Categorical and the dimensional approaches to personality Disorders…

moniqueanneyCategorical and the dimensional approaches to personality Disorders…Categorical and the dimensional approaches to personality DisordersThe DSM-5 and the ICD-11 have both started incorporating dimensional assessment aspects into the assessment of personality disorders, recognizing the limitations of the categorical approach and the importance of capturing the heterogeneity and complexity of these disorders.The DSM-5 and the ICD-11 have both recognized the limitations of the categorical approach to personality disorders and have started incorporating dimensional assessment aspects into the assessment of these disorders. This approach is purported to provide a more valid and reliable alternative to the categorical approach and offers a more comprehensive and nuanced understanding of personality disorders. However, the implementation of these dimensional models in clinical practice remains a challenge, as clinicians require additional training and education to effectively use these models in the assessment and treatment of personality disorders.Read the attached articles and discuss  views on both the categorical and dimensional assessmentExamining the DSM-5 Alternative Model of Personality Disorders Operationalization of Obsessive-Compulsive Personality Disorder in a Mental Health Sample Jacqueline Liggett Australian National University Martin Sellbom University of Otago The current study evaluated the continuity between the diagnostic operationalizations of obsessive- compulsive personality disorder (OCPD) in the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition, both as traditionally operationalized and from the perspective of the alternative model of personality disorders. Using both self-report and informant measures, the study had the following four aims: (a) to examine the extent to which self-report and informant data correspond, (b) to investigate whether both self-report and informant measures of the alternative model of OCPD can predict traditional OCPD, (c) to determine if any traits additional to those proposed in the alternative model of OCPD can predict traditional OCPD, and (d) to investigate whether a measure of OCPD-specific impairment is better at predicting traditional OCPD than are measures of general impairment in personality functioning. A mental health sample of 214 participants was recruited and administered measures of both the traditional and alternative models of OCPD. Self-report data moderately corresponded with informant data, which is consistent with the literature. Results further confirmed rigid perfectionism as the core trait of OCPD. Perseveration and workaholism were also associated with OCPD. Hostility was identified as a trait deserving further research. A measure of OCPD-specific impairment demonstrated its ability to incrementally predict OCPD over general measures of impairment. Keywords: obsessive- compulsive personality disorder, DSM-5 personality traits, PID-5, personality impairment Obsessive- compulsive personality disorder (OCPD) is characterized by perfectionism, a preoccupation with orderliness, and mental and interpersonal control at the expense of flexibility, openness, and efficiency (American Psychiatric Association, 2013). The way in which personality disorders (PDs), including OCPD, have been operationalized in the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5; American Psychiatric Association, 2013) has been the subject of significant criticism (e.g., for reviews, see Clark, 2007; Skodol, 2012). In an attempt to address these criticisms and lay the framework for future scientific inquiry, an alternative hybrid categorical- dimensional model for the diagnosis of PDs, referred to as the alternative model of personality disorders (AMPD; Krueger & Markon, 2014), is outlined in Section III of the DSM-5 (American Psychiatric Association, 2013). Traditional and Alternative Models of OCPD The traditional model of OCPD, indexed in DSM-5 Section II, requires the presence of four of eight behavioral criteria for a diagnosis. This categorical model of diagnosis has been widely criticized since its introduction in the DSM-III, for reasons including extreme heterogeneity, high comorbidity with other mental disorders, arbitrary and inconsistent diagnostic boundaries, and poor coverage of disorders (Clark, 2007; Skodol, 2012). As validity research on the AMPD continues to be produced and the model is further refined, it may come to serve as the primary operationalization of PDs in future DSM iterations. The AMPD uses disorder-specific types of impairment in self and interpersonal functioning (Criterion A) and combinations of dimensional personality traits (Criterion B) to produce a categorical PD diagnosis (American Psychiatric Association, 2013; Krueger et al., 2011; Skodol, 2012). For Criterion B to be met for OCPD, an individual must display clinically elevated levels of rigid perfectionism, as well as two of the following three traits: perseveration, intimacy avoidance, and restricted affectivity. To operationalize Criterion B, Krueger, Derringer, Markon, Watson, and Skodol (2012) developed a self-report inventory of the DSM-5 traits, the Personality Inventory for the DSM-5 (PID-5). This instrument has demonstrated considerable promise in community, student, and clinical samples (Anderson et al., 2013; Anderson, Snider, Sellbom, Krueger, & Hopwood, 2014; Morey, Benson, & Skodol, 2016; Quilty, Ayearst, Chmielewski, Pollock, & Bagby, 2013; Wright et al., 2012). Maintaining continuity This article was published Online First June 21, 2018. Jacqueline Liggett, Research School of Psychology, Australian National University; Martin Sellbom, Department of Psychology, University of Otago. This research was supported by an Australian Government Research Training Program Scholarship. Correspondence concerning this article should be addressed to Martin Sellbom, Department of Psychology, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand. E-mail: m..m@psy.otago.ac.nz This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. Personality Disorders: Theory, Research, and Treatment © 2018 American Psychological Association 2018, Vol. 9, No. 5, 397- 407 1949-2715/18/$12.00 http://dx.doi.org/10.1037/per0000285 397 between the traditional and alternative models of PD diagnosis was, among others, a significant aim in the development of the AMPD, to minimize the disruption caused by the change to clinicians, and to encourage the model’s adoption. For Criterion A to be met for OCPD, an individual must demonstrate OCPD-specific forms of functional impairment (American Psychiatric Association, 2013). The AMPD, however, was not published with accompanying measures of disorder-specific impairment. Instead, the American Psychiatric Association (2013) released a general measure of impairment in personality functioning, known as the Levels of Personality Functioning Scale (LPFS). Subsequently, measures of disorder-specific impairment have been developed (including a measure for OCPD; see Liggett, Carmichael, Smith, & Sellbom, 2017) but need to be further validated. Personality Traits Relevant to OCPD OCPD is an understudied disorder (Diedrich & Voderholzer, 2015). Much of what is known about it comes from studies investigating PDs generally. Using the PID-5 and a large student sample, Hopwood, Thomas, Markon, Wright, and Krueger (2012) found that the constellations of facets the AMPD uses to define disorders generally correspond with their counterparts in the traditional model. However, of the traits specified for OCPD, only rigid perfectionism and perseveration were moderately correlated with traditional OCPD, as indexed by the Personality Diagnostic Questionnaire-Fourth Edition Plus (PDQ-4; Hyler, 1994). Restricted affectivity and intimacy avoidance were not found to be meaningfully associated with traditional OCPD. In addition, they found that two facets not originally included in the AMPD facet list for OCPD (emotional lability and distractibility) were significantly correlated with traditional OCPD (Hopwood et al., 2012). Anderson et al. (2014) found similar results in a university sample, where rigid perfectionism and perseveration predicted traditional OCPD, but intimacy avoidance and restricted affectivity did not. Further, they found that three additional facets (anxiousness, hostility, and submissiveness) were correlated with traditional OCPD. Of these, only anxiousness and hostility uniquely incremented the prediction of traditional OCPD (Anderson et al., 2014). Crego, Samuel, and Widiger (2015) observed similar results where stronger associations between OCPD were found for rigid perfectionism and perseveration relative to those for intimacy avoidance or restricted affectivity. In a large Italian community sample, rigid perfectionism, perseveration, and suspiciousness were found to predict a substantial amount of variance in traditional OCPD (Fossati, Krueger, Markon, Borroni, & Maffei, 2013). In a study of psychiatric patients, all four proposed traits were associated with traditional OCPD, with rigid perfectionism having the strongest correlation, followed by perseveration (Yam & Simms, 2014). Anxiousness was also moderately correlated with traditional OCPD. In a regression model, however, only rigid perfectionism uniquely predicted traditional OCPD scores. Similarly, all four proposed traits were correlated with OCPD in a large Finnish community sample, with rigid perfectionism and perseveration having the strongest associations (Bastiaens, Smits, De Hert, Vanwalleghem, & Claes, 2016). Submissiveness, withdrawal, and depressivity were also found to augment the prediction of OCPD in a regression model. Morey et al. (2016) found that the traits specified as diagnostic indicators for OCPD in the AMPD demonstrated higher correlations than all other traits in a clinical sample, with rigid perfectionism demonstrating the largest association. In a more recent study, rigid perfectionism, perseveration, and intimacy avoidance (but not restricted affectivity) uniquely accounted for a large proportion of variance in a latent traditional OCPD construct (Liggett, Sellbom, & Carmichael, 2017). The traits of anxiousness and (low) impulsivity were also found to augment the prediction of latent OCPD scores. Other personality traits not operationalized by the PID-5 have also been associated with OCPD. Research and clinical experts in the field of OCPD have, for example, identified workaholism in the Computerized Adaptive Test of Personality Disorder (CATPD; Simms et al., 2011) or achievement striving in the five-factor model as a trait of particular relevance (Lynam & Widiger, 2001; Samuel & Widiger, 2004). Associated behaviors of such traits have a long history in the OCPD literature (American Psychiatric Association, 1952). In general, the AMPD appears to be garnering support. However, for OCPD, there is inconsistent evidence about which traits are most relevant to its operationalization. The optimal trait profile for OCPD therefore warrants further examination. Better understanding the trait profile of OCPD will enable the alternative model of OCPD to be refined such that it is sufficiently coterminous with the traditional operationalization. A complete reconceptualization of the disorder would deny practitioners the benefit of existing research on the disorder. A degree of continuity between the traditional and alternative operationalizations of OCPD is therefore desirable until dimensional models have fully integrated with clinical practice. Indexing Personality Dysfunction With Impairment As noted previously, one of the main ways in which the AMPD differs from the traditional model is the former’s emphasis on disorder-specific impairment. This innovation has proved somewhat controversial (Porter & Risler, 2014; Verheul, 2012), as there is an open question about the extent to which impairment in personality functioning can be meaningfully distinguished from personality traits. Some scholars have indicated that it is difficult to meaningfully separate traits from impairment (Clark & Ro, 2014). Other research suggests that general impairment criteria can augment personality traits. Bastiaansen, De Fruyt, Rossi, Schotte, and Hofmans (2013), for example, found that although normal personality traits and impairment were strongly correlated, they showed significant incremental validity over and above each other among a psychiatric sample. These findings were replicated in a German psychiatric sample, with both traits and impairment found to provide mutual incremental validity over one another in the prediction of personality pathology (Hentschel & Pukrop, 2014). Further, Berghuis, Kamphuis, and Verheul (2014) found that measures of impairment augmented the prediction of maladaptive traits, but only marginally. In an undergraduate sample, researchers found that baseline ratings for a measure of general impairment were able to predict future psychosocial dysfunction beyond maladaptive personality traits (Calabrese & Simms, 2014). Together, these findings indicate that general measures of personality dysfunction This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. 398 LIGGETT AND SELLBOM represent a construct different from that captured by personality traits. In contrast, Few et al. (2013) evaluated impairment using the LPFS (American Psychiatric Association, 2013) in a clinical sample. They found that although traits were able to increment above impairment, impairment did not add incremental validity above that of traits. Thus, although there is some evidence of the relationship between general impairment and PDs, the AMPD’s assumption that each PD is associated with a disorder-specific form of impairment needs to be tested. The four studies to evaluate the extent to which particular PDs are associated with particular impairment profiles have produced conflicting results. Using an adapted version of the LPFS, Wygant and colleagues (2016) found that disorder-specific impairment incrementally predicted antisocial PD and psychopathy above and beyond AMPD traits in a male correctional sample. A subsequent study found that a measure of OCPD-specific impairment augmented the prediction of latent traditional OCPD scores (Liggett et al., 2017). In contrast, Anderson and Sellbom (2016) found in a large university sample that, with the exception of avoidant PD, self-reported disorder-specific impairment did not contribute to the prediction of scores on AMPD measures. Similarly, Sellbom, Carmichael, and Liggett (2017) found that general impairment augmented personality traits in predicting avoidant PD but that a disorder-specific measure of impairment did not. Self-Report and Informant Measures of Personality Studies examining person perception (how an individual’s personality characteristics are perceived by others) have the potential to change the way PDs are assessed (Clark, 2007; Widiger & Samuel, 2005). Research suggests that, at best, there is only a modest correlation between how individuals see themselves and how others see them (Biesanz, West, & Millevoi, 2007; Klonsky, Oltmanns, & Turkheimer, 2002; Watson, Hubbard, & Wiese, 2000). A meta-analysis investigating the correlation between self and informant report measures of individual personality traits found that the median correlation was .35 for Cluster C PDs (the cluster within which OCPD sits), .35 for Cluster A PDs, and .45 for Cluster B PDs (Klonsky et al., 2002). These results indicate that there are often substantial differences between how personality disordered individuals see themselves and how others see them. The concordance between self and informant assessments of personality appears to be marginally higher for antisocial, borderline, and histrionic PDs than for other PDs (Klonsky et al., 2002). Differences have also been noted depending on the personality trait being investigated. For example, higher levels of agreement have been found for extraversion, than for the other Big Five personality traits (Kenny, 1994). Given the potential for significant discrepancies between the way individuals see themselves and the way others see them, it is somewhat surprising that personality research has historically been so exclusively reliant on self-report data (such as questionnaires or diagnostic interviews). This approach likely results in biased, misleading, and incomplete information. A more complete analysis of personality would involve a combination of self-report data with data from other sources, such as informant reports. Indeed, evidence suggests that informant reports may demonstrate greater criterion-related validity in specific situations (Connelly & Ones, 2010; Duckworth & Kern, 2011; Oh, Wang, & Mount, 2011). One reason for this lacuna may be the general lack of informant measures for the major personality inventories. The PID-5 has both a self-report and informant version. The latter is known as the Personality Inventory for DSM-5-Informant Report Form (PID-5- IRF; Markon, Quilty, Bagby, & Krueger, 2013). However, to the authors’ knowledge, no studies examining the relationship between the traditional and alternative models of PDs have used the PID-5-IRF. This study aims to fill this gap with respect to OCPD specifically. The Current Study The current study aimed to contribute to the empirical literature on the alternative model for OCPD by addressing four major research questions among a mental health sample. To the authors’ knowledge, it is the first study to investigate the alternative model of OCPD using both informant and self-reports. First, we investigated the extent to which self-report and informant data on traits and impairment correspond (i.e., the extent to which people view themselves in the same way that others see them). Second, we evaluated whether self-report and informant measures of the four AMPD trait facets could predict traditional OCPD. Third, we examined whether any additional trait facets could augment the prediction of traditional OCPD. Finally, we investigated whether a measure of OCPD-specific impairment was better able to predict traditional OCPD than were measures of general impairment in personality functioning. Regarding our first aim, we hypothesized that there would be a weak-to-moderate correlation between self-report and informant responses on all measures based on previous research that has demonstrated weak-to-moderate agreement between self-report and informant measures of personality, particularly for OCPD (Klonsky et al., 2002; Modestin & Puhan, 2000; Oltmanns & Turkheimer, 2009). Regarding our second aim, we hypothesized that rigid perfectionism and perseveration would be correlated with and predict traditional OCPD. Based on the findings of previous studies, we hypothesized that rigid perfectionism would have the strongest relationship with traditional OCPD, followed by perseveration (Anderson et al., 2014; Bastiaens et al., 2016; Fossati et al., 2013; Hopwood et al., 2012; Liggett et al., 2017; Morey et al., 2016; Yam & Simms, 2014). Regarding our third aim, we hypothesized that anxiousness, hostility, submissiveness, suspiciousness, and (low) impulsivity would all be moderately correlated with traditional OCPD. Reflecting the findings of previous research, which have implicated these traits in OCPD, we also expected that they would augment the prediction of traditional OCPD above and beyond the four traits (Anderson et al., 2014; Bastiaens et al., 2016; Fossati et al., 2013; Hopwood et al., 2012; Liggett et al., 2017; Morey & Benson, 2016; Yam & Simms, 2014). Based on its conceptual relevance to the disorder, we also hypothesized that the trait of workaholism would be correlated with and predict traditional OCPD. Regarding our fourth aim, we tentatively expected that OCPDspecific impairment would provide greater predictive utility than general impairment in the prediction of traditional OCPD. Whereas the broader literature on disorder-specific impairment is equivocal (Anderson & Sellbom, 2016; Liggett et al., 2017; Sellbom et al., 2017; Wygant et al., 2016), the lone study on OCPDspecific impairment supported the use of a measure of OCPDThis document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. ALTERNATIVE MODEL OF OCPD 399 specific impairment (Liggett et al., 2017); more specifically, it augmented the prediction of traditional OCPD above and beyond the AMPD traits. Method Participants Target participants included 214 individuals who reported being engaged in mental health care support (via pharmacotherapy, psychotherapy, or both) currently or within the previous 12 months. Target participants had a mean age of 22.47 (SD 8.43) years and were 72.4% female, and 65.4% identified as Australian. The vast majority of individuals reported engagement in psychotherapy or mental health counseling (n 203, 94.9%), and 97 (45.3%) endorsed being currently prescribed psychotropic medication by a general practitioner or psychiatrist currently or within the past 12 months. Previous hospitalization due to a mental health condition was reported by 15% of the participants, 25% of whom had been hospitalized within the previous 12 months. The most commonly self-reported mental health conditions were mood disorders (n 154, 72%), anxiety disorders (n 142, 66.4%), and eating disorders (n 29, 13.6%). Initially, a total of 247 participants completed the survey; however, 11 were excluded from the data set based on embedded validity scale scores. More specifically, an infrequency scale was used to exclude participants who endorsed two or more highly improbable survey items, for example, “I am allergic to water.” Another 22 participants were removed due to their nominated informants not completing the survey. Additionally, six individuals who had not engaged in any mental health treatment in the previous 12 months, but nevertheless attempted to complete the survey, were screened out and were not included in the research project. Informant participants included 214 individuals who were nominated by the target participants, as people who knew the participant well. Of the informant participants, 40.7% identified themselves as a relative, 19.6% as a romantic partner, 37.4% as a friend, and 0.9% as a close colleague. Regarding length of relationship with the target participant, 61.7% reported a relationship of 5 years or more, 18.2% reported a relationship of between 2 and 5 years, and 6.5% indicated that they had known the target participant for less than 1 year. Participants chose to receive either course credit or financial incentive for their participation. Informants entered a lottery to win a gift voucher for their participation. Informed consent was obtained from all participants. Measures Personality Inventory for DSM-5-100-Item Version. The PID-5 (Krueger et al., 2012) is a 220-item self-report questionnaire used to measure the personality domains and facets found in Section III of the DSM-5. Individuals record their responses to statements about personality functioning on a 4-point scale ranging from 0 (very false or often false) to 3 (very true or often true). An abbreviated measure of 100 items has been found to reliably and validly assess Section III PD traits (Maples et al., 2015). Reliability coefficients showed good internal consistency for self-report OCPD traits (rigid perfectionism: .82; perseveration: .79; intimacy avoidance: .85; restricted affectivity: .77), as well as the additional traits (anxiousness: .85; hostility: .80; submissiveness: .83; suspiciousness: .70; impulsivity: .88). Personality Inventory for DSM-5-Informant Report Form. The PID-5-IRF (Markon et al., 2013) is a 221-item questionnaire based on the PID-5, with all references to the first person replaced by third person references (e.g., “I” replaced with “he” or “she”). Items retained the same 4-point response format as the self-report form. Only the 100 items from the PID-5 100-item version were used in this study. The measure’s scales have shown adequate psychometric properties, showing a clear five-factor structure resembling the five-factor model and demonstrating external validity in its relationships with other scales (Markon et al., 2013). Reliability coefficients demonstrated good internal consistency for the OCPD traits (rigid perfectionism: .83; perseveration: .82; intimacy avoidance: .80; restricted affectivity: .79), as well as the additional traits (anxiousness: .86; hostility: .80; submissiveness: .82; suspiciousness: .75; impulsivity: .85). The Personality Diagnostic Questionnaire. The PDQ-4 (Hyler, 1994) is a 99-item questionnaire measuring the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV; Section II), PDs in nonclinical samples, with each item directly corresponding to behavioral criteria associated with each DSM-IV PD. Individuals are asked to endorse (score of 1) or reject (score of 0) statements based on how they think, feel, or behave. Lower scores indicate lower levels of symptomatology. Only the eight items relating to OCPD were included in the questionnaire. Informants were not asked to complete this measure, in an attempt to reduce the amount of time it would take them to complete the survey (and so increase the survey completion rate). Reliability coefficients showed adequate internal consistency for OCPD ( .64) in light of its heterogeneity. Structured Clinical Interview for the DSM-IV Axis II Disorders-Personality Questionnaire. The OCPD scale of the Structured Clinical Interview for the DSM-IV Axis II Disorders- Personality Questionnaire (SCID-II-PQ; First, Gibbon, Spitzer, Williams, & Benjamin, 1997) includes nine true/false self-report questions that assess OCPD according to the DSM-IV diagnostic criteria. Individuals endorse (score of 1) or reject (score of 0) statements based on how they think, feel, or behave. Lower scores indicate lower levels of symptomatology. Only the items relating to OCPD were included in the questionnaire. For the current study, we also used an informant version, where “you” was replaced with “he” or “she” in all questions. Cronbach’s alpha in the current study was .58 for self-report and .70 for informants. Obsessive-Compulsive Personality Disorder Impairment Scale. The Obsessive-Compulsive Personality Disorder Impairment Scale (OCPD-IS; Liggett et al., 2017) measures personality impairment specific to the disorder, as outlined in Criterion A of the AMPD. The OCPD-IS asks participants to select one of five statements of ascending severity (ranging from 0 no impairment, to 4 severe impairment). Example items include “I have no difficulties expressing a range of emotions” (0) and “I don’t feel strong emotions about anything” (4). Each item reflects explicit content within DSM-5 Section III Criterion A for OCPD, addressing each of the four facets (identity, self-direction, empathy, and intimacy). Scores are averaged, with lower scores indicating lower This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. 400 LIGGETT AND SELLBOM levels of self and interpersonal impairment. Initial results provide promising validity data, in that the scale scores are associated with a range of extratest impairment criterion measures reflecting self, interpersonal, and basic-living skills impairment (Liggett et al., 2017). This measure was adapted by the authors for informant participants, where “I” was replaced with “he” or “she” in all questions. Cronbach’s alpha for self-report was .68 and .69 for informant report. The Level of Personality Functioning Scale-Brief Form. The Level of Personality Functioning Scale-Brief Form (LPFSBF; Hutsebaut, Feenstra, & Kamphuis, 2016) is a 12-item selfreport measure of personality dysfunction. Items such as “I often do not know who I really am” are responded to with “yes” (score of 1) or “no” (score of 0). The LPFS-BF has been shown to yield a two-factor structure, corresponding with self and interpersonal functioning scales. The LPFS was adapted by the authors for informant participants, where “I” was replaced with “he” or “she” in all questions. Cronbach’s alpha for self-report was .73 and .81 for informant report. Measure of Disordered Personality Functioning. The Measure of Disordered Personality Functioning (Parker et al., 2004) is a 20-item self-report questionnaire that assesses disordered functioning in personality. The measure indexes the two higher-order domains of noncooperativeness and noncoping as well as seven lower-order scales. Reliability analyses demonstrated good internal consistency for the total self-report score ( .87). This measure was adapted by the authors for informant participants, where the “I” was replaced with “he” or “she” in all questions. Cronbach’s alpha for the informant total score was .91. Social Functioning Questionnaire. The Social Functioning Questionnaire (Tyrer et al., 2005) is an eight-item self-report scale developed to assess social dysfunction over the previous 2 weeks. This measure evaluates social functioning in the areas of work, finance, interpersonal relationships, and home and spare time activities. Items are scored using a 4-point Likert scale, ranging from 0 (no problems) to 3 (severe problems). This measure has demonstrated good interrater and test-retest reliability, in addition to good construct validity (Tyrer et al., 2005). Reliability analysis indicated adequate internal consistency ( .64). This measure was adapted by the authors for informant participants, where “I” was replaced with “he” or “she” in all questions. Cronbach’s alpha for the informant version was .72. Computerized Adaptive Test of Personality Disorder-Static Form. The Computerized Adaptive Test of Personality Disorder (CAT-PD)-Static Form is a self-report inventory drawing from the item pool of the CAT-PD (Simms et al., 2011). Responses range from 1 (very untrue) to 5 (very true) on statements such as “I work too much.” Only the six items from the workaholism scale were included, and the measure was only administered to target participants. Cronbach’s alpha was .91. Procedure This research was approved by the Australian National University Human Research Ethics Board. Target participants were recruited via flyers located in private psychological and medical practices and the university psychology clinic. Electronic notices were also placed on online community mental health notice boards. Interested individuals contacted the lead author by e-mail and were provided with an information sheet about the research project. Target participants completed the survey on a computer via a Qualtrics URL link under the supervision of the lead researcher. At the end of the survey, participants nominated the names and e-mail addresses of two individuals who knew them well. The first-listed informant was contacted via e-mail and invited to complete a shortened version of the survey on their personal devices. If the first-listed informant did not respond within a week, the secondlisted informant was contacted. Results For all analyses involving self-reported OCPD symptoms, an aggregate score of the PDQ-4 and the SCID-II-PQ was used to provide a more reliable measure of OCPD. In all scenarios involving general impairment, we used an aggregate measure composed of data from the LPFS-BF, Social Functioning Questionnaire, and the Measure of Disordered Personality Functioning. Our first research question examined the extent to which our self-report measures were correlated with informant measures. An aggregate measure of self-reported traditional OCPD was moderately correlated with informant SCID-II-PQ OCPD scores (r .40). Similarly, three of the four self-report traits were moderately correlated with their informant counterparts (rigid perfectionism, intimacy avoidance, and restricted affectivity). Self-reported perseveration, however, was only weakly correlated with informant-reported p