Psychometric evaluation of the depressive personality disorder inventory

Enhancement of aerobic fitness improves social functioning in individuals with schizophrenia

Individuals with schizophrenia display substantial deficits in social functioning (SF), characterized by chronic, lifelong presentations. Yet, at present there are few effective interventions to enhance SF in this population. Emerging evidence from studies of clinical populations that display similar SF deficits suggests that aerobic exercise (AE) may improve social skills. However, this putative impact has not been investigated in schizophrenia. Employing a single-blind, randomized clinical trial design, 33 individuals with schizophrenia were randomized to receive 12 weeks of Treatment-As-Usual (TAU; n = 17) or TAU + AE (n = 16) utilizing active-play video games (Xbox 360 Kinect) and traditional AE equipment. Participants completed an evaluation of aerobic fitness (VO₂max) as well as self-, informant-, and clinician-reported SF measures at baseline and after 12 weeks. Twenty-six participants completed the study (79%; TAU = 13; AE = 13). At follow-up, the AE participants improved their VO₂max by 18.0% versus - 0.5% in the controls (group x time interaction, F_1,24 = 12.88; p = .002). Hierarchical stepwise regression analyses indicated improvements in VO₂max significantly predicted enhancement in SF as indexed by self-, informant-, and clinician-reported measures, predicting 47%, 33%, and 25% of the variance, respectively (controlling for baseline demographics, medications, mood symptoms, and social networks). Compared to the TAU group, AE participants reported significant improvement in SF (23.0% vs. - 4.2%; group × time interaction, F_1,24 = 7.48, p = .012). The results indicate that VO₂max enhancement leads to improvements in SF in people with schizophrenia. Furthermore, low VO₂max represents a modifiable risk factor of SF in people with schizophrenia, for which AE training offers a safe, non-stigmatizing, and nearly side-effect-free intervention.

Social Media and Social Functioning in Psychosis: A Systematic Review

BACKGROUND

Individuals with psychosis are heavy consumers of social media. It is unknown to what degree measures of social functioning include measures of online social activity.

OBJECTIVE

To examine the inclusion of social media activity in measures of social functioning in psychosis and ultrahigh risk (UHR) for psychosis.

METHODS

Two independent authors conducted a search using the following electronic databases: Epistemonikos, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, MEDLINE, Embase, and PsycINFO. The included articles were required to meet all of the following criteria: (1) an empirical study published in the English language in a peer-reviewed journal; (2) the study included a measure of objective or subjective offline (ie, non-Web-mediated contact) and/or online social functioning (ie, Web-mediated contact); (3) the social functioning measure had to be used in samples meeting criteria (ie, Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases) for a psychotic disorder or UHR for psychosis; and (4) the study was published between January 2004 and February 2019. Facebook was launched as the first large-scale social media platform in 2004 and, therefore, it is highly improbable that studies conducted prior to 2004 would have included measures of social media activity.

RESULTS

The electronic search resulted in 11,844 distinct articles. Full-text evaluation was conducted on 719 articles, of which 597 articles met inclusion criteria. A total of 58 social functioning measures were identified. With some exceptions, reports on reliability and validity were scarce, and only one measure integrated social media social activity.

CONCLUSIONS

The ecological validity of social functioning measures is challenged by the lack of assessment of social media activity, as it fails to reflect an important aspect of the current social reality of persons with psychosis. Measures should be revised to include social media activity and thus avoid the clinical consequences of inadequate assessment of social functioning.

TRIAL REGISTRATION

International Prospective Register of Systematic Reviews (PROSPERO) CRD42017058514; http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017058514.

Expanding the utility of the malignant self-regard construct

The empirical and theoretical literature suggest that several proposed personality disorders (PDs) - Masochistic/Self-Defeating, Depressive, and Vulnerably Narcissistic - may be related through a common self-representation know as Malignant Self-Regard (MSR). To assess this construct, the MSR Questionnaire (MSRQ) was developed. Though its initial psychometric properties were very strong, the present study extended these findings by examining the relationship of the MSRQ with measures of other PDs and depressive subtypes, and by establishing four-week and eight-week test-retest reliability in two samples (Ns=840, 911) of undergraduate students. The MSRQ was internally consistent and temporally stable over four and eight weeks. It was positively correlated with measures of introjective and anaclitic depression, measures of Self-Defeating, Depressive, and Vulnerably Narcissistic personalities (rs ranging between 0.60 and 0.82), and other select PDs. After controlling for depressive symptoms and self-esteem, the highest remaining partial correlations were with Vulnerably Narcissistic, Self-Defeating, Depressive, and Avoidant personalities. A factor analysis of the MSRQ with measures of other PDs yielded a two-factor solution, with MSR loading most strongly on one factor, along with Vulnerably Narcissistic, Avoidant, Depressive, and Self-Defeating personalities. It is concluded that MSR is a psychometrically supported construct that might have good clinical utility in explaining personality pathology that has historically been difficult to assess.

Emotional granularity and social functioning in individuals with schizophrenia: an experience sampling study

Previous research has shown that healthy individuals who fail to differentiate among emotional states (i.e., those with low emotional granularity; EG) have poorer social functioning (SF) than those with high EG. It is unknown, however, whether these associations extend to clinical disorders characterized by impaired SF, such as schizophrenia. In the present study, we compared SF and EG in individuals with schizophrenia and healthy controls, and then, within the schizophrenia group, we examined the links between EG and SF. Employing an Experience Sampling Method approach, 77 individuals with schizophrenia and 27 healthy controls rated their momentary emotions (sadness, anxiety, anger, and happiness) up to 10 times/day over a two-day period using mobile electronic devices. For each participant, we then calculated the within-subject average correlations among the momentary emotion ratings, producing two EG indices - EGIall for all emotions and EGIneg for negative ones. A subsample of participants with schizophrenia also completed self-report, interview, and ability-based measures of SF. Compared to healthy controls, individuals with schizophrenia displayed significantly poorer SF and lower EGIall, but comparable EGIneg. Within the schizophrenia group, hierarchical multiple regression analyses indicated that EGIall, but not EGIneg, significantly predicted social dysfunction after controlling for emotional awareness, symptoms, and emotional intensity and variability. Our findings indicate that individuals with schizophrenia have a relatively intact ability to differentiate among negative emotions in everyday life. However, they experience significant difficulties differentiating between positive and negative emotions, and this may contribute to their social difficulties.

Malignant self-regard: accounting for commonalities in vulnerably narcissistic, depressive, self-defeating, and masochistic personality disorders

Several personality disorders (PDs) have been of interest in the clinical literature, yet failed to have been adequately represented in the diagnostic manuals. Some of these are masochistic, self-defeating, depressive, and narcissistic PDs. The theoretical and empirical relationships among these disorders are reviewed. It is proposed that a particular type of self-structure, malignant self-regard (MSR), may account for similarities among all of them and provide a better framework upon which to understand the nature of these personality types and their discrimination from related constructs. Subsequently, a questionnaire to assess MSR was created and evaluated for its psychometric properties. The measure was found to be reliable (Cronbach's alpha=.93) and valid, given its correlations with measures of self-defeating, depressive, and vulnerably narcissistic personalities (rs range from .66 to .76). MSR also can be meaningfully differentiated from a nomological network of related constructs, including neuroticism, extraversion, depression, and grandiose narcissism. The utility of assessing self-structures, such as MSR, in the diagnostic manuals is discussed.

Emotion awareness and regulation in individuals with schizophrenia: Implications for social functioning

Successful social functioning requires adaptive forms of emotion awareness and regulation. However, despite well-documented deficits in social functioning in individuals with schizophrenia, little is known about emotion awareness and regulation in this population. Therefore, we compared emotion awareness and regulation in individuals with schizophrenia and healthy controls, and then, within the schizophrenia group, we examined their impact on social functioning. Forty-four individuals with schizophrenia and 20 healthy controls completed measures of emotion awareness, emotion regulation, and social functioning, in addition to control measures, including neurocognitive functioning. Compared to controls, individuals with schizophrenia displayed significant deficits describing and identifying their emotions and used significantly less reappraisal and more suppression to regulate their emotions. Among the schizophrenia group, better social functioning was associated with the ability to identify, and in particular to describe emotions, better emotion management, as well as greater use of reappraisal and less use of suppression. A hierarchical multiple regression analysis indicated that, after controlling for age and neurocognition, difficulties describing feelings accounted for 35% of the social functioning variance. The present study highlights the importance of emotion awareness and regulation in schizophrenia, pointing to their substantial influence on social functioning above and beyond the impact of neurocognitive functioning.

Psychometric properties of the Spanish version of the diagnostic interview for depressive personality

The aim of this study was to evaluate the reliability and validity of the Spanish-language version of the diagnostic interview for depressive personality (DIDP). The DIDP was administered to 328 consecutive outpatients and the test-retest and inter-rater reliability were assessed. Factor analysis was used in search of factors capable of explaining the scale and a cutoff point was established. The DIDP scales showed adequate Cronbach's α values and acceptable test-retest and inter-rater reliability coefficients. Convergent and discriminant validity were explored, the latter with respect to avoidant and borderline personality disorders. The results of the factor analysis were consistent with the four-factor structure of the DIDP scales. The receiver operating characteristic (ROC) analysis revealed the area under the curve to be 0.848. We found 30 to be a good cutoff point, with a sensitivity of 74.5% and a specificity of 78.5%. The DIDP proved to be a reliable and valid instrument for assessing depressive personality disorder, at least among our outpatients. The psychometric properties of the DIDP support its clinical usefulness in assessing depressive personality.

The Swedish Depressive Personality Disorder Inventory: psychometrics and clinical correlates from a DSM-IV and proposed DSM-5 perspective

BACKGROUND

Depressive personality is commonly seen in clinical practice, and today only one exclusive self-report instrument-the Depressive Personality Disorder Inventory (DPDI)-is available for its assessment based on the DSM-IV description of the construct.

AIMS

The purpose of this research was to evaluate a Swedish version of this measure (DPDI-Swe) in terms of its reliability, internal structure, and convergent validity using related variables from the DSM-IV criteria for depressive personality disorder (DPD) and the proposed DPD trait set for DSM-5.

METHODS

A non-clinical sample of 255 adults in southern Sweden completed a self-report package, which, in addition to DPD, included the assessment of self-esteem, optimism, hope, rumination, worry, depression, and anxiety. Quality of life was also measured.

RESULTS

Results indicated that the DPDI-Swe was internally consistent (α = 0.96). Exploratory factor analysis with oblique rotation yielded three components, together accounting for 48.21% of the variance in DPDI-Swe scores. There were strong positive associations between the DPDI-Swe and measures of depression, anxiety, rumination, and worry, and strong negative associations between the DPDI-Swe and measures of self-esteem, optimism, hope, and quality of life. These significant relationships remained, albeit slightly diminished, after statistically controlling for current depressed mood.

CONCLUSIONS AND CLINICAL IMPLICATIONS

The DPDI-Swe appears to be a reliable and valid measure of DPD, and it is available for clinical and research use.

Mood and Global Symptom Changes among Psychotherapy Clients with Depressive Personality

The present study assessed the rate of depressive personality (DP), as measured by the self-report instrument depressive personality disorder inventory (DPDI), among 159 clients entering psychotherapy at an outpatient university clinic. The presenting clinical profile was evaluated for those with and without DP, including levels of depressed mood, other psychological symptoms, and global severity of psychopathology. Clients were followed naturalistically over the course of therapy, up to 40 weeks, and reassessed on these variables again after treatment. Results indicated that 44 percent of the sample qualified for DP prior to treatment, and these individuals had a comparatively more severe and complex presenting disposition than those without DP. Mixed-model repeated-measures analysis of variance was used to examine between-groups changes on mood and global severity over time, with those with DP demonstrating larger reductions on both outcome variables, although still showing more symptoms after treatment, than those without DP. Only eleven percent of the sample continued to endorse DP following treatment. These findings suggest that in routine clinical situations, psychotherapy may benefit individuals with DP.

The depressive personality disorder inventory and current depressive symptoms: implications for the assessment of depressive personality

The Depressive Personality Disorder Inventory (DPDI; Huprich, Margrett, Barthelemy, & Fine, 1996; see Appendix) was created to assess Depressive Personality Disorder in clinical and nonclinical samples. Since its creation, the DPDI has been used in multiple studies, and the psychometric properties of the measure have generally supported its reliability, convergent validity, and construct validity; however, evidence for the measure's discriminant validity has been mixed. Specifically, the DPDI tends to correlate highly with measures of current depressive symptoms, which limits its efficacy in differentiating current depressive symptoms from a depressive personality structure. A principal components analysis of 362 individuals who completed both the DPDI and Beck Depression Inventory (BDI-II; Beck, Steer, & Brown, 1996) found that 49% of the variance was accounted for in two components. Seven items from the DPDI loaded more strongly on the first component composed of many BDI-II items. These items were removed in order to create a measure believed to assess DPD without the confounding influence of current depressive symptomology. Principal components analysis of the revised measure yielded three components, accounting for 46% of the variance. The revised DPDI was used to calculate convergent, discriminant, and construct validity coefficients from measures used in former studies. Virtually no improvement in the validity coefficients was observed. It is concluded that assessing DPD via self-report is limited in its utility.

Depressive Personality Disorder: A Comparison of Three Self-Report Measures

Depressive personality disorder (DPD) was included in the appendix of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition ( DSM-IV) for further study. Questions abound regarding this disorder in terms of its distinctiveness from extant diagnostic constructs and clinical significance.This study examines the interrelations between three assessments of DPD and their relations to pathological personality traits and disorders in a sample of undergraduates ( N = 182). The DPD indices evinced adequate convergence with each other (mean r = .60) and similar pathological personality profiles. The authors also tested the incremental validity of the DPD scores in relation to psychological functioning, after controlling for depressive symptoms and the DSM-IV personality disorders (PDs). The DPD scores manifested limited incremental validity, mainly in the form of predicting lower levels of positive affectivity. Our results suggest that this is not specific to DPD, however, as the official PDs also manifested limited incremental validity.

What should become of depressive personality disorder in DSM-V?

Depressive personality disorder (DPD) has been under consideration for inclusion in the Diagnostic and Statistical Manual of Mental Disorders for many years. The wealth of empirical studies on the validity of DPD has raised many questions about the validity of the DPD construct and its measures. This article specifically reviews studies on the validity of that construct and how it is measured. Although the evidence supports the idea that DPD is a viable diagnostic category, there remain significant challenges to its assessment. These findings are discussed in the context of some potential changes that may occur in the classification and diagnosis of personality disorders in DSM-V.

Comparison of prototypic cases of depressive personality disorder and dysthymic disorder

Although depressive personality disorder (DPD) was included in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 1994) appendix as a proposed category needing further research, there are concerns that it overlaps excessively with dysthymic disorder (DD). The purpose of this investigation was to identify the characteristic features of representative patients with DPD and patients with DD, and to determine whether they could be distinguished by their symptoms. Two matched samples of psychologists (n=57, n=48) identified a prototypic patient with DPD or DD, provided demographic and treatment information about the patient, and rated the patient's symptoms on a series of mood and personality disorder symptoms taken from the DSM-IV and the literature. When composite descriptions were constructed using the highest rated symptoms, there was considerable overlap in symptoms of identified DPD and DD patients. The DSM-IV research criteria for DPD provided the best description of the DPD patients; however, there was a high degree of correlation between DPD and DD criteria sets. There was also considerable comorbidity, with the majority of the patients in both groups meeting criteria for DPD and DD. However, there was a significant difference in comorbid diagnoses (and other differences in family history, outcome, and treatment history that failed to reach the more stringent level of statistical significance, i.e., p<.001) suggesting that there may be some important differences between DPD and DD. Nevertheless, the symptom ratings imply blurred boundaries between DPD and DD, suggesting the need for clearer differentiation between the two disorders or the need to adopt an alternative model of classification.

Depressive personality disorder, dysthymia, and their relationship to perfectionism

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

Functional health status and its relationship to depressive personality disorder, dysthymia, and major depression: preliminary findings

Controversy continues on the extent to which depressive personality disorder (DPD) and dysthymic disorder (DYST) may be differentiated. Although affective disorders often are accompanied by changes in functional health status, to date no study has examined how functional health associated with affective disorders may assist in differentiating the two disorders. In this study, we hypothesized that measures of DPD would have fewer correlations with functional health status than would measures of DYST and major depressive disorder (MDD). African American women (n=110) completed questionnaires that assessed for depressive disorders, somatic concerns, and physical health. Measures of DPD, DYST, and MDD were all significantly correlated with functional health status. When symptoms of MDD were controlled, DYST was more associated with functional health status than was a DSM-IV measure of DPD, although a self-report measure of DPD--the Depressive Personality Disorder Inventory [DPDI; Huprich et al., 1996: J Clin Psychol 52:152-159]--remained significantly correlated with functional health status. When symptoms of DYST were controlled, DSM-IV symptoms of DPD were not strongly associated with functional health status, although measures of MDD and the DPDI were correlated with functional health status. We concluded that despite the overlap in depressive symptoms and functional health status, DPD may be less associated with functional health status in a primary care population than DYST and MDD. Implications for the assessment of DPD are provided.

The Depressive Personality Disorder Inventory and Its Relationship to Quality of Life, Hopefulness, and Optimism

The construct validity of the Depressive Personality Disorder Inventory (DPDI; Huprich, Margrett, Barthelemy, & Fine, 1996) was examined through its relationship to the constructs of hope, optimism, and quality of life (QOL). Three hundred thirty-two undergraduate students were administered the DPDI and measures of the aforementioned constructs. As predicted, the DPDI negatively correlated with all measures. Individuals classified with a depressive personality disorder had significantly higher scores on measures of hope, optimism, and QOL compared to a control group. Stepwise regression analysis indicated that optimism, QOL, and one component of hope significantly predicted DPDI scores, although more variance was accounted for in women than men. These findings are explained in light of Carver and Scheier's (2000) explanation of optimism and its relationship to hope. In sum, it appears that the construct validity of the DPDI is supported within an undergraduate sample.

Convergent and Discriminant Validity of Three Measures of Depressive Personality Disorder

Sixty-eight outpatients from a veterans' administration psychiatry clinic and community mental health center were assessed with 3 measures of depressive personality disorder (DPD)-the Diagnostic Interview for Depressive Personality Disorder (Gunderson, Phillips, Triebwasser, & Hirschfeld, 1994), the Depressive Personality Disorder Inventory (Huprich, Margrett, Barthelemy, & Fine, 1996), and the Structured Clinical Interview for DSM-IV Axis II Disorders (First, Gibbon, Spitzer, Williams, & Benjamin, 1997a)-to evaluate their convergent and discriminant validity. Evidence supporting the measures' validity was mixed. The rate of convergence of depressive personality diagnoses across 3 measures was less than optimal, but the degree of intercorrelation among the measures was strong. Although depressive personality scores had moderate levels of intercorrelations with other personality disorders, the degree of intercorrelation decreased substantially after controlling for depressive symptoms. I conclude that further work is needed to strengthen the validity of measures of DPD.

Evaluating facet-level predictions and construct validity of depressive personality disorder

The purpose of this study was to evaluate Widiger, Trull, Clarkin, Sanderson, and Costa's (1994) facet-level predictions about depressive personality disorder, thereby evaluating the validity of the depressive personality disorder construct. A sample of 67 patients was collected from two treatment facilities. Participants completed three different measures of depressive personality disorder and the NEO-PI-R (Costa & McCrae, 1992). All measures of depressive personality disorder were significantly correlated with three of the four predicted facets: Anxiety, Depression, and Self-Consciousness. All three measures were significantly correlated with the Vulnerability, Warmth, Gregariousness, Assertiveness, Positive Emotions, Actions, Trusts, and Achievement Striving facets. A series of regression analyses was performed. Two of the predicted facets--Self-Consciousness and Tendermindedness--were able to uniquely account for variance in all three measures of depressive personality across most analyses. However, there was a lack of specificity across other facets in predicting the depressive personality disorder. A facet-level understanding of depressive personality disorder appears to be empirically justified, and the validity of the depressive personality disorder further supported. Additional work is needed on improving the measurement of depressive personality disorder.

Depressive personality and its relationship to depressed mood, interpersonal loss, negative parental perceptions, and perfectionism

Eighty veteran psychiatric outpatients were evaluated for depressive personality disorder on the Depressive Personality Disorder Inventory (DPDI). It was predicted that those classified with depressive personality would report higher levels of interpersonal loss, negative perceptions of their parents, and higher levels of perfectionism than psychiatric control subjects. Nine of the 12 measures of these variables were significantly greater in those with depressive personality compared with psychiatric control subjects. When statelike depression was controlled for, seven of the nine variables still significantly differed between the two groups. Hierarchical regression analysis and discriminant function analysis found that these variables predicted 9% of the variance in the DPDI above and beyond statelike depression, and that a combination of these variables correctly classified 91% of the depressive personalities and 88% of the psychiatric control subjects. It is concluded that, as hypothesized, depressive personality disorder is associated with loss, negative parental perceptions, and perfectionism, and that these relationships are not accounted for exclusively by a depressed mood.