1
|
García LF, Gutiérrez F, García O, Aluja A. The Alternative Model of Personality Disorders: Assessment, Convergent and Discriminant Validity, and a Look to the Future. Annu Rev Clin Psychol 2024; 20:431-455. [PMID: 38211624 DOI: 10.1146/annurev-clinpsy-081122-010709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
The Alternative Model of Personality Disorders (AMPD) is a dimensional, empirically based diagnostic system developed to overcome the serious limitations of traditional categories. We review the mounting evidence on its convergent and discriminant validity, with an incursion into the less-studied ICD-11 system. In the literature, the AMPD's Pathological Trait Model (Criterion B) shows excellent convergence with normal personality traits, and it could be useful as an organizing framework for mental disorders. In contrast, Personality Functioning (Criterion A) cannot be distinguished from personality traits, lacks both discriminant and incremental validity, and has a shaky theoretical background. We offer some suggestions with a view to the future. These include removing Criterion A, using the real-life consequences of traits as indicators of severity, delving into the dynamic mechanisms underlying traits, and furthering the integration of currently disengaged psychological paradigms that can shape a sounder clinical science.
Collapse
Affiliation(s)
- Luis F García
- Department of Biological and Health Psychology, Universidad Autónoma de Madrid, Madrid, Spain;
- Institute of Biomedical Research of Lleida Dr. Pifarré Foundation, Lleida, Catalonia, Spain
| | - Fernando Gutiérrez
- Personality Disorder Unit, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
- Institut d'Investigacions Biomèdiques August Pi Sunyer, Barcelona, Catalonia, Spain
| | - Oscar García
- Institute of Biomedical Research of Lleida Dr. Pifarré Foundation, Lleida, Catalonia, Spain
- Department of Psychology, European University of Madrid, Madrid, Spain
| | - Anton Aluja
- Institute of Biomedical Research of Lleida Dr. Pifarré Foundation, Lleida, Catalonia, Spain
- Department of Psychology, University of Lleida, Lleida, Catalonia, Spain
| |
Collapse
|
2
|
Gutiérrez F, Vicente E, Aluja A, Peri JM, Gutiérrez-Zotes A, Baillés E, Edo Villamón S, Ruipérez Rodríguez MÁ, Meliá de Alba A, Vall G, Gallardo-Pujol D. A third hierarchical level of narrower traits for the Dimensional Assessment of Personality Pathology-Basic Questionnaire. Personal Ment Health 2021; 15:239-251. [PMID: 33871181 DOI: 10.1002/pmh.1511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 03/28/2021] [Accepted: 03/29/2021] [Indexed: 11/10/2022]
Abstract
Current dimensional taxonomies of personality disorder show a stronger empirical grounding than categories, but may lack the necessary level of detail to make accurate predictions and case formulations. We need to further develop the lower levels of the hierarchy until reaching the building blocks of personality pathology. The Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ) is well-suited to this purpose due to its multilayered structure and its agreement with the official dimensional classifications. We disaggregated the 18 DAPP-BQ mid-level facets through exploratory and confirmatory factor analysis in a sample of 3233 community subjects and outpatients. We obtained a set of 72 clinically relevant, narrower subfacets, which were reliable, well-fitted to the data, and invariant between clinical and community subjects and between the sexes. This third level of abstraction increases by 4.7% the capacity to predict DSM categorical personality disorders, gives a particular advantage in capturing dependent, histrionic, paranoid, obsessive, and schizoid features and can provide the detailed information that clinical decisions demand.
Collapse
Affiliation(s)
- Fernando Gutiérrez
- Personality Disorder Unit, Institute of Neuroscience, Hospital Clinic of Barcelona, Barcelona, Spain.,IDIBAPS, Barcelona, Spain
| | - Enrique Vicente
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain.,Psychiatry and Psychology Service, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Anton Aluja
- Department of Psychology, University of Lleida, Lleida, Spain.,Lleida Institute for Biomedical Research Dr. Pifarré Foundation, Lleida, Spain
| | - Josep M Peri
- Clinical and Health Psychology Unit, Institute of Neuroscience, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Alfonso Gutiérrez-Zotes
- Pere Virgili Health Research Institute (IISPV), Tarragona, Spain.,Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
| | - Eva Baillés
- Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
| | - Silvia Edo Villamón
- Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Castellón de la Plana, Spain
| | | | - Amanda Meliá de Alba
- Higher Institute of Psychological Studies (ISEP), Valencia, Spain.,CEDINSALUD, Valencia, Spain
| | - Gemma Vall
- Lleida Institute for Biomedical Research Dr. Pifarré Foundation, Lleida, Spain.,Department of Psychiatry, Mental Health, and Addiction, GSS-Hospital Santa María, Lleida, Spain
| | - David Gallardo-Pujol
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain.,Institute of Neurosciences (UBNeuro), Barcelona, Spain
| |
Collapse
|
3
|
Gutiérrez F, Ruiz J, Peri JM, Gárriz M, Vall G, Cavero M. Toward an Integrated Model of Pathological Personality Traits: Common Hierarchical Structure of the PID-5 and the DAPP-BQ. J Pers Disord 2020; 34:25-39. [PMID: 31210573 DOI: 10.1521/pedi_2019_33_431] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A dimensional classification seems to be the next move in the personality disorders field. However, it is not clear whether there is one dimensional model or many, or whether the currently available dimensional instruments measure the same traits. To help clarify these issues, the authors administered the Personality Inventory for DSM-5 (PID-5) and the Dimensional Assessment of Personality Pathology (DAPP-BQ) to 414 psychiatric outpatients. Factor analyses showed that a common hierarchical structure underlies both instruments, even if each one measures slightly different aspects of it. Disattenuated correlations indicated that, at the lower order level, two thirds of the PID-5 and DAPP-BQ facets measure essentially the same traits, although the pairings were not exactly as predicted. Among higher order domains, only PID Negative Affectivity and Detachment converged unambiguously with DAPP Emotional Dysregulation and Inhibition. Overall, the PID-5 and the DAPP-BQ reflect, with small divergences, one and the same structure of pathological personality traits.
Collapse
Affiliation(s)
- Fernando Gutiérrez
- Personality Disorder Unit, Institute of Neuroscience, Hospital Clínic de Barcelona, Spain, and Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - José Ruiz
- Department of Clinical Psychology and Psychobiology, Section of Personality, Assessment and Psychological Treatments, University of Barcelona, Spain
| | | | - Miguel Gárriz
- CSMA La Mina, Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona, Spain
| | - Gemma Vall
- Department of Psychiatry, Mental Health, and Addiction, GSS-Hospital Santa Maria, Lleida, and IRB (Institut de Recerca Biomèdica), Lleida, Spain
| | - Myriam Cavero
- Institute of Neuroscience, Hospital Clínic de Barcelona, Spain
| |
Collapse
|
4
|
Gutiérrez F, Aluja A, Ruiz J, García LF, Gárriz M, Gutiérrez-Zotes A, Gallardo-Pujol D, Navarro-Haro MV, Alabèrnia-Segura M, Mestre-Pintó JI, Torrens M, Peri JM, Sureda B, Soler J, Pascual JC, Vall G, Calvo N, Ferrer M, Oltmanns JR, Widiger TA. Personality Disorders in the ICD-11: Spanish Validation of the PiCD and the SASPD in a Mixed Community and Clinical Sample. Assessment 2020; 28:759-772. [PMID: 32583685 PMCID: PMC7961637 DOI: 10.1177/1073191120936357] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The International Classification of Diseases–11th revision (ICD-11) classification of personality disorders is the official diagnostic system that is used all over the world, and it has recently been renewed. However, as yet very few data are available on its performance. This study examines the Personality Inventory for ICD-11 (PiCD), which assesses the personality domains of the system, and the Standardized Assessment of Severity of Personality Disorder (SASPD), which determines severity. The Spanish versions of the questionnaires were administered to a community (n = 2,522) and a clinical sample (n = 797). Internal consistency was adequate in the PiCD (α = .75 to .84) but less so in the SASPD (α = .64 and .73). Factor analyses suggested a unidimensional or bidimensional structure for severity, while revealing that the personality trait qualifiers are organized into four factors: negative affectivity, detachment, dissociality, and a bipolar domain of disinhibition–anankastia. The mutual relationships between traits and severity were analyzed, as well as the ability of the whole system to identify clinical subjects. Although further improvements are required, the results generally support the use of the PiCD and the SASPD and help substantiate the new ICD-11 taxonomy that underlies them.
Collapse
Affiliation(s)
| | - Anton Aluja
- University of Lleida, Lleida, Spain.,Biomedical Research Institute of Lleida, Lleida, Spain
| | - José Ruiz
- University of Barcelona, Barcelona, Spain
| | - Luis F García
- Biomedical Research Institute of Lleida, Lleida, Spain.,Autonomous University of Madrid, Madrid, Spain
| | - Miguel Gárriz
- Institut de Neuropsiquiatria i Addiccions, Barcelona, Spain
| | | | - David Gallardo-Pujol
- University of Barcelona, Barcelona, Spain.,Institute of Neurosciences, Barcelona, Spain
| | - Maria V Navarro-Haro
- University of Zaragoza, Zaragoza, Spain.,Aragón Health Research Institute, Zaragoza, Spain
| | | | - Joan Ignasi Mestre-Pintó
- IMIM Hospital del Mar Medical Research Institute, Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain
| | - Marta Torrens
- IMIM Hospital del Mar Medical Research Institute, Barcelona, Spain.,Universitat Autònoma de Barcelona, Spain
| | | | | | - Joaquim Soler
- Universitat Autònoma de Barcelona, Spain.,Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Juan Carlos Pascual
- Universitat Autònoma de Barcelona, Spain.,Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Gemma Vall
- Biomedical Research Institute of Lleida, Lleida, Spain.,GSS-Hospital Santa Maria, Lleida, Spain
| | - Natalia Calvo
- Universitat Autònoma de Barcelona, Spain.,Vall d'Hebron University Hospital, Barcelona, Spain
| | - Marc Ferrer
- Universitat Autònoma de Barcelona, Spain.,Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | |
Collapse
|
5
|
Lilienfeld SO, Watts AL, Murphy B, Costello TH, Bowes SM, Smith SF, Latzman RD, Haslam N, Tabb K. Personality Disorders as Emergent Interpersonal Syndromes: Psychopathic Personality as a Case Example. J Pers Disord 2019; 33:577-622. [PMID: 31621543 DOI: 10.1521/pedi.2019.33.5.577] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Personality disorders have long been bedeviled by a host of conceptual and methodological quandaries. Starting from the assumption that personality disorders are inherently interpersonal conditions that reflect folk concepts of social impairment, the authors contend that a subset of personality disorders, rather than traditional syndromes, are emergent interpersonal syndromes (EISs): interpersonally malignant configurations (statistical interactions) of distinct personality dimensions that may be only modestly, weakly, or even negatively correlated. Preliminary support for this perspective derives from a surprising source, namely, largely forgotten research on the intercorrelations among the subscales of select MMPI/MMPI-2 clinical scales. Using psychopathic personality as a case example, the authors offer provisional evidence for the EIS hypothesis from four lines of research and delineate its implications for personality disorder theory, research, and classification. Conceptualizing some personality disorders as EISs elucidates long-standing quandaries and controversies in the psychopathology literature and affords fruitful avenues for future investigation.
Collapse
Affiliation(s)
- Scott O Lilienfeld
- Emory University, Atlanta, Georgia.,University of Melbourne, Melbourne, Australia
| | | | | | | | | | | | | | - Nick Haslam
- University of Melbourne, Melbourne, Australia
| | | |
Collapse
|
6
|
Peri JM, Muñoz-Champel A, Torrubia R, Gutiérrez F. The General Criteria for Personality Disorders Assessed by Interview: Do They Still Have a Role to Play? J Pers Disord 2019; 33:515-S9. [PMID: 30307831 DOI: 10.1521/pedi_2018_32_356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
On the path to developing dimensional models of personality disorder (PD), we are at risk of leaving key diagnostic aspects behind. The general criteria for PD may be important ones because they reflect the defining aspects of personality pathology: long duration, independence from psychopathological states, and harmfulness. We assessed these criteria by interview in a sample of 362 psychiatric outpatients after administering the Personality Diagnostic Questionnaire-4+. The result was a 42.5% fall in self-reported endorsements, due to misinterpretations (11.5%), short duration of traits or contamination by state psychopathology (9.8%), and traits being non-harmful (21.2%). However, not all personality traits and disorders underwent correction to the same extent, and ultimately, the interview did not improve the prediction of clinical variables. These findings raise doubts about the practical relevance of the general criteria for PD and support the role of self-report questionnaires for diagnostic purposes.
Collapse
Affiliation(s)
- Josep M Peri
- Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Ana Muñoz-Champel
- Department of Legal Medicine, Faculty of Medicine, Universitat Autònoma de Barcelona
| | - Rafael Torrubia
- Department of Legal Medicine, Faculty of Medicine, Universitat Autònoma de Barcelona
| | - Fernando Gutiérrez
- Personality Disorder Unit, Institute of Neuroscience, Hospital Clínic de Barcelona, and Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS), Barcelona
| |
Collapse
|