Dimensional Model Of Personality Pathology Research Articles

Examining the Validity of the Levels of Personality Functioning Questionnaire for Adolescents Aged 12-18 (LOPF-Q 12-18): A Replication and Extension With a Sample of Lithuanian Adolescents.

With the shift to the dimensional model of personality pathology, the need for measures assessing personality functioning in adolescence has emerged. The Levels of Personality Functioning Questionnaire 12-18 (LoPF-Q 12-18) was developed specifically for adolescents, tailoring the Alternative Model of Personality Disorders in the DSM-5. Using the Lithuanian LoPF-Q 1218, we further investigate its validity by reexamining its factorial structure and extending convergent, discriminant, and incremental validity analyses. A total of 1,048 community-based and clinically referred 12-18-year-old adolescents completed the LoPF-Q 12-18 along with other self-report measures of personality pathology, psychopathological symptoms, and psychosocial functioning. In line with previous findings, the results supported the bifactor model consisting of a strong general factor and little multidimensionality caused by the group factors, overall suggesting an essentially unidimensional structure. Further analyses provided additional information on the construct validity of the LoPF-Q 12-18.

The Influence of Personality Functioning and Pathological Traits on the Mental Well-being of Older Persons with Personality Disorders

Background:Why should you pay attention to personality pathology in geriatric psychiatry? To what extent is mental well-being determined by this? How does that relate to the influence of mental disorders? Does the Alternative Dimensional Model of Personality pathology (AMPD) as proposed by the DSM-5 provide more insight into this than the DSM-IV and DSM-5 categorical diagnoses of personality disorders?Method:These questions were examined in baseline data of 145 patients included in our randomized controlled trial (RCT) into group Schema therapy enriched with psychomotor therapy in older patients with a personality disorder (see Oude Voshaar in this symposium). Mental well-being was measured by a combination of psychological distress (53-item Brief Symptom Inventory), positive mental health (Warwick-Edinburgh Mental Well-being Scale), assessment of own health (RAND-36), and satisfaction with life (Cantrill’s ladder). Personality pathology was assessed according to the categorical personality model using the Structured Clincal Interview for Personality Disorder (SCID-II) as well as the AMDP DSM-5 model using the Severity Indices of Personality Problems (SIPP-short form) and the Personality Iventory for DSM-5 (PID-25). The relationship between personality pathology and mental well-being was investigated using multivariate regression analysis.Results:Three quarters of the included people with a personality disorder also had another psychiatric disorder (beyond personality pathology). However, personality pathology was found to be responsible for the bulk of the mental health burden and outweighed the influence of these psychiatric disorders. Personality dimensions were highly predictive of mental well-being. This contrasted with the absence of any influence from categorical personality disorders. Although dimensions of personality functioning – and in particular Identity Integration – were the primary predictors of mental well-being, pathological traits added significant predictive value (particularly Disinhibition and Negative Affectivity).Conclusions:Personality pathology seriously affects the mental well-being of patients and exceeds the impact of comorbid psychiatric disorders. Contrary to the assumption in the alternative DSM-5 and ICD-10 model, both personality functioning and pathological traits contribute to this impact on mental well-being. Screening and systematic assessment of personality pathology in geriatric psychiatry seems warranted.

The Co-occurrence of Personality Disorders and Substance Use Disorders.

Despite significant negative outcomes, the co-occurrence of personality disorders (PDs) and substance use disorders (SUDs) continues to be underrecognized, and the mechanisms contributing to this co-occurrence remain unclear. This review summarizes recent work on PD-SUD co-occurrence, with a focus on borderline and antisocial PDs, general substance use patterns among those with PDs, and the association of personality traits with SUDs. The prevalence of co-occurring PD-SUD is generally high, with estimates ranging depending on the type of PD and SUD, the population assessed, and the sampling methods and measures used. Current theoretical explanations for co-occurrence include shared etiology and predisposition models, with research highlighting the importance of transactional processes. Potential underlying mechanisms include personality traits and transdiagnostic characteristics. Recent research has increased focus on substances besides alcohol, dimensional models of personality pathology, and transactional explanations of co-occurrence, but more research is needed to disentangle the nuanced PD-SUD relationship.

Operationalizing intimacy and identity aspects of personality functioning in relation to personality disorder in adolescents.

According to dimensional models of personality pathology, deficits in interpersonal (intimacy and empathy) and self (identity and self-direction) function (Criterion A) are core to all personality disorders. These aspects of personality functioning (Criterion A) have seldom been evaluated for how they might relate to one another in the context of personality pathology in adolescents. Moreover, the use of performance-based measures to evaluate aspects of Criterion A function remains an untapped resource. Therefore, the present study aimed to evaluate relations between two features of Criterion A, maladaptive intimacy and maladaptive (or diffused) identity, in adolescence. For intimacy, we leverage a performance-based approach to studying intimacy, operationalized in a developmentally relevant way (perceived parental closeness). For identity, we rely on a validated self-report measure of identity diffusion. We examined the relationship between these features with each other and their relations with borderline features. Additionally, we explored whether identity diffusion mediated the expected relationship between perceived parental closeness and borderline features. We hypothesized that greater distance in perceived parental closeness would be associated with higher levels of borderline features, as well as higher levels of identity diffusion, and that identity diffusion would account for the relationship between intimacy and personality pathology. The sample included 131 inpatient adolescents (M age = 15.35, 70.2% female). Results indicated that intimacy, operationalized as perceived parental closeness, with both mothers and fathers was significantly associated with levels of identity diffusion and borderline features. In addition, greater feelings of closeness with parents were associated with lower severity of borderline features via healthier identity function. Implications of the results, limitations, and future directions are discussed.

Mapping a hierarchical dimensional structure of high experiential permeability: A bass-ackward approach to linking positive schizotypy and openness to experience.

Research on dimensional models of personality pathology has achieved a good deal of consensus on the 5 broad constructs that span adaptive and maladaptive personality traits. Nonetheless, connections between the 5th domain, typically called openness to experience within general personality measures and psychoticism or schizotypy on maladaptive measures, have proven more challenging to integrate. Using experiential permeability as a guiding framework, the current study seeks to develop a hierarchical, empirically derived lower order structure with these concepts. Using a top-down "Bass-Ackward" approach, we examined the item-level structure of adaptive and maladaptive components of high experiential permeability. Results showed support for a hierarchical model with a 6-component solution including mystical beliefs/experiences, oddity, intellect, openness to aesthetics, openness to ideas, and introspection. These components from items drawn from general and maladaptive measures related to one another within and across levels, specifically oddity and openness to aesthetics. Findings also highlight the importance of using lower level analyses when examining larger, heterogeneous constructs such as schizotypal thinking and perception and openness. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Malignant Self-Regard: Overview and Future Directions.

Malignant self-regard (MSR) is a self-representation that encompasses the shared features of depressive personality disorder, masochistic/self-defeating personality disorder, depressive-masochistic personality, and vulnerable narcissism. In this review we begin by describing the construct's historical precursors, which begin in early psychoanalytic/dynamic theory, and then trace its development across iterations of the Diagnostic and Statistical Manual of Mental Disorders. Special attention is paid to differentiating MSR from vulnerable narcissism. We then consider MSR's place within transdiagnostic, transtheoretical, and dimensional models of personality pathology. We focus heavily on MSR's impact on various personality systems (e.g., thought and affect systems) and also on overall personality functioning. The empirical research on MSR in relation to these systems is thoroughly reviewed and largely supports its psychometric properties and clinical significance. We suggest that MSR may map onto the distress subfactor in the hierarchical taxonomy of psychopathology (HiTOP) and that MSR seems to occupy the shared internalizing space across the neurotic and borderline level of personality organization in Kernberg's model of personality disorders. We also identify four major directions for future research: the possible benefits of self-defeating tendencies that involve pathological narcissism and self-esteem; MSR's relationship to overall health and well-being; depressive states and MSR severity; and how MSR fits within the Alternative Model for Personality Disorders and the personality disorder framework of the International Classification of Diseases.

Stability and consistency of maladaptive personality domains across multiple admissions to an acute care setting.

Personality has recently been positioned as one overarching framework for conceptualizing psychopathology. Further, the DSM-5 put forth an alternative dimensional model of personality pathology which includes measurement of maladaptive personality domains. Few studies have examined the stability of maladaptive personality scores, and even fewer have done so using clinical samples not characterized by the diagnosis of personality disorder. The goal of the current study, therefore, was to examine the extent to which individual ratings of maladaptive personality were stable across multiple presentations in a clinically acute setting. Using a large sample of patients who repeatedly presented-between 2 and 4 times-for treatment at a partial hospital program (N = 482), we assessed the extent to which their scores on the Personality Inventory for DSM-5, Brief Form (PID-5 BF), differed across subsequent admissions. Results indicated that across admissions, individuals showed little differences in scores on the PID-5 BF across time, in either rank-order stability, or mean level differences. In addition, though previous scores predicted subsequent admission scores of the same maladaptive personality domains, there were few between-domain temporal associations. These results suggest that DSM-5 personality pathology domains appear highly stable and consistent over time. In addition, these findings bear implications for the continued understanding of how maladaptive personality is associated with both personality and nonpersonality psychopathology. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Relational Aggression and Narcissistic Traits: How Youth Personality Pathology Informs Aggressive Behavior.

Low agreeableness features centrally in personality profiles of Cluster B personality disorder (PD) diagnoses, and it has been associated with relational aggression (RAgg; intentionally damaging others' social relationships). Researchers have hypothesized that RAgg may be a potential developmental precursor for Cluster B PDs. However, a dimensional approach to personality dysfunction is preferable to the categorical system found in the current diagnostic manual. To build a bridge between two disjointed literatures (categorical PDs and RAgg), the aim of this project is to detail how RAgg in youth is situated in the trait space represented by disagreeableness in a dimensional model of personality pathology. Caregivers of 911 youth (ages 6-18) reported on youth's RAgg and disagreeableness. We found that RAgg was most strongly related to three facets: Narcissistic traits, Hyperexpressive traits, and Dominance-Egocentrism traits. Overall, these findings provide support for RAgg as an early manifestation of personality pathology, particularly for narcissistic traits.

Moving beyond categories and dimensions in personality pathology assessment and diagnosis.

It has been suggested that a dimensional model of personality pathology should be adopted for the development and refinement of personality disorder classification. In this article, the advantages and challenges of moving toward a dimensional model are briefly reviewed. However, it is suggested that although categories and dimensions are valuable frameworks for personality pathology diagnosis, an expansion beyond categories and dimensions is needed to improve the shortcoming seen in current diagnostic systems. Ideas and examples are offered for how this might occur.Declaration of interestNone.

The Association between DSM-5 Personality Pathology Traits and Violence

The recently published DSM-5 included a dimensional model of personality pathology, which includes pathological traits. This model is a response to the many criticisms and problems documented with the traditional categorical modal of personality disorders. To date, numerous studies have demonstrated that the trait model is more valid and reliable than the traditional categorical model (Krueger and Markon 2013). This study expands research on the trait model by assessing the association between the DSM-5 traits and propensity for, or attitudes about, violence.

The Association between DSM-5 Personality Pathology Traits and Violence

The recently published DSM-5 included a dimensional model of personality pathology, which includes pathological traits. This model is a response to the many criticisms and problems documented with the traditional categorical modal of personality disorders. To date, numerous studies have demonstrated that the trait model is more valid and reliable than the traditional categorical model (Krueger and Markon 2013). This study expands research on the trait model by assessing the association between the DSM-5 traits and propensity for, or attitudes about, violence.

The Association between DSM-5 Personality Pathology Traits and Violence

The recently published DSM-5 included a dimensional model of personality pathology, which includes pathological traits. This model is a response to the many criticisms and problems documented with the traditional categorical modal of personality disorders. To date, numerous studies have demonstrated that the trait model is more valid and reliable than the traditional categorical model (Krueger and Markon 2013). This study expands research on the trait model by assessing the association between the DSM-5 traits and propensity for, or attitudes about, violence.

Ten aspects of the Big Five in the Personality Inventory for DSM-5.

Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) includes a dimensional model of personality pathology, operationalized in the Personality Inventory for DSM-5 (PID-5), with 25 facets grouped into 5 higher order factors resembling the Big Five personality dimensions. The present study tested how well these 25 facets could be integrated with the 10-factor structure of traits within the Big Five that is operationalized by the Big Five Aspect Scales (BFAS). In 2 healthy adult samples, 10-factor solutions largely confirmed our hypothesis that each of the 10 BFAS would be the highest loading BFAS on 1 and only 1 factor. Varying numbers of PID-5 scales were additional markers of each factor, and the overall factor structure in the first sample was well replicated in the second. Our results allow Cybernetic Big Five Theory (CB5T) to be brought to bear on manifestations of personality disorder, because CB5T offers mechanistic explanations of the 10 factors measured by the BFAS. Future research, therefore, may begin to test hypotheses derived from CB5T regarding the mechanisms that are dysfunctional in specific personality disorders.

Pathological personality traits modulate neural interactions

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), includes an empirically supported dimensional model of personality pathology that is assessed via the Personality Inventory for the DSM-5 (PID-5). Here we used magnetoencephalography (MEG; 248 sensors) to evaluate resting-state neural network properties associated with the five primary DSM-5 maladaptive personality domains (negative affect, detachment, antagonism, disinhibition, and psychoticism) in 150 healthy veterans ("control" group) and 179 veterans with various psychiatric disorders ("psychopathology" group). Since a fundamental network property is the strength of functional connectivity among network elements, we used the absolute value of the pairwise correlation coefficient (aCC) between prewhitened MEG sensor time series as a measure of neural functional connectivity and assessed its relations to the quantitative PID-5 scores in a linear regression model, where the log-transformed aCC was the dependent variable and individual PID scores, age, and gender were the independent variables. The partial regression coefficient (pRC) for a specific PID-5 score in that model provided information concerning the direction (positive, negative) and size (absolute value) of the PID effect on the strength of neural correlations. We found that, overall, PID domains had a negative effect (i.e., negative pRC; decorrelation) on aCC in the control group, but a positive one (i.e., positive pRC; hyper-correlation) in the psychopathology group. This dissociation of PID effects on aCC was especially pronounced for disinhibition, psychoticism, and negative affect. These results document for the first time a fundamental difference in neural-PID relations between control and psychopathology groups.

Does a latent class underlie schizotypal personality disorder? Implications for schizophrenia.

Despite growing enthusiasm for dimensional models of personality pathology, the taxonic versus dimensional status of schizotypal personality disorder (PD) remains a point of contention in modern psychiatry. The current study aimed to determine empirically the latent structure of schizotypal PD. We examined the latent structure of schizotypal PD in the Psychiatric Morbidity Survey in Great Britain and the second wave of the U.S.-based National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) survey. We analyzed composite indicators created from participant responses using the mean above minus mean below a cut (MAMBAC), Maximum Covariance (MAXCOV), and latent mode factor analysis (L-Mode) taxometric procedures. We also analyzed item-level responses using two latent variable mixture models--latent class analysis and latent class factor analysis. Taxometric and latent variable mixture analyses supported a dimensional, rather than taxonic, structure in both epidemiological samples. The dimensional model better predicted psychosis, intellectual functioning, disability, and treatment seeking than the categorical model based on DSM-IV diagnosis. People meeting criteria for schizotypal PD appear to exist on a spectrum of severity with the rest of the population. The possible dimensionality of schizotypal PD adds to growing support for a dimensional structure of PDs including other Cluster A disorders.

Characterizing Psychopathy Using DSM-5 Personality Traits

Despite its importance historically and contemporarily, psychopathy is not recognized in the current Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revised (DSM-IV-TR). Its closest counterpart, antisocial personality disorder, includes strong representation of behavioral deviance symptoms but weak representation of affective-interpersonal features considered central to psychopathy. The current study evaluated the extent to which psychopathy and its distinctive facets, indexed by the Triarchic Psychopathy Measure, can be assessed effectively using traits from the dimensional model of personality pathology developed for DSM-5, operationalized by the Personality Inventory for DSM-5 (PID-5). Results indicate that (a) facets of psychopathy entailing impulsive externalization and callous aggression are well-represented by traits from the PID-5 considered relevant to antisocial personality disorder, and (b) the boldness facet of psychopathy can be effectively captured using additional PID-5 traits. These findings provide evidence that the dimensional model of personality pathology embodied in the PID-5 provides effective trait-based coverage of psychopathy and its facets.

Grandiose and Vulnerable Narcissism and the DSM–5 Pathological Personality Trait Model

The Diagnostic and Statistical Manual of Personality Disorders (4th ed., American Psychiatric Association, 2000) personality disorders (PDs) that will be included in the DSM–5 will be diagnosed in an entirely different manner; the explicit criterion sets will be replaced with impairments in self and interpersonal functioning and personality traits from a 25-trait dimensional model of personality pathology. From a trait perspective, narcissistic personality disorder (NPD), the focus of this study, is assessed using 2 specific traits: grandiosity and attention seeking. Using a sample collected online from Amazon's Mechanical Turk (MTurk; N = 306), we examined the relations among traits from a new measure of DSM–5's trait model—the Personality Inventory for DSM–5 (PID5; Krueger, Derringer, Markon, Watson, & Skodol, in press)—and grandiose and vulnerable narcissism. The 25 traits from PID5 captured a significant portion of the variance in grandiose and vulnerable factors, although the 2 specific facets designated for the assessment of NPD fared substantially better in the assessment of grandiose rather than vulnerable narcissism. These results are discussed in the context of improving the DSM–5's ability to capture both narcissism dimensions.

Where is multidimensional perfectionism in DSM-5? A question posed to the DSM-5 personality and personality disorders work group.

A radical reworking of Axis II has been proposed for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders whereby personality disorder categories will be replaced by a trait dimensional model of personality pathology. Perfectionism is specified as a lower order facet of Compulsivity within this proposed model. This marginalization of the perfectionism construct is inconsistent with the empirical literature that suggests that perfectionism is an important dimension of maladaptive personality in its own right, complete with its own set of more specific lower order facets. Further, perfectionism in the current proposed system is relevant only to the characterization of the obsessive-compulsive personality disorder type, despite compelling empirical research that demonstrates that various dimensions of perfectionism are differentially associated with personality pathology of all kinds. The present article reviews existing research on the role of various dimensions of perfectionism in personality disorder, highlights these seemingly ignored areas of the perfectionism literature, and discusses the problems and consequences that will arise if perfectionism continues to be defined narrowly and is largely excluded from dimensional models of personality pathology.

Incremental validity of positive and negative valence in predicting personality disorder.

The Big Seven model of personality includes five dimensions similar to the Big Five model as well as two evaluative dimensions—Positive Valence (PV) and Negative Valence (NV)—which reflect extremely positive and negative person descriptors, respectively. Recent theory and research have suggested that PV and NV predict significant variance in personality disorder (PD) above that predicted by the Big Five, but firm conclusions have not been possible because previous studies have been limited to only single measures of PV, NV, and the Big Five traits. In the present study, we replicated and extended previous findings using three markers of all key constructs—including PV, NV, and the Big Five—in a diverse sample of 338 undergraduates. Results of hierarchical multiple regression analyses revealed that PV incrementally predicted Narcissistic and Histrionic PDs above the Big Five and that NV nonspecifically incremented the prediction of most PDs. Implications for dimensional models of personality pathology are discussed.

A meta‐analysis of psychopathy‐, antisocial PD‐ and FFM associations

This research meta‐analytically summarizes the relationships of the Five‐Factor Model (FFM) with psychopathy and Antisocial Personality Disorder (APD). Effect sizes of the associations between psychopathy, APD and the FFM were compiled from 26 independent samples (N = 6913) for psychopathy and 57 independent samples (N = 16 424) for APD. The results revealed predominantly points of similarity and some differences in the FFM associations of both disorders. Symptoms of psychopathy and APD were negatively associated with Conscientiousness and Agreeableness facets and positively with scores on Angry–Hostility (N2), Impulsiveness (N5), Excitement Seeking (E5) and negatively with Warmth (E1). Only psychopathy had a small negative association with Anxiety (N1) and was characterized by stronger negative associations with Agreeableness and Straightforwardness (A2), Compliance (A4) and Modesty (A5) compared to APD. The moderator analyses showed that sample type, use of the NEO‐PI‐R and APD instrument moderated the APD FFM associations, while psychopathy instrument and age group were moderators in the psychopathy MA. Implications of this research for the assessment of APD and psychopathy relying on dimensional models of personality pathology are discussed. Copyright © 2009 John Wiley & Sons, Ltd.