Alternative Model For Personality Disorders Research Articles

Mentalizing the pain-Implementation of amentalization-based manual for the therapeutic support of pain patients.

Chronic pain is usually acomplex disorder with possible indications for an impairment at the personality functioning level. Guidelines recommend amultiprofessional interdisciplinary treatment approach. Based on the alternative model of personality disorders of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) and the International Classification of Diseases, eleventh revision (ICD-11), an integrative manual was designed to exactly fit the interdisciplinary multimodal treatment of patients of the day clinic for pain at the orthopedic clinic of the University Hospital Heidelberg. The treatment manual specifically promotes various areas of personality functioning levels, such as emotion regulation, identity, empathy and relationships through individual and group interventions against the background of amentalization-based therapeutic attitude. Afocus group was used to qualitatively evaluate the implementation of the new treatment manual. With good applicability of the manual and satisfaction of the therapy team, acommon language for the interdisciplinary team could be created to improve the therapeutic interaction.

Using the Personality Assessment Inventory to Assess the Alternative Model for Personality Disorders: Criterion Validity in a Clinical Sample

The Personality Assessment Inventory (PAI) is a broadband measure of psychopathology that is widely used in applied settings. Researchers developed regression-based estimates that use the PAI to measure constructs of the Alternative Model for Personality Disorders (AMPD) – a hybrid dimensional and categorical approach to conceptualizing personality disorders. Although prior work has linked these estimates to formal measures of the AMPD, there is little work investigating the clinical correlates of this scoring approach of the PAI. The current study examines associations between these PAI-based AMPD estimates and life data in a large, archival dataset of psychiatric outpatients and inpatients. We found general support for the criterion validity of AMPD estimate scores, such that a theoretically consistent pattern of associations emerged with indicators such as prior academic achievement, antisocial behavior, psychiatric history, and substance abuse. These results provide preliminary support to this scoring approach for use in clinical samples.

An evolutionarily informed therapy for adolescents with prominent schizotypal traits: a pilot five case series

ABSTRACT Background There is a growing interest in the early assessment and treatment of maladaptive forms of personality traits in adolescents, though little is known about effective interventions. This case series aims to present the adaption of a therapy specifically tailored on schizotypal traits to adolescents. The treatment – Evolutionary Systems Therapy for Schizotypy – integrates evolutionary psychopathology, metacognitively oriented psychotherapy and compassion focused therapy. Methods Five adolescents attended 6-months of individual psychotherapy. All participants were diagnosed with schizotypal personality disorder in accordance with the DSM-5 Alternative Model of Personality Disorders. Primary outcome was remission from diagnosis. Secondary outcomes were a reliable change in personality pathology and distress and the acceptability of the intervention. Results Four out of five patients showed remission from diagnosis. All the participants showed reliable changes in personality pathology and distress whether comparing initial and final assessments or investigating monthly variations. Changes were maintained at 1-month follow-up. No adverse events were reported, and intervention was described as satisfactory and sustainable. Discussion Further research is needed to confirm the feasibility of the proposed treatment. This study suggests the importance of developing effective interventions for adolescents with personality disorder, especially for those at risk for severe manifestations.

Five-Factor Model and DSM-5 Alternative Model of Personality Disorder Profile Construction: Associations with Cognitive Ability and Clinical Symptoms

Although numerous studies have explored latent profiles using the Five-Factor Model (FFM) of normative personality, no studies have investigated how broad personality traits (i.e., FFM) and pathological personality traits using the alternative model of personality disorder (AMPD) may combine for latent personality profiles. The present study recruited outpatients (N = 201) who completed the Big Five Aspects Scales (BFAS), Personality Inventory for DSM-5 (PID-5), Structured Clinical Interview for DSM-IV (SCID-I/P), gambling and alcohol use measures, and the Weschler Intelligence subtests. When FFM and AMPD measures were combined, latent profile analyses revealed four profiles, Internalizing-Thought disorder, Externalizing, Average-Detached, and Adaptive. Detachment and openness to experience were the most and least essential traits for profile distinction, respectively. No associations between group membership and cognitive ability measures were found. Internalizing-Thought disorder membership was linked with a current mood and anxiety disorder diagnosis. Externalizing profile membership was associated with younger age, problematic gambling, alcohol use, and a current substance use disorder diagnosis. The four FFM-AMPD profiles overlapped with the four FFM-only and three AMPD-only profiles. Overall, the FFM-AMPD profiles appeared to have better convergent and discriminant validity with DSM-relevant psychopathology.

The maladaptive domains according to the alternative model of personality disorders (AMPD) criterion B in patients with affective disorders and temperamental triads related to these domains: two unique profiles

ObjectivesThe study aimed to (i) compare the maladaptive domains and facets according to the Alternative Model of Personality Disorders (AMPD) Criterion B in patients with a type II bipolar disorder (BD-II) or major depressive disorder (MDD) with healthy controls (HCs), and (ii) investigating the relationship between affective temperaments and these domains and facets in the total sample.MethodsOutpatients diagnosed with current BD-II (n = 37; female 62.2%) or MDD (n = 17; female 82.4%) based on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria and community HCs (n = 177; female 62.1%) in Kermanshah from July to October 2020 included this case-control study. All participants completed the Personality Inventory for DSM-5 (PID-5), the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A), and the second version of the Beck Depression Inventory (BDI-II). Data were analyzed using analysis of variance (ANOVA), Pearson correlation, and multiple regression.ResultsThe score of patients with BD-II in all five domains and those with MDD in three domains including negative affectivity, detachment, and disinhibition are significantly higher than the HCs (p < 0.05). Depressive temperament (related to negative affectivity, detachment, and disinhibition) and cyclothymic temperament (related to antagonism and psychoticism) were the most important correlates of the maladaptive domains.ConclusionsTwo unique profiles are proposed, including three domains of negative affectivity, detachment, and disinhibition associated with the depressive temperament for MDD, and two domains of antagonism and psychoticism related to cyclothymic temperament for BD-II.

Investigating the overlap and predictive validity between Criterion A and B in the alternative model for personality disorders in DSM-5

The Alternative DSM-5 Model for Personality Disorders (AMPD) consists of level of personality functioning (Criterion A) and maladaptive personality traits (Criterion B). The brief scale versions of these are understudied, while often being used by clinicians and researchers. In this study, we wanted to investigate the overlap and predictive validity of Criterion A and B. Participants (N = 253) were measured on level of personality functioning (LPFS-BF) and maladaptive personality traits (PID-5-BF), as well as internalizing outcomes such existential meaninglessness (EMS) and externalizing outcomes such as substance and behavioral addictions (SSAB). Data analysis was conducted with principal component analysis (PCA) and regression analyses. The results showed over 50% overlap between the brief versions of Criterion A and B, while Criterion B slightly outperformed Criterion A in outcomes of EMS and SSAB. We discuss the potential redundancy and usefulness of personality functioning and maladaptive personality traits.

The predictive validity of the DSM-5 alternative model for borderline personality disorder: Associations with coping strategies, general distress, rumination, and suicidal ideation across one year.

The DSM-5 Alternative Model for Personality Disorders (AMPD) characterizes borderline personality disorder (BPD) in part as a constellation of maladaptive personality trait facets including emotional lability, anxiousness, separation insecurity, depressivity, impulsivity, risk-taking, and hostility. Previous studies have supported the construct validity of AMPD-BPD; however, research examining its predictive validity in relation to theoretically and clinically relevant constructs remains needed. The present study investigates the longitudinal relationships between AMPD-BPD and general distress, rumination, and suicidal ideation, as well as adaptive and maladaptive coping targeted in Dialectical Behavior Therapy (DBT) in a sample of participants with elevated BPD symptomology. We also examined if dysfunctional coping skill use at 9-month follow-up explained the relationship between baseline BPD traits and outcomes at 1-year. There were significant correlations between baseline trait BPD with dysfunctional coping skill use at 9-month follow-up and psychological distress and rumination at 1-year follow-up. Dysfunctional skill use exhibited a significant indirect effect in the association between trait BPD and rumination after 1 year. The findings of this study support the construct validity of AMPD-BPD that can inform treatment and research.

Bridging the ICD11 and the DSM-5 personality disorders classification systems: The role of the PID5BF + M.

In both the ICD-11 Classification of Personality Disorders and the DSM-5 Alternative Model of Personality Disorders (AMPD) personality disorders (PD) are characterized by impairments in self- and interpersonal functioning which distinguish the various levels of dysfunction. Moreover, pathological traits are used by these classification systems to define the stylistic expression of personality dysfunction. Negative affectivity, detachment, antagonism/dissociality, and disinhibition feature as trait domains in each of these models. However, there are also differences between the two models, namely, in the psychoticism domain, which does not feature as a personality trait domain in the ICD-11, and in the anankastia domain, corresponding to compulsivity in the DSM-5, which was removed from the final AMPD model. Furthermore, facets are acknowledged by the DSM-5 within each trait domain, while this does not occur in the ICD-11. In view of the similarity between these classification systems, their harmonization would be beneficial for the clinical profession. With this goal in mind, the PID5BF + M, an algorithm that assesses the DSM-5 and ICD-11 six trait domains and 18 facets, was developed and has proven to adequately characterize the ICD-11 trait domains by means of DSM-5 trait facets. The current study compares a community sample (N = 280, M age = 48.01, 53.2% females) with a PD sample (N = 131, M age = 42.66, 45.0% females) along with the PID5BF + M, the LPFS-SR and the PID-5. Given that the PID5BF + M total can be seen as a measure of the level of personality dysfunction, strong relations between the PID5BF + M total and the LPFS-SR total are expected. Strong relations between the trait specifiers measured by the PID5BF + M and the PID-5 are also expected. Finally, the community and clinical samples are expected to differentiate by means of the dimensions assessed through the three afore-mentioned measures. The Spearman rank-order correlation coefficient was used to measure the strength and direction of associations between the PID5BF + M total and the LPFS-SR total and between the PID5BF + M and the PID-5 traits. Group differences were explored using the Mann-Whitney U test for independent samples. As expected, there were strong, significant, and positive relations between the measures. Furthermore, higher scores were observed in all the variables for the PD group against the community group. Although this study has limitations, its findings sustain that the PID5BF + M has potential to assess the severity of personality disfunction and to characterize the stylistic features of PD as they are conceived by both the ICD-11 and the DSM-5. Although more research is needed regarding the convergent validity of the PID5BF + M, this new test contributes to the harmonization of both systems and to parsimony in the assessment of PD, which is the main objective of clinical practice.

Evaluating the Construct Validity of the Norwegian Version of the Level of Personality Functioning Scale – Brief Form 2.0 in a Large Clinical Sample

The Level of Personality Functioning – Brief Form 2.0 (LPFS-BF 2.0) is a 12-item self-report questionnaire developed to gain a quick impression of the severity of personality pathology according to the DSM-5 Alternative Model for Personality Disorders (AMPD). The current study evaluated the construct validity and reliability of the Norwegian version of the LPFS-BF 2.0 in a large clinical sample (N = 1673). Dimensionality was examined using confirmatory factor analysis and bifactor analysis followed by an analysis of distinctiveness of the subscales using the proportional reduction in mean squared error (PRMSE), and the concurrent validity was examined using correlations with self-report questionnaires and clinical interviews assessing PDs according to section II of the DSM-5. Taking the findings of the dimensionality and concurrent validity results together, we found moderate to good support for the use of total scores for the Norwegian version of the LPFS-BF 2.0. We would advise against the use of subscale scores, since the subscales provided only a small amount of reliable unique variance.

Combining Novel Trait and Neurocognitive Frameworks to Parse Heterogeneity in Borderline Personality Disorder.

Borderline Personality Disorder (BPD) diagnosis comprises several constellations of trait, neurocognitive and psychosocial alterations. Dimensional models of psychopathology provide new opportunities to parse heterogeneity and create a stronger interface between individual characterisation and psychosocial outcomes. However, dimensional models have focused on either traits or neurocognitive features, lacking integration to capture the multifaceted nature of BPD. We assessed 100 participants with BPD using a combination of tools stemming from trait (Alternative Model for Personality Disorders) and neurocognitive models (Research Domain Criteria; RDoC) to examine if trait-derived subgroups display distinctive social-processing and psychosocial profiles. We used two complementary analytical approaches: person-centered (k-means clustering) and construct-based (multiple-factor analysis). Our person-centered approach identified four subgroups with separable internalizing, detached, externalizing, and low psychopathology trait-profiles. These profiles revealed distinctive patterns of affiliation, emotion recognition and mentalisation performance in RDoC tasks, and psychosocial measures of quality of life and social connectedness. RDoC-based measures showed close construct proximity with negative affectivity, disinhibition, and antagonism trait domains, relative to the detachment domain, which had close proximity with self-knowledge. Altogether, findings support consilience between trait-based and neurobiological frameworks and suggest that trait models are useful to parse BPD heterogeneity leading to unique social functioning profiles.

Situating Psychopathy Within the DSM-5 Alternative Model of Personality Disorders (AMPD) Among Italian Community-Dwelling Adults

Given growing evidence for a joint hierarchical framework of clinical and personality symptomatology, situating triarchic traits within this model would acknowledge transdiagnostic trait-related variance and provide a basis for linking the DSM-5 Alternative Model of Personality Disorders (AMPD) domains to established indicators of these neurobehavioral traits. The current study (N = 2,041 Italian adults) sought to replicate and extend recent evidence regarding the locations of triarchic traits within the AMPD and to examine relations with criterion measures at different levels of the hierarchy. "Bass-ackwards" analyses revealed a hierarchical structure of personality pathology in which triarchic traits aligned with broad dispositional domains of the AMPD. Boldness, meanness, and disinhibition were clearly situated within the Externalizing branch of the hierarchy and helped to differentiate the Negative Affect, Antagonism, Detachment, and Disinhibition domains at lower levels. The current findings support the view of psychopathy as multidimensional and encompassing developmentally meaningful and neurobehaviorally relevant traits.

Associations between physical health and the alternative model of personality disorders: A cross-sectional age study.

The Alternative Model of Personality Disorders (AMPD) is a relatively new dimensional model of personality disorders (PDs) that assesses two diagnostic constructs: personality functioning and pathological personality traits. Thus far, research on the AMPD among older adults has been limited, but the research that does exist suggests limited generalizability to the unique biopsychosocial context of later life. To further examine the applicability of the AMPD to older adults, the purpose of this study was to examine relationships between the AMPD's two constructs with perceived physical health status among younger and older adult samples. Older adults (n = 222) and younger adults (n = 215) completed the Short Form-36 (SF-36), Levels of Personality Functioning Scale-Self-Report (LPFS-SR), and Personality Inventory for DSM-5-Brief Form (PID-5-BF). Correlations and Fisher's z-tests revealed significantly stronger relationships between the SF-36 with the LPFS-SR and PID-5-BF domains for older adults than younger adults. Additionally, age group significantly moderated the relationships between personality functioning and pathological personality traits and health. The stronger relationships between health and the AMPD's constructs for older adults suggest meaningful overlap between negative health outcomes and PD pathology. Future research should further investigate specific mechanisms in which personality pathology negatively impacts health in older adults.

The Self-Concept and Identity Measure in Patients with Personality Disorders: A Psychometric Evaluation and Associations With Identity Processes, Core Domains of Self-Functioning, and Personality Disorder Symptoms.

As developmental and clinical research on identity has largely developed in disconnect, scholars recommend adopting a developmental psychopathology perspective on identity, which considers adaptive and pathological identity functioning. Such a perspective has also been introduced in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) Alternative Model for Personality Disorders (AMPD), which suggests that all personality disorders (PDs) are marked by moderate to extreme deficits in self-functioning (i.e., identity and self-direction). The present study aims to validate the Dutch Self-Concept and Identity Measure (SCIM), a 27-item self-report questionnaire that assesses consolidated identity, disturbed identity, and lack of identity, in 153 psychiatric inpatients with PDs (75.2% female; Mage = 31.73). We investigated the factor structure and reliability of the SCIM, and examined associations of SCIM scales with typical identity processes, AMPD domains of self-functioning, and symptoms of all PDs. Results indicated that a 23-item Dutch SCIM produced valid and reliable scores among patients with PDs. Furthermore, SCIM scales were significantly and differentially related to identity commitment processes, ruminative identity exploration, domains of self-functioning, and symptoms of all PDs. Moreover, findings indicated that PDs varied regarding the severity of identity impairment.

Influence of maladaptive personality traits on women's posttraumatic cognitions of IPV.

Intimate partner violence (IPV) is a problem for women worldwide. One factor that affects the severity of women's distress in the aftermath of IPV is how they make meaning of the violence they experienced. Posttraumatic meaning-making takes the form of 3 distinct posttraumatic cognitions: self-blame, other negative thoughts about oneself, and negative thoughts about the world. Women's posttraumatic cognitions in the aftermath of IPV are in part a function of personality. Research on personality and posttraumatic cognitions has focused primarily on the influence of normative personality traits, although maladaptive personality traits are more common in clinical assessment. One of the most common models of maladaptive traits is DSM-5's Alternative Model of Personality Disorder (AMPD), which contains 5 maladaptive variants of normative personality traits (Antagonism, Detachment, Disinhibition, Negative Affect, and Psychoticism). Although there is increasing research on the AMPD traits in general, there is limited research on the influence of these traits on women's response to IPV specifically. In this study we examine the association between AMPD traits and posttraumatic cognitions of IPV in a sample of women exposed to IPV (N = 199) using a Bayesian approach to multiple regressions. Results suggest that IPV and Negative Affect were the primary influences on all 3 IPV-related posttraumatic cognitions and that other traits had differential effects depending on the type of posttraumatic cognition under analysis. These findings clarify our understanding of individual differences in posttraumatic response and have implications for the treatment of women exposed to IPV. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Supplemental Material for A Severity-Matching Strategy Illustrated Using the Alternative Model for Personality Disorders in Violence Risk Assessment on College Campuses

Supplemental Material for A Severity-Matching Strategy Illustrated Using the Alternative Model for Personality Disorders in Violence Risk Assessment on College Campuses

Supplemental Material for Criterion A of the Alternative Model of Personality Disorders: Structure and Validity in a Community Sample

Supplemental Material for Criterion A of the Alternative Model of Personality Disorders: Structure and Validity in a Community Sample

Abnormal Personality Traits and Social Network Addiction Among Soran University Students ((Alternative Model for Personality Disorders According to the Fifth Diagnostic and Statistical Manual (DSM-5)))

The phenomenon of social network addiction has attracted the attention of many specialists and researchers as it represents a growing problem in the field of mental health based on the current evidence. Majority of the studies have tried to find out a relationship between the personality traits and the social network addiction.&#x0D; Most of researchers and clinicians have followed the DSM categorization, but others believe that this categorization is very general, thus, they proposed more specific alternative approach to determine abnormal personality traits. Based on this proposal, the DSM-5 has recommended researchers to carry out further investigation. Based on those facts, the aim of this study is to identify the extent to which each dimension and wich abnormal personality traits contributes to predicting social network addiction among Soran University students.&#x0D; For reaching the researche aim, the researchers have prepared two scales: first for measuring the social network addiction that is consists of 18 items. Second, for measuring the abnormal personality traits by the suggested alternative model in (DSM-5) and it consists of 50 items. This scales were implemented on the students of Soran University in both science and humanities, in which their number 600 students. For solving the data, the research has utilized the Statistical Package for Social Sciences (SPSS).The results demonstrate that there is a significant effect for both dimensions (Negative Affectivity and Antagonism) and seventeen out of twenty-five traits in predicting the social network addiction among Soran University students. Hence, the researcher has analyzed those results, based the study findings, some recommendations and suggestions have been provided.

Connecting DSM-5 and ICD-11 trait domains with schema therapy and dialectical behavior therapy constructs.

The DSM-5 Section III alternative model of personality disorder (AMPD) and the International Classification of Diseases - 11th Edition's (ICD-11) personality disorder classification allow clinicians to identify individual trait domains in which people score highly. However, how these domains relate to constructs associated with efficacious treatment approaches is unclear. The current study aimed to determine whether constructs from two evidence-based treatments (schema therapy [ST] and dialectical behavior therapy [DBT]) were associated with maladaptive personality traits in a way consistent with underlying theories. We examined associations between ST constructs, DBT skill use and maladaptive coping styles, and personality traits in a sample of 525 adults. Bivariate intercorrelations and a series of multiple regression analyses were conducted to investigate the associations. As hypothesized, maladaptive coping was strongly associated with all trait domains. Surprisingly, poor DBT-skill use was only associated with negative affectivity, detachment, and disinhibition trait domains. Specific schema domains were associated with each personality trait domain, supporting trait domain-schema domain specificity. The current study highlights the potential clinical utility of the AMPD and ICD-11 trait models and ultimately contributes to the dearth of evidence on their likely usefulness for treatment selection, planning, and applications.

Construct Validity of the Dutch, English, French, and Spanish LPFS-BF 2.0: Measurement Invariance Across Language and Gender and Criterion Validity.

With the introduction of the Alternative Model of Personality Disorders in the DSM-5, the need for short measures of the level of personality functioning has emerged, both for screening purposes and for assessing change during treatment. The Level of Personality Functioning Scale-Brief Form 2.0 (LPFS-BF 2.0) was constructed for this and has received support for its two-factor structure and criterion validity. The authors aimed to provide additional construct validity evidence for the LPFS-BF 2.0 by examining its factor structure and measurement invariance across the Dutch, English, French, and Spanish versions and across gender, and its criterion validity. Results showed that the two-factor model had a good fit to the data in the four linguistic versions. Configural and metric invariance were supported across linguistic versions and gender, while scalar invariance was partially supported. Reporting a mental health disorder and having consulted with a mental health professional were associated with higher LPFS-BF 2.0 scores.

Psychometric evaluation of the Estonian version of the Semi-structured Interview for Personality Functioning DSM-5 (STiP-5.1)

BackgroundThe DSM-5 Alternative Model for Personality Disorders introduced a dimensional perspective on personality disorders. The model assesses functioning in four domains: Identity, Self-Direction, Empathy, and Intimacy. This study evaluates the psychometric properties of the Semi-Structured Interview for Personality Functioning DSM-5 (STiP-5.1) in Estonian.MethodThe sample consists of 131 participants: 58 from the general population and 73 from a mixed clinical sample that is further divided into a mood and anxiety disorder sample and personality disorder sample. All participants completed the STiP-5.1 interview and the Level of Personality Functioning Scale–Brief Form (LPFS-BF 2.0).ResultsThe Estonian STiP-5.1 interview has good internal consistency (McDonald's ω between .94–.98) and high convergent validity (correlations with LPFS-BF 2.0 above .7). Interview scores successfully differentiated the general population from the mixed clinical sample (Cohen’s d = 2.68), as well as patients with personality disorder from those without (Cohen’s d = 1.76). The LPFS-BF 2.0 total score differentiates the general population sample from the mixed clinical sample (Cohen’s d = 1.99) but not the personality disorder sample from other clinical sample participants.ConclusionsThe properties of the Estonian STiP-5.1 replicate those of other languages, and empirically support a unified personality functioning dimension that can be meaningfully thought of as reflecting impairments in self and interpersonal functioning. Findings of this study will be discussed in the light of the ongoing debate on the dimensionality of personality pathology and the use of self-report versus interview measures for assessing personality pathology.