Attachment, Mentalization and New Dimensional Diagnosis of Personality Disorders

Data have been collected since 2020 and we plan to end data collection on May 2023. An interview and a battery of questionnaires were administered by trained psychologists. A convenience sample of participants was recruited from psychiatric clinical services (inpatient group) and universities and the local community (nonclinical group). As we wanted to include people with the whole spectrum of PD (none, subclinic, mild, severe) two sample sources were used to increase the heterogeneity of the sample at the level of adaptation. Inclusion criteria was 18 to 45 years of age. Exclusion criteria were acute episodes of psychosis, major depression or bipolar disorder, substance dependence, brain injuries, and language difficulties. The participants were compensated for their time with a shopping voucher. This study was reviewed and approved by the Human Research Ethics Committee at Adam Mickiewicz University in Poznań. Methods: The Structured Clinical Interview for DSM-5 Personality Disorders and screening questionnaire SCID-SPQ, The Self and Interpersonal Functioning Scale, The Personality Inventory for DSM-5, The Reflective Functioning Questionnaire, A Movie for the Assessment of Social Cognition, Experiences in Close Relationships – Revised We plan to answer two main research questions in this project: 1. Our first aim is to provide a head-to-head comparison of categorical and dimensional diagnosis (Criterion A and B) of PD in predicting severe, negative clinical outcome. The main exploratory question is which model of PD diagnosis best predicts a severe negative clinical outcome. We do not use mentalization and attachment data in this project, and The Structured Clinical Interview for DSM-5 Personality Disorder, The Self and Interpersonal Functioning Scale and The Personality Inventory for DSM-5 are used to measure independent variable here. We create a new dependent variable (negative clinical outcome) for the purpose of this study. We have not performed any analyses in this research aim yet. Our data analysis strategy is to conduct a series of logistic regressions to estimate odds of negative PD outcome for each predictor: DSM-5 Criterium A, DSM-5 Criterium B and DSM-5 categorical diagnosis of PD (number of symptoms). Adjusted differences in the likelihood will be assessed controlling for sex, age and education level. The odds ratios and 95% confidence intervals will be determined. To establish the predictive performance of different diagnostic systems for negative PD outcome we will compare the odds ratio for each predictor. 2. Our second aim is to examine the relationship between attachment insecurity, two aspects of MT (self-reported and performance-based) and personality pathology conceptualized in new dimensional models of PD: the level of personality functioning (Criterion A) and maladaptive personality traits (Criterion B). We use The Structured Clinical Interview for DSM-5 Personality Disorders only for group characteristics. The Self and Interpersonal Functioning Scale and The Personality Inventory for DSM-5 are used to measure dependent variable here. We plan to build a mediation model where the relationship between insecure attachment and personality pathology is mediated by mentalization. We plan to use SEM analysis. We conducted preliminary analyses on this topic in September 2022 (N=77) to prepare a conference poster. Those results are available at: https://www.researchgate.net/publication/366412087_New_Dimensional_Diagnosis_of_Personality_Disorders_Exploring_The_Role_of_Attachment_and_Mentalization). Update entered on April 17, 2024. 1. We have changed the outcome variable from „negative clinical outcome” (NCO) to psychiatric hospitaliation. The NCO initially consisted of psychiatric hospitalisation plus additional self-reported indices of disturbances in the mental health domain (e.g., emotional distress, suicidal ideation and behavior, and emotional dysregulation), and the behavioral domain (evident in self-harm, impulsivity, and aggression, assessed by SCID-PD-SPQ (self-reported questionnaire). We have decided to remove this self-reported part of an outcome measure due to the serious concerns of the validity of this outcome measure raised by the reviewers. The inclusion of the SCID screener was aimed at assessing outcome indicators for personality disorders in line with the ICHOM recommendations (Prevolnick Rupel et al., 2021). While we acknowledge its substantive value, incorporating multiple indicators from various domains specified by ICHOM, we recognize that it may raise methodological concerns, as the outcome tool is not entirely independent of the predictor measurement tool. Therefore, we decided to remove this controversial indicator. This change has some impact on the study, since the outcome variable has changed, but we have also shown that this has not changed the results substantially. Our result indicates consistency in the observed results when using differently constructed outcomes (solely hospitalization, history of suicide attempts, or their combinations, as we originally intended in creating the negative clinical outcome indicator). Those analyses are added in the supplementary data. 2. We have included one person above the a priori age limit (47 years old) into the study. This inclusion resulted from a procedural oversight where the individual was inadvertently enrolled by the research investigator and the study was already done. Given that the study involved an engaging and time-intensive procedure lasting 2-3 hours, inclusive of the SCID interview, and considering the limited availability of patients in psychiatric facilities, we opted not to exclude this participant from the study. Omitting this participant would have led to the forfeiture of valuable data and would have rendered the participant's effort in the study futile. Moreover, this inclusion did not affect the study's outcomes, as the primary results remained consistent (see supplementary materials presenting the stepwise regression excluding this participant).