Assessment of ICD-11 Personality Disorder Severity in Forensic Patients Using the Semi-structured Interview for Personality Functioning DSM-5 (STiP-5.1): Preliminary Findings

Abstract

In forensic settings, several challenges may affect reliability of assessment of personality pathology, specifically when based upon self-report. This study investigates the Semi-Structured Interview for DSM-5 Personality Functioning (STiP-5.1) to assess level of severity of personality functioning in incarcerated patients. Thirty inpatients of three forensic psychiatric facilities completed the STiP 5.1 and additionally completed self-report questionnaires assessing symptom severity, personality functioning and traits. Staff members completed informant versions of personality functioning questionnaires. Previously assessed community (N = 18) and clinical samples (N = 80) were used as a reference. Interrater reliability and internal consistency of the STiP 5.1 were good. As expected, no associations were found between self-report and expert-ratings (STiP 5.1) of personality functioning. Remarkably, no associations were found between informant rated personality functioning and the STiP 5.1. This study confirms the discrepancies between self-report and expert-ratings in forensic settings and identifies the need to design and test assessment instruments within this context instead of generalizing findings obtained in regular mental health care samples. The STiP-5.1 may be a candidate for use in forensic samples, particularly to guide treatment planning and individual patient policy, although it remains unclear what specific information it offers above and beyond self-report and informant-report.

Reliability, structure, and validity of module I (personality functioning) of the Structured Clinical Interview for the alternative DSM–5 model for personality disorders (SCID-5-AMPD-I).

“…Most studies have been conducted with the Semi-Structured Interview for Personality Functioning DSM-5 (STiP-5.1; Hutsebaut et al, 2017) and the Structured Clinical Interview for the AMPD-Module I (SCID-5-AMPD-I; Bender et al, 2018). Overall good to excellent interrater reliability could be demonstrated with both, the STiP-5.1 (Hutsebaut et al, 2017(Hutsebaut et al, , 2021Weekers et al, 2021;Zettl et al, 2019) and SCID-5-AMPD-I (Buer Christensen et al, 2018;Somma et al, 2020). Test-retest reliability was also good when using the SCID-5-AMPD-I, though the coefficients for a few subdomains were questionable (Buer Christensen et al, 2018).…”

Criteria A and B of the Alternative DSM-5 Model for Personality Disorders (AMPD) Capture Borderline Personality Features Among Adolescents

“…First, as the study included only self-report measures only, this could lead to method-inherent pitfalls in each sample. Empirical studies have shown that self-report scores on personality functioning should be interpreted cautiously in forensic settings ( 56 ). Secondly, it used a specific measure of BPFSC-11 which limits the results to the current measure of borderline personality.…”

Changes in the classification of personality disorders: Comparing the DSM–5 Section II personality disorder model to the alternative model for personality disorders using structured clinical interviews.

“…The STiP 5.1 has shown theoretically consistent associations with other instruments assessing personality pathology, supporting construct validity (Hutsebaut et al, 2017). Replication studies have been conducted in different languages, age groups, and in a diversity of patient samples (Heissler et al, 2021; Hutsebaut et al, 2021; Weekers et al, 2020; Zettl et al, 2019). Taken together, the STiP-5.1 interview has demonstrated good psychometric properties across different samples.…”