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DSM-5 classification of personality disorders versus Operationalized Psychodynamic diagnosis in children: a clinical comparison

Ivo Peixoto, Cristina Marques

1- Àrea de Pedopsiquiatria, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central,

- 16th ESCAP Congress (Poster)
- Peixoto et al. DSM-5 classification of personality disorders versus Operationalized Psychodynamic diagnosis in children: a clinical comparison. Eur Child Adolesc Psychiatry (2015) 24 (Suppl 1):S1–S303 (Publicação de Abstract)

Background: The diagnosis of mental and disorders is currently dominated by descriptive diagnostic systems. For the first time, in its fifth edition, the DSM proposes a new classification system for personality disorders (PD), which incorporates evidence-based concepts and constructs, and with potential for greater clinical (and research) utility while further facilitating the assessment and comprehension of pediatric patients. Coupled with this, in the last decade, psychoanalytically inspired assessment tools were developed in which psychic structure and mental functioning have become a diagnostic core concept. The operationalized psychodynamic diagnosis in children and adolescents-2 (OPD-KJ-2) is one such attempt at the operationalization of psychodynamic concepts, delivering clinical practice-oriented insights while showing good psychometric properties. It is our aim to describe such assessment strategies and provide a discussion of their clinical and scientific value.
Methods: With the aid of a clinical case vignette we took the recommended standard approach to the assessment of personality pathology according to the new DSM-5 proposal and using the Personality Inventory for DSM-5 (PID-5)—Child version and examined the “structure” axis following the OPD-KJ-2 manual. A clinical comparison between both approaches is herewith drawn. A computerized selective review of the most recent evidence was conducted.
Results: The use of multidimensional and research-guided approaches provides interesting and clinically relevant information, while shedding some light on features like identity integration and maladaptive personality traits and capturing better the nuances of development. As expected, the level of psychic structure integration in the OPD-KJ-2 shares many common factors with the level of personality functioning scale of the DSM-5 proposed model, in particular in self-concept and interpersonal profiles.
Conclusion: Although there is a lively controversy regarding the concept of PD in children, this kind of approaches broadens our understanding of patient psychopathology and opens up new realms for planning and guiding psychotherapeutic interventions without the pressure of a categorical diagnosis. Whilst the proposed changes in the new model of PD disrupt progress in the field of both PD research and clinical practice, it reflects the best evidence to date in personality pathology. It is our opinion that future studies should encompass an integrative and multidimensional view in order to advance the field of psychoanalytically informed neuroscience in child psychiatry.

Keywords: DSM-5; Personality disorder; Operationalized Psychodynamic diagnosis; Child psychiatry