An empirical evaluation of the structure of DSM-IV personality disorders in a nationally representative sample: results of confirmatory factor analysis in the National Epidemiologic Survey on Alcohol and Related Conditions Waves 1 and 2.

Individual personality disorders (PD) are grouped into three clusters in the DSM-IV (A, B, and C). There is very little empirical evidence available concerning the validity of this model in the general population. The current study included all 10 of the DSM-IV PD assessed in Wave 1 and Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Confirmatory factor analysis was used to evaluate three plausible models of the structure of Axis II personality disorders (the current hierarchical DSM-IV three-factor model in which individual PD are believed to load on their assigned clusters, which in turn load onto a single Axis II factor; a general single-factor model; and three independent factors). Each of these models was tested in both the total and also separately for gender. The higher order DSM-IV model demonstrated good fit to the data on a number of goodness-of-fit indices. The results for this model were very similar across genders. A model of PD based on the current DSM-IV hierarchical conceptualization of a higher order classification scheme received strong empirical support through confirmatory factor analysis using a number of goodness-of-fit indices in a nationally representative sample. Other models involving broad, higher order personality domains such as neuroticism in relation to personality disorders have yet to be tested in epidemiologic surveys and represent an important avenue for future research.