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Journal ArticleDOI

Assessment and Diagnosis of Personality Disorder: Perennial Issues and an Emerging Reconceptualization

01 Jan 2007-Annual Review of Psychology (Annual Reviews)-Vol. 58, Iss: 1, pp 227-257
TL;DR: This chapter reviews recent personality disorder research, focusing on three major domains: assessment, comorbidity, and stability, and finds a new model for assessing PD-and perhaps all psychopathology-emerges from integrating these interrelated reconceptualizations.
Abstract: This chapter reviews recent (2000–2005) personality disorder (PD) research, focusing on three major domains: assessment, comorbidity, and stability. (a) Substantial evidence has accrued favoring dimensional over categorical conceptualization of PD, and the five-factor model of personality is prominent as an integrating framework. Future directions include assessing dysfunction separately from traits and learning to utilize collateral information. (b) To address the pervasiveness and extent of comorbidity, researchers have begun to move beyond studying overlapping pairs or small sets of disorders and are developing broader, more integrated common-factor models that cross the Axis I–Axis II boundary. (c) Studies of PD stability have converged on the finding that PD features include both more acute, dysfunctional behaviors that resolve in relatively short periods, and maladaptive temperamental traits that are relatively more stable—similar to normal-range personality traits—with increasing stability ...

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Citations
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Journal ArticleDOI
TL;DR: It is found that common mental disorders are strongly linked to personality and have similar trait profiles, and greater attention to these constructs can significantly benefit psychopathology research and clinical practice.
Abstract: We performed a quantitative review of associations between the higher order personality traits in the Big Three and Big Five models (i.e., neuroticism, extraversion, disinhibition, conscientiousness, agreeableness, and openness) and specific depressive, anxiety, and substance use disorders (SUD) in adults. This approach resulted in 66 meta-analyses. The review included 175 studies published from 1980 to 2007, which yielded 851 effect sizes. For a given analysis, the number of studies ranged from three to 63 (total sample size ranged from 1,076 to 75,229). All diagnostic groups were high on neuroticism (mean Cohen's d = 1.65) and low on conscientiousness (mean d = -1.01). Many disorders also showed low extraversion, with the largest effect sizes for dysthymic disorder (d = -1.47) and social phobia (d = -1.31). Disinhibition was linked to only a few conditions, including SUD (d = 0.72). Finally, agreeableness and openness were largely unrelated to the analyzed diagnoses. Two conditions showed particularly distinct profiles: SUD, which was less related to neuroticism but more elevated on disinhibition and disagreeableness, and specific phobia, which displayed weaker links to all traits. Moderator analyses indicated that epidemiologic samples produced smaller effects than patient samples and that Eysenck's inventories showed weaker associations than NEO scales. In sum, we found that common mental disorders are strongly linked to personality and have similar trait profiles. Neuroticism was the strongest correlate across the board, but several other traits showed substantial effects independent of neuroticism. Greater attention to these constructs can significantly benefit psychopathology research and clinical practice.

2,003 citations

Journal ArticleDOI
TL;DR: A maladaptive personality trait model and corresponding instrument are developed as a step on the path toward helping users of DSM-5 assess traits that may or may not constitute a formal personality disorder.
Abstract: Background DSM-IV-TR suggests that clinicians should assess clinically relevant personality traits that do not necessarily constitute a formal personality disorder (PD), and should note these traits on Axis II, but DSM-IV-TR does not provide a trait model to guide the clinician. Our goal was to provide a provisional trait model and a preliminary corresponding assessment instrument, in our roles as members of the DSM-5 Personality and Personality Disorders Workgroup and workgroup advisors. Method An initial list of specific traits and domains (broader groups of traits) was derived from DSM-5 literature reviews and workgroup deliberations, with a focus on capturing maladaptive personality characteristics deemed clinically salient, including those related to the criteria for DSM-IV-TR PDs. The model and instrument were then developed iteratively using data from community samples of treatment-seeking participants. The analytic approach relied on tools of modern psychometrics (e.g. item response theory models). Results A total of 25 reliably measured core elements of personality description emerged that, together, delineate five broad domains of maladaptive personality variation: negative affect, detachment, antagonism, disinhibition, and psychoticism. Conclusions We developed a maladaptive personality trait model and corresponding instrument as a step on the path toward helping users of DSM-5 assess traits that may or may not constitute a formal PD. The inventory we developed is reprinted in its entirety in the Supplementary online material, with the goal of encouraging additional refinement and development by other investigators prior to the finalization of DSM-5. Continuing discussion should focus on various options for integrating personality traits into DSM-5.

1,322 citations


Cites background or methods from "Assessment and Diagnosis of Persona..."

  • ...…trait and disorder models in the literature (Harkness et al. 1995 ; Austin & Deary, 2000 ; Costa & Widiger, 2002 ; De Clercq et al. 2006 ; Clark, 2007 ; Livesley, 2007 ; Nestadt et al. 2008 ; Watson et al. 2008 ; Piedmont et al. 2009 ; Widiger et al. 2009 ; Markon, 2010 ; Pincus et al.…...

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  • ...…f 2011 American Psychiatric Association ORIGINAL ARTICLE With regard to a personality trait model suitable for DSM-5, a variety of compelling models exist, instantiated in a corresponding variety of assessment instruments (for reviews, see Trull & Durrett, 2005 ; Clark, 2007)....

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  • ...…members and consultants pursued the creation of a maladaptive personality trait model and corresponding assessment instrument, drawing on and extending models in the existing literature (for recent reviews, see Trull & Durrett, 2005, Widiger & Simonsen, 2005, Clark, 2007 ; Krueger & Eaton, 2010)....

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Journal ArticleDOI
TL;DR: In this paper, the authors focus on two major influences on current conceptualizations of psychopathy: one clinical, with its origins largely in the early case studies of Cleckley, and the other empirical, the result of widespread use of the Hare Psychopathy Checklist-Revised (PCL-R) for assessment purposes.
Abstract: In this review, we focus on two major influences on current conceptualizations of psychopathy: one clinical, with its origins largely in the early case studies of Cleckley, and the other empirical, the result of widespread use of the Hare Psychopathy Checklist-Revised (PCL-R) for assessment purposes. Some investigators assert that the PCL-R, ostensibly based on Cleckley’s work, has “drifted” from the construct described in his Clinical Profile. We evaluate this profile, note its basis in an unrepresentative sample of patients, and suggest that its literal and uncritical acceptance by the research community has become problematical. We also argue that the idea of construct “drift” is irrelevant to current conceptualizations of psychopathy, which are better informed by the extensive empirical research on the integration of structural, genetic, developmental, personality, and neurobiological research findings than by rigid adherence to early clinical formulations. We offer some suggestions for future research on psychopathy.

1,143 citations

Journal ArticleDOI
TL;DR: 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, but notable exceptions to the hypotheses did occur and even some findings that were consistent with FFM theory could be said to be instrument specific.

870 citations


Cites background or methods or result from "Assessment and Diagnosis of Persona..."

  • ...There are also alternative dimensional models of personality structure that have been associated conceptually with the DSM personality disorders (Clark, 2007; Trull & Durrett, 2005; Widiger & Simonsen, 2005), such as the three three-factor model of Tellegen, as assessed by the Multidimensional…...

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  • ...However, researchers have increasingly noted the limitations of this categorical system (Clark, 2005, 2007; Krueger, Markon, Patrick, & Iacono, 2005; Livesley, 2003; Trull & Durrett, 2005; Watson, 2005; Widiger & Samuel, 2005) and have suggested alternative dimensional models of personality…...

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  • ...Since that time, quite a number of additional studies have expanded on this research base and provided further empirical support for understanding the DSM-IV-TR personality disorders in terms of the FFM domains and facets (Mullins-Sweatt & Widiger, 2006; Clark, 2007; Widiger & Trull, 2007)....

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  • ...In sum, in her seminal review of the personality disorder literature, Clark (2007) asserted that “the five-factor model of personality is widely accepted as representing the higher-order structure of both normal and abnormal personality traits” (p. 246)....

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  • ..., 2006); SWAP = Shedler and Westen Assessment Procedure (Shedler, 2002); SNAP = Schedule for Nonadaptive and Adaptive Personality (Clark, 1993b); PDI-IV = Personality Disorder Interview — IV (Widiger, Mangine, Corbitt, Ellis, & Thomas, 1995); PDQ-R = Personality Diagnostic Questionnaire — Revised (Hyler & Rieder, 1987). 1330 D.B. Samuel, T.A. Widiger / Clinical Psychology Review 28 (2008) 1326–1342...

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Journal ArticleDOI
TL;DR: 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.
Abstract: 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.

849 citations

References
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Book
01 Jan 1890
TL;DR: For instance, the authors discusses the multiplicity of the consciousness of self in the form of the stream of thought and the perception of space in the human brain, which is the basis for our work.
Abstract: Arguably the greatest single work in the history of psychology. James's analyses of habit, the nature of emotion, the phenomenology of attention, the stream of thought, the perception of space, and the multiplicity of the consciousness of self are still widely cited and incorporated into contemporary theoretical accounts of these phenomena.

14,049 citations

Book
01 Jan 2010

8,181 citations

Journal ArticleDOI
TL;DR: A psychobiological model of the structure and development of personality that accounts for dimensions of both temperament and character is described, for the first time, for three dimensions of character that mature in adulthood and influence personal and social effectiveness by insight learning about self-concepts.
Abstract: In this study, we describe a psychobiological model of the structure and development of personality that accounts for dimensions of both temperament and character. Previous research has confirmed four dimensions of temperament: novelty seeking, harm avoidance, reward dependence, and persistence, which are independently heritable, manifest early in life, and involve preconceptual biases in perceptual memory and habit formation. For the first time, we describe three dimensions of character that mature in adulthood and influence personal and social effectiveness by insight learning about self-concepts. Self-concepts vary according to the extent to which a person identifies the self as (1) an autonomous individual, (2) an integral part of humanity, and (3) an integral part of the universe as a whole. Each aspect of self-concept corresponds to one of three character dimensions called self-directedness, cooperativeness, and selftranscendence, respectively. We also describe the conceptual background and development of a self-report measure of these dimensions, the Temperament and Character Inventory. Data on 300 individuals from the general population support the reliability and structure of these seven personality dimensions. We discuss the implications for studies of information processing, inheritance, development, diagnosis, and treatment. (Arch Gen Psychiatry. 1993;50:975-990)

4,964 citations


"Assessment and Diagnosis of Persona..." refers background in this paper

  • ...Cloninger et al. (1993) added three “character” dimensions (self-directedness, cooperativeness, and selftranscendence), said to develop from experience, to the three (or four) “innate” temperament dimensions....

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Journal ArticleDOI
TL;DR: The UPPS Impulsive Behavior Scale as mentioned in this paper was developed to identify four distinct personality facets associated with impulsive-like behavior which were labeled urgency, lack of premeditation, pre-emption, and perseverance.

3,440 citations


"Assessment and Diagnosis of Persona..." refers background in this paper

  • ...…term that has come under increasing scrutiny as evidence has accrued that it is used to denote several unrelated constructs, some measured by self-report and others via laboratory tasks, each of which has some research support (Bornovalova et al. 2005, Looper & Paris 2000, Whiteside & Lynam 2001)....

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