The construct composition of the Level of Personality Functioning Scale (LPFS; Criterion A) of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition alternative model for personality disorders (American Psychiatric Association, 2013) was examined in a clinical vignette rating study. Multiple indices of level of personality functioning, psychiatric and psychosocial impairment, Criterion B maladaptive personality traits, and conceptually divergent variables (intellectual level, socioeconomic status, and likability) were used to deconstruct the LPFS. Most variables were highly intercorrelated, but partial correlational analyses showed the LPFS possesses meaningful personality construct variance not fully explained by severity of pathological traits, psychiatric and psychosocial impairment, or the conceptually divergent variables. This exploratory study offers initial evidence that the LPFS contains substantive LPF variance beyond PD severity. Results are framed and discussed in terms of the known conceptual and empirical overlap between Criterion A and Criterion B as well as the differing ways a dimension of personality disorder (PD) severity may be interpreted. We propose the LPFS is more than statistical artifact created by empirical covariation but less than a true latent dimension of PD severity. The LPFS may be understood as a methodologically pragmatic but theoretically substantive dimension of PD severity.
The Minnesota Multiphasic Personality Inventory (MMPI) instruments are frequently used to assess personality and psychopathology. Recent publications of personality disorder (PD) spectra scales for dimensionalized PD syndromes with MMPI instruments may advance PD assessment. To this end, we examined MMPI-Second Edition (2) and MMPI-2-Restructured Form (-RF) PD Spectra scales within the lens of a contemporary dimensional model of PDs, the alternative model for personality disorders (AMPD). The core dimension of PD, Criterion A of the AMPD or level of personality functioning (LPF), was characterized quantitatively within the PD Spectra scales. By sequentially factor analyzing the scales of the Severity Indices of Personality Problems (SIPP-118) to a common general factor of PD, an index of LPF external to the MMPI item pool was established. This LPF dimension was strongly represented across most PD Spectra scales. LPF variances within the PD Spectra scales were deconstructed using measures of general demoralization (RCdemoralization) and maladaptive personality traits indexed by the Personality Psychopathology-5 (PSY-5). Nuanced LPF and PD Spectra scale relationships were discerned. Dimensionalized Antisocial PD, Borderline PD, Dependent PD, and Paranoid PD showed meaningful association with LPF after demoralization, and maladaptive trait variances were removed. The examination of the MMPI-3 item pool reveals that the existing PD Spectra scale item sets are largely carried forward in the new edition of the MMPI. This suggests PD Spectra scale correlates, including LPF relationships, may be discernable in the newest edition of the MMPI, pending future study.
The Social Cognition and Object Relations Scale-Global Rating Method (SCORS-G) can be used to measure Level of Personality Functioning (LPF). Using a clinical vignette methodology, we examined differential relationships between SCORS-G variables and components of the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) Alternative Model for Personality Disorders (AMPD) as well as general psychiatric functional impairment. This included relationships with (a) Level of Personality Functioning Scale (LPFS; Criterion A of the AMPD), (b) average Criterion B maladaptive trait elevation, and (c) Global Assessment of Functioning (GAF) ratings. By statistically controlling for AMPD pathological trait level and GAF, nuanced relationships between the SCORS-G factor composites and LPFS were found. These results demonstrate that LPF includes significant and specific personality construct variance beyond psychosocial impairment (GAF) and maladaptive trait elevation. These results support using the SCORS-G as a proxy for LPF and suggest ways that clinical practice can be informed by the SCORS-G.
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