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Reliability of the ICD‐11 personality disorder severity ratings and diagnosis

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Personality and Mental Health
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Tuğba Aydın‐Seyrek
Tuğba Aydın‐Seyrek
Tuğba Aydın‐Seyrek
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Tarık Gandur at Fenerbahçe University
Tarık Gandur
Neslihan Turgut
Neslihan Turgut
Neslihan Turgut
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Duygu Aslan Kunt
Duygu Aslan Kunt
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Abstract

The present study aimed to investigate the interrater reliability of the dichotomous and dimensional personality disorder (PD) diagnoses based on the overall severity assessment on a rating form consisting of 18 anchored items encompassing diagnostic requirements of the International Classification of Diseases 11th Revision (ICD‐11). We also aimed to examine the extent of consistency within the diagnostic requirements grouped under the domains of self‐ and interpersonal functioning, specific manifestations of personality dysfunction, and distress and impairment in psychosocial functioning. Our data involved a total of 184 inter‐ratings of 46 consenting patients by the same set of four clinicians. The chance‐corrected agreement levels were estimated at intraclass correlation coefficient (ICC) = 0.89 for the overall severity composite, ICC = 0.83 for the dimensional PD diagnosis and Fleiss' kappa = 0.77 for the dichotomous PD diagnosis. Internal consistency analysis of the overall severity composite and the domain composites revealed Cronbach's alpha coefficients approaching or exceeding 0.90 level. Our findings suggest that the diagnostic requirements listed in the ICD‐11 and related documents for the severity determination in PD compose an internally consistent set. With the guidance of a rating form comprised of anchored items covering this set, competency‐level clinicians are likely to perform reliable evaluations of the severity of personality disturbance, and dimensional and dichotomous PD diagnoses. The development of semi‐structured interviews that would further facilitate the task of inspecting and rating each diagnostic requirement reliably will possibly enhance the implementation of the ICD‐11 classification for PD around the world.
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RESEARCH ARTICLE
Reliability of the ICD-11 personality disorder severity
ratings and diagnosis
Tu
gba Aydın-Seyrek
1
| Tarık Gandur
2
| Neslihan Turgut
3
|
Duygu Aslan Kunt
3
| Ferhan Dereboy
4
1
Dr Cevdet Aykan Mental Health
Hospital, Tokat, Turkey
2
Department of Psychology, Faculty of
Economics, Administrative and Social
Sciences, Fenerbahçe University, _
Istanbul,
Turkey
3
Private Practice, Aydın, Turkey
4
Faculty of Medicine, Adnan Menderes
University, Aydın, Turkey
Correspondence
Ferhan Dereboy, Ba
gdat Caddesi No:
286-290, Mesa Cadde KonutlarıB-79,
Maltepe, Istanbul 34843, Turkey.
Email: fdereboy@gmail.com;fdereboy@
adu.edu.tr
Funding information
This research received no external
funding.
Abstract
The present study aimed to investigate the interrater reliability of the dichoto-
mous and dimensional personality disorder (PD) diagnoses based on the over-
all severity assessment on a rating form consisting of 18 anchored items
encompassing diagnostic requirements of the International Classification of
Diseases 11th Revision (ICD-11). We also aimed to examine the extent of con-
sistency within the diagnostic requirements grouped under the domains of
self- and interpersonal functioning, specific manifestations of personality dys-
function, and distress and impairment in psychosocial functioning. Our data
involved a total of 184 inter-ratings of 46 consenting patients by the same set
of four clinicians. The chance-corrected agreement levels were estimated at
intraclass correlation coefficient (ICC) =0.89 for the overall severity compos-
ite, ICC =0.83 for the dimensional PD diagnosis and Fleiss' kappa =0.77 for
the dichotomous PD diagnosis. Internal consistency analysis of the overall
severity composite and the domain composites revealed Cronbach's alpha coef-
ficients approaching or exceeding 0.90 level. Our findings suggest that the diag-
nostic requirements listed in the ICD-11 and related documents for the
severity determination in PD compose an internally consistent set. With the
guidance of a rating form comprised of anchored items covering this set,
competency-level clinicians are likely to perform reliable evaluations of the
severity of personality disturbance, and dimensional and dichotomous PD
diagnoses. The development of semi-structured interviews that would further
facilitate the task of inspecting and rating each diagnostic requirement reliably
will possibly enhance the implementation of the ICD-11 classification for PD
around the world.
INTRODUCTION
The personality disorder (PD) diagnostic guideline of the
International Classification of Diseases 11th Revision
(ICD-11) represents a radical division from those of the
previous versions in several ways. First, it gives priority
to the diagnosis of general PD instead of about a dozen
specific PDs. Second, it requires a thorough assessment of
impairment in personality functioning instead of a series
of symptoms thought to be indicative of specific PD
Ferhan Dereboy is a retired professor of psychiatry at Adnan Menderes University.
Received: 5 February 2024 Accepted: 15 June 2024
DOI: 10.1002/pmh.1629
Personal Ment Health. 2024;18:339–346. wileyonlinelibrary.com/journal/pmh © 2024 John Wiley & Sons Ltd 339
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Article
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Objectives The International Classification of Diseases, 11th edition includes a new personality disorder diagnosis, in light of growing concerns of the categorical personality disorder diagnoses. The purpose of the current study was to examine the reliability and validity of the severity dimension of the new International Classification of Diseases, 11th edition diagnosis, through multi-method assessment. Method In a community mental health sample ( n = 311), we examined the interrater reliability of the severity diagnosis and evaluated the diagnosis against self-report measures of dimensional personality pathology and psychopathology constructs and traditional categorical and informant-report measures. Results Intraclass correlations indicated ‘excellent’ reliability of the diagnostic ratings. Large associations were observed between the International Classification of Diseases, 11th edition clinician diagnosis and overall impairment measures. Generally, the International Classification of Diseases, 11th edition clinician diagnosis exhibited largest associations with measures of internalising dysfunction, and more variable associations with interpersonal and externalising impairment. The International Classification of Diseases, 11th edition clinician diagnosis showed a large association with borderline personality disorder symptom scores and moderate associations with Paranoid, Schizoid and Avoidant personality disorder scores. Similar patterns emerged of the associations between the International Classification of Diseases, 11th edition personality disorder diagnosis with self-report and informant-report measures, although the associations were larger with self-report measures. Conclusion These findings provide promising initial evidence for the reliability and validity of the new International Classification of Diseases, 11th edition personality disorder diagnosis, indicating that the new conceptualisation of personality disorders may address issues within the categorical model.
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