Maladaptive Personality Domains Research Articles

Clinical Utility and Diagnostic Validity of the Hierarchical Taxonomy of Psychopathology for Borderline Personality Disorder

Background: The hierarchical taxonomy of psychopathology (HiTOP) aims to address the limitations of traditional nosologies. This model organizes borderline personality disorder (BPD) along two dimensions: The distress sub-factor of negative affectivity and antagonism. Objectives: For the HiTOP model to be effectively integrated into clinical practice, its clinical utility must be established. This study aimed to assess the clinical utility and diagnostic validity of HiTOP in diagnosing BPD. Methods: This cross-sectional study included 113 inpatients with a primary diagnosis of BPD and 100 nonclinical individuals. The Structured Clinical Interview for diagnostic and statistical manual of mental disorders (DSM-5) Personality Disorders, Structured Clinical Interview for DSM-5-Screening Personality Questionnaire, Personality Inventory for DSM-5, and the Personality Assessment Inventory–Borderline Features Scale were used for BPD diagnosis and severity assessment. Multiple regression analyses were conducted on BPD-HiTOP-related and other maladaptive personality domains to identify the best predictive factors for BPD. Borderline personality disorder scales were created based on the regression algorithms. Receiver operating characteristic (ROC) analyses and diagnostic efficiency statistics were used to assess the relative diagnostic efficiency of these scales. Results: Regression analyses indicated that negative affectivity and disinhibition significantly predicted BPD severity, whereas antagonism did not. The ROC analysis demonstrated that both the HiTOP-BPD algorithm (antagonism/negative affectivity) and the proposed BPD algorithm (disinhibition/negative affectivity) showed excellent accuracy. Regarding diagnostic validity, the proposed BPD algorithm exhibited higher sensitivity and specificity levels compared to the HiTOP-BPD algorithm. Conclusions: These findings support the clinical utility of the disinhibition-negative affectivity algorithm in diagnosing BPD.

Physical multimorbidity in psychiatric patients with personality disorders: Insights within the ICD-11 framework

ObjectiveRecent research has revealed poor physical health among individuals with personality disorders (PDs). We aimed to compare chronic physical illnesses (CPI) and chronic physical multimorbidity (CPM) prevalence between the general population (GEP) and PD patients, and to explore the relationship between CPM and various aspects of PD, predominantly within the ICD-11 framework. MethodsThis cross-sectional study included 126 PD patients and 126 matched controls from the GEP. Patients were evaluated for the ICD-11 PD severity and maladaptive personality domains, subjective emptiness, and reflective functioning. CPI was assessed using a standardized self-report questionnaire. ResultsPD patients had a higher mean number of CPIs (2.05 vs. 1.02) and a more frequent CPM occurrence (49.2% vs. 26.2%) compared to the matched controls (p < .001). The ICD-11 PD severity (OR = 1.143, p = .007) and maladaptive domain Negative affectivity (OR = 4.845, p = .002), and poor reflective functioning (OR = 1.694, p = .007) were significant predictors of CPM, independent of sociodemographic, clinical and lifestyle factors. Negative affectivity showed the most robust effect on CPM, while smoking did not significantly mediate these relationships. ConclusionOur study found increased CPM burden in PD patients and a link between CPM and various PD aspects under the ICD-11 framework, highlighting the need for more integrated healthcare.

Intervening Effect of Maladaptive Personality on the Relationship Between Defense Styles and Psychiatric Symptoms Among Prisoners.

Prison settings are stress-inducing environments that make individuals more vulnerable to psychopathology. Defense styles and personality traits have long been associated with psychopathology. The current study aimed to explain the intervening role of maladaptive personality domains on the relationship between defense styles and psychiatric symptoms among male convicts imprisoned in nine Central Jails of Punjab, Pakistan. Through cross-sectional design, data was collected through purposive sampling. 509 respondents (who were serving their sentence for the crime committed) with a Mean age of 35 years (10.21) provided data on self-reported translated versions of the Cross-Cutting Symptoms Measure, Personality Inventory for DSM 5 - Adult version (Short Form), and Defense Style Questionnaire. Findings of the mediation analysis showed that negative affectivity, disinhibition, and psychoticism mediated the relationship between immature defense style and psychiatric symptoms whereas moderation analysis showed a significant interactional effect of antagonism with mature and neurotic defense style on psychiatric symptoms exclusively. Findings have highlighted that defense styles and certain personality domains intervene to have a combined indirect effect on psychiatric symptoms. The study also contributes to the literature by specifying the interactional effect of antagonism and mature defense style on predicting psychiatric symptoms.

Differentiation of Self and Interpersonal Functioning with the Level of Personality Functioning Scale – Brief Form 2.0

Research on Criterion A of the alternative model for personality disorders is recently expanding and provides mixed results concerning the unidimensional operational definition of severity by the model, characterized by impaired self (identity and self-direction) and interpersonal (empathy and intimacy) functioning. Studies resulted in one, as well as two or more factor structures. The present study demonstrated the importance of the structural and relational differentiation of self and interpersonal dimensions of personality functioning. One thousand seventy-four participants (community and clinical mixed sample) completed the Level of Personality Functioning Scale – Brief Form 2.0 (LPFS-BF 2.0), the Personality Inventory for DSM-5 Short Form and the Questionnaire for the World Health Organization Disability Assessment. An LPFS-BF 2.0 two-factor structure with self and interpersonal functioning factors was corroborated by confirmatory factor analyses and bifactor modeling. Joint Exploratory Factor Analysis of the LPFS-BF 2.0 domains with maladaptive personality domains clearly differentiated the personality functioning factors. While the self-functioning factor was more closely linked to negative affect (and to disinhibition and psychoticism), the interpersonal functioning factor connected to detachment. Self-functioning predicted functional impairment along and beyond personality domains. The LPFS-BF 2.0 appears a useful tool for clinical routine monitoring of both self and interpersonal functioning.

Is there a bias in the diagnosis of borderline personality disorder among racially minoritized patients?

Empirical evidence documents disparities in the diagnosis of severe forms of psychopathology among racial/ethnic minority persons. However, research on diagnostic differences in personality disorders is equivocal: Some suggest higher prevalence of personality disorders among racial/ethnic minority persons, whereas other results suggest the opposite. The goal of the current study was to investigate (a) differences in the diagnosis of borderline personality disorder (BPD) in a mostly cisgender, heterosexual sample among racial/ethnic minority patients compared with non-Hispanic White patients and (b) whether any observed differences were attributable to differences in underlying maladaptive personality domains. Using data from partial hospital patients (N = 2,657), we found few differences in the diagnosis of BPD based on racial/ethnic group membership. We also conducted measurement invariance analyses of the Personality Inventory for DSM-5-Brief Form (PID-5-BF), finding evidence of invariance across White and non-White participants in these data. Any instances of diagnostic disparity were explained by group differences in maladaptive personality domains. These results provide context to the extant literature documenting mixed results about racial/ethnic differences in prevalence of personality disorders. In addition, they suggest relative specificity in BPD diagnostic bias related to sexual minority populations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Maladaptive personality domains and crime related characteristics among convicts incarcerated in central jails of Pakistan

PurposeThis study aims to differentiate maladaptive personality domains through crime-related characteristics among convicts incarcerated in central jails of Punjab (CJP). In total, 552 respondents were taken from nine CJP.Design/methodology/approachData were collected through the Personality Inventory for Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 Short Form (PID-5 SF) (Maples et al., 2015), and forced-choice questions were designed to measure crime-related characteristics.FindingsConfirmatory factor analysis showed that PID-5 SF exhibited a good to excellent construct validity based on the DSM-5 criteria of using three facets to measure a domain (APA, 2013). Multivariate analysis showed that convicts who have committed different crime types and have criminal records exhibit different personality domains.Originality/valueIn addition to the literature, the data from all CJP, Pakistan, was collected and tested so that need for personality-oriented intervention could be identified for the prison setting. This also highlights that the usefulness of PID-5 SF is not only in identifying maladaptive personality among incarcerated convicts but also in differentiating between different crime-related characteristics.

Stalking perpetration through the lens of the alternative DSM-5 model for personality disorders.

Emerging dimensional models of personality disorders such as the Alternative DSM-5 Model for Personality Disorders (AMPD) provide new opportunities to explore the associations between personality pathology and harmful interpersonal behaviours such as stalking perpetration. Two goals are pursued by this study: (a) To document associations between stalking, level of personality pathology, and pathological personality domains/facets; and (b) to determine the relative importance of maladaptive personality facets in the statistical prediction of stalking. Data from 1489 young adults (18-30 years old) from a community sample were analysed. Moderate positive significant correlations were found between stalking, level of personality pathology, and maladaptive personality domains. A clear gradient of severity of stalking behaviours was found across five severity degrees of personality pathology. Dominance analyses revealed that Deceitfulness was the most dominant statistical predictor in women. Unusual Beliefs and Experiences, a facet from the Psychoticism domain, made an important contribution in the prediction of stalking in men only. Impulsivity was a key predictor in both genders but more markedly in men. Results suggest that the AMPD represents a useful framework to study stalking perpetration. Identification of key personality predictors might prove relevant for identifying risk factors, underlying motives, and treatment targets for stalking perpetrators.

The Personality Inventory for ICD-11 (PiCD): Reliability and Validity of the German Version in a Clinical and Non-Clinical Sample

The 11th version of the International Statistical Classification of Diseases and Related Health Problems (ICD-11) marks a paradigm shift in the diagnosis of personality disorders: In the near future, their classification will no longer be categorical, but dimensional along the severity of personality impairments and optionally regarding the presence of maladaptive personality traits. This study examines the reliability and validity of the German version of the Personality Inventory for ICD-11 (PiCD), a questionnaire designed to assess ICD-11 maladaptive personality domains, in a clinical and nonclinical sample (N=939). The factor structure of the PiCD was examined using Exploratory Factor Analysis (EFA) and showed a tendency for a four-factor model (Negative Affectivity, Dissociality, Detachment, and a bipolar factor Disinhibition-Anankastia). The subscales of the PiCD demonstrated acceptable to excellent reliability coefficients with Cronbach's α (0.79 - 0.89) and McDonald's ω (0.76 - 0.90). Convergent and discriminant validity were examined in conjunction with other questionnaires and were found to be satisfactory. The results suggest that the German version of the PiCD is a reliable and largely valid measurement instrument for assessing ICD-11 maladaptive personality traits. However, further research on factor structure, appropriate cut-off as well as norm values is needed.

The relationship between obsessive-compulsive spectrum disorders and DSM-5 dysfunctional personality domains in a nonclinical sample of Italian women.

To evaluate the usefulness of the DSM-5 maladaptive personality domains in explaining the similarities and differences among four disorders included in the obsessive-compulsive spectrum, 428 Italian community-dwelling women (mean age=31.96years, SD=12.30years) were administered the Obsessive-Compulsive Spectrum Disorder Scales and the Personality Inventory for DSM-5-Short Form as part of an ongoing online survey on women's health. Multiple Indicators Multiple Causes (MIMIC) confirmatory bifactor analysis results showed that the OCSD general factor (i.e., obsessive-compulsive spectrum factor) was positively associated with Negative Affectivity, whereas Body Dysmorphic Disorder (BDD), Hoarding Disorder (HD), and Skin-Picking Disorder (SPD) specific factors showed significant and substantial differential relationships with dysfunctional personality domains. Specifically, BDD was positively associated with Negative Affectivity, Detachment and Psychoticism domains; HD was associated with high Negative Affectivity and Psychoticism; and SPD was associated with Detachment. © 2020 John Wiley & Sons, Ltd.

A longitudinal study on clinically relevant self-reported depression, anxiety and acute stress features among Italian community-dwelling adults during the COVID-19 related lockdown: Evidence of a predictive role for baseline dysfunctional personality dimensions

Background: Although necessary for public health, quarantine has been documented to cause post-traumatic stress symptoms, anxiety, and depression. We designed the present longitudinal study to evaluate the psychological impact of quarantine in Italian community-dwelling adult participants.Methods: A sample of 304 Italian community-dwelling adult participants (75.7% female; mean age = 35.28 years) was administered self-reported measures of depression, anxiety and acute stress symptoms at the beginning and at the end of the lockdown. Potential predictors of clinically relevant symptoms at the end of the lockdown were assessed. Specifically, data on gender, civil status, education level, occupation, and area of residence, as well as maladaptive personality domains were collected.Results: More than 43% of participants suffered from the early impact of the lockdown; at the end of the lockdown roughly 32% of participants still reported any clinically relevant depression anxiety, and/or acute stress disorder condition. Clinically relevant acute stress reaction at the beginning of lockdown was a particularly important risk factor for experiencing clinically relevant acute stress, depression, and anxiety at the end of the lockdown. Maladaptive personality domains represent non-trivial predictors of participants’ self-reports of clinically relevant depression, anxiety, and acute stress conditions at the end of the lockdown.Limitations: Excess of female participants and the impossibility of evaluating if participants suffered from any internalizing disorder before the COVID-19 quarantine represent major limitations of our study.Conclusions: Our findings suggest assessment of internalizing disorder symptoms during quarantine may be helpful in identifying people who may benefit from early treatment interventions.

Is There a Bias in the Diagnosis of Borderline Personality Disorder Among Lesbian, Gay, and Bisexual Patients?

High prevalence of borderline personality disorder (BPD) diagnosis is observed among sexual minority samples. It is unclear if sexual minority individuals are systematically diagnosed with BPD at higher rates than heterosexual individuals, and if potential diagnostic disparity can be explained by differences in maladaptive personality domains. Utilizing data from partial hospital patients (N = 1,099) the current study explored (a) differences in the frequency of diagnosis of BPD based on sexual orientation, (b) whether disparities explained differences in psychopathology across groups, and (c) the congruence between traditional methods of BPD diagnosis (i.e., clinical assessment) versus diagnosis based on elevations in self-reported maladaptive personality domains consistent with the alternative model for personality disorders. Sexual minority individuals were more likely to be diagnosed with BPD than heterosexual individuals (odds ratio [OR] = 2.43, p < .001), even after controlling for differences in clinical correlates of BPD diagnosis (age, gender, comorbid posttraumatic stress disorder, maladaptive personality domains; OR = 1.59, p < .05). Diagnostic disparity was highest for bisexual compared with heterosexual patients. These results suggest that clinicians may be predisposed to provide a BPD diagnosis to sexual minority patients that is independent of presenting psychopathology and bear important implications for future research aimed at discerning whether such predisposition is due to measure or clinician bias.

Associations between maladaptive personality domains and premature termination in an acute clinical setting.

Maladaptive personality has been positioned as one overarching framework with the potential to streamline conceptualization of both personality- and nonpersonality-related psychopathology. However, few studies have examined maladaptive personality in relation to (a) clinical outcomes in a naturalistic setting and (b) using measures short enough to be incorporated into standard clinical care. The goal of the current study, therefore, investigated the extent to which maladaptive personality domains-as measured by the Personality Inventory for DSM-5-Brief Form (PID-5 BF)-predicted premature treatment termination in one naturalistic clinical setting. Using a large sample (N = 2,730; 64% female) of psychiatric patients referred for treatment at a partial hospital program, we explored the associations between PID-5 BF domains and the likelihood of premature termination. Individuals who terminated treatment prematurely reported higher levels on all PID-5 BF domains, except antagonism, compared with those who successfully completed treatment. Further, elevations in the disinhibition and psychoticism domains were associated with approximately twice the odds of premature termination than normative levels, when examined in both single and multiple regression frameworks. Negative affectivity and antagonism were associated with reduced likelihood of premature termination only after controlling for elevations in other PID-5 BF domains; they showed no bivariate associations with premature termination. These results add to the literature on the clinical utility of the PID-5. Further, they suggest importance of considering personality pathology within diverse clinical populations and the use of the PID-5 BF as one easily administered screening tool that can provide important information about differential treatment response. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Pathways to incarceration: an examination of childhood maltreatment and personality psychopathology in incarcerated adults

ABSTRACT Early-life exposure to childhood maltreatment, whether physically-, emotionally-, and/or sexually-based has been linked consistently to psychological distress throughout the lifespan, including the development of personality disorders (PDs). Individuals with PD diagnoses are at an increased risk for criminal behavior, and borderline and antisocial PDs are particularly common in forensic settings. However, little research has assessed associations among all three variables: childhood maltreatment, personality psychopathology, and adult criminal behavior. The current study sought to address this gap in the literature by examining the associations among childhood maltreatment, maladaptive personality domains, and adult criminal behavior broadly, as well as examining the mediation pathway from childhood maltreatment to maladaptive personality to adult criminal behavior. Data collection for the current study occurred at a county jail in the Southern United States (n = 180), where participants were administered self-report measures of demographics, adult arrest history, maladaptive personality, and childhood trauma. Pearson correlation and path analyses were used to examine the data, and support was found for both broad associations of childhood maltreatment with maladaptive personality domains and adult criminal behavior, and a relationship between childhood maltreatment and adult criminal behavior, which was mediated by maladaptive personality. Implications and directions for future research are discussed.

DSM-5 Maladaptive Personality Domains among Treatment-Seeking Individuals with Alcohol Use Disorder: The Role of Disinhibition and Negative Affectivity

Background: Dimensional models of personality and personality disorders (PDs) have been widely investigated among individuals with alcohol use disorders (AUD). Nevertheless, DSM-5 maladaptive personality domains showed mixed associations with AUD. Furthermore, no studies have explored the role of DSM-5 maladaptive personality domains on the comorbidity between AUD and different PDs. Objective(s): This study aims at investigating whether DSM-5 maladaptive personality dimensions could differentiate individuals with AUD from normative and healthy controls (HCs) subjects. The study also investigated relationships between these personality dimensions and AUD clinical features (i.e. onset, severity of concurrent substance use disorders), as well as their role in accounting for the comorbidity between AUD and PDs. Methods: This study administered the personality inventory for DSM-5 (PID-5) to 99 treatment-seeking individuals (male 68.8%; female 31.2%; age: 48.12 (14.32)) with AUD (41 AUD only; 58 AUD with PDs), comparing the participants’ levels of PID-5 domains with normative data and the data from a HC sample (N = 40; male 50%; female 50%; age: 48.12 (14.32)). Results: Disinhibition and negative affectivity were relevant maladaptive personality dimensions of AUD, even when controlling for the impact of PD diagnoses. Disinhibition and negative affectivity were associated to the onset of AUD and the severity of concurrent substance use disorders. The co-occurrence of AUD and PDs is related to other two domains, namely antagonism and detachment. Conclusions: AUD is a complex psychopathological disorder in which both externalizing and internalizing aspects determine relevant clinical features.

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).

The Five-Factor Personality Inventory for ICD-11: A facet-level assessment of the ICD-11 trait model.

The International Classification of Diseases-11th edition (ICD-11) includes a dimensional model of personality disorder assessing five domains of maladaptive personality. To avoid unnecessary complexity, the ICD-11 model includes assessment of personality traits only at the domain level. A measure exists to assess the domains of the ICD-11 model (the Personality Inventory for ICD-11), yet a more rich and useful assessment of personality is provided at the facet level. We used items from the scales assessing the five-factor model of personality disorder to develop the Five-Factor Personality Inventory for ICD-11 (FFiCD), a new 121-item, 20-facet, self-report measure of the ICD-11 maladaptive personality domains at the facet level. Further, the FFiCD includes 47 short scales organized beneath the facets-at the "nuance" level. Items were selected and evaluated empirically across two independent data collections, and the resulting scales were further validated in a third data collection. Correlational and factor analytic results comparing the scales of the FFiCD to the five-factor model, Personality Inventory for ICD-11, and Personality Inventory for DSM-5 supported the validity of the theoretical structure of the FFiCD and the ICD-11 model. The FFiCD may be a useful instrument for clinicians and researchers interested in a more specific assessment of maladaptive personality according to the dimensional ICD-11 personality disorder model. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Supplemental Material for Associations Between Maladaptive Personality Domains and Premature Termination in an Acute Clinical Setting

Supplemental Material for Associations Between Maladaptive Personality Domains and Premature Termination in an Acute Clinical Setting

Maladaptive Personality Functioning and Psychopathological Symptoms in Problematic Video Game Players: A Person-Centered Approach.

BackgroundA need exists to increase our understanding of the association between maladaptive personality traits, psychopathological symptoms, game preference, and different types of video game use. In the present study, we used a person-centered approach to identify different subtypes of video game players and we explored how they differ in personality profiles, clinical symptoms, and video game usage.MethodsWe assessed problematic gaming via the nine-item Internet Gaming Disorder Scale and self-reported screen time playing video games in a sample of 366 adolescents and young adult gamers. Participants also completed measures on maladaptive personality domains (Personality Inventory for DSM-5 Brief Form), alexithymia (Toronto Alexithymia Scale—20 items), and psychopathological symptoms (DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure) and reported which genre of video games they preferred.ResultsUsing a person-centered, cluster-analytic approach, we identified four clusters of video game players (Occasional, Passionate, Preoccupied, and Disordered) presenting peculiar combinations of problematic gaming scores and time spent online playing video games. Non-problematic gamers (Occasional and Passionate) represented the majority of the sample (62.3% of the participants). Highly involved gamers who exhibited excessive screen time playing video games (Disordered gamers) presented the highest level of maladaptive personality traits and psychopathological symptoms, and were characterized by the greatest use of Multiplayer Online Battle Arena (MOBA) games.ConclusionThese results have clinical implications on suggesting the importance to determining whether or not problematic gaming activities reflect a dysfunctional emotion-focused coping strategy to avoid inner unpleasant emotional or a more generally compromised emotional and social functioning.

Dark Ladies: Maladaptive Personality Domains, Alexithymia, and the Dark Triad in Women.

ObjectiveThe Dark Triad (DT) traits (Machiavellianism, narcissism, and psychopathy) have been linked with both alexithymia and maladaptive personality domains (negative affectivity, detachment, disinhibition, antagonism, psychoticism) comprised in the alternative model of personality disorder (AMPD) of the DSM 5. However, the differential associations of DT with the AMPD personality domains need to be further examined in research with homogeneous samples, in order to improve our understanding of malevolent personality traits.MethodWe examined the associations between maladaptive personality domains, DT traits and alexithymia factors in 420 women aged between 18 and 66 years old.ResultsDespite uniform bivariate associations, distinct profiles emerged from multiple regression analyses, in line with conceptual expectations. Antagonism was the only common positive predictor of all DT traits. Negative affectivity was positively associated with narcissism, but negatively with psychopathy and Machiavellianism. Psychopathy was related to high detachment and disinhibition. Alexithymia exerted a mediating effect in the association between AMPD domains and both psychopathy (positively) and Machiavellianism (negatively).ConclusionsFindings showed differential personality profiles associated with the DT traits in women based on maladaptive traits that characterize personality pathology, with specific emotional mechanisms that may link maladaptive personality domains and the three DT components among women.

The role of maladaptive personality domains across multiple levels of the HiTOP structure.

This study aimed to examine associations between maladaptive personality traits and psychopathology from the perspective of the hierarchical taxonomy of psychopathology (HiTOP). We tested hierarchical structural models to further validate a portion of the structural components of HiTOP. We also tested a priori personality and psychopathology associations with three levels of the HiTOP hierarchy: general psychopathology, spectra and syndromes/disorders. We used a large sample from the general Australian population who completed a large set of personality and psychopathology inventories online. Confirmatory factor analyses indicated that internalizing, externalizing and thought dysfunction spectra emerged structurally, as expected per HiTOP, but also revealed that obsessive-compulsive disorder loaded on both internalizing and thought dysfunction and attention deficit hyperactivity disorder on both externalizing and internalizing. Furthermore, results indicated that almost all personality and psychopathology hypotheses were supported, although trait antagonism did not predict externalizing to the degree initially expected. Implications for personality and psychopathology are discussed. © 2019 John Wiley & Sons, Ltd.