Determining essential dimensions for the clinical approximation of personality dysfunction severity - a multimethod study

Decades of research on the dimensional nature of personality disorder (PD) have led to thereplacement of categorical PD diagnoses by a dimensional assessment of personalitydysfunction severity (PDS) in ICD-11, which essentially corresponds to the dimensional PDmodel in Section III of DSM-5. Besides advancing the focus in the diagnosis of PD onimpairments in self and interpersonal functioning, this shift also urges clinicians worldwide toget familiar with new diagnostic approaches. This study investigated which PDS dimensionsamong different assessment methods and conceptualizations have the most predictive valuefor overall PDS. Using multi-method assessments with (semi-)standardized clinical interviewsand self-ratings of personality functioning, personality organization, and personality structurein clinical samples of different settings in Switzerland and Germany ( n = 285), we calculated alatent, method-adjusted general factor for PDS (g-PDS) by applying a correlated traitcorrelated method – 1 model. Our results showed that four interview-assessed PDSdimensions - defense mechanisms , desire and capacity for closeness , sense of self withboundaries to others , and comprehension and appreciation of experiences and motivations ofothers account for 95.0% of variance of g-PDS, with a combination of either two of these fourdimensions already explaining between 81.8% and 91.3%. Regarding self-reports, thedimensions depth and duration of connections, emotional range and regulation , and objectperception predicted 69.5% of the variance of a latent interview-based score, with allinvestigated self-reported dimensions together adding up to 74.9% variance explanation.Taken together, our data suggest that focusing on specific subdomains of, e.g., intimacy andidentity in time-limited settings might be effective in determining PDS.