Why, How, and When to Integrate Narrative Identity Within Dimensional Approaches to Personality Disorders

Abstract

The Alternative DSM-5 Model for Personality Disorders (AMPD) retains six specific personality disorders (PDs) that can be diagnosed based on Criterion A level of impairment and Criterion B maladaptive facets. Those specific diagnoses are still underresearched, despite the preference expressed by most PD scholars for a mixed/hybrid classification. This study explores the possibility of using Criterion A and B self-report questionnaires to extract the specific AMPD diagnoses. Plausible prevalence estimates were found in three samples (outpatient PD, private practice, community; N = 766) using the facet score > 2 and t score > 65 methods for determining the presence of a Criterion B facet; diagnoses had meaningful correlations with external variables. This study provides evidence—albeit preliminary—that the extraction of the specific AMPD PDs from self-report questionnaires might be a viable avenue. Ultimately, it could promote the use and dissemination of those diagnoses for screening purposes in clinical and research settings.

The Self-Concept and Identity Measure in Patients with Personality Disorders: A Psychometric Evaluation and Associations With Identity Processes, Core Domains of Self-Functioning, and Personality Disorder Symptoms

“…Yet, as a dimensional perspective on identity has gained greater footing in current classifications of personality disorders (PDs; e.g., American Psychiatric Association [APA], 2013), scholars increasingly advocate for a developmental psychopathology perspective on identity. Such a perspective considers both adaptive and disturbed identity functioning in the emergence and maintenance of personality pathology (Kaufman et al, 2014;Lind et al, 2022).To advance this research, the present study aimed to validate the Dutch version of the Self-Concept and Identity Measure (SCIM; Kaufman et al, 2015) in psychiatric inpatients with PDs. The SCIM is a brief self-report questionnaire designed to assess both developmental and clinically significant dimensions of identity (i.e., consolidated identity, disturbed identity, and lack of identity).…”

Situating personality disorder within its maladaptive narrative identity ecology

“…However, a comprehensive narrative ecology has not yet been presented, elucidating how the atypical or maladaptive narrative identity is mutually constructed within an atypical narrative ecology. This is particularly relevant in the context of mental illness in general and in PD specifically, as PD is repeatedly linked with disturbed narrative identity ( 14 , 15 ). In two recently published reviews ( 15 , 16 ), I display how individuals suffering from PD construct narrative identities differently from individuals without such pathology within at least three overarching narrative identity domains; structural elements (i.e., how the narrative is organized—the overall architecture), motivational/affective themes (i.e., what drives the narrator and their emotional tone), and autobiographical reasoning (i.e., the underlying, reflective process) ( 17 ).…”

“…This is particularly relevant in the context of mental illness in general and in PD specifically, as PD is repeatedly linked with disturbed narrative identity ( 14 , 15 ). In two recently published reviews ( 15 , 16 ), I display how individuals suffering from PD construct narrative identities differently from individuals without such pathology within at least three overarching narrative identity domains; structural elements (i.e., how the narrative is organized—the overall architecture), motivational/affective themes (i.e., what drives the narrator and their emotional tone), and autobiographical reasoning (i.e., the underlying, reflective process) ( 17 ). To summarize the most consistent findings, PD has been linked with more fragmented and idiosyncratic narratives that are lower on agency and communion fulfillment.…”

“…The vast majority of extant research on narrative identity in general ( 13 ) and in PD specifically ( 15 ), has focused on personal narrative identity in isolation. A few studies have started to build the narrative identity ecology from the Micro-Level in PD (see Figure 1 ).…”

“Self” and “other”: A conceptual bridge linking normal with pathological personality

“…Narrative identity is often the route by which subjective self-continuity is established and maintained ( 15 ). A review of recent literature on narrative identity in PD acknowledges that current knowledge about narrative identity and PD is based primarily on community samples of predominantly females with BPD ( 16 ). With this caveat, the authors state that, taken together, narrative identity research paints a compelling picture of the subjective sense of self in (B)PD as fragmented, defective, non-agentic, confused, and emotionally isolated .…”