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Symposia

Improved Use of Research Evidence

Dimensional models of psychopathology can help CBT therapists and their patients: Findings from clinical utility studies

4 - (SYM 89) Identity Disturbance and the Five-factor Model

Saturday, November 16, 2024
12:30 PM – 2:00 PM EST
Location: Congress B, Fourth Floor, Loews Hotel
Abstract Body

The Alternative Model of Personality Disorders (AMPD) is a hybrid categorical-dimensional model proposed to replace the current categorical personality disorder model implemented in DSM-5-TR (APA 2022). Personality disorders in the AMPD are diagnosed according to two criteria, A and B. To meet Criterion A, patients must exhibit impairment on self- or other-functioning, measured by deficits in some combination of identity disturbance, self-direction, empathy, or intimacy. To meet Criterion B, patients must exhibit elevations in one or more of five maladaptive personality dimensions that closely align with the five-factor model (FFM), compared to ten categorical personality disorders (each of which has its own criteria) in the DSM-5-TR. Researchers have proposed that the dimensional traits in Criterion B may account for the functional impairments described in Criterion A, rendering Criterion A unnecessary. Although the authors interpreted this to indicate a distinction, when subjected to a factor analysis, items from all Criterion A domains except identity disturbance loaded onto Criterion B FFM factors (Berghuis et al., 2012). In the current study, we conducted a replication and extension of this study using a wider variety of measures of identity disturbance to test if identity disturbance is separable from Criterion B FFM factors. We administered five identity measures and two FFM measures to a large community sample (N = 502). When all identity subscales of a particular measure were modeled together (e.g., all five Severity Indices of Personality Problems identity problems subscales), the best-fitting structural equation model included an identity disturbance factor separate from the FFM domains. However, when just one identity subscale was included alongside FFM measures, the identity subscale loaded onto the neuroticism factor in the best-fitting model. These results replicated across all five identity measures. Thus, identity disturbance may only form its own factor when identity items are overrepresented relative to Criterion B measures; when each of the five personality domains and identity disturbance are represented by an approximately equal number of items, identity problems may be better conceptualized as a facet of neuroticism. This finding can help optimize the AMPD and speak to its clinical utility: namely, that the five dimensions included in Criterion B may adequately capture the breadth of dysfunction characteristic of personality pathology.