The structure of dimensions of psychopathology in normative and clinical samples: Applying causal discovery to MMPI-2-RF scales to investigate clustering of psychopathology spectra and p-factors.

We applied a Bayesian Constraint-based Causal Discovery method (BCCD) to examine the hierarchical structure of the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) Restructured Clinical (RC) scales. Two different general psychopathology super spectra (p-factor) scales were extracted from (1) all RC scales and (2) all RC scales except the RCd (Demoralization) scale. These p-factor scales were included in separate models to investigate the structure of dimensions of psychopathology in a normative (n = 3,242) and clinical (n = 2,466) sample, as well as the combined normative/clinical sample (N = 5,708), by applying the BCCD algorithm to obtain a data-driven reconstruction of the internal hierarchical structure of the MMPI-2-RF. Research on the underlying structure of the MMPI-2-RF has clinical relevance as well as conceptual relevance in the context of the HiTOP model. Results demonstrated that the syndromes measured with the RC-scales-in presence of a p-factor-cluster into six spectra: internalizing, disinhibited-externalizing, antagonistic-externalizing, thought disorder, detachment, and somatoform. These results may support a super spectrum construct, as it was necessary for obtaining a bottom-up reconstruction of this six-spectrum structure. We found support for superiority of a broad super spectrum with additional variance over and above demoralization, as it resulted in the clearest structure (i.e., clustering of the RC scales). Furthermore, our results indicate independent support for the bifactor structure model of psychopathology.

An Exploratory Study of MMPI-2-RF Personality and Psychopathology Profiles of Adults with Autism Spectrum Disorder without Intellectual Disability.

Objective: More empirical research is needed to disentangle the phenotypes of autism spectrum disorder (ASD) and cluster C personality symptomatology (CCPD), as both show similarities in their clinical presentation. We explored personality and psychopathology dimensions as conceptualized in contemporary dimensional taxonomies (i.e., hierarchical taxonomy of psychopathology; HiTOP) in adults with ASD without intellectual disability operationalized by the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF). Method: Applying secondary analytic processes using clinical data, we cross-examined the MMPI-2-RF profiles of adults with ASD (n = 28) compared to adults with Cluster C personality disorders (CCPD; n = 28) and a control group (n = 28) by conducting nonparametric tests and assessing effect sizes. Results: The profiles of the ASD and CCPD groups evidenced to be similar, and both average clinical profiles diverged from the average control group profiles by elevated levels of demoralization, internalizing, and somatization symptomatology. There were small differences between the average profiles of adults with ASD and adults with CCPD. Additional research using dimensional measures of psychopathology could elucidate the dimensional phenotypes of ASD and CCPD. Conclusions: Based on the results in this study, the MMPI-2-RF may not meaningfully discriminate between the two clinical presentations, with the exception of various externalizing scales.

Robustness of the Maladaptive Personality Plaster: An Investigation of Stability of the PSY-5-r in Adults over 20 Years.

The long-term stability of maladaptive personality traits in the general population has been under-investigated. The current study examined the longitudinal 20-year mean-level stability and rank-order consistency of five maladaptive personality traits-as measured with the Personality Psychopathology-5-r scales. Correlations and regression analysis were conducted to test both types of stability comparing raw scores of scale administrations in a general population sample in both 1992 and 2012 (N = 65). Repeated measures analysis of variance demonstrated significant mean-level stability of the PSY-5-r traits over 20 years. The PSY-5-r scales demonstrated significant rank-order consistency as evidenced by correlational analyses and reliability coefficients. The scales Aggressiveness-r (r = .73), Neuroticism/Negative Emotionality-r (r = .65), Introversion/Low Positive Emotionality-r (r = .63), and Disconstraint-r (r = .56), evidenced strong rank-order stability, whereas Psychoticism-r (r = .3) showed moderate rank-order consistency. The results of the present study indicate that maladaptive personality traits as measured with the PSY-5-r scales are relatively stable over 20 years in an adult community population.

The Power of Systemizing in Autism.

Identifying autism in clinical practice is complex because the causes of autism are still unclear and the features of autism are highly diverse. The Empathizing-Systemizing theory is successful in interpreting the core features of autism, both social and non-social, compared to other current theories of autism. This study provides an overview of the current state of research regarding the systemizing concept. High systemizing abilities are characteristic and specific in autism and as a result, three non-social features of autism are seen: restricted and repetitive behavior, obsessional interests, and, savant skills. We found solid evidence that, in order to identify autism in clinical practice, at least the use of an instrument which is specialized in measuring one's systemizing abilities is required.

Mesocorticolimbic dopamine functioning in primary psychopathy: A source of within-group heterogeneity.

Despite similar emotional deficiencies, primary psychopathic individuals can be situated on a continuum that spans from controlled to disinhibited. The constructs on which primary psychopaths are found to diverge, such as self-control, cognitive flexibility, and executive functioning, are crucially regulated by dopamine (DA). As such, the goal of this review is to examine which specific alterations in the meso-cortico-limbic DA system and corresponding genes (e.g., TH, DAT, COMT, DRD2, DRD4) might bias development towards a more controlled or disinhibited expression of primary psychopathy. Based on empirical data, it is argued that primary psychopathy is generally related to a higher tonic and population activity of striatal DA neurons and lower levels of D2-type DA receptors in meso-cortico-limbic projections, which may boost motivational drive towards incentive-laden goals, dampen punishment sensitivity, and increase future reward-expectancy. However, increasingly higher levels of DA activity in the striatum (moderate versus pathological elevations), lower levels of DA functionality in the prefrontal cortex, and higher D1-to-D2-type receptor ratios in meso-cortico-limbic projections may lead to increasingly disinhibited and impetuous phenotypes of primary psychopathy. Finally, in order to provide a more coherent view on etiological mechanisms, we discuss interactions between DA and serotonin that are relevant for primary psychopathy.

Revenge: An Analysis of Its Psychological Underpinnings.

An overview of the literature and theories concerning revenge is presented in this study. The aim is to clarify the boundaries between a healthy and pathological way of dealing with revenge to improve diagnostics, with regard to both theory and clinical practice. Revenge is an intrapersonal phenomenon and the extent to which people need revenge has a certain degree of stability. A healthy way of dealing with revenge may restore the psychological balance that has previously been disturbed. However, the desire for revenge can be long-lasting and dysfunctional due to, among other things, early problems in development and specific personality traits. Consequently, a pathological way of dealing with revenge can be part of a disorder and can lead to destructive acts such as homicide and even mass murder. Some clinical examples are presented and points of attention regarding diagnostics and treatment are discussed.

Personality and psychopathology: mapping the MMPI-2-RF on Cloninger's psychobiological model of personality.

This study investigates the relationship between the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) and the Temperament and Character Inventory (TCI) in a combined data set (N = 491) of patients with a broad range of psychiatric disorders (n = 286) as well as alcohol use disorder (n = 205). We examined bivariate correlations between both measures. The MMPI-2-RF scales relate to the TCI dimensions as was hypothesized, and relationships between both measurements were largely similar for psychiatric patients and alcohol-dependent patients. Theoretical and clinical implications are considered.

Systematic review, structural analysis, and new theoretical perspectives on the role of serotonin and associated genes in the etiology of psychopathy and sociopathy.

Since its theoretical inception, psychopathy has been considered by philosophers, clinicians, theorists, and empirical researchers to be substantially and critically explained by genetic factors. In this systematic review and structural analysis, new hypotheses will be introduced regarding gene-gene and gene-environment interactions in the etiology of psychopathy and sociopathy. Theory and research from neurobiological and behavioral sciences will be integrated in order to place this work in a broader conceptual framework and promote synergy across fields. First, a between groups comparison between psychopathy and sociopathy is made based on their specific dysfunctions in emotional processing, behavioral profiles, etiological pathways, HPA-axis functioning, and serotonergic profiles. Next, it is examined how various polymorphisms in serotonergic genes (e.g., TPH, 5HTT, HTR1A, HTR2A, HTR2C, and HTR3) might contribute either individually or interactively to the development of these disorders and through which specific biological and behavioral endophenotypes this effect could be mediated. A short introduction is made into mediating variables such as GABAergic functioning and testosterone which could potentially alter the decisive effect of serotonergic genotypes on behavior and physiology. Finally, critical commentary is presented on how to interpret the hypotheses put forward in this review.

An investigation of different aspects of overgeneralization in patients with major depressive disorder and borderline personality disorder.

OBJECTIVE: The aim of this study was to investigate whether (a) overgeneralization is restricted to negative attributions directed at the self; or whether it also extends to positive self-attributions and to attributions of situations in the outside world, and (b) whether the valence and direction (positively or negatively, to the self- or across situations) of overgeneralization processes vary among different patient populations. METHODS: Patients with major depressive disorder (MDD, n = 34), borderline personality disorder (BPD, n = 18), or both (n = 35), and never-depressed non-patients (NPs; n = 50) completed various measures of overgeneralization. RESULTS: Patients with MDD show higher levels of negative overgeneralization but lower levels of positive overgeneralization to the self- and across situations than NPs. Patients with MDD show more negative than positive overgeneralization to the self: a negative bias. They, however, do show higher levels of positive than negative overgeneralization across situations. Patients with BPD show the same pattern for overgeneralization to the self, but their higher levels of negative overgeneralization across situations are not exceeded by their positive counterpart. CONCLUSIONS: Results indicate that patient groups differ from NPs not only with respect to negative, but also with respect to positive overgeneralization. Furthermore, the valence and direction of overgeneralization processes vary among MDD and BPD patient populations. More specifically, findings suggest that, as compared to never-depressed individuals, patients with BPD and patients with MDD alike, lack a buffer against negative overgeneralization directed at the self. In patients with BPD, not only the high level of overgeneralization to the self, but also the high level of overgeneralization across situations seems to be problematic, since both types of overgeneralization appear not to be buffered by their positive counterparts.

A review on the relationship between testosterone and life-course persistent antisocial behavior.

Life-course persistent antisocial behavior is 10 to 14 times more prevalent in males and it has been suggested that testosterone levels could account for this gender bias. Preliminary studies with measures of fetal testosterone find inconsistent associations with antisocial behavior, especially studies that use the 2D:4D ratio as a proxy for fetal testosterone. However, circulating testosterone consistently shows positive associations with antisocial behaviors throughout childhood, adolescence, and adulthood, particularly in males. It is suggested that high fetal/circulating testosterone interactively influence the maturation and functionality of mesolimbic dopaminergic circuitry, right orbitofrontal cortex, and cortico-subcortical connectivity, resulting in a strong reward motivation, low social sensitivity, and dampened regulation of strong motivational/emotional processes. The link between these testosterone induced endophenotypes and actual display of antisocial behavior is strongly modulated by different social (e.g., social rejection, low SES) and genetic (e.g., MAOA, 5HTT) risk factors that can disturb socio-, psycho-, and biological development and interact with testosterone in shaping behavior. When these additional risk factors are present, the testosterone induced endophenotypes may increase the risk for a chronic antisocial lifestyle. However, behavioral endophenotypes induced by testosterone can also predispose towards socially adaptive traits such as a strong achievement motivation, leadership, fair bargaining behaviors, and social assertiveness. These adaptive traits are more likely to emerge when the high testosterone individual has positive social experiences that promote prosocial behaviors such as strong and secure attachments with his caregivers, affiliation with prosocial peers, and sufficient socioeconomic resources. A theoretical model is presented, various hypotheses are examined, and future venues for research are discussed.

A review on the relationship between testosterone and the interpersonal/affective facet of psychopathy.

Testosterone (T) has received increasing interest in the recent years as a probable biological determinant in the etiology of male-biased clinical conditions such as psychopathy (i.e. psychopathy is more prevalent in men and leads to an earlier onset and more severe expression of antisocial and aggressive behavior in men compared to women). In this review, the authors evaluated the potential relationship between T and different constructs closely related to the core characteristics of psychopathy (affective empathy, fear-reactivity, and instrumental aggression). After a thorough examination of the literature, it is concluded that high T exposure in utero and high circulating T levels throughout important life phases (most notably adolescence) or in response to social challenges (e.g. social stress, competition) could be an important etiological risk factor in the emergence of psychopathic behavior. Nevertheless, studies consistently indicate that high T is not related to a significantly reduced fear-reactivity and is only indirectly associated with the increased levels of instrumental aggression observed in psychopathic individuals. Therefore, psychopathy is likely to arise from an interaction between high T levels and other biological and socio-psychological risk factors, such as a constitutionally based dampened fear-reactivity, insecure/disordered attachment processes in childhood, and social discrimination/rejection in adolescence and/or adulthood.

Integrating psychopathology and personality disorders conceptualized by the MMPI-2-RF and the MCMI-III: a structural validity study.

The Minnesota Multiphasic Personality Inventory-2-Restructured Form (Ben-Porath & Tellegen, 2008 ) Restructured Clinical scales and Higher Order scales were linked to the Millon Clinical Multiaxial Inventory-III (Millon, Millon, Davis, & Grossman, 2009 ) personality disorder scales and clinical syndrome scales in a Flemish/Dutch sample of psychiatric inpatients and outpatients, substance abuse patients, correctional inmates, and forensic psychiatric patients (N = 968). Structural validity of psychopathology and personality disorders as conceptualized by both instruments was investigated by means of principal component analysis. Results reveal a higher order structure with 4 dimensions (internalizing disorders, externalizing disorders, paranoid ideation/thought disturbance, and pathological introversion) that parallels earlier research on pathological personality dimensions as well as research linking pathological personality traits with mental disorders. Theoretical and clinical implications are considered.

Emotional intelligence of mental health nurses.

AIMS: The aim of this study is to gain insight into the level of emotional intelligence of mental health nurses in the Netherlands. BACKGROUND: The focus in research on emotional intelligence to date has been on a variety of professionals. However, little is known about emotional intelligence in mental health nurses. METHOD: The emotional intelligence of 98 Dutch nurses caring for psychiatric patients is reported. Data were collected with the Bar-On Emotional Quotient Inventory within a cross-sectional research design. RESULTS: The mean level of emotional intelligence of this sample of professionals is statistically significant higher than the emotional intelligence of the general population. Female nurses score significantly higher than men on the subscales Empathy, Social Responsibility, Interpersonal Relationship, Emotional Self-awareness, Self-Actualisation and Assertiveness. No correlations are found between years of experience and age on the one hand and emotional intelligence on the other hand. CONCLUSIONS: The results of this study show that nurses in psychiatric care indeed score above average in the emotional intelligence required to cope with the amount of emotional labour involved in daily mental health practice. RELEVANCE TO CLINICAL PRACTICE: The ascertained large range in emotional intelligence scores among the mental health nurses challenges us to investigate possible implications which higher or lower emotional intelligence levels may have on the quality of care. For instance, a possible relation between the level of emotional intelligence and the quality of the therapeutic nurse-patient relationship or the relation between the level of emotional intelligence and the manner of coping with situations characterised by a great amount of emotional labour (such as caring for patients who self-harm or are suicidal).

Using the Megargee system among Belgian prisoners: cross-cultural prevalence of the MMPI-2 based types.

On the basis of the Minnesota Multiphasic Personality Inventory, and later the MMPI-2, E. I. Megargee and colleagues empirically developed a classification system to enhance management and treatment of offenders throughout the criminal justice system. This preliminary study extended the application of the MMPI-2 based system for the first time to a non-U.S. prison sample and classified the MMPI-2 profiles of 1,636 male inmates from Belgian federal prisons. The typology was capable of classifying most of the subjects and all 10 Megargee types were represented. Compared to American prevalence data, types Delta and Charlie were overrepresented and type George was underrepresented. Issues that warrant further investigation are discussed.

MMPI-2 clusters of alcohol-dependent patients and the relation to Cloninger's temperament-character inventory.

OBJECTIVE: Psychometric research in the field of alcohol dependence has concentrated on identifying certain (personality) characteristics (i.e. typologies). This paper is aimed to identify such typologies and studies the relation of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and Cloninger's temperament-character inventory (TCI). METHOD: To find MMPI-2 scales associated with maximization of group differences between 222 DSM-IV alcohol dependent inpatients and a control group of 222 normal subjects, discriminant analysis was used. In addition, a cluster analysis was performed with these scales, and the MMPI-2 mean scale values of the resulting patient clusters were examined for their TCI-correlates. RESULTS: The discriminant analyses showed several MMPI-2 scales that could clearly distinguish between alcohol-dependent patients and the normal controls. Cluster analysis resulted in semantically different MMPI-2 profiles implying qualitatively different groups of patients. When related to TCI scales, these differences revealed harm avoidance, self-directedness, and persistence, amongst others, as important elements in the description of the clusters. CONCLUSION: Evidence for the validity of MMPI-2 constructs as well as those of the TCI in the assessment of alcohol-dependent patients was provided.

Personality disorders, depression, and coping styles in Argentinean bulimic patients.

This study investigates the coping styles of bulimic patients with personality disorders (PDs) and the effects of the level of depression on the relations between PDs and coping. The sample consisted of 75 Argentinean bulimic outpatients engaged in treatment. Patients completed the SCID II (Structural Interview for DSM IV-Personality Disorders), COPE (Coping Inventory), and the SCL-90-R (Symptom Checklist-90-Revised). No differences in the coping styles of bulimic patients with or without a PD were found. However, when three specific PDs were considered-Avoidant, Obsessive-Compulsive, or Borderline PDs-clear differences in the coping styles of the bulimics were found. However, the differences disappeared when depression was controlled. Regarding the severity of the three specific PDs, coping styles were only found to be associated with the Avoidant PD. Depression showed to affect the relations between coping styles and two specific PDs-Avoidant and Borderline PDs-in bulimic patients.

The role of core beliefs in the specific cognitions of bulimic patients.

Cognitive models of bulimia nervosa have stressed the importance of self-beliefs in the maintenance of the disorder. However, new findings show a deeper and more general level of beliefs also to play a role in eating disorders. These beliefs are long-standing, absolute, and unconditional. In the present study, the relations between such core beliefs and specific cognitions regarding eating, shape, and weight were examined. The sample consisted of 75 bulimic outpatients who started treatment. The patients completed the Schema Questionnaire, the Eating Disorders Inventory-2, the SCL-90-R, and the Mizes Anorectic Cognitions Questionnaire at intake. Strong relations between some core beliefs and the specific cognitions regarding shape, weight, and eating were found. The modification of core beliefs appears to be a very important issue to incorporate into treatment.

Emotional intelligence and adaptive success of nurses caring for people with mental retardation and severe behavior problems.

The emotional intelligence profiles, gender differences, and adaptive success of 380 Dutch nurses caring for people with mental retardation and accompanying severe behavior problems are reported. Data were collected with the Bar-On Emotional Quotient Inventory, Utrecht-Coping List, Utrecht-Burnout Scale, MMPI-2, and GAMA. Absence due to illness and job change were measured across a 2-year period. A clear relation between emotional intelligence and adaptive success was detected at an.01 level of significance. A negative correlation was found between emotional intelligence and both burnout and psychopathology. Emotional intelligence did not appear to be related to absence or job change. Based on these findings, training programs for nurses can possibly help to avoid employee burnout.

Cross-cultural replication of the five-factor model and comparison of the NEO-PI-R and MMPI-2 PSY-5 scales in a Dutch psychiatric sample.

The authors investigated cross-cultural replicability of the five-factor model (FFM) of personality as represented by the revised NEO Personality Inventory (NEO-PI-R; P. T. Costa & R. R. McCrae, 1992) in a sample of 423 Dutch psychiatric patients. Also, NEO-PI-R domain scales were compared with the Personality Psychopathology Five (PSY-5; A. R. Harkness & J. L. McNulty, 1994) scales of the Minnesota Multiphasic Personality Inventory-2 (J. N. Butcher, W. G. Dahlstrom, J. R. Graham, A. Tellegen, & B. Kaemmer, 2002). Principal-components analysis with procrustean rotation confirmed the hypothesized structural similarity of the present sample with the U.S. normative factor scores. All of the hypothesized relations between NEO-PI-R and PSY-5 scales were confirmed. The results provide evidence for cross-cultural replicability of the FFM and for validity of the NEO-PI-R and PSY-5 constructs in the psychological assessment of psychiatric patients.

Korsakoff's syndrome on the MMPI-2.

BACKGROUND: This article describes an exploratory study of MMPI-2 administration to 20 patients with Korsakoff's disease, all admitted to the Korsakoff unit of a major psychiatric hospital in the Netherlands. METHODS: We compared their MMPI-2 basic profiles with those of an inpatient alcohol-dependent non-Korsakoff group. Attention was also given to content scales and some selected supplementary scales. Furthermore, we explored the differences between MMPI-2 profiles of Korsakoff patients with and without insight into oneself and one's disease. RESULTS: Compared with both the Dutch norms and the scale means of the non-Korsakoff alcoholics, Korsakoff patients showed an extraordinary flat profile. Illness insight appeared to be related to the levels of the various scales. DISCUSSION: The results show the potential usefulness of the MMPI-2 in the differential diagnosis of chronic alcoholism and Korsakoff's disease.