Using clinician-rated five-factor model data to score the DSM-IV personality disorders

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.

Assessing Aberrant Personality in Managerial Coaching: Measurement Issues and Prevalence Rates across Employment Sectors

The convergent and discriminant validity of two methods to assess a broad spectrum of aberrant personality tendencies was examined in a large sample of managers who were administered the NEO–PI–R (N = 11 862) and the Hogan Development Survey (N = 6774) in the context of a professional development assessment. Five–Factor Model (FFM) aberrant compounds, defined as linear combinations of NEO–PI–R facets, converged for the antisocial, borderline, histrionic, avoidant and obsessive–compulsive tendencies with their respective Hogan Development Survey counterparts. Alternative linear FFM combinations did improve convergent results for the schizoid and obsessive–compulsive pattern. Risk for various aberrant tendencies was roughly equal across different employment sectors, with a higher prevalence of borderline, avoidant and dependent tendencies in the legal and more histrionic tendencies in the retail sector. Adopting FFM aberrant compound cut–offs developed for coaching purposes to flag at risk individuals showed that 20% to 25% of all managers qualified for at least one and 10% to 15% were flagged as at risk for two or more aberrant tendencies. The theoretical implications and the repercussions of this research for the design of professional development and coaching trajectories are discussed. Copyright © 2013 European Association of Personality Psychology

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.

Reliability and Hierarchical Structure of DSM-5 Pathological Traits in a Danish Mixed Sample

In this study we assessed the DSM-5 trait model in a large Danish sample (n = 1,119) with respect to reliability of the applied Danish version of the Personality Inventory for DSM-5 (PID-5) self-report form by means of internal consistency and item discrimination. In addition, we tested whether the five-factor structure of the DSM-5 trait model can be replicated in a Danish independent sample using the PID-5 self-report form. Finally, we examined the hierarchical structure of DSM-5 traits. In terms of internal consistency and item discrimination, the applied PID-5 scales were generally found reliable and functional; our data resembled the five-factor structure of previous findings, and we identified a hierarchical structure from one to five factors that was conceptually reasonable and corresponded with existing findings. These results support the new DSM-5 trait model and suggest that it can be generalized to other languages and cultures.

Personality disorders in older adults: emerging research issues

Empirical research focusing on personality disorders (PDs) among older adults is mainly limited to studies on psychometric properties of age-specific personality tests, the age neutrality of specific items/scales, and validation of personality inventories for older adults. We identified only two treatment studies-one on dialectical behavior therapy and one on schema therapy-both with promising results among older patients despite small and heterogeneous populations. More rigorous studies incorporating age-specific adaptations are needed. Furthermore, in contrast to increasing numbers of psychometric studies, the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 pays little attention to the characteristics of older adults with PDs. Moreover, the constructs "personality change due to another medical condition" and "late-onset personality disorder" warrant further research among older adults. These needs will become even more pressing given the aging society worldwide.

Examination of the Section III DSM-5 diagnostic system for personality disorders in an outpatient clinical sample

The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013), includes a novel approach to the diagnosis of personality disorders (PDs) in Section III, to stimulate further research with the possibility that this proposal will be included more formally in future DSM iterations. This study provides the 1st test of this proposal in a clinical sample by simultaneously examining its 2 primary components: a system for rating personality impairment and a newly developed dimensional model of pathological personality traits. Participants were community adults currently receiving outpatient mental health treatment who completed a semistructured interview for DSM-IV PDs and were then rated in terms of personality impairment and pathological traits. Data on the pathological traits were also collected through self-reports using the Personality Inventory for DSM-5 (PID-5). Both sets of trait scores were compared with self-report measures of general personality traits, internalizing symptoms, and externalizing behaviors. Interrater reliabilities for the clinicians' ratings of impairment and the pathological traits were fair. The impairment ratings manifested substantial correlations with symptoms of depression and anxiety, DSM-5 PDs, and DSM-5 pathological traits. The clinician and self-reported personality trait scores demonstrated good convergence with one another, both accounted for substantial variance in DSM-IV PD constructs, and both manifested expected relations with the external criteria. The traits but not the impairment ratings demonstrated incremental validity in the prediction of the DSM-IV PDs. Overall, these results support the general validity of several of the components of this new PD diagnostic system and point to areas that may require further modification.

Self-other knowledge asymmetries in personality pathology

OBJECTIVE

Self-reports of personality provide valid information about personality disorders (PDs). However, informant reports provide information about PDs that self-reports alone do not provide. The current article examines whether and when one perspective is more valid than the other in identifying PDs.

METHOD

Using a representative sample of adults 55 to 65 years of age (N = 991; 45% males), we compared the validity of self- and informant (e.g., spouse, family, or friend) reports of the Five-Factor Model traits in predicting PD scores (i.e., composite of interviewer, self-, and informant reports of PDs).

RESULTS

Self-reports (particularly of Neuroticism) were more valid than informant reports for most internalizing PDs (i.e., PDs defined by high Neuroticism). Informant reports (particularly of Agreeableness and Conscientiousness) were more valid than self-reports for externalizing and/or antagonistic PDs (i.e., PDs defined by low Agreeableness and Conscientiousness). Neither report was consistently more valid for thought disorder PDs (i.e., PDs defined by low Extraversion). However, informant reports (particularly of Agreeableness) were more valid than self-reports for PDs that were both internalizing and externalizing (i.e., PDs defined by high Neuroticism and low Agreeableness).

CONCLUSIONS

The intrapersonal and interpersonal manifestations of PDs differ, and these differences influence who knows more about pathology.

Validation of the FFM PD count technique for screening personality pathology in later middle-aged and older adults

Research on the applicability of the five factor model (FFM) to capture personality pathology coincided with the development of a FFM personality disorder (PD) count technique, which has been validated in adolescent, young, and middle-aged samples. This study extends the literature by validating this technique in an older sample. Five alternative FFM PD counts based upon the Revised NEO Personality Inventory (NEO PI-R) are computed and evaluated in terms of both convergent and divergent validity with the Assessment of DSM-IV Personality Disorders Questionnaire (shortly ADP-IV; DSM-IV, Diagnostic and Statistical Manual of Mental Disorders - Fourth edition). For the best working count for each PD normative data are presented, from which cut-off scores are derived. The validity of these cut-offs and their usefulness as a screening tool is tested against both a categorical (i.e., the DSM-IV - Text Revision), and a dimensional (i.e., the Dimensional Assessment of Personality Pathology; DAPP) measure of personality pathology. All but the Antisocial and Obsessive-Compulsive counts exhibited adequate convergent and divergent validity, supporting the use of this method in older adults. Using the ADP-IV and the DAPP - Short Form as validation criteria, results corroborate the use of the FFM PD count technique to screen for PDs in older adults, in particular for the Paranoid, Borderline, Histrionic, Avoidant, and Dependent PDs. Given the age-neutrality of the NEO PI-R and the considerable lack of valid personality assessment tools, current findings appear to be promising for the assessment of pathology in older adults.

The role of co-morbid personality pathology in predicting self-reported aggression in patients with schizophrenia

BACKGROUND

Personality pathology affects behavioral patterns in patients with schizophrenia notwithstanding psychotic symptomatology. An investigation of the role of co-morbid personality pathology in the occurrence of aggression in schizophrenia is explored using both categorical and dimensional approaches to personality pathology.

METHODS

In a cross-sectional study we evaluate, in 97 patients diagnosed with schizophrenia, the effect of personality pathology on the occurrence of aggression in schizophrenia using both a categorical approach, as described in DSM-IV-TR Axis II, and a dimensional approach, as operationalized in the Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ). We also employ mediation analyses to explore the extent to which dimensions within the DAPP mediate the relationship between co-morbid personality disorders and aggression.

RESULTS

Personality pathology accounts for aggression in schizophrenia. Both the categorical and the dimensional approaches equally well account for the occurrence of aggression, with each model accounting for 60% of the variance. Interestingly, the mediation analysis reveals that the association between categorically defined personality pathology and aggression is substantially mediated by the higher-order-trait dissocial behavior of the DAPP-BQ, accounting for 50.6 % of the total effect size.

CONCLUSION

Personality pathology can be a significant predictor of aggression in patients with schizophrenia. While both the categorical and the dimensional trait models of personality disorders equally explain the aggression data, much of the relationship between the categorically defined personality disorders and the occurrence of aggression in schizophrenia can be explained by the presence of dissocial behavior as operationalized in the DAPP-BQ dimensional model.

Integrating normal and abnormal personality structure: the Five-Factor Model

It is evident that the conceptualization, diagnosis, and classification of personality disorder (PD) is shifting toward a dimensional model. The purpose of this special issue of Journal of Personality is to indicate how the Five-Factor Model (FFM) can provide a useful and meaningful basis for an integration of the description and classification of both normal and abnormal personality functioning. This introductory article discusses its empirical support and the potential advantages of understanding personality disorders, including those included within the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders and likely future PDs from the dimensional perspective of the FFM.

Five-Factor Model personality disorder prototypes: a review of their development, validity, and comparison to alternative approaches

In this article, the development of Five-Factor Model (FFM) personality disorder (PD) prototypes for the assessment of DSM-IV PDs are reviewed, as well as subsequent procedures for scoring individuals' FFM data with regard to these PD prototypes, including similarity scores and simple additive counts that are based on a quantitative prototype matching methodology. Both techniques, which result in very strongly correlated scores, demonstrate convergent and discriminant validity, and provide clinically useful information with regard to various forms of functioning. The techniques described here for use with FFM data are quite different from the prototype matching methods used elsewhere.

Construct validation theory applied to the study of personality dysfunction

The authors review theory validation and construct validation principles as related to the study of personality dysfunction. Historically, personality disorders have been understood to be syndromes of heterogeneous symptoms. The authors argue that the syndrome approach to description results in diagnoses of unclear meaning and constrained validity. The alternative approach of describing personality dysfunction in terms of homogeneous dimensions of functioning avoids the problems of the syndromal approach and has been shown to provide more valid description and diagnosis. The authors further argue that description based on homogeneous dimensions of personality function/dysfunction is more useful because it provides direct connections to validated treatments.

Five-factor model personality disorder prototypes in a community sample: self- and informant-reports predicting interview-based DSM diagnoses

The need for an empirically validated, dimensional system of personality disorders is becoming increasingly apparent. While a number of systems have been investigated in this regard, the five-factor model of personality has demonstrated the ability to adequately capture personality pathology. In particular, the personality disorder prototypes developed by Lynam and Widiger (2001) have been tested in a number of samples. The goal of the present study is to extend this literature by validating the prototypes in a large, representative community sample of later middle-aged adults using both self and informant reports. We found that the prototypes largely work well in this age group. Schizoid, Borderline, Histrionic, Narcissistic, and Avoidant personality disorders demonstrate good convergent validity, with a particularly strong pattern of discriminant validity for the latter four. Informant-reported prototypes show similar patterns to self reports for all analyses. This demonstrates that informants are not succumbing to halo representations of the participants, but are rather describing participants in nuanced ways. It is important that informant reports add significant predictive validity for Schizoid, Antisocial, Borderline, Histrionic, and Narcissistic personality disorders. Implications of our results and directions for future research are discussed.

The plight of personality disorders in the DSM-5

This article provides a brief history of the development of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association, and how it relates to the proposed fifth edition to be published in 2013. Of particular emphasis is Axis II and how this axis is likely to be restructured. The reconceptualization of the nosology for personality disorders has been controversial since the publication of the DSM-III-R (Wilson, 1993). In both the clinical and academic communities, ongoing debate about diagnostic classification of personality disorders has been common. One recurrent theme among the deliberations on diagnosis and personality disorder focuses on the question of whether distinct (categorical) diagnoses exist or whether diagnoses are dimensionally related to each other in some empirically determined way. The proposed changes for Axis II in the DSM-5 are likely to bridge the gap between these two arguments by revamping the overall criteria and discarding the three currently used diagnostic clusters. The resulting nosology proposes six personality disorders with common factors in Criteria A and Criteria B. However, a major concern and a continuing problem not likely to be resolved in this edition is the symptom resemblance of borderline personality disorder and bipolar disorder. This article suggests some ways the revised DSM might affect mental health nursing practice.

Comparison of alternative models for personality disorders, II: 6-, 8- and 10-year follow-up

BACKGROUND

Several conceptual models have been considered for the assessment of personality pathology in DSM-5. This study sought to extend our previous findings to compare the long-term predictive validity of three such models: the five-factor model (FFM), the schedule for nonadaptive and adaptive personality (SNAP), and DSM-IV personality disorders (PDs).

METHOD

An inception cohort from the Collaborative Longitudinal Personality Disorder Study (CLPS) was followed for 10 years. Baseline data were used to predict long-term outcomes, including functioning, Axis I psychopathology, and medication use.

RESULTS

Each model was significantly valid, predicting a host of important clinical outcomes. Lower-order elements of the FFM system were not more valid than higher-order factors, and DSM-IV diagnostic categories were less valid than dimensional symptom counts. Approaches that integrate normative traits and personality pathology proved to be most predictive, as the SNAP, a system that integrates normal and pathological traits, generally showed the largest validity coefficients overall, and the DSM-IV PD syndromes and FFM traits tended to provide substantial incremental information relative to one another.

CONCLUSIONS

DSM-5 PD assessment should involve an integration of personality traits with characteristic features of PDs.

The convergent and concurrent validity of trait-based prototype assessment of personality disorder categories in homeless persons

The DSM-5 proposal indicates that personality disorders (PDs) be defined as collections of maladaptive traits but does not provide a specific diagnostic method. However, researchers have previously suggested that PD constructs can be assessed by comparing individuals' trait profiles with those prototypic of PDs and evidence from the five-factor model (FFM) suggests that these prototype matching scores converge moderately with traditional PD instruments. The current study investigates the convergence of FFM PD prototypes with interview-assigned PD diagnoses in a sample of 99 homeless individuals. This sample had very high rates of PDs, which extends previous research on samples with more modest prevalence rates. Results indicated that diagnostic agreement between these methods was generally low but consistent with the agreement previously observed between explicit PD measures. Furthermore, trait-based and diagnostic interview scores evinced similar relationships with clinically important indicators such as abuse history and past suicide attempts. These findings demonstrate the validity of prototype methods and suggest their consideration for assessing trait-defined PD types within DSM-5.

Can DSM-IV borderline personality disorder be diagnosed via dimensional personality traits? Implications for the DSM-5 personality disorder proposal

The proposal for the diagnosis of personality disorders (PDs) in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5;American Psychiatric Association, in preparation) involves, in part, the use of elevated scores on dimensional personality traits. For instance, the diagnosis of borderline personality disorder (BPD) in the DSM-5 will require evidence of self- and interpersonal impairment as well as elevated scores on traits of emotional lability, anxiousness, separation insecurity, depressivity, impulsivity, risk taking, and hostility. Using a sample of individuals from the community (N = 134), half of whom were receiving psychiatric treatment, we tested whether the summation of relevant personality trait scores, using data derived from a measure of the Five-Factor Model of personality (FFM), would result in a construct that corresponds to the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV, American Psychiatric Association, 2000) BPD construct as scored by expert consensus ratings. The DSM-IV and FFM BPD scores were significantly correlated (r = .60) and generated highly similar patterns of relations (ricc = .84) with key constructs from BPD's nomological network. These data should serve to allay concerns that the DSM-5's new diagnostic approach will be detrimental to the identification of BPD.

Computerized adaptive assessment of personality disorder: introducing the CAT-PD project

Assessment of personality disorders (PD) has been hindered by reliance on the problematic categorical model embodied in the most recent Diagnostic and Statistical Model of Mental Disorders (DSM), lack of consensus among alternative dimensional models, and inefficient measurement methods. This article describes the rationale for and early results from a multiyear study funded by the National Institute of Mental Health that was designed to develop an integrative and comprehensive model and efficient measure of PD trait dimensions. To accomplish these goals, we are in the midst of a 5-phase project to develop and validate the model and measure. The results of Phase 1 of the project--which was focused on developing the PD traits to be assessed and the initial item pool--resulted in a candidate list of 59 PD traits and an initial item pool of 2,589 items. Data collection and structural analyses in community and patient samples will inform the ultimate structure of the measure, and computerized adaptive testing will permit efficient measurement of the resultant traits. The resultant Computerized Adaptive Test of Personality Disorder (CAT-PD) will be well positioned as a measure of the proposed DSM-5 PD traits. Implications for both applied and basic personality research are discussed.