Deconstructing criterion a of the alternative model for personality disorders.

Abstract

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.

Reconceptualization of borderline conditions through the lens of the alternative model of personality disorders.

“…The intercorrelation of the LPFS and the five trait domains in the present study were not as high as could be expected thus suggesting some discriminant validity of the AMPD components for this sample. Similar to earlier findings that indicated LPFS showing variance beyond maladaptive traits (Garcia et al, 2020).…”

Criterion A of the DSM-5 Alternative Model for Personality Disorders in MMPI-2/RF Personality Disorder Scales

“…We deduce that the overall LPF and PD Spectra scale association reflects impaired personality functioning (i.e., LPF), a more personality-specific severity dimension than general psychiatric distress per se. This finding is consistent with results from (Garcia et al, 2021) who identified separable dimensions of variance for substantive LPF, psychosocial impairment, and maladaptive trait severity in indices which formed the conceptual basis for the LPFS of Criterion A. Regarding MMPI-based assessment of PD, the PD Spectra scales of ANT, BOR, and PAR yielded appreciable LPF correlations when demoralization was removed.…”

“…More broadly, Criterion A can be regarded as a way to benchmark the classic construct of psychological structure or level of personality organization (Kernberg, 1967), while also capturing agentic qualities of personhood beyond stylistic expression of Criterion B maladaptive traits (Sharp and Wall, 2021). Criterion A has been found to be generally reliable, useful, and intuitive to many (see Birkhölzer et al, 2021)In a manner similar to our approach with the SIPP-118 LPF index and MMPI-based PD scales, Garcia et al (2021) deconstructed sources of variance within several measures conceptually related to LPF. They concluded that LPF is a theoretically substantive dimension of PD severity beyond general psychiatric impairment or severity of maladaptive traits.…”

The alternative DSM Model for Personality Disorders in psychological assessment and treatment.

“…These dimensions include Complexity of Representation of People (COM), Affective Quality of Representations (AFF), Emotional Investment in Relationships (EIR), Emotional Investment in Values and Moral Standards (EIM), Understanding of Social Causality (SC), Experience and Management of Aggressive Impulses (AGG), Self-Esteem (SE), and Identity and Coherence of Self (ICS). Garcia et al (2021) showed that SCORS-G dimensions are highly correlated with the LPFS as well as several maladaptive traits (see also Stein et al, 2018). Performance-based assessment methods have been more often used in study of Criterion A rather than the Criterion B maladaptive traits (e.g., Beheydt et al, 2020;Zettl et al, 2020).…”