Psychiatry Research 196 (2012) 123–132

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Psychiatry Research
journal homepage: www.elsevier.com/locate/psychres

Taxometric analyses of paranoid and schizoid personality disorders

Anthony Olufemi Ahmed a,⁎, Bradley Andrew Green b, Peter Francis Buckley a, Megan Elizabeth McFarland b
a
Department of Psychiatry and Health Behavior, Georgia Health Sciences University, 997 Saint Sebastian Way, Augusta, GA 30912, United States
b
Department of Psychology, University of Southern Mississippi, 118 College Drive, #5025 Hattiesburg, MS 39406, United States

a r t i c l e i n f o a b s t r a c t

Article history: There remains debate about whether personality disorders (PDs) are better conceptualized as categorical,
Received 2 February 2011 reflecting discontinuity from normal personality; or dimensional, existing on a continuum of severity with
Received in revised form 9 October 2011 normal personality traits. Evidence suggests that most PDs are dimensional but there is a lack of consensus
Accepted 11 October 2011
about the structure of Cluster A disorders. Taxometric methods are adaptable to investigating the taxonic sta-
tus of psychiatric disorders. The current study investigated the latent structure of paranoid and schizoid PDs
Keywords:
Paranoid
in an epidemiological sample (N = 43,093) drawn from the National Epidemiological Survey on Alcohol and
Schizoid Related Conditions (NESARC) using taxometric analyses. The current study used taxometric methods to an-
Personality disorders alyze three indicators of paranoid PD — mistrust, resentment, and functional disturbance — and three indica-
Taxometrics tors of schizoid PD — emotional detachment, social withdrawal, and functional disturbance — derived factor
Latent structure analytically. Overall, taxometrics supported a dimensional rather than taxonic structure for paranoid and
Schizophrenia spectrum schizoid PDs through examination of taxometric graphs and comparative curve fit indices. Dimensional
models of paranoid and schizoid PDs better predicted social functioning, role-emotional, and mental health
scales in the survey than categorical models. Evidence from the current study supports recent efforts to rep-
resent paranoid and schizoid PDs as well as other PDs along broad personality dimensions.
© 2012 Elsevier Ireland Ltd. All rights reserved.

1. Introduction
The question of whether psychiatric disorders should be repre-
sented categorically or dimensionally in diagnostic systems (e.g.,
World Health Organization, 1992; American Psychiatric Association,
2000) remains a point of contention in psychiatry. This debate is espe-
cially salient to personality disorders (PDs), which many argue are
best represented dimensionally (Clark et al., 1997; Widiger and Trull,
2007). Categorical models consider diagnostic entities qualitatively dis-
tinct from one another and non-pathology. Dimensional models, how-
ever, view PDs as existing on a continuum of severity with normal
personality traits and attempt to represent PDs along a set of broad
facets of normal personality (Widiger and Trull, 2007). Critics highlight
limitations of categorical representations of PDs including high rates of
diagnostic co-occurrence, limited construct validity, and high rates of
subthreshold cases and Not Otherwise Specified (NOS) diagnoses (Clark
et al., 1997; Widiger and Clark, 2000; Widiger and Trull, 2007). More-
over, evidence suggests that dimensional models of PDs are better at
predicting variables such as functional impairment, suicidal gestures,
hospitalization, and criminal offender status than categorical models
(Ullrich et al., 2001; Skodol et al., 2005; Morey et al., 2007). With
the publication of the Diagnostic and Statistical Manual of Mental
⁎ Corresponding author. Tel.: + 1 706 721 7874; fax: +1 706 721 1793.
E-mail address: aahmed@geogiahealth.edu (A.O. Ahmed).
Disorders — fifth edition (DSM-V) imminent, there has been a strong
push for a dimensional reorganization of PDs. A number of studies
have also presented viable dimensional alternatives to the predominant
categorical scheme, most of which suggest organizing personality
pathology along three to seven broad domains (e.g., Cloninger et al.,
1993; Harkness and McNulty, 1994; Cloninger, 2000; Livesley, 2003;
Shedler and Westen, 2004; Widiger and Simonsen, 2005).
In general, attempts at organizing PDs into broad dimensions have
ensued without direct empirical evidence that they are actually
dimensional. Evidence supporting the superior predictive validity of
severity scores relative to diagnosis in relation to clinically relevant
variables does not establish latent structure as inherently dimensional
(e.g., Goedeker and Tiffany, 2008). Further, evidence that PDs can be
organized into dimensions via factor modeling does not provide direct
tests of their latent structure as dimensional rather than taxonic. Direct
empirical evidence of the relative viabilities of continuity and disconti-
nuity models of PDs can be obtained using taxometric methods devel-
oped by Meehl and colleagues (Grove and Meehl, 2009; Meehl and
Yonce, 1994; Meehl, 1995; Meehl and Yonce, 1996; Waller and Meehl,
1998). Taxometric methods determine latent structure by modeling
the pattern of relationships among indicators of a construct, which are
depicted graphically. Using a multiple hurdles framework, it requires
convergence across multiple procedures with the aid of consistency
tests and numerical indices (Meehl, 1995; Ruscio, 2007). Taxometric
investigations of the latent structure of PDs appear to support a dimen-
sional structure for most PDs investigated to date with a few exceptions
(Haslam, 2003, 2007). Schizotypal PD has been the most extensively

0165-1781/$ – see front matter © 2012 Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/j.psychres.2011.10.010
124 A.O. Ahmed et al. / Psychiatry Research 196 (2012) 123–132
demonstrated to possess a taxonic structure (e.g., Tyrka et al., 1995;
Lenzenweger, 1999).
The consensus that PDs likely exist on a continuum of severity
with normal personality traits wanes when Cluster A disorders are
in question. One reason for this departure relates to the perceived
genetic/familial relationship between Cluster A disorders and schizo-
phrenia. Studies have demonstrated that there is a higher rate of
Cluster A disorders among relatives of individuals with schizophrenia
when compared to controls (Kendler et al., 1993; Chang et al., 2002;
Kendler et al., 2006). Given evidence of the taxonic structure of
schizophrenia phenotypes or schizotypy (Tyrka et al., 1995;
Lenzenweger, 1999), Cluster A symptoms may demonstrate a taxonic
structure. Meehl (1962, 1990) suggested in his theory that schizo-
phrenia emerges from a genetic defect that leads to hypokrisia, a
generalized CNS defect or neurological aberration caused by neuro-
chemical, neurophysiological, or neuroanatomical deficiencies.
Hypokrisia leads to schizotaxia characterized by “neurointegrative
defect” that leads to social avoidance and sociocognitive deficits. Schi-
zotaxia results in the vulnerability to schizophrenia and spectrum dis-
orders by working in tandem with other predispositions and
environmental factors such as personality traits, life stressors, social
learning, and polygenetic factors to result in a schizotypic personality
organization. Although neither equivalent to nor isomorphic with
DSM diagnosis of schizophrenia or Cluster A PDs, schizotypy overlaps
with the DSM constructs and some schizotypes do in fact develop
Cluster A PDs or schizophrenia.
Although their study supported ultimately a dimensional structure
for paranoid PD, Edens et al. (2009) suggested the possibility that is
similar to the relationship between schizotaxia, schizotypal personality,
and schizophrenia; a paranoid taxon could result in vulnerability to
paranoid PD that could work in tandem with other factors to increase
the risk of developing paranoid schizophrenia or delusional disorder.
Similarly, a schizoid taxon may be present in schizoid PD that subse-
quently results in negative symptoms characteristic of schizophrenia
in some individuals (American Psychiatric Association, 2000; Chang et
al., 2002). Social anhedonia, a core feature of schizophrenia and schizoid
PD has received attention in taxometric studies, which suggest a taxonic
structure (Blanchard et al., 2000; Horan et al., 2004). It is noteworthy
that although Golden and Meehl (1979) reported a taxometric study
of schizoid taxon or schizoidia, the construct investigated was more con-
sistent with a schizotypic personality organization described in Meehl's
theory. Thus, there have been no taxometric studies of schizoid person-
ality or schizoid PD.
In addition, taxonicity has yet to be demonstrated for paranoid PD.
Arntz et al. (2009) conducted a series of taxometric analyses in a sample
of 1879 individuals drawn from various mental health facilities, prisons,
and hospitals across Europe. One of the constructs investigated was
paranoid PD, the indicators of which they drew from the Structured
Clinical Interview for DSM-IV Axis-II Personality Disorders (SCID-II).
Arntz et al. analyzed the indicators using the MAMBAC, MAXEIG, and
L-Mode taxometric procedures and determined latent structure by
examining graphical outputs with simulated comparison data, and
comparative curve fit indices. Their results across procedures supported
a dimensional structure. Similarly, Edens et al. (2009) examined the
latent structure of paranoid PD in two studies using taxometric
methods. The first study examined the latent structure in a clinical sam-
ple (n = 713) drawing indicators of paranoid PD from a diagnostic in-
terview. The second study examined latent structure in a clinical
(n = 1246) and community sample (n = 1000), drawing indicators
from the Personality Assessment Inventory (PAI). Both studies imple-
mented the MAMBAC and MAXCOV taxometric procedures and also
compared the criterion-related validities of both a taxonic and a dimen-
sional model. Overall, the results of their study supported a dimensional
model through an examination of taxometric plots, fit indices, and the
relative criterion-related validities of a taxonic versus dimensional
model. The convergence of evidence from community and clinical
samples and indicators drawn from diagnostic interviews and a self-
report measure provided support for a dimensional structure.
The Arntz et al. study sampled only a few putative taxon members.
Of a sample of 1816, only 95 participants met paranoid PD diagnostic
criteria. Although Monte Carlo simulations have demonstrated the
ability of taxometric methods to detect low base rate taxons, there
have been limited systematic studies of the threshold for the absolute
size of the putative taxon required to obtain clear taxonic results via
visual inspection. Schmidt et al. (2004) suggested a threshold of 30
taxon members; however, this was not based on a systematic evalu-
ation of taxon group size in combination with other data conditions.
For example, whether the threshold of 30 would still be reasonable
if the total sample size was much more than the 300 minimum
recommended for taxometric studies (Meehl, 1995) is an empirical
question. Further investigation with larger taxon group sizes may
confirm or disconfirm their latent structure findings. We investigated
the latent structure of paranoid PD in a large epidemiological sample
using taxometric methods. Using a large epidemiological sample to
study the latent structure of paranoid PD increases our likelihood of
including more putative taxon members in the analysis. In fact, the
number of individuals meeting diagnostic criteria for paranoid PD in
the sample is 2105. Given that there have been no taxometric studies
of the DSM-defined schizoid PD; our study consolidates this gap in
the taxometric literature on PDs by examining if the 1425 individuals
meeting diagnostic criteria for schizoid PD in the survey represent a
qualitatively distinct class. Unfortunately, the survey did not collect
data on schizotypal PD so we were unable to investigate the latent
structure of schizotypal PD in the study.
2. Method
2.1. Participants
The study analyzed the responses of participants on the 2001–2002 National Epi-
demiologic Survey on Alcohol and Related Conditions (NESARC; National Institute on
Alcohol Abuse and Alcoholism (NIAAA), 2006). The survey obtained a representative
sample (N = 43,093) of individuals living in the United States at least 18 years of age
and currently non-institutionalized. African-Americans (19.1%) and Hispanics (19.3%)
were well represented in the sample. The age of participants ranged from 18 to 98
(M = 46.40, S.D. = 18.18). Women represented a majority (57%) of the sample. Individ-
uals who participated in the survey completed diagnostic interviews assessing a range
of psychiatric disorders including substance use problems, mood disorders, anxiety
disorders, and PDs. The psychiatric symptoms were assessed using the NIAAA Alcohol
Use Disorders and Associated Disabilities Interview Schedule — DSM-IV Version
(AUDADIS-IV;Grant et al., 2001). The AUDADIS was designed to be administered by
trained lay interviewers. Grant et al. (2003) obtained test–retest reliabilities ranging
from .50 to .79 for PD dimensions (10-week retest interval) in a subsample of 315 re-
spondents who completed the original NESARC survey. Personality pathology as mea-
sured by the PD section of the AUDADIS-IV has been demonstrated to be associated
with disability as measured by subscales of the Short-Form 12-Item Health Survey,
Version 2 (SF-12v2) (Pulay et al., 2008).
The paranoid PD portion of the survey included 18 items assessing suspiciousness and
pervasive mistrust in personal relationships as well as items assessing disturbance in
occupational and relational functioning. The schizoid PD portion of the survey included
20 items assessing emotional constriction, detachment from interpersonal relationships,
social isolation, and functional problems.
2.2. Analyses
To investigate the latent structure of paranoid and schizoid PDs, responses on the
survey were submitted to taxometric procedures including MAMBAC (Mean Above
Minus Below A Cut; Meehl and Yonce, 1994), MAXEIG (MAXimum EIGenvalue;
Waller and Meehl, 1998), and L-Mode (Latent Mode Factor Analysis; Waller and
Meehl, 1998). The MAMBAC procedure is implemented with at least two indicators
of the construct. One of the indicators is designated as the input indicator and the
other is designated as the output. Successive cuts are made on the input indicator
and at each cut; the difference (d) between the mean score of cases falling above the
cut and cases falling below the cut on the output variable is computed. A graph of
the successive cuts (50 in the current study) on the x-axis is plotted against d on the
y-axis. For the MAMBAC analyses, each indicator served as both the output, paired
with another indicator as input, and input, paired with another indicator as output,
yielding one MAMBAC graph per each permutation of indicator pairs. Taxonic situa-
tions usually yield single-peaked d(x) functions with the location of the peak
 A.O. Ahmed et al. / Psychiatry Research 196 (2012) 123–132
corresponding to the base rate of the taxon. Dimensional situations typically yield a
“concave up” graphical function.
The MAXEIG procedure is implemented with at least three indicators of the construct.
One of the indicators is designated as the input and the remaining indicators are designat-
ed as outputs. Successive overlapping windows (50 in the current study) are created on
the input variable with adjacent windows sharing 90% of their cases. At each window,
the first eigenvalue reflecting the covariation among all of the output indicators is
obtained. The graph of the eigenvalue (on the y-axis) is plotted against the windows
created on the input indicator (x-axis). Taxonic situations will yield single-peaked condi-
tional eigenvalue functions with peaks representing the location of the hitmax, whereas
dimensional situations yield plots with no apparent peaks. In MAXEIG analyses, each indi-
cator served as an input with the remaining indicators serving as the multivariate output
indicator for that analysis, yielding one MAXEIG graph per indicator. We configured
MAXEIG to produce graphs of Bayesian posterior probability distributions for putative
taxon group membership for both the paranoid and schizoid PD analyses. Taxonic situa-
tions usually produce probabilities that cluster around 0 and 1, whereas dimensional
situations produce probabilities that cluster around various values between 0 and 1,
thus providing a useful inferential tool of latent structure.
The L-Mode procedure conducts an exploratory factor analysis on the indicator vari-
ables and identifies latent structure by calculating factor scores for all cases using a one-
factor latent variable model. L-Mode graphs the factor density plot of the distribution
and the distribution is examined for local modes. If the construct of interest is taxonic,
the distribution of factor scores should be bimodal. L-Mode estimates the base rate of
the taxon by using the location of the upper (right) and lower (left) modes of the research
curve. On the other hand, dimensional situations should produce evidence of a unimodal
distribution of factor scores. It was conjectured that if the latent structure of paranoid PD
was taxonic, the putative groups would have unequal mixing proportions. Thus, it was de-
cided prior to analysis that the program would be configured to manually search for latent
modes following an initial visual inspection of the research curve to ensure that the right
mode was correctly located.
The shape of taxometric curves often deviates from the descriptions offered above,
usually due to factors such as non-normality, base rate, and levels of nuisance covariance
and indicator validity. The graphical outputs of research data obtained from the taxo-
metric procedures were interpreted by visual inspection aided by comparison to graphical
outputs obtained from simulated taxonic and dimensional data, generated to match the
distributional characteristics of the research data including sample size, skew, kurtosis,
and indicator correlations. For each analysis, 100 to 1000 samples of taxonic and dimen-
sional comparison data were generated. In addition to visual inspection aided by simulat-
ed comparison data, the use of simulated taxonic and dimensional datasets allows a
Comparison Curve Fit Index (CCFI) to be computed to compare the relative fits of taxonic
versus dimensional latent structures to the data. CCFI values range from 0 (strongest sup-
port for dimensional structure) to 1 (strongest support for taxonic 0.structure), with
values close to 0.50 representing ambiguous results. In the current study, CCFIs are imple-
mented with dual thresholds with values between 0.40 and 0.60 suggesting ambiguous
results. CCFIs have demonstrated excellent accuracies at distinguishing between taxonic
and dimensional data in several large-scale Monte Carlo studies under data configurations
that violate multiple statistical assumptions (Ruscio and Kaczetow, 2009; Ruscio et al.,
2010). Taxometric analysis implements a multiple hurdles consistency testing approach
to determining correct latent structure by requiring that conclusions be drawn based on
converging evidence from multiple methods (Meehl, 1995). Ruscio et al. (2010) deter-
mined that this is best implemented with CCFIs by computing the mean CCFI across taxo-
metric methods. When mean CCFIs are implemented with dual thresholds in inferring
latent structure, CCFIs distinguish taxonic from dimensional Monte Carlo samples with
over 99% accuracy (Ruscio et al., 2010). The analysis configurations were carried out
using Ruscio's taxometric program (Ruscio, 2010) implemented in the R Computing Envi-
ronment (R Foundation for Statistical Computing, 2010).
2.3. Construction of indicators
Indicators for the taxometric analyses were created by first identifying items mea-
suring the symptoms of paranoid and schizoid PDs. Following recommendations by
Cole (2004) and Beauchaine (2003), the current study used composite indicators rath-
er than item level indicators to increase the likelihood of obtaining stable taxometric
curves with clear resolution. In the NESARC survey, each item assessing DSM-IV PD
symptom was followed up with an item assessing social and/or occupational dysfunc-
tion phrased as “did this ever trouble you or cause problems at work or school, or with
your family or other people?” In all, 18 items assessed paranoid PD and 20 items
assessed schizoid PD. In the diagnostic algorithm for the NESARC survey, at least one
of the criteria for diagnosis had to be associated with social and/or occupational dys-
function for a diagnosis to be assigned when the required number of symptoms has
been met.
To create candidate indicators for the taxometric analyses, we summed the social/
occupational dysfunction items into two functional disturbance scales — one for each
construct. Next, we submitted the remaining items to principles components analyses
(PCA) with Promax rotation. For the remaining nine paranoid PD items, we selected a
two-component solution accounting for 46.90% variance in the model. The first compo-
nent labeled mistrust comprised six items assessing mistrust in interpersonal relation-
ships including beliefs about others motives. The second component named
resentment comprised three items assessing antipathy towards others including emo-
tional coldness and hypersensitivity to criticism.
125
For the remaining 10 schizoid PD items, a two-component solution accounting for
38.25% variance in the model was selected. The first component labeled emotional de-
tachment comprised five items assessing constriction in emotional expression and
emotional disconnection from others. The second component labeled social withdraw-
al comprised five items assessing social isolation and lack of interest in engaging with
others socially. We created two additional candidate indicators for both paranoid and
schizoid PDs by summing items into scales guided by the component solutions.
Table 1 summarizes the items used in the study and their corresponding scales.
The paranoid and schizoid PD scales were submitted to MAMBAC, MAXEIG, and L-
Mode to determine the latent structure of paranoid and schizoid PDs in the sample.
Following Meehl's (1995) recommendation, indicators are evaluated to ensure ade-
quate validities for detecting taxonicity (threshold d ≥ 1.25 separations between puta-
tive taxon and complement groups) and adequate nuisance correlation — i.e., residual
correlations not accounted for by group membership. To this end, we estimated the
validities and nuisance correlation of the data using the Indicator.Dist function in the
program using DSM-IV diagnostic status as a priori classification. For paranoid PD, in-
dicator validities ranged from 2.29 to 5.21 (M = 3.89, S.D. = 1.48). The average nui-
sance correlation within the taxon (r = 0.21, S.D. = 0.33) and complement groups
(r = 0.31, S.D. = 0.04) were acceptable. For schizoid PD, validities ranged from 1.68 to
5.62 (M = 3.18, S.D. = 2.14) and nuisance correlation within taxon (r = 0.11,
S.D. = 0.25) and complement groups (r = 0.19, S.D. = 0.21) were also acceptable. The
indicators for paranoid and schizoid PDs had average correlations of 0.54 and 0.35 re-
spectively. We conducted taxometric runs using the same a priori classifications based
on DSM-IV diagnostic status using the “Supplied.Class” option in the program that al-
lows class membership to be defined. We also generated simulated categorical com-
parison data to accompany the research data using the same a priori classifications
thus ensuring that identical populations of comparison data are being generated across
taxometric procedures.
While not direct tests of latent structure, some researchers have recommended
that taxometric investigations also compare the relative validities of taxonic and di-
mensional models of psychiatric disorders to determine how well both models predict
relevant clinical variables (Watson, 2006). It may be that even when a construct is
taxonic, a dimensional model accounts for substantially more variance in relevant cri-
terion variables that the utility of dimensional assessment is still substantiated. In the
current study, three variables in the NESARC data were designated as external vari-
ables for investigating the comparative validity of categorical and dimensional models
of paranoid and schizoid PDs. These were the Mental Health Component, Social Func-
tioning, and Role-Emotional Function scales derived from the Short-Form 12-item
Health Survey (SF-12v2), which was administered in the NESARC survey. Norm-
based scores on the scales range from 0 to 100 (M = 50), with lower scores on the vari-
ables generally denote poorer functioning. The scales have been shown to be associat-
ed with personality pathology (Pulay et al., 2008). We compared the severity scores to
DSM-IV diagnostic status in terms of their association with external variables. We
obtained severity scores by summing the number of endorsed items into a total sever-
ity indicator. Whereas severity scores represented the dimensional model, DSM-IV di-
agnostic status represented the categorical model.
3. Results
3.1. Latent structure of paranoid PD
3.1.1. MAMBAC analysis
MAMBAC (all pairs) produced six individual graphs, five of which
appeared to be rising, and one demonstrating a “hook” at the high
end of the distribution. The average MAMBAC curve appeared to be
rising, consistent with a dimensional structure. Comparing the aver-
age MAMBAC curve to the curves produced by the simulated taxonic
and dimensional data, the average curve appeared to equally fit both
simulations across the entire distribution (Fig. 1).
3.1.2. MAXEIG analysis
MAXEIG produced two individual curves that appeared to be ris-
ing and one that was flat or fluctuating around a mean eigenvalue.
The average curve appeared to be rising with no apparent peaks con-
sistent with a dimensional structure. Fig. 2 depicts the average curve
superimposed over curves produced by the simulated taxonic and di-
mensional data. The average curve appears more consistent with that
of the simulated dimensional data.
3.1.3. L-Mode analysis
The L-Mode curve produced appeared quite atypical of a taxonic
or dimensional structure. It was characteristically multimodal with
the height of the modes decreasing progressively. The form of devia-
tion from prototypical L-Mode curves is likely a result of the indicator
126 A.O. Ahmed et al. / Psychiatry Research 196 (2012) 123–132

Table 1
Items used, scale location, and endorsement rates.

Construct Scale Endorsed Not-endorsed

Paranoid PD items
Often have to keep an eye out to keep people from using/hurting/lying to you Mistrust 16.40 83.60
Ever trouble you or cause problems at work/school or with family/other people Functional disturbance 5.30 94.70
Spend a lot of time wondering if can trust friends/people you work with Mistrust 7.50 92.50
Ever trouble you or cause problems at work/school or with family/other people Functional disturbance 2.80 97.20
Find it is best not to let others know much about you because they will use it against it Mistrust 12.10 87.90
Ever trouble you or cause problems at work/school or with family/other people Functional disturbance 2.60 97.40
Detect hidden threats or insults in things people say or do Mistrust 6.80 93.20
Ever trouble you or cause problems at work/school or with family/other people Functional disturbance 2.50 97.50
The kind of person who takes a long time to forgive people who have insulted/slighted you Resentment 16.90 83.10
Ever trouble you or cause problems at work/school or with family/other people Functional disturbance 4.60 95.40
Many people you can't forgive because they said/did something long ago Resentment 8.70 91.30
Ever trouble you or cause problems at work/school or with family/other people Functional disturbance 2.90 97.10
Often get angry or lash out when someone criticizes or insults you Resentment 9.40 90.60
Ever trouble you or cause problems at work/school or with family/other people Functional disturbance 3.30 96.70
Often suspected that your spouse or partner has been unfaithful Mistrust 8.00 92.00
Ever trouble you or cause problems at work/school or with family/other people Functional disturbance 4.50 95.50
When around people, often feel that you are being watched or stared at Mistrust 6.60 93.40
Ever trouble you or cause problems at work/school or with family/other people Functional disturbance 1.60 98.40

Schizoid PD items
Are there very few people you're really close to outside of immediate family? Social withdrawal 32.40 67.60
Ever trouble you or cause problems at work/school or with family/other people Functional disturbance 1.40 98.60
Would be just happy without having any close relationship Social withdrawal 17.10 82.90
Ever trouble you or cause problems at work/school or with family/other people Functional disturbance 0.70 99.30
Take little pleasure in being with others Social withdrawal 8.30 91.70
Ever trouble you or cause problems at work/school or with family/other people Functional disturbance 0.70 99.30
Have almost always preferred to do things alone rather than with others. Social withdrawal 15.60 88.40
Ever trouble you or cause problems at work/school or with family/other people Functional disturbance 1.50 98.50
Could be content without ever being sexually involved with anyone Social withdrawal 32.00 68.00
Ever trouble you or cause problems at work/school or with family/other people Functional disturbance 1.10 98.90
Rarely show much emotion Emotional detachment 17.40 82.60
Ever trouble you or cause problems at work/school or with family/other people Functional disturbance 2.00 98.00
Very few things that give you pleasure Emotional detachment 8.20 91.80
Ever trouble you or cause problems at work/school or with family/other people Functional disturbance 1.00 99.00
Rarely react to praise or criticism Emotional detachment 13.10 86.90
Ever trouble you or cause problems at work/school or with family/other people Functional disturbance 0.90 99.10
The sort of person who doesn't care about what people think about you Social withdrawal 32.50 67.50
Ever trouble you or cause problems at work/school or with family/other people Functional disturbance 1.80 98.20
Find nothing makes you happy or sad Emotional detachment 5.60 94.40
Ever trouble you or cause problems at work/school or with family/other people Functional disturbance 0.70 99.30

N = 43,093. Scale locations of study items. All scales except functional disturbance scales are based on PCA with promax rotation.

distribution deviating from a continuous distribution and approxi-
mating an ordered categorical variable. However, this characteristic
of the data is unlikely to confound the performance of L-Mode
when implemented with CCFIs (Ruscio and Walters, 2009). In Fig. 3,
the research curve appeared to be more consist with that of the sim-
ulated dimensional data.
Applying the multiple hurdles consistency testing approach to
evaluating our results, there appears to be greater support for a di-
mensional model. The CCFIs across the three taxometric methods
(0.521, 0.378, and 0.274, respectively) have an average of 0.391.
This just falls outside the dual-threshold range of 0.40 to 0.60 and bet-
ter supports a dimensional, rather than taxonic structure for paranoid
PD.
3.2. Latent structure of schizoid PD
3.2.1. MAMBAC analysis
MAMBAC produced six individual curves; five appeared to be rising
at the high end of the distribution, and one appeared flat. The average
curve also appeared to be rising at the high end of the distribution. In
Fig. 4, the average MAMBAC curve superimposed over curves produced
from simulated data suggests a closer fit with the simulated dimension-
al data.
3.2.2. MAXEIG analysis
MAXEIG produced three curves that appeared to be rising at the
high end of the distribution. Although most of the average MAXEIG
curve did not fall within the area bounding the graph from the simu-
lated dimensional data, it still appears to be rising like the graph from
the simulated dimensional data (Fig. 5). It is also a better fit compared
to that of the simulated taxonic data, thus supporting a dimensional
structure.
3.2.3. L-Mode analysis
Similar to paranoid PD indicators, the L-Mode curve produced also
appeared atypical, characteristically multimodal with the height of
the modes decreasing progressively. Notwithstanding, the L-Mode re-
search curve appeared to be a better fit with that of the simulated di-
mensional data (Fig. 6).
Overall, results appear to converge on a dimensional structure.
The CCFIs produced from the taxometric procedures (0.384, 0.36,
and 0.436, respectively) have an average of 0.368. This falls outside
the dual threshold of 0.40 to 0.60 and better supports a dimensional
rather than taxonic structure for schizoid PD.
The Bayesian probability distributions for paranoid and schizoid
PDs (Figs. 7 and 8, respectively) conform to what may be expected
of a dimensional structure. Probability estimates are converging
around five or six values including 0 and 1 rather than conversing
 A.O. Ahmed et al. / Psychiatry Research 196 (2012) 123–132 127

Categorical Comparison Data Dimensional Comparison Data

0.35
0.35

0.30
0.30

0.25
0.25
Mean Difference

Mean Difference
0.20
0.20

0.15
0.15

0.10
0.10
0.05

0.05
0.00

0.00
0 10000 20000 30000 40000 0 10000 20000 30000 40000

50 Cuts 50 Cuts

Fig. 1. Averaged MAMBAC (all pairs) curve for the paranoid PD indicators juxtaposed over taxonic and dimensional comparison simulations in the left and right panels respectively.
For all figures, darker lines represent the actual data and the lighter lines represent the area bounding the minimum and maximum values of the taxonic and dimensional compar-
ison data. The gray band when visible represents the middle 50% of data points obtained in the simulation.

around 0 and 1 alone, which may have been expected for a taxonic
construct.
3.3. Comparative validities of categorical versus dimensional models
Next, we examined the comparative validities of categorical and di-
mensional models of paranoid and schizoid PDs (Table 2) at predicting
social functioning, role-emotional, and mental health scales. For the di-
mensional model, we summed all the scales into one severity indicator.
For the categorical model, cases were designated based on diagnostic
information contained in the survey (i.e., meeting or not meeting DSM
criteria). There were some missing cases for these analyses for individ-
uals who did not complete the SF-12v2 scales (327, 323, and 339 cases
respectively). From Table 2, it is clear that the dimensional model

Categorical Comparison Data Dimensional Comparison Data

1.5

1.5
Eigenvalue

Eigenvalue
1.0

1.0
0.5

0.5
0.0

0.0

-0.5 0.0 0.5 1.0 1.5 2.0 2.5 -0.5 0.0 0.5 1.0 1.5 2.0 2.5

100 Windows 100 Windows

Fig. 2. MAXEIG average curve for the paranoid PD indicators juxtaposed over taxonic and dimensional comparison simulations in the left and right panels, respectively.
128 A.O. Ahmed et al. / Psychiatry Research 196 (2012) 123–132

Categorical Comparison Data Dimensional Comparison Data

6
6

5
5

4
4
Density

Density
3
3

2
2

1
1

0
0

0 2 4 6 0 2 4 6
Factor Scores Factor Scores

Fig. 3. L-Mode curve obtained from the paranoid PD analysis juxtaposed over simulated taxonic and dimensional data in the left and right panels, respectively.

generally outperforms the categorical model at predicting the three
variables.
4. Discussion
We set out to investigate the latent structure of paranoid and schiz-
oid PDs, two personality disorders that have received little attention
from taxometric investigations. We obtained converging evidence of a
dimensional structure for both paranoid and schizoid PDs across the
three taxometric procedures. For both paranoid and schizoid PDs, a di-
mensional model outperformed a categorical model at predicting the
designated external variables — mental health, social, and role-
emotional functioning.
Our evidence of a dimensional structure for paranoid PD is consis-
tent with similar studies from two prior investigations of the same
construct (Arntz et al., 2009; Edens et al., 2009), adding to growing

Categorical Comparison Data Dimensional Comparison Data

0.25
0.25

0.20
0.20
Mean Difference

Mean Difference
0.15
0.15

0.10
0.10

0.05
0.05
0.00

0.00

0 10000 20000 30000 40000 0 10000 20000 30000 40000

50 Cuts 50 Cuts

Fig. 4. Averaged MAMBAC (all pairs) curve for the schizoid PD indicators juxtaposed over taxonic and dimensional comparison simulations in the left and right panels, respectively.
 A.O. Ahmed et al. / Psychiatry Research 196 (2012) 123–132 129

Categorical Comparison Data Dimensional Comparison Data

0.8

0.8
0.6

0.6
Eigenvalue

Eigenvalue
0.4

0.4
0.2
0.2

0.0
0.0

-0.5 0.0 0.5 1.0 1.5 -0.5 0.0 0.5 1.0 1.5
50 Windows 50 Windows

Fig. 5. Averaged MAXEIG curve for the schizoid PD indicators juxtaposed over taxonic and dimensional comparison simulations in the left and right panels, respectively.

support for the dimensionality of this construct. Our study was the
first to examine the structure of schizoid PD. We were somewhat sur-
prised at our dimensional findings for this construct, given the partial
overlap of schizoid symptoms with social anhedonia, which has dem-
onstrated taxonicity in previous studies (Blanchard et al., 2000;
Horan et al., 2004). Obtaining dimensional evidence for schizoid and
paranoid PD is also surprising given their perceived genetic/familial
relationship with schizophrenia. Further, schizotypy, a vulnerability
factor for schizophrenia spectrum has received consistent support
for a taxonic structure.
The results of our study should, however, not be regarded as being
in conflict with numerous taxometric studies supporting a taxonic
structure for schizotypy. It may be that paranoid and schizoid PDs
possess latent structures dissimilar from schizotypy and schizotypal
PD because they represent phenomenologically separate entities
from the rest of the schizophrenia spectrum. As noted by Edens and

Categorical Comparison Data Dimensional Comparison Data

1.2

1.2
1.0

1.0
0.8

0.8
Density

Density
0.6

0.6
0.4

0.4
0.2

0.2
0.0

0.0

0 2 4 6 8 0 2 4 6 8
Factor Scores Factor Scores

Fig. 6. L-Mode curve obtained from the schizoid PD indicators juxtaposed on simulated taxonic and dimensional comparison data.
130
DISTRIBUTION OF BAYESIAN PROBABILITIES
35000
30000
25000
Frequency
20000
15000
10000
5000
0
0.0 0.2 0.4 0.6
Prob(Taxon Member)
Fig. 7. Bayesian posterior probability distribution for paranoid PD.
colleagues, this state of affairs may be reflected in the lack of consen-
sus in studies examining the genetic relationship between schizo-
phrenia and paranoid PD. In this regard, it may also be useful to
consider the indicators that have been used to study schizotypy and
schizotypal PD and our indicators for paranoid and schizoid PDs.
The majority of the studies that obtained a taxonic structure for schi-
zotypy drew indicators from Chapman et al. (1976) widely used mea-
sure of schizotypy and focused on the Perceptual Aberration, Magical
Ideation, Referential Thinking, Social Anhedonia, and Physical Anhe-
donia subscales. Lenzenweger et al. (2007) obtained taxonic findings
with endophenotypes. Social and Physical Anhedonia scales slightly
overlap with our Social Withdrawal and Emotional Detachment
scales for schizoid PD but are hardly equivalent. Thus there is no rea-
son to expect that our results would be congruent with studies using
those scales as indicators.
Another possibility is that schizoid and paranoid symptoms do
exist on a dimension of severity and impairment relative to non-
pathology. However, in combination with other vulnerability/protec-
tive and environmental factors (e.g., birth environment), individuals
scoring high on the paranoid and schizoid PD spectrums diverge
into a distinct taxon. This is consistent with multifactorial threshold
models of schizophrenia (e.g., Gottesman and Shields, 1976; McGue
et al., 1983) that allow for dichotomous outcomes when continuously
distributed dispositions reach a critical threshold. Gottesman's model
incorporates the effects of multiple genes and multiple environmen-
tal factors working in an additive fashion to yield schizophrenia.
Schizoid features are peculiar in their symptomatic overlap with
the deficit subtype of schizophrenia, characterized primarily by social
anhedonia, blunted affect, and poverty of speech (Kirkpatrick et al.,
DISTRIBUTION OF BAYESIAN PROBABILITIES
10000 15000 20000 25000 30000 35000
Frequency
5000
0
0.0 0.2 0.4 0.6
Prob(Taxon Member)
Fig. 8. Bayesian posterior probability distribution for schizoid PD.
A.O. Ahmed et al. / Psychiatry Research 196 (2012) 123–132
Table 2
Predictive validities of categorical and dimensional Models.
External variables Categorical model Dimensional model
Paranoid PD
Norm-based social functioning scale rpb = − 0.15** r = − 0.20**
rpb = − 0.14** r = − 0.18**
Norm-based role emotional scale
Norm-based mental health scale rpb = − 0.19** r = − 0.25**
Schizoid PD
Norm-based social functioning scale rpb = − 0.12** r = − 0.16**
Norm-based role emotional scale rpb = − 0.11** r = − 0.13**
Norm-based mental health scale rpb = − 0.14** r = − 0.16**
Categorical model is based on DSM-IV status and the dimensional model is based on
severity scores.
Missing cases (n = 327 for norm-based social functioning scale, n = 323 for norm-
0.8 1.0
based role emotional scale, and n = 339 for norm-based mental health scale).
1998; Kirkpatrick et al., 2002). Recently, Kirkpatrick et al. (2008) de-
termined that summer birth and male biological sex, critical factors in
the pathogenesis of deficit schizophrenia, were also associated with
schizoid-like features in non-clinical individuals. This state of affairs
is also explainable within a threshold model of vulnerability to deficit
schizophrenia. Similar risk factors are found within deficit schizo-
phrenia and individuals with schizoid features because the distribu-
tion of risk is dimensional and additive. At critical levels of other
vulnerability factors working in tandem with summer birth and
male biological sex (e.g., neurocognitive functioning), a likely taxonic
deficit syndrome emerges (Blanchard et al., 2000; Horan et al., 2004).
Our dimensional results add to growing taxometric evidence of
the dimensional structure of most DSM-defined PDs (Haslam, 2003,
2007). The study findings support incorporating paranoid and schiz-
oid PDs into current research efforts to organize PDs into broad di-
mensions. Tackett et al. (2008) recently demonstrated that the
application of a five-factor model of personality pathology adequately
incorporates Cluster A PDs. They uncovered a “peculiarity” factor cor-
related with “odd/eccentric” features in a sample that included first
degree relatives of individuals with schizophrenia and schizoaffective
disorder. Although some researchers have called for a complete over-
haul of the current categorical scheme, taxometrics has not complete-
ly supported dimensionality for all PDs. Indeed more studies support
the taxonic status of schizotypal PD although a recent study sug-
gested that it may be dimensional (Rawlings et al., 2008). Our find-
ings add to growing support for their dimensional representation,
but the presence of taxonic PD findings may lend better credence to
a combination of categorical and dimensional models rather than a
complete overhaul of a categorical model (Ruscio et al., 2006). More-
over, as Arntz and colleagues contend, a number of other considerations
should factor into decisions to adopt a completely dimensional model.
These include the degree to which diagnostic criteria of individual PDs
are incorporated into studies of normal personality functioning and
the extent to which the broad domains proposed in factor models
truly represent the spectrum of clinical phenomena of interest to
clinicians.
4.1. Limitations
The limitations of our study are as follows. One limitation is the
number and scope of the items we used to create candidate indicators,
half of which were items assessing functional problems. This reflects a
limitation of using archived epidemiological data, as the researcher is
often constrained to variables contained in the data. Notwithstanding
0.8 1.0 the few items contained in the survey, DSM diagnostic criteria were
assessed for both PDs, increasing confidence in conclusions about
their latent structure. It was the case that the simulated taxonic and
dimensional comparison curves were often similar, particularly
 A.O. Ahmed et al. / Psychiatry Research 196 (2012) 123–132
MAMBAC and L-Mode making it difficult to clearly determine latent
structure by mere visual inspection. This may reflect a limitation in
the indicators — we had only three indicators per construct one of
which had only four ordered categories. A rejoinder is that Walters
and Ruscio (2009) found that with adequate validities and nuisance
correlation, indicators with four or more ordered categories distin-
guished with high accuracy.
A related issue is the degree to which DSM criteria thoroughly ac-
cess the characteristics of paranoid and schizoid PDs (Arntz et al.,
2009). Current results better support a dimensional structure based
on DSM criteria; however, it may be that features not included in
DSM criteria such as cognitive style, self-concept, endophenotypes,
or perhaps features specifically shared with schizotypy may reveal a
taxonic structure. Meehl (1989) noted that efforts at studying “schi-
zotaxia” should focus on biological indicators or endophenotypes
given their closeness to genetic causes. He suggested that such indica-
tors are more likely to reflect schizotaxia given that they depend less
on social learning, environmental stressors, and life experiences. The
distinction between DSM-conceptualized paranoid and schizoid PD
criteria as verbal indicators assessed by higher level cognitive pro-
cesses, and endophenotypes as intermediate processes, is compelling
for studies of the latent structure of schizophrenia and related disor-
ders. Thus, future taxometric studies of paranoid and schizoid PDs
should incorporate schizophrenia endophenotypes present in these
PDs as candidate indicators of putative taxa.
The apparent discordance of clinical interviews and self-report
measures in the categorical diagnosis of personality disorders
(Zimmerman and Coryell, 1990) poses a challenge for classifying in-
dividuals as putative taxon versus complement members, raising a
question about whether the latent structure of personality disorders
would change as a function of the assessment modality. In the current
study, our indicators were drawn from census interview items, thus
the argument may be made that our dimensional findings should be
constrained to clinical interviews. It should be noted however that
the Edens et al. (2009) study did find paranoid PD to be dimensional
using both self-report and clinical interview data but this issue is yet
to be resolved for schizoid PD. Overall, we advocate a system of indi-
cator selection that draws candidate indicators from multiple modal-
ities including self-report, clinical interview, endophenotypes, and
biomarkers in future studies of paranoid and schizoid PD.
Another limitation is that PD assessment in the NESARC was con-
ducted by lay interviewers using the AUDADIS-IV, a measure
designed for this purpose, but that has yet to be extensively studied
to determine its association with more established instruments such
as the SCID-II. One concern is the degree to which this assessment
strategy can validly and reliably assess personality pathology, which
may require considerable clinical sophistication. There has been little
study about the congruence between lay interviewer diagnoses and
expert diagnoses for PDs using the AUDADIS-IV, representing a gap
in the psychometric study of the measure. One exception is the
NIMH Diagnostic Interview Schedule (DIS) that was also developed to
be administered by expert or lay interviewers. The DIS demonstrated
at least moderate congruence in diagnosing PDs when lay interviewers
and psychiatrists were compared (Robins et al., 1981). There is no ques-
tion however that confidence in our findings may hinge on the validity
of the lay-administered AUDADIS-IV at identifying PD cases.
Finally, although indicator validities for the analyses exceeded the
threshold recommended by Meehl (1995), one concern that could be
raised is that detecting taxa in the current study would have required
much larger effect sizes than those obtained from the current study
(Beauchaine et al., 2008). Notwithstanding, given that this is the
first study to examine the latent structure of schizoid PD, additional
studies are needed to confirm or disconfirm the dimensional findings.
As noted, it would be particularly useful to draw indicators from
different measurement modalities, assessing DSM criteria and other
features of paranoid and schizoid PD.
131
Conflict of interest
None
Role of funding source
The reported study was not externally funded or sponsored.
Acknowledgment
The authors acknowledge the National Institute of Health and the
National Institute on Alcohol Abuse and Alcoholism for providing
access to the NESARC data.
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