Clinical Utility of the Level of Personality Functioning Scale: A Survey of German Mental Health Professionals

The DSM-5 Alternative Model for Personality Disorders (AMPD) and ICD-11 adopt a dimensional approach to personality disorders, defining them in terms of impairments of self-related (identity, self-direction) and interpersonal (empathy, intimacy) personality functions. This study examined the clinical utility of a clinician-rated global evaluation of personality functioning based on the Level of Personality Functioning Scale (LPFS). A total of 346 German mental health professionals provided LPFS ratings for 1,403 patients, stratified by thirty-eight diagnostic categories. Recommended treatment components and treatment outcomes were obtained for each patient to examine the predictive utility of the LPFS. Clinicians further provided their perspective on its clinical utility and potential risk of stigmatizing patients. On average, clinicians rated the LPFS as "very useful", its applicability as "rather easy", and the risk of patient stigmatization as "rather low". Logistic and ordinal Bayesian multilevel models indicated pronounced associations between pretreatment LPFS ratings and treatment variables, thereby providing evidence for its predictive utility. In particular, greater impairments in personality functioning were associated with poorer treatment outcomes, and associations with recommended treatment components yielded a nuanced pattern, with short-term outpatient psychotherapy being rather recommended for mild impairments, long-term psychotherapy for moderate to severe impairments, and intensive care interventions for extreme impairments (e.g., outreach care, psychiatric nursing, assisted living). The results indicate that German mental health professionals consider the LPFS as a clinically useful concept that may be valuable in providing prognostic information about patients and guiding treatment decisions.