An interpersonal perspective on Criterion A of the DSM-5 Alternative Model for Personality Disorders

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Highlights

  • DSM-5 Alternative Model for Personality Disorders aligns with interpersonal theory.

  • The interpersonal situation links interpersonal perception, behavior, and affect.

  • The interpersonal situation operationalizes personality impairments in Criterion A.

  • Personality pathology impacts interpersonal functioning in daily life.

  • Personality pathology impacts interpersonal behavior in dyadic interactions.

This paper links Criterion A of the Diagnostic and Statistical Manual of Mental Disorders  5th Edition Alternative Model for Personality Disorders with the contemporary interpersonal model of personality pathology. Advances in interpersonal theory and assessment are outlined to demonstrate that Criterion A's self (identity, self-direction) and interpersonal (empathy, intimacy) impairments are related to the interpersonal meta-constructs and agency and communion and are operationalized by perceptual, behavioral, and affective mechanisms of the interpersonal situation framework. Research informed by the interpersonal situation examining interpersonal functioning in personality disorders is reviewed. Specifically, studies employing experience sampling with event-contingent designs examine social functioning in daily life and studies employing continuous assessment of interpersonal dynamics examine the moment-to-moment unfolding of interpersonal behavior in dyadic interactions.

Introduction

Criterion A of the Diagnostic and Statistical Manual of Mental Disorders  5th Edition Alternative Model for Personality Disorders (AMPD) [1, 2] defines personality pathology in terms of impairments in ‘self’ (identity, self-direction) and ‘interpersonal’ (empathy, intimacy) functioning. Articulated as a set of dynamic regulatory and relational processes that are stratified in the Level of Personality Functioning Scale (LPFS) [1], these impairments involve how individuals think and feel about themselves and others and how they relate to others [3]. Thus, AMPD Criterion A implies that the core features of personality pathology are interpersonal.

Although AMPD Criterion A semantics differentiates self and interpersonal impairments, the two are intertwined (e.g. depends excessively on others for identity, self-esteem, and emotion regulation with compromised boundaries; hyper-attuned to others, but only with respect to perceived relevance to self) and the LPFS rightly renders a single severity rating. Hopwood and colleagues [4, 5••] argued that aligning the AMPD with the integrative, clinically rich, evidence-based contemporary interpersonal model of personality disorders [6, 7] would i) enhance its theoretical coherence, ii) provide a mature clinical paradigm to frame empirical investigation of its components and iii) maximize its clinical utility. This review focuses on the first two propositions by highlighting advances in interpersonal theory and assessment, and reviewing recent research on interpersonal functioning in personality disorder.

Section snippets

DSM-5 AMPD Criterion A meets contemporary interpersonal theory and assessment

Pincus [8] first asserted that the Criterion A impairments in self (identity, self-direction) and interpersonal (empathy, intimacy) align themselves with agency and communion respectively, the core meta-constructs of interpersonal personality theory (Figure 1). This forms a superordinate structure used to derive explanatory and descriptive concepts at different levels of specificity (e.g. motives, dispositions, behaviors). Contemporary interpersonal theory combines this empirically validated

Studying the interpersonal situation and personality disorders

Research investigating aspects of the interpersonal situation commonly employs intensive repeated measurement of interpersonal perception and behavior at different timescales [20]. Several studies employ experiencing sampling methods using event contingent recording (ECR) designs to examine interpersonal functioning in social interactions in daily life [21, 22]. Another method growing in popularity involves Continuous Assessment of Interpersonal Dynamics (CAID) [23••, 24] to model the

Conclusions

The DSM-5 AMPD is an important advance [49], in part because it distinguishes general severity of personality pathology (Criterion A) from individual differences in expression (Criterion B) [50••]. This is consistent with the contemporary interpersonal model, where severity of personality impairment is based on the pervasiveness of dysregulation and distortion in interpersonal situations reflected in patterns of agentic and communal perceptions/behaviors and affective experiences. Linking

Conflict of interest statement

Nothing declared.

References and recommended reading

Papers of particular interest, published within the period of review, have been highlighted as:

  • •• of outstanding interest

Acknowledgements

I thank Christopher J Hopwood and Aidan GC Wright for their continued scholarly collaboration in extending interpersonal theory and expanding the interpersonal situation framework.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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