Lecture 5 Flashcards by fientje suntrop

Article: Krueger & Hobbs (2020) “An overview of DSM-5 alternative model of personality disorder”

Krueger&Hobbs (2020)

Article provides a detailed explanation of the Alternative Model of Personality Disorders (AMPD) as proposed in DSM-5 and contrasts it with earlier, more categorical models of diagnosing personality disorders (PDs).

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Background and shift toward dimensional models

Krueger&Hobbs (2020)

Historically, psychiatric nosology (classification of diseases) was mostly categorical, especially after DSM-3 with structured criteria for PDs.

This lead to problems like comorbidity and within-category heterogenity (variations within one diagnosis).

–> As this became apparent, calls for dimensional model grew, leading to AMPD in DSM-5

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AMPD

Criterion A: Personality functioning

Krueger&Hobbs (2020)

Refers to impairments in both the sense of self and interpersonal functioning

The Levels of personality functioning scale (LPFS) operationalized this, breaking personality functioning into four aspects:
- Self-functioning: identity and self-direction
- Interpersonal functioning: empathy and intimacy

Levels of impairment are rated on a scale from mild to severe

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AMPD

Criterion B: Maladaptive personality traits

Krueger&Hobbs (2020)

These traits are grouped in 5 domains, derived from 5-factor model but representing their pathological versions:
- Negative affectivity: tendency toward anxiety and depression
- Detachment: withdrawal from social interactions
- Antagonism: manipulativeness, hostility
- Disinhibition: impulsivity, lack of planning
- Psychoticism: odd, eccentric thoughts and behaviors

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AMPD

Criteria C-G

Krueger&Hobbs (2020)

These adress issues such as
- Inflexibility (C)
- Stability over time (D)
- Ruling out other mental or medical causes (E, F)
- Sociocultural norms (G)

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Clinical utility AMPD

Krueger&Hobbs (2020)

Aims to reframe classic DMS-4 PD types (BPD, NPD, APD).

Instead of using fixed symptom list, these disorders are viewed through combinations of personality functioning (criterion A) and maladaptive traits (criterion B).

This approach allows more nuanced, individualized understanding of personality pathology.

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Emperical research

Reliability and validity of criterion A

Krueger&Hobbs (2020)

Found moderate inter-rater reliability for LPFS, with structured interviews improving reliability.

Criterion A linked to important clinical outcomes, like treatment dropout rates and severity of PDs.

Ongoing debate over exact structure of criterion A

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Emperical research

Criterion B

Krueger&Hobbs (2020)

Personality inverntory for DSM-5 (PID-5) is often used to assess maladaptive traits.

Research supports reliability and validity of 5-factor structure, and these traits have been shown to effectively capture DSM-4 PD features.

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Correlation between criterion A and B

Krueger&Hobbs (2020)

Substantial correlations between criteria, which led to discussion whether these should remain separate.

One side: correlations might suggest that criteria should be simplified.

Other side: keeping them distinct allows for a richer understanding of personality pathology

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AMPD compared to ICD-11

Krueger&Hobbs (2020)

ICD-11 also uses a dimensional approach (like AMPD)

Uses severity-based classification system (mild, moderate, severe) and trait similar to those in AMPD

Difference: ICD excludes psychoticism, focusing on traits like anankastia (obsessive-compulsive features)

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Conclusion

Krueger&Hobbs (2020)

AMPD provides flexible, individualized approach to diagnosis, and research supports its clinical validity.

Challenges remain in: connecting this model to intervention strategies and integrating it with existing clinical frameworks.

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Emmelkamp&Kamphuis (2020) CH2: Diagnosis and assessment

Emmelkamp&Kamphuis (2020)

How are PDs diagnosed in DSM-5?
2 models of PDs (5-factor and AMPD)
PD assessment instruments
Issues in clinical assessment of PDs

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Construct validity

Emmelkamp&Kamphuis (2020)

Degree to which a test measures what it claims, or purports, to be measuring.

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To diagnose PD, DSM5 requires 2 step procedure:

Emmelkamp&Kamphuis (2020)

Establish whether patient meets the general criteria for PD
The more specific criteria comprise a description of the dynamics of the PD, with a specification of its set of specific constituent diagnostic criteria

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Polythetic criteria

Emmelkamp&Kamphuis (2020)

No single criterion is absolutely required or essential to the disorder

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five-factor model (FFM) and PDs

Emmelkamp&Kamphuis (2020)

Neuroticism
Extraversion
Agreeableness
Openess to experience
Conscientiousness (organization and achievement motivation)

PDs can be described as maladaptive variants of normal FFM:
- ASPD: high antagonism (facets of A), low deliberation, dutifulness, self-discipline (C), low anxiety and self-consciousness (N), high impulsiveness (N), excitement seeking (E), angry hostility (N)
- BPD: high anxiousness, angry hostility, depressiveness, impulsivity and vulnerability (N), high openness to feelings and ideas (O), low deliberation (C)

Limitations FFM

Emmelkamp&Kamphuis (2020)

Not all factors have been found to be equal
Not sure if FFM captures more severe manifestations of personality psychopathology, like: self-harm behavior in BPD
Clinician has to be well-trained to discriminate in traits to make adequate appraisal of risk behavior
Negative affect is stronger and more robust predictor of suicide attempts

Alternative model of DSM-5 (AMPD)

Emmelkamp&Kamphuis (2020)

Integrates 2 important key concepts of PD:
A. Level of personality functioning
B. Dimensional model of 25 personality traits based on 5 domains:
1. Negative affectivity
2. Detachment
3. Antagonism
4. Disinhibition
5. Psychoticism

AMPD assumes that PDs are characterized by problems in self-functioning and interpersonal functioning

PD assessment instruments

Structural clinical interview for DSM-5 PD (SCIP-5-PD)

Emmelkamp&Kamphuis (2020)

Semi-structured interview to assess DSM-5 cluster A, B and C

Accordin to categorical approach
Possibility of scoring severity with a dimensional approach
Investigates comorbidity and underlying structure of PD

PD assessment instruments

Structured interview for DSM-IV Personality (SIDP-IV)

Emmelkamp&Kamphuis (2020)

Semi-structured diagnostic interview for PDs

Questions arranged by theme rather than by disorder to minimize focus on personality pathology and reduce interview bias
Each criterion rated on scale
Interrater reliability is good

PD assessment instruments

Personality inventory for DSM-5 (PID-5)

Emmelkamp&Kamphuis (2020)

Measures 5 domains of FFM and 25 maladaptive traits of personality of the DSM-5 AMPD

Good contruct validity in internal structure
Good convergent, discriminant and criterion validity
Good convergenct validity with other models of persoanlity, such as PSY-5 and FFM

PD assessment instruments

Semi-structured interview for personality functioning DSM-5 (STiP-5.1)

Emmelkamp&Kamphuis (2020)

Measures level of personality functioning according to AMPD

Limited research
Interrater reliability among an outpatient sample was adequate to good across dimensions
Correlated with impairments in self-functioning and interpersonal functioning and other measures of personality impairment

What has gained the “golden standard” for assessing PD?

Emmelkamp&Kamphuis (2020)

Structured clinical interviews

What are risks of self-report assessment of personality pathology?

Emmelkamp&Kamphuis (2020)

Personality pathology is by definition ego-syntonic, and personality-disordered individuals may thus be liable to produce biased self-portrayals

# Self-reports Milion clinical multiaxial inventory-III (MCMI-III) | Emmelkamp&Kamphuis (2020)

Intended to provide info on personality traits and psychopathology including DSM PDs - Based on Theodore Millon's evolutionary theory - Includes, besides 15 personality pattern scales, the following scales measuring different aspects: ten clinical syndrome scales and 5 different validity scales

# Self-reports Personality disorder questionnaire-IV (PDQ-4) | Emmelkamp&Kamphuis (2020)

A forced choice, self-report, 99-item questionnaire designed to measure the DSM-IV PDs - Hasn't been found to be useful as a screening instrument in clinical practive

# Self-reports Personality assessment inventory (PAI) | Emmelkamp&Kamphuis (2020)

344-item self-report personality test that assesses personality and psychopathology - Each item is a statement which has to be rated on a four-point scale - Shows good convergent validity with the MMPI - Discriminates from feigned syndrome disorders

# Self-reports Dimensional assessment of personality patholohy basic questionnaire (DAPP-BQ) | Emmelkamp&Kamphuis (2020)

290-item self-report instrument developed to assess dimensions of PDs in clinical populations and shows a robust four-factor structure - Strong predictor of both PD rating and the severity of PDs

# Self-reports Minnesota multiphasic personality inventory 2-RF (MMPI-2-RF) | Emmelkamp&Kamphuis (2020)

One of most widely used personality inventories used for structural diagnosis within a person to het more insight into psychopathology, dynamics, and motivation, and gives the clinician an idea about the validity of the assessment and possible response sets. - Provides clinician with more structural information about patient - Danger for interpretation bias, especially in case of comorbid symptoms - 9 restructured main scales - Provides clinician with profile of PSY-5-RF which relates to FFM and AMPD very well - Includes a set of 5 interpersonal scales designed specifically to measure variations of interpersonal problems

# Self-reports NEO-personality inventory-revised (NEO-PI-R) | Emmelkamp&Kamphuis (2020)

Personality questionnaire of Big Five - Reports on 6 subcategories of each Big Five personality traits

# Self-reports Shedler and Western assessment procedure-200 (SWAP-200) | Emmelkamp&Kamphuis (2020)

A clinicians report rather than a self-report instrument - More comprehensive and clinically relevant - Items consist of PD and disorder symptoms - Clinicians sort statements into 8 categories from least descriptive to most descriptive

# Self-reports Temperament and character inventory - revised (TCI-R) | Emmelkamp&Kamphuis (2020)

240-item self-report inventory of personality traits related to the dimensions of personality in Zuckerman's alternative five, Eysenck's model and FFM. - 4 dimensions operationalized as "temperament" - 3 dimensions operationalized as "character" - Based on model that attempts to explain underlying causes of individual differences in personality traits

# Self-reports Young schema questionnaire (YSC) | Emmelkamp&Kamphuis (2020)

Consists of 5 broad categories of unmet needs which were grouped into 18 maladaptive schemas resulting in maladaptive coping styles. - 5 schema domains: disconnection/rejection, imparied autonomy and/or performance, impaired limits, other-directedness and overvigilance/inhibition - In PD patients these schemas tend to be more severe and rigid

What are problems with self-reports | Emmelkamp&Kamphuis (2020)

1. Unclear if patients can give unbiased description of themselves --> clinicians should rely on informants or clinician-rated methods 2. It seems plausible that PD patients don't present accurate views on own thoughts, behavior and feelings --> but no hard-emperical evidence that that's the case.