Symptom-level analysis of DSM-IV/DSM-5 personality pathology in later life: Hierarchical structure and predictive validity across self- and informant ratings

Abstract

Dissatisfaction with the categorical model of personality disorder led to several investigations on alternative, dimensional systems. The majority of these studies were conducted at the syndrome-level where each diagnostic criterion is summed or averaged within each disorder. Studies at the symptom-level have identified symptom dimensions that define and cut across categories, but the number and nature of dimensions varies across studies. The purpose of the present study was to examine the hierarchical structure and impact of personality pathology at the symptom-level across self- and informant ratings in a large community sample of older adults (N = 1,630; ages 55 to 64). Results indicated that multiple structural patterns can be organized within a common hierarchical framework, with a general factor of maladjustment at the top, 2 broad dimensions of internalizing and externalizing pathology directly below, and progressively more specific symptom dimensions toward the bottom. Factors at each level of the hierarchy were similar across self- and informant ratings. The 4-factor model showed significant incremental validity in predicting a range of life outcomes over simpler models, while increasingly complex models incrementally but modestly improved predictive power. Several consistencies emerged between the current findings and prior factor analytic studies. The most unexpected result was the conspicuous absence of a disinhibition factor reflecting antisocial and impulsivity-related problems. This anomaly may involve the older age of our sample and the changing expression of personality pathology in later life. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Figure 1

Hierarchical Representation of Self-Reported Personality Disorder Symptoms on the Multisource Assessment of Personality Pathology Note. Correlations are presented for each factor at adjoining levels of the hierarchy. Numerical factor labels correspond to Table 1.

Figure 2

Prediction of Self-Reported Outcomes from Self-and Informant Rated PD Symptom Factors. Note. Solid blue [black] lines show R² values for factor scores based on self-report data (dotted blue [black] lines show adjusted R² values); solid orange [gray] lines show R² values for factor scores based on informant report data (dotted orange [gray] lines show adjusted R² values). R² values are presented for each level of the hierarchy, including all preceding levels. Asterisks indicate significant ΔR² values when comparing a given hierarchical level against all simpler structures combined. * p < .05. ^** p < .01. ^*** p < .001; two-tailed. The colored version of this figure is available in the online article.

Figure 3

Prediction of Informant-Reported Outcomes from Self-and Informant Rated PD Symptom Factors. Note. Solid orange [gray] lines show R² values for factor scores based on informant report data (dotted orange [gray] lines show adjusted R² values); solid blue [black] lines show R² values for factor scores based on self-report data (dotted blue [black] lines show adjusted R² values). R² values are presented for each level of the hierarchy, including all preceding levels. Asterisks indicate significant ΔR² values when comparing a given hierarchical level against all simpler structures combined. * p < .05. ** p < .01. *** p < .001; two-tailed. The colored version of this figure is available in the online article.