Specific Personality Traits and General Personality Dysfunction as Predictors of the Presence and Severity of Personality Disorders in a Clinical Sample

This study examined the associations of specific personality traits and general personality dysfunction in relation to the presence and severity of Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM–IV]; American Psychiatric Association, 1994) personality disorders in a Dutch clinical sample. Two widely used measures of specific personality traits were selected, the Revised NEO Personality Inventory as a measure of normal personality traits, and the Dimensional Assessment of Personality Pathology-Basic Questionnaire as a measure of pathological traits. In addition, 2 promising measures of personality dysfunction were selected, the General Assessment of Personality Disorder and the Severity Indices of Personality Problems. Theoretically predicted associations were found between the measures, and all measures predicted the presence and severity of DSM–IV personality disorders. The combination of general personality dysfunction models and personality traits models provided incremental information about the presence and severity of personality disorders, suggesting that an integrative approach of multiple perspectives might serve comprehensive assessment of personality disorders.     

Millon's Evolutionary Model of Personality Assessment: A Case for Categorical/Dimensional Prototypes

Theodore Millon (1928–2014) was arguably one of the most influential figures in conceptualizing and detailing personality styles and disorders in the latter 20th and early 21st centuries. A prominent member of the Axis II Work Group of DSM–III, III–R, and IV, Millon continued refining his evolutionary model long after his active involvement with these committees, and remained focused on the future of personality assessment until his death in 2014. This article is an exploration of his latter works, critiques of recent DSM–5 developments, and commentary on the usefulness of his deductive methodology as it continues to apply to the study, classification, and clinical application of personality assessment.     

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.     

Development and Validation of an Adjective Check List to Assess the Millon Personality Types in a Normal Population

A 405-item experimental Personality Adjective Check List (PACL) was refined into a 153-item form to assess the personality types outlined by Millon (1969, 1981) in a normal population. Scale construction and validation followed a method outlined by Loevinger (1957, 1972). Nine scales were developed based on the responses of 459 men and women, one for each of Milton's eight basic personalities plus an Experimental scale measuring aspects of his three more severe types. Extensive reliability and validity analyses were conducted involving over 2,200 men and women from across the United States, including a factor analysis of scales. These revealed good internal consistency for each scale, good test-retest reliability over a 3-month period, adequate factor structure, and good convergent and discriminant validity based on self-report data. Results indicated that Millon's basic types exist in normal form much as they are postulated to exist as disorders. Research efforts focusing on Millon's theory as it applies to normals may bring a more complete understanding of the entire spectrum of personality.     

The DAPP–SF as a Screener for Personality Disorder in a Forensic Setting

Studies on the Dimensional Assessment of Personality Pathology–Short Form (DAPP–SF) have shown its ability to identify treatment-seeking patients with personality disorders. This study focuses on its screening potential for personality disorder in 89 criminal suspects (77 men, 12 women; M age = 37.0 years) undergoing residential pretrial psychological assessments in a high-security setting. It was expected that Structured Interview for DSM–IV Personality (SIDP–IV) criteria met for personality disorder(s) would be associated with higher DAPP–SF scores. A floor effect was found in DAPP–SF scores: The forensic population reported less personality pathology than the general population. Only moderate associations between DAPP–SF and SIDP–IV outcome were found. Receiver operating characteristic analysis showed that some DAPP–SF subscales did not exceed chance level in their ability to screen for personality disorders. It is concluded that the DAPP–SF has limited usefulness as a screener for personality disorders in a forensic pretrial setting. Alternative forensic screening instruments are presented.     

Beyond the DSM‐IV: Assumptions,Alternatives, and Alterations

Current diagnostic processes reflect the limitations and utility of the framework of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM‐IV; American Psychiatric Association, 1994). Clinical information in the DSM‐IV's 5‐axis system almost exclusively focuses on weaknesses and pathology and is summarized in a flawed categorical system. Hence, the authors describe 3 adjunctive, or alternative, means of conceptualizing behavior; several means of altering the current DSM‐IV system; and 2 future directions in the diagnosis of strengths.     

Effects of Theodore Millon's Teaching,Mentorship, Theory,and Scientific Contributions on Health Psychology and Behavioral Medicine Research and Practice

This article summarizes the impact of Theodore Millon's work on the disciplines of health psychology and behavioral medicine over the past 5 decades spanning from the late 1960s to present. The article is written from my perspectives as a graduate student mentored by Millon on through my faculty career as a collaborator in test construction and empirical validation research. Several of the most recent entries in this summary reflect projects that were ongoing at the time of his passing, revealing the innovation and visionary spirit that he demonstrated up until the end of his life. Considering that this summary is restricted to Millon's contributions to the disciplines of health psychology and behavioral medicine, this work comprises only a small portion of his larger contribution to the field of psychology and the areas of personality theory and psychological assessment more broadly.     

Evolution of the Millon Clinical Multiaxial Inventory

Dr. Theodore Millon (1928–2014) was a primary architect for the personality disorders in the DSM–III, a structure that has endured into the DSM–5. His 1969 book, Modern Psychopathology, created an elegant framework into which the well-known personality prototypes could be fitted and understood. His theoretical work soon led into the creation of several psychological inventories, most notably the Millon Clinical Multiaxial Inventory (MCMI). The MCMI, now in preparation for its 4th major edition, has been a very popular instrument among clinicians. This article explores the history of the MCMI's development from its origins, through 2 distinct theoretical phases, and to its current status as the MCMI–IV is finalized.     

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.     

A Comparison of Obsessive–Compulsive Personality Disorder Scales

In this study, we utilized a large undergraduate sample (N = 536), oversampled for the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision [DSM–IV–TR]; American Psychiatric Association, 2000) obsessive–compulsive personality disorder (OCPD) pathology, to compare 8 self-report measures of OCPD. No prior study has compared more than 3 measures, and the results indicate that the scales had only moderate convergent validity. We also went beyond the existing literature to compare these scales to 2 external reference points: their relationships with a well-established measure of the five-factor model of personality (FFM) and clinicians' ratings of their coverage of the DSM–IV–TR criterion set. When the FFM was used as a point of comparison, the results suggest important differences among the measures with respect to their divergent representation of conscientiousness, neuroticism, and agreeableness. Additionally, an analysis of the construct coverage indicated that the measures also varied in terms of their representation of particular diagnostic criteria. For example, whereas some scales contained items distributed across the diagnostic criteria, others were concentrated more heavily on particular features of the DSM–IV–TR disorder.     

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.     

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.     

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.     

International Adaptations of the Millon Clinical Multiaxial Inventory: Construct Validity and Clinical Applications

This article examines the influence of the Millon Clinical Multiaxial Inventory (MCMI) as a clinical and research instrument beyond the borders of the United States. The MCMI's theoretical and empirical grounding, its alignment with the Diagnostic and Statistical Manual of Mental Disorders (DSM), and scales that can be interpreted both categorically and dimensionally, are the primary features that make the test attractive. We begin with studies that evaluated the construct equivalence of the different language adaptations. Data from the most widely researched non English-language forms (Danish, Dutch, and Spanish) show excellent comparability with Millon's original. Nevertheless, significant problems were noted in efforts to create clinical groups that would allow for equivalence of diagnostic accuracy when using the cutoff scores. Although dimensional aspects of the scale scores were not affected by this, the adapted measures might show attenuated diagnostic accuracy compared with Millon's original. Next, we present MCMI studies conducted in clinical settings to document where the adapted tests have made their greatest impact in the international literature. A wide variety of clinical applications demonstrated broad utility, and given the high number of issues addressed, we think Millon's influence will certainly stand the test of time in different domains and settings.     

Capturing the DSM‐5 Alternative Personality Disorder Model Traits in the Five‐Factor Model's Nomological Net

Several studies have shown structural and statistical similarities between the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM‐5) alternative personality disorder model and the Five‐Factor Model (FFM). However, no study to date has evaluated the nomological network similarities between the two models. The relations of the Revised NEO Personality Inventory (NEO PI‐R) and the Personality Inventory for DSM‐5 (PID‐5) with relevant criterion variables were examined in a sample of 336 undergraduate students (M_age = 19.4; 59.8% female). The resulting profiles for each instrument were statistically compared for similarity. Four of the five domains of the two models have highly similar nomological networks, with the exception being FFM Openness to Experience and PID‐5 Psychoticism. Further probing of that pair suggested that the NEO PI‐R domain scores obscured meaningful similarity between PID‐5 Psychoticism and specific aspects and lower‐order facets of Openness. The results support the notion that the DSM‐5 alternative personality disorder model trait domains represent variants of the FFM domains. Similarities of Openness and Psychoticism domains were supported when the lower‐order aspects and facets of Openness domain were considered. The findings support the view that the DSM‐5 trait model represents an instantiation of the FFM.     

Conceptualizations of Personality Disorders with the Five Factor Model-count and Empathy Traits

Previous research has long advocated that emotional and behavioral disorders are related to general personality traits, such as the Five Factor Model (FFM). The addition of section III in the latest Diagnostic and Statistical Manual of Mental Disorders (DSM) recommends that extremity in personality traits together with maladaptive interpersonal functioning, such as lack of empathy, are used for identifying psychopathology and particularly personality disorders (PD). The objective of the present study was to measure dispositions for DSM categories based on normal personality continuums, and to conceptualize these with empathy traits. We used a validated FFM-count method based on the five personality factors (neuroticism, extraversion, openness, agreeableness, and conscientiousness), and related these to 4 empathy traits (emphatic concern, perspective-taking, fantasy, and personal distress). The results showed that FFM-based PD scores overall could be conceptualized using only two of the empathy traits, low emphatic concern and high personal distress. Further, specific dispositions for personality disorders were characterized with distinct empathy traits (e.g., histrionic with high fantasy, and paranoid with low perspective-taking). These findings may have both theoretical and practical implications in capturing potential for personality disorders with ease and efficiency.     

The Validity of the PAT in the Selection of Tabulating Machine Operators: An Analysis of Predictive Power

For the past 4 decades Theodore Millon has provided the field with a series of articles and books that illustrate his unprecedented effort to build a unified science of personology and psychopathology. Especially significant is the nonreductionist synthesis of personology with universal principles grounded in the concept of evolution. His theoretically derived personality disorder prototypes are most unusual in that they correspond in almost all regards to the official Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) Axis II classification schema. In this article, I summarize major elements of Millon's model, past and present, including the personality disorder types and stages of personality development. Perhaps best known to the readers of Journal of Personality Assessment is his publication of several objective diagnostic instruments (e.g., Millon Clinical Multiaxial Inventory-III; Millon, Millon, &; Davis, 1994; Millon Adolescent Clinical Inventory; Millon, Millon, &; Davis, 1993). Most recent is the construction of a clinician-rated checklist (Millon Personality Disorder Checklist; Millon, 1997) of structural and functional forms of psychic pathology. I touch on these measures as well as his very recent framework of personality-guided, synergistic treatment for both Axis I syndromes and Axis II disorders.     

The Unstructured Clinical Interview

In mental health, family, and community counseling settings, master's‐level counselors engage in unstructured clinical interviewing to develop diagnoses based on the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM‐IV‐TR; American Psychiatric Association, 2000). Although counselors receive education about diagnosis and the DSM classification system, the majority of them are not specifically trained in clinical interviewing. This article provides information about using the unstructured clinical interview to make a DSM‐IV‐TR diagnosis for adult clients with Axis I and Axis II disorders.     

Development and Validation of Personality Disorder Spectra Scales for the MMPI–2–RF

The purpose of this study was to develop and validate a set of MMPI–2–RF (Ben-Porath &; Tellegen, 2008/2011) personality disorder (PD) spectra scales. These scales could serve the purpose of assisting with DSM–5 PD diagnosis and help link categorical and dimensional conceptions of personality pathology within the MMPI–2–RF. We developed and provided initial validity results for scales corresponding to the 10 PD constructs listed in the DSM–5 using data from student, community, clinical, and correctional samples. Initial validation efforts indicated good support for criterion validity with an external PD measure as well as with dimensional personality traits included in the DSM–5 alternative model for PDs. Construct validity results using psychosocial history and therapists' ratings in a large clinical sample were generally supportive as well. Overall, these brief scales provide clinicians using MMPI–2–RF data with estimates of DSM–5 PD constructs that can support cross-model connections between categorical and dimensional assessment approaches.