A dimensional model of personality disorder: incorporating DSM Cluster A characteristics.
ABSTRACT 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 first-degree 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.
A Dimensional Model of Personality Disorder: Incorporating DSM
Cluster A Characteristics
Jennifer L. Tackett
University of Toronto
Amy L. Silberschmidt
Minneapolis Veterans Affairs Medical Center
Robert F. Krueger
University of Minnesota—Twin Cities
Scott R. Sponheim
Minneapolis Veterans Affairs Medical Center
and University of Minnesota—Twin Cities
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 first-
degree 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.
Keywords: personality pathology, DSM–V, dimensional models, five-factor model, schizotypal person-
As progress toward the next edition of the Diagnostic and
Statistical Manual of Mental Disorders (DSM) continues, the
importance of research that addresses potential changes in DSM–V
becomes more salient. The question of what will happen to per-
sonality disorders in the transition between DSM–IV–TR (4th ed.,
text revised; American Psychiatric Association, 2000) and DSM–V
has gained increasing attention. Comprehensive, empirically based
proposals have been put forth that argue for a move to a dimen-
sional system for personality pathology in DSM–V (Widiger, Si-
monsen, Krueger, Livesley, & Verheul, 2005; Widiger & Trull,
2007). Such a shift would represent a paradigmatic change in the
conceptualization of psychiatric disorder (Kupfer, First, & Regier,
2002; Widiger & Trull, 2007). A primary concern related to
making such a change is how to obtain an empirically based,
comprehensive consensus structure (Widiger & Simonsen, 2005;
Widiger & Trull, 2007).
One of the predominant nominees for such a dimensional sys-
tem is a four-factor structure of maladaptive personality (De
Clercq, De Fruyt, Van Leeuwen, & Mervielde, 2006; Livesley,
2005; Widiger & Simonsen, 2005) that largely corresponds to
maladaptive variants of four of the five factors in the five-factor
model (FFM), a common approach to conceptualizing and mea-
suring normal-range personality in adult populations. Specifically,
the FFM consists of the following higher order traits: Neuroticism,
Extraversion, Agreeableness, Conscientiousness, and Openness to
Experience (Goldberg, 1993; McCrae & Costa, 2001). Proposed
four-factor models of personality pathology often define the fol-
lowing higher order dimensions: Emotional Dysregulation
(roughly corresponding to extreme Neuroticism), Introversion
(corresponding to the maladaptive opposite of Extraversion), An-
Jennifer L. Tackett, Department of Psychology, University of Toronto,
Toronto, Canada; Amy L. Silberschmidt, Minneapolis Veterans Affairs
Medical Center, Minneapolis, Minnesota; Robert F. Krueger, Department
of Psychology, University of Minnesota—Twin Cities; Scott R. Sponheim,
Minneapolis Veterans Affairs Medical Center, and Departments of Psy-
chiatry and Psychology, University of Minnesota—Twin Cities.
This work was supported in part by grants awarded to Scott R. Spon-
heim from the Department of Veterans Affairs Medical Research Service,
the Mental Illness and Neuroscience Discovery (MIND) Institute, and the
Mental Health Patient Service Line at the Minneapolis Veterans Affairs
Medical Center. We gratefully acknowledge Althea Noukki and Bridget
Hegeman for the supervision of data collection, and Jessica Barker and
Anna Docherty for their assistance with data management and acquisition.
Correspondence concerning this article should be addressed to Jennifer
L. Tackett, Department of Psychology, University of Toronto, 100 St.
George Street, Toronto, Ontario M5S 3G3, Canada. E-mail:
Journal of Abnormal Psychology
2008, Vol. 117, No. 2, 454–459
Copyright 2008 by the American Psychological Association
tagonism (corresponding to the maladaptive opposite of Agree-
ableness), and Compulsivity (corresponding to extreme Conscien-
tiousness). The proposed four-factor model is based on points of
convergence among numerous dimensional models and is, in part,
a response to the concern that there are presently too many dimen-
sional systems from which to choose (Widiger & Simonsen, 2005).
Most of this work on understanding personality pathology in terms
of dimensional models of personality has failed to find a direct
pathological analog to the fifth factor, Openness to Experience
(Livesley, 2005; Widiger, 1998). Researchers have also noted
questions concerning how cognitive and perceptual aberrations
(e.g., symptoms characterizing Cluster A personality disorders in
the DSM–IV–TR) might fit into such a four-factor model (Widiger
& Costa, 1994; Widiger & Simonsen, 2005).
Amidst this convergence on a potential four-factor dimensional
model of personality pathology that might be considered for
DSM–V, important issues remain to be resolved before such a
significant change could be put in motion. Specifically, a primary
issue that has been discussed is whether the four-factor model of
personality pathology provides comprehensive coverage of those
characteristics currently codified in Axis II. In A Research Agenda
for DSM–V, First et al. (2002) wrote
Future research should address such questions as . . . whether there are
particular components or aspects of the DSM–IV personality disorders
that are not adequately represented within or covered by existing
dimensional models (e.g., identity disturbances, attachment conflicts,
cognitive aberrations, or perceptual abnormalities). (p. 144)
It has been suggested that characteristics that index cognitive
aberrations and perceptual abnormalities (e.g., those associated
with Cluster A personality disorders such as schizotypal person-
ality disorder) represent too small a factor to be meaningful or that
they do not have a place in a dimensional system of personality
pathology (Widiger & Simonsen, 2005). Similarly, researchers
have called for empirical investigations (First et al., 2002) to
determine whether these Cluster A characteristics would fit into a
dimensional model for Axis II.
In this brief report, we respond to this call by investigating a
comprehensive higher order factor structure that may better
account for the Cluster A disorders. Specifically, we question
whether the predominant four-factor structure of personality
pathology fully accounts for additional variation in personality
pathology, such as the tendency to have unusual perceptual
experiences. The Dimensional Assessment of Personality Pa-
thology (DAPP; Livesley & Jackson, in press) is a self-report
measure that assesses 18 factorially derived lower order scales
that together index the consensus four-factor structure at a
higher order level. In addition to the DAPP, we employ existing
measures that typically are used to assess characteristics asso-
ciated with the Cluster A personality disorders from DSM–
IV–TR and the schizophrenia spectrum more broadly, and we
investigate whether such measures capture additional meaning-
ful variance beyond the four-factor structure as assessed by the
DAPP. Through the use of a sample of first-degree relatives of
individuals with schizophrenia or schizoaffective disorder or
bipolar disorder, we expect to increase the variance in such
measures compared to a typical, or “normal,” population while
avoiding some of the potential limitations in assessing a group
that is actively disordered (e.g., the ability of such a group to
provide extensive personality data).
We studied 98 first-degree relatives of probands with schizo-
phrenia or schizoaffective disorder, 50 first-degree relatives of
probands with bipolar disorder, and 92 nondiagnosed participants
from the community who acted as controls, for a combined sample
of 240 participants. Demographics of the groups are presented in
Table 1. Probands were recruited through the Minneapolis Veter-
ans Affairs Medical Center, community support programs for
persons with mental illness, and a county mental health clinic.
Probands provided personal contact information and permission to
contact relatives to study staff. A trained doctoral level clinical
psychologist confirmed probands’ diagnoses by administering the
Diagnostic Interview for Genetic Studies (Nurnberger et al., 1994).
A trained graduate student or doctoral level psychologist then
completed a consensus diagnosis process through the use of med-
ical records and information from a family informant as well as the
original interview. In order to maximize the number of participat-
ing relatives, first-degree relatives were excluded from participat-
ing only if they had a physical problem that would render study
measures impossible to administer (e.g., blindness) or if they were
younger than age 18. Control participants were recruited through
posted announcements in the Minneapolis Veterans Affairs Med-
ical Center and in the greater community (e.g., libraries, fitness
centers). Trained study staff screened control participants for an
absence of affective disorders and psychotic disorders. Recruit-
ment and study procedures are described further elsewhere (Spon-
heim, McGuire, & Stanwyck, 2006). All participants completed an
informed consent process. The Minneapolis Veterans Affairs Med-
ical Center and University of Minnesota Institutional Review
Board approved the study protocol. Participants were paid for their
Participants completed the Dimensional Assessment for Person-
ality Pathology—Basic Questionnaire (DAPP–BQ; Livesley &
Jackson, in press). The DAPP–BQ is a 290-item, 1–5 Likert scale
questionnaire that consists of 18 subscales: Affective Lability,
Anxiousness, Callousness, Cognitive Distortions, Compulsivity,
Conduct Problems, Identity Problems, Insecure Attachment, Inti-
macy Problems, Narcissism, Oppositionality, Rejection, Restricted
Expression, Self-Harm, Social Avoidance, Stimulus Seeking, Sub-
M Age (SD)
vidual with schizophrenia or schizoaffective disorder; BPD-Rel ? first
degree relative of individual with bipolar disorder.
Age is reported in years. SCZ-Rel ? first-degree relative of indi-
missiveness, and Suspiciousness. Scale reliability as assessed by
Cronbach’s alpha for the DAPP–BQ scales ranged from .81 (Con-
duct Problems) to .92 (Self-Harm), with an average Cronbach’s
alpha across all scales of .87.
Participants also completed a 298-item, true–false questionnaire
designed to measure psychosis proneness entitled “Survey of At-
titudes and Experiences” that consisted of the Schizotypal Person-
ality Questionnaire (SPQ; Raine, 1991), Chapman Psychosis
Proneness Scales—namely, Perceptual Aberration, Magical Ide-
ation, revised Physical Anhedonia (Chapman, Chapman, & Raulin,
1976, 1978; Eckblad & Chapman, 1983), and revised Social An-
hedonia (Eckblad, Chapman, Chapman, & Mishlove, 1982)—the
Chapman Infrequency Scale (Chapman & Chapman, 1983), and
the L and K scales from the Minnesota Multiphasic Personality
Inventory–2 (MMPI–2; Pope, Butcher, & Seelen, 2000). The SPQ
consists of nine subscales: Constricted Affect, Excessive Social
Anxiety, Ideas of Reference, No Friends, Odd Beliefs, Odd Be-
haviors, Odd Speech, Suspiciousness, and Unusual Perceptions.
Scale reliability as assessed by Cronbach’s alpha for the SPQ
scales ranged from .63 (Unusual Perceptions) to .85 (No Friends),
with an average Cronbach’s alpha across all scales of .74. Scale
reliability as assessed by Cronbach’s alpha for the Chapman scales
ranged from .74 (Magical Ideation) to .86 (Social Anhedonia),
with an average Cronbach’s alpha across all scales of .80.
The SPQ was designed with subscales that tap directly into
various DSM criteria for schizotypal personality disorder in order
to measure traits of the disorder. In the validation study (Raine,
1991) and subsequent research (Kremen, Faraone, Toomey, Seid-
man, & Tsuang, 1998), it has been shown that individuals who
score in the top 10% on the SPQ have high rates of schizotypal
personality disorder. Although initially designed to measure psy-
chosis proneness, the Chapman Psychosis Proneness Scales yield
elevated scores in individuals with schizophrenia spectrum per-
sonality disorders (Thaker, Moran, Adami, & Cassady, 1993), and
Magical Ideation and Perceptual Aberration are most strongly
associated with symptom counts of schizotypal personality disor-
der among DSM personality disorders (Meyer & Hautzinger,
Full participants, which included all control participants and
most (n ? 109) relatives, were mailed the questionnaires. Partic-
ipants completed the questionnaires at home and brought them to
the study site on the day of their participation. In order to maxi-
mize the number of participating relatives, relatives who were over
the age of 60 or unable or unwilling to come to the study site were
given the option of limited participation. Limited participants were
mailed a copy of the questionnaires. These participants mailed the
questionnaires to study offices upon completion (n ? 39).
The distributions of all variables were examined for extreme
skewness and kurtosis. A variety of transformations (logarithmic,
natural logarithmic, and square root) were performed on skewed
and kurtotic variables, and distributional properties were re-
examined. When distributional properties improved, the transfor-
mation was applied. This resulted in a natural logarithmic trans-
formation of five variables: DAPP Conduct Problems, Chapman
Magical Ideation, Chapman Social Anhedonia, Chapman Percep-
tual Aberrations, and Chapman Physical Anhedonia. Additionally,
a number of variables with restricted range of endorsement rates
were not amenable to transformations and were treated as categor-
ical in these analyses (i.e., all of the scales from the SPQ as well
as the DAPP Self-Harm scale). Missing values were estimated
using the expectation-maximization (EM) algorithm, a maximum
likelihood estimation procedure, which resulted in the data used
for the factor analysis. We conducted an exploratory factor anal-
ysis with the statistical analysis program Mplus (Muthe ´n & Mu-
the ´n, 1998–2006) using a weighted least squares mean and vari-
ance adjusted estimator.
Five factors with eigenvalues greater than 1 were extracted
(11.12, 3.50, 2.28, 1.84, and 1.41), which converged with exami-
nation of the scree plot, indicating a break after extraction of five
factors. See Table 2 for factor loadings from the five-factor struc-
ture with varimax rotation and a root-mean-square error of approx-
imation (RMSEA) of .075. This solution accounted for 65% of the
overall variance. Further, extraction of a four-factor solution
showed a poorer fit (RMSEA ? .093). Four of the factors in the
five-factor solution correspond to the four-factor structure estab-
lished for the DAPP–BQ scales (Schroeder, Wormworth, & Lives-
ley, 2002): Introversion/Inhibition, Antagonism/Dissocial, Emo-
tional Dysregulation, and Compulsivity. The fifth factor (emerging
third in the analysis), which we labeled Peculiarity, is indexed by
scales from the SPQ and Chapman measures that reflect unusual
These results support a five-factor structure of personality pa-
thology that encompasses the perceptual aberrations and cognitive
distortions characterizing Cluster A personality disorders in DSM–
IV–TR. Specifically, the common four-factor structure of person-
ality pathology established in the literature (De Clercq et al., 2006;
Livesley, 2005; Widiger & Simonsen, 2005) is replicated in these
data. However, a substantial fifth factor also emerges that seems to
dispel previous suggestions that such a factor does not fit into a
dimensional structure of personality pathology or that it might be
too small to be meaningful. Through the use of data from a unique
sample of first-degree relatives of patients who are severely dis-
ordered, a substantial five-factor model of personality pathology
emerged that provides more comprehensive coverage of existing
Axis II disorders. We believe these results provide support for a
dimensional model of personality pathology in DSM–V that might
address the numerous limitations of the current system (Widiger &
Trull, 2007) without neglecting characteristics currently codified
in the DSM–IV–TR personality disorders.
This work is consistent with structural studies of the schizotypy
construct that have differentiated negative schizotypal character-
istics (e.g., constricted affect, having few friends, anhedonia) from
positive schizotypal characteristics (e.g., unusual perceptual expe-
riences; e.g., Kerns, 2006; Reynolds, Raine, Mellingen, Venables,
& Mednick, 2000). This distinction is evidenced in the present
study by the differential loadings of the Chapman and SPQ scales
on the Introversion factor and the Peculiarity factor. An exception
is the SPQ Suspiciousness scale which loads on both factors,
consistent with other factorial work on schizotypal characteristics
(e.g., Reynolds et al., 2000). To further distinguish disorganized
schizotypal characteristics (which load with the positive schizo-
typal characteristics in the present study) may require a more
actively disordered sample, or one larger than the sample used in
this study, and represents an important area for further research.
One notable result was that the DAPP Cognitive Distortions
scale loaded on Emotional Dysregulation rather than on Peculiar-
ity. This is consistent with structural analyses of the DAPP–BQ
when the Cognitive Distortions scale is included (Livesley, Jang,
& Vernon, 1998), perhaps suggesting that the Cognitive Distor-
tions scale taps into aspects of cognitive dysregulation that are
related more strongly to emotional experiences and that are distinct
from aberrant perceptual experiences. For example, some items on
this scale inquire about behaviors such as difficulty thinking
clearly under pressure and may be heavily influenced by charac-
teristics such as anxiety proneness or stress reactivity. In addition,
other structural studies with the DAPP have been unable to include
the Cognitive Distortions scale due to low endorsement (e.g.,
Schroeder et al., 2002), which leaves some questions as to the best
way to conceptualize the scale content in a comprehensive frame-
work. Future work will be needed to clarify the relation of this
scale in a broader dimensional model of personality pathology that
also includes the Cluster A personality disorders.
An important avenue for future research is explicit integration of
the five-factor personality pathology structure presented here and
the widely used measure of normative personality traits, the FFM.
Although FFM data were not available in this sample to make such
direct comparisons, future studies should make greater efforts to
include measures of normative personality, such as the FFM, in
studies that investigate personality pathology. In particular, the
FFM has been proposed as one potential framework for revising
Axis II in DSM–V. Widiger and Simonsen (2005) offered an
integrated review of existing evidence that provides strong support
for links between the existing four-factor pathology structure as
captured by the DAPP–BQ and the first four factors of the FFM
(e.g., Neuroticism–Emotional Dysregulation, Extraversion–
Introversion, Agreeableness–Antagonism, and Conscientiousness–
Compulsivity). Explicit empirical comparisons have shown strong
converging evidence for connections between the DAPP–BQ
scales and the first four factors of the FFM, with little systematic
evidence for connections with Openness to Experience (e.g., Clark
& Livesley, 2002; Schroeder et al., 2002).
The extent to which the Peculiarity factor estimated here is
analogous to Openness to Experience or, alternatively, is better
represented as a sixth factor within the FFM structure remains to
Factor Loadings for Exploratory Factor Analysis With Varimax Rotation of Personality Pathology Scales
SPQ Constricted Affect
Excessive Social Anxiety
Ideas of Reference
Chapman Magical Ideation
Factor loadings ? .40 are in bold text. SPQ ? Schizotypal Personality Questionnaire; DAPP ? Dimensional Assessment of Personality
be empirically demonstrated. Ross, Lutz, and Bailley (2002) dem-
onstrated that the Magical Ideation and Perceptual Aberration
subscales of the Chapman scales, both of which load highly on the
Peculiarity factor in the present study, showed significant positive
correlations with Openness to Experience. Similarly, Camisa et
al.’s (2005) factor analysis of the FFM domains and a subset of the
Chapman scales found a distinct factor represented by Chapman
Magical Ideation, Chapman Perceptual Aberration, and Openness
to Experience. Taken together, these studies suggest that the ex-
panded Peculiarity factor presented here may yield similar positive
connections with Openness to Experience. However, in a recent
study with a sample of undergraduate students, Watson, Clark, and
Chmielewski (in press) found that positive schizotypy scales from
the SPQ loaded with dissociation symptoms on a factor distinct
from Openness to Experience. Thus, more work is needed to
explicate this relationship fully.
When conducting empirical demonstrations of the relationship
between Openness to Experience and Peculiarity, researchers
should be cautious about how restrictions on variance imposed by
the use of more normative samples might present misleading
results should Peculiarity and Openness to Experience emerge as
distinct factors. In future studies, efforts should be made to engage
samples with the potential for increased variance in Cluster A
characteristics, as we did with the sample used in the present study.
Similarly, previous research has shown that manipulations of items
in the Openness to Experience domain that are specifically written
to capture maladaptive variants of this domain show stronger links
to Cluster A symptoms (Haigler & Widiger, 2001). Thus, those
researching such investigations should use broader measures of the
Openness to Experience domain that may increase the potential for
links with relevant personality disorder constructs.
In summary, these results provide preliminary support for in-
clusion of additional scales in a dimensional measure of person-
ality pathology. The use of first-degree relatives of patients with
schizophrenia, schizoaffective, or bipolar disorder strengthens our
ability to identify the five-factor structure pertinent to important
elements of severe psychopathology that may have been under-
represented in previous analyses of dimensional psychopathology.
An alternative suggestion to the incorporation of such character-
istics in a dimensional model of personality disorder is to consider
them variants of schizophrenia, similar to the approach taken by
the World Health Organization (First et al., 2002). We feel that
these results suggest an important place for characteristics related
to perceptual aberrations in the broader domain of personality
pathology (Widiger & Simonsen, 2005). Future research could
extend this work to specific clinical populations (e.g., individuals
with schizophrenia spectrum disorders) to determine whether the
fifth factor accounts for meaningful variance in individuals who
are actively disordered. Further, there is a need for such a dimen-
sional model to demonstrate clinical utility and feasibility of
implementation in future work. However, this study builds on the
growing consensus that a dimensional model of personality pa-
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Received June 18, 2007
Revision received October 22, 2007
Accepted October 30, 2007 ?
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