DSM-5 AMPD Maladaptive Personality Traits: One-Year Temporal Stability and Associations with Therapeutic Processes and Outcomes

DSM-5 AMPD Maladaptive Personality Traits: One-Year Temporal Stability and Associations with Therapeutic Processes and Outcomes | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL Journal of Clinical Psychology This is a preprint and has not been peer reviewed. Data may be preliminary. 6 January 2025 V1 Latest version Share on DSM-5 AMPD Maladaptive Personality Traits: One-Year Temporal Stability and Associations with Therapeutic Processes and Outcomes Authors : Brittany Buck , Kapil Chauhan , Rebecca Thompson , and John Donahue 0000-0002-6175-811X [email protected] Authors Info & Affiliations https://doi.org/10.22541/au.173615057.74808140/v1 Published Journal of Clinical Psychology Version of record Peer review timeline 812 views 326 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Objective: The Personality Inventory for DSM-5 (PID-5) is the primary operationalization of the DSM-5 AMPD maladaptive trait framework. This study sought to examine the temporal stability of the PID-5 across one-year, as well as its concurrent and longitudinal associations with clinically relevant external criteria. Methods: Participants with heighted borderline personality features completed the PID-5 and measures of emotional, cognitive, and behavioral processes, as well as psychiatric symptomology, at baseline ( N = 107) and 1-year follow-up ( N = 72). Rank-order stability and mean-level changes for the PID-5 domains and facets were calculated, along with correlations with outcomes. Results: Results suggest high stability in terms of rank-order (median test-retest reliability estimate of .74 for domains and .70 for facets), but small to moderate mean-level changes were common. Prospective associations with clinical criteria suggest domains and facets are predictive of important therapeutic change processes and outcomes in theoretically expected ways. Conclusion: Findings generally support the stability of AMPD maladaptive traits and provide further evidence for the model’s clinical utility. DSM-5 AMPD Maladaptive Personality Traits: One-Year Temporal Stability and Associations with Therapeutic Processes and Outcomes Abstract Objective: The Personality Inventory for DSM-5 (PID-5) is the primary operationalization of the DSM-5 AMPD maladaptive trait framework. This study sought to examine the temporal stability of the PID-5 across one-year, as well as its concurrent and longitudinal associations with clinically relevant external criteria. Methods: Participants with heighted borderline personality features completed the PID-5 and measures of emotional, cognitive, and behavioral processes, as well as psychiatric symptomology, at baseline ( N = 107) and 1-year follow-up ( N = 72). Rank-order stability and mean-level changes for the PID-5 domains and facets were calculated, along with correlations with outcomes. Results: Results suggest high stability in terms of rank-order (median test-retest reliability estimate of .74 for domains and .70 for facets), but small to moderate mean-level changes were common. Prospective associations with clinical criteria suggest domains and facets are predictive of important therapeutic change processes and outcomes in theoretically expected ways. Conclusion: Findings generally support the stability of AMPD maladaptive traits and provide further evidence for the model’s clinical utility. Keywords: Personality disorders; temporal stability; alternative model of personality disorders; PID-5; therapeutic processes; convergent validity DSM-5 AMPD Maladaptive Personality Traits: One-Year Temporal Stability and Associations with Therapeutic Processes and Outcomes The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013) included an alternative model for personality disorders in Section III to promote additional research on this proposed dimensional model of personality pathology. The AMPD classifies personality pathology using two primary criteria. Criterion A reflects impairments in personality functioning and characterizes general severity, whereas Criterion B is a maladaptive trait system characterizing the general expression of personality pathology. Criterion B of the AMPD is based on five broad domains, understood largely as extreme maladaptive variants of the five-factor model of personality. The domains include Negative Affectivity (vs. Neuroticism/Emotional Stability), Detachment (vs. Extraversion), Antagonism (vs. Agreeableness), Disinhibition (vs. Conscientiousness), and Psychoticism (which may be related to Openness). The model explicitly acknowledges a hierarchical structure of personality, with 25 lower-order facets of maladaptive personality traits, thus facilitating assessment of higher and lower levels of variation in personality pathology (Krueger et al., 2011). The Personality Inventory for DSM-5 (PID-5; Krueger et al., 2012) is a 220-item self-report instrument that was developed as the initial primary tool for operationalizing the AMPD and was released contemporaneously to the DSM-5 in 2013. The inclusion of the AMPD in Section III of DSM-5, and the development and release of the PID-5 generated substantial research on the reliability and validity of maladaptive personality traits over the past 12 years, and recent reviews have supported the clinical utility of the AMPD framework as well (Bach & Tracy, 2022; Milinkovic & Tiliopoulos, 2020). The primary aim of the present study is to extend this line of research evaluating the psychometric properties of the PID-5.11Although short forms and informant-based measures of the PID-5 have also been developed and subjected to investigation, this paper will focus on research using the original PID-5 and its translations. Reliability and Validity of PID-5 Evidence of test-retest reliability Research on the PID-5 has demonstrated it to be a promising instrument with adequate psychometric characteristics, including internally consistent scales, a replicable factor structure, evidence of convergent and construct validity, but potential issues with discriminant validity and other identified areas that may require refinement (Al-Dajani et al., 2016; Clark & Watson, 2022; Krueger & Markon, 2014). When considering test-retest reliability, only a small number of studies have examined the temporal stability of the PID-5 (Al-Dajani et al., 2016; Barchi-Ferreira & Osorio, 2020). Most studies examining the test-retest reliability of the PID-5 have focused on short-term intervals, ranging from two weeks to two months, and have generally found adequate temporal stability across these periods (Chmielewski et al., 2017; Suzuki et al., 2015; Pires et al., 2017; Zimmermann et al., 2017; Adhiatma & Halim, 2021; Nagy et al., 2022). One exception is a study by Wright and colleagues (2015), which examined a substantially longer interval compared to other PID-5 research on this topic (approximately 1.4 years). Specifically, in a clinical sample of outpatients with at least one PD ( N = 93), the overall change was small for both trait domains ( Mdn d = -.13; Range: .00, .17) and facets ( Mdn d = -.12; Range: .07, .30). Rank order stability estimates for domains ranged from .62 to .75 ( Mdn r = .73) and facets ranged from .41 to .75 ( Mdn r = .68). Based on these findings, Wright et al. concluded there was negligible change and test-retest reliability was highly stable across the study interval. Despite the growing number of studies examining the reliability of the PID-5, additional research continues to be warranted. With the exception of Wright and colleagues’ study, most research on the test-retest reliability of the PID-5 employed fairly brief intervals, and largely included university student participants. Indeed, the status of test-retest reliability research has been described as relatively poor due to the limited number of studies in this area (Barchi-Ferreira & Osorio, 2020) and it is essential that research continue to evaluate the stability of the PID-5 and other operationalizations of the AMPD, with greater emphasis on longer-term intervals and non-student samples. Evidence of convergent validity Relatively robust lines of research have provided support for the convergent validity of the PID-5, or, how well PID-5 domains and facets converge with other measures of the same or similar underlying constructs, including agreement between self- and informant-reports of PID-5 domains and traits (Oltmanns & Oltmanns, 2021); associations with other measures of maladaptive personality traits (Crego et al., 2015; Crego & Widiger, 2016); convergence with the FFM general personality trait structure (Suzuki et al., 2015); and adequate coverage of DSM-5 Section II categorical PD diagnostic symptomology (Al-Dajani et al., 2016). While a thorough review of this literature is beyond the scope of this paper, readers are referred to Zimmerman and colleagues (2019) for a more exhaustive review of the breadth of research in these domains. Another important area relevant to convergent validity is the association between maladaptive personality traits and clinically relevant external criteria. The PID-5 domains and traits are associated with a wide range of external criteria, including psychological distress and other forms of psychiatric symptomology, interpersonal functioning difficulties, aggressive behavior, and impairment in a range of domains, among others (see Zimmerman et al. [2019] for a comprehensive list). In sum, findings across various lines of research have provided strong support for the convergent validity of the PID-5 and its translations. Although the AMPD has shown promise in terms of its clinical utility (Bach & Tracy, 2022; Milinkovic & Tiliopoulos, 2020), a critical aspect to consider is its utility in clinical case formulation and treatment. As part of this, research on the convergent validity of the PID-5 should also emphasize associations with therapeutic change processes, defined as theory-based underlying mechanisms of change that can result in the achievement of various treatment goals (Hayes & Hofmann, 2019). For example, emotion dysregulation is a putatively transdiagnostic process, frequently targeted within psychotherapy, and shown to be a core aspect of borderline personality disorder (BPD), but the role of emotion dysregulation in other forms of personality pathology remains somewhat unclear (Fitzpatrick et al., 2023). Research has demonstrated PID-5 domains are predictive of difficulties with emotion regulation, particularly negative affectivity and detachment (Fowler et al., 2017), supporting the utility of the PID-5 in case formulation and treatment. However, further research examining the pattern of associations between emotion dysregulation and maladaptive traits remains needed. Likewise, rumination is a cognitive process, argued to be transdiagnostic, that has been implicated in the development and maintenance of behavioral dysregulation in BPD (Selby & Joiner, 2009). Further, recent research has also demonstrated an association between AMPD constructs and depressive rumination, specifically negative affectivity, detachment, and psychoticism (Hong & Tan, 2021). Despite these promising findings, research examining associations between maladaptive personality traits and therapeutic process variables are largely cross-sectional, and longitudinal studies are necessary to better elucidate these relationships. The Present Study The broad aim of this research is to expand upon the growing literature on the reliability and validity of the PID-5 assessment of maladaptive personality traits within the AMPD framework. As most studies examining the PID-5’s psychometric characteristics have used student samples and employed cross-sectional designs (Al-Dajani et al., 2016), the present study builds upon prior work through the use of a 1-year longitudinal design and a community sample of participants with heightened symptoms of BPD features . In terms of reliability, as the temporal stability of AMPD maladaptive traits continues to be a lesser studied area (Al-Dajani et al., 2016; Barchi-Ferreira & Osorio, 2020; Freilech et al., 2023), we sought to examine the test-retest reliability of the PID-5 domains and facets across a period of one year by characterizing both rank-order stability (Pearson’s r ) and mean-level change (Cohen’s d ). In terms of convergent validity, we sought to examine the concurrent and 1-year prospective associations between PID-5 domains and facets and a series of theoretically relevant emotional, cognitive, and behavioral processes, as well as psychiatric symptomology. Emotional processes included measures of difficulties with emotion regulation, distress intolerance, and experiential avoidance11Although experiential avoidance is often considered a broader construct than emotional avoidance, reflecting tendencies to avoid other experiences such as thoughts and sensations, for the purposes of this paper, we are discussing experiential avoidance alongside other neighboring measures of emotion regulation (Conway et al., 2020).; cognitive processes included measures of depressive rumination, anger rumination, and fusion with thoughts; and behavioral processes included measures of coping (adaptive and maladaptive) and aggression. Finally, psychiatric symptomology was indexed via measures of BPD symptoms, psychological distress, and suicidal ideation and intent. Participants and Procedure Participants were recruited using Amazon’s Mechanical Turk (MTurk), an online crowdsourcing marketplace where research participants are recruited for compensation, as part of a larger study on the association between AMPD-indexed BPD constructs and clinical and workplace outcomes among individuals with elevated borderline personality disorder (BPD) symptomology (see Redacted for Blinding Purposes ). Inclusion criteria was as follows: participants must have been at least 18 years of age, able to read and write, employed (full or part-time), and obtained a score of 6 or higher on the McLean Screening Instrument for BPD (MSI-BPD; Zanarini et al., 2003) during the screening phase. Participants were also required to have an MTurk approval rating of 95% or greater, and duplicate IP addresses and suspicious Geocode locations were blocked. Seven hundred MTurk workers located in the United States responded to an advertisement for our study, with 124 meeting inclusion criteria and receiving an invitation to participate. At the time of screening, participants provided their MTurk identification codes so they could be directly contacted by the study team for follow-up. A total of 107 participants with elevated BPD symptomology ultimately enrolled in the study, with ages ranging from 18 to 57 years ( M = 30.94, SD = 7.33), and 51% of the sample identifying as female and 49% identifying as male. The racial/ethnic distribution of the sample included 73% identifying as White, 7% African American, 6% Asian/Pacific Islander, 6% Multiracial, 5% Hispanic, and 1% Native American. As part of the larger study, participants were reassessed on various occupational and mental health outcomes every 3 months for a period of 1 year. This study focuses on measurements taken at baseline ( N = 107) and 1-year follow-up ( N = 72), which reflects an attrition rate of 33%. Materials AMPD Maladaptive Personality Trait Measure Personality Inventory for DSM-5 (PID-5). The PID-5 (Krueger et al., 2012) is a 220-item self-report questionnaire that evaluates five broad domains (Negative Affectivity, Detachment, Antagonism, Disinhibition, and Psychoticism) and 25 underlying facets of maladaptive personality traits. Participants rate each item on a 4-point Likert-type scale ranging from 0 ( very false or often false ) to 3 ( very true or often true ), with 4-14 items averaged for each facet, and sets of three primary facets averaged for each domain to calculate overall domain scores. Research has demonstrated the PID-5 possesses adequate internal consistency and evidence of convergent validity (see Al-Dajani et al., 2016). In the present study, domain level McDonald’s omega values ranged from .90 (Antagonism) to .95 (Psychoticism) at baseline and from .92 (Antagonism and Disinhibition) to .96 (Psychoticism) at Time 2. Facet-level values ranged from .79 (Restricted Affectivity) to .95 (Eccentricity) at baseline, and from .71 (Suspiciousness) to .94 (Eccentricity) at Time 2. Emotional Process Measures Difficulties in Emotion Regulation Scale (DERS). The DERS (Gratz & Roemer, 2004) is a 36-item self-report measure designed to assess an individual’s perceived difficulties with experiencing and responding to distressing emotions. Participants select the frequency of behaviors, experiences, or beliefs on a 5-point Likert-type scale ranging from 1 ( almost never ) to 5 ( almost always ), with higher scores indicating greater difficulties in emotion regulation. Prior research has demonstrated strong internal consistency (Gratz & Roemer, 2004), as well as convergent validity with other emotion regulation measures, psychiatric symptoms, and impulsive behaviors (Miller et al., 2022; Sörman et al., 2022). In the present study, internal consistency was considered good at both baseline (𝝎 = .93) and Time 2 (𝝎 = .95). Distress Tolerance Scale (DTS). The DTS (Simons and Gaher, 2005) is a 15-item self-report measure designed to assess an individual’s perceived capacity to withstand negative emotional states. Participants rate their behavior on a 5-point Likert-type scale ranging from 1 ( strongly agree ) to 5 ( strongly disagree ), with higher scores indicative of greater intolerance of distress. Prior research has demonstrated good internal consistency, test-retest reliability, and convergent and discriminant validity for the DTS (Simon and Gaher, 2005; Leyro et al., 2011). In the present study, McDonald’s omega values were 𝝎 = .92 at baseline and 𝝎 = .95 at Time 2. Acceptance and Action Questionnaire-II (AAQ-II). The AAQ-II (Bond et al., 2011) is a 7-item self-report instrument designed to assess experiential avoidance and psychological inflexibility. Participants rate each statement on a 7-point Likert-type scale ranging from 1 ( never true ) to 7 ( always true ). Higher scores on the AAQ-II indicate greater psychological inflexibility/experiential avoidance. Studies have demonstrated adequate construct validity and reliability for the AAQ-II (Fledderus et al., 2012; Renshaw, 2018), however recent concerns about the discriminant validity of the AAQ-II apart from neuroticism/distress have been identified as well (Rochefort et al., 2018; Wolgast, 2014). In the present study, the AAQ-II was not administered at baseline and internal consistency at 1-year follow-up was 𝝎 = .93. Brief Experiential Avoidance Questionnaire (BEAQ). The BEAQ (Gámez et al., 2014) is a 15-item shortened version of the Multidimensional Experiential Avoidance Questionnaire (MEAQ; Gámez et al., 2011) and is designed to measure experiential avoidance. Items are rated on a 6-point Likert-type scale ranging from 1 ( strongly disagree ) to 6 ( strongly agree ), with higher scores corresponding to greater levels of experiential avoidance. Previous research using the BEAQ indicates adequate discriminant validity and convergent validity (Gámez et al., 2014; Rochefort et al., 2018; Tyndall et al., 2019). The BEAQ was not administered at baseline in the present study, and McDonald’s omega at 1-year follow-up was 𝝎 = .85. Cognitive Process Measures Ruminative Responses Scale (RRS). The RRS (Treynor et al., 2003) is a 22-item self-report questionnaire assessing the frequency with which one tends to negatively self-reflect and think about the causes and the consequences of their mood when feeling sad or depressed. The 5-item Brooding subscale was used in the present study, which reflects a passive and judgmental style of rumination that is predictive of depressive symptomology (Schoofs et al., 2010). Participants rate how often they negatively reflect when feeling sad or depressed on a 4-point Likert-type scale ranging from 1 ( almost never ) to 4 ( almost always ). Prior research demonstrated RRS-Brooding has adequate reliability (Treynor et al., 2003; Watkins, 2009) and associations with increased psychiatric symptomology (Schoofs et al., 2010; Watkins, 2009). In the present study, McDonald’s omega was 𝝎 = .81 at baseline and 𝝎 = .78 at Time 2. Anger Rumination Scale (ARS). The ARS (Sukhodolsky et al., 2001) is a 19-item self-report measure designed to assess an individual’s tendency to repetitively think about current anger-provoking experiences, recall past anger episodes, and think about the causes and consequences of anger episodes and revenge. Participants rate each item on a 4-point Likert-type scale ranging from 1 ( almost never ) to 4 ( almost always ), with higher scores reflecting more frequent angry rumination. Prior research suggests adequate internal consistency and test-retest reliability for the ARS (Sukhodolsky et al., 2001), as well as evidence of convergent validity (Hosie et al., 2022). In the present study, 𝝎 = .93 at baseline and 𝝎 = .95 at Time 2. Cognitive Fusion Questionnaire (CFQ). The CFQ (Gillanders et al., 2014) is a 7-item self-report measure that assesses an individual’s tendency to engage with thoughts literally and be overly influenced by their content. Individuals rate each item on a 7-point Likert-type scale ranging from 1 ( never true ) to 7 ( always true ) with higher scores indicating greater fusion with cognitions. Prior research on the CFQ in clinical and non-clinical samples has demonstrated adequate construct validity and reliability (Donati et al., 2021; Gillanders et al., 2014). The CFQ was not administered at baseline in the present study, but at 1-year follow-up, 𝝎 = .94. Behavioral Process Measures Forms of Aggression Instrument (FOA). The FOA (Verona et al., 2008) is a 40-item self-report questionnaire that measures frequency of engagement in five forms of aggressive behavior: physical aggression, property aggression, verbal aggression, relational aggression, and passive-rational aggression. Individuals rate each item on a 5-point Likert-type scale ranging from 1 ( almost never ) to 5 ( always ). The total score was used in the present study, with higher scores reflecting more frequent general aggressive behavior. Past research using the FOA demonstrates adequate reliability as well as convergent validity (Schoenleber et al., 2021; Schoenleber et al., 2011; Verona et al., 2008). In the present study, 𝝎 = .97 at both time points. Dialectical Behavior Therapy Ways of Coping Checklist (DBT-WCCL). The DBT-WCCL (Neacsiu et al., 2010) is a measure of frequency of coping strategy use that includes two subscales: DBT skill use and dysfunctional coping skill use. The DBT-WCCL is a 59-item self-report instrument that uses a 4-point Likert-type scale ranging from 0 ( never use ) to 3 ( always use ). DBT skill use (DBT-WCCL-DSS) is reflected in the frequency of use of four skills taught in DBT: mindfulness, emotional regulation, interpersonal effectiveness, and distress tolerance. Dysfunctional coping skill use (DBT-WCCL-DCS) refers to both generalized dysfunctional coping and blaming others for issues/problems. Previous research indicates adequate internal consistency, convergent validity, and discriminant validity (Neacsiu et al., 2010; Stein et al., 2016). The DBT-WCCL was not administered at baseline, but at 1-year follow-up, internal consistency for DBT-WCCL-DSS was 𝝎 = .95 and DBT-WCCL-DCS was 𝝎 = .85. Psychiatric Symptomology Measures McLean Scoring Instrument for BPD (MSI-BPD). The MSI-BPD (Zanarini et al., 2003) is a 10-item self-report questionnaire designed to screen for borderline personality disorder (BPD), with participants responding to prompts about DSM BPD criteria with either yes (1) or no (0). Prior sensitivity and specificity analyses have suggested a cutoff of 7 or above is indicative of a likely BPD diagnosis. Research has indicated the MSI-BPD possesses good internal consistency (Zanarini et al., 2003; Martin et al., 2023), test-retest reliability (Zanarini et al., 2003), and adequate criterion validity (Patel et al., 2011). In the present study, participants were selected for inclusion if they scored 6 or above on the MSI-BPD in the screening phase. They were then administered the MSI-BPD at baseline (𝝎 = .61), and again at Time 2 (𝝎 = .76). Depression Anxiety and Stress Scale (DASS-21). The DASS-21 (Lovibond & Lovibond, 1995) is a 21-item self-report instrument measuring severity of depressive, anxious, and stress symptoms. Participants rate the degree to which each item applied to them over the past week on a 4-point Likert-type scale ranging from 0 ( did not apply to me ) to 3 ( applied to me very much, or most of the time ). Although the DASS includes three subscales, research suggests it can best be interpreted as a unidimensional index of psychological distress (Zanon et al., 2021) and we therefore used the total score as our variable of interest. Prior research using the DASS-21 has supported its reliability and construct validity (Lee, 2019; Zanon et al., 2021). In the present study, the DASS-21 was not administered at baseline and 𝝎 = .95 at 1-year follow-up. Suicidality . Suicidal ideation and intent was assessed via two items that were appended to the DASS-21, “ I thought about death or suicide ” and “ I wanted to kill myself. ” Consistent with the structure of the DASS-21, participants rate each item on a 4-point Likert-type scale ranging from 0 ( did not apply to me ) to 3 ( applied to me very much, or most of the time ) with regards to the last week. A mean of both items was calculated with higher scores reflecting greater suicidal ideation/intent. These were not administered at baseline but were administered at 1-year follow-up and internal consistency was .89 (Spearman-Brown coefficient). Results Temporal Stability of PID-5 Table 1 depicts means, standard deviations, and internal consistency estimates for primary study variables at both time points,11Because of the attrition between baseline and 1-year follow-up, we conducted independent samples t tests for the five PID-5 trait domain scores at baseline comparing those who completed both assessment points ( N = 72) and those who dropped out ( N = 35). Only Detachment demonstrated a significant group difference, with those completing both assessment points exhibiting significantly higher scores than those who dropped out, t (105) = -2.35, d = -.48, p = .02. as well as estimates of the temporal stability of the PID-5. Given the small sample size, 95% confidence intervals are also reported in tables to characterize the degree of uncertainty around point estimates. To calculate the temporal stability of AMPD maladaptive traits, we first computed a series of zero-order correlations (Pearson’s r ) between baseline PID-5 domain and facet scores with scores at 1-year follow-up. Estimates for the five maladaptive trait domains across one year were somewhat similar, with a range of .68 (Negative Affectivity) to a high of .78 (Psychoticism). Across the five PID-5 domains, both the mean and median r values were .74. Correlations among facets were more varied, ranging from .49 (Submissiveness) to .86 (Callousness), with a mean value of .69 and a median value of .70. The Antagonism domain demonstrated the largest degree of intra-domain facet variability with a range of .32, while Psychoticism exhibited the least intra-domain variability with a range of .02. Intra-domain facet variability for the remainder of the domains were as follows: .21 for Negative Affectivity, .15 for Disinhibition, and .06 for Detachment. To calculate the magnitude of mean-level change across 1 year among the AMPD maladaptive traits, a series of paired samples t -tests were computed, and effect sizes were calculated using Cohen’s d . Across the five trait domains, the magnitude of change ranged from d = -.21 (Detachment) to d = -.58 (Negative Affectivity), with a mean d of -.47 ( Mdn = -.56) suggesting PID-5 domains exhibited small to moderate changes overall. Again, facet-level changes were much more variable, with Intimacy Avoidance exhibiting the lowest degree of change ( d = -.04), Distractibility exhibiting the largest change in mean scores ( d = -.61), and a mean change of .34 ( Mdn = -.40). In considering intra-domain facet-level variability, ranges varied from a low of .14 for Antagonism, and a high of .46 for Disinhibition. Convergent Validity of PID-5 To examine the associations between AMPD maladaptive personality traits and therapeutic processes and psychiatric symptomology, a series of zero-order correlations (Pearson’s r ) were computed between the PID-5 scales at baseline, and measures of emotional, cognitive, and behavioral processes, as well as psychiatric symptomology at baseline and at 1-year follow-up. Results are depicted in Table 2. Emotional Processes. In terms of emotional processes, correlations were computed between baseline PID-5 scales, the DERS and DTS at baseline and 1-year follow-up, and the AAQ-II and BEAQ, which were only administered at 1-year follow-up. At the domain level, concurrent associations with the DERS were moderate to strong for four of the five trait domains ( r ’s ranging from .43 to .69), and no significant associations were found with Antagonism ( r = .07). Similarly, relationships between Negative Affectivity, Disinhibition, and Psychoticism and the DTS were also moderate to strong ( r ’s ranging from .40 to .74), however associations with Detachment ( r = .23) and Antagonism ( r = .17) were small to negligible. At the facet level, the DERS exhibited statistically significant associations with 21 of 25 PID-5 facets, with Negative Affectivity facets generally exhibiting the strongest and most consistent associations ( r ’s ranging from .29 to .72). Statistically significant associations were found between the DTS and the PID-5 across 19 of 25 facets, with Negative Affectivity facets again generally demonstrating the strongest and most consistent associations ( r ’s ranging from .26 to .73). Evidence for links with facets of Antagonism was weakest, with only Deceitfulness demonstrating significant associations with the DERS ( r = .27) and the DTS ( r = .31). Across one year, longitudinal correlations between individual PID-5 domains and the DERS at follow-up ranged from a low of r = .08, p = .51 (Antagonism) to r = .55, p < .001 (Negative Affectivity), with four of the five domains again demonstrating statistically significant associations. Regarding the DTS, 1-year associations ranged from r = .03, p = .82 (Antagonism), to r = .62, p < .001 (Negative Affectivity), with three of five domain associations reaching statistical significance. The AAQ-II exhibited statistically significant and positive longitudinal associations with four of five domains, with Negative Affectivity demonstrating the strongest correlation ( r = .54, p < .001) and Antagonism, on the other hand, not reaching statistical significance ( r = .06, p = .61). All five PID-5 domains were significantly associated with the BEAQ, with r ’s ranging from .31 (Disinhibition) to .43 (Negative Affectivity). Longitudinal facet-level associations were generally attenuated as compared to concurrent associations, with 13 of 25 facets demonstrating statistically significant links with the DERS, again with Negative Affectivity facets exhibiting the strongest and most consistent correlations. Similarly, 13 of 25 statistically significant associations were also identified with the DTS, and associations with Negative Affectivity facets again emerged as generally stronger and more consistent. Seventeen of 25 baseline PID-5 facets exhibited significant associations with the AAQ-II. Finally, 21 of 25 PID-5 facets longitudinally predicted the BEAQ across 1-year. Cognitive Processes. To examine the concurrent and predictive associations between the PID-5 scales and measures of cognitive processes, correlations were computed with the RRS (depressive rumination), ARS (angry rumination), and CFQ (cognitive fusion; measured at 1-year follow-up). At baseline, four of five PID-5 domains were significant and positively associated with RRS, with Antagonism demonstrating a nonsignificant association ( r = .15, p = .13). However, all PID-5 domains were significantly and positively associated with ARS, with r ’s ranging from .35 to .51. At the facet level, statistically significant associations were found between a large number of PID-5 facets and the RRS (21 of 25) as well as the ARS (20 of 25), however there were some notable divergences in associations. Namely, associations with Antagonism facets were generally consistently stronger for the ARS ( r ’s ranging from .12 to .48) as compared to the RRS ( r ’s ranging from .03 to .28). In terms of longitudinal associations, just two of five PID-5 domains were significantly associated with the RRS (Negative Affectivity, r = .60, p < .001; Detachment, r = .36, p = .002), while all five PID-5 domains continued to exhibit significant and positive associations with the ARS ( r ’s ranging from .30 to .54). The CFQ, which was not administered at baseline, was significantly predicted by three of five PID-5 domains (Negative Affectivity, r = .57, p < .001; Detachment, r = .37, p < .001; Psychoticism, r = .24, p = .04). At the facet level, both the RRS and the CFQ were associated with 11 of 25 PID-5 facets, whereas the ARS exhibited significant associations with 17 of 25 facets. Behavioral Processes. In our examination of associations between AMPD constructs and behavioral processes, we computed correlations between the PID-5 scales and measures of aggression (FOA) and the use of various adaptive and maladaptive coping strategies (DBT-WCCL; measured at 1-year follow-up only). At baseline, the FOA demonstrated significant and positive correlations with four of five PID-5 domains, with Antagonism exhibiting the strongest association ( r = .62, p < .001) amongst the domains, and the lone nonsignificant relationship being with Negative Affectivity ( r = .15, p = .13). At the facet-level, 22 of 25 associations with the FOA were statistically significant, with all facets underlying Antagonism ( r ’s ranging from .48 to .70), Disinhibition ( r ’s running from .20 to .57), and Psychoticism ( r ’s ranging from .34 to .50) exhibiting significant and positive associations. Longitudinally, the FOA again exhibited significant associations with four of five PID-5 domains in a pattern similar to that of the concurrent analyses, with Antagonism displaying the strongest domain-level association ( r = .55, p < .001) and that of Negative Affectivity being nonsignificant ( r = .08, p = .49). Sixteen of 25 facets were longitudinally associated with FOA, with all facets of Antagonism ( r ’s ranging from .40 to .64) and Psychoticism ( r ’s ranging from .31 to .41) again displaying at least moderate associations. The scales of the DBT-WCCL diverged in their associations with PID-5 scales, as all five PID-5 domains and the PID-5 total score were significant and positive predictors of DBT-WCCL-DCS (dysfunctional coping), whereas neither the PID-5 total score nor any of the PID-5 domains significantly predicted DBT-WCCL-DSS (DBT skills use). Similarly, at the facet level, 20 of 25 PID-5 facets exhibited significant positive associations with DBT-WCCL-DCS, whereas just two of 25 facets were significantly associated with DBT-WCCL-DSS, Anhedonia ( r = -.34, p = .003) and Grandiosity ( r = .27, p = .02). Psychiatric Symptomology. To examine associations between AMPD constructs and psychiatric symptoms, we computed correlations between the PID-5 scales and BPD symptoms (MSI-BPD), psychological distress (DASS-21; measured at 1-year follow-up only), and suicidality (DASS-SI; measured at 1-year follow-up only). At baseline, four PID-5 domains exhibited significant and positive associations with the MSI-BPD ( r ’s ranging from .20 to .51), with Antagonism as the lone domain to not demonstrate a significant association ( r = .06, p = .55). Among facets, 14 of 25 PID-5 facets were concurrently associated with the MSI-BPD, with Negative Affectivity (five of six facets), Detachment (four of six facets), and Psychoticism (all facets) showing more consistent associations. Longitudinal associations between the PID-5 and the MSI-BPD were markedly attenuated, with just one domain exhibiting a significant association (Negative Affectivity, r = .24, p = .04), and just four of 25 facets demonstrating significant associations. Associations between baseline PID-5 domains and the DASS-21 were more pronounced, with the PID-5 total score and four of five domains exhibiting significant and positive associations (with the exception of Antagonism). Fourteen of 25 facets exhibited significant and positive associations with DASS-21 as well, with Negative Affectivity (five of six facets), Detachment (four of six facets), and Psychoticism (all facets) demonstrating the most consistent relationships. Regarding suicidality, Disinhibition was the only domain to demonstrate a significant and positive longitudinal association with the DASS-SI ( r = .28, p =.02), and just four of 25 facets exhibited significant and positive associations, namely, Anhedonia, Depressivity, Distractibility, and Perceptual Dysregulation. Discussion The categorical approach to diagnosis used in the DSM is characterized by numerous features of a useful classification system (see Haeffel et al., 2022), and a goal of the AMPD was to develop a model that converges with the traditional categorical personality disorders, while also reorganizing information into empirically informed dimensions (see Sharp & Miller, 2024). Since its introduction approximately a dozen years ago, the PID-5 has been the primary operationalization of the Criterion B maladaptive trait framework in the DSM-5 AMPD and this has resulted in a large literature on its reliability and validity characteristics (Zimmermann et al., 2019). A primary aim of our study was to examine one understudied aspect of the PID-5’s reliability, that of temporal stability (Al-Dajani et al., 2016; Barchi-Ferreira & Osorio, 2020; Freilich et al., 2023). Results suggest that in a sample of participants with elevated BPD features, PID-5 traits exhibit moderate to high rank order stability across a 1-year period, although small to moderate degrees of mean-level changes were quite common. In terms of rank-order stability, findings from the present study are quite consistent with prior research. Here, we found a median test-retest reliability estimate of .74 for PID-5 domains and .70 for facets. As the majority of studies examining PID-5 test-retest reliability have used shorter-term time intervals, the most optimal comparison study to ours is that of Wright and colleagues (2015), who followed 93 outpatients diagnosed with at least one PD for a period of roughly 1.4 years. There, researchers found a median test-retest domain estimate of .73 and the median estimate for primary facets was .68, which is both nearly identical to our findings and comparable to the stability of other self-report measures of personality-based psychopathology (Samuel et al., 2011). Not surprisingly, facets varied more than domains in the present study, with manipulativeness, separation insecurity, and submissiveness demonstrating some of the lowest test-retest reliabilities. Interestingly, submissiveness exhibited the lowest test-retest correlation in both the present study and that of Wright and colleagues, suggesting this trait, as currently indexed by the PID-5, may be less stable as compared to other maladaptive traits. Although PID-5 traits were overall quite stable in the present study regarding rank, less stability was observed when examining mean-level change across the 1-year period. At the trait domain level, only detachment exhibited a small change ( d = -.21) while the remaining four domains were all in the moderate range ( d ’s ranging from -.54 to -.58). Facet-level changes varied more widely, ranging from little to no change (Intimacy Avoidance, d = -.04) to moderate change (Distractibility, d = -.61). Although no domains or facets exhibited large mean-level changes based on conventional interpretations of Cohen’s d (> .80), some degree of change was the norm, with 19 out of 25 facets exhibiting d values greater than .20 (reflecting at least small change). The degree of change observed in the present study is inconsistent with the findings by Wright and colleagues (2015), who found a median absolute Cohen’s d of .12 for primary traits and .13 for domains, reflecting little to no change overall. Further, in contrast to our findings, 19 out of 25 facets in the Wright et al. study exhibited d values of less than .20. One possible explanation of the larger degree of change in our sample as compared to prior research is the likelihood of regression to the mean. Notably, all mean-level changes in the present study were in the downward direction (though not necessarily statistically significant) and given that participants were selected on the basis of elevated BPD symptomology, it is possible that baseline measurements in this study were somewhat higher than what is typical for these participants. Another major aim of this study was to examine the PID-5’s convergent validity with therapeutic processes and psychiatric symptomology, both concurrently and longitudinally. Support for the convergent validity of the PID-5 and its translations is abundant and strong (see Zimmerman et al., 2019 for a review), however one area of clinically relevant external criteria that may be considered understudied in relation to the PID-5 is that of therapeutic change processes (i.e., theory-based mechanisms of change that are targeted in the context of psychosocial treatments; Hayes & Hofmann, 2019). A better understanding of the therapeutic processes that may underlie the AMPD framework (both Criterion A and B) will shed more light on the clinical utility of the model, specifically its utility for clinical intervention and management (Bach & Tracy, 2022). To further these efforts, the present study examined associations between PID-5 domains and facets and a range of emotional, cognitive, and behavioral processes, as well as indicators of psychiatric symptomology. Findings revealed both patterns of consistencies, as well as divergences, in the associations between PID-5 scales and external criteria. Emotionally, while experiential avoidance (particularly as indexed by the BEAQ) was longitudinally predicted by all trait domains, difficulties with emotion regulation and distress intolerance were clearly less relevant for the antagonism domain. Cognitively, while all maladaptive trait domains exhibited associations with rumination, content of ruminative thoughts varied, with depressive rumination more characteristic of internalizing dimensions and angry rumination more characteristic of externalizing and psychoticism dimensions. Additionally, the tendency to fuse with thoughts, or treat them as literal truths and be overly dominated by their content, appeared to be particularly relevant for internalizing dimensions and to a lesser extent, psychoticism. Behaviorally, all trait domains appeared to be characterized by increased dysfunctional coping in general, but externalizing dimensions (and in particular, antagonistic externalizing) were most closely associated with aggressive behavior. There were no domain-level predictors of adaptive coping via DBT skill use, which is consistent with prior research indicating putatively adaptive emotion regulation strategies tend to be less strongly related to psychopathology than maladaptive strategies (Aldao et al., 2010). Finally, in terms of psychiatric symptomology, distress and symptoms appeared most closely related to internalizing dimensions and psychoticism, with antagonism being negligibly associated with symptomology in general. At the domain level, only disinhibition prospectively predicted suicidal ideation and intent, however facets of detachment and psychoticism emerged as predictors as well. Taken together, and consistent with prior research, there is a lack of discriminant validity across domains for some processes (e.g., dysfunctional coping, experiential avoidance, general rumination), which may be a function of the general personality pathology variance shared by all dimensions. With that said, findings from the present study also suggest patterns of associations that are relatively unique to specific dimensions, particularly over time (e.g., depressive vs, angry rumination). Accordingly, we will review the emotional, cognitive, behavioral, and psychiatric profile of each trait domain in turn, and consider them each in the context of tentative treatment recommendations for Criterion B traits outlined in Bach and Tracy (2022). In the AMPD, negative affectivity and detachment fall within the broader internalizing domain of psychopathology. The negative affectivity domain reflects frequent and intense experiences of a range of negative emotions. In the present sample, and consistent with research on neuroticism (Lopez et al., 2023; Paulus et al., 2016; Yoon et al., 2013), negative affectivity was characterized by difficulties with emotional processes, including distress intolerance, emotion dysregulation, and experiential avoidance. Given the consistently stronger concurrent and longitudinal associations between these measures and PID-5 negative affectivity as compared to other domains, and recent work suggesting distress intolerance, emotion dysregulation, and experiential avoidance reflect a broader distress intolerance dimension (Conway et al., 2020), findings are supportive both of the interdependence of these constructs as well as the potential role of aversive reactivity to negative emotions as a functional link between neuroticism/negative affectivity and poor outcomes (Bullis et al., 2019; Semcho et al., 2023). Next, consistent with prior research on neuroticism (du Pont et al., 2019; Pux et al., 2022), elevations in negative affectivity were also associated with cognitive processes such as fusion with thoughts and depressive rumination, and to a lesser extent, angry rumination. Behaviorally, negative affectivity is associated with more frequent use of dysfunctional coping in difficult situations, but not necessarily coping strategies that are considered more effective or skillful, or alternatively, aggressive behavior. Although it is expected that negative affectivity would display less robust associations with aggression as compared to the externalizing pathological personality trait domains, the lack of an association with aggression is inconsistent with prior research using the PID-5 (Collison & Lynam, 2023; Sleep et al., 2018). Some facet-level associations with aggression were found both concurrently and longitudinally, however these only emerged in secondary domain markers, and notably, two of the significant predictors of aggression have demonstrated to be interstitial in nature (hostility and perseveration; see Clark & Watson, 2022). Finally, in terms of psychiatric symptomology, negative affectivity was characterized by increased general distress and BPD features, but surprisingly, did not exhibit a longitudinal association with suicidality. Overall, findings from the present study support Bach and Tracy’s treatment recommendations for negative affectivity, which include a focus on emotion dysregulation, building distress tolerance and acceptance of negative emotions, and implementation of adaptive coping and stress management techniques. The detachment domain is defined by avoidance of socioemotional experiences, interpersonal withdrawal, and restricted affective experience and expression. In the present study, detachment exhibited a broadly similar pattern of correlations with therapeutic processes as compared to negative affectivity, with some exceptions. Emotionally, detachment is characterized in the present study by heightened emotion dysregulation and experiential avoidance, with evidence of small positive associations with distress intolerance. Cognitive processes such as fusion and rumination are also elevated among those high in detachment, with evidence that angry rumination is more relevant to this domain as compared to that of negative affectivity. Here, a mistrustful and suspicious approach to interpersonal situations may facilitate rumination on anger-provoking episodes and vengeful thoughts, which is consistent with prior research demonstrating positive associations between extraversion (the opposite pole of detachment) and thoughts of forgiveness (Berry et al., 2005). In the behavioral realm, similar to negative affectivity, detachment is associated with more use of dysfunctional coping strategies, but a significant association with skillful strategy use was not found. Notably, the anhedonia facet did display a moderate negative association with DBT skill use (just one of two significant associations between adaptive coping skill use and a PID-5 facet). Interestingly, unlike negative affectivity, detachment exhibited both concurrent and prospective associations with aggression. This pattern of results suggests that while those high in negative affectivity may experience anger more covertly, those higher in detachment may be more likely to act on their anger in verbal, physical, or relational ways. Finally, detachment is associated with heightened psychological distress, borderline personality features (concurrently, but not longitudinally), and while it was not a significant predictor of suicidality, the facets of anhedonia and depressivity did exhibit moderate positive associations with suicidal ideation and intent. In terms of treatment considerations, findings from the present study support recommendations for social skills training, assertiveness training, and behavioral activation (Bach & Tracy, 2022), and also suggest interventions focused on emotion regulation skill building and disrupting repetitive negative thinking patterns may be useful. The AMPD domains of disinhibition and antagonism fall under the broader externalizing dimension of psychopathology. Disinhibition reflects an orientation toward immediate gratification, impulsive behaviors, and limited consideration of future consequences. In the present study, disinhibition is characterized by disruptions in emotional processes including emotion dysregulation, experiential avoidance, and mixed findings regarding distress intolerance. In terms of cognitive processes, disinhibition is characterized by heightened depressive rumination, albeit to a lesser extent than internalizing domains. Moderate associations with angry rumination were also identified, with the magnitude of concurrent and longitudinal correlations similar to those with negative affectivity. Behaviorally, disinhibition is linked with heightened aggression and dysfunctional skills use, but is unrelated to frequency of adaptive DBT skill use. In the prediction of psychiatric symptomology, disinhibition exhibits small positive associations with psychological distress, borderline personality features (concurrently, but not prospectively), and suicidality. Among the facets, only distractibility was positively and significantly associated with suicidality. Taken together, concurrent and longitudinal correlates of PID-5 disinhibition are consistent with prior research on markers of disinhibition/low conscientiousness, suggesting it is characterized by heightened emotion dysregulation/distress intolerance and distress (Donahue et al., 2014; Donahue & Khan, 2022; Sleep et al., 2018; Stanton et al., 2016), as well as aggression and other forms of maladaptive coping (Donahue & Khan, 2022; Sleep et al., 2018). Findings are supportive of the use of behaviorally focused interventions and emotion regulation skill building (Bach & Tracy, 2022), and also suggest strategies targeting repetitive negative thinking and acceptance of negative emotions may be indicated as well. Antagonism is characterized by a callous antipathy toward others, a sense of self-importance and a lack of awareness of the needs and feelings of others, and an exploitative interpersonal style. In the present study, the antagonism domain exhibited a somewhat divergent pattern of findings. In terms of emotional processes, antagonism was not significantly associated with distress intolerance or emotion dysregulation, and findings were mixed with regard to experiential avoidance (i.e., moderate associations with the BEAQ and a null relationship with the AAQ-II). Cognitively, antagonism was not significantly associated with depressive rumination or fusion with thoughts, however moderate concurrent and longitudinal associations with angry rumination were observed, consistent with recent research examining antagonism and forms of rumination (Mason & DeShong, 2024). Behaviorally, antagonism demonstrated strong positive associations with aggressive behavior, which is consistent with a large volume of research (Jones et al., 2011; Miller & Lynam, 2001), including evidence that aggressiveness is itself a facet of antagonism (Chester & West, 2020; Sleep et al., 2021). In addition, moderate associations with the use of dysfunctional coping strategies were identified, but no significant associations with DBT skills use (though it should be noted the grandiosity facet exhibited a small positive longitudinal association with DBT skill use). Finally, in terms of psychiatric symptomology, antagonism did not display significant associations with psychological distress, borderline personality features, nor suicidality. Together, the pattern of correlations suggest characteristics of limited emotional distress or dysregulation, but increased aggression and rumination on anger-provoking episodes and thoughts of revenge, as well as other forms of maladaptive coping. The positive association between BEAQ-indexed experiential avoidance is interesting, as this finding is inconsistent with other measures of emotional dysregulation and avoidance. One potential explanation of these mixed findings is the possibility the BEAQ better indexes experiential avoidance than the AAQ-II (Gamez et al., 2014; Rochefort et al., 2018; Wolgast, 2014), and while PID-5 antagonism is marked by shallow emotional processing, avoidant tendencies are also present. Findings are overall consistent with Bach and Tracy (2022) treatment recommendations that include empathic confrontation combined with arguments for the benefits of prosocial behavior, as well as interpersonal effectiveness skill building. Further, given aggression’s link with a lack of values clarity and less value-driven behavior (Donahue et al., 2024), values-based interventions may be beneficial as well. The fifth AMPD trait domain, psychoticism, is defined by a range of culturally incongruent odd or unusual perceptions, cognitions, and behaviors. In this study, psychoticism is characterized by emotional process disruptions including heightened distress intolerance, emotion dysregulation, and experiential avoidance, concurrently and longitudinally. Findings are consistent with prior research indicating emotion regulation difficulties are associated with schizotypic (Gunn & Donahue, 2022) and Cluster A (Garofalo et al., 2018) personality traits. Cognitively, psychoticism is linked to small increases in fusion with thoughts, as well as increased rumination, though evidence for heightened anger rumination is more consistent than that of depressive rumination. Psychoticism is linked to behavioral processes such as use of dysfunctional coping and aggression, although associations with DBT skills use were again not observed. Finally, psychoticism is associated with increased psychological distress, as well as BPD features (concurrently, but only the eccentricity facet displayed a longitudinal association). Although global psychoticism was not significantly associated with suicidality at 1-year follow-up, the perceptual dysregulation facet did exhibit a moderate positive and significant correlation. Taken together, and consistent with prior research (Garofalo et al., 2018; Gunn & Donahue, 2022; Sleep et al., 2018), PID-5 psychoticism displays a profile of heightened difficulties with emotional processing and regulation, increased difficulties with internalizing and externalizing problems, and use of maladaptive coping behaviors in general. Findings are support of treatment recommendations including emotion recognition and regulation skill building, cognitive reappraisal, and social cognition training (Back & Tracy, 2022). The current study has several important strengths and limitations that warrant consideration. The primary strength is the 1-year longitudinal design, as the vast majority of examinations of PID-5 test-retest reliability have occurred across very brief intervals. Next, while not a clinical sample per se, the present study recruited participants, in part, based on elevations in BPD features. Means of variables measuring BPD features, emotion dysregulation, psychological distress, and rumination were all in the clinical range at both baseline and follow-up, suggesting this was indeed a distressed and potentially impaired sample comparable to clinical samples. Regarding limitations, perhaps the most notable is the small sample size of this study. Research suggests correlations begin to stabilize in samples of 150 to 250 (Schonbrodt & Perugini, 2013), therefore results should be interpreted with a degree of caution, including the meaning of null relationships as the study may have been underpowered to identify small associations between variables. Given the smaller sample size, 95% confidence intervals are reported for all correlations, so the degree of uncertainty around estimates is appropriately considered when interpreting results. Further, there was attrition over time, with 33% of the baseline sample not completing 1-year follow-up assessments. Although meta-analytic findings have yielded higher average attrition rates in longitudinal studies on personality (e.g., 44%; Roberts et al., 2006), this impacts our interpretations about the generalizability of findings, particularly if attrition was nonrandom in some way. In terms of other limitations, all constructs were assessed using self-report instruments, therefore there is a risk of inflated correlations between the PID-5 and external criteria due to mono-method bias. Next, this study employed an observational design, restricting interpretations about causality. Accordingly, it is important to consider any interpretations about treatment implications as highly preliminary, as correlations with therapeutic processes do not necessarily indicate these are the processes that underlie impairment and/or distress. Also, although our data suggest this was a sample experiencing high distress, studies focusing on clinical-analogue samples must be replicated using bona fide clinical samples to ensure confidence in results. Related, as this was part of a larger study examining maladaptive personality predictors of workplace outcomes, all participants were required to be employed at baseline and it is possible this inclusion criterion resulted in a less impaired sample (at least in the occupational domain). Finally, participation in mental health treatment was not assessed as part of this study, therefore it is unclear how many participants were currently undergoing treatment. Evidence indicates a range of psychotherapeutic interventions can change personality traits along with mental health outcomes (see Allemand & Flückiger, 2017), particularly that of emotional stability/negative affectivity (Roberts et al., 2017), and this may affect the temporal stability of PID-5 traits. In conclusion, the current study provided further evidence for the 1-year temporal stability and convergent validity of AMPD Criterion B maladaptive personality traits, as assessed by the PID-5. Trait domains and facets exhibited a high degree of rank-order stability, although mean-level changes were more pronounced compared to prior research. Additional research examining the stability of both Criterion A and Criterion B of the AMPD over longer periods of time are necessary so as to better characterize the ability of this model to capture the purported enduring and stable nature of personality pathology. Further, longitudinal associations with therapeutic processes and psychiatric symptomology provide additional support for the clinical utility of Criterion B of the AMPD framework, demonstrating cognitive, emotional, and behavioral process profiles across domains that may be more consistent over time. 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A screening measure for BPD: the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD). Journal of personality disorders , 17 (6), 568–573. https://doi.org/10.1521/pedi.17.6.568.25355 Zimmermann, J., Mayer, A., Leising, D., Krieger, T., Grosse Holtforth, M., & Pretsch, J. (2015). Exploring occasion specificity in the assessment of DSM-5 maladaptive personality traits. European Journal of Psychological Assessment . Supplementary Material File (table 1.docx) Download 27.03 KB File (table 2 continued.docx) Download 38.54 KB File (table 2.docx) Download 39.13 KB Information & Authors Information Version history V1 Version 1 06 January 2025 Peer review timeline Published Journal of Clinical Psychology Version of Record 27 Nov 2025 Published Copyright This work is licensed under a Non Exclusive No Reuse License. Collection Journal of Clinical Psychology Keywords assessment borderline personality disorder personality disorder classification personality disorders Authors Affiliations Brittany Buck University of Baltimore View all articles by this author Kapil Chauhan Howard University College of Medicine View all articles by this author Rebecca Thompson ICF International Inc View all articles by this author John Donahue 0000-0002-6175-811X [email protected] University of Baltimore View all articles by this author Metrics & Citations Metrics Article Usage 812 views 326 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Brittany Buck, Kapil Chauhan, Rebecca Thompson, et al. DSM-5 AMPD Maladaptive Personality Traits: One-Year Temporal Stability and Associations with Therapeutic Processes and Outcomes. Authorea . 06 January 2025. 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