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We aimed to determine and compare the longitudinal predictive power of Diagnostic and Statistical Manual of Mental Disorders, fifth edition's (DSM-5 ) two models of personality disorder (PD) for multiple clinically relevant outcomes. A sample of 600 community-dwelling adults-half recruited by calling randomly selected phone numbers and screening-in for high-risk for personality pathology and half in treatment for mental health problems-completed an extensive battery of self-report and interview measures of personality pathology, clinical symptoms, and psychosocial functioning. Of these, 503 returned for retesting on the same measures an average of 8 months later. We used Time 1 interview data to assess DSM-5 personality pathology, both the Section-II PDs and the alternative ( DSM-5 ) model of personality disorder's (AMPD) Criterion A (impairment) and Criterion B (adaptive-to-maladaptive-range trait domains and facets). We used these measures to predict 20 Time 2 functioning outcomes. Both PD models significantly predicted functioning-outcome variance, albeit modestly-averaging 12.6% and 17.9% (Section-II diagnoses and criterion counts, respectively) and 15.2% and 23.2% (AMPD domains and facets, respectively). Each model significantly augmented the other in hierarchical regressions, but the AMPD domains (6.30%) and facets (8.62%) predicted more incremental variance than the Section-II diagnoses (3.74%) and criterion counts (3.31%), respectively. Borderline PD accounted for just over half of Section II's predictive power, whereas the AMPD's predictive power was more evenly distributed across components. We note the predictive advantages of dimensional models and articulate the theoretical and clinical advantages of the AMPD's separation of personality functioning impairment from how this is manifested in personality traits. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Background: Research on the Alternative DSM-5 Model for Personality Disorders (AMPD) in DSM-5 's Section-III has demonstrated acceptable interrater reliability, a largely consistent latent structure, substantial correlations with theoretically and clinically relevant measures, and evidence for incremental concurrent and predictive validity after controlling for DSM-5 's Section II categorical personality disorders (PDs). However, the AMPD is not yet widely used clinically. One clinician concern may be caseness - that the new model will diagnose a different set of PD patients from that with which they are familiar. The primary aim of this study is to determine whether this concern is valid, by testing how well the two models converge in terms of prevalence and coverage., Method: Participants were 305 psychiatric outpatients and 302 community residents not currently in mental-health treatment who scored above threshold on the Iowa Personality Disorder Screen (Langbehn et al., ). Participants were administered a semi-structured interview for DSM-5 PD, which was scored for both Section II and III PDs., Results: Convergence across the two PD models was variable for specific PDs, Good when specific PDs were aggregated, and Very Good for 'any PD.', Conclusions: Results provide strong evidence that the AMPD yields the same overall prevalence of PD as the current model and, further, identifies largely the same overall population. It also addresses well-known problems of the current model, is more consistent with the ICD-11 PD model, and provides more complete, individualized characterizations of persons with PD, thereby offering multiple reasons for its implementation in clinical settings.

Background: Although antidepressant medication (ADM) has produced small advantages over pill placebo in randomized controlled trials, consuming ADM has predicted prospectively increasing depressive symptom severity in samples of community-dwelling adults., Objective: We extended the community literature by testing ADM's relations to changes in personality and quality of life that may underpin depression., Method: In this longitudinal, observational study, community-dwelling adults (N = 601) were assessed twice, 8 months apart on average. Assessments included depressive symptoms, personality, life satisfaction and quality, and prescription medication consumption., Results: Consuming ADM at time 1 predicted relative increases in depressive symptoms (dysphoria), maladaptive traits (negative affect, negative temperament, disinhibition, low conscientiousness), personality dysfunction (non-coping, self-pathology), and decreases in life satisfaction and quality from time 1 to 2, before and after adjustment for age, gender, race, income, education, physical health problems, and use of other psychotropics. In no analysis did ADM use predict better outcomes., Conclusion: Among community-dwelling adults, ADM use is a risk factor for psychosocial deterioration in domains including depressive symptoms, personality pathology, and quality of life. Until mechanisms connecting ADM to poor outcomes in community samples are understood, additional caution in use of ADM and consideration of empirically supported non-pharmacologic treatments is prudent.

Personality pathology is increasingly conceptualized within hierarchical, dimensional trait models. The Comprehensive Assessment of Traits Relevant to Personality Disorders (CAT-PD) is a pathological-trait measure with potential to improve on currently prevailing instruments because it has wider content coverage; however, its domain-level structure, which is of scientific and clinical interest, is not established. In this study, we investigated the structure and construct validity of the CAT-PD's domain level to facilitate wider use of the measure. We estimated five- and six-factor models with exploratory factor analysis in a pooled sample of eight independent subsamples ( N = 3,987) and found that both models fit the data well; each had interpretable factors that were invariant across gender, sample type, and Black/White racial groups; and the factors had good convergent validity with other measures of maladaptive traits, Big Five personality, and interpersonal problems. Our results support the validity of the CAT-PD for assessing multiple levels of the pathological trait hierarchy.

We critique the general state of methodological rigor in contemporary personality pathology research, focusing on challenges in study design, assessment, and data analysis resulting from two pervasive problems: comorbidity and heterogeneity. To inform our understanding of this literature, we examined every article published in the two main specialty journals for personality pathology research- Personality Disorders: Theory, Research, and Treatment and the Journal of Personality Disorders -in the 18-month period from January 2020 to June 2021 (a total of 23 issues and 197 articles). Our review of this database indicated that only three forms of personality pathology have generated substantial attention in the recent literature: borderline personality disorder (featured in 93 articles), psychopathy/antisocial personality disorder (39 articles), and narcissism/narcissistic personality disorder (28 articles), so we highlight them in our review. We discuss comorbidity-related problems that arise from group-based designs and recommend instead that researchers assess multiple forms of psychopathology as continuous dimensions. We offer separate recommendations for addressing heterogeneity in diagnosis- versus trait-based studies. For the former, we recommend that researchers (a) use measures that permit criterion-level analyses and (b) routinely report criterion-level results. For the latter, we emphasize the importance of examining specific traits when measures are known to be highly heterogeneous/multidimensional. Finally, we encourage researchers to work toward a truly comprehensive trait dimensional model of personality pathology. We suggest that this might include expanding the current alternative model of personality disorders to include additional content related to borderline features, psychopathy, and narcissism. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Publication of the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (American Psychiatric Association, 2013), which included an alternative model of personality disorders (AMPD), was followed by an explosion of publications on the new model. The large majority of these publications focused on the AMPD's Criterion B, which consists of 25 trait facets arranged in 5 broad domains that bear strong similarity to the established five-factor model (FFM) of personality. The operationalization of AMPD traits that has received the most research attention is its self-report measure, the Personality Inventory for Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (PID-5; Krueger et al., 2012). Much of this literature concerns its internal structure and relations with FFM measures. Many of these studies report that a number of the facets appear to be (a) interstitial (cross-loading on 2 or more factors), (b) placed in the wrong domain (i.e., considered by the AMPD to be a facet of a different domain from the one on which it typically loads), or (c) both. Clarifying the structural location of measures is fundamental in understanding their nomological net-and, thereby, the constructs they assess. Therefore, this review focuses on the PID-5 structure in the context of the broader domain of personality, especially the FFM, and primarily examines (1) which facets are interstitial and (2) the best domain(s) in which to place each facet. Also considered are important PD constructs-including multiple facets and one domain-that the AMPD does not include. The review ends with a set of recommendations for AMPD-5.1 and PID-5.1. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Hierarchical Taxonomy of Psychopathology (HiTOP) is an empirically and quantitatively derived dimensional classification system designed to describe the features of psychopathology and, ultimately, to replace categorical nosologies. Among the constructs that HiTOP organizes are "symptom components" and "maladaptive traits," but past HiTOP publications have not fully explicated the distinction between symptoms and traits. We propose working definitions of symptoms and traits and explore challenges, exceptions, and remaining questions. Specifically, we propose that the only systematic difference between symptoms and traits in HiTOP is one of time frame. Maladaptive traits are dispositional constructs that describe persistent tendencies to manifest features of psychopathology, whereas symptoms are features of psychopathology as they are manifest during any specific time period (from moments to days to months). This has the consequence that almost every HiTOP dimension, at any level of the hierarchy, can be assessed as either a trait or a symptom dimension, by adjusting the framing of the assessment. We discuss the implications of these definitions for causal models of the relations between symptoms and traits and for distinctions between psychopathology, normal personality variation, and dysfunction., (© 2020 Wiley Periodicals LLC.)

To evaluate the psychometric properties of the Italian translation of the Schedule for Nonadaptive and Adaptive Personality-2 (SNAP-2) diagnostic scales, 837 Italian community-dwelling adults and 429 consecutively admitted Italian psychiatric adults were administered the SNAP-2. The 12 SNAP-2 diagnostic scales yielded reliable scores in both community (median ω value = .90) and psychiatric (median ω value = .92) samples. The 6-month temporal stability was adequate for all SNAP-2 diagnostic scales (median test-retest r-value = .84) in a subsample of the community-dwelling adults (n = 97). When we examined the correlations between the SNAP-2 diagnostic scales and the Five-Factor Model Rating Form trait scales among the community-dwelling adults, the double-entry intraclass correlation values (median ICCDE = .94) indicated a marked similarity between our correlation profiles and the correlation profiles that were reported in Samuel and Widiger (2008) meta-analysis. In our psychiatric-adult sample, the SNAP-2 diagnostic scales showed adequate convergent-validity coefficients (median r-value = .61) with criterion measures of DSM-IV axis II/DSM-5 Section II personality disorders (PDs). Finally, relative-weight analysis results showed that selected Personality Inventory for DSM-5 trait-scale scores explained a substantial amount of variance in SNAP-2 antisocial, avoidant, borderline, narcissistic, obsessive-compulsive, and schizotypal PD scale scores (median R 2 value = .55). As a whole, our data suggest that the Italian SNAP-2 diagnostic scales have adequate reliability and construct validity in the Italian culture. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

This commentary on Livesley's paper in this special issue on International Classification of Diseases (ICD)-11's personality disorder (PD) section addresses each of four issues that Livesley claims are impeding progress towards an evidence-based system for the classification of personality pathology. I focus my commentary on the third issue, but also comment briefly on the others. Regarding, first, the complexity of personality pathology and, second, problematic assumptions about the nature of personality pathology, I contend that Livesley's comments are accurate, but omit that the fundamental impediment is the refusal of the Diagnostic and Statistical Manual of Mental Disorders (DSM) establishment to allow the official classification to reflect the reality of personality pathology that he describes, in contrast to its acceptance in the ICD-11. In response to Livesley's third claim that a viable alternative to categorical diagnosis is not available, I take issue with various aspects of his assertions and develop arguments that the ICD-11 PD model provides a useful, although admittedly imperfect, system. Finally, I agree with Livesley that the revision processes for official classifications are conservative and open to non-scientific influences, but maintain that whereas the Diagnostic and Statistical Manual of Mental Disorders establishment held fast to the status quo, the ICD-11 PD Working Group made considerable progress towards a valid PD diagnostic system. © 2020 John Wiley & Sons, Ltd., (© 2020 John Wiley & Sons, Ltd.)

We review evidence establishing important parallels between the general structure of psychopathology, the more specific structure of personality pathology and the structure of normal-range personality. We then present data to explicate the nature of associations between the alternative model of personality disorder (AMPD)-as operationalized by the Personality Inventory for DSM-5-and the domains and facets subsumed within the five-factor model of personality. Our data demonstrate substantial links between four of the five domains within these models but also indicate that the AMPD could be realigned to enhance its convergence with the five-factor model of personality. Based on our data, we tentatively propose an expanded four-facet model of AMPD Negative Affectivity (Anxiousness, Depressivity, Hostility and Emotional Lability); an alternative bipolar scheme for Detachment that includes two positively keyed (Withdrawal and Anhedonia) and two negatively keyed (Risk Taking and Attention Seeking) facets; a broader five-facet model of Antagonism (Deceitfulness, Manipulativeness, Callousness, Grandiosity and Suspiciousness); and a reduced two-facet model of Disinhibition (Irresponsibility and Impulsivity). These alternative scores generally showed superior convergent and discriminant validity when compared with current measures of the AMPD domains but also raise other issues. Our findings highlight the strong overlap between normal and pathological personality and clarify the nature of the associations between them. © 2019 John Wiley & Sons, Ltd., (© 2019 John Wiley & Sons, Ltd.)

The alternative dimensional model of personality disorder (PD) diagnosis, based on personality-functioning impairment and pathological traits, opens the door for tailoring treatments to individuals with more homogeneous personality profiles than diagnostic categories. Such a transdiagnostic PD treatment approach requires robust, replicable, personality-relevant dimensions, which we found using a large battery of self-report measures: Self-pathology and negative affectivity (NA) traits, interpersonal pathology and detachment traits, and interpersonal pathology and antagonism traits. Using these dimensions, we identified three groups that had, respectively, elevations on (1) all three dimensions, (2) self-pathology/NA (with/without interpersonal-pathology elevation(s)) and (3) either or both interpersonal-pathology dimensions, without elevated self-pathology/NA. Using the same personality-functioning measures and a half-overlapping trait set, we replicated these profiles in an additional sample. Interview-based measures of functioning and personality pathology provided external validity evidence for the method, suggesting it represents a critical first step towards treatment research targeting transdiagnostic processes rather than diagnoses. For example, two groups might benefit from treatments focused, respectively, on emotional dysregulation and interpersonal relations, whereas the multiple-problem group may need a sequenced treatment approach. Research is needed to test these hypotheses and to expand the method to include a wider range of pathological personality traits. © 2019 John Wiley & Sons, Ltd., (© 2019 John Wiley & Sons, Ltd.)

In this update of Clark and Watson (1995), we provide a synopsis of major points of our earlier article and discuss issues in scale construction that have become more salient as clinical and personality assessment has progressed over the past quarter-century. It remains true that the primary goal of scale development is to create valid measures of underlying constructs and that Loevinger's theoretical scheme provides a powerful model for scale development. We still discuss practical issues to help developers maximize their measures' construct validity, reiterating the importance of (a) clear conceptualization of target constructs, (b) an overinclusive initial item pool, (c) paying careful attention to item wording, (d) testing the item pool against closely related constructs, (e) choosing validation samples thoughtfully, and (f) emphasizing unidimensionality over internal consistency. We have added (g) consideration of the hierarchical structures of personality and psychopathology in scale development, discussion of (h) codeveloping scales in the context of these structures, (i) "orphan," and "interstitial" constructs, which do not fit neatly within these structures, (j) problems with "conglomerate" constructs, and (k) developing alternative versions of measures, including short forms, translations, informant versions, and age-based adaptations. Finally, we have expanded our discussions of (l) item-response theory and of external validity, emphasizing (m) convergent and discriminant validity, (n) incremental validity, and (o) cross-method analyses, such as questionnaires and interviews. We conclude by reaffirming that all mature sciences are built on the bedrock of sound measurement and that psychology must redouble its efforts to develop reliable and valid measures. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The categorical model of personality disorder classification in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (5th ed. [ DSM-5 ]; American Psychiatric Association, 2013 ) is highly and fundamentally problematic. Proposed for DSM- 5 and provided within Section III (for Emerging Measures and Models) was the Alternative Model of Personality Disorder (AMPD) classification, consisting of Criterion A (self-interpersonal deficits) and Criterion B (maladaptive personality traits). A proposed alternative to the DSM-5 more generally is an empirically based dimensional organization of psychopathology identified as the Hierarchical Taxonomy of Psychopathology (HiTOP; Kotov et al., 2017 ). HiTOP currently includes, at the highest level, a general factor of psychopathology. Further down are the five domains of detachment, antagonistic externalizing, disinhibited externalizing, thought disorder, and internalizing (along with a provisional sixth somatoform dimension) that align with Criterion B. The purpose of this article is to discuss the potential inclusion and placement of the self-interpersonal deficits of the DSM-5 Section III Criterion A within HiTOP.

The alternative model of personality disorder in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; American Psychiatric Association, 2013), Section III, "Emerging Measures and Models," includes both personality dysfunction and pathological-range traits. However, the nature of personality dysfunction and its relation to pathological-range traits needs further explication. In existing measures, the personality constructs of traits and functioning are highly overlapping. For example, a joint factor analysis of a large set of such measures found 5 factors, 2 of which were composed of both trait and functioning scales (Clark & Ro, 2014); however, the basis for this comingling remains unclear. In this research, we explored whether the comingling was at least partly due to similarity in the scales' item content. Specifically, we examined the affective, behavioral, and cognitive (ABC) composition of 212 items, each of which was rated by subsets of 7 judges. Results indicated that personality trait and functioning scales that load on a common factor have ABC profiles that are similar to each other but distinct from those of scales loading on other factors. These results suggest that combined trait-and-functioning factors emerge partly because of similarities in their scales' item content, despite the fact that the constructs they were intended to assess are theoretically distinct. Thus, ABC profiles may represent basic characteristics of empirical trait-and-functioning factors, suggesting that our conceptualization and/or measurement of these constructs need revision. Drawing from classic trait theory, we suggest that traits and functioning may be complementary rather than distinct. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

It is commonly accepted that gathering information via multiple assessment methods (e.g., interview and questionnaire, self- and informant report) is important for establishing construct validity. Although numerous articles report convergent and discriminant agreement correlations between self- and other ratings of personality, studies of the structure of personality from such ratings are less common. The present study addresses this gap using a meta-analytic data set ( N range = 157-9,295) of various versions (i.e., self- and other-report, full-length and short alternative format) of the Schedule for Nonadaptive and Adaptive Personality (SNAP; Clark, 1993; Clark, Simms, Wu, & Casillas, 2014). We hypothesized that (a) structures across all measure formats would be highly comparable and (b) to the extent that they were dissimilar, perspective (self vs. other) and measure format (long vs. short form), respectively, would influence comparability. Results revealed strong congruence among 3-factor structures (Negative Emotionality, Positive Emotionality, and Disinhibition vs. Constraint) across all versions of the SNAP, suggesting that personality as assessed by this broad measure of personality traits across the normal-abnormal spectrum has a robust structure across different rater perspectives and rating formats. Because the comparability analyses were highly congruent and differences among the comparisons were minimal, we concluded-contrary to our expectations-that different formats and different rater perspectives have little effect on structural comparability. Results generally support Funder's (1995) realistic accuracy model, suggesting that trait relevance, cue detection, and information usage are key factors in structuring informant ratings. Limitations of the present study and implications for future research are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Impairment in personality functioning (briefly, personality impairment) is the core pathology in personality disorder (PD) and an essential indicator of PD-severity. It also is a difficult construct to define and assess. We argue that personality-impairment severity is a latent construct that can be modeled with four indicators: within-PD comorbidity, problematic course/prognosis of both PD and comorbid clinical syndromes, PD-associated psychosocial dysfunction, and features of DSM-5-II borderline PD (BPD). Our literature review documents interrelations among the first three indicators, and studies of PD structure reveal a higher order factor of general PD severity marked most strongly by BPD features. Together, these findings indicate that BPD features may be helpful in the important tasks of defining and assessing personality-impairment severity., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

It is widely known that personality traits collectively discussed as the Dark Triad are antagonistic and associated with poor interpersonal relationships, but few studies have examined how specific facets of antagonism are associated with psychosocial adjustment or how antagonism relates to psychosocial adjustment other than interpersonal functioning. The purpose of this study was to examine how 6 antagonism facets-manipulativeness, grandiosity, attention-seeking, hostility, callousness, and deceitfulness-relate to comprehensive psychosocial functional domains (i.e., well-being, interpersonal relationships, basic daily functioning) using information about both antagonism and functioning from 3 sources-self, informant, and interviewer. Data were from 318 primary participants and informants. We present 3 main findings: (1) When psychosocial functioning and antagonism traits were both rated by informants, all psychosocial disability domains were consistently positively associated with antagonism traits. (2) We next created a single psychosocial-disability factor score via principal factors analysis of all raters' psychosocial-functioning scores. When all 3 raters' reports of domain-level antagonism were used as independent variables in a simultaneous regression analysis to predict this overall functioning score, informant-reported antagonism most strongly predicted psychosocial functioning, followed by interviewer-rated antagonism. (3) We then created 6 facet scores by summing the 3 raters' scores on each. When we used these scores to predict psychosocial functioning, hostility was the main trait significantly predicting psychosocial functioning. The study provides further insight into associations of psychosocial disability with antagonism facets from different raters' perspectives. The findings thus further our understanding of psychosocial outcomes associated with antagonism, the core of the dark traits. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)

The primary goal of this study was to explicate the construct validity of the Narcissistic Personality Inventory (NPI) and the Hypomanic Personality Scale (HPS) by examining their relations both to each other and to measures of personality and psychopathology in a community sample ( N = 255). Structural evidence indicates that the NPI is defined by Leadership/Authority, Grandiose Exhibitionism, and Entitlement/Exploitativeness factors, whereas the HPS is characterized by specific dimensions reflecting Social Vitality, Mood Volatility, and Excitement. Our results establish that (a) factor-based subscales from these instruments display divergent patterns of relations that are obscured when relying exclusively on total scores and (b) some NPI and HPS subscales more clearly tap content specifically relevant to narcissism and mania, respectively, than others. In particular, our findings challenge the construct validity of the NPI Leadership/Authority and HPS Social Vitality subscales, which appear to assess overlapping assertiveness content that is largely adaptive in nature.

Recent editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013) conceptualize personality disorders (PDs) as categorical constructs, but high PD co-occurrence suggests underlying latent dimensions. Moreover, several borderline PD criteria resemble Criterion A of the new DSM-5 Section III general criteria for personality pathology (i.e., self and interpersonal dysfunction). We evaluated a bifactor model of PD pathology in which a general factor and several specific factors of personality pathology (PD 'g' and 's' factors, respectively) account for the covariance among PD criteria. In particular, we examined the extent to which the borderline PD criteria would load exclusively onto the g-factor versus on both the g- and one or more s-factors. A large (N = 966) sample of inpatients were interviewed for six DSM-IV (American Psychiatric Association, 1994) PDs using the (Structured Clinical Interview for Personality Disorders (SCID-II; First, Spitzer, Gibbon, Williams, & Benjamin, 1994) with no skip-outs. We ran a series of confirmatory, exploratory, and bifactor exploratory factor analyses on the rated PD criteria. The confirmatory analysis largely replicated the DSM PDs, but with high factor correlations. The "standard" exploratory analysis replicated four of the DSM PDs fairly well, but nearly half the criteria cross-loaded. In the bifactor analysis, borderline PD criteria loaded only on the general factor; the remaining PDs loaded either on both the general and a specific factor or largely only on a specific factor. Results are interpreted in the context of several possibilities to define the nature of the general factor., ((c) 2015 APA, all rights reserved).)

The pervasive effect of personality disorder is often overlooked in clinical practice, both as an important moderator of mental state and physical disorders, and as a disorder that should be recognised and managed in its own right. Contemporary research has shown that maladaptive personality (when personality traits are extreme and associated with clinical distress or psychosocial impairment) is common, can be recognised early in life, evolves continuously across the lifespan, and is more plastic than previously believed. These new insights offer opportunities to intervene to support more adaptive development than before, and research shows that such intervention can be effective. Further research is needed to improve classification, assessment, and diagnosis of personality disorder across the lifespan; to understand the complex interplay between changes in personality traits and clinical presentation over time; and to promote more effective intervention at the earliest possible stage of the disorder than is done at present. Recognition of how personality disorder relates to age and developmental stage can improve care of all patients., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

The Schedule for Nonadaptive and Adaptive Personality full-length (SNAP) and short versions (SNAP-SRF and SNAP-ORF) were developed as measures of normal-range and more pathological personality traits. This study investigated the validity of the SNAP Brief Self-Description Rating Form (SNAP-BSRF), an alternative version of the SNAP Self-Description Rating Form (SNAP-SRF) revised for further brevity. The scales of the SNAP-BSRF showed good convergence with the SNAP-SRF and the SNAP Other-Description Rating Form (SNAP-ORF) scales. A three-factor structure consistent with extant literature was found for the SNAP-BSRF using an exploratory structural equation modeling approach. Scales from the SNAP-BSRF showed meaningful associations with self-reported internalizing symptoms. Results suggest that this new version is a reasonable substitute for the SNAP-SRF and will be useful when a very brief measure of adaptive and maladaptive personality is needed., (© The Author(s) 2014.)

In the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; American Psychiatric Association, 2013) personality disorder trait model, maladaptive behavior is located at one end of continuous scales. Widiger and colleagues, however, have argued that maladaptive behavior exists at both ends of trait continua. We propose that the role of evaluative variance differentiates these two perspectives and that once evaluation is isolated, maladaptive behaviors emerge at both ends of nonevaluative trait dimensions. In Study 1, we argue that evaluative variance is worthwhile to measure separately from descriptive content because it clusters items by valence regardless of content (e.g., lazy and workaholic; apathetic and anxious; gullible and paranoid; timid and hostile, etc.), which is unlikely to describe a consistent behavioral style. We isolate evaluation statistically (Study 2) and at the time of measurement (Study 3) to show that factors unrelated to valence evidence maladaptive behavior at both ends. We argue that nonevaluative factors, which display maladaptive behavior at both ends of continua, may better approximate ways in which individuals actually behave.

The alternative dimensional model of personality disorder (PD) in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5; American Psychiatric Association, 2013), Section III, has two main criteria: impairment in personality functioning and one or more pathological personality traits. The former is defined as disturbances in self-functioning (viz., identity, self-direction), and/or interpersonal functioning (viz., empathy, intimacy). Distinguishing personality functioning and traits is important conceptually, because simply having extreme traits is not necessarily pathological. However, adding personality functioning to PD diagnosis represents an empirical challenge, because the constructs overlap conceptually. Further, there is debate regarding whether diagnosis of mental disorder requires either distress or disability, concepts that also overlap with maladaptive-range personality traits and personality dysfunction. We investigated interrelations among these constructs using multiple self-report measures of each domain in a mixed community-patient sample (N = 402). We examined the structures of functioning (psychosocial disability and personality) and personality traits, first independently, then jointly. The disability/functioning measures yielded the 3 dimensions we have found previously (Ro & Clark, 2013). Trait measures had a hierarchical structure which, at the 5-factor level, reflected neuroticism/negative affectivity (N/NA), (low) sociability, disinhibition, (dis)agreeableness, and rigid goal engagement. When all measures were cofactored, a hierarchical structure again emerged which, at the 5-factor level, included (a) internalizing (N/NA and self-pathology vs. quality-of-life/satisfaction); (b) externalizing (social/interpersonal dysfunction, low sociability, and disagreeableness); (c) disinhibition; (d) poor basic functioning; and (e) rigid goal engagement. Results are discussed in terms of developing an integrated PD diagnostic model.

Comments on the original article by Gunderson (see record 2013-45025-012). This commentary has three sections: (a) gratitude and agreements, (b) factual issues, and (c) disagreements. Clark first acknowledges potential conflicts of interest: She was a work group (WG) member for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013). Clark is also the author of a trait-dimensional measure for personality disorder (PD) assessment, and she has worked for PD trait-dimensional diagnosis since 1980, when she was shocked to learn that although the third edition of the DSM (American Psychiatric Association, 1980) defined PD in terms of maladaptive traits, PD diagnosis was not based systematically on traits., (PsycINFO Database Record (c) 2013 APA, all rights reserved.)

The Schedule for Nonadaptive and Adaptive Personality-Youth Version (SNAP-Y) is a new, reliable self-report questionnaire that assesses 15 personality traits relevant to both normal-range personality and the alternative DSM-5 model for personality disorder. Community adolescents, 12 to 18 years old (N = 364), completed the SNAP-Y; 347 also completed the Big Five Inventory-Adolescent, 144 provided 2-week retest data, and 128 others completed the Minnesota Multiphasic Personality Inventory-Adolescent. Outpatient adolescents (N = 103) completed the SNAP-Y, and 97 also completed the Minnesota Multiphasic Personality Inventory-Adolescent. The SNAP-Y demonstrated strong psychometric properties, and structural, convergent, discriminant, and external validities. Consistent with the continuity of personality, results paralleled those in adult and college samples using the adult Schedule for Nonadaptive and Adaptive Personality-Second Edition (SNAP-2), from which the SNAP-Y derives and which has established validity in personality-trait assessment across the normal-abnormal continuum. The SNAP-Y thus provides a new, clinically useful instrument to assess personality traits and personality pathology in adolescents.

Decrements in one or more domains of psychosocial functioning (e.g., poor job performance, poor interpersonal relations) are commonly observed in psychiatric patients. The purpose of this study is to increase understanding of psychosocial functioning as a broad, multifaceted construct as well as its associations with both adaptive- and maladaptive-range personality traits in both nonclinical and psychiatric outpatient samples. The study was conducted in two phases. In Study 1, a nonclinical sample (N = 429) was administered seven psychosocial functioning and adaptive-range personality trait measures. In Study 2, psychiatric outpatients (N = 181) were administered the same psychosocial functioning measures, and maladaptive- as well as adaptive-range personality trait measures. Exploratory (both studies) and confirmatory (Study 2) factor analyses indicated a common three-factor, hierarchical structure of psychosocial functioning-Well Being, Social/Interpersonal Functioning, and Basic Functioning. These psychosocial functioning domains were closely--and differentially--linked with personality traits, especially strongly so in patients. Across samples, Well Being was associated with both Neuroticism/Negative Affectivity and Extraversion/Positive Affectivity, Social/Interpersonal Functioning was associated with both Agreeableness and Conscientiousness/Disinhibition, and Basic Functioning was associated with Conscientiousness/Disinhibition, although only modestly in the nonclinical sample. These relations generally were maintained even after partialing out current general dysphoric symptoms. These findings have implications for considering psychosocial functioning as an important third domain in a tripartite model together with personality and psychopathology., (PsycINFO Database Record (c) 2013 APA, all rights reserved.)

The Personality Inventory for DSM-5 (PID-5) assesses traits relevant for diagnosing personality disorder in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). We examined the PID-5 in relation to the Big-Three and Big-Five personality traits in outpatient and community adult samples. Domain-level analyses revealed that PID-5 Negative Affectivity correlated strongly with Neuroticism, and PID-5 Antagonism and Disinhibition correlated strongly negatively with Agreeableness and Conscientiousness, respectively; Antagonism and Disinhibition also were both linked strongly to Big-Three trait Disinhibition. PID-5 Detachment related strongly to personality, including Extraversion/Positive Temperament, but did not show its expected specificity to this factor. Finally, PID-5 Psychoticism correlated only modestly with Openness. Facet-level analyses indicated that some PID-5 scales demonstrated replicable deviations from their DSM-5 model placements. We discuss implications of these data for the DSM-5 model of personality disorder, and for integrating it with well-established structures of normal personality.

Recently, integrative, hierarchical models of personality and personality disorder (PD)--such as the Big Three, Big Four, and Big Five trait models--have gained support as a unifying dimensional framework for describing PD. However, no measures to date can simultaneously represent each of these potentially interesting levels of the personality hierarchy. To unify these measurement models psychometrically, we sought to develop Big Five trait scales within the Schedule for Nonadaptive and Adaptive Personality--Second Edition (SNAP-2). Through structural and content analyses, we examined relations between the SNAP-2, the Big Five Inventory (BFI), and the NEO Five-Factor Inventory (NEO-FFI) ratings in a large data set (N = 8,690), including clinical, military, college, and community participants. Results yielded scales consistent with the Big Four model of personality (i.e., Neuroticism, Conscientiousness, Introversion, and Antagonism) and not the Big Five, as there were insufficient items related to Openness. Resulting scale scores demonstrated strong internal consistency and temporal stability. Structural validity and external validity were supported by strong convergent and discriminant validity patterns between Big Four scale scores and other personality trait scores and expectable patterns of self-peer agreement. Descriptive statistics and community-based norms are provided. The SNAP-2 Big Four Scales enable researchers and clinicians to assess personality at multiple levels of the trait hierarchy and facilitate comparisons among competing big-trait models., (PsycINFO Database Record (c) 2012 APA, all rights reserved.)

The DSM-IV model of personality disorders is composed of trait sets arranged into 10 theoretically distinct, polythetically assessed categories, with little regard for how the traits comprising these disorders are interrelated and structured. Research since the publication of DSM-III has shown that this model is untenable. The question is not whether this model needs revision; rather, the question is how to move from the existing DSM-IV framework to a model better connected with data. Empirically-based models of personality trait variation provide a starting point for DSM-5, and ongoing research will be used to delineate further the empirical structure of personality traits in the pathological range. The ultimate goal is to frame future DSMs in a way that is maximally useful for clinicians as well as researchers. It is also critical to understand that the DSM-5 is intended to be a living document that will facilitate novel inquiry and clinical applications, as opposed to a document designed to promote and perpetuate a fixed set of constructs. Thus, we view a proposed trait system as a first step on a path to a well-validated, clinically-useful structure.

The Personality and Personality Disorders Work Group has proposed five specific personality disorder (PD) types for DSM-5, to be rated on a dimension of fit: antisocial/psychopathic, avoidant, borderline, obsessive-compulsive, and schizotypal. Each type is identified by core impairments in personality functioning, pathological personality traits, and common symptomatic behaviors. The other DSM-IV-TR PDs and the large residual category of personality disorder not otherwise specified (PDNOS) will be represented solely by the core impairments combined with specification by individuals' unique sets of personality traits. This proposal has three main features: (1) a reduction in the number of specified types from 10 to 5; (2) description of the types in a narrative format that combines typical deficits in self and interpersonal functioning and particular configurations of traits and behaviors; and (3) a dimensional rating of the degree to which a patient matches each type. An explanation of these modifications in approach to diagnosing PD types and their justifications--including excessive co-morbidity among DSM-IV-TR PDs, limited validity for some existing types, lack of specificity in the definition of PD, instability of current PD criteria sets, and arbitrary diagnostic thresholds--are the subjects of this review.

A major reconceptualization of personality psychopathology has been proposed for DSM-5 that identifies core impairments in personality functioning, pathological personality traits, and prominent pathological personality types. A comprehensive personality assessment consists of four components: levels of personality functioning, personality disorder types, pathological personality trait domains and facets, and general criteria for personality disorder. This four-part assessment focuses attention on identifying personality psychopathology with increasing degrees of specificity, based on a clinician's available time, information, and expertise. In Part I of this two-part article, we describe the components of the new model and present brief theoretical and empirical rationales for each. In Part II, we will illustrate the clinical application of the model with vignettes of patients with varying degrees of personality psychopathology, to show how assessments might be conducted and diagnoses reached.

The four-part assessment of personality psychopathology proposed for DSM-5 focuses attention on identifying personality psychopathology with increasing degrees of specificity, based on a clinician's available time, information, and expertise. In Part I of this two-part article, we described the components of the new model and presented brief rationales for them. In Part II, we illustrate the clinical application of the model with vignettes of patients with varying degrees of personality psychopathology, selected from the DSM-IV-TR Casebook, to show how assessments might be conducted and diagnoses reached.

The Diagnostic and Statistical Manual of Mental Disorders (DSM–IV–TR) currently conceptualizes personality disorders (PDs) as categorical syndromes that are distinct from normal personality. However, an alternative dimensional viewpoint is that PDs are maladaptive expressions of general personality traits. The dimensional perspective postulates that personality pathology exists at a more extreme level of the latent trait than does general personality. This hypothesis was examined using item response theory analyses comparing scales from two personality pathology instruments—the Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ; Livesley & Jackson, in press) and the Schedule for Nonadaptive and Adaptive Personality (SNAP; Clark, 1993; Clark, Simms, Wu, & Casillas, in press)—with scales from an instrument designed to assess normal range personality, the NEO Personality Inventory–Revised (NEO PI-R; Costa & McCrae, 1992). The results indicate that respective scales from these instruments assess shared latent constructs, with the NEO PI-R providing more information at the lower (normal) range and the DAPP-BQ and SNAP providing more information at the higher (abnormal) range. Nevertheless, the results also demonstrated substantial overlap in coverage. Implications of the findings are discussed with respect to the study and development of items that would provide specific discriminations along underlying trait continua.

Psychological assessment research concerns how to describe psychological dysfunction in ways that are both valid and useful. Recent advances in assessment research hold the promise of facilitating significant improvements in description and diagnosis. One such contribution is in the classification of personality disorder symptomatology. The American Psychiatric Association's diagnostic manual considers personality disorders to be categorically distinct entities. However, research assessing personality disorders has consistently supported a dimensional perspective. Recognition of the many limitations of categorical models of personality disorder classification has led to the development of a variety of alternative proposals, which further research has indicated can be integrated within a common hierarchical structure. This article offers an alternative integrated dimensional model of normal and abnormal personality structure, and it illustrates how such a model could be used clinically to describe patients' normal adaptive personality traits as well as their maladaptive personality traits that could provide the basis for future assessments of personality disorder. The empirical support, feasibility, and clinical utility of the proposal are discussed. Points of ambiguity and dispute are highlighted, and suggestions for future research are provided., (Copyright 2009 APA, all rights reserved.)

The broad personality trait of disinhibition reflects the tendency to behave in an underconstrained versus overconstrained manner and is associated with externalizing psychopathology and risk-taking behaviors. This article describes the development and initial validation of the Disinhibition Inventory (DIS-I), a multifaceted measure of disinhibition that helps explicate the nature of this important higher-order dimension more fully. Factor analyses of an initial item pool resulted in five content-distinct, yet correlated scales measuring both high (Manipulativeness, Distractibility, Risk Taking) and low (Prosociality, Orderliness) levels of disinhibition that cross-validated in an independent sample. Evidence for the construct validity of the DIS-I is presented, including convergent and discriminant relations with Big-Three and Big-Five/five-factor model measures of personality. Results indicate that the DIS-I scales are associated most strongly with other measures of disinhibition, but that the DIS-I additionally contains content absent in extant adult measures of disinhibition that may prove useful in the assessment of externalizing psychopathology.

There is increasing agreement that the current categorical system of personality disorders (PDs) in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 2000) should be replaced by a trait dimensional scheme in DSM-V. In particular, the consensus appears to be converging on a hierarchical Big Four model. The broad factors that form the apex of this hierarchy are essentially maladaptive variants of the Big Five traits of normal personality, minus Openness. We argue that this Big Four model is incomplete, however, in that it fails to model characteristics related to the "odd or eccentric" Cluster A PDs adequately. We report the results of three studies that examine these odd, eccentric characteristics in relation to basic dimensions of normal and abnormal personality. The results of these studies establish the existence of an Oddity factor that is (a) broader than the Cluster A traits and (b) distinct from Openness and the other Big Five dimensions. Consequently, its addition yields an alternative five-factor model of personality pathology (considering only abnormal traits) and an expanded, integrated Big Six taxonomy that subsumes both normal and abnormal personality characteristics.

This chapter reviews recent (2000-2005) personality disorder (PD) research, focusing on three major domains: assessment, comorbidity, and stability. (a) Substantial evidence has accrued favoring dimensional over categorical conceptualization of PD, and the five-factor model of personality is prominent as an integrating framework. Future directions include assessing dysfunction separately from traits and learning to utilize collateral information. (b) To address the pervasiveness and extent of comorbidity, researchers have begun to move beyond studying overlapping pairs or small sets of disorders and are developing broader, more integrated common-factor models that cross the Axis I-Axis II boundary. (c) Studies of PD stability have converged on the finding that PD features include both more acute, dysfunctional behaviors that resolve in relatively short periods, and maladaptive temperamental traits that are relatively more stable-similar to normal-range personality traits-with increasing stability until after 50 years of age. A new model for assessing PD-and perhaps all psychopathology-emerges from integrating these interrelated reconceptualizations.

Personality and psychopathology long have been viewed as related domains, but the precise nature of their relations remains unclear. Through most of the 20th century, they were studied as separate fields; within psychopathology, clinical syndromes were separated from personality disorders in 1980. This division led to the revelation of substantial overlap among disorders both within and across axes and to the joint study of normal and abnormal personality. The author reviews these literatures and proposes an integrative framework to explain personality-psychopathology relations: Three broad, innate temperament dimensions--negative affectivity, positive affectivity, and disinhibition--differentiate through both biologically and environmentally based developmental processes into a hierarchical personality trait structure and, at their extremes, are risk factors (diatheses) for psychopathology, especially given adverse life experiences (stress)., (Copyright (c) 2005 APA, all rights reserved.)

Three major longitudinal studies of personality disorder jointly provide new insights into the nature of stability and change in this important domain of psychopathology. This commentary highlights some of the many convergent results, which indicate robust findings that can be considered "established," and also differences in the studies' purposes and methods that permit each study to make unique contributions. One of the most important findings across the studies is that DSM- diagnosed personality disorder is not as stable as the characteristic traits that underlie personality pathology, leading to the insight that DSM personality disorders are hybrids of more acute, "Axis I-like" symptoms that resolve more quickly and longer lasting affective, cognitive, and behavioral personality dysfunctions. Implications for future research are considered.

Conceptual overlap and heterogeneity have long been noted as weaknesses of the Minnesota Multiphasic Personality Inventory's clinical scales. Restructured clinical (RC) scales recently were developed to address these concerns (A. Tellegen et al., 2003). The authors evaluated the psychometric properties of the RC scales in psychology clinic clients (N=285) and military veterans (N=567). The RC scales were as internally consistent as the clinical scales and correlated strongly with their original counterparts (except for RC3/Hysteria). They also were less intercorrelated, produced conceptually clearer relations with measures of personality and psychopathology, and yielded somewhat greater incremental utility than the clinical scales. Thus, the RC scales demonstrated several psychometric strengths while utilizing 60% fewer items, but the 2 sets of scales cannot be used interchangeably. Interpretive considerations are discussed.

The authors tested neighborhood context, negative life events, and negative affectivity as predictors of the onset of major depression among 720 African American women. Neighborhood-level economic disadvantage (e.g., percentage of residents below the poverty line) and social disorder (e.g., delinquency, drug use) predicted the onset of major depression when controlling for individual-level demographic characteristics. Neighborhood-level disadvantage/disorder interacted with negative life events, such that women who experienced recent negative life events and lived in high disadvantage/disorder neighborhoods were more likely to become depressed than were those who lived in more benign settings, both concurrently and over a 2-year period. Neighborhood disadvantage/disorder can be viewed as a vulnerability factor that increases susceptibility to depression following the experience of negative life events., (Copyright (c) 2005 APA, all rights reserved.)

Results have been inconsistent regarding the ability of personality measures to predict future depression severity levels, leading some researchers to question the validity of personality assessment, especially when patients are acutely depressed. Using a combination of regression and factor analytic techniques, we separated the variance of personality measures into stable trait and variable state-affect components. Findings supported the hypotheses that depression severity measured at different time points would correlate with both stable trait and concurrent state-affect components in personality measures, whereas change in depression severity would correlate with state changes but not with stable trait scores. Thus, personality assessments tap both state affect and trait variance, with the state-affect variance masking the trait variance when patients are depressed.

The authors examined the level and structure of the Inventory of Interpersonal Problems-Circumplex version (IIP-C; L. M. Horowitz, L. E. Alden, J. S. Wiggins, & A. L. Pincus, 2000) before and after 20 sessions of acute-phase cognitive therapy for depression (N = 118), as well as associations with the Schedule for Nonadaptive and Adaptive Personality (L. A. Clark, 1993b) and the Social Adjustment Scale--Self-Report version (M. M. Weissman & S. Bothwell, 1976). Interpersonal problems had a 3-factor structure (Interpersonal Distress, Love, and Dominance), with the latter 2 factors approximating a circumplex, both before and after therapy. Interpersonal Distress decreased and social adjustment increased with therapy, but the Love and Dominance dimensions were relatively stable, similar to personality constructs. Social adjustment related negatively to Interpersonal Distress but not to Love or Dominance. Personality pathology related broadly to Interpersonal Distress and discriminantly to Love and Dominance. These findings support the reliability and validity of the IIP-C and are discussed in the context of personality theory and measurement.

Cluster B personality disorders (PDs) (i.e., antisocial, borderline, histrionic, and narcissistic) typically show a high degree of comorbidity with substance use disorders (SUDs). Previous research suggests that the broad-based personality domains of Disinhibition and Negative Temperament/Neuroticism may be common factors to both types of disorders. Using a two-phase process (i.e., screening and follow-up), this study examined three lower-order personality traits (i.e., dependency, impulsivity, and self-harm) that fall within the Disinhibition and Neuroticism domains. The study evaluated the hypotheses that these traits (a) are related both to cluster B PDs and to SUDs; and (b) underlie the association between the two types of disorders. Results indicate that impulsivity and self-harm play a significant role in cluster B PDs and SUDs, as well as in their association with each other. However, dependency was not associated with either type of disorder. These results indicate that sets of individual traits can be of significant utility in understanding the comorbidity between PDs and SUDs.

This article outlines the Phase 1 efforts of the HiTOP Measure Development group for externalizing constructs, which include disinhibited externalizing, antagonistic externalizing, attention deficit hyperactivity disorder, substance use, and externalizing/maladaptive behaviors. We provide background on the constructs included and the process and issues involved in developing a measure for this diverse range of psychopathology symptoms, traits, and behaviors. [ABSTRACT FROM AUTHOR]

The ICD-11 personality disorder model is the first fully dimensional assessment of personality pathology. It consists of a personality disorder (PD) dysfunction-severity dimension, which encompasses both self- and interpersonal dysfunction, and six optional qualifiers for five prominent personality traits—Negative Affectivity (NA), Detachment (DET), Dissociality (DSL), Disinhibition (DSN), and Anankastia (ANK)—plus a borderline pattern that is defined by the criteria of DSM-IV borderline PD. This article reports on the development of a new self-report measure to assess self- and interpersonal dysfunction and the five trait qualifiers. It is the first comprehensive measure of the ICD-11 PD model in that (a) it is the only one to include both PD dysfunction-severity as well as trait scales and because (b) it is based on the Clinical Description and Diagnostic Guidelines, which are more detailed than the "statistical" model description that is currently on the ICD-11 website. The authors wrote 992 items and then reduced the pool to 300 items by eliminating redundancy and selecting the consensus best few items for each subconstruct. Data were collected using an online sample of 383 Prolific workers. Using exploratory factor analysis, seven domain scales were developed, each of which contained two to four scales assessing components of the domain. These preliminary scales' psychometrics were excellent, as were the domains' and their components' convergent and discriminant validity, with a few generally minor exceptions. Structural analyses at the component level revealed a three-factor structure consisting of two moderately correlated Internalizing factors, one centered on Self Dysfunction with two NA components and a DSN component (Distractibility) and the other on Interpersonal Dysfunction with DET and ANK components; as well as an Externalizing factor with DSL and a DSN component (Reckless Impulsivity) that was uncorrelated with the other two factors. Two aspects of the results in particular are striking: (1) ANK was not the opposite end of a DSN dimension, but rather contributed to an Internalizing Interpersonal Dysfunction dimension and (2) DSN had both an Internalizing and an Externalizing component. Implications of the findings and study limitations are discussed. [ABSTRACT FROM AUTHOR]

Purpose A core element of Schema Therapy ( ST) is 'schema modes' or fluctuating emotional states. ST assumes that particular personality pathology consists of specific combinations of maladaptive schema modes. There is confirmatory evidence for the modes hypothesized to be central to borderline and narcissistic personality disorder ( PD) in non-forensic patients. In this study, we tested three aspects of the construct validity of schema modes in cluster- B personality disordered offenders, examining its factorial validity, and the relations among personality disorders and violence risk. Method Our sample consisted of 70 offenders who were diagnosed with an antisocial, borderline, or narcissistic PD. Schema modes were assessed with the Schema Mode Inventory ( SMI), personality disorders with the Schedule for Nonadaptive and Adaptive Personality-Forensic Version ( SNAP- FV), and violence risk with the Historical, Clinical, and Risk management scheme ( HCR-20V2). Results When controlling for the two other PDs, three schema mode factors distinguished antisocial PD as a disorder involving both low scores on internalizing and high scores on externalizing modes, and borderline PD as involving high scores on internalizing modes. Furthermore, the externalizing schema modes were a significant predictor for violence risk inside the hospital. Conclusions The hypothesized mode models were partially supported for all three PDs. The findings thus provide some support for the construct validity of schema modes in a forensic sample. [ABSTRACT FROM AUTHOR]

The article presents the response of the team led by Peter Tyrer who developed a classification of personality disorders (PDs) to be incorporated into the International Classification of Diseases and Related Health Problems, 11th Edition (ICD-11). It stresses the team's definition of severity as a pattern of general impairment in human relationships that prevent mutual understanding. The article also argues that the revised classification synthesizes the advances made in the past 30 years.