Background
Most clinicians and researchers agree on the importance of detecting and treating personality disorders (PD) early, preferably during adolescence. Unfortunately, the implementation of treatment programs for adolescents with PDs in clinical practice has been challenging, with a few exceptions. This may be partly due to the current diagnostic system assuming that PDs can be divided into ten separate categories, which has limited clinical utility and increase the risk of stigmatization. It is likely that a diagnostic system emphasizing the severity of PD and maladaptive personality traits will function better in clinical practice than the traditional categorical system.
NorAMP-J Project
The Norwegian study on the Alternative DSM-5 Model for Personality Disorders – Junior (NorAMP-J) aims to investigate the clinical utility of the Alternative DSM-5 Model for Personality Disorders (AMPD) in adolescents. The study is carefully designed to provide insight into whether AMPD is suitable for use in the adolescent population. By including a broad age group and thoroughly evaluating both clinical utility and psychometric properties, we seek to gain a comprehensive understanding of the model's effectiveness and reliability in assessing personality disorders among adolescents.
The severity of PD is assessed through the first module of the "Structured Clinical Interview for AMPD," adapted for adolescents (SCID-5-AMPD-I-Junior). The interview focuses on the core challenges in patients with PD, including issues related to self-esteem / identity, impaired self-control, a tendency to misunderstand others, and difficulties in forming connections with others. The areas are rated on a scale from 0 (no personality problems) to 4 (very severe personality problems) using the "Level of Personality Functioning Scale" (LPFS). Unfavorable personality traits are evaluated through the second module of SCID-5-AMPD.
The project is conducted in three phases. In the first phase, we will examine the inter-rater reliability of SCID-5-AMPD-I-Junior through a test-retest design (24 participants).
In the second phase, we will assess the clinical utility of AMPD for both patients and clinicians. This is done through a simple "randomized clinical trial," where patients are assessed either according to the traditional categorical model using the SCID-5-PD or according to the alternative model (100 patients). After the assessment, participants complete a questionnaire about their perceived clinical usefulness. The patients' therapists complete a similar questionnaire after receiving an assessment report. Thus, about 50 patients and their therapists will report on the clinical utility of the categorical model and about 50 patients will report on the clinical utility of the AMPD.
In the third phase, we will include an additional 132 patients who will only be assessed according to AMPD. By including a total of 250 patients, we have a basis to examine the psychometric properties of SCID-5-AMPD-I-Junior and other aspects of the validity of this model.
The planned start of the project is in February 2024. We will seek research funding to conduct additional follow-up studies after approximately 2, 5, 10, and 20 years.
Collaboration
The project is conducted in collaboration with clinicians and researchers at the Østfold Hospital, where the majority of patients are recruited, Oslo University Hospital, and University of Oslo. From September 2024, the Sørlandet Hospital and University of Tromsø will also be participating in the project. International collaborations include Donna Bender (USA), Andrew Skodol (USA), Carla Sharp (USA), Joost Hutsebaut (The Netherlands) and Laura Weekers (The Netherlands).
Contact
Principal investigator: Benjamin Hummelen, Section for Treatment Research, Department of Research and Innovation, Clinic Mental Health and Addiction, Oslo University Hospital. E-mail: uxbeum@ous-hf.no.
Project coordinator Østfold Hospital: Ingvild Kalsnes Jørstad Aurebekk (PhD candidate). E-mail: Ingvild.Aurebekk@so-hf.no.
Impact
With this study, we aim to contribute to informing practices and decision-making in the field to better understand and manage PDs among adolescents in clinical settings. The results from the NorAMP-Jr project will be valuable in assessing whether AMPD can be implemented in Child and Adolescent Psychiatry in its current form, whether changes should be made, or whether the categorical model should be maintained. The study will also provide insights into whether AMPD is capable of detecting personality problems at an early stage.
Acknowledgements
We would like to acknowledge the contributions of Laura Weekers and Joost Hutsebaut who brought up the idea to randomize patients to either assessment according to the categorical model or to assessment according to the AMPD.