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The DSM-5 introduced an alternative model of personality disorder (AMPD) that includes personality dysfunction plus maladaptive-range traits. This study clarifies relations of depression diagnoses and symptoms with AMPD personality pathology.Two samples (Ns 402 and 601) of outpatients and community-dwelling adults completed four depression (criteria met for major depressive disorder and dysthymia; dysphoria and low well-being scales), ten trait (two scales for each of five domains-negative affectivity, detachment, disinhibition, antagonism, psychoticism), and eight dysfunction (four scales for each of two domains-self- and interpersonal pathology) measures. Diagnoses were made using a semi-structured interview; other measures were self-reports. We quantified cross-sectional relations between depression and personality pathology with correlation and multiple regression analyses.Collectively (median RGeneralization of findings to other populations (e.g., adolescents), settings (e.g., primary care), and measures (e.g., traditional personality disorder diagnoses) is uncertain. Cross-sectional analyses did not test changes over time or establish causality.The AMPD is highly relevant to depression. Assessment of personality pathology, including both personality dysfunction and maladaptive-range traits, stands to advance understanding of depression in adults.

In this paper we present the Hierarchical Taxonomy of Psychopathology (HiTOP), an evidence-based alternative to the categorical approach to diagnostic classification with considerable promise for integrative psychotherapy research and practice. We first review issues associated with the categorical approach that may have constrained advances in psychotherapy. We next describe how the HiTOP model addresses some of these issues. We then offer suggestions regarding potentially mutual benefits of integrating HiTOP with treatment principles from the common factors literature as well as the cognitive-behavioral and relational psychotherapy traditions. We conclude by enumerating principles for psychotherapy research and practice based on the HiTOP model, which are illustrated with a case example.

Objectives To test the exploratory hypothesis that client perceptions of therapists are most favorable when therapists self-disclose their own personal experience with the same psychological problem to a moderate (vs. none, mild, or extreme) extent. Method Undergraduate participants (N = 104; 63.5% female) were randomly assigned to read one of the four vignettes, which differed only in the extent to which the therapist disclosed their own personal experience with the same presenting problem (none, mild, moderate, or extreme). Participants then responded to questions assessing their perceptions of the therapist. Results The data generally supported the hypothesis. The moderate disclosure condition yielded the most favorable client perceptions, which differed significantly from those yielded by the no disclosure condition. Conclusions Despite limitations and need for replication, this study provides perhaps the first empirical data regarding the effect of the extent, rather than the mere presence or absence, of therapist self-disclosure regarding personal psychological experiences.

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.

This chapter discusses the alternative model for personality disorders and its two criteria: impairment/dysfunction and personality disordered traits. Specifically, the chapter explores the distinctiveness between the two criteria. It notes that there is descriptive overlap between them, and it reports on a study examining the degree of empirical overlap. This overlap was reported to be extremely high, with correlations of .76 and .80 for self-report and interview ratings, respectively.

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.

To test the exploratory hypothesis that client perceptions of therapists are most favorable when therapists self-disclose their own personal experience with the same psychological problem to a moderate (vs. none, mild, or extreme) extent.Undergraduate participants (N = 104; 63.5% female) were randomly assigned to read one of the four vignettes, which differed only in the extent to which the therapist disclosed their own personal experience with the same presenting problem (none, mild, moderate, or extreme). Participants then responded to questions assessing their perceptions of the therapist.The data generally supported the hypothesis. The moderate disclosure condition yielded the most favorable client perceptions, which differed significantly from those yielded by the no disclosure condition.Despite limitations and need for replication, this study provides perhaps the first empirical data regarding the effect of the extent, rather than the mere presence or absence, of therapist self-disclosure regarding personal psychological experiences.

Psychosocial functioning is a broad construct that encompasses a wide range of behaviors. Impairment in one or more areas of functioning is commonly observed in psychiatric patients. Moreover, an enduring, rigid pattern of maladaptive behaviors (e.g., interpersonal conflict) are frequent manifestations of personality pathology. The purpose of this study was to understand this comprehensive, yet underexamined, construct of psychosocial functioning by studying the construct’s structure and associations with external correlates (e.g., personality traits and pathology, mood symptoms). The study was conducted in two phases. In Phase 1 study, 429 community residents (student N = 218; community sample N = 211) were recruited and administered eight psychosocial functioning measures sampled from three psychosocial functioning domains: Daily functioning measures typically used in Axis I disorders, personality functioning measures developed for use with Axis II disorder, and quality of life/ satisfaction measures. Personality traits—specifically the big five personality traits (Neuroticism, Extraversion, Agreeableness, Conscientiousness, and Openness)—and mood/affect measures also were administered to understand their associations with psychosocial functioning scales. Results suggested that psychosocial functioning could be understood as having a threefactor structure: Positive General Functioning, Poor Personality Functioning, and Poor Basic Functioning. When four of the five personality traits were added as variables (Openness excluded), a four-factor structure emerged—Positive General Functioning, Poor Basic Functioning, Internalizing Dysfunction, and Externalizing Dysfunction—with personality traits strong markers of the psychosocial functioning factors with the exception of Basic Functioning. In Phase 2, psychiatric outpatients were recruited

The alternative dimensional model for personality disorder (PD) in DSM-5, Section III (DSM-5–III) includes two main criteria: (A) personality-functioning impairment, and (B) personality-trait pathology; provides specific functioning-and-trait criteria for six PD-type diagnoses; and introduces PD-trait specified (PD-TS), which requires meeting the general PD criteria and not meeting criteria for any specific PD type. We termed this Simple PD-TS and developed two additional definitions: Mixed PD-TS, meeting criteria for one or two PD types and having five or more additional pathological traits; and Complex PD-TS, meeting criteria for three or more PD types. In a mixed sample of 165 outpatients and 215 community adults screened to be at highrisk for PD, we investigated the effect of these additional definitions on coverage, prevalence, comorbidity, and within-diagnosis heterogeneity, and conclude that eliminating the PD-type diagnoses and thus having PD-TS as the only PD diagnosis would be both more parsimonious and more useful clinically.

Objectives This study examined relations between comprehensive domains of psychosocial disability and mental disorders to determine (1) whether differential patterns of associations exist between psychosocial disability dimensions and commonly diagnosed mental disorders and (2) whether these relations differ between self-reported and interviewer-rated psychosocial disability domains. Method Self-reported and interviewer-rated psychosocial functioning measures and an interviewer-rated diagnostic assessment tool were administered to 181 psychiatric outpatients. Results Internalizing disorders showed the strongest and most pervasive associations with psychosocial impairment across both self-reported and interviewer-rated measures, followed by thought disorder; externalizing showed the weakest associations. More specifically, logistic regression analyses indicated that lower well-being factor score significantly increased the odds of distress-disorder diagnoses, and poor basic functioning increased the odds of PTSD. Conclusions Results clearly showed differences in the magnitude of associations between three dimensions of psychosocial-disability and commonly diagnosed disorders, and that these differences were similar regardless of rater type.

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

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.

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.

Relationship satisfaction and adjustment have been the target outcome variables for almost all couple research and therapies. In contrast, far less attention has been paid to the assessment of relationship quality. The present study introduces the Relationship Quality Interview (RQI), a semistructured, behaviorally anchored individual interview. The RQI was designed to provide a more objective assessment of relationship quality as a dynamic, dyadic construct across 5 dimensions: (a) quality of emotional intimacy in the relationship, (b) quality of the couple's sexual relationship, (c) quality of support transactions in the relationship, (d) quality of the couple's ability to share power in the relationship, and (e) quality of conflict/problem-solving interactions in the relationship. Psychometric properties of RQI ratings were examined through scores obtained from self-report questionnaires and behavioral observation data collected cross-sectionally from a sample of 91 dating participants and longitudinally from a sample of 101 married couples. RQI ratings demonstrated strong reliability (internal consistency, interrater agreement, interpartner agreement, and correlations among scales), convergent validity (correlations between RQI scale ratings and questionnaire scores assessing similar domains of relationship quality), and divergent validity (correlations between RQI scale ratings and (a) behavioral observation codes assessing related constructs, (b) global relationship satisfaction scores, and (c) scores on individual difference measures of related constructs). Clinical implications of the RQI for improving couple assessment and interventions are discussed.

The authors evaluated the psychometric properties of three measures of psychological aggression: The Conflict Tactics Scales-2nd Version: Psychological Aggression Scale (CTS2-PS), The Multidimensional Measure of Emotional Abuse (MMEA), and The Test of Negative Social Exchange (TENSE). One hundred newlywed couples completed these measures as well as measures of communication, marital satisfaction, physical aggression, and depressive symptoms. Couples also participated in two problem-solving discussions that were later coded for positive and negative affect. Psychological aggression measures were internally consistent at the overall scale level (Cronbach’s αs >0.77), with the exception of the CTS2-PS. The internal consistency coefficients of the MMEA and TENSE subscales were variable. Finally, convergent validity correlations were moderate and divergent validity analyses revealed that the three measures correlated moderately with negative communication pattern measures. Implications for enhancing conceptual models and intervention efforts are discussed.

The alternative dimensional model of personality disorder (PD) in the Diagnostic and Statistical Manual of Mental Disorders, Fifth 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 three dimensions we have found previously (Ro & Clark, 2013). Trait measures had a hierarchical structure which, at the five-factor level, reflected neuroticism/negative affectivity (N/NA), (low) sociability, disinhibition, (dis)agreeableness, and rigid goal engagement. When all measures were co-factored, a hierarchical structure again emerged which, at the five-factor level, included (1) internalizing (N/NA and self-pathology vs. quality-of-life/satisfaction), (2) externalizing (social/interpersonal dysfunction, low sociability, and disagreeableness), (3) disinhibition, (4) poor basic functioning, and (5) rigid goal engagement. Results are discussed in terms of developing an integrated PD diagnostic model.

This chapter examines the relation between personality disorder (PD) and depression, disorders that are commonly comorbid in clinical and community populations. This comorbidity presents both clinical and conceptual challenges. In anticipation of the upcoming introduction of theDiagnostic and Statistical Manual of Mental Disorders(fifth edition;DSM-5), we review research on the associations of depression with both PD and traits in order to help bridge the current and future literatures. Issues distinguishing PD and depression are reviewed, including conceptual concerns, the nature of the associations between depression and PD and traits, and current evidence on associations between depression and PD and chief personality trait dimensions. Data are presented from an ongoing study examining associations between depressive symptoms, maladaptive-range personality, and psychosocial functioning using proposedDSM-5criteria for depression and PD trait domains and facets. Depressive disorders exhibit large associations with negative affect and more moderate links with positive affect and conscientiousness/disinhibition, though there appear to be even more differentiated patterns of associations at the facet level. However, our understanding of the processes responsible for the associations of PD and depression is still limited. Despite this lack of clarity, the links between depression and PD and traits have important clinical implications for assessment and treatment of both disorders. Assessment approaches and challenges are discussed, as well as the implications of co-occurring PD and traits for the treatment of depressive disorders. Finally, future research directions are summarized.

This chapter discusses new theoretical and research developments related to the Schedule for Adaptive and Nonadaptive Personality-2 (SNAP-2; Clark, Simms, Wu, & Casillas, in press) in the context of the forthcoming Diagnostic and Statistical Manual of Mental Disorders (DSM-5), particularly regarding personality disorder (PD). The theoretical underpinnings of dimensional taxonomies of personality traits and PD, and between personality and psychosocial functioning, are considered first. Next, recent SNAP-2 research is reviewed, most notably in the areas of dependency, impulsivity, and schizotypy. In aggregate, the findings suggest that existing SNAP-2 scales cover significant variance in these content domains, but that a SNAP-3 would benefit by increased coverage of each, specifically active/emotional dependency, carefree/-less behavior, and schizotypal disorganization. Information about additional SNAP versions for informant ratings and adolescent personality/PD, respectively, is provided. Finally, the utility of a program of research elucidating relations between personality and functioning is presented.

Psychosocial functioning is an important focus of attention in the revision of the Diagnostic and Statistical Manual of Mental Disorders. Researchers and clinicians are converging upon the opinion that psychometrically strong, comprehensive assessment of individuals' functioning is needed to characterize disorder fully. Also shared is the realization that existing theory and research in this domain have critical shortcomings. The authors urge that the field reexamine the empirical evidence and address theoretical issues to guide future development of the construct and its measurement. The authors first discuss several theoretical issues relevant to the conceptualization and assessment of functioning: (a) definitions of functioning, (b) the role of functioning in defining disorder, and (c) understanding functioning within environmental contexts. The authors then present data regarding empirical domains of psychosocial functioning and their interrelations. Self-reported data on multiple domains of psychosocial functioning were collected from 429 participants. Factor-analytic results (promax rotation) suggest a 4-factor structure of psychosocial functioning: Well-Being, Basic Functioning, Self-Mastery, and Interpersonal and Social Relationships. Finally, the authors propose an integration of theory and empirical findings, which they believe will better incorporate psychosocial functioning into future diagnostic systems.

The differential effects of psychological and physical victimization on depression and anxiety symptoms were examined via APIM and growth curve modeling techniques in a sample of newlyweds (N = 103 couples) assessed four times over the first 3 years of marriage. On average, husbands and wives reported moderate levels of psychological aggression, and there were no sex differences in prevalence rates or mean levels. Changes in psychological victimization were associated with changes in depression and anxiety symptoms, even after controlling for the effects of physical victimization. This study demonstrates the severe impact of psychological aggression on its victims and expands on previous studies of battering samples to demonstrate that psychological victimization may be more damaging than physical victimization in nonbattering, community couples.