Borderline personality disorder in adolescents: evidence in support of the Childhood Interview for DSM-IV Borderline Personality Disorder in a sample of adolescent inpatients.

Empirical evidence is increasing in support of the validity of the construct of borderline personality disorder (BPD) in adolescence. There is growing consensus that the early identification and treatment of emerging borderline traits may be an important focus. However, few diagnostic (questionnaire- or interview-based) measures specifically developed or adapted for adolescents and children exist. The Childhood Interview for DSM-IV Borderline Personality Disorder (CI-BPD) [Zanarini, 2003] is a promising interview-based measure of adolescent BPD. Currently, no studies have explicitly been designed to examine the psychometric properties of the CI-BPD. The aim of the current study was to examine various psychometric properties of the CI-BPD in an inpatient sample of adolescents (n = 245). A confirmatory factor analytic approach was used to examine the internal factor structure of the 9 CI-BPD items. In addition, internal consistency, interrater reliability, convergent validity (with clinician diagnosis and 2 questionnaire-based measures of BPD), and concurrent validity (with Axis I psychopathology and deliberate self-harm) were examined. Similar to several adult studies, the confirmatory factor analytic results supported a unidimensional factor structure for the CI-BPD, indicating that the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria on which the CI-BPD is based constitute a coherent combination of traits and symptoms even in adolescents. In addition, other validity criteria were excellent. Taken together, the current study provides strong evidence for the validity of the CI-BPD for use in adolescents.

The relationship between the youth psychopathic traits inventory and psychopathology in a U.S. community sample of male youth.

The Youth Psychopathic Traits Inventory (YPI) is a self-report measure of juvenile psychopathic traits. Validity data for this measure are limited, especially for nonreferred samples. This report investigated the concurrent validity of the YPI by assessing 171 nonreferred male youth (M age = 12.96 years) with a battery of self-, parent-, and peer-report measures including the Child Behavior Checklist (CBCL), the Reactive-Proactive Aggression Questionnaire (RPQ), the Antisocial Process Screening Device (APSD), and a peer-sociometric measure of aggression. Results confirmed the expected correlations between the YPI and measures of proactive aggression, other externalizing and internalizing behavior, and parent-report psychopathic-like traits. In addition, cluster analyses of YPI scores revealed 2 groups of youth (low vs. high) who scored differently on measures of externalizing behavior. This study supports the utility of the YPI as a research tool for assessing juvenile psychopathic traits.

Symptom burden in cancer survivors 1 year after diagnosis: a report from the American Cancer Society's Studies of Cancer Survivors.

BACKGROUND: Few studies have examined risk for severe symptoms during early cancer survivorship. By using baseline data from the American Cancer Society's Study of Cancer Survivors-I, the authors examined cancer survivors with high symptom burden, identified risk factors associated with high symptom burden, and evaluated the impact of high symptom burden on health-related quality of life (HRQoL) 1 year postdiagnosis. METHODS: Participants were enrolled from 11 state cancer registries approximately 1 year after diagnosis and were surveyed by telephone or mail. The outcomes measures used were the Modified Rotterdam Symptom Checklist and the Profile of Mood States-37 (to assess symptom burden) and the Satisfaction with Life Domains Scale-Cancer (to assess HRQoL). RESULTS: Of 4903 survivors, 4512 (92%) reported symptoms related to their cancer and/or its treatment. Two-step clustering yielded 2 subgroups, 1 with low symptom burden (n = 3113) and 1 with high symptom burden (n = 1399). Variables that were associated with high symptom burden included lung cancer (odds ratio [OR], 2.27), metastatic cancer (OR, 2.05), the number of comorbid conditions (OR, 1.76), remaining on active chemotherapy (OR, 1.93), younger age (OR, 2.31), lacking insurance/being underinsured (OR, 1.57), having lower income (OR, 1.61), being unemployed (OR, 1.27), and being less educated (OR, 1.29). Depression, fatigue, and pain had the greatest impact on HRQoL in survivors with high symptom burden, who also had lower HRQoL (P < .0001). CONCLUSIONS: More than 1 in 4 cancer survivors had high symptom burden 1 year postdiagnosis, even after treatment termination. These results indicate a need for continued symptom monitoring and management in early post-treatment survivorship, especially for the underserved.

DSM Borderline Criterion Function Across Age-Groups: A Cross-Sectional Mixed-Method Study.

DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) Section II criteria for borderline personality disorder (BPD) lack developmental operationalization. The aim of the current study was to evaluate whether DSM criteria operate similarly across adolescents and adults to determine if developmental adjustment for DSM criteria was needed. Three age cohorts were recruited: adolescents (ages 12-17 years; n = 484), young adults (ages 18-25 years; n = 442), and adults (ages ≥26 years; n = 953). The Child Interview for DSM-IV BPD and the Structured Clinical Interview for DSM-IV Axis II disorders were administered to adolescents and adults, respectively. Item response theory methods were used to evaluate differential item (or criterion) functioning (DIF) of BPD criteria across adolescents and adults. Qualitative analyses were then used to evaluate the potential sources of DIF. Item response theory results demonstrated DIF across adolescents and adults for all DSM BPD criteria. Qualitative analyses suggested that the source of DIF was most likely due to rater/interviewer bias. Results furthermore suggested that behavioral criteria may represent the heterotypic features of BPD, while intra- and interpersonal criteria represent the homotypic features of the disorder. The article concludes with recommendations for developmentally informed guidelines for the assessment of BPD.

Psychometric evaluation of the Overall Anxiety Severity And Impairment Scale (OASIS) in individuals seeking outpatient specialty treatment for anxiety-related disorders.

BACKGROUND: Comorbidity among anxiety-related diagnoses is common, highlighting the need for brief, meaningful measures of anxiety that cut across diagnoses. METHODS: The current study examined the psychometric properties of one such measure, the Overall Anxiety Severity and Impairment Scale (OASIS) (Norman et al., 2006), in a naturalistic sample of individuals seeking treatment at an outpatient anxiety treatment center. We examined the measure׳s structure, convergent validity, and potential effects of respondent gender. Using ROC analysis, we estimated an optimal cut-score for determining presence of an anxiety disorder in this sample. Finally, we examined the responsiveness of the OASIS to clinical change and calculated a reliable change index. RESULTS: We found strong psychometric properties of the OASIS. A unitary factor structure with correlated residuals on the first two items provided the best fit to the data. A cut-score of eight best distinguished the presence of an anxiety-related diagnosis. In measurement invariance analyses, we found evidence that men and women respond similarly to the measure. In addition, we found that change in the OASIS was correlated with change in other measures, and we estimated that a four-point change in the OASIS can be considered clinically reliable. LIMITATIONS: Sample characteristics may limit generalizability. Diagnoses were established by clinicians using a semi-structured interview that, while based upon DSM-IV diagnostic criteria, has not been psychometrically evaluated. CONCLUSION: The results provide support for the use of the OASIS in specialty treatment for anxiety-related diagnoses and further highlight the strengths of this measure in clinical practice and research settings.

An investigation of differential item functioning across gender of BPD criteria.

Gender differences in prevalence rates of Borderline Personality Disorder (BPD) may reflect true differences between groups or may reflect some form of gender bias in diagnostic criteria. The detection of differential item functioning (DIF) using item response theory methods provides a powerful method of evaluating whether gender differences in prevalence rates of BPD reflect true mean differences or criterion bias. The aim of the current study was to evaluate gender-based DIF in DSM BPD criteria. The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) Axis II Personality Disorders (SCID-II: First, Spitzer, Gibbon, Williams, & Benjamin, 1994) was administered to 747 adult inpatients. Results indicated DIF for 2 BPD criteria (impulsivity and uncontrolled anger), such that it was easier for these items to be endorsed for men compared with women at the same level of latent trait. At the level of the test, men were expected to be rated slightly higher than women on the SCID-II at the same level of latent BPD liability. Implications of these results for research and clinical assessment are discussed.

An item response theory analysis of the DSM-IV borderline personality disorder criteria in a population-based sample of 11- to 12-year-old children.

Although a growing body of empirical literature provides some support for the diagnosis of borderline personality disorder (BPD) in youth, little is known about the internal structure of BPD and the performance of the individual diagnostic criteria, especially in younger samples. We used item response theory (IRT) methods to investigate the psychometric properties of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) BPD criteria in a large, population-based sample (n = 6,339) of young adolescents from the United Kingdom (ages 11 to 12). BPD was assessed using the Childhood Interview for DSM-IV Borderline Personality Disorder (CI-BPD; Zanarini, Horwood, Waylen, & Wolke, 2004). A single underlying dimension adequately accounted for covariation among the BPD criteria. Each criterion was found to be discriminating to a degree comparable to what has been reported in adult studies. BPD criteria were most informative within a range of severity of BPD pathology between +1 and +3 standard units. Five criteria were found to exhibit differential item functioning (DIF) between boys and girls. However, DIF balanced out for the total interview score. Despite the controversy associated with applying the borderline construct to youth, the current findings provide psychometric evidence in favor of doing so.

Revisiting Lynam's notion of the "fledgling psychopath": are HIA-CP children truly psychopathic-like?

BACKGROUND: In his developmental model of emerging psychopathy, Lynam proposed that the "fledgling psychopath" is most likely to be located within a subgroup of children elevated in both hyperactivity/inattention/impulsivity (HIA) and conduct problems (CP). This approach has garnered some empirical support. However, the extent to which Lynam's model captures children who resemble psychopathy with regard to the core affective and interpersonal features remains unclear. METHODS: In the present study, we investigated this issue within a large community sample of youth (N = 617). Four groups (non-HIA-CP, HIA-only, CP-only, and HIA-CP), defined on the basis of teacher reports of the Strengths and Difficulties Questionnaire (SDQ), were compared with respect to parent-reported psychopathic-like traits and subjective emotional reactivity in response to unpleasant, emotionally-laden pictures from the International Affective Pictures System (IAPS). RESULTS: Results did not support Lynam's model. HIA-CP children did not appear most psychopathic-like on dimensions of callous-unemotional and narcissistic personality, nor did they report reduced emotional reactivity to the IAPS relative to the other children. Post-hoc regression analyses revealed a significant moderation such that elevated HIA weakened the association between CP and emotional underarousal. CONCLUSIONS: Implications of these findings with regard to the development of psychopathy are discussed.

A multitrait--multimethod examination of the reynolds intellectual assessment scales in a college sample.

This study assessed trait validity of the Reynolds Intellectual Assessment Scales' (RIAS) Verbal Index (VIX) and Nonverbal Index (NIX) scores in a group of college students. Using both observation of patterns and latent variable modeling of a multitrait-multimethod correlation/covariance matrix, the results indicate that the RIAS VIX scores behaved in a manner predicted from the theory behind their construction; namely, they related strongly to other measures of crystallized intelligence (Gc) and, together, they formed a salient Gc factor. The NIX scores, however, did not behave as predicted-showing as strong, or stronger, associations with measures of Gc than measures of fluid intelligence. Although more studies of this type are needed across different samples before making broad generalizations, the results from the present study support the use and interpretation of the RIAS VIX score, but not the NIX score.

The development of a mentalization-based outcomes and research protocol for an adolescent inpatient unit.

The authors describe the development of a theory-driven assessment and research protocol at the Adolescent Treatment Program of The Menninger Clinic. First, the theoretical framework behind a mentalization-based model for assessment and treatment is described. Next, the process whereby measures were selected to operationalize key components of the mentalization-based model is discussed, including a brief discussion of each measure and assessment procedure. The next section describes the clinical and research use of the data collected. Here, the authors describe how outcomes assessment information is integrated into the clinical decision-making process, and they outline the research questions they aim to answer through the assessment protocol. The authors conclude with a section on the challenges, pitfalls, and future directions of the project.