Examination of the Section III DSM-5 diagnostic system for personality disorders in an outpatient clinical sample
TL;DR: Overall, these results support the general validity of several of the components of this new PD diagnostic system and point to areas that may require further modification.
Abstract: The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013), includes a novel approach to the diagnosis of personality disorders (PDs) in Section III, to stimulate further research with the possibility that this proposal will be included more formally in future DSM iterations. This study provides the 1st test of this proposal in a clinical sample by simultaneously examining its 2 primary components: a system for rating personality impairment and a newly developed dimensional model of pathological personality traits. Participants were community adults currently receiving outpatient mental health treatment who completed a semistructured interview for DSM-IV PDs and were then rated in terms of personality impairment and pathological traits. Data on the pathological traits were also collected through self-reports using the Personality Inventory for DSM-5 (PID-5). Both sets of trait scores were compared with self-report measures of general personality traits, internalizing symptoms, and externalizing behaviors. Interrater reliabilities for the clinicians' ratings of impairment and the pathological traits were fair. The impairment ratings manifested substantial correlations with symptoms of depression and anxiety, DSM-5 PDs, and DSM-5 pathological traits. The clinician and self-reported personality trait scores demonstrated good convergence with one another, both accounted for substantial variance in DSM-IV PD constructs, and both manifested expected relations with the external criteria. The traits but not the impairment ratings demonstrated incremental validity in the prediction of the DSM-IV PDs. Overall, these results support the general validity of several of the components of this new PD diagnostic system and point to areas that may require further modification.
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TL;DR: Research to date suggests that the DSM-5 trait model provides reasonable coverage of personality pathology but also suggest areas for continued refinement, which provides a way of evolving psychopathology classification on the basis of research evidence as opposed to clinical authority.
Abstract: The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) represents a watershed moment in the history of official psychopathology classification systems because it is the first DSM to feature an empirically based model of maladaptive personality traits. Attributes of patients with personality disorders were discussed by the DSM-5 Personality and Personality Disorders Work Group and then operationalized and refined in the course of an empirical project that eventuated in the construction of the Personality Inventory for DSM-5 (PID-5). We review research to date on the DSM-5 trait model, with a primary aim of discussing how this kind of research could serve to better tether the DSM to data as it continues to evolve. For example, studies to date suggest that the DSM-5 trait model provides reasonable coverage of personality pathology but also suggest areas for continued refinement. This kind of research provides a way of evolving psychopathology classification on the basis of res...
445 citations
TL;DR: It is suggested that a failure to distinguish between grandiose and vulnerable presentations of narcissism has led to a less cohesive and coherent literature and that trait-based models of personality and personality disorder can bring greater clarity to many of these important debates.
Abstract: There has been a surge in interest in and research on narcissism and narcissistic personality disorder (NPD). Despite or because of this increased attention, there are several areas of substantial debate that surround the construct, including descriptions of grandiose and vulnerable dimensions or variants, questions regarding the existence of a consensual description, central versus peripheral features of narcissism, distinctions between normal and pathological narcissism, possible etiological factors, the role of self-esteem in narcissism, where narcissism should be studied, how it can be assessed, and its representation in diagnostic nosologies. We suggest that a failure to distinguish between grandiose (i.e., overtly immodest, self-centered, entitled, domineering) and vulnerable (e.g., self-centered, distrustful, neurotic, introverted) presentations of narcissism has led to a less cohesive and coherent literature and that trait-based models of personality and personality disorder can bring greater clarity to many of these important debates.
315 citations
Cites background from "Examination of the Section III DSM-..."
...…categories and exemplars tied to one’s ability to function adaptively (e.g., to work and love) (see Pilkonis et al. 2011 for a discussion) as there are concerns with the reliability and incremental utility of the impairment ratings above and beyond the pathological traits (e.g., Few et al. 2013)....
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TL;DR: Support is provided for the use of the IPIP-NEO and both 120-item IPIP -NEO measures as assessment tools for measurement of the five-factor model.
Abstract: There has been a substantial increase in the use of personality assessment measures constructed using items from the International Personality Item Pool (IPIP) such as the 300-item IPIP-NEO (Goldberg, 1999), a representation of the Revised NEO Personality Inventory (NEO PI-R; Costa & McCrae, 1992). The IPIP-NEO is free to use and can be modified to accommodate its users' needs. Despite the substantial interest in this measure, there is still a dearth of data demonstrating its convergence with the NEO PI-R. The present study represents an investigation of the reliability and validity of scores on the IPIP-NEO. Additionally, we used item response theory (IRT) methodology to create a 120-item version of the IPIP-NEO. Using an undergraduate sample (n = 359), we examined the reliability, as well as the convergent and criterion validity, of scores from the 300-item IPIP-NEO, a previously constructed 120-item version of the IPIP-NEO (Johnson, 2011), and the newly created IRT-based IPIP-120 in comparison to the NEO PI-R across a range of outcomes. Scores from all 3 IPIP measures demonstrated strong reliability and convergence with the NEO PI-R and a high degree of similarity with regard to their correlational profiles across the criterion variables (rICC = .983, .972, and .976, respectively). The replicability of these findings was then tested in a community sample (n = 757), and the results closely mirrored the findings from Sample 1. These results provide support for the use of the IPIP-NEO and both 120-item IPIP-NEO measures as assessment tools for measurement of the five-factor model.
220 citations
TL;DR: The psychometric characteristics of the Personality Inventory for the DSM–5 demonstrate adequate psychometric properties, including a replicable factor structure, convergence with existing personality instruments, and expected associations with broadly conceptualized clinical constructs.
Abstract: The paradigm of personality psychopathology is shifting from one that is purely categorical in nature to one grounded in dimensional individual differences. Section III (Emerging Measures and Models) of the Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM-5]; American Psychiatric Association, 2013), for example, includes a hybrid categorical/dimensional model of personality disorder classification. To inform the hybrid model, the DSM-5 Personality and Personality Disorders Work Group developed a self-report instrument to assess pathological personality traits-the Personality Inventory for the DSM-5 (PID-5). Since its recent introduction, 30 papers (39 samples) have been published examining various aspects of its psychometric properties. In this article, we review the psychometric characteristics of the PID-5 using the Standards for Educational and Psychological Testing as our framework. The PID-5 demonstrates adequate psychometric properties, including a replicable factor structure, convergence with existing personality instruments, and expected associations with broadly conceptualized clinical constructs. More research is needed with specific consideration to clinical utility, additional forms of reliability and validity, relations with psychopathological personality traits using clinical samples, alternative methods of criterion validation, effective employment of cut scores, and the inclusion of validity scales to propel this movement forward.
208 citations
Cites background from "Examination of the Section III DSM-..."
...PID–5 in predicting important outcomes outside of conceptually related constructs, Few et al. (2013) examined the PID–5 in...
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...…studies finding a relationship between these two traits (e.g., Chmielewski, Bagby, Markon, Ring, & Ryder, 2014; De Fruyt et al., 2013; Gore & Widiger, 2013; Thomas et al., 2013), and others finding no relationship (Few et al., 2013; Quilty et al., 2013; Suzuki et al., 2015; Watson et al., 2013)....
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...In considering the importance of examining the utility of the PID–5 in predicting important outcomes outside of conceptually related constructs, Few et al. (2013) examined the PID–5 in relation to relevant behavioral and psychological outcomes....
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...Few et al. (2013) examined relationships between PID–5...
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..., 2013), and others finding no relationship (Few et al., 2013; Quilty et al., 2013; Suzuki et al., 2015; Watson et al., 2013)....
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TL;DR: The authors used item response theory-based analyses in a large sample (n = 1,417) to investigate whether a reduced set of 100 items could be identified from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) that could measure the 25 traits and 5 domains.
Abstract: The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes an alternative model of personality disorders (PDs) in Section III, consisting in part of a pathological personality trait model. To date, the 220-item Personality Inventory for DSM-5 (PID-5; Krueger, Derringer, Markon, Watson, & Skodol, 2012) is the only extant self-report instrument explicitly developed to measure this pathological trait model. The present study used item response theory-based analyses in a large sample (n = 1,417) to investigate whether a reduced set of 100 items could be identified from the PID-5 that could measure the 25 traits and 5 domains. This reduced set of PID-5 items was then tested in a community sample of adults currently receiving psychological treatment (n = 109). Across a wide range of criterion variables including NEO PI-R domains and facets, DSM-5 Section II PD scores, and externalizing and internalizing outcomes, the correlational profiles of the original and reduced versions of the PID-5 were nearly identical (rICC = .995). These results provide strong support for the hypothesis that an abbreviated set of PID-5 items can be used to reliably, validly, and efficiently assess these personality disorder traits. The ability to assess the DSM-5 Section III traits using only 100 items has important implications in that it suggests these traits could still be measured in settings in which assessment-related resources (e.g., time, compensation) are limited.
149 citations
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11 Jun 2013
113,134 citations
TL;DR: The AUDIT provides a simple method of early detection of hazardous and harmful alcohol use in primary health care settings and is the first instrument of its type to be derived on the basis of a cross-national study.
Abstract: The Alcohol Use Disorders Identification Test (AUDIT) has been developed from a six-country WHO collaborative project as a screening instrument for hazardous and harmful alcohol consumption. It is a 10-item questionnaire which covers the domains of alcohol consumption, drinking behaviour, and alcohol-related problems. Questions were selected from a 150-item assessment schedule (which was administered to 1888 persons attending representative primary health care facilities) on the basis of their representativeness for these conceptual domains and their perceived usefulness for intervention. Responses to each question are scored from 0 to 4, giving a maximum possible score of 40. Among those diagnosed as having hazardous or harmful alcohol use, 92% had an AUDIT score of 8 or more, and 94% of those with non-hazardous consumption had a score of less than 8. AUDIT provides a simple method of early detection of hazardous and harmful alcohol use in primary health care settings and is the first instrument of its type to be derived on the basis of a cross-national study.
11,042 citations
Book•
01 Jan 1997
TL;DR: The Structured Clinical Interview for DSM-IV Axis II personality disorders (SCID-II) as mentioned in this paper is an efficient, user-friendly instrument that will help researchers and clinicians make standardized, reliable, and accurate diagnoses of the 10 DSM-III personality disorders as well as depressive personality disorder, passive-aggressive personality disorder and personality disorder not otherwise specified.
Abstract: The Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II) is an efficient, user-friendly instrument that will help researchers and clinicians make standardized, reliable, and accurate diagnoses of the 10 DSM-IV Axis II personality disorders as well as depressive personality disorder, passive-aggressive personality disorder, and personality disorder not otherwise specified. Now compatible with DSM-IV, the interview questions have been redesigned to reflect the subject's inner experience. This instrument begins with a brief overview that characterizes the subject's typical behavior and relationships and elicits information about the subject's capacity for self-reflection. It then considers each of the personality disorders in detail. The Questionnaire is a single-use personality questionnaire to be completed by the patient that can be used as a screening tool to shorten the interview. Bound separately, it is sold only with the Interview booklet. The Interview is a single-use booklet that is bound separately but used in conjunction with the Questionnaire. It contains the interview questions and provides space to record responses. At the conclusion of the Interview, the clinician completes the Summary Score Sheet and computes a dimensional score for each personality disorder. This is a package of 5.
6,124 citations
TL;DR: In this article, the authors discuss theoretical principles, practical issues, and pragmatic decisions to help developers maximize the construct validity of scales and subscales, and propose factor analysis as a crucial role in ensuring unidimensionality and discriminant validity.
Abstract: A primary goal of scale development is to create a valid measure of an underlying construct. We discuss theoretical principles, practical issues, and pragmatic decisions to help developers maximize the construct validity of scales and subscales. First, it is essential to begin with a clear conceptualization of the target construct. Moreover, the content of the initial item pool should be overinclusive and item wording needs careful attention. Next, the item pool should be tested, along with variables that assess closely related constructs, on a heterogeneous sample representing the entire range of the target population. Finally, in selecting scale items, the goal is unidimensionality rather than internal consistency ; this means that virtually all interitem correlations should be moderate in magnitude. Factor analysis can play a crucial role in ensuring the unidimensionality and discriminant validity of scales.
5,867 citations