Personality disorders最新文献

We aimed to determine and compare the longitudinal predictive power of Diagnostic and Statistical Manual of Mental Disorders, fifth edition's (DSM-5) two models of personality disorder (PD) for multiple clinically relevant outcomes. A sample of 600 community-dwelling adults-half recruited by calling randomly selected phone numbers and screening-in for high-risk for personality pathology and half in treatment for mental health problems-completed an extensive battery of self-report and interview measures of personality pathology, clinical symptoms, and psychosocial functioning. Of these, 503 returned for retesting on the same measures an average of 8 months later. We used Time 1 interview data to assess DSM-5 personality pathology, both the Section-II PDs and the alternative (DSM-5) model of personality disorder's (AMPD) Criterion A (impairment) and Criterion B (adaptive-to-maladaptive-range trait domains and facets). We used these measures to predict 20 Time 2 functioning outcomes. Both PD models significantly predicted functioning-outcome variance, albeit modestly-averaging 12.6% and 17.9% (Section-II diagnoses and criterion counts, respectively) and 15.2% and 23.2% (AMPD domains and facets, respectively). Each model significantly augmented the other in hierarchical regressions, but the AMPD domains (6.30%) and facets (8.62%) predicted more incremental variance than the Section-II diagnoses (3.74%) and criterion counts (3.31%), respectively. Borderline PD accounted for just over half of Section II's predictive power, whereas the AMPD's predictive power was more evenly distributed across components. We note the predictive advantages of dimensional models and articulate the theoretical and clinical advantages of the AMPD's separation of personality functioning impairment from how this is manifested in personality traits. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Stigmatizing views surrounding mental illness are widespread. Personality disorders (PDs) are among the most stigmatized mental illnesses, as individuals with PDs are often described using pejorative terms, which might impact clinicians' a priori expectations and increase the likelihood of stigmatization, discrimination, or early termination from treatment. The degree to which the terms used in any diagnostic classification systems are stigmatizing has never been examined. The current study aims to explore the level of stigma perceived in diagnostic terms used and to compare which systems of classification (the Diagnostic and Statistical Manual of Mental Disorders, fifth edition [DSM-5] Section II, DSM-5 Alternative Model of Personality Disorder, and Hierarchical Taxonomy of Psychopathology [HiTOP]) are reported as less stigmatizing. The current study consisted of three samples. Individuals with lived experience of personality pathology (n = 218) completed an online survey examining the level of stigma perceived in diagnostic terms; mental health care providers (n = 75) and undergraduate psychology students (n = 732) also completed online surveys examining their perceptions of stigma within diagnostic terms. We examined differences in perceived stigma between the three classification systems across the three samples. Among mental health care providers, the HiTOP was rated as the least stigmatizing while DSM-5 categorical labels were rated as the most stigmatizing. There were no significant differences found among individuals with lived experience or undergraduate students. Understanding the degree to which the terms used to describe personality pathology contributes to reducing stigma has potentially important repercussions for research and clinical practice. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Youth with personality pathology are at a greater risk of developing broader psychopathology and experiencing poorer life outcomes in general. Therefore, detecting personality problems, specifically features of borderline personality disorder (BPD), provides opportunities for early intervention. In this study, we investigated the incremental value of Criteria A and B of the alternative model for personality disorders (AMPD) compared to a BPD symptom count based on the Diagnostic and Statistical Manual of Mental Disorders, fifth edition Section II personality disorder model in broader psychopathology (i.e., internalizing and externalizing symptoms) and age-adequate psychosocial functioning (i.e., attainment of developmental milestones). In a clinical sample of 246 young people (M_age = 19.22, SD = 2.76, 81.7% female), separate path analyses showed that a BPD symptom count, Criterion A, and Criterion B were all relatively strongly related to the outcome measures. In a combined path model, the AMPD and especially Criterion B explained additional variance in internalizing and externalizing pathology and age-adequate psychosocial functioning. The current results underscore the value of the AMPD for the early detection of negative psychopathological and psychosocial outcomes commonly associated with BPD. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Despite substantial evidence in support of the alternative model for personality disorder (AMPD) that has accumulated over the last decade, a gap remains in terms of head-to-head comparisons of the predictive power of Section II categorical diagnoses versus Section III AMPD diagnoses for clinical outcomes. The current study uses archival data from a naturalistic treatment outcome study in an adolescent psychiatric inpatient sample to compare the predictive power of the Section III AMPD (combined Criterion A and B assessment) versus Section II borderline personality disorder (BPD) in predicting treatment outcomes from admission to discharge. Outcomes in general psychiatric severity and emotion dysregulation were assessed in a sample of 59 adolescents (76.3% female, M_age = 15.27, SD = 1.17) at admission and at discharge on average about a month later. Results showed that, on average, predictive power of both AMPD measures and BPD were relatively modest. However, the AMPD, operationalized through combined measures of identity diffusion and maladaptive traits, was a stronger predictor of reduction in general psychiatric severity than a measure of BPD. The findings of the study add to a growing body of literature pointing to the advantages of Section III AMPD over Section II categorical diagnosis for clinical utility in predicting treatment response. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The goal of this study was to compare the predictive validity of the alternative model for personality disorders (AMPD) versus the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Section II categorical model regarding clinician judgments about mental health outcomes. To do so, we instructed a national sample of 136 mental health professionals to provide clinical judgments on a random subset of four (out of a possible 12) case vignettes. For each case, they made a variety of diagnostic judgments corresponding to each model, as well as clinical outcome judgments (e.g., prognosis). Our analyses included hierarchical and individual regressions to compare the predictive value of each diagnostic system toward these clinical outcome judgments. We found that the AMPD predictors consistently added unique variance beyond the Section II predictors, whereas the Section II predictors were rarely incremental above the AMPD. Further, the AMPD judgments predicted outcome judgments very consistently (98.3% of regressions) compared to the Section II predictors (70% of regressions), and the single Criterion A judgment (level of personality functioning) was the strongest overall predictor. Finally, the categorical borderline personality disorder diagnoses from the two systems performed similarly in predicting clinical outcomes and agreed in 79% of cases. We interpreted our results to suggest that the AMPD is at least as effective, and by some measures more effective, than the DSM-5 categorical model at predicting clinician's judgment of outcomes in clinical cases. We conclude by discussing the value of this evidence in relation to the broader AMPD literature, as well as possible paths forward for the diagnosis of personality disorders. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The alternative model for personality disorders (AMPD) has been extensively studied over the past decade, but to date there is no direct comparison of the clinical utility of the AMPD model relative to the Section II personality disorder (PD) model in an ecologically valid design. The current study examined the clinical utility of an AMPD-informed assessment procedure and Section II PD assessment procedure as assessed by both patients and clinicians in a randomized controlled trial. A sample of 119 patients were randomly assigned to either an AMPD or a Section II PD assessment procedure. At the end of the assessment, patients filled out questionnaires pertaining to clinical utility, satisfaction, motivation for treatment, and general experience of the assessment. Clinicians who subsequently started treatment with these patients also completed two clinical utility questionnaires. There were no significant differences between the AMPD and Section II PD assessment procedure on patients' reported clinical utility, motivation for treatment, satisfaction, and general experience of the assessment nor were there significant differences between the models on clinician reported clinical utility. Explorative analyses revealed that, for patients, a positive relationship with the assessor was predictive of experienced utility. This study shows no superiority of the AMPD in terms of clinical utility but suggests that the alliance with the assessor is a particularly salient factor in clinical utility. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Traditional personality disorders (PDs; e.g., Diagnostic and Statistical Manual of Mental Disorders, fifth edition [DSM-5] Section II PDs), as well as dimensional traits (e.g., alternative model for PD [AMPD]), offer unique advantages in personality pathology assessment. However, very little is known about how these systems compare in predicting observable behavior. This study compares self-report ratings of PD symptoms (i.e., Structured Clinical Interview for DSM-IV PD) with self-reports of AMPD traits (i.e., Personality Inventory for DSM-5) in predicting clinical outcomes, 1 year later, via three different methods: (a) naturalistically observed psychosocial functioning (i.e., electronically activated recorder [EAR]), (b) informant-reported interpersonal functioning (i.e., Inventory of Interpersonal Problems-32), and (c) self-reported suicidality (SI), depression, anxiety, and substance use symptoms (i.e., Psychiatric Diagnostic Screening Questionnaire). Data were analyzed from 72 individuals in current or recent psychiatric treatment meeting diagnosis for at least one PD. Results showed that DSM Section II PD and AMPD ratings yielded meaningful and comparable predictions of naturalistically observed EAR variables and informant-rated interpersonal functioning. The AMPD appeared to offer slight advantages in the prediction of EAR-observed negative affect, hostile words, and informant-rated interpersonal functioning, with clearer advantages at the facet level. Overall, these results provide tentative evidence that both DSM Section II PD and AMPD systems show meaningful links with clinical outcomes measured via multiple methods 1 year later, but with clearer advantages for the AMPD at the facet level. Moreover, results show that the EAR is a viable method for capturing naturalistically observed clinically meaningful, in vivo behavior of individuals exhibiting maladaptive personality patterns. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Borderline personality disorder (BPD) is defined by the presence of at least five of nine symptoms in Section II of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition. In the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, Section III Alternative Model of Personality Disorders (AMPD), BPD is defined by deficits in self and/or interpersonal functioning (Criterion A), elevated negative affectivity, and elevated antagonism and/or disinhibition (Criterion B). However, it is unclear if these definitions describe the same people and if the AMPD criteria explain unique variability in treatment outcomes in this population. In a treatment-seeking sample of adult participants diagnosed with BPD according to Section II criteria (n = 65, M_age = 27.60, 70.8% female, 76.9% White), we found a majority (66.2%) would have also received the diagnosis based on AMPD criteria. Those meeting AMPD criteria reported more severe Section II BPD symptoms than those who did not, ps < .02, ds > 0.60, and the presence or severity of Section II fears of abandonment and inappropriate anger uniquely predicted AMPD BPD diagnoses, ps < .03, ORs ≥ 2.31. Changes in AMPD dimensions explained 34% of the variability in change in work/social adjustment (p = .13) and quality of life (p = .22), respectively, over and above changes in Section II symptoms during a novel cognitive-behavioral treatment for BPD. These results suggest that AMPD criteria capture a more severe subset of BPD than Section II criteria and may be important predictors of treatment outcomes. We discuss the potential trade-offs of this shift in diagnosis. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

In 2022, PDs: Theory, Research, and Treatment published a 10-year retrospective on the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), Section III, Alternative Model for PDs (AMPD; American Psychiatric Association, 2013). The articles of the 10-year retrospective provided evidence in support of the validity, reliability, and clinical utility of the AMPD. Specifically, it provided evidence in support of the unidimensional factor structure of the LPF and the five-dimensional structure of the pathological trait domains. In addition, evidence in support of the construct validity of the LPF in its association with psychiatric severity, functional outcomes, traditional PDs, cognitive, emotional, and contextual correlates, and other indices of maladaptive self- and interpersonal functioning was provided. Despite this evidence, a significant gap has since been identified related to how the American Psychiatric Association (APA) decides to accept proposed revisions to diagnostic criteria. The goal of the current special issue is to address this gap. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

In this study, we compare the incremental predictive capacities of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) Section II personality disorders (SII-PDs) with Section III trait domains of the Alternative Model of Personality Disorders (AMPD) in a psychiatric outpatient sample (N = 185). To this end, a series of hierarchical regression analyses was conducted in which the 10 SII-PDs and the five AMPD trait domains served as the predictor variables and five areas of clinical dysfunction as the criterion variables. Two models for each criterion were tested. In Model A, the 10 PDs were entered as a block, followed by the block entry of trait domains; in Model B, the block entry of these predictors was reversed. As the AMPD was designed to address the shortcomings of the SII-PDs, it was hypothesized that the AMPD trait domains would show greater predictive capacity vis-à-vis the latter by (a) explaining more overall variance for each criterion variables when entered first into the model versus when SII-PDs was entered first and (b) explaining more incremental variance than SII-PDs when block was entered second. These hypotheses were partially supported. Overall, the AMPD trait domains predicted more variance than SII-PDs and demonstrated better model fit and more predictive power for three of the criterion variables. Similarly, the AMPD domains predicted a significant but modest incremental increase in variance over that of the SII-PDs for three of the criterion variables. We conclude that more work needs to be done to improve the AMPD, particularly in the assessment of externalizing psychopathology as it relates to clinical dysfunction. (PsycInfo Database Record (c) 2024 APA, all rights reserved).