Exploring Kernberg’s Model of Personality Functioning as a Moderator of Traits: Focus on DSM-5’s Section III Alternative Model of Personality Disorder

Sexton, James E.; Hilton, Margaret R.; Benson, Stephanie; Rosen, Adam B.

doi:10.1177/0003065119898772

Cited by 10 publications

(16 citation statements)

References 10 publications

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“…For example, within the framework of schema therapy, a maladaptive schema of “abandonment” substantially aligns with the Criterion B facet of separation insecurity, whereas the trans-diagnostic mode of “healthy adult” substantially aligns with Criterion A (Bach & Bernstein, 2019). Similar patterns of clinically informative AMPD associations have been found for psychodynamic theory in general (Granieri et al, 2017; Natoli, 2019; Roche et al, 2018) including object relations theory (Clarkin et al, 2020; Sexton et al, 2019) and theory of mentalization (Zettl et al, 2020) more specifically. In light of these findings, it seems reasonable to suggest that the AMPD framework fulfills what the DSM–III and DSM-IV Axis II was originally intended for: to encourage awareness of personality itself and its implications for treatment (Morey & Benson, 2016).…”

Section: Perceived Clinical Utility Of the Ampdsupporting

confidence: 70%

Clinical utility of the alternative model of personality disorders: A 10th year anniversary review.

Bach¹,

Tracy²

2022

Personality Disorders: Theory, Research, and Treatment

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The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM–5) alternative model of personality disorders (AMPD) has now been available for researchers and clinicians for a decade. The present article aims to provide a narrative review of literature on the AMPD framework with particular emphasis on its clinical utility, inclusive of clinicians’ and patients’ acceptability, ease of use, diagnostic accuracy, continuity with clinically familiar constructs, and proposed utility for treatment planning, case-formulation, and clinical management. The review specifically covers the utility of Criterion A (i.e., Level of Personality Functioning Scale) and Criterion B (i.e., maladaptive personality traits) in relation to common disorders of personality. By drawing on empirical studies, surveys, clinical cases, and recommendations, the current review points to various aspects of clinical utility as well as areas for improvement. One way of increasing the AMPD’s feasibility for clinicians is to omit the transitional personality disorder (PD) hybrid types while retaining a purer diagnostic classification of PD severity and traits that also align with the International Classification of Diseases, Eleventh Revision (ICD-11), PD classification. This would allow for a more efficient assessment for busy practitioners working in general psychiatry and primary care while retaining the possibility of a more fine-grained elaboration of the PD diagnosis in high-resource specialist settings. Such revision could possibly be introduced in DSM–5.1 or DSM–6. We also propose that future exploration of the AMPD’s clinical utility may involve its potential value for allocation of clinical resources, communication between clinicians and their patients’ relatives, and utility for informing different treatment modalities.

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Section: Perceived Clinical Utility Of the Ampdsupporting

confidence: 70%

Clinical utility of the alternative model of personality disorders: A 10th year anniversary review.

Bach¹,

Tracy²

2022

Personality Disorders: Theory, Research, and Treatment

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“…Other empirical results support the multidimensionality of Criterion A, e.g., the four elements having distinctive nomological networks and speci c associations with multiple types of dysfunction (e.g., [32-33, 38]) and with speci c daily patterns of oscillations in personality impairment [39]. There also appears to be meaningful interactions between Criterion A elements and Criterion B domains [40].…”

Section: Introductionmentioning

confidence: 72%

Latent Profiles of Patients with Borderline Pathology Based on the Alternative DSM-5 Model for Personality Disorders

Gamache

Savard

Leclerc

et al. 2020

Preprint

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Background There have been multiple attempts to try to parse out heterogeneity within borderline pathology by identifying patient subtypes; thus far, these works have yielded few consistent results. Recent developments in the operationalization of borderline pathology may provide new opportunities to identify clinically and conceptually meaningful subgroups of patients. The Alternative DSM-5 Model for Personality Disorders (AMPD) offers a categorical-dimensional operationalization of Borderline personality disorder (BPD) that has yet to be tested for identification of patient subgroups. The purpose of the present study is to test whether the combination of the Criterion A elements (pertaining to level of severity) and the seven pathological traits from Criterion B that define BPD in the AMPD can yield meaningful patient profiles. Methods A total of 211 outpatients from a specialized PD treatment program (133 women, Mage = 33.66, SD = 10.97) were selected based on the presence of at least moderate borderline pathology according to cutoffs recently proposed for the Borderline Symptom List-23. Valid Criterion A (Self and Interpersonal Functioning Scale) and B (Personality Inventory for DSM-5-Short Form) self-reports were administered to measure elements and traits that define BPD in the AMPD model; these variables were used as indicators in a Latent profile analysis (LPA). Results The optimal solution generated by LPA yielded four distinct profiles: (a) Borderline traits; (b) Low borderline pathology with Impulsivity; (c) Moderate borderline pathology with Identity problems and Depressivity; and (d) Severe borderline pathology. Clinically meaningful distinctions emerged between profiles on AMPD indicators and external variables relevant to PD, especially aggression and impulsivity. Conclusions Profiles reflected both the “severity” and “style” components imbedded within Criterion A and B of the AMPD, as they were mainly distinguished by a continuum of severity but also by some meaningful qualitative differences that may have important clinical implications for treatment planning and contracting. Results also suggest that the four Criterion A elements have independent value to identify important differences in patients with borderline pathology. They also highlight that some Criterion B traits that define BPD in the AMPD may be especially important to identify subgroups of patients, mainly Impulsivity and Depressivity.

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“…Therefore, the following hypothesis must be considered with caution: Antagonism and Disinhibition will most likely statistically predict aggression, while prediction by Negative Affectivity and Detachment is possible although uncertain. Personality dysfunction*trait interactions have been reported only in non-aggression studies (Benzi et al, 2019;Sexton et al, 2019). Nevertheless, the following hypothesis can be formulated: dysfunction will moderate traits (i.e., higher personality impairment will increase the association between statistically significant trait predictors and aggression), in line with Kernberg's model.…”

Section: The Present Studymentioning

confidence: 96%

“…This is a promising avenue to document both the combined utility of dysfunction and traits, as well as what is the most appropriate personality dysfunction structure (in the case of the AMPD). For instance, some Criterion A elements (Self-Direction, Empathy) and traits (Detachment, Antagonism) have shown interactions in the prediction of self-reported satisfaction in work and love relations (Sexton et al, 2019). In another study, the Severity Indices of Personality Problems (SIPP-118) (Verheul et al, 2008) dimensions (a measure of personality dysfunction) also moderated the relationship between three Criterion B traits (Negative Affectivity, Detachment, Psychoticism) and psychological distress (Benzi et al, 2019).…”

Section: Introductionmentioning

confidence: 97%

“…However, the interaction between dysfunction and traits has been understudied thus far, which has been underscored for both the AMPD (Meehan et al, 2019) and the ICD-11 (Bach & Simonsen, 2021). Indeed, if redundancy is complete, then no interaction should be obtained (e.g., through regressions or factor analyses incorporating an interaction term) (Sexton et al, 2019). This is a promising avenue to document both the combined utility of dysfunction and traits, as well as what is the most appropriate personality dysfunction structure (in the case of the AMPD).…”

Section: Introductionmentioning

confidence: 99%

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Analysis of the interaction between personality dysfunction and traits in the statistical prediction of physical aggression: Results from outpatient and community samples

Leclerc

Savard

Vachon

et al. 2021

Personality & Mental Health

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The Alternative Model for Personality Disorders (AMPD), included in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) and the World Health Organization's International Classification of Diseases (11th ed.; ICD-11) are, respectively, hybrid categorical-dimensional and dimensional frameworks for personality disorders (PDs). Both models emphasize personality dysfunction and personality traits. Previous studies investigating the links between the AMPD and ICD-11, and self-reported physical aggression have mostly focused on traits and did not take into account the potential interaction between personality dysfunction and traits. Thus, the aim of this study is to identify dysfunction*trait interactions using regression-based analysis. Outpatients with personality disorder from a specialized public clinic (N = 285) and community participants (N = 995) were recruited to complete self-report questionnaires. Some small-size, albeit significant and clinically/ conceptually meaningful personality dysfunction*trait interactions were found to predict physical aggression in both samples. Interaction analyses might further inform, to some degree, about the current discussion pertaining to the potential redundancy between dysfunction and traits, the optimal personality dysfunction structure (in the case of the AMPD), as well as clinical assessment based on AMPD/ICD-11 PD frameworks.

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Exploring Kernberg’s Model of Personality Functioning as a Moderator of Traits: Focus on DSM-5’s Section III Alternative Model of Personality Disorder

Cited by 10 publications

References 10 publications

Clinical utility of the alternative model of personality disorders: A 10th year anniversary review.

Clinical utility of the alternative model of personality disorders: A 10th year anniversary review.

Latent Profiles of Patients with Borderline Pathology Based on the Alternative DSM-5 Model for Personality Disorders

Analysis of the interaction between personality dysfunction and traits in the statistical prediction of physical aggression: Results from outpatient and community samples

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