Clarifying the Nature and Structure of Personality Disorder
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Clarifying the Nature and Structure
of Personality Disorder
TAKAKUNI SUZUKI and DOUGLAS B. SAMUEL
Abstract
Past research has suggested that personality disorders (PDs) are best conceptualized
as a maladaptive extreme variants of the same traits that define general personality.
Such a dimensional approach to PD classification has officially been included in the
latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
as an alternative diagnostic model for PD. The current essay provides an overview of
the rationale for the dimensional approach to PDs and highlights compelling directions for future research.
The classification of mental disorder is detailed in the Diagnostic and Statistical Manual of Mental Disorders—Fifth Edition (DSM-5; APA, American
Psychiatric Association, 2013). Within the primary section of the DSM-5, personality disorders (PDs) are defined by 10 categorical constructs that are considered distinct from each other and from normal personality functioning.
However, many in the PD field have recognized the limitations and flaws of
this categorical system, such as the high co-occurrence of PD and heterogeneity within categories. As such, many scientists and practitioners have voiced
the advantages offered by a dimensional approach to PD classification (e.g.,
Widiger & Trull, 2007; Clark, 2007).
Considering these issues, researchers have proposed alternative dimensional personality models. One prominent model with a great deal of
empirical support is the Five-Factor Model (FFM), which has been suggested as a suitable that spans both normal and abnormal personality
(Widiger & Trull, 2007). The FFM consists of five bipolar broad trait domains
and is a popular model in general personality research (e.g., Costa &
McCrae, 1992; John, Naumann, & Soto, 2008). The five domains are neuroticism (vs emotional stability), extraversion (vs detachment), openness
to experience (vs closedness to experience), agreeableness (vs antagonism),
and conscientiousness (vs disinhibition). The FFM has robust empirical
Emerging Trends in the Social and Behavioral Sciences. Edited by Robert Scott and Stephen Kosslyn.
© 2015 John Wiley & Sons, Inc. ISBN 978-1-118-90077-2.
1
2
EMERGING TRENDS IN THE SOCIAL AND BEHAVIORAL SCIENCES
evidence and has been shown to account reasonably well for many other
personality models (e.g., Widiger & Simonsen, 2005). The FFM has also
been shown to be universal across a wide number of cultures (McCrae &
Costa, 1997) and the traits exhibit test—retest stability approaching 0.70 over
long periods (Ferguson, 2010). The five broad, higher order domains of the
FFM can be further subdivided into related, yet distinguishable, traits that
are called facets (Costa & McCrae, 1992; Saucier & Ostendorf, 1999). These
lower order facets allow the FFM to comprehensively assess an individual’s
personality at the level of five broad domains and at a more precise facet
level.
Over the past two decades, a great deal of research has investigated
whether the existing PD categories within the DSM can be conceptualized as
maladaptive, extreme versions of the FFM traits. For example, studies have
collected ratings of prototypic cases of the PDs in terms of the FFM. These
ratings, collected from expert researchers and practicing clinicians, show
strong agreement across raters and bear out conceptual links between the
FFM and PDs (Lynam & Widiger, 2001; Samuel & Widiger, 2004). In addition,
a meta-analysis suggested relatively consistent and predictable correlations
between self-report measures of the FFM and PDs (Samuel & Widiger,
2008). For example, the construct of borderline PD exhibited strong positive
relationships with the domain of neuroticism, negative correlations with
conscientiousness, and moderate negative correlations with extraversion
and agreeableness.
Research has also investigated the hierarchical structure of PD symptoms
and found compelling similarities to the structure of normal personality
(Markon, Krueger, & Watson, 2005; O’Connor, 2005). For example, factor
analyses of personality pathology typically converge on five domains that
readily map onto the domains of the FFM. These studies suggest that the
similar constructs underlie the FFM domains and PDs, which supports
one of the assumptions of the dimensional approach to PDs. In addition to
structural similarity, research using item-response theory analyses has also
suggested that the distinction between normal and abnormal function is one
of degree, rather than kind. Specifically, Samuel, Simms, Clark, Livesley, and
Widiger (2010) examined the relationships between a measure of general
personality functioning and two measures of PD and found that, consistent
with their development, the general personality measure assessed the
normative range of the underlying construct and PD measures provided
more information at the more extreme levels. Taken together, the literature
provides support for structural similarity between general personality and
personality pathology as well as meaningful and predictable relationships
between the constructs. As such, there is compelling support that the FFM,
Clarifying the Nature and Structure of Personality Disorder
3
which was derived from models of normative functioning, can be fruitfully
applied to the conceptualization of PD.
DSM-5: AN ALTERNATIVE PD MODEL
Building upon the research base, a hybrid model of PD diagnosis was
included within Section III (Emerging Models and Measures) of the DSM-5.
The diagnosis of PD within this alternative model is based on two core criteria: Severity of impairments in self and interpersonal functioning (Criterion
A) and extreme standings on one or more of 25 pathological traits (Criterion
B; APA, 2013). The 25 traits within this model were developed on the basis
of expert consensus and later refined using an iterative, empirical process
based on a self-report inventory: the Personality Inventory for the DSM-5
(PID-5; Krueger, Derringer, Markon, Watson, & Skodol, 2012). Research has
suggested that the 25 traits are organized under five broad, higher order
domains to form a hierarchical structure that is extremely similar to that
of the FFM (Gore & Widiger, 2013; Griffin & Samuel, 2014; Thomas, Yalch,
Krueger, Wright, Markon, & Hopwood, 2013; Wright & Simms, 2014; Wright,
Thomas, Hopwood, Markon, Pincus, & Krueger, 2012). Thus, the emerging
consensus is that the DSM-5 Section III Trait model can be considered a
version of the FFM. Along with the hybrid model, the DSM-5 Section III also
lists the hypothesized traits relevant to 6 of the 10 PDs from the Section II
(APA, 2013).
FUTURE DIRECTIONS
There now exists a general consensus that PDs can be described using five
broad trait domains. However, the least consistent link between these structures has been for the FFM domain of openness to experience, which measures an individual’s tendency to be creative, and open to feelings, artistic
interests, and new ideas. Conceptually, openness to experience maps onto
the PD constructs that have been labeled schizotypy, oddity, eccentric, or psychoticism. However, the empirical link lacks the consistency relative to the
other four FFM domains (e.g., Samuel & Widiger, 2008; Chmielewski, Bagby,
Markon, Ring, & Ryder, 2014). This domain seems to be the most inconsistent
domain in general personality research, as well. For example, in the lexical
tradition using factor analyses of adjectives in dictionaries related to personality, openness to example is the last of the five domains to emerge and have
resulted in slightly different forms, such as Intellect and Culture, depending on the language and sample population (McCrae, 1994; Norman, 1963).
Thus, it appears that the specific instantiations of openness and schizotypy
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EMERGING TRENDS IN THE SOCIAL AND BEHAVIORAL SCIENCES
can lead to somewhat different relationships between the constructs (DeYoung, Grazioplene, & Peterson, 2012). Future research is clearly necessary to
further investigate the historically inconsistent relationship.
As noted previously, traits below the five domains are typically needed
to further flesh out the information provided by the higher domains. For
example, an individual might be particularly high on the conscientiousness
facet of orderliness (i.e., keeping one’s belongings organized and tidy),
but low on the facet of achievement-striving (i.e., the orientation toward
pursuing goals). Indeed, multiple studies have demonstrated the utility
and importance of the facets for characterizing PDs and, specifically for
distinguishing between them (Axelrod, Widiger, Trull, & Corbitt, 1997;
Reynolds & Clark, 2001). For example, when applying the NEO PI-R-based
FFM framework to characterize antisocial PD, there is considerable variation
within the domain of neuroticism. Specifically, an individual who presents
with features of antisocial PD might be described by high standings on the
facets of angry hostility and impulsiveness, but relatively low standings
on self-consciousness and depressiveness. As such, the domain level alone
would provide an incomplete picture of the individual; sacrificing valuable
information. Facets also tend to have stronger relationships with specific
behavioral outcomes. For example, Paunonen and Ashton (2001) found that
selected five FFM facets predicted outcome behaviors, such as willingness
to share money and religiosity rating, better than the FFM domains. Thus,
although there is widespread acknowledgement that facets are important,
there is little agreement about the specific facets that are necessary for comprehensively describing personality pathology. In contrast to the general
agreement on the presence of five broad higher order domains, such a
consensus is less clear at the lower order facet level.
As noted, the DSM-5 Section III PD model includes 25 traits, with between
3 and 9 assigned to each domain. Nonetheless, a variety of other facet
scales exist on alternative measures of PD and normative personality.
Perhaps the most prominent facet model posited for the FFM is that from
the NEO Personality Inventory—Revised (Costa & McCrae, 1992), which
subdivides each domain into six facets, for a total of 30. Within trait models
of personality pathology, there are also a wide variety of lower order
structures. The Schedule for Nonadaptive and Adaptive Personality—2
(Clark, Simms, Wu, & Casillas, 2014) has 13 lower order trait scales, the
Dimensional Assessment for Personality Pathology (Livesley & Jackson,
2009) has 19 traits, and the newly developed Computer Adaptive Test of
PD (Simms, Goldberg, Roberts, Watson, Welte, & Rotterman, 2011) has 33
traits. Future research that determines which specific traits are necessary
for a comprehensive and efficient model of personality pathology is sorely
needed. In particular, it is likely that many of the trait facets across existing
Clarifying the Nature and Structure of Personality Disorder
5
models are highly overlapping and even redundant. Clearly, delineating the
optimal lower order structure of personality pathology represents a crucial
research agenda within the field of PDs.
An important characteristic of the FFM is that the domains are explicitly
bipolar (Costa & McCrae, 1992). Conceptually, this assumes that high and
low standings on each trait are equally informative. Specifically, an individual can be rated on a dimension anchored by two mutually exclusive traits at
each end, such as considering extraversion and introversion to be opposite
ends of the same underlying spectrum. On the other hand, PD traits have
typically been conceptualized as unipolar, which suggests that the spectrum
ranges from possessing the pathological characteristics to other who lack the
pathology. This can be conceptualized as considering only one tail of the normal curve. Taking the extraversion example, this would mean that someone
who scores extremely low on extraversion scale lacks extraversion, but this
has no implication on whether the individual is introverted.
The DSM-5 Section III trait model does explicitly include bipolar indicators
for the trait domains (e.g., detachment vs extraversion), but not for the lower
order facets. Thus, a particularly important line of future inquiry would be
to determine the nature and meaning of low scores on the PID-5 scales. There
are an appreciable number of advantages of bipolar conceptualization over
unipolar conceptualization of constructs (e.g., Samuel, 2011). For example,
by focusing on one tail of the distribution, unipolar assessment neglects the
extreme cases on the other side of the distribution that could potentially be
informative. In case of agreeableness, for example, although low standings
on agreeableness (i.e., antagonism) have important social and interpersonal
costs, it would also be important to characterize those individuals on the
other end of the spectrum who might be impaired by extreme deference to
others and self-sacrifice. By focusing on one side of the construct, unipolar
conceptualization essentially lacks the capability of assessing the neglected
side. Similarly, utilizing explicitly bipolar conceptualizations and assessments of PD traits also allows for the introduction of normative levels of the
traits into clinical practice. For example, knowing a client’s relative standing
on conscientiousness would presumably be quite informative for treatment
compliance, even if the trait level was not itself pathological.
SUMMARY AND CONCLUSIONS
In sum, despite a long history of categorical conceptualization, the field of
PDs has moved boldly toward a hybrid-dimensional model that defines the
disorders in part by extreme standing on traits that span normal and abnormal functioning. This is an exciting trend in the PD literature and appears
to hold promise for improving the diagnosis and ultimately treatment of
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EMERGING TRENDS IN THE SOCIAL AND BEHAVIORAL SCIENCES
these debilitating conditions. Although these have been important advances,
there remain several research questions that demand answers. Such areas of
research interest include the relevance of openness to experience in PD conceptualization, the specific structure of the facets, and the bipolarity of traits.
Better understanding the explicit links between the general trait of openness
to experience and the pathological trait of psychoticism/schizotypy will help
inform possible measures that can fully span all ranges of personality. Perhaps the largest unresolved issue within the field is the refinement of the
lower order facet structure. Although there is now some agreement on the
hierarchical structure of personality pathology, the work on the specific facets
that comprise these domains remains unsettled.
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EMERGING TRENDS IN THE SOCIAL AND BEHAVIORAL SCIENCES
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H. (2011). Computerized adaptive assessment of personality disorder: Introducing the CAT-PD project. Journal of Personality Assessment, 93, 380–389. doi:10.1080/
00223891.2011.577475
Thomas, K. M., Yalch, M. M., Krueger, R. F., Wright, A. G., Markon, K. E., &
Hopwood, C. J. (2013). The convergent structure of DSM-5 personality trait
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doi:10.1037/0003-066X.62.2.71
Wright, A. G. C., & Simms, L. J. (2014). On the structure of personality disorder traits:
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Wright, A. G., Thomas, K. M., Hopwood, C. J., Markon, K. E., Pincus, A. L., &
Krueger, R. F. (2012). The hierarchical structure of DSM-5 pathological personality
traits. Journal of Abnormal Psychology, 121, 951–957. doi:10.1037/a0027669
FURTHER READING
Widiger, T. A., & Costa, P. T. (Eds.) (2013). Personality disorders and the five-factor
model of personality (3rd ed.). Washington, DC: American Psychological Association 10.1037/13939-000
TAKAKUNI SUZUKI SHORT BIOGRAPHY
Takakuni Suzuki is a graduate student in Clinical Psychology at Purdue
University. He received his BS degrees in Psychology and Physiology from
Michigan State University and an MS degree in Psychology from Villanova
University.
DOUGLAS B. SAMUEL SHORT BIOGRAPHY
Douglas B. Samuel is an Assistant Professor of Clinical Psychology at
Purdue University. He obtained his BA in Psychology from Indiana University and his PhD from the University of Kentucky. Following his clinical
internship, he completed postdoctoral fellowship through the Yale School
Clarifying the Nature and Structure of Personality Disorder
9
of Medicine and the Department of Veteran’s Affairs. Dr. Samuel’s primary
research interests are in the development of dimensional trait models of
personality disorder and their application in clinical practice. He currently
serves as an associate editor of the journal Assessment.
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-
Clarifying the Nature and Structure
of Personality Disorder
TAKAKUNI SUZUKI and DOUGLAS B. SAMUEL
Abstract
Past research has suggested that personality disorders (PDs) are best conceptualized
as a maladaptive extreme variants of the same traits that define general personality.
Such a dimensional approach to PD classification has officially been included in the
latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
as an alternative diagnostic model for PD. The current essay provides an overview of
the rationale for the dimensional approach to PDs and highlights compelling directions for future research.
The classification of mental disorder is detailed in the Diagnostic and Statistical Manual of Mental Disorders—Fifth Edition (DSM-5; APA, American
Psychiatric Association, 2013). Within the primary section of the DSM-5, personality disorders (PDs) are defined by 10 categorical constructs that are considered distinct from each other and from normal personality functioning.
However, many in the PD field have recognized the limitations and flaws of
this categorical system, such as the high co-occurrence of PD and heterogeneity within categories. As such, many scientists and practitioners have voiced
the advantages offered by a dimensional approach to PD classification (e.g.,
Widiger & Trull, 2007; Clark, 2007).
Considering these issues, researchers have proposed alternative dimensional personality models. One prominent model with a great deal of
empirical support is the Five-Factor Model (FFM), which has been suggested as a suitable that spans both normal and abnormal personality
(Widiger & Trull, 2007). The FFM consists of five bipolar broad trait domains
and is a popular model in general personality research (e.g., Costa &
McCrae, 1992; John, Naumann, & Soto, 2008). The five domains are neuroticism (vs emotional stability), extraversion (vs detachment), openness
to experience (vs closedness to experience), agreeableness (vs antagonism),
and conscientiousness (vs disinhibition). The FFM has robust empirical
Emerging Trends in the Social and Behavioral Sciences. Edited by Robert Scott and Stephen Kosslyn.
© 2015 John Wiley & Sons, Inc. ISBN 978-1-118-90077-2.
1
2
EMERGING TRENDS IN THE SOCIAL AND BEHAVIORAL SCIENCES
evidence and has been shown to account reasonably well for many other
personality models (e.g., Widiger & Simonsen, 2005). The FFM has also
been shown to be universal across a wide number of cultures (McCrae &
Costa, 1997) and the traits exhibit test—retest stability approaching 0.70 over
long periods (Ferguson, 2010). The five broad, higher order domains of the
FFM can be further subdivided into related, yet distinguishable, traits that
are called facets (Costa & McCrae, 1992; Saucier & Ostendorf, 1999). These
lower order facets allow the FFM to comprehensively assess an individual’s
personality at the level of five broad domains and at a more precise facet
level.
Over the past two decades, a great deal of research has investigated
whether the existing PD categories within the DSM can be conceptualized as
maladaptive, extreme versions of the FFM traits. For example, studies have
collected ratings of prototypic cases of the PDs in terms of the FFM. These
ratings, collected from expert researchers and practicing clinicians, show
strong agreement across raters and bear out conceptual links between the
FFM and PDs (Lynam & Widiger, 2001; Samuel & Widiger, 2004). In addition,
a meta-analysis suggested relatively consistent and predictable correlations
between self-report measures of the FFM and PDs (Samuel & Widiger,
2008). For example, the construct of borderline PD exhibited strong positive
relationships with the domain of neuroticism, negative correlations with
conscientiousness, and moderate negative correlations with extraversion
and agreeableness.
Research has also investigated the hierarchical structure of PD symptoms
and found compelling similarities to the structure of normal personality
(Markon, Krueger, & Watson, 2005; O’Connor, 2005). For example, factor
analyses of personality pathology typically converge on five domains that
readily map onto the domains of the FFM. These studies suggest that the
similar constructs underlie the FFM domains and PDs, which supports
one of the assumptions of the dimensional approach to PDs. In addition to
structural similarity, research using item-response theory analyses has also
suggested that the distinction between normal and abnormal function is one
of degree, rather than kind. Specifically, Samuel, Simms, Clark, Livesley, and
Widiger (2010) examined the relationships between a measure of general
personality functioning and two measures of PD and found that, consistent
with their development, the general personality measure assessed the
normative range of the underlying construct and PD measures provided
more information at the more extreme levels. Taken together, the literature
provides support for structural similarity between general personality and
personality pathology as well as meaningful and predictable relationships
between the constructs. As such, there is compelling support that the FFM,
Clarifying the Nature and Structure of Personality Disorder
3
which was derived from models of normative functioning, can be fruitfully
applied to the conceptualization of PD.
DSM-5: AN ALTERNATIVE PD MODEL
Building upon the research base, a hybrid model of PD diagnosis was
included within Section III (Emerging Models and Measures) of the DSM-5.
The diagnosis of PD within this alternative model is based on two core criteria: Severity of impairments in self and interpersonal functioning (Criterion
A) and extreme standings on one or more of 25 pathological traits (Criterion
B; APA, 2013). The 25 traits within this model were developed on the basis
of expert consensus and later refined using an iterative, empirical process
based on a self-report inventory: the Personality Inventory for the DSM-5
(PID-5; Krueger, Derringer, Markon, Watson, & Skodol, 2012). Research has
suggested that the 25 traits are organized under five broad, higher order
domains to form a hierarchical structure that is extremely similar to that
of the FFM (Gore & Widiger, 2013; Griffin & Samuel, 2014; Thomas, Yalch,
Krueger, Wright, Markon, & Hopwood, 2013; Wright & Simms, 2014; Wright,
Thomas, Hopwood, Markon, Pincus, & Krueger, 2012). Thus, the emerging
consensus is that the DSM-5 Section III Trait model can be considered a
version of the FFM. Along with the hybrid model, the DSM-5 Section III also
lists the hypothesized traits relevant to 6 of the 10 PDs from the Section II
(APA, 2013).
FUTURE DIRECTIONS
There now exists a general consensus that PDs can be described using five
broad trait domains. However, the least consistent link between these structures has been for the FFM domain of openness to experience, which measures an individual’s tendency to be creative, and open to feelings, artistic
interests, and new ideas. Conceptually, openness to experience maps onto
the PD constructs that have been labeled schizotypy, oddity, eccentric, or psychoticism. However, the empirical link lacks the consistency relative to the
other four FFM domains (e.g., Samuel & Widiger, 2008; Chmielewski, Bagby,
Markon, Ring, & Ryder, 2014). This domain seems to be the most inconsistent
domain in general personality research, as well. For example, in the lexical
tradition using factor analyses of adjectives in dictionaries related to personality, openness to example is the last of the five domains to emerge and have
resulted in slightly different forms, such as Intellect and Culture, depending on the language and sample population (McCrae, 1994; Norman, 1963).
Thus, it appears that the specific instantiations of openness and schizotypy
4
EMERGING TRENDS IN THE SOCIAL AND BEHAVIORAL SCIENCES
can lead to somewhat different relationships between the constructs (DeYoung, Grazioplene, & Peterson, 2012). Future research is clearly necessary to
further investigate the historically inconsistent relationship.
As noted previously, traits below the five domains are typically needed
to further flesh out the information provided by the higher domains. For
example, an individual might be particularly high on the conscientiousness
facet of orderliness (i.e., keeping one’s belongings organized and tidy),
but low on the facet of achievement-striving (i.e., the orientation toward
pursuing goals). Indeed, multiple studies have demonstrated the utility
and importance of the facets for characterizing PDs and, specifically for
distinguishing between them (Axelrod, Widiger, Trull, & Corbitt, 1997;
Reynolds & Clark, 2001). For example, when applying the NEO PI-R-based
FFM framework to characterize antisocial PD, there is considerable variation
within the domain of neuroticism. Specifically, an individual who presents
with features of antisocial PD might be described by high standings on the
facets of angry hostility and impulsiveness, but relatively low standings
on self-consciousness and depressiveness. As such, the domain level alone
would provide an incomplete picture of the individual; sacrificing valuable
information. Facets also tend to have stronger relationships with specific
behavioral outcomes. For example, Paunonen and Ashton (2001) found that
selected five FFM facets predicted outcome behaviors, such as willingness
to share money and religiosity rating, better than the FFM domains. Thus,
although there is widespread acknowledgement that facets are important,
there is little agreement about the specific facets that are necessary for comprehensively describing personality pathology. In contrast to the general
agreement on the presence of five broad higher order domains, such a
consensus is less clear at the lower order facet level.
As noted, the DSM-5 Section III PD model includes 25 traits, with between
3 and 9 assigned to each domain. Nonetheless, a variety of other facet
scales exist on alternative measures of PD and normative personality.
Perhaps the most prominent facet model posited for the FFM is that from
the NEO Personality Inventory—Revised (Costa & McCrae, 1992), which
subdivides each domain into six facets, for a total of 30. Within trait models
of personality pathology, there are also a wide variety of lower order
structures. The Schedule for Nonadaptive and Adaptive Personality—2
(Clark, Simms, Wu, & Casillas, 2014) has 13 lower order trait scales, the
Dimensional Assessment for Personality Pathology (Livesley & Jackson,
2009) has 19 traits, and the newly developed Computer Adaptive Test of
PD (Simms, Goldberg, Roberts, Watson, Welte, & Rotterman, 2011) has 33
traits. Future research that determines which specific traits are necessary
for a comprehensive and efficient model of personality pathology is sorely
needed. In particular, it is likely that many of the trait facets across existing
Clarifying the Nature and Structure of Personality Disorder
5
models are highly overlapping and even redundant. Clearly, delineating the
optimal lower order structure of personality pathology represents a crucial
research agenda within the field of PDs.
An important characteristic of the FFM is that the domains are explicitly
bipolar (Costa & McCrae, 1992). Conceptually, this assumes that high and
low standings on each trait are equally informative. Specifically, an individual can be rated on a dimension anchored by two mutually exclusive traits at
each end, such as considering extraversion and introversion to be opposite
ends of the same underlying spectrum. On the other hand, PD traits have
typically been conceptualized as unipolar, which suggests that the spectrum
ranges from possessing the pathological characteristics to other who lack the
pathology. This can be conceptualized as considering only one tail of the normal curve. Taking the extraversion example, this would mean that someone
who scores extremely low on extraversion scale lacks extraversion, but this
has no implication on whether the individual is introverted.
The DSM-5 Section III trait model does explicitly include bipolar indicators
for the trait domains (e.g., detachment vs extraversion), but not for the lower
order facets. Thus, a particularly important line of future inquiry would be
to determine the nature and meaning of low scores on the PID-5 scales. There
are an appreciable number of advantages of bipolar conceptualization over
unipolar conceptualization of constructs (e.g., Samuel, 2011). For example,
by focusing on one tail of the distribution, unipolar assessment neglects the
extreme cases on the other side of the distribution that could potentially be
informative. In case of agreeableness, for example, although low standings
on agreeableness (i.e., antagonism) have important social and interpersonal
costs, it would also be important to characterize those individuals on the
other end of the spectrum who might be impaired by extreme deference to
others and self-sacrifice. By focusing on one side of the construct, unipolar
conceptualization essentially lacks the capability of assessing the neglected
side. Similarly, utilizing explicitly bipolar conceptualizations and assessments of PD traits also allows for the introduction of normative levels of the
traits into clinical practice. For example, knowing a client’s relative standing
on conscientiousness would presumably be quite informative for treatment
compliance, even if the trait level was not itself pathological.
SUMMARY AND CONCLUSIONS
In sum, despite a long history of categorical conceptualization, the field of
PDs has moved boldly toward a hybrid-dimensional model that defines the
disorders in part by extreme standing on traits that span normal and abnormal functioning. This is an exciting trend in the PD literature and appears
to hold promise for improving the diagnosis and ultimately treatment of
6
EMERGING TRENDS IN THE SOCIAL AND BEHAVIORAL SCIENCES
these debilitating conditions. Although these have been important advances,
there remain several research questions that demand answers. Such areas of
research interest include the relevance of openness to experience in PD conceptualization, the specific structure of the facets, and the bipolarity of traits.
Better understanding the explicit links between the general trait of openness
to experience and the pathological trait of psychoticism/schizotypy will help
inform possible measures that can fully span all ranges of personality. Perhaps the largest unresolved issue within the field is the refinement of the
lower order facet structure. Although there is now some agreement on the
hierarchical structure of personality pathology, the work on the specific facets
that comprise these domains remains unsettled.
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FURTHER READING
Widiger, T. A., & Costa, P. T. (Eds.) (2013). Personality disorders and the five-factor
model of personality (3rd ed.). Washington, DC: American Psychological Association 10.1037/13939-000
TAKAKUNI SUZUKI SHORT BIOGRAPHY
Takakuni Suzuki is a graduate student in Clinical Psychology at Purdue
University. He received his BS degrees in Psychology and Physiology from
Michigan State University and an MS degree in Psychology from Villanova
University.
DOUGLAS B. SAMUEL SHORT BIOGRAPHY
Douglas B. Samuel is an Assistant Professor of Clinical Psychology at
Purdue University. He obtained his BA in Psychology from Indiana University and his PhD from the University of Kentucky. Following his clinical
internship, he completed postdoctoral fellowship through the Yale School
Clarifying the Nature and Structure of Personality Disorder
9
of Medicine and the Department of Veteran’s Affairs. Dr. Samuel’s primary
research interests are in the development of dimensional trait models of
personality disorder and their application in clinical practice. He currently
serves as an associate editor of the journal Assessment.
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