Personality assessment in DSM-5: empirical support for rating severity, style, and traits

Despite a general consensus that dimensional models are superior to the categorical representations of personality disorders in DSM-IV, proposals for how to depict personality pathology dimensions vary substantially. One important question involves how to separate clinical severity from the style of expression through which personality pathology manifests. This study empirically distinguished stylistic elements of personality pathology symptoms from the overall severity of personality disorder in a large, longitudinally assessed clinical sample (N = 605). Data suggest that generalized severity is the most important single predictor of current and prospective dysfunction, but that stylistic elements also indicate specific areas of difficulty. Normative personality traits tend to relate to the general propensity for personality pathology, but not stylistic elements of personality disorders. Overall, findings support a three-stage diagnostic strategy involving a global rating of personality disorder severity, ratings of parsimonious and discriminant valid stylistic elements of personality disorder, and ratings of normative personality traits.     

An Interactionist Perspective on Genetic and Environmental Contributions to Personality

It is now well established that nature and nurture are both important contributors to variation in human personality. As a result, the field of personality behavior genetics is moving beyond simply estimating the magnitude of genetic and environmental influences on various personality constructs. Recent methodological advances provide for the study of how these different sources of influence interact in the development of personality. Specifically, newer biometrical moderation models allow for group‐specific estimates of heritability and environmental influences on personality (a form of gene–environment interaction). In the current paper, we review selected recent research using these models. Furthermore, we explore how moderation might also be important in understanding links between specific genes and personality. Accounting for the contingencies between genes and environment will be an important catalyst for the molecular genetic study of personality, as unmoderated ‘main effect’ types of gene → personality associations have been elusive.     

Brand personality,self‐congruity,and preference: A knowledge structures approach

Using the construct of brand personality to measure automobile and soft drink personalities, two studies represented self‐congruity by combining brands and the self‐image into Pathfinder associative networks (Schvaneveldt et al., 1989 ). Self‐congruity, the number of links between the self and each brand, was predictive of preference and ideal brand. Because brand personality and self‐image are knowledge structures, and facets of brand personality also describe the self, self‐congruity can be represented and measured in networks. This approach could be helpful to marketers studying how the self is related to each brand and how brands interrelate. Copyright © 2011 John Wiley & Sons, Ltd.     

Person, personality, self, and identity: a philosophically informed conceptual analysis

Who is the person, or self, associated with personality disorder and its treatment? How are we to account for a self conceptualized in terms of schemas and representations, that at the same time--as self--scrutinizes these schemas and representations (as in cognitive therapy for personality disorders)? Five approaches to personhood are examined: metaphysical, empirical, transcendental, hermeneutical, and phenomenological. An elementary sense of selfhood is tied to all one's experiences and activities; this sense of self is experientially irreducible and conceptually connected to a primordial form of self-relatedness. After examining these issues, I formulate four provisional conclusions: (a) the separation between person and roles (functions, personality features) is a modern fiction--persons are not neutral bearers of roles and functions; (b) the concept of personality in DSM-IV refers to nonhomogeneous behaviors such as feelings, moods, inclinations, temperaments, and habits, and these behaviors differ with respect to their distance to the core self; (c) there exists an enormous variety of ways of self-relating and this variety may affect the contents of the core self under certain circumstances; and (d) the concept of person may be primitive; that is, irreducible and referring to a background of unity and integrity.     

Bayesian inferences about the self (and others): A review

Viewing the brain as an organ of approximate Bayesian inference can help us understand how it represents the self. We suggest that inferred representations of the self have a normative function: to predict and optimise the likely outcomes of social interactions. Technically, we cast this predict-and-optimise as maximising the chance of favourable outcomes through active inference. Here the utility of outcomes can be conceptualised as prior beliefs about final states. Actions based on interpersonal representations can therefore be understood as minimising surprise – under the prior belief that one will end up in states with high utility. Interpersonal representations thus serve to render interactions more predictable, while the affective valence of interpersonal inference renders self-perception evaluative. Distortions of self-representation contribute to major psychiatric disorders such as depression, personality disorder and paranoia. The approach we review may therefore operationalise the study of interpersonal representations in pathological states.     

Current status of the scientific study of the personality disorders: an overview of epidemiological, longitudinal, experimental psychopathology, and neurobehavioral perspectives

Research on the nature and development of personality disorders has grown immensely over the past thirty years. A selective summary overview is given of the current status of the scientific study of the personality disorders from several perspectives, including the epidemiological, longitudinal, experimental psychopathology, and neurobehavioral perspectives. From this research, we now know that approximately 10 percent of the general population suffer from a diagnosable personality disorder. Moreover, contrary to nearly a century of theory and clinical pedagogy, modern longitudinal studies clearly suggest that personality disorders decrease in severity over time. The mechanisms by which this change occurs are not understood at present, though it is not likely that change in underlying normal personality systems drives the change in personality disorder. The methods of the experimental psychopathology laboratory, including neuroimaging approaches, are being brought to bear on the nature of personality disorders in efforts to relate neurobiological and neurocognitive functions to personality disorder symptomatology. A model that links personality disorder feature development to underlying, interacting brain-based neurobehavioral systems is reviewed in brief. Current issues and findings illustrative of these developments are given using borderline personality disorder as an exemplar. Finally, areas of intersection between psychoanalytic treatment approaches and the growing science of personality disorder are highlighted.     

Shame regulation in personality pathology

Drawing on extant work on shame and emotion regulation, this article proposes that three broad forms of maladaptive shame regulation strategies are fundamental in much of personality pathology: Prevention (e.g., dependence, fantasy), used preemptively, lessens potential for shame; Escape (e.g., social withdrawal, misdirection) reduces current or imminent shame; Aggression, used after shame begins, refocuses shame into anger directed at the self (e.g., physical self-harm) or others (e.g., verbal aggression). This article focuses on the contributions of shame regulation to the development and maintenance of personality pathology, highlighting how various maladaptive shame regulation strategies may lead to personality pathology symptoms, associated features, and dimensions. Consideration is also given to the possible shame-related constructs necessitating emotion regulation (e.g., shame aversion and proneness) and the points in the emotion process when regulation can occur.     

Examining the construct validity of the elemental psychopathy assessment

Lynam and colleagues recently developed a new self-report inventory for the assessment of psychopathy, the Elemental Psychopathy Assessment (EPA). Using a sample of undergraduates (N = 227), the authors examined the construct validity of the EPA by examining its correlations with self and stranger ratings on the Five-Factor Model, as well as self-reported ratings of personality disorders, social cognition, and love styles. The EPA psychopathy scores manifested expected correlations with both self and stranger ratings of the Five-Factor Model, particularly with the domains of Agreeableness and Conscientiousness, and were significantly related to various forms of personality pathology such as narcissism and antisocial personality disorders. The EPA also manifested expected relations with aggressive social cognitions. Finally, the EPA psychopathy scores were correlated with romantic love styles indicative of game playing and infidelity. The current results provide further evidence of the construct validity of the EPA as it manifests relations consistent with the nomological network of psychopathy.     

Late adolescent nonsuicidal self-injury: the roles of coping style, self-esteem, and personality pathology

This study examined the relationship between late adolescent nonsuicidal self-injury (NSSI) and coping style, self-esteem, and personality pathology. Participants were 302 late adolescent (18-19-year-old) college students who completed questionnaires on self-esteem, coping style, personality disorder symptoms, and NSSI. Participants who engaged in NSSI reported more personality pathology, more maladaptive coping styles, less rational coping, and lower self-esteem than did non self-harming participants. As hypothesized, total NSSI correlated with several personality disorders, emotional coping style, and inversely related to self-esteem and adaptive coping styles. Regression equations tested several mediation models to determine whether self-esteem or coping style mediates the relationship between personality disorder symptoms and NSSI. Emotional coping and self-esteem each fully mediated the relationship between various personality disorders and NSSI in the anticipated direction. Results also indicate self-esteem, rational, detached, and emotional coping partially mediate the relationship between several personality disorders and NSSI.     

Emotional Intelligence,Social Problem‐Solving Skills,and Psychological Distress: A Study of Chinese Undergraduate Students1

This study examines how emotional intelligence (EI), personality, and social problem‐solving skills were linked to depression and life dissatisfaction in 144 Chinese undergraduate students in Hong Kong. Factor analyses of questionnaire responses yielded 3 separate dimensions of depression (affective, somative, and cognitive). Structural equation modeling showed that EI (self‐emotions appraisal and use of emotion) was linked to somatic and cognitive symptoms of depression, after controlling for personality. Also, social problem solving was linked to psychological distress, and moderated its links with personality and EI. These results underscore the differences among the links between the components of EI and of psychological health, and support the possibility of promoting people's psychological health through EI and social problem‐solving interventions.     

Do you feel better or worse? The validity of perceived deviations of mood states from mood traits

The advantages of assessing self‐perceived deviations of mood states from mood traits in cross‐sectional as well as longitudinal studies are discussed in detail. The validity of self‐perceived mood deviations is analysed in a longitudinal study with three occasions of measurement and 176 participants. In order to assess self‐perceived mood deviations, participants rated the deviation of their momentary mood from how they felt in general with respect to 32 mood adjectives belonging to three mood scales (pleasant–unpleasant, calm–restless, awake–sleepy). Furthermore, mood states, mood traits, and other personality variables (hedonic level, neuroticism, extraversion, openness, agreeableness, conscientiousness) are assessed by self‐report. Using models of latent state–trait theory, it is shown that the self‐perceived mood deviation scales are reliable (reliabilities between 0.73 and 0.95) and sensitive to occasion‐specific fluctuations (occasion specificities between 0.38 and 0.72). The self‐perceived deviation scales show high correlations with latent occasion‐specific deviation variables defined on the basis of repeatedly measured mood states (high convergent validity). In contrast to self‐reported mood states, however, self‐perceived mood deviations show much smaller and in most cases non‐significant correlations with personality variables (high discriminant validity). Furthermore, it is shown that self‐perceived mood deviations can be used to suppress stable situation‐specific variance in mood traits defined as aggregated states. Therefore, it can be demonstrated that including self‐perceived mood deviations in analyses on mood–personality associations enhances the association coefficients considerably. Finally, the implications of the results for the individual assessment of mood deviations, as well as for studies on affect and personality, are discussed. Copyright © 1999 John Wiley & Sons, Ltd.     

Self-knowledge: An expanded view

This paper argues for a more extensive study of self-knowledge. From the cognitive perspective, self-knowedge is a critical component of personality. Until quite recently, however, the study of self-knowledge has been narrowly conceived, focusing primarily on how individuals describe their roles and characteristic behaviors. Yet individuals also have knowledge about their preferences and values, their goals and motives, and their rules and strategies for regulating behavior. These dynamic aspects of self-knowledge are significant because they can be importantly revealing of future behavior. The content and organization of self-knowledge is important first because it indicates which domains of behavior are regarded as the most self-relevant. It is in these domains that the strongest links between personality and behavior will be observed. Second, self-knowledge cognitively represents desired and undesired states for the self, as well as specific ideas about how to realize or avoid these states. It thus indicates the likely course of behavior in self-relevant domains. A number of recent research efforts can be intepreted as explorations of self-knowledge. These are briefly reviewed and integrated to provide a general outline for an expanded view of self-knowledge.     

A dimensional model of personality disorder: incorporating DSM Cluster A characteristics

The authors articulate an expanded dimensional model of personality pathology to better account for symptoms of DSM-defined Cluster A personality disorders. Two hundred forty participants (98 first-degree relatives of probands with schizophrenia or schizoaffective disorder, 92 community control participants, and 50 first-degree relatives of probands with bipolar disorder) completed a dimensional personality pathology questionnaire, a measure of schizotypal characteristics, and Chapman measures of psychosis proneness. Scales from all questionnaires were subjected to an exploratory factor analysis with varimax rotation. A 5-factor structure of personality pathology emerged from the analyses, with Peculiarity forming an additional factor to the common 4-factor structure of personality pathology (consisting of Introversion, Emotional Dysregulation, Antagonism, and Compulsivity). These results support a 5-factor dimensional model of personality pathology that better accounts for phenomena encompassed by the Cluster A personality disorders in DSM-IV-TR (4th ed., text revised; American Psychiatric Association, 2000). This study has implications for the consideration of a dimensional model of personality disorder in DSM-V by offering a more comprehensive structural model that builds on previous work in this area.     

Psychic skin: psychotic defences, borderline process and delusions

In this paper, I apply the concept of psychic skin to analytic work with people suffering from personality disorders and psychoses. When psychoses emerge, the defensive skin which protects the ego is breached and violent unconscious forces rip through the personality. Some of the patients diagnosed as schizophrenic with whom I work have identified with archetypal characters such as Christ, Satan, John Lennon and the Queen. I attempt to show how the adoption of these inflated personas can serve as secondary psychic skins. Such delusional identifications can provide a protective shield to hide the denuded self and prevent intrusion from the external world. Through clinical example, I try to demonstrate how these archetypal 'second skins' can preserve life until internal and external conditions make it possible for the self to emerge. I contrast such psychotic identifications with 'thin-skinned' and 'thick-skinned' narcissism as well as 'defences of the self' in borderline states where the psychic skin may be damaged but does not disintegrate. I also look at the ways in which Jung's own personal experience was different from this and how he managed to avert psychotic breakdown.     

Neurobiological dimensional models of personality: a review of the models of Cloninger, Depue, and Siever

Neurobiological dimensional models of personality aim to account for the structure of personality traits and disorders through links to neurotransmitter systems. Three such models are reviewed: those of Cloninger, Depue, and Siever. While these proposals have heuristic value, none of them has obtained strong empirical support. Our current understanding of neurobiology is insufficient to develop a model of personality on this basis. At this point, dimensions of personality should be derived from factor analysis rather than from neurobiological theories.     

New Directions in the Conceptualization and Assessment of Personality—A Dynamic Systems Approach

In this paper, we demonstrate how an integrative approach to personality—one that combines within-person and between-person differences—can be achieved by drawing on the principles of dynamic systems theory. The dynamic systems perspective has the potential to reconcile both the stable and dynamic aspect of personality, it allows including different levels of analysis (i.e. traits and states), and it can account for regulatory mechanisms, as well as dynamic interactions between the elements of the system, and changes over time. While all of these features are obviously appealing, implementing a dynamic systems approach to personality is challenging. It requires new conceptual models, specific longitudinal research designs, and complex data analytical methods. In response to these issues, the first part of our paper discusses the Personality Dynamics model, a model that integrates the dynamic systems principles in a relatively straightforward way. Second, we review associated methodological and statistical tools that allow empirically testing the PersDyn model. Finally, the model and associated methodological and statistical tools are illustrated using an experience sampling methodology data set measuring Big Five personality states in 59 participants (N = 1916 repeated measurements). © 2020 The Authors. European Journal of Personality published by John Wiley & Sons Ltd on behalf of European Association of Personality Psychology     

Borderline personality disorder,complex trauma,and problems with self and identity: A social-communicative approach

Borderline personality disorder (BPD) is a relatively highly prevalent psychiatric disorder that is associated with very high personal and socioeconomic costs. This paper provides a state-of-the-art review of the relationship between complex trauma and key features of BPD, with a focus on problems with self-coherence and self-continuity. We first review evidence for the high prevalence of complex trauma in BPD patients. This is followed by a discussion of emerging knowledge concerning the biobehavioral mechanisms involved in problems related to self and identity in BPD. We emphasize three biobehavioral systems that are affected by complex trauma and are centrally implicated in identify diffusion in BPD: the attachment system, mentalizing or social cognition, and the capacity for epistemic trust—that is, an openness to the reception of social communication that is personally relevant and of generalizable significance. We formulate a new approach to personality and severe personality disorders, and to problems with self and identity in these disorders, rooted in a social-communicative understanding of the foundations of selfhood. We also discuss how extant evidence-based treatments address the above-mentioned biobehavioral systems involved in identity diffusion in BPD and related disorders, and the supporting evidence. We close the paper with recommendations for future research.     

Toward a model for assessing level of personality functioning in DSM-5, part I: a review of theory and methods

Personality disorders are associated with fundamental disturbances of self and interpersonal relations, problems that vary in severity within and across disorders. This review surveyed clinician-rated measures of personality psychopathology that focus on self-other dimensions to explore the feasibility and utility of constructing a scale of severity of impairment in personality functioning for DSM-5. Robust elements of the instruments were considered in creating a continuum of personality functioning based on aspects of identity, self-direction, empathy, and intimacy. Building on preliminary findings (Morey et al., 2011 /this issue), the proposed Levels of Personality Functioning will be subjected to extensive empirical testing in the DSM-5 field trials and elsewhere. The resulting version of this severity measure is expected to have clinical utility in identifying personality psychopathology, planning treatment, building the therapeutic alliance, and studying treatment course and outcome.     

Identifying Personality Pathology Associated With Major Depressive Episodes: Incremental Validity of Informant Reports

Major limitations are associated with the use of a single source of information to assess personality pathology. The construct validity of standardized interviews and informant reports on personality pathology has been established relative to other measures of personality pathology, but it is also important to consider these measures in relation to other constructs that should be related to personality pathology. One example is major depression. In this study, we evaluated whether less common clinical methods of assessment for measuring the same personality pathology constructs, including semistructured interviews and informant reports, demonstrate unique validity, using major depressive episode (MDE) as the external criterion. This analysis focuses on a representative, community-based sample of 1,437 participants and informants. We conducted a hierarchical logistic regression analysis and determined the order of entering the predictor variables based on likelihood of being used in a clinical setting as well as empirical recommendations. Each step of our regression model significantly increased our ability to predict lifetime MDE, including self, interviewer, and informant reports of personality pathology. Overall, these findings indicate that multiple sources of personality assessment provide unique information about the relationship between maladaptive personality traits and a history of MDE. Thus, semistructured diagnostic interviews and informant reports can be used as a resource to improve the validity of personality assessments.