Article Review on Journal of Personality and Personality Disorders
Introduction
This is an article review paper based on empirical research. In the bid to research personality disorders (PD) I have decided to use an article titled “Validation of the DSM–5 Alternative Model Personality Disorder Diagnoses in Turkey, Part 1: LEAD Validity and Reliability of the Personality Functioning Ratings,” authored by Dereboy and colleagues (2018). The latter authors of this article belong to the Department of Psychiatry, “Adnan Menderes Universitesi Tip Fakultesi, and Aydin, Turkey.” This is evidence that the research paper is valid to address personality disorders. Additionally, this paper is peer-reviewed as it was first presented on 8 August 2017, and reviewed or revised on 23 November 2017, this makes it applicable for this review, more so it is within the 7-year range indicated in the instructions.
The purpose of this study conducted by these scholars was aimed at addressing the longitudinal, expert, all data (LEAD) validity and reliability of the personality functioning ratings based on Turkey. The reason to carry this research was “essential in assessing Criterion A for the entire DSM-5 alternative model for personality disorder (AMPD) diagnosis.” This research followed after the lack of provision in the diagnostic and statistical manual for mental disorders in the fourth edition in assessing the severity of impairments as a result of personality disorders (Dereboy, Dereboy, & Eskin, 2018). The authors sought to develop recent research that would include two different approaches of personality entitled as “Diagnostic Statistical Manual of Mental Disorders,” (DSM-5), the fifth edition. For this edition, the research would incorporate identity and self-direction, which are the attributes of self-functioning as well as empathy and intimacy which are the components attributed to interpersonal functioning.
According to various reports sourced from surveys on personality and personality disorders work from clinicians across North America supports the validity and utility of the alternative diagnostic strategies. Various researches have been conducted, for instance by Morey and Skodol aimed at investigating the use of alternative diagnostic strategies that could be applied to rate diagnostic rules. The latter rules had utility in stipulating the presence of impairment in any of the two components for PD diagnosis, using categorical components. More precisely, this paper hypothesized the psychometric performance of the two alternative requirements as it would sum up the dimensional component ratings that would either sum the least moderately impaired components to either total or surpass the maximum threshold.
Methods
In order to succeed in this study, the researchers deployed a group of 120 participants, of this group 80 were female while 4 were male. Also in this list of psychiatric patients, 78 were out-patients while 42 were in-patients, whose age ranged between 16 to 63 years. From the same group, 51 of them were single, 53 were married and the rest 16 had separated either by divorce or widowed. The group was also described in terms of occupations only 39 were employed, 31 categorized as housewives, 26 still studying, 13 found to be unemployed and only 11 had retired. Based on socio-economic characteristics of the respondents 30 belonged to the high class and 2 were from a very high social class, 71 were of medium class, 9 poor, and 6 very poor (Dereboy, Dereboy, & Eskin, 2018). Most importantly, on the principle diagnosis already listed in the charts in the routine assessment 70 had already been diagnosed for mood disorders 47 with anxiety disorders, while 6 with somatoform disorders.
After the details on the respondents, various tests were done, using various instruments. One of the instruments was used to determine the level of personality functioning scale, the Turkish version, which provided anchors to the rates of impairments in components of self-functioning and interpersonal functioning using a 5-point scale, zero being minimal and 4- extreme. Additionally, structure interviews were also sought on DSM-III_R, Axis II, where patients would conduct a self-reporting to report either absence or presence of PD symptoms, the participants would respond to 12-forced choice questions of a screening instrument, from where they could be now rated concerning the 102 diagnostic criteria. The previously stated instruments were then followed by familiarization of the criteria for assessment by conduction open LPFS trait ratings, which incorporated the in- and out-patients who were literate to participate in filling informed consent forms and self-reporting instrument to participate in the study, excluding the illiterate, those with mental retardation, or psychotic disorders.
The participants were evaluated by an intake clinician and SCID-II ratings were performed. The raters had access to the patient’s charts, and also took part in interviewing the participants and informants seeking information useful in rating personality functioning and traits on PD symptoms. Another set of individual ratings were also subjected to validity and reliability analyses. After the collection of the individual ratings analysis and disclosure of the DSM-III-R and DSM-5 individuals were now capable to use the available longitudinal data to determine the LEAD diagnoses panel that would help attain maximum diagnostic efficiency and thus making informed and sound decisions. The latter decisions would be useful to determine whether individual personality is disordered; this can be achieved by evaluation of the variables, which can be defined, which are either independent or dependent. These variables were used to perform various statistical analyses, aimed at gauging the agreement levels between PD diagnosis by the individual clinicians and the LEAD panel. These variables include self-direction, intimacy, empathy, LPFS score, based on the 120 participants.
Results
The purpose of this study was to address the distribution, diagnostic utility, and reliability of the two summary scores: “the LPFS total representing the sum dimensional component rating and the LPFS composite representing the sum of components at least moderately impaired.” From table 1 the component ratings for the first and the second set of data revealed that the second data tends to slightly higher than the first one, which is comparably a greater impairment in the personality functioning of the involved participants. The CIs means overlap revealing that there is no significant difference between the two rating sets. Besides, based on the validity of PD ratings against LEAD diagnoses, the ROC analysis reveals that both LPFS composite seemed convenient to predict LEAD diagnoses (Dereboy, Dereboy, & Eskin, 2018). Also, the table reveals that when employed with optimal cutoffs with a score of 2 and LPFS value of 6, the summary score works with equal accuracy when differentiating subjects with LEAD diagnoses from those without. The LPFS composite matches closely with the DSM-5 AMPD criteria requirement to manifest personality functioning.
Additionally, the results on the validity of individual clinicians’ diagnosis against LEAD diagnosis reveal that the accuracy of intake of diagnostic decisions improved considerably as they gained experience in rating the LPFS and SCID-II. Also, the AMPD evaluations portrayed that stability of the accuracy in DSM-5 overlapped regardless of the raters’ perception about the people being rated. In the bid to explore the validity of LPFS as a tool to gauge the severity of the personality pathology, following a correlation computation on LPFS individual components and summary scores with a sum of current PD symptoms and SCID-II ratings, the results on the correlation between the two were mostly medium for the entire sample, small to medium for similar conditions and medium to strong for different rater condition. Thus the improvement of LPFS and SCI-II ratings could be increased by increasing both their convergence and creating a strong association with each other. Lastly, the internal test-retest reliability of the LPFS score revealed that the sample reliability estimates were in good or questionable limits, lower limits of the CIs getting to unacceptable levels, while population estimates for LPFS summary score remaining in safe ranges.
Discussion
Based on the research above, the application of the diagnostic criterion validity matches experts’ gauges. From the observation and study results, it is true that coders are capable of performing accurate decisions and thus make considerable improvement in LEAD validity on PD through whichever criteria as they gained experience in rating the SCID-II and LPFS throughout the study (Dereboy, Dereboy, & Eskin, 2018). More so, the LPFS total and composite scores seem equally useful in making valid decisions based on Criterion A of the AMPD, apart from which LPFS would assess global severity of PD as well, revealing a significant and strong correlation between LPFS components and summary score with the sum of SCID-II PD symptoms. The results revealed in this study were consistent with minor variations making it satisfactory and reliable in reporting LPFS total on clinical samples and unprecedented AMPD literature, thus supporting the reliability of Criterion A decisions based on the diagnostic rule that requires two or more impaired components.
References
Dereboy, F., Dereboy, Ç., & Eskin, M. (2018). Validation of the DSM–5 alternative model personality disorder diagnoses in Turkey, Part 1: LEAD validity and reliability of the personality functioning ratings. Journal of personality assessment, 100(6), 603-611.
