Skip to main content
SpringerLink
Log in

Self-Ratings of Personality Pathology: Insights Regarding Their Validity and Treatment Utility

  • Personality Disorders (M Zimmerman, Section Editor)
  • Published:
Current Treatment Options in Psychiatry Aims and scope Submit manuscript

Abstract

Purpose of review

The validity of self-ratings of personality pathology often is questioned because personality disorders (PD) historically have been viewed as being characterized by poor insight. However, recent research indicates that PD self-ratings are valid in many ways and have significant clinical utility. Building upon this growing literature, our goal here is to provide practical discussion of how incorporating dimensional PD ratings into assessment protocols can benefit diagnosis and treatment.

Recent findings

We first review evidence suggesting that PD self-ratings are particularly useful for assessing constructs related to individuals’ own subjective experiences (e.g., propensities for experiencing negative mood states). We then highlight research indicating that PD self-ratings (a) change positively with intervention and (b) meaningfully inform diagnosis, treatment planning, and treatment outcome. Finally, we illustrate how freely available, well-validated self-report PD measures can be used to efficiently obtain clinically useful information in a manner comprehensible to both practitioners and patients.

Summary

Self-ratings of personality pathology are valid and useful in many ways and can be efficiently incorporated into assessment protocols. Key future directions for advancing knowledge of self-report PD assessment include examining the extent to which self-ratings of antagonism—a core PD trait—are accurate across contexts.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as:• Of major importance

  1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.

    Book  Google Scholar 

  2. Clarkin JF, Cain NM, Lenzenweger MF. Advances in transference-focused psychotherapy derived from the study of borderline personality disorder: clinical insights with a focus on mechanism. Curr Opin Psychol. 2018;21:80–5. https://doi.org/10.1016/j.copsyc.2017.09.008.

    Article  PubMed  Google Scholar 

  3. Diamond D, Yeomans FE, Stern B, Levy KN, Hörz S, Doering S, et al. Transference focused psychotherapy for patients with comorbid narcissistic and borderline personality disorder. Psychoanal Inq. 2013;33:527–51. https://doi.org/10.1080/07351690.2013.815087.

    Article  Google Scholar 

  4. Krueger RF. Continuity of Axes I and II: toward a unified model of personality, personality disorders, and clinical disorders. J Personal Disord. 2005;19:233–61. https://doi.org/10.1521/pedi.2005.19.3.233.

    Article  Google Scholar 

  5. Haeffel GJ, Howard GS. Self-report: psychology’s four-letter word. Am J Psychol. 2010;123:181–8. https://doi.org/10.5406/amerjpsyc.123.2.0181.

    Article  PubMed  Google Scholar 

  6. Carlson EN, Vazire S, Oltmanns TF. You probably think this paper’s about you: narcissists’ perceptions of their personality and reputation. J Pers Soc Psychol. 2011;101:185–201. https://doi.org/10.1037/a0023781.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Miller JD, Sleep CE, Lamkin J, Vize C, Campbell WK, Lynam DR. Personality disorder traits: perceptions of likability, impairment, and ability to change as correlates and moderators of desired level. Personal Disord Theory Res Treat. 2018;9:478–83. https://doi.org/10.1037/per0000263.

    Article  Google Scholar 

  8. Samuel DB, Suzuki T, Bucher MA, Griffin SA. The agreement between clients’ and their therapists’ ratings of personality disorder traits. J Consult Clin Psychol. 2018;86:546–55. https://doi.org/10.1037/ccp0000304.

    Article  PubMed  Google Scholar 

  9. • Bucher MA, Suzuki T, Samuel DB. A meta-analytic review of personality traits and their associations with mental health treatment outcomes. Clinical Psychology Review. 2019;70:51–63. https://doi.org/10.1016/j.cpr.2019.04.002 Meta-analytic research indicating that personality traits meaningfully predict treatment outcome in many ways.

    Article  PubMed  Google Scholar 

  10. Krueger RF, Derringer J, Markon KE, Watson D, Skodol AE. Initial construction of a maladaptive personality trait model and inventory for DSM-5. Psychol Med. 2012;42:1879–90. https://doi.org/10.1017/S0033291711002674.

    Article  CAS  PubMed  Google Scholar 

  11. Watson D, Clark LA. Personality traits as an organizing framework for personality pathology. Personality and Mental Health Advance online publication doi. 2019. https://doi.org/10.1002/pmh.1458.

  12. Widiger TA, Sellbom M, Chmielewski M, Clark LA, DeYoung CG, Kotov R, et al. Personality in a hierarchical model of psychopathology. Clin Psychol Sci. 2019;7:77–92. https://doi.org/10.1177/2167702618797105.

    Article  Google Scholar 

  13. Watson D, Stanton K, Khoo S, Ellickson-Larew S, Stasik-O’Brien SM. Extraversion and psychopathology: a multilevel hierarchical review. J Res Pers. 2019;81:1–10. https://doi.org/10.1016/j.jrp.2019.04.009.

    Article  Google Scholar 

  14. Wright AGC, Simms LJ. On the structure of personality disorder traits: conjoint analyses of the CAT-PD, PID-5, and NEO-PI-3 trait models. Personal Disord Theory Res Treat. 2014;5:43–54. https://doi.org/10.1037/per0000037.

    Article  Google Scholar 

  15. • Kotov, R., Krueger, R. F., Watson, D., Achenbach, T. M., Althoff, R. R., Bagby, R. M., . . . Zimmerman, M. (2017). The hierarchical taxonomy of psychopathology (HiTOP): a dimensional alternative to traditional nosologies. Journal of Abnormal Psychology, 126, 454–477. doi: https://doi.org/10.1037/abn0000258 Key article presenting a dimensional nosological framework that represents an alternative to the Diagnostic and Statistical Manual of Mental Disorders.

  16. • Sleep CE, Lamkin J, Lynam DR, Campbell WK, Miller JD. Personality disorder traits: testing insight regarding presence of traits, impairment, and desire for change. Personality Disorders: Theory, Research, and Treatment. 2019;10:123–31 http://dx.doi.org/10.1037/per0000305Recent study demonstrating that individuals possess considerable insight into their own pathological personality traits.

  17. Carlson EN. Honestly arrogant or simply misunderstood? Narcissists’ awareness of their narcissism. Self Identity. 2013;12:259–77. https://doi.org/10.1080/15298868.2012.659427.

    Article  Google Scholar 

  18. LeDoux JE, Hofmann SG. The subjective experience of emotion: a fearful view. Curr Opin Behav Sci. 2018;19:67–72. https://doi.org/10.1016/j.cobeha.2017.09.011.

    Article  Google Scholar 

  19. Naragon-Gainey K, McMahon TP, Park J. The contributions of affective traits and emotion regulation to internalizing disorders: current state of the literature and measurement challenges. Am Psychol. 2018;73:1175–86. https://doi.org/10.1037/amp0000371.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Vazire S. Who knows what about a person? The self–other knowledge asymmetry (SOKA) model. J Pers Soc Psychol. 2010;98:281–300. https://doi.org/10.1037/a0017908.

    Article  PubMed  Google Scholar 

  21. Hopwood CJ, Morey LC, Edelen MO, Shea MT, Grilo CM, Sanislow CA, et al. A comparison of interview and self-report methods for the assessment of borderline personality disorder criteria. Psychol Assess. 2008;20:81–5. https://doi.org/10.1037/1040-3590.20.1.81.

    Article  Google Scholar 

  22. Samuel DB, Suzuki T, Griffin SA. Clinicians and clients disagree: five implications for clinical science. J Abnorm Psychol. 2016;125:1001–10. https://doi.org/10.1037/abn0000201.

    Article  PubMed  Google Scholar 

  23. Sun J, Vazire S. Do people know what they’re like in the moment? Psychol Sci. 2019;30:405–14. https://doi.org/10.1177/0956797618818476.

    Article  PubMed  Google Scholar 

  24. Gnambs T. A meta-analysis of dependability coefficients (test–retest reliabilities) for measures of the Big Five. J Res Pers. 2014;52:20–8. https://doi.org/10.1016/j.jrp.2014.06.003.

    Article  Google Scholar 

  25. Allan J, Leeson P, De Fruyt F, Martin S. Application of a 10 week coaching program designed to facilitate volitional personality change: overall effects on personality and the impact of targeting. International Journal of Evidence Based Coaching and Mentoring. 2018;16:80–94. https://doi.org/10.24384/000470.

    Article  Google Scholar 

  26. Roberts BW, Hill PL, Davis JP. How to change conscientiousness: the sociogenomic trait intervention model. Personal Disord Theory Res Treat. 2017;8:199–205. https://doi.org/10.1037/per0000242.

    Article  Google Scholar 

  27. • Roberts BW, Luo J, Briley DA, Chow PI, Su R, Hill PL. A systematic review of personality trait change through intervention. Psychological Bulletin. 2017;143:117–41. https://doi.org/10.1037/bul000008 Key meta-analytic study indicating that personality traits can be positively changed with intervention.

    Article  PubMed  Google Scholar 

  28. Hudson NW, Fraley RC. Volitional personality trait change: can people choose to change their personality traits? J Pers Soc Psychol. 2015;109:490–507. https://doi.org/10.1037/pspp0000021.

    Article  PubMed  Google Scholar 

  29. Hudson NW, Briley DA, Chopik WJ, Derringer J. You have to follow through: attaining behavioral change goals predicts volitional personality change. Journal of Personality and Social Psychology Advance online publication. 2018. https://doi.org/10.1037/pspp0000221.

    Article  Google Scholar 

  30. Lahey BB. Public health significance of neuroticism. Am Psychol. 2009;64:241–56. https://doi.org/10.1037/a0015309.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Sisti D, Segal AG, Siegel AM, Johnson R, Gunderson J. Diagnosing, disclosing, and documenting borderline personality disorder: a survey of psychiatrists’ practices. J Personal Disord. 2016;30:848–56. https://doi.org/10.1521/pedi_2015_29_228.

    Article  Google Scholar 

  32. Ozer DJ, Benet-Martínez V. Personality and the prediction of consequential outcomes. Annu Rev Psychol. 2006;57:401–21. https://doi.org/10.1146/annurev.psych.57.102904.190127.

    Article  PubMed  Google Scholar 

  33. Samuel DB, Sanislow CA, Hopwood CJ, Shea MT, Skodol AE, Morey LC, et al. Convergent and incremental predictive validity of clinician, self-report, and structured interview diagnoses for personality disorders over 5 years. J Consult Clin Psychol. 2013;81:650–9. https://doi.org/10.1037/a0032813.

    Article  Google Scholar 

  34. Gunderson JG, Links PS, Reich JH. Competing models of personality disorders. J Personal Disord. 1991;5:60–8. https://doi.org/10.1521/pedi.1991.5.1.60.

    Article  Google Scholar 

  35. Bach B, Markon K, Simonsen E, Krueger RF. Clinical utility of the DSM-5 alternative model of personality disorders: six cases from practice. J Psychiatr Pract. 2015;21:3–25. https://doi.org/10.1097/01.pra.0000460618.02805.ef.

    Article  PubMed  Google Scholar 

  36. Glover NG, Crego C, Widiger TA. The clinical utility of the five-factor model of personality disorder. Personal Disord Theory Res Treat. 2012;3:176–84. https://doi.org/10.1037/a0024030.

    Article  Google Scholar 

  37. Morey LC, Skodol AE, Oldham JM. Clinician judgments of clinical utility: a comparison of DSM-IV-TR personality disorders and the alternative model for DSM-5 personality disorders. J Abnorm Psychol. 2014;123:398–405. https://doi.org/10.1037/a0036481.

    Article  PubMed  Google Scholar 

  38. Samuel DB, Widiger TA. Clinicians’ use of personality disorder models within a particular treatment setting: a longitudinal comparison of temporal consistency and clinical utility. Personal Ment Health. 2011;5:12–28. https://doi.org/10.1002/pmh.152.

    Article  Google Scholar 

  39. Herpertz SC, Huprich SK, Bohus M, Chanen A, Goodman M, Mehlum L, et al. The challenge of transforming the diagnostic system of personality disorders. J Personal Disord. 2017;31:577–89. https://doi.org/10.1521/pedi_2017_31_338.

    Article  Google Scholar 

  40. Tyrer P, Mulder R, Kim YR, Crawford MJ. The development of the ICD-11 classification of personality disorders: an amalgam of science, pragmatism, and politics. Annu Rev Clin Psychol. 2019;15:481–502. https://doi.org/10.1146/annurev-clinpsy-050718-095736.

    Article  PubMed  Google Scholar 

  41. Oltmanns JR, Widiger TA. A self-report measure for the ICD-11 dimensional trait model proposal: the personality inventory for ICD-11. Psychol Assess. 2018;30:154–69. https://doi.org/10.1037/pas0000459.

    Article  PubMed  Google Scholar 

  42. Butcher JN, Graham JR, Ben-Porath YS, Tellegen A, Dahlstrom WG, Kaemmer B. MMPI–2: manual for administration, scoring, and interpretation. Rev. ed. Minneapolis: University of Minnesota Press; 2001.

    Google Scholar 

  43. Hofmann SG, Hayes SC. The future of intervention science: process-based therapy. Clin Psychol Sci. 2019;7:37–50. https://doi.org/10.1177/2167702618772296.

    Article  PubMed  Google Scholar 

  44. du Pont A, Rhee SH, Corley RP, Hewitt JK, Friedman NP. Are rumination and neuroticism genetically or environmentally distinct risk factors for psychopathology? J Abnorm Psychol. 2019;128:385–96. https://doi.org/10.1037/abn0000430.

    Article  PubMed  Google Scholar 

  45. Stanton K, Rozek DC, Ellickson-Larew S, Stasik-O’Brien SM, Watson D. A transdiagnostic approach to examining the incremental predictive power of emotion regulation and basic personality dimensions. J Abnorm Psychol. 2016;125:960–75. https://doi.org/10.1037/abn0000208.

    Article  PubMed  Google Scholar 

  46. Maples JL, Guan L, Carter NT, Miller JD. A test of the International Personality Item Pool representation of the Revised NEO Personality Inventory and development of a 120-item IPIP-based measure of the five-factor model. Psychol Assess. 2014;26:1070–84. https://doi.org/10.1037/pas0000004.

    Article  PubMed  Google Scholar 

  47. • Waszczuk, M. A., Zimmerman, M., Ruggero, C., Li, K., MacNamara, A., Weinberg, A., . . . Kotov, R. (2017). What do clinicians treat: diagnoses or symptoms? The incremental validity of a symptom-based, dimensional characterization of emotional disorders in predicting medication prescription patterns. Comprehensive Psychiatry, 79, 80–88. doi: https://doi.org/10.1016/j.comppsych.2017.04.004 Key study indicating that psychiatric medication prescription corresponds more closely with homogeneous symptom dimensions than heterogenous diagnostic categories.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Simms LJ, Goldberg LR, Roberts JE, Watson D, Welte J, Rotterman JH. Computerized adaptive assessment of personality disorder: introducing the CAT–PD Project. J Pers Assess. 2011;93:380–9. https://doi.org/10.1080/00223891.2011.577475.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Crego C, Oltmanns JR, Widiger TA. FFMPD scales: comparisons with the FFM, PID-5, and CAT-PD-SF. Psychol Assess. 2018;30:62–73. https://doi.org/10.1037/pas0000495.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Fossati A, Somma A, Borroni S, Markon KE, Krueger RF. The personality inventory for DSM-5 brief form: evidence for reliability and construct validity in a sample of community-dwelling Italian adolescents. Assessment. 2017;24:615–31. https://doi.org/10.1177/1073191115621793.

    Article  PubMed  Google Scholar 

  51. Mullins-Sweatt SN, Jamerson JE, Samuel DB, Olson DR, Widiger TA. Psychometric properties of an abbreviated instrument of the five-factor model. Assessment. 2006;13:119–37. https://doi.org/10.1177/1073191106286748.

    Article  PubMed  Google Scholar 

  52. Biskin RS. The lifetime course of borderline personality disorder. Can J Psychiatry. 2015;60:303–8. https://doi.org/10.1177/070674371506000702.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Stanton K, McDonnell CG, Hayden EP, Watson D. Transdiagnostic approaches to psychopathology measurement: recommendations for measure selection, data analysis, and participant recruitment: Journal of Abnormal Psychology. Advance online publication; 2019.

Download references

Author information

Authors and Affiliations

  1. Psychology Department, Virginia Polytechnic Institute and State University, 121 Williams Hall, Blacksburg, VA, 24061, USA

    Kasey Stanton PhD

  2. Department of Psychology, Western University, 361 Windermere Rd., London, ON, N6A 3K7, Canada

    Kasey Stanton PhD & Matthew F. D. Brown MSc

  3. Department of Psychological Sciences, Purdue University, 703 Third Street, West Lafayette, IN, 47907, USA

    Meredith A. Bucher MS, Caroline Balling BS & Douglas B. Samuel PhD

Authors
  1. Kasey Stanton PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Matthew F. D. Brown MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Meredith A. Bucher MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Caroline Balling BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Douglas B. Samuel PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kasey Stanton PhD.

Ethics declarations

Conflict of interest

Kasey Stanton declares that he has no conflict of interest. Matthew F. D. Brown declares that he has no conflict of interest. Meredith A. Bucher declares that she has no conflict of interest. Caroline Balling declares that she has no conflict of interest. Douglas B. Samuel declares that he has no conflict of interest.

Human and animal rights and informed consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Personality Disorders

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Stanton, K., Brown, M.F.D., Bucher, M.A. et al. Self-Ratings of Personality Pathology: Insights Regarding Their Validity and Treatment Utility. Curr Treat Options Psych 6, 299–311 (2019). https://doi.org/10.1007/s40501-019-00188-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40501-019-00188-6

Keywords

Search

Navigation