests that the PDS‐ICD‐11 constitutes a promising instrument that provides a quick impression of the severity of personality dysfunction according to the official ICD‐11 PD guidelines. Clearly, more research is needed to corroborate its validity and utility. The PDS‐ICD‐11 scale is provided as online supporting information.

Preliminary Scales for ICD-11 Personality Disorder: Self and Interpersonal Dysfunction Plus Five Personality Disorder Trait Domains

“…The Standardized Assessment of Severity of Personality Disorder (SASPD; Olajide et al, 2018 ), which was adapted from the Standardized Assessment of Personality–Abbreviated Scale ( Moran et al, 2003 ), assesses PD severity via level of disability (minimal to none, mild, moderate, and severe) in nine areas of personality and psychosocial functioning—four that have an interpersonal focus (i.e., friendships; and being with, trusting, and caring about other people) and five that are more intrapsychic/behavioral (i.e., two items concerning affect and/or emotion regulation and three items assessing acting on impulse, being organized, and self-reliance, respectively). In contrast, Bach et al (2021) developed the ICD-11 Personality Disorder Severity Scale (PDS- ICD-11 ), a 14-item measure to assess aspects of personality functioning that contribute to ICD-11 PD severity, based on the ICD-11 CDDG, which include four aspects of self dysfunction (e.g., ability to maintain an overall positive and stable sense of self-worth), four aspects of interpersonal dysfunction (e.g., interest in engaging in relations with others), three domains in which personality dysfunction is manifested (i.e., emotional, cognitive, and behavioral) and, finally, the extent to which the dysfunction is associated with distress or disability in important areas of functioning (e.g., social, occupational).…”

Editorial: Entering the Brave New World of ICD-11 Personality Disorder Diagnosis

“…For the overall assessment of PD severity, researchers and clinicians may use the 14-item Personality Disorder Severity-ICD-11 (PDS-ICD-11) scale ( 8 ), which is currently being adapted to a clinician-rating form. As highlighted in this special topic, a preliminary tool by Clark et al may also be used to measure specific ICD-11 features of self- and interpersonal functioning by means of 65 designated items.…”

“…In comparison, the STiP 5.1 structured interview used by Hutsebaut et al , the 24-item SIFS measure used by Gamache et al , and the 80-item LPFS-SF measure used by Nazari et al may be employed to capture more general features of self- and interpersonal functioning that are relevant but not specific for the ICD-11 model. Nevertheless, of the aforementioned instruments of PD severity, only the PDS-ICD-11 scale ( 8 ) seems to account for emotional, cognitive, and behavioral manifestations, which are used in the ICD-11 to determine PD severity with respect to self-harm, reality testing (e.g., psychotic-like perceptions), and risk of harm.…”

“…Yet, preliminary research suggests that global severity of personality dysfunction substantially accounts for the variance described by Borderline PD ( 29 – 32 ). The ICD-11 classification of PD severity may specifically capture borderline features such as maladaptive identity functioning, poor emotion regulation, impaired reality testing under stress, and risk of harm to self ( 8 ). In addition, clinical research and meta-analytic evidence suggest that trait domains of Negative Affectivity (e.g., emotional lability), Disinhibition (e.g., impulsivity), and Dissociality (e.g., aggression) elucidate the heterogeneity of Borderline PD ( 33 , 34 ).…”

Specialist teams as constituted are unsatisfactory for treating people with personality disorders

“…Fortunately, the simple classification by severity in the new ICD-11 classification 11 is suitable for this task and straightforward scales are available to help with diagnosis. 12,13 Patients with personality disorder who are not treatment seeking currently account for a disproportionate proportion of total costs 14 and to fail to address their extra needs is negligent.…”