Toward an Empirically Based Classification of Personality Pathology

University of Colorado at Boulder, Boulder, Colorado, United States
Clinical Psychology Science and Practice (Impact Factor: 2.92). 05/2007; 14(2):77 - 93. DOI: 10.1111/j.1468-2850.2007.00065.x


A number of investigations have utilized factor analysis or similar data analytic methods to examine the empirical validity of the Diagnostic and Statistical Manual of Mental Disorders classification system of Axis II personality pathology. This article reviews analyses of the Axis II cluster structure and the latent structure of individual personality disorder criteria. Overall, these studies do not provide sound empirical support for the current personality disorder organization described in the Diagnostic and Statistical Manual of Mental Disorders. They highlight the need for identifying the latent dimensions of personality pathology in order to create a different representation that would more accurately correspond to both a theoretical and functional model of personality disorder. Preliminary research identifying consensus across datasets is summarized. Clinical implications of these findings and future directions for research on personality pathology are discussed.

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    • "These studies have used both CFA and EFA and have varied considerably in terms of the basic unit of analysis (e.g., individual PD criteria or dimensional PD scores), the assessment method (e.g., self-or clinician report), the sample type (e.g., community or clinical sample), and the statistical procedures (e.g., parallel analysis or scree test in EFA). A comprehensive summary of the findings is clearly beyond the scope of this chapter (see e.g., Mulder, Newton-Howes, Crawford, & Tyrer, 2011; Sheets & Craighead, 2007). However, several issues seem noteworthy here: First, studies focusing on PD diagnoses as the basic unit of analysis (i.e., either the presence or absence of diagnoses, or the number of criteria fulfilled) have failed to find strong support for the assumption that the pattern of covariation can be explained by three (correlated) latent dimensions representing the higher-order clusters of oddeccentric , dramatic-emotional, and anxious-fearful disturbances. "
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    ABSTRACT: Rigorous science and effective treatment both rest on a foundation of valid and reliable assessment and diagnosis. In the consulting room, assessment and diagnosis should provide useful information for clear communication among professionals and to patients, establishing prognosis and ultimately deciding whether, and if so how, to treat. In the laboratory, assessment and diagnosis are necessary to decide which participants to include and exclude from studies, while also providing data of interest to examine as predictors and outcomes. In turn, assessment and diagnosis are predicated on the understanding of the nature and structure of the target phenomenon, in this case personality disorder (PD). Thoroughly and accurately assessing and diagnosing PD can be a demanding enterprise. Patients with severe PDs often lead chaotic lives and have a fragmented or diffuse sense-of-self that can become embodied in a frenzied assessment process and a muddled clinical picture. In contrast, milder but nevertheless impairing personality pathology often becomes apparent only as a clinician learns the patient’s characteristic manner of perceiving and responding to others, and set ways of regulating self and affect. These difficulties in the assessment process are understandable and to be expected given the nature of the pathology. However, a further challenge to this enterprise is that the current diagnostic framework more often than not serves to obfuscate as opposed to clarify clinical description. For more than 30 years, the modern era of the Diagnostic and Statistical Manual of Mental Disorders (DSM; APA, 2013) has furthered a model of personality pathology in which patients can receive one of ten putatively discrete, categorical PD diagnoses, or a diagnosis of PD not otherwise specified (PD-NOS). Despite a growing body of scientific work that calls its fundamental structure in to question (Widiger & Trull, 2007), this remains the model for the foreseeable future as it has been ported virtually verbatim from DSM-IV to DSM-5. Here we highlight a number of key questions that emerge when the extant PD model is applied in clinical practice, and demonstrate how they are directly amenable to investigation using contemporary quantitative methodology.
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    • "The IPDE (World Health Organization, 1996) is a 99-item semistructured clinical interview that produces both dimensional and categorical scores for the DSM-IV personality disorders. Due to inconsistent empirical support for the DSM-IV Axis II structure (Sheets & Craighead, 2007), the present study focused on the total dimensional score of personality pathology, rather than cluster or disorder specific scores. Twenty percent of the interviews from the larger project were assessed for inter-rater reliability across six interviewers. "
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    ABSTRACT: Understanding how persistent interpersonal difficulties distinctly affect the course of major depressive disorder (MDD) during emerging adulthood is critical, given that early experiences impact future coping resources and functioning. Research on stress and MDD has mostly concentrated on stressful life events, while chronic stress largely has not been explored. The present study examined interpersonal (intimate relationship, close friendships, social life, family relationships) and noninterpersonal (academic, work, financial, personal health, and family members' health) domains of chronic stress as time-varying predictors of depressive recurrence in emerging adults. Baseline assessments identified previously depressed emerging adults (N = 119), who subsequently completed 6-month, 12-month and 18-month follow-up interviews to determine chronic stress experiences and onset of new major depressive episodes. Survival analyses indicated that time-varying total chronic stress and chronic interpersonal stress predicted higher risk for depression recurrence; however, chronic noninterpersonal stress was not associated with recurrence. Intimate relationship stress, close friendship stress, family relationship stress, personal health, and family members' health independently predicted MDD recurrence, over and above well-established depression risk factors of dysfunctional cognitions and personality disorder symptoms. Evidence that interpersonal stress could have substantial impact on course of depression is consistent with theories of emerging adulthood, a time when young people are individuating from the family and experiencing significant social transition.
    Full-text · Article · Dec 2014 · Behaviour Research and Therapy
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    • "Research on the empirical structure of pathological personality trait dimensions (PPTDs) has identified four broad domains appearing with reasonable consistency in cross-sectional studies. They include: (a) negative emotionality or emotional dysregulation, (b) introversion or detachment, (c) antagonism, and (d) disinhibition (Krueger et al. 2011; Livesley 2007; Sheets and Craighead 2007; Widiger and Simonsen 2005). Many studies (e.g., Tackett et al. 2008), and meta-analyses (e.g., O'Connor 2005), have identified these same domains that purportedly tap the core traits underlying pathological personality functioning through structural analysis of numerous self-rated pathological personality inventories. "
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    ABSTRACT: This study explores longitudinally a four-factor structure of pathological personality trait dimensions (PPTDs) to examine both its structural stability and intra-individual changes among PPTDs over time. Personality Disorder (PD) scales of the Millon Clinical Multiaxial Inventory-III were administered to 361 low-income women with various psychiatric conditions (drug dependence, depression), who were followed in a two-wave study over 5-years. Cross-sectional and longitudinal factor analyses outlined a robust factorial structure of PPTDs, extrinsically invariant over time, representing Negative Emotionality, Introversion, Antagonism and Impulsivity. Despite moderate rank-order stability in the PPTDs, results also indicated substantial intra-individual variability in the degree and direction of change, consistent with trajectories of change in participants' clinical diagnoses. Results are discussed in light of current debates on the structure and dynamic of pathological personality.
    Full-text · Article · Jun 2013 · Journal of Psychopathology and Behavioral Assessment
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