The incremental validity of level of personality functioning over borderline personality features in associations...

More work is needed to establish the validity of the Alternative Model of Personality Disorders (AMPD) in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Acceptance of the AMPD as the primary model of personality disorder requires identifying neurocognitive validators of AMPD-defined personality functioning and demonstrating superiority of the AMPD over the traditional categorical model of personality disorder. It is also important to establish the utility of the AMPD in a developmental context given evidence that personality disorder emerges in adolescence. We assessed the incremental validity of AMPD-defined level of personality functioning (LPF) versus borderline personality features (BPF) in explaining alterations in neural processing of social acceptance feedback in early adolescent girls. One hundred nine girls (M_age = 12.21, SD = 1.21; N = 79 with a psychiatric history) completed a computerized peer interaction task to elicit neural response to social acceptance feedback via electroencephalogram (EEG). Subjects or caregivers reported adolescent psychopathology. In hierarchical regressions controlling for neural response to social rejection and internalizing and externalizing symptoms, LPF incremented BPF and all other covariates in predicting response to social acceptance, but BPF did not. Higher LPF impairment was associated with enhanced reactivity to social acceptance (St.b = 0.274, p = 0.018). LPF appears to provide additional information about neural response to social reward in early adolescence beyond that provided by borderline personality features. These findings add to an emerging literature demonstrating the validity and superiority of the AMPD and help build the rationale for moving toward the AMPD as the primary model of personality disorder classification.