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The International Classification of Diseases–11th revision (ICD-11) classification of personality disorders is the official diagnostic system that is used all over the world, and it has recently been renewed. However, as yet very few data are available on its performance. This study examines the Personality Inventory for ICD-11 (PiCD), which assesses the personality domains of the system, and the Standardized Assessment of Severity of Personality Disorder (SASPD), which determines severity. The Spanish versions of the questionnaires were administered to a community (n = 2,522) and a clinical sample (n = 797). Internal consistency was adequate in the PiCD (α =.75 to.84) but less so in the SASPD (α =.64 and.73). Factor analyses suggested a unidimensional or bidimensional structure for severity, while revealing that the personality trait qualifiers are organized into four factors: negative affectivity, detachment, dissociality, and a bipolar domain of disinhibition–anankastia. The mutual relationships between traits and severity were analyzed, as well as the ability of the whole system to identify clinical subjects. Although further improvements are required, the results generally support the use of the PiCD and the SASPD and help substantiate the new ICD-11 taxonomy that underlies them., This work was supported by project PI15/00536, part of the Plan Estatal de Investigación Científica y Técnica y de Innovación 2013-2016, financed by the ISCIII Subdirección General de Evaluación and the cofinanced by the European Regional Development Fund (ERDF, “A way to build Europe”; PI: F. Gutiérrez)

The promise of replacing the diagnostic categories of personality disorder with a better-grounded system has been only partially met. We still need to understand whether our main dimensional taxonomies, those of the International Classification of Diseases, 11th Revision (ICD-11) and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), are the same or different, and elucidate whether a unified structure is possible. We also need truly independent pathological domains, as they have shown unacceptable overlap so far. To inquire into these points, the Personality Inventory for DSM-5 (PID-5) and the Personality Inventory for ICD-11 (PiCD) were administered to 677 outpatients. Disattenuated correlation coefficients between 0.84 and 0.93 revealed that both systems share four analogous traits: negative affectivity, detachment, dissociality/antagonism, and disinhibition. These traits proved scalar equivalence too, such that scores in the two questionnaires are roughly interchangeable. These four domains plus psychoticism formed a theoretically consistent and well-fitted five-factor structure, but they overlapped considerably, thereby reducing discriminant validity. Only after the extraction of a general personality disorder factor (g-PD) through bifactor analysis, we could attain a comprehensive model bearing mutually independent traits.

The many studies examining the relationship between anorexia nervosa (AN) and personality abnormalities have observed high comorbidity. However, no definitive studies to date have established whether there is a causal connection or whether it is a complication. The current study aimed to explore the nature of the relationship between personality disorder (PD) traits, obsessionality and perfectionism, using a study design that allows the testing of some comorbidity models. Twenty-nine women were recruited from a group of former AN patients treated during their adolescence in a specialized unit around 20 years before the time of this study. They were divided into two groups according to the current presence of eating disorder (ED) symptoms (current-ED, n = 11; recovered, n = 18). Both groups were compared to a matched control group (n = 29) regarding current PD traits, obsessive beliefs and perfectionism. Borderline PD traits, most cluster C PD traits and overestimation of threat were more common in the current-ED group than in the control and recovered groups. Obsessive–compulsive PD traits, intolerance of uncertainty, and perfectionism were also significantly more prevalent in the current-ED group compared to controls but did not reach significance when compared to the recovered group. No significant differences were found between the recovered and control groups. Our results mostly support the personality abnormalities observed as a transient effect related to the presence of ED psychopathology in patients with adolescent-onset AN. Level III, case–control analytic studies.

Background On the way toward an agreed dimensional taxonomy for personality disorders (PD), several pivotal questions remain unresolved. We need to know which dimensions produce problems and in what domains of life; whether impairment can be found at one or both extremes of each dimension; and whether, as is increasingly advocated, some dimensions measure personality functioning whereas others reflect style. Method To gain this understanding, we administered the Temperament and Character Inventory to a sample of 862 consecutively attended outpatients, mainly with PDs (61.2%). Using regression analysis, we examined the ability of personality to predict 39 variables from the Life Outcome Questionnaire concerning career, relationships, and mental health. Results Persistence stood out as the most important dimension regarding career success, with 24.2% of explained variance on average. Self-directedness was the best predictor of social functioning (21.1%), and harm avoidance regarding clinical problems (34.2%). Interpersonal dimensions such as reward dependence and cooperativeness were mostly inconsequential. In general, dimensions were detrimental only in one of their poles. Conclusions Although personality explains 9.4% of life problems overall, dimensions believed to measure functioning (character) were not better predictors than those measuring style (temperament). The notion that PD diagnoses can be built upon the concept of “personality functioning” is unsupported.

Personality variation is increasingly thought to have an adaptive function. This is less clear for personality disorders (PDs)—extreme variants of personality that cause harm in most aspects of life. However, the possibility that PDs may be maintained in the population because of their advantages for fitness has been not convincingly tested. In a sample of 959 outpatients, we examined whether, and how, sexual selection acts on the seven main dimensions of personality pathology, taking into account mating success, reproductive success, and the mediating role of status. We find that, to varying extents, all personality dimensions are under sexual selection. Far from being predominantly purifying, selective forces push traits in diverging, often pathological, directions. These pressures differ moderately between the sexes. Sexual selection largely acts in males through the acquisition of wealth, and through the duration (rather than the number) of mates. This gives a reproductive advantage to males high in persistence–compulsivity. Conversely, because of the decoupling between the number of mates and offspring, the promiscuous strategy of psychopaths is not so successful. Negative emotionality, the most clinically detrimental trait, is slightly deleterious in males but is positively selected in females, which can help to preserve variation. The general picture is that at least some PDs form part of high-risk alternative strategies, although a sole evolutionary mechanism is unlikely to apply to all traits. An evolutionary perspective on PDs can provide a better understanding of their nature and causes than we have achieved to date by considering them as illnesses.

A dimensional classification seems to be the next move in the personality disorders field. However, it is not clear whether there is one dimensional model or many, or whether the currently available dimensional instruments measure the same traits. To help clarify these issues, the authors administered the Personality Inventory for DSM-5 (PID-5) and the Dimensional Assessment of Personality Pathology (DAPP-BQ) to 414 psychiatric outpatients. Factor analyses showed that a common hierarchical structure underlies both instruments, even if each one measures slightly different aspects of it. Disattenuated correlations indicated that, at the lower order level, two thirds of the PID-5 and DAPP-BQ facets measure essentially the same traits, although the pairings were not exactly as predicted. Among higher order domains, only PID Negative Affectivity and Detachment converged unambiguously with DAPP Emotional Dysregulation and Inhibition. Overall, the PID-5 and the DAPP-BQ reflect, with small divergences, one and the same structure of pathological personality traits.

Personality Disorders have proved to be more fluid through the life course than previously thought. However, because analyses have usually been undertaken at the level of diagnostic categories, relevant findings may be obscured. An examination at the criteria level could bypass arbitrary aggregations of heterogeneous traits and thus offer more accurate information. To this end, we administered the Personality Diagnostic Questionnaire-4+ (PDQ-4+) to 1,477 patients aged 15 to 82. Nine of 12 disorders declined to some extent over the lifespan, but the evolution of individual criteria diverged within categories. At this level, 45 of 93 criteria showed age-related decreases, whereas only seven presented increases. A clearer picture is offered of the PD traits that change and those that remain stable. Thus, pathological features are not only more fluid, but developmentally more heterogeneous than previously believed.

Objectives Dimensional pathology models are increasingly being accepted for the assessment of disordered personalities, but their ability to predict negative outcomes is yet to be studied. We examine the relative clinical impact of seven basic dimensions of personality pathology through their associations with a wide range of clinical outcomes. Methods A sample of 960 outpatients was assessed through a 7-factor model integrating the Cloninger, the Livesley, and the DSM taxonomies. Thirty-six indicators of clinical outcome covering three areas – dissatisfaction, functional difficulties, and clinical severity – were also assessed. The unique contribution of each personality dimension to clinical outcome was estimated through multiple regressions. Results Overall, personality dimensions explained 17.6% of the variance of clinical outcome, but varied substantially in terms of their unique contributions. Negative Emotionality had the greatest impact in all areas, contributing 43.9% of the explained variance. The remaining dimensions led to idiosyncratic patterns of clinical outcomes but had a comparatively minor clinical impact. A certain effect was also found for combinations of dimensions such as Negative Emotionality × Impulsive Sensation Seeking, but most interactions were clinically irrelevant. Conclusions Our findings suggest that the most relevant dimensions of personality pathology are associated with very different clinical consequences and levels of harmfulness. Practitioner points The relative clinical impact of seven basic dimensions of personality pathology is examined. Negative Emotionality (Neuroticism) is 6–14 times as harmful as other pathological dimensions. The remaining dimensions and their interactions have very specific and comparatively minor clinical consequences. Limitations We examine only a handful of clinical outcomes. Our results may not be generalizable to other clinical or life outcomes. Our variables are self-reported and hence susceptible to bias. Our design does not allow us to establish causal relationships between personality and clinical outcomes.

Despite general support for dimensional models of personality disorder, it is currently unclear which, and how many, dimensions a taxonomy of this kind should include. In an attempt to obtain an empirically-based, comprehensive, and usable structure of personality, three instruments – The Temperament and Character Inventory-Revised (TCI-R), the Personality Diagnostic Questionnaire-4 + (PDQ-4 + ), and the Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ) – were administered to 960 outpatients and their scales factor-analyzed following a bass ackwards approach. The resulting hierarchical structure was interpretable and replicable across gender and methods up to seven factors. This structure highlights coincidences among current dimensional models and clarifies their apparent divergences, and thus helps to delineate the unified taxonomy of normal and abnormal personality that the field requires.

In the personality disorder section of the DSM-V research agenda, the authors stress the need for studies on the relevance of a change from diagnostic categorical models to dimensional ones. These studies should identify the underlying genetic and neurobiologic mechanisms and appropriate representation on the dimensions of clinical criteria as cognitive disturbances, identity conflicts and attachment. Livesley's behavioral-genetic model represents an interesting dimensional paradigm of personality pathology. It was elaborated deductively from the consensus and statistical refinement of data collected by a large number of clinicians from different psychopathological tendencies. The traits are made operative in the "Dimensional Assessment of Personality Pathology-Basic Questionnaire" (DAPP-BQ) tool with 18 dimensions (that became 30) and 4 higher rank factors (adapted to Spanish by Gutiérrez- Zotes et al, 2008). The model has shown an appropriate relationship with important personality paradigms and good predictive power for personality disorders. The authors incorporate methods of variance breakdown for statistical processing of the genetic-environmental mechanism underlying each personality disorder dimension. Homologation of DSM-IV-TR criteria for personality disorders is proposed so that the model's dimensions capture and represent the clinical complexity of the symptoms in a convenient manner for the new location in DSM-V.

Introduction:The assessment and diagnosis of personality disorders (PDs) has been of great interest to researchers and clinicians. PDs are related with poorer therapy outcomes and increased health service costs. Interviews are quite lengthy and require specialized training, leading to a very high cost of administration. An initial screening with good properties would eliminate the need for detailed assessment in most noncases. We reviewed papers that analyze screening instruments for PDs.Method:Medline, PsycINFO, and Academic Search Premier were computer-searched for relevant studies. The key words used were screen* and personality disorder*. The references of the obtained journal articles were also examined. Inclusion criterion was providing the necessary information to calculate hit rates and kappas related to gold standards interviews.Results:26 studies met inclusion criteria. Considerable variation in predictive ability existed among studies Hit rates ranged from 0.53 to 0.94. Kappas ranged from 0.20 to 0.89. Performed analyses showed differences between questionnaires and interviews.Discussion:We discuss different options according to the context of application, feasibility, number of items and psychometric properties.

Personality disorders (PD) are highly prevalent and impairing stable patterns of maladaptive behavior that are associated to high health care costs. Although PD detection in clinical settings is a priority issue, it is still unknown which are the most reliable and valid screening instruments. For this purpose, 26 studies examining the diagnostic ability of 19 different screening tools that included structured interviews as the gold standard were meta-analyzed. The total median for the kappa was 0.40 (range 0.14 to 0.86), indicating poor to moderate agreement. Brief instruments created ad hoc showed the best predictive ability (Mdkappa=0.56) and are, because of their easy application, the first-line screening tools.