Classification Of Personality Disorders Research Articles

The FFOCI and other measures and models of OCPD.

The Five Factor Obsessive Compulsive Inventory (FFOCI) was developed in part to facilitate a shift from the categorical classification of personality disorder to a dimensional trait model, more specifically, the five-factor model (FFM). Questions though have been raised as to whether obsessive-compulsive personality disorder (OCPD) can be understood as a maladaptive variant of FFM conscientiousness. The present study provides a further validation of the FFOCI, emphasizing in particular its association with FFM conscientiousness, as well as comparing alternative measures and models of OCPD. A total of 380 undergraduates (obtained in two samples of 274 and 106), including 146 oversampled for OCPD traits (93 for the first sample and 53 for the second), completed the FFOCI, measures of general personality, OCPD trait scales, and alternative measures of OCPD. Results supported the validity of the FFOCI as a measure of OCPD and maladaptive variants of FFM traits, as well as identifying substantive differences among the alternative measures of OCPD, particularly with respect to their relationship with FFM conscientiousness, antagonism, and introversion.

An Empirically Derived Classification of Adolescent Personality Disorders

This study describes an empirically derived approach to diagnosing adolescent personality pathology that is clinically relevant and empirically grounded. A random national sample of psychiatrists and clinical psychologists (N = 950) described a randomly selected adolescent patient (aged 13-18 years, stratified by age and gender) in their care using the Shedler-Westen Assessment Procedure-II-A for Adolescents (SWAP-II-A) and several additional questionnaires. We applied a form of factor analysis to identify naturally occurring personality groupings within the patient sample. The analysis yielded 10 clinically coherent adolescent personality descriptions organized into 3 higher-order clusters (internalizing, externalizing, and borderline-dysregulated). We also obtained a higher-order personality strengths factor. These factors and clusters strongly resembled but were not identical to factors similarly identified in adult patients. In a second, independent sample from an intensive day treatment facility, 2 clinicians (the patients' treating clinician and the medical director) independently completed the SWAP-II-A, the Child Behavior Checklist (CBCL), and a measure of adaptive functioning. Two additional clinicians, blinded to the data from the first 2 clinicians, independently rated patients' ward behavior using a validated measure of interpersonal behavior. Clinicians diagnosed the personality syndromes with high agreement and minimal comorbidity among diagnoses, and SWAP-II-A descriptions strongly correlated in expected ways with the CBCL, adaptive functioning, and ward ratings. The results support the importance of personality diagnosis in adolescents and provide an approach to diagnosing adolescent personality that is empirically based and clinically useful.

Diagnosing antisocial behavior and psychopathy

Purpose– Psychopathy and antisocial personality are controversial disorders with alternate behavioral and dynamic formulations. As such, diagnostic approaches are often fragmentary and inconsistent. The purpose of this paper is to delineate the various conceptual parameters and to propose a comprehensive diagnostic approach.Design/methodology/approach– A model is presented based on the congruence and differences among various categories of psychopathic and antisocial personality disorders and their clinical manifestations. Diagnostic approaches are critiqued and evaluated. Specific assessment tools and measures are recommended based on referrals and symptomatology.Findings– Key factors of low frustration tolerance, poor social intelligence, aggression-driven psychopathy, sadism, and superego impairment are shown as central in the differential diagnostics of antisocial individuals.Originality/value– The model enables the differentiation of problematic behaviors which may appear similar but require different forensic, legal, diagnostic, and intervention strategies.

The Validity and Clinical Utility of Structured Diagnoses of Antisocial Personality Disorder With Forensic Patients

Current DSM-based instruments for personality disorders (PDs) limit the investigation of the course and outcome of treatment of these disorders. This study examined the validity of the Shedler-Westen Assessment Procedure-200 (SWAP-200) and the Structured Clinical Interview for DSM-IV Axis II PD (SCID-II) in a sample of forensic PD patients. Results based on 66 participants indicated that the SWAP-200 Q-factors reduced the frequency of diagnostic comorbidity of PD categories by half compared with the SCID-II. Only the SWAP-200's Antisocial PD category showed good convergent and discriminant validity with respect to other instruments describing aspects of PD. The validity of the cutoff score for severe antisocial PD was confirmed, and this category predicted severe incidents in the hospital at 1 year of follow-up. A violence risk scale was constructed, which differentiated violent and nonviolent offenders. The results support the validity of the SWAP-200 and its potential clinical utility with forensic PD patients.

Time to choose – DSM-5, ICD-11 or both?

Abstract: DSM-5 was published in May 2013, and ICD 11 is not due to be published until the end of 2015 at the earliest. Nevertheless, it is possible to make a comparison at this early stage as much of the main decisions have been made with both classifications. DSM-5 aimed to make a paradigm shift by providing objective, independent measures of classification, but in this respect it clearly failed. It did respond to previous criticisms that there were too many diagnoses in the classification and that eliminated some conditions in favour of larger groupings (eg, autism spectrum disorder), but it has still come in for heavy criticism. ICD 11 deviates from DSM-5 in radically different classifications of personality and stress disorders and in general has pursued a different pathway, concentrating on clinical utility as the main guide to the classification. It is up to practitioners to choose which they prefer, but ICD 11 will be in a much stronger position than ICD 10 was when it was published in 1992.

A Review of the Measures Designed to Assess DSM-5 Personality Disorders

The definition, classification and assessment of personality disorders (PDs) have attracted considerable debate for nearly 50 years. This paper attempts a comprehensive review of the instruments to assess all, or specific, individual disorders as described in DSM-5, including structured interviews and inventories. The review should be helpful for clinicians, researchers and also industrial and organizational psychologists, to screen and assess the personality pathology spectrum from subclinical manifestations to full blown personality pathology. A decision tree helpful to choose among the different measures is also provided.

Introduction to the Special Section on the Personality Psychopathology Five (PSY–5) and DSM–5 Trait Dimensional Diagnostic Systems for Personality Disorders: Emerging Convergence

In this Special Section, 7 studies focusing on the PSY–5 model of individual differences relevant to adaptive functioning are presented. The first study by Harkness, McNulty, et al. (this issue) describes the development of the revised PSY–5 scales for the MMPI–2–RF, followed by another article by Harkness, Reynolds, and Lilienfeld (this issue) arguing for the adoption of a review of systems strategy for evaluating psychological functioning. McNulty and Overstreet (this issue) describe an alternative hierarchical strategy for organizing the interpretation of the MMPI–2–RF using the PSY–5 scales. Extending the PSY–5 model to adolescents, Veltri et al. (this issue) examine the convergent and discriminant validity of the MMPI–A PSY–5 in predicting violent delinquent behavior. Bagby and colleagues (this issue) examine the hierarchical structure of the PSY–5 model across nonclinical and clinical samples and, with a few notable exceptions, find the PSY–5 model to map well onto the DSM–5 personality trait dimensional model. Finn, Arbisi, Erbes, Polusny, and Thuras (this issue) examine the convergence between the DSM–5 proposed trait dimensions and PSY–5 model demonstrating the potential for the MMPI–2–RF PSY–5 scales to serve as a bridge between DSM–5 and DSM–IV personality disorder diagnoses. Finally, Sellbom, Smid, de Saeger, Smit, and Kamphuis(this issue) directly examine the convergence of MMPI–2–RF PSY–5 scales with DSM–IV personality disorder categories and proposed DSM–5 trait dimensions further establishing the potential for the PSY–5 scales to serve as a bridge between DSM categorical and dimensional diagnostic schemas.

Antisocial Personality Disorder: A Current Review

The Diagnostic and Statistical Manual of Mental Disorders (DSM 5) classification of antisocial personality disorder (ASPD) describes individuals who engage in repetitive irresponsible, delinquent, and criminal behavior. The diagnosis is highly controversial, with many researchers and clinicians arguing that the category is too heterogeneous, overinclusive, and demonstrates considerable overlap with other disorders. This review focuses on recent studies that have improved our understanding of the characteristics of individuals who fit the ASPD definition by exploring how subtypes differ and how comorbid conditions influence the presentation of ASPD. In addition, we discuss research on the etiology of ASPD that has identified genetic and environmental factors that may contribute to the development and persistence of antisocial behavior, and brain imaging research that has improved our understanding of the relationships between ASPD and other psychopathology. Finally, we discuss promising preliminary research on treatment for this disorder.

Prevalence of aggressive challenging behaviours in intellectual disability and its relationship to personality status: Jamaican study

Both the classification of personality disorder in intellectual disability (ID) and its identification in practice are deemed to be difficult. A simpler approach to classification and its relationship to challenging behaviours were tested in an adult Jamaican population with ID. The study was carried out in Kingston, Jamaica, as part of a programme of field trials to determine the utility of the proposed revision of personality disorders in the 11th Revision of the International Classification of Diseases (ICD-11), in a population of adults with ID living with their families or in supported care homes. Thirty-eight people with borderline (n = 5), mild (n = 16), moderate (n = 14) and severe (n = 3) ID were assessed at face-to-face interview and with relatives or staff using the provisional criteria for severity of personality disorder and its associated domain traits, and challenging behaviour was assessed using the Problem Behaviour Check List (PBCL) (a 5-point, 7-item scale). Using the severity scale 18 patients (47%) had no personality disorder, 7 (18%) had personality difficulty, 9 (24%) had mild personality disorder, and 4 (11%) had moderate personality disorder. None of the sample had severe personality disorder in which there is high risk of harm to self or others. Of the four major trait domains, provisionally named anankastic, detached, emotional and dissocial, three were evenly distributed in those with personality disturbance with the antagonistic (antisocial) trait less commonly shown (6 only). Scores on the PBCL were higher in those with increasing severity of personality disorder (P = 0.03) and those in the antagonistic personality trait domain had the highest PCL scores. Despite previous difficulties in assessing personality disorder in intellectual difficulties the ICD-11 classification was easy to administer in practice in this population, and the higher problem behaviour scores in those with greater severity of personality disturbance support its construct validity.

The Impact of Personality Disorders on Legally Supervised Community Treatment: A Systematic Literature Review

Mental health needs are common among community corrections offenders and many are enrolled in some form of supervised or mandated treatment. One category of mental health problem which may be germane to both treatment completion and recidivism among those in legally supervised treatment is the diagnosis of Personality Disorder (PD). This systematic review reports on sixteen studies comprised of full or mixed legally-supervised samples of offender in community-based treatment and examines the impact of PDs on treatment completion. These studies were difficult to compare because of the differences in program setting, definition of treatment completion, definition of PD, method of PD assessment and type of treatment, among other variables. The impact of antisocial personality disorder in treatment was a common focus, and other PDs were rarely assessed. The relevance of DSM PD categories to offender management in community corrections as well as the limitations of the current PD diagnostic categories is discussed.

Comparing Five Sets of Five–Factor Model Personality Disorder Counts in a Heterogeneous Sample of Psychiatric Patients

The research agenda for DSM–5 emphasizes the implementation of dimensional trait models into the classification of personality disorders (PDs). However, because assessment psychologists may still want to recover the traditional DSM–IV categories, researchers developed a count technique that uses sums of selected Five–Factor Model facets to assess the DSM–IV PDs. The presented study examined the convergent and divergent validity of different linear combinations of trait facets to describe specific DSM–IV PDs in a heterogeneous clinical sample (N = 155) with sufficient prevalence of all PDs, using semi–structured interviews to obtain all diagnostic information, and comparing alternative counts from five different sources for each PD. The results show that none of the schizotypal, antisocial, and dependent counts succeeded in combining good convergent with adequate divergent validity. However, the original counts could be optimized for five of the seven remaining PDs by using alternative Five–Factor Model prototypes. The diagnostic and taxonomic implications of these findings are discussed. Copyright © 2012 John Wiley & Sons, Ltd.

A perspective on the current issues in the DSM-5 classification of personality disorders

David Kupfer chaired the DSM-5 Task Force, and Andrew Skodol the working group, on personality disorders. Various initial propositions were posted on the Internet in 2010 for comment and discussion: new general definition, new criteria, new diagnostic procedures, reduction in the number of categories, and dimensional representation. Following numerous criticisms, the Task Force's final decisions were made public on December 1, 2012. Personality disorders now figure alongside other mental disorders, because of the deletion of Axis II. The methodology concerning personality traits is in a third section to promote new studies. The new proposed hybrid system has not, to date, proven better than the categories of the DSM-IV. These various decisions are commented upon.

Dimensional models of personality: the five-factor model and the DSM-5

It is evident that the classification of personality disorder is shifting toward a dimensional trait model and, more specifically, the five-factor model (FFM). The purpose of this paper is to provide an overview of the FFM of personality disorder. It will begin with a description of this dimensional model of normal and abnormal personality functioning, followed by a comparison with a proposal for future revisions to DSM-5 and a discussion of its potential advantages as an integrative hierarchical model of normal and abnormal personality structure.

Personality disorders and the prediction of alcohol use outcomes for women: Dimensional versus categorical classification

The impending shift in the fifth edition of Diagnostic and Statistical Manual of Mental Disorders from categorical to a hybrid categorical-dimensional diagnosis scheme has generated considerable interest in the relative merits of these respective approaches. This is particularly true for the diagnostically complex category of personality disorders (PDs). The present study assessed whether categorical or dimensional measures better predicted alcohol consumption in a sample of 102 women enrolled in a clinical trial comparing individual cognitive behavioral therapy (CBT) to conjoint CBT for alcohol use disorders (AUDs). Linear regression was used to evaluate whether each PD diagnosis (categorical), or the number of PD symptoms endorsed per PD (dimensional) better predicted percent days drinking over the course of six months of treatment. PD criteria (dimensional) better predicted drinking for Paranoid, Borderline, and Obsessive-Compulsive PDs, while diagnosis (categorical) was a better predictor only for passive-aggressive PD. Both schemes predicted drinking outcomes for avoidant, dependent, and depressive PDs, and neither was predictive for narcissistic PD. These findings suggest that the addition of a dimensional approach for PDs potentially enhances the prediction of alcohol use outcomes.

Combining Interpersonal and Intrapersonal Perspectives on Personality Pathology: A Commentary on Hopwood et al.

Sometimes the limitations of a conceptual framework or classification system are illuminated not by the nature of the criticisms leveled at it, but by who is doing the criticizing. Such has been the case with the personality disorder (PD) symptoms and categories in DSM-IV (American Psychiatric Association [APA], 1994) and DSM-IV-TR (APA, 2000). Behaviorists, psychoanalysts, trait theorists, cognitive researchers, and humanistic psychologists agree on very little, but they are of one mind in disliking the current framework for conceptualizing and diagnosing PDs. Problems with the extant DSM conceptualization of PDs have been documented extensively. Among the major limitations noted by clinicians and clinical researchers are excessive PD overlap and comorbidity, and reliance on a threshold model of PD diagnosis that is inconsistent with a plethora of research demonstrating that personality dysfunction exists on a continuum of severity, with no sharp cutoff distinguishing normality from pathology. Critics have also noted the difficulties that stem from heterogeneity within PD categories and the equal weighting of different PD symptoms even when these symptoms contrast sharply with respect to pathognomonic value (see Huprich & Hopwood, 2013, for reviews of limitations in extant PD models). Accompanying these criticisms has come a diverse array of proposed solutions—alternative frameworks for conceptualizing and diagnosing personality pathology. These include the formal proposal offered by the DSM-5 Personality and Personality Disorders (PPD) Work Group (see Skodol, 2012), and the Personality (P) Axis of the Psychodynamic Diagnostic Manual (Alliance of Psychoanalytic Organizations, 2006). Other prominent alternatives include trait-based frameworks (e.g., Krueger, Derringer,

Levels of Personality Functioning and Their Association With Clinical Features and Interpersonal Functioning in Patients With Personality Disorders

Recently, the DSM-5 Personality and Personality Disorders Work Group has proposed a multiple level approach toward the classification and diagnosis of personality disorders (PDs), with the first level entailing a rating of impairments in levels of personality functioning. Although a number of measures that assess levels of personality functioning have been validated, given its prominent status in the DSM-5 proposal and contemporary theories of personality pathology, the Work Group has called for more research in this area (e.g., Bender, Morey, & Skodol, 2011). In response to this call, this study investigates the relationship between two major, well-validated dimensional measures of levels of personality functioning, that is, the Differentiation-Relatedness Scale (DR-S; Diamond, Blatt, Stayner, & Kaslow, 1991), as scored on the Object Relations Inventory (ORI; Blatt, Wein, Chevron, & Quinlan, 1979), and the Inventory of Personality Organization (IPO; Lenzenweger, Clarkin, Kernberg, & Foelsch, 2001), a self-report instrument, and their relationship with different measures of clinical and interpersonal functioning in 70 patients with a PD. First, results showed that higher levels of differentiation and relatedness of descriptions of self and significant others, and of the self in particular, were negatively related to indices of personality functioning as assessed by the IPO. Lower levels of personality functioning, as measured with both the DR-S and the IPO, were positively related to severity of depression, symptomatic distress, self-harm, and interpersonal problems. Finally, results showed that the DR-S and the IPO independently predicted clinical features and interpersonal functioning. Hence, this study lends further support for the concurrent and predictive validity of the DR-S and the IPO in assessing levels of personality functioning. However, more research concerning the validity of these measures in assessing levels of personality functioning is needed. Suggestions for further research are formulated.

The Psychometric Properties of the Personality Inventory for DSM-5 in an APA DSM-5 Field Trial Sample

Section 3 of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes a hybrid model of personality pathology, in which dimensional personality traits are used to derive one of seven categorical personality disorder diagnoses. The Personality Inventory for DSM-5 (PID-5) was developed by the DSM-5 Personality and Personality Disorders workgroup and their consultants to produce a freely available instrument to assess the personality traits within this new system. To date, the psychometric properties of the PID-5 have been evaluated primarily in undergraduate student and community adult samples. In the current investigation, we extend this line of research to a psychiatric patient sample who participated in the APA DSM-5 Field Trial (Centre for Addiction and Mental Health site). A total of 201 psychiatric patients (102 men, 99 women) completed the PID-5 and the Revised NEO Personality Inventory (NEO PI-R). The internal consistencies of the PID-5 domain and facet trait scales were acceptable. Results supported the unidimensional structure of all trait scales but one, and the convergence between the PID-5 and analogous NEO PI-R scales. Evidence for discriminant validity was mixed. Overall, the current investigation provides support for the psychometric properties of this diagnostic instrument in psychiatric samples.

Refining personality disorder subtypes and classification using finite mixture modeling.

The current Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic system for Axis II disorders continues to be characterized by considerable heterogeneity and poor discriminant validity. Such problems impede accurate personality disorder (PD) diagnosis. As a result, alternative assessment tools are often used in conjunction with the DSM. One popular framework is the object relational model developed by Kernberg and his colleagues (J. F. Clarkin, M. F. Lenzenweger, F. Yeomans, K. N. Levy, & O. F. Kernberg, 2007, An object relations model of borderline pathology, Journal of Personality Disorders, Vol. 21, pp. 474-499; O. F. Kernberg, 1984, Severe Personality Disorders, New Haven, CT: Yale University Press; O. F. Kernberg & E. Caligor, 2005, A psychoanalytic theory of personality disorders, in M. F. Lenzenweger & J. F. Clarkin, Eds., Major Theories of Personality Disorder, New York, NY: Guilford Press). Drawing on this model and empirical studies thereof, the current study attempted to clarify Kernberg's (1984) PD taxonomy and identify subtypes within a sample with varying levels of personality pathology using finite mixture modeling. Subjects (N = 141) were recruited to represent a wide range of pathology. The finite mixture modeling results indicated that 3 components were harbored within the variables analyzed. Group 1 was characterized by low levels of antisocial, paranoid, and aggressive features, and Group 2 was characterized by elevated paranoid features. Group 3 revealed the highest levels across the 3 variables. The validity of the obtained solution was then evaluated by reference to a variety of external measures that supported the validity of the identified grouping structure. Findings generally appear congruent with previous research, which argued that a PD taxonomy based on paranoid, aggressive, and antisocial features is a viable supplement to current diagnostic systems. Our study suggests that Kernberg's object relational model offers a plausible substantive aid in refining PD classification.

The General Assessment of Personality Disorder (GAPD): Factor Structure, Incremental Validity of Self-Pathology, and Relations to DSM–IV Personality Disorders

Recent developments in the classification of personality disorder, especially moves toward more dimensional systems, create the need to assess general personality disorder apart from individual differences in personality pathology. The General Assessment of Personality Disorder (GAPD) is a self-report questionnaire designed to evaluate general personality disorder. The measure evaluates 2 major components of disordered personality: self or identity problems and interpersonal dysfunction. This study explores whether there is a single factor reflecting general personality pathology as proposed by the Diagnostic and Statistical Manual of Mental Disorders (5th ed.), whether self-pathology has incremental validity over interpersonal pathology as measured by GAPD, and whether GAPD scales relate significantly to Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM–IV]) personality disorders. Based on responses from a German psychiatric sample of 149 participants, parallel analysis yielded a 1-factor model. Self Pathology scales of the GAPD increased the predictive validity of the Interpersonal Pathology scales of the GAPD. The GAPD scales showed a moderate to high correlation for 9 of 12 DSM–IV personality disorders.

Personality disorders in a community sample in Turkey: Prevalence, associated risk factors, temperament and character dimensions

Data from Turkey on prevalence of personality disorders (PD) in the normal population are sparse. The present study conducted in a community sample aimed to investigate personality disorders in terms of prevalence, associated risk factors and personality dimensions. A stratified sampling procedure allowed us to compose a sample consisting of 774 participants residing in Aydin, Turkey. The DSM-IV and ICD-10 Personality Questionnaire (DIP-Q) and the Temperament and Character Inventory (TCI) were used to assess PDs and personality dimensions, respectively. Roughly 20% of the participants received a PD diagnosis. Among the individual PD categories, schizotypal and obsessive-compulsive PDs were the most prevalent diagnoses. Participants with PD were more likely to have lower [corrected] self-directedness and cooperativeness scores. These risk factors and personality dimensions were most strongly associated with the cluster B disorders. New versions of the diagnostic systems should include schizotypal, obsessive-compulsive and cluster B PDs as separate diagnostic categories, and impaired self-directedness as well as cooperativeness as a general diagnostic criterion for the sake of backward and forward compatibility of the research in this field.