1
|
Hopwood CJ. Personality Functioning, Problems in Living, and Personality Traits. J Pers Assess 2024:1-16. [PMID: 38700238 DOI: 10.1080/00223891.2024.2345880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/12/2024] [Indexed: 05/05/2024]
Abstract
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.
Collapse
|
2
|
Clark LA, Ro E, Nuzum H, Vanderbleek EN, Allen X. Personality disorder coverage, prevalence, and convergence: do the DSM-5's two models of personality disorder identify the same patients? Psychol Med 2024:1-12. [PMID: 38501282 DOI: 10.1017/s0033291724000357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND Research on the Alternative DSM-5 Model for Personality Disorders (AMPD) in DSM-5's Section-III has demonstrated acceptable interrater reliability, a largely consistent latent structure, substantial correlations with theoretically and clinically relevant measures, and evidence for incremental concurrent and predictive validity after controlling for DSM-5's Section II categorical personality disorders (PDs). However, the AMPD is not yet widely used clinically. One clinician concern may be caseness - that the new model will diagnose a different set of PD patients from that with which they are familiar. The primary aim of this study is to determine whether this concern is valid, by testing how well the two models converge in terms of prevalence and coverage. METHOD Participants were 305 psychiatric outpatients and 302 community residents not currently in mental-health treatment who scored above threshold on the Iowa Personality Disorder Screen (Langbehn et al., ). Participants were administered a semi-structured interview for DSM-5 PD, which was scored for both Section II and III PDs. RESULTS Convergence across the two PD models was variable for specific PDs, Good when specific PDs were aggregated, and Very Good for 'any PD.' CONCLUSIONS Results provide strong evidence that the AMPD yields the same overall prevalence of PD as the current model and, further, identifies largely the same overall population. It also addresses well-known problems of the current model, is more consistent with the ICD-11 PD model, and provides more complete, individualized characterizations of persons with PD, thereby offering multiple reasons for its implementation in clinical settings.
Collapse
Affiliation(s)
- Lee Anna Clark
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Eunyoe Ro
- Department of Psychology, Southern Illinois University Edwardsville, Edwardsville, IL, USA
| | - Hallie Nuzum
- Veterans Affairs Puget Sound Health Care System, Seattle Division, Seattle, WA, USA
| | | | - Xia Allen
- And Still We Rise, LLC, Boston, MA, USA
| |
Collapse
|
3
|
Postigo Á, González-Nuevo C, García-Fernández J, García-Cueto E, Soto CJ, Napolitano CM, Roberts BW, Cuesta M. The Behavioral, Emotional, and Social Skills Inventory: A Spanish Adaptation and Further Validation in Adult Population. Assessment 2024:10731911231225197. [PMID: 38311900 DOI: 10.1177/10731911231225197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Social, emotional, and behavioral (SEB) skills encompass a broad range of interpersonal and intrapersonal abilities that are crucial for establishing and maintaining relationships, managing emotions, setting and pursuing goals, and exploring new learning opportunities. To address the lack of consensus regarding terminology, definition, and assessment of SEB skills, Soto et al. developed the Behavioral, Emotional, and Social Skills Inventory (BESSI), which consists of 192 items, 32 facets, and 5 domains. The objective of the current study was to adapt the BESSI to Spanish (referred to as BESSI-Sp) and enhance the overall understanding of the BESSI framework. A sample of 303 people was employed with a mean age of 30.35 years (SD = 14.73), ranging from 18 to 85 years. The results indicate that the BESSI-Sp demonstrates strong psychometric properties. Its facet- and domain-level structure aligns with the theoretical expectations and closely resembles the English-language source version. The facets exhibit high reliability (mean ω = .89), and the scores demonstrate adequate stability after 3 to 4 weeks (mean rICC = .77). The BESSI-Sp also displays evidence of convergent validity and integrates well with the Big Five framework, providing incremental validity for various outcomes. We discuss the implications of these findings for the assessment of SEB skills and future research in this field.
Collapse
|
4
|
Vittengl JR, Jarrett RB, Ro E, Clark LA. Associations of antidepressant medication consumption with changes in personality pathology and quality of life among community-dwelling adults. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2024; 35:5-18. [PMID: 37718854 DOI: 10.3233/jrs-230016] [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: 09/19/2023]
Abstract
BACKGROUND Although antidepressant medication (ADM) has produced small advantages over pill placebo in randomized controlled trials, consuming ADM has predicted prospectively increasing depressive symptom severity in samples of community-dwelling adults. OBJECTIVE We extended the community literature by testing ADM's relations to changes in personality and quality of life that may underpin depression. METHOD In this longitudinal, observational study, community-dwelling adults (N = 601) were assessed twice, 8 months apart on average. Assessments included depressive symptoms, personality, life satisfaction and quality, and prescription medication consumption. RESULTS Consuming ADM at time 1 predicted relative increases in depressive symptoms (dysphoria), maladaptive traits (negative affect, negative temperament, disinhibition, low conscientiousness), personality dysfunction (non-coping, self-pathology), and decreases in life satisfaction and quality from time 1 to 2, before and after adjustment for age, gender, race, income, education, physical health problems, and use of other psychotropics. In no analysis did ADM use predict better outcomes. CONCLUSION Among community-dwelling adults, ADM use is a risk factor for psychosocial deterioration in domains including depressive symptoms, personality pathology, and quality of life. Until mechanisms connecting ADM to poor outcomes in community samples are understood, additional caution in use of ADM and consideration of empirically supported non-pharmacologic treatments is prudent.
Collapse
Affiliation(s)
| | - Robin B Jarrett
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Eunyoe Ro
- Department of Psychology, Southern Illinois University Edwardsville, Edwardsville, IL, USA
| | - Lee Anna Clark
- Department of Psychology, Notre Dame University, Notre Dame, IN, USA
| |
Collapse
|
5
|
Vittengl JR, Jarrett RB, Ro E, Clark LA. Evaluating a Comprehensive Model of Euthymia. PSYCHOTHERAPY AND PSYCHOSOMATICS 2023; 92:133-138. [PMID: 36917971 PMCID: PMC10871685 DOI: 10.1159/000529784] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/15/2023] [Indexed: 03/16/2023]
Abstract
INTRODUCTION In research and treatment of mood disorders, "euthymia" traditionally denotes the absence of clinically significant mood disturbance. A newer, expanded definition of euthymia also includes positive affect and psychological well-being. OBJECTIVE We aimed to test this comprehensive model of euthymia and estimate the coherence and predictive power of each factor in the model. METHODS Community-dwelling adults (N = 601), including both mental health outpatients and non-patients at high risk for personality pathology, completed a battery of interviews and questionnaires at time 1. Most (n = 497) were reassessed on average 8 months later (time 2). We modeled euthymia using standard mood, personality, and psychosocial functioning assessments rather than measures designed specifically for euthymia. RESULTS The hypothesized model of euthymia was supported by confirmatory factor analysis: specific measures loaded on three lower order factors (mood disturbance, positive affect, and psychological well-being) that reflected general euthymia at time 1. Each factor (general euthymia plus lower order factors) demonstrated moderately strong concurrent (time 1) and predictive (time 1-2) correlations with outcomes, including employment status, income, mental health treatment consumption, and disability. Compared to positive affect and psychological well-being, mood disturbance had stronger incremental (i.e., nonoverlapping) relations with these outcomes. CONCLUSIONS Support for a comprehensive model of euthymia reinforces efforts to improve assessment and treatment of mood and other disorders. Beyond dampening of psychological distress, euthymia-informed treatment goals encompass full recovery, including enjoyment and meaning in life.
Collapse
Affiliation(s)
| | - Robin B. Jarrett
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Eunyoe Ro
- Department of Psychology, Southern Illinois University Edwardsville, Edwardsville, IL, USA
| | - Lee Anna Clark
- Department of Psychology, Notre Dame University, Notre Dame, IN, USA
| |
Collapse
|
6
|
Vittengl JR, Jarrett RB, Ro E, Clark LA. How can the DSM-5 alternative model of personality disorders advance understanding of depression? J Affect Disord 2023; 320:254-262. [PMID: 36191644 DOI: 10.1016/j.jad.2022.09.146] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/23/2022] [Accepted: 09/27/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The DSM-5 introduced an alternative model of personality disorder (AMPD) that includes personality dysfunction plus maladaptive-range traits. This study clarifies relations of depression diagnoses and symptoms with AMPD personality pathology. METHOD Two samples (Ns 402 and 601) of outpatients and community-dwelling adults completed four depression (criteria met for major depressive disorder and dysthymia; dysphoria and low well-being scales), ten trait (two scales for each of five domains-negative affectivity, detachment, disinhibition, antagonism, psychoticism), and eight dysfunction (four scales for each of two domains-self- and interpersonal pathology) measures. Diagnoses were made using a semi-structured interview; other measures were self-reports. We quantified cross-sectional relations between depression and personality pathology with correlation and multiple regression analyses. RESULTS Collectively (median R2; ps < 0.0001), the trait (0.46) and dysfunction (0.50) scales predicted the depression measures strongly, with most predictive power shared (0.41) between traits and dysfunction. However, trait and dysfunction scales altogether predicted depression (median R2 = 0.54) more strongly than either domain alone, ps < 0.0001. Participants with depression diagnoses showed elevations on all nonadaptive trait and personality dysfunction measures, particularly negative temperament/affectivity and self-pathology measures. LIMITATIONS Generalization of findings to other populations (e.g., adolescents), settings (e.g., primary care), and measures (e.g., traditional personality disorder diagnoses) is uncertain. Cross-sectional analyses did not test changes over time or establish causality. CONCLUSIONS The AMPD is highly relevant to depression. Assessment of personality pathology, including both personality dysfunction and maladaptive-range traits, stands to advance understanding of depression in adults.
Collapse
Affiliation(s)
| | | | - Eunyoe Ro
- Southern Illinois University Edwardsville, USA
| | | |
Collapse
|
7
|
Ringwald WR, Hallquist MN, Dombrovski AY, Wright AG. Transdiagnostic Associations With Interpersonal and Affective Variability in Borderline Personality Pathology. J Pers Disord 2022; 36:320-338. [PMID: 35647774 PMCID: PMC9830454 DOI: 10.1521/pedi.2022.36.3.320] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Emotional and behavioral variability are unifying characteristics of borderline personality disorder (BPD). Ambulatory assessment (AA) has been used to quantify this variability in terms of the categorical BPD diagnosis, but evidence suggests that BPD instead reflects general personality pathology. This study aimed to clarify the conceptualization of BPD by mapping indices of variability in affect, interpersonal behavior, and perceptions of others onto general and specific dimensions of personality pathology. A sample of participants who met diagnostic criteria for BPD (n = 129) and healthy controls (n = 47) reported on their daily interactions during a 21-day AA protocol. Multilevel SEM was used to examine associations between shared and specific variance in maladaptive traits with dynamic patterns of functioning. The authors found that variability is an indicator of shared trait variance and Negative Affectivity, not any other specific traits, reinforcing the idea that BPD is best understood as general personality pathology.
Collapse
Affiliation(s)
| | - Michael N. Hallquist
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill
| | | | | |
Collapse
|
8
|
Gutiérrez F, Aluja A, Rodríguez C, Gárriz M, Peri JM, Gallart S, Calvo N, Ferrer M, Gutiérrez-Zotes A, Soler J, Pascual JC. Severity in the ICD-11 personality disorder model: Evaluation in a Spanish mixed sample. Front Psychiatry 2022; 13:1015489. [PMID: 36699492 PMCID: PMC9868964 DOI: 10.3389/fpsyt.2022.1015489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/16/2022] [Indexed: 01/12/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Fernando Gutiérrez
- Institute of Neuroscience, Hospital Clínic of Barcelona, Barcelona, Spain.,Institut d'Investigacións Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Anton Aluja
- Lleida Institute for Biomedical Research Dr. Pifarré Foundation, Lleida, Spain.,Department of Psychology, University of Lleida, Lleida, Spain
| | - Claudia Rodríguez
- Institute of Neuroscience, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Miguel Gárriz
- Neuropsychiatry and Drug Addiction Institute, Parc de Salut Mar, Barcelona, Spain
| | - Josep M Peri
- Institute of Neuroscience, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Salvador Gallart
- Department of Psychiatry, Mental Health, and Addiction, GSS-Hospital Santa Maria, Lleida, Spain
| | - Natalia Calvo
- Department of Psychiatry, Vall d'Hebron University Hospital, Barcelona, Spain.,Network Centre for Biomedical Research in Mental Health (CIBERSAM), Barcelona, Spain.,Psychiatry and Legal Medicine Department, Autonomous University of Barcelona, Barcelona, Spain
| | - Marc Ferrer
- Department of Psychiatry, Vall d'Hebron University Hospital, Barcelona, Spain.,Network Centre for Biomedical Research in Mental Health (CIBERSAM), Barcelona, Spain.,Psychiatry and Legal Medicine Department, Autonomous University of Barcelona, Barcelona, Spain
| | - Alfonso Gutiérrez-Zotes
- Network Centre for Biomedical Research in Mental Health (CIBERSAM), Barcelona, Spain.,Pere Virgili Health Research Institute (IISPV), CERCA, Reus, Spain.,Pere Mata Psychiatric University Hospital, Reus, Spain
| | - Joaquim Soler
- Psychiatry and Legal Medicine Department, Autonomous University of Barcelona, Barcelona, Spain.,Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Juan Carlos Pascual
- Psychiatry and Legal Medicine Department, Autonomous University of Barcelona, Barcelona, Spain.,Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| |
Collapse
|
9
|
Barchi-Ferreira Bel AM, Osório FL. The Personality Inventory for DSM-5: Psychometric Evidence of Validity and Reliability-Updates. Harv Rev Psychiatry 2021; 28:225-237. [PMID: 32692087 DOI: 10.1097/hrp.0000000000000261] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To perform a systematic review of the literature on the psychometric characteristics of different versions of the Personality Inventory for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (PID-5) and to integrate the current findings with those of previous reviews by Al Dajani and colleagues (2015) and Watters and Bagby (2018). METHODS This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses protocol. PubMed, PsycINFO, SciELO, Web of Science, and LILACS were searched using two keywords: personality AND DSM-5. Studies published from 2015 to 2018 were included. RESULTS Sixty-four new studies were evaluated. The PID-5-self-report form (SRF) was concluded to have a factorial structure consisting of five factors and 25 facets, as well as excellent indicators of internal consistency, test-retest reliability, and convergent validity with different personality instruments and with other clinical constructs. The form also has predictive and discriminative potential, warranting further exploration in studies with samples of personality disorders in relation to different parameters and not only the diagnostic algorithm of DSM-5 Section III. The brief and informant versions, although less studied, also showed good psychometric indicators, comparable to the original version. CONCLUSIONS The PID-5 showed psychometric suitability for use in different cultures and contexts. The form's use in clinical practice and as a means of operationalizing the diagnostic evaluation of the DSM-5 dimensional model is promising and should be encouraged.
Collapse
Affiliation(s)
- Ana Maria Barchi-Ferreira Bel
- From the Medical School of Ribeirão Preto, São Paulo University; National Institute for Science and Technology (INCT-TM, CNPq), Brasília, Brazil (Dr. Osório)
| | | |
Collapse
|
10
|
Bach B, Brown TA, Mulder RT, Newton-Howes G, Simonsen E, Sellbom M. Development and initial evaluation of the ICD-11 personality disorder severity scale: PDS-ICD-11. Personal Ment Health 2021; 15:223-236. [PMID: 34002530 DOI: 10.1002/pmh.1510] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/23/2021] [Indexed: 11/07/2022]
Abstract
AIM No measure has formally been developed to assess the published ICD-11 model of Personality Disorder (PD) severity. We therefore set out to develop and evaluate the 14-item Personality Disorder Severity ICD-11 (PDS-ICD-11) scale. METHOD A representative U.S. community sample (N = 428; 50.9% women) and a New Zealand mental health sample (N = 87; 61.5% women) completed the PDS-ICD-11 scale along with a series of established PD and impairment measures. RESULTS Item response theory supported the unidimensionality of PDS-ICD-11 (median item loading of 0.68) and indicated that a PDS-ICD-11 score of 17.5 may serve as a benchmark for pronounced dysfunction. Correlation and regression analyses supported both criterion validity and incremental validity in predicting impairment and PD symptoms. The PDS-ICD-11 was particularly associated with measures of Level of Personality Functioning Scale (LPFS), Global PD severity, and Borderline PD symptom score. A comparison between clinical individuals diagnosed with an ICD-11 PD vs. no PD supported diagnostic validity. CONCLUSION This initial construction study suggests that the PDS-ICD-11 constitutes a promising instrument that provides a quick impression of the severity of personality dysfunction according to the official ICD-11 PD guidelines. Clearly, more research is needed to corroborate its validity and utility. The PDS-ICD-11 scale is provided as online supporting information.
Collapse
Affiliation(s)
- Bo Bach
- Psychiatric Research Unit, Center for Personality Disorder Research, Region Zealand, Slagelse, Denmark
| | - Tiffany A Brown
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Roger T Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Giles Newton-Howes
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Erik Simonsen
- Psychiatric Research Unit, Center for Personality Disorder Research, Region Zealand, Slagelse, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Martin Sellbom
- Department of Psychology, University of Otago, Dunedin, New Zealand
| |
Collapse
|
11
|
Steinert C, Heim N, Leichsenring F. Procrastination, Perfectionism, and Other Work-Related Mental Problems: Prevalence, Types, Assessment, and Treatment-A Scoping Review. Front Psychiatry 2021; 12:736776. [PMID: 34707522 PMCID: PMC8542725 DOI: 10.3389/fpsyt.2021.736776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/09/2021] [Indexed: 11/25/2022] Open
Abstract
Work-related mental problems can be defined as behaviors, emotions and cognitions that impede the successful completion of a task in a given time frame, i. e., the difficulty or inability to achieve important work-related goals. They are highly prevalent but have been neglected in psychology in general and as a target of psychotherapy in particular. Although work-related problems do not represent a mental disorder per se, they are associated with severe distress and high psychosocial costs. In this article, the prevalence of work-related problems, associated burden, diagnostic assessment and treatment are reviewed. So far, research has primarily focused on procrastination, i.e., the act of postponing or delaying tasks until the last minute or past the deadline. However, procrastination represents just one type of work-related problems among several others. Further forms of work-related problems are presented (e.g., perfectionism, or work-related problems in the context of specific personality types). The relation of work-related problems to specific mental disorders is discussed. Psychosocial interventions are the treatment of choice for work-related mental problems. However, response rates for the treatment of procrastination are limited, which calls for further research into which treatments work for whom. No evidence-based treatments are currently available for other types of work-related problems, with the exception of perfectionism, a personality trait that is also linked to problems in the field of work. Thus, there is a need to further improve the treatment of work-related problems including procrastination. For other types of work-related problems, effective treatments need to be developed and validated. They may be based on existing manualized treatments and extended by specific aspects or modules focusing on work-related problems.
Collapse
Affiliation(s)
- Christiane Steinert
- International Psychoanalytic University, Berlin, Germany.,Clinic for Psychosomatics and Psychotherapy, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Nikolas Heim
- Tavistock and Portman NHS Foundation Trust, London, United Kingdom
| | - Falk Leichsenring
- Clinic for Psychosomatics and Psychotherapy, Justus-Liebig-University of Giessen, Giessen, Germany.,Clinic of Psychosomatic Medicine and Psychotherapy, University of Rostock, Rostock, Germany
| |
Collapse
|
12
|
Sharp C, Wall K. DSM-5 Level of Personality Functioning: Refocusing Personality Disorder on What It Means to Be Human. Annu Rev Clin Psychol 2020; 17:313-337. [PMID: 33306924 DOI: 10.1146/annurev-clinpsy-081219-105402] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
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.
Collapse
Affiliation(s)
- Carla Sharp
- Department of Psychology, University of Houston, Houston, Texas 77204, USA; ,
| | - Kiana Wall
- Department of Psychology, University of Houston, Houston, Texas 77204, USA; ,
| |
Collapse
|
13
|
Body Dysmorphic Disorder in the Perspective of the Alternative DSM-5 Model for Personality Disorder: A Study on Italian Community-Dwelling Women. J Nerv Ment Dis 2020; 208:974-981. [PMID: 32947452 DOI: 10.1097/nmd.0000000000001239] [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] [Indexed: 11/25/2022]
Abstract
To evaluate the relationships between body dysmorphic disorder (BDD) and Alternative DSM-5 Model for Personality Disorder (AMPD) criterion A and dysfunctional personality trait (i.e., criterion B) measures, 420 Italian community-dwelling women were administered three measures of BDD (i.e., the Body Dysmorphic Disorder Questionnaire, the Body Dysmorphic Disorder-Dimensional Scale, and the Appearance Anxiety Inventory), as well as the Level of Personality Functioning Scale-Brief Form (LPFS-BF) and the Personality Inventory for DSM-5-Short Form (PID-5-SF). The three BDD measures showed substantial convergent validity correlations and could be reliably cumulated to obtain the BDD Cumulative Index (BDDCI). Several significant, nonnegligible correlations were observed between the BDDCI as well as the LPFS-BF scale scores and PID-5-SF personality trait scale scores. Relative importance weight analysis results showed that LPFS-BF scale scores and PID-5-SF trait scale scores were substantial predictors of the BDDCI scores (R = 0.42, f = 0.72). In particular, AMPD criterion A impairment in self-functioning and AMPD criterion B depressivity, anhedonia, perseveration, separation insecurity, and cognitive and perceptual dysregulation were core components of the dysfunctional personality profile associated with BDD.
Collapse
|
14
|
Obbarius A, Ehrenthal JC, Fischer F, Liegl G, Obbarius N, Sarrar L, Rose M. Applying Item Response Theory to the OPD Structure Questionnaire: Identification of a Unidimensional Core Construct and Feasibility of Computer Adaptive Testing. J Pers Assess 2020; 103:645-658. [PMID: 33052064 DOI: 10.1080/00223891.2020.1828435] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
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.
Collapse
Affiliation(s)
- Alexander Obbarius
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, California
| | - Johannes C Ehrenthal
- Center for Psychosocial Medicine, Institute of Medical Psychology, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix Fischer
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Gregor Liegl
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nina Obbarius
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lea Sarrar
- Department of Psychology, Medical School Berlin, Berlin, Germany.,Department of Audiology and Phoniatrics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Rose
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Quantitative Health Sciences, Medical School, University of Massachusetts, Amherst, Massachusetts
| |
Collapse
|
15
|
Clark LA, Nuzum H, Shapiro JL, Vanderbleek EN, Daly EJ, Simons AD, Ro E. Personality profiles as potential targets for intervention: Identification and replication. Personal Ment Health 2020; 14:142-163. [PMID: 31343113 DOI: 10.1002/pmh.1455] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/04/2019] [Accepted: 05/13/2019] [Indexed: 01/07/2023]
Abstract
The alternative dimensional model of personality disorder (PD) diagnosis, based on personality-functioning impairment and pathological traits, opens the door for tailoring treatments to individuals with more homogeneous personality profiles than diagnostic categories. Such a transdiagnostic PD treatment approach requires robust, replicable, personality-relevant dimensions, which we found using a large battery of self-report measures: Self-pathology and negative affectivity (NA) traits, interpersonal pathology and detachment traits, and interpersonal pathology and antagonism traits. Using these dimensions, we identified three groups that had, respectively, elevations on (1) all three dimensions, (2) self-pathology/NA (with/without interpersonal-pathology elevation(s)) and (3) either or both interpersonal-pathology dimensions, without elevated self-pathology/NA. Using the same personality-functioning measures and a half-overlapping trait set, we replicated these profiles in an additional sample. Interview-based measures of functioning and personality pathology provided external validity evidence for the method, suggesting it represents a critical first step towards treatment research targeting transdiagnostic processes rather than diagnoses. For example, two groups might benefit from treatments focused, respectively, on emotional dysregulation and interpersonal relations, whereas the multiple-problem group may need a sequenced treatment approach. Research is needed to test these hypotheses and to expand the method to include a wider range of pathological personality traits. © 2019 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Lee Anna Clark
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Hallie Nuzum
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Jaime L Shapiro
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | | | - Elizabeth J Daly
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Anne D Simons
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Eunyoe Ro
- Southern Illinois University Edwardsville, Edwardsville, IL, USA
| |
Collapse
|
16
|
WAKABAYASHI A. ARE PERSONALITY DISORDERS EXTREME VARIANTS OF NORMAL PERSONALITY?: QUERIES ABOUT THE VALIDITY OF THE FIVE-FACTOR MODEL OF PERSONALITY TO DIAGNOSE PERSONALITY DISORDER. PSYCHOLOGIA 2020. [DOI: 10.2117/psysoc.2020-b002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
17
|
Allen TA, DeYoung CG, Bagby RM, Pollock BG, Quilty LC. A Hierarchical Integration of Normal and Abnormal Personality Dimensions: Structure and Predictive Validity in a Heterogeneous Sample of Psychiatric Outpatients. Assessment 2019; 27:643-656. [PMID: 31729250 DOI: 10.1177/1073191119887442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hierarchical, quantitative models of psychopathology focus primarily on higher-order constructs, whereas less is known about the structure and content comprising lower-order dimensions of psychopathology. Here, we address this gap in the literature by using targeted factor analysis to integrate the 25 maladaptive facet-level traits of the Personality Inventory for Diagnostic and Statistical Manual of Mental Disorder-Fifth edition and the 10 aspect-level traits of the normal personality hierarchy within a sample of 198 psychiatric outpatients. A 10-factor solution replicated previous work, with each of the 10 aspects primarily characterizing only one factor. In addition, the 10 factors differentially predicted a range of diagnoses, including alcohol use disorder, major depression, panic disorder, social anxiety, and borderline and avoidant personality disorders. Our results suggest that research on the development, causes, and structure of lower-order traits within the normal personality hierarchy may serve as an important guide to research on the causes and structure of maladaptive personality.
Collapse
Affiliation(s)
| | | | - R Michael Bagby
- University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Bruce G Pollock
- University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Lena C Quilty
- University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| |
Collapse
|
18
|
Evaluating the role of functional impairment in personality psychopathology. Psychiatry Res 2018; 270:1017-1026. [PMID: 29609984 DOI: 10.1016/j.psychres.2018.03.049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 03/20/2018] [Accepted: 03/21/2018] [Indexed: 11/22/2022]
Abstract
DSM-5's Section III Alternative Model for Personality Disorder (AMPD) model states that an individual must show impairment in self and interpersonal functioning for PD diagnosis. The current study investigated dimensional personality trait associations with impairment, including differential patterns of impairment across specific PDs, and whether traits have improved our assessment of functional impairment in PDs. Two-hundred and seventy-seven participants were administered measures of Antisocial PD, Avoidant PD, Borderline PD, Narcissistic PD, Obsessive-Compulsive PD, and Schizotypal PD from the perspectives of Section II (PDQ-4) and Section III (PID-5) PD models, as well as measures of functional impairment in interpersonal and intrapersonal domains. Pearson correlations showed associations between ratings of impairment and most Section II and Section III PDs and trait facets, with the exception of narcissistic PD. Hierarchical regression analyses revealed that Section III PDs added predictive validity beyond Section II PDs in predicting impairment, except narcissistic PD. These findings provide support both for the impairment criterion in the AMPD and for the association between trait-based PDs and impairment, and suggest that this trait-based measurement adds uniquely to the understanding of functional impairment.
Collapse
|
19
|
Sleep CE, Wygant DB, Miller JD. Examining the Incremental Utility of DSM-5 Section III Traits and Impairment in Relation to Traditional Personality Disorder Scores in a Female Correctional Sample. J Pers Disord 2018; 32:738-752. [PMID: 28972814 DOI: 10.1521/pedi_2017_31_320] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Personality disorders (PDs) are challenging to assess and are associated with great individual and societal costs. In response to the limitations of categorical models, the DSM-5 included an alternative model (i.e., Section III), which uses impairment (Criterion A) and pathological traits (Criterion B) to diagnose PDs. Although numerous studies have illustrated dimensional trait models' ability to capture personality psychopathology, less attention has been paid to personality impairment. The present investigation sought to examine Criterion A's ability to contribute incrementally to the prediction of antisocial (ASPD), borderline (BPD), and narcissistic personality disorders (NPD), and Interpersonal-Affective (F1) and Impulsive-Antisocial (F2) features of psychopathy. The current study used 200 female inmates and found that impairment contributed to the prediction of BPD, NPD, and psychopathy F1 scores and did not add to the prediction of ASPD and psychopathy F2 scores. Difficulties in distinguishing between personality impairment and personality disordered traits are discussed.
Collapse
Affiliation(s)
| | - Dustin B Wygant
- Department of Psychology, Eastern Kentucky University, Richmond, Kentucky
| | | |
Collapse
|
20
|
Zimmerman M, Morgan TA, Stanton K. The severity of psychiatric disorders. World Psychiatry 2018; 17:258-275. [PMID: 30192110 PMCID: PMC6127765 DOI: 10.1002/wps.20569] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 06/13/2018] [Accepted: 06/13/2018] [Indexed: 12/19/2022] Open
Abstract
The issue of the severity of psychiatric disorders has great clinical importance. For example, severity influences decisions about level of care, and affects decisions to seek government assistance due to psychiatric disability. Controversy exists as to the efficacy of antidepressants across the spectrum of depression severity, and whether patients with severe depression should be preferentially treated with medication rather than psychotherapy. Measures of severity are used to evaluate outcome in treatment studies and may be used as meaningful endpoints in clinical practice. But, what does it mean to say that someone has a severe illness? Does severity refer to the number of symptoms a patient is experiencing? To the intensity of the symptoms? To symptom frequency or persistence? To the impact of symptoms on functioning or on quality of life? To the likelihood of the illness resulting in permanent disability or death? Putting aside the issue of how severity should be operationalized, another consideration is whether severity should be conceptualized similarly for all illnesses or be disorder specific. In this paper, we examine how severity is characterized in research and contemporary psychiatric diagnostic systems, with a special focus on depression and personality disorders. Our review shows that the DSM-5 has defined the severity of various disorders in different ways, and that researchers have adopted a myriad of ways of defining severity for both depression and personality disorders, although the severity of the former was predominantly defined according to scores on symptom rating scales, whereas the severity of the latter was often linked with impairments in functioning. Because the functional impact of symptom-defined disorders depends on factors extrinsic to those disorders, such as self-efficacy, resilience, coping ability, social support, cultural and social expectations, as well as the responsibilities related to one's primary role function and the availability of others to assume those responsibilities, we argue that the severity of such disorders should be defined independently from functional impairment.
Collapse
Affiliation(s)
- Mark Zimmerman
- Department of Psychiatry and Human BehaviorBrown University School of Medicine, Rhode Island HospitalProvidenceRIUSA
| | - Theresa A. Morgan
- Department of Psychiatry and Human BehaviorBrown University School of Medicine, Rhode Island HospitalProvidenceRIUSA
| | - Kasey Stanton
- Department of Psychiatry and Human BehaviorBrown University School of Medicine, Rhode Island HospitalProvidenceRIUSA
| |
Collapse
|
21
|
Ro E, Watson D, Clark LA. Domains of psychosocial disability and mental disorders. J Clin Psychol 2018; 74:2082-2093. [DOI: 10.1002/jclp.22650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 04/02/2018] [Accepted: 05/15/2018] [Indexed: 01/07/2023]
Affiliation(s)
- Eunyoe Ro
- Southern Illinois University Edwardsville
| | | | | |
Collapse
|
22
|
Widiger TA, Bach B, Chmielewski M, Clark LA, DeYoung C, Hopwood CJ, Kotov R, Krueger RF, Miller JD, Morey LC, Mullins-Sweatt SN, Patrick CJ, Pincus AL, Samuel DB, Sellbom M, South SC, Tackett JL, Watson D, Waugh MH, Wright AGC, Zimmermann J, Bagby RM, Cicero DC, Conway CC, De Clercq B, Docherty AR, Eaton NR, Forbush KT, Haltigan JD, Ivanova MY, Latzman RD, Lynam DR, Markon KE, Reininghaus U, Thomas KM. Criterion A of the AMPD in HiTOP. J Pers Assess 2018; 101:345-355. [PMID: 29746190 DOI: 10.1080/00223891.2018.1465431] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The categorical model of personality disorder classification in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM-5]; American Psychiatric Association, 2013 ) is highly and fundamentally problematic. Proposed for DSM-5 and provided within Section III (for Emerging Measures and Models) was the Alternative Model of Personality Disorder (AMPD) classification, consisting of Criterion A (self-interpersonal deficits) and Criterion B (maladaptive personality traits). A proposed alternative to the DSM-5 more generally is an empirically based dimensional organization of psychopathology identified as the Hierarchical Taxonomy of Psychopathology (HiTOP; Kotov et al., 2017 ). HiTOP currently includes, at the highest level, a general factor of psychopathology. Further down are the five domains of detachment, antagonistic externalizing, disinhibited externalizing, thought disorder, and internalizing (along with a provisional sixth somatoform dimension) that align with Criterion B. The purpose of this article is to discuss the potential inclusion and placement of the self-interpersonal deficits of the DSM-5 Section III Criterion A within HiTOP.
Collapse
Affiliation(s)
| | - Bo Bach
- b Psychiatric Research Unit, Slagelse Psychiatric Hospital , Slagelse , Denmark
| | | | | | - Colin DeYoung
- e Department of Psychology , University of Minnesota
| | | | - Roman Kotov
- g Department of Psychiatry , Stony Brook University
| | | | | | | | | | | | - Aaron L Pincus
- l Department of Psychology , Pennsylvania State University
| | | | - Martin Sellbom
- n Department of Psychology , University of Otago , Dunedin , New Zealand
| | - Susan C South
- m Department of Psychological Sciences , Purdue University
| | | | - David Watson
- d Department of Psychology , University of Notre Dame
| | - Mark H Waugh
- p Department of Psychology , University of Tennessee
| | | | | | - R Michael Bagby
- s Departments of Psychology and Psychiatry , University of Toronto , Toronto , Canada
| | - David C Cicero
- t Department of Psychology , University of Hawaii at Manoa
| | | | - Barbara De Clercq
- v Department of Developmental, Personality, and Social Psychology Ghent University , Ghent , Belgium
| | | | | | | | - J D Haltigan
- z Department of Psychiatry , University of Toronto , Toronto , Canada
| | | | | | - Donald R Lynam
- m Department of Psychological Sciences , Purdue University
| | | | - Ulrich Reininghaus
- ad Department of Psychiatry and Psychology , Masstricht University , Maastricht , The Netherlands , and Institute of Psychiatry, Psychology, and Neuroscience, King's College , London
| | | |
Collapse
|
23
|
Hopwood CJ, Good EW, Morey LC. Validity of the DSM-5 Levels of Personality Functioning Scale-Self Report. J Pers Assess 2018; 100:650-659. [PMID: 29424568 DOI: 10.1080/00223891.2017.1420660] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In this study we examined the structure, reliability, and validity of the Levels of Personality Functioning Scale-Self Report (LPFS-SR) in 3 large community samples. The LPFS-SR is a questionnaire with content that corresponds directly to the DSM-5 alternative model of personality disorders, Criterion A. We found that the LPFS-SR was highly reliable across a brief retest interval. LPFS-SR scores correlated substantially with a wide range of maladaptive personality traits, personality disorder constructs, and interpersonal problems. The LPFS-SR did not correlate as strongly with aspects of personality with less clear relations to distress and dysfunction. Data further support that identity, self-direction, intimacy, and empathy components of the LPFS-SR can be characterized by a single factor and have similar correlations with criterion variables, consistent with the hypothesis that DSM-5 Criterion A is a relatively homogeneous construct. Overall, these results support the validity of the LPFS-SR, highlight important issues in assessing personality pathology, and point toward novel avenues for research on personality disorder classification.
Collapse
Affiliation(s)
| | - Evan W Good
- b Department of Psychology , Michigan State University
| | | |
Collapse
|
24
|
Thimm JC. The Norwegian Computerized Adaptive Test of Personality Disorder-Static Form (CAT-PD-SF): Reliability, Factor Structure, and Relationships With Personality Functioning. Assessment 2017; 27:585-595. [PMID: 29281896 DOI: 10.1177/1073191117749296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Computerized Adaptive Test of Personality Disorder-Static Form (CAT-PD-SF) is a self-report inventory developed to assess pathological personality traits. The current study explored the reliability and higher order factor structure of the Norwegian version of the CAT-PD-SF and the relationships between the CAT-PD traits and domains of personality functioning in an undergraduate student sample (N = 375). In addition to the CAT-PD-SF, the short form of the Severity Indices of Personality Problems and the Brief Symptom Inventory were administered. The results showed that the Norwegian CAT-PD-SF has good score reliability. Factor analysis of the CAT-PD-SF scales indicated five superordinate factors that correspond to the trait domains of the alternative DSM-5 model for personality disorders. The CAT-PD traits were highly predictive of impaired personality functioning after controlling for psychological distress. It is concluded that the CAT-PD-SF is a promising tool for the assessment of personality disorder traits.
Collapse
Affiliation(s)
- Jens C Thimm
- UiT The Arctic University of Norway, Tromsø, Norway
| |
Collapse
|
25
|
Sellbom M, Carmichael KLC, Liggett J. Examination of DSM-5 Section III avoidant personality disorder in a community sample. Personal Ment Health 2017; 11:299-313. [PMID: 28703479 DOI: 10.1002/pmh.1388] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 06/06/2017] [Accepted: 06/08/2017] [Indexed: 01/01/2023]
Abstract
The current research evaluated the continuity between DSM-5 Section II and Section III diagnostic operationalizations of avoidant personality disorder (AvPD). More specifically, the study had three aims: (1) to examine which personality constructs comprise the optimal trait constellation for AvPD; (2) to investigate the utility of the proposed structure of the Section III AvPD diagnosis, in regard to combining functional impairment (criterion A) and a dimensional measure of personality (criterion B) variables; and (3) to determine whether AvPD-specific impairment confers incremental meaningful contribution above and beyond general impairment in personality functioning. A mixed sample of 402 university and community participants was recruited, and they were administered multiple measures of Section II PD, personality traits, and personality impairment. A latent measurement model approach was used to analyse data. Results supported the general continuity between Section II and Section III of the DSM-5; however, three of the four main criterion B traits were the stronger predictors. There was also some support for the trait unassertiveness augmenting the criterion B trait profile. The combination of using functional impairment criteria (criterion A) and dimensional personality constructs (criterion B) in operationalizing AvPD was supported; however, the reliance of disorder-specific over general impairment for criterion A was not supported. Copyright © 2017 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Martin Sellbom
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | | | - Jacqueline Liggett
- Research School of Psychology, Australian National University, Canberra, Australia
| |
Collapse
|
26
|
Fossati A, Somma A, Borroni S, Miller JD. Assessing Dimensions of Pathological Narcissism: Psychometric Properties of the Short Form of the Five-Factor Narcissism Inventory in a Sample of Italian University Students. J Pers Assess 2017; 100:250-258. [DOI: 10.1080/00223891.2017.1324457] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Andrea Fossati
- Faculty of Psychology, Vita-Salute San Raffaele University, Milan, Italy
- Clinical Psychology and Psychotherapy Unit, San Raffaele Turro Hospital, Milan, Italy
| | - Antonella Somma
- Faculty of Psychology, Vita-Salute San Raffaele University, Milan, Italy
- Clinical Psychology and Psychotherapy Unit, San Raffaele Turro Hospital, Milan, Italy
| | - Serena Borroni
- Faculty of Psychology, Vita-Salute San Raffaele University, Milan, Italy
- Clinical Psychology and Psychotherapy Unit, San Raffaele Turro Hospital, Milan, Italy
| | | |
Collapse
|
27
|
Carmichael KLC, Sellbom M, Liggett J, Smith A. A personality and impairment approach to examine the similarities and differences between avoidant personality disorder and social anxiety disorder. Personal Ment Health 2016; 10:337-347. [PMID: 27653504 DOI: 10.1002/pmh.1349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 06/06/2016] [Accepted: 08/24/2016] [Indexed: 11/08/2022]
Abstract
The current study examined whether avoidant personality disorder (AvPD) and social anxiety disorder (SAD) should be considered distinct disorder constructs, which is a persistent and controversial issue in the clinical literature. We examined whether relative scores on SAD and AvPD were associated with the same personality profile and severity of impairment. The current research used a cross-sectional design and self-report inventories, including multiple measures of personality, impairment and psychopathology. Results from a mixed sample of 402 university and community participants found that scores on AvPD and SAD were similarly associated with personality traits and impairment indices. Moreover, a latent construct accounting for the shared variance for AvPD and SAD was associated with personality traits and impairment, whereas the residuals representing the uniquenesses of these disorder constructs were not. These findings support the view that AvPD and SAD are similar disorders from a phenotypic personality trait and impairment perspective. These findings are contrary to a prevalent view in the literature, known as severity continuum hypothesis, because the two disorders could not be meaningfully differentiated based on severity of impairment. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Kieran L C Carmichael
- Research School of Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Martin Sellbom
- Research School of Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia.
| | - Jacqueline Liggett
- Research School of Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Alexander Smith
- Research School of Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia
| |
Collapse
|
28
|
Wright AGC, Hopwood CJ, Skodol AE, Morey LC. Longitudinal validation of general and specific structural features of personality pathology. JOURNAL OF ABNORMAL PSYCHOLOGY 2016; 125:1120-1134. [PMID: 27819472 PMCID: PMC5119768 DOI: 10.1037/abn0000165] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Theorists have long argued that personality disorder (PD) is best understood in terms of general impairments shared across the disorders as well as more specific instantiations of pathology. A model based on this theoretical structure was proposed as part of the DSM-5 revision process. However, only recently has this structure been subjected to formal quantitative evaluation, with little in the way of validation efforts via external correlates or prospective longitudinal prediction. We used the Collaborative Longitudinal Study of Personality Disorders dataset to: (a) estimate structural models that parse general from specific variance in personality disorder features, (b) examine patterns of growth in general and specific features over the course of 10 years, and (c) establish concurrent and dynamic longitudinal associations in PD features and a host of external validators including basic personality traits and psychosocial functioning scales. We found that general PD exhibited much lower absolute stability and was most strongly related to broad markers of psychosocial functioning, concurrently and longitudinally, whereas specific features had much higher mean stability and exhibited more circumscribed associations with functioning. However, both general and specific factors showed recognizable associations with normative and pathological traits. These results can inform efforts to refine the conceptualization and diagnosis of personality pathology. (PsycINFO Database Record
Collapse
|
29
|
How temperament and character affect our career, relationships, and mental health. Compr Psychiatry 2016; 70:181-9. [PMID: 27565773 DOI: 10.1016/j.comppsych.2016.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/29/2016] [Accepted: 07/31/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND On the way toward an agreed dimensional taxonomy for personality disorders (PD), several pivotal questions remain unresolved. We need to know which dimensions produce problems and in what domains of life; whether impairment can be found at one or both extremes of each dimension; and whether, as is increasingly advocated, some dimensions measure personality functioning whereas others reflect style. METHOD To gain this understanding, we administered the Temperament and Character Inventory to a sample of 862 consecutively attended outpatients, mainly with PDs (61.2%). Using regression analysis, we examined the ability of personality to predict 39 variables from the Life Outcome Questionnaire concerning career, relationships, and mental health. RESULTS Persistence stood out as the most important dimension regarding career success, with 24.2% of explained variance on average. Self-directedness was the best predictor of social functioning (21.1%), and harm avoidance regarding clinical problems (34.2%). Interpersonal dimensions such as reward dependence and cooperativeness were mostly inconsequential. In general, dimensions were detrimental only in one of their poles. CONCLUSIONS Although personality explains 9.4% of life problems overall, dimensions believed to measure functioning (character) were not better predictors than those measuring style (temperament). The notion that PD diagnoses can be built upon the concept of "personality functioning" is unsupported.
Collapse
|
30
|
Liggett J, Carmichael KLC, Smith A, Sellbom M. Validation of Self-Report Impairment Measures for Section III Obsessive–Compulsive and Avoidant Personality Disorders. J Pers Assess 2016; 99:1-14. [DOI: 10.1080/00223891.2016.1185613] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
31
|
Fossati A, Somma A, Borroni S, Markon KE, Krueger RF. The Personality Inventory for DSM-5 Brief Form: Evidence for Reliability and Construct Validity in a Sample of Community-Dwelling Italian Adolescents. Assessment 2015; 24:615-631. [PMID: 26676917 DOI: 10.1177/1073191115621793] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To assess the reliability and construct validity of the Personality Inventory for DSM-5 Brief Form (PID-5-BF) among adolescents, 877 Italian high school students were administered the PID-5-BF. Participants were administered also the Measure of Disordered Personality Functioning (MDPF) as a criterion measure. In the full sample, Cronbach's alpha values for the PID-5-BF scales ranged from .59 (Detachment) to .77 (Psychoticism); in addition, all PID-5-BF scales showed mean interitem correlation values in the .22 to .40 range. Cronbach's alpha values for the PID-5-BF total score was .83 (mean interitem r = .16). Although 2-month test-retest reliability could be assessed only in a small ( n = 42) subsample of participants, all PID-5-BF scale scores showed adequate temporal stability, as indexed by intraclass r values ranging from .78 (Negative Affectivity) to .97 (Detachment), all ps <.001. Exploratory structural equation modeling analyses provided at least moderate support for the a priori model of PID-5-BF items. Multiple regression analyses showed that PID-5-BF scales predicted a nonnegligible amount of variance in MDPF Non-Cooperativeness, adjusted R2 = .17, p < .001, and Non-Coping scales, adjusted R2 = .32, p < .001. Similarly, the PID-5-BF total score was a significant predictor of both MDPF Non-Coping, and Non-Cooperativeness scales.
Collapse
Affiliation(s)
- Andrea Fossati
- 1 LUMSA University, Rome, Italy.,2 San Raffaele Hospital, Milan, Italy
| | - Antonella Somma
- 1 LUMSA University, Rome, Italy.,2 San Raffaele Hospital, Milan, Italy
| | - Serena Borroni
- 2 San Raffaele Hospital, Milan, Italy.,3 Vita-Salute San Raffaele University, Milan, Italy
| | | | | |
Collapse
|
32
|
The Brave New World of Personality Disorder-Trait Specified: Effects of Additional Definitions on Coverage, Prevalence, and Comorbidity. ACTA ACUST UNITED AC 2015; 2:52-82. [PMID: 26097740 DOI: 10.5127/pr.036314] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The alternative dimensional model for personality disorder (PD) in DSM-5, Section III (DSM-5-III) includes two main criteria: (A) personality-functioning impairment, and (B) personality-trait pathology; provides specific functioning-and-trait criteria for six PD-type diagnoses; and introduces PD-trait specified (PD-TS), which requires meeting the general PD criteria and not meeting criteria for any specific PD type. We termed this Simple PD-TS and developed two additional definitions: Mixed PD-TS, meeting criteria for one or two PD types and having five or more additional pathological traits; and Complex PD-TS, meeting criteria for three or more PD types. In a mixed sample of 165 outpatients and 215 community adults screened to be at high-risk for PD, we investigated the effect of these additional definitions on prevalence, coverage, comorbidity, and within-diagnosis heterogeneity, and conclude that eliminating the PD-type diagnoses and thus having PD-TS as the only PD diagnosis would be both more parsimonious and more useful clinically.
Collapse
|
33
|
Krueger RF, Hopwood CJ, Wright AGC, Markon KE. DSM‐5 and the path toward empirically based and clinically useful conceptualization of personality and psychopathology. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/cpsp.12073] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
34
|
Carr WA. The impact of personality disorders on legally supervised community treatment: a systematic literature review. Community Ment Health J 2014; 50:664-72. [PMID: 24068584 DOI: 10.1007/s10597-013-9649-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 08/24/2013] [Indexed: 11/25/2022]
Abstract
Mental health needs are common among community corrections offenders and many are enrolled in some form of supervised or mandated treatment. One category of mental health problem which may be germane to both treatment completion and recidivism among those in legally supervised treatment is the diagnosis of Personality Disorder (PD). This systematic review reports on sixteen studies comprised of full or mixed legally-supervised samples of offender in community-based treatment and examines the impact of PDs on treatment completion. These studies were difficult to compare because of the differences in program setting, definition of treatment completion, definition of PD, method of PD assessment and type of treatment, among other variables. The impact of antisocial personality disorder in treatment was a common focus, and other PDs were rarely assessed. The relevance of DSM PD categories to offender management in community corrections as well as the limitations of the current PD diagnostic categories is discussed.
Collapse
Affiliation(s)
- W Amory Carr
- Department of Psychology, University of New Haven, 300 Boston Post Road, West Haven, CT, 06516, USA,
| |
Collapse
|
35
|
Abstract
The essential features of the general criteria for personality disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), are based on impairments in self and interpersonal functioning (criterion A) and pathological personality traits (criterion B). The current study investigated the relationship between criteria A and B in a German psychiatric sample (N = 149). Criterion A was measured by the General Assessment of Personality Disorder (GAPD); criterion B, by the Dimensional Assessment of Personality Pathology (DAPP) and the Revised NEO Personality Inventory (NEO-PI-R). There was a significant relationship between the GAPD, the DAPP, and the NEO-PI-R. The DAPP and NEO-PI-R domains increased the predictive validity of the GAPD (by 7.5% and 14.6%, respectively). The GAPD increased the variance explained by the DAPP by 1.5% and by the NEO-PI-R by 6.5%. The results suggest a substantial relationship between criteria A and B. Criterion B shows incremental validity over criterion A but criterion A only in part over criterion B. Future research should investigate whether it is possible to assess functional impairment apart from personality traits.
Collapse
|
36
|
Calabrese WR, Simms LJ. Prediction of daily ratings of psychosocial functioning: can ratings of personality disorder traits and functioning be distinguished? Personal Disord 2014; 5:314-22. [PMID: 24730507 DOI: 10.1037/per0000071] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Current categorical and dimensional conceptualizations of personality disorder (PD) typically confound pathological PD traits with distress and impairment (dysfunction). The current study examines whether dimensions of personality pathology and psychosocial dysfunction can be psychometrically distinguished. To that end, we collected self-report ratings of personality pathology and dysfunction at baseline, along with daily ratings of dysfunctional behavior, over 10 consecutive days. Correlations revealed substantial overlap between traits and dysfunction measured at baseline. However, follow-up hierarchical regressions revealed that baseline dysfunction ratings incrementally predicted daily dysfunction ratings after accounting for personality trait ratings, suggesting that traits and dysfunction are at least partially differentiable. However, the incremental effects were stronger for some dysfunction domains (i.e., Self-Mastery and Basic Functioning) than for others (Well-Being and Interpersonal), suggesting that maladaptive trait measures are more confounded with the latter types of impairment. These findings suggest that distinguishing maladaptive PD traits from functioning in PD classification systems is likely more difficult than would be expected, a finding that has important implications for the competing Section II and Section III conceptualizations of PD presented in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.
Collapse
Affiliation(s)
- William R Calabrese
- Department of Psychology, University at Buffalo, The State University of New York
| | - Leonard J Simms
- Department of Psychology, University at Buffalo, The State University of New York
| |
Collapse
|
37
|
Clark LA, Ro E. Three-pronged assessment and diagnosis of personality disorder and its consequences: personality functioning, pathological traits, and psychosocial disability. Personal Disord 2014; 5:55-69. [PMID: 24588062 PMCID: PMC4316724 DOI: 10.1037/per0000063] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The alternative dimensional model of personality disorder (PD) in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5; American Psychiatric Association, 2013), Section III, has two main criteria: impairment in personality functioning and one or more pathological personality traits. The former is defined as disturbances in self-functioning (viz., identity, self-direction), and/or interpersonal functioning (viz., empathy, intimacy). Distinguishing personality functioning and traits is important conceptually, because simply having extreme traits is not necessarily pathological. However, adding personality functioning to PD diagnosis represents an empirical challenge, because the constructs overlap conceptually. Further, there is debate regarding whether diagnosis of mental disorder requires either distress or disability, concepts that also overlap with maladaptive-range personality traits and personality dysfunction. We investigated interrelations among these constructs using multiple self-report measures of each domain in a mixed community-patient sample (N = 402). We examined the structures of functioning (psychosocial disability and personality) and personality traits, first independently, then jointly. The disability/functioning measures yielded the 3 dimensions we have found previously (Ro & Clark, 2013). Trait measures had a hierarchical structure which, at the 5-factor level, reflected neuroticism/negative affectivity (N/NA), (low) sociability, disinhibition, (dis)agreeableness, and rigid goal engagement. When all measures were cofactored, a hierarchical structure again emerged which, at the 5-factor level, included (a) internalizing (N/NA and self-pathology vs. quality-of-life/satisfaction); (b) externalizing (social/interpersonal dysfunction, low sociability, and disagreeableness); (c) disinhibition; (d) poor basic functioning; and (e) rigid goal engagement. Results are discussed in terms of developing an integrated PD diagnostic model.
Collapse
Affiliation(s)
| | - Eunyoe Ro
- Department of Psychology, University of Notre Dame
| |
Collapse
|
38
|
Berghuis H, Kamphuis JH, Verheul R. Specific personality traits and general personality dysfunction as predictors of the presence and severity of personality disorders in a clinical sample. J Pers Assess 2013; 96:410-6. [PMID: 24111812 DOI: 10.1080/00223891.2013.834825] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study examined the associations of specific personality traits and general personality dysfunction in relation to the presence and severity of Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) personality disorders in a Dutch clinical sample. Two widely used measures of specific personality traits were selected, the Revised NEO Personality Inventory as a measure of normal personality traits, and the Dimensional Assessment of Personality Pathology-Basic Questionnaire as a measure of pathological traits. In addition, 2 promising measures of personality dysfunction were selected, the General Assessment of Personality Disorder and the Severity Indices of Personality Problems. Theoretically predicted associations were found between the measures, and all measures predicted the presence and severity of DSM-IV personality disorders. The combination of general personality dysfunction models and personality traits models provided incremental information about the presence and severity of personality disorders, suggesting that an integrative approach of multiple perspectives might serve comprehensive assessment of personality disorders.
Collapse
Affiliation(s)
- Han Berghuis
- a GGz Centraal , Innova , Amersfoort , The Netherlands
| | | | | |
Collapse
|
39
|
Hentschel AG, Livesley WJ. The General Assessment of Personality Disorder (GAPD): Factor Structure, Incremental Validity of Self-Pathology, and Relations toDSM–IVPersonality Disorders. J Pers Assess 2013; 95:479-85. [DOI: 10.1080/00223891.2013.778273] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
40
|
Abstract
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.
Collapse
Affiliation(s)
- Christopher J Hopwood
- Department of Psychology, Michigan State University, East Lansing, MI 48824-1116, USA.
| | | | | | | |
Collapse
|
41
|
Berghuis H, Kamphuis JH, Verheul R. Core features of personality disorder: differentiating general personality dysfunctioning from personality traits. J Pers Disord 2012; 26:704-16. [PMID: 23013339 DOI: 10.1521/pedi.2012.26.5.704] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The distinction between general personality dysfunctioning (GPD) and specific personality traits (SPT) is an important focus of attention in the proposed revisions of the DSM-5. The present study explores the distinction between GPD and SPT using the self-report questionnaires General Assessment of Personality Disorder (GAPD) and Severity Indices for Personality Problems (SIPP-118) to measure GPD, and the NEO-PI-R to measure SPT. The sample consisted of 424 psychiatric patients. Using principal component analysis, GPD and SPT appeared to be clearly distinct components of personality. Our GPD model consisted of three factors, i.e., Self-identity dysfunctioning, Relational dysfunctioning, and Prosocial functioning. This model remained by and large intact when combined with SFT factors. Our findings support the distinction between personality traits and personality dysfunction laid down in the recent proposal by the Personality and Personality Disorders Work Group of the DSM-5 Task Force.
Collapse
Affiliation(s)
- Han Berghuis
- GGz Centraal Psychiatric Center, Amersfoort, The Netherlands.
| | | | | |
Collapse
|
42
|
Berghuis H, Kamphuis JH, Verheul R, Larstone R, Livesley J. The General Assessment of Personality Disorder (GAPD) as an instrument for assessing the core features of personality disorders. Clin Psychol Psychother 2012; 20:544-57. [PMID: 22915478 DOI: 10.1002/cpp.1811] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 07/02/2012] [Accepted: 07/09/2012] [Indexed: 11/12/2022]
Abstract
UNLABELLED This study presents a psychometric evaluation of the General Assessment of Personality Disorder (GAPD), a self-report questionnaire for assessing the core components of personality dysfunction on the basis of Livesley's (2003) adaptive failure model. Analysis of samples from a general (n = 196) and a clinical population (n = 280) from Canada and the Netherlands, respectively, found a very similar two-component structure consistent with the two core components of personality dysfunction proposed by the model, namely, self-pathology and interpersonal dysfunction. Moreover, the GAPD discriminated between patients diagnosed with and without Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV-TR) personality disorder(s) and demonstrated discriminative power in detecting the severity of personality pathology. Correlations with a DSM-IV symptom measure and a pathological traits model suggest partial conceptual overlap. Although further testing is indicated, the present findings suggest the GAPD is suitable for assessing the core components of personality dysfunction. It may contribute to a two-step integrated assessment of personality pathology that assesses both personality dysfunction and personality traits. KEY PRACTITIONER MESSAGE The core features of personality disorder can be defined as disorders in the self and in the capacity for interpersonal functioning. A clinically useful operationalization of disordered functioning of personality is needed to determine the maladaptivity of personality traits. An integrated assessment of personality (dys)functioning and personality traits provides a more comprehensive clinical picture of the patient, which may aid treatment planning.
Collapse
Affiliation(s)
- Han Berghuis
- GGz Centraal Psychiatric Center, Hilversum, The Netherlands
| | | | | | | | | |
Collapse
|
43
|
Wright AGC, Pincus AL, Hopwood CJ, Thomas KM, Markon KE, Krueger RF. An interpersonal analysis of pathological personality traits in DSM-5. Assessment 2012; 19:263-75. [PMID: 22589411 DOI: 10.1177/1073191112446657] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
Collapse
|
44
|
Samuel DB, Miller JD, Widiger TA, Lynam DR, Pilkonis PA, Ball SA. Conceptual changes to the definition of borderline personality disorder proposed for DSM-5. JOURNAL OF ABNORMAL PSYCHOLOGY 2012; 121:467-76. [PMID: 21875165 PMCID: PMC3706458 DOI: 10.1037/a0025285] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 Personality and Personality Disorders Work Group proposed the elimination of diagnostic criterion sets in favor of a prototype matching system that defines personality disorders using narrative descriptions. Although some research supports this general approach, no empirical studies have yet examined the specific definitions proposed for DSM-5. Given the wide interest in borderline personality disorder (BPD), it is crucial to determine how this methodological shift might affect the content and conceptualization of the diagnosis. Eighty-two experts on BPD provided ratings of the DSM-IV-TR or DSM-5 version of BPD in terms of 37 traits proposed for DSM-5. Analyses revealed significant and meaningful differences among the two constructs, with the DSM-5 version evincing increased interpersonal dependency but a decreased emphasis on antagonism and disinhibition. A second study within a clinical sample demonstrated that both antagonism and disinhibition mediated the relationships between DSM-IV BPD and impairment, suggesting that the proposed changes might have important consequences for BPD's coverage, prevalence, and nomological network. More globally, our results illustrate that unanticipated shifts in diagnostic constructs can stem from seemingly minor revisions and suggest that research is needed to understand how these, or other changes, might affect our conceptualization, diagnosis, and treatment of BPD.
Collapse
Affiliation(s)
- Douglas B Samuel
- Department of Psychiatry, Yale University School of Medicine, USA.
| | | | | | | | | | | |
Collapse
|
45
|
Abstract
Personality disordered patients present with multiple problem areas and potential targets of change. This complex clinical situation can be addressed by an integrated approach to the treatment by using treatment strategies and techniques from the various schools of therapy, sequenced and adapted to the individual patient. An optimal choice and sequencing of treatment techniques is organized around general treatment strategies (assessment and case formulation, treatment structuring, observing the therapeutic relationship, addressing problematic personality organization, and addressing sequential goals) with the severity of the personality disturbance in mind. The biggest threat to successful integration of the treatment is the reaction of severe personality disordered patients who lack an integrated sense of self and suffer from intense, fluctuating emotions that challenge an inexperienced, reactive therapist.
Collapse
Affiliation(s)
- John F Clarkin
- New York Presbyterian Hospital, Weill-Cornell Medical Center, 21 Bloomingdale Road, White Plains, NY 10605, USA.
| |
Collapse
|
46
|
Krueger RF, Eaton NR, Derringer J, Markon KE, Watson D, Skodol AE. Personality inDSM–5:Helping Delineate Personality Disorder Content and Framing the Metastructure. J Pers Assess 2011; 93:325-31. [DOI: 10.1080/00223891.2011.577478] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
47
|
Hopwood CJ, Malone JC, Ansell EB, Sanislow CA, Grilo CM, McGlashan TH, Pinto A, Markowitz JC, Shea MT, Skodol AE, Gunderson JG, Zanarini MC, Morey LC. Personality assessment in DSM-5: empirical support for rating severity, style, and traits. J Pers Disord 2011; 25:305-20. [PMID: 21699393 DOI: 10.1521/pedi.2011.25.3.305] [Citation(s) in RCA: 198] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Despite a general consensus that dimensional models are superior to the categorical representations of personality disorders in DSM-IV, proposals for how to depict personality pathology dimensions vary substantially. One important question involves how to separate clinical severity from the style of expression through which personality pathology manifests. This study empirically distinguished stylistic elements of personality pathology symptoms from the overall severity of personality disorder in a large, longitudinally assessed clinical sample (N = 605). Data suggest that generalized severity is the most important single predictor of current and prospective dysfunction, but that stylistic elements also indicate specific areas of difficulty. Normative personality traits tend to relate to the general propensity for personality pathology, but not stylistic elements of personality disorders. Overall, findings support a three-stage diagnostic strategy involving a global rating of personality disorder severity, ratings of parsimonious and discriminant valid stylistic elements of personality disorder, and ratings of normative personality traits.
Collapse
|
48
|
Abstract
The Work Group for the DSM-5 personality disorders has submitted their proposal to the professional community. In this paper, we consider the proposal in light of its ability to meet criteria for clinical utility as proposed by First and colleagues (2004). While the Work Group's proposal has addressed some of these concerns, we conclude that there remain several unanswered problems with how the proposal will improve the clinical utility of personality disorders section of the DSM-5. Though these concerns can be addressed to some extent in the field trials, it is incumbent upon the Work Group and clinical researchers to attend carefully to these issues so that shortcomings of previous diagnostic manuals are not repeated in the future.
Collapse
Affiliation(s)
- John F Clarkin
- Department of Psychiatry, New York Presbyterian Hospital-Cornell Medical Center Westchester Division, 21 Bloomingdale Road, White Plains, NY 10605, USA.
| | | |
Collapse
|
49
|
Widiger TA, Mullins-Sweatt SN. Five-factor model of personality disorder: a proposal for DSM-V. Annu Rev Clin Psychol 2009; 5:197-220. [PMID: 19046124 DOI: 10.1146/annurev.clinpsy.032408.153542] [Citation(s) in RCA: 159] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The predominant dimensional model of general personality structure within psychology is the five-factor model (FFM). Research indicates that the personality disorders of the American Psychiatric Association's diagnostic manual can be understood as maladaptive variants of the domains and facets of the FFM. The current review provides a proposal for the classification of personality disorder from the perspective of the FFM. Discussed as well are implications and issues associated with an FFM of personality disorder, including the integration of a psychiatric nomenclature with general personality structure, the inclusion of a domain of openness to experience, the identification of problems in living associated with maladaptive personality traits, the setting of a diagnostic threshold, prototypal matching, feasibility, and clinical utility.
Collapse
Affiliation(s)
- Thomas A Widiger
- Department of Psychology, University of Kentucky, Lexington, KY 40506-0044, USA.
| | | |
Collapse
|
50
|
Gutiérrez F, Navinés R, Navarro P, García-Esteve L, Subirá S, Torrens M, Martín-Santos R. What do all personality disorders have in common? Ineffectiveness and uncooperativeness. Compr Psychiatry 2008; 49:570-8. [PMID: 18970905 DOI: 10.1016/j.comppsych.2008.04.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Revised: 04/17/2008] [Accepted: 04/30/2008] [Indexed: 11/19/2022] Open
Abstract
We still lack operative and theoretically founded definitions of what a personality disorder (PD) is, as well as empirically validated and feasible instruments to measure the disorder construct. The Temperament and Character Inventory (TCI) is the only personality instrument that explicitly distinguishes personality style and disordered functioning. Here, we seek to (1) confirm in a clinical sample that the character dimensions of the TCI capture a general construct of PD across all specific PD subtypes, (2) determine whether such core features can be used to detect the presence of PD, and (3) analyze whether such detection is affected by the presence and severity of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Axis I symptoms. Two hundred five anxious/depressed outpatients were evaluated with the Structural Clinical Interview for DSM-IV Axis I and II Disorders. Assessment also included the TCI, the Hamilton rating scales for depression and anxiety, and the Panic and Agoraphobia Scale. Sixty-one patients (29.8%) were diagnosed as having a DSM-IV PD. Self-directedness and Cooperativeness, but no other TCI dimensions, predicted the presence of PD (Nagelkerke R(2) = 0.35-0.45) and had a moderate diagnostic utility (kappa = 0.47-0.58) when Axis I symptoms were absent or mild. However, accuracy decreased in anxious or depressed patients. Our study supports the hypothesis of a disorder construct that is not related to the intensity of any specific PD subtype but which is common to all PDs. This construct relies largely on internal representations of the self revealing ineffectiveness and uncooperativeness.
Collapse
Affiliation(s)
- Fernando Gutiérrez
- Psychology Service, Neurosciences Institute, Hospital Clinic Barcelona, Spain
| | | | | | | | | | | | | |
Collapse
|