Whitney L. Gore

The DSM-5 dimensional trait model and five-factor models of general personality.

The current study tests empirically the relationship of the dimensional trait model proposed for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) with five-factor models of general personality. The DSM-5 maladaptive trait dimensional model proposal included 25 traits organized within five broad domains (i.e., negative affectivity, detachment, antagonism, disinhibition, and psychoticism). Consistent with the authors of the proposal, it was predicted that negative affectivity would align with five-factor model (FFM) neuroticism, detachment with FFM introversion, antagonism with FFM antagonism, disinhibition with low FFM conscientiousness and, contrary to the proposal; psychoticism would align with FFM openness. Three measures of alternative five-factor models of general personality were administered to 445 undergraduates along with the Personality Inventory for DSM-5. The results 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.

A Five-Factor Measure of Schizotypal Personality Traits

The current study provides convergent, discriminant, and incremental validity data for a new measure of schizotypy from the perspective of the five-factor model (FFM) of general personality structure. Nine schizotypy scales were constructed as maladaptive variants of respective facets of the FFM (e.g., Aberrant Ideas as a maladaptive variant of FFM Openness to Ideas). On the basis of data from 143 undergraduates, the convergent validity of these nine scales was tested with respect to seven established measures of schizotypy and the respective facets of the FFM. Discriminant validity was tested with respect to facets from other FFM domains and components of schizotypy. Incremental validity was tested with respect to the ability of the FFM schizotypy scales to account for variance in two established measures of schizotypy, after variance accounted for by respective FFM facets and other established measures of schizotypy were first removed. The findings support the validity of these new scales as measures of schizotypal traits and as maladaptive variants of the FFM.

Testing Whether the DSM-5 Personality Disorder Trait Model Can Be Measured With a Reduced Set of Items: An Item Response Theory Investigation of the Personality Inventory for DSM-5

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes an alternative model of personality disorders (PDs) in Section III, consisting in part of a pathological personality trait model. To date, the 220-item Personality Inventory for DSM-5 (PID-5; Krueger, Derringer, Markon, Watson, & Skodol, 2012) is the only extant self-report instrument explicitly developed to measure this pathological trait model. The present study used item response theory-based analyses in a large sample (n = 1,417) to investigate whether a reduced set of 100 items could be identified from the PID-5 that could measure the 25 traits and 5 domains. This reduced set of PID-5 items was then tested in a community sample of adults currently receiving psychological treatment (n = 109). Across a wide range of criterion variables including NEO PI-R domains and facets, DSM-5 Section II PD scores, and externalizing and internalizing outcomes, the correlational profiles of the original and reduced versions of the PID-5 were nearly identical (rICC = .995). These results provide strong support for the hypothesis that an abbreviated set of PID-5 items can be used to reliably, validly, and efficiently assess these personality disorder traits. The ability to assess the DSM-5 Section III traits using only 100 items has important implications in that it suggests these traits could still be measured in settings in which assessment-related resources (e.g., time, compensation) are limited.

A Five-Factor Measure of Dependent Personality Traits

This study provides convergent, discriminant, and incremental validity data for a new measure of dependent personality traits from the perspective of the five-factor model (FFM). Dependent personality trait scales were constructed as maladaptive variants of FFM facets (e.g., Gullibility as a maladaptive variant of FFM trust). Based on responses from 383 undergraduates, the convergent validity of the Five-Factor Dependency Inventory (FFDI) scales was tested with respect to 2 measures of the FFM, 6 dependency trait scales, and 4 measures of dependent personality disorder. Discriminant validity was tested with respect to FFM facets from alternative domains. Incremental validity was tested with respect to the ability of the FFM dependent personality trait scales to account for variance in 2 established measures of dependency, after variance accounted for by respective FFM facet scales and other measures of DPD was first removed. The results of this study provided support for the validity of the FFDI assessment of dependency from the perspective of the FFM.

Maladaptive variants of conscientiousness and agreeableness.

Although reasonably strong support has been obtained for the Five-Factor Models (FFM) ability to account for the existing personality disorder (PD) constructs, the support for obsessive-compulsive PD (OCPD) and dependent PD (DPD) has been relatively less consistent. Specifically, the expected correlation between OCPD and the FFM trait of Conscientiousness has varied in magnitude across studies while DPD has, at times, also evinced rather weak relationships with FFM Agreeableness. We determined that these inconsistencies were due primarily to the reliance on FFM measures that lack adequate fidelity to assess the maladaptive aspects of high Conscientiousness and Agreeableness. When alternative measures were utilized, the correlations were generally large and in line with expectations. We conclude that OCPD and DPD can be fruitfully conceptualized within the FFM but encourage the use of measures that provide a comprehensive assessment of both the adaptive and maladaptive aspects of the FFM traits.

The discriminant (and convergent) validity of the Personality Inventory for DSM-5.

A considerable body of research has rapidly accumulated with respect to the validity of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) dimensional trait model as it is assessed by the Personality Inventory for Diagnostic and Statistical Manual of Mental Disorders (PID-5; Krueger et al., 2012). This research though has not focused specifically on discriminant validity, although allusions to potentially problematic discriminant validity have been raised. The current study addressed discriminant validity, reporting for the first time the correlations among the PID-5 domain scales. Also reported are the bivariate correlations of the 25 PID-5 maladaptive trait scales with the personality domain scales of the NEO Personality Inventory-Revised (Costa & McCrae, 1992), the International Personality Item Pool-NEO (Goldberg et al., 2006), the Inventory of Personal Characteristics (Almagor et al., 1995), the 5-Dimensional Personality Test (van Kampen, 2012), and the HEXACO Personality Inventory-Revised (Lee & Ashton, 2004). The results are discussed with respect to the implications of and alternative explanations for potentially problematic discriminant validity. (PsycINFO Database Record

Assessment of dependency by the FFDI: Comparisons to the PID-5 and maladaptive agreeableness

The present study explores the validity of the Five Factor Dependency Inventory (FFDI), a measure of dependent personality traits from the perspective of the five factor model, examined across three separate samples and two studies. The first study examined the FFDI with respect to the traits assigned to assess dependent personality disorder (DPD) by the DSM-5 work group, two measures of DSM-IV-TR DPD and three measures of dependent traits, sampling 184 Mechanical Turk participants and 83 students (the latter oversampled for DPD features). Based on responses from an additional 137 students, the second study investigated the role of maladaptive agreeableness in dependency by examining the FFDI in relation to the interpersonal circumplex using three alternative measures. Discriminant validity was provided with respect to DSM-5 traits and the interpersonal circumplex. Incremental validity was provided with respect to the ability of the FFDI to account for variance within DPD measures beyond the variance explained by DSM-5 traits. Implications for the assessment of dependency and the proposed DSM-5 dimensional trait model are discussed.

Simultaneous Treatment of Co-occurring Posttraumatic Stress Disorder and Substance Use Disorder

Opinion statementPosttraumatic stress disorder (PTSD) and substance use disorder (SUD) frequently co-occur. Existent evidence suggests that SUD often develops in reaction to PTSD symptoms, as individuals attempt to “self-medicate” their PTSD symptoms. Once the SUD develops, the disorders establish a bi-directional loop, with PTSD driving further substance use behaviors, and the SUD symptoms mirroring and reinforcing symptoms of PTSD. Once this bi-directional cycle is locked in, the disorders become more resistant to treatment and result in poorer prognoses and worse health outcomes versus having only one of these disorders. Traditional approaches to treatment of co-occurring PTSD and SUD have involved segregated and sequential treatment models. Normally, this involves treatments focused first on the SUD followed by a referral to different providers to address the PTSD. This traditional sequential and segregated treatment model presents several challenges to patients and treatment providers and may unintentionally contribute to the poorer prognosis observed in individuals with co-occurring PTSD-SUD. There are now state-of-the-art treatment approaches that focus on simultaneously treating PTSD and SUD. Psychotherapeutic protocols are available to simultaneously treat PTSD and SUD. Findings show that psychotherapies that simultaneously address PTSD and SUD show superior outcomes in reducing PTSD versus SUD treatment as usual. Recent studies also support the efficacy of several medications, including sertraline, naltrexone, and prazosin in treating co-occurring PTSD-SUD. Although treatments are shown to produce benefits to either reduce PTSD or improve SUD outcomes, no psychotherapeutic treatment, psychopharmacologic treatment, or combination thereof is shown to produce greater benefits versus SUD treatment as usual for simultaneously reducing both PTSD symptoms and improving SUD outcomes. The current research suggests that clinicians should consider simultaneous treatment approaches for co-occurring PTSD and SUD.

Negative emotionality across diagnostic models: RDoC, DSM-5 Section III, and FFM.

The research domain criteria (RDoC) were established in an effort to explore underlying dimensions that cut across many existing disorders and to provide an alternative to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). One purpose of the present study was to suggest a potential alignment of RDoC negative valence with 2 other dimensional models of negative emotionality: five-factor model (FFM) neuroticism and the DSM-5 Section III negative affectivity. A second purpose of the study, though, was to compare their coverage of negative emotionality, more specifically with respect to affective instability. Participants were adult community residents (N = 90) currently in mental health treatment. Participants received self-report measures of RDoC negative valence, FFM neuroticism, and DSM-5 Section III negative affectivity, along with measures of affective instability, borderline personality disorder, and impairment. Findings suggested that RDoC negative valence is commensurate with FFM neuroticism and DSM-5 Section III negative affectivity, and it would be beneficial if it was expanded to include affective instability.

A Comparison of Veterans Who Repeat Versus Who Do Not Repeat a Course of Manualized, Cognitive-Behavioral Therapy for Posttraumatic Stress Disorder

Despite evidence that cognitive-behavioral therapy (CBT) for posttraumatic stress disorder (PTSD) is effective, some individuals do not experience clinically significant reduction or remission of their PTSD symptoms. These individuals may return for additional PTSD-focused psychotherapy. However, there is no research to know whether PTSD treatment repeaters have worse symptoms prior to the initial treatment episode or display differences in other pretreatment characteristics versus nonrepeaters. Research is also needed to explore whether treatment repeaters exhibit PTSD symptom changes during an initial or second course of treatment. The current study examines differences in pretreatment characteristics and treatment response among U.S. military veterans who participated in either a single course (n = 711) or in two separate courses (n = 87) of CBT for PTSD through an outpatient Veterans Affairs PTSD treatment program. Veterans completing two courses of CBT for PTSD were more likely to be married and employed and more likely to drop out of their initial course of treatment versus those who completed a single course. Hierarchical linear models showed that reductions in PTSD symptoms during treatment were not different for those who completed a second versus single course of CBT for PTSD. However, for those participating in two courses of CBT for PTSD, a relapse in PTSD symptoms was observed between the first and second course. These findings show that a second course of CBT may be viable for those with ongoing PTSD symptoms.