A Dimensional Model for Personality Disorders in Later Life
ConditionPsychiatric Disorders
Trial statusRecruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age18+
SponsorUniversitair Ziekenhuis Brussel
About this trial
Research on personality disorders (PDs) in older adults is currently limited. This is surprising, given that PDs are also common in this age group. Moreover, PDs show high co-morbidity with other disorders (both mental and physical) and often have a negative effect on treatment. With this in mind, the conceptualization, diagnosis and treatment of PDs in older adults represents an important task for mental health care. To this end, problems with the current classification of PDs need to be tackled, as they currently complicate this task. The current DSM-5 (Diagnostic and Statistical Manual, Edition 5) (APA, 2013) categorical PD criteria are mainly based on the living conditions of younger adults and are therefore often not suited for PD diagnosis in older adults. Currently, however, a paradigm shift is taking place from a categorical to a dimensional approach of PDs. The "Alternative Model for Personality Disorders" (AMPD) (APA, 2013) and the approach by ICD-11 (International Classification of Diseases 11th Revision) (WHO, 2019) are examples of new, dimensional models for PDs. These models conceptualize PDs using two dimensional criteria: (1) criterion A, which captures the overall level of personality (dis)functioning and (2) criterion B which describes the PD style by pathological/maladaptive personality traits. This paradigm shift offers the possibility to give the aging context the attention it deserves, by examining the suitability of this new dimensional conceptualization of PD among older adults.
The goal of this research is to examine whether the combined AMPD and ICD-11 dimensional approach is appropriate for use in older adults. This will be done by administering instruments capturing criterion A and B in the general population in younger (18-64) and older (65 and older) adults to evaluate their age-neutrality, as well as in a clinical sample of older (65 and older) adults, to empirically evaluate its clinical relevance in later life.
Eligibility criteria
This trial accepts healthy volunteersQualifiers
ONLY older adults: from the age of 65
Dutch speaking
Disqualifiers
Severe cognitive impairment (Patients who are admitted because of cognitive impairment will be excluded from the participant pool, other than this the psychiatrists and psychologists of the participating institutions will make an evaluation of the patients' cognitive capacities)
Acute state of mental impairment which would interfere with the reliability of the patients' responses (for example severe psychosis), as evaluated by the psychiatrists and psychologist of the participating institutions.
Trial design
Design model
Parallel
Treatments tested in this trial
PID-5-BF+M and LPFS-BF 2.0 (self-report questionnaires)
Other interventionAll participants will be asked to fill in the PID-5-BF+M and the LPFS-BF 2.0 to examine personality disorders as defined by the AMPD and ICD-11. PID-5-BF+M consists of 36 self-report items. It has 18 facet scales and 6 domain scales (Anankastia, Negative Affectivity, Antagonism, Disinhibition, Psychoticism and Detachment). The LPFS-BF 2.0 has 12 items, measuring 4 domains of personality functioning (identity, intimacy, self-direction and empathy).
Secondary Questionnaires (self-report and informant questionnaires)
Other interventionThe patients fill in a standard test battery during the first weeks of their admission in the institutions, including questionnaires and interviews. The research team will analyze the results retrospectively. This includes: YSQ- SF16 (Young \& Brown, 1994; Pauwels et al., 2018) GPS (van Alphen et al., 2006) HoNOS 65+ (Burns et al., 1999) HAP 2.0 (Barendse \& Thissen, 2006) SCL-90-R (Derogatis, 1983; Dutch version: Arrindell, \& Ettema, 1975, 1986, 2005) ADP-IV (Schotte \& De Doncker, 1998) CERQ (Garnefski et al., 2007) UCL (Scheurs et al., 1994; 1988) BIS/BAS Scales (Carver \& White, 1994) EC Scale of the ATQ (Rothbart et al., 2000) BSI (Derogatis, 1975; Dutch version: Beurs, 2008) SIPP-SF (derived from the SIPP-118; Verheul et al., 2008) SMI (Young et al., 2008) WHO-5 (Dutch version: WHO, 1998) SQ3-SF (Young \& Brown, 2005) SCID-5-P (First et al., 2017; Dutch translation: Arntz et al., 2017)
Clinical Ratings of the dimensional model
Diagnostic testClinical ratings of criteria A and B will also be collected. Only a small part of the patients will be selected for this, in order to make the research more feasible. The rater (a clinician or researcher) assesses the patient (in terms of level of personality functioning and personality traits) by means of (structured) clinical interviews. Given clinical ratings of the dimensional criteria are not part of the standard care in either institution, the ratings can be conducted by the doctorandus and Master Thesis students, trained by the doctorandus (in order not to overburden the clinicians). The clinical interviews that will be used for the ratings are: * The Semigestructureerd Interview voor Persoonlijkheidsfunctioneren DSM-5 (STIP) (Hutsebaut et al., 2014). * The Structured Clinical Interview for the DSM-5 (SCID-5-AMPD) (First et al., 2018), only if a Dutch translation is available by the time of this intervention.
PID-5-BF+M and LPFS-BF 2.0 (Informant questionnaires)
Other interventionIn the clinical population, participants will be asked to include an informant (family member, partner, friend, acquaintance), to fill in an informant version of the PID-5-BF+M and LPFS-BF 2.0 questionnaires. It is also possible for the patient to participate in the study without giving permission to include an informant. The informant will be asked to fill in the informant versions of the questionnaires, which contain the exact same items as the self-report versions, adjusted to the third person.
Treatment groups
750 Participants
are divided into 2 treatment groupsGroup A: General populationOther 1 intervention
Group B: Clinical PopulationOther 4 interventions
Trial outcomes
Primary outcomes
1
PID-5-BF+M questionnaire
Item scores, scale scores and total scores of the questionnaire Items: \- 38 items (36 original items + 2 additional items) Scale scores: * 19 personality facets (18 original facet scores + additional facet made up from the additional items) (Emotional Lability, Anxiety, Separation Insecurity, Withdrawal, Anhedonia, Intimacy Avoidance, Manipulativeness, Deceitfulness, Grandiosity, Irresponsibility, Impulsivity, Distractibility, Perfectionism, Rigidity, Orderliness, Unusual Beliefs \& Experiences, Eccentricity, Perceptual Dysregulation and Perseveration) * 7 personality domains (6 original domains + alternative composition of the Anankastia domain)(Negative Affectivity, Detachment, Antagonism, Disinhibition, Anankastia, Psychoticism and Anankastia by Kerber et al., 2019)
Time frame
Throughout the patient's first weeks of being in in- or outpatient, on average 1 month after admission2
LPFS-BF 2.0 questionnaire
Item scores, scale scores and total scores of the questionnaire Items: \- 12 items Scale scores: \- 4 domains of personality functioning (identity, intimacy, self-direction and empathy)
Time frame
Throughout the patient's first weeks of being in in- or outpatient, on average 1 month after admissionSecondary outcomes
1
The PID-5-BF+M informant version questionnaire
Scale scores and total scores of the questionnaires. The informant versions of the questionnaires consist of the same scales as the self-report versions.
Time frame
Throughout the patient's first weeks of being in in- or outpatient, on average 1 month after admission2
LPFS-BF 2.0 informant version questionnaire
Scale scores and total scores of the questionnaires. The informant versions of the questionnaires consist of the same scales as the self-report versions.
Time frame
Throughout the patient's first weeks of being in in- or outpatient, on average 1 month after admission3
The PID-5-BF+M clinical rating
The total scores and scale scores of the clinical rating. After conducting the clinical ratings with STIP and/or SCID-5-AMPD, the rater gives a clinical rating on criterion B as defined by DSM-5: A description of the criterion B domains and each of the facets is given, as well as a possibility for rating, ranging from 0 (not at all descriptive) to 3 (extremely descriptive). These scores then make up the clinical scale scores and total score of The PID-5-BF+M.
Time frame
Throughout the patient's hospitalization and the study completion, on average 1 year after the start of data collection4
LPFS-BF 2.0 clinical rating result
The total scores and scale scores of the clinical rating. After conducting the clinical ratings with STIP and/or SCID-5-AMPD, the rater gives a clinical rating on criterion A defined by DSM-5: DSM-5 offers descriptions of the four dimensions of criteria A (identity, self-direction, intimacy and empathy) and asks the rater to give an assessment on a Likert-scale ranging from 0 (healthy) to 4 (severely impaired). These scores then make up the clinical scale scores and total score of the LPFS-BF 2.0.
Time frame
Throughout the patient's hospitalization and the study completion, on average 1 year after the start of data collectionSponsors and contacts
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Universitair Ziekenhuis Brussel
Lead sponsor
Fund for Scientific Research, Flanders, Belgium
Collaborator
Alexianen Zorggroep Tienen
Collaborator
Mondriaan
Collaborator
GGZ Breburg
Collaborator
Source ClinicalTrials.gov