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

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

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

Personality Functioning, Problems in Living, and Personality Traits

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

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

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

Volitional Change in Pathological Traits: Can People Change Their Maladaptive Traits?

Research suggests people want to change their normative personality traits-and they can volitionally do so. However, studies have not yet addressed volitional change in pathological personality. Consequently, the current study examined (a) people's desires to change pathological traits, (b) whether these change goals predict subsequent trait change, (c) whether this withstands controlling normative traits, and (d) the extent to which pathological trait change predicts relevant outcomes. College students (N = 463) self-reported their pathological traits weekly for up to 16 weeks. People with elevated pathological traits generally desired to decrease these traits. Furthermore, goals to change negative affectivity and disinhibition predicted corresponding trait change. Thus, people want to reduce their pathological traits-and they may be able to do so for some traits.

Contribution of the alternative model for DSM-5 personality disorders to relationship satisfaction

Introduction

Personality is a central factor associated with relationship discord, conflicts, and separation, as well as with dyadic adjustment and relationship stability. The Alternative Model for Personality Disorders (AMPD) of the DSM-5 offers a hybrid model for understanding personality based on personality dysfunction (Criterion A) and pathological domains and facets (Criterion B). So far, few studies have integrated this model into the understanding of relationship quality. Therefore, the aim of this study was to examine the contribution of Criterion B to relationship satisfaction in individuals involved in an intimate relationship. We also explored the joint contribution of Criteria A and B, as well as their interaction effects, to relationship satisfaction.

Methods

Participants were drawn from two clinical samples: patients with personality disorders (PD; N = 101) and clients consulting in private practice clinics (PPC; N = 350). They completed self-report questionnaires assessing relationship satisfaction and AMPD Criteria A (only for PPC sample) and B.

Results

Hierarchical regressions showed that, for the PD sample, the Detachment and Negative Affectivity domains, especially the pathological facets of Intimacy Avoidance and Separation Insecurity, explained 22.5% of relationship satisfaction's variance. For PPC clients, Detachment, Negative Affectivity, and Antagonism domains, and especially the pathological facets of Intimacy Avoidance, Anxiousness, and Grandiosity, contribute significantly to relationship satisfaction, explaining 14.8% of its variance. Criterion A elements did not evince incremental value to the regression models in the PPC sample, and no Criteria A and B interaction effects were found. Clinical implications as well as limitations of the study are discussed.

Opportunities of measuring hierarchical models of psychopathology

All psychiatric phenomena are positively associated, and several different models can account for this observation. These include the correlated factors, network, general psychopathology as outcome, and hierarchical models. Advantages of hierarchical models, which consist of one general and several (general factor-residualized) specific factors, is that the general factor provides an opportunity to reliably measure global distress and impairment, while the specific factors might improve the ability to discriminate between individuals with different kinds of problems. Nevertheless, other models also have their respective advantages, and it remains challenging to empirically determine which model best accounts for the positive manifold in psychiatry. Instead, I present two non-empirical arguments in favor of hierarchical models. First, by measuring the general factor in isolation, the specific factors tend to include both favorable and unfavorable correlates, which might reduce stigma compared to psychiatric diagnoses that by and large are associated with only unfavorable outcomes. Second, the general psychopathology factor displays an unusual psychometric property in that it includes symptoms of opposite meaning if they have similar valence (e.g., self-reported symptoms such as gullible and paranoid, lazy and workaholic, and terrified and apathetic load in the same direction), which one might want to measure in isolation from variance capturing the content of symptoms. I conclude by speculating that tests designed based on hierarchical models might help clinical assessment.

Combining novel trait and neurocognitive frameworks to parse heterogeneity in borderline personality disorder

OBJECTIVE

Borderline Personality Disorder (BPD) diagnosis comprises several constellations of trait, neurocognitive, and psychosocial alterations. Dimensional models of psychopathology provide new opportunities to parse heterogeneity and create a stronger interface between individual characterization and psychosocial outcomes. However, dimensional models have focused on either traits or neurocognitive features, lacking integration to capture the multifaceted nature of BPD.

METHOD

We assessed 100 participants with BPD using a combination of tools stemming from trait (Alternative Model for Personality Disorders) and neurocognitive models (Research Domain Criteria; RDoC) to examine if trait-derived subgroups display distinctive social-processing and psychosocial profiles. We used two complementary analytical approaches: person-centered (k-means clustering) and construct-based (multiple factor analysis).

RESULTS

Our person-centered approach identified four subgroups with separable internalizing, detached, externalizing, and low psychopathology trait profiles. These profiles revealed distinctive patterns of affiliation, emotion recognition and mentalization performance in RDoC tasks, and psychosocial measures of quality of life and social connectedness. RDoC-based measures showed close construct proximity with negative affectivity, disinhibition, and antagonism trait domains, relative to the detachment domain, which had close proximity with self-knowledge.

CONCLUSIONS

Altogether, findings support consilience between trait-based and neurobiological frameworks and suggest that trait models are useful to parse BPD heterogeneity leading to unique social functioning profiles.

Understanding the association between normal and maladaptive personality traits: Replication and extension of Morey et al. (2020)

BACKGROUND/OBJECTIVE

The Alternative Model for Personality Disorders (AMPD) within the DSM-5 includes separable components representing general personality dysfunction (Criterion A) and maladaptive personality traits (Criterion B). Some critique Criterion A for accounting for little incremental variance in PD beyond Criterion B. However, Morey et al. (2020) hypothesized that personality dysfunction is a key mechanism through which normal-range traits account for the maladaptive component of personality traits, justifying its inclusion. We sought to replicate and extend this work in a psychiatric sample with mixed methods.

METHOD

In total, 152 participants recruited from mental health clinics completed multiple measures of personality dysfunction and normal-range and maladaptive traits.

RESULTS

Replication was only partially achieved. The degree of incremental prediction of maladaptive traits and the extent to which personality dysfunction explained the relations between normal-range and maladaptive traits varied significantly across traits, and those effects that reached significance were small in magnitude. Removing variance due to personality dysfunction reduced intercorrelations among maladaptive traits by only a small amount.

CONCLUSION

Counter to Morey et al. (2020), our results failed to support maladaptive traits as composites of normal-range traits and personality dysfunction, suggesting that other methods of distinguishing personality pathology severity and style are needed.

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

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

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

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

Differentiating Abnormal, Normal, and Ideal Personality Profiles in Multidimensional Spaces

Abstract: Current dimensional taxonomies of personality disorder (PD) establish that intense traits do not suffice to diagnose a disorder, and additional constructs reflecting dysfunction are required. However, traits appear able to predict maladaptation by themselves, which might avoid duplications and simplify diagnosis. On the other hand, if trait-based diagnoses are feasible, it is the whole personality profile that should be considered, rather than individual traits. This takes us into multidimensional spaces, which have their own particular – but poorly understood – logic. The present study examines how profile-level differences between normal and disordered subjects can be used for diagnosis. The Dimensional Assessment of Personality Pathology – Basic Questionnaire (DAPP-BQ) and the Personality Inventory for DSM-5 (PID-5) were administered to a community and a clinical sample each (total n = 1,925 and 3,543 respectively). Intense traits proved to be common in the general population, so empirically-based thresholds are indispensable not to take as abnormal what is at most unideal. Profile-level parameters such as Euclidean and Mahalanobis distances outperformed individual traits in predicting mental problems and equaled the performance of published measures of dysfunction or severity. Personality profiles can play a more central role in identifying disorders than is currently acknowledged, provided that adequate metrics are used.

Dimensional models of personality disorders: Challenges and opportunities

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

Psychotic spectrum features in borderline and bipolar disorders within the scope of the DSM-5 section III personality traits: a case control study

BACKGROUND

Psychotic spectrum features in borderline personality disorder (PD) are a long-standing phenomenon, but remarkably, to date, they have not been the focus of many empirical studies. Moreover, the comparative studies that acknowledge their links to affective psychoses are even more scarce. Likewise, the contributions of empirical research on the DSM-5 dimensional approach to this topic are also uncommon. This study seeks to identify the best set of pathological personality traits and/or symptoms that are predictors of psychotic features (psychoticism and ideation paranoid symptoms) in borderline PD and in bipolar disorder, based on the framework of the DSM-5 section III personality traits.

METHODS

A cross-sectional study of two clinical samples: 1) Borderline PD group of 63 participants; 2) Bipolar disorder group of 65 participants. Self-reported assessment: Personality Inventory for DSM-5 (PID-5); Brief Symptom Inventory (BSI). A series of linear and logistic regression analyses were computed.

RESULTS

Overall, the data emerging as common predictors are detachment, negative affectivity, psychoticism, depressivity, grandiosity, suspiciousness and interpersonal sensitivity symptoms. Borderline PD has the highest score in BSI paranoid ideation which emerges as its discriminating trait (Nagelkerke R² = .58): cognitive and perceptual dysregulation (OR: 13.02), restricted affectivity (OR: 12.09), withdrawal (OR: 11.70), anhedonia (OR: 10.98) and emotional lability (OR: 6.69).

CONCLUSIONS

Besides the commonality that appears to overlap both disorders with a psychosis superspectrum, the patterns of the pathological personality-symptoms underlying the psychotic features appear to reinforce a position between schizophrenia and bipolar disorders that borderline PD may occupy, highlighting the possibility of its intersection with schizoaffective/psychosis spectra. The pathological personality nature of the psychotic features emerges as a potential comprehensive trait of the phenomenological dimensions.

Operationalizing intimacy and identity aspects of personality functioning in relation to personality disorder in adolescents

According to dimensional models of personality pathology, deficits in interpersonal (intimacy and empathy) and self (identity and self-direction) function (Criterion A) are core to all personality disorders. These aspects of personality functioning (Criterion A) have seldom been evaluated for how they might relate to one another in the context of personality pathology in adolescents. Moreover, the use of performance-based measures to evaluate aspects of Criterion A function remains an untapped resource. Therefore, the present study aimed to evaluate relations between two features of Criterion A, maladaptive intimacy and maladaptive (or diffused) identity, in adolescence. For intimacy, we leverage a performance-based approach to studying intimacy, operationalized in a developmentally relevant way (perceived parental closeness). For identity, we rely on a validated self-report measure of identity diffusion. We examined the relationship between these features with each other and their relations with borderline features. Additionally, we explored whether identity diffusion mediated the expected relationship between perceived parental closeness and borderline features. We hypothesized that greater distance in perceived parental closeness would be associated with higher levels of borderline features, as well as higher levels of identity diffusion, and that identity diffusion would account for the relationship between intimacy and personality pathology. The sample included 131 inpatient adolescents (M _age = 15.35, 70.2% female). Results indicated that intimacy, operationalized as perceived parental closeness, with both mothers and fathers was significantly associated with levels of identity diffusion and borderline features. In addition, greater feelings of closeness with parents were associated with lower severity of borderline features via healthier identity function. Implications of the results, limitations, and future directions are discussed.

Understanding loneliness: The roles of self- and interpersonal dysfunction and early parental indifference

Many factors are implicated in developing and maintaining loneliness, including aspects of personality functioning and experience of early adverse childhood events. This study aimed to examine the relationship between domains of personality dysfunction, including self- and interpersonal functioning, and loneliness and determine whether such personality factors mediate the relationship between childhood parental indifference and loneliness. In total, 393 community-dwelling adults, mean age 34.3 (SD = 12.67), were recruited online for cross-sectional assessment of loneliness, personality functioning, big-five personality traits and perceived childhood parental indifference. Linear regression analyses were conducted followed by a parallel mediation model. Self- and interpersonal dysfunction were positively associated with loneliness and remained significant predictors of loneliness after controlling for five-factor personality traits. Impaired personality functioning accounted for 12% of loneliness variance. Finally, self-dysfunction mediated the relationship between childhood parental indifference and loneliness. Findings emphasize the importance of addressing personality functioning when developing psychosocial interventions aimed at tackling loneliness.

The Relationship Between Patients' Personality Traits, the Alliance, and Change in Interpersonal Distress in Intensive Group Treatment for Personality Dysfunction

This study examined patients' personality traits as operationalized by the five-factor model in relation to early alliance and reduction of interpersonal distress through an intensive group treatment program for personality dysfunction. A sample of 79 consecutively admitted psychiatric outpatients with personality dysfunction who attended an 18-week intensive group treatment program completed the NEO Five-Factor Inventory at pretreatment, the Inventory of Interpersonal Problems at pre- and posttreatment, and the Edmonton Therapeutic Alliance Scale, a measure of the therapeutic alliance with the program therapist, at Session 5. Results indicated that patients who were relatively extraverted tended to rate the alliance with their program therapist higher and subsequently reported more improvement of interpersonal distress. The presence of a personality disorder did not moderate this mediation. Patients' extraversion likely promotes a bonding with the therapist and facilitates the interpersonal group work necessary for improvement. Assessing patients' level of extraversion before starting intensive group treatment might indicate which intervention strategies could be useful with that patient within the program frame.

An exploratory study of associations between the ICD-11 personality disorder model and eating pathology

BACKGROUND

Recently, the International Classification of Diseases 11th Revision (ICD-11) has introduced a paradigm shift in personality disorder conceptualization. The novel ICD-11 personality disorder model comprises a dimensional assessment of personality dysfunction and five maladaptive personality trait domains. Maladaptive personality plays a central role in eating pathology. Yet, relations between the ICD-11 personality disorder model and eating pathology are, to date, unclear. Thus, this study aimed to explore the bivariate, incremental, and interactive associations of the ICD-11 personality disorder model components with eating pathology domains.

METHODS

A predominantly female (85%) sample of 888 German-speaking community adults completed validated self-report measures of personality dysfunction, the ICD-11 personality trait domains, and five eating pathology domains (drive for thinness, bulimia, body dissatisfaction, orthorexia, binge eating). Bivariate and hierarchical regressions models were used to investigate bivariate, incremental, and interactive relations between the ICD-11 personality disorder model components and eating pathology.

RESULTS

Personality dysfunction and the ICD-11 personality trait domains showed statistically significant bivariate relations with eating pathology. Additionally, personality dysfunction and most ICD-11 personality trait domains displayed incremental links with eating pathology. Finally, the relations of the ICD-11 personality trait domains with eating pathology were largely independent of the severity of personality dysfunction.

CONCLUSIONS

This study indicated that all ICD-11 personality disorder model components are uniquely linked to eating pathology. Beyond maladaptive personality trait domains, the strong and incremental relations of personality dysfunction with eating pathology have potential implications for theory building. Further research using longitudinal designs is needed to evaluate causal links between the ICD-11 personality disorder model components and eating pathology.

Comparison of the relative sensitivity of two dimensional personality models to the psychopathological symptoms: the section III DSM-5 maladaptive traits versus affective temperaments

BACKGROUND

The Personality Inventory for DSM-5 (PID-5) and Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A) are tools designed for personality dispositions for mental health symptoms. The present study was conducted to compare these models in terms of their relative sensitivity to the symptoms of personality disorders (PDs) and non-personality disorders (NPDs).

METHODS

Subjects in this cross-sectional study were 1232 (805 female; 63.5%) community samples in western Iran. Data were collected using the PID-5, the TEMPS-A, the Symptom Checklist-90 (SCL-90-R), and the Personality Diagnostic Questionnaire (PDQ-4). Correlations and Regression models were used to examine associations between traits and symptoms.

RESULTS

Maladaptive traits assessed by the PID-5 were more strongly associated with PD symptoms, whereas affective temperaments measured by the TEMPS-A were more strongly associated with NPD symptoms.

CONCLUSION

The present findings highlighted the practical utility of both the PID-5 and TEMPS-A indicating risk for psychopathology, but also suggest a distinction between PDs and NPDs in terms of underlying personality dispositions.

Latent classes of maladaptive personality traits exhibit differences in social processing

OBJECTIVE

Social processing (SP) deficits manifest across numerous mental disorders. However, this research has been plagued by heterogeneity and a piecemeal approach whereby skills are examined in isolation rather than as part of an integrated cognitive system. Here, we combined two dimensional frameworks of psychopathology to address these limitations.

METHOD

We utilized the Alternative Model for Personality Disorders (AMPD) to distill trait-related heterogeneity within a community sample (n = 200), and the Research Domain Criteria (RDoC) 'Systems for Social Processes' to comprehensively assess SP. We first applied latent class analyses (LCA) to derive AMPD-based groups and subsequently contrasted the performance of these groups on a SP test battery that we developed to align with the RDoC SP constructs.

RESULTS

Our LCA yielded four distinct subgroups. The recognizable trait profiles and psychopathological symptoms of these classes suggested they were clinically meaningful. The subgroups differed in their SP profiles: one displayed deficits regarding the self, a second displayed deficits in understanding others, a third displayed more severe deficits including affiliation problems, whilst the fourth showed normal performance.

CONCLUSIONS

Our results support the link between clusters of maladaptive personality traits and distinctive profiles of SP deficits, which may inform research on disorders involving SP dysfunctions.

Using Interpersonal Dimensions of Personality and Personality Pathology to Examine Momentary and Idiographic Patterns of Alliance Rupture

The Alternative Model of Personality Disorders (AMPD) integrates several theoretical models of personality functioning, including interpersonal theory. The interpersonal circumplex dimensions of warmth and dominance can be conceptualized as traits similar to those in AMPD Criterion B, but interpersonal theory also offers dynamic hypotheses about how these variables that change from moment to moment, which help to operationalize some of the processes alluded to in AMPD Criterion A. In the psychotherapy literature, dynamic interpersonal behaviors are thought to be critical for identifying therapeutic alliance ruptures, yet few studies have examined moment-to-moment interpersonal behaviors that are associated with alliance ruptures at an idiographic level. The current study examined the concurrent and cross-lagged relationships between interpersonal behaviors and alliance ruptures within each session in the famous Gloria films (“Three Approaches to Psychotherapy”). Interpersonal behaviors (warmth and dominance) as well as alliance ruptures (i.e., withdrawal and confrontation) were calculated at half minute intervals for each dyad. We identified distinct interpersonal patterns associated with alliance ruptures for each session: Gloria (patient)’s warmth was positively related with withdrawal ruptures concurrently in the session with Carl Rogers; Gloria’s dominance and coldness were related with increased confrontation ruptures in the session with Fritz Perls concurrently, while her coldness was also predicted by confrontation ruptures at previous moments; lastly, both Gloria’s dominance and Albert Ellis’s submissiveness were positively related with withdrawal ruptures. These interpersonal patterns demonstrated the promise of using AMPD dimensions to conceptualize momentary interpersonal processes related to therapy ruptures, as well as the clinical importance of attuning to repetitive, dyad-specific interpersonal cues of ruptures within each session.

Stability and Change in Relations Between Personality Traits and the Interpersonal Problems Circumplex During Cognitive Therapy for Recurrent Depression

Both personality impairment and maladaptive-range traits are necessary for diagnosis in the alternative model of personality disorder. We clarified personality impairment-trait connections using measures of the interpersonal problems circumplex and personality traits among adult outpatients (N = 351) with major depressive disorder receiving cognitive therapy (CT). The trait scales' circumplex projections were summarized by elevation (correlations with general interpersonal problems), amplitude (specific relations to the circumplex dimensions of dominance and affiliation), and angle (predominant orientation in the two-dimensional circumplex). Most trait scales showed hypothesized circumplex relations, including substantive elevation (e.g., negative temperament, mistrust), amplitude (e.g., aggression, detachment), and expected angles (e.g., positive temperament and manipulativeness oriented toward overly nurturant/intrusive or domineering/vindictive problems, respectively), that were stable across time during CT. These results revealed meaningful and consistent impairment-trait connections, even during CT when mean depressive affect decreased substantially.

Integration of the ICD-11 and DSM-5 Dimensional Systems for Personality Disorders Into a Unified Taxonomy With Non-overlapping Traits

The promise of replacing the diagnostic categories of personality disorder with a better-grounded system has been only partially met. We still need to understand whether our main dimensional taxonomies, those of the International Classification of Diseases, 11th Revision (ICD-11) and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), are the same or different, and elucidate whether a unified structure is possible. We also need truly independent pathological domains, as they have shown unacceptable overlap so far. To inquire into these points, the Personality Inventory for DSM-5 (PID-5) and the Personality Inventory for ICD-11 (PiCD) were administered to 677 outpatients. Disattenuated correlation coefficients between 0.84 and 0.93 revealed that both systems share four analogous traits: negative affectivity, detachment, dissociality/antagonism, and disinhibition. These traits proved scalar equivalence too, such that scores in the two questionnaires are roughly interchangeable. These four domains plus psychoticism formed a theoretically consistent and well-fitted five-factor structure, but they overlapped considerably, thereby reducing discriminant validity. Only after the extraction of a general personality disorder factor (g-PD) through bifactor analysis, we could attain a comprehensive model bearing mutually independent traits.

The Structure of Psychopathology in a Sample of Clinically Referred, Emotionally Dysregulated Early Adolescents

This investigation answers and amplifies calls to model the transdiagnostic structure of psychopathology in clinical samples of early adolescents and using stringent psychometric criteria. In 162 clinically referred, clinically evaluated 11-13-year-olds, we compared a correlated two-factor model, containing latent internalizing and externalizing factors, to a bifactor model, which added a transdiagnostic general factor. We also evaluated the bifactor model psychometrically, including criterion validity with broad indicators of psychosocial functioning. In doing so, we compared alternative approaches to defining and interpreting criterion validity: a recently proposed incremental definition based on amounts of variance in criterion factors explained, and the more typical definition based on the presence of conceptually meaningful relationships. While traditional fit statistics favored the bifactor model as expected, psychometric analyses added important nuance. Despite moderate reliability, the general factor was not fully transdiagnostic (i.e., was not informed by several externalizing scores), and was partially redundant with internalizing scores. Approaches to criterion validity yielded opposing results. Compared to the correlated two-factor model, the bifactor model redistributed, without incrementally increasing, the total variance explained in criterion indicators of psychosocial functioning. Yet, the bifactor model did improve the precision of clinically important relationships to psychosocial functioning, raising questions about meaningful tests of bifactor psychopathology models.