A meta-structure for DSM-5 and ICD-11 pathological traits and the differentiation of personality functioning at different trait levels in older adults

Abstract

Objectives

Categorical criteria are not well suited to inform personality disorder (PD) diagnoses in older adults. More promising are the ICD-11 and DSM-5 alternative models. Both conceptualize PD by level of severity and maladaptive traits. Severity is conditional for making a PD diagnosis. Trait levels portray stylistic differences in PD expression. Yet, in older adults the hierarchical trait structure is unknown. Neither is the differentiation of the severity criterion from maladaptive traits confirmed.

Methods

A series of exploratory factor analyses with progressively greater numbers of factors were conducted to examine the hierarchical trait structure in 293 community dwelling older adults. The on average differentiation of a single higher order personality functioning factor from trait factors at succeeding levels of the hierarchy was estimated with Cohen q effect size.

Results

Six meaningful trait levels were identified. From the fourth trait level on the general personality functioning factor shared less than 15% variance on average with the trait factors. Trait factors at the sixth level corresponded to both DSM-5 and ICD-11 pathological traits.

Conclusion

A future nosology integrating DSM-5 and ICD-11 trait proposals would be applicable in older adults. Personality functioning can be differentiated from traits, so separate assessment of traits and severity is worthwhile.

Keywords:

• Personality disorders
• Alternative Model for Personality Disorders (AMPD)
• ICD-11 model for personality disorders
• older adults
• pathological traits
• personality functioning
• meta-structure
• mental health assessments

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethical declarations

Informed consent was obtained from all individual participants included in the study. Data collection was originally done for the Debast et al. (2017) study. At the time the study was conducted research in community samples did not require ethical approval under Belgian Law, yet the study followed the principles of the Declaration of Helsinki.

Funding

The author(s) reported there is no funding associated with the work featured in this article.