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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 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.

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.

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.

Two major challenges that must be addressed by dimensional models, if they are to be considered viable alternatives to the present categorical system for diagnosing personality disorders, involve the issues of coverage and cutoffs. Several dimensional models of personality and personality pathology are evaluated with these issues in mind. There is growing consensus for the relevance of at least four higher-order domains of personality functioning that are clearly related to personality pathology: neuroticism/negative affectivity/emotional dysregulation, extraversion/positive emotionality, dissocial/antagonistic behavior, and constraint/compulsivity/conscientiousness. A proposal for developing a dimensionally based diagnostic system for personality disorders incorporating these higher-order traits is offered.

This paper describes a mentalization-based model of the development of borderline personality disorder (BPD). The model takes into account constitutional vulnerability and is rooted in attachment theory and its elaboration by contemporary developmental psychologists. The model suggests that disruption of the attachment relationship early in development in combination with later traumatic experiences in an attachment context interacts with neurobiological development. The combination leads to hyper-responsiveness of the attachment system which makes mentalizing, the capacity to make sense of ourselves and others in terms of mental states, unstable during emotional arousal. The emergence of earlier modes of psychological function at these times accounts for the symptoms of BPD. The model has clinical implications and suggests that the aim of treatment is not only to encourage development of mentalizing but also to facilitate its maintenance when the attachment system is stimulated.

To survey the opinions of personality disorder (PD) experts on possible revisions in the classification system for PDs in the DSM-V. Four hundred members of two international associations, the Association for Research on Personality Disorders, and the International Society for the Study of Personality Disorders, were asked to take a 78-item web survey. Of the experts who completed the survey (N = 96), 74% felt that the DSM-IV's categorical system of PD diagnosis should be replaced. Eighty percent felt that PDs are better conceived of as personality dimensions or illness spectra, than as categories. The most frequently endorsed alternative system for PDs was a mixed system of categories and dimensions. Most experts preferred the PDs to remain on Axis II. Only 31.3% wanted the term, \"Borderline Personality Disorder,\" retained in the DSM-V. A clear majority of the PD experts were dissatisfied with the current diagnostic system for PDs.

In How to Talk to a Borderline , Joan Lachkar introduces Borderline Personality Disorder (BPD) and outlines the challenges and difficulties it presents to clinicians. She expands current understanding of BPD by outlining eight different kinds of borderline personality disorders and how each of these requires specific communication techniques and methods. Case examples are offered throughout the text and in some cases describe the kinds of partners borderlines attract. This book offers new approaches to communicating, working with, and treating borderline personality disorders while integrating more contemporary treatment methods. Living in Borderland. Overview of the Borderline Personality. The Pathological Borderline. The Malignant Borderline. The Depressive Borderline. The Obsessive-Compulsive Borderline. The Antisocial Borderline. The Passive-Aggressive Borderline. The Histrionic Borderline. The Cross-cultural Borderline. Closing Thoughts. Joan Lachkar, Ph.D., is a psychotherapist and psychohistorian in private practice in Tarzana, California. She is the author of numerous publications on marital and political conflict, as well as the author of the successful book, How to Talk to a Narcissist . Joan Lachkar is an affiliate member and instructor at the New Center for Psychoanalysis, and is a contributing writer for The Journal of Psychohistory , FrontPage Magazine , and Family Security Matters .

Taxometric procedures have been used extensively to investigate whether individual differences in personality and psychopathology are latently dimensional or categorical (‘taxonic’). We report the first meta-analysis of taxometric research, examining 317 findings drawn from 183 articles that employed an index of the comparative fit of observed data to dimensional and taxonic data simulations. Findings supporting dimensional models outnumbered those supporting taxonic models five to one. There were systematic differences among 17 construct domains in support for the two models, but psychopathology was no more likely to generate taxonic findings than normal variation (i.e. individual differences in personality, response styles, gender, and sexuality). No content domain showed aggregate support for the taxonic model. Six variables – alcohol use disorder, intermittent explosive disorder, problem gambling, autism, suicide risk, and pedophilia – emerged as the most plausible taxon candidates based on a preponderance of independently replicated findings. We also compared the 317 meta-analyzed findings to 185 additional taxometric findings from 96 articles that did not employ the comparative fit index. Studies that used the index were 4.88 times more likely to generate dimensional findings than those that did not after controlling for construct domain, implying that many taxonic findings obtained before the popularization of simulation-based techniques are spurious. The meta-analytic findings support the conclusion that the great majority of psychological differences between people are latently continuous, and that psychopathology is no exception.

Purpose of Review Both the Alternative DSM-5 Model for Personality Disorders (AMPD) and the chapter on personality disorders (PD) in the recent version of ICD-11 embody a shift from a categorical to a dimensional paradigm for the classification of PD. We describe these new models, summarize available measures, and provide a comprehensive review of research on the AMPD. Recent Findings A total of 237 publications on severity (criterion A) and maladaptive traits (criterion B) of the AMPD indicate (a) acceptable interrater reliability, (b) largely consistent latent structures, (c) substantial convergence with a range of theoretically and clinically relevant external measures, and (d) some evidence for incremental validity when controlling for categorical PD diagnoses. However, measures of criterion A and B are highly correlated, which poses conceptual challenges. Summary The AMPD has stimulated extensive research with promising findings. We highlight open questions and provide recommendations for future research.