Personality Assessment Inventory Clinical Scales Research Articles

58 Emotional Functioning in Long COVID Neuropsychological Evaluations: Comparison to Post-Concussion Syndrome Using the Personality Assessment Inventory

Objective:COVID-19 has significantly impacted society for over 2.5 years, and Long COVID is concerning for its long-term impact on the healthcare system. Further, cognitive and emotional functioning in Long COVID has limited research, but 2 recent studies (Whiteside et al., 2022a, Whiteside et al., 2022b) examined cognitive and emotional functioning in Long COVID patients approximately 6 months post-diagnosis. The studies found limited cognitive deficits, but significant depression and anxiety, which in turn were the best predictors of low average cognitive scores. Further, the mean Personality Assessment Inventory (PAI) profile included highest mean elevations on somatic preoccupation (SOM) and depression (DEP) subscales. To further explore personality functioning in Long COVID, this study compared PAI profiles of Long COVID patients with a potentially similar group with post-concussion syndrome (PCS) which has been shown to have a strong psychological component.Participants and Methods:Participants included 44 consecutive outpatients (Mean age = 47.89, SD = 13.05, 84% Female, 75% Caucasian) referred from a Long COVID clinic with cognitive complaints related to COVID, while the comparison group of PCS patients included 50 consecutive referrals (Mean age = 38.82, SD = 16.24, 52% Female, 90% Caucasian) related to cognitive complaints attributed to PCS. A series of t-tests between the 2 groups was conducted on the PAI validity, clinical, interpersonal, and treatment consideration scales. PAI clinical subscales were also compared. To control for multiple comparisons, p < .01 was utilized and effect sizes were compared.Results:The results demonstrated that both Long COVID (SOM M = 68.66, SD = 12.56; DEP M = 63.39, SD = 12.70) and PCS groups (SOM M = 65.28, SD = 12.06; DEP M = 70.32, SD = 16.15) displayed the highest mean elevations on PAI SOM and DEP scales but no statistically significant differences in mean scale elevations between Long COVID and PCS groups on SOM (t [92] = 1.33, p = .80) and DEP (t [92] = -2.11, p = .097). However, results demonstrated statistically significant differences on the paranoia subscale (PAR; t [92] = -3.27, p = .009), antisocial features subscale (ANT; t [92] = -2.22, p = .01), stress subscale (STR; t [90] = -3.51, p = .006) and suicidal ideation subscale (SUI; t [92] = -2.73, p = .000) of the PAI. Specifically, the mean scores for the PCS group were higher across the paranoia (M = 57.30), antisocial features (M= 52.24), stress (M = 58.44), and suicidal ideation subscales (M = 57.82) of the PAI than the Long COVID group. While these patterns of reporting differed between groups, mean scores for both groups were in the normal range.Conclusions:Results support the similarities in emotional/personality functioning across Long COVID and PCS patients and the importance of evaluating psychological functioning in these samples as a standard part of neuropsychological evaluations. Further, the results suggest that psychological treatment strategies utilized with PCS patients may be helpful for Long COVID patients, but more research is needed.

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

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

Temporal Stability of the Personality Assessment Inventory: Investigating Potential Predictors.

In this study, we explored the temporal stability of the Personality Assessment Inventory (PAI), which has not been comprehensively reexamined since it was first published. Our three specific aims were to determine the utility of PAI indicators of basic protocol validity (inconsistent responses [ICN] and highly unusual/unlikely responses [INF]) in identifying suspect responding; calculate the stability coefficients for each PAI scale and subscale across 3-, 6-, and 9-week spans; and explore whether profile stability across four measurements could be prospectively predicted. We administered the PAI to a sample of undergraduates (N = 579) at four separate timepoints. ICN and INF effectively identified likely attriters and inconsistent responders. All PAI full scales and subscales evidenced good test-retest reliability, with some small exceptions. Finally, all PAI clinical scales were correlated with profile instability although many of these correlations were no longer significant when controlling for mean clinical elevation of the profile. We interpreted these results as evidence for the utility of PAI validity scales, the temporal reliability of the PAI, and the role of psychopathology in response variability over time. We also discussed some preliminary evidence that this variability can be prospectively predicted, suggesting that it in part reflects substantive changes rather than random error variance.

Factor analysis of the Personality Assessment Inventory in service members with traumatic brain injury

ABSTRACT Primary Objective To identify the factor structure of the Personality Assessment Inventory (PAI) clinical scales for military service members with traumatic brain injury (TBI). Research Design Retrospective analysis of existing data base. Methods and Procedures The sample included 210 service members with TBI who completed the PAI as part of a neuropsychological evaluation at a military TBI clinic. Statistical analysis included exploratory factor analysis of 214 items of the 11 PAI clinical scales. Main Outcomes and Results Exploratory factor analysis indicated a four-factor solution accounting for 30.4% of the variance in scores. A review of the face validity of the items from each factor generated the following factor labels: Somatic/Psychiatric/Cognitive Distress, Social Distress, Substance Misuse, and Depression. Conclusions The PAI appears to assess general distress (i.e., somatic/psychiatric/cognitive) and substance misuse constructs for both psychiatric and TBI populations, but it also appears to assess a “social distress” construct (i.e., difficulties socializing in both military and civilian populations) that is unique to military populations. Suggestions are offered to re-conceptualize PAI clinical scales specific to psychopathology (i.e., schizophrenia, paranoia, mania, borderline, antisocial) and personality disorders (i.e., borderline, antisocial) in terms of neurologic and military specific issues for service members with TBI.

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

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

Evaluating symptom endorsement typographies of trauma-exposed veterans on the Personality Assessment Inventory (PAI): A latent profile analysis

Research on symptom endorsement patterns in those with trauma exposure frequently emphasizes presentation subtypes. Most frequently, internalizing, externalizing, and dissociative symptom clusters are identified; however, evidence for the emergence of disorder subtypes is not always consistent. To expand its clinical utility, this study examines symptom endorsement subtypes on the Personality Assessment Inventory (PAI) within a sample of trauma exposed individuals. Specifically, a series of latent profile analyses (LPA) were conducted on 376 U.S. military veterans evaluated while seeking outpatient treatment for PTSD within the Veteran Affairs system. Results from these analyses identify two primary findings. First, the observed class models support the notion that the PAI clinical scales are a useful aid in detecting broad patterns of distress common to those with trauma exposure (e.g., depression, suicidal thoughts, avoidant behaviors, etc.). Second, the PAI did not demonstrate distinct response styles consistent with the theoretically and empirically supported diagnostic subtypes. Implications for research with, and the clinical use of, the PAI in veterans and those with trauma-associated symptoms are discussed.

Clinical Utility of the Personality Assessment Inventory in Predicting Symptom Change and Clinical Outcome in an Inpatient Chemical Dependency Rehabilitation Unit

Newly admitted inpatients in a 28-day chemical dependency rehabilitation unit completed the Personality Assessment Inventory (PAI) at admission and measures of clinical symptomatology (Symptom Checklist–90–Revised) and clinical outcome (Schwartz Outcome Scale–10) at admission and discharge. PAI drug and alcohol scale scores were clinically elevated in this inpatient sample. Modest elevations were found on scales measuring stress, depression, and antisocial and borderline features. Lower scores on most PAI clinical scales were associated with greater symptom reduction and improved psychological well-being, while controlling for pretreatment levels. Multivariate analysis controlling for contributions of clinical scales measuring borderline, depressive, and antisocial traits, as well as pretreatment outcome measures, demonstrated that the PAI Suicidal Ideation and Treatment Rejection scales were significant individual predictors of symptom reduction and improved psychological well-being, respectively, although the treatment scales as a group failed to incrementally contribute to prediction. Overall, the results support the clinical utility of using the PAI to predict clinical improvement among inpatients treated for substance use disorders.

Personality profiles of patients with alcohol use disorder and opioid use disorder in an inpatient treatment setting

The present study aimed to compare personality profiles of alcohol use disorder and opioid use disorder patients in an inpatient chemical dependency rehabilitation unit using a multidimensional personality inventory, the Personality Assessment Inventory (PAI). Ninety-six patients meeting DSM-IV-TR diagnoses for alcohol use or opioid use disorders completed the PAI at admission. Results revealed largely normative patterns across most PAI scales, though alcohol use disorder patients showed clinically elevated scores on Alcohol Problems and Drug Problems, and opioid use disorder patients showed clinical elevations on Antisocial Features, Borderline Features, and Drug Problems. Opioid use disorder patients showed, on average, significantly higher scores than alcohol use disorder patients on Borderline Features, Antisocial Features, Drug Problems, and Suicidal Ideation. Alcohol use disorder patients showed significantly higher scores than opioid use disorder patients only on Alcohol Problems. Discriminant function analysis (DFA) showed discriminability between patient groups using the PAI clinical scales and treatment scales, highlighting higher levels of disturbed functioning among opioid use disorder patients with respect to clinical syndromes, especially borderline features, antisocial features, suicidal ideation, and anxiety. These findings underscore the need to tailor treatment recommendations to distinctive patterns of personality pathology, especially among opioid use disorder patients.

Evaluating the clinical utility of the Validity-10 for detecting amplified symptom reporting for patients with mild traumatic brain injury and comorbid psychological health conditions

ABSTRACTThe objective of this study was to compare the Validity-10 scale with the PAI Negative Impression Management Scale (PAI-NIM) for detecting exaggerated symptom reporting in active-duty military service members (SMs) admitted with unremitting mild TBI symptoms and comorbid psychological health conditions (mTBI/PH). Data were analyzed from 254 SMs who completed the Neurobehavioral Symptom Inventory (NSI) and Personality Assessment Inventory (PAI) as a part of a larger battery of self-report symptom scales upon admission to the intensive-outpatient TBI treatment program at a military medical center. Symptom exaggeration was operationalized using the PAI Negative Impression Management Scale (PAI-NIM). A PAI-NIM score of ≥73 was categorized as positive for symptom exaggeration (SVTpos), while a lower score was categorized as negative for symptom exaggeration (SVTneg). SMs in the SVTpos group (n = 34) had significantly higher scores (p ≤ .004) on the PAI clinical scales as well as on the NSI total score (range: d = 0.59–1.91) compared to those who were SVTneg (n = 220). The optimal cut-score for the NSI Val-10 scale to identify possible symptom exaggeration was ≥26 (sensitivity = .29, specificity = .95, PPP = .74, NPP = .71). In patients suffering from mTBI/PH, the Validity-10 requires a higher cut-score than previously reported to be useful as a metric of exaggerated symptom reporting.

Exploring the Reliability and Component Structure of the Personality Assessment Inventory in a Neuropsychological Sample

The current study was designed to advance general research investigating the Personality Assessment Inventory (PAI), by examining whether the psychometric properties of the PAI would generalize to a sample differing from the original standardization sample. Specifically, the reliability and factor structure of the PAI were examined in a mixed neuropsychological sample. Reliability full scale coefficients ranged from .72 to .94, and subscale coefficients ranged from .60 to .90. Confirmatory factor analysis (CFA) was conducted to test Morey’s original four-factor model (for all 22 PAI scales) and three-factor model (for the 11 clinical scales). CFA results indicated that Morey’s original factor solutions were not a good fit. Thus, following Morey’s original methodology, principal components analyses (PCA) were conducted on all 22 PAI scales and on the 11 PAI clinical scales and the results indicated evidence for a five-component solution (for all 22 PAI scales) and a two-component solution (for the 11 clinical scales). Overall, while results indicated some relatively subtle differences between the original standardization sample and the current sample, they still supported the notion that the PAI is a reliable and valid measure when used in a neuropsychological sample. This study expands upon the existing literature related to the clinical utility of the PAI in specialized samples.

Subjective cognitive complaints and neuropsychological test performance following military-related traumatic brain injury.

This study examined the relation between neuropsychological test performance and self-reported cognitive complaints following traumatic brain injury (TBI). Participants were 109 servicemembers from the U.S. military who completed a neuropsychological evaluation within the first 2 yr following mild-severe TBI. Measures included the Personality Assessment Inventory (PAI), Posttraumatic Stress Disorder Checklist (PCL-C), Neurobehavioral Symptom Inventory (NSI), and 17 select measures from a larger neurocognitive test battery that corresponded to three self-reported cognitive complaints from the NSI (i.e., memory, attention/concentration, and processing speed/organization). Self-reported cognitive complaints were significantly correlated with psychological distress (PCL-C total: r = 0.50-0.58; half the PAI clinical scales: r = 0.40-0.58). In contrast, self-reported cognitive complaints were not significantly correlated with overall neurocognitive functioning (with the exception of five measures). There was a low rate of agreement between neurocognitive test scores and self-reported cognitive complaints. For the large minority of the sample (38.5%-45.9%), self-reported cognitive complaints were reported in the presence of neurocognitive test scores that fell within normal limits. In sum, self-reported cognitive complaints were not associated with neurocognitive test performance, but rather were associated with psychological distress. These results provide information to contextualize cognitive complaints following TBI.

Neuropsychological Outcome from Uncomplicated Mild, Complicated Mild, and Moderate Traumatic Brain Injury in US Military Personnel

This study compared the neuropsychological outcome in military personnel following mild-to-moderate traumatic brain injury (TBI). Participants were 83 service members divided into three injury severity groups: uncomplicated mild TBI (MTBI; n = 24), complicated MTBI (n = 17), and moderate TBI (n = 42). Participants were evaluated within 6 months following injury (73% within 3 months) using neurocognitive testing and the Personality Assessment Inventory (PAI). There were no significant differences between the three groups on the majority of neurocognitive measures. Similarly, there were no significant differences between the three groups on the majority of PAI clinical scales (all p > .05), with the exception of two scales. The uncomplicated MTBI group had significantly higher scores on the Anxiety-Related Disorders and Aggression scales compared with the complicated MTBI group, but not the moderate TBI group. Overall, these results suggest that within the first 6 months post injury, there were few detectable differences in the neuropsychological outcome following uncomplicated MTBI, complicated MTBI, or moderate TBI in this military sample.

Relationship between suboptimal cognitive effort and the clinical scales of the Personality Assessment Inventory

Little research has examined the relationship between the Personality Assessment Inventory (PAI) and cognitive effort. The current study extends the research on personality assessment and suboptimal cognitive effort by evaluating the relationship between the PAI clinical scales and the Test of Memory Malingering (TOMM) in a neuropsychological population. Utilizing corrections for multiple comparisons, rank-order correlations with the TOMM Trial 2 (T2) and the PAI clinical scales indicated a significant relationship with the SOM (rho = −.26, p <.001), with additional scales (SCZ, ANX, and DEP) trending toward significance. Analysis of SOM subscales indicated a significant relationship between SOM-C and T2 as well. To further explore the relationship between SOM and the TOMM, ANOVA results indicated that individuals scoring within normal limits on the SOM had higher mean TOMM scores than those with extremely elevated SOM. Additional analyses indicated that utilizing the cut-off for extreme responding on the SOM scale (T > 87) had adequate sensitivity (93%) and specificity (76%) in predicting TOMM performance, with a positive predictive power of 54% and a negative predictive power of 97%, resulting in a 91% correct classification rate. Thus, the evidence suggests that extreme scores on SOM should prompt careful evaluation for suboptimal cognitive effort.

Should I stay or should I go? Personality Assessment Inventory and Rorschach indices of early withdrawal from psychotherapy.

The Personality Assessment Inventory (PAI) and the Rorschach were used to investigate differences between patients who withdrew early from university-based outpatient psychodynamic psychotherapy and those who continued in treatment. The study employs two sets of analyses, one utilizing the complete sample (N = 101) and a second comprised of comparison pairs matched on the specific therapist delivering treatment (n = 36 for Rorschach; n = 38 for PAI). It was hypothesized that early withdrawers would score higher on the PAI Treatment Rejection Scale (RXR) and the PAI Treatment Process Index (TPI) than treatment continuers. It was also hypothesized that early treatment withdrawers will have better overall interpersonal relationships, less need for closeness and intimacy, less available psychological resources and more current stimulus demands, and lower levels of psychological/cognitive disturbance as measured by the Rorschach. In addition, differences between the two groups on PAI treatment and clinical scales and subscales were examined. Results indicated that PAI RXR differentiated between the two groups (p< .05) in the expected direction. Limited differences between withdrawers and continuers were found on the Rorschach and other PAI scales. Potential explanations for the findings as well as a discussion of clinical applicability are presented.

An Item-Level Psychometric Analysis of the Personality Assessment Inventory

Multi-item multiscale self-report measures are increasingly used in inpatient assessments. When considering a measure for this setting, it is important to evaluate the psychometric properties of the clinical scales and items to ensure that they are functioning as intended in a highly distressed clinical population. The present study examines scale properties for a self-report measure frequently employed in inpatient assessments, the Personality Assessment Inventory (PAI). In addition to examining internal consistency statistics, this study extends prior PAI research by considering key issues related to inpatient assessment (e.g., scale distinctiveness, ceiling effects). Coefficient alphas, interitem correlations, and item- scale relationships suggest that the PAI clinical scales and subscales are internally consistent. Items for respective clinical scales generally showed significantly higher item-scale correlations with their intended scale (as compared with their item-scale correlation with scales they were not intended to measure). In addition, scales' coefficient alpha scores were higher than their interscale correlations. Taken as a whole, these results support the hypothesis that PAI scales were measuring relatively distinct constructs in this inpatient sample. Findings are discussed with regard to the implications for scale interpretation in inpatient assessment, functioning of individual scales and subscales, and functioning of specific items. Limitations of the present study and directions for future research are discussed.

Comparison of personality traits in patients with frontal and temporal lobe epilepsies

The current study sought to characterize and compare personality traits of patients with temporal lobe epilepsy (TLE) and frontal lobe epilepsy (FLE). Ninety-seven adults with medically intractable epilepsy (TLE n = 58, FLE n = 39) completed the Personality Assessment Inventory (PAI) as part of routine preoperative investigations. Not surprisingly, both epilepsy groups endorsed significantly more symptoms across PAI clinical scales than the normative sample, most notably on scales assessing Depression and Somatic Complaints. Direct comparison of personality profiles of people with FLE and TLE revealed that FLE was associated with relative elevations on scales assessing emotional lability and relationship difficulties (i.e., Mania, Borderline Features, Antisocial, Stress, and Nonsupport). Although effect sizes were moderate to large, the clinical significance of these differences was questionable (<1 SD). However, results of a logistic regression suggested that the Borderline Features and Anxiety scales have incremental validity in predicting seizure site (FLE vs TLE) above education and duration of recurrent seizures. These results suggest that patients with FLE may exhibit more behavioral traits associated with frontal dysfunction than patients with TLE.

The Wender Utah Rating Scale

Objective: The Wender Utah Rating Scale (WURS) is used to retroactively assess ADHD symptoms. This study sought to determine whether the WURS actually functions as an index of dysfunctional personality traits. Method: Five hundred twenty-two adult participants completed the WURS and at least one of the following measures: Wechsler Adult Intelligence Scale—III (WAIS-III), Trails Making Test (Forms A and B), Conners' Continuous Performance Test, d2 Test of Attention, and the Personality Assessment Inventory (PAI). Results: The WURS correlated significantly with all PAI clinical and treatment scales; however, of the neuropsychological measures, only the CPT significantly correlated with the WURS score. Multiple regression analyses revealed a significant model that included clinical and treatment scales from the PAI as well as working memory and processing speed indexes from the WAIS-III that accounted for 39% of the variance in WURS scores. Conclusion: Performance on the WURS was more related to dysfunctional personality traits than to actual attentional performance in this young adult sample. (J. of Att. Dis. 2009; 13(1) 87-94)

Use of the Personality Assessment Inventory in Assessment of Posttraumatic Stress Disorder in Women

This study investigated the utility of the Personality Assessment Inventory (PAI) for the assessment of posttraumatic stress disorder (PTSD). Participants were 55 community-residing adult women who were administered a comprehensive battery that included the PAI and the Clinician-Administered PTSD Scale (CAPS). Participants were classified as either PTSD or non-PTSD based on the CAPS, and PAI profiles were compared between the two groups. Significant group differences were found for seven PAI clinical scales (Anxiety, Depression, Anxiety-Related Disorders, Somatic Complaints, Paranoia, Borderline Features, and Schizophrenia), one validity scale (Negative Impression), and two treatment scales (Nonsupport and Treatment Rejection). When all PAI scales and component subscales are considered, the largest group differences were found for the physiological subscale of the Depression scale (DEP-P) and the Traumatic Stress subscale of the Anxiety-Related Disorders scale (ARD-T). ARD-T and DEP-P also demonstrated excellent diagnostic utility. Finally, correlations between PAI scales and four CAPS symptom clusters provided additional validity evidence, in particular supporting a distinction between effortful avoidance and numbing. Taken together, these results support the use of the PAI in the assessment of PTSD.