Structure of clinician-reported ICD-11 personality disorder trait qualifiers

The International Classification of Diseases-11th Edition (ICD-11) Classification of Personality Disorders provides the option of coding 5 trait domain qualifiers that contribute to the individual expression of personality dysfunction (i.e., Negative Affectivity, Detachment, Dissociality, Disinhibition, and Anankastia). Previous investigations of these trait domains are based on self-reported data, and so is much of the research literature from which the ICD-11 trait model has evolved. However, the ICD-11 itself involves judgments made by clinicians about their patients. Thus, it is important to examine whether the trait domains identified in self-report studies can also be obtained from clinician-reported data. A sample of 238 mental health patients were characterized by clinicians using an informant-report form of the Personality Inventory for ICD-11 (PiCD-IRF). As expected, exploratory factor analysis (EFA) indicated that clinician-reported ICD-11 trait domains could be captured by both 4- and 5-factor structures, of which the 5-factor solution seemed less conceptually sound relative to the 4-factor solution. The 4-factor model captured the unipolar domains of Negative Affectivity, Detachment, Dissociality, along with a bipolar domain of Disinhibition versus Anankastia, whereas the 5-factor model furthermore captured features of Disinhibition and Anankastia as 2 separate factors. The hierarchical structure from 1 to 5 factors partially resembled previously reported trait structures and models of psychopathology. These findings overall support the multimethod robustness of ICD-11 trait domain qualifiers and the potential for their valid ratings by mental health clinicians. The PiCD-IRF is provided in the online supplementary material - for clinical or research purposes.