Toward a Model-Based Approach to the Clinical Assessment of Personality Psychopathology

Abstract

Recent years have witnessed tremendous growth in the scope and sophistication of statistical methods available to explore the latent structure of psychopathology, involving continuous, discrete, and hybrid latent variables. The availability of such methods has fostered optimism that they can facilitate movement from classification primarily crafted through expert consensus to classification derived from empirically based models of psychopathological variation. The explication of diagnostic constructs with empirically supported structures can then facilitate the development of assessment tools that appropriately characterize these constructs. Our goal in this article is to illustrate how new statistical methods can inform conceptualization of personality psychopathology and therefore its assessment. We use magical thinking as an example, because both theory and earlier empirical work suggested the possibility of discrete aspects to the latent structure of personality psychopathology, particularly forms of psychopathology involving distortions of reality testing, yet other data suggest that personality psychopathology is generally continuous in nature. We directly compared the fit of a variety of latent variable models to magical thinking data from a sample enriched with clinically significant variation in psychotic symptomatology for explanatory purposes. Findings generally suggested a continuous latent variable model best represented magical thinking, but results varied somewhat depending on different indexes of model fit. We discuss the implications of the findings for classification and applied personality assessment. We also highlight some limitations of this type of approach that are illustrated by these data, including the importance of substantive interpretation, in addition to use of model fit indexes, when evaluating competing structural models.

Notes

It is noteworthy that not all psychopathology measurement attempts are based solely on assessment devices detailing DSM-based constructs. For instance, the ongoing Research Domain Criteria (RDoC) effort from the National Institute of Mental Health attempts to understand psychopathology based on dimensions of neurobehavioral functioning. However, overall, personality disorder assessment reflecting a DSM-based tradition is pervasive.