An interpersonal perspective on Criterion A of the DSM-5 Alternative Model for Personality Disorders

BackgroundThe DSM-5 Personality and Personality Disorders Work Group formulated a hybrid dimensional/categorical model that represented personality disorders as combinations of core impairments in personality functioning with specific configurations of problematic personality traits. Specific clusters of traits were selected to serve as indicators for six DSM categorical diagnoses to be retained in this system – antisocial, avoidant, borderline, narcissistic, obsessive–compulsive and schizotypal personality disorders. The goal of the current study was to describe the empirical relationships between the DSM-5 section III pathological traits and DSM-IV/DSM-5 section II personality disorder diagnoses.MethodData were obtained from a sample of 337 clinicians, each of whom rated one of his or her patients on all aspects of the DSM-IV and DSM-5 proposed alternative model. Regression models were constructed to examine trait–disorder relationships, and the incremental validity of core personality dysfunctions (i.e. criterion A features for each disorder) was examined in combination with the specified trait clusters.ResultsFindings suggested that the trait assignments specified by the Work Group tended to be substantially associated with corresponding DSM-IV concepts, and the criterion A features provided additional diagnostic information in all but one instance.ConclusionsAlthough the DSM-5 section III alternative model provided a substantially different taxonomic structure for personality disorders, the associations between this new approach and the traditional personality disorder concepts in DSM-5 section II make it possible to render traditional personality disorder concepts using alternative model traits in combination with core impairments in personality functioning.

Download Full-text

Examining the Structure and Validity of Self-Report Measures of DSM-5 Alternative Model for Personality Disorders Criterion A

Journal of Personality Disorders ◽

10.1521/pedi_2021_35_531 ◽

2021 ◽

pp. 1-33

Author(s):

Chloe F. Bliton ◽

Michael J. Roche ◽

Aaron L. Pincus ◽

David Dueber

Keyword(s):

Personality Traits ◽

Personality Disorders ◽

Alternative Model ◽

Explanatory Power ◽

Principal Component ◽

Incremental Validity ◽

Self Report ◽

Measurement Development ◽

Dsm 5 ◽

Criterion A

The Level of Personality Functioning Scale (LPFS) operationalizes Criterion A of the DSM-5 Alternative Model for Personality Disorders. Despite progress in LPFS measurement development and validation, there is a lack of research, and some disagreement, concerning structural, convergent, and incremental validity of LPFS self-report measures. The present study aimed to compare the LPFS Self-Report, LPFS Self-Report of Criterion A, and LPFS Brief Form. Internal structure was assessed through principal component analyses, factor analyses, and bifactor analyses of unidimensionality. Associations with both pathological and basic personality characteristics among the LPFS measures were explored. Incremental validity of LPFS severity in predicting pathological personality outcomes controlling for basic personality traits, and the reverse, were examined. Results suggest a unidimensional structure robustly associated with other pathological personality assessments. LPFS severity and basic personality traits mutually offered unique explanatory power. We discuss the implications of assessing personality pathology using LPFS self-report measures.

Download Full-text

Supplemental Material for The Latent Structure of Personality Functioning: Investigating Criterion A From the Alternative Model for Personality Disorders in DSM–5

Journal of Abnormal Psychology ◽

10.1037/abn0000059.supp ◽

2015 ◽

Keyword(s):

Personality Disorders ◽

Alternative Model ◽

Latent Structure ◽

Personality Functioning ◽

Dsm 5 ◽

Criterion A

Download Full-text

The latent structure of personality functioning: Investigating criterion a from the alternative model for personality disorders in DSM–5.

Journal of Abnormal Psychology ◽

10.1037/abn0000059 ◽

2015 ◽

Vol 124 (3) ◽

pp. 532-548 ◽

Cited By ~ 45

Author(s):

Johannes Zimmermann ◽

Jan R. Böhnke ◽

Rhea Eschstruth ◽

Alessa Mathews ◽

Kristin Wenzel ◽

...

Keyword(s):

Personality Disorders ◽

Alternative Model ◽

Latent Structure ◽

Personality Functioning ◽

Dsm 5 ◽

Criterion A

Download Full-text

Assessment of Pathological Traits in DSM-5 Personality Disorders By the DAPP-BQ: How Do These Traits Relate to the Six Personality Disorder Types of the Alternative Model?

Journal of Personality Disorders ◽

10.1521/pedi_2017_31_329 ◽

2019 ◽

Vol 33 (1) ◽

pp. 49-70 ◽

Cited By ~ 2

Author(s):

Han Berghuis ◽

Theo J. M. Ingenhoven ◽

Paul T. van der Heijden ◽

Gina M. P. Rossi ◽

Chris K. W. Schotte

Keyword(s):

Personality Disorder ◽

Personality Disorders ◽

Alternative Model ◽

Psychiatric Patients ◽

Personality Pathology ◽

Personality Functioning ◽

Dsm 5 ◽

Criterion A ◽

Dsm Iv ◽

Dimensional Assessment

The six personality disorder (PD) types in DSM-5 section III are intended to resemble their DSM-IV/DSM-5 section II PD counterparts, but are now described by the level of personality functioning (criterion A) and an assigned trait profile (criterion B). However, concerns have been raised about the validity of these PD types. The present study examined the continuity between the DSM-IV/DSM-5 section II PDs and the corresponding trait profiles of the six DSM-5 section III PDs in a sample of 350 Dutch psychiatric patients. Facets of the Dimensional Assessment of Personality Pathology—Basic Questionnaire (DAPP-BQ) were presumed as representations (proxies) of the DSM-5 section III traits. Correlational patterns between the DAPP-BQ and the six PDs were consistent with previous research between DAPP-BQ and DSM-IV PDs. Moreover, DAPP-BQ proxies were able to predict the six selected PDs. However, the assigned trait profile for each PD didn't fully match the corresponding PD.

Download Full-text

Age-Neutrality of a Brief Assessment of the Section III Alternative Model for Personality Disorders in Older Adults

Assessment ◽

10.1177/1073191118754706 ◽

2018 ◽

Vol 25 (3) ◽

pp. 310-323 ◽

Cited By ~ 10

Author(s):

Inge Debast ◽

Gina Rossi ◽

S. P. J. van Alphen

Keyword(s):

Older Adults ◽

Personality Disorders ◽

Alternative Model ◽

Convergent Validity ◽

Short Form ◽

Community Sample ◽

Personality Functioning ◽

Dsm 5 ◽

Criterion A ◽

The Impact

The alternative model for personality disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders ( DSM-5) is considered an important step toward a possibly better conceptualization of personality pathology in older adulthood, by the introduction of levels of personality functioning (Criterion A) and trait dimensions (Criterion B). Our main aim was to examine age-neutrality of the Short Form of the Severity Indices of Personality Problems (SIPP-SF; Criterion A) and Personality Inventory for DSM-5–Brief Form (PID-5-BF; Criterion B). Differential item functioning (DIF) analyses and more specifically the impact on scale level through differential test functioning (DTF) analyses made clear that the SIPP-SF was more age-neutral (6% DIF, only one of four domains showed DTF) than the PID-5-BF (25% DIF, all four tested domains had DTF) in a community sample of older and younger adults. Age differences in convergent validity also point in the direction of differences in underlying constructs. Concurrent and criterion validity in geriatric psychiatry inpatients suggest that both the SIPP-SF scales measuring levels of personality functioning (especially self-functioning) and the PID-5-BF might be useful screening measures in older adults despite age-neutrality not being confirmed.

Download Full-text

An evaluation of DSM-5 Section III Personality Disorder Criterion A (Impairment) in accounting for psychopathology

10.31234/osf.io/z48tv ◽

2018 ◽

Cited By ~ 2

Author(s):

Chelsea Sleep ◽

Donald Lynam ◽

Thomas A. Widiger ◽

Michael L Crowe ◽

Josh Miller

Keyword(s):

Personality Disorders ◽

Discriminant Validity ◽

Factor Model ◽

Incremental Validity ◽

Self Report ◽

Statistical Prediction ◽

Dsm 5 ◽

Criterion A ◽

Personality Dysfunction ◽

Axis I

An alternative diagnostic model of personality disorders (AMPD) was introduced in DSM-5 that diagnoses PDs based on the presence of personality impairment (Criterion A) and pathological personality traits (Criterion B). Research examining Criterion A has been limited to date, due to the lack of a specific measure to assess it; this changed, however, with the recent publication of a self-report assessment of personality dysfunction as defined by Criterion A (Levels of Personality Functioning Scale – Self-report; LPFS-SR; Morey, 2017). The aim of the current study was to test several key propositions regarding the role of Criterion A in the AMPD including the underlying factor structure of the LPFS-SR, the discriminant validity of the hypothesized factors, whether Criterion A distinguishes personality psychopathology from Axis I symptoms, the overlap between Criterion A and B, and the incremental predictive utility of Criterion A and B in the statistical prediction of traditional PD symptom counts. Neither a single factor model nor an a priori four-factor model of dysfunction fit the data well. The LPFS-SR dimensions were highly interrelated and manifested little evidence of discriminant validity. In addition, the impairment dimensions manifested robust correlations with measures of both Axis I and II constructs, challenging the notion that personality dysfunction is unique to PDs. Finally, multivariate regression analyses suggested that the traits account for substantially more unique variance in DSM-5 Section II PDs than does personality impairment. These results provide important information as to the functioning of the two main components of the DSM-5 AMPD and raise questions about whether the model may need revision moving forward.Keywords: dysfunction, impairment, personality disorders, Section III, incremental validity Public Significance: The alternative model of personality disorders included in Section III of the 5th addition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes two primary components: personality dysfunction and maladaptive traits. The current results raise questions about how a new, DSM-5 aligned measure of personality dysfunction operates with regard its factor structure, discriminant validity, ability to differentiate between personality and non-personality based forms of psychopathology, and incremental validity in the statistical prediction of traditional DSM personality disorders.

Download Full-text