Validation of the DSM–5 Alternative Model Personality Disorder Diagnoses in Turkey, Part 1: LEAD Validity and Reliability of the Personality Functioning Ratings

Abstract

This study addresses longitudinal, expert, all data (LEAD) validity and reliability of the personality functioning ratings in Turkey, which are essential in assessing Criterion A for the entire DSM-5 alternative model for personality disorders (AMPD) diagnoses. A total of 120 consenting patients recruited at a university psychiatry clinic were rated by individual clinicians with respect to DSM-III-R and AMPD criteria. Subsequently, a LEAD panel consisting of 3 senior clinicians convened to reach a consensus personality disorder diagnosis for each participant. Blind personality functioning ratings of a subgroup of 20 participants by the same set of 4 clinicians were obtained for test-retest reliability investigation. Concordance between the LEAD and AMPD diagnoses was as good as that between the LEAD and DSM-III-R diagnoses (kappas = .68). The personality functioning scores correlated strongly (r > .50) with the sum of specific DSM-III-R diagnoses. Reliability estimates pertaining to the personality functioning scores and resultant AMPD Criterion A decisions were mostly in the good range. In conclusion, DSM-5 alternative model-oriented personality functioning ratings yield total or composite scores that are evidently valid and reliable tools to diagnose general personality disorder and to estimate its global severity.

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.…”

“…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 Level of Personality Functioning Scale‐Brief Form 2.0: Update of a brief instrument for assessing level of personality functioning

“…14,15 On the other hand, other studies demonstrated the model lends itself well for instruction, such that graduate students and inexperienced raters were able to apply the model with adequate interrater reliability. [16][17][18] An important way to improve clinical utility and ease of use is to develop assessment instruments for assessing the LPFS and pathological personality traits. Since its publication, several instruments for assessing the LPFS have been developed independently by different research groups, including two interview schedules 3,14 and (at least) three self-report questionnaires.…”

Validating the Level of Personality Functioning Scale: We don’t use multimethod research designs

“…Two studies included in this systematic review made use of multimethod measurement. Dereboy, Dereboy, & Eskin (2018) The second study included in this systematic review that made use of multimethod measurement, Zimmermann et al (2014), investigated the association between LPFS ratings and various external criterion measures. Two self-report outcome measures (i.e., number of personality disorder diagnoses and presence versus absence of a personality disorder, both derived from the SCID-II) and one secondhand outcome measure (i.e., an expert-rated measure that was used to score a recorded clinical interview 1 ) related to personality functioning were used by Zimmermann et al (2014) to assess the validity of the LPFS.…”