Initial construction of a maladaptive personality trait model and inventory for DSM-5.
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.
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Stony Brook University1, University of Minnesota2, University of Notre Dame3, University of Vermont4, University of Toronto5, Boston University6, University of Maryland, Baltimore7, Duke University8, University of Kansas9, King's College London10, Columbia University11, Broad Institute12, Purdue University13, University of Iowa14, University of Georgia15, Texas A&M University16, Oklahoma State University–Stillwater17, University of Groningen18, Florida State University19, Uniformed Services University of the Health Sciences20, Bryn Mawr College21, University of North Texas22, University of Otago23, University at Buffalo24, University of Arizona25, University of New South Wales26, Northwestern University27, Emory University28, University of Kentucky29, University of Pittsburgh30, Brown University31
TL;DR: The HiTOP promises to improve research and clinical practice by addressing the aforementioned shortcomings of traditional nosologies and provides an effective way to summarize and convey information on risk factors, etiology, pathophysiology, phenomenology, illness course, and treatment response.
Abstract: The reliability and validity of traditional taxonomies are limited by arbitrary boundaries between psychopathology and normality, often unclear boundaries between disorders, frequent disorder co-occurrence, heterogeneity within disorders, and diagnostic instability. These taxonomies went beyond evidence available on the structure of psychopathology and were shaped by a variety of other considerations, which may explain the aforementioned shortcomings. The Hierarchical Taxonomy Of Psychopathology (HiTOP) model has emerged as a research effort to address these problems. It constructs psychopathological syndromes and their components/subtypes based on the observed covariation of symptoms, grouping related symptoms together and thus reducing heterogeneity. It also combines co-occurring syndromes into spectra, thereby mapping out comorbidity. Moreover, it characterizes these phenomena dimensionally, which addresses boundary problems and diagnostic instability. Here, we review the development of the HiTOP and the relevant evidence. The new classification already covers most forms of psychopathology. Dimensional measures have been developed to assess many of the identified components, syndromes, and spectra. Several domains of this model are ready for clinical and research applications. The HiTOP promises to improve research and clinical practice by addressing the aforementioned shortcomings of traditional nosologies. It also provides an effective way to summarize and convey information on risk factors, etiology, pathophysiology, phenomenology, illness course, and treatment response. This can greatly improve the utility of the diagnosis of mental disorders. The new classification remains a work in progress. However, it is developing rapidly and is poised to advance mental health research and care significantly as the relevant science matures. (PsycINFO Database Record
1,635 citations
Cites background or methods from "Initial construction of a maladapti..."
...Robert F. Krueger is a coauthor of the PID-5 and provides consulting services to aid users of the PID-5 in the interpretation of test scores....
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...The most recent efforts to map personality pathology are the Personality Inventory for DSM–5 (PID-5; Krueger et al., 2012) and the Computerized Adaptive Test of Personality Disorder (CAT-PD; Simms et al., 2011)....
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...The CAT-PD (Simms et al., 2011) was developed independently of the PID-5 with the same goal....
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...A comparison with the PID-5 suggests that emotional dysfunction combines internalizing and detachment spectra, behavioral dysfunction reflects general externalizing (i.e., it combines disinhibited and antagonistic elements), and thought dysfunction maps onto thought disorder (Anderson et al., 2015)....
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...Specifically, internalizing dimensions were drawn from nonredundant scales of the IMAS, IDAS, PID-5, PAI, and FFM-PD (Crego & Widiger, 2016; Hopwood et al., 2013; Watson et al., 2012)....
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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
Cites background or methods or result from "Initial construction of a maladapti..."
...As of this writing, and subsequent to the initial report by Krueger et al. (2012), there have been a number of additional studies of the PID-5 structure....
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...As a result, we developed and refined an inventory over the course of three rounds of data collection from national samples of research participants (Krueger et al. 2012)....
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...That is, in the initial investigation of Krueger et al. (2012), the empirical structure of the 25 elements of maladaptive personality measured by the PID-5 appeared to represent maladaptive extremes of the five-factor model (FFM) of personality that has usefully framed extensive research in the…...
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...Preliminary structural findings on the PID-5 were reported by Krueger et al. (2012)....
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...The initial report of Krueger et al. (2012) provided both indices of measurement precision for the 25 PID-5 scales....
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TL;DR: Personality disorder is also associated with premature mortality and suicide, and needs to be identified more often in clinical practice than it is at present.
430 citations
TL;DR: Beyond the description of individual differences in personality disorder, the trait dimensions might provide a framework for the metastructure of psychopathology in the DSM-5 and the integration of a number of ostensibly competing models of personality trait covariation.
Abstract: A multidimensional trait system has been proposed for representing personality disorder (PD) features in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to address problematic classification issues such as comorbidity. In this model, which may also assist in providing scaffolding for the underlying structure of major forms of psychopathology more generally, 25 primary traits are organized by 5 higher order dimensions: Negative Affect, Detachment, Antagonism, Disinhibition, and Psychoticism. We examined (a) the generalizability of the structure proposed for DSM-5 PD traits, and (b) the potential for an integrative hierarchy based upon DSM-5 PD traits to represent the dimensions scaffolding psychopathology more generally. A large sample of student participants (N 2,461) completed the Personality Inventory for DSM-5, which operationalizes the DSM-5 traits. Exploratory factor analysis replicated the initially reported 5-factor structure, as indicated by high factor congruencies. The 2-, 3-, and 4-factor solutions estimated in the hierarchy of the DSM-5 traits bear close resemblance to existing models of common mental disorders, temperament, and personality pathology. Thus, beyond the description of individual differences in personality disorder, the trait dimensions might provide a framework for the metastructure of psychopathology in the DSM-5 and the integration of a number of ostensibly competing models of personality trait covariation.
386 citations
TL;DR: These results show promising test-retest reliability results for this group of assessments, many of which are newly developed or have not been previously tested in psychiatric populations.
Abstract: ObjectiveThe authors sought to document, in adult and pediatric patient populations, the development, descriptive statistics, and test-retest reliability of cross-cutting symptom measures proposed for inclusion in DSM-5.MethodData were collected as part of the multisite DSM-5 Field Trials in large academic settings. There were seven sites focusing on adult patients and four sites focusing on child and adolescent patients. Cross-cutting symptom measures were self-completed by the patient or an informant before the test and the retest interviews, which were conducted from 4 hours to 2 weeks apart. Clinician-report measures were completed during or after the clinical diagnostic interviews. Informants included adult patients, child patients age 11 and older, parents of all child patients age 6 and older, and legal guardians for adult patients unable to self-complete the measures. Study patients were sampled in a stratified design, and sampling weights were used in data analyses. The mean scores and standard d...
314 citations
Cites methods from "Initial construction of a maladapti..."
...Other measures were tested in the DSM-5 Field Trials, including the World Health Organization Disability Assessment Schedule (30) and an inventory of maladaptive personality traits (31)....
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TL;DR: In this paper, the problem of selecting one of a number of models of different dimensions is treated by finding its Bayes solution, and evaluating the leading terms of its asymptotic expansion.
Abstract: The problem of selecting one of a number of models of different dimensions is treated by finding its Bayes solution, and evaluating the leading terms of its asymptotic expansion. These terms are a valid large-sample criterion beyond the Bayesian context, since they do not depend on the a priori distribution.
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TL;DR: In this paper, the problem of selecting one of a number of models of different dimensions is treated by finding its Bayes solution, and evaluating the leading terms of its asymptotic expansion.
Abstract: The problem of selecting one of a number of models of different dimensions is treated by finding its Bayes solution, and evaluating the leading terms of its asymptotic expansion. These terms are a valid large-sample criterion beyond the Bayesian context, since they do not depend on the a priori distribution.
36,760 citations
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TL;DR: This personal historical article traces the development of the Big-Five factor structure, whose growing acceptance by personality researchers has profoundly influenced the scientific study of individual differences.
Abstract: This personal historical article traces the development of the Big-Five factor structure, whose growing acceptance by personality researchers has profoundly influenced the scientific study of individual differences. The roots of this taxonomy lie in the lexical hypothesis and the insights of Sir Francis Galton, the prescience of L. L. Thurstone, the legacy of Raymond B. Cattell, and the seminal analyses of Tupes and Christal. Paradoxically, the present popularity of this model owes much to its many critics, each of whom tried to replace it, but failed. In reaction, there have been a number of attempts to assimilate other models into the five-factor structure. Lately, some practical implications of the emerging consensus can be seen in such contexts as personnel selection and classification.
4,025 citations
"Initial construction of a maladapti..." refers methods in this paper
...In a meta-analytic review of literature linking the Five Factor Model of personality (FFM; see Goldberg, 1993; Costa & Widiger, 2002) – which bears a strong resemblance to the model described by Widiger & Simonsen (2005) – with the DSM-IV PDs (Samuel & Widiger, 2008), DSM-IV PDs were associated…...
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TL;DR: The first large-scale testing of PROMIS item banks and their short forms provide evidence that they are reliable and precise measures of generic symptoms and functional reports comparable to legacy instruments.
3,365 citations
"Initial construction of a maladapti..." refers background in this paper
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