The DSM-5 alternative model for personality disorders and psychotic symptoms: A two-sample study in help-seeking adolescents

Background and hypothesis While the link between positive psychotic symptoms (PPS) and categorical personality disorder (PD) is well established, it remains unclear if it extends to the dimensional PD approach. This study examined whether PPS are associated with (1) personality functioning impairment (PFI) and (2) maladaptive personality traits (MPT) as defined by the DSM-5 Alternative Model for Personality Disorders (AMPD), controlling for concurrent psychiatric diagnoses, in two distinct clinical adolescent samples. Study design Adolescents aged 12–17 years were recruited from a specialized outpatient clinic for early PD intervention ( N = 432; “at-risk for PD sample”) and general inpatient units ( N = 317; “general psychiatric sample”). PFI and MPTs were assessed using the STiP-5.1 and the PID-5-BF. PPS were measured with the PQ-B and the SCID-5 hallucination and delusion items. Multiple and nested linear regression models tested whether PFI and MPTs explained variance in PPS beyond concurrent psychiatric diagnoses. Study results PFI was positively associated with PSS and explained variance beyond psychiatric diagnoses in both samples. In the general psychiatric sample, in which hallucinations and delusions were analyzed separately, PFI was associated with both symptom domains. Adding MPTs significantly improved the explanation of PPS variance in both samples, diminishing the unique contribution of PFI. Conclusions The findings extend the PD-PPS link to the dimensional AMPD framework, with both PFI and MPTs showing positive associations with PPS beyond psychiatric diagnoses. Longitudinal research is needed to examine whether improvements in PFI and MPTs lead to a reduction of PPS over time.