Parental Problem Drinking and Maladaptive Personality Features in Children: The Role of Marital Conflict.

The personality characteristics of children of exposed to parental problem drinking have been of interest to clinicians and researchers for several decades, but personality research on this population often focuses on identifying a unique cluster of adult personality traits. The current study adopts a cutting-edge dimensional approach to understanding personality pathology as extreme variants of the five factor model, and examines pathways of risk to personality pathology through marital conflict and emotional insecurity. Participants were 199 two-parent families with a child between the ages of 6 and 12 years. Parents completed questionnaire measures of their problem drinking, marital conflict, child emotional insecurity (i.e., emotional reactivity to conflict), and child maladaptive personality traits. Structural equation models found an indirect pathway from mother and father problem drinking to pathological child disagreeableness, introversion, emotional instability, and compulsivity via greater mother destructive marital conflict behavior and child emotional reactivity to conflict. There was also some evidence that this pathway of effects was stronger for girls than for boys. Findings support the use of a dimensional approach to understanding maladaptive personality among individuals exposed to parental problem drinking.

The Hierarchical Taxonomy of Psychopathology (HiTOP) in psychiatric practice and research.

The Hierarchical Taxonomy of Psychopathology (HiTOP) has emerged out of the quantitative approach to psychiatric nosology. This approach identifies psychopathology constructs based on patterns of co-variation among signs and symptoms. The initial HiTOP model, which was published in 2017, is based on a large literature that spans decades of research. HiTOP is a living model that undergoes revision as new data become available. Here we discuss advantages and practical considerations of using this system in psychiatric practice and research. We especially highlight limitations of HiTOP and ongoing efforts to address them. We describe differences and similarities between HiTOP and existing diagnostic systems. Next, we review the types of evidence that informed development of HiTOP, including populations in which it has been studied and data on its validity. The paper also describes how HiTOP can facilitate research on genetic and environmental causes of psychopathology as well as the search for neurobiologic mechanisms and novel treatments. Furthermore, we consider implications for public health programs and prevention of mental disorders. We also review data on clinical utility and illustrate clinical application of HiTOP. Importantly, the model is based on measures and practices that are already used widely in clinical settings. HiTOP offers a way to organize and formalize these techniques. This model already can contribute to progress in psychiatry and complement traditional nosologies. Moreover, HiTOP seeks to facilitate research on linkages between phenotypes and biological processes, which may enable construction of a system that encompasses both biomarkers and precise clinical description.

The distinction between symptoms and traits in the Hierarchical Taxonomy of Psychopathology (HiTOP).

The Hierarchical Taxonomy of Psychopathology (HiTOP) is an empirically and quantitatively derived dimensional classification system designed to describe the features of psychopathology and, ultimately, to replace categorical nosologies. Among the constructs that HiTOP organizes are "symptom components" and "maladaptive traits," but past HiTOP publications have not fully explicated the distinction between symptoms and traits. We propose working definitions of symptoms and traits and explore challenges, exceptions, and remaining questions. Specifically, we propose that the only systematic difference between symptoms and traits in HiTOP is one of time frame. Maladaptive traits are dispositional constructs that describe persistent tendencies to manifest features of psychopathology, whereas symptoms are features of psychopathology as they are manifest during any specific time period (from moments to days to months). This has the consequence that almost every HiTOP dimension, at any level of the hierarchy, can be assessed as either a trait or a symptom dimension, by adjusting the framing of the assessment. We discuss the implications of these definitions for causal models of the relations between symptoms and traits and for distinctions between psychopathology, normal personality variation, and dysfunction.

Les progrès dans la réalisation de la classification quantitative de la psychopathologie.

Shortcomings of approaches to classifying psychopathology based on expert consensus have given rise to contemporary efforts to classify psychopathology quantitatively. In this paper, we review progress in achieving a quantitative and empirical classification of psychopathology. A substantial empirical literature indicates that psychopathology is generally more dimensional than categorical. When the discreteness versus continuity of psychopathology is treated as a research question, as opposed to being decided as a matter of tradition, the evidence clearly supports the hypothesis of continuity. In addition, a related body of literature shows how psychopathology dimensions can be arranged in a hierarchy, ranging from very broad "spectrum level" dimensions, to specific and narrow clusters of symptoms. In this way, a quantitative approach solves the "problem of comorbidity" by explicitly modeling patterns of co-occurrence among signs and symptoms within a detailed and variegated hierarchy of dimensional concepts with direct clinical utility. Indeed, extensive evidence pertaining to the dimensional and hierarchical structure of psychopathology has led to the formation of the Hierarchical Taxonomy of Psychopathology (HiTOP) Consortium. This is a group of 70 investigators working together to study empirical classification of psychopathology. In this paper, we describe the aims and current foci of the HiTOP Consortium. These aims pertain to continued research on the empirical organization of psychopathology; the connection between personality and psychopathology; the utility of empirically based psychopathology constructs in both research and the clinic; and the development of novel and comprehensive models and corresponding assessment instruments for psychopathology constructs derived from an empirical approach.

The Alternative Model of Personality Disorders (AMPD) from the Perspective of the Five-Factor Model.

The fifth edition of the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders(DSM-5; American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington: American Psychiatric Association; 2013) includes an Alternative Model of Personality Disorders (AMPD). The AMPD includes two components: the Criterion A level of personality functioning (i.e., impairments or deficits in the sense of self and interpersonal relatedness) and the Criterion B five-domain maladaptive trait model. The purpose of the current paper is to discuss the AMPD from the perspective of the Five-Factor Model (FFM) of general personality structure. The conclusion of this review is that both the Criterion A self-other deficits and the Criterion B traits can be understood as maladaptive variants of the FFM.

Bruno Klopfer Award Address: Five-Factor Model Personality Disorder Scales.

The predominant model of general personality structure is the Five-Factor Model (FFM), consisting of the five broad domains of neuroticism, extraversion, openness, agreeableness, and conscientiousness. A hypothesis of long-standing interest has been that personality disorders can be understood as extreme or maladaptive variants of the domains and facets of the FFM. The purpose of this article was to discuss the development and validation of FFM personality disorder scales. These scales assess the DSM-5 Section II personality disorders from the perspective of the FFM, as well as maladaptive variants of both poles of all five domains of the FFM.

Criterion A of the AMPD in HiTOP.

The categorical model of personality disorder classification in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM-5]; American Psychiatric Association, 2013 ) is highly and fundamentally problematic. Proposed for DSM-5 and provided within Section III (for Emerging Measures and Models) was the Alternative Model of Personality Disorder (AMPD) classification, consisting of Criterion A (self-interpersonal deficits) and Criterion B (maladaptive personality traits). A proposed alternative to the DSM-5 more generally is an empirically based dimensional organization of psychopathology identified as the Hierarchical Taxonomy of Psychopathology (HiTOP; Kotov et al., 2017 ). HiTOP currently includes, at the highest level, a general factor of psychopathology. Further down are the five domains of detachment, antagonistic externalizing, disinhibited externalizing, thought disorder, and internalizing (along with a provisional sixth somatoform dimension) that align with Criterion B. The purpose of this article is to discuss the potential inclusion and placement of the self-interpersonal deficits of the DSM-5 Section III Criterion A within HiTOP.

Ratings of affective and interpersonal tendencies differ for grandiose and vulnerable narcissism: A replication and extension of Gore and Widiger (2016).

OBJECTIVE: Theoretical conceptions of narcissism have long been characterized by two seemingly opposing poles: grandiosity and vulnerability. The goal of the current study was to investigate the extent to which traits associated with one profile are perceived to co-occur with the other within an individual. METHOD: Lay raters (N = 862; 56% female; 80% Caucasian; Mage = 37) recruited from Amazon's MTurk were assigned to one of four conditions in which they rated how often a series of narcissistic traits were displayed by a prototypical grandiose narcissist, a vulnerable narcissist, a close friend, or themselves. Vulnerable narcissism items were specifically worded to assess internalizing- versus externalizing-based emotional responses. RESULTS: Results suggest that grandiosely narcissistic individuals are seen as responding angrily to ego-threatening situations, whereas vulnerably narcissistic individuals are seen as responding with a broader array of negative emotions, including anger, sadness, and shame. In contrast, vulnerably narcissistic individuals were not rated as consistently demonstrating behaviors, attitudes, or cognitions associated with grandiose narcissism. CONCLUSIONS: Grandiose and vulnerable narcissistic individuals both exhibit anger in response to ego threat, but sadness/shame responses are more characteristic of vulnerable narcissism.

Preschool Oppositional Defiant Disorder: A Disorder of Negative Affect, Surgency, and Disagreeableness.

Oppositional defiant disorder (ODD) is conceptualized as a disorder of negative affect and low effortful control. Yet empirical tests of trait associations with ODD remain limited. The current study examined the relationship between temperament and personality traits and Diagnostic and Statistical Manual of Mental Disorders (5th ed.) ODD symptom domains and related impairment in a preschool-age sample. Participants were 109 children ages 3-6 (59% male), overrecruited for ODD from the community, and their primary caregivers (87% mothers). ODD symptoms and impairment were measured using the Kiddie-Disruptive Behavior Disorder Schedule, temperament traits were measured using parent report on the Child Behavior Questionnaire and the Laboratory Temperament Assessment Battery, and personality traits were measured using examiner report on the California Child Q-Sort. Results suggest that high negative affect was associated with all three ODD symptom domains, whereas low agreeableness was specifically associated with the angry/irritable ODD symptom domain, and high surgency was associated with the argumentative/defiant and vindictive ODD symptom domains. Negative affect and surgency interacted with agreeableness to predict impairment, but not symptoms: Low agreeableness was associated with high impairment, regardless of other trait levels, whereas high negative affect and high surgency predicted high impairment in the presence of high agreeableness. Overall, results suggest ODD is a disorder of high negative affect. Furthermore, low agreeableness is differentially associated with affective ODD symptoms, and high surgency is associated with behavioral ODD symptoms. These traits interact in complex ways to predict impairment. Therefore, negative affect, agreeableness, and surgency may be useful early markers of ODD symptoms and impairment.

Clinicians' Judgments of the Clinical Utility of Personality Disorder Trait Descriptions.

Proposed for the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) was a five-domain, 25-dimensional trait model that would have constituted a significant part of the diagnostic criteria for each personality disorder. A primary concern with respect to the proposal was that clinicians might find such an approach to be unacceptable. This study provides results from three independent data collections that compared clinicians' clinical utility ratings for each iteration of the DSM-5 dimensional trait assignments, along with an alternative list of traits derived from the Five Factor Form (FFF). The clinicians considered the final trait assignments that were posted for the avoidant, narcissistic, obsessive-compulsive, and schizoid personality disorders to be significantly less acceptable than the original assignments. They also considered the FFF trait assignments to be preferable to the DSM-5 final postings with respect to the avoidant, narcissistic, obsessive-compulsive, dependent, and histrionic personality disorders. The implications of these results for future editions of the diagnostic manual are discussed.

Psychopathy and the DSM.

Psychopathy is one of the more well-established personality disorders. However, its relationship with the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) has been controversial. The purpose of this article is to trace and discuss the history of this relationship from the very first edition of the DSM to the current fifth edition. Emphasized in particular is the problematic relationship of DSM antisocial personality disorder with the diagnosis of psychopathy by Cleckley (1941, 1976) and the Psychopathy Checklist- Revised (Hare, 2003), as well as with the more recently developed models of psychopathy by Lilienfeld and Widows (2005), Lynam et al. (2011), and Patrick, Fowles, and Krueger (2009).

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 ). 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.

Evidence-Based Assessment of Personality Disorder.

The purpose of this article is to provide a description and discussion of the evidence-based assessment of personality disorder. Considered herein is the assessment of the Section II personality disorders included within the fifth edition of the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.; DSM-5-TR), within Section III of DSM-5-TR, and within the 11th edition of the World Health Organization's International Classification of Diseases (WHO). The recommendation for an evidence-based assessment is for a multimethod approach: first administer a self-report inventory to alert the clinician to maladaptive personality functioning that might not have otherwise been anticipated, followed by a semi-structured interview to verify the personality disorder's presence. The validity of this multimethod strategy can be improved further by considering the impact of other disorders on the assessment, documenting temporal stability, and establishing a compelling, empirical basis for cutoff points.

Different routes to the same destination? Comparing Diagnostic and Statistical Manual of Mental Disorders, fifth edition Section II- and alternative model of personality disorder-defined borderline personality disorder.

Borderline personality disorder (BPD) is defined by the presence of at least five of nine symptoms in Section II of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition. In the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, Section III Alternative Model of Personality Disorders (AMPD), BPD is defined by deficits in self and/or interpersonal functioning (Criterion A), elevated negative affectivity, and elevated antagonism and/or disinhibition (Criterion B). However, it is unclear if these definitions describe the same people and if the AMPD criteria explain unique variability in treatment outcomes in this population. In a treatment-seeking sample of adult participants diagnosed with BPD according to Section II criteria (n = 65, Mage = 27.60, 70.8% female, 76.9% White), we found a majority (66.2%) would have also received the diagnosis based on AMPD criteria. Those meeting AMPD criteria reported more severe Section II BPD symptoms than those who did not, ps < .02, ds > 0.60, and the presence or severity of Section II fears of abandonment and inappropriate anger uniquely predicted AMPD BPD diagnoses, ps < .03, ORs ≥ 2.31. Changes in AMPD dimensions explained 34% of the variability in change in work/social adjustment (p = .13) and quality of life (p = .22), respectively, over and above changes in Section II symptoms during a novel cognitive-behavioral treatment for BPD. These results suggest that AMPD criteria capture a more severe subset of BPD than Section II criteria and may be important predictors of treatment outcomes. We discuss the potential trade-offs of this shift in diagnosis. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Basic traits predict the prevalence of personality disorder across the life span: the example of psychopathy.

Personality disorders (PDs) may be better understood in terms of dimensions of general personality functioning rather than as discrete categorical conditions. Personality-trait descriptions of PDs are robust across methods and settings, and PD assessments based on trait measures show good construct validity. The study reported here extends research showing that basic traits (e.g., impulsiveness, warmth, straightforwardness, modesty, and deliberation) can re-create the epidemiological characteristics associated with PDs. Specifically, we used normative changes in absolute trait levels to simulate age-related differences in the prevalence of psychopathy in a forensic setting. Results demonstrated that trait information predicts the rate of decline for psychopathy over the life span; discriminates the decline of psychopathy from that of a similar disorder, antisocial PD; and accurately predicts the differential decline of subfactors of psychopathy. These findings suggest that basic traits provide a parsimonious account of PD prevalence across the life span.

Clinical application of the five-factor model.

The Five-Factor Model (FFM) has become the predominant dimensional model of general personality structure. The purpose of this paper is to suggest a clinical application. A substantial body of research indicates that the personality disorders included within the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM) can be understood as extreme and/or maladaptive variants of the FFM (the acronym "DSM" refers to any particular edition of the APA DSM). In addition, the current proposal for the forthcoming fifth edition of the DSM (i.e., DSM-5) is shifting closely toward an FFM dimensional trait model of personality disorder. Advantages of this shifting conceptualization are discussed, including treatment planning.

Parent Grandiose Narcissism and Child Socio-Emotional Well Being: The Role of Parenting.

Previous research has highlighted how parent narcissism relates to parenting broadly. However, research has not examined how facets of grandiose narcissism are associated with parenting tactics, nor how these facets may indirectly affect child development. The current study assesses parenting tactics as intervening variables in associations between facets of grandiose narcissism and child internalizing/externalizing. Participants were 457 parents of a child between six and 18. Parents completed a survey assessing grandiose narcissism, positive and negative parenting tactics, and reported on child internalizing/externalizing behaviors. Higher parent grandiosity and entitlement/exploitation were associated with more negative parenting tactics and less positive parenting tactics. Negative parenting tactics intervened in relations between these facets of grandiose narcissism and child internalizing and externalizing. Conversely, higher levels of leadership/authority were related to more positive parenting tactics. Results suggest that deficits in parenting may be a mechanism for how parent grandiose narcissism relates to child mental health.

Experimental Manipulation of the BFI-2, IPIP-NEO-120, and the IPC-5.

Research assessing the relationship of the five-factor model (FFM) to personality disorder symptomatology has generally been confirmatory, with three exceptions. The exceptions have been failures to confirm associations of conscientiousness with the obsessive-compulsive personality disorder, agreeableness with dependent, and openness with schizotypal. Haigler and Widiger demonstrated empirically years ago that this was occurring because the predominant FFM measure at that time, the NEO Personality Inventory-Revised, does not include a sufficient representation of maladaptive variants of the respective FFM personality trait domains. Research since their study has continued to fail to confirm the FFM hypotheses, using other measures of the FFM. The current study extended the work of Haigler and Widiger by considering three additional FFM measures, the Big Five Inventory-2 (BFI-2), the International Item Pool-NEO-120 (IPIP-NEO-120), and the Inventory of Personal Characteristics-5 (IPC-5). Data were obtained from a community sample of adults with experience of mental health treatment. The results confirmed an improvement in the FFM-personality disorder relationships when the experimentally manipulated versions of the BFI-2, IPIP-NEO-120, and IPC-5 were used. The implications of the findings for existing and future FFM-personality disorder research are discussed.

Psychopathy and antisocial personality disorder in the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders: An attempted replication of Wygant et al. (2016).

The fifth edition of the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Section III Alternative Model of Personality Disorder (AMPD) was developed to ameliorate some of the concerns of the DSM-5 Section II categorical model by moving away from the discrete boundaries of behaviorally specific criteria to a hybridized dimensional trait-based approach. Wygant et al. (2016) examined the extent to which the AMPD improved the operationalization of antisocial personality disorder to more closely align with psychopathy, a notable weakness of DSM-5 Section II (Crego & Widiger, 2015; Lynam & Vachon, 2012; Strickland et al., 2013). Wygant et al. found that the DSM-5 Section III AMPD outperformed Section II in predicting various operationalizations of psychopathy in a sample of 200 male inmates. In the spirit of the importance in exploring replication (Tackett et al., 2017), the current study sought to replicate and extend these findings by comparing the ability of the AMPD and alternative trait models to account for psychopathy. Analyses showed a partial replication of Wygant et al.'s findings, indicating that additional traits to account for psychopathy should be included in DSM-5 Section III. The current study was not preregistered. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Interpersonal and personality disorders: Commentary on Wright et al. (2022).

Wright et al. (2022) propose to replace personality disorders with a new classification of interpersonal disorders. We suggest that the trait model addresses well the limitations of the personality disorder categorical syndromes and accommodates the dynamics asserted as strengths of the interpersonal model. We identify weaknesses of the interpersonal model that explain why it has never been officially adopted. (PsycInfo Database Record (c) 2023 APA, all rights reserved).