It's not that Difficult: An Interrater Reliability Study of the DSM–5 Section III Alternative Model for Personality Disorders

Abstract

The Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM-5]; American Psychiatric Association, 2013 ) Section III Alternative Model for Personality Disorders (AMPD) represents a novel approach to the diagnosis of personality disorder (PD). In this model, PD diagnosis requires evaluation of level of impairment in personality functioning (Criterion A) and characterization by pathological traits (Criterion B). Questions about clinical utility, complexity, and difficulty in learning and using the AMPD have been expressed in recent scholarly literature. We examined the learnability, interrater reliability, and clinical utility of the AMPD using a vignette methodology and graduate student raters. Results showed that student clinicians can learn Criterion A of the AMPD to a high level of interrater reliability and agreement with expert ratings. Interrater reliability of the 25 trait facets of the AMPD varied but showed overall acceptable levels of agreement. Examination of severity indexes of PD impairment showed the level of personality functioning (LPF) added information beyond that of global assessment of functioning (GAF). Clinical utility ratings were generally strong. The satisfactory interrater reliability of components of the AMPD indicates the model, including the LPF, is very learnable.

Mental health professionals' perceived clinical utility of the ICD‐10 vs. ICD‐11 classification of personality disorders

“…These particular questions were designed to assess essential components of clinical utility as originally outlined by First et al, and ratings were provided on a 5‐point Likert scale from 1 (not at all useful) to 5 (extremely useful). To allow for comparisons across studies, the wording of the questions and the 5‐point response scale was identical to previous research on clinical utility …”

“…To allow for comparisons across studies, the wording of the questions and the 5-point response scale was identical to previous research on clinical utility. [28][29][30]32,38…”

A Brief but Comprehensive Review of Research on the Alternative DSM-5 Model for Personality Disorders

“…Results indicated that when using the LPFS based on written life history data, case vignettes, systematic interviews, or unstructured clinical impressions, interrater reliability was largely acceptable (with ICCs ranging from 0.42 to 0.67), even for untrained and clinically inexperienced raters [41-44, 46, 50, 131]. However, training sessions may increase the interrater reliability [132], and the interrater reliability tends to be better when based on structured interviews that were explicitly tailored to gathering the required information [26,34,133,134].…”

“…The interrater reliability of expert or informant ratings of maladaptive personality traits according to the AMPD is surprisingly unexplored. The only three studies available suggest that when using the PTRF based on clinical interview material or case vignettes, the interrater reliability of most trait facets may be acceptable (with median ICCs around 0.50), although some facets (e.g., perseveration) consistently yielded unsatisfactory results [41,131,132]. This highlights the need for applying structured interviews that are tailored to gathering the relevant information such as the SCID-AMPD Module II [36].…”

Interrater Reliability of the Structured Clinical Interview for the DSM–5 Alternative Model of Personality Disorders Module i: Level of Personality Functioning Scale

“…However, the reliability of the LPFS mean score across raters was extremely high (ICC ¼ .96). In another recently published study (Garcia et al, 2018), 13 advanced clinical psychology doctoral students with minimal familiarity with the LPFS evaluated clinical vignettes though three sessions of learning. The estimates of reliability (ICC) improved for each learning session, resulting in ratings for the domains in the range of .59 to .75, for global LPFS rating .81.…”