Incremental Validity of the DSM-5 Section III Personality Disorder Traits With Respect to Psychosocial Impairment

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.

Personality Pathology and Functional Impairment in Patients With Hypochondriasis

BACKGROUND

Research indicates substantial co-occurance of personality pathology and hypochondriasis, which both involve significant psychosocial impairment.

OBJECTIVE

This study sought to investigate the role of personality pathology for explaining functional impairment in patients with hypochondriasis, while accounting for the influence of health anxiety severity.

METHODS

Patients diagnosed with hypochondriasis (N = 84; 60% women) were administered interview- and self-report instruments for personality pathology, health anxiety severity, and functional impairment (general, social, and physical): The Structured Clinical Interview for DSM-IV Axis II (SCID-II), the Personality Inventory for DSM-5 (PID-5), the Short Health Anxiety Inventory (SHAI), the 36-item Short Form health survey (SF-36), and the Global Assessment of Functioning (GAF). Hierarchical regression analyses were performed with boot-strapping (1000 samples).

RESULTS

Findings overall showed that personality pathology incrementally explained functional impairment over the influence of health anxiety severity. More specifically, findings revealed that the incremental effect of PID-5 trait dimensions was substantially larger than the SCID-II personality disorder criterion-count. Functional impairment was specifically associated with SCID-II symptoms of Avoidant Personality disorder and dependent personality disorder as well as PID-5 trait domains of negative affectivity, detachment, and psychoticism.

CONCLUSIONS

The findings highlight the potential significance of personality pathology for understanding and clinical management of functional impairment in patients with hypochondriasis. The personality features that best explained functional impairment were avoidant personality disorder and dependent personality disorder and, in particular, DSM-5 and the International Classification of Diseases, 11th revision personality trait domains of negative affectivity, detachment, and psychoticism.

Self-esteem mediates effects of normal and pathological personality traits on subjective well-being

As subjective well-being is foundational to understanding people, researchers have sought to uncover its correlates. Some theorizing proposes that effects of broad personality traits on subjective well-being constructs are mediated by self-esteem; unfortunately, evidence pertaining to this idea has been limited to the study of "normal" broad personality traits and limited measures of subjective well-being. Here, we provided a more comprehensive test of this theory, and we examined the dominance of self-esteem over normal and pathological broad personality traits in predicting an array of subjective well-being constructs. In a primarily college sample (N = 272), we found that self-esteem generally mediated the effects of all Five-Factor Model (FFM) traits except Agreeableness and all pathological personality traits-represented in the Personality Inventory of The Diagnostic and Statistical Manual of Mental Disorders traits (5th edition; PID-5)-except Antagonism on a set of subjective well-being measures; moreover, dominance analyses showed that self-esteem was generally more important than any FFM or PID-5 trait in predicting the subjective well-being measures. We discuss limitations of our study along with some of its basic and applied implications.

Looking under the tinfoil hat: Clarifying the personological and psychopathological correlates of conspiracy beliefs

OBJECTIVE

We sought to replicate and extend provisional research on the personological correlates of conspiracy beliefs by examining their associations with abnormal- and normal-range personality domain-level traits and, for the first time, lower-order personality facets; we also examined internalizing symptoms.

METHOD

The study comprised four samples of community and student participants (N_total  = 1,927), and examined the cross-sectional relations between self-reported conspiratorial ideation and measures of (a) the six-factor model of general personality, (b) intellectual humility (IH), (c) traits relevant to certain personality disorder features (narcissism, psychopathy, disinhibition), and (d) internalizing symptoms (depression, anxiety, anger).

RESULTS

Agreeableness and conscientiousness were significant, albeit modest, negative correlates of conspiracy beliefs, although other general personality dimensions tended to manifest negligible associations. Significant associations between lower-order personality facets and conspiracy beliefs, not evident at the domain level, emerged. Indices of IH were significant negative correlates. Conspiracy beliefs were also associated with a range of personality disorder features and internalizing symptoms.

CONCLUSIONS

Our results suggest that the nonclinical individual prone to conspiratorial ideation is somewhat likely to display a complex mixture of traits including distress, immodesty, impulsivity, and negative affect. Future research should investigate potential multiplicative relations among personological variables in predicting conspiracy beliefs.

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.

Convergent and Discriminant Validity of Personality Inventory for DSM-5-BF in a Primary Care Sample

A growing body of research supports the validity of the Personality Inventory for DSM-5 (PID-5) in evaluating community and psychiatric samples. Although maladaptive personality also has significant relevance in primary care settings, research on the PID-5 in primary care samples is limited. In this study, the authors examined the intercorrelations, convergent validity, and discriminant validity of the brief form of the PID-5 (PID-5-BF) in 100 primary care outpatients. Results are consistent with findings in other samples in suggesting that PID-5 domains are moderately intercorrelated and associated with a variety of mental health variables. Smaller associations with physical health variables support the discriminant validity of the instrument. Overall, results suggest that the PID-5-BF can provide a useful psychiatric screening tool in primary care settings.

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.

Diagnosis and classification of personality disorders: novel approaches

PURPOSE OF REVIEW

To provide an update of the recent studies, which have evaluated the radical changes in personality disorder classification in DSM-5 and ICD-11.

RECENT FINDINGS

Although the DSM-5 Committee rejected the personality disorders Work Group proposal for personality disorder classification, the model was published in DSM-5 Section III. This Alternative Model of Personality Disorders (AMPD) has been widely adopted by the research community resulting in multiple studies evaluating its reliability and clinical utility. The ICD-11 Personality Classification has recently been accepted by the WHO and is also receiving increasing study. Both models emphasize personality disorder severity, which most studies report is consistently linked to impairment and outcome. Both models propose five descriptive domains, which appear to capture most of the current personality disorder diagnoses, and can also be linked to disease extremes of normal personality such as the Five Factor Model.

SUMMARY

The changes in DSM-5 AMPD and ICD-11 represent a significant paradigm shift in the diagnosis of personality disorders. Early research suggests that the changes may be beneficial for clinicians and researchers. The models more closely align with the large body of literature supporting dimensional models of normal personality. The severity dimensions are consistent with the large body of evidence that personality disorder severity is a strong determinant of impairment and outcome. It remains to be seen if clinicians will use the classification to plan and predict treatment for a wide range of mental disorders.

Evaluating the role of functional impairment in personality psychopathology

DSM-5's Section III Alternative Model for Personality Disorder (AMPD) model states that an individual must show impairment in self and interpersonal functioning for PD diagnosis. The current study investigated dimensional personality trait associations with impairment, including differential patterns of impairment across specific PDs, and whether traits have improved our assessment of functional impairment in PDs. Two-hundred and seventy-seven participants were administered measures of Antisocial PD, Avoidant PD, Borderline PD, Narcissistic PD, Obsessive-Compulsive PD, and Schizotypal PD from the perspectives of Section II (PDQ-4) and Section III (PID-5) PD models, as well as measures of functional impairment in interpersonal and intrapersonal domains. Pearson correlations showed associations between ratings of impairment and most Section II and Section III PDs and trait facets, with the exception of narcissistic PD. Hierarchical regression analyses revealed that Section III PDs added predictive validity beyond Section II PDs in predicting impairment, except narcissistic PD. These findings provide support both for the impairment criterion in the AMPD and for the association between trait-based PDs and impairment, and suggest that this trait-based measurement adds uniquely to the understanding of functional impairment.

Continuity Between DSM-5 Section II and III Personality Disorders in a Dutch Clinical Sample

The goal of this study was to evaluate the continuity across the Section II personality disorders (PDs) and the proposed Section III model of PDs in the Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM-5]; American Psychiatric Association, 2013a ). More specifically, we analyzed association between the DSM-5 Section III pathological trait facets and Section II PDs among 110 Dutch adults (M age = 35.8 years, range = 19-60 years) receiving mental health care. We administered the Structured Clinical Interview for DSM-IV Axis II Disorders to all participants. Participants also completed the self-report Personality Inventory for DSM-5 (PID-5) as a measure of pathological trait facets. The distributions underlying the dependent variable were modeled as criterion counts, using negative binomial regression. The results provided some support for the validity of the PID-5 and the DSM-5 Section III Alternative Model, although analyses did not show a perfect match. Both at the trait level and the domain level, analyses showed mixed evidence of significant relationships between the PID-5 trait facets and domains with the traditional DSM-IV PDs.

Maladaptive personality traits and romantic relationship satisfaction: A monozygotic co-twin control analysis

The recent inclusion of an alternative model for personality disorders in the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5; American Psychiatric Association, 2013a) highlights the importance of extreme variants of personality for psychopathology. The maladaptive personality traits described in the alternative model comprise 5 higher-order domains and 25 lower-order facets that capture pathological levels of personality. The present report adds to a growing body of research on the implications of maladaptive personality traits for functioning by demonstrating significant associations between each of the higher-order domains (Negative Affect, Detachment, Antagonism, Disinhibition, and Psychoticism) and most of the lower-order facets and lower romantic relationship satisfaction in a population-based sample of 284 monozygotic (MZ) adult twins. We further capitalized upon co-twin differences in levels of personality pathology in a causally informative approach, the MZ co-twin control study design. Co-twin control analyses indicated that higher levels of Negative Affect, Detachment, Disinhibition, and Psychoticism, as well as several lower-order facets, were associated with lower romantic relationship satisfaction even after accounting for the genetic and environmental factors shared by twins that confer liability toward personality pathology and psychosocial dysfunction. The present results lend support to the potentially causal implications of personality pathology for interpersonal functioning, even in a community sample unlikely to be evidencing clinical levels of pathology, by suggesting that extreme variants of personality, manifested by comparably extreme deviations in thinking, feeling, behaving, and interacting with others, may lead to impaired functioning in important domains. (PsycINFO Database Record

The Norwegian Computerized Adaptive Test of Personality Disorder-Static Form (CAT-PD-SF): Reliability, Factor Structure, and Relationships With Personality Functioning

The Computerized Adaptive Test of Personality Disorder-Static Form (CAT-PD-SF) is a self-report inventory developed to assess pathological personality traits. The current study explored the reliability and higher order factor structure of the Norwegian version of the CAT-PD-SF and the relationships between the CAT-PD traits and domains of personality functioning in an undergraduate student sample (N = 375). In addition to the CAT-PD-SF, the short form of the Severity Indices of Personality Problems and the Brief Symptom Inventory were administered. The results showed that the Norwegian CAT-PD-SF has good score reliability. Factor analysis of the CAT-PD-SF scales indicated five superordinate factors that correspond to the trait domains of the alternative DSM-5 model for personality disorders. The CAT-PD traits were highly predictive of impaired personality functioning after controlling for psychological distress. It is concluded that the CAT-PD-SF is a promising tool for the assessment of personality disorder traits.

Impact of personality pathology on psychosocial functioning

Personality disorders impair social, occupational, leisure, and global functioning more than a significant disorder such as major depressive disorder. Impairment is found in clinical and community populations. Impairment is independent of co-occurring other mental disorders. Impairment is more stable over time than are the diagnoses themselves. Personality traits are also impairing and may be more predictive of outcomes over time, but a hybrid of personality disorder features and normal range personality traits may be the most predictive model. A general, 'transdiagnostic,' self-other severity factor may be important for understanding the relationship of personality pathology and psychosocial functioning over time. The Alternative DSM-5 Model for Personality Disorders may be useful for the study of psychosocial functioning in individuals with personality pathology.

Psychological Assessment with the DSM-5 Alternative Model for Personality Disorders: Tradition and Innovation

The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) Section III Alternative Model for Personality Disorders (AMPD; APA, 2013) represents an innovative system for simultaneous psychiatric classification and psychological assessment of personality disorders (PD). The AMPD combines major paradigms of personality assessment and provides an original, heuristic, flexible, and practical framework that enriches clinical thinking and practice. Origins, emerging research, and clinical application of the AMPD for diagnosis and psychological assessment are reviewed. The AMPD integrates assessment and research traditions, facilitates case conceptualization, is easy to learn and use, and assists in providing patient feedback. New as well as existing tests and psychometric methods may be used to operationalize the AMPD for clinical assessments.

World Health Organization disability assessment schedule 2.0: An international systematic review

PURPOSE

This systematic review examines research and practical applications of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) as a basis for establishing specific criteria for evaluating relevant international scientific literature. The aims were to establish the extent of international dissemination and use of WHODAS 2.0 and analyze psychometric research on its various translations and adaptations. In particular, we wanted to highlight which psychometric features have been investigated, focusing on the factor structure, reliability, and validity of this instrument.

METHOD

Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology, we conducted a search for publications focused on "whodas" using the ProQuest, PubMed, and Google Scholar electronic databases.

RESULTS

We identified 810 studies from 94 countries published between 1999 and 2015. WHODAS 2.0 has been translated into 47 languages and dialects and used in 27 areas of research (40% in psychiatry).

CONCLUSIONS

The growing number of studies indicates increasing interest in the WHODAS 2.0 for assessing individual functioning and disability in different settings and individual health conditions. The WHODAS 2.0 shows strong correlations with several other measures of activity limitations; probably due to the fact that it shares the same disability latent variable with them. Implications for Rehabilitation WHODAS 2.0 seems to be a valid, reliable self-report instrument for the assessment of disability. The increasing interest in use of the WHODAS 2.0 extends to rehabilitation and life sciences rather than being limited to psychiatry. WHODAS 2.0 is suitable for assessing health status and disability in a variety of settings and populations. A critical issue for rehabilitation is that a single "minimal clinically important .difference" score for the WHODAS 2.0 has not yet been established.