Narcissistic personality disorder and the DSM-V.

We address 3 issues relevant to narcissistic personality disorder (NPD) and the DSM–V. First, we argue that excluding NPD while retaining other traditional personality disorder constructs (e.g., avoidant) makes little sense given the research literature on NPD and trait narcissism and their association with clinically relevant consequences such as aggression, self-enhancement, distorted self-presentation, failed relationships, cognitive biases, and internalizing and externalizing dysregulation. Second, we argue that the DSM–V must include content (in diagnostic form or within a dimensional trait model) that allows for the assessment of both grandiose and vulnerable variants of narcissism. Finally, we suggest that any dimensional classification of personality disorder should recover all of the important component traits of narcissism and be provided with official recognition in the coding system. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Further comments toward a dimensional classification of personality disorder.

Responds to the comments by H. N. Garb (see record 2007-19520-012) and A. M. Ruscio (see record 2007-19520-013) on the current authors' original article "Plate tectonics in the classification of personality disorder: Shifting to a dimensional model" (see record 2007-01685-001). Unable to respond to all of Garb's and Ruscio's concerns given space limitations, the current authors attempt to respond to key points regarding their article on integrating the classification of personality disorder with a dimensional model of general personality structure. These points include: clinical judgments; feasibility; communication; thresholds; and validity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Borderline personality traits and disorder: Predicting prospective patient functioning.

Objective: Decisions about the composition of personality assessment in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–V) will be heavily influenced by the clinical utility of candidate constructs. In this study, we addressed 1 aspect of clinical utility by testing the incremental validity of 5-factor model (FFM) personality traits and borderline personality disorder (BPD) symptoms for predicting prospective patient functioning. Method: FFM personality traits and BPD features were correlated with one another and predicted 2-, 4-, 6-, 8-, and 10-year psychosocial functioning scores for 362 patients with personality disorders. Results: Traits and symptom domains related significantly and pervasively to one another and to prospective functioning. FFM extraversion and agreeableness tended to be most incrementally predictive of psychosocial functioning across all intervals; cognitive and impulse action features of BPD features incremented FFM traits in some models. Conclusions: These data suggest that BPD symptoms and personality traits are important long-term indicators of clinical functioning that both overlap with and increment one another in clinical predictions. Results support the integration of personality traits and disorders in DSM–V. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Plate tectonics in the classification of personality disorder: Shifting to a dimensional model.

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. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Judgment research and the dimensional model of personality.

Comments on the original article "Plate tectonics in the classification of personality disorder: Shifting to a dimensional model," by T. A. Widiger and T. J. Trull (see record 2007-01685-001). The purpose of this comment is to address (a) whether psychologists know how personality traits are currently assessed by clinicians and (b) the reliability and validity of those evaluations. Although Widiger and Trull argued that the shift to a dimensional model will improve the diagnosis of personality disorders, we can also expect that it will lead to improvements in evaluating personality traits. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A dimensional model of personality disorder: Incorporating DSM Cluster A characteristics.

The authors articulate an expanded dimensional model of personality pathology to better account for symptoms of DSM-defined Cluster A personality disorders. Two hundred forty participants (98 firstdegree relatives of probands with schizophrenia or schizoaffective disorder, 92 community control participants, and 50 first-degree relatives of probands with bipolar disorder) completed a dimensional personality pathology questionnaire, a measure of schizotypal characteristics, and Chapman measures of psychosis proneness. Scales from all questionnaires were subjected to an exploratory factor analysis with varimax rotation. A 5-factor structure of personality pathology emerged from the analyses, with Peculiarity forming an additional factor to the common 4-factor structure of personality pathology (consisting of Introversion, Emotional Dysregulation, Antagonism, and Compulsivity). These results support a 5-factor dimensional model of personality pathology that better accounts for phenomena encompassed by the Cluster A personality disorders in DSM-IV-TR (4th ed., text revised; American Psychiatric Association, 2000). This study has implications for the consideration of a dimensional model of personality disorder in DSM-V by offering a more comprehensive structural model that builds on previous work in this area. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Important questions remain to be addressed before adopting a dimensional classification of mental disorders.

Comments on the original article "Plate tectonics in the classification of personality disorder: Shifting to a dimensional model," by T. A. Widiger and T. J. Trull (see record 2007-01685-001). Widiger and Trull raised important nosological issues that warrant serious consideration not only for the personality disorders but for all mental disorders as the Diagnostic and Statistical Manual of Mental Disorders (DSM) is revised during the next few years. As argued compellingly by these authors, dimensional classification may indeed offer substantial improvement over the present categorical system. Several questions remain to be addressed in evaluating whether this is the case and, if so, how dimensional classification can be implemented to best serve the disparate users of the DSM. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The undisordered personality: Normative assumptions underlying personality disorder diagnoses.

Clinical diagnoses are impossible without referring to normative assumptions about what is desirable functioning. In this paper, the authors explicate the implicit normative assumptions that seem to have guided the formulation of the Diagnostic and Statistical Manual of Mental Disorders (DSM–IV) personality disorder (PD) criteria. Then the authors discuss various conceptual reference frames in which such assumptions may be grounded: (1) a given diagnostician’s personal value system, (2) the expectations of the culture in which a person currently lives, (3) the expectations of the culture in which a person was raised, (4) models of “natural” personality functioning that are rooted in evolution theory, and (5) the presence of distress and/or impairment. In accordance with Wakefield (1992a, 2006), the authors argue that PD diagnoses necessarily involve both an evolutionary and a cultural component. If PDs were defined completely in cultural terms, investigating their biological underpinnings would be nonsensical. In addition, the values of any specific culture should not be given too much weight, because cultural expectations may themselves be harmful. Future editions of DSM should define personality pathology in less culture-relative terms, and address the inevitable issue of values more explicitly. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A shaky future for personality disorders.

The major accomplishment of the fourth edition of the American Psychiatric Association's diagnostic manual was not in the development of surprising new content but rather in the careful, cautious, and systematic method with which it was constructed. The authors of the forthcoming fifth edition may have reversed the priorities, instead emphasizing radical changes without first conducting careful, systematic, thorough, or objective reviews of the scientific literature. Of particular concern are the proposals to cut half of the diagnoses from the manual, to abandon diagnostic criterion sets, and to include a dimensional model that lacks empirical support, fails to be integrated with normal personality functioning, and will lack official recognition. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Transitional relatedness and borderline personality disorder.

This study examined various aspects of transitional relatedness among individuals diagnosed as borderline or antisocial personality disorder. This study was a follow-up to an earlier report (Cooper, 1983) using the Rorschach Transitional Object Scale, which found only marginal support for Modell's clinical hypothesis that the borderline personality disorder involves a developmental arrest at the stage of the transitional object. The authors approached the concept of transitional relatedness as a series of external and internalized modes of relating including the perceptual capacity to distinguish between object and symbol on the Rorschach as well as self-reported current and past reliance on transitional objects and self-soothing activities. The study failed to provide evidence to suggest that reliance on a past or present transitional object per se is a unique or diagnostic feature of the borderline personality disorder. Particular aspects of current transitional relatedness, however, were strongly associated with borderline psychopathology. The clinical and research implications of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An item response theory integration of normal and abnormal personality scales.

[Correction Notice: An erratum for this article was reported in Vol 1(3) of Personality Disorders: Theory, Research, and Treatment (see record 2010-17135-005). In the acknowledgments, Douglas Samuel was incorrectly listed as the author of the DAPP-BQ instrument. John Livesley is the correct author of the DAPP-BQ instrument.] The Diagnostic and Statistical Manual of Mental Disorders (DSM–IV–TR) currently conceptualizes personality disorders (PDs) as categorical syndromes that are distinct from normal personality. However, an alternative dimensional viewpoint is that PDs are maladaptive expressions of general personality traits. The dimensional perspective postulates that personality pathology exists at a more extreme level of the latent trait than does general personality. This hypothesis was examined using item response theory analyses comparing scales from two personality pathology instruments—the Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ; Livesley & Jackson, in press) and the Schedule for Nonadaptive and Adaptive Personality (SNAP; Clark, 1993; Clark, Simms, Wu, & Casillas, in press)—with scales from an instrument designed to assess normal range personality, the NEO Personality Inventory–Revised (NEO PI-R; Costa & McCrae, 1992). The results indicate that respective scales from these instruments assess shared latent constructs, with the NEO PI-R providing more information at the lower (normal) range and the DAPP-BQ and SNAP providing more information at the higher (abnormal) range. Nevertheless, the results also demonstrated substantial overlap in coverage. Implications of the findings are discussed with respect to the study and development of items that would provide specific discriminations along underlying trait continua. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The construct validity of depressive personality disorder.

This study examined the construct validity of depressive personality disorder (DPD; American Psychiatric Association, 1994). Adult Psychiatric outpatients (N=900) underwent comprehensive Axis I and II evaluations and provided data on 4,768 of their 1st-degree relatives. Despite modest overlap, DPD was not redundant with any Axis I or II disorder. Participants with DPD exhibited more Axis I and Axis II comorbidity, and greater psychosocial dysfunction, than participants without DPD. Relatives of participants with DPD had higher rates of mood disorders, alcohol abuse, and antisocial personality. Results are consistent with findings of several other similar investigations. The authors argue that DPD is a valid construct and should be conceptualized as a personality disorder as opposed to a mood disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Speed and accuracy of facial expression classification in avoidant personality disorder: A preliminary study.

The aim of this preliminary study was to examine whether individuals with avoidant personality disorder (APD) could be characterized by deficits in the classification of dynamically presented facial emotional expressions. Using a community sample of adults with APD (n = 17) and non-APD controls (n = 16), speed and accuracy of facial emotional expression recognition was investigated in a task that morphs facial expressions from neutral to prototypical expressions (Multi-Morph Facial Affect Recognition Task; Blair, Colledge, Murray, & Mitchell, 2001). Results indicated that individuals with APD were significantly more likely than controls to make errors when classifying fully expressed fear. However, no differences were found between groups in the speed to correctly classify facial emotional expressions. The findings are some of the first to investigate facial emotional processing in a sample of individuals with APD and point to an underlying deficit in processing social cues that may be involved in the maintenance of APD. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Borderline personality disorder from the perspective of general personality functioning.

The authors extended previous work on the hypothesis that borderline personality disorder (BPD) can be understood as a maladaptive variant of personality traits included within the 5-factor model (FFM) of personality. In each of 3 samples, an empirically derived prototypic FFM borderline profile was correlated with individuals' FFM profiles to yield a similarity score, an FFM borderline index. Results across all samples indicated that the FFM borderline index correlated as highly with existing borderline measures as they correlated with one another, and the FFM borderline index correlated as highly with measures of dysfunction, history of childhood abuse, and parental psychopathology as did traditional measures of BPD. Findings support the hypothesis that BPD is a maladaptive variant of FFM personality traits. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The stability of personality traits in individuals with borderline personality disorder.

Although stability and pervasive inflexibility are general criteria for Diagnostic and Statistical Manual of Mental Disorders, 4th edition (American Psychiatric Association, 1994) personality disorders (PDs), borderline PD (BPD) is characterized by instability in several domains, including interpersonal behavior, affect, and identity. The authors hypothesized that such inconsistencies notable in BPD may relate to instability at the level of the basic personality traits that are associated with this disorder. Five types of personality trait stability across 4 assessments over 6 years were compared for BPD patients (N = 130 at first interval) and patients with other PDs (N = 302). Structural stability did not differ across groups. Differential stability tended to be lower for 5-factor model (FFM) traits in the BPD group, with the strongest and most consistent effects observed for Neuroticism and Conscientiousness. Growth curve models suggested that these 2 traits also showed greater mean-level change, with Neuroticism declining faster and Conscientiousness increasing faster, in the BPD group. The BPD group was further characterized by greater individual-level instability for Neuroticism and Conscientiousness in these models. Finally, the BPD group was less stable in terms of the ipsative configuration of FFM facet-level profiles than was the other PD group over time. Results point to the importance of personality trait instability in characterizing BPD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Conscientiousness and obsessive-compulsive personality disorder.

A dimensional perspective on personality disorder hypothesizes that the current diagnostic categories represent maladaptive variants of general personality traits. However, a fundamental foundation of this viewpoint is that dimensional models can adequately account for the pathology currently described by these categories. While most of the personality disorders have well established links to dimensional models that buttress this hypothesis, obsessive–compulsive personality disorder (OCPD) has obtained only inconsistent support. The current study administered multiple measures of 1) conscientiousness-related personality traits, 2) DSM–IV OCPD, and 3) specific components of OCPD (e.g., compulsivity and perfectionism) to a sample of 536 undergraduates who were oversampled for elevated OCPD scores. Six existing measures of conscientiousness-related personality traits converged strongly with each other supporting their assessment of a common trait. These measures of conscientiousness correlated highly with scales assessing specific components of OCPD, but obtained variable relationships with measures of DSM–IV OCPD. More specifically, there were differences within the conscientiousness instruments such that those designed to assess general personality functioning had small to medium relationships with OCPD, but those assessing more maladaptive variants obtained large effect sizes. These findings support the view that OCPD does represent a maladaptive variant of normal-range conscientiousness. (PsycINFO Database Record (c) 2011 APA, all rights reserved)