VALIDATION OF THE DSM-5 ALTERNATE MODEL FOR PERSONALITY DISORDERS AMONG OLDER ADULTS

Abstract Introduction: The Personality Inventory for DSM-5 (PID-5) is a measure of the alternative model of personality disorders (PDs), proposed in Section III of the DSM-5, but the PID-5 has limited evidence of validity for use among older adults. This study examined the validity of the alternate model through associations with the 10 traditional PDs in DSM-5. It was hypothesized that the PID-5 would relate to the traditional PDs in patterns predicted by the alternate model. Method: Older adults (N = 202) completed the PID-5 and the Coolidge Axis II Inventory (CATI), a measurement of the 10 PDs. Results: Correlations were computed between the PID-5’s 25 facets and the CATI’s 10 PD scales. All facets were found to significantly (p < .001) and positively correlate with all 10 PD scales, with large effect sizes (> .30). Next, regressions were conducted, with the PID-5 facets predicting each PD scale. Overall, across the 10 regression analyses, the PID-5 facets accounted for significant variance in the CATI PD scales, ranging from 64% (Avoidant) to 71% (Obsessive-Compulsive). Discussion: Although some DSM-5 hypothesized facets were significant predictors, many unexpected significant relationships were also detected. Of the 10 PD models, seven models included more unpredicted significant traits than predicted ones; two models included more significant predicted traits than unpredicted ones; one model included an equal number of predicted and unpredicted significant traits. We found substantially more overlap between the PID-5 and CATI than anticipated in unpredicted directions, suggesting that the PID-5 has good specificity but lacks sensitivity.

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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.

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An Empirical Evaluation of the DSM-5 Alternative Model of Personality Disorders in Later Life

The International Journal of Aging and Human Development ◽

10.1177/0091415020980762 ◽

2020 ◽

pp. 009141502098076

Author(s):

Lisa E. Stone ◽

Daniel L. Segal

Keyword(s):

Older Adults ◽

Personality Traits ◽

Personality Disorders ◽

Alternative Model ◽

Empirical Evaluation ◽

Self Report ◽

Personality Functioning ◽

Dsm 5 ◽

Age Related ◽

Pathological Personality Traits

Personality disorders (PDs) in the Diagnostic and Statistical Manual of Mental Disorders ( DSM-5) are conceptualized as distinct clinical syndromes. However, debate persists about the clinical utility of this categorical model, with many researchers supporting a dimensional model that focuses on pathological personality traits and personality dysfunction. This model was published in Section III of DSM-5 and named the Alternative Model of Personality Disorders (AMPD). This study evaluated the AMPD by examining relationships between traits and dysfunction with traditional categorical PD constructs among older adults. Older adults ( N = 202) completed the Personality Inventory for DSM-5, Levels of Personality Functioning Scale-Self-Report, and Coolidge Axis II Inventory. Results indicated that pathological personality traits do not relate to categorical PDs in directions predicted by the AMPD. Personality functioning related to categorical PDs in expected theoretical patterns according to the AMPD but lacked incremental validity above pathological personality traits. An implication of these findings is that the AMPD does not fully resolve the age-related issues with the traditional categorical PD model.

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DSM-5 alcohol use disorder features among treatment-seeking older adults

SUCHT - Zeitschrift für Wissenschaft und Praxis / Journal of Addiction Research and Practice ◽

10.1024/0939-5911/a000550 ◽

2018 ◽

Vol 64 (4) ◽

pp. 185-196 ◽

Cited By ~ 2

Author(s):

Silke Behrendt ◽

Barbara Braun ◽

Randi Bilberg ◽

Gerhard Bühringer ◽

Michael Bogenschutz ◽

...

Keyword(s):

Older Adults ◽

Alcohol Use ◽

Alcohol Use Disorder ◽

The Elderly ◽

Treatment Seeking ◽

Controlled Clinical Trial ◽

Dsm 5 ◽

Wide Range ◽

And Gender ◽

International Multicenter

Abstract. Background: The number of older adults with alcohol use disorder (AUD) is expected to rise. Adapted treatments for this group are lacking and information on AUD features in treatment seeking older adults is scarce. The international multicenter randomized-controlled clinical trial “ELDERLY-Study” with few exclusion criteria was conducted to investigate two outpatient AUD-treatments for adults aged 60+ with DSM-5 AUD. Aims: To add to 1) basic methodological information on the ELDERLY-Study by providing information on AUD features in ELDERLY-participants taking into account country and gender, and 2) knowledge on AUD features in older adults seeking outpatient treatment. Methods: baseline data from the German and Danish ELDERLY-sites (n=544) were used. AUD diagnoses were obtained with the Mini International Neuropsychiatric Interview, alcohol use information with Form 90. Results: Lost control, desired control, mental/physical problem, and craving were the most prevalent (> 70 %) AUD-symptoms. 54.9 % reported severe DSM-5 AUD (moderate: 28.2 %, mild: 16.9 %). Mean daily alcohol use was 6.3 drinks at 12 grams ethanol each. 93.9 % reported binging. More intense alcohol use was associated with greater AUD-severity and male gender. Country effects showed for alcohol use and AUD-severity. Conclusion: European ELDERLY-participants presented typical dependence symptoms, a wide range of severity, and intense alcohol use. This may underline the clinical significance of AUD in treatment-seeking seniors.

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Psychopathy and the DSM-5: Gender Differences in the Associations with Borderline and Antisocial Personality Disorders

PsycEXTRA Dataset ◽

10.1037/e571212013-506 ◽

2013 ◽

Author(s):

Brandee E. Marion ◽

Martin Sellbom

Keyword(s):

Gender Differences ◽

Personality Disorders ◽

Antisocial Personality ◽

Dsm 5

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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.

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Personality disorders in older adults: expert opinion as a first step toward evaluating the criterion validity of an informant questionnaire (HAP)

International Psychogeriatrics ◽

10.1017/s1041610213001312 ◽

2013 ◽

Vol 26 (1) ◽

pp. 173-174 ◽

Cited By ~ 7

Author(s):

H.P.J. Barendse ◽

G. Rossi ◽

S.P.J. Van Alphen

Keyword(s):

Older Adults ◽

Personality Disorders ◽

Delphi Study ◽

Elderly Population ◽

Criterion Validity ◽

Personality Questionnaire ◽

Measurement Instruments ◽

Validated Questionnaires ◽

Dsm Iv ◽

Research Questions

There is a lack of validated questionnaires for screening personality disorders (PDs) in older adults (e.g. Van Alphen et al., 2012). The development of measurement instruments is hampered because the criteria of DSM-IV-TR PD are not age-neutral that might lead to over- and underdiagnosis (Balsis et al., 2007). As far as we know only three measurement instruments have been specifically developed for older adults, including the Hetero- Anamnestic Personality questionnaire (HAP; Barendse et al., 2013). However, we did not find any articles concerning the criterion validity of all ten PDs in an elderly population. In this Delphi study, a panel of experts examined two research questions: (1) To what extend are the items of the HAP age-neutral? (2) Does the HAP detect all ten specific PD's of DSM-IV-TR, based on qualitative research?

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