It's not that Difficult: An Interrater Reliability Study of the DSM–5 Section III Alternative Model for Personality Disorders

ABSTRACT

The Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM–5]; American Psychiatric Association, 2013) Section III Alternative Model for Personality Disorders (AMPD) represents a novel approach to the diagnosis of personality disorder (PD). In this model, PD diagnosis requires evaluation of level of impairment in personality functioning (Criterion A) and characterization by pathological traits (Criterion B). Questions about clinical utility, complexity, and difficulty in learning and using the AMPD have been expressed in recent scholarly literature. We examined the learnability, interrater reliability, and clinical utility of the AMPD using a vignette methodology and graduate student raters. Results showed that student clinicians can learn Criterion A of the AMPD to a high level of interrater reliability and agreement with expert ratings. Interrater reliability of the 25 trait facets of the AMPD varied but showed overall acceptable levels of agreement. Examination of severity indexes of PD impairment showed the level of personality functioning (LPF) added information beyond that of global assessment of functioning (GAF). Clinical utility ratings were generally strong. The satisfactory interrater reliability of components of the AMPD indicates the model, including the LPF, is very learnable.

Acknowledgments

We gratefully acknowledge the contributions of the students in the graduate psychometrics course who provided rating data. We also thank Donna Bender, PhD, for 10 case vignettes illustrating LPF. Portions of this article were presented in a poster at the Society for Personality Assessment meeting, San Francisco, CA, March 2017. We have made these data publicly available at the Open Science Framework Web site at https://osf.io/xv645/.

Financial disclosure

This work is the opinion of the authors and does not represent the position or endorsement by UT Battelle, LLC, ORNL, & the U.S, Department of Energy. This article has been authored by UT-Battelle, LLC, under Contract No. DE-AC05-00OR22725 with the U.S. Department of Energy. The United States Government retains and the publisher, by accepting the article for publication, acknowledges that the United States Government retains a nonexclusive, paid-up, irrevocable, worldwide license to publish or reproduce the published form of this article, or allow others to do so, for United States Government purposes. The Department of Energy will provide public access to these results of federally sponsored research in accordance with the DOE Public Access Plan (http://energy.gov/downloads/doe-public-access-plan).

Notes

¹ Case vignettes are available on request.

² All qualitative descriptors for ICC as are from Cicchetti (1994): poor = < .40, fair = .40 to .59, good = .60 to .74, and excellent = > .75.

³ Rater agreement among the five student raters was .49; mean student facet ratings correlated highly with the sixth author's ratings (ICC of .70). Thus, ratings were pooled as six raters, and the overall ICC was .51.