Initial construction of a maladaptive personality trait model and inventory for DSM-5

Abstract

Background DSM-IV-TR suggests that clinicians should assess clinically relevant personality traits that do not necessarily constitute a formal personality disorder, and should note these traits on Axis II, but DSM-IV-TR does not provide a trait model to guide the clinician. Our goal was to provide a provisional trait model and a preliminary corresponding assessment instrument, in our roles as members of the DSM-5 personality and personality disorders workgroup and workgroup advisors. Methods An initial list of specific traits and domains (broader groups of traits) was derived from DSM-5 literature reviews and workgroup deliberations, with a focus on capturing maladaptive personality characteristics deemed clinically salient, including those related to the criteria for DSM-IV-TR personality disorders (PDs). The model and instrument were then developed iteratively using data from community samples of treatment seeking participants. The analytic approach relied on tools of modern psychometrics (e.g., item response theory models). Results Twenty-five reliably measured core elements of personality description emerged that, together, delineate five broad domains of maladaptive personality variation: negative affect, detachment, antagonism, disinhibition, and psychoticism. Conclusions We developed a maladaptive personality trait model and corresponding instrument as a step on the path toward helping users of DSM-5 assess traits that may or may not constitute a formal PD. The inventory we developed is reprinted in its entirety in the supplementary materials, with the goal of encouraging additional refinement and development by other investigators prior to the finalization of DSM-5. Continuing discussion should focus on various options for integrating personality traits into DSM-5.

The Hierarchical Taxonomy of Psychopathology (HiTOP): A dimensional alternative to traditional nosologies.

“…Moreover, multiple dimensions were found within nearly all syndromes, amounting to 31 homogeneous components in total (Waszczuk et al, in press). Parallel IMAS and IDAS scales show strong covergence (Ruggero et al, 2014;Watson et al, 2007Watson et al, , 2012. At the higher-order level, both instruments can operationalize distress, fear, and mania subfactors.…”

“…There is accumulating evidence that mania, and bipolar disorders generally, are related to the internalizing spectrum (Blanco et al, 2015;Keyes et al, 2013;Watson, 2005;Watson et al, 2012). However, mania also has been linked with the thought disorder spectrum (Caspi et al, 2014;Keyes et al, 2013;Kotov, Ruggero, et al, 2011).…”

“…The Inventory of Depression and Anxiety Symptoms (IDAS; Watson et al, 2007Watson et al, , 2012) is a self-report instrument designed to assess symptom components within internalizing. This measure was designed for adults but also has shown satisfactory psychometric properties in adolescents.…”

“…This measure was designed for adults but also has shown satisfactory psychometric properties in adolescents. Structural analyses of the IDAS item pool found six symptom dimensions within MDD, three within OCD, two within both PTSD and mania, and single factors related to social phobia, panic disorder, and claustrophobia (Watson et al, 2007(Watson et al, , 2012. The Interview for Mood and Anxiety Symptoms (IMAS; targets the same domain as the IDAS using an interview format.…”

“…We chose lower-order dimensions based on an instrument that provides the most comprehensive coverage of a given spectrum, augmenting it with additional dimensions that are clearly missing (Figure 3). Specifically, internalizing dimensions were drawn from non-redundant scales of the IMAS, IDAS, PID-5, PAI, and FFM-PD (Crego & Widiger, 2016;Hopwood et al, 2013;Watson et al, 2012). Mania dimensions were drawn from the IMAS.…”