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

Personality assessment in nursing home residents with mental and physical multimorbidity: two informant perspectives

OBJECTIVES

In older patients with mental and physical multimorbidity (MPM), personality assessment is highly complex. Our aim was to examine personality traits in this population using the Hetero-Anamnestic Personality questionnaire (HAP), and to compare the premorbid perspective of patients' relatives (HAP) with the present-time perspective of nursing staff (HAP-t).

DESIGN

Cross-sectional.

SETTING

Dutch gerontopsychiatric nursing home (GP-NH) units.

PARTICIPANTS

Totally, 142 GP-NH residents with MPM (excluding dementia).

MEASUREMENTS

NH norm data of the HAP were used to identify clinically relevant premorbid traits. Linear mixed models estimated the differences between HAP and HAP-t trait scores (0-10). Agreement was quantified by intraclass correlation coefficients (ICCs). All HAP-HAP-t analyses were corrected for response tendency (RT) scores (-10-10).

RESULTS

78.4% of the patients had at least one premorbid maladaptive trait, and 62.2% had two or more. Most prevalent were: "disorderly" (30.3%), "unpredictable/impulsive" (29.1%) and "vulnerable" (27.3%) behavior. The RT of relatives appeared significantly more positive than that of nursing staff (+1.8, 95% CI 0.6-2.9, p = 0.002). After RT correction, the traits "vulnerable", "perfectionist" and "unpredictable/impulsive" behavior scored higher on the HAP than HAP-t (respectively +1.2, 95% CI 0.6-1.7, p < 0.001; +2.1, 95% CI 1.3-2.8, p < 0.001; +0.6, 95% CI 0.1-1.1, p = 0.013), while "rigid" behavior scored lower (-0.7, 95% CI -1.3 to -0.03, p = 0.042). Adjusted ICCs ranged from 0.15 to 0.58.

CONCLUSIONS

Our study shows high percentages of premorbid maladaptive personality traits, which calls for attention on personality assessment in MPM NH residents. Results also indicate that the HAP and HAP-t questionnaires should not be used interchangeably for this patient group in clinical practice.

A new performance-based measure of personality functioning impairment: development and preliminary evaluation of reliability and validity

Personality functioning impairment is at the center of many dimensional models of personality. Available measures of personality functioning impairment are limited to self-report, clinician-/informant-rated, and interview methods. Although researchers have begun investigating established performance-based instruments' potential for assessing personality functioning impairment, administration and scoring of these instruments is complex and the latent variables they measure diverge from personality functioning impairment as described in the ICD-11 and the Alternative Model for Personality Disorders (AMPD) of the DSM. We address this absence by developing and psychometrically evaluating the Level of Personality Functioning Scale-Questionnaire-based Implicit Association Test (LPFS-qIAT). The LPFS-qIAT's psychometric properties were evaluated across four studies, producing initial evidence supporting the new instrument's reliability as well as its convergent, discriminant, and criterion-related validity. As the first performance-based measure of personality functioning impairment that aligns with the AMPD and, to a degree the ICD-11, that is easily administered, scored, and interpreted, the LPFS-qIAT shows potential to become a valuable tool in both research and clinical practice.

Personality disorders in older adults: Differences in self-informant ratings

Previous research on self-informant reports in assessing personality disorders (PDs) has been mainly focused on adults, leaving older adults under-studied. We examined self-informant agreement in PD screening among older adults (≥60 years) using the Gerontological Personality disorders Scale (GPS). Potential differences such as who reports more personality pathology on a PD screener (i.e., GPS), item accessibility and the effect of relational aspects were studied as well. Data of 326 older adult-informant dyads, of which the older adults were sampled from five general practices in the Netherlands, were used. Results indicate that self-informant agreement ranged from r = 0.26-0.73, with lower concordance on the GPS-subscale measuring intrapersonal aspects of personality pathology. Informants were more sensitive to habitual pathological personality features than older adults. Two GPS items showed differential item functioning across self- and informant-report. Of relational aspects, only congeniality affected the GPS-iv scores; lower ratings on congeniality were associated with higher GPS-iv scores (i.e., higher reporting of personality problems).

Differentiation of Self and Interpersonal Functioning with the Level of Personality Functioning Scale - Brief Form 2.0

Research on Criterion A of the alternative model for personality disorders is recently expanding and provides mixed results concerning the unidimensional operational definition of severity by the model, characterized by impaired self (identity and self-direction) and interpersonal (empathy and intimacy) functioning. Studies resulted in one, as well as two or more factor structures. The present study demonstrated the importance of the structural and relational differentiation of self and interpersonal dimensions of personality functioning. One thousand seventy-four participants (community and clinical mixed sample) completed the Level of Personality Functioning Scale - Brief Form 2.0 (LPFS-BF 2.0), the Personality Inventory for DSM-5 Short Form and the Questionnaire for the World Health Organization Disability Assessment. An LPFS-BF 2.0 two-factor structure with self and interpersonal functioning factors was corroborated by confirmatory factor analyses and bifactor modeling. Joint Exploratory Factor Analysis of the LPFS-BF 2.0 domains with maladaptive personality domains clearly differentiated the personality functioning factors. While the self-functioning factor was more closely linked to negative affect (and to disinhibition and psychoticism), the interpersonal functioning factor connected to detachment. Self-functioning predicted functional impairment along and beyond personality domains. The LPFS-BF 2.0 appears a useful tool for clinical routine monitoring of both self and interpersonal functioning.

Pre-COVID brain network topology prospectively predicts social anxiety alterations during the COVID-19 pandemic

Background

Social anxiety (SA) is a negative emotional response that can lead to mental health issues, which some have experienced during the coronavirus disease 2019 (COVID-19) pandemic. Little attention has been given to the neurobiological mechanisms underlying inter-individual differences in SA alterations related to COVID-19. This study aims to identify neurofunctional markers of COVID-specific SA development.

Methods

110 healthy participants underwent resting-state magnetic resonance imaging and behavioral tests before the pandemic (T1, October 2019 to January 2020) and completed follow-up behavioral measurements during the pandemic (T2, February to May 2020). We constructed individual functional networks and used graph theoretical analysis to estimate their global and nodal topological properties, then used Pearson correlation and partial least squares correlations examine their associations with COVID-specific SA alterations.

Results

In terms of global network parameters, SA alterations (T2-T1) were negatively related to pre-pandemic brain small-worldness and normalized clustering coefficient. In terms of nodal network parameters, SA alterations were positively linked to a pronounced degree centrality pattern, encompassing both the high-level cognitive networks (dorsal attention network, cingulo-opercular task control network, default mode network, memory retrieval network, fronto-parietal task control network, and subcortical network) and low-level perceptual networks (sensory/somatomotor network, auditory network, and visual network). These findings were robust after controlling for pre-pandemic general anxiety, other stressful life events, and family socioeconomic status, as well as by treating SA alterations as categorical variables.

Conclusions

The individual functional network associated with SA alterations showed a disrupted topological organization with a more random state, which may shed light on the neurobiological basis of COVID-related SA changes at the network level.

Examining the associations between difficulties in emotion regulation and symptomatic outcome measures among individuals with different mental disorders

Background

Difficulties in emotion regulation (ER) abilities have been found to play a central role in different psychiatric disorders. However, researchers rarely compare ER across different diagnostic groups. In the current study, we examined ER and its relation to functional and symptomatic outcome among three distinct diagnostic groups: people with schizophrenia (SCZ), people with emotional disorders (EDs; i.e., depression and/or anxiety), and individuals without any psychiatric diagnosis (controls).

Methods

Participants in this study comprised 108 adults who requested psychotherapy at a community clinic in the year 2015 and between 2017 and 2019. Clients were interviewed and filled out questionnaires measuring depression, distress, and difficulties in ER abilities.

Results

Results showed that individuals with psychiatric diagnoses reported higher levels of difficulties in ER abilities than did controls. Moreover, there were very few differences in levels of ER difficulty between SCZ and EDs. Further, the associations between maladaptive ER and psychological outcomes were significant in each diagnostic group, and especially for SCZ.

Conclusion

Our study indicates that difficulties in ER abilities partially have a transdiagnostic nature, and that these difficulties are associated with psychological outcomes among both clinical populations and controls. There were very few differences in levels of ER ability difficulties between SCZ and EDs, suggesting that the two groups share difficulties in relating and responding to emotional distress. The associations between difficulties in ER abilities and outcome were more robust and stronger among SCZ than the other groups, highlighting the potential contribution of targeting ER abilities in the treatment of schizophrenia.

Operationalizing intimacy and identity aspects of personality functioning in relation to personality disorder in adolescents

According to dimensional models of personality pathology, deficits in interpersonal (intimacy and empathy) and self (identity and self-direction) function (Criterion A) are core to all personality disorders. These aspects of personality functioning (Criterion A) have seldom been evaluated for how they might relate to one another in the context of personality pathology in adolescents. Moreover, the use of performance-based measures to evaluate aspects of Criterion A function remains an untapped resource. Therefore, the present study aimed to evaluate relations between two features of Criterion A, maladaptive intimacy and maladaptive (or diffused) identity, in adolescence. For intimacy, we leverage a performance-based approach to studying intimacy, operationalized in a developmentally relevant way (perceived parental closeness). For identity, we rely on a validated self-report measure of identity diffusion. We examined the relationship between these features with each other and their relations with borderline features. Additionally, we explored whether identity diffusion mediated the expected relationship between perceived parental closeness and borderline features. We hypothesized that greater distance in perceived parental closeness would be associated with higher levels of borderline features, as well as higher levels of identity diffusion, and that identity diffusion would account for the relationship between intimacy and personality pathology. The sample included 131 inpatient adolescents (M _age = 15.35, 70.2% female). Results indicated that intimacy, operationalized as perceived parental closeness, with both mothers and fathers was significantly associated with levels of identity diffusion and borderline features. In addition, greater feelings of closeness with parents were associated with lower severity of borderline features via healthier identity function. Implications of the results, limitations, and future directions are discussed.

Bottom-up transdiagnostic personality subtypes are associated with state psychopathology: A latent profile analysis

Introduction

Personality-based profiling helps elucidate associations between psychopathology symptoms and address shortcomings of current nosologies. The objective of this study was to bracket the assumption of a priori diagnostic class borders and apply the profiling approach to a transdiagnostic sample. Profiles resembling high-functioning, undercontrolled, and overcontrolled phenotypes were expected to emerge.

Methods

We used latent profile analysis on data from a sample of women with mental disorders (n = 313) and healthy controls (n = 114). 3-5 profile solutions were compared based on impulsivity, perfectionism, anxiety, stress susceptibility, mistrust, detachment, irritability, and embitterment. The best-fitting solution was then related to measures of depression, state anxiety, disordered eating, and emotion regulation difficulties to establish clinical significance.

Results

A 5-profile solution proved best-fitting. Extracted profiles included a high-functioning, a well-adapted, an impulsive and interpersonally dysregulated, an anxious and perfectionistic, and an emotionally and behaviorally dysregulated class. Significant differences were found in all outcome state measures, with the emotionally and behaviorally dysregulated class exhibiting the most severe psychopathology.

Discussion

These results serve as preliminary evidence of the predictive nature and clinical utility of personality-based profiles. Selected personality traits should be considered in case formulation and treatment planning. Further research is warranted to replicate the profiles and assess classification stability and profiles' association with treatment outcome longitudinally.

Picturing disturbed body experience: A comparison of body drawings in persons with somatoform disorder and a general population sample

People with somatic symptom disorder or somatoform disorder are considered to have a troubled relationship to their body that is hard to assess with self-report questionnaires alone. To examine the potential value of own-body drawings as an assessment tool, objective features of drawings from 179 patients referred to treatment for somatoform disorder, were compared to those of 173 age-and-sex matched persons from the general population. While two factors had been found in the somatoform disorder sample, in the general population only the factor that reflected 'details' in own-body drawings was replicated. The two samples did not score differently on this factor. The general population sample showed a less strong association between objective body drawings scores on this 'details' factor and self-reported scores of body experience than the somatoform disorder sample. Moreover, the phenomenological contents of the drawings were more oriented towards health or appearance than the mostly mixed or unclear orientation of persons with somatoform disorder. Because the objective scoring of body drawings did not differ between groups while the contents of body drawings appeared to differ, the results suggest that this objective scoring of body drawings is not appropriate to distinguish people with and without somatoform disorder.

Relationships between Nursing Students’ Skill Mastery, Test Anxiety, Self-Efficacy, and Facial Expressions: A Preliminary Observational Study

Test anxiety and self-efficacy significantly influence the mastery of nursing skills. Facial expression recognition tools are central components to recognising these elements. This study investigated the frequent facial expressions conveyed by nursing students and examined the relationships between nursing skill mastery, test anxiety, self-efficacy, and facial expressions in a test-taking situation. Thirty-three second-year nursing students who were attending a university in a Korean metropolitan city participated. Test anxiety, self-efficacy, and facial expressions were collected while the students inserted indwelling catheters. Using Microsoft Azure software, the researchers examined the students’ facial expressions. Negative facial expressions, such as anger, disgust, sadness, and surprise, were more common during the test-taking situation than the practice trial. Fear was positively correlated with anxiety. None of the facial expressions had significant relationships with self-efficacy; however, disgust was positively associated with nursing skill mastery. The facial expressions during the practice and test-taking situations were similar; however, fear and disgust may have been indicators of test anxiety and skill mastery. To create a screening tool for detecting and caring for students’ emotions, further studies should explore students’ facial expressions that were not evaluated in this study.

Assessment of ICD-11 Personality Disorder Severity in Forensic Patients Using the Semi-structured Interview for Personality Functioning DSM-5 (STiP-5.1): Preliminary Findings

In forensic settings, several challenges may affect reliability of assessment of personality pathology, specifically when based upon self-report. This study investigates the Semi-Structured Interview for DSM-5 Personality Functioning (STiP-5.1) to assess level of severity of personality functioning in incarcerated patients. Thirty inpatients of three forensic psychiatric facilities completed the STiP 5.1 and additionally completed self-report questionnaires assessing symptom severity, personality functioning and traits. Staff members completed informant versions of personality functioning questionnaires. Previously assessed community (N = 18) and clinical samples (N = 80) were used as a reference. Interrater reliability and internal consistency of the STiP 5.1 were good. As expected, no associations were found between self-report and expert-ratings (STiP 5.1) of personality functioning. Remarkably, no associations were found between informant rated personality functioning and the STiP 5.1. This study confirms the discrepancies between self-report and expert-ratings in forensic settings and identifies the need to design and test assessment instruments within this context instead of generalizing findings obtained in regular mental health care samples. The STiP-5.1 may be a candidate for use in forensic samples, particularly to guide treatment planning and individual patient policy, although it remains unclear what specific information it offers above and beyond self-report and informant-report.

The Construct Validity of the ICD-11 Severity of Personality Dysfunction Under Scrutiny of Object-Relations Theory

The current classification of personality disorder in ICD-11 includes a description of personality functioning, derived from a number of theoretical paradigms, but most notably consistent with the psychodynamic approach. Concurrently, an object-relations model of personality functioning in a dimensional assessment of severity is provided in the Structured Interview of Personality Organization-Revised (STIPO-R). To date, there are no published measures of International Classification of Diseases-11 (ICD-11) personality severity, though the construct is very comparable to the concepts assessed in the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) levels of personality functioning concept, which is measured by the Level of Personality Functioning Scale-Self-Report (LPFS-SR). This study examined the validity of ICD-11 personality functioning, as measured by the LPFS-SR, by evaluating its associations with the STIPO-R in Kurdistan region. The samples included 231 University students and 419 inpatient participants across four hospitals (267 with a diagnosed personality disorder). All the components of LPFS-SR and STIPO-R were positively and significantly intercorrelated. The components of each measure discriminated PD and non-PD patients from a University, non-clinical group adequately. Despite slightly better performance of the STIPO-R in this discrimination, the measures had a high congruence in predicting personality dysfunction. Overall, the findings of the present study support the validity of ICD-11 construct for evaluating personality functioning.

The Clinics of Work: An Alternative Vision of Occupational Health

This theoretical paper depicts the clinics of work as a subdisciplinary and interdisciplinary field of the social psychology of work and organizations, interested in analyzing and intervening from a critical-clinical perspective in the subjectivity-work-context relationship, in the context of discomfort, suffering, and pleasure, and thus, in the mental health within this field. Consequently, it separates from traditional occupational health, which ignores subjective singularities. The subdiscipline of CW develops the determinants of pleasure, discomfort, and suffering at work, standing out in the process as a possible alternative of occupational health, based on research practice and intervention from a critical perspective.

Development of the Body-Relatedness Observation Scale: A feasibility study

BACKGROUND

One characteristic of somatoform (DSM-IV) and somatic symptom disorder (DSM-5) is the troubled relation of patients to their body. To assess body-relatedness, standardized observation by a physical therapist may add valuable information to questionnaires. Purpose: This study examines the feasibility of a physiotherapeutic observation instrument: the Body-Relatedness Observation Scale (BROS). Methods: Factorial validity and inter-rater reliability of observer scores were studied in 191 patients performing two short exercises, lying face up. Fourteen indicators of body-relatedness were selected, covering execution of instructions, perception of the body, muscle tension, and behavioral adaptation to somatic symptoms. Results: Inter-rater reliability values (Kappa or Intraclass correlation [ICC] according to model 1,1) were excellent for four observation scores, substantial for two, fair for two, and poor for six. Four out of five items relating to patients' ability to perceive the body had low inter-rater reliability values (ICC < 0.40 or Kappa < 0.20). Categorical principal components analysis with the eight reliable scores indicated a 1-factor structure including seven items with Cronbach's alpha 0.69. Conclusion: This initial analysis of a structured physical therapeutic observation for people with somatic symptom disorder indicated modestly sound psychometric quality of observations of execution of instructions, muscle tension, and behavioral adaptation, but not of patients' ability to perceive the body adequately. This shows that body-related observations are feasible and indicates the viability of further development of the BROS.

A biopsychosocial network model of fatigue in rheumatoid arthritis: a systematic review

Fatigue in RA is prevalent, intrusive and disabling. We propose a network model of fatigue encompassing multiple and mutually interacting biological, psychological and social factors. Guided by this model, we reviewed the literature to offer a comprehensive overview of factors that have been associated with fatigue in RA. Six categories of variables were found: physical functioning, psychological functioning, medical status, comorbidities and symptoms, biographical variables and miscellaneous variables. We then systematically reviewed associations between fatigue and factors commonly addressed by rheumatology health professionals. Correlations of fatigue with physical disability, poor mental well-being, pain, sleep disturbance and depression and anxiety were ∼0.50. Mostly these correlations remained significant in multivariate analyses, suggesting partly independent influences on fatigue and differences between individuals. These findings indicate the importance of research into individual-specific networks of biopsychosocial factors that maintain fatigue and tailored interventions that target the influencing factors most relevant to that person.

Personality Disorders in Older Adults: a Review of Epidemiology, Assessment, and Treatment

PURPOSE OF REVIEW

The aim of the paper is reviewing recent literature on the epidemiology, assessment, and treatment of personality disorders (PDs) among older adults (≥ 60 years).

RECENT FINDINGS

Since 2015, 12 primary empirical studies have been published addressing PDs in older adults; 3 addressing epidemiological aspects, 6 on assessment, 2 exploring both epidemiology and assessment, and 1 examining treatment. PD research in older adults is steadily growing and is predominantly focused on assessment. The studies showed that PDs were rather prevalent ranging from 10.6-14.5% in community-dwelling older adults, to 57.8% in nursing home-residing older adults. The Severity Indices of Personality Problems-Short Form, Gerontological Personality disorders Scale, and Assessment of DSM-IV Personality Disorders turned out to be promising instruments for assessing PDs in later life. Furthermore, schema therapy seems to be a feasible and effective intervention. Despite promising findings, there is an urgent need for studies addressing PDs in older adults, especially studies investigating epidemiological aspects and treatment options. Furthermore, new areas of interest arise such as PDs in other settings, and behavioral counseling.

The Role of Depression in the Relationship Between Psychological and Physical Intimate Partner Violence

Physical and psychological intimate partner violence (IPV) are significant public health concerns often associated with negative consequences for individuals, families, and society. Because IPV occurs within an interpersonal relationship, it is important to better understand how each partner's depressive symptoms, marital satisfaction, and psychological and physical IPV are interlinked. The purpose of this study was to identify actor and partner effects in a dyadic data analysis association between marital satisfaction and depressive symptoms, its links to psychological IPV, and then to physical IPV. Guided by the social information processing model, this study has implications for understanding the processes leading to various types of IPV in people seeking couples therapy. Using cross-sectional data from 126 heterosexual couples, we conducted an actor-partner interdependence model (APIM) to test actor and partner effects. Indirect actor and partner effects were also assessed. More depressive symptoms were associated with lower marital satisfaction. More depressive symptoms were generally linked with increased perpetration of psychological and physical IPV. Psychological IPV was associated with an individual's use of physical IPV. Effect sizes were moderate to large in magnitude. Four specific indirect effects were identified from depressive symptoms to psychological IPV to physical IPV. Depressive symptoms may be an important factor related to psychological and physical IPV for males and females. Implications include assessing for and treating depression in both partners, and discussing preferred ways of supporting each other that do not include psychological or physical IPV.

The General Criteria for Personality Disorders Assessed by Interview: Do They Still Have a Role to Play?

On the path to developing dimensional models of personality disorder (PD), we are at risk of leaving key diagnostic aspects behind. The general criteria for PD may be important ones because they reflect the defining aspects of personality pathology: long duration, independence from psychopathological states, and harmfulness. We assessed these criteria by interview in a sample of 362 psychiatric outpatients after administering the Personality Diagnostic Questionnaire-4+. The result was a 42.5% fall in self-reported endorsements, due to misinterpretations (11.5%), short duration of traits or contamination by state psychopathology (9.8%), and traits being non-harmful (21.2%). However, not all personality traits and disorders underwent correction to the same extent, and ultimately, the interview did not improve the prediction of clinical variables. These findings raise doubts about the practical relevance of the general criteria for PD and support the role of self-report questionnaires for diagnostic purposes.

Convergent and Discriminant Validity of Self-Report and Performance-Based Assessment of Object Relations

This study evaluated the Social Cognition and Object Relations Global Rating Method (SCORS-G; Stein, Hilsenroth, Mulford, & Pinkser, 2011; Stein and Mulford, 2018; Westen, 1995) and the Bell Object Relation and Reality Testing Inventory (BORRTI; Bell, 1995) to determine the extent to which the measures were correlated with each other and their relationships with 2 disorders characterized by disrupted object relations: borderline personality disorder (BPD) and depressive personality disorder (DPD). One hundred sixty-nine psychiatric outpatients and 171 undergraduate students were assessed with the Personality Disorder Interview for DSM-IV (Widiger, Corbett, Ellis, Mangine, & Tomas, 1995) and the Structured Clinical Interview for DSM-IV Axis II Disorders (First et al., 1997) for BPD and DPD. Modest correlations were observed among the diagnostic interviews with the BORRTI and the SCORS-G. An exploratory factor analysis yielded 3 distinct factors, 1 of which was mainly comprised of the BORRTI scales, whereas the 2 other factors were comprised of SCORS-G dimensions. Hierarchical multiple regressions demonstrated that the BORRTI accounted for greater variance among interview scores for both groups. However, the addition of SCORS-G variables incremented the variance accounted for in the BORRTI.

Implicitly and explicitly assessed anxiety: No relationships with recognition of and brain response to facial emotions

Trait anxiety, the disposition to experience anxiety, is known to facilitate perception of threats. Trait anxious individuals seem to identify threatening stimuli such as fearful facial expressions more accurately, especially when presented under temporal constraints. In past studies on anxiety and emotion face recognition, only self-report or explicit measures of anxiety have been administered. Implicit measures represent indirect tests allowing to circumvent problems associated with self-report. In our study, we made use of implicit in addition to explicit measures to investigate the relationships of trait anxiety with recognition of and brain response to emotional faces. 75 healthy young volunteers had to identify briefly presented (67 ms) fearful, angry, happy, and neutral facial expressions masked by neutral faces while undergoing functional magnetic resonance imaging. The Implicit Association Test, the State-Trait Anxiety Inventory and the Beck Anxiety Inventory were applied as implicit and explicit measures of trait anxiety. After corrections for multiple testing, neither implicitly nor explicitly measured anxiety correlated with recognition of emotional facial expressions. Moreover, implicitly and explicitly assessed anxiety was not linked to brain response to emotional faces. Our data suggest links between discrimination accuracy and brain response to facial emotions. Activation of the caudate nucleus seems be of particular importance for recognizing fear and happiness from facial expressions. Processes of somatosensory resonance appear to be involved in identifying fear from facial expressions. The present data indicate that, regardless of assessment method, trait anxiety does not affect the recognition of fear or other emotions as has been proposed previously.

Dimensional measure of self and interpersonal functioning: Comparisons with treatment alliance and readiness for inpatient psychotherapy

The social cognition and object relations scale-global rating method is a clinical rating system assessing 8 domains of self and interpersonal functioning. It can be applied to score numerous forms of narrative data. In this study, we investigate the SCORS-G relationship to measures of alliance and readiness for psychotherapy with an adolescent inpatient sample. Seventy-two psychiatrically hospitalized adolescents were consented and subsequently rated by their individual and group therapist using the SCORS-G. The unit psychiatrist also completed an assessment of patients' readiness for inpatient psychotherapy. The patients completed a self-report of their alliance with the inpatient treatment team as a whole. SCORS-G ratings were positively correlated with assessments of readiness for inpatient psychotherapy and patient-reported alliance. This study further demonstrates the clinical utility of the SCORS-G with adolescents.

A Preliminary Probe of Personality Predicting Psychotherapy Outcomes: Perspectives from Therapists and Their Clients

BACKGROUND

It is widely established that personality disorder has as broad negative impact on psychotherapy outcomes. Given the increased emphasis on dimensional traits for personality pathology in the DSM-5 and the proposal for the ICD-11, it is important to understand how traits are linked to treatment outcomes. Building on past research with general traits, we hypothesized that more nuanced and specific relations would be apparent. Furthermore, much of the past research has relied upon self-reports of personality and little is known about how ratings from therapists might be related to outcomes.

SAMPLING AND METHODS

The present paper examined how dimensional traits from the Five-Factor Model predicted outcomes in a case series of 54 therapist-client dyads within a doctoral training clinic. Importantly, this extends past research as dimensional traits were rated by both therapists and clients at intake as well as sequentially over the course of therapy.

RESULTS

Correlations and regression analyses indicated that traits predicted a variety of outcomes including initial engagement in treatment as well as overall symptom reduction across therapy. Specifically, preliminary evidence suggests that therapist-rated conscientiousness at intake was positively related to clients' early engagement in therapy. In addition, openness to experience after the 4th session - particularly as rated by the client - was predictive of long-term therapy outcomes.

CONCLUSIONS

Broadly, these results provided preliminary information about the promise of dimensional models for improving the clinical utility of personality disorder diagnoses. More specifically, these results reinforced the relevance of personality assessment during therapy and indicated the potential predictive value of ratings by therapists and their clients.

Linguistic Analysis as a Method for Assessing Symptoms After Sexual Trauma Among Female Adolescent Psychiatric Inpatients

Using a sample of female psychiatric inpatient adolescents, the current study aimed to extend this literature to an adolescent sample for the first time by examining if linguistic markers and their subcategories (cognitive process words, pronoun use, and somatosensory detail) in a trauma account are related to trauma symptomology and recovery during inpatient care. Results indicated that greater use of body words and fewer insight words were related to increased trauma symptoms at admission. In addition, use of fewer cognitive process words at admission predicted greater symptom change at discharge, extending previous research findings to an adolescent sample. Findings suggest that linguistic analysis may be an important component of adolescent trauma symptom assessment and treatment monitoring.

Role of Personality Functioning in the Quality of Life of Patients with Depression

Depression is associated with reduced quality of life (QoL), and personality pathology is associated with higher impairment and poorer treatment outcomes in patients with depression. This study aims to analyze the effects of personality functioning on the QoL of patients with depression. Severity of depressive symptoms (Beck Depression Inventory), level of personality functioning (Operationalized Psychodynamic Diagnosis Structure Questionnaire), and QoL (Medical Outcome Study 36-item Short-Form) were assessed in a sample of 84 depressive outpatients. Personality functioning showed main effects on both the mental and physical components of QoL. A moderating effect of personality functioning on the relationship between depressive symptoms and QoL was tested but not confirmed. Severity of depressive symptoms was found to mediate the effect of personality functioning on the mental component of QoL. These results suggest that the effect of personality functioning on the QoL of patients with depression may be related to the higher severity of depressive symptoms found in patients with lower levels of personality functioning.

The Fantasy Questionnaire: A Measure to Assess Creative and Imaginative Fantasy

This article reports the construction and validation of a comprehensive self-report measure of fantasy. Unlike previous measures of fantasy, which focus on psychopathology, we conceive fantasy as a trait with positive connotation. Principal component analysis (N = 318) and confirmatory factor analyses (N = 345) were conducted using 2 sociodemographically diverse samples. The results provided support for a 2-factor conceptualization of the construct, with the dimensions imaginative fantasy and creative fantasy. Imaginative fantasy refers to vivid imagination and absorption in these images and daydreams. Creative fantasy refers to the activity of using fantasy to create new ideas. The trait measure showed good internal consistency, test-retest reliability, discriminant and convergent construct validity, as well as incremental validity. Moreover, in 3 behavioral studies, we put fantasy scores in relationship with behavioral data to provide further proof of validity. A comprehensive measure of fantasy can contribute to our understanding of individual differences in inner experiences, creative processes, and problem solving.

Diagnostic Agreement Between Clinicians and Clients: The Convergent and Discriminant Validity of the SWAP-200 and MCMI-III Personality Disorder Scales

A particularly controversial aspect in the field of personality assessment is the use of self-report measures, versus clinicians' evaluations, for diagnosing personality disorder (PD). No studies have systematically documented the agreement between these sources for the entire array of DSM-5 PDs using comprehensive measures and experienced clinicians' judgments. The present work fills this gap by indexing the agreement between patients' self-descriptions and clinicians' judgments, relying on standardized and thorough PD instruments. The Shedler-Westen Assessment Procedure-200 (SWAP-200; Westen & Shedler, 1999a, 1999b) and the Millon Clinical Multiaxial Inventory-III (Millon, Davis, & Millon, 1997) were both completed in a clinical series of 56 adult outpatients. Analyses highlighted moderate correlations between the two measures for the 10 DSM-5 PDs (Mdn = .35). Agreement was highest for psychological features that are more easily observable by the clinicians. Furthermore, results revealed problematic discriminant validity between the two instruments.

Assessing Anger Expression: Construct Validity of Three Emotion Expression-Related Measures

Self-report measures of emotional expression are common, but their validity to predict objective emotional expression, particularly of anger, is unclear. We tested the validity of the Anger Expression Inventory (AEI; Spielberger et al., 1985 ), Emotional Approach Coping Scale (EAC; Stanton, Kirk, Cameron, & Danoff-Burg, 2000 ), and Toronto Alexithymia Scale-20 (TAS-20; Bagby, Taylor, & Parker, 1994 ) to predict objective anger expression in 95 adults with chronic back pain. Participants attempted to solve a difficult computer maze by following the directions of a confederate who treated them rudely and unjustly. Participants then expressed their feelings for 4 min. Blinded raters coded the videos for anger expression, and a software program analyzed expression transcripts for anger-related words. Analyses related each questionnaire to anger expression. The AEI Anger-Out scale predicted greater anger expression, as expected, but AEI Anger-In did not. The EAC Emotional Processing scale predicted less anger expression, but the EAC Emotional Expression scale was unrelated to anger expression. Finally, the TAS-20 predicted greater anger expression. Findings support the validity of the AEI Anger-Out scale but raise questions about the other measures. The assessment of emotional expression by self-report is complex and perhaps confounded by general emotional experience, the specificity or generality of the emotion(s) assessed, and self-awareness limitations. Performance-based or clinician-rated measures of emotion expression are needed.

An examination of generalized anxiety disorder and dysthymia utilizing the Rorschach inkblot method

This study examined transdiagnostic features of generalized anxiety disorder (GAD) and dysthymia in an outpatient clinical sample. Fifteen patients who met DSM-IV criteria for GAD and twenty-one patients who met DSM-IV criteria for dysthymia but who did not have comorbid anxiety disorder were evaluated utilizing the Rorschach. Salient clinical variables were then compared. Results showed that patients with GAD scored significantly higher on variables related to cognitive agitation and a desire/need for external soothing. In addition, there was a trend for patients with GAD to produce higher scores on a measure of ruminative focus on negative aspects of the self. Thus, not surprisingly, GAD patients' experienced more distress than the dysthymic patients. The implications of these findings are discussed with regards to better understanding the shared and distinct features of GAD and dysthymia.

Development and Examination of the Five-Factor Obsessive-Compulsive Inventory–Short Form

The Five-Factor Obsessive-Compulsive Inventory (FFOCI) is an assessment of obsessive-compulsive personality disorder (OCPD) that is based on the conceptual framework of the five-factor model (FFM) of personality. The FFOCI has 12 subscales that assess those five-factor model facets relevant to the description of OCPD. Research has suggested that the FFOCI scores relate robustly to existing measures of OCPD and relevant scales from general personality inventories. Nonetheless, the FFOCI’s length—120 items—may limit its clinical utility. This study derived a 48-item FFOCI–Short Form (FFOCI-SF) from the original measure using item response theory methods. The FFOCI-SF scales successfully recreated the nomological network of the original measure and improved discriminant validity relative to the long form. These results support the use of the FFOCI-SF as a briefer measure of the lower-order traits associated with OCPD.

Convergence of Self-Reports and Informant Reports on the Personality Assessment Screener

The present study is the first to investigate the Personality Assessment Screener, a brief self-report measure of risk for emotional and behavioral dysfunction, in relation to the informant report version of this instrument, the Personality Assessment Screener–Other. Among a sample of undergraduate roommate dyads ( N = 174), self-report and informant report total scores on the Personality Assessment Screener/Personality Assessment Screener–Other moderately converged ( r = 0.45), with generally greater agreement between perspectives observed for externalizing behaviors compared with internalizing distress. In addition, selves tended to report more psychological difficulties relative to informant ratings ( d = 0.45) with an average absolute discrepancy between sources of 6.31 ( SD = 4.96) out of a possible range of 66. Discrepancies between self-report and informant report were significantly associated with characteristics of the dyadic relationship (e.g., length of acquaintanceship) as well as the severity of self-reported psychological difficulties and positive impression management.

Personality Assessment in the Diagnostic Manuals: On Mindfulness, Multiple Methods, and Test Score Discontinuities

Recent controversies have illuminated the strengths and limitations of different frameworks for conceptualizing personality pathology (e.g., trait perspectives, categorical models), and stimulated debate regarding how best to diagnose personality disorders (PDs) in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.), and in other diagnostic systems (i.e., the International Classification of Diseases, the Psychodynamic Diagnostic Manual). In this article I argue that regardless of how PDs are conceptualized and which diagnostic system is employed, multimethod assessment must play a central role in PD diagnosis. By complementing self-reports with evidence from other domains (e.g., performance-based tests), a broader range of psychological processes are engaged in the patient, and the impact of self-perception and self-presentation biases can be better understood. By providing the assessor with evidence drawn from multiple modalities, some of which provide converging patterns and some of which yield divergent results, a multimethod assessment compels the assessor to engage this evidence more deeply. The mindful processing that ensues can help minimize the deleterious impact of naturally occurring information processing bias and distortion on the part of the clinician (e.g., heuristics, attribution errors), bringing greater clarity to the synthesis and integration of assessment data.

The association between HIV/AIDS-related knowledge and perception of risk for infection: a systematic review

This systematic review tries to elucidate the association between what people know about HIV/AIDS and how they perceive their risk of infection. The initial search for articles yielded 1,595 abstracts, 16 of which met the inclusion criteria. Five studies found a positive correlation, four reported a negative correlation and seven found no association between knowledge and risk perception. It was found that the existing psychometrically sound measure of HIV/AIDS risk perception had not been used in any of the studies. The context in which the risk is assessed is pivotal to whether an association between knowledge and the perceived risk is found. Biases in judgement such as optimistic bias, psychological distancing, anchoring bias and overconfidence also explain how knowledge may fail to predict risk perception. It was concluded that the association between HIV/AIDS knowledge and risk perception might follow a continuum from positive to no association and finally to negative. The hypothesis, however, still needs to be studied further.

Using the TAT to Assess the Relation Between Gender Identity and the Use of Defense Mechanisms

The purpose of this study is to explore whether 2 different dimensions of personality, when assessed at an implicit level with the Thematic Apperception Test (TAT; Murray, 1943 ) will show a theoretically meaningful coherence not demonstrated when 1 is assessed at an implicit level and the other at an explicit level. Gender identity and defense mechanisms were assessed implicitly using the TAT. Gender identity was compared with a self-report measure of gender-related attributes assessed at the explicit level. The results showed a theoretically meaningful coherence when different dispositions were assessed at the same level, but a lack of agreement when similar dispositions were assessed at different levels. The study is based on a secondary analysis of data from 2 previously published papers (Cramer, 1998 ; Cramer & Westergren, 1999 ).

Interpersonal assessment of borderline personality disorder: preliminary findings

We examined the reliability and validity of scores on an interpersonal measure of borderline personality disorder (BPD). Ratings on the Interpersonal Measure of Borderline Personality Disorder (IM-B) were based on nonverbal behaviors and interpersonal interactions occurring during clinical interviews with 276 adults. Scores on the IM-B exhibited good reliability. IM-B scores also displayed expected patterns of associations with scores on other measures of BPD, as well as with scores on measures of affective dysfunction, interpersonal pathology, and behavioral impairment associated with BPD, including indexes of maladaptive emotion regulation, interpersonal sensitivity, and self-harm. The pattern of associations for IM-B scores was quite similar to what would be expected for a dimensional measure of BPD symptoms. Scores on the IM-B were also associated with symptoms of disorders generally comorbid with BPD. Finally, IM-B scores contributed incrementally to the prediction of interpersonal dysfunction and suicidal ideation and behavior. Discussion focuses on implications for the assessment of BPD.

Self-Report Assessments of Emotional Competencies

This Special Issue of the Journal of Psychoeducational Assessment offers a critical appraisal of the validity, applied utility, and limitations of self-report assessments of emotional competencies. Using self-concept theory as an integrative theoretical framework, this introductory editorial highlights key methodological and validity issues raised in the contributing articles: (a) distinction between emotional competence self-perceptions and objectively measured abilities, (b) effects of response biases and respondents’ age on the psychometric properties of self-reports, (c) importance of adopting a multi-dimensional assessment strategy, and (d) various aspects of construct validity (conceptual definitions and paradigms, gender differences, relationships with basic personality, mechanisms and scope of prediction). The added value of conceptualizing emotional competence self-reports as self-concepts (as proposed in this article) is illustrated in the discussion of practical implications, outstanding questions, and directions for future research on the meaning and uses of these assessments.

Clinical validity of a dimensional assessment of self- and interpersonal functioning in adolescent inpatients

The Social Cognition and Object Relations Scale-Global Version (SCORS-G) is a clinical rating system assessing 8 domains of self- and interpersonal relational experience that can be applied to narrative response data (e.g., Thematic Apperception Test [TAT; Murray, 1943], early memories narratives) or oral data (e.g., psychotherapy narratives, relationship anecdotal paradigms). In this study, 72 psychiatrically hospitalized adolescents consented and were rated by their individual and group therapist using the SCORS-G. Clinicians also rated therapy engagement, personality functioning, quality of peer relationships, school functioning, global assessment of functioning (GAF), history of eating-disordered behavior, and history of nonsuicidal self-injury. SCORS-G composite ratings achieved an acceptable level of interrater reliability and were associated with theoretically predicted variables (e.g., engagement in therapy, history of nonsuicidal self-injury). SCORS-G ratings also incrementally improved the prediction of therapy engagement and global functioning beyond what was accounted for by GAF scores. This study further demonstrates the clinical utility of the SCORS-G with adolescents.

Implicit versus explicit measures of self-concept of self-control and their differential predictive power for spontaneous trait-relevant behaviors

BACKGROUND AND OBJECTIVES

Low trait self-control constitutes a core criterion in various psychiatric disorders. Personality traits such as low self-control are mostly indexed by self-report measures. However, several theorists emphasized the importance of differentiating between explicit and implicit indices of personality traits, Therefore, the present study examined the unique predictive validity of an implicit measure of trait self-control for spontaneous dysfunctional behavior.

METHODS

As a measure of implicit trait self-control, we used an irrelevant feature task: a speeded reaction time task comprising a task-relevant stimulus feature (i.e., capital vs. lower case letter type) and a task-irrelevant feature (high vs. low self-control word type). The irrelevant feature had to be ignored, while participants (n = 34) responded to the relevant stimulus feature. However, their response was either congruent or incongruent with the irrelevant stimulus feature, resulting in facilitated or deteriorated task performance. As indicators of trait-related spontaneous dysfunctional behavior, we included indices of frustration tolerance and the preference for short-term reward over meeting long-term goals. We also included two explicit measures of trait self-control: a self-report questionnaire and an explicit self-relevance rating of the implicit task stimuli.

RESULTS

Specifically the implicit measure of trait self-control showed predictive validity for the target self-control behaviors.

LIMITATIONS

The predictive validity of implicit measures of personality traits requires further study in larger, non-student samples.

CONCLUSIONS

As predicted, the implicit measure of trait self-control showed superior predictive power for spontaneous trait-related behavior. This finding points to the relevance of complementing the routinely used self-report measures with implicit measures of trait self-control.