Autistic Personality Traits and Treatment Outcome for Alcohol Use Disorders.

ABSTRACT: The importance of personality traits for the outcome of psychiatric treatment, including treatment for alcohol use disorder (AUD), has been widely acknowledged. Also, research on autism spectrum disorders has evolved in recent years, emphasizing that the behavioral traits within these neuropsychiatric disorders exist on a dimension both within and outside the boundaries of psychopathology. In the present study, the relationship between personality traits associated with autistic functioning and level of alcohol use among patients before and after concluded AUD treatment was investigated. The participants (n = 165, diagnosed with AUD) were part of a longitudinal project on AUD treatment. Data from personality questionnaires (Structured Clinical Interview of Personality Disorders II and Temperament and Character Inventory) were used to assess autistic personality traits (APTs) based on behavior within Wing's triad, which were related to background and treatment outcome. The chosen APT items illustrated a personality functioning with an emphasis on social interaction and rigidity. Only certain included questions were indicative of still having a problematic drinking pattern 2.5 years after treatment entry, which adhered to phobic, obsessive-compulsive, and schizoid personality traits, as well as rigidity/stubbornness. Albeit with modest influence, the degree of APTs was associated with heavier drinking at treatment entry, and symptoms relating to social interaction and rigidity were associated with still having a problematic drinking pattern 2.5 years after treatment entry. A higher degree of such traits may result in having problems taking advice from others and establishing treatment alliance, important parts of treatment efficacy, making assessment of such traits relevant to clinicians.

Temperament, character and decision-making characteristics of patients with major depressive disorder following a suicide attempt.

BACKGROUND: Multiple psychological factors of suicidal behaviour have been identified so far; however, little is known about state-dependent alterations and the interplay of the most prominent components in a suicidal crisis. Thus, the combined effect of particular personality characteristics and decision-making performance was observed within individuals who recently attempted suicide during a major depressive episode. METHODS: Fifty-nine medication-free major depressed patients with a recent suicide attempt (within 72 h) and forty-five healthy control individuals were enrolled in this cross-sectional study. Temperament and character factors, impulsivity and decision-making performance were assessed. Statistical analyses aimed to explore between-group differences and the most powerful contributors to suicidal behaviour during a depressive episode. RESULTS: Decision-making and personality differences (i.e. impulsivity, harm avoidance, self-directedness, cooperativeness and transcendence) were observed between the patient and the control group. Among these variables, decision-making, harm avoidance and self-directedness were shown to have the strongest impact on a recent suicide attempt of individuals with a diagnosis of major depressive disorder according to the results of the binary logistic regression analysis. The model was significant, adequately fitted the data and correctly classified 79.8% of the cases. CONCLUSIONS: The relevance of deficient decision-making, high harm avoidance and low self-directedness was modelled in the case of major depressed participants with a recent suicide attempt; meaning that these individuals can be described with the myopia for future consequences, a pessimistic, anxious temperament; and a character component resulting in the experience of aimlessness and helplessness. Further studies that use a within-subject design should identify and confirm additional characteristics specific to the suicidal mind.

Long-term stress in dogs is related to the human-dog relationship and personality traits.

Previously, we found that dogs belonging to the herding breed group, selected for human cooperation, synchronise their long-term stress levels with their owners. The aim of the current study was to investigate features that could influence long-term stress levels in ancient dog breeds, genetically closer to wolves, and dogs specifically selected to work independently of their owner. Twenty-four ancient breed dogs and 18 solitary hunting dogs were recruited and hair samples were obtained from both dogs and owners from which hair cortisol concentration (HCC) was analysed. Additionally, the owners completed lifestyle surveys, the Monash Dog Owner Relationship Scale (MDORS) on human-dog relationship, and both dog and owner personality questionnaires (Dog Personality questionnaire and Big Five Inventory survey). The results from the MDORS indicate that the subscale Perceived cost correlated to the dog HCC of tested breed groups: solitary hunting breeds (χ2 = 4.95, P = 0.026, ß = 0.055), ancient breeds (χ2 = 2.74, P = 0.098, ß = 0.027), and herding dogs included from a previous study (χ2 = 6.82, P = 0.009, ß = - 0.061). The HCC of the solitary hunting dogs was also related to the owner personality traits Agreeableness (χ2 = 12.30, P < 0.001, ß = - 0.060) and Openness (χ2 = 9.56, P = 0.002, ß = 0.048) suggesting a more substantial influence of the owner on the solitary hunting dog's HCC compared to the ancient breeds. No effect of owner HCC on dog HCC was found in either ancient or in solitary hunting breeds. Hence, the long-term stress synchronisation is likely to be a trait in breeds selected for human cooperation. In conclusion, dog HCC is often related to the owners' personality, but is primarily influenced by the owner-dog relationship.

Nightmare experience and personality disorder functioning styles in healthy volunteers and nightmare disorder patients.

Nightmares are prevalent in psychiatric disorders, and personality disorder features might be associated with nightmare experience, especially in nightmare disorder patients. The authors invited 219 healthy volunteers and 118 nightmare disorder patients to undergo tests of the Nightmare Experience Questionnaire (NEQ), the Parker Personality Measure (PERM), and the Plutchik-van Praag Depression Inventory. Compared to healthy volunteers, nightmare disorder patients scored significantly higher on annual nightmare frequency and NEQ Physical Effect, Negative Emotion, Meaning Interpretation, and Horrible Stimulation, and higher on PERM Paranoid, Schizotypal, Borderline, Histrionic, Narcissistic, Avoidant, and Dependent styles. Borderline, Schizotypal, and Passive-Aggressive styles in healthy volunteers and Dependent, Avoidant, Histrionic, and Paranoid in patients were significant predictors of some NEQ scales. Higher annual nightmare frequency, higher scale scores of nightmare experience and personality disorder styles, and more associations between the two were found in nightmare disorder patients, implying the need for personality-adjustment therapy for nightmare disorder.

The Relationship between the Level of Anterior Cingulate Cortex Metabolites, Brain-Periphery Redox Imbalance, and the Clinical State of Patients with Schizophrenia and Personality Disorders.

Schizophrenia is a complex mental disorder whose course varies with periods of deterioration and symptomatic improvement without diagnosis and treatment specific for the disease. So far, it has not been possible to clearly define what kinds of functional and structural changes are responsible for the onset or recurrence of acute psychotic decompensation in the course of schizophrenia, and to what extent personality disorders may precede the appearance of the appropriate symptoms. The work combines magnetic resonance spectroscopy imaging with clinical evaluation and laboratory tests to determine the likely pathway of schizophrenia development by identifying peripheral cerebral biomarkers compared to personality disorders. The relationship between the level of metabolites in the brain, the clinical status of patients according to International Statistical Classification of Diseases and Related Health Problems, 10th Revision ICD-10, duration of untreated psychosis (DUP), and biochemical indices related to redox balance (malondialdehyde), the efficiency of antioxidant systems (FRAP), and bioenergetic metabolism of mitochondria, were investigated. There was a reduction in the level of brain N-acetyl-aspartate and glutamate in the anterior cingulate gyrus of patients with schisophrenia compared to the other groups that seems more to reflect a biological etiopathological factor of psychosis. Decreased activity of brain metabolites correlated with increased peripheral oxidative stress (increased malondialdehyde MDA) associated with decreased efficiency of antioxidant systems (FRAP) and the breakdown of clinical symptoms in patients with schizophrenia in the course of psychotic decompensation compared to other groups. The period of untreated psychosis correlated negatively with glucose value in the brain of people with schizophrenia, and positively with choline level. The demonstrated differences between two psychiatric units, such as schizophrenia and personality disorders in relation to healthy people, may be used to improve the diagnosis and prognosis of schizophrenia compared to other heterogenous psychopathology in the future. The collapse of clinical symptoms of patients with schizophrenia in the course of psychotic decompensation may be associated with the occurrence of specific schizotypes, the determination of which is possible by determining common relationships between changes in metabolic activity of particular brain structures and peripheral parameters, which may be an important biological etiopathological factor of psychosis. Markers of peripheral redox imbalance associated with disturbed bioenergy metabolism in the brain may provide specific biological factors of psychosis however, they need to be confirmed in further studies.

Effects of Omega 3 Fatty Acids on Main Dimensions of Psychopathology.

The usefulness of polyunsaturated fatty acids on inflammatory, cardiovascular, and the nervous system was studied in the last decades, but the mechanisms underlying their benefic properties are still partially unknown. These agents seem to express their action on the membrane phospholipid composition and permeability and modulation of second messenger cascades. In psychiatry, the efficacy and tolerability of omega-3 fatty acids were investigated in several psychiatric disorders, including major depression, bipolar disorder, personality disorders, high-risk conditions to develop psychosis, attention-deficit hyperactivity disorder, and autism spectrum disorders. Initial findings in this field are promising, and some relevant questions need to be addressed. In particular, the effects of these agents on the main symptom dimensions have to be investigated in a trans-diagnostic perspective. The present systematic review is aimed to examine the available data on the efficacy of omega-3 fatty acids on domains of psychotic symptoms, affective symptoms, impulsivity, and aggressiveness, and harmful behaviors, and suicide risk.

The Feeling of Emptiness: A Review of a Complex Subjective Experience.

A feeling of emptiness is commonly encountered in clinical practice, but it is poorly understood, with incongruent approaches to its definition and possible role in various disorders. This review examines the conceptualization of the feeling of emptiness and its place in psychopathology. We found an imbalance between theoretical approaches to this phenomenon and empirical research, and argue that more studies using adequate assessment tools are needed. Based on our literature review, we propose that a feeling of emptiness is a complex, negative emotional state that is experienced in different ways by different individuals. This feeling includes a physical or bodily component, a component of aloneness or social disconnectedness, and a component of a deep sense of personal unfulfillment or lack of purpose. The feeling of emptiness is related to other emotional states (dysphoria, boredom, loneliness, and numbness) and overlaps to some extent with them. Although the feeling of emptiness is most often considered in the context of borderline personality disorder, it is also encountered in depression, narcissistic personality disorder, and schizophrenia spectrum disorders, with its features potentially varying between different conditions. The feeling of emptiness may lead to nonsuicidal self-injury and may also have an important relationship with suicidality. We conclude by offering suggestions for further research, emphasizing a need to refine the multidimensional conceptualization of the feeling of emptiness and to better understand its manifestations and relationships with other emotions within various forms of psychopathology.

Evaluation of Motivation for the Treatment of Drug Addicts with Personality Disorders.

Lack of motivation for the treatment of drug addiction is associated with dropout and relapses. Further, personality disorders (PD) have traditionally been linked to low motivation and therapeutic failure. Thus, the present study aims to analyze the structure of the Motivation for Treatment Questionnaire (MTQ-8), as well as to determine differences in motivation due to the presence of PD and the impact of psychological adjustment on motivation. The sample included 125 patients (84% male) who started a treatment for their addiction to cocaine and alcohol. Rasch analysis was applied for the first objective, and means contrast and regression analysis for the others. The two subscales of the MTQ-8 fit the Rasch model, with appropriate psychometric characteristics when merging Items 5 and 7. The presence of PD was not associated with reduced motivation. Motivation for treatment was greater when abstinence was less than three weeks, and psychological distress predicted motivation for treatment. The present study confirms that MTQ-8 subscales are suitable for measuring motivation for treatment and readiness for change in drug-dependent patients. It is noted that the presence of PD should not be associated with a lower level of motivation, and that psychological distress influences motivation.

Disorganized Attachment pattern affects the perception of Affective Touch.

Touch, such as affective caress, can be interpreted as being pleasant. The emotional valence that is assigned to touch is related to certain bottom-up factors, such as the optimal activation of C-tactile (CT) afferents. Tactile processing with a hedonic or emotional component has been defined as affective touch-a component that CT fibers are likely to convey. Tactile deficiencies are frequent in the psychiatric population but also in healthy people with disorganized attachment; accordingly, it is likely that affective difficulties in adults with disorganized attachment are reflected in altered perception of affective touch. To test this hypothesis, we combined methods from clinical psychology, psychophysics, and neuroimaging. We found that people with a history of traumatic parental bonds and a disorganized attachment pattern perceive a "caress-like" stimulus as being unpleasant, whereas participants with organized attachment consider the same tactile stimulation to be pleasant. Further, unlike in organized adults, the responses of disorganized adults to CT and non-CT stimulation activated limbic and paralimbic structures in a fight-or-flight manner, suggesting that early experiences with parental deficiencies shape the physiological responses of peripheral CT fibers and central nervous networks.

Disrupted physiological coregulation during a conflict predicts short-term discord and long-term relationship dysfunction in couples with personality pathology.

Interpersonal dysfunction is a core feature of personality disorders, often affecting close relationships. Nevertheless, little is known about the moment-to-moment dynamic processes by which personality pathology contributes to dysfunctional relationships. Here, we investigated the role of physiological attunement during a conflict discussion in romantic couples oversampled for personality pathology. We hypothesized that physiological coregulation would be disrupted in individuals with personality pathology, subsequently predicting short-term discord and long-term relationship dissatisfaction. One hundred twenty-one couples completed a 10-min discussion about an area of disagreement while cardiovascular physiology and behavior were recorded. We quantified coregulation using a dynamical systems model of heart rate changes. We found that greater interpersonal problem severity was associated with more contrarian coregulation, exacerbating negative affect and interpersonal perceptions. Furthermore, the extent to which coregulation was associated with increased discord prospectively predicted relationship dissatisfaction 1 year later. Altogether, this work sheds light on a pathway by which personality pathology contributes to problems in romantic relationships. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Posttraumatic stress symptoms mediate the relationship between adverse childhood experiences, avoidant personality traits and resilience.

Background and Objectives: It is widely recognized that posttraumatic stress (PTS) symptoms, resulting from adverse childhood experiences (ACEs), have a myriad of detrimental effects on the wellbeing of sufferers. Yet the extent to which PTS symptoms mediate positive and negative outcomes is less well-known. This study, therefore, explored whether PTS symptoms indirectly explain avoidant personality disorder (AVPD) traits and resilience following multiple ACEs. Design: A correlational design using mediation analyses was conducted. Method: One-hundred and seventy-seven participants (68.4% female; aged 18-73 years) completed an online survey measuring experiences of childhood adversity, AVPD traits, resilience, and PTS symptoms. Results: The pathway from ACEs to AVPD mediated by PTS symptoms was both positive and significant. The indirect relationship from ACEs to resilience was also significantly and negatively mediated by PTS symptoms. Of the PTS dimensions, avoidance and hyperarousal mediated the relationship between the number of ACEs and AVPD traits, while intrusions mediated the association between the number of ACEs and resilience. Conclusions: These findings indicate that PTS symptoms can have both detrimental and adaptive effects on psychological wellbeing. Treatment and management of PTS symptoms is, therefore, key to the improvement of overall psychological functioning following ACEs.

[A comparative study of the P300 wave and evoked theta-rhythm in schizophrenia and personality disorders]. / Sravnitel'noe issledovanie kharakteristik volny R300 i vyzvannogo teta-ritma pri shizofrenii i rasstroistvakh lichnosti.

OBJECTIVE: Amplitude and latency of evoked potential P300 are considered as major correlates of cognitive functions. At the same time the changes in the theta-band event-related oscillations that appears at the same time window as P300 wave are less studied. The purpose of this study was to provide the complex assessment and comparison of neurophysiological indices of cognitive processes in healthy people and patients with personality disorder, schizotypal disorder and schizophrenia with different levels of cognitive dysfunction. MATERIAL AND METHODS: The total number of participants was 124, including 44 healthy volunteers, 40 schizophrenic patients, 22 patients with personality disorder, 18 patients with schizotypal disorder. Patients were examined in standard two-stimulus oddball paradigm. The P300 amplitude and latency, and evoked theta-band power and coherence were identified for target and non-target stimuli. RESULTS AND CONCLUSION: The decrease in P300 amplitude, prolongation of P300 latency, and reduction in the evoked theta-band power and coherence were revealed in all groups of patients compared to healthy subjects. These changes were spatially generalized and the most pronounced in schizophrenic patients. In patients with personality and schizotypal disorders, the changes had a local character, and didn't differ significantly when the groups were compared. The results show the gradual cognitive decline as follows: healthy patients, patients with schizotypal disorder, patients with personality disorder, and patients with schizophrenia. Such cognitive decline might be in line with the reduction of critical and prognostic abilities.

Internal and external validity of the brief version of the Multidimensional Personality Questionnaire: Exploratory structural equation modelling.

The present study used exploratory structural equation modelling (ESEM) to examine the theorized dimension structure of the brief version of the Multidimensional Personality Questionnaire (MPQ-BR) at the scale-level (i.e., 11 lower-order primary factors loading on four higher-order factors) and item-level (sets of 12 items loading on 11 lower-order primary factors). A total of 214 adults from the community addressed the MPQ-BR and the Behavioral Inhibition System (BIS)/Behavioral Approach System (BAS) scales. The findings revealed poor fit and poorly defined factors at the item-level alongside adequate fit and well-defined factors at the scale-level. The higher-order factors in the latter model were supported for external validity in terms of demonstrating the expected theoretical and empirical correlations with the scales of the BIS/BAS scales. Result related implications for professional application, as well as potential revisions of the MPQ-BF are illustrated.

Association between DSM-5 and ICD-11 personality dimensional traits in a general medical cohort and readmission and mortality.

BACKGROUND: Personality has long been studied as a factor associated with health outcomes. Investigations of large, generalizable clinical cohorts are limited by variations in personality diagnostic methodologies and difficulties with long-term follow-up. METHODS: Electronic health records of a cohort of patients admitted to a general hospital were characterized using a previously developed natural language processing tool for extracting DSM-5 and ICD-11 personality domains. We used Cox regression and Fine-Gray competing risk survival to analyze the relationships between these personality estimates, sociodemographic features, and risk of readmission and mortality. RESULTS: Among 12,274 patients, 2379 deaths occurred in the course of 61,761 patient-years at risk, with 19,985 admissions during follow-up. Detachment was the most common personality feature. Presence of disinhibition was independently associated with a higher mortality risk, while anankastic traits were associated with a lower mortality risk. Increased likelihood of readmission was predicted by detachment, while decreased likelihood of readmission was associated with disinhibition and psychoticism traits. CONCLUSIONS: Personality features can be identified from electronic health records and are associated with readmission and mortality risk. Developing treatment strategies that target patients with higher personality symptom burden in specific dimensions could enable more efficient and focused interventions.

Mood variations and personality traits in patients with epilepsy over the course of their menstrual cycle.

INTRODUCTION: The incidence of mood disorders and psychopathology is more frequent in patients with epilepsy (PWE) than in the general population. Also, it has been reported that PWE suffer more seizures during certain phases of their menstrual cycle (MC). Still, limited information exists regarding the relationship between the physical and emotional changes during the MC in PWE. Therefore, in this study, we aimed to evaluate the mood and personality traits of PWE during their MC and to compare them with controls. METHODS: A cohort of 22 PWE and nine controls was gathered. All the participants underwent psychiatric, electroencephalographic, and gynecological evaluations. RESULTS: Overall, PWE scored higher in depression compared with controls (p < 0.05), PWE also obtained higher scores for the personality traits of neuroticism and self-isolation (p < 0.05). During the evaluation of the symptoms of premenstrual syndrome (PMS), PWE were more symptomatic during the early follicular (EF) phase in comparison with the rest of the phases of their MC, whereas the control group showed the known premenstrual pattern of symptoms during the late luteal (LL) phase. The frequency of seizures (40.6%) and electroencephalographic abnormalities (34.8%) was also higher during the EF phase of the MC when compared with the other phases of the MC (p < 0.05). CONCLUSIONS: The results of this study suggest that unlike the PMS present in women without epilepsy, PWE appear to show a "menstrual syndrome" that consists of similar mood changes and physical symptoms. This arrangement of symptoms seems to have an impact on the increase in seizure activity.

The General Factor of Psychopathology.

An important advance in understanding and defining mental disorders has been the development of empirical approaches to mapping dimensions of dysfunction and their interrelatedness. Such empirical approaches have consistently observed intercorrelations among the many forms of psychopathology, leading to the identification of a general factor of psychopathology (the p factor). In this article, we review empirical support for p, including evidence for the stability and criterion validity of p. Further, we discuss the strong relationship between p and both the general factor of personality and the general factor of personality disorder, substantive interpretations of p, and the potential clinical utility of p. We posit that proposed substantive interpretations of p do not explain the full range of symptomatology typically included in p. The most plausible explanation is that p represents an index of impairment that has the potential to inform the duration and intensity of a client's mental health treatment.

Treatment-related changes towards normalization of the abnormal external signal processing in panic disorder.

Despite the scientific consensus on the efficacy of psychotherapy for the treatment of psychological disorders, the evidence of treatment-related changes towards normalization of abnormal brain functions in patients is mixed. In the present experiment, we investigated whether treatment can affect early information processing, by testing abnormal event-related potentials (ERPs) evoked by internal and external signals in panic disorder. Sixteen patients with panic disorder and comorbid personality disorder and sixteen control participants performed a response-choice task and a passive viewing task in two testing sessions, separated by around 14 months. During this period, patients received psychological treatment. In agreement with previous studies of performance monitoring, the abnormal amplitude of the Ne/ERN-an index of error processing based on internal signals-did not change between the first and second testing session. However, treatment-related changes were evident for the abnormal vertex positive potential (VPP) evoked by external signals in the response-choice task and the passive viewing task. In patients, the VPP was smaller in the second session compared to the first session, whereas no significant changes occurred in controls. This result supplies evidence of treatment-related changes towards normalization in the early information processing of external visual stimuli in panic disorder.

The healthy personality from a basic trait perspective.

What basic personality traits characterize the psychologically healthy individual? The purpose of this article was to address this question by generating an expert-consensus model of the healthy person in the context of the 30 facets (and 5 domains) of the Revised NEO Personality Inventory (Costa & McCrae, 1992) system of traits. In a first set of studies, we found that the healthy personality can be described, with a high level of agreement, in terms of the 30 facets of the NEO-PI-R. High levels of openness to feelings, positive emotions, and straightforwardness, together with low levels on facets of neuroticism, were particularly indicative of healthy personality functioning. The expert-generated healthy personality profile was negatively correlated with profiles of pathological personality functioning and positively correlated with normative personality functioning. In a second set of studies, we matched the NEO-PI-R profiles of over 3,000 individuals from 7 different samples with the expert-generated healthy prototype to yield a healthy personality index. This index was characterized by good retest reliability and cross-rater agreement, high rank-order stability, and substantial heritability. Individuals with high scores on the healthy personality index were psychologically well-adjusted, had high self-esteem, good self-regulatory skills, an optimistic outlook on the world, and a clear and stable self-view. These individuals were low in aggression and meanness, unlikely to exploit others, and were relatively immune to stress and self-sufficient. We discuss the results in the light of their implications for both research and theory on healthy personality functioning. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Dissociative subtype of posttraumatic stress disorder or PTSD with comorbid dissociative disorders: Comparative evaluation of clinical profiles.

INTRODUCTION: The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013) introduced a dissociative subtype for patients with posttraumatic stress disorder (PTSD) and depersonalization and/or derealization symptoms. Despite high comorbidity rates between PTSD and dissociative disorders (DDs), research has not paid attention to the differentiation or overlap between the dissociative subtype of PTSD and DDs. This raises a question: To what extent do patients with dissociative PTSD differ from patients with PTSD and comorbid DDs? METHOD: We compared three groups of complex patients with trauma-related disorders and/or personality disorders (n = 150): a dissociative PTSD, a nondissociative PTSD, and a non-PTSD group of patients with mainly personality disorders. We used structured clinical interviews and self-administered questionnaires on dissociative symptoms and disorders, personality disorders, trauma histories, depression, anxiety, and general psychopathology. The Dissociative Experiences Scale (DES; ≥20) and the depersonalization/derealization subscale of the DES were used for differentiating dissociative PTSD from nondissociative PTSD. RESULTS: Of all patients, 33% met criteria for dissociative PTSD. More than half of the dissociative PTSD patients (54%) met criteria for one or more DDs; using the depersonalization/derealization subscale of the DES, even 66% had a comorbid DD. But also of the non-PTSD patients, 24% had a mean DES score of ≥20. There were no symptomatic differences (e.g., depression and anxiety) between dissociative PTSD with and without comorbid DDs. CONCLUSION: Overlap between dissociative PTSD and DD is large and we recommend replication of previous studies, using structured clinical assessment of DDs. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Personality traits as an organizing framework for personality pathology.

We review evidence establishing important parallels between the general structure of psychopathology, the more specific structure of personality pathology and the structure of normal-range personality. We then present data to explicate the nature of associations between the alternative model of personality disorder (AMPD)-as operationalized by the Personality Inventory for DSM-5-and the domains and facets subsumed within the five-factor model of personality. Our data demonstrate substantial links between four of the five domains within these models but also indicate that the AMPD could be realigned to enhance its convergence with the five-factor model of personality. Based on our data, we tentatively propose an expanded four-facet model of AMPD Negative Affectivity (Anxiousness, Depressivity, Hostility and Emotional Lability); an alternative bipolar scheme for Detachment that includes two positively keyed (Withdrawal and Anhedonia) and two negatively keyed (Risk Taking and Attention Seeking) facets; a broader five-facet model of Antagonism (Deceitfulness, Manipulativeness, Callousness, Grandiosity and Suspiciousness); and a reduced two-facet model of Disinhibition (Irresponsibility and Impulsivity). These alternative scores generally showed superior convergent and discriminant validity when compared with current measures of the AMPD domains but also raise other issues. Our findings highlight the strong overlap between normal and pathological personality and clarify the nature of the associations between them. © 2019 John Wiley & Sons, Ltd.