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Ruchensky JR, Kelley SE, Massey C, Richardson LA, Blais MA, Stein MB. Using the Personality Assessment Inventory to Assess the Alternative Model for Personality Disorders: Criterion Validity in a Clinical Sample. J Pers Assess 2024; 106:72-82. [PMID: 37220386 DOI: 10.1080/00223891.2023.2203240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 02/06/2023] [Accepted: 03/31/2023] [Indexed: 05/25/2023]
Abstract
The Personality Assessment Inventory (PAI) is a broadband measure of psychopathology that is widely used in applied settings. Researchers developed regression-based estimates that use the PAI to measure constructs of the Alternative Model for Personality Disorders (AMPD) - a hybrid dimensional and categorical approach to conceptualizing personality disorders. Although prior work has linked these estimates to formal measures of the AMPD, there is little work investigating the clinical correlates of this scoring approach of the PAI. The current study examines associations between these PAI-based AMPD estimates and life data in a large, archival dataset of psychiatric outpatients and inpatients. We found general support for the criterion validity of AMPD estimate scores, such that a theoretically consistent pattern of associations emerged with indicators such as prior academic achievement, antisocial behavior, psychiatric history, and substance abuse. These results provide preliminary support to this scoring approach for use in clinical samples.
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Affiliation(s)
- Jared R Ruchensky
- Department of Psychology & Philosophy, Sam Houston State University, Huntsville, Texas
| | - Shannon E Kelley
- Clinical Psychology Department, William James College, Newton, Massachusetts
| | - Christina Massey
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Laura A Richardson
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mark A Blais
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Michelle B Stein
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Stanton K, Watts AL, Levin-Aspenson HF, Carpenter RW, Emery NN, Zimmerman M. Focusing Narrowly on Model Fit in Factor Analysis Can Mask Construct Heterogeneity and Model Misspecification: Applied Demonstrations across Sample and Assessment Types. J Pers Assess 2023; 105:1-13. [PMID: 35286224 DOI: 10.1080/00223891.2022.2047060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 02/09/2022] [Indexed: 02/01/2023]
Abstract
This study builds upon research indicating that focusing narrowly on model fit when evaluating factor analytic models can lead to problematic inferences regarding the nature of item sets, as well as how models should be applied to inform measure development and validation. To advance research in this area, we present concrete examples relevant to researchers in clinical, personality, and related subfields highlighting two specific scenarios when an overreliance on model fit may be problematic. Specifically, we present data analytic examples showing that focusing narrowly on model fit may lead to (a) incorrect conclusions that heterogeneous item sets reflect narrower homogeneous constructs and (b) the retention of potentially problematic items when developing assessment measures. We use both interview data from adult outpatients (N = 2,149) and self-report data from adults recruited online (N = 547) to demonstrate the importance of these issues across sample types and assessment methods. Following demonstrations with these data, we make recommendations focusing on how other model characteristics (e.g., factor loading patterns; carefully considering the content and nature of factor indicators) should be considered in addition to information provided by model fit indices when evaluating factor analytic models.
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Affiliation(s)
| | - Ashley L Watts
- Department of Psychological Sciences, University of Missouri
| | | | - Ryan W Carpenter
- Department of Psychological Sciences, University of Missouri-St. Louis
| | - Noah N Emery
- Department of Psychology, Colorado State University
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Iacob CI, Folostina R, Avram E. Trait resilience as a moderator between personality dysfunction and caregiving stress in caregivers of children and adults with developmental disabilities. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2022; 70:425-434. [PMID: 38699495 PMCID: PMC11062279 DOI: 10.1080/20473869.2022.2092934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 06/17/2022] [Indexed: 05/05/2024]
Abstract
Background Long-term care of a relative with a disability is associated with negative consequences on the caregiver's mental health. Therefore, investigating how some personality traits, such as resilience, protect caregivers with dysfunctional personality traits from caregiving stress is necessary. This study examines the moderating role of resilience in the relationship between caregiver's personality dysfunction and care stress. Methods A total of 224 family caregivers of children and adults with developmental disabilities participated in this cross-sectional research. They completed self-report measures of resilience, personality dysfunction, and care stress. Results The results show that medium and high levels of resilience protect familial caregivers from the adverse effects of personality dysfunction on stress. The relationship is maintained for three of the five dysfunctional personality traits (antagonism, disinhibition, and psychoticism). Conclusions From a theoretical point of view, the results show the contribution of the dimensional personality model to the study of caregiving stress. From a practical standpoint, the results can be used to optimise the resilience of familial caregivers, providing them with tools to take better care of their relatives.
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Affiliation(s)
- Claudia I. Iacob
- Department of Applied Psychology and Psychotherapy, University of Bucharest, Bucharest, Romania
| | - Ruxandra Folostina
- Department of Special Education, University of Bucharest, Bucharest, Romania
| | - Eugen Avram
- Department of Applied Psychology and Psychotherapy, University of Bucharest, Bucharest, Romania
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Gamache D, Savard C, Leclerc P, Payant M, Côté A, Faucher J, Lampron M, Tremblay M. Latent profiles of patients with borderline pathology based on the alternative DSM-5 model for personality disorders. Borderline Personal Disord Emot Dysregul 2021; 8:4. [PMID: 33568234 PMCID: PMC7876791 DOI: 10.1186/s40479-021-00146-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There have been multiple attempts to try to parse out heterogeneity within borderline pathology by identifying patient subtypes; thus far, these works have yielded few consistent results. Recent developments in the operationalization of borderline pathology may provide new opportunities to identify clinically and conceptually meaningful subgroups of patients. The Alternative DSM-5 Model for Personality Disorders (AMPD) offers a categorical-dimensional operationalization of Borderline personality disorder (BPD) that has yet to be tested for identification of patient subgroups. The purpose of the present study is to test whether the combination of the Criterion A elements (pertaining to level of severity) and the seven pathological facets from Criterion B that define BPD in the AMPD can yield meaningful patient profiles. METHODS A total of 211 outpatients from a specialized PD treatment program (133 women, Mage = 33.66, SD = 10.97) were selected based on the presence of at least moderate borderline pathology according to cutoffs recently proposed for the Borderline Symptom List-23. Valid Criterion A (Self and Interpersonal Functioning Scale) and B (Personality Inventory for DSM-5 Faceted Brief Form) self-reports were administered to measure elements and facets that define BPD in the AMPD model; these variables were used as indicators in a latent profile analysis (LPA). RESULTS The optimal solution generated by LPA yielded four distinct profiles: (a) Borderline traits; (b) Moderate pathology with Impulsivity; (c) Moderate pathology with Identity problems and Depressivity; and (d) Severe pathology. Clinically meaningful distinctions emerged among profiles on AMPD indicators and external variables relevant to PD, especially aggression and impulsivity. CONCLUSIONS Profiles reflected both the "severity" and "style" components imbedded within Criterion A and B of the AMPD, as they were mainly distinguished by a continuum of severity but also by some meaningful qualitative differences that may have important clinical implications for treatment planning and contracting. Results also suggest that the four Criterion A elements have independent value to identify important differences in patients with borderline pathology. They also highlight that some Criterion B facets that define BPD in the AMPD may be especially important to identify subgroups of patients, mainly Impulsivity and Depressivity.
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Affiliation(s)
- Dominick Gamache
- Department of Psychology, Université du Québec à Trois-Rivières, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada.
- CERVO Brain Research Centre, Quebec City, QC, Canada.
- Interdisciplinary Research Centre on Intimate Relationship Problems and Sexual Abuse, Montreal, QC, Canada.
| | - Claudia Savard
- CERVO Brain Research Centre, Quebec City, QC, Canada
- Interdisciplinary Research Centre on Intimate Relationship Problems and Sexual Abuse, Montreal, QC, Canada
- Department of Educational Fundamentals and Practices, Université Laval, Quebec City, QC, Canada
| | - Philippe Leclerc
- Department of Psychology, Université du Québec à Trois-Rivières, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada
| | - Maude Payant
- Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada
| | - Alexandre Côté
- Department of Psychology, Université du Québec à Trois-Rivières, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada
| | - Jonathan Faucher
- Department of Psychology, Université du Québec à Trois-Rivières, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada
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Sleep CE, Lynam DR, Campbell WK, Miller JD. Insight Regarding the Presence of Antagonism-Related Traits and Their Subsequent Impairment in Relation to Psychopathy, Narcissism, and Machiavellianism. J Pers Disord 2021; 35:57-72. [PMID: 30785862 DOI: 10.1521/pedi_2019_33_422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Clinical theory is skeptical of individuals' ability to recognize the presence, severity, and impact of clinical symptoms and pathological traits (Oltmanns & Powers, 2012); however, empirical work has found moderate self-other convergence for reports of pathological traits and for Antagonism-related personality disorder (PD) constructs (i.e., psychopathy, narcissism, and Machiavellianism), which are characterized by low insight. Nevertheless, empirical examinations of insight into perceptions of impairment are scant. Thus, the present study sought to examine individuals' insight regarding pathological traits and related impairment in two samples. In Sample 1, more psychopathic, narcissistic, and Machiavellian individuals reported higher levels of pathological traits and were aware of related impairment. In Sample 2, individuals reported higher levels of pathological traits and, albeit to a lesser degree, more Antagonism-related impairment. Thus, more psychopathic, narcissistic, and Machiavellian individuals possess a reasonable degree of insight into their trait levels and associated impairment.
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Gamache D, Savard C, Leclerc P, Payant M, Berthelot N, Côté A, Faucher J, Lampron M, Lemieux R, Mayrand K, Nolin MC, Tremblay M. A Proposed Classification of ICD-11 Severity Degrees of Personality Pathology Using the Self and Interpersonal Functioning Scale. Front Psychiatry 2021; 12:628057. [PMID: 33815167 PMCID: PMC8012561 DOI: 10.3389/fpsyt.2021.628057] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/19/2021] [Indexed: 01/07/2023] Open
Abstract
Background: The 11th version of the World Health Organization's International Classification of Diseases (ICD-11) has adopted a dimensional approach to personality disorder (PD) nosology. Notably, it includes an assessment of PD degree of severity, which can be classified according to five categories. To date, there is no gold standard measure for assessing degree of PD severity based on the ICD-11 model, and there are no empirically-based anchor points to delineate the proposed categories. With the operationalization of PD degrees of severity in the ICD-11 PD model now being closely aligned with Criterion A of the DSM-5 Alternative Model for Personality Disorders (AMPD), sharing a focus on self and interpersonal dysfunction, self-report instruments developed for the latter model might prove useful as screening tools to determine degrees of severity in the former. Methods: The Self and Interpersonal Functioning Scale, a brief validated self-report questionnaire originally designed to assess level of personality pathology according to the AMPD framework, was used to derive anchor points to delineate the five severity degrees from the ICD-11 PD model. Data from five clinical and non-clinical samples (total N = 2,240) allowed identifying anchor points for classification, based on Receiver Operating Characteristic curve analysis, Latent Class Analysis, and data distribution statistics. Categories were validated using multiple indices pertaining to externalizing and internalizing symptoms relevant to PD. Results: Analyses yielded the following anchor points for PD degrees of severity: No PD = 0-1.04; Personality Difficulty = 1.05-1.29; Mild PD = 1.30-1.89; Moderate PD = 1.90-2.49; and Severe PD = 2.50 and above. A clear gradient of severity across the five categories was observed in all samples. A high number of significant contrasts among PD categories were also observed on external variables, consistent with the ICD-11 PD degree of severity operationalization. Conclusions: The present study provides potentially useful guidelines to determine severity of personality pathology based on the ICD-11 model. The use of a brief self-report questionnaire as a screening tool for assessing PD degrees of severity should be seen as a time-efficient support for clinical decision and treatment planning.
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Affiliation(s)
- Dominick Gamache
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Claudia Savard
- Department of Educational Fundamentals and Practices, Université Laval, Quebec City, QC, Canada
| | - Philippe Leclerc
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Maude Payant
- Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada
| | - Nicolas Berthelot
- Department of Nursing Sciences, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Alexandre Côté
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Jonathan Faucher
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | | | - Roxanne Lemieux
- Department of Nursing Sciences, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Kristel Mayrand
- School of Psychology, Université Laval, Quebec City, QC, Canada
| | - Marie-Chloé Nolin
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Marc Tremblay
- Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, QC, Canada
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Rodriguez-Seijas C, Ruggero C, Eaton NR, Krueger RF. The DSM-5 Alternative Model for Personality Disorders and Clinical Treatment: a Review. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s40501-019-00187-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Zimmermann J, Kerber A, Rek K, Hopwood CJ, Krueger RF. A Brief but Comprehensive Review of Research on the Alternative DSM-5 Model for Personality Disorders. Curr Psychiatry Rep 2019; 21:92. [PMID: 31410586 DOI: 10.1007/s11920-019-1079-z] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Both the Alternative DSM-5 Model for Personality Disorders (AMPD) and the chapter on personality disorders (PD) in the recent version of ICD-11 embody a shift from a categorical to a dimensional paradigm for the classification of PD. We describe these new models, summarize available measures, and provide a comprehensive review of research on the AMPD. RECENT FINDINGS A total of 237 publications on severity (criterion A) and maladaptive traits (criterion B) of the AMPD indicate (a) acceptable interrater reliability, (b) largely consistent latent structures, (c) substantial convergence with a range of theoretically and clinically relevant external measures, and (d) some evidence for incremental validity when controlling for categorical PD diagnoses. However, measures of criterion A and B are highly correlated, which poses conceptual challenges. The AMPD has stimulated extensive research with promising findings. We highlight open questions and provide recommendations for future research.
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Affiliation(s)
- Johannes Zimmermann
- Department of Psychology, University of Kassel, Holländische Str. 36-38, 34127, Kassel, Germany.
| | | | - Katharina Rek
- Max-Planck-Institut für Psychiatrie, Munich, Germany
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Hart W, Tortoriello GK, Richardson K. Are personality disorder traits ego-syntonic or ego-dystonic? Revisiting the issue by considering functionality. JOURNAL OF RESEARCH IN PERSONALITY 2018. [DOI: 10.1016/j.jrp.2018.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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