Assessment of DSM–5 Personality Disorder

The purpose of this article is to present an approach to defining, identifying, and assessing personality disorders, including the links between these definitions and personality assessment, with a particular reference to the proposed revisions to the personality disorders section of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM–5]; American Psychiatric Association, 2013 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Routledge.[Crossref] , [Google Scholar]). The article discusses measures of maladaptive variants of the Five-factor model (FFM) that are coordinated with both the traditional personality disorder syndromes as well as the DSM–5 dimensional trait model. Discussed as well is the assessment of the more psychodynamically oriented deficits in sense of self and interpersonal relatedness that are also included within the hybrid model proposed for DSM–5.     

Development of a Response Inconsistency Scale for the Personality Inventory for DSM–5

The advent of a dimensional model of personality disorder included in DSM–5 has necessitated the development of a new measurement scheme, specifically a self-report questionnaire termed the Personality Inventory for DSM–5 (PID–5; Krueger, Derringer, Markon, Watson, &; Skodol, 2012 Krueger, R. F., Derringer, J., Markon, K. E., Watson, D., &; Skodol, A. E. (2012). Initial construction of a maladaptive personality trait model and inventory for DSM–5. Psychological Medicine, 42, 1879–1890. doi:10.1017/S0033291711002674[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]). However, there are many threats to the validity of a self-report measure, including response inconsistency. This study outlines the development of an inconsistency scale for the PID–5. Across both college student and clinical samples, the inconsistency scale was able to reliably differentiate real from random responding. Random responses led to increased scores on the PID–5 facets, indicating the importance of detecting inconsistent responding prior to test interpretation. Thus, this inconsistency scale could be of use to researchers and clinicians in detecting inconsistent responses to this new personality disorder measure.     

Assessment of DSM–5 Section II Personality Disorders With the MMPI–2–RF in a Nonclinical Sample

The Minnesota Multiphasic Personality Inventory–2–Restructured Form (MMPI–2–RF; Ben-Porath &; Tellegen, 2008 Kamphuis, J. H., Arbisi, P. A., Ben-Porath, Y. S., &; McNulty, J. L. (2008). Detecting comorbid Axis-II status among inpatients using the MMPI–2 restructured clinical scales. European Journal of Psychological Assessment, 24, 157–164. doi:10.1027/1015-5759.24.3.157[Crossref], [Web of Science ®] , [Google Scholar]/2011 Ben-Porath, Y. S., &; Tellegen, A. (2011). Minnesota Multiphasic Personality Inventory–2 Restructured Form: Manual for administration, scoring, and interpretation. Minneapolis: University of Minnesota Press. (Original work published 2008) [Google Scholar]) is frequently used in clinical practice. However, there has been a dearth of literature on how well this instrument can assess symptoms associated with personality disorders (PDs). This investigation examined a range of hypothesized MMPI–2–RF scales in predicting PD symptoms. We evaluated these associations in a sample of 397 university students who had been administered the MMPI–2–RF and the Structured Clinical Interview for DSM–IV Axis II Disorders–Personality Questionnaire (First, Gibbon, Spitzer, Williams, &; Benjamin, 1997 First, M. B., Gibbon, M., Spitzer, R. L., Williams, J. B. W., &; Benjamin, L. S. (1997). Structured Clinical Interview for DSM–IV Axis II personality disorders (SCID–II). Washington, DC: American Psychiatric Press. [Google Scholar]). Zero-order correlation analyses and negative binomial regression models indicated that a wide range of MMPI–2–RF scale hypotheses were supported; however, the least support was available for predicting schizoid and obsessive–compulsive PDs. Implications for MMPI–2–RF interpretation and PD diagnosis are discussed.     

The Effect of Response Bias on the Personality Inventory for DSM–5 (PID–5)

Valid self-report assessment of psychopathology relies on accurate and credible responses to test questions. There are some individuals who, in certain assessment contexts, cannot or choose not to answer in a manner typically representative of their traits or symptoms. This is referred to, most broadly, as test response bias. In this investigation, we explore the effect of response bias on the Personality Inventory for DSM–5 (PID–5; Krueger, Derringer, Markon, Watson, & Skodol, 2013 Krueger, R. F., Derringer, J., Markon, K. E., Watson, D., & Skodol, A. E. (2013). The Personality Inventory for DSM–5 (PID–5)–Adult (Full version). Washington, DC: American Psychiatric Association. [Google Scholar]), a self-report instrument designed to assess the pathological personality traits used to inform diagnosis of the personality disorders in Section III of DSM–5. A set of Minnesota Multiphasic Personality Inventory Restructured Form (MMPI–2–RF; Ben-Porath & Tellegen, 2008 Tellegen, A., & Ben-Porath, Y. S (2008). MMPI–2–RF technical manual. Minneapolis: University of Minnesota Press. [Google Scholar]/2011 Ben-Porath, Y. S., & Tellegen, A. (2011). MMPI–2–RF manual for administration, scoring, and interpretation. Minneapolis: University of Minnesota Press. (Original work published 2008) [Google Scholar]) validity scales, which are used to assess and identify response bias, were employed to identify individuals who engaged in either noncredible overreporting (OR) or underreporting (UR), or who were deemed to be reporting or responding to the items in a “credible” manner—credible responding (CR). A total of 2,022 research participants (1,587 students, 435 psychiatric patients) completed the MMPI–2–RF and PID–5; following protocol screening, these participants were classified into OR, UR, or CR response groups based on MMPI–2–RF validity scale scores. Groups of students and patients in the OR group scored significantly higher on the PID–5 than those students and patients in the CR group, whereas those in the UR group scored significantly lower than those in the CR group. Although future research is needed to explore the effects of response bias on the PID–5, results from this investigation provide initial evidence suggesting that response bias influences scale elevations on this instrument.     

Hierarchical Structure and Cross-Cultural Measurement Invariance of the Norwegian Version of the Personality Inventory for DSM–5

The Personality Inventory for DSM–5 (PID–5) was created to aid a trait-based diagnostic system for personality disorders (PDs) in the Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM–5]; American Psychiatric Association, 2013a American Psychiatric Association. (2013a). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.[Crossref] , [Google Scholar]). In this study, we aimed to evaluate the Norwegian version of the PID–5 by examining its score reliability, hierarchical structure, congruency with international findings, and cross-cultural measurement invariance with a matched U.S. sample. For this purpose, 503 university students (76% females) were administered the PID–5. The Norwegian PID–5 showed good score reliability and structural validity from 1 to 5 factors. The 5-factor structure was generally congruent with international findings, and support for measurement invariance across the Norwegian and a matched U.S. sample was found. Conclusively, the results indicate that scores on the Norwegian PID–5 have sound psychometric properties, which are substantially comparable with the original U.S. version, supporting its use in a Norwegian population.     

The Validity and Clinical Utility of the Personality Inventory for DSM–5 Response Inconsistency Scale

The Personality Inventory for DSM–5 (PID–5; Krueger, Derringer, Markon, Watson, & Skodol, 2012) is a self-report instrument designed to assess the personality traits of the alternative model of personality disorders (AMPD) in Section III of the DSM–5. Despite its relatively recent introduction to the field, the instrument is frequently and widely used. One criticism of this instrument is that it does not include validity scales to detect potentially invalidating response style, including noncredible over- and underreporting and inconsistent (random) responding. Keeley, Webb, Peterson, Roussin, and Flanagan (2016) constructed an inconsistency scale (the PID–5–INC) to assess random responding on PID–5 and proposed a number of potential cut scores that could be applied. In this study, we attempted to cross-validate the PID–5–INC, including whether the scale could detect randomly generated protocols and distinguish them from nonrandom protocols produced by two student and two clinical samples. The PID–5–INC successfully distinguished random from nonrandom protocols and the best cut scores were similar to those reported by Keeley et al. (2016). We also found that a relatively low amount of random responding compromised the psychometric validity of the PID–5 trait scales, which extended previous work on this instrument.     

Using Clinician-Rated Five-Factor Model Data to Score the DSM–IV Personality Disorders

Proposals suggest that many or all of the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM–IV]; American Psychiatric Association, 1994) personality disorders (PDs) may be omitted from the DSM (5th ed.; DSM–V) and replaced with a dimensional trait model of personality pathology (Krueger, Skodol, Livesley, Shrout, &; Huang, 2007 Krueger, R. F., Skodol, A. E., Livesley, W. J., Shrout, P. E. and Huang, Y. 2007. Synthesizing dimensional and categorical approaches to personality disorders: Refining the research agenda for DSM-V Axis II. International Journal of Methods in Psychiatric Research, 16: 65–73. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]; Skodol, 2009 Skodol, A. 2009. Emerging DSM-V perspectives on personality disorders. Plenary address presented at the Eleventh International ISSPD Congress. August2009, New York, New York.  [Google Scholar]). Several authors have expressed concerns that this may be difficult for clinicians and researchers who are more comfortable with the extant PD diagnoses. In this study, we tested whether clinician ratings of traits from the Five-factor model (FFM; Costa &; McCrae, 1990) can be used to recreate DSM–IV PDs. Using a sample of 130 clinical outpatients, we tested the convergent and discriminant validity of the FFM PD counts in relation to consensus ratings of the DSM–IV PDs. We then examined whether the FFM and DSM–IV PD scores correlate in similar ways with self-reported personality traits from the Schedule for Nonadaptive and Adaptive Personality (Clark, 1993 Clark, L. A. 1993. Manual for the Schedule for Nonadaptive and Adaptive Personality (SNAP), Minneapolis: University of Minnesota Press.  [Google Scholar]). Finally, we tested the clinical utility of the FFM PD counts in relation to functional impairment. Overall, the FFM PD counts, scored using clinician ratings of the FFM traits, appeared to function like the DSM–IV PDs, thus suggesting that the use of a dimensional trait model of personality in the DSM–V may still allow for an assessment of the DSM–IV PD constructs.     

Contributions to the Dimensional Assessment of Personality Disorders Using Millon's Model and the Millon Clinical Multiaxial Inventory (MCMI–III)

To determine if psychopaths with low anxiety are afflicted with a variety of neurosis, groups of psychopaths reporting low and high anxiety were examined with a variety of projective techniques. The use of repressive defenses, accuracy of cognition, and existence of areas of intrapsychic conflict were compared. Variance analyses indicated that the low anxious psychopaths represented a mixture of psychopathic types with a wide range of use of repressive mechanisms. Analysis of uncommon themes on the TAT produced a list of apparent appropriateness for both types of subjects.     

Trait Variance and Response Style Variance in the Scales of the Personality Inventory for DSM–5 (PID–5)

Using self- and observer reports on the Personality Inventory for DSM–5 (PID–5) and the HEXACO Personality Inventory–Revised (HEXACO–PI–R), we identified for each inventory several trait dimensions (each defined by both self- and observer reports on the facet-level scales belonging to the same domain) and 2 source dimensions (each defined by self-reports or by observer reports, respectively, on all facet-level scales). Results (N = 217) showed that the source dimensions of the PID–5 were very large (much larger than those of the HEXACO–PI–R), and suggest that self-report (or observer report) response styles substantially inflate the intercorrelations and the alpha reliabilities of the PID–5 scales. We discuss the meaning and the implications of the large PID–5 source components, and we suggest some methods of controlling their influence.     

Mapping the Personality Psychopathology Five Domains Onto DSM–IV Personality Disorders in Dutch Clinical and Forensic Samples: Implications for DSM–5

The Personality Psychopathology Five (PSY–5) model represents 5 broadband dimensional personality domains that align with the originally proposed DSM–5 personality trait system, which was eventually placed in Section III for further study. The main objective of this study was to examine the associations between the PSY–5 model and personality disorder criteria. More specifically, we aimed to determine if the PSY–5 domain scales converged with the alternative DSM–5 Section III model for personality disorders, with a particular emphasis on the personality trait profiles proposed for each of the specific personality disorder types. Two samples from The Netherlands consisting of clinical patients from a personality disorder treatment program (n = 190) and forensic psychiatric hospital (n = 162) were used. All patients had been administered the MMPI–2 (from which MMPI–2–RF PSY–5 scales were scored) and structured clinical interviews to assess personality disorder criteria. Results based on Poisson or negative binomial regression models showed statistically significant and meaningful associations for the hypothesized PSY–5 domains for each of the 6 personality disorders, with a few minor exceptions that are discussed in detail. Implications for these findings are also discussed.     

A Psychometric Review of the Personality Inventory for DSM–5 (PID–5): Current Status and Future Directions

The paradigm of personality psychopathology is shifting from one that is purely categorical in nature to one grounded in dimensional individual differences. Section III (Emerging Measures and Models) of the Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM–5]; American Psychiatric Association, 2013), for example, includes a hybrid categorical/dimensional model of personality disorder classification. To inform the hybrid model, the DSM–5 Personality and Personality Disorders Work Group developed a self-report instrument to assess pathological personality traits—the Personality Inventory for the DSM–5 (PID–5). Since its recent introduction, 30 papers (39 samples) have been published examining various aspects of its psychometric properties. In this article, we review the psychometric characteristics of the PID–5 using the Standards for Educational and Psychological Testing as our framework. The PID–5 demonstrates adequate psychometric properties, including a replicable factor structure, convergence with existing personality instruments, and expected associations with broadly conceptualized clinical constructs. More research is needed with specific consideration to clinical utility, additional forms of reliability and validity, relations with psychopathological personality traits using clinical samples, alternative methods of criterion validation, effective employment of cut scores, and the inclusion of validity scales to propel this movement forward.     

Validity Rates of the Personality Assessment Inventory and the Minnesota Multiphasic Personality Inventory–2 in a VA Medical Center Setting

This paper presents some notions regarding the all important question of projective stimulus ambiguity. It is suggested that in spite of the observation that TAT stimulus ambiguity has been the most studied, the problem of stimulus ambiguity must be considered a vital problem in relation to projective tests as a whole. Findings specific to an extended DAP (involving the inclusion of a self-portrait) are reported and the relevance of these findings to the problem of stimulus ambiguity is discussed.     

Construct Validity of the DSM–5 Section III Personality Trait Profile for Borderline Personality Disorder

This study evaluated the nomological network of the borderline personality disorder (BPD) trait profile in the Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM–5]) Section III. BPD symptoms include a variety of maladaptive thoughts and behaviors, and it is important to determine if the Section III trait operationalization for BPD captures these behavioral symptoms, as well as shows similar associations as the traditional Section II version with external criteria. For this purpose, we used a sample of 285 undergraduate students and conducted correlation and regression analyses to delineate the associations between Section III BPD traits and conceptually relevant external criteria. A Section III Total score was meaningfully associated with all criteria. Moreover, externalizing psychopathology tended to be most highly associated with disinhibitory Section III BPD traits, whereas internalizing psychopathology tended to have its strongest unique associations with traits reflective of negative affectivity. These results provide support for the construct validity of the trait profile for BPD in DSM–5 Section III.     

The MMPI–2 Restructured Form Personality Psychopathology Five Scales: Bridging DSM–5 Section 2 Personality Disorders and DSM–5 Section 3 Personality Trait Dimensions

This study examined in a college sample and a sample of non-treatment-seeking, trauma-exposed veterans the association between the MMPI–2 Restructured Form (MMPI–2–RF) Personality Psychopathology Five (PSY–5) Scales and DSM–5 Section 2 personality disorder (PD) criteria, the same system used in DSM–IV–TR, and the proposed broad personality trait dimensions contained in Section 3 of DSM–5. DSM–5 Section 2 PD symptoms were assessed using the SCID–II–PQ, and applying a replicated rational selection procedure to the SCID–II–PQ item pool, proxies for the DSM–5 Section 3 dimensions and select facets were constructed. The MMPI–2–RF PSY–5 scales demonstrated appropriate convergent and discriminant associations with both Section 2 PDs and Section 3 dimensions in both samples. These findings suggest the MMPI–2–RF PSY–5 scales can serve both conceptually and practically as a bridge between the DSM–5 Section 2 PD criteria and the DSM–5 Section 3 personality features.     

Introduction to the Special Section on the Personality Psychopathology Five (PSY–5) and DSM–5 Trait Dimensional Diagnostic Systems for Personality Disorders: Emerging Convergence

In this Special Section, 7 studies focusing on the PSY–5 model of individual differences relevant to adaptive functioning are presented. The first study by Harkness, McNulty, et al. (this issue) describes the development of the revised PSY–5 scales for the MMPI–2–RF, followed by another article by Harkness, Reynolds, and Lilienfeld (this issue) arguing for the adoption of a review of systems strategy for evaluating psychological functioning. McNulty and Overstreet (this issue) describe an alternative hierarchical strategy for organizing the interpretation of the MMPI–2–RF using the PSY–5 scales. Extending the PSY–5 model to adolescents, Veltri et al. (this issue) examine the convergent and discriminant validity of the MMPI–A PSY–5 in predicting violent delinquent behavior. Bagby and colleagues (this issue) examine the hierarchical structure of the PSY–5 model across nonclinical and clinical samples and, with a few notable exceptions, find the PSY–5 model to map well onto the DSM–5 personality trait dimensional model. Finn, Arbisi, Erbes, Polusny, and Thuras (this issue) examine the convergence between the DSM–5 proposed trait dimensions and PSY–5 model demonstrating the potential for the MMPI–2–RF PSY–5 scales to serve as a bridge between DSM–5 and DSM–IV personality disorder diagnoses. Finally, Sellbom, Smid, de Saeger, Smit, and Kamphuis(this issue) directly examine the convergence of MMPI–2–RF PSY–5 scales with DSM–IV personality disorder categories and proposed DSM–5 trait dimensions further establishing the potential for the PSY–5 scales to serve as a bridge between DSM categorical and dimensional diagnostic schemas.     

Continuity Between DSM–5 Section II and III Personality Disorders in a Dutch Clinical Sample

The goal of this study was to evaluate the continuity across the Section II personality disorders (PDs) and the proposed Section III model of PDs in the Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM–5]; American Psychiatric Association, 2013a American Psychiatric Association. (2013a). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.[Crossref] , [Google Scholar]). More specifically, we analyzed association between the DSM–5 Section III pathological trait facets and Section II PDs among 110 Dutch adults (M age = 35.8 years, range = 19–60 years) receiving mental health care. We administered the Structured Clinical Interview for DSM–IV Axis II Disorders to all participants. Participants also completed the self-report Personality Inventory for DSM–5 (PID–5) as a measure of pathological trait facets. The distributions underlying the dependent variable were modeled as criterion counts, using negative binomial regression. The results provided some support for the validity of the PID–5 and the DSM–5 Section III Alternative Model, although analyses did not show a perfect match. Both at the trait level and the domain level, analyses showed mixed evidence of significant relationships between the PID–5 trait facets and domains with the traditional DSM–IV PDs.     

How popular is the Personality Assessment Inventory in practice and training?

A review of recent survey data indicates that the Personality Assessment Inventory ranks among the most frequently used objective personality tests in practice and clinical training.     

Society for Personality Assessment — the Way to Go

For six consecutive days, six series of inkblots, similar to Rorschach cards, were shown to six male and six female university students. The results showed that the M + Sum C scores fluctuate close to a sine curve. According to Rorschach M and color responses are sensitive to mood changes. Therefore these results suggest that different persons have mood changes with different amplitudes and periods. It also points out that the current use of test-retest reliability measurements of these scores are not appropriate and the criticisms of Rorschach based on the poor test-retest reliability measurements of these scores are unwarranted.     

A Comparison of Passive–Aggressive and Negativistic Personality Disorders

Passive–aggressive personality disorder (PAPD) has historically played an important role in clinical theorizing and was diagnosable prior to the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM–IV]; American Psychiatric Association, 1994), in which the construct was relabeled negativistic (NEGPD), expanded to include negative affective symptoms, and appendicized. In this study we tested the hypothesis that the expansion of PAPD to include content related to negative moods and nonspecific personality pathology compromised its discriminant validity. In an undergraduate sample (N = 1,215), a self-report measure of PAPD was only moderately related to NEGPD and showed less diagnostic overlap with other personality disorders than NEGPD. Furthermore, a conjoint factor analysis yielded a strong first factor (moodiness) that appeared less specific to passive–aggressive behavior than 3 other factors (irresponsibility, inadequacy, and contempt). We conclude that future research on this potentially important clinical construct should focus on core passive–aggressive features and abandon the negativistic content that has been added to it in successive editions of the DSM.