Relations between facets and personality domains with impulsivity: New evidence using the DSM-5 Section III framework in patients with substance use disorders

Changes in substance use, recovery, and quality of life during the initial phase of the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic disrupted lives on a massive scale. While the pandemic appeared to worsen mental health outcomes broadly, its effects on alcohol/substance use and recovery are unclear. Many studies convolved the sociopolitical unrest beginning in May 2020 with the pandemic. We assessed pandemic-related changes in substance use, recovery involvement, and quality of life among US adults at two specified time periods that isolated pandemic effects from potentially confounding sociopolitical factors.

OBJECTIVES

We tested the following hypotheses: the pandemic and consequent policies (1) increased use of alcohol and illicit substances in active users; (2) increased use of alcohol/substances among people in early recovery; (3) reduced participation in recovery activities among those in early recovery, and that (4) use amount and use events correlated with impulsivity in both groups and that (5) substance use and abstinence correlated with resilience.

METHODS

We recruited 1,685 participants through Amazon's Mechanical Turk (MTurk). We assessed demographics, quality of life, alcohol/substance use, recovery activities, and measures of impulsivity and resilience at two time points, pre-pandemic and (early) during-pandemic. Only n = 45 (Active Users; males n = 32) and n = 34 (Recovery; males n = 20) passed data quality checks and were included in the primary analyses.

RESULTS

Among Active Users, weekly alcohol consumption and days spent using alcohol and illicit substances decreased during the pandemic. Resilience negatively correlated with pandemic-related substance use in early recovering participants. Significant reduction in the quality of life was coincident with a trend of lower recovery activity participation (31% decline) during the pandemic.

CONCLUSIONS

The reduced alcohol/substance use and participation in recovery activities might be expected from conditions that promote social isolation. The high prevalence of low-quality data from MTurk cautions for careful use of online data sourcing.

Maladaptive personality traits in patients with recent-onset psychosis: A case-control study using the Personality Inventory for the DSM-5 (PID-5)

BACKGROUND

The relationship between maladaptive personality traits and psychotic disorders in the early stages of disease has not been thoroughly investigated, even though it is essential for developing prevention and early intervention strategies.

METHODS

The five domains and the 25 facets of the Personality Inventory for DSM-5 (PID-5) were compared between 102 patients with recent-onset psychosis (ROP) and 116 community subjects (C) with a general linear model including age and sex in the analyses. In addition, multiple linear regression models were used to identify which factors associated with the PID-5 domains in ROP, and correlation analyses were used to explore the relationship between personality traits.

RESULTS

Patients with ROP, compared to C, exhibited higher scores in four out of the five domains with medium effect sizes (Cohen's f² ≥ 0.15) in two of them: negative affect (NA, p = 0.013, f² = 0.04), detachment (DET, p < 0.001, f² = 0.15), disinhibition (DIS, p < 0.001, f² = 0.14) and psychoticism (PSY, p < 0.001, f² = 0.16). Significant group differences were observed in 15 of the 25 facets and the largest effects were observed in the facets of withdrawal (p ≤ 0.001, f² = 0.20), irresponsibility (p < 0.001, f² = 0.23) and unusual beliefs (p = 0.001, f² = 0.22). Interestingly, being on antidepressants and high scores on the positive subscale of the Positive and Negative Syndrome Scale (PANSS) were associated with high scores of NA, antagonism (ANT) and PSY.

CONCLUSIONS

Maladaptive personality traits were prominent in persons with ROP. These findings suggest that personality traits might play a role in vulnerability to psychosis and highlight the importance of evaluating personality in the early stages of psychosis.

Psychometric study of the brazilian version of the personality inventory for DSM-5-paper-and-pencil version

The Personality Inventory for DSM-5 - Self Reported Form (PID-5-SRF) operationalizes Criterion B of the personality alternative model of DSM-5 Section III and has already been cross-culturally adapted to many countries. The objective is to present evidence of validity and reliability of the Brazilian version of PID-5 (pencil-and-paper) in a Brazilian community sample. The sample was composed of 730 individuals from the general population [67.8% women, aged 33.84 (SD = ±15.2), 69.5% ≥ 12 years of schooling]. The participants were recruited in academic, organizational, healthcare, and business facilities in three Brazilian states. The snowball method was used. The PID-5 Brazilian version and the Revised NEO-Five Factor Inventory (NEO-FFI-R) were individually applied, and the retest was applied 30 days after. Satisfactory internal consistency (facets α ≥0.51; domains α ≥0.82) and test-retest reliability (facets ICC ≥ 0.45; domains ICC ≥0.76) were found, but a floor effect was verified in 97.7% of the items. Regarding convergent validity, strong correlations were found between the PID-5 and the NEO-FFI-R domains (r = -0.44 to 0.70). Ten facets did not fit the unidemensional structure. Confirmatory Factor Analyses did not present adequate goodness of fit, and Exploratory Analyses indicated that a five-factor model is more appropriate, though it presents some peculiarities concerning the original model. PID-5 also presented satisfactory goodness of fit to the personality hierarchical model. Generally, the instrument's psychometric indicators favor its use in the Brazilian context. However, some aspects demand attention, and more specific studies should be conducted to verify the impact of reverse-scored items, floor effect, and peculiarities of its internal structure (some facets' multidimensionality and interstitiality) concerning the original model.

Severity of anabolic steroid dependence, executive function, and personality traits in substance use disorder patients in Norway

INTRODUCTION

Anabolic androgenic steroids (AAS), including testosterone and synthetic derivatives, are typically used to increase muscle mass. Many users develop a dependence on these substances, contributing to worsened physical and mental health outcomes. Aspects of personality and executive dysfunction may represent underlying vulnerabilities for developing dependence.

OBJECTIVE

To identify levels of AAS dependence within substance use disorder (SUD) treatment patients and assess the relationship between dependence severity and personality traits and executive function (EF).

METHODS

Data were collected from patients at 38 SUD treatment facilities in Norway. Questionnaires were completed for measures of personality and EF. Measures of symptoms of AAS dependence were used in latent class analysis to identify sub-groups of patients, which were evaluated for association with EF and personality traits, and compared with a group of non-AAS using SUD patients.

RESULTS

Three classes were identified; largely reflecting low, moderate, and high symptoms of dependence. Multinomial regression analyses indicated that moderate and high symptoms were associated with several measures of EF and personality traits, particularly self-monitoring, antagonism, disinhibition, and rigid perfectionism while users with low symptoms exhibited higher capacities for emotional control and shift, and lower negative affectivity, relative to non-AAS using SUD patients. Backward stepwise regressions indicated antagonism, and decreased self-monitoring as key personality and cognitive characteristics of SUD patients with severe AAS dependence.

CONCLUSION

Our findings indicate that specific executive dysfunctions and personality features, particularly those associated with poor emotional control, reduced empathy, and impulsivity are associated with more severe AAS dependence in the SUD population.

Assessment of Recidivism Risk in Sex Offenders: A Pilot Study in Central Italy

Knowing the risk factors of recidivism in sex offenders is important in order to prepare effective preventative interventions and treatment in custody. In this regard, the following paper shows the results of a pilot study carried out in the prisons of central Italy in which 44 sex offenders participated. These participants were given the following tests: Historical Clinical Risk Management-20-version 3 (HCR20v3), Psychopathy Checklist-Revised (PCL-R) and Personal Inventory Dimensional (PID-5). The results show a high positivity in the factors of the sub-scales H (historical factors) and C (clinical factors) of HCR20v3; the average total score of the PCR-L is 16.47, with five subjects who are in the “high psychopathy” range (X ≥ 30); with regard to PID-5, the most positive domain is negative affectivity (56.10%).

Maladaptive personality traits in depressive and substance use disorders: A study with the PID-5

Studies on the relationship between personality and depressive disorders (DD) or substance use disorders (SUD) often refer to the normal personality model and focus mainly on the "big" factors. Domain level results with the Personality Inventory for DSM-5 (PID-5) tend to be consistent with NEO-PI-R or NEO-FFI results, however facet level results in the specific characteristics of these disorders are scarce. The main objective of this study was to characterize DD and SUD's maladaptive personality traits through the PID-5. A sample of DD was compared with a sample of SUD, with a sample of other disorders, and with a community sample. A sample of the general Portuguese population (N = 693) and a heterogeneous clinical sample (N = 310) were studied. Participants responded to the PID-5 and to the Brief Symptom Inventory (BSI). Depressivity, Irresponsibility and Anhedonia were the main characteristics of DD. However, high values in Depressivity and in depressive symptomatology were present in all the clinical subsamples. Irresponsibility, Deceitfulness and Callousness were the main characteristics of SUD. The occurrence of DD, SUD or Other disorders could be predicted using multinonomial logisitic regression analysis, and PID-5 facets as independent variables. These results are in line with comorbidity data and tend to confirm the PID-5 validity.

The Personality Inventory for DSM-5: Psychometric Evidence of Validity and Reliability-Updates

OBJECTIVE

To perform a systematic review of the literature on the psychometric characteristics of different versions of the Personality Inventory for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (PID-5) and to integrate the current findings with those of previous reviews by Al Dajani and colleagues (2015) and Watters and Bagby (2018).

METHODS

This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses protocol. PubMed, PsycINFO, SciELO, Web of Science, and LILACS were searched using two keywords: personality AND DSM-5. Studies published from 2015 to 2018 were included.

RESULTS

Sixty-four new studies were evaluated. The PID-5-self-report form (SRF) was concluded to have a factorial structure consisting of five factors and 25 facets, as well as excellent indicators of internal consistency, test-retest reliability, and convergent validity with different personality instruments and with other clinical constructs. The form also has predictive and discriminative potential, warranting further exploration in studies with samples of personality disorders in relation to different parameters and not only the diagnostic algorithm of DSM-5 Section III. The brief and informant versions, although less studied, also showed good psychometric indicators, comparable to the original version.

CONCLUSIONS

The PID-5 showed psychometric suitability for use in different cultures and contexts. The form's use in clinical practice and as a means of operationalizing the diagnostic evaluation of the DSM-5 dimensional model is promising and should be encouraged.

Differential Effects of Psychological Interventions in Online and Face-to-Face Settings on DSM-5 and ICD-11 Maladaptive Trait Domains: An Exploratory Pilot Study

While mental health treatments have proven to be effective for a range of mental health problems, there is comparably little research on its effects on personality disorders or difficulty (PD). New dimensional conceptualizations of PD such as the ICD-11 PD model enable the cost- and time-effective dimensional assessment of severity and style of PD. Furthermore, they constitute a promising tool to investigate PD, not only as a treatment endpoint but also as a predictive or influencing factor for mental health treatments. In this study, we investigated the effects in two different mental health treatment settings [online (N = 38); face-to-face and blended [FTF/blended] (N = 35)] on the reduction of maladaptive personality traits as well as the interaction between maladaptive personality patterns and the response on primary endpoints (i.e., mental distress). Results indicate that both treatment settings have comparable within-group effects on the reduction of distress symptoms, while the treatment in the FTF/blended setting seems to have a stronger impact on the reduction of maladaptive traits. Further, reduction of maladaptive trait expressions was a reliable predictor of treatment response in the FTF/blended setting while explaining less variance in the online setting. Beyond the promising findings on the utility of maladaptive trait change as an outcome measure, we discuss possible applications as an information source for treatment decisions.

Comparing impulsivity in borderline personality, schizophrenia and obsessional-compulsive disorders: Who is ahead?

OBJECTIVE

Impulsivity impacts life domains and in a psychiatric context is often associated with disorders severity and stigmatization. Borderline personality disorder's (BPD), Schizophrenic disorder's (SZD), and obsessional compulsive disorder's (OCD) impulsivity issues relate to worse prognosis. This study aims to compare these disorders assessing their proneness to impulsivity and urgency.

METHODS

We recruited 90 patients among them OCD (n = 25), SZD (n = 23), and BPD (n = 50), and 24 healthy control participants (HC). We assessed the diagnosis according and measured the impulsivity level.

RESULTS

Our results showed that BPD was significantly more impulsive than HC, SZD, and OCD. HC, SZD, and OCD being equivalent on their global Urgency-Premeditation-Perseverance-Sensation seeking scores. For urgency, BPD was also superior to others, OCD was superior to HC, but SZD and HC were equivalent. The urgency was correlated to SZD's scale for SZD, no link appeared between borderline personality questionnaire and Yale-Brown Obsessive-Compulsive Scale's score.

CONCLUSION

These results question the existent literature relating impulsivity and SZD.

Which came first: Cannabis use or deficits in impulse control?

Impulse control deficits are often found to co-occur with substance use disorders (SUDs). On the one hand, it is well known that chronic intake of drugs of abuse remodels the brain with significant consequences for a range of cognitive behaviors. On the other hand, individual variation in impulse control may contribute to differences in susceptibility to SUDs. Both of these relationships have been described, thus leading to a "chicken or the egg" debate which remains to be fully resolved. Does impulsivity precede drug use or does it manifest as a function of problematic drug usage? The link between impulsivity and SUDs has been most strongly established for cocaine and alcohol use disorders using both preclinical models and clinical data. Much less is known about the potential link between impulsivity and cannabis use disorder (CUD) or the directionality of this relationship. The initiation of cannabis use occurs most often during adolescence prior to the brain's maturation, which is recognized as a critical period of development. The long-term effects of chronic cannabis use on the brain and behavior have started to be explored. In this review we will summarize these observations, especially as they pertain to the relationship between impulsivity and CUD, from both a psychological and biological perspective. We will discuss impulsivity as a multi-dimensional construct and attempt to reconcile the results obtained across modalities. Finally, we will discuss possible avenues for future research with emerging longitudinal data.

Investigation on the capacity of the factors of the Clinical Dimensional Personality Inventory 2 for identifying people with substance dependence

The study aimed to verify the discriminant capacity of the factors of the Clinical Dimensional Personality Inventory 2 (IDCP-2) in the identification of people with substance dependence, as well as to compare this capacity with another instrument that evaluates pathological traits, the Personality Inventory for DSM-5 (PID-5). The sample was composed of 253 adults distributed in three groups: community sample, represented by 110 individuals with ages between 20 and 66 years (M = 32.3; SD = 10,1), 71.8% women; subclinical, 119 individual aged from 18 to 63 (M = 30.4; SD = 8.34), 61.3% women; clinical, 24 individual with ages between 19 and 59 (M = 36,4; SD = 11.2), 83.3% men. Two scales for substance dependence identification were administered (AUDIT and ASSIST), IDCP-2, and PID-5. Findings indicated that IDCP-2 is capable of discriminating between groups, mainly the extreme ones (i.e., clinical sample versus community sample). Moreover, similar discriminant capacity between IDCP-2 and PID-5 was observed. These findings are preliminary evidence that the IDCP-2 factors can identify people with substance dependence, with Hopelessness being the leading factor in the assessment of substance dependents.

DSM-5 Maladaptive Personality Domains among Treatment-Seeking Individuals with Alcohol Use Disorder: The Role of Disinhibition and Negative Affectivity

Background: Dimensional models of personality and personality disorders (PDs) have been widely investigated among individuals with alcohol use disorders (AUD). Nevertheless, DSM-5 maladaptive personality domains showed mixed associations with AUD. Furthermore, no studies have explored the role of DSM-5 maladaptive personality domains on the comorbidity between AUD and different PDs. Objective(s): This study aims at investigating whether DSM-5 maladaptive personality dimensions could differentiate individuals with AUD from normative and healthy controls (HCs) subjects. The study also investigated relationships between these personality dimensions and AUD clinical features (i.e. onset, severity of concurrent substance use disorders), as well as their role in accounting for the comorbidity between AUD and PDs. Methods: This study administered the personality inventory for DSM-5 (PID-5) to 99 treatment-seeking individuals (male 68.8%; female 31.2%; age: 48.12 (14.32)) with AUD (41 AUD only; 58 AUD with PDs), comparing the participants' levels of PID-5 domains with normative data and the data from a HC sample (N = 40; male 50%; female 50%; age: 48.12 (14.32)). Results: Disinhibition and negative affectivity were relevant maladaptive personality dimensions of AUD, even when controlling for the impact of PD diagnoses. Disinhibition and negative affectivity were associated to the onset of AUD and the severity of concurrent substance use disorders. The co-occurrence of AUD and PDs is related to other two domains, namely antagonism and detachment. Conclusions: AUD is a complex psychopathological disorder in which both externalizing and internalizing aspects determine relevant clinical features.

Personality Traits and Impulsivity Tasks Among Substance Use Disorder Patients: Their Relations and Links With Retention in Treatment

BACKGROUND

Various authors have described the elements of impulsive approach and inhibitory control in drug users. These two components have been studied in terms of personality traits, performance on tasks that measure impulsive behavior, and neurophysiology. However, few studies have analyzed the association between these constructs. Thus, the aim of the present study is to analyze the associations between personality traits and performance on impulsivity tasks.

METHODS

A follow-up study was conducted with a baseline assessment at the beginning and end of treatment. The sample was composed of 121 patients undergoing treatment in therapeutic communities. Personality domains were evaluated through the PID-5. The impulsivity tasks employed were the Iowa Gambling Task (IGT), Delay Discounting Test (DDT), Go/No-Go and Stroop test.

RESULTS

A correlation was found between DDT scores and the domains of detachment (r = -.315; p<.01), antagonism (r = -.294; p<.01), and disinhibition (r = .215; p<.05). Performance on the Stroop task was significantly associated with psychoticism (r = .232; p<.05) and negative affect (r = .212; p<.05). Multivariate analysis revealed that IGT scores and negative affect predict retention in treatment.

CONCLUSIONS

These findings partially support the hypothesized association between sensation-seeking personality traits and detachment with impulsive choice tasks; and the relationships between negative affect and psychoticism traits with performance on inhibitory control tasks. Further, impulsive choice task scores and negative affect are both shown to predict retention in treatment.

A Brief but Comprehensive Review of Research on the Alternative DSM-5 Model for Personality Disorders

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.

Serious mental illness and negative substance use consequences among adults on probation

BACKGROUND

Adults on probation are at greater risk of both using substances and having a mental disorder compared to the general population. Several theories explain the relationship between substance use and poor mental health. However, the interaction between substance use, mental health, and substance-related consequences is not well understood. A better understanding of this relationship may help treatment programs become more responsive to people with serious mental illness (SMI).

METHOD

The current study used interview data from 313 adults on probation who reported recent substance use. We examined associations between SMI risk, substance use, and substance use consequences.

RESULTS

A substantial proportion of the sample (37.5%) screened at risk of having a SMI. Adjusting for type and amount of substance use, those who screened at risk of having a SMI reported more negative substance use consequences. Significant interaction effects were observed between use of alcohol or opiates and SMI risk. Alcohol use was associated with more negative substance use consequences among those at risk of SMI, while opiate use was associated with more consequences among those not at risk.

CONCLUSIONS

Programs are sorely needed to identify and treat adults with comorbid substance use and mental health symptoms, particularly for adults in the justice system. Clinicians should carefully consider how mental health may interact with substance use to exacerbate consequences.