Assessing the Level of Structural Integration Using Operationalized Psychodynamic Diagnosis (OPD): Implications for DSM–5

Abstract

A key ingredient in the current proposal of the DSM–5 Work Group on Personality and Personality Disorders is the assessment of overall severity of impairment in personality functioning: the Levels of Personality Functioning Scale (LPFS). The aim of this article is to contribute a conceptual and empirical discussion of the LPFS from the perspective of the Operationalized Psychodynamic Diagnosis (OPD) system (OPD Task Force, 2008). First, we introduce the OPD Levels of Structural Integration Axis (OPD–LSIA), a measure of individual differences in severity of personality dysfunction that is rooted in psychodynamic theory. We show that the OPD–LSIA is reliable, valid, and highly associated with observer ratings of personality disorders. In the second part, we present results from an OPD expert consensus study exploring potential limitations of the current LPFS item set from the perspective of the OPD–LSIA. We conclude with highlighting implications for future revisions of the DSM–5 proposal.

Notes

Conversely, our data can also be used to assess which LPFS domains and items are underrepresented in the OPD–LSIA framework. Bonferroni-corrected post-hoc tests revealed that LPFS items representing intimacy and empathy could be better matched to OPD subdimensions than items representing self-direction, ps < .01. For example, OPD experts have failed to consensually find an OPD subdimension that captures the ability to “utilize appropriate standards of behavior, attaining fulfillment in multiple realms.” Although not central to this article, this finding might be important for future revisions of the OPD system.