An interpersonal perspective on Criterion A of the DSM-5 Alternative Model for Personality Disorders
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.
References (50)
- et al.
Multimethod assessment of interpersonal dynamics
- et al.
Quarrelsome behavior in borderline personality disorder: influence of behavioral and affective reactivity to perceptions of others
J Abnorm Psychol
(2013) - et al.
Evocative gene–environment correlation in the mother–child relationship: a twin study of interpersonal processes
Dev Psychopathol
(2013) Diagnostic and Statistical Manual of Mental Disorders
(2013)Personality disorders in the DSM-5
Annu Rev Clin Psycho
(2012)- et al.
Toward a model for assessing level of personality functioning in DSM-5. Part I. A review of theory and methods
J Pers Assess
(2011) - et al.
The interpersonal core of personality pathology
J Pers Disord
(2013) - et al.
Psychological assessment with the DSM-5 alternative model for personality disorders: tradition and innovation
Prof Psychol
(2017) A contemporary integrative interpersonal theory of personality disorders
- et al.
A contemporary interpersonal model of personality pathology and personality disorder
Some comments on nomology, diagnostic process, and narcissistic personality disorder in the DSM-5 proposal for personality and personality disorders
Pers Disord
Interpersonal theory of personality
The situation through an interpersonal lens
Eur J Pers
The interpersonal situation: integrating personality assessment, case formulation, and intervention
The interpersonal situation: an integrative framework for the study of personality, psychopathology, and psychotherapy
Contemporary integrative interpersonal theory of personality
Interpersonal diagnosis of psychopathology
Integrating trait and process based conceptualizations of pathological narcissism in the DSM-5 era
Connecting personality structure and dynamics: towards a more evidence based and clinically useful diagnostic scheme
J Pers Disord
The Cognitive–Affective Processing System (CAPS) approach to personality and the concept of personality disorder: integrating clinical and social-cognitive research
J Res Pers
Interpersonal Reconstructive Therapy
Treating maladaptive interpersonal signatures
Event-contingent recording
Coming full circle: conceptualizing the study of interpersonal behaviour
Can Psychol
DARMA: dual axis rating and media annotation
Behav Res Methods
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