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Under the Axis II Radar: Clinically Relevant Personality Constellations That Escape DSM-IV Diagnosis

Blagov, Pavel S. MA; Bradley, Rebekah PhD; Westen, Drew PhD

Journal of Nervous & Mental Disease:
doi: 10.1097/NMD.0b013e318064e824
Original Article

Research suggests that personality pathology lies on a continuum from relatively severe to less severe and that subthreshold variants may not be adequately captured by axis II of DSM-IV. In this study, we used a measure of personality and psychopathology designed for experienced clinical observers (the SWAP-200) to derive subthreshold personality constellations in a sample of 159 psychotherapy patients who were high functioning but nevertheless suffered from maladaptive personality patterns. Using Q-factor analysis (an empirical clustering procedure), we identified 4 diagnostic groupings or SPC, which resembled the clinical concept of “neurotic styles”: depressive, hostile-competitive, obsessive, and hysterical. The results of this study should stimulate further research on subthreshold personality configurations.

Author Information

Department of Psychology, Emory University, Atlanta, Georgia.

Supported in part by NIMH grants MH62377 and MH62378 (to D.W.).

Send reprint requests to Drew Westen, PhD, Department of Psychology, Emory University, 532 North Kilgo Circle, Atlanta, GA 30322. E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.