Trait correlates of relational aggression in a nonclinical sample: DSM-IV personality disorders and psychopathy

The implications of adult relational aggression in adults for personality pathology are poorly understood. We investigated the association between relational aggression and features of DSM-IV personality disorders and psychopathy in a sample of undergraduates (N = 220). In contrast to the childhood literature, we found no significant difference in relational aggression between men and women. Unlike overt aggression, which correlated about equally highly with features of all three personality disorder clusters, relational aggression correlated significantly more highly with features of Cluster B than Clusters A or C. In addition, even after controlling for overt aggression, relational aggression correlated significantly with features of psychopathy, although only with Factor 2 traits. With the exception of sadistic personality disorder features, gender did not moderate the relationship between relational aggression and personality pathology. Further research on the psycho-pathological implications of relational aggression in more severely affected samples is warranted.     

Diagnostic efficiency of the Iowa personality disorder screen items in a nonclinical sample

The diagnostic efficiency of the 11-item Iowa Personality Disorder Screen (IPDS; Langbehn et al., 1999) was evaluated in a nonclinical sample of young adults, 35% of whom met DSM-III-R criteria for a personality disorder, in a retrospective analysis of SIDP-R data. Results indicated that two IPDS item sets (i.e., combinations of items) produced hit rates of more than 80% along with good sensitivity, specificity, positive predictive power, and negative predictive power. Combined with the findings of Langbehn et al. (1999), these results suggest that the IPDS may be useful as a screening measure for personality disorder in both clinical and nonclinical populations.     

Assessing the DSM-IV structure of personality disorder with a sample of Chinese psychiatric patients

The validity of the three-cluster system of personality disorders (PDs) in the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; APA, 1994) was examined in a sample of Chinese psychiatric patients (n = 227), who completed the self-report Personality Disorders Questionnaire for DSM-IV (PDQ-4; Hyler, 1994) and who were also administered the clinician-rated Personality Disorders Interview-IV (PDI-IV; Widiger, Mangine, Corbit, Ellis, & Thomas,). Using confirmatory factor analysis, a three-factor model corresponding to the DSM-IV clusters was tested and compared statistically to a one-factor model and a set of random, three-factor models. Only the clinician-rated instrument supported the DSM-IV three-cluster model, and then only when the factors were allowed to correlate. Results from the theoretically more rigorous uncorrelated model testing did not support the DSM-IV model for either assessment modality.     

The structure of traits delineating personality disorder in a Chinese sample

The present study examined the factorial structure of a Chinese language version of the self-report Dimensional Assessment of Personality Pathology Questionnaire in 581 adults. Four factors were extracted (Emotional Dysregulation, Dissocial, Inhibition, and Compulsivity) that are similar to the factors extracted in the scales' normative clinical and general population samples from North America (factor comparability coefficients range from .88 to .96), supporting the idea that this trait structure is invariant across diverse populations. The internal consistency of the scales (Cronbach's alpha) was satisfactory across age and gender groups with the exception of the Intimacy Problems scale. Possible explanations for the poor internal consistency of the Intimacy Problems scale, such as cultural differences in social factors influencing marital and romantic relationships in Chinese populations, as opposed to other populations are discussed.     

DSM-5 personality traits and DSM-IV personality disorders

Two issues pertinent to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) proposal for personality pathology, the recovery of DSM-IV personality disorders (PDs) by proposed DSM-5 traits and the validity of the proposed DSM-5 hybrid model, which incorporates both personality pathology symptoms and maladaptive traits, were evaluated in a large undergraduate sample (N = 808). Proposed DSM-5 traits as assessed with the Personality Inventory for DSM-5 explained a substantial proportion of variance in DSM-IV PDs as assessed with the Personality Diagnostic Questionnaire-4+, and trait indicators of the 6 proposed DSM-5 PDs were mostly specific to those disorders with some exceptions. Regression analyses support the DSM-5 hybrid model in that pathological traits, and an indicator of general personality pathology severity provided incremental information about PDs. Findings are discussed in the context of broader issues around the proposed DSM-5 model of personality disorders.     

Borderline personality traits in nonclinical young adults

The main purpose of this study was to explore the dimensionality of the borderline personality disorder in nonclinical young adults by means of the Borderline Personality Questionnaire (BPQ; Poreh et al., 2006). We also studied the phenotypic expression of the borderline personality traits as a function of participants' gender and age, and the relationship between BPQ subscales and measures of depressive symptoms, anxiety, stress, hallucinatory predisposition, and paranoid ideation. The sample comprised 809 young adults, 562 (69.5%) were women, with a mean age of 20.2 years (SD = 2.9). The results indicate that the BPQ self-report has adequate psychometric properties. The levels of internal consistency for the BPQ subscales ranged between .78 and .93. Analysis of the internal structure of the BPQ subscales yielded a one-dimensional solution. In contrast, second-order principal components analysis at the item level yielded a five-dimensional solution. Likewise, statistically significant differences in the mean scores of the borderline personality traits as a function of participants' gender and age were found. The BPQ subscales correlated significantly with measures of depression, anxiety, stress, paranoid ideation, and hallucinatory predisposition. These results help to improve our understanding of the dimensional structure of the borderline personality in the general population. Future research should continue to identify participants who are at risk for the development of borderline personality disorder and facilitating the development of early detection and prevention programs.     

Predicting personality disorder traits with the Defense Style Questionnaire in a normal sample.

This research examined the efficacy of the 40-item Defense Style Questionnaire (DSQ-40), measuring mature, neurotic and immature defense styles, to predict DSM-III-R personality disorders. The Coolidge Axis II Inventory, the Millon Clinical Multiaxial Inventory-II, and the MMPI personality disorder scales were used to measure 11 personality disorders in a nonclinical sample. The results show that most personality disorders are positively associated with the highly maladaptive immature defense style, and negatively associated with the mature defense style. Multiple regression analyses reveal that the combined variance accounted for by the defense styles range from 12% to 42% on the CATI, 3% to 42% on the MCMI-II, and 2% to 32% on the MMPI-PD. However, specific personality disorders cannot be predicted with the defense styles on any measure.     

Evaluation of the SCID-II personality disorder traits for DSM-IV: coherence, discrimination, relations with general personality traits, and functional impairment

The utility of the DSM personality disorder (PD) system remains a concern. The strategy employed represents one approach designed to evaluate and improve the diagnostic efficiency of the SCID-II PDs. Using a sample of 203 patients, SCID-II PD items-based on the criterion sets of the 10 DSM-IV PDs-were evaluated with respect to (a) convergent validity; (b) divergent validity; (c) relation to general personality traits; and (d) association with functional impairment. Only Borderline PD items were satisfactory on all four evaluation criteria. Histrionic and Obsessive-Compulsive PD items met criteria for convergent and divergent validity and relation to personality dimensions of the Five-Factor Model of Personality (FFM) but were not related to functional impairment, suggesting they might be reconsidered as disorders. Schizotypal PD items met three of the four criteria but showed no relation to FFM dimensions, suggesting that it may be a candidate for reassignment to Axis I.     

Psychopathy and the DSM-IV criteria for antisocial personality disorder

The Axis II Work Group of the Task Force on DSM-IV has expressed concern that antisocial personality disorder (APD) criteria are too long and cumbersome and that they focus on antisocial behaviors rather than personality traits central to traditional conceptions of psychopathy and to international criteria. We describe an alternative to the approach taken in the rev. 3rd ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R; American Psychiatric Association, 1987), namely, the revised Psychopathy Checklist. We also discuss the multisite APD field trials designed to evaluate and compare four criteria sets: the DSM-III-R criteria, a shortened list of these criteria, the criteria for dyssocial personality disorder from the 10th ed. of the International Classification of Diseases (World Health Organization, 1990), and a 10-item criteria set for psychopathic personality disorder derived from the revised Psychopathy Checklist.     

Opinions of personality disorder experts regarding the DSM-IV personality disorders classification system

OBJECTIVE: To survey the opinions of personality disorder (PD) experts on possible revisions in the classification system for PDs in the DSM-V. METHOD: Four hundred members of two international associations, the Association for Research on Personality Disorders, and the International Society for the Study of Personality Disorders, were asked to take a 78-item web survey. RESULTS: Of the experts who completed the survey (N = 96), 74% felt that the DSM-IV's categorical system of PD diagnosis should be replaced. Eighty percent felt that PDs are better conceived of as personality dimensions or illness spectra, than as categories. The most frequently endorsed alternative system for PDs was a mixed system of categories and dimensions. Most experts preferred the PDs to remain on Axis II. Only 31.3% wanted the term, "Borderline Personality Disorder," retained in the DSM-V. CONCLUSIONS: A clear majority of the PD experts were dissatisfied with the current diagnostic system for PDs.     

Genetic and environmental contributions to the co-occurrence of depressive personality disorder and DSM-IV personality disorders

One of the main controversies with regard to depressive personality disorder (DPD) concerns the co-occurrence with the established DSM-IV personality disorders (PDs). The main aim of this study was to examine to what extent DPD and the DSM-IV PDs share genetic and environmental risk factors, using multivariate twin modeling. The DSM-IV Structured Interview for Personality was applied to 2,794 young adult twins. Paranoid PD from Cluster A, borderline PD from Cluster B, and all three PDs from Cluster C were independently and significantly associated with DPD in multiple regression analysis. The genetic correlations between DPD and the other PDs were strong (.53-.83), while the environmental correlations were moderate (.36-.40). Close to 50% of the total variance in DPD was disorder specific. However, only 5% was due to disorder-specific genetic factors, indicating that a substantial part of the genetic vulnerability to DPD also increases the vulnerability to other PDs.     

Perceived dysfunction of male-typed and female-typed DSM-IV personality disorder criteria

To determine whether female-typed personality disorders are associated with a different pattern of dysfunction than male-typed disorders, lay judges (N = 216) estimated the amount of social impairment, occupational impairment, and personal distress related to symptoms of personality disorders. Results for both the subset of six disorders originally rated by clinician judges in the research of Funtowicz and Widiger (1999) and for a larger set of nine disorders revealed a pattern originally reported by Funtowicz and Widiger where female-typed disorders were associated with relatively higher ratings of personal distress, whereas male-typed disorders were associated with relatively higher ratings of social (and sometimes occupational) impairment. Findings are discussed with respect to the emphasis of different forms of dysfunction for male- and female-typed disorders, lay versus clinician judgments, and directions for future research.     

Borderline personality: traits and disorder

Although the 5-factor model (FFM) has been advocated as an alternative to representing the construct of borderline personality, some argue that this diagnosis carries essential information that is not well captured by the FFM. The present study examined antecedent, concurrent, and predictive markers of construct validity in a sample of 362 patients with personality disorders. The results indicated that neuroticism best distinguished borderline and nonborderline patients, whereas the FFM as a whole captured a sizable proportion of the variance in the borderline diagnosis. However, the residual of the borderline diagnosis that was not explained by the FFM was found to be significantly related to childhood abuse history, family history of mood and substance use disorders, concurrent symptoms, and 2-year and 4-year outcomes. Thus, some elements of the borderline diagnosis may not be fully captured in a 5-factor representation.     

Reliability and validity of three screening measures of borderline personality disorder in a nonclinical population

This study explored reliability and validity of three self-report screening measures of borderline personality disorder (BPD): the Personality Assessment Inventory-Borderline Features Scale (PAI-BOR; Morey, 1991), Personality Diagnostic Questionnaire-4-BPD scale (PDQ4-BPD; Hyler, 1994) and Mclean Screening Instrument for BPD (MSI-BPD; Zanarini et al., 2003). Participants (N = 523) were drawn predominantly from community and student populations. All three measures were internally consistent. Confirmatory Factor Analysis of the PAI-BOR did not support Jackson and Trull’s (2001) six-factor structure or Morey’s (1991) four-factor structure. The three measures converged highly, despite the broader theoretical basis of the PAI-BOR. Expected demographic differences on the measures supported construct validity, and concurrent validity in relation to theoretical-related criteria was also supported. Only the PAI-BOR and PDQ4-BPD showed incremental validity in predicting specific criteria, although, the amount of unique variance predicted was small.     

Reliability of personality disorder symptoms and personality traits in substance-dependent inpatients

The authors compared the internal consistency, 1-year temporal stability, and self-informant agreement of ratings of personality trait (NEO Five-Factor Inventory; NEO-FFI; P. T. Costa & R. R. McCrae, 1992) and personality disorder symptom severity (Structured Clinical Interview for DSM-III-R Personality Disorders Questionnaire; SCID-II-Q; R. L. Spitzer, J. B. W. Williams, M. Gibbon, & M. First, 1990) in 131 substance-dependent inpatients. Internal consistency coefficients were acceptable to very good for most NEO-FFI and SCID-II-Q scales, and temporal stability correlations were significant for all measures. Agreement between patient and informant ratings was more modest. Substance abuse and depression symptom severity moderated the temporal stability and self-informant agreement of several personality trait and disorder ratings. The authors did not find that the five factors were more reliable than the Axis II symptoms. Issues related to the reliability of personality assessment in multiply diagnosed patients are discussed.     

Confirmatory factor analyses of DSM-IV Cluster C personality disorder criteria

Notwithstanding its research and clinical relevance, the dimensionality and validity of the DSM-IV avoidant, dependent, and obsessive-compulsive personality disorders (PDs) criteria is still a largely unexplored topic. The aim of this study was to test the factor structure for DSM-IV Cluster C PD criteria in a sample of 641 consecutively admitted outpatients. Factor analysis results suggested that avoidant, dependent, and obsessive-compulsive PDs share a common latent dimension, and supported the three-factor structure of both observer and self-report ratings of DSM-IV Cluster C PD criteria. The pattern of factor loadings, however, was different from the one expected according to the DSM-IV classification.     

The validity of DSM-IV passive-aggressive (negativistic) personality disorder

Passive-Aggressive (Negativistic) Personality Disorder (NEGPD), listed in Appendix B of the DSM-IV, is not an officially recognized personality disorder. Its future as a discrete disorder is uncertain (Widiger, 2003). Yet, NEGPD occupies a role in some theoretical formulations of personality pathology (Millon & Davis, 1996), and many clinicians believe that passive-aggressive traits are not adequately represented by other PDs (Westen, 1997). In this study, 1158 psychiatric outpatients were assessed for Axis I and Axis II disorders. Thirty-five (3.02%) met criteria for NEGPD. Participants with NEGPD did not differ significantly from those without NEGPD on demographic variables. The internal consistency of the DSM-IV's seven NEGPD items was 0.50. Corrected item- total correlations for the 7 criteria averaged 0.27. Participants with NEGPD had higher rates of lifetime anxiety disorders, and almost 90% had an additional PD. An exploratory factor analysis suggested a two- factor solution that accounted for 43.4% of the variance. The first factor reflected the belief that life is unfair, while the second factor seemed to reflect modes of anger expression. A confirmatory factor analysis showed that the two-factor model fit the data better than a unidimensional model. We discuss implications of these results for the future of the NEGPD diagnosis.     

Predicting borderline personality disorder features from personality traits, identity orientation, and attachment styles in Italian nonclinical adults: issues of consistency across age ranges

The aims of this study were to assess whether Borderline Personality Disorder (BPD) features could be predicted by Big Five traits, impulsivity, identity orientation, and adult attachment patterns in a sample of 1,192 adult nonclinical participants, and to evaluate the consistency of these regression models across four age groups (<30 years, 30-39 years, 40-49 years, and >50 years, respectively). In the full sample, measures of neuroticism (N), impulsivity, and anxious insecure attachment were substantial predictors of BPD features (adjusted R(2) = .38, p < .001). Attachment scales were significant predictors of BPD features across all age groups, but different scales were relevant in different age groups. Our results suggest that in nonclinical populations, BPD may represent a complex constellation of personality traits and disturbed attachment patterns.     

MCMI-II personality traits and symptom traits in parents of children with selective mutism: a case-control study.

The etiology of selective mutism (SM) in children is unknown but is regarded as multifactorial. SM is frequently associated with social anxiety and language disorder or delay. The present study addresses SM and social anxiety as a familial phenomenon by comparing self-reported personality traits and symptom traits (Millon Clinical Multiaxial Inventory) in parents of 50 SM children with control parents. Personality and symptom traits reflecting social anxiety are also explored separately in the parents of SM children with and without a comorbid communication disorder. The results confirm SM and social anxiety as a familial phenomenon. Assessment and treatment planning should take this into account. The family data also suggest different family transmissions of SM and social anxiety in the SM group with and without a comorbid communication disorder.     

Dimensional models of personality disorder: coverage and cutoffs

Two major challenges that must be addressed by dimensional models, if they are to be considered viable alternatives to the present categorical system for diagnosing personality disorders, involve the issues of coverage and cutoffs. Several dimensional models of personality and personality pathology are evaluated with these issues in mind. There is growing consensus for the relevance of at least four higher-order domains of personality functioning that are clearly related to personality pathology: neuroticism/negative affectivity/emotional dysregulation, extraversion/positive emotionality, dissocial/antagonistic behavior, and constraint/compulsivity/conscientiousness. A proposal for developing a dimensionally based diagnostic system for personality disorders incorporating these higher-order traits is offered.