Theoretical and Empirical Integration of "Dark" Traits and Socially Aversive Personality Psychopathology

Conceptual work integrating constructs from mainstream personality research (especially so-called "dark" traits) and clinical psychopathology research has been limited. Herein, we propose all socially and/or ethically aversive traits as "flavored" manifestations of the D factor of personality (D). We argue that the D framework provides the commonality of all aversive traits, including the aversive traits from the DSM-5 Alternative Model for Personality Disorders (AMPD), a more thorough theoretical foundation. Moreover, D covers aspects that are not captured by any of the aversive AMPD traits directly (e.g., greed), thus offering indications for possible expansions to the AMPD. We tested our predictions in two online studies (N = 1,781 and N = 2,006) using quota-representative samples of the German population regarding age and gender. Twelve aversive traits from mainstream personality research and eight aversive AMPD traits were assessed together with consequential behavior in an economic game. Analyses using structural equation modeling overall confirmed predictions.

The sensitivity of the ICD-11 trait model to the symptoms of clinical disorders in young adults

Hierarchical psychopathology contributes to providing a broader picture of the links between emerging personality structures such as the DSM-5/ICD-11 trait models and clinical disorders. The present study aimed to predict the specific and general clinical symptoms by the less studied constructs of the ICD-11 model (negative affectivity, detachment, dissociality, disinhibition, and anankastia). Data from 642 young adults from Iran (63% female, 18-34 years) were collected by three mental symptom scales and the Personality Inventory for DSM-5 (PID-5), which was recently used to harmonize the constructs of the DSM-5 and ICD-11 trait models. Multiple linear regressions showed that the ICD-11 model significantly predicted both the specific clinical symptoms (ranging from R2 = 0.15 to 0.40) and the general factor of clinical symptoms extracted by exploratory factor analysis (R2 = 0.40, all p < 0.001). Negative affectivity was the strongest construct correlated with both the specific symptoms (ranging from β = 0.36 to 0.69) and the general symptom factor (β = 0.59, all p < 0.001). Because the ICD-11 trait model is a practical structure related to the clinical psychopathology in young adults, screening for maladaptive traits can help clinicians in case formulation for diagnosis and treatment.

Replicability of the five-factor structure of DSM-5 and ICD-11 trait systems and their associations with binge eating and bipolar spectrum psychopathology

Since the research on contemporary personality models-and psychopathology-mainly originate from the Western world, we aimed to test the factorial structure of two trait systems assessed with the Personality Inventory for DSM-5 (PID-5) in a non-Western sample and to compare the extracted models' relative associations with binge eating disorder (BED) and bipolar spectrum disorder (BSD) symptoms. A community sample (N = 516; 72% female) was administered the PID-5, which can operationalize both the DSM-5 and ICD-11 systems. The factor structures of both systems were tested using exploratory structural equation modeling (ESEM). The congruence coefficients of all factor loadings with international studies were calculated. The Binge Eating Scale (BES), Bipolar Spectrum Diagnostic Scale (BSDS), and Hypomania Checklist-32-Revised (HCL-32) were used to measure the criterion variables. Linear regression models were used for comparing the DSM-5 and ICD-11 systems in predicting the BED and BSD. The findings supported five-factor solutions for both trait systems. Both systems significantly predicted dimensional measures of both BED and BSD (all p < 0.001). The present findings support an acceptable five-factor structure for both personality systems in the non-Western sample. Different algorithms of maladaptive domains on both systems are related to binge eating and bipolar spectrum psychopathology.

Examining Measurement Invariance in the Personality Inventory for DSM-5 Brief Form Across Sexual and Gender Minority Status

The Personality Inventory for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Brief Form (PID-5-BF) was developed with an assumption of invariance across sexual and gender minority (SGM) individuals. This assumption has yet to be tested empirically. Using multigroup confirmatory factor analysis, we examined measurement invariance in the PID-5-BF across the SGM status in clinical (N = 1,174; n = 254 SGM) and nonclinical (N = 1,456; n = 151 SGM) samples. Measurement invariance was supported for the PID-5-BF structure, item thresholds, and factor loadings, but not at the item intercept level. SGM individuals endorsed higher negative affectivity, antagonism, disinhibition, and psychoticism domains in both samples. In the clinical sample, adjusting for partial invariance decreased detachment and antagonism levels for SGM persons. In the nonclinical sample, adjusting for partial invariance reduced antagonism disparities in the SGM group, even rendering original group differences null. Our results support the use of the PID-5-BF in SGM populations but indicate that some measurement bias may drive observed disparities in maladaptive trait domains and, in turn, personality disorder diagnosis.

Measurement invariance of the Personality Inventory for DSM-5 across sex

Introduction

There has been an international movement towards dimensional models of personality disorders (PDs) in the last decades, which culminated in the publication of the Alternative Model of Personality Disorders (AMPD) in the Emerging Measures and Models section of the DSM-5. This model was accompanied by a APA-sanctioned Personality Inventory for DSM-5 (PID-5) for the assessment of the AMPD pathological personality traits. One major issue with the assessment of personality disorders pertains to sex differences, and measurement invariance across sex in assessment instruments for PDs is necessary in order to ensure non-biased evaluations and to make valid comparisons between men and women. This study aimed to provide more information on measurement invariance across sex for the PID-5, using both the original scoring approach provided by the authors of the instrument and the scoring approach suggested by the APA in the published version of the PID-5.

Methods

This study was conducted with a sample of 2273 participants from the general Québec (Canada) adult population aged 18 to 90 years (M = 46.59; SD = 16.32; 51.8% women).

Results

The original scoring approach model showed good fit to data after freeing paths between certain traits and reached strict invariance. The APA scoring approach also showed good fit to data and reached strict invariance, but needed an adjustment (path freed between Emotional lability and Impulsivity in men) to reach scalar invariance.

Discussion

In line with previous research, the PID-5 is invariant across sex and the five-factor structure adjusts well to data. The APA scoring approach appears to attenuate the cross-loading problem observed with the original scoring approach. In light of these results, we recommend using the APA scoring approach to derive domain scores.

Differentiation of Self and Interpersonal Functioning with the Level of Personality Functioning Scale - Brief Form 2.0

Research on Criterion A of the alternative model for personality disorders is recently expanding and provides mixed results concerning the unidimensional operational definition of severity by the model, characterized by impaired self (identity and self-direction) and interpersonal (empathy and intimacy) functioning. Studies resulted in one, as well as two or more factor structures. The present study demonstrated the importance of the structural and relational differentiation of self and interpersonal dimensions of personality functioning. One thousand seventy-four participants (community and clinical mixed sample) completed the Level of Personality Functioning Scale - Brief Form 2.0 (LPFS-BF 2.0), the Personality Inventory for DSM-5 Short Form and the Questionnaire for the World Health Organization Disability Assessment. An LPFS-BF 2.0 two-factor structure with self and interpersonal functioning factors was corroborated by confirmatory factor analyses and bifactor modeling. Joint Exploratory Factor Analysis of the LPFS-BF 2.0 domains with maladaptive personality domains clearly differentiated the personality functioning factors. While the self-functioning factor was more closely linked to negative affect (and to disinhibition and psychoticism), the interpersonal functioning factor connected to detachment. Self-functioning predicted functional impairment along and beyond personality domains. The LPFS-BF 2.0 appears a useful tool for clinical routine monitoring of both self and interpersonal functioning.

Structure of Pathological Personality Traits Through the Lens of the CAT-PD Model

Personality pathology is increasingly conceptualized within hierarchical, dimensional trait models. The Comprehensive Assessment of Traits Relevant to Personality Disorders (CAT-PD) is a pathological-trait measure with potential to improve on currently prevailing instruments because it has wider content coverage; however, its domain-level structure, which is of scientific and clinical interest, is not established. In this study, we investigated the structure and construct validity of the CAT-PD's domain level to facilitate wider use of the measure. We estimated five- and six-factor models with exploratory factor analysis in a pooled sample of eight independent subsamples (N = 3,987) and found that both models fit the data well; each had interpretable factors that were invariant across gender, sample type, and Black/White racial groups; and the factors had good convergent validity with other measures of maladaptive traits, Big Five personality, and interpersonal problems. Our results support the validity of the CAT-PD for assessing multiple levels of the pathological trait hierarchy.

[The alternative model of personality disorders among the French population: Assessment with brief tools]

OBJECTIVES

The aim of this work was to study whether the French versions of the brief tools available to clinicians within the framework of the Alternative Model of Personality Disorders (AMPD) can account for the risks of personality disorders in the general population. Tools are available to accurately investigate either the Level of Personality Functioning (LPF) or the Pathological Personality Dimensions (PPD) which in turn allow the validation of the relevance of the AMPD for its criteria A and B. As these tools, such as Morey's Level of Personality Functioning Scale Self Rated (LPFS-SR) for Criteria A or the Personality Inventory for DSM-5 (PID5) by Krueger et al. for Criteria B, are lengthy, the question arises as to the use of the short tools derived from them.

METHOD

Data was collected from a sample of 433 people recruited on a volunteer basis with a complete protocol. The sample was predominantly female (83% female, 16% male, 2 people who did not wish to report their gender) and rather young (67% were 18-24 years old). The short version, the LPFS- BF of Hutsbaut et al., which we used in this work allows, as confirmed by several works, to consider on the basis of 12 items the global level of personality functioning. In order to assess the pathological dimensions of personality (PPD), we chose the short version of the Personality Inventory for DSM 5 (PID 5 BF) by Krueger et al. and used its validated French translation that satisfies the factor composition of the original version: Negative Affectivity, Antagonism, Detachment, Disinhibition and Psychoticism. To assess the intensity of personality disorders we used the dedicated subscale (Items 19 and 20) that the DSM 5 proposes in its Cross-Cutting Symptoms Measures of Level 1, in its French translation. A score higher than 2 was our Gold Standard when we tested the metric capacity of the two questionnaires to evaluate the A Criteria and then the B Criteria of the AMPD.

RESULTS

The overall results (Table 1) show levels that place the group in a non-clinical level. In terms of the severity of personality disorders it can be seen that 27 % are at risk of personality disorder (PDs>2). Comparing these two sub-groups (Table 1), we observed significant differences for all the factors studied, pointing towards a higher score for people at risk of PDs. A logistic regression analysis of the evaluation of persons at risk lead us to find that gender and age do not have a significant influence (p=0.225 and p=0.065 respectively) in a valid model (chi square=157, df=4, p<0.001) including the overall score on the LPFS (z=5.76, p<0.001) and the PID 5 (z=2.26, p<0.001). The Area Under the Curve (AUC=0.859) of this translation (Table 3) is consistent with the original version (AUC=0.84). It has metrological qualities (Sn=73.91%, Sp=85.33%, LR+=5.1, LR-=0.3005) that allowed us to use a threshold of 24 as a discriminant of a risk of moderate or severe personality disorder. In addition, if we followed the AMPD and considered the threshold of 24 on the LFPS-BF to be a risk score for personality disorder, we could see (Fig. 2) that the scores on the PID 5 BF fairly well reflected the expected pattern with a large AUC (0.901). According to the AMPD, the cut-points for the dimensions that would evoke the presence of criteria B in the case of the presence of criterion A (LPFS-BF>24) could be either a score greater than 2 for Negative Affectivity, a score greater than 0.8 for Detachment, Antagonism and Disinhibition, or a score greater than 1.2 for Psychoticism (Table 4).

DISCUSSION

The translation of the LPFS-BF that we used in this work has sufficient qualities to assess situations at risk of personality disorders when higher than 24. Its consistency was good (=0.84), and its factor composition in two factors (Self and Interpersonal Relations) was equivalent to the original version. The use of PID5-BF could therefore be used as a complement to the screening of AMPD A criteria, with a 25 for cut-point. The evaluation of the AMPD B criteria with the PID5-BF seemed relevant in view of our results; each of the subscales seemed to be able to correctly evaluate (AUC) persons with an LPFS-BF score at risk. However, the risk thresholds need to be confirmed in further work because of the essential role that the dimensions play in the diagnosis of types of personality disorders.

Construct and criterion validity of the HiTOP spectra to predict dimensional and categorical somatization in a large non-western sample

The Hierarchical Taxonomy of Psychopathology (HiTOP) is a phenotypic data-driven framework for the classification of psychopathology. We tested the construct and criterion validity of the HiTOP spectra measured by the Personality Inventory for DSM-5 (PID-5) using exploratory structural equation modeling (ESEM) and hierarchical regressions both to predict somatic symptom and related disorders (SSRD) and a somatization factor. The case-control study used hierarchical logistic regressions to distinguish 257 cases with SSRD from 1007 healthy controls by both the maladaptive and the temperament factors. The extracted factors were also used in hierarchical linear regressions to predict the dimensional somatization factor. The seven temperament factors explained more variance above and beyond the five maladaptive factors when predicting SSRD (pseudo R2 = 0.169 to 0.266 versus 0.125 to 0.196; change in pseudo R2 = 0.055 to 0.087 versus 0.011 to 0.017). The temperament factors also explained more variance above and beyond the maladaptive factors when predicting the somatization factor (R2 = 0.392 versus 0.269; change in R2 = 0.146 versus 0.023). Although the HiTOP spectra measured by PID-5 are significant structures related to the categorical and dimensional measurements of somatoform, our findings highlight potential problems with both the construct and criterion validity of the HiTOP spectra.

The underlying structure of the Personality Inventory for DSM-5 (PID-5): a general factor of personality psychopathology

BACKGROUND

The psychopathology of personality is currently undergoing a paradigm shift from a categorical to a dimensional approach. This work aimed to study the underlying structure of pathological personality traits of the DSM-5 Alternative Model for Personality Disorders (AMPD). For this purpose, the internal structure of a version of the Personality Inventory for the DSM-5 (PID-5) was examined by a confirmatory factor analysis. This version assesses the five higher-order pathological personality domains (negative affectivity, detachment, antagonism, disinhibition, and psychoticism) and the 25 lower-order pathological personality facets through a reduced number of items. Four alternative models were compared: five-factor oblique; second-order (five first-order factors and one second-order factor); bifactor (five specific factors and a general factor), and one-factor.

PARTICIPANTS AND PROCEDURE

We worked with an Argentinean sample of N = 525 subjects from the general population who answered the Argentine version of the PID-5.

RESULTS

The five-factor model was slightly superior to the second order model, and the bifactor model presented the best fit.

CONCLUSIONS

These findings, while preliminary, suggest that the PID-5 facets could reflect five specific pathological personality traits (which correspond to AMPD domains) but also a general factor (which would reflect a general propensity for psychopathology).

The Placement of Obsessive-Compulsive Symptoms Within a Five-Factor Model of Maladaptive Personality

Dimensional models of obsessive-compulsive (OC) symptoms, as seen in obsessive-compulsive disorder (OCD), are instrumental in explaining the heterogeneity observed in this condition and for informing cutting-edge assessments. Prior structural work in this area finds that OC symptoms cross-load under both Negative Affectivity and Psychoticism traits within the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) Alternative Model of Personality Disorder (AMPD). However, tests of OC symptoms in conjunction with assessments of the full AMPD structure and its 25 lower-level facets representing narrower symptom content are lacking. We applied joint exploratory factor analysis to an AMPD measure (Personality Inventory for DSM-5; PID-5) and OC symptom data from two separate samples (total N = 1,506) to locate OC symptoms within AMPD space. OC symptoms cross-loaded on Negative Affectivity, Psychoticism, and on the low end of Disinhibition. We also report exploratory analyses of OC symptom subscales with PID-5 variables. Results are discussed in the context OC symptoms' location in PID-5 space, implications for assessment, and placement of OCD within the Hierarchical Taxonomy of Psychopathology.

Dimensional models of personality disorders: Challenges and opportunities

Categorical models of personality disorders have been beneficial throughout psychiatric history, providing a mechanism for organizing and communicating research and treatment. However, the view that individuals with personality disorders are qualitatively distinct from the general population is no longer tenable. This perspective has amassed steady criticism, ranging from inconsequential to irreconcilable. In response, stronger evidence has been accumulated in support of a dimensional perspective that unifies normal and pathological personality on underlying trait continua. Contemporary nosology has largely shifted toward this dimensional perspective, yet broader adoption within public lexicon and routine clinical practice appears slow. This review focuses on challenges and the related opportunities of moving toward dimensional models in personality disorder research and practice. First, we highlight the need for ongoing development of a broader array of measurement methods, ideally facilitating multimethod assessments that reduce biases associated with any single methodology. These efforts should also include measurement across both poles of each trait, intensive longitudinal studies, and more deeply considering social desirability. Second, wider communication and training in dimensional approaches is needed for individuals working in mental health. This will require clear demonstrations of incremental treatment efficacy and structured public health rebates. Third, we should embrace cultural and geographic diversity, and investigate how unifying humanity may reduce the stigma and shame currently generated by arbitrarily labeling an individual's personality as normal or abnormal. This review aims to organize ongoing research efforts toward broader and routine usage of dimensional perspectives within research and clinical spaces.

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

The DSM-5 Alternative Model for Personality Disorders (AMPD) includes two main criteria: moderate or greater impairment in personality functioning (Criterion A) and the presence of one or more pathological personality traits (Criterion B). The aim of the study was to investigate the incremental utility of Criteria A and B for predicting DSM-5 Section II personality disorders (PD). The sample (N = 317) consisted of three well-defined groups: non-clinical participants (n = 35), psychiatric patients with PD (n = 193), and without PD (n = 83). All were assessed using the Structured Clinical Interview for the DSM-5 Alternative Model for Personality Disorders Module I (SCID-5-AMPD-I): Level of Personality Functioning Scale (LPFS), and the Personality Inventory for DSM-5 (PID-5). Logistic regression analyses showed that the SCID-5-AMPD-I could predict the presence of PDs in general, and the three specific PDs that were investigated (i.e., Antisocial, Borderline, and Avoidant PDs). The PID-5 domains enhanced prediction of the specific PDs, but not the presence of PDs in general, when entered in the second step. Our results support the AMPD model: Criterion A predicted the presence of DSM-5 Section II PDs in general, whereas measures of Criterion B incremented prediction of Antisocial, Borderline, and Avoidant PDs.

Classification and assessment of fear and anxiety in personality and psychopathology

We examine fear and anxiety in the context of structural models of personality (the five-factor model, or FFM) and psychopathology (the Hierarchical Taxonomy of Psychopathology, or HiTOP); we also highlight important issues related to their assessment. Anxiety is a sustained, future-oriented response to potential threat. Trait measures of anxiety represent a core facet within the broader domain of neuroticism in the FFM. Anxiety-related symptoms are indicators of the distress subfactor within the internalizing spectrum in HiTOP. In contrast, fear is a brief, present-focused response to an acute threat. We distinguish between two ways of assessing individual differences in fear. The first type assesses phobic responses to specific stimuli. Phobia measures are moderately correlated with measures of neuroticism in the FFM and define the fear subfactor of internalizing in HiTOP. The second type assesses individual differences in harm avoidance versus risk taking. Measures of risk taking (i.e., low fear) are moderately related to disinhibition/low conscientiousness and antagonism/low agreeableness in the FFM and are indicators of the externalizing superspectrum in HiTOP.

Psychometric study of the brazilian version of the personality inventory for DSM-5-paper-and-pencil version

The Personality Inventory for DSM-5 - Self Reported Form (PID-5-SRF) operationalizes Criterion B of the personality alternative model of DSM-5 Section III and has already been cross-culturally adapted to many countries. The objective is to present evidence of validity and reliability of the Brazilian version of PID-5 (pencil-and-paper) in a Brazilian community sample. The sample was composed of 730 individuals from the general population [67.8% women, aged 33.84 (SD = ±15.2), 69.5% ≥ 12 years of schooling]. The participants were recruited in academic, organizational, healthcare, and business facilities in three Brazilian states. The snowball method was used. The PID-5 Brazilian version and the Revised NEO-Five Factor Inventory (NEO-FFI-R) were individually applied, and the retest was applied 30 days after. Satisfactory internal consistency (facets α ≥0.51; domains α ≥0.82) and test-retest reliability (facets ICC ≥ 0.45; domains ICC ≥0.76) were found, but a floor effect was verified in 97.7% of the items. Regarding convergent validity, strong correlations were found between the PID-5 and the NEO-FFI-R domains (r = -0.44 to 0.70). Ten facets did not fit the unidemensional structure. Confirmatory Factor Analyses did not present adequate goodness of fit, and Exploratory Analyses indicated that a five-factor model is more appropriate, though it presents some peculiarities concerning the original model. PID-5 also presented satisfactory goodness of fit to the personality hierarchical model. Generally, the instrument's psychometric indicators favor its use in the Brazilian context. However, some aspects demand attention, and more specific studies should be conducted to verify the impact of reverse-scored items, floor effect, and peculiarities of its internal structure (some facets' multidimensionality and interstitiality) concerning the original model.

Reliability and validity of the Hungarian version of the Personality Inventory for DSM-5 (PID-5)

Objectives and methods

In order to assess the internal consistency, fit indexes, test-retest reliability, and validity of the Personality Inventory for the DSM-5 (PID-5) and its associations with age, gender, and education, 471 non-clinical (69,6% female; mean age: 37,63) and 314 clinical participants (69,7% female, mean age: 37,41) were administered the Hungarian translation of the PID-5, as well as the SCL-90-R and the SCID-II Personality Questionnaire.

Results

We found that; (a) temporal consistency of the Hungarian PID-5 was confirmed by one-month test-retest reliability analysis, (b) validity of the PID-5 instrument is acceptable in the clinical and the non-clinical sample as well, based on significant correlations with SCID-II and SCL-90-R, (c) PID-5 facets’ and domains’ associations with gender, age, and level of education are in accordance with previous findings.

Conclusion

These findings support that the Hungarian PID-5 is a reliable and valid instrument for both clinical and non-clinical populations.

Factor Convergence and Predictive Analysis of the Five Factor and Alternative Five Factor Personality Models with the Five-Factor Personality Inventory for ICD-11 (FFICD)

The authors analyze and compare the factor convergence and predictive power of the Revised NEO Personality Inventory (NEO-PI-R) and the Zuckerman-Kuhlman-Aluja Personality Questionnaire (ZKA-PQ/SF) with respect to the Five-Factor Personality Inventory for ICD-11 (FFiCD). A total of 803 White Spanish subjects were analyzed. All the personality domains had significant predictive power with regard to the FFiCD except NEO Openness. The explained variance of the personality domains with respect to FFiCD Negative Affectivity (71% and 77%) and Detachment (56% and 56%) were similar for NEO-PI-R and ZKA-PQ/SF, respectively, but the NEO-PI-R accounted for greater variance for FFiCD Anankastia, Dissociality, and Disinhibition. The FFiCD facets of Rashness, Thrill- Seeking (Disinhibition), and Unassertiveness (Detachment) were located in factors other than those theoretically expected. The authors conclude that normal personality measured by the NEO-PI-R and the ZKA-PQ/SF contribute, in a differential but complementary way, to knowledge of the maladaptive personality measured by the FFiCD.

Factor Convergence and Predictive Analysis of the Five Factor and Alternative Five Factor Personality Models With the Five-Factor Personality Inventory for ICD-11 (FFiCD)

The authors analyze and compare the factor convergence and predictive power of the Revised NEO Personality Inventory (NEO-PI-R) and the Zuckerman-Kuhlman-Aluja Personality Questionnaire (ZKA-PQ/SF) with respect to the Five-Factor Personality Inventory for ICD-11 (FFiCD). A total of 803 White Spanish subjects were analyzed. All the personality domains had significant predictive power with regard to the FFiCD except NEO Openness. The explained variance of the personality domains with respect to FFiCD Negative Affectivity (71% and 77%) and Detachment (56% and 56%) were similar for NEO-PI-R and ZKA-PQ/SF, respectively, but the NEO-PI-R accounted for greater variance for FFiCD Anankastia, Dissociality, and Disinhibition. The FFiCD facets of Rashness, Thrill- Seeking (Disinhibition), and Unassertiveness (Detachment) were located in factors other than those theoretically expected. The authors conclude that normal personality measured by the NEO-PI-R and the ZKA-PQ/SF contribute, in a differential but complementary way, to knowledge of the maladaptive personality measured by the FFiCD.

Psychopathy: Current Knowledge and Future Directions

Research on psychopathy has progressed considerably in recent years against the backdrop of important advances in the broader field of clinical psychological science. My major aim in this review is to encourage integration of investigative work on dispositional, biobehavioral, and developmental aspects of psychopathy with counterpart work on general psychopathology. Using the triarchic model of psychopathy as a frame of reference, I offer perspective on long-standing debates pertaining to the conceptualization and assessment of psychopathy, discuss how dispositional facets of psychopathy relate to subdimensions of internalizing and externalizing psychopathology, and summarize findings from contemporary biobehavioral and developmental research on psychopathy. I conclude by describing a systematic strategy for coordinating biobehavioral-developmental research on psychopathy that can enable it to be informed by, and help inform, ongoing research on mental health problems more broadly. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 18 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): III. Emotional dysfunction superspectrum

The Hierarchical Taxonomy of Psychopathology (HiTOP) is a quantitative nosological system that addresses shortcomings of traditional mental disorder diagnoses, including arbitrary boundaries between psychopathology and normality, frequent disorder co-occurrence, substantial heterogeneity within disorders, and diagnostic unreliability over time and across clinicians. This paper reviews evidence on the validity and utility of the internalizing and somatoform spectra of HiTOP, which together provide support for an emotional dysfunction superspectrum. These spectra are composed of homogeneous symptom and maladaptive trait dimensions currently subsumed within multiple diagnostic classes, including depressive, anxiety, trauma-related, eating, bipolar, and somatic symptom disorders, as well as sexual dysfunction and aspects of personality disorders. Dimensions falling within the emotional dysfunction superspectrum are broadly linked to individual differences in negative affect/neuroticism. Extensive evidence establishes that dimensions falling within the superspectrum share genetic diatheses, environmental risk factors, cognitive and affective difficulties, neural substrates and biomarkers, childhood temperamental antecedents, and treatment response. The structure of these validators mirrors the quantitative structure of the superspectrum, with some correlates more specific to internalizing or somatoform conditions, and others common to both, thereby underlining the hierarchical structure of the domain. Compared to traditional diagnoses, the internalizing and somatoform spectra demonstrated substantially improved utility: greater reliability, larger explanatory and predictive power, and greater clinical applicability. Validated measures are currently available to implement the HiTOP system in practice, which can make diagnostic classification more useful, both in research and in the clinic.

Self-reported narcissistic traits in patients with addiction through the lens of the ICD-11 model for personality disorders

BACKGROUND

There is a presumption that pathological narcissism, or narcissistic personality disorder per se, can be considered a precursor to addiction. Although the ICD-11 model does not distinguish specific personality disorders, narcissistic psychopathology should be captured through personality trait qualifiers.

OBJECTIVES

To verify the capacity of the ICD-11 model in the detection of narcissistic psychopathology in patients with addiction; to test its discrimination capacity, convergent validity, and specificity toward the gender and the type of addiction.

MATERIALS AND METHODS

Two samples were employed in the study. Sample 1 (n = 421) consisted of patients with addiction; Sample 2 (n = 567) consisted of general population volunteers. Age range was 18-75 years and a battery of self-assessment questionnaires containing Personality Inventory for DSM-5-Brief Form Plus Modified; Triarchic Psychopathy Measure; Hypersensitive Narcissism Scale; and Level of Personality Functioning Scale-Self-Report was administered by pencil-and-paper method.

RESULTS

The following was confirmed: (1) capacity of the ICD-11 model in relation to capture narcissistic pathology; (2) the differentiation capacity between the clinical and non-clinical population; (3) gender specificity in relation to grandiose and vulnerable narcissism; (4) the connection between the overall degree of impairment in personality functioning and most of trait qualifiers; (5) certain specifics of patients with addiction in relation to the type of addiction.

CONCLUSION

Results support the empirical and clinical relevance of the ICD-11 model in capturing narcissistic pathology in addicted patients. Clinical implications concerning assessment and treatment in addiction settings, and certain limits regarding the Anankastia domain are discussed.

The Personality Inventory for DSM-5: Psychometric Evidence of Validity and Reliability-Updates

OBJECTIVE

To perform a systematic review of the literature on the psychometric characteristics of different versions of the Personality Inventory for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (PID-5) and to integrate the current findings with those of previous reviews by Al Dajani and colleagues (2015) and Watters and Bagby (2018).

METHODS

This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses protocol. PubMed, PsycINFO, SciELO, Web of Science, and LILACS were searched using two keywords: personality AND DSM-5. Studies published from 2015 to 2018 were included.

RESULTS

Sixty-four new studies were evaluated. The PID-5-self-report form (SRF) was concluded to have a factorial structure consisting of five factors and 25 facets, as well as excellent indicators of internal consistency, test-retest reliability, and convergent validity with different personality instruments and with other clinical constructs. The form also has predictive and discriminative potential, warranting further exploration in studies with samples of personality disorders in relation to different parameters and not only the diagnostic algorithm of DSM-5 Section III. The brief and informant versions, although less studied, also showed good psychometric indicators, comparable to the original version.

CONCLUSIONS

The PID-5 showed psychometric suitability for use in different cultures and contexts. The form's use in clinical practice and as a means of operationalizing the diagnostic evaluation of the DSM-5 dimensional model is promising and should be encouraged.

Cross-Cultural Measurement Invariance in the Personality Inventory for DSM-5✰

The validity of cross-cultural comparisons of test scores requires that scores have the same meaning across cultures, which is usually tested by checking the invariance of the measurement model across groups. In the last decade, a large number of studies were conducted to verify the equivalence across cultures of the dimensional Alternative Model of Personality Disorders (DSM-5 Section III). These studies have provided information on configural invariance (i.e., the facets that compose the domains are the same) and metric invariance (i.e., facet-domain relationships are equal across groups), but not on the stricter scalar invariance (i.e., the baseline levels of the facets are the same), which is a prerequisite for meaningfully comparing group means. The present study aims to address this gap. The Personality Inventory for DSM-5 (PID-5) was administered to five samples differing on country and language (Belgium, Catalonia, France, Spain, and Switzerland), with a total of 4,380 participants. Configural and metric invariance were supported, denoting that the model structure was stable across samples. Partial scalar invariance was supported, being minimal the influence of non-invariant facets. This allowed cross-cultural mean comparisons. Results are discussed in light of the sample composition and a possible impact of culture on development of psychopathology.

The Hierarchical Structure and Predictive Validity of the Personality Inventory for DSM-5 in Chinese Nonclinical Adolescents

To evaluate the factor structure, reliability, and validity of the Personality Inventory for DSM-5 (PID-5) in Chinese nonclinical adolescents, a total of 1,442 Chinese middle school youths (M_age = 14.85, girls = 52.4%) were recruited in the present study. All the participants completed the full-length 220-item PID-5. Some participants (n = 1,003) were administered adolescents' social adjustment as a criterion measure at the same time and 236 participants took part in longitudinal assessment of the PID-5 and adolescents' social adjustment 6 months later. First, exploratory structural equation modeling analyses supported a six-factor structure of the PID-5 in our present sample. Second, Negative Affectivity, Detachment, Antagonistic, and Disinhibition domains had positive correlations with negative social adjustment, and negative correlations with positive social adjustment concurrently and longitudinally, with the exception of Constraint and Psychoticism. Third, Cronbach's alpha for the PID-5 traits ranged from .57 to .91 in the full sample. The 6-month test-retest reliability by indexes of interclass correlation coefficient showed poor to good stability. As a whole, our findings provided preliminary evidence of the PID-5 as a reliable and valid measure of adolescents' maladaptive personality traits in mainland China.

Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): II. Externalizing superspectrum

The Hierarchical Taxonomy of Psychopathology (HiTOP) is an empirical effort to address limitations of traditional mental disorder diagnoses. These include arbitrary boundaries between disorder and normality, disorder co-occurrence in the modal case, heterogeneity of presentation within dis-orders, and instability of diagnosis within patients. This paper reviews the evidence on the validity and utility of the disinhibited externalizing and antagonistic externalizing spectra of HiTOP, which together constitute a broad externalizing superspectrum. These spectra are composed of elements subsumed within a variety of mental disorders described in recent DSM nosologies, including most notably substance use disorders and "Cluster B" personality disorders. The externalizing superspectrum ranges from normative levels of impulse control and self-assertion, to maladaptive disinhibition and antagonism, to extensive polysubstance involvement and personality psychopathology. A rich literature supports the validity of the externalizing superspectrum, and the disinhibited and antagonistic spectra. This evidence encompasses common genetic influences, environmental risk factors, childhood antecedents, cognitive abnormalities, neural alterations, and treatment response. The structure of these validators mirrors the structure of the phenotypic externalizing superspectrum, with some correlates more specific to disinhibited or antagonistic spectra, and others relevant to the entire externalizing superspectrum, underlining the hierarchical structure of the domain. Compared with traditional diagnostic categories, the externalizing superspectrum conceptualization shows improved utility, reliability, explanatory capacity, and clinical applicability. The externalizing superspectrum is one aspect of the general approach to psychopathology offered by HiTOP and can make diagnostic classification more useful in both research and the clinic.

Alternative DSM-5 Model for Personality Disorders Through the Lens of an Empirical Network Model

The Alternative Model for Personality Disorders defined in Diagnostic and Statistical Manual of Mental Disorders-Fifth edition (DSM-5) has recently attracted considerable interest in empirical research, with different hypotheses being proposed to explain the discordant results shown in previous research. Empirical network analysis has begun to be applied for complementing the study of psychopathological phenomena according to a new perspective. This article applies this analysis to personality facets measured in a sample of 626 patients with mental disorders and a 1,034 normative sample, using the Personality Inventory for DSM-5. The results reveal five substructures partially equivalent to domains defined in the DSM-5. Discordant facets (suspiciousness, hostility, rigid perfectionism, attention seeking, and restricted affectivity) play the role of connectors between substructures. Invariance between clinical and community networks was found except for the connection between unusual beliefs and perceptual dysregulation (stronger in the clinical sample). Considering the strength centrality index, anxiousness, emotional lability, and depressivity can be highlighted for their relative importance within both clinical and normative networks.

The ICD-11 Personality Disorder Trait Model Fits the Kurdish Population Better Than the DSM-5 Trait Model

The ICD-11 Classification of Personality Disorders and the DSM-5 Alternative Model of Personality Disorders (AMPD) operate with trait domains that contribute to the individual expression of personality disturbance (i.e., negative affectivity, detachment, dissociality, disinhibition, anankastia, and psychoticism). To date, these trait frameworks have not been investigated sufficiently in Middle Eastern cultures. Thus, the present study explored the structure of the ICD-11 and AMPD personality disorder (PD) trait domains in a large mixed sample from the Kurdistan zone of Iran. The ICD-11 and AMPD trait domains were operationalized using empirically supported algorithms for the Personality Inventory for DSM-5 (PID-5). The PID-5 was administered to a large mixed sample (N = 3,196) composed of 2,678 community and 518 clinical participants. Structural validity was investigated using Exploratory Factor Analysis (EFA), whereas differential construct validity was explored by comparing clinical and community scores. Model fit and the expected factor structure were deemed appropriate for the ICD-11 trait model, but less adequate for the DSM-5 trait model (i.e., disinhibition did not emerge as a separate factor). All domain and facet scores showed significant differences between clinical and community subsamples with moderate to large effects, mostly for disinhibition and dissociality/antagonism while least for anankastia. The findings of the present study may suggest that the ICD-11 trait model is more cross-culturally fitting than the DSM-5 AMPD trait model, at least with respect to a large mixed sample from the region of Kurdistan. Accordingly, there is evidence for using PID-5 data for WHO ICD-11 purposes in this part of the World.

Psychometric Properties of the Personality Inventory for DSM-5 in a Romanian Community Sample

The Personality Inventory for DSM-5 (PID-5) evaluates 25 maladaptive personality traits proposed in the Alternative Model of Personality Disorders. The questionnaire has been extensively investigated and validated in several languages. The current research sought to examine the psychometric properties of the instrument in a sample of nonclinical Romanian participants (N = 1276). Results indicated excellent internal consistency for the domain level, and very good reliability for the facet level. The assumption of unidimensionality was supported at both the domain and facet levels, apart from Risk Taking. Two domain scoring methods were also compared. One of them takes into consideration all the 25 lower order facets, whereas the other uses only 15 facets. Results show that mean differences across the two scoring methods were small, except for Disinhibition. Moreover, confirmatory factor analyses revealed slightly better fit indices for the model which uses 15 facets only. Lastly, the hierarchical structure of maladaptive personality traits was explored. Results are discussed in the light of previous literature.

Psychometric Properties of the Independent 36-Item PID5BF+M for ICD-11 in the Czech-Speaking Community Sample

Background: Empirical soundness and international robustness of the PID5BF+M, a shortened version of the PID-5 developed for simultaneous evaluation of maladaptive personality traits in the DSM-5 AMPD and ICD-11 models for personality disorders, was recently confirmed in 16 samples from different countries. Because the modified PID5BF+ scale (36 items) was extracted from the complete 220-item PID-5, an independent evaluation of psychometric properties of a stand-alone PID5BF+M is still missing. Objectives: The present study evaluated the validity and reliability of the 36-item PID5BF+M in comparison with the extracted version from the original PID-5. It also assessed associations between the Borderline Pattern qualifier and trait domain qualifiers. Methods: Two non-clinical samples meeting the inclusion criteria were employed in the study. Sample 1 (n = 614) completed the 220-item PID-5; Sample 2 (n = 1,040) completed the independent 36-item PID5BF+M. Participants were from all 14 regions of the Czech Republic. The Borderline Pattern qualifier was evaluated using a shortened IPDEQ screener. Results: The proposed latent structure of the independent PID5BF+M was confirmed, with an exception of the Disinhibition domain. The results confirmed good internal consistency and test-retest reliability of the measure, as well as some support for the measurement invariance of the independent PID5BF+M in comparison with the extracted version from the original PID-5. Significant associations between the Negative affectivity, Disinhibition, and Psychoticism qualifiers and the IPDEQ items for the emotionally unstable personality disorder of both impulsive and borderline types confirmed good predictive validity of the PID5BF+M in pursuing borderline psychopathology within the ICD-11 model. Conclusions: The independent PID5BF+M was found to be a valid and reliable tool for evaluation of the ICD-11 trait model. However, the Disinhibition domain deserves further investigation in clinical samples as well as in international community samples.

Psychometric Properties of the Personality Inventory for DSM-5 (PID-5) in Brazilian Samples

Abstract This study aimed to investigate the psychometric properties of the Personality Inventory for DSM-5 (PID-5) in Brazilian community and clinical samples. This research included 1,210 people, 554 of them with psychopathology indicators. The participants answered the PID-5 and the Self-Reporting Questionnaire, in addition to a sociodemographic and health data questionnaire that included the six items of the suicidality module of the Mini International Neuropsychiatric Interview. The results showed that the 25 facets of the PID-5 had adequate reliability coefficients and evidence of unidimensionality. The instrument’s five-factor structure was replicated with high levels of congruence with the representative sample from North America. PID-5 scores were statistically different between clinical and community groups and were positively correlated with measures of suicide risk and psychopathological symptoms. This study presents the psychometric properties of PID-5 and its suitability for use in the Brazilian population.

Development of a Short and ICD-11 Compatible Measure for DSM-5 Maladaptive Personality Traits Using Ant Colony Optimization Algorithms

While Diagnostic and Statistical Manual of Mental Disorders–Fifth edition (DSM-5) Section III and ICD-11 (International Classification of Diseases 11th–Revision) both allow for dimensional assessment of personality pathology, the models differ in the definition of maladaptive traits. In this study, we pursued the goal of developing a short and reliable assessment for maladaptive traits, which is compatible with both models, using the item pool of the Personality Inventory for DSM-5 (PID-5). To this aim, we applied ant colony optimization algorithms in English- and German-speaking samples comprising a total N of 2,927. This procedure yielded a 34-item measure with a hierarchical latent structure including six maladaptive trait domains and 17 trait facets, the “Personality Inventory for DSM-5, Brief Form Plus” (PID5BF+). While latent structure, reliability, and criterion validity were ascertained in the original and in two separate validation samples (n = 849, n = 493) and the measure was able to discriminate personality disorders from other diagnoses in a clinical subsample, results suggest further modifications for capturing ICD-11 Anankastia.

The Inter-Rater Reliability and Validity of the Italian Translation of the Structured Clinical Interview for DSM-5 Alternative Model for Personality Disorders Module I and Module II: A Preliminary Report on Consecutively Admitted Psychotherapy Outpatients

To evaluate the reliability and convergent validity of the Structured Clinical Interview for DSM-5 Alternative Model for Personality Disorders (SCID-5-AMPD) Module I and Module II, 88 adult psychotherapy participants were administered the Italian translations of the SCID-5-AMPD Module I and Module II, Level of Personality Functioning Scale-Brief Form (LPFS-BF), Level of Personality Functioning Scale-Self Report (LPFS-SF), Personality Inventory for DSM-5 (PID-5), Personality Diagnostic Questionnaire-4+ (PDQ-4+), and Structured Clinical Interview for DSM-5 Personality Disorders (SCID-5-PD) relying on a Williams crossover design. SCID-5-AMPD Module I and Module II showed excellent inter-rater reliability. In terms of convergent validity, meaningful associations were observed between SCID-5-AMPD Module I scores and self-report measures of Criterion A; similarly, SCID-5-AMPD Module II trait scores were meaningfully related to PID-5 trait scores. As a whole, our preliminary findings supported the clinical utility of DSM-5 AMPD.

Body Dysmorphic Disorder in the Perspective of the Alternative DSM-5 Model for Personality Disorder: A Study on Italian Community-Dwelling Women

To evaluate the relationships between body dysmorphic disorder (BDD) and Alternative DSM-5 Model for Personality Disorder (AMPD) criterion A and dysfunctional personality trait (i.e., criterion B) measures, 420 Italian community-dwelling women were administered three measures of BDD (i.e., the Body Dysmorphic Disorder Questionnaire, the Body Dysmorphic Disorder-Dimensional Scale, and the Appearance Anxiety Inventory), as well as the Level of Personality Functioning Scale-Brief Form (LPFS-BF) and the Personality Inventory for DSM-5-Short Form (PID-5-SF). The three BDD measures showed substantial convergent validity correlations and could be reliably cumulated to obtain the BDD Cumulative Index (BDDCI). Several significant, nonnegligible correlations were observed between the BDDCI as well as the LPFS-BF scale scores and PID-5-SF personality trait scale scores. Relative importance weight analysis results showed that LPFS-BF scale scores and PID-5-SF trait scale scores were substantial predictors of the BDDCI scores (R = 0.42, f = 0.72). In particular, AMPD criterion A impairment in self-functioning and AMPD criterion B depressivity, anhedonia, perseveration, separation insecurity, and cognitive and perceptual dysregulation were core components of the dysfunctional personality profile associated with BDD.

A Psychometric Analysis of the Structured Clinical Interview for the DSM-5 Alternative Model for Personality Disorders Module I (SCID-5-AMPD-I): Level of Personality Functioning Scale

The current study aims to examine the psychometric properties of the Structured Clinical Interview for the DSM-5 Alternative Model for Personality Disorders Module I (SCID-5-AMPD-I) assessing the Level of Personality Functioning Scale (LPFS) in a heterogeneous sample of 282 nonpsychotic patients. Latent variable models were used to investigate the dimensionality of the LPFS. The results indicate that the LPFS, as assessed by the SCID-5-AMPD-I, can be considered as a unidimensional construct that can be measured reliably across a wide range of the latent trait. Threshold parameters for the 12 indicators of the LPFS increased gradually over the latent scale, indicating that the five LPFS levels were ordered as predicted by the model. In general, the increase of threshold parameters was relatively small for the shift from Level 2 to Level 3. A better distinction among the different severity levels might be obtained by fine-tuning the interview guidelines or the Level 2 indicators themselves.

Scripting the DSM-5 Alternative Model for Personality Disorders assessment procedure: A clinically feasible multi-informant multi-method approach

Published case studies on the DSM-5 (section III) Alternative Model for Personality Disorders (AMPD) generally utilized unstandardized assessment procedures or mono-method approaches. We present a case from clinical practice to illustrate a standardized, clinically feasible procedure for assessing personality pathology according to the full AMPD model, using a multi-method approach. We aim to present a procedure that can guide and inspire clinicians that are going to work with dimensional models as presented in DSM-5 and ICD-11. Specifically, we show how questionnaire and interview data from multiple sources (i.e. patient and family) can be combined. The clinical case also illustrates how Criterion A (i.e. functioning) and B (i.e. traits) are interrelated, suggesting that the joint assessment of both Criterion A and B is necessary for a comprehensive and clinically relevant case formulation. It also highlights how multi-method information can enhance diagnostic formulations. Finally, we show how the AMPD model can serve treatment planning and provide suggestions for how patient feedback might be delivered. © 2020 John Wiley & Sons, Ltd.

The assessment of personality pathology in adolescence from the perspective of the Alternative DSM-5 Model for Personality Disorder

Applying personality disorder diagnosis to adolescents is still a controversial topic. Notwithstanding there is now general agreement that personality disorders have its roots in childhood and adolescence, skepticism with regard to personality disorder diagnoses in adolescence seem to continue among clinicians. The aim of the present review is to summarize the available emerging literature on the assessment of personality pathology in adolescence according to the Alternative DSM-5 Model for Personality Disorders (AMPD). Specifically, we will provide an overview of the available instruments for assessing AMPD Criterion A and Criterion B, with a particular focus on their measurement properties in adolescence. Finally, suggestions for future researches are provided.

Psychometric Properties of the Personality Inventory for DSM-5-Brief Form in a Community Sample with High Rates of Trauma Exposure

In the current study, we used a sample of predominantly African-American women with high rates of trauma exposure (N = 434) to examine psychometric properties of the Personality Inventory for DSM-5-Brief Form (PID-5-BF). We compared model fit between a model with five correlated latent factors and a higher-order model in which the five latent factors were used to estimate a single "general pathology" factor. Additionally, we computed estimates of internal consistency and domain interrelations and examined indices of convergent/discriminant validity of the PID-5-BF domains by examining their relations to relevant criterion variables. The expected five-factor structure demonstrated good fit indices in a confirmatory factor analysis, and the more parsimonious, higher-order model was retained. Within this higher-order model, the first-order factors accounted for more variance in the criterion variables than the general pathology factor in most instances. The PID-5-BF domains were highly interrelated (rs = .38 to .66), and convergent/discriminant validity of the domains varied: Negative Affectivity and Detachment generally showed the hypothesized pattern of relations with external criteria, while Antagonism and Disinhibition displayed less consistent and discriminant relations. Results are discussed in terms of the costs and benefits of using brief pathological trait measures in samples characterized by high levels of psychopathology.

An Overview of the DSM-5 Alternative Model of Personality Disorders

Authoritative classification systems for psychopathology such as the DSM and ICD are shifting toward more dimensional approaches in the field of personality disorders (PDs). In this paper, we provide a brief overview of the dimensionally oriented DSM-5 alternative model of PDs (AMPD). Since its publication in 2013, the AMPD has inspired a substantial number of studies, underlining its generative influence on the field. Generally speaking, this literature illustrates both the reliability and validity of the constructs delineated in the AMPD. The literature also illustrates empirical challenges to the conceptual clarity of the AMPD, such as evidence of substantial correlations between indices of personality functioning (criterion A in the AMPD) and maladaptive personality traits (criterion B in the AMPD). Key future directions pertain to linking the AMPD literature with applied efforts to improve the lives of persons who suffer from PDs, and surmounting challenges germane to the evolution of the DSM itself.

International Assessment of DSM-5 and ICD-11 Personality Disorder Traits: Toward a Common Nosology in DSM-5.1

INTRODUCTION

The DSM-5 Alternative Model of Personality Disorders (AMPD) and the ICD-11 classification of personality disorders (PD) are largely commensurate and, when combined, they delineate 6 trait domains: negative affectivity, detachment, antagonism/dissociality, disinhibition, anankastia, and psychoticism.

OBJECTIVE

The present study evaluated the international validity of a brief 36-item patient-report measure that portrays all 6 domains simultaneously including 18 primary subfacets.

METHODS

We developed and employed a modified version of the Personality Inventory for DSM-5 - Brief Form Plus (PID5BF+). A total of 16,327 individuals were included, 2,347 of whom were patients. The expected 6-factor structure of facets was initially investigated in samples from Denmark (n = 584), Germany (n = 1,271), and the USA (n = 605) and subsequently replicated in both patient- and community samples from Italy, France, Switzerland, Belgium, Norway, Portugal, Spain, Poland, Czech Republic, the USA, and Brazil. Associations with interview-rated DSM-5 PD categories were also investigated.

RESULTS

Findings generally supported the empirical soundness and international robustness of the 6 domains including meaningful associations with familiar interview-rated PD types.

CONCLUSIONS

The modified PID5BF+ may be employed internationally by clinicians and researchers for brief and reliable assessment of the 6 combined DSM-5 and ICD-11 domains, including 18 primary subfacets. This 6-domain framework may inform a future nosology for DSM-5.1 that is more reasonably aligned with the authoritative ICD-11 codes than the current DSM-5 AMPD model. The 36-item modified PID5BF+ scoring key is provided in online supplementary Appendix A see www.karger.com/doi/10.1159/000507589 (for all online suppl. material).

Further Validation of the Response Inconsistency Scale for the Personality Inventory for DSM-5

Assessment of protocol validity is essential for structured personality tests used in clinical decision making. Measures of inconsistent responding allow researchers and clinicians to identify random or careless response patterns that compromise an accurate interpretation of test results. Keeley and colleagues (2016) developed an Inconsistency scale (INC) for the widely used Personality Inventory for DSM-5 (PID-5; Krueger, Derringer, Markon, Watson, & Skodol. 2012. Initial construction of a maladaptive personality trait model and inventory for DSM-5. Psychological Medicine, 42(9), 1879-1890.). The INC produced highly promising results in initial validation studies, and the current study provides a series of additional tests of the adaptability of the INC item pairs across different populations, translations, and versions of the PID-5. Study 1 examines the diagnostic utility of a shortened version of the original INC scale (INC-S) that can be used with the 100-item version of the PID-5; optimum cut scores are identified for this short form adaptation. Study 2 cross-validates the INC-S and compares diagnostic utility to the INC in a sample that completed the full PID-5. Study 3 examines the diagnostic utility of the INC and INC-S using a German translation of the PID-5 with undergraduates and clinical patients. Overall, these validation studies provide robust support for the INC and INC-S scales to discriminate random-generated versus real PID-5 protocols.

Personality Inventory for DSM-5 (PID-5): cross-cultural adaptation and content validity in the Brazilian context

Abstract Objective To describe the process of cross-cultural adaptation of the Personality Inventory for DSM-5 (PID-5) to the Brazilian context. Methods Cross-cultural adaptation involved the steps of independent translation of the instrument, synthesis version, and back-translation. Analysis of content validity was conducted by a multidisciplinary expert committee and consisted of quantitative assessment of agreement indicators. The test was then applied to a target population. Results All the steps required for a cross-cultural adaptation were followed and satisfactory agreement values (≥ 4.75) were reached for most of the structures assessed. Most of the changes suggested by the experts were followed; these changes consisted primarily of adjustments to verb tense and agreement and the inclusion of letters and words to allow gender inflection. In the pre-test, no suggestions were made and the instrument was considered comprehensible. Conclusion The Brazilian version of the PID-5 was found to be adequate to the Brazilian context from semantic, idiomatic, cultural, and conceptual perspectives. The Brazilian version assessed here can be freely used, was approved by the publishers who hold the copyright on the instrument, and is considered the official version of the instrument. New studies are underway to determine the validity and reliability of the PID-5.

A Brief but Comprehensive Review of Research on the Alternative DSM-5 Model for Personality Disorders

PURPOSE OF REVIEW

Both the Alternative DSM-5 Model for Personality Disorders (AMPD) and the chapter on personality disorders (PD) in the recent version of ICD-11 embody a shift from a categorical to a dimensional paradigm for the classification of PD. We describe these new models, summarize available measures, and provide a comprehensive review of research on the AMPD.

RECENT FINDINGS

A total of 237 publications on severity (criterion A) and maladaptive traits (criterion B) of the AMPD indicate (a) acceptable interrater reliability, (b) largely consistent latent structures, (c) substantial convergence with a range of theoretically and clinically relevant external measures, and (d) some evidence for incremental validity when controlling for categorical PD diagnoses. However, measures of criterion A and B are highly correlated, which poses conceptual challenges. The AMPD has stimulated extensive research with promising findings. We highlight open questions and provide recommendations for future research.

Schema therapy conceptualization of personality functioning and traits in ICD-11 and DSM-5

PURPOSE OF REVIEW

Schema therapy conceptualizes personality disorders in terms of modes and underlying schemas. This article reviews the literature on schema therapy conceptualization of personality disorder functioning and traits, and proposes how these findings apply to novel personality disorder classification in ICD-11 and the DSM-5 Alternative Model of Personality Disorders (AMPD).

RECENT FINDINGS

Maladaptive schemas and modes are generally associated with personality dysfunction and traits in conceptually coherent ways. The healthy adult mode, a transdiagnostic core concept in schema therapy, corresponds to the ICD-11 and DSM-5-AMPD features of core personality functioning. Modes and underlying schemas substantially overlap with specific ICD-11 and DSM-5-AMPD traits, which denote individual themes and styles of personality dysfunction.

SUMMARY

The dimensional personality disorder framework in ICD-11 and DSM-5-AMPD is largely compatible with the schema therapy model. The ICD-11 and DSM-5-AMPD provide a scientifically derived and theory-free framework for all practitioners, which may be connected to clinical theory of schema therapy in a coherent manner. Level of personality functioning can be conceptualized as healthy adult functioning (e.g. sense of identity, self-worth, emotion regulation, intimacy, and fulfillment), which inform intensity of treatment. Trait qualifiers can be conceptualized by associated modes (e.g., compliant surrender) and underlying schemas (e.g. abandonment), which inform focus and style of treatment.