Preliminary field trial of a putative research algorithm for diagnosing ICD-11 personality disorders in psychiatric patients: 2. Proposed trait domains

Abstract

This field trial examines the discriminant validity of five trait domains of the originally proposed research algorithm for diagnosing International Classification of Diseases (ICD)-11 personality disorders. This trial was carried out in South Korea where a total of 124 patients with personality disorder participated in the study. Participants were assessed using originally proposed monothetic trait domains of asocial-schizoid, antisocial-dissocial, anxious-dependent, emotionally unstable and anankastic-obsessional groups of the research algorithm in ICD-11. Their assessments were compared to those from the Personality Assessment Schedule interview, and the five-factor model (FFM). A total of 48.4% of patients were found to have pathology in two or more domains. In the discriminant analysis, 64.2% of the grouped cases of the originally proposed ICD-11 domains were correctly classified by the five domain categories using the Personality Assessment Schedule, with the highest accuracy in the anankastic-obsessional domain and the lowest accuracy in the emotionally unstable domain. In comparison, the asocial-schizoid, anxious-dependent and the emotionally unstable domains were moderately correlated with the FFM, whereas the anankastic-obsessional or antisocial-dissocial domains were not significantly correlated with the FFM. In this field trial, we demonstrated the limited discriminant and the convergent validities of the originally proposed trait domains of the research algorithm for diagnosing ICD-11 personality disorder. The results suggest that the anankastic, asocial and dissocial domains show good discrimination, whereas the anxious-dependent and emotionally unstable ones overlap too much and have been subsequently revised.

Validating the proposed ICD‐11 domains

“…As noted in the introduction, a systematic review reported similar higher order dimensions in other patient samples (Mulder et al, ). A study attempting to validate our prior proposed domains suggested that while the Anankastic, Detached and Dissocial domains showed good discrimination, the emotionally unstable and anxious dependent ones did not (Kim et al, ). The Detached, Anankastic and Negative Affective domains are consistent with most higher‐order factor studies.…”

The time has come for dimensional personality disorder diagnosis

“…In contrast, there is a vast body of empirical literature supporting dimensional models of personality disorder that are closely aligned with the proposed model , in addition to the emerging body of work on the specific dimensions proposed for ICD‐11 . The ICD‐11 proposal has two elements.…”

Long‐term impact of temporary and persistent personality disorder on anxiety and depressive disorders

“…The differences in outcome shown between moderate and mild personality disorder in the ICD‐11 classification show the advantages of a single‐dimensional rating of personality disorder, and offset criticisms that such a simplified version of personality assessment is inadequate for clinicians prevented from using formal diagnostic categories (Pedersen et al, ). The evidence that there is good discrimination between the outcomes of those with mild and moderate personality disorder, without the need for further categories and qualified only by domain traits (Kim et al, ), shows an important advantage of the ICD‐11 dimensional system that is likely to be copied in future editions of DSM.…”