Journal of Personality Assessment

ISSN: 0022-3891 (Print) 1532-7752 (Online) Journal homepage: http://www.tandfonline.com/loi/hjpa20

Exploring the Assessment of the DSM–5

Alternative Model for Personality Disorders With
the Personality Assessment Inventory

Alexander J. Busch, Leslie C. Morey & Christopher J. Hopwood

To cite this article: Alexander J. Busch, Leslie C. Morey & Christopher J. Hopwood (2016):
Exploring the Assessment of the DSM–5 Alternative Model for Personality Disorders With the
Personality Assessment Inventory, Journal of Personality Assessment

To link to this article: http://dx.doi.org/10.1080/00223891.2016.1217872

Published online: 06 Sep 2016.

Submit your article to this journal

View related articles

View Crossmark data

Full Terms & Conditions of access and use can be found at

http://www.tandfonline.com/action/journalInformation?journalCode=hjpa20

Download by: [Cornell University Library] Date: 07 September 2016, At: 08:14
JOURNAL OF PERSONALITY ASSESSMENT
http://dx.doi.org/10.1080/00223891.2016.1217872

Exploring the Assessment of the DSM–5 Alternative Model for Personality Disorders
With the Personality Assessment Inventory
Alexander J. Busch,1 Leslie C. Morey,1 and Christopher J. Hopwood2
1
Department of Psychology, Texas A&M University; 2Department of Psychology, Michigan State University

ABSTRACT ARTICLE HISTORY

Section III of the Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM–5]; American Received 29 July 2015
Psychiatric Association, 2013) contains an alternative model for the diagnosis of personality disorder Revised 24 June 2016
involving the assessment of 25 traits and a global level of overall personality functioning. There is hope
that this model will be increasingly used in clinical and research settings, and the ability to apply
established instruments to assess these concepts could facilitate this process. This study sought to
develop scoring algorithms for these alternative model concepts using scales from the Personality
Assessment Inventory (PAI). A multiple regression strategy used to predict scores in 2 undergraduate
samples on DSM–5 alternative model instruments: the Personality Inventory for the DSM–5 (PID–5) and the
General Personality Pathology scale (GPP; Morey et al., 2011). These regression functions resulted in scores
that demonstrated promising convergent and discriminant validity across the alternative model concepts,
as well as a factor structure in a cross-validation sample that was congruent with the putative structure of
the alternative model traits. Results were linked to the PAI community normative data to provide
normative information regarding these alternative model concepts that can be used to identify elevated
traits and personality functioning level scores.

Section II of the fifth edition of the Diagnostic and Statistical
Manual of Mental Disorders (DSM–5; American Psychiatric
Association, 2013) retains a categorical model for the diagnosis
of personality disorders (PDs). However, the DSM–5 also
includes an alternative model for PD diagnosis within Section
III, Emerging Measures and Models. This new model uses
dimensional measures of self and interpersonal dysfunction
(Criterion A) as well as hierarchically organized traits (Criterion
B) as a means of conceptualizing personality pathology and spe-
cific forms of PD. The aim of the model was to provide a broad
but coherent system for identifying personality psychopathol-
ogy, quantifying its severity, and characterizing its myriad clini-
cal manifestations in terms of impairments in personality
functioning and pathological personality traits (Skodol, Morey,
Bender, & Oldham, 2013). Early research results have been
promising (Krueger & Markon, 2014; Morey, Benson, Busch, &
Skodol, 2015). However, one practical obstacle to its adoption
involves the availability and novelty of validated assessment
approaches for assessing Section III features. The purpose of
this study was to develop and evaluate methods to assess Crite-
rion B traits and the Criterion A level of disordered personality
severity with a widely used clinical assessment tool, the Person-
ality Assessment Inventory (PAI; Morey, 1991).
A large body of research demonstrates the benefits of consid-
ering a general severity dimension of personality pathology (e.g.,
Bender, Morey, & Skodol, 2011; Hopwood et al., 2011) as well as
reorganizing variants of PDs using personality traits with
established validity in basic personality science (Markon,
Krueger, & Watson, 2005; Samuel & Widiger, 2008; Widiger &
Costa, 1994; Widiger & Simonsen, 2005; Widiger & Trull, 2007;
Wiggins & Pincus, 1989). Therefore the inclusion of each of these
elements was part of deliberations on the DSM–5 process from
very early on (Skodol, 2011). The Personality and Personality
Disorder Work Group attempted to develop initial descriptors of
these characteristics that were operationalized, evaluated, and
ultimately refined using self-report measures. The Personality
Inventory for the DSM–5 (PID–5; Krueger, Derringer, Markon,
Watson, & Skodol, 2012) was used to assess and evaluate the trait
dimensions. Similarly, a composite General Personality Pathol-
ogy (GPP) scale (Morey et al., 2011) derived from two instru-
ments, the Structured Inventory for Personality Pathology
(SIPP–118; Verhuel et al., 2008) and the General Assessment of
Personality Disorder (GAPD; Livesley, 2006), was used to reflect
severity. The PID–5 is made up of 25 relatively homogeneous
traits that can be organized hierarchically under five broad fac-
tors: negative affectivity, detachment, antagonism, disinhibition,
and psychoticism (Krueger et al., 2012; Wright et al., 2012). Ini-
tial research with the PID–5 (see review by Krueger & Markon,
2014) suggests that this structure replicates fairly well across
samples (e.g., Wright et al., 2012), resembles that found in clini-
cal judgments of these 25 traits (Morey, Krueger, & Skodol,
2013), and converges reasonably well with the Five-Factor Model
of normative personality (Gore & Widiger, 2013; Thomas et al.,
2013). Furthermore, a number of studies indicate that PID–5

CONTACT Leslie C. Morey morey@tamu.edu Department of Psychology, Texas A&M University, 282 Psychology Building, College Station, TX 77843-4235.

© 2016 Taylor & Francis

2 BUSCH, MOREY, HOPWOOD
scores correlate as expected with measures of PDs and other
forms of psychopathology and dysfunction (Hopwood et al.,
2013; Krueger & Markon, 2014). Similarly, the GPP scale has
been shown to be a sensitive and specific indicator of whether
patients received a diagnosis of DSM–IV PD, and higher scores
on this scale were found to significantly predict PD comorbidity
(Morey et al., 2011).
Given the relatively recent introduction of this alternative model
for formulating PDs and the importance of supporting additional
research using this model, there is a need for additional strategies
for assessing these constructs. At present, the PID–5 and the GPP
scale represent initial forays into this area, but there are other instru-
ments that could conceivably be adapted for this purpose. This
would be expected given the presumption that these traits and this
global severity dimension permeate most measures of personality
problems, and there are a number of measures that are given rou-
tinely in clinical practice to assess such problems, such as the
MMPI–2/MMPI–2–RF (Sellbom, Anderson, & Bagby, 2013). This
article seeks to provide such a strategy using the scales of the PAI
(Morey, 1991), an instrument widely used in many clinical settings
(e.g., Archer, Buffington-Vollum, Stredny, & Handel 2006) and one
that, unlike the PID–5 or GPP, include validity scales that can iden-
tify problematic distortions in responding as well as providing
assessments of several other important diagnostic and clinical con-
structs. Initial research suggests that the PAI scales have relatively
strong and systematic correlations with the PID–5 (Hopwood et al.,
2013). In that study, conjoint exploratory factor analysis (EFA) of a
large sample of undergraduate students followed by exploratory
structural equation modeling (ESEM) with target rotation replicated
convergence at the broad level around five factors also seen in other
studies involving the PID–5 (Krueger et al., 2012; Wright et al.,
2012). Furthermore, the bivariate correlations between PID–5 and
PAI scales suggested a level of specificity that speaks to the potential
utility of the PAI for DSM–5 trait assessment. Specifically, appreci-
able correlations between PID–5 traits and PAI scales suggests that
particular collections of PAI scales could be used to develop sensitive
and discriminating indicators of DSM–5 traits and trait domains as
measured by the PID–5. Along similar lines, preliminary research
has indicated that the GPP scale demonstrated strong associations
with the PAI, particularly the Borderline Features (PAI-BOR) scale
(Lowmaster & Morey, 2011), and such borderline characteristics
have been identified in other studies as indicators of core personality
impairments (e.g., Sharp et al., 2015; Turkheimer, Ford, &
Oltmanns, 2008). However, these initial studies did not describe
specific scoring algorithms that could allow a direct translation of
PAI scale scores into the constructs of the DSM–5 alternative model.
Accordingly, a purpose of this study was to build on this initial
research to develop and test a specific method for assessing such
constructs using the PAI.
A number of approaches have been suggested from which one
can make inferences about personality and psychopathology con-
structs using the PAI (e.g., Morey, 1996), with the most direct
approach involving the use of individual PAI scales for interpreta-
tion. However, many of the DSM–5 alternative model constructs
seem to reflect a higher order combination of features measured by
the PAI. For instance, Table 1 in Hopwood et al. (2013) suggests
that although the DSM–5 trait facet of withdrawal is strongly corre-
lated with PAI social detachment (SCZ-S), as would be expected,
other PAI scales related to depression and low warmth are also
strongly related to DSM–5 withdrawal. This might suggest that
DSM–5 withdrawal involves elements of aloof detachment tinged
with concerns about closeness and experiences of negative affect.
Thus, the degree to which single PAI scales or collections of PAI
scales would optimally indicate DSM–5 traits and personality func-
tioning is an empirical question. To address this question, we sought
to develop predictive functions to optimize measurement of particu-
lar constructs (in this case, DSM–5 traits and levels of personality
functioning) using multiple regression. It was anticipated that this
empirically driven approach (in contrast to an attempt to rationally
select scale combinations) would provide predictive functions with
reasonable convergent and divergent validity as calibrated against
the PID–5 and GPP scale scores. PAI regression functions could be
then subsequently translated into interpretable scores using norms
against the census-matched community sample as well as the clini-
cal normative of the PAI.
Methods
Participants
Two samples of participants were examined in this study. The
PID–5 sample included 1,187 college students recruited to par-
ticipate in exchange for course credit. These participants were
administered the PID–5 and the PAI. Participant scores were
excluded from the study if missing more than 10% of the items,
for scoring above 67T on the PAI Positive Impression Manage-
ment (PIM) scale, or for scoring above 81T (a cut score identi-
fied as optimal in a meta-analysis by Hawes & Boccaccini,
2009) on the PAI Negative Impression Management (NIM)
scale,1 leaving 922 valid cases. A total of 72% of the included
participants were women, and the mean age was 19.63 years
(SD D 2.31). Eight-hundred forty-one (84%) of the participants
were White, 38 (4%) were African American, 32 (3%) were
Asian American, 23 (2%) were multiracial, 21 (2%) were His-
panic, 32 (3%) were “other,” and 14 participants did not report
their ethnicity.
To assess the level of personality functioning, a different
sample was used that included 104 college students enrolled in
an upper level course on personality psychology. Participation
represented an optional educational research project as an
opportunity to learn more about personality traits and disor-
ders; 104 of the 115 students in the course (90.4%) elected to
participate in the project. These participants were administered
the Borderline Features (BOR) scale of the PAI and the GPP.
The average age of the sample was 21.4 years; 64.4% were
women and 35.6% were men.
Measures
Personality Inventory for DSM–5
The PID–5 is comprised of 220 items and contains 25 nonover-
lapping scales that can be combined into five higher order
dimensions of negative affect, detachment, antagonism,
1
Scores on the PAI Inconsistency and Infrequency scales were not available in this
sample; as such, a more conservative score on NIM was selected because PAI
protocols with considerable random responding will typically obtain NIM scores
at or above such scores (Morey, 2007).

disinhibition, and psychoticism (Krueger et al., 2012; Wright
et al., 2012). Internal consistencies across all trait scales as mea-
sured in this sample ranged from .40 to .84. Each PID–5 item is
endorsed on a 4-point scale and receives an item score ranging
from 0 (very false) to 3 (very true); scale scores are computed to
reflect the average item score on that scale, with higher values
indicating greater degrees of the indicated trait.
Personality Assessment Inventory
The PAI includes 344 items that are combined into 22 full
scales and 31 subscales to provide broad coverage of psychopa-
thology and clinical constructs. In this sample, the internal con-
sistencies for all PAI full scales ranged from .69 to .91 and from
.56 to .86 for all PAI subscales.
General Personality Pathology scale
The GPP consists of 65 items that were selected from the SIPP–118
(Verheul et al., 2008) and the GAPD (Livesley, 2006). These two
measures are self-report questionnaires designed to assess the sever-
ity and core components of personality pathology. Items for the
GPP were initially selected from these instruments on the basis of
their conceptual relationship with the core impairments in person-
ality pathology as described in the DSM–5 alternative model
(Bender et al., 2011), including impairments in identity, self-direc-
tion, empathy, and intimacy. This initial scale was subsequently
refined using item response theory to provide a unidimensional
marker of impairments in personality functioning at various levels.
Items on the GPP are endorsed on a 4-point scale ranging from 1
(strongly disagree) to 4 (strongly agree), with the total score reflecting
the sum of items scores such that higher scores indicate greater per-
sonality pathology. The GPP demonstrated an internal consistency
of .97 in this sample.
Analysis
Data analyses involved stepwise entry multiple regression (p < .05
to enter, p > .10 to remove) using the PAI scales or subscales
(excluding the validity scales ICN and INF) to predict the individual
scores resulting from the PID–5 and the GPP. To predict PID–5
scores, all PAI scales other than the ICN and INF validity scales
(which are not measures of substantive constructs) were included in
these analyses, as there were no explicit hypotheses about relation-
ships between PAI and PID–5 constructs. The analyses predicting
GPP scores focused exclusively on the four PAI-BOR subscales, as
these subscales have previously been hypothesized to be related to
general personality pathology (e.g., Morey, 1991). To estimate the
generalizability of these predictive functions to a cross-validation
sample, we employed the predicted residual sums of squares
(PRESS) cross-validation method to correct for potential model
overfitting (Stevens, 2002). A PRESS analysis builds a model with
data from every participant except the person whose score is being
predicted, and this recurs for every participant. Model effect size is
estimated based on the observed residuals in the entire sample, pro-
viding a cross-validation uninfluenced by overfitting resulting from
larger numbers of predictors in the regression model. Such an
approach is particularly useful to control for overfitting artifacts
arising from the use of correlated predictor variables (Weisberg,
1985), which is typically the case when studying mental health vari-
ables as predictors.
ASSESSING DSM–5 PERSONALITY PATHOLOGY WITH THE PAI 3
To assess discriminant validity, the predicted scores from each
construct in the DSM–5 alternative model were saved for each
participant, and then correlated with all other constructs (both
individual facet traits and the general personality pathology indi-
cator). The mean of the absolute values of these discriminant
validity correlations (using the r to z transformation in calculat-
ing these means) provided estimates of discriminant validity at a
global level, whereas any particularly problematic discriminant
validity correlations (instances where PAI-predicted scores for a
certain DSM–5 construct actually displayed a larger correlation
with a different DSM–5 construct) were noted.
To provide a reference point for determinations regarding “ele-
vation” of a particular DSM–5 construct as predicted by PAI
scales, the predictive functions for the DSM–5 constructs were
applied to the census-matched community and the clinical nor-
mative samples of the PAI (Morey, 1991) and means and standard
deviations were calculated. The community sample estimates are
of particular interest given the stipulation in the alternative model
that to be of clinical significance, traits should be determined to be
“elevated” in comparison to population norms. At this point, there
are few empirical methods for making such a determination, and
thus the norms from the PAI community sample provide an
important opportunity for such comparisons.
Finally, the factor structure of the PAI-predicted DSM–5
pathological trait constructs was also examined to determine
whether it corresponded to the anticipated five-factor structure
described by that model. This factor analysis involved an extrac-
tion of five factors with a principal axis factoring followed by an
oblique Equamax rotation, the approach used by Krueger et al.
(2012) in the initial derivation of the PID–5. The resulting factor
structure loadings were then compared to that described for the
PID–5 by using coefficients of congruence, examining congru-
ence both for the Equamax rotation as well as a Procrustes rota-
tion to Krueger et al.’s solution to evaluate structure replication.
Results
The Appendix provides the derived regression functions for pre-
dicting the 25 DSM–5 pathological traits and the global level of
personality pathology using PAI scales or subscales. These func-
tions provide empirically selected PAI indicators that can be
applied to obtained PAI scores as a means of assessing the
respondent’s DSM–5 traits and level of personality functioning.2
To determine the effectiveness of these selected PAI scales in
predicting DSM–5 traits and personality pathology severity,
Table 1 provides estimates of convergent and discriminant
2
Given the complexity of the estimation formulas provided in the Appendix, we
also tested unit-weighted functions using significant PAI scales as predictors, as
suggested by Cohen (1990), who observed that weighted and (more parsimoni-
ous) unweighted functions tend to yield results that are very highly correlated.
Two unit-weighting approaches were examined, one using all significant predic-
tors from the regression models, and the second using only unit-weighted pre-
dictors demonstrating a zero-order correlation of at least .40 with the criterion
PID scale. Both of these approaches yielded significant reductions in the differen-
tiation of convergent and discriminant validity correlations in the resulting multi-
trait–multimethod matrix, relative to that provided by the empirical regression
function weights, after jack-knifed cross-validation within this sample (complete
details are available on request). It is an open question whether unit weights
would demonstrate comparable generalization in a new sample with different
characteristics.
4 BUSCH, MOREY, HOPWOOD

Table 1. Regression functions and descriptive statistics predicting DSM–5 traits from Personality Assessment Inventory scales.

Communitya Clinicalb Mean discriminant validity

Convergent PRESS
Alternative model construct M SD M SD multiple R correlation R Worst

Submissiveness 1.31 0.32 1.44 0.41 .53 .51 .08 .35

Depressivity 0.25 0.39 0.79 0.65 .86 .85 .49 .81
Separation insecurity 0.88 0.41 1.33 0.53 .61 .60 .28 .51
Anxiousness 1.18 0.47 1.70 0.66 .82 .82 .29 .69
Emotional lability 0.87 0.51 1.44 0.73 .74 .73 .35 .62
Suspiciousness 0.84 0.40 1.19 0.53 .77 .76 .46 .62
Restricted affectivity 0.86 0.35 0.98 0.42 .60 .59 .26 .47
Withdrawal 0.80 0.42 1.13 0.57 .79 .79 .40 .67
Intimacy avoidance 0.41 0.32 0.64 0.38 .52 .50 .29 .49
Anhedonia 0.92 0.41 1.45 0.64 .84 .84 .44 .70
Manipulativeness 0.98 0.41 1.15 0.48 .61 .60 .30 .53
Deceitfulness 0.69 0.37 0.92 0.43 .66 .65 .43 .61
Hostility 0.99 0.43 1.26 0.55 .79 .78 .44 .60
Callousness 0.41 0.31 0.57 0.39 .73 .72 .45 .69
Attention seeking 1.03 0.40 1.16 0.46 .59 .57 .20 .43
Grandiosity 0.78 0.35 0.80 0.39 .60 .59 .25 .51
Irresponsibility 0.41 0.33 0.69 0.43 .70 .69 .47 .68
Impulsivity 0.73 0.41 1.03 0.55 .70 .69 .38 .59
Distractibility 0.95 0.41 1.34 0.60 .73 .72 .38 .56
Perseveration 0.91 0.37 1.26 0.53 .68 .67 .43 .60
Rigid perfectionism 1.21 0.46 1.32 0.56 .77 .77 .18 .32
Risk taking 1.21 0.37 1.26 0.48 .81 .80 .11 .56
Eccentricity 1.02 0.44 1.29 0.55 .66 .64 .42 .60
Perceptual dysregulation 0.61 0.34 0.93 0.50 .75 .74 .51 .75
Unusual beliefs 0.71 0.41 0.92 0.58 .73 .72 .44 .72
Personality disorder severity 111.13 22.34 140.98 30.48 .86 .84 .38 .80

n D 1,000. bn D 1,246.
a

validity. The convergent multiple correlation provides the cor-
relation between the PID–5 and GPP scales and the PAI com-
posite constructed to predict that scale score. The PRESS
correlations provide the cross-validated multiple correlation
convergent values; as expected, there is some shrinkage in the
convergent validity values after cross-validation. For discrimi-
nant validity, the average (following an r to z transformation)
correlation between a given PAI composite and all other PID–5
scales is presented. The median convergent validity correlation
for these constructs was .71 (PRESS r average D .70), demon-
strating a reasonably strong relationship between PAI compo-
sites and the target traits that displayed only modest shrinkage
in PRESS cross-validation. The PAI scale combination predict-
ing level of personality functioning had the highest convergent
multiple r value, at .86. In contrast, the mean discriminant
validity values had an average of .35 (Table 1). Table 1 also
presents the most problematic discriminant validity correlation
for each scale; only one instance (of 325 total discriminant
validity correlations) was noted where a discriminant validity
correlation exceeded the cross-validated PRESS multiple corre-
lation, this being the PAI perceptual dysregulation composite,
which demonstrated a slightly larger correlation with the PID–
5 eccentricity trait than with the target perceptual dysregulation
scale. However, in general, the PAI composites demonstrated a
solid combination of convergent and discriminant validity, sug-
gesting that these selected PAI scale combinations are poten-
tially useful predictors of DSM–5 traits and level of personality
functioning.
Applying these PAI scale composites to the PAI community
and clinical normative data provides an opportunity to estab-
lish norms for the trait and functional constructs of the DSM–5
Section III model. The means and standard deviations of these
composites as applied to the PAI normative data are also pre-
sented in Table 1. It is worth noting that estimated PID–5
scores of two or greater, which indicate an average response of
“present” across the items on a scale, represent a score at least 1
SD above the community mean for all traits. Furthermore, as
expected, the mean scores for the PAI clinical normative sam-
ple were higher than that for the community sample on every
DSM–5 alternative model construct.
As a final gauge of the verisimilitude of the PAI-estimated
DSM–5 alternative model scores to the target constructs, an
EFA of the estimated scores for the pathological trait constructs
was conducted, as applied to the PAI community normative
sample (Morey, 2007). This factor analysis involved a principal
axis factoring of the 25 PAI-estimated PID–5 scores, followed
by an oblique Equamax rotation of five factors following the
approach of Krueger et al. (2012) in the derivation of the PID–
5. The factor loadings from this model are presented in Table 2.
In Table 2, trait facets as assigned to the relevant domains in
DSM–5 Section II are shown in bold. The pattern of factor
loadings is consistent with the structural organization of the
pathological traits presented in DSM–5. As a summary of this
convergence, Tucker coefficients of congruence between these
PAI-estimated scale factor loadings and those presented by
Krueger et al. (2012) in the derivation of the PID–5 are pre-
sented in the final row of Table 2, with four of the five congru-
ence coefficients exceeding .85. Following the method of
Paunonen (1997), a Procrustes rotation to the Krueger et al.
(2012) solution yielded five factors with Tucker coefficients
ranging from .91 to .96, well above the 99% confidence interval
for replication provided by Paunonen. These results signify
 ASSESSING DSM–5 PERSONALITY PATHOLOGY WITH THE PAI 5

Table 2. Five-factor exploratory factor analysis solution from Personality Assessment Inventory (PAI)-estimated DSM–5 trait scores in the PAI community normative
sample.
Facet trait Negative affectivity Detachment Antagonism Disinhibition Psychoticism

Emotional lability .78 .06 .24 .22 .30

Anxiousness .82 .19 .09 .02 .33
Separation insecurity .79 .06 .17 .14 .38
Perseveration .68 .24 .26 .09 .59
Submissiveness .53 ¡.07 ¡.23 ¡.18 .37
Hostility .53 .23 .47 .36 .14
Restricted affectivity ¡.20a .82 .17 .22 .11
Depressivity .50 .57 ¡.01 .25 .42
Suspiciousness .50 .43 .42 .15 .32
Withdrawal .22 .86 .05 .01 .18
Anhedonia .47 .71 ¡.01 .21 .26
Intimacy avoidance .01 .74 .10 .12 .32
Manipulativeness .10 .20 .76 .50 .14
Deceitfulness .28 .48 .48 .54 .22
Grandiosity ¡.05 .12 .85 .24 .20
Attention seeking .14 ¡.34 .76 .38 .18
Callousness .13 .56 .52 .49 .18
Irresponsibility .26 .51 .23 .54 .44
Impulsivity .16 .23 .28 .78 .36
Rigid perfectionism .46 .10 .35 ¡.31y .10
Distractibility .47 .25 ¡.10 .37 .65
Risk taking ¡.25 ¡.03 .30 .80 .03
Unusual beliefs and experiences .13 .23 .50 .13 .74
Eccentricity .28 .20 .44 .39 .59
Cognitive and perceptual dysregulation .27 .37 .32 .26 .78
Congruence with Krueger et al. (2012) .88 .85 .87 .85 .91

Note. N D 1,000. DSM–5-based hypothesized factor specifications are shown in bold.

a
Trait relationship hypothesized to be negative.

reasonable cross-instrument and cross-sample congruence in
the factor structure of the PID–5 and that of the PAI-estimated
DSM–5 trait scores.
Discussion
The DSM–5 Section III model attempts to link empirical
research in personality with the widely used DSM system of
psychiatric diagnosis (Krueger & Markon, 2014). The model
has the potential to improve the validity and clinical utility of
personality diagnosis and more effectively connect clinical
practice with basic research on normal personality and psycho-
pathology. Furthermore, this model provides a more explicit
structural framework that can connect dimensional psychologi-
cal assessment data with personality-related diagnostic con-
cepts. Research that connects this new model to existing
personality measures that are well validated and widely used in
psychopathology will facilitate research and application using
this model.
The goal of this study was to develop a strategy for using the
PAI to assess DSM–5 traits and personality functioning, pro-
viding a currently unique opportunity to assess both compo-
nents of the DSM–5 alternative model for PD. A series of
regression analyses were used to develop composites of PAI
scales that could be used as indicators of DSM–5 Section III
concepts. The evidence of convergent and discriminant validity
of these composites with respect to the PID–5 and GPP meas-
ures provides an important first step in attempting to establish
their construct validity for the DSM–5 Section III model, and
the obtained convergent and discriminant validity estimates
tend to be equal to or better than similar values found when
measuring traditional PD concepts (e.g., Clark, Livesley, &
Morey 1997). It should be noted that there are a number of
potential benefits to providing such indicators in the context of
a broadband clinical measure such as the PAI. For example, the
PAI provides measures of a host of other diagnostic constructs
related, for example, to substance misuse, psychotic disorders,
mood disorders, and somatic disorders, that can provide
broader diagnostic perspective than PD-specific measures such
as the PID–5 or the GPP. Another advantage in the use of the
PAI is the provision of normative scores for these composites,
as calculated in a large, national, census-matched community
sample that serves as the normative basis for the PAI itself.
Such norms are essential for an understanding of these con-
cepts, given that the Section III model notes that for these
dimensional concepts, “the judgment that a specific trait is ele-
vated (and therefore is present for diagnostic purposes) could
involve comparison of individuals’ personality trait levels with
population norms” (American Psychiatric Association, 2013,
p. 774). The provision of descriptive statistics for these DSM–5
alternative model score composites provides a much needed
foundation for making such determinations of elevation, a step
critical in diagnostic determinations. Finally, the availability of
a host of empirically supported indicators of PAI profile valid-
ity augments the clinical utility of the information derived from
the DSM–5 alternative model.
The convergence of these PAI-estimated DSM–5 model
scores with the model itself was also examined through the use
of EFA to compare the obtained structure with that hypothe-
sized in DSM–5 Section III. In most respects, there was appreci-
able convergence between these PAI-estimated scores and the
hypothesized five-factor structure of the DSM–5 pathological
trait model. Certain traits demonstrated some unanticipated
cross-factor loadings—most noticeably distractibility, a putative
6 BUSCH, MOREY, HOPWOOD
disinhibition trait that displayed appreciable cross-loadings on
negative affectivity and psychoticism. However, at the global
level there was clear similarity between the structure of these
PAI-estimated scores and those generated by the PID–5. For
example, the median coefficient of congruence between the
PAI-estimated traits score factors, as calculated in the PAI nor-
mative sample, and the factor loadings presented in the original
PID–5 article (Krueger et al., 2012) was .87. By comparison,
Wright et al. (2012) attempted to replicate the Krueger et al.
(2012) five-factor EFA solution in a sample of college under-
graduates, and obtained a median coefficient of congruence of
.82 across the five factors. It is noteworthy that the structural
replication for these PAI-estimated scores, which were derived
from a different sample and a different instrument from
Krueger et al. (2012), provided stronger replication of this
structure using PAI composites than did Wright et al. (2012)’s
cross-sample EFA replication of the PID–5 itself. This confir-
mation of a hypothesized pattern of anticipated interrelation-
ships is an important step in the process described by Westen
and Rosenthal (2003), who suggested a means by which con-
struct validity could be quantified in a way that allows for com-
parisons across studies and measures.
It is important to underscore that this study is an initial step
toward a strategy for specifying DSM–5 alternative model con-
cepts using a widely used clinical tool—the PAI. There is clearly
a need for additional research, both on these PAI scores as well
as on the alternative model, and it is hoped that the former
might help serve as a catalyst for the latter. It will be particu-
larly important to evaluate these indicators against clinical
judgments of DSM–5 alternative model concepts, such as the
Level of Personality Functioning scale provided in the DSM. It
should also be acknowledged that the reference point for the
development of these PAI indicators, the PID–5 and the GPP,
are both relatively recently introduced measures with a limited
body of validity evidence behind them. In particular, the dis-
criminant validity of these reference measures has not been
well-established; for example, Markon, Quilty, Bagby, and
Krueger (2013) and Crego, Gore, Rojas, and Widiger (2015)
both noted some discriminant validity issues with the PID–5
scales that present an important consideration in the further
study and refinement of these PAI composites. In terms of this
study, there was a tendency for PAI scales to be included in
multiple composites across 26 personality pathology constructs,
with the median PAI scale involved in 7 of the 26 predictive
functions. However, a diverse set of PAI indicators were
involved, with 38 of 42 PAI scales or subscales being repre-
sented on at least one composite. It might be this diversity of
predictors that allowed the generally good discriminant validity
results across scales that were observed in Table 1.
Furthermore, a major limitation of the study that should
also be noted is that the functions in this study were derived
using university student samples, which might limit the imme-
diate direct clinical utility of the results. Cross-validation in a
clinical sample with significant personality pathology will be an
important next step for research. Despite such limitations, as
noted by Cronbach and Meehl (1955), the concept of boot-
strapping is often necessary in the initial development and sub-
sequent refinement of measures, whereby various indicators
might ultimately prove to be more valid than the initial
phenomena that they were validated against. It was the goal of
the DSM–5 Personality and Personality Disorders Work Group
to provide a comprehensive model of personality structure and
dysfunction that would tie to important concepts in contempo-
rary personality science. To continue to evaluate this model,
objective and replicable methods to measure the concepts of
this model are needed. The results from this study provide sup-
port for the notion that the concepts from the alternative model
could be estimated using combinations of scores from the PAI,
and thus application of this strategy might assist the field in
determining whether the DSM–5 alternative model is indeed a
viable and useful model for conceptualizing and assessing per-
sonality psychopathology.
Disclosure
Leslie C. Morey is the author of the Personality Assessment Inventory and
derives royalties from its sale.
References
American Psychiatric Association. (2013). Diagnostic and statistical man-
ual of mental disorders (5th ed.). Arlington, VA: Author.
Archer, R. P., Buffington-Vollum, J. K., Stredny, R. V., & Handel, R. W.
(2006). A survey of psychological test use patterns among forensic psy-
chologists. Journal of Personality Assessment, 87, 84–94.
Bender, D. S., Morey, L. C., & Skodol, A. E. (2011). Toward a model for
assessing level of personality functioning in DSM–5, part I: A review of
theory and methods. Journal of Personality Assessment, 93, 332–346.
Clark, L. A., Livesley, W. J., & Morey, L. C. (1997). Personality disorder
assessment: The challenge of construct validity. Journal of Personality
Disorders, 11, 205–231.
Cohen, J. (1990). Things I have learned (so far). American Psychologist, 45,
1304–1312.
Crego, C., Gore, W. L., Rojas, S. L., & Widiger, T. A. (2015). The discrimi-
nant (and convergent) validity of the Personality Inventory for DSM–
5. Personality Disorders: Theory, Research, and Treatment, 6, 321–335.
Cronbach, L. J., & Meehl, P. E. (1955). Construct validity in psychological
tests. Psychological Bulletin, 52, 281–302.
Gore, W. L., & Widiger, T. A. (2013). The DSM–5 dimensional trait model
and five factor models of general personality. Journal of Abnormal Psy-
chology, 122, 816–821.
Hawes, S. W., & Boccaccini, M. T. (2009). Detection of overreporting of
psychopathology on the Personality Assessment Inventory: A meta-
analytic review. Psychological Assessment, 21(1), 112–124.
Hopwood, C. J., Malone, J. C., Ansell, E. B., Sanislow, C. A., Grilo, C. M.,
McGlashan, T. H., … Morey, L. C. (2011). Personality assessment in
DSM–V: Empirical support for rating severity, style, and traits. Journal
of Personality Disorder, 25, 305–320.
Hopwood, C. J., Wright, A. G., Krueger, R. F., Schade, N., Markon, K. E., &
Morey, L. C. (2013). DSM–5 pathological personality traits and the
Personality Assessment Inventory. Assessment, 20, 269–285.
Krueger, R. F., Derringer, J., Markon, K. E., Watson, D., & Skodol, A. E.
(2012). Initial construction of a maladaptive personality trait model
and inventory for DSM–5. Psychological Medicine, 42, 1879–1890.
Krueger, R. F., & Markon, K. E. (2014). The role of the DSM–5 personality
trait model in moving toward a quantitative and empirically-based
approach to classifying personality and psychopathology. Annual
Review of Clinical Psychology, 10, 477–501.
Livesley, W. J. (2006). General assessment of personality disorder (GAPD).
Vancouver, Canada: Department of Psychiatry, University of British
Columbia.
Lowmaster, S. E., & Morey, L. C. (2011, March). Support for a core person-
ality pathology impairment dimension in an undergraduate sample.
Paper presented at the annual meeting of the Society for Personality
Assessment, Boston, MA.

Markon, K. E., Krueger, R. F., & Watson, D. (2005). Delineating the
structure of normal and abnormal personality: An integrative hier-
archical approach. Journal of Personality and Social Psychology, 88,
139–157.
Markon, K. E., Quilty, L. C., Bagby, R. M., & Krueger, R. F. (2013). The
development and psychometric properties of an informant-report form
of the Personality Inventory for DSM–5 (PID–5). Assessment, 20,
370–383.
Morey, L. C. (1991). Professional manual for the Personality Assessment
Inventory. Odessa, FL: Psychological Assessment Resources.
Morey, L. C. (1996). An interpretive guide to the Personality Assessment
Inventory. Odessa, FL: Psychological Assessment Resources.
Morey, L. C. (2007). Personality Assessment Inventory professional manual
(2nd ed.). Odessa, FL: Psychological Assessment Resources.
Morey, L. C., Benson, K. T., Busch, A. J., & Skodol, A. E. (2015). Personal-
ity disorders in DSM–5: Emerging research on the alternative model.
Current Psychiatry Reports, 17(4), 1–9. doi:10.1007/s11920-015-0558-0
Morey, L. C., Berghuis, H., Bender, D. S., Verheul, R., Krueger, R. F., &
Skodol, A. E. (2011). Toward a model for assessing level of personality
functioning in DSM–5, Part II: Empirical articulation of a core dimen-
sion of personality pathology. Journal of Personality Assessment, 93,
347–353.
Morey, L. C., Krueger, R. F., & Skodol, A. E. (2013). The hierarchical struc-
ture of clinician ratings of proposed DSM–5 pathological personality
traits. Journal of Abnormal Psychology, 122, 836–841.
Paunonen, S. V. (1997). On chance and factor congruence following
orthogonal Procrustes rotation. Educational and Psychological Mea-
surement, 57, 33–59.
Samuel, D. B., & Widiger, T. A. (2008). A meta-analytic review of the relation-
ships between the Five-Factor Model and DSM–IV–TR personality disor-
ders: A facet level analysis. Clinical Psychology Review, 28, 1326–1342.
Sellbom, M., Anderson, J. L., & Bagby, R. M. (2013). Assessing DSM–5
Section III personality traits and disorders with the MMPI–2–RF.
Assessment, 20, 709–722.
Sharp, C., Wright, A. C., Fowler, J. C., Frueh, B. C., Allen, J. G., Oldham, J.,
& Clark, L. A. (2015). The structure of personality pathology: Both gen-
eral (‘g’) and specific (‘s’) factors? Journal of Abnormal Psychology, 124,
387–398.
Skodol, A. E. (2011). Scientific issues in the revision of personality disor-
ders for DSM–5. Personality and Mental Health, 5, 97–111.
Skodol, A. E., Morey, L. C., Bender, D. S., & Oldham, J. E. (2013). The
ironic fate of personality disorders in DSM–5. Personality Disorders:
Theory, Research and Treatment, 4, 342–349.
Stevens, J. (2002). Applied multivariate statistics for the social sciences (4th
ed.). Mahwah, NJ: Erlbaum.
Thomas, K. M., Yalch, M. M., Krueger, R. F., Wright, A., Markon, K. E., &
Hopwood, C. J. (2013). The convergent structure of DSM–5 personality
trait facets and Five-Factor Model trait domains. Assessment, 20,
308–311.
Turkheimer, E., Ford, D. C., & Oltmanns, T. F. (2008). Regional analysis of
self-reported personality disorder criteria. Journal of Personality, 76,
1587–1622.
Verheul, R., Andrea, H., Berghout, C., Dolan, C. C., van Busschbach, J. J.,
Van Der Kroft, P. J. A., … Fonagy, P. (2008). Severity Indices of Per-
sonality Problems (SIPP–118): Development, factor structure, reliabil-
ity, and validity. Psychological Assessment, 20, 23–34.
Weisberg, S. (1985). Applied linear regression (2nd ed.). New York, NY:
Wiley.
Westen, D., & Rosenthal, R. (2003). Quantifying construct validity: Two
simple measures. Journal of Personality and Social Psychology, 84,
608–618.
Widiger, T. A., & Costa, P. T. (1994). Personality and personality disor-
ders. Journal of Abnormal Psychology, 103, 78–91.
Widiger, T. A., & Simonsen, E. (2005). Alternative dimensional models of
personality disorder: Finding a common ground. Journal of Personality
Disorders, 19, 110–130.
Widiger, T. A., & Trull, T. J. (2007). Plate tectonics in the classification of
personality disorder. American Psychologist, 62, 71–83.
Wiggins, J. S., & Pincus, A. L. (1989). Conceptions of personality disorders
and dimensions of personality. Psychological Assessment, 1, 305–316.
ASSESSING DSM–5 PERSONALITY PATHOLOGY WITH THE PAI 7
Wright, A. G. C., Thomas, K. M., Hopwood, C. J., Markon, K. E., Pincus,
A. L., & Krueger, R. F. (2012). The hierarchical structure of DSM–5
pathological personality traits. Journal of Abnormal Psychology, 121,
951–957.
Appendix: PAI regression equations for DSM–5 alter-
native PD model constructs
To obtain PAI indicator scores on the DSM–5 alternative
model, the T scores (using standard PAI community norms)
for all indicated PAI scales and subscales should be multiplied
by the corresponding regression weight and then summed, as
presented in the formulas listed here. All PAI scale and subscale
acronyms are as delineated in the PAI test manual (Morey,
2007).
 Submissiveness D (TARDO  .005520) C (TMANI 
.013345) C (TPARH  –.005810) C (TANTA 
–.007323) C (TBORI  .006113) C (TALC  .004922) C
(TSTR  –.006354) C (TRXR  –.008159) C (TDOM 
–.029352) C (TWRM  .009416) C (2.194113).
 Depressivity D (TNIM  .004155) C (TPIM  ¡.003700)
C (TDEPA  .011554) C (TDEPC  .017550) C
(TMANG  .003136) C (TMANI  –.005167) C (TDRG
 –.002799) C (TSUI  .008055) C (TNON  .003176) C
(TWRM  –.003899) C (–1.345765).
 Separation insecurity D (TANXC  .006378) C (TMANI
 .007556) C (TSCZS  –.012544) C (TBORI  .028201)
C (TANTS  –.005552) C (TAGGA  .006029) C
(TNON  .007672) C (TDOM  –.009658) C (–.519245).
 Anxiousness D (TNIM  –.005511) C (TPIM  –.006017)
C (TANXA  .007727) C (TANXC  .033481) C (TPARH
 .005490) C (TSCZP  –.004210) C (TBORI  .007347) C
(TANTA  –.004620) C (TDOM  –.003988) C
(–.304736).
 Emotional lability D (TNIM  .008713) C (TSOMC 
–.004824) C (TANXA  .009669) C (TANXC  .005332)
C (TPARH  –.006651) C (TPARR  .007335) C
(TBORA  .037376) C (TBORI  .010142) C (TANTA 
–.008144) C (TSUI  –.005632) C (TWRM  .009092) C
(–2.250505).
 Suspiciousness D (TANXC  .004636) C (TARDO 
.002381) C (TMANG  .002693) C (TPARH  .012267)
C (TPARP  .015801) C (TPARR  .008535) C (TBORN
 .005899) C (TANTA  –.004247) C (TANTE 
.003045) C (TDOM  –.005427) C (–1.438204).
 Restricted affectivity D (TANXC  –.008010) C (TARDP
 –.006660) C (TDEPA  .009528) C (TMANA 
.006978) C (TPARH  .007878) C (TBORA  –.012317)
C (TANTE  .008854) C (TANTS  .009177) C (TAGGV
 –.008450) C (TWRM  –.026460) C (1.835072).
 Withdrawal D (TPIM  –.003320) C (TARDT  .003969)
C (TPARH  .003317) C (TSCZS  .026469) C (TANTA
 –.004228) C (TANTE  .005883) C (TAGGV 
–.005817) C (TSUI  –.003035) C (TWRM  –.015729)
C (.423567).
 Intimacy avoidance D (TNIM  .006642) C (TPIM 
.007632) C (TDEPP  .005648) C (TMANI  –.008867) C
(TPARH  .005113) C (TSCZT  .006911) C (TBORS 
–.005706) C (TANTE  .018430) C (TALC  .003732) C
8 BUSCH, MOREY, HOPWOOD
(TAGGV  –.005913) C (TWRM  –.012467) C
(–.644794).
 Anhedonia D (TDEPA  .026289) C (TDEPC  .005579)
C (TPARP  –.004497) C (TANTS  .002200) C (TNON
 .005400) C (TWRM  –.014167) C (–.122591).
 Manipulativeness D (TANXP  –.004399) C (TMANG 
.006847) C (TMANI  .007985) C (TPARR  .005714) C
(TBORS  .006571) C (TANTA  .008268) C (TANTE 
.021988) C (TAGGV  .005879) C (TDRG  –.004059)
C (TDOM  .005185) C (–2.020781).
 Deceitfulness D (TPIM  –.006776) C (TARDT  –.006000)
C (TPARR  .007805) C (TBORA  .004758) C (TBORS 
.004780) C (TANTA  .014409) C (TANTE  .017846) C
(TDRG  –.005428) C (TWRM  –.005229) C (–.625298).
 Hostility D (TPIM  –.011202) C (TANXC  –.003552)
C (TMANI  .012324) C (TPARR  .003906) C (TBORA
 .012637) C (TDRG  –.004163) C (TAGGA  .010586)
C (TAGGV  .010102) C (TRXR  .004766) C (TWRM
 –.007767) C (–.390267).
 Callousness D (TARDT  –.002781) C (TDEPA 
.004529) C (TDEPC  .003582) C (TDEPP  –.002813)
C (TMANG  .004133) C (TPARP  .004414) C (TSCZP
 .003645) C (TBORI  –.003510) C (TANTA  .006537)
C (TANTE  .007457) C (TAGGP  .009431) C
(TAGGV  .005411) C (TSUI  –.003047) C (TRXR 
.004306) C (TWRM  –.011116) C (–1.100108).
 Attention seeking D (TDEPP  –.006087) C (TMANA 
.006489) C (TMANG  .014967) C (TMANI  .005221)
C (TPARR  .005334) C (TSCZS  –.007167) C (TBORA
 .007999) C (TANTE  .008072) C (TALC  .005530) C
(TAGGV  .005569) C (TNON  .007573) C (TWRM 
.016511) C (–2.473992).
 Grandiosity D (TARDT  –.005302) C (TMANG 
.023614) C (TMANI  .005727) C (TPARP  .004050) C
(TPARR  .004483) C (TSCZP  .004800) C (TSCZS 
.007054) C (TANTE  .005448) C (TAGGV  .004619)
C (TRXR  .006211) C (–2.260406).
 Irresponsibility D (TARDO  –.005286) C (TARDP 
.003907) C (TARDT  –.003692) C (TDEPC  .005077)
C (TPARP  .007542) C (TPARR  .003215) C (TSCZT
 .006791) C (TBORN  –.005237) C (TBORS 
.006072) C (TANTA  .003726) C (TANTE  .006465)
C (TALC  .003672) C (TDRG  .003150) C (TAGGP 
.003562) C (TWRM  –.004271) C (–1.328749).
 Impulsivity D (TSOMC  –.005311) C (TARDO 
–.003881) C (TDEPC  .005768) C (TSCZT  .005651)
C (TPARP  .004304) C (TBORS  .018269) C (TANTA
 .006842) C (TANTS  .018401) C (TSUI  –.003445) C
(–1.607169).
 Distractibility D (TPIM  –.011481) C (TARDO 
–.006347) C (TARDT  –.004194) C (TDEPC  .018527)
C (TMANG  .004864) C (TPARP  –.006178) C
(TSCZP  –.005413) C (TSCZT  .026363) C (TBORS 
.004762) C (TANTS  .004191) C (TSUI  –.007085) C
(TDOM  –.008551) C (.477284).
 Perseveration D (TPIM  –.007551) C (TARDO 
.006440) C (TARDP  .004509) C (TDEPC  .008228) C
(TMANG  .005658) C (TMANI  .005453) C (TPARR
 .003130) C (TSCZT  .013790) C (TBORA  .005268)
C (TSUI  –.006588) C (TDOM  –.009031) C
(–.560214).
 Rigid perfectionism D (TANXC  .004767) C (TARDO 
.043882) C (TARDP  .004911) C (TARDT  –.006748)
C (TPARR  .006521) C (–1.520032).
 Risk taking D (TSOMC  –.004372) C (TARDO 
–.005489) C (TARDP  –.008047) C (TMANI 
–.002802) C (TSCZS  –.003053) C (TBORS 
.003992) C (TANTS  .030160) C (TDRG  .003772)
C (TAGGV  .004242) C (TDOM  .003304) C
(.119584).
 Eccentricity D (TNIM  –.008873) C (TPIM  –.006347)
C (TARDO  –.005108) C (TDEPC  .007788) C
(TMANA  .008291) C (TMANG  .009087) C (TSCZP
 .017789) C (TSCZT  .007732) C (TBORA  .008147)
C (TBORS  –.006573) C (TANTS  .012707) C (TALC
 –.006430) C (TRXR  –.006484) C (TWRM 
–.009265) C (–.102238).
 Perceptual dysregulation D (TSOMC  .005476) C
(TDEPC  .005083) C (TMANG  .003798) C (TSCZP 
.010402) C (TSCZT  .014835) C (TANTA  .002809) C
(TANTS  .002752) C (TWRM  –.006233) C
(–1.333644).
 Unusual beliefs D (TSOMC  .009420) C (TMANG 
.009505) C (TSCZP  .025136) C (TSCZT  .009724) C
(TANTA  .004603) C (TALC  –.006416) C (TWRM 
–.007738) C (–1.508141).
 PD severity D (TBORA  .962733) C (TBORI 
1.244508) C (TBORN  .358478) C (–16.937825).