The DSM-5 presents an Alternative Model for Personality Disorder (AMPD) recommending the assessment of impairments in core personality functions as well as clinically relevant personality traits. ...Although a self-report assessment instrument has been provided corresponding to the trait model proposed in the AMPD, no comparable instrument provides a direct assessment of the specific indicators of core personality functions described in that model. The goal of this paper is to provide preliminary reliability and validity data for a measure that directly corresponds to core personality pathology as operationalized in the AMPD. Self-report questions were generated to capture each diagnostic indicator provided in the Level of Personality Functioning Scale, a clinician rating guide provided in the AMPD that describes characteristic impairments in identity, self-direction, empathy, and intimacy at 5 different levels of personality functioning. These questions were administered to a community sample of 306 participants, with the resulting scale examined for internal consistency, unidimensionality, and concurrent validity with 4 other self-report measures of global personality dysfunction. Items representing the 4 subcomponents of personality dysfunction were found to manifest high degrees of internal consistency, and were highly related to each other, supporting the AMPD contention that these core dysfunctions reflect a single dimension of personality dysfunction. Correlations with concurrent validity measures were large, with associations at the global level of dysfunction often exceeding .80. The developed instrument is reprinted in the supplementary materials, with the goal of encouraging additional refinement and development by other investigators as part of the call for additional research on the AMPD.
Public Significance Statement
This study presents the development and initial study of a questionnaire designed to measure the specific set of indicators of personality disorder proposed in the recent revision of the DSM-5 diagnostic manual. The results indicate that responses to questions corresponding to these indicators appear to be measuring a global dimension of impairment that is related to many other measures of personality problems.
In a recent article, Sleep, Lynam, Widiger, Crowe, and Miller (2019) examined various properties of measures of Criterion A and Criterion B of the Alternative Model for Personality Disorders ...presented in DSM-5. This commentary discusses the suitability of certain indicators of factor structure, discriminant validity, and incremental validity as evaluative metrics for the assessment of personality disorder, both in general and as applied in that specific study.
Public Significance Statement
This article discusses potential drawbacks to various evaluative criteria for the classification of personality disorder, as applied in a recent paper in this journal.
As online data collection services such as Amazon’s Mechanical Turk (MTurk) gain popularity, the quality and representativeness of such data sources have gained research attention. To date, the ...majority of existing studies have compared MTurk workers with undergraduate samples, localized community samples, or other Internet-based samples, and thus, there remains little known about the personality and mental health constructs of MTurk workers relative to a national representative sample. The present study addresses these limitations and broadens the scope of existing research through the use of the Personality Assessment Inventory, a multiscale, self-report questionnaire which provides information regarding data validity and personality and psychopathology features standardized against a national U.S. census–matched normative sample. Results indicate that MTurk workers generally provide high-quality data and are reasonably representative of the general population across most psychological dimensions assessed. However, several distinguishing features of MTurk workers emerged that were consistent with prior findings of such individuals, primarily involving somewhat higher negative affect and lower social engagement.
Sleep, Lynam, Widiger, Crowe, and Miller (2019) discuss a number of concerns previously raised with respect to the distinction between impairment and trait in the Alternative Model of Personality ...Disorders (AMPD). In particular, they cite issues of overlap between the 2 as raising concerns about parsimony of representation. In this response, I briefly address both the importance of parsimony and its limitations as a consideration in the classification of personality disorders.
Public Significance Statement
This rejoinder briefly discusses the role and limitations of parsimony in the classification of personality disorders.
This study examined the interdiagnostician reliability and potential gender bias of the
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Section II and
Alternative Model definitions of borderline personality disorder. A national sample of 123 ...mental health professionals provided diagnostic judgments on 12 case vignettes selected to represent a range of personality pathology. Two versions of each case were included, one identified as male and the other as female, but which were otherwise identical. Analyses examined the intraclass correlation between clinicians and also examined rates of diagnostic assignments as a function of case gender. Reliability of diagnosis of borderline personality did not differ across the two diagnostic approaches, and concordance of diagnoses across the two systems was significant. The dimensional components of the
Alternative Model demonstrated significantly more diagnostic reliability than the
categorical diagnoses. The
Alternative Model conceptualization of borderline personality can be diagnosed with comparable or greater reliability than the extant
definition.
Objective
The DSM‐5 Alternative Model of Personality Disorders distinguishes core personality dysfunction common to all personality pathology from maladaptive traits that delineate specific variants ...of disorder. Previous research shows the convergence between maladaptive and normal range trait domains as well as substantial correlations between maladaptive traits and core dysfunctions, leading some to conclude that personality traits and dysfunction are redundant. This study sought to examine the potential utility of the concept of core dysfunctions as a means of clarifying the nature of the relationship between maladaptive and normal‐range traits.
Method
Three nonclinical samples (n = 178, 307, and 1,008) were evaluated for personality dysfunction, maladaptive traits, and normal‐range traits using different measures.
Results
Results indicated that: (1) normal trait domains and core dysfunction contribute independently to understanding maladaptive traits; (2) the correlation of a normal trait domain with its putative maladaptive equivalent is consistently accounted for in part by core dysfunction; and (3) the multitrait multimethod matrices of normal and maladaptive personality trait domains demonstrate appreciable discriminant validity problems that are clarified by a consideration of core dysfunction.
Conclusion
These results suggest that maladaptive traits reflect the distinguishable contributions of core personality dysfunction (problems) and normal‐range personality traits (person).
In this study, we explored the temporal stability of the Personality Assessment Inventory (PAI), which has not been comprehensively reexamined since it was first published. Our three specific aims ...were to determine the utility of PAI indicators of basic protocol validity (inconsistent responses ICN and highly unusual/unlikely responses INF) in identifying suspect responding; calculate the stability coefficients for each PAI scale and subscale across 3-, 6-, and 9-week spans; and explore whether profile stability across four measurements could be prospectively predicted. We administered the PAI to a sample of undergraduates (N = 579) at four separate timepoints. ICN and INF effectively identified likely attriters and inconsistent responders. All PAI full scales and subscales evidenced good test–retest reliability, with some small exceptions. Finally, all PAI clinical scales were correlated with profile instability although many of these correlations were no longer significant when controlling for mean clinical elevation of the profile. We interpreted these results as evidence for the utility of PAI validity scales, the temporal reliability of the PAI, and the role of psychopathology in response variability over time. We also discussed some preliminary evidence that this variability can be prospectively predicted, suggesting that it in part reflects substantive changes rather than random error variance.
Personality disorders are associated with fundamental disturbances of self and interpersonal relations, problems that vary in severity within and across disorders. This review surveyed ...clinician-rated measures of personality psychopathology that focus on self-other dimensions to explore the feasibility and utility of constructing a scale of severity of impairment in personality functioning for DSM-5. Robust elements of the instruments were considered in creating a continuum of personality functioning based on aspects of identity, self-direction, empathy, and intimacy. Building on preliminary findings (
Morey et al., 2011
/this issue), the proposed Levels of Personality Functioning will be subjected to extensive empirical testing in the DSM-5 field trials and elsewhere. The resulting version of this severity measure is expected to have clinical utility in identifying personality psychopathology, planning treatment, building the therapeutic alliance, and studying treatment course and outcome.
In this study we examined the structure, reliability, and validity of the Levels of Personality Functioning Scale-Self Report (LPFS-SR) in 3 large community samples. The LPFS-SR is a questionnaire ...with content that corresponds directly to the DSM-5 alternative model of personality disorders, Criterion A. We found that the LPFS-SR was highly reliable across a brief retest interval. LPFS-SR scores correlated substantially with a wide range of maladaptive personality traits, personality disorder constructs, and interpersonal problems. The LPFS-SR did not correlate as strongly with aspects of personality with less clear relations to distress and dysfunction. Data further support that identity, self-direction, intimacy, and empathy components of the LPFS-SR can be characterized by a single factor and have similar correlations with criterion variables, consistent with the hypothesis that DSM-5 Criterion A is a relatively homogeneous construct. Overall, these results support the validity of the LPFS-SR, highlight important issues in assessing personality pathology, and point toward novel avenues for research on personality disorder classification.
Attention Deficit Hyperactivity Disorder is a relatively common and often disabling disorder in adults. However, feigning ADHD symptomatology is both easy and potentially common. We explored the most ...effective strategies for A) identifying individuals who had been diagnosed with ADHD based on existing PAI symptom indicators, and B), discriminating between feigned and genuine ADHD symptoms using PAI negative distortion indicators. Our sample consisted of 463 college aged participants who had been diagnosed with ADHD (n = 60), were asked to feign ADHD (n = 71), and a control group (n = 333). Self-reported diagnosis and successful feigning were corroborated by the CAARS-S: E scale. We first compared two PAI-derived ADHD indicators to determine which best differentiated between our ADHD and Control groups. Next, we compared seven negative distortion indicators to determine which could best distinguish between real and feigned ADHD symptoms. Our results revealed that the PAI-ADHD scale was the most effective symptom indicator. Further, the Negative Distortion Scale (NDS) was the most effective for identifying feigners. When assessing ADHD based on the PAI, the PAI-ADHD scale appears promising as an indicator of symptomatology, while the NDS appears useful to rule-out feigning.
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