Examining the structure of personality dysfunction.

Personality impairment is a core feature of personality disorders in both current (i.e., Diagnostic and Statistical Manual of Mental Disorders, fifth edition [DSM-5] personality disorders, International Classification of Diseases,11th revision personality disorders) and emerging (i.e., DSM-5's alternative model of personality disorders) models of psychopathology. Yet, despite its importance within clinical nosology, attempts to identify its optimal lower-order structure have yielded inconsistent findings. Given its presence in diagnostic models, it is important to better understand its empirical structure across a variety of instantiations. To the degree that impairment is multifaceted, various factors may have different nomological networks and varied implications for assessment, diagnosis, and treatment. Therefore, participants were recruited from two large public universities in the present preregistered study (N = 574) to explore the construct's structure with exploratory "bass-ackward" factor analyses at the item level. Participants completed over 250 items from six commonly used measures of personality dysfunction. Criterion variables in its nomological network were also collected (e.g., general and pathological personality traits, internalizing/externalizing behavior, and personality disorders) using both self- and informant-reports. These factor analyses identified four lower-order facets of impairment (i.e., negative self-regard, disagreeableness, intimacy problems, and lack of direction), all of which showed moderate to strong overlap with traits from both general and pathological models of personality. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Evidence-Based Assessment of Substance Use Disorder.

The current review describes updated information on the evidence-based assessment of substance use disorder. We offer an overview of the state of the science for substance-related assessment targets, instruments (screening, diagnosis, outcome and treatment monitoring, and psychosocial functioning and wellbeing) and processes (relational and technical) as well as recommendations for each of these three components. We encourage assessors to reflect on their own biases, beliefs, and values, including how those relate to people that use substances, and to view the individual as a whole person. It is important to consider a person's profile of symptoms and functioning inclusive of strengths, comorbidities, and social and cultural determinants. Collaborating with the patient to select the assessment target that best fits their goals and integration of assessment information in a holistic manner is critical. We conclude by providing recommendations for assessment targets, instruments, and processes as well as recommendations for comprehensive substance use disorder assessment, and describe future directions for research.

Is Personality Pathology Ego-Syntonic? Self- and Meta-Perception of Maladaptive Personality Traits.

Research has challenged the assumption that personality pathology is "ego-syntonic" or perceived favorably and consistent with one's self-image. The present study employed a community sample (n = 401) to examine relations between self-rated maladaptive personality and liking of maladaptive traits in self and others as well as meta-perception of personality pathology (i.e., how likable participants believe others find maladaptive traits). In general, individuals with higher self-rated maladaptive traits provided higher ratings of the likability of these traits in themselves and others. However, as hypothesized, comparison of liking ratings for high scorers and the rest of the sample revealed that individuals who score high on most pathological personality traits do not "like" these traits (or rate others as "liking" them) but simply dislike them less. Results support a dimensional view of ego-syntonicity.

Surveying veterans affairs mental health care providers on experiences working with veteran patients with antagonistic clinical presentations.

We surveyed N = 84 mental health care providers (i.e., psychiatrists, psychologists, social workers) working across two Veterans Affairs health care sites about their experiences working with Veteran patients with antagonism-based clinical presentations (e.g., callous, aggressive, grandiose features), as well as negative affect-based clinical presentations (e.g., depressive, anxious, self-conscious features). Providers reported on aspects of these clinical interactions, including assessments and interventions used, treatment outcomes, interpersonal experiences, and training and preparedness to treat this type of presentation in the future. Compared to treatment experiences with patients with predominant negative affect, providers reported that treatment experiences with antagonistic (ANT) patients tended to be shorter (d = -.60), less effective at improving psychological functioning (d = -.61), more emotionally draining (d = 1.03), and more often marked by relationship ruptures (instance of ≥1 rupture = 72.6% vs. 15.5%). Providers also reported less professional training to treat antagonism (d = -1.56) and less preparedness to treat ANT patients in the future (d = -1.81). These results highlight the important role of patient characteristics in providers' experiences and underscore the need for more training and resources to support mental health providers working with ANT patients. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Examining the Therapeutic Effect of Ceremonial Ayahuasca on Narcissistic Personality and Antagonistic Externalizing in Adults.

Changes in narcissistic traits (e.g., entitlement) following the ceremonial use of ayahuasca were examined across three timepoints (baseline, postretreat, 3-month follow-up) in a sample of 314 adults using self- and informant-report (N = 110) measures. Following ceremonial use of ayahuasca, self-reported changes in narcissism were observed (i.e., decreases in Narcissistic Personality Inventory [NPI] Entitlement-Exploitativeness, increases in NPI Leadership Authority, decreases in a proxy measure of narcissistic personality disorder [NPD]). However, effect size changes were small, results were somewhat mixed across convergent measures, and no significant changes were observed by informants. The present study provides modest and qualified support for adaptive change in narcissistic antagonism up to 3 months following ceremony experiences, suggesting some potential for treatment efficacy. However, meaningful changes in narcissism were not observed. More research would be needed to adequately evaluate the relevance of psychedelic-assisted therapy for narcissistic traits, particularly studies examining individuals with higher antagonism and involving antagonism-focused therapeutic approaches.

Welcome to the Jangle: Comparing the Empirical Profiles of the "Dark" Factor and Antagonism.

This study examines the congruency between the recently introduced Dark Factor of Personality (D) and Antagonism (A; low Agreeableness) from the Five-Factor Model of personality. Using two samples (Ns of 365 and 600), we examined simple zero-order correlations between D and A (rs of .69 and .64). In addition, we used a range of relevant external criteria (e.g., antisocial behavior, aggression, domains and facets of personality, Diagnostic and Statistical Manual of Mental Disorders [DSM] personality disorders [PDs], impulsivity, and political skill) to examine the degree of absolute similarity in the relations that D and A bear to these criteria. These similarity coefficients were then compared with the similarities produced by measures of constructs different from D and A but similar among themselves (i.e., psychopathy and narcissism in both samples, plus depression in Sample 1). The degree of similarity between D and A (rICCs = .96 and .93) is consistent with what is observed between other measures of the same construct. We conclude that D and A yield largely identical empirical correlates and thus likely represents an instance of the jangle fallacy. We believe that future efforts would be better spent furthering the literature around the well-established Agreeableness versus Antagonism construct.

Association of Multidimensional Schizotypy with PID-5 Domains and Facets.

The underlying vulnerability for schizophrenia-spectrum disorders is expressed across a continuum of clinical and subclinical symptoms referred to as schizotypy. Schizotypy is a multidimensional construct with positive, negative, and disorganized dimensions. The present study examined associations of positive, negative, and disorganized schizotypy with pathological personality traits and facets assessed by the Personality Inventory for DSM-5 (PID-5) in 1,342 young adults. As hypothesized, positive schizotypy was associated with the PID-5 psychoticism domain and facets, negative schizotypy was associated with the detachment domain and facets and the restricted affectivity facet, and disorganized schizotypy's strongest associations were with the distractibility and eccentricity facets and the negative affect domain. The PID-5 facets accounted for upwards of two thirds of the variance in each schizotypy dimension. The authors conclude by providing regression-based algorithms for computing positive, negative, and disorganized schizotypy scores based on the PID-5 facets.

The problems with Criterion A: A comment on Morey et al. (2022).

The alternative model of personality disorder (American Psychiatric Association, 2013), introduced in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, represents a significant advancement in our understanding of personality disorders. Despite this advancement, nearly 10 years after its introduction, considerable debate remains regarding the conceptualization, operationalization, and ultimately the utility of personality impairment (i.e., Criterion A). Morey et al. (2022) review the impetus for, conceptualization of, the current state of our understanding of Criterion A, and conclude that Criterion A is a valid and clinically useful component of the alternative model of personality disorder. In our commentary, we present a more pessimistic view and review literature critical of Criterion A not included in the main text of their review. We conclude that Criterion A, as currently operationalized by the Level of Personality Functioning Scale, does not provide the functionality or utility as suggested by Morey and colleagues in their review. Instead, we suggest that pathological traits are well-positioned to capture severity of dysfunction and likely carry the most clinically useful information. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Distinguishing PTSD, complex PTSD, and borderline personality disorder using exploratory structural equation modeling in a trauma-exposed urban sample.

There is debate about the validity of the complex posttraumatic stress disorder (CPTSD) diagnosis and whether disturbances in self-organization (DSO) in CPTSD can be differentiated from borderline personality disorder (BPD). How PTSD is defined may matter. The present study used exploratory structural equation modeling (ESEM) to replicate and extend prior work by including two models to examine how PTSD (ICD-11, DSM-5), DSO, and BPD symptoms relate. Participants (N = 470; 98.1% women; 97.7% Black) were recruited from medical clinics within an urban hospital. PTSD, CPTSD, and BPD were assessed using semi-structured interviews and trauma-related avoidance, aggressive behavior, and anxious attachment were assessed using self-report measures. ESEM models of PTSD, DSO, and BPD symptoms were run. We found a three-factor ESEM model of CPTSD (ICD-11 PTSD and DSO symptoms) and BPD symptoms best fit the data and found support for discriminant validity between factors across trauma-related avoidance, aggressive behavior, and anxious attachment. For DSM-5 PTSD, a two-factor ESEM model was best-fitting (PTSD and DSO/BPD). The findings demonstrate clear distinguishing and overlapping features of ICD-11 PTSD, CPTSD, and BPD and the necessity to consider the diagnostic structure of PTSD in determining the additive value of CPTSD as a distinct construct.

Understanding individuals' desire for change, perceptions of impairment, benefits, and barriers of change for pathological personality traits.

Despite clinical theory suggesting that individuals are largely unaware of personality-related problems (Gallrein et al., 2013; Oltmanns & Powers, 2012); work in this area shows that individuals possess insight into their pathological traits and the impairment they may cause. Individuals generally dislike pathological traits and desire change in the direction of greater adaptivity (Lamkin et al., 2018; Miller et al., 2018). Individuals may also be able to make small, intentional changes in some personality domains (e.g., neuroticism; Hudson & Fraley, 2015; Hudson & Roberts, 2014) but not others (no positive change in conscientiousness or agreeableness). It remains unclear why many individuals exhibit relatively little change in their pathological traits (e.g., antagonism), given their awareness of the problems these traits cause and their desire for change. The goal of the present study was to explore the relation between personality disorder (PD) traits and desire for change, perceived impairment and benefits, and barriers to change among an online sample (N = 497). Findings suggest that most individuals were uninterested in changing their trait levels; however, individuals with elevated PD traits were more interested in change than those with lower levels. Pathological traits were generally perceived as impairing rather than beneficial; however, mean level analyses revealed similar levels of perceived impairment and benefits for those relatively high on antagonism. Individuals reported that personality change was stymied in part because it was too hard, they were unmotivated to make the changes, or they did not know how to go about making such changes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Uncovering the structure of antagonism.

Despite the advances in our understanding of the structure of personality and psychopathology (see Kotov et al., 2017), less attention has been paid to empirically examining their underlying facet structure. To gain a more nuanced understanding of the structure of personality, it is important to identify empirically derived lower order structures of these trait domains; thus, the present study sought to examine the structure of antagonism as represented by items from commonly used measures of pathological personality traits. Participants were recruited from a large, southeastern university (N = 532) and completed 234 antagonism items selected from seven measures of pathological personality traits. Criterion variables measuring interpersonal adjectives, aggression, substance use, depression, and anxiety were also collected. A series of factor analyses were conducted to examine the structure of antagonism at a range of specificities. A seven-factor solution emerged as being both comprehensive and reasonably parsimonious with factors labeled Callousness, Grandiosity, Domineering, Manipulation, Suspiciousness, Aggression, and Risk Taking. The present findings demonstrate how trait Antagonism unfolds at varying levels of specificity as well as how the emergent factors differentially relate to outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

DSM-5 alternative model for personality disorders trait domains and PTSD symptoms in a sample of highly traumatized African American women and a prospective sample of trauma center patients.

Posttraumatic stress disorder (PTSD) has a specified precipitant (i.e., trauma), and thus, is particularly well-suited to examine risk and maintenance factors for the development of the disorder. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) alternative model of personality disorder (AMPD) is based, in part, on a dimensional trait model; previous research suggests that personality traits are related to PTSD symptoms. To date, there is little research examining this model with regard to PTSD symptoms, and such research could elucidate new strategies for identification and prevention. The present study investigates associations between AMPD traits and PTSD symptoms in a cross-sectional high-risk sample (N = 490; 100% female; 97.8% African American) and in a prospective, longitudinal sample of Level 1 trauma center patients (N = 185; 46.8% female; 72.5% African American). The Personality Inventory for DSM-5 Brief Form domains were significantly associated with PTSD total symptom severity and symptom clusters across both self-report and clinical interview measures. Personality Inventory for DSM-5 Negative Affectivity and Psychoticism emerged as significant predictors of concurrent PTSD. When prospectively predicting PTSD symptoms in the longitudinal cohort, Negative Affectivity and Psychoticism were significant predictors of PTSD symptom severity. These findings indicate how the DSM-5 AMPD pathological traits are associated with risk for stress-related disorders cross-sectionally and prospectively. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Insight Regarding the Presence of Antagonism-Related Traits and Their Subsequent Impairment in Relation to Psychopathy, Narcissism, and Machiavellianism.

Clinical theory is skeptical of individuals' ability to recognize the presence, severity, and impact of clinical symptoms and pathological traits (Oltmanns & Powers, 2012); however, empirical work has found moderate self-other convergence for reports of pathological traits and for Antagonism-related personality disorder (PD) constructs (i.e., psychopathy, narcissism, and Machiavellianism), which are characterized by low insight. Nevertheless, empirical examinations of insight into perceptions of impairment are scant. Thus, the present study sought to examine individuals' insight regarding pathological traits and related impairment in two samples. In Sample 1, more psychopathic, narcissistic, and Machiavellian individuals reported higher levels of pathological traits and were aware of related impairment. In Sample 2, individuals reported higher levels of pathological traits and, albeit to a lesser degree, more Antagonism-related impairment. Thus, more psychopathic, narcissistic, and Machiavellian individuals possess a reasonable degree of insight into their trait levels and associated impairment.

Psychometric Properties of the Personality Inventory for DSM-5-Brief Form in a Community Sample with High Rates of Trauma Exposure.

In the current study, we used a sample of predominantly African-American women with high rates of trauma exposure (N = 434) to examine psychometric properties of the Personality Inventory for DSM-5-Brief Form (PID-5-BF). We compared model fit between a model with five correlated latent factors and a higher-order model in which the five latent factors were used to estimate a single "general pathology" factor. Additionally, we computed estimates of internal consistency and domain interrelations and examined indices of convergent/discriminant validity of the PID-5-BF domains by examining their relations to relevant criterion variables. The expected five-factor structure demonstrated good fit indices in a confirmatory factor analysis, and the more parsimonious, higher-order model was retained. Within this higher-order model, the first-order factors accounted for more variance in the criterion variables than the general pathology factor in most instances. The PID-5-BF domains were highly interrelated (rs = .38 to .66), and convergent/discriminant validity of the domains varied: Negative Affectivity and Detachment generally showed the hypothesized pattern of relations with external criteria, while Antagonism and Disinhibition displayed less consistent and discriminant relations. Results are discussed in terms of the costs and benefits of using brief pathological trait measures in samples characterized by high levels of psychopathology.

A Comparison of the Validity of Very Brief Measures of the Big Five/Five-Factor Model of Personality.

Personality is of great lay, clinical, and research interest with important functional implications. The field has largely settled on five- or six-factor models as being largely sufficient for descriptive purposes, at least in W.E.I.R.D settings and, as such, numerous measures have been created of varying length and breadth. For a number of reasons, however, super-short forms have come to be quite popular in research endeavors with a number created in the past 20 years. The goal of the present study was to compare the time with completion and general psychometric properties of these measures, as well as examine their convergence with one another and with longer measures in an online community sample (N = 494). Generally, the psychometric properties of the measures varied considerably in terms of internal consistency and convergence with one another. The brief measures demonstrated mostly adequately convergence with longer measures. Despite this convergence, longer measures were found to contain considerably more variance that was not accounted for by brief measures. We consider the advantages and disadvantages of these measures and suggest that longer measures be prioritized whenever possible.

Fearless Dominance/Boldness Is Not Strongly Related to Externalizing Behaviors: An Item Response-Based Analysis.

There is substantial and ongoing debate regarding the centrality of Fearless Dominance/Boldness (FD/B) to psychopathic personality due, in part, to its generally weak relations with externalizing behaviors. In response to these findings, proponents of FD/B have offered two hypotheses. First, FD/B may have nonlinear associations with externalizing outcomes such that FD/B may lead to resilience at moderate levels, but an overabundance of FD/B will yield maladaptive behavioral outcomes. Second, FD/B may be related to antisocial outcomes when paired with high scores on other psychopathic traits such as self-centered impulsivity, meanness, or disinhibition. The current study tests these two possibilities using two large samples (Study 1: 787 undergraduates; Study 2: 596 Amazon's Mechanical Turk participants). An item response theory scoring approach particularly sensitive to curvilinearity was used to maximize our ability to find a true curvilinear effect, if present. No evidence in favor of the curvilinearity hypothesis was found. Only a single significant interaction predicting substance use was observed between boldness and meanness. These findings contribute to a growing literature raising concerns regarding the relevance of FD/B to psychopathy.

Personality impairment in the DSM-5 and ICD-11: Current standing and limitations.

PURPOSE OF REVIEW: The current review provides an examination of the levels of personality functioning outlined by the International Classification of Diseases-11 and the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders. RECENT FINDINGS: Across self-report measures, high convergence is observed, and they evince relatively robust relations with general and pathological traits as well as other clinical symptoms. At the same time, current measures of impairment also demonstrate unstable factor structures, poor discriminant validity (when measures offer subscales aligned with different forms of personality impairment), and tend to account for relatively little unique variance beyond traits. As a result, some have questioned the utility of personality impairment, as currently measured. SUMMARY: The dimensional models of personality psychopathology included in the International Classification of Diseases-11 and 5th edition of the Diagnostic and Statistical Manual of Mental Disorders signify important steps toward an empirically supported and clinically useful diagnostic model; however, self-report measures of impairment are problematic. The authors conclude by calling for the refinement of these measures to more directly assess deficits in various domains of functioning as well as the dimensional models, by assessing traits first, and then examining the nature of the associated personality impairment.

Evaluating the Instantiation of Narcissism Components in Contemporary Measures of Psychopathy.

Narcissistic traits figure prominently in classical conceptualizations of psychopathy and bear substantial empirical overlap with components of psychopathy. Yet the degree to which various widely used self-report measures of psychopathy include relevant narcissistic content has not been evaluated, especially in relation to new, multidimensional models of narcissism. Using a large undergraduate sample (N = 432) and self- and informant-ratings of narcissism, the present study examined narcissism's instantiation in several commonly used self-report psychopathy measures. A modern conceptualization of narcissism at three levels of hierarchical organization (i.e., Trifurcated Model of Narcissism) was applied to comprehensively evaluate narcissism's instantiation in these psychopathy measures. Although narcissistic traits related to self-centered antagonism were well-instantiated across psychopathy self-report measures, narcissistic traits related to agentic extraversion were represented more modestly by most (i.e., Triarchic Psychopathy Measure, Self-Report Psychopathy Scale: Version III, Levenson Self-Report Psychopathy Scale), but not all (i.e., Elemental Psychopathy Assessment [EPA]) psychopathy measures. Only the EPA contained substantial representation of all narcissism components. Given the theoretical and empirical overlap between psychopathy and narcissism, it behooves researchers to be aware of the degree to which psychopathy measures capture narcissistic content.

The DSM-5 section III personality disorder criterion a in relation to both pathological and general personality traits.

Following the introduction of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), section III alternative model of personality disorder, much of the empirical attention has been directed toward testing the performance of Criterion B (i.e., pathological traits). Much more recently, with the development of assessment tools related to Criterion A (i.e., personality impairment), a burgeoning literature base is forming for it as well. A closer look at the Criterion A component, however, reveals disagreements around its structure, discriminant validity, ability to distinguish between personality-based and nonpersonality-based forms of psychopathology, overlap between the two criteria, and incremental validity. The goal of the current study (N = 365 undergraduates) was to test Criterion A in relation to both pathological personality traits, as specified in the DSM-5, and general personality traits, as some scholars suggested that might be more appropriate. The results suggest that impairment domains overlap substantially with pathological and general traits, and these traits account for considerable variance in impairment domains. Most importantly, the findings suggest that general and pathological traits functioned in nearly identical ways, as evidenced by the similar relations that they evinced with traditional DSM-5 personality disorder constructs. In line with previous work, the present findings demonstrate limited discriminant validity among impairment domains and an inability to distinguish between Axis I and II symptoms. Further research on the alternative model of personality disorder is needed to test the necessity and sufficiency of its constituent components. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

An evaluation of DSM-5 Section III personality disorder Criterion A (impairment) in accounting for psychopathology.

An alternative diagnostic model of personality disorders (AMPD) was introduced in DSM-5 that diagnoses PDs based on the presence of personality impairment (Criterion A) and pathological personality traits (Criterion B). Research examining Criterion A has been limited to date, due to the lack of a specific measure to assess it; this changed, however, with the recent publication of a self-report assessment of personality dysfunction as defined by Criterion A (Levels of Personality Functioning Scale-Self-report; LPFS-SR; Morey, 2017). The aim of the current study was to test several key propositions regarding the role of Criterion A in the AMPD including the underlying factor structure of the LPFS-SR, the discriminant validity of the hypothesized factors, whether Criterion A distinguishes personality psychopathology from Axis I symptoms, the overlap between Criterion A and B, and the incremental predictive utility of Criterion A and B in the statistical prediction of traditional PD symptom counts. Neither a single factor model nor an a priori four-factor model of dysfunction fit the data well. The LPFS-SR dimensions were highly interrelated and manifested little evidence of discriminant validity. In addition, the impairment dimensions manifested robust correlations with measures of both Axis I and II constructs, challenging the notion that personality dysfunction is unique to PDs. Finally, multivariate regression analyses suggested that the traits account for substantially more unique variance in DSM-5 Section II PDs than does personality impairment. These results provide important information as to the functioning of the two main components of the DSM-5 AMPD and raise questions about whether the model may need revision moving forward. (PsycINFO Database Record (c) 2019 APA, all rights reserved).