Do PID-5 Trait Scores Predict Symptom Disorders? A Meta-analytic Review.

The Personality Inventory for DSM-5 (PID-5) has become influential in the dimensional assessment of personality dysfunction. Though most studies have examined links between PID-5 trait domains and personality pathology, a number of investigations have assessed relationships between PID-5 scores and symptom disorders (e.g., depression, anxiety). We employed meta-analytic techniques to synthesize findings in this area, identifying 26 publications assessing associations between PID-5 scores and symptom disorders (N of effect sizes across the five trait domains = 260). PID-5 domain score effect sizes (rs) ranged from 0.20 for Antagonism to 0.35 for Negative Affect (all ps < .00001). Relationships between PID-5 scores and specific forms of psychopathology were generally consistent with expectations, with some unanticipated relationships as well. Findings confirm that the pathological personality traits assessed by the PID-5 predict symptom disorders as well as personality dysfunction, extending the heuristic value and clinical utility of the measure.

Intrapersonal dynamics of closeness versus distance: Qualities of the self-concept distinguish destructive overdependence, dysfunctional detachment, and healthy dependency.

INTRODUCTION: People vary in the degree to which they affiliate with others; exaggerated efforts maintain interpersonal closeness versus distance are codified in longstanding categorical models of personality pathology, and in contemporary dimensional frameworks as well. OBJECTIVE: To examine associations between destructive overdependence (DO), dysfuntional detachment (DD), and healthy dependency (HD) and qualities of the self-concept. METHOD: A mixed-sex sample of 229 adults completed the Relationship Profile Test to assess DO, DD, and HD, and the Object Relations Inventory (ORI) to assess qualities of the self-concept. RESULTS AND CONCLUSION: Analyses indicated that (1) the ORI Strong dimension was uniquely predictive of DO (inversely related); (2) ORI Warm and Nurturing were unique predictors of DD (both inversely related); and (3) ORI Nurturing and Successful were unique predictors of HD. This study illuminates key intrapersonal features of these three personality styles.

Toward a More Nuanced Perspective on Detachment: Differentiating Schizoid and Avoidant Personality Styles through Qualities of the Self-Representation.

Avoidant personality disorder was introduced in DSM-III (American Psychiatric Association [APA], 1980), and debate persists regarding the utility of having two separate variants of the "detached personality." The present study addressed this issue through ratings of open-ended self-descriptions provided by community adults with high scores on schizoid versus avoidant personality traits (N = 229). The self-concept of individuals with avoidant personality style reflected a lack of positive self-regard and low self-efficacy/agency. Regarding schizoid personalities, neither positive nor negative self-regard, self-complexity, or self-efficacy/agency was found. Examination of specific variables yielded a relationship between avoidant personality styles, depression, and anxiety, consistent with literature noting simultaneous desire and fear of interpersonal relationships in avoidant patients (APA, 1980; Sheldon & West, 1990). Similarly, examination of individual variables yielded a negative association between schizoid personality styles and tolerance for contradictory aspects of the self, consistent with theoretical writings in this area (Kernberg, 1976; McWilliams, 2006). Results support the argument that these two personality styles represent distinct constructs. Findings support the utility of self-concept assessment to assist treatment planning and differential diagnosis. Treatment implications include using open-ended descriptions of patients' self-concepts to explore changes that may not be accessible via more structured forms of patient self-report.

The smartphone as a "significant other": interpersonal dependency and attachment in maladaptive smartphone and social networks use.

Smartphones are increasingly widespread throughout the world and, although smartphones provide various benefits, excessive and maladaptive use is often reported. Given the penetration of smartphones in the individual's daily life, it is relevant to identify the mechanisms sustaining their use, including the affective bond that the owner may develop with the device. The aim of the current study is to test a novel model to explain smartphone and Social Network Sites (SNS) use from an interpersonal perspective. We hypothesized that adult attachment style and interpersonal patterns (i.e., features of interpersonal dependency) generalize to the emotional bond with the mobile device, interacting with psychological correlates and background factors to predict smartphone and SNS consumption. 341 nonclinical adults (57.2% females; age M = 35.5, SD = 14.6) completed a battery consisting of the Attachment Style Questionnaire, the Relationship Profile Test, the Rosenberg Self-Esteem Scale, the Toronto Alexithymia Scale, the Young Adult Attachment to Phone Scale, and the Social Network Intensity and Social Network Access via Mobile phone Applications. A multi-mediation model supported the hypothesis regarding the influence of interpersonal style in the relationship of the individual with their smartphone and use of SNS. A parallel between attachment style and the emotional bond with the smartphone emerged, with anxious attachment style and destructive overdependence being potential risk factors for maladaptive smartphone use especially in individuals involved in a romantic relationship. Findings are discussed in terms of theoretical implications and intervention strategies towards smartphone dependency.

Convergence in patient and therapist alliance ratings early in treatment with Personality Assessment Inventory clinical scales and subscales.

We examined discrepancies in 81 patient-therapist dyads' alliance ratings early in treatment (3rd or 4th session) in relation to Personality Assessment Inventory clinical scales, subscales and global psychopathology. Results indicated that PAI global psychopathology (mean clinical elevation) and the scales of Aggression [AGG], Somatization [SOM], and Anxiety-Related Disorders [ARD] were significantly, negatively associated with an absolute difference of patient and therapist alliance ratings at Session 3. Higher initial scores on these clinical scales at treatment onset are associated with less difference (i.e., more convergence) in patient/ therapist ratings of alliance at Session 3. Correlations between PAI clinical subscales and absolute differences of patient and therapist alliance ratings at Session 3 also demonstrated statistically significant inverse relationships for several PAI subscales of Aggression- Attitude [AGG-A], Aggression-Physical [AGG-P], Somatic- Health Concerns [SOM-H], Anxiety-Related Disorders-Traumatic Stress [ARD-T], Anxiety-Related Disorders- Obsessive Compulsive [ARD-O], Borderline Features-Affective Instability [BOR-A], Borderline- Self-Harm [BOR-S], Anxiety-Physiological [ANX-P], Depression-Physiological [DEP-P] and Antisocial-Stimulus Seeking [ANT-S]. Again, higher scores on these subscales at treatment onset are associated with less difference (i.e., more convergence) in patient/therapist ratings. We also examined group differences between patients rating alliance higher (Group 1) and therapists rating alliance higher (Group 2) and found that Group 1 had significantly lower scores on Mania-Activity Level [MAN-A]. Clinical implications of results are discussed.

Dependency, Detachment, and Health-Related Behavior in Adult Primary Care Patients.

This investigation examined links between three related personality styles as assessed with the Relationship Profile Test-destructive overdependence, dysfunctional detachment, and healthy dependency-and indices of health and health-related behavior in a mixed-sex (74% female) sample of 100 primary care patients with a mean age of 38.62 (SD = 12.99). Fourteen primary care physicians also participated. As hypothesized, destructive overdependence and dysfunctional detachment scores were positively correlated with number of contacts with the emergency department; healthy dependency scores were inversely related to emergency department contacts and number of overnight hospitalizations. Healthy dependency scores were associated with an array of positive health behaviors; destructive overdependence scores were negatively associated with positive health behaviors. In addition, healthy dependency scores were inversely related to physician ratings of a difficult doctor-patient relationship. These results demonstrate that destructive overdependence, dysfunctional detachment and healthy dependency scores are associated in expected ways with indices of health and health-related behavior, and help illuminate the underlying factors that contribute to comparatively poor health and variations in health service use among overdependent and detached medical patients.

Personality assessment inventory items in relation to patient- and therapist-rated alliance.

Based on the results of prior research, we examined relationships between Personality Assessment Inventory (PAI) items on clinical scales of antisocial features (ANT) and anxiety-related disorders (ARD) with patient- and therapist-rated alliance early in treatment (third or fourth session). We also explored the relationship between the PAI treatment rejection scale (RXR) and early session therapist-rated alliance, despite null findings in previous work. We used PAI protocols from a clinical outpatient sample (N = 80). Data were analysed using backwards linear regressions. Results indicated that a group of ANT items from different ANT subscales predicted patient-rated therapeutic alliance, F(8,59) = 5.182, p = .000, R2 of .413, f2 = 0.70. Additionally, a group of ARD items from different ARD subscales significantly predicted therapist-rated alliance, F(6,62) = 3.007, p = .012, R2 of .225, f2 = 0.29. No significant relationships were found for RXR items and therapist-rated alliance, consistent with prior findings. Clinical implications are discussed.

Italian Version of the Relationship Profile Test (RPT-I): Temporal Stability, Construct Validity, and Cross-Cultural Comparison.

This study presents the adaptation to the Italian context of the Relationship Profile Test (RPT; Bornstein & Languirand), a self-report measure of Destructive Overdependence (DO), Dysfunctional Detachment (DD), and Healthy Dependency (HD). The RPT was administered to a community sample of 661 nonclinical Italian adults together with the Attachment Style Questionnaire, the Relational-Interdependent Self-Construal Scale, the Rosenberg Self-Esteem Scale, the Self-Compassion Scale, the Positive Affect-Negative Affect Scale, and the Toronto Alexithymia Scale. A randomly selected subset of participants (n = 67) completed the RPT again approximately 5 months after the first administration. The factor structure of the RPT obtained in the main sample was compared with that obtained in a sample of 603 adult participants from the US and was found to be similar. Internal consistency for DO, DD, and HD scores in the Italian sample fell between the acceptable to good range, and test-retest reliability coefficients were all above .70. The three scales yielded the expected pattern of correlations with theoretically related constructs, documenting good criterion validity. Findings are discussed in light of the literature on the RPT as a measure of interpersonal dependency and detachment. Suggestions for future research are offered.

Personality Assessment Inventory Clinical Scales in Relation to Patient and Therapist Rated Alliance Early in Treatment.

We examined relationships between the Personality Assessment Inventory (PAI) clinical scales (e.g., Somatic Complaints [SOM]) and subscales (e.g., Conversion [SOM-C]) with patient- and therapist-rated alliance early in treatment (third or fourth session). We also replicated and extended findings from a previous study examining PAI treatment scales (Treatment Rejection, Treatment Process Index) and early session therapist-rated alliance. We used PAI protocols from a clinical outpatient sample (N = 84). Data were analyzed using stepwise linear regressions. Results suggest that patients who report lower early session alliance also report more antisocial features (ß = -.219, p = .050, f2 = 0.05) specifically more antisocial behaviors (ß = -.315, p = .004, f2 = 0.11). Additionally, therapists report higher early session alliance with patients who report more anxiety-related disorders (ß = .274, p = .012, f2 = 0.08), specifically traumatic stress (ß = .325, p = .003, f2 = 0.12). No significant relationships were found between patient- or therapist-rated alliance and Treatment Rejection and Treatment Process Index, consistent with prior findings. Clinical implications are discussed.

Context-Driven Variability in Personality and Interpersonal Behavior: Evidence-Based Assessment Strategies.

How can assessors capture context-driven variability in personality and interpersonal behavior in ways that are both empirically sound and clinically useful? Scott et al. (2021) offer one potential solution as they discuss the Relational Self-Schema Measure, designed to assess variations in the self-schema across different relationship domains (e.g., self-with-parents, self-with-friends). This Comment outlines an evidence-based framework for assessing variability in personality and interpersonal behavior, describing three strategies that may be used by practitioners in the clinic and beyond. These are: 1) complementing decontextualized personality test results with domain-specific self-report and performance-based test data; 2) employing ambulatory assessment techniques to capture contextual variations in responding in vivo; and 3) using nomothetic test results as a springboard for patient narrative, with patient and therapist working together to explore relationship-specific variations in personality and interpersonal behavior.

Narcissism and Reactions to a Self-Esteem Insult: An Experiment Using Predictions from Self-Report and the Rorschach Task.

We used self-reported narcissistic grandiosity and vulnerability and a component derived from 11 potential grandiosity and narcissism variables (GNVs) coded from Rorschach behavior to predict fluctuations in self-esteem and their links to anger and defensive reactions. We assessed state mood, state self-esteem, and performance attributions in 105 college students who underwent a self-esteem manipulation involving success followed by failure on cognitive testing. Self-reported grandiosity predicted the disavowal of effortful ability as a factor in failure, but we did not replicate other previously reported findings for this variable. Self-reported vulnerability predicted oscillations in self-reported mood and self-esteem. The GNV scale predicted spontaneously expressed hostility and externalization following self-esteem insult, and attributions mediated its relationship with anger expressed after failure. We discuss implications of these results and recommend additional replication research.

Clinical utility of categorical and dimensional perspectives on personality pathology: A meta-analytic review.

Increasing dissatisfaction with categorical personality disorder (PD) diagnoses has led to the development of dimensional PD frameworks, which have gained influence in recent years. Although most studies contrasting the dimensional and categorical frameworks focus on issues related to construct validity, there is a burgeoning literature evaluating the clinical utility of these two approaches, with studies typically contrasting clinicians' ratings of various dimensions of clinical utility in the 2 frameworks using case vignettes or actual patients. This study used meta-analytic techniques to synthesize extant findings in this area, integrating data from 11 studies (103 total effect sizes, N of raters = 2,033) wherein clinical utility ratings of categorical and dimensional PD frameworks were compared. Dimensional models in general, and the five-factor model in particular, received more positive clinical utility ratings than categorical PD models in the majority of clinical utility domains. Stronger results were obtained for ratings of actual patients than ratings derived from case vignettes. Implications of these findings for the conceptualization and diagnosis of personality pathology are discussed, and suggestions for future research in this area are offered. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Does interpersonal dependency affect therapeutic outcome? A meta-analytic review.

This study examined whether interpersonal dependency affects therapeutic outcome, using meta-analytic techniques to synthesize results from 31 studies (49 effect sizes; overall N = 3807). High levels of dependency were associated with more positive outcome in psychodynamic therapy (r = 0.11, p < 0.05), but not cognitive-behavioural therapy (r = -0.05, ns), and were associated with a less positive outcome in pharmacological treatment (r = -0.15, p < 0.001). Other predictors of outcome included patient diagnosis (high levels of dependency were linked with more positive outcome for patients with anxiety disorders but not those with depression), outcome measure (high levels of dependency were associated with significantly greater improvement in global functioning but not symptom reduction) and dependency measure (cognitive and cognitive-behavioural dependency scales yielded less positive results than other types of measures). These results contribute to a growing body of literature examining effects of personality on treatment process and outcome. © 2019 John Wiley & Sons, Ltd.

The trait-type dialectic: Opportunities, challenges, and constructive dialogue.

In their incisive and engaging commentaries Drs. Lilienfeld and Widiger make a number of cogent points regarding how personality pathology should be conceptualized and assessed, both arguing strongly that dimensional models are superior to categorical personality disorder frameworks. In this response, I describe areas of convergence and divergence between my perspective and those of my colleagues and argue that-current ascendance of dimensional models notwithstanding-the trait-type dialectic will continue into the future as empirical evidence and clinical experience illuminate previously unrecognized strengths and limitations of each approach. To foster productive collaboration and constructive dialogue, I offer suggestions regarding studies that allow for rigorous comparison of the construct validity and clinical utility of categorical and dimensional perspectives on personality pathology, in the laboratory and in vivo. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Beyond trait reductionism: Implications of network structures for dimensional models of psychopathology.

Borsboom et al. discuss the implications of network structures for neurobiology-based reductionism, but inherent in the network approach is that dimensional models of psychopathology are untenable as well. Insofar as mental disorders are complex dynamic constellations of symptoms, the "trait reductionism" of dimensional psychopathology frameworks suffers from the same limitations as neurobiological reductionism.

Synergistic dependencies in partner and elder abuse.

Although dependency in its various forms has been widely studied, most investigations examine manifestations of dependency within individuals. Scrutiny of the literature reveals that synergistic dependencies-situations wherein both members of a dyad manifest excessive dependency of one form or another-play a role in some forms of partner and elder abuse. High levels of interpersonal or economic dependency in a woman coupled with high levels of interpersonal dependency in her male partner increase the likelihood of partner abuse. When family member caregivers are economically dependent on a functionally dependent older adult, risk for elder abuse increases. Although these synergistic dependencies differ across abuse domains, two prevailing themes emerge. The interpersonal, economic, and functional dependencies of abused partners and older adults are associated with feelings of helplessness, powerlessness, and an inability to challenge the abuser. The common dependency-related dynamic in perpetrators of abuse is fear-fear of abandonment leading to partner abuse, and fear of loss of financial support increasing risk for elder abuse. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The trait-type dialectic: Construct validity, clinical utility, and the diagnostic process.

The current debate regarding how best to conceptualize, operationalize, and assess personality pathology is often framed as a choice between categorical ("type") and dimensional ("trait") models, but when viewed from the perspective of the diagnostician, these two approaches actually have much in common. It is not possible to assign symptom ratings in any categorical personality disorder framework without first evaluating the severity of each symptom on a continuum, nor to implement dimensional personality disorder assessments in clinical settings without using thresholds that demarcate the presence of personality pathology, or severity of personality dysfunction. Although recent discussions of these two frameworks have focused primarily on issues regarding construct validity (and to a lesser extent, clinical utility), it is important to consider the impact of the diagnostic process as well. When considered within this broader context, the advantages and limitations of each perspective are illuminated, and it becomes clear that the categorical and dimensional frameworks represent an evolving dialectic that will continue into the future, as new and better models alter the focus of these debates. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

From Structure to Process: On the Integration of AMPD and HiTOP.

In recent years the limitations of traditional categorical frameworks for conceptualizing and diagnosing psychopathology have become increasingly clear, prompting the development of dimensional models wherein psychological dysfunction is assessed on a series of continua. Two frameworks have been particularly influential: the Alternative Model for Personality Disorders (AMPD) outlined in DSM-5 (American Psychiatric Association, 2013 ), and the Hierarchical Taxonomy of Psychopathology (HiTOP; Kotov et al., 2017 ). Widiger et al.'s timely and insightful review addresses two key questions regarding AMPD and HiTOP: Do deficits in self- and interpersonal functioning (AMPD Criterion A) have incremental validity over maladaptive traits (Criterion B), and if so, should Criterion A be included in HiTOP? In this commentary I argue that to resolve these questions conclusively, studies of factor structure and construct covariation must be complemented by investigations that address three issues: (a) Are there identifiable causal links between Criterion A impairments and Criterion B traits; (b) Do salient life events, therapeutic interventions, and experimental manipulations differentially affect Criterion A and Criterion B scores; and (c) Do Criterion A and Criterion B scores predict different outcomes in laboratory, clinical, and field settings?

Unhealthy dependency in victims and perpetrators of child maltreatment: A meta-analytic review.

OBJECTIVE: Theoretical conceptualizations of interpersonal dependency and dependent personality disorder suggest that (a) high levels of dependency in parents may increase risk for perpetration of child abuse and neglect and (b) children who are victimized may show elevated levels of dependency later in life. This study used meta-analytic techniques to examine these hypothesized links. METHOD: A systematic search of psychological and medical online databases revealed 14 published studies (21 effect sizes) examining the link between parental dependency and perpetration of abuse or neglect (overall N of perpetrators = 1,321), and 14 published studies (25 effect sizes) assessing dependency in victims of child abuse and neglect (overall N of victims = 38,265). RESULTS: The dependency-abuse effect size (d) for perpetrators collapsed across all moderating variables was 0.36, which is considered to be in the medium range. The dependency-victimization effect size (d) collapsed across all moderating variables was 0.29, also a medium effect size. CONCLUSION: These results support and extend analyses of the relationship between dependency and child maltreatment, and suggest that dependency may be both a precipitant of child maltreatment and consequence of victimization. Theoretical and clinical implications are discussed, with suggestions for further research outlined.