Hierarchical structure of maladaptive personality traits in older adults: joint factor analysis of the PID-5 and the DAPP-BQ

In DSM-5, the categorical model and criteria for the 10 personality disorders included in DSM-IV will be reprinted in Section II. Moreover, an alternative dimensional classification model will appear in Section III. This alternative DSM-5 proposal for the diagnosis of a personality disorder is based on two fundamental criteria: impairments in personality functioning (Criterion A) and the presence of pathological personality traits (Criterion B). In the maladaptive trait model that has been developed to operationalize Criterion B, 25 pathological traits are organized according to five higher order dimensions. The current study focuses on the convergence of the proposed DSM-5 trait model (as measured by the Personality Inventory for DSM-5 [PID-5]) with the Dimensional Assessment of Personality Pathology (DAPP) model (as measured by the Dimensional Assessment of Personality Pathology–Basic Questionnaire [DAPP-BQ]) in a sample of older people. A joint hierarchical factor analysis showed clear convergence between four PID-5 dimensions (Negative Affect, Detachment, Antagonism, Disinhibition) and conceptually similar DAPP-BQ components. Moreover, the PID-5 and the DAPP-BQ showed meaningful associations on different levels of their joint hierarchical factor structure. Methodological and theoretical implications of these initial results for the conceptualization of personality pathology are discussed

The Dutch DAPP-BQ: improvements, lower- and higher-order dimensions, and relationship with the 5DPT.

Jackson, 2002), the present DAPP-BQ scales (with or without Self-Harm included) were subjected to a principal components analysis with oblimin or varimax rotation in a general population sample of 478 subjects, retaining four factors. All four (higherorder) factors (Emotional Dysregulation, Dissocial, Inhibition, and Compulsivity) proved identical to the factors originally derived in Canada, with Tucker coefficients of factor similarity approaching unity. Particularly the (unexpected) finding that the present Dutch version of the DAPP-BQ also resulted in an Inhibition factor (and not, like the former Dutch version, in an Intimacy Problems factor) was considered positive. In addition, a principal components analysis with oblimin rotation was conducted on the 282 items contained in the 18 DAPP-BQ scales, investigating the lower-order structure of the DAPP-BQ; in this case, 18 factors were retained. Although the structure originally derived by Livesley and colleagues could not be recovered completely, the degree of similarity was of such a magnitude that the 18 DAPP-BQ scales were considered to give a dependable account of the “true” lower-order structure of disordered personality. Moreover, based on the finding that the 18 scales are sufficiently reliable (Cronbach's alpha) and correlate as predicted in a subsample of 284 subjects with the normal personality scales of Van Kampen's 5DPT (or, Five-Dimensional Personality Test), the DAPP-BQ appears to be a valuable instrument

Toward an Integrated Model of Pathological Personality Traits: Common Hierarchical Structure of the PID-5 and the DAPP-BQ

A dimensional classification seems to be the next move in the personality disorders field. However, it is not clear whether we have one dimensional model or many, or whether the currently available dimensional instruments measure the same traits. To help clarify these issues, we administered the Personality Inventory for DSM-5 (PID-5) and the Dimensional Assessment of Personality Pathology (DAPP-BQ) to 414 psychiatric outpatients. Factor analyses showed that a common hierarchical structure underlies both instruments, and that both cover every aspect of this structure equally well. Furthermore, disattenuated correlations indicated that two thirds of the PID and DAPP facets measure essentially the same traits, although the pairings were not exactly as predicted. Among higher-order domains, only PID Negative Affectivity and Detachment converged unambiguously with DAPP Emotional Dysregulation and Inhibition. Overall, the PID-5 and the DAPP-BQ reflect one and the same structure of personality pathology and can be used interchangeably

Disparity between General Symptom Relief and Remission Criteria in the Positive and Negative Syndrome Scale (PANSS): A Post-treatment Bifactor Item Response Theory Model.

Objective: Total scale scores derived by summing ratings from the 30-item PANSS are commonly used in clinical trial research to measure overall symptom severity, and percentage reductions in the total scores are sometimes used to document the efficacy of treatment. Acknowledging that some patients may have substantial changes in PANSS total scores but still be sufficiently symptomatic to warrant diagnosis, ratings on a subset of 8 items, referred to here as the "Remission set," are sometimes used to determine if patients' symptoms no longer satisfy diagnostic criteria. An unanswered question remains: is the goal of treatment better conceptualized as reduction in overall symptom severity, or reduction in symptoms below the threshold for diagnosis? We evaluated the psychometric properties of PANSS total scores, to assess whether having low symptom severity post-treatment is equivalent to attaining Remission. Design: We applied a bifactor item response theory (IRT) model to post-treatment PANSS ratings of 3,647 subjects diagnosed with schizophrenia assessed at the termination of 11 clinical trials. The bifactor model specified one general dimension to reflect overall symptom severity, and five domain-specific dimensions. We assessed how PANSS item discrimination and information parameters varied across the range of overall symptom severity (θ), with a special focus on low levels of symptoms (i.e., θ<-1), which we refer to as "Relief" from symptoms. A score of θ=-1 corresponds to an expected PANSS item score of 1.83, a rating between "Absent" and "Minimal" for a PANSS symptom. Results: The application of the bifactor IRT model revealed: (1) 88% of total score variation was attributable to variation in general symptom severity, and only 8% reflected secondary domain factors. This implies that a general factor may provide a good indicator of symptom severity, and that interpretation is not overly complicated by multidimensionality; (2) Post-treatment, 534 individuals (about 15% of the whole sample) scored in the "Relief" range of general symptom severity, but more than twice that number (n = 1351) satisfied Remission criteria (37%). 2 in 3 Remitted patients had scores that were not in a low symptom range (corresponding to Absent or Minimal item scores); (3) PANSS items vary greatly in their ability to measure the general symptom severity dimension; while many items are highly discriminating and relatively "pure" indicators of general symptom severity (delusions, conceptual disorganization), others are better indicators of specific dimensions (blunted affect, depression). The utility of a given PANSS item for assessing a patient depended on the illness level of the patient. Conclusion: Satisfying conventional Remission criteria was not strongly associated with low levels of symptoms. The items providing the most information for patients in the symptom Relief range were Delusions, Preoccupation, Suspiciousness Persecution, Unusual Thought Content, Conceptual Disorganization, Stereotyped Thinking, Active Social Avoidance, and Lack of Judgment and Insight. Lower scores on these items (item scores ≤2) were strongly associated with having a low latent trait θ or experiencing overall symptom relief. The inter-rater agreement between Remission and Relief subjects suggested that these criteria identified different subsets of patients. Alternative subsets of items may offer better indicators of general symptom severity and provide better discrimination (and lower standard errors) for scaling individuals and judging symptom relief, where the "best" subset of items ultimately depends on the illness range and treatment phase being evaluated

The DSM-5 Dimensional Trait Model and the Five Factor Model

The current thesis tests empirically the relationship of the dimensional trait model proposed for the fifth edition of the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders with five-factor models (FFM) of personality disorder (PD). The DSM-5 Personality and Personality Disorders Work Group proposes to diagnose the disorders largely in terms of a 25 trait dimensional model organized within five broad domains (i.e., negative affectivity, detachment, antagonism, disinhibition, and psychoticism). Consistent with the authors of DSM-5, it was predicted that negative affectivity would align with FFM neuroticism, detachment with FFM introversion, antagonism with FFM antagonism, disinhibition with low FFM conscientiousness and, contrary to the authors of DSM-5, psychoticism would align with FFM openness. Suggested changes in trait placements according to FFM of PD research were also tested. Four measures of five factor models of general personality were administered to 445 undergraduates along with the Personality Inventory for DSM-5. The results of the present study provided support for the hypothesis that all five domains of the DSM-5 dimensional trait model are maladaptive variants of general personality structure, including the domain of psychoticism; however, the findings provided mixed support for suggested trait placement changes in the DSM-5 model

The DAPP-BQ in the Netherlands: Factor structure and relationship with basic personality dimensions.

0.20 in a sample of 223 normal subjects, Cronbach's α coefficients were calculated for the remaining items in the 18 scales of this instrument. The ‘Dutch’ α coefficients proved to be satisfactory. Furthermore, the Dutch DAPP-BQ scales were factor analyzed, retaining four factors. Three of these factors proved to be identical (Emotional Dysregulation and Dissocial) or nearly identical (Compulsivity) to the Canadian factors. However, the original factor Inhibition was not the same as the remaining Dutch factor Intimacy Problems. In a sample of 115 students, the estimated scores for the Dutch Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ) factors were correlated with the scales of Van Kampen's Four-Dimensional Personality Test. As expected, Emotional Dysregulation was found to correlate with Neuroticism, Dissocial with Insensitivity, and Compulsivity with Orderliness. The Intimacy Problems factor proved to be negatively correlated with Extraversion. The results obtained are embedded in the context of the evidence favoring a dimensional model of personality disorder. Furthermore, Livesley's proposal that separate diagnostic criteria for the existence of a personality disorder must be formulated to supplement the assessment by means of the DAPP-BQ is critically discussed

Psychometric Qualities of the Dimensional Assessment of Personality Pathology – Short Form for Adolescents

A growing body of research recognizes the occurrence and validity of personality pathology during adolescence as well as its relevance as a developmental precursor of adult personality pathology.The present study recognizes the need for a comprehensive and concise instrument to assess the dimensions of personality pathology in adolescents. Therefore, the psychometric qualities of an abbreviated version of the Dimensional Assessment of Personality Pathology - Basic Questionnaire for Adolescents (DAPP-BQ-A), which has been denoted as the DAPP - Short Form for Adolescents (DAPP-SF-A), were examined.The factorial structure, internal consistency, test-retest reliability, discriminative validity, and classification accuracy of the DAPP-SF-A scales were examined in three samples: 1596 non-referred adolescents; 166 adolescents referred to inpatient and outpatient mental health services; and 58 referred and general population adolescents.Despite a reduction in the number of items by 50% (from 290 to 144 items), the promising psychometric qualities established for the DAPP-BQ-A were replicated for the DAPP-SF-A.The results of this study are promising regarding the qualities of the DAPP-SF-A and its utility in both clinical and research settings. In addition, the equivalence of the instruments for adolescents and (young) adults enables the investigation of developmental trajectories across different life stages

Using the Hierarchical Taxonomy of Psychopathology (HiTOP) as a Framework to Dimensionally Map Neurodevelopmental Disorders.

Mental disorders are organised via the categorical framework of the DSM-5-TR, which has several issues (e.g., extensive co-occurrence). However, evidence alternatively supports the Hierarchical Taxonomy of Psychopathology (HiTOP), a dimensional framework of mental disorders. We extended the HiTOP by considering the dimensional position of Neurodevelopmental disorders and related experiences, and found that they generally fitted under existing HiTOP domains (i.e., autism under Detachment, ADHD under Disinhibition, and specific learning disorder and tic disorders under Psychoticism)

Borderline and schizotypal traits in college students: Relationship and personality profiles

The relationships between borderline and schizotypal traits are still debated. Borderline traits, schizotypal traits, and several psychopathological symptoms were assessed among 2,341 college students. A factor analysis was performed on borderline and schizotypal personality measures, leading to 10 factors. Borderline factors were largely intercorrelated, as were schizotypal factors. Moreover, borderline factors were weakly to largely correlated to schizotypal factors. Five factors were very strongly correlated (r > .50). Dissociation was strongly related to Odd Beliefs/Unusual Perceptive Experiences and Anxious-Depressive factors. Social Anxiety was strongly related to Suspiciousness. Based on these 10 factors, a cluster analysis was conducted, and resulted in four clearly distinct groups: a Low Traits cluster, a Narcissistic cluster, a Social Anxiety cluster, and a High Traits cluster. This High Traits cluster had the lowest levels of academic achievement and the highest levels of internalizing behaviors and externalizing behaviors. The clinical implications of the results are discussed