The General Assessment of Personality Disorder (GAPD): factor structure, incremental validity of self-pathology, and relations to DSM-IV personality disorders.

Recent developments in the classification of personality disorder, especially moves toward more dimensional systems, create the need to assess general personality disorder apart from individual differences in personality pathology. The General Assessment of Personality Disorder (GAPD) is a self-report questionnaire designed to evaluate general personality disorder. The measure evaluates 2 major components of disordered personality: self or identity problems and interpersonal dysfunction. This study explores whether there is a single factor reflecting general personality pathology as proposed by the Diagnostic and Statistical Manual of Mental Disorders (5th ed.), whether self-pathology has incremental validity over interpersonal pathology as measured by GAPD, and whether GAPD scales relate significantly to Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]) personality disorders. Based on responses from a German psychiatric sample of 149 participants, parallel analysis yielded a 1-factor model. Self Pathology scales of the GAPD increased the predictive validity of the Interpersonal Pathology scales of the GAPD. The GAPD scales showed a moderate to high correlation for 9 of 12 DSM-IV personality disorders.

BPD Compass: A different direction to the treatment of borderline personality disorder?: Comment on Sauer-Zavala et al. (2022).

Comments on an article by S. Sauer-Zavala et al. (see record 2022-23735-001), which presents BPD-Compass as a new intervention for borderline personality disorder (BPD). In this comment, the author says that BPD-Compass is described as comprehensive and short term. But, it is difficult to be both. As a short-term intervention, is the Compass proposed as a first-line treatment? If so, why are crises, self-harm, and suicidality, dominant issues in the early stages of most therapies, not addressed systematically? (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Progress but no cigar: Comment on Bach and Tracy (2022).

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition alternative model of personality disorder (AMPD) introduced innovations that are likely to be enduring features of a scientific classification of personality disorder: (a) an explicit definition of personality disorder, (b) a description of levels of severity, (c) a dimensional model of individual differences, and (d) the important principle that classifications should use and be consistent with the findings of normal personality science. Bach and Tracy's review of evidence of the clinical utility of the alternative model compared with traditional typal diagnoses clearly demonstrates that dimensional classification does not adversely affect clinical utility. Based on this evidence, they propose that the AMPD minus the hybrid component be adopted as the Diagnostic and Statistical Manual of Mental Disorders classification of personality disorder. It is argued that the recommendation is premature because evidence of clinical utility is insufficient in the absence of evidence of construct validity. The rest of the commentary explores the conceptual and methodological problems arising from the way the AMPD's innovative features are translated into a diagnostic classification. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Why is an evidence-based classification of personality disorder so elusive?

Despite recent revisions, the classification of personality disorder remains a matter of dispute, and there is little evidence of consistent progress toward an evidence-based system. This essay examines four issues impeding taxonomic progress and explores how they might be addressed. First, the phenomenological and aetiological complexity of personality disorder poses a formidable challenge to traditional taxonomic methods. Second, current classifications incorporate assumptions such as a stringent version of medical model and an essentialist philosophy that are inconsistent with empirical evidence. Third, despite the claims of trait psychology, a viable alternative to categorical diagnosis is not available. Contemporary trait models have not gained widespread clinical acceptance and substantial conceptual and methodological limitations compromise their clinical value. Finally, the processes used to revise official classifications are biased toward conservative revisions and difficult to shield from non-scientific influences. It is suggested that rather making further attempts to develop a general monolithic classification that meets all needs, consideration be given to developing a more flexible and multifaceted framework that combines diagnosis and assessment. © 2020 John Wiley & Sons, Ltd.

An integrative dimensional classification of personality disorder.

Psychological assessment research concerns how to describe psychological dysfunction in ways that are both valid and useful. Recent advances in assessment research hold the promise of facilitating significant improvements in description and diagnosis. One such contribution is in the classification of personality disorder symptomatology. The American Psychiatric Association's diagnostic manual considers personality disorders to be categorically distinct entities. However, research assessing personality disorders has consistently supported a dimensional perspective. Recognition of the many limitations of categorical models of personality disorder classification has led to the development of a variety of alternative proposals, which further research has indicated can be integrated within a common hierarchical structure. This article offers an alternative integrated dimensional model of normal and abnormal personality structure, and it illustrates how such a model could be used clinically to describe patients' normal adaptive personality traits as well as their maladaptive personality traits that could provide the basis for future assessments of personality disorder. The empirical support, feasibility, and clinical utility of the proposal are discussed. Points of ambiguity and dispute are highlighted, and suggestions for future research are provided.

Structure of personality pathology in normal and clinical samples: Spanish validation of the DAPP-BQ.

Given that the DSM taxonomy of personality disorders is flawed by severe classificatory problems, the development of alternative classificatory systems, such as the Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ), has now become a priority. This study examined the internal consistency, second-order factor structure, and criterion validity of a Spanish translation of the DAPP-BQ in two samples: subjects with personality disorder (n = 155) and subjects from the general population (n = 300). Alpha coefficients ranged satisfactorily from .75 to .93. Four second-order factors of Emotional Dysregulation, Dissocial Behavior, Inhibitedness, and Compulsivity were obtained, which were replicable between samples and identical to those reported in the literature. Finally, disordered subjects scored significantly higher than normal subjects on 17 of the 18 DAPP-BQ traits. Some pending issues in the construction of an alternative taxonomy of personality disorders are discussed.

Synthesizing dimensional and categorical approaches to personality disorders: refining the research agenda for DSM-V Axis II.

Personality disorder researchers have long considered the utility of dimensional approaches to diagnosis, signaling the need to consider a dimensional approach for personality disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). Nevertheless, a dimensional approach to personality disorders in DSM-V is more likely to succeed if it represents an orderly and logical progression from the categorical system in DSM-IV. With these considerations and opportunities in mind, the authors sought to delineate ways of synthesizing categorical and dimensional approaches to personality disorders that could inform the construction of DSM-V. This discussion resulted in (1) the idea of having a set of core descriptive elements of personality for DSM-V, (2) an approach to rating those elements for specific patients, (3) a way of combining those elements into personality disorder prototypes, and (4) a revised conception of personality disorder as a construct separate from personality traits.

A framework for integrating dimensional and categorical classifications of personality disorder.

Although empirical evidence strongly supports a dimensional representation of personality disorder, there is strong resistance to dimensional classification due in part to concerns about clinical utility. Acceptance of an evidence-based dimensional classification would be facilitated by information on how such a system would map onto existing diagnoses. With this objective in mind, an integrated framework is proposed that combines categorical and dimensional diagnoses. A two-component classification is adopted that distinguishes between the diagnosis of general personality disorder and the assessment of individual differences in the form the disorder takes. Then, the DSM definition of personality disorders is extended by defining individual disorders as categories of trait dimensions. This makes it possible to develop an integrated classification organized around a set of empirically derived primary traits. Assessments of these traits may then be combined to generate categorical and dimensional diagnoses. It is argued that this approach would introduce an etiological perspective into the classification of personality disorder and improve categorical classification by providing an explicit definition of each diagnosis. The clinical utility of incorporating a dimensional classification is discussed in terms of convenience and acceptability, value in predicting outcomes and treatment planning, and usefulness in organizing and selecting interventions.

Is the genetic structure of human personality universal? A cross-cultural twin study from North America, Europe, and Asia.

This study examined whether universality of the 5-factor model (FFM) of personality operationalized by the Revised NEO Personality Inventory is due to genetic influences that are invariant across diverse nations. Factor analyses were conducted on matrices of phenotypic, genetic, and environmental correlations estimated in a sample of 1,209 monozygotic and 701 dizygotic twin pairs from Canada, Germany, and Japan. Five genetic and environmental factors were extracted for each sample. High congruence coefficients were observed when phenotypic, genetic, and environmental factors were compared in each sample as well as when each factor was compared across samples. These results suggest that the FFM has a solid biological basis and may represent a common heritage of the human species.

Cerebral information processing in personality disorders: I. Intensity dependence of auditory evoked potentials.

Patients with personality disorders such as the histrionic type exaggerate their responses when receiving external social or environmental stimuli. We speculated that they might also show an augmenting pattern of the auditory evoked potential N1-P2 component in response to stimuli with increasing levels of intensity, a response pattern that is thought to be inversely correlated with cerebral serotonin (5-HT) activity. To test this hypothesis, we collected auditory evoked potentials in 191 patients with personality disorders (19 patients with the paranoid type, 12 schizoid, 14 schizotypal, 18 antisocial, 15 borderline, 13 histrionic, 17 narcissistic, 25 avoidant, 30 dependent and 28 obsessive-compulsive) and 26 healthy volunteers. Their personality traits were measured using the Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ). Compared with healthy subjects and other patient groups, the histrionic group scored higher on the basic traits Affective Instability, Stimulus Seeking, Rejection and Narcissism, and on the higher traits Emotional Dysregulation and Dissocial, than the other groups, and the schizoid group scored lower on most of the DAPP-BQ basic and higher traits. In addition, the histrionic group showed steeper amplitude/stimulus intensity function (ASF) slopes at three midline scalp electrodes than the healthy controls or the other patient groups. The ASF slopes were not correlated with any DAPP-BQ traits in the total sample of 217 subjects. However, the DAPP-BQ basic trait Rejection was positively correlated with the ASF slopes at all three electrode sites in the histrionic group. The increased intensity dependence of the auditory N1-P2 component might indicate that cerebral 5-HT neuronal activity is, on average, weak in the histrionic patients.

The University of British Columbia Twin Project: personality is something and personality does something.

The University of British Columbia (UBC) Twin Project is a registry of approximately 1500 pairs of reared-together twins recruited from Vancouver, British Columbia and surrounding municipalities. The focus of the project is to examine personality and its disorders from a behavioral genetic perspective. The primary measures include self-report measures of variables from the major models of personality and personality disorders. Subsamples of the study have also been surveyed on a wide range of psychiatric conditions and symptoms, including, for example, substance use, mood, anxiety, coping, posttraumatic stress disorder, schizotypy, and several measures of the environment and experience. Also surveyed are general health and basic psychological processes including cognitive ability. This broad assessment has enabled us to examine not only the structure of personality, but also its potential role in psychopathology and other psychological processes. A feature of the project is that the measures selected reflect current thinking in the field as opposed to traditional psychiatric diagnostic criteria. The UBC Twin Project has been used in a number of collaborative projects on personality and psychopathology with other world-wide twin registries. At the present time, no DNA has been collected; however the facility to collect these data is available. Collaborative projects on this and future questionnaire studies are welcome.

Behavioral and molecular genetic contributions to a dimensional classification of personality disorder.

This article examines the possible contribution of behavioral and molecular genetic research to the development of a dimensional classification of personality disorder. It is argued that the results of molecular studies are too preliminary to have immediate nosological significance. However, behavioral genetic methods could play a useful role in constructing a classification that reflects the genetic architecture of personality disorder. It is also argued that the best approach to constructing a valid classification would be to integrate behavioral genetic methods with the construct validation framework used in test construction. An integrative approach is proposed that seeks to combine constructs from alternative dimensional models. It is suggested that strong evidence of a four-dimensional structure to personality disorder provides a way to organize a preliminary model. An initial set of primary traits to define these secondary domains would then be compiled from existing models and refined using a combination of traditional psychometric analyses and behavioral genetic methods. It is concluded that an etiologically based classification is feasible for the DSM-V.

Personality disorder research agenda for the DSM-V.

The American Psychiatric Association is sponsoring a series of international conferences to set a research agenda for the development of the next edition of the diagnostic manual. The first conference in this series, "Dimensional Models of Personality Disorder: Etiology, Pathology, Phenomenology, and Treatment," was devoted to reviewing the existing research and setting a future research agenda that would be most effective in leading the field toward a dimensional classification of personality disorder. The purpose of this article, authored by the Steering Committee of this conference, was to provide a summary of the conference papers and their recommendations for research. Covered herein are the reviews and recommendations concerning alternative dimensional models of personality disorder, behavioral genetics and gene mapping, neurobiological mechanisms, childhood antecedents, cross-cultural issues, Axes I and II continuity, coverage and cutoff points for diagnosis, and clinical utility.

The borderline diagnosis III: identifying endophenotypes for genetic studies.

Although it is generally acknowledged that borderline personality disorder (BPD) has a complex, multifactorial etiology with interacting genetic and environmental substrates, the specific genetic underpinnings of this disorder have not been extensively investigated. Family aggregation studies suggest the heritability for BPD as a diagnosis, but the genetic basis for this disorder may be stronger for dimensions such as impulsivity/aggression and affective instability than for the diagnostic criteria itself. Family, adoptive, and twin studies also converge to support an underlying genetic component to the disorder. An endophenotypic approach to defining the genetics of this complex disorder may be called for. Twin studies in an epidemiologic, non-clinically ascertained sample using both diagnostic measures and laboratory measures that can be operationalized, including neuropsychologic, psychophysiologic, and operationalized behavioral tests, may be useful. Large-scale family studies of clinically ascertained samples with careful diagnostic demarcation and measurement of endophenotypes in probands and relatives may also prove to be a promising approach. The use of laboratory paradigms for measures of aggression and affective instability are discussed in the context of such endophenotypic approaches.

The borderline diagnosis I: psychopathology, comorbidity, and personality structure.

Borderline personality disorder (BPD) is a complex and serious mental disorder associated with severe functional impairment, substantial treatment utilization, and a high rate of mortality by suicide. Recently, BPD has become a focus of intensifying study. In Part I of this three-part article meant to provide a foundation to researchers on the current status of the borderline diagnosis and prospects for its future development, we examine the psychopathology, comorbidity, and personality structure of BPD. Although the descriptive characteristics of BPD are well-represented by DSM-IV diagnostic criteria, other important aspects of BPD psychopathology are not included. The descriptive criteria in conjunction with semistructured interviews have, however, increased the ability of investigators to diagnose BPD as reliably as many Axis I disorders. Frequent comorbidity of BPD with Axis I disorders necessitates a broad assessment of psychopathology to help account for clinical heterogeneity. Because of the absence of evidence of the validity of the diagnostic threshold for a categorical diagnosis of BPD, and because of the heterogeneity within the diagnosis, investigators should also supplement their DSM-IV diagnoses with assessments of underlying personality trait structures. Although there are a number of competing models of personality structure, they have remarkable convergence on a set of three to five basic personality dimensions.

The borderline diagnosis II: biology, genetics, and clinical course.

In Part I of this three-part article, consideration of the core features of BPD psychopathology, of comorbidity with Axis I disorders, and of underlying personality trait structure suggested that the borderline diagnosis might be productively studied from the perspective of dimensions of trait expression, in addition to that of the category itself. In Part II, we review the biology, genetics, and clinical course of borderline personality disorder (BPD), continuing to attend to the utility of a focus on fundamental dimensions of psychopathology. Biological approaches to the study of personality can identify individual differences with both genetic and environmental influences. The aspects of personality disorder that are likely to have biologic correlates are those involving regulation of affects, impulse/action patterns, cognitive organization and anxiety/inhibition. For BPD, key psychobiological domains include impulsive aggression, associated with reduced serotonergic activity in the brain, and affective instability, associated with increased responsivity of cholinergic systems. There may be a strong genetic component for the development of BPD, but it seems clear, at least, that there are strong genetic influences on traits that underlie it, such as neuroticism, impulsivity, anxiousness, affective lability, and insecure attachment. The course of BPD suggests a heterogeneous disorder. Predictors of poor prognosis include history of childhood sexual abuse, early age at first psychiatric contact, chronicity of symptoms, affective instability, aggression, substance abuse, and increased comorbidity. For research purposes, at least, biological, genetic, and prognostic studies all continue to suggest the need to supplement categorical diagnoses of BPD with assessments of key underlying personality trait dimensions and with historical and clinical observations apart from those needed to make the borderline diagnosis itself.

Genetic and environmental influences on trauma exposure and posttraumatic stress disorder symptoms: a twin study.

OBJECTIVE: Posttraumatic stress disorder (PTSD) develops in only a subset of persons exposed to traumatic stress, suggesting the existence of stressor and individual differences that influence risk. In this study the authors examined the heritability of trauma exposure and PTSD symptoms in male and female twin pairs of nonveteran volunteers. METHOD: Scores on a traumatic events inventory and a DSM-IV PTSD symptom inventory were examined in 222 monozygotic and 184 dizygotic twin pairs. Biometrical model fitting was conducted by using standard statistical methods. RESULTS: Additive genetic, common environmental, and unique environmental effects best explained the variance in exposure to assaultive trauma (e.g., robbery, sexual assault), whereas exposure to nonassaultive trauma (e.g., motor vehicle accident, natural disaster) was best explained by common and unique environmental influences. PTSD symptoms were moderately heritable, and the remaining variance was accounted for by unique environmental experiences. Correlations between genetic effects on assaultive trauma exposure and on PTSD symptoms were high. CONCLUSIONS: Genetic factors can influence the risk of exposure to some forms of trauma, perhaps through individual differences in personality that influence environmental choices. Consistent with symptoms in combat veterans, PTSD symptoms after noncombat trauma are also moderately heritable. Moreover, many of the same genes that influence exposure to assaultive trauma appear to influence susceptibility to PTSD symptoms in their wake.

Heritability of individual depressive symptoms.

BACKGROUND: In attempting to understand the familial basis of depression, most studies have focused on broad indices of depression and mood change. Broad indices may not adequately reflect the heritable basis of depression because of an unexplored possibility that not all symptoms are heritable. METHODS: The heritability of individual depressive symptoms was estimated from a sample of 343 general population volunteer twin pairs who completed the Beck Depression Inventory, the Centre for Epidemiologic Studies Depression Scale and items from the Symptom Checklist assessing depressive symptoms. Principal component analysis of the items extracted 14 factors that represented a wide range of depressive symptomatology. RESULTS: The factors were differentially heritable (h2 range: 0.0-35.0%). The factors that have a heritable basis described endogenous or physiological functions (e.g. loss of appetite, libido/pleasure). Symptoms such as negative affect or tearfulness did not have a heritable basis, suggesting that these symptoms are responses to negative life events/experiences or a learned association to changes in physiologic function. LIMITATIONS: Relatively small size of the sample. CONCLUSIONS: Depressive symptoms are differentially heritable and the results suggest that future research, such as genotyping studies, separates heritable and non-heritable symptom clusters prior to analysis. This will help identify which genes are involved and what their function in depression may be, leading to the development of more targeted and effective therapies.

Exposure to traumatic events and experiences: aetiological relationships with personality function.

Empirical research has shown that the odds of experiencing traumatic events are influenced by genetic factors and the heritability of trauma exposure varies with the type of trauma. Traumatic events per se are unlikely to be heritable; more likely to be inherited are factors such as personality that influence the person's risk for entering into, or creating, potentially hazardous situations. With data from 406 twin pairs (222 monozygotic and 184 dizygotic twin pairs) from the urban general population, the present study used multiple regression analysis to identify personality variables associated with exposure to trauma, and estimated the degree to which these relationships were mediated by genetic factors. The experience of violent assaultive traumatic events was predicted by antisocial personality traits, specifically juvenile antisocial behavior, self-harming behavior, Psychoticism (e.g. adult antisocial behavior and substance misuse), and being open to new ideas and experiences. Genetic factors were found to partially mediate these relationships as indexed by the genetic correlation coefficient. The values of the genetic correlations were statistically significant and ranged from 0.14 to 0.36, accounting for 5-11% of the observed correlation between personality and trauma exposure. These findings suggest that heritable personality characteristics explain part of the variance in the likelihood of exposure to some classes of traumatic events.