Toward a model for assessing level of personality functioning in DSM-5, part II: empirical articulation of a core dimension of personality pathology.
The extensive comorbidity among Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV];  American Psychiatric Association, 1994 ) personality disorders might be compelling evidence of essential commonalities among these disorders reflective of a general level of personality functioning that in itself is highly relevant to clinical decision making. This study sought to identify key markers of such a level, thought to reflect a core dimension of personality pathology involving impairments in the capacities of self and interpersonal functioning, and to empirically articulate a continuum of severity of these problems for DSM-5. Using measures of hypothesized core dimensions of personality pathology, a description of a continuum of severity of personality pathology was developed. Potential markers at various levels of severity of personality pathology were identified using item response theory (IRT) in 2 samples of psychiatric patients. IRT-based estimates of participants' standings on a latent dimension of personality pathology were significantly related to the diagnosis of DSM-IV personality disorder, as well as to personality disorder comorbidity. Further analyses indicated that this continuum could be used to capture the distribution of pathology severity across the range of DSM-IV personality disorders. The identification of a continuum of personality pathology consisting of impairments in self and interpersonal functioning provides an empirical foundation for a "levels of personality functioning" rating proposed as part of a DSM-5 personality disorder diagnostic formulation.
Department of Psychology, Texas A&M University, College Station, TX 77843–4235, USA. morey@tamu.edu
Leslie C
LC
Morey
Han
H
Berghuis
Donna S
DS
Bender
Roel
R
Verheul
Robert F
RF
Krueger
Andrew E
AE
Skodol
D000293:Adolescent; D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D010551:Personality; D010552:Personality Assessment; D010554:Personality Disorders / Q000145:classification / Q000175:diagnosis* / Q000523:psychology; D011594:Psychometrics