Background
Over the past 30 years, increasing attention has been paid to patients with personality disorders (PD), partly because the diagnoses from 1980 were given a separate axis in DSM-III which stimulated research into PD, and partly because as a synergy of this research effective treatment methods have been developed.
Patients with personality disorders are characterized by long-term and fixed patterns in ways of thinking, feeling and acting, which prevent the possibility of favorable social and occupational adaptation, and which also impair general well-being and quality of life. The patients experience great symptom pressure, and often have additional disorders such as drug addiction, anxiety and depression.
PF is highly prevalent i.a. in drug populations, in eating disorders and in recurrent depression. If the personality disorders are not focused on in the treatment, patients often end up in the health care system for a long time with many courses of treatment and emergency admissions without achieving lasting improvement, many then drop out of school and working life, and become disabled. Without adequate treatment, the quality of life is seriously impaired and these disorders can take up large resources in society.
ICD-11, which came in 2018 and will soon be introduced in Norway, is very similar to the alternative model in DSM-5 (Sharp & Miller, 2022), called DSM-5-AMPD. As common problem areas for all personality pathology in AMPD, the severity of personality functioning is emphasized first and foremost, and is a decisive premise for the diagnosis. The model includes both dimensional and categorical aspects through two main criteria:
- Impaired personality functioning (A criterion)
- Pathological personality traits (B criterion)
The A criterion is operationalized through the Level of Personality Functioning Scale (LPFS) and measures impairment of self- and interpersonal functioning on five levels that vary from no impairment to extreme impairment. The B criterion includes five pathological personality trait domains and 25 trait facets that are also measured by severity.
Much research has been done on the measurement of personality functioning on the LPFS in recent years, but little has focused on young people. This despite the fact that the great importance of early intervention in PD in adolescence is well documented (Chanen et al., 2016; Sharp & Fonagy, 2015). Early intervention is not possible without early detection, which requires valid and relevant clinical tools.
The AMPD provides particular advantages for assessing personality functioning in adolescence over traditional approaches because its dimensional nature allows the assessment of personality pathology at earlier stages of the disorder (Sharp, Kerr & Chanen, 2021). It will then be possible to identify vulnerable young people before they possibly meet the PD criteria. This dimensional approach fits better in clinical practice, not least in a youth population where the focus is more on personality problems than on personality disorders.
Norwegian version of LoPF-Q 12-18 and WSAS-Y
Levels of Personality Functioning Questionaire for youth between 12 and 18 years, LoPF-Q 12-18 was developed in Switzerland by Kristin Goth and colleagues (Goth, Birkhoelzer & Schmeeck, 2018). The instrument's psychometric properties are well documented and it shows good validity (Cosgun et al., 2021; Goth et al., 2018; Kerr et al., 2022). It differentiates well between young people who have and those who do not have personality problems (Gander et al ., 2020; Goth et al., 2018), and can indicate different degrees of severity. The instrument has been translated into several languages, including English, Spanish, Lithuanian and Turkish, and is the only measure of personality functioning after the LPFS that has been specially developed for young people. It is based on self-reporting and intended for young people aged 12 to 18.
Together with the National Advisory unit for Personality Psychiatry (NAPP), a group of researchers and clinicians from the Nic Waals Institute, BUPA, Network for Personality Disorders, and the University of Tromsø, have translated LoPF-Q 12-18 into Norwegian from both German and English. Finally, the translation was quality assured by a back-translation. Furthermore, The Work and Social Adjustment Scale for Youth (WSAS-Y: Jassy et al; 2020) was translated into Norwegian based on both the English and Swedish versions.
Aims
The purpose of this project is a further quality assurance of the Norwegian translations of LPF-Q 12-18 and WSAS-Y under Norwegian conditions. Primarily, we will quality-assure the instruments' linguistic design and its psychometric properties, and obtain an estimate of expected levels of personality functioning in a relevant sample of young people between the ages of 12 and 18.
If the psychometric properties of the instrument prove satisfactory also among Norwegian youth, it will be possible to go further and investigate the suitability of the instruments in distinguishing between youth with and without personality problems / PD, and compare this with psychosocial impairment. The instruments will then potentially represent clinical aids in mapping young people in BUPA.
A synergy of the project is an increased focus on personality problems in young people, considering that more in this patient group with personality problems can receive more adequate and quality-assured assessment, and early help.
Method
Sub projects
- Evaluation of linguistic design among the target group by asking a small group of young people to read through the forms, and give feedback on language and word choice.
- Standardization within BUPA, by obtaining estimates of expected levels from scores of the instruments from patients who are in contact with BUPA.
- Investigate psychometric properties, through analyzes of scale reliability and factor structure.
Participants
- Sub project 1: Young people from a small normal sample, as well as young people in BUPA, both of relevant ages, N=10.
- Sub project 2: Young people in BUPA with various degrees of personality problems, N=500.
Data handling
Data is collected digitally via "Nettskjema". All recorded data is anonymous. In addition to the LoPF-Q and WSAS-Y questionnaires, gender and age are also recorded. The anonymised data is sent to Oslo University Hospital, where it is stored on a secure server.
Schedule
The project started in March 2023. Including translation work, pilot surveys, data collection and analyses, the project is scheduled to end in December 2023. Then comes the work on the article, with planned submission in spring 2024.
Scheduled articles
Publication
One scientific publication from the study is planned, with the provisional title: "The Levels of Personality Functioning Questionnaire (LoPF-Q 12-18) and The Work and Social Adjustment Scale for Youth (WSAS-Y) - Psychometric properties of the Norwegian versions"
Organization
The project is organized as a collaboration between the National Advisory unit for Personality Psychiatry (NAPP), BUPA at Oslo University Hospital (OUS), the Nic Waals Institute at Lovisenberg Hospital, the Department of Psychology at the University of Oslo (UiO), the Network for Personality Disorders at OUS, and the Department of Psychology, The University of Tromsø. The group is composed of the following people:
- Ingeborg Ulltveit-Moe Eikenæs, leader of NAPP
- Line Indrevoll Stänicke, Institute of Psychology, University of Oslo, Nic Waals Institue, Lovisenberg Hospital
- Hans Ole Korsgaard, Dep. physician, Nic Waals Instite, Lovisenberg Hospital
- Anne Brager-Larsen, psychologist specialist and unit leader, BUPA, OUS
- Ruth Kari Ramlet, senior physician and medical adviser, BUPA, OUS
- Geir Pedersen, Network for Personality Disorders, OUS
- Jens Thimm, Universitetet i Tromsø
References
- Jassi, A., Lenhard, F., Krebs, G., Gumpert, M., Jolstedt, M Andrén, P., Nord, M., Aspvall, K., Wahlund, T., Volz, C., & Mataix‑Cols, D (2020). The Work and Social Adjustment Scale, Youth and Parent Versions: Psychometric Evaluation of a Brief Measure of Functional Impairment in Young People. Child Psychiatry & Human Development, 51, 453–460. https://doi.org/10.1007/s10578-020-00956-z
- Sharp, C., & Miller, J. (2022). Ten-year retrospective on the DSM–5 Alternative Model of Personality Disorder: Seeing the forest for the trees. Personality Disorders: Theory, Research and Treatment, 13(4), 301–304. DOI: 10.1037/per0000595
- Gander, M., Buchheim, A., Bock, A., Steppan, M., Sevecke, K., & Goth, K. (2020). Unresolved attachment mediates the relationship between childhood trauma and impaired personality functioning in adolescence. Journal of Personality Disorders, 34(Supplement B), 84–103. doi: 10.1521/pedi_2020_34_468
- Goth, K., Birkhölzer, M., & Schmeck, K. (2018) Assessment of Personality Functioning in Adolescents With the LoPF–Q 12–18 Self-Report Questionnaire, Journal of Personality Assessment, 100:6, 680-690, DOI: 10.1080/00223891.2018.1489258
- Kerr, S., McLaren, V., Cano, K., Vanwoerden, S., Goth, K., & Sharp, C. (2022). Levels of Personality Functioning Questionnaire 12-18 (LoPF-Q 12-18): Factor Structure, Validity, and Clinical Cut-Offs. Assessment, 1-13. DOI: 10.1177/10731911221124340
- Cosgun, S., Goth, K. & Cakiroglu, S. (2021). Levels of Personality Functioning Questionnaire (LoPF-Q) 12–18 Turkish Version: Reliability, Validity, Factor Structure and Relationship with Comorbid Psychopathology in a Turkish Adolescent Sample. J Psychopathol Behav Assess, 43, 620–631. https://doi.org/10.1007/s10862-021-09867-2
- Chanen, A. M., Berk, M., & Thompson, K. (2016). Integrating early intervention for borderline personality disorder and mood disorders. Harv Rev Psychiatry, 24(5), 330–341. https://doi.org/10.1097/HRP.0000000000000105
- Sharp, C., & Fonagy, P. (2015). Practitioner Review: Borderline personality disorder in adolescence–recent conceptualization, intervention, and implications for clinical practice. Journal of Child Psychology and Psychiatry, 56(12), 1266–1288. DOI: 10.1111/jcpp.12449