Evaluation of Diagnostic Thresholds for Criterion A in the Alternative <i>DSM-5</i> Model for Personality Disorders

Christensen, Tore Buer; Hummelen, Benjamin; Paap, Muirne C. S.; Eikenaes, Ingeborg; Selvik, Sara Germans; Kvarstein, Elfrida Hartveit; Pedersen, Geir; Bender, Donna S.; Skodol, Andrew E.; Nysæter, Tor Erik

doi:10.1521/pedi_2019_33_455

Cited by 19 publications

(24 citation statements)

References 45 publications

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“…The result that mentalizing fully mediated the relationship between BPD severity and interpersonal functioning confirmed our hypothesis and is in line with prior research on the relationship between both personality functioning and mentalizing (31,61) as well as personality pathology and personality functioning (22)(23)(24)(25). Further, this result is in line with the mentalizing theory according to which mentalizing concerns the apprehension and interpretation of interpersonal interaction and, therefore, has a key function in constructive and meaningful interpersonal functioning (62).…”

Section: Discussionsupporting

confidence: 90%

“…Hence, a PD is assessed by rating its severity on a continuum ranging from normal (healthy) personality functioning through mild and moderate to severe personality pathology. The link between personality pathology and personality functioning has previously been described thoroughly in the literature (19)(20)(21) and has been supported empirically (22)(23)(24)(25), emphasizing the relevance of impaired personality functioning as a measure of the severity of personality pathology.…”

Section: Introductionmentioning

confidence: 76%

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Personality Functioning and Mentalizing in Patients With Subthreshold or Diagnosed Borderline Personality Disorder: Implications for ICD-11

Rishede

Juul

et al. 2021

Front. Psychiatry

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The 11th revision of the International Classification of Diseases for Mortality and Morbidity Statistics (ICD-11) defines personality disorder according to personality functioning, which relates to self- and interpersonal functioning. The aim of the present study was to assess the relationship between mentalizing and personality functioning in patients with subthreshold or diagnosed borderline personality disorder. A total of 116 eligible participants were included. Mentalizing was assessed using the Mentalization Questionnaire (MZQ), personality functioning (self- and interpersonal functioning) was assessed using the Level of Personality Functioning Scale-Brief Form 2.0 (LPFS-BF), and borderline severity was assessed using the Zanarini Rating Scale (ZAN-BPD). Mediation analysis was employed to test if mentalizing accounted for the relationship between borderline severity and self- and interpersonal functioning. We found a significant relationship between borderline severity and both subscales of the LPFS-BF. Mentalizing fully and significantly mediated the relationship between borderline severity and interpersonal functioning. However, mentalizing only partly mediated the relationship between borderline severity and self-functioning. Controlling for the covariates gender and age did not impact the results. Mentalizing is likely to be involved in the ICD-11 model of personality functioning, especially interpersonal functioning. This could emphasize the relevance of therapy aimed at strengthening mentalizing abilities when treating personality pathology in general and people with borderline personality disorder in particular. However, self-functioning may be more nuanced, as aspects other than mentalizing also influence self-functioning. The study is explorative in nature and has methodological limitations that require caution in the interpretation and generalizability.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 76%

Personality Functioning and Mentalizing in Patients With Subthreshold or Diagnosed Borderline Personality Disorder: Implications for ICD-11

Rishede

Juul

et al. 2021

Front. Psychiatry

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“…Buer Christensen et al ( 2020) found a mean LPFS score for BPD with comorbid PDs of 2.67 (SD = .64), which is consistent with our findings for BPD (M = 2.72; SD = .25). Buer Christensen et al also reported means for the domains of BPD: Identity 2.81 (SD = .78), Self-Direction 2.24 (SD = .91), Empathy 2.91 (SD = .57), and Intimacy 2.72 (SD = .73;Buer Christensen et al, 2020), which are close to our findings. For SPD without comorbid PDs, they reported a mean LPFS of only 1.72 (SD = 1.56), which seems low considering that LPFS operationalizes the levels and subdomains by using prototypical descriptions, where BPD is in Level 3 (severe impairment) and SPD is in Level 4 (extreme impairment).…”

Section: Criterion a In The Borderline Conditionssupporting

confidence: 91%

“…Only a few studies have used the AMPD Module I interview (Buer Christensen et al, 2018, 2020; Kampe et al, 2018). Buer Christensen et al (2020) found a mean LPFS score for BPD with comorbid PDs of 2.67 ( SD = .64), which is consistent with our findings for BPD ( M = 2.72; SD = .25). Buer Christensen et al also reported means for the domains of BPD: Identity 2.81 ( SD = .78), Self-Direction 2.24 ( SD = .91), Empathy 2.91 ( SD = .57), and Intimacy 2.72 ( SD = .73; Buer Christensen et al, 2020), which are close to our findings.…”

Section: Discussionmentioning

confidence: 99%

Reconceptualization of borderline conditions through the lens of the alternative model of personality disorders.

Meisner

Bach

Lenzenweger

et al. 2022

Personality Disorders: Theory, Research, and Treatment

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Borderline (BPD) and schizotypal personality disorder (SPD) were introduced in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III). However, the clinical differentiation of the 2 diagnoses (e.g., psychotic-like features) was challenging for diagnostic classification and clinical management. With the introduction of the alternative model for personality disorders (AMPD) in DSM-5 Section III, a dimensional approach was proposed, which potentially holds promise for better future differentiation between BPD and SPD. The present study sought to examine the psychopathology using the AMPD model. A total of 105 patients were interviewed, 25 were excluded according to exclusion criteria, and the final sample comprised 80 patients who fulfilled the DSM-5 criteria for BPD (n = 35), SPD (n = 25), and comorbid BPD þ SPD (n = 20), respectively. All patients were administered The Structured Clinical Interview for DSM-5 alternative model for personality disorders Modules I and II. One-way analysis of variance tests with planned contrasts were used. Results showed that for AMPD Criterion A, the BPD þ SPD group had the most severe impairment of personality functioning, except for Identity, where the SPD group showed the most severe impairment. For AMPD Criterion B, the domain of Detachment and the facet of Eccentricity from the Psychoticism domain were most prominent for the SPD group relative to the 2 other groups. The differentiating between BPD and SPD manifestations of cognitive/perceptual disturbances does not seem resolved by the Psychoticism domain, which covers broader aspects of psychopathology. Future research should further investigate the construct of Psychoticism, especially to differentiate nonpsychotic symptoms (e.g., dissociation) and address thought disorder.

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“…In addition, nine participants from the research project, “An Examination of the DSM‐5 Level of Personality Functioning Scale in a Representative Clinical Sample” (Buer Christensen et al, 2020; Buer Christensen et al, 2019; Buer Christensen et al, 2018), who had agreed to be contacted at a later stage for additional research purposes, were approached by the first author (A). They received written information about the research via their therapists.…”

Section: Methodsmentioning

confidence: 99%

Subjective experience of the origin and development of avoidant personality disorder

et al. 2020

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Objective To better understand how persons diagnosed with avoidant personality disorder (AVPD) make sense of the origin and development of their current everyday struggles. Methods Persons with AVPD (N = 15) were interviewed twice using semi‐structured qualitative interviews, which were analyzed through interpretative‐phenomenological analysis. Persons with the first‐hand experience of AVPD were included in the research. Results The superordinate theme, “a story of becoming forlorn,” encompassed three main themes: “it goes all the way back to when I was little,” “there was a distance between others and me,” and “transitions made it worse.” Conclusions Though the results are not necessarily specific to AVPD, the findings clarify how people with AVPD can make sense of their current struggles by constructing developmental life stories in the interplay between themselves as persons and the growing demands of their social world. Furthermore, childhood relational vulnerabilities may challenge the ongoing development of social cognition and skills.

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Evaluation of Diagnostic Thresholds for Criterion A in the Alternative DSM-5 Model for Personality Disorders

Cited by 19 publications

References 45 publications

Personality Functioning and Mentalizing in Patients With Subthreshold or Diagnosed Borderline Personality Disorder: Implications for ICD-11

Personality Functioning and Mentalizing in Patients With Subthreshold or Diagnosed Borderline Personality Disorder: Implications for ICD-11

Reconceptualization of borderline conditions through the lens of the alternative model of personality disorders.

Subjective experience of the origin and development of avoidant personality disorder

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