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

The Alternative DSM-5 Model for Personality Disorders (AMPD) and ICD-11 adopt a dimensional approach to personality disorders, defining them in terms of impairments in 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, including, but not limited to, personality disorders. Clinicians reported on each patient’s treatment outcome, recommended optimal treatment components for each patient, and provided their perspective on the clinical utility of the LPFS and its 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 meaningful associations between LPFS ratings and clinical judgments, highlighting its effectiveness in conveying clinical impressions. Greater impairments in personality functioning were associated with poorer clinician-rated treatment outcome and poorer prognosis. In addition, associations with optimal treatment components yielded a nuanced pattern, with clinicians typically recommending short-term outpatient psychotherapy for patients with mild impairments, long-term psychotherapy for patients with moderate to severe impairments, and intensive care interventions (e.g., outreach care, assisted living) for those with extreme impairments. The results indicate that German mental health professionals consider the LPFS to be a clinically useful concept and that it may be valuable in organizing and communicating information about patients.