Self-Ratings of Personality Pathology: Insights Regarding Their Validity and Treatment Utility

Stanton, Kasey; Brown, Matthew F.; Bucher, Meredith A.; Balling, Caroline; Samuel, Douglas B.

doi:10.1007/s40501-019-00188-6

Cited by 14 publications

(11 citation statements)

References 56 publications

(68 reference statements)

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“…Also, the external validity of conclusions is obviously contingent upon the extraction of the optimal number of profiles; it must be acknowledged that our retained four-profile solution was not completely unambiguous (as shown by other plausible alternatives; see Table 1 and Supplementary Figure 1 ). Data were mostly collected through self-report questionnaires, which comes with the risk of dishonesty and/or poor insight in some cases; however, evidence supporting the validity and usefulness of self-ratings of personality pathology is accumulating [ 57 ], as most patients seem to report considerable levels of personality pathology through self-report assessment [ 58 ]. While file-rated aggression showed meaningful distinctions among profiles, the absence of significant results for file-rated suicidality and self-harm might point to a lack of sensitivity of the scales designed to rate them, to a lack of power in contrast with other indicators and variables (as there were a number of missing data), or to an “authentic”—albeit surprising—absence of difference among profiles on these critical outcome variables.…”

Section: Discussionmentioning

confidence: 99%

Latent profiles of patients with borderline pathology based on the alternative DSM-5 model for personality disorders

Gamache

Savard

Leclerc

et al. 2021

bord personal disord emot dysregul

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Background There have been multiple attempts to try to parse out heterogeneity within borderline pathology by identifying patient subtypes; thus far, these works have yielded few consistent results. Recent developments in the operationalization of borderline pathology may provide new opportunities to identify clinically and conceptually meaningful subgroups of patients. The Alternative DSM-5 Model for Personality Disorders (AMPD) offers a categorical-dimensional operationalization of Borderline personality disorder (BPD) that has yet to be tested for identification of patient subgroups. The purpose of the present study is to test whether the combination of the Criterion A elements (pertaining to level of severity) and the seven pathological facets from Criterion B that define BPD in the AMPD can yield meaningful patient profiles. Methods A total of 211 outpatients from a specialized PD treatment program (133 women, Mage = 33.66, SD = 10.97) were selected based on the presence of at least moderate borderline pathology according to cutoffs recently proposed for the Borderline Symptom List-23. Valid Criterion A (Self and Interpersonal Functioning Scale) and B (Personality Inventory for DSM-5 Faceted Brief Form) self-reports were administered to measure elements and facets that define BPD in the AMPD model; these variables were used as indicators in a latent profile analysis (LPA). Results The optimal solution generated by LPA yielded four distinct profiles: (a) Borderline traits; (b) Moderate pathology with Impulsivity; (c) Moderate pathology with Identity problems and Depressivity; and (d) Severe pathology. Clinically meaningful distinctions emerged among profiles on AMPD indicators and external variables relevant to PD, especially aggression and impulsivity. Conclusions Profiles reflected both the “severity” and “style” components imbedded within Criterion A and B of the AMPD, as they were mainly distinguished by a continuum of severity but also by some meaningful qualitative differences that may have important clinical implications for treatment planning and contracting. Results also suggest that the four Criterion A elements have independent value to identify important differences in patients with borderline pathology. They also highlight that some Criterion B facets that define BPD in the AMPD may be especially important to identify subgroups of patients, mainly Impulsivity and Depressivity.

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Section: Discussionmentioning

confidence: 99%

Latent profiles of patients with borderline pathology based on the alternative DSM-5 model for personality disorders

Gamache

Savard

Leclerc

et al. 2021

bord personal disord emot dysregul

View full text Add to dashboard Cite

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“…The main limitation of the present study is the sole reliance on self-reported variables as external validators. While evidence supporting the validity and usefulness of self-ratings of personality pathology is mounting [e.g., ( 74 , 75 )], the impact of response style bias as a potential confounding variable could not be taken into account. Future investigations of the validity of the present degrees of severity should not only include multiple instruments, but also multiple methods, as well as longitudinal and behavioral outcomes assessment, most notably to assess the risk of harm to self and others.…”

Section: Discussionmentioning

confidence: 99%

A Proposed Classification of ICD-11 Severity Degrees of Personality Pathology Using the Self and Interpersonal Functioning Scale

et al. 2021

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Background: The 11th version of the World Health Organization's International Classification of Diseases (ICD-11) has adopted a dimensional approach to personality disorder (PD) nosology. Notably, it includes an assessment of PD degree of severity, which can be classified according to five categories. To date, there is no gold standard measure for assessing degree of PD severity based on the ICD-11 model, and there are no empirically-based anchor points to delineate the proposed categories. With the operationalization of PD degrees of severity in the ICD-11 PD model now being closely aligned with Criterion A of the DSM-5 Alternative Model for Personality Disorders (AMPD), sharing a focus on self and interpersonal dysfunction, self-report instruments developed for the latter model might prove useful as screening tools to determine degrees of severity in the former.Methods: The Self and Interpersonal Functioning Scale, a brief validated self-report questionnaire originally designed to assess level of personality pathology according to the AMPD framework, was used to derive anchor points to delineate the five severity degrees from the ICD-11 PD model. Data from five clinical and non-clinical samples (total N = 2,240) allowed identifying anchor points for classification, based on Receiver Operating Characteristic curve analysis, Latent Class Analysis, and data distribution statistics. Categories were validated using multiple indices pertaining to externalizing and internalizing symptoms relevant to PD.Results: Analyses yielded the following anchor points for PD degrees of severity: No PD = 0–1.04; Personality Difficulty = 1.05–1.29; Mild PD = 1.30–1.89; Moderate PD = 1.90–2.49; and Severe PD = 2.50 and above. A clear gradient of severity across the five categories was observed in all samples. A high number of significant contrasts among PD categories were also observed on external variables, consistent with the ICD-11 PD degree of severity operationalization.Conclusions: The present study provides potentially useful guidelines to determine severity of personality pathology based on the ICD-11 model. The use of a brief self-report questionnaire as a screening tool for assessing PD degrees of severity should be seen as a time-efficient support for clinical decision and treatment planning.

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“…Rather, we were interested in patients’ subjective experiences of difficulties with the identification and description of feelings. Also, recent research suggests that self‐report assessment may actually be more suited for assessing patients’ subjective experiences than previously thought (59). Still, an alternative assessment of alexithymia, for example an observer‐rated measure like the Toronto Structured Interview for Alexithymia (60), would have been highly valuable in light of our findings and could perhaps be applied in future studies.…”

Section: Discussionmentioning

confidence: 99%

Borderline patients have difficulties describing feelings; bipolar II patients describe difficult feelings. An alexithymia study

Bøen

Hummelen

Boye

et al. 2020

Acta Psychiatr Scand

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Objective Apparent similarities between borderline personality disorder (BPD) and bipolar II disorder (BIP‐II) contribute to clinical difficulties in distinguishing between the disorders. Here, we aimed to explore how subjective Difficulties with the Identification and Description of Feelings (DIDF), a major constituent of the alexithymia construct and assessed as a part of the Toronto Alexithymia Scale (TAS), are related to relationship problems and health complaints in these groups. Methods Twenty‐two patients with BPD; 22 patients with BIP‐II; and 23 healthy controls (HC) completed TAS. Health complaints, including symptoms associated with mood swings, were assessed with the Giessener Subjective Complaints List (Giessener Beschwerdebogen—GBB), and relationship problems with the Health of the Nation Outcome scale, Relationship item (HoNOSR). Bivariate correlations were run. Results Both patient groups had high DIDF and GBB scores. In BPD only, there was a significant positive correlation between DIDF and HoNOSR. In BIP‐II only, there was a significant positive correlation between DIDF and GBB total score. In BIP‐II, DIDF correlated highly with those GBB subscales assessing symptoms typically occurring during bipolar mood swings (cardiovascular and gastrointestinal symptoms, exhaustion). Conclusion Our results suggest that in BPD, high DIDF scores represent genuine problems with identifying and describing emotions which are expected to correlate with relationship problems. In BIP‐II, high DIDF scores could potentially represent difficulties with understanding the unpredictable symptoms of bipolar mood swings. The findings suggest that difficulties with identifying and describing feelings in patients should be carefully explored to increase the validity of the diagnostic evaluation.

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Self-Ratings of Personality Pathology: Insights Regarding Their Validity and Treatment Utility

Cited by 14 publications

References 56 publications

Latent profiles of patients with borderline pathology based on the alternative DSM-5 model for personality disorders

Latent profiles of patients with borderline pathology based on the alternative DSM-5 model for personality disorders

A Proposed Classification of ICD-11 Severity Degrees of Personality Pathology Using the Self and Interpersonal Functioning Scale

Borderline patients have difficulties describing feelings; bipolar II patients describe difficult feelings. An alexithymia study

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