Reconceptualizing personality pathology in DSM-5: limitations in evidence for eliminating dependent personality disorder and other DSM-IV syndromes

Functional MRI findings in personality disorders: A review

Personality disorders (PDs) have a prevalence of approximately 10% in the United States, translating to over 30 million people affected in just one country. The true prevalence of these disorders may be even higher, as the paucity of objective diagnostic criteria could be leading to underdiagnosis. Because little is known about the underlying neuropathologies of these disorders, patients are diagnosed using subjective criteria and treated nonspecifically. To better understand the neural aberrancies responsible for these patients' symptoms, a review of functional MRI literature was performed. The findings reveal that each PD is characterized by a unique set of activation changes corresponding to individual structures or specific neural networks. While unique patterns of neural activity are distinguishable within each PD, aberrations of the limbic/paralimbic structures and default mode network are noted across several of them. In addition to identifying valuable activation patterns, this review reveals a void in research pertaining to paranoid, schizoid, histrionic, narcissistic, and dependent PDs. By delineating patterns in PD neuropathology, we can more effectively direct future research efforts toward enhancing objective diagnostic techniques and developing targeted treatment modalities. Furthermore, understanding why patients are manifesting certain symptoms can advance clinical awareness and improve patient outcomes.

Dependent Personality in Depressed Older Adults: A Case Report and Systematic Review

Personality pathology in older adults is largely understudied. Here, we present a case report of an older adult who presented to an inpatient geriatric psychiatry unit with dependent personality traits in the context of chronic major depressive disorder, followed by a systematic review of the literature to identify research regarding the diagnosis and prevalence of dependent personality in depressed older adults. We identified 11 studies relevant to this topic. Synthesis of these data revealed that dependent personality is generally more common in depressed older adults compared to other personality disorders. However, studies were limited by small sample sizes and the use of assessments not validated for use in older adults. Therefore, it is difficult to draw conclusions from the available data. Potential implications for patient outcomes and health care services utilization are discussed. Our review highlights the need for larger scale research and personality assessments which are sensitive to age-related factors in order to draw evidence-based conclusions.

Italian Version of the Relationship Profile Test (RPT-I): Temporal Stability, Construct Validity, and Cross-Cultural Comparison

This study presents the adaptation to the Italian context of the Relationship Profile Test (RPT; Bornstein & Languirand), a self-report measure of Destructive Overdependence (DO), Dysfunctional Detachment (DD), and Healthy Dependency (HD). The RPT was administered to a community sample of 661 nonclinical Italian adults together with the Attachment Style Questionnaire, the Relational-Interdependent Self-Construal Scale, the Rosenberg Self-Esteem Scale, the Self-Compassion Scale, the Positive Affect-Negative Affect Scale, and the Toronto Alexithymia Scale. A randomly selected subset of participants (n = 67) completed the RPT again approximately 5 months after the first administration. The factor structure of the RPT obtained in the main sample was compared with that obtained in a sample of 603 adult participants from the US and was found to be similar. Internal consistency for DO, DD, and HD scores in the Italian sample fell between the acceptable to good range, and test-retest reliability coefficients were all above .70. The three scales yielded the expected pattern of correlations with theoretically related constructs, documenting good criterion validity. Findings are discussed in light of the literature on the RPT as a measure of interpersonal dependency and detachment. Suggestions for future research are offered.

Personality Disorders in the ICD-11: Opportunities and Challenges for Advancing the Diagnosis of Personality Pathology

PURPOSE OF REVIEW

The International Classification of Diseases-11th edition (ICD-11) is poised to make a dramatic change in the diagnosis of personality disorders by introducing a fully dimensionalized framework. In this paper, the history of this process is reviewed, along with international efforts taken to address some underlying concerns with this transition. Recent studies of this framework are also reviewed.

RECENT FINDINGS

Studies have concluded that the ICD-11 proposal is supported; however, there are a number of methodological limitations to these studies, including the utilization of measures that are not directly derived from the ICD-11 description of levels of personality severity and trait domains. There is a clear need for additional studies with measures that directly reflect the ICD-11 description of personality disorders. While there are some potentially positive effects of moving toward the dimensional model, there are a number of concerns remaining about the clinical utility of moving in this way.

Dimensional clinical personality inventory-2: investigating key factors on the assessment of dependent personality disorder

Dimensional literature reinforces the relevance of specific Dependent personality disorder (DPD) traits, as submissiveness, insecurity and avoidance of abandonment. In this paper we measured these traits through the Dimensional Clinical Personality Inventory-2 (IDCP-2). This study aims to verify the capacity of IDCP-2 factors to discriminate and predict DPD related symptoms. From a dataset with 4,503, a total of 305 people was divided in three groups: the community group (n = 200), the non-DPD group (N = 84), and the DPD group (n = 21). We administered six factors from IDCP-2, Insecurity, Abandonment Avoidance, Self-devaluation, Submissiveness, Masochism, and Self-driven Hopelessness. Groups comparison were significant, showing high effects in mostly cases. Multiple regression analysis showed the best predictors of the groups, i.e. Abandonment Avoidance and Self-driven Hopelessness. The findings of this study demonstrate that IDCP-2 covers the core traits of DPD, therefore, being a valid and applicable measure to discriminate DPD, which is particularly relevant in clinical settings. Although our findings suggested two factors as the most relevant measures to discriminant DPD patients from non-DPD/community samples, we did not suggest the restrict use of the Abandonment Avoidance and Self-driven Hopelessness factors for DPD screening. Limitations of the study were discussed.

Assessing Level of Personality Organization With the Psychodiagnostic Chart: A Validity Study

Heterogeneity within diagnostic types and comorbidity across diagnostic groups render a specific personality disorder anything but specific, leading researchers and clinicians to increasingly focus on the general severity of personality pathology. Personality pathology severity is reflected in one's level of personality organization (LPO) and research has demonstrated that LPO is a significant predictor of treatment response. This investigation examined the reliability and validity of the Psychodiagnostic Chart (PDC) in assessing the LPO dimension of the Psychodynamic Diagnostic Manual (PDM; PDM Task Force, 2006). Among a sample of 88 urban-dwelling women seeking primary medical care, the LPO dimension of the PDC received fair to good interrater reliability among 6 psychodynamic psychologists. Convergent validity was demonstrated with contrast analysis and individual correlations that yielded statistically significant associations between LPO scores and conceptually related psychodynamic variables (e.g., defensive functioning, object relations) and self-reported personality pathology scores. Support for discriminant validity was limited by the modest power associated with the sample size. Exploratory analyses examining LPO scores and measures of physical health and intimate partner violence were conducted. Our results supported the reliability, validity, and practical use of the LPO dimension of the PDC.

Coverage of the DSM-IV-TR/DSM-5 Section II Personality Disorders With the DSM-5 Dimensional Trait Model

Section III of DSM-5, for emerging measures and models, includes a five-domain, 25-trait model, assessed by the Personality Inventory for DSM-5. A primary concern with respect to the trait model is its coverage of the DSM-IV-TR personality disorder syndromes (all of which were retained in DSM-5). The current study considered not only total scale scores of three independent measures of DSM-IV-TR personality disorders but also the coverage of each diagnostic criterion included within six personality disorders: antisocial, borderline, avoidant, dependent, narcissistic, and obsessive-compulsive. Participants were 425 community adults, all of whom had received mental health treatment (36% currently; 75% within the past year). Results provided support for the coverage of the diagnostic criteria for the antisocial, borderline, avoidant, dependent, and narcissistic personality disorders. Coverage could perhaps be improved for a few of the criteria for obsessive-compulsive personality disorder.

Establishing a clinically relevant cutoff to the Dependency Scale from the dimensional clinical personality inventory

The Clinical Dimensional Personality Inventory (IDCP) is a 163-item self-report tool developed for the assessment of 12 dimensions of personality pathology. One of the scales comprising the instrument-the Dependency scale-is intended to provide psychometric information on traits closely related to the Dependent Personality Disorder (DPD). In the present study, we used both Item Response Theory modeling and Receiver Operating Characteristic curve analysis to establishing a clinically meaningful cutoff for the IDCP Dependency Scale. Participants were 2.481 adults, comprised by outpatients diagnosed with DPD, outpatients diagnosed with other PDs, and adults from the general population. The Wright's item map graphing technique revealed that outpatients were located at the very high levels in the latent scale continuum of the Dependency Scale, with a very large effect size for the mean difference between patients and non-patients. The ROC curve analysis supported a cutoff at 2.3 points in the Dependency Scale, which yielded 0.86 of sensitivity and 0.79 of specificity. Findings from the present investigation suggest the IDCP Dependency Scale is useful as a screening tool of the core features of the DPD. We address potential clinical applications for the instrument, and discuss limitations from the present study.

Beyond passivity: Dependency as a risk factor for intimate partner violence

Interpersonal dependency in male perpetrators of intimate partner violence (IPV) is an understudied phenomenon but one that has noteworthy clinical implications. The present investigation used meta-analytic techniques to quantify the dependency-IPV link in all extant studies examining this relationship (n of studies = 17). Studies were gathered via an extensive literature search using relevant dependency/IPV search terms in the PsychInfo, Medline and Google Scholar databases. Results revealed a small but statistically significant relationship between dependency and perpetration of IPV in men (r = 0.150, Combined Z = 4.25, p < 0.0001), with the magnitude of the dependency-IPV link becoming stronger (r = 0.365, Combined Z = 6.00, p < 0.0001) when studies using measures of dependent personality disorder symptoms were omitted. Other moderators of the dependency-IPV effect size included IPV measure, type of sample and perpetrator age. These findings illuminate the underlying dynamics and interpersonal processes involved in some instances of IPV and may aid in understanding how to identify and treat male perpetrators of domestic violence.

Assessment of dependency by the FFDI: Comparisons to the PID-5 and maladaptive agreeableness

The present study explores the validity of the Five Factor Dependency Inventory (FFDI), a measure of dependent personality traits from the perspective of the five factor model, examined across three separate samples and two studies. The first study examined the FFDI with respect to the traits assigned to assess dependent personality disorder (DPD) by the DSM-5 work group, two measures of DSM-IV-TR DPD and three measures of dependent traits, sampling 184 Mechanical Turk participants and 83 students (the latter oversampled for DPD features). Based on responses from an additional 137 students, the second study investigated the role of maladaptive agreeableness in dependency by examining the FFDI in relation to the interpersonal circumplex using three alternative measures. Discriminant validity was provided with respect to DSM-5 traits and the interpersonal circumplex. Incremental validity was provided with respect to the ability of the FFDI to account for variance within DPD measures beyond the variance explained by DSM-5 traits. Implications for the assessment of dependency and the proposed DSM-5 dimensional trait model are discussed.

Manifestations of interpersonal dependency and depressive subtypes in outpatient psychotherapy patients

The present study investigated the relationship between normative and pathological dependency and anaclitic and introjective depressive experiences among 71 patients participating in outpatient psychotherapy at a university-based psychology clinic. We examined the interrelationships among the Relationship Profile Test subscales, the Depressive Experiences Questionnaire subscales and the Outcome Questionnaire-45.2. Results indicated that destructive overdependence was positively correlated with anaclitic and introjective depression and negatively correlated with overall perceptions of mental health. Dysfunctional detachment was positively correlated with introjective depression and negatively correlated with generalized perceptions of one's own mental health. Healthy dependency was negatively correlated with introjective depression and positively correlated with mental health. These results not only support the construct validity of the Relationship Profile Test but also shed light on a link between depression, dependence and self-criticism.

Structure of the DSM-IV personality disorders as revealed in clinician ratings

The revisions proposed for the DSM-5 would greatly alter how personality pathology is conceptualized, assessed, and diagnosed. One aspect of the proposed changes, elimination of four current personality disorders, has raised considerable controversy. The present study attempts to inform this debate by exploring clinicians' views of the structure of Personality Disorders using the current diagnostic system, the DSM-IV. An exploratory factor analysis was conducted on the DSM-IV Personality Disorder criteria using clinician ratings for 280 patients. The factor analysis revealed eight clear and meaningful factors. The eight factors contained all six personality disorders proposed for retention in DSM-5 but also contained clear representations of two disorders (Paranoid and Schizoid) identified for removal from the system. These conditions appear to have clinical utility and their removal may have unintended negative consequences in clinical practice. Dependent and Avoidant criteria also merged to form a new construct with interesting clinical implications. These findings provide new insights into the complex typologies clinicians employ when applying the DSM-IV system to personality disordered patients. Lastly we argue that successful refinement of clinically significant constructs, like diagnostic systems, requires a balanced appraisal of evidence for clinical utility as well as external and internal validity.

Too few or too many? Reactions to removing versus retaining specific personality disorders in DSM-5

PURPOSE OF REVIEW

The present review examines the decision of the DSM-5 Personality and Personality Disorders Working Group to retain or to remove specific personality disorders included in DSM-IV-TR and presents the reactions elicited by the decision and published between 10 February 2010 and 30 September 2012.

RECENT FINDINGS

In the first draft of Chapter P (Personality disorders), posted on the DSM-5 Internet site on 10 February 2010, the DSM-5 Personality and Personality Disorders Working Group proposed to remove paranoid, schizoid, histrionic, dependent and narcissistic personality disorders from the classification. A revised version of the draft, posted on the Internet in June 2011, reinstated narcissistic personality disorder but not the four remaining types that had been slated for removal. Underlying the decision of the Work Group for retaining versus removing specific personality disorder types are arguments concerning the clinical utility and validity of each type. The arguments provided by the Work Group have not been accepted unanimously by other personality disorder experts.

SUMMARY

DSM-5 will retain six out of the 10 personality disorder types listed in DSM-IV-TR while removing the remaining four types. Reactions to the decision and to the arguments presented for doing so have been mixed.

An invisible college view of the DSM-5 personality disorder classification

The DSM-5 Personality and Personality Disorders Work Group released the final proposed changes for the upcoming manual in May 2012. The proposal, located at www.dsm5.org , included a hybrid dimensional/categorical method of diagnosing personality disorders. This brief article examines the reference section of the DSM-5 personality disorder proposal rationale (American Psychiatric Association, 2012). The authors counted the number of authors and the coauthorships; coauthorship patterns were then examined and diagramed. The data suggested that a group of researchers involved with the Collaborative Longitudinal Personality Disorders Study (CLPS) were central to the hybrid classification created by the DSM-5 work group.

Which DSM-IV personality disorders are most strongly associated with indices of psychosocial morbidity in psychiatric outpatients?

The DSM-5 Work Group for Personality and Personality Disorders (PDs) recommended retaining 6 specific PD "types" (antisocial, avoidant, borderline, narcissistic, obsessive-compulsive, and schizotypal) and eliminating the other 4 PDs currently included in DSM-IV (paranoid, schizoid, histrionic, and dependent). One important clinical aspect of PDs is their association with indices of psychosocial morbidity. Because the literature on the relationship between PDs and psychosocial morbidity in psychiatric patients is limited, we undertook the current analysis of the Rhode Island Methods to Improve Diagnostic Assessment and Services project database to examine which PDs were most strongly associated with a variety of measures of psychosocial morbidity. We tested the hypothesis that the disorders recommended for retention in DSM-5 would be associated with more severe morbidity than the disorders recommended for deletion. A total of 2150 psychiatric outpatients were evaluated with semistructured diagnostic interviews for DSM-IV Axes I and II disorders and 7 measures of psychosocial morbidity. We examined the correlation between each PD dimensional score and each measure of morbidity and then conducted multiple regression analyses to determine which PDs were independently associated with the indices of morbidity. For the 6 PDs proposed for retention in DSM-5, 36 (85.7%) of the 42 correlations were significant, whereas for the 4 PDs proposed for deletion, 26 (92.9%) of the 28 correlations were significant. In the regression analyses for the 6 PDs proposed for retention in DSM-5, 19 (45.2%) of the 42 β coefficients were significant, whereas for the 4 PDs proposed for deletion, 7 (25.0%) of the 28 β coefficients were significant. The results of the present study, along with the results of other studies, do not provide clear evidence for the preferential retention of some PDs over others based on their association with indices of psychosocial morbidity.

Retention or deletion of personality disorder diagnoses for DSM-5: an expert consensus approach

One of the official proposals for the fifth edition of the American Psychiatric Association's (APA) diagnostic manual (DSM-5) is to delete half of the existing personality disorders (i.e., dependent, histrionic, narcissistic, paranoid, and schizoid). Within the APA guidelines for DSM-5 decisions, it is stated that there should be expert consensus agreement for the deletion of a diagnostic category. Additionally, categories to be deleted should have low clinical utility and/or minimal evidence for validity. The current study surveyed members of two personality disorder associations (n = 146) with respect to the utility, validity, and status of each DSM-IV-TR personality disorder diagnosis. Findings indicated that the proposal to delete five of the personality disorders lacks consensus support within the personality disorder community.

Personality disorders in DSM-5

A substantive revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM) last occurred in 1994; therefore, the mental health field should anticipate significant changes to the classification of mental disorders in the fifth edition. Since DSM-5 Work Groups have recently proposed revisions for the major diagnostic classes of mental disorders, an article on the current status of the personality disorders (PDs) is timely. This article reviews scientific principles that have influenced the development of proposed changes for the assessment and diagnosis of personality psychopathology in DSM-5, presents the proposed model as of the summer of 2011, summarizes rationales for the changes, and discusses critiques of the model. Scientific principles were articulated for DSM-5 more than a decade ago; their application to the process has not been straightforward, however. Work Group members have labored to improve the DSM-5 approach to personality and PDs to make the classification more valid and more clinically useful. The current model continues to be a work in progress.

Toward a multidimensional model of personality disorder diagnosis: implications for DSM-5

This article outlines a model of personality disorder (PD) diagnosis that combines clinically useful constructs from the Diagnostic and Statistical Manual of Mental Disorders (DSM) with assessment procedures that maximize reliability and clinical utility while minimizing problems associated with threshold-based PD classification. I begin by addressing limitations in the current DSM conceptualization of PDs: excessive comorbidity, use of arbitrary cutoffs to distinguish normal from pathological functioning, failure to capture variations in the adaptive value of PD symptoms, and inattention to situational influences that shape PD-related behaviors. The revisions proposed by the DSM-5 Personality and Personality Disorders Work Group help resolve some of these issues, but create new problems in other areas. A better solution would be to employ a multidimensional model of PD diagnosis in which clinicians (a) assign a single dimensional rating of overall level of personality dysfunction, (b) provide separate intensity and impairment ratings for each PD dimension, and (c) list those personality traits-including PD-related traits-that enhance adaptation and functioning. Preliminary evidence bearing on the multidimensional model is reviewed, and broader clinical and empirical implications of the model are discussed.

Assessing the level of structural integration using operationalized psychodynamic diagnosis (OPD): implications for DSM-5

A key ingredient in the current proposal of the DSM-5 Work Group on Personality and Personality Disorders is the assessment of overall severity of impairment in personality functioning: the Levels of Personality Functioning Scale (LPFS). The aim of this article is to contribute a conceptual and empirical discussion of the LPFS from the perspective of the Operationalized Psychodynamic Diagnosis (OPD) system (OPD Task Force, 2008 ). First, we introduce the OPD Levels of Structural Integration Axis (OPD-LSIA), a measure of individual differences in severity of personality dysfunction that is rooted in psychodynamic theory. We show that the OPD-LSIA is reliable, valid, and highly associated with observer ratings of personality disorders. In the second part, we present results from an OPD expert consensus study exploring potential limitations of the current LPFS item set from the perspective of the OPD-LSIA. We conclude with highlighting implications for future revisions of the DSM-5 proposal.

Illuminating a neglected clinical issue: societal costs of interpersonal dependency and dependent personality disorder

OBJECTIVES

To determine the degree to which patients with high levels of trait dependency or dependent personality disorder (DPD) engage in behaviors that harm themselves and others (e.g., domestic violence, child abuse).

METHOD

Six domains of literature were reviewed: (a) dependency as a risk factor for physical illness; (b) health care utilization and expenditures; (c) global and domain-specific functional impairment; (d) violence toward others; (e) victimization by others; and (f) self-harm.

RESULTS

High levels of trait dependency and DPD are associated with elevated risk for physical illness, partner and child abuse, and suicidality, as well as with high levels of functional impairment and increased health care expenditure.

CONCLUSIONS

Contrary to clinical lore, trait dependency and DPD are associated with behaviors that lead to myriad negative consequences for the dependent person, those close to them, and society as a whole. These patterns have noteworthy implications for assessment and treatment of dependent patients and suggest that DPD should be included as a diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition.

An interpersonal analysis of pathological personality traits in DSM-5

The proposed changes to the personality disorder section of the Diagnostic and statistical manual of mental disorders (5th ed.) places an increased focus on interpersonal impairment as one of the defining features of personality psychopathology. In addition, a proposed trait model has been offered to provide a means of capturing phenotypic variation on the expression of personality disorder. In this study, the authors subject the proposed DSM-5 traits to interpersonal analysis using the inventory of interpersonal problems-circumplex scales via the structural summary method for circumplex data. DSM-5 traits were consistently associated with generalized interpersonal dysfunction suggesting that they are maladaptive in nature, the majority of traits demonstrated discriminant validity with prototypical and differentiated interpersonal problem profiles, and conformed well to a priori hypothesized associations. These results are discussed in the context of the DSM-5 proposal and contemporary interpersonal theory, with a particular focus on potential areas for expansion of the DSM-5 trait model.

From Dysfunction to Adaptation: An Interactionist Model of Dependency

Contrary to clinical lore, a dependent personality style is associated with active as well as passive behavior and may be adaptive in certain contexts (e.g., in fostering compliance with medical and psychotherapeutic treatment regimens). The cognitive/interactionist model conceptualizes dependency-related responding in terms of four components: (a) motivational (a marked need for guidance, support, and approval from others); (b) cognitive (a perception of oneself as powerless and ineffectual); (c) affective (a tendency to become anxious when required to function autonomously); and (d) behavioral (use of diverse self-presentation strategies to strengthen ties to potential caregivers). Clinicians' understanding of the etiology and dynamics of dependency has improved substantially in recent years; current challenges include delineating useful subtypes of dependency, developing valid symptom criteria for Dependent Personality Disorder in DSM-5 and beyond, and working effectively with dependent patients in the age of managed care.

The convergent and concurrent validity of trait-based prototype assessment of personality disorder categories in homeless persons

The DSM-5 proposal indicates that personality disorders (PDs) be defined as collections of maladaptive traits but does not provide a specific diagnostic method. However, researchers have previously suggested that PD constructs can be assessed by comparing individuals' trait profiles with those prototypic of PDs and evidence from the five-factor model (FFM) suggests that these prototype matching scores converge moderately with traditional PD instruments. The current study investigates the convergence of FFM PD prototypes with interview-assigned PD diagnoses in a sample of 99 homeless individuals. This sample had very high rates of PDs, which extends previous research on samples with more modest prevalence rates. Results indicated that diagnostic agreement between these methods was generally low but consistent with the agreement previously observed between explicit PD measures. Furthermore, trait-based and diagnostic interview scores evinced similar relationships with clinically important indicators such as abuse history and past suicide attempts. These findings demonstrate the validity of prototype methods and suggest their consideration for assessing trait-defined PD types within DSM-5.

A five-factor measure of dependent personality traits

This study provides convergent, discriminant, and incremental validity data for a new measure of dependent personality traits from the perspective of the five-factor model (FFM). Dependent personality trait scales were constructed as maladaptive variants of FFM facets (e.g., Gullibility as a maladaptive variant of FFM trust). Based on responses from 383 undergraduates, the convergent validity of the Five-Factor Dependency Inventory (FFDI) scales was tested with respect to 2 measures of the FFM, 6 dependency trait scales, and 4 measures of dependent personality disorder. Discriminant validity was tested with respect to FFM facets from alternative domains. Incremental validity was tested with respect to the ability of the FFM dependent personality trait scales to account for variance in 2 established measures of dependency, after variance accounted for by respective FFM facet scales and other measures of DPD was first removed. The results of this study provided support for the validity of the FFDI assessment of dependency from the perspective of the FFM.

Dysfunctional cognitions in personality pathology: the structure and validity of the Personality Belief Questionnaire

BACKGROUND

This study examines the structure of the Personality Belief Questionnaire (PBQ), a self-report instrument designed to assess dysfunctional beliefs associated with personality pathology, as proposed by the cognitive theory of personality dysfunction.

METHOD

The PBQ was examined using exploratory factor analysis (EFA) with responses from 438 depressed out-patients, and confirmatory factor analysis (CFA) with responses from 683 treatment-seeking psychiatric out-patients. All participants were assessed for personality disorder (PD) using a standard clinical interview. The validity of the resulting factor structure was assessed in the combined sample (n=1121) by examining PBQ scores for patients with and without PD diagnoses.

RESULTS

Exploratory and confirmatory analyses converged to indicate that the PBQ is best described by seven empirically identified factors: six assess dysfunctional beliefs associated with forms of personality pathology recognized in DSM-IV. Validity analyses revealed that those diagnosed with a PD evidenced a higher average score on all factors, relative to those without these disorders. Subsets of patients diagnosed with specific DSM-IV PDs scored higher, on average, on the factor associated with their respective diagnosis, relative to all other factors.

CONCLUSIONS

The pattern of results has implications for the conceptualization of personality pathology. To our knowledge, no formal diagnostic or assessment system has yet systematically incorporated the role of dysfunctional beliefs into its description of personality pathology. The identification of dysfunctional beliefs may not only aid in case conceptualization but also may provide unique targets for psychological treatment. Recommendations for future personality pathology assessment systems are provided.