Five factor model personality disorder research

Abstract

The purpose of this chapter is to provide a summary of the FFM of personality disorder research. Widiger and Costa (2002) provided a summary of this research in the prior edition of this text (Chapter 6 of the second edition). They listed and summarized 56 studies concerned specifically with the relationship of the FFM to personality disorder symptomatology. At the time, 56 was a substantial number, at least in comparison with the research concerning the alternative dimensional models. For the current chapter, we attempted to again compile a comprehensive list of all FFM personality disorder studies but gave up after a few months, as it became apparent that the reference list alone would be longer than the space limitations of this chapter. We quit after identifying well over 200 studies.

Full text

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CHAPTER SIX
Five Factor Model Personality Disorder Research
Thomas A. Widiger
Department of Psychology
University of Kentucky
Paul T. Costa, Jr.
Department of Mental Heath
Johns Hopkins Bloomberg School of Public Health
Whitney L. Gore and Cristina Crego
Department of Psychology
University of Kentucky
Authors’ notes: Address correspondence concerning this chapter to Thomas A. Widiger, Ph.D.,
115 Kastle Hall, University of Kentucky, Lexington, KY, 40506-0044; widiger@uky.edu.

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FFM Personality Disorder Research
The question of whether personality disorders are discrete clinical conditions or arbitrary
distinctions along dimensions of general personality functioning has been a longstanding issue
(Widiger & Simonsen, 2005-b). The third edition of the American Psychiatric Association’s
(APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-III; APA, 1980) was quite
innovative in many respects but it continued to diagnose personality disorders categorically
despite the improvements in validity and clinical utility that would be obtained through a
dimensional model of classification (Cloninger, 1987; Frances, 1982; Livesley, 1985; Widiger &
Frances, 1985). The authors of the revised, third edition of the APA diagnostic manual
attempted to address some of the problems inherent to the categorical model by using
polythetic criterion sets in which multiple diagnostic criteria are provided, only a subset of which
would be necessary for the diagnosis (Widiger, Frances, Spitzer, & Williams, 1988). Compelling
proposals for a more fundamental shift in how personality disorders are classified and
diagnosed, however, continued to be made (Clark, 1992; Cloninger, Svrakic, & Przybeck, 1993;
Widiger, 1993).
The first research planning conference for the forthcoming DSM-5 (Kupfer, First, & Regier,
2002) included a work group whose task was to lay the conceptual groundwork for the eventual
development of a dimensional model of personality disorder (First et al., 2002). The members of
this work group focused in particular on the four dimensional model of the Dimensional
Assessment of Personality Psychopathology - Basic Questionnaire (DAPP-BQ; Livesley &
Jackson, 2009), the three dimensional model of the Schedule for Nonadaptive and Adaptive
Personality (SNAP; Clark, 1993), the seven dimensional model of the Temperament and
Character Inventory (TCI; Cloninger, 2006), and the five factor model (FFM; McCrae & Costa,
2003). In a subsequent DSM-5 research planning conference devoted to shifting the personality

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towards toward a dimensional classification, Widiger and Simonsen (2005-a) identified eighteen
alternative ways in which the DSM-IV-TR (APA, 2000) personality disorders could be
conceptualized dimensionally. They proposed a four dimensional model in an effort to find a
common ground among the major alternatives. This model consisted of emotional dysregulation
versus emotional stability, extraversion versus introversion, antagonism versus compliance, and
constraint versus impulsivity. Included within each domain were the normal and abnormal trait
scales from existing alternative models.
Widiger and Simonsen (2005-a) suggested though that a fifth broad domain,
unconventionality versus closed to experience, would also be necessary to fully account for all
of the maladaptive trait scales included within the alternative dimensional models. This fifth
domain was not included within their common model because it was missing from the
predominant alternatives; more specifically, the four factor model of Livesley (2007) and the
three factor model of Clark (1993; Clark & Watson, 2008). A domain of unconventionality versus
closedness to experience though was included within the FFM as maladaptive variants of
openness versus closedness to experience (Widiger, Costa, & McCrae, 2002; Widiger &
Mullins-Sweatt, 2009). The latest version of the proposed dimensional model of personality
disorder for DSM-5 now includes this fifth domain (Krueger et al., 2011), albeit it is quite
possible that the final version will not be commensurate with the current version.
In her authoritative Annual Review of Clinical Psychology article devoted to the assessment
and classification of personality disorder, Clark (2007) suggested that there were three primary
alternatives: the FFM (Widiger & Trull, 2007), the TCI (Cloninger, 2006), and the factor structure
derived from the Shedler-Westen Assessment Procedure-200 (SWAP-200; Shedler & Westen,
2004). She concluded that the FFM had the strongest conceptual and empirical support. As she
indicated, "the five-factor model of personality is widely accepted as representing the higher-
order structure of both normal and abnormal personality traits" (Clark, 2007, p. 246).

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The purpose of this chapter is to provide a summary of the FFM of personality disorder
research. Widiger and Costa (2002) provided a summary of this research in the prior edition of
this text. They listed and summarized 56 studies concerned specifically with the relationship of
the FFM to personality disorder symptomatology. At the time, 56 studies was a substantial
number, at least in comparison to the research concerning the alternative dimensional models.
We attempted to again compile a comprehensive list of all FFM personality disorder studies, but
gave up after a few months, as it became apparent that the reference list alone would be longer
than the space limitations of this chapter. We quit after identifying well over 200 studies.
We will instead cover within this chapter studies concerned with some of the central topics or
issues concerning the FFM of personality disorder, as well as emphasizing studies that have
been published since the prior review (Widiger & Costa, 2002). We also attempt to avoid
overlap with other chapters within this text. So, for example, covered elsewhere within this book
will be the extensive FFM research concerning psychopathy (see Chapter 7 by Derefinko and
Lynam), borderline (see Chapter 8 by Trull and Brown), schizotypy (see Chapter 10 by
Edmunson and Kwapil), dependency (see Chapter 11 by Gore and Pincus), and narcissisism
(see Chapter 9 by Campbell and Miller). Also covered elsewhere is the considerable body of
research concerning the clinical utility of the FFM (see Chapter 20 by Mullins-Sweatt), FFM
prototype matching (see Chapter 17 by Miller), informant assessments (see Chapter 16 by
Oltmanns & Carlson) and childhood antecedents (see Chapter 4 by De Fruyt and De Clerq).
FFM Coverage of Alternative Trait Models
One of the strengths of the FFM is its robustness (Widiger & Costa, in press). "Personality
psychology has been long beset by a chaotic plethora of personality constructs that sometimes
differ in label while measuring nearly the same thing, and sometimes have the same label while
measuring very different things" (Funder, 2001, p. 2000). "One of the great strengths of the Big
Five taxonomy is that it can capture, at a broad level of abstraction, the commonalities among

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most of the existing systems of personality traits, thus providing an integrative descriptive
model" (John et al., 2008, p.139). Literature reviews of vast sets of personality trait research are
often organized with respect to the FFM, reflecting its coherence and comprehensiveness.
Examples include the trait literature concerning temperament (Shiner & Caspi, 2003), temporal
stability (Roberts & Del Vecchio, 2000), gender (Feingold, 1994), health psychology
(Segerstrom, 2000), positive and negative life outcomes (Ozer & Benet-Martinez, 2006), and
even animal species behavior (Weinstein, Capitano, & Gosling, 2008).
The “first wave” of FFM personality disorder research (Widiger & Costa, 2002) was devoted
largely to demonstrating empirically this robustness. Costa, McCrae, and their colleagues
conducted a substantial number of studies indicating how the FFM can account for constructs
contained within alternative models of personality, including (but not limited to) the constructs of
the interpersonal circumplex (McCrae & Costa, 1989-b), Henry Murray's 20 need dispositions
(Costa & McCrae, 1988), the California Psychological Inventory (McCrae, Costa, & Piedmont,
1993), the Myers-Briggs Type Indicator (McCrae & Costa, 1989-b), the MMPI (Costa,
Zonderman, McCrae, & Williams, 1985) and many others. Resistance to the FFM was perhaps
futile, as all major instruments were eventually assimilated.
This initial research is traditionally classified as studies of normal personality. However, the
results of much of this research are quite relevant to the question of the extent to which the FFM
accounts for personality disorder symptomatology, as most of the instruments and scales they
investigated have been and continue to be used within clinical populations to assess
maladaptive personality traits. For example, McCrae, Costa, and Busch (1986) demonstrated
how the 100 items within the California Q-Set (CQS; Block, 2008) could be readily understood
from the perspective of the FFM. The CQS items were developed by successive panels of
psychodynamically-oriented clinical psychologists seeking a common language. A factor
analysis of the complete set of items yielded five factors that corresponded closely to the FFM.

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For example, the neuroticism factor contrasted such CQS items as "thin-skinned,"
"extrapunitive," and "brittle ego defenses," with "socially poised" and "calm, relaxed;"
extraversion contrasted such items as "talkative," "behaves assertively," and "self-dramatizing,"
with "avoids close relationships" and "emotionally bland;" openness contrasted "values
intellectual matters," "rebellious nonconforming," "unusual thought processes," and "engages in
fantasy, daydreams," with "moralistic," "uncomfortable with complexities," and "favors
conservative values;" agreeableness contrasted "behaves in giving way" and "warm,
compassionate, with "basically distrustful," "expresses hostility directly," and "critical, skeptical;"
and conscientiousness contrasted "dependable, responsible" and "has high aspiration level"
with "self-indulgent," and "unable to delay gratification." Support for their interpretation of these
factors was obtained from convergent and discriminant correlations with self and peer NEO
Personality Inventory scales (Costa & McCrae, 1992). The results of their study demonstrated
well a close correspondence of a sophisticated psychodynamic nomenclature with the FFM. The
CQS "represents a distillation of clinical insights, and the fact that very similar factors can be
found in it provides striking support for the five-factor model" (McCrae et al., 1986, p. 442).
Mullins-Sweatt and Widiger (2007-b) reported similar results for the SWAP-200, a
psychodynamically-oriented clinician Q-set rating form comparable to the CQS (Shedler &
Westen, 2004). They had persons with significant personality problems described in terms of
the SWAP-200 and the FFM. They reported close convergence of the FFM and SWAP-200
descriptions, both with respect to personality disorder scales (e.g., SWAP-200 and FFM
borderline personality scales) and trait scales (e.g., SWAP-200 Dysphoria and NEO PI-R
Neuroticisim). There were a few SWAP-200 trait scales that were unrelated to the FFM, such as
Oedipal Conflict (e.g., sexual involvement with persons significantly different in age) and Sexual
Conflict (e.g., premature ejaculation or inhibited orgasm). These negative results might have
reflected inadequate range within their sample and/or the possibility that these particular SWAP-

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200 scales are assessing constructs that do indeed lie outside of general personality structure.
On the basis of their research, Mullins-Sweatt and Widiger (2008) subsequently reported how
SWAP-200 items can be used to assess the FFM.
O'Connor (2002) conducted integrative factor analyses with previously published findings in
approximately 75 studies involving FFM variables and the scales of 28 popular and commonly
used personality inventories. He concluded that "the factor structures that exist in the scales of
many popular inventories can be closely replicated using data derived solely from the scale
associations with the FFM" (O'Connor, 2002, p. 198). O'Connor (2002) further suggested that
"the basic dimensions that exist in other personality inventories can thus be considered 'well
captured' by the FFM" (p. 198).
FFM Descriptions of Personality Disorders
Widiger, Trull, Clarkin, Sanderson, and Costa (2002) provided a hypothetical translation of
the 10 DSM-IV-TR personality disorders into the language of the FFM by coding each of the
diagnostic criteria and DSM-IV-TR text descriptions of each respective personality disorder in
terms of the 60 poles of the 30 facets of the FFM. Lynam and Widiger (2001) surveyed
personality disorder researchers, asking them to describe a prototypic case of each of the 10
DSM-IV-TR personality disorders in terms of the FFM, using a one-page rating form that
eventually became the Five-Factor Model Rating Form (FFMRF; Mullins-Sweatt, Jamerson,
Samuel, Olson, & Widiger, 2006). Samuel and Widiger (2004) surveyed practicing clinicians and
similarly asked them to describe a prototypic case of each of the 10 DSM-IV-TR personality
disorders, again using the FFMRF.
The agreement between the researchers’ and clinicians’ FFM descriptions was considerable,
ranging from .90 (dependent) to .97 (antisocial). The agreement of the researchers’ and
clinicians’ FFM descriptions with those of Widiger, Trull, et al. (2002) were in all cases
significant but not as strong as the agreement between the researchers’ and clinicians’

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descriptions. For example, the agreement between the descriptions by the researchers with
Widiger et al. ranged from .77 (antisocial) to .83 (avoidant) for 6 of the personality disorders,
and .54 (narcissistic) to .58 (obsessive-compulsive) for the remaining four.
Table 1 provides an integrative summary of these FFM descriptions. It is apparent from
Table 1 that each of the DSM-IV-TR (APA, 2000) personality disorders is well described in
terms of the FFM. The FFM has the withdrawal evident in both the avoidant and schizoid
personality disorders (see facets of introversion), but also the anxiousness and self-
consciousness that distinguishes the avoidant from the schizoid (see facets of neuroticism), as
well as the anhedonia (low positive emotions) that distinguishes the schizoid from the avoidant
(Widiger, 2001). The FFM has the intense attachment needs (high warmth of extraversion), the
deference, gullibility, selfless self-sacrifice, and meekness (faces of agreeableness), and the
self-conscious anxiousness of the dependent personality disorder (Lowe, Edmundson, &
Widiger, 2009); the perfectionism and workaholism of the obsessive-compulsive (high
conscientiousness; Samuel & Widiger, 2011); and the fragile vulnerability and emotional
dysregulation of the borderline (Widiger, 2005).
The deviation of the descriptions by Widiger, Trull, et al. (2002) with the researchers’ and
clinicians’ descriptions is due largely to the fact that the former was confined to a coding of the
DSM-IV-TR diagnostic criterion sets and text descriptions. It is evident that researchers and
clinicians will not always be in agreement with the APA diagnostic manual with respect to how a
personality disorder should be described. For example, the greatest degree of disagreement
occurred between the researchers’ and the DSM-IV-TR description of narcissistic personality
disorder (NPD). Widiger, Trull, et al. (2002) described the prototypic case of NPD as involving
high levels of self-consciousness and vulnerability (reflecting the references in the text of DSM-
IV-TR to extreme sensitivity to criticism, rebuke, or failure), whereas the researchers described
the prototypic case as being low in self-consciousness and vulnerability (reflecting perhaps their

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emphasis on grandiose rather than vulnerable narcissism; Miller, Widiger, & Campbell, 2010).
The descriptions by the researchers and the clinicians were generally broader, not being
limited by the DSM-IV-TR criterion sets and text. Their FFM descriptions included what is
contained in the DSM-IV-TR but went further to provide fuller, more comprehensive descriptions
(Widiger & Mullins-Sweatt, 2009). For example, the researchers’ descriptions of a prototypic
case of obsessive-compulsive personality disorder (OCPD) went beyond the DSM-IV-TR
criterion set to include traits that describe an excessive inhibition (e.g., extremely low on
excitement-seeking) and a narrow closed-mindedness (low scores on openness to values). Both
FFM profiles described the paranoid person as being very high in mistrust, as well as deceptive,
oppositional, and hostile, but the clinicians’ FFM description went beyond the DSM-IV-TR to
include low positive emotionality, low openness to values, high anxiousness, low warmth, low
gregariousness, low altruism, and low tender mindedness.
The FFM includes the traits of DSM-IV-TR antisocial personality disorder (deception,
exploitation, aggression, irresponsibility, negligence, rashness, angry hostility, impulsivity,
excitement-seeking, and assertiveness; see Table 1), and goes beyond DSM-IV-TR to include
traits that are unique to the widely popular Psychopathy Checklist-Revised (PCL-R; Hare &
Neumann 2008), such as glib charm (low self-consciousness), arrogance (low modesty), and
lack of empathy (tough-minded callousness) and goes even further to include traits of
psychopathy emphasized originally by Cleckley (1941) but not included in either the DSM-IV-TR
or the PCL-R, such as low vulnerability (fearlessness) and low anxiousness (Hare & Neumann,
2008; Hicklin & Widiger, 2005; Lynam & Widiger, 2007-a).
The FFM descriptions of each respective personality disorder also go well beyond the trait
descriptions that may be provided for DSM-5 (APA, 2011). For example, the proposed criterion
set for DSM-5 obsessive-compulsive personality disorder is confined simply to the traits of rigid
perfectionism and perseveration, narcissistic is confined to grandiosity and attention-seeking,

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dependent to just submissiveness, anxiousness, and separation insecurity, and avoidant to just
anxiousness, intimacy avoidance, withdrawal, and anhedonia (APA, 2011). This is due in large
part to their list being confined to an arbitrary maximum of just 25 total traits. There are clearly
substantially more maladaptive personality traits beyond the 25 proposed for DSM-5 (albeit that
list may indeed expand prior to the final decision). Further discussion of the FFM descriptions of
the borderline, antisocial (psychopathic), narcissistic, dependent, and schizotypal personality
disorders are provided (respectively) in the chapters by Trull and Brown (Chapter 8), Derefinko
and Lynam (Chapter 7), Campbell and Miller (Chapter 9), Gore and Pincus (Chapter 11), and
Edmundson and Kwapil (Chapter 10).
An advantage of the FFM of personality disorder relative to the DSM-IV-TR is its ability to
provide a means of describing personality disorder constructs not recognized within the official
APA nomenclature (Piedmont, Sherman, Sherman, Dy-Liacco, & Williams, 2009).. There were
proposals for DSM-IV to include such constructs as depressive personality disorder and
alexithymia. However, any increase in coverage would exacerbate diagnostic co-occurrence
and make an already highly problematic differential diagnosis even worse. Therefore, there was
little enthusiasm to include any new diagnoses (Pincus, Frances, Davis, First, & Widiger, 1992).
Nevertheless, a complementary limitation of the DSM-IV-TR has been its lack of coverage
(Westen & Arkowitz-Westen, 1998). The diagnosis of personality disorder not otherwise
specified (PDNOS) is provided when a clinician concludes that a personality disorder is indeed
present but is not well described by one of the existing categories. The fact that PDNOS is
among the most frequent diagnoses in clinical practice is a testament to a failure of the
diagnostic manual to provide adequate coverage (Verheul & Widiger, 2004).
This failing will be much worse in DSM-5. It is not clear what personality disorder diagnoses
will in fact survive (see Chapter 19 by Widiger, Costa, and McCrae). The FFM is considerably
more stable, as well as more comprehensive in its coverage. For example, Luminet, Bagby,

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Wagner, Taylor, and Parker (1999) and Zimmerman, Rossier, de Stadelhofen, and Gaillard
(2005) indicate how alexithymia can be understood from the perspective of the FFM. Flynn
(2005) describes how close-minded prejudice and racism can be understood from the
perspective of the FFM. Taylor and Bagby (Chapter 13) provide a thorough review of the
research on the FFM conceptualization of alexithymia.
Vachon, Sellbom, Ryder, Miller, and Bagby (2009), following the methodology of Lynam and
Widiger (2001), asked personality disorder experts to describe a prototypic case of depressive
personality disorder in terms of the 30 facets of the FFM using the FFMRF (Mullins-Sweatt et
al., 2006). Their description converged onto an FFM profile consisting of high depressiveness,
anxiousness, vulnerability, and modesty, along with low activity, excitement-seeking, and
positive emotions. Vachon et al. indicated how this profile can be used to identify persons within
clinical practice that match the profile, and how the profile can itself be used to conduct research
on the hypothesized syndrome of depressive personality disorder. See the chapter by Bagby
and Taylor (Chapter 12) for a further discussion of and research concerning depressive
personality disorder from the perspective of the FFM.
Mullins-Sweatt, Glover, Derefinko, Miller, and Widiger (2010) obtained a consensus
description of a prototypic successful psychopath. Successful psychopaths are, in theory,
individuals who are psychopathic, having certain fundamental traits (e.g., callousness,
exploitativeness, glib charm, and deceptive manipulation), but largely succeed in their
exploitation. Psychopathy theorists have long made anecdotal references to psychopathic
lawyers, professors, businessmen, and politicians who have not committed crimes that
warranted arrest or have successfully avoided investigation. However, obtaining any useful
sample of “successful psychopaths” has eluded investigators (Hall & Benning, 2006). Mullins-
Sweatt et al. surveyed criminal lawyers, forensic psychologists, and clinical psychology
professors, asking them if they had ever known someone personally that they would describe as

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a psychopath whom they also felt had been successful in his or her psychopathic endeavors.
Their descriptions were highly convergent with each other, but a notable difference between the
description of the successful psychopath from the prototypic psychopath was that the former
was characterized by high levels of conscientiousness, whereas the latter by low levels. This
finding is consistent with an earlier description of the serial murderer Ted Bundy who is often
described as being psychopathic. His FFM profile is also characterized by high rather than low
conscientiousness (Samuel & Widiger, 2006), perhaps contributing to his many years
successfully avoiding capture and incarceration. These findings are also commensurate with a
considerable body of literature that documents the importance of conscientiousness to a variety
of positive life outcomes and low conscientious to negative life outcomes, such as arrest record
(e.g., Ozer & Benet-Martinez, 2006). Mullins-Sweatt et al. demonstrates the value of a
descriptive model that includes adaptive, as well as maladaptive, traits, thereby providing the
means of describing both the successful and the unsuccessful psychopath within the same
descriptive system.
Empirical Support for FFM Descriptions
Quite a bit of the FFM personality disorder research has been concerned with the extent to
which personality disorder sympomatology can be understood as maladaptive and/or extreme
variants of the FFM (e.g., Madsen, Parsons, & Grubin, 2006; Nestadt et al., 2008; Rolland & de
Fruyt, 2003), often relative to an alternative dimensional model (e.g., Gaughan, Miller, Pryor, &
Lynam, 2009; Mullins-Sweatt & Widiger, 2007-a; Quirk, Christiansen, Wagner, & McNulty, 2003;
Ramanaiah, Rielage, & Cheng, 2002; Reynolds & Clark, 2001; Stepp, Trull, Burr, Wolftenstein,
& Vieth, 2005). Many of these studies test in particular the validity of the specific FFM
descriptions that have been proposed for each personality disorder (e.g., Aluja, Cuevas,
Garcia, & Garcia, 2007; Bagby, Sellbom, Costa, & Widiger, 2008; Bagby et al., 2005; De Fruyt,
De Clercq, van de Wiele, & Van Heeringen, 2006; Few et al., 2010; Furnham & Crump, 2005;

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Huprich, 2003; Rossier & Rigozzi, 2008; Trull, Widiger, & Burr, 2001).
Wiggins and Pincus (1989) provided the first published study concerned explicitly with the
empirical relationship of the FFM to personality disorder symptomatology, conducing joint factor
analyses of measures of the FFM, the interpersonal circumplex, and DSM personality disorders
(DSM refers to the diagnostic manual, in general, unless a given edition is specified). They
concluded that "conceptions of personality disorders were strongly and clearly related to
dimensions of normal personality traits" (Wiggins & Pincus, 1989, p. 305), including (but not
limited to) a close relationship of schizotypal symptomatology with openness; dependent with
agreeableness; antisocial, paranoid, and narcissistic with antagonism; borderline with
neuroticism; histrionic and narcissistic with extraversion; schizoid with introversion, and
compulsive with conscientiousness. Although the interpersonal circumplex was able to provide a
meaningful and informative understanding of a subset of the personality disorders, Wiggins and
Pincus (1989) reached the conclusion that "the full 5-factor model was required to capture and
clarify the entire range of personality disorders" (p. 305).
Trull (1992) provided the first study to include the administration of measures of the FFM and
personality disorder symptomatology within a clinical sample. He administered the NEO-PI
(Costa & McCrae, 1992) and three independent measures of the DSM-III-R personality
disorders. He concluded, “the FFM appears to be useful in conceptualizing and differentiating
among the DSM-III-R personality disorders” (Trull, 1992, p. 557), with some findings replicating
“across all three personality disorder assessment instruments” (p. 557).
Saulsman and Page (2004) conducted a meta-analysis of twelve studies containing a total of
15 independent samples that related a measure of the five FFM domains with the ten DSM
personality disorders. They concluded that the “results of this meta-analysis are consistent with
the view that personality disorders can be conceptualized using the five-factor model of normal
personality” (Saulsman and Page, 2004, p. 1075). Saulsman and Page considered the specific

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descriptions of each personality disorder in terms of the FFM and reached the conclusion that
“the five-factor model is related to each individual personality disorder category in meaningful
and predictable ways” (p. 1081).
O'Connor (2005) conducted a similar investigation into the combined structure of the FFM
and the DSM personality disorders using interbattery factor analysis. Interbattery factor analysis
is useful because “it permits factor analyses to be conducted on the associations between two
sets of variables (such as the FFM and the personality disorders), while excluding the
covariation that is contained in the within-set data (such as the intercorrelation between
personality disorders)” (p. 326). O'Connor first calculated the consensus factor structure of the
DSM personality disorders based on 33 studies which had reported their 10×10 correlation
matrix. He then calculated the consensus factor structure using 20 matrices that reported
correlations between the DSM personality disorders and the five domains of the FFM. The
results of these procedures indicated that a four-factor structure (the domain of openness did
not appear to be well represented) provided the best fit for both analyses. O'Connor (2005)
concluded that “the dimensions that underlie personality disorders can be understood by
reference to dimensions that have emerged from research on normal personality” (p. 340).
Bastiaansen, Rossi, Schotte, and De Fruyt (2011) tested alternative structures of the DSM-
IV-TR personality disorders suggested by the three cluster arrangement within the diagnostic
manual (APA, 2000) versus a structure suggested by the FFM, using structural equation
modeling in a sample of 1,688 participants (1,029 of whom were clinical participants). There
was substantially better support for the FFM structure, including conscientiousness defined by
OCPD and extraversion by the histrionic personality disorder.
A potential limitation of the meta-analyses of O’Connor (2005) and Saulsman and Page
(2004) was that they were confined to analyses at the broad domain level. Some personality
disorders are hypothesized to be associated with the same domain (e.g., schizotypal and

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avoidant with low extraversion) but for largely different reasons (schizotypal and avoidant
sharing the facet of low gregariousness but schizotypal being associated with low warmth and
low positive emotions, and avoidant being associated with low assertiveness and low
excitement seeking; see Table 1). In addition, some personality disorders are predicted to be
associated with only one or two facets of a particular domain (e.g., schizotypal with the facet of
low trust from agreeableness and narcissism with high achievement striving from
conscientiousness; see Table 1). These more specific aspects of a respective personality
disorder would be missed by an analysis confined to the domains of the FFM, yet they can be
quite important and fundamental to the description or understanding of a respective personality
disorder.
Markon, Krueger, and Watson (2005) conducted meta-analytic as well as exploratory
hierarchical factor analyses at the facet level of numerous measures of normal and abnormal
personality functioning, including (for instance) the DAPP-BQ (Livesley & Jackson, 2009), the
SNAP (Clark, 1993), and the NEO PI-R (Costa & McCrae, 1992). Their results consistently
yielded a five factor solution that they indicated "strongly resembles the Big Five factor structure
commonly described in the literature, including Neuroticism, Agreeableness, Extraversion,
Conscientiousness, and Openness factors" (McCrae et al., 2005, p. 144). They considered this
five-factor solution to be preferable to all other factor solutions, and concluded that their “results
indicate that the Big Five traits occupy an important, unique position in the hierarchy, in that the
other Big Trait models can be derived from the Big Five in some way” (p. 154).
Samuel and Widiger (2008-b) replicated and extended the meta-analysis of Saulsman and
Page (2004) with studies that administered a measure of the FFM that included facet scale
analyses; more specifically, the NEO PI-R (Costa & McCrae, 1992), the Structured Interview for
the Five Factor Model (SIFFM; Trull, Widiger, & Burr, 2001), or the FFMRF (Mullins-Sweatt et
la., 2006). They obtained FFM facet correlations with the 10 DSM-IV-TR personality disorders

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from 16 studies that contained a total of 18 independent samples with a combined 3,207
participants (only one study was previously reported in Saulsman & Page). Some studies
reported results for more than one measure, yielding thereby a total of 38 correlation matrices.
The results of this meta-analysis provided strong support for the ability of the FFM to account for
the DSM-IV-TR personality disorders. With respect to the specific FFM profiles obtained from
researchers and clinicians, the empirical results correlated with these profiles from a low of .60
for the dependent personality disorder with that of Lynam and Widiger (2001) to a high of .92 for
the obsessive–compulsive prototype with that of Samuel and Widiger (2004). One of the more
important results from their meta-analysis though was strong instrument effects, particularly for
the relationship of conscientiousness to OCPD, openness to schizotypal personality disorder,
and extraversion with histrionic personality disorder. The implicaton of these findings will be
discussed further below.
Samuel, Simms, Clark, Livesley, and Widiger (2010) demonstrated empirically through item
response theory analysis that the maladaptive personality trait scales of the DAPP-BQ (Livesley
& Jackson, 2009) and the SNAP (Clark, 1993) lie along the same latent traits as those assessed
by the NEO PI-R (Costa & McCrae, 1992), the primary distinction being that the DAPP-BQ and
SNAP scales have relatively greater fidelity for the assessment of the (maladaptively) extreme
variants of FFM traits, whereas the NEO PI-R has relatively greater fidelity for the more normal
variants. However, it was also evident from this study that there is considerably more overlap
among the scales than differences, due in part to the fact that the NEO PI-R does assess a
considerable amount of maladaptivity with respect to high neuroticism, introversion, low
openness, antagonism, and low conscientiousness. Samuel, Caroll, Rounsaville, and Ball (in
press) extended this research to focus specifically on the DSM-IV-TR borderline personality
disorder symptomatology. They indicated that the borderline symptoms (e.g., recurrent
suicidality) lie along the same latent trait as FFM neuroticism, have relatively greater fidelity for

17
the assessment of the (maladaptively) extreme variants of neuroticism, whereas the NEO PI-R
has relatively greater fidelity for the more normal variants.
FFM and DSM-5 Dimensional Trait Model
It is not really clear what the personality disorders section of DSM-5 will contain, or even if
there will in fact be a section for personality disorders (Siever, 2011). Nevertheless, it is evident
that if DSM-5 does still include personality disorders, there will be a significant shift toward a
dimensional classification and the FFM in particular. This would be evident through the inclusion
of a 5 dimensional model of maladaptive traits (Kruege et al., 2011) closely aligned with the
FFM (Widiger, 2011-b; see Chapter 19 by Widiger,Costa, and McCrae) and perhaps even the
use of these traits as a major component of the diagnostic criteria for the personality disorder
types in a manner that closely parallels FFM prototype matching (Miller, Bagby, Pilkonis,
Reynolds, & Lynam, 2005; see Chapter 17 by Miller).
The original proposal for the dimensional model consisted of six unipolar domains (i.e.,
negative emotionality, introversion, antagonism, disinhibition, compulsivity, and schizotypy) with
37 underlying traits. This proposal was subsequently modified by shifting compulsivity to be
opposite to disinhibition (i.e., albeit compulsivity represented by just one trait, keyed negatively),
and by deleting 12 of the lower-order traits to yield a five domain model with 25 traits (Krueger
et al., 2011). Figure 1 indicates how the 25 traits are aligned with the FFM. As noted in Chapter
19, DSM-5 negative affectivity (also called in DSM-5 emotional dysregulation) aligns with FFM
neuroticism, detachment aligns with FFM introversion, peculiarity (also called psychoticism)
aligns with FFM openness, antagonism aligns with FFM antagonism, and compulsivity aligns
with high FFM conscientiousness and disinhibition with low FFM conscientiousness (Widiger,
2011-b). A considerable amount of FFM research has been concerned with these alignments,
some of which was summarized earlier in this chapter. Of particular focus here will be the
alignment of compulsivity with conscientiousness and peculiarity with FFM openness.

18
Compulsivity and conscientiousness. The essential feature of OCPD is "a preoccupation with
orderliness, perfectionism, and mental and interpersonal control" (APA, 2000, p. 669), including
within its diagnostic criteria such traits as perfectionism, preoccupation with order and
organization, workaholism, and, quite explicitly, overconscientiousness. Similarly, FFM
conscientiousness includes such facets as order, discipline, achievement-striving, and
deliberation (Costa & McCrae, 1992). It is not difficult to infer that maladaptive and/or extreme
variants of order, discipline, achievement-striving, and deliberation would be the OCPD traits of
perfectionism, preoccupation with order and organization, workaholism, and
overconscientiousness.
Saulsman and Page (2004) reported in their meta-analysis a relatively small but significant
association of OCPD with FFM conscientiousness, concluding that "those [personality disorders]
particularly characterised by orderliness show positive associations with Conscientiousness
(e.g., Obsessive-Compulsive)" (p. 1075). O'Connor (2005) in his meta-analysis concluded that
OCPD aligned well with conscientiousness (obtaining a loading of .72 on the respective factor),
replicating two earlier meta-analytic studies by O'Connor and colleagues that also clearly
aligned compulsivity with conscientiousness (i.e., O'Connor, 2002; O'Connor & Dyce, 1998).
Samuel and Widiger (2008-b) similarly concluded in their meta-analysis that "a predominant
finding of the studies included within this meta-analysis was a positive correlation of FFM
conscientiousness facets with obsessive-compulsivity personality disorder" (p. 12).
The relationship of OCPD with conscientiousness will not necessarily be strong in part
because OCPD is a heterogeneous personality disorder that includes more than just facets of
conscientiousness. Joint factor analyses of measures of the FFM with measures of the more
specific OCPD components of compulsivity (assessed by the DAPP-BQ; Livesley & Jackson,
2009) and workaholism and propriety (assessed by the SNAP; Clark, 1993) have provided
clear, consistent, and strong evidence for the association of these more specific components

19
with conscientiousness (e.g., Clark et al. 1996; Clark et al., 2002; Markon et al., 2005;
Schroeder, Wormworth, & Livesley, 1992). In reviewing their models together, Clark and
Livesley (2002) concluded that "compulsivity (conventionality-rigidity) undoubtedly tapped
conscientiousness" (p. 167). In an early draft of the dimensional trait model for DSM-5, Krueger
et al. (2008) included "orderliness" and "conscientiousness" as facet scales for the domain of
compulsivity.
Samuel and Widiger (2011) explored the relationship of conscientiousness with compulsivity
using six alternative measures of conscientiousness, seven alternative measures of OCPD, and
three scales assessing specific components of OCPD (i.e., compulsivity, workaholism, and
propriety). They reported a consistent and strong relationship of compulsivity with all six
measures of conscientiousness. Workaholism and propriety also related consistently and
strongly with FFM conscientiousness, consistent with prior research that has related measures
of perfectionism with FFM conscientiousness (Stoeber, Otto, & Dalbert, 2009). The relationship
weakened somewhat with measures of OCPD, which include as well some components of
personality beyond conscientiousness, such as high neuroticism and low openness (Lynam &
Widiger, 2001; Samuel & Widiger, 2008, 2010-b).
Peculiarity with openness. The FFM of personality disorder hypothesizes that the primary
maladaptive variants of high openness currently included within the DSM-IV-TR nomenclature
are the cognitive and perceptual aberrations of the schizotypal personality disorder (Widiger,
Costa, et al., 2002; see also Chapter 19). This hypothesis has received inconsistent empirical
support (Saulsman & Page, 2004; O’Connor, 2005). For example, Watson et al. (2008) reported
a separation of adaptive openness from maladaptive peculiarity in their particular factor analysis
but it was through an analysis that heavily loaded these two constructs with so many scales that
a factor analysis would be compelled to separate them. In other factor analytic studies by
Camisa et al. (2005), Kwapil, Barrantes-Vidas, and Silvia (2008), McCrae et al. (1986), and

20
Wiggins and Pincus (1989), cognitive-perceptual aberrations and/or schizotypal symptoms,
clearly loaded on the FFM openness factor.
It is also worth noting that studies have indicated that schizotypal symptomatology may have
opposite relationships to different facets of openness. Kwapil et al. (2008) and Ross, Lutz, and
Bailey (2002) reported that the positive symptoms of schizotypia (e.g., magical ideation and
perceptual aberrations) correlate positively with FFM openness, whereas negative symptoms of
schizotypia (e.g., physical anhedonia) correlate negatively. Asail, Sugimori, Bando, and Tanno
(2011) replicated the relationship of positive symptoms to FFM openness. To the extent that an
assessment of schizotypal personality disorder includes both components, a correlation with
FFM openness might not appear as they may cancel each other out.
Samuel and Widiger (2008-b) suggested in their meta-analysis that the relationship is
inconsistently confirmed when the FFM is assessed with the NEO PI-R (Costa & McCrae,
1992), but is confirmed more consistently when using a semi-structured interview to assess
FFM openness. Haigler and Widiger (2001) also demonstrated empirically that when NEO PI-R
openness items are revised to assess maladaptive variants of the same content, correlations
with schizotypy emerge.
Piedmont et al. (2009) developed scales to assess maladaptive variants of both high and low
FFM openness. Their "Odd and Eccentric" openness scale correlates strongly with schizotypal
personality disorder and various aberrant perceptions and paranormal beliefs. Van Kampen
(2009) includes within his 5-Dimensional Personality Test (5DPT) an Absorption scale, which
aligns explicitly with FFM openness and assesses dissociative absorption and positive
symptoms of schizotypy. The HEXACO-Personality Inventory (HEXACO-PI; Lee & Ashton,
2004) includes an Openness to Experience scale that corresponds conceptually and empirically
with FFM openness. This HEXACO-PI scale includes four facet scales, one of which is titled
Unconventionality that assesses the disposition to be eccentric, weird, peculiar, odd, and

21
strange. Tellegen similarly includes an Unconventionality domain and scale that is aligned
explicitly with FFM openness, containing items that assess normal openness (e.g., curious,
inquisitive, imaginative, and creative) as well as items that concern such attributes as having
ideas or beliefs that have little basis within reality, dwelling upon fantasies, or often engaging in
activities that are bizarre, deviant, or aberrant (Tellegen & Waller, 1987). Further discussion of
the relationship of schizotypy with the FFM and openness in particular is provided in the chapter
by Edmundson and Kwapil (Chapter 10).
Grazioplene, Jung, and Chavez (2011) have even developed and supported empirically a
neurobiological model for the relationship of FFM openness with cognitive-perceptual
aberrations. Advances in neuroimaging allow for increasingly precise analysis of the
neurobiology of personality traits (DeYoung, et al., 2010). Diffusion tensor imaging (DTI) reveals
the microstructural properties of white matter tracts in the brain; fractional anisotropy (FA) is a
DTI index of white matter integrity and coherence. Grazioplene et al. correlated openness and
divergent thinking scores with FA in 72 young adults, controlling for sex, age, and IQ. Openness
was significantly inversely related to FA within the right anterior thalamic radiation (ATR), and
divergent thinking performance was inversely related to FA bilaterally in the ATR. Perhaps most
interesting, these regions of the ATR exhibit substantial overlap with frontothalamic white matter
regions known to exhibit lower FA in schizotypal spectrum disorders. Grazioplene et al. (2011)
suggested that “these results may indicate that although some aspects of Openness/Intellect
are related to intelligence, other aspects appear to reflect a literal physical as well as cognitive
diffusivity in frontal circuits related to working memory function, perhaps accounting for the
“overinclusive” perceptual tendencies common to both Openness and schizotypy.”
Maladaptive Variants of the FFM
A proposal for DSM-5 has been to separate the diagnosis of mental disorder from the
assessment of impairment or disability. A special issue of World Psychiatry was devoted to this

22
proposal (Sartorius, 2009), and it also has received consideration within the field of personality
disorder (Clark, 2007; Krueger et al., 2008; Parker et al., 2004; Ro & Clark, 2009). This
separation would allow for the possibility that a disorder could exist independently of the
presence of any particular impairment or dysfunction.
The separation of the assessment of traits and impairment is already consistent with the
FFM procedure for the diagnosis of a personality disorder, which first assesses for the presence
of personality traits and then secondly for impairments and/or maladaptive variants of these
FFM traits (as indicated by Mullins-Sweatt & Widiger, 2010, it might not be possible to truly
separate an assessment of a maladaptive trait from an assessment of impairment). For
example, gullibility is hypothesized to be a potential problem associated with high levels of
agreeableness, whereas fighting is hypothesized to be a potential problem with low levels of
agreeableness. Widiger, Costa, and McCrae (2002) listed typical impairments associated with
each of the 60 poles of the 30 facets of the FFM. McCrae, Lockenhoff, and Costa (2005)
provided a further extension of this list (see chapter 19, for a more extensive discussion of the
full four step procedure).
Simms et al. (2011) are developing maladaptive personality trait scales for each domain of
the FFM. As noted earlier, Widiger and Simonsen (2005-a) had proposed five fundamental
domains of personality that integrated alternative dimensional models of normal and abnormal
personality within one common hierarchical structure. These domains were emotional
dysregulation, extroversion versus introversion, unconventionality versus closedness to
experience, antagonism versus compliance, and constraint versus impulsivity, which parallel
closely the five domains of the FFM. Working from this model, Simms et al. are in the process of
identifying maladaptive variants of each of the five domains, eventually leading to scales
developed through item response theory analysis that would be able to cover the full range of
normal and abnormal personality functioning within one common five-factor model. Their effort

23
parallels closely the development of the maladaptive trait scales being developed by Lynam et
al. (2010), Edmunson et al. (in press), and Tomiatti et al. (in press), described in more detail in
the chapter by Lynam (see Chapter 18).
De Fruyt et al. (2009) demonstrated, using data from four different countries, the validity and
usefulness of FFM personality disorder scores (assessed with the NEO PI-R) in predicting
criteria of central importance to industrial, work, and organizational psychologists for selection
and career development decisions. Skeem, Miller, Mulvey, Tiemann, and Monahan (2005)
compared (favorably) the ability of FFM traits relative to psychopathy to predict future violent
behavior.
The FFM might be especially advantageous in separating the assessment of personality
from impairment and distress, as it could offer a meaningful and useful organization of
assessment consistent with the typical definition of personality disorder Presence of distress,
social impairment, and/or occupational impairment are the three fundamental components of the
APA’s (2000) definition of personality disorder (p. 689). Mullins-Sweatt and Widiger (2010)
administered relatively comprehensive measures of distress and impairment (along with
measures of the FFM) to persons who were currently or recently in psychological treatment for
personality-related problems in living. They reported significant correlations of distress with
neuroticism, social impairment with extraversion and agreeableness, and occupational
impairment with conscientiousness; with each FFM domain obtaining incremental validity over
the other domains that also obtained significant correlations (e.g., agreeableness had
incremental validity over conscientiousness in accounting for measures of social impairment),
whereas the reverse did not occur. The one exception to this specificity of the relationships of
FFM domains to distress, social impairment, and occupational impairment was that neuroticism
did continue to contribute to social impairment even when controlling for extraversion and
agreeableness, a finding consistent with the broader literature indicating substantial

24
contributions of neuroticism to a broad array of negative life outcomes (Lahey, 2009; Ozer &
Benet-Martinez, 2006; Widiger, 2009).
The Collaborative Longitudinal Personality Disorders Study (CLPS) has also considered
whether the DSM-IV-TR personality disorders relate to social functioning, occupational
functioning, and leisure activities (e.g., Skodol et al., 2002). Unfortunately, there is no indication
of any unique or specific relationships for a respective DSM-IV-TR personality disorder, other
than the global finding that OCPD is consistently related to less dysfunction across all three
areas. Hopwood et al. (2009) reported, using CLPS data, that FFM conscientiousness was
specifically associated with work dysfunction, and extraversion and agreeableness were
associated social dysfunction, after accounting for DSM-IV-TR personality disorder symptoms.
The findings of Hopwood et al. (2009) and Mullins-Sweatt and Widiger (2010) are consistent
with general personality research. Ozer and Benet-Martinez (2006) indicated in their extensive
review that all five domains of the FFM are predictive of a wide variety of both successful and
unsuccessful life outcomes and, most importantly, these relationships are relatively specific for
each domain. For example, subjective well-being was related most strongly to low neuroticism.
High agreeableness and extraversion predicted social acceptance, and low agreeableness was
the primary domain related to relationship dissatisfaction, conflict, and criminality. Job
performance was most strongly related to conscientiousness. Openness to experience was the
principal domain related to existential/paranormal beliefs, creativity, and educational level.
Boudreaux and Ozer (2011) administered an extensive multi-context problems checklist to
over 400 participants, along with a measure of the FFM. One of the more intriguing results of
their study was indicating the presence of problems secondary to all but one of the 10 poles of
the FFM. For example, high openness was associated with having an overactive imagination,
being overly involved in work, and having too many career interests. Low openness was
associated with being unable to think “outside the box,” being unaware of needs of partner, and

25
being unable to work without clear rules and guidelines. Antagonism was associated with
always needing to be right, not caring about many people, being too argumentative, feeling
superior to other people, and being too critical or judgmental, whereas agreeableness was
associated with not being able to say “no,” not managing time effectively, and not being able to
prioritize work tasks (the latter two difficulties perhaps reflecting an excessive agreeableness to
take on any responsibility or request that is asked of them). The only pole of a domain of the
FFM not associated with some type of problems was low neuroticism.
In sum, the findings of Hopwood et al. (2009), Boudreaux and Ozer (2011), and Mullins-
Sweatt and Widiger (2010) support not just simply the presence of impairments secondary to
the domains of the FFM, but as well to the specificity of these impairments with respect to each
respective FFM domain. This will facilitate the development of more specific treatment planning
and implications for outcome than is currently possible with the DSM-IV-TR heterogeneous
syndromes (Smith & Zapolski, 2009; see also Zapolski, Guller, and Smith, Chapter 3).
Comparison of Personality Disorder Instruments
Ozer and Reiss (1994) and Goldberg (1993) likened the domains of the FFM to the
coordinates of latitude and longitude that cartographers used to map the world, suggesting that
the FFM might be similarly useful in comparing and contrasting different personality measures
with respect to their relative saturation of these fundamental personality traits. The FFM has
indeed been shown to be useful in comparing and contrasting different conceptualizations and
measures of personality disorder (e.g., Paulhus & Williams, 2002; Ruiz, Pincus, & Schinka,
2008; Trobst, Ayearst, & Salekin, 2004), including more specifically the antisocial (Costa &
McCrae, 1990; Decuyper, De Pauw, De Fruyt, De Bolle, & De Clercq, 2009; Gudonis, Miller,
Miller, & Lynam, 2008; Hicklin & Widiger, 2005; Seibert, Miller, Few, Zeichner, & Lynam; in
press), dependent (Lowe et al., 2009; McBride, Zuroff, Bagby, & Bacchiochi, 2006; Mongrain,
1993; Pincus & Gurtman, 1995; Zuroff, 1994), narcissistic (Miller & Campbell, 2008; Samuel &

26
Widiger, 2008-a), histrionic (Gore, Tomiatti, & Widiger, 2011), and obsessive-compulsive
(Samuel & Widiger, 2010-b).
Costa and McCrae (1990) compared different editions of the Millon Clinical Multiaxial
Inventory (MCMI; Millon, Millon, Davis, & Grossman, 2009) with respect to the FFM. They
indicated, for example, how early versions of the antisocial personality disorder scale were
saturated with high neuroticism that was removed from subsequent versions which, in turn,
increased a representation of low conscientiousness. Samuel and Widiger (2010-b) compared
eight different DSM-IV-TR OCPD measures from the perspective of the FFM. One notable
finding was that the MMPI-2 (Somwaru & Ben-Porath, 1995) assessment of OCPD, in contrast
to the others, was confined largely to neuroticism, with little to no representation of low
conscientiousness, likely due to the fact that the MMPI-2 item pool in general lacks much
representation of FFM conscientiousness (Trull, Useda, Costa, and McCrae, 1995). The SNAP
(Clark, 1993) provided approximately equal weight to its coverage of neuroticism and
conscientiousness, whereas the MCMI-III was largely saturated with items assessing
conscientiousness. Even more striking for the MCMI-III was its negative correlation with
neuroticism, whereas all other OCPD measures correlated positive with neuroticism. From this
perspective, it is not surprising that the MCMI-III OCPD scale obtains weak convergent validity
with other measures of OCPD (Widiger & Boyd, 2009).
Gore et al. (2011) indicated how different measures of histrionic personality traits can be
understood from the perspective of the FFM. The MCMI-III and MMPI-2 assessments of
histrionic personality disorder (HPD) correlated negatively with neuroticism, whereas in striking
contrast the Coolidge Axis II Inventory (CATI; Coolidge & Merwin, 1992), SNAP, OMNI
Personality Inventory-IV (OMNI-IV; Loranger, 2001), PDQ-4, and WISPI (Klein et al., 1993) HPD
scales correlated positively. Further, the MCMI-III and MMPI-2 HPD scales correlated
substantially with extraversion (above .70), whereas the PDQ-IV, OMNI-IV, and WISPI were

27
uncorrelated with extraversion (the SNAP and CATI obtained moderately high positive
correlations). The PDQ-IV, OMNI-IV, and WISPI HPD scales correlated negatively with
conscientiousness, whereas the MMPI-2 and MCMI-III were uncorrelated with
conscientiousness.
Whiteside and Lynam (2001) compared and contrasted alternative measures of “impulsivity”
from the perspective of the FFM, leading to the useful distinction of negative urgency (facet of
neuroticism), lack of premeditation (low deliberation), lack of perseverance (low self-discipline),
and sensation seeking (facet of extraversion). They demonstrated how existing measures of
“impulsivity” vary considerably with respect to which variant is being assessed, as well as the
social and clinical importance of the four different variants. A considerable amount of
subsequent validation and extension of these FFM variants have since been published (e.g.,
Lynam, Miller, Miller, Bournovalova, & Lejuez, 2011; Ruiz et al., 2008; Whiteside, Lynam,
Miller, & Reynolds, 2005). Bechara (2005) has even placed these four traits into a larger
neurocognitive framework.
Samuel and Widiger (2008-a) compared and contrasted five alternative measures of
narcissism. Among their findings was that the SNAP (Clark, 1993) and PDQ-IV (Bagby &
Farvolden, 2004) were confined largely to aspects of antagonism with no relationship with
neuroticism or extraversion. In stark contrast, the MMPI-2 assessment of NPD was unrelated to
antagonism and was evenly weighted in its coverage of neuroticism and extraversion. The
MCMI-III fell in between, including a negative relationship with neuroticism and positive
relationships with antagonism and extraversion. Similar findings were reported by Miller and
Campbell (2008). In sum, some studies have suggested that the FFM is unable to provide an
adequate differentiation among the personality disorders (Morey, Gunderson, Quigley, & Lyons,
2000). However, in stark contrast to this conclusion, the FFM is in fact able to provide
meaningful and clinically important differentiations among scales purportedly assessing the

28
same personality disorder construct.
Personality Disorder Construct Validity
Some of the FFM personality disorder research has helped to understand findings,
correlates, discrepancies, and even the etiology of DSM-IV-TR personality disorders (e.g.,
Ryder, Costa, & Bagby, 2005; Trobst et al., 2004). For example, Distel et al. (2009) examined
the phenotypic and genetic association between borderline personality and FFM personality
traits in 4403 monozygotic twins, 4425 dizygotic twins, and 1661 siblings from 6140 Dutch,
Belgian, and Australian families. Multivariate genetic analyses indicated that the genetic factors
that influenced individual differences in neuroticism, agreeableness, conscientiousness, and
extraversion accounted for all of the genetic liability for borderline personality (albeit unique
environmental effects were not completely shared with the FFM traits).
The widely published CLPS study (Skodol et al., 2005) has included assessments of FFM
general personality structure, and has yielded a number of interesting results. For example, one
of the difficulties for the DSM-IV-TR personality disorders is a temporal stability that is less than
one would have expected for a disorder of personality. Temporal stability "goes to the heart of
how personality traits are conceptualized" (Roberts & DelVecchio, 2000, p. 3). Over two-year
(Warner et al., 2004) and four-year (Morey et al., 2007) follow-up periods the temporal stability
of FFM traits has been substantially higher than obtained for the DSM-IV-TR constructs. This
has also contributed to greater predictive validity over time for the FFM than for the DSM-IV-TR
(Morey et al., 2007). As indicated by Warner et al. (2004) changes in FFM personality predicted
changes in personality disorder but not vice versa. Warner et al. (2004) concluded that this
finding "supports the contention that personality disorders stem from particular constellations of
personality traits" (pp. 222-223). Nestadt et al. (2010) suggest that the DSM-IV-TR diagnostic
criteria are assessing FFM personality traits, but many of them at a lower level of behavioral
specificity, leading perhaps then to less temporal stability (Nestadt et al., 2010).

29
As noted earlier, some studies have suggested that the FFM is unable to provide an
adequate differentiation among the personality disorders (Morey et al., 2000). This criticism is
somewhat ironic, given that a major failing of the DSM-IV-TR diagnostic categories is their
problematic diagnostic co-occurrence and lack of adequate discriminant validity (Clark, 2007;
Trull & Durrett, 2005; Widiger & Trull, 2007). The excessive diagnostic co-occurrence has been
so problematic that it is touted as the primary reason for the deletion of four of the 10 diagnostic
categories from DSM-5 (Skodol, 2010). This might be a rather draconian solution to this
problem (Widiger, 2011-a) but it does reflect on the serious difficulty the categorical model has
had with discriminant validity.
No instrument or model can adequately differentiate the DSM-IV-TR personality disorder
constructs because they are inherently overlapping. Scales to assess them often contain
common items precisely because they share many of the same traits (Widiger & Boyd, 2009).
Lynam and Widiger (2001) and O'Connor (2005) in fact indicated how the FFM can explain the
problematic diagnostic co-occurrence among the DSM-IV-TR personality disorders. Lynam and
Widiger indicated empirically that the extent to which the personality disorders shared FFM traits
explained much of the co-occurrence among the diagnostic categories. The "overlap among
FFM profiles reproduced well the covariation obtained for the schizoid, schizotypal, antisocial,
borderline, histrionic, narcissistic, avoidant, and compulsive PDs aggregated across several
sets of studies" (Lynam & Widiger, 2001, p. 410).
Poor results were obtained for only one personality disorder, dependent, precisely because
its FFM description provided considerably more differentiation from other personality disorders
than is in fact found using the DSM-IV-TR criterion sets. Discriminant validity would clearly be
better with the factor-analytically based FFM constructs relative to the explicitly overlapping
constructs of the DSM-IV-TR. Samuel and Widiger (2010-a) demonstrated this empirically in a
direct comparison of the FFM and DSM-IV-TR models of classification across four methods of

30
assessment: self-report, semi-structured interview, peer report, and clinician rating.
As discussed by Oltmanns and Carlson (Chapter 16) cross-method (e.g., peer, interviewer,
and self-report) assessments of personality disorders have generally not obtained adequate
convergent or discriminant validity. Three studies have directly compared cross-method
convergence and/or divergence of the FFM versus the DSM (i.e., Ball, Rounsaville, Tennen, &
Kranzler, 2001; Miller, Pilkonis, & Clifton, 2005; Samuel & Widiger, 2010-a). In the most recent
of these three studies, including therapist ratings, peer report, self-report, and semi-structured
interview assessments for both the DSM-IV-TR and the FFM, Samuel and Widiger (2010-a)
reported an appreciable advantage over the DSM-IV-TR in terms of convergent validity at the
domain level (and, as noted earlier, discriminant validity at the domain and facet level).
Gender bias within the personality disorder nomenclature has been a heated issue for quite
some time (Morey, Alexander, & Boggs, 2005). The differential sex prevalence rates that have
been reported were difficult to justify in the absence of any theoretical basis for knowing what
differential sex prevalence should be obtained. In contrast, the FFM has proved useful in
helping to explain and understand gender differences in personality (Costa, Terracciano, &
McCrae, 2001; Feingold, 1994). Lynam and Widiger (2007-b) demonstrated that the differential
sex prevalence rates obtained for the DSM-IV-TR personality disorders are well explained if
these disorders are understood as maladaptive variants of the domains and facets of the FFM.
They reported that the differential sex prevalence rates obtained through a meta-analytic
aggregation of prior studies was consistent with the sex differences that would be predicted if
the personality disorders were understood to be maladaptive variants of the FFM. One
exception was for HPD. The FFM conceptualization predicted no differential sex prevalence rate
whereas this personality disorder is diagnosed much more frequently in women. This finding is
consistent with the fact that HPD has been the most controversial diagnosis with respect to
concerns of gender bias (Morey et al., 2005). In addition, the FFM profile for HPD is a mix of

31
traits for which women generally obtain higher scores (e.g., the extraversion facets of
gregariousness, activity, and positive emotions) as well as traits for which they usually obtain
lower scores (e.g., the extraversion facet of excitement seeking and the neuroticism facet of low
self-consciousness), making for a complex prediction of differential sex prevalence. The
differential sex prevalence that is obtained for HPD will depend upon which combination of traits
predominate within any particular sample. Samuel and Widiger (2009) indicated empirically as
well how a reformulation of the personality disorders in terms of the FFM could help to diminish
gender assumptions and stereotypic expectations.
Conclusions
Discussed in this chapter was research concerning the coverage of alternative trait models,
the DSM-IV-TR personality disorders, and the DSM-5 dimensional trait model; maladaptive
variants of the FFM; comparisons among alternative measures of DSM-IV-TR personality
disorders; and construct validity of the DSM-IV-TR personality disorders. Covered elsewhere in
this book is the considerable body of FFM personality disorder research concerning the clinical
utility of the FFM (see Chapter 20 by Mullins-Sweatt), FFM prototype matching (see Chapter 17
by Miller), and childhood antecedents (see Chapter 4 by De Fruyt and De Clerq), as well as the
research concerning individual personality disorders, such as psychopathy (see Chapter 7 by
Derefinko and Lynam), borderline (see Chapter 8 by Trull and Brown), schizotypal (see Chapter
10 by Edmunson and Kwapil), and narcissistic (see Chapter 9 by Campbell and Miller). It is
evident from the above review and these additional chapters that a substantial amount of
published research on the relationship of the FFM to personality disorders has been published
since the original review by Widiger and Costa (2002).
We anticipate that there will continue to be a considerable amount of research devoted to
understanding personality disorders from the perspective of the FFM. The FFM has received the
most attention with respect to the alternative dimensional models of personality disorder (Ball,

32
2001; Clark, 2007; Widiger & Costa, in press), and this is likely to escalate further with the shift
of the DSM-5 toward the FFM, with respect to both the dimensional trait model and the
diagnostic criterion sets (see Chapter 19 by Widiger, Costa, and McCrae).

33
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Table 1
DSM-IV Personality Disorders from the Perspective of the Five Factor Model of General Personality Structure
PRN SZD SZT ATS BDL HST NCS AVD DPD OCP
Neuroticism (vs emotional stability)
Anxiousness H L H H H H
Angry Hostility H H H H
Depressiveness H H H
Self-Consciousness H L H L/H H H
Impulsivity H H L
Vulnerability L H H H H H
Extraversion (vs introversion)
Warmth (vs coldness) L L L H H L
Gregariousness (vs withdrawal) L L L H H L
Assertiveness (vs unassertiveness) L H H L L
Activity (vs passivity) L H L
Excitement-Seeking L H H H L L
Positive Emotionality (vs anhedonia) L L L
Openness (vs closedness)
Fantasy H H H H
Aesthetics
Feelings (vs alexithymia) L H L
Actions L L H H L L
Ideas H
Values L L
Agreeableness (vs antagonism)
Trust (vs mistrust) L L L L H L H
Straightforwardness (vs deception) L L L L L
Altruism (vs exploitation) L L L H
Compliance (vs aggression) L L L H
Modesty (vs arrogance) L L L H H
Tender-Mindedness (vs tough-minded) L L L
Conscientiousness (vs disinhibition)
Competence (vs laxness) L H
Order (vs disordered) L H
Dutifulness (vs irresponsibility) L H
Achievement-Striving H H
Self-Discipline (vs negligence) L L H
Deliberation (vs rashness) L L L H
______________________________________________________________________________________________________________________
Note. PRN = paranoid, SZD = schizoid, SZT = schizotypal, ATS = antisocial, BDL = borderline, HST = histrionic, NCS = narcissistic, AVD = avoidant,
DPD = dependent, and OCP = obsessive-compulsive. Adapted from Lynam and Widiger (2001), Samuel and Widiger (2004), and Widiger et al. (2002)

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Figure 1: DSM-5 Dimensional Model Traits Within the FFM