Personality DisordersTheory, Research, And

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Personality Disorders: Theory, Research, andTreatment

Five-Factor Model Personality Disorder Prototypes in aCommunity Sample: Self- and Informant-ReportsPredicting Interview-Based DSM Diagnoses

Erin M. Lawton, Andrew J. Shields, and Thomas F. OltmannsOnline First Publication, March 28, 2011. doi: 10.1037/a0022617

CITATION

Lawton, E. M., Shields, A. J., & Oltmanns, T. F. (2011, March 28). Five-Factor Model

Personality Disorder Prototypes in a Community Sample: Self- and Informant-Reports

Predicting Interview-Based DSM Diagnoses. Personality Disorders: Theory, Research, and

Treatment. Advance online publication. doi: 10.1037/a0022617


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Five-Factor Model Personality Disorder Prototypes in a CommunitySample: Self- and Informant-Reports Predicting Interview-Based

DSM Diagnoses

Erin M. Lawton, Andrew J. Shields, and Thomas F. OltmannsWashington University in St. Louis

The need for an empirically validated, dimensional system of personality disorders isbecoming increasingly apparent. While a number of systems have been investigated inthis regard, the five-factor model of personality has demonstrated the ability toadequately capture personality pathology. In particular, the personality disorder proto-types developed by Lynam and Widiger (2001) have been tested in a number ofsamples. The goal of the present study is to extend this literature by validating theprototypes in a large, representative community sample of later middle-aged adultsusing both self and informant reports. We found that the prototypes largely work well

in this age group. Schizoid, Borderline, Histrionic, Narcissistic, and Avoidant person-ality disorders demonstrate good convergent validity, with a particularly strong patternof discriminant validity for the latter four. Informant-reported prototypes show similarpatterns to self reports for all analyses. This demonstrates that informants are notsuccumbing to halo representations of the participants, but are rather describingparticipants in nuanced ways. It is important that informant reports add significantpredictive validity for Schizoid, Antisocial, Borderline, Histrionic, and Narcissisticpersonality disorders. Implications of our results and directions for future research arediscussed.

Keywords: personality disorder, prototypes, five-factor model, informant report, validity

Over the last few decades, dimensional mod-els of personality disorders (PDs) have garnereda great deal of support and enthusiasm. Of thediagnoses in the Diagnostic and Statistical

Manual(DSMIV; American Psychological As-sociation, 1994), PDs are often considered themost problematic (e.g., in terms of reliabilityand co-occurrence). However, there are a num-ber of reasons to be hopeful that a dimensionalmodel may yield a dramatic improvement indealing with these issues. First, evidence has

demonstrated that personality pathology is con-

tinuously distributed (Livesley, 1998; Widiger,1992). It appears that, rather than askingwhether a PD is or is not present, researchersand clinicians should be asking about thedegreeto which features are present. Dimensionalmodels of PDs have also gained support throughthe consistent finding that abnormal personalityis highly related to normal personality function-ing, which has long been conceptualized as con-tinuous (Costa & Widiger, 2002; OConnor,2002). Finally, Skodol et al. (2005) found thatdimensional models of four PDsSchizotypal,Borderline, Avoidant, and Obsessive-Compul-sive PDsaccounted for more variance in func-tional impairment (e.g., work or interpersonalfunctioning) than did theDSMIVcategories orsimply measures of normal personality. Each ofthese areas of research seems to suggest thatidentifying and implementing a dimensionalmodel of PDs would provide a much-neededempirical base for the diagnosis and study ofpersonality pathology.

Of the various dimensional models that havebeen proposed, the five-factor model (FFM) ofpersonality has received the most attention, and

Erin M. Lawton, Andrew J. Shields, and Thomas F.Oltmanns, Department of Psychology, Washington Univer-sity in St. Louis.

This research was supported by a grant from the NationalInstitute of Mental Health (MH077840). We thank MerlynRodrigues, Tami Curl, Rickey Louis, Christie Spence, Am-ber Bolton, and Marci Gleason for their assistance with datacollection and management.

Correspondence concerning this article should be ad-dressed to Thomas F. Oltmanns, Department of Psychology,WA University, 1 Brookings Drive, Campus Box 1125, St.Louis, MO 63130. E-mail: [email protected]

Personality Disorders: Theory, Research, and Treatment 2011 American Psychological Association2011, Vol. , No. , 000000 1949-2715/11/$12.00 DOI: 10.1037/a0022617

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research suggests that the FFM is largely able todepict the 10 DSMIVPDs (Costa & Widiger,2002; Saulsman & Page, 2004; Schroeder,Wormworth, & Livesly, 1992). This model is

based on lexical analyses of trait descriptors andsuggests five higher-order domains of personal-ity: neuroticism, extraversion, openness to ex-perience, agreeableness, and conscientiousness.The NEO Personality Inventory (NEO-PI-R;Costa & McCrae, 1992), the most widely usedmeasure of the FFM, further separates each ofthese five broad domains into six facets.

Using item response theory, Samuel, Simms,Clark, Livesley, and Widiger (2010) examinedthe relationship between the NEO-PI-R and twomeasures of personality pathology (the Sched-ule for Nonadaptive & Adaptive Personality;Clark, 1993; and the Dimensional Assessmentof Personality Pathology; Livesley & Jackson,2009). Results from these analyses demonstratea shared dimensional structure among measuresof normal and pathological personality, withfour of the five domains emerging (opennesswas not consistently found). Moreover, thisstudy found that, while the measures of patho-logical personality typically provided more in-formation at higher levels of the latent trait

dimensions, there was a large degree of overlapbetween instrument coverage. This providesstrong evidence that features of personality dis-orders can indeed be conceptualized as extremevariants of general personality traits.

At the most basic level, high neuroticism andlow agreeableness appear to be associated withmost of the PDs. The exception is DependentPD, which is characterized by both high neurot-icism and high agreeableness (Saulsman &Page, 2004). However, more differentiating re-

lationships between the NEO-PI-R and PDs areachieved at the facet level (Widiger, Trull, Clar-kin, Sanderson, & Costa, 1994). Lynam andWidiger (2001) proposed a more disorder-specific approach using expert consensus to de-termine a distinct subset of facets characteristicof each PD. This approach enjoys a number ofbenefits, such as an aggregation of judgmentsand the identification of facets not overtly iden-tified in DSMIVcriteria.

Since their development, these prototypicalprofiles have been validated in a number of

samples. Miller, Reynolds, and Pilkonis (2004)found generally good agreement between theexpert consensus prototypes and NEO-PI-R

profiles in a clinical sample, with the exceptionof Obsessive-Compulsive PD and DependentPD. These authors also found overall good con-vergent and discriminant validity with respect

to two measures of personality pathology. Thesame study reported high temporal stability andadequate predictive validity with regard to theseprototypes across 6- and 12-month periods in asecond clinical sample. Again, Obsessive-Compulsive PD had the lowest similarityscores. This and other studies have indicatedthat this prototype does not seem to be workingas well as the others. More generally, a numberof studies have reported that the FFM is not ableto describe Obsessive-Compulsive PD consis-tently (Haigler & Widiger, 2001; Miller, Bagby,& Pilkonis, 2005).

To avoid the time consuming and demandingmethod of prototype matching, Miller, Bagby,Pilkonis, Reynolds, and Lynam (2005) devel-oped a simplified scoring technique. This tech-nique (known as the PD count method) createsa summed score of all relevant NEO-PI-R facetsfor each PD. The PD count score techniqueyields correlations comparable to those betweensimilarity scores and PD symptom counts(Miller, Bagby, Pilkonis, et al., 2005). These

count scores can then be compared to the NorthAmerican, French, or Dutch-Flemish normativescores established and validated by Miller et al.(2008). The FFM PD count scores have alsobeen validated when assessed via StructuredInterview for the Five-Factor Model of Person-ality, as well as when rated by clinicians(Miller, Bagby, & Pilkonis, 2005; Miller,Maples, et al., 2010).

One limitation of many of the aforemen-tioned studies is their reliance on self-report.

Although some attempt has been made to ex-plore the utility of other-report (Miller, Pilko-nis, & Clifton, 2005; Miller, Pilkonis, & Morse,2004), the use of informants with respect to thePD prototypes is largely absent despite beingacknowledged as an important pursuit (e.g., Wi-diger & Samuel, 2005). It is commonly recog-nized in the literature that individuals with per-sonality pathology often lack insight due to theego-syntonic nature of these disorders (Klon-sky, Oltmanns, & Turkheimer, 2002). Indeed,research using peer-report of PD features has

suggested that this source seems to be adding aunique perspective; although informant reportappears to differ appreciably from self report,

2 LAWTON, SHIELDS, AND OLTMANNS


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informants tend to agree with each other (Klon-sky et al., 2002; Oltmanns & Turkheimer,2009). The fact that others agree suggests thatmeaningful constructs are being captured.

This begs the question: are there systematicdifferences with regard to the constructs that theself versus an informant can draw upon whenreporting? Much of this literature has focusedon the observability of traits. In terms of theFFM, neuroticism is typically associated withlow observability, while extraversion is linkedto high observability. Because it relies heavilyon knowledge of internal thoughts and feelings,neuroticism should produce somewhat lowerself-other agreement. Conversely extraversionis, by definition, more observable and shouldtherefore result in higher levels of self-otheragreement. Indeed a number of studies havedemonstrated this pattern (e.g., Harkness, Tel-legen, & Waller, 1995; Naumann, Vazire, Rent-frow, & Gosling, 2009), though agreement ontraits of neuroticism appear to increase some-what as level of acquaintance between the targetand the observer increases (Vazire, 2010). Ingeneral then we see that the observability oftraits plays an important role in the study andinterpretation of other reports.

Beyond the realm of normal personality, dif-ferent sources appear to provide varied infor-mation regarding PDs and functioning. UsingFFM domain and facet scores, rather than pro-totypes, Miller, Pilkonis, and Clifton (2005)found that other report generally provided ad-ditional information with respect to a targetspersonality pathology in a clinical sample, par-ticularly for Paranoid PD and the Cluster Bdisorders (Antisocial, Borderline, Histrionic,and Narcissistic). Miller, Pilkonis, and Morse

(2004) found a median correlation of .47 be-tween self- and informant-reported PD proto-type scores in another sample of psychiatricpatients. Informant-reported prototypes demon-strated incremental validity in the prediction offunctional and interpersonal impairment in thisstudy. This pattern was particularly strong forParanoid, Antisocial, Borderline, Histrionic,and Avoidant PDs. Additionally, their analysesindicated that self-other agreement increased asthe observability of maladaptive traits in-creased. This may provide an explanation for

why informants are proving particularly usefulas a source of information regarding Cluster Bdisorders, pathologies for which criteria tend to

be more externalizing than the other PD diag-noses. Ultimately, Miller, Pilkonis, and Morse(2004) suggest that while internal distress isbetter predicted by self report, interpersonal

dysfunction is better predicted by informants.A suggested advantage of a dimensional

model is the ability to account for and handlethe considerable diagnostic co-occurrence seenwith PDs (Lynam & Widiger, 2001; Trull &McCrae, 2002; Widiger & Frances, 2002). Re-search studies consistently show that individu-als diagnosed with one PD frequently meet cri-teria for at least one other (e.g., Oldham et al.,1992; Widiger & Chaynes, 2003). However, asnoted by Lynam and Widiger, a great deal ofPD comorbidity may be explained using theFFM, as disorders are expected to co-occur tothe extent that they assess common FFM do-mains and facets (p. 403). Because the FFMallows a wide variety of personality profiles,latent PD constructs may be more accuratelyrepresented. Before such a system can be im-plemented, its relationship to the existing sys-tem must be examined.

In addition to the benefits of any dimensionalmodel (e.g., consistent empirical support thatpersonality pathology is continuous, their po-

tential to better handle diagnostic co-occur-rence), because they are based on normalpersonality, the NEO prototypes may prove par-ticularly useful when examining age. In herreview on stability and variability in PDs, Clark(2009) noted an overall decrease in personalitypathology over time. However, Balsis, Gleason,Woods, and Oltmanns (2007) found that a num-ber of the DSMIVcriteria contain age bias. Anolder adult in their sample was more likely toendorse the Dependent PD criterion, feels un-

comfortable and helpless when alone because ofexaggerated fears of being unable to care forhimself or herself than a younger adult with thesame level of underlying latent variable. TheNEO-PI-R, on the other hand, has been usedextensively in later middle-aged and olderadults, and has demonstrated good temporal sta-bility (Costa & McCrae, 1994; Widiger & Trull,2007). For these reasons, the prototypes may bebetter indicators of levels of latent pathology inolder adults than the DSMIVdiagnoses.

The present study addresses several issues.

First, we attempt to validate the PD prototypesin a later middle-aged adult sample. Throughthe use of informants, we are able to examine

3SELF AND INFORMANT PD PROTOTYPES


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self-other agreement among the prototypes, aswell as to identify the areas in which otherreport may be particularly useful. Very fewstudies look at informant-generated prototypes,

particularly in a community sample. Addition-ally, this study expands upon earlier work byshedding light on the relation between age andself-other congruence using the FFM and pro-totypes, as opposed to pathological personalitymeasures. Finally, we examine convergent anddiscriminant validity, looking both at the rela-tionships among the prototypes as well as be-tween each prototype and an interview-basedmeasure.

Method

Participants

Results in this manuscript are reported as partof an ongoing, prospective study of the trajec-tory of personality pathology in later middle-age (Oltmanns & Gleason, 2011). This commu-nity sample was recruited using standardepidemiological methods and consisted of 898adults between the ages of 55 and 64 yearsliving in the St. Louis Metropolitan area (demo-

graphic characteristics are reported in Table 1).Though we do not possess data regarding thespecific racial/ethnic break-down for this age

group, census data for St. Louis city and countyindicate a 65% white and 29% black population.Therefore, this sample is representative of St.Louis racial/ethnic composition. Data from

males and females were analyzed together forthis paper, as it is neither our purpose to exam-ine gender differences, nor are findings consis-tent with respect to established gender differ-ences in the prevalence of specific PDs (with theexception of Antisocial PD; e.g., Grant et al.,2004; Lenzenweger, Lane, Loranger, & Kes-sler, 2007; Torgersen, Kringlen, & Cramer,2001). Analyses conducted separately by gen-der revealed that correlations for each groupwere typically very close to those reported forthe whole sample, and there did not appear to beany systematic differences. When they differed,correlations for males were frequently slightlysmaller than those for females. Similarly, nosystematic differences emerged when analyseswere stratified by participant race/ethnicity andthese too were very close to the entire samplecorrelations. In general, the prototypes seemedto be functioning approximately equivalently inboth groups, supporting the analysis of the over-all sample.

We utilized a community sample for a num-

ber of reasons. Perhaps most important is thefact that most middle-aged people who wouldmeet the diagnostic criteria for a personalitydisorder are likely not in treatment. Studies thatfocus on clinical samples have the advantage ofincluding people with more pronounced person-ality pathology, but there is no way to determinewhether those problems are representative ofthe nature or extent of personality disorders inthe general population. While the NEO PD pro-totypes have been used with informants in clin-

ical samples (e.g., Miller, Pilkonis, et al., 2005),the relationship between self and other reportshas not yet been examined in a communitysample.

Participants were recruited using a pool ofrandomly selected, listed phone numbers forhouseholds with at least one inhabitant in ourage range. Specific information regarding resi-dents was provided by a sampling company thatcross-referenced households with census data.Households were asked to identify all eligibleresidents between the ages of 55 and 64 years. If

a household contained more than one eligibleresident, the Kish method (Kish, 1949) wasused to randomly select a target. We did not

Table 1Sample Demographic Characteristics

%

Sex

Female 55.4

Race/ethnicity

White 69.4African American 29.4

Other 1.2

Born in St. Louis 58.7

Education

High school 40.5

College 26.2

Advanced degree 32.1

Employment

Full-time 46.1

Part-time 19.4

Retired 32.4

Unemployed due to disability 9.7

Median household income $40,000$59,999

Note. Employment exceeds 100% due to those workingpart-time since retirement.



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recruit other eligible residents if the target re-fused to participate (sampling without replace-ment). Participants were paid $60 to complete a3-hr assessment.

Informants

Each participant was asked to identify some-one who would be able to provide the bestdescription of the participants personality char-acteristics. We preferred that the participantidentify a spouse or romantic partner as theirinformant. If a romantic partner was unavailableor refused to participate, the participant wasasked to identify another person who knewthem well. For this sample, data were collectedfrom 760 informants, comprised of 47.4% ro-mantic partners, 24.8% family members, 23.0%close friends, and 4.8% other.

Measures

Structured Interview for DSMIVPerson-ality (SIDP-IV). The SIDP-IV (Pfohl, Blum,& Zimmerman, 1997) is a semistructured inter-view designed to assess each criterion of the 10

DSMIVpersonality disorders. Questions on the

SIDP-IV are arranged by themes (e.g., emo-tions, self-perception, stress and anger) ratherthan by disorder. Items are written in nonpejo-rative lay language. The SIDP-IV utilizes a5-year rule, meaning participants were asked todescribe personality traits that predominatedover the most recent 5-year period. PD criteriaare rated on a 0 to 3 scale, from not presenttostrongly present. Diagnoses can be obtainedusing the SIDP-IV by simply dichotomizing theitem scores (i.e., 0 and 1 indicate that the crite-

rion is not present, while a 2 or a 3 wouldindicate presence). However, we maintained thedimensional nature of the scoring by simplycreating a summed score of the total points foreach disorder for the analyses in the currentstudy.

NEO Personality InventoryRevised(NEO-PI-R). The NEO-PI-R (Costa &McCrae, 1992) is a 240-item questionnairemeasuring the FFM of personality. It provides asystematic assessment of emotional, interper-sonal, experiential, attitudinal, and motivational

styles. The NEO-PI-R is a concise measure ofthe five major domains of personality (neuroti-cism, extraversion, openness, agreeableness,

and conscientiousness), as well as six facetsassessing more specific traits comprising eachdomain. Parallel forms of the NEO-PI-R wereused for self- (form S) and informant-reports

(form R). Items are rated on a 5-point Likertscale, with responses ranging fromstrongly dis-agreetostrongly agree. Taken together, the fivedomains and 30 facet scales of the NEO-PI-Rprovide a comprehensive and detailed assess-ment of adult personality.

PD counts were computed by summingscores on FFM facets that were deemed proto-typically high or low as reported by Lynam andWidiger (2001). Prototypically low facet scoreswere reverse coded, and summed with prototyp-ically high facet scores. For example, theSchizotypal PD prototype was computed bysumming two facets of neuroticism (anxiety andself-consciousness), one facet of openness(ideas), three reverse-scored facets of extraver-sion (warmth, gregariousness, and positiveemotions), and one reverse-scored facet of con-scientiousness (order). Count scores were cre-ated for each of the 10 PDs, and separate scoreswere computed for self- and informant-ratings.We used the revised scoring method for theDependent PD count (Miller & Lynam, 2008).1

Results

Nine percent of the participants in our samplequalify for a diagnosis of at least one PD. Thisprevalence rate is comparable to those reportedin other epidemiological studies, which consis-tently find estimates of 913% (e.g., Ekselius,Tillfors, Furmark, & Fredrikson, 2001; Samuelset al., 2002; Torgerson, 2005). An addi-tional 8.6% of our participants (i.e., those whodid not qualify for a PD) fell short of a diagnosisby only one criterion.

We began our analyses by considering self-other agreement on the NEO-PI-R, both at thedomain and the facet level. As demonstrated inTable 2, bivariate correlations were generallymoderate and all were significant at the p .01level. Domain correlation coefficients rangedfrom .35 (agreeableness) to .51 (both extraver-sion and openness). Facet-level rs ranged from

1

Although a prototype exists for psychopathic personal-ity, the discussion surrounding its relationship to AntisocialPD lies beyond the scope of the current study. For thisreason, it is not included in these analyses.



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.23 (altruism, from the agreeableness domain)to .57 (aesthetics, from the openness domain).Median rs within each domain were .37 (neu-roticism), .47 (extraversion), .46 (openness), .32(agreeableness), and .38 (conscientiousness).

We then examined the relations among inter-view-based PD scores pathology, self-reportedprototypes, and informant-reported prototypesusing bivariate correlations (see diagonals inTable 6). The self-reported prototypes correlate

significantly (p .01) with SIDP scores fornine of the 10 PDs, the exception being Obses-sive-Compulsive PD. Of these nine significant

findings, correlation coefficients ranged from.22 (Schizotypal PD) to .50 (Avoidant PD), witha medianrof .34. We found the same pattern ofcorrelations between informant-reported proto-

types and SIDP scores, again with the onlynonsignificant result being Obsessive-Compul-sive PD. Significant correlations ranged from.14 (Schizotypal PD) to .39 (Borderline PD),with a median r of .24. The correlations be-tween self-reported prototypes and informant-reported prototypes were as follows: Paranoid(.42), Schizoid (.51), Schizotypal (.50), Antiso-cial (.45), Borderline (.43), Histrionic (.47),Narcissistic (.43), Avoidant (.55), Dependent(.44), ObsessiveCompulsive PD (.52). Allwere significant at the p .01 level.

Next, we examined the connection betweenself-reported NEO prototypes and the SIDP af-ter controlling for the variance accounted for byneuroticism and agreeableness using partial cor-relations. This analysis was conducted to ensurethat these prototypes provided incremental va-lidity beyond the broad personality domainsthat are most obviously associated with PDs. Ascan be seen in Table 3, the prototypes continueto correlate significantly (p .01) with SIDPpathology for all 10 PDs even after partialing

these two related higher-order factors, demon-strating the incremental validity of the proto-types. Partial correlation coefficients range from.09 (Paranoid) to .36 (Schizoid) with a medianpartial rof .16.

We also used partial correlations to explorethe association between informant-reported pro-totypes and the SIDP while controlling for self-

Table 3

Correlations Between SIDP Interview Scores andSelf Prototype After Controlling for Levels ofNeuroticism and Agreeableness

pr p

Paranoid .09 .01

Schizoid .36 .001

Schizotypal .13 .001

Antisocial .16 .001

Borderline .16 .001

Histrionic .32 .001

Narcissistic .13 .001

Avoidant .31 .001

Dependent .16 .001Obsessive-compulsive .10 .01

Note. N 862.

Table 2Self-Other Agreement of NEO-PI-R Domains

and Facets

r

Anxiety .39

Angry hostility .36

Depression .46

Self-consciousness .32

Impulsiveness .37

Vulnerability .37

Neuroticism .46

Warmth .41

Gregariousness .49

Assertiveness .50

Activity .48

Excitement seeking .45

Positive emotions .44

Extraversion .51Fantasy .30

Aesthetics .57

Feelings .36

Actions .43

Ideas .48

Values .54

Openness .51

Trust .35

Straightforwardness .24

Altruism .23

Compliance .39

Modesty .30

Tendermindedness .34Agreeableness .35

Competence .35

Order .50

Dutifulness .30

Achievement striving .43

Self-discipline .40

Deliberation .27

Conscientiousness .42

Note. N varies from 491 to 502 across correlations due tosporadic missing data. All correlations were significant at

p 0.01.



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reported prototypes. As Table 4 shows, five ofthe 10 informant prototypes maintain a signifi-cant relationship with the SIDP at p .05. Wefound interesting that all four Cluster B PDs

were significant, with Schizoid PD yielding thefinal significant result. Among the significantpartial correlations, coefficients range from .08(Schizoid PD) to .24 (Borderline PD).

We subsequently examined the associationsamong the self-reported prototypes as the firststep in evaluating their convergent and discrim-inant validity. As can be seen in Table 5, cor-relations are mostly moderate with a few in thehigh range. Significant correlations among self-reported prototypes range from .07 (betweenAntisocial and Schizotypal PD, p .05) to .86(between Antisocial and Narcissistic PD). Themedianrwas .43. The analysis was repeated forthe informant-reported prototypes, and the re-sults show a similar pattern. Significant corre-lations among informant prototypes range from.08 (Borderline with Schizoid, p .05) to .90(Antisocial with Narcissistic, p .01). Themedianrwas .40. Additionally, Cronbachs al-phas were largely good to very good. The low-est alpha was obtained for Schizotypal PD (.54and .53 for self- and informantreport, respec-

tively) and the highest was obtained with De-pendent PD (.87 for self-report and .86 for in-formants). The median alpha for self-reportedprototypes was .67 and for informant-reportedprototypes was .76.

We concluded our analyses by extending theexamination of the validity of the self- andinformant-reported prototypes using SIDP rat-ings as the criteria. The heterotrait-hetero-

method matrix (as defined by Campbell &Fiske, 1959) for self-report in Table 6 showsthat each of the values in the validity diagonalare significant, with the exception of Obsessive-

Compulsive PD. Five of the 10 PDs demon-strate good convergent validity. The Schizoid,Borderline, Histrionic, Narcissistic, andAvoidant prototypes each show their highestcorrelation with their corresponding SIDP PDratings. Of the five prototypes showing conver-gent validity, four demonstrate a particularlystrong pattern of discriminant validity (Border-line, Histrionic, Narcissistic, and Avoidant).Median discriminant r across all PDs was .13(p .01). Furthermore, expected relationshipsamong the PDs emerged across measurementtype. It is interesting that the presence of nu-merous negative correlations suggests that asimple halo effect, or tendency to endorse, isunlikely.

The heterotrait-heteromethod matrix for in-formant-report shows generally lower correla-tions, but largely the same pattern as that of theself. Nine of the 10 coefficients in the validitydiagonal (all but Obsessive-Compulsive PD)are significant. Similarly, the Schizoid, Border-line, Histrionic, Narcissistic, and Avoidant PD

prototypes demonstrate good convergent valid-ity. The latter four again showed the strongestpattern of discriminant validity. Median dis-criminantramong informant prototypes acrossall disorders was .10 (p .01). We find ex-pected relationships among the PDs within in-formant report, as well.

Discussion

The transition to a dimensional model of PDs

would afford many empirically supported ben-efits. This conceptualization provides more in-formation, offers a way to describe diagnosticco-occurrence and within-disorder heterogene-ity, and avoids the dichotomization of aconsistently demonstrated continuous variable(Livesley, 1998; Widiger & Chaynes, 2003).Additionally, research has shown the distinctionbetween normal and abnormal personality to belargely arbitrary (OConnor, 2002). For in-stance, the DSMIVPDs are largely able to bedescribed within the framework of the FFM

(Schroeder et al., 1992; Widiger & Trull, 2007)and IRT analyses indicate a great deal of over-lap among the NEO and measures of personality

Table 4Correlations Between Informant Prototype and

SIDP Rating After Partialing Self Prototype

pr p

Paranoid .07 .06

Schizoid .08 .04

Schizotypal .04 .33

Antisocial .15 .001

Borderline .24 .001

Histrionic .09 .02

Narcissistic .15 .001

Avoidant .07 .08

Dependent .06 .10Obsessive-compulsive .00 .92

Note. N 729.



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Table5

BivariateCorrelationsAmongSelf-ReportedPrototypesandAmongInforma

nt-ReportedPrototypes

Self-reportedNEO

prototypes

Paranoi

d

Schizoid

Schizotypal

Antis

ocial

Borderline

Histrionic

N

arcissistic

Avoidant

Dependent

Obsessive-

compulsive

Paranoid

(.79)

Schizoid

.62

(.79)

Schizotypal

.61

.68

(.54)

Antisocial

.48

.2

2

.07

(.6

0)

Borderlin

e

.41

.05

.52

.4

5

(.74)

Histrionic

.5

0

.8

3

.4

4

.4

0

.24

(.63)

Narcissis

tic

.68

.05

.21

.8

6

.28

.01

(.60)

Avoidant

.49

.84

.74

.3

8

.30

.7

1

.2

0

(.70)

Dependent

.48

.44

.70

.1

2

.79

.1

7

.07

.68

(.87)

Obsessiv

e-compulsive

.06

.20

.2

0

.5

1

.4

9

.5

7

.1

5

.21

.3

3

(.55)

Informant-reportedNEO

prototyp

es

Paranoid

(.85)

Schizoid

.60

(.80)

Schizotypal

.61

.68

(.53)

Antisocial

.65

.0

3

.19

(.7

4)

Borderlin

e

.48

.08

.54

.5

4

(.78)

Histrionic

.4

0

.7

5

.4

0

.3

4

.27

(.63)

Narcissis

tic

.80

.17

.28

.9

0

.40

.01

(.74)

Avoidant

.39

.79

.73

.2

8

.30

.6

1

.1

5

(.67)

Dependent

.45

.38

.69

.2

7

.83

.0

2

.18

.61

(.86)

Obsessiv

e-compulsive

.0

4

.18

.1

5

.5

1

.4

3

.5

2

.2

2

.28

.3

9

(.65)

Note.

S

elf-reportedNEO

prototypeN

875,

andinformant-reportedN

760.

Valuesonthediagonalsindicateinternalconsistencycoefficients.

p

.05.

p

0.0

1.



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pathology (Samuel et al., 2010). Lynam andWidiger (2001) proposed expert-generatedNEO prototypes that, along with Miller, Bagby,Pilkonis et al.s (2005) count score method,have largely demonstrated good convergent anddiscriminant validity. These prototypes have

also shown satisfactory predictive validity andstrong temporal stability.While previous studies have demonstrated

the utility of the prototypes, most have done soin clinical samples. Our representative sampleof community residents not only taps a typicallyoverlooked population in PD research (the5564 age group), but also utilizes informantreport. While informant report is likely to beuseful for the assessment of many disorders andtheir associated functioning, we believe that it isparticularly important for PDs due to their ego-

syntonic nature. To our knowledge, this is thefirst study examining the informant-reportedprototypes in an adult, community sample. The

present study therefore takes advantage of anovel sample to broaden the scope of the pro-totypes use.

In the current study, we first wanted to deter-mine whether the prototypes were useful in oursample of later middle-aged adults. We found

that, with the exception of Obsessive-Compul-sive PD, the PD prototypes as reported by bothself and informant were significantly correlatedwith ratings based on the SIDP interview. TheSIDP was used as the validity criterion, becausesemistructured diagnostic interviews are oftenconsidered the gold standard in personality dis-order assessment. It is not our intention, how-ever, to suggest that the DSMIVor its relatedmeasures are without fault. Instead our goal wasto compare two alternative approaches to themeasurement of latent constructs associated

with conventionally accepted definitions of per-sonality pathology. Ultimately, the questionwill be which measure proves more value with

Table 6Bivariate Correlations Among Self- and Informant-Reported NEO PD Prototypes and SIDP Ratings

SIDP ratings

Self-reported NEO PD prototypes

PRD SZD SZTL ASPD BDL HSTR NARC AVD DEP OCPD

PND .33 .12 .22 .17 .24 .14 .22 .16 .23 .02

SZD .34 .39 .34 .02 .08 .33 .11 .32 .16 .07

SZTL .26 .17 .22 .09 .13 .16 .17 .14 .15 .03

ASPD .20 .00 .07 .26 .20 .06 .22 .01 .15 .15

BDL .29 .08 .25 .25 .47 .02 .19 .17 .39 .18

HSTR .01 .29 .11 .26 .22 .29 .12 .22 .07 .20

NARC .17 .14 .04 .34 .13 .14 .34 .18 .02 .07

AVD .27 .38 .45 .16 .31 .29 .11 .50 .49 .02

DEP .13 .15 .21 .05 .27 .05 .09 .28 .38 .09

OCPD .22 .11 .22 .05 .19 .09 .06 .18 .21 .02

Informant-reported NEO PD prototypes

PRD SZD SZTL ASPD BDL HSTR NARC AVD DEP OCPD

PND .20 .08 .13 .15 .18 .04 .16 .07 .17 .06

SZD .23 .25 .25 .05 .10 .20 .11 .20 .15 .01

SZTL .18 .09 .14 .14 .13 .06 .15 .07 .15 .08

ASPD .22 .05 .10 .24 .19 .04 .22 .02 .16 .15

BDL .25 .10 .23 .24 .39 .05 .18 .13 .36 .20

HSTR .03 .17 .05 .19 .18 .21 .12 .13 .09 .16

NARC .18 .04 .08 .29 .12 .08 .29 .13 .02 .09

AVD .15 .24 .25 .06 .18 .18 .03 .33 .27 .03

DEP .03 .05 .11 .02 .19 .02 .06 .16 .23 .06

OCPD .14 .14 .18 .04 .07 .11 .06 .14 .11 .00

Note. Self,N 898; Informant,N 743. PND Paranoid; SZD Schizoid; SZTL Schizotypal; ASPD Antisocial

Personality; BDL Borderline; HSTR Histrionic; NARC Narcissistic; AVD Avoidant; DEP Dependent;OCPD Obsessive-compulsive Personality Disorder. p 0.01. p .05.



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regard to identifying current and future prob-lems in social adjustment, health, and subjectivewell-being. In a far more stringent test of utility,we computed partial correlations while control-

ling for neuroticism and agreeableness. As ex-pected, the strength of the associations de-creased, but all 10 relationships remained sig-nificant at the p .01 level or below, withObsessive-Compulsive PD actually becomingsignificant. Because neuroticism and agreeable-ness are the global personality domains mostconsistently associated with PDs (OConnor,2002), these results are a robust testament to thevalue of the prototypes, and demonstrate theirutility in a middle-aged sample.

We also found levels of self-other agreementamong the prototypes very similar to those re-ported by Miller, Pilkonis et al. (2004). Theseauthors reported a median correlation of .47,while we found a median correlation of .46. Ofnote, the self-other agreement between the pro-totypes (as reported here and in the Miller,Pilkonis, et al., 2004 study) is generally largerthan that found using other measures of patho-logical personality (Klonsky et al., 2002).Perhaps informants are more familiar with con-sidering others normal range traits and be-

haviors than those of a pathological nature. Thefact that correlations between the prototypesand the SIDP are lower than those between self-and informant-reported prototypes is not sur-prising given the method variance of both in-terview versus questionnaire and normal versusabnormal personality functioning.

We next examined the contribution of infor-mant report with respect to the prototypes. Theinformant report correlated moderately with selfreport for all 10 PDs. An even more compelling

argument for the use of informants in additionto self report is that, for five of the 10 PDs,informants account for unique variance in theinterviewers ratings after controlling for theself. Other report adds significant predictiveutility for Schizoid, Antisocial, Borderline, His-trionic, and Narcissistic PDs. The fact that allfour Cluster B disorders emerge as significant isconsistent with findings that the observability ofthe features may play a key role in the extent ofself-other agreement (Miller, Pilkonis, et al.,2004). However, our results further suggest that

observability may also play an important role inthe ability of others to contribute additionalinformation. It is therefore remarkable that in-

formants account for unique variance in osten-sibly more internalizing disorders, such asSchizoid (p .04) and Avoidant (p .08)PDs. Because these prototypes contain a num-

ber of facets of extraversion, we might haveexpected higher self-other agreement for theseprototypes. However, we did not necessarilyexpect informants to provide more informationthan the self. In this way, the performance ofinformant-reported prototypes somewhat ex-ceeded our expectations. The replication of thisfinding and its interpretation within the self-other knowledge asymmetry model (Vazire,2010) will be an interesting direction for futureresearch.

The interrelationships among the prototypesfor both self and informant were also encourag-ing. Associations between disorders that wewould expect to see (e.g., Schizoid andAvoidant, or Antisocial and Narcissistic) didemerge. Although within-cluster correlationsare not specifically high, which might be ex-pected, the associations between disorders areoften intuitive. For example, the strong relationbetween Borderline and Dependent is likelydriven by the intense fear of being left alone thatis characteristic of both PDs. Conversely the

insignificant relation between Histrionic andNarcissistic PD is also easily interpretable, asHistrionic PD is characterized by feelings ofcloseness toward many people while Narcis-sistic is characterized by feelings of superior-ity over others. It is important that theserelationships were mirrored in the informant-reported prototypes. This suggests that thereis not simply a tendency to generalize positiveor negative feelings toward a target, but ratherinformants are painting nuanced pictures of

the participants.We also find evidence of good convergentvalidity for the Schizoid, Borderline, Histrionic,Narcissistic, and Avoidant prototypes, and aparticularly strong pattern of discriminant va-lidity for the latter four disorders. Because anumber of the PDs as we currently know themare facing potential elimination (includingSchizoid, Histrionic, and Narcissistic), countscores such as these may be the method bywhich the constructs in question need to beassessed. The demonstration of convergent and

discriminant validity in these PDs are thereforeparticularly encouraging. Among the five re-maining prototypes that did not demonstrate



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convergent validity, four shared their largestcorrelation with an intuitive alternative, or wereconsistent with co-occurrence literature (e.g.,Lenzenweger et al., 2007; Oldham et al., 1992).

Namely, the Paranoid prototype was slightlymore strongly related to Schizoid SIDP ratings,Schizotypal was most strongly related toAvoidant, Antisocial most highly correlatedwith Narcissistic PD ratings, and Dependentslargest association was with Borderline PD. Un-like pathological personality measures thatlargely do not have items that contribute tomultiple disorders, the PD prototypes necessar-ily contain overlap, as they are driven by theitems.

Of particular interest is the relationship be-tween Antisocial and Narcissistic PDs. Thesetwo disorders are consistently shown to behighly correlated (Gunderson & Ronningstam,2001; Oldham et al., 1992), and the presentstudy finds the Antisocial prototype morehighly related to SIDP ratings of Narcissismthan to those of Antisocial. One potential inter-pretation of this result is that, as Antisocialindividuals age, they find themselves unable toengage in the reckless or aggressive behaviorsindicative of this disorder. Instead, they may

turn to more subtle actions, such as manipula-tion. The concept of heterotypic continuity sug-gests that there may be a number of ways inwhich a latent trait can manifest, and this man-ifestation may be dependent upon context (e.g.,across cultures or age). Thus, it is possible thatantisocial behaviors shift toward a more narcis-sistic presentation as the person approacheslater life. We mention this simply because theexamination of potential heterotypic continuitywill be an important direction for further re-

search in the study of PDs in older adults.Although expected relations emerge as stron-ger, a large number of the correlations amongprototypes are significant. These, as well as thesomewhat low discriminant validity of a few ofthe disorders, attest to the considerable overlapamong the constructs (Lenzenweger et al.,2007; Widiger & Chaynes, 2003). Because PDsare highly co-occurring syndromes, we wouldexpect toand dofind the same to be true forthe prototypes.

One noticeable aspect of our results is the

relatively weak evidence for the validity of theSchizotypal prototype. It has the lowest corre-lation with the SIDP for both self- and infor-

mant-report. Furthermore, the prototype corre-lates highly with Avoidant and Dependent PDs(.74 and .70, respectively for self report, and .73and .69 for informants). Similarly when com-

pared with the SIDP, the Schizotypal prototypeshows poor convergent and discriminant valid-ity. The strong relation with Avoidant PD par-ticularly suggests that this prototype may bedoing an adequate job of tapping interpersonaldiscomfort. However, because the NEO-PI-Rwas developed to assess general personality,aspects of Schizotypal PD such as odd percep-tual experiences are not covered well. Kruegerand Eaton (2010) instead argue that an alterna-tive personality dimension, which they term pe-culiarity, is needed to obtain sufficient coverageof this disorder. Inquiries such as these arebecoming increasingly important as DSM-5discussions continue.

A potential limitation of the current study isthat the strength of the associations dependsupon the amount of variability in the sample.Because ours is a representative communitysample of later middle-aged adults, we havelimited variation with respect to the features ofsome disorders. As compared with the others,we found relatively poor convergent and dis-

criminant validity for Schizotypal, Antisocial,and Dependent PDs. These disorders are lesswell represented in our sample, which may sim-ply indicate that with greater heterogeneity,stronger patterns of validity may emerge.

In addition, some aspects of the FFM havebeen criticized for their inability to describepathological personality traits. Some research-ers have questioned whether these prototypesare subject to a ceiling effect. For instance, onewould expect a relationship between conscien-

tiousness and Obsessive-Compulsive PD. How-ever, this relationship is consistently reported asweak or absent (Miller, Bagby, Pilkonis, et al.,2005; Trull, 1992). Haigler and Widiger (2001)suggest that the NEO-PI-R uses considerablymore adaptive behaviors to define the high endof conscientiousness, agreeableness, and open-ness in comparison to items that define the lowends of these dimensions. In an attempt to cap-ture the more maladaptive extremes of the do-mains, Haigler and Widigers study rewordeditems from the NEO-PI-R (e.g., by adding the

word excessively). These authors found thatcorrelations between Obsessive-CompulsivePD and conscientiousness increased markedly.



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In a similar vein, the Pathological Five Model(Krueger & Eaton, 2010) has been proposed forincorporation into the DSM-5 as a means ofassessing the maladaptive extremes of neuroti-

cism, extraversion, agreeableness, and consci-entiousness. Their proposed domains thereforeconsist of negative emotionality, introversion,antagonism, and disinhibition. As noted above,they label their fifth domain peculiarity. Therelationship between peculiarity and opennessis still relatively unexplored, but appears to benonredundant. Investigating the relationship be-tween the PD prototypes and models that spe-cifically attempt to include pathological featureswill be an interesting and important avenue forfuture research.

Conversely, one could argue that the use ofDSMIVPD conceptualizations as the validitycriterion provides drawbacks of its own. In theirexamination of clinician-rated NEO PD proto-types, Miller et al. (2010) found that these pro-totypes accounted for unique variance (i.e., be-yond that ofDSMIVcategories) in occupation,social, and overall impairment, as well as dis-tress caused to others. This research indicatesthat, while the predominant model, the currentDSM is limited in its function as the point of

comparison. It also highlights the importance ofvaried validation criteria.

Though the 10 PDs as they are currentlydefined may not be retained in DSM-5, severalprinciples appear to emerge from the presentanalyses. Indeed, these are precisely the issuesraised by Krueger, Skodol, Livesley, Shrout,and Huang (2007) in their discussion of direc-tions for DSM-5. Their review speaks specifi-cally to the use of facet-level traits to compriseprototypes to which individuals can be matched.

Research investigating the relative validity ofsuch models is of critical importance as thedevelopment ofDSM-5 proceeds.

As the field approaches a dimensional con-ceptualization, researchers will be charged withthe task of defining a model, and thus far allevidence seems to suggest that the FFM is doinga reasonably good job of capturing pathology.More specifically, Lynam and Widigers (2001)PD prototypes have been useful in a variety ofsample types and age ranges. These prototypeshave also now demonstrated similarly good

convergent and discriminant validity for infor-mant report. And by using informants as well asself-report, we are able to explain significant

additional variance in five of the 10 PDs. Ofcourse, the next question is concerned with con-struct validity. By establishing the prototypes asan empirically supported system of PDs, in

which the benefits of a dimensional model canbe coupled with meaningful informant report,we can begin to examine its relation to real lifeproblems and functioning.

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