Validity of the DSM-5 Levels of Personality Functioning Scale-Self Report

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

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

First Psychometric Evaluation of the English Version of the Semi-Structured Interview for Personality Functioning (STiP-5.1)

The Alternative Model for Personality Disorders provides a dimensional framework for the conceptualization of personality disorders where Criterion A concerns the assessment of one's level of personality functioning (LPF). This study examines the psychometric properties of the English translation of the Semi-Structured Interview for Personality Functioning (STiP-5.1) to validate this translation for the assessment of LPF in English-speaking populations; and examine whether this measure increments self-report measures of LPF and personality pathology in predicting general functioning. The sample consisted of 129 emerging adults between 18 and 25 years of age (M = 20.54, SD = 2.08) from a mixed college and clinical sample. Results support a unidimensional factor structure of the STiP-5.1, good internal consistency, and high inter-rater reliability. Construct validity was supported through associations of the STiP-5.1 with self-report measures of LPF and personality pathology. The STiP-5.1 incremented self-report measures of personality pathology in predicting functional impairment, though additional variance explained was modest. Finally, STiP-5.1 scores differentiated individuals who obtained a score at or above the clinical cutoff from those below on self-report measures of personality pathology and LPF with large effect sizes. Findings support the validity of the English translation of the STiP-5.1 for the assessment of LPF.

Competing Models of Personality Disorder: Relations With Psychosocial Functioning

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5; American Psychiatric Association, 2013), includes 10 categorical personality disorders (PD) in Section II (Section II PD) and a dimensional alternative model of PD (AMPD) in Section III. We compared the two models in explaining concurrent psychosocial functioning levels in psychiatric outpatients and community residents screened as at risk for PD pathology (N = 600). The AMPD's fully dimensional form showed stronger associations with psychosocial difficulties and explained more of their variance compared with the categorical Section II PD. AMPD Criterion A (personality functioning impairment) and Criterion B (pathological traits) incrementally predicted psychosocial functioning about equally with some unique predictions. Finally, AMPD's six categorical PD diagnoses did not show stronger associations with psychosocial functioning than the corresponding Section II PD diagnoses. Findings directly comparing the two models remain important and timely for informing future conceptualizations of PD in the diagnostic system.

Personality Functioning, Problems in Living, and Personality Traits

The publication of the Alternative Model of Personality Disorder (AMPD) was a signpost achievement in the personality assessment. However, research on the AMPD has generally not led to either a deeper understanding of personality disorder or personality assessment or new ideas about how to provide better care for people with personality disorder diagnoses. A significant portion of research has focused on narrow issues and appears to be driven in part by ideological differences between scholars who prefer Criterion A (personality functioning) or Criterion B (maladaptive traits). I trace these issues to ambiguity about the concept of personality functioning as defined in the AMPD and its conceptual distinction from personality traits and problems in living. In this paper, I reground these concepts in coherent and distinct definitions, elaborate upon the implications of their differences, and show how these differences can help clarify and reorient AMPD research to focus on generating clinically useful models for personality pathology and personality assessment.

The Utility of the Level of Personality Functioning Scale in Maternal Samples: A Brief Report

Maternal personality plays a role in how a mother parents her children and adolescents. Current trait-based measures of personality are acceptable for use in maternal samples, but the presence or absence of given personality traits might not be enough to describe how personality relates to parenting. The Level of Personality Functioning Scale (LPFS) could serve as a solution, as it was designed to capture level of dysfunction in personality without being reliant on specific personality traits. Research, however, has yet to demonstrate the LPFS as a useful measure of personality in maternal samples, thus the goal of this study. A sample of 123 mothers reported on behavioral problems in their adolescent-aged children and their own personality using both a trait-based measure and the LPFS. Our data showed that maternal reports on the LPFS were associated with maternal perceptions of adolescent behavioral problems, in addition to being an acceptable measure of personality in our maternal sample. We also provide support for incremental validity of the LPFS in our sample, as the LPFS uniquely predicted maternal perceptions of adolescent behavioral problems even after controlling for maternal personality traits. Our results are discussed in light of the limitations of the extant work on maternal personality and add to the literature by demonstrating that the LPFS is an acceptable and ubiquitous measure of personality in maternal samples.

Perception and memory-based representations of facial emotions: Associations with personality functioning, affective states and recognition abilities

Personality traits and affective states are associated with biases in facial emotion perception. However, the precise personality impairments and affective states that underlie these biases remain largely unknown. To investigate how relevant factors influence facial emotion perception and recollection, Experiment 1 employed an image reconstruction approach in which community-dwelling adults (N = 89) rated the similarity of pairs of facial expressions, including those recalled from memory. Subsequently, perception- and memory-based expression representations derived from such ratings were assessed across participants and related to measures of personality impairment, state affect, and visual recognition abilities. Impairment in self-direction and level of positive affect accounted for the largest components of individual variability in perception and memory representations, respectively. Additionally, individual differences in these representations were impacted by face recognition ability. In Experiment 2, adult participants (N = 81) rated facial image reconstructions derived in Experiment 1, revealing that individual variability was associated with specific visual face properties, such as expressiveness, representation accuracy, and positivity/negativity. These findings highlight and clarify the influence of personality, affective state, and recognition abilities on individual differences in the perception and recollection of facial expressions.

A new performance-based measure of personality functioning impairment: development and preliminary evaluation of reliability and validity

Personality functioning impairment is at the center of many dimensional models of personality. Available measures of personality functioning impairment are limited to self-report, clinician-/informant-rated, and interview methods. Although researchers have begun investigating established performance-based instruments' potential for assessing personality functioning impairment, administration and scoring of these instruments is complex and the latent variables they measure diverge from personality functioning impairment as described in the ICD-11 and the Alternative Model for Personality Disorders (AMPD) of the DSM. We address this absence by developing and psychometrically evaluating the Level of Personality Functioning Scale-Questionnaire-based Implicit Association Test (LPFS-qIAT). The LPFS-qIAT's psychometric properties were evaluated across four studies, producing initial evidence supporting the new instrument's reliability as well as its convergent, discriminant, and criterion-related validity. As the first performance-based measure of personality functioning impairment that aligns with the AMPD and, to a degree the ICD-11, that is easily administered, scored, and interpreted, the LPFS-qIAT shows potential to become a valuable tool in both research and clinical practice.

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.

Evaluating the Psychometric Properties of the German Self and Interpersonal Functioning Scale (SIFS)

The Self and Interpersonal Functioning Scale (SIFS) is a 24-item self-report questionnaire assessing personality functioning according to the alternative DSM-5 model for personality disorders. We evaluated the German SIFS version in a total sample of 886 participants from Germany and Switzerland. Its factor structure was investigated with confirmatory factor analysis comparing bifactor models with two specific factors (self- and interpersonal functioning) and four specific factors (identity, self-direction, empathy, and intimacy). The SIFS sum and domain scores were tested for reliability and convergent validity with self-report questionnaires and interviews for personality functioning, -organization, -traits, -disorder categories, and well-being. None of the bifactor models yielded good model fit, even after excluding two items with low factor loadings and including a method factor for reverse-keyed items. Based on a shortened 22-item SIFS version, models suggested that the g-factor explained 52.9-59.6% of the common variance and that the SIFS sum score measured the g-factor with a reliability of .68-.81. Even though the SIFS sum score showed large test-retest reliability and correlated strongly with well-established self-report questionnaires and interviews, the lack of structural validity appears to be a serious disadvantage of the SIFS compared to existing self-reports questionnaires of personality functioning.

Levels of Personality Functioning Questionnaire 12-18 (LoPF-Q 12-18): Factor Structure, Validity, and Clinical Cut-Offs

The Levels of Personality Functioning Questionnaire 12-18 (LoPF-Q 12-18) is the only self-report measure informed by the Level of Personality Functioning (Diagnostic and Statistical Manual of Mental Disorders [5th ed.; DSM-5; American Psychiatric Association, 2013]) Alternative Model of Personality Disorders developed for adolescents. The present investigation includes two studies evaluating the English LoPF-Q 12-18. In Study 1, single-factor and bifactor structures (unidimensional severity criterion and four specific factors: identity, self-direction, empathy, intimacy) were evaluated in an ethnically diverse community sample (N = 453; age 10-18; 57% female). Study 2 used a community control (n = 298; age 10-18; 54.4% female) and clinical sample (n = 94; age 11-18; 58.5% female) to examine reliability, validity, and clinical utility. Study 1 results supported the bifactor model, with a robust general factor and little multidimensionality caused by the group factors, suggesting an essentially unidimensional structure. Study 2 revealed good internal consistency and construct validity and provided clinical cut-offs, supporting the use of the LoPF-Q 12-18 total score in research and clinical applications.

Differences in Perceived Threat and Efficacy in Managing Opioid Use Disorder versus Alcohol Use Disorder

Background: Efforts to increase the availability of Medication Assisted Treatment for alcohol use disorder (AUD) and opioid use disorder (OUD) may be futile if patients lack motivation for recovery and are unwilling to seek treatment. Objectives: In this cross-sectional, online survey, we used the Extended Parallel Process Model (EPPM) to assess how participants at risk of AUD or OUD react to their perceived threat and assess their response to pharmacotherapy as a potential treatment. EPPM constructs were assessed using the Risk Based Diagnosis Scale. Descriptive statistics measure the proportion of treated vs untreated participants. Untreated participants were sorted into one of three groups categorizing perceived threat - low threat appraisal, and danger or fear control. Results: Of 411 total responses, most (n = 293[71.29%]) sorted into the AUD cohort and 118(28.71%) into the OUD cohort. Overall, 104(25.30%) had received treatment and 307(74.70%) didn't. Within the OUD cohort, there were 67 untreated participants - 16(23.88%) exhibited low threat appraisal, 13(19.40%) were likely to undergo fear control, and 38(56.72%) were likely to undergo danger control. Within the AUD cohort, there were 240 untreated participants - 75(31.25%) exhibited low threat appraisal, 100(41.67%) were likely to experience fear control, and 65(27.08%) were likely to experience danger control. Participants in the OUD cohort were more likely to undergo danger control than those in the AUD cohort (χ2 = 19.26, p < 0.05). Conclusions: This study identified perceived threat and efficacy when an individual was at risk of a SUD, but more insight into potential early interventions is needed - particularly in those individuals with polysubstance use disorder.

Comparing Measures of Criterion A to Better Understand Incremental Validity in the Alternative Model of Personality Disorders

The Alternative Model of Personality Disorders distinguishes between the severity of personality dysfunction (Criterion A) and individual differences in personality disorder expression (Criterion B). Several Criterion A measures exist, but few studies have compared these measures with each other. Moreover, debates about whether the constructs of Criteria A and B are redundant (i.e., weak incremental validity) should be framed around how different Criterion A measures perform relative to others. This study of 204 undergraduate students evaluated multiple measures of Criterion A. These measures were strongly correlated with Criterion B, but evidenced incremental validity (39% of outcomes, 5% average additional variance explained) with outcomes of psychopathology and interpersonal impairments, and less consistent incremental validity with suicidality, aggression, and mental health utilization. We discuss how these results inform the construct of Criterion A relative to Criterion B and evaluate strengths/weaknesses of Criterion A measures.

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.

Bridging the ICD11 and the DSM-5 personality disorders classification systems: The role of the PID5BF + M

Introduction

In both the ICD-11 Classification of Personality Disorders and the DSM-5 Alternative Model of Personality Disorders (AMPD) personality disorders (PD) are characterized by impairments in self- and interpersonal functioning which distinguish the various levels of dysfunction. Moreover, pathological traits are used by these classification systems to define the stylistic expression of personality dysfunction. Negative affectivity, detachment, antagonism/dissociality, and disinhibition feature as trait domains in each of these models. However, there are also differences between the two models, namely, in the psychoticism domain, which does not feature as a personality trait domain in the ICD-11, and in the anankastia domain, corresponding to compulsivity in the DSM-5, which was removed from the final AMPD model. Furthermore, facets are acknowledged by the DSM-5 within each trait domain, while this does not occur in the ICD-11. In view of the similarity between these classification systems, their harmonization would be beneficial for the clinical profession. With this goal in mind, the PID5BF + M, an algorithm that assesses the DSM-5 and ICD-11 six trait domains and 18 facets, was developed and has proven to adequately characterize the ICD-11 trait domains by means of DSM-5 trait facets.

Methods

The current study compares a community sample (N = 280, M age = 48.01, 53.2% females) with a PD sample (N = 131, M age = 42.66, 45.0% females) along with the PID5BF + M, the LPFS-SR and the PID-5. Given that the PID5BF + M total can be seen as a measure of the level of personality dysfunction, strong relations between the PID5BF + M total and the LPFS-SR total are expected. Strong relations between the trait specifiers measured by the PID5BF + M and the PID-5 are also expected. Finally, the community and clinical samples are expected to differentiate by means of the dimensions assessed through the three afore-mentioned measures. The Spearman rank-order correlation coefficient was used to measure the strength and direction of associations between the PID5BF + M total and the LPFS-SR total and between the PID5BF + M and the PID-5 traits. Group differences were explored using the Mann-Whitney U test for independent samples.

Results

As expected, there were strong, significant, and positive relations between the measures. Furthermore, higher scores were observed in all the variables for the PD group against the community group.

Discussion

Although this study has limitations, its findings sustain that the PID5BF + M has potential to assess the severity of personality disfunction and to characterize the stylistic features of PD as they are conceived by both the ICD-11 and the DSM-5. Although more research is needed regarding the convergent validity of the PID5BF + M, this new test contributes to the harmonization of both systems and to parsimony in the assessment of PD, which is the main objective of clinical practice.

Examining individual differences in personality trait changes after negative life events

Personality traits can change throughout the entire life span, but people differ in their personality trait changes. To better understand individual differences in personality changes, we examined personal (personality functioning), environmental (environmental changes), and event-related moderators (e.g., perceived event characteristics) of personality trait changes. Therefore, we used a sample of 1069 participants who experienced a negative life event in the last 5 weeks and assessed their personality traits at five measurement occasions over 6 months. Employing preregistered multilevel lasso estimation, we did not find any significant effects. While exploratory analyses generally confirmed this conclusion, they also identified some effects that might being worth to be considered in future research (e.g., perceived impact and perceived social status changes were associated with changes in agreeableness after experiencing a relationship breakup). In total, our moderators explained less than 2% of variance in personality traits. Nonetheless, our study has several important implications for future research on individual differences in personality change. For example, future research should consider personal, environmental, and event-related moderators, use different analytical methods, and rely on highly powered samples to detect very small effects.

Influence of Child Abuse and Neglect on Histrionic Personality Pathology

Histrionic personality pathology is among the most common forms of personality pathology, although little is known about its potential risk factors. One possible factor that may influence histrionic personality pathology is childhood trauma, most notably sexual abuse and physical/emotional neglect. However, there is little research on how these and other forms of childhood trauma may influence histrionic personality pathology relative to each other. To address this, in this study we examined the relative effects of different forms of child abuse and neglect on histrionic personality pathology in a sample of women and men from Amazon's Mechanical Turk (N = 399) using a Bayesian approach to structural equation modeling. Results suggest that child sexual abuse is the strongest predictor of histrionic personality pathology in adulthood. However, this differs between women and men such that physical neglect also predicts histrionic personality pathology for women, whereas physical and emotional abuse as well as emotional neglect predict histrionic personality pathology for men. These findings provide insight into the developmental precursors to histrionic personality pathology and have implications for research on and clinical intervention with people exhibiting histrionic personality pathology.

How are psychodynamic conflicts associated with personality functioning? A network analysis

Personality functioning and psychodynamic conflicts are central constructs in psychoanalytic theories of psychopathology as well as in many psychodynamic treatment models. Although there has been a longstanding conceptual discussion on how they relate to each other, empirical evidence on this question is still scarce. In this study, we explore the associations between psychodynamic conflicts and levels of structural integration (which can be used synonymously with personality functioning) by means of a partial correlation network analysis in a sample of N = 220 outpatients interviewed and rated according to Operationalized Psychodynamic Diagnosis (OPD-2). We examined network centrality, bridge centrality, clustering, and network stability. The network analysis resulted in separate clusters for levels of structural integration and conflicts, supporting the assumption of distinct psychodynamic constructs. The greatest association between the two clusters was found between the individuation vs. dependency conflict (C1) and the structural capacity to attach to internal objects. In general, C1 showed significantly greater connections with structural dimensions compared to the other five OPD conflicts included. C1 was also more central in the network compared to most other conflicts, whereas the structural dimensions did not differ in centrality. All structural dimensions were found to be strongly interconnected. C1 showed exclusively negative edges to the other conflicts, suggesting that a profound C1 decreases the probability of other psychodynamic conflicts. We discuss clinical as well as conceptual implications of our findings for psychodynamic diagnosis and treatment.

Recovery from chronic depression and structural change: 5-year outcomes after psychoanalytic and cognitive-behavioural long-term treatments (LAC depression study)

OBJECTIVE

Psychotherapy of chronic depression has remained a challenge due to limited prognosis and high rates of recurrence. We present 5-year outcome data from a multicentre trial comparing psychoanalytic (PAT) and cognitive-behavioural (CBT) long-term treatments with randomized and preferred allocations analysing symptom (N = 227) and structural change (N = 134) trajectories.

METHOD

Self- and blinded expert ratings of depression symptoms were performed at yearly intervals using the Beck Depression Inventory-II (BDI-II) and Quick Inventory of Depressive Symptoms (QIDS-C). Blinded expert ratings of Operationalized Psychodynamic Diagnosis (OPD) and the Heidelberg Restructuring Scale (HRS) at baseline, 1, 3, and 5 years assessed structural change in a subsample.

RESULTS

Lasting and comparable symptom changes were achieved by PAT and CBT. However, compared to CBT, PAT was more successful in restructuring, a major goal of long-term psychodynamic treatments with high frequency and duration.

LIMITATIONS

Due to practical reasons, the time criterion for chronic depression of an acute phase had to be defined for over 1 year in the present study, which does not correspond to the DSM-5 criterion of 2 years. Therapy duration and session frequency were not incorporated into the statistical models.

CONCLUSION

Long-term psychotherapy helps patients with a yearlong history of depression and often multiple unsuccessful treatment attempts to achieve lasting symptom changes. Future follow-up will clarify whether restructuring promotes further sustainable improvements.

Validation of the DSM-5 Level 1 Cross-Cutting Symptom Measure in a Community Sample

The shift toward transdiagnostic and dimensional approaches to diagnosing mental disorders has created a need for assessment tools that efficiently measure a range of mental health symptoms and their severity. The present study aimed to evaluate the psychometric properties and diagnostic utility of the DSM-5 Level 1 Cross-Cutting Symptom Measure (CCSM), developed by the American Psychiatric Association as a brief transdiagnostic measure of mental health symptoms, in community-dwelling adults. Participants (N = 482) completed symptom measures corresponding to CCSM domains and self-reported diagnostic criteria were used to establish DSM-5 diagnoses. The results showed CCSM domains had significant validity correlations with longer measures of the same or similar mental health constructs and overall symptom severity was associated with functional impairments and current treatment status. Several domains demonstrated moderate diagnostic efficiency for corresponding DSM-5 diagnoses. The recommended thresholds for depression, anxiety, and substance use domains showed strong sensitivity (≥ 0.83) but low specificity (range = 0.60-.73), whereas the personality functioning threshold showed low sensitivity (0.51) and excellent specificity (0.92). These results suggest CCSM domains are internally consistent and valid measures of psychopathology. Further, these findings indicate the CCSM shows promise as a screening tool for specific DSM-5 disorders in community samples.

Probabilistic graphical model for the evaluation of the emotional and dramatic personality disorders

Personality disorders are psychological ailments with a major negative impact on patients, their families, and society in general, especially those of the dramatic and emotional type. Despite all the research, there is still no consensus on the best way to assess and treat them. Traditional assessment of personality disorders has focused on a limited number of psychological constructs or behaviors using structured interviews and questionnaires, without an integrated and holistic approach. We present a novel methodology for the study and assessment of personality disorders consisting in the development of a Bayesian network, whose parameters have been obtained by the Delphi method of consensus from a group of experts in the diagnosis and treatment of personality disorders. The result is a probabilistic graphical model that represents the psychological variables related to the personality disorders along with their relations and conditional probabilities, which allow identifying the symptoms with the highest diagnostic potential. This model can be used, among other applications, as a decision support system for the assessment and treatment of personality disorders of the dramatic or emotional cluster. In this paper, we discuss the need to validate this model in the clinical population along with its strengths and limitations.

Development and Validation of a German Interpersonal Sensitivities Circumplex (ISC-G)

Abstract. The Interpersonal Sensitivities Circumplex (ISC) assesses individual differences in sensitivities to aversive interpersonal behaviors. In this research (total N = 1,519), we developed and validated a German adaptation of the ISC (ISC-G) and extended the nomological net of interpersonal sensitivity as a construct. Using the structural summary method, we investigated associations with self- and informant reports of adaptive (interpersonal) personality traits as well as self-reported personality functioning, maladaptive personality traits, childhood trauma, and hypersensitivity. Replicating and extending previous findings with the ISC, the present research sheds light on the interplay between different personality traits and the perception of others’ interpersonal behavior. Results suggested that individuals report experiencing interpersonal behavior opposite to their own self-description in terms of agency and communion as aversive. This oppositional pattern was most pronounced for antagonistic vs. agreeable traits/behaviors. We discuss these results in the context of research on personality pathology.

The Assessment of Identity Development in Adolescence (AIDA) Questionnaire: First Psychometric Evaluation in Two North American Samples of Young People

The Assessment of Identity Development in Adolescence (AIDA) is a recently developed measure of identity diffusion in young people. Originally validated in Switzerland, the English version has not yet been validated. Our aim was to evaluate the AIDA's internal factor structure, internal consistency, incremental validity, and relations to other variables in adolescents and young adults and derive clinical cutoffs for use in clinical settings. Study 1, involving 2,119 undergraduate students between the ages of 18-25 years, confirmed the expected bi-factor structure for the AIDA. Study 2 involved the recruitment of 122 adolescent inpatients (ages 12-17), of whom 36 met full DSM-based criteria for Borderline Personality Disorder, in addition to 164 adolescents of the same age, recruited from public schools (total 286 adolescents). Results of both studies demonstrated strong internal consistency and correlations of the expected magnitude and direction with other self-report measures of personality pathology. In addition, Study 2 demonstrated that the AIDA could successfully discriminate between adolescent inpatients with and without BPD, as well as healthy controls, and established preliminary clinical cutoffs that should be replicated in future studies. In all, these studies provide support for further validation and use of the AIDA in young people.

A bifactor model of personality organization in adolescence: the validity of a brief screening measure assessing severity and core domains of functioning

BACKGROUND

Both the latest edition of the DSM-5 as well as the new ICD-11 have established a new focus in the diagnosis of personality disorders: the assessment of personality functioning. This recent shift in focus converges with long-standing psychodynamic conceptualizations of personality pathology, particularly Kernberg's object relations model. Although a significant amount of research supports these models in adults, much less is known about the validity of these frameworks in youth. Considering the paucity of brief measures of personality functioning in adolescents, the current study aimed to develop and investigate the validity of the Inventory of Personality Organization for Adolescents-Short Form, a theoretically-informed measure assessing severity and core domains of functioning in adolescents.

METHODS

A total sample of N = 525 adolescents aged 13 to 19 years were recruited through a community University-Health Psychology Clinic as current patients (n = 94) or who responded to an online research call (n = 431).

RESULTS

Results indicate that a bifactor model provided the best fit to the data and consisted of a general factor reflecting core self-other functioning and three specific factors, representing additional dimensions of personality organization.

CONCLUSIONS

A brief 15-item version of the IPO-A was successfully derived for time-efficient screening of personality pathology in youth. Similarities with the ICD-11 framework are discussed.

The General Factors of Personality Disorder, Psychopathology, and Personality

There is considerable interest in the study of the general factors of personality disorder (g-PD), psychopathology (p factor), and personality (GFP). One prominent interpretation of the g-PD is that it is defined by the self-interpersonal impairments of Criterion A of the DSM-5 Section III. However, no study has directly tested this hypothesis as no prior g-PD study has included a measure of Criterion A. The current study provides a direct test of this hypothesis, along with comparing g-PD with the general factors of psychopathology and personality. Also extracted was a common general factor across all three domains. Suggested herein is that the g-PD, the p factor, and the GFP reflect the impairments (e.g., social and occupational dysfunction) that are secondary to the traits and disorders rather than the traits and/or disorders themselves.

Examining the Structure and Validity of Self-Report Measures of DSM-5 Alternative Model for Personality Disorders Criterion A

The Level of Personality Functioning Scale (LPFS) operationalizes Criterion A of the DSM-5 Alternative Model for Personality Disorders. Despite progress in LPFS measurement development and validation, there is a lack of research, and some disagreement, concerning structural, convergent, and incremental validity of LPFS self-report measures. The present study aimed to compare the LPFS Self-Report, LPFS Self-Report of Criterion A, and LPFS Brief Form. Internal structure was assessed through principal component analyses, factor analyses, and bifactor analyses of unidimensionality. Associations with both pathological and basic personality characteristics among the LPFS measures were explored. Incremental validity of LPFS severity in predicting pathological personality outcomes controlling for basic personality traits, and the reverse, were examined. Results suggest a unidimensional structure robustly associated with other pathological personality assessments. LPFS severity and basic personality traits mutually offered unique explanatory power. We discuss the implications of assessing personality pathology using LPFS self-report measures.

Severity in the ICD-11 personality disorder model: Evaluation in a Spanish mixed sample

Severity is the main component of the ICD-11 personality disorder (PD) classification, but pertinent instruments have only recently been developed. We analyzed the psychometric properties of the ICD-11 Personality Disorder Severity scale (PDS-ICD-11) in a mixed sample of 726 community and clinical subjects. We also examined how the different components of the ICD-11 PD system -five trait domains, the borderline pattern specifier, and severity, all of them measured through self-reports- are interconnected and operate together. PDS-ICD-11 properties were adequate and similar to those of the original instrument. However, regressions and factor analyses showed a considerable overlap of severity with the five personality domains and the borderline specifier (72.6%). Bifactor modeling resulted in a general factor of PD (g-PD) that was not equivalent to severity nor improved criterion validity. The whole ICD-11 PD system, i.e., five personality domains, borderline, and severity, explained an average of 43.6% of variance of external measures of well-being, disability, and clinical problems, with severity contributing 4.8%. Suggestions to further improve the ICD-11 PD taxonomy include remodeling the present definition of severity to give more weight to the real-life consequences of traits.

Assessing Self-Definition and Relatedness in Level of Personality Functioning

The two polarities model (TPM) of personality organizes psychological assessment and psychotherapy and connects to personality disorder diagnosis using the DSM-5 Alternative Model for Personality Disorders (AMPD). The authors developed scales assessing the TPM from an existing self-report measure for level of personality functioning (LPF), a core component of the AMPD. Iterative content analyses of the LPF measure yielded scales for Autonomy and Communion corresponding to dimensions of the TPM. The scales were refined via internal consistency analyses using a measure of psychological attachment and studied in development and validation samples. Associations with relevant external criteria were explored in a series of multiple regressions. The new content-based LPF scales were illustrated with a case vignette. Although the new Autonomy/Communion scales await further validation prior to clinical use, initial evidence suggests that they may bridge the nomological nets of the TPM and AMPD and potentially offer clinical utility in assessment and treatment planning.

Criterion A of the DSM-5 Alternative Model for Personality Disorders in MMPI-2/RF Personality Disorder Scales

The Minnesota Multiphasic Personality Inventory (MMPI) instruments are frequently used to assess personality and psychopathology. Recent publications of personality disorder (PD) spectra scales for dimensionalized PD syndromes with MMPI instruments may advance PD assessment. To this end, we examined MMPI-Second Edition (2) and MMPI-2-Restructured Form (-RF) PD Spectra scales within the lens of a contemporary dimensional model of PDs, the alternative model for personality disorders (AMPD). The core dimension of PD, Criterion A of the AMPD or level of personality functioning (LPF), was characterized quantitatively within the PD Spectra scales. By sequentially factor analyzing the scales of the Severity Indices of Personality Problems (SIPP-118) to a common general factor of PD, an index of LPF external to the MMPI item pool was established. This LPF dimension was strongly represented across most PD Spectra scales. LPF variances within the PD Spectra scales were deconstructed using measures of general demoralization (RCdemoralization) and maladaptive personality traits indexed by the Personality Psychopathology-5 (PSY-5). Nuanced LPF and PD Spectra scale relationships were discerned. Dimensionalized Antisocial PD, Borderline PD, Dependent PD, and Paranoid PD showed meaningful association with LPF after demoralization, and maladaptive trait variances were removed. The examination of the MMPI-3 item pool reveals that the existing PD Spectra scale item sets are largely carried forward in the new edition of the MMPI. This suggests PD Spectra scale correlates, including LPF relationships, may be discernable in the newest edition of the MMPI, pending future study.

Personality functioning as a mediator of adult mental health following child maltreatment

BACKGROUND

The broad range of adverse health outcomes following child maltreatment (child maltreatment) underscores the need to investigate shared trajectories that contribute to associated physical and mental health problems. Previous research focused on different mechanisms, such as emotion regulation or attachment. In the present study, we propose personality functioning, comprising self- and interpersonal regulation and perception, to mediate between child maltreatment and mental and physical health.

METHODS

In a German representative sample (N = 2,508), we assessed remembered child maltreatment, levels of personality functioning, and different health outcomes in adulthood, namely somatic symptoms, general mental distress, and body dysmorphic concern. We conducted path analyses to investigate mediation effects in the total sample as well as in female and male subsamples.

RESULTS

Child maltreatment significantly predicted the assessed health outcomes and showed significant associations with lower levels of personality functioning. Personality functioning partially mediated all health outcomes assessed by significant indirect effects and lowered direct effects of child maltreatment on health outcomes. An exploratory analysis of different facets of personality functioning revealed a pronounced impact of identity perception and self-reflective capacities in mediating between child maltreatment and physical and mental health. Comparable results were found in female and male participants.

LIMITATIONS

Major limitations of the study are the reliance on cross-sectional data and the use of a screening measure to assess experienced child maltreatment.

CONCLUSION

Personality functioning may represent a transdiagnostic link to different somatic and psychological symptoms in the aftermath of child maltreatment.

Preliminary Scales for ICD-11 Personality Disorder: Self and Interpersonal Dysfunction Plus Five Personality Disorder Trait Domains

The ICD-11 personality disorder model is the first fully dimensional assessment of personality pathology. It consists of a personality disorder (PD) dysfunction-severity dimension, which encompasses both self- and interpersonal dysfunction, and six optional qualifiers for five prominent personality traits-Negative Affectivity (NA), Detachment (DET), Dissociality (DSL), Disinhibition (DSN), and Anankastia (ANK)-plus a borderline pattern that is defined by the criteria of DSM-IV borderline PD. This article reports on the development of a new self-report measure to assess self- and interpersonal dysfunction and the five trait qualifiers. It is the first comprehensive measure of the ICD-11 PD model in that (a) it is the only one to include both PD dysfunction-severity as well as trait scales and because (b) it is based on the Clinical Description and Diagnostic Guidelines, which are more detailed than the "statistical" model description that is currently on the ICD-11 website. The authors wrote 992 items and then reduced the pool to 300 items by eliminating redundancy and selecting the consensus best few items for each subconstruct. Data were collected using an online sample of 383 Prolific workers. Using exploratory factor analysis, seven domain scales were developed, each of which contained two to four scales assessing components of the domain. These preliminary scales' psychometrics were excellent, as were the domains' and their components' convergent and discriminant validity, with a few generally minor exceptions. Structural analyses at the component level revealed a three-factor structure consisting of two moderately correlated Internalizing factors, one centered on Self Dysfunction with two NA components and a DSN component (Distractibility) and the other on Interpersonal Dysfunction with DET and ANK components; as well as an Externalizing factor with DSL and a DSN component (Reckless Impulsivity) that was uncorrelated with the other two factors. Two aspects of the results in particular are striking: (1) ANK was not the opposite end of a DSN dimension, but rather contributed to an Internalizing Interpersonal Dysfunction dimension and (2) DSN had both an Internalizing and an Externalizing component. Implications of the findings and study limitations are discussed.

Three Dimensional Approaches to Personality Disorders: a Review on Personality Functioning, Personality Structure, and Personality Organization

PURPOSE OF REVIEW

The concept of personality functioning (Alternative DSM-5 Model of Personality Disorders) has led to increased interest in dimensional personality disorder diagnosis. While differing markedly from the current categorical classification, it is closely related to the psychodynamic concepts of personality structure and personality organization. In this review, the three dimensional approaches, their underlying models, and common instruments are introduced, and empirical studies on similarities and differences between the concepts and the categorical classification are summarized. Additionally, a case example illustrates the clinical application.

RECENT FINDINGS

Numerous studies demonstrate the broad empirical basis, validated assessment instruments and clinical usefulness of the dimensional concepts. Their advantages compared to the categorical approach, but also the respective differences, have been demonstrated empirically, in line with clinical observations. Evidence supports the three dimensional concepts, which share conceptual overlap, but also entail unique aspects of personality pathology, respectively.

Beliefs About Emotion Shift Dynamically Alongside Momentary Affect

This study examined if beliefs about emotion change across emotional contexts in daily life, and it investigated whether people with prominent features of borderline personality pathology experience greater shifts in emotion beliefs during emotional states. Undergraduate participants with (n = 49) and without borderline features (n = 50) completed a 1-week ecological momentary assessment study where they provided ratings of affect, nine different beliefs about emotion, and indicators of momentary self-efficacy. Results support the notion of beliefs as relatively schematic. However, most of the beliefs about emotion shifted with either positive or negative affect, and they predicted momentary self-efficacy for tolerating distress and exerting willpower. Those with borderline features experienced greater instability of beliefs, and borderline features moderated the relationships between affect and many beliefs. Results confirm that there are implications for emotion beliefs for people who struggle with emotion regulation and impulsivity (i.e., people with features of borderline personality).

An Evaluation of Age-Group Latent Mean Differences in Maladaptive Identity in Adolescence

Little is known about the differences between age groups in maladaptive personality function as denoted in Criterion A of the Alternative Model for Personality Disorder (AMPD) in the DSM-5, which is the entry criterion for diagnosing personality disorder in the upcoming ICD-11. The current study aimed to address this gap by evaluating latent mean age group differences in maladaptive identity, which is one aspect that has been identified as an important feature of maladaptive, general personality function as represented in the DSM-5 and ICD-11. We were also interested whether mean differences would track with mean differences in borderline personality disorder (BPD) features given prior data suggesting that general personality function overlap with the construct of BPD. A community sample of N = 2,381 adolescents, representing a mix of different socio-economic and educational backgrounds, ages 12-18 (M = 14.92, SD = 1.94; 46% male) completed a measure of maladaptive identity. A subset (n = 1,165) completed a measure of borderline personality features. Latent variable modeling was used to evaluate latent mean differences across seven age bands. Results suggested a normative increase in maladaptive identity after age 12, which remained consistent until age 17 when it dropped back to levels observed in 12-year-olds. Maladaptive identity was significantly associated with mean-level increases in borderline personality features, with these constructs becoming more closely associated with increasing age.

Personality impairment in the DSM-5 and ICD-11: Current standing and limitations

PURPOSE OF REVIEW

The current review provides an examination of the levels of personality functioning outlined by the International Classification of Diseases-11 and the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders.

RECENT FINDINGS

Across self-report measures, high convergence is observed, and they evince relatively robust relations with general and pathological traits as well as other clinical symptoms. At the same time, current measures of impairment also demonstrate unstable factor structures, poor discriminant validity (when measures offer subscales aligned with different forms of personality impairment), and tend to account for relatively little unique variance beyond traits. As a result, some have questioned the utility of personality impairment, as currently measured.

SUMMARY

The dimensional models of personality psychopathology included in the International Classification of Diseases-11 and 5th edition of the Diagnostic and Statistical Manual of Mental Disorders signify important steps toward an empirically supported and clinically useful diagnostic model; however, self-report measures of impairment are problematic. The authors conclude by calling for the refinement of these measures to more directly assess deficits in various domains of functioning as well as the dimensional models, by assessing traits first, and then examining the nature of the associated personality impairment.

An Empirical Evaluation of the DSM-5 Alternative Model of Personality Disorders in Later Life

Personality disorders (PDs) in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) are conceptualized as distinct clinical syndromes. However, debate persists about the clinical utility of this categorical model, with many researchers supporting a dimensional model that focuses on pathological personality traits and personality dysfunction. This model was published in Section III of DSM-5 and named the Alternative Model of Personality Disorders (AMPD). This study evaluated the AMPD by examining relationships between traits and dysfunction with traditional categorical PD constructs among older adults. Older adults (N = 202) completed the Personality Inventory for DSM-5, Levels of Personality Functioning Scale-Self-Report, and Coolidge Axis II Inventory. Results indicated that pathological personality traits do not relate to categorical PDs in directions predicted by the AMPD. Personality functioning related to categorical PDs in expected theoretical patterns according to the AMPD but lacked incremental validity above pathological personality traits. An implication of these findings is that the AMPD does not fully resolve the age-related issues with the traditional categorical PD model.

DSM-5 Level of Personality Functioning: Refocusing Personality Disorder on What It Means to Be Human

Level of Personality Functioning (LPF) represents the entry criterion (Criterion A) of the Alternative Model for Personality Disorders (AMPD) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). It is defined as a dimensional general severity criterion common to all personality disorders and conceptually independent of personality types or traits, and it represents maladaptive self (identity and self-direction) and interpersonal (empathy and intimacy) functioning. We review the history, measurement, and significance of LPF. We show that the inclusion of LPF in the AMPD is well justified if it is defined as a general adaptive failure of a subjective intrapsychic system needed to fulfill adult life tasks. If so defined, LPF distinguishes itself from maladaptive traits (Criterion B of the AMPD) and captures the contribution humans make as agentic authors to the interpretation and management of the self. While Criterion B maladaptive traits provide important descriptive nuance to manifestations of personality pathology, maladaptive LPF is conditional to the diagnosis of personality disorder.

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.

Applying Item Response Theory to the OPD Structure Questionnaire: Identification of a Unidimensional Core Construct and Feasibility of Computer Adaptive Testing

Recent developments in the dimensional assessment of personality functioning have made the implementation of latent measurement models increasingly attractive. In this study, we applied item response theory (IRT) to a well-established personality functioning instrument (the OPD Structure Questionnaire) to identify a unidimensional latent trait and to evaluate the feasibility of computer adaptive testing (CAT). We hypothesized that the use of IRT could reduce the test burden - compared to a fixed short form - while maintaining high precision over a wide range of the latent trait. The OPD-SQ was collected from 1235 patients in a psychosomatic clinic. IRT assumptions were fulfilled. A 9-factor model yielded sufficient fit and unidimensionality in exploratory factor analysis with bifactor rotation. Items were iteratively reduced, and a graded-response IRT model was fitted to the data. Simulations showed that a CAT with approximately 7 items was able to capture an OPD-SQ global severity score with an accuracy similar to that of a fixed 12-item short form. The final item bank and CAT yielded satisfactory content validity. Strong correlations with depression and anxiety replicated previous results on the OPD-SQ. We concluded that IRT applications could be useful to reduce the test burden of personality functioning instruments.

Assessment of Criterion A

The diagnostic concept of Personality Disorder (PD) is changing. A dimensional PD concept that focuses on severity of impairment of personality functioning was introduced in the DSM 5 Section III in 2013 and is adopted by the upcoming ICD-11 in a similar manner. Several reliable, valid and useful instruments to assess personality functioning (Criterion A) either as self-report, expert rating or clinical interview were developed in the past years. This article gives a latest state-of-the-art overview of these measures. It underlines the importance of multi-informant multi-method assessment of, and a longitudinal perspective on PD pathology and the importance of standardized inclusion of PD individuals in studies to increase the significance of research findings.

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.

Personality functioning scale: A scale to assess DSM-5’s Criterion A personality disorders

The Section III on Emerging Measures and Models included in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, introduces a hybrid alternative approach, dimensional-categorical, to diagnose personality disorders. The Criterion A establishes the assessment of the impairment in personality functioning in terms of two dimensions: self and interpersonal. The present study was aimed at developing a short scale to measure both dimensions. The sample was composed of 342 adults from Buenos Aires city and its outskirts, with ages ranging from 19 to 82 years old (M = 39.90, SD = 13.75). Data were gathered using the Personality Functioning Scale, developed in this study, as well as the Personality Inventory for DSM‐5 Brief Form, the Mental Health Continuum Short Form, and the Symptom Check List-27. A principal components analysis conducted on 28 items found 2 factors, interpersonal and self. Internal consistency, estimated by ordinal Alphas, achieved values between .92 and .86 whilst Cronbach’s Alphas were .88 and .87. Significant and positive correlations between the Personality Functioning Scale scores on the one hand, and the Personality Inventory for DSM‐5 Brief Form scores and the Symptom Check List-27 score on the other, were found. Negative correlations between PFS scores and the Mental Health Continuum Short Form were calculated. As a result, a short scale with adequate psychometric features, suitable to assess Criterion A in adult Argentinian population has been developed.

Global personality dysfunction and the relationship of pathological and normal trait domains in the DSM-5 alternative model for personality disorders

OBJECTIVE

The DSM-5 Alternative Model of Personality Disorders distinguishes core personality dysfunction common to all personality pathology from maladaptive traits that delineate specific variants of disorder. Previous research shows the convergence between maladaptive and normal range trait domains as well as substantial correlations between maladaptive traits and core dysfunctions, leading some to conclude that personality traits and dysfunction are redundant. This study sought to examine the potential utility of the concept of core dysfunctions as a means of clarifying the nature of the relationship between maladaptive and normal-range traits.

METHOD

Three nonclinical samples (n = 178, 307, and 1,008) were evaluated for personality dysfunction, maladaptive traits, and normal-range traits using different measures.

RESULTS

Results indicated that: (1) normal trait domains and core dysfunction contribute independently to understanding maladaptive traits; (2) the correlation of a normal trait domain with its putative maladaptive equivalent is consistently accounted for in part by core dysfunction; and (3) the multitrait multimethod matrices of normal and maladaptive personality trait domains demonstrate appreciable discriminant validity problems that are clarified by a consideration of core dysfunction.

CONCLUSION

These results suggest that maladaptive traits reflect the distinguishable contributions of core personality dysfunction (problems) and normal-range personality traits (person).

Comparative Content Analysis of Self-Report Scales for Level of Personality Functioning

Content validity analyses of eight self-report instruments for assessing severity of personality disorder (PD), also known as Level of Personality Functioning (LPF), were conducted using the conceptual scheme of the Alternative Model for Personality Disorders (AMPD; APA, 2013). The item contents of these eight inventories were characterized for the LPF constructs of Identity (ID), Self-Direction (SD), Empathy (EM), and Intimacy (IN) along with the pathological personality trait domains of Negative Affectivity, Detachment, Antagonism, Disinhibition, and Psychoticism. Severity of pathology (SV) reflected in item content was also rated. Raters demonstrated robust agreement for AMPD and SV constructs across instruments. Similarity between instrument AMPD construct profiles was quantified by intraclass correlations (ICC). Results showed the instruments were generally similar in AMPD-construct coverage, but some important differences emerged. The subscales of the instruments also were characterized for the degree to which they reflect the four LPF (ID, SD, EM, IN) domain constructs. Collectively, these content validity comparisons clarify the equivalence of instruments for AMPD constructs and the relative proportions of construct coverage within instrument subscales. These results can inform future research with LPF self-report instruments and guide clinicians in selecting an LPF-related instrument for use in practice.

Exploring Kernberg's Model of Personality Functioning as a Moderator of Traits: Focus on DSM-5's Section III Alternative Model of Personality Disorder

A current trend emphasizes simplified models of traits and personality functioning that would reduce individuals to as few as five potential traits and one dimension of personality functioning. However, the evidence behind those models is based on linear methods of analysis that authors from Cattell to Kernberg (2016) believe do not capture the potential moderating interaction effects of personality. Using models of traits and functioning from the DSM-5, this study demonstrates not only that traits and functioning interact, but that they do so in a rich and meaningful way that points up the dangers of collapsing these concepts. Without taking the interaction into account, satisfaction in romantic or work relationships often could not be predicted or understood. If we cannot predict satisfaction in these relationships with precision, honest confusion arises over how to guide others toward these goals. Low Detachment depends on high levels of Self-Definition, just as low Antagonism relies on high levels of Empathy to be successful. Most interestingly, negative traits and low functioning can actually lead to individual satisfaction, suggesting not only that interaction is key but that nonlinear effects may also be present.

Introduction to the Special Series on the Personality Functioning Component of the Alternative DSM-5 Model for Personality Disorders

The Alternative DSM-5 Model for Personality Disorders (AMPD; American Psychiatric Association, 2013 ) was created to remedy the previously well-explicated limitations of the categorical DSM-IV personality disorders. The AMPD combines dimensional assessments of personality functioning (Criterion A) and traits (Criterion B), which can be used independently or together, and serve as the basis for defining six categorical disorder options. The Criterion A Level of Personality Functioning Scale (LPFS) defines a continuum characterized by the four elements of identity, self-direction, empathy, and intimacy. Empirical work related to the LPFS has been growing, and this Journal of Personality Assessment special series features reports from a variety of research groups around the world. These studies provide contributions for better understanding the reliability, validity, and utility of the LPFS, as well as describing new measures that have been created to investigate personality functioning.

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.