Understanding the Extrinsic Disability Associated with Personality Disorder: Conceptual, Terminological, and Empirical Challenges

It is well established that personality disorders (PD) and pathological levels of personality traits are associated with various types of consequential difficulties, often called functional impairment or psychosocial disability. I use the term “extrinsic disability” to refer to these difficulties, to distinguish them from impairment in functioning that is an inherent part of personality pathology, specifically, Criterion A of the Section-III alternative dimensional PD model in the fifth edition of the Diagnostic and Statistical Manual (DSM-5; American Psychiatric Association, 2013). However, the literature lacks clarity in both its theoretical conceptualization of extrinsic disability constructs, particularly as they relate to disorder constructs, and also the empirical measurement of extrinsic disability. A comprehensive exploration of the functional consequences of PD is crucial to understanding its diagnosis and treatment, especially now that the field is in a time of great transition. Although several studies have examined relations between personality pathology and its associated extrinsic disability, these studies rarely include a comprehensive assessment of both maladaptive personality traits and measures of extrinsic disability; moreover, studies of the DSM-5 Section III alternative dimensional PD model, with its component of impairment in personality functioning, are still developing. Current research efforts to improve psychiatric diagnosis and classification support the use of a hierarchical dimensional approach, but research incorporating functioning and extrinsic disability constructs into structural models is limited. This study assessed personality pathology as well as a broader range of functioning and extrinsic disability variables than is typically used in studies of personality pathology. In two mixed samples of community adults and psychiatric outpatients (Ns = 402 in Phase 1 and 605 in Phase 2), I examined the extent to which, and how, extrinsic disability fits into the recently established joint dimensional structure of personality and various constructs of psychosocial functioning (see Clark & Ro, 2014) by creating and replicating a hierarchical factor structure of these constructs using Goldberg’s (2006) “bass-ackwards” method. Results highlight considerable empirical overlap of theoretically distinct constructs and show a fairly robust factor structure in replication, particularly at higher levels of hierarchical factor extraction.