Personality Disorders

The present study investigated the predictive validity of Criterion A and B of the Alternative Model for Personality Disorders (AMPD) compared to the DSM-5 Section II personality disorder (PD) model in predicting patient outcomes 1 year after initial assessment, in a hetero-method longitudinal design. A clinical sample of 84 participants were administered both traditional Section II and AMPD interviews by two independent interviewers. One year after assessment, disability (World Health Organization Disability Assessment Schedule 2...

The assessment of personality pathology based on dimensional models may improve self-other agreement, but previous research mainly adopted a categorical approach and overlooked the role of the person of the therapist. Our study examined patient-clinician agreement in a mixed sample of Italian outpatients using the Personality Inventory for DSM-5 (PID-5) and the PID-5-Informant Form (PID-5-IRF). Moreover, the role of clinician personality traits on agreement was preliminary explored. Sixty-eight outpatients (51...

Loneliness has broad public health importance, especially in older adulthood, and there is some evidence suggesting it is associated with several personality disorders (PDs). The etiology of these PD-loneliness associations, however, has rarely been studied, especially in the context of the maladaptive traits of the DSM-5 alternative model of personality disorder (AMPD). To address these limitations, we estimated phenotypic, genetic, and unique environmental associations between loneliness and maladaptive personality traits in a sample of older adults from the Minnesota Twin Registry ( n = 1,356, M age = 70...

Callous-unemotional (CU) traits (i.e., tendencies to experience low levels of guilt and empathy) are associated with severe and persistent conduct problems in youth. However, some youth with elevated CU traits do not exhibit severe externalizing problems, and further research is needed to identify conditions under which CU traits are more versus less strongly associated with higher levels of externalizing behavior. To this end, the current preregistered study examined whether internalizing problems, five-factor model personality traits, and parenting practices moderated associations between CU traits and externalizing problems...

The Alternative Model of Personality Disorders (AMPD), introduced in Section III of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013), was proposed as a new operationalization of personality disorders (PDs) aiming to overcome the several limitations of the traditional symptom-based model (Waugh et al., 2017; Zimmerman et al., 2019). In the AMPD, PDs are defined by two-dimensional criteria (the level of personality functioning and maladaptive personality traits), but as a hybrid model, it also allows for categorical assessment of PDs (i...

In our article, "How much does that cost? Examining the economic costs of crime in North America attributable to people with psychopathic personality disorder" (Gatner et al., 2023, pp. 391-400), we estimated that psychopathic personality disorder (PPD) was associated with substantial crime costs, using a top-down approach of national costs in the United States and Canada. Verona and Joyner (2023) raised several concerns about our findings. Although we think some of their points help to map directions for future research, we disagree with others they raised related to the conceptualization of PPD, the problem of undetected crimes, and their concerns with putative national comparisons...

In their crime cost estimation, Gatner et al. (2022) conclude that psychopathic personality disorder (PPD) is associated with billions of dollars of crime costs in the United States (US) and Canada. Gatner et al.'s analysis goes far in putting a cost estimate to PPD, when the burden of psychopathy for the criminal justice system has been unspecified for years. Nonetheless, in the present commentary, we identify two broad problems with their analyses that motivate caution in the interpretation of the findings and their potential applicability: (a) the conceptualization of psychopathy that formed the bases for estimates of PPD, and (b) the assumptions underlying crime cost estimates made by Gatner et al...

BPD Compass is a short-term (18-session) intervention for borderline personality disorder (BPD) that was designed to address the higher-order dimensions of personality implicated in this condition in the Alternative Model of Personality Disorders (AMPD): Negative affectivity, Antagonism, and Disinhibition. We received three commentaries on our manuscript describing the conceptual background for BPD Compass; the purpose of this rejoinder is to respond to that feedback. In our rejoinder, we challenge researchers and clinicians to stretch their assumptions about what treatment for BPD should look like, describe the utility of a cognitive-behavioral approach for subsequent dissemination, and discuss how information Criterion A of the AMPD can also be used to personalize course of treatment with BPD Compass...

Comments on the article by S. Sauer-Zavala et al. (see record 2022-23735-001), which presents BPD-Compass as a new intervention for borderline personality disorder (BPD). Sauer-Zavala et al. have written a stimulating article that challenges fixed beliefs about the treatment of personality disorders and offers the first attempt to design a treatment according to the heuristic framework of the alternative model of personality disorders. This article presents several elements of the direction our field is developing to but may have underrated the importance of Criterion A in designing good-quality generic PD treatment...

Comments on an article by S. Sauer-Zavala et al. (see record 2022-23735-001), which presents BPD-Compass as a new intervention for borderline personality disorder (BPD). In this comment, the author says that BPD-Compass is described as comprehensive and short term. But, it is difficult to be both. As a short-term intervention, is the Compass proposed as a first-line treatment? If so, why are crises, self-harm, and suicidality, dominant issues in the early stages of most therapies, not addressed systematically? (PsycInfo Database Record (c) 2023 APA, all rights reserved)...

Comments on the article by S. Sauer-Zavala et al. (see record 2022-23735-001). Since its empirical debut in the early 1990s, dialectical behavior therapy (DBT) has amassed substantial support for treating individuals struggling with chronic suicidality, emotion dysregulation, impulsivity, and interpersonal distress. Today, it is known to be one of the most effective psychotherapies for complex mental health presentations, such as in borderline personality disorder (BPD). In this comment, the authors highlight strengths and limitations of one promising intervention, BPD Compass, as presented by Sauer-Zavala et al...

Recent initiatives in the empirically based classification of psychopathology, namely, the Hierarchical Taxonomy of Psychopathology (HiTOP), have made significant strides in addressing the limitations of traditional taxonomies (i.e., Diagnostic and Statistical Manual of Mental Disorders, International Classification of Diseases ). The current study aimed to extend this work by helping to clarify the lower order structure of an understudied dimension of psychopathology-antagonism (i.e., HiTOP antagonistic externalizing spectrum)-a core feature of many externalizing disorders and related to important outcomes such as interpersonal problems, childhood conduct problems, and incarceration...

Establishing maladaptive personality traits at a younger age in a developmentally appropriate and clinically tangible way may alert clinicians to dysfunction earlier, and thus reduce the risk of significant impairment later in life. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Alternative Model for Personality Disorders (AMPD) provides a set of traits useful for organizing behavioral and experiential patterns central to daily personality functioning. The goal of the present study was to evaluate manifestations indicative of AMPD traits via ambulatory assessments in the daily lives of adolescent girls...

This study examined the indirect effect via Criterion A (personality functioning) of the Alternative Model for Personality Disorders (AMPD) in the relationship between retrospective reports of perceived parental invalidation and borderline personality traits measured by Criterion B (pathological personality traits). A total of 3,019 college students completed self-report scales of the Chinese Invalidating Family Scale, Level of Personality Functioning Scale-Brief Form 2.0, and Personality Inventory for DSM-5...

There is a long tradition of theory and research on putative variants of psychopathic and other antisocial clinical presentations. However, using different samples, psychopathy measures, terminologies, and analytic methods makes interpretation of the findings difficult. Emerging research suggests that the validated four-factor model of the Psychopathy Checklist-Revised (PCL-R) provides a consistent and empirically robust framework for identifying psychopathic variants and antisocial subtypes (Hare et al., 2018; Neumann et al...

Despite evidence for the intergenerational transmission of borderline personality disorder (BPD) pathology from mothers to offspring, the factors underlying the relation between mother and child BPD symptoms remain unclear and little is known about the pathways through which maternal BPD symptoms may relate to BPD symptoms in their offspring. One set of factors that warrants consideration in this regard is mother and child emotion regulation (ER) difficulties. In particular, theory and research suggest an indirect relation between mother and child BPD symptoms through maternal ER difficulties (and related maladaptive emotion socialization strategies) and, subsequently, child ER difficulties...

Different psychotherapeutic approaches demonstrated their efficacy but the possible neurobiological mechanism underlying the effect of psychotherapy in borderline personality disorder (BPD) patients is poorly investigated. We assessed the effects of metacognitive interpersonal therapy (MIT) on BPD features and other dimensions compared to structured clinical management (SCM). We also assessed changes in amygdala activation by viewing emotional pictures after psychotherapy. One hundred forty-one patients were referred and 78 BPD outpatients were included and randomized to MIT or SCM...

Borderline personality disorder (BPD) has been associated with a reduced functional flexibility of the autonomic nervous system (ANS), indexed by decreased vagally mediated heart rate variability (vmHRV). Employing a comprehensive Section II-based assessment approach and a partial Section III-based assessment approach (including Criterion A of the alternative model of personality disorders [AMPD]), the present study investigates how different conceptualizations of personality disorders (PDs) according to the Diagnostic and Statistical Manual for Mental Disorders, 5th edition relate to ANS function...

The alternative model for personality disorder (AMPD) is currently included in Section III of the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5). This review sought to summarize the literature concerning the interrater reliability (IRR) of the AMPD. Despite high heterogeneity, meta-analysis provided tentative support for the IRR of Criterion A of the AMPD, with pooled intraclass correlation coefficients (ICCs) for the Level of Personality Functioning Scale (LPFS) and its domains falling above DSM acceptability levels...

The fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5; American Psychiatric Association, 2013) introduced the clinician-rated Levels of Personality Functioning Scale (LPFS) as an indicator of general personality functioning based on four elements: Identity, Self-Direction, Empathy, and Intimacy. Construct validation strategies were employed to select and evaluate items from the Personality Assessment Inventory (PAI; Morey, 2007) to measure the four elements of the LPFS. In Study 1, conceptual ratings of PAI items produced lists of candidate items for the four elements...