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

  • L. C. Morey (a1), C. J. Hopwood (a2), J. C. Markowitz (a3), J. G. Gunderson (a4), C. M. Grilo (a5), T. H. McGlashan (a5), M. T. Shea (a6), S. Yen (a6), C. A. Sanislow (a7), E. B. Ansell (a5) and A. E. Skodol (a8)...

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).


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.


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.


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

Corresponding author
*Address for correspondence: L. C. Morey, Ph.D., Department of Psychology, Texas A&M University, College Station, TX 77843-4235, USA. (Email:
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Alden LE, Wiggins JS, Pincus A (1990). Construction of circumplex scales for the Inventory of Interpersonal Problems. Journal of Personality Assessment 55, 521536.
APA (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, text revision. Washington, DC: American Psychiatric Press.
Blashfield RK, Intoccia V (2000). Growth of the literature on the topic of personality disorders. American Journal of Psychiatry 157, 472473.
Clark LA (1993). Manual for the Schedule of Nonadaptive and Adaptive Personality. University of Minnesota Press: Minneapolis, MN.
Costa PT Jr., McCrae RR (1992). NEO PI-R Professional Manual (Revised NEO Personality Inventory and NEO Five-Factor Inventory). Psychological Assessment Resources: Odessa, FL.
Distel MA, Trull TJ, Willemsen G, Vink JM, Derom CA, Lynskey M, Martin NG, Boomsma DI (2009). The five-factor model of personality and borderline personality disorder: a genetic analysis of comorbidity. Biological Psychiatry 66, 11311138.
Grucza RA, Goldberg LR (2007). The comparative validity of 11 modern personality inventories: predictions based on behavioral acts, informant reports, and clinical indicators. Journal of Personality Assessment 89, 167187.
Gunderson JG, Shea MT, Skodol AE, McGlashan TH, Morey LC, Stout RL, Zanarini MC, Grilo CM, Oldham JM, Keller M (2000). The Collaborative Longitudinal Personality Disorders Study. I: Development, aims, design, and sample characteristics. Journal of Personality Disorders 14, 300315.
Heumann KA, Morey LC (1990). Reliability of categorical and dimensional judgments of personality disorder. American Journal of Psychiatry 147, 498500.
Keller MB, Lavori PW, Friedman B, Nielson E, Endicott J, McDonald-Scott P, Andreason NC (1987). The Longitudinal Interval Follow-up Evaluation: a comprehensive method for assessing outcome in prospective longitudinal studies. Archives of General Psychiatry 44, 540548.
Krueger RF, Eaton NR, Derringer J, Markon KE, Watson D, Skodol AE (2011). Personality in DSM-5: helping delineate personality disorder content and framing the metastructure. Journal of Personality Assessment 94, 325331.
Krueger RF, Skodol AE, Livesley WJ, Shrout PE, Huang Y (2007). Synthesizing categorical and dimensional approaches to personality disorders: refining the research agenda for DSM-V, Axis II. International Journal of Methods in Psychiatric Research 16, 6573.
Livesley WJ, Jang KL, Vernon PA (1998). Phenotypic and genetic structure of traits delineating personality disorder. Archives of General Psychiatry 55, 941948.
Markon KE, Chmielewski M, Miller CJ (2011). The reliability and validity of discrete and continuous measures of psychopathology: a quantitative review. Psychological Bulletin 137, 856879.
Miller JD, Maples J, Few LR, Morse JQ, Yaggi KE, Pilkonis PA (2010). Using clinician-rated five-factor model data to score the DSM-IV personality disorders. Journal of Personality Assessment 92, 296305.
Morey LC (1991). Personality Assessment Inventory – Professional Manual. Psychological Assessment Resources: Odessa, FL.
Morey LC, Hopwood CJ, Gunderson JG, Shea MT, Skodol AE, Grilo CM, Yen S, McGlashan TH (2007). Comparison of alternative models for personality disorders. Psychological Medicine 37, 983994.
Morey LC, Zanarini MC (2000). Borderline personality: traits and disorder. Journal of Abnormal Psychology 109, 733737.
Shedler J, Beck A, Fonagy P, Gabbard GO, Gunderson J, Kernberg O, Michels R, Westen D (2010). Personality disorders in DSM-5. American Journal of Psychiatry 167, 10261028.
Skodol AE, Bender DS, Morey LC, Clark LA, Oldham JM, Alarcon RD, Krueger RF, Verheul R, Bell CC, Siever LJ (2011 a). Personality disorder types proposed for DSM-5. Journal of Personality Disorders 25, 136169.
Skodol AE, Clark LA, Bender DS, Krueger RF, Morey LC, Verheul R, Alarcon RD, Bell CC, Siever LJ, Oldham JM (2011 b). Proposed changes in personality and personality disorder assessment and diagnosis for DSM-5, Part I: Description and rationale. Personality Disorders: Theory, Research, and Treatment 2, 4–22.
Skodol AE, Oldham JE, Bender DS, Dyck IR, Stout RL, Morey LC, Shea MT, Zanarini MC, Sanislow CA, Grilo CM, McGlashan TH, Gunderson JG (2005). Dimensional representations of DSM-IV personality disorders: relationships to functional impairment. American Journal of Psychiatry 162, 19191925.
Stevens J (2002). Applied Multivariate Statistics for the Social Sciences, 4th edn. Lawrence Erlbaum Associates: Mahwah, NJ.
Weisberg S (1985). Applied Linear Regression, 2nd edn. John Wiley: New York.
Widiger TA (2011). The DSM-5 dimensional model of personality disorder: rationale and empirical support. Journal of Personality Disorders 25, 222234.
Widiger TA, Coker LA (2002). Assessing personality disorders. In Clinical Personality Assessment: Practical Approaches , 2nd edn (ed. Butcher J.), pp. 407434. Oxford University Press: Oxford.
Widiger TA, Livesley WJ, Clark LA (2009). An integrative dimensional classification of personality disorder. Psychological Assessment 21, 243255.
Widiger TA, Trull TJ (2007). Plate tectonics in the classification of personality disorder: shifting to a dimensional model. American Psychologist 62, 7183.
Zanarini MC, Skodol AE, Bender DS, Dolan R, Sanislow CA, Schaefer E, Morey LC, Grilo CM, Shea MT, McGlashan TH, Gunderson JG (2000). The Collaborative Longitudinal Personality Disorders Study: reliability of Axis I and II diagnoses. Journal of Personality Disorders 14, 291299.
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Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
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