There is a substantial literature on the associations between personality disorder (PD) and sleep dysfunction, but the majority of studies have focused on borderline PD. Studies that have taken a broader perspective have indicated that associations between PD and sleep problems are diffuse. The current study examined associations between the International Classification of Diseases, 11th revision (ICD-11) PD (severity and traits) with a diverse set of sleep problems as well as the role of adverse childhood experiences (ACEs) and executive functioning in explaining the overlap between PD and sleep dysfunction. Participants were 503 individuals with mental health histories recruited via Prolific Academic from six English-speaking countries and completed a battery of self-report questionnaires targeting the constructs of interest. The results show that ICD-11 PD severity and negative affectivity were both distinctly associated with insomnia severity and presleep arousal. To a lesser degree, disinhibition was primarily associated with an eveningness chronotype and daytime sleepiness. Although both ACEs and executive dysfunction explained the overlap of the PD constructs with insomnia severity and presleep arousal, the latter was associated with a much larger effect size. The findings indicate that a dimensional PD model such as the one included in ICD-11 can be useful in elucidating how PD is related to sleep problems, and this overlap should also signal to clinicians to assess for and intervene with sleep problems in clients with PDs. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Paranoia, the unfounded belief and mistrust about other people's intentions as threatening, and social anxiety, the intense worry and fear regarding social interactions, share a number of phenomenological features. Furthermore, both can be conceptualized as traits ranging from mild or subclinical to severe clinical expressions. However, few studies have examined how these trait-level vulnerabilities differentially map onto individuals' daily experiences. The present study used experience sampling methodology to disentangle the overlap and differentiation of trait-level social anxiety and paranoia in daily life. A total of 238 young adults were prompted 8 times daily for 1 week to complete experience sampling methodology questionnaires that assessed affect, cognitive appraisals, suspicious thoughts, activities, and social behaviors. As hypothesized, paranoia and social anxiety were both independently associated with negative affect and negative self- and other-related appraisals. However, after controlling for shared variance, only paranoia was uniquely associated with anger, intense feelings, and threat-related suspicious thoughts, whereas only social anxiety was uniquely associated with feeling not cared for, preference to be alone while with others, and among participants who were alone, interpreting being alone as due to others' dislike. Cross-level interactions further showed that only social anxiety exacerbated the inverse association between momentary reports of feeling close to others and the preference to be alone. Overall, these findings suggest that although paranoia and social anxiety are closely intertwined in daily life, they may reflect partially distinct interpersonal processing: paranoia involving heightened threat detection and suspiciousness, and social anxiety involving heightened sensitivity to rejection and unease. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Scholarly debate continues regarding whether borderline personality disorder (BPD) represents a distinct categorical disorder or primarily reflects elevated levels of personality functioning (LPFs) as conceptualized in the Diagnostic and Statistical Manual of Mental Disorders, fifth ed., Alternative Model of Personality Disorders. The present study examined the overlap between measures of LPF and BPD by analyzing archival data from 289 adults receiving community-based mental health treatment. Participants completed both clinician-rated and self-report measures assessing BPD symptoms, LPF, and relevant psychopathology and personality constructs. Results indicated substantial overlap between measures of BPD and LPF, with confirmatory factor analyses and bifactor modeling supporting a dominant general factor that accounted for most shared variance between the 2 constructs. Concurrently, BPD retained modest yet consistent unique variance, primarily associated with externalizing domains. Together, these findings indicate that BPD largely reflects LPF with some stylistic features remaining unique that are likely artifacts of the behavioral focus of BPD in the Diagnostic and Statistical Manual of Mental Disorders, fifth ed. This observation suggests that resources currently directed toward BPD-specific frameworks may be more effectively invested in dimensional models targeting general personality impairment, with benefits extending across broader personality pathology. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Although the Personality Inventory for Diagnostic and Statistical Manual of Mental Disorders (5th ed.; PID-5) was initially designed to assess the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) trait model, a modified scoring algorithm was developed to evaluate the International Statistical Classification of Diseases and Related Health Problems (11th ed.; ICD-11) trait model constructs. This meta-analysis aimed to examine the internal (structural and discriminant types) and external (convergent and criterion types) validity of the PID-5 to measure the ICD-11 trait model constructs (the PID ICD scale). Systematic searches in PubMed, Scopus, PsycNET, and Google Scholar were used to screen all articles published between January 2013 and October 2024. Given the high heterogeneity in the results of the included studies, the random-effects method was used for all pooled estimates. Ten medium to high-quality reports consisting of 12,840 people (2,551 psychiatric patients and 10,289 nonpatients) were entered into the meta-analysis. The pooled estimates supported the five-factor structure with good model fit indices (root-mean-square error of approximation = .06, comparative fit index = .97, Tucker-Lewis index = .93, standardized root-mean-square residual = .02). Alpha coefficients were between .86 and .93 for all factors (Mdn = 0.89) and the factor intercorrelations were between .11 and .49. The expected correlations were found between the factors and symptoms of 10 personality disorders (all between -.07 and .62). The mean scores of all factors were significantly higher in the clinical than nonclinical sample (d between 0.68 and 1.37) and the Area Under the receiver operating characteristic Curve values were significant (all between .65 and .83). We tentatively suggest that the PID ICD may function as an applicable questionnaire with generally acceptable internal and external validity, while noting that the Anankastia scale-particularly the perseveration subfacet-warrants extra caution in interpretation due to its poor convergence with regular ICD scales. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Stand-alone dialectical behavior therapy skills training groups (DBT-ST) are widely used for borderline personality disorder (BPD), yet skills-specific benchmarks for symptom change and tolerability are unclear. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched PubMed, APA PsycARTICLES, APA PsycINFO, Psicodoc, and Psyke (English/Spanish) for adult stand-alone DBT-ST covering the four standard modules. Eligible designs were randomized clinical trials, controlled trials, and pre-post studies with standardized BPD diagnoses. Continuous outcomes were synthesized as standardized mean differences (Hedges-corrected d); within-arm pre-post effects used standardized mean change (assumed r = .50 when missing). Dropout was pooled on the logit scale and back transformed to retention. Random-effects model with Hartung-Knapp adjustments quantified heterogeneity and ran sensitivity/bias diagnostics. Seven studies met criteria; five entered meta-analysis. BPD clinical severity showed large within-arm improvement (d = -1.32, 95% confidence interval [CI; -1.99, -0.64]) with substantial heterogeneity. Depression decreased largely (k = 4; d = -1.04, 95% CI [-1.33, -0.75]); global psychopathology decreased moderately (k = 2; d = -0.73, 95% CI [-1.39, -0.08]). Pooled dropout was 29% (95% CI [23%, 36%]), implying 71% retention. Stand-alone DBT-ST is associated with large symptom reductions and acceptable retention, providing skills-specific benchmarks to inform implementation, whereas heterogeneity indicates the need for more robust comparative trials. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Positive schizotypy is a dimension of traits ranging from odd beliefs and experiences in the general population to the positive psychotic symptoms of schizophrenia (i.e., delusions and hallucinations), with high levels of positive schizotypy found in some personality disorders. Psychosis is related to increased dorsal striatal dopamine, suggesting that positive schizotypy might also reflect alterations in dorsal striatal functioning. The dorsal striatum is involved in reinforcement learning and cognitive flexibility. The current research examined whether positive schizotypy is related to impaired learning from probabilistic positive and negative feedback and to impaired attentional set switching. Participants included a group with extreme levels of positive schizotypy, a positive schizotypy control group, and a group with extreme levels of negative schizotypy. They completed feedback-related learning tasks and an attentional set-switching task. They also completed a response inhibition task to help assess for generalized task performance deficits. To further assess specificity, they also completed a range of mood and other measures. Overall, there was evidence that positive schizotypy was associated with poor feedback-related learning, perhaps especially and specifically with poorer learning from positive feedback. Positive schizotypy was also associated with poorer attentional set switching, but not with poorer response inhibition. Overall, the current study provides further evidence that positive schizotypy is associated with poor performance on reinforcement learning and cognitive flexibility tasks thought to involve the dorsal striatum. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Body modifications such as tattoos and piercings have known identity-affirming functions. Despite this, as a subject of psychological research, they are mainly studied in relation to self-injurious behavior. Given the frequency of both self-damaging behavior and unstable identity in borderline personality disorder (BPD), and informed by a sample of 17 pilot interviews, we hypothesized that for people with BPD, body modifications provide relief from internal and aversive identity-related concerns. The present study takes a qualitative approach to examine body modification and related emotional and intrapersonal experiences in BPD. Participants with BPD (N = 47) participated in a semistructured interview targeting appearance-modification experiences. Rapid qualitative analysis methods were used to sort interview content into five domains of interest: physical sensations, affect regulation, sense of self, emptiness and identity disturbance, and impulsivity. Participants described a wide range of body modifications and associated experiences. Results substantiated the potential for appearance modifications to positively impact sense of self in BPD-mitigating identity disturbance and emptiness-and revealed complex emotional consequences when these modifications do not "work." The results also challenge inferred causal relationships between nonsuicidal self-injury history and appearance modification: Although participants reported sensory similarities between the behaviors, appearance modifications carried specific positive connotations and consequences that nonsuicidal self-injury did not. This study reveals a complex and nuanced picture of appearance modification in BPD, with particular implications for identity affirmation and mood induction. The results identify common themes across highly variable and personal narratives, opening a window into BPD lived experience. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Subjective emptiness is a state characterized by persistent feelings of unfulfillment and disconnection from the external world. Traditionally associated with borderline personality disorder, subjective emptiness is increasingly recognized as a transdiagnostic construct linked to adverse clinical outcomes and substantial psychosocial impairment. Despite its relevance, specific instruments for assessing this construct remain scarce. To address this gap, Price et al. (2022) developed the Subjective Emptiness Scale (SES), a five-item self-report measure designed to capture the core features of emptiness. Study 1 examined the psychometric properties of the Italian version of the SES in a nonclinical sample of 1,204 participants (71.3% female; Mage = 30.79, SD = 11.31). Study 2 aimed to replicate these findings in a clinical sample of 177 individuals diagnosed with personality disorders (56% female; Mage = 33.22, SD = 11.71). Results from both studies indicated that the Italian version of the SES demonstrated a stable unidimensional structure, full measurement invariance across sex, and good internal consistency across general and clinical populations. SES scores also exhibited the expected pattern of correlations with conceptually related constructs. However, its incremental validity beyond depressive symptoms appeared questionable, suggesting a substantial overlap between subjective emptiness and depression-related experiences. Accurate assessment of subjective emptiness may contribute to a more refined understanding of its role as a central psychological mechanism in personality pathology and inform the development of targeted interventions, ultimately improving treatment outcomes. Future research should clarify the conceptual and empirical boundaries between emptiness and depression to improve measurement precision. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Structured clinical interviews are the gold standard for identifying borderline personality disorder (BPD) in research. No self-report instrument has been validated as a replacement tool for BPD diagnosis. However, clinical interviews can be time and cost-intensive, limiting their utility as appropriate screening tools. Also, data are lacking regarding the level of training and education interviewers need to use BPD screening instruments effectively. The goal of this project was to clarify best practices for brief screening interviews to identify potential research participants with BPD. We analyzed data from research participants (N = 366) who completed both a brief phone screen and clinical interview assessments of BPD symptom experience. A subset (n = 120) also completed BPD-focused self-report questionnaires. Agreement between the full-length interview and the brief phone screen assessment was moderate (Cohen's κ = .63), and phone screens were more sensitive than specific (sensitivity = .92, specificity = .73). Fitting a logistic regression model to observations did not increase specificity without lowering sensitivity. Using a decision tree to shorten the phone screen process did not increase misclassifications, remained ∼18%; χ²(1) = 0.13, p = .72. Self-report instruments were not highly correlated with clinical interview scores and were more specific than sensitive, suggesting they are poor screening tools (r values .1-.28). Finally, screener education level did not predict agreement between assessments. Our findings suggest that full-length clinical interview assessments remain necessary for accurate identification of BPD in research contexts. However, phone screens, even if shortened and conducted by nonclinically trained personnel, can serve as a reliable first step in the screening process. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Inner emptiness is a transdiagnostic experience linked to self-injurious and suicidal behaviors, yet its underlying structure and psychosocial correlates remain poorly understood, particularly in nonclinical young adults. This mixed-methods study examined the structure of emptiness and its associations with identity and personality functioning, health risk behaviors, and coping strategies in community young adults, a developmental period marked by identity and personality consolidation, and increased vulnerability to maladaptive behaviors. A total of 737 young adults (Mage = 21.70; 66.6% female) completed online self-report measures and wrote personal narratives about their experience of emptiness. Exploratory and confirmatory factor analyses were conducted on the Subjective Emptiness Scale and the Multidimensional Sense of Emptiness Scale. Quantitative analyses assessed associations with psychosocial factors, and narrative data were thematically analyzed for subjective experiences of emptiness and coping strategies in response to emptiness. Factor analyses revealed a three-factor structure: Feelings of Inner Emptiness, Absence of Relatedness, and Meaninglessness. Narrative analysis supported this structure. Experiences of emptiness were often described in physical terms and varied in frequency, chronicity, and triggers. Feelings of Inner Emptiness were strongly associated with identity disturbances, personality dysfunction, and greater engagement in self-harm and disordered eating. Furthermore, emptiness was linked to greater use of externalizing and distancing coping strategies, alongside adaptive strategies such as seeking support. These findings offer a more nuanced understanding of emptiness beyond clinical populations and highlight its connections to self- and interpersonal dysfunction, engagement in internalizing health risk behaviors, and avoidance-focused coping strategies. Longitudinal research is needed to investigate temporal pathways. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
The alternative model of personality disorders has gained widespread recognition, yet the degree of conceptual and empirical overlap among personality functioning, maladaptive traits, and normal-range personality traits-and its implications for clinical assessment-remains debated. Recent studies have begun to examine these associations in a more systematic manner; however, longitudinal evidence is still limited, and the generalizability of existing findings remains insufficiently tested. In this preregistered study, we conducted a conceptual replication of 11 preregistered hypotheses originally examined in a recent longitudinal study of Chinese offenders. Using a Norwegian community sample, we investigated associations and distinctions among personality functioning, normal-range traits, and maladaptive traits across 4 waves of data collected over 6 months (N = 1,418). Overall, we largely replicated the pattern of findings reported in the original study. Results revealed systematic differences in the distributions and longitudinal properties of personality functioning and personality traits. Across time, maladaptive traits were jointly predicted by impairments in personality functioning and normal-range personality traits, indicating both shared and unique contributions. Taken together, these findings provide further longitudinal support for both similarities and distinctions between personality functioning and trait dimensions within the alternative model of personality disorders framework. By extending prior work to a different population and methodological context, this replication study strengthens the evidence for the robustness and generalizability of existing conclusions. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
This work investigates fantasy in daily life, in relation to momentary mood and personality pathology. First, a pilot study gathers and pretests a set of items to assess and differentiate grandiose fantasy (GF) and schizoid fantasy: A two-factor structure emerges, despite the strong correlation between the factors. Then, the main preregistered study uses ecological momentary assessment in a community sample (N = 150; 3,396 observations) to investigate the correlates of momentary fantasy. Narcissistic traits are uniquely associated with GF but not with schizoid fantasy. The opposite is true for schizoid traits, in line with our hypotheses. Also, momentary negative mood is associated with both fantasies. Exploratory analyses suggest that (a) this pattern of associations holds when controlling for personality dysfunction; (b) narcissistic traits of agentic extraversion and antagonism are responsible for the association of narcissism with GF; (c) there is no evidence that associations between momentary mood and fantasies are moderated by personality traits; and (d) there is no cross-lagged association between mood and fantasy. The study indicates that fantasy may not be a unitary construct, and that both stable individual differences and momentary mood are associated with its deployment. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
The three-step theory of suicide (3ST) states that pain and hopelessness cause suicidal desire and that the extent to which pain exceeds connectedness determines the strength of suicidal desire. The ability of these premises to account for elevated suicidal desire in those with borderline personality disorder (BPD) traits was examined in 852 undergraduates oversampled for suicide risk (456 had histories of suicide ideation or attempts). Validated self-report questionnaires assessed BPD traits, current suicidal desire, psychological pain, hopelessness, and connectedness. Consistent with Step 1 of the 3ST, variance explained in suicidal desire by BPD traits was reduced from 16% to only 1% when controlling for pain and hopelessness. Consistent with Step 2, among those with suicidal desire, variance explained in the magnitude of that suicidal desire by BPD reduced from 6% to 0% when controlling for a pain-connectedness difference score. In a simpler model, controlling for pain, hopelessness, and connectedness reduced variance explained in suicidal desire by BPD from 16% to 0%. These findings suggest that the 3ST provides a useful lens to understand elevated suicidal desire in individuals with BPD and can inform suicide treatment and prevention strategies. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
The alternative model for personality disorders include two-dimensional criteria: self and interpersonal dysfunction (Criterion A) and maladaptive personality traits (Criterion B). Criterion A is appraised using the Levels of Personality Functioning Scale (LPFS). Personality disorder-specific impairments are also described. This scoping review and meta-analysis evaluates the criterion validity of self-report and observer-rated LPFS measures, and two antisocial personality disorder (ASPD)-specific measures, in assessing Criterion A for ASPD, psychopathy, antisocial behavior, and aggression. Six databases (CINAHL, EMBASE, EMCare, MEDLINE, PsycINFO, and PubMed) were searched for studies assessing Criterion A and ASPD, aggression, antisocial behavior, and/or psychopathy. Thirty-two studies were identified. Meta-analysis revealed strong pooled associations between self-report and clinician-rated LPFS measures and Section II ASPD. Effects with psychopathy for self-report LPFS measures were moderate and weak for clinician-rated LPFS. Weak to moderate pooled effects for LPFS with aggression and antisocial behavior were found. ASPD-specific impairments showed moderate associations with Section II ASPD and large associations for psychopathy. Overall, general and ASPD-specific measures demonstrated variable criterion validity with Section II ASPD and associated antisocial constructs. Caution is warranted when assessing Criterion A impairment for antisociality using a single measure in isolation. A clinician-led, multimethod approach that integrates general LPFS-based assessment with instruments specifically designed to capture antisocial features is likely to (a) enhance diagnostic accuracy and (b) improve the clinical utility of Criterion A assessment in informing violence risk formulation and management. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Fewer men than women with borderline personality disorder (BPD) may be found in clinical and research settings, and so the majority of dialectical behavior therapy (DBT) treatment studies have focused on women. Because of this, DBT has not been sufficiently studied for treating BPD in men. The aim of this study was to examine the influence of gender on symptom trajectory differences and on the frequency and reasons for premature termination of treatment during a 3-month certified inpatient DBT program. The treatment-seeking sample included n = 1,991 women and n = 295 men with BPD who received treatment in a psychosomatic care hospital. Self-rated BPD symptoms were the primary outcome. There was no substantial moderating effect of sex on symptom trajectories from pre- to posttreatment. The effect sizes for borderline symptoms were g = .16 for men and g = .37 for women, respectively. According to the reliable change index, 26.1% of men and 17.9% of women experienced a deterioration in borderline symptoms; conversely, 42.1% of the women reliably improved compared with 35.9% of the men. No differences were observed in either the frequency of premature treatment discontinuation or the reasons for it. Due to symptom deterioration or the absence of improvement, a larger subgroup of men seemed to benefit less from therapy compared with women. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Clinical theory has long characterized personality disorders (PDs) as difficult to treat, reflecting limited insight into impairment, and harmonious with the self-concept. However, recent evidence suggests that PD traits can diminish over time and that individuals higher in PD traits report greater impairment and motivation to change. We proposed the proportionality hypothesis to reconcile these seemingly contradictory perspectives on PDs. This hypothesis suggests that people elevated in PD traits do acknowledge impairment and express motivation to change, but their motivation is reduced relative to the extent of their acknowledged impairment. In Study 1, participants reported their PD traits, current life impairment, and change motivation. As expected, PD traits were associated with greater impairment and change motivation. However, consistent with the proportionality hypothesis, the positive association between impairment and change motivation was weakened with increments in psychoticism and antagonism, and this attenuation was also apparent for the global PD-trait composite. Study 2 included Study 1's domain-general indicators of impairment and change motivation along with trait-specific indicators of these two constructs. Largely consistent with Study 1, the positive association between domain-general impairment and change motivation was weakened with increments in all PD traits except detachment as well as the global composite; however, proportionality effects failed to clearly extend to the trait-specific measures. We speculate about potential mechanisms underlying these patterns and highlight potential clinical implications and directions for future research. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
To address the need for a more dynamic assessment of the progress and severity of borderline personality disorder (BPD), as well as associated treatment needs, various models of clinical staging and risk profiling have been proposed. Clinical staging involves estimating disorder severity along a continuum, whereas risk profiling predicts progression across stages using known risk factors. This study examines these models' reliability and clinical utility in predicting dosage (total registered units of direct patient contacts) and outcome for BPD patients. We used anonymized information from patient records of 128 patients treated for (subthreshold) BPD in the Netherlands (M age = 30.51, SD = 11.85; range: 14-61 years). After establishing interrater reliability, a retrospective analysis of routine clinical data was used to examine the relationship between two clinical staging models and one risk profile model on total treatment dosage and outcome. The results showed that staging models and risk profiles could be reliably assessed and that patients in earlier stages required less treatment and achieved better outcomes compared with later stages. However, the contribution of risk profiling was minimal and insignificant. Furthermore, results suggest that the transition from Stage 1 to Stage 2 represents a critical turning point in BPD progression and underscores the importance of early intervention. Despite limitations, clinical staging models explained significant variance in treatment dosage and symptom reduction, offering valuable insights into BPD treatment needs. The study highlights the potential of these models to support early detection and intervention by improving prognosis and guiding more personalized treatment. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Suicide is a leading cause of death among emerging adults in the United States. Despite decades of research attempting to target risk factors, our ability to predict suicide remains insufficient. The objective of our examination was to investigate the utility of Criterion A of the Alternative Model for Personality Disorders in predicting suicide outcomes by identifying the level-specific contribution of levels of personality functioning (LPF) to suicidal thoughts and behaviors. To address our research questions, we employed generalized additive modeling in subsamples of 145 young adults endorsing suicidal ideation, and 158 young adults endorsing at least one lifetime suicide attempt who were recruited from college and clinical settings. Clinical participants endorsed past or current, confirmed or subthreshold borderline personality disorder. Results indicated a nonlinear trend in suicidal ideation with the sharpest increase at Level 2 of the LPF scale, operationalized via the Semistructured Interview for Personality Functioning. In addition, the increase in lifetime attempt history was nonuniform, with the greatest increase in odds ratio ratios occurring between Level 1 and Level 2. Findings support Level 2 of LPF as a potential inflection point for suicide risk detection and further challenge the notion of linear relationships between personality pathology severity and suicide risk. Implications of these findings are discussed. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
The Diagnostic and Statistical Manual of Mental Disorders' (5th ed.; DSM-5) official self-report instrument to assess personality disorders is the Personality Inventory for DSM-5 (PID-5). To screen for response bias, three validity scales have been constructed from the PID-5 item pool to assess, respectively, inconsistency, overreporting, and underreporting. Nonetheless, the prevalence and impact of PID-5 response bias on diverse psychometric properties are largely underdocumented. Thus, this study aims at: (a) identifying the rates of positive screening of each validity scale, (b) identifying the degree of overlap between validity scales, and (c) documenting the impact of each bias on scale scores, criterion validity (correlations with self- and informant-assessed personality pathology), and internal consistency. Preregistered analyses were conducted among a large population-representative sample (n = 2,505, 51.2% females) and an at-risk sample of young adults (n = 321, 48.3% females). For each sample, respectively, plausible estimates were obtained for inconsistency (4.7% and 7.2%) and overreporting (2.9% and 5.6%), whereas the underreporting scale likely led to an overestimation of the prevalence (38.6% and 32.4%). Screening positive on two PID-5 validity scales was rare (<2% of cases). Each bias had distinctive impacts on scores, correlates, and reliability. Screening for multiple biases is paramount to replicating research findings and ensuring sound clinical conclusions. Recalibrating or developing a new PID-5 validity scale to detect underreporting among populations with low to medium levels of psychopathology, as well as a scale for acquiescent/counteracquiescent bias, would be warranted. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
The Alternative Model of Personality Disorders suggests that borderline personality disorder (BPD) is characterized by disturbed personality functioning (self- and other), along with elevated levels of negative affectivity, antagonism, and disinhibition. This study explored the extent to which BPD Compass, a cognitive-behavioral intervention targeting maladaptive personality variants most associated with BPD, addresses the components of Alternative Model of Personality Disorders-defined BPD. In addition, we explored whether improvements in personality functioning were associated with improvements in BPD symptoms. Our intent-to-treat sample included 100 adults (N = 93 who started treatment and had data available for analyses) who met criteria for BPD and were, on average, 28.13 (SD = 8.80) years old, White (n = 88; 88.9%), identified as female (n = 73; 73.7%), and identified as sexual minorities (n = 64; 64.6%). We employed a series of hierarchical linear models to evaluate changes across personality domains and facets during 18 sessions of BPD Compass delivered via telehealth. We also tested whether changes in personality functioning were associated with changes in BPD symptoms using multilevel structural equation modeling. Results suggest significant improvements in negative affectivity, antagonism, disinhibition, and personality functioning during treatment, with medium-to-large effect sizes observed for multiple facets. BPD Compass also was associated with significant improvements in BPD symptoms, and changes in symptoms were significantly correlated with changes in each higher order personality trait. This pattern of results provides support for the feasibility of targeting dimensional traits and indicates that targeting higher order personality traits may streamline care and improve outcomes for BPD patients. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
