Personality Disorders: Theory, Research, and Treatment 2015, Vol. 6, No. 3, 261–266
© 2015 American Psychological Association 1949-2715/15/$12.00 http://dx.doi.org/10.1037/per0000120
BRIEF REPORT
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Impulsivity-Related Traits and Their Relation to DSM–5 Section II and III Personality Disorders Lauren R. Few
Donald R. Lynam
Washington University School of Medicine
Purdue University
Joshua D. Miller University of Georgia Difficulties with impulse control are considered a core feature of personality disorders (PDs) as assessed by the Diagnostic and Statistical Manual of Mental Disorders (5th edition [DSM–5]; American Psychiatric Association, 2013). Despite this, there has been relatively little examination of the manner in which DSM–5 PDs are characterized by multidimensional models of impulsivity that parse this broad umbrella construct into smaller, more unidimensional constructs. Using the UPPS model and measure of impulsivity (Whiteside & Lynam, 2001), the relations between 4 impulsivity-related traits and interview-rated scores on both DSM–5 Section II and III PDs and PD traits were examined in a community sample of individuals currently receiving psychological or psychiatric care (N ⫽ 106). As expected, the UPPS traits manifested correlations with the new Section III trait model that were generally consistent with the assertion that this new DSM–5 trait model reflects a pathological variant of the Five-Factor Model (FFM; e.g., UPPS traits associated with FFM conscientiousness were most strongly related to DSM–5 disinhibition traits). Overall, the UPPS traits accounted best for variance in DSM–5 Section II and III Cluster B PDs, consistent with these PDs being characterized, in part, by emotionally and cognitively based forms of impulsivity. Keywords: impulsivity, UPPS, personality disorders, DSM–5
develop a model and associated measure of the construct. Whiteside and Lynam argued that impulsivity is “an artificial umbrella term” (p. 687) that comprises four different personality traits from three different Five-Factor Model (FFM) domains (i.e., neuroticism, extraversion, conscientiousness) and that these traits represent distinct pathways to behaviors that others judge to be risky or problematic. To examine this hypothesis, 17 subscales from widely used impulsivity measures were submitted to an exploratory factor analysis, along with four facets of the Revised NEO Personality Inventory (NEO PI-R; Costa & McCrae, 1992). Results of their analyses identified four factors that aligned with the four FFM facets; these factors were used to select items that form the scales of the resultant measure (UPPS: Urgency, (Lack of) Premeditation, (Lack of) Perseverance, Sensation Seeking). Urgency measures the tendency to engage in impulsive behavior when experiencing negative emotion. Lack of Premeditation captures the tendency to act without consideration of potential consequences. Lack of Perseverance is related to problems in maintaining goal-directed behavior when performing tasks that may be boring or difficult. Finally, Sensation Seeking captures both the tendency to enjoy activities that are exciting and openness to activities that could potentially be dangerous. A fifth factor, labeled Positive Urgency, which can be assessed using the revised UPPS-P measure (Lynam, Smith, Whiteside, & Cyders, 2006), was identified in subsequent research (Cyders et al., 2007) and reflects rash behavior in the context of positive mood.
There is ample research devoted to the study of impulsivity, partly because of its inclusion within the diagnostic criteria of various psychiatric disorders (e.g., borderline personality disorder [BPD]) and its association with externalizing pathology (e.g., Kotov, Gamez, Schmidt, & Watson, 2010). However, the existing literature on self-report measures of impulsivity is laden with mixed findings as a result of the multidimensional nature of impulsivity (Sharma, Markon, & Clark, 2014). This is partly because impulsivity-related traits are found in all major models of personality, but the labels used and the placement on higher order domains vary substantially across models and measures. To bring greater clarity to the impulsivity literature, Whiteside and Lynam (2001) utilized a general personality framework to conceptualize and organize the commonalities across impulsivity measures and
This article was published Online First April 13, 2015. Lauren R. Few, Department of Psychiatry, Washington University School of Medicine; Donald R. Lynam, Department of Psychological Sciences, Purdue University; Joshua D. Miller, Department of Psychology, University of Georgia. Correspondence concerning this article should be addressed to Lauren R. Few, Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8134, St. Louis, MO 63110. E-mail: [email protected] 261
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There is substantial research supporting the utility of the UPPS model in clinical populations (e.g., Weiss, Tull, Anestis, & Gratz, 2013; Whiteside, Lynam, Miller, & Reynolds, 2005). One advantage of the UPPS is its ability to characterize specific impulsivityrelated pathways to various problematic behaviors such as aggression (e.g., Miller, Zeichner, & Wilson, 2012), eating pathology (e.g., Pearson, Combs, Zapolski, & Smith, 2012), substance use (e.g., Cyders, Flory, Rainer, & Smith, 2009), and self-harm (e.g., Glenn & Klonsky, 2010). The UPPS can also be used to compare and contrast the role of impulsivity-related traits in various disorders. For instance, DeShong and Kurtz (2013) used the UPPS model to examine which traits best characterize borderline and antisocial personality disorders (PDs), both of which are characterized by deficient constraint (Lynam & Widiger, 2001). Other studies have used the UPPS to understand PDs in isolation, such as psychopathy (Ray, Poythress, Weir, & Rickelm, 2009) and BPD (e.g., Tragesser & Robinson, 2009). Despite some promising initial work using the UPPS model to understand the role of impulsivity-related traits in specific PDs or subsets of PDs, there has yet to be a comprehensive examination of the manner with which PDs relate to the UPPS dimensions. This is surprising because one of the cardinal symptoms of PDs, as defined by the general definition of PD used in the Diagnostic and Statistical Manual of Mental Disorders (5th edition [DSM–5]; American Psychiatric Association, 2013), is problems with impulse control. Consistent with this model, expert ratings (Lynam & Widiger, 2001) and meta-analyses (Samuel & Widiger, 2008) suggest that impulsivity-related traits are relevant to various PDs but are most consistently and robustly related to Cluster B PDs such as antisocial and borderline PDs. The approach to the conceptualization, assessment, and diagnosis of PDs has changed substantially in DSM–5 in that a dimensional personality trait model was included with the goal of providing an alternative approach to diagnosing PDs. This pathological trait model is included in Section III of DSM–5 on “emerging measures and models,” whereas the traditional PD constructs are included in Section II. The Section III trait model, a pathological variant of the FFM, assesses five broad domains and 25 more specific traits. The Section III traits can be used to diagnose six traditional PD constructs as well as additional trait-specified types. In the former case, a PD such as BPD is diagnosed based on elevations of specific traits and evidence of personality impairment. Research has demonstrated that Section III PD counts, which can be generated using clinician ratings or self-report, are substantially correlated with Section II PDs and manifest similar personality profiles (Miller, Few, Lynam, & MacKillop, 2015). Because the Section III dimensional trait model represents a substantial departure from the approach used in the existing Section II categorical model, it is important to understand whether the UPPS traits relate similarly to PDs from these alternative diagnostic approaches. In the current study, we examined the relations between the UPPS traits and DSM–5 Section II and III PDs, as well as Section III PD traits, in a sample of 109 community participants who were receiving psychological or psychiatric treatment at the time of the study. We first tested the relations between self-reported UPPS dimensions and interview ratings of the pathological traits included in the DSM–5 Section III model. We hypothesized that the UPPS traits would align with the domains and facets of the DSM–5
trait model in a manner similar to the FFM (e.g., Whiteside & Lynam, 2001), such that UPPS Urgency would be most strongly related to the DSM–5 domain and facets of negative affectivity, (Lack of) Premeditation and Perseverance would be most strongly related to the domain and facets of DSM–5 disinhibition, and Sensation Seeking would be positively related to DSM–5 disinhibition and its facets and negatively related to DSM–5 detachment and its facets, which are thought to represent low FFM extraversion. Next, we examined the relations between the UPPS dimensions and interview-based ratings of the DSM–5 Section II and III PDs. Here, we hypothesized that antisocial and borderline PDs would be robustly related to impulsivity-related traits, whereas other PDs would demonstrate more limited relations (e.g., Lack of Perseverance with avoidant and dependent PDs). Finally, because Urgency reflects disinhibited behavior during periods of extreme emotion, we also tested their relations with pathological personality traits and PDs after controlling for the variance shared with FFM neuroticism. These analyses examine whether Urgency manifests unique relations with DSM–5 PDs and PD traits above and beyond the known role of neuroticism in these disorders (e.g., Samuel & Widiger, 2008). This is the first study to examine the UPPS dimensions in relation to the PDs and pathological traits assessed in Section II and III of the DSM–5.
Method Participants and Procedures Participants included 109 community adults (70% female; 90% Caucasian, 6% African American; M age ⫽ 35.8 years [SD ⫽ 12.6]) who were currently receiving psychological and/or psychiatric treatment. Participation also required individuals to (a) be between the ages of 18 and 65 years, (b) have a minimum of an eighth-grade education, (c) use a computer ⱖ3 days/week (to ensure that they could complete computerized assessments), and (d) not be experiencing psychotic symptoms. Individuals were administered a semistructured interview for PD symptoms and completed several self-report measures. Of the 109 individuals, 84 self-reported one or more current psychiatric diagnoses. Sixty-six participants reported a current mood disorder, 31 reported a current anxiety disorder, 7 reported an attention deficit/hyperactivity disorder, 6 reported a PD, and 1 reported an alcohol use disorder. Of the 25 who did not report a current diagnosis, 22 indicated that that they were currently undergoing treatment for symptoms of depression and/or anxiety. Participants reported, on average, 8.8 (SD ⫽ 9.7) individual psychotherapy sessions and 3.5 (SD ⫽ 4.31) appointments for pharmacotherapy management in the last 6 months. In addition, 22% of the participants had been hospitalized for psychiatric reasons in their lifetime. Individuals were compensated $30 for their participation.
Measures Structured Clinical Interview for DSM–IV Axis II PDs. DSM–5 Section II PD scores were generated using the Structured Clinical Interview for DSM-IV Axis II PDs (SCID II; First, Gibbon, Spitzer, Williams, & Benjamin, 1997), a semistructured interview that assesses 10 DSM–5 PDs. Each symptom is scored using a 1 to 3 rating. Symptom ratings were completed by the
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interviewer (i.e., a doctoral student in clinical psychology) and a second rating was completed (n ⫽ 103) via a review of the videotaped interview by trained graduate students who were blind to the primary ratings; the secondary ratings were used for testing the interrater reliability, which ranged from .79 to .92. The ␣s for the Section II PD scores ranged from .68 to .84. In terms of diagnoses, 37.6% of the sample met criteria for at least one PD. DSM–5 PD traits. Upon completion of the SCID-II, the interviewer rated each participant on the five domains and 25 more specific DSM–5 Section III PD traits using a single-item clinician rating form developed by the DSM–5 Personality Disorder Work Group. Ratings for each of the dimensions were provided using a 0 (not at all descriptive) to 3 (extremely descriptive) scale. Interrater reliabilities for these 25 traits ranged from .12 (perseveration) to .83 (impulsivity) with a median of .55 (see Few et al., 2013 for details). The Section III PD counts were created by summing the traits specified for each PD in the Section III model and previous presentations by the DSM–5 Personality and Personality Disorder Work Group; although only 6 PDs are officially recognized in Section III, we scored all 10 PDs to maintain consistency with the PDs in Section II. The DSM–5 Section II and III PD scores were strongly related (rs ranged from .50 to .86 with a median of .73). UPPS-P Impulsive Behavior Scale. The UPPS-P (Lynam et al., 2006) is a 59-item self-report inventory designed to assess five personality pathways to impulsive behavior: Negative Urgency, (Lack of) Perseverance, (Lack of) Premeditation, Sensation Seeking, and Positive Urgency. The ␣s in the current study ranged from .78 (Urgency; Premeditation) to .95 (Positive Urgency). The correlations among the traits ranged from .00 (Perseverance—Sensation Seeking) to .71 (Negative—Positive Urgency) with a median of .39. Because of the strong relation between Negative and Positive Urgency and their similar correlates with the criterion variables used here (intraclass correlation ⫽ .94), we combined these dimensions to form a general Urgency factor (␣ ⫽ .95). NEO PI-R. The NEO PI-R (Costa & McCrae, 1992) is a 240-item self-report measure of the five domains and 30 facets of the FFM. Only the neuroticism domain (minus the Impulsiveness facet) was used here as a covariate in some analyses (␣ ⫽ .95).
Results All statistics were generated using SPSS, Version 22 (IBM, 2013). In addition, because of the number of analyses conducted, we lowered our significance level to p ⬍ .01.
UPPS Impulsivity-Related Traits and DSM–5 Section III Personality Traits The relations between the four self-reported UPPS impulsivityrelated traits and the interviewer ratings of the DSM–5 Section III personality traits were examined first (see Table 1). Urgency manifested the most consistent relations with the DSM–5 domains as demonstrated by its significant positive correlations with DSM–5 domains of disinhibition, negative affectivity, and antagonism (Lack of). Perseverance was positively related to the DSM–5 domains of disinhibition and negative affectivity, whereas (Lack of) Premeditation was only significantly related to disinhibition. Finally, Sensation Seeking was unrelated to the DSM–5 domains.
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At the facet level, Urgency manifested the largest number of significant correlations with the DSM–5 traits (i.e., 14 of 25), including several that would be considered moderate to large in nature, including impulsivity, risk taking, emotional lability, irresponsibility, deceitfulness, separation insecurity, hostility, and depressivity. Likewise, (Lack) of Premeditation manifested eight significant correlations, the largest of which were from the DSM–5 disinhibition domain including risk taking, impulsivity, and irresponsibility. (Lack of) Perseverance produced four significant relations with the DSM–5 traits including depressivity, irresponsibility, separation insecurity, and distractibility. Finally, Sensation Seeking manifested only three relatively small correlations with attention seeking, intimacy avoidance, and risk taking. Given Urgency’s strong relation—conceptually and empirically—to the domain of neuroticism (Whiteside & Lynam, 2001), which is a robust correlate of most internalizing and externalizing symptoms (Kotov et al., 2010) as well as many PDs (Samuel & Widiger, 2008), we also tested Urgency’s relations to the DSM–5 traits when controlling for its overlap with FFM neuroticism (minus the facet of Impulsiveness, which is conceptually and empirically similar to Urgency). Twelve of the 14 correlations between Urgency and the DSM–5 traits remained significant even when controlling for its overlap with neuroticism (e.g., impulsivity; irresponsibility), although, as expected, many of the correlations with facets from negative affectivity were substantially reduced (i.e., by ⱖ50%).
UPPS Impulsivity-Related Traits and DSM–5 Section II and III PDs Next, we examined the relations between the UPPS traits and the DSM–5 Section II and III PDs (see Table 2). In general, relations between the UPPS and Section II and III PDs were consistent across the two DSM–5 models. At the individual trait level, Urgency was the most consistent correlate of the Section II (7 of 10) and Section III PDs (6 of 10), with particularly large correlations for borderline and antisocial PDs. (Lack of) Premeditation also showed relatively consistent and robust correlations with the Section II (4 of 10) and III PDs (5 of 10), and manifested its largest relations with antisocial and borderline PDs. (Lack of) Perseverance manifested a more limited number of correlations because it only correlated significantly with dependent (both Sections), avoidant (Section I), and borderline PDs (Section II). Finally, Sensation Seeking manifested the most restricted relations because it was only significantly correlated with Section II histrionic PD and Section III narcissistic PD. We again tested whether Urgency was correlated with the DSM–5 PDs even after controlling for its overlap with neuroticism (minus the facet of Impulsiveness). These analyses provide additional clarity about the relation of Urgency to the PDs. Of the 13 significant positive correlations between Urgency and the Section II and III PDs, only the 8 Cluster B PD correlations (4 for each section) remained significant when controlling for the variance that Urgency shared with neuroticism: antisocial (Section II and III), borderline (Section II and III), histrionic (Section II and III), and Narcissistic (Section II and III). The relations found between Urgency and paranoid, schizotypal, and dependent PDs were no longer significant when controlling for the overlap between Urgency and neuroticism, suggesting that, in these cases, Urgency’s
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Table 1 Correlations Between UPPS Impulsivity Traits and the DSM–5 Section III Trait Model
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Section III traits Negative Affectivity Detachment Antagonism Disinhibition Psychoticism Emotional Lability Anxiousness Restricted Affectivity Separation Insecurity Hostility Perseveration Submissiveness Withdrawal Anhedonia Depressivity Intimacy Avoidance Suspiciousness Manipulativeness Deceitfulness Grandiosity Attention Seeking Callousness Irresponsibility Impulsivity Rigid Perfectionism Distractibility Risk Taking Unusual Beliefs Eccentricity Cognitive/Perceptual Dysregulation Mean r
Urgency r (sr)
Sensation seeking r
(Lack of) Perseverance R
(Lack of) Premeditation R
.48 (.17) .06 (⫺.23) .41 (.41) .56 (.51) .24 (.22) .50 (.31) .13 (⫺.19) ⫺.11 (⫺.20) .45 (.22) .45 (.31) .14 (⫺.03) .19 (⫺.03) .04 (⫺.23) .16 (⫺.10) .44 (.12) ⫺.06 (ⴚ.27) .29 (.13) .39 (.40) .46 (.40) .20(.25) .26 (.34) .25 (.27) .50 (.46) .60 (.56) ⫺.07 (⫺.18) .28 (.22) .60 (.56) .30 (.32) .10 (.05)
⫺.01 ⫺.21 .24 .20 .19 ⫺.02 ⫺.11 ⫺.10 .09 .04 ⫺.02 ⫺.22 ⫺.20 ⫺.07 ⫺.05 ⴚ.29 ⫺.02 .24 .13 .23 .30 .11 .06 .23 ⫺.17 .20 .27 .18 .16
.32 .19 .05 .37 .06 .21 .19 .11 .34 .12 .01 .23 .24 .18 .38 .07 ⫺.01 .14 .15 ⫺.12 ⫺.04 ⫺.05 .36 .24 ⫺.12 .33 .18 .04 .04
.13 ⫺.16 .24 .47 .13 .25 ⫺.24 ⫺.20 .23 .19 ⫺.07 ⫺.02 ⫺.14 ⫺.05 .21 ⫺.24 ⫺.07 .21 .25 .16 .29 .07 .44 .48 ⴚ.28 .23 .50 .18 .07
.19 .06
.08 .14
.08 .12
.24 (.21) .30 (.18)
Note. Bolded correlations are significant at p ⱕ .01. sr ⫽ semipartial correlations between Urgency and pathological traits after removing the variance that Urgency shares with FFM neuroticism (computed without the Impulsiveness facet).
bivariate relations with these PDs simply reflected the greater psychological distress and negative emotionality associated with these PDs, but not the disinhibited behavior that sometimes accompanies these emotional experiences. The amount of variance the UPPS traits accounted for in the DSM–5 PD scores was also examined. Overall, the UPPS traits accounted for between 6% (DSM–5 Section II schizoid) and 39% (DSM–5 Section III BPD) of the variance in the PDs with a mean of 22%. Across the two sets of ratings, the Cluster A PDs were the least well accounted for by the UPPS traits (mean R2 ⫽ 14%), and the Cluster B PDs were the most successfully explained (mean R2 ⫽ 26%). The variance explained by the UPPS traits in the Cluster C PDs was intermediate in nature (mean R2 ⫽ 22%), and this included both positive and negative effects.
Discussion The UPPS is a promising measure and model of impulsivity because it conceptualizes and assesses impulsivity as a multifaceted construct that includes various, separable, and distinct pathways to impulsive behavior—an approach that has become increasingly popular given its ability to differentiate the relations
between these traits and important behavioral outcomes (Sharma, Kohl, Morgan, & Clark, 2013). However, to date, the UPPS has not been comprehensively examined in relation to DSM PDs, which is surprising in that impulsivity is a hallmark feature included in the general definition of PDs (American Psychiatric Association, 2013). The current study examined the UPPS traits in relation to DSM–5 Section II and III PDs and in relation to the traits included as a central component of the alternative diagnostic model included in Section III of the DSM–5. In terms of relations between the UPPS and Section III traits, results were generally consistent with hypotheses. As expected, Urgency was strongly related to negative affectivity; however, it was also strongly related to the disinhibition domain, which likely reflects the positioning of the impulsivity facet on this domain and use of language that is highly relevant to Urgency (i.e., “. . . a sense of urgency and self-harming behavior under emotional distress”). This deviates from the loading of the conceptually related FFM facet of Impulsiveness, which is subsumed by the FFM neuroticism domain. At the facet level, Urgency converged as expected with several facets, including emotional lability, irresponsibility, impulsivity, and risk taking. Furthermore, even after accounting
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Table 2 Relations Between UPPS Impulsivity Traits and DSM–5 Section II and III PDs
DSM–5 PDs
Urgency r (sr)
Sensation seeking r
(Lack of) Perseverance R
(Lack of) Premeditation R
R2
Paranoid-II Paranoid-III Schizoid-II Schizoid-III Schizotypal-II Schizotypal-III Antisocial-II Antisocial-III Borderline-II Borderline-III Histrionic-II Histrionic-III Narcissistic-II Narcissistic-III Avoidant-II Avoidant-III Dependent-II Dependent-III OCPD-II OCPD-III
.38ⴱ (.17) .35ⴱ (.17) .09 (⫺.09) .02 (⫺.24ⴱ) .31ⴱ (.18) .20 (.03) .59ⴱ (.56ⴱ) .61ⴱ (.56ⴱ) .62ⴱ (.40ⴱ) .65ⴱ (.41ⴱ) .32ⴱ (.41ⴱ) .51ⴱ (.45ⴱ) .29ⴱ (.28ⴱ) .26ⴱ (.34ⴱ) .23 (⫺.14) .04 (⫺.25ⴱ) .40ⴱ (.08) .34ⴱ (.02) .23 (.04) ⫺.03 (⫺.26ⴱ)
⫺.02 ⫺.04 ⫺.17 ⫺.20 .10 .00 .18 .20 .12 .10 .30ⴱ .21 .19 .30ⴱ ⫺.17 ⫺.21 ⫺.06 ⫺.09 .05 ⫺.23
.07 .08 .11 .18 .10 .12 .23 .22 .31 .34ⴱ .07 .14 .03 ⫺.09 .45ⴱ .21 .44ⴱ .34ⴱ .06 .02
.02 .02 ⫺.11 ⫺.18 .10 ⫺.04 .47ⴱ .42ⴱ .37ⴱ .35ⴱ .28ⴱ .33ⴱ .19 .26ⴱ .01 ⫺.21 .28ⴱ .01 ⫺.14 ⫺.30ⴱ
.21ⴱ .18ⴱ .08 .14ⴱ .11 .09 .38ⴱ .39ⴱ .39ⴱ .44ⴱ .16ⴱ .28ⴱ .11 .19ⴱ .28ⴱ .20ⴱ .27ⴱ .25ⴱ .18ⴱ .15ⴱ
Note. II ⫽ DSM–5 Section II PDs; III ⫽ DSM–5 Section III PDs; OCPD ⫽ obsessive-compulsive PD; sr ⫽ semipartial correlations between Urgency and PDs after removing the variance that Urgency shares with FFM neuroticism (computed without the Impulsiveness facet). R2 values are derived from regression analyses in which the DSM–5 PD scores were simultaneously regressed on the four UPPS traits. ⴱ p ⱕ .01.
for the overlap with neuroticism, the latter three traits remained strongly associated with Urgency. However, there was limited evidence for discriminant validity because Urgency was strongly correlated with facets across all five DSM–5 trait domains. Some of these relations reflect the saturation of the Section III traits with negative emotionality, as evidenced by smaller correlations when controlling for neuroticism. Also consistent with hypotheses, both (Lack of) Perseverance and Premeditation were most strongly correlated with the disinhibition domain, and these UPPS traits evidenced relatively good convergent and discriminant validity at the facet level. Specifically, Premeditation was strongly correlated with 4 of the 5 facets from the disinhibition domain and correlated only weakly with three other facets across the remaining domains. Likewise, (Lack of) Perseverance was correlated with both irresponsibility and distractibility, both of which were expected given their conceptual overlap with this UPPS trait. However, the equally strong associations of the (Lack of) Perseverance trait with separation insecurity and depressivity are less clear, although they may reflect the fact that these traits are important components of dependent PD (e.g., Hopwood, Thomas, Markon, Wright, & Krueger, 2012). Miller and Lynam (2008) hypothesized that dependency may result, in part, from real or imagined perceptions of oneself as lacking in core conscientiousness-related traits such as competence and perseverance/self-discipline that are important to individuals’ abilities to operate relatively autonomously. Contrary to the hypothesized associations with detachment (negative) and disinhibition (positive), UPPS Sensation Seeking was unrelated to all of the trait domains, but at the facet level, it was correlated with risk taking from the disinhibition domain and intimacy avoidance from the
detachment domain, as well as attention seeking from the antagonism domain. In terms of relations with Section II and Section III PDs, as hypothesized, the UPPS traits, particularly Urgency and (Lack of) Premeditation, were most consistently related to Cluster B PDs. Although Urgency was significantly associated with 7 of the 10 Section II PDs and 6 of 10 Section III PDs, the associations outside of Cluster B were primarily accounted for by neuroticism. Both Urgency and (Lack of) Premeditation were most strongly associated with antisocial and borderline PDs, consistent with findings from DeShong and Kurtz (2013). Sensation Seeking manifested relatively limited correlations with PDs, most notably with histrionic, narcissistic, and antisocial PDs, although some of these positive effects were small and nonsignificant; these findings were generally consistent with previous meta-analytic findings using FFM excitement seeking as a proxy (Samuel & Widiger, 2008). Finally, in addition to BPD, (Lack of) Perseverance was also linked to avoidant and dependent PDs, which is consistent with meta-analytic findings that these PDs are characterized by low levels of FFM competence and self-discipline from a trait perspective (Miller & Lynam, 2008). Overall, these findings are relevant to case conceptualization and treatment planning. For example, (Lack of) Premeditation and Urgency may help explain the high rates of substance use and other externalizing behaviors associated with borderline and antisocial PD. Identifying impulsive traits that differ across PDs may also aid in more targeted treatment approaches. For instance, developing a treatment plan for an individual who engages in impulsive behavior when experiencing negative emotion (e.g., BPD) may be different than a treatment plan that targets impulsive behavior resulting from a perception that one lacks in the basic
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capacities necessary for independent and adaptive functioning (e.g., [Lack of] Perseverance’s relation with dependent and avoidant PDs). Both may be different still from a treatment plan for an individual who acts without consideration of the consequences (e.g., deficient Premeditation as in antisocial PD). Limitations of the current study include the use of a relatively small sample of individuals currently receiving mental health-related treatment, in which the heterogeneity and severity of certain PDs were limited. In addition, ratings for the Section III traits were based on a semistructured PD interview that was designed to assess the traditional PDs included in DSM–IV and DSM–5 (Section II). An additional limitation is that only Criterion B of the Section III model was used in the construction of the Section III PDs, not Criterion A. However, there is only limited support that these criteria provide additional information beyond Criterion B in the assessment of PDs (see Few et al., 2013). Future studies should examine Section II and III PDs in relation to the UPPS using larger samples and measures designed to assess Section III traits. In conclusion, the UPPS demonstrates substantial correlations with the DSM–5 Section III trait model that are largely consistent with a priori hypotheses. As expected, impulsivity-related constructs represent a prominent feature of PDs in general and specifically those that are most strongly associated with externalizing and dysregulated behaviors such as borderline and antisocial PDs. The current findings suggest that these PDs are characterized by broad difficulties with the ability to consider consequences of behavior before acting, as well as more specific deficits related to disinhibition associated with the experience of intense emotion.
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Hopwood, C. J., Thomas, K. M., Markon, K. E., Wright, A. G., & Krueger, R. F. (2012). DSM-5 personality traits and DSM–IV personality disorders. Journal of Abnormal Psychology, 121, 424 – 432. http://dx.doi.org/ 10.1037/a0026656 Kotov, R., Gamez, W., Schmidt, F., & Watson, D. (2010). Linking “big” personality traits to anxiety, depressive, and substance use disorders: A meta-analysis. Psychological Bulletin, 136, 768 – 821. http://dx.doi.org/ 10.1037/a0020327 Lynam, D., Smith, G., Whiteside, S., & Cyders, M. (2006). The UPPS-P: Assessing five personality pathways to impulsive behavior (Technical report). West Lafayette, IN: Purdue University. Lynam, D. R., & Widiger, T. A. (2001). Using the five-factor model to represent the DSM–IV personality disorders: An expert consensus approach. Journal of Abnormal Psychology, 110, 401– 412. http://dx.doi .org/10.1037/0021-843X.110.3.401 Miller, J. D., Few, L. R., Lynam, D. R., & MacKillop, J. (2015). Pathological personality traits can capture DSM–IV personality disorder types. Personality Disorders: Theory, Research and Treatment, 6, 32– 40. http://dx.doi.org/10.1037/per0000064 Miller, J. D., & Lynam, D. R. (2008). Dependent personality disorder: Comparing an expert generated and empirically derived five-factor model personality disorder count. Assessment, 15, 4 –15. http://dx.doi .org/10.1177/1073191107306095 Miller, J. D., Zeichner, A., & Wilson, L. F. (2012). Personality correlates of aggression: Evidence from measures of the five-factor model, UPPS model of impulsivity, and BIS/BAS. Journal of Interpersonal Violence, 27, 2903–2919. http://dx.doi.org/10.1177/0886260512438279 Pearson, C. M., Combs, J. L., Zapolski, T. C., & Smith, G. T. (2012). A longitudinal transactional risk model for early eating disorder onset. Journal of Abnormal Psychology, 121, 707–718. http://dx.doi.org/ 10.1037/a0027567 Ray, J., Poythress, N., Weir, J., & Rickelm, A. (2009). Relationships between psychopathy and impulsivity in the domain of self-reported personality features. Personality and Individual Differences, 46, 83– 87. http://dx.doi.org/10.1016/j.paid.2008.09.005 Samuel, D. B., & Widiger, T. A. (2008). A meta-analytic review of the relationships between the five-factor model and DSM–IV–TR personality disorders: A facet level analysis. Clinical Psychology Review, 28, 1326 – 1342. http://dx.doi.org/10.1016/j.cpr.2008.07.002 Sharma, L., Kohl, K., Morgan, T. A., & Clark, L. A. (2013). “Impulsivity”: Relations between self-report and behavior. Journal of Personality and Social Psychology, 104, 559 –575. http://dx.doi.org/10.1037/a0031181 Sharma, L., Markon, K. E., & Clark, L. A. (2014). Toward a theory of distinct types of “impulsive” behaviors: A meta-analysis of self-report and behavioral measures. Psychological Bulletin, 140, 374 – 408. http:// dx.doi.org/10.1037/a0034418 Tragesser, S. L., & Robinson, R. J. (2009). The role of affective instability and UPPS impulsivity in borderline personality disorder features. Journal of Personality Disorders, 23, 370 –383. http://dx.doi.org/10.1521/ pedi.2009.23.4.370 Weiss, N. H., Tull, M. T., Anestis, M. D., & Gratz, K. L. (2013). The relative and unique contributions of emotion dysregulation and impulsivity to posttraumatic stress disorder among substance dependent inpatients. Drug and Alcohol Dependence, 128, 45–51. http://dx.doi.org/ 10.1016/j.drugalcdep.2012.07.017 Whiteside, S., & Lynam, D. (2001). The Five Factor Model and impulsivity: Using a structural model of personality to understand impulsivity. Personality and Individual Differences, 30, 669 – 689. http://dx.doi.org/ 10.1016/S0191-8869(00)00064-7 Whiteside, S., Lynam, D., Miller, J., & Reynolds, S. (2005). Validation of the UPPS impulsive behavior scale: A four-factor model of impulsivity. European Journal of Personality, 19, 559 –574. http://dx.doi.org/ 10.1002/per.556
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BRIEF REPORT
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Impulsivity-Related Traits and Their Relation to DSM–5 Section II and III Personality Disorders Lauren R. Few
Donald R. Lynam
Washington University School of Medicine
Purdue University
Joshua D. Miller University of Georgia Difficulties with impulse control are considered a core feature of personality disorders (PDs) as assessed by the Diagnostic and Statistical Manual of Mental Disorders (5th edition [DSM–5]; American Psychiatric Association, 2013). Despite this, there has been relatively little examination of the manner in which DSM–5 PDs are characterized by multidimensional models of impulsivity that parse this broad umbrella construct into smaller, more unidimensional constructs. Using the UPPS model and measure of impulsivity (Whiteside & Lynam, 2001), the relations between 4 impulsivity-related traits and interview-rated scores on both DSM–5 Section II and III PDs and PD traits were examined in a community sample of individuals currently receiving psychological or psychiatric care (N ⫽ 106). As expected, the UPPS traits manifested correlations with the new Section III trait model that were generally consistent with the assertion that this new DSM–5 trait model reflects a pathological variant of the Five-Factor Model (FFM; e.g., UPPS traits associated with FFM conscientiousness were most strongly related to DSM–5 disinhibition traits). Overall, the UPPS traits accounted best for variance in DSM–5 Section II and III Cluster B PDs, consistent with these PDs being characterized, in part, by emotionally and cognitively based forms of impulsivity. Keywords: impulsivity, UPPS, personality disorders, DSM–5
develop a model and associated measure of the construct. Whiteside and Lynam argued that impulsivity is “an artificial umbrella term” (p. 687) that comprises four different personality traits from three different Five-Factor Model (FFM) domains (i.e., neuroticism, extraversion, conscientiousness) and that these traits represent distinct pathways to behaviors that others judge to be risky or problematic. To examine this hypothesis, 17 subscales from widely used impulsivity measures were submitted to an exploratory factor analysis, along with four facets of the Revised NEO Personality Inventory (NEO PI-R; Costa & McCrae, 1992). Results of their analyses identified four factors that aligned with the four FFM facets; these factors were used to select items that form the scales of the resultant measure (UPPS: Urgency, (Lack of) Premeditation, (Lack of) Perseverance, Sensation Seeking). Urgency measures the tendency to engage in impulsive behavior when experiencing negative emotion. Lack of Premeditation captures the tendency to act without consideration of potential consequences. Lack of Perseverance is related to problems in maintaining goal-directed behavior when performing tasks that may be boring or difficult. Finally, Sensation Seeking captures both the tendency to enjoy activities that are exciting and openness to activities that could potentially be dangerous. A fifth factor, labeled Positive Urgency, which can be assessed using the revised UPPS-P measure (Lynam, Smith, Whiteside, & Cyders, 2006), was identified in subsequent research (Cyders et al., 2007) and reflects rash behavior in the context of positive mood.
There is ample research devoted to the study of impulsivity, partly because of its inclusion within the diagnostic criteria of various psychiatric disorders (e.g., borderline personality disorder [BPD]) and its association with externalizing pathology (e.g., Kotov, Gamez, Schmidt, & Watson, 2010). However, the existing literature on self-report measures of impulsivity is laden with mixed findings as a result of the multidimensional nature of impulsivity (Sharma, Markon, & Clark, 2014). This is partly because impulsivity-related traits are found in all major models of personality, but the labels used and the placement on higher order domains vary substantially across models and measures. To bring greater clarity to the impulsivity literature, Whiteside and Lynam (2001) utilized a general personality framework to conceptualize and organize the commonalities across impulsivity measures and
This article was published Online First April 13, 2015. Lauren R. Few, Department of Psychiatry, Washington University School of Medicine; Donald R. Lynam, Department of Psychological Sciences, Purdue University; Joshua D. Miller, Department of Psychology, University of Georgia. Correspondence concerning this article should be addressed to Lauren R. Few, Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8134, St. Louis, MO 63110. E-mail: [email protected] 261
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There is substantial research supporting the utility of the UPPS model in clinical populations (e.g., Weiss, Tull, Anestis, & Gratz, 2013; Whiteside, Lynam, Miller, & Reynolds, 2005). One advantage of the UPPS is its ability to characterize specific impulsivityrelated pathways to various problematic behaviors such as aggression (e.g., Miller, Zeichner, & Wilson, 2012), eating pathology (e.g., Pearson, Combs, Zapolski, & Smith, 2012), substance use (e.g., Cyders, Flory, Rainer, & Smith, 2009), and self-harm (e.g., Glenn & Klonsky, 2010). The UPPS can also be used to compare and contrast the role of impulsivity-related traits in various disorders. For instance, DeShong and Kurtz (2013) used the UPPS model to examine which traits best characterize borderline and antisocial personality disorders (PDs), both of which are characterized by deficient constraint (Lynam & Widiger, 2001). Other studies have used the UPPS to understand PDs in isolation, such as psychopathy (Ray, Poythress, Weir, & Rickelm, 2009) and BPD (e.g., Tragesser & Robinson, 2009). Despite some promising initial work using the UPPS model to understand the role of impulsivity-related traits in specific PDs or subsets of PDs, there has yet to be a comprehensive examination of the manner with which PDs relate to the UPPS dimensions. This is surprising because one of the cardinal symptoms of PDs, as defined by the general definition of PD used in the Diagnostic and Statistical Manual of Mental Disorders (5th edition [DSM–5]; American Psychiatric Association, 2013), is problems with impulse control. Consistent with this model, expert ratings (Lynam & Widiger, 2001) and meta-analyses (Samuel & Widiger, 2008) suggest that impulsivity-related traits are relevant to various PDs but are most consistently and robustly related to Cluster B PDs such as antisocial and borderline PDs. The approach to the conceptualization, assessment, and diagnosis of PDs has changed substantially in DSM–5 in that a dimensional personality trait model was included with the goal of providing an alternative approach to diagnosing PDs. This pathological trait model is included in Section III of DSM–5 on “emerging measures and models,” whereas the traditional PD constructs are included in Section II. The Section III trait model, a pathological variant of the FFM, assesses five broad domains and 25 more specific traits. The Section III traits can be used to diagnose six traditional PD constructs as well as additional trait-specified types. In the former case, a PD such as BPD is diagnosed based on elevations of specific traits and evidence of personality impairment. Research has demonstrated that Section III PD counts, which can be generated using clinician ratings or self-report, are substantially correlated with Section II PDs and manifest similar personality profiles (Miller, Few, Lynam, & MacKillop, 2015). Because the Section III dimensional trait model represents a substantial departure from the approach used in the existing Section II categorical model, it is important to understand whether the UPPS traits relate similarly to PDs from these alternative diagnostic approaches. In the current study, we examined the relations between the UPPS traits and DSM–5 Section II and III PDs, as well as Section III PD traits, in a sample of 109 community participants who were receiving psychological or psychiatric treatment at the time of the study. We first tested the relations between self-reported UPPS dimensions and interview ratings of the pathological traits included in the DSM–5 Section III model. We hypothesized that the UPPS traits would align with the domains and facets of the DSM–5
trait model in a manner similar to the FFM (e.g., Whiteside & Lynam, 2001), such that UPPS Urgency would be most strongly related to the DSM–5 domain and facets of negative affectivity, (Lack of) Premeditation and Perseverance would be most strongly related to the domain and facets of DSM–5 disinhibition, and Sensation Seeking would be positively related to DSM–5 disinhibition and its facets and negatively related to DSM–5 detachment and its facets, which are thought to represent low FFM extraversion. Next, we examined the relations between the UPPS dimensions and interview-based ratings of the DSM–5 Section II and III PDs. Here, we hypothesized that antisocial and borderline PDs would be robustly related to impulsivity-related traits, whereas other PDs would demonstrate more limited relations (e.g., Lack of Perseverance with avoidant and dependent PDs). Finally, because Urgency reflects disinhibited behavior during periods of extreme emotion, we also tested their relations with pathological personality traits and PDs after controlling for the variance shared with FFM neuroticism. These analyses examine whether Urgency manifests unique relations with DSM–5 PDs and PD traits above and beyond the known role of neuroticism in these disorders (e.g., Samuel & Widiger, 2008). This is the first study to examine the UPPS dimensions in relation to the PDs and pathological traits assessed in Section II and III of the DSM–5.
Method Participants and Procedures Participants included 109 community adults (70% female; 90% Caucasian, 6% African American; M age ⫽ 35.8 years [SD ⫽ 12.6]) who were currently receiving psychological and/or psychiatric treatment. Participation also required individuals to (a) be between the ages of 18 and 65 years, (b) have a minimum of an eighth-grade education, (c) use a computer ⱖ3 days/week (to ensure that they could complete computerized assessments), and (d) not be experiencing psychotic symptoms. Individuals were administered a semistructured interview for PD symptoms and completed several self-report measures. Of the 109 individuals, 84 self-reported one or more current psychiatric diagnoses. Sixty-six participants reported a current mood disorder, 31 reported a current anxiety disorder, 7 reported an attention deficit/hyperactivity disorder, 6 reported a PD, and 1 reported an alcohol use disorder. Of the 25 who did not report a current diagnosis, 22 indicated that that they were currently undergoing treatment for symptoms of depression and/or anxiety. Participants reported, on average, 8.8 (SD ⫽ 9.7) individual psychotherapy sessions and 3.5 (SD ⫽ 4.31) appointments for pharmacotherapy management in the last 6 months. In addition, 22% of the participants had been hospitalized for psychiatric reasons in their lifetime. Individuals were compensated $30 for their participation.
Measures Structured Clinical Interview for DSM–IV Axis II PDs. DSM–5 Section II PD scores were generated using the Structured Clinical Interview for DSM-IV Axis II PDs (SCID II; First, Gibbon, Spitzer, Williams, & Benjamin, 1997), a semistructured interview that assesses 10 DSM–5 PDs. Each symptom is scored using a 1 to 3 rating. Symptom ratings were completed by the
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IMPULSIVITY AND DSM–5 PERSONALITY DISORDERS
interviewer (i.e., a doctoral student in clinical psychology) and a second rating was completed (n ⫽ 103) via a review of the videotaped interview by trained graduate students who were blind to the primary ratings; the secondary ratings were used for testing the interrater reliability, which ranged from .79 to .92. The ␣s for the Section II PD scores ranged from .68 to .84. In terms of diagnoses, 37.6% of the sample met criteria for at least one PD. DSM–5 PD traits. Upon completion of the SCID-II, the interviewer rated each participant on the five domains and 25 more specific DSM–5 Section III PD traits using a single-item clinician rating form developed by the DSM–5 Personality Disorder Work Group. Ratings for each of the dimensions were provided using a 0 (not at all descriptive) to 3 (extremely descriptive) scale. Interrater reliabilities for these 25 traits ranged from .12 (perseveration) to .83 (impulsivity) with a median of .55 (see Few et al., 2013 for details). The Section III PD counts were created by summing the traits specified for each PD in the Section III model and previous presentations by the DSM–5 Personality and Personality Disorder Work Group; although only 6 PDs are officially recognized in Section III, we scored all 10 PDs to maintain consistency with the PDs in Section II. The DSM–5 Section II and III PD scores were strongly related (rs ranged from .50 to .86 with a median of .73). UPPS-P Impulsive Behavior Scale. The UPPS-P (Lynam et al., 2006) is a 59-item self-report inventory designed to assess five personality pathways to impulsive behavior: Negative Urgency, (Lack of) Perseverance, (Lack of) Premeditation, Sensation Seeking, and Positive Urgency. The ␣s in the current study ranged from .78 (Urgency; Premeditation) to .95 (Positive Urgency). The correlations among the traits ranged from .00 (Perseverance—Sensation Seeking) to .71 (Negative—Positive Urgency) with a median of .39. Because of the strong relation between Negative and Positive Urgency and their similar correlates with the criterion variables used here (intraclass correlation ⫽ .94), we combined these dimensions to form a general Urgency factor (␣ ⫽ .95). NEO PI-R. The NEO PI-R (Costa & McCrae, 1992) is a 240-item self-report measure of the five domains and 30 facets of the FFM. Only the neuroticism domain (minus the Impulsiveness facet) was used here as a covariate in some analyses (␣ ⫽ .95).
Results All statistics were generated using SPSS, Version 22 (IBM, 2013). In addition, because of the number of analyses conducted, we lowered our significance level to p ⬍ .01.
UPPS Impulsivity-Related Traits and DSM–5 Section III Personality Traits The relations between the four self-reported UPPS impulsivityrelated traits and the interviewer ratings of the DSM–5 Section III personality traits were examined first (see Table 1). Urgency manifested the most consistent relations with the DSM–5 domains as demonstrated by its significant positive correlations with DSM–5 domains of disinhibition, negative affectivity, and antagonism (Lack of). Perseverance was positively related to the DSM–5 domains of disinhibition and negative affectivity, whereas (Lack of) Premeditation was only significantly related to disinhibition. Finally, Sensation Seeking was unrelated to the DSM–5 domains.
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At the facet level, Urgency manifested the largest number of significant correlations with the DSM–5 traits (i.e., 14 of 25), including several that would be considered moderate to large in nature, including impulsivity, risk taking, emotional lability, irresponsibility, deceitfulness, separation insecurity, hostility, and depressivity. Likewise, (Lack) of Premeditation manifested eight significant correlations, the largest of which were from the DSM–5 disinhibition domain including risk taking, impulsivity, and irresponsibility. (Lack of) Perseverance produced four significant relations with the DSM–5 traits including depressivity, irresponsibility, separation insecurity, and distractibility. Finally, Sensation Seeking manifested only three relatively small correlations with attention seeking, intimacy avoidance, and risk taking. Given Urgency’s strong relation—conceptually and empirically—to the domain of neuroticism (Whiteside & Lynam, 2001), which is a robust correlate of most internalizing and externalizing symptoms (Kotov et al., 2010) as well as many PDs (Samuel & Widiger, 2008), we also tested Urgency’s relations to the DSM–5 traits when controlling for its overlap with FFM neuroticism (minus the facet of Impulsiveness, which is conceptually and empirically similar to Urgency). Twelve of the 14 correlations between Urgency and the DSM–5 traits remained significant even when controlling for its overlap with neuroticism (e.g., impulsivity; irresponsibility), although, as expected, many of the correlations with facets from negative affectivity were substantially reduced (i.e., by ⱖ50%).
UPPS Impulsivity-Related Traits and DSM–5 Section II and III PDs Next, we examined the relations between the UPPS traits and the DSM–5 Section II and III PDs (see Table 2). In general, relations between the UPPS and Section II and III PDs were consistent across the two DSM–5 models. At the individual trait level, Urgency was the most consistent correlate of the Section II (7 of 10) and Section III PDs (6 of 10), with particularly large correlations for borderline and antisocial PDs. (Lack of) Premeditation also showed relatively consistent and robust correlations with the Section II (4 of 10) and III PDs (5 of 10), and manifested its largest relations with antisocial and borderline PDs. (Lack of) Perseverance manifested a more limited number of correlations because it only correlated significantly with dependent (both Sections), avoidant (Section I), and borderline PDs (Section II). Finally, Sensation Seeking manifested the most restricted relations because it was only significantly correlated with Section II histrionic PD and Section III narcissistic PD. We again tested whether Urgency was correlated with the DSM–5 PDs even after controlling for its overlap with neuroticism (minus the facet of Impulsiveness). These analyses provide additional clarity about the relation of Urgency to the PDs. Of the 13 significant positive correlations between Urgency and the Section II and III PDs, only the 8 Cluster B PD correlations (4 for each section) remained significant when controlling for the variance that Urgency shared with neuroticism: antisocial (Section II and III), borderline (Section II and III), histrionic (Section II and III), and Narcissistic (Section II and III). The relations found between Urgency and paranoid, schizotypal, and dependent PDs were no longer significant when controlling for the overlap between Urgency and neuroticism, suggesting that, in these cases, Urgency’s
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Table 1 Correlations Between UPPS Impulsivity Traits and the DSM–5 Section III Trait Model
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Section III traits Negative Affectivity Detachment Antagonism Disinhibition Psychoticism Emotional Lability Anxiousness Restricted Affectivity Separation Insecurity Hostility Perseveration Submissiveness Withdrawal Anhedonia Depressivity Intimacy Avoidance Suspiciousness Manipulativeness Deceitfulness Grandiosity Attention Seeking Callousness Irresponsibility Impulsivity Rigid Perfectionism Distractibility Risk Taking Unusual Beliefs Eccentricity Cognitive/Perceptual Dysregulation Mean r
Urgency r (sr)
Sensation seeking r
(Lack of) Perseverance R
(Lack of) Premeditation R
.48 (.17) .06 (⫺.23) .41 (.41) .56 (.51) .24 (.22) .50 (.31) .13 (⫺.19) ⫺.11 (⫺.20) .45 (.22) .45 (.31) .14 (⫺.03) .19 (⫺.03) .04 (⫺.23) .16 (⫺.10) .44 (.12) ⫺.06 (ⴚ.27) .29 (.13) .39 (.40) .46 (.40) .20(.25) .26 (.34) .25 (.27) .50 (.46) .60 (.56) ⫺.07 (⫺.18) .28 (.22) .60 (.56) .30 (.32) .10 (.05)
⫺.01 ⫺.21 .24 .20 .19 ⫺.02 ⫺.11 ⫺.10 .09 .04 ⫺.02 ⫺.22 ⫺.20 ⫺.07 ⫺.05 ⴚ.29 ⫺.02 .24 .13 .23 .30 .11 .06 .23 ⫺.17 .20 .27 .18 .16
.32 .19 .05 .37 .06 .21 .19 .11 .34 .12 .01 .23 .24 .18 .38 .07 ⫺.01 .14 .15 ⫺.12 ⫺.04 ⫺.05 .36 .24 ⫺.12 .33 .18 .04 .04
.13 ⫺.16 .24 .47 .13 .25 ⫺.24 ⫺.20 .23 .19 ⫺.07 ⫺.02 ⫺.14 ⫺.05 .21 ⫺.24 ⫺.07 .21 .25 .16 .29 .07 .44 .48 ⴚ.28 .23 .50 .18 .07
.19 .06
.08 .14
.08 .12
.24 (.21) .30 (.18)
Note. Bolded correlations are significant at p ⱕ .01. sr ⫽ semipartial correlations between Urgency and pathological traits after removing the variance that Urgency shares with FFM neuroticism (computed without the Impulsiveness facet).
bivariate relations with these PDs simply reflected the greater psychological distress and negative emotionality associated with these PDs, but not the disinhibited behavior that sometimes accompanies these emotional experiences. The amount of variance the UPPS traits accounted for in the DSM–5 PD scores was also examined. Overall, the UPPS traits accounted for between 6% (DSM–5 Section II schizoid) and 39% (DSM–5 Section III BPD) of the variance in the PDs with a mean of 22%. Across the two sets of ratings, the Cluster A PDs were the least well accounted for by the UPPS traits (mean R2 ⫽ 14%), and the Cluster B PDs were the most successfully explained (mean R2 ⫽ 26%). The variance explained by the UPPS traits in the Cluster C PDs was intermediate in nature (mean R2 ⫽ 22%), and this included both positive and negative effects.
Discussion The UPPS is a promising measure and model of impulsivity because it conceptualizes and assesses impulsivity as a multifaceted construct that includes various, separable, and distinct pathways to impulsive behavior—an approach that has become increasingly popular given its ability to differentiate the relations
between these traits and important behavioral outcomes (Sharma, Kohl, Morgan, & Clark, 2013). However, to date, the UPPS has not been comprehensively examined in relation to DSM PDs, which is surprising in that impulsivity is a hallmark feature included in the general definition of PDs (American Psychiatric Association, 2013). The current study examined the UPPS traits in relation to DSM–5 Section II and III PDs and in relation to the traits included as a central component of the alternative diagnostic model included in Section III of the DSM–5. In terms of relations between the UPPS and Section III traits, results were generally consistent with hypotheses. As expected, Urgency was strongly related to negative affectivity; however, it was also strongly related to the disinhibition domain, which likely reflects the positioning of the impulsivity facet on this domain and use of language that is highly relevant to Urgency (i.e., “. . . a sense of urgency and self-harming behavior under emotional distress”). This deviates from the loading of the conceptually related FFM facet of Impulsiveness, which is subsumed by the FFM neuroticism domain. At the facet level, Urgency converged as expected with several facets, including emotional lability, irresponsibility, impulsivity, and risk taking. Furthermore, even after accounting
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Table 2 Relations Between UPPS Impulsivity Traits and DSM–5 Section II and III PDs
DSM–5 PDs
Urgency r (sr)
Sensation seeking r
(Lack of) Perseverance R
(Lack of) Premeditation R
R2
Paranoid-II Paranoid-III Schizoid-II Schizoid-III Schizotypal-II Schizotypal-III Antisocial-II Antisocial-III Borderline-II Borderline-III Histrionic-II Histrionic-III Narcissistic-II Narcissistic-III Avoidant-II Avoidant-III Dependent-II Dependent-III OCPD-II OCPD-III
.38ⴱ (.17) .35ⴱ (.17) .09 (⫺.09) .02 (⫺.24ⴱ) .31ⴱ (.18) .20 (.03) .59ⴱ (.56ⴱ) .61ⴱ (.56ⴱ) .62ⴱ (.40ⴱ) .65ⴱ (.41ⴱ) .32ⴱ (.41ⴱ) .51ⴱ (.45ⴱ) .29ⴱ (.28ⴱ) .26ⴱ (.34ⴱ) .23 (⫺.14) .04 (⫺.25ⴱ) .40ⴱ (.08) .34ⴱ (.02) .23 (.04) ⫺.03 (⫺.26ⴱ)
⫺.02 ⫺.04 ⫺.17 ⫺.20 .10 .00 .18 .20 .12 .10 .30ⴱ .21 .19 .30ⴱ ⫺.17 ⫺.21 ⫺.06 ⫺.09 .05 ⫺.23
.07 .08 .11 .18 .10 .12 .23 .22 .31 .34ⴱ .07 .14 .03 ⫺.09 .45ⴱ .21 .44ⴱ .34ⴱ .06 .02
.02 .02 ⫺.11 ⫺.18 .10 ⫺.04 .47ⴱ .42ⴱ .37ⴱ .35ⴱ .28ⴱ .33ⴱ .19 .26ⴱ .01 ⫺.21 .28ⴱ .01 ⫺.14 ⫺.30ⴱ
.21ⴱ .18ⴱ .08 .14ⴱ .11 .09 .38ⴱ .39ⴱ .39ⴱ .44ⴱ .16ⴱ .28ⴱ .11 .19ⴱ .28ⴱ .20ⴱ .27ⴱ .25ⴱ .18ⴱ .15ⴱ
Note. II ⫽ DSM–5 Section II PDs; III ⫽ DSM–5 Section III PDs; OCPD ⫽ obsessive-compulsive PD; sr ⫽ semipartial correlations between Urgency and PDs after removing the variance that Urgency shares with FFM neuroticism (computed without the Impulsiveness facet). R2 values are derived from regression analyses in which the DSM–5 PD scores were simultaneously regressed on the four UPPS traits. ⴱ p ⱕ .01.
for the overlap with neuroticism, the latter three traits remained strongly associated with Urgency. However, there was limited evidence for discriminant validity because Urgency was strongly correlated with facets across all five DSM–5 trait domains. Some of these relations reflect the saturation of the Section III traits with negative emotionality, as evidenced by smaller correlations when controlling for neuroticism. Also consistent with hypotheses, both (Lack of) Perseverance and Premeditation were most strongly correlated with the disinhibition domain, and these UPPS traits evidenced relatively good convergent and discriminant validity at the facet level. Specifically, Premeditation was strongly correlated with 4 of the 5 facets from the disinhibition domain and correlated only weakly with three other facets across the remaining domains. Likewise, (Lack of) Perseverance was correlated with both irresponsibility and distractibility, both of which were expected given their conceptual overlap with this UPPS trait. However, the equally strong associations of the (Lack of) Perseverance trait with separation insecurity and depressivity are less clear, although they may reflect the fact that these traits are important components of dependent PD (e.g., Hopwood, Thomas, Markon, Wright, & Krueger, 2012). Miller and Lynam (2008) hypothesized that dependency may result, in part, from real or imagined perceptions of oneself as lacking in core conscientiousness-related traits such as competence and perseverance/self-discipline that are important to individuals’ abilities to operate relatively autonomously. Contrary to the hypothesized associations with detachment (negative) and disinhibition (positive), UPPS Sensation Seeking was unrelated to all of the trait domains, but at the facet level, it was correlated with risk taking from the disinhibition domain and intimacy avoidance from the
detachment domain, as well as attention seeking from the antagonism domain. In terms of relations with Section II and Section III PDs, as hypothesized, the UPPS traits, particularly Urgency and (Lack of) Premeditation, were most consistently related to Cluster B PDs. Although Urgency was significantly associated with 7 of the 10 Section II PDs and 6 of 10 Section III PDs, the associations outside of Cluster B were primarily accounted for by neuroticism. Both Urgency and (Lack of) Premeditation were most strongly associated with antisocial and borderline PDs, consistent with findings from DeShong and Kurtz (2013). Sensation Seeking manifested relatively limited correlations with PDs, most notably with histrionic, narcissistic, and antisocial PDs, although some of these positive effects were small and nonsignificant; these findings were generally consistent with previous meta-analytic findings using FFM excitement seeking as a proxy (Samuel & Widiger, 2008). Finally, in addition to BPD, (Lack of) Perseverance was also linked to avoidant and dependent PDs, which is consistent with meta-analytic findings that these PDs are characterized by low levels of FFM competence and self-discipline from a trait perspective (Miller & Lynam, 2008). Overall, these findings are relevant to case conceptualization and treatment planning. For example, (Lack of) Premeditation and Urgency may help explain the high rates of substance use and other externalizing behaviors associated with borderline and antisocial PD. Identifying impulsive traits that differ across PDs may also aid in more targeted treatment approaches. For instance, developing a treatment plan for an individual who engages in impulsive behavior when experiencing negative emotion (e.g., BPD) may be different than a treatment plan that targets impulsive behavior resulting from a perception that one lacks in the basic
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capacities necessary for independent and adaptive functioning (e.g., [Lack of] Perseverance’s relation with dependent and avoidant PDs). Both may be different still from a treatment plan for an individual who acts without consideration of the consequences (e.g., deficient Premeditation as in antisocial PD). Limitations of the current study include the use of a relatively small sample of individuals currently receiving mental health-related treatment, in which the heterogeneity and severity of certain PDs were limited. In addition, ratings for the Section III traits were based on a semistructured PD interview that was designed to assess the traditional PDs included in DSM–IV and DSM–5 (Section II). An additional limitation is that only Criterion B of the Section III model was used in the construction of the Section III PDs, not Criterion A. However, there is only limited support that these criteria provide additional information beyond Criterion B in the assessment of PDs (see Few et al., 2013). Future studies should examine Section II and III PDs in relation to the UPPS using larger samples and measures designed to assess Section III traits. In conclusion, the UPPS demonstrates substantial correlations with the DSM–5 Section III trait model that are largely consistent with a priori hypotheses. As expected, impulsivity-related constructs represent a prominent feature of PDs in general and specifically those that are most strongly associated with externalizing and dysregulated behaviors such as borderline and antisocial PDs. The current findings suggest that these PDs are characterized by broad difficulties with the ability to consider consequences of behavior before acting, as well as more specific deficits related to disinhibition associated with the experience of intense emotion.
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