Qualitative and quantitative distinctions in personality disorder

Editorial: What is computational psychopathology, and why do we need it?

Computational Psychopathology is an emerging discipline, which is based around the theoretical and mechanistic focus of explanatory psychopathology and computational psychiatry, and reflects the general move in psychiatric research away from whole disorders to component symptoms or transdiagnostic processes. In this Editorial, we present a brief summary of these disciplines and how they combine together to form a 'Computational Psychopathology', and present a brief possible taxonomy. We highlight the papers that form part of this Special Issue, along with their place in our putative taxonomy. We conclude this Editorial by highlighting the benefits of a Computational Psychopathology for research into mental health.

Fluctuations in grandiose and vulnerable narcissistic states: A momentary perspective

Theories of narcissism emphasize the dynamic processes within and between grandiosity and vulnerability. Research seeking to address this has either not studied grandiosity and vulnerability together or has used dispositional measures to assess what are considered to be momentary states. Emerging models of narcissism suggest grandiosity and vulnerability can further be differentiated into a three-factor structure-Exhibitionistic Grandiosity, Entitlement, and Vulnerability. Research in other areas of maladaptive personality (e.g., borderline personality disorder) has made headway in engaging data collection and analytic methods that are specifically meant to examine such questions. The present study took an exploratory approach to studying fluctuations within and between grandiose and vulnerable states. Fluctuations-operationalized as gross variability, instability, and lagged effects-were examined across three samples (two undergraduate and a community sample oversampled for narcissistic features; total person N = 862, total observation N = 36,631). Results suggest variability in narcissistic states from moment to moment is moderately associated with dispositional assessments of narcissism. Specifically, individuals who are dispositionally grandiose express both grandiosity and vulnerability, and vary in their overall levels of grandiosity and vulnerability over time. On the other hand, dispositionally vulnerable individuals tend to have high levels of vulnerability and low levels of grandiosity. Entitlement plays a key role in the processes that underlie narcissism and narcissistic processes appear unique to the construct and not reflective of broader psychological processes (e.g., self-esteem). Future research should consider using similar methods and statistical techniques on different timescales to study dynamics within narcissism. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Daily stress reactivity: The unique roles of personality and social support

BACKGROUND

The processes through which social support exerts its influence in daily life are not well understood. Arguably, its salutary effects as an environmental variable might be construed as shared effects of personality.

METHOD

To test this possibility, we investigated the unique and shared effects of personality and social support on daily stressor exposure (social conflict, task strain) and on the within-person association of stressor exposure with perceived stress. A community-sample of N = 391 adults completed an ambulatory assessment protocol for two 2-day periods with fixed hourly intervals spread across 16 hr.

RESULTS

Consistent with our preregistered hypotheses, multilevel structural equation models returned that both, personality and perceived social support, predicted daily stressor exposure and moderated within-person effects of daily stressors on perceived stress. In contrast to our hypotheses, received social support had no effect on daily stress processes. When Extraversion, Neuroticism, and social support were added as joint predictors, Neuroticism and Extraversion were related to stressor exposure, and further moderated the within-person link between stressor exposure and stress experience, while perceived social support had an incremental beneficial effect on social conflict exposure and stress appraisal.

CONCLUSION

Social support does not increment the well-established relationships between Neuroticism or Extraversion and stress reactivity.

Personalized models of psychopathology as contextualized dynamic processes: An example from individuals with borderline personality disorder

OBJECTIVE

Psychopathology research has relied on discrete diagnoses, which neglects the unique manifestations of each individual's pathology. Borderline personality disorder combines interpersonal, affective, and behavioral regulation impairments making it particularly ill-suited to a "one size fits all" diagnosis. Clinical assessment and case formulation involve understanding and developing a personalized model for each patient's contextualized dynamic processes, and research would benefit from a similar focus on the individual.

METHOD

We use group iterative multiple model estimation, which estimates a model for each individual and identifies general or shared features across individuals, in both a mixed-diagnosis sample (N = 78) and a subsample with a single diagnosis (n = 24).

RESULTS

We found that individuals vary widely in their dynamic processes in affective and interpersonal domains both within and across diagnoses. However, there was some evidence that dynamic patterns relate to transdiagnostic baseline measures. We conclude with descriptions of 2 person-specific models as an example of the heterogeneity of dynamic processes.

CONCLUSIONS

The idiographic models presented here join a growing literature showing that the individuals differ dramatically in the total patterning of these processes, even as key processes are shared across individuals. We argue that these processes are best estimated in the context of person-specific models, and that so doing may advance our understanding of the contextualized dynamic processes that could identify maintenance mechanisms and treatment targets. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Personalized Models of Psychopathology

The personalized approach to psychopathology conceptualizes mental disorder as a complex system of contextualized dynamic processes that is nontrivially specific to each individual, and it seeks to develop formal idiographic statistical models to represent these individual processes. Although the personalized approach draws on long-standing influences in clinical psychology, there has been an explosion of research in recent years following the development of intensive longitudinal data capture and statistical techniques that facilitate modeling of the dynamic processes of each individual's pathology. Advances are also making idiographic analyses scalable and generalizable. We review emerging research using the personalized approach in descriptive psychopathology, precision assessment, and treatment selection and tailoring, and we identify future challenges and areas in need of additional research. The personalized approach to psychopathology holds promise to resolve thorny diagnostic issues, generate novel insights, and improve the timing and efficacy of interventions.

Abnormalities of confidence in psychiatry: an overview and future perspectives

Our behavior is constantly accompanied by a sense of confidence and its' precision is critical for adequate adaptation and survival. Importantly, abnormal confidence judgments that do not reflect reality may play a crucial role in pathological decision-making typically seen in psychiatric disorders. In this review, we propose abnormalities of confidence as a new model of interpreting psychiatric symptoms. We hypothesize a dysfunction of confidence at the root of psychiatric symptoms either expressed subclinically in the general population or clinically in the patient population. Our review reveals a robust association between confidence abnormalities and psychiatric symptomatology. Confidence abnormalities are present in subclinical/prodromal phases of psychiatric disorders, show a positive relationship with symptom severity, and appear to normalize after recovery. In the reviewed literature, the strongest evidence was found for a decline in confidence in (sub)clinical OCD, and for a decrease in confidence discrimination in (sub)clinical schizophrenia. We found suggestive evidence for increased/decreased confidence in addiction and depression/anxiety, respectively. Confidence abnormalities may help to understand underlying psychopathological substrates across disorders, and should thus be considered transdiagnostically. This review provides clear evidence for confidence abnormalities in different psychiatric disorders, identifies current knowledge gaps and supplies suggestions for future avenues. As such, it may guide future translational research into the underlying processes governing these abnormalities, as well as future interventions to restore them.

Borderline personality disorder is equally trait-like and state-like over ten years in adult psychiatric patients

Borderline personality disorder (PD) has historically been cast as an unabating condition. Longitudinal data, however, support a more variable time course marked by remission and relapse. In the present study, we tested the possibility that borderline PD has both stable (i.e., consistently present across time and situation, as modern diagnostic systems stipulate) and dynamic (i.e., episodic and situational) elements. Participants were 668 patients from the Collaborative Longitudinal Personality Disorders Study who were administered semistructured diagnostic interviews 5 times over a decade. Trait-state-occasion modeling dissected borderline pathology into time-invariant (i.e., trait) and time-varying (i.e., state) components. Contradicting traditional views of PD intransigence, less than half of borderline PD variability (approximately 45%) was time-invariant (i.e., perfectly stable) over the study timeframe. Furthermore, we found that the time-invariant component of borderline pathology, which we termed borderline proneness, was very closely related (r = .81) to a previously validated Five Factor Model trait composite of borderline features. Moreover, the trait versus state components showed a clear pattern of discriminant validity in relation to several putative causal agents for borderline PD (i.e., environmental pathogens, temperament dimensions). We conclude that borderline pathology contains a stable core and sizable situational components, and that both elements relate systematically to normative personality dimensions and known risk factors. These findings have key implications for etiological research, prognosis, and treatment for borderline PD. (PsycINFO Database Record

Measuring personality functioning in older adults: construct validity of the Severity Indices of Personality Functioning - Short Form (SIPP-SF)

OBJECTIVE

The dimensional personality disorders model in the Diagnostic and Statistical Manual (DSM)-5 section III conceptually differentiates impaired personality functioning (criterion A) from the presence of pathological traits (criterion B). This study is the first to specifically address the measurement of criterion A in older adults. Moreover, the convergent/divergent validity of criterion A and criterion B will be compared in younger and older age groups.

METHOD

The Severity Indices of Personality Functioning - Short Form (SIPP-SF) was administered in older (N = 171) and younger adults (N = 210). The factorial structure was analyzed with exploratory structural equation modeling. Differences in convergent/divergent validity between personality functioning (SIPP-SF) and pathological traits (Personality Inventory for DSM-5; Dimensional Assessment of Personality Pathology-Basic Questionnaire) were examined across age groups.

RESULTS

Identity Integration, Relational Capacities, Responsibility, Self-Control, and Social Concordance were corroborated as higher order domains. Although the SIPP-SF domains measured unique variation, some high correlations with pathological traits referred to overlapping constructs. Moreover, in older adults, personality functioning was more strongly related to Psychoticism, Disinhibition, Antagonism and Dissocial Behavior compared to younger adults.

DISCUSSION

The SIPP-SF construct validity was demonstrated in terms of a structure of five higher order domains of personality functioning. The instrument is promising as a possible measure of impaired personality functioning in older adults. As such, it is a useful clinical tool to follow up effects of therapy on levels of personality functioning. Moreover, traits were associated with different degrees of personality functioning across age groups.

Stability and fluctuation of personality disorder features in daily life

Very little is known about the daily stability and fluctuation of personality pathology. To address this gap in knowledge, we investigated the naturalistic manifestation of personality pathology over the course of 100 days. A group of individuals (N = 101) diagnosed with any personality disorder (PD) completed a daily diary study over 100 consecutive days (Mdn = 94 days, range = 33-101 days). Participants completed daily ratings of 30 manifestations of personality pathology. Patterns of stability and variability over the course of the study were then examined. Results indicated that individual PD manifestations and domains of PD manifestations were variable across days and differed widely in their frequency. Additionally, individual averages and level of variability in PD domains were highly stable across months, individual averages of PD domains were predicted by baseline dispositional ratings of PD traits with a high degree of specificity, and daily variability PD domains was associated with elevated levels of PD traits. This pattern of findings suggests that dynamic processes of symptom exacerbation and diminution that are stable in mean level and variability in expression over time characterizes personality pathology. Further, dispositional ratings are significant predictors of average daily expression of PD features. (PsycINFO Database Record

Examining the Dynamic Structure of Daily Internalizing and Externalizing Behavior at Multiple Levels of Analysis

Psychiatric diagnostic covariation suggests that the underlying structure of psychopathology is not one of circumscribed disorders. Quantitative modeling of individual differences in diagnostic patterns has uncovered several broad domains of mental disorder liability, of which the Internalizing and Externalizing spectra have garnered the greatest support. These dimensions have generally been estimated from lifetime or past-year comorbidity patters, which are distal from the covariation of symptoms and maladaptive behavior that ebb and flow in daily life. In this study, structural models are applied to daily diary data (Median = 94 days) of maladaptive behaviors collected from a sample (N = 101) of individuals diagnosed with personality disorders (PDs). Using multilevel and unified structural equation modeling, between-person, within-person, and person-specific structures were estimated from 16 behaviors that are encompassed by the Internalizing and Externalizing spectra. At the between-person level (i.e., individual differences in average endorsement across days) we found support for a two-factor Internalizing-Externalizing model, which exhibits significant associations with corresponding diagnostic spectra. At the within-person level (i.e., dynamic covariation among daily behavior pooled across individuals) we found support for a more differentiated, four-factor, Negative Affect-Detachment-Hostility-Disinhibition structure. Finally, we demonstrate that the person-specific structures of associations between these four domains are highly idiosyncratic.

Personality Pathology and Interpersonal Problem Stability

Personality disorders (PDs) are often described as stable, which ignores the important dynamic processes and shifts that are observed clinically in individuals with PD. The current study examined patterns of variability in problematic interpersonal functioning, a core feature of personality pathology. Participants (N = 150) were assessed for personality pathology at baseline and also completed the Inventory of Interpersonal Problems-Circumplex Scales at baseline and every 3 months over the course of a year. Baseline PD was used to predict individual means and variability parameters in generalized interpersonal distress, agentic problems, and communal problems across repeated assessments. Disorders associated with disinhibition predicted variability in generalized distress and agentic problems, whereas only antagonism-related disorders predicted variability in communal problems. These associations reveal dynamic processes involved in multiple dimensions of personality pathology and suggest that future research on instability is needed that expands beyond the historical focus on borderline PD.

Predicting problematic alcohol use with the DSM-5 alternative model of personality pathology

High comorbidity between personality disorders and alcohol use disorders appears related to individual differences in underlying personality dimensions of behavioral undercontrol and affective dysregulation. However, very little is known about how the Diagnostic and Statistical Manual of Mental Disorders (5th edition; DSM-5) Section III trait model of personality pathology relates to alcohol problems or how the strength of the relationship between personality pathology and alcohol problems changes with age and across gender. The current study examined these questions in a sample of 877 participants using the General Assessment of Personality Disorder to assess general personality dysfunction, the Personality Inventory for DSM-5 to measure specific traits, and the Alcohol Use Disorder Identification Test (AUDIT) to assess problematic alcohol use. Results demonstrated that general personality pathology (Criterion A) was significantly related to problematic alcohol use after controlling for age and gender effects. Furthermore, 2 of the 5 higher-order personality trait domains (Criterion B), Antagonism and Disinhibition, remained significant predictors of problematic alcohol use after accounting for the influence of general personality pathology; however, general personality pathology no longer predicted hazardous alcohol use once Antagonism and Disinhibition were added into the model. Finally, these 2 specific traits interacted with age, such that Antagonism was a stronger predictor of AUDIT scores among older individuals and Disinhibition was a stronger predictor of alcohol problems among younger individuals. Findings support the general validity of this new personality disorder diagnostic system and suggest important age effects in the relationship between traits and problematic alcohol use. (PsycINFO Database Record

On the Measure and Mismeasure of Narcissism: A Response to "Measures of Narcissism and Their Relations to DSM-5 Pathological Traits: A Critical Reappraisal"

Narcissism continues to suffer from a lack of consensual definition. Variability in the definition is reflected in the growing multitude of measures with oftentimes diverging nomological nets. Although the themes of narcissistic grandiosity and vulnerability appear to have achieved reasonable agreement on their central importance, the lower order structure of each is not well understood and debates remain about how (and whether) they can be integrated into a coherent whole. However, it is clear that a narrow focus on higher order grandiosity without consideration of concomitant vulnerability neglects clinically important features of narcissism. Occasioned by the potential for a new personality disorder model in the Diagnostic and Statistical Manual of Mental Disorders-Fifth edition, several colleagues and I demonstrated that pathological narcissism, as measured by the Pathological Narcissism Inventory, could not be adequately summarized by the lower order traits of Grandiosity and Attention Seeking, and argued that this should be reflected in the diagnostic manual in some form. Miller, Lynam, and Campbell then subjected these same data to critical reanalysis and interpretation. I respond here to several points raised by Miller and colleagues. In so doing, I highlight areas of agreement, disagreement, and suggest directions for future research.

Daily Interpersonal and Affective Dynamics in Personality Disorder

In this naturalistic study, the authors adopt the lens of interpersonal theory to examine between- and within-person differences in dynamic processes of daily affect and interpersonal behaviors among individuals (N = 101) previously diagnosed with personality disorders who completed daily diaries over the course of 100 days. Dispositional ratings of interpersonal problems and measures of daily stress were used as predictors of daily shifts in interpersonal behavior and affect in multilevel models. Results indicate that ∼40%-50% of the variance in interpersonal behavior and affect is due to daily fluctuations, which are modestly related to dispositional measures of interpersonal problems but strongly related to daily stress. The findings support conceptions of personality disorders as a dynamic form of psychopathology involving the individuals interacting with and regulating in response to the contextual features of their environment.

Maladaptive Personality at Work: Exploring the Darkness

Important changes in how personality is conceptualized and measured are occurring in clinical psychology. We focus on 1 aspect of this work that industrial psychologists have been slow to embrace, namely, a new trait model that can be viewed as a maladaptive counterpart to the Big 5. There is a conspicuous absence of work psychology research emerging on this trait model despite important implications for how we understand personality at work. We discuss objections to the trait model in a work context and offer rejoinders that might make researchers and practitioners consider applying this model in their work. We hope to stimulate discussion of this topic to avoid an unnecessary bifurcation in the conceptualization of maladaptive personality between industrial and clinical settings.

On the structure of personality disorder traits: conjoint analyses of the CAT-PD, PID-5, and NEO-PI-3 trait models

The current study examines the relations among contemporary models of pathological and normal range personality traits. Specifically, we report on (a) conjoint exploratory factor analyses of the Computerized Adaptive Test of Personality Disorder static form (CAT-PD-SF) with the Personality Inventory for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition and NEO Personality Inventory-3 First Half, and (b) unfolding hierarchical analyses of the three measures in a large general psychiatric outpatient sample (n = 628; 64% Female). A five-factor solution provided conceptually coherent alignment among the CAT-PD-SF, PID-5, and NEO-PI-3FH scales. Hierarchical solutions suggested that higher-order factors bear strong resemblance to dimensions that emerge from structural models of psychopathology (e.g., Internalizing and Externalizing spectra). These results demonstrate that the CAT-PD-SF adheres to the consensual structure of broad trait domains at the five-factor level. Additionally, patterns of scale loadings further inform questions of structure and bipolarity of facet and domain level constructs. Finally, hierarchical analyses strengthen the argument for using broad dimensions that span normative and pathological functioning to scaffold a quantitatively derived phenotypic structure of psychopathology to orient future research on explanatory, etiological, and maintenance mechanisms.

Malignant self-regard: accounting for commonalities in vulnerably narcissistic, depressive, self-defeating, and masochistic personality disorders

Several personality disorders (PDs) have been of interest in the clinical literature, yet failed to have been adequately represented in the diagnostic manuals. Some of these are masochistic, self-defeating, depressive, and narcissistic PDs. The theoretical and empirical relationships among these disorders are reviewed. It is proposed that a particular type of self-structure, malignant self-regard (MSR), may account for similarities among all of them and provide a better framework upon which to understand the nature of these personality types and their discrimination from related constructs. Subsequently, a questionnaire to assess MSR was created and evaluated for its psychometric properties. The measure was found to be reliable (Cronbach's alpha=.93) and valid, given its correlations with measures of self-defeating, depressive, and vulnerably narcissistic personalities (rs range from .66 to .76). MSR also can be meaningfully differentiated from a nomological network of related constructs, including neuroticism, extraversion, depression, and grandiose narcissism. The utility of assessing self-structures, such as MSR, in the diagnostic manuals is discussed.

Dynamic of Change in Pathological Personality Trait Dimensions: A Latent Change Analysis Among at-Risk Women

This study explores longitudinally a four-factor structure of pathological personality trait dimensions (PPTDs) to examine both its structural stability and intra-individual changes among PPTDs over time. Personality Disorder (PD) scales of the Millon Clinical Multiaxial Inventory-III were administered to 361 low-income women with various psychiatric conditions (drug dependence, depression), who were followed in a two-wave study over 5-years. Cross-sectional and longitudinal factor analyses outlined a robust factorial structure of PPTDs, extrinsically invariant over time, representing Negative Emotionality, Introversion, Antagonism and Impulsivity. Despite moderate rank-order stability in the PPTDs, results also indicated substantial intra-individual variability in the degree and direction of change, consistent with trajectories of change in participants' clinical diagnoses. Results are discussed in light of current debates on the structure and dynamic of pathological personality.

The interpersonal core of personality pathology

The purpose of this article is to demonstrate that personality pathology is, at its core, fundamentally interpersonal. The authors review the proposed DSM-5 Section 3 redefinition of personality pathology involving self and interpersonal dysfunction, which they regard as a substantial improvement over the DSM-IV (and Section 2) definition. They note similarities between the proposed scheme and contemporary interpersonal theory and interpret the Section 3 definition using the underlying assumptions and evidence base of the interpersonal paradigm in clinical psychology. The authors describe how grounding the proposed Section 3 definition in interpersonal theory, and in particular a focus on the "interpersonal situation," adds to its theoretical texture, empirical support, and clinical utility. They provide a clinical example that demonstrates the ability of contemporary interpersonal theory to augment the definition of personality pathology. The authors conclude with directions for further research that could clarify the core of personality pathology, and how interpersonal theory can inform research aimed at enhancing the Section 3 proposal and ultimately justify its migration to Section 2.

Clarifying interpersonal heterogeneity in borderline personality disorder using latent mixture modeling

Significant interpersonal impairment is a cardinal feature of borderline personality disorder (BPD). However, past research has demonstrated that the interpersonal profile associated with BPD varies across samples, which is evidence for considerable interpersonal heterogeneity. The current study used inventory of interpersonal problems-circumplex (IIP-C; Alden, Wiggins, & Pincus, 1990) scale scores to investigate interpersonal inhibitions and excesses in a large sample (N = 255) selected for significant borderline pathology. Results indicated that BPD symptom counts were unrelated to the primary dimensions of the IIPC, but were related to generalized interpersonal distress. A latent class analysis clarified this finding by revealing six homogeneous interpersonal classes with prototypical profiles associated with Intrusive, Vindictive, Avoidant, Nonassertive, and moderate and severe Exploitable interpersonal problems. These classes differed in clinically relevant features (e.g., antisocial behaviors, self-injury, past suicide attempts). Findings are discussed in terms of the incremental clinical utility of the interpersonal circumplex model and the implications for developmental and nosological models of BPD.

Introduction to the special issue on personality assessment in the DSM-5

The DSM-5 is poised to dramatically reshape the way clinicians and researchers assess personality by reconfiguring the conceptualization of DSM-IV personality disorders. This special issue brings together leading scholars in personality pathology, including members of the DSM-5 Personality and Personality Pathology Work Group, as well as personality assessors operating from a variety of theoretical perspectives, to describe various facets of these changes and their potential impacts and in some cases to propose alternative solutions. As we describe in this brief introductory article, the articles in this special issue highlight several important and controversial issues in the transition to DSM-5 personality assessment.

An interpersonal analysis of pathological personality traits in DSM-5

The proposed changes to the personality disorder section of the Diagnostic and statistical manual of mental disorders (5th ed.) places an increased focus on interpersonal impairment as one of the defining features of personality psychopathology. In addition, a proposed trait model has been offered to provide a means of capturing phenotypic variation on the expression of personality disorder. In this study, the authors subject the proposed DSM-5 traits to interpersonal analysis using the inventory of interpersonal problems-circumplex scales via the structural summary method for circumplex data. DSM-5 traits were consistently associated with generalized interpersonal dysfunction suggesting that they are maladaptive in nature, the majority of traits demonstrated discriminant validity with prototypical and differentiated interpersonal problem profiles, and conformed well to a priori hypothesized associations. These results are discussed in the context of the DSM-5 proposal and contemporary interpersonal theory, with a particular focus on potential areas for expansion of the DSM-5 trait model.

DSM-5 personality traits and DSM-IV personality disorders

Two issues pertinent to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) proposal for personality pathology, the recovery of DSM-IV personality disorders (PDs) by proposed DSM-5 traits and the validity of the proposed DSM-5 hybrid model, which incorporates both personality pathology symptoms and maladaptive traits, were evaluated in a large undergraduate sample (N = 808). Proposed DSM-5 traits as assessed with the Personality Inventory for DSM-5 explained a substantial proportion of variance in DSM-IV PDs as assessed with the Personality Diagnostic Questionnaire-4+, and trait indicators of the 6 proposed DSM-5 PDs were mostly specific to those disorders with some exceptions. Regression analyses support the DSM-5 hybrid model in that pathological traits, and an indicator of general personality pathology severity provided incremental information about PDs. Findings are discussed in the context of broader issues around the proposed DSM-5 model of personality disorders.

A parallel process growth model of avoidant personality disorder symptoms and personality traits

Avoidant personality disorder (AVPD), like other personality disorders, has historically been construed as a highly stable disorder. However, results from a number of longitudinal studies have found that the symptoms of AVPD demonstrate marked change over time. Little is known about which other psychological systems are related to this change. Although cross-sectional research suggests a strong relationship between AVPD and personality traits, no work has examined the relationship of their change trajectories. The current study sought to establish the longitudinal relationship between AVPD and basic personality traits using parallel process growth curve modeling. Parallel process growth curve modeling was applied to the trajectories of AVPD and basic personality traits from the Longitudinal Study of Personality Disorders (Lenzenweger, M. F., 2006, The longitudinal study of personality disorders: History, design considerations, and initial findings. Journal of Personality Disorders, 20, 645-670. doi:10.1521/pedi.2006.20.6.645), a naturalistic, prospective, multiwave, longitudinal study of personality disorder, temperament, and normal personality. The focus of these analyses is on the relationship between the rates of change in both AVPD symptoms and basic personality traits. AVPD symptom trajectories demonstrated significant negative relationships with the trajectories of interpersonal dominance and affiliation, and a significant positive relationship to rates of change in neuroticism. These results provide some of the first compelling evidence that trajectories of change in PD symptoms and personality traits are linked. These results have important implications for the ways in which temporal stability is conceptualized in AVPD specifically, and PD in general.

The hierarchical structure of DSM-5 pathological personality traits

A multidimensional trait system has been proposed for representing personality disorder (PD) features in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to address problematic classification issues such as comorbidity. In this model, which may also assist in providing scaffolding for the underlying structure of major forms of psychopathology more generally, 25 primary traits are organized by 5 higher order dimensions: Negative Affect, Detachment, Antagonism, Disinhibition, and Psychoticism. We examined (a) the generalizability of the structure proposed for DSM-5 PD traits, and (b) the potential for an integrative hierarchy based upon DSM-5 PD traits to represent the dimensions scaffolding psychopathology more generally. A large sample of student participants (N = 2,461) completed the Personality Inventory for DSM-5, which operationalizes the DSM-5 traits. Exploratory factor analysis replicated the initially reported 5-factor structure, as indicated by high factor congruencies. The 2-, 3-, and 4-factor solutions estimated in the hierarchy of the DSM-5 traits bear close resemblance to existing models of common mental disorders, temperament, and personality pathology. Thus, beyond the description of individual differences in personality disorder, the trait dimensions might provide a framework for the metastructure of psychopathology in the DSM-5 and the integration of a number of ostensibly competing models of personality trait covariation.

A comparison of passive-aggressive and negativistic personality disorders

Passive-aggressive personality disorder (PAPD) has historically played an important role in clinical theorizing and was diagnosable prior to the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994), in which the construct was relabeled negativistic (NEGPD), expanded to include negative affective symptoms, and appendicized. In this study we tested the hypothesis that the expansion of PAPD to include content related to negative moods and nonspecific personality pathology compromised its discriminant validity. In an undergraduate sample (N = 1,215), a self-report measure of PAPD was only moderately related to NEGPD and showed less diagnostic overlap with other personality disorders than NEGPD. Furthermore, a conjoint factor analysis yielded a strong first factor (moodiness) that appeared less specific to passive-aggressive behavior than 3 other factors (irresponsibility, inadequacy, and contempt). We conclude that future research on this potentially important clinical construct should focus on core passive-aggressive features and abandon the negativistic content that has been added to it in successive editions of the DSM.