Examining criterion a: DSM–5 level of personality functioning as assessed through life story interviews.

Abstract

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition alternative model for personality disorders offers a two-part definition of personality pathology, separating personality functioning from traits. The Level of Personality Functioning Scale (LPFS) from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition alternative model for personality disorders encapsulates the personality functioning criterion, and several methods have been used to assess it. Previous interview rating methods have overlapped with an assessment of personality traits and symptoms, biasing the assessment of functioning, and recently developed self-report instruments rely on the participant’s awareness of their personality pathology. The purpose of the current analyses was to examine the reliability and validity of LPFS ratings based on open-ended, nondiagnostic interviews. The sample consisted of 162 community-dwelling, older adult participants from the St. Louis Personality and Aging Network. Undergraduate students rated video recordings of Life Story Interviews, using a 12-item version of the LPFS. One-way random, average measures intraclass correlation coefficient for the total LPFS was .80. A principal components analysis indicated that a single underlying dimension could characterize the LPFS. Component scores derived from this analysis demonstrated theoretically consistent associations with both normal-range and maladaptive personality traits. The component scores also contributed small but significant variance to the prediction of personality disorder symptoms, health, and functional outcomes over and above personality traits. These findings support the reliability and validity of the LPFS as assessed using Life Story Interviews and suggest that personality functioning ratings may have utility in predicting clinically relevant outcomes.

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

“…In the AMPD, the assessment of PD severity was originally conceived of as applying the LPFS as an expert rating on a single five-point scale [40]. Other researchers have applied the LPFS in a more differentiated way by separately rating the four domains [41,42], the 12 subdomains [34,[43][44][45][46], or the 60 prototypical descriptions [47••] and aggregating the ratings afterwards. To systematically collect the information that is relevant to make these ratings, several structured clinical interviews have been developed, including the Semi-Structured Interview for Personality Functioning DSM-5 (STiP-5.1) [34], the Clinical Assessment of the Level of Personality Functioning Scale (CALF) [26], and the Structured Clinical Interview for the Level of Personality Functioning Scale (SCID-AMPD Module I) [35].…”

“…Internal consistency of the LPFS total score has been shown to be acceptable when computed based on ratings of the four domains [40,42] and very high when computed based on ratings of subdomains [34,46,48,135] or individual items [29, 51, 136••]. Moreover, the four domains [27,29,43,46,51,136••] and the 12 subdomains [47••] also showed rather high internal consistency. Most subdomains appear to be unidimensional, albeit this may not be true for all of them (e.g., desire and capacity for closeness is probably more heterogeneous) [47••].…”

“…The convergent validity of the LPFS as an expert rating has been demonstrated to be substantial with regard to the presence and/or number of section II PDs [34,[42][43][44]46], the number of PD symptoms [34,40,41], psychodynamic conceptualizations of PD severity [43,44,133], as well as selfreported PD severity [34,50,138], maladaptive traits [46], and symptom distress [34,41]. In addition, studies have established associations with psychosocial functioning, short-term risk, proposed treatment intensity, and estimated prognosis [40], lifetime mental health treatment, history of substance use, mental and physical health, and social and relationship adjustment [46], as well as risk for dropout from inpatient treatment [139].…”

“…The LPFS total score has been shown to predict the presence and severity of PD when controlling for symptom distress or comorbid mental disorders [43,44], and to predict psychosocial functioning, short-term risk, proposed treatment intensity, and estimated prognosis when controlling for categorical PD diagnoses [40]. Moreover, a recent study suggested that the LPFS total score predicts several specific PDs and life outcomes when controlling for general personality traits [46]. Research on the incremental validity when controlling for maladaptive traits (criterion B) will be summarized below.…”

“…With regard to incremental validity, the results are somewhat mixed. While some studies found support for the incremental validity of severity compared to maladaptive traits when predicting some section II PDs [46,137,209], personality dynamics in daily life [45,49], symptom distress [135], substance use and physical health [46], well-being [27,135], maladaptive schemas [135], and interpersonal dependency [27], the effect sizes were typically rather small, and other studies did not find incremental value for severity ratings when predicting section II PDs [41, 88••] and problematic alcohol use [226•]. In contrast, the incremental validity of maladaptive traits when controlling for severity seems to be more robust [41, 45, 49, 88••, 135, 137, 226•].…”