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.     

Self- and peer perspectives on pathological personality traits and interpersonal problems

This study compares the relationship between personality disorders and interpersonal problems as obtained by self-report and peer-report measures. Participants (N = 393) were administered self- and peer-report versions of the Peer Inventory for Personality Disorder and the Inventory of Interpersonal Problems-64. Canonical analyses demonstrated similar relationships between personality disorder features and interpersonal problems as measured by either self or peer. Analyses between self and peer found little shared variance across sources, indicating a large method variance. Results indicate that although similar constructs are identified by self and peers in their understanding of personality pathology and associated interpersonal problems, self-report information overlaps very little with information obtained from peers, underscoring the importance of obtaining multiple sources of information.     

Personality traits in the DSM-5

Recent advances in personality research coupled with a broad acknowledgment of the limitations of the representation of personality pathology in the third and fourth editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III and DSM-IV) have positioned personality science to influence the shape of personality assessment in the fifth edition (DSM-5). Representing normative personality with well-validated traits that are broad, normally distributed, theoretically integrative, and distinct from personality disorder constructs would take optimal advantage of this opportunity. The assessment of normative traits would also link a large body of personality research with the practice of clinical diagnosis and would encourage clinicians to consider every patient's personality regardless of his or her diagnosis. Furthermore, conceptualizing personality traits and disorders separately would promote more careful clinical consideration of the functional severity and specific symptom constellations among personality disorders. Based on these considerations I argue that Five-factor model personality traits should be assessed separately from personality disorders in the DSM-5.     

Deriving an empirical structure of personality pathology for DSM-5

The DSM-IV model of personality disorders is composed of trait sets arranged into 10 theoretically distinct, polythetically assessed categories, with little regard for how the traits comprising these disorders are interrelated and structured. Research since the publication of DSM-III has shown that this model is untenable. The question is not whether this model needs revision; rather, the question is how to move from the existing DSM-IV framework to a model better connected with data. Empirically-based models of personality trait variation provide a starting point for DSM-5, and ongoing research will be used to delineate further the empirical structure of personality traits in the pathological range. The ultimate goal is to frame future DSMs in a way that is maximally useful for clinicians as well as researchers. It is also critical to understand that the DSM-5 is intended to be a living document that will facilitate novel inquiry and clinical applications, as opposed to a document designed to promote and perpetuate a fixed set of constructs. Thus, we view a proposed trait system as a first step on a path to a well-validated, clinically-useful structure.     

Assessing personality in the DSM-5: the utility of bipolar constructs

All previous editions of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) have described and assessed personality solely in terms of pathological categories. Nonetheless, there is compelling evidence that normal-range personality traits also provide clinically useful information, emphasizing the importance of thoroughly assessing both adaptive and maladaptive aspects of personality within a clinical context. The proposed inclusion of a dimensional trait model in the upcoming DSM-5 represents an important shift in the understanding of personality pathology and provides an ideal opportunity to integrate the assessment of normal personality into clinical practice. Building on research conceptualizing personality disorders as maladaptive, extreme variants of general personality traits, it is proposed that both normal and abnormal personality can be assessed within the same dimensional model using bipolar constructs. The inclusion of bipolar traits, such as a continuum ranging from introversion to extraversion, would hold numerous advantages for a dimensional model. These benefits include a strong foundation of existing validity research, comprehensive coverage of personality pathology, and the ability to provide useful information about all individuals. Despite potential complexities, the adoption of bipolar constructs within DSM-5's dimensional model presents the greatest opportunity to maximize efficiency, validity, and clinical utility.     

Introduction to the special issue on personality assessment in the DSM-5

The DSM-5 is poised to dramatically reshape the way clinicians and researchers assess personality by reconfiguring the conceptualization of DSM-IV personality disorders. This special issue brings together leading scholars in personality pathology, including members of the DSM-5 Personality and Personality Pathology Work Group, as well as personality assessors operating from a variety of theoretical perspectives, to describe various facets of these changes and their potential impacts and in some cases to propose alternative solutions. As we describe in this brief introductory article, the articles in this special issue highlight several important and controversial issues in the transition to DSM-5 personality assessment.     

An interpersonal perspective on the personality assessment process

Many aspects of therapeutic approaches to the personality assessment process derived from or are consistent with Sullivan's interpersonal approach to clinical practice, but the link between such approaches and contemporary interpersonal theory remains underdeveloped. In this article, I argue that contemporary interpersonal theory provides a valuable framework within which to conceptualize the personality assessment process. Specifically, I argue that interpersonal models can parsimoniously represent client behavior and can facilitate discussions of assessment data with assessees. Further, I show that hypotheses on the therapeutic mechanisms of personality assessment can be reframed in contemporary interpersonal metatheory so that they can be compared and tested directly.     

A critique of the proposed prototype rating system for personality disorders in DSM-5

The DSM-5 Personality and Personality Disorders (PDs) Work Group has recommended a reformulation of the PD section, one component of which is a replacement of specified operational criteria with a prototype matching dimensional rating system. The Work Group indicated that prototype ratings have been demonstrated to have good interrater reliability. No study was cited to support this statement, and a review of the reliability literature does not support this claim. The one study that directly compared the reliability of prototype and DSM-IV criteria counting approaches found the DSM-IV approach was much more reliably applied. The Work Group cited 2 studies supporting the validity of the prototype matching approach, one of which had significant methodological limitations and the other changed the a priori threshold on the PD prototype dimensional rating scale to categorize patients into PD positive and negative groups. The Work Group also cited 2 studies suggesting that prototype matching approaches are preferred by clinicians. Several studies have raised concerns about the adequacy of psychiatric diagnostic evaluations conducted in routine clinical practice thereby raising questions about the value of studies of clinicians' preferences in comparing different diagnostic practices. In conclusion, if the prototype matching dimensional approach described in the DSM-5 draft proposal is adopted, then it will have been adopted with essentially no empirical support demonstrating improved reliability or validity. In fact, there is evidence that reliability will be worse than the DSM-IV approach.     

Personality, interpersonal circumplex, and DSM-5: A commentary on five studies

Much of personality is interpersonal, and what is interpersonal can be elegantly organized through the crossing of 2 fundamental dimensions of personality: agency and communion. The interpersonal circumplex has enriched substantially what is known about personality and in particular personality disorder, emphasizing to clinicians the importance of considering maladaptive interpersonal functioning when conducting clinical assessments. The purpose of this article is to provide a commentary on 5 articles concerning the interpersonal perspective on personality assessment. The contributions of these 5 studies are also understood relative to the proposed revisions to the American Psychiatric Association's personality disorder nomenclature, as the proposed revisions will be cutting out half of the interpersonal circumplex from further recognition.     

Gender-related personality traits and interpersonal resource exchange among brother—sister relationships

Brother-sister relationships are understudied within the field of personal relationships. Accordingly, the present study examines patterns of interpersonal resource exchange (drawing upon resource exchange theory; Foa & Foa, 1974), along with influences of gender-related personality traits (i.e., agency and communion) on individuals’giving of interpersonal resources (i.e., affection and respect), among 79 brother-sister pairs. Consistent with predictions, brothers’and sisters’exchanges of both affection and respect were positive and significant. Also, consistent with predictions, communion was a positive and significant predictor of respectful behavior among sisters. However, contrary to hypotheses, communion did not achieve or approach significance as a predictor of respectful behavior among brothers, nor did communion achieve or approach significance as a predictor of affectionate behavior among sisters or brothers Implications for the study of male-female relationships in general—and brother-sister relationships in particular—are discussed.     

Toward a multidimensional model of personality disorder diagnosis: implications for DSM-5

This article outlines a model of personality disorder (PD) diagnosis that combines clinically useful constructs from the Diagnostic and Statistical Manual of Mental Disorders (DSM) with assessment procedures that maximize reliability and clinical utility while minimizing problems associated with threshold-based PD classification. I begin by addressing limitations in the current DSM conceptualization of PDs: excessive comorbidity, use of arbitrary cutoffs to distinguish normal from pathological functioning, failure to capture variations in the adaptive value of PD symptoms, and inattention to situational influences that shape PD-related behaviors. The revisions proposed by the DSM-5 Personality and Personality Disorders Work Group help resolve some of these issues, but create new problems in other areas. A better solution would be to employ a multidimensional model of PD diagnosis in which clinicians (a) assign a single dimensional rating of overall level of personality dysfunction, (b) provide separate intensity and impairment ratings for each PD dimension, and (c) list those personality traits-including PD-related traits-that enhance adaptation and functioning. Preliminary evidence bearing on the multidimensional model is reviewed, and broader clinical and empirical implications of the model are discussed.     

The DSM-5 dimensional model of personality disorder: rationale and empirical support

Ideally, a dimensional model of normal and abnormal personality functioning within the forthcoming DSM-5 would represent a common ground among the existing alternative models and would be consistent with the substantial body of empirical research that has accumulated on such models. The DSM-5 Work Group had the opportunity to make an historic step toward the integration of the normal personality traits researched within psychology with the personality disorders of psychiatry. They chose instead to construct a cumbersome six-dimensional model of personality disorder that excludes normal personality traits, is inconsistent with the preponderance of the research, and is distinguished explicitly from the predominant dimensional model of general personality structure.     

Reconceptualizing personality pathology in DSM-5: limitations in evidence for eliminating dependent personality disorder and other DSM-IV syndromes

The DSM-5 Personality and Personality Disorders Workgroup proposed that five DSM-IV personality disorders be eliminated as formal diagnostic categories (paranoid, schizoid, histrionic, narcissistic, and dependent), because these syndromes purportedly have low clinical utility and minimal evidence for validity. Scrutiny of studies cited in support of this proposal reveals difficulties in three areas: (1) Inadequate information regarding parameters of the literature search; (2) Mixed empirical support for proposed changes; and (3) Selective attention to certain disorders and not others. Review of validity and clinical utility data related to dependent personality disorder indicates that evidence regarding this syndrome does not differ from that of syndromes proposed for retention in DSM-5. Limitations in the research base cited by the workgroup illuminates gaps in the personality disorder literature, and may serve as a starting point for systematic research on personality pathology so that adequate empirical data are available to decide which syndromes to retain, revise, or remove in future versions of the diagnostic manual.     

Personality in DSM-5: helping delineate personality disorder content and framing the metastructure

The transition from the Diagnostic and Statistical Model of Mental Disorders (4th ed., text revision [DSM-IV-TR]; American Psychiatric Association, 2000 ) to the fifth edition (DSM-5) represents an unprecedented opportunity to integrate dimensional personality trait models into the official nosology. Not surprisingly, a variety of issues have arisen in contemplating this challenging integration. In this article, we address how a dimensional personality trait model could be a helpful component of DSM-5, from the perspective of our roles as work group members and advisors involved in the creation of a trait model and corresponding assessment instrument. We focus in particular on two potential roles for a trait model in DSM-5 that are under official consideration. First, a dimensional personality trait model might be helpful in delineating the content of personality disorders. Second, a trait model might assist in organizing the "metastructure" of DSM-5 (i.e., the arrangement of chapters and other broader classificatory rubrics).     

A factor analysis of mental abilities and personality traits

The relationship between measures of verbal fluency and certain personality traits is examined by factor techniques. From a matrix of eight factor scores derived from mental tests plus five personality scores, six factors were obtained. An oblique solution lends limited support to the hypothesized relationship between the two domains.This study was supported by a grant from the Research Foundation of the University of Utah.Currently on leave of absence with the National Research Council.