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A large body of research has focused on identifying the optimal number of dimensions – or spectra – to model individual differences in psychopathology. Recently, it has become increasingly clear that ostensibly competing models with varying numbers of spectra can be synthesized in empirically derived hierarchical structures. We examined the convergence between top-down (bass-ackwards or sequential principal components analysis) and bottom-up (hierarchical agglomerative cluster analysis) statistical methods for elucidating hierarchies to explicate the joint hierarchical structure of clinical and personality disorders. Analyses examined 24 clinical and personality disorders based on semi-structured clinical interviews in an outpatient psychiatric sample (n=2900). The two methods of hierarchical analysis converged on a three-tier joint hierarchy of psychopathology. At the lowest tier, there were seven spectra – disinhibition, antagonism, core thought disorder, detachment, core internalizing, somatoform, and compulsivity – that emerged in both methods. These spectra were nested under the same three higher-order superspectra in both methods: externalizing, broad thought dysfunction, and broad internalizing. In turn, these three superspectra were nested under a single general psychopathology spectrum, which represented the top tier of the hierarchical structure. The hierarchical structure mirrors and extends upon past research, with the inclusion of a novel compulsivity spectrum, and the finding that psychopathology is organized in three superordinate domains. This hierarchy can thus be used as a flexible and integrative framework to facilitate psychopathology research with varying levels of specificity (i.e., focusing on the optimal level of detailed information, rather than the optimal number of factors).

Despite a lively debate about the dimensional vs. categorical nature of Personality Disorders (PDs), direct empirical tests of the underlying structure are missing for most PDs. Taxometrics can be used to investigate whether latent structures are categorical or dimensional. We investigated the latent structure underlying Avoidant, Dependent, Obsessive-Compulsive, Depressive, Paranoid, and Borderline PD by means of three types of taxometric analyses. SCID-II based DSM-IV PD criterion scores from 1,816 patients from Mental Health and Forensic Institutes, and 63 nonpatients, were analyzed with three types of taxometric analyses. MAMBAC, MAXEIG, and L-MODE taxometric analyses were applied on multiple criteria sets, constituted both on theoretical grounds and randomly. Assumptions for taxometric analyses were generally met. All but two of the 78 taxometric analyses indicated greater evidence for a latent dimensional structure, with better fit of empirical data to dimensional than to taxonic simulations; mean Comparative Curve Fit Index (CCFI) = .23, SD = .09. Only two analyses yielded ambiguous evidence (CCFI in the .40-.60 range) and none indicated taxonic structure.

The Personality Inventory for DSM-5 (PID-5), a new measure of maladaptive personality traits, has recently been developed by the DSM-5 Personality and Personality Disorders Workgroup. The PID-5 variables were examined within the seven-factor space defined by the six HEXACO factors and the Schizotypy/Dissociation factor (Ashton & Lee, 2012) using participant samples from Canada (N = 378) and the Netherlands (N = 476). Extension analyses showed that several PID-5 facet-level scales represented each of the Honesty-Humility, Emotionality, Extraversion, Conscientiousness, and Schizotypy/Dissociation factors. In contrast, only one PID-5 scale loaded strongly on HEXACO Agreeableness, and no PID-5 scales loaded strongly on Openness to Experience. In addition, a joint factor analysis involving the PID-5 variables and facets of the Five-Factor Model was conducted in the Canadian sample and recovered a set of seven factors corresponding rather closely to the HEXACO factors plus Schizotypy/Dissociation. The authors discuss implications for the assessment and structure of normal and abnormal personality.

The distinction between general personality dysfunctioning (GPD) and specific personality traits (SPT) is an important focus of attention in the proposed revisions of the DSM-5. The present study explores the distinction between GPD and SPT using the self-report questionnaires General Assessment of Personality Disorder (GAPD) and Severity Indices for Personality Problems (SIPP-118) to measure GPD, and the NEO-PI-R to measure SPT. The sample consisted of 424 psychiatric patients. Using principal component analysis, GPD and SPT appeared to be clearly distinct components of personality. Our GPD model consisted of three factors, i.e., Self-identity dysfunctioning, Relational dysfunctioning, and Prosocial functioning. This model remained by and large intact when combined with SFT factors. Our findings support the distinction between personality traits and personality dysfunction laid down in the recent proposal by the Personality and Personality Disorders Work Group of the DSM-5 Task Force.

There is general agreement that the classification of personality disorders in DSM-IV is unsatisfactory. We systematically reviewed all studies that have analyzed patterns of personality disorder symptoms and signs in psychiatric patients; twenty-two papers were included in the final synthesis. There is reasonable consistency over the number and type of personality pathology traits reported despite differing samples, varying assessment methods, and different statistical manipulations. There are three or four high order traits; an externalizing factor incorporating borderline, narcissistic, histrionic, and antisocial traits (the latter is sometimes recorded as a separate trait); an internalizing factor incorporating avoidant and dependent traits; a schizoid factor; and often a compulsive factor. Using these domains of personality pathology would simplify classification, have higher clinical utility, and allow relatively easy translation of current research.

The extant major psychiatric classifications DSM-IV and ICD-10 are purportedly atheoretical and largely descriptive. Although this achieves good reliability, the validity of a medical diagnosis is greatly enhanced by an understanding of the etiology. In an attempt to group mental disorders on the basis of etiology, five clusters have been proposed. We consider the validity of the fifth cluster, externalizing disorders, within this proposal. We reviewed the literature in relation to 11 validating criteria proposed by the Study Group of the DSM-V Task Force, in terms of the extent to which these criteria support the idea of a coherent externalizing spectrum of disorders. This cluster distinguishes itself by the central role of disinhibitory personality in mental disorders spread throughout sections of the current classifications, including substance dependence, antisocial personality disorder and conduct disorder. Shared biomarkers, co-morbidity and course offer additional evidence for a valid cluster of externalizing disorders. Externalizing disorders meet many of the salient criteria proposed by the Study Group of the DSM-V Task Force to suggest a classification cluster.

An empirically-based classification is proposed based on studies of the phenotypic structure and genetic architecture of personality disorder. The proposed system has two parts: (1) a definition of general personality disorder, and (2) a system for diagnosing different forms of disorder. General personality disorder is conceptualized as a pervasive disturbance in the overall structure and organization of the personality system that is manifested as the failure to establish a coherent self-system and the capacity for adaptive interpersonal and social behavior. Different forms of disorder are represented by a dimensional system consisting of 30 primary traits organized into four higher-order domains. The system is intended to offer a systematic and comprehensive diagnosis of personality disorder for clinical and research purposes. It is also intended to be used in a flexible but prescribed way to provide a diagnostic assessment tailored to different assessment needs.

This study evaluated the accuracy of hypothesized relationships of the five-factor model of personality to four targeted personality disorders in a large multisite sample of patients. Data were gathered from 668 patients, who were assigned to one of five study cells: Borderline, Schizotypal, Avoidant, and Obsessive-Compulsive Personality Disorder, and a Major Depression without personality disorder comparison group. Patients were administered a questionnaire designed to assess the domains and facets of the five-factor model and results were compared among diagnostic groups and between patients and community norms. Although many relationships between personality traits and disorders were obtained, the magnitude of the relationships varied greatly as a function of the comparison group involved. In general, the differences between the personality disorder patients and community norms were far larger than the differences between the specific personality disorder groups. Also, for avoidant personality, it appeared that statistical interactions between personality factors are needed to better differentiate it from other personality disorder groups. The four personality disorder groups studied could each be distinguished from community norms on the personality dimensions of the five-factor model. However, differentiating among the four groups proved more difficult, as each shared the configuration of high Neuroticism, low Agreeableness, and low Conscientiousness. It does not appear that these disorders represent extremes of different personality dimensions, but rather each appears to be a variant of the same extreme configuration. Differences between personality disorders may reflect diverse interactions among the dimensions, rather than differences on single dimensions.

Objective: To examine the prevalence of comorbid Axis I (current and lifetime) and II disorders in adult men and women with attention-deficit hyperactivity disorder (ADHD). Method: Adult patients (n = 447; 266 men, 181 women) received comprehensive assessments for ADHD and Axis I and II disorders. Adults were aged between 17 and 74 years. Among the patients diagnosed with ADHD (n = 335), there were those with ADHD inattentive subtype (ADHD-I) (n = 199), hyperactive–impulsive subtype (ADHD-H) (n = 24), or combined ADHD subtype (ADHD-C) (n = 112). Chi-square and logistic regression analyses were performed to examine associations between adults with and without ADHD on Axis I and II disorders. Results: Adults with ADHD, compared with those without ADHD, had higher rates of Axis I (46.9% and 27.31%) and Axis II (50.7% and 38.2%) disorders. Adults with ADHD-C were more likely to have mood disorder, anxiety, conduct disorder, and substance use disorder as well as obsessive–compulsive personality disorder, passive–aggressive personality disorder, depressive personality disorder, narcissistic personality disorder, and borderline personality disorder (BPD). Men with ADHD were more likely to have antisocial personality disorder and had higher rates of current drug abuse than women with ADHD. Women with ADHD had higher rates of past and current panic disorder, and past anorexia and bulimia. Women with ADHD were more likely to have BPD than men with ADHD. Conclusions: Adults with ADHD have very high rates of comorbid Axis I and II disorders, with differences found between men and women on certain comorbid disorders.

Past research on socially aversive personalities has focused on subclinical psychopathy, subclinical narcissism, and Machiavellianism—the \"Dark Triad\" of personality. In the research reported here, we evaluated whether an everyday form of sadism should be added to that list. Acts of apparent cruelty were captured using two laboratory procedures, and we showed that such behavior could be predicted with two measures of sadistic personality. Study 1 featured a bug-killing paradigm. As expected, sadists volunteered to kill bugs at greater rates than did nonsadists. Study 2 examined willingness to harm an innocent victim. When aggression was easy, sadism and Dark Triad measures predicted unprovoked aggression. However, only sadists were willing to work for the opportunity to hurt an innocent person. In both studies, sadism emerged as an independent predictor of behavior reflecting an appetite for cruelty. Together, these findings support the construct validity of everyday sadism and its incorporation into a new \"Dark Tetrad\" of personality.