Integration of the ICD-11 and DSM-5 dimensional systems for personality disorders into a unified taxonomy with non-overlapping traits

Gutiérrez, Fernando; Peri, Josep M.; Gárriz, Miguel; Vall, Gemma; Arqué, Estela; Ruiz, Laura; Condomines, Jaume; Calvo, Natalia; Ferrer, Marc; Sureda, Bárbara

doi:http://dx.doi.org/10.3389/fpsyt.2021.591934

Integration of the ICD-11 and DSM-5 dimensional systems for personality disorders into a unified taxonomy with non-overlapping traits

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Gutiérrez F, Peri JM, Gárriz M, Vall G, Arqué E, Ruiz L, Condomines J, Calvo N, Ferrer M, Sureda B. Integration of the ICD-11 and DSM-5 dimensional systems for personality disorders into a unified taxonomy with non-overlapping traits. Front Psychiatry. 2021;12:591934. DOI: 10.3389/fpsyt.2021.591934

Abstract

The promise of replacing the diagnostic categories of personality disorder with a better-grounded system has been only partially met. We still need to understand whether our main dimensional taxonomies, those of the International Classification of Diseases, 11th Revision (ICD-11) and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), are the same or different, and elucidate whether a unified structure is possible. We also need truly independent pathological domains, as they have shown unacceptable overlap so far. To inquire into these points, the Personality Inventory for DSM-5 (PID-5) and the Personality Inventory for ICD-11 (PiCD) were administered to 677 outpatients. Disattenuated correlation coefficients between 0.84 and 0.93 revealed that both systems share four analogous traits: negative affectivity, detachment, dissociality/antagonism, and disinhibition. These traits proved scalar equivalence too, such that scores in the two questionnaires are roughly interchangeable. These four domains plus psychoticism formed a theoretically consistent and well-fitted five-factor structure, but they overlapped considerably, thereby reducing discriminant validity. Only after the extraction of a general personality disorder factor (g-PD) through bifactor analysis, we could attain a comprehensive model bearing mutually independent traits.