Furthermore, few studies considering the clinical utility of these models have been carried out in a naturalistic clinical setting. Although these studies presented important findings about the learnability of the AMPD, few studies have directly compared the learnability and clinical utility of the AMPD to the standard categorical model. Morey ( 2018) further found that the concepts of the first module of the DSM-5, the Levels of Personality Functioning Scale (LPFS), could be reliably applied by untrained students who had not previously been introduced to the AMPD. ( 2018) found that relatively untrained raters could provide ratings similar to more experienced expert raters and that agreement between these novices and experts increased with training. Since the publication of the DSM-5, studies on inter-rater reliability among untrained raters have contested initial claims of the AMPD’s complexity (e.g., Few et al., 2013 Garcia et al., 2018 Zimmermann et al., 2014). Due to a number of concerns, such as the model’s supposed complexity, lack of empirical support, and insufficient continuity with the standard categorical model, the AMPD was placed in Section III for further research and development (see Zachar et al., ( 2016) for a review of the AMPD development process). The AMPD was designed to replace the standard categorical model and to solve commonly cited issues with the categorical model (for a review, see Clark, 2007) by providing a dimensional framework for classifying personality disorders. The B criterion is a collection of five pathological personality trait domains, organized into twenty-five trait facets rated on a scale of 0 to 3, with 0 indicating “very little or not at all descriptive,” and 3 indicating “very descriptive.” A PD diagnosis requires a moderate level of impairment of personality functioning (level 2), as well as the presence of at least one pathological personality trait. The A criterion is the Levels of Personality Functioning Scale (LPFS), a global scale of personality functioning ranging from 0 (little or no impairment) to 4 (extreme impairment). The dimensional nature of personality pathology is captured by the A and B criteria of the AMPD. The standard categorical model delineates specific PD diagnostic categories defined by the presence of a specified number of symptom criteria, whereas the AMPD is a hybrid model including both dimensional aspects and categorical diagnoses.
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The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) presents two competing diagnostic frameworks for personality disorders (PDs): 1) the standard categorical model and 2) the Alternative Model of Personality Disorders (American Psychiatric Association, 2013). We comment on how our findings relate to the debate surrounding the AMPD, and recommend development of clear training guidelines for both interviews.
Moreover, the SCID-5-AMPD-I was considered to rely more explicitly on theory specific to the development and content of the AMPD model in general and the LPFS specifically We also identified shared and unique challenges and shortcomings of each interview. We found that training and clinical experience were considered to be important for both interviews. We identified four themes for each group, relating to required skills, training, challenges and information gained through the interview. Separate thematic analyses were conducted for SCID-II/5-PD and SCID-5-AMPD-I groups, and group themes were compared. We interviewed twenty Norwegian clinicians about their experiences with either the SCID-II/5-PD (n = 9), SCID-5-AMPD-I (n = 8), or both (n = 3). Though inter-rater reliability studies have contested initial claims of the model’s complexity, little attention has been paid to how clinicians experience the usability and learnability of either model. The AMPD was initially criticized for being too complex and theory laden for clinical implementation.
The DSM-5 presents two competing diagnostic frameworks for personality disorders: the standard categorical model and the Alternative Model of Personality Disorders (AMPD).