The trait model of the DSM–5 alternative model of personality disorder (AMPD): A structural review.

Abstract

Publication of the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (American Psychiatric Association, 2013), which included an alternative model of personality disorders (AMPD), was followed by an explosion of publications on the new model. The large majority of these publications focused on the AMPD's Criterion B, which consists of 25 trait facets arranged in 5 broad domains that bear strong similarity to the established five-factor model (FFM) of personality. The operationalization of AMPD traits that has received the most research attention is its self-report measure, the Personality Inventory for Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (PID-5; Krueger et al., 2012). Much of this literature concerns its internal structure and relations with FFM measures. Many of these studies report that a number of the facets appear to be (a) interstitial (cross-loading on 2 or more factors), (b) placed in the wrong domain (i.e., considered by the AMPD to be a facet of a different domain from the one on which it typically loads), or (c) both. Clarifying the structural location of measures is fundamental in understanding their nomological net-and, thereby, the constructs they assess. Therefore, this review focuses on the PID-5 structure in the context of the broader domain of personality, especially the FFM, and primarily examines (1) which facets are interstitial and (2) the best domain(s) in which to place each facet. Also considered are important PD constructs-including multiple facets and one domain-that the AMPD does not include. The review ends with a set of recommendations for AMPD-5.1 and PID-5.1.

Revising the trait model of the alternative model of personality disorders: Comment on Clark and Watson’s structural review.

“…Our reservations arise with the limited nature of the information source that they frame. Clark and Watson (2022), in essence, are proposing substantial revisions to the AMPD model based entirely on a single method of measurement (i.e., a self-report of the target of observation). Although Clark and Watson (2022) do forewarn of this problem (the "vast majority of the literature is based on the PID-5"), and consider the AMPD and the PID-5 essentially the same, stating that, "the measure is the model," and acknowledge that "this is not ideal," they nonetheless argue most broadly for modifications to the model and not specifically to the instrument designed to measure that model.…”

“…In contrast, there are very few studies that have use other methods of measurement of the AMPD, for example, the informant version of the PID-5 (PID-5-IRF; Markon et al, 2013) and various interview forms. Clark and Watson (2022) state clearly that because of this they did not include studies that use this type of assessment.…”

“…And we wonder if in that regard their recommendations for revision to the AMPD are premature. Again, to be fair, Clark and Watson (2022) do indicate that their focus is on structural analyses of the PID-5 and the latent domain factors and the constituent facets of each of these domains. Yet, after more than 10 years of research on the AMPD, is it sufficient to make recommendations for modifications to this model based on structural and correlational analyses of a single self-report instrument eschewing, in essence, potential contributions using other methods of assessments.…”

“…Most problematic, is that self-report measure is subject to potential response bias that if left unchecked, compromises the validity and reliability of research that uses such data. Clark and Watson (2022) are correct in noting that future researchers need to assess the newly proposed model (the AMPD 5.1) with alternative forms of measurement including informant reports and interview-based assessment methods. But this cautionary advice comes after their model modifications are proffered.…”

The DSM should replace maladaptive traits with the five-factor model: Comment on Clark and Watson (2022).

“…Clark and Watson (2022) provided a scholarly, objective, and fair review of the evidence for the alternative model of personality disorder (AMPD) Criterion B traits and offered several thoughtful and specific recommendations for how to improve the model of maladaptive traits in the Diagnostic and Statistical Manual of Mental Disorders ( DSM ). Their recommendations largely focused on the model’s lower order facets and issues related to content coverage and interstitiality.…”