Personality Disorders in the ICD-11: Spanish Validation of the PiCD and the SASPD in a Mixed Community and Clinical Sample

The International Classification of Diseases–11th revision (ICD-11) classification of personality disorders is the official diagnostic system that is used all over the world, and it has recently been renewed. However, as yet very few data are available on its performance. This study examines the Personality Inventory for ICD-11 (PiCD), which assesses the personality domains of the system, and the Standardized Assessment of Severity of Personality Disorder (SASPD), which determines severity. The Spanish versions of the questionnaires were administered to a community (n = 2,522) and a clinical sample (n = 797). Internal consistency was adequate in the PiCD (α = .75 to .84) but less so in the SASPD (α = .64 and .73). Factor analyses suggested a unidimensional or bidimensional structure for severity, while revealing that the personality trait qualifiers are organized into four factors: negative affectivity, detachment, dissociality, and a bipolar domain of disinhibition–anankastia. The mutual relationships between traits and severity were analyzed, as well as the ability of the whole system to identify clinical subjects. Although further improvements are required, the results generally support the use of the PiCD and the SASPD and help substantiate the new ICD-11 taxonomy that underlies them.

Personality disorder features through the life course

Personality Disorders have proved to be more fluid through the life course than previously thought. However, because analyses have usually been undertaken at the level of diagnostic categories, relevant findings may be obscured. An examination at the criteria level could bypass arbitrary aggregations of heterogeneous traits and thus offer more accurate information. To this end, we administered the Personality Diagnostic Questionnaire-4+ (PDQ-4+) to 1,477 patients aged 15 to 82. Nine of 12 disorders declined to some extent over the lifespan, but the evolution of individual criteria diverged within categories. At this level, 45 of 93 criteria showed age-related decreases, whereas only seven presented increases. A clearer picture is offered of the PD traits that change and those that remain stable. Thus, pathological features are not only more fluid, but developmentally more heterogeneous than previously believed.

Borderline, where are you? A psychometric approach to the personality domains in the International Classification of Diseases, 11th Revision (ICD-11)

The inclusion of the borderline pattern in the International Classification of Diseases, 11th Revision (ICD-11) dimensional classification of personality disorders (PDs) has caused controversy. Unease about leaving out these clinically challenging patients seems to conflict with the need of an evidence-based and credible diagnostic system. However, the accommodation of borderline within the new diagnostic system has not yet been studied in depth. To this end, we examine in a sample of 1799 general population and clinical subjects the joint structure of the five initial ICD-11 domains and the borderline pattern. Regression and item-level factor analyses reveal that borderline criteria do not form a separate construct and are indissociable from negative affectivity. Furthermore, borderline adds nothing to the remaining domains when it comes to predict PD severity. The borderline pattern appears as largely superfluous and even misguiding, unless their criteria are properly integrated within the structure of personality pathology. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Toward an Integrated Model of Pathological Personality Traits: Common Hierarchical Structure of the PID-5 and the DAPP-BQ

A dimensional classification seems to be the next move in the personality disorders field. However, it is not clear whether there is one dimensional model or many, or whether the currently available dimensional instruments measure the same traits. To help clarify these issues, the authors administered the Personality Inventory for DSM-5 (PID-5) and the Dimensional Assessment of Personality Pathology (DAPP-BQ) to 414 psychiatric outpatients. Factor analyses showed that a common hierarchical structure underlies both instruments, even if each one measures slightly different aspects of it. Disattenuated correlations indicated that, at the lower order level, two thirds of the PID-5 and DAPP-BQ facets measure essentially the same traits, although the pairings were not exactly as predicted. Among higher order domains, only PID Negative Affectivity and Detachment converged unambiguously with DAPP Emotional Dysregulation and Inhibition. Overall, the PID-5 and the DAPP-BQ reflect, with small divergences, one and the same structure of pathological personality traits.

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.

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.

Mean-level change in pathological personality dimensions over 4 decades in clinical and community samples: A cross-sectional study

Although normal personality traits change gradually with age, personality disorders have been reported to remit rapidly and completely in little more than 10 years. Such a benign prognosis is surprising and may be due in part to the combined use of categorical diagnoses, seriously ill patients, and longitudinal designs in the existing literature. This study examines, for the first time, the development of personality pathology across a life span by means of dimensional models, represented by the Dimensional Assessment of Personality Pathology-Basic Questionnaire and the Personality Inventory for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. We draw upon a cross-sectional design and four large clinical and community samples to avoid previous biases. We found that personality pathology declined by around 0.5 SD overall from age 20 to 60, though with noticeable differences between domains: Dissocial behavior and antagonism decreased by between two thirds and 1 SD; compulsivity increased at the same rate; disinhibition, negative affect, and psychoticism dropped by 0.5 SD; and detachment remained stable or rose slightly. In short, the changes in many clinically important traits are modest, occur at a slow pace, and roughly parallel the maturation effect found for normal personality traits. The resulting picture of personality disorder development is not as optimistic as previous studies would have us believe. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

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

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

A third hierarchical level of narrower traits for the Dimensional Assessment of Personality Pathology-Basic Questionnaire

Current dimensional taxonomies of personality disorder show a stronger empirical grounding than categories, but may lack the necessary level of detail to make accurate predictions and case formulations. We need to further develop the lower levels of the hierarchy until reaching the building blocks of personality pathology. The Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ) is well-suited to this purpose due to its multilayered structure and its agreement with the official dimensional classifications. We disaggregated the 18 DAPP-BQ mid-level facets through exploratory and confirmatory factor analysis in a sample of 3233 community subjects and outpatients. We obtained a set of 72 clinically relevant, narrower subfacets, which were reliable, well-fitted to the data, and invariant between clinical and community subjects and between the sexes. This third level of abstraction increases by 4.7% the capacity to predict DSM categorical personality disorders, gives a particular advantage in capturing dependent, histrionic, paranoid, obsessive, and schizoid features and can provide the detailed information that clinical decisions demand.

A Double-Track Pathway to Fast Strategy in Humans and Its Personality Correlates

The fast-slow paradigm of life history (LH) focuses on how individuals grow, mate, and reproduce at different paces. This paradigm can contribute substantially to the field of personality and individual differences provided that it is more strictly based on evolutionary biology than it has been so far. Our study tested the existence of a fast-slow continuum underlying indicators of reproductive effort-offspring output, age at first reproduction, number and stability of sexual partners-in 1,043 outpatients with healthy to severely disordered personalities. Two axes emerged reflecting a double-track pathway to fast strategy, based on restricted and unrestricted sociosexual strategies. When rotated, the fast-slow and sociosexuality axes turned out to be independent. Contrary to expectations, neither somatic effort-investment in status, material resources, social capital, and maintenance/survival-was aligned with reproductive effort, nor a clear tradeoff between current and future reproduction was evident. Finally, we examined the association of LH axes with seven high-order personality pathology traits: negative emotionality, impulsivity, antagonism, persistence-compulsivity, subordination, and psychoticism. Persistent and disinhibited subjects appeared as fast-restricted and fast-unrestricted strategists, respectively, whereas asocial subjects were slow strategists. Associations of LH traits with each other and with personality are far more complex than usually assumed in evolutionary psychology.