Nothing About Us Without Us: Centering Lived Experience as the AMPD Moves Forward.

A Young Attorney Presents for Outpatient Treatment of Depression Ms.Bisa32-year-oldsingleCaucasianwomanwhowasreferred byafriend’spsychiatristformentalhealthtreatmentforthe first time after a 4-month period of depression. She reported persistent feelings of “emptiness” and “worthlessness,” increased sleeping with difficulty getting out of bed, impaired concentration, decreased energy nearly every day, slight weight gain, and ruminations about her childhood and family life. The depressionstartedaftershewastoldather firmthatshewasnotgoingto be considered for partnership. Her initial reaction was one of anger, bitter disappointment, and shame, but this gave way to feelingsofdepressionandworryaboutherfuture.Sheadmittedto thoughts of death and dying but denied having any suicidal ideation. Ms. B does notdrink alcoholor use any other substances and she denies ever having felt “manic.” Her physical health is good. Ms. B also reported that she did not consider her life, in general, to be satisfactory or fulfilling. Although she had been highly successful in school, earning excellent grades at a firstrate college and law school, she has had difficulty making friends and now sees the few friends who she believes “like her” only occasionally, for “attention” and “support.” She has only“dated”oneman,brieflyincollege,butshefeltinhibitedin the relationship, afraid and ashamed to let the man know that she cared about him. Even though they drifted apart after only afewmonths,sheoftenthinksofhimandwonderswhetherher life would be better if they had gotten together. She is pessimisticaboutherprospectsforanotherrelationshipinthefuture because she believes that it would be very hard for her to find someone who would live up to her expectations. Ms. B has few interests outside of work. With respect to music, art, or sports, she said that whatever she tried, she was “not very good at it,” quickly lost interest, and gave up.

Dimensional Model of Personality Disorder Incorporated Into ICD-11

There is an ongoing debate on which model for diagnosing personality disorders is optimal, with the DSM-5 Alternative Model for Personality Disorders being one of the most prominent. The Structured Clinical Interview for the DSM-5 Alternative Model for Personality Disorders (SCID-5-AMPD) is a semistructured diagnostic interview to guide the assessment of the three parts of the Alternative DSM-5 Model for Personality Disorders (hereafter referred to as the Alternative Model), as published in DSM-5 Section III. The structured interview has been tested and translated to several languages, however, not to Swedish. To examine the psychometric properties of the Swedish translation of the Structured Clinical Interview for DSM-5 Alternative Model for Personality Disorders, Module I and Module II for treatment seeking persons with suspected personality pathology including reliability in a Swedish clinical context. This study of 38 outpatients with suspected personality disorder studied the test-retest interrater reliability (Intraclass correlation coefficient (ICC)), estimates of Cronbach's alpha values in a clinical setting. The main results were that ICC ranged between 0.1 and 0.56 for the domain scales of Modules I and II, whereas the estimates of scale reliability (α) ranged from 0.25 to 0.85. Despite the challenges posed by the limited number of raters and the small sample size, this study provides valuable insights into the application of the SCID-5-AMPD model within a Swedish context. While the results suggest that further exploration is needed to fully establish the model's effectiveness and benefits in clinical practice, they also highlight the importance of proper training, clinical experience and calibration for achieving optimal reliability. Continued research is essential to refine the tool and assess its broader applicability. With appropriate enhancements in training and methodological rigor, the SCID-5-AMPD has the potential to significantly contribute to the assessment of personality disorders.

The alternative model for personality disorders (AMPD) is outlined in Section III of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. This model includes 25 dimensional trait facets that are used as criteria for six personality disorders in addition to impairment in functioning. Numerous previous studies have examined the degree to which the proposed trait facets converge with the Section II personality disorders (PDs) they are meant to capture, but the results from these various studies have been inconsistent. The current investigation sought to provide a meta-analysis of published and unpublished data, and in particular, to develop empirically derived trait criterion profiles for each of the six AMPD PDs. A total of 25 independent data sets utilizing diverse samples and methods that included measurement of AMPD traits and at least one Section II PD derived from both published and unpublished work were considered for this review. The findings indicated general support for the traits proposed for each of the six PDs within the AMPD, with obsessive-compulsive PD the notable exception. The discriminant validity, however, was questionable for several of the PDs; several nonproposed traits also correlated with the Section II PD counterparts at moderate to large degrees. Intraclass correlations used to model the agreement across the empirically derived trait profiles for each of the six PDs, however, revealed that most of the disorders were relatively distinct from one another. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Social anxiety in the context of the alternative DSM-5 model of personality disorder.

Both Kernberg's model of personality organization and the alternative model for personality disorders (AMPD) in the Diagnostic and Statistical Manual of Mental Disorders-5th edition provide a multidimensional framework for assessing personality pathology, while having a dual focus on general and specific personality pathology. The present study was the first to investigate the empirical convergence between measures of personality organization and the AMPD (personality functioning and pathological personality traits), considering general and specific personality pathology. A mixed clinical sample completed self-reports for personality organization, personality functioning and pathological personality traits, as well as an interview for personality organization. Two bifactor models with three specific exploratory factors were estimated, comprising a self-report model based on domain scores using exploratory factor analysis (n = 336) and a multi-method model predominantly based on subdomain scores applying exploratory structural equation modelling (n = 277). Both bifactor models yielded strong general factors with high loadings of the personality organization domains identity and primitive defences, as well as the personality functioning domains. The specific factors suggest convergence between other-directed aggression (personality organization), restricted moral functioning (personality organization) and antagonism (pathological personality traits), between diminished reality testing (personality organization) and psychoticism (pathological personality traits) and between maladaptive object relations (personality organization), impaired interpersonal functioning (personality functioning) and detachment (pathological personality traits). It can be concluded that measures of personality organization and the AMPD strongly converge regarding both general and specific personality pathology. Kernberg's model of personality organization may serve as a valuable complement to the AMPD, guiding forthcoming research and the clinical assessment of personality pathology.

Objectives: The Alternative Model of Personality Disorders (AMPD) is a classification system for personality disorders (PDs) proposed in Section III of DSM-5. The AMPD contains two diagnostic constructs: personality functioning and pathological personality traits. Previous research has suggested that the model performed differently among older adults than younger adults (e.g., more generalized patterns). However, explanations for this difference in performance remain unclear. This study examined how self-reported cognitive dysfunction (a common complaint among older adults) impacts the AMPD’s two constructs among a later life sample. Method Older adults (N = 202) completed the Levels of Personality Functioning Scale-Self-Report, Personality Inventory for DSM-5, and Coolidge Axis II Inventory with its six self-report cognitive dysfunction scales. Results Results suggested high correlational overlap between subjective cognitive problems with personality functioning and pathological personality, as measured by the AMPD. Hierarchical regressions revealed that subjective measures of executive functions, perceptual motor, and language difficulties were most strongly related to the AMPD’s constructs. Results are discussed in the context of prior research on objective cognitive impairment among individuals with PDs. Conclusion The degree of overlap found within the current older adult sample suggested an age-related problem or potential age-bias, with older adults being at-risk of (a) having their subjective cognitive problems being incorrectly interpreted as personality pathology under the AMPD or (b) having personality pathology being overlooked under the AMPD, with symptoms instead attributed to subjective cognitive issues. This study suggested that subjective cognitive dysfunction may be one mechanism that contributes to differential performance of the AMPD among older adults.

While prior research has explored the relationship between Object Relations Theory (ORT) and the Alternative Model for Personality Disorders (AMPD), comprehensive comparisons across diverse clinical populations and methodologies remain limited. This study investigated the predictive accuracy of AMPD and ORT in identifying personality psychopathology using neural network models within a mixed sample of 639 participants (229 non-clinical undergraduates, 410 psychiatric inpatients). Data were collected using Persian translations of the Level of Personality Functioning Scale—Self-Report (LPFS-SR), the Personality Inventory for DSM-5 (PID-5) (AMPD measures), and the Structured Interview of Personality Organization-Revised (STIPO-R) (ORT measure). Results indicated significant differences in all subscales of both models between clinical and non-clinical groups. Notably, the borderline personality disorder group showed elevated scores on specific STIPO-R subscales and all AMPD constructs except empathy. Neural network models achieved over 65% accuracy in predicting group membership, with AMPD slightly surpassing ORT (66%+ vs. 65%+). Receiver Operating Characteristic (ROC) analysis demonstrated high sensitivity for both models, with Area Under the Curve (AUC) values ranging from 0.79 to 0.94. These findings underscore the significant utility of both AMPD and ORT for the assessment, early identification, and diagnosis of personality disorders.

A substantial body of empirical evidence has accumulated over the last 12 years since the publication of the Alternative Model for Personality Disorders (AMPD) in the DSM-5. As yet, this evidence has not been organized and reported using the criteria required by the American Psychiatric Association (APA) for proposals submitted to revise the DSM-5. These criteria are based on the Kendler-Kupfer update and expansion of the classic Robins-Guze criteria for establishing psychiatric diagnostic validity. We have been invited by the APA to undertake a review of the last decade of research on the AMPD and to propose a revised, simplified version of the model informed by this evidence. Here we present the findings of the review and our recommendations for the revision of the model. We begin with a brief reiteration of the background and rationale for the AMPD, followed by a description of the revision criteria required by the APA. We then summarize the evidence in support of the AMPD using the required framework. Our review indicates that AMPD-defined personality disorder (PD) shows similar patterns of associations as have been demonstrated for categorical PD diagnoses in terms of antecedent, concurrent and predictive validators. Head-to-head comparisons between AMPD-defined PD and categorical diagnoses suggest a more precise characterization of personality pathology by the AMPD. In addition, AMPD-defined PD appears to show higher reliability estimates than categorical PDs, and strong clinical utility, often outperforming categorical PD diagnoses. We conclude that the AMPD is ready for inclusion in the main section of the DSM. Recommendations are made for: a) further streamlining the AMPD in light of the last decade of accumulated evidence, and b) future research directions in areas where evidence is lacking or more limited.

ABSTRACTThis study addresses longitudinal, expert, all data (LEAD) validity and reliability of the personality functioning ratings in Turkey, which are essential in assessing Criterion A for the entire DSM–5 alternative model for personality disorders (AMPD) diagnoses. A total of 120 consenting patients recruited at a university psychiatry clinic were rated by individual clinicians with respect to DSM–III–R and AMPD criteria. Subsequently, a LEAD panel consisting of 3 senior clinicians convened to reach a consensus personality disorder diagnosis for each participant. Blind personality functioning ratings of a subgroup of 20 participants by the same set of 4 clinicians were obtained for test–retest reliability investigation. Concordance between the LEAD and AMPD diagnoses was as good as that between the LEAD and DSM–III–R diagnoses (kappas = .68). The personality functioning scores correlated strongly (r > .50) with the sum of specific DSM–III–R diagnoses. Reliability estimates pertaining to the personality functioning scores and resultant AMPD Criterion A decisions were mostly in the good range. In conclusion, DSM–5 alternative model-oriented personality functioning ratings yield total or composite scores that are evidently valid and reliable tools to diagnose general personality disorder and to estimate its global severity.

Deficits in theory of mind (ToM)-the ability to infer the mental states of others-have been linked to antagonistic traits in community samples. ToM deficits have also been identified in people with personality disorders (PD), although with conflicting evidence, partly due to the use of categorical diagnoses. The DSM-5 Alternative Model for Personality Disorders (AMPD) provides an opportunity for a more precise understanding of the interplay between ToM abilities and personality pathology. Therefore, the study aims to determine whether and how individuals with diverse ToM profiles differ regarding personality impairment (AMPD Criterion A) and pathological facets (AMPD Criterion B). Adults with PD (n = 39) and from the community (n = 42) completed tests assessing ToM skills and self-reported questionnaires assessing AMPD Criteria A and B. Hierarchical agglomerative and TwoStep cluster analyses were consecutively computed using scores and subscores from ToM tests as clustering variables. Multivariate analyses of variance were subsequently performed to compare the clusters on both AMPD Criteria. Five clinically and conceptually meaningful clusters were found. The most notable differences across clusters were observed for Intimacy and Empathy dysfunctions (Criterion A), as well as for the Deceitfulness, Callousness, and Hostility facets from the Antagonism domain and the Restricted affectivity facet from the Detachment domain (Criterion B). The results support the association between antagonistic personality facets and ToM deficits. However, clusters showing impairments in ToM abilities did not necessarily exhibit high levels of personality dysfunction or pathological facets, emphasizing that both constructs are not isomorphic. Nevertheless, specific profiles can help refine existing interventions to make them more sensitive and specific to the nature of ToM dysfunctions while considering personality functioning and facets.

Authoritative classification systems for psychopathology such as the DSM and ICD are shifting toward more dimensional approaches in the field of personality disorders (PDs). In this paper, we provide a brief overview of the dimensionally oriented DSM-5 alternative model of PDs (AMPD). Since its publication in 2013, the AMPD has inspired a substantial number of studies, underlining its generative influence on the field. Generally speaking, this literature illustrates both the reliability and validity of the constructs delineated in the AMPD. The literature also illustrates empirical challenges to the conceptual clarity of the AMPD, such as evidence of substantial correlations between indices of personality functioning (criterion A in the AMPD) and maladaptive personality traits (criterion B in the AMPD). Key future directions pertain to linking the AMPD literature with applied efforts to improve the lives of persons who suffer from PDs, and surmounting challenges germane to the evolution of the DSM itself.

The alternative model for personality disorders (AMPD) constitutes a major shift in conceptualizing personality pathology and has gained considerable attention among both clinicians and personality pathology researchers. The AMPD has two core components: personality dysfunction (Criterion A) and maladaptive traits (Criterion B). As measures of these components are strongly correlated in self-report, cross-sectional data, some researchers question Criterion A's necessity. We used both self- and interviewer-reported methods to enhance understanding of these AMPD components through principal factors analysis (PFA) and bifactor analysis. Further, we investigated these factors' associations with psychopathology (e.g., mood and anxiety disorder symptoms, criteria for substance use disorders) and psychosocial functioning dimensions (e.g., life satisfaction, interpersonal and occupational problems, daily functioning), again using both self-reported and interviewer-rated measures of these constructs. Six hundred community adults, half each either screened-in as at-risk for personality pathology or currently in outpatient therapy, participated in the study. In both the PFA and bifactor analyses, a distress-and-pathology factor emerged (e.g., negative affectivity, poor self-dysfunction) along with two primarily interpersonal factors: antagonism-disinhibition and detachment. A key difference between the PFA and bifactor analyses was that the interpersonal factors emerged without distress in the bifactor analysis because of the extraction of a general factor and reflected distinct self versus interviewer perspectives. The distress-and-pathology factor consistently displayed meaningful associations with psychopathology symptoms, personality pathology, and psychosocial functioning, whereas the two interpersonal factors were more specifically associated with personality pathology. We discuss the findings' implications for conceptualizing personality pathology and its treatment. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

BackgroundConceptualizations of personality disorders (PD) are increasingly moving towards dimensional approaches. The definition and assessment of borderline personality disorder (BPD) in regard to changes in nosology are of great importance to theory and practice as well as consumers. We studied empirical connections between the traditional DSM-5 diagnostic criteria for BPD and Criteria A and B of the Alternative Model for Personality Disorders (AMPD).MethodRaters of varied professional backgrounds possessing substantial knowledge of PDs (N = 20) characterized BPD criteria with the four domains of the Level of Personality Functioning Scale (LPFS) and 25 pathological personality trait facets. Mean AMPD values of each BPD criterion were used to support a nosological cross-walk of the individual BPD criteria and study various combinations of BPD criteria in their AMPD translation. The grand mean AMPD profile generated from the experts was compared to published BPD prototypes that used AMPD trait ratings and the DSM-5-III hybrid categorical-dimensional algorithm for BPD. Divergent comparisons with DSM-5-III algorithms for other PDs and other published PD prototypes were also examined.ResultsInter-rater reliability analyses showed generally robust agreement. The AMPD profile for BPD criteria rated by individual BPD criteria was not isomorphic with whole-person ratings of BPD, although they were highly correlated. Various AMPD profiles for BPD were generated from theoretically relevant but differing configurations of BPD criteria. These AMPD profiles were highly correlated and showed meaningful divergence from non-BPD DSM-5-III algorithms and other PD prototypes.ConclusionsResults show that traditional DSM BPD diagnosis reflects a common core of PD severity, largely composed of LPFS and the pathological traits of anxiousness, depressively, emotional lability, and impulsivity. Results confirm the traditional DSM criterion-based BPD diagnosis can be reliably cross-walked with the full AMPD scheme, and both approaches share substantial construct overlap. This relative equivalence suggests the vast clinical and research literatures associated with BPD may be brought forward with DSM-5-III diagnosis of BPD.

The goal of this study was to compare the predictive validity of the alternative model for personality disorders (AMPD) versus the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Section II categorical model regarding clinician judgments about mental health outcomes. To do so, we instructed a national sample of 136 mental health professionals to provide clinical judgments on a random subset of four (out of a possible 12) case vignettes. For each case, they made a variety of diagnostic judgments corresponding to each model, as well as clinical outcome judgments (e.g., prognosis). Our analyses included hierarchical and individual regressions to compare the predictive value of each diagnostic system toward these clinical outcome judgments. We found that the AMPD predictors consistently added unique variance beyond the Section II predictors, whereas the Section II predictors were rarely incremental above the AMPD. Further, the AMPD judgments predicted outcome judgments very consistently (98.3% of regressions) compared to the Section II predictors (70% of regressions), and the single Criterion A judgment (level of personality functioning) was the strongest overall predictor. Finally, the categorical borderline personality disorder diagnoses from the two systems performed similarly in predicting clinical outcomes and agreed in 79% of cases. We interpreted our results to suggest that the AMPD is at least as effective, and by some measures more effective, than the DSM-5 categorical model at predicting clinician's judgment of outcomes in clinical cases. We conclude by discussing the value of this evidence in relation to the broader AMPD literature, as well as possible paths forward for the diagnosis of personality disorders. (PsycInfo Database Record (c) 2024 APA, all rights reserved).