The NorAMP-Project

The Norwegian Study of the Alternative DSM-5 Model for Personality Disorders (NorAMP)

Introduction

The Alternative DSM-5 Model for Personality Disorders (AMPD) offers a new way of diagnosing personality disorders by embracing both dimensional and categorical aspects of personality pathology. According to the new model, personality disorders are characterized by two main criteria:

  1. Impairment of personality functioning (Criterion A)
  2. Pathological personality traits (Criterion B).

Criterion A is operationalized by the Level of Personality Functioning Scale (LPFS)(Bender, Morey, & Skodol, 2011), and measures impairment of self and interpersonal functioning at five levels of severity, ranging from no impairment to extreme impairment of personality functioning. It helps patients and clinicians gain insight into how well someone navigates their internal world (self) and external relationships (interpersonal), providing a dimensional perspective rather than a rigid categorical diagnosis.  Criterion B includes five pathological personality trait domains and 25 trait facets (Krueger, Derringer, Markon, Watson, & Skodol, 2012).

The Norwegian Study of the AMPD (NorAMP) aims at examining the validity, reliability, and clinical utility of the Alternative DSM-5Model Personality Disorders (AMPD) with particular focus on the LPFS. The cross-sectional study was completed by 2017, and by August 2022, the 7-years follow-up evaluation had included the first ten patients.

Baseline study

A total of 317 participants were included in the baseline study; 282 patients and 35 were non-clinical controls. Most patients were recruited from the Sørlandet Hospital, Oslo University Hospital (OUS), Namsos Hospital, and Vestfold Hospital. Patients with personality disorders were mainly recruited from the Norwegian Network for Personality Disorders, including units at the Sørlandet Hospital, Vestfold Hospital, OUS, Lovisenberg Diaconal Hospital, and Akershus University Hospital. The baseline investigation lasted from 2015 to 2017.

The Norwegian translation of the first module of the "Structured Clinical Interview for the DSM-5 AMPD (SCID-5-AMPD-I)" was used to assess the LPFS. Raters were trained by Donna Bender during a two-day workshop. Section II personality disorders were assessed by the Structured Clinical Interview for DSM-5 Personality Disorders (SCID-5-PD). Personality trait domains and trait facets were assessed by the Personality Inventory for DSM-5 (PID-5). A number of other self-report instruments were included such as the Severity Index of Personality Problems (SIPP), Work and Social Adjustment Scale (WSAS), and Personality and Health Questionnaire (PHQ; depressive symptoms).

Seven-year follow-up study

The 7-year prospective follow-up study of NorAMP started in May 2022, and by November 2023, more than 100 participants are included. The primary aim of this follow-up study is to clarify whether the LPFS is a useful diagnostic measure with respect to its ability to predict clinical course and capture personality change that is meaningful in clinical practice. The 7-year follow-up study uses the same instruments as the baseline study, albeit far fewer self-report questionnaires. Most interviews are administered online, using media that are approved by the local Data Protection Officer.

The list of raters participating in the 7-year follow-up is provided below. Self-report questionnaires are filled in online, using “Nettskjema”, operated by the University of Oslo. Data are stored at the “Tjenester for sensitive data” (TSD) at the University of Oslo, approved by the Data Protection Officer at the OUS and Regional Committee for Research Ethics.

Project group NorAMP 2022;  7-year follow-up study

Principal investigator: Benjamin Hummelen, Section for Treatment Research, Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital Contact: Uxbeum@ous-hf.no

Raters

  • Tore Buer Christensen, MD, PhD, Specialist in psychiatry, Sørlandet Hospital
  • Tor Erik Nysæter, PhD, Specialist in psychology,  Sørlandet Hospital.
  • Ingeborg Eikenæs, PhD, Specialist in psychiatry, Nasjonal Kompetansetjeneste for Personlighetspsykiatri, Oslo University Hospital.
  • Elfrida Kvarstein, MD, PhD, Associate professor, Institute of Clinical Medicine, UiO, head of the Research Group of Personality Psychiatry.
  • Katharina Morken, PhD, Specialist in clinical psychology, Associate professor, the Faculty of Psychology, University of Bergen.
  • Aleksander Bodolai, MS, psychologist at Lovisenberg Diaconal Hospital.
  • Ingvild Aurebekk, MD, Specialist in youth psychiatry, Østfold Hospital.
  • Sara Germans, MD, PhD, Associate professor, Norwegian University of Science and Technology, Trondheim. Specialist in psychiatry, Namsos Hospital.

Research assistents

  • Julie Hertzberg Formo, Master student, Institute of Psychology, UiO.

Scientific collaborators

  • Aleksander Gulla Heltne, PhD student at the UiO.

  • Johan Braeken, PhD, professor, Center of Educational Measurement , University of Oslo.

  • Donna Bender, PhD,  Director of Strategic Initiatives, University of Michigan.

  • Andrew E. Skodol, MD, Research Professor of Psychiatry, University of Arizona.

  • Muirne Paap, PhD, Associate professor, Department of Child and Family Welfare, Faculty of Behavioural and Social Sciences, University of Groningen, the Netherlands.

  • Geir Pedersen, PhD, Senior researcher, Oslo University Hospital.

  • Carl-Aksel Sveen, MS in Economics, and Specialist in clinical psychology, Department of Psychiatry, Vestre Viken Hospital.

Previous collaboration (baseline study)

  • Kjetil Bremer, Psykologspesialist, Oslo University Hspital
  • Kristoffer Walther, Psykologspesialist, Oslo University Hspital

Publications NorAMP

  1. Buer Christensen T, Paap MCS, Arnesen M, Koritzinsky K, Nysaeter TE, Eikenaes I, et al. Interrater Reliability of the Structured Clinical Interview for the DSM–5 Alternative Model of Personality Disorders Module i: Level of Personality Functioning Scale. Journal of personality assessment. 2018;100(6):630-41.
  2. Nysaeter TE, Langjord T, Buer Christensen TB, Bremer K, Hummelen B. Personlighetsfungering som diagnostisk kriterium.  Hva er empirisk status? Tidsskrift for Norsk psykologforening. 2018;45(4):262-70.
  3. Buer Christensen T, Hummelen B, Paap MCS, Eikenaes I, Selvik SG, Kvarstein E, et al. Evaluation of Diagnostic Thresholds for Criterion A in the Alternative DSM-5 Model for Personality Disorders. Journal of personality disorders. 2019:1-22.
  4. Buer Christensen T, Eikenaes I, Hummelen B, Pedersen G, Nysæter T-E, Bender DS, et al. Level of personality functioning as a predictor of psychosocial functioning—Concurrent validity of criterion A. Personality Disorders: Theory, Research, and Treatment. 2020;11(2):79.
  5. Hummelen B, Braeken J, Buer Christensen T, Nysaeter TE, Germans Selvik S, Walther K, et al. A Psychometric Analysis of the Structured Clinical Interview for the DSM-5 Alternative Model for Personality Disorders Module I (SCID-5-AMPD-I): Level of Personality Functioning Scale. Assessment. 2020.
  6. Eikeseth FF, Sætren SS, Benjamin B, Ulltveit-Moe Eikenæs IH, Sütterlin S, Hummelen B. The test-retest reliability of heart rate variability and its association with personality functioning. Frontiers in Psychiatry. 2020;11.
  7. Heltne A, Bode C, Hummelen B, Falkum E, Selvik SG, Paap MC. Norwegian clinicians’ experiences of learnability and usability of scid-ii, scid-5-pd and scid-5-ampd-i interviews: A sequential multi-group qualitative approach. Journal of personality assessment. 2021:1-14.
  8. Nysaeter TE, Hummelen B, Christensen TB, Eikenaes IU-M, Selvik SG, Pedersen G, et al. The Incremental Utility of Criteria A and B of the DSM-5 Alternative Model for Personality Disorders for Predicting DSM-IV/DSM-5 Section II Personality Disorders. Journal of Personality Assessment. 2022:1-10.
  9. Heltne A, Braeken J, Hummelen B, Falkum E, Germans Selvik S, Buer Christensen T, et al. Do flexible administration procedures promote individualized clinical assessments? An explorative analysis of how clinicians utilize the funnel structure of the SCID-5-AMPD Module I: LPFS. Journal of Personality Assessment. (Submitted)

Other relevant papers

  • Bender, D. S., Morey, L. C., & Skodol, A. E. (2011). Toward a model for assessing level of personality functioning in DSM-5, part I: a review of theory and methods. J Pers Assess, 93(4), 332-346. doi:10.1080/00223891.2011.583808
  • DSM-5. (2013) Diagnostic and Statistical Manual of Mental Disorders (Vol. Fifth, pp. 767 - 771). Arlington, Va.: American Psychiatric Association.
  • Krueger, R. F., Derringer, J., Markon, K. E., Watson, D., & Skodol, A. E. (2012). Initial construction of a maladaptive personality trait model and inventory for DSM-5. Psychol Med, 42(9), 1879-1890. doi:10.1017/s0033291711002674
  • Zimmermann, J., Kerber, A., Rek, K., Hopwood, C. J., & Krueger, R. (2019). A brief but comprehensive review of research on the Alternative DSM-5 Model for Personality Disorders. Current Psychiatry Reports, 21(92). https://doi.org/10.1007/s11920-019-1079
Published Feb. 22, 2022 2:48 PM - Last modified Dec. 13, 2023 10:18 AM