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Comparison of alternative models for personality disorders, II: 6-, 8- and 10-year follow-up

Published online by Cambridge University Press:  02 December 2011

L. C. Morey ,
C. J. Hopwood ,
J. C. Markowitz ,
J. G. Gunderson ,
C. M. Grilo ,
T. H. McGlashan ,
M. T. Shea ,
S. Yen ,
C. A. Sanislow  and
E. B. Ansell
...Show all authors
L. C. Morey*
Affiliation:
Department of Psychology, Texas A&M University, College Station, TX, USA
C. J. Hopwood
Affiliation:
Department of Psychology, Michigan State University, East Lansing, MI, USA
J. C. Markowitz
Affiliation:
New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons, New York, NY, USA
J. G. Gunderson
Affiliation:
Department of Psychiatry, Harvard Medical School and McLean Hospital, MA, USA
C. M. Grilo
Affiliation:
Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
T. H. McGlashan
Affiliation:
Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
M. T. Shea
Affiliation:
Department of Veterans Affairs and Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
S. Yen
Affiliation:
Department of Veterans Affairs and Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
C. A. Sanislow
Affiliation:
Department of Psychology, Wesleyan University, Middletown, CT, USA
E. B. Ansell
Affiliation:
Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
A. E. Skodol
Affiliation:
University of Arizona School of Medicine and the Sunbelt Collaborative, Tucson, AZ, USA
*
*Address for correspondence: L. C. Morey, Ph.D., Department of Psychology, Texas A&M University, College Station, TX 77843-4235, USA. (Email: [email protected])
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Abstract

Background

Several conceptual models have been considered for the assessment of personality pathology in DSM-5. This study sought to extend our previous findings to compare the long-term predictive validity of three such models: the Five-Factor Model (FFM), the Schedule for Nonadaptive and Adaptive Personality (SNAP), and DSM-IV personality disorders (PDs).

Method

An inception cohort from the Collaborative Longitudinal Personality Disorder Study (CLPS) was followed for 10 years. Baseline data were used to predict long-term outcomes, including functioning, Axis I psychopathology, and medication use.

Results

Each model was significantly valid, predicting a host of important clinical outcomes. Lower-order elements of the FFM system were not more valid than higher-order factors, and DSM-IV diagnostic categories were less valid than dimensional symptom counts. Approaches that integrate normative traits and personality pathology proved to be most predictive, as the SNAP, a system that integrates normal and pathological traits, generally showed the largest validity coefficients overall, and the DSM-IV PD syndromes and FFM traits tended to provide substantial incremental information relative to one another.

Conclusions

DSM-5 PD assessment should involve an integration of personality traits with characteristic features of PDs.

Keywords

ClassificationDSM-5personality disorders.
Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 8 , August 2012 , pp. 1705 - 1713
Copyright
Copyright © Cambridge University Press 2011

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References

Alden, LE, Wiggins, JS, Pincus, A (1990). Construction of circumplex scales for the Inventory of Interpersonal Problems. Journal of Personality Assessment 55, 521–536.Google Scholar
APA (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, text revision. Washington, DC: American Psychiatric Press.Google Scholar
Blashfield, RK, Intoccia, V (2000). Growth of the literature on the topic of personality disorders. American Journal of Psychiatry 157, 472–473.CrossRefGoogle ScholarPubMed
Clark, LA (1993). Manual for the Schedule of Nonadaptive and Adaptive Personality. University of Minnesota Press: Minneapolis, MN.Google Scholar
Costa, PT Jr., McCrae, RR (1992). NEO PI-R Professional Manual (Revised NEO Personality Inventory and NEO Five-Factor Inventory). Psychological Assessment Resources: Odessa, FL.Google Scholar
Distel, MA, Trull, TJ, Willemsen, G, Vink, JM, Derom, CA, Lynskey, M, Martin, NG, Boomsma, DI (2009). The five-factor model of personality and borderline personality disorder: a genetic analysis of comorbidity. Biological Psychiatry 66, 1131–1138.Google Scholar
Grucza, RA, Goldberg, LR (2007). The comparative validity of 11 modern personality inventories: predictions based on behavioral acts, informant reports, and clinical indicators. Journal of Personality Assessment 89, 167–187.Google Scholar
Gunderson, JG, Shea, MT, Skodol, AE, McGlashan, TH, Morey, LC, Stout, RL, Zanarini, MC, Grilo, CM, Oldham, JM, Keller, M (2000). The Collaborative Longitudinal Personality Disorders Study. I: Development, aims, design, and sample characteristics. Journal of Personality Disorders 14, 300–315.CrossRefGoogle Scholar
Heumann, KA, Morey, LC (1990). Reliability of categorical and dimensional judgments of personality disorder. American Journal of Psychiatry 147, 498–500.Google Scholar
Keller, MB, Lavori, PW, Friedman, B, Nielson, E, Endicott, J, McDonald-Scott, P, Andreason, NC (1987). The Longitudinal Interval Follow-up Evaluation: a comprehensive method for assessing outcome in prospective longitudinal studies. Archives of General Psychiatry 44, 540–548.Google Scholar
Krueger, RF, Eaton, NR, Derringer, J, Markon, KE, Watson, D, Skodol, AE (2011). Personality in DSM-5: helping delineate personality disorder content and framing the metastructure. Journal of Personality Assessment 94, 325–331.Google Scholar
Krueger, RF, Skodol, AE, Livesley, WJ, Shrout, PE, Huang, Y (2007). Synthesizing categorical and dimensional approaches to personality disorders: refining the research agenda for DSM-V, Axis II. International Journal of Methods in Psychiatric Research 16, 65–73.Google Scholar
Livesley, WJ, Jang, KL, Vernon, PA (1998). Phenotypic and genetic structure of traits delineating personality disorder. Archives of General Psychiatry 55, 941–948.Google Scholar
Markon, KE, Chmielewski, M, Miller, CJ (2011). The reliability and validity of discrete and continuous measures of psychopathology: a quantitative review. Psychological Bulletin 137, 856–879.CrossRefGoogle ScholarPubMed
Miller, JD, Maples, J, Few, LR, Morse, JQ, Yaggi, KE, Pilkonis, PA (2010). Using clinician-rated five-factor model data to score the DSM-IV personality disorders. Journal of Personality Assessment 92, 296–305.Google Scholar
Morey, LC (1991). Personality Assessment Inventory – Professional Manual. Psychological Assessment Resources: Odessa, FL.Google Scholar
Morey, LC, Hopwood, CJ, Gunderson, JG, Shea, MT, Skodol, AE, Grilo, CM, Yen, S, McGlashan, TH (2007). Comparison of alternative models for personality disorders. Psychological Medicine 37, 983–994.Google Scholar
Morey, LC, Zanarini, MC (2000). Borderline personality: traits and disorder. Journal of Abnormal Psychology 109, 733–737.Google Scholar
Shedler, J, Beck, A, Fonagy, P, Gabbard, GO, Gunderson, J, Kernberg, O, Michels, R, Westen, D (2010). Personality disorders in DSM-5. American Journal of Psychiatry 167, 1026–1028.Google Scholar
Skodol, AE, Bender, DS, Morey, LC, Clark, LA, Oldham, JM, Alarcon, RD, Krueger, RF, Verheul, R, Bell, CC, Siever, LJ (2011 a). Personality disorder types proposed for DSM-5. Journal of Personality Disorders 25, 136–169.Google Scholar
Skodol, AE, Clark, LA, Bender, DS, Krueger, RF, Morey, LC, Verheul, R, Alarcon, RD, Bell, CC, Siever, LJ, Oldham, JM (2011 b). Proposed changes in personality and personality disorder assessment and diagnosis for DSM-5, Part I: Description and rationale. Personality Disorders: Theory, Research, and Treatment 2, 4–22.CrossRefGoogle ScholarPubMed
Skodol, AE, Oldham, JE, Bender, DS, Dyck, IR, Stout, RL, Morey, LC, Shea, MT, Zanarini, MC, Sanislow, CA, Grilo, CM, McGlashan, TH, Gunderson, JG (2005). Dimensional representations of DSM-IV personality disorders: relationships to functional impairment. American Journal of Psychiatry 162, 1919–1925.Google Scholar
Stevens, J (2002). Applied Multivariate Statistics for the Social Sciences, 4th edn. Lawrence Erlbaum Associates: Mahwah, NJ.Google Scholar
Weisberg, S (1985). Applied Linear Regression, 2nd edn. John Wiley: New York.Google Scholar
Widiger, TA (2011). The DSM-5 dimensional model of personality disorder: rationale and empirical support. Journal of Personality Disorders 25, 222–234.CrossRefGoogle ScholarPubMed
Widiger, TA, Coker, LA (2002). Assessing personality disorders. In Clinical Personality Assessment: Practical Approaches , 2nd edn (ed. Butcher, J.), pp. 407–434. Oxford University Press: Oxford.Google Scholar
Widiger, TA, Livesley, WJ, Clark, LA (2009). An integrative dimensional classification of personality disorder. Psychological Assessment 21, 243–255.Google Scholar
Widiger, TA, Trull, TJ (2007). Plate tectonics in the classification of personality disorder: shifting to a dimensional model. American Psychologist 62, 71–83.Google Scholar
Zanarini, MC, Skodol, AE, Bender, DS, Dolan, R, Sanislow, CA, Schaefer, E, Morey, LC, Grilo, CM, Shea, MT, McGlashan, TH, Gunderson, JG (2000). The Collaborative Longitudinal Personality Disorders Study: reliability of Axis I and II diagnoses. Journal of Personality Disorders 14, 291–299.Google Scholar