Psychological Medicine

Original Articles

Comparison of alternative models for personality disorders, II: 6-, 8- and 10-year follow-up

L. C. Moreya1 c1, C. J. Hopwooda2, J. C. Markowitza3, J. G. Gundersona4, C. M. Griloa5, T. H. McGlashana5, M. T. Sheaa6, S. Yena6, C. A. Sanislowa7, E. B. Ansella5 and A. E. Skodola8

a1 Department of Psychology, Texas A&M University, College Station, TX, USA

a2 Department of Psychology, Michigan State University, East Lansing, MI, USA

a3 New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons, New York, NY, USA

a4 Department of Psychiatry, Harvard Medical School and McLean Hospital, MA, USA

a5 Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA

a6 Department of Veterans Affairs and Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA

a7 Department of Psychology, Wesleyan University, Middletown, CT, USA

a8 University of Arizona School of Medicine and the Sunbelt Collaborative, Tucson, AZ, USA


Background Several conceptual models have been considered for the assessment of personality pathology in DSM-5. This study sought to extend our previous findings to compare the long-term predictive validity of three such models: the Five-Factor Model (FFM), the Schedule for Nonadaptive and Adaptive Personality (SNAP), and DSM-IV personality disorders (PDs).

Method An inception cohort from the Collaborative Longitudinal Personality Disorder Study (CLPS) was followed for 10 years. Baseline data were used to predict long-term outcomes, including functioning, Axis I psychopathology, and medication use.

Results Each model was significantly valid, predicting a host of important clinical outcomes. Lower-order elements of the FFM system were not more valid than higher-order factors, and DSM-IV diagnostic categories were less valid than dimensional symptom counts. Approaches that integrate normative traits and personality pathology proved to be most predictive, as the SNAP, a system that integrates normal and pathological traits, generally showed the largest validity coefficients overall, and the DSM-IV PD syndromes and FFM traits tended to provide substantial incremental information relative to one another.

Conclusions DSM-5 PD assessment should involve an integration of personality traits with characteristic features of PDs.

(Received October 21 2010)

(Revised October 13 2011)

(Accepted October 22 2011)

(Online publication December 02 2011)