Clinical Multiaxial Inventory Research Articles

Pre-injury psychiatric history, subacute symptoms and personality traits predict social reintegration at 3-month post-mild traumatic brain injury

ABSTRACT Background The purpose of the study was to identify whether the presence of a pre-injury psychiatric history, subacute post-concussive symptoms (PCS) and personality traits were predictive of less favorable social reintegration for 3 months following a mild traumatic brain injury (mTBI). Method A total of 76 patients with mTBI were included, and the presence of a pre-injury psychiatric history was identified from the medical chart. One-month post-accident, these patients completed the Millon Multiaxial Clinical Inventory, 3rd Edition assessing personality traits and the Rivermead Post-Concussion Symptoms Questionnaire to measure subacute PCS. Social reintegration was measured using the Mayo-Portland Adaptability Inventory, 4th Edition at 3-month post-accident. Results The presence of pre-injury psychiatric history, high levels of subacute PCS and Cluster B personality traits such as histrionic and borderline features were significant predictors of social reintegration quality at 3-month post injury. Conclusion This study provides new insights on cluster B personality traits and its influence on recovery and social reintegration at 3-month post mTBI.

The relationship between personality disorders and parents' social capital with the social health of children and adolescents in Yazd

Background: Considering that personality disorders and parents' social capital are two important factors that can affect the social health of children and adolescents, therefore, the present study aims to examine the relationship between personality disorders and parents' social capital with the social health of children and adolescents in Yazd. Methods: This is a descriptive_ correlational study that was done in the province of Yazd in which 1035 children and adolescents between the ages of 6 to 18 participated. These participants were selected on the base of multi-stage random cluster sampling. The social capital questionnaire and parents' personality disorders (Millon Clinical Multiaxial Inventory - Third Edition (MCMI-III) which parents completed and the lifestyle questionnaire was completed by children and adolescents. Data analysis was done by applying descriptive statistics and calculation of odds ratio with a 95% confidence interval. Results: A total of 1035 parents children and adolescents were enrolled, participants (44.1%) were males and (55.9%) were females. Millon's test of fathers demonstrates a significant correlation with the average scores of structural social capital, cognitive social capital, communicative social capital, and total social capital (P-value <0.001). Millon’s test of fathers had a significant relationship with total social capital in all age groups (P-value<0.05). On the other hand, Millon’s test of mothers had a significant relationship with total social capital in fathers aged 19-34 years (P-value<0.001). Conclusion: Family social capital improves children and adolescent’s social health. Consequently, caregivers have a significant impact on the social and psychological well-being of young individuals. Enhancing the level of social capital and promoting mutual understanding among parents is imperative to achieve this goal. It is necessary to strengthen the level of social capital, and mutual understanding between parents. In addition, it can be suggested to pay more attention to the psychological characteristics of parents in the process of diagnosis and therapeutic intervention of children and adolescents.

Ethnic Differences in the Prevalence of Compulsive and Histrionic Traits among Pilots in the UAE: A Comparative Study

This study aims to examine the prevalence rates of compulsive and histrionic characteristics among pilots from diverse demographic backgrounds such as South Asian, Middle Eastern, and Western pilots. The research aims to identify differences in personality traits and explore potential correlations within each ethnic group of commercial pilots. The data was provided by sixty pilots, equally representing three different ethnic groups, with twenty participants in each demographic. To collect the data, the researchers used a measuring tool designed to reveal signs of mental disorders, known as the Millon Clinical Multiaxial Inventory (MCMI). According to ANOVA results, there is a notable difference in prevalence rates for compulsive and histrionic traits among the three different ethnic groups (F (2,87) = 4.76, p =0.00057). Overall, the results showed that South Asian pilots had more compulsive traits than Middle Eastern and Western pilots. On the other hand, Middle Eastern pilots were found to have a higher occurrence of histrionic traits compared to their counterparts from South Asia and Westen pilots. The correlation analysis confirmed that there was a substantial link between histrionic and compulsive traits (r = 0.51, p < 0.05). A similar trend was seen for Middle Eastern pilots, where a weakly positive link (r = 0.24, p < 0.05) was visible. On the other hand, the Western pilots showed a weak, inverse correlation between compulsive and histrionic characteristics (r = - 0.14, p<00), displaying unique profiles within this group in terms of their mutual interaction. These results offer a profound understanding of the relationship between ethnicity and personality traits in pilots.

Factor Structure of the Fourth Edition of the Millon Clinical Multiaxial Inventory

Objective: The aim of the present study was to examine the construct validity (factorial) of the fourth edition of the Millon Clinical Multiaxial Inventory (MCMI-IV) with an emphasis on personality patterns and personality disorders. Methods and Materials: Given the nature of standardization, this study employed an analytical cross-sectional method. This method examined the current status and situation and included both descriptive and correlational methods. The statistical population of this study comprised all individuals who visited counseling centers or treatment clinics in Tehran from June 2022 to September 2022. Participants were at least 18 years old, had completed at least five grades of schooling, and had either sought initial treatment or continued their treatment at these centers or had been referred to them. In this study, a purposive sampling method was used to select 500 visitors from counseling centers in Tehran. The measurement tool included the standardized Millon Clinical Multiaxial Inventory (fourth edition). To analyze the data statistically, the KMO index, Bartlett's test, and factor analysis were performed using SPSS-26 software. Findings: The results of the factor analysis in this study of visitors to family counseling centers in Tehran indicated that four factors were identified: 1) styles of clinical personality patterns, 2) severe personality pathology, 3) clinical syndromes, and 4) severe clinical syndromes. Conclusion: These results demonstrate that the MCMI-IV has a distinct factor structure that can effectively measure personality and clinical characteristics. This factor analysis enhances the construct validity of the test and improves the accuracy of measuring the intended characteristics. Based on the findings of the present study, it can be concluded that the fourth edition of the MCMI has a suitable factor structure and can be used as a reliable tool for measuring personality and clinical characteristics. These findings can aid researchers, counselors, and physicians in diagnosing and treating personality and clinical disorders.

Exploring the associations between dark triad personality and psychopathology in convicted offenders: Identifying their role in reincarceration

AbstractDysfunctional personality and psychopathological characteristics are increasingly studied in offenders separately, but only a few studies have analysed their relationship in this specific population. In this research, we focus on the so‐called Dark Triad personality, consisting of the Machiavellian, the narcissistic and the psychopathic personalities. The main objective of this study was to examine the association between Dark Triad personality and psychopathology and also to know the role of these mental health variables in recidivism. Participants were 63 offenders (44 men and 19 women) from two different penitentiary institutions. Sociodemographic data as well as clinical and personality characteristics were recorded. Psychopathology was assessed with the third version of the Millon Clinical Multiaxial Inventory and dark personality with the Short Dark Triad. Results of descriptive statistical analyses revealed a high prevalence of psychopathology in convicted participants and reincarcerated offenders. Correlational analyses showed a strong relation between the Dark Triad personality and psychopathology, being the psychopathic personality the one with the highest association. Finally, we found that the psychopathological variables contributing most to the discrimination of reincarcerated participants were substance and alcohol abuse disorders and in relation to dysfunctional personality were psychopathy and narcissism, the latter in negative direction. These data highlight the relevance of a necessity for research exploring long‐term patterns of re‐incarceration for both men and women, including mental health disorders and personality models. The importance of taking into account the relationship between variables in preventive and treatment interventions inside and outside penitentiary institutions is discussed.

Preliminary psychometric properties of the Chinese version of the structured interview of personality organization (STIPO-CH)

BackgroundKernberg originally proposed the psychoanalytic concept of personality organization (PO), which measures personality pathology from a dimensional approach with multiple scales and can be evaluated using the Structured Interview of Personality Organization (STIPO) from six domains: identity, object relations, primitive defenses, coping vs. rigidity, aggression, and moral values. The present study translated the original version into the Chinese STIPO (STIPO-CH) version and evaluated its reliability and validity.MethodsThe STIPO-CH was administered to 49 non-clinical subjects. They also completed the Chinese version of the Inventory of Personality Organization and the Millon Clinical Multiaxial Inventory to evaluate criterion-related reliability. Interrater reliability was assessed with intraclass correlations. An item analysis was carried out to explore the structure and internal consistency.ResultsInterrater reliability (intraclass correlations) ranged from 0.98 to 0.99. Results suggested acceptable internal consistency for identity and moral values. The correlations between STIPO-CH domains and self-report questionnaires indicated that construct validity and criterion-related validity were acceptable to good.ConclusionsOverall, this study presents preliminary psychometric properties of STIPO-CH. Limitations regarding the sample, interviewers, and cultural differences are discussed. Future research is highly recommended.

Prevalence of Personality Disorders in Adults With Attention Deficit Hyperactivity Disorder (ADHD)

Objective: To estimate the prevalence of PDs according to Millon’s evolution-based model among adult ADHD outpatients. Method: Cross-sectional study of consecutive patients referred to an adult ADHD clinic. PDs were evaluated with Millon Clinical Multiaxial Inventory–III (MCMI-III). Results: One-hundred-eighty-one participants had valid MCMI-III, of whom147 were diagnosed with ADHD. Mean age: 32.97, SD:11.56, females: 74 (50.3%). Among the 147 participants with ADHD, 29 (19.7%) did not meet criteria for any PD, 43 (29.3%) met the criteria for one PD, 34 (23.1%) for two PDs and the rest three or more. Most common PD was Dependent (n = 58) followed by Depressive (n = 45). Inattentive sub-type was associated with dependent PD, while combined type with antisocial, negativistic (passive/aggressive) and sadistic PD. Conclusion: Particular personality profiles were more common with different ADHD subtypes. Given the developmental origins of PD, further research may help identify possible links with childhood difficulties.

Investigating the Relationship between Behavioral Activation and Inhibition Systems (BIS/BAS) and Effortful Control (EC) with Clinical Symptoms and Personality Disorders in Patients with Substance Abuse Disorders

Objective: Substance abuse is considered one of the most important factors that threaten well-being and health, so it is important to identify the factors related to this disorder. This study aimed to investigate the relationship between behavioral activation and inhibition systems (BIS/BAS) and effortful control (EC) or clinical symptoms and personality disorders in patients with substance abuse disorders. Method: The descriptive research method was correlation type. The researched population was all the people suffering from substance abuse in 2022 who had visited Jask City addiction treatment centers in the first half of this year, 112 of them were selected using the cluster random sampling method. The measurement tools include the Drug Abuse Screening Test (DAST-20), Carver and White's BIS/BAS Scale (1994), short form of Adult Temperament Questionnaire (ATQ), Symptom Checklist 90-R (SCL-90-R), and Millon Clinical Multiaxial Inventory – Third Edition (MCMI-III). Finally, the collected data were analyzed using Pearson's correlation test and multiple regression under SPSS-23 software. Results: The research data analysis revealed a significant correlation between clinical symptoms and personality disorders. BIS/BAS and effortful control were predictive variables, and their role in predicting most clinical and personality variables was meaningful. Conclusion: In general, the results of this research showed that there is a relationship BIS/BAS and EC with clinical symptoms and personality disorders in patients with substance abuse disorders.

Validity of Adult Psychopathology Model Using Psychiatric Patient Sample from a Developing Country: Confirmatory Factor Analysis

Objectives. This study is aimed at testing and validating the two-factor measurement model of the Millon Clinical Multiaxial Inventory (MCMI). Specifically, this paper reported construct validity, particularly focusing on convergent and discriminant validities of the internalizing-externalizing MCMI model of adult psychopathology using a psychiatric sample from a developing country, the Republic of Yemen. Methods. MCMI was distributed among 232 outpatients from the Hospital of Taiz City and two private psychiatry clinics in Yemen; data were collected using structured interviews over four months. We used exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to explore and confirm the latent structure MCMI and verify the evidence of convergent and discriminant validity. Results. The CFA results indicated that MCMI was a good fit for the internalizing-externalizing two-factor model of adult psychopathology, comparative fit index CFI = 0.95 , and RMSEA = 0.07 . The results of the CFA provide evidence of convergent and discriminant validity characterized by MCMI with the internalizing-externalizing model. Conclusion. The adult psychopathology of internalizing-externalizing is a valid measurement model of MCMI with ten personality disorders and eight clinical syndromes.

The stress response of intensive care unit medical doctors facing repeated severe emergencies.

This study assesses the psychopathological distress experienced by doctors working in an Intensive care unit (ICU) during the COVID-19 pandemic. These doctors were the same who faced the consequences of a previous natural disaster, a severe 6.3 magnitude earthquake. A second objective is to evaluate their current mental attitude, professional performances and coping strategies adopted in the pandemic in relation to the conditioning effect of that first emergency, the earthquake. Thirty-seven ICU medical doctors were recruited and assessed using Rapid Stress Assessment (RSA) rating scale, Symptom Checklist-90 Revised (SCL-90-R), Zung Self-Rating Anxiety Scale, Beck Depression Inventory, Beck Hopelessness Scale, Millon Clinical Multiaxial Inventory III. Comparison between exposure to the earthquake and COVID pandemic has been made in terms of professional role and psychological burden. Comparison between 2009 earthquake catastrophe and COVID pandemic conditions evidenced relevant changes in professional role, team, environment, shifts, and work organization. The doctors, who already experienced the 2009 earthquake reported a feeling of greater insecurity facing this latter catastrophe, the COVID pandemic, as well as perception of greater concern for their family and the global situation. However, having participated in the medical management of another emergency (the 2009 earthquake) appears to have contributed to limiting demoralization and psychological distress. The feeling of having greater decision-making possibilities and participation in the organization of work, strengthen coping skills in the face of the emergency.

Personality disorders as predictors for the conversion from major depressive disorder to bipolar disorder: A prospective cohort study

Studies suggest that personality disorders can predict mood disorders. The present study aims to assess whether personality traits in individuals with major depressive disorder (MDD) can predict the conversion to bipolar disorder (BD). This was a prospective cohort study conducted in two waves. In the first wave, 585 subjects were diagnosed with MDD; in the second wave, all of them were reevaluated in a three-year follow-up. Personality traits were evaluated, in the first phase, using the Millon Clinical Multiaxial Inventory (MCMI). MDD and BD diagnosis was performed by trained psychologists using a clinical structured interview based on diagnostics criteria of DSM IV, the Mini International Neuropsychiatric Interview, Plus version (MINI-PLUS). During the second wave, 468 individuals were reevaluated. Diagnostic conversion rate from MDD to BD was 12.4%. Higher mean scores in Antissocial, Borderline personality traits and in the sum of all Cluster B disorders were found among individuals who had converted to BD. In addition, individuals who converted to BD had lowest scores in obsessive-compulsive personality traits. Our findings suggest that Cluster B personality disorders can be considered as predictors of diagnostics conversion from MDD to BD. Also, it seems that obsessive-compulsive traits were lower among those individuals who have converted to BD. • Diagnostic conversion rate from MDD to BD was 12.4%. • Greater severity of symptoms in cluster B were found among subjects who converted to BD. • Individuals who converted to BD had lowest scores in obsessive-compulsive personality disorder.

Personality characteristics in specialist and generalist intimate partner violence perpetrators.

Intimate partner violence (IPV) is one of the most common types of violence against women. Although personality disorders have been associated with IPV, perpetration research regarding personality according to the classification specialist/generalist IPV perpetrators is scarce. The general aim of this study was to describe personality in a large sample of IPV Spanish male perpetrators considering their classification (specialist vs. generalist). Participants were 1093 men convicted of IPV crimes whose ages ranged from 18 to 76 years old (M = 40.15; SD = 10.32). Of them, 554 men were classified as specialist perpetrators and 539 men were classified as generalist perpetrators. Participants completed questionnaires regarding sociodemographic and violence aspects as well as the Spanish version of the Millon Clinical Multiaxial Inventory III. Generalist perpetrators showed higher means in nearly all the personality disorders scales compared to specialist perpetrators. Prevalence rates in the majority of personality disorders were lower than 5%. Higher scores on the avoidant, histrionic, and self-defeating scales and lower scores on the aggressive, borderline, and drug dependence scales were related to being a specialist perpetrator. This study contributes to a better understanding of personality among generalist and specialist perpetrators.

Proposing a "Brain Health Checkup (BHC)" as a Global Potential "Standard of Care" to Overcome Reward Dysregulation in Primary Care Medicine: Coupling Genetic Risk Testing and Induction of "Dopamine Homeostasis".

In 2021, over 100,000 people died prematurely from opioid overdoses. Neuropsychiatric and cognitive impairments are underreported comorbidities of reward dysregulation due to genetic antecedents and epigenetic insults. Recent genome-wide association studies involving millions of subjects revealed frequent comorbidity with substance use disorder (SUD) in a sizeable meta-analysis of depression. It found significant associations with the expression of NEGR1 in the hypothalamus and DRD2 in the nucleus accumbens, among others. However, despite the rise in SUD and neuropsychiatric illness, there are currently no standard objective brain assessments being performed on a routine basis. The rationale for encouraging a standard objective Brain Health Check (BHC) is to have extensive data available to treat clinical syndromes in psychiatric patients. The BHC would consist of a group of reliable, accurate, cost-effective, objective assessments involving the following domains: Memory, Attention, Neuropsychiatry, and Neurological Imaging. Utilizing primarily PUBMED, over 36 years of virtually all the computerized and written-based assessments of Memory, Attention, Psychiatric, and Neurological imaging were reviewed, and the following assessments are recommended for use in the BHC: Central Nervous System Vital Signs (Memory), Test of Variables of Attention (Attention), Millon Clinical Multiaxial Inventory III (Neuropsychiatric), and Quantitative Electroencephalogram/P300/Evoked Potential (Neurological Imaging). Finally, we suggest continuing research into incorporating a new standard BHC coupled with qEEG/P300/Evoked Potentials and genetically guided precision induction of “dopamine homeostasis” to diagnose and treat reward dysregulation to prevent the consequences of dopamine dysregulation from being epigenetically passed on to generations of our children.

Demographic Characteristics and Personality Disorders in People With Gender Dysphoria in East Azerbaijan Province, Iran

Background: Gender identity is an important part of human identity. It is a personal conception of oneself as male or female. One of the major goals of treatment for individuals with Gender Dysphoria (GD) is to treat comorbid psychological and psychiatric disorders such as personality disorders. The present study aims to investigate demographic characteristics and personality disorders in people with GD seeking gender reassignment therapy in East Azerbaijan Province, Iran. Methods: In this descriptive cross-sectional study, study population consists of all patients with GD referred to the forensic medicine centers in East Azerbaijan province during 2016-2020, of whom 61 (21 males and 40 females) were selected using a convenience sampling method. Their age, gender, educational level, and marital status were recorded and their personality profile was assessed by the Millon Clinical Multiaxial Inventory–III. Results: The frequency (percentage) of Cluster A, B and C personality disorders in males were 0(0%), 9(50%) and 2(11.10%), while in females they were 1(5.56%), 4(22.40%), and 2(11.10%), respectively. The frequency (percentage) of antisocial, obsessive, borderline, avoidant, narcissistic, histrionic, and paranoid personality disorders in males were 4(22.2%), 2(11.10%), 3(16.67%), 0(0%), 0(0%), 2(11.10%), and 0(0%), while in females they were 4(22.20%), 1(5.56%), 3(16.67%), 1(5.56%), 1(5.56%), 2(11.10%), and 1(5.56%), respectively. The prevalence of different clusters (P=0.34) and types (P=0.18) of personality disorders was not significantly different between males and females. Conclusion: Personality disorders are comorbid with GD. They exist in one-third of patients with GD in East Azerbaijan Province. Personality disorders are significantly more prevalent in male patients with GD than in females.

To thine own self be true: interoceptive accuracy and interpersonal problems

BackgroundBorderline Personality Disorder involves strong interpersonal disruptions, often associated with early maltreatment. However, the individual capacities which alter BPD-related interpersonal problems are unclear. Here, we examine two contributors to interpersonal functioning: interoceptive accuracy and parasympathetic activity. Interoceptive accuracy is the ability to correctly perceive body states, such as how quickly one’s heart is beating, and has been associated with emotional experience and various crucial social capacities. Similarly, parasympathetic activity is related to social processing and inhibition of impulses. As such, both may contribute to BPD interpersonal symptoms, albeit different types of interpersonal problems.MethodSixty-five individuals completed the Inventory of Interpersonal Problems and the Millon Clinical Multiaxial Inventory followed by a task to assess interoceptive accuracy, the heart rate monitoring task, in which participants counted their heartbeats while concurrent physiological data was recorded; and an assessment of vagal tone, used as an index of regulatory flexibility.ResultsParticipants who reported poor interpersonal boundaries, consistent with borderline personality disorder styles, had worse interoception, whereas those high in aggression had lower vagal tone. Borderline personality symptoms overall were related to IA and significantly to vagal tone.ConclusionsThese findings suggest that interoceptive accuracy is associated with interpersonal problems, where people are overly influenced or enmeshed with others, possibly to compensate for the absence of their physical and emotional awareness.

Comparing prevalence of sexual dysfunctions between narcissists and healthy persons

Introduction: Sexual dysfunction is considered a common sexual problem affecting different aspects of life, and it seems to be rooted in individual's personality. Aim: This paper aims to compare prevalence of sexual dysfunctions between those with narcissistic personality disorder (NPD) and healthy persons. Method: This is a causal – comparative research. To do so, 700 males and females from Tehran City were screened in 2021, among them 120 persons were diagnosed with NPD and 41 persons were selected through convenience sampling as individuals with disorder. Data of 40 healthy persons were analyzed for comparative purposes. Millon Clinical Multiaxial Inventory (MCMI3), Female Sexual Functions Index (FSFI) and International Index of Erectile Function (ILEF) were used. Data were analyzed by comparing two independent groups in SPSS, Version 26. Results: In females, there were no significant differences in sexual function (t=1.011, P=0.320), moisture (t=0.537, P=0.595), orgasm (t=-0.539, P=0.594), sexual pleasure (t=0.164, P=0.871) and pain (t=0.999, P=0.327) between narcissists and healthy persons. Difference in sexuality (t=2.289, P<0.05) and arousal (t=2.107, P<0.05) in healthy persons was more significant than narcissists. Moreover, in males, the difference in sexual function (t=7.545, P<0.001), sexuality (t=12.871, P<0.001) and erection (t=4.832, P<0.001) in healthy persons was more significant than narcissists, and orgasm (t=-3.426, P<0.01) in narcissists was less than in healthy persons. However, there was no significant difference between sexual pleasure in both groups (t=-0.866, P=0.393). Conclusion: The results show that prevalence of sexual dysfunctions in narcissists is more than healthy persons. Therefore, it is recommended that counselors and psychologists consider personality traits in diagnosis and treatment of sexual disorders.

Comparing the Effectiveness of Schema Therapy With Acceptance and Commitment Therapy on Cognitive Avoidance in Patients With Generalized Anxiety Disorder

Objective: This study aimed to compare the effectiveness of schema therapy with acceptance and commitment therapy (ACT) using exposure techniques on cognitive avoidance in female patients with generalized anxiety disorder. Methods: A total of 10 women with generalized anxiety disorder were selected through purposeful sampling with Structured Clinical Interview for DSM Disorders (SCID-5). To determine the absence of personality disorder, Millon’s clinical multiaxial inventory (MCMI-III) (Millon and Groosman, 2005) was used. Schema therapy was conducted for 20 weekly sessions and ACT with exposure techniques for 12 weeks and follow-up for 6 weeks. The cognitive avoidance questionnaire (CAQ) (Sexton and Douglas, 2004) was used as a pretest and posttest to follow up on the results. Analysis of variance with repeated measures was used to test the research hypotheses. Results: The results showed that schema therapy is more effective than ACT in the subscales of thought suppression (F=12.80, P=0.037) and avoidance of threatening (F=25.61, P=0.015), but they have no significant statistical difference in other subscales and total score. Both treatments significantly reduced the total score of cognitive avoidance, but they lacked a statistically significant difference. Conclusion: Schema therapy and ACT with exposure techniques are effective in reducing the severity of symptoms and improving cognitive avoidance in females with generalized anxiety disorder.

INABILITY TO CONTROL RECURRING AGGRESSIVE IMPULSES: PSYCHOLOGICAL MANAGEMENT. A CASE REPORT

Background: Intermittent explosive disorder is recurrent behavioral outburst with failure to control aggressive impulses. A case of intermittent explosive disorder with differential diagnosis of Adjustment disorder and Borderline Personality traits. Mental Status Examination reflected guilt, regret and distress due to inability to control anger followed by aggressive action. Millon Clinical Multiaxial Inventory III (MCMI-III) and Rorschach Ink Blot Test were used for psychological evaluation. Assessments results indicates traits of lower stress tolerance, feels uncomfortable about her ability to deal adequately with negative feelings and often have problems modulating her own affective displays and impulsive. Methodology: A re-educative approach of treatment was planned with short term goals to increase awareness of anger, avoidance and escape, managing physical arousal, relaxation skill development. The long term goals were focused on cognitive restructuring, assertive training, self-instructional and self-regulation training. Treatment Outcome: After psychological management, patient reported more satisfied and better aware of physiological arousal when angry, use distraction technique when required and regulate anger. There was improvement in daily functioning, coping and problem solving and in relationship with his parents and peer. Future plan is focused on providing Neurofeedback training to enhance her self-regulation. Implication and Recommendation: In cases like Intermitted explosive disorder and other conditions of Impulse control disorder, along with psychotherapy or pharmacotherapy, effect of neurofeedback training could be explored.

Measuring emptiness: Validation of the Italian version of the Subjective Emptiness Scale in clinical and non-clinical populations

• Subjective emptiness scale (SES) assesses core aspects of the feeling of emptiness. • Psychometric properties of the Italian version of the SES (SES-I) were examined. • SES-I is a valid and reliable instrument for clinical and non-clinical populations. • SES-I scores were higher in clinical than in non-clinical population. • There was no significant relationship between SES-I scores and self-harming behavior. Although a feeling of emptiness is listed only as a symptom of the DSM-5 borderline personality disorder, it is commonly encountered in other disorders. The aim of this study was to validate the Italian version of the Subjective Emptiness Scale (SES-I), a 7-item self-report instrument assessing the feeling of emptiness. Participants in one clinical group ( n = 63) and one non-clinical group ( n = 48) completed the SES-I along with several other instruments. A principal component analysis was used to analyze the structure of the SES-I and Cronbach's alpha and Rho's Spearman were used to establish aspects of reliability and validity, respectively. The SES-I has a unidimensional structure reflecting the core feature of the feeling of emptiness. It showed an excellent internal consistency ( a = 0.92) and convergent validity, as demonstrated by significant correlations with scores on the Beck Depression Inventory – II and conceptually related scales and subscales of the Millon Clinical Multiaxial Inventory – III and Personality Inventory for DSM-5. Divergent validity was also demonstrated for the SES-I. SES-I scores in the clinical group were significantly higher than in the non-clinical group. A significant relationship was not found between the feeling of emptiness and self-harming behavior, impulsivity and acting-out. A small sample size, several significant differences between the clinical and non-clinical groups and diagnostic heterogeneity in the clinical group limit generalizability of the study. The SES-I is a valid and reliable instrument, which should improve assessment of the feeling of emptiness and help clinicians better understand this complex phenomenon.

Psychometric Properties of the Millon Clinical Multiaxial Inventory-III in an Arabic Clinical Sample Compared With American, Italian, and Dutch Cultures.

Millon Clinical Multiaxial Inventory MCMI–III is a multidimensional measure of psychopathology with excellent construct validity, test-retest reliability as well as internal consistency. Factor analysis of the MCMI-III has produced mixed results, extracting parsimonious three-factor solutions, or replicating the original four-factor solution in psychiatric samples from Western countries. However, little work has been done on the psychometric properties of the MCMI–III, using non-Western psychiatric samples. Outpatients (N = 212) completed the MCMI–III during a semi-structured interview. Eight exploratory factor analysis (EFA) methods were used to explore the underlying structure of MCMI–III. Skewness, kurtosis, and descriptive statistics confirmed that scales of MCMI–III were normally distributed. High-internal consistency was found. The eight EFA methods applied to the 24 clinical scales identified a consensual three-factor solution: factor I (internalizing psychopathology; 18 scales), factor II (externalizing psychopathology; 4 scales) and factor III (psychological disturbance; 2 scales), accounting for a total of 72% of the common variance. Regarding the cross-cultural equivalence of the MCMI–III structure, Tucker's congruence coefficient (Φ) was used and confirmed that internalizing (F1) and externalizing psychopathology (F2) factors obtained in this study are similar to high vs. low psychopathology and emotional constraint factors provided by American study of Haddy et al. (2005) (Φ was 0.86 and 0.97). These two factors are also similar to the general adjustment and antisocial acting out factors provided by the American study of Craig and Bivens (1998) (Φ was 0.82 and 0.96). The first two factors in this study also reflect high similarity with the factor solutions obtained with the Italian and Dutch versions of MCMI-III (Rossi et al., 2007; Pignolo et al., 2017). Despite using a psychiatric sample from a non-Western culture, the two factors identified for this MCMI–III Arabic version were similar to those reported on studies with MCMI–III, using primarily Western samples (Craig and Bivens, 1998; Rossi et al., 2007).