Contrasting social knowledge and theory of mind patterns in adults with personality disorders, schizophrenia spectrum disorders, and healthy controls.

INTRODUCTION: Personality disorders (PD) and schizophrenia spectrum disorders (SSD) are distinct conditions displaying common symptoms, like impairments in social cognition, that make them hard to distinguish, especially in severe cases. To date, few studies have compared theory of mind skills in these two disorders, and none have compared social knowledge skills. This study aims to compare the social cognitive abilities of patients with these conditions. METHOD: Non-parametric analyses of covariance were used to compare severe PD patients (n = 37), SSD patients (n = 44), and healthy controls (HC; n = 49) on the Social Knowledge Test and two measures of theory of mind: the Reading the Mind in the Eyes Test and the Combined Stories Test, which incorporates items from various widely used tests. RESULTS: While no significant group differences were found on the Social Knowledge Test, SSD patients performed lower than the HC group on both theory of mind tests. PD patients only had lower performance than the HC group on specific items from the Combined Stories Test. CONCLUSIONS: PD and SSD patients demonstrated distinctive patterns of social cognitive impairments, with items of greater complexity or with an affective orientation being the most discriminant for PD.

Contribution of the alternative model for DSM-5 personality disorders to relationship satisfaction.

Introduction: Personality is a central factor associated with relationship discord, conflicts, and separation, as well as with dyadic adjustment and relationship stability. The Alternative Model for Personality Disorders (AMPD) of the DSM-5 offers a hybrid model for understanding personality based on personality dysfunction (Criterion A) and pathological domains and facets (Criterion B). So far, few studies have integrated this model into the understanding of relationship quality. Therefore, the aim of this study was to examine the contribution of Criterion B to relationship satisfaction in individuals involved in an intimate relationship. We also explored the joint contribution of Criteria A and B, as well as their interaction effects, to relationship satisfaction. Methods: Participants were drawn from two clinical samples: patients with personality disorders (PD; N = 101) and clients consulting in private practice clinics (PPC; N = 350). They completed self-report questionnaires assessing relationship satisfaction and AMPD Criteria A (only for PPC sample) and B. Results: Hierarchical regressions showed that, for the PD sample, the Detachment and Negative Affectivity domains, especially the pathological facets of Intimacy Avoidance and Separation Insecurity, explained 22.5% of relationship satisfaction's variance. For PPC clients, Detachment, Negative Affectivity, and Antagonism domains, and especially the pathological facets of Intimacy Avoidance, Anxiousness, and Grandiosity, contribute significantly to relationship satisfaction, explaining 14.8% of its variance. Criterion A elements did not evince incremental value to the regression models in the PPC sample, and no Criteria A and B interaction effects were found. Clinical implications as well as limitations of the study are discussed.

Associations between the Personality Inventory for DSM-5 trait facets and aggression among outpatients with personality disorder: A multimethod study.

BACKGROUND: Most research on the Personality Inventory for DSM-5 (PID-5) was conducted with self-reports. One of the specific areas for which a multimethod design has yet to be implemented is for the PID-5's associations with aggression. The main objectives of this study were to (a) compare the PID-5 associations with self-reported and file-rated aggression, (b) compare these associations between women and men, and (c) identify the relative importance of PID-5 facet predictors. METHODS: A sample of outpatients with personality disorder (N = 285) was recruited in a specialized public clinic to complete questionnaires, and a subsample was assessed for file-rated aggression (n = 227). Multiple regression analyses were performed with PID-5 facets as statistical predictors but using distinct operationalizations of aggression (self-reported vs. file-rated). Moderation analyses were performed to identify the moderating effect of biological sex. Dominance analyses were computed to identify the relative importance of predictors. RESULTS: PID-5 facet predictors of self-reported and file-rated aggression were very consistent in both conditions. However, the amount of explained variance was reduced in the latter case (from 39% to 14%), especially for women (from 40% to 2%). The most important predictors were Hostility, Risk Taking, and Callousness. CONCLUSION: Pertaining to the statistically significant facets associated with aggression, strong evidence of multimethod replication was found. The women-men discrepancies were not most obvious in their specific associations with aggression, but rather in their amount of explained variance, maybe reflecting examiners' or patients' implicit biases, and/or different manifestations of aggression between women and men.

A Scoring Procedure for Malignant Narcissism Based on Personality Inventory for DSM-5 Facets.

The current study focuses on the development and validation of a scoring procedure for malignant narcissism using the Personality Inventory for DSM-5, a self-report measure of Criterion B from the Alternative Model for Personality Disorders. In Study 1, a prototype matching approach was used to aggregate ratings from 15 clinicians specializing in personality disorder treatment and/or assessment. Indices of inter-rater agreement and inter-rater reliability revealed high convergence as to the most important maladaptive facets for malignant narcissism. The scoring procedure, based on additive counts for score computation, included eleven Criterion B facets covering core features of malignant narcissism. Study 2 evaluated the criterion and incremental validity of the scoring procedure in a sample of 288 patients from a personality disorder treatment clinic, as well as in a sample of 1103 participants from the community. In both samples, results from nonparametric mean comparisons, receiver operating characteristic curves, bivariate Pearson correlations, and hierarchical multiple linear regressions showed significant associations between malignant narcissism and broader components of personality functioning, as well as with relevant emotional, relational, and/or behavioral features. This new scoring procedure is a simple and valid method for measuring malignant narcissism, and is suitable for clinical and research settings.

Preliminary Steps Toward Extracting the Specific Alternative Model for Personality Disorders Diagnoses From Criteria A and B Self-Reports.

The Alternative DSM-5 Model for Personality Disorders (AMPD) retains six specific personality disorders (PDs) that can be diagnosed based on Criterion A level of impairment and Criterion B maladaptive facets. Those specific diagnoses are still underresearched, despite the preference expressed by most PD scholars for a mixed/hybrid classification. This study explores the possibility of using Criterion A and B self-report questionnaires to extract the specific AMPD diagnoses. Plausible prevalence estimates were found in three samples (outpatient PD, private practice, community; N = 766) using the facet score ≥ 2 and t score > 65 methods for determining the presence of a Criterion B facet; diagnoses had meaningful correlations with external variables. This study provides evidence-albeit preliminary-that the extraction of the specific AMPD PDs from self-report questionnaires might be a viable avenue. Ultimately, it could promote the use and dissemination of those diagnoses for screening purposes in clinical and research settings.

Analysis of the interaction between personality dysfunction and traits in the statistical prediction of physical aggression: Results from outpatient and community samples.

The Alternative Model for Personality Disorders (AMPD), included in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) and the World Health Organization's International Classification of Diseases (11th ed.; ICD-11) are, respectively, hybrid categorical-dimensional and dimensional frameworks for personality disorders (PDs). Both models emphasize personality dysfunction and personality traits. Previous studies investigating the links between the AMPD and ICD-11, and self-reported physical aggression have mostly focused on traits and did not take into account the potential interaction between personality dysfunction and traits. Thus, the aim of this study is to identify dysfunction*trait interactions using regression-based analysis. Outpatients with personality disorder from a specialized public clinic (N = 285) and community participants (N = 995) were recruited to complete self-report questionnaires. Some small-size, albeit significant and clinically/conceptually meaningful personality dysfunction*trait interactions were found to predict physical aggression in both samples. Interaction analyses might further inform, to some degree, about the current discussion pertaining to the potential redundancy between dysfunction and traits, the optimal personality dysfunction structure (in the case of the AMPD), as well as clinical assessment based on AMPD/ICD-11 PD frameworks.

[Validation of a screening procedure for borderline personality disorder based on the Alternative DSM-5 Model for Personality Disorders]. / Validation d'une procédure de dépistage du trouble de personnalité limite selon le Modèle alternatif pour les troubles de la personnalité du DSM-5.

Objectives The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes an Alternative Model for Personality Disorders (DSM-5), which defines personality disorders based on two dimensional criteria. Criterion A corresponds to the severity of personality dysfunction in the areas of self and interpersonal functioning, while Criterion B comprises five pathological domains including a total of 25 facets. Six specific disorders, including borderline personality disorder (BPD), are defined in the AMPD based on Criteria A and B. However, there is currently very little data on these diagnoses as they are operationalized in the MATP. This study aims to present data on this recent operationalization of BPD. More specifically, we will first introduce a procedure, based on self-reported questionnaires covering the two main MATP criteria, implemented to generate the BPD diagnosis from the AMPD. Then, we will assess its validity (a) by documenting its prevalence in a clinical sample; (b) by determining its degree of correspondence with the "traditional" BPD categorical diagnosis and with a dimensional measure of borderline symptomatology; (c) by presenting convergent validity data with constructs relevant to the study of BPD (impulsivity, aggression); and (d) by determining the incremental validity of the proposed procedure in contrast with a simplified approach where only Criterion B would be considered. Method Data from 287 patients recruited as part of the admission process at the Centre de traitement le Faubourg Saint-Jean of the CIUSSS-Capitale-Nationale were analyzed. The BPD diagnosis from the MATP was generated based on two validated self-report questionnaires, in their French version, namely the Self and Interpersonal Functioning Scale (Criterion A) and the Personality Inventory for DSM-5-Faceted Brief Form (Criterion B). Results The BPD diagnosis, as operationalized in the AMPD, had a prevalence of 39.7% in the sample. A moderate fit with the clinician's diagnosis of BPD according to the traditional DSM-5 categorical model was observed, as well as a strong correlation with a dimensional measure of borderline symptomatology. Nomological network analysis revealed high and theoretically expected correlations between the disorder and measures of aggression and impulsivity. The proposed diagnostic extraction procedure, which uses Criteria A and B, showed incremental validity in the statistical prediction of external variables (borderline symptomatology, aggression, impulsivity) compared to a simplified procedure using only Criterion B. Conclusions The proposed procedure for generating the BPD diagnosis according to the MATP definition yields promising results and could allow screening for the disorder based on this contemporary conceptualization of personality pathologies.

[Perpetrators and victims of intimate partner violence: Personological profiles of people with borderline personality disorder]. / Violence conjugale commise et subie : profils personnologiques de personnes avec un trouble de personnalité limite.

Objective Personality disorders and intimate partner violence (IPV) are two problems recognized as major public health issues associated with serious individual and societal repercussions. Several studies have documented the links between borderline personality disorder (BPD) and IPV; however, we know very little about the specific pathological traits contributing to IPV. The study aims to document the phenomenon of IPV committed and suffered in persons with BPD and to draw profiles from the personality facets of the DSM-5 Alternative Model for Personality Disorders (AMPD). Method One hundred and eight BPD participants (83.3% female; Mage = 32.39, SD = 9.00) referred to a day hospital program following a crisis episode completed a battery of questionnaires including the French versions of the Revised Conflict Tactics Scales, evaluating physical and psychological IPV committed and suffered, and the Personality Inventory for the DSM-5- Faceted Brief Form, evaluating 25 pathological facets of personality. Results Among the participants, 78.7% report having committed psychological IPV, while 68.5% have been victims, which is more than the estimates published by the World Health Organization (27%). In addition, 31.5% would have committed physical IPV, while 22.2% would have been victims. IPV appears to be bidirectional since 85.9% of participants who are perpetrators of psychological IPV also report suffering from it and 52.9% of participants who are perpetrators of physical IPV report being also victims. Nonparametric group comparisons indicate that Hostility, Suspiciousness, Duplicity, Risk-Taking, and Irresponsibility facets distinguish physically and psychologically violent participants from nonviolent participants. High results on Hostility, Callousness, Manipulation, and Risk-taking facets characterize participants who are victims of psychological IPV, while an elevation in Hostility, Withdrawal, Avoidance of intimacy, and Risk-taking facets and a low result on the Submission facet distinguish participants who are victims of physical IPV from non-victims. Regression analyzes show that the Hostility facet alone explains a significant variance in the results of IPV perpetrated, while the Irresponsibility facet contributes substantially to the variance of the results of IPV experienced. Conclusion Results show the high prevalence of IPV in a sample of persons with BPD, as well as its bidirectional nature. Beyond the diagnosis of BPD, certain specific facets of the personality (including Hostility and Irresponsability) make it possible to target persons at greater risk of committing and suffering from psychological and physical IPV.

A Proposed Classification of ICD-11 Severity Degrees of Personality Pathology Using the Self and Interpersonal Functioning Scale.

Background: The 11th version of the World Health Organization's International Classification of Diseases (ICD-11) has adopted a dimensional approach to personality disorder (PD) nosology. Notably, it includes an assessment of PD degree of severity, which can be classified according to five categories. To date, there is no gold standard measure for assessing degree of PD severity based on the ICD-11 model, and there are no empirically-based anchor points to delineate the proposed categories. With the operationalization of PD degrees of severity in the ICD-11 PD model now being closely aligned with Criterion A of the DSM-5 Alternative Model for Personality Disorders (AMPD), sharing a focus on self and interpersonal dysfunction, self-report instruments developed for the latter model might prove useful as screening tools to determine degrees of severity in the former. Methods: The Self and Interpersonal Functioning Scale, a brief validated self-report questionnaire originally designed to assess level of personality pathology according to the AMPD framework, was used to derive anchor points to delineate the five severity degrees from the ICD-11 PD model. Data from five clinical and non-clinical samples (total N = 2,240) allowed identifying anchor points for classification, based on Receiver Operating Characteristic curve analysis, Latent Class Analysis, and data distribution statistics. Categories were validated using multiple indices pertaining to externalizing and internalizing symptoms relevant to PD. Results: Analyses yielded the following anchor points for PD degrees of severity: No PD = 0-1.04; Personality Difficulty = 1.05-1.29; Mild PD = 1.30-1.89; Moderate PD = 1.90-2.49; and Severe PD = 2.50 and above. A clear gradient of severity across the five categories was observed in all samples. A high number of significant contrasts among PD categories were also observed on external variables, consistent with the ICD-11 PD degree of severity operationalization. Conclusions: The present study provides potentially useful guidelines to determine severity of personality pathology based on the ICD-11 model. The use of a brief self-report questionnaire as a screening tool for assessing PD degrees of severity should be seen as a time-efficient support for clinical decision and treatment planning.

Latent profiles of patients with borderline pathology based on the alternative DSM-5 model for personality disorders.

BACKGROUND: There have been multiple attempts to try to parse out heterogeneity within borderline pathology by identifying patient subtypes; thus far, these works have yielded few consistent results. Recent developments in the operationalization of borderline pathology may provide new opportunities to identify clinically and conceptually meaningful subgroups of patients. The Alternative DSM-5 Model for Personality Disorders (AMPD) offers a categorical-dimensional operationalization of Borderline personality disorder (BPD) that has yet to be tested for identification of patient subgroups. The purpose of the present study is to test whether the combination of the Criterion A elements (pertaining to level of severity) and the seven pathological facets from Criterion B that define BPD in the AMPD can yield meaningful patient profiles. METHODS: A total of 211 outpatients from a specialized PD treatment program (133 women, Mage = 33.66, SD = 10.97) were selected based on the presence of at least moderate borderline pathology according to cutoffs recently proposed for the Borderline Symptom List-23. Valid Criterion A (Self and Interpersonal Functioning Scale) and B (Personality Inventory for DSM-5 Faceted Brief Form) self-reports were administered to measure elements and facets that define BPD in the AMPD model; these variables were used as indicators in a latent profile analysis (LPA). RESULTS: The optimal solution generated by LPA yielded four distinct profiles: (a) Borderline traits; (b) Moderate pathology with Impulsivity; (c) Moderate pathology with Identity problems and Depressivity; and (d) Severe pathology. Clinically meaningful distinctions emerged among profiles on AMPD indicators and external variables relevant to PD, especially aggression and impulsivity. CONCLUSIONS: Profiles reflected both the "severity" and "style" components imbedded within Criterion A and B of the AMPD, as they were mainly distinguished by a continuum of severity but also by some meaningful qualitative differences that may have important clinical implications for treatment planning and contracting. Results also suggest that the four Criterion A elements have independent value to identify important differences in patients with borderline pathology. They also highlight that some Criterion B facets that define BPD in the AMPD may be especially important to identify subgroups of patients, mainly Impulsivity and Depressivity.