Abstract
Section III of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes an alternative model for diagnosing personality disorders (PDs). This model highlights identity impairment as a potential criterion of all PDs, which has stimulated researchers to characterize identity functioning across PD presentations. Accordingly, the present study examined associations between dimensions of identity functioning and PD symptomatology among 242 Flemish community adults (49.2% female; Mage = 42.76, SD = 14.42). Participants completed the Self-Concept and Identity Measure (Kaufman, Cundiff, & Crowell, 2015) to assess identity functioning and the Assessment of DSM-IV Personality Disorders (Schotte, De Doncker, Vankerckhoven, Vertommen, & Cosyns, 1998) to assess dimensionally measured PDs. A correlational analysis yielded negative associations between the consolidated identity subscale and all PDs, whereas scores on both disturbed identity and lack of identity scales were positively associated with PDs. A multivariate regression analysis indicated that the consolidated identity scale did not account for unique variance in PD dimensions. Disturbed identity and lack of identity scale scores positively predicted variance in all PDs, with the lack of identity scale being the stronger predictor of symptoms of paranoid, schizotypal, and borderline PDs. Study findings generally support identity impairment as a central dimension in PD symptomatology in a Flemish community sample.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Notes
For more information about the relatively low Cronbach’s alpha coefficient of the consolidated identity scale, please see Bogaerts et al., 2018.
When the assumption of homogeneity was not met, we performed a Welch F-statistic.
References
Achenbach, T. M., McConaughy, S. H., & Howell, C. T. (1987). Child/adolescent behavioral and emotional problems: Implications of cross-informant correlations for situational specificity. Psychological Bulletin, 101, 213–232. https://doi.org/10.1037/0033-2909.101.2.213.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.
Bogaerts, A., Claes, L., Verschueren, M., Bastiaens, T., Kaufman, E. A., Smits, D., & Luyckx, K. (2018). The Dutch self-concept and identity measure (SCIM): Factor structure and associations with identity dimensions and psychopathology. Personality and Individual Differences, 123, 56–64. https://doi.org/10.1016/j.paid.2017.11.007.
Clarkin, J. F., Cain, N. M., & Lenzenweger, M. F. (2018). Advances in transference-focused psychotherapy derived from the study of borderline personality disorder: Clinical insights with a focus on mechanism. Current Opinion in Psychology, 21, 80–85. https://doi.org/10.1016/j.copsyc.2017.09.008.
Côté, J. E., & Schwartz, S. J. (2002). Comparing psychological and sociological approaches to identity: Identity status, identity capital, and the individualization process. Journal of Adolescence, 25, 571–586. https://doi.org/10.1006/jado.2002.0511.
Courjaret, J., Schotte, C. K. W., Wijnants, H., Moorkens, G., & Cosyns, P. (2009). Chronic fatigue syndrome and DSM-IV personality disorders. Journal of Psychosomatic Research, 66, 13–20. https://doi.org/10.1016/j.jpsychores.2008.07.001.
Cumming, G. (2009). Inference by eye: Reading the overlap of independent confidence intervals. Statistics in Medicine, 28, 205–220. https://doi.org/10.1002/sim.3471.
De Doncker, D., Schotte, C. K. W., & Cosyns, P. (2000). ADP-IV questionnaire: Aspects of reliability and validity. European Psychiatry, 15, 73–73.
Debast, I., Rossi, G., Van Alphen, S. P. J., Pauwels, E., Claes, L., Dierckx, E., et al. (2015). Age neutrality of categorically and dimensionally measured DSM-5 section II personality disorder symptoms. Journal of Personality Assessment, 97, 321–329. https://doi.org/10.1080/00223891.2015.1021814.
Erikson, E. H. (1950). Childhood and society. New York: Norton.
Erikson, E. H. (1968). Identity, youth and crisis. New York: Norton.
Feenstra, D. J., Hutsebaut, J., Verheul, R., & van Limbeek, J. (2014). Changes in the identity integration of adolescents in treatment for personality disorders. Journal of Personality Disorders, 28, 101–112. https://doi.org/10.1521/pedi.2014.28.1.101.
Few, L. R., Miller, J. D., Rothbaum, A. O., Meller, S., Maples, J., Terry, D. P., Collins, B., & MacKillop, J. (2013). Examination of the section III DSM-5 diagnostic system for personality disorders in an outpatient clinical sample. Journal of Abnormal Psychology, 122, 1057–1069. https://doi.org/10.1037/a0034878.
Fonagy, P., & Luyten, P. (2009). A developmental, mentalization-based approach to the understanding and treatment of borderline personality disorder. Development and Psychopathology, 21, 1355–1381. https://doi.org/10.1017/S0954579409990198.
Grilo, C. M., McGlashan, T. H., & Skodol, A. E. (2000). Stability and course of personality disorders: The need to consider comorbidities and continuities between axis I psychiatric disorders and axis II personality disorders. Psychiatric Quarterly, 71, 291–309. https://doi.org/10.1023/A:1004680122613.
Hentschel, A. G., & Livesley, W. J. (2013). The general assessment of personality disorder (GAPD): Factor structure, incremental validity of self-pathology, and relations to DSM-IV personality disorders. Journal of Personality Assessment, 95, 479–485. https://doi.org/10.1080/00223891.2013.778273.
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-5: Empirical support for rating severity, style, and traits. Journal of Personality Disorders, 25, 305–320. https://doi.org/10.1521/pedi.2011.25.3.305.
Jørgensen, C. R. (2009). Identity style in patients with borderline personality disorder and normal controls. Journal of Personality Disorders, 23, 101–112. https://doi.org/10.1521/pedi.2009.23.2.101.
Jørgensen, C. R. (2010). Identity and borderline personality disorder. Journal of Personality Disorders, 24, 344–364. https://doi.org/10.1521/pedi.2010.24.3.344.
Kaufman, E. A., & Crowell, S. E. (2018). Biological and behavioral mechanisms of identity pathology development: An integrative review. Review of General Psychology., 22, 245–263. https://doi.org/10.1037/gpr0000138.
Kaufman, E. A., Cundiff, J. M., & Crowell, S. E. (2015). The development, factor structure, and validation of the self-concept and identity measure (SCIM): A self-report assessment of clinical identity disturbance. Journal of Psychopathology and Behavioral Assessment, 37, 122–133. https://doi.org/10.1007/s10862-014-9441-2.
Kaufman, E. A., Montgomery, M. J., & Crowell, S. E. (2014). Identity-related dysfunction: Integrating clinical and developmental perspectives. Identity, 14, 297–311. https://doi.org/10.1080/15283488.2014.944699.
Kaufman, E. A., Puzia, M. E., Crowell, S. E., & Price, C. J. (2019). Replication of the self-concept and identity measure (SCIM) among a treatment-seeking sample. Identity, 19, 18–28. https://doi.org/10.1080/15283488.2019.1566068.
Kempke, S., Van Den Eede, F., Schotte, C., Claes, S., Van Wambeke, P., Van Houdenhove, B., & Luyten, P. (2013). Prevalence of DSM-IV personality disorders in patients with chronic fatigue syndrome: A controlled study. International Journal of Behavioral Medicine, 20, 219–228. https://doi.org/10.1007/s12529-012-9273-y.
Kenan, M. M., Kendjelic, E. M., Molinari, V. A., Williams, W., Norris, M., & Kunik, M. E. (2000). Age-related differences in the frequency of personality disorders among inpatient veterans. International Journal of Geriatric Psychiatry, 15, 831–837. https://doi.org/10.1002/1099-1166(200009)15:9<831::AID-GPS208>3.0.CO;2-H.
Kernberg, O. F. (1984). Object-relations theory and clinical psychoanalysis. New Haven: Yale University Press.
Kernberg, O. F. (2006). Identity: Recent findings and clinical implications. The Psychoanalytic Quarterly, 75, 969–1004. https://doi.org/10.1002/j.2167-4086.2006.tb00065.x.
Kernberg, O. F., & Caligor, E. (2005). A psychoanalytic theory of personality disorders. In M. F. Lenzenweger & J. F. Clarkin (Eds.), Major theories of personality disorder (2nd ed., pp. 114–156). New York: Guilford press.
Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford press.
Livesley, W. J. (1998). Suggestions for a framework for an empirically based classification of personality disorder. Canadian Journal of Psychiatry, 43, 137–147. https://doi.org/10.1177/070674379804300202.
Marcia, J. E. (2006). Ego identity and personality disorders. Journal of Personality Disorders, 20, 577–596. https://doi.org/10.1521/pedi.2006.20.6.577.
McWilliams, N. (1994). Developmental levels of personality organization. In Psychoanalytic diagnosis: Understanding personality structure in the clinical process (pp. 40–66). New York; London: The Guilford press.
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 dimension of personality pathology. Journal of Personality Assessment, 93, 347–353. https://doi.org/10.1080/00223891.2011.577853.
Neacsiu, A. D., Herr, N. R., Fang, C. M., Rodriguez, M. A., & Rosenthal, M. Z. (2015). Identity disturbance and problems with emotion regulation are related constructs across diagnoses. Journal of Clinical Psychology, 71, 346–361. https://doi.org/10.1002/jclp.22141.
Paris, J. (2004). Gender differences in personality traits and disorders. Current Psychiatry Reports, 6, 71–74. https://doi.org/10.1007/s11920-004-0042-8.
Podsakoff, P. M., MacKenzie, S. B., Lee, J.-Y., & Podsakoff, N. P. (2003). Common method biases in behavioral research: A critical review of the literature and recommended remedies. Journal of Applied Psychology, 88, 879–903. https://doi.org/10.1037/0021-9010.88.5.879.
Rossouw, T. I., & Fonagy, P. (2012). Mentalization-based treatment for self-harm in adolescents: A randomized controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry, 51, 1304–1313. https://doi.org/10.1016/j.jaac.2012.09.018.
Samuels, J., Eaton, W. W., Bienvenu, O., Brown, C., Costa, P., & Nestadt, G. (2002). Prevalence and correlates of personality disorders in a community sample. British Journal of Psychiatry, 180, 536–542. https://doi.org/10.1192/bjp.180.6.536.
Schmeck, K., Goth, K., & Schluter-Muller, S. (2015). The role of identity in the DSM5-classification of personality disorders. European Child and Adolescent Psychiatry, 24, 1–11.
Schotte, C. K. W., De Doncker, D., Vankerckhoven, C., Vertommen, H., & Cosyns, P. (1998). Self-report assessment of the DSM-IV personality disorders, measurement of trait and distress characteristics: The ADP-IV. Psychological Medicine, 28, 1179–1188. https://doi.org/10.1017/S0033291798007041.
Schwartz, S. J., Beyers, W., Luyckx, K., Soenens, B., Zamboanga, B. L., Forthun, L. F., Hardy, S. A., Vazsonyi, A. T., Ham, L. S., Kim, S. Y., Whitbourne, S. K., & Waterman, A. S. (2011). Examining the light and dark sides of emerging adults’ identity: A study of identity status differences in positive and negative psychosocial functioning. Journal of Youth and Adolescence, 40, 839–859. https://doi.org/10.1007/s10964-010-9606-6.
Schwartz, S. J., Zamboanga, B. L., Luyckx, K., Meca, A., & Ritchie, R. A. (2013). Identity in emerging adulthood: Reviewing the field and looking forward. Emerging Adulthood, 1, 96–113. https://doi.org/10.1177/2167696813479781.
Schwartz, S. J., Zamboanga, B. L., Wang, W., & Olthuis, J. V. (2009). Measuring identity from an Eriksonian perspective: Two sides of the same coin? Journal of Personality Assessment, 91, 143–154. https://doi.org/10.1080/00223890802634266.
Skodol, A. E. (2012). Personality disorders in DSM-5. Annual Review of Clinical Psychology, 8, 317–344. https://doi.org/10.1146/annurev-clinpsy-032511-143131.
Torgersen, S., Kringlen, E., & Cramer, V. (2013). The prevalence of personality disorders in a community sample. In The Science of Mental Health: Volume 7: Personality and Personality Disorder (Vol. 7, pp. 132–138). Taylor and Francis.
Verheul, R., Bartak, A., & Widiger, T. (2007). Prevalence and construct validity of personality disorder not otherwise specified (PDNOS). Journal of Personality Disorders, 21, 359–370. https://doi.org/10.1521/pedi.2007.21.4.359.
Verschueren, M., Rassart, J., Claes, L., Moons, P., & Luyckx, K. (2017). Identity statuses throughout adolescence and emerging adulthood: A large-scale study into gender, age, and contextual differences. Psychologica Belgica, 57, 32–42. https://doi.org/10.5334/pb.348.
Westen, D., Betan, E., & Defife, J. A. (2011). Identity disturbance in adolescence: Associations with borderline personality disorder. Development and Psychopathology, 23, 305–313. https://doi.org/10.1017/S0954579410000817.
Widiger, T. A., Bach, B., Chmielewski, M., Clark, L. A., DeYoung, C., Hopwood, C. J., Kotov, R., Krueger, R. F., Miller, J. D., Morey, L. C., Mullins-Sweatt, S. N., Patrick, C. J., Pincus, A. L., Samuel, D. B., Sellbom, M., South, S. C., Tackett, J. L., Watson, D., Waugh, M. H., Wright, A. G. C., Zimmermann, J., Bagby, R. M., Cicero, D. C., Conway, C. C., de Clercq, B., Docherty, A. R., Eaton, N. R., Forbush, K. T., Haltigan, J. D., Ivanova, M. Y., Latzman, R. D., Lynam, D. R., Markon, K. E., Reininghaus, U., & Thomas, K. M. (2018). Criterion a of the AMPD in HiTOP. Journal of Personality Assessment, 101, 1–11. https://doi.org/10.1080/00223891.2018.1465431.
Acknowledgements
The authors like to thank Marie Govaerts and Julie Michiels for their help with the data-collection.
Funding
This study was not funded.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
All authors declare that they have no conflict of interest.
Ethical Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed Consent
Informed consent was obtained from all participants included in the study.
Experiment Participants
The study was approved by the Ethical Committee of the Faculty of Psychology and Educational Sciences of KU Leuven (G-2016 08603).
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Bogaerts, A., Luyckx, K., Bastiaens, T. et al. Identity Impairment as a Central Dimension in Personality Pathology. J Psychopathol Behav Assess 43, 33–42 (2021). https://doi.org/10.1007/s10862-020-09804-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10862-020-09804-9