Prediction of remission of major depressive disorder from the alternative DSM-5 model of personality disorders.

BACKGROUND

The Alternative DSM-5 Model of Personality Disorder (AMPD) is useful in defining and measuring personality pathology comorbid with depression, including impaired personality functioning and maladaptive traits. The present study tested AMPD dimensions' prospective prediction of remission of major depressive disorder (MDD), and dysphoria and low well-being (anhedonia) symptom levels.

METHOD: Adults with MDD (N = 179; including mental-health outpatients and non-patients at risk for personality pathology) completed self-report measures of personality functioning (self and interpersonal) and traits (negative affectivity, detachment, disinhibition, antagonism, psychoticism), plus three depression measures (interviewer-rated MDD; self-reported dysphoria and well-being). Most participants completed reassessment 8 months later, on average.

RESULTS

Personality functioning and traits predicted all three depression measures (R2 range 0.11 to 0.44). Predictive power was largely shared across sets of functioning and trait measures, although functioning and traits both showed incremental prediction of dysphoria and well-being (R2 range 0.05 to 0.13). The strongest predictors of MDD non/remission (standardized odds ratios) included trait detachment (1.83) and impaired self functioning (2.01).

LIMITATIONS: The study design was observational. Treatment was not provided. Correlations were small to moderate. Risk mechanisms connecting personality pathology and depression are unknown.

CONCLUSIONS

Remission of MDD was more likely among adults with AMPD-defined better personality functioning and less severe traits. In particular, self-report measures indicating better self functioning (e.g., stronger identity and self regulation) and less trait detachment (e.g., more frequent and enjoyable social engagement) predicted favorable outcomes. These AMPD dimensions may be helpful in MDD case conceptualization and treatment planning.