An Evolutionary Perspective on the DSM-5 Alternative Model for Personality Disorders.

Recent work has nested the Alternative Model for Personality Disorders (AMPD) within several theoretical paradigms of personality and clinical psychology (e.g., multivariate, psychodynamic). This has both spurred on additional research and aided in practical application. Connecting the model to other theoretical heuristics may lead to further advances. One candidate for such a theory is that of evolutionary psychology, which attempts to provide explanations of human behavior (including personality traits) rooted in adaptation. In this article, we review and integrate the theoretical and empirical literature on the AMPD and evolutionary psychology, providing a synthesis of the two models in the hope of furthering the research and application of both.

Narcissistic personality disorder in the ICD-11: Severity and trait profiles of grandiosity and vulnerability.

Modern diagnostic and classification frameworks such as the ICD-11 and DSM-5-AMPD have adopted a dimensional approach to diagnosing personality disorder using a dual "severity" and "trait" model. As narcissistic personality has historically struggled to be adequately captured in dominant diagnostic systems, this study investigated the utility of the new ICD-11 framework in capturing diverse narcissistic expressions. Participants were mental health clinicians (N = 180, 67% female, age = 38.9), who completed ratings of ICD-11 personality severity, trait domains and a clinical reflection for two hypothetical case vignettes reflecting either prototypical "grandiose" or "vulnerable" narcissism. The majority of clinicians (82%) endorsed a diagnosis of personality disorder for both grandiose and vulnerable vignettes. Discriminant elements of personality impairment included rigid, unrealistically positive self-view, low empathy and high conflict with others for grandiosity, and incoherent identity, low self-esteem and hypervigilant, avoidant relations with others for vulnerability. Regarding trait profile, grandiose narcissism was predominately dissocial whereas vulnerable narcissism was primarily associated with negative affectivity and detachment. Qualitative responses highlight distinct clinical themes for each presentation. These findings suggest that clinicians using the ICD-11 framework are able to identify common core elements of personality dysfunction in grandiose and vulnerable narcissism while also recognizing their distinctive differences.

Convergence of the dimensional assessment of personality pathology (DAPP-BQ) and the five-factor personality inventory for the international classification of diseases 11th edition (FFiCD) in the context of the five-factor model and personality disorders.

The current manuscript presents the convergence of the Dimensional Assessment of Personality Pathology (DAPP-BQ), using its short form the DAPP-90, and the Five-Factor Personality Inventory for International Classification of Diseases (ICD-11), the FFiCD, in the context of the five-factor personality model and the categorical approach of personality disorders (PDs). The current manuscript compares the predictive validity of both the FFiCD and the DAPP-90 regarding personality disorder scales and clusters. Results demonstrate a very high and meaningful convergence between the DAPP-90 and the FFiCD personality pathology models and a strong alignment with the FFM. The DAPP-90 and the FFiCD also present an almost identical predictive power of PDs. The DAPP-90 accounts for between 18% and 47%, and the FFiCD between 21% and 47% of PDs adjusted variance. It is concluded that both DAPP-90 and FFiCD questionnaires measure strongly similar pathological personality traits that could be described within the frame of the FFM. Additionally, both questionnaires predict a very similar percentage of the variance of personality disorders.

Los trastornos de la personalidad ¿realidad o ficción? El sombrío futuro de su diagnóstico / Personality disorders: reality or fiction? The bleak future of your diagnosis

El diagnóstico categorial de los trastornos de la personalidad (TTPP) ha sido criticado por diversas razones, entras las que se encuentran el solapamiento de síntomas entre distintos trastornos, su elevada comorbilidad o el carácter dicotómico de su diagnóstico. Estas críticas han llevado al desarrollo de un planteamiento dimensional en las últimas versiones de los sistemas de clasificación, DSM-5/DSM-5-TR y CIE-11, considerando dos aspectos: el funcionamiento de la personalidad y una serie de rasgos patológicos. A pesar de la cuantiosa literatura publicada desde principio de este siglo sobre esta propuesta dimensional, no está claro, a día de hoy, que tenga alguna utilidad clínica. La vaga, abstracta y poco operativizable exposición de lo que constituye el funcionamiento de la personalidad y la compleja y forzada designación de rasgos mayores y menores (facetas) en el DSM-5/DSM-5-TR o sólo mayores y opcionales en la CIE-11, complican el diagnóstico dimensional de los TTPP. En este trabajo se discuten todas estas cuestiones en un intento de aportar algo de luz para un futuro menos sombrío que el actual panorama de los TTPP.(AU)

The categorical diagnosis of personality disorders (PDs) has been criticized forvarious reasons, among which are overlapping of symptoms between differentdisorders, their high comorbidity, and the dichotomous nature of their diagnosis.These criticisms have led to the development of a dimensional approach in thelatest versions of the classification systems, DSM-5/DSM-5-TR and ICD-11,considering two substantial aspects for its new diagnosis: personality functioning,and a series of pathological features. Despite the large amount of literature thathas been published since the beginning of this century on this dimensionalproposal, it is not clear, to date, that this approach enhances clinical utility. Thevague, abstract, and inoperative exposition of what constitutes personalityfunctioning and the complex and forced designation of major and minor traits(facets) in the DSM-5/DSM-5-TR, and only major and optional traits in the ICD-11,complicate, in an unusual way, the dimensional diagnosis of PDs. This paperdiscusses all of these issues in an attempt to shed some light on the potentially darkfuture of the current PDs panorama.(AU)

Datos normativos, fiabilidad y validez de las escalas de trastornos de la personalidad del NEO PI-R / Normative data, reliability and validity of the NEO PI-R personality disorders scales

Hay un creciente interés por entender los trastornos de la personalidad (TTPP) desde el modelo de los cinco factores. Miller et al. (2005) y Costa y McCrae (2005) propusieron dos conjuntos de escalas basadas en las facetas del “Inventario de personalidad NEO-revisado” (NEO PI-R) para evaluar los TTPP del DSM-5. Existen baremos españoles para las escalas de Miller et al. (2005) a partir de muestras de selección de personal, pero no son apropiados en contextos con deseabilidad social baja. Se presentan datos normativos, de fiabilidad y validez convergente/ discriminante para ambos conjuntos de escalas con voluntarios de la población general española (N= 682). Los índices de consistencia interna y validez convergente/ discriminante fueron excelentes o buenos para todas las escalas, especialmente para las de Miller et al. (2005). Las diferencias entre la muestra de voluntarios y de selección de personal (d= 0,61) y entre varones y mujeres (d= 0,34-0,38) justifican el desarrollo de baremos para los dos conjuntos de escalas de TTPP para situaciones de deseabilidad social baja y separados por sexo. Se discute su utilidad en diferentes contextos.(AU)

There is increasing interest in understanding personality disorders (PDs) fromthe five-factor model. Miller et al. (2005) and Costa and McCrae (2005) proposedtwo sets of scales based on the NEO Personality Inventory-Revised (NEO PI-R) facetsto assess DSM-5 PDs. There are Spanish norms for the scales of Miller et al. (2005)based on personnel selection samples, but they are not appropriate for contextswith low social desirability. Normative, reliability, and convergent/discriminantvalidity data are presented for both sets of scales with volunteers from the generalSpanish population (N= 682). The internal consistency and convergent/discriminantvalidity indices were excellent or good for all scales, especially for those of Miller etal. (2005). The differences between the sample of volunteers and that of personnelselection (d= 0.61) and between males and females (d= 0.34-0.38) justify the development of norms for the two sets of PD scales for situations of low socialdesirability and separate for males and females. Their usefulness in differentcontexts is discussed.(AU)

The Alternative Model of Personality Disorders: Assessment, Convergent and Discriminant Validity, and a Look to the Future.

The Alternative Model of Personality Disorders (AMPD) is a dimensional, empirically based diagnostic system developed to overcome the serious limitations of traditional categories. We review the mounting evidence on its convergent and discriminant validity, with an incursion into the less-studied ICD-11 system. In the literature, the AMPD's Pathological Trait Model (Criterion B) shows excellent convergence with normal personality traits, and it could be useful as an organizing framework for mental disorders. In contrast, Personality Functioning (Criterion A) cannot be distinguished from personality traits, lacks both discriminant and incremental validity, and has a shaky theoretical background. We offer some suggestions with a view to the future. These include removing Criterion A, using the real-life consequences of traits as indicators of severity, delving into the dynamic mechanisms underlying traits, and furthering the integration of currently disengaged psychological paradigms that can shape a sounder clinical science.

An empirically derived hierarchical tree typology of DSM-5 pathological personality traits in adolescence.

Traditional personality disorder (PD) taxonomies have been developed for adult populations. We aimed to identify an adolescent hierarchical tree typology of PD indicators to provide classification into broad severity classes but also more fine-grained classification within those classes. A large sample of community adolescents (N = 1,940) completed a validated dimensional measure that covers a comprehensive range of pathologically formulated personality traits, the Personality Inventory for DSM-5. Latent class tree modeling suggested three classes at the first level of the tree representing high, medium, and low PD-trait levels-thus spanning the range between normal and pathological personality. These classes were divided into subclasses lower in the hierarchy, which suggested subclinical variants of patterns that are often found in clinical samples, medium levels of externalizing and internalizing behaviors, and differential profiles of thriving in the low-risk classes. The identified classes had promising initial criterion validity based on meaningful relations with self- and peer-reported measures of friendship and social functioning with peers. Our hierarchical PD tree typology may represent groups at differential risk for developing PDs and could therefore be useful for preventive purposes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Group schema therapy for patients with cluster-C personality disorders: A case study on avoidant personality disorder.

This article presents a clinical illustration of group schema therapy (GST) for cluster-C personality disorders (CL-C PDs) to provide therapists an example on how one can perform GST for CL-C PDs and break through persistent avoidance and control mechanisms. A summary of evidence supporting the effectiveness of GST for CL-C PD's is given followed by an overview of basic principles of schema therapy and GST. A case presentation next illustrates the application of GST principles and interventions in the GST CL-C protocol, which improve clients understanding of emotional core needs and development of adaptive ways of getting needs better met, instead of avoiding life. Implications of the case for future applications of GST for CL-C PDs are discussed.

The borderline pattern descriptor in the International Classification of Diseases, 11th Revision: A redundant addition to classification.

OBJECTIVE: The International Classification of Diseases, 11th Revision classification of personality disorder removes all categories of disorder in favour of a single diagnostic spectrum extending from no personality dysfunction to severe personality disorder. Following concerns from some clinicians and Personality Disorder Societies, it was subsequently agreed to include a borderline pattern descriptor as a qualifier of the main diagnosis. We explore the value of this additional descriptor by examining personality data in patients with major depression. METHOD: We examined personality data obtained using the Structured Clinical Interview for Personality Disorder-II in 606 patients enrolled in five randomised controlled trials of depression. The Structured Clinical Interview for Personality Disorder-II uses the Diagnostic and Statistical Manual of Mental Disorders categorical system, which includes borderline personality disorder. The International Classification of Diseases, 11th Revision classification has five domain traits. Each of the Diagnostic and Statistical Manual of Mental Disorders personality disorder symptoms or behaviours from Structured Clinical Interview for Personality Disorder-II was reordered into the five domains independently by two assessors. The relationship between the two systems was examined by tabular and correlational analysis. RESULTS: The findings showed that the symptoms of borderline personality disorder were associated with greater severity of personality disturbance in the International Classification of Diseases, 11th Revision classification (p < 0.0001) and were associated primarily with the Negative Affective, Dissocial and Disinhibited domains. There was only a weak association with the other two domains, Anankastia and Detachment. CONCLUSION: The addition of a borderline pattern descriptor is likely to add little to the International Classification of Diseases, 11th Revision classification of personality disorder. Its features are well represented within the severity/domain structure, which allows for more fine-grained description of the personality features that constitute the borderline concept.

Dimensions over categories: a meta-analysis of taxometric research.

Taxometric procedures have been used extensively to investigate whether individual differences in personality and psychopathology are latently dimensional or categorical ('taxonic'). We report the first meta-analysis of taxometric research, examining 317 findings drawn from 183 articles that employed an index of the comparative fit of observed data to dimensional and taxonic data simulations. Findings supporting dimensional models outnumbered those supporting taxonic models five to one. There were systematic differences among 17 construct domains in support for the two models, but psychopathology was no more likely to generate taxonic findings than normal variation (i.e. individual differences in personality, response styles, gender, and sexuality). No content domain showed aggregate support for the taxonic model. Six variables - alcohol use disorder, intermittent explosive disorder, problem gambling, autism, suicide risk, and pedophilia - emerged as the most plausible taxon candidates based on a preponderance of independently replicated findings. We also compared the 317 meta-analyzed findings to 185 additional taxometric findings from 96 articles that did not employ the comparative fit index. Studies that used the index were 4.88 times more likely to generate dimensional findings than those that did not after controlling for construct domain, implying that many taxonic findings obtained before the popularization of simulation-based techniques are spurious. The meta-analytic findings support the conclusion that the great majority of psychological differences between people are latently continuous, and that psychopathology is no exception.

Construct validity of the personality inventory for ICD-11 (PiCD): Evidence from the MMPI-2-RF and CAT-PD-SF.

The Personality Inventory for ICD-11 (PiCD) was recently developed to assess the ICD-11 model of personality disorders. The purpose of this study was to examine the construct validity of the PiCD using the Minnesota Multiphasic Personality Inventory (MMPI)-2-Restructured Form (MMPI-2-RF) and the Computerized Adaptive Test of Personality Disorders Static Form (CAT-PD-SF). We administered these tests to 328 college students (150 males, 178 females). We found that the PiCD had adequate internal consistency reliability. Correlations between scores from the PiCD scales and the criterion measures generally indicated adequate discriminant validity. Along the same lines, convergent validity was adequate for the PiCD Negative Affective, Disinhibition, and Dissocial scales. However, the evidence was more mixed for the PiCD Detachment and Anankastic domains, which may be due to limitations with the content domains for these scales. Consistent with other research and theoretical expectations, a conjoint exploratory factor analysis utilizing the PiCD and MMPI-2-RF PSY-5 scales also indicated that anankastic and disinhibition may be more appropriately conceptualized as measuring opposite poles of one construct. Implications of these findings for the PiCD and the ICD-11 model are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

International Assessment of DSM-5 and ICD-11 Personality Disorder Traits: Toward a Common Nosology in DSM-5.1.

INTRODUCTION: The DSM-5 Alternative Model of Personality Disorders (AMPD) and the ICD-11 classification of personality disorders (PD) are largely commensurate and, when combined, they delineate 6 trait domains: negative affectivity, detachment, antagonism/dissociality, disinhibition, anankastia, and psychoticism. OBJECTIVE: The present study evaluated the international validity of a brief 36-item patient-report measure that portrays all 6 domains simultaneously including 18 primary subfacets. METHODS: We developed and employed a modified version of the Personality Inventory for DSM-5 - Brief Form Plus (PID5BF+). A total of 16,327 individuals were included, 2,347 of whom were patients. The expected 6-factor structure of facets was initially investigated in samples from Denmark (n = 584), Germany (n = 1,271), and the USA (n = 605) and subsequently replicated in both patient- and community samples from Italy, France, Switzerland, Belgium, Norway, Portugal, Spain, Poland, Czech Republic, the USA, and Brazil. Associations with interview-rated DSM-5 PD categories were also investigated. RESULTS: Findings generally supported the empirical soundness and international robustness of the 6 domains including meaningful associations with familiar interview-rated PD types. CONCLUSIONS: The modified PID5BF+ may be employed internationally by clinicians and researchers for brief and reliable assessment of the 6 combined DSM-5 and ICD-11 domains, including 18 primary subfacets. This 6-domain framework may inform a future nosology for DSM-5.1 that is more reasonably aligned with the authoritative ICD-11 codes than the current DSM-5 AMPD model. The 36-item modified PID5BF+ scoring key is provided in online supplementary Appendix A see www.karger.com/doi/10.1159/000507589 (for all online suppl. material).

Facet-level analysis of the relations between personality and laboratory aggression.

Multiple reviews and meta-analyses have identified the low pole of the Five-Factor Model (FFM) Agreeableness (also called Antagonism) as the primary domain-level personality correlates of aggression across self-report and behavioral methodologies. In the current study, we expand on this literature by investigating the relations between FFM facets and aggressive behavior as measured by laboratory competitive reaction time tasks (CRTTs). Across three samples (total N = 639), we conducted weighted mean analyses, multiple regression analyses, and dominance analyses to determine which FFM facets were the strongest predictors of aggression within and across domains. These analyses suggested that facets of Agreeableness were among the strongest consistent predictors of CRTT aggression, including Sympathy (r = -.21) and Cooperation (r = -.14), but facets from other FFM domains also yielded meaningful relations (e.g., Anger from Neuroticism; r = .17). We conclude by discussing these results in the context of controversies surrounding laboratory aggression paradigms and emphasizing the importance of considering small effect sizes in the prediction of societally harmful behavior like aggression.

La Personalidad como Vulnerabilidad Unidimensional y Bidimensional: el Papel Mediador de las Variables Cognitivas en la Gravedad Sintomatológica en una Muestra de Personas con Trastorno Grave de Personalidad / Personality as unidimensional and bidimensional vulnerability: The mediator role of cognitive variables in symptom severity in a sample of people with severe personality disorder

Los problemas de conceptualización de los trastornos de personalidad (TP) y su acomodo con el resto de las patologías siguen suscitando un prometedor esfuerzo investigador y clínico que va dando frutos al identificar procesos transdiagnósticos y proponer modelos heurísticos de interacción. Desde el marco de la personalidad como diátesis, estudiamos en una muestra de personas con TP grave (N = 310) el papel mediador de diversas variables en la gravedad sintomatológica. Mediante análisis de conglomerados hallamos una tipología bidimensional que divide de manera exhaustiva y exclusiva al 100% de los participantes. El análisis de mediación revela que el efecto de la personalidad como continuum unidimensional en gravedad sintomatológica está mediado por pensamientos automáticos negativos y fusión cognitiva; su efecto como tipología bidimensional (internalización y externalización) parece mediado solo por pensamientos automáticos. Se discuten los hallazgos e implicaciones de cara al nuevo paradigma de una ciencia clínica basada en procesos

The problems of conceptualization of personality disorders (PD) and their adjustment within the rest of pathologies continue to boost a promising research and clinical effort that helps to identify transdiagnostic processes and suggestheuristic interaction models. Understanting personality from the framework of diathesis, we analized the mediating role of a number of variables in symptom severity in a sample of people with severe PD (N = 310). By means of cluster analysis, we found a two-dimension typology that divides exhaustively and exclusively 100% of the participants. Mediation analyses found that personality as a one-dimension continuum has an effect on symptomatic severity mediated by negative automatic thoughts and by cognitive fusion; its effect as a two-dimension typology (internalization and externalization) appears to be mediated only by automatic thoughts. These findings and their implications are discussed in the context of a new paradigm of a process-based clinical science

The General Factor of Psychopathology.

An important advance in understanding and defining mental disorders has been the development of empirical approaches to mapping dimensions of dysfunction and their interrelatedness. Such empirical approaches have consistently observed intercorrelations among the many forms of psychopathology, leading to the identification of a general factor of psychopathology (the p factor). In this article, we review empirical support for p, including evidence for the stability and criterion validity of p. Further, we discuss the strong relationship between p and both the general factor of personality and the general factor of personality disorder, substantive interpretations of p, and the potential clinical utility of p. We posit that proposed substantive interpretations of p do not explain the full range of symptomatology typically included in p. The most plausible explanation is that p represents an index of impairment that has the potential to inform the duration and intensity of a client's mental health treatment.

Treatment of personality pathology through the lens of the hierarchical taxonomy of psychopathology: Developing a research agenda.

Despite the emphasis on evidence-based treatment for psychological disorders, to date, there has been limited research examining treatment for nine of the 10 categorical personality disorders in DSM-5 Section 2. This is perhaps not surprising given the complex heterogeneity and co-morbidity within personality pathology. The hierarchical taxonomy of psychopathology (HiTOP) was proposed to address limitations within the traditional categorical model of the diagnostic system. Within this system are five spectra: detachment, antagonistic externalizing, disinhibited externalizing, thought disorder and internalizing. These foundational personality traits potentially have direct and specific treatment implications. The purpose of this paper is to highlight potential psychotherapeutic and pharmacological treatment recommendations within the personality spectra. Additionally, we outline the advantages of considering the personality science found within dimensional models of psychopathology in clinical assessment and intervention to aid in treatment planning. © 2019 John Wiley & Sons, Ltd.

Personality profiles as potential targets for intervention: Identification and replication.

The alternative dimensional model of personality disorder (PD) diagnosis, based on personality-functioning impairment and pathological traits, opens the door for tailoring treatments to individuals with more homogeneous personality profiles than diagnostic categories. Such a transdiagnostic PD treatment approach requires robust, replicable, personality-relevant dimensions, which we found using a large battery of self-report measures: Self-pathology and negative affectivity (NA) traits, interpersonal pathology and detachment traits, and interpersonal pathology and antagonism traits. Using these dimensions, we identified three groups that had, respectively, elevations on (1) all three dimensions, (2) self-pathology/NA (with/without interpersonal-pathology elevation(s)) and (3) either or both interpersonal-pathology dimensions, without elevated self-pathology/NA. Using the same personality-functioning measures and a half-overlapping trait set, we replicated these profiles in an additional sample. Interview-based measures of functioning and personality pathology provided external validity evidence for the method, suggesting it represents a critical first step towards treatment research targeting transdiagnostic processes rather than diagnoses. For example, two groups might benefit from treatments focused, respectively, on emotional dysregulation and interpersonal relations, whereas the multiple-problem group may need a sequenced treatment approach. Research is needed to test these hypotheses and to expand the method to include a wider range of pathological personality traits. © 2019 John Wiley & Sons, Ltd.

Personality traits as an organizing framework for personality pathology.

We review evidence establishing important parallels between the general structure of psychopathology, the more specific structure of personality pathology and the structure of normal-range personality. We then present data to explicate the nature of associations between the alternative model of personality disorder (AMPD)-as operationalized by the Personality Inventory for DSM-5-and the domains and facets subsumed within the five-factor model of personality. Our data demonstrate substantial links between four of the five domains within these models but also indicate that the AMPD could be realigned to enhance its convergence with the five-factor model of personality. Based on our data, we tentatively propose an expanded four-facet model of AMPD Negative Affectivity (Anxiousness, Depressivity, Hostility and Emotional Lability); an alternative bipolar scheme for Detachment that includes two positively keyed (Withdrawal and Anhedonia) and two negatively keyed (Risk Taking and Attention Seeking) facets; a broader five-facet model of Antagonism (Deceitfulness, Manipulativeness, Callousness, Grandiosity and Suspiciousness); and a reduced two-facet model of Disinhibition (Irresponsibility and Impulsivity). These alternative scores generally showed superior convergent and discriminant validity when compared with current measures of the AMPD domains but also raise other issues. Our findings highlight the strong overlap between normal and pathological personality and clarify the nature of the associations between them. © 2019 John Wiley & Sons, Ltd.

Personality traits across the psychosis spectrum: A Hierarchical Taxonomy of Psychopathology conceptualization of clinical symptomatology.

Psychotic disorders have varied clinical presentations, diagnostic stability is poor and other mental disorders often co-occur with the conditions. To improve the clinical and pathophysiological utility of classification systems for psychosis, it is necessary to consider how symptoms may reflect dimensions of psychopathology that extend beyond the boundaries of traditional diagnostic classifications. We examined personality deviation as a means for explaining symptom variation across individuals with serious mental illness. Participants (N = 312) with psychosis, first-degree biological relatives and healthy controls underwent comprehensive clinical evaluations that included symptom ratings and Diagnostic Statistical Manual consensus diagnoses. They completed the Personality Inventory for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PID-5), which provides multidimensional assessment of personality disturbances and characterizes psychosis-relevant phenomena, and the Schizotypal Personality Questionnaire (SPQ), a widely accepted measure of schizotypal traits. PID-5 was comparable with SPQ in differentiating between participants with and without psychosis. Greater psychotic symptomatology and higher scores on the SPQ Cognitive-perceptual dimension were associated with higher scores on PID-5 Psychoticism. Facet-level traits showed diverse associations with existing clinical syndromes, suggesting they have utility for quantifying separable symptom dimensions that cut across existing disorders. Yet the patient groups were similar across four of the five PID-5 personality trait domains, indicating shared patterns of personality expression that challenge existing categorical delineations. © 2019 John Wiley & Sons, Ltd.

[Attention-deficit/hyperactivity disorder in adults in the clinical description and classification of Emil Kraepelin]. / Die Aufmerksamkeitsdefizit­/Hyperaktivitätsstörung bei Erwachsenen in der klinischen Beschreibung und der Klassifikation von Emil Kraepelin.

This study presents descriptions of symptoms specific to the adult form of attention-deficit/hyperactivity disorder (ADHD) in the 8th edition of the Textbook on Psychiatry by Emil Kraepelin (1856-1926). To identify whether ADHD is a new, fashionable phenomenon in adults or whether early psychiatrists also saw such patients and how they classified them, this textbook is an essential source. Published between 1905 and 1915, it can be perceived as the culmination and at the same time terminal point of Kraepelin's conceptual and nosological work, which in turn marked the beginning of present-day psychiatric classification. Kraepelin did not perceive ADHD as a psychiatric entity of its own, which is either due to the fact that he saw no necessity to do so or that he did not recognize this. If the latter, Kraepelin may have been misled by the manifold psychiatric comorbidities typical for ADHD, which may have masked ADHD. Kraepelin seems to have grouped patients obviously suffering from the adult form of ADHD into two groups: on the one hand into the so-called basic constitution (Grundzustand) of manic-depressive disorder, which he called manic disposition or constitutional excitement (manische Veranlagung oder konstitutionelle Erregung) and on the other hand into the so-called group of anchorless people (Haltlose), which he perceived as a special form of psychopathic personality. It seems that Kraepelin grouped milder grades of ADHD with predominantly ADHD-associated mood swings into the group of manic disposition while grouping more severe forms, which usually occur together with distinct personality disorders and addictive disorders, into that of anchorless people.