Alternative DSM-5 Model for Personality Disorders (DSM-5 Section III)
Which of the following statements about the relationship between severity of personality dysfunction—as rated on the Level of Personality Functioning Scale (LPFS)—and presence of a personality disorder is false? a. A patient must have "some impairment" as rated on the LPFS in order to be diagnosed with a personality disorder. b. "Moderate impairment" on the LPFS predicts the presence of a personality disorder. c. "Severe impairment" on the LPFS predicts the presence of more than one personality disorder. d. "Severe impairment" on the LPFS predicts the presence of one of the more severe personality disorders. e. The LPFS does not take into account the level of impairment, merely the presence or absence of functional impairment.
A patient must have "some impairment" as rated on the LPFS in order to be diagnosed with a personality disorder. Explanation: The LPFS (see Table 2, DSM-5 pp. 775-778) uses the elements of self functioning (identity and self-direction) and interpersonal functioning (empathy and intimacy) to differentiate five levels of impairment, ranging from little or no impairment (i.e., healthy, adaptive functioning; Level 0) to some (Level 1), moderate (Level 2), severe (Level 3), and extreme (Level 4) impairment. Impairment in personality functioning predicts the presence of a personality disorder, and the severity of impairment predicts whether an individual has more than one personality disorder or one of the more typically severe personality disorders. A moderate level of impairment in personality functioning is required for the diagnosis of a personality disorder; this threshold is based on empirical evidence that the moderate level of impairment maximizes the ability of clinicians to accurately and efficiently identify personality disorder pathology.
Which of the following statements about the Level of Personality Functioning Scale (LPFS) is false? a. An assessment indicating "moderate impairment" as described by the LPFS is necessary for diagnosis of a personality disorder. b. An assessment indicating "moderate impairment" as described by the LPFS is sufficient for diagnosis of a personality disorder. c. The LPFS can be used without specification of a personality disorder diagnosis. d. The LPFS can be used to describe individuals with personality characteristics that do not reach the threshold for a personality disorder diagnosis. e. The LPFS can be used to describe a person's level of impairment at any given time.
An assessment indicating "moderate impairment" as described by the LPFS is sufficient for diagnosis of a personality disorder. Explanation: To use the LPFS, the clinician selects the level that most closely captures the individual's current overall level of impairment in personality functioning. The rating is necessary for the diagnosis of a personality disorder (moderate or greater impairment) and can be used to specify the severity of impairment present for an individual with any personality disorder at a given point in time. The LPFS may also be used as a global indicator of personality functioning without specification of a personality disorder diagnosis, or in the event that personality impairment is subthreshold for a disorder diagnosis.
In order to meet the proposed diagnostic criteria for antisocial personality disorder (ASPD) in the Alternative DSM-5 Model for Personality Disorders, an individual must have maladaptive personality traits in which of the following domains? A. Negative affectivity. B. Detachment. C. Antagonism. D. Suicidality. E. Psychoticism.
Antagonism. Explanation: ASPD is characterized by maladaptive traits in the domains of antagonism (especially manipulativeness, deceitfulness, callousness, and hostility) and disinhibition (especially irresponsibility, impulsivity, and risk taking). Negative affectivity is more characteristic of borderline personality disorder; detachment of schizotypal or avoidant personality disorders; and psychoticism of schizotypal personality disorder. Individuals with ASPD do not have a markedly increased incidence of suicidality (which is not a personality trait).
In addition to negative affectivity, which of the following maladaptive trait domains is most associated with avoidant personality disorder? A. Detachment. B. Antagonism. C. Disinhibition. D. Compulsivity. E. Psychoticism.
Detachment. Explanation: Avoidant personality disorder is characterized by avoidance of social situations and inhibition in interpersonal relationships related to feelings of ineptitude and inadequacy, anxious preoccupation with negative evaluation and rejection, and fears of ridicule or embarrassment. In the Alternative DSM-5 Model for Personality Disorders, the specific maladaptive trait domains are Negative Affectivity and Detachment. In addition, characteristic dif- ficulties are apparent in the personality functioning areas of identity, self- direction, empathy, and/or intimacy.
Which of the following is a domain of the Alternative DSM-5 Model for Personality Disorders? A. Neuroticism. B. Extraversion. C. Disinhibition. D. Agreeableness. E. Conscientiousness.
Disinhibition. Explanation: The personality trait system presented in the Alternative DSM-5 Model for Personality Disorders includes five broad domains of personality trait variation—Negative Affectivity (vs. Emotional Stability), Detachment (vs. Extraversion), Antagonism (vs. Agreeableness), Disinhibition (vs. Conscientiousness), and Psychoticism (vs. Lucidity)—comprising 25 specific personality trait facets. These five broad domains are maladaptive variants of the five domains of the extensively validated and replicated personality model known as the "Big Five," or Five Factor Model of personality (FFM), and are also similar to the domains of the Personality Psychopathology Five (PSY-5). The specific 25 facets represent a list of personality facets chosen for their clinical relevance.
In the Alternative DSM-5 Model for Personality Disorders, personality functioning includes both self functioning (involving identity and self-direction) and interpersonal functioning (involving empathy and intimacy). Which of the following is a characteristic of healthy self functioning? A. Comprehension and appreciation of others' experiences and motivations. B. Variability of self-esteem. C. Tolerance of differing perspectives. D. Fluctuating boundaries between self and others. E. Experience of oneself as unique.
Experience of oneself as unique. Explanation: Disturbances in self and interpersonal functioning constitute the core of personality psychopathology, and in Criterion A of the Alternative DSM-5 Model for Personality Disorders, these aspects of personality functioning are evaluated on a continuum. The identity component of self functioning includes experience of oneself as unique, with clear boundaries between self and others; stability of self-esteem and accuracy of self-appraisal; and capacity for, and ability to regulate, a range of emotional experience. The empathy component of interpersonal functioning includes comprehension and appreciation of others' experiences and motivations; tolerance of differing perspectives; and understanding the effects of one's own behavior on others.
Which of the following terms best describes the diagnostic approach proposed in the Alternative DSM-5 Model for Personality Disorders? A. Categorical. B. Dimensional. C. Hybrid. D. Polythetic. E. Socratic.
Hybrid. Explanation: Shortly after the publication of DSM-III, debates about the relative merits of categorical versus dimensional approaches to personality disorder diagnoses arose. Critiques of a categorical approach included the arbitrary cutoff between "normal" and "disordered" as well as the use of polythetic (i.e., having many, but not all, properties in common) criteria, which resulted in heterogeneity among patients with the same diagnosis. Dimensional diagnoses, although having greater validity, make it difficult to distinguish between traits and disorders. The transition from a categorical diagnostic system of individual disorders to one based on the relative distribution of personality traits has not been widely accepted. In DSM-5, the categorical personality disorders are virtually unchanged from the previous edition. However, an alternative "hybrid" model has been proposed in Section III to guide future research that separates interpersonal functioning assessments and the expression of pathological personality traits for six specific disorders. A more dimensional profile of personality trait expression is also proposed for a trait-specified approach.
In addition to an assessment of pathological personality traits, a personality disorder diagnosis in the alternative DSM-5 model requires an assessment of which of the following? A. Level of impairment in personality functioning. B. Comorbidity with Axis I disorders. C. Degree of introversion versus extroversion. D. Stability of the personality traits over time. E. Familial inheritance of specific traits.
Level of impairment in personality functioning. Explanation: In the Alternative DSM-5 Model for Personality Disorders, a diagnosis of a personality disorder requires two determinations: 1) an assessment of the level of impairment in personality functioning, which is needed for Criterion A, and 2) an evaluation of pathological personality traits, which is required for Criterion B. The impairments in personality functioning and personality trait expression are relatively inflexible and pervasive across a broad range of personal and social situations (Criterion C); relatively stable across time, with onsets that can be traced back to at least adolescence or early adulthood (Criterion D); not better explained by another mental disorder (Criterion E); not attributable to the effects of a substance or another medical condition (Criterion F); and not better understood as normal for an individual's developmental stage or sociocultural environment (Criterion G). All Section III personality disorders described by criteria sets, as well as personality disorder—trait specified (PD-TS), meet these general criteria, by definition.
The diagnosis of personality disorder—trait specified in the Alternative DSM- 5 Model of Personality Disorders differs from the DSM-IV diagnosis of personality disorder not otherwise specified in that the DSM-5 diagnosis includes personality trait domains based on which of the following? A. The level of impairment. B. Their resemblance to Axis I disorders. C. The five-factor model of personality. D. Cognitive theories of behavior. E. Neurobiological correlates of behavior.
The five-factor model of personality. Explanation: The personality trait system presented in the Alternative DSM-5 Model for Personality Disorders includes five broad domains of personality trait variation—Negative Affectivity (vs. Emotional Stability), Detachment (vs. Extraversion), Antagonism (vs. Agreeableness), Disinhibition (vs. Conscientiousness), and Psychoticism (vs. Lucidity)—comprising 25 specific personality trait facets. These five broad domains are maladaptive variants of the five domains of the extensively validated and replicated personality model known as the "Big Five," or Five Factor Model of personality (FFM), and are also sim- ilar to the domains of the Personality Psychopathology Five (PSY-5).
Which of the following is not a personality disorder criterion in the Alternative DSM-5 Model for Personality Disorders? a. The impairments in personality functioning and the individual's personality trait expression are relatively inflexible and pervasive across a broad range of personal and social situations. b. The impairments in personality functioning and the individual's personality trait expression are relatively stable across time, with onsets that can be traced back to at least adolescence or early adulthood. c. The impairments in personality functioning and the individual's personality trait expression are not solely attributable to the physiological effects of a substance or another medical condition (e.g., severe head trauma). d. The impairments in personality functioning are not comorbid with another mental disorder. e. The impairments in personality functioning and the individual's personality trait expression are not better understood as normal for an individual's developmental stage or sociocultural environment.
The impairments in personality functioning are not co-morbid with another mental disorder. Explanation: In the Alternative DSM-5 Model for Personality Disorders, a diagnosis of a personality disorder requires two determinations: 1) an assessment of the level of impairment in personality functioning, which is needed for Criterion A, and 2) an evaluation of pathological personality traits, which is required for Criterion B. The impairments in personality functioning and personality trait expression are relatively inflexible and pervasive across a broad range of personal and social situations (Criterion C); relatively stable across time, with onsets that can be traced back to at least adolescence or early adulthood (Criterion D); not better explained by another mental disorder (Criterion E); not attributable to the effects of a substance or another medical condition (Criterion F); and not better understood as normal for an individual's developmental stage or sociocultural environment (Criterion G). Lack of comorbidity is not a criterion, and in fact, personality disorders are commonly comorbid with other mental disorders.
In the Alternative DSM-5 Model for Personality Disorders, which of the following is not an element used to assess level of impairment in personality functioning? A. Identity. B. Self-direction. C. Empathy. D. Work performance. E. Intimacy.
Work performance. Explanation: Disturbances in self and interpersonal functioning constitute the core of personality psychopathology. Self functioning involves identity and self-direction; interpersonal functioning involves empathy and intimacy. Although work performance was used in the DSM-IV Global Assessment of Functioning Scale, it is not used for the assessment of personality functioning.
