A Test of the Empirical Profile and Coherence of the DSM–5 Psychopathy Specifier

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The Diagnostic and Statistical Manual of Mental Disorders–5th edition (DSM–5; American Psychiatric Association, 2013) introduced a psychopathy specifier (DSM–5 PS) as part of the Section III diagnostic model of antisocial personality disorder. Designed to capture the construct of fearless dominance/boldness, the DSM–5 PS is assessed on the basis of the presence of low scores on traits of withdrawal and anxiousness, and high scores on attention seeking. These constructs have garnered attention in the past decade but are the subject of substantial debate as to their role in the conceptualization and assessment of psychopathy, given their limited relations to the maladaptive outcomes typically associated with this personality disorder. In the current study (N = 340 undergraduates; 170 informants), we examined the DSM–5 PS, both in composite form and its trait subscales, to investigate the degree to which the DSM–5 PS manifested empirical profiles associated with psychopathy and its maladaptive correlates. Consistent with prior fearless dominance/boldness research, the DSM–5 PS manifested limited relations with other components of psychopathy, symptoms of DSM–5 Section II and III antisocial personality disorder, and self- and informant-related impairment scores. When examined at the individual subscale level, the 3 DSM–5 PS subscales manifested only partially overlapping profiles and only 1 of the 3—Attention Seeking—demonstrated an association with maladaptivity (e.g., externalizing behaviors). These findings raise important concerns about the coherence and utility of the DSM–5 PS as a diagnostic specifier included in a psychiatric nosology.

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