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.

The Development of the Five-Factor Schizoid Inventory.

The current study sought to provide evidence for a measure of schizoid personality disorder (SZD PD) traits using the Five-Factor Model framework of personality. In the first study, undergraduate participants (n = 496) completed the Five-Factor Schizoid Inventory (FFZI) and other self-report measures. The first half of the sample was used to develop the FFZI, while the second half was used to validate it. The FFZI demonstrated excellent internal consistency, convergent validity with measures of SZD PD and hypothesized IPIP-NEO facets, and discriminant validity with other PDs and non-hypothesized IPIP-NEO facets. The second study recruited MTurk participants (n = 181) and demonstrated preliminary support for the reliability and validity of the FFZI in an online, community sample. Ultimately, these data suggest that the FFZI is a useful measure of SZD PD and provide further evidence that SZD PD can be conceptualized as a maladaptive extension of introversion traits.

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.

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).

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).

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.

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.

Traits are dynamic.

There has long been opposition to conceptualizing personality disorders as maladaptive variants of the 5-factor model. The debate though is now shifting away from the coverage of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Section II personality disorders to the coverage of moment-to-moment contingencies within everyday life. Miskewicz et al. (2022) reported that trait models do account well for the intensity of triggers and the symptomatic response to these triggers but not for the contingency of the symptoms on the triggers. However, there are fundamental conceptual, methodological, and empirical problems that should question its apparent critique of the 5-factor model of personality disorder. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition alternative model of personality disorder.

The fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013) includes within a section for emerging measures and models an alternative model of personality disorder (AMPD). This article provides a brief overview of its development, noting, in particular, issues and controversies. The article concludes with a discussion of and recommendations for further research in regard to 8 issues: (a) whether the DSM-5 AMPD offers any incremental validity over DSM-IV with respect to the validity or clinical utility; (b) development of the treatment implications for the AMPD components; (c) whether the DSM-5 AMPD level of personality functioning (LPF) is a unitary construct; (d) whether the LPF does in fact identify the core of personality disorder, (e) whether the LPF is even necessary; (f) whether the AMPD trait model is sufficiently comprehensive in its coverage; (g) the synchronization of International Classification of Diseases, Eleventh Revision, and DSM-5 Section III; and (h) whether the future classification of personality disorder should continue to include any of the DSM-IV syndromes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

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.

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).

Developing Preliminary Scales for Assessing the HiTOP Detachment Spectrum.

The Hierarchical Taxonomy of Psychopathology (HiTOP) is an empirical-based classification of psychopathology. Detachment is one of the six spectra in the current HiTOP working model. The aim of this study was to develop preliminary scales for the HiTOP Detachment spectrum that can be used in the next phase of developing a comprehensive measure of HiTOP. We had 456 participants from MTurk (Sample 1) and 266 university students (Sample 2) complete an online survey including a pool of 247 Detachment items assessing 15 consensually defined low-order constructs. Using a stepwise procedure involving factor analyses and ant colony optimization methods, we developed seven 8-item scales that capture unipolar facets of Detachment: anhedonia, suspiciousness, social withdrawal, intimacy avoidance, unassertiveness, risk aversion, and restricted affectivity. Three other 8-item scales emerged that tapped into a Maladaptive Extraversion construct (attention-seeking, thrill-seeking, and domineering), which was mostly unrelated to unipolar Detachment in factor analyses. The 10 scales were unidimensional, reliable, and showed some evidence of convergent and discriminant validity. We discuss challenges of assessing Detachment when moving forward with developing a comprehensive measure of HiTOP.

The General Factors of Personality Disorder, Psychopathology, and Personality.

There is considerable interest in the study of the general factors of personality disorder (g-PD), psychopathology (p factor), and personality (GFP). One prominent interpretation of the g-PD is that it is defined by the self-interpersonal impairments of Criterion A of the DSM-5 Section III. However, no study has directly tested this hypothesis as no prior g-PD study has included a measure of Criterion A. The current study provides a direct test of this hypothesis, along with comparing g-PD with the general factors of psychopathology and personality. Also extracted was a common general factor across all three domains. Suggested herein is that the g-PD, the p factor, and the GFP reflect the impairments (e.g., social and occupational dysfunction) that are secondary to the traits and disorders rather than the traits and/or disorders themselves.

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.

Development of Measures for the Hierarchical Taxonomy of Psychopathology (HiTOP): A Collaborative Scale Development Project.

In this article, we describe the collaborative process that is underway to develop measures for the Hierarchical Taxonomy of Psychopathology (HiTOP). The HiTOP model has generated much interest in the psychiatric literature in recent years, but research applications and clinical translation of the model require measures that are specifically keyed to the model. To that end, the Measures Development Workgroup of HiTOP has been engaged in a collaborative effort to develop both questionnaire and interview methods that (a) are specifically tied to the elements of the HiTOP structure, and (b) provide one means of testing that structure. The work has been divided among five subgroups that are focused on specific HiTOP spectra. Our scale development methods are rooted in the principles of construct valid scale development. This report describes Phase 1 of this project, summarizes the methods and results thus far, and discusses the interplay between measurement and HiTOP model revisions. Finally, we discuss future phases of the scale development and the steps we are taking to improve clinical utility of the final measures.

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 self- and informant-personality inventories for ICD-11: Agreement, structure, and relations with health, social, and satisfaction variables in older adults.

The International Classification of Diseases-11th Edition (ICD-11) includes a dimensional trait model of personality disorder. The Personality Inventory for ICD-11 (PiCD) was the first self-report measure developed for its assessment. The present study examines the validity of an informant-report version of the PiCD, the Informant-Personality Inventory for ICD-11 (the IPiC), and is the first study to test self-other agreement, ratings from close others, and the criterion validity of both the IPiC and the PiCD for several popular and well-validated measures of life functioning: Life and romantic relationship satisfaction, social support, physical and mental health, depressive symptoms, insomnia symptoms, and cognitive decline. The present study is also the first to examine the IPiC and PiCD in a sample of older adults in the community. Results suggest that the IPiC and the PiCD show moderate self-other agreement, are associated significantly with several important life functioning areas, and have structural validity even at the item level. Further replication and validation are necessary for these instruments, but the IPiC and the PiCD have shown strong validation evidence to date, now including evidence of consensual and criterion validity, in addition to structural validity. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Five-Factor Model Personality Disorder Traits, Health Behaviors, Health Perceptions, and Insomnia Symptoms in Older Adults.

Personality traits predict physical health outcomes, including health behaviors, disease, and mortality. Maladaptive traits of personality disorders may predict even more variance in physical health indicators. Dimensional models of maladaptive personality traits are replacing categorical models of personality disorder, and the Five-Factor Model of personality disorder (FFMPD) is a useful dimensional model of maladaptive traits. However, there has been little work investigating the criterion validity of the FFMPD. The present study serves as a broad initial overview of the FFMPD scales in the prediction of health behaviors, heath perceptions, and insomnia symptoms across two time points in a representative community sample of older adults (N = 1,060). Findings indicate that the FFMPD scales explain a significant amount of variance in the physical health variables across time. Exploratory analyses indicate that the FFMPD traits have incremental validity over covariates, normal-range personality traits, and personality disorder criteria.

Personality Disorders in the ICD-11: Spanish Validation of the PiCD and the SASPD in a Mixed Community and Clinical Sample.

The International Classification of Diseases-11th revision (ICD-11) classification of personality disorders is the official diagnostic system that is used all over the world, and it has recently been renewed. However, as yet very few data are available on its performance. This study examines the Personality Inventory for ICD-11 (PiCD), which assesses the personality domains of the system, and the Standardized Assessment of Severity of Personality Disorder (SASPD), which determines severity. The Spanish versions of the questionnaires were administered to a community (n = 2,522) and a clinical sample (n = 797). Internal consistency was adequate in the PiCD (α = .75 to .84) but less so in the SASPD (α = .64 and .73). Factor analyses suggested a unidimensional or bidimensional structure for severity, while revealing that the personality trait qualifiers are organized into four factors: negative affectivity, detachment, dissociality, and a bipolar domain of disinhibition-anankastia. The mutual relationships between traits and severity were analyzed, as well as the ability of the whole system to identify clinical subjects. Although further improvements are required, the results generally support the use of the PiCD and the SASPD and help substantiate the new ICD-11 taxonomy that underlies them.

The Development of the Informant Five-Factor Borderline Inventory.

Borderline personality disorder (BPD) is one of the most studied personality disorders and is associated with significant outcomes such as suicide. Although BPD is represented in DSM-5 as a categorical diagnosis, it may be better characterized dimensionally, such as from the perspective of the five-factor model of general personality (FFM). The Five-Factor Borderline Inventory (FFBI) assesses BPD from the perspective of maladaptive variants of FFM traits. Previous research suggests that informant-reports may increase the validity of personality disorder assessment, providing additional information that may supplement self-report. Therefore, the current study developed an informant measure of the FFBI, Informant Five-Factor Borderline Inventory (IFFBI) and examined its convergent and discriminant validity compared with the self-report FFBI, FFM, and traditional measure of BPD. Overall, the IFFBI demonstrated good convergent validity and moderate discriminant validity with the FFBI, FFM, and other traditional measures of BPD.