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.

Core traits of psychopathy.

There remains considerable debate as to what are the core traits of psychopathy. One approach to addressing this question is to identify the traits that are present in persons said to be actual or even prototypic examples of psychopathy. Ted Bundy, Clyde Barrow, Bernie Madoff, James Bond, Chuck Yeager, and Sherlock Holmes have all been described as being a psychopath. The current study conducted nine data collections, obtaining ratings on these six persons. Biographical summaries of each person were provided. In addition, for 3 cases (Bundy, Bond, and Holmes), participants who indicated that they knew the person well provided ratings without the biographical history. Each person was described with respect to the five-factor model, the Cleckley criteria, and additional traits from more recent models of psychopathy (e.g., boldness and fearlessness). Traits evident across all six persons were fearlessness, boldness, feels invulnerable, thrill-seeking, and excitement-seeking. However, this includes persons who would not be said to be psychopaths. The traits that were most specific to psychopathy were traits of antagonism, such as callousness, manipulativeness, dishonesty, arrogance, and cruelty. The results are discussed with respect to historical and current models of psychopathy. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The convergent, discriminant, and structural relationship of the DAPP-BQ and SNAP with the ICD-11, DSM-5, and FFM trait models.

The predominant maladaptive trait models are now provided by Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) Section III, assessed by the Personality Inventory for DSM-5 (PID-5; Krueger, Derringer, Markon, Watson, & Skodol, 2012), and the International Classification of Diseases-11th Revision (ICD-11; assessed by the Personality Inventory for ICD-11 (PiCD; Oltmanns & Widiger, 2018). However, 2 historical precedents are the Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ; Livesley & Jackson, 2009) and the Schedule for Nonadaptive and Adaptive Personality (SNAP; Clark, 1993). The current study administered the DAPP-BQ, SNAP, PiCD, and PID-5 to a sample of 323 persons with a history of mental health treatment. The results provided support for the historical precedence of the DAPP-BQ and SNAP, although also suggest that additional traits should perhaps be included in current models. The results also bear on additional ongoing issues, including (but not limited to) the bipolarity of maladaptive personality structure, the conceptualization of identity problems as a trait, and the discriminant validity of maladaptive trait models and their assessment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Obtaining and losing the bipolarity of the five-factor model through factor analysis.

The predominant model of general personality structure is arguably the 5-factor model (FFM), consisting of the 5 broad domains of neuroticism, extraversion, openness, agreeableness, and conscientiousness. A FFM of personality disorder (FFMPD) has proposed maladaptive variants at both poles of the FFM. The purpose of the current study was to identify a subset of FFMPD scales, using factor analysis, that illustrate the bipolarity present in the FFMPD, but equally important, to demonstrate that the presence of bipolarity is impaired by a number of concerns, including the impact of nondiametric scales and the occupation of interstitial space. All of the FFMPD scales were administered to 443 community participants recruited from Amazon Mechanical Turk. Bipolarity was evident in a series of factor analyses of subsets of FFMPD scales, with the exception of openness due to the presence of nondiametric scales. Scales identified in the current study can be used to provide an alternative measure of maladaptive personality structure, particularly if there is an interest in assessing for maladaptive variants at both poles, but an additional point of emphasis in the current study was also the fragility of this bipolar factor structure within factor analytic research. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

The bipolarity of normal and abnormal personality structure: Implications for assessment.

The predominant model of general personality structure is arguably the Five Factor Model (FFM), consisting of the 5 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 and/or maladaptive variants of the domains and facets of the FFM. This hypothesis has now been formally recognized within Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) Section III and within the proposal for the 11th edition of the World Health Organization's diagnostic manual. However, a notable feature of both proposals is that they are largely (albeit not exclusively) unipolar with respect to maladaptive personality structure. The purpose of the current article is to present theoretical and empirical support for the presence of maladaptivity at both poles of all 5 domains of the FFM. Discussed in particular are implications for assessment for this maladaptive personality structure. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Informant assessment: The Informant Five-Factor Narcissism Inventory.

A series of self-report measures of personality disorder from the perspective of the five-factor model (FFM) have been published; however, no informant-report versions have been developed. An informant version of the Five Factor Narcissism Inventory (FFNI) is particularly apt, given the degree of distortion in self-description inherent to narcissism. The present study provides initial validation for the Informant Five-Factor Narcissism Inventory (IFFNI). In Study 1, informant reports from friends, romantic partners, parents, and other family members were compared with self-reports provided by undergraduate college students on the IFFNI, FFM personality, and social dysfunction. Self-other agreement for IFFNI Grandiose (G) was higher than what has been found with other narcissism measures. No self-informant convergence, though, was found for IFFNI Vulnerable (V). From the informant view, IFFNI-G and V narcissism were associated with social dysfunction, whereas from the self-view only FFNI-V was associated with social dysfunction. In Study 2, grandiose and vulnerable narcissists, identified by participants recruited from MTurk, were described in terms of the IFFNI, FFM, and Pathological Narcissism Inventory (PNI). Results indicated that the IFFNI discriminated well between G and V narcissism for all but a few scales. The exceptions may reflect vulnerable narcissistic traits within grandiose narcissists. In comparison, the PNI obtained a very similar informant profile for the G and V narcissists. In sum, the results of the current study suggest value in having an informant-based measure of narcissism. (PsycINFO Database Record

FFMPD scales: Comparisons with the FFM, PID-5, and CAT-PD-SF.

A series of 8 Five Factor Model Personality Disorder (FFMPD) scales have been developed to assess, from the perspective of the Five Factor Model (FFM), the maladaptive traits included within DSM-5 Section II personality disorders. An extensive body of FFMPD research has accumulated. However, for the most part, each study has been confined to the scales within 1 particular FFMPD Inventory. The current study considered 36 FFMPD scales, at least 1 from each of the 8 FFMPD inventories, including 8 scales considered to be from neuroticism, 8 from extraversion, 5 from openness, 8 from agreeableness, and 7 from conscientiousness. Their convergent, discriminant, and structural relationship with the FFM was considered, and compared with the structural relationship with the FFM obtained by the Personality Inventory for DSM-5 (PID-5) and the Computerized Adaptive Test-Personality Disorder-Static Form (CAT-PD-SF). Support for an FFM structure was obtained (albeit with agreeableness defining 1 factor and antagonism a separate factor). Similarities and differences across the FFMPD, PID-5, and CAT-PD-SF scales were highlighted. (PsycINFO Database Record

Basic personality model.

The personality structure of persons within clinical populations may not be fundamentally different from the personality structure of persons who have not sought treatment for their maladaptive personality traits. Indeed, there has long been an interest in understanding personality disorders as maladaptive variants of general personality structure. Presented herein is an understanding of personality disorder from the perspective of basic personality research; more specifically, the five factor model (FFM) of general personality structure. Potential advantages of understanding personality disorders from the perspective of the FFM are provided.

Development and Examination of the Five-Factor Obsessive-Compulsive Inventory-Short Form.

The Five-Factor Obsessive-Compulsive Inventory (FFOCI) is an assessment of obsessive-compulsive personality disorder (OCPD) that is based on the conceptual framework of the five-factor model (FFM) of personality. The FFOCI has 12 subscales that assess those five-factor model facets relevant to the description of OCPD. Research has suggested that the FFOCI scores relate robustly to existing measures of OCPD and relevant scales from general personality inventories. Nonetheless, the FFOCI's length-120 items-may limit its clinical utility. This study derived a 48-item FFOCI-Short Form (FFOCI-SF) from the original measure using item response theory methods. The FFOCI-SF scales successfully recreated the nomological network of the original measure and improved discriminant validity relative to the long form. These results support the use of the FFOCI-SF as a briefer measure of the lower-order traits associated with OCPD.

The Conceptualization and Assessment of Schizotypal Traits: A Comparison of the FFSI and PID-5.

The purpose of the present study was to compare the cognitive and perceptual aberration scales from the Five-Factor Schizotypal Inventory (FFSI; Edmundson, Lynam, Miller, Gore, & Widiger, 2011) and the Personality Inventory for DSM-5 (Krueger, Derringer, Markon, Watson, & Skodol,, 2012), as well as to address more generally the validity of the FFSI as a measure of both schizotypal personality traits and the FFM. Two independent samples were obtained, including 259 college students (55 of whom were preselected with elevated scores on a measure of schizotypal personality disorder [STPD]) and 346 adult MTurk participants (43% of whom had been or were currently in mental health treatment). Administered were the FFSI, the PID-5 Psychoticism scales, and alternative measures of general personality, openness, STPD, and schizotypal cognitive-perceptual aberrations. The results of the study are discussed with respect to the validity of the FFSI and PID-5 schizotypal cognitive and perception scales.

Convergent and discriminant validity of alternative measures of maladaptive personality traits.

The purpose of the current study was to test empirically the convergent and discriminant validity of 3 recently developed, alternative measures of maladaptive personality traits: the Personality Inventory for Diagnostic and Statistical Manual for Mental Disorders-Fifth Edition (DSM-5, PID-5; Krueger, Derringer, Markon, Watson, & Skodol, 2012), the Computerized Adaptive Test-Personality Disorder Static Form (CAT-PD-SF; Simms et al., 2011), and Five Factor Model Personality Disorder scales (FFMPD; Widiger, Lynam, Miller, & Oltmanns, 2012). These measures were constructed with different rationales and methods, yet the result was highly congruent. The PID-5 and CAT-PD-SF were administered to 286 community adults with current or a history of mental health treatment; the CAT-PD-SF and FFMPD scales to 262 such adults; and the PID-5 and FFMPD scales to 266. The results indicated good to excellent internal consistency, as well as good to excellent convergent and discriminant validity for most scales with a few notable exceptions. Suggestions for future research are provided, including the potential benefits of scales that are unique to a respective instrument, replication of a dependency factor, and exploration as to the basis for instances of questionable convergent or discriminant validity. (PsycINFO Database Record

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.

Cleckley's psychopaths: Revisited.

The most influential figure in the study of psychopathy is Hervey Cleckley, the author of the widely cited text, "The Mask of Sanity" (Cleckley, 1941, 1955). Researchers often refer to Cleckley when disputing what should belong within a conceptualization or assessment of psychopathy, at times disagreeing as to what Cleckley meant or intended. Cleckley though included within his text 15 detailed case studies of prototypic psychopaths. The current study was the first to provide systematic ratings of these 15 cases, including ratings with respect to (a) the 16 Cleckley criteria (e.g., anxiousness and inadequately motivated antisocial behavior), (b) 33 additional traits included within or considered for more recently developed measures and models of psychopathy (e.g., boldness, fearlessness, disobliged, cruelty, and aggression), and (c) 30 traits of the 5-factor model of general personality. The results are discussed with respect to implications for both historic and current models of psychopathy.

Thinking Structurally About Narcissism: An Examination of the Five-Factor Narcissism Inventory and Its Components.

The Five-Factor Narcissism Inventory (FFNI) is a self-report measure of the traits linked to grandiose and vulnerable narcissism, as well as narcissistic personality disorder (NPD), from a five-factor model perspective (FFM). In the current studies, the factor structure of the FFNI was explored and the results supported the extraction of three factors: Antagonism (e.g., Arrogance), Neuroticism (e.g., Need for Admiration), and Agentic Extraversion (e.g., Authoritativeness). In Study 2, the FFNI factors manifested convergent validity with their corresponding Big Five domains and diverging relations with measures of grandiose and vulnerable narcissism, NPD, and self-esteem. Ultimately, the FFNI factors help explicate the differences between various expressions of narcissism such that all are related to Antagonism but differ with regard to Neuroticism (relevant to vulnerable narcissism and NPD) and Agentic Extraversion (relevant to grandiose narcissism and NPD). The results also highlight the complex relation between self-esteem and the traits that comprise narcissism measures.

Testing whether the DSM-5 personality disorder trait model can be measured with a reduced set of items: An item response theory investigation of the Personality Inventory for DSM-5.

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes an alternative model of personality disorders (PDs) in Section III, consisting in part of a pathological personality trait model. To date, the 220-item Personality Inventory for DSM-5 (PID-5; Krueger, Derringer, Markon, Watson, & Skodol, 2012) is the only extant self-report instrument explicitly developed to measure this pathological trait model. The present study used item response theory-based analyses in a large sample (n = 1,417) to investigate whether a reduced set of 100 items could be identified from the PID-5 that could measure the 25 traits and 5 domains. This reduced set of PID-5 items was then tested in a community sample of adults currently receiving psychological treatment (n = 109). Across a wide range of criterion variables including NEO PI-R domains and facets, DSM-5 Section II PD scores, and externalizing and internalizing outcomes, the correlational profiles of the original and reduced versions of the PID-5 were nearly identical (rICC = .995). These results provide strong support for the hypothesis that an abbreviated set of PID-5 items can be used to reliably, validly, and efficiently assess these personality disorder traits. The ability to assess the DSM-5 Section III traits using only 100 items has important implications in that it suggests these traits could still be measured in settings in which assessment-related resources (e.g., time, compensation) are limited.

The discriminant (and convergent) validity of the Personality Inventory for DSM-5.

A considerable body of research has rapidly accumulated with respect to the validity of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) dimensional trait model as it is assessed by the Personality Inventory for Diagnostic and Statistical Manual of Mental Disorders (PID-5; Krueger et al., 2012). This research though has not focused specifically on discriminant validity, although allusions to potentially problematic discriminant validity have been raised. The current study addressed discriminant validity, reporting for the first time the correlations among the PID-5 domain scales. Also reported are the bivariate correlations of the 25 PID-5 maladaptive trait scales with the personality domain scales of the NEO Personality Inventory-Revised (Costa & McCrae, 1992), the International Personality Item Pool-NEO (Goldberg et al., 2006), the Inventory of Personal Characteristics (Almagor et al., 1995), the 5-Dimensional Personality Test (van Kampen, 2012), and the HEXACO Personality Inventory-Revised (Lee & Ashton, 2004). The results are discussed with respect to the implications of and alternative explanations for potentially problematic discriminant validity. (PsycINFO Database Record

Development of a Short Form of the Five-Factor Narcissism Inventory: the FFNI-SF.

The Five-Factor Narcissism Inventory (FFNI; Glover, Miller, Lynam, Crego, & Widiger, 2012) is a 148-item self-report inventory of 15 traits designed to assess the basic elements of narcissism from the perspective of a 5-factor model. The FFNI assesses both vulnerable (i.e., cynicism/distrust, need for admiration, reactive anger, and shame) and grandiose (i.e., acclaim seeking, arrogance, authoritativeness, entitlement, exhibitionism, exploitativeness, grandiose fantasies, indifference, lack of empathy, manipulativeness, and thrill seeking) variants of narcissism. The present study reports the development of a short-form version of the FFNI in 4 diverse samples (i.e., 2 undergraduate samples, a sample recruited from MTurk, and a clinical community sample) using item response theory. The validity of the resultant 60-item short form was compared against the validity of the full scale in the 4 samples at both the subscale level and the level of the grandiose and vulnerable composites. Results indicated that the 15 subscales remain relatively reliable, possess a factor structure identical to the structure of the long-form scales, and manifest correlational profiles highly similar to those of the long-form scales in relation to a variety of criterion measures, including basic personality dimensions, other measures of grandiose and vulnerable narcissism, and indicators of externalizing and internalizing psychopathology. Grandiose and vulnerable composites also behave almost identically across the short- and long-form versions. It is concluded that the FFNI-Short Form (FFNI-SF) offers a well-articulated assessment of the basic traits comprising grandiose and vulnerable narcissism, particularly when assessment time is limited.

The FFOCI and other measures and models of OCPD.

The Five Factor Obsessive Compulsive Inventory (FFOCI) was developed in part to facilitate a shift from the categorical classification of personality disorder to a dimensional trait model, more specifically, the five-factor model (FFM). Questions though have been raised as to whether obsessive-compulsive personality disorder (OCPD) can be understood as a maladaptive variant of FFM conscientiousness. The present study provides a further validation of the FFOCI, emphasizing in particular its association with FFM conscientiousness, as well as comparing alternative measures and models of OCPD. A total of 380 undergraduates (obtained in two samples of 274 and 106), including 146 oversampled for OCPD traits (93 for the first sample and 53 for the second), completed the FFOCI, measures of general personality, OCPD trait scales, and alternative measures of OCPD. Results supported the validity of the FFOCI as a measure of OCPD and maladaptive variants of FFM traits, as well as identifying substantive differences among the alternative measures of OCPD, particularly with respect to their relationship with FFM conscientiousness, antagonism, and introversion.

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).