International Journal of Testing, 17: 141–157, 2017

Copyright Ó International Test Commission

ISSN: 1530-5058 print / 1532-7574 online
DOI: 10.1080/15305058.2017.1279164

Conceptualizations of Personality Disorders

with the Five Factor Model-count and
Empathy Traits
Petri J. Kajonius
Department of Social and Behavioral Studies, University West, Sweden,
Department of Psychology, University of Gothenburg, Sweden, and Department
of Cognitive Neuroscience, University of Sk€
ovde, Sweden

Anna M. Daderman
Department of Social and Behavioral Studies, University West, Sweden

Previous research has long advocated that emotional and behavioral disorders are
related to general personality traits, such as the Five Factor Model (FFM). The addition
of section III in the latest Diagnostic and Statistical Manual of Mental Disorders
(DSM) recommends that extremity in personality traits together with maladaptive
interpersonal functioning, such as lack of empathy, are used for identifying
psychopathology and particularly personality disorders (PD). The objective of the
present study was to measure dispositions for DSM categories based on normal
personality continuums, and to conceptualize these with empathy traits. We used a
validated FFM-count method based on the five personality factors (neuroticism,
extraversion, openness, agreeableness, and conscientiousness), and related these to 4
empathy traits (emphatic concern, perspective-taking, fantasy, and personal distress).
The results showed that FFM-based PD scores overall could be conceptualized using
only two of the empathy traits, low emphatic concern and high personal distress.
Further, specific dispositions for personality disorders were characterized with distinct
empathy traits (e.g., histrionic with high fantasy, and paranoid with low perspective-
taking). These findings may have both theoretical and practical implications in
capturing potential for personality disorders with ease and efficiency.

Keywords: empathy, FFM, personality disorders, personality traits

We are grateful to the participants for volunteering their time and effort to complete the question-
naire required for the investigation; and the motivated students for help with distribution of question-
naires. Partial results from this study were presented at the 2nd World Conference on Personality,
March 31 to April 4, 2016, Buzios, Brazil.
Correspondence should be sent to Petri J. Kajonius, University West, S-461 32 Trollh€attan,
Sweden. E-mail: [Link]@[Link]
Color versions of one or more of the figures in the article can be found online at [Link]/hijt.
 
142 KAJONIUS AND DADERMAN

The quest to categorize, conceptualize, and measure personality-related disor-

ders (PDs) is one of the important tasks overarching the future of psychiatric
nosology. This is particularly central, since more than 10% of the Western popu-
lation is estimated to suffer from emotional and behavioral disorders in the form
of one or more of the 10 classic PD categories (Widiger, 2012). Psychological
and clinical research has provided ample indications that general personality
traits constitute a valid theoretical and empirical foundation for psychopathology
(e.g., Glover, Crego, & Widiger, 2012). One such indicator is that extreme var-
iants of personality traits are more common in the psychiatric population
  
(Daderman, 1999; Daderman, & Edman, 2001; Daderman, & Kristiansson,
2004). The personality trait model incorporated in the latest Diagnostic and Sta-
tistical Manual of Mental Disorders (DSM-5); American Psychiatric Associa-
tion [APA], 2013) is based on the emerging consensus on a five factor-structure
for personality traits. Using personality traits as criteria for psychopathology is
not new, such as the Personality Psychopathology Five (PSY-5) model (see
Harkness, Finn, McNulty, & Shields, 2012). Several recent models, such as the
NEO Personality Inventory (NEO-PI3), Personality Inventory for DSM-5 (PID-
5), and Computerized Adaptive Test of Personality Disorders (CAT-PD) have
shown promising predictive validity on particularly interpersonal complications
(Williams & Simms, 2016).
The DSM-5 describes personality-based disorders as a common form of psy-
chopathology in terms of extreme personality traits together with impairments in
interpersonal functioning. We are currently seeing a large body of empirical
studies testing the usefulness of personality traits in measuring psychopathology
(e.g., Miller et al., 2008), which attempts to further clarify in what constitutes
the presence of psychopathological disorders. One such important marker is
interpersonal functioning in terms of empathy, as described in the DSM-5 (APA,
2013). The clinical research field is rapidly moving toward dimensional trait
thinking, in contrast to typological categories, but has not yet fully developed
the role of empathy in personality dysfunction. Thus, in this study, we highlight
the use of a Five Factor Model (FFM)-count method for disorder scores (Miller,
Bagby, Pilkonis, Reynolds, & Lynam, 2005), and we also attempt to conceptual-
ize disorder levels in relation to everyday functioning in terms of interpersonal
empathy dimensions (cf. Southard, Noser, Pollock, Mercer, & Zeigler-Hill,
2015).

Identifying Personality Disorders with Personality Traits

The DSM-5 suggests that there are 10 categories of personality-based disorders,
which can be further divided into three clusters with different characteristics: the
eccentric, erratic (antagonistic), and anxious clusters (APA, 2013). These have
typically been identified by using prototypical criteria and extracted by clinical
 CONCEPTUALIZATIONS OF PERSONALITY DISORDERS 143

interviews. However, a host of problems have been implicated with this tradi-
tional way of identifying psychopathology, such as the atheoretical foundation
and comorbid and heterogeneous diagnoses, which implicate inefficient theory
and practice (see the review by Krueger & Markon, 2014).
An alternative to the traditional way of identifying and classifying PDs was
among others suggested by Costa and McCrae (1990). They posited that extreme
levels of the personality traits from their Five Factor Model (FFM)—neuroti-
cism, extraversion, openness, agreeableness, and conscientiousness—could con-
stitute the foundation for PD. Subsequent research suggests that personality
traits are intimately connected to all sorts of emotional and behavioral disorders
and that the FFM indeed can successfully identify disorder categories (Saulsman
& Page, 2004; Butrus & Witenberg, 2015). Diagnoses based on the FFM have
shown high corrected inter-correlations with clinicians’ ratings up to r D 0.80
(Lynam & Widiger, 2001). The FFM has furthermore been demonstrated to
work both with self and informant reports (Lawton, Shields, & Oltmanns, 2011).
The FFM has also shown improvement over the traditional ways of diagnosing,
demonstrating up to twice the explained variance in clinical psychopathy scales
(Few, Lynam, Maples, MacKillop, & Miller, 2015). Although not perfect, the
FFM and PD categories are shown to share a substantial overlap (77%) (Hen-
gartner et al., 2014).
The new section III in DSM-5 assumes that disorders measure on a trait-con-
tinuum, ranging from healthy to severely pathological, and that diagnosis is
needed when interpersonal relations become maladaptive (see Section III, APA,
2013). Previous research has shown that valid knowledge concerning the struc-
ture of psychopathology can be extracted also from the general healthy popula-
tion (e.g., a large Danish sample in Bo, Bach, Mortensen, & Simonsen, 2015; or
a Swedish sample in Kajonius, Persson, & Jonasson, 2015). The present study
aligns with the notion that personality traits constitute a renewed paradigm in
terms of more valid diagnoses for both researchers and clinicians.

The Relevance of Empathic Traits

Empathy has been conceived as one of the most important measurements of
everyday functioning due to its entailing of moral schemas revealed in social
interactions (i.e., how we treat and approach each other) (Myyrya, Juuj€arvi, &
Pesso, 2010). Empathy has for instance demonstrated links to several maladap-
tive dispositions such as narcissism and criminal offending (Hepper, Hart,
Meek, Cisek, & Sedikides, 2014). A popular way to think about empathy is
describe the phenomena of coming to feel the affective experience of another
upon perception of the person’s situation. Empathy is often conceived as a multi-
dimensional trait (Davis, 1983), composed of empathic concern (EC; i.e., the
tendency to experience feelings of warmth and concern for others), perspective-
 
144 KAJONIUS AND DADERMAN

taking (PT; i.e., the tendency to see things from other people’s point of views),
fantasy (FS; i.e., the disposition to identify with others’ feelings and actions in
fictional situations), personal distress (PD; i.e., anxiety and discomfort while wit-
nessing other’s negative experiences). It may be worth considering whether the
personal distress subscale reflects true “empathic” distress or how much is just a
general tendency to experience negative affect in general. Also, empathic con-
cern possibly measures the general tendency to experience low distress and high
positive affect for others.
Nevertheless, Section III in the DSM-5 suggests empathy as a criterion for mal-
adaptive functioning. A key point in our study was to assess empathy as a multidi-
mensional trait, examined in association with the proposed trait-paradigm. Using
continuous scales as opposed to categorical scales is known to improve accuracy, by
increasing reliability (15%) and validity (37%) (see meta-analysis by Markon,
Chmielewski, & Miller, 2011). Further, failure to assess the multidimensional nature
of empathy may create a lack of nuance in what constitutes emotional and behavioral
disorders. If these can be measured by dimensional FFM traits (cf. Krueger & Mar-
kon, 2014), and if these are related to empathy traits, then these should be clearly
related, which is what the current study will put to the test.

The Present Study

This study attempted to extend current knowledge on emotional and behavioral
disorders, based on personality traits and empathy. The aim of the present study
was to investigate associations between Five Factor model–based levels of disor-
ders and empathy traits. These links could lend important insight into the con-
ceptualization and what may constitute a potential personality disorder. In
addition, the study contributes to research in psychopathology across different
populations and cultures (Samuel, A nez, Paris, & Grilo, 2014).

METHOD

Participants
The medium-sized sample consisted of N D 284 Swedish participants from a
community (pop. 50,000). A majority were women 69%, and ranged in age from
18 to 50 years (M D 26.5, SD D 7.0). The sample-size was deemed sufficient
and beyond the suggested “point of stability” (N D 250), where correlations are
shown to stabilize around the true values (Sch€onbrodt & Perugini, 2013). The
survey was conducted for two weeks during April 2015. The requests were dis-
tributed personally. No payment was offered, but the high response rate (90%)
by volunteers may have been due to the personal approach. The estimated aver-
age time for filling out the rather comprehensive questionnaire was
 CONCEPTUALIZATIONS OF PERSONALITY DISORDERS 145

approximately 20 minutes. The survey method may have induced some selection
bias in the sample and calls the representativeness of the sample into question.
For instance, more empathic people may have agreed to do the questionnaire.
We thus compared the present sample characteristics with a neighboring country
Finnish study of N D 599 (74% women with an average age of 23.9) (Myyrya
et al., 2010). The comparison showed a similar level of empathic concern (t
(517) D 1.82, p D 0.07). Although the sample was constituted by people from
various walks of life as in a typical social network, some students, and most in
working life (Mage D 26.5), the sample cannot be said to be a representative
community sample. However, the purpose of the present study was not primarily
to describe a community sample, but rather test the link between FFM PD and
empathy traits. Only English versions of all instruments were used due to the
pronounced knowledge of English among Swedes in the present age-span, thus
enabling comparisons with other international studies. The questionnaire data
were anonymous and volunteered.

Instruments

IPIP-NEO-120. The Five Factor model (FFM) was assessed with the Interna-
tional Personality Item Pool (IPIP), and the scale IPIP-NEO-120 (Johnson, 2014).
This consists of 120 items yielding 5 factors, which further are divided into 30 fac-
ets, which also is an open-source representation of the well-established factor-struc-
ture (Costa & McCrae, 1990). The average convergent validity of IPIP-120 with the
original NEO-PI-R facets, after correction for unreliability, was 0.94 (Johnson,
2014). The IPIP-120 items were answered on a 0–4 scale (“Do not agree at all” to
“Do agree very well”). In the present study, the factor internal consistencies (alpha-
coefficients) were high (Neuroticism, a D 0.87, Extraversion, a D 0.87, Openness,
a D 0.77, Agreeableness, a D 0.81, and Conscientiousness, a D 0.87).

IRI. Empathy was assessed by one of the most frequently used instruments,
the Interpersonal Reactivity Index (IRI) (Davis, 1983). The scale consists of four
traits: empathic concern (EC, a D 0.76), perspective-taking (PT, a D 0.65), fan-
tasy (FS, a D 0.80), and personal distress (Pd, a D 0.65); each trait constituted
by 7 items, totaling 28 items. The scale ranges from 0 (“Does not describe me
well”) to 4 (“Describes me very well”).

FFM PD. Basing PDs on FFM scores was formalized by Miller et al.
(2008), who proposed formulas for summing together relevant facets from the
FFM for each disorder category. The method is called the FFM-count method,
which is based on expert prototypes and empirical reviews (Lynam & Widiger,
2001). Each category has a distinct set of FFM facets; for example, dependent
 
146 KAJONIUS AND DADERMAN

PD is the sum of N1 (anxiety) C N4 (self-consciousness) C N6 (vulnerability) C

E3r (assertiveness, reversed) C A1 (trust) C A4 (cooperation) C A5 (modesty).
(See supplementary material for all the formulas used.) Scale consistencies
ranged from low a D 0.50 (narcissistic) to sufficiently high 0.79 (borderline).
The skewness and kurtosis values indicated that the scores were normally dis-
tributed, which was expected when based on dimensional FFM traits. A sum-
mary of all FFM-based PD categories are found in Table 1. Subsequent
corroborations of this FFM-count method have been fruitful (e.g., Decuyper, De
Clercq, De Bolle, & De Fruyt, 2009), and more studies such as the present are
needed.

RESULTS

The descriptive statistics of the 10 DSM categories are summarized in Table 1.

The present sample was average in scores on paranoid and schizoid scores,
when compared to a normative US sample (N D 1000) (Bornstein, 2012), while
lower in antisocial scores, and higher in histrionic, dependent, and obsessive-
compulsive scores. These discrepancies are likely to be explained by the over-
representation of women (69%) in the present sample, and not culture (Widiger,
2012; Widiger & Costa, 2013).

Empathy and Personality Disorders

The main objective was to investigate PD categories and how they can be con-
ceptualized with empathy traits. Overall, according to Table 1, empathic con-
cern was negatively related to PD (i.e., the lower the concern, the higher the
PD), and personal distress positively to PD (i.e., the higher the distress, the
higher the PD). Further, perspective-taking was only minimally negatively to
PD; and fantasy only weakly positively to PD. The broad increasing and decreas-
ing patterns for each empathy trait related to the specific PDs aligning with these
trends are graphically shown in Figure 1.
To further analyze how empathy can contribute to the conceptualization of
personality-based disorders, we ran multiple linear regression models, one for
each category regressed on the four empathic traits concurrently, thus controlling
for within-taxonomy variance. The explained variances by empathy were gener-
ally large, between 30% and 40% with narcissistic (NAR), dependent (DEP),
paranoid (PAR), and borderline (BPD), in ascending order. Only obsessive-com-
pulsive (OCD) was minimally accounted for by empathy (< 10%). The first
empathy trait, empathic concern (EC), predicted the majority of disorders nega-
tively (with the notable exceptions for histrionic (HST) and DEP. In other words,
the higher the empathy (concern) level, the lower the disorder scores. Also, the
 TABLE 1
Descriptive Statistics of Personality Disorder (PD) Categories Related to Four Empathy Traits

Personality Disorders M SD a S K r(b) EC r(b) PT r(b) FS r(b) Pd R2

Paranoid (PAR) 10.60 3.23 0.71 0.06 ¡0.21 ¡0.51*** (¡0.55***) ¡0.23*** (¡0.11*) ¡0.10* (0.06) 0.23*** (0.30***) 0.39
Schizoid (SZD) 13.52 4.00 0.77 0.29 ¡0.08 ¡0.32*** (¡0.33***) ¡0.12* (¡0.01) ¡0.13* (¡0.09) 0.24*** (0.34***) 0.21
Schizotypal (SCT) 13.95 4.25 0.71 0.55 ¡0.15 ¡0.10 (¡0.24***) 0.06 (0.13*) 0.15** (0.09*) 0.35*** (0.38***) 0.19
Antisocial (ASD) 12.39 2.23 0.55 ¡0.02 ¡0.11 ¡0.33*** (¡0.41***) ¡0.14* (¡0.03) ¡0.06 (0.08) 0.03 (¡0.00) 0.16
Borderline (BPD) 11.63 3.81 0.79 0.18 0.31 ¡0.07 (¡0.25***) ¡0.03 (¡0.03) 0.30*** (0.29***) 0.50*** (0.50***) 0.39
Histrionic (HST) 17.16 2.84 0.58 0.15 0.36 0.35*** (0.25***) 0.15** (0.04) 0.30*** (0.23***) 0.00 (¡0.10) 0.16
Narcissistic (NAR) 11.77 2.37 0.50 0.17 0.12 ¡0.54*** (¡0.59***) ¡0.18*** (¡0.01) ¡0.16** (0.05) ¡0.07 (¡0.01) 0.34
Avoidant (AVD) 14.47 3.44 0.69 0.21 0.00 ¡0.06 (¡0.09) ¡0.06 (¡0.04) 0.06 (¡0.00) 0.43*** (0.48***) 0.23
Dependent (DEP) 16.77 3.47 0.54 0.18 ¡0.15 0.23*** (0.16**) 0.03 (¡0.03) 0.20** (0.04) 0.53*** (0.55***) 0.36
Obsessive (OCD) 17.36 2.56 0.56 ¡0.29 0.03 ¡0.08 (0.11) ¡0.13* (¡0.17**) ¡0.19** (¡0.16*) ¡0.20** (¡0.18**) 0.09
1a. FFM PD ¡0.19** (¡0.24***) ¡0.01 (¡0.02) 0.02 (0.01) 0.39*** (0.45***) 0.24
2a. Internalizing PDs ¡0.01 (¡0.12*) ¡0.00 (0.01) 0.17** (0.09) 0.51*** (0.54***) 0.31
2b. Externalizing PDs ¡0.44*** (¡0.55***) ¡0.16** (¡0.05) 0.01 (0.18***) 0.13* (0.16**) 0.30
3a. Detached PDs ¡0.39*** (¡0.38***) ¡0.14* (¡0.01) ¡0.17** (¡0.10) 0.18** (0.28***) 0.22
3b. Neurotic PDs 0.27*** (0.17***) 0.09 (0.01) 0.29*** (0.12*) 0.52*** (0.51***) 0.37
3c. Antagonistic PDs ¡0.33*** (¡0.47***) ¡0.14* (¡0.07) 0.13* (0.26***) 0.25*** (0.26***) 0.28

Note. Numbers 1a–3c corresponds to the latent higher order variables (see Figure 3). S D skewness, K D kurtosis. EC D empathic concern, PT D perspec-
tive-taking, FS D fantasy, Pd D personal distress.
*p < 0.05, **p < 0.01 ***p < 0.001 (2-tailed).
CONCEPTUALIZATIONS OF PERSONALITY DISORDERS
147
 
148 KAJONIUS AND DADERMAN

FIGURE 1
The personality disorders (PD) that increase or decrease with the four empathic traits. The
figures show the original empathy traits (scaled 0–4) and corresponding mean PD scores
(0–32); one graph for each trait (EC, PT, FS, and Pd).

empathic trait, personal distress (Pd) overall predicted disorders positively. In

other words, higher levels of empathy (Pd) were associated with higher scores of
disorders. The other empathic traits, PT, furthermore showed no or very weak
predictive relationships with the disorders, and FS only related to BPD and HST.
The specific associations with the two most impacting empathy traits, EC and
Pd, are visually conceptualized in Figure 2, where disorder categories overall
clearly align with increasing Pd and decreasing EC.
In order to further conceptualize PD with empathy, we generated higher-
order variables by using Goldberg’s (2006) “bass-ackwards” approach. This
is different from the bottom-up methods of exploring cluster analysis or con-
firmatory factor analysis with set structures. The bass-ackwards method
allows for a top-down structure with path coefficients. This is done by work-
ing out a hierarchical factor structure level by level, with recommended prin-
cipal component analysis, starting with extracting one fixed component, then
two fixed components, and then three fixed components, and so on correlating
the components between levels (see Figure 3). In the end, we opted for
exploratory factor analysis with oblique (oblimin) rotation, due to the known
comorbidity between factors. We then related the retained variables from
three hierarchical levels with empathy traits (bottom section of Table 1). The
purpose of this exercise was to further flesh out higher-order relations
between personality disorder potential and empathic traits. Indirectly, this
would simultaneously check the structural validity of the FFM measurement
in the sample. The higher-order factors retrieved from the factor analyses
 CONCEPTUALIZATIONS OF PERSONALITY DISORDERS 149

FIGURE 2
Personality disorders (PDs) and their zero-order correlations with empathic concern (EC) and
personal distress (Pd). The gray line is a visualization of how the majority of the DSM catego-
ries (excluding outliers) can be conceptualized by low EC and high Pd. 1 D Paranoid (PAR), 2
D Schizoid (SZD), 3 D Schizotypal (SCT), 4 D Antisocial (APD), 5 D Borderline (BPD),
6 D Histrionic (HST), 7 D Narcissistic (NAR), 8 D Avoidant (AVD), 9 D Dependent (DEP), 10
D Obsessive-compulsive disorder (OCD). (See Appendix for 11 D Depressive PD and 12 D
Psychopathic PD).

aligned well with previously known higher-order organization such as inter-

nalizing and externalizing (cf. Uliaszek, Al-Dajani, & Bagby, 2015).
As seen in Table 1, the highest-order FFM Psychopathology-factor (1) was
overall negatively related to EC and positively to Pd. Interestingly, on the next
level of order (2), internalizing PDs were mostly characterized by Pd, while
externalizing PDs mostly by low EC. On the third level (3), the detached cluster
(3a) (PAR, SZD, SCT) furthermore was characterized primarily by low EC, the
neurotic cluster (3b) (AVD, DEP) primarily by high Pd, while the antagonistic
cluster (3c) (ASD, BPD, HST, NAR) primarily by low EC, high Pd, as well as
FS. Note that PT overall did not contribute much to the higher-order disorders.
The conclusion is that higher-order disorders as well as the FFM PD categories
align with increasing personal distress and decreasing empathic concern, and
that empathic fantasy occasionally plays a part in psychopathology.

DISCUSSION

The present study was an attempt to increment conceptualization of the 10 classic

DSM personality-based categories. We related PD categories to normal personality
and empathy traits on a continuum (and not by the old paradigm with symptoms
 
150 KAJONIUS AND DADERMAN

FIGURE 3
Structural hierarchy of the 10 DSM personality disorders and correlations with higher order
factors, based on the FFM-count method. PAR D Paranoid, SZD D Schizoid, SCT D Schizo-
typal, APD D Antisocial, BPD D Borderline, HST D Histrionic, NAR D Narcissistic, AVD D
Avoidant, DEP D Dependent, OCD D Obsessive-compulsive disorder.

forming typologies). Dimensional models of personality psychopathology instead of

categorical have the advantage that research can be carried out also in nonclinical
samples. The main result was the clear associations between FFM-based disorder
levels and empathy traits. First, the results demonstrate that emotional and behav-
ioral disorders can be calculated based on the FFM personality traits, showing rea-
sonable consistency in terms of reliability and validity. Second, the results suggest
that empathy overall may be a key aspect of psychopathology and that both specific
and higher-order disorders can be characterized and distinguished by specific
empathic traits (for instance, the addition of the empathy dimensions fantasy can
predict externalizing and erratic (antagonistic), such as histrionic behaviors. Third,
empathic concern and personal distress specifically stood out as the empathy com-
ponents being particularly related to all levels of FFM PD (cf. Figure 2). The trait
 CONCEPTUALIZATIONS OF PERSONALITY DISORDERS 151

paradigm as suggested by researchers and by DSM-5 shows promise in measuring

potential behavioral disturbance levels in the community.
The endeavor of validating and conceptualizing psychopathology with
adjacent constructs has been performed before, with the concepts of unco-
operativeness and self-directedness (Gutierrez et al., 2008). These con-
structs may have conceptual overlaps with the present study: empathic
concern with uncooperativeness and personal distress with self-directed-
ness. Moreover, both these empathy dimensions (empathic concern and
personal distress) are considered to belong to the affective side of empathy
(Persson & Kajonius, 2016), in contrast to perspective-taking and fantasy
as belonging to the cognitive side of empathy. It has been suggested that
cognitive and emotional traits operate differently, for example regarding
moral values (Grankvist & Kajonius, 2015). The conceptualization in the
present study implies that emotional deficiency may be the more important
part.
On a note for societal relevance, several large-sample studies have
recently shown that particularly the affective side of empathy is in decline
in the overall population (with decreasing empathic concern and increasing
personal distress) (Twenge, 2000; Konrath, O’Brien, & Hsing, 2011;
Twenge, Campbell, & Freeman, 2012). The present study suggests this trend
could also be an indicator of a general mental health decline. Empathic defi-
ciency has been shown to characterize for instance psychopathic disorder
with increases in callousness (e.g., Forth & Flight, 2007). To further confirm
this line of reasoning, participants from the community that are identified
with a diagnosis should also be tested with the current instruments—FFM-
count and empathy.
The practical aspects of the present study may have implications on the
possibility of finding personality disorders at large in the community, seeing
how mounting evidence shows that normal personality traits on a continuum
are precursors to manifest emotional problems (e.g., Hengartner et al.,
2014). With this present study we have shown a way to test for prevalence
of disorder potential; empathy testing is a practical and publically available
instrument for practitioners in all walks of life, such as for instance in
teacher relationships or school counselors (cf. Crum, Waschbusch, & Wil-
loughby, 2016). It has for instance been postulated that a proportion of the
common population shows correlates of psychopathy (Lilienfeld, Latzman,
Watts, Smith, & Dutton, 2014), which would be useful for the community
to intercept. The links between disorder scores and empathy found in the
present community sample has been shown in psychiatric samples, using the
same measurement of empathy (IRI) (Forth & Flight, 2007). The advantage
of the FFM-count method may be the ease and efficiency with which PD
candidates can be screened, before proceeding with more clinical
 
152 KAJONIUS AND DADERMAN

instruments. An encouraging scenario would be that the common FFM trait

paradigm provides not only conceptual advancement, but also practical
opportunities.

Limitations
Among the limitations in the present study was the potential failure with
obsessive-compulsive disorder, which was an outlier as seen in Figures 2
and 3, and which was the least explained by empathy (Table 1). However,
this is regularly shown to be the case due to the predictively weak FFM
openness trait (Widiger, 2012), which contributes a whole four facets (16
items) to obsessive-compulsive in the FFM-count method (see Appendix).
The other potential outlier, histrionic disorder (Figure 2) can be explained
similarly with the weak performance of the openness trait (Suzuki, Samuel,
Pahlen, & Krueger, 2015).
Among the limitations was that the prevalence of participants actually having
a diagnosis was likely very limited (e.g., 10% as suggested by Widiger, 2012),
which somewhat restricts further conclusions on the usefulness of the FFM count
method. Additionally, the sample might not be fully representative of the pro-
posed community, even though the comparison norms with previous Finnish and
US samples were positive. Also, an overrepresentation of women (69%) implies
slightly higher FFM agreeableness and consequently likely higher empathy
scores than average.
From a statistical standpoint, the present study needs replication. Seeing
the sample size and number of correlations in Table 1, several significant
relationships could have arisen simply due to chance. Also, the present
study was limited by using only one data source, self-reporting, which may
inflate method variance. Lacking external validations, this encourages future
studies on the topic. The uncontrolled initial levels and shared variance
between FFM agreeableness and empathic concern might further confound
the relationship between disorders and empathy somewhat (see Vachon,
Lynam, & Johnson, 2014). Similarly, it is unclear to what extent the IRI-
empathy measurement covers facets of empathy, and to what extent it is
confounded by, for instance, neuroticism. Ultimately, the present study not
only relates overall empathy to emotional and behavioral disorders, but
more straightforwardly to the FFM.
For practitioners, even though the theoretical, empirical, and applied
advantages of basing initial screening on FFM count might be convincing,
one limitation is that the use for clinical diagnosis is less clear. There is still
a need for an established cut-off point, whether it is for diagnosing specific
psychopathology or screening children’s aptness for certain school curricu-
lums or candidates for high executive positions. Another practical issue
 CONCEPTUALIZATIONS OF PERSONALITY DISORDERS 153

which needs further investigation is to what extent the measures conceptu-

ally overlap and confound with empathy, when using other instruments than
the FFM-count formulas. The applications of the FFM-count method are
still in its exciting early stages.

Conclusion
The debate on whether personality disorders can be measured based on general
personality traits has found some support in the present study through the con-
ceptualization with empathic traits, as both specific disorder categories as well
as higher order levels showed patterns of increased distress and decreased con-
cern. This study is one of many emerging studies investigating the nascent foun-
dations for the categorization, conceptualization, and trait measurement in social
and clinical psychology.

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156 KAJONIUS AND DADERMAN

APPENDIX
The FFM Personality-Disorder Count-Method

PAR D (N2 C E1_R C E2_R C O4_R C O6_R C A1_R C A2_R C A3_R C A4_R C A6_R).
SZD D (E1_R C E2_R C E3_R C E4_R C E5_R C E6_R C O3_R C O4_R).
SCT D (N1 C N4 C E1_R C E2_R C E6_R C O5 C C2_R).
APD D (N1_R C N2 C N4_R C N5 C E3 C E4 C E5 C O4 C A1_R C A2_R C A3_R C A4_R C
A5_R C A6_R C C3_R C C5_R C C6_R).
BPD D (N1 C N2 C N3 C N5 C N6 C O1 C A4_R C C6_R).
(Updated by Mullins-Sweatt, Edmundson, Sauer-Zavala, Lynam, Miller, & Widiger, 2012).
HST D (N4_R C N5 C E2 C E4 C E5 C E6 C O1 C O3 C O4 C A1 C C5_R C C6_R).
NAR D (N2 C N4_R C E1_R C E3 C E5 C O3_R C O4 C A1_R C A2_R C A3_R C A4_R C
A5_R C A6_R).
AVD D (N1 C N4 C N5_R C N6 C E2_R C E3_R C E5_R C E6_R C O4_R C A5).
DEP D (N1 C N4 C N6 C E3_R C A1 C A4 C A5).
(Updated by Miller, Bagby, Pilkonis, Reynolds, & Lynam, 2005)
OCD D (N1 C N5_R C E5_R C O3_R C O4_R C O5_R C O6_R C C1 C C2 C C3 C C4 C C5 C
C6).
DEPR D (N1 C N3 C N6 C E4_R C E5_R C E6_R C A5).
(Added by Lynam, Gaughan, Miller, Miller, Mullins-Sweatt, & Widiger, 2011)
PPD D (E1_R C A1_R C A2_R C A3_R C A6_R C N1_R C N3_R C N6_R C N5 C E5 C A4_R
C C3_R C C5_R C C6_R C N2 C N4 C E3 C A5_R).
(Added by Vachon, Sellbom, Ryder, Miller, & Bagby, 2009).

PAR D Paranoid, SZD D Schizoid, SCT D Schizotypal, APD D Antisocial, BPD D Borderline,
HST D Histrionic, NAR D Narcissistic, AVD D Avoidant, DEP D Dependent, OCD D Obsessive-
Compulsive, DEPR D Depressive, PPD D Psychopathic PD.1
1
Further notes on the FFM PD count: The originally published FFM count method by Miller et al.
(2005/2008) has undergone some suggested updates. Crego, Samuel, and Widiger (2015) suggested a
new facet combination for obsessive-compulsive PD. In the present study, this new count reported a
much lower alpha compared to the original and was therefore not used. Similarly, Glover, Miller,
Lynam, Crego, and Widiger (2012) upgraded the count on narcissistic PD, however, the very low
alpha made us use the original version. The only upgrade used in the present study was borderline
PD (Mullins-Sweatt, Edmundson, Sauer-Zavala, Lynam, Miller, & Widiger 2012). In addition, there
are two new non-DSM PD counts: Depressive PD (Lynam, Gaughan, Miller, Miller, Mullins-Sweatt,
& Widiger 2011) and psychopathic PD (Vachon, Sellbom, Ryder, Miller, & Bagby 2009). It should
be noted that DSM-5 Section III as an alternative classifies PDs in 6 categories: Antisocial, avoidant,
borderline, narcissistic, obsessive-compulsive, and schizotypal.

Crego, C., Samuel, D. B., & Widiger, T. A. (2015). The FFOCI and other measures and models of
OCPD. Assessment, 22, 135–151.
Glover, N., Miller, J. D., Lynam, D. R., Crego, C., & Widiger, T. A. (2012). The five-factor nar-
cissism inventory: A five-factor measure of narcissistic personality traits. Journal of
Personality Assessment, 94, 500–512.
Lynam, D. R., Gaughan, E. T., Miller, J. D., Miller, D. J., Mullins-Sweatt, S., & Widiger, T.
(2011). Assessing the basic traits associated with psychopathy: Development and validation of
the Elemental Psychopathy Assessment. Psychological Assessment, 23, 108.
 CONCEPTUALIZATIONS OF PERSONALITY DISORDERS 157

Mullins-Sweatt, S. N., Edmundson, M., Sauer-Zavala, S., Lynam, D. R., Miller, J. D., & Widiger,
T. A. (2012). Five-factor measure of borderline personality traits. Journal of Personality
Assessment, 94, 475–487.
Vachon, D. D., Sellbom, M., Ryder, A. G., Miller, J. D., & Bagby, R. M. (2009). A five-factor
model description of depressive personality disorder. Journal of Personality Disorders, 23,
447–465.
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