Personality, disorder, and personality disorder: towards a more rational conceptualization

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.

Personality traits, types, and disorders: an examination of the relationship between three self‐report measures

As part of an assessment centre 431 candidates completed three self‐report measures: one of personality disorders (Hogan Development Survey, HDS; Hogan & Hogan, 1997), one of personality traits (NEO‐PI, Costa & McCrae, 1992), and one of personality type (MBTI; Briggs & Myers, 1987). Correlational and regressional analysis tested various hypotheses about the overlap between the different dimensions and confirmed previous research using different instruments (Saulsman & Page, 2004). Results revealed highest correlation between the HDS and NEO, showing neuroticism correlating (as predicted) with excitable (borderline) and cautious (avoidant); introversion correlating with avoidant (cautious), schizoid (detached), and (negatively) with colourful (histrionic); openness correlating with schizotypal (imaginative) and conscientiousness with diligent (obsessive–compulsive). Many of the ‘overlaps’ were suggested by Widiger, Trull, Clarkin, Sanderson, and Costa (2002). The overlap and lack of overlap is considered at the psychometric and conceptual level. Copyright © 2005 John Wiley & Sons, Ltd.

Honoring the Past, Envisioning the Future: ABCT's 50th Anniversary Presidential Address

The theme of the Association for Behavioral and Cognitive Therapies (ABCT) 50th Anniversary was to honor the past and envision the future. From the wisdom, foresight, and determination of the pioneers of our organization, and the continuous upholding of the scientific method over the last 50 years, cognitive behavioral therapy (CBT) has become the most empirically supported psychological treatment for a wide array of mental health problems. Yet, we still have a long way to go. This address outlines a vision for the future of CBT, which involves greater collaborative science, with all minds working together on the same problem, and greater attention to the risk factors and critical processes that underlie psychopathology and explain treatment change. Such knowledge generation can inform the development of new, more efficient and more effective therapies that are tailored with more precision to the needs of each person. Latest technologies provide tools for a precision focus while at the same time increasing the reach of our treatments to the many for whom traditional therapies are unavailable. Our impact will be greatly enhanced by large samples with common methods and measures that inform a precision approach. We have come a long way since ABCT was founded in 1966, and we are poised to make even larger strides in our mission to enhance health and well-being by harnessing science, our major guiding principle.

Evaluation of the validity of the Multidimensional Personality Questionnaire-Simplified-Wording Form (MPQ-SF) in adolescents with treatment histories

The Multidimensional Personality Questionnaire (MPQ) is a widely used personality assessment instrument informing lower- and higher-order personality dimensions. Despite recent developments of brief (MPQ-BF) and simplified wording (MPQ-SF) forms, there is relatively little work on the utility and validity of the MPQ in younger samples with lower reading levels. This study is the first to assess the reliability, factor structure, and criterion validity of the MPQ-SF in a sample of treatment-referred mid-adolescents (N = 105; 12-17 years). Results suggest adequate reliabilities for most of the lower-order primary scales and support a three-factor structure of the MPQ-SF, consistent with previous research with adult and college-aged samples. However, there were also notable cross-loadings for particular scales, which we discuss in relation to the four-factor MPQ model and the Five Factor Model of Personality. Relationships between MPQ personality dimensions and psychopathology using youth, parent, and clinician-rated psychopathology indices supported criterion-related validity. Together, these results confirm the utility of the MPQ in youth with treatment histories.

New directions for an old construct: Depressive personality research in the DSM-5 era

The DSM-5 Personality and Personality Disorders Work Group has suggested that the DSM-IV depressive personality disorder (DPD) construct be assessed within a proposed set of trait domains, which include anxiousness, depressivity, and anhedonia, and that the diagnostic category itself be removed from the DSM-5. A review of studies on DPD has demonstrated many challenges and limitations to DPD research, despite strong evidence of its validity and clinical utility. Nevertheless, there remains much interest in how a depressive personality construct fits into a dimensionalized framework of assessing psychopathology. In this paper, I offer three major research directions that can help advance our understanding of the depressive personality construct. These directions can inform researchers and clinicians how depressive personality fits within broad trait dimensions of classification, as well as the internal psychological processes, dynamics and content that characterize this type of psychopathology.

A controlled study of personality and affect in Tourette syndrome

OBJECTIVE

Tourette syndrome (TS) can increase the likelihood of social and emotional difficulties which may shape an individual's personality and self-perception. We investigated personality and affect in patients with TS.

METHODS

Twenty-five adults with TS (2 with co-morbid obsessive compulsive disorder, 4 with co-morbid attention-deficit hyperactivity disorder and 4 with both co-morbidities), who were not clinically depressed, and 25 matched controls participated in the study. They completed the Ten-Item Personality Index, the Positive and Negative Affect Scale and the Beck Depression Inventory.

RESULTS

Adults with TS exhibited no differences from controls in reported emotional experience or depressive symptoms but did differ for four of the five assessed personality dimensions; extraversion, conscientiousness, openness and emotional stability. Individuals with pure TS (who had no co-morbid conditions) exhibited reduced extraversion and emotional stability compared to controls. Personality scores were not related to tic severity, yet lower emotional stability scores were associated with higher ratings of negative affect.

CONCLUSIONS

This study is limited by a restricted sample in terms of size and source. However, our findings indicate that in the absence of depression and common co-morbidities, people with TS differ from controls in indices of personality, which are linked to negative affectivity.

Psychometric properties of the Spanish version of the diagnostic interview for depressive personality

The aim of this study was to evaluate the reliability and validity of the Spanish-language version of the diagnostic interview for depressive personality (DIDP). The DIDP was administered to 328 consecutive outpatients and the test-retest and inter-rater reliability were assessed. Factor analysis was used in search of factors capable of explaining the scale and a cutoff point was established. The DIDP scales showed adequate Cronbach's α values and acceptable test-retest and inter-rater reliability coefficients. Convergent and discriminant validity were explored, the latter with respect to avoidant and borderline personality disorders. The results of the factor analysis were consistent with the four-factor structure of the DIDP scales. The receiver operating characteristic (ROC) analysis revealed the area under the curve to be 0.848. We found 30 to be a good cutoff point, with a sensitivity of 74.5% and a specificity of 78.5%. The DIDP proved to be a reliable and valid instrument for assessing depressive personality disorder, at least among our outpatients. The psychometric properties of the DIDP support its clinical usefulness in assessing depressive personality.

Conscientiousness and externalizing psychopathology: Overlap, developmental patterns, and etiology of two related constructs

The present paper focuses on the trait domain of conscientiousness, its development, and its relation to psychopathology. The definition of conscientiousness and its interface with specific forms of psychopathology, such as externalizing psychopathology, are discussed first. Then an overview of the known developmental changes in conscientiousness across the life course is provided, as well as the potential shared developmental etiology of conscientiousness and externalizing psychopathology. Given the lack of data, testing etiological factors that may contribute to the development of both conscientiousness and externalizing disorders, we report on three studies examining the childhood experiences associated with both conscientiousness and externalizing behaviors. Last, future directions are discussed.

What should become of depressive personality disorder in DSM-V?

Depressive personality disorder (DPD) has been under consideration for inclusion in the Diagnostic and Statistical Manual of Mental Disorders for many years. The wealth of empirical studies on the validity of DPD has raised many questions about the validity of the DPD construct and its measures. This article specifically reviews studies on the validity of that construct and how it is measured. Although the evidence supports the idea that DPD is a viable diagnostic category, there remain significant challenges to its assessment. These findings are discussed in the context of some potential changes that may occur in the classification and diagnosis of personality disorders in DSM-V.

Depressive personality disorder, dysthymia, and their relationship to perfectionism

This paper reports the results of two studies in a nonclinical (n=105) and primary care outpatient sample (n=110), in which Depressive Personality Disorder (DPD), Dysthymia, and depression were assessed for their distinctive relationship with perfectionism. Results from both studies found that self-reported DPD, Dysthymia, and depressive symptoms were all intercorrelated, and that DPD, Dysthymia, and depressive symptoms were correlated with three dimensions of perfectionism-Concern over Mistakes, Doubts about Actions, and Parental Criticism. In the nonclinical sample, variance in measures of DPD was predicted by measures of perfectionism after controlling for depression and Dysthymia symptoms. A similar pattern of findings was observed in the primary care sample. This relationship with perfectionism did not occur when Dysthymia or depressive symptoms were predicted. Nevertheless, much of the variance in measures of DPD, Dysthymia, and depressive symptoms is associated with each other and not perfectionism. It is concluded that a common factor or set of factors underlies these disorders, but that DPD may be more strongly related to perfectionism than Dysthymia and depression. As a common factor(s) is identified, measures of DPD and Dysthymia may be refined, thereby increasing the discriminant validity of their measures.

Disentangling depressive personality disorder from avoidant, borderline, and obsessive-compulsive personality disorders

Several studies have found that 3 personality disorders (PDs) tend to share moderate rates of comorbidity with depressive PD: avoidant, borderline, and obsessive-compulsive. This study sought to evaluate the diagnostic criteria of each disorder in an effort to understand where areas of overlap may occur and to modify criteria sets where reasonable to reduce any degree of overlap. One thousand two hundred psychiatric outpatients were interviewed with the Structured Interview for DSM-IV Personality Disorders. The highest degree of comorbidity was observed between avoidant PD and depressive PD. Logistic regression analyses indicated that 2 criteria-avoidant criterion 5 and depressive criterion 2-could be removed from the diagnostic criteria sets and reduce the rates of overlap by as much as 15%. A factor analysis of the criteria of all 4 PDs indicated that there is a common clustering of many of the symptoms of avoidant, borderline, depressive, and obsessive-compulsive PDs and that borderline symptoms tend to cluster together most consistently. Avoidant and obsessive-compulsive personality symptoms clustered in ways that may reflect a problem of how to engage with others, suggestive of an approach-avoidance conflict. Depressive PD symptoms clustered in a way suggestive of problems with anger that is directed toward oneself and others. The factor analysis results suggest that an organization of symptoms around themes of conflict may provide useful ways of understanding the personality patterns of these 4 disorders.

Depressive personality and dysthymia: evaluating symptom and syndrome overlap

BACKGROUND

Depressive Personality (DP) is being evaluated for future inclusion in DSM. One recurring issue has been conceptual and empirical redundancy with Dysthymia (i.e., Dysthymic Disorder; DD).

METHODS

The symptom and syndrome overlap of DP and DD were tested in a clinical sample (N = 125) using both self-report and clinician ratings.

RESULTS

Confirmatory factor analyses of the DP and DD symptoms indicated that models which separate these two syndromes had a better fit than a model in which all symptoms were classified together, particularly for the clinician-rated data. At the same time, the syndromes were highly correlated. Binary diagnostic analysis showed that over 80% of the individuals meeting criteria for DP also met criteria for DD. As predicted, the best fit was obtained when the 'psychological' symptoms of DD-- low self-esteem and feelings of hopelessness-- were allowed to be part of both syndromes, and 82% of patients who met criteria for both DP and DD endorsed these two symptoms.

LIMITATIONS

Clinical ratings rather than structured diagnostic interviews were used. As well, some models required modification to improve fit.

CONCLUSIONS

Depressive personality traits can be empirically separated from DD symptoms, but including DP as a categorical diagnosis would lead to a high degree of diagnostic overlap. Much of this overlap is due to sharing psychological features in common. Revisions in the diagnostic system should find a way to incorporate depressive personality traits without insisting that they be diagnosed in a categorical manner.

Personality Disorders and Intelligence

Over 500 working adults completed two intelligence tests: the GMA (Graduate Management Assessment) and the WG (Watson-Glaser), a measure of the Big-Five personality traits (NEO-FFM), and a personality disorders measure (Hogan Development Survey). Regressing first the Big-Five personality traits, then the personality disorders, onto the two different measures of intelligence suggested evidence for the incremental validity of personality disorders, which in both studies accounted for an additional 5% of the variance. Results were slightly different in the two analyses though clearly obsessive-compulsiveness is negatively correlated with intelligence test scores.

Depressive personality disorder: rates of comorbidity with personality disorders and relations to the five-factor model of personality

Depressive personality disorder (DPD) is listed in the DSM-IV as one of the "Disorders for Further Study." In this investigation we examined (1) the rates of comorbidity of DPD with the 10 personality disorders (PDs) in the main text of DSM-IV, and (2) the convergent and discriminant validity of DPD in its relation to the 30 facet traits of the Five-Factor Model of personality (FFM). One hundred and sixty-nine participants with psychiatric diagnoses were interviewed with the Structured Clinical Interview for DSM-IV Personality Disorders Questionnaire (SCID-II) and completed the Revised NEO Personality Inventory (NEO PI-R). A total of 26 (15%) of the participants met diagnostic criteria for at least one of the 10 main text PDs, and 15 (9%) met criteria for DPD. Of those who met criteria for DPD, 10 (59%) of the participants also met criteria for one or more of the 10 main text PDs. Regression analyses indicated a four-facet trait set derived from the NEO PI-R thought to be uniquely associated with DPD accounted for a significant amount of variance in DPD SCID-II PD scores and was significantly larger for DPD than it was for the 9 of the 10 main text PDs; the sole exception was for avoidant PD. Diagnostically, DPD overlaps significantly with other PDs but is distinguishable in its unique relation with traits from the FFM.

Borderline personality disorder from the perspective of general personality functioning

The authors extended previous work on the hypothesis that borderline personality disorder (BPD) can be understood as a maladaptive variant of personality traits included within the 5-factor model (FFM) of personality. In each of 3 samples, an empirically derived prototypic FFM borderline profile was correlated with individuals' FFM profiles to yield a similarity score, an FFM borderline index. Results across all samples indicated that the FFM borderline index correlated as highly with existing borderline measures as they correlated with one another, and the FFM borderline index correlated as highly with measures of dysfunction, history of childhood abuse, and parental psychopathology as did traditional measures of BPD. Findings support the hypothesis that BPD is a maladaptive variant of FFM personality traits.

Personality and psychopathology: working toward the bigger picture

There are systematic and meaningful links among normal and abnormal personality traits and Axis I and II constructs from the DSM. Nevertheless, much research in this area focuses on pairs of constructs (e.g., the link between personality traits and a specific Axis I disorder), rather than on the broader multivariate structure of the personality-psychopathology domain. We underscore the need for this broader perspective, a perspective that would transcend largely artificial boundaries between current constructs (e.g., normal and abnormal personality). We outline our approach to research from this perspective and we emphasize the internalizing (mood and anxiety) and externalizing (substance use and antisocial behavior) spectra as promising foci for initial research on the joint structure of personality and psychopathology.

Psychometric evaluation of the depressive personality disorder inventory

The purpose of this study was to evaluate the psychometric properties of the Depressive Personality Disorder Inventory (DPDI; Huprich, Margrett, Barthelemy, & Fine, 1996). The DPDI was found to have strong internal consistency in both an undergraduate and a veteran, psychiatric outpatient population. The DPDI had significant, positive correlations with other measures of depressive personality, supporting its convergent validity. These relationships remained even after controlling for state-like depression, suggesting that the DPDI has incremental validity. The DPDI also significantly predicted scores on measures of interpersonal loss, even after controlling for state-like depression, suggesting that the DPDI has good construct validity. In support of discriminant validity, the DPDI was more correlated with another measure of depressive personality than it was with measures of other personality disorders. Finally, the DPDI had strong diagnostic efficiency statistics: (a) Sensitivity = .82, (b) Specificity = .80, (c) Positive Predictive Power = .75, (d) Negative Predictive Power = .86, and (e) Overall Diagnostic Power = .81. It appears that the DPDI has good psychometric properties.

Recent research of relationships among eating disorders and personality disorders

This review focuses on recent research examining the relationships among eating disorders (ED) and personality disorders (PD). Studies that have examined rates of PD in patients with ED and rates of ED in patients with PD have generally reported high rates of diagnostic co-occurrence, although the marked inconsistency and variability in rates across studies is striking. Methodologic limitations and conceptual problems make interpretation of the existing literature ambiguous. Overall, circumspect review suggests that anorexia nervosa may be associated with obsessional and perfectionistic forms of personality disturbances, bulimia nervosa with impulsive and unstable personality disturbances, and binge eating disorder with avoidant and anxious forms of personality disturbances. In terms of longitudinal associations, PD may be more closely associated with the course of general psychiatric or psychosocial functioning than with fluctuations in the course of ED. The significance (and more precise nature) of these associations, however, is unclear and will require sophisticated longitudinal studies to arrive at more definitive answers.

Adult psychopathology: issues and controversies

This review discusses issues and controversies with respect to the construct of a mental disorder, models of etiology and pathology, and domains of psychopathology. Fundamental to the science of psychopathology is a conceptualization of mental disorder, yet inadequate attention is being given to the differentiation of normal and abnormal psychological functioning in current research. The boundaries between mental and physical disorders are equally problematic. Neurophysiological models are receiving particular emphasis in large part because of the substantial progress being made in documenting and clarifying the important role of neurophysiological structures and mechanisms in etiology and pathology. However, this attention might be at the expense of the recognition of equally valid psychological models. Problematic diagnostic boundaries are also considered, including those within and between different classes of disorder. Dimensional models may offer a more precise and comprehensive classification of psychopathology.

Reliability of personality disorder symptoms and personality traits in substance-dependent inpatients

The authors compared the internal consistency, 1-year temporal stability, and self-informant agreement of ratings of personality trait (NEO Five-Factor Inventory; NEO-FFI; P. T. Costa & R. R. McCrae, 1992) and personality disorder symptom severity (Structured Clinical Interview for DSM-III-R Personality Disorders Questionnaire; SCID-II-Q; R. L. Spitzer, J. B. W. Williams, M. Gibbon, & M. First, 1990) in 131 substance-dependent inpatients. Internal consistency coefficients were acceptable to very good for most NEO-FFI and SCID-II-Q scales, and temporal stability correlations were significant for all measures. Agreement between patient and informant ratings was more modest. Substance abuse and depression symptom severity moderated the temporal stability and self-informant agreement of several personality trait and disorder ratings. The authors did not find that the five factors were more reliable than the Axis II symptoms. Issues related to the reliability of personality assessment in multiply diagnosed patients are discussed.