Discussion: Scholarly article review guideline

NR326 Mental Health Nursing

RUA: Scholarly Article Review Guidelines

NR326 RUA Scholarly Article Review Guideline 1

Purpose
The student will review, summarize, and critique a scholarly article related to a mental health topic.

Course outcomes: This assignment enables the student to meet the following course outcomes.
(CO 4) Utilize critical thinking skills in clinical decision-making and implementation of the nursing process for

psychiatric/mental health clients. (PO 4)
(CO 5) Utilize available resources to meet self-identified goals for personal, professional, and educational

development appropriate to the mental health setting. (PO 5)
(CO 7) Examine moral, ethical, legal, and professional standards and principles as a basis for clinical decision-making.

(PO 6)
(CO 9) Utilize research findings as a basis for the development of a group leadership experience. (PO 8)

Due date: Your faculty member will inform you when this assignment is due. The Late Assignment Policy applies to
this assignment.

Total points possible: 100 points

Preparing the assignment
1) Follow these guidelines when completing this assignment. Speak with your faculty member if you have questions.

a. Select a scholarly nursing or research article, published within the last five years, related to mental health
nursing. The content of the article must relate to evidence-based practice.
• You may need to evaluate several articles to find one that is appropriate.

b. Ensure that no other member of your clinical group chooses the same article, then submit your choice for
faculty approval.

c. The submitted assignment should be 2-3 pages in length, excluding the title and reference pages.
2) Include the following sections (detailed criteria listed below and in the Grading Rubric must match exactly).

a. Introduction (10 points/10%)
• Establishes purpose of the paper
• Captures attention of the reader

b. Article Summary (30 points/30%)
• Statistics to support significance of the topic to mental health care
• Key points of the article
• Key evidence presented
• Examples of how the evidence can be incorporated into your nursing practice

c. Article Critique (30 points/30%)
• Present strengths of the article
• Present weaknesses of the article
• Discuss if you would/would not recommend this article to a colleague

d. Conclusion (15 points/15%)
• Provides analysis or synthesis of information within the body of the text
• Supported by ides presented in the body of the paper
• Is clearly written

e. Article Selection and Approval (5 points/5%)
• Current (published in last 5 years)
• Relevant to mental health care
• Not used by another student within the clinical group
• Submitted and approved as directed by instructor

f. APA format and Writing Mechanics (10 points/10%)

2

NR326 Mental Health Nursing
RUA: Scholarly Article Review Guidelines

NR326 RUA Scholarly Article Review Guideline 2

• Correct use of standard English grammar and sentence structure
• No spelling or typographical errors
• Document includes title and reference pages
• Citations in the text and reference page

For writing assistance (APA, formatting, or grammar) visit the APA Citation and Writing page in the online library.

Please note that your instructor may provide you with additional assessments in any form to determine that you fully
understand the concepts learned in the review module.

NR326 Mental Health Nursing
RUA: Scholarly Article Review Guidelines

NR326 RUA Scholarly Article Review Guideline 4 3

Grading Rubric Criteria are met when the student’s application of knowledge demonstrates achievement of the outcomes for this assignment.

Assignment Section and
Required Criteria

(Points possible/% of total points available)

Highest Level of
Performance

High Level of
Performance

Satisfactory Level
of Performance

Unsatisfactory
Level of

Performance

Section not
present in paper

Introduction
(10 points/10%)

10 points 8 points 0 points

Required criteria
1. Establishes purpose of the paper
2. Captures attention of the reader

Includes 2 requirements for section. Includes 1
requirement for
section.

No requirements for this section presented.

Article Summary
(30 points/30%)

30 points 25 points 24 points 11 points 0 points

Required criteria
1. Statistics to support significance of the topic to

mental health care
2. Key points of the article
3. Key evidence presented
4. Examples of how the evidence can be incorporated

into your nursing practice

Includes 4
requirements for
section.

Includes 3
requirements for
section.

Includes 2
requirements for
section.

Includes 1
requirement for
section.

No requirements for
this section
presented.

Article Critique
(30 points/30%)

30 points 25 points 11 points 0 points

Required criteria
1. Present strengths of the article
2. Present weaknesses of the article
3. Discuss if you would/would not recommend this

article to a colleague

Includes 3 requirements for section. Includes 2
requirements for
section.

Includes 1
requirement for
section.

No requirements for
this section
presented.

Conclusion
(15 points/15%)

15 points 11 points 6 points 0 points

1. Provides analysis or synthesis of information within
the body of the text

2. Supported by ides presented in the body of the paper
3. Is clearly written

Includes 3 requirements for section. Includes 2
requirements for
section.

Includes 1
requirement for
section.

No requirements for
this section
presented.

Article Selection and Approval
(5 points/5%)

5 points 4 points 3 points 2 points 0 points

1. Current (published in last 5 years) Includes 4 Includes 3 Includes 2 Includes 1 No requirements for

NR326 Mental Health Nursing
RUA: Scholarly Article Review Guidelines

NR326 RUA Scholarly Article Review Guideline 4 4

2. Relevant to mental health care
3. Not used by another student within the clinical group
4. Submitted and approved as directed by instructor

requirements for
section.

requirements for
section.

requirements for
section.

requirement for
section.

this section
presented.

APA Format and Writing Mechanics
(10 points/10%)

10 points 8 points 7 points 4 points 0 points

1. Correct use of standard English grammar and
sentence structure

2. No spelling or typographical errors
3. Document includes title and reference pages
4. Citations in the text and reference page

Includes 4
requirements for
section.

Includes 3
requirements for
section.

Includes 2
requirements for
section.

Includes 1
requirement for
section.

No requirements for
this section
presented.

Total Points Possible = 100 points

Running Head: THE DIAGNOSIS OF BIPOLAR DISORDER 1

The delay in the diagnosis of bipolar disorder

Chamberlain College of Nursing

NR 326: Mental Health

00/ 2018

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BIPOLAR DISORDER
2

Introduction

Bipolar disorder has a significant cause to morbidity and mortality rate. Although we

have an active treatment, there is an extensive wait before diagnosis and treatment are initiated.

This research was done to examine factors associated with the delay of bipolar disorder before

the diagnosis and the onset of treatment. Bipolar disorder is also called manic depression. This

disorder is characterized with the events of mood swings ranging from depressive lows to manic

highs. The history of bipolar disorder presents with depression, so initial episodes look very

similar to a major depressive disorder. Therefore, there is often a prolonged delay in the exact

diagnosis of bipolar disorder, and any significant wait influence the initiation of appropriate

treatment. This paper investigates whether the delay in the diagnosis of bipolar disorder is

inescapable. This means is the delay in diagnosing bipolar disorder unavoidable or unpreventable

(Fritz et al, 2017).

Article summary

Bipolar disorder frequently beings with an early diagnosis of depression. This creates a

delay in the exact judgement and treatment of bipolar disorder. Although research has focused on

predictors in the analytic change from the depression stage to bipolar disorder. The research on

this prolonged diagnosis is scant. These researchers examine the time it took to diagnose one

with bipolar disorder after an early diagnosis of major depressive disorder to understand the

patient features and psychological factors that may explain the delay. However, when manic

signs are evident, the diagnosis changes to be bipolar disorder. Research shows that the time

from diagnosing a major depressive disorder to the time of diagnosing bipolar disorder is about

10 years. This means before the optimal treatment for bipolar disorder can be made, there might

be a delay in treatment for almost a decade. This is one of many reasons why it is important to

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BIPOLAR DISORDER
3

investigate the cause, and the delay from the diagnosis of major depressive disorder to time of

bipolar disorder (Fritz et al., 2017).

One of the most common predictors of exploratory conversion from major depressive

disorder to bipolar disorder is with antidepressant treatment resistance. There is a rise in the rate

of diagnostic conversion to bipolar disorder after a failure to respond to two treatments with the

use of antidepressant. Another factor that is associated with the diagnostics change from major

depressive disorder to bipolar disorder is with the initial onset of depression. Studies show that

patients who were formerly diagnosed with major depressive disorder are likely to be diagnosed

with bipolar disorder if they had an early onset of depression and were unresponsive to

antidepressant treatment. Also, the conversion to bipolar disorder has been found related to the

patient family history, but the findings are not truly reliable (Fritz et al., 2017).

The information from the article could be used in nursing practice because it educates the

nurse on the factors that might affect the early diagnosis of bipolar disorder. For example, some

statistical data from this research proves the delay as it was stated in this article. The conversion

time from major depressive disorder to bipolar disorder was about 42.8% lesser in female than it

was in male. Also, for every 1-year increase in the initial diagnosis of major depressive disorder,

the time for bipolar disorder conversion decrease by 2.8%. This data was made after a clinical

evaluation of 382 patients by a psychiatrist and with the of use series of questionnaires. When

there is an increase in the diagnosis of major disorder there is a decrease in the diagnosis of

bipolar and verse versa. Another example is to understand those factors associated with the delay

in bipolar disorder which will help the nurse better understand why some patients are diagnosed

with bipolar and other patients showing the same behavior have not been diagnosed. This article

will help the nurse better understand the diagnosis and the delayed process of bipolar disorder

(Fritz et al, 2017).

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BIPOLAR DISORDER
4

Article critique

Based on the study done, the delay is due to the disease process and other factors that

prolong the diagnosis. This article is informative about the process it takes to diagnose bipolar

disorder. The researchers put together resources from various aspect from their research to

provide why the delay is present. For example, Fritz et al. (2017) found an undesirable

correlation between the age at which the disease is initialed to the time of diagnostic conversion.

This means the younger the age of the patient, the longer the delay in diagnosing the patient.

Therefore, understanding the patient’s features and psychological behavior are also reasons that

may delay bipolar disorder from being diagnosed after an early diagnosis of a major depressive

disorder (Fritz et al, 2017).

Weakness

I feel that although the article did tell us about the factors that are associated with the

delay to diagnose bipolar disorder, the researchers did not show how those factors can be

evitable. Within the article there should have been a clear picture or graph explaining ways to

reduce the long process to diagnosing one with bipolar disorder. The weakness I believe in this

article is not especially from the article presentation, but it is from the disease process. The

weakness in this article is seen in the length of time it takes to diagnose one with bipolar.

Recommendations

I will recommend this article to a colleague because it gave a detailed explanation of the

aim of this research. This article is a good starting point to know why there is a prolonged wait in

the diagnosis of bipolar disorder. As a nursing student, this article makes me understand why

most people who exhibit similar behavior with people diagnosed with bipolar disorder have not

been medically diagnosed. As it was explained in the article, age makes a big difference to

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BIPOLAR DISORDER
5

diagnose a person with bipolar disorder because of patient characteristics and psychological

factors. Younger patients are not mentally developed as an adult patient would be.

Conclusion

In conclusion, this study shows that certain individuals experience a significant delay in

diagnosis and treatment of bipolar disorder which varies depending on different factors. I believe

when there is a better understanding of the factors associated with the delay to diagnose bipolar

disorder, then there will be developmental strategies to reduce them. These findings indicate the

need for an early recognition and initiation of active treatment of bipolar disorder which will

most likely diminish disability and improve outcomes.

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BIPOLAR DISORDER
6

References

Fritz, K., Russell, A., Allwang, C., Kuiper, S., Lampe, L., Malhi, G., (2017). Bipolar disorder: Is

a delay in the diagnosis of bipolar disorder inevitable? 19, 396–400. doi:10.1111/bdi.12499.

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An Examination of Dependent Personality Disorder
in the Alternative DSM-5 Model for Personality Disorders

Andrew S. McClintock1,2 & Shannon M. McCarrick1

Published online: 5 August 2017
# Springer Science+Business Media, LLC 2017

Abstract Although the diagnosis of dependent personality
disorder (DPD) has demonstrated construct validity and clin-
ical utility, little is known about how best to model DPD in the
DSM-5’s new, alternative model for diagnosing personality
disorders. The current research aimed to represent DPD using
the 25 pathological personality traits of the alternative model.
Self-report measures of the 25 pathological personality traits,
DPD, avoidant personality disorder, borderline personality
disorder, and maladaptive interpersonal dependency were ad-
ministered to an undergraduate sample (N = 194). Results
indicated that— as consistent with extant theory— anxious-
ness, submissiveness, and separation insecurity were the three
traits most strongly related to DPD symptoms. As a
group, anxiousness, submissiveness, and separation inse-
curity were more strongly related to DPD symptoms
(r = 0.55) than were the remaining 22 personality traits
(r = 0.34). This group of three traits was strongly asso-
ciated, however, with avoidant personality disorder
symptoms (r = 0.55), suggesting that additional scrutiny
of DPD and avoidant personality disorder in the alter-
native model may be needed. Limitations and directions
for future research are presented.

Keywords Dependent personality disorder . Avoidant
personality disorder . DSM . Alternative model

In light of frequent criticism of the personality disorder diag-
nostic system in the DSM-IV (American Psychiatric
Association 2000; for criticisms, see Widiger et al. 2009),
the Personality and Personality Disorders Work Group pro-
posed a novel approach to the diagnosis of personality disor-
ders. This approach, titled the alternative DSM model for per-
sonality disorders (AMPD), was not accepted as the official
diagnostic system for the DSM-5 (American Psychiatric
Association 2013) but rather was published in DSM-
5’s Section III (Bemerging measures and models^ p.
729). If the AMPD holds up to empirical scrutiny, and
even outperforms established diagnostic criteria, then the
AMPD may become the official system in future edi-
tions of the DSM (Few et al. 2013).

In contrast to previous models, the AMPD is a dimensional
trait model that represents personality disorders as combina-
tions of core personality-related impairments and various con-
figurations of 25 pathological personality traits (American
Psychiatric Association 2013; Krueger et al. 2012; Morey
and Skodol 2013; Skodol 2012). The pathological personality
traits are organized into five higher-order domains (i.e., nega-
tive affect, detachment, antagonism, disinhibition, and
psychoticism) that align with the extensively validated
five-factor model of general personality (McCrae and
Costa 2003; see Gore and Widiger 2015). That is, the
AMPD models personality disorders as extreme, mal-
adaptive variants of the same traits that describe normal
personality (Samuel et al. 2013).

Four personality disorders were excluded from the AMPD:
paranoid personality disorder, schizoid personality disorder,
histrionic personality disorder, and— as most relevant to the

* Andrew S. McClintock
[email protected]

Shannon M. McCarrick
[email protected]

1 Department of Psychology, Ohio University, 264 Porter Hall,
Athens, OH 45701, USA

2 Department of Family Medicine and Community Health, University
of Wisconsin School of Medicine and Public Health, Madison, WI,
USA

J Psychopathol Behav Assess (2017) 39:635–641
DOI 10.1007/s10862-017-9621-y

current research— dependent personality disorder (DPD).
According to developers of the AMPD (Skodol 2012), DPD
was excluded because of lower prevalence estimates, relative-
ly weak associations with functional impairment, and little
evidence for discriminant validity. Consequently, individuals
who exhibit the signs of DPD would be diagnosed in the
AMPD as personality disorder- trait specified and would be
described with the three pathological traits of anxiousness,
submissiveness, and separation insecurity (American
Psychiatric Association 2013; Skodol et al. 2011).

Some scholars, however, have disputed the decision to ex-
clude DPD from the AMPD. Bornstein (2011) noted, for in-
stance, that DPD prevalence rates are comparable to the prev-
alence rates of personality disorders included in the AMPD.
There is also evidence that the DPD diagnosis is clinically
useful, as DPD symptoms are associated with suicidality, part-
ner and child abuse, important elements of treatment process
and outcome, and high levels of functional impairment
(Bornstein 2012a, b). Indeed, Soeteman et al. (2008) reported
that health care costs associated with DPD were higher than
the costs associated with obsessive-compulsive, antisocial,
and avoidant personality disorders (all included in the
AMPD). Furthermore, although DPD overlaps with other per-
sonality disorders, particularly avoidant personality disorder
and borderline personality disorder (Bastiaansen et al. 2012;
Disney 2013; Miller et al. 2015), DPD seems to have comor-
bidity rates that are similar to those of personality disorders
included in the AMPD (Bornstein 2011, 2012a, b; Disney
2013; Zimmermann et al. 2005).

Because DPD might be at least as valid and clinically useful
as personality disorders retained in the AMPD (Bornstein
2011), empirical research is needed to model DPD with
AMPD’s pathological personality traits. While theory impli-
cates three pathological traits in DPD (i.e., anxiousness,
submissiveness, and separation insecurity; Skodol et al. 2011),
empirical support for this configuration is mixed. Bornstein
(2011) astutely noted that much of the research in this area
focuses on personality disorders retained in the AMPD, and
thus the evidence base for these personality disorders tends to
be larger than the evidence base for excluded personality disor-
ders (e.g., DPD). Nevertheless, the data that do exist suggest
that anxiousness and separation insecurity are integral to DPD
(Anderson et al. 2014; Bornstein 2012b; Hopwood et al. 2012;
Morey et al. 2016; Gore and Widiger 2015), whereas submis-
siveness may (Bach et al. 2016a, b; Gore and Widiger 2015;
Morey et al. 2016; Smith et al. 2009) or may not (Anderson
et al. 2014; Bornstein 2012b; Fossati et al. 2013) be integral to
DPD. Bornstein (2012b) reported that individuals with DPD
can be quite assertive in certain contexts (e.g., when important
relationships are threatened), and thus submissiveness should
not be regarded as a core trait of DPD.

Even if the Personality and Personality Disorders Work
Group is correct in their assertion that DPD is best

characterized by anxiousness, submissiveness, and separation
insecurity (Skodol et al. 2011), it remains to be seen if this
configuration is distinct from the configurations of other per-
sonality disorders. There is evidence that anxiousness, sub-
missiveness, and/or separation insecurity are elevated in
avoidant personality disorder (APD) and borderline personal-
ity disorder (BPD) (Anderson et al. 2014; Disney 2013;
Fossati et al. 2013; Gude et al. 2004, 2006; Hopwood et al.
2012; Leising et al. 2006; Morey et al. 2016; Yam and Simms
2014), suggesting that the proposed configuration of DPD
may lack discriminant validity.

The present research aimed to model DPD using AMPD’s
pathological personality traits and to determine if this config-
uration of personality traits is distinct from the configurations
of APD and BPD. APD and BPD were selected because, of all
10 personality disorders, these two seem to be most
strongly related to DPD (Bastiaansen et al. 2012;
Disney 2013; Miller et al. 2015). In addition to the
DPD measure, we included a measure of maladaptive
interpersonal dependency to compare the DPD configu-
ration with the maladaptive dependency configuration.

Method

Participants

Participants in the present study were 200 undergraduates at a
large Midwestern university who received course credit for
their participation. Six students were excluded for invalid
responding, resulting in a final sample of 194 participants.
The majority identified as female (66.0%), heterosexual
(84.0%), and never married (98.5%). In addition, 84.0% of
participants identified as Caucasian, 4.6% identified as
African American, 3.6% identified as Asian American, 3.6%
identified as Hispanic, 3.6% identified as multiracial, and
0.5% identified as American Indian. Participants had a mean
age of 18.7 years (SD = 2.9).

Measures

The Personality Inventory for DSM-5 (PID-5; Krueger et al.
2012) is a 220-item, self-report questionnaire that assesses the
25 pathological personality traits (and five higher-order do-
mains) of the AMPD. This measure asks participants to rate
statements on a 4-point Likert scale from 0 (very false or often
false) to 3 (very true or often true). A sample item is BI usually
do things on impulse without thinking about what might hap-
pen as a result.^ The PID-5 has demonstrated construct valid-
ity, convergent validity, and discriminant validity in past re-
search (e.g., Quilty et al. 2013; Wright et al. 2012). In the
current research, the PID-5 scales exhibited acceptable to

636 J Psychopathol Behav Assess (2017) 39:635–641

good levels of internal consistency (Cronbach αs ranged from
0.75 [PID-5-Grandiosity] to 0.96 [PID-5-Eccentricity]).

The Personality Diagnostic Questionnaire 4+ (PDQ-4+;
Hyler 1994) is a 99-item, self-report instrument used to screen
for each of the DSM-IV personality disorders. In the present
study, only the DPD (8 items), APD (7 items), and BPD (9
items) scales were administered. All items use a true-false
response format. Representative items for each scale include
BI prefer that other people assume responsibility for me,^
(DPD), BI avoid working with others who may criticize me,^
(APD), and BI’ll go to extremes to prevent those who I love
from ever leaving me^ (BPD). In the present study, we chose
to measure symptoms dimensionally as opposed to assessing
personality disorders categorically, as dimensional scales tend
to be more reliable and valid (Hopwood et al. 2012; Markon
et al. 2011). Because PDQ-4+ response options are binary
(i.e., true/false), we calculated Kuder-Richardson 20 coeffi-
cients for the PDQ-4 + −DPD (0.58), PDQ-4 + −APD
(0.71), and PDQ-4 + −BPD (0.54).

The Relationship Profile Test (RPT; Bornstein et al. 2003)
is a 30-item, self-report measure of three interpersonal styles:
healthy dependency, detachment, and overdependence. In the
present study, only the Destructive Overdependence (DO)
subscale (10 items) was administered. Each item is rated on
a 7-point scale, ranging from 1 (not at all true of me) to 7 (very
true of me). A representative item from the DO subscale is,
BBeing responsible for things makes me nervous.^ The items
were constructed based on the dependency literature and aim
to assess the cognitive, emotional, motivational, and behav-
ioral features of maladaptive dependency (Bornstein et al.
2003). The RPT has exhibited good construct validity in prior
research (Bornstein et al. 2003; Haggerty et al. 2010). In the
current study, the RPT-DO had acceptable internal consisten-
cy (Cronbach α= 0.89).

Procedure

This study was conducted at a large Midwestern university
during the 2015–2016 academic year. IRB approval was ob-
tained, and all ethical standards were followed. Participants

completed the above measures online in partial fulfillment of
research requirements for psychology courses.

Plan of Analysis

Correlational analyses were first employed to assess the rela-
tionships between DPD, APD, BPD, and maladaptive inter-
personal dependency. Next, correlations were used to deter-
mine how DPD, APD, BPD, and maladaptive dependency are
related to the 25 pathological personality traits. Given the
large number of analyses, coupled with our goal of identifying
the core traits of these conditions, we regarded correlations >
.40 (and p values < .001) as meaningful (see Hopwood et al.
2012). Finally, we used correlations to examine the relation-
ships between personality disorder symptoms, proposed trait
configurations, and the remaining non-proposed traits. For
these analyses, the following variables were created: DPD
Proposed Traits (M of anxiousness, submissiveness, and sep-
aration insecurity), DPD Non-Proposed Traits (M of 23 traits;
all but anxiousness, submissiveness, and separation insecuri-
ty), APD Proposed Traits (M of anhedonia, anxiousness, inti-
macy avoidance, and withdrawal), APD Non-Proposed Traits
(M of 21 traits; all but anhedonia, anxiousness, intimacy
avoidance, and withdrawal),

BPD Proposed Traits (M of anxiousness, depressivity,
emotional lability, hostility, impulsivity, risk taking, separa-
tion insecurity), BPD Non-Proposed Traits (M of 18 traits;
all but anxiousness, depressivity, emotional lability, hostility,
impulsivity, risk taking, separation insecurity). For each per-
sonality disorder (DPD, APD, BPD), we evaluated whether
the correlation of the personality disorder and the proposed
configuration is significantly larger than the correlation of the
personality disorder and the non-proposed traits.

Results

Correlations between PDQ-4 + −DPD, PDQ-4 + −APD,
PDQ-4 + −BPD, and RPT-DO are presented in Table 1. Of
note, PDQ-4 + −DPD was highly correlated with PDQ-4 +
−APD (r = 0.56) and PDQ-4 + −BPD (r = 0.50). Surprisingly,

Table 1 Correlations between measures of DPD, APD, BPD, and maladaptive dependency (N = 194)

M (SD) PDQ-4 + − DPD PDQ-4 + − APD PDQ-4 + − BPD RPT- DO

PDQ-4 + −DPD 1.55 (1.56) − .56* .50* .56*
PDQ-4 + −APD 2.61 (2.00) − .47* .63*
PDQ-4 + −BPD 2.73 (1.80) − .32*
RPT-DO 26.77 (8.14) −

PDQ-4+ Personality Diagnostic Questionnaire 4+, DPD Dependent Personality Disorder, APD Avoidant Personality Disorder, BPD Borderline
Personality Disorder, RPT-DO Relationship Profile Test-Destructive Overdependence

*p < .001

J Psychopathol Behav Assess (2017) 39:635–641 637

RPT-DO was at least as strongly related to the PDQ-4 + −APD
(r = 0.63) as it was to PDQ-4 + −DPD (r = 0.56).

Correlations of PDQ-4 + −DPD, PDQ-4 + −APD, PDQ-
4 + −BPD, and RPT-DO with PID-5 traits/domains are pre-
sented in Table 2. The three PID-5 scales most strongly cor-
related with PDQ-4 + −DPD were PID-5-Anxiousness,
(r = 0.41), PID-5-Submissiveness (r = 0.42), and PID-5-
Separation Insecurity (r = 0.52). This configuration was gen-
erally replicated with RPT-DO, as PID-5-Anxiousness and
PID-5-Submissiveness were the two scales most strongly

correlated with RPT-DO, and PID-5-Separation Insecurity
was the fifth scale most strongly correlated with RPT-DO.
Importantly, PID-5-Anxiousness, PID-5-Submissiveness,
and PID-5-Separation Insecurity were also strongly correlated
with PDQ-4 + −APD (all rs > 0.40).

Next, correlations were conducted to examine the relation-
ships between personality disorder symptoms, proposed trait
configurations, and the remaining non-proposed traits (see
Table 3). The proposed configuration of DPD (i.e., PID-5-
Anxiousness, PID-5-Submissiveness, and PID-5-Separation

Table 2 Correlations between
PID-5 traits/domains and
measures of DPD, APD, BPD,
and maladaptive dependency
(N = 194)

M (SD) PDQ-4 + −
DPD

PDQ-4 + −
APD

PDQ-4 + −
BPD

RPT-
DO

PID-5 Traits

Emotional Lability 0.98 (0.70) .39 .44 .58 .44

Anxiousness 1.45 (0.72) .41 .49 .46 .54

Separation Insecurity 0.84 (0.65) .52 .41 .36 .42

Submissiveness 1.03 (0.70) .42 .46 .32 .57

Hostility 0.91 (0.52) .26 .24 .55 .12

Perseveration 0.86 (0.59) .36 .32 .46 .36

Depressivity 0.59 (0.61) .36 .48 .56 .38

Suspiciousness 1.03 (0.45) .29 .34 .47 .18

Restricted Affectivity 0.89 (0.66) .07 .07 .10 −.06
Withdrawal 0.79 (0.59) .21 .42 .40 .26

Intimacy Avoidance 0.68 (0.64) .09 .15 .23 .10

Anhedonia 0.85 (0.61) .29 .41 .50 .27

Manipulativeness 0.85 (0.66) .11 −.02 .22 −.10
Deceitfulness 0.67 (0.56) .23 .14 .33 .08

Grandiosity 0.63 (0.54) .16 −.07 .15 −.05
Attention Seeking 0.93 (0.64) .23 .06 .23 .11

Callousness 0.50 (0.49) .12 −.04 .29 .16
Irresponsibility 0.53 (0.51) .35 .24 .43 .22

Impulsivity 0.83 (0.62) .18 .07 .34 .08

Distractibility 1.03 (0.66) .38 .39 .47 .44

Risk Taking 1.43 (0.50) −.14 −.23 .01 −.29
Rigid Perfectionism 1.01 (0.66) .19 .15 .22 .11

Unusual Beliefs &
Experiences

0.68 (0.59) .18 .13 .32 .12

Eccentricity 0.93 (0.76) .22 .15 .37 .23

Perceptual Dysregulation 0.64 (0.53) .33 .28 .47 .28

PID-5 Domains

Negative Affect 1.09 (0.58) .52 .53 .56 .56

Detachment 0.77 (0.50) .24 .40 .47 .26

Antagonism 0.72 (0.51) .19 .02 .27 −.03
Disinhibition 0.80 (0.49) .37 .29 .50 .31

Psychoticism 0.75 (0.56) .26 .20 .42 .24

Traits that are used to describe each personality disorder in the alternative model are bolded. Correlations >0.4
were regarded as meaningful

PID-5 Personality Inventory for DSM-5, PDQ-4+ Personality Diagnostic Questionnaire 4+, DPD Dependent
Personality Disorder, APD Avoidant Personality Disorder, BPD Borderline Personality Disorder, RPT-DO
Relationship Profile Test-Destructive Overdependence

638 J Psychopathol Behav Assess (2017) 39:635–641

Insecurity) accounted for 30% of the variability in PDQ-4 +
−DPD scores (r = 0.55). The non-proposed traits (i.e., all but
PID-5-Anxiousness, PID-5-Submissiveness, and PID-5-
Separation Insecurity) collectively accounted for 12% of the
variability in PDQ-4 + −DPD scores (r = 0.34). These corre-
lation coefficients were significantly different (p < 0.05). Of
note, the proposed configuration of DPD was as strongly re-
lated to PDQ-4 + −APD (r = 0.55) as it was to PDQ-4 +
−DPD (r = 0.55).

The proposed configuration of APD (i.e., PID-5-Anhedonia,
PID-5-Anxiousness, PID-5-Intimacy Avoidance, and PID-5-
Withdrawal) accounted for 25% of the variability in PDQ-
4 + −APD scores (r = 0.50). The non-proposed traits (i.e., all
but PID-5-Anhedonia, PID-5-Anxiousness, PID-5-Intimacy
Avoidance, and PID-5-Withdrawal) collectively accounted for
9% of the variability in PDQ-4 + −APD scores (r = 0.30).
These correlation coefficients were significantly different
(p < 0.05).

The proposed configuration of BPD (i.e., PID-5-
Anxiousness, PID-5-Depressivity, PID-5-Emotional
Lability, PID-5-Hostility, PID-5-Impulsivity, PID-5-Risk
Taking, and PID-5-Separation Insecurity) accounted for
40% of the variability in PDQ-4 + −BPD scores
(r = 0.63). The non-proposed traits (i.e., all but PID-5-
Anxiousness, PID-5-Depressivity, PID-5-Emotional
Lability, PID-5-Hostility, PID-5-Impulsivity, PID-5-Risk
Taking, and PID-5-Separation Insecurity) collectively
accounted for 27% of the variability in in PDQ-4 +
−BPD scores (r = 0.52). These correlation coefficients
were not significantly different.

Discussion

We found that— of all personality traits included in the
AMPD— anxiousness, submissiveness, and separation inse-
curity were most strongly associated with DPD symptoms.
These are the same traits used to describe DPD symptomatol-
ogy in the current edition of the AMPD (e.g., see Skodol et al.
2011). Past research has consistently linked anxiousness and
separation insecurity to DPD symptoms (Anderson et al.
2014; Hopwood et al. 2012; Morey et al. 2016; Gore and
Widiger 2015), though the link between submissiveness and
DPD symptoms has received somewhat mixed results
(Anderson et al. 2014; Bornstein 2012b; Fossati et al. 2013;
Gore and Widiger 2015; Leising et al. 2006; Morey et al.
2016; Smith et al. 2009).

Correlation analyses revealed that anxiousness, submis-
siveness, and separation insecurity collectively accounted for
30% of the variability in DPD symptoms, which is compara-
ble to figs. (28–36%) reported in prior research (Anderson
et al. 2014; Few et al. 2013). We also found that DPD symp-
toms were more strongly related to anxiousness, submissive-
ness, and separation insecurity as a group (r = 0.55) than to the
remaining 22 personality traits (r = 0.34). Taken together,
these results suggest that DPD can be well-modeled with anx-
iousness, submissiveness, and separation insecurity (see
Skodol et al. 2011).

Substantial overlap was observed, however, between DPD
and APD. Specifically, APD was strongly associated with
both DPD (r = 0.56) and maladaptive interpersonal dependen-
cy (r = 0.63). Furthermore, and as consistent with extant

Table 3 Correlations (N = 194)
between DPD, APD, BPD,
proposed traits, and non-proposed
traits (N = 194)

1 2 3 4 5 6 7 8 9

PDQ-4 + −DPD (1) – 0.55 0.34 0.56 0.35 0.39 0.50 0.45 0.31
DPD Proposed Traits (2) – 0.56 0.55 0.64 0.64 0.47 0.78 0.52

DPD Non-Proposed Traits (3) – 0.29 0.76 0.99 0.53 0.84 0.89

PDQ-4 + −APD (4) – 0.50 0.30 0.47 0.44 0.40
APD Proposed Traits (5) – 0.69 0.55 0.71 0.92

APD Non-Proposed Traits (6) – 0.53 0.88 0.83

PDQ-4 + −BPD (7) – 0.63 0.52
APD Proposed Traits (8) – 0.70

APD Non-Proposed Traits (9) –

DPD Proposed Traits (anxiousness, submissiveness, and separation insecurity), DPD Non-Proposed Traits (23
traits; all but anxiousness, submissiveness, and separation insecurity). APD Proposed Traits (anhedonia, anxious-
ness, intimacy avoidance, and withdrawal), APD Non-Proposed Traits (21 traits; all but anhedonia, anxiousness,
intimacy avoidance, and withdrawal). BPD Proposed Traits (anxiousness, depressivity, emotional lability, hostil-
ity, impulsivity, risk taking, separation insecurity), BPD Non-Proposed Traits (18 traits; all but anxiousness,
depressivity, emotional lability, hostility, impulsivity, risk taking, separation insecurity). All correlations coeffi-
cients were significant at p < 0.001. Bold values indicate a significant difference between correlation coefficients
for the proposed and non-proposed traits for that personality disorder

PDQ-4+ Personality Diagnostic Questionnaire 4+, DPD Dependent Personality Disorder, APD Avoidant
Personality Disorder, BPD Borderline Personality Disorder

J Psychopathol Behav Assess (2017) 39:635–641 639

literature (e.g., Anderson et al. 2014; Hopwood et al. 2012;
Morey et al. 2016), APD symptoms were strongly correlated
(all rs > 0.40) with the traits representing DPD (i.e., anxious-
ness, submissiveness, and separation insecurity), and these
correlations were as strong or stronger than the correlations
between APD symptoms and the APD’s proposed traits (i.e.,
anhedonia, anxiousness, intimacy avoidance, and withdraw-
al). It stands to reason, from these results, that anxiousness,
submissiveness, and separation insecurity may be integral to
both DPD and APD.

For decades, scholars have expressed doubt about
whether DPD and APD are truly distinct (Grant et al.
2005; Trull et al. 1987). Large correlations (e.g.,
r = 0.66) have been documented between DPD and
APD symptoms, regardless of whether symptoms are
assessed via self-report (Bachrach et al. 2012) or struc-
tured interview (Leising et al. 2006). In a large, nationally
representative survey of the U.S. population, Grant et al.
(2005) found that the comorbidity of DPD and APD was
exceedingly high (odds ratio = 118.6). The high degree of
overlap between DPD and APD raises concerns about
their validity as independent disorders (Disney 2013).
On the other hand, we found that detachment was corre-
lated with APD symptoms at 0.40 and DPD symptoms at
0.24, which may suggest that while DPD and APD are
highly similar in the negative affect domain (i.e., anxious-
ness, submissiveness, and separation insecurity), APD
may include additional features belonging to the detach-
ment domain (e.g., withdrawal and anhedonia). This in-
terpretation should be regarded as speculative; future re-
search is needed to examine how and to what degree DPD
and APD are distinct.

This research has several shortcomings. The use of a non-
clinical (undergraduate) sample, comprised mostly of young,
White females, limits the generalizability of our results to
clinical populations, males, people of color, and members of
other age groups. Additionally, our reliance on self-report data
may have led to shared method variance, potentially inflating
the size of the associations. This concern is somewhat miti-
gated by our focus on correlations >0.40. Nevertheless, given
that some participants may have been unaware of their own
behavior and symptoms, future research should attempt to
replicate these findings with structured interviews and
informant-based assessments (e.g., see Bach et al. 2016b).

In sum, the present research corroborates the idea that DPD
can be well-modeled with anxiousness, submissiveness, and
separation insecurity in the AMPD. At the same time, each of
these traits was robustly associated with APD symptoms, sug-
gesting that additional work is needed to understand the dis-
tinction between DPD and APD in the AMPD. We are hopeful
that the current study will spur efforts to verify DPD and APD
and to determine how these diagnoses best fit into our ever-
evolving diagnostic systems.

Compliance with Ethical Standards

Funding This study was not funded.

Ethical Approval All procedures performed in studies involving hu-
man 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 individual
participants included in the study.

Conflict of Interest Andrew S. McClintock and Shannon M.
McCarrick declare that they have no conflict of interest.

Experiment Participants This study received approval by the
university’s Institutional Review Board.

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