The distinct roles of assessment method and theoretical framework in predicting functional impairment and alcohol use

The DSM-5 Alternative Model for Personality Disorders (AMPD) and Kernberg's object relations theory are prominent frameworks for assessing personality dysfunction. This study investigates their structural overlap and evaluates their specific capacity to predict clinical outcomes using a multi-method approach.

A sample of 189 Hungarian psychotherapy inpatients (127 females, 55 males, 7 undisclosed; mean age = 34.0 years) were assessed using four personality dysfunction measures (SCID-5-AMPD, STIPO-R, LPFS-BF, IPO) alongside measures of functional impairment (WSAS) and alcohol use risk (AUDIT). Confirmatory Factor Analysis (CFA) and Structural Equation Modelling (SEM) evaluated latent structures and predictive validity.

CFA supported a model with three distinct latent constructs: levels of self-functioning, interpersonal functioning, and personality organisation, alongside specific method factors. SEM revealed distinct predictive patterns: general functional impairment was uniquely predicted by descriptive self-functioning, while alcohol use risk was associated with the level of personality organisation. However, these findings are limited to a low-risk inpatient psychotherapy sample and should not be generalised to broader substance-dependent populations.

The AMPD and Kernberg models are complementary rather than redundant. Assessing both descriptive functioning and dynamic organisation via a multi-method approach provides a more comprehensive, clinically actionable understanding of personality pathology and specific behavioural risks.