The diagnostic categories of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders were developed in the spirit of a traditional medical model that considers mental disorders to be qualitatively distinct conditions (see, e.g., American Psychiatric Association, 2000). Work is now beginning on the fifth edition of this influential diagnostic manual. It is perhaps time to consider a fundamental shift in how psychopathology is conceptualized and diagnosed. More specifically, it may be time to consider a shift to a dimensional classification of personality disorder that would help address the failures of the existing diagnostic categories as well as contribute to an integration of the psychiatric diagnostic manual with psychology's research on general personality structure.

Temporal instability of affect is a defining characteristic of psychological disorders such as borderline personality disorder (BPD) and mood cycling disorders. Ecological momentary assessment (EMA) enables researchers to directly assess such frequent and extreme fluctuations over time. The authors examined 4 operationalizations of such temporal instability: the within-person variance (WPV), the first-order autocorrelation, the mean square successive difference (MSSD), and the probability of acute change (PAC). It is argued that the MSSD and PAC measures are preferred indices of affective instability because they capture both variability and temporal dependency in a time series. Additionally, the performance of these 2 measures in capturing within- and between-day instability is discussed. To illustrate, the authors present EMA data from a study of negative mood in BPD and major depressive disorder patients. In this study, MSSD and PAC captured affective instability better than did WPV. Given that MSSD and PAC are individual difference measures, the authors propose that group differences on these indices be explored using generalized multilevel models. Versions of MSSD and PAC that adjust for randomly elapsed time interval between assessments are also presented.

Ecological momentary assessment (EMA; Stone & Shiffman, 1994) was used to characterize and quantify a dynamic process--affective instability in borderline personality disorder (BPD). Sixty outpatients (34 with BPD and affective instability; 26 with current depressive disorder but not with BPD or affective instability) carried electronic diaries for approximately 1 month and were randomly prompted to rate their mood state up to 6 times a day. Results indicated that BPD patients (a) did not report significantly different mean levels of positive or negative affect; (b) displayed significantly more variability over time in their positive and negative affect scores; (c) demonstrated significantly more instability on successive scores (i.e., large changes) for hostility, fear, and sadness than did patients with depressive disorders; and (d) were more likely to report extreme changes across successive occasions (>or=90th percentile of change scores across participants) for hostility scores. Results illustrate different analytic approaches to quantifying variability and instability of affect based on intensive longitudinal data. Further, results suggest the promise of electronic diaries for collecting data from individuals in their natural environment for purposes of clinical research and assessment.

We discuss the relation between personality factors and two adult forms of disinhibitory psychopathology--alcohol abuse or dependence and antisocial personality disorder. First, we briefly review various methodological issues relevant to research in this area. Next, we review empirical findings relating three broad-band personality trait dimensions neuroticism/emotionality, impulsivity/disinhibition, extraversion/sociability) to both alcohol abuse and dependence and antisocial personality disorder. Finally, theoretical models of the relationship between personality and each of these two disorders are presented. We conclude that although no single personality description is likely to be both a sensitive and specific indicator of either alcoholism or antisocial personality disorder, personality variables are important components of etiological models of these disorders.

Ambulatory assessment (AA) covers a wide range of assessment methods to study people in their natural environment, including self-report, observational, and biological/physiological/behavioral. AA methods minimize retrospective biases while gathering ecologically valid data from patients’ everyday life in real time or near real time. Here, we report on the major characteristics of AA, and we provide examples of applications of AA in clinical psychology (a) to investigate mechanisms and dynamics of symptoms, (b) to predict the future recurrence or onset of symptoms, (c) to monitor treatment effects, (d) to predict treatment success, (e) to prevent relapse, and (f) as interventions. In addition, we present and discuss the most pressing and compelling future AA applications: technological developments (the smartphone), improved ecological validity of laboratory results by combined lab-field studies, and investigating gene-environment interactions. We conclude with a discussion of acceptability, compliance, privacy, and ethical issues.

We applied different diagnostic rules for diagnosing personality disorders to the NESARC epidemiological study of over 40,000 individuals. Specifically, unlike previous NESARC publications, we required that each personality disorder criterion be associated with significant distress or impairment in order to be counted toward a personality disorder (PD) diagnosis. Results demonstrated significant reductions in prevalence rates for PDs (9.1% versus 21.5% using original NESARC algorithms), and these revised prevalence rates were much more consistent with recent epidemiological studies in the U.S. and Great Britain. We also found gender differences in the prevalence rate for most PDs. Comorbidity analyses revealed strong associations between PDs and alcohol dependence, drug dependence, and tobacco dependence. PD diagnoses were also associated with scores on dysfunction and impairment, perceived stress and less social support, lifetime history of suicide attempts, interpersonal difficulties, and problems with legal authorities.

We review major categorical and dimensional models of personality pathology, highlighting advantages and disadvantages of these approaches. Several analytic and methodological approaches to the question of the categorical versus dimensional status of constructs are discussed, including taxometric analyses, latent class analyses, and multivariate genetic analyses. Based on our review, we advocate a dimensional approach to classifying personality pathology. There is converging evidence that four major domains of personality are relevant to personality pathology: neuroticism/negative affectivity/emotional dysregulation; extraversion/positive emotionality; dissocial/antagonistic behavior; and constraint/compulsivity/conscientiousness. Finally, we discuss how dimensional approaches might be integrated into the diagnostic system, as well as some of the major issues that must be addressed in order for dimensional approaches to gain wide acceptance.

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