Personality profiles as potential targets for intervention: Identification and replication.

The alternative dimensional model of personality disorder (PD) diagnosis, based on personality-functioning impairment and pathological traits, opens the door for tailoring treatments to individuals with more homogeneous personality profiles than diagnostic categories. Such a transdiagnostic PD treatment approach requires robust, replicable, personality-relevant dimensions, which we found using a large battery of self-report measures: Self-pathology and negative affectivity (NA) traits, interpersonal pathology and detachment traits, and interpersonal pathology and antagonism traits. Using these dimensions, we identified three groups that had, respectively, elevations on (1) all three dimensions, (2) self-pathology/NA (with/without interpersonal-pathology elevation(s)) and (3) either or both interpersonal-pathology dimensions, without elevated self-pathology/NA. Using the same personality-functioning measures and a half-overlapping trait set, we replicated these profiles in an additional sample. Interview-based measures of functioning and personality pathology provided external validity evidence for the method, suggesting it represents a critical first step towards treatment research targeting transdiagnostic processes rather than diagnoses. For example, two groups might benefit from treatments focused, respectively, on emotional dysregulation and interpersonal relations, whereas the multiple-problem group may need a sequenced treatment approach. Research is needed to test these hypotheses and to expand the method to include a wider range of pathological personality traits. © 2019 John Wiley & Sons, Ltd.

Affect, behavior, and cognition in personality and functioning: An item-content approach to clarifying empirical overlap.

The alternative model of personality disorder in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; American Psychiatric Association, 2013), Section III, "Emerging Measures and Models," includes both personality dysfunction and pathological-range traits. However, the nature of personality dysfunction and its relation to pathological-range traits needs further explication. In existing measures, the personality constructs of traits and functioning are highly overlapping. For example, a joint factor analysis of a large set of such measures found 5 factors, 2 of which were composed of both trait and functioning scales (Clark & Ro, 2014); however, the basis for this comingling remains unclear. In this research, we explored whether the comingling was at least partly due to similarity in the scales' item content. Specifically, we examined the affective, behavioral, and cognitive (ABC) composition of 212 items, each of which was rated by subsets of 7 judges. Results indicated that personality trait and functioning scales that load on a common factor have ABC profiles that are similar to each other but distinct from those of scales loading on other factors. These results suggest that combined trait-and-functioning factors emerge partly because of similarities in their scales' item content, despite the fact that the constructs they were intended to assess are theoretically distinct. Thus, ABC profiles may represent basic characteristics of empirical trait-and-functioning factors, suggesting that our conceptualization and/or measurement of these constructs need revision. Drawing from classic trait theory, we suggest that traits and functioning may be complementary rather than distinct. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Brave New World of Personality Disorder-Trait Specified: Effects of Additional Definitions on Coverage, Prevalence, and Comorbidity.

The alternative dimensional model for personality disorder (PD) in DSM-5, Section III (DSM-5-III) includes two main criteria: (A) personality-functioning impairment, and (B) personality-trait pathology; provides specific functioning-and-trait criteria for six PD-type diagnoses; and introduces PD-trait specified (PD-TS), which requires meeting the general PD criteria and not meeting criteria for any specific PD type. We termed this Simple PD-TS and developed two additional definitions: Mixed PD-TS, meeting criteria for one or two PD types and having five or more additional pathological traits; and Complex PD-TS, meeting criteria for three or more PD types. In a mixed sample of 165 outpatients and 215 community adults screened to be at high-risk for PD, we investigated the effect of these additional definitions on prevalence, coverage, comorbidity, and within-diagnosis heterogeneity, and conclude that eliminating the PD-type diagnoses and thus having PD-TS as the only PD diagnosis would be both more parsimonious and more useful clinically.