Long term predictive validity of diagnostic models for personality disorder: Integrating trait and disorder concepts
Background. Several conceptual models have been considered for the assessment of personality pathology in DSM-5. This study sought to extend our previous findings to compare the long-term predictive validity of three such models: the Five-Factor Model (FFM), the Schedule for Nonadaptive and Adaptive Personality (SNAP), and DSM-IV personality disorders (PDs).
Method. An inception cohort from the Collaborative Longitudinal Personality Disorder Study (CLPS) was followed for 10 years. Baseline data were used to predict long-term outcomes, including functioning, Axis I psychopathology, and medication use.
Results. Each model was significantly valid, predicting a host of important clinical outcomes. Lower-order elements of the FFM system were not more valid than higher-order factors, and DSM-IV diagnostic categories were less valid than dimensional symptom counts. Approaches that integrate normative traits and personality pathology proved to be most predictive, as the SNAP, a system that integrates normal and pathological traits, generally showed the largest validity coefficients overall, and the DSM-IV PD syndromes and FFM traits tended to provide substantial incremental information relative to one another.
Conclusions. DSM-5 PD assessment should involve an integration of personality traits with characteristic features of PDs.
Morey, L. C., Hopwood, C. J., Markowitz, J. C., Gunderson, J. G., Grilo, C. M., McGlashan, T. H., Shea, M. T., Yen, S., Sanislow, C. A., & Skodol, A.E. (in press). Long term predictive validity of diagnostic models for personality disorder: Integrating trait and disorder concepts. Psychological Medicine.