Deriving the Transdiagnostic Scales From the Personality Assessment Inventory and SPECTRA: Indices of Psychopathology: A Demonstration.

Transdiagnostic models of psychopathology address many of the shortcomings common to categorical diagnostic systems. These empirically derived models conceptualize psychopathology as a few broad interrelated and hierarchically arranged dimensions, with an overarching general psychopathology dimension, the p-factor, at the apex. While transdiagnostic models are gaining prominence in mental health research, the lack of available tools has limited their clinical translation. The present study explored the potential of creating transdiagnostic scales from the joint factor structure of the Personality Assessment Inventory, Alternative Model of Personality Disorder trait scales (AMPD), and the clinical scales of the SPECTRA: Indices of Psychopathology (SPECTRA). Exploratory factor analysis in a clinical sample (n = 212) identified five factors corresponding to the Negative Affect/Internalizing, Detachment, Antagonism/Externalizing, Disinhibition/Externalizing, and Thought Disorder transdiagnostic dimensions. Goldberg's "Bass-Ackward" method supported a hierarchical structure. Five composite transdiagnostic scales were created by summing each factor's highest loading PAI and SPECTRA scales. A global psychopathology scale was created by summing the five composite scales. All the composite scales demonstrated adequate internal consistency. Correlations between the composite scales and the NEO Five-Factor Inventory-3 provide initial validity evidence for four composite and global scales. The composite thought disorder scale had no conceptually corresponding NEO domain. Clinical implications and study limitations are discussed.

Using the Personality Assessment Inventory to Assess the Alternative Model for Personality Disorders: Criterion Validity in a Clinical Sample.

The Personality Assessment Inventory (PAI) is a broadband measure of psychopathology that is widely used in applied settings. Researchers developed regression-based estimates that use the PAI to measure constructs of the Alternative Model for Personality Disorders (AMPD) - a hybrid dimensional and categorical approach to conceptualizing personality disorders. Although prior work has linked these estimates to formal measures of the AMPD, there is little work investigating the clinical correlates of this scoring approach of the PAI. The current study examines associations between these PAI-based AMPD estimates and life data in a large, archival dataset of psychiatric outpatients and inpatients. We found general support for the criterion validity of AMPD estimate scores, such that a theoretically consistent pattern of associations emerged with indicators such as prior academic achievement, antisocial behavior, psychiatric history, and substance abuse. These results provide preliminary support to this scoring approach for use in clinical samples.

The relationship between trainee therapist traits with the use of self-disclosure and immediacy in psychotherapy.

The goal of the present study was to explore how self-disclosure (SD) and immediacy relate to trainee therapists' personal characteristics. A prospective multitrait multimethod assessment approach was utilized to assess a wide range of trainee characteristics at the beginning of graduate school. Results showed a significant, positive relationship between trainee interpersonal problems and SD for trainees (n = 33) in their third psychotherapy session with their first patient. Moreover, greater use of SD correlated with less session depth, as rated by the trainee. Greater use of immediacy was positively related to trainee undergraduate grade point average and trainee-reported post-session arousal. Notably, all statistically significant findings had a moderate magnitude of effect. Finally, qualitative analyses of the SDs and immediacy statements were included to aid the discussion of potential reasons for the results. Overall, our findings provide preliminary conclusions about which trainees utilize SD and immediacy, what types of SDs and immediacy interventions they tend to use, and how trainees and patients perceived the session in which SD and immediacy were implemented. Implications for supervision and training are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Neuropsychological functioning and profile validity on the Personality Assessment Inventory (PAI): An investigation in multiple psychiatric settings.

Psychologists in medical settings are frequently tasked with providing comprehensive evaluations of patients with complex medical and psychiatric conditions. In order to achieve these aims, standardized measures of neurocognitive and psychological functioning are often employed to empirically assess a patient's level of functioning across an array of relevant clinical domains. However, less is known about the degree to which cognitive impairment affects a patient's ability to complete these more comprehensive assessments, raising questions about test validity. The current study sought to contribute to this growing body of literature by examining whether neurocognitive functioning is associated with profile validity on the Personality Assessment Inventory (PAI) in both outpatient (N = 321) and inpatient (N = 131) psychiatric settings. In Study 1, results indicate that while multiple cognitive domains are associated with overall profile validity in psychiatric outpatients, attentional impairment specifically was found to be a significant predictor of profile invalidity after accounting for the effects of overall intellectual functioning (accounting for 13% of the variance overall). The magnitude of attentional impairment specifically, and number of impaired cognitive domains more generally, were also found to be meaningfully associated with overall profile validity. Likewise, in Study 2, PAI profile validity was found to be meaningfully associated with gross cognitive impairment on the WMS-IV Brief Cognitive Status Examination (BCSE) in an inpatient psychiatric setting, with almost half of the patients in the most impaired group yielding invalid PAI profiles. The clinical implications of these findings are discussed.

Extending the validity of the Personality Assessment Inventory's (PAI) Level of Care Index (LOCI) in multiple psychiatric settings.

The purpose of this study was to extend the validity and clinical application of the Level of Care Index (LOCI) from the Personality Assessment Inventory (PAI) in 2 independent psychiatric samples. In Study 1 (N = 201), the LOCI effectively differentiated level of care (inpatients from outpatients), and was also meaningfully associated with risk factors for psychiatric admission (e.g., suicidal ideation, self-harming behavior, previous psychiatric admission, etc.), even after controlling for other demographic variables (range of Cohen's ds = 0.57-1.00). Likewise, the LOCI also incremented other risk indicators (suicide and violence history) and relevant PAI indexes (i.e., Mean Clinical Elevation, and Suicide and Violence Potential) in predicting level of care, and explained an additional 6% to 12% of variance in the target variable. Diagnostic efficiency analyses indicated LOCI scores in the range of 15 to 18 optimize positive and negative predictive power, and classification rate. In Study 2 (N = 96), the LOCI was found to be significantly higher in those with a recent psychiatric admission within the past 6 months (d = 0.64), as compared to those without an admission. Similarly, those who were admitted for suicide risk had significantly higher mean LOCI scores as compared to those who did not (d = 0.70). The clinical implications of these findings and potential application of the LOCI are discussed.

Clinical validity of a dimensional assessment of self- and interpersonal functioning in adolescent inpatients.

The Social Cognition and Object Relations Scale-Global Version (SCORS-G) is a clinical rating system assessing 8 domains of self- and interpersonal relational experience that can be applied to narrative response data (e.g., Thematic Apperception Test [TAT; Murray, 1943], early memories narratives) or oral data (e.g., psychotherapy narratives, relationship anecdotal paradigms). In this study, 72 psychiatrically hospitalized adolescents consented and were rated by their individual and group therapist using the SCORS-G. Clinicians also rated therapy engagement, personality functioning, quality of peer relationships, school functioning, global assessment of functioning (GAF), history of eating-disordered behavior, and history of nonsuicidal self-injury. SCORS-G composite ratings achieved an acceptable level of interrater reliability and were associated with theoretically predicted variables (e.g., engagement in therapy, history of nonsuicidal self-injury). SCORS-G ratings also incrementally improved the prediction of therapy engagement and global functioning beyond what was accounted for by GAF scores. This study further demonstrates the clinical utility of the SCORS-G with adolescents.

Development and preliminary validation of the Level of Care Index (LOCI) from the Personality Assessment Inventory (PAI) in a psychiatric sample.

Research over the last decade has been promising in terms of the incremental utility of psychometric tools in predicting important clinical outcomes, such as mental health service utilization and inpatient psychiatric hospitalization. The purpose of this study was to develop and validate a new Level of Care Index (LOCI) from the Personality Assessment Inventory (PAI). Logistic regression was initially used in a development sample (n = 253) of psychiatric patients to identify unique PAI indicators associated with inpatient (n = 75) as opposed to outpatient (n = 178) status. Five PAI variables were ultimately retained (Suicidal Ideation, Antisocial Personality-Stimulus Seeking, Paranoia-Persecution, Negative Impression Management, and Depression-Affective) and were then aggregated into a single LOCI and independently evaluated in a second validation sample (n = 252). Results indicated the LOCI effectively differentiated inpatients from outpatients after controlling for demographic variables and was significantly associated with both internalizing and externalizing risk factors for psychiatric admission (range of ds = 0.46 for history of arrests to 0.88 for history of suicidal ideation). The LOCI was additionally found to be meaningfully associated with measures of normal personality, performance-based tests of psychological functioning, and measures of neurocognitive (executive) functioning. The clinical implications of these findings and potential utility of the LOCI are discussed.

Validity of DSM-IV axis V global assessment of relational functioning scale: a multimethod assessment.

We investigate the convergent validity of the DSM-IV Axis V Global Assessment of Relational Functioning Scale (GARF; American Psychiatric Association, 1994). This study included 79 patients at a university-based outpatient treatment clinic. We examined clinician-rated GARF and the relationship to self-reported (Inventory of Interpersonal Problems; IIP-C; Horowitz et al. 2000) and free response themes [Social Cognition and Object Relations Scale: SCORS; Hilsenroth, Stein & Pinsker, 2004; Westen, 1995] of interpersonal functioning. Clinician ratings of the GARF scale and SCORS variables were highly reliable and internally consistent. Convergent Validity among the GARF, SCORS, and IIP scores was calculated using a Principal Components Analysis and Confirmatory Factor Analysis (CFA). Results of the Principal Components Analysis revealed that the GARF, SCORS, and IIP scores converged on a single factor, although findings of the CFA did not fully confirm the 1 factor model originally proposed. Intercorrelations among the GARF, SCORS, and IIP variables were analyzed and a pattern of significant relationships was found between the GARF and SCORS variables. This study helps support the convergent validity GARF as a relational functioning measure and is one of the first investigations to examine this scale multidimensionally.

Borderline pathology and the Personality Assessment Inventory (PAI): an evaluation of criterion and concurrent validity.

In this study, we examined how patients diagnosed with borderline pathology (BP) would respond on the Personality Assessment Inventory (PAI; Morey, 1991) Borderline (BOR) scales in relation to patients without BP pathology. In addition, we examined whether the PAI BOR scales would be related to variables on the Social Cognition and Object Relations Scale (SCORS; Hilsenroth, Stein, & Pinsker, 2004; Westen, 1995) derived from early memory narratives. Results indicate that outpatients with a Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) diagnosis of BP scored significantly higher on the PAI BOR Total (BOR-Total) score, Identity Problems, and Self- Harm scales in comparison to a Non-BP clinical sample. The overall correct classification rate for the presence or absence of BP using the BOR Total scale (T >or= 70) was 73%. In addition, there were several significant relationships between dimensional PAI BOR scales and the presence versus absence of DSM-IV BP. Moreover, both the BOR-Total and Affect Instability scales were significantly related to the SCORS variable Complexity of Representations. We provide clinical examples to illustrate these research findings in an applied manner.

Reliability and validity of the Social Cognition and Object Relations Scale (SCORS) in the assessment of dream narratives.

In this study, we aimed to investigate the application of an externally rated measure of interpersonal representations (Social Cognition and Object Relations Scale [SCORS]; Westen, 1995) to dream narratives. A total of 80 student participants enrolled at a private university in the New York City metropolitan area completed a Dream Log and affect adjective checklist (Wellman, 2002) based on a recalled dream at both 1 month and 3 months following the September 11, 2001, terrorist attacks. Using the dreams provided in this study we examined the interrater reliability of SCORS ratings, the relationship of SCORS variables to an independently rated measure of dream distortion, and the relationship of SCORS variables to participants' own ratings of dream affect. Results indicated that dreams were reliably rated using the SCORS, 3 cognitive SCORS variables were significantly related to dream distortion, and affective SCORS variables were meaningfully related to participants' own ratings of affect in their dreams. Findings from this study provide support for the application of SCORS ratings to dream narratives. We discuss implications for further research and clinical application.