Clinical profiles of adolescent personality pathology according to Criterion A of the AMPD, and comparison with the categorical model of BPD
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Abstract
Background: The alternative model for personality disorders (AMPD) operationalises personality pathology as a dimensional construct, as in the level of personality functioning scale (LPFS; Criterion A). However, it is not yet known if psychopathological correlates of LPFS and Borderline Personality Disorder (BPD) differ, nor has the LPFS been extensively explored in adolescent samples. Finally, attempts to disentangle clinical heterogeneity in adolescents reflected in Criterion A have not yet been conducted, and we aimed to elucidate clinically meaningful profiles. Methods: N=526 adolescents were assessed with the Semi-Structured Interview for Personality Functioning DSM-5 (STiP-5.1), and SCID-II for BPD criteria, to examine clinical overlap. To explore the latent structure, and subsequently, find homogenous subgroups of the STiP-5.1, we compared latent class analysis, factor analysis, and Factor Mixture Models (FMM), then further characterised the profiles. Results: 11.4% met diagnostic threshold of both the LPFS and BPD, 16.1% for the LPFS only, and 64.1% for neither (no PD). Unexpectedly, 8.4% did not fulfil threshold for LPFS, but did so for BPD (BPD only). The highest burden was found in those with impairment in personality functioning, and fulfilling BPD diagnosis. A complex 4-class, 2-factor FFM-3 (a hybrid of dimensional and categorical components) best described the latent structure of the STiP-5. The four classes differed in both overall severity of personality functioning impairment, and in clinical relevance on each element of the STiP-5.1 (qualitative differences), and other clinical variables. Conclusions: Findings confirm the high psychopathological burden associated with both BPD and LPFS. Not all adolescents fulfilling formal BPD diagnosis had clinically significant impairments in LPFS, possibly referring to a distinct diagnostic group. Criterion A provides clinically useful information beyond severity alone, and findings regarding the classes can help to parse out clinical heterogeneity in personality pathology in adolescents, and help to inform early identification and intervention.
Date Issued
2024-09-25
Publication Type
Conference Item
Language(s)
en
Author(s)