Patterns of Treatment Disengagement and Personality Traits Associated With Posttraumatic Stress Disorder in Recent-Era U.S. Veterans Receiving Cognitive Processing Therapy.

Low treatment engagement is a barrier to implementation of empirically supported treatments for posttraumatic stress disorder (PTSD) among veterans. Understanding personality traits that predict dropout may help focus attempts to improve engagement. The current study included 90 veterans who served in recent conflicts in Iraq and/or Afghanistan and participated in a trial of cognitive processing therapy for PTSD. Goals were to characterize (a) personality correlates of PTSD, (b) patterns of engagement (i.e., attendance and homework completion), and (c) personality correlates of reduced engagement. Higher levels of PTSD symptoms were associated with a range of characteristics, including affective lability, r = .44 p < .001; anxiety, r = .38, p < .001; identity problems, r = .57, p < .001; intimacy problems, r = .34, p = .001; low affiliation, r = .33, p = .002; oppositionality, r = .36, p = .001; restricted expression, r = .35, p = .001; and suspiciousness, r = .50, p < .001. Notably, veterans with worse PTSD symptoms endorsed more cognitive dysregulation, r = .40, p < .001; and less insecure attachment, r = .14, p = .190, than expected. Only 52.2% of veterans completed the 12-session course of treatment and 31.0% of participants completed fewer than six sessions. Personality traits did not predict attendance or homework completion. Disengagement continues to be a significant issue in trauma-focused treatment for veterans with PTSD. Understanding veteran-level factors, such as personality traits, may be useful considerations for future research seeking to understand and improve engagement.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Patrones de desconexión del tratamiento y rasgos de personalidad asociados con el trastorno de estrés postraumático en Recientes Veteranos Estadounidenses que reciben terapia de procesamiento cognitivo DESCONEXIÓN DEL TRATAMIENTO Y PERSONALIDAD EN VETERANOS El bajo compromiso con el tratamiento es una barrera para la implementación de tratamientos con apoyo empírico para el trastorno de estrés postraumático (TEPT) entre los veteranos. Comprender los rasgos de personalidad que predicen el abandono puede ayudar a enfocar los intentos de mejorar el compromiso con el tratamiento en esta población. El estudio actual incluyó una muestra de 90 veteranos que habían servido en conflictos recientes en Irak y / o Afganistán y que estaban inscritos en el ensayo de terapia de procesamiento cognitivo para el TEPT. Los objetivos principales del estudio fueron (a) describir los correlatos de la personalidad y el TEPT de los veteranos, (b) caracterizar los patrones de compromiso (es decir, la asistencia y la finalización de la tarea), y (c) identificar los rasgos de personalidad asociados con el poco compromiso . Los niveles más altos de síntomas de TEPT se asociaron con una amplia gama de problemas de personalidad, incluida la labilidad afectiva, ansiedad, desregulación cognitiva, problemas de identidad, problemas de intimidad, baja afiliación, oposicionismo, expresión restringida y desconfianza. En particular, los veteranos con niveles más altos de síntomas de TEPT mostraron más desregulación cognitiva y menos problemas con el apego inseguro de lo esperado. Solo el 52.2% de los veteranos completaron el curso de tratamiento de 12 sesiones. Casi un tercio de los participantes (31.0%) completó menos de seis sesiones. Los rasgos de personalidad no fueron predictivos de la asistencia o la finalización de la tarea en el presente estudio. El abandono del tratamiento con apoyo empírico sigue siendo un problema importante en el tratamiento centrado en el trauma para los veteranos con TEPT. Comprender los factores a nivel de veteranos, como los rasgos de personalidad, puede ser una consideración útil para futuras investigaciones que buscan comprender y mejorar el compromiso con el tratamiento.

How Likable Are Personality Disorder and General Personality Traits to Those Who Possess Them?

OBJECTIVE: The goal of the present study was to investigate whether having higher scores on maladaptive personality traits was related to rating these traits as more likable. METHOD: Two studies were conducted, one with personality disorder traits (N = 219; Mage = 19.4; 63.8% female; 76.6% Caucasian) and one with general personality traits (N = 198; Mage = 19.5; 69.7% female; 77.3% Caucasian). In each study, participants self-rated their own personality and separately provided ratings of how "likable" they considered those personality traits. RESULTS: As expected, participants rated maladaptive traits more favorably if they considered themselves to possess those traits as well. Also as expected, individuals with higher Antagonism scores (including self-rated Dark Triad constructs of narcissism, psychopathy, and Machiavellianism) rated Antagonism and its related facets as "tolerable"-not necessarily likable, but as less unlikable than the average participant. CONCLUSIONS: These findings have implications for the ways that individuals with personality pathology perceive the people around them, which may in turn impact their expectations and behaviors.

Identifying Human Trafficking Victims on a Psychiatry Inpatient Service: a Case Series.

Human trafficking is a serious and prevalent human rights violation that closely intersects with mental health. Limited empirical attention has been paid to the presentations and identification of trafficking victims in psychiatric settings. The primary goal of this paper is to describe the varied presentations of trafficking victims on an urban inpatient psychiatric unit. A literature review was conducted to identify relevant empirical articles to inform our examination of cases. Adult inpatient cases meeting criteria for known or possible human trafficking were systematically identified and illustrative cases were described. Six cases were identified including one male and five females. Two had been labor trafficked and four were suspected or confirmed to have been sex trafficked. The cases demonstrated a tremendous diversity of demographic and psychiatric identifying factors. These cases indicate the importance of routinely screening for trafficking victims in inpatient psychiatry settings. Identification of cases is a requisite step in providing informed and evidence-based treatments and enabling the secondary prevention of re-exploitation. Additional research is warranted given the limited current empirical research on this topic area.

Towards a Definition of "Self-Neglect" in Psychiatric Patients: Descriptions of a Case Series.

Self-neglect, although frequently studied in geriatric populations, has received only limited attention in psychiatric populations. To address this gap, we utilize a behavioral framework to present a set of case examples in order to illustrate the complex relationship between self-neglect behaviors and conditions and various psychiatric illness. Cases are discussed with respect to ascending severity of presentations of self-neglect in adult non-geriatric inpatient psychiatric populations. Self-neglect is conceptualized as a range of behaviors, as well as an overall condition that affects an individual's functioning in several major domains. The concept of self-neglect in non-geriatric psychiatric patients warrants additional study, including development of a formal definition, as well as evaluation of its associated manifestations and implications for treatment and prognosis.

Personality trait domains predict psychiatric symptom and functional outcomes.

A review of high intensity, high dose mentalization-based inpatient psychiatric treatment indicated large effect-size reductions in symptoms of depression, anxiety, somatization, and improving emotion-regulation functioning (Allen et al., 2017). This study examined the impact of pathological personality traits has on baseline symptoms and functioning, as well as their impact on the longitudinal course in a large cohort of adult inpatient psychiatric sample (N = 804). The Personality Inventory for DSM-5 (PID-5; Krueger et al., 2012) was used to assess trait domains impact on longitudinal outcomes (anxiety, depression, somatic symptoms, and functional impairment) using hierarchical repeated measures modeling. Results indicate Negative Affectivity and Detachment were related to higher admission severity in all four outcome domains. Psychoticism was related to somatic symptoms, while Antagonism and Disinhibition were related to functional impairment. Paradoxically, when symptoms were plotted over 2-week intervals during hospitalization, patients with higher admission PID-5 trait scores exhibited greater improvement over time. The PID-5 appears to contribute to prediction of treatment outcome response above and beyond demographic and burden of illness. Importantly, the findings add to a growing body of literature indicating that impairments in personality traits do not preclude positive treatment response, particularly when treatments target pathological personality features. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Validation of curriculum-based reading passages and comparison of college students with and without dyslexia or ADHD.

Although reading is an essential skill for college success, little is known about how college students with and without disabilities read within their actual college curriculum. In the present article, we report on two studies addressing this issue. Within study 1, we developed and validated curriculum-based oral reading fluency measures using a sample of college students without disabilities (N = 125). In study 2, we administered the curriculum-based measures to four groups (each with n = 25): college students without disabilities, college students with dyslexia, college students with ADHD, and a clinical control group. Study 1 results indicated that the curriculum-based measures demonstrated good reliability and criterion validity. Results from study 2 indicated that college students with dyslexia were substantially slower readers than all groups without dyslexia (ds > 1.8). The curriculum-based measures demonstrated high accuracy in classifying participants with dyslexia and with impaired oral reading fluency (area under the curve > .94). Implications for incorporating curriculum-based measures in postsecondary settings are discussed.

Personality disorder traits: Testing insight regarding presence of traits, impairment, and desire for change.

Mixed findings exist as to whether personality pathology involves a critical lack of awareness and insight. Research questions about insight and awareness in personality pathology are typically assessed via comparing self- and informant reports of traits. However, recent studies have measured insight by asking individuals to evaluate additional questions about impairment and desire to change. The present study uses a variety of approaches to examine these issues, including investigations of convergence between self- and informant reports (N = 197 dyads; correlations and comparisons of means) of personality psychopathology, desired trait levels, and perceptions of impairment. Convergence was observed between levels of self- and informant-reported traits, desired traits, and impairment. However, individuals rated themselves higher on pathological trait levels and impairment than did their informants. Furthermore, individuals with relatively higher pathological traits desired higher levels of these traits (but lower than their actual scores) than individuals with lower scores; on the actual measurement scale, however, these higher scorers rated their desired level below the neutral point. Overall, individuals with pathological personality traits possess a reasonable degree of insight into their actual trait levels and associated impairment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Examining the relations among the DSM-5 alternative model of personality, the five-factor model, and externalizing and internalizing behavior.

Given long-standing criticisms of the DSM's reliance on categorical models of psychopathology, including the poor reliability and validity of personality-disorder diagnoses, the American Psychiatric Association (APA) published an alternative model (AM) of personality disorders in Section III of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; APA, 2013), which, in part, comprises 5 pathological trait domains based on the 5-factor model (FFM). However, the empirical profiles and discriminant validity of the AM traits remain in question. We recruited a sample of undergraduates (N = 340) for the current study to compare the relations found between a measure of the DSM-5 AM traits (i.e., the Personality Inventory for DSM-5; PID-5; Krueger, Derringer, Markon, Watson, & Skodol, 2012) and a measure of the FFM (i.e., the International Personality Item Pool; IPIP; Goldberg, 1999) in relation to externalizing and internalizing symptoms. In general, the domains from the 2 measures were significantly related and demonstrated similar patterns of relations with these criteria, such that Antagonism/low Agreeableness and Disinhibition/low Conscientiousness were related to externalizing behaviors, whereas Negative Affectivity/Neuroticism was most significantly related to internalizing symptoms. However, the PID-5 demonstrated large interrelations among its domains and poorer discriminant validity than the IPIP. These results provide additional support that the conception of the trait model included in the DSM-5 AM is an extension of the FFM, but highlight some of the issues that arise due to the PID-5's more limited discriminant validity. (PsycINFO Database Record

Failure to engage: A qualitative study of veterans who decline evidence-based psychotherapies for PTSD.

Low engagement in posttraumatic stress disorder (PTSD) psychotherapy is a common problem in the U.S. Department of Veteran Affairs (VA), with up to half of veterans who are referred to an evidence-based psychotherapy failing to engage in that treatment. Prior research has focused on identifying general barriers to mental health treatment rather than barriers specific to evidence-based treatments for PTSD. The purpose of the current study was to identify barriers for veterans who referred specifically for evidence-based psychotherapy (i.e., cognitive processing therapy or prolonged exposure) but who did not attend any sessions of those psychotherapies. Qualitative interviews (N = 24) were used to gain a better understanding of the experiences and attitudes of these veterans. Most veterans reported multiple barriers to treatment engagement (M = 4.2 barriers), suggesting that an accumulation of barriers contributes to poor engagement. Barriers fell into 5 categories: practical, knowledge, emotional, therapy-related, and VA-system-related. The most-endorsed category, mentioned by two thirds of the sample, was VA-system-related barriers, including inefficiencies and delays, negative experiences with VA staff and providers, discomfort with the VA environment, and difficulty navigating the VA system. Veterans' experienced barriers to beginning PE and CPT were diverse but, overall, highlighted the need to transform the VA to a more patient-centered model of care. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

A test of the empirical profile and coherence of the DSM-5 psychopathy specifier.

The Diagnostic and Statistical Manual of Mental Disorders-5th edition (DSM-5; American Psychiatric Association, 2013) introduced a psychopathy specifier (DSM-5 PS) as part of the Section III diagnostic model of antisocial personality disorder. Designed to capture the construct of fearless dominance/boldness, the DSM-5 PS is assessed on the basis of the presence of low scores on traits of withdrawal and anxiousness, and high scores on attention seeking. These constructs have garnered attention in the past decade but are the subject of substantial debate as to their role in the conceptualization and assessment of psychopathy, given their limited relations to the maladaptive outcomes typically associated with this personality disorder. In the current study (N = 340 undergraduates; 170 informants), we examined the DSM-5 PS, both in composite form and its trait subscales, to investigate the degree to which the DSM-5 PS manifested empirical profiles associated with psychopathy and its maladaptive correlates. Consistent with prior fearless dominance/boldness research, the DSM-5 PS manifested limited relations with other components of psychopathy, symptoms of DSM-5 Section II and III antisocial personality disorder, and self- and informant-related impairment scores. When examined at the individual subscale level, the 3 DSM-5 PS subscales manifested only partially overlapping profiles and only 1 of the 3-Attention Seeking-demonstrated an association with maladaptivity (e.g., externalizing behaviors). These findings raise important concerns about the coherence and utility of the DSM-5 PS as a diagnostic specifier included in a psychiatric nosology. (PsycINFO Database Record

Personality disorder traits: Perceptions of likability, impairment, and ability to change as correlates and moderators of desired level.

Historical conceptualizations have framed personality disorders (PDs) as unchanging and ego-syntonic. However, recent evidence suggests that individuals with PD traits may have some insight into their personality and consider those traits to be somewhat ego-dystonic. To replicate and extend previous findings, participants (N = 328) self-reported their PD trait levels, likability of those traits, impairment, capability for change, and desired trait levels. The results demonstrated that individuals with PD traits tolerate but still dislike those traits, believe that they cause them problems, and are interested in reducing them. Level of PD trait did not relate to perception of capability for change. Likability and impairment moderated most of the relations between actual PD trait and desired level. That is, there was a stronger correlation between actual and desired levels among individuals who liked the trait more; there was also greater agreement between actual and desired levels among individuals who found the traits less impairing. For 2 of the traits-Negative Affectivity and Detachment-individuals who felt more capable of changing these traits demonstrated greater agreement between their actual and desired levels. These data suggest that individuals with PD traits do not generally see them as particularly likable and see them as impairing; such impressions may have important implications for where individuals ultimately prefer to reside on these PD trait domains. (PsycINFO Database Record

Narcissism and self-esteem: A nomological network analysis.

Similarity between narcissism and self-esteem seems intuitive, as both capture positive perceptions of the self. In the current undertaking, we provide a broad comparison of the nomological networks of grandiose narcissism and explicit self-esteem. Pooling data from 11 existing samples (N = 4711), we compared the relations of narcissism and self-esteem to developmental experiences, individual differences, interpersonal functioning, and psychopathology. Both constructs are positively related to agentic traits and assertive interpersonal approaches, but differ in relation to agreeableness/communion. Self-esteem emerged as a wholly adaptive construct negatively associated with internalizing psychopathology and generally unrelated to externalizing behaviors. Unlike self-esteem, narcissism was related to callousness, grandiosity, entitlement, and demeaning attitudes towards others that likely partially explain narcissism's links to maladaptive outcomes.

Trait Impulsivity and Newlyweds' Marital Trajectories.

Despite the relationship of impulsivity with interpersonal dysfunction, including romantic relationship dysfunction, surprisingly little research has examined the degree to which impulsivity predicts how marriages unfold over time. The current study used data from 172 newlywed couples to examine spouses' impulsivity in relation to their 4-year trajectories of marital satisfaction, marital problems, relationship commitment, and verbal aggression, as well as their 10-year divorce rates. Hierarchical linear modeling indicated that husbands' and wives' impulsivity predicted their own intercepts of marital satisfaction and marital problems, reflecting lower levels of satisfaction and higher levels of problems. Wives' impulsivity also predicted their relationship commitment and their verbal aggression intercepts. No cross-spouse effects or effects on slopes were found, and impulsivity did not predict 10-year divorce rates. These findings indicate that the relationship distress associated with impulsivity begins early in marriage, and they suggest a need for further research on the processes by which impulsivity undermines marital quality.

Viewing the triarchic model of psychopathy through general personality and expert-based lenses.

The recently articulated and increasingly prominent triarchic model of psychopathy (TPM) posits the existence of 3 components of meanness, disinhibition, and boldness. In the current studies, 2 issues are addressed. First, although typically conceptualized in isolation from trait models of personality, the TPM components may be manifestations of basic personality dimensions. In Study 1 (N = 335), we test whether basic traits from the five-factor model (FFM) can account for the TPM's psychopathy domains. The FFM domains (Mean R2 = .65) and facets (Mean R2 = .75) accounted for substantial variance in the TPM domains, suggesting that the TPM can be viewed as being nested within a broader trait framework. Second, there is disagreement about which personality components are necessary and sufficient for psychopathy. In Study 2, we examine this issue using a between subject design in which expert raters (N = 46) were asked to view an FFM profile of the TPM domains and total score derived in Study 1 and rate the degree to which an individual with this profile would manifest symptoms of psychopathy, Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) personality disorders, and a variety of other psychiatric disorders. As expected, the profile associated with boldness was rated as less emblematic of psychopathy and related disorders (e.g., antisocial personality disorder; externalizing disorders) than the profiles for meanness or the total TPM score. These findings contribute to an ongoing debate addressing the degree to which domains like those articulated in the TPM are necessary or sufficient for the construct of psychopathy. (PsycINFO Database Record

Identifying Essential Features of Juvenile Psychopathy in the Prediction of Later Antisocial Behavior: Is There an Additive, Synergistic, or Curvilinear Role for Fearless Dominance?

Despite years of research, and inclusion of psychopathy DSM-5, there remains debate over the fundamental components of psychopathy. Although there is agreement about traits related to Agreeableness and Conscientiousness, there is less agreement about traits related to Fearless Dominance (FD) or Boldness. The present paper uses proxies of FD and Self-centered Impulsivity (SCI) to examine the contribution of FD-related traits to the predictive utility of psychopathy in a large, longitudinal, sample of boys to test four possibilities: FD 1. assessed earlier is a risk factor, 2. interacts with other risk-related variables to predict later psychopathy, 3. interacts with SCI interact to predict outcomes, and 4. bears curvilinear relations to outcomes. SCI received excellent support as a measure of psychopathy in adolescence; however, FD was unrelated to criteria in all tests. It is suggested that FD be dropped from psychopathy and that future research focus on Agreeableness and Conscientiousness.

Narcissism and newlywed marriage: Partner characteristics and marital trajectories.

Despite narcissism's relation with interpersonal dysfunction, surprisingly little empirical research has been devoted to understanding narcissism's effect on intimate relationships in general or marital relationships in particular. The current study addressed this gap using longitudinal data from a community sample of 146 newlywed couples assessed 6 times over the first 4 years of marriage. First, we examined partner characteristics associated with higher levels of narcissism to determine the degree to which couples were matched on narcissism and related traits. Second, we examined how narcissism predicted the trajectory of marital quality over time, testing narcissism's association with initial levels of relationship functioning (the intercept) and changes in relationship functioning (the slope). Results indicated a small degree of homophily but otherwise no clear pattern of partner characteristics for individuals higher in narcissism. Hierarchical linear modeling indicated that wives' total narcissism and entitlement/exploitativeness scores predicted the slope of marital quality over time, including steeper declines in marital satisfaction and steeper increases in marital problems. Husbands' narcissism scores generally had few effects on their own marital quality or that of their wives. These findings are notable in indicating that the effects of personality characteristics on marital functioning may take some time to manifest themselves, even if they were present from early in the marriage. Future research into the mediating psychological and interpersonal processes that link wives' narcissism with poorer marital functioning over time would be valuable.

Borderline personality disorder symptoms and newlyweds' observed communication, partner characteristics, and longitudinal marital outcomes.

Given borderline personality disorder's (BPD) relation with interpersonal dysfunction, there is substantial interest in understanding BPD's effect on marriage. The current study used data from a community sample of 172 newlywed couples to examine spouses' BPD symptoms in relation to their observed communication, partner BPD symptoms, 4-year marital quality trajectories, and 10-year divorce rates. BPD symptoms were correlated cross-sectionally with more negative skills during observational problem-solving and social support tasks, and spouses reporting more BPD symptoms were married to partners reporting more BPD symptoms. Longitudinally, hierarchical linear modeling of newlyweds' 4-year marital trajectories indicated that BPD symptoms predicted the intercept of marital quality for spouses and their partners, reflecting lower levels of marital satisfaction and higher levels of marital problems. BPD symptoms did not predict 10-year divorce rates. These findings highlight the chronic relationship impairment associated with BPD symptoms, indicate that distress begins early in marriage, and suggest that partners with higher levels of BPD symptoms remain in more troubled marriages.

A test of two brief measures of the dark triad: the dirty dozen and short dark triad.

There has been a substantial increase in the simultaneous study of 3 related constructs--psychopathy, Machiavellianism, and narcissism--since being termed the dark triad (DT; Paulhus & Williams, 2002). Growing interest in the DT has led to the development of 2 short, efficient measures that reduce the number of items typically used from 124 to 12 (Dirty Dozen, or DD; Jonason & Webster, 2010) and 27 (Short Dark Triad, or SD3; Jones & Paulhus, in press), respectively. Using a community sample collected online (N = 287), we examined the convergent, discriminant, incremental, and criterion validity of scores from 2 brief measures of the DT. In general, scores from the SD3 scales manifested stronger convergent and incremental validity in relation to longer, more established measures of the DT constructs. Scores from both brief DT measures evidenced adequate discriminant validity as well as criterion validity in relation to traits from the five-factor model. However, the SD3 Narcissism Scale appears to assess primarily the grandiose aspects of this construct, whereas the DD captures both vulnerable and grandiose features of narcissism. Overall, if a short measure of the DT is required, the SD3 yields data that are more consistent with these constructs as they are measured using more established and validated measures.

An examination of the perceptions of social network characteristics associated with grandiose and vulnerable narcissism.

Two dimensions of narcissism exist, grandiose and vulnerable, which are thought to be associated with distinctly different patterns of interpersonal behavior. Social network analysis is a way of quantifying and analyzing interpersonal interactions that may prove useful for characterizing the networks associated with these narcissism dimensions. In the current study, participants (N = 148) completed scales assessing both narcissism dimensions and a measure of the five-factor model of personality. Egocentric network information about participants' 30 closest friends and family members (i.e., "alters") was also obtained. Both narcissism dimensions were characterized by negative perceptions of the individuals who comprise one's social networks, and many of these relations were mediated by individuals' higher levels of antagonism. Grandiose narcissism also interacted with alter centrality (i.e., importance to the network) such that individuals low on grandiose narcissism were less likely to perceive central alters in a negative light and were more attuned to central alters than were individuals high on grandiose narcissism. Overall, both narcissism dimensions were associated with perceiving one's overall social environment negatively because of the high levels of antagonism that characterize both narcissism dimensions. Individuals high on grandiose narcissism, however, appear to be more insensitive to the relative importance of individuals in their social networks.