skip to main content
DOE PAGES title logo U.S. Department of Energy
Office of Scientific and Technical Information

Title: It's not that Difficult: An Interrater Reliability Study of the DSM–5 Section III Alternative Model for Personality Disorders

Abstract

The Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM–5]; American Psychiatric Association, 2013) Section III Alternative Model for Personality Disorders (AMPD) represents a novel approach to the diagnosis of personality disorder (PD). In this model, PD diagnosis requires evaluation of level of impairment in personality functioning (Criterion A) and characterization by pathological traits (Criterion B). Questions about clinical utility, complexity, and difficulty in learning and using the AMPD have been expressed in recent scholarly literature. We examined the learnability, interrater reliability, and clinical utility of the AMPD using a vignette methodology and graduate student raters. Results showed that student clinicians can learn Criterion A of the AMPD to a high level of interrater reliability and agreement with expert ratings. Interrater reliability of the 25 trait facets of the AMPD varied but showed overall acceptable levels of agreement. Examination of severity indexes of PD impairment showed the level of personality functioning (LPF) added information beyond that of global assessment of functioning (GAF). Clinical utility ratings were generally strong. Lastly, the satisfactory interrater reliability of components of the AMPD indicates the model, including the LPF, is very learnable.

Authors:
 [1];  [1];  [1];  [1];  [1];  [2]
  1. Univ. of Tennessee, Knoxville, TN (United States). Dept. of Psychology
  2. Univ. of Tennessee, Knoxville, TN (United States). Dept. of Psychology; Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)
Publication Date:
Research Org.:
Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)
Sponsoring Org.:
USDOE
OSTI Identifier:
1436951
Grant/Contract Number:  
AC05-00OR22725
Resource Type:
Accepted Manuscript
Journal Name:
Journal of Personality Assessment
Additional Journal Information:
Journal Volume: 100; Journal Issue: 6; Journal ID: ISSN 0022-3891
Publisher:
Taylor & Francis
Country of Publication:
United States
Language:
English
Subject:
99 GENERAL AND MISCELLANEOUS

Citation Formats

Garcia, Darren J., Skadberg, Rebecca M., Schmidt, Megan, Bierma, Shane, Shorter, Rebecca L., and Waugh, Mark H. It's not that Difficult: An Interrater Reliability Study of the DSM–5 Section III Alternative Model for Personality Disorders. United States: N. p., 2018. Web. doi:10.1080/00223891.2018.1428982.
Garcia, Darren J., Skadberg, Rebecca M., Schmidt, Megan, Bierma, Shane, Shorter, Rebecca L., & Waugh, Mark H. It's not that Difficult: An Interrater Reliability Study of the DSM–5 Section III Alternative Model for Personality Disorders. United States. doi:10.1080/00223891.2018.1428982.
Garcia, Darren J., Skadberg, Rebecca M., Schmidt, Megan, Bierma, Shane, Shorter, Rebecca L., and Waugh, Mark H. Mon . "It's not that Difficult: An Interrater Reliability Study of the DSM–5 Section III Alternative Model for Personality Disorders". United States. doi:10.1080/00223891.2018.1428982. https://www.osti.gov/servlets/purl/1436951.
@article{osti_1436951,
title = {It's not that Difficult: An Interrater Reliability Study of the DSM–5 Section III Alternative Model for Personality Disorders},
author = {Garcia, Darren J. and Skadberg, Rebecca M. and Schmidt, Megan and Bierma, Shane and Shorter, Rebecca L. and Waugh, Mark H.},
abstractNote = {The Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM–5]; American Psychiatric Association, 2013) Section III Alternative Model for Personality Disorders (AMPD) represents a novel approach to the diagnosis of personality disorder (PD). In this model, PD diagnosis requires evaluation of level of impairment in personality functioning (Criterion A) and characterization by pathological traits (Criterion B). Questions about clinical utility, complexity, and difficulty in learning and using the AMPD have been expressed in recent scholarly literature. We examined the learnability, interrater reliability, and clinical utility of the AMPD using a vignette methodology and graduate student raters. Results showed that student clinicians can learn Criterion A of the AMPD to a high level of interrater reliability and agreement with expert ratings. Interrater reliability of the 25 trait facets of the AMPD varied but showed overall acceptable levels of agreement. Examination of severity indexes of PD impairment showed the level of personality functioning (LPF) added information beyond that of global assessment of functioning (GAF). Clinical utility ratings were generally strong. Lastly, the satisfactory interrater reliability of components of the AMPD indicates the model, including the LPF, is very learnable.},
doi = {10.1080/00223891.2018.1428982},
journal = {Journal of Personality Assessment},
number = 6,
volume = 100,
place = {United States},
year = {2018},
month = {3}
}

Journal Article:
Free Publicly Available Full Text
Publisher's Version of Record

Figures / Tables:

Table 1 Table 1: Rater agreement by phased learning of the level of personality functioning (ICCs).

Save / Share:

Works referenced in this record:

Personality Disorders in DSM-5
journal, September 2010


Impact of personality pathology on psychosocial functioning
journal, June 2018


Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology.
journal, December 1994


Development and initial evaluation of a self-report form of the DSM–5 Level of Personality Functioning Scale.
journal, October 2017


Self-Report Methodology is Insufficient for Improving the Assessment and Classification of Axis II Personality Disorders
journal, October 2011

  • Huprich, Steven K.; Bornstein, Robert F.; Schmitt, Thomas A.
  • Journal of Personality Disorders, Vol. 25, Issue 5
  • DOI: 10.1521/pedi.2011.25.5.557

Clinicians' judgments of clinical utility: A comparison of the DSM-IV and five-factor models.
journal, January 2006


Diagnostic Agreement Between Clinicians and Clients: The Convergent and Discriminant Validity of the SWAP-200 and MCMI-III Personality Disorder Scales
journal, December 2016

  • Gritti, Emanuela S.; Samuel, Douglas B.; Lang, Margherita
  • Journal of Personality Disorders, Vol. 30, Issue 6
  • DOI: 10.1521/pedi_2015_29_231

Plate tectonics in the classification of personality disorder: Shifting to a dimensional model.
journal, January 2007


Relating DSM-5 section III personality traits to section II personality disorder diagnoses
journal, October 2015


The Conceptual Development of DSM-V
journal, June 2009


Opinions of Personality Disorder Experts Regarding The DSM-IV Personality Disorders Classification System
journal, October 2007

  • Bernstein, David P.; Iscan, Cuneyt; Maser, Jack
  • Journal of Personality Disorders, Vol. 21, Issue 5
  • DOI: 10.1521/pedi.2007.21.5.536

Application of the DSM-5 Level of Personality Functioning Scale by Lay Raters
journal, October 2018


Clinician judgments of clinical utility: A comparison of DSM-IV-TR personality disorders and the alternative model for DSM-5 personality disorders.
journal, January 2014

  • Morey, Leslie C.; Skodol, Andrew E.; Oldham, John M.
  • Journal of Abnormal Psychology, Vol. 123, Issue 2
  • DOI: 10.1037/a0036481

The Philosophy of Nosology
journal, May 2017


A Psychology of the Stranger
journal, April 1994


Psychological assessment with the DSM–5 Alternative Model for Personality Disorders: Tradition and innovation.
journal, April 2017

  • Waugh, Mark H.; Hopwood, Christopher J.; Krueger, Robert F.
  • Professional Psychology: Research and Practice, Vol. 48, Issue 2
  • DOI: 10.1037/pro0000071

The DSM-III Personality Disorders: Perspectives From Psychology
journal, June 1985


Tell Me a Story: MMPI Responses and Personal Biography in the Case of a Serial Killer
journal, June 2006


Clinical Utility of Five Dimensional Systems for Personality Diagnosis: A ???Consumer Preference??? Study
journal, January 2008

  • Spitzer, Robert L.; First, Michael B.; Shedler, Jonathan
  • The Journal of Nervous and Mental Disease, Vol. 196, Issue 5
  • DOI: 10.1097/NMD.0b013e3181710950

Some comments on nomology, diagnostic process, and narcissistic personality disorder in the DSM-5 proposal for personality and personality disorders.
journal, January 2011

  • Pincus, Aaron L.
  • Personality Disorders: Theory, Research, and Treatment, Vol. 2, Issue 1
  • DOI: 10.1037/a0021191

Psychometrics is Datametrics: the Test is not Reliable
journal, April 2000

  • Thompson, Bruce; Vacha-Haase, Tammi
  • Educational and Psychological Measurement, Vol. 60, Issue 2
  • DOI: 10.1177/0013164400602002

Clinical Utility of Dimensional Models for Personality Pathology
journal, June 2005


A new Big Five: Fundamental principles for an integrative science of personality.
journal, January 2006


Clinical utility and DSM-V.
journal, January 2009

  • Mullins-Sweatt, Stephanie N.; Widiger, Thomas A.
  • Psychological Assessment, Vol. 21, Issue 3
  • DOI: 10.1037/a0016607

The structure of phenotypic personality traits.
journal, January 1993


DSM-5 and the Path Toward Empirically Based and Clinically Useful Conceptualization of Personality and Psychopathology
journal, September 2014

  • Krueger, Robert F.; Hopwood, Christopher J.; Wright, Aidan G. C.
  • Clinical Psychology: Science and Practice, Vol. 21, Issue 3
  • DOI: 10.1111/cpsp.12073

Toward a process-focused model of test score validity: Improving psychological assessment in science and practice.
journal, June 2011

  • Bornstein, Robert F.
  • Psychological Assessment, Vol. 23, Issue 2
  • DOI: 10.1037/a0022402

Development and Preliminary Psychometric Evaluation of a Brief Self-Report Questionnaire for the Assessment of the DSM–5 level of Personality Functioning Scale: The LPFS Brief Form (LPFS-BF).
journal, January 2016

  • Hutsebaut, Joost; Feenstra, Dine J.; Kamphuis, Jan H.
  • Personality Disorders: Theory, Research, and Treatment, Vol. 7, Issue 2
  • DOI: 10.1037/per0000159

Clinical Utility as a Criterion for Revising Psychiatric Diagnoses
journal, June 2004

  • First, Michael B.; Pincus, Harold Alan; Levine, John B.
  • American Journal of Psychiatry, Vol. 161, Issue 6
  • DOI: 10.1176/appi.ajp.161.6.946

The latent structure of personality functioning: Investigating criterion a from the alternative model for personality disorders in DSM–5.
journal, January 2015

  • Zimmermann, Johannes; Böhnke, Jan R.; Eschstruth, Rhea
  • Journal of Abnormal Psychology, Vol. 124, Issue 3
  • DOI: 10.1037/abn0000059

Toward a Model for Assessing Level of Personality Functioning in DSM–5 , Part I: A Review of Theory and Methods
journal, July 2011

  • Bender, Donna S.; Morey, Leslie C.; Skodol, Andrew E.
  • Journal of Personality Assessment, Vol. 93, Issue 4
  • DOI: 10.1080/00223891.2011.583808

Vignette methodologies for studying clinicians’ decision-making: Validity, utility, and application in ICD-11 field studies
journal, May 2015

  • Evans, Spencer C.; Roberts, Michael C.; Keeley, Jared W.
  • International Journal of Clinical and Health Psychology, Vol. 15, Issue 2
  • DOI: 10.1016/j.ijchp.2014.12.001

Initial construction of a maladaptive personality trait model and inventory for DSM-5
journal, December 2011


Psychiatric classifications: validity and utility
journal, February 2016


An Introduction to the Five-Factor Model and Its Applications
journal, June 1992


A quantitative and qualitative evaluation of trainee opinions of four methods of personality disorder diagnosis.
journal, July 2017

  • Nelson, Sharon M.; Huprich, Steven K.; Shankar, Sneha
  • Personality Disorders: Theory, Research, and Treatment, Vol. 8, Issue 3
  • DOI: 10.1037/per0000227

The Classification of Personality Disorder: I. The Choice of Category Concept
journal, August 1985


The Use of Vignettes in Survey Research
journal, April 1978

  • Alexander, Cheryl S.; Becker, Henry Jay
  • Public Opinion Quarterly, Vol. 42, Issue 1
  • DOI: 10.1086/268432

Epistemological Pluralism and Scientific Development: An Argument Against Authoritative Nosologies
journal, October 2013


The twofold diagnosis of personality disorder: How do personality dysfunction and pathological traits increment each other at successive levels of the trait hierarchy?
journal, January 2016

  • Bastiaansen, Leen; Hopwood, Christopher J.; Van den Broeck, Joke
  • Personality Disorders: Theory, Research, and Treatment, Vol. 7, Issue 3
  • DOI: 10.1037/per0000149

Self-Other Knowledge Asymmetries in Personality Pathology: Self-Other Knowledge Asymmetries
journal, March 2013


Assessing DSM–5 Level of Personality Functioning From Videotaped Clinical Interviews: A Pilot Study With Untrained and Clinically Inexperienced Students
journal, November 2013

  • Zimmermann, Johannes; Benecke, Cord; Bender, Donna S.
  • Journal of Personality Assessment, Vol. 96, Issue 4
  • DOI: 10.1080/00223891.2013.852563

The Global Assessment Scale: A Procedure for Measuring Overall Severity of Psychiatric Disturbance
journal, June 1976


Convergent and incremental predictive validity of clinician, self-report, and structured interview diagnoses for personality disorders over 5 years.
journal, August 2013

  • Samuel, Douglas B.; Sanislow, Charles A.; Hopwood, Christopher J.
  • Journal of Consulting and Clinical Psychology, Vol. 81, Issue 4
  • DOI: 10.1037/a0032813

Examination of the Section III DSM-5 diagnostic system for personality disorders in an outpatient clinical sample.
journal, January 2013

  • Few, Lauren R.; Miller, Joshua D.; Rothbaum, Alex O.
  • Journal of Abnormal Psychology, Vol. 122, Issue 4
  • DOI: 10.1037/a0034878

Assessment of DSM–5 Personality Disorder
journal, May 2015


Assessing the assessors: The feasibility and validity of clinicians as a source for personality disorder research.
journal, January 2017

  • Samuel, Douglas B.; Bucher, Meredith A.
  • Personality Disorders: Theory, Research, and Treatment, Vol. 8, Issue 2
  • DOI: 10.1037/per0000190

    Figures/Tables have been extracted from DOE-funded journal article accepted manuscripts.