What is a psychopathology dimension?

Coherence in the science and practice of mental health assessment depends upon a tight connection between psychopathology concepts that are used and the way those concepts are operationalized and defined. In contrast, the use of the same word to mean more than one thing contributes to incoherence, inefficiency, and confusion. In this paper, we review three possible meanings of the word "dimension" as it relates to the assessment of psychopathology and describe how the indiscriminate use of this word has caused confusion in the general context of the transition to a more evidence-based approach to mental health diagnosis. We attempt to disambiguate the term "dimension" by demarcating three concepts that can be distinguished based on different empirical standards: continuous variables, unidimensional dimensions, and distinct dimensions.

Temporal Stability of the Personality Assessment Inventory: Investigating Potential Predictors

In this study, we explored the temporal stability of the Personality Assessment Inventory (PAI), which has not been comprehensively reexamined since it was first published. Our three specific aims were to determine the utility of PAI indicators of basic protocol validity (inconsistent responses [ICN] and highly unusual/unlikely responses [INF]) in identifying suspect responding; calculate the stability coefficients for each PAI scale and subscale across 3-, 6-, and 9-week spans; and explore whether profile stability across four measurements could be prospectively predicted. We administered the PAI to a sample of undergraduates (N = 579) at four separate timepoints. ICN and INF effectively identified likely attriters and inconsistent responders. All PAI full scales and subscales evidenced good test-retest reliability, with some small exceptions. Finally, all PAI clinical scales were correlated with profile instability although many of these correlations were no longer significant when controlling for mean clinical elevation of the profile. We interpreted these results as evidence for the utility of PAI validity scales, the temporal reliability of the PAI, and the role of psychopathology in response variability over time. We also discussed some preliminary evidence that this variability can be prospectively predicted, suggesting that it in part reflects substantive changes rather than random error variance.

Detecting Attention Deficit Hyperactivity Disorder and its feigning using the Personality Assessment Inventory

Attention Deficit Hyperactivity Disorder is a relatively common and often disabling disorder in adults. However, feigning ADHD symptomatology is both easy and potentially common. We explored the most effective strategies for A) identifying individuals who had been diagnosed with ADHD based on existing PAI symptom indicators, and B), discriminating between feigned and genuine ADHD symptoms using PAI negative distortion indicators. Our sample consisted of 463 college aged participants who had been diagnosed with ADHD (n = 60), were asked to feign ADHD (n = 71), and a control group (n = 333). Self-reported diagnosis and successful feigning were corroborated by the CAARS-S: E scale. We first compared two PAI-derived ADHD indicators to determine which best differentiated between our ADHD and Control groups. Next, we compared seven negative distortion indicators to determine which could best distinguish between real and feigned ADHD symptoms. Our results revealed that the PAI-ADHD scale was the most effective symptom indicator. Further, the Negative Distortion Scale (NDS) was the most effective for identifying feigners. When assessing ADHD based on the PAI, the PAI-ADHD scale appears promising as an indicator of symptomatology, while the NDS appears useful to rule-out feigning.

Borderline personality disorder symptom networks across adolescent and adult clinical samples: examining symptom centrality and replicability

BACKGROUND

Numerous theories posit different core features to borderline personality disorder (BPD). Recent advances in network analysis provide a method of examining the relative centrality of BPD symptoms, as well as examine the replicability of findings across samples. Additionally, despite the increase in research supporting the validity of BPD in adolescents, clinicians are reluctant to diagnose BPD in adolescents. Establishing the replicability of the syndrome across adolescents and adults informs clinical practice and research. This study examined the stability of BPD symptom networks and centrality of symptoms across samples varying in age and clinical characteristics.

METHODS

Cross-sectional analyses of BPD symptoms from semi-structured diagnostic interviews from the Collaborative Longitudinal Study of Personality Disorders (CLPS), the Methods to Improve Diagnostic Assessment and Service (MIDAS) study, and an adolescent clinical sample. Network attributes, including edge (partial association) strength and node (symptom) expected influence, were compared.

RESULTS

The three networks were largely similar and strongly correlated. Affective instability and identity disturbance emerged as relatively central symptoms across the three samples, and relationship difficulties across adult networks. Differences in network attributes were more evident between networks varying both in age and in BPD symptom severity level.

CONCLUSIONS

Findings highlight the relative importance of affective, identity, and relationship symptoms, consistent with several leading theories of BPD. The network structure of BPD symptoms appears generally replicable across multiple large samples including adolescents and adults, providing further support for the validity of the diagnosis across these developmental phases.

Video-based Interpersonal Behavioral Evaluation (VIBE): A novel method for the assessment of interpersonal judgment

One barrier to fully understanding and treating the interpersonal difficulties associated with a variety of psychiatric disorders is a current lack of suitable methodology, which aligns with contemporary interpersonal theory and offers a comprehensive assessment of interpersonal judgment. Specifically, no standardized behavioral interpersonal assessment exists that assesses the accuracy and biases of both interpersonal perceptions and anticipated reactions in a dyadic interaction. The present study presents the development and initial validation of a novel methodology, the Video-based Interpersonal Behavioral Evaluation (VIBE), which (a) utilizes a dynamic (i.e., video-based) behavioral assessment method, (b) assesses the accuracy and biases of both interpersonal perceptions and anticipated reactions, and (c) aligns with interpersonal theory and the structure of the interpersonal circumplex. The VIBE is anticipated to better direct research efforts investigating the interpersonal judgments of individuals with a variety of clinical presentations and ultimately aid in the development of more specifically targeted treatment interventions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Exploring the predictive validity of personality disorder criteria

We tested the predictive validity of personality disorder (PD) indicators at different levels of aggregation, ranging from general PD severity to PD syndrome scales to individual PD criteria. We compared the predictive validity of models on these levels based on interview data on all 78 DSM-IV PD criteria, by using 19 outcome scales in three different samples (N = 651, N = 552, and N = 1,277). We hypothesized that criteria of personality pathology yield a significant increase in predictive validity compared with scales that are aggregated at the syndrome- or general severity-level. We assessed out of sample performance of predictive models in a repeated cross-validation design using regularized linear regression and regression forest algorithms. We observed no significant difference in predictive performance between models trained at the item-level and models trained on scale-level data. We further tested the predictive performance of the trained linear models across samples on outcome measures shared between samples and inspected models for criteria-level information they relied on to make predictions. Our results suggest that little predictive variance is lost when interview items assessing DSM-IV PD criteria are aggregated to dimensional PD scales. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The self-reference effect as a behavioral indicator of identity disturbances associated with borderline personality features in a non-clinical sample

BACKGROUND

Identity disturbances are a common feature of personality pathology and BPD. The Self-Reference Effect paradigm is a method used to measure the impact of self-relevant processing on encoding/memory, whereby self-relevant information is typically advantaged in cognitive processes. We postulated that difficulties with identity might impede the process by which one encodes self-relevant information. Based on this reasoning, we predicted that high levels of identity disturbance could be associated with atypical impact of the SRE.

METHODS

Undergraduate participants were randomized into one of three groups where they were exposed to 60 trait adjectives for seven seconds each. Depending on condition, participants either indicated whether a word was/wasn't capitalized (Capitalization condition), whether it was a good synonym for "openness" (Synonyms condition), or whether it described them as a person (Self-reference condition). After a brief delay, all participants were asked to recall as many of the 60 words as possible. Finally, we measured identity disturbance using the Borderline Features-Identity Problems (BOR-I) scale from the Personality Assessment Inventory.

RESULTS

We found significant but modest correlations between Recall and scores on the BOR-I subscale in the Self-Reference condition, but not the two control conditions. Contrary to expectations, the interaction between BOR-I and Condition was not a significant predictor of Recall, suggesting that identity disturbance did not significantly moderate the SRE.

CONCLUSIONS

While our primary hypothesis was not supported, there is a need for multimethod approaches to studying personality pathology. Future research should continue to examine the extent to which behavioral paradigms like the SRE might be useful indicators of identity disturbance/personality pathology, with an emphasis on the use of clinical populations.

The prognostic utility of personality traits versus past psychiatric diagnoses: Predicting future mental health and functioning

Past psychiatric diagnoses are central to patient case formulation and prognosis. Recently, alternative classification models such as the Hierarchical Taxonomy of Psychopathology (HiTOP) proposed to assess traits to predict clinically-relevant outcomes. The current study directly compared personality traits and past diagnoses as predictors of future mental health and functioning in three independent, prospective samples. Regression analyses found that personality traits significantly predicted future first onsets of psychiatric disorders (ΔR2=06-.15), symptom chronicity (ΔR2=.03-.06), and functioning (ΔR2=.02-.07), beyond past and current psychiatric diagnoses. Conversely, past psychiatric diagnoses did not provide an incremental prediction of outcomes when personality traits and other concurrent predictors were already included in the model. Overall, personality traits predicted a variety of outcomes in diverse settings, beyond diagnoses. Past diagnoses were generally not informative about future outcomes when personality was considered. Together, these findings support the added value of personality traits assessment in case formulation, consistent with HiTOP model.

A Comparison of Two Five-Factor Model Operationalizations of the Triarchic Model of Psychopathy in a Clinical Sample

Structural models of personality traits, particularly the five-factor model (FFM), continue to inform ongoing debates regarding what personality attributes and trait domains are central to psychopathy. A growing body of literature has linked the constructs of the triarchic model of psychopathy (boldness, meanness, disinhibition) to the FFM. Recently, researchers developed both item and regression-based measures of the triarchic model of psychopathy using the NEO Personality Inventory-Revised-a popular measure of the FFM. The current study examines the correlates of these two FFM-derived operationalizations of the triarchic model using data from the Collaborative Longitudinal Personality Disorders Study. The two approaches had strong convergent validity coefficients and similar patterns of criterion-related validity coefficients. Meanness related to greater personality pathology characterized by exploitation of others and poor attachment, whereas disinhibition related to indicators of greater negative affect and poor behavioral constraint. Boldness related to reduced negative affect and greater narcissistic personality traits. Although the item and regression-based approaches showed similar patterns of associations with criterion-variables, the item-based approach has some practical and psychometric advantages over the regression-based approach given strong correlations between the meanness and disinhibition scores from the regression approach.

Developing Preliminary Scales for Assessing the HiTOP Detachment Spectrum

The Hierarchical Taxonomy of Psychopathology (HiTOP) is an empirical-based classification of psychopathology. Detachment is one of the six spectra in the current HiTOP working model. The aim of this study was to develop preliminary scales for the HiTOP Detachment spectrum that can be used in the next phase of developing a comprehensive measure of HiTOP. We had 456 participants from MTurk (Sample 1) and 266 university students (Sample 2) complete an online survey including a pool of 247 Detachment items assessing 15 consensually defined low-order constructs. Using a stepwise procedure involving factor analyses and ant colony optimization methods, we developed seven 8-item scales that capture unipolar facets of Detachment: anhedonia, suspiciousness, social withdrawal, intimacy avoidance, unassertiveness, risk aversion, and restricted affectivity. Three other 8-item scales emerged that tapped into a Maladaptive Extraversion construct (attention-seeking, thrill-seeking, and domineering), which was mostly unrelated to unipolar Detachment in factor analyses. The 10 scales were unidimensional, reliable, and showed some evidence of convergent and discriminant validity. We discuss challenges of assessing Detachment when moving forward with developing a comprehensive measure of HiTOP.

Association of Borderline Personality Disorder Criteria With Suicide Attempts: Findings From the Collaborative Longitudinal Study of Personality Disorders Over 10 Years of Follow-up

IMPORTANCE

Borderline personality disorder (BPD) has been identified as a strong risk factor for suicidal behavior, including suicide attempts. Delineating specific features that increase risk could inform interventions.

OBJECTIVE

To examine factors associated with prospectively observed suicide attempts among participants in the Collaborative Longitudinal Study of Personality Disorders (CLPS), over 10 years of follow-up, with a focus on BPD and BPD criteria.

DESIGN, SETTING, AND PARTICIPANTS

The CLPS is a multisite, naturalistic, prospective study of adult participants with 4 personality disorders (PDs) and a comparison group of adults with major depressive disorder and minimal PD features. Participants were all treatment-seeking and recruited from inpatient, partial, and outpatient treatment settings across New York, New York, Boston, Massachusetts, New Haven, Connecticut, and Providence, Rhode Island. A total of 733 participants were recruited at baseline, with 701 completing at least 1 follow-up assessment. The cohorts were recruited from September 1996 through April 1998 and September 2001 through August 2002. Data for this study using this follow-up sample (N = 701) were analyzed between March 2019 and August 2020.

MAIN OUTCOMES AND MEASURES

Participants were assessed annually using semistructured diagnostic interviews and a variety of self-report measures for up to 10 years. Multiple logistic regression analyses were used to examine baseline demographic and clinical risk factors, including BPD and individual BPD criteria, of suicide attempt assessed over 10 years of prospective follow-up.

RESULTS

Of the 701 participants, 447 (64%) identified as female, 488 (70%) as White, 527 (75%) as single, 433 (62%) were unemployed, and 512 (73%) reported at least some college education. Of all disorders, BPD emerged as the most robust factor associated with prospectively observed suicide attempt(s) (odds ratio [OR], 4.18; 95% CI, 2.68-6.52), even after controlling for significant demographic (sex, employment, and education) and clinical (childhood sexual abuse, alcohol use disorder, substance use disorder, and posttraumatic stress disorder) factors. Among BPD criteria, identity disturbance (OR, 2.21; 95% CI, 1.37-3.56), chronic feelings of emptiness (OR, 1.63; 95% CI, 1.03-2.57), and frantic efforts to avoid abandonment (OR, 1.93; 95% CI, 1.17-3.16) emerged as significant independent factors associated with suicide attempt(s) over follow-up, when covarying for other significant factors and BPD criteria.

CONCLUSIONS AND RELEVANCE

In the multisite, longitudinal study of adults with personality disorders, identity disturbance, chronic feelings of emptiness, and frantic efforts to avoid abandonment were significantly associated with suicide attempts. Identity disturbance, chronic feelings of emptiness, and frantic efforts to avoid abandonment may be clinically overlooked features of BPD in context of suicide risk assessment. In light of the high rates of BPD diagnostic remission, our findings suggest that these criteria should be independently assessed and targeted for further study as suicide risk factors.

Development and Validation of a Validity Scale for Use with the UPPS-P and Short UPPS-P Impulsive Behavior Scales

Two of the most widely used self-report measures of impulsivity are the UPPS-P Impulsive Behavior Scale and its shortened version, the SUPPS-P, which currently are limited by their inability to detect careless and/or random responding. The present study develops and cross-validates an inconsistency scale for use with the UPPS-P and SUPPS-P in order to accurately screen for data quality and better detect invalid responding. A total of 443 participants were recruited from Amazon's MTurk online data collection service to serve as the derivation sample and 231 undergraduates were recruited to serve as the cross-validation sample. The inconsistency scale demonstrated good classification accuracy in differentiating between genuine and random protocols and moderated the relationships between the UPPS-P/SUPPS-P and a criterion measure of impulsivity, the Barratt Impulsiveness Scale-11 (BIS-11). Thus, the inconsistency scale shows promise as an indicator of variable response inconsistency for use with both the UPPS-P and SUPPS-P in community and undergraduate research samples.

Les progrès dans la réalisation de la classification quantitative de la psychopathologie☆

Shortcomings of approaches to classifying psychopathology based on expert consensus have given rise to contemporary efforts to classify psychopathology quantitatively. In this paper, we review progress in achieving a quantitative and empirical classification of psychopathology. A substantial empirical literature indicates that psychopathology is generally more dimensional than categorical. When the discreteness versus continuity of psychopathology is treated as a research question, as opposed to being decided as a matter of tradition, the evidence clearly supports the hypothesis of continuity. In addition, a related body of literature shows how psychopathology dimensions can be arranged in a hierarchy, ranging from very broad "spectrum level" dimensions, to specific and narrow clusters of symptoms. In this way, a quantitative approach solves the "problem of comorbidity" by explicitly modeling patterns of co-occurrence among signs and symptoms within a detailed and variegated hierarchy of dimensional concepts with direct clinical utility. Indeed, extensive evidence pertaining to the dimensional and hierarchical structure of psychopathology has led to the formation of the Hierarchical Taxonomy of Psychopathology (HiTOP) Consortium. This is a group of 70 investigators working together to study empirical classification of psychopathology. In this paper, we describe the aims and current foci of the HiTOP Consortium. These aims pertain to continued research on the empirical organization of psychopathology; the connection between personality and psychopathology; the utility of empirically based psychopathology constructs in both research and the clinic; and the development of novel and comprehensive models and corresponding assessment instruments for psychopathology constructs derived from an empirical approach.

Brief Report: Expert Preferences for Categorical, Dimensional, and Mixed/Hybrid Approaches to Personality Disorder Diagnosis

The authors asked 361 personality disorder experts to rank order their preferences for a categorical, dimensional, or mixed/hybrid approach to personality disorder diagnosis in manuals such as the DSM and ICD. Respondents reported a general preference for the mixed/hybrid approach over a purely dimensional approach, and a clear preference against a categorical model. Although there were some statistically significant differences in the rates across training background, age, and gender, this overall pattern of preferences held across these factors. Preferences were notably similar to those reported by Bernstein et al. (2007) prior to the beginnings of deliberations on DSM-5 that ultimately led to a hybrid model. Results are informative for discussions regarding how to classify personality disorders in diagnostic manuals.

Latent variable modeling of item-based factor scales: Comment on Triarchic or septarchic?-Uncovering the Triarchic Psychopathy Measure's (TriPM) Structure, by Roy et al

We critique Roy et al.'s (2020; this issue) approach to characterizing the item-level factor structure of the three scales of the Triarchic Psychopathy Measure (TriPM), in light of the manner in which the TriPM scales were developed, the purposes they were designed to serve, and the growing body of evidence supporting their construct validity. We focus on three major points: (1) The TriPM scales are item-based factor scales - i.e., item sets designed to index broad factors of larger multi-scale (parent) inventories; (2) item-level structural analysis can be useful for representing broad dimensions tapped by such scales, but it cannot be expected to provide an accurate picture of narrower subdimensions (facets) assessed by their parent inventories; and (3) it is critical to consider the nomological networks of the TriPM scales (and other triarchic scale measures) in appraising their effectiveness as operationalizations of the triarchic model constructs. We illustrate the first and second of these points by applying Roy et al.'s analytic approach to the trait scales of the NEO-FFI, which were developed to index broad personality dimensions of the multi-scale NEO-PI-R. We address the third point with reference to the growing body of literature supporting the construct validity of the TriPM scales and demonstrating their utility for advancing an integrative understanding of psychopathy. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Global personality dysfunction and the relationship of pathological and normal trait domains in the DSM-5 alternative model for personality disorders

OBJECTIVE

The DSM-5 Alternative Model of Personality Disorders distinguishes core personality dysfunction common to all personality pathology from maladaptive traits that delineate specific variants of disorder. Previous research shows the convergence between maladaptive and normal range trait domains as well as substantial correlations between maladaptive traits and core dysfunctions, leading some to conclude that personality traits and dysfunction are redundant. This study sought to examine the potential utility of the concept of core dysfunctions as a means of clarifying the nature of the relationship between maladaptive and normal-range traits.

METHOD

Three nonclinical samples (n = 178, 307, and 1,008) were evaluated for personality dysfunction, maladaptive traits, and normal-range traits using different measures.

RESULTS

Results indicated that: (1) normal trait domains and core dysfunction contribute independently to understanding maladaptive traits; (2) the correlation of a normal trait domain with its putative maladaptive equivalent is consistently accounted for in part by core dysfunction; and (3) the multitrait multimethod matrices of normal and maladaptive personality trait domains demonstrate appreciable discriminant validity problems that are clarified by a consideration of core dysfunction.

CONCLUSION

These results suggest that maladaptive traits reflect the distinguishable contributions of core personality dysfunction (problems) and normal-range personality traits (person).

Integrating the Hierarchical Taxonomy of Psychopathology (HiTOP) into clinical practice

OBJECTIVE

Diagnosis is a cornerstone of clinical practice for mental health care providers, yet traditional diagnostic systems have well-known shortcomings, including inadequate reliability, high comorbidity, and marked within-diagnosis heterogeneity. The Hierarchical Taxonomy of Psychopathology (HiTOP) is a data-driven, hierarchically based alternative to traditional classifications that conceptualizes psychopathology as a set of dimensions organized into increasingly broad, transdiagnostic spectra. Prior work has shown that using a dimensional approach improves reliability and validity, but translating a model like HiTOP into a workable system that is useful for health care providers remains a major challenge.

METHOD

The present work outlines the HiTOP model and describes the core principles to guide its integration into clinical practice.

RESULTS

Potential advantages and limitations of the HiTOP model for clinical utility are reviewed, including with respect to case conceptualization and treatment planning. A HiTOP approach to practice is illustrated and contrasted with an approach based on traditional nosology. Common barriers to using HiTOP in real-world health care settings and solutions to these barriers are discussed.

CONCLUSIONS

HiTOP represents a viable alternative to classifying mental illness that can be integrated into practice today, although research is needed to further establish its utility. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Detecting Feigning in Adolescents on the Personality Assessment Inventory-Adolescent Form

Much of the research on identifying feigning in psychological assessment has focused on adults with less attention to adolescents. The purpose of the present study is to expand the limited literature on detecting feigning in adolescents using the Personality Assessment Inventory - Adolescent. The study included 114 nonclinical adolescents (ages 15 to 18) recruited from high schools in the Midwest who were randomly assigned to experimental groups: honest nonclinical, uncoached feigning, and coached feigning. 50 randomly selected individuals with depression from the PAI-A clinical standardization sample were included as the honest clinical group. Sample demographics included a mean age of 16.64 years; 51.2% young men, 48.2% young women; 85.4% Caucasian, 6.7% African American, 5.5% Hispanic, and 2.4% Asian. 80% of feigning profiles reported clinical levels of depression. MANOVA results showed strong support for the Rogers Discriminant Function (RDF; d range = 1.85-2.05). The Negative Impression Management (NIM) scale also demonstrated promise (d range = 0.77-1.08), while the smallest effects for detecting feigning were found for the Malingering Index (d range = 0.58-0.70). The negative distortion indices showed good utility in differentiating between groups. Cut-scores and pragmatic implications are presented.

Interdiagnostician Reliability of the DSM-5 Section II and Section III Alternative Model Criteria for Borderline Personality Disorder

This study examined the interdiagnostician reliability and potential gender bias of the DSM-IV/DSM-5 Section II and DSM-5 Alternative Model definitions of borderline personality disorder. A national sample of 123 mental health professionals provided diagnostic judgments on 12 case vignettes selected to represent a range of personality pathology. Two versions of each case were included, one identified as male and the other as female, but which were otherwise identical. Analyses examined the intraclass correlation between clinicians and also examined rates of diagnostic assignments as a function of case gender. Reliability of diagnosis of borderline personality did not differ across the two diagnostic approaches, and concordance of diagnoses across the two systems was significant. The dimensional components of the DSM-5 Alternative Model demonstrated significantly more diagnostic reliability than the DSM-IV categorical diagnoses. The DSM-5 Alternative Model conceptualization of borderline personality can be diagnosed with comparable or greater reliability than the extant DSM-IV definition.

Temporal stability and dynamic convergence of the Personality Assessment Screener in a prison sample

Although the Personality Assessment Screener (PAS; Morey, 1997) has garnered substantial research interest, the measure's temporal stability and sensitivity to change have remained largely uninvestigated. The present study employs a dynamic approach to investigating the convergent and discriminant validity of the PAS by examining relationships between temporal changes on the PAS and changes on external criterion measures, thereby exploring the extent to which changes on the PAS offer meaningful information regarding changes in psychological functioning. Data were obtained from a public dataset funded by the United States Department of Justice in which male inmates were administered various psychological measures at 5 time points spanning the course of a year. The PAS demonstrated appreciable stability across all testing intervals and the full study period, and temporal changes on the PAS correlated as expected with changes on both conceptually similar and distinct external criterion measures. These findings offer evidence to suggest that temporal variations across testing intervals are not fully explained by error, as conceptualized in classical test-retest analyses, but rather may indicate meaningful changes in functioning. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Convergence between Thematic Apperception Test (TAT) and self-report: Another look at some old questions

OBJECTIVE

This study extends upon the investigation of the influence of response format on the convergence between performance-based and self-report assessments of similar mental health constructs, to further examine the role of method variance in poor heteromethod convergence.

METHODS

An online sample of 455 participants (57% male; mean age = 35.5 years) completed a multiple-choice adaptation of the Thematic Apperception Test (TAT)-the Iowa Picture Interpretation Test (IPIT)-and two self-report instruments: the Personality Assessment Inventory (PAI) and the International Personality Item Pool (IPIP) representation of the domain traits of the five-factor model.

RESULTS

Several significant and meaningful interrelationships emerged between the IPIT and the PAI and IPIP five-factor scales.

CONCLUSIONS

Findings suggest that TAT methodology can correlate meaningfully with similar constructs assessed using self-report when comparable response formats are utilized, offering further support for the role of method variance in precluding heteromethod relationships.

An investigation of the influence of case and clinician gender in clinical decision-making

The present study was intended to assess the reliability of clinician judgments, with a particular interest in how such judgments vary by the gender of the case vignette and clinician. A national sample of 123 mental health professionals (57.7% male) provided clinical judgments on 12 case vignettes primarily representing personality pathology; two identical versions of each vignette were prepared, with the only difference being the use of masculine or feminine pronouns identifying the client. Clinical judgments included evaluations of adaptive functioning, long-term prognostic assessments, short-term risk evaluations, and treatment recommendations. Analyses included intraclass correlations between clinicians to assess reliability, as well as an examination of the variance of clinical judgments as a function of the identified gender of the case and the gender of the participating clinician. No significant two-way interactions were found between case gender and clinician gender in predicting the clinical judgments. A significant main effect of case gender in predicting vocational functioning was observed, such that female cases were rated as having better estimated vocational functioning than male cases. In addition, a significant main effect of clinician gender in predicting aggression and violence risk was found, such that ratings by female clinicians were higher than ratings by male clinicians. Results offer little if any evidence to suggest the influence of client or clinician gender on the majority of clinical judgments made in the present study. However, these results bear replication, particularly in light of the two significant main effects that did emerge. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Convergence between Rorschach and self-report: A new look at some old questions

OBJECTIVE

This study presents an examination of the influence of response format on convergence between performance-based and self-report assessments of similar mental health constructs, to determine if such method variance might account for prior findings of lack of relationship.

METHODS

An online sample of 455 participants (57% male; average age, 35.5) completed a multiple-choice version of the Rorschach and two self-report instruments, the Personality Assessment Inventory (PAI) and the International Personality Item Pool (IPIP) representation of the domain traits of the five-factor model (FFM).

RESULTS

Several significant interrelationships emerged between the Rorschach Amplified Multiple Choice Test and the PAI and IPIP five-factor scales.

CONCLUSIONS

These findings suggest that the Rorschach can correlate meaningfully with similar constructs assessed using self-report methodology when comparable response formats are utilized.

Application of the DSM-5 Level of Personality Functioning Scale by Lay Raters

One concern that has been expressed with the Alternative Model for Personality Disorders (AMPD) presented in DSM-5 is that the description of characteristic impairments in personality function uses concepts requiring considerable experience and clinical inference to apply. To examine this question, the individual indicators included in the AMPD's Level of Personality Functioning Scale (LPFS) that describes these core impairments were abstracted as individual items, and then rated on a target acquaintance by 194 undergraduate college students with minimal training in personality disorder and no training in the AMPD. Results indicated that the LPFS indicators were highly internally consistent as rated in this sample, and that the degree of discrimination between groups corresponded very well with the putative level of severity represented for each indicator in the LPFS. These findings support the contention that using the LPFS might not require any particular clinical experience or training.

Progress in achieving quantitative classification of psychopathology

Shortcomings of approaches to classifying psychopathology based on expert consensus have given rise to contemporary efforts to classify psychopathology quantitatively. In this paper, we review progress in achieving a quantitative and empirical classification of psychopathology. A substantial empirical literature indicates that psychopathology is generally more dimensional than categorical. When the discreteness versus continuity of psychopathology is treated as a research question, as opposed to being decided as a matter of tradition, the evidence clearly supports the hypothesis of continuity. In addition, a related body of literature shows how psychopathology dimensions can be arranged in a hierarchy, ranging from very broad "spectrum level" dimensions, to specific and narrow clusters of symptoms. In this way, a quantitative approach solves the "problem of comorbidity" by explicitly modeling patterns of co-occurrence among signs and symptoms within a detailed and variegated hierarchy of dimensional concepts with direct clinical utility. Indeed, extensive evidence pertaining to the dimensional and hierarchical structure of psychopathology has led to the formation of the Hierarchical Taxonomy of Psychopathology (HiTOP) Consortium. This is a group of 70 investigators working together to study empirical classification of psychopathology. In this paper, we describe the aims and current foci of the HiTOP Consortium. These aims pertain to continued research on the empirical organization of psychopathology; the connection between personality and psychopathology; the utility of empirically based psychopathology constructs in both research and the clinic; and the development of novel and comprehensive models and corresponding assessment instruments for psychopathology constructs derived from an empirical approach.

Properties of the Continuous Assessment of Interpersonal Dynamics Across Sex, Level of Familiarity, and Interpersonal Conflict

The Continuous Assessment of Interpersonal Dynamics (CAID) is a method in which trained observers continuously code the dominance and warmth of individuals who interact with one another in dyads. This method has significant promise for assessing dynamic interpersonal processes. The purpose of this study was to examine the impact of individual sex, dyadic familiarity, and situational conflict on patterns of interpersonal warmth, dominance, and complementarity as assessed via CAID. We used six samples with 603 dyads, including two samples of unacquainted mixed-sex undergraduates interacting in a collaborative task, two samples of couples interacting in both collaborative and conflict tasks, and two samples of mothers and children interacting in both collaborative and conflict tasks. Complementarity effects were robust across all samples, and individuals tended to be relatively warm and dominant. Results from multilevel models indicated that women were slightly warmer than men, whereas there were no sex differences in dominance. Unfamiliar dyads and dyads interacting in more collaborative tasks were relatively warmer, more submissive, and more complementary on warmth but less complementary on dominance. These findings speak to the utility of the CAID method for assessing interpersonal dynamics and provide norms for researchers who use the method for different types of samples and applications.

Borderline personality disorder is equally trait-like and state-like over ten years in adult psychiatric patients

Borderline personality disorder (PD) has historically been cast as an unabating condition. Longitudinal data, however, support a more variable time course marked by remission and relapse. In the present study, we tested the possibility that borderline PD has both stable (i.e., consistently present across time and situation, as modern diagnostic systems stipulate) and dynamic (i.e., episodic and situational) elements. Participants were 668 patients from the Collaborative Longitudinal Personality Disorders Study who were administered semistructured diagnostic interviews 5 times over a decade. Trait-state-occasion modeling dissected borderline pathology into time-invariant (i.e., trait) and time-varying (i.e., state) components. Contradicting traditional views of PD intransigence, less than half of borderline PD variability (approximately 45%) was time-invariant (i.e., perfectly stable) over the study timeframe. Furthermore, we found that the time-invariant component of borderline pathology, which we termed borderline proneness, was very closely related (r = .81) to a previously validated Five Factor Model trait composite of borderline features. Moreover, the trait versus state components showed a clear pattern of discriminant validity in relation to several putative causal agents for borderline PD (i.e., environmental pathogens, temperament dimensions). We conclude that borderline pathology contains a stable core and sizable situational components, and that both elements relate systematically to normative personality dimensions and known risk factors. These findings have key implications for etiological research, prognosis, and treatment for borderline PD. (PsycINFO Database Record

Evaluating new supplemental indicators for the Personality Assessment Inventory: Standardization and cross-validation

As the research literature on the Personality Assessment Inventory (PAI; Morey, 1991) has expanded, several supplemental indicators have been introduced to aid in the interpretation of PAI results for the purpose of addressing particular assessment questions, such as protocol validity or treatment-related considerations. However, many of these indicators have remained largely unexamined beyond the initial validation studies in which they were derived. The purpose of the present study was to provide normative data for these new supplemental indicators, as well as to cross-validate these indicators in other existing PAI data sets and provide information about incremental validity beyond existing PAI scales and indices. Comparison effect sizes indicated that nearly all of the new supplemental indicators discriminated as intended, with the majority of indicators also contributing significantly beyond existing PAI indicators. These results suggest that some of these supplemental indicators may prove to be useful additions to the standard scoring of the PAI. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Criterion A of the AMPD in HiTOP

The categorical model of personality disorder classification in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM-5]; American Psychiatric Association, 2013 ) is highly and fundamentally problematic. Proposed for DSM-5 and provided within Section III (for Emerging Measures and Models) was the Alternative Model of Personality Disorder (AMPD) classification, consisting of Criterion A (self-interpersonal deficits) and Criterion B (maladaptive personality traits). A proposed alternative to the DSM-5 more generally is an empirically based dimensional organization of psychopathology identified as the Hierarchical Taxonomy of Psychopathology (HiTOP; Kotov et al., 2017 ). HiTOP currently includes, at the highest level, a general factor of psychopathology. Further down are the five domains of detachment, antagonistic externalizing, disinhibited externalizing, thought disorder, and internalizing (along with a provisional sixth somatoform dimension) that align with Criterion B. The purpose of this article is to discuss the potential inclusion and placement of the self-interpersonal deficits of the DSM-5 Section III Criterion A within HiTOP.

Validity of the DSM-5 Levels of Personality Functioning Scale-Self Report

In this study we examined the structure, reliability, and validity of the Levels of Personality Functioning Scale-Self Report (LPFS-SR) in 3 large community samples. The LPFS-SR is a questionnaire with content that corresponds directly to the DSM-5 alternative model of personality disorders, Criterion A. We found that the LPFS-SR was highly reliable across a brief retest interval. LPFS-SR scores correlated substantially with a wide range of maladaptive personality traits, personality disorder constructs, and interpersonal problems. The LPFS-SR did not correlate as strongly with aspects of personality with less clear relations to distress and dysfunction. Data further support that identity, self-direction, intimacy, and empathy components of the LPFS-SR can be characterized by a single factor and have similar correlations with criterion variables, consistent with the hypothesis that DSM-5 Criterion A is a relatively homogeneous construct. Overall, these results support the validity of the LPFS-SR, highlight important issues in assessing personality pathology, and point toward novel avenues for research on personality disorder classification.

Evaluation of the PAI-A Anxiety and Depression Scales: Evidence of Construct Validity

Against the background of a dearth of studies examining the properties of the scale scores of the Personality Assessment Inventory-Adolescent (PAI-A; Morey, 2007), this study was conducted to evaluate evidence of construct validity for the Anxiety (ANX) and Depression (DEP) scales of the PAI-A. Convergent and discriminant validity of the ANX and DEP scale scores were investigated using a sample of adolescents admitted to the adolescent program of a private tertiary care inpatient treatment facility. Multiple methods assessing anxious and depressive symptomology and diagnoses were included. Construct validity of the ANX and DEP scales was mostly supported. Advantages of using the PAI-A for the assessment of anxiety and depression were discussed.

Psychological Assessment with the DSM-5 Alternative Model for Personality Disorders: Tradition and Innovation

The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) Section III Alternative Model for Personality Disorders (AMPD; APA, 2013) represents an innovative system for simultaneous psychiatric classification and psychological assessment of personality disorders (PD). The AMPD combines major paradigms of personality assessment and provides an original, heuristic, flexible, and practical framework that enriches clinical thinking and practice. Origins, emerging research, and clinical application of the AMPD for diagnosis and psychological assessment are reviewed. The AMPD integrates assessment and research traditions, facilitates case conceptualization, is easy to learn and use, and assists in providing patient feedback. New as well as existing tests and psychometric methods may be used to operationalize the AMPD for clinical assessments.

Using the Personality Assessment Inventory Antisocial and Borderline Features Scales to Predict Behavior Change: A Multisite Longitudinal Study of Youthful Offenders

A substantial amount of research has examined the developmental trajectory of antisocial behavior and, in particular, the relationship between antisocial behavior and maladaptive personality traits. However, research typically has not controlled for previous behavior (e.g., past violence) when examining the utility of personality measures, such as self-report scales of antisocial and borderline traits, in predicting future behavior (e.g., subsequent violence). Examination of the potential interactive effects of measures of both antisocial and borderline traits also is relatively rare in longitudinal research predicting adverse outcomes. The current study utilizes a large sample of youthful offenders ( N = 1,354) from the Pathways to Desistance project to examine the separate effects of the Personality Assessment Inventory Antisocial Features (ANT) and Borderline Features (BOR) scales in predicting future offending behavior as well as trends in other negative outcomes (e.g., substance abuse, violence, employment difficulties) over a 1-year follow-up period. In addition, an ANT × BOR interaction term was created to explore the predictive effects of secondary psychopathy. ANT and BOR both explained unique variance in the prediction of various negative outcomes even after controlling for past indicators of those same behaviors during the preceding year.

Longitudinal validation of general and specific structural features of personality pathology

Theorists have long argued that personality disorder (PD) is best understood in terms of general impairments shared across the disorders as well as more specific instantiations of pathology. A model based on this theoretical structure was proposed as part of the DSM-5 revision process. However, only recently has this structure been subjected to formal quantitative evaluation, with little in the way of validation efforts via external correlates or prospective longitudinal prediction. We used the Collaborative Longitudinal Study of Personality Disorders dataset to: (a) estimate structural models that parse general from specific variance in personality disorder features, (b) examine patterns of growth in general and specific features over the course of 10 years, and (c) establish concurrent and dynamic longitudinal associations in PD features and a host of external validators including basic personality traits and psychosocial functioning scales. We found that general PD exhibited much lower absolute stability and was most strongly related to broad markers of psychosocial functioning, concurrently and longitudinally, whereas specific features had much higher mean stability and exhibited more circumscribed associations with functioning. However, both general and specific factors showed recognizable associations with normative and pathological traits. These results can inform efforts to refine the conceptualization and diagnosis of personality pathology. (PsycINFO Database Record

Personality and life events in a personality disorder sample

Individuals with a personality disorder (PD) tend to experience more negative life events (NLEs) than positive life events (PLEs). In community samples, the Five Factor Model of personality (FFM) predicts both positive and negative life events. The present research examined whether FFM normal personality traits were associated with positive and negative life events among individuals with 1 of 4 PDs: avoidant, borderline, schizotypal, and obsessive-compulsive, and tested whether associations between the FFM of personality and PLEs and NLEs were similar across the 4 PD groups and a control group. Among aggregated PDs, neuroticism was positively associated with NLEs, whereas extraversion, openness to experience, and conscientiousness were positively associated with PLEs. Comparisons of each PD group to a control group of individuals with a major depressive disorder indicated that the FFM traits operated similarly across clinical samples with and without PD. Our findings indicate that normal personality traits can be used to help understand the lives of individuals with PD. (PsycINFO Database Record

Relating DSM-5 section II and section III personality disorder diagnostic classification systems to treatment planning

BACKGROUND

Beginning with DSM-III, the inclusion of a "personality" axis was designed to encourage awareness of personality disorders and the treatment-related implications of individual differences, but since that time there is little accumulated evidence that the personality disorder categories provide substantial treatment-related guidance. The DSM-5 Personality and Personality Disorders Work Group sought to develop an Alternative Model for personality disorder, and this study examined whether this model is more closely related to clinicians' decision-making processes than the traditional categorical personality disorder diagnoses.

PROCEDURES

A national sample of 337 clinicians provided complete personality disorder diagnostic information and several treatment-related clinical judgments about one of their patients.

FINDINGS

The dimensional concepts of the DSM-5 Alternative Model for personality disorders demonstrated stronger relationships than categorical DSM-IV/DSM-5 Section II diagnoses to 10 of 11 clinical judgments regarding differential treatment planning, optimal treatment intensity, and long-term prognosis.

CONCLUSIONS

The constructs of the DSM-5 Alternative Model for personality disorders may provide more clinically useful information for treatment planning than the official categorical personality disorder diagnostic system retained in DSM-5 Section II.