Determinants of Diagnostic Prototypicality Judgments of the Personality Disorders

Evans, Diana L.; Herbert, James D.; Nelson-Gray, Rosemary O.; Gaudiano, Brandon A.

doi:10.1521/pedi.16.1.95.22554

Cited by 12 publications

(7 citation statements)

References 27 publications

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“…This finding suggests that, although a minimal level of BPD symptomatology is clinically significant in general (Zimmerman et al, 2012), it is important to consider what specific symptom is present. The current findings also support the idea that the validity of diagnostic systems (whether categorical or dimensional) for research and practice can be improved by weighting different features of personality disorder constructs differently based on their implications for an individual's functioning (e.g., Cooper & Balsis, 2009;Evans, Herbert, Nelson-Gray, & Gaudiano, 2002). It is noteworthy that chronic feelings of emptiness was the criterion most consistently associated with psychosocial morbidity among those considered in the current study.…”

Section: Discussionsupporting

confidence: 81%

The Clinical Significance of Single Features of Borderline Personality Disorder: Anger, Affective Instability, Impulsivity, and Chronic Emptiness in Psychiatric Outpatients

Ellison¹,

Rosenstein²,

Chelminski³

et al. 2016

Journal of Personality Disorders

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Although dimensional models of borderline personality disorder (BPD) are consistent with findings showing that minimal levels of pathology are associated with substantial increases in psychosocial impairment, it is still unclear whether different individual BPD criteria are each clinically significant on their own. The current study uses semistructured interview data from 1,870 adults presenting for outpatient psychiatric treatment to investigate whether the BPD criteria of impulsivity, affective instability, emptiness, and anger are each related to psychosocial morbidity when met in the absence of the other eight criteria. Analyses showed that each of these criteria was associated with dysfunction in comparison with a control group meeting zero BPD criteria, but only the emptiness criterion was a marker of impairment on all indices of psychosocial morbidity: suicidality, history of suicide attempts and psychiatric hospitalizations, social and work dysfunction, Axis I comorbidity, and global functioning. Implications for the study of borderline pathology are discussed.

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Section: Discussionsupporting

confidence: 81%

The Clinical Significance of Single Features of Borderline Personality Disorder: Anger, Affective Instability, Impulsivity, and Chronic Emptiness in Psychiatric Outpatients

Ellison¹,

Rosenstein²,

Chelminski³

et al. 2016

Journal of Personality Disorders

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“…One possible solution would be to assign weights to each of the diagnostic criteria (e.g., Evans, Herbert, Nelson-Gray, & Gaudiano, 2002). Under this system, a weighted sum score would replace the raw score.…”

Section: Discussionmentioning

confidence: 99%

When less is more: How fewer diagnostic criteria can indicate greater severity.

Cooper¹,

Balsis²

2009

Psychological Assessment

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For diagnosing many mental disorders, the current Diagnostic and Statistical Manual of Mental Disorders (DSM) system weights each diagnostic criterion equally--each criterion counts the same toward meeting the diagnostic threshold. Research on the diagnostic efficiency of criteria, however, reveals that some diagnostic criteria are more useful than others for identifying their associated mental disorders. That some criteria are more useful than others suggests that the criteria may indicate different levels of severity, but this has yet to be empirically tested. Using data from a large epidemiological study (N = 41,227) and two-parameter logistic item response theory models, the level of latent severity associated with each diagnostic criterion for a particular DSM mental disorder was estimated. Maximum likelihood estimates for all possible response patterns to the criteria were then calculated, and results indicated that items and combinations of items identified varying levels of severity. Furthermore, different response patterns associated with the same raw score identified a range (or band) of latent severity. In many instances, these bands overlapped, revealing that some response patterns with fewer endorsed criteria had higher estimated latent severity than did response patterns with more endorsed criteria. Specifically, many response patterns associated with a raw score of 3 (below threshold for the analyzed disorder) indicated greater latent severity than did response patterns associated with a raw score of 4 (at threshold).

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“…Thus, in relation to the construct of psychopathy, this approach can help explicate which characteristics or symptoms are salient or essential to the construct and which characteristics and symptoms should be viewed as at the boundary, or indeed, outside the boundary of the construct (Broughton, 1990). Prototypical analysis has a long pedigree; it has been found to be useful in the validation of lexical models of normal personality (Mollaret, 2009) and diagnostic criteria for various mental disorders (Blashfield & Livesley, 1991;Horowitz, Post, French, Wallis, & Siegelman, 1981;Livesley, Reiffer, Sheldon, & West, 1987;Samuel & Widiger, 2004), including personality disorder and psychopathy (Cruise, Colwell, Lyons, & Baker, 2003;Evans, Herbert, Nelson-Gray, & Gaudiano, 2002;Rogers, Duncan, Lynett, & Sewell, 1994).…”

mentioning

confidence: 99%

A Prototypicality Validation of the Comprehensive Assessment of Psychopathic Personality Model (CAPP)

Hoff¹,

Rypdal²,

Mykletun³

et al. 2012

Journal of Personality Disorders

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Cooke and colleagues recently developed the lexically based model of psychopathy named the Comprehensive Assessment of Psychopathic Personality (CAPP, Cooke, Hart, Logan, & Michie, 2004). The current study was the first to evaluate aspects of the validity of a translated version of the CAPP model, which comprises 33 symptoms from six domains of personality functioning. Prototypicality ratings from 796 Norwegian community residents, forensic mental health professionals, and corrections professionals were obtained. Most CAPP symptoms were evaluated as highly prototypical of psychopathy by all three groups. Symptoms from the Self, Dominance, and Attachment domains were perceived as more prototypical than those from the Behavioral domain. Confirmatory Factor Analysis (CFA) indicated that two CAPP domains were unidimensional whereas evidence of unidimensionality was somewhat weaker for the other domains, but improved substantially after removal of problematic symptoms. Overall, the findings support the content validity of the CAPP model. This may have relevance to the current considerations regarding reformulation of the criteria for Antisocial Personality Disorder in DSM-V.

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Determinants of Diagnostic Prototypicality Judgments of the Personality Disorders

Cited by 12 publications

References 27 publications

The Clinical Significance of Single Features of Borderline Personality Disorder: Anger, Affective Instability, Impulsivity, and Chronic Emptiness in Psychiatric Outpatients

The Clinical Significance of Single Features of Borderline Personality Disorder: Anger, Affective Instability, Impulsivity, and Chronic Emptiness in Psychiatric Outpatients

When less is more: How fewer diagnostic criteria can indicate greater severity.

A Prototypicality Validation of the Comprehensive Assessment of Psychopathic Personality Model (CAPP)

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