Assessment of personality functioning in ICD-11 posttraumatic stress disorder and complex posttraumatic stress disorder.

Abstract

The newly added diagnosis complex posttraumatic stress disorder (CPTSD) in the 11th edition of the International Classification of Diseases (ICD-11) includes a domain of disturbances in self-organization (DSO), in addition to PTSD. The DSO construct appears to have definitional overlap with the dimensional personality pathology severity measure, personality functioning. This study investigated the association between personality functioning and ICD-11 CPTSD, and the associations between DSO clusters and personality functioning domains. The sample comprised 83 outpatients with ICD-11 PTSD or CPTSD. Personality functioning was operationalized with the Level of Personality Functioning Scale (LPFS) and assessed with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Alternative Model for Personality Disorders, Module I. Results showed an average level of moderate impairment in personality functioning (i.e., Identity, Self-Direction, Empathy, and Intimacy) for the whole sample. However, the levels of impairment in personality functioning were significantly more severe in patients with ICD-11 CPTSD, compared with patients with PTSD. Furthermore, the results revealed strong significant positive associations between the personality functioning domains and the DSO symptom clusters, except for the LPFS Identity domain and the DSO Affective Dysregulation cluster. Contrary to expectations, we found a significant positive association between the PTSD symptom cluster Avoidance and the LPFS domains Identity, Self-Direction, and Intimacy. Furthermore, higher levels of impairment in the Identity and Intimacy domain were associated with an increase in DSO symptom severity. New development in assessment of personality functioning may assist clinicians in differential diagnosis of PTSD and CPTSD.

Differences in personality functioning impairment in mood, anxiety, and personality disorders: a cluster analysis

“…It was even suggested that Criterion A closely aligns with the so-called general factor of psychopathology included in the alternative nosology of mental disorders, the Hierarchical Taxonomy of Psychopathology (HiTOP) [ 11 , 28 , 29 ]. Nonetheless, this could also consequently lead to difficulties with differential assessment between personality disorders and other mental disorders, because many of them can fulfill the diagnostic threshold as well [ 26 ]. This can be important especially when using the ICD-11, where the emphasis is primarily on characterizing personality functioning problems, and description using trait domain qualifiers is rather voluntary [ 5 , 53 ].…”

“…Internal consistency, measured by McDonald’s ω, was high in our sample (total = 0.936, Self = 0.898, Interpersonal = 0.89). In our study, in addition to the total severity score, we use the two domain scores – Self and Interpersonal functioning – and twelve facets scores as well (as already done by previous studies exploring personality functioning [ 26 , 27 ]).…”

“…The personality functioning was conceptualized to assess impairment and delayed development of the adaptive intrapsychic system needed for mature fulfillment in adult life [ 12 , 21 ]. Thus, it is plausible to assume that personality functioning is to some degree also impaired in other mental disorders in addition to personality disorders [ 4 , 22 – 26 ]. Furthermore, the interest in personality functioning in other mental disorders than personality disorders has increased in recent years [ 25 ].…”

“…For example, Di Pierro et al [ 24 ] found that people with psychopathologies other than personality disorders showed impairment in facets of personality functioning (i.e., identity, empathy), however, the impairment just rarely satisfied the Criterion A of the AMPD. Møller et al [ 26 ] found associations between impairments in personality functioning and posttraumatic stress disorder, with possible further utilization in the differential diagnosis. There are also initial results indicating that personality functioning can have an impact on psychosocial functioning across various diagnostic categories [ 27 ].…”

“…There are also initial results indicating that personality functioning can have an impact on psychosocial functioning across various diagnostic categories [ 27 ]. Though the utility of personality functioning assessment beyond personality disorders was repeatedly supported by research [ 17 , 22 , 24 , 26 , 27 ], with some authors even proposing that personality functioning might represent a general psychopathology factor [ 28 – 30 ], little is still known about the nature of personality functioning impairment in other-than-personality-disorders diagnoses.…”