Thomson Madelyn, Cavelti Marialuisa, Lerch Stefan, Koenig Julian, Reichl Corinna, Mürner-Lavanchy Ines, Wyssen Andrea, Kaess Michael
University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
Borderline Personal Disord Emot Dysregul. 2024 Apr 9;11(1):9. doi: 10.1186/s40479-024-00252-5.
Despite the introduction of dimensional conceptualisations of personality functioning in the latest classification systems, such as Criterion A of the Alternative Model of Personality Disorders in the DSM-5, heterogeneous clinical presentation of personality pathology remains a challenge. Relatedly, the latent structure of personality pathology as assessed by the Semi-Structured Interview for Personality Functioning DSM-5 (STiP-5.1) has not yet been comprehensively examined in adolescents. Therefore, this study aimed to examine the latent structure of the STiP-5.1, and, based on those findings, to describe any unique clinical profiles that might emerge.
The final sample comprised 502 participants aged 11-18 years consecutively recruited from a specialised personality disorder outpatient service, as well as general day clinic and inpatient wards at the University Hospital University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Bern, Switzerland. Participants were assessed using the STiP-5.1, as well as a battery of other psychological measures by clinical psychologists or trained doctoral students. Variations of Factor Analysis, Latent Class Analysis and Factor Mixture Models (FMM) were applied to the STiP-5.1 to determine the most appropriate structure.
The best fitting model was an FMM comprising four-classes and two factors (corresponding to self- and interpersonal-functioning). The classes differed in both overall severity of personality functioning impairment, and in their scores and clinical relevance on each element of the STiP-5.1. When compared to the overall sample, classes differed in their unique clinical presentation: class 1 had low impairment, class 2 had impairments primarily in self-functioning with high depressivity, class 3 had mixed levels of impairment with emerging problems in identity and empathy, and class 4 had severe overall personality functioning impairment.
A complex model incorporating both dimensional and categorical components most adequately describes the latent structure of the STiP-5.1 in our adolescent sample. We conclude that Criterion A provides clinically useful information beyond severity (as a dimensional continuum) alone, and that the hybrid model found for personality functioning in our sample warrants further attention. Findings can help to parse out clinical heterogeneity in personality pathology in adolescents, and help to inform early identification and intervention efforts.
尽管最新的分类系统中引入了人格功能的维度概念，如《精神疾病诊断与统计手册》第5版（DSM-5）中人格障碍替代模型的A标准，但人格病理学的异质性临床表现仍然是一个挑战。相关地，通过《DSM-5人格功能半结构化访谈》（STiP-5.1）评估的人格病理学潜在结构尚未在青少年中得到全面研究。因此，本研究旨在检验STiP-5.1的潜在结构，并基于这些发现描述可能出现的任何独特临床特征。
最终样本包括502名年龄在11至18岁之间的参与者，他们是从瑞士伯尔尼大学儿童医院和青少年精神病学与心理治疗大学医院的专门人格障碍门诊服务以及普通日间诊所和住院病房连续招募的。参与者接受了STiP-5.1评估，以及临床心理学家或受过培训的博士生进行的一系列其他心理测量。将因子分析、潜在类别分析和因子混合模型（FMM）的变体应用于STiP-5.1，以确定最合适的结构。
最佳拟合模型是一个包含四类和两个因子（对应自我和人际功能）的FMM。这些类别在人格功能损害的总体严重程度以及STiP-5.1每个元素的得分和临床相关性方面存在差异。与总体样本相比，这些类别在其独特的临床表现上存在差异：第1类损害程度低，第2类主要在自我功能方面有损害且抑郁程度高，第3类有混合程度的损害，在身份认同和同理心方面出现问题，第4类总体人格功能有严重损害。
一个包含维度和类别成分的复杂模型最能充分描述我们青少年样本中STiP-5.1的潜在结构。我们得出结论，A标准除了单独作为严重程度（作为一个维度连续体）之外，还提供了临床上有用的信息，并且我们样本中为人格功能发现的混合模型值得进一步关注。研究结果有助于梳理青少年人格病理学中的临床异质性，并有助于为早期识别和干预工作提供信息。
