Improving characterization of psychopathy within the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), alternative model for personality disorders: Creation and validation of Personality Inventory for DSM-5 Triarchic scales.

The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) bridges a significant gap in psychiatric nosology by providing trait-based characterizations of psychopathy along with antisocial personality disorder within the Section III alternative model for personality disorders (AMPD). However, the representation of psychopathy in the AMPD has met with some criticisms (Crego & Widiger, 2014; Few, Lynam, Maples, MacKillop, & Miller, 2015). The current study was undertaken to establish an improved means for characterizing psychopathy in DSM-5 Section III terms, by creating scale measures of triarchic psychopathy dimensions using items from the best-established assessment instrument for the AMPD, the Personality Inventory for DSM-5 (PID-5). Using data from a sample of community adults (N = 210), we employed a construct rating and psychometric refinement approach to develop item-based PID-5 Triarchic scales for measuring psychopathy dimensions of boldness, meanness, and disinhibition. The validity of the PID-5 Triarchic scales was then evaluated in relation to criteria including other scale measures of the triarchic constructs and psychopathy, self-reported antisocial behavior and substance use, empathy, internalizing and other clinical problems, and personality within the development sample and a separate independent sample of adults (N = 240) recruited to have elevated psychopathic traits. Results of this work provide a foundation for improved characterization of psychopathy in terms of the AMPD trait system and provide a mechanism for future research oriented toward clarifying the developmental interface between childhood conduct disorder and psychopathy, as well as identifying neurobiological correlates of dimensions of psychopathy. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Categorical and Dimensional Conceptions of Personality Pathology in DSM-5: Toward a Model-Based Synthesis.

Symptom-based models, typically operationalized through diagnostic interview, and trait models, typically operationalized via questionnaire inventories, reflect historically competing conceptions of personality disorder (PD). DSM-5 includes models of both types, in Sections II and III, respectively. In this study, we sought to synthesize these alternative conceptualizations by fitting bifactor models to data for both Section II PD symptoms (assessed using the SCID-II interview protocol) and dimensional traits for the six PDs retained in Section III (assessed using the Personality Inventory for DSM-5). Bifactor models fit the data effectively for all six PDs, and trait and symptom indicators both loaded appreciably on general factors reflecting cross-domain PD constructs. These results provide the basis for a principled, quantitative synthesis of categorical/interview and dimensional/self-report approaches to operationalizing and studying PDs, with considerable implications for diagnosis, research, and practice.

Evidence of a prominent genetic basis for associations between psychoneurometric traits and common mental disorders.

Threat sensitivity (THT) and weak inhibitory control (or disinhibition; DIS) are trait constructs that relate to multiple types of psychopathology and can be assessed psychoneurometrically (i.e., using self-report and physiological indicators combined). However, to establish that psychoneurometric assessments of THT and DIS index biologically-based liabilities, it is important to clarify the etiologic bases of these variables and their associations with clinical problems. The current work addressed this important issue using data from a sample of identical and fraternal adult twins (N=454). THT was quantified using a scale measure and three physiological indicators of emotional reactivity to visual aversive stimuli. DIS was operationalized using scores on two scale measures combined with two brain indicators from cognitive processing tasks. THT and DIS operationalized in these ways both showed appreciable heritability (0.45, 0.68), and genetic variance in these traits accounted for most of their phenotypic associations with fear, distress, and substance use disorder symptoms. Our findings suggest that, as indices of basic dispositional liabilities for multiple forms of psychopathology with direct links to neurophysiology, psychoneurometric assessments of THT and DIS represent novel and important targets for biologically-oriented research on psychopathology.

Externalizing proneness and brain response during pre-cuing and viewing of emotional pictures.

Externalizing proneness, or trait disinhibition, is a concept relevant to multiple high-impact disorders involving impulsive-aggressive behavior. Its mechanisms remain disputed: major models posit hyperresponsive reward circuitry or heightened threat-system reactivity as sources of disinhibitory tendencies. This study evaluated alternative possibilities by examining relations between trait disinhibition and brain reactivity during preparation for and processing of visual affective stimuli. Forty females participated in a functional neuroimaging procedure with stimuli presented in blocks containing either pleasurable or aversive pictures interspersed with neutral, with each picture preceded by a preparation signal. Preparing to view elicited activation in regions including nucleus accumbens, whereas visual regions and bilateral amygdala were activated during viewing of emotional pictures. High disinhibition predicted reduced nucleus accumbens activation during preparation within pleasant/neutral picture blocks, along with enhanced amygdala reactivity during viewing of pleasant and aversive pictures. Follow-up analyses revealed that the augmented amygdala response was related to reduced preparatory activation. Findings indicate that participants high in disinhibition are less able to process implicit cues and mentally prepare for upcoming stimuli, leading to limbic hyperreactivity during processing of actual stimuli. This outcome is helpful for integrating findings from studies suggesting reward-system hyperreactivity and others suggesting threat-system hyperreactivity as mechanisms for externalizing proneness.

Characterizing psychopathy using DSM-5 personality traits.

Despite its importance historically and contemporarily, psychopathy is not recognized in the current Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revised (DSM-IV-TR). Its closest counterpart, antisocial personality disorder, includes strong representation of behavioral deviance symptoms but weak representation of affective-interpersonal features considered central to psychopathy. The current study evaluated the extent to which psychopathy and its distinctive facets, indexed by the Triarchic Psychopathy Measure, can be assessed effectively using traits from the dimensional model of personality pathology developed for DSM-5, operationalized by the Personality Inventory for DSM-5 (PID-5). Results indicate that (a) facets of psychopathy entailing impulsive externalization and callous aggression are well-represented by traits from the PID-5 considered relevant to antisocial personality disorder, and (b) the boldness facet of psychopathy can be effectively captured using additional PID-5 traits. These findings provide evidence that the dimensional model of personality pathology embodied in the PID-5 provides effective trait-based coverage of psychopathy and its facets.