Using Clinician-Rated Five-Factor Model Data to Score the DSM–IV Personality Disorders

Abstract

Proposals suggest that many or all of the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM–IV]; American Psychiatric Association, 1994) personality disorders (PDs) may be omitted from the DSM (5th ed.; DSM–V) and replaced with a dimensional trait model of personality pathology (Krueger, Skodol, Livesley, Shrout, & Huang, 2007; Skodol, 2009). Several authors have expressed concerns that this may be difficult for clinicians and researchers who are more comfortable with the extant PD diagnoses. In this study, we tested whether clinician ratings of traits from the Five-factor model (FFM; Costa & McCrae, 1990) can be used to recreate DSM–IV PDs. Using a sample of 130 clinical outpatients, we tested the convergent and discriminant validity of the FFM PD counts in relation to consensus ratings of the DSM–IV PDs. We then examined whether the FFM and DSM–IV PD scores correlate in similar ways with self-reported personality traits from the Schedule for Nonadaptive and Adaptive Personality (Clark, 1993). Finally, we tested the clinical utility of the FFM PD counts in relation to functional impairment. Overall, the FFM PD counts, scored using clinician ratings of the FFM traits, appeared to function like the DSM–IV PDs, thus suggesting that the use of a dimensional trait model of personality in the DSM–V may still allow for an assessment of the DSM–IV PD constructs.

Acknowledgment

This research was supported by National Institute of Mental Health Grant R01 MH056888, Interpersonal Functioning in Borderline Personality award, to P. A. Pilkonis.

Notes

¹The numbers generated by these PD counts will be difficult to interpret without some type of normative database to which these scores can be compared. Miller et al. (2008) took steps to demonstrate how normative databases could be developed and used to provide context for these PD counts.

²There have been some attempts to create instruments based on the FFM that might be even more successful at assessing extreme levels of these traits that are associated with personality disorders. For instance, the Structured Interview for the FFM (SIFFM; Trull & Widiger, 1997) explicitly assesses the impairment associated with each trait. In addition, there are ongoing research efforts to create self-report measures that assess more extreme and pathological aspects of the FFM (e.g., Lynam, Gaughan, Miller, & Widiger, 2010).

³The data used in this study are the same data used in the Few et al. (in press) study.

⁴Each case conference addressed only one research participant.

⁵Previous research suggests that the FFM dependent PD prototype differs in meaningful ways from empirical results (Miller & Lynam, 2008) and that a revised FFM dependent PD prototype manifests larger correlations with DSM–IV dependent PD. As such, we used the Miller and Lynam (2008) revised dependent prototype in this study.

*p ≤ .01.

⁶The lower correlations found between the Cluster A FFM and DSM–IV PDs may also be due to the fact that the FFM may not contain content that references oddity and other traits that are germane to these PDs. Watson, Clark, and Chmielewski (2008) argued that such a dimension (i.e., oddity; peculiarity) is both distinct from FFM openness and necessary for capturing disorders such as schizotypal PD.

*p ≤ .01.

*p ≤ .01.