Symptom-based models, typically operationalized through diagnostic interview, and trait models, typically operationalized via questionnaire inventories, reflect historically competing conceptions of personality disorder (PD). DSM-5 includes models of both types, in Sections II and III, respectively. In this study, we sought to synthesize these alternative conceptualizations by fitting bifactor models to data for both Section II PD symptoms (assessed using the SCID-II interview protocol) and dimensional traits for the six PDs retained in Section III (assessed using the Personality Inventory for DSM- 5). Bifactor models fit the data effectively for all six PDs, and trait and symptom indicators both loaded appreciably on general factors reflecting cross-domain PD constructs. These results provide the basis for a principled, quantitative synthesis of categorical/interview and dimensional/selfreport approaches to operationalizing and studying PDs, with considerable implications for diagnosis, research, and practice.
Bibliographical noteFunding Information:
From Florida State University, Tallahassee, Florida (C. M. S., C. J. P.); University of California, Davis, Davis, California (C. J. H.); University of South Florida, Tampa, Florida (M. A. B.); Veteran’s Affairs, Palo Alto Healthcare System (VAPAHCS), Palo Alto, California (E. C. R.); and University of Minnesota, Minneapolis, Minnesota (R. F. K.). Casey M. Strickland and Christopher J. Hopwood contributed equally to the writing of this article. Work on this project was supported by grant MH089727 from the National Institute of Mental Health and grant W911NF-14-1-0018 from the U.S. Army. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the U.S. Government, Department of Defense, Department of the Army, Department of Veterans Affairs, or U.S. Recruiting Command. C. M. S. and C. J. P. developed the study concept. Testing and data collection were performed by C. M. S. C. M. S. performed the data analysis and interpretation under the supervision of C. J. P. and R. F. K. C. M. S. and C. J. H. drafted the article, and C. J. P., M. A. B., and E. C. R. provided critical revisions. All authors approved the final version of the article for submission. We are grateful to Jackie Fishalow and Isabella Palumbo for their roles in coordinating this project, to Laura Drislane and Sarah Brislin for assistance with clinical interviews and diagnostic ratings, and to Noah Venables, Beth Walters, and James Yancey for their assistance with data collection and coding. Address correspondence to Christopher J. Patrick, Department of Psychology, Florida State University, 1107 West Call St., Tallahassee, FL 32306. E-mail: firstname.lastname@example.org
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