Personality Disorders: Theory, Research, and Treatment © 2016 American Psychological Association

2017, Vol. 8, No. 3, 228 –236 1949-2715/17/$12.00 http://dx.doi.org/10.1037/per0000213

Comparing the Dependability and Associations With Functioning of the

DSM–5 Section III Trait Model of Personality Pathology and the DSM–5
Section II Personality Disorder Model

Michael Chmielewski Camilo J. Ruggero

Southern Methodist University University of North Texas

Roman Kotov Keke Liu

Stony Brook University University of North Texas
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.

Robert F. Krueger
University of Minnesota

Two competing models of personality psychopathology are included in the fifth edition of the Diagnostic
Statistical Manual of Mental Disorders (DSM–5; American Psychiatric Association, 2013); the tradi-
tional personality disorder (PD) model included in Section II and an alternative trait-based model
included in Section III. Numerous studies have examined the validity of the alternative trait model and
its official assessment instrument, the Personality Inventory for DSM–5 (PID-5; Krueger, Derringer,
Markon, Watson, & Skodol, 2012). However, few studies have directly compared the trait-based model
to the traditional PD model empirically in the same dataset. Moreover, to our knowledge, only a single
study (Suzuki, Griffin, & Samuel, 2015) has examined the dependability of the PID-5, which is an
essential component of construct validity for traits (Chmielewski & Watson, 2009; McCrae, Kurtz,
Yamagata, & Terracciano, 2011). The current study directly compared the dependability of the DSM-5
traits, as assessed by the PID-5, and the traditional PD model, as assessed by the Personality Diagnostic
Questionnaire-4 (PDQ-4⫹), in a large undergraduate sample. In addition, it evaluated and compared their
associations with functioning, another essential component of personality pathology. In general, our
findings indicate that most DSM–5 traits demonstrate high levels of dependability that are superior to the
traditional PD model; however, some of the constructs assessed by the PID-5 may be more state like. The
models were roughly equivalent in terms of their associations with functioning. The current results
provide additional support for the validity of PID-5 and the DSM–5 Section III personality pathology
model.

Keywords: dependability, PID-5, functioning, personality disorders, DSM–5 Section III

The fifth edition the Diagnostic Statistical Manual of Mental
Disorders (DSM–5; American Psychiatric Association [APA],
2013) includes two competing models of personality pathology:
the traditional categorical personality disorder (PD) model from
DSM–IV and an alternative trait-based model in Section III. Prob-
This article was published Online First September 12, 2016.
Michael Chmielewski, Department of Psychology, Southern Methodist
University; Camilo J. Ruggero, Department of Psychology, University of
North Texas; Roman Kotov, Department of Psychiatry and Behavioral
Sciences, Stony Brook University; Keke Liu, Department of Psychology,
University of North Texas; Robert F. Krueger, Department of Psychology,
University of Minnesota.
Robert Krueger has served as a paid consultant to preValio LLC,
developers of psychological reports based on the Personality Inventory for
DSM-5 (PID-5).
Correspondence concerning this article should be addressed to Michael
Chmielewski, Department of Psychology, Southern Methodist University,
PO Box 75275-0442, Dallas, TX 75275. E-mail: mchmielewski@smu.edu
228
lems with the traditional PD model have been extensively re-
viewed (Clark, 2007; Widiger & Samuel, 2005; Widiger & Trull,
2007). They include extreme heterogeneity (Chmielewski & Wat-
son, 2008; Johansen, Karterud, Pedersen, Gude, & Falkum, 2004),
high rates of diagnostic comorbidity (Oldham et al., 1992), arbi-
trary boundaries with normality (Widiger & Samuel, 2005), low
interrater reliability (Tyrer et al., 2007), poor convergent/discrim-
inant validity (Clark, Livesley, & Morey, 1997), excessive not
otherwise specified diagnosis (Verheul & Widiger, 2004), and low
diagnostic stability (Shea et al., 2002; Skodol et al., 2005).
Considerable research has been conducted on the DSM–5 alter-
native model and the official assessment instrument for the trait
aspect of the model, the Personality Inventory for DSM–5 (PID-5;
Krueger, Derringer, Markon, Watson, & Skodol, 2012). Numerous
studies have demonstrated the structural validity of the PID-5 (De
Fruyt et al., 2013; Krueger et al., 2012; Wright et al., 2012;
Zimmermann et al., 2014). Moreover, the DSM–5 traits capture the
variance within the traditional PD model (Hopwood, Thomas,
Markon, Wright, & Krueger, 2012; Miller, Few, Lynam, & MacK-
 DSM–5 TRAITS AND TRADITIONAL PD MODEL
illop, 2015; Samuel, Hopwood, Krueger, Thomas, & Ruggero,
2013), are strongly associated with other models of personality and
personality pathology (Anderson et al., 2012; Ashton, Lee, de
Vries, Hendrickse, & Born, 2012; De Fruyt et al., 2013; Gore &
Widiger, 2013; Hopwood et al., 2012; Miller et al., 2015; Quilty,
Ayearst, Chmielewski, Pollock, & Bagby, 2013; Samuel et al., 2013;
Suzuki, Griffin, & Samuel, 2015; Thomas et al., 2012; Zimmermann
et al., 2014), and have meaningful ties to other clinical constructs
(Hopwood et al., 2013; Zimmermann et al., 2014).
The accumulated research provides support for the validity of
the DSM–5 trait model and the PID-5; nevertheless, important gaps
remain regarding their construct validity. First, few data exist
regarding the dependability of the DSM–5 trait model and the
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PID-5. Second, only a handful of studies have examined the
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association between DSM–5 traits and functioning. Third, very few
studies have directly compared the DSM–5 traits to the traditional
PDs by simultaneously examining the performance of both models
in the same dataset.
Dependability, Transient Error, and Stability
Cattell, Eber, and Tatsuoka (1970, p. 30) defined dependability
“as the correlation between two administrations of the same test
when the lapse of time is insufficient for people themselves to
change.” Dependability correlations are the primary method of
assessing transient measurement errors, which are systematic mea-
surement errors caused by fluctuations in participants’ psycholog-
ical state on any particular day (Cattell et al., 1970; Chmielewski
& Watson, 2009; Gnambs, 2014; McCrae, Kurtz, Yamagata, &
Terracciano, 2011; Schmidt, Le, & Ilies, 2003; Watson, 2004).
Because transient errors produce consistent responses during the
same assessment session but inconsistent responses across differ-
ent assessment sessions they cannot be detected using indices of
reliability computed from a single administration (e.g., internal
consistency, Cronbach’s ␣). Importantly, transient errors can mas-
querade as true trait change, making it difficult to determine the
stability of the construct that a scale assesses (see Anusic, Lucas,
& Donnellan, 2012; Chmielewski & Watson, 2009; Gnambs,
2014; McCrae et al., 2011).
As noted in the DSM–5, personality pathology must have “an
enduring pattern” and be “stable over time” (APA, 2013, p. 645).
One of the many limitations of the traditional DSM PD model is
that PDs demonstrate, at best, modest stability (Grilo et al., 2004;
Lenzenweger, 1999; McGlashan et al., 2005; Shea et al., 2002;
Zanarini, Frankenburg, Reich, & Fitzmaurice, 2012). To our
knowledge, only a single study (Wright et al., 2015) has examined
the stability of DSM–5 traits. They reported a mean PID-5 domain
stability of r ⫽ .73 (range: r ⫽ .62 to .75) and a median facet
stability of r ⫽ .68 (range: r ⫽ .41 to.78) over a 1.4-year interval
in 93 outpatients. Wright et al. (2015) concluded that the DSM–5
traits were “highly stable over the course of the study” (p. 202).
However, this broad statement overshadows substantial differ-
ences in stability (r ⫽ .41 to .78) among the various PID-5 traits.
Because a measure’s dependability sets an upper limit on its
stability, it is possible that the observed differences are due to
differential levels of transient error (i.e., differential dependability)
across the PID-5 scales. Moreover, it is possible that transient error
is responsible for the poor stability of the traditional DSM PD
model. In fact, Zimmerman (1994) concluded that state effects
229
(i.e., transient error) substantially influence assessments of the
traditional PD model.
Transient errors can also distort associations with other con-
structs, result in failures to replicate research, and substantially
alter study outcomes (Chmielewski, Sala, Tang, & Baldwin, 2016;
Chmielewski & Watson, 2009). Moreover, they may lead to an
overinclusion of “false positives” and exclusion of “false nega-
tives” in clinical samples (Chmielewski & Watson, 2009). Despite
the potential influence of transient error, to our knowledge only a
single study has examined the dependability of the PID-5. Suzuki
et al. (2015) reported a mean domain dependability of .83 (range ⫽
.81 to .83) and a mean facet dependability of .78 (range ⫽ .66 to
.86), which was similar to values for the Revised NEO Personality
Inventory (NEO-PI-R) in the sample. Although these findings pro-
vide initial evidence for the dependability of the PID-5, some of the
facet dependabilities were low, suggesting that transient error may be
a concern. Moreover, their sample (N ⫽ 266) was below recom-
mended cutoffs (N ⫽ 300) for examining dependability (Watson,
2004). Given the importance of transient error, replication of these
findings in a larger sample is necessary.
Personality Pathology and Functioning
The traditional PD model and the alternative model (Criterion
A) both include functional impairment (American Psychiatric As-
sociation, 2013). The traditional PD model is associated with
functioning across various domains, including work, social rela-
tionships, and leisure (Miller, Campbell, & Pilkonis, 2007; Skodol
et al., 2005). To our knowledge, only three studies have examined
associations between the DSM–5 traits and functioning. Wright et
al. (2015) reported that the DSM–5 traits predicted psychosocial
functioning 1.4 years later in a patient sample. Ackerman and
Corretti (2015) found that higher levels of detachment in college
students lead to their roommates feeling less close to them. Keeley,
Flanagan, and McCluskey (2014) demonstrated that the DSM–5
traits concurrently explained variance in several functioning do-
mains in student and patient samples.
Results from these studies have generally reflected impairments
(e.g., interpersonal relationships) aligned with Criterion A of the
alternative model. However, several unexpected findings emerged,
including significant associations with impairments in mobility
and self-care (Keeley et al., 2014). Moreover, Risk Taking, Atten-
tion Seeking, and Manipulativeness were not associated with func-
tioning in the student sample (Keeley et al., 2014). Given the
importance of functioning for personality pathology, replication of
these counterintuitive findings is necessary. Finally, is worth not-
ing that Keeley et al. (2014) hypothesized transient errors could
have influenced their results and called for further research regard-
ing this issue.
Current Study
The current study was designed to provide evidence regarding
the construct validity of the DSM–5 traits and the PID-5. First, we
examined the dependability of the PID-5 in a sample large enough
(i.e., minimum N ⫽ 300; Watson, 2004) to provide precise de-
pendability estimates. Second, we examined the concurrent asso-
ciations of the DSM–5 traits with functional impairment across a
wide range of domains. Finally, we directly compared the DSM–5
 230 CHMIELEWSKI, RUGGERO, KOTOV, LIU, AND KRUEGER

trait (PID-5) and traditional PD (PDQ-4⫹) models empirically in Table 1

the same sample. Although the alternative model was created to PID Internal Consistency and Dependability
address limitations inherent in the traditional PD model, only two
studies have directly tested these models against each other in the Time 1 Time 2
same sample. They found that the models had similar associations Scale ␣ AIC ␣ AIC Dependability
with psychopathology and normal personality (Fossati et al., 2015;
Domains
Miller et al., 2015). As Chmielewski and Watson (2009, p. 199) Negative Affectivity .94 .41 .95 .45 .91
note, “consideration of transient error could help determine which Detachment .93 .36 .93 .36 .89
PD models are more valid and reliable” making the current anal- Psychoticism .95 .37 .96 .42 .88
yses very relevant in comparing the two models. Finally, we Antagonism .91 .33 .92 .35 .86
categorically and dimensionally examined traditional PDs because Disinhibition .92 .34 .93 .38 .86
PID-5 Domain Mean .93 .36 .94 .39 .88
(a) dimensional representations are more valid and reliable than Facets
categorical ones (Markon, Chmielewski, & Miller, 2011) and (b) Withdrawal .91 .49 .92 .54 .89
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dimensional representations have been suggested as an alternative Depressivity .93 .49 .94 .52 .88
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model of traditional PDs (Oldham & Skodol, 2000). Eccentricity .96 .65 .97 .72 .88
Emotional Lability .89 .53 .92 .61 .88
Anxiousness .91 .51 .91 .53 .88
Separation Insecurity .86 .47 .88 .52 .86
Method Hostility .86 .38 .88 .43 .85
Risk Taking .87 .33 .88 .34 .85
Anhedonia .87 .45 .89 .51 .84
Participants and Procedures Restricted Affect .83 .40 .85 .45 .84
Deceitfulness .87 .41 .89 .44 .84
Participants were undergraduate students (N ⫽ 572; 68.3% Intimacy Avoidance .83 .44 .83 .44 .84
female, 71.8% Caucasian, 12.4% African American, 18.3% His- Callousness .86 .31 .88 .33 .84
panic, mean age ⫽ 21.9 years) who completed all measures online. Distractibility .91 .52 .92 .56 .84
Approximately 2 weeks later all participants were invited to com- Attention Seeking .89 .50 .91 .55 .84
Manipulativeness .83 .50 .87 .57 .83
plete the PID-5 a second time, 382 of whom did, allowing for Rigid Perfectionism .91 .51 .92 .53 .83
precise dependability estimates (see Watson, 2004). The Person- Perceptual Dysregulation .84 .30 .85 .32 .80
ality Diagnostic Questionnaire-4 (PDQ-4⫹) was later added to the Unusual Beliefs .77 .29 .84 .39 .80
second assessment, resulting in a subset of participants (N ⫽ 202 Irresponsibility .74 .29 .77 .32 .80
Impulsivity .86 .51 .86 .50 .79
of the 382) who also completed it twice. Participants who com-
Perseveration .87 .43 .89 .48 .78
pleted both assessments scored higher on PID-5 Separation Inse- Submissiveness .80 .51 .85 .59 .77
curity and lower on Callousness, Manipulativeness, Risk Taking, Suspiciousness .71 .26 .72 .26 .76
and Irresponsibility than those completing one assessment. Those Grandiosity .76 .34 .79 .38 .76
who completed both assessments also scored lower on the PID facet mean .85 .44 .87 .47 .83
PDQ-4⫹ Antisocial symptoms and World Health Organization Note. N T ⫽ 572, T2 ⫽ 382. Italic values represents mean of the scales.
Disability Assessment Schedule 2.0 (WHODAS) Life Activities.

Measures
PID-5. The PID-5 (Krueger et al., 2012) is the official mea-
sure of the DSM–5 dimensional trait-based model of personality
pathology. It includes 25 lower order traits and 5 higher order
domains. Facet scores were calculated as item means; domain
scores were calculated based on APA guidelines in which each
domain score is the mean of three facet scales. Several studies
previously reviewed have documented the validity of the PID-5.
PDQ-4ⴙ. The PDQ-4⫹ (Hyler, 1994) maps directly onto the
traditional DSM PD model and is one of the most widely used
measures of the model (Widiger & Coker, 2002). The PDQ-4⫹
demonstrates high sensitivity and moderate specificity (Davison,
Leese, & Taylor, 2001). The PDQ-4⫹ was examined categorically
and dimensionally (i.e., by summing symptoms for each PD).
WHODAS. The WHODAS was completed during the first as-
sessment. It assesses functioning across six domains: Cognition, Mo-
bility, Self-Care, Getting Along (i.e., interpersonal relationships), Life
Activities, and Participation in Society.1 Internal consistency esti-
mates range from .94 to .96 and dependability estimates range from
.93 to .96 (Üstün et al., 2010). The WHODAS is also included in
Section III of the DSM–5 as a replacement for the Global Assessment
of Functioning scale and is the same measure used by Keeley et al.
(2014), allowing for a direct comparison with their findings.
Results
Cronbach’s ␣s for the PID-5 (see Table 1) were at least adequate
(e.g., ⬎.70; Nunnally, 1978), with 88% being considered good
(e.g., ⬎.80; Clark & Watson, 1995). Average interitem correla-
tions (AICs) for most PID-5 scales were generally within recom-
mendations, suggesting that the scales assess homogenous con-
structs (see Clark & Watson, 1995). However, some scales
demonstrated higher than optimal AICs, especially considering the
breadth of the constructs they assess. This was particularly true for
Eccentricity, which demonstrated a very high AIC at both assess-
ments (i.e., .65 and .72), suggesting that it contains items that
could be considered redundant in this sample. In contrast, none of
the ␣s for the PDQ-4⫹ dimensional symptom counts were above
.80. Moreover, 85% were below .70, and the AICs were quite low
1
The Mobility and Self-Care domains were added as the study was in
progress and therefore completed by a subset (N ⫽ 275) of the sample.
 DSM–5 TRAITS AND TRADITIONAL PD MODEL 231

Table 2 Associations With Functioning

PDQ-4 Internal Consistency and Dependability
Because Criterion A of the trait model includes dysfunction in
Time 1 Time 2 Dependability identity, self-direction, empathy, and intimacy, we would expect
Scale ␣ AIC ␣ AIC Sym. Cat. stronger associations with certain WHODAS domains (e.g., get-
ting along with others) and weaker associations with others (e.g.,
Avoidant .77 .32 .78 .34 .82 .63 self-care, mobility). Nearly every PID-5 scale was significantly
Borderline .67 .18 .65 .17 .81 .72
Paranoid .65 .21 .70 .25 .78 .63 associated with poorer functioning across every WHODAS do-
Schizotypal .62 .15 .68 .19 .78 .44 main (see Table 3).3 Many of these associations were medium in
Antisocial .56 .14 .50 .11 .74 .70 size; however, certain traits (e.g., Grandiosity and Manipulative-
Dependent .68 .21 .66 .20 .73 .52
Schizoid .54 .14 .51 .13 .73 .62
ness) appear to be less strongly associated with functioning than
Histrionic .56 .14 .59 .15 .72 .56 others. A notable exception was that Risk Taking was not signif-
Obs. Comp. .47 .10 .50 .11 .69 .53 icantly associated with any WHODAS domain, which replicates
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Narcissistic .55 .12 .52 .11 .68 .36 previous counterintuitive findings (Keeley et al., 2014). In this
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Mean .61 .17 .61 .18 .75 .57

Note. T1 N ⫽ 572, T2 N ⫽ 202. Sym. ⫽ symptom count; Cat. ⫽
categorical scoring; Obs. Comp. ⫽ Obsessive Compulsive. Dependability
statistic for categorical scoring is ␬. We also computed dependability for
the categorical scoring as intraclass correlations, and results were essen-
tially identical. Italic values represents mean of the scales.
(see Table 2). These results reflect the heterogeneity of symptoms
included within the traditional PD constructs.
Dependability
It is highly unlikely that true changes in personality pathology
would have occurred over the short 2-week dependability interval;
therefore, any dependability coefficients (see Table 1) below 1.0
indicate the presence of measurement error. The PID-5 domains
demonstrated high levels of dependability that approach 1.0 (e.g.,
r ⫽ .86 to .91, mean domain r ⫽ .88).2 However, there was
considerable variability across the PID-5 facets (mean dependabil-
ity; r ⫽ .83), with some approaching 1.0 (e.g., Withdrawal; r ⫽
.89) and others being appreciably lower (e.g., Grandiosity and
Suspiciousness; r ⫽ .76).
In sharp contrast, the dependability of the PDQ-4⫹ symptom
count scales (see Table 2) were well below 1.0, ranging from r ⫽
.68 (Narcissistic) to r ⫽ .82 (Avoidant) with a mean of only r ⫽
.75. This low level of dependability indicates a substantial amount
of measurement error. The PDQ-4⫹ categorical PDs demonstrated
even poorer dependability (␬ ⫽ .36 to .72; mean ␬ ⫽ .57),
demonstrating that a substantial portion of their variance is due to
measurement error. These results are in line with past evidence
indicating that categorical representations of psychopathology are
less reliable and valid than dimensional ones (Markon et al., 2011).
Unexpectedly, strong correlations emerged between dependability
and Cronbach’s ␣ (PID-5: domain mean r ⫽ .62, facet mean r ⫽
.77; PDQ-4⫹: mean r ⫽ .82).
Next, we conducted significance tests (Pearson Filon for non-
overlapping variables from the same sample) comparing the PID-5
and PDQ-4⫹ symptom count scales, which were more dependable
than the PDQ-4⫹ categories, in the subsample (N ⫽ 202) that
completed both measures twice. The PID-5 domains were signif-
icantly more dependable than the PDQ-4⫹ scales in 94% of the
comparisons and the facets were significantly more dependable in
63% of comparisons. The PDQ-4⫹ scales were never more de-
pendable than the PID-5 scales.
regard, Crego and Widiger (2014) suggested that reverse-keyed
items underperform when assessing psychopathy-related traits.
Given the high percentage of reverse-keyed items in the Risk
Taking scale (43%), we created two risk-taking composites (one
using reverse-keyed items and one using nonreverse-keyed items).
These two composites correlated r ⫽ .50 with each other; how-
ever, the nonreverse-keyed composite demonstrated small positive
associations (mean r ⫽ .13) and the reverse-keyed composite
demonstrated small negative associations (mean r ⫽ ⫺.15) with
the WHODAS. Next, we conducted separate multiple regression
analyses for the PID-5 domains and facets to determine the amount
of variance each explained in the WHODAS. The weakest PID-5
associations were with mobility (domain R2 ⫽ .12, facet R2 ⫽ .17)
and self-care (domain R2 ⫽ .21, facet R2 ⫽ .28), domains hypo-
thetically less related to Criterion A, suggesting that the PID-5
demonstrates evidence of specificity. The PDQ-4⫹ symptom
count scales (see Table 4) demonstrated significant associations
(R2 ⫽ .21 to .47) with all WHODAS functioning domains. How-
ever, the PDQ-4⫹ scales were more broadly associated with
functioning in that the PDQ-4⫹ associations with Mobility (R2 ⫽
.22) and Self-Care (R2 ⫽ .28) were not as differentiated from
associations with the other WHODAS domains.
The incremental ability of each personality pathology measure
to predict concurrent functioning was examined using hierarchical
regressions analyses (see Table 5). In Step 1, the PDQ-4⫹ symp-
tom count scores were entered, then in Step 2 the PID-5 domains
(or facets) were entered. The order of entry was then reversed. The
PID-5 domains and facets added incremental prediction beyond
the PDQ-4⫹ for all areas of functioning except Mobility and
Self-Care. For most areas of functioning the additional variance
was modest; however, it was more substantial for life activities
(domain ⫽ 6.6%, facet ⫽ 14.8%), cognition (domain ⫽ 8.9%,
facet ⫽ 15.7%), and overall functioning (domain ⫽ 3.2%, facet ⫽
11.1%). Likewise, the PDQ-4⫹ symptom counts added incremen-
tal validity beyond the PID-5 domains (⬃4 –13%) and facets
(⬃4 –11%) for all functioning domains, with the greatest incre-
mental validity (10 –12% additional variance) for Mobility and
Self-Care. Moreover, the PDQ-4⫹ added approximately 10% pre-
2
The dependability the PID-5 Brief Form, scored from the full PID-5,
ranged from .78 to .83 with a mean of .80.
3
Associations between the PID-5 Brief Form and functioning were very
similar.
 232 CHMIELEWSKI, RUGGERO, KOTOV, LIU, AND KRUEGER

Table 3
PID-5 Relationship to WHODAS Functioning

Scale Cognition Mobility Self-Care Get Along Life Act Society Overall

NA .49 .26 .36 .42 .39 .49 .52

Anxiousnessⴱ .45 .21 .29 .38 .37 .43 .48
Depressivity .48 .33 .40 .50 .42 .45 .56
Emot. Labil.ⴱ .44 .29 .36 .36 .34 .43 .51
Perseveration .51 .22 .23 .39 .39 .43 .46
Rigid Perfect. .20 .11 .07 .20 .15 .27 .24
Sep. Insecur.ⴱ .35 .16 .26 .33 .27 .37 .34
Submissive. .32 .14 .18 .27 .28 .29 .28
Suspicious. .41 .25 .26 .42 .32 .40 .42
Detachment .40 .20 .21 .50 .33 .35 .42
Anhedoniaⴱ .39 .22 .23 .46 .39 .38 .43
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Intim. Av.ⴱ .23 .14 .12 .29 .17 .16 .28

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Restrict Aff .15 .05 .02 .21 .13 .13 .14

Withdrawalⴱ .34 .15 .18 .46 .25 .31 .35
Antagonism .18 .15 .15 .17 .18 .22 .20
Att. Seeking .18 .10 .13 .06 .16 .15 .13
Callousness .16 .15 .17 .26 .14 .18 .20
Deceit.ⴱ .27 .20 .19 .24 .20 .27 .24
Hostility .31 .24 .26 .34 .24 .36 .38
Grandiosityⴱ .10 .11 .08 .08 .08 .11 .15
Manipulat.ⴱ .10 .09 .11 .11 .16 .18 .12
Disinhibition .51 .32 .36 .37 .42 .38 .53
Distractⴱ .55 .27 .30 .34 .46 .34 .51
Impulsivityⴱ .29 .21 .27 .21 .23 .24 .32
Irresponsib.ⴱ .43 .36 .38 .38 .36 .36 .52
Risk Taking ⫺.01 .02 .06 ⫺.04 ⫺.02 ⫺.02 .02
Psychoticism .47 .27 .29 .40 .37 .41 .50
Eccentricityⴱ .37 .18 .20 .36 .31 .32 .41
Perc. Dys.ⴱ .52 .32 .37 .41 .36 .44 .55
Unsl. Beliefsⴱ .37 .23 .23 .30 .31 .35 .39
R2
Domains .37 .12 .17 .33 .24 .28 .39
Facets .44 .21 .28 .37 .32 .34 .49
Brief Domains .31 .10 .16 .27 .18 .25 .33
Adjusted R2
Domains .37 .10 .16 .32 .23 .28 .38
Facets .42 .14 .20 .34 .29 .31 .43
Brief Domains .31 .08 .14 .26 .17 .24 .32
Note. N ⫽ 561–570 for Cognition, Getting Along with Others, Engaging in Life Activities, and Participation in
Society; N ⫽ 265–275 for Mobility, Self-Care, and Overall Functioning. Underline ⫽ p ⬍ .05. bold ⫽ p ⬍ .01. ⴱ ⫽
scales scored in the PID-5 domains. Emot. Labil. ⫽ Emotional Lability; Rigid Perfect. ⫽ Rigid Perfectionism; NA ⫽
Negative Affect; Schizd ⫽ Schizoid; STPD ⫽ Schizotypal PD; Antisoc ⫽ Antisocial; Sep. Ins. ⫽ Separation
Insecurity; Submissive. ⫽ Submissiveness; Suspicious. ⫽ Suspiciousness; Intim. Av. ⫽ Intimacy Avoidance; Restrict
Aff. ⫽ Restricted Affect; Att. Seeking ⫽ Attention Seeking; Deceit. ⫽ Deceitfulness; Manipulat. ⫽ Manipulative-
ness; Irresponsib. ⫽ Irresponsibility; Perc. Dys. ⫽ Perceptual Dysregulation; Unsl. Belfs. ⫽ Unusual Beliefs; Get
Along ⫽ Getting Along; Life Act ⫽ Life Activities; Society ⫽ Participation in Society.

dictive utility for overall functioning, regardless of if the PID-5 Dependability

domains or facets were included in the model.
Discussion
The current study adds to the evidence supporting the DSM–5
alternative model of personality pathology and the PID-5. To our
knowledge, it is only the second study to examine the dependabil-
ity of the PID-5 and the first to use a sample large enough to meet
recommendations (Watson, 2004). It is also one of a few studies
examining the association between DSM–5 pathological personal-
ity traits and functioning. Finally, only two other studies (Fossati
et al., 2015; Miller et al., 2015) directly tested the alternative
model against the traditional PD model in the same dataset, neither
of which addressed the current issues.
High levels of dependability are essential for the construct
validity of trait measures and models (Chmielewski & Watson,
2009; Gnambs, 2014; McCrae et al., 2011; Watson, 2004). Al-
though measurement error is present to some degree in all PID-5
scales, the dependability of the PID-5 domains approached 1.0
(mean domain dependability r ⫽ .88), indicating relatively low
levels of transient error. However, there was considerable variabil-
ity among the PID-5 facet scales (mean r ⫽ .83), with depend-
abilities ranging from high (e.g., r ⫽ .89) to relatively low (e.g.,
r ⫽ .76). The current dependabilities appear higher than those
reported by Suzuki et al. (2015; domain M ⫽ .83, range ⫽ .81 to
.83; facet M ⫽ .78, range ⫽ .66 to .86). Despite the differences in
magnitude, the correlation of dependability coefficients across the
 DSM–5 TRAITS AND TRADITIONAL PD MODEL 233

Table 4
PDQ-4 Symptom Count Relationship to Functioning

Scale Cognition Mobility Self-Care Get Along Life Act Society Overall

Paranoid .30 .25 .26 .33 .31 .36 .39

Schizoid .29 .30 .29 .39 .22 .27 .40
Schizotypal .43 .38 .34 .45 .36 .45 .52
Antisocial .21 .18 .31 .19 .20 .28 .29
Borderline .46 .33 .42 .46 .36 .50 .58
Histrionic .32 .34 .36 .23 .26 .32 .40
Narcissistic .25 .20 .19 .17 .24 .24 .27
Avoidant .43 .29 .35 .53 .35 .42 .53
Dependent .46 .31 .38 .43 .38 .42 .53
Obs. Comp .28 .17 .19 .25 .22 .31 .32
R2 .32 .22 .28 .38 .21 .34 .47
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Adjusted R2 .31 .19 .25 .37 .20 .32 .45

This document is copyrighted by the American Psychological Association or one of its allied publishers.

Note. N ⫽ 561–570 for Cognition, Getting Along with Others, Engaging in Life Activities, and Participation
in Society; N ⫽ 265–275 for Mobility, Self-Care, and Overall Functioning. Underline ⫽ p ⬍ .05. bold ⫽ p ⬍
.01. Obs. Comp ⫽ Obsessive Compulsive; Get Along ⫽ Getting Along; Life Act ⫽ Life Activities; Society ⫽
Participation in Society.

two studies was high (r ⫽ .66), indicating that the relative depend-
ability of these PID-5 scales was similar across the studies. In other
words, some PID-5 scales are consistently more dependable than
others are.
Overall, the dependability results from the current study and
those from Suzuki et al. (2015) compare favorably to dependability
estimates for “normal” personality traits in similar samples
(Chmielewski et al., 2016; Chmielewski & Watson, 2009; Suzuki
et al., 2015). Nevertheless, it should be noted that dependability
estimates in the .75 range represent a high level of measurement
error (e.g., ⬃25% error variance) and that even fairly low levels of
transient error can have substantial effects on study outcomes (see
Chmielewski & Watson, 2009). Therefore, we echo previous calls
in the literature for further research into the causes of transient
error. This is especially important because previous explanations
for transient error, such as item formats, response formats, or
instruction sets (see Chmielewski & Watson, 2009; Watson, 2004),
cannot explain the differences in dependability across PID-5
scales.
The current results suggest that some of the constructs assessed
by the PID-5 may, instead of representing traits, be best concep-
tualized as more transient and state like. This interpretation is in
line with past suggestions that personality pathology may subsume
both traits and acute symptoms (Clark, 2007; McGlashan et al.,
2005; Oldham & Skodol, 2000). More recently, Wright et al.
(2015) raised this as a possible explanation for the differential

Table 5
Hierarchical Regression Analyses Predicting Functioning

PID-5 incremental validity PDQ-4 incremental validity

WHODAS ⌬R 2
⌬F p ⌬R 2
⌬F p

Domain level
Cognition .089 16.86 .000 .041 3.90 .000
Mobility .022 1.50 .191 .126 4.35 .000
Self-Care .011 .83 .533 .114 4.13 .000
Getting Along .026 4.78 .000 .079 7.33 .000
Life Activities .066 9.94 .000 .038 2.85 .002
Society .023 3.99 .001 .075 6.49 .000
Overall .032 3.18 .008 .109 5.40 .000
Facet level
Cognition .157 6.48 .000 .037 3.86 .000
Mobility .100 1.43 .091 .109 3.86 .000
Self-Care .100 1.52 .058 .100 3.82 .000
Getting Along .048 1.80 .011 .058 5.35 .000
Life Activities .148 4.86 .000 .043 3.51 .000
Society .057 1.99 .003 .053 4.66 .000
Overall .111 2.42 .000 .090 4.91 .000
Note. N ⫽ 561–570 for Cognition, Getting Along with Others, Engaging in Life Activities, and Participation
in Society; N ⫽ 265–275 for Mobility, Self-Care, and Overall Functioning; Significant estimates are bolded.
Columns 2, 3, and 4 present results of the model where the PDQ-4⫹ was entered in the first block and then the
PID-5 (domains or facets) in the second block; Columns 5, 6, and 7 present results of the model where the PID-5
(domains or facets) was entered in the first block and then the PDQ-4⫹ entered in the second block. Society ⫽
Participation in Society.
 234 CHMIELEWSKI, RUGGERO, KOTOV, LIU, AND KRUEGER
1.4-year stability of the PID-5 scales, arguing that it was essential
for future research to address this issue. The current research,
combined with that of Suzuki et al. (2015), provides further
evidence for this possibility. Nevertheless, it is worth noting that
there was a significant association between the number of items a
facet contained and its dependability (r ⫽ .49), suggesting that
scale length may have influenced the dependability of the PID-5
facets. As such, additional research is necessary to determine
which constructs included within the PID-5 are best conceptual-
ized as acute states.
Our dependability results suggest that the PID-5 outperforms the
PDQ-4⫹ regardless of whether the latter was categorically or
dimensionally assessed. Because dependability analyses provide a
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
metric for comparing models of personality pathology
This document is copyrighted by the American Psychological Association or one of its allied publishers.
(Chmielewski & Watson, 2009), the current results empirically
demonstrate the superiority of the alternative DSM–5 model over
the traditional PD model, at least as assessed by these commonly
used measures. It is worth noting that the PID-5 Brief Form, which
contains only 25 items (compared with 99 items in the PDQ-4⫹),
demonstrated as strong if not stronger dependabilities than the
PDQ-4⫹, indicating that the PID-5’s higher dependability is not
solely due to it having more items than the PDQ-4⫹. Our results
also highlight that the categorical nature of traditional DSM PDs
makes them far more susceptible to transient error, suggesting that
transient error is at least partially responsible for the poor stability
of the traditional categorical PD model (Chmielewski & Watson,
2009; Clark et al., 1997; Skodol et al., 2005; Zimmerman, 1994).
Taken together, these results add to the large body of research
indicating that dimensional representations of psychopathology are
superior to categorical ones (Markon et al., 2011). It is worth
noting that interview assessments of PDs have lower stability than
do self-report measures (Samuel et al., 2011). Moreover, past
research has documented poor dependability for interviewer-
assessed mood and anxiety disorders (Chmielewski, Clark, Bagby,
& Watson, 2015), suggesting that dependability of interviewer-
based PD assessments would likely be lower than self-report PD
assessments.
Functioning
The PID-5 scales demonstrated broad associations with multiple
functioning domains. In line with previous research (Keeley et al.,
2014), the DSM–5 traits appear to be more strongly associated with
functioning domains conceptually aligned with personality pathol-
ogy (e.g., getting along with others) than more distal domains (e.g.,
mobility, self-care). With one notable exception, the current asso-
ciations were very similar to those reported by Keeley et al.
(2014); the current results align very strongly with results from
their student sample for five of the WHODAS domains (mean
cross study correlation of the PID-5 associations with functioning
was r ⫽ .83, range r ⫽ .71 to .91). However, a major discrepancy
emerged for Participation in Society; in the current study nearly
every PID-5 scale was significantly associated with Participation
in Society (domain mean r ⫽ .28, facet mean r ⫽ .34), whereas no
PID-5 scales were in the Keeley et al. (2014) student sample
(domain mean r ⫽ .00, facet mean r ⫽ .01). We note that
significant correlations did emerge in their clinical sample. Finally,
we replicated Keeley et al.’s (2014) finding of no association
between PID-5 Risk Taking and functioning. It is interesting to
note that Wright et al. (2015) also found no association between
Risk Taking and functioning in their longitudinal study. Keeley et
al. (2014) suggested that the self-report nature of the PID-5 might
have led to this unexpected finding, and we would add that the
high number of reverse-keyed items in this scale may have influ-
enced the results (Crego & Widiger, 2014)
Despite demonstrating lower dependability, the PDQ-4⫹ was
associated with functioning at least as strongly as the PID-5 was.
Although this finding may seem counterintuitive, it is in line with
previous studies demonstrating that the traditional PDs and the
alternative model have similar associations with psychopathology
and normal personality (Fossati et al., 2015; Miller et al., 2015).
This equivalence may be due, in part, to the fact that the models
share a considerable amount of variance and cover the same basic
content organized in a different manner (Hopwood et al., 2012;
Miller et al., 2015; Samuel et al., 2013). In addition, the PID-5
specifically assesses the trait component of the model (Criterion B)
and not the dysfunction component (Criterion A), whereas the
PDQ-4⫹ does not explicitly make such a distinction. It is worth
noting that the PID-5 Brief Form demonstrated similar associa-
tions to the full PID-5, suggesting that scale length was not a major
factor. Finally, the PID-5 and PDQ-4⫹ provided significant incre-
mental validity over each other for various functioning domains.
The PID-5 provided the most incremental validity for the Cogni-
tion domain whereas the PDQ-4⫹ had its greatest incremental
validity for Mobility and Self-Care. These results suggest that the
two models differ in their specificity in regards to functioning,
with the traditional PD model linked to a broader range of func-
tioning and the DSM–5 trait model demonstrating more specific
links.
Limitations, Future Directions, and Conclusions
Despite its strengths, there are some limitations to the current
study. First, although the PID-5 is the APA’s official instrument
for assessment of the DSM–5 traits and the PDQ-4⫹ is a widely
used measure specifically created to assess traditional PDs, differ-
ent self-report measures assessing these models, informant reports,
or clinician ratings may lead to different results, which is an
important direction for future research. Second, the strong associ-
ation between dependability and ␣ is in contrast to previous studies
(Chmielewski et al., 2016; Chmielewski & Watson, 2009;
Gnambs, 2014; McCrae et al., 2011), including those of the PID-5
(Suzuki et al., 2015). The reasons for the high correlation in the
current sample, as well as for the differences in magnitude of
PID-5 dependabilities between the current study and that of Suzuki
et al. (2015), are unclear, especially considering that past studies
have used similar samples and test administration techniques.
Third, it is unclear if the current student results would replicate in
community or clinical samples. Additional dependability studies of
the PID-5 using large samples are required to address these issues.
However, previous evidence suggests that the relative level of
dependability is consistent across different samples (Chmielewski
& Watson, 2009).
In conclusion, the current study provides evidence regarding the
dependability, a crucial component of construct validity for trait
measures, of the PID-5. In general, the results indicate the DSM–5
traits are highly dependable and outperform the traditional PD
model in this regard. However, some constructs assessed by the
 DSM–5 TRAITS AND TRADITIONAL PD MODEL
PID-5 may be best conceptualized as more state like. In addition,
the current results replicate previous studies demonstrating impor-
tant associations between the DSM–5 traits and functioning. It is
worth noting that both the traditional PD and alternative models
demonstrated similar associations with functioning, suggesting
that the DSM–5 traits capture the important aspects of the tradi-
tional PD model.
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