The alternative model for personality disorders include two-dimensional criteria: self and interpersonal dysfunction (Criterion A) and maladaptive personality traits (Criterion B). Criterion A is appraised using the Levels of Personality Functioning Scale (LPFS). Personality disorder-specific impairments are also described. This scoping review and meta-analysis evaluates the criterion validity of self-report and observer-rated LPFS measures, and two antisocial personality disorder (ASPD)-specific measures, in assessing Criterion A for ASPD, psychopathy, antisocial behavior, and aggression. Six databases (CINAHL, EMBASE, EMCare, MEDLINE, PsycINFO, and PubMed) were searched for studies assessing Criterion A and ASPD, aggression, antisocial behavior, and/or psychopathy. Thirty-two studies were identified. Meta-analysis revealed strong pooled associations between self-report and clinician-rated LPFS measures and Section II ASPD. Effects with psychopathy for self-report LPFS measures were moderate and weak for clinician-rated LPFS. Weak to moderate pooled effects for LPFS with aggression and antisocial behavior were found. ASPD-specific impairments showed moderate associations with Section II ASPD and large associations for psychopathy. Overall, general and ASPD-specific measures demonstrated variable criterion validity with Section II ASPD and associated antisocial constructs. Caution is warranted when assessing Criterion A impairment for antisociality using a single measure in isolation. A clinician-led, multimethod approach that integrates general LPFS-based assessment with instruments specifically designed to capture antisocial features is likely to (a) enhance diagnostic accuracy and (b) improve the clinical utility of Criterion A assessment in informing violence risk formulation and management. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Akoka et al. (2026) studied this question.