Structured Interview Of Personality Organization Research Articles

Establishing Levels of Personality Functioning Using the Structured Interview of Personality Organization (STIPO-R): a Latent Profile Analysis

Both the new ICD-11 and the latest Alternative DSM-5 Model for Personality Disorders focus on self and interpersonal functioning as the central feature of personality pathology, also acknowledging that personality disorders are organized along a dimensional continuum of severity. This revised understanding is in line with long-standing psychodynamic conceptualisations of personality pathology, in particular Kernberg’s object relations model of personality organization. Despite existing evidence for the clinical utility of the derived Structured Interview of Personality Organization (STIPO-R), empirical support for the identification of clear cut-points between the different levels of personality functioning is missing. For this purpose, a total of 764 adult participants were recruited across two clinical (outpatient and inpatient) settings (n = 250) and two non-clinical (university students and general community) samples (n = 514). Results from the mixture modeling suggested the existence of five groups across the clinical and non-clinical samples that covered: healthy personality functioning, maladaptive personality rigidity, and mild, moderate, and severe levels of personality pathology. All five indicators of personality organization were found to be reliable predictors of personality pathology. Of the five STIPO-R indicators, Aggression and Moral Values had the most discriminative power for differentiating between the Mild, Moderate, and Severe personality disorder groups. Implications of these findings are discussed.

Personality functioning and self-disorders in individuals at ultra-high risk for psychosis, with first-episode psychosis and with borderline personality disorder.

Assessment of personality functioning in different stages of psychotic disorders could provide valuable information on psychopathology, course of illness and treatment planning, but empirical data are sparse. To investigate personality functioning and sense of self in individuals at ultra-high risk (UHR) for psychosis and with first-episode psychosis (FEP) in comparison with a clinical control group of individuals with borderline personality disorder (BPD) and healthy controls. In a cross-sectional design, we investigated personality functioning (Structured Interview of Personality Organization, STIPO; Level of Personality Functioning Scale, LPFS) and disturbances of the basic self (Examination of Anomalous Self-Experience, EASE) in 107 participants, comprising 24 individuals at UHR, 29 individuals with FEP, 27 individuals with BPD and 27 healthy controls. The UHR, FEP and BPD groups had moderate to severe deficits in personality organisation (STIPO) compared with the healthy control group. Self-functioning with its subdomain (facet) 'self-direction' (LPFS) was significantly worse in participants with manifest psychosis (FEP) compared with those at-risk for psychosis (UHR). The FEP group showed significantly worse overall personality functioning than the UHR group and significantly higher levels of self-disturbance (EASE) than the BPD group, with the UHR group lying between these diagnostic groups. Hierarchical cluster analysis based on the seven STIPO domains yielded three clusters differing in level of personality functioning and self-disturbances. Our data demonstrate that psychotic disorders are associated with impaired personality functioning and self-disturbances. Assessment of personality functioning can inform treatment planning for patients at different stages of psychotic disorder.

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.

Ability to assess the severity of personality psychopathology based on the Structured Interview of Personality Organization (STIPO) in master's students of “Addictology”

BackgroundWith the development of multidisciplinary addictology teams, the ability of an addictologist to reliably assess personality psychopathology can be considered an important prerequisite that significantly enters the process of treatment planning. AimsVerification of the reliability and validity of the assessment of personality psychopathology in master's students of Addictology (addiction science) based on the Structured Interview of Personality Organization (STIPO) scoring course. Methods31 Master's students of Addictology independently evaluated 7 STIPO protocols based on recordings. The presented patients were unknown to the students. The resulting scores of students were compared with 1. expert scores of a clinical psychologist with extensive experience with the STIPO; 2. scores of 4 psychologists without previous experience with the STIPO who have attended the course; 3. information on previous clinical experience and education of the students. The comparison of scores was performed using a coefficient of intraclass correlation, a social relation model analysis and linear mixed-effect models. ResultsStudents demonstrated a high degree of inter-rater reliability with a significant degree of agreement in patient assessments, as well as a high to satisfactory degree of validity in the STIPO assessments. An increase in validity after the individual phases of the course was not proven. Their evaluations were generally independent of previous education, as well as diagnostic and therapeutic experience. ConclusionsThe STIPO seems to be a useful tool to facilitate the communication of personality psychopathology between independent experts within multidisciplinary addictology teams. Training in the STIPO can be a useful addition to the study curriculum.

Identifying Splitting Through Sentiment Analysis.

In Kernerg's Object Relations Theory model of personality pathology, splitting, the mutual polarization of aspects of experience, is thought to result in a failure of identity integration. The authors sought to identify a clinician-independent, automated measure of splitting by examining 54 subjects' natural speech. Splitting in these individuals, recruited from the community, was investigated and evaluated with a shortened version of the Structured Interview of Personality Organization (STIPO-R). A type of automated sentiment textual analysis called VADER was applied to transcripts from the section of the STIPO-R that probes identity integration. Higher variability in speech valence, more negative minimum valence, and more frequent shifts in valence polarity were associated with more severe identity disturbance. The authors concluded that the degree of splitting elicited during the description of self and others is related to the degree of identity disturbance, and to the degree of negativity and instability of these descriptions of self and others.

Impact of Object Relations Couple Therapy on Marital Intimacy of Divorce Applicant Couples With High-leveL Borderline Personality Organization: A Pilot Study Considering the Moderating Role of Executive Functions

Objective: Recently, the stability of marriages and the proper communication between couples has become more difficult. Therefore, exploring the impacts of relevant clinical interventions in resolving marital conflicts seems crucial. This study investigates the effectiveness of object relations couple therapy on marital intimacy of divorce applicant couples with high-level borderline personality organization while considering the moderating role of executive functioning. Methods: Using a quasi-experimental design, a sample of 90 volunteers was selected from all couples seeking a divorce and referred to counseling centers in Tehran City, Iran. All participants were screened by Structured Interview of Personality Organization (STIPO). A final sample of 38 individuals with high-level personality organization was randomly divided into control and experimental groups. After dropping the sample, 11 couples remained in the experimental group and 8 in the control group. Participants in the experimental group received 14 sessions of object relations couple therapy, while the control group remained on the waiting list. The Wisconsin Card Classification Test (WCST) and Thompson and Walker’s marital intimacy scale were administered on pre- and post-intervention occasions as well. The data were analyzed by a multivariate analysis of covariance. Results: Significant positive effects were found on marital intimacy in the post-intervention stage (P<0.001). Significantly, better results were also evident for couples with higher executive function scores (P<0.001). Conclusion: It could be concluded that object relation couple therapy could promote the marital intimacy of couples with high-level borderline personality organization, and executive functioning could moderate the therapeutic effects.

The Level of Personality Functioning Scale Applied to Clinical Material From the Structured Interview of Personality Organization (STIPO): Utility in Detecting Personality Pathology.

The Alternative Model for Personality Disorders states that personality pathology involves significant impairment in personality functioning that can be assessed using the Level of Personality Functioning Scale (LPFS). However, the ability of the LPFS to capture impairments typical of personality pathology, rather than of general psychopathology, is still unclear. The authors applied a 12-item version of the LPFS to clinical interviews (i.e., the Structured Interview of Personality Organization [STIPO]) to test whether differences in levels of impairment in domains related to both self- and interpersonal functioning can be detected among patients with personality disorders (n = 33), psychiatric outpatients (n = 30), and nonclinical controls (n = 30). Results show that the 12-item version of the LPFS scored using clinical material gathered through STIPO interviews captures impairments in identity, self-direction, and empathy uniquely linked to personality pathology. However, impairments in intimacy do not differentiate between patients with and without personality disorders.

Comparison of the Structured DSM–5 Clinical Interview for the Level of Personality Functioning Scale With the Structured Interview of Personality Organization

In Section III of DSM–5, the Level of Personality Functioning Scale (LPFS), a component of the DSM–5 Alternative Model for Personality Disorders (AMPD), offers a dimensional approach to the assessment of personality pathology. Similar to the psychoanalytic concept of personality organization developed by Kernberg (1984), personality disorders are assessed not only by categorical diagnoses, but also by measuring impairment of personality functioning. In this study we empirically investigate the convergence between two instruments examining personality functioning, the Structured Clinical Interview for the DSM–5 Alternative Model for Personality Disorders Module I (SCID-AMPD) and the Structured Interview of Personality Organization (STIPO). For this goal, correlations between both the overall scores of the two instruments as well as between the corresponding domain scale scores were examined. In addition, the relationship between interview ratings and clinical criteria quantifying the severity of the disorder (suicide attempts, frequency of psychiatric hospitalization, ICD–10 diagnoses) were analyzed. Based on videotaped assessments of 30 psychotherapeutic in- and outpatients with both instruments, significant correlations between overall scores and domain scales of the two interviews were found. Moreover, the ratings from both interviews showed high correlations with criteria of clinical severity.

Using the Structured Interview of Personality Organization for DSM–5 Level of Personality Functioning Rating Performed by Inexperienced Raters

ABSTRACTWe argue that clinical information related to an object-relations model of personality pathology can be used by untrained and clinically inexperienced students to rate personality-disordered patients on the Level of Personality Functioning Scale (LPFS). To do so, 73 clinically inexperienced undergraduate students were asked to assess personality functioning of 10 female inpatients using the LPFS from audio recordings of the Structured Interview of Personality Organization (STIPO). LPFS ratings showed acceptable interrater reliability. Moreover, LPFS ratings were significantly associated with external measures of severity of personality pathology (number of DSM–IV–TR personality disorders) as assessed by experienced clinicians. Finally, the students' ratings were also associated with the level of personality organization as measured by experienced clinicians using the STIPO. Our findings confirm that untrained raters can reliably assess personality pathology by rating the LPFS based on material from the STIPO. Implications related to the use of the STIPO as a tool for the assessment of personality pathology according to the DSM–5 Alternative model are discussed.

Cosa Nostra and the Camorra: Assessment of personality, alexithymic traits, and attachment styles

The Mafia (Cosa Nostra) and the Camorra are criminal organizations deeply rooted in an immoral familyism in which group interests are protected to the detriment of the individual. The aim of this study was to investigate the presence of personality disorders, alexithymic traits and specific attachment styles in a sample of members belonging to these two different organized crime groups. We carried out two studies adopting two different perspectives. In the first study, we recruited 20 participants (10 members of Cosa Nostra and 10 members of the Camorra) who were serving time in the Augusta (Sicily) prison for crimes they had committed as members of the two Mafia-type organizations. The age of the Cosa Nostra members ranged from 28 to 62 years (M = 47.40, SD = 10.25); the age of the Camorra members ranged from 45 to 68 (M = 55.30, SD = 7.06). We tested personality profiles, attachment styles, alexithymia, and psychopathy and compared the results between the two groups. In this study while we did not find significant differences between the two groups, we were able to identify some discrepancies in a few of the variables analysed. In the second study, we used the Structured Interview of Personality Organization (STIPO) to analyse the personality organization of 10 of 20 participants (5 members of Cosa Nostra and 5 members of Camorra). Analysing the results at the STIPO we found a significant presence of borderline personality organization in both groups. As regards attachment style, we found that Camorra-members' scores high (75°) on the Discomfort with Closeness (related to Avoidant Attachment Style) and Relationship as Secondary factors of the Attachment Style Questionnaire. The Data collected in our study were not sufficient to identify a specific personality disorder or a specific serious psychological condition in the two groups of participants. Nonetheless, thanks to use of the STIPO we were able to determine that in the sample analysed there was not one subject with a psychotic personality organization; we did however find the presence of borderline personality organization and neurotic personality organization in some of the subjects.

Clinical Components of Borderline Personality Disorder and Personality Functioning

Background: Impairment in personality functioning (PF) represents a salient criterion of the DSM-5 alternative diagnostic model for personality disorders (AMPD). The main goal of this study is to analyze the relationship of the borderline personality disorder (BPD) clinical components derived from the DSM-5 categorical diagnostic model (affective dysregulation, behavioral dysregulation, and disturbed relatedness) with personality organization (PO), i.e., PF, assessed by the Structured Interview of Personality Organization (STIPO). Methods: STIPO and the Structured Clinical Interviews for DSM-IV (SCID-I and -II) were administered to 206 BPD patients. The relationship between PO and BPD components were studied using Spearman correlations and independent linear regression analyses. Results: Significant positive correlations were observed between STIPO scores and several DSM-5 BPD criteria and comorbid psychiatric disorders. STIPO dimensions mainly correlated with disturbed relatedness and, to a lesser extent, affective dysregulation components. Each BPD clinical component was associated with specific STIPO dimensions. Conclusions: Both diagnostic models, DSM-5 BPD criteria and PO, are not only related but complementary concepts. The results of this study particularly recommend STIPO for the assessment of relational functioning, which is a major domain of the Personality Functioning Scale Levels of the DSM-5 AMPD.

Personality organization and its association with clinical and functional features in borderline personality disorder

Patients with borderline personality disorder (BPD) show poor psychosocial functioning over the course of their lives. To date, predictors of functionality in BPD patients have remained mostly unexplored. In this study, we aimed to assess the association between personality organization and clinical and functional features in a sample of 50 patients with BPD referred to a specialized outpatient clinic. We used the Structured Interview of Personality Organization (STIPO) to assess personality organization and the Global Assessment of Functioning (GAF) scale to measure functionality. Clinical and demographic associations with personality organization were also explored. STIPO scores were negatively correlated with GAF scores (i.e. higher scores in the STIPO dimensions, which reflected greater personality pathology, were significantly associated with lower psychosocial functioning). After controlling for potential confounders, the STIPO domain “identity” significantly accounted for 26.7% of the variance in the GAF, while the STIPO subscale “sense of self” significantly accounted for 31.2% of the variance in the GAF. These findings suggest that identity and its pathological correlate, identity diffusion, may play a key role in the functional prognosis of BPD patients.

Clinician-Guided Assessment of Personality Using the Structural Interview and the Structured Interview of Personality Organization (STIPO)

ABSTRACTThis article demonstrates the utility of a theory-guided psychodynamic approach to the assessment of personality and personality pathology based on the object relations model developed by Kernberg (1984). We describe a clinical interview, the Structural Interview (SI; Kernberg, 1984), and also a semistructured approach, the Structured Interview of Personality Organization (STIPO; Clarkin, Caligor, Stern, & Kernberg, 2004) based on this theoretical model. Both interviews focus on the assessment of consolidated identity versus identity disturbance, the use of adaptive versus lower level defensive operations, and intact versus loss of reality testing. In the context of a more clinically oriented assessment, the SI makes use of tactful confrontation of discrepancies and contradictions in the patient's narrative, and also takes into account transference and countertransference phenomena, whereas the more structured approach of the STIPO incorporates clinical judgment informed by clinical theory into a well-guided interaction with the patient. Both interviews have good interrater reliability and are coherent with the alternative model for personality disorder diagnosis proposed by the Diagnostic and Statistical Manual of Mental Disorders (5th ed.), Section III. Finally, they provide the clinician with specific implications for prognosis and treatment planning and can rationally guide clinical decision making.

Mentalization And Personality Organization In Heroin Addicted Patients : A Narrative Analysis

The relationship between the dimensions of personality organization and the quality of mentalization is an important object of study in contemporary psychodynamic theory and it also contributes to the understanding of heroin addiction with comorbid personality disorders. The current study aims to assess levels of personality organization and its main domains (Identity, Object relations, Defense Mechanisms) in patients with opiate addiction, as well as the quality of affect mentalization and possible connections between them. In order to do so we have adopted quantitative text-analysis method of affect mentalization to parts of а interview, trying to show that the language which participants use could be in itself a psychodiagnostic means. A group of 30 heroin addicted patients in a methadone treatment programme and a control group of 30 healthy participants were assessed with the Structured Interview of Personality Organization (STIPO), VEA (Verbal Elaboration of Affect Scale) and The Measure of Affect Contents (MAC). Results show significant differences between the two groups, concerning all dimensions of personality organization as well as some core areas of affect mentalization. The capacity for affect mentalization is significantly correlated to the level of personality organization. The results are discussed from the point of view of the adopted theoretical models and the implications for psychotherapeutic work in the bio-psycho-social model.

Assessment of personality according to Otto Kernberg’s conception

The subject matter of this paper is the model of personality developed by Otto Kernberg and the research tools designed on the basis of that conception. The paper presents the spectrum of diagnostic methods differing in terms of the level of structuralizing and the form in which they are applied. The first one constructed, the Structural Interview, due to the high requirements within psychoanalytical knowledge and clinical abilities for the individuals who apply it, initiated the development of subsequent methods. They include: the Structured Interview of Personality Organization (STIPO), inventory methods, and a clinician-rated instrument referred to as the Personality Organization Diagnostic Form (PODF). Within the scope of inventory methods, two principal tools for which Polish adaptations have been developed are presented, namely: the Inventory of Personality Organization of Kernberg and collaborators, and the Borderline Personality Inventory of Leichsenring. The existence of a broad spectrum of assessment methods of the personality structure makes it possible to take advantage of the conception of Kernberg in the realms of clinical diagnosis, scientific research, and recently also forensic psychology.

Personality Structure Features Associated with Early Dropout in Patients with Substance-Related Disorders and Comorbid Personality Disorders

This study aims at investigating factors associated with early dropout in dual diagnosis patients, considering socio-demographic, diagnostic and personality structure variables. We hypothesized that the personality structure of the patient will show stronger associations with dropout, as compared to descriptive variables. Forty-seven patients consecutively admitted in a dual diagnosis residential treatment unit were administered the Structured Interview of Personality Organization (STIPO), the Structured Clinical Interview for Axis II Disorders (SCID II), the Response Evaluation Measure 71 (REM71), the Symptom Check List 90–R (SCL90-R), and the Borderline Personality Disorder Check List (BPDCL). Significant differences emerged between the dropout and no-dropout group: Investments and self-coherence problems (STIPO) were higher among dropouts; moreover, in the dropout group a significantly higher number of patients showed a borderline personality organization (88.9 %). Results support the use of structural interviews in the assessment of dual diagnosis patients; implications regarding research and clinical practice are discussed.

Reliability and validity of the German version of the Structured Interview of Personality Organization (STIPO)

BackgroundThe assessment of personality organization and its observable behavioral manifestations, i.e. personality functioning, has a long tradition in psychodynamic psychiatry. Recently, the DSM-5 Levels of Personality Functioning Scale has moved it into the focus of psychiatric diagnostics. Based on Kernberg’s concept of personality organization the Structured Interview of Personality Organization (STIPO) was developed for diagnosing personality functioning. The STIPO covers seven dimensions: (1) identity, (2) object relations, (3) primitive defenses, (4) coping/rigidity, (5) aggression, (6) moral values, and (7) reality testing and perceptual distortions. The English version of the STIPO has previously revealed satisfying psychometric properties.MethodsValidity and reliability of the German version of the 100-item instrument have been evaluated in 122 psychiatric patients. All patients were diagnosed according to the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV) and were assessed by means of the STIPO. Moreover, all patients completed eight questionnaires that served as criteria for external validity of the STIPO.ResultsInterrater reliability varied between intraclass correlations of .89 and 1.0, Crohnbach’s α for the seven dimensions was .69 to .93. All a priori selected questionnaire scales correlated significantly with the corresponding STIPO dimensions. Patients with personality disorder (PD) revealed significantly higher STIPO scores (i.e. worse personality functioning) than patients without PD; patients cluster B PD showed significantly higher STIPO scores than patients with cluster C PD.ConclusionsInterrater reliability, Crohnbach’s α, concurrent validity, and differential validity of the STIPO are satisfying. The STIPO represents an appropriate instrument for the assessment of personality functioning in clinical and research settings.

Psychiatric Comorbidity and Personality Structure in Patients with Polyvalent Addiction

Background: This study focuses on the systematic psychiatric evaluation of polydrug-using opiate-dependent patients, using the standard DSM-IV diagnostic interviews and a new psychodynamic instrument operationalizing personality organization (Structured Interview of Personality Organization, STIPO). Sampling and Method: 50 patients were interviewed with the Structured Clinical Interview for DSM-IV Disorders (SCID) I and II and the STIPO by two independent researchers at a detoxification treatment unit. Results: According to the SCID I and II, all patients had at least one axis I disorder, 90% at least one axis II disorder. A correspondence was found between STIPO and SCID results, in that more pathology in the SCID coincided with more severity in the STIPO. According to the STIPO, 100% of the patients were located at the level of borderline personality organization, indicating identity pathology according to Kernberg's model. Conclusion: Given the fact that comorbid psychiatric disorders compromise the outcome of detoxification and dehabituation treatments, it is highly relevant to diagnose these disorders and to assess underlying personality pathology. While the evidence of psychosocial treatments in addiction therapy is still weak, the integration of syndrome-tailored treatment modules may help improve the treatment of patients with this chronically relapsing condition. Limitation: small sample size.

The Self-Image in Borderline Personality Disorder: An in-Depth Qualitative Research Study

Patients with borderline personality disorder (BPD) suffer from affective instability, impulsivity, and identity disturbance which particularly manifest in an unstable or insecure self-image. One main problem for studies of core psychopathology in BPD is the complex subject of identity disturbance and self-image. The purpose of this study was to investigate the self-image of BPD patients with a qualitative research approach. Twelve patients with BPD were compared to 12 patients with remitted major depressive disorder (MDD) without personality disorder, using the Structured Interview of Personality Organization (STIPO). The transcribed interviews were analyzed using a combination of content analysis and grounded theory. BPD patients described themselves predominantly as helpful and sensitive; reported typical emotions were sadness, anger, and anxiety. MDD patients on the other hand reported numerous and various characteristics and emotions, including happiness, as well as sadness and anxiety. Other persons were characterized by the BPD group as egoistic and satisfied, while the MDD group described others as being balanced and secretive. BPD patients displayed an altruistic, superficial, and suffering self-image. Aggressive tendencies were only seen in other persons. Our findings support the concept of a self and relationship disturbance in BPD which is highly relevant for psychotherapy treatment.

The Relationship between Personality Organization and Psychiatric Classification in Chronic Pain Patients

Background: The present study investigated the relationship between psychiatric classification and personality organization (PO) in a secondary/tertiary clinical sample of chronic pain patients (CPPs). Sampling andMethods: Forty-three patients were administered the Structured Clinical Interview for DSM-IV (SCID I+II) and the Structured Interview of Personality Organization (STIPO). The prevalence of axis I and axis II disorders was correlated with the STIPO level of PO. The STIPO dimensional ratings of patients without personality disorder (PD) were compared to those of patients diagnosed with one or more PDs. Results: Axis I comorbidity was high (93%), and 63% of the patients met the criteria for at least one axis II diagnosis. Twenty-five patients (58%) were diagnosed as borderline PO, with high-level impairments in the dimensions ‘coping/rigidity’, ‘primitive defenses’ and ‘identity’. Higher axis I and axis II comorbidity corresponded with greater severity of PO impairment. No difference was found between the dimensional ratings of patients without PD and those of patients with one or more PDs. Conclusions: The assessment of PO is a crucial issue for diagnosis and treatment planning in CPPs, since it represents a measure of structural impairment that is to a considerable extent independent of axis I and II diagnoses. Moreover, the STIPO dimensional rating focuses on the most salient dysfunctions at a given time.