Personality dimensions across cultures

Characterizing the Relationship between Personality Dimensions and Psychosis-Specific Clinical Characteristics

Background

Past studies associating personality with psychosis have been limited by small nonclinical samples and a focus on general symptom burden. This study uses a large clinical sample to examine personality's relationship with psychosis-specific features and compare personality dimensions across clinically and neurobiologically defined categories of psychoses.

Methods

A total of 1352 participants with schizophrenia, schizoaffective disorder, and bipolar with psychosis, as well as 623 healthy controls (HC), drawn from the Bipolar-Schizophrenia Network for Intermediate Phenotypes (BSNIP-2) study, were included. Three biomarker-derived biotypes were used to separately categorize the probands. Mean personality factors (openness, conscientiousness, extraversion, agreeableness, and neuroticism) were compared between HC and proband subgroups using independent sample t-tests. A robust linear regression was utilized to determine personality differences across biotypes and diagnostic subgroups. Associations between personality factors and cognition were determined through Pearson's correlation. A canonical correlation was run between the personality factors and general functioning, positive symptoms, and negative symptoms to delineate the relationship between personality and clinical outcomes of psychosis.

Results

There were significant personality differences between the proband and HC groups across all five personality factors. Overall, the probands had higher neuroticism and lower extraversion, agreeableness, conscientiousness, and openness. Openness showed the greatest difference across the diagnostic subgroups and biotypes, and greatest correlation with cognition. Openness, agreeableness, and extraversion had the strongest associations with symptom severity.

Conclusions

Individuals with psychosis have different personality profiles compared to HC. In particular, openness may be relevant in distinguishing psychosis-specific phenotypes and experiences, and associated with biological underpinnings of psychosis, including cognition. Further studies should identify potential causal factors and mediators of this relationship.

Common Features in Compulsive Sexual Behavior, Substance Use Disorders, Personality, Temperament, and Attachment-A Narrative Review

Do addictions share common traits of an “addictive personality” or do different addictions have distinct personality profiles? This narrative review examines the differences in the associations between substance use disorder (SUD) and compulsive sexual behavior disorder (CSBD), on the one hand, and personality traits, attachment dispositions, and temperament, on the other hand. We found that both people with a SUD and people with CSBD tended to be more spontaneous, careless, and less reliable, to place self-interest above getting along with others, to show emotional instability and experience negative emotions such as anger, anxiety, and/or depression, to be less able to control their attention and/or behavior, and to be engulfed with a constant sensation of “wanting”. Only people with CSBD, but not SUD, noted concerns with their social ties, fear of losing close others, and/or trusting others around them. Results also suggested that people with a SUD and people with CSBD share high commonalities in personality traits and temperament, yet there are noted differences in their social tendencies, especially with close others. People with CSBD reported more concerns with possible relationship losses compared to people with SUD issues, who may be more worried about losing their source of escapism.

The role of migration processes and cultural factors in the classification of personality disorders

Migrants and ethnic minorities are at risk of being under- and overdiagnosed with personality disorders (PDs). A culturally informed approach to the classification of PDs guides clinicians in incorporating migration processes and cultural factors, to arrive at a reliable and valid assessment of personality pathology. In this article, we provide a tentative framework to highlight specific interactions between personality disorders, migration processes, and cultural factors. It is argued that migration processes can merely resemble personality pathology, activate certain (latent) vulnerabilities, and aggravate pre-existing personality pathology. We propose that these migration processes can include manifestations of grief about the loss of pre-migratory psychosocial and economic resources, and the struggle to attain psychosocial and economic resources in the host culture. Moreover, several cultural dimensions are outlined that can either resemble or mask personality pathology. The term "culturally masked personality disorder" is coined, to delineate clinical cases in which cultural factors are overused or misused to rationalize behavioral patterns that are consistently inflexible, distressing, or harmful to the individual and/or significant others, lead to significant impairment, and exceed the relevant cultural norms. Additionally, the role of historical trauma is addressed in the context of potential overdiagnosis of personality disorders in Indigenous persons, and the implications of misdiagnosis in migrants, ethnic minorities, and Indigenous populations are elaborated. Finally, clinical implications are discussed, outlining various diagnostic steps, including an assessment of temperament/character, developmental history, systemic/family dynamics, migration processes, cultural dimensions, and possible historical trauma.

A cross-national examination of cannabis protective behavioral strategies' role in the relationship between Big Five personality traits and cannabis outcomes

Background: Problematic cannabis use is common among young adults across the world. However, limited research has examined whether etiological models predicting negative consequences are universal.Objective: The present study examined whether the Five-Factor Model of personality (openness, conscientiousness, extraversion, agreeableness, and neuroticism) relates to cannabis outcomes via use of cannabis protective behavioral strategies (PBS) in a cross-national sample of college student cannabis users (i.e., used cannabis in the last 30 days).Method: Participants were 1175 university students (63.27% female) across five countries (United States, Argentina, Spain, Uruguay, and the Netherlands) recruited to complete an online survey.Results: PBS use mediated the associations between personality traits and cannabis consequences, such that higher conscientiousness (β = .20), agreeableness (β = .11), and lower emotional stability [i.e., higher neuroticism] (β = -.14) were associated with more PBS use. Higher PBS use was, in turn, associated with lower frequency of cannabis use (β = -.32); lower frequency of use was then associated with fewer cannabis consequences (β = .34). This sequential pathway was invariant across sex, but not countries. Notably, there were a number of differences in links between PBS and cannabis outcomes when comparing countries (e.g., negative associations in the US sample, but positive associations in the Argentina sample).Conclusions: Cannabis PBS mediates the relationship between personality traits and cannabis outcomes, but there are nuanced differences across countries (i.e., relationship between PBS and cannabis outcomes). Overall, students that are low in conscientiousness, agreeableness, and neuroticism and/or report low rates of PBS use may benefit from cannabis PBS-focused interventions that promote utilization of PBS.

Personality traits of Russians from the observer's perspective

Data were collected by the members of the Russian character and personality survey from 39 samples in 33 administrative areas of the Russian Federation. Respondents (N = 7065) identified an ethnically Russian adult or college‐aged man or woman whom they knew well and rated the target using the Russian observer rating version of the Revised NEO Personality Inventory, which measures neuroticism, extraversion, openness to experience, agreeableness and conscientiousness. Factor analyses within samples showed that the factor structure of an international sample combining data from 50 different cultures was well replicated in all 39 Russian samples. Sex differences replicated the known pattern in all samples, demonstrating that women scored higher than men on most of the neuroticism, openness, agreeableness and conscientiousness facet scales. Cross‐sectional analyses demonstrated consistent age differences for four factors: Older individuals compared to younger ones were less extraverted and open but more agreeable and conscientious. The mean levels of traits were similar in all 39 samples. Although in general personality traits in Russians closely followed the universal pattern, some reliable culture‐specific effects were also found that future studies can help interpret. Copyright © 2009 John Wiley & Sons, Ltd.

A Cultural Comparison of Personality Profiles of U.S. and Japanese Centenarians

The purpose of this study was a cross-cultural examination of centenarians' personality through a person-centered approach to examine if there is a "resilient" personality profile consistent across cultures. Proxy reports information was obtained from family and close friends of 239 U.S. centenarians from the Georgia Centenarians Study and 272 Japanese centenarians from the Tokyo Centenarian Study. Latent profile analyses were conducted to identify personality profiles in centenarians from the United States and Japan. Two personality profiles were identified in both samples: a "resilient" personality profile and "nonresilient" personality profile. The "resilient" group had higher levels of positive personality traits with higher scores on agreeableness and extraversion and lower scores on neuroticism, conscientiousness, and openness. The "nonresilient" group had higher scores on neuroticism and lower scores on extraversion, openness, agreeableness, and conscientiousness. Fifty percent of U.S. centenarians and 65% of Japanese centenarians were in the "resilient" group.

DSM-5 Maladaptive Personality Domains among Treatment-Seeking Individuals with Alcohol Use Disorder: The Role of Disinhibition and Negative Affectivity

Background: Dimensional models of personality and personality disorders (PDs) have been widely investigated among individuals with alcohol use disorders (AUD). Nevertheless, DSM-5 maladaptive personality domains showed mixed associations with AUD. Furthermore, no studies have explored the role of DSM-5 maladaptive personality domains on the comorbidity between AUD and different PDs. Objective(s): This study aims at investigating whether DSM-5 maladaptive personality dimensions could differentiate individuals with AUD from normative and healthy controls (HCs) subjects. The study also investigated relationships between these personality dimensions and AUD clinical features (i.e. onset, severity of concurrent substance use disorders), as well as their role in accounting for the comorbidity between AUD and PDs. Methods: This study administered the personality inventory for DSM-5 (PID-5) to 99 treatment-seeking individuals (male 68.8%; female 31.2%; age: 48.12 (14.32)) with AUD (41 AUD only; 58 AUD with PDs), comparing the participants' levels of PID-5 domains with normative data and the data from a HC sample (N = 40; male 50%; female 50%; age: 48.12 (14.32)). Results: Disinhibition and negative affectivity were relevant maladaptive personality dimensions of AUD, even when controlling for the impact of PD diagnoses. Disinhibition and negative affectivity were associated to the onset of AUD and the severity of concurrent substance use disorders. The co-occurrence of AUD and PDs is related to other two domains, namely antagonism and detachment. Conclusions: AUD is a complex psychopathological disorder in which both externalizing and internalizing aspects determine relevant clinical features.

Relationship between childhood maltreatment and geriatric depression: the mediator effect of personality traits

BACKGROUND

Childhood maltreatment is an important factor associated with adverse mental health outcomes including geriatric depression and the "big five" personality characteristics. The objective of this study was to evaluate a model where personality characteristics mediate the relationship between childhood maltreatment and geriatric depression.

METHOD

In this cross-sectional study, elderly subjects from socioeconomically disadvantaged neighborhoods of Porto Alegre, Brazil (n = 260) completed the Childhood Trauma Questionnaire (CTQ), NEO-Five Factor Inventory (NEO-FFI), and Mini International Neuropsychiatric Interview 5.0 (MINI plus). We used structural equation modeling (SEM) to evaluate the mediation hypothesis.

RESULTS

The five personality factors (neuroticism, extraversion, agreeableness, openness, and conscientiousness) were related to childhood maltreatment and depression. Mediation analysis revealed that neuroticism and extraversion are complete mediators, agreeableness and conscientiousness are partial mediators, and openness is not a mediator.

CONCLUSIONS

These findings support the hypothesis in which childhood maltreatment is associated with geriatric depression and mediated by personality factors. These results suggest that reducing the maladaptive personality trait in elderly people who suffered childhood maltreatment could prevent geriatric depression.

A new way to look at the data: Similarities between groups of people are large and important

Most published research focuses on describing differences, while neglecting similarities that are arguably at least as interesting and important. In Study 1, we modified and extended prior procedures for describing similarities and demonstrate the importance of this exercise by examining similarities between groups on 22 social variables (e.g., moral attitudes, human values, and trust) within 6 commonly used social categories: gender, age, education, income, nation of residence, and religious denomination (N = 86,272). On average, the amount of similarity between 2 groups (e.g., high vs. low educated or different countries) was greater than 90%. Even large effect sizes revealed more similarities than differences between groups. Studies 2–5 demonstrated the importance of presenting information about similarity in research reports. Compared with the typical presentation of differences (e.g., barplots with confidence intervals), similarity information led to more accurate lay perceptions and to more positive attitudes toward an outgroup. Barplots with a restricted y-axis led to a gross underestimation of similarities (i.e., a gross overestimation of the differences), and information about similarities was rated as more comprehensible. Overall, the presentation of similarity information achieves more balanced scientific communication and may help address the file drawer problem.

Sluggish Cognitive Tempo and Personality: Links to BIS/BAS Sensitivity and the Five Factor Model

We evaluated sluggish cognitive tempo (SCT) symptoms in relation to personality as assessed via both the Reinforcement Sensitivity Theory (BIS/BAS) and Five Factor (Big 5) Model of personality. 3,172 students from five universities completed psychopathology, BIS/BAS, and Big 5 measures. Correlations and path models with SCT, attention-deficit/hyperactivity disorder (ADHD) dimensions, and anxiety/depression in relation to personality were examined. SCT evidenced a different pattern of relations to adult personality than ADHD and anxiety/depression. SCT was significantly uniquely associated with higher BIS and Neuroticism, as well as higher BAS Fun-Seeking. SCT was uniquely associated with lower Extraversion and Conscientiousness. This study provides the first evidence linking SCT to adult personality and underscores the importance of differentiating SCT from both ADHD and anxiety/depression.

Mean Profiles of the NEO Personality Inventory

The Revised NEO Personality Inventory (NEO-PI-R) and its latest version, the NEO-PI-3, were designed to measure 30 distinctive personality traits, which are grouped into Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness domains. The mean self-rated NEO-PI-R scores for 30 subscales have been reported for 36 countries or cultures in 2002. As a follow-up, this study reports the mean scores of the NEO-PI-R/3 for 71,870 participants from 76 samples and 62 different countries or cultures and 37 different languages. Mean differences in personality traits across countries and cultures were about 8.5 times smaller than differences between any two individuals randomly selected from these samples. Nevertheless, a multidimensional scaling of similarities and differences in the mean profile shape showed a clear clustering into distinctive groups of countries or cultures. This study provides further evidence that country/culture mean scores in personality are replicable and can provide reliable information about personality dispositions.

Examining Variability in Values Attributed to Culture

Prior work examining the role of cultural groupings (i.e., national membership) on personal values showed small to moderate amounts of variability attributable to culture, refuting the idea that culture determines values. We extend this research by examining the proportion of variance in values that could be explained by cultural membership. Because there is no definitive level of proportion of variance that would lead to a conclusion that values are culturally determined, personality, which is arguably not culturally determined, was used as a relative benchmark. Language groups were used as an alternate conception of cultural groupings. A large data set of 144,857 workers from across 31 major language groups revealed that language groups explained a significant and non-negligible amount of variance in personal value dimensions (7%-17%). Nevertheless, this was not significantly larger than any single personality dimension (3%-12%). In other words, our data failed to support the notion that personal values are strongly determined by cultural groupings compared with personality.

Temperamental Predictive Factors for Success in Korean Professional Baseball Players

OBJECTIVE

In this five-year cohort study, we hypothesize that factors of temperament and character in professional baseball players predict the speed of obtaining success and the quality of success as well as anxiety control.

METHODS

Participants included 120 male rookie players from the Korea Baseball Organization (KBO) and 107 male non-players with no history of playing baseball. The personality/characters and state/trait anxieties of participants were assessed with the Temperament and Character Inventory (TCI) and Spielberg's State-Trait Anxiety Inventory-Y (STAI-Y). Over the duration of five years, all the players were subsequently classified into either a success group (major leaguers) or a non-success group (non-major leaguers), depending on their status in the professional baseball league in Korea.

RESULTS

The players in the group of starters had higher novelty seeking (NS) scores than those of non-starters. The reward dependence (RD) scores of the success group were higher than those of the non-success group. The state anxiety scores in the starter group were negatively correlated with NS scores. The state and trait anxieties in the non-success group were positively correlated with RD scores.

CONCLUSION

The results of this study suggest that predictive temperamental factors for success in baseball players include traits of novelty seeking and reward dependence.

Personality Traits and Personal Values

Personality traits and personal values are important psychological characteristics, serving as important predictors of many outcomes. Yet, they are frequently studied separately, leaving the field with a limited understanding of their relationships. We review existing perspectives regarding the nature of the relationships between traits and values and provide a conceptual underpinning for understanding the strength of these relationships. Using 60 studies, we present a meta-analysis of the relationships between the Five-Factor Model (FFM) of personality traits and the Schwartz values, and demonstrate consistent and theoretically meaningful relationships. However, these relationships were not generally large, demonstrating that traits and values are distinct constructs. We find support for our premise that more cognitively based traits are more strongly related to values and more emotionally based traits are less strongly related to values. Findings also suggest that controlling for personal scale-use tendencies in values is advisable.

Dimensional models of personality: the five-factor model and the DSM-5

It is evident that the classification of personality disorder is shifting toward a dimensional trait model and, more specifically, the five-factor model (FFM). The purpose of this paper is to provide an overview of the FFM of personality disorder. It will begin with a description of this dimensional model of normal and abnormal personality functioning, followed by a comparison with a proposal for future revisions to DSM-5 and a discussion of its potential advantages as an integrative hierarchical model of normal and abnormal personality structure.

Personality disorders as maladaptive, extreme variants of normal personality: borderline personality disorder and neuroticism in a substance using sample

Although the current diagnostic manual conceptualizes personality disorders (PDs) as categorical entities, an alternative perspective is that PDs represent maladaptive extreme versions of the same traits that describe normal personality. Existing evidence indicates that normal personality traits, such as those assessed by the five-factor model (FFM), share a common structure and obtain reasonably predictable correlations with the PDs. However, very little research has investigated whether PDs are more extreme than normal personality traits. Utilizing item-response theory analyses, the authors of the current study extend previous research to demonstrate that the diagnostic criterion for borderline personality disorder and FFM neuroticism could be fit along a single latent dimension. Furthermore, the authors' findings indicate that the borderline criteria assessed the shared latent trait at a level that was more extreme (d = 1.11) than FFM neuroticism. This finding provides further evidence for dimensional understanding of personality pathology and suggests that a trait model in DSM-5 should span normal and abnormal personality functioning, but focus on the extremes of these common traits.

Integrating normal and abnormal personality structure: the Five-Factor Model

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.

Clinical application of the five-factor model

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.

Contributions from personality- and psychodynamically oriented assessment to the development of the DSM-5 personality disorders

Advances in personality assessment over the past 20 years have notably influenced the proposed assessment and classification of personality disorders in the Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM-5]). However, a considerable body of personality assessment and psychodynamically oriented assessment research has significant relevance to the way in which personality disorders are evaluated that appears to have gone unrecognized in the current proposals for DSM-5. In this article, I discuss the ways in which some of these 2 bodies of literature can and should inform the DSM-5 so that the diagnostic nomenclature can be more scientifically and comprehensively informed and consequently improve the clinical utility of a diagnostic system in need of considerable revision.

An Investigation of the Factor Structure and Convergent and Discriminant Validity of the Five-Factor Model Rating Form

The Five-Factor Model Rating Form (FFMRF) is a one-page measure designed to provide an efficient assessment of the higher order domains of the Five Factor Model (FFM) as well as the more specific, lower order facets proposed by McCrae and Costa. Although previous research has suggested that the FFMRF’s assessment of the lower order facets converge reasonably with other FFM measures, the structural validity of the domain-level assessment has not yet been evaluated. The current study employed an exploratory structural equation modeling framework to investigate the fit of a five-factor solution within a combined sample of 757 participants. This was a novel analysis using a combined sample drawn from three previously published studies and was composed primarily of undergraduates but also included a smaller clinical subsample. Results indicated that the FFMRF is well accommodated within a five-factor solution. Furthermore, the FFMRF domain scores evinced large correlations with domain scores from the NEO Personality Inventory–Revised. The results suggest that the FFMRF might hold promise as a choice for those seeking a brief measure that provides a valid assessment of both the broad and specific traits of the FFM.

Measures to assess maladaptive variants of the five-factor model

The five-factor model (FFM) is the predominant dimensional model of general personality structure. A considerable body of research supports the hypothesis that personality disorders can be conceptualized as extreme or maladaptive variants of the domains and facets of the FFM. However, existing measures of the FFM are confined largely to the normal variants. The purpose of this special section of the Journal of Personality Assessment is to provide the development and initial validation of self-report inventory scales to assess obsessive-compulsive, borderline, narcissistic, avoidant, and dependent personality traits from the perspective of the FFM, which complement the similarly constructed existing measures for psychopathic, histrionic, and schizotypal personality traits.

Self-other representations mediate the relationship between Five-Factor Model depression and depressive states

While it is well established that trait depression is a risk factor for experiencing increased rates of episodes of depression, it is also the case that the ways in which the self and others are perceived, and nature of the relationship between self and other, predispose individuals to frequent depressive episodes. In this study, 182 psychiatric outpatients at three treatment facilities were evaluated for Five-Factor Model depressive traits, depressive states, and self-other representations (object relations). It was hypothesized that object relations would mediate the relationship between trait and state depression. Results partially confirmed this hypothesis. While trait depression significantly predicted variance in the Beck Depression Inventory-II (BDI-II; Beck et al., 1988), two dimensions of the Bell Object Relations and Reality Testing Inventory (BORRTI; Bell, 1995)--Alienation and Insecure Attachment--partially mediated the relationship between trait and state depression. Similarly, trait depression predicted tendencies to experience frequent shifts toward depressive episodes, although the Insecure Attachment and Egocentricity scales of the BORRTI fully mediated the relationship between trait depression and depressive lability. Knowledge of self-other representations, which is being considered for inclusion in the DSM-5, allows for a more refined understanding of those factors that contribute shifts in depressive mood.

Personality traits in patients with Parkinson's disease: assessment and clinical implications

This study reviews empirical evidence on the association between personality traits and Parkinson's disease (PD), with a twofold aim. First, to better identify non-motor symptoms, such as affective symptoms and personality changes, that could help to define the pre-motor phase of PD; second, to better understand the neurobiological bases of personality traits, a goal that is not fully accomplished by a purely anatomical approach. A literature review was performed on studies of personality traits in PD patients, in electronic databases ISI Web of Knowledge, Medline and PsychInfo, conducted in July 2011. We found evidence that the existence of a characteristic premorbid personality profile of PD patients is not actually sustained by robust empirical evidence, mainly due to the methodological bias of the retrospective assessment of personality; PD patients present a personality profile of low novelty seeking and high harm avoidance. We concluded that the definition of a pre-motor phase of PD, based on non-motor symptoms, should search for the presence of concomitant affective disorders and for a positive psychiatric history for affective disorders rather than for a typical personality profile or personality changes. The low novelty seeking profile is probably related to the dopaminergic deficit, while the high harm avoidance profile is probably associated with the presence of affective disorders. Clinical implications of these findings, in regard to personality assessment and pharmacological treatments in PD, are also discussed.

Integrating normal and abnormal personality structure: a proposal for DSM-V

The personality disorders section of the American Psychiatric Association's fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) is currently being developed. The purpose of the current paper is to encourage the authors of DSM-V to integrate normal and abnormal personality structure within a common, integrative model, and to suggest that the optimal choice for such an integration would be the five-factor model (FFM) of general personality structure. A proposal for the classification of personality disorder from the perspective of the FFM is provided. Discussed as well are implications and issues associated with an FFM of personality disorder, including validity, coverage, feasibility, clinical utility, and treatment implications.

A Five-Factor Measure of Schizotypal Personality Traits

The current study provides convergent, discriminant, and incremental validity data for a new measure of schizotypy from the perspective of the five-factor model (FFM) of general personality structure. Nine schizotypy scales were constructed as maladaptive variants of respective facets of the FFM (e.g., Aberrant Ideas as a maladaptive variant of FFM Openness to Ideas). On the basis of data from 143 undergraduates, the convergent validity of these nine scales was tested with respect to seven established measures of schizotypy and the respective facets of the FFM. Discriminant validity was tested with respect to facets from other FFM domains and components of schizotypy. Incremental validity was tested with respect to the ability of the FFM schizotypy scales to account for variance in two established measures of schizotypy, after variance accounted for by respective FFM facets and other established measures of schizotypy were first removed. The findings support the validity of these new scales as measures of schizotypal traits and as maladaptive variants of the FFM.

Impact of cultural and linguistic factors on symptom reporting by patients with cancer

BACKGROUND

Patient reporting of the severity and impact of symptoms is an essential component of cancer symptom management and cancer treatment clinical trials. In multinational clinical trials, cultural and linguistic variations in patient-reported outcomes instruments could confound the interpretation of study results.

METHODS

The severity and interference of multiple symptoms in 1433 cancer patients with mixed diagnoses and treatment status from the United States, China, Japan, Russia, and Korea were measured with psychometrically validated language versions of the M. D. Anderson Symptom Inventory (MDASI). Mixed-effect ordinal probit regression models were fitted to the pooled data to compare the magnitude of the effect of "country" (nation and linguistic factors) with between-subjects effects on symptom reporting, adjusted for patient and clinical factors (age, sex, performance status, and chemotherapy status).

RESULTS

For the pooled sample, fatigue, disturbed sleep, distress, pain, and lack of appetite were the most severe patient-reported MDASI symptoms. The magnitude of the variance of the country random effects was only one-fourth to one-half of the interpatient variation (sigma(2) = 0.23-0.46) for all symptoms, except nausea and vomiting.

CONCLUSIONS

Cultural and linguistic variations in symptom reporting among the five language versions of the validated MDASI were limited. Ordinal probit modeling provided a simple mechanism for accounting for cultural and linguistic differences in patient populations. The equivalence among MDASI translations in this study suggests that symptom ratings collected from various cultural and language groups using the MDASI can be interpreted in a similar way in oncology practice, clinical trials, and clinical research.

Childhood antecedents of personality disorder: an alternative perspective

One of the fundamental limitations of the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition, Text Revision (DSM-IV-TR) categorical model of personality disorder classification has been the lack of a strong scientific foundation, including an understanding of childhood antecedents. The DSM-IV-TR personality disorders, however, do appear to be well understood as maladaptive variants of the domains and facets of the general personality structure as conceptualized within the five-factor model (FFM). Integrating the classification of personality disorder with the FFM brings to an understanding of the personality disorders a considerable body of scientific research on childhood antecedents. The temperaments and traits of childhood do appear to be antecedent to the FFM of adult personality structure, and these temperament and traits of childhood and adolescence are the likely antecedents for adult personality disorder, providing further support for the conceptualization of the adult personality disorders as maladaptive variants of the domains and facets of the FFM. Conceptualizing personality disorders in terms of the FFM thereby provides a basis for integrating the classification of abnormal and normal personality functioning across the life span.

Überprüfung der psychometrischen Qualität der deutschen Version des Angstsensitivitätsindex-3

Zusammenfassung. Angstsensitivität ist ein Konstrukt, das bei der Ätiologie von Angststörungen relevant ist und sich in der internationalen Forschung zunehmender Beliebtheit erfreut. Bisher existiert jedoch kein aktuelles deutschsprachiges Instrument mit einer robusten faktoriellen Validität zur Erfassung von Angstsensitivität. Daher zielte diese Studie darauf ab, die psychometrische Qualität einer deutschsprachigen Version des Anxiety Sensitivity Index-3 ( Taylor et al., 2007 ) zu überprüfen. In die Auswertung gingen Daten von insgesamt N = 5477 Personen aus drei Ländern ein. Die Ergebnisse belegen eine zufriedenstellende Messgenauigkeit, faktorielle Validität und Konstruktvalidität der Übersetzung. Zudem konnte die Messinvarianz mit der englischsprachigen Originalversion gezeigt werden. Die praktischen und theoretischen Implikationen der Ergebnisse werden diskutiert.

Five-factor model of personality disorder: a proposal for DSM-V

The predominant dimensional model of general personality structure within psychology is the five-factor model (FFM). Research indicates that the personality disorders of the American Psychiatric Association's diagnostic manual can be understood as maladaptive variants of the domains and facets of the FFM. The current review provides a proposal for the classification of personality disorder from the perspective of the FFM. Discussed as well are implications and issues associated with an FFM of personality disorder, including the integration of a psychiatric nomenclature with general personality structure, the inclusion of a domain of openness to experience, the identification of problems in living associated with maladaptive personality traits, the setting of a diagnostic threshold, prototypal matching, feasibility, and clinical utility.

Personality traits and endocrine response as possible asymmetry factors of agonistic outcome in karate athletes

Individual variations of plasma levels of hormones testosterone (T) and cortisol (C), before (pre) and after (post) Kumite (real fight) and Kata (ritualized fight) were measured in male karate athletes and analyzed in relation with the agonistic outcome (i.e. winning or losing the fight) and personality trait measures. T and C increased only during Kumite contest and pre- and post-competition C levels were higher in losers than winners. Losers showed higher levels of harm avoidance and anxiety as well as lower level of novelty seeking than winners. Importantly, novelty seeking negatively correlates with pre C and the higher the level of risk assessment, emotionality and insecurity indexes the higher the pre C level. In conclusion, personality traits might be an important factor asymmetry between athletes influencing both the probability of winning or losing an agonistic interaction and the different anticipatory endocrine response to the incipient fight.

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.

A cross-cultural comparison of the Eating Disorder Inventory

OBJECTIVE

A systematic analysis of data collected with the Eating Disorder Inventory (EDI) was made.

METHOD

A literature search identified 94 sources in which the mean values of the EDI or EDI-2 subscales were reported, comprising 310 samples differing by sex, age, diagnosis, language, ethnicity, or some other relevant attribute. The total number of respondents was 43,722, from 25 different countries, having used the EDI in one of the 16 languages (1-94).

RESULTS

The factorial structure of the aggregate means of the EDI subscales, for both clinical versus nonclinical and Western versus non-Western samples, was almost identical suggesting generalizability across languages and cultures. Non-Western participants scored higher than Western participants on virtually all EDI subscales, both in normal and eating-disordered samples. It was shown that age is a risk factor when someone is already diagnosed with an eating disorder but, in the general population, increasing age reduces the likelihood of being afflicted by eating disorders.

DISCUSSION

Symptoms of eating disorders are more pronounced in non-Western than in Western samples.

A dimensional model of personality disorder: proposal for DSM-V

A proposal made for DSM-IV was to include a means with which to provide a dimensional profile of a patient in terms of the diagnostic categories. However, a suggestion of the DSM-V Research Planning Conference on personality disorders was to develop a more fundamental revision through an integration of alternative dimensional models of personality disorder and general personality structure. A purpose of the current article is to provide this proposal. Also discussed is a primary concern with respect to the implementation of any such dimensional model: clinical utility. Discussed in particular are concerns regarding feasibility and treatment implications.

Reflections on International Translation of Evidence-Based Health Behavior Programs

In this concluding article, the authors describe factors that influence the international translation of programs. These include language, control over the translation process, local normative challenges to translation, program adaptation, and globalization. The authors suggest that systematic efforts at language translation, program adaptation partnership, and compromise are general principals needed to surmount these challenges.

Personality disorders and the five-factor model among French speakers in Africa and Europe

OBJECTIVE

To describe the relation between personality disorders (PDs) and the Five-Factor Model (FFM)--a dimensional model describing normal personality traits known for its invariance across cultures--in 2 different cultural settings. Several authors have suggested that PDs may be more accurately described using a dimensional model instead of a categorical one.

METHOD

Subjects from 9 French-speaking African countries (n = 2014) and from Switzerland (n = 697) completed both the French version of the International Personality Disorder Examination screening questionnaire, assessing the 10 DSM-IV PDs, and the French version of the Revised NEO Personality Inventory, assessing the 5 domains and 30 facets of the FFM.

RESULTS

Correlations between PDs and the 5 domains of the FFM were similar in both samples. For example, neuroticism was highly correlated with borderline, avoidant, and dependent PDs in both Africa and Switzerland. The total rank-order correlation (rho) between the 2 correlation matrices was very high (rho = 0.93) and significant (P < 0.001), as were the rhos for all domains of the FFM and all PDs, except paranoid and dependent PDs. However, the rhos for PDs across facet scales were all highly significant (P < 0.001). Moreover, 80% of Widiger and colleagues' predictions and 70% of Lynam and Widiger's prototypes, concerning the relation between PDs and the FFM, were confirmed in both samples.

CONCLUSIONS

The relation between PDs and the FFM was stable in 2 samples separated by a great cultural distance. These results suggest that a dimensional approach and in particular the FFM may be useful for describing PDs in various cultural settings.

Borderline Personality Disorder: What do We Know? Diagnosis, Course, Co-Morbidity, and Aetiology

Evidence regarding the diagnostic dilemmas, course, co-morbidity, and aetiology of Borderline Personality Disorder (BPD) is reviewed. After considering problems that the clinician and researcher face in using BPD as a diagnostic category, I argue that current evidence indicates that there is reason to be more optimistic about the course of BPD. Emerging dilemmas in considering co-morbidity in the BPD patient are considered. Aetiological factors are presented in support of a ‘multiple pathways’ model of aetiology where characterological and temperamental characteristics interact in complex idiosyncratic ways.