The Pathoplastic Relationship Between Interpersonal Problems and Fear of Failure

Pneumonia diagnosis performance in the emergency department: a mixed-methods study about clinicians' experiences and exploration of individual differences and response to diagnostic performance feedback

OBJECTIVES

We sought to (1) characterize the process of diagnosing pneumonia in an emergency department (ED) and (2) examine clinician reactions to a clinician-facing diagnostic discordance feedback tool.

MATERIALS AND METHODS

We designed a diagnostic feedback tool, using electronic health record data from ED clinicians' patients to establish concordance or discordance between ED diagnosis, radiology reports, and hospital discharge diagnosis for pneumonia. We conducted semistructured interviews with 11 ED clinicians about pneumonia diagnosis and reactions to the feedback tool. We administered surveys measuring individual differences in mindset beliefs, comfort with feedback, and feedback tool usability. We qualitatively analyzed interview transcripts and descriptively analyzed survey data.

RESULTS

Thematic results revealed: (1) the diagnostic process for pneumonia in the ED is characterized by diagnostic uncertainty and may be secondary to goals to treat and dispose the patient; (2) clinician diagnostic self-evaluation is a fragmented, inconsistent process of case review and follow-up that a feedback tool could fill; (3) the feedback tool was described favorably, with task and normative feedback harnessing clinician values of high-quality patient care and personal excellence; and (4) strong reactions to diagnostic feedback varied from implicit trust to profound skepticism about the validity of the concordance metric. Survey results suggested a relationship between clinicians' individual differences in learning and failure beliefs, feedback experience, and usability ratings.

DISCUSSION AND CONCLUSION

Clinicians value feedback on pneumonia diagnoses. Our results highlight the importance of feedback about diagnostic performance and suggest directions for considering individual differences in feedback tool design and implementation.

Examining the Interpersonal Profiles and Nomological Network Associated with Narcissistic Grandiosity and Narcissistic Vulnerability

Theory and research have consistently shown that pathological narcissism can best be described by 2 phenotypic expressions, narcissistic grandiosity and narcissistic vulnerability. The current study sought to examine the specific types of interpersonal problems reported by those high in narcissistic grandiosity and high in narcissistic vulnerability as well as examine the nomological network associated with these 2 manifestations of narcissism. In a sample of university students who completed self-report measures of pathological narcissism, interpersonal problems, depression, self-esteem, malignant self-regard, self-defeating personality disorder symptoms, and anger, we found that narcissistic grandiosity (n = 108) was associated with one distinct interpersonal profile, for example, being overly intrusive in relationships with others, while narcissistic vulnerability (n = 88) was associated with a wider range of interpersonal problems on the interpersonal circumplex. Using cluster analysis, we found 3 interpersonal subtypes associated with narcissistic vulnerability, an intrusive subtype, a cold subtype, and a socially avoidant subtype. Further examination of group differences showed that the 3 interpersonal subtypes associated with narcissistic vulnerability could also be distinguished based on their experience and expression of anger. This suggests the importance of assessing profiles of interpersonal functioning and anger in narcissistic vulnerability. The clinical implications of our results are discussed.

Personality Heterogeneity in Adolescents With Disruptive Behavior Disorders1

We first confirmed adolescents diagnosed with disruptive behavior disorders (oppositional defiant, conduct disorder; n = 158) had lower constraint and higher negative emotionality, and greater psychiatric comorbidity and psychosocial dysfunction, relative to adolescents without (n = 755), in a population-based sample enriched for externalizing psychopathology (mean age = 17.90 years; 52% female). We then explored whether different personality types, defined by patterns of personality identified via latent profile analysis, were differently associated with clinical features in adolescents with a disruptive behavior disorder diagnosis. Four distinct personality types ("disinhibited," "high distress," "low distress," "positive") were meaningfully different from one another. Results highlight personality heterogeneity as a means of identifying individuals at greatest risk for the most deleterious forms of externalizing psychopathology.

The latent structure of interpersonal problems: Validity of dimensional, categorical, and hybrid models

Interpersonal problems are key transdiagnostic constructs in psychopathology. In the past, investigators have neglected the importance of operationalizing interpersonal problems according to their latent structure by using divergent representations of the construct: (a) computing scores for severity, agency, and communion (“dimensional approach”), (b) classifying persons into subgroups with respect to their interpersonal profile (“categorical approach”). This hinders cumulative research on interpersonal problems, because findings cannot be integrated both from a conceptual and a statistical point of view. We provide a comprehensive evaluation of interpersonal problems by enlisting several large samples (Ns = 5,400, 491, 656, and 712) to estimate a set of latent variable candidate models, covering the spectrum of purely dimensional (i.e., confirmatory factor analysis using Gaussian and nonnormal latent t-distributions), hybrid (i.e., semiparametric factor analysis), and purely categorical approaches (latent class analysis). Statistical models were compared with regard to their structural validity, as evaluated by model fit (corrected Akaike’s information criterion and the Bayesian information criterion), and their concurrent validity, as defined by the models’ ability to predict relevant external variables. Across samples, the fully dimensional model performed best in terms of model fit, prediction, robustness, and parsimony. We found scant evidence that categorical and hybrid models provide incremental value for understanding interpersonal problems. Our results indicate that the latent structure of interpersonal problems is best represented by continuous dimensions, especially when one allows for nonnormal latent distributions.

This study suggests that interpersonal problems are best characterized by continuous differences in severity and interpersonal style (i.e., agency and communion), and not by “types” of people.

Behavioral Landscapes and Earth Mover's Distance: A New Approach for Studying Individual Differences in Density Distributions

Contemporary views of personality highlight intraindividual variability. We forward a general method for quantifying individual differences in behavioral tendencies based on Earth Mover's Distance. Using data from 150 individuals who reported on their and others' interpersonal behavior in 64,112 social interactions, we illustrate how this new approach can advance notions of personality as density distributions. Results provide independent confirmation and establish validity of existing representations of individual differences in interpersonal behavior, and identify new dimensions and profiles of personality and well-being. Benefits of the EMD method include freedom from assumptions about the shape and form of density distributions, generality of application to n-dimensional behavior captured in experience sampling studies, and natural integration of personality structure and dynamics.

A Multisurface Interpersonal Circumplex Assessment of Rejection Sensitivity

Individuals high in rejection sensitivity (RS) are at risk for experiencing high levels of interpersonal distress, yet little is known about the interpersonal profiles associated with RS. This investigation examined the interpersonal problems, sensitivities, and values associated with RS in 2 samples: 763 multicultural undergraduate students (Study 1) and 365 community adults (Study 2). In Study 1, high anxious RS was associated with socially avoidant interpersonal problems, whereas low anxious RS was associated with vindictive interpersonal problems. In Study 2, we assessed both anxious and angry expectations of rejection. Circumplex profile analyses showed that the high anxious RS group reported socially avoidant interpersonal problems, sensitivities to remoteness in others, and valuing connections with others, whereas the high angry RS group reported vindictive interpersonal problems, sensitivities to submissiveness in others, and valuing detached interpersonal behavior. Low anxious RS was related to domineering interpersonal problems, sensitivity to attention-seeking behavior, and valuing detached interpersonal behavior, whereas low angry RS was related to submissive interpersonal problems, sensitivity to attention-seeking behavior, and valuing receiving approval from others. Overall, results suggest that there are distinct interpersonal profiles associated with varying levels and types of RS.

Are there subtypes of panic disorder? An interpersonal perspective

OBJECTIVE

Panic disorder (PD) is associated with significant personal, social, and economic costs. However, little is known about specific interpersonal dysfunctions that characterize the PD population. The current study systematically examined these interpersonal dysfunctions.

METHOD

The present analyses included 194 patients with PD out of a sample of 201 who were randomized to cognitive-behavioral therapy, panic-focused psychodynamic psychotherapy, or applied relaxation training. Interpersonal dysfunction was measured with the Inventory of Interpersonal Problems-Circumplex (Horowitz, Alden, Wiggins, & Pincus, 2000).

RESULTS

Individuals with PD reported greater levels of interpersonal distress than that of a normative cohort (especially when PD was accompanied by agoraphobia), but lower than that of a cohort of patients with major depression. There was no single interpersonal profile that characterized PD patients. Symptom-based clusters (with vs. without agoraphobia) could not be discriminated on core or central interpersonal problems. Rather, as revealed by cluster analysis based on the pathoplasticity framework, there were 2 empirically derived interpersonal clusters among PD patients that were not accounted for by symptom severity and were opposite in nature: domineering-intrusive and nonassertive. The empirically derived interpersonal clusters appear to be of clinical utility in predicting alliance development throughout treatment: Although the domineering-intrusive cluster did not show any changes in the alliance throughout treatment, the nonassertive cluster showed a process of significant strengthening of the alliance.

CONCLUSIONS

Empirically derived interpersonal clusters in PD provide clinically useful and nonredundant information about individuals with PD.

A dimensional approach to assessing personality functioning: examining personality trait domains utilizing DSM-IV personality disorder criteria

BACKGROUND

This study compared a dimensional, trait domain approach to characterizing personality pathology with the traditional polythetic approach with respect to their associations with interpersonal functioning and personality traits from the five factor model.

METHODS

Psychiatric inpatients (N=1476) were administered the Structured Clinical Interview for DSM-IV Axis II personality disorders. Dimensional representations of trait domains were derived from reorganizing DSM-IV criteria into personality trait domains from DSM-5 Alternative Model. Dimensional scores and personality disorder (PD) total criterion scores served as independent variables in predicting interpersonal profile clusters, as well as extraversion, agreeableness conscientiousness, neuroticism and openness from the five factor model traits.

RESULTS

Trait domain scores and PD criteria totals were significantly correlated with submissive interpersonal style yet none proved significant in regression analyses. Avoidant and borderline PD total criteria were negatively associated with a normative interpersonal style. Combined trait domain of detachment and avoidant PD total criteria predicted a hostile/withdrawn interpersonal style. The trait domain of detachment was negatively associated with five factor traits of extroversion, whereas borderline PD total criteria were negatively associated with conscientiousness. Avoidant and borderline PD total criteria were positively associated with neuroticism.

CONCLUSIONS

The cross-cutting dimensional approach provided useful information in predicting a hostile/withdrawn interpersonal style as well as extroversion. Importantly, PD criterion scores and dimensional trait scores combined to predict this interpersonal style providing support to the alternative model of personality diagnosis in DSM-5. Clinicians are encouraged to assess dimensions of personality traits as these are related to interpersonal problems frequently encountered in psychiatric settings. While potentially useful, the dimensional approach articulated here did not yield substantial prediction of behavior.

Personality heterogeneity in PTSD: distinct temperament and interpersonal typologies

Researchers examining personality typologies of posttraumatic stress disorder (PTSD) have consistently identified 3 groups: low pathology, internalizing, and externalizing. These groups have been found to predict functional severity and psychiatric comorbidity. In this study, we employed Latent Profile Analysis to compare this previously established typology, grounded in temperament traits (negative emotionality; positive emotionality; constraint), to a novel typology rooted in interpersonal traits (dominance; warmth) in a sample of individuals with PTSD (n = 155). Using Schedule for Nonadaptive and Adaptive Personality (SNAP) traits to create latent profiles, the 3-group temperament model was replicated. Using Interpersonal Circumplex (IPC) traits to create latent profiles, we identified a 4-group solution with groups varying in interpersonal style. These models were nonredundant, indicating that the depiction of personality variability in PTSD depends on how personality is assessed. Whereas the temperament model was more effective for distinguishing individuals based on distress and comorbid disorders, the interpersonal model was more effective for predicting the chronicity of PTSD over the 10 year course of the study. We discuss the potential for integrating these complementary temperament and interpersonal typologies in the clinical assessment of PTSD.

Heterogeneity of interpersonal problems among depressed young adults: associations with substance abuse and pathological personality traits

This study extended previous theory and research on interpersonal heterogeneity in depression by identifying groups of depressed young adults who differ in their type and degree of interpersonal problems, and by examining patterns of pathological personality traits and alcohol abuse among these groups. We examined the interpersonal problems, personality traits, and alcohol-related problems of 172 college students with at least moderate levels of self-reported depression on the Patient Health Questionnaire (Spitzer, Kroenke, & Williams, 1999). Scores from the Inventory of Interpersonal Problems-Short Circumplex (Soldz, Budman, Demby, & Merry, 1995) were subjected to latent profile analysis, which classified individuals into 5 distinct groups defined by the types of interpersonal problems they experience (dominant, warm, submissive, cold, and undifferentiated). As hypothesized, groups did not differ in depression severity, but did show predicted patterns of differences on normative and maladaptive personality traits, as well as alcohol-related problems. The presence of clinically meaningful interpersonal heterogeneity in depression could have important implications for designing more individualized treatments and prevention efforts for depression that target diverse associated interpersonal problems.

A revised interpersonal circumplex inventory of children's social goals

Motivational factors such as social goals are important features of developing social adjustment, and thus researchers studying social adjustment need psychometrically sound measures of social goals. A valid measure of social goals for English-speaking youth is lacking. Such a measure would increase understanding of children's social adjustment and allow for testing developmental models of social goals and interpersonal functioning. The authors' aim was to revise the Interpersonal Goals Inventory for Children (IGI-C) for an English-speaking sample and examine its validity. The revised IGI-C (IGI-CR) fit a circumplex model and performed as expected with most external criterion variables examined. In addition, some differences were observed across males and females, offering insights into gender differences in social goals. Results support the IGI-CR as a sound measure.

The circumplex structure of interpersonal sensitivities

Previous research on aversive interpersonal behavior has provided limited links between interpersonal sensitivities and comprehensive models of personality and social behavior. Study 1 (N = 1,336) of this article demonstrated that interpersonal sensitivities can be mapped onto the interpersonal circumplex and that people generally find others' behavior that is least similar to their own generally most aversive. In Study 2 (N = 299), a broader array of correlates with interpersonal sensitivities was investigated, and results again suggested that interpersonal opposites are generally perceived as most aversive. Study 3 (N = 315) specified romantic, platonic, or nonclose relationships and again found this pattern. Conceptualizing sensitivities with the interpersonal circumplex model permits investigators to distinguish general from specific kinds of sensitivity, allows for tests of the convergent and discriminant validity of interpersonal sensitivities, and integrates sensitivities into a well-established nomological net composed of multiple constructs relevant to social behavior and interpersonal dysfunction.

Interpersonal impact messages associated with different forms of achievement motivation

Two studies evaluated relations between different forms of achievement motivation and transactional interpersonal impact messages during a dyadic puzzle-solving task. In Study 1,400 college students received no formal competence feedback during the task. In Study 2, competence feedback was manipulated for 600 college students and used to create high-, low-, and mixed-status dyads. Expectancies of success had robust actor and partner effects on submission in both studies. Competence valuation was linked with communal partner effects in Study 1 and a generalized interpersonal sensitivity in Study 2. When competence was ambiguous, approach and avoidance achievement motives exhibited affectively driven actor and partner effects consistent with their roots in pride and shame, respectively; however, when competence was established formally, motives had more cognitively driven effects on person perception and behavior (e.g., rejection sensitivity). Collectively, these findings highlight the importance of the achievement motivation system for organizing interpersonal impact messages during competence pursuits.

Interpersonal subtypes in social phobia: diagnostic and treatment implications

Interpersonal assessment may provide a clinically useful way to identify subtypes of social phobia. In this study, we examined evidence for interpersonal subtypes in a sample of 77 socially phobic outpatients. A cluster analysis based on the dimensions of dominance and love on the Inventory of Interpersonal Problems-Circumplex Scales (Alden, Wiggins, & Pincus, 1990) found 2 interpersonal subtypes of socially phobic patients. These subtypes did not differ on pretreatment global symptom severity as measured by the Brief Symptom Inventory (Derogatis, 1993) or diagnostic comorbidity but did exhibit differential responses to outpatient psychotherapy. Overall, friendly-submissive social phobia patients had significantly lower scores on measures of social anxiety and significantly higher scores on measures of well-being and satisfaction at posttreatment than cold-submissive social phobia patients. We discuss the results in terms of interpersonal theory and the clinical relevance of assessment of interpersonal functioning prior to beginning psychotherapy with socially phobic patients.

Fear of failure and student athletes' interpersonal antisocial behaviour in education and sport

BACKGROUND. The link between fear of failure and students' antisocial behaviour has received scant research attention despite associations between fear of failure, hostility, and aggression. Also, the effect of sport experience on antisocial behaviour has not been considered outside of the sport context in adult populations. Further, to date, sex differences have not been considered in fear of failure research. AIMS. To examine whether (a) fear of failure and sport experience predict antisocial behaviour in the university and sport contexts in student athletes, and whether this prediction is the same in males and females; and (b) sex differences exist in antisocial behaviour and fear of failure. SAMPLE. British university student athletes (n= 176 male; n= 155 female; M(age) = 20.11 years). METHOD. Participants completed questionnaires assessing fear of failure, sport experience, and antisocial behaviour in both contexts. RESULTS. (a) Fear of failure and sport experience positively predicted antisocial behaviour in university and sport and the strength of these predictions did not differ between males and females; (b) females reported higher levels of fear of devaluing one's self-estimate than males whereas males reported higher levels of fear of important others losing interest than females. Males engaged more frequently than females in antisocial behaviour in both contexts. CONCLUSIONS. Fear of failure and sport experience may be important considerations when trying to understand antisocial behaviour in student athletes in education and sport; moreover, the potential effect of overall fear of failure and of sport experience on this frequency does not differ by sex. The findings make an important contribution to the fear of failure and morality literatures.

Specificity of interpersonal problems in generalized anxiety disorder versus other anxiety disorders and depression

We examined the diagnostic specificity of interpersonal problems (IP) in generalized anxiety disorder (GAD). We expected generally higher interpersonal distress, and specifically higher levels of nonassertive, exploitable, overly nurturant, and intrusive behavior in n = 58 patients with Diagnostic and Statistical Manual of Mental Disorders, 4th Edition GAD compared with patients with post-traumatic stress disorder (n = 46), other anxiety disorders (n = 47), and unipolar depressive disorders (n = 47). IP were assessed with the Inventory of Interpersonal Problems. Specificity in the sense of heightened interpersonal distress for GAD was not supported in any of the aforementioned scales, neither for pure nor for comorbid GAD. This finding persisted after accounting for the degree of depressiveness (Beck Depression Inventory). GAD patients are rather not characterized by more self-ascribed IPs although they may worry more about interpersonal issues in general.