The DSM-5 Alternative Model for Personality Disorders The DSM-5 Alternative Model for Personality Disorders reviews and advances this innovative and increasingly popular scheme for diagnosing and evaluating personality disorders. The authors identify the multiple clinical, theoretical, and research paradigms that co-exist in the Alternative Model for Personality Disorders (AMPD) and show how the model can aid the practicing mental health professional in evaluating and treating patients, as well as show its importance in stimulating research and theore- tical understanding of this domain. This work explores and summarizes methods of personality assessment and psychiatric evaluation, research findings, and clinical applications of the AMPD, highlighting its usefulness to clinical teaching and supervision, forensic application, and current research. It is a go-to reference for experienced professionals and researchers, those who wish to learn this new diagnostic system, and for clinicians in training. Christopher J. Hopwood is an associate professor of psychology at the University of California, Davis. Abby L. Mulay is a postdoctoral fellow in clinical forensic psychology at the Medical University of South Carolina, Charleston. Mark H. Waugh is a staff psychologist at the Oak Ridge National Labora- tory, adjunct clinical and teaching faculty at the University of Tennessee, Knoxville, and is in private practice in Oak Ridge, Tennessee. This page intentionally left blank The DSM-5 Alternative Model for Personality Disorders Integrating Multiple Paradigms of Personality Assessment Edited by Christopher J. Hopwood, Abby L. Mulay and Mark H. Waugh First published 2019 by Routledge 52 Vanderbilt Avenue, New York, NY 10017 and by Routledge 2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN Routledge is an imprint of the Taylor & Francis Group, an informa business © 2019 Taylor & Francis The right of Christopher J. Hopwood, Abby L. Mulay, and Mark H. Waugh to be identified as the authors of the editorial material, and of the authors for their individual chapters, has been asserted in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Library of Congress Cataloging in Publication Data Names: Hopwood, Christopher J., 1976- editor. | Mulay, Abby L., editor. | Waugh, Mark H., editor. Title: The DSM-5 alternative model for personality disorders : integrating multiple paradigms of personality assessment / edited by Christopher J. Hopwood, Abby L. Mulay, and Mark H. Waugh. Description: New York, NY : Routledge, 2019. | Includes bibliographical references and index. Identifiers: LCCN 2018044678 (print) | LCCN 2018045892 (ebook) | ISBN 9781315205076 (E-book) | ISBN 9781138693135 (hardback) | ISBN 9781138696327 (pbk.) | ISBN 9781315205076 (ebk.) Subjects: | MESH: Diagnostic and statistical manual of mental disorders. 5th ed. | Personality Disorders--diagnosis | Personality Assessment | Models, Psychological Classification: LCC RC473.P56 (ebook) | LCC RC473.P56 (print) | NLM WM 190 | DDC 616.85/81075--dc23 LC record available at https://lccn.loc.gov/2018044678 ISBN: 978-1-138-69313-5 (hbk) ISBN: 978-1-138-69632-7 (pbk) ISBN: 978-1-315-20507-6 (ebk) Typeset in Times New Roman by Taylor & Francis Books Christopher J. Hopwood: I dedicate this book to my teachers, students, and patients. I am grateful to the DSM-5 Personality and Personality Disorders Work Group, whose Alternative Model has been a watershed in the mental health revolution that was a long time coming. Finally, it has been a privilege to work with Mark Waugh and Abby Mulay, whose clinical sensitivity, scholarship, and good nature largely explain any contribution this book might make in promoting a more holistic, integrative, and evidence-based conceptualization of people and their difficulties. Abby L. Mulay: My journey to clinical psychology was nonlinear and required a little bit of faith in me by my mentors, so I dedicate this work to those who are willing to take a chance on the unexpected. I am grateful for the continued mentorship of Christopher J. Hopwood, Mark H. Waugh, and my graduate school advisor, Nicole M. Cain. I also dedicate this work to all of the patients/clients I have encountered as a therapist in criminal justice settings. Thank you for challenging me to grow as a therapist, demonstrating the healing power of humor, and inspiring hope in the recovery process. Mark H. Waugh: I dedicate this book to many teachers. These include the guiding lights of Jane Loevinger and Paul Meehl, and the gifts of Roger Blashfield, Sidney Blatt, and many talented professors and supervisors too numerous to list. Beginnings include my physician-scientist father, William H. Waugh, my mother, Eileen G. Waugh, who “knew” people and opposed social injustice long before it was fashionable, and Virginia Forr- est, who practiced what Donald Winnicott has to say about children. Presently, Lorrie G. Beevers and Michael J. O’Connell continue to teach me about people and life. Most important are my best teachers, the many patients who opened their selves to me and therein helped me to know more about being a person. Thank you. This page intentionally left blank Contents List of illustrations ix List of contributors xi Foreword xiv Preface xx 1 Construct and Paradigm in the AMPD 1 MARK H. WAUGH 2 Paradigms of Personality Assessment and Level of Personality Functioning in Criterion A of the AMPD 48 AARON L. PINCUS AND MICHAEL J. ROCHE 3 Criterion B of the AMPD and the Interpersonal, Multivariate, and Empirical Paradigms of Personality Assessment 60 ROBERT F. KRUEGER 4 Research and Assessment with the AMPD 77 CHRISTOPHER J. HOPWOOD 5 Clinical Utility and Application of the AMPD 96 MARK H. WAUGH 6 The AMPD and Three Well-Known Cases 141 CHRISTOPHER J. HOPWOOD AND MARK H. WAUGH 7 The AMPD and Three Well-Known Literary Characters 156 CHRISTOPHER J. HOPWOOD AND MARK H. WAUGH 8 The AMPD in Assessment, Treatment Planning, and Clinical Supervision 184 MARK H. WAUGH, JENNIFER L. BISHOP AND MEGAN R. SCHMIDT viii Contents 9 Forensic Applications of the AMPD and Case Illustration 209 ABBY L. MULAY AND MARK H. WAUGH 10 Concluding Comments: The Value of AMPD Diagnosis 221 NICOLE M. CAIN References 229 Index 282 Illustrations Figures 1.1 The Captain’s Ocean Chart revealed by the Bellman in Lewis Carroll’s (1876/1981) The hunting of the snark: An agony in eight fits. Plate 4, by Henry Holliday. Image in the public domain 24 1.2 Paradigm and construct representation ratings of LPFS, traits, and full AMPD. Dark bar = LPFS; light bar = traits; line = full AMPD. LPFS & traits significantly differed (p < .452 or less) except for characteristic adaptation & interpersonal. One-way ANOVA yielded these effect sizes: η2 = .44, 0, .32, .11, .01, .27, .48, .60, .42). Selected data and figure adapted from Mulay et al. (in press, 2018) 41 1.3 Author’s rating of Ellen West with the LPFS domains and the 25 trait-facet ratings of the AMPD based on various sources 45 1.4 Meehl’s (1964) Checklist of Schizotypic Signs cross-walked with the pathological personality trait-facets of the AMPD 46 2.1 Criterion A aligns with Agency and Communion. From Pincus, A.L. (2011, p. 45). Some comments on nomology, diagnostic process, and narcissistic personality disorder in the DSM-5 proposal for personality and personality disorders. Personality Disorders: Theory, Research, and Treatment, 2, p. 45. Adapted with permission of the American Psychological Association 49 2.2 A multisurface interpersonal assessment. From Pincus, A. L., Sadler, P., Woody, E., Roche, M.J., Thomas, K.M., & Wright, A.G.C. (2014, p.60). Reprinted with permission from Guilford Press 51 x List of illustrations 2.3 Affiliation behavior (top graph), dominance behavior (middle graph), and both affiliation and dominance behavior (bottom graph) over time for Richard. From Sadler, Woody, McDonald, Lizdek, & Little (2015, p.534). Reprinted with permission from P. Sadler and Guilford Press 53 2.4 Aspects of levels of personality organization 54 2.5 Object-relations dyad, dyad reversal, and defended dyad 55 4.1 DSM-5 AMPD Criterion B Hierarchical Trait Model 89 6.1a Madeline’s Level of Personality Functioning profile 145 6.1b Madeline’s Maladaptive Traits profile 145 6.2a Mr. Z’s Level of Personality Functioning profile 149 6.2b Mr. Z’s Maladaptive Traits profile 149 6.3a Jeffery Dahmer’s Level of Personality Functioning profile 152 6.3b Jeffery Dahmer’s Maladaptive Traits profile 152 7.1a Mudwoman’s Level of Personality Functioning profile 164 7.1b Mudwoman’s Maladaptive Traits profile 164 7.2a Humbert Humbert’s Level of Personality Functioning profile 173 7.2b Humbert Humbert’s Maladaptive Traits profile 174 7.3a Lolita’s Level of Personality Functioning profile 179 7.3b Lolita’s Maladaptive Traits profile 179 8.1 PAI profile for Mr. M & Ms. K 188 8.2a Mr. M & Ms. K combined (mean) ratings on LPFS (extended) constructs 191 8.2b Mr. M & Ms. K combined (mean) ratings on 25 trait-facets 191 Tables 4.1 Measures of DSM-5 Alternative Model of Personality Disorders Criterion A Personality Dysfunction 79 4.2 Measures of DSM-5 Alternative Model of Personality Disorders Criterion B Maladaptive Traits 86 6.1 Perceived clinical utility of AMPD among 25 clinician raters 154 6.2 Correlations between AMPD profiles and Morey, Benson, and Skodol (2016) personality disorder prototypes 154 7.1 Correlations between AMPD profiles and Morey et al. (2016) personality disorder prototypes 181 8.1 Meehl (1964) Checklist of Schizotypic Signs: Mr.