Personality Types and Personality Traits in DSM-5: Do They Really Match?

Oliveira, Sérgio Eduardo Silva de; Oliveira, Tiago Cunha de; Bandeira, Denise Ruschel; Krueger, Robert Frank

doi:10.1590/0102.3772e36nspe15

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Brasil

Psicologia: Teoria e Pesquisa

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Sumário

Special Commemorative Number of the 15th Anniversary of the Graduate Program in Clinical Psychology and Culture • Psic.: Teor. e Pesq. 36 (spe) • 2020 • https://doi.org/10.1590/0102.3772e36nspe15 copy

Personality Types and Personality Traits in DSM-5: Do They Really Match?^* * Apoio: CNPq; MCTI/CNPq/MEC/CAPES Nº 18/2012; CAPES; PDSE-CAPES (number 99999.007135/2014-09).

Tipos e Traços de Personalidade no DSM-5: Eles Realmente Combinam?

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The alternative model of personality disorders introduced in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders provides a diagnostic system that is expected to correspond to the well-known categorical approach of personality disorder diagnoses. The current study aims to improve knowledge about the relationship between pathological personality traits and their corresponding personality types. A Brazilian sample of 1,162 people took part in this study. The results point to some level of continuity between the two models when the variables were treated as dimensional. Contrariwise, there is a lack of strong scientific evidence to justify the maintenance of the categorical approach. We recommend the exclusion of the categorical approach from personality disorder diagnosis systems.

Keywords:
categorical model; dimensional model; personality disorder diagnosis

	Community		Clinical		Total
	(n = 592)		(n = 570)		(n = 1,162)
Age
- Minimum \| Maximum	15	73	15	64	15	73
- M (SD)	30.15	(11.15)	28.08	(8.90)	29.13	(10.16)
Gender - f (%)
- Male	148	(25.0)	107	(18.8)	255	(21.9)
- Female	420	(71.0)	443	(77.7)	863	(74.3)
- Missing	24	(4.1)	20	(3.5)	44	(3.8)
Ethnicity^a - f (%)
- White	439	(74.2)	399	(70.0)	838	(72.1)
- Black	18	(3.0)	32	(5.6)	50	(4.3)
- Yellow	5	(0.8)	9	(1.6)	14	(1.2)
- Indian	2	(0.3)	0	(0.0)	2	(0.2)
- Brown (Pardo)	91	(15.4)	101	(17.7)	192	(16.5)
- Other	11	(1.9)	9	(1.6)	20	(1.7)
- Missing	26	(4.4)	20	(3.5)	46	(4.0)
Marital Status - f (%)
- Single	193	(32.6)	201	(35.3)	394	(33.9)
- Single in a relationship	176	(29.7)	181	(31.8)	357	(3.7)
- Married	161	(27.2)	142	(24.9)	303	(26.1)
- Divorced	18	(3.0)	18	(3.2)	36	(3.1)
- Divorced in a relationship	8	(1.4)	9	(1.6)	17	(1.5)
- Widower	3	(0.5)	0	(0.0)	3	(0.3)
- Widower in a relationship	1	(0.2)	0	(0.0)	1	(0.1)
- Other	3	(0.5)	3	(0.5)	6	(0.5)
- Missing	29	(4.9)	16	(2.8)	45	(3.9)
Educational Level - f (%)
- Low	2	(0.3)	6	(1.1)	8	(0.7)
- Medium	21	(3.6)	43	(7.5)	64	(5.5)
- High	543	(91.7)	496	(87.0)	1039	(89.4)
- Missing	26	(4.4)	25	(4.4)	51	(4.4)
Socioeconomic level - f (%)
- Low	6	(1.0)	7	(1.2)	13	(1.1)
- Medium-Low	196	(33.1)	244	(42.8)	440	(37.9)
- Medium	159	(26.9)	140	(24.6)	299	(25.7)
- Medium-High	91	(15.4)	74	(13.0)	165	(14.2)
- High	107	(18.1)	77	(13.5)	184	(15.8)
- Missing	33	(5.6)	28	(4.9)	61	(5.3)

	Retained personality disorders												Removed personality disorders								Other personality disorders
	Antisocial		Avoidant		Borderline		Narcissistic		Obs.-Comp.		Schizotypal		Paranoid		Schizoid		Histrionic		Dependent		Pa.-Aggres.		Depressive
	Co	Cl	Co	Cl	Co	Cl	Co	Cl	Co	Cl	Co	Cl	Co	Cl	Co	Cl	Co	Cl	Co	Cl	Co	Cl	Co	Cl
ANHE	.12	.16	.47^a	.55^a	.40	.50	.28	.30	.25	.18	.31	.41	.31	.37	.41^a	.50^a	-.04	-.02	.23	.26	.43	.45	.56^a	.66^a
ANXI	.10	.06	.41^a	.43^a	.43^a	.53^a	.34	.32	.31	.23	.39	.47	.38	.42	.09	.24	.20	.21	.39^a	.46^a	.43	.41	.58^a	.60^a
ATT-S	.32	.19	.07	-.05	.33	.34	.53^a	.56^a	.19	.18	.30	.27	.28	.25	.00	-.07	.56^a	.67^a	.26	.26	.35	.25	.23	.15
CALL	.42^a	.39^a	.20	.18	.47	.47	.56	.58	.18	.25	.34	.40	.45	.42	.31	.32	.17	.23	.09	.03	.40	.36	.32	.31
DECE	.47^a	.39^a	.21	.19	.47	.47	.56	.62	.16	.18	.34	.41	.39	.40	.18	.16	.41	.45	.24	.23	.43	.39	.30	.32
DEPR	.14	.23	.43	.51	.46^a	.63^a	.30	.35	.17	.15	.35	.47	.31	.43	.29	.39	.06	.11	.30	.38	.46^a	.45^a	.64^a	.71^a
DIST	.14	.19	.31	.35	.40	.51	.26	.29	.11	.09	.27	.36	.23	.30	.16	.26	.18	.23	.31	.37	.42	.40	.36	.44
ECCE	.34	.25	.18	.26	.47	.55	.42	.43	.25	.22	.52^a	.57^a	.39	.39	.26	.34	.17	.24	.14	.17	.43	.37	.33	.35
EMO-L	.17	.13	.23	.28	.51^a	.65^a	.29	.32	.22	.18	.42	.48	.35	.42	.05	.20	.27^a	.32^a	.36	.44	.39	.39	.37	.46
GRAN	.32	.21	.09	.04	.34	.35	.60^a	.63^a	.37	.30	.39	.41	.35	.34	.19	.18	.29	.41	.10	.07	.34	.36	.22	.18
HOST	.34^a	.32^a	.25	.22	.58^a	.62^a	.53	.54	.30	.35	.40	.47	.56^a	.56^a	.19	.29	.25	.32	.20	.20	.52^a	.52^a	.38	.42
IMPU	.34^a	.30^a	.13	.13	.58^a	.62^a	.34	.38	.10	.11	.30	.37	.32	.36	.10	.13	.32	.35	.28	.34	.38	.37	.29	.32
INT-A	.12	.13	.27^a	.29^a	.15	.25	.18	.20	.13^a	.17^a	.22	.29	.21	.24	.43^a	.41^a	-.04	.02	.01	-.05	.17	.18	.20	.26
IRRE	.42^a	.32^a	.25	.25	.47	.54	.45	.41	.09	.02	.38	.39	.35	.30	.18	.20	.28	.27	.28	.27	.46	.46	.25	.35
MANI	.40^a	.33^a	.07	-.04	.39	.37	.51	.55	.23	.23	.35	.31	.32	.29	.09	.07	.43^a	.50^a	.15	.11	.31	.27	.18	.16
PER-D	.33	.33	.25	.24	.57	.64	.45	.50	.27	.24	.61^a	.64^a	.43	.43	.21	.28	.25	.34	.25	.29	.46	.46	.37	.43
PERS	.22	.17	.35	.38	.47	.50	.40	.38	.39^a	.33^a	.44	.46	.35	.39	.23	.22	.16	.30	.32	.37	.46	.37	.42	.45
RES-A	.22	.19	.39	.28	.27	.30	.32	.35	.22^a	.19^a	.31^a	.30^a	.33	.27	.43^a	.40^a	-.02	.04	.05	-.02	.29	.24	.32	.24
RIG-P	.15	.01	.21	.16	.26	.23	.34	.29	.57^a	.51^a	.42	.33	.36	.31	.19	.17	.05	.14	.18	.07	.26	.19	.28	.24
RIS-T	.34^a	.25^a	-.12	-.20	.26^a	.24^a	.20	.26	.04	-.01	.22	.13	.18	.06	-.01	-.02	.26	.28	.02	-.01	.15	.13	.00	-.02
SEP-I	.14	.08	.28	.22	.37^a	.43^a	.34	.35	.13	.05	.27	.33	.29	.30	.01	.00	.23	.32	.55^a	.59^a	.38	.23	.37	.40
SUBM	.10	.06	.36	.35	.29	.29	.28	.19	.18	.09	.25	.22	.18	.20	.09	.09	.18	.23	.40^a	.41^a	.31	.18	.33	.36
SUSP	.31	.23	.31	.32	.49	.58	.53	.52	.28	.29	.59^a	.62^a	.62^a	.66^a	.31	.33	.23	.24	.30	.26	.47	.47	.44	.52
U-B-E	.34	.29	.08	.10	.44	.46	.43	.41	.29	.23	.69^a	.65^a	.37^a	.35^a	.18	.27	.22	.25	.15	.12	.38	.35	.23	.25
WITH	.19	.17	.54^a	.56^a	.33	.45	.36	.28	.28	.20	.39^a	.47^a	.39	.43	.52^a	.53^a	-.10	-.10	.17	.09	.34	.32	.44	.48
NEG-A	.23	.19	.40	.43	.61	.70	.49	.46	.32	.25	.51	.57	.49	.55	.12	.23	.31	.36	.53	.57	.57	.49	.58	.66
DETA	.25	.25	.54	.56	.45	.60	.44	.44	.30	.26	.48	.56	.48	.52	.55	.57	.01	.06	.21	.20	.47	.47	.56	.64
ANTA	.48	.38	.18	.10	.55	.56	.71	.74	.32	.32	.46	.48	.50^a	.48^a	.19	.19	.49	.57	.23	.20	.50	.46	.34	.32
DISI	.35	.34	.12	.14	.49	.56	.28	.33	-.13	-.10	.22	.30	.22	.24	.07	.14	.33	.32	.24	.31	.38	.38	.21	.29
PSYC	.39	.32	.19	.23	.56	.61	.50	.49	.31	.25	.69	.68	.46	.43	.26	.34	.23	.30	.20	.21	.48	.43	.35	.38

DSM-5	DSM-IV
	Retained personality disorders												Removed personality disorders								Other personality disorders
	ASPD		APD		BPD		NPD		OCPD		STPD		PPD		SPD		HPD		DPD		PAPD		DEPPD
	Co	Cl	Co	Cl	Co	Cl	Co	Cl	Co	Cl	Co	Cl	Co	Cl	Co	Cl	Co	Cl	Co	Cl	Co	Cl	Co	Cl
ASPD	.54	.46	.19	.14	.66	.68	.63	.66	.23	.23	.47	.50	.52	.49	.20	.22	.45	.49	.26	.25	.53	.50	.35	.38
APD	.18	.17	.58	.61	.45	.57	.40	.36	.33	.26	.49	.54	.44	.48	.49	.56	.01	.03	.28	.25	.47	.45	.61	.66
BPD	.34	.28	.35	.35	*.71*	*.79*	.51	.53	.28	.22	.52	.58	.53	.54	.14	.26	.37	.40	.47	.52	.59	.53	.57	.62
NPD	.36	.22	.09	-.01	.39	.39	*.64*	*.67*	.31	.27	.39	.38	.35	.33	.10	.05	.49	.62	.22	.20	.39	.38	.26	.19
OCPD	.25	.18	.43	.39	.40	.44	.44	.43	.47	.43	.49	.49	.44	.43	.46	.43	.05	.17	.19	.12	.41	.34	.43	.41
STPD	.38	.37	.41	.40	.56	.64	.55	.53	.35	.30	*.67*	*.69*	.56	.55	.45	.48	.14	.20	.22	.19	.52	.47	.48	.49
PPD	.40	.33	.34	.33	.60	.66	.60	.57	.36	.36	*.67*	.68	.64	.63	.41	.45	.23	.28	.23	.18	.55	.52	.45	.50
SPD	.21	.21	.51	.54	.35	.48	.36	.36	.27	.24	.38	.47	.39	.42	*.56*	*.59*	-.06	-.02	.13	.09	.38	.38	.47	.52
HPD	.39	.28	.16	.08	.53	.59	.58	.62	.27	.26	.46	.46	.41	.42	.06	.09	.55	*.64*	.33	.35	.45	.39	.34	.34
DPD	.14	.08	.45	.42	.46	.52	.41	.37	.26	.15	.39	.43	.36	.38	.08	.13	.26	.33	*.57*	*.63*	.48	.35	.55	.57
PAPD	.32	.32	.39	.43	.65	.73	.53	.53	.30	.28	.47	.55	.56	.58	.28	.40	.22	.25	.29	.35	.61	.57	.59	.67
DEPPD	.14	.18	.53	.58	.52	.64	.38	.38	.31	.21	.43	.52	.41	.47	.30	.44	.10	.12	.38	.43	.53	.51	*.71*	*.76*

Personality Disorders	Model 1						Model 2
	R ²		∆R ²				R ²		∆R ²
	R ²		Specified traits		Non-specified traits		R ²		Specified traits		Other correlated traits
	Co	Cl	Co	Cl	Co	Cl	Co	Cl	Co	Cl	Co	Cl
Retained
Antisocial	.34	.27	.12^c	.11^c	.03	.05^b	.32	.25	.13^c	.13^c	.01	.03^c
Avoidant	.45	.49	.07^c	.07^c	.08^c	.08^c	.40	.44	.10^c	.12^c	.03^b	.04^c
Borderline	.61	.70	.12^c	.12^c	.06^c	.05^c	.60	.70	.12^c	.12^c	.06^c	.04^c
Narcissistic	.58	.61	.06^c	.06^c	.16^c	.16^c	.58	.61	.06^c	.06^c	.16^c	.15^c
Ob.- Comp.	.39	.33	.12^c	.12^c	.06^c	.06^c	.35	.30	.15^c	.15^c	.01^a	.03^c
Schizotypal	.63	.61	.23^c	.17^c	.03^b	.02^a	.63	.61	.25^c	.18^c	.03^c	.02^b
Removed
Paranoid	.51	.52	.11^c	.13^c	.03	.03^a	.51	.51	.11^c	.13^c	.02	.03^a
Schizoid	.37	.41	.14^c	.10^c	.04^a	.05^c	.34	.36	.18^c	.16^c	.01	.01
Histrionic	.41	.54	.09^c	.09^c	.08^c	.07^c	.37	.48	.14^c	.19^c	.04^c	.01
Dependent	.40	.47	.13^c	.10^c	.05^b	.06^c	.37	.44	.16^c	.17^c	.02^a	.02^b
Pas.-Aggr.	.48	.46	.03^c	.03^c	.11^c	.14^c	.47	.46	.03^c	.03^c	.11^c	.13^c
Depressive	.55	.61	.16^c	.14^c	.03^b	.03^c	.54	.61	.17^c	.15^c	.03^b	.03^c

			Categorical Model (DSM-IV)		Predictive Value		Correspondence
			Negative	Positive	Negative	Positive	Kappa	p-value
Alternative Model (DSM-5)	Antisocial	Negative	1049	88	98.96	13.73	.193	< .001
	Antisocial	Positive	11	14	98.96	13.73	.193	< .001
	Avoidant	Negative	735	72	77.29	65.88	.341	< .001
	Avoidant	Positive	216	139	77.29	65.88	.341	< .001
	Borderline	Negative	960	86	97.36	51.14	.564	< .001
	Borderline	Positive	26	90	97.36	51.14	.564	< .001
	Narcissistic	Negative	1016	71	97.32	39.83	.443	< .001
	Narcissistic	Positive	28	47	97.32	39.83	.443	< .001
	Obsessive-Compulsive	Negative	1020	103	97.70	12.71	.148	< .001
	Obsessive-Compulsive	Positive	24	15	97.70	12.71	.148	< .001
	Schizotypal	Negative	1020	59	96.68	44.86	.462	< .001
	Schizotypal	Positive	35	48	96.68	44.86	.462	< .001
	Paranoid	Negative	968	141	98.78	22.53	.299	< .001
	Paranoid	Positive	12	41	98.78	22.53	.299	< .001
	Schizoid	Negative	963	129	97.37	25.43	.302	< .001
	Schizoid	Positive	26	44	97.37	25.43	.302	< .001
	Histrionic	Negative	1061	75	98.79	14.77	.200	< .001
	Histrionic	Positive	13	13	98.79	14.77	.200	< .001
	Dependent	Negative	948	166	98.75	17.82	.237	< .001
	Dependent	Positive	12	36	98.75	17.82	.237	< .001
	Passive-Aggressive	Negative	857	194	97.28	30.96	.356	< .001
	Passive-Aggressive	Positive	24	87	97.28	30.96	.356	< .001
	Depressive	Negative	878	149	97.23	42.47	.479	< .001
	Depressive	Positive	25	110	97.23	42.47	.479	< .001

	Retained personality disorders						Removed personality disorders				Other personality disorders
	ASPD (n = 18)	APD (n = 30)	BPD (n = 4)	NPD (n = 6)	OCPD (n = 17)	STPD (n = 4)	PPD (n = 10)	SPD (n = 35)	HPD (n = 14)	DPD (n = 31)	PAPD (n = 36)	DEPPD (n = 15)
Anhedonia	5.6	20.0^a	50.0	0.0	11.8	25.0	0.0	22.9^a	0.0	22.6	19.4	46.7^b
Anxiousness	5.6	26.7^b	0.0^a	16.7	11.8	25.0	20.0	8.6	28.6	25.8^b	13.9	40.0^b
Attention Seeking	11.1	3.3	0.0	50.0^b	0.0	25.0	30.0	5.7	21.4^b	12.9	5.6	13.3
Callousness	5.6^a	3.3	25.0	16.7	5.9	0.0	10.0	8.6	7.1	3.2	8.3	0.0
Deceitfulness	11.1^a	0.0	25.0	33.3	0.0	0.0	10.0	5.7	7.1	12.9	13.9	6.7
Depressivity	5.6	33.3	75.0^a	0.0	0.0	25.0	10.0	17.1	7.1	19.4	16.7^b	26.7^b
Distractibility	5.6	26.7	25.0	33.3	11.8	25.0	0.0	8.6	7.1	25.8	13.9	26.7
Eccentricity	22.2	6.7	75.0	16.7	11.8	50.0^a	10.0	8.6	7.1	9.7	25.0	0.0
Emotional Lability	11.1	13.3	50.0^a	33.3	5.9	50.0	10.0	5.7	14.3^b	16.1	19.4	0.0
Grandiosity	0.0	3.3	25.0	50.0^b	5.9	0.0	10.0	11.4	14.3	9.7	13.9	0.0
Hostility	11.1^a	3.3	25.0^c	33.3	11.8	0.0	10.0^a	11.4	7.1	16.1	13.9^b	6.7
Impulsivity	5.6^a	13.3	75.0^c	33.3	5.9	0.0	20.0	0.0	14.3	12.9	19.4	6.7
Intimacy Avoidance	5.6	10.0^a	25.0	16.7	0.0^a	25.0	20.0^a	28.6^b	7.1	3.2	5.6	6.7
Irresponsibility	5.6^a	16.7	50.0	0.0	0.0	50.0	10.0	8.6	0.0	6.5	5.6	6.7
Manipulativesness	16.7^a	6.7	0.0	33.3	11.8	25.0	20.0	5.7	14.3^b	16.1	11.1	0.0
Perceptual Dysregul.	22.2	0.0	75.0	16.7	5.9	25.0^a	0.0	0.0	7.1	9.7	5.6	0.0
Perseveration	0.0	6.7	50.0	16.7	11.8^a	25.0	10.0	2.9	7.1	16.1	11.1	13.3
Restricted Affectivity	33.3	10.0	75.0	0.0	5.9^a	25.0^a	10.0	14.3^a	0.0	3.2	5.6	6.7
Rigid Perfectionism	5.6	3.3	50.0	0.0	17.6^b	0.0	0.0	2.9	7.1	19.4	11.1	13.3
Risk Taking	16.7^a	0.0	25.0^c	0.0	0.0	0.0	10.0	2.9	28.6	3.2	8.3	6.7
Separation Insecurity	0.0	10.0	25.0^a	16.7	5.9	0.0	20.0	2.9	7.1	29.0^b	19.4	26.7
Submissiveness	0.0	23.3	0.0	0.0	0.0	25.0	10.0	5.7	0.0	19.4^b	13.9	20.0
Suspiciousness	0.0	6.7	25.0	16.7	5.9	0.0^a	40.0^b	5.7	7.1	9.7	11.1	0.0
Unusual Beli. & Exp.	5.6	0.0	50.0	0.0	5.9	75.0^a	10.0^a	2.9	7.1	9.7	8.3	0.0
Withdrawal	11.1	20.0^a	25.0	0.0	11.8	50.0^a	0.0	25.7^a	0.0	0.0	13.9	6.7
Negative Affectivity	0.0	23.3	25.0	33.3	5.9	25.0	40.0	2.9	21.4	35.5	16.7	20.0
Detachment	5.6	20.0	50.0	16.7	0.0	25.0	0.0	20.0	0.0	3.2	11.1	13.3
Antagonism	16.7	0.0	0.0	66.7	11.8	0.0	30.0	8.6	14.3	25.8	13.9	6.7
Disinhibition	11.1	10.0	50.0	0.0	0.0	0.0	10.0	2.9	14.3	3.2	11.1	6.7
Psychoticism	11.1	3.3	75.0	0.0	11.8	75.0	10.0	2.9	7.1	6.5	13.9	0.0

Instituto de Psicologia, Universidade de Brasília Instituto de Psicologia, Universidade de Brasília, 70910-900 - Brasília - DF - Brazil, Tel./Fax: (061) 274-6455 - Brasília - DF - Brazil
E-mail: revistaptp@gmail.com

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Personality Types and Personality Traits in DSM-5: Do They Really Match?* * Apoio: CNPq; MCTI/CNPq/MEC/CAPES Nº 18/2012; CAPES; PDSE-CAPES (number 99999.007135/2014-09).

Tipos e Traços de Personalidade no DSM-5: Eles Realmente Combinam?

Abstract

Personality Types and Personality Traits in DSM-5: Do They Really Match?^* * Apoio: CNPq; MCTI/CNPq/MEC/CAPES Nº 18/2012; CAPES; PDSE-CAPES (number 99999.007135/2014-09).