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.     

The circumplex structure of interpersonal sensitivities

Previous research on aversive interpersonal behavior has provided limited links between interpersonal sensitivities and comprehensive models of personality and social behavior. Study 1 (N = 1,336) of this article demonstrated that interpersonal sensitivities can be mapped onto the interpersonal circumplex and that people generally find others' behavior that is least similar to their own generally most aversive. In Study 2 (N = 299), a broader array of correlates with interpersonal sensitivities was investigated, and results again suggested that interpersonal opposites are generally perceived as most aversive. Study 3 (N = 315) specified romantic, platonic, or nonclose relationships and again found this pattern. Conceptualizing sensitivities with the interpersonal circumplex model permits investigators to distinguish general from specific kinds of sensitivity, allows for tests of the convergent and discriminant validity of interpersonal sensitivities, and integrates sensitivities into a well-established nomological net composed of multiple constructs relevant to social behavior and interpersonal dysfunction.     

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.     

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.     

Exploring the Assessment of the DSM–5 Alternative Model for Personality Disorders With the Personality Assessment Inventory

Section III of the Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM–5]; American Psychiatric Association, 2013) contains an alternative model for the diagnosis of personality disorder involving the assessment of 25 traits and a global level of overall personality functioning. There is hope that this model will be increasingly used in clinical and research settings, and the ability to apply established instruments to assess these concepts could facilitate this process. This study sought to develop scoring algorithms for these alternative model concepts using scales from the Personality Assessment Inventory (PAI). A multiple regression strategy used to predict scores in 2 undergraduate samples on DSM–5 alternative model instruments: the Personality Inventory for the DSM–5 (PID–5) and the General Personality Pathology scale (GPP; Morey et al., 2011 Morey, L. C., Berghuis, H., Bender, D. S., Verheul, R., Krueger, R. F., &; Skodol, A. E. (2011). Toward a model for assessing level of personality functioning in DSM–5, Part II: Empirical articulation of a core dimension of personality pathology. Journal of Personality Assessment, 93, 347–353.[Taylor &; Francis Online], [Web of Science ®] , [Google Scholar]). These regression functions resulted in scores that demonstrated promising convergent and discriminant validity across the alternative model concepts, as well as a factor structure in a cross-validation sample that was congruent with the putative structure of the alternative model traits. Results were linked to the PAI community normative data to provide normative information regarding these alternative model concepts that can be used to identify elevated traits and personality functioning level scores.     

Hypnotherapy and cognitive behaviour therapy of acute stress disorder: a 3-year follow-up

The long-term benefits of cognitive behaviour therapy (CBT) for trauma survivors with acute stress disorder were investigated by assessing patients 3 years after treatment. Civilian trauma survivors (n=87) were randomly allocated to six sessions of CBT, CBT combined with hypnosis, or supportive counselling (SC), 69 completed treatment, and 53 were assessed 2 years post-treatment for post-traumatic stress disorder (PTSD) with the Clinician-Administered PTSD Scale. In terms of treatment completers, 2 CBT patients (10%), 4 CBT/hypnosis patients (22%), and 10 SC patients (63%) met PTSD criteria at 2-years follow-up. Intent-to-treat analyses indicated that 12 CBT patients (36%), 14 CBT/hypnosis patients (46%), and 16 SC patients (67%) met PTSD criteria at 2-year follow-up. Patients who received CBT and CBT/hypnosis reported less re-experiencing and less avoidance symptoms than patients who received SC. These findings point to the long-term benefits of early provision of CBT in the initial month after trauma.     

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.