Patients' versus informants' reports of personality disorders in predicting 7 1/2-year outcome in outpatients with depressive disorders

Eyes of the beholders: Multi-method relationships between internalizing and externalizing symptom dimensions and aggression risk

Although aggression occurs across a range of disorders, associations between dimensions of psychopathology and self- and other-directed aggression are not well understood. Investigating associations between psychopathology dimensions and aggression helps further understanding about the etiology of aggression, and ultimately, can inform intervention and prevention strategies. This study adopted a multi-method approach to examine associations between internalizing and externalizing dimensions of psychopathology and self- and other-directed aggression as a function of reporter (participant and informant) and modality of aggression measurement (subjective and objective). Participants were an unselected sample of 151 racially diverse adults recruited from the community. Dimensions of psychopathology were assessed using interview and questionnaire reports from participants and collateral informants, and forms of aggression were measured via subjective reports and an objective, laboratory aggression paradigm. Analyses of participant-reported psychological symptom data consistently linked externalizing symptoms to other-directed aggression, and internalizing symptoms to self-directed aggression. Results across informant and participant reporters replicated prior findings showing a significant interaction between internalizing and externalizing dimensions in predicting intimate partner violence. Most other effects in informant models were nonsignificant. The findings uncover consistency in and replicability of relationships between dimensions of psychopathology and certain manifestations of aggression and highlight the importance of examining multiple forms of aggression in etiological research. Examining aggression through a transdiagnostic lens can help us better understand and intervene upon processes implicated in devasting forms of self- and other-directed aggression.

The Role of Personality in the Mental and Physical Health of World Trade Center Responders: Self- versus Informant-Reports

Personality is linked to important health outcomes, but most prior studies have relied on self-reports, making it possible that shared-method variance explains the associations. The present study examined self- versus informant-reports of personality and multi-method outcomes. World Trade Center (WTC) responders and informants, 283 pairs, completed five-factor model personality measures and multi-method assessments of stressful events, functioning, mental disorders, 9/11-related treatment costs, BMI, and daily activity across three years. Self-reports were uniquely related to stressful events and functioning. Both self-reports and informant-reports showed incremental validity over one another for mental disorder diagnoses and treatment costs. For objective outcomes daily activity and BMI, informant-reports showed incremental validity over self-reports, accounting for all self-report variance and more. The findings suggest that informant-reports of personality provide better validity for objective health outcomes, which has implications for understanding personality and its role in mental and physical health.

A developmental perspective on personality and psychopathology across the life span

Taking a developmental perspective, guided by core principles of developmental science and developmental psychopathology, is necessary to move the fields of personality science and psychopathology forward. Personality and psychopathology can be delineated using hierarchical models of individual differences, as evidenced by decades of converging evidence across community and psychiatric samples, countries and cultures, and ages and developmental periods. A large body of empirical research likewise documents associations between personality and various forms of psychopathology. Cross-sectional investigations of personality-psychopathology links in samples of adults now yield diminishing returns. Prospective, longitudinal investigations that assess personality, psychopathology, and their co-development across the life span are needed to determine their temporal ordering, capture dynamic associations over time and development, and elucidate causal origins and underlying mechanisms. We lay out a developmental framework that integrates across the developmental, personality, and psychopathology literatures in order to further understanding and guide future investigations of the nature of personality-psychopathology links.

Self-informant Agreement for Personality and Evaluative Person Descriptors: Comparing Methods for Creating Informant Measures

Little attention typically is paid to the way self-report measures are translated for use in self-informant agreement studies. We studied two possible methods for creating informant measures: (a) the traditional method in which self-report items were translated from the first- to the third-person and (b) an alternative meta-perceptual method in which informants were directed to rate their perception of the targets' self-perception. We hypothesized that the latter method would yield stronger self-informant agreement for evaluative personality dimensions measured by indirect item markers. We studied these methods in a sample of 303 undergraduate friendship dyads. Results revealed mean-level differences between methods, similar self-informant agreement across methods, stronger agreement for Big Five dimensions than for evaluative dimensions, and incremental validity for meta-perceptual informant rating methods. Limited power reduced the interpretability of several sparse acquaintanceship effects. We conclude that traditional informant methods are appropriate for most personality traits, but meta-perceptual methods may be more appropriate when personality questionnaire items reflect indirect indicators of the trait being measured, which is particularly likely for evaluative traits.

Incremental Validity of Self- and Informant Report of Personality Disorders in Later Life

Research shows moderate agreement between different sources of information when assessing personality disorders (PDs) in older adults. The differences between measurement methods appear to be not only the result of measurement error, but also an indication that each source holds nonredundant information relevant to PD diagnosis. The current article examines three sources of diagnostic information (self-report, informant report, and clinical interview) and the utility of these instruments in predicting important outcomes in older adulthood. We analyzed data from 1,630 adults between the ages of 55 and 64 years participating in a longitudinal study of later life. PD symptomatology was assessed using multiple methods, which were then used to predict health, marital satisfaction, and cognitive decline. All three sources contributed significantly to the prediction of these outcomes, with important implications for the assessment of older adults in research and clinical settings.

Stable psychological functioning after surgery for epilepsy: An informant-based perspective

OBJECTIVE

Psychological adjustment following surgery for epilepsy has been assessed primarily with self-report measures. In the current work, we investigated pre- to postoperative changes in various dimensions of personality and behavior from the perspective of a well-known family member or friend for 27 patients operated on for medically intractable epilepsy.

METHODS

For each patient, a close family member or friend ("informant") provided pre- and postoperative ratings on five dimensions of personality and behavior. All ratings were collected during the chronic epoch of recovery, when personality and behavior of the patients are relatively stable. Self-report measures were also used to examine the relation between self-report and informant-report assessment of psychological adjustment. Lastly, the relation between seizure outcomes and psychological adjustment was investigated.

RESULTS

Personality and behavior characteristics, as rated by an informant, remained stable and within a normal range of functioning following surgery for epilepsy. There were no significant differences between pre- and postoperative levels of executive functioning, social behavior, hypo-emotionality, irascibility, or distress. Informant-ratings on levels of current depression and overall current psychological functioning were significantly related to patient reports of current depression and global personality characteristics derived from the MMPI-2 (e.g., psychasthenia, schizophrenia, hypomania, psychopathic deviation, social introversion). There was no significant relationship between seizure outcome and psychological adjustment.

SIGNIFICANCE

Informant-based reports on psychological adjustment following surgery for epilepsy provide a unique perspective on important aspects of the success of the intervention. Assessing outcomes beyond seizure status is important for developing a comprehensive understanding of the potential consequences of surgery for epilepsy. Based on the current work, personality and behavior seem to be stable following surgery for epilepsy, and our study provides a unique informant-based perspective on this encouraging result.

Research Review: Multi-informant integration in child and adolescent psychopathology diagnosis

BACKGROUND

An empirically based, clinically usable approach to cross-informant integration in clinical assessment is needed. Although the importance of this ongoing issue is becoming increasingly recognized, little in the way of solid recommendations is currently provided to researchers and clinicians seeking to incorporate multiple informant reports in diagnosis of child psychopathology. The issue is timely because recent developments have created new opportunities for improved handling of this problem. For example, advanced theories of psychopathology and normal and abnormal child development provide theoretical guidance for how integration of multiple informants should be handled for specific disorders and at particular ages. In addition, more sophisticated data analytic approaches are now available, including advanced latent variable models, which allow for complex measurement approaches with consideration of measurement invariance.

FINDINGS

The increasing availability and mobility of computing devices suggests that it will be increasingly feasible for clinicians to implement more advanced methods rather than being confined to the easily memorized algorithms of the DSM system.

CONCLUSIONS

Development of models of cross-informant integration for individual disorders based on theory and tests of the incremental validity of more sophisticated cross-informant integration approaches in comparison to external validation criteria (e.g. longitudinal trajectories and outcomes, treatment response, and behavior genetic etiology) should be a focus of future work.

The Psychopathy Q-Sort

Scant research has examined the validity of instruments that permit observer ratings of psychopathy. Using a nonclinical (undergraduate) sample, the authors examined the associations between both self-and observer ratings on a psychopathy prototype (Psychopathy Q-Sort, PQS) and widely used measures of psychopathy, antisocial behavior, and negative emotionality. Self- and observer prototype correlations generally displayed predicted patterns of convergent and discriminant validity for the PQS. Future research using the PQS should focus on potential domains of incremental validity of peer-rated psychopathy beyond self-reported psychopathy.

Agreement Between Self- and Informant-Reported Ratings of Personality Traits: The Moderating Effects of Major Depressive and/or Panic Disorder

Several personality traits are risk factors for psychopathology. As symptoms of psychopathology may influence self-rated personality, informant reports of personality are also sometimes collected. However, little is known about self-informant agreement in individuals with anxiety and/or depression. We investigated whether self-informant agreement on positive and negative affectivity (PA and NA) and anxiety sensitivity differs for individuals with major depressive disorder (MDD) and/or panic disorder (PD; total n = 117). Informant- and self-reported PA was correlated among those with MDD, but not among those without MDD. Informant- and self-reported anxiety sensitivity was correlated among those with PD, but not among those without PD. Informant- and self-reported NA was correlated irrespective of diagnosis. Results indicate that the agreement of self- and informant-reported personality may vary as a function of depression and/or anxiety disorders.

An Examination of the Higher-Order Structure of Psychopathology and its Relationship to Personality

This study compared a series of higher-order models encompassing symptoms of both clinical and personality disorders. The final model was then correlated with a latent variable model of normal personality traits. A total of 420 undergraduates completed a battery of self-report symptom and personality questionnaires, with informant-reports and diagnostic interviews provided by overlapping subsamples. A three-level model with two factors at the highest level and four factors at the second level was the best fitting model. The higher-order internalizing and externalizing factors were then correlated with 30 latent personality facets. Results demonstrate an elevation on the neuroticism facets for the higher-order internalizing factor, along with low positive emotions, low actions, and low competence. The higher-order externalizing factor was negatively associated with most conscientiousness and agreeableness factors, while showing an elevation on excitement-seeking, impulsivity, and angry hostility. Future studies should replicate these models with the inclusion of more low base-rate disorders (i.e., psychosis).

Investigating the Personality Inventory for DSM-5 using self and spouse reports

Two new clinical tools, the Personality Inventory for DSM-5 (PID-5) and its informant report version, the PID-5-IRF, were developed to assess personality pathology as described by the new trait-based model within Section III of DSM-5. The current study used both self and spousal reports to evaluate agreement between the PID-5 and the PID-5-IRF and to determine the extent to which these measures capture personality pathology as conceptualized in Section II of DSM-5. A nonclinical sample (N = 96 individuals) of recently married couples completed the self-report PID-5, the PID-5-IRF, and the SNAP-2 to assess self-reported DSM-IV PD criteria. Analyses found good to excellent agreement between spousal reports on the PID-5 and the PID-5-IRF for facets in the negative affectivity, detachment, and antagonism domains. In addition, both the PID-5 and the PID-5-IRF each individually accounted for a significant proportion of variance in self-reported DSM-IV PD criteria. Implications for the present findings are discussed.

Psychometric Comparison of Self- and Informant-Reports of Personality

Self-reports are the most relied on assessment method in psychology. In the area of personality, informant-reports are a reasonable alternative assessment strategy. However, agreement between self- and informant-reports of personality is only moderately good. A portion of the observed discrepancies between self- and informant-reports of personality may come from differences in psychometric measurement across raters. That is, it is unknown whether the constructs assessed via self- and informant-reports are psychometrically identical. We examined four key personality scales--Well-Being, Social Closeness, Stress Reaction, and Harm Avoidance--in male and female dyads who provided self- and informant-reports for their partner. Similarities in self- and informant-reports of personality were evaluated by testing measurement invariance. Overall, models supported configural, metric, and scalar invariance for each of the four personality dimensions. These results suggest that the same psychometric constructs are assessed via self- and informant-reports of these personality dimensions. Informant-reports can be used in studies to avoid biases from relying solely on self-reports.

The aversive interpersonal behaviors associated with pathological personality traits

Although interpersonal dysfunction is a defining feature of personality disorders (PDs), relatively little is known about how features of PD are perceived by others. In the current study, students (n = 225) reported on the traits and aversive interpersonal behaviors of individuals with pathological personality features. Aversive behaviors were measured using the Interpersonal Sensitivity Circumplex, and pathological personality features were assessed using the DSM-5 Section 3 traits. The structural summary method for circumplex data was used to evaluate how pathological traits related to both general and specific aversive behaviors. Most traits associated with PDs were related to general aversive behaviors. Specific associations suggested that young adults are most irritated when individuals with personality pathology try to form or sustain attachments, as opposed to control, withdraw, or submit to them. These results are consistent with the assumption that personality pathology is broadly characterized by aversive behaviors and imply that individuals are most bothered by maladaptive attempts by others to become or stay connected.

Collecting Information for Rating Global Assessment of Functioning (GAF): Sources of Information and Methods for Information Collection

INTRODUCTION

Global Assessment of Functioning (GAF) is an assessment instrument that is known worldwide. It is widely used for rating the severity of illness. Results from evaluations in psychiatry should characterize the patients. Rating of GAF is based on collected information. The aim of the study is to identify the factors involved in collecting information that is relevant for rating GAF, and gaps in knowledge where it is likely that further development would play a role for improved scoring.

METHODS

A literature search was conducted with a combination of thorough hand search and search in the bibliographic databases PubMed, PsycINFO, Google Scholar, and Campbell Collaboration Library of Systematic Reviews.

RESULTS

Collection of information for rating GAF depends on two fundamental factors: the sources of information and the methods for information collection. Sources of information are patients, informants, health personnel, medical records, letters of referral and police records about violence and substance abuse. Methods for information collection include the many different types of interview - unstructured, semi-structured, structured, interviews for Axis I and II disorders, semistructured interviews for rating GAF, and interviews of informants - as well as instruments for rating symptoms and functioning, and observation. The different sources of information, and methods for collection, frequently result in inconsistencies in the information collected. The variation in collected information, and lack of a generally accepted algorithm for combining collected information, is likely to be important for rated GAF values, but there is a fundamental lack of knowledge about the degree of importance.

CONCLUSIONS

Research to improve GAF has not reached a high level. Rated GAF values are likely to be influenced by both the sources of information used and the methods employed for information collection, but the lack of research-based information about these influences is fundamental. Further development of GAF is feasible and proposals for this are presented.

The enduring impact of maladaptive personality traits on relationship quality and health in later life

Over the past 5 years, the St. Louis Personality and Aging Network (SPAN) has been collecting data on personality in later life with an emphasis on maladaptive personality, social integration, and health outcomes in a representative sample of 1,630 adults aged 55-64 living in the St. Louis area. This program has confirmed the importance of considering both the normal range of personality and in particular the role of maladaptive traits in order to understand individuals' relationships, life events, and health outcomes. In the current article, we discuss the explanatory benefits of considering maladaptive traits or traits associated with personality disorders when discussing the role of personality in social and health outcomes, with an emphasis on adults in middle to later life, and integrate these findings into the greater literature.

Self-other knowledge asymmetries in personality pathology

OBJECTIVE

Self-reports of personality provide valid information about personality disorders (PDs). However, informant reports provide information about PDs that self-reports alone do not provide. The current article examines whether and when one perspective is more valid than the other in identifying PDs.

METHOD

Using a representative sample of adults 55 to 65 years of age (N = 991; 45% males), we compared the validity of self- and informant (e.g., spouse, family, or friend) reports of the Five-Factor Model traits in predicting PD scores (i.e., composite of interviewer, self-, and informant reports of PDs).

RESULTS

Self-reports (particularly of Neuroticism) were more valid than informant reports for most internalizing PDs (i.e., PDs defined by high Neuroticism). Informant reports (particularly of Agreeableness and Conscientiousness) were more valid than self-reports for externalizing and/or antagonistic PDs (i.e., PDs defined by low Agreeableness and Conscientiousness). Neither report was consistently more valid for thought disorder PDs (i.e., PDs defined by low Extraversion). However, informant reports (particularly of Agreeableness) were more valid than self-reports for PDs that were both internalizing and externalizing (i.e., PDs defined by high Neuroticism and low Agreeableness).

CONCLUSIONS

The intrapersonal and interpersonal manifestations of PDs differ, and these differences influence who knows more about pathology.

Identifying personality pathology associated with major depressive episodes: incremental validity of informant reports

Major limitations are associated with the use of a single source of information to assess personality pathology. The construct validity of standardized interviews and informant reports on personality pathology has been established relative to other measures of personality pathology, but it is also important to consider these measures in relation to other constructs that should be related to personality pathology. One example is major depression. In this study, we evaluated whether less common clinical methods of assessment for measuring the same personality pathology constructs, including semistructured interviews and informant reports, demonstrate unique validity, using major depressive episode (MDE) as the external criterion. This analysis focuses on a representative, community-based sample of 1,437 participants and informants. We conducted a hierarchical logistic regression analysis and determined the order of entering the predictor variables based on likelihood of being used in a clinical setting as well as empirical recommendations. Each step of our regression model significantly increased our ability to predict lifetime MDE, including self, interviewer, and informant reports of personality pathology. Overall, these findings indicate that multiple sources of personality assessment provide unique information about the relationship between maladaptive personality traits and a history of MDE. Thus, semistructured diagnostic interviews and informant reports can be used as a resource to improve the validity of personality assessments.

Convergent and incremental predictive validity of clinician, self-report, and structured interview diagnoses for personality disorders over 5 years

OBJECTIVE

Research has demonstrated poor agreement between clinician-assigned personality disorder (PD) diagnoses and those generated by self-report questionnaires and semistructured diagnostic interviews. No research has compared prospectively the predictive validity of these methods. We investigated the convergence of these 3 diagnostic methods and tested their relative and incremental validity in predicting independent, multimethod assessments of psychosocial functioning performed prospectively over 5 years.

METHOD

Participants were 320 patients in the Collaborative Longitudinal Personality Disorders Study diagnosed with PDs by therapist, self-report, and semistructured interview at baseline. We examined the relative incremental validity of therapists' naturalistic ratings relative to these other diagnostic methods for predicting psychosocial functioning at 5-year follow-up.

RESULTS

Hierarchical linear regression analyses revealed that both the self-report questionnaire and semistructured interview PD diagnoses had significant incremental predictive validity over the PD diagnoses assigned by a treating clinician. Although, in some cases, the clinicians' ratings for individual PDs did have validity for predicting subsequent functioning, they did not generally provide incremental prediction beyond the other methods. These findings remained robust in a series of analyses restricted to a subsample of therapist ratings based on clinical contact of 1 year or greater.

CONCLUSIONS

These results from a large clinical sample echo previous research documenting limited agreement between clinicians' naturalistic PD diagnoses and those from self-report and semistructured interview methods. They extend prior work by providing the first evidence about the relative predictive validity of these different methods. Our findings challenge the validity of naturalistic PD diagnoses and suggest the use of structured diagnostic instruments.

Thin slice ratings of client characteristics in intake assessments: predicting symptom change and dropout in cognitive therapy for depression

Thin slice ratings of personality have been shown to predict a number of outcomes, but have yet to be examined in the context of psychotherapy. In a sample of 66 clients participating in cognitive therapy for depression, we examined the predictive utility of thin slice rated pre-treatment client traits. On the basis of short video clip excerpts (i.e., thin slices) of intake assessments, trained observers rated clients on personality characteristics and specific personality disorder (PD) traits. Clients' therapy interest and neuroticism predicted lower odds of dropout. Ratings of extraversion predicted greater symptom change across treatment; ratings of clients' Avoidant and Schizoid PD traits predicted less marked symptom improvement. Ratings of agreeableness and likeability also predicted greater symptom change, but these relations were only significant in one of two analytic approaches used. Evidence for the predictive validity of thin slice ratings was generally stronger than that observed for self-reported PD traits and PD status. Moreover, these self-report and diagnostic assessments failed to account for the thin slice-outcome relations identified. Findings support the clinical utility of quick, thin slice impressions of clients, as these ratings could be used to identify clients with a high risk of dropout or poor treatment outcome.

Self-concept of college students with ADHD: discordance between self- and parent-reports

OBJECTIVE

To investigate the self-concept of college students with ADHD.

METHOD

College students with ADHD and their parents completed self-report and observer-report measures of self-concept, respectively.

RESULTS

Results indicated that college students with ADHD did not report problems with self-concept but their parents did for them. This difference was statistically significant and large in magnitude (d = .84).

CONCLUSION

Perceptions of the self-concept of college students with ADHD appear to vary by informant source. Hypotheses for the discordance between self- and parent-reports are discussed. Multi-informant assessment is recommended as a way to obtain a more complete clinical picture than reliance on self- or parent-report alone.

Personality disorder symptoms are differentially related to divorce frequency

Divorce is associated with a multitude of outcomes related to health and well-being. Data from a representative community sample (N = 1,241) of St. Louis residents (ages 55-64) were used to examine associations between personality pathology and divorce in late midlife. Symptoms of the 10 DSM-IV personality disorders were assessed with the Structured Interview for DSM-IV Personality and the Multisource Assessment of Personality Pathology (both self and informant versions). Multiple regression analyses showed Paranoid and Histrionic personality disorder symptoms to be consistently and positively associated with number of divorces across all three sources of personality assessment. Conversely, Avoidant personality disorder symptoms were negatively associated with number of divorces. The present paper provides new information about the relationship between divorce and personality pathology at a developmental stage that is understudied in both domains.

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).

Agreement between informant and self-reported personality in depressed older adults: what are the roles of medical illness and cognitive function?

In a sample of 77 dyads, involving depressed patients at least 50 years of age and their family or friends (informants), patient illness burden and cognitive decline were associated with self-informant rating discrepancies for facets of Revised NEO Personality Inventory (NEO-PI-R) Openness and Extraversion. Informant judgments about Neuroticism and Conscientiousness were not associated with illness burden or cognitive function, underscoring the potential utility of risk-detection strategies that rely on informant-report in these two domains. Findings suggest the need for research on how patient illness severity and cognitive function affect how friends and family use or misuse information when making judgments about older depressed patients.

Reconceptualizing personality pathology in DSM-5: limitations in evidence for eliminating dependent personality disorder and other DSM-IV syndromes

The DSM-5 Personality and Personality Disorders Workgroup proposed that five DSM-IV personality disorders be eliminated as formal diagnostic categories (paranoid, schizoid, histrionic, narcissistic, and dependent), because these syndromes purportedly have low clinical utility and minimal evidence for validity. Scrutiny of studies cited in support of this proposal reveals difficulties in three areas: (1) Inadequate information regarding parameters of the literature search; (2) Mixed empirical support for proposed changes; and (3) Selective attention to certain disorders and not others. Review of validity and clinical utility data related to dependent personality disorder indicates that evidence regarding this syndrome does not differ from that of syndromes proposed for retention in DSM-5. Limitations in the research base cited by the workgroup illuminates gaps in the personality disorder literature, and may serve as a starting point for systematic research on personality pathology so that adequate empirical data are available to decide which syndromes to retain, revise, or remove in future versions of the diagnostic manual.

Level of agreement between self and spouse in the assessment of personality pathology

Informant reports can provide important information regarding the presence of pathological personality traits, and they can serve as useful supplements to self-report instruments. Ratings from a spouse may be a particularly valuable source of personality assessment because spouses are very well acquainted with the target person, have typically known the person for a long time, and witness behaviors across a variety of situations. In the current study, self- and spouse report measures based on the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) personality disorder criteria were collected from a nonclinical sample of 82 couples (N = 164). Agreement between self- and spouse report for several pathological personality factors was significant and somewhat higher than has been found for self and peer agreement. Nevertheless, the magnitude of self-spouse agreement was still moderate in size (mean r = .36). Findings are discussed with regard to using spouse report in the assessment of personality pathology.

Comparing personality disorder models: cross-method assessment of the FFM and DSM-IV-TR

The current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; American Psychiatric Association, 2000) defines personality disorders as categorical entities that are distinct from each other and from normal personality traits. However, many scientists now believe that personality disorders are best conceptualized using a dimensional model of traits that span normal and abnormal personality, such as the Five-Factor Model (FFM). However, if the FFM or any dimensional model is to be considered as a credible alternative to the current model, it must first demonstrate an increment in the validity of the assessment offered within a clinical setting. Thus, the current study extended previous research by comparing the convergent and discriminant validity of the current DSM-IV-TR model to the FFM across four assessment methodologies. Eighty-eight individuals receiving ongoing psychotherapy were assessed for the FFM and the DSM-IV-TR personality disorders using self-report, informant report, structured interview, and therapist ratings. The results indicated that the FFM had an appreciable advantage over the DSM-IV-TR in terms of discriminant validity and, at the domain level, convergent validity. Implications of the findings and directions for future research are discussed.

Pathological narcissism and narcissistic personality disorder

We review the literature on pathological narcissism and narcissistic personality disorder (NPD) and describe a significant criterion problem related to four inconsistencies in phenotypic descriptions and taxonomic models across clinical theory, research, and practice; psychiatric diagnosis; and social/personality psychology. This impedes scientific synthesis, weakens narcissism's nomological net, and contributes to a discrepancy between low prevalence rates of NPD and higher rates of practitioner-diagnosed pathological narcissism, along with an enormous clinical literature on narcissistic disturbances. Criterion issues must be resolved, including clarification of the nature of normal and pathological narcissism, incorporation of the two broad phenotypic themes of narcissistic grandiosity and narcissistic vulnerability into revised diagnostic criteria and assessment instruments, elimination of references to overt and covert narcissism that reify these modes of expression as distinct narcissistic types, and determination of the appropriate structure for pathological narcissism. Implications for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders and the science of personality disorders are presented.

Examining the reliability and validity of clinician ratings on the Five-Factor Model Score Sheet

Despite substantial research use, measures of the five-factor model (FFM) are infrequently used in clinical settings due, in part, to issues related to administration time and a reluctance to use self-report instruments. The current study examines the reliability and validity of the Five-Factor Model Score Sheet (FFMSS), which is a 30-item clinician rating form designed to assess the five domains and 30 facets of one conceptualization of the FFM. Studied in a sample of 130 outpatients, clinical raters demonstrated reasonably good interrater reliability across personality profiles and the domains manifested good internal consistency with the exception of Neuroticism. The FFMSS ratings also evinced expected relations with self-reported personality traits (e.g., FFMSS Extraversion and Schedule for Nonadaptive and Adaptive Personality Positive Temperament) and consensus-rated personality disorder symptoms (e.g., FFMSS Agreeableness and Narcissistic Personality Disorder). Finally, on average, the FFMSS domains were able to account for approximately 50% of the variance in domains of functioning (e.g., occupational, parental) and were even able to account for variance after controlling for Axis I and Axis II pathology. Given these findings, it is believed that the FFMSS holds promise for clinical use.

Self-other disagreement in personality assessment: significance and prognostic value

The feasibility of the use of multiple informant reports in clinical practice was examined in a sample of 105 psychiatric outpatients who provided self-ratings and (2-3) informants' reports on the Five Factor Personality Inventory. The response rate was 97%. The patients assessed themselves as less extraverted and more emotionally stable than their proxies did. In addition, the significance of self-other disagreement was investigated. Our first hypothesis, stating that self-other disagreement would correlate with (personality) pathology, was confirmed: self-other disagreement predominantly occurred in introverted, shy, hostile and depressed persons who tended to have more personality problems and co-morbidity. We found no support for our second hypothesis, stating that self-other disagreement would predict a diminished therapy effect. An important finding, however, was that self-other disagreement proved to be a strong predictor of dropout. Furthermore, a decrease in depression, hostility and shyness was positively correlated with a decrease in self-other disagreement.

[Assessment of personality and personality pathology in older persons]

Compared to other domains in personality research, research on personality and personality pathology in the elderly is still in its infancy. However, with the growing proportion of older people in the population, the interest in this topic has increased sharply in the past years. Nevertheless, our knowledge about this domain remains relatively limited. Researchers in this domain are facing several challenges. On the one hand, little is known about the course of personality and psychopathology in later life, because longitudinal studies are scarce or non-existent. On the other hand, both clinical practice and the research literature indicate a growing demand for reliable and valid instruments for the assessment of personality in the elderly. In this article we discuss the main conceptual and methodological issues, as well as recent evolutions concerning this research domain in the Netherlands and Flanders.

Comparison of Three Self-Report Measures of Personality Pathology

Levels of convergence among three measures of personality pathology, the Personality Diagnostic Questionnaire-4+ (PDQ-4+), the Structured Clinical Interview for DSM-IV Axis II Personality Disorders Questionnaire (SCID-IIQ) and the Multi-source Assessment of Personality Pathology (MAPP) were examined. Each questionnaire was administered three times in an alternating sequence over nine consecutive weekdays to a sample of college students. There was some degree of convergence among the three instruments, but there were also substantial empirical differences between them. The data suggest three related conclusions: (1) in general, the self-report version of the MAPP is more conservative than the other two questionnaires, (2) these questionnaires should not be considered interchangeable measures of the same constructs, and (3) the breadth of measurement provided varies as a function of both the questionnaire and the specific personality disorder being measured.

Person Perception and Personality Pathology

Studies of person perception (people's impressions and beliefs about others) have developed important concepts and methods that can be used to help improve the assessment of personality disorders. They may also inspire advances in our knowledge of the nature and origins of these conditions. Information collected from peers and other types of informants is reliable and provides a perspective that often differs substantially from that obtained using questionnaires and interviews. For some purposes, this information is quite useful. Much remains to be learned about the incremental validity (and potential biases) associated with data from various kinds of informants.

Personality disorder symptoms and marital functioning

Pathological personality is strongly linked with interpersonal impairment, yet no study to date has examined the relationship between concurrent personality pathology and dysfunction in marriage--a relationship that most people find central to their lives. In a cross-sectional study of a community sample of married couples (N = 82), the authors used multilevel modeling to estimate the association of self- and spouse-reported symptoms of personality disorder (PD) with levels of marital satisfaction and verbal aggression and perpetration of physical violence. Inclusion of self- and spouse report of total PD symptoms resulted in improved model fit and greater variance explained, with much of the improvement coming after the addition of spouse report. The incremental validity of spouse report for several of the 10 PD scales was supported for marital satisfaction and verbal aggression, particularly for the Borderline and Dependent PD scales.

Detection of aberrant responding on a personality scale in a military sample: an application of evaluating person fit with two-level logistic regression

Person-fit assessment is used to identify persons who respond aberrantly to a test or questionnaire. In this study, S. P. Reise's (2000) method for evaluating person fit using 2-level logistic regression was applied to 13 personality scales of the Schedule for Nonadaptive and Adaptive Personality (SNAP; L. Clark, 1996) that had been administered to military recruits (N = 2,026). Results revealed significant person-fit heterogeneity and indicated that for 5 SNAP scales (Disinhibition, Entitlement, Exhibitionism, Negative Temperament, and Workaholism), the scale was more discriminating for some people than for others. Possible causes of aberrant responding were explored with several covariates. On all 5 scales, severe pathology emerged as a key influence on responses, and there was evidence of differential test functioning with respect to gender, ethnicity, or both. Other potential sources of aberrancy were carelessness, haphazard responding, or uncooperativeness. Social desirability was not as influential as expected.

Depressive personality disorder, dysthymia, and their relationship to perfectionism

This paper reports the results of two studies in a nonclinical (n=105) and primary care outpatient sample (n=110), in which Depressive Personality Disorder (DPD), Dysthymia, and depression were assessed for their distinctive relationship with perfectionism. Results from both studies found that self-reported DPD, Dysthymia, and depressive symptoms were all intercorrelated, and that DPD, Dysthymia, and depressive symptoms were correlated with three dimensions of perfectionism-Concern over Mistakes, Doubts about Actions, and Parental Criticism. In the nonclinical sample, variance in measures of DPD was predicted by measures of perfectionism after controlling for depression and Dysthymia symptoms. A similar pattern of findings was observed in the primary care sample. This relationship with perfectionism did not occur when Dysthymia or depressive symptoms were predicted. Nevertheless, much of the variance in measures of DPD, Dysthymia, and depressive symptoms is associated with each other and not perfectionism. It is concluded that a common factor or set of factors underlies these disorders, but that DPD may be more strongly related to perfectionism than Dysthymia and depression. As a common factor(s) is identified, measures of DPD and Dysthymia may be refined, thereby increasing the discriminant validity of their measures.

Assessing normal and abnormal personality functioning: strengths and weaknesses of self-report, observer, and performance-based methods

Assessing personality characteristics; distinguishing the boundaries between normal and abnormal functioning; identifying impairment in the domains of work, interpersonal relationships, and emotional state due to maladaptive personality traits; and translating these findings into effective, appropriate treatment interventions is a complicated endeavor. Valid, reliable conclusions about an individual's personality functioning and adjustment cannot be reached unless one has accurate information about that person's patterns of behavior, cognitions, emotions, and interpersonal relationships. I discuss strengths and weaknesses of assessment approaches utilizing explicit assessment methods, such as self-report measures and clinical interviews; information obtained from knowledgeable observers; and performance-based, implicit assessment methods such as the Rorschach Comprehensive System (Exner, 2003). In contrast to explicit methods of assessment, implicit methods can provide salient information about a personality construct whether or not individuals have accurately conceptualized that construct, have weighed how the construct describes them, are self-aware, and are willing to openly provide information relevant to that construct. I propose that the accuracy of conclusions about an individual's personality style, problems in adjustment, and treatment needs may be improved if conclusion are based on a multimethod assessment approach that incorporates information gathered using explicit assessment methods, information provided by significant others, and data from performance-based or implicit measures of personality.

An overview of issues related to categorical and dimensional models of personality disorder assessment

Despite long-standing efforts to improve the current diagnostic system for Axis II, problems remain with the categorical conceptualization of personality disorders (PDs). Due in part to these problems, interest has developed in dimensional models of PD classification. In this article, we discuss four issues relevant to categorical vs. dimensional assessment of PDs: (a) problems with self-reports in PD patients, (b) methodological issues in behavioral and clinician assessment of PDs, (c) challenges that arise when dimensional models are applied to patient and nonpatient samples, and (d) clinical implications of categorical and dimensional PD models. We suggest that researchers and clinicians address these concerns to avoid implementing a new PD assessment model that-although different from the current system-would otherwise remain fraught with difficulties.

Adolescent Cluster A personality disorder symptoms, role assumption in the transition to adulthood, and resolution or persistence of symptoms

Cluster A odd or eccentric personality disorder (PD) symptoms may reflect a schizophrenia spectrum biological vulnerability in at least some persons. Consequently, this symptom pattern may have particularly negative effects on the transition from adolescent to adult roles. A general population sample of 200 young adults was assessed on Cluster A PD at mean ages 17 and 22, and subsequently provided detailed narratives about their monthly experiences and behaviors between these two ages. Adolescent Cluster A PD was related to the developmental trajectories of residential, career, financial, romantic, and family formation roles during this period, and trajectories were related to a change in symptoms over this period. Symptoms were associated with early parenthood and less advanced education, but for other developmental outcomes tended to differ for men and women. These gender differences were attributable, in part, to the differential meaning and consequences of early parenthood for men and women.

Temperament as a unifying basis for personality and psychopathology

Personality and psychopathology long have been viewed as related domains, but the precise nature of their relations remains unclear. Through most of the 20th century, they were studied as separate fields; within psychopathology, clinical syndromes were separated from personality disorders in 1980. This division led to the revelation of substantial overlap among disorders both within and across axes and to the joint study of normal and abnormal personality. The author reviews these literatures and proposes an integrative framework to explain personality-psychopathology relations: Three broad, innate temperament dimensions--negative affectivity, positive affectivity, and disinhibition--differentiate through both biologically and environmentally based developmental processes into a hierarchical personality trait structure and, at their extremes, are risk factors (diatheses) for psychopathology, especially given adverse life experiences (stress).

Testing hypotheses regarding the causes of comorbidity: examining the underlying deficits of comorbid disorders

The authors examined the validity of a method commonly used to test alternative hypotheses regarding the causes of comorbidity: the examination of underlying deficits of comorbid disorders. The authors simulated data in which the true causes of comorbidity were known, then compared the patterns of underlying deficits of the comorbid disorders found in the simulated data with the predicted results. The method of examining the underlying deficits of comorbid disorders could distinguish between several comorbidity models, including those that could not be distinguished well using other methods. The ability to distinguish the correct model decreased as the sample size and the correlation between the underlying deficits and the symptom scores decreased, suggesting that the issue of power should be considered carefully.