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.     

A framework for integrating dimensional and categorical classifications of personality disorder

Although empirical evidence strongly supports a dimensional representation of personality disorder, there is strong resistance to dimensional classification due in part to concerns about clinical utility. Acceptance of an evidence-based dimensional classification would be facilitated by information on how such a system would map onto existing diagnoses. With this objective in mind, an integrated framework is proposed that combines categorical and dimensional diagnoses. A two-component classification is adopted that distinguishes between the diagnosis of general personality disorder and the assessment of individual differences in the form the disorder takes. Then, the DSM definition of personality disorders is extended by defining individual disorders as categories of trait dimensions. This makes it possible to develop an integrated classification organized around a set of empirically derived primary traits. Assessments of these traits may then be combined to generate categorical and dimensional diagnoses. It is argued that this approach would introduce an etiological perspective into the classification of personality disorder and improve categorical classification by providing an explicit definition of each diagnosis. The clinical utility of incorporating a dimensional classification is discussed in terms of convenience and acceptability, value in predicting outcomes and treatment planning, and usefulness in organizing and selecting interventions.     

Incorporating narrative identity into structural approaches to personality and psychopathology

Structural models that connect personality and psychopathology have tended to adopt a somewhat narrow view of personality, focused on dispositional traits. In this paper, we lay the groundwork for incorporating narrative identity into future research on the structure of personality and psychopathology. Narrative identity is a well-mapped domain of personality, one with demonstrated incremental validity in the association with and prediction of psychological well-being. In this paper, we provide a brief overview of the construct of narrative identity, situate it within the broader endeavor of integrating basic personality science with the science of psychopathology, particularly involving personality pathology, and describe an agenda for future research on this vital and largely overlooked topic.     

Structures of Personality and Their Relevance to Psychopathology: II. Further Articulation of a Comprehensive Unified Trait Structure

ABSTRACT There is increasing agreement that the current categorical system of personality disorders (PDs) in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM‐IV; American Psychiatric Association, 2000) should be replaced by a trait dimensional scheme in DSM‐V. In particular, the consensus appears to be converging on a hierarchical Big Four model. The broad factors that form the apex of this hierarchy are essentially maladaptive variants of the Big Five traits of normal personality, minus Openness. We argue that this Big Four model is incomplete, however, in that it fails to model characteristics related to the “odd or eccentric” Cluster A PDs adequately. We report the results of three studies that examine these odd, eccentric characteristics in relation to basic dimensions of normal and abnormal personality. The results of these studies establish the existence of an Oddity factor that is (a) broader than the Cluster A traits and (b) distinct from Openness and the other Big Five dimensions. Consequently, its addition yields an alternative five‐factor model of personality pathology (considering only abnormal traits) and an expanded, integrated Big Six taxonomy that subsumes both normal and abnormal personality characteristics.     

Personality judgment and personality pathology: self-other agreement in adolescents with conduct disorder

We examine two issues linking personality pathology and judgment of traits within the Five-Factor Model of personality. We hypothesize that pathology moderates self-other agreement--"target" participants with pathology should be less judgable than participants without pathology. In addition, we hypothesize that pathology could partially produce agreement across a variety of traits, particularly those traits fundamental to the pathology. In an adolescent sample including a group with Conduct Disorder (CD) and a Control group, we examine agreement between adolescents' self-reports and their mothers' informant reports. Using trait-centered and person-centered perspectives, we find support for both hypotheses. Results have implications for understanding the processes affecting personality judgment, for increasing integration of traditional personality research and personality pathology, and for personality assessment.     

Emergent Issues in Assessing Personality Pathology: Illustrations from Two Studies of Adolescent Personality and Related Pathology

As illustrated by two articles that each investigate personality pathology and its correlates in adolescents—Aelterman et al. (2010) on obsessive-compulsive personality disorder (OCPD) from a dimensional personality perspective, and Barry and Wallace (2010) on indicators of pathological and normative development of youth narcissism—this commentary discusses four important assessment issues that have become more salient as the field considers a shift, through proposed changes in the DSM, to an approach that incorporates trait dimensions as an important aspect of diagnosis: (1) the importance of using multiple information sources for valid personality/ PD assessment; (2) relations of personality traits to (mal)adaptivity in general and also with regard to (3) trait uni- versus bi-polarity; and (4) whether personality types have incremental predictive value beyond their component personality traits and related pathology. The article also discusses why research on childhood and adolescent personality/ PD is important in addressing these issues.     

Cluster B personality pathology in incarcerated girls: structure, comorbidity, and aggression

Several studies have linked Cluster B personality pathology to aggression in clinical and community samples. However, the structure of Cluster B traits, and association to aggression and psychopathology, has yet to be investigated among young female offenders. In order to better inform treatments for female aggression, we studied 121 incarcerated girls, aged 13 to 19 years, who completed a series of self-report inventories that measured overt and relational aggression, as well as symptoms of depression and anxiety. Personality was assessed through a structured interview. Factor analysis of Cluster B traits revealed a three factor solution, with each factor demonstrating a unique pattern of association to relational and overt aggression and psychopathology. The implications with regard to treatment of personality pathology and aggression in the juvenile justice setting are discussed.     

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.     

人格特质与外显自尊和内隐自尊的关系

自尊被认为与人格特质之间存在紧密的联系。近年来社会认知研究领域发现,在传统“外显自尊”以外,个体还存在一个“内隐自尊”结构。由于中国人格结构与西方“大五”人格结构存在系统性的差异,本研究试图考察在中国文化下个体的人格特质与自尊水平之间的关系。结果发现,外显自尊主要与中国人人格结构中的“自我指向”的人格特点关系紧密;内隐自尊作为一个独立于外显自尊的内隐态度结构,与各个人格特质不存在显著的相关     

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.     

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.     

Depression and Axis II symptomatology in an adolescent community sample: concurrent and longitudinal associations

The relationship between personality pathology and depression has been the focus of increasing attention, but few investigators have examined this issue prospectively or in adolescent community samples. The present study used both self report and interviewer assessments of personality disorder symptomatology and depression in a sample of 155 late adolescent women followed over three years. Personality pathology cluster and total scores demonstrated moderate to fairly high degrees of stability, indicating endurance of these traits in late adolescence. As predicted, Axis II symptoms were associated with concurrent depressive symptomatology. Overall, self-reported personality disorder symptoms, as well as those specifically in Clusters A and B, predicted interviewer-rated depression over two years beyond the contribution of initial depression, indicating that subclinical Axis II symptoms are a risk factor for subsequent depressive symptomatology.     

A developmental perspective on personality disorders: lessons from research on normal personality development in childhood and adolescence

Recent work on normal personality development in children and adolescents points to several conclusions that are relevant for understanding personality pathology. First, child temperament and adult personality traits share many features in common. Second, youths' individual differences can be described in terms of the Big Five personality traits observed in adults; an integrative taxonomy of individual differences in childhood and adolescence is articulated in this article. Third, personality is already moderately stable by the preschool years, but considerable personality change occurs well into the adult years. Taken together, these findings suggest that childhood personality functioning can and should be integrated into developmental research and applied work on personality disorders.     

Comparing hierarchical models of personality pathology

Two dimensional, hierarchical classification models of personality pathology have emerged as alternatives to traditional categorical systems: multi-tiered models with increasing numbers of factors and models that distinguish between a general factor of severity and specific factors reflecting style. Using a large sample (N = 840) with a range of psychopathology, we conducted exploratory factor analyses of individual personality disorder criteria to evaluate the validity of these conceptual structures. We estimated an oblique, “unfolding” hierarchy and a bifactor model, then examined correlations between these and multi-method functioning measures to enrich interpretation. Four-factor solutions for each model, reflecting rotations of each other, fit well and equivalently. The resulting structures are consistent with previous empirical work and provide support for each theoretical model.     

Passive‐Submissive and Active‐Emotional Trait Dependency: Evidence for a Two‐Factor Model

ABSTRACT Dependency plays an important role in both normal and abnormal personality, but the construct remains loosely defined, both in clinical practice and the research literature. Moreover, although a number of measures purport to measure trait dependency, little agreement exists as to the structure of dependency within or across these instruments. Furthermore, what constitutes the low end of trait dependency remains unclear. Five hundred nine undergraduates completed a battery of 14 dependency scales and subscales, a subset of whom (n=322) also completed a broad measure of personality pathology (SNAP‐2). Exploratory factor analysis of the dependency measures yielded two correlated factors—Passive‐Submissive and Active‐Emotional dependency—as well as a third, unrelated factor, Detachment/Autonomy, all with differential correlates to the pathological personality traits of the SNAP‐2. Taken together, these data suggest a clear, 2‐factor model for trait dependency that is distinct from detachment/autonomy.     

大五人格5个维度及10个面的发展水平——基于我国15～75岁横断样本调查

基于人格毕生发展理论及中国社会文化背景,调查了我国从青少年到老年3192名被试,探究了中国人大五人格5维度及10个面毕生发展水平。总体上,年龄与神经质、焦虑、抑郁、活跃、开放性、审美、创意显著负相关,与外倾性、宜人性、尽责性、自信、利他、顺从、条理和自律显著正相关。在60岁以下的人群中,年龄大的个体神经质更低,而在大于60岁的人群中,年龄大的个体神经质反而更高;在50岁以下的人群中,年龄大的个体外倾性水平相对较高,但50岁之后年龄大的个体外倾性相对较低;整体上,年龄大的个体开放性水平相对较低,而年龄大的个体宜人性水平反而更高;年龄大的个体尽责性水平也相对较高,但较之40到49岁群体而言,50岁以上群体的尽责性则相对较低。男性和女性不同年龄群体的大五人格具有一定差异性,特别是男性的尽责性高于女性,以及女性的神经质高于男性等性别差异。进一步分析了年龄与大五人格10个面的关系,描绘了不同年龄群体10个面的发展水平。     

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.