Alternative Model For Personality Disorders Research Articles

Borderline personality disorder and aggressive behavior: A study based on the DSM-5 alternative model

IntroductionUnplanned reactive aggressive acts are a clinical feature of particular interest in patients with borderline personality disorder (BPD). The early identification of personality traits correlated to aggressive behavior is certainly desirable in BDP populations. This study analyzes a clinical sample of 122 adult outpatients with BPD referred to Adult Mental Health Services of the Department of Mental Health of Bologna, in Italy. MethodsThe study examines the relationship with personality facets of the DSM-5 alternative model for personality disorders (AMPD), Personality Inventory for DSM (PID-5), with respect to the four main components of aggression measured by the Aggression Questionnaire (AQ): hostility, anger, verbal and physical aggression. Using robust regression models, the relationships between PID-5 facets and domains and the aggression components under consideration were identified. ResultsVerbal and physical aggression in our sample of BPD outpatients is mainly associated to PID-5 antagonism domain. Physically aggressive behavior is also related to callousness facet. ConclusionsThe traits most consistently associated with aggression were the domain of Antagonism and the facet of Hostility. The study findings highlight the need for clinicians working with individuals with BPD to pay particular attention to traits of hostility, callousness, and hostility to understand aggression.

The relationship between bullying victimization and impairment in personality functioning in a clinical adolescent sample.

Problematic interpersonal relationships may represent both, a risk factor for the development or trigger of personality disorder (PD) symptoms and its consequences. Since peer relationships become more and more important in adolescence, the current study explores the cross-sectional association between recent bullying experiences and levels of impairment in personality functioning according to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) alternative model of personality disorders (AMPD; Criterion A) in help-seeking adolescents (N = 493). Logistic and multiple regression analyses revealed that patients who were frequently bullied in the past 3 months (i.e., at least once a week) were more likely to reach the diagnostic threshold for PD according to the AMPD (OR = 1.71, p = .025) and showed higher levels of impairment in identity (β = .41, p < .001), empathy (β = .26, p = .002), and intimacy (β = .30, p = .001), but not self-direction, compared to patients who did not report any bullying experiences. Occasional bullying in the past 3 months (i.e., every few weeks) was neither associated with a greater likelihood to reach the diagnostic threshold for PD nor with greater impairments in identity, self-direction, empathy, or intimacy compared to no bullying. While the current study provides support for a correlation between bullying experiences and personality dysfunction (particularly in the elements identity and intimacy), longitudinal research is needed to clarify whether experiences of bullying cause or trigger personality dysfunction or/and vice versa. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Supplemental Material for Comparing the DSM-5 Categorical Model of Personality Disorders and the Alternative Model of Personality Disorders Regarding Clinician Judgments of Risk and Outcome

Supplemental Material for Comparing the DSM-5 Categorical Model of Personality Disorders and the Alternative Model of Personality Disorders Regarding Clinician Judgments of Risk and Outcome

Enhancing Diabetes Management Through Personality Assessment: A Pilot Study.

The aims of this study were to evaluate the utility of therapeutic assessment (therapeutic assessment) as a brief intervention to target reduction in A1C levels and to assess the levels of personality functioning and broad trait domains described in the DSM-5 Alternative Model for Personality Disorders in a sample of patients with Type 2 diabetes and their relationship to A1C levels at baseline and follow-up. Participants (n = 99) were recruited from a primary care office and provided feedback on how their personality functioning and pathological personality traits might influence their diabetes management. Results indicated that 66.25% of participants receiving TA feedback decreased their A1C levels below 7. Those who improved reported less difficulty with intimacy and trends toward higher levels of personality functioning and lower levels of interpersonal detachment. Results suggest that providing TA feedback is worthy of further investigation for considering its therapeutic effects in helping patients to manage Type 2 diabetes.

Measurement invariance of the Personality Inventory for DSM-5 across sex.

There has been an international movement towards dimensional models of personality disorders (PDs) in the last decades, which culminated in the publication of the Alternative Model of Personality Disorders (AMPD) in the Emerging Measures and Models section of the DSM-5. This model was accompanied by a APA-sanctioned Personality Inventory for DSM-5 (PID-5) for the assessment of the AMPD pathological personality traits. One major issue with the assessment of personality disorders pertains to sex differences, and measurement invariance across sex in assessment instruments for PDs is necessary in order to ensure non-biased evaluations and to make valid comparisons between men and women. This study aimed to provide more information on measurement invariance across sex for the PID-5, using both the original scoring approach provided by the authors of the instrument and the scoring approach suggested by the APA in the published version of the PID-5. This study was conducted with a sample of 2273 participants from the general Québec (Canada) adult population aged 18 to 90 years (M = 46.59; SD = 16.32; 51.8% women). The original scoring approach model showed good fit to data after freeing paths between certain traits and reached strict invariance. The APA scoring approach also showed good fit to data and reached strict invariance, but needed an adjustment (path freed between Emotional lability and Impulsivity in men) to reach scalar invariance. In line with previous research, the PID-5 is invariant across sex and the five-factor structure adjusts well to data. The APA scoring approach appears to attenuate the cross-loading problem observed with the original scoring approach. In light of these results, we recommend using the APA scoring approach to derive domain scores.

Head-to-head comparison of the alternative model for personality disorders and Section II personality disorder model in terms of predicting patient outcomes 1 year later.

The present study investigated the predictive validity of Criterion A and B of the Alternative Model for Personality Disorders (AMPD) compared to the DSM-5 Section II personality disorder (PD) model in predicting patient outcomes 1 year after initial assessment, in a hetero-method longitudinal design. A clinical sample of 84 participants were administered both traditional Section II and AMPD interviews by two independent interviewers. One year after assessment, disability (World Health Organization Disability Assessment Schedule 2.0) and symptom severity (Brief Symptom Inventory) were assessed. The Section II PD model did not predict disability (R² = .01) nor symptom severity (R² = .03). The AMPD model, on the other hand, predicted both disability (R² = .23) and symptom severity (R² = .29) 1-year postinitial assessment. Both Criterion A and B were significant predictors, but when jointly combined only Criterion A remained significantly predictive of both disability and symptom severity while Criterion B did not. Criterion A thus appears to capture core vulnerabilities of personality-disordered patients that are related to future functioning and symptom severity. Implications for clinical practice are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A new performance-based measure of personality functioning impairment: development and preliminary evaluation of reliability and validity

Personality functioning impairment is at the center of many dimensional models of personality. Available measures of personality functioning impairment are limited to self-report, clinician-/informant-rated, and interview methods. Although researchers have begun investigating established performance-based instruments’ potential for assessing personality functioning impairment, administration and scoring of these instruments is complex and the latent variables they measure diverge from personality functioning impairment as described in the ICD-11 and the Alternative Model for Personality Disorders (AMPD) of the DSM. We address this absence by developing and psychometrically evaluating the Level of Personality Functioning Scale-Questionnaire-based Implicit Association Test (LPFS-qIAT). The LPFS-qIAT’s psychometric properties were evaluated across four studies, producing initial evidence supporting the new instrument’s reliability as well as its convergent, discriminant, and criterion-related validity. As the first performance-based measure of personality functioning impairment that aligns with the AMPD and, to a degree the ICD-11, that is easily administered, scored, and interpreted, the LPFS-qIAT shows potential to become a valuable tool in both research and clinical practice.

An examination of the cross-cultural equivalence of the personality inventory for DSM-5 across Chinese and U.S. samples.

The Personality Inventory for DSM-5 (PID-5) was designed to measure the personality traits of the alternative model of personality disorders (AMPD). It is comprised of 25 lower order facet scales. Factor analytic investigation of these scales has consistently recovered five factors corresponding to the trait domains of the AMPD. Most of these factor analytic studies, however, have been conducted in the United States and Western European countries and languages. Fewer studies have examined the factor structure of the PID-5 in East Asian countries; and no studies have examined whether the five-factor structure found in Western countries/cultures/languages is congruent with those from East Asia. In this study, we examine the PID-5 factor structure in adult community samples from the People's Republic of China (PRC; N = 233 [116 females], Mage = 35.88, range = 22-60) and the United States (N = 237 [118 females], Mage = 35.44, range = 22-60) using exploratory structural equation modelling and assess whether the factor structures across these samples are congruent using Tucker's congruence coefficient. A five-factor solution was an adequate-to-good fit in both samples. The factor structure obtained from the U.S. sample was congruent with the PID-5 normative sample factor structure. The compositional configuration of the factors in the five-factor structure in the PRC sample, however, showed poor congruence with the U.S. sample. A six-factor model proved to be a better fitting model in the PRC sample. We conclude that the PID-5 does not have factor structure equivalence across U.S. and Chinese cultures/languages. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Comparing the clinical utility of the alternative model for personality disorders to the Section II personality disorder model: A randomized controlled trial.

The alternative model for personality disorders (AMPD) has been extensively studied over the past decade, but to date there is no direct comparison of the clinical utility of the AMPD model relative to the Section II personality disorder (PD) model in an ecologically valid design. The current study examined the clinical utility of an AMPD-informed assessment procedure and Section II PD assessment procedure as assessed by both patients and clinicians in a randomized controlled trial. A sample of 119 patients were randomly assigned to either an AMPD or a Section II PD assessment procedure. At the end of the assessment, patients filled out questionnaires pertaining to clinical utility, satisfaction, motivation for treatment, and general experience of the assessment. Clinicians who subsequently started treatment with these patients also completed two clinical utility questionnaires. There were no significant differences between the AMPD and Section II PD assessment procedure on patients' reported clinical utility, motivation for treatment, satisfaction, and general experience of the assessment nor were there significant differences between the models on clinician reported clinical utility. Explorative analyses revealed that, for patients, a positive relationship with the assessor was predictive of experienced utility. This study shows no superiority of the AMPD in terms of clinical utility but suggests that the alliance with the assessor is a particularly salient factor in clinical utility. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Contribution of the alternative model for DSM-5 personality disorders to relationship satisfaction.

Personality is a central factor associated with relationship discord, conflicts, and separation, as well as with dyadic adjustment and relationship stability. The Alternative Model for Personality Disorders (AMPD) of the DSM-5 offers a hybrid model for understanding personality based on personality dysfunction (Criterion A) and pathological domains and facets (Criterion B). So far, few studies have integrated this model into the understanding of relationship quality. Therefore, the aim of this study was to examine the contribution of Criterion B to relationship satisfaction in individuals involved in an intimate relationship. We also explored the joint contribution of Criteria A and B, as well as their interaction effects, to relationship satisfaction. Participants were drawn from two clinical samples: patients with personality disorders (PD; N = 101) and clients consulting in private practice clinics (PPC; N = 350). They completed self-report questionnaires assessing relationship satisfaction and AMPD Criteria A (only for PPC sample) and B. Hierarchical regressions showed that, for the PD sample, the Detachment and Negative Affectivity domains, especially the pathological facets of Intimacy Avoidance and Separation Insecurity, explained 22.5% of relationship satisfaction's variance. For PPC clients, Detachment, Negative Affectivity, and Antagonism domains, and especially the pathological facets of Intimacy Avoidance, Anxiousness, and Grandiosity, contribute significantly to relationship satisfaction, explaining 14.8% of its variance. Criterion A elements did not evince incremental value to the regression models in the PPC sample, and no Criteria A and B interaction effects were found. Clinical implications as well as limitations of the study are discussed.

Profiles of theory of mind impairments and personality in clinical and community samples: integrating the alternative DSM-5 model for personality disorders.

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.

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.

Connecting loneliness with pathological personality traits: Evidence for genetic and environmental mediation from a study of older twins.

Loneliness has broad public health importance, especially in older adulthood, and there is some evidence suggesting it is associated with several personality disorders (PDs). The etiology of these PD-loneliness associations, however, has rarely been studied, especially in the context of the maladaptive traits of the DSM-5 alternative model of personality disorder (AMPD). To address these limitations, we estimated phenotypic, genetic, and unique environmental associations between loneliness and maladaptive personality traits in a sample of older adults from the Minnesota Twin Registry (n = 1,356, Mage = 70.4). Loneliness was moderately to strongly associated with each of the AMPD domains of negative affect, detachment, antagonism, disinhibition, and psychoticism (r = .22-.58), with evidence of both genetic (rg = .45-.75) and unique environmental (re = .10-.48) influences explaining the associations to varying degrees. We argue that loneliness may be an underappreciated concomitant of personality pathology, with PD traits perhaps underlying its development. Indeed, these findings suggest that loneliness may be a manifestation of the genetic and environmental forces that also lead to pathological personality variation. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Supplemental Material for Exploring Personality Correlates of Psychiatric Hospitalization: A Cross-Sectional Comparison of Section II Personality Disorder Model and Alternative Model for Personality Disorders

Supplemental Material for Exploring Personality Correlates of Psychiatric Hospitalization: A Cross-Sectional Comparison of Section II Personality Disorder Model and Alternative Model for Personality Disorders

THE EFFECT OF LIFESPAN TRAUMA EXPOSURE ON PATHOLOGICAL PERSONALITY TRAITS

Abstract Introduction The Alternative Model of Personality Disorders (AMPD) is a dimensional model of personality disorder pathology focusing on pathological personality traits, with five trait domains. Limited knowledge exists about relationships between cumulative exposure to traumatic events and the AMPD, a gap particularly relevant for older adults who have had a lifetime of potential exposure. Method: Older adults (n = 200) completed the Trauma Health Questionnaire (THQ) and Personality Inventory for DSM-5 (PID-5). Results Multivariate analysis of covariance (MANCOVA) revealed significant differences in the five PID-5 domains across four levels of cumulative trauma exposure (Pillai’s Trace =.14, F(5, 519) =1.73, p =.04, ηp2=.05). Years since first traumatic event was not significant as a covariate (Pillai’s Trace =.02, F(4, 173) =0.80, p =.55, ηp2=.02). Significant group differences were found in the PID-5’s Psychoticism (F(3, 175) = 5.71, p &amp;lt; .001, ηp2 = .09) and Detachment (F(3, 175) = 2.91, p = .03, ηp2 = .05). According to Bonferroni post-hoc tests, the high trauma exposure group was significantly higher in Psychoticism than low trauma exposure, low to medium trauma exposure, and medium to high trauma exposure groups. For Detachment, the high trauma exposure group was significantly higher than the low trauma exposure and low to medium exposure groups. Discussion Findings suggest that cumulative trauma exposure is associated with specific pathological personality traits in older adults. High levels of trauma exposure may be particularly related to eccentric and detached traits that persist in later life, reflecting the need for clinical assessment in both domains.

Obsessive-compulsive symptoms and dimensional models of psychopathology: The contribution of “not just right experiences”

Dimensional models provide a framework for characterizing psychopathology and personality disorders based on lower-order maladaptive traits, typically organized into five overarching domains: Negative Affect or Internalizing, Detachment, Antagonism, Disinhibition, and Psychoticism or Thought Disorder. Within the context of these dimensional models, the classification of Obsessive-Compulsive (OC) symptoms has raised questions, as they are often placed within the Negative Affect/Internalizing or Psychoticism/Thought Disorder domains. The discrepancy in their categorization may be attributed to the diversity in how these symptoms manifest. An alternative perspective involves the adoption of a measure associated with a vulnerability factor for OCD, which may transcend the specific symptoms of the disorder. In this study, our objective was to explore the association between 'Not Just Right Experiences' (NJREs) and the dimensions specified in the DSM-5 Alternative Model of Personality Disorders (AMPD). We utilized two distinct samples, one consisting of 978 participants and the other comprising 1004, all of whom were non-clinical individuals. Through a series of exploratory factor analyses conducted on the initial sample, we uncovered a hierarchical structure of general psychopathology. Within this structure, NJREs were situated within the AMPD's Psychoticism domain. Furthermore, the Psychoticism domain exhibited a strong and unique association with all OC symptoms, surpassing the influence of other AMPD components. A structural equation model applied to the second sample validated these findings, indicating that both the Psychoticism and Negative Affect played significant roles in explaining a substantial portion of the variance observed in NJRE measures. These outcomes have pertinent clinical implications, particularly in the context of Cognitive-Behavioral Therapy for individuals with OCD.

Applications of the alternative model for personality disorders to threat assessment.

Applications of the alternative model for personality disorders to threat assessment.

A severity-matching strategy illustrated using the alternative model for personality disorders in violence risk assessment on college campuses.

A severity-matching strategy illustrated using the alternative model for personality disorders in violence risk assessment on college campuses.

The alternative model for personality disorders and violence risk: Where are we now? Where are we going?

The alternative model for personality disorders and violence risk: Where are we now? Where are we going?

Personality Pathology and Suicide Risk: Examining the Relationship Between DSM-5 Alternative Model Traits and Suicidal Ideation and Behavior in College-Aged Individuals.

This study examines the link between personality pathology and suicide risk regarding the DSM-5 alternative model of personality disorders. The study investigates the facets, domains, internalizing, and externalizing of personality pathology and their correlation and predictive significance for suicidal ideation and behavior. This study examined a diverse and balanced sample of 1,398 college students aged between 18- and 29-year-olds from nine colleges in Kafrelshiekh University, with nearly equal representation of both genders (687 males, 711 females), a mix of rural and urban residents (807 rural, 591 urban), and a wide range of socioeconomic backgrounds (15 very low SES, 84 low SES, 878 moderate SES, 364 high SES, and 57 very high SES). The Personality Inventory for the DSM-5 (PID-5) was utilized to assess personality pathology. Columbia-Suicide Severity Rating Scale (C-SSRS) was used to evaluate suicidal ideation and behavior. Logistic regression reveals significant associations between personality traits and suicidal ideation (e.g., Anhedonia, Suspiciousness) and behavior (e.g., Risk Taking, Depressivity). Negative Affect and Detachment are significantly linked to suicidal ideation, while Detachment, Disinhibition, and Psychoticism are linked to suicidal behavior. Internalizing personality pathology predicts both ideation and behavior, indicating a contribution to suicidal thoughts and self-destructive acts. Externalizing is a significant predictor of suicidal behavior.