Categorical and Dimensional Conceptions of Personality Pathology in DSM-5: Toward a Model-Based Synthesis.

Symptom-based models, typically operationalized through diagnostic interview, and trait models, typically operationalized via questionnaire inventories, reflect historically competing conceptions of personality disorder (PD). DSM-5 includes models of both types, in Sections II and III, respectively. In this study, we sought to synthesize these alternative conceptualizations by fitting bifactor models to data for both Section II PD symptoms (assessed using the SCID-II interview protocol) and dimensional traits for the six PDs retained in Section III (assessed using the Personality Inventory for DSM-5). Bifactor models fit the data effectively for all six PDs, and trait and symptom indicators both loaded appreciably on general factors reflecting cross-domain PD constructs. These results provide the basis for a principled, quantitative synthesis of categorical/interview and dimensional/self-report approaches to operationalizing and studying PDs, with considerable implications for diagnosis, research, and practice.

Evidence-based treatment and supervision practices for co-occurring mental and substance use disorders in the criminal justice system.

BACKGROUND: Over seven million persons in the United States are supervised by the criminal justice system, including many who have co-occurring mental and substance use disorders (CODs). This population is at high risk for recidivism and presents numerous challenges to those working in the justice system. OBJECTIVES: To provide a contemporary review of the existing research and examine key issues and evidence-based treatment and supervision practices related to CODs in the justice system. METHODS: We reviewed COD research involving offenders that has been conducted over the past 20 years and provide an analysis of key findings. RESULTS: Several empirically supported frameworks are available to guide services for offenders who have CODs, including Integrated Dual Disorders Treatment (IDDT), the Risk-Need-Responsivity (RNR) model, and Cognitive-Behavioral Therapy (CBT). Evidence-based services include integrated assessment that addresses both sets of disorders and the risk for criminal recidivism. Although several evidence-based COD interventions have been implemented at different points in the justice system, there remains a significant gap in services for offenders who have CODs. Existing program models include Crisis Intervention Teams (CIT), day reporting centers, specialized community supervision teams, pre- and post-booking diversion programs, and treatment-based courts (e.g., drug courts, mental health courts, COD dockets). Jail-based COD treatment programs provide stabilization of acute symptoms, medication consultation, and triage to community services, while longer-term prison COD programs feature Modified Therapeutic Communities (MTCs). CONCLUSION: Despite the availability of multiple evidence-based interventions that have been implemented across diverse justice system settings, these services are not sufficiently used to address the scope of treatment and supervision needs among offenders with CODs.

Elaborating on the construct validity of the Minnesota Borderline Personality Disorder Scale (MBPD): a multi-sample, longitudinal examination.

Borderline personality disorder (BPD) is frequently conceptualized as an extreme variant of normal personality traits. A previous study successfully developed and validated a self-report BPD measure, the Minnesota Borderline Personality Disorder Scale (MBPD). We conducted 2 studies aimed at providing further validation for this measure. Results from Study 1 (clinical sample of substance users) indicated that the MBPD exhibited strong positive correlations with measures of convergent validity. In addition, the MBPD showed similar correlations with external correlates as those of the convergent validity measures as well as incremental utility in predicting these external correlates above and beyond negative affect and adult antisocial behavior. Also, a receiver operating characteristic curve analysis indicated that diagnostic accuracy of the MBPD was excellent for differentiation between BPD and non-BPD individuals. Likewise, Study 2 (nonclinical sample of undergraduate students followed over 6 months) showed strong correlations with an index of convergent validity, similar correlations with external correlates as that of the convergent validity index, and incremental predictive utility. Finally, in this study, the MBPD exhibited high rank-order stability. These data provide further evidence that the MBPD is a valid indicator of BPD.

A further validation of the Minnesota Borderline Personality Disorder Scale.

Previous research indicates that borderline personality disorder (BPD) is well conceptualized as a dimensional construct that can be represented using normal personality traits. A previous study successfully developed and validated a BPD measure embedded within a normal trait measure, the Minnesota Borderline Personality Disorder Scale (MBPD). The current study performed a further validation of the MBPD by examining its convergent validity, external correlates, and heritability in a sample of 429 female twins. The MBPD correlated strongly with the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II) screener for BPD and moderately with external correlates. Moreover, the MBPD and SCID-II screener exhibited very similar patterns of external correlations. Additionally, results indicated that the genetic and environmental influences on MBPD overlap with the genetic and environmental influences on the SCID-II screener, which suggests that these scales are measuring the same construct. These data provide further evidence for the construct validity of the MBPD.