Field trial of a putative research algorithm for diagnosing ICD‐11 personality disorders in psychiatric patients: 1. Severity of personality disturbance

Kim, Youl‐Ri; Blashfield, Roger K.; Tyrer, Peter; Hwang, Soon-taeg; Lee, Hong Seock

doi:10.1002/pmh.1248

Cited by 34 publications

(30 citation statements)

References 28 publications

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“…Yet, there is only one rather small field trial that has assessed the reliability of the yes/no decision based on these general criteria (Kim, Blashfield, Tyrer, Hwang, & Lee, 2014). …”

Section: The Icd-11 Proposal: Limitations Of a Purely Dimensional Appmentioning

confidence: 99%

“…The selection of the optimal classification scheme needs to be informed by evidence, but to our knowledge, there has only been one rather small head-to-head field trial (Kim et al 2014) comparing the face or predictive validity of DSM-5 section II versus ICD-11 proposals. We would encourage such studies, as they might help to guide the field forward.…”

Section: The Icd-11 Proposal: Limitations Of a Purely Dimensional Appmentioning

confidence: 99%

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The Challenge of Transforming the Diagnostic System of Personality Disorders

Herpertz

Huprich

Bohus

et al. 2017

Journal of Personality Disorders

140

100

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While the DSM-5 alternative model of personality disorder (PD) diagnosis allows the field to systematically compare categorical and dimensional classifications, the ICD-11 proposal suggests a radical change by restricting the classification of PDs to one category, deleting all specific types, basing clinical service provision exclusively upon a severity dimension, and restricting trait domains to secondary qualifiers without defining cutoff points. This article reflects broad international agreement about the state of PD diagnosis. It is argued that diagnosis according to the ICD-11 proposal is based on broad, potentially stigmatizing descriptions of impaired functioning and ignores much of the impressive body of research and treatment guidelines that have advanced the care of adults and adolescents with borderline and other PDs. Before radically changing classification, which highly impacts the provision of health care, head-to-head field trials coupled with the views of patients as well as thorough debate among scientists are urgently needed.

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“…Yet, there is only one rather small field trial that has assessed the reliability of the yes/no decision based on these general criteria (Kim, Blashfield, Tyrer, Hwang, & Lee, 2014). …”

Section: The Icd-11 Proposal: Limitations Of a Purely Dimensional Appmentioning

confidence: 99%

Section: The Icd-11 Proposal: Limitations Of a Purely Dimensional Appmentioning

confidence: 99%

The Challenge of Transforming the Diagnostic System of Personality Disorders

Herpertz

Huprich

Bohus

et al. 2017

Journal of Personality Disorders

140

100

View full text Add to dashboard Cite

show abstract

“…It has been suggested that even a crude three-level dimensional approach (absent, sub-threshold traits, present) utilizing the results for SCID-II may be a more valid measure of psychosocial morbidity than the traditional categorical approach [11]. Recently, Kim et al (2014) also used a modified four-level dimensional approach with a classification of personality disturbances ranging from “Personality difficulty” (the mildest) to “Severe personality disorder” (the most severe) [12]. …”

Section: Introductionmentioning

confidence: 99%

Clinical importance of personality difficulties: diagnostically sub-threshold personality disorders

et al. 2017

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BackgroundCurrent categorical classification of personality disorders has been criticized for overlooking the dimensional nature of personality and that it may miss some sub-threshold personality disturbances of clinical significance. We aimed to evaluate the clinical importance of these conditions. For this, we used a simple four-level dimensional categorization based on the severity of personality disturbance.MethodsThe sample consisted of 352 patients admitted to mental health services. All underwent diagnostic assessments (SCID-I and SCID-II) and filled in questionnaires concerning their social situation and childhood adversities, and other validated tools, including the Beck Depression Inventory (BDI), Alcohol Use Disorders Identification Test (AUDIT), health-related quality of life (15D), and the five-item Mental Health Index (MHI-5). The patients were categorized into four groups according to the level of personality disturbance: 0 = No personality disturbance, 1 = Personality difficulty (one criterion less than threshold for one or more personality disorders), 2 = Simple personality disorder (one personality disorder), and 3 = Complex/Severe personality disorder (two or more personality disorders or any borderline and antisocial personality disorder).ResultsThe proportions of the groups were as follows: no personality disturbance 38.4% (n = 135), personality difficulty 14.5% (n = 51), simple personality disorder 19.9% (n = 70), and complex/severe personality disorder 24.4% (n = 86). Patients with no personality disturbance were significantly differentiated (p < 0.05) from the other groups regarding the BDI, 15D, and MHI-5 scores as well as the number of Axis I diagnoses. Patients with complex/severe personality disorders stood out as being worst off. Social dysfunction was related to the severity of the personality disturbance. Patients with a personality difficulty or a simple personality disorder had prominent symptoms and difficulties, but the differences between these groups were mostly non-significant.ConclusionsAn elevated severity level of personality disturbance is associated with an increase in psychiatric morbidity and social dysfunction. Diagnostically sub-threshold personality difficulties are of clinical significance and the degree of impairment corresponds to actual personality disorders. Since these two groups did not significantly differ from each other, our findings also highlight the complexity related to the use of diagnostic thresholds for separate personality disorders.

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“…However, the linear trend between the number of co-occurring PD categories and the prevalence of reported violence suggests that the association can be explained by the total number of traits, rather than a specific combination of those traits. These findings might suggest support for the notion of classifying PD according to severity (Crawford, Koldobsky, Mulder, & Tyrer, 2011); Kim and colleagues showed that with increasing severity of PD, there is an increase in clinical pathology and social dysfunction (Kim, Blashfield, Tyrer, Hwang, & lee, 2014). In the present study, increasing severity corresponds to an increasing number of abnormal personality traits as indicated by the increasing number of PD categories.…”

Section: Co-occurring Psychopathologymentioning

confidence: 52%

Personality disorder and violence in the national household population of Britain

Coid

González

Igoumenou

et al. 2016

The Journal of Forensic Psychiatry & Psychology

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IntroductionViolence is believed to be more common in people with personality disorder (PD). Patients with these conditions were previously excluded from health care services due to concerns over potential violence and disruptive behaviour (National Institute for Mental Health in England, 2003). Subsequent policy required mental health professionals to take action to protect the public from people with PD. Epidemiological evidence supports concerns over PD, ABSTRACT Background: Antisocial personality disorder (ASPD) is strongly associated with violence but the effects of other personality disorder (PD) categories are uncertain. Purpose: To investigate associations between 10 DSM-IV PD categories and effects of co-occurring disorders on self-reported violence. Method: Cross-sectional survey of 8397 adults aged 16-74 years in households in Great Britain. Results: ASPD contributed strongly to the burden of violence in the British population. Paranoid and obsessive-compulsive PD made additional independent contributions, and narcissistic PD contributed to intimate partner violence. The prevalence of violence correlated with the number of PD categories. Comorbid alcohol dependence further increased the risk. Conclusions: Risk of violence increases with increasing severity of PD, measured by the number of PD categories, and with co-occurring alcohol dependence. Not all PD categories are associated with violence, and avoidant PD was protective. Identification of targets for future interventions may be obscured using a classification based solely on severity.

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Field trial of a putative research algorithm for diagnosing ICD‐11 personality disorders in psychiatric patients: 1. Severity of personality disturbance

Cited by 34 publications

References 28 publications

The Challenge of Transforming the Diagnostic System of Personality Disorders

The Challenge of Transforming the Diagnostic System of Personality Disorders

Clinical importance of personality difficulties: diagnostically sub-threshold personality disorders

Personality disorder and violence in the national household population of Britain

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