Personality pathology in youth: A comparison of the categorical and alternative model in relation to internalizing and externalizing pathology and age-adequate psychosocial functioning

Youth with personality pathology are at a greater risk of developing broader psychopathology and experiencing poorer life outcomes in general. Therefore, detecting personality problems, specifically features of borderline personality disorder (BPD), provides opportunities for early intervention. In this study, we investigated the incremental value of Criteria A and B of the alternative model for personality disorders (AMPD) compared to a BPD symptom count based on the Diagnostic and Statistical Manual of Mental Disorders, fifth edition Section II personality disorder model in broader psychopathology (i.e., internalizing and externalizing symptoms) and age-adequate psychosocial functioning (i.e., attainment of developmental milestones). In a clinical sample of 246 young people (Mage = 19.22, SD = 2.76, 81.7% female), separate path analyses showed that a BPD symptom count, Criterion A, and Criterion B were all relatively strongly related to the outcome measures. In a combined path model, the AMPD and especially Criterion B explained additional variance in internalizing and externalizing pathology and age-adequate psychosocial functioning. The current results underscore the value of the AMPD for the early detection of negative psychopathological and psychosocial outcomes commonly associated with BPD.