Comparing the utility of DSM-5 Section II and III antisocial personality disorder diagnostic approaches for capturing psychopathic traits

Clinical cut scores for the Persian version of the personality inventory for DSM-5

BACKGROUND

The cut points of psychological tools to diagnose clinical conditions are not universal and depend on the region and prevalence of the disorder. Thus, we aimed to identify the cutoff points of the Persian original version of the personality inventory for DSM-5 (PID-5; 220 items) that would optimally distinguish nonclinical from clinical groups.

METHODS

Both nonclinical (N = 634, 73% female, 34.0 ± 10.8 years) and clinical (N = 454, 29% female, 29.5 ± 7.4 years) samples from the West of Iran participated in the study. Data were analyzed using receiver operating characteristic (ROC) and Youden's index was used to determine the cutoff scores across the PID-5 domains and facets. The means and standard deviations of both the clinical male and female were compared with the nonclinical group using Cohen's d and independent t-tests.

RESULTS

All the PID-5 algorithms and facets significantly distinguished clinical from nonclinical samples with some unique findings for male and female samples. The mean score of all the PID-5 algorithms and facets in the clinical male and female samples were respectively 1.0-2.0 SD and 0.5-1.0 SD above the mean for the nonclinical counterparts. A score higher than 1.5 on ranging from 0 to 3 in each domain or facet indicated clinical status.

CONCLUSION

Raw cutting scores throughout the PID-5 algorithms can be well used to diagnose any pathology of personality and the severity of the disorder in clinical patients. The cut scores provide a useful tool for the clinical use of the original version of PID-5 in Iran.

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.

Concurrent, Convergent, and Discriminant Validity of the DSM-5 Section III Psychopathy Specifier

Section III of the fifth iteration of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes an alternative model of personality disorder diagnosis that conceptualizes antisocial personality disorder as an interpersonal, rather than behavioral, construct. However, the diagnostic specifier for psychopathy has been met with recent controversy due to its conceptual and empirical overlap with triarchic boldness, which has been debated as a necessary and sufficient domain of psychopathy. This study examined the concurrent, convergent, and discriminant validity of the specifier using canonical correlation analysis in samples of undergraduate students (N = 224) and community adults with prior criminal involvement (N = 306). Findings highlight the specifier as a multidimensional construct with divergent associations across its three facets. There was limited validity evidence for two of the three facets, raising concerns regarding the clinical utility of the psychopathy specifier.

Three Dimensional Approaches to Personality Disorders: a Review on Personality Functioning, Personality Structure, and Personality Organization

PURPOSE OF REVIEW

The concept of personality functioning (Alternative DSM-5 Model of Personality Disorders) has led to increased interest in dimensional personality disorder diagnosis. While differing markedly from the current categorical classification, it is closely related to the psychodynamic concepts of personality structure and personality organization. In this review, the three dimensional approaches, their underlying models, and common instruments are introduced, and empirical studies on similarities and differences between the concepts and the categorical classification are summarized. Additionally, a case example illustrates the clinical application.

RECENT FINDINGS

Numerous studies demonstrate the broad empirical basis, validated assessment instruments and clinical usefulness of the dimensional concepts. Their advantages compared to the categorical approach, but also the respective differences, have been demonstrated empirically, in line with clinical observations. Evidence supports the three dimensional concepts, which share conceptual overlap, but also entail unique aspects of personality pathology, respectively.

The association between toddlerhood empathy deficits and antisocial personality disorder symptoms and psychopathy in adulthood

The present study examined empathy deficits in toddlerhood (age 14 to 36 months) as predictors of antisocial personality disorder (ASPD) symptoms and psychopathy measured by the Levenson Self-Report Psychopathy scale (Levenson, Kiehl, & Fitzpatrick, 1995) in adulthood (age 23 years) in 956 individuals from the Colorado Longitudinal Twin Study. Consistent with the hypothesis that antisocial behavior is associated with "active" rather than "passive" empathy deficits, early disregard for others, not lack of concern for others, predicted later ASPD symptoms. Early disregard for others was also significantly associated with factor 1 of the Levenson Self-Report Psychopathy Scale, which includes items assessing interpersonal and affective deficits, but not with factor 2, which includes items assessing impulsivity and poor behavioral control. The association between early disregard for others and psychopathy factor 2 was near zero after controlling for the shared variance between psychopathy factors 1 and 2. These results suggest that there is a propensity toward adulthood ASPD symptoms and psychopathy factor 1 that can be assessed early in development, which may help identify individuals most at risk for stable antisocial outcomes.

Psychopathy and the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition alternative model of personality disorder: a synthesis and critique of the emergent literature

PURPOSE OF REVIEW

Including the psychopathic specifier within the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition alternative model of personality disorder (AMPD) trait conceptualization of antisocial personality disorder (ASPD) represents a significant development in the history of the conceptualization of ASPD and its relationship to psychopathy. This review presents a synthesis and critique of emerging literature pertaining to AMPD ASPD and the psychopathic specifier.

RECENT FINDINGS

The current review draws attention to the utility of ASPD impairment ratings and traits to effectively measure psychopathy, shortcomings of the psychopathic specifier, research efforts to improve upon the conceptualization of AMPD psychopathy, and ASPD and psychopathic specifier trait complexity.

SUMMARY

AMPD domains and ASPD designated traits converge with interpersonal, antagonistic, and disinhibitory domains of psychopathy but demonstrate poorer convergence with boldness/fearless dominance. The separate assessment of ASPD impairment adds little to the prediction of psychopathy beyond ASPD trait severity. Although the psychopathic specifier maps onto boldness/fearless dominance domains of psychopathy, theoretical and empirical limitations hinder the utility of the psychopathic specifier and reconceptualization will likely be required. Finally, complex ASPD and psychopathic specifier facet interrelationships and diverse relationships with externalizing outcomes suggests the development of advanced interpretive guides for clinical practice should be a high priority.

The Importance of Antagonism: Explaining Similarities and Differences in Psychopathy and Narcissism's Relations With Aggression and Externalizing Outcomes

Psychopathy and narcissism are multidimensional constructs with substantial overlap. Low agreeableness (i.e., antagonism) features prominently in clinical and theoretical descriptions of both disorders. The authors examined whether antagonism components of their assessments accounted for the overlap between narcissism and psychopathy. Next, they tested whether the antagonism components were responsible for the relations that narcissism and psychopathy bore to aggression outcomes. Using multiple regression, the authors found that the low agreeableness component accounted for the majority of overlap between psychopathy and narcissism, nearly all of the variance in narcissism's relations with aggression outcomes, and the majority of variance in psychopathy's relations with aggression outcomes. Disinhibitory traits, which serve to distinguish psychopathy from narcissism, accounted for incremental variance in aggression outcomes for psychopathy. Results are discussed in the context of the overlap between narcissism and psychopathy. The authors argue that low agreeableness is largely responsible for the maladaptive outcomes associated with grandiose narcissism and psychopathy.

An Examination of the Reliability and Validity of the Comprehensive Assessment of Traits Relevant to Personality Disorder-Static Form (CAT-PD-SF)

The current study examined the reliability and validity of the Comprehensive Assessment of Traits Relevant to Personality Disorder-Static Form (CAT-PD-SF), a dimensional measure of personality psychopathology. Specifically, we used exploratory factor analysis to determine the best higher order structure for the CAT-PD-SF traits. Results suggested a five-factor structure, albeit with marginal model fit. Second, we used correlation analyses to compare the CAT-PD-SF with two additional dimensional measures of personality, the Personality Inventory for DSM-5-Brief Form and the Five-Factor Model Rating Form. The results demonstrated the CAT-PD-SF scale scores were associated with domain and facet scores from these two models in a conceptually expected manner. Finally, we explored the association between the CAT-PD-SF scores and functional impairment and found moderate associations between CAT-PD-SF trait and functional impairment scores (as measured by the Measure of Disordered Personality Functioning Scale). Overall, findings add support to the structure of the CAT-PD model, and the use of the CAT-PD-SF in measuring dimensional personality psychopathology and impairment.

Improving characterization of psychopathy within the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), alternative model for personality disorders: Creation and validation of Personality Inventory for DSM-5 Triarchic scales

The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) bridges a significant gap in psychiatric nosology by providing trait-based characterizations of psychopathy along with antisocial personality disorder within the Section III alternative model for personality disorders (AMPD). However, the representation of psychopathy in the AMPD has met with some criticisms (Crego & Widiger, 2014; Few, Lynam, Maples, MacKillop, & Miller, 2015). The current study was undertaken to establish an improved means for characterizing psychopathy in DSM-5 Section III terms, by creating scale measures of triarchic psychopathy dimensions using items from the best-established assessment instrument for the AMPD, the Personality Inventory for DSM-5 (PID-5). Using data from a sample of community adults (N = 210), we employed a construct rating and psychometric refinement approach to develop item-based PID-5 Triarchic scales for measuring psychopathy dimensions of boldness, meanness, and disinhibition. The validity of the PID-5 Triarchic scales was then evaluated in relation to criteria including other scale measures of the triarchic constructs and psychopathy, self-reported antisocial behavior and substance use, empathy, internalizing and other clinical problems, and personality within the development sample and a separate independent sample of adults (N = 240) recruited to have elevated psychopathic traits. Results of this work provide a foundation for improved characterization of psychopathy in terms of the AMPD trait system and provide a mechanism for future research oriented toward clarifying the developmental interface between childhood conduct disorder and psychopathy, as well as identifying neurobiological correlates of dimensions of psychopathy. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Heterogeneity in the Development of Drug Use Versatility: Risk Factors for Polydrug Use throughout the Life-Course

BACKGROUND

Polydrug use is a major public health issue associated with numerous undesirable physical and mental health outcomes. While past research has identified risk factors for polydrug use and elevated drug use variety, there has yet to be any research which seeks to examine this phenomenon from a developmental perspective. There also has yet to be any research which examines the impact of risk factors for predicting differential development.

OBJECTIVES

Identify developmental subgroups of polydrug use. Identify risk factors predicting heterogeneity in development.

METHODS

The Pathways to Desistance data were used in this research. The present study used group-based trajectory modeling to elucidate general developmental patterns of drug use variety and sought to identify risk factors predicting the heterogeneity in the development of this outcome using multinomial logistic regression among a sample of juvenile offenders.

RESULTS

A six group model best fit the drug use variety count data. Several risk factors were identified which predicted assignment to the most problematic developmental subgroup, including: low self-control, low religiosity, and history of victimization at baseline. White participants were more likely to engage in any level of drug use. Conclusions/Importance: These results indicate that juvenile offenders are at-risk for chronic issues with polydrug use and more general engagement in polydrug use. Public health and criminal justice professionals should work together to develop and implement psychosocial interventions for targeting risk factors associated with accelerating and chronic polydrug use.

Examining the Incremental Utility of DSM-5 Section III Traits and Impairment in Relation to Traditional Personality Disorder Scores in a Female Correctional Sample

Personality disorders (PDs) are challenging to assess and are associated with great individual and societal costs. In response to the limitations of categorical models, the DSM-5 included an alternative model (i.e., Section III), which uses impairment (Criterion A) and pathological traits (Criterion B) to diagnose PDs. Although numerous studies have illustrated dimensional trait models' ability to capture personality psychopathology, less attention has been paid to personality impairment. The present investigation sought to examine Criterion A's ability to contribute incrementally to the prediction of antisocial (ASPD), borderline (BPD), and narcissistic personality disorders (NPD), and Interpersonal-Affective (F1) and Impulsive-Antisocial (F2) features of psychopathy. The current study used 200 female inmates and found that impairment contributed to the prediction of BPD, NPD, and psychopathy F1 scores and did not add to the prediction of ASPD and psychopathy F2 scores. Difficulties in distinguishing between personality impairment and personality disordered traits are discussed.

Clinician Perspectives of Antisocial and Borderline Personality Disorders Using DSM-5 Section III Dimensional Personality Traits

The DSM-5 includes an alternative model for the diagnosis of personality disorders (PDs). Although there has been growing support for this model there has been little investigation into how it will be utilized by clinicians. The current study evaluated clinician perspectives of a "prototypical" individual with antisocial and borderline PD using Section III traits in a sample of 105 mental health professionals. Results showed that clinicians' perspectives of these disorders were generally consistent with the Section III trait operationalizations. Indeed, clinicians rated each trait facet as more prototypical than nonproposed facets. Similarly, they rated nonproposed facets as less prototypical than included facets for both disorders, with some exceptions for borderline PD. Furthermore, the authors found that these ratings were generally in statistical agreement with empirical associations between Section III traits and Section II PDs found in previous studies. Overall, results suggest support for the trait operationalizations of these disorders by clinicians.

Stability and change in personality and personality disorders

In this paper, we review recent findings related to stability and change in personality and personality disorder. Estimates of stability vary depending on a number of methodological and substantive factors. These factors include the type of stability being examined, the type of construct being assessed, the method being used to assess personality, how participants are sampled, and developmental trends in personality stability and change. We describe current evidence about personality stability with respect to each of these factors. We conclude that current gaps in the literature can be filled by more carefully attending to factors that impact estimates of stability and change, and provide recommendations about how future research can fill those gaps.

Comparing the lexical similarity of the triarchic model of psychopathy to contemporary models of psychopathy

OBJECTIVE

The triarchic model of psychopathy (Patrick, Fowles, & Krueger, 2009) posits that psychopathic personality comprises three domains: boldness, meanness, and disinhibition. The present study aimed to clarify conceptual overlap between contemporary definitions of psychopathy, with particular emphasis given to the relevance of boldness (i.e., social dominance, venturesomeness, emotional resiliency)-a topic of recent debate.

METHOD

Undergraduate students (N = 439) compared the lexical similarity of triarchic domains with two contemporary models of psychopathy: the Comprehensive Assessment of Psychopathic Personality (CAPP; Cooke, Hart, Logan, & Michie, 2012) and the Five-Factor Model of psychopathy (FFM; Widiger & Lynam, 1998).

RESULTS

From a content validity perspective, meanness and disinhibition were lexically similar to both the CAPP and FFM psychopathy, whereas boldness was less strongly associated with these models. Meanness showed the strongest lexical similarity in comparison with past prototypicality ratings of the CAPP and FFM psychopathy.

CONCLUSIONS

These findings bear implications for defining and comparing conceptualizations of psychopathy that underpin its assessment.

Identifying Essential Features of Juvenile Psychopathy in the Prediction of Later Antisocial Behavior: Is There an Additive, Synergistic, or Curvilinear Role for Fearless Dominance?

Despite years of research, and inclusion of psychopathy DSM-5, there remains debate over the fundamental components of psychopathy. Although there is agreement about traits related to Agreeableness and Conscientiousness, there is less agreement about traits related to Fearless Dominance (FD) or Boldness. The present paper uses proxies of FD and Self-centered Impulsivity (SCI) to examine the contribution of FD-related traits to the predictive utility of psychopathy in a large, longitudinal, sample of boys to test four possibilities: FD 1. assessed earlier is a risk factor, 2. interacts with other risk-related variables to predict later psychopathy, 3. interacts with SCI interact to predict outcomes, and 4. bears curvilinear relations to outcomes. SCI received excellent support as a measure of psychopathy in adolescence; however, FD was unrelated to criteria in all tests. It is suggested that FD be dropped from psychopathy and that future research focus on Agreeableness and Conscientiousness.

DSM-5 section III personality traits and section II personality disorders in a Flemish community sample

The Personality Inventory for DSM-5 (PID-5; Krueger et al., 2012) is a dimensional self-report questionnaire designed to measure personality pathology according to the criterion B of the DSM-5 Section III personality model. In the current issue of DSM, this dimensional Section III personality model co-exists with the Section II categorical personality model derived from DSM-IV-TR. Therefore, investigation of the inter-relatedness of both models across populations and languages is warranted. In this study, we first examined the factor structure and reliability of the PID-5 in a Flemish community sample (N=509) by means of exploratory structural equation modeling and alpha coefficients. Next, we investigated the predictive ability of section III personality traits in relation to section II personality disorders through correlations and stepwise regression analyses. Results revealed a five factor solution for the PID-5, with adequate reliability of the facet scales. The variance in Section II personality disorders could be predicted by their theoretically comprising Section III personality traits, but additional Section III personality traits augmented this prediction. Based on current results, we discuss the Section II personality disorder conceptualization and the Section III personality disorder operationalization.