Personality Pathology Research Articles

First Psychometric Evaluation of the English Version of the Semi-Structured Interview for Personality Functioning (STiP-5.1)

The Alternative Model for Personality Disorders provides a dimensional framework for the conceptualization of personality disorders where Criterion A concerns the assessment of one’s level of personality functioning (LPF). This study examines the psychometric properties of the English translation of the Semi-Structured Interview for Personality Functioning (STiP-5.1) to validate this translation for the assessment of LPF in English-speaking populations; and examine whether this measure increments self-report measures of LPF and personality pathology in predicting general functioning. The sample consisted of 129 emerging adults between 18 and 25 years of age (M = 20.54, SD = 2.08) from a mixed college and clinical sample. Results support a unidimensional factor structure of the STiP-5.1, good internal consistency, and high inter-rater reliability. Construct validity was supported through associations of the STiP-5.1 with self-report measures of LPF and personality pathology. The STiP-5.1 incremented self-report measures of personality pathology in predicting functional impairment, though additional variance explained was modest. Finally, STiP-5.1 scores differentiated individuals who obtained a score at or above the clinical cutoff from those below on self-report measures of personality pathology and LPF with large effect sizes. Findings support the validity of the English translation of the STiP-5.1 for the assessment of LPF.

The Effectiveness of Emotional Schema Therapy on Death Anxiety Nurses with Obsessive-Compulsive Pathological Personality Traits Working in The Corona Ward

The Effectiveness of Emotional Schema Therapy on Death Anxiety Nurses with Obsessive-Compulsive Pathological Personality Traits Working in The Corona Ward

Clinical Staging for Personality Disorders in Older Adults.

This scientific research aimed to investigate the feasibility of implementing a clinical staging (CS) model for personality disorders (PDs) in older adults. The CS model could provide valuable insights into the life course of personality pathology, prognosis, and treatment decisions for PDs in older adults. The study employed an international Delphi methodology with three rounds and involved 21 experts. Consensus was achieved on 12 out of 17 statements, confirming the viability of a CS model for PDs in older adults. The proposed model incorporates the Alternative Model for PDs, criterion A, and integrates life course information, distinguishing between chronic PD, re-emergent PD, late-onset PD, and past PD. The findings suggest that international experts support the implementation of a CS model for PDs in older adults, considering both the severity of personality functioning and the retrospective life course of PD expression.

A brief screener for impairment in personality functioning: Psychometric validation of the Five-Item Screening Scale for Personality Disorders in a Dutch-speaking clinical sample.

Personality disorders (PDs) are characterized by problems with identity and self-direction. Since the recent dimensional PD models of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) and the International Statistical Classification of Diseases and Related Health Problems, 11th edition, the role of identity and self-direction in personality pathology has been made explicitly by including these problems in a general personality pathology criterion. This criterion reflects impairment in personality functioning (IPF), which is assessed on a continuum to determine the severity of personality pathology. The present study aimed to psychometrically evaluate the Five-Item Screening Scale for Personality Disorders (FISSPD; Skodol et al., 2011), a short screener for IPF, in a Dutch-speaking clinical sample of 820 adults. This screener mainly taps into self-related impairment, with four items measuring self-related impairment and one item measuring interpersonal impairment. The factor structure, scale reliability, measurement invariance (across sex, age, and patients with vs. without PD), and convergent validity were investigated. The Dutch FISSPD showed a unidimensional structure and good scale reliability. Scalar measurement invariance was established across sex, age (patients below vs. above age 40), and patients with versus without PD. The Dutch FISSPD was significantly related to identity and all DSM-IV/5 Section-II PD symptoms. The present study indicates that the Dutch FISSPD has potential as a reliable and valid screener for personality pathology in adult patients. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Convergence of the dimensional assessment of personality pathology (DAPP-BQ) and the five-factor personality inventory for the international classification of diseases 11th edition (FFiCD) in the context of the five-factor model and personality disorders

The current manuscript presents the convergence of the Dimensional Assessment of Personality Pathology (DAPP-BQ), using its short form the DAPP-90, and the Five-Factor Personality Inventory for International Classification of Diseases (ICD-11), the FFiCD, in the context of the five-factor personality model and the categorical approach of personality disorders (PDs). The current manuscript compares the predictive validity of both the FFiCD and the DAPP-90 regarding personality disorder scales and clusters. Results demonstrate a very high and meaningful convergence between the DAPP-90 and the FFiCD personality pathology models and a strong alignment with the FFM. The DAPP-90 and the FFiCD also present an almost identical predictive power of PDs. The DAPP-90 accounts for between 18% and 47%, and the FFiCD between 21% and 47% of PDs adjusted variance. It is concluded that both DAPP-90 and FFiCD questionnaires measure strongly similar pathological personality traits that could be described within the frame of the FFM. Additionally, both questionnaires predict a very similar percentage of the variance of personality disorders.

The assessment of pathways towards suicide in adolescent patients: A PDM-2-oriented approach.

Increasing evidence has supported the mutual relationship between suicidal motivations and personality pathology, especially in adolescence. Distinctive aspects of personality functioning can explain the tendency to resort to suicidal ideation and behaviours, which, in turn, may play a specific role in exacerbating severe impairments in self-regulation mechanisms that underlie personality pathology. This study illustrates, through two clinical cases, the clinical utility of using the Psychodynamic Diagnostic Manual - Second Edition (PDM-2) to better understand distinct pathways of suicidal processes. Two adolescents, named Luis and Gael, who attempted suicide multiple times were assessed using the Psychodiagnostic Chart Adolescent (PDC-A) of the PDM-2 to evaluate their mental functioning, emerging personality styles or syndromes, and symptom patterns. They were interviewed using the Motivational Interview for Suicidality in Adolescence (MIS-A) to identify the motivations underpinning their suicidal behaviour. The results showed that Luis presented a narcissistic personality characterized by the need to deny his vulnerabilities through suicidal fantasies as a form of escape, while Gael presented a borderline personality characterized by the use of suicide attempts to express her inner and unspeakable pain. The study seems to support the reciprocal interconnections between personality functioning and suicidal motivations that should be better identified to plan tailored and more effective interventions.

The Personality Inventory for DSM-5-Brief Form (PID-5-BF): Psychometric indicators in a Brazilian community sample

Objective: To investigate psychometric properties (internal structure, convergent/discriminant validity, internal consistency, and test-retest) of the Personality Inventory for DSM-5-Brief Form (PID-5-BF) in a Brazilian community sample. Method: This is a study with a psychometric design. A sample of 527 adults from the general population (69.9% women; 33.5 ± 14.0 years; 74.0% ≥ 12 years education) responded to the instrument online after the study was disseminated on social networks and to the researchers’ contacts. The NEO-PI-R and sociodemographic questionnaire were applied besides the PID-5-BF, and a retest was applied 15-30 days after the initial assessment for reliability assessment. Data were analyzed using statistical techniques (IBM SPSS19 and Factor20); the significance level was set at p ≤ 0.05 for all the analyses. Results: Internal consistency was verified using Cronbach’s alpha and was adequate (domains α ≥ 0.69; total α = 0.87), in addition to test-retest reliability (domains ICC ≥ 0.82; total ICC = 0.95). Divergences were found between the PID-5-BF different domains despite them being significantly correlated with each other. Convergent validity with the NEO-PI-R was adequate, with moderate/strong correlations between the domains theoretically associated (r > 0.38). The internal structure (Exploratory Factor Analysis) indicated that the original five-factor model (CFI = 0.991; TLI = 0.986; RMSEA = 0.033) and one-factor model were adequate (CFI = 0.908; TLI = 0.899; RMSEA = 0.089. Conclusions: The findings support using the PID-5-BF Brazilian version, which presented adequate psychometric properties comparable to the original version. This instrument can be helpful in the clinical and research fields to screen general and specific traits of personality pathology. Future studies are suggested to expand the psychometric findings among clinical samples, confirming the instrument’s scope of reach.

335. Personality Pathology and the Tracking of Cooperation Incentives in the Human Default Network

335. Personality Pathology and the Tracking of Cooperation Incentives in the Human Default Network

Sex Differences in Personality Disorder and Childhood Maltreatment of Patients with Schizophrenia.

Despite numerous studies investigating personality disorder (PD) and childhood maltreatment (CM) characteristics in individuals with schizophrenia (SZ), there remains a scarcity of research focusing on sex differences in PD and CM within large samples of SZ patients. A total of 592 participants (257 males, 335 females) were consecutively sampled from patients diagnosed with SZ at the psychiatric and psycho-counseling clinics at Shanghai Mental Health Center. PDs were assessed using a self-reported personality diagnostic questionnaire and a structured clinical interview, while CMs were evaluated using the Chinese version of the Child Trauma Questionnaire Short Form. Male patients exhibited a prominent self-reported trait of antisocial PD (t=1.972, p=0.049), while female patients demonstrated a notable emphasis on histrionic PD traits (t=-2.057, p=0.040). Structured interviews for PD diagnoses further indicated a higher comorbidity of schizotypal (χ2=4.805, p=0.028) and schizoid (χ2=6.957, p=0.008) PDs among male patients compared to female patients. Additionally, male patients reported a higher degree (t=2.957, p=0.003) and proportion (χ2=5.277, p=0.022) of experiences of physical abuse in their self-reported CM. Logistic regression analyses highlight distinct factors: higher antisocial PD traits and physical abuse are associated with male patients, while histrionic PD traits and emotional abuse are associated with female patients. These findings underscore the importance of recognizing and addressing sex-specific manifestations of personality pathology and the nuanced impact of CM in the clinical management of individuals with SZ. The study advocates for tailored interventions that consider the distinct needs associated with sex differences in both personality traits and CM experiences among SZ patients.

Changes in Personality Functioning and Pathological Personality Traits as a Function of Treatment: A Feasibility Study

With the dimensional shift, personality pathology is now commonly conceptualized using a combination of personality functioning and (pathological) personality traits. Personality functioning has been deemed more sensitive to treatment than the specific trait combination of personality problems. To empirically examine just that, the goal of this pilot study was to simultaneously compare changes in personality functioning (LPFS-BF 2.0), pathological traits (PID-5-BF), and normal-range traits (BFI-2) among individuals receiving integrative, dynamic-relational psychotherapy (baseline n = 52, follow-up n = 31) and a matched control group (n = 31). The results showed that clients had stronger changes in personality functioning than in traits when compared to the control group. In addition, clients lower on personality functioning were more inclined to drop-out of therapy. This study points to the unique clinical utility of personality functioning and provides a foundation for future research focusing on the sensitivity of personality functioning and personality traits to changes within the context of psychotherapy.

Influence of the typology and timing of childhood trauma in psychoticism.

Child maltreatment (CM) is associated with psychosis; however little is known about the frequency, type, and timing of abuse in the personality pathology domain of psychoticism (PSY) in the DSM-5. The purpose of this study was to analyze childhood trauma typology and frequency according to gender and to identify sensitive periods of susceptibility to CM in women with high PSY. The Maltreatment and Abuse Chronology Exposure (MACE) scale was used to evaluate the frequency, severity and timing of each type of maltreatment. The full sample consisted of 83 participants with different psychiatric diagnoses. Psychoticism was assessed with the DSM-5 Personality Inventory (PID-5). To identify the differences in CM exposure between the PSY+ (high psychoticism) and PSY- (low psychoticism) groups, the Mann-Whitney U test, the chi square test and random forest (RF) test were used. Comparing PSY + and PSY-, revealed gender differences in the impact of abuse, with highly frequent and severe types of abuse, in women. In women, PSY + and PSY-, were differentiated especially in non-verbal emotional abuse, peer physical bullying and parental verbal abuse. Several periods with a major peak at age seven followed by peaks at age 17 and 12 years old were identified. Increased exposure to CM occurs in women with PSY+. A sensitivity to CM exposure during early childhood and late adolescence could be a risk factor for psychoticism in women.

Identity and Personality Pathology in Adult Forensic Psychiatric Patients and Healthy Controls.

Since the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), identity impairment has become a diagnostic criterion for all personality disorders. The current study examined the occurrence of identity dimensions, clinically relevant identity impairments and personality pathology, and associations between these constructs in 92 forensic patients and 139 healthy controls. Patients showed higher levels of almost all identity dimensions, identity impairments, personality disorders, and almost all maladaptive personality traits than controls. Various identity dimensions were associated with consolidated identity as well as identity impairments in both groups. Both patients and controls with high ruminative exploration and identity malfunctioning showed more personality pathology. Different associations between identity functioning and particularly antisocial and borderline personality disorder showed to be stronger in patients than in controls. Our results highlight the importance of identity impairment as a crucial criterion to assess and treat personality pathology in forensic patients.

Adult ADHD and pathological narcissism: A retrospective-analysis

Adult attention deficit hyperactivity disorder (ADHD) is often associated with personality pathology. However, only few studies have been conducted on the link between ADHD and pathological narcissism (PN), with or without a diagnosis of narcissistic personality disorder (NPD). In order to fill this gap, PN and NPD were assessed in 164 subjects suffering from ADHD, with several other measures including ADHD severity, quality of life, depression, anxiety, impulsivity, and emotion dysregulation (ED). We found that a significant proportion of ADHD patients suffered from NPD, and that both narcissistic grandiosity and vulnerability were associated with ADHD hyperactivity and impulsivity symptoms, but not with inattentive symptoms. These two dimensions seemed to be negatively associated with well-being and positively associated with most of the other studied psychiatric dimensions except ED, the latter being only associated with vulnerability, even after adjustment on borderline symptoms. Overall, despite important limitations that limit the generalizability of our findings to the overall ADHD population (notably linked to selection bias), we believe that this exploratory study sheds light on the potential clinical relevance of narcissistic pathology in adult ADHD patients.

Intimate partner sexual violence: the apple and the snake

Intimate partner violence (IPV) is now considered a real scourge by society, particu-larly as the rate of mortality worldwide remains so high. Noticeable by its absence is the phenomenon of intimate partner sexual violence (IPSV) and this article is there-fore concerned with understanding its nature and the form it takes within couple relationships. To some extent sexual violence is most often a genitalised extension of IPV but it may also exist in its own right. Indeed, certain pathological personality organisations consider the spouse’s body as an object, a property, or an extension of the self. The consequences for both physical and mental health are significant, and although IPSV has much in common with IPV it also presents specific risk factors. Because of this, care must be both comprehensive and multidisciplinary, providing support and protection for the victim, as well as for both members of the couple to help them defuse, individualise, or emancipate themselves from the controlling aspects of the relationship. At a collective level, it is through a strong commitment to public policies of sexual health, education, and justice that we can tackle this complex and hitherto neglected process. Psychotherapy also has an important role to play in providing a secure and safe space for partners to explore the presence of sexual violence within the couple relationship and to address the issues concerned.

The Brazilian version of the Inventory of Depression and Anxiety Symptoms-Expanded Version: Internal structure, invariance by sex and race, and associations with pathological personality traits.

The Inventory of Depression and Anxiety Symptoms-Expanded version (IDAS-II) is one of the few tools designed to assess internalizing symptoms based on dimensional models. We conducted two studies, the first testing internal validity aspects of the IDAS-II and the second testing the external validity of the scales. In the first study we adapted the IDAS-II to Brazilian Portuguese and tested its internal structure, including a higher order factorial solution coherent with the internalizing spectrum, the stability of the factor structure, and its measurement invariance for sex and racial groups. Participants were 2,379 Brazilian adults. In the second study, we investigated the IDAS-II scales' associations with broad pathological personality traits in Brazilian (N = 245) and North American (N = 402) samples. The results of the first study indicated that the IDAS-II scales are grouped into three first-order factors (Distress, Obsessions/Fear, and Positive Mood), replicating Wester et al. (2022) and Petre et al. (2023). Our results also suggested the plausibility of an internalizing second-order factor for the IDAS-II Brazilian version. The multigroup confirmatory factor analysis shows that this scale is invariant for males and females and for White and Black/Brown people. In the second study, the IDAS-II scales demonstrated mostly coherent associations with broad domains of pathological personality traits. Besides the internal validity of the Brazilian IDAS-II, our results also provide information about its external validity and expand its nomological network, as it is the first study reporting its associations with broad domains of pathological personality traits. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Clinical profiles of adolescent personality pathology: a latent structure examination of the Semi-Structured Interview for Personality Functioning DSM-5 (STiP-5.1) in a help-seeking sample

BackgroundDespite the introduction of dimensional conceptualisations of personality functioning in the latest classification systems, such as Criterion A of the Alternative Model of Personality Disorders in the DSM-5, heterogeneous clinical presentation of personality pathology remains a challenge. Relatedly, the latent structure of personality pathology as assessed by the Semi-Structured Interview for Personality Functioning DSM-5 (STiP-5.1) has not yet been comprehensively examined in adolescents. Therefore, this study aimed to examine the latent structure of the STiP-5.1, and, based on those findings, to describe any unique clinical profiles that might emerge.MethodsThe final sample comprised 502 participants aged 11–18 years consecutively recruited from a specialised personality disorder outpatient service, as well as general day clinic and inpatient wards at the University Hospital University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Bern, Switzerland. Participants were assessed using the STiP-5.1, as well as a battery of other psychological measures by clinical psychologists or trained doctoral students. Variations of Factor Analysis, Latent Class Analysis and Factor Mixture Models (FMM) were applied to the STiP-5.1 to determine the most appropriate structure.ResultsThe best fitting model was an FMM comprising four-classes and two factors (corresponding to self- and interpersonal-functioning). The classes differed in both overall severity of personality functioning impairment, and in their scores and clinical relevance on each element of the STiP-5.1. When compared to the overall sample, classes differed in their unique clinical presentation: class 1 had low impairment, class 2 had impairments primarily in self-functioning with high depressivity, class 3 had mixed levels of impairment with emerging problems in identity and empathy, and class 4 had severe overall personality functioning impairment.ConclusionsA complex model incorporating both dimensional and categorical components most adequately describes the latent structure of the STiP-5.1 in our adolescent sample. We conclude that Criterion A provides clinically useful information beyond severity (as a dimensional continuum) alone, and that the hybrid model found for personality functioning in our sample warrants further attention. Findings can help to parse out clinical heterogeneity in personality pathology in adolescents, and help to inform early identification and intervention efforts.

Predicting psychological need satisfaction and frustration from early maladaptive schemas and DSM-5 and ICD-11 personality traits

The satisfaction of basic psychological needs is closely connected with an individual’s well-being and mental health. The purpose of the present study was to examine the associations of persistent and pervasive negative cognitions about oneself and others (early maladaptive schemas) and pathological personality traits (DSM-5 and ICD-11 personality traits) with the satisfaction and frustration of basic psychological needs. To this aim, self-report measures of psychological need satisfaction (Basic Psychological Need Satisfaction and Frustration Scale), early maladaptive schemas (Young Schema Questionnaire – Short Form 3), and pathological personality traits (Modified Personality Inventory for DSM-5 and ICD-11 – Brief Form Plus), were administered in a community sample (N = 322, Mage = 35.3 years, SDage = 12.5 years, 66% female). The data were analyzed using correlation analysis, linear regression analysis, and a machine-learning approach (XGBoost). The results showed strong negative relationships of early maladaptive schemas and pathological personality traits with the satisfaction and frustration of the needs for autonomy, relatedness, and competence, especially the disconnection/rejection and impaired autonomy/performance schema domains and the pathological personality traits of negative affectivity and detachment. Early maladaptive schemas predicted the frustration of the psychological needs for relatedness and competence above pathological personality traits. The study findings add to the understanding of current psychological need satisfaction.

Do PID-5 Trait Scores Predict Symptom Disorders? A Meta-analytic Review.

The Personality Inventory for DSM-5 (PID-5) has become influential in the dimensional assessment of personality dysfunction. Though most studies have examined links between PID-5 trait domains and personality pathology, a number of investigations have assessed relationships between PID-5 scores and symptom disorders (e.g., depression, anxiety). We employed meta-analytic techniques to synthesize findings in this area, identifying 26 publications assessing associations between PID-5 scores and symptom disorders (N of effect sizes across the five trait domains = 260). PID-5 domain score effect sizes (rs) ranged from 0.20 for Antagonism to 0.35 for Negative Affect (all ps < .00001). Relationships between PID-5 scores and specific forms of psychopathology were generally consistent with expectations, with some unanticipated relationships as well. Findings confirm that the pathological personality traits assessed by the PID-5 predict symptom disorders as well as personality dysfunction, extending the heuristic value and clinical utility of the measure.

The Dimensional Conceptualization of Personality Disorders: Personality Organization, Personality Functioning, and Personality Disorders.

Over the past several decades, significant criticism of the categorical classification system for personality disorders has highlighted the need to transition to a dimensional classification system. This study reviewed key issues involved in the potential conversion of the diagnostic system of personality disorders from a categorical to a dimensional model. The result suggests that Kernberg's concept of personality organization can be used to indicate the overall severity of personality pathology.

Assessing Criterion A of the Alternative Model for Personality Disorders: The Potential of Performance-Based Personality Measures.

The conceptualization of personality disorder has been refined through recent nosological advances introduced in the Alternative Model for Personality Disorders (AMPD). These advances locate self and interpersonal (dys)function at the core of personality pathology. Self-report personality assessment instruments have demonstrated promise in the assessment of Criterion A domains. However, research highlighting the utility of performance-based personality assessment instruments has been largely absent in these advances, despite acknowledgment of their potential. We adhered to PRISMA review guidelines to survey and assess the potential relevance and utility of select performance-based personality instruments in assessing Criterion A domains of the AMPD. We conclude that performance-based personality measures are uniquely positioned to assess maladaptive self- and interpersonal functioning and may address some limitations of self-report measures. Toward this end, we propose a working model that provides ranges of test scores that correspond to the 5-point scale of the Criterion A domains of the AMPD.