Screening for personality disorder: a comparison of personality disorder assessment by patient and informants

Age-neutrality of the SCID-II: Differential Item Functioning in Younger Outpatients (Aged 20-45) and Older Outpatients (Aged 65+)

OBJECTIVES

Measurements are often developed for the assessment of personality disorders (PDs) in younger adults and seldom evaluated on the applicability in older adults. Remarkably, research has not yet been conducted into age-group appropriateness of the gold standard for the assessment of PDs, known as Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II). Therefore, the current study empirically investigated the age-neutrality of the PDs assessed by the SCID-II.

METHODS

Age-neutrality was examined in 84 younger adults (aged 20-45 years) and 68 older adults (aged 65-85) by Differential Item Functioning (DIF). The impact of DIF on scale level was further examined using Differential Test Functioning analyzes to examine the impact of the amount of DIF variance in the items on scale level.

RESULTS

Overall, the great majority, 95.8% of the categorically measured items and 87.5% of the dimensionally measured items, was endorsed in the same way by younger adults and older adults with equal scores on the PD scale. Subsequent analyzes revealed no large DTF for PD scales.

CONCLUSIONS

Overall the SCID-II in an outpatient population is age-neutral for both categorically and dimensionally scored PD scales.

CLINICAL IMPLICATIONS

The SCID-II can be used for the assessment of PDs in older adults.

Informant assessment: The Informant Five-Factor Narcissism Inventory

A series of self-report measures of personality disorder from the perspective of the five-factor model (FFM) have been published; however, no informant-report versions have been developed. An informant version of the Five Factor Narcissism Inventory (FFNI) is particularly apt, given the degree of distortion in self-description inherent to narcissism. The present study provides initial validation for the Informant Five-Factor Narcissism Inventory (IFFNI). In Study 1, informant reports from friends, romantic partners, parents, and other family members were compared with self-reports provided by undergraduate college students on the IFFNI, FFM personality, and social dysfunction. Self-other agreement for IFFNI Grandiose (G) was higher than what has been found with other narcissism measures. No self-informant convergence, though, was found for IFFNI Vulnerable (V). From the informant view, IFFNI-G and V narcissism were associated with social dysfunction, whereas from the self-view only FFNI-V was associated with social dysfunction. In Study 2, grandiose and vulnerable narcissists, identified by participants recruited from MTurk, were described in terms of the IFFNI, FFM, and Pathological Narcissism Inventory (PNI). Results indicated that the IFFNI discriminated well between G and V narcissism for all but a few scales. The exceptions may reflect vulnerable narcissistic traits within grandiose narcissists. In comparison, the PNI obtained a very similar informant profile for the G and V narcissists. In sum, the results of the current study suggest value in having an informant-based measure of narcissism. (PsycINFO Database Record

Development and Diagnostic Accuracy of the Screening of the Dimensional Clinical Personality Inventory

Abstract: The assessment of personality disorders assumes unquestioned clinical relevance when considering the prevalence rates in the general population. Tests assessing the typical pathological traits of these disorders has been adapted to and developed in Brazil. However, there is a gap in the country of screening tools for personality disorders. Screening tools are designed to allow a fast and informative application on the likelihood of a positive diagnosis, where the consequence should be conveyed to a diagnostic assessment. Using as a base the Dimensional Clinical Personality Inventory (IDCP), developed at the national level, the objective of this research was to develop a screening tool for personality disorders, as well as investigate its diagnostic accuracy. The study included 1,196 people, aging between 18 and 73 years (M = 26.32, SD = 8.69), and 64.1% female. The sample was divided into clinical and non-clinical group. We used an empirical approach based on criteria for selection of items similar to those adopted in the development of Minnesota Multiphasic Personality Inventory was used (MMPI). The logistic regression analysis and also the calculation of Cohen's d indicated the items that best discriminate against people with personality disorders and those without this diagnosis. We achieved a final set of 15 items with satisfactory sensitivity and specificity for screening test. We discusses the strengths and limitations of screening version of the IDCP and guidelines for further study.

Self- and informant-reported perspectives on symptoms of narcissistic personality disorder

Because narcissistic individuals tend to have an inflated view of themselves and their abilities, the reliance on self-reported information in the assessment and diagnosis of narcissistic personality disorder (NPD) is problematic. Hence, the use of informants in the assessment of NPD may be necessary. In the current study we examined self- and informant-reported features of NPD using agreement, frequency, and discrepancy analyses. The results indicated that informants tended to report more NPD features than selves, and that there were either low or nonsignificant levels of self-informant agreement among the 9 NPD diagnostic criteria and its categorical diagnosis. Informants were increasingly more likely to report higher raw scores relative to selves, indicating that the discrepancy between self- and informant reports increases with the NPD scale. Informants also reported NPD features that selves often did not, suggesting that current prevalence estimates of NPD, which use only self-reported information, are most likely underestimates. These results highlight the importance of gathering informant-reported data in addition to self-reported data when assessing NPD. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

Assessment and diagnosis of personality disorder: perennial issues and an emerging reconceptualization

This chapter reviews recent (2000-2005) personality disorder (PD) research, focusing on three major domains: assessment, comorbidity, and stability. (a) Substantial evidence has accrued favoring dimensional over categorical conceptualization of PD, and the five-factor model of personality is prominent as an integrating framework. Future directions include assessing dysfunction separately from traits and learning to utilize collateral information. (b) To address the pervasiveness and extent of comorbidity, researchers have begun to move beyond studying overlapping pairs or small sets of disorders and are developing broader, more integrated common-factor models that cross the Axis I-Axis II boundary. (c) Studies of PD stability have converged on the finding that PD features include both more acute, dysfunctional behaviors that resolve in relatively short periods, and maladaptive temperamental traits that are relatively more stable-similar to normal-range personality traits-with increasing stability until after 50 years of age. A new model for assessing PD-and perhaps all psychopathology-emerges from integrating these interrelated reconceptualizations.

Screening for personality disorders

A brief but valid self-report measure to screen for personality disorders (PDs) would be a valuable tool in making decisions about further assessment and in planning optimal treatments. In psychiatric and nonpsychiatric samples, we compared the validity of three screening measures: the PD scales from the Inventory of Interpersonal Problems, a self-report version of the Iowa Personality Disorder Screen, and the selfdirectedness scale of the Temperament and Character Inventory. Despite their different theoretical origins, the screeners were highly correlated in a range from .71 to .77. As a result, the use of multiple screeners was not a significant improvement over any individual screener, and no single screener stood out as clearly superior to the others. Each performed modestly in predicting the presence of any PD diagnosis in both the psychiatric and nonpsychiatric groups. Performance was best when predicting a more severe PD diagnosis in the psychiatric sample. The results also highlight the potential value of multiple assessments when relying on self-reports.