Prepared by Lee Anna Clark, Ph.D., and Robert F. Krueger, Ph.D.

I.  For our terminological usage: 

Dimension: The term dimension refers to any scaled continuum and thus must always be modified (e.g., personality trait dimension) for clarity.   

Trait: Similarly, the term “trait” refers to any characteristic (e.g., curly hair is a trait), but we always use it to mean “personality trait.”   

Domain: The term domain is associated in the personality literature with “broad” or “higher order” trait dimensions, and we have adopted that terminology for consistency with that literature.  However, this term also is used to refer to distinct areas of functioning (e.g., “interpersonal domain”), so we modify the term (i.e., trait domain) when referring to higher order personality trait dimensions. 

Facet: The term facet is associated in the personality literature with “specific” or “lower order” trait dimensions, and we have adopted that terminology for consistency with that literature.  Again, however, because the term has other, generic meanings, we will use the term trait facets to refer to lower order personality trait dimensions. 

II. For proposing traits per se as the PD diagnostic criteria. The use of trait profiles:

A. Eliminates comorbidity and all PD-NOS by providing a specific trait profile for every patient with PD  (Clark, 2005, 2007; Krueger, Skodol, Livesley, Shrout, & Hunag, 2007; Trull & Durrett, 2005).

B. Clarifies within-diagnosis heterogeneity by providing a specific trait profile for every patient with PD (Clark, 2007; Trull & Durrett, 2005).

C. Increases diagnostic stability (traits are more stable than PD diagnoses; multiple references, see below).

D. Acknowledges the continuous nature of personality and personality disorder; provides the option of generating a personality trait profile for any patient (i.e., not just those with a PD diagnosis) Trull & Durrett (2005); O’Connor (2002, 2005); Saulsman & Page (2004).

E. Improves convergent and discriminant validity of PD assessment (Clark & Harrison, 2001; Clark, Livesley, & Morey, 1997).

III. For the specifically proposed trait set: 

Considerable evidence relates current DSM PDs to 4 broad, higher order trait domains of the five-factor model (FFM) of personality: Neuroticism, Extraversion, Agreeableness, & Conscientiousness (e.g., O’Connor, 2005; Saulsman & Page, 2004; Widiger & Simonsen, 2005), but meta-analyses also indicate that the 5^th factor, Openness, is not strongly related to PD (e.g., O’Connor, 2005; Saulsman & Page, 2004). 

Conversely, meta-analyses indicate that Obsessive-Compulsive PD is not well-covered by the FFM (Saulsman & Page, 2004) and that only the “social and interpersonal deficits” of Schizotypal PD, and not the “cognitive or perceptual distortions and eccentricities of behavior” is tapped by FFM traits.  Therefore, we added a domain of compulsivity and of schizotypy to address these missing elements.  The schizotypy domain also has been shown to form an important 6^th factor in analyses of both normal and abnormal personality (Tackett et al., 2008; Watson et al., 2008). 

Finally, the proposed specific trait facets were selected as representative based on existing measures of normal and abnormal personality, as well as recommendations by experts in personality assessment.  Nonetheless, the proposed trait set is provisional, and currently is being tested for its structural validity before finalizing the DSM-V proposal. 

References for trait system:

I. Broad Reviews:

Clark, L.A. (2007). Assessment and diagnosis of personality disorder: Perennial issues and emerging conceptualization.  Annual Review of Psychology, 58, 227-258. (esp. II. A.-C.)

Krueger, R. F., Skodol, A. E., Livesley, W. J., Shrout, P., & Huang, Y. (2007). Synthesizing dimensional and categorical approaches to personality disorders: Refining the research agenda for DSM-V Axis II. International Journal of Methods in Psychiatric Research, 16(S1), S65-S73.

Trull, T. J., & Durrett, C. A. (2005). Categorical and dimensional models of personality disorder. Annual Review of Clinical Psychology, 1:355-380. (II. A., B., D.) 

II. For proposing traits per se as the PD diagnostic criteria:

A. Comorbidity.

Clark,  L. A. (2005). Temperament as a unifying basis for personality and psychopathology. Journal of Abnormal Psychology, 114:505-521.

Krueger, R. F. (2005). Continuity of Axes I and II: Toward a unified model of personality, personality disorders, and clinical disorders. Journal of Personality Disorders, 19, 233-261.

Clark, L. A. (2007).   Trull T. J., & Durrett, C. A. (2005). (see Broad Reviews above). 

C. Stability.

Durbin C, Klein DN. (2006). Ten-year stability of personality disorders among outpatients with mood disorders. Journal of Abnormal Psychology 115:75-84.

Grilo CM, Sanislow CA, Gunderson JG, Pagano ME, Yen S, et al. (2004). Two-year stability and change of schizotypal borderline avoidant and obsessive-compulsive personality disorders. Journal of Consulting &  Clinical Psychology 72:767-775.

Johnson JG, Cohen P, Kasen S, Skodol AE, Hamagami F, et al. (2000a). Age-related change in personality disorder trait levels between early adolescence and adulthood: a community-based longitudinal investigation. Acta Psychiatrica Scandinavica, 102:265-275.

Lenzenweger MF, Johnson MD, Willett JB. (2004). Individual growth curve analysis illuminates stability and change in personality disorder features: the longitudinal study of personality disorders. Archives General Psychiatry 61:1015-1024.

Shea MT, Stout R, Gunderson J, Morey LC, Grilo CM, et al. (2002). Short-term diagnostic stability of schizotypal borderline avoidant and obsessive-compulsive personality disorders. American Journal of Psychiatry, 159:2036-2041.

Zanarini MC, Frankenburg FR, Hennen J, Reich DB, Silk KR. (2005). The McLean Study of Adult Development (MSAD): overview and implications of the first six years of prospective follow-up. Journal of Personality Disorders, 19:505-523.

Zimmerman M. (1994). Diagnosing personality disorders: a review of issues and research models. Archives of General Psychiatry 51:225-245.

D. Continuity of normal/abnormal personality.

Markon, K., Krueger, R. F., & Watson, D. (2005). Delineating the structure of normal and abnormal personality: An integrative hierarchical approach.  Journal of Personality and Social Psychology, 88, 139-157.

O’Connor BP. (2002). The search for dimensional structure differences between normality and abnormality: a statistical review of published data on personality and psychopathology. Journal of Personality & Social Psychology, 83:962-982.

O’Connor BP. (2005). A search for consensus on the dimensional structure of personality disorders. Journal of Clinical Psychology. 61:323-345.

Saulsman, LM & Page, AC (2004). The five-factor model and personality disorder empirical literature: A meta-analytic review. Clinical Psychology Review, 23, 1055-1085.

Widiger TA, Simonsen E. (2005). Alternative dimensional models of personality disorder: finding a common ground. Journal of Personality Disorders, 19, 110-130.

E. Convergent/ discriminant validity.

Clark, L. A.  & Harrison, J. A. (2001).  Assessment instruments.  In W. J. Livesley (Ed.).  Handbook of personality disorders (pp. 277-306).  Guilford Press.

Clark, L. A., Livesley, W. J., & Morey, L. (1997).  Personality disorder assessment: The challenge of construct validity.  Journal of Personality Disorders, 11, 205-231.

III. The specifically proposed trait set.

Correspondence with key elements of the Five-Factor Model of Personality:

O’Connor BP. (2005). A search for consensus on the dimensional structure of personality disorders. Journal of Clinical Psychology. 61:323-345.

Saulsman, LM & Page, AC (2004). The five-factor model and personality disorder empirical literature: A meta-analytic review. Clinical Psychology Review, 23, 1055-1085.

Widiger TA, Simonsen E. (2005). Alternative dimensional models of personality disorder: finding a common ground. Journal of Personality Disorders, 19, 110-130.

Addition of the Compulsivity Domain:

O’Connor BP. (2005). A search for consensus on the dimensional structure of personality disorders. Journal of Clinical Psychology. 61:323-345.

Saulsman, LM & Page, AC (2004). The five-factor model and personality disorder empirical literature: A meta-analytic review. Clinical Psychology Review, 23, 1055-1085 .

Addition of the Schizotypy Domain:

Tackett JL, Silberschmidt AL, Krueger RF, & Sponheim SR. (2008).A dimensional model of personality disorder: Incorporating DSM Cluster A characteristics. Journal of Abnormal Psychology, 117(2), 454-459.

Watson D, Clark LA, & Chmielewski M. (2008).  Structures of personality and their relevance to psychopathology: II. Further articulation of a comprehensive unified trait structure.  Journal of Personality, 76(6), 1485-1522.

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