Although personality disorders (PDs) and subthreshold personality pathology are increasingly implicated as diatheses and moderators of treatment response for many Axis I disorders, researchers have identified a number of problems that limit their utility, two of which are particularly significant. First, dimensional approaches to personality diagnosis consistently outperform categorical diagnosis, and it appears clear that DSM-V will move toward dimensional diagnosis of PDs. However, no study has yet examined the comparative validity of the major dimensional alternatives. Second, virtually all PD research relies on patient self-reports;however, increasing evidence suggests limitations in the exclusive reliance on self-reports. The primary aim of this proposal is to evaluate the comparative validity of categorical PD diagnosis and four dimensional alternatives: dimensionalized DSM-IV diagnosis (number of symptoms met per disorder);the recently developed consensus four-factor trait model identified factor-analytically from self-report data;dimensional PD syndromes derived empirically;and PD traits derived factor-analytically using a method that does not rely primarily on self-reports. The secondary aim, given the potential retention in DSM-V of a dimensionalized version of the current PDs, is to compare methods of diagnosing patients dimensionally using the current PDs that vary in their reliance on self-reports. Ss will be 240 patients across three sites. For both aims, we will use the following criterion variables to assess validity: (a) aggregated lay informant-report PD and trait data;(b) treating-clinician PD and trait data;(c) adaptive functioning assessed concurrently and longitudinally (18-month follow-up);(d) etiologic data, including developmental history (childhood trauma), family history of psychiatric disorders, and molecular genetics;and (e) laboratory (implicit) measures targeted to assess specific PDs. Our general goal is to assess validity using two sets of criteria that today are largely seen as a single approach: Robins and Guze criteria (i.e., whether diagnoses differ in etiology, prognosis, laboratory tests, etc.) and construct validation (i.e., whether diagnoses differ in their external correlates in predictable ways).

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH078100-05
Application #
8327292
Study Section
Adult Psychopathology and Disorders of Aging Study Section (APDA)
Program Officer
Shoham, Varda
Project Start
2007-08-22
Project End
2013-07-31
Budget Start
2012-08-01
Budget End
2013-07-31
Support Year
5
Fiscal Year
2012
Total Cost
$622,575
Indirect Cost
$118,286
Name
Emory University
Department
Psychology
Type
Schools of Arts and Sciences
DUNS #
066469933
City
Atlanta
State
GA
Country
United States
Zip Code
30322
Westen, Drew; Waller, Niels G; Shedler, Jonathan et al. (2014) Dimensions of personality and personality pathology: factor structure of the Shedler-Westen assessment procedure-II (SWAP-II). J Pers Disord 28:281-318
Huprich, Steven K; Defife, Jared; Westen, Drew (2014) Refining a complex diagnostic construct: subtyping Dysthymia with the Shedler-Westen Assessment Procedure-II. J Affect Disord 152-154:186-92
Westen, Drew; DeFife, Jared A; Malone, Johanna C et al. (2014) An empirically derived classification of adolescent personality disorders. J Am Acad Child Adolesc Psychiatry 53:528-49
Ortigo, Kile M; Westen, Drew; Defife, Jared A et al. (2013) Attachment, social cognition, and posttraumatic stress symptoms in a traumatized, urban population: evidence for the mediating role of object relations. J Trauma Stress 26:361-8
DeFife, Jared A; Peart, Joanne; Bradley, Bekh et al. (2013) Validity of prototype diagnosis for mood and anxiety disorders. JAMA Psychiatry 70:140-8
Westen, Drew; Shedler, Jonathan; Bradley, Bekh et al. (2012) An empirically derived taxonomy for personality diagnosis: bridging science and practice in conceptualizing personality. Am J Psychiatry 169:273-84
Bradley, Bekh; DeFife, Jared A; Guarnaccia, Clifford et al. (2011) Emotion dysregulation and negative affect: association with psychiatric symptoms. J Clin Psychiatry 72:685-91