Comparing the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, personality disorder models scored from the same interview.

The alternative model of personality disorders (AMPD) traits were designed to maintain continuity with the Section II personality disorder (PD) diagnoses by retaining the same clinical information. Whether the AMPD traits achieve this is not well established. Prior work testing incremental validity of AMPD traits and Section II diagnoses is limited by the fact each model was measured by a different instrument or rater, making it unclear whether discrepancies are due to the constructs or methods. Here, we compare the incremental validity of AMPD traits versus Section II PDs assessed by the same instrument and rater. Participants (N = 311, 50% received past-year mental health treatment) completed a clinical interview, baseline self-reports, and 14-day ambulatory assessment protocol. Interviewers rated AMPD domains, facets, and Section II criteria from the same interview (Structured Interview for DSM-IV Personality). We used hierarchical regression models to evaluate the variance predicted in 17 clinically relevant cross-sectional and momentary variables by the AMPD traits and Section II PDs. Incremental R² showed that Section II PDs account for little variance in outcomes over and above the AMPD domains/facets, whereas the AMPD facets were generally more predictive of outcomes than the Section II PDs. Results add novel evidence that dimensional PD traits-not a particular assessment method-are equivalent or superior to PD categories for predicting social, emotional, and behavioral functioning. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Characterizing Stress Processes by Linking Big Five Personality States, Traits, and Day-to-Day Stressors.

The accumulation of day-to-day stressors can impact mental and physical health. How people respond to stressful events is a key mechanism responsible for the effects of stress, and individual differences in stress responses can either perpetuate or prevent negative consequences. Most research on daily stress processes has focused on affective responses to stressors, but stress responses can involve more than just affect (e.g., behavior, cognitions). Additionally, most research has studied the role of neuroticism in shaping those responses, but many other individual differences are associated with stress. In this study, we more broadly characterized daily stress processes by expanding the nomological networks of stress responses to include Big Five personality states. We also linked those stress responses to all Big Five traits, as well as individual differences in stress variety, severity, and controllability. We studied a sample of participants (N = 1,090) who reported on stressful events, their appraisal of events in terms of severity and controllability, and their Big Five personality states daily for 8-10 days (N = 8,870 observations). Multi-level structural equation models were used to separate how characteristics of the perceived stressful situation and characteristics of the person play into daily stress processes. Results showed that (1) all Big Five personality states shift in response to perceived stress, (2) all Big Five personality traits relate to average levels of perceived stress variety, severity, and controllability, (3) individual differences in personality and average perceived stress variety and perceived severity relate to the strength of personality state responses to daily stress, albeit in a more limited fashion. Our results point to new pathways by which stressors affect people in everyday life and begin to clarify processes that may explain individual differences in risk or resilience to the harmful effects of stress.

Considering the 'With Whom': Differences Between Event- and Signal-Contingent ESM Data of Person-Specific Social Interactions.

Experience sampling studies often aim to capture social interactions. A central methodological question in such studies is whether to use event- or signal-contingent sampling. The little existing research on this issue has not taken into account that social interactions occur with unique interaction partners (e.g., Anna or Tom). We analyze one week of social interaction data of 286 students from the University of Pittsburgh (60.8% male, mean age 19.2 years), taking into account the unique interaction partners of each student. Specifically, we investigate the differences between event- and signal contingent sampling in (1) the total number of unique interaction partners captured, as well as (2) the kinds of relationships, and (3) the quality of social interactions with these captured interaction partners. Apart from a larger quantity of interactions and unique interaction partners in the event-contingent sampling design, our analyses indicate subtle differences between the two designs when aiming to assess social interactions with more distant interaction partners, such as coworkers or strangers. Most importantly, in our analyses, specific interaction partners and social roles explained a considerable amount of variance in the quality of social interactions (up to 20.5%), suggesting that future research would benefit greatly from considering "with whom" individuals interact.

Weekly links among irritability and suicidal thoughts and behaviors in high-risk youth.

BACKGROUND: Previous studies demonstrate a link between irritability and suicidal thoughts and behaviors (STBs) in youth samples. However, they have mostly assessed irritability in community samples and as a largely dispositional (i.e. trait-like) construct. Thus, it remains unclear to what extent links between irritability and STBs reflect within-person processes of elevated risk in clinically meaningful time periods. METHODS: The present study used clinical data from 689 adolescents aged 12-19 years attending a total of 6,128 visits at a specialty Intensive Outpatient Program for depressed and suicidal youth to examine patterns in weekly assessments of irritability and STBs throughout treatment, including associations among trends and fluctuations departing from these trends via multilevel structural equation modeling. Youth completed self-report measures of irritability, depression, and STBs weekly as part of standard IOP clinical care. RESULTS: Overall, two-thirds of variance in weekly irritable mood was accounted for by between-person differences and the remaining portion by weekly fluctuations. After controlling for depression, during weeks when youth were more irritable they experienced increased STBs. Rates of change in irritability and STBs tended to track together at early stages of treatment, but these effects were generally accounted for by depression severity. CONCLUSIONS: Our results suggest that although changes in STBs are best accounted for by depression, irritability can be understood as a specific, proximal risk factor for youth STBs that exacerbates youth STBs in clinically informative timeframes above and beyond depression.

Is it time to discard the Diagnostic and Statistical Manual of Mental Disorders (DSM) in psycho-oncology?

The conceptual basis of psychopathology within cancer survivorship is critical, as the chosen conceptualisation informs assessment and explanatory models, as well as interventions and supportive care approaches. The validity of a chosen conceptualisation of psychopathology is therefore paramount for ensuring cancer survivors receive high-quality and efficacious care and support that can be iteratively improved via coordinated research efforts. In this paper, we discuss the traditional diagnostic approach to conceptualising psychopathology within cancer care, including the diagnostic system the 'Diagnostic and Statistical Manual of Mental Disorders' (DSM) [1], and the significant issues it presents within cancer survivorship. We detail and discuss how an alternate conceptualisation of psychopathology may enhance both research and practice within psycho-oncology. We ultimately pose, and provide our perspective, on the question "Is it Time to Discard the DSM in Psycho-Oncology?"

Patterns of emotion-network dynamics are orthogonal to mood disorder status: An experience sampling investigation.

Individuals differ markedly in how they experience the ebb and flow of emotions. In this study, we used daily experience sampling to examine whether these differences reflect the nature and presence of mood disorders or whether they can better be characterized as distinct dynamic emotion profiles that cut-across diagnostic boundaries. We followed 105 individuals in 2019-2020 with diagnoses of major depression, remitted major depression, bipolar disorder, or no history of disorder, over 14 days (n = 6,543 experience-sampling assessments). We applied group iterative multiple model estimation, using both diagnosis-based and data-driven methods to investigate similarities in unfolding within-person emotion-network time-courses. Results did not support diagnosis-based subgroupings but rather revealed two significant data-driven subgroups based on dynamic emotion patterns. These data-driven subgroups did not significantly differ in terms of clinical features or demographics, but did differ on key emotion metrics-instability, granularity, and inertia. These data-driven subgroupings, agnostic to diagnostic status, provide insights into the nature of idiographic emotion-network dynamics that cut-across clinical diagnostic divisions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Principles and procedures for revising the hierarchical taxonomy of psychopathology.

Quantitative, empirical approaches to establishing the structure of psychopathology hold promise to improve on traditional psychiatric classification systems. The Hierarchical Taxonomy of Psychopathology (HiTOP) is a framework that summarizes the substantial and growing body of quantitative evidence on the structure of psychopathology. To achieve its aims, HiTOP must incorporate emerging research in a systematic, ongoing fashion. In this article, we describe the historical context and grounding of the principles and procedures for revising the HiTOP framework. Informed by strengths and shortcomings of previous classification systems, the proposed revisions protocol is a formalized system focused around three pillars: (a) prioritizing systematic evaluation of quantitative evidence by a set of transparent criteria and processes, (b) balancing stability with flexibility, and (c) promoting inclusion over gatekeeping in all aspects of the process. We detail how the revisions protocol will be applied in practice, including the scientific and administrative aspects of the process. Additionally, we describe areas of the HiTOP structure that will be a focus of early revisions and outline challenges for the revisions protocol moving forward. The proposed revisions protocol is designed to ensure that the HiTOP framework reflects the current state of scientific knowledge on the structure of psychopathology and fulfils its potential to advance clinical research and practice. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Inaugural editorial.

In this inaugural editorial, the author discusses his editorial priorities for the Journal of Psychopathology and Clinical Science (JCPS), as well as transparency and openness as they relate to the journal. In sum, the author believes psychopathology is amid a major paradigm shift. Some of the associated changes are quite visible, as they relate to moving away from traditional diagnostic nosologies toward more scientifically tractable models. However, to be successful in the next era we need to develop models that are transdiagnostic, multilevel, temporally informed, and for everyone. JPCS has long been a leader in publishing this work, and he intends to ensure it continues in its role as a forward-thinking and rigorous journal devoted to understanding psychopathology. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Mindfulness-Based Stress Reduction reduces pro-inflammatory gene regulation but not systemic inflammation among older adults: A randomized controlled trial.

OBJECTIVE: Aging is associated with increased pro-inflammatory gene expression and systemic inflammation, and psychosocial stress may accelerate these changes. Mindfulness interventions show promise for reducing psychosocial stress and extending healthspan. Inflammatory pathways may play a role. In a sample of lonely older adults, we tested whether mindfulness training reduces proinflammatory gene expression and protein markers of systemic inflammation. METHODS: Lonely older adults (65-85 years; N = 190) were randomly assigned to an 8-week Mindfulness-Based Stress Reduction (MBSR) or matched Health Enhancement Program (HEP). Blood was drawn pre- and post-intervention and at 3-month follow-up. In peripheral blood mononuclear cells (PBMCs), RNA profiling was used to assess transcriptional regulation by pro-inflammatory NF-kB as well as ß-adrenergic CREB, antiviral IRF, and glucocorticoid receptor (GR) transcription factors. Plasma was assayed for proinflammatory markers IL-6 and CRP. Analyses tested time (pre, post, follow-up) by condition (MBSR versus HEP) effects. RESULTS: MBSR reduced NF-kB (d = .17, p = .028) but did not alter CREB (d = .10, p = .20), IRF (d = .13, p = .086), or GR activity (d = .14, p = .063) relative to HEP over time. Contrary to predictions, there were no time × condition effects of MBSR compared to HEP on reducing circulating IL-6 or CRP. CONCLUSIONS: In lonely older adults, MBSR reduced cellular pro-inflammatory gene regulation in ways that would predict reduced disease risk. However, no similar effect was observed for circulating protein markers of inflammation. These results provide specificity about how mindfulness interventions may impact distinct inflammatory markers among aging adults in ways that may have important implications for healthspan. TRIAL REGISTRATION: Clinical Trials identifier NCT02888600.

The development of personality-From metatraits to facets-Across adolescence and into adulthood in a sample of Mexican-origin youth.

The time between adolescence and adulthood is a transformative period of development. During these years, youth are exploring work, relationships, and worldviews while gaining the capacities needed to take on adult roles. These social and psychological processes are reflected in how personality develops across this period. Most youth personality development research has focused on the Big Five domains, ignoring the hierarchical structure of personality and missing broader, higher order processes and more specific, lower order processes. Toward a more comprehensive account, this study examines how personality develops from adolescence into the early years of adulthood at the metatrait (stability, plasticity), domain (Big Five), and facet levels. Data come from a longitudinal study of Mexican-origin youth (N = 645) with few socioeconomic resources who were assessed 5 times from Ages 14 to 23. We used latent growth curve models to investigate mean-level change, rank-order consistency, and the maintenance of trajectories for self-reported personality metatraits, domains, and facets. We found distinct developmental processes unfolding at each level of the hierarchy, including (a) mean-level changes in the metatraits and domains indicating increases in exploratory tendencies (i.e., plasticity) and maturity (i.e., increases in agreeableness and conscientiousness, decreases in neuroticism), and divergent change patterns between facets within each domain indicating nuanced maturational processes; (b) comparable levels of rank-order consistency for metatraits, domains, and facets; and (c) evidence that deviations from youth's developmental trajectories did not persist over time. Our findings offer insights into personality development that would be impossible to glean from the domain-level alone and adds needed sociocultural diversity to the literature. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Associations of state and trait empathy with daily alcohol use.

BACKGROUND: A growing literature documents associations between lower trait empathy and heavier alcohol use and more alcohol problems in adolescent and young adult samples. Prior work linking empathy and alcohol use/problems in these populations has thus far focused on trait rather than state empathy, and researchers often do not differentiate between cognitive and affective empathy. Further, no prior studies have examined associations between daily fluctuations in state empathy and alcohol use. The goal of the current study is to advance knowledge about the associations between state (vs. trait) and cognitive (vs. affective) empathy and alcohol use. METHODS: Adult alcohol drinkers (n = 492; Mage = 22.89, SD = 5.53; 53.70% female) participated in ecological momentary assessment studies for 7 to 10 days (day n = 4683). Multilevel hurdle models were used to investigate associations between day-level state empathy and daily alcohol use at the within-person level, and associations between individual differences in trait empathy and alcohol use across days at the between-person level. RESULTS: Higher day-level state affective empathy was not associated with the likelihood of drinking on a particular day, but it was significantly associated with a greater number of drinks consumed on alcohol-consuming days, with the latter associations remaining after controlling for day-level positive affect (PA) and negative affect (NA). No associations were found for day-level state cognitive empathy, or trait affective or cognitive empathy. CONCLUSIONS: On drinking days, when individuals reported more affective empathy than is typical for them, they were more likely to consume a greater number of alcoholic drinks, results that remained when controlling for levels of PA and NA. Daily shifts in affective empathy may be important to consider in efforts to understand alcohol use.

On definition and description in psychopathology: Reply to Widiger et al. (2023).

We reply to Wright et al.'s (2023) commentary and suggestion that personality trait models would be the preferred way to reconfigure the personality disorders (PDs). Though we agree that personality trait models are powerful descriptive tools, we highlight that they lack definitional or explanatory power, and that is why they have not been able to define or distinguish what PDs are (Hopwood, 2018; Mõttus et al., 2020; Pincus, 2011). Scientific models must do more than describe; they must define. This is why we propose a specific interpersonal model, contemporary integrative interpersonal theory, and why a generic interpersonal model has been formally adopted in psychiatric classification (e.g., International Classification of Diseases; 11th ed.; World Health Organization, 2019) but traits remain optional adjunct descriptors. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Daily manifestations of caregiver- and self-reported maladaptive personality traits in adolescent girls.

Establishing maladaptive personality traits at a younger age in a developmentally appropriate and clinically tangible way may alert clinicians to dysfunction earlier, and thus reduce the risk of significant impairment later in life. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Alternative Model for Personality Disorders (AMPD) provides a set of traits useful for organizing behavioral and experiential patterns central to daily personality functioning. The goal of the present study was to evaluate manifestations indicative of AMPD traits via ambulatory assessments in the daily lives of adolescent girls. Caregivers and girls (N = 129; age: M = 12.27, SD = 0.80) provided baseline assessments of girls' trait vulnerabilities (negative affectivity, detachment, antagonism, disinhibition, psychoticism) and girls additionally completed a 16-day ecological momentary assessment protocol (N = 5,036 observations), rating social behaviors and experiences in their daily lives. Multilevel structural equation models revealed that trait vulnerabilities were linked to more extreme shifts in interpersonal experiences and behaviors from one moment to the next, suggesting that maladaptive personality traits were linked to greater variability. Furthermore, AMPD traits were positively and strongly related to negative affect in daily interpersonal situations. More specifically, girls' trait ratings were associated with elevated mean-levels of boredom, as well as interpersonal tension. Caregiver-reports complemented this perspective of dissatisfying social interactions, suggesting that especially detachment and antagonism accounted for lower levels of social connectedness and more variability in social activities in girls' daily lives. Results are discussed in terms of the short-term dynamics and related intervention targets of developmental personality pathology. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Age and gender differences in narcissism: A comprehensive study across eight measures and over 250,000 participants.

Age and gender differences in narcissism have been studied often. However, considering the rich history of narcissism research accompanied by its diverging conceptualizations, little is known about age and gender differences across various narcissism measures. The present study investigated age and gender differences and their interactions across eight widely used narcissism instruments (i.e., Narcissistic Personality Inventory, Hypersensitive Narcissism Scale, Dirty Dozen, Psychological Entitlement Scale, Narcissistic Personality Disorder Symptoms from the Diagnostic and Statistical Manual of Mental Disorders, Version IV, Narcissistic Admiration and Rivalry Questionnaire-Short Form, Single-Item Narcissism Scale, and brief version of the Pathological Narcissism Inventory). The findings of Study 1 (N = 5,736) revealed heterogeneity in how strongly the measures are correlated. Some instruments loaded clearly on one of the three factors proposed by previous research (i.e., Neuroticism, Extraversion, Antagonism), while others cross-loaded across factors and in distinct ways. Cross-sectional analyses using each measure and meta-analytic results across all measures (Study 2) with a total sample of 270,029 participants suggest consistent linear age effects (random effects meta-analytic effect of r = -.104), with narcissism being highest in young adulthood. Consistent gender differences also emerged (random effects meta-analytic effect was -.079), such that men scored higher in narcissism than women. Quadratic age effects and Age × Gender effects were generally very small and inconsistent. We conclude that despite the various conceptualizations of narcissism, age and gender differences are generalizable across the eight measures used in the present study. However, their size varied based on the instrument used. We discuss the sources of this heterogeneity and the potential mechanisms for age and gender differences. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Contemporary integrative interpersonal theory: Integrating structure, dynamics, temporal scale, and levels of analysis.

Theoretical accounts of psychopathology often emphasize social context as etiologically central to psychological dysfunction, and interpersonal impairments are widely implicated for many legacy diagnostic categories that span domains of psychopathology (e.g., affective, personality, thought disorders). Contemporary Integrative Interpersonal Theory (CIIT) seeks to explain the emergence, expression, and maintenance of socioaffective functioning and dysfunction across levels and timescales of analysis. We emphasize the importance of cohesively addressing the often-segregated challenges of establishing empirically supported structure, functional accounts of dynamic processes, and how together these facilitate theoretical and methodological consistency across levels of analysis ranging from biology to behavior. We illustrate the potential of CIIT to serve as an integrative theory for generating falsifiable hypotheses that support strong inference investigations into the nature of psychological dysfunction across a range of traditional diagnostic constructs and superordinate spectra of psychopathology. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Personality (Dys)Function and General Instability.

Humans adapt to a dynamic environment while maintaining psychological equilibrium. Systems theories of personality hold that generalized processes control stability by regulating how strongly a person reacts to various situations. Research shows there are higher-order traits of general personality function (Stability) and dysfunction (general personality pathology; GPP), but whether or not they capture individual differences in reactivity is largely theoretical. We tested this hypothesis by examining how general personality functioning manifests in everyday life in two samples (Ns=205; 342 participants and 24,920; 17,761 observations) that completed an ambulatory assessment protocol. Consistent with systems theories, we found (1) there is a general factor reflecting reactivity across major domains of functioning, and (2) reactivity is strongly associated with Stability and GPP. Results provide insight into how people fundamentally adapt (or not) to their environments, and lays the foundation for more practical, empirical models of human functioning.

Suicidal urges and attempted suicide at multiple time scales in borderline personality disorder.

BACKGROUND: There is strong evidence for an enduring suicidal diathesis among individuals with a history of suicide attempts, particularly among people diagnosed with borderline personality disorder (BPD). However, the progression of suicidal crises among people predisposed to suicidal behavior remains poorly understood. METHODS: Via multilevel structural equation modeling we tested the hypothesis that a history of attempted suicide predicts a stronger dynamic link between affect and impulsivity with suicidal ideation (i.e., suicidal urges) - both moment-to-moment and day-to-day. 153 patients diagnosed with BPD, 105 of whom had a history of medically serious suicide attempts completed a 21-day ecological momentary assessment protocol (17,926 total assessments). RESULTS: Individuals with higher average levels of negative affect reported more suicidal thoughts. Moments characterized by more negative affect, hostility, impulsivity, and less positive affect were also characterized by elevated suicidal ideation. For hostility and positive affect, these significant links generalized to the daily level. At the same time, for negative affect and hostility the within-person coupling was stronger among attempters in comparison to non-attempters, and these effects did not significantly differ across timescales. LIMITATIONS: Follow-up studies replicating our findings of the dysregulation-suicidality nexus in clinically more diverse samples are needed. CONCLUSIONS: The diathesis for suicidal behavior manifests in tighter dynamic links between negative affect or hostility and suicidal ideation. Because these within-person links were amplified in attempters compared to non-attempters, differential coupling patterns may index potentially lethal processes that generalize beyond BPD reflecting distinct diathesis components.

Studying personality pathology with ecological momentary assessment: Harmonizing theory and method.

Over the past 20 years, ecological momentary assessment (EMA) has become a vital part of the methods repertoire used to study personality pathology. This is because EMA facilitates modeling (dys)function consistent with clinical theory as an ensemble of contextualized dynamic within-person processes, such as when and how relevant socio-affective responses may become disrupted in daily life. Despite its popularity, there is little systematic work on the conceptual adequacy and cross-study consistency in the design choices and reporting standards of EMA studies on personality disorders. EMA protocol design choices impact the reliability and validity of conclusions, and variability in choices affect replicability and thus credibility of the conclusions drawn. We provide an overview of the core decisions researchers face in designing an EMA study organized around the "three Ds": density (frequency of surveys), depth (length of surveys), and duration (number of days in a protocol). To identify the typical and range of used study designs, including what personality disorder researchers view as important and where there are gaps in our knowledge, we reviewed relevant studies published over the years 2000 to 2021. Of 66 identified unique EMA protocols, studies scheduled ~6.5 assessments per day with an average of ~21 items, lasted for ~13 days, and obtained a compliance of ~75%. Generally, denser studies had less depth and shorter duration, whereas protocols with longer duration tended to be deeper. We offer recommendations on how valid research on personality disorders can be organized around these considerations with the goal of reliably uncovering temporal dynamics in personality (dys)functioning. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Structure of Pathological Personality Traits Through the Lens of the CAT-PD Model.

Personality pathology is increasingly conceptualized within hierarchical, dimensional trait models. The Comprehensive Assessment of Traits Relevant to Personality Disorders (CAT-PD) is a pathological-trait measure with potential to improve on currently prevailing instruments because it has wider content coverage; however, its domain-level structure, which is of scientific and clinical interest, is not established. In this study, we investigated the structure and construct validity of the CAT-PD's domain level to facilitate wider use of the measure. We estimated five- and six-factor models with exploratory factor analysis in a pooled sample of eight independent subsamples (N = 3,987) and found that both models fit the data well; each had interpretable factors that were invariant across gender, sample type, and Black/White racial groups; and the factors had good convergent validity with other measures of maladaptive traits, Big Five personality, and interpersonal problems. Our results support the validity of the CAT-PD for assessing multiple levels of the pathological trait hierarchy.