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.     

Multidimensional perfectionism and the DSM-5 personality traits

Encouraging further research on the dimensional assessment of personality disorders (PDs), Section III of the DSM-5 introduced a hybrid model for the assessment of six PDs employing self-reports on 25 maladaptive personality traits (“DSM-5 personality traits”). Following suggestions that multidimensional perfectionism is an important characteristic across various personality disorders (Ayearst, Flett, & Hewitt, 2012), the present study investigated how personal (self-oriented) and interpersonal (other-oriented and socially prescribed) forms of perfectionism predicted the DSM-5 personality traits in a sample of 311 university students. Multiple regressions (controlling for the overlap between the different forms of perfectionism) showed that socially prescribed perfectionism positively predicted the traits defining schizotypal, borderline, avoidant, and obsessive-compulsive PD; other-oriented perfectionism positively predicted the traits defining narcissistic PD; and both socially prescribed and other-oriented perfectionism positively predicted the traits defining antisocial PD. In contrast, self-oriented perfectionism positively predicted only one of the four traits defining obsessive-compulsive PD (rigid perfectionism). Showing that multidimensional perfectionism predicted all DSM-5 traits defining the personality disorders of Section III, the findings suggest that future DSM-5 updates may profit from including interpersonal aspects of perfectionism as a diagnostic criterion.     

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).     

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.     

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.     

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.     

Narzisstische Persönlichkeitsstörung

Narcissism is a multifaceted term which encompasses traits of normal personality as well as a specific personality disorder. While much research has been concerned with narcissism as a trait there are only few empirical studies on narcissistic personality disorder (NPS). The current diagnostic system of NPS according to DSM-5 (section II) focuses on grandiose narcissism whereas vulnerable narcissism, which is emphasized by clinicians and researchers, has not yet been recognized. While treating NPD patients an increased suicide risk has to be taken into consideration. Psychotherapy of narcissistic patients mainly focuses on processes during patient-therapist interactions, the analysis and processing of grandiose and vulnerable schemas, emotion regulation techniques and a correction of narcissistic behavior in favor of prosocial interactions.     

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.     

Connecting DSM-5 Personality Traits and Pathological Beliefs: Toward a Unifying Model

Dissatisfaction with the DSM-IV model of personality disorders has led to the development of alternative conceptualizations, including pathological trait models and models linked to particular theoretical approaches, such as Beck and Freeman’s (1990) cognitive framework. An important issue involves the potential to interweave such models into a single, parsimonious system that combines their distinct advantages. In this study, pathological trait and dysfunctional belief data from 616 individuals in a non-clinical sample were evaluated for commensurability using structural equation modeling. These models can be integrated via five higher-order factors, and that specific dimensions of dysfunctional beliefs can be differentiated based on features of the DSM-5 trait model. Overall, these results suggest that traits provide scaffolding for individual differences in pathological personality, within which dysfunctional beliefs offer specific vectors for clinical intervention in a cognitive framework. Implications of the empirical commensurability of trait and cognitive models are discussed.     

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.     

Predicting counterproductive work behavior from the interaction of personality traits

Much attention has been given to enhancing the prediction of counterproductive work behavior (CWB), with a particular focus on the relationship between the five factor model of personality and CWB. Several scholars have advocated for a more complex view of this relationship, and rather than focusing simply on main effects, to examine the interaction of personality traits in predicting employee behavior. In consideration of the traits most strongly related to CWB, we examined the interaction between: (1) conscientiousness and emotional stability, (2) agreeableness and emotional stability, and (3) conscientiousness and agreeableness on CWB directed at individuals (CWB-I) and the organization (CWB-O). Results from a multi-national sample illustrate the interaction of traits increases the prediction of CWB over and above a single trait approach. The interactions suggest employees perform the least CWB when they are high on both traits (in the respective trait pairings), but low levels on either trait relate to increased CWB, and at levels comparable to individuals low on both traits. We conclude research on personality and CWB would benefit from an interactive approach as it allows for greater prediction of CWB-O and CWB-I, which is important in light of the organizational and interpersonal consequences of employee misbehavior.     

Interpersonal variability in dependent personality

The interpersonal circumplex (IPC) was recommended as a personality trait dimensional model with good potential to identify the phenomenological scope of personality disorders whose core dysfunction involves maladaptive expression of interpersonal traits. The IPC was then applied to the reconceptualization of dependent personality and dependent personality disorder. In Study 1, Pincus and Gurtman's (1995) three interpersonal vectors of dependency were validated via factor analyses conducted on two large samples (N = 921; N = 472) and a reliable self-report measure, the 3 Vector Dependency Inventory (3VDI) was constructed. In Study 2, two samples (N = 103; N = 122) of individuals identified as predominantly endorsing submissive dependence, exploitable dependence, or love dependence, or who were low in aspects of dependency were compared via ANOVA and chi-square analyses on parental representations, adult attachment styles, loneliness, and pathological attachment. Submissive dependence was associated with higher scores on maladaptive constructs (fearful attachment, pathological attachment, and loneliness) and was also associated with lower parental affiliation and higher maternal control. Love dependence was associated with lower scores on maladaptive constructs and higher scores on secure attachment and parental affiliation. Variability in dependent phenomenology was related to its three component traits. Multiple perspectives on integrating love dependence, exploitable dependence, and submissive dependence into a reconceptualization of dependent personality disorder were articulated.     

人际自立特质对大学生情绪调节策略作用的纵向研究

虽然不少学者认为人格会影响情绪调节策略的使用,但是目前尚缺乏人格与认知重评、表达抑制这两种情绪调节策略关系的纵向研究。根据人际自立与情绪关系的系列研究,假设人际自立会影响情绪调节策略的使用。采用青少年学生人际自立量表和情绪调节问卷对374名大学生进行了间隔6个月的两次调查。结果发现,人际主动、人际灵活显著预测6个月后的认知重评。这说明某些人格特质可以影响特定情绪调节策略的使用。     

人际自立与抑郁的关系

前期研究显示人际自立与抑郁负相关, 本研究用两个调查来进一步探索人际自立与抑郁关系的价值与特点。研究一使用青少年学生人际自立量表、社会依赖量表中文修订版和自评抑郁量表对471名有效被试进行了调查, 结果发现：①人际主动、人际灵活与社会依赖无关; ②在控制了社会依赖后, 人际自立对抑郁仍有显著的负向预测作用。研究二使用青少年学生人际自立量表、症状自评量表中的抑郁分量表、社会支持评定量表对287名有效被试进行了调查。结果发现, 调节模型不被支持, 社会支持在人际独立、人际开放、人际主动与抑郁的关系中起到中介作用。综上所述可以认为：人际自立负向预测抑郁的能力很可能不会受其他抑郁相关人格的明显影响, 很可能是新的抑郁的保护性人格因素; 人际因素很可能在人际自立与抑郁的关系中起到中介作用。