Revolutionizing Personality Disorder Diagnosis: Understanding the DSM-5's Alternative Model of Personality Disorders (AMPD) and its Clinical Implications with Dr. Robert Krueger Part 2

It's Part 2 of Dan's conversation with Dr. Robert Krueger as they continue to dive deep into the alternative model of personality disorders.

Dr. Krueger is a clinical psychologist and member of the DSM-5 Personality Disorders Workgroup. Dan and Dr. Krueger explore the concept of personality disorders and the alternative model of personality disorders (AMPD). Can personality disorders be seen as extreme versions of regular personality traits, and can these traits have both adaptive and maladaptive features depending on the context? Then, Dr. Krueger goes over the importance of understanding the individual and their goals when working with personality disorders, rather than viewing them as unremittingly pathological.

Special Guest:
Dr. Rober Krueger
HiTop Website
The Personality Inventory for DSM-5 (PID-5)
Practitioner's Guide to the Alternative Model of Personality Disorders

Keywords: personality disorders, DSM-5, clinical case conceptualization, alternative model, AMPD, diagnostic criteria, self-related dysfunction, personality traits, psychiatric classification

Takeaways

Understanding a person's personality is important in clinical case conceptualization.

The decision-making process behind the alternative model for personality disorders involved considering the scientific evidence and the impact on individuals who have already been diagnosed.

The Alternative Model for Personality Disorders (AMPD) includes criterion A (self-related dysfunction) and criterion B (personality traits).

There is a tension between making psychiatric classification more scientifically justifiable and clinically beneficial while considering the impact on individuals.

Self-report measures for criterion A may have limitations, and additional perspectives, such as expert judgments and collateral data, can provide a more comprehensive understanding of personality pathology.

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Transcript

Broadcasting from the most beautiful city in the world, I'm your host, Dr. Dan Cox, a Professor of Counseling Psychology at the University of British Columbia. Welcome to episode number 16 of Psychotherapy and Applied Psychology, where we dive deep with the world's leading applied psychology researchers to uncover practical insights, pull back the curtain, and hopefully have some fun along the way in an attempt to bring new ideas to helping professionals, those training to be helping professionals, and the applied psychology curious. This is it.
This is the last episode of season one of the show. My goal was to do 13 episodes and I've made it to 16, so let's call that a success. We're going to take a short hiatus and enjoy the rest of the summer, and then I'll be back in September.
I already have several very special guests lined up, but in the meantime, I'd love to connect with you. So send me a text or leave me a voice message using the links in the show notes, and feel free to let me know your name and where you're from. This is part two of my conversation on the Alternative Model of Personality Disorders, or the AMPD.
In this episode, we discuss the relation between adaptive and maladaptive personality, working with clients who have personality dysfunction, the role of context, and the Hierarchical Taxonomy of Psychopathology, or the HITOP model. My very special guest is the Hathaway Distinguished Professor of Clinical Psychology, and Distinguished McKnight University Professor in the Department of Psychology at the University of Minnesota. He's the Co-Editor-in-Chief of the Journal of Personality Disorders, and he was part of the DSM-5 Working Group on Personality Disorders.
We begin our conversation with my guest responding to my question, where I asked him if disordered personality is just regular personality, but with the volume turned up such that it becomes problematic. So without further ado, it is my pleasure to welcome back Dr. Robert Krueger.
Yeah, we're expressed in ways that are not typically regarded as maladaptive in contemporary societies. I would use some phrase like that. Like we've used the word maladaptive to describe these things.
Because that gets tricky, right? Like you want to be careful about the potentially pejorative aspects of these things. And something I have thought about, certainly I thought about this clinically, like sometimes these things that are maladaptive can have adaptive features in certain kinds of circumstances, right?
There are times when the qualities that are described in the DSM-4 Personality Disorders, because that's what the PIN-5 is trying to do, right? It's trying to get at that stuff, reformulate it, you know, structurally based on the empirical way in which those things go together into the five domains, right? Sometimes that stuff can have adaptive features in certain sorts of circumstances.
But I think the way we've come to sort of write about it or think about it is that those things are generally maladaptive. Like across most circumstances, it leads people to have challenges and struggles, right, with those kinds of dispositional tendencies.
But, right, it has to be combined with actual maladaptivity, which is maybe what Criterion A is doing or something like this, right? You can have an unusual kind of personality and still be able to navigate a lot of things. And there may be circumstances where certain of those features provide some advantages, right, in certain kinds of circumstances, right?
So, I mean, like I'll pick an example just to make this more concrete. Like there's a harm avoidance scale, right, on the PID-5, right? You know, like risk, risk taking, I think we called it, right?
Like, so, you know, is it bad to take risks? Well, it depends, right? Like, it's generally maladaptive to really not consider the potential of serious risk.
But, you know, some people could take wild risks, like, I don't know, of financial nature or whatever, and succeed wildly. So, you have to be a little bit careful about the idea that these things are, you know, obviously and continuously maladaptive. So, when I think about working with those constructs clinically, it's like, well, people often struggle with this stuff.
Do you find you have some struggles in this domain? Because the instrument is saying, like, you have some of these qualities. What's that like for you, right, to have those qualities?
Can you think of times where that's been a challenge for you because it led to some problems? And maybe also other times where it might have provided some advantages, right, versus saying, like, you know, all of this is maladaptive. I'm just alluding to, like, how one might use the thing clinically in a way that's more sensitive and nuanced than, you know, thinking of it as unremittingly pathological, I guess.
Right. So, if I'm recalling correctly, there's some research on sort of some longitudinal work and sort of an argument that these personality traits are persistent over time. And it's that what we sort of want to do optimally is help people to, I hope might not be the right word, it might not be the wrong word, might just isn't, but be able to have these traits that are likely not going to change, but be able to exist more effectively or adaptively, adaptively, with them, rather than trying to change the traits themselves.
Yeah, no, I think that's really insightful, what you just said there. I tend to think of, I tend to wonder which thing is possible in certain cases, because there may be ways in which it is possible to kind of, but I don't want to give the impression that personality is indelible or people can't change. I think that's not accurate, right?
Like personality can and does change in adulthood. It's often very challenging to take on, you know, these kinds of features. But a motivated client or patient can do it.
You have to be pretty motivated and you have to be pretty open to change. And you have to work hard in psychotherapy and you have to confront some stuff that's not easy. But people can do it, right?
I've seen it happen. But, yeah, in many cases, it might make more sense to think of it the way you kind of, I think we're saying, right, about, like, well, you know, how can you work around this so it's less maladaptive, but still you have these tendencies, right? You know, so you OK, again, we'll use the risk-taking example, right?
There are more and less, you know, obviously harmful and dangerous ways of taking risk.
Right, right.
Right? Is there a way to kind of at least ameliorate it or express it differently or something like this, right? Like cruising around the city in the middle of the night seeking highly illegal drugs, you know, dangerous sex, like stuff like that.
Like, maybe that's not ideal, right? In terms of like being able to function as an adult, right? Because you're neglecting other responsibilities and so on.
But, you know, there's other stuff you might be interested in doing, right? Like exotic travel. I don't know if you have the means to do that, right, or dangerous, you know, sporting kinds of activities that other people might find dangerous, but you find exciting, right?
Just as examples of like how can you take a trade and express it in ways that are less harmful to you, right? Because that's kind of the bottom line in this motivational interviewing kind of sense, right? Like, is this working for you?
Because if it isn't, then that's something we could work on and talk about, right? Like, how can we work with that? And yeah, I think there's language of amelioration, like, can we tone that down a little bit?
But there's also language of adaptation, like, can we work with that so that you can, you know, express this thing that feels natural to you, but it isn't expressed in ways that are so damaging, right, in terms of your life and your goals. It's kind of in the personality literature, there's this distinction between sort of these basic traits and what might be called characteristic adaptations, right, like the way in which you express these things. Being argumentative might be a trait, choosing to be a trial attorney might be a characteristic adaptation, like a way of being argumentative that society values, right, just as an example of a characteristic adaptation.
So there's ideas like that and language like that that I think you can use with clients to kind of, you know, talk about how to use that information in a therapeutic way from these kinds of assessments.
Right. And one of the things that was popping in my head, and you said this a couple of minutes ago, which is it's very context dependent. So for that argumentative person, being the trial lawyer could be, is a great place to pull from that characteristic when your wife tells you that, you know, she wants you to, you know, when she gives you some feedback on your, how she felt when she was telling you something and you weren't listening, that's not the time to pull on that characteristic.
To like learning that context dependencies is extremely clinically valuable because that person's intuition is, particularly the patient who's going to show up in your office, that, with that antagonistic trait, their intuition is likely to be antagonistic all of the time. So helping them differentiate that is, it gets back to what you said, which is sort of like the societal component of it.
For sure. And that presentation gives a lot of grace to the therapeutic mill too, just in terms of the relationship in this consulting room. People like that often want to argue with the therapist, even though they're there seeking help.
I don't really like what we're doing here, and I don't really think this is working, stuff like this. So it's challenging to sometimes handle that stuff, but if you can handle it and say, does this seem to be another example of how these things arise? Because now here we are at Loggerheads, when my job is to be open and try to be helpful, but every time we try to do something that sort of changes, you have issues with it and want to argue with the therapist about it, this kind of thing.
So it's the usual therapeutic basic skills of timing and tact and so on. But it leads back to one of my basic points, I think, from earlier. You're always dealing with a person.
In the broad personality context way, like you're not dealing with a disorder, even though there might be a prominent set of features that the person's concerned about, or recent experiences that have led to notable psychopathology or whatever, right? I'm not saying you don't want to, you have to pay attention to that stuff. What I'm saying is that's always in a personality context.
Because everybody has a personality, and it's not easily reduced to just some specific focal disorder in my experience, or in my way of thinking about stuff clinically.
Yeah, it's interesting. I don't know if there's a book, I think it's called Defending Normal, I think that's right, with one of the people who is really involved with DSM-4. And it's really that, and just sort of my own human experience is that having met a lot of really exceptional people who've done a lot of really exceptional things, that if you opened up the DSM and did a clinical interview with them, you could tick some boxes.
And it's sort of like, okay, so if when we characterize these traits, characteristics, whatever, as psychiatric disorders, as medical conditions, it's like, I don't think that's right. Because then it sort of seems like, I mean, implicit, linguistically implicit in psychiatric disorder, medical condition is we want to either turn it down or get rid of it. And it's like, well, but I don't think we do all the time.
Yeah, another deep topic that you've touched on there for sure, right? But the way I tend to think about that is, I mean, is it working? Because if it's really like not working for the person, that's why they're presenting in the way that they're presenting.
Even if it worked in certain ways, like, you know, I mean, I can think of a lot of different examples, but, you know, like an energetic kind of disagreeable grandiosity, just to pick an example, right? Like people who have something to contribute, believe they have the ability to contribute, have the energy to contribute something, right? And are willing to go their own way and, you know, disagree with peers and so on, right?
And like, you can see how that could be maladaptive in certain respects. But that's kind of the essence of being a successful entrepreneur in other respects, right? Because you've got to have those kinds of qualities or you're never, you're just going to end up, I don't know, like working for somebody else or they're doing something, you know, it's more cut and dried, right?
So I think that's an example that comes to mind, I think, the kind of thing you're talking about where it's like, well, how's that working though? Because I think that's the key thing in therapy that you want to think about with the client. So just I'm making up an example here, but someone who has that style and they've succeeded wildly and they sold their business, right?
And they're now wealthy and they're in their 50s or whatever and they've left behind broken relationships because their focus was on making that happen. And that's their presenting issue and they have that kind of style. So right, there's pluses and minuses to the way that style played out in that person's life, right?
There are ways in which that's what they intended to do and they succeeded and they, you know, accomplished what they were intending to accomplish, but, you know, at what cost? And they might present with, right, you know, like these captains of industry sort of, you know, presentations, right? Like they might present with, now my life feels very empty.
I did all of that. I sold the business. Well, now what do I do?
Right? I've got a couple of broken marriages, kids who won't talk to me. Like, I'm just, I'm making up a presentation, but you can imagine that this is a plausible kind of presentation that one might see.
So then, were those traits maladaptive? Well, in some respects, were they adaptive? In other respects, they were.
But what's going on now? Right? What that person that I'm trying to portray is concerned about is like, what is the meaning and nature of my life now that I've done all of this?
I'd like to have a more meaningful, intimate relationship. You know, can you help me, right, with how I can do that now? So that's how I tend to think about it.
Like, these things often have these flip sides, and it's not always about, we need to eliminate this, you know, tendency. It's more like, how can we work within who you are to help you accomplish your goals? And can we have some clarity around what you're trying to do?
Like, in my example, I, you know, that person is trying to establish a successful, meaningful, intimate relationship because they've never had that, because the rest of it was ruinous or superficial or whatever, right? I don't know. That's the kind of thing that I think about, right?
These, to summarize my thoughts there, right? These traits have different sides and different angles to them. They can lead to some kinds of things that people might want in life.
They might lead to things that people didn't want in life. And so when you, you know, start working with a person, it's like, where are you in life? And what are your goals?
Like, what do you feel is missing? Or something that you'd like to kind of, you know, have in your life, right? A change that you're seeking.
And how can we work with, you know, these qualities, either, again, reducing or ameliorating them as possible or working around them or with them? I think that's a sort of basic therapeutic approach that can be pretty effective when working with an adaptive or maladaptive personality profile. When you're trying to work with the whole profile and try to get a sense of who's this person.
One of the things that I've read in talking about the alternative model, and I've thought about two, is... So let's take the antagonistic, just because we've sort of been talking about that, that on one side of the spectrum you have antagonism, or on the continuum, I should probably say. On one side of the continuum you have antagonism, and then on the other side of the continuum you have agreeableness, or something like that.
That folks have written about that when it comes to personality disorders, we're looking at that problematic antagonism side of things, but not as much the other side, which is sort of like that problematic agreeableness side of things. And this is consistent for all five of the facets of the alternative model, that there's two sides of the coin. What are your thoughts about that?
Am I clear?
No, I think what you're talking about is something people have definitely written about and thought about a lot, which is, I might summarize it as, if it is the case that the five domains are all neatly bipolar, which is maybe debatable in certain respects, but let's say they are, is it the case that maladaptivity is sitting at both ends? Right, so that you can be, antagonism is sort of obvious in terms of its potential maladaptive implications, but being extremely agreeable to the point of being like a doormat, right, could also be maladaptive. I think that's the example that you're referring to.
This is a challenging issue. We have studied it. We had a recent paper that my student Kelsey Hobbs led, right, trying to understand if you were to model this stuff in a formal and statistical way, and you look at things like people's quality of life, does it diminish at both ends of these putatively bipolar continua, right, these five domains?
We found in that research that it really does tilt toward the more obviously maladaptive end, right, so that people, you know, like if you were looking at something like people's quality of life, their ability to function successfully, that that was, you know, worse if they're more disagreeable than if they're more agreeable. And we didn't find a lot of evidence for, okay, if you went up on the agreeableness continuum, do you also see diminished quality of life there?
So the consequences of being on the disagreeable side of the continuum are greater than the consequences of being on the far side of the disagreeable, are greater than the consequence of being on the far side of the agreeable, which one might call, I would think of as passive.
That is what we found in this research. Now, there are other ways to approach it, like other criteria you could look at. It may be that we're incomplete in our thinking, but that's one way to think about the proposition, the hypothesis, right, is that these domains, which are supposed to be bipolar, would then have a kind of curvilinear relationship with some outcome, like life function.
That's the model. That's what we were trying to do in this research, sort of examine the evidence for that statistically by formally attempting to model the potential for that kind of curve to best fit the data versus this kind of curve, where there is no curved feature.
So I think about it sort of like a Goldilocks effect, right? Sort of like the too much to a little just right, sort of.
Yeah, exactly, right. That's what we were trying to study there. And again, that's what we found, right, that the more obviously maladaptive poll was the poll more associated with diminished quality of life in that particular project.
Now again, that's an area that's ripe for more research, thinking about different kinds of criteria, right? Like maybe it's not quality of life that's diminished, high agreeableness levels, it's something else, right? Like there's lots of ways to extend this line of research, but just I wanted to point out that we've studied it, thought about it, you know, written about it, published on it, right?
This kind of thing, and that's what we've found. And so, yeah, I think it's hard to adduce evidence for the maladaptivity of the more obviously adaptive features in the five-factor space. Like I haven't seen a lot of super compelling evidence that being extremely extroverted causes serious problems for people.
And I think part of what's going on there is that some of those qualities change their location, right? So, for example, being highly, I don't know, agreeable to the point of being a doormat and letting other people walk all over you and they can do whatever they want, sort of looks in some ways maybe like dependency. And those qualities want to shift location, right?
They don't want to be indicators of high agreeableness. They want to be indicators of like neuroticism, for example. So there's some ways in which psychometrically these things kind of shift location when they become more maladaptive in their features.
So the domains might not be neatly bipolar in the sense of where the maladaptivity is sitting. But these are interesting issues that deserve more study. And so I don't want to say like the jury's reached a...
like we know, like we're done, like no more science to do. I think that's something to think about a lot, right? What other criteria can we study?
What other ways can we get at the potential bipolarity of the domains, you know, sort of psychometrically, you know? And the statistics are interesting to me, too. Like the kind of modeling approaches that you need to get at this are interesting to think about.
Like how do you model this kind of cause for change, right? There's different ways to think about how to model that. So, yeah, an area for more research, but based on things that at least our group has done so far, our evidence where the criterion is quality of life, right, is diminished at the more like PID-5 style maladaptive poles of the five domains in a way that's more linear than like curvilinear.
So, I think what you said sort of, I think might have led to an insight in me, but just to clarify for the listener that so, so introversion, extraversion is kind of an, although I always find that they're not as simple as I used to think that those things are, but that you would think about those on a continuum. So you have on the right or the left-hand side, it doesn't matter, on the right-hand side of a straight line, you have extraversion. On the left-hand side, you have introversion.
At the midpoint, you have zero or something. And then, you know, you sort of go plus however many to extraversion, plus however many to introversion. But what you're saying or at least suggesting as a possibility is that when you actually look at that empirically, that isn't a straight line, that you go from high extraversion or, you know, extremely high extraversion, down to the zero point, and then when you start going towards introversion, the line sort of, there's an angle there so that introversion is not, the introversion-extroversion continua is not straight.
There's a bend at that midpoint. I don't know if what I'm saying is making sense.
I think it's a challenging area because it's kind of at the intersection of, well, psychological features and statistical modeling of those features. But my sense of how this works, right, is that there are some domains like extroversion, introversion, that are pretty neatly bipolar in terms of the personality features per se. So for that to work out, right, the introversion features need to be negatively correlated with the extroversion features so that you get neat bipolarity of the indicators of that dimension.
And I think that's achievable, right? I think there are instruments that have bipolar features, right, in the sense that they're measuring a continuum from extreme extroversion to extreme introversion with the population being sitting somewhere in the middle. So again, to get that to happen, you've got to work out the psychometrics.
You have to have the item content that causes that thing to behave like that. So I think that is established. Now once you have that, you can ask, how does it associate with some outcome of interest?
What's the form of the population regression line, essentially, that relates extroversion and introversion to this outcome? So in the stuff that we've done, the outcome is separate. It's quality of life in the study that I was citing.
And that's being regressed on some domain, like extroversion and introversion, that is measured in a way that looks pretty bipolar, in terms of having features at both extremes of that domain. And so the tilt is a thing that could happen in terms of the form of the regression between the predictor variable, the personality thing that's bipolar, and the outcome you're trying to study, the quality of life or some kind of dependent variable, if you will. That regression could take on different forms, and that gives you empirical leverage, that gives you a chance to ask scientifically, is there any possibility of it being U-shaped, or is it more like a line, or what does it look like?
That's how I've thought about that problem. But the ability to measure the domains in a neatly bipolar fashion, I think, is pretty clear for most of the domains. The one domain that's a little complicated is the psychoticism openness thing.
Yeah, I've sort of like looked through some papers where they were, there's a lot of space taken trying to understand that.
Yeah, that's a more complicated set of relationships. But the other domains are pretty neat, bipolar, pretty clear. Pretty well measured on both ends, I think.
I think that's fair to say.
A question I had, which we're hitting on right now, is a lot of this work in terms of looking at the structure of personality disorders has used factor analysis.
Where do you think that, like, what are the other methods that you're thinking about that can be useful as we move forward in trying to understand these phenomena?
Yeah, that's a great question. That's a question I've thought a lot about over the years because I'm interested in statistics and statistical modeling. And the way I got interested in that stuff was, well, you can get some empirical angle on these interesting questions.
Does that make sense? It started with the kind of thing you were just asking about. Like, okay, how could we figure out how personality actually, you know, sort of is best modeled in nature?
And yeah, like people have classically used factor analysis for these purposes. Certainly, we've got a lot of mileage in our research out of those kinds of techniques. And so I've been super interested in trying other things, other kinds of latent variable modeling techniques and so on.
And the universe of available approaches is pretty wide now, right? So a lot of stuff has been worked out. It's kind of interesting and tractable, if that makes sense.
Techniques that weren't readily available or couldn't easily be implemented until somewhat recently, at least, right? Were you thinking about the latent variables having class-like features, for example? So in our research, at least, and I think most people have this experience, when we try other kinds of things, like, okay, well, maybe there's groups of people, right, or something like this, right?
And when we try to fit models that have those kinds of features, they just don't really work out very well. So this gets pretty technical pretty fast, but to make it kind of like maybe easy to kind of digest, right? Like you can compare the fit of those models, essentially, right?
So you're asking, all right, if I posit a model in which people come in a bunch of categories, and I compare that to a model in which people's personality features are arranged along a series of dimensions, which one has a better fit to the data, like provides a better account of what I observed, and better, you know, like what do we mean by that, right? Well, we mean like it captures what presumably is the model in the population, right? Like the actual, you know, sort of statistical model that we're trying to infer from the data.
We and other people tend to find that those dimensional factor analytics style models fit better than models that are positing like categories and things like this. Right, so there's a, you know, a literature on that, and I don't think there's a lot of evidence that the categorical accounts fit better. So that's the reason, you know, in a scientific sense that we and other groups, you know, have argued that a dimensional account is closer to what seems to be going on in nature.
So, right, like you just don't see people's features causing them to, or you don't see like features of the data that allow you to infer the existence of kind of categories of people. The data just don't seem to work like that. It's more like those features are smoothly distributed, so that it's more empirically accurate to describe people in terms of dimensions of personality.
So I wonder if it's worth just spending, we could spend a week, but I think the work that you and your colleagues are doing with the high top stuff, even we're not going to dig into it here just because we don't have enough time, but I do think that when, and I'll link to the primary website, the high top website, because it's a great resource, and I'll say that most academic websites are not that great, but this one exceeds most. Could you just give us sort of a 30,000-foot view of what you all are up to?
So, high top stands for the Hierarchical Taxonomy of Psychopathology, which has been a kind of grassroots consortium up to this point that got started in, I think, the first publication came out in 2017, so it would have been right around that era. And I was happy to be kind of part of the small group of people that founded this thing, right? And then it took off, right?
People found it interesting. They wanted to participate in meetings. They wanted to organize workgroups to focus on different topics.
They wanted to get together around kind of a, well, a dimensional alternative to kind of the classical DSM way of organizing psychopathology. And yeah, that's gone in a lot of, I think, exciting and interesting directions. And I'm really glad that you found the website helpful.
Something that we're working toward, right, is kind of having a formal scientific society, you know, associated with HITOP, right? It's been kind of an informal grassroots consortium up to this point. But something that I'm very interested in trying to organize, right, is turn into like, you know, a society, right?
In the sense that there'd be annual meetings, and people would come to the meetings and present their research. And kind of, you know, the usual functions of scientific societies, but oriented around these kinds of empirical alternatives to classical psychiatric categories. So HITOP is meant to be a big tent, right?
There's a clinical network that's associated with HITOP that I think is a pretty exciting aspect of it, right? So really trying to work hard to bridge that kind of research clinical divide that, you know, unfortunately persists in a lot of the field. So lots of ways to get involved in HITOP, right?
And kind of, if you find the ideas interesting, ways to connect with the consortium, connect with colleagues around these kinds of things. So I'm glad you brought it up. Like I think it's been a lot of fun in the intellectual sense, right?
Like it's been great to see, and you know, like rewarding, right, to see the level of interest in, well, I mean, taking this more evidence-based perspective to psychopathology, right? And moving away from just diagnosis by tradition and being kind of stuck with the categories because they were handed down, you know, through history, right? And sort of working towards something that's more evidence-based and newer.
So I found it exciting and fun, right, to be involved with HITOM.
Yeah, and for those who are unfamiliar, and again, I'll link the website. That was sort of my experience of spending a bit of time on the website is you have these experts, researchers and clinicians from all over the globe who, this is an outsider, this is my perception, who sort of got together and were like, hey, let's sort of create a little group, which isn't too little, but that really is going to work together, separately and together, to try to understand or better understand empirically to an extent what mental health, mental disorder, psychiatric disorder, mental health challenge, what that is. And let's, you know, we have people with, you know, obviously different people with different data sets, different people with different analytic skill sets, different people with different perspectives, to try to move us in a direction.
And there's all these wonderful resources, really, it can be a little overwhelming because there's so much, but, you know, freely available documents, things that I think would be like white papers. I don't really understand exactly what a white paper is, but I think white papers. With useful visualizations of how you can think about sort of mental disorders.
I don't even know what the word would be to describe it, but it sort of seems like, oh, this is how research is supposed to work.
Yeah.
Well, it's a community of scholars who are pushing each other and I don't know, my experience of it is an outsider.
No, I think that's what I was alluding to, right? Like why it's been fun and interesting for me is watching people get interested in engaging with each other and it's been, you know, a productive and impactful, you know, set of efforts, right? So that's nice, right?
Like I think that's great, right? Because you can get kind of like stuck with the traditional things and feel a bit hopeless about anything ever changing, right? But that is not the vibe that, you know, is going on with HiveTop, right?
There's an interest in moving in a newer direction. And I would emphasize in that respect that the generativity aspects of it are really critical, right? So the most, you know, sort of gratifying thing for somebody like me at a later point in their career, right, is that young people are interested in it.
Younger in the sense of being earlier in their training, right, for example, right? So people who are just entering the discipline, who are in training and this kind of thing, have shown a lot of enthusiasm, you know, for doing something new. And it's great to pick up on that, you know, sort of spirit, right?
And for somebody like me who's been doing this for some decades now, right, to try to be generative, right, to try to foster a new generation of scholars who can, well, I mean, the goal of all of this, of course, right, is to come up with something that's closer to reality because that presumably is going to position us to better help patients. So that's obviously the ultimate goal of any endeavor like this, right? Can we come up with something that's going to be, you know, evidence-based and therefore more effective in trying to ameliorate, you know, the notable public health problem that is mental disorder in contemporary societies, right?
So what pushback have you and your colleagues gotten for your work?
You mean high tops specifically?
No, well, it could be, but I was thinking more about the Alternative Model of Personality Disorders. But I think, I mean, to an extent, it kind of all comes together, right?
Yeah, no, there's a certain sense in which these things that I get entangled in, right, are counter-cultural. I mean, that's a strong word, like running counter to tradition. That's fair to say, right, that these are not things that are tethered to traditional conceptualizations, right?
So my, you know, sort of work through the years has not taken the focus of like, well, I'm going to be an expert in this particular and specific categorical disorder, right? And I'm going to know everything that I can about that categorical disorder and publish on that disorder and become the world's expert in that disorder, right? That's never been a thing that I've done.
So, yeah, I think that a lot of the, you know, sort of pushback to the perspective that I and others take that's more dimensional and multi-dimensional, right, instead of being focused on a specific category is that it's sometimes harder for people to parse because for whatever reason, they're attached to some specific categorical concept.
Right, people who have spent a career studying antisocial personality disorder or whatever, they don't want that category to go away.
Well, yeah, and that's not invariantly true, right? There are people who have created a notable body of work surrounding some concept like that, but still are interested in the dimensional and multidimensional perspective. So there are some people who kind of react like that for sure, right?
Because they see how the thing that they've been interested in kind of fits with the bigger picture. But, you know, there are also people who see this as running counter to what's important to them, right, for various reasons.
If the kind of thing that we're doing with AMPD or HITOP ends up in deconstructing, if you will, or diminishing the importance of a category label, I can see how people who are very attached to those labels might see that as a threat or a problem, right? Something that they need to, you know, react against, because then it's a problem for them in terms of, well, what are you doing if you're setting a potentially fictive category, right? Like, I can see that.
And so, yeah, you asked about pushback. Well, like, sometimes it has that kind of flavor, right?
So for folks who want to learn more, what would be one or two resources that you would point them to and things that I can include in the show notes?
With reference to HITOP, it would be the website, I think, is a great place to start, because that points to some of the academic papers and things and, you know, points to ways to get involved, points to the clinical network. I think that's a great place to start. You know, with the AMPV specifically, right, with the PID-5, there's the manual that we just published, right, that might be helpful to people if they're interested in using that instrument.
There's also a practitioner's guide to the AMPV that Guilford is about to publish. I think we just signed off on the page proofs. So this is a book that I worked on along with colleagues.
Bobach, you know, led the effort, and Chris Hopwood and Eric Simonson are also authors of this book. So, right, if you want to, if you're interested in the AMPV in terms of like how to use it clinically, that was the point of us writing that book, right? So we have this book coming out from Guilford.
I think it's called The Practitioner's Guide to the AMPV, as I recall. That's the title. So that should be out, you know, sometime this year.
Right, so those are some recent things that I've been involved in that people might find interesting. And of course, there's this, you know, sort of scholarly literature too, but I'm thinking of those things because they're closer to clinical application, you know. Mm-hmm.
And so here's a, I didn't prep you for this, so this might be a follow-up, but if I were teaching a class, so I'm not teaching a psychopathology class, but I'm sure that some people who are listening to this will be, that if you were to say like, and they wanted to include a reading or two, is there a particular chapter, book, reference that you would point them to?
Yeah, these literatures aren't small, right? There's lots of high-top publications and there's lots of AMPD publications. So it's kind of a hard question to answer in the sense of like one or two articles, right?
Right.
Well, so I do teach Psychopathology, right? That's the class that I teach every year. So one thing I could say, if there are folks like this listening, like you can find me on the UMN website.
I'm happy to share my syllabus, which ends up to be kind of a high-top oriented Psychopathology class because what else am I going to do since I'm teaching it? So it has a little bit of the flavor of my kind of work, right? But so I've thought about it in terms of like whole syllabus.
It's a little harder to say like if you had to pick one paper, right? Like here's the one because there's, you know, well, you know, this is how this works, right? We're supposed to keep publishing things all the time, right?
So like there's this proliferation of literature. So it's a little hard to say like, okay, that's the one, right? But yeah, I'm happy to correspond with people about this kind of question, right?
Like, you know, I want to teach about this stuff. I want to learn about this stuff. You know, where can I start?
I'm happy to share my syllabus too, right, for psychopathology.
That's great. Well, I really appreciate this conversation.
Yeah.
Yeah. So ladies and gentlemen, Dr. Robert Krueger.
That's a wrap on part two of my conversation with Dr. Robert Krueger and a wrap on season one of the show. Please reach out by sending a text or leaving a voice message using the links in the show notes. And as I said in the intro, we'll be back with new episodes in a few weeks.
So until next time.