Client and Clinical Utility of the Assessment of Personality Disorders.

ABSTRACT: Clinical utility and client utility are important desirable properties when developing and evaluating a new classification system for mental disorders. This study reports on four focus groups followed up by a Delphi study among clinicians working with clients with personality disorders (PD) and clients with PD themselves to harness both user groups' perspectives on the utility of PD diagnosis. Our findings show that the client and clinician views of the concept of utility were closely aligned and include aspects of transparency of communication and the ability of an assessment to enhance hope, curiosity, motivation, and insight into a client's personality patterns. Unique to clinicians' appraisal was the ability of an assessment to capture both vulnerabilities and resilience of clients and to give information about the prognosis in treatment. Unique to clients' appraisal was the ability of an assessment to be destigmatizing and collaborative. These findings may serve to expand our definition and measurement of clinical utility, in that collaborative and nonstigmatizing procedures likely promote client acceptability. To capture both aspects, we offer two preliminary questionnaires (i.e., item sets open to further empirical testing) based on the data derived from the Delphi procedure.

Cross-sectional and prospective association between personality traits and IADL/ADL limitations.

Prior research has shown that personality traits are associated with activities of daily living (ADLs) and instrumental ADLs (IADLs). To advance research on the psychological factors related to aging-related functional limitations, this study examined the relation between personality traits and both concurrent and incident functional limitations, tested whether these associations are similar across IADLs and ADLs, and tested potential mediators of these associations. Participants were drawn from eight longitudinal samples from the U.S., England, and Japan. Participants provided data on demographic variables, the five major personality traits, and on the Katz ADL-scale and Lawton IADL-scales. IADL/ADL limitations were assessed again 3-18 years later. A consistent pattern of associations was found between personality traits and functional limitations, with associations slightly stronger for IADLs than ADLs, and robust across samples that used different measures and from different cultural contexts. The meta-analysis indicated that higher neuroticism was related to a higher likelihood of concurrent and incident IADL/ADL limitations, and higher conscientiousness, extraversion, and openness were associated with lower risk. Higher agreeableness was associated with lower risk of concurrent IADL/ADL, but unrelated to incident limitations. Physical activity, disease burden, depressive symptoms, self-rated health, handgrip strength, falls, and smoking status mediated the relation between personality traits and incident IADL/ADL limitations. The present study indicates that personality traits are risk factors for both IADL and ADL limitations across multiple national cohorts, identifies potential mediators, and informs conceptual models on psychological risk factors for functional decline. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A preliminary study: designing and validating projective images of Young's early maladaptive schema (EMS) domains.

BACKGROUND: This study aims to design and validate ten projective images of Young's Early Maladaptive Schema (EMS) domains. For this purpose, two questions are to be addressed. (1) How is the factorial structure of the projective images of EMS domains? (2) Do the images designed in the domains of disconnection and rejection, impaired autonomy and performance, impaired limits, other-directedness, and over-vigilance and inhibition have sufficient validity? METHODS: This is an applied mixed-methods exploratory study, in which the statistical population consisted of psychologists from Tehran Province in the qualitative section (n = 8) as well as other individuals aged between 18 and 65 years (mean age = 33) from Qazvin in the quantitative section (n = 102) in 2018. The research questions were analyzed through principal axis factoring with a varimax rotation, confirmatory factor analysis, Pearson correlation coefficient, and Cronbach's alpha. RESULTS: According to the results, ten images and five domains of Young's EMSs contribute to a simple structure. Accounting for 70.35% of the total variance of EMSs, the five dimensions include disconnection and rejection, impaired autonomy and performance, impaired limits, other-directedness, and over-vigilance and inhibition. CONCLUSIONS: The results indicated that the designed projective images yielded acceptable construct validity.

Does the Rorschach Performance Assessment System (R-PAS) Differ from the Comprehensive System (CS) on Variables Relevant to Interpretation?

We examined the impact of the changes in administration and coding introduced by the Rorschach Performance Assessment System (R-PAS) relative to the Comprehensive System (CS) on the Rorschach response process, as manifested in variables relevant to interpretation. We also examined the efficiency of each system to obtain protocols in an optimal range of responses (R) for interpretation. As hypothesized, when comparing 50 CS and 50 R-PAS nonpatient protocols, R-PAS produced many more protocols in the optimal R range (18-27) than the CS (78% vs. 24%) and it eliminated the need for re-administration, which was required for five CS protocols. As expected, R was less variable with R-PAS, as were two variables derived from it, R8910% and Complexity. In addition, as expected because of different Form Quality tables, R-PAS showed notably fewer and less variable perceptual distortions than the CS, and an increase in more conventional perceptions. The other 58 variables showed no reliable differences in means or standard deviations, though modest power precluded definitive inferences about equivalence. Overall, our results support previous findings about the benefit of R-PAS to obtain protocols in an optimal range for interpretation, while keeping the core manifestations of the response process unchanged.

Using a Thin Slice Coding Approach to Assess Preschool Personality Dimensions.

A large literature assessing personality across the lifespan has used the Big Five as an organizing framework, with evidence that variation along different dimensions predicts aspects of psychopathology. Parent reports indicate that these dimensions emerge as early as preschool, but there is a need for objective, observational measures of personality in young children, as parent report can be confounded by the parents' own personality and psychopathology. The current study observationally coded personality dimensions in a clinically enriched sample of preschoolers. A heterogeneous group of preschoolers oversampled for depression (N = 299) completed 1-8 structured observational tasks with an experimenter. Big Five personality dimensions of extraversion, agreeableness, conscientiousness, neuroticism, and openness to experience were coded using a "thin slice" technique with 7,820 unique ratings available for analysis. Thin slice ratings of personality dimensions were reliably observed in preschoolers ages 3-6 years. Within and across-task, consistency was also evident, with consistency estimates higher than found in adult samples. Divergent validity was limited, with coders distinguishing between three (extraversion/openness; agreeableness/conscientiousness; and neuroticism) rather than five dimensions. Personality dimensions can be observationally identified in preschool-age children and offer reliable estimates that stand across different observational tasks. Study findings highlight the importance of observational approaches to assessing early personality dimensions, as well as the utility of the thin slice approach for meaningful secondary data analysis.

Understanding At-Risk Youths: Average PAI-A Scores and Their Associations with Impulsivity-Related Constructs.

The purpose of this study was to extend research on the Personality Assessment Inventory-Adolescent (PAI-A; Morey, 2007) to include an examination of mean PAI-A results and associations between the PAI-A and indicators of impulsivity in a large sample of at-risk adolescents (Mage = 16.75; 79% male; 64% Caucasian) in a military-style residential program. Included in this study are archival records for a diverse sample of 497 youths who participated in the program during a 2-year period. Average T scores on PAI-A scales ranged from 44.67 to 65.41. Moderate to large positive associations (rs = .30-.65) were found between relevant PAI-A scales and both UPPS-P scales and self-reported substance use. There were smaller effects (r = .17) for associations between the PAI-A and program disciplinary infractions. Small to large group differences (ds = .19-.93) on PAI-A scales differentiated youths who had experience with arrests or NSSI from those who did not. This study provides information about the under-studied but vulnerable youths occupying the space between the normative population and youths with identified clinical or legal problems. It also clarifies how impulsivity and impulsivity-related behaviors may be represented on the PAI-A.

The Development and Validation of a Multidimensional Forced-Choice Format Character Measure: Testing the Thurstonian IRT Approach.

There has been reemerging interest within psychology in the construct of character, yet assessing it can be difficult due to social desirability of character traits. Forced-choice formats offer one way to address response bias, but traditional scoring methods (i.e., ipsative) associated with this format makes comparing scores between people problematic. Nevertheless, recent advances in modeling item responding (Thurstonian IRT) enable scoring that recovers absolute standing on latent traits and allows for score comparisons between people. Based on recent work in character measurement (CIVIC), we developed a multidimensional forced-choice measure of character (CIVIC-MFC) and scored it using Thurstonian IRT. Initial validation using a sample of 798 participants demonstrated good support for factorial, convergent, and concurrent validity for scores on the CIVIC-MFC, although they did not demonstrate more faking resistance than scores on a Likert-type format version. Potential explanations are discussed.

BIS and BAS Sensitivities at Different Levels of Personality Description: A Latent-Variable Approach with Self- and Informant-Ratings.

We examine the structural overlap of the Behavioral Inhibition System (BIS) and the Behavioral Approach System (BAS) with Stability and Plasticity, the two higher-order factors encompassing the Big Five. Carver and White's BIS/BAS and the Big Five Inventory were administered to a sample of 330 adults, serving both as targets and informants. Self- and other-ratings were modeled by using the Correlated Trait-Correlated Method model. BIS and BAS correlated highly with metatraits, after method variance and measurement error were partialled out: BIS was positively related to Stability, while BAS was positively related to Plasticity and negatively related to Stability. After the higher-order factors were controlled, the BIS was highly and positively related to Emotional stability, whereas the BAS had a small but significant relationship with Extraversion. Findings are discussed with regard to the most appropriate level of generality/specificity at which the personality correlates of BIS and BAS can be investigated.

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.

Personality Assessment and Psychotherapy Preferences: Congruence between Client Personality and Therapist Personality Preferences.

Consideration of client preferences has been emphasized as important to therapeutic outcomes, such as treatment engagement and retention. Although studies have investigated several client and therapist characteristics associated with client preferences, few have considered whether people have preferences regarding a potential therapist's personality. The current study extended prior research on client preferences by examining the influence of participants' Big Five personality traits on preferences for therapist personality characteristics utilizing latent profile analysis. We expected congruence between client personality traits and preferred psychotherapist personality traits. In both undergraduate and community samples, results indicated that participants generally prefer a psychotherapist with personality characteristics similar to their own. Our findings establish the presence of preferences based on personality factors and have implications for future research directions and the role of personality assessment in routine clinical practice.

Personality Disturbances as Emergent Phenomena Reflective of Underlying Neurobehavioral Systems: Beyond Dimensional Measurement, Phenotypic Trait Descriptors, and Factor Analysis.

BACKGROUND AND OVERVIEW: The conceptualization of personality pathology, or personality disturbance, is now at a substantive crossroads. Some researchers (and clinicians) prefer a focus on the domains of personality pathology that are well-described and captured in traditional categorical diagnostic approaches that, in some instances, abut normal personality constructs. Other workers argue to move the study of personality disorder (PD) closer to personality science seeking continuous connections between PD and established dimensions of healthy-range, normal personality. Most of the latter efforts revolve around correlational and factor analytic study of phenotypic expressions of PD features and normal personality dimensions. It is notable, however, that both visions of the PD/personality interface are essentially unlinked to an understanding of shared neurobiological underpinnings (i.e., neurotransmitter-influenced neurobehavioral systems) of both personality disturbance and normal personality1. Here, we present a nontechnical, conceptual overview of our approach to this problem, advancing a neurobehavioral approach that seeks to anchor both normal personality and personality disturbance within a matrix of brain-based neurobiological systems, incorporating genetic, epigenetic, and environmental inputs. In this brief paper, we seek only to provide a necessarily cursory introduction to how we conceptualize this area and illustrate, in broad outline, our effort to characterize both personality and personality disturbance anchored in neurobehavioral systems. Our approach, which we began developing in the middle 1990s, can be juxtaposed with the more recently proposed DSM-5 Alternative Model of Personality Disorders as well as the well-established five-factor approach to PD.

Forensic assessment may be based on common sense assumptions rather than science.

Forensic assessments must be scientifically founded, because courts should obtain expert evidence with acceptable evidential value. In Slovenia, professional guidelines of forensic personality assessment are too general and not always in line with international professional recommendations. Thus, experts have no strict guidelines which would lead them to scientifically grounded expert opinions. The aim of the research was to establish which tests are employed in forensic assessment in Slovenia and to what extent the professional guidelines for expert opinions are followed. A total of 166 forensic personality assessments were reviewed, representing the majority of expert opinions issued in the period 2003-2018. The results of the analysis revealed that questionable projective tests are most commonly used. Typically, an expert opinion was rendered based on two tests, at least one of which was projective. What is more, expert opinions did not include hypotheses, in-text citations, reference lists, or proof of the expert witness's competence. The tests and their results were mentioned briefly and inadequately, without mention of their reliability and validity. Possible malingering of the person being evaluated was not detected. Professional guidelines were not followed and non-standardized tests without normative values and of questionable scientific merit were predominantly used, despite lack of proof that they truly measure what they claim to be measuring. These findings significantly differ from the results of similar research, raising serious concerns over the credibility of expert opinions in Slovenia.

Scripting the DSM-5 Alternative Model for Personality Disorders assessment procedure: A clinically feasible multi-informant multi-method approach.

Published case studies on the DSM-5 (section III) Alternative Model for Personality Disorders (AMPD) generally utilized unstandardized assessment procedures or mono-method approaches. We present a case from clinical practice to illustrate a standardized, clinically feasible procedure for assessing personality pathology according to the full AMPD model, using a multi-method approach. We aim to present a procedure that can guide and inspire clinicians that are going to work with dimensional models as presented in DSM-5 and ICD-11. Specifically, we show how questionnaire and interview data from multiple sources (i.e. patient and family) can be combined. The clinical case also illustrates how Criterion A (i.e. functioning) and B (i.e. traits) are interrelated, suggesting that the joint assessment of both Criterion A and B is necessary for a comprehensive and clinically relevant case formulation. It also highlights how multi-method information can enhance diagnostic formulations. Finally, we show how the AMPD model can serve treatment planning and provide suggestions for how patient feedback might be delivered. © 2020 John Wiley & Sons, Ltd.

Generalizability of statistical prediction from psychological assessment data: An investigation with the MMPI-2-RF.

In the present study, the author employed tools and principles from the domain of machine learning to investigate four questions related to the generalizability of statistical prediction in psychological assessment. First, to what extent do predictive methods common to psychology research and machine learning actually tend to predict new data points in new settings? Second, of what practical value is parsimony in applied prediction? Third, what is the most effective way to select model predictors when attempting to maximize generalizability? Fourth, how well do the methods considered compare with one another with respect to prediction generalizability? To address these questions, the author developed various types of predictive models on the basis of Minnesota Multiphasic Personality Inventory (MMPI)-2-RF scales, using multiple prediction criteria, in a calibration inpatient sample, then externally validated those models by applying them to one or two clinical samples from other settings. Model generalizability was then evaluated based on prediction accuracy in the external validation samples. Noteworthy findings from the present study include (a) statistical models generally demonstrated observable performance shrinkage across settings regardless of modeling approach, though they nevertheless tended to retain non-negligible predictive power in new settings; (b) of the modeling approaches considered, regularized (penalized) regression methods appeared to produce the most consistently robust predictions across settings; (c) parsimony appeared more likely to reduce than to enhance model generalizability; and (d) multivariate models whose predictors were selected automatically tended to perform relatively well, often producing substantially more generalizable predictions than models whose predictors were selected based on theory. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Validating Circumplex Scales of Perceived Impairments and Benefits from prototypically problematic interpersonal tendencies.

Clinical and personality research and theorizing has benefitted from assessing people's experiences of interpersonal problems, but these assessments have neglected assessing people's subjective perceptions of impairments and benefits from such problems. To address this gap, 2 studies tested the reliability and validity of 2 interpersonal circumplex-based measures of subjectively perceived impairments ("Circumplex Scales of Interpersonal Problems-Impairments" or "CSIP-Impairments") and benefits ("CSIP-Benefits") from prototypically problematic interpersonal tendencies. Study 1 (N = 291) found evidence supporting the internal consistencies and circumplex structures of both CSIP-Impairments and CSIP-Benefits, and it compared their structures to other IPC-based measures; Study 2 (N = 564) replicated support for these internal consistencies and circumplex structures and provided construct validity evidence for CSIP-Impairments and CSIP-Benefits by relating them to dark personalities and personality disorder traits. CSIP-Impairments and CSIP-Benefits may aid researchers and clinicians in further understanding and developing therapy strategies for treating problematic interpersonal tendencies. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

HERO Wellness Scale: Examining a new mental wellness scale.

BACKGROUND: Mental wellness has traditionally not been tracked by mental health clinicians. The aim is to examine the reliability and validity of the HERO Wellness Scale. METHODS: Eighty-four college students (age ≥18) with and without psychiatric morbidity from a small, private college in the north-central United States enrolled in the WILD 5 Wellness Program-a longitudinal, quasi-experimental clinical trial that included 2 groups (intervention and waitlist). Mental wellness scores at the beginning of the WILD 5 intervention were assessed by the HERO Wellness Scale and the World Health Organization-Five (WHO-5) Well-Being Index. RESULTS: Internal consistency was calculated from baseline data (N = 84) using Cronbach's alpha for the 5-item HERO composite = .93. The corrected item-total correlations were adequate (>.50), ranging from .67 (resilience) to .86 (mental wellness). The HERO Wellness Scale covers a representative sample of the domain of wellness. It diverges from WHO-5 items by specifically assessing for well-established positive psychology traits such as happiness, enthusiasm, resilience, and optimism. CONCLUSIONS: The HERO Wellness Scale showed good validity and reliability, and should be considered for individual-level assessment of mental wellness. The HERO Wellness Scale adds to the body of knowledge in psychiatry, nursing, and psychology.

Assessment of Personality and Psychopathology in Healthcare Settings: Introduction to the Special Section.

Healthcare in the United States has increasingly benefited from the adoption of multidisciplinary providers. Many multidisciplinary teams include psychologists who often conduct psychological and personality assessments in their practice. This special section highlights areas of personality and psychological assessment in applied healthcare contexts. Nghiem and colleagues review the psychometric performance of various personality and psychopathology instruments and provide recommendations for the assessment of solid organ transplant evaluations. Gottschling and colleagues present a culturally adapted screener for anxiety-related symptoms in geriatric adults that can easily be administered in various healthcare settings. Perry and colleagues provide a rationale and method for including a brief personality assessment for patients with cancer. McCord presents a broadband screener, the Multidimensional Behavioral Health Screen (MBHS), that assesses 9 components of psychopathology. Mitchell and colleagues provide evidence for using the MBHS in primary care clinics as an alternative to the Patient Health Questionnaire-9. This special section provides evidence-based information regarding personality and psychological assessments that will likely be useful in varied healthcare contexts.

DSM-5 Assessments of the Level of Personality Functioning: Intrapersonal and Interpersonal Functioning.

Objective: In DSM-5, Section III, the Level of Personality Functioning (LPF) was proposed as a severity index of personality disorders (PDs), but as it reflects both trait-like (availability) and state-like (accessibility) features, of which, moreover, the relationship with the experience of patients is unclear, we critically examined LPF in patients with general psychopathology. Method: This study compared the validity of the direct Inventory of Personality Organization (IPO), and the indirect Differentiation-Relatedness Scale (DRS) LPF-measure, in relation to measures of intrapersonal and interpersonal functioning. The sample consisted of 70 inpatients with general psychopathology and no primary PDs. Associations of both measures with DSM-PDs were examined, with and without controlling for clinical distress. Results: The IPO was significantly related to age and clinical distress. When controlling for clinical distress, the IPO was still associated with cluster A (odd) and B (erratic) PD features, high levels of self-criticism, conflict in relationships and low levels of adaptive coping strategies. The DRS was only related to the schizotypical PD. Conclusions: In patients with general psychopathology, both the IPO and the DRS, appear to have limitations in measuring LPF. The IPO seems to be prone to state effects, although correlations with PDs remained significant when controlling for clinical distress. The DRS seemed to be more independent from clinical distress but was unexpectedly unrelated to features of personality pathology. DRS reflects availability, while IPO also reflects different degrees of accessibility of LPF in PDs.

Development of a Short Form for the DSM-5 Levels of Personality Functioning Questionnaire.

The Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM-5]; American Psychiatric Association, 2013) introduced the Alternative DSM-5 Model for Personality Disorders (AMPD). Criterion A of the AMPD conceptualizes level of personality functioning (LOPF) in terms of self- and interpersonal functioning. This article describes the development of a short form for the DSM-5 Level of Personality Functioning Questionnaire (DLOPFQ). A sample of 1,279 participants was drawn from community, clinical, and college settings. All participants completed the DLOPFQ full form. The sample was split into a derivation sample (n = 640) and a validation sample (n = 639). Exploratory factor analysis of the derivation sample data was used to select short-form items. Using the validation sample, confirmatory factor analyses (CFAs) were used to assess fit for proposed item-to-subscale assignments. Short-form subscales had good internal consistency estimates, correlated strongly with full-form subscales, correlated with one another, and were associated with relevant constructs. CFA supported a second-order factor model (i.e., four factors loading onto a higher order LOPF factor). Overall, the DLOPFQ Short Form provides a brief assessment of the constructs measured by the full form. Limitations of the study are reviewed, speculations for improving the measure are discussed, and suggestions for future directions are provided.

An Integrated Approach to Personality Assessment Based on the Personality Systems Framework.

Psychologists who carry out personality assessments must be conversant in diverse technical languages to describe their clients' social contexts and inner personality function. The clinician needs to understand a person's family, gender role, ethnic identity, religious beliefs, and similar qualities, and also a client's inner personality functioning, including the workings of motives, emotions, cognition, and self-control: These can be characterized by relevant psychiatric symptoms, personality traits, and individual test scores such as those on the MMPI-2-RF and Rorschach-Performance Assessment System. The Personality Systems Framework for Assessment (PSF-A) can support the assessment process by organizing information about both an individual's context and personality function, freeing professionals to optimally focus on characterizing their clients.