The structure of personality disorders in individuals with posttraumatic stress disorder

Personal Disord. 2011 Oct;2(4):261-78. doi: 10.1037/a0023168.

Abstract

Research on the structure of personality disorders (PDs) has relied primarily on exploratory analyses to evaluate trait-based models of the factors underlying the covariation of these disorders. This study used confirmatory factor analysis to evaluate whether a model that included both PD traits and a general personality dysfunction factor would account for the comorbidity of the PDs better than a trait-only model. It also examined if the internalizing/externalizing model of psychopathology, developed previously through research on the structure of Axis I disorders, might similarly account for the covariation of the Axis II disorders in a sample of 245 veterans and nonveterans with posttraumatic stress disorder. Results indicated that the best fitting model was a modified bifactor structure composed of nine lower-order common factors. These factors indexed pathology ranging from aggression to dependency, with the correlations among them accounted for by higher-order Internalizing and Externalizing factors. Further, a general factor, reflecting a construct that we termed boundary disturbance, accounted for additional variance and covariance across nearly all the indicators. The Internalizing, Externalizing, and Boundary Disturbance factors evidenced differential associations with trauma-related covariates. These findings suggest continuity in the underlying structure of psychopathology across DSM-IV Axes I and II and provide empirical evidence of a pervasive, core disturbance in the boundary between self and other across the PDs.

Publication types

  • Evaluation Study
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Aged
  • Aggression
  • Comorbidity
  • Dependency, Psychological
  • Diagnostic and Statistical Manual of Mental Disorders*
  • Factor Analysis, Statistical
  • Female
  • Humans
  • Internal-External Control
  • Interpersonal Relations
  • Life Change Events
  • Male
  • Middle Aged
  • Models, Psychological*
  • Models, Statistical*
  • Personality / classification
  • Personality Disorders / classification
  • Personality Disorders / epidemiology*
  • Personality Disorders / psychology
  • Personality Inventory / statistics & numerical data
  • Psychiatric Status Rating Scales / statistics & numerical data
  • Self Concept
  • Severity of Illness Index
  • Stress Disorders, Post-Traumatic / epidemiology*
  • Stress Disorders, Post-Traumatic / psychology
  • Veterans / psychology
  • Young Adult