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Somma A, Gialdi G, Krueger RF, Markon KE, Fossati A. Understanding Grandiose and Vulnerable Narcissism in Adult Outpatients: A Head-to-Head Comparison Between DSM-5 Section II Personality Disorders and DSM-5 Alternative Model for Personality Disorders. J Pers Disord 2025; 39:113-132. [PMID: 40293804 DOI: 10.1521/pedi.2025.39.2.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2025]
Abstract
To compare the effectiveness of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), Section II personality disorder (PD) model, and of the Alternative Model for Personality Disorders (AMPD) model in characterizing vulnerable (VN) and grandiose (GN) narcissism, a sample of clinical psychotherapy participants (N = 369) was administered the Schedule for Nonadaptive and Adaptive Personality-2, the Levels of Personality Functioning Scale-Self Report (LPFS-SR), the Personality Inventory for DSM-5, the Five-Factor Narcissism Inventory-Short Form (FFNI-SF), and the Pathological Narcissism Inventory (PNI). In multiple regression models, the LPFS-SR scales and the Personality Inventory for DSM-5 (PID-5) domain scales explained 34.6% and 23.7% more variance than the self-reports of the 10 Section II PD symptom counts in the FFNI-SF and PNI GN scores, respectively. Similarly, AMPD measures outperformed self-reported symptom counts of the 10 Section II PDs, accounting for 28.8% and 22.6% more variance in the FFNI-SF and PNI VN scale scores, respectively.
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Affiliation(s)
- Antonella Somma
- From School of Psychology, Vita-Salute San Raffaele University, Milan, Italy, and Clinical Psychology and Psychotherapy Unit, IRCCS San Raffaele Turro Hospital, Milan, Italy
| | - Giulia Gialdi
- From School of Psychology, Vita-Salute San Raffaele University, Milan, Italy, and Clinical Psychology and Psychotherapy Unit, IRCCS San Raffaele Turro Hospital, Milan, Italy
| | - Robert F Krueger
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota
| | - Kristian E Markon
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota
| | - Andrea Fossati
- From School of Psychology, Vita-Salute San Raffaele University, Milan, Italy, and Clinical Psychology and Psychotherapy Unit, IRCCS San Raffaele Turro Hospital, Milan, Italy
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2
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Rexand-Galais F, Pithon L. Dataset yielded by an assessment of personality disorders among young French adults using the Inventory of Personality Organization. Data Brief 2024; 56:110806. [PMID: 39234052 PMCID: PMC11372618 DOI: 10.1016/j.dib.2024.110806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 07/31/2024] [Accepted: 08/02/2024] [Indexed: 09/06/2024] Open
Abstract
Data on personality disorders in young French adults were collected using the validated French version of the Inventory of Personality Organization (IPO-fr). Respondents also completed the Personality Diagnostic Questionnaire-4th Edition (PDQ-4+). The sample comprised 607 students aged 18-26 years enrolled on a variety of courses at Angers University (France). Of these, 170 had a personality disorder according to the PDQ-4+, and their data were used to define IPO cut-off scores for Cluster A, B or C personality disorders. The data are stored in a comma-separated value format that can be easily downloaded from a Mendeley data repository (https://data.mendeley.com/datasets/tv6w6yyfy8/4). The data concerned by this article can be identified at this address under the name "Study 3".
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Affiliation(s)
- Franck Rexand-Galais
- CLiPsy research unit, Angers University, SFR CONFLUENCES, Angers, France
- Spaces and Societies (ESO) research unit, Angers University, CNRS, SFR CONFLUENCES, Angers, France
| | - Lucas Pithon
- CLiPsy research unit, Angers University, SFR CONFLUENCES, Angers, France
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3
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Kim S, Hong S, Park DH, Ryu SH, Ha JH, Jeon HJ. Temperament Clusters in Patients With Panic Disorder in Relation to Character Maturity. Psychiatry Investig 2024; 21:174-180. [PMID: 38433416 PMCID: PMC10910162 DOI: 10.30773/pi.2023.0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 11/28/2023] [Indexed: 03/05/2024] Open
Abstract
OBJECTIVE This study explored whether temperament profiles are associated with psychological functioning and whether character maturity affects this association in patients with panic disorders (PD). METHODS A total of 270 patients with PD were enrolled in this study. Measurements included the Temperament and Character Inventory-revised-short (TCI-RS), a self-report version of the Panic Disorder Severity Scale (PDSS-SR), Beck Depression Inventory-II (BDI-II), and Spielberger State-Trait Anxiety Inventory (STAI). Cluster analysis was used to define the patients' temperament profiles, and the differences in discrete variables among temperament clusters were calculated using a one-way analysis of variance. An analysis of covariance was conducted to control for the impact of character maturity on psychological functioning among clusters. RESULTS We identified four temperament clusters of patients with PD. Significant differences in the PDSS-SR, BDI-II, STAI-state, and STAI-trait scores among the four clusters were detected [F(3, 262)=9.16, p<0.001; F(3, 266)=33.78, p<0.001; F(3, 266)=19.12, p<0.001; F(3, 266)=39.46, p<0.001]. However, after controlling for the effect of character maturity, the effect of cluster type was either eliminated or reduced ([STAI-state] cluster type: F(3, 262)=0.94, p>0.05; SD+CO: F(1, 262)=65.95, p<0.001, ηp2 =0.20). CONCLUSION This study enabled a more comprehensive and integrated understanding of patients by exploring the configuration of all temperament dimensions together rather than each temperament separately. Furthermore, we revealed that depending on the degree of character maturity, the psychological functioning might differ even within the same temperament cluster. These results imply that character maturity can complement inherently vulnerable temperament expression.
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Affiliation(s)
- Seolmin Kim
- Department of Psychiatry, Konkuk University Medical Center, Seoul, Republic of Korea
- Department of Psychology, The Catholic University of Korea, Bucheon, Republic of Korea
| | - Sumin Hong
- Department of Psychiatry, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Doo-Heum Park
- Department of Psychiatry, Konkuk University Medical Center, Seoul, Republic of Korea
- Department of Psychiatry, School of Medicine, Konkuk University, Seoul, Republic of Korea
| | - Seung-Ho Ryu
- Department of Psychiatry, Konkuk University Medical Center, Seoul, Republic of Korea
- Department of Psychiatry, School of Medicine, Konkuk University, Seoul, Republic of Korea
| | - Jee Hyun Ha
- Department of Psychiatry, Konkuk University Medical Center, Seoul, Republic of Korea
- Department of Psychiatry, School of Medicine, Konkuk University, Seoul, Republic of Korea
| | - Hong Jun Jeon
- Department of Psychiatry, Konkuk University Medical Center, Seoul, Republic of Korea
- Department of Psychiatry, School of Medicine, Konkuk University, Seoul, Republic of Korea
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4
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Pithon L, Rexand-Galais F. French version of the Inventory of Personality Organization (IPO-fr): psychometric properties in young adults. CURRENT ISSUES IN PERSONALITY PSYCHOLOGY 2023; 12:91-99. [PMID: 38807697 PMCID: PMC11129049 DOI: 10.5114/cipp/174519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 04/12/2023] [Accepted: 10/25/2023] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND The Inventory of Personality Organization (IPO) is a self-assessment instrument designed to measure the level of personality organization. In the present study, we developed and validated a French version (IPO-fr) of this instrument in a population of young adults. Its validity was established on the basis of two studies examining (1) its internal structure, and (2) its convergent validity with the Personality Diagnostic Questionnaire-4+, the Positive and Negative Affect Schedule (PANAS), the Hospital Anxiety and Depression Scale (HADS), and the Aggression Questionnaire (AQ). PARTICIPANTS AND PROCEDURE In the first study, we assessed the reliability of the internal structure of the French form of the IPO (IPO-fr) in a nonclinical population. Our sample comprised 602 first- and second-year psychology students, with a mean age of 19.40 years (SD = 1.95). The second study assessed the convergent validity of the questionnaire in nonclinical samples, with regard to the three clusters (A, B, and C) of personality disorders, positive and negative affect, and aggression and depressive symptoms. The sample for this second study consisted of 305 first-, second- and third-year psychology students, with a mean age of 19.83 years (SD = 2.12). RESULTS The French version of the IPO is shorter than the English: 40 items instead of 57. Its internal clarity and its discriminative capacity make it easier to interpret. CONCLUSIONS This study has established the relevance of the IPO-fr as a reliable and brief instrument for assessing individual personality. It could make a major contribution to the screening of personality pathology in the French population and to the assessment of treatment programs.
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García-Franco JD, Díez FJ, Carrasco MÁ. Probabilistic graphical model for the evaluation of the emotional and dramatic personality disorders. Front Psychol 2022; 13:996609. [PMID: 36507004 PMCID: PMC9732555 DOI: 10.3389/fpsyg.2022.996609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/21/2022] [Indexed: 11/27/2022] Open
Abstract
Personality disorders are psychological ailments with a major negative impact on patients, their families, and society in general, especially those of the dramatic and emotional type. Despite all the research, there is still no consensus on the best way to assess and treat them. Traditional assessment of personality disorders has focused on a limited number of psychological constructs or behaviors using structured interviews and questionnaires, without an integrated and holistic approach. We present a novel methodology for the study and assessment of personality disorders consisting in the development of a Bayesian network, whose parameters have been obtained by the Delphi method of consensus from a group of experts in the diagnosis and treatment of personality disorders. The result is a probabilistic graphical model that represents the psychological variables related to the personality disorders along with their relations and conditional probabilities, which allow identifying the symptoms with the highest diagnostic potential. This model can be used, among other applications, as a decision support system for the assessment and treatment of personality disorders of the dramatic or emotional cluster. In this paper, we discuss the need to validate this model in the clinical population along with its strengths and limitations.
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Affiliation(s)
- Jose D. García-Franco
- Department of Artificial Intelligence, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
| | - Francisco J. Díez
- Department of Artificial Intelligence, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
| | - Miguel Á. Carrasco
- Department of Psychology of Personality, Evaluation and Treatment. Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
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Diamond D, Yeomans F, Keefe JR. Transference-Focused Psychotherapy for Pathological Narcissism and Narcissistic Personality Disorder (TFP-N). Psychodyn Psychiatry 2021; 49:244-272. [PMID: 34061655 DOI: 10.1521/pdps.2021.49.2.244] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In this article, we provide an overview of transference-focused psychotherapy for patients with pathological narcissism and narcissistic personality disorder (TFP-N). In TFP-N we have modified and refined the tactics and techniques of TFP, an evidence-based treatment for borderline personality disorder, to meet the specific challenges of working with patients with narcissistic personality pathology whose retreat from reality into an illusory grandiosity makes them particularly difficult to engage in treatment. We first describe a model of narcissistic pathology based on considerations of psychological structure stemming from object relations theory. This model provides a unifying understanding of the core structure of narcissistic pathology, the pathological grandiose self, that underlies the impairments in self and interpersonal functioning of those with narcissistic pathology across the levels of personality organization (from high functioning to borderline to malignant). We then delineate the clinical process of working with patients with pathological narcissism and narcissistic personality disorder. Starting with the assessment process, using a detailed clinical example, we guide the reader through the progression of TFP-N as it helps the patient move from the distorted, unintegrated sense of self underlying the narcissistic presentation to the more integrated, realistic sense of self that characterizes healthier personality functioning. In TFP-N the focus on the disturbed interpersonal patterns of relating in the here and now of the therapeutic interaction is the vehicle to diminish grandiosity and improve relatedness, thereby effecting enduring changes in mental representation and real-world functioning.
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Affiliation(s)
- Diana Diamond
- Weill Medical College of Cornell University, New School for Social Research, New York University Postdoctoral Program for Psychotherapy and Psychoanalysis, City University of New York
| | - Frank Yeomans
- Weill Medical College of Cornell University, Columbia Center for Psychoanalytic Training and Research, New York
| | - John R Keefe
- Weill Medical College of Cornell University, New York
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7
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McCrae RR, Löckenhoff CE, Costa PT. A step toward DSM‐V: cataloguing personality‐related problems in living. EUROPEAN JOURNAL OF PERSONALITY 2020. [DOI: 10.1002/per.564] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Intractable problems with DSM‐IV's Axis II mandate an entirely new approach to the diagnosis of personality‐related pathology. The Five‐Factor Model of personality provides a scientifically grounded basis for personality assessment, and Five‐Factor Theory postulates that personality pathology is to be found in characteristic maladaptations that are shaped by both traits and environment. A four‐step process of personality disorder (PD) diagnosis is proposed, in which clinicians assess personality, problems in living, clinical severity, and, optionally, PD patterns. We examine item content in five problem checklists to update the list of personality‐related problems used in Step 2 of the four‐step process. Problems were reliably assigned to relevant factors and facets, and a number of additions were made to an earlier catalogue. The four‐step process can be used by clinicians, and may be incorporated in a future DSM. This article is a U.S. government publication and is in the public domain in the United States.
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8
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Bagby RM, Costa PT, Widiger TA, Ryder AG, Marshall M. DSM‐IV personality disorders and the Five‐Factor Model of personality: a multi‐method examination of domain‐ and facet‐level predictions. EUROPEAN JOURNAL OF PERSONALITY 2020. [DOI: 10.1002/per.563] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The personality disorder classification system (Axis II) in the various versions of the Diagnostic and Statistical Manuals of Mental Disorders (DSM) has been the target of repeated criticism, with conceptual analysis and empirical evidence documenting its flaws. In response, many have proposed alternative approaches for the assessment of personality psychopathology, including the application of the Five‐Factor Model of personality (FFM). Many remain sceptical, however, as to whether domain and facet traits from a model of general personality functioning can be successfully applied to clinical patients with personality disorders (PDs). In this study, with a sample of psychiatric patients (n = 115), personality disorder symptoms corresponding to each of the 10 PDs were successfully predicted by the facet and domain traits of the FFM, as measured by a semi‐structured interview, the Structured Interview for the Five Factor Model (SIFFM; Trull & Widiger, 1997) and a self‐report questionnaire, the Revised NEO Personality Inventory (NEO PI‐R; Costa and McCrae, 1992). These results provide support for the perspective that personality psychopathology can be captured by general personality dimensions. The FFM has the potential to provide a valid and scientifically sound framework from which to assess personality psychopathology, in a way that covers most of the domains conceptualized in DSM while transcending the limitations of the current categorical approach to these disorders. Copyright © 2005 John Wiley & Sons, Ltd.
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Affiliation(s)
- R. Michael Bagby
- Centre for Addiction and Mental Health, University of Toronto, Canada
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9
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Caligor E, Stern BL. Diagnosis, Classification, and Assessment of Narcissistic Personality Disorder Within the Framework of Object Relations Theory. J Pers Disord 2020; 34:104-121. [PMID: 32186989 DOI: 10.1521/pedi.2020.34.supp.104] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Narcissistic personality disorder (NPD) remains a controversial diagnosis, with lack of consensus on essential features of the disorder and its boundaries. Within the framework of object relations theory (ORT), core organizing, structural features define NPD and provide a coherent conceptual framework for understanding clinical features of the disorder. In the ORT model, both grandiose and vulnerable presentations of NPD are characterized by a specific form of self-pathology, reflecting the impact of a grandiose self-structure in the setting of borderline personality organization. The grandiose self-structure provides some stability of self-functioning but does not confer the self-regulatory capacities provided by normal identity formation and is reliant on maintaining a sense of the self as exceptional. We compare the ORT model of NPD to diagnostic criteria in the Alternative Model for Personality Disorders (AMPD) of the DSM-5, highlighting significant correspondence between the two models as well as conceptual differences.
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Affiliation(s)
- Eve Caligor
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York
| | - Barry L Stern
- Department of Medical Psychology in Psychiatry, Columbia University College of Physicians and Surgeons, New York
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10
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Rosario M, Espinosa A, Gagnon G, Talhouk L, Neff B. Associations among parental and romantic attachment, personality disorder symptoms, and physical health. J Health Psychol 2019; 26:1609-1624. [PMID: 31789584 DOI: 10.1177/1359105319890027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The relations of parental and romantic attachment with physical health symptoms and the mediating role of personality disorder symptoms in those relations were examined in an online survey of US young adults. Latent class analysis identified two groups: occasionally sick and healthier. Insecure attachment was related to being occasionally sick and to personality disorder symptoms (poor reality testing, primitive defenses, and diffused identity). Primitive defenses/identity diffusion mediated relations between insecure parental attachment and physical symptoms. Maternal and paternal attachment each provided unique information about these relations. Romantic attachment was not associated with physical symptoms after adjusting for parental attachment and personality disorder symptoms.
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Affiliation(s)
- Margaret Rosario
- The City College, The City University of New York, USA.,The Graduate Center, The City University of New York, USA
| | | | - Gregory Gagnon
- The Graduate Center, The City University of New York, USA
| | - Leila Talhouk
- The City College, The City University of New York, USA
| | - Brian Neff
- The City College, The City University of New York, USA
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11
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Stern BL, Caligor E, Hörz-Sagstetter S, Clarkin JF. An Object-Relations Based Model for the Assessment of Borderline Psychopathology. Psychiatr Clin North Am 2018; 41:595-611. [PMID: 30447727 DOI: 10.1016/j.psc.2018.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The authors describe an object-relations based model drawing on the work of Kernberg and colleagues for the assessment of borderline pathology. The substrate of internal object relations that constitutes borderline pathology internally or structurally is described and a model for assessing such pathology in a clinical interview format focusing on identity, defensive style, and quality of object relations is presented. Two clinical examples illustrate how these data can be compiled for purposes of psychodynamic case formulation and decisions about psychodynamic treatment.
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Affiliation(s)
- Barry L Stern
- Columbia University Medical Center, 122 East 42nd Street, Suite 3200, New York, NY 10168, USA.
| | - Eve Caligor
- Columbia University Medical Center, 122 East 42nd Street, Suite 3200, New York, NY 10168, USA
| | - Susanne Hörz-Sagstetter
- Psychologische Hochschule Berlin, Clinical Psychology and Psychotherapy, Am Köllnischen Park 2, 10179 Berlin, Germany
| | - John F Clarkin
- Columbia University Medical Center, 122 East 42nd Street, Suite 3200, New York, NY 10168, USA
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12
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Mou D, Kleiman EM, Fedor S, Beck S, Huffman JC, Nock MK. Negative affect is more strongly associated with suicidal thinking among suicidal patients with borderline personality disorder than those without. J Psychiatr Res 2018; 104:198-201. [PMID: 30103067 PMCID: PMC6445251 DOI: 10.1016/j.jpsychires.2018.08.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/20/2018] [Accepted: 08/02/2018] [Indexed: 10/28/2022]
Abstract
Patients suffering from borderline personality disorder (BPD) are at elevated risk for suicidal thoughts and behaviors (STBs), but this well-described and clinically important association is not well-understood. Prior research suggests that STBs often function as an attempt to escape aversive affect, and that people with BPD experience stronger emotion reactivity and greater discomfort with emotion than those without BPD. Here, we tested whether negative affective states are more likely to predict suicidal thoughts among those with BPD than those without this disorder. Data on affective states and suicidal thoughts were collected several times per day from 35 psychiatric inpatients using their smartphones to capture real-time associations between negative affect and suicidal thoughts. Results revealed that the association between negative affective states (e.g., abandonment, desperation, guilt, hopelessness, loneliness, rage, self-hatred, and upset), and severity of suicidal thinking was stronger among those with BPD than among those without BPD. This finding has implications for risk assessment and intervention in the clinical setting: for a given degree of reported negative affect, patients with BPD experience more suicidal ideation than those without. Further research needs to be done to elucidate the mechanism of this effect.
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Affiliation(s)
- David Mou
- Massachusetts General Hospital, Department of Psychiatry, USA; Harvard Medical School, Department of Psychiatry, USA.
| | | | - Szymon Fedor
- Massachusetts Institute of Technology, Media Lab, USA
| | - Stuart Beck
- Massachusetts General Hospital, Department of Psychiatry, USA,Harvard Medical School, Department of Psychiatry, USA
| | - Jeff C. Huffman
- Massachusetts General Hospital, Department of Psychiatry, USA,Harvard Medical School, Department of Psychiatry, USA
| | - Matthew K. Nock
- Massachusetts General Hospital, Department of Psychiatry, USA,Harvard University, Department of Psychology, USA
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13
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Buer Christensen T, Paap MCS, Arnesen M, Koritzinsky K, Nysaeter TE, Eikenaes I, Germans Selvik S, Walther K, Torgersen S, Bender DS, Skodol AE, Kvarstein E, Pedersen G, Hummelen B. Interrater Reliability of the Structured Clinical Interview for the DSM–5 Alternative Model of Personality Disorders Module i: Level of Personality Functioning Scale. J Pers Assess 2018; 100:630-641. [DOI: 10.1080/00223891.2018.1483377] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - Muirne C. S. Paap
- Department of Special Needs, Education, and Youth Care, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
| | | | | | | | - Ingeborg Eikenaes
- Department of Personality Psychiatry, Division of Mental Health and Addiction Treatment, Vestfold Hospital Trust, Vestfold, Norway
| | - Sara Germans Selvik
- Department of Psychiatry, Hospital Namsos, Namsos, Norway
- Department of Mental Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Kristoffer Walther
- Department of Personality Psychiatry, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | | | - Donna S. Bender
- Department of Psychiatry and Behavioral Sciences and Counseling and Psychological Services, Tulane University
| | - Andrew E. Skodol
- 9Department of Psychiatry, University of Arizona College of Medicine, Oslo University Hospital, Oslo, Norway
| | - Elfrida Kvarstein
- Department of Personality Psychiatry, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Geir Pedersen
- Department of Personality Psychiatry, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- NORMENT, KG Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Benjamin Hummelen
- Department of Personality Psychiatry, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Department of Research and Development, Clinic Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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14
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Biberdzic M, Ensink K, Normandin L, Clarkin JF. Empirical typology of adolescent personality organization. J Adolesc 2018; 66:31-48. [DOI: 10.1016/j.adolescence.2018.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 04/23/2018] [Accepted: 04/25/2018] [Indexed: 11/15/2022]
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15
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Stern BL, Yeomans F. The Psychodynamic Treatment of Borderline Personality Disorder: An Introduction to Transference-Focused Psychotherapy. Psychiatr Clin North Am 2018; 41:207-223. [PMID: 29739521 DOI: 10.1016/j.psc.2018.01.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The authors describe the application of a twice-weekly exploratory psychotherapy, transference-focused psychotherapy (TFP), to patients with borderline personality disorder. The article describes the pathology of internal object relations that provides a framework for understanding borderline personality and how TFP establishes a treatment framework to address such pathology and set the stage for working at the level of internal psychological structure. An outline of the assessment and treatment protocol is described along with a case example to illustrate the same.
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Affiliation(s)
- Barry L Stern
- Columbia University College of Physicians and Surgeons, Columbia University Center for Psychoanalytic Training and Research, 122 East 42nd Street, Suite 3200, New York, NY 10168, USA.
| | - Frank Yeomans
- New York Presbyterian Hospital, Weill Medical College at Cornell University, 122 East 42nd Street, Suite 3200, New York, NY 10168, USA
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Abstract
The management of individuals with personality disorder is one of the most challenging and sometimes controversial areas of psychiatry. This paper describes the principles involved in identifying the clinical problems and formulating a management plan for patients with personality disorder in everyday clinical practice. It demonstrates that the principles of assessing and managing personality disorders and the clinical skills required are no different from those of treating any other chronic mental disorder.
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17
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Nakash O, Nagar M. Assessment of diagnostic information and quality of working alliance with clients diagnosed with personality disorders during the mental health intake. J Ment Health 2017. [DOI: 10.1080/09638237.2017.1294740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Ora Nakash
- Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel
| | - Maayan Nagar
- Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel
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18
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Borderline Personality Disorder and Narcissistic Personality Disorder Diagnoses From the Perspective of the DSM-5 Personality Traits: A Study on Italian Clinical Participants. J Nerv Ment Dis 2016; 204:939-949. [PMID: 27660996 DOI: 10.1097/nmd.0000000000000587] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To evaluate the associations between Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) Alternative Model of Personality Disorder traits and domains and categorically diagnosed narcissistic personality disorder (NPD) and borderline personality disorder (BPD), respectively, 238 inpatient and outpatient participants who were consecutively admitted to the Clinical Psychology and Psychotherapy Unit of San Raffaele Hospital in Milan, Italy, were administered the Personality Inventory for DSM-5 (PID-5) and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). Based on SCID-II, the participants were assigned to the following groups: a) NPD (n = 49), b) BPD (n = 32), c) any other PD (n = 91), and d) no PD (n = 63). Emotional lability, separation insecurity, depressivity, impulsivity, risk taking, and hostility were significantly associated with BPD diagnosis. Attention seeking significantly discriminated participants who received an SCID-II categorical NPD diagnosis. Separation insecurity, impulsivity, distractibility, and perceptual dysregulation were the DSM-5 traits that significantly discriminated BPD participants. Domain-level analyses confirmed and extended trait-level findings.
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Frankowski S, Lupo AK, Smith BA, Dane'El M, Ramos C, Morera OF. Developing and Testing a Scale to Measure Need for Drama. PERSONALITY AND INDIVIDUAL DIFFERENCES 2016. [DOI: 10.1016/j.paid.2015.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Leonardi JL, Meyer SB. Prática Baseada em Evidências em Psicologia e a História da Busca pelas Provas Empíricas da Eficácia das Psicoterapias. PSICOLOGIA: CIÊNCIA E PROFISSÃO 2015. [DOI: 10.1590/1982-3703001552014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Tradicionalmente, a escolha pelo tipo de intervenção psicoterápica para diferentes quadros clínicos depende fundamentalmente da experiência profissional do terapeuta e de sua predileção por determinadas estratégias clínicas. Todavia, esse cenário tem se modificado no contexto da prática baseada em evidências. Apesar do extenso e acalorado debate na literatura internacional da Psicologia nos últimos anos, o tema da prática baseada em evidências tem sido pouco discutido na Psicologia brasileira. Em vista disso, este artigo tem por objetivo apresentar o paradigma de prática baseada em evidências em Psicologia sob uma perspectiva histórica, enfatizando o embate entre os diferentes posicionamentos sobre o assunto e os esforços da American Psychological Association em elaborar um modelo representativo das diversas perspectivas teóricas, metodológicas, conceituais e práticas com o intuito de preencher a lacuna entre ciência e prática ainda existente na Psicologia Clínica. Espera-se que este artigo possa contribuir para uma maior participação da Psicologia brasileira nesse movimento.
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Velotti P, Garofalo C. Personality styles in a non-clinical sample: The role of emotion dysregulation and impulsivity. PERSONALITY AND INDIVIDUAL DIFFERENCES 2015. [DOI: 10.1016/j.paid.2015.01.046] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
The current study sought to evaluate the validity and reliability of a brief measure of overall functioning for adolescents. Clinicians were asked to complete the Overall Functioning Scale (OFS) for 72 adolescents consecutively admitted to the adolescent psychiatric inpatient service of a community safety net medical center. The results revealed that this new measure is related to the patients' length of stay, clinician-rated measures of social cognition and object relations, Global Assessment of Functioning (GAF) score at admission, as well as global rating of engagement in individual psychotherapy. The results also showed that the OFS was related to the patients' history of nonsuicidal self-harm as well as treatment outcome as assessed by measures of psychological health and well-being as well as symptoms. Hierarchical regressions reveal that the OFS shows incremental validity greater than the admission GAF score in predicting length of stay. The results also showed that the OFS demonstrates interrater reliability in the excellent range (intraclass correlation coefficient(1,2)) of 0.88. Clinical implications of the use of this tool and areas of future research are discussed.
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Mela M, Audu M, Tesfaye M, Gurmu S. A developing world perspective on homicide and personality disorder. MEDICINE, SCIENCE, AND THE LAW 2014; 54:132-138. [PMID: 24166685 DOI: 10.1177/0025802413499911] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
High rates of psychotic disorder among special populations of homicide offenders, females, youth and the mentally disordered, have received much investigation. Personality disorder, especially antisocial personality disorder, augments the relative risk ratio of violence, especially in combination with substance use disorder. Few studies of these correlates of violence and especially homicide have been reported in low- and medium-income countries (LMIC). Using the structured clinical interview for DSM diagnosis (SCID), personality disorders were identified in a cross sectional study involving 546 homicide offenders in Jimma prison, Ethiopia. Predictors of personality disorder were determined using multivariate analysis of various demographic and clinical variables, for example, age, psychiatric history and substance use. Out of the 316 offenders who completed the SCID, only 16% fulfilled DSM IV criteria for personality disorder. The rationale for killing, self-defence, anger and revenge (52% of offenders), planning involved in offending (50%) and reasonably high level of relationship functioning (57% married) were different from most data from the high-income countries. Diagnostically relevant cultural factors in LMIC, not in play in high-income countries, may explain the differences in personality disorders similar to other mental disorders and the underlying mediators of homicide.
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Taubner S, Wiswede D, Kessler H. Neural activity in relation to empirically derived personality syndromes in depression using a psychodynamic fMRI paradigm. Front Hum Neurosci 2013; 7:812. [PMID: 24363644 PMCID: PMC3850238 DOI: 10.3389/fnhum.2013.00812] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 11/10/2013] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The heterogeneity between patients with depression cannot be captured adequately with existing descriptive systems of diagnosis and neurobiological models of depression. Furthermore, considering the highly individual nature of depression, the application of general stimuli in past research efforts may not capture the essence of the disorder. This study aims to identify subtypes of depression by using empirically derived personality syndromes, and to explore neural correlates of the derived personality syndromes. MATERIALS AND METHODS In the present exploratory study, an individually tailored and psychodynamically based functional magnetic resonance imaging paradigm using dysfunctional relationship patterns was presented to 20 chronically depressed patients. RESULTS from the Shedler-Westen Assessment Procedure (SWAP-200) were analyzed by Q-factor analysis to identify clinically relevant subgroups of depression and related brain activation. RESULTS The principle component analysis of SWAP-200 items from all 20 patients lead to a two-factor solution: "Depressive Personality" and "Emotional-Hostile-Externalizing Personality." Both factors were used in a whole-brain correlational analysis but only the second factor yielded significant positive correlations in four regions: a large cluster in the right orbitofrontal cortex (OFC), the left ventral striatum, a small cluster in the left temporal pole, and another small cluster in the right middle frontal gyrus. DISCUSSION The degree to which patients with depression score high on the factor "Emotional-Hostile-Externalizing Personality" correlated with relatively higher activity in three key areas involved in emotion processing, evaluation of reward/punishment, negative cognitions, depressive pathology, and social knowledge (OFC, ventral striatum, temporal pole). RESULTS may contribute to an alternative description of neural correlates of depression showing differential brain activation dependent on the extent of specific personality syndromes in depression.
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Affiliation(s)
- Svenja Taubner
- Hanse Institute for Advanced StudyDelmenhorst, Germany
- Department for Psychology, Alpen-Adria-Universität KlagenfurtKlagenfurt, Austria
| | - Daniel Wiswede
- Hanse Institute for Advanced StudyDelmenhorst, Germany
- Department of Neurology, University of LübeckLübeck, Germany
| | - Henrik Kessler
- Hanse Institute for Advanced StudyDelmenhorst, Germany
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr-University BochumBochum, Germany
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Shiner RL, Allen TA. Assessing personality disorders in adolescents: Seven guiding principles. ACTA ACUST UNITED AC 2013. [DOI: 10.1111/cpsp.12047] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Zimmermann J, Benecke C, Bender DS, Skodol AE, Schauenburg H, Cierpka M, Leising D. AssessingDSM–5Level of Personality Functioning From Videotaped Clinical Interviews: A Pilot Study With Untrained and Clinically Inexperienced Students. J Pers Assess 2013; 96:397-409. [DOI: 10.1080/00223891.2013.852563] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Widiger TA, Costa PT. Integrating normal and abnormal personality structure: the Five-Factor Model. J Pers 2013; 80:1471-506. [PMID: 22320149 DOI: 10.1111/j.1467-6494.2012.00776.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
It is evident that the conceptualization, diagnosis, and classification of personality disorder (PD) is shifting toward a dimensional model. The purpose of this special issue of Journal of Personality is to indicate how the Five-Factor Model (FFM) can provide a useful and meaningful basis for an integration of the description and classification of both normal and abnormal personality functioning. This introductory article discusses its empirical support and the potential advantages of understanding personality disorders, including those included within the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders and likely future PDs from the dimensional perspective of the FFM.
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Affiliation(s)
- Thomas A Widiger
- Department of Psychology, University of Kentucky, Lexington, KY 40506-0044, USA.
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Piedmont RL, Sherman MF, Sherman NC. Maladaptively high and low openness: the case for experiential permeability. J Pers 2013; 80:1641-68. [PMID: 22320184 DOI: 10.1111/j.1467-6494.2012.00777.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The domain of Openness within the Five-Factor Model (FFM) has received inconsistent support as a source for maladaptive personality functioning, at least when the latter is confined to the disorders of personality included within the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; APA, ). However, an advantage of the FFM relative to the DSM-IV-TR is that the former was developed to provide a reasonably comprehensive description of general personality structure. Rather than suggest that the FFM is inadequate because the DSM-IV-TR lacks much representation of Openness, it might be just as reasonable to suggest that the DSM-IV-TR is inadequate because it lacks an adequate representation of maladaptive variants of both high and low Openness. This article discusses the development and validation of a measure of these maladaptive variants, the Experiential Permeability Inventory.
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Affiliation(s)
- Ralph L Piedmont
- Department of Pastoral Counseling, Loyola University Maryland, Columbia, MD 21093, USA.
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Livesley WJ. Moving beyond specialized therapies for borderline personality disorder: the importance of integrated domain-focused treatment. Psychodyn Psychiatry 2013; 40:47-74. [PMID: 23006029 DOI: 10.1521/pdps.2012.40.1.47] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This article argues the recent emphasis on specializing treatments for borderline personality disorder needs to be replaced by a more integrated and evidence-based approach that combines effective methods from all therapies. This proposition is based on evidence that specialized treatments for borderline personality disorder do not differ significantly from each and that they are not more effective than good structured care designed to meet the needs of patients with the disorder. It is also argued that current therapies are limited because they do not recognize or accommodate the extensive heterogeneity of borderline personality disorder and its complex etiology. These factors make a one-approach-fits-all strategy inappropriate for treatment. An integrated approach is proposed as an alternative to the specialized therapies that makes use of all effective interventions regardless of their conceptual origins and delivers them in a coordinated way. A two-component framework is proposed for organizing integrated treatment: 1. a system for conceptualizing borderline personality disorder based on current empirical knowledge about the structure, etiology, and stability of borderline pathology that serves as a guide when selecting and delivering interventions; and 2. a model of therapeutic change based on the general literature on psychotherapy outcome and specific studies of PD treatments. This framework proposes that integrated treatment be organized around principles of therapeutic change common to all effective therapies supplemented with more specific treatment methods taken from the different therapies as needed to tailor treatment to individual patients and treat specific problems and psychopathology.
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Affiliation(s)
- W John Livesley
- Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada.
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Abstract
The Five-Factor Model (FFM) has become the predominant dimensional model of general personality structure. The purpose of this paper is to suggest a clinical application. A substantial body of research indicates that the personality disorders included within the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM) can be understood as extreme and/or maladaptive variants of the FFM (the acronym "DSM" refers to any particular edition of the APA DSM). In addition, the current proposal for the forthcoming fifth edition of the DSM (i.e., DSM-5) is shifting closely toward an FFM dimensional trait model of personality disorder. Advantages of this shifting conceptualization are discussed, including treatment planning.
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Mullins-Sweatt SN, Lengel GJ. Clinical Utility of the Five-Factor Model of Personality Disorder. J Pers 2012; 80:1615-39. [DOI: 10.1111/j.1467-6494.2012.00774.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Westen D, Malone JC, DeFife JA. An empirically derived approach to the classification and diagnosis of mood disorders. World Psychiatry 2012; 11:172-80. [PMID: 23024677 PMCID: PMC3449351 DOI: 10.1002/j.2051-5545.2012.tb00127.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
This article describes a system for diagnosing mood disorders that is empirically derived and designed for its clinical utility in everyday practice. A random national sample of psychiatrists and clinical psychologists described a randomly selected current patient with a measure designed for clinically experienced informants, the Mood Disorder Diagnostic Questionnaire (MDDQ), and completed additional research forms. We applied factor analysis to the MDDQ to identify naturally occurring diagnostic groupings within the patient sample. The analysis yielded three clinically distinct mood disorder dimensions or spectra, consistent with the major mood disturbances included in the DSM and ICD over successive editions (major depression, dysthymia, and mania), along with a suicide risk index. Diagnostic criteria were determined strictly empirically. Initial data using diagnostic efficiency statistics supported the accuracy of the dimensions in discriminating DSM-IV diagnoses; regression analyses supported the discriminant validity of the MDDQ scales; and correlational analysis demonstrated coherent patterns of association with family history of mood disorders and functional outcomes, supporting validity. Perhaps most importantly, the MDDQ diagnostic scales demonstrated incremental validity in predicting adaptive functioning and psychiatric history over and above DSM-IV diagnosis. The empirically derived syndromes can be used to diagnose mood syndromes dimensionally without complex diagnostic algorithms or can be combined into diagnostic prototypes that eliminate the need for ever-expanding categories of mood disorders that are clinically unwieldy.
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Affiliation(s)
- Drew Westen
- Department of Psychology and Psychiatry, Emory University, 36 Eagle Row, Atlanta, GA 30322, USA
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Livesley WJ. Disorder in the Proposed DSM-5 Classification of Personality Disorders. Clin Psychol Psychother 2012; 19:364-8. [DOI: 10.1002/cpp.1808] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- W. John Livesley
- University of British Columbia; Department of Psychiatry; Vancouver; BC; Canada
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Thiry B. An assessment of personality disorders with the Five-Factor Model among Belgian inmates. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2012; 35:327-333. [PMID: 22560670 DOI: 10.1016/j.ijlp.2012.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Many international studies report a high prevalence of personality disorders among inmates on the basis of (semi)-structured diagnostic interviews. The present study proposes a self-reported evaluation of personality disorders using the NEO PI-R. The sample consists of 244 male and 18 female inmates (N=262) who were psychologically assessed. The analysis of the five psychological domains shows that the French-speaking Belgian inmates are as stable, as extroverted, more closed, more agreeable and more conscientious than the normative sample. The NEO PI-R facets are also analyzed. The mean Cohen's d (.26) is small. Two personality disorders have medium effect sizes: obsessive compulsive personality disorder (high) and histrionic personality (low). Small effect sizes exist for antisocial personality (low), psychopathy (low), narcissistic personality (low), schizoid personality (high) and borderline personality (low). In our view, the context of the assessment can partially explain these results but not entirely. The results do not confirm previous studies and question the high rates of psychiatric prevalence in prison.
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Affiliation(s)
- Benjamin Thiry
- Forest Prison, Avenue de la Jonction 52, 1190 Brussels, Belgium.
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Livesley J. Tradition versus empiricism in the current DSM-5 proposal for revising the classification of personality disorders. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2012; 22:81-90. [PMID: 22431232 DOI: 10.1002/cbm.1826] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Gupta S, Mattoo SK. Personality disorders: prevalence and demography at a psychiatric outpatient in North India. Int J Soc Psychiatry 2012; 58:146-52. [PMID: 21177705 DOI: 10.1177/0020764010387548] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Even though personality disorders are common among psychiatric populations, the data from India on their prevalence and demography are sparse. AIM To profile the prevalence and demography of personality disorders in North India. METHODS The retrospective study was based on patients attending the outpatient of a general hospital psychiatric centre in North India between June 1996 and June 2006. The specified data were collected from the case records of those receiving a primary or comorbid ICD-10 diagnosis of a personality disorder. RESULTS Personality disorders had a prevalence of 1.07%, with a preponderance of those aged 21-40 years (69.4%), men (64.9%), employed and students (37.3% and 32.8% respectively), unmarried (56%), graduates and undergraduates (27.6% each), and referred by the family (68.7%). The most common personality disorders were anxious-avoidant and borderline. Compared with the anxious-avoidant group, the borderline group was younger (mean age 24.44 vs 29.66 years) and had a preponderance of females (60% vs 27.1%). CONCLUSION The prevalence of personality disorders among the psychiatric outpatients was low compared to most of the research literature reporting clinically diagnosed personality disorders. The differences between the borderline and anxious-avoidant personality disorder subjects were largely explained by interrelated demographic variables.
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Affiliation(s)
- Swapnil Gupta
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Malone JC, Westen D, Levendosky AA. Personalities of adults with traumatic childhood separations. J Clin Psychol 2011; 67:1259-82. [DOI: 10.1002/jclp.20844] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Stevenson J, Datyner A, Boyce P, Brodaty H. The effect of age on prevalence, type and diagnosis of personality disorder in psychiatric inpatients. Int J Geriatr Psychiatry 2011; 26:981-7. [PMID: 21845601 DOI: 10.1002/gps.2645] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Accepted: 09/03/2010] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine age-related differences in personality disorder (PD) comorbidity and in their diagnosis in psychiatric inpatients. METHODS Two hundred thirty-one consenting adults consecutively admitted to inpatient psychiatry units and aged between the age of 18 and 100 were assessed using the Structured Clinical Interview for DSM IV Axis I and II (SCID-I and -II), after excluding cognitively impaired, non-English speaking, short stay and respite patients. Hospital files were audited for clinical diagnoses, in particular for recorded PDs. Rates of PD prevalence and clinician diagnosis were compared for young (n = 76), middle-age (n = 57) and older (n = 98) patients. RESULTS Significant personality comorbidity was evident at all ages, but rates were lowest in the older group. PD was present in 73.7% of young, 71.9% of middle-age and 58.8% of older patients. Complex PD was more common in young patients. Only 19.8% of PDs were noted by their clinicians to have PD. CONCLUSION Comorbid PD is common in psychiatric inpatient groups regardless of age but seldom diagnosed clinically.
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Affiliation(s)
- Janine Stevenson
- Department of Psychiatry, Westmead Hospital, Wentworthville, NSW, Australia.
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Bos EH, van Wel EB, Appelo MT, Verbraak MJPM. Effectiveness of Systems Training for Emotional Predictability and Problem Solving (STEPPS) for borderline personality problems in a 'real-world' sample: moderation by diagnosis or severity? PSYCHOTHERAPY AND PSYCHOSOMATICS 2011; 80:173-81. [PMID: 21389754 DOI: 10.1159/000321793] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Accepted: 10/03/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a group treatment for borderline personality disorder (BPD). Two prior randomized controlled trials (RCTs) have shown the efficacy of this training. In both RCTs, patients with borderline features who did not meet the DSM-IV criteria for BPD were excluded, which were many. We investigated the effectiveness of STEPPS in a sample representative of routine clinical practice and examined whether DSM-IV diagnosis and/or baseline severity were related to differential effectiveness. METHODS Patients whom their practicing clinician diagnosed with BPD were randomized to STEPPS plus adjunctive individual therapy (STEPPS, n = 84) or to treatment as usual (TAU, n = 84). RESULTS STEPPS recipients showed more improvement on measures of general and BPD-specific psychopathology as well as quality of life than TAU recipients, both at the end of treatment and at a 6-month follow-up. Presence of DSM-IV-diagnosed BPD was not related to differential treatment effectiveness, but dimensional measures of symptom severity were; STEPPS was superior to TAU particularly in patients with higher baseline severity scores. CONCLUSIONS The findings show the effectiveness of STEPPS in a 'real-world' sample, and underscore the importance of dimensional versus categorical measures of personality disturbance.
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Affiliation(s)
- Elisabeth H Bos
- Lentis, University Medical Center Groningen, Groningen, The Netherlands.
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Mullins-Sweatt SN, Widiger TA. Clinician's judgments of the utility of the DSM-IV and five-factor models for personality disordered patients. J Pers Disord 2011; 25:463-77. [PMID: 21838562 DOI: 10.1521/pedi.2011.25.4.463] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of the current study was to examine the clinical utility of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 2000) and the Five Factor Model of personality disorder (FFM; Widiger, Costa, & McCrae, 2002) in describing personality pathology. In the current study, practicing psychologists described one or two of their personality disordered patients in terms of the FFM and DSM models. In some instances, the patient was someone who met the criteria for one of the 10 DSM-IV personality disorders; in others, the patient was someone who received a diagnosis of personality disorder, not otherwise specified. Participants then rated each model on six aspects of clinical utility. The current study found that the FFM was consistently rated higher than the DSM model in terms of four of the six aspects of clinical utility. Across both cases, the clinicians rated the FFM as significantly more useful with respect to its ability to provide a global description of the individual's personality, to communicate information to clients, and to encompass all of the individual's important personality difficulties.
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Dimensionale versus kategoriale Klassifikation von Persönlichkeitsstörungen. FORENSISCHE PSYCHIATRIE PSYCHOLOGIE KRIMINOLOGIE 2011. [DOI: 10.1007/s11757-011-0118-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
Using the Shedler-Westen Assessment Procedure (SWAP)-200 Q-Sort items in a large clinical sample of outpatients (N = 105), we developed the SWAP insight scale. The rationale, psychometric properties, and convergent validity of this insight scale are reported. Through factor analysis, six of the SWAP-200 items were identified as psychometrically optimal in the assessment of insight (presence or absence) with an alpha coefficient of 0.78. We examined the construct validity of this SWAP insight scale using independent clinical videotape ratings of the Capacity for Dynamic Process Scale, specifically the items "appears introspective" and "manifests insight." We also examined the relationship between the SWAP insight scale using independent clinical videotape ratings of the Social Cognition and Object Relations Scale-Global Ratings, specifically ratings of "complexity of representations" and "social causality." The results demonstrated significant positive correlation between the SWAP insight scale and all five of these criterion measures. Partial correlations demonstrated that, even when the effects of global psychiatric severity are controlled for, the SWAP insight scale maintains a significant relationship with independent clinical videotape ratings of patients manifesting insight during sessions. Future research directions and clinical implications of the SWAP insight scale are discussed.
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Rottman BM, Kim NS, Ahn WK, Sanislow CA. Can personality disorder experts recognize DSM-IV personality disorders from five-factor model descriptions of patient cases? J Clin Psychiatry 2011; 72:630-9. [PMID: 21208595 PMCID: PMC3493484 DOI: 10.4088/jcp.09m05534gre] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2009] [Accepted: 10/30/2009] [Indexed: 10/18/2022]
Abstract
BACKGROUND Dimensional models of personality are under consideration for integration into the next Diagnostic and Statistical Manual of Mental Disorders (DSM-5), but the clinical utility of such models is unclear. OBJECTIVE To test the ability of clinical researchers who specialize in personality disorders to diagnose personality disorders using dimensional assessments and to compare those researchers' ratings of clinical utility for a dimensional system versus for the DSM-IV. METHOD A sample of 73 researchers who had each published at least 3 (median = 15) articles on personality disorders participated between December 2008 and January 2009. The Five-Factor Model (FFM), one of the most-studied dimensional models to date, was compared to the DSM-IV. Participants provided diagnoses for case profiles in DSM-IV and FFM formats and then rated the DSM-IV and FFM on 6 aspects of clinical utility. RESULTS Overall, participants had difficulty identifying correct diagnoses from FFM profiles (t₇₂ = 12.36, P < .01), and the same held true for a subset reporting equal familiarity with the DSM-IV and FFM (t₂₃ = 6.96, P < .01). Participants rated the FFM as less clinically useful than the DSM for making prognoses, devising treatment plans, and communicating with professionals (all t₆₉ > 2.19, all P < .05), but more useful for communicating with patients (t₆₉ = 3.03, P < .01). CONCLUSIONS The results suggest that personality disorder expertise and familiarity with the FFM are insufficient to correctly diagnose personality disorders using FFM profiles. Because of ambiguity inherent in FFM profile descriptors, this insufficiency may prove unlikely to be attenuated with increased clinical familiarity with the FFM.
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Affiliation(s)
| | - Nancy S. Kim
- Department of Psychology, Northeastern University; Boston, MA
| | - Woo-kyoung Ahn
- Department of Psychology, Yale University; New Haven, CT
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Huang J, He W, Chen W, Yu W, Chen W, Shen M, Wang W. The Zuckerman-Kuhlman Personality Questionnaire predicts functioning styles of personality disorder: a trial in healthy subjects and personality-disorder patients. Psychiatry Res 2011; 186:320-325. [PMID: 20699194 DOI: 10.1016/j.psychres.2010.07.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Revised: 06/01/2010] [Accepted: 07/09/2010] [Indexed: 10/19/2022]
Abstract
Normal personality traits, as measured by the Zuckerman-Kuhlman Personality Questionnaire (ZKPQ), predicted some personality disorders in a sample of healthy volunteers. Whether these predictions could be more pronounced in patients with personality disorders remains unknown. We administered the ZKPQ and the Parker Personality Measure (PERM), which describes the functioning styles of personality disorder, in 134 patients with a range of personality disorders and in 268 age-, gender- and education level-matched healthy volunteers. Cluster A patients scored lowest on Sociability, cluster B highest on Impulsive Sensation Seeking and Aggression-Hostility, cluster C1 (Avoidant and Dependent types) highest on Neuroticism-Anxiety, and cluster C2 (Obsessive-Compulsive type) highest on Activity. Most of the predictors were consistent across both the healthy and patient groups. The variances that accounted for predicting most PERM styles by the ZKPQ traits in the patient group were higher than those in the healthy group. Our results showed that the ZKPQ traits could specifically predict the PERM styles in both healthy subjects and personality-disorder patients. This result was more pronounced in the latter group. The most powerful predictions were obtained for Antisocial, Dependent, Borderline and Avoidant styles, and the weakest for the Schizotypal and Schizoid styles in the patient group.
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Affiliation(s)
- Jingyi Huang
- Department of Clinical Psychology, Zhejiang University School of Medicine, Hangzhou, China
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Elliott T, Tyrer P, Horwood J, Fergusson D. Assessment of abnormal personality in childhood: a Delphi survey of questionnaire data. J Pers Disord 2011; 25:89-100. [PMID: 21309625 DOI: 10.1521/pedi.2011.25.1.89] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
As an investigation into the feasibility of recording personality status from questionnaire data in younger people we used a three phase Delphi survey to assess items from the Christchurch Health and Development Study, administered at ages 12 to 16 years. Twelve experts took part in Phase I, and 22 in Phases II and III, 16 of whom were experts in adult personality disorder (PD), and 6 were experts who work with children. In total, 189 questions (55% of the total (238) in the questionnaires) were identified as possibly being related to personality abnormality in one or more clusters with high consensus. Experts who work with children were less likely to label features as related to personality than experts in PD (p < 0.001), and the four personality factors (equivalent to Mulder and Joyce's antisocial, asocial, asthenic, and anankastic) chosen for assessment showed variable agreement. Confirmatory factor analysis showed the best fitting model of the data was a 3 factor solution involving asocial/asthenic, antisocial, and anankastic factors. This represents the first attempt to use existing recorded data to code personality status and the results of this Delphi survey give some grounds for optimism that this approach has potential in the early identification of personality features.
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Affiliation(s)
- Tamara Elliott
- Centre for Mental Health, Imperial College, St. Dunstan's Road, London W6 8RP, UK
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Samuel DB, Widiger TA. Clinicians' Use of Personality Disorder Models within a Particular Treatment Setting: A Longitudinal Comparison of Temporal Consistency and Clinical Utility. Personal Ment Health 2011; 5:10.1002/pmh.152. [PMID: 24288580 PMCID: PMC3840725 DOI: 10.1002/pmh.152] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
An active line of current investigation is how the five-factor model (FFM) of personality disorder might be applied by clinicians and particularly, how clinically useful this model is in comparison to the existing nomenclature. The current study is the first to investigate the temporal consistency of clinicians' application of the FFM and the DSM-IV-TR to their own patients. Results indicated that FFM ratings were relatively stable over six-months of treatment, supporting their use by clinicians, but also indexed potentially important clinical changes. Additionally, ratings of utility provided by the clinicians suggested that the FFM was more useful for clinical decision making than was the DSM-IV-TR model. We understand the clinical utility findings within the context of previous research indicating that the FFM is most useful among patients who are not prototypic for a personality disorder.
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Confusion and Incoherence in the Classification of Personality Disorder: Commentary on the Preliminary Proposals for DSM-5. PSYCHOLOGICAL INJURY & LAW 2010. [DOI: 10.1007/s12207-010-9094-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Wright AGC, Lukowitsky MR, Pincus AL, Conroy DE. The Higher Order Factor Structure and Gender Invariance of the Pathological Narcissism Inventory. Assessment 2010; 17:467-83. [DOI: 10.1177/1073191110373227] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Pathological Narcissism Inventory (PNI) is a recently developed multidimensional inventory for the assessment of pathological narcissism. The authors describe and report the results of two studies that investigate the higher order factor structure and gender invariance of the PNI. The results of the first study indicate that the PNI has a higher order factor structure that conforms to the theoretical structure of pathological narcissism with one factor representing narcissistic grandiosity and the other capturing narcissistic vulnerability. These results uniquely place the PNI as the only measure to broadly assess the two phenotypic themes of pathological narcissism. In the second study, results from tests of measurement invariance indicate that the PNI performs similarly in large samples of men ( n = 488) and women ( n = 495). These results further establish the psychometric properties of the PNI and suggest that it is well suited for the assessment of pathological narcissism.
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