Download Using the Five-Factor Model to Represent the DSM-IV

Copyright 2001 by the American Psychological Association, Inc.
0021-843X/01/S5.00 DOI: 10.1037//0021-843X. 110.3.401
Journal of Abnormal Psychology
2001, Vol. 110, No. 3,401-412
Using the Five-Factor Model to Represent the DSM-IV Personality
Disorders: An Expert Consensus Approach
Donald R. Lynam and Thomas A. Widiger
University of Kentucky
This study sought to extend previous work on the five-factor dimensional model (FFM) of personality
disorder (PD) by developing more comprehensive FFM descriptions of prototypic cases. Specifically, the
authors asked experts in each of the 10 DSM-IV PDs to rate the prototypic case by using all 30 facets
of the FFM. Aggregating across raters of the given disorder generated a prototype for each disorder. In
general, there was good agreement among experts and with previous theoretical and empirical FFM
translations of DSM diagnostic criteria. Furthermore, the ability of the FFM explanation to reproduce the
high comorbidity rates among PDs was demonstrated. The authors concluded that, with the possible
exception of schizotypal PD, the DSM PDs can be understood from the dimensional perspective of the
FFM. Future directions for research, including the use of the present prototypes to "diagnose" personality
disorder, are discussed.
personality disorder categories can be seen as configurations of
basic dimensions of personality.
The five-factor model (FFM) of personality was derived originally from studies of the English language to identify the domains
of personality functioning most important in describing the personality traits of oneself and other persons (Digman, 1990; John &
Srivastava, 1999; Wiggins & Pincus, 1992). This lexical research
has emphasized five broad domains of personality, identified as
extraversion (surgency or positive affectivity), agreeableness (vs.
antagonism), conscientiousness (or constraint), neuroticism (negative affectivity), and openness to experience (intellect or unconventionality; John & Srivastava, 1999). Each of these five domains
can be further differentiated into underlying facets or components.
Costa and McCrae (1995) proposed six facets within each domain
on the basis of their research with the NEO Personality Inventory—Revised (NEO-PI-R; Costa & McCrae, 1992). For example,
they suggested that the domain of agreeableness can be usefully
differentiated into more specific facets of trust (vs. mistrust or
skepticism), straightforwardness (vs. deception or manipulation),
altruism (vs. egocentrism or exploitation), compliance (vs. oppositionalism or aggression), modesty (vs. arrogance), and tendermindedness (vs. toughmindedness or callousness).
Empirical support for the construct validity of the FFM is
extensive, at both the domain and the facet levels, including
convergent and discriminant validation across self, peer, and
spouse ratings (Costa & McCrae, 1988); temporal stability across
7-10 years (Costa & McCrae, 1994); cross-cultural replication (De
Raad, Perugini, Hrebickova, & Szarota, 1998); and heritability
(Jang, McCrae, Angleitner, Reimann, & Livesley, 1998; Plomin &
Caspi, 1999). The FFM has been used as an integrative model of
personality functioning for children (Halverson, Kohnstamm, &
Martin, 1994), adults (McCrae & Costa, 1990), the elderly (Costa
& McCrae, 1994), and even animal species (Gosling & John,
1999). Instructive and informative critiques of the FFM have been
provided (e.g., Block, 1995; Westen, 1995), but there does appear
to be sufficient empirical support for the "basicness" of the FFM
The American Psychiatric Association's Diagnostic and Statistical Manual'of Mental Disorders, fourth edition (DSM-IV; American Psychiatric Association, 1994), provides personality disorder
diagnostic categories. There is good evidence that these diagnoses
identify clinically meaningful maladaptive personality traits; several diagnoses seem especially well-validated, including antisocial
(see Stoff, Breiling, & Maser, 1997), borderline (see Clarkin,
Marziali, & Munroe-Blum, 1992), schizotypal (Raine, Lencz, &
Mednick, 1995), narcissistic (Ronningstam, 1998) and dependent
(see Bornstein, 1992) personality disorders. These disorders have
long clinical traditions, are related to cognitive and perceptual
abnormalities, influence the life outcomes of individuals, have
implications for psychological treatment, and show some genetic
component (Clarkin & Lenzenweger, 1996; Livesley, 2001).
Nonetheless, the DSM-IV personality disorders have been criticized for the fundamental assumption that "Personality Disorders
represent qualitatively distinct clinical syndromes" (American
Psychiatric Association, 1994, p. 633). A variety of studies and
methodologies have raised compelling concerns regarding the validity of the categorical model (Clark, Livesley, & Morey, 1997;
Livesley, 1998; Widiger, 1993) and have proposed alternative
dimensional models for the personality disorders, including (but
not limited to) the 15-factor model of Clark (1993), the interpersonal circumplex (Benjamin, 1993), the 7-factor model of Cloninger (Cloninger, Svrakic, Bay on, & Przybeck, 1999), the 18factor model of Livesley (1998), and the 5-factor model (Widiger
& Costa, 1994). From these dimensional perspectives, the DSM
Donald R. Lynam and Thomas A. Widiger, Department of Psychology,
University of Kentucky.
This research was supported in part by National Institute of Mental
Health Grant MH60104.
Correspondence concerning this article should be addressed to Donald
R. Lynam, University of Kentucky, Department of Psychology, 115 Kastle
Hall, Lexington, Kentucky 40506-0044. Electronic mail may be sent to
[email protected].
401
402
LYNAM AND WIDIGER
to consider it for use as a possible dimensional model of personality disorder symptomatology (Widiger & Costa, 1994).
From the perspective of the FFM, personality disorders represent configurations of basic dimensions of personality. Much research is consistent with this possibility. The dimensions of the
FFM are related to personality disorder symptomatology. Widiger
and Costa (in press) have identified over 50 published studies that
have shown relations between the FFM and personality disorder
symptoms. Most of the studies have examined the relations between scores on FFM inventories and scores on measures of
personality disorder symptoms. Almost all of the authors have
concluded that their findings provided support for understanding
personality disorder symptomatology from the perspective of the
FFM.
Many of these FFM studies addressed specific hypotheses put
forth by Widiger, Trull, Clarkin, Sanderson, and Costa (1994),
who provided five-factor translations of the DSM-III-R personality disorders (American Psychiatric Association, 1987). Besides
serving as useful heuristics for studies concerned explicitly with
DSM-III-R personality disorders, these translations suggest that
the FFM possesses the language necessary for the description of
the personality disorders and illustrate the beginnings of an important alternative approach to understanding the personality disorders in terms of the FFM. To the extent that the FFM can be used
as a starting point in reproducing the PDs and the nomological nets
that surround them, support is generated for the FFM account.
In the present study, we seek to extend this previous work by
using an alternative approach to the development of FFM personality disorder profiles, the use of expert consensus. This study
examines the degree to which experts agree in their FFM descriptions of the personality disorders. In addition, we investigate how
well the expert consensus approach agrees with theoretical and
empirical approaches to profile development. Finally, this study
examines how well the overlap among FFM prototypes can reproduce the high and differential comorbidity rates among the DSM
personality disorders—an epidemiological fact that a theory of
personality disorders should be able to explain but a fact with
which the categorical model has had much difficulty (Clark et al.,
1997; Lilienfeld, Waldman, & Israel, 1994; Livesley, 1998; Widiger, 1993).
The expert consensus approach to be used in the present article
was used previously by Miller, Lynam, Widiger, and Leukefeld
(2001) and Lynam (in press) in their attempts to understand
psychopathy from the perspective of the FFM. Miller et al. (2001)
developed an FFM profile of psychopathy by compiling the descriptions obtained from 15 nationally recognized psychopathy
researchers of a prototypic case of psychopathy with respect to
each of the 30 Costa and McCrae (1995) facets of the FFM. This
expert consensus FFM profile was then compared with Widiger
and Lynam's (1998) FFM translation of the 20 items within Hare's
(1991) Revised Psychology Checklist (PCL-R) in an attempt to
provide convergent validity for the FFM conceptualization of
psychopathy. The correlation between the expert consensus profile
and the PCL-R FFM profile provided by Widiger and Lynam was
.64, indicating good convergence but also suggesting some notable
disagreements reflecting a lack of coverage of the PCL-R.
In a comparison between the expert consensus prototype approach and the criteria translation approach, the consensus approach seems to enjoy some advantages. First, in the case of Miller
et al. (2001), the expert consensus FFM profile was constructed by
persons with varying degrees of familiarity with the FFM rather
than by investigators with initial expectations of the profile that
should be obtained. Thus, results should be more compelling when
obtained from personality disorder researchers than from the FFM
investigators themselves. Second, aggregation across multiple experts blunts idiosyncratic interpretations or judgments concerning
the criterion and brings out in stark contrast the points of agreement. In these respects, the consensus approach of Miller et al.
could be said to provide a more empirical, objective, and independent FFM profile. Third, the expert consensus methodology allows
for the possibility of obtaining elevations on facets of the FFM not
included explicitly within a particular criteria set. In the case of
psychopathy, although the PCL-R is the most widely used and
compelling measure of psychopathy, concerns have been raised
with respect to the adequacy of its coverage and conceptualization
of psychopathy (Lilienfeld, 1994; Lykken, 1995). Fourth, the
consensus methodology allows for an evaluation of the internal
consistency and interrater reliability of the FFM descriptions. If the
FFM is to serve as a model of personality disorder symptomology,
experts should agree in their FFM parsings of the symptoms. For
example, Miller et al. obtained good agreement among the psychopathy researchers with respect to their FFM ratings. More than
half of the 30 facets obtained standard deviations of less than .70,
and only 17% had a standard deviation greater than 1.0; interrater
reliability ranged from .61 to .84, with a mean of .75. Fifth and
finally, the expert consensus approach provides a quantitative
profile against which individuals' FFM profiles can be matched to
determine the degree of similarity; individuals who are more
similar to the prototype possess the disorder to a greater degree.
Using data from a longitudinal community sample of 481 adults,
Miller et al. found that individuals who more closely approximated
the psychopathic profile had higher scores on a psychopathy
inventory; more symptoms of antisocial personality disorder, substance abuse, and substance dependence; more frequent and varied
antisocial activities; and fewer internalizing symptoms. All of
these relations replicate those in previous studies using incarcerated, PCL-R defined psychopaths.
Because of the advantages to this consensus approach, a purpose
of the current study is to generate expert consensus FFM profiles
for each of the DSM-FV (American Psychiatric Association, 1994)
personality disorders. Internal consistency and interrater reliability
are examined along with a comparison to the profiles generated
theoretically by Widiger et al. (1994) and empirically by Dyce and
O'Connor (1998) to assess convergent validity, points of disagreement, and divergent coverage. In addition, the current study further
explores the validity of the expert consensus FFM profiles by
determining the extent to which the overlap among the profiles
mirrors the covariation or co-occurrence among the personality
disorder diagnostic categories.
Comorbidity of personality disorder diagnoses is the norm
rather than the exception, despite the hope or aspiration of
DSM-IV that only one personality disorder diagnosis would be
applicable for any particular patient (Gunderson, 1992; Gunderson, Links, & Reich, 1991). Several studies have demonstrated that
most patients who meet diagnostic criteria for one personality
disorder will meet the criteria for a number of other personality
disorder diagnoses (e.g., Skodol, Rosnick, Kellman, Oldham, &
Hyler, 1991; Widiger & Trull, 1998). As noted by Mineka,
403
FFM PD PROTOTYPES
Watson, and Clark (1998), "the greatest challenge that the extensive comorbidity data pose to the current nosological system
concerns the validity of the diagnostic categories themselves—do
these disorders constitute distinct clinical entities?" (p. 380).
Although high comorbidity presents a fundamental challenge to
the validity of the categorical approach, it is easily accommodated
within a dimensional model that views the categories as configurations of basic dimensions of personality (Clark et al., 1997;
Livesley, 1998; Widiger, 1993). From this view, the apparent
comorbidity among the personality disorders is understood as the
co-occurrence of diagnoses that have overlapping constellations of
maladaptive personality traits (Lilienfeld et al., 1994). Much of the
co-occurrence among the DSM personality disorders might be
explained by the domains and facets of the FFM; from the FFM
perspective, disorders are expected to co-occur to the extent that
they assess common FFM domains and facets. For example, the
co-occurrence of the avoidant and schizoid personality disorders
may reflect the involvement of introversion in both disorders
(Widiger et al., 1994). Borderline personality disorder is the most
commonly diagnosed and co-occurring personality disorder, consistent with its FFM conceptualization as being the personality
disorder defined primarily by the facets of neuroticism (Clarkin,
Hull, Cantor, & Sanderson, 1993; Widiger et al., 1994).
Only one prior FFM personality disorder study has addressed
personality disorder covariation (O'Connor & Dyce, 1998). Although the results of this study provided support for the FFM
conceptualization of personality disorders, it was limited by not
addressing comorbidity hypotheses with respect to individual personality disorders and by confining the analyses to the five broad
domains of the FFM. Some differentiation among the personality
disorders can occur with respect to the five domains, but more
precise differentiation might be obtained at the level of the 30
facets (Axelrod, Widiger, Trull, & Corbitt, 1997; Dyce &
O'Connor, 1998; Trull, Widiger, & Burr, 2001). The current study
extends the findings of O'Connor and Dyce (1998) by determining
the extent to which the diagnostic co-occurrence or covariation
among personality disorders identified in prior studies can be
recreated within the expert consensus FFM profiles. To the extent
that this can happen, support is generated for the FFM account.
Method
Experts were identified through electronic searches of the psychological
and psychiatric literature by using the personality disorders as search terms.
To be included in the present research, an individual had to have published
at least one article on the specific personality disorder (although most
participants had published more than two articles). Between 25 and 30
experts were identified for most disorders. Address information was collected from the articles or through a search of the World Wide Web. A total
of 197 experts were identified; the number of experts per disorder ranged
from a low of 23 for schizotypal personality disorder to a high of 29 for
histrionic and dependent personality disorders. Of these 197 experts, 20
were asked to rate three different personality disorders, 33 were asked to
rate two different personality disorders, and 144 were asked to rate only
one personality disorder.
Experts were asked to rate prototypic cases of the various personality
disorders with respect to the 30 facets of the FFM as described by the
NEO-PI-R (Costa & McCrae, 1992). The identifying label"for each of
the 30 facets was provided, along with two to four adjectives that described
both poles of each of the facets. Adjectives were taken from the NEO-PI-R
test manual and FFM adjective checklists (Costa & McCrae, 1992; Gold-
berg, 1992; Saucier, 1994). For example, anxiousness was assessed with
the following descriptors: fearful, apprehensive versus relaxed, unconcerned, cool. Order was assessed by using these descriptors: organized,
methodical, ordered versus haphazard, disorganized, sloppy. For each of
the 30 traits, experts were asked to rate the prototypic case of a specified
personality disorder on a l-to-5 scale. Specifically, he or she was asked the
following:
In particular, we would like you to describe the prototypic case for
[one, each of the two, or each of the three] personality disorders on a 1
to 5 point scale, where 1 indicates that the prototypic person would be
extremely low on the trait (i.e., extremely lower than the average
person), 2 indicates that the prototypic person would be low, 3
indicates that the person would be neither low nor high (i.e., does not
differ from the average individual), 4 indicates that the prototypic
person would be high on that trait, and 5 indicates that the prototypic
person would be extremely high on that trait. For example, for the
vulnerability trait dimension, a score of 1 would indicate that the
prototypic case for that respective personality disorder would be
extremely low in vulnerability (i.e., stalwart, brave, fearless, unflappable), whereas a score of 5 would indicate that the prototypic person
with that respective personality disorder would be extremely high in
vulnerability (i.e., fragile, helpless). Please rate the prototypic case for
the respective personality disorder on each of the 30 trait dimensions.
Experts were provided with one rating form for each disorder, a demographic questionnaire, and a return, postage-paid envelope with no means
for the researchers to identify the respondent. Experts were told that the
ratings they provided would be consolidated with ratings obtained from
other selected experts, and they were assured that their individual ratings
would be kept confidential and not be reported.
We received 170 completed ratings from 120 experts. The average
completion rate of 63% compares well with similar previous studies; Miller
et al. (2001) obtained a completion rate of 69% in their FFM study of
psychopathy, and Lynam (in press) obtained a completion rate of 57% in
his study of fledgling psychopathy. The per-disorder completion rate
ranged from a low of 38% for paranoid PD to over 85% for antisocial and
borderline PD. A total of 93% of the 120 individuals completed the
demographic questionnaire. Of these, 77% were male, 81% were Caucasian, and the median age was 47 years. Fully 96% had doctorate or medical
degrees, 56% worked in an academic setting, and 22% worked in medical
centers. Finally, on a scale ranging from 1 (not at all familiar) to 4 (very
familiar), 98% of the experts said they were at least moderately familiar
(3), and 77% indicated they were very familiar with the DSM-fV personality disorders.
Results
Personality Disorder Prototype Descriptions
Table 1 provides the means and standard deviations for each of
the 30 facets of the FFM for each of the 10 personality disorders
included within the DSM-IV. As in Miller et al. (2001), taking any
facet with a mean score of 2 and lower (low) or 4 and higher (high)
as characteristic, it is possible to describe each of the personality
disorders with the language of the FFM. For example, antisocial
personality disorder was represented by low scores on all 6 facets
of agreeableness, 3 of 6 facets of conscientiousness (dutifulness,
self-discipline, and deliberation), and 2 facets of neuroticism (anxiousness and self-consciousness); it was also represented by high
scores on 3 of the 6 facets of extraversion (assertiveness, activity,
and excitement seeking) and 2 facets of neuroticism (angry hostility and impulsiveness).
404
LYNAM AND WIDIGER
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405
Table 2
Measures of Agreement Among Experts for the 10 Personality Disorders
Disorder
Paranoid
Schizoid
Schizotypal
Antisocial
Borderline
Histrionic
Narcissistic
Avoidant
Dependent
Compulsive
No. of
raters
Average
rWSa
Average
SDb
Average
interrater rc
Average corrected
item-total t*
a for
composite6
r with
Widiger et al.f
r with Dyce &
O'Connor8
10
13
0.65
0.75
0.63
0.66
0.70
0.63
0.65
0.67
0.70
0.71
0.82
0.67
0.83
0.80
0.76
0.85
0.79
0.78
0.75
0.75
0.51
0.53
0.48
0.65
0.53
0.56
0.63
0.63
0.56
0.66
0.68
0.71
0.66
0.75
0.68
0.74
0.78
0.78
0.73
0.80
0.91
0.93
0.91
0.97
0.96
0.96
0.95
0.97
0.96
0.97
0.79
0.55
0.79
0.77
0.72
0.58
0.54
0.83
0.78
0.58
0.72
0.64
0.74
0.78
0.78
0.54
0.75
0.72
0.61
0.83
12
22
24
19
12
21
19
17
" rwg = the proportional reduction in error variance relative to a discrete uniform distribution. b Average SD = the arithmetic mean of the standard
deviations. c Average interrater r = the average of the correlations between experts' ratings in which experts are treated as variables and facets as
cases. d Average corrected item-total r = the average of the correlations between each rater's profile and the composite profile computed without that
rating. e a for composite = coefficient alpha for the composite prototype in which experts are treated as variables and facets as cases; it does depend,
in part, on the number of raters. f This is the correlation with the prototypes taken from Widiger et al. (1994). These prototypes were created by assigning
a score, ranging from 4 (high) to —4 (low) for each facet according to the following: a 4 or —4 for facets that are high or low according to DSM-HI-R
criteria; a 3 or - 3 for facets that are high or low on the basis of clinical literature; a 2 or - 2 for facets that are high or low on the basis of associated features
in the DSM-IH-R; a 1 or -1 for facets that are somewhat high or low on the basis of the clinical literature; and a 0 for facets that are neither high nor
low. g This is the correlation of the consensus prototype with the correlations between the five-factor model of personality and the measures of personality
disorder obtained by Dyce and O'Connor (1998) in a sample of undergraduates.
Agreement Among Experts
Table 2 presents several measures of agreement among our
experts. The second column provides information on the average
within-group agreement, rwg, for the FFM facets for each personality disorder. This coefficient has been offered as a means of
"assessing agreement among the judgements made by a single
group of judges on a single variable in regard to a single target"
(James, Demaree, & Wolf, 1984, as cited in James, Demaree, &
Wolf, 1993) and represents the proportional reduction in error
variance relative to a random process. On average, agreement at
the facet level appeared fairly high; in all cases, the expert ratings
achieved at least a 60% reduction in error. The third column of
Table 2 provides information on agreement at the facet level
through examination of the standard deviations of expert ratings.
In general, the average standard deviations were good: all were
below 0.90. For most disorders, fewer than 20% of the facets
achieved standard deviations greater than one; this compares favorably to the 17% of facets with standard deviations greater than
one in the Miller et al. (2001) study.1 According to these criteria
(i.e., high rwg and low SD), agreement was best for schizoid,
dependent, and compulsive PDs and worst for schizotypal and
histrionic PDs.
The next three columns of Table 2 provide information about
agreement among raters across the entire profile. The fourth column provides the average interrater correlation (i.e., the average
correlation of one rater's profile with every other rater's profile)
for each personality disorder. These average interrater correlations
range from a low of .48 for schizotypal personality disorder to a
high of .66 for obsessive-compulsive personality disorder; all of
these correlations are somewhat lower than the average of .75
reported by Miller et al. (2001). The fifth column provides the
average correlation between an individual expert's rating and the
composite made without his or her rating contributing to it; as
such, it offers information on how well individual ratings agree
with the overall composite. These average, corrected item-total
correlations are all relatively high, ranging from a low of .66 for
schizotypal personality disorder to a high of .80 for obsessivecompulsive personality disorder. The sixth column provides information on the reliability of the composite through calculation of
coefficient alpha.2 These reliability estimates are all relatively
high, ranging from .91 for paranoid and schizotypal personality
disorders to .97 for antisocial, avoidant, and obsessivecompulsive personality disorders. All compare favorably to the .98
found for the psychopathy ratings. According to these three indices, agreement was best for compulsive, antisocial, and avoidant
PDs and worst for schizotypal, schizoid, and paranoid PDs.
Agreement With Hypothesized FFM-PD Relations
(Widiger et al., 1994)
The seventh column in Table 2 provides information on the
convergence between the present expert-generated prototypes and
a quantification of the hypotheses put forth by Widiger et al.
(1994). The FFM descriptions of the personality disorders by
Widiger et al. were hierarchical according to whether they concerned core features or associated features and whether they were
based on the DSM-HI-R or the clinical literature. For the purposes
of this study, hypotheses based on the diagnostic criteria were
1
The Miller et al. (2001) study on psychopathy provides a fairly good
upper-bound comparison for the present results. We believe the Miller et
al. study serves as an upper bound because of its concentration on psychopathy, which is (a) a disorder described predominantly in terms of
personality traits rather than behaviors, which serve as the bases for many
of the DSM criteria; and (b) studied by a relatively small, homogeneous
group of investigators. Both of these factors can be expected to contribute
to high agreement among raters.
2
For this analysis, raters served as variables and facets served as cases.
406
LYNAM AND WIDIGER
Table 3
Examples of Hypothetical (Widiger et al, 1994) and Empirical (Dyce & O'Connor, 1998)
FFM-PD Profiles
Widiger et al.a
Domain and facet
Neuroticism
Anxiousness
Angry hostility
Depressiveness
Self-consciousness
Impulsiveness
Vulnerability
Extraversion
Warmth
Gregariousness
Assertiveness
Activity
Excitement seeking
Positive emotions
Openness
Fantasy
Aesthetics
Feelings
Actions
Ideas
Values
Agreeableness
Trust
Straightforwardness
Altruism
Compliance
Modesty
Tendermindedness
Conscientiousness
Competence
Order
Dutifulness
Achievement striving
Self-discipline
Deliberation
Paranoid
Dyce & O'Connorb
Narcissistic
2
0
4
0
0
4
0
0
-2
4
0
Histrionic
Compulsive
-.29
-.11
-.32
-.36
.00
-.14
-.13
.01
-.30
-.15
.04
3
-.23
0
0
3
0
0
0
.48
.42
.43
.39
.36
0
4
••y
0
0
0
0
0
.12
.11
.21
.19
.12
-2
-2
0
0
0
2
-2
-3
0
0
.42
-.01
-4
0
.18
-4
0
-4
-2
-2
-.11
^
2
0
0
0
0
0
.04
-.10
.00
.06
-.13
.02
-.28
.01
-.04
-.12
-.01
-.14
-4
.16
.12
.18
.23
0
-4
-4
-.05
.19
-.23
.06
.09
.11
.21
.38
.48
.45
.43
.51
.43
2
0
0
1
0
0
-.04
.02
.17
.14
-.14
Note. FFM = five-factor model of personality; PD = measures of personality disorder.
a
Numbers in these columns represent quantification of qualitative hypotheses regarding relations between FFM
and PD put forth by Widiger et al. (1994). b The data in columns 3 and 4 are from Table 2 of "Personality
Disorders and the Five-Factor Model: A Test of Facet-Level Predictions," by J. A. Dyce and B. P. O'Connor,
1998, Journal of Personality Disorders, 12, pp. 37-38. Copyright 1998 by Guilford Press. Reprinted with
permission. Numbers in these columns represent empirical correlations between FFM and PD symptoms
reported by Dyce and O'Connor (1998).
given a rating of 4 or —4 (a high or low rating on a facet,
respectively); hypotheses based on the core features in the clinical
literature were given a 3 or —3; hypotheses based on associated
features in the DSM-III-R were given a rating of 2 or -2; and
hypotheses based on associated features in the clinical literature
were given scores of 1 or — 1. A score of 0 was assigned if Widiger
et al. provided no hypotheses for the facet in question.3 Table 3
provides examples of this quantification; the full quantification is
available on request. To obtain the degree of convergence, each
expert prototype was correlated with the respective Widiger et al.
prototype in an analysis in which facets were treated as cases.
It is evident from Table 2 that there was considerable convergence between our expert prototype ratings and the Widiger et al.
(1994) hypotheses for 6 of the 10 personality disorders: paranoid,
schizotypal, antisocial, borderline, avoidant, and dependent per-
sonality disorders. For these disorders, the convergent validity
correlations ranged from .77 (antisocial) to .83 (avoidant).4 These
convergent validity coefficients for the DSM-TV personality disorders compare favorably with the .64 correlation obtained by
Miller et al. (2001) for the FFM description of psychopathy.
3
Results change very little under alternative quantification schemes
(e.g., including only facets based on DSM criteria or associated features,
making no distinction between DSM criteria and clinical literature, or
reversing the coding of clinical core features and DSM associated features).
4
Because these correlations are used descriptively rather than inferentially to index the convergence between our profiles and the Widiger et al.
profiles, no statistical significance tests were performed.
FFM PD PROTOTYPES
Lower but still relatively large convergent relations were also
obtained for the remaining four personality disorders: schizoid,
histrionic, narcissistic, and obsessive-compulsive. For these
disorders, correlations ranged from .54 (narcissistic) to .58
(obsessive-compulsive). Comparisons of the expert and hypothetical profiles provide information on the divergences that
contributed to these relatively lower convergent validity coefficients. For example, both the schizoid PD researchers and
Widiger et al. (1994) characterized the schizoid PD as being
very low in gregariousness, positive emotionality, excitement
seeking, warmth, and openness to feelings. However, Widiger
et al. also described the schizoid PD as being low in selfconsciousness and high in hostility, whereas the schizoid expert
consensus prototype was neither high nor low in any facets of
neuroticism. In addition, the consensus prototype included low
scores for schizoid PD on the two additional facets of extraversion (i.e., assertiveness and activity) and openness to
actions.
The experts and Widiger et al. (1994) characterized the histrionic personality disorder as involving facets of extraversion, including gregariousness, excitement seeking, activity, and positive
emotionality; facets of openness to fantasy, feelings, and actions;
and low self-discipline, a facet of conscientiousness. The divergence appeared to be driven by extreme differences in the ratings
of self-consciousness (rated high by Widiger et al., 1994, but low
by the experts); the characterization by Widiger et al. (1994) of
histrionic PD as high in hostility; and by the inclusion in the expert
consensus prototype of two additional facets representing impulsivity that were not included by Widiger et al. (1994): high
impulsiveness and low deliberation.
The greatest disagreement occurred for the narcissistic personality disorder. There was agreement with respect to several facets
of antagonism, particularly low altruism, low modesty, and low
tendermindedness, as well as the neuroticism facet of angry hostility and the extraversion facet of assertiveness. Similar to the case
for histrionic PD, Widiger et al. (1994) characterized the narcissistic personality disorder as being very high in self-consciousness
and vulnerability, whereas the expert raters described the prototypic narcissist as being very low in self-consciousness and did not
believe that vulnerability was particularly defining. The expert
raters also described the narcissistic individual as being very low
in all facets of agreeableness (including trust, straightforwardness,
and compliance), two facets of extraversion (warmth and excitement seeking), and openness to feelings, but high in openness to
actions.
The expert raters and Widiger et al. (1994) also disagreed in
some respects in their descriptions of the obsessive-compulsive
PD. Both descriptions included high scores on several facets of
conscientiousness and low scores on warmth, openness to feelings, and actions. However, the prototype derived from
obsessive-compulsive PD experts also included additional facets related to the extreme control of impulses (i.e., low scores
on impulsiveness and excitement seeking, and high scores on
self-discipline), low scores on openness to ideas and values, and
high scores on anxiousness and competence. In addition, Widiger et al. (1994), but not the experts, indicated that obsessivecompulsive PD was characterized by low scores on two facets
of agreeableness (altruism and compliance) and high scores on
assertiveness.
407
Agreement With Empirical FFM-PD Relations (Dyce &
O'Connor, 1998)
The final column of Table 2 provides the convergence between
the present expert-generated prototypes and an empirically derived
profile taken from a study by Dyce and O'Connor (1998) in which
scores on the NEO-PI-R were correlated with PD symptomology
assessed with the Millon Clinical Multiaxial Inventory—III (MilIon, Millon, & Davis, 1994). In this analysis, facets were again
treated as cases and the FFM profiles were correlated with the
correlations between the NEO-PI-R facets and personality disorder symptoms taken from Dyce and O'Connor (1998); Table 3
provides examples of the empirical FFM-PD profiles taken from
Dyce and O'Connor. As can be seen in Table 2, convergence was
again quite good. Correlations were above .70 for seven of the
disorders: compulsive, antisocial, borderline, narcissistic, schizotypal, paranoid, and avoidant; agreement was not as strong for the
remaining three, especially for histrionic PD. Five of the disorders
that converged well with the Widiger et al. (1994) profiles also
converged well with the Dyce and O'Connor profiles (paranoid,
schizotypal, antisocial, borderline, and avoidant), whereas two
converged moderately for both (schizoid and histrionic).
As before, a comparison of the expert and empirical profiles
provided information on the nature of the divergences. For schizoid PD, both sources (the experts and the empirical relations)
agreed that this PD was characterized by low levels of all facets of
extraversion and two facets of openness (feelings and actions). The
sources diverged in that the empirical profile, but not the experts,
indicated that schizoid PD was also characterized as high in two
facets of neuroticism (depression and self-consciousness) and low
in trust.
Expert and empirical descriptions agreed in the characterization
of histrionic PD as high in all facets of extraversion, two facets of
openness (feelings and actions), and trust and as low in selfconsciousness and deliberation. The sources diverged in that experts, but not the empirical profile, characterized histrionic PD as
high in impulsiveness and low in self-discipline. Conversely, the
empirical profile, but not the experts, suggested that histrionic PD
is characterized by low scores on additional facets of neuroticism
(anxiety, depression, and vulnerability).
Finally, there was agreement across sources in the characterization of dependent PD as high in most facets of neuroticism (except
for angry hostility and impulsiveness) and as low in assertiveness.
The divergence appears to be due to dependent PD being characterized as high in three facets of agreeableness (trust, compliance,
and modesty) by the experts but not by the empirical profile. In
addition, the empirical profile, but not the expert raters, suggested
that dependent PD is characterized as low in competence.
Using the FFM Prototypes to Reproduce DSM
Comorbidities
To examine how well the FFM model could reproduce the
comorbidities among the personality disorders, we first correlated
the FFM prototypes with one another to generate a matrix representing the conceptual overlap among the prototypes; this was
accomplished through an analysis that treated facets as cases and
treated different PDs as variables. Results are provided in Table 4.
408
LYNAM AND WIDIGER
Table 4
Correlations Among Five-Factor Model Expert Prototypes
10
1. Paranoid
2. Schizoid
3. Schizotypal
4. Antisocial
5. Borderline
6. Histrionic
7. Narcissistic
8. Avoidant
9. Dependent
10. Compulsive
.51
.48
.08
.27
-.36
.29
.41
-.23
.53
.64
-.49
•JC
,L~J
-.69
-.32
.72
.33
.50
-.17
.34
-.20
-.15
.66
.28
.01
—
.63
.67
.80
-.67
-.74
-.52
—
.56
.39
-.03
-.18
-.49
—
.51
-.57
-.28
-.75
—
-.56
-.81
-.16
—
.69
.43
—
.12
—
Note. These correlations were obtained through an analysis that treated facets as cases and personality
disorders as variables.
Correlations ranged from —.81 between dependent PD and narcissistic PD to .80 between antisocial PD and narcissistic PD.5
Next, we assessed the congruence between this matrix and two
previously generated comorbidity matrices aggregated across multiple studies. This examination was accomplished by correlating
the comorbidity estimates for a given PD taken from one matrix
with those estimates taken from another matrix. For example, the
numbers in the first column of Table 4 representing the overlap
between the FFM paranoid profile and the other FFM profiles were
correlated with comorbidity estimates for paranoid PD taken from
one of the other comorbidity matrices to give an estimate of the
congruence across matrices. To the extent that the .matrix generated by the expert consensus prototypes mirrors the observed
comorbidities (expressed as high correlations between the estimates), evidence is generated for the FFM account. Matrices
aggregated across multiple studies were used because of the low
agreement between comorbidity estimates taken from any two
single studies (Oldham et al., 1992).6
The first aggregate matrix of comorbidities was a correlation
matrix reported previously by Widiger et al. (1991), who aggregated the covariation among the DSM-II1 personality disorder
criterion sets provided in nine previously published studies. The
second matrix came out of work by the DSM-IV Personality
Disorders Work Group, who obtained data on the criterion sets for
all of the DSM-IU-R personality disorders from six independent
research sites. The co-occurrence rates among the DSM-III-R
personality disorders were then aggregated across the data sets and
reported by Widiger and Trull (1998) in the fourth volume of the
DSM-IV Sourcebook.
For each disorder, its association with the other 9 disorders in a
given data set (FFM, aggregation of the 9 previously published
DSM-HI studies, and the DSM-IV MacArthur comorbidities) was
correlated with its degree of association with the other 9 disorders
in each of the other two data sets. This correlation provides an
index of how well the various comorbidity estimates for a given
disorder compare across the data sets; the higher the correlation,
the greater the congruence. Table 5 provides these results. The first
two columns provide the correlations between the FFM prototype
matrix and the comorbidities from the 9 previously published
DSM-III studies and the 6 data sets from the DSM-IV MacArthur
data. The third column provides the correlation between the two
aggregated DSM comorbidity matrices. The convergences between
the overlap from the FFM profiles and the DSM-III comorbidities
ranged from a low of .58 for dependent PD to a high of .95 for
narcissistic PD. Convergence was highest for antisocial and narcissistic PDs, with correlations greater than .90; five additional
correlations were greater than .70 (schizoid, schizotypal, borderline, histrionic, and avoidant). Three disorders showed weaker
convergence (paranoid, dependent, and compulsive), with correlations less than .70. Over half of these correlations equal or exceed
those obtained from a comparison of the two aggregated matrices,
which provides an important benchmark.7
The congruence between the association of FFM profiles and
the comorbidity estimates from the DSM-IV MacArthur studies
was generally less than what was observed for the DSM-III Comorbidities. These correlations ranged from a low of .09 for
paranoid PD to a high of .89 for schizotypal PD. The three highest
convergences were found for schizotypal, antisocial, and narcissistic PDs, with all correlations greater than .75. Somewhat lower
convergence was found for schizoid, histrionic, avoidant, and
compulsive PDs, with correlations ranging from .60 to .70. Finally,
frankly poor convergence was obtained for dependent and paranoid PDs. Almost half of all correlations were as high or higher
than the convergences obtained for the two aggregated matrices.
Discussion
This study sought to extend the five-factor model understanding
of personality disorders as configurations of extreme scores on
common dimensions of personality. First, it extended understand5
Note that negative correlations are expected from the FFM account,
although they are infrequently observed in empirical comorbidity estimates
and are actually impossible with co-occurrence data. We believe these
differences are due to the fact the FFM allows for individuals to score at
either pole of a trait but PD symptoms assess only one pole. For example,
individuals can be either suspicious or gullible on the trust facet of
agreeableness but only suspicious or not in the paranoid criteria.
6
For example, using data from a study of Oldham et al. (1992) that
assessed the same patieats with two different structured interviews, we
found that the correlations between the co-occurrences for a given disorder
calculated from each interview ranged from .07 to .86 with a mean of .51.
7
Again, because these correlations are used descriptively rather than
inferentially, no statistical significance tests were performed.
409
FFM PD PROTOTYPES
Table 5
Similarity Among Comorbidity of FFM Prototype and Two Other DSM Comorbidity Matrices by
Personality Disorder
FFMa and nine
DSM-HI studies6
FFM and DSM-IV
MacArthur Project0
DSM-IV MacArthur Project and
nine DSM-HI studies
Paranoid
Schizoid
Schizotypal
Antisocial
Borderline
Histrionic
Narcissistic
Avoidant
Dependent
Compulsive
.60
.75
.09
.70
.06
.72
.83
.92
.89
.87
.70
.92
.75
.84
.95
.84
.50
.58
.65
.76
.63
.33
.60
.80
.85
.89
.84
AH personality disorders
.76
.60
Personality disorder
.68
.90
.84
.78
Note. FFM = five-factor model; DSM-111 and DSM-IV = Diagnostic and Statistical Manual of Mental
Disorders (3rd & 4th eds.; American Psychiatric Association, 1987, 1994). The numbers represent correlations
between Comorbidity rates for each disorder taken from different sources.
a
"Comorbidities" for the FFM represent correlations among expert prototypes. b Comorbidities represent
correlations among personality disorders averaged across nine studies reported in Widiger et al. (1991). c Comorbidities represent co-occurrence rates among personality disorders from the DSM-IV MacArthur Project
reported in Widiger and Trull (1998).
ing by developing comprehensive FFM descriptions of the personality disorders provided by published researchers. Agreement
among the expert raters for almost all of the DSM-IV PDs was
quite good; standard deviations were low, proportional reductions
in error variance were high, and average interrater correlations,
average corrected item-total correlations, and composite coefficient alphas were all high. Agreement is especially impressive in
light of the fact that experts were rating prototypic cases from their
own diverse experiences and not the same individual case. These
results suggest that most of the DSM-IV PDs can be readily
described, and usually with a high level of agreement, in terms of
the 30 facets of the FFM. The lowest interrater and ratercomposite agreement were obtained for the schizotypal PD (.48
and .66, respectively), which has also obtained relatively weaker
support as a maladaptive variant of common personality traits in
studies correlating measures of the FFM to PD symptomatology
(e.g., Trull, 1992). Although these results may reflect shortcomings in the FFM assessment of the cognitive-perceptual domain,
they may also be due to the fact that schizotypal personality
disorder might be better understood as a variant of schizophrenia
rather than as a personality disorder (Siever & Davis, 1991; Widiger & Costa, 1994).
The expert-generated prototypes converged very well with the
FFM translations of DSM-IV symptoms provided by Widiger et al.
(1994) and with empirical relations found between the FFM and
personality disorders (Dyce & O'Connor, 1998). Although some
of this convergence may have been due to previous familiarity
with the Widiger et al. prototypes, we believe this was unlikely.
Expert raters were selected on the basis of their familiarity with the
personality disorders not with the FFM; they were instructed to
rate prototypic cases, and there were interesting divergences that
we believe were mostly due to the more comprehensive coverage
of FFM facets provided by the expert consensus ratings. For
example, obsessive-compulsive PD experts suggested that this
personality disorder also involves a substantial anxiousness, a
controlled restraint (low impulsiveness), and an excessive cautiousness (low excitement seeking) that are not recognized by the
DSM-IV criteria for this disorder (American Psychiatric Association, 1994). Although it is possible that our experts, rather than the
DSM descriptions, were mistaken, our approach to aggregation
requires that these mistakes or misconceptions be widely held by
experts; if these misconceptions were held only by a few raters,
they would have been blunted in the aggregated profile.
Some disagreement also reflected points of dispute in the development of the diagnostic criteria. For example, there was considerable disagreement between the narcissistic PD researchers
and the ZWM-based descriptions with respect to self-consciousness
and vulnerability. Widiger et al. (1994) described the narcissistic
PD as being high in self-consciousness and vulnerability, whereas
the narcissistic PD researchers described the prototypic case of this
disorder as being low in these traits. This disagreement parallels a
difficulty the authors of the narcissistic diagnostic criterion sets
have had with the apparently inconsistent response of these persons to praise, criticism, or rebuke from others (Gunderson, Ronningstam, & Smith, 1991; Ronningstam & Gunderson, 1990; Widiger, Frances, Spitzer, & Williams, 1988).
Finally, we examined how well the FFM descriptions of the
personality disorders could reproduce the very high Comorbidity
rates reported in the literature. Although these high Comorbidities
are nettlesome to the categorical approach (Clark et al., 1997;
Lilienfeld et al., 1994; Livesley, 1998; Mineka et al., 1998), they
are expected under a dimensional model that views the personality
disorders as configurations of a finite number of basic personality
dimensions. Under the FFM account, disorders appear comorbid to
the extent that they are characterized by the same facets. Although
our results cannot prove that this is the case, we believe that, to the
extent the high rates of comorbidity among disorders can be
reproduced when one begins with these trait dimensions rather
410
LYNAM AND WIDIGER
than the disorders themselves, support is generated for the dimensional understanding.
The conceptual overlap among FFM profiles reproduced well
the covariation obtained for the schizoid, schizotypal, antisocial,
borderline, histrionic, narcissistic, avoidant, and compulsive PDs
aggregated across several sets of studies. The FFM predictions
correlated as highly with the co-occurrence rates reported in nine
previously published studies, as these studies correlated with the
DSM-IV Mac Arthur co-occurrence rates for 8 of the 10 personality
disorders. Poor results were obtained across both data sets for only
one personality disorder, dependent PD. This may be due to the
fact that the FFM profiles are constructed with bipolar descriptors
in contrast to the DSM criterion sets, which assess only one pole of
a dimension, resulting in much greater differentiation within the
FFM profiles than within general clinical settings. This will be
especially true when co-occurrence rates are used. The greatest
differentiation among the personality disorders was, in fact, predicted for the dependent PD, with correlations of —.81 and — .74
with narcissistic and antisocial PDs, respectively, whereas the
dependent PD was in fact reported to be somewhat comorbid with
the antisocial and narcissistic PDs in most of the prior comorbidity
studies (Widiger & Trull, 1998).
The distinctiveness between PDs in the present study stands in
contrast to results from a recent study by Morey, Gunderson,
Quigley, and Lyons (2000), who concluded that the FFM was
unsuccessful in providing much differentiation among the personality disorders because the FFM profile they obtained was essentially the same for each personality disorder. However, the primary
reasons for the failure of Morey et al. to obtain adequate differentiation was the inadequate differentiation among the disorders
themselves and their use of the NEO-FFI (Costa & McCrae, 1992),
which only assesses the five domains of the FFM. In their study,
each of the 11 DSM-III-R PDs met, on average, the diagnostic
criteria for 3 other personality disorders; persons who met the
histrionic and narcissistic criteria met the criteria for 5 other
personality disorders on average. Similar FFM profiles will be
obtained for different personality disorders if there is substantial
co-occurrence among them because the same individuals will
contribute to the ratings of each disorder. Moreover, more precise
differentiation between disorders can be obtained at the level of
the 30 facets (Axelrod et al., 1997).
Several researchers (e.g., Clark et al., 1997; Widiger & Frances,
1994) have previously argued for the superiority of the dimensional approach; we believe the present results underscore this
conclusion. The dimensional approach avoids dichotomous blackwhite decisions and the cognitive biases that come with such
decisions (Cantor & Genero, 1986). Under the FFM account, an
individual is described by using his or her standing on the 30 facets
of the NEO-PI-R (which provides a very detailed and specific
description using all available information) or by their degree of
approximation to a prototype. Similarly, personality disorders are
understood as constellations of basic traits and described by the
relative standings of the prototypic case on all 30 facets. Information on all facets is preserved, and prototypic cases of different
disorders may diverge in degree for a given facet. In addition, as
noted previously, a dimensional model anticipates high rates of
comorbidity among disorders; present results suggest that shared
dimensions across disorders is sufficient to account for the high
comorbidity. Finally, and often underappreciated, a dimensional
model of personality ties applied research into a corpus of knowledge derived from basic research on personality. That is, to the
extent that personality disorders are understood from a dimensional perspective, basic research in personality can be easily
brought to bear on personality disorders. For example, research on
the structure (John & Srivastava, 1999; Watson, Clark, & Harkness, 1994), genetics (Bouchard, Lykken, McGue, Segal, & Tellegen, 1990; Rutter et al., 1997), neurobiology (Depue, 1996;
Zuckerman, 1994), and development (Caspi, 1997; Scarr & McCartney, 1983) of personality can be applied to research on personality disorders to extend the understanding of mechanisms and
treatment and to generate theory.
In sum, the current results provide support for the specific FFM
account and the more general dimensional approach to understanding the personality disorders. Personality disorders do appear to
involve constellations of maladaptive variants of the personality
traits included within the more general FFM of personality functioning. We note, however, that simply because the personality
disorders can be understood from a dimensional perspective does
not render them useless as descriptions of configurations of traits.
Antisocial personality disorder is an important construct because
the particular combination of high antagonism; low deliberation,
dutifulness, and self-discipline; low anxiety and self-consciousness; and high impulsiveness, excitement seeking, and angry hostility is so virulent (Widiger & Lynam, 1998).
Where does one go from here? Up to this point, we have
demonstrated that (a) the FFM can be used to describe DSM
personality disorders, (b) experts can agree in their descriptions,
(c) various approaches to this description agree with one another,
and (d) the FFM can incorporate a finding with which the current
categorical approach has difficulty—excessive comorbidity
among the personality disorders. Next steps will involve further
demonstrating the power of this approach by examining its ability
to reproduce the nomological network surrounding the DSM personality disorders. For example, it is possible to ask whether
personality disorders "diagnosed" using the present FFM prototypes behave similarly in terms of interpersonal, social, and occupational functioning as do traditional PD diagnoses. The prototypes generated here can be matched against an individual's NEOPI-R profile to yield a set of similarity scores. The more similar an
individual is to a given prototype, the more he or she could be said
to have that particular personality disorder. For example, in the
Miller et al. (2001) study on psychopathy, we used an intraclass
correlation coefficient to assess the degree of similarity between
the FFM profile of the prototypic psychopath and an individual's
NEO-PI-R FFM profile.8 This similarity index was then used as an
index of psychopathy. We found that individuals who more closely
approximated the prototype had higher scores on a psychopathy
inventory; more symptoms of antisocial personality disorder, substance abuse, and substance dependence; more frequent and varied
antisocial activities; and fewer internalizing symptoms. All of
these relations replicated those in previous studies using incarcerated, PCL-R (Hare, 1991) defined psychopaths. When the FFM
8
The intraclass correlation was used because it takes into account not
only similarity in shape but also similarity in height of the profiles. It is
calculated as a double-entry correlation in which facets serve as participants and participants serve as variables.
FFM PD PROTOTYPES
profiles are shown to reproduce the nomological networks surrounding the existing diagnostic categories, then a strong argument
might be made for replacing these diagnostic categories with the
FFM.
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Received August 24, 2000
Revision received January 10, 2001
Accepted February 25, 2001