Background DSM-IV-TR suggests that clinicians should assess clinically relevant personality traits that do not necessarily constitute a formal personality disorder, and should note these traits on Axis II, but DSM-IV-TR does not provide a trait model to guide the clinician. Our goal was to provide a provisional trait model and a preliminary corresponding assessment instrument, in our roles as members of the DSM-5 personality and personality disorders workgroup and workgroup advisors. Methods An initial list of specific traits and domains (broader groups of traits) was derived from DSM-5 literature reviews and workgroup deliberations, with a focus on capturing maladaptive personality characteristics deemed clinically salient, including those related to the criteria for DSM-IV-TR personality disorders (PDs). The model and instrument were then developed iteratively using data from community samples of treatment seeking participants. The analytic approach relied on tools of modern psychometrics (e.g., item response theory models). Results Twenty-five reliably measured core elements of personality description emerged that, together, delineate five broad domains of maladaptive personality variation: negative affect, detachment, antagonism, disinhibition, and psychoticism. Conclusions We developed a maladaptive personality trait model and corresponding instrument as a step on the path toward helping users of DSM-5 assess traits that may or may not constitute a formal PD. The inventory we developed is reprinted in its entirety in the supplementary materials, with the goal of encouraging additional refinement and development by other investigators prior to the finalization of DSM-5. Continuing discussion should focus on various options for integrating personality traits into DSM-5.

The reliability and validity of traditional taxonomies are limited by arbitrary boundaries between psychopathology and normality, often unclear boundaries between disorders, frequent disorder co-occurrence, heterogeneity within disorders, and diagnostic instability. These taxonomies went beyond evidence available on the structure of psychopathology and were shaped by a variety of other considerations, which may explain the aforementioned shortcomings. The Hierarchical Taxonomy Of Psychopathology (HiTOP) model has emerged as a research effort to address these problems. It constructs psychopathological syndromes and their components/subtypes based on the observed covariation of symptoms, grouping related symptoms together and thus reducing heterogeneity. It also combines co-occurring syndromes into spectra, thereby mapping out comorbidity. Moreover, it characterizes these phenomena dimensionally, which addresses boundary problems and diagnostic instability. Here, we review the development of the HiTOP and the relevant evidence. The new classification already covers most forms of psychopathology. Dimensional measures have been developed to assess many of the identified components, syndromes, and spectra. Several domains of this model are ready for clinical and research applications. The HiTOP promises to improve research and clinical practice by addressing the aforementioned shortcomings of traditional nosologies. It also provides an effective way to summarize and convey information on risk factors, etiology, pathophysiology, phenomenology, illness course, and treatment response. This can greatly improve the utility of the diagnosis of mental disorders. The new classification remains a work in progress. However, it is developing rapidly and is poised to advance mental health research and care significantly as the relevant science matures.

Comorbidity has presented a persistent puzzle for psychopathology research. We review recent literature indicating that the puzzle of comorbidity is being solved by research fitting explicit quantitative models to data on comorbidity. We present a meta-analysis of a liability spectrum model of comorbidity, in which specific mental disorders are understood as manifestations of latent liability factors that explain comorbidity by virtue of their impact on multiple disorders. Nosological, structural, etiological, and psychological aspects of this liability spectrum approach to understanding comorbidity are discussed.

Increasing evidence indicates that normal and abnormal personality can be treated within a single structural framework. However, identification of a single integrated structure of normal and abnormal personality has remained elusive. Here, a constructive replication approach was used to delineate an integrative hierarchical account of the structure of normal and abnormal personality. This hierarchical structure, which integrates many Big Trait models proposed in the literature, replicated across a metaanalysis as well as an empirical study, and across samples of participants as well as measures. The proposed structure resembles previously suggested accounts of personality hierarchy and provides insight into the nature of personality hierarchy more generally. Potential directions for future research on personality and psychopathology are discussed.In recent years, there has been increasing consensus that normal and abnormal personality variation can be treated within a single, unified structural framework (Eysenck, 1994;O'Connor, 2002;. A variety of studies have indicated, for example, that personality structure is essentially the same in clinical and nonclinical samples (O'Connor, 2002), that normal and abnormal personality are strongly related at the etiologic level (Jang & Livesley, 1999;Markon, Krueger, Bouchard, & Gottesman, 2002), and that abnormal personality can be modeled as extremes of normal personality variation (O'Connor & Dyce, 2001).Despite consensus about the possibility of describing normal and abnormal personality within a single structural framework, however, there is less consensus about what this structural framework might be. Although there is emerging consensus about the superordinate structure of normal personality (Goldberg, 1993), less consensus exists about a similar structure of abnormal personality (Livesley, 2001). Delineating a unified superordinate structure across normal and abnormal domains of personality has been even more challenging. Empirical results have supported a variety of conclusions, and validity has been demonstrated for multiple structural models (e.g., Jang & Livesley, 1999;Markon et al., 2002;O'Connor, 2002).Here, we argue that abnormal and normal personality variation is best described within a single integrative hierarchy. We demonstrate that this hierarchical structure replicates across a metaanalytic dataset and empirical sample, replicates across different sets of measures, and is consistent with previous integrative analyses of superordinate personality structure.Correspondence concerning this article should be addressed to Kristian E. Markon Structural Models of Abnormal PersonalityMany models of personality structure, including those of Eysenck (1947;Eysenck & Eysenck, 1976) and Cloninger (1987;Cloninger, Svrakic, & Przybeck, 1993), were formulated with an explicit goal of describing both normal and abnormal trait variation. Other prominent models, such as the Big Five, were developed without explicit attention to any distinction between normal and...

Antisocial behavior, substance use, and impulsive and aggressive personality traits often co-occur, forming a coherent spectrum of personality and psychopathology. In the current research, the authors developed a novel quantitative model of this spectrum. Over 3 waves of iterative data collection, 1,787 adult participants selected to represent a range across the externalizing spectrum provided extensive data about specific externalizing behaviors. Statistical methods such as item response theory and semiparametric factor analysis were used to model these data. The model and assessment instrument that emerged from the research shows how externalizing phenomena are organized hierarchically and cover a wide range of individual differences. The authors discuss the utility of this model for framing research on the correlates and the etiology of externalizing phenomena. Keywords drug; alcohol; impulsivity; aggression; classificationThe existence of individual differences in the tendency to contain versus express impulses has been recognized in academic psychology since its inception as a discipline (James, 1890(James, /1983. In more recent times, this domain has been instantiated in psychological constructs ranging from disinhibition (Clark & Watson, 1999;Gorenstein & Newman, 1980) to impulsivity (Barratt, 1994;Dickman, 1990;Gray, 1981;Whiteside & Lynam, 2001), ego control (J. Block, 1965; J. H. Block & Block, 1980), constraint (Tellegen, 1985), the problem behavior syndrome (Jessor & Jessor, 1977), sensation seeking (Zuckerman & Kuhlman, 2000), and novelty seeking (Cloninger, Svrakic, & Przybeck, 1993). In addition, a dimension of effortful control is a salient feature of childhood temperament that likely relates to these disinhibitory personality characteristics in adulthood (Rothbart, Ahadi, & Evans, 2000). Robust correlations have also been observed between these disinhibitory personality constructs and mental disorders involving substance problems and antisocial behavior (for a review, see Sher & Trull, 1994).In spite of these rich interrelations, many of these constructs continue to be studied and conceptualized as separate entities, in separate literatures. A major reason for this fragmentation is the lack of an integrative model of this domain (Widiger & Clark, 2000). The purpose of the current research is to further the development of an empirically based model of NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript this broad domain of personality and psychopathology, which we term the externalizing spectrum (Krueger, Markon, Patrick, & Iacono, 2005). Origins of the Externalizing Spectrum ConceptualizationAs applied to adult psychopathology, the externalizing spectrum conceptualization emerged initially from research on mental disorders defined within current nosologies. In the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text. rev.; DSM-IV-TR; American Psychiatric Association, 2000), various forms of substance problems are conceptualized as discrete disorder...

Impulsivity is considered a personality trait affecting behavior in many life domains, from recreational activities to important decision making. When extreme, it is associated with mental health problems, such as substance use disorders, as well as with interpersonal and social difficulties, including juvenile delinquency and criminality. Yet, trait impulsivity may not be a unitary construct. We review commonly used self-report measures of personality trait impulsivity and related constructs (e.g., sensation seeking), plus the opposite pole, control or constraint. A meta-analytic principal-components factor analysis demonstrated that these scales comprise 3 distinct factors, each of which aligns with a broad, higher order personality factor-Neuroticism/Negative Emotionality, Disinhibition versus Constraint/Conscientiousness, and Extraversion/Positive Emotionality/Sensation Seeking. Moreover, Disinhibition versus Constraint/Conscientiousness comprise 2 correlated but distinct subfactors: Disinhibition versus Constraint and Conscientiousness/Will versus Resourcelessness. We also review laboratory tasks that purport to measure a construct similar to trait impulsivity. A meta-analytic principal-components factor analysis demonstrated that these tasks constitute 4 factors (Inattention, Inhibition, Impulsive Decision-Making, and Shifting). Although relations between these 2 measurement models are consistently low to very low, relations between both trait scales and laboratory behavioral tasks and daily-life impulsive behaviors are moderate. That is, both independently predict problematic daily-life impulsive behaviors, such as substance use, gambling, and delinquency; their joint use has incremental predictive power over the use of either type of measure alone and furthers our understanding of these important, problematic behaviors. Future use of confirmatory methods should help to ascertain with greater precision the number of and relations between impulsivity-related components.

A multidimensional trait system has been proposed for representing personality disorder (PD) features in DSM-5 to address problematic classification issues such as comorbidity. In this model, which may also assist in providing scaffolding for the underlying structure of major forms of psychopathology more generally, 25 primary traits are organized by 5 higher order dimensions: Negative Affect, Detachment, Antagonism, Disinhibition, and Psychoticism. We examined a) the generalizability of the structure proposed for DSM-5 PD traits and b) the potential for an integrative hierarchy based upon DSM-5 PD traits to represent the dimensions scaffolding psychopathology more generally. A large sample of student participants (N=2,461) completed the Personality Inventory for DSM-5, which operationalizes the DSM-5 traits. Exploratory factor analysis replicated the initially reported five-factor structure as indicated by high factor congruencies. The two-, three-, and four- factor solutions estimated in the hierarchy of the DSM-5 traits bear close resemblance to existing models of common mental disorders, temperament, and personality pathology. Thus, beyond the description of individual differences in personality disorder, the trait dimensions might provide a framework for the metastructure of psychopathology in the DSM-5 and the integration of a number of ostensibly competing models of personality trait covariation.

In neuropsychological assessment, and many areas of research, it is common for the same test to be administered on more than one occasion to measure change. Measured changes are presumed to reflect true changes in the construct being measured by the test; for example, cognitive changes due to processes such as aging, advancing neurological disease, or treatment interventions. However, practice effects, defined as score increases due to factors such as memory for specific test items, learned strategies, or test sophistication, complicate the interpretation of change. This review presents meta-analyses of nearly 1600 individual effect sizes representing changes in mean-level performance on tests commonly used to assess core domains of neuropsychological function, with the goal of quantitatively summarizing the magnitude of practice effects on such tests. The use of alternate forms, the ages of participants, clinical diagnoses of study participants, and length of the test-retest interval were associated with the magnitude of change in many cases. These findings have important implications for the practice of clinical neuropsychology, as well as for research applications, and highlight the need for practice effects to be taken into account in interpreting change across time with multiple measurements.