Skip to main content
NCBI home page
PLOS One logoLink to PLOS One
. 2024 Jun 27;19(6):e0300706. doi: 10.1371/journal.pone.0300706

The Portuguese version of the self-report form of the DSM-5 Level of Personality Functioning Scale (LPFS-SR) in a community and clinical sample

Rute Pires 1,2,*, Joana Henriques-Calado 1,2, Ana Sousa Ferreira 1,3, João Gama Marques 4,5, Ana Ribeiro Moreira 6, Bernardo C Barata 7, Marco Paulino 1,4, Leslie Morey 8, Bruno Gonçalves 1,2
Editor: Paulo Alexandre Azevedo Pereira Santos9
PMCID: PMC11210752  PMID: 38935649

Abstract

The Level of Personality Functioning Scale–Self-Report (LPFS-SR) operationalizes Criterion A of the DSM-5 Alternative Model for Personality Disorders. The current study aimed 1) to examine the internal consistency of the Portuguese version of the LPFS-SR in a community sample and a clinical sample, 2) to compare non-clinical participants (N = 282, Mage = 48.01, SD = 10.87) with two samples of clinical participants, one composed of patients with a personality disorder diagnosis (PD sample, n = 40, Mage = 46.18, SD = 13.59) and the other of patients with other psychiatric diagnoses (OD sample, n = 148, Mage = 49.49, SD = 11.88), with respect to LPFS-SR dimensions and total score, 3) to examine the capacity of the LPFS-SR to discriminate between samples through the ROC curve analyses, and 4) to examine the factor structure of the Portuguese version of the LPFS-SR. The Portuguese version of the LPFS-SR revealed adequate internal consistency results, akin to the original data, in the community and clinical samples. The community sample differed significantly from both clinical samples in all the LPFS-SR dimensions and total score. The ROC curve analysis indicated an optimal cut-off for the total score of 272.00, corresponding to a sensitivity of 75% and a specificity of 89%, in the PD vs. community samples. The LPFS-SR total score discriminative capacity between the PD and OD samples was lower, albeit also significant (area-under-the-curve of .63; p = .027; 95% CI: .52-.74). The current study provided evidence of the LPFS-SR’s unidimensionality in both community and clinical samples. Although this study has limitations, its findings contribute to a deeper understanding of the LPFS-SR construct, as well as to its cross-cultural validation.

Introduction

Both the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM; [1]), and the ICD-11 Classification of Personality Disorders (WHO, [2]) consider the severity of impairments in self- and interpersonal functioning as the core feature of personality disorders (PD), although personality traits are also important for describing the stylistic manifestations of personality dysfunction. In the DSM-5 Alternative Model for Personality Disorders [1], the specific pathological trait patterns (Criterion B) that characterize each PD may be assessed through the Personality Inventory for DSM-5 (PID-5; [3]). Substantial research has been conducted on this inventory over the last decade in a range of countries across Western and Eastern cultures [4–18]. Notwithstanding the centrality of personality dysfunction in the diagnosis of PD, fewer studies have focused on the level of personality functioning (Criterion A) relative to traits (Criterion B) over the last decade. This is most likely due to the fact that the DSM-5 has proposed a clinician-rated scale for its characterization (LPFS; [19]), which is less suitable for research purposes than self-report measures.

The LPFS model describes personality functioning on a continuum, differentiating five levels of impairment ranging from little or no impairment (Level 0) to extreme impairment (Level 4). Although personality functioning is a single dimension that reflects the global severity level of personality, impairments can manifest themselves in self (Identity and Self-Direction) and/or interpersonal functioning (Empathy or Intimacy). Moderate (Level 2) or greater impairment in personality functioning, manifested by problems in two or more of these dimensions (Identity, Self-Direction, Empathy, or Intimacy) is required for the diagnosis of PD [1].

Given the centrality of personality dysfunction in PD assessment and diagnosis, self-report measures for Criterion A, which are vital to furthering research, have emerged. Among other authors (see [20, 21]), Hutsebaut et al. [22–24] and Huprich et al. [25] have developed self-report measures to assess the LPFS construct, but these measures do not strictly adhere to the LPFS descriptors presented in the DSM-5. In response, Morey [26] developed an 80 item self-report measure that directly operationalizes the LPFS construct as described in the DSM-5. Unlike the previously reported measures, the items of the LPFS-SR were written to target the LPFS characteristic descriptors of impairment in self-functioning (e.g., different levels of identity integration and self-direction) and interpersonal functioning (e.g., different capacities for empathy and intimacy) presented within Table 2 of the DSM-5 AMPD [1]. This indicator-by-indicator mapping of the LPFS into self-report permits a close examination of the precise strengths and weaknesses of the description of global personality pathology provided in the AMPD. Moreover, its adequate psychometric properties allow for a deeper understanding of the ways personality dysfunction and personality traits interweave. Although the discussion surrounding the relationship between personality functioning and traits is beyond the scope of this manuscript (see [20] for a revision), it should be noted that on the 10th anniversary of the publication of the DSM-5, this issue is still under debate [20, 27]. Although conceptually distinct, there appears to be a considerable empirical overlap between maladaptive personality functioning and maladaptive personality content, which raises questions as to the maintenance of both criteria in future editions of the AMPD [20, 28–44]. Leaving behind an “either-or” discussion, Criterion A components span across the normal adaptative realm, which is not the case of all pathological traits, and from a clinical stand point, this constitutes a noticeable and useful difference between Criterion A and B. Conversely, considering that “pathological traits represent pieces of disturbed self and other narratives” [45], personality dysfunction and traits cannot be independent.

Table 2. LPFS-SR scales’ means (M) and standard deviations (SD) in the Portuguese personality disorder sample and in the other diagnoses sample.

Personality Disorder
(n = 40)		 Other diagnoses
(n = 148)
M SD M SD
Identity 101.97 24.28 92.72 25.16
Self-Direction 74.92 21.59 67.23 20.14
Empathy 53.15 12.06 49.79 14.33
Intimacy 80.67 20.34 72.50 21.47
Total 309.58 71.37 281.47 73.42
Open in a new tab

In line with the assumption that Criterion A reflects a single dimension of global personality dysfunction, research has supported the unidimensional structure of the LPFS-SR, albeit one that can be manifested in both interpersonal and intrapsychic ways [26, 46, 47]. However, Sleep et al. [43] report that in their data neither confirmatory nor exploratory factor analyses provided evidence for a single-factor structure and called for a re-evaluation of the measure’s structure. Morey [20, 48] and Sleep et al. [43, 44] have exchanged arguments regarding the dimensionality of the LPFS-SR, with Morey stating that in Sleep’s study a confirmatory factor analysis model (CFA) was applied with its usual restrictions, to test a four-factor model, revealing, however, a poor fit in several indices. Additionally, this four-factor model would be incoherent with the Criterion A assumption of an underlying continuum of global personality disfunction. In turn, Sleep responded, stating that Morey’s CFA analysis for a single-factor model also revealed a poor fit and drew attention to the author’s Principal Component Analyses (PCA) results, which extracted a single factor, thus rendering these models somewhat unconvincing. The current study pertains to contribute to this ongoing debate, examining the factor structure of the Portuguese version of the LPFS-SR using a method that determines the optimal balance between model fit and model complexity [49].

This study focused on the psychometric properties of the Portuguese version of the LPFS-SR, seeking to contribute to its cross-cultural validity. It addressed: 1) the internal consistency of the Portuguese LPFS-SR in community and clinical samples; 2) the analysis of the community sample results on the Portuguese LPFS-SR and its comparison to those obtained by two Portuguese clinical subsamples, one composed of personality disorders (PD sample) and the other of other psychiatric diagnoses (OD sample); 3) the capacity of the LPFS-SR to discriminate between the PD sample and the community sample and between both clinical samples (PD and OD samples) through ROC curve analyses; 4) the factor structure of the Portuguese version of the LPFS-SR.

At the outset, the internal consistency of the Portuguese LPFS-SR was expected to be akin to Morey’s original data [26]. Aiming to validate the Portuguese version of the LPFS-SR and its clinical usage, the clinical samples were expected to obtain higher results on the LPFS-SR than the community sample. Considering that the LPFS-SR is intended to assess core personality functions in the interest of diagnosing personality disorder, the PD sample was also expected to yield higher results on the LPFS-SR than the OD sample. Furthermore, we sought to replicate previously published studies on clinical populations (e.g., Hemmati et al. [50]) in which ROC curve analyses were used to examine the capacity of the LPFS-SR to discriminate between the PD sample and the community sample and between both clinical samples (PD and OD samples). Finally, we expected to confirm the unidimensional structure of the LPFS-SR in the community and clinical samples, which has been supported by research [26, 46, 47, 50] and is consistent with the assumption that Criterion A reflects a single dimension of global personality dysfunction.

Method

This study was conducted under a research project entitled “Personality and Psychopathology III: Validation Studies of the Alternative DSM-5 Model for Personality Disorders in the Portuguese Population” approved by the Ethics Committee of the Faculty of Psychology, Lisbon University. Participants were recruited between 1st November 2021 and 1st July 2022. All the participants provided written informed consent.

Sample

The community sample consisted of 282 volunteers aged between 21 and 83 years (Mage = 48.01, SD = 10.87, 46.8% male, 53.2% female), recruited from the relatives and acquaintances of undergraduate students of the University of Lisbon attending a subject whose programme focused on personality and individual differences. Each student who volunteered to participate in the sample collection process, applied the research protocol to two adults from the community and received an award in the final mark of the subject. Participants from the general population answered the research protocol on paper, at home, with the responses returned in a sealed envelope. They did not receive any incentive to participate.

The clinical sample was collected for research purposes, after establishing partnerships with several mental health units. The sample was composed of 188 patients aged between 18 and 77 years (Mage = 48.79, SD = 12.30, 45.2% male, 54.8% female), who were undergoing treatment at the time at mental health units. In each affiliated mental health unit, a clinician coordinated the sampling procedures and selected the participants from the clinical databases of the institution, or from whom they had been referred. The collected clinical sample relied on the direct clinical evaluation of several psychiatrists, whose diagnosis had been previously discussed and agreed upon by a clinical team. Patients were selected according to their DSM-5 diagnosis (Sections I, II) and the study’s inclusion and exclusion criteria. The study’s inclusion criteria were individuals aged 18 years or above. Diagnoses of intellectual disability, schizophrenia, and major and mild neurocognitive disorders were the exclusion criteria. Some patients answered the research protocol during their short- term hospitalizations, others were outpatients, admitted sequentially in the sample whenever they had a follow-up consultation. This clinical sample was divided into two clinical subsamples, one composed of patients diagnosed with a personality disorder (n = 40, Mage = 46.18, SD = 13.59, 47.5% male, 52.5% female), and the other of patients with several psychiatric diagnoses, other than personality disorders (n = 148, Mage = 49.49, SD = 11.88, 44.6% male, 55.4% female). Regarding the personality disorders subsample, patients were assigned to this group whenever they had a personality disorder diagnosis as a major diagnosis or in comorbidity. Comorbid diagnoses included depressive disorders, bipolar and related disorders, and anxiety disorders. As for the other diagnoses group, the major diagnoses comprised depressive disorders, bipolar and related disorders, anxiety disorders, obsessive-compulsive and related disorders, substance-related and addictive disorders and trauma and stressor related disorders. Comorbid diagnoses included depressive disorders, substance-related and addictive disorders, trauma and stressor related disorders, anxiety disorders, and obsessive-compulsive and related disorders.

Instruments

Level of Personality Functioning Scale–Self-Report (LPFS-SR; [26])

The LPFS-SR is a self-report measure that operationalizes Criterion A of the DSM-5 Alternative Model for Personality Disorders. It consists of 80 items, rated on a 4-point Likert scale ranging from 1 (totally false, not at all true) to 4 (very true) which characterize a global severity level and four dimensions of personality dysfunction (Identity, Self-Direction, Empathy, and Intimacy). The scoring of the LPFS-SR is designed so that higher scores represent personality problems of increasing severity.

The authorization to translate the LPFS-SR into Portuguese was obtained from the author of the test. Upon authorization, an expert in the field of personality research and proficient in the English language translated the original English items into Portuguese. The Portuguese translation of the LPFS-SR was independently evaluated by two senior personality researchers, all well acquainted with test development procedures. The final wording was obtained after consensus among the two researchers and the translator. This preliminary Portuguese version of the test was then given to a native English speaker who is also a professional translator for back-translation and was finally sent to the author of the LPFS-SR for revision and approval.

Data analysis

Analyses were undertaken with the IBM SPSS Statistics (Version 27) and FACTOR software (version 12.04.23) [51]. The FACTOR software freely obtained from Rovira i Virgili University, is one of the most complete statistical programs for conducting an EFA, given that it congregates both CFA indexes and EFA. FACTOR includes the most current criteria for fundamental decisions: the correlation matrix to be used, the method to be adopted for extracting common factors, the number of factors to be retained and the rotation method [52]. Additionally, this software provides some goodness-of-fit indexes and the corresponding confidence intervals are based on bootstrap techniques, which are unusual in EFA algorithms.

Descriptive statistics for the LPFS-SR dimensions and total score were obtained, as well as the item-total correlations and the inter-scale correlations in the community and clinical samples. The Cohen’s d was used as a measure of effect size, to study the mean score differences between the Portuguese community sample and the US original sample. The effect size was considered small when d ≤ .20, medium when .20 < d ≤ .50, large when .50 < d ≤ 1.0, and very large when d > 1.0 [53]. Internal consistency was examined through Cronbach’s alphas. To explore the normality of the scales’ distributions, the following criteria were used: skewness, kurtosis, Kolmogorov-Smirnov Goodness-of-Fit Test (N > 30), steam and leaf diagrams and Q-Q plots. Given that most of the LPFS-SR scales did not follow a normal distribution in the community sample, the Kruskal-Wallis test with multiple pairwise comparisons was used to compare the three groups (PD sample, OD sample and community sample). In addition, the epsilon-squared (ε2) estimate of effect size was obtained, in which ε2 < .01 is negligible, .01 ≤ ε2 < .04 is weak, .04 ≤ ε2 < .16 is moderate, .16 ≤ ε2 < .36 is relatively strong, .36 ≤ ε2 < .64 is strong and .64 ≤ε2 <1.00 is very strong [53]. The capacity of the LPFS-SR total score to discriminate between the PD and the community samples; and between the PD and OD samples was examined through the ROC curve analysis. The factor structure of the Portuguese version of the LPFS-SR in the community and clinical samples was examined through the FACTOR software, in which the Hull method with unweighted least squares extraction and Promax rotation was applied, and the Hull scree-test value, the Comparative Fit Index (CFI) and the Non-normed Fit Index (NNFI or TLI) were used to test the goodness of fit. CFI and TLI above .95 indicate a good to excellent fit of the model. Additionally, to test closeness to unidimensionality, the Unidimensional Congruence (UniCo), the Explained Common Variance (ECV) and the Mean of Item Residual Absolute Loading (MIREAL) indexes were analysed. A UniCo score above .95, a ECV score above .85 and a MIREAL score below .30 suggest that the data can be treated as essentially unidimensional [51].

To analyse the similarity between factor results, Tucker’s congruence coefficient [54] was used. A value in the range [.85, .94] indicates that the two compared factors are fairly similar, while a value equal to or higher than 0.95 signifies good similarity [49].

Results

Table 1 presents the Cronbach’s alphas (α), means (M), standard deviations (SD), and Cohen’s d between the USA sample [26] and the Portuguese community and clinical samples for the LPFS-SR domains and total.

Table 1. Cronbach’s alphas (α), means (M), standard deviations (SD), and Cohen’s d between the USA sample [26] and the Portuguese community and clinical samples for the LPFS-SR domains and total.

Morey (2017)
(N = 293*)		 Community
(N = 282)		 Clinical
(N = 188)
M SD α M SD α d M SD α
Identity 75.83 25.17 .89 69.37 18.72 .87 .29 94.68 25.19 .86
Self-Direction 53.37 20.19 .88 50.24 13.46 .82 .18 68.92 20.65 .86
Empathy 39.09 14.26 .82 40.37 10.32 .67 -.10 50.50 13.91 .65
Intimacy 64.09 22.99 .88 55.59 15.02 .80 .44 74.20 21.44 .82
Total 232.38 76.45 .96 214.58 50.14 .96 .27 287.24 73.66 .95
Open in a new tab

* USA community sample

Note. Small effect d ≤ .20, medium effect size .20 < d ≤ .50, large .50 < d ≤ 1.0, and very large d > 1.0

In the community sample, descriptive statistics for the domains and total of the Portuguese version of the LPFS-SR were compared with Morey’s original data [26] through Cohen’s d. There were low (≤ 0.2) to medium effect sizes (0.2–0.5). These slight variations suggest that the Portuguese version of the LPFS-SR produces scores in the same range as those found with the original version of the LPFS-SR. Therefore, this study tends to contribute to the cross-cultural validation.

Cronbach’s alphas for the subcomponents of the LPFS-SR in the community and clinical samples were generally in the .80 range, with lower internal consistency noted for the empathy subscale. Notably, the alphas for the total score were .96 in the community sample (.96 in the USA community sample; [26]) and .95 in the clinical sample. Item-total correlations showed that most of the items correlated at acceptable levels (> .30) with their respective scale and the total score. It was noted that items 40, 44, 51, 61 and 76 in the community sample, and items 11, 14, 40, 44, 51, 61 and 76 in the clinical sample obtained negative item-total correlations. These are all reverse-keyed items that represent positive personality features, and are thus weighted negatively in computing the overall LPFS-SR total score.

Table 2 presents the LPFS-SR scales’ means (M) and standard deviations (SD) in the Portuguese community sample, in the PD sample and in the OD sample.

The LPFS-SR scale means were higher in the PD sample, followed by the OD sample and finally by the community sample (Tables 1 and 2).

Tables 3–6 display the LPFS-SR scales’ intercorrelations in the Portuguese community sample, in the clinical sample and sub-samples, the PD sample and in the OD sample, respectively.

Table 3. LPFS-SR scales’ intercorrelations in the Portuguese community sample.

Community (N = 282)
Identity Self-Direction Empathy Intimacy Total
Identity 1.00
Self-Direction .74** 1.00
Empathy .60** .65** 1.00
Intimacy .62** .56** .62** 1.00
Total .90** .85** .80** .82** 1.00
Open in a new tab

** p < .01

Table 6. LPFS-SR scales’ intercorrelations in the Portuguese other diagnoses sample.

Other diagnoses (n = 148)
Identity Self-Direction Empathy Intimacy Total
Identity 1.00
Self-Direction .76** 1.00
Empathy .70** .66** 1.00
Intimacy .71** .71** .72** 1.00
Total .90** .89** .83** .88** 1.00
Open in a new tab

** p < .01

Table 5. LPFS-SR scales’ intercorrelations in the Portuguese personality disorder sample.

Personality Disorder (n = 40)
Identity Self-Direction Empathy Intimacy Total
Identity 1.00
Self-Direction .70** 1.00
Empathy .63** .55** 1.00
Intimacy .72** .60** .56** 1.00
Total .88** .82** .82** .89** 1.00
Open in a new tab

** p < .01

The four LPFS-SR scales revealed strong intercorrelations ranging from .56 to .74 in the community sample, from .64 to .76 in the total clinical sample, from .55 to .72 in the PD sample, and from .66 to 76 in the OD sample. Scale to total correlations ranged from .80 to .90 in the community sample, from .82 to .91 in the total clinical sample, from .82 to .89 in the PD sample, and from .83 to .90 in the OD sample.

The Kruskal-Wallis H-test with multiple pairwise comparisons was used to compare the three groups (PD group, OD group and community sample).

Table 7 presents the Kruskal-Wallis test results in the three samples.

Table 7. Mean ranks, Independent Samples Kruskal-Wallis (χ2) and size effects (ε2) in the community, personality disorder and other diagnoses samples.

LPFS-SR scales Samples Mean ranks χ 2 p ε2
Identity Community 174.37 115.26 < .001 .26
Personality Disorders 341.09
Other Diagnoses 298.53
Self-Direction Community 177.05 104.99 < .001 .23
Personality Disorders 336.83
Other Diagnoses 295.00
Empathy Community 186.22 65.75 < .001 .15
Personality Disorders 317.96
Other Diagnoses 276.72
Intimacy Community 175.56 88.71 < .001 .20
Personality Disorders 327.67
Other Diagnoses 280.23
Total Community 156.76 103.76 < .001 .26
Personality Disorders 308.16
Other Diagnoses 268.71
Open in a new tab

Note. ε2; negligible effect: < .01, weak effect: .01 - .04, moderate effect: .04 - .16, relatively strong effect .16 - .36, strong effect .36 - .64, very strong effect: .64–1.00

The PD sample, the OD sample and the community sample differed in all the LPFS-SR scales and total scores (p < .001), with relatively strong effects in all the dimensions, except in the empathy scale in which the epsilon-squared estimate of effect size was moderate.

Multiple pairwise comparisons also revealed that in all the LPFS-SR scales and total scores, the community sample differed significantly from the OD group (p < .001) and the PD group (p = .001). The clinical samples did not differ in the LPFS-SR scales, although the PD mean ranks were higher than the OD mean ranks.

ROC analyses were used to examine the capacity of the LPFS-SR total score to discriminate between the samples. Considering that the LPFS-SR is intended to specifically assess the core personality features of PD, only the LPFS-SR total score ROC discriminative capacity between the PD and community samples and between the PD and OD samples were reported. The optimal cut-off points were selected such that the sum of sensitivity and specificity was maximized, thus the optimal score would produce few incorrect decisions under conditions of equal a priori probabilities. Classification results using the optimal cut-off score obtained by the ROC analysis are provided.

The LPFS-SR total score ROC discriminative capacity between the PD and community samples demonstrated a significant area-under-the-curve of .86 (p < .001; 95% CI: .78-.94), indicating that the LPFS-SR total score significantly discriminated between the community and the PD samples (see Fig 1). The optimal cut-off was a total score of 272.00, corresponding to a sensitivity (true positive rate) of 75% and a specificity (true negative rate) of 89% (1-.11). This cut-off accurately classified 88% of the cases, 89% of the community sample and 75% of the PD sample.

Fig 1. Receiver Operator Characteristic (ROC) curve for the LPFS-SR in differentiating the community and PD samples.

Fig 1

Open in a new tab

Fig 2 shows that the LPFS-SR total score demonstrated a significant but small degree of discrimination between the PD and OD samples. The area-under-the-curve was of .63 (p = .027; 95% CI: .52-.74). The optimal cut-off was a total score of 294.50, corresponding to a sensitivity (true positive rate) of 66% and a specificity (true negative rate) of 59% (1-.41). This cut-off accurately classified 60% of the cases, 59% of the OD sample and 66% of the PD sample.

Fig 2. Receiver Operator Characteristic (ROC) curve for the LPFS-SR in differentiating the PD and OD samples.

Fig 2

Open in a new tab

In line with Hemmati et al. [50], the Factor software [51], was used to address the unidimensionality of the LPFS-SR in the community and in the clinical samples. In the community sample, preliminary data checks revealed that the Kaiser-Meyern (KMO) measure of sampling adequacy was good (.87). The results are consistent with those obtained by Hemmati et al. [50] and support a one-dimensional factor solution: the Hull method with unweighted least squares, scree-test value = 21.69, CFI = .999, NNFI (TLI) = 1.038, UniCo = .959, ECV = .871 and MIREAL = .179. Also, the strong intercorrelations among the four LPFS-SR scales and the LPFS-SR total score support the unidimensional nature of the measure (see Table 3). Moreover, the fact that the eigenvalue of the first factor (17.05; 21%) is much larger than the eigenvalue of the second factor (4.91; 6%) further suggests that the 80 items of the LPFS-SR can be treated as essentially unidimensional.

In the clinical sample, preliminary data checks also showed that the Kaiser-Meyern (KMO) measure of sampling adequacy was good (.81). The results are in line with those obtained for the community sample, although the reduced number of psychiatric patients in the clinical sample led to more modest index values, but supported a one-dimensional factor solution: the Hull method with unweighted least squares and Promax rotation, scree-test value = 20.15, CFI = .982, NNFI (TLI) = .987, UniCo = .952, ECV = .875 and MIREAL = .213. Also, the strong intercorrelations among the four LPFS-SR scales and the LPFS-SR total score support the unidimensional nature of the measure (see Table 4). Moreover, the fact that the eigenvalue of the first factor (18.66; 23%) is much larger than the eigenvalue of the second factor (5.49; 7%) further suggests that the 80 items of the LPFS-SR can be treated as essentially unidimensional.

Table 4. LPFS-SR scales’ intercorrelations in the total clinical sample.

Clinical (N = 188)
Identity Self-Direction Empathy Intimacy Total
Identity 1.00
Self-Direction .76** 1.00
Empathy .69** .64** 1.00
Intimacy .72** .71** .70** 1.00
Total .91** .88** .82** .89** 1.00
Open in a new tab

** p < .01

The similarity between the extracted factors in the community and clinical samples, and international studies with available factors results, was analysed using Tucker’s congruence coefficient (φ). We compared the factor results of the Portuguese community sample, the Portuguese clinical sample, and the item factor loadings of Bliton et al. [55].

φ(Community vs. Clinical samples) = .98, φ(Community sample vs. Bliton study) = .94 and φ(Clinical sample vs. Bliton study) = .94. Thus, the factor structures for the community and clinical samples exhibit good similarity; community factor loadings and Bliton study factor loadings are fairly similar; clinical sample and Bliton study factor results are also fairly similar.

Discussion

The aim of this study was to contribute to the cross-cultural validation of the LPFS-SR in Portuguese community and clinical samples and to address the LPFS-SR’s potential for distinguishing between non-clinical participants and clinical participants with respect to the severity of personality dysfunction, as well as the dimensionality of the LPFS-SR construct.

The Portuguese version of the LPFS-SR showed adequate psychometric properties. The results for internal consistency were in line with those obtained with the original test [26, 55], with the Persian version of the test [50], in which both a clinical and community sample were studied, and with its Polish version, in a community sample [47]. In the Polish adaptation, the alpha of the empathy scale was akin to the Portuguese alpha in both samples, that is lower than the other scales’ alphas.

As for its validity, the results showed that the Portuguese LPFS-SR was able to differentiate the clinical and community samples. As expected for a measure of personality pathology severity, the community sample yielded significantly lower results in all the LPFS-SR scales than both clinical samples. Moreover, considering that the LPFS-SR is intended to assess personality dysfunction severity in the interest of diagnosing PD, the Portuguese version of the LPFS-SR should be able to screen and predict a PD diagnosis. The ROC analysis showed that the highest LPFS-SR total score discriminative capacity was obtained between the PD and community samples (AUC = .86; p < .001; optimal cut-off of 272.00, corresponding to a sensitivity of 75% and a specificity of 89%), however, although our PD sample was small and had comorbidities, the LPFS-SR total score discriminative capacity between the PD and the OD sample was also significant (AUC = .63; p = .027). It should be noted that the LPFS model not only seeks to describe core features of PD, but may also characterize impairments in self and interpersonal functioning underlying many forms of psychopathology [45, 56]. Some have proposed that the LPFS construct is closely aligned with a general factor of psychiatric severity, such as the p factor [57], reflecting the overall level of impairment or dysfunction [34, 45]. Given that all psychopathology is mediated by the individual’s subjective self-other experience, this may account for its less discriminative capacity between PDs and non-PD pathology.

In keeping with Hemmati et al. [50] and Łakuta et al.’s [47] findings, in this study the Cronbach’s alpha values for the community and clinical samples were high, above or equal to .80 and .82, respectively, except for the empathy scale. Moreover, all the LPFS-SR scales showed strong intercorrelations in both samples. Finally, the EFA and CFA indexes obtained in this study supported a unidimensional structure for the LPFS-SR in the community and clinical sample [26, 34, 46, 55]. Therefore, the current study supports the premise that the LPFS-SR construct lays in a continuum that captures the degree of severity of personality dysfunction.

Despite the promising and convergent results that contribute to the validation of LPFS-SR usage in clinical contexts, the validation of the Portuguese version of the LPFS-SR is still in progress. Conducting validity studies (for convergent validity data, please refer to [36]) and performing scale reliability analyses with a test-retest design, are essential future endeavours to ensure the accuracy of the LPFS-SR for use in clinical practice and scientific research. Other limitations are related to the small size of the samples and the comorbid diagnoses which, although reflecting the reality of the psychiatric population, may have accounted for the less clearly interpretable differences between the PD and the OD samples. Although each diagnosis assignment relied on the clinical evaluation of several psychiatrists per mental health institution, the fact that no structured clinical interview was used may have undermined diagnostic reliability and contributed to less expressive differences between the PD and OD samples. On the other hand, the fact that in the current study, besides the clinical, a community sample was used instead of solely a college sample, reinforces the cross-cultural validation of the LPFS-SR. Moreover, on the 10th anniversary of the publication of the AMPD [1], and in line with Zimmermann’s appeal [41], this study offers a modest contribution to a constructive discussion regarding the strengths and limitations of Criterion A, namely supporting its one-dimensionality [20, 26, 46].

As future directions and considering the cross-validation of the LPFS-SR, it would be interesting to compare Portuguese results with those obtained in other Portuguese speaking countries. The study of the discriminative capacity of the LPFS-SR with enlarged PD samples and other clinical and non-clinical samples is one of the most anticipated future developments for this study as it may be another step in the validation of the DSM-5 AMPD model, eventually contributing to its definitive inclusion in the official DSM-5 PD classification.

Supporting information

S1 File

(PDF)

pone.0300706.s001.pdf (200.5KB, pdf)
S2 File

(PDF)

pone.0300706.s002.pdf (225.4KB, pdf)
S3 File

(XLSX)

pone.0300706.s003.xlsx (31.3KB, xlsx)

Acknowledgments

To Tania Gregg for specialized assistance in the proofreading of this paper. To all the study participants without whom this study would not have been possible and to whom it is dedicated.

Data Availability

All relevant data are within the manuscript and its Supporting Information files.

Funding Statement

- This work received national funding from the FCT – Fundação para a Ciência e a Tecnologia, I.P [Foundation for Science and Technology], through the Research Centre for Psychological Science of the Faculty of Psychology, University of Lisbon (UIDB/04527/2020; UIDP/04527/2020) and the Business Research Unit, BRU-IUL (UIDB/00315/2020). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

References

  • 1.Diagnostic and statistical manual of mental Disorders: DSM-5. 5th ed., American Psychiatric Association, 2013. [DOI] [PubMed]
  • 2.International Classification of Diseases: ICD-11. 11th revision, World Health Organization, 2018. https://icd.who.int/
  • 3.Krueger RF, Derringer J, Markon KE, Watson D, Skodol AE. Initial construction of a maladaptive personality trait model and inventory for DSM-5. Psychol Med. 2012;42(9):1879–1890. doi: 10.1017/S0033291711002674 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4.Al-Attiyah AA, Megreya AM, Alrashidi M, Dominguez-Lara SA, Al-Sheerawi A. The psychometric properties of an Arabic version of the Personality Inventory for DSM-5 (PID-5) across three Arabic-speaking Middle Eastern countries. Int J Cult Ment Health. 2017;10(2):197–205. doi: 10.1080/17542863.2017.1290125 [DOI] [Google Scholar]
  • 5.Al-Dajani N, Gralnick TM, Bagby RM. A psychometric review of the Personality Inventory for DSM–5 (PID–5): Current status and future directions. J Pers Assess. 2016;98(1):62–81. doi: 10.1080/00223891.2015.1107572 [DOI] [PubMed] [Google Scholar]
  • 6.Bach B, Maples-Keller JL, Bo S, Simonsen E. The alternative DSM–5 personality disorder traits criterion: A comparative examination of three self-report forms in a Danish population. Personal Disord. 2016;7(2):124–135. doi: 10.1037/per0000162 [DOI] [PubMed] [Google Scholar]
  • 7.Bach B, Sellbom M, Simonsen E. Personality inventory for DSM-5 (PID-5) in clinical versus nonclinical individuals: Generalizability of psychometric features. Assessment. 2018;25(7):815–825. doi: 10.1177/1073191117709070 [DOI] [PubMed] [Google Scholar]
  • 8.Coelho O, Pires R, Ferreira AS, Gonçalves B, AlJassmi M, Stocker J. Arabic version of the personality inventory for the DSM-5 (PID-5) in a community sample of United Arab Emirates Nationals. Clin Pract Epidemiol Ment Health. 2020;16:180–188. doi: 10.2174/1745017902016010180 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Coelho O, Pires R, Ferreira AS, Gonçalves B, Alkhoori SA, Sayed MA et al. The Arabic Version of the personality inventory for the DSM-5 (PID-5) in a clinical sample of United Arab Emirates (UAE) Nationals. Am J Health Behav. 2020;44(6):794–806. doi: 10.5993/AJHB.44.6.5 [DOI] [PubMed] [Google Scholar]
  • 10.Coelho O, Pires R, Ferreira AS, Gonçalves B, Alkhoori SA, Sayed M et al. Cross-cultural Study of the Personality Inventory for the DSM-5 (PID-5) across the Portuguese and the United Arab Emirates (UAE) Community and Clinical Populations. Clin Pract Epidemiol Ment Health. 2022;18:1–16. doi: 10.2174/17450179-v18-e2207130 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.De Clercq B, De Fruyt F, De Bolle M, Van Hiel A, Markon KE, Krueger RF. The hierarchical structure and construct validity of the PID‐5 trait measure in adolescence. J Pers. 2014;82(2):158–69. doi: 10.1111/jopy.12042 [DOI] [PubMed] [Google Scholar]
  • 12.De Fruyt F, De Clercq B, De Bolle M, Wille B, Markon K, Krueger RF. General and maladaptive traits in a five-factor framework for DSM-5 in a university student sample. Assessment. 2013;20(3):295–307. doi: 10.1177/1073191113475808 [DOI] [PubMed] [Google Scholar]
  • 13.Fossati A, Krueger RF, Markon KE, Borroni S, Maffei C. Reliability and validity of the Personality Inventory for DSM-5 (PID-5) predicting DSM-IV personality disorders and psychopathy in community-dwelling Italian adults. Assessment. 2013;20(6):689–708. doi: 10.1177/1073191113504984 [DOI] [PubMed] [Google Scholar]
  • 14.Gutiérrez F, Aluja A, Peri JM, Calvo N, Ferrer M, Baillés E et al. Psychometric properties of the Spanish PID-5 in a clinical and a community sample. Assessment. 2017;24(3):326–336. doi: 10.1177/1073191115606518 [DOI] [PubMed] [Google Scholar]
  • 15.Pires R, Sousa Ferreira A, Guedes D. The psychometric properties of the Portuguese version of the personality inventory for DSM‐5. Scand J Psychol. 2017;58(5):468–475. doi: 10.1111/sjop.12383 [DOI] [PubMed] [Google Scholar]
  • 16.Pires R, Sousa Ferreira A, Gonçalves B, Henriques‐Calado J, Paulino M. The Portuguese version of the Personality Inventory for the DSM‐5 in a community and a clinical sample. Personal Ment Health. 2019;13(1):40–52. doi: 10.1002/pmh.1437 [DOI] [PubMed] [Google Scholar]
  • 17.Roskam I, Galdiolo S, Hansenne M, Massoudi K, Rossier J, Gicquel L, et al. (2015) The Psychometric Properties of the French Version of the Personality Inventory for DSM-5. PLoS ONE 10(7): e0133413. doi: 10.1371/journal.pone.0133413 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18.Zimmermann J, Altenstein D, Krieger T, Holtforth MG, Pretsch J, Alexopoulos J et al. The structure and correlates of self-reported DSM-5 maladaptive personality traits: Findings from two German-speaking samples. J Pers Disord. 2014;28(4):518–540. doi: 10.1521/pedi_2014_28_130 [DOI] [PubMed] [Google Scholar]
  • 19.Bender DS, Morey LC, Skodol AE. Toward a model for assessing level of personality functioning in DSM–5, part I: A review of theory and methods. J Pers Assess 2011;93(4):332–346. doi: 10.1080/00223891.2011.583808 [DOI] [PubMed] [Google Scholar]
  • 20.Morey LC, Good EW, Hopwood CJ. Global personality dysfunction and the relationship of pathological and normal trait domains in the DSM‐5 alternative model for personality disorders. J Pers. 2022;90(1):34–46. doi: 10.1111/jopy.12560 [DOI] [PubMed] [Google Scholar]
  • 21.Waugh MH, McClain CM, Mariotti EC, Mulay AL, DeVore EN, Lenger KA et al. Comparative content analysis of self-report scales for level of personality functioning. J Pers Assess. 2021. Mar;103(2):161–173. doi: 10.1080/00223891.2019.1705464 [DOI] [PubMed] [Google Scholar]
  • 22.Hutsebaut J, Feenstra DJ, Kamphuis JH. Development and preliminary psychometric evaluation of a brief self-report questionnaire for the assessment of the DSM–5 level of Personality Functioning Scale: The LPFS brief form (LPFS-BF). Personal Disord. 2016;7(2): 192–197. doi: 10.1037/per0000159 [DOI] [PubMed] [Google Scholar]
  • 23.Weekers LC, Hutsebaut J, Kamphuis JH. The level of Personality Functioning Scale-Brief Form 2.0: Update of a brief instrument for assessing level of personality functioning. Personal Ment Health. 2029;13(1): 3–14. doi: 10.1002/pmh.1434 [DOI] [PubMed] [Google Scholar]
  • 24.Weekers LC, Sellbom M, Hutsebaut J, Simonsen S, Bach B. (2023). Normative data for the LPFS‐BF 2.0 derived from the Danish general population and relationship with psychosocial impairment. Personal Ment Health. 2023;17(2): 157–164. doi: 10.1002/pmh.1570 [DOI] [PubMed] [Google Scholar]
  • 25.Huprich SK, Nelson SM, Meehan KB, Siefert CJ, Haggerty G, Sexton J et al. Introduction of the DSM-5 levels of Personality Functioning Questionnaire. Personal Disord.2018;9(6): 553–563. doi: 10.1037/per0000264 [DOI] [PubMed] [Google Scholar]
  • 26.Morey LC. Development and initial evaluation of a self-report form of the DSM–5 Level of Personality Functioning Scale. Psychol Assess. 2017;29(10): 1302–1308. doi: 10.1037/pas0000450 [DOI] [PubMed] [Google Scholar]
  • 27.Sharp C, Miller JD. Ten-year retrospective on the DSM–5 alternative model of personality disorder: Seeing the forest for the trees. Personal Disord. 2022;13(4): 301–304. doi: 10.1037/per0000595 [DOI] [PubMed] [Google Scholar]
  • 28.Crawford MJ, Koldobsky N, Mulder R, Tyrer P. Classifying personality disorder according to severity. J Pers Disord. 2011;25(3):321–330. doi: 10.1521/pedi.2011.25.3.321 [DOI] [PubMed] [Google Scholar]
  • 29.Gamache D, Savard C, Leclerc P, Côté A. Introducing a short self-report for the assessment of DSM–5 level of personality functioning for personality disorders: The Self and Interpersonal Functioning Scale. Personal Disord. 2019;10(5):438–447. doi: 10.1037/per0000335 [DOI] [PubMed] [Google Scholar]
  • 30.Hopwood CJ, Malone JC, Ansell EB, Sanislow CA, Grilo CM, McGlashan TH, et al. Personality assessment in DSM-5: Empirical support for rating severity, style, and traits. J Personal Disord. 2011;25(3):305–320. doi: 10.1521/pedi.2011.25.3.305 [DOI] [PubMed] [Google Scholar]
  • 31.Keeley JW, Flanagan EH, McCluskey DL. Functional impairment and the DSM-5 dimensional system for personality disorder. J Pers Disord. 2014;28(5):657–674. doi: 10.1521/pedi_2014_28_133 [DOI] [PubMed] [Google Scholar]
  • 32.Krueger RF, Markon KE. The role of the DSM-5 personality trait model in moving toward a quantitative and empirically based approach to classifying personality and psychopathology. Annu Rev Clin Psychol. 2014;10:477–501. doi: 10.1146/annurev-clinpsy-032813-153732 [DOI] [PubMed] [Google Scholar]
  • 33.Nysaeter TE, Hummelen B, Christensen TB, Eikenaes IU, Selvik SG, Pedersen G, et al. The incremental utility of criteria A and B of the DSM-5 alternative model for personality disorders for predicting DSM-IV/DSM-5 section II personality disorders. J Pers Assess. 2023;105(1):111–120. doi: 10.1080/00223891.2022.2039166 [DOI] [PubMed] [Google Scholar]
  • 34.Morey LC, McCredie MN, Bender DS, Skodol AE. Criterion A: Level of personality functioning in the alternative DSM–5 model for personality disorders. Personal Disord. 2022;13(4): 305–315. doi: 10.1037/per0000551 [DOI] [PubMed] [Google Scholar]
  • 35.Pires R, Henriques-Calado J, Sousa Ferreira A, Bach B, Paulino M, Gama Marques J, et al. The utility of ICD-11 and DSM-5 traits for differentiating patients with personality disorders from other clinical groups. Front Psychiatry. 2021;12:633882. doi: 10.3389/fpsyt.2021.633882 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 36.Pires R, Henriques-Calado J, Sousa Ferreira A, Gama Marques J, Ribeiro Moreira A, Barata BC, et al. Bridging the ICD11 and the DSM-5 personality disorders classification systems: The role of the PID5BF+ M. Front Psychiatry. 2023;14:1004895. doi: 10.3389/fpsyt.2023.1004895 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 37.Samuel DB, Hopwood CJ, Krueger RF, Thomas KM, Ruggero CJ. Comparing methods for scoring personality disorder types using maladaptive traits in DSM-5. Assessment. 2013;20(3):353–361. doi: 10.1177/1073191113486182 [DOI] [PubMed] [Google Scholar]
  • 38.Sharp C, Wright AG, Fowler JC, Frueh BC, Allen JG, Oldham J, Clark LA. The structure of personality pathology: Both general (‘g’) and specific (‘s’) factors?. J Abnorm Psychol. 2015;124(2):387–398. doi: 10.1037/abn0000033 [DOI] [PubMed] [Google Scholar]
  • 39.Zimmermann J, Kerber A, Rek K, Hopwood CJ, Krueger RF. A brief but comprehensive review of research on the alternative DSM-5 model for personality disorders. Curr Psychiatry Rep. 2019;21:1–9. doi: 10.1007/s11920-019-1079-z [DOI] [PubMed] [Google Scholar]
  • 40.Zimmermann J, Müller S, Bach B, Hutsebaut J, Hummelen B, Fischer F. A common metric for self-reported severity of personality disorder. Psychopathology. 2020;53(3–4):168–178. doi: 10.1159/000507377 [DOI] [Google Scholar]
  • 41.Zimmermann J. Beyond defending or abolishing Criterion A: Comment on Morey et al.(2022). Personal Disord.2020;13(4): 321–324. doi: 10.1037/per0000561 [DOI] [PubMed] [Google Scholar]
  • 42.Krueger RF, Kotov R, Watson D, Forbes MK, Eaton NR, Ruggero CJ, et al. Progress in achieving quantitative classification of psychopathology. World psychiatry. 2018;17(3):282–293. doi: 10.1002/wps.20566 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 43.Sleep CE, Lynam DR, Widiger TA, Crowe ML, Miller JD. An evaluation of DSM–5 Section III personality disorder Criterion A (impairment) in accounting for psychopathology. Psychol Assess. 2019;31(10):1181–1191. doi: 10.1037/pas0000620 [DOI] [PubMed] [Google Scholar]
  • 44.Sleep CE, Lynam DR. The problems with Criterion A: A comment on Morey et al.(2022). Personal Disord. 2022;13(4): 325–327. doi: 10.1037/per0000585 [DOI] [PubMed] [Google Scholar]
  • 45.Bender DS. The P-factor and what it means to be human: commentary on criterion A of the AMPD in HiTOP. J Pers Assess. 2019;101(4):356–359. doi: 10.1080/00223891.2018.1492928 [DOI] [PubMed] [Google Scholar]
  • 46.Hopwood CJ, Good EW, Morey LC. Validity of the DSM–5 levels of personality functioning scale–self report. J Pers Assess. 2018;100(6):650–659. doi: 10.1080/00223891.2017.1420660 [DOI] [PubMed] [Google Scholar]
  • 47.Łakuta P, Cieciuch J, Strus W, Morey LC. Psychometric evaluation of the polish adaptation of a self-report form of the DSM-5 level of personality functioning scale (LPFS-SR). Psychiatr Pol. 2023;57(2):261–274. doi: 10.12740/PP/OnlineFirst/142888 [DOI] [PubMed] [Google Scholar]
  • 48.Morey LC. Thoughts on the assessment of the DSM–5 alternative model for personality disorders: Comment on Sleep et al. (2019). Psychol Assess. 2019; 31(10), 1192–1199. doi: 10.1037/pas0000710 [DOI] [PubMed] [Google Scholar]
  • 49.Lorenzo-Seva U, Timmerman ME, Kiers HA (2011). The Hull method for selecting the number of common factors. Multivariate Behav Res. 2011; 46(2), 340–364. doi: 10.1080/00273171.2011.564527 [DOI] [PubMed] [Google Scholar]
  • 50.Hemmati A, Morey LC, McCredie MN, Rezaei F, Nazari A, Rahmani F. Validation of the Persian translation of the Level of Personality Functioning Scale—Self-Report (LPFS-SR): Comparison of college students and patients with personality disorders. J Psychopathol Behav Assess. 2020;42:546–559. doi: 10.1007/s10862-019-09775-6 [DOI] [Google Scholar]
  • 51.Ferrando PJ, Seva UL. Program FACTOR at 10: Origins, development and future directions/10 anos del programa factor: una revision critica de sus origenes, desarrollo y lineas futuras. Psicothema. 2017;29(2), 236–241. [DOI] [PubMed] [Google Scholar]
  • 52.Rogers P. (2022). Best practices for your exploratory factor analysis: A factor tutorial. Rev Adm Contemp. 2022; 26(06), e-210085. doi: 10.1590/1982-7849rac2022210085.en [DOI] [Google Scholar]
  • 53.Tomczak M, Tomczak E. The need to report effect size estimates revisited. An overview of some recommended measures of effect size. Trends Sport Sci.2014;1(21):19–25. [Google Scholar]
  • 54.Tucker LR. A method for synthesis of factor analysis studies. Personnel Research Section Report No.984. Washington: Department of the Army; 1951. [Google Scholar]
  • 55.Bliton CF, Roche MJ, Pincus AL, Dueber D. Examining the structure and validity of self-report measures of DSM-5 alternative model for personality disorders Criterion A. J Pers Disord. 2022;36(2):157–182. doi: 10.1521/pedi_2021_35_531 [DOI] [PubMed] [Google Scholar]
  • 56.Sharp C. Fulfilling the promise of the LPF: Comment on Morey et al.(2022).Personal Disord. 2022;13(4):316–320. doi: 10.1037/per0000567 [DOI] [PubMed] [Google Scholar]
  • 57.Caspi A, Houts RM, Belsky DW, Goldman-Mellor SJ, Harrington H, Israel S, Meier MH, Ramrakha S, Shalev I, Poulton R, Moffitt TE. The p factor: One general psychopathology factor in the structure of psychiatric disorders? Clin Psychol Sci. 2014;2(2):119–137. doi: 10.1177/2167702613497473 [DOI] [PMC free article] [PubMed] [Google Scholar]

Decision Letter 0

Paulo Alexandre Azevedo Pereira Santos

7 Sep 2023

PONE-D-23-22309The Portuguese version of the self-report form of the DSM-5 Level of Personality Functioning Scale (LPFS-SR) in a community and clinical samplePLOS ONE

Dear Dr. Pires,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. This is a very interesting and good quality article, There are several aspects to improve as pointed by reviewers. Please, consider to publish the Portuguese translated version as an anex to the article, instead of the approval by scientific council of your institution.

Please submit your revised manuscript by Oct 22 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

  • A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.

  • A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.

  • An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Paulo Alexandre Azevedo Pereira Santos, PhD

Academic Editor

PLOS ONE

Journal requirements:

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

2. Thank you for stating the following financial disclosure:

“This work received national funding from the FCT – Fundação para a Ciência e a Tecnologia, I.P [Foundation for Science and Technology], through the Research Center for Psychological Science of the Faculty of Psychology, University of Lisbon (UIDB/04527/2020; UIDP/04527/2020) and the Business Research Unit, BRU-IUL (UIDB/00315/2020).”

Please state what role the funders took in the study.  If the funders had no role, please state: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."

If this statement is not correct you must amend it as needed.

Please include this amended Role of Funder statement in your cover letter; we will change the online submission form on your behalf.

3. We note that you have indicated that data from this study are available upon request. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. For more information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions.

In your revised cover letter, please address the following prompts:

a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially sensitive information, data are owned by a third-party organization, etc.) and who has imposed them (e.g., an ethics committee). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent.

b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings as either Supporting Information files or to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories.

We will update your Data Availability statement on your behalf to reflect the information you provide.

Additional Editor Comment:

This is a very interesting and good quality article, There are several aspects to improve as pointed by reviewers.

Please, consider to publish the Portuguese translated version as an anex to the article, instead of the approval by scientific council of your institution.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: No

**********

2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: I Don't Know

**********

3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

Reviewer #2: No

**********

4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: No

**********

5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This manuscript reports on the psychometric properties of a Portuguese translation of the Levels of Personality Functioning Scales (LPFS-SR), self-report version developed by Morey (2017). The study provides useful information for users of the LPFS in Portuguese-speaking populations, and it provides a needed cultural analysis of this relatively new clinical instrument. I have some suggestions for the authors to consider in further revisions of the manuscript.

1. The number of ROC analyses reported in the paper seems excessive. I see the merit in examining basic contrasts of the means for the LPFS elements and total score between the community and clinical samples. The LPFS is intended to assess core personality functions in the interest of diagnosing personality disorder (PD); thus, the ROC analysis contrasting clinical patients with PD versus clinical patients without PD is considerably more relevant to the study aims than the other contrasts. What is the relevance of a cut score for discriminating community adults from patients who do not have PD on a measure specifically designed for the assessment of PD? Moreover, nearly all clinical measures will discriminate community adults from clinical patients, so the comparisons of different diagnostic groups are most useful for validating the LPFS.

2. Comparing the community adults from Portugal to the US sample presented in Morey (2017) would effectively address the stated aim to evaluate the “cross-cultural validity.”

3. Regarding the community sample described in Lines 120-122. What incentives, if any, were offered to these acquaintances of university students? Why did they participate? How did they access the study protocol? Were the instruments administered remotely, online, or in person?

4. Likewise, I think some further details on the mode of data collection for the clinical patients would be helpful. Was the LPFS-SR administered only for research purposes? Or was it part of a clinical assessment that informed care of these patients?

5. The decision to investigate dimensionality only with the community sample, defended in Lines 302-304, is questionable. I do not follow these arguments, and given the intended use of the LPFS-SR in clinical settings, the inclusion of patient respondents seems essential.

6. As for future directions, it would be interesting to administer this translation in Brazil to see if the psychometric properties are comparable to those from persons in Lisbon.

7. Line 64: It is an overstatement to say “few studies” have focused on Criterion A. I think the authors mean to say that fewer studies have addressed Criterion A relative to Criterion B.

8. Line 87: I disagree that adequate psychometric properties “guarantee” a deeper understanding of something as complex as personality pathology. They are a necessary start in that direction.

9. Lines 68-70: I don’t understand this sentence about Quilty’s conclusion. The point seems circular.

10. Lines 95-96: I assume “the original data” refer to information about the derivation of the LPFS-SR in Morey (2017). If so, that should be stated explicitly here.

11. Line 108: I think the word “call” is meant here, not “claim.”

12. Line 363: I think the word “affirms” or “supports” is more apt here, not “sustains.”

Reviewer #2: This is an interesting paper on the psychometric properties of the LPFS-SR, which is among the best self-report questionnaires for the assessment of the A criterion of the Alternative DSM-5 Model for Personality Disorders, maybe the best. I have no comments on the design and implementation of the study. However, I found the reasoning in the introduction and discussion quite flawed from time to time.

Line 63-67: I am not sure if this statement is correct. First, by the time of publication of DSM-5 a decade ago, the LPFS was a brand-new scale whereas the PID-5 already existed in 2013 and had been evaluated extensively. This is probably the main reason why there are fewer studies on the LPFS than on the PID-5. Moreover, the decade after the publication of DSM-5 witnessed a bourgeoning of research on the LPFS so it is certainly not correct to state that only a few studies have focused on the LPFS, e.g., (Zimmermann et al., 2019). Moreover, the statement on line 66 authors suggests that the LPFS should be assessed by clinicians whereas this is not required for the trait model. I really could not find this information in the DSM-5. The trait model also plays a role in the diagnostic process, requiring the use of a structured diagnostic interview.

Line 68-70. The authors make it clear that personality impairment should be assessed using a clinician-rated instrument. However, the current study uses a self-report instrument. How could this be reconciled? The concluding sentence of the first paragraph highlights the importance of clinician-rated instruments, giving the impression that the current study is on a clinical interview. Since this is not the case, the focus of the first paragraph should be redirected.

Line 81. The authors refer to only one study evaluating the LPFS-BF and this study concerns the first version of the LPFS-BF. The second version has better psychometric properties as supported by several studies. Please correct.

Line 79-92. I think it could be emphasized more that the LPFS-SR is the only self-report instrument that takes both the vertical and horizontal structure of the LPFS into account.

Line 93-111. I had troubles following along with the aims of the study because this section is merely a combination of research aims, methodological issues such as sample descriptions, the rationale for the study, and empirical findings. I hope the authors will be able to formulate the research questions more clearly. Also, what are “the original data”?

Line 90-92. Do the authors suggest that maladaptive personality functioning is distinct from maladaptive personality content?

Line 106-111. The authors seem to suggest that there is no doubt that the LPFS-SR reflects an unidimensional factor whereas Sleep and colleagues are totally wrong. These formulations poorly reflect the discussion between Morey and Sleep about the dimensionality of the LPFS-SR. I think it would be wise to explain this discussion in more detail since it provides the main rationale for the current study. I also recommend to move this discussion to the introduction.

Line 148-164: I could not find any information about personality disorder assessment. How were PD diagnoses and symptom diagnoses assessed? If no structured clinical interviews were used, this should be mentioned as a limitation in the discussion. It is well known that clinical assessment of PDs without making use of structured diagnostic interviews, has poor diagnostic reliability. Thus, the lack of differences between the PD sample and non-PD sample could as well be due to poor assessment procedures.

Overall, I think the manuscript could benefit from some more text-editing to make it more reader-friendly at some places. For instance, regarding the explanation of the translation process on line 156-164, the authors could write “obtained” instead of “requested” and “translator” instead of “author of the translation”. Moreover, it is not clear whether the back-translation was done by one person (a native English speaker who also was a professional translator) or two persons (a native English speaker and a professional translator).

Line 182-188: I am not acquainted with the Factor software and have never seen other papers using this program. This might be due to lack of expertise on my part but it could also be due to the infrequent use of this program in the PD field. Therefore, I think it would be appropriate to give a more extensive explanation of this program in the Methods chapter. I would also recommend to restrict the explanation of the statistical procedures to the “Data analysis” section, i.e., move the explanation that “CFA and EFA are congregated” to the Methods chapter. It should be noted that, since I am not a psychometrician and do not have any background knowledge about the Factor package, my ability to assess the adequacy of the statistical analyses is limited.

Line 321-343: In scientific papers, it is common to provide several explanations for unexpected findings. I have already mentioned the possibility of poor diagnostic reliability. Could there be other explanations for the finding that the LPFS-SR could not make a distinction between the two clinical samples? Such a discussion is more interesting and informative than just a repetition of the results and a conclusion that more research is needed.

Line 340-343: the information in the section is not correct. Self pathology and interpersonal problems are the core features of PD, by definition.

Line 344-355. This is an important section, which needs thorough revision. First, I couldn’t find back the proposed threshold values in the paper of Morey et al. (Morey, 2017). I neither could find any information about the interpretative criterion in this paper. Could the authors give some more explanation of these “threshold values” and “interpretative criterion”? I also had difficulties understanding how cultural factors could have increased the threshold in the Iranian sample and why we should address interpretability of the LPFS-SR scores. Could this be explained more clearly? To me, it seems that sample characteristics are more important than possible cultural factors. After all, the sample of Hemmati et al. consisted of inpatients, most of whom were diagnosed with either borderline PD or antisocial PD. Moreover, I did not manage to understand the last sentence of this paragraph. Could the authors’ point be explained more clearly?

Line 359: It is a common error to interpret a large Chronbach’s alpha value as proof for unidimensionality. The authors could easily avoid this error by focusing more on the results of the factor analyses.

Line 365-381: The section about limitations should have a stronger on the very limitations rather than repeating the results. How could these imitations have influenced the results? For instance, what kind of errors could be associated with the small size of the PD sample? And how could comorbidity have influenced the results? (Is this really a limitation? A clinical sample without any comorbidity would be a rarity and not very representative.) If it is correct that no structured diagnostic instruments were used, this should also be mentioned as a limitation. Finally, I am not sure if it is wise to write “Criterion A’s opponents”. In my view, this formulation has a rather negative connotation in this context. I assume that the authors are referring to Sleep & colleagues. Sure, these authors are critical to the view that the LPFS is a unidimensional construct but I really cannot see that they are opposing the A criterion.

Morey, L. C. (2017). Development and Initial Evaluation of a Self-Report Form of the DSM-5 Level of Personality Functioning Scale. Psychological Assessment, 27(10), 1302.

Zimmermann, J., Kerber, A., Rek, K., Hopwood, C. J., & Krueger, R. (2019). A brief but comprehensive review of research on the Alternative DSM-5 Model for Personality Disorders. Current Psychiatry Reports, 21(92). https://doi.org/10.1007/s11920-019-1079

**********

6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: John E Kurtz

Reviewer #2: Yes: Benjamin Hummelen

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

PLoS One. 2024 Jun 27;19(6):e0300706. doi: 10.1371/journal.pone.0300706.r002

Author response to Decision Letter 0

11 Nov 2023

The Portuguese version of the self-report form of the DSM-5 Level of Personality Functioning Scale (LPFS-SR) in a community and clinical sample [PONE-D-23-22309]

RESPONSE TO REVIEWERS

REVIEWER 1

We would like to thank Reviewer 1 for considering our manuscript entitled The Portuguese version of the self-report form of the DSM-5 Level of Personality Functioning Scale (LPFS-SR) in a community and clinical sample [Manuscript ID: PONE-D-23-22309] for revision. Reviewer 1's comments have provided detailed and constructive feedback on our manuscript which has given us an outer perspective of our work and helped us to think critically and, we believe, to improve the paper. We have now revised the manuscript according to Reviewer 1's suggestions and we hope that we have been able to address all the issues raised and comments. Please note that in the document “Revised Manuscript with Track Changes” the changes and insertions are highlighted (green colour). In the following lines we respond to the points addressed, our comments and inserted text are in green, and follow the order in which they were raised.

1. The number of ROC analyses reported in the paper seems excessive. I see the merit in examining basic contrasts of the means for the LPFS elements and total score between the community and clinical samples. The LPFS is intended to assess core personality functions in the interest of diagnosing personality disorder (PD); thus, the ROC analysis contrasting clinical patients with PD versus clinical patients without PD is considerably more relevant to the study aims than the other contrasts. What is the relevance of a cut score for discriminating community adults from patients who do not have PD on a measure specifically designed for the assessment of PD? Moreover, nearly all clinical measures will discriminate community adults from clinical patients, so the comparisons of different diagnostic groups are most useful for validating the LPFS.

Thank you for this outer perspective of our work which, we believe, has helped us improve the paper. We have followed the suggestion and have reported only the ROC contrasts between the PD sample and the community sample and the PD sample and the other clinical sample.

We agree that these contrasts are the most relevant for the validity of a measure that pertains to assess features relevant to a PD diagnosis.

Thus, we have decided to exclude from the text the reference to the optimal cut-off to discriminate between the clinical and the non-clinical population. The decision to mention it derived from Hemmati et al.'s study, however since this was also questioned by Reviewer #2, the text has been reformulated.

Please see lines: 227-229; 314-318; 401-415.

2. Comparing the community adults from Portugal to the US sample presented in Morey (2017) would effectively address the stated aim to evaluate the “cross-cultural validity.”

Thank you for this suggestion which, we believe, enriches the manuscript, and, indeed, contributes to LPFS-SR cross-cultural validity. To compare the community adults from Portugal to the US sample presented in Morey (2017) we used the Cohen’s d and obtained low to medium effect sizes that suggest slight variations between the Portuguese version and Morey’s original data (2017). Please see lines 215-218; 249-257.

3. Regarding the community sample described in Lines 120-122. What incentives, if any, were offered to these acquaintances of university students? Why did they participate? How did they access the study protocol? Were the instruments administered remotely, online, or in person?

Thank you for the opportunity to clarify the sampling procedures. Please see lines 150-158.

4. Likewise, I think some further details on the mode of data collection for the clinical patients would be helpful. Was the LPFS-SR administered only for research purposes? Or was it part of a clinical assessment that informed care of these patients?

Thank you for the opportunity to clarify the sampling procedures. Please see lines 159-160.

5. The decision to investigate dimensionality only with the community sample, defended in Lines 302-304, is questionable. I do not follow these arguments, and given the intended use of the LPFS-SR in clinical settings, the inclusion of patient respondents seems essential.

We have followed Reviewer #1's suggestion and have also explored dimensionality in the clinical sample. Please see lines 229-238; Table 3B; 362-384; 419-423.

6. As for future directions, it would be interesting to administer this translation in Brazil to see if the psychometric properties are comparable to those from persons in Lisbon.

Thank you for the suggestion which has been incorporated in the paper as a future direction. Please see lines 438-440.

7. Line 64: It is an overstatement to say “few studies” have focused on Criterion A. I think the authors mean to say that fewer studies have addressed Criterion A relative to Criterion B.

Thank you for the correction. Please see lines 60-62.

8. Line 87: I disagree that adequate psychometric properties “guarantee” a deeper understanding of something as complex as personality pathology. They are a necessary start in that direction.

Thank you for the correction. Please see line 89.

9. Lines 68-70: I don’t understand this sentence about Quilty’s conclusion. The point seems circular.

We agree that the sentence is not clear. Given that our manuscript does not concern clinician rated measures, there is no point in mentioning that they should be improved. We have deleted the sentence.

10. Lines 95-96: I assume “the original data” refer to information about the derivation of the LPFS-SR in Morey (2017). If so, that should be stated explicitly here.

Thank you. Please see line 130.

11. Line 108: I think the word “call” is meant here, not “claim.”

Thank you. Please see line 106.

12. Line 363: I think the word “affirms” or “supports” is more apt here, not “sustains.”

Thank you. Please see line 421.

REVIEWER 2

We would like to thank Reviewer 2 for considering our manuscript entitled The Portuguese version of the self-report form of the DSM-5 Level of Personality Functioning Scale (LPFS-SR) in a community and clinical sample [Manuscript ID: PONE-D-23-22309] for revision. Reviewer 2's comments have provided detailed feedback on our manuscript which, we hope, has given us an opportunity to improve it. Please note that in the document “Revised Manuscript with Track Changes” the changes and insertions are highlighted (green colour). In the following lines we respond to the points addressed, our comments and inserted text are in green, and follow the order in which they were raised.

Line 63-67: I am not sure if this statement is correct. First, by the time of publication of DSM-5 a decade ago, the LPFS was a brand-new scale whereas the PID-5 already existed in 2013 and had been evaluated extensively. This is probably the main reason why there are fewer studies on the LPFS than on the PID-5. Moreover, the decade after the publication of DSM-5 witnessed a bourgeoning of research on the LPFS so it is certainly not correct to state that only a few studies have focused on the LPFS, e.g., (Zimmermann et al., 2019).

Thank you for the opportunity to clarify the sentence. It was certainly not our intention to state that there were only a few studies with the LPFS. However, over the last decade, and compared to the studies focusing on the PID-5, there have been fewer studies with the LPFS than with the PID-5.

As reported by Zimmerman et al. (2019), 85% of the published studies on the AMPD addressed Criterion B while only 15% addressed Criterion A, and this may be explained by the original lack of a self-report measure for Criterion A (Le Corff et al., 2022).

We hope that the following reformulation clarifies the sentence and what we were trying to highlight:

Lines 59-62: “Notwithstanding the centrality of personality dysfunction in the diagnosis of PD, fewer studies have focused on the level of personality functioning (Criterion A) relative to traits (Criterion B) over the last decade.”

- Zimmerman, J., Kerber, A., Rek, K., Hopwood, C. J., & Krueger, R. F. (2019). A brief but comprehensive review of research on the Alternative Model for Personality Disorders. Current Psychiatric Reports, 21(9), 92. https://doi.org/10.1007/s11920-019-1079-z

- Le Corff, Y., Aluja, A., Rossi, G., Lapalme, M., Forget, K., García, L. F., & Rolland, J. P. (2022). Construct Validity of the Dutch, English, French, and Spanish LPFS-BF 2.0: Measurement Invariance Across Language and Gender and Criterion Validity. Journal of Personality Disorders, 36(6), 662-679. https://doi.org/10.1521/pedi.2022.36.6.662

Moreover, the statement on line 66 authors suggests that the LPFS should be assessed by clinicians whereas this is not required for the trait model. I really could not find this information in the DSM-5. The trait model also plays a role in the diagnostic process, requiring the use of a structured diagnostic interview.

In line 66, we were trying to say that, compared to clinician rating scales, self-report measures, like the LPFS-SR, facilitate research.

As clinicians we agree that the diagnostic process should ultimately rely on clinical expertise. However, psychometric instruments can be useful in the process of collecting information about a patient. In the DSM-5 (APA, 2013), p. 774, there is a section regarding assessment of pathological traits where it is stated that this assessment “is facilitated by the use of formal psychometric instruments designed to measure specific facets and domains of personality. For example, the personality trait model is operationalized in the Personality Inventory for DSM-5 (PID-5), which can be completed in its self-report form by patients and in its informant-report form by those who know the patient well (e.g., a spouse).”

Please inform us if any other change is required so that the sentence is properly understood:

“Notwithstanding the centrality of personality dysfunction in the diagnosis of PD, fewer studies have focused on the level of personality functioning (Criterion A) relative to traits (Criterion B) over the last decade. This is most likely due to the fact that the DSM-5 has proposed a clinician-rated scale for its characterization (LPFS; [19]), which is less suitable for research purposes than self-report measures” (Lines 59-64).

Line 68-70. The authors make it clear that personality impairment should be assessed using a clinician-rated instrument. However, the current study uses a self-report instrument. How could this be reconciled? The concluding sentence of the first paragraph highlights the importance of clinician-rated instruments, giving the impression that the current study is on a clinical interview. Since this is not the case, the focus of the first paragraph should be redirected.

Both Reviewers found the sentence [“Although little research has explored the psychometric properties of the AMPD clinician-rated measures, Quilty et al. [20] have recently concluded that as far as personality impairment is concerned, finer grained clinician-rated measures may be required.”] unclear. Given that it was not primarily related to our manuscript’s contents, it has been deleted. What we meant to say was that personality dysfunction may be assessed with clinician-rated measures or self-report measures. Our perspective is that self-reports facilitate research, therefore our manuscript is related to the LPFS-SR and not to a clinician-rated measure. However, personality dysfunction may also be assessed with clinician-rated measures, even if Quilty et al. (2021) consider that finer grained clinician-rated measures are also needed to achieve that goal.

Line 81. The authors refer to only one study evaluating the LPFS-BF and this study concerns the first version of the LPFS-BF. The second version has better psychometric properties as supported by several studies. Please correct.

Thank you for the opportunity to clarify the reason why we referred only to the first study concerning the LPFS-BF (Hutsebaut et al. 2016). We are aware that after the publication of the LPFS-SR (Morey, 2017), there was an update of the LPFS-BF which has seen several developments (Weekers et al., 2019; Weekers et al., 2022; Le Corff et al., 2022, among others). However, our study concerns the LPFS-SR whose development is a response to the fact that the existing measures at the time of the LPFS-SR development were not strictly aligned with the LPFS descriptors presented in the DSM-5. In the case of the first version of the LPFS-BF (Hutsebaut et al. 2016), the only one available at that time, Morey (2017) also refers to its limited internal consistency.

We have reformulated the sentence to highlight the fact that the LPFS-SR (Morey, 2017) was developed to respond to the need for a sufficiently detailed measure that would enable researchers to closely examine the particular strengths and weaknesses of the description of global personality pathology provided in the AMPD.

Please see lines 78-82.

- Le Corff, Y., Aluja, A., Rossi, G., Lapalme, M., Forget, K., García, L. F., & Rolland, J. P. (2022). Construct Validity of the Dutch, English, French, and Spanish LPFS-BF 2.0: Measurement Invariance Across Language and Gender and Criterion Validity. Journal of Personality Disorders, 36(6), 662-679. https://doi.org/10.1521/pedi.2022.36.6.662

- Weekers, L. C., Hutsebaut, J., & Kamphuis, J. H. (2019). The level of Personality Functioning Scale-Brief Form 2.0: Update of a brief instrument for assessing level of personality functioning. Personality and Mental Health, 13(1), 3–14. https://doi.org/10.1002/pmh.1434

- Weekers, L. C., Sellbom, M., Hutsebaut, J., Simonsen, S., & Bach, B. (2023). Normative data for the LPFS‐BF 2.0 derived from the Danish general population and relationship with psychosocial impairment. Personality and Mental Health, 17(2), 157-164. https://doi.org/10.1002/pmh.1570

Line 79-92. I think it could be emphasized more that the LPFS-SR is the only self-report instrument that takes both the vertical and horizontal structure of the LPFS into account.

Accomplished. Please see lines 82-88.

Line 93-111. I had troubles following along with the aims of the study because this section is merely a combination of research aims, methodological issues such as sample descriptions, the rationale for the study, and empirical findings. I hope the authors will be able to formulate the research questions more clearly. Also, what are “the original data”?

We have reformulated the research aims and hope that they are now more easily understandable. Please see lines 121-141.

Line 90-92. Do the authors suggest that maladaptive personality functioning is distinct from maladaptive personality content?

From a conceptual point of view, Criterion A relates to core impairment in self and interpersonal function (i.e., personality pathology severity) which is complemented by Criterion B’s description of the unique constellation of the pathological personality traits manifested (i.e., personality pathology style). However, from an empirical point of view, an overlap between Criterion A and Criterion B has been consistently documented (Morey, 2022).

Please, see lines 90-101.

- Morey, L. C., McCredie, M. N., Bender, D. S., & Skodol, A. E. (2022). Criterion A: Level of personality functioning in the alternative DSM–5 model for personality disorders. Personality Disorders: Theory, Research, and Treatment, 13(4), 305. https://doi.org/10.1037/per0000551

Line 106-111. The authors seem to suggest that there is no doubt that the LPFS-SR reflects an unidimensional factor whereas Sleep and colleagues are totally wrong. These formulations poorly reflect the discussion between Morey and Sleep about the dimensionality of the LPFS-SR. I think it would be wise to explain this discussion in more detail since it provides the main rationale for the current study. I also recommend to move this discussion to the introduction.

We have reformulated the paragraphs that refer to the debate around the unidimensionality of the LPFS-SR and have moved them to the introduction. Please see lines 102-118.

Line 148-164: I could not find any information about personality disorder assessment. How were PD diagnoses and symptom diagnoses assessed? If no structured clinical interviews were used, this should be mentioned as a limitation in the discussion. It is well known that clinical assessment of PDs without making use of structured diagnostic interviews, has poor diagnostic reliability. Thus, the lack of differences between the PD sample and non-PD sample could as well be due to poor assessment procedures.

In this sample collection, we did not use structured clinical interviews, however the assignment of diagnoses was a judicious process and followed a diagnosis-related group (DRG) system (Fetter et al., 1980).

In each affiliated mental health institution, a clinician coordinated the sampling procedures and selected the participants with the respective diagnoses contained in our study from the clinical databases of their institution, or from whom they had been referred. In general, our collected clinical samples relied on the direct clinical evaluation of several psychiatrists, whose diagnosis had been previously discussed and agreed upon by a clinical team. It should be noted that each diagnosis is the result of a medical psychiatric evaluation, held on the clinical records and conducted by at least three different clinicians: the assistant psychiatrist; the coding doctor, responsible for the respective Diagnosis-Related Groups (DRG) (Fetter et al., 1980); and the collaborating researcher.

The fact that we did not use a structured clinical interview to assess each diagnosis, which we agree may have hampered the diagnostic reliability, has been added as a limitation of this study. However, it should be noted that the LPFS-SR total score was able to discriminate between the PD and the OD sample (AUC = .63; p = .027).

- Fetter, R. B., Shin, Y., Freeman, J. L., Averill, R. F., & Thompson, J. D. (1980). Case mix definition by diagnosis-related groups. Medical care, 18(2), 1-53. http://www.jstor.org/stable/3764138

Overall, I think the manuscript could benefit from some more text-editing to make it more reader-friendly at some places. For instance, regarding the explanation of the translation process on line 156-164, the authors could write “obtained” instead of “requested” and “translator” instead of “author of the translation”. Moreover, it is not clear whether the back-translation was done by one person (a native English speaker who also was a professional translator) or two persons (a native English speaker and a professional translator).

We would like to thank Reviewer #2's suggestions regarding the explanation of the translation process which makes the text clearer. Please see lines 198-202.

To make the manuscript more reader-friendly, the text-editing of all the manuscript was performed by a native English speaker who is a professional translator.

Line 182-188: I am not acquainted with the Factor software and have never seen other papers using this program. This might be due to lack of expertise on my part but it could also be due to the infrequent use of this program in the PD field. Therefore, I think it would be appropriate to give a more extensive explanation of this program in the Methods chapter. I would also recommend to restrict the explanation of the statistical procedures to the “Data analysis” section, i.e., move the explanation that “CFA and EFA are congregated” to the Methods chapter. It should be noted that, since I am not a psychometrician and do not have any background knowledge about the Factor package, my ability to assess the adequacy of the statistical analyses is limited.

We have tried to comply with Reviewer #2's request to explain the advantages of the Factor software, however we were unable to find a suitable part of the manuscript other than the data analysis section to include this information. Please see lines 205-212.

Factor analysis is one of the multivariate statistical methodologies most used in Psychology, both for instrument validation and for reducing data dimensionality. Two approaches to factor analysis, namely Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA), are permanently confronted while their followers stand in opposition, wielding a huge set of arguments. Both aim to reproduce the relationships observed in a set of items and differ fundamentally in the nature of their specifications and a priori restrictions imposed by the model. An EFA is a data-based approach model, that is, no specifications are placed on either the number of factors or the dependency relationships between the items and factors. In the CFA model, the number of factors is specified a priori as well as the relational structure between the items and factors, namely the imposition in the CFA that each item can only be loaded onto a single factor.

The FACTOR software freely obtained from Rovira i Virgili University, is one of the most complete statistical programs for conducting an EFA, given that it congregates both CFA and EFA indexes. It includes the most current criteria for fundamental decisions: the correlation matrix to be used, the method to be adopted for extracting common factors, the number of factors to be retained and the rotation method. Additionally, this software provides some goodness-of-fit indexes and the corresponding confidence intervals are based on bootstrap techniques, which are unusual in EFA algorithms.

- Ferrando, P. J., & Lorenzo Seva, U. (2017). Program FACTOR at 10: Origins, development and future directions. Psicothema, 29(2), 236-241.

- Rogers, P. (2022). Best practices for your exploratory factor analysis: A factor tutorial. Revista de Administração Contemporânea, 26(06). https://doi.org/10.1590/1982-7849rac2022210085.en

Line 321-343: In scientific papers, it is common to provide several explanations for unexpected findings. I have already mentioned the possibility of poor diagnostic reliability. Could there be other explanations for the finding that the LPFS-SR could not make a distinction between the two clinical samples? Such a discussion is more interesting and informative than just a repetition of the results and a conclusion that more research is needed.

Please see lines 404-415 and 428-432.

However, it should be noted that the LPFS-SR total score was able to discriminate between the PD and the OD sample (AUC = .63; p = .027).

Line 340-343: the information in the section is not correct. Self pathology and interpersonal problems are the core features of PD, by definition.

We believe there has been a misunderstanding. We are not saying that self-pathology and interpersonal problems are not the core features of PD, but rather that the LPFS also captures impairments in self and interpersonal functioning underlying other psychiatric diagnoses. In other words, what we mean to say is that in a depressive disorder, for instance, there are also impairments in self and interpersonal functioning. Criterion A relates to personality and personality shapes psychopathological manifestations.

Perhaps the following formulation is clearer?

“Moreover, it should be noted that the LPFS model not only seeks to describe the core features of PD, but may also characterize impairments in self and interpersonal functioning underlying many forms of psychopathology.” (Lines 409-411)

- Bender, D. S. (2019). The P-factor and what it means to be human: commentary on criterion A of the AMPD in HiTOP. Journal of personality assessment, 101(4), 356-359. https://doi.org /10.1080/00223891.2018.1492928

Line 344-355. This is an important section, which needs thorough revision. First, I couldn’t find back the proposed threshold values in the paper of Morey et al. (Morey, 2017). I neither could find any information about the interpretative criterion in this paper. Could the authors give some more explanation of these “threshold values” and “interpretative criterion”? I also had difficulties understanding how cultural factors could have increased the threshold in the Iranian sample and why we should address interpretability of the LPFS-SR scores. Could this be explained more clearly? To me, it seems that sample characteristics are more important than possible cultural factors. After all, the sample of Hemmati et al. consisted of inpatients, most of whom were diagnosed with either borderline PD or antisocial PD. Moreover, I did not manage to understand the last sentence of this paragraph. Could the authors’ point be explained more clearly?

We have followed the suggestion of Reviewer # 1 and reported only the ROC contrasts between the PD sample and the community sample and the PD sample and the other clinical sample.

We agree that these contrasts are the most relevant for the validity of a measure that pertains to assess features relevant to a PD diagnosis.

Thus, we have decided to exclude from the text the reference to the optimal cut-off to discriminate between the clinical and non-clinical population. The decision to mention it derived from Hemmati et al.'s study, however since this was also questioned by Reviewer #2, the text has been reformulated.

Please see lines: 227-229; 314-318; 401-415.

Line 359: It is a common error to interpret a large Chronbach’s alpha value as proof for unidimensionality. The authors could easily avoid this error by focusing more on the results of the factor analyses.

This methodological option was taken in the interest of comparing this study's results with Hemmati et al.'s study (2020) but since this was called into question, the text has been reformulated. Please see lines 362-384.

Line 365-381: The section about limitations should have a stronger on the very limitations rather than repeating the results. How could these imitations have influenced the results? For instance, what kind of errors could be associated with the small size of the PD sample? And how could comorbidity have influenced the results? (Is this really a limitation? A clinical sample without any comorbidity would be a rarity and not very representative.) If it is correct that no structured diagnostic instruments were used, this should also be mentioned as a limitation. Finally, I am not sure if it is wise to write “Criterion A’s opponents”. In my view, this formulation has a rather negative connotation in this context. I assume that the authors are referring to Sleep & colleagues. Sure, these authors are critical to the view that the LPFS is a unidimensional construct but I really cannot see that they are opposing the A criterion.

Regarding the sentence related to “Criterion A’s opponents”, we have changed it as we are not interested in Manichaean views. Our one and only main interest is to share the data we have obtained which supports the unidimensionality of the LPFS-SR. Please see lines 416-423.

However, we are of the opinion that Sleep et al. (2022) really do oppose Criterion A. Please consider the following reference that led us to conclude this and share part of its conclusions:

“As demonstrated here, the LPFS does not discriminate PD pathology from other forms of psychopathology, does not account for patterns of comorbidity among the PDs, shows problematic levels of overlap with both disordered and nondisordered personality traits, fails to provide incremental validity over these same traits, and has an unstable internal structure. In short, it does not do what it is supposed to do. Until a better system comes along, the traits themselves carry the most useful information.”

- Sleep, C. E., & Lynam, D. R. (2022). The problems with Criterion A: A comment on Morey et al.(2022). Personality Disorders: Theory, Research, and Treatment, 13(4), 325–327. https://doi.org/10.1037/per0000585

Attachment

Submitted filename: Response to Reviewers_11-11-23.docx

pone.0300706.s004.docx (43.3KB, docx)

Decision Letter 1

Paulo Alexandre Azevedo Pereira Santos

2 Jan 2024

PONE-D-23-22309R1The Portuguese version of the self-report form of the DSM-5 Level of Personality Functioning Scale (LPFS-SR) in a community and clinical samplePLOS ONE

Dear Dr. Pires,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

==============================

ACADEMIC EDITOR: Thank you for the review you made in this paper, taking into account the comments sent. The result is very close to a version acceptable for publication. However, reviewers made some more minor comments that I think will improve your paper and strenghen the discussion.

Please read carefully and incorporate them in your manuscript.============================== Please submit your revised manuscript by Feb 16 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

  • A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.

  • A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.

  • An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Paulo Santos, PhD

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments:

This paper is almost acceptable for publishing. However, reviewers introduced several minor comments that would improve the final version and strengthen the discussion.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #3: All comments have been addressed

Reviewer #4: All comments have been addressed

Reviewer #5: (No Response)

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #3: Yes

Reviewer #4: Yes

Reviewer #5: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #3: Yes

Reviewer #4: No

Reviewer #5: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #3: Yes

Reviewer #4: Yes

Reviewer #5: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #3: Yes

Reviewer #4: Yes

Reviewer #5: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #3: After reading the revised manuscript, I think that the authors addressed all the reviewers´ concerns.

Reviewer #4: Dear Editor,

Thank you for giving me the opportunity to share my thoughts on the manuscript entitled "The Portuguese version of the self-report form of the DSM-5 Level of Personality Functioning Scale (LPFS-SR) in a community and clinical sample". The paper provides valuable results that may contribute to the cross-cultural generalizability of current personality models. In my opinion, the authors have carefully answered all the comments and suggestions of the journal reviewers in the previous stage. However, I have some more suggestions that I think will help provide a better work.

• What was the criteria of the authors to determine the LPFS-SR cutoff scores? For example, Youden index or Gini index? The following reference may be a good pattern for the authors:

- Komasi S, Rezaei F, Hemmati A, Nazari A, Nasiri Y, Faridmarandi B, Zakiei A, Saeidi M, Hopwood CJ. Clinical cut scores for the Persian version of the personality inventory for DSM-5. J Clin Psychol. 2023. https://doi.org/10.1002/jclp.23614

• According to the cut-off scores of the scale, the authors can report the true positive rate (TPR) and the true negative rate (TNR).

• What is the similarity between the extracted factors with international studies? I recommend reporting Tucker’s congruence coefficients.

• Although examining convergent validity was probably not one of the goals of the study, if data are available, reporting correlations between LPFS-SR and other dimensional measures of personality would provide readers with additional information.

Reviewer #5: Dear authors,

Thank you for the opportunity to review the manuscript "The Portuguese version of the self-report form of the DSM-5 Level of Personality Functioning Scale (LPFS-SR) in a community and clinical sample".

It is an interesting study and the manuscript is very clear and well written. I believe that the reviewers' comments helped to improve the understanding of the content of this study and all the suggestions from the same reviewers were responded to in an assertive manner.

My only additional suggestion is that the authors mention the limitations of the study is that the validation of the Portuguese version of the LPFS-SR is not yet complete. This is due to the absence of scale reliability tests. According to COSMIN, in addition to internal consistency, reliability is an umbrella clinimetric property that encompasses reliability (the ability of the instrument to detect similar responses in repeated applications on the same patient, if he/she is clinically stable) and the error of measurement (size of the error systematically present during the application of the instrument). Along with criterion and discriminant validity, reliability would ensure the complete accuracy of the scale for use in clinical practice and scientific research. However, the reliability test depends on a test and retest design, and this was probably the reason for its failure.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #3: No

Reviewer #4: Yes: I agree that my name will be published as a reviewer of the article.

Reviewer #5: Yes: Adriana C Lunardi

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

PLoS One. 2024 Jun 27;19(6):e0300706. doi: 10.1371/journal.pone.0300706.r004

Author response to Decision Letter 1

14 Feb 2024

The Portuguese version of the self-report form of the DSM-5 Level of Personality Functioning Scale (LPFS-SR) in a community and clinical sample [PONE-D-23-22309R1]

RESPONSE TO REVIEWERS

We would like to thank Reviewers 3, 4 and 5 for recognizing and appreciating the amendments made, as well as for encouraging us to continue improving the paper.

REVIEWER 4

In the following lines we respond to Reviewer 4’s comments and suggestions. Our comments and inserted text are in blue, and follow the order in which they were raised.

1. What was the criteria of the authors to determine the LPFS-SR cutoff scores? For example, Youden index or Gini index?

ROC curve analyses were used to examine the capacity of the LPFS-SR total score in discriminating between the samples. Optimal cutoff scores were determined to maximize the sum of sensitivity and specificity, ensuring the fewest incorrect decisions under conditions of equal a priori probabilities.

The Youden index is calculated as Sensitivity + Specificity - 1, and the Gini coefficient is given by 2 × AUC − 1.

2. According to the cut-off scores of the scale, the authors can report the true positive rate (TPR) and the true negative rate (TNR).

In our manuscript, we reported the sensitivity (true positive rate) and the specificity (true negative rate).

3. What is the similarity between the extracted factors with international studies? I recommend reporting Tucker’s congruence coefficients.

Tucker’s congruence coefficient is an index of the similarity between factor results (Lorenzo-Seva et al., 2006). The most popular tool for such comparisons was initially proposed by Burt (1948) and later gained popularity as Tucker’s congruence coefficient (Tucker, 1951). Its values range between -1 and +1.

Tucker’s congruence coefficient is defined as φ_C= (∑▒〖x_i y_i 〗)/√(∑▒〖x_i^2 ∑▒y_i^2 〗^ ) where xi and yi are the loadings of variable i on factor X and Y, respectively, i=1, …, n.

As suggested, we determined the Tucker’s congruence coefficient between the factor results of the Portuguese community sample, the Portuguese clinical sample, and the item factor loadings of Bliton et al. (2022). Unfortunately, we couldn't find other international factor results to compute the Tucker coefficient. Please see lines 235-238 and 382-391.

- Burt, C. (1948). The factorial study of temperament traits. British Journal of Psychology, Statistical Section, 1, 178-203.

- Lorenzo-Seva, U., & Ten Berge, J. M. (2006). Tucker's congruence coefficient as a meaningful index of factor similarity. Methodology, 2(2), 57-64.

- Tucker, L. R. (1951). A method for synthesis of factor analysis studies. Personnel Research Section Report No.984, Washington D.C.: Department of the Army.

4. Although examining convergent validity was probably not one of the goals of the study, if data are available, reporting correlations between LPFS-SR and other dimensional measures of personality would provide readers with additional information.

Data examining the LPFS-SR convergent validity with other dimensional measures of personality is already published. Please see the following reference for more details:

- Pires, R., Henriques-Calado, J., Sousa Ferreira, A., Gama Marques, J., Ribeiro Moreira, A., Barata, B. C., Paulino, M., & Gonçalves, B. (2023). Bridging the ICD11 and the DSM-5 personality disorders classification systems: The role of the PID5BF + M. Frontiers in Psychiatry, 14, 1004895. https://doi.org/ 10.3389/fpsyt.2023.1004895

REVIEWER 5

1. My only additional suggestion is that the authors mention the limitations of the study is that the validation of the Portuguese version of the LPFS-SR is not yet complete. This is due to the absence of scale reliability tests. According to COSMIN, in addition to internal consistency, reliability is an umbrella clinimetric property that encompasses reliability (the ability of the instrument to detect similar responses in repeated applications on the same patient, if he/she is clinically stable) and the error of measurement (size of the error systematically present during the application of the instrument). Along with criterion and discriminant validity, reliability would ensure the complete accuracy of the scale for use in clinical practice and scientific research. However, the reliability test depends on a test and retest design, and this was probably the reason for its failure.

We have followed Reviewer 5's suggestion, which has been implemented in the following lines: 432-436.

Attachment

Submitted filename: Response to Reviewers_12-02-24.docx

pone.0300706.s005.docx (25.6KB, docx)

Decision Letter 2

Paulo Alexandre Azevedo Pereira Santos

5 Mar 2024

The Portuguese version of the self-report form of the DSM-5 Level of Personality Functioning Scale (LPFS-SR) in a community and clinical sample

PONE-D-23-22309R2

Dear Dr. Pires,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Paulo Alexandre Azevedo Pereira Santos, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Acceptance letter

Paulo Alexandre Azevedo Pereira Santos

23 Mar 2024

PONE-D-23-22309R2

PLOS ONE

Dear Dr. Pires,

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team.

At this stage, our production department will prepare your paper for publication. This includes ensuring the following:

* All references, tables, and figures are properly cited

* All relevant supporting information is included in the manuscript submission,

* There are no issues that prevent the paper from being properly typeset

If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps.

Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

If we can help with anything else, please email us at customercare@plos.org.

Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Professor Paulo Alexandre Azevedo Pereira Santos

Academic Editor

PLOS ONE

Associated Data

    This section collects any data citations, data availability statements, or supplementary materials included in this article.

    Supplementary Materials

    S1 File

    (PDF)

    pone.0300706.s001.pdf (200.5KB, pdf)
    S2 File

    (PDF)

    pone.0300706.s002.pdf (225.4KB, pdf)
    S3 File

    (XLSX)

    pone.0300706.s003.xlsx (31.3KB, xlsx)
    Attachment

    Submitted filename: Response to Reviewers_11-11-23.docx

    pone.0300706.s004.docx (43.3KB, docx)
    Attachment

    Submitted filename: Response to Reviewers_12-02-24.docx

    pone.0300706.s005.docx (25.6KB, docx)

    Data Availability Statement

    All relevant data are within the manuscript and its Supporting Information files.

    Articles from PLOS ONE are provided here courtesy of PLOS

    RESOURCES