Personality disorder coverage, prevalence, and convergence: do the DSM-5's two models of personality disorder identify the same patients?

BACKGROUND: Research on the Alternative DSM-5 Model for Personality Disorders (AMPD) in DSM-5's Section-III has demonstrated acceptable interrater reliability, a largely consistent latent structure, substantial correlations with theoretically and clinically relevant measures, and evidence for incremental concurrent and predictive validity after controlling for DSM-5's Section II categorical personality disorders (PDs). However, the AMPD is not yet widely used clinically. One clinician concern may be caseness - that the new model will diagnose a different set of PD patients from that with which they are familiar. The primary aim of this study is to determine whether this concern is valid, by testing how well the two models converge in terms of prevalence and coverage. METHOD: Participants were 305 psychiatric outpatients and 302 community residents not currently in mental-health treatment who scored above threshold on the Iowa Personality Disorder Screen (Langbehn et al., ). Participants were administered a semi-structured interview for DSM-5 PD, which was scored for both Section II and III PDs. RESULTS: Convergence across the two PD models was variable for specific PDs, Good when specific PDs were aggregated, and Very Good for 'any PD.' CONCLUSIONS: Results provide strong evidence that the AMPD yields the same overall prevalence of PD as the current model and, further, identifies largely the same overall population. It also addresses well-known problems of the current model, is more consistent with the ICD-11 PD model, and provides more complete, individualized characterizations of persons with PD, thereby offering multiple reasons for its implementation in clinical settings.

Potential Benefits of Physical Activity in MCI and Dementia.

Physical activity improves overall health and reduces the risk of many negative health outcomes and may be effective in improving cognition, independent functioning, and psychological health in older adults. Given the evidence linking physical activity with improvements in various aspects of health and functioning, interventions exploring pathways for decreasing risk of dementia in those with mild cognitive impairment (MCI) and improving outcomes for those with dementia are of critical importance. The present review highlights the work examining physical activity interventions in order to achieve a comprehensive understanding of the potential benefits of physical activity for individuals experiencing cognitive decline. The primary focus is on aerobic exercise as this is the main intervention in the literature. Our review supports the thesis that physical activity can promote healthy aging in terms of cognition, independent functioning, and psychological health for individuals experiencing cognitive decline. Specifically, physical activity improves cognition, especially executive functioning and memory in MCI, independent functioning in MCI and dementia, and psychological health in dementia. Given that benefits of physical activity have been observed across these domains, such interventions provide an avenue for preventing decline and/or mitigating impairment across several domains of functioning in older adults with MCI or dementia and may be recommended (and adjusted) for patients across a range of settings, including medical and mental health settings. Further implications for clinical intervention and future directions for research are discussed.

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).

Comparability of self- and other-rated personality structure.

It is commonly accepted that gathering information via multiple assessment methods (e.g., interview and questionnaire, self- and informant report) is important for establishing construct validity. Although numerous articles report convergent and discriminant agreement correlations between self- and other ratings of personality, studies of the structure of personality from such ratings are less common. The present study addresses this gap using a meta-analytic data set (N range = 157-9,295) of various versions (i.e., self- and other-report, full-length and short alternative format) of the Schedule for Nonadaptive and Adaptive Personality (SNAP; Clark, 1993; Clark, Simms, Wu, & Casillas, 2014). We hypothesized that (a) structures across all measure formats would be highly comparable and (b) to the extent that they were dissimilar, perspective (self vs. other) and measure format (long vs. short form), respectively, would influence comparability. Results revealed strong congruence among 3-factor structures (Negative Emotionality, Positive Emotionality, and Disinhibition vs. Constraint) across all versions of the SNAP, suggesting that personality as assessed by this broad measure of personality traits across the normal-abnormal spectrum has a robust structure across different rater perspectives and rating formats. Because the comparability analyses were highly congruent and differences among the comparisons were minimal, we concluded-contrary to our expectations-that different formats and different rater perspectives have little effect on structural comparability. Results generally support Funder's (1995) realistic accuracy model, suggesting that trait relevance, cue detection, and information usage are key factors in structuring informant ratings. Limitations of the present study and implications for future research are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Manifestations of personality impairment severity: comorbidity, course/prognosis, psychosocial dysfunction, and 'borderline' personality features.

Impairment in personality functioning (briefly, personality impairment) is the core pathology in personality disorder (PD) and an essential indicator of PD-severity. It also is a difficult construct to define and assess. We argue that personality-impairment severity is a latent construct that can be modeled with four indicators: within-PD comorbidity, problematic course/prognosis of both PD and comorbid clinical syndromes, PD-associated psychosocial dysfunction, and features of DSM-5-II borderline PD (BPD). Our literature review documents interrelations among the first three indicators, and studies of PD structure reveal a higher order factor of general PD severity marked most strongly by BPD features. Together, these findings indicate that BPD features may be helpful in the important tasks of defining and assessing personality-impairment severity.

Antagonism trait facets and comprehensive psychosocial disability: Comparing information across self, informant, and interviewer reports.

It is widely known that personality traits collectively discussed as the Dark Triad are antagonistic and associated with poor interpersonal relationships, but few studies have examined how specific facets of antagonism are associated with psychosocial adjustment or how antagonism relates to psychosocial adjustment other than interpersonal functioning. The purpose of this study was to examine how 6 antagonism facets-manipulativeness, grandiosity, attention-seeking, hostility, callousness, and deceitfulness-relate to comprehensive psychosocial functional domains (i.e., well-being, interpersonal relationships, basic daily functioning) using information about both antagonism and functioning from 3 sources-self, informant, and interviewer. Data were from 318 primary participants and informants. We present 3 main findings: (1) When psychosocial functioning and antagonism traits were both rated by informants, all psychosocial disability domains were consistently positively associated with antagonism traits. (2) We next created a single psychosocial-disability factor score via principal factors analysis of all raters' psychosocial-functioning scores. When all 3 raters' reports of domain-level antagonism were used as independent variables in a simultaneous regression analysis to predict this overall functioning score, informant-reported antagonism most strongly predicted psychosocial functioning, followed by interviewer-rated antagonism. (3) We then created 6 facet scores by summing the 3 raters' scores on each. When we used these scores to predict psychosocial functioning, hostility was the main trait significantly predicting psychosocial functioning. The study provides further insight into associations of psychosocial disability with antagonism facets from different raters' perspectives. The findings thus further our understanding of psychosocial outcomes associated with antagonism, the core of the dark traits. (PsycINFO Database Record

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.