Joshua R. Oltmanns

Neuroticism is a fundamental domain of personality with enormous public health implications

Neuroticism is the trait disposition to experience negative affects, including anger, anxiety, self-consciousness, irritability, emotional instability, and depression. Persons with elevated levels of neuroticism respond poorly to environmental stress, interpret ordinary situations as threatening, and can experience minor frustrations as hopelessly overwhelming. Neuroticism is one of the more well established and empirically validated personality trait domains, with a substantial body of research to support its heritability, childhood antecedents, temporal stability across the life span, and universal presence. Neuroticism has enormous public health implications. It provides a dispositional vulnerability for a wide array of different forms of psychopathology, including anxiety, mood, substance, somatic symptom, and eating disorders. Many instances of maladaptive substance use are efforts to quell or quash the dismay, anxiousness, dysphoria, and emotional instability of neuroticism. Clinically significant episodes of anxiety and depressed mood states will often represent an interaction of the trait or temperament of neuroticism with a life stressor. Neuroticism is comparably associated with a wide array of physical maladies, such as cardiac problems, disrupted immune functioning, asthma, atopic eczema, irritable bowel syndrome, and even increased risk for mortality. The relationship of neuroticism to physical problems is both direct and indirect, in that neuroticism provides a vulnerability for the development of these conditions, as well as a disposition to exaggerate their importance and a failure to respond effectively to their treatment. Neuroticism is also associated with a diminished quality of life, including feelings of ill-will, excessive worry, occupational failure, and marital dissatisfaction. High levels of neuroticism will contribute to poor work performance due to emotional preoccupation, exhaustion, and distraction. Similar to the duel-edged effect of neuroticism on physical conditions, high levels of neuroticism will result in actual impairment to marital relationships but also subjective feelings of marital dissatisfaction even when there is no objective basis for such feelings, which can though in turn lead to actual spousal frustration and withdrawal. Given the contribution of neuroticism to so many negative life outcomes, it has been recommended that the general population be screened for clinically significant levels of neuroticism during routine medical visits. Screening in the absence of available treatment would be problematic. However, neuroticism is responsive to pharmacologic intervention. Pharmacotherapy can and does effectively lower levels of the personality trait of neuroticism. Barlow et al have also developed an empirically-validated cognitive-behavioral treatment of neuroticism, called the Unified Protocol (UP). They have suggested that current psychological treatments have become overly specialized, focusing on disorderspecific symptoms. The UP was designed to be transdiagnostic. Recognizing the impact of neuroticism across a diverse array of physical and mental health care concerns, the authors of the UP again note that “the public-health implications of directly treating and even preventing the development of neuroticism would be substantial”. Neuroticism has long been recognized since the beginning of basic science personality research and may even be the first domain of personality that was identified within psychology. Given its central importance for so many different forms of mental and physical dysfunction, it is not surprising that neuroticism is evident within the predominant models of personality, personality disorder, and psychopathology. Neuroticism is one of the fundamental domains of general personality included within the five-factor model or Big Five. It is also within the dimensional trait model included in Section III of the DSM-5 for emerging measures and models. This trait model consists of five broad domains, including negative affectivity (along with detachment, psychoticism, antagonism, and disinhibition). As expressed in the DSM-5, “these five broad domains are maladaptive variants of the five domains of the extensively validated and replicated personality model known as the ‘Big Five’ or Five Factor Model of personality”. Neuroticism is likewise aligned with the negative affective domain included within the dimensional trait model of personality disorder proposed for the ICD-11. Finally, it is also evident within the transdiagnostic Research Domain Criteria (RDoC) of the National Institute of Mental Health, as RDoC negative valence encapsulates such constructs as fear, distress, frustration, and perceived loss. It would be inaccurate to suggest that RDoC negative valence is equivalent to neuroticism, but it is self-evident that they are closely aligned. Currently, there is considerable interest in the general factors of psychopathology, personality disorder, and personality. To the extent that degree of impairment and dysfunction (which largely defines the general factors) is associated with level of distress and dismay, which is quite likely to be the case, we would propose that neuroticism will explain a substantial proportion of the variance in those general factors. In sum, neuroticism is a fundamental domain of personality that has enormous public health implications, impacting a wide array of psychopathological and physical health care concerns. It contributes to the occurrence of many significantly harmful life outcomes, as well as impairing the ability of persons to adequately address them. It has long been recognized as one of the more important and significant domains of personality and is being increasingly recognized as a fundamental domain of personality disorder and psychopathology more generally.

The General Factor of Psychopathology and Personality

Snyder, Young, and Hankin (2017, this issue) provide further support for a general factor of psychopathology. However, they acknowledge, “more importantly, it will be important for future research to continue to understand the nature of the p factor.” We suggest a comparison with the general factor of personality. A predominant personality trait model is the Big Five, consisting of negative emotionality, extraversion (versus introversion), openness (or unconventionality), agreeableness (versus antagonism), and conscientiousness (versus disinhibition). Above the Big Five are the Big Four, Three, Two, and even a Big One. How best to understand the first general factor of personality, though, is in dispute. At the level of the Big Five, traits align in a conceptual manner. Traits that are opposite in meaning anchor opposing poles (e.g., introversion vs. extraversion). However, this conceptual arrangement is severely disrupted at the level of the Big One. One understanding of the Big One is that it is artifactual, reflecting simply a disposition to evaluate oneself in a positive or negative manner (Pettersson, Turkheimer, Horn, & Menatti, 2012). The predominant rationale for this understanding is that traits that are essentially opposite to one another (e.g., unambitious and workaholic) load comparably. Persons cannot be endorsing the presence of opposite traits if they are providing accurate selfdescription. Proponents of this view suggest that variance due to evaluation should be extracted from the lower order factors in order to obtain more unbiased and substantively interpretable scales. The evaluation bias explanation is a rebirth of the social desirability hypothesis promulgated years ago. Scales were even developed to assess for this impression management. This hypothesis, though, was ultimately discredited (McCrae & Costa, 1983). It is evident that most persons are providing reasonably accurate and honest self-descriptions. It would be quite unlikely that such a large degree of variance would reflect simply impression management. Individual differences on social desirability scales reflect true individual differences in positive versus negative attributes. Indeed, the Big One is probably a reflection of adaptivity versus maladaptivity, as this is the primary, if not the only, meaningful way to align all traits along a single common dimension. One cannot conceptually align traits that have no shared meaning along a common latent dimension (e.g., traits from different five-factor model [FFM] domains are unrelated conceptually to one another). However, one can align these traits with respect to their implications for adaptive functioning. Some suggest that the Big One reflects a true substantive dimension, reflecting (for instance) a degree of survival fitness or general emotional satisfaction (Musek, 2007). This is comparable to the proposals within psychopathology research for a nonspecific psychopathological disposition that subsequently becomes more differentiated into more specific forms through the course of development (Caspi et al., 2014). There has been some interest in developing a nomenclature of psychopathology in which disorder is diagnosed independently of dysfunction. There is also a comparable interest in personality, to assess traits independent of implications for impairment. To the extent that this could be done, it might indeed be the case that the etiology for the traits (i.e., their location within the Big Five) is different from the etiology for their dysfunction (i.e., their location within the Big One). However, assessing for the presence of traits (or disorder) separate from dysfunction is proving to be exceedingly difficult, if not impossible. One cannot assess (for instance) irresponsibility or gullibility without implicitly, if not explicitly, assessing for their maladaptive consequences. A few traits can be assessed in a neutral manner, but these appear to be the exceptions. Dysfunctional (or functional) outcome could very well be inherent to the presence of particular traits (and disorders). 657042 CPXXXX10.1177/2167702616657042Widiger, OltmannsPsychopathology and Personality research-article2016

Self-pathology, the five-factor model, and bloated specific factors: A cautionary tale.

The five-factor model (FFM) is widely regarded as a useful model for the structure of both normal and maladaptive personality traits. However, recent factor analytic studies have suggested that deficits in the sense of self fall outside the FFM. The current study replicates and extends these findings, illustrating that factors can be situated outside a higher-order domain by including a relatively large number of closely related scales, forming what is known as a bloated specific factor. A total of 1,553 participants (M age = 37.8 years, SD = 13.1) were recruited across 3 studies. One measure of self-pathology (including 15 scales) and 2 measures of the FFM were administered, along with 17 measures of anxiousness and 12 measures of social withdrawal/sociability. Across 2 independent samples and 2 different measures of the FFM, deficits in the sense of self separated from neuroticism when all 15 scales of self-pathology were included. However, self-pathology loaded with FFM neuroticism when only a subset of the self-pathology scales was included. This finding was replicated with measures of social withdrawal/sociability, although only partially replicated with measures of anxiousness. Implications of these findings for past and future factor analytic studies of the structure of psychopathology are discussed.

Borderline personality pathology and insomnia symptoms in community-dwelling older adults.

Prior research has associated BPD with sleep problems, but the relationship has been explored primarily in small clinical samples of younger adults. Findings from our lab have demonstrated that borderline symptoms remain present in later middle age and are associated with several negative life outcomes. A representative community sample of older adults (N = 633, Mage  = 62.3) was obtained from the St Louis area, and interviewer-reports, self-reports, and informant-reports of personality pathology were completed along with an insomnia symptoms questionnaire. Cross-sectional analyses revealed that symptoms from all 10 DSM-IV personality disorders were significantly correlated with insomnia symptoms. However, after statistically controlling for major depression, body-mass index, race and gender, only borderline personality pathology remained significantly associated with insomnia symptoms. Our results demonstrate that in addition to other negative health outcomes, borderline personality pathology is uniquely associated with sleep problems in later middle-aged adults in the community.

FFMPD scales: Comparisons with the FFM, PID-5, and CAT-PD-SF.

A series of 8 Five Factor Model Personality Disorder (FFMPD) scales have been developed to assess, from the perspective of the Five Factor Model (FFM), the maladaptive traits included within DSM–5 Section II personality disorders. An extensive body of FFMPD research has accumulated. However, for the most part, each study has been confined to the scales within 1 particular FFMPD Inventory. The current study considered 36 FFMPD scales, at least 1 from each of the 8 FFMPD inventories, including 8 scales considered to be from neuroticism, 8 from extraversion, 5 from openness, 8 from agreeableness, and 7 from conscientiousness. Their convergent, discriminant, and structural relationship with the FFM was considered, and compared with the structural relationship with the FFM obtained by the Personality Inventory for DSM–5 (PID-5) and the Computerized Adaptive Test-Personality Disorder-Static Form (CAT-PD-SF). Support for an FFM structure was obtained (albeit with agreeableness defining 1 factor and antagonism a separate factor). Similarities and differences across the FFMPD, PID-5, and CAT-PD-SF scales were highlighted.

A Self-Report Measure for the ICD-11 Dimensional Trait Model Proposal: The Personality Inventory for ICD-11

Proposed for the 11th edition of the World Health Organization’s International Classification of Diseases (ICD-11) is a dimensional trait model for the classification of personality disorder (Tyrer, Reed, & Crawford, 2015). The ICD-11 proposal consists of 5 broad domains: negative affective, detachment, dissocial, disinhibition, and anankastic (Mulder, Horwood, Tyrer, Carter, & Joyce, 2016). Several field trials have examined this proposal, yet none has included a direct measure of the trait model. The purpose of the current study was to develop and provide initial validation for the Personality Inventory for ICD-11 (PiCD), a self-report measure of this proposed 5-domain maladaptive trait model. Item selection and scale construction proceeded through 3 initial data collections assessing potential item performance. Two subsequent studies were conducted for scale validation. In Study 1, the PiCD was evaluated in a sample of 259 MTurk participants (who were or had been receiving mental health treatment) with respect to 2 measures of general personality structure: The Eysenck Personality Questionnaire—Revised and the 5-Dimensional Personality Test. In Study 2, the PiCD was evaluated in an additional sample of 285 participants with respect to 2 measures of maladaptive personality traits: The Personality Inventory for DSM-5 and the Computerized Adaptive Test for Personality Disorders. Study 3 provides an item-level exploratory structural equation model with the combined samples from Studies 1 and 2. The results are discussed with respect to the validity of the measure and the potential benefits for future research in having a direct, self-report measure of the ICD-11 trait proposal.

Informant assessment: The Informant Five-Factor Narcissism Inventory.

A series of self-report measures of personality disorder from the perspective of the five-factor model (FFM) have been published; however, no informant-report versions have been developed. An informant version of the Five Factor Narcissism Inventory (FFNI) is particularly apt, given the degree of distortion in self-description inherent to narcissism. The present study provides initial validation for the Informant Five-Factor Narcissism Inventory (IFFNI). In Study 1, informant reports from friends, romantic partners, parents, and other family members were compared with self-reports provided by undergraduate college students on the IFFNI, FFM personality, and social dysfunction. Self–other agreement for IFFNI Grandiose (G) was higher than what has been found with other narcissism measures. No self-informant convergence, though, was found for IFFNI Vulnerable (V). From the informant view, IFFNI-G and V narcissism were associated with social dysfunction, whereas from the self-view only FFNI-V was associated with social dysfunction. In Study 2, grandiose and vulnerable narcissists, identified by participants recruited from MTurk, were described in terms of the IFFNI, FFM, and Pathological Narcissism Inventory (PNI). Results indicated that the IFFNI discriminated well between G and V narcissism for all but a few scales. The exceptions may reflect vulnerable narcissistic traits within grandiose narcissists. In comparison, the PNI obtained a very similar informant profile for the G and V narcissists. In sum, the results of the current study suggest value in having an informant-based measure of narcissism.

Dissimilarity in physical attractiveness within romantic dyads and mate retention behaviors

The present study investigated the relations among physical attractiveness and inter- and intrasexual mate retention tactics used by individuals in romantic relationships. Seventy-three undergraduate romantic dyads were photographed and completed a questionnaire about their mate retention tactics. Independent judges rated the photographs for physical attractiveness. Actor–partner interdependence models indicated that (a) partner’s physical attractiveness was positively associated with the individual’s own use of mate retention behavior, (b) an individual’s own level of physical attractiveness was not related to the individual’s own use of mate retention behavior, however, (c) there was a dissimilarity effect for predicting mate retention behaviors. Specifically, participants who were less physically attractive and were in romantic relationships with physically attractive partners employed more intrasexual retention tactics.

The Validation of a Classification of Psychopathology

Their article is indeed quite fitting with the recent yet controversial appearances of the fifth edition of the APA’s (2013) DSM-5 and the neurobiologically oriented RDoC of the National Institute of Mental Health (NIMH; Insel, 2013). Their resulting article though is perhaps relatively more concerned with the etiology of psychopathology than with diagnosis and classification (albeit they did discuss the dimensional-categorical debate for depression). Our article is, in a complementary fashion, relatively more concerned with the structure of mental disorders or, more specifically, how best to develop or validate a diagnostic manual, such as the DSM and RDoC. However, the points and principles articulated within this article would naturally apply as well to research on etiology. The importance of having an official classification of psychopathology is well established (Kendell, 1975; Salmon, Copp, May, Abbot, & Cotton, 1917; Sartorius et al., 1993). Imagine if clinicians were free to use whatever classification system they preferred, including their own. They would speak, think, and diagnose on the basis of diverse and disparate clinical concepts, with little to no likelihood that there would be meaningful communication or the potential for the development of reliable treatment planning. The primary purpose of a diagnostic manual is to facilitate reliable (and valid) diagnostic practice for clinicians and public health care agencies. A common language is also advantageous for scientific research (Widiger, 2012). It would be quite difficult to accumulate a body of knowledge for any respective disorder if each researcher used his or her own idiosyncratic nomenclature and/or criterion sets. Of course, an authoritative nomenclature, such as DSM-5 (APA, 2013), might in principle hinder creativity, innovation, and progress if it stifled alternative conceptualizations. Hyman (2010), past director of NIMH, argued passionately against the predominance of the APA diagnostic system for research purposes. This complaint is now somewhat ironic, given that NIMH has since indicated that researchers should use the newly developed diagnostic system of NIMH in order to obtain funding (Insel, 2013). In any case, it is questionable whether the APA diagnostic system has in fact stifled or hindered the development of alternative or innovative diagnostic systems. The APA nomenclature can in fact be said to have served as a useful foil, a common point of comparison. Researchers have been free to assert through argument and research that their version of a diagnostic construct is preferable to the APA’s. For example, there has clearly been quite a bit of productive research on dimensional models of classification, much of which has been in direct contrast with the APA categorical system (Helzer et al., 2008; Widiger & Clark, 2000). However, the construction of a diagnostic manual that will be optimal for clinical practice and research is exceedingly difficult, subject to substantial disagreement as well as even intense controversy, as illustrated by the proposals for homosexuality in DSM-III (Bayer & Spitzer, 1982) to bereavement (Wakefield, 2013) and autism (Volkmar & McPartland, in press) in DSM-5. This is due in part to the fact that the decision to consider a particular pattern of behavior, affect, and/or cognition a mental disorder is a matter of opinion rather than fact, and the outcome of this decision can have significant implications for clinical, social, and public health care decisions (Frances & Widiger, 2012). There is no objective laboratory measure to document with any certainty the existence of a mental disorder (Kapur, Phillips, & Insel, 2012). Mental disorders are hypothetical constructs (Meehl, 1986). One infers the presence of a mental disorder on the basis of impairment, dysfunction, distress, pathology, and/or dyscontrol (Spitzer & Williams, 1982; Widiger & Sankis, 2000), and there is a wide array of potential behavior patterns, affects, and cognitions that are associated with such indicators. In this regard the social-constructionist critique of a diagnostic manual has some validity (e.g., Maddux, Gosselin, & Winstead, 2012). On the other hand, the APA diagnostic system is not simply the whimsical creation of local folklore. It is intended to be the result of compelling scientific

Borderline Personality Pathology, Polysomnography, and Self-Reported Sleep Problems: A Review

There is a growing body of research that links borderline personality pathology to sleep disturbance through polysomnography (PSG) and self-report studies. Twelve PSG studies are reviewed that found sleep differences in recordings of sleep parameters such as sleep continuity, non-REM sleep, and REM sleep in borderline personality disorder (BPD) patients compared to controls. Further, since the turn of the century, self-report methodology has been increasingly utilized to investigate this relationship, and findings from these studies are reviewed. The evidence suggests that borderline personality pathology is uniquely associated with sleep disturbance. Future directions for this research are discussed.