Proposed for the 11th edition of the World Health Organization's International Classification of Diseases (ICD-11) is a dimensional trait model for the classification of personality disorder (Tyrer, ...Reed, & Crawford, 2015). The ICD-11 proposal consists of 5 broad domains: negative affective, detachment, dissocial, disinhibition, and anankastic (Mulder, Horwood, Tyrer, Carter, & Joyce, 2016). Several field trials have examined this proposal, yet none has included a direct measure of the trait model. The purpose of the current study was to develop and provide initial validation for the Personality Inventory for ICD-11 (PiCD), a self-report measure of this proposed 5-domain maladaptive trait model. Item selection and scale construction proceeded through 3 initial data collections assessing potential item performance. Two subsequent studies were conducted for scale validation. In Study 1, the PiCD was evaluated in a sample of 259 MTurk participants (who were or had been receiving mental health treatment) with respect to 2 measures of general personality structure: The Eysenck Personality Questionnaire-Revised and the 5-Dimensional Personality Test. In Study 2, the PiCD was evaluated in an additional sample of 285 participants with respect to 2 measures of maladaptive personality traits: The Personality Inventory for DSM-5 and the Computerized Adaptive Test for Personality Disorders. Study 3 provides an item-level exploratory structural equation model with the combined samples from Studies 1 and 2. The results are discussed with respect to the validity of the measure and the potential benefits for future research in having a direct, self-report measure of the ICD-11 trait proposal.
Public Significance Statement
The purpose of the present study was to develop and validate a self-report measure of the personality disorder trait model proposed for the World Health Organization's International Classification of Diseases (ICD-11). Three studies addressed the convergent and discriminant validity of the PiCD with respect to other normal and abnormal personality trait measures, as well as its factor structure.
Theory and research have suggested that the personality disorders contained within the American Psychiatric Association's
Diagnostic and Statistical Manual of Mental Disorders (
DSM-IV-TR) can be ...understood as maladaptive variants of the personality traits included within the five-factor model (FFM). The current meta-analysis of FFM personality disorder research both replicated and extended the 2004 work of Saulsman and Page (The five-factor model and personality disorder empirical literature: A meta-analytic review.
Clinical Psychology Review, 23, 1055–1085) through a facet level analysis that provides a more specific and nuanced description of each
DSM-IV-TR personality disorder. The empirical FFM profiles generated for each personality disorder were generally congruent at the facet level with hypothesized FFM translations of the
DSM-IV-TR personality disorders. However, notable exceptions to the hypotheses did occur and even some findings that were consistent with FFM theory could be said to be instrument specific.
The diagnostic categories of the American Psychiatric Association's
Diagnostic and Statistical Manual of Mental Disorders
were developed in the spirit of a traditional medical model that considers ...mental disorders to be qualitatively distinct conditions (see, e.g.,
American Psychiatric Association, 2000
). Work is now beginning on the fifth edition of this influential diagnostic manual. It is perhaps time to consider a fundamental shift in how psychopathology is conceptualized and diagnosed. More specifically, it may be time to consider a shift to a dimensional classification of personality disorder that would help address the failures of the existing diagnostic categories as well as contribute to an integration of the psychiatric diagnostic manual with psychology's research on general personality structure.
PERSONALITY AND PSYCHOPATHOLOGY CAN RELATE TO ONE ANOTHER IN THREE DIFFERENT WAYS: personality and psychopathology can influence the presentation or appearance of one another (pathoplastic ...relationships); they can share a common, underlying etiology (spectrum relationships); and they can have a causal role in the development or etiology of one another. Each of these possible forms of inter-relationship is considered in this paper.
The Five-Factor Model (FFM) is a dimensional model of general personality structure, consisting of the domains of neuroticism (or emotional instability), extraversion versus introversion, openness ...(or unconventionality), agreeableness versus antagonism, and conscientiousness (or constraint). The FFM is arguably the most commonly researched dimensional model of general personality structure. However, a notable limitation of existing measures of the FFM has been a lack of coverage of its maladaptive variants. A series of self-report inventories has been developed to assess for the maladaptive personality traits that define Diagnostic and Statistical Manual of Mental Disorders (fifth edition; DSM-5) Section II personality disorders (American Psychiatric Association APA, 2013) from the perspective of the FFM. In this paper, we provide an introduction to this Special Section, presenting the rationale and empirical support for these measures and placing them in the historical context of the recent revision to the APA diagnostic manual. This introduction is followed by 5 papers that provide further empirical support for these measures and address current issues within the personality assessment literature.
Public Significance Statement
The Five-Factor Model (FFM) is the predominant model for describing persons' characteristic way of thinking, feeling, and relating to others. This paper describes the effort to develop self-report measures of the dysfunctional or maladaptive variants of all 10 poles of all 5 domains of the FFM.
The predominant maladaptive trait models are now provided by Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) Section III, assessed by the Personality Inventory for DSM-5 ...(PID-5; Krueger, Derringer, Markon, Watson, & Skodol, 2012), and the International Classification of Diseases-11th Revision (ICD-11; assessed by the Personality Inventory for ICD-11 (PiCD; Oltmanns & Widiger, 2018). However, 2 historical precedents are the Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ; Livesley & Jackson, 2009) and the Schedule for Nonadaptive and Adaptive Personality (SNAP; Clark, 1993). The current study administered the DAPP-BQ, SNAP, PiCD, and PID-5 to a sample of 323 persons with a history of mental health treatment. The results provided support for the historical precedence of the DAPP-BQ and SNAP, although also suggest that additional traits should perhaps be included in current models. The results also bear on additional ongoing issues, including (but not limited to) the bipolarity of maladaptive personality structure, the conceptualization of identity problems as a trait, and the discriminant validity of maladaptive trait models and their assessment.
Public Significance Statement
The current predominant trait models are provided by the 11th edition of the International Classification of Diseases and the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders. However, considered within the current study are 2 historical precedents to these trait models.
The ICD-11 model of personality disorder consists of a level of severity, 5 trait domains, and a borderline pattern qualifier. Level of severity is assessed by the Standardized Assessment of Severity ...of Personality Disorder (SASPD; Olajide et al., 2018), the trait model by the Personality Inventory for ICD-11 (PiCD; Oltmanns & Widiger, 2018), and the borderline pattern qualifier by the Borderline Pattern Specifier inventory (BPS; Oltmanns & Widiger, 2019). The DSM-5 Section III Alternative Model of Personality Disorder includes a level of personality functioning and the five-domain trait model. These two components are assessed by the Level of Personality Functioning Scale (LPFS; Morey, 2017) and the Personality Inventory for DSM-5 (PID-5; Krueger, Derringer, Markon, Watson, & Skodol, 2012). Components of each model have been related to one another, but no study has yet considered all of the components for both models within one study. The current study considers the convergent, discriminant, and structural validity of the relationship of the LPFS and PID-5 with the SASPD, PiCD, and BPS. Also included were multiple measures of borderline personality disorder to determine if the BPS obtains incremental validity in accounting for borderline personality disorder variance above and beyond the trait models.
Public Significance Statement
The current predominant trait models are provided by the 11th edition of the International Classification of Diseases and the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders. Considered within the current study are their relationship with one another.
Proposed for the ICD-11 is a dimensional model of personality disorder that, if approved, would be a paradigm shift in the conceptualization of personality disorder. The proposal consists of a ...general severity rating, 5 maladaptive personality trait domains, and a borderline pattern qualifier. The general severity rating can be assessed by the Standardized Assessment of Severity of Personality Disorder (SASPD), the trait domains by the Personality Inventory for ICD-11 (PiCD), and the borderline pattern by the Borderline Pattern Scale (BPS), which is developed in the present study. To date, no study has examined the relations among all 3 components, due in part to the absence of direct measures for each component (until recently). The current study develops and provides initial validation evidence for the BPS, and examines the relations among the BPS, SASPD, and PiCD. Also considered is their relationship with the 5-factor model of general personality as well as with 2 other measures of personality disorder severity (including the DSM-5 Level of Personality Functioning Scale LPFS). Further, an alternative trait-based coding of the DSM-5 LPFS is examined (modeled after the ICD-11 SASPD), suggesting that its coverage of diverse maladaptivity may not be because it assesses the core of personality disorder, but rather because it has items specific to the different domains of personality.
Public Significance Statement
The upcoming ICD-11 proposes a dimensional model of personality disorder that, if approved, would be an enormous change in how personality disorder is diagnosed across the world. The current study is the first to examine the relations among all three components of the model.
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