The Personality Inventory for DSM-5 Short Form (PID-5-SF): psychometric properties and association with big five traits and pathological beliefs in a Norwegian population

The Alternative Model of Personality Disorders: Assessment, Convergent and Discriminant Validity, and a Look to the Future

The Alternative Model of Personality Disorders (AMPD) is a dimensional, empirically based diagnostic system developed to overcome the serious limitations of traditional categories. We review the mounting evidence on its convergent and discriminant validity, with an incursion into the less-studied ICD-11 system. In the literature, the AMPD's Pathological Trait Model (Criterion B) shows excellent convergence with normal personality traits, and it could be useful as an organizing framework for mental disorders. In contrast, Personality Functioning (Criterion A) cannot be distinguished from personality traits, lacks both discriminant and incremental validity, and has a shaky theoretical background. We offer some suggestions with a view to the future. These include removing Criterion A, using the real-life consequences of traits as indicators of severity, delving into the dynamic mechanisms underlying traits, and furthering the integration of currently disengaged psychological paradigms that can shape a sounder clinical science.

Exploring Potential Ethnic Bias Among MMPI-3 Scales in Assessing Personality Psychopathology

This study examined statistical bias in the measurement of personality psychopathology in the Latinx population using the Minnesota Multiphasic Personality Inventory-3 (MMPI-3). Data were extracted from two studies that yielded a composite data set of 103 White individuals and 250 Latinx individuals. All participants were administered the MMPI-2-Restructured Form-Extended Battery (MMPI-2-RF-EX) or MMPI-3 and the Personality Inventory for the DSM-5 Short Form (PID-5-SF). First, we conducted correlation analyses between theoretically overlapping scales of the PID-5-SF and the MMPI-3 among White and Latinx individuals. The majority of theoretically associated scales were found to be at least moderately associated in the total sample. In addition, Steiger's z-tests indicated that correlations were similar in magnitude across the White and Latinx ethnic groups. Hierarchical regression subsequently determined the presence of slope and/or intercept bias. Only one analysis (the MMPI-3 Anger Proneness prediction of PID-5-SF Negative Affectivity) indicated statistically significant intercept bias. No evidence of slope bias was found. In other words, these analyses indicated that the vast majority of the relationships between MMPI-3 scales and associated personality psychopathology constructs (as measured by the PID-5-SF) remained consistent across both ethnic groups. Overall, the results supported the appropriate cross-cultural use of the MMPI-3 to assess personality psychopathology.

Clinical cut scores for the Persian version of the personality inventory for DSM-5

BACKGROUND

The cut points of psychological tools to diagnose clinical conditions are not universal and depend on the region and prevalence of the disorder. Thus, we aimed to identify the cutoff points of the Persian original version of the personality inventory for DSM-5 (PID-5; 220 items) that would optimally distinguish nonclinical from clinical groups.

METHODS

Both nonclinical (N = 634, 73% female, 34.0 ± 10.8 years) and clinical (N = 454, 29% female, 29.5 ± 7.4 years) samples from the West of Iran participated in the study. Data were analyzed using receiver operating characteristic (ROC) and Youden's index was used to determine the cutoff scores across the PID-5 domains and facets. The means and standard deviations of both the clinical male and female were compared with the nonclinical group using Cohen's d and independent t-tests.

RESULTS

All the PID-5 algorithms and facets significantly distinguished clinical from nonclinical samples with some unique findings for male and female samples. The mean score of all the PID-5 algorithms and facets in the clinical male and female samples were respectively 1.0-2.0 SD and 0.5-1.0 SD above the mean for the nonclinical counterparts. A score higher than 1.5 on ranging from 0 to 3 in each domain or facet indicated clinical status.

CONCLUSION

Raw cutting scores throughout the PID-5 algorithms can be well used to diagnose any pathology of personality and the severity of the disorder in clinical patients. The cut scores provide a useful tool for the clinical use of the original version of PID-5 in Iran.

A Network Analysis Study to Evaluate Obsessive-Compulsive Beliefs/Dimensions and Personality Beliefs in Patients with Obsessive-Compulsive Disorder (OCD): A Cross-Sectional Study in Two Common OCD Subtypes

Objective: Obsessive-Compulsive Disorder (OCD) has been considered a heterogeneous psychiatric disorder. Identifying this heterogeneity can lead to better diagnosis and treatment. The two most common OCD subtypes include contamination/cleaning and danger/checking. This study aimed to identify the network structure of OCD symptoms, personality, and obsessive beliefs in these OCD subtypes. Method : 333 patients with OCD were included in the study (156 patients with the danger/check subtype and 177 patients with the contamination/cleaning subtype). In addition, 276 healthy individuals participated in this study. We used a network analysis approach to determine the OCD central symptoms [nodes]. The Personality Beliefs Questionnaire-Short Form [PBQ-SF], Obsessive-Compulsive Inventory-Revised [OCI-R], and Obsessional Beliefs Questionnaire-44 [OBQ-44] were used for network estimation. Results: The results indicated that the network structure in healthy individuals was different from the network structure in patients with obsessive-compulsive disorder [PwOCD]. In healthy individuals, "obsessive" personality belief and "danger" obsessive belief were the most strength nodes and formed the core of the central communication between symptoms in these subjects. Regarding the contamination/cleaning subtype, the most central symptoms include "washing" obsessive symptom, "danger" obsessive belief, and "wash" obsessive symptom. However, "perfect" obsessive beliefs, "check" obsessive symptoms, and "avoidant" personality beliefs were the most central symptoms in the danger/check subtype. These results demonstrated that each of the studied groups had a unique network structure, which is consistent with the heterogeneous nature of OCD. Conclusion: Different OCD subtypes have different cognitive-behavioral network structures. According to the results of this study, these symptoms should be given priority in OCD theoretical models and treatment strategies.

Personality change in a trial of psilocybin therapy v. escitalopram treatment for depression

BACKGROUND

Psilocybin Therapy (PT) is being increasingly studied as a psychiatric intervention. Personality relates to mental health and can be used to probe the nature of PT's therapeutic action.

METHODS

In a phase 2, double-blind, randomized, active comparator controlled trial involving patients with moderate-to-severe major depressive disorder, we compared psilocybin with escitalopram, over a core 6-week trial period. Five-Factor model personality domains, Big Five Aspect Scale Openness aspects, Absorption, and Impulsivity were measured at Baseline, Week 6, and Month 6 follow-up.

RESULTS

PT was associated with decreases in neuroticism (B = -0.63), introversion (B = -0.38), disagreeableness (B = -0.47), impulsivity (B = -0.40), and increases in absorption (B = 0.32), conscientiousness (B = 0.30), and openness (B = 0.23) at week 6, with neuroticism (B = -0.47) and disagreeableness (B = -0.41) remaining decreased at month 6. Escitalopram Treatment (ET) was associated with decreases in neuroticism (B = -0.38), disagreeableness (B = -0.26), impulsivity (B = -0.35), and increases in openness (B = 0.28) at week 6, with neuroticism (B = -0.46) remaining decreased at month 6. No significant between-condition differences were observed.

CONCLUSIONS

Personality changes across both conditions were in a direction consistent with improved mental health. With the possible exception of trait absorption, there were no compelling between-condition differences warranting conclusions regarding a selective action of PT (v. ET) on personality; however, post-ET changes in personality were significantly moderated by pre-trial positive expectancy for escitalopram, whereas expectancy did not moderate response to PT.

Cross-cultural Study of the Personality Inventory for the DSM-5 (PID-5) across the Portuguese and the United Arab Emirates (UAE) Community and Clinical Populations

Aims

The present paper focused on compare the PID-5 mean score levels across two matched community and clinical samples of Portugal and the UAE.

Background

The generalizability and universality of the Alternative Model of Personality Disorders has been thoroughly studied through the Personality Inventory for DSM-5 (PID-5) across countries and languages. However, studies comparing Western and Middle Eastern countries are still limited, in particular those who assess the PID-5 measurement invariance.

Objectives

We examined measurement invariance of the PID-5 scales across matched Emirati and Portuguese clinical and nonclinical groups, as well as compare and contrast the PID-5 mean score levels across both countries and samples.

Methods

The Arabic and the Portuguese versions of the PID-5 was administered to Emirati community participants (N = 300, 80% women and 20% men, M_age = 27.95) which were matched with Portuguese community participants (N = 300, 80.3% women and 19.7% men, M_age = 28.96), as well as clinical participants of the UAE (N = 150, 61.3% women and 38.7% men, M_age = 31.29) and Portugal (N = 150, 52% men and 48% women, M_age = 44.97). We examined measurement invariance through an unrestricted Factor Analysis based program, and mean scores levels were compared and analyzed.

Results

Our findings supported the PID-5 measurement invariance across the Emirati and Portuguese clinical samples pointing to the universality and generalizability of the Alternative Model of Personality Disorders. The Emirati psychiatric sample exhibited somehow higher results than the Portuguese psychiatric participants, albeit the small effect size for most of the PID-5 scales.

Conclusion

Further research is needed to examine the applicability of the PID-5 across non-clinical representative samples of Portugal and the UAE, and other Middle Eastern countries.

Personality traits and alcohol consumption: Secondary analysis of the Self-Match Study

Background

This secondary analysis of the Self‐Match Study explores whether personality traits affect the treatment outcome for alcohol use disorders (AUD). We designed the Self‐Match Study to investigate whether clients choosing between treatment options improves treatment outcomes. The primary outcome report revealed no difference in the outcome, whether treatment allocation was based on clinician matching or self‐matching. Because willingness to choose, choice of treatment method, and compliance with treatment may be related to personality, this exploratory sub‐study investigated the influence of personality traits on treatment outcome.

Method

We enrolled 402 consecutive clients (female 46.7%, mean age 47.4) seeking treatment at the outpatient alcohol treatment center in Odense, Denmark. Clients were randomized to treatment by expert‐match or self‐matching. Data on alcohol consumption (Timeline Follow Back), personality traits (NEO‐FFI‐3), and retention in care were collected at baseline and 6‐month follow‐up. Outcomes were compliance, sensible drinking (alcohol intake below National Recommendations), and the number of heavy drinking days at follow‐up.

Results

A high neuroticism score was negatively associated with treatment completion. Further, clients with a high score on neuroticism, openness, and extraversion, or a low score on conscientiousness were less likely to reduce their drinking to a sensible level at follow‐up. We also found that low scores on conscientiousness were associated with having more heavy drinking days at follow‐up. The personality traits neuroticism and openness were associated with treatment preferences.

Conclusions

Personality traits influence 6 months drinking outcomes for people receiving AUD treatment.

Personality traits seem to not affect treatment completion. However, a high score on neuroticism, openness, extraversion, or a low score on conscientiousness influence the drinking pattern in different ways at 6‐month follow‐up. The personality traits neuroticism and openness were associated with preferences for specific treatment methods, but further research is needed on this matter. Tentative conclusions are that client‐centered treatment is preferable and shared decision‐making should be considered as part of the treatment regimen.

Impact of personality functioning and pathological traits on mental wellbeing of older patients with personality disorders

BACKGROUND

Although personality disorders are common and consequential, they are largely ignored in geriatric mental healthcare. We examined the relative contributions of different aspects of personality disorders and comorbid mental disorders to the impairment of mental wellbeing in older adults.

METHODS

Baseline data were used of 138 patients who participated in a randomized controlled trial on schema therapy for geriatric mental health outpatients with a full or subthreshold cluster B or C personality disorder. Personality was assessed according to both the categorical and dimensional model of DSM-5. Aspects of mental wellbeing assessed were; psychological distress, positive mental health, subjective health, and life satisfaction. The current study uses baseline data of the RCT to examine the associations between different aspects of personality pathology and mental wellbeing by multivariate regression analysis, controlling for age, sex, level of education, and number of chronic somatic illnesses.

RESULTS

The vast majority of patients (79.0%) had one or more mental disorders in addition to personality disorder. Personality pathology was responsible for the core of the mental health burden experienced by patients, and negated the influence of co-occurring mental disorders when entered subsequently in multivariate analysis. Personality dimensions proved to be highly predictive of mental wellbeing, and this contrasted with absence of influence of personality disorder diagnosis. Although the personality functioning dimensions - and in particular Identity integration (large effect size with partial eta-squared = 0.36) - were the primary predictors of mental wellbeing, personality trait dimensions added significant predictive value to that (Disinhibition 0.25 and Negative affect 0.24).

CONCLUSIONS

Personality disorders seriously affect the mental wellbeing of patients, and this overshadows the impact of comorbid mental disorders. In particular personality functioning and pathological traits of the Alternative Model of Personality Disorders (AMPD) of DSM-5 contribute to this impact on mental wellbeing. Alertness for and treatment of personality disorders in geriatric mental healthcare seems warranted.

Personalized treatment - which interaction ingredients should be focused to capture the unconscious

A recent meta-analysis revealed that mental health and baseline psychological impairment affect the quality of life and outcomes in different chronic conditions. Implementing mental health care in physical care services is still insufficient. Thus, interdisciplinary communication across treatment providers is essential. The standardized language provided by the diagnostic statistical manual favors a clear conceptualization. However, this approach might not focus on the individual, as thinking in categories might impede recognizing the continuum from healthy to diseased. Psychoanalytic theory is concerned with an individual’s unconscious conflictual wishes and motivations, manifested through enactments like psychic symptoms or (maladaptive) behavior with long-term consequences if not considered. Such modifiable internal and external factors often are inadequately treated. However, together with the physical chronic condition constraints, these factors determine degrees of freedom for a self-determined existence. The effect of therapeutic interventions, and especially therapy adherence, relies on a solid therapeutic relationship. Outcome and process research still investigates the mechanism of change in psychotherapeutic treatments with psychanalysis’s focus on attachment problems. This article examines existing knowledge about the mechanism of change in psychoanalysis under the consideration of current trends emerging from psychotherapy research. A clinical example is discussed. Additionally, further directions for research are given. The theoretical frame in psychoanalytic therapies is the affect-cognitive interface. Subliminal affect-perception is enabled via awareness of subjective meanings in oneself and the other; shaping this awareness is the main intervention point. The interactional ingredients, the patient’s inherent bioenvironmental history meeting the clinician, are relevant variables. Several intrinsic, subliminal parameters relevant for changing behavior are observed. Therapeutic interventions aim at supporting the internalization of the superego’s functions and at making this ability available in moments of self-reflection. By supporting mentalization abilities, a better understanding of oneself and higher self-regulation (including emotional regulation) can lead to better judgments (application of formal logic and abstract thinking). Thus, this facilitates enduring behavior change with presumably positive effects on mental and physical health.

Competition within Cross-Functional Teams: A Structural Equation Model on Knowledge Hiding

The modern challenges of business success make the use of interdisciplinary cross-functional teamwork necessary to tackle social and economic issues alike. The study examines the role of knowledge hiding in within-team coopetition, taking into account its subsequent factors influencing team efficiency. For the investigation, a self-made model was applied that associates the personality of individuals, their role inside the organization and work-environmental aspects with the individual’s behavior as the antecedent of within-team competition. The objective of this study revolves around the question of which factors apply to the efficiency of cross-functional teams. The modern concept of interdisciplinary coopetition faces more difficulties than traditional teams regarding voluntary adoption in new environments. The model was empirically applied to a dataset of 129 participants working in cross-functional teams. Three hypotheses were drafted and statistically evaluated. The factor of knowledge hiding was evaluated as one of the crucial factors blocking the efficiency of team-based work, based on the results from the literature review. This was further fueled by antagonistic behavior and a competitive supervisor. The empirical findings further elaborate that individuals with a competitive supervisor tend to be more antagonistic and competitive themselves. Equally, a highly developed personality trait of antagonism correlates positively with knowledge hiding, thereby resulting in the limiting of team performance. Surprisingly, competitiveness among individuals is negatively correlated with knowledge hiding, indicating that different personality traits and different real-life situations react drastically differently towards competitive environments. The results close the research gap of a strategic necessity for supervisors and managers designing business organizations alike, namely, that an individually adapted and situationally aware leadership is indispensable for a successful cross-functional team approach, even more than in traditional team compositions. As for now, only the effects on personality in educational environments were discussed in previous research.

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.

The Personality Inventory for DSM-5: Psychometric Evidence of Validity and Reliability-Updates

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.

Cross-Cultural Measurement Invariance in the Personality Inventory for DSM-5✰

The validity of cross-cultural comparisons of test scores requires that scores have the same meaning across cultures, which is usually tested by checking the invariance of the measurement model across groups. In the last decade, a large number of studies were conducted to verify the equivalence across cultures of the dimensional Alternative Model of Personality Disorders (DSM-5 Section III). These studies have provided information on configural invariance (i.e., the facets that compose the domains are the same) and metric invariance (i.e., facet-domain relationships are equal across groups), but not on the stricter scalar invariance (i.e., the baseline levels of the facets are the same), which is a prerequisite for meaningfully comparing group means. The present study aims to address this gap. The Personality Inventory for DSM-5 (PID-5) was administered to five samples differing on country and language (Belgium, Catalonia, France, Spain, and Switzerland), with a total of 4,380 participants. Configural and metric invariance were supported, denoting that the model structure was stable across samples. Partial scalar invariance was supported, being minimal the influence of non-invariant facets. This allowed cross-cultural mean comparisons. Results are discussed in light of the sample composition and a possible impact of culture on development of psychopathology.

Attachment, Mentalization, and Criterion B of the Alternative DSM-5 Model for Personality Disorders (AMPD)

BACKGROUND

The mentalization theory posits that interpersonal difficulties and maladaptive personality traits develop from an insecure attachment pattern with one's caregiver and corresponding deficits in mentalizing-the ability to understand others' and one's own mental states. Mentalizing deficits have been theorized as the basis for all psychopathology, with the paradigmatic case being Borderline Personality Disorder. Nevertheless, developments in the personality field indicate personality pathology is best represented dimensionally, and such a proposal was outlined by the Alternative DSM-5 Model for Personality Disorders (AMPD). Despite evidence linking the mentalization theory to personality disorders, however, it has yet to be applied to Criterion B of the AMPD. The aim of the present study was to evaluate the moderating role of mentalizing in the relation between attachment and Criterion B maladaptive trait function in a sample of undergraduates. We hypothesized a model in which: (1) attachment insecurity would be positively associated with the Negative Affectivity, Antagonism, and Disinhibition personality domains; (2) mentalizing ability would be negatively associated with these domains; and, (3) there would be an interaction effect between attachment and mentalizing when predicting these same domains.

METHODS

Personality domains were measured dimensionally via the Personality Inventory for DSM-5 (PID-5-SF), while the dependence and avoidance domains of attachment were assessed via the Relationship Questionnaire (RQ). Mentalizing ability was tapped by the Movie for the Assessment of Social Cognition (MASC). The AMPD personality domains and trait facets were examined as dependent variables; attachment dependence, attachment avoidance, and overall mentalizing ability were entered as independent variables; and interaction terms between mentalizing and each attachment dimension were used to test moderation via MANCOVAs.

RESULTS

Consistent with expectations, results indicated overall mentalizing moderated the relation between attachment avoidance and Negative Affectivity. Posthoc analyses revealed similar effects on the relations between attachment avoidance and the Emotional Lability, Hostility, and Perseveration trait facets; however, there were no significant moderation findings related to attachment dependence.

CONCLUSIONS

These results support the mentalization theory's application to Criterion B of the AMPD, particularly in relation to the links between Negative Affectivity and borderline-related traits, and encourage future research of dimensional maladaptive personality. They further bolster support for understanding maladaptive personality as a dimensional construct.

Alternative DSM-5 Model for Personality Disorders Through the Lens of an Empirical Network Model

The Alternative Model for Personality Disorders defined in Diagnostic and Statistical Manual of Mental Disorders-Fifth edition (DSM-5) has recently attracted considerable interest in empirical research, with different hypotheses being proposed to explain the discordant results shown in previous research. Empirical network analysis has begun to be applied for complementing the study of psychopathological phenomena according to a new perspective. This article applies this analysis to personality facets measured in a sample of 626 patients with mental disorders and a 1,034 normative sample, using the Personality Inventory for DSM-5. The results reveal five substructures partially equivalent to domains defined in the DSM-5. Discordant facets (suspiciousness, hostility, rigid perfectionism, attention seeking, and restricted affectivity) play the role of connectors between substructures. Invariance between clinical and community networks was found except for the connection between unusual beliefs and perceptual dysregulation (stronger in the clinical sample). Considering the strength centrality index, anxiousness, emotional lability, and depressivity can be highlighted for their relative importance within both clinical and normative networks.

Psychometric Properties of the Independent 36-Item PID5BF+M for ICD-11 in the Czech-Speaking Community Sample

Background: Empirical soundness and international robustness of the PID5BF+M, a shortened version of the PID-5 developed for simultaneous evaluation of maladaptive personality traits in the DSM-5 AMPD and ICD-11 models for personality disorders, was recently confirmed in 16 samples from different countries. Because the modified PID5BF+ scale (36 items) was extracted from the complete 220-item PID-5, an independent evaluation of psychometric properties of a stand-alone PID5BF+M is still missing. Objectives: The present study evaluated the validity and reliability of the 36-item PID5BF+M in comparison with the extracted version from the original PID-5. It also assessed associations between the Borderline Pattern qualifier and trait domain qualifiers. Methods: Two non-clinical samples meeting the inclusion criteria were employed in the study. Sample 1 (n = 614) completed the 220-item PID-5; Sample 2 (n = 1,040) completed the independent 36-item PID5BF+M. Participants were from all 14 regions of the Czech Republic. The Borderline Pattern qualifier was evaluated using a shortened IPDEQ screener. Results: The proposed latent structure of the independent PID5BF+M was confirmed, with an exception of the Disinhibition domain. The results confirmed good internal consistency and test-retest reliability of the measure, as well as some support for the measurement invariance of the independent PID5BF+M in comparison with the extracted version from the original PID-5. Significant associations between the Negative affectivity, Disinhibition, and Psychoticism qualifiers and the IPDEQ items for the emotionally unstable personality disorder of both impulsive and borderline types confirmed good predictive validity of the PID5BF+M in pursuing borderline psychopathology within the ICD-11 model. Conclusions: The independent PID5BF+M was found to be a valid and reliable tool for evaluation of the ICD-11 trait model. However, the Disinhibition domain deserves further investigation in clinical samples as well as in international community samples.

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.

New vision on the mental problems of Vincent van Gogh; results from a bottom-up approach using (semi-)structured diagnostic interviews

Background

On July 29, 1890 at the age of 37 years, the Dutch painter Vincent van Gogh died from the consequences of a suicide attempt with a gun 2 days earlier. Since then many medical and psychological theories were suggested about what had happened to Van Gogh.

Aim

To present an overview of the history of the mental problems of Van Gogh and the most likely diagnoses.

Method

(Semi-)structured diagnostic interviews were applied to three art historians who are very familiar with Van Gogh from his correspondence and other sources as well as a neuropsychiatric examination to evaluate whether the symptoms might be explained by a medical condition.

Results

Several previously suggested diagnoses could be excluded as being highly unlikely, while other diagnoses could be classified as more of less likely.

Conclusion

Most likely Van Gogh suffered from comorbid illnesses. Since young adulthood, he likely developed a (probably bipolar) mood disorder in combination with (traits of) a borderline personality disorder as underlying vulnerability. This likely worsened through an alcohol use disorder combined with malnutrition, which then led, in combination with rising psychosocial tensions, to a crisis in which he cut off his ear. Thereafter, he likely developed two deliriums probably related to alcohol withdrawal, followed by a worsening with severe depressive episodes (of which at least one with psychotic features) from which he did not fully recover, finally leading to his suicide. As additional comorbidity, focal (temporal lobe) epilepsy cannot be excluded.

Elucidating the relationship between borderline personality disorder and intimate partner violence

This study examined the established association between borderline personality disorder (BPD) and intimate partner violence (IPV). More specifically, it compared the DSM-5 traditional categorical personality disorder (PD) model with the DSM-5 Alternative Model of PD (AMPD) operationalizations of BPD in their relative associations with IPV. The effects of gender, as well as the associations between BPD and different forms of IPV were also considered. Additionally, we investigated the specific BPD-relevant AMPD personality traits that influence the BPD-IPV association. The study sample were 250 community-dwelling men and women recruited through an established crowdsourcing platform. Results revealed that both the 'traditional' and AMPD operationalizations of BPD were approximately equally associated with IPV perpetration, although the traditional BPD operationalization demonstrated some minor advantages in this regard. The AMPD trait facets of hostility (negative affectivity), suspiciousness (negative affectivity) and risk taking (disinhibition) were most strongly associated with IPV perpetration for the total sample, and additional negative affectivity trait facets were also associated with IPV for men only. Implications for these findings are discussed. © 2020 John Wiley & Sons, Ltd.

Arabic Version of the Personality Inventory for the DSM-5 (PID-5) in a Community Sample of United Arab Emirates Nationals

Background:

Section III of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) proposes a model for conceptualizing personality disorders in which they are characterized by impairments in personality functioning and maladaptive personality traits. The Personality Inventory for DSM-5 (PID-5) is a self-report measure that assesses the presence and severity of these maladaptive personality traits.

Objective:

The current study examined the reliability and validity of the Arabic version of the Personality Inventory for DSM-5 (PID-5) to measure maladaptive personality traits in the Emirati population of the United Arab Emirates.

Methods:

The Arabic version of the PID-5 was administered to a community sample of 1,090 United Arab Emirates nationals (89.5% female and 10.5% male, mean age = 22.44 years old). The descriptive measures, internal consistency, test-retest reliability, convergent validity with NEO – Five Factor Inventory, as well as PID-5’s factor structure, were all addressed.

Results:

The PID-5facets and domains mean scores were higher in the Emirati sample compared to the original US sample. Internal consistency of the PID-5 scales was acceptable to high and test-retest coefficients ranged from 0.84 (facets) to 0.87 (domains). As expected, the five domains of the Arabic version of the PID-5 correlated significantly with all Five-Factor Model domains of personality. Additionally, the Arabic version of the PID-5 confirmed a five-factor structure that resembles the PID-5 domains.

Conclusion:

The findings of this study provided initial support for the use of the Arabic version of the PID-5 to assess maladaptive personality traits in the Emirati population of the United Arab Emirates.

An Object Relations Model Perspective on the Alternative Model for Personality Disorders (DSM-5)

The Alternative Model of DSM-5 combines dimensional ratings of self-functioning, interpersonal functioning, and traits with categorical classification. The object relations model has a long tradition pre-dating the Alternative Model and, in part, has been incorporated into the Alternative Model. The object relations model provides a theoretical background (generally missing in the Alternative Model) that enhances the clinical assessment of personality pathology and its relationship to treatment planning.

A Brief but Comprehensive Review of Research on the Alternative DSM-5 Model for Personality Disorders

PURPOSE OF REVIEW

Both the Alternative DSM-5 Model for Personality Disorders (AMPD) and the chapter on personality disorders (PD) in the recent version of ICD-11 embody a shift from a categorical to a dimensional paradigm for the classification of PD. We describe these new models, summarize available measures, and provide a comprehensive review of research on the AMPD.

RECENT FINDINGS

A total of 237 publications on severity (criterion A) and maladaptive traits (criterion B) of the AMPD indicate (a) acceptable interrater reliability, (b) largely consistent latent structures, (c) substantial convergence with a range of theoretically and clinically relevant external measures, and (d) some evidence for incremental validity when controlling for categorical PD diagnoses. However, measures of criterion A and B are highly correlated, which poses conceptual challenges. The AMPD has stimulated extensive research with promising findings. We highlight open questions and provide recommendations for future research.

Personality Inventory for DSM-5-Short Form (PID-5-SF): Reliability, Factorial Structure, and Relationship With Functional Impairment in Dual Diagnosis Patients

Section III of the Diagnostic and Statistical Manual of Mental Disorders-Fifth edition (DSM-5) has generated a personality paradigm consisting of 25 personality facets identified in five domains. The developed assessment instrument Personality Inventory for DSM-5 (PID-5) has showed good psychometric properties, but the potential for certain improvements still remain. In this article, a sample of 282 dual diagnosis patients is used to provide evidence of the psychometric properties of the PID-5-Short Form. The mean value of Cronbach's alpha coefficients reached .73 on the facets and .84 for domains and test-retest values ranged between .57 to .83 for facets and .70 to .87 for the domains. Confirmatory factor analyses conducted showed good fit on both models tested: the five correlated factor structure and hierarchical structure of personality traits. The WHODAS 2.0 domains of understanding and communicating, and participating in society, appear to show the strongest relationship with personality facets. In general, the PID-5-Short Form shows adequate psychometric properties for use in dual diagnosis patients.

Group schema-focused therapy enriched with psychomotor therapy versus treatment as usual for older adults with cluster B and/or C personality disorders: a randomized trial

BACKGROUND

Several types of psychotherapy have been proven successful in the treatment of personality disorders in younger age groups, however studies among older patients are lacking. We developed a group schema-focused therapy (SFT) enriched with psychomotor therapy (PMT) for older adults with cluster B and/or C personality disorders. This paper describes the design of a randomized controlled trial (RCT). We will evaluate the (cost-)effectiveness of this therapy protocol in specialized mental health care. We hypothesize that our treatment program is cost-effective and superior to treatment as usual (TAU) in reducing psychological distress and improving quality of life in older adults treated to specialized mental healthcare.

METHODS

A multicenter RCT with a one-year follow-up comparing group schema-focused therapy enriched with psychomotor therapy (group SFT + PMT) and TAU for adults aged 60 years and older who suffer from either a cluster B and/or C personality disorder. The primary outcome is general psychological distress measured with the 53-item Brief Symptom Inventory. Secondary outcomes are the Schema Mode Inventory (118-item version) and the Young Schema Questionnaire. Cost-effectiveness analysis will be performed from a societal perspective with the EuroQol five dimensions questionnaire and structured cost-interviews.

DISCUSSION

This study will add to the knowledge of psychotherapy in later life. The study specifically contributes to the evidence on (cost-) effectiveness of group SFT enriched with PMT adapted to the needs of for older adults with cluster b and/or c personality.

TRIAL REGISTRATION

Netherlands Trial Register NTR 6621 . Registered on 20 August 2017.

Psychometric properties and diagnostic utility of a Brazilian version of the PCL-5 (complete and abbreviated versions)

Background: With the release of the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5), the Posttraumatic Stress Disorder Checklist (PCL) has been updated to meet the revisions of the diagnostic criteria for Posttraumatic Stress Disorder (PTSD). However, the diagnostic utility and reliability of a Brazilian version of the new Posttraumatic Stress Disorder Checklist (PCL-5) have not been investigated yet. Objective: To investigate the internal consistency, test-retest reliability, and diagnostic utility of the complete version (21-item) and two abbreviated (8-item and 4-item) versions of the Brazilian PCL-5. Methods: A total of 85 individuals with a history of exposure to at least one traumatic event underwent a diagnostic interview using the Structured Clinical Interview for DSM-5 (SCID-5-CV) and completed the Brazilian version of the PCL-5. Moreover, participants were invited to complete the checklist for a second time 10-30 days after the first assessment. Results: Both the complete and abbreviated versions of the Brazilian PCL-5 showed good internal consistency (complete PCL-5, α = .96; 8-item, α = .93; 4-item, α = .85) and test-retest reliability (complete PCL-5, ICC .87 [95% CI, 0.65-0.95]; 8-item, ICC .84 [95% CI, 0.60-0.94]; 4-item, ICC .84 [95% CI, 0.58-0.94]). Diagnostic utility analyses using the Structured Clinical Interview for DSM-5 (SCID-5-CV) revealed that a cutoff point of 36 presented the higher overall efficiency for predicting a PTSD diagnosis Overall Efficiency (OE, .80) and corresponded to Youden's index J (.65). For the 8-item version, a cutoff point of 13 corresponded to Youden's index J (.61), while scores of 21 or more were associated with the highest OE (.78). For the 4-item PCL-5, scores > 7 presented the highest OE (.77) and corresponded to Youden's index J (.59). Conclusions: Overall, the findings provide relevant evidence regarding the high reliability and diagnostic utility of this Brazilian version of the PCL-5.

Item Response Theory Analyses, Factor Structure, and External Correlates of the Italian Translation of the Personality Inventory for DSM-5 Short Form in Community-Dwelling Adults and Clinical Adults

To assess the psychometric properties of the Italian translation of the 100-item short form of the Personality Inventory for DSM-5 (PID-5-SF), 2,143 community-dwelling adults (59.6% female), and 706 adult clinical participants (52.4% female) were administered the Italian translation of the PID-5. Clinical participants were also administered the Structured Clinical Interview for DSM-IV (SCID-II), and the Personality Diagnostic Questionnaire-4+ (PDQ-4+). Item response theory analysis showed that all proposed PID-5-SF items showed adequate item discrimination parameters in both community-dwelling adults and clinical adults. All PID-5-SF trait scales showed satisfactory internal consistency estimates. PID-5-SF five-factor structure closely matched the factor structure of the PID-5 in both community-dwelling participants and clinical participants and was invariant across the two samples that participated in this study. Moreover, the factor structure of the PID-5-SF closely replicated the factor of the PID-5-SF that was originally reported in Maples et al.'s study. In our clinical sample, dominance analysis results showed that PID-5-SF scales explained a nonnegligible and significant amount of variance in both SCID-II and PDQ-4+ ratings of selected DSM-5 Section II personality disorder, and the use of the PID-5-SF did not result in a substantial loss of information as compared with the original PID-5.

Strengths and Weaknesses of Two Empathy Measures: A Comparison of the Measurement Precision, Construct Validity, and Incremental Validity of Two Multidimensional Indices

The quality of empathy research, and clinical assessment, hinges on the validity and proper interpretation of the measures used to assess the construct. This study investigates, in an online sample of 401 adult community participants, the construct validity of the Affective and Cognitive Measure of Empathy (ACME) relative to that of the Interpersonal Reactivity Index (IRI), the most widely used multidimensional empathy research measure. We investigated the factor structures of both measures, as well as their measurement precision across varying trait levels. We also examined them both in relation to convergent and discriminant criteria, including broadband personality dimensions, general emotionality, personality disorder features, and interpersonal malignancy. Our findings suggest that the ACME possesses incremental validity beyond the IRI for most constructs related to interpersonal malignancy. Our results further indicate that the IRI Personal Distress scale is severely deficient in construct validity, raising serious concerns regarding past findings that have included it when computing total empathy scores. Finally, our results indicate that both questionnaires display poor measurement precision at high trait levels, emphasizing the need for future researchers to develop indices that can reliably measure high levels of empathy.

Structure of DSM-5 and ICD-11 personality domains in Iranian community sample

AIM

Personality disorders (PD) have been deemed the most problematic diagnostic grouping in terms of validity and utility, which particularly applies to non-Western societies. The current study evaluated the structural validity of PD trait domains in the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) Section III and the proposed International Classification of Diseases-11 (ICD-11) in the Iranian population.

METHODS

Community-dwelling adults (n = 285; 66% women) were administered the Personality Inventory for DSM-5, whereas the proposed ICD-11 trait domains were delineated using an algorithm for Personality Inventory for DSM-5 trait facets. The five-factor organization and higher-order hierarchical structure of both models were examined using exploratory structural equation modelling analyses.

RESULTS

The five-factor exploratory structural equation modelling loadings overall resembled international findings on DSM-5 Section III traits (including Psychoticism), whereas the ICD-11 five-factor structure aligned with the proposed ICD-11 domain features (including Anankastia). Additionally, we identified a hierarchical structure from one to five factors for both models that conceptually aligned with established models of personality and psychopathology.

CONCLUSIONS

This study provided initial support for the structural validity of DSM-5 and ICD-11 PD trait models in Iranian culture. Future research warrants replication in larger samples and clinical populations. Copyright © 2018 John Wiley & Sons, Ltd.