An evaluation of DSM-5 Section III personality disorder Criterion A (impairment) in accounting for psychopathology

Chelsea E. Sleep, Donald R. Lynam, Thomas A. Widiger, Michael L. Crowe, Joshua D. Miller

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78 Scopus citations


An alternative diagnostic model of personality disorders (AMPD) was introduced in DSM-5 that diagnoses PDs based on the presence of personality impairment (Criterion A) and pathological personality traits (Criterion B). Research examining Criterion A has been limited to date, due to the lack of a specific measure to assess it; this changed, however, with the recent publication of a self-report assessment of personality dysfunction as defined by Criterion A (Levels of Personality Functioning Scale-Self-report; LPFS-SR; Morey, 2017). The aim of the current study was to test several key propositions regarding the role of Criterion A in the AMPD including the underlying factor structure of the LPFS-SR, the discriminant validity of the hypothesized factors, whether Criterion A distinguishes personality psychopathology from Axis I symptoms, the overlap between Criterion A and B, and the incremental predictive utility of Criterion A and B in the statistical prediction of traditional PD symptom counts. Neither a single factor model nor an a priori four-factor model of dysfunction fit the data well. The LPFS-SR dimensions were highly interrelated and manifested little evidence of discriminant validity. In addition, the impairment dimensions manifested robust correlations with measures of both Axis I and II constructs, challenging the notion that personality dysfunction is unique to PDs. Finally, multivariate regression analyses suggested that the traits account for substantially more unique variance in DSM-5 Section II PDs than does personality impairment. These results provide important information as to the functioning of the two main components of the DSM-5 AMPD and raise questions about whether the model may need revision moving forward. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Original languageEnglish
Pages (from-to)1181-1191
Number of pages11
JournalPsychological Assessment
Issue number10
StatePublished - Oct 1 2019

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health


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