Development of a Short and ICD-11 Compatible Measure for DSM-5 Maladaptive Personality Traits Using Ant Colony Optimization Algorithms

The Expression Regulation Scale (ERS): Validation of Three Emotion Domains for Expressive Norms with Close and Distant Others in Private and Public Situations

The social norms that guide emotional expression are critical for successful interpersonal interaction. However, the intricate emotional architecture underpinning these norms has remained largely unexplored. Our study is the first to rigorously investigate "display rules" or expressive norms for a comprehensive set of 64 theory-based emotions, utilizing a representative sample from the United Kingdom. The sample reflected national census demographics based on age, sex, and ethnicity. We measured expressive norms ranging from suppression to amplification in four social situations, combining two settings (public vs. private) and interactant types (close relations vs. distant others). Using a theory-building subsample (n = 507), we employed ant colony optimization (AOC) algorithms and a suite of factor analytical techniques to distill the emotions into three domains: affiliative, vulnerable, and disruptive. Subsequent validation in a separate confirmatory subsample (n = 506) supported this structure in all four situations (conditions), providing evidence these domains were robust. Notably, this new Expression Regulation Scale (ERS) demonstrated scalar invariance across all situations using repeated measures confirmatory factor analysis. We introduce scoring metrics and norms to aid researchers and practitioners in their analytical endeavors and highlight potential avenues for future research aimed at enriching our understanding of expression regulation.

Validation of the Persian Version of the ICD-11 Compatible Personality Inventory for DSM-5- Brief Form Plus, Modified

Clinical assessment increasingly emphasizes six maladaptive domains of the DSM-5 and ICD-11 trait models, including negative affectivity, detachment, antagonism/dissociality, disinhibition, psychoticism, and anankastia. The present study aimed to validate the Persian version of the ICD-11 compatible Personality Inventory for DSM-5-Brief Form Plus, Modified (PID5BF + M). Data from a mixed sample including 1,615 adults (community N = 1,476 and outpatient N = 139) were used to assess the latent structure, congruence coefficients, reliability, convergent validity, and criterion validity of the PID5BF + M. The results supported the six-factor structure of the PID5BF + M whose traits are largely congruent with those from previous studies. The scale reliabilities were acceptable, and strong associations were observed with personality disorder-type symptom counts (r ranging from .15 to .59, all p < .001). PID5BF + M scales also distinguished clinical and non-clinical samples. The present results support the validity and utility of the PID5BF + M for personality psychopathology screening in the Iranian population.

Wherefrom and Whither PD? Recent Developments and Future Possibilities in DSM-5 and ICD-11 Personality Disorder Diagnosis

PURPOSE OF REVIEW

Provide an overview of the Alternative DSM-5 model of Personality Disorder (AMPD) and ICD-11's PD diagnostic model; review the models' assessment measures and construct validity; describe the models' current and ongoing status.

RECENT FINDINGS

The models have many content similarities but differ significantly in that maladaptive-range traits are an AMPD requirement, but optional specifiers in ICD-11. An extensive literature using the Personality Inventory for DSM-5 (PID-5) has yielded comprehensive reviews of its clinical utility and construct validity. Structural meta-analyses found three core facets for each of the five domains, and correlations with non-FFM measures identified 13 traits with maladaptive content not assessed by the PID-5. Joint analyses of AMPD personality-functioning measures find a clear general factor, but have raised concerns about discriminant validity among measures and with Criterion B. For both criteria, the multimethod assessment literature is sparce. Regarding ICD-11, few measures assess the required personality functioning, but one has shown promising construct validity. Multiple measures assess the optional trait specifiers, the most noteworthy of which was developed by an international group, exists in 12 languages, and assesses all six domains of the DSM-5 and ICD-11.

CONCLUSION

The status of the ongoing revision process for the AMPD is described. It seems likely-but far from guaranteed-to result in a dimensional model in the main DSM-5 section. The next step for the ICD-11 is development of a version with Research Diagnostic Criteria, but the timeline is unknown.

A Meta-Analysis of the Psychometric Properties of the ICD-11 Compatible Personality Inventory for DSM-5-Brief Form Plus, Modified (PID5BF+M)

The ICD-11 compatible, Personality Inventory for DSM-5-Brief Form Plus, Modified (PID5BF+M), has recently been developed to assess the constructs of the ICD-11 and DSM-5 maladaptive trait models. This meta-analysis aimed to evaluate the pooled estimates of the structural validity (model fit indices, factor loadings, and internal consistency of individual scales), discriminant validity (factor intercorrelations), and criterion validity (standardized mean differences between clinical and nonclinical samples) of the PID5BF+M. A systematic search for scientific articles published between January 2013 and November 2024 was conducted in PubMed, PsycNET, and Google Scholar. The pooled estimates were calculated using the random effects method following the PRISMA guidelines. The quality of individual studies, heterogeneity, and publication bias were checked. Five high-quality reports including 21 independent samples (3056 patients and 17,361 nonpatients) were entered into the meta-analysis. The six-factor structure of the PID5BF+M was supported by the pooled estimates of model fit (RMSEA = 0.03, CFI = 0.98, TLI = 0.96, and SRMR = 0.01), moderate to very strong factor loadings (from 0.43 to 0.74), and an acceptable internal consistency (ω between 0.70 and 0.79 for all factors with a median of 0.75). The factor intercorrelations were weak to moderate (from 0.05 to 0.38) and the mean scores of most factors (except antagonism) were higher in the patients. The PID5BF+M is an applicable scale to measure maladaptive personality constructs with acceptable structural, discriminant, and criterion validity. Mental health professionals and researchers can use the scale, taking into account some methodological considerations of the present meta-analysis. The study protocol was preregistered in PROSPERO-CRD42024507164.

Shortening Psychological Scales: Semantic Similarity Matters

In this study, we proposed a novel scale abbreviation method based on sentence embeddings and compared it to two established automatic scale abbreviation techniques. Scale abbreviation methods typically rely on administering the full scale to a large representative sample, which is often impractical in certain settings. Our approach leverages the semantic similarity among the items to select abbreviated versions of scales without requiring response data, offering a practical alternative for scale development. We found that the sentence embedding method performs comparably to the data-driven scale abbreviation approaches in terms of model fit, measurement accuracy, and ability estimates. In addition, our results reveal a moderate negative correlation between item discrimination parameters and semantic similarity indices, suggesting that semantically unique items may result in a higher discrimination power. This supports the notion that semantic features can be predictive of psychometric properties. However, this relationship was not observed for reverse-scored items, which may require further investigation. Overall, our findings suggest that the sentence embedding approach offers a promising solution for scale abbreviation, particularly in situations where large sample sizes are unavailable, and may eventually serve as an alternative to traditional data-driven methods.

Psychometric Properties of the Persian Version of PID5BF + M in Iranian Drug Users

BACKGROUND

This study aimed to adapt and evaluate the psychometric properties of the PID5BF + M as a brief measure for assessing DSM-5 and ICD-11 personality disorder traits in Iranian drug users. The sample consisted of 380 participants, including both clinical (28.68%) and nonclinical (71.32%) groups, with 43.7% female participants. All participants completed the Personality Inventory for DSM-5 and ICD-11 Brief Form-Modified (PID5BF + M), the Symptom Checklist-25 (SCL-25), the Brief Five-Factor Inventory (BFI-10), the Level of Personality Functioning Scale-Brief Form (LPFS-BF 2.0), and the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST).

RESULTS

The findings revealed that the PID5BF + M demonstrates strong psychometric properties, with a six-factor structure that is culturally appropriate for the Iranian population. Significant associations were found between the ICD-11/DSM-5 traits and both internalizing and externalizing symptoms, as well as with normal personality factors.

CONCLUSIONS

The PID5BF + M appears to be a valid and reliable tool for assessing DSM-5 and ICD-11 personality disorder traits in Iranian drug users, showing promising potential for use in clinical and research settings within this cultural context.

Culture and ICD-11 personality disorder: Implications for clinical practice across diverse ethnic groups

BACKGROUND

Personality disorder (PD) in ICD-11 is defined primarily by self and interpersonal dysfunction and optionally by other qualifiers. This definition is inseparable from relativism of cultural determinants.

AIMS

This review aimed to synthesize the relevant aspects of the influence of culture on clinical practice and health management for this condition, aligning them to the ICD-11 PD model.

METHOD

In Scopus, we systematically searched for studies that included the text strings: cultur* | personality AND (disorder* OR patholog*) without any restrictions on publication date or language or other exclusion criteria, up to November 2022.

RESULTS

Evidence suggests that cultural variables in ethnic groups (Western and non-Western) such as the individualist/collectivist philosophy, historical/generational trauma, immigration, acculturation, religion, and gender influence the etiology, semiology, epidemiology, evaluation, diagnosis, treatment, and management of health services for ICD-11 PD. We discuss the limitations and propose future lines of research on this topic based on our knowledge and experience. In this review, we provide the scientific community and clinicians with relevant cultural information to guide their practice and propose strategies to manage PD from the ICD-11 model.

CONCLUSIONS

More research is needed using mixed study methodologies on stigma, the experiences of patients, clinicians, and health agencies, to reduce the care gaps and achieve a culturally comprehensive, inclusive, and competent use of this new model.

A Meta-Analysis of the Structural Validity of Original and Brief Versions of the Personality Inventory for DSM-5 in Iran

Objective: The Personality Inventory for DSM-5 (PID-5) is a widely used scale to evaluate the dimensional constructs of two trait models proposed by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the International Classification of Diseases (ICD-11). The present meta-analysis first aimed to examine the factor structure, reliability, and congruence coefficients of the Persian version of the PID-5 to assess both trait models. The second aim was to evaluate the factor structure and reliability of the Persian version of the Personality Inventory for DSM-5-Brief Form (PID-5-BF). Method : A systematic search was conducted in PubMed, Magiran, and SID to find records in English and Farsi from January 2013 to December 2023. According to the PRISMA, data from nine medium- to high-quality reports including 7,608 participants were analyzed using the random-effects method. Quality of studies, heterogeneity, and publication bias were reported. Results: The five-factor structure of the PID-5 to measure both trait models was supported by the pooled estimates of factor loadings. The alpha coefficient median for the DSM-5 model was 0.83 (range: 0.82-0.90), and the congruence coefficient median was .91 (range: 0.80-0.97). The ICD-11 alpha median was .78 (range: 0.68-0.91), and congruency median was 0.90 (range: 0.71-0.96). The factor loadings for negative affectivity, detachment, antagonism, disinhibition, and psychoticism on the PID-5-BF were 0.44-0.69, 0.38-0.67, 0.46-0.72, 0.42-0.70, and 0.44-0.76, respectively, and the alpha median was 0.73 (range: 0.65-0.76). Conclusion: Since both the original and brief versions of the PID-5 are valid and strongly similar to international structures, the clinical and research applications of these questionnaires are recommended to mental health professionals in Iran.

Screening tools assessing mental illness in primary care: A systematic review

BACKGROUND

To better manage patients with a wide range of mental health problems, general practitioners would benefit from diagnostically accurate and time-efficient screening tools that comprehensively assess mental illness. Therefore, the aim of this systematic review was to identify screening tools that either take a multiple-mental disorder or a transdiagnostic approach. As primary and secondary outcomes, diagnostic accuracy and time efficiency were investigated.

METHODS

The data bases MEDLINE, Embase, Cochrane Library, Psyndex and PsycINFO were searched. Studies reporting on multiple-mental disorder or transdiagnostic screening tools used in primary care with adult patients were included. Sensitivity, specificity, positive and negative predictive value served as measures of diagnostic accuracy. Time efficiency was evaluated by the number of items of a screening tool and the time required for its completion and evaluation.

RESULTS

Eleven studies met the inclusion criteria. The majority of screening tools assessed multiple mental disorders separately. A sub-group of screening tools took a transdiagnostic approach by examining the spectrum of mood, anxiety and stress-related disorders. One screening tool used internalised, cognitive/somatic and externalised dysfunction as transdiagnostic domains of mental illness. Mostly, a sufficient sensitivity and specificity was reported. All screening tools were found to be time efficient.

CONCLUSION

The eleven identified screening tools can support general practitioners to identify patients with mental health problems. However, there was great heterogeneity concerning their diagnostic scope of psychopathology. Further screening tools for primary care are needed that target broad constructs of mental illness, such as transdiagnostic factors or personality dysfunction.

Epistemic trust and associations with psychopathology: Validation of the German version of the Epistemic Trust, Mistrust and Credulity-Questionnaire (ETMCQ)

Epistemic trust, defined as trust in socially transmitted knowledge, is discussed as a psychopathological factor in the context of new transdiagnostic approaches for the assessment of mental disorders. The aim of this study is to test the factorial, convergent, and discriminant validity of the German version of the new Epistemic Trust, Mistrust and Credulity-Questionnaire (ETMCQ). Data were collected cross-sectionally from the German-speaking general population (N = 584) and in a second sample of clinical (n = 30) and non-clinical (n = 30) participants. The previously proposed three-factor structure of the ETMCQ was analyzed using confirmatory factor analysis. The ETMCQ's ability to differentiate between clinical and non-clinical participants was tested with t-tests. Correlations with early childhood trauma, maladaptive personality traits, and impairments in personality functioning were examined. The relationship between epistemic trust and mentalization was analyzed in a structural equation model. Regarding the factorial validity, the model fit of the originally proposed ETMCQ proved to be insufficient. The model fit to the data was good for a shortened 12-item version. The study was unable to identify any significant differences between clinical and non-clinical participants. For mistrust and credulity, correlations with associated constructs supported their construct validity. However, the results for the trust subscale were heterogeneous. The study offers initial empirical support for a revised 12-item self-report measure of epistemic trust and for the link between mistrust and credulity with markers of psychopathology. Further investigation of the ETMCQ and its psychometric properties, as well as research on integration of epistemic trust into new, transdiagnostic approaches to psychopathology is needed.

Evaluating the Psychometric Properties of the German Self and Interpersonal Functioning Scale (SIFS)

The Self and Interpersonal Functioning Scale (SIFS) is a 24-item self-report questionnaire assessing personality functioning according to the alternative DSM-5 model for personality disorders. We evaluated the German SIFS version in a total sample of 886 participants from Germany and Switzerland. Its factor structure was investigated with confirmatory factor analysis comparing bifactor models with two specific factors (self- and interpersonal functioning) and four specific factors (identity, self-direction, empathy, and intimacy). The SIFS sum and domain scores were tested for reliability and convergent validity with self-report questionnaires and interviews for personality functioning, -organization, -traits, -disorder categories, and well-being. None of the bifactor models yielded good model fit, even after excluding two items with low factor loadings and including a method factor for reverse-keyed items. Based on a shortened 22-item SIFS version, models suggested that the g-factor explained 52.9-59.6% of the common variance and that the SIFS sum score measured the g-factor with a reliability of .68-.81. Even though the SIFS sum score showed large test-retest reliability and correlated strongly with well-established self-report questionnaires and interviews, the lack of structural validity appears to be a serious disadvantage of the SIFS compared to existing self-reports questionnaires of personality functioning.

Internal consistency of measures for ICD-11 personality disorder severity and traits: A systematic review and meta-analysis

A number of measures and scales have been developed for the ICD-11 personality disorder (PD) diagnosis, including severity and trait dimensions. The present systematic review and meta-analysis sought to evaluate the internal consistency of these measures across different populations and cultures. A systematic search was conducted across four databases where relevant studies were subjected to explicit eligibility criteria resulting in 49 included studies and 370 effect sizes. Study characteristics were tabulated, their methodological quality was evaluated, and findings were synthesized using random effects meta-analysis. Findings overall indicated that measures of ICD-11 PD severity and trait domains have adequate levels of internal consistency (α/ω = 0.82, 95% CI [0.81; 0.83], I2 = 97.3%). Aspects such as sample, country, language, format, and measured construct were significant sources of variation. Additional meta-analyses revealed that some measures performed better than others for certain dimensions. Internal consistency was overall supported across ICD-11 measures of severity and trait domains. Future research should further investigate the interrater reliability, test-retest reliability and stability, and alignment with interview-based PD diagnoses.

Verification of five-factor models and reference scores for personality dysfunction and trait domains of the Personality Assessment Questionnaire for ICD-11 (PAQ-11), revised version

A brief self-reported measure of the Personality Assessment Questionnaire for the 11th edition of the World Health Organization's International Classification of Disease (ICD-11) (PAQ-11) was developed to evaluate ICD-11 personality traits. The aim of this study was to investigate the validity of the revised PAQ-11 version (PAQ-11R) with an additional item in the Dissociality domain and thresholds for the severity of personality dysfunction and domains. Study 1 examined the construct validity of the PAQ-11R in 192 university students in Korea. Study 2 estimated tentative reference scores of personality dysfunction and domains of the PAQ-11R in 91 patients in Korea. In study 1, the PAQ-11R had a five-factor structure and the revised Dissociality scale had better convergent and discriminant validities than the previous version. In study 2, the receiver operating characteristic (ROC) curve of the PAQ-11R identified a threshold score of 35. Reference scores for domains were estimated as 15 for Negative Affectivity, 10 for Detachment, 8 for Anankastia, and 5 each for Disinhibition and Dissociality. These scores contribute to severity of personality disturbance but remain qualifiers only; they are not diagnostic. The results suggest that the PAQ-11R is useful as a quick assessment tool for identifying the domains of personality dysfunction in clinical practice in harmony with the ICD-11 guidelines.

Development and Validation of Dimensional Clinical Personality Inventory 2 (IDCP-2) Algorithms to Assess ICD-11 Personality Trait Domain Qualifiers

With the advent of the new diagnostic model for personality disorders in the 11th revision of the International Classification of Diseases (ICD-11), researchers and practitioners in World Health Organization signatory countries are urged to implement it. This study aims to develop a brief, reliable, and valid scale for assessing maladaptive personality traits according to the ICD-11 model, using the item pool of the Dimensional Clinical Personality Inventory (IDCP-2). Quantitative and qualitative criteria for item selection were applied to a sample of 251 Brazilian adults. As a result, the 25 items (five items per factor) were selected, demonstrating promising evidence of validity based on the internal structure with a database of 1,659 Brazilian adults. In addition, we found good evidence of validity based on relationships with external variables, particularly those related to personality pathology, in a sample of 617 Brazilian adults. The implications of these findings are discussed.

Longitudinal Associations of Experiential and Reflective Dimensions of Meaning in Life With Psychopathological Symptoms

Background

Rather than being rooted in deliberate reflection, the experience of meaning has been shown to evolve from intuitive processes (Heintzelman & King, 2013b, https://doi.org/10.1007/978-94-007-6527-6_7). Accordingly, experiential and reflective dimensions of meaning in life can be distinguished (Hill et al., 2019, https://doi.org/10.1080/09515070.2018.1434483). In this preregistered study, we explored how these dimensions are longitudinally associated with psychopathological symptoms. We expected that experiencing more meaning would predict fewer depressive symptoms and fewer personality functioning impairments six months later, whereas reflecting about meaning would predict more psychopathological symptoms.

Method

A German-speaking sample of N = 388 completed self-report measures assessing meaning in life, depression, and personality functioning at baseline and six months later.

Results

Controlling for depression at baseline, elevated levels of experiencing meaning in life predicted a decrease in depressive symptoms. Experiencing meaning did not predict personality functioning impairments six months later. However, exploratory analyses with a larger sample tentatively showed that experiencing meaning in life predicted less impairments in personality functioning. Evidence supporting the hypothesized association between reflection and future depression as well as future personality functioning impairments was discerned through exploratory analyses. Generalizability of results to clinical care settings is limited due to the studied non-clinical sample. No causal conclusions can be drawn from the data because the study employed an observational design with two assessment points.

Conclusion

Experiencing meaning in life emerged as a potential protective factor against future psychopathological symptoms, whereas exploratory analyses pointed to an opposite relationship for reflection about meaning in life. Results are discussed with regard to clinical implications and directions for future research.

Ant colony optimization for parallel test assembly

Ant colony optimization (ACO) algorithms have previously been used to compile single short scales of psychological constructs. In the present article, we showcase the versatility of the ACO to construct multiple parallel short scales that adhere to several competing and interacting criteria simultaneously. Based on an initial pool of 120 knowledge items, we assembled three 12-item tests that (a) adequately cover the construct at the domain level, (b) follow a unidimensional measurement model, (c) allow reliable and (d) precise measurement of factual knowledge, and (e) are gender-fair. Moreover, we aligned the test characteristic and test information functions of the three tests to establish the equivalence of the tests. We cross-validated the assembled short scales and investigated their association with the full scale and covariates that were not included in the optimization procedure. Finally, we discuss potential extensions to metaheuristic test assembly and the equivalence of parallel knowledge tests in general.

Cognitions in antisocial personality and their association with "dark" traits

Unlike the cognitions associated with depressive symptoms, little is known about those associated with antisocial personality and with its related traits ("dark traits"). Using the scrambled sentences task, an instrument from depression research, we investigated cognitions such as justifications (external blaming for one's behavior) and harm to others (based on the notion that some of these individuals enjoy harming or humiliating others) that we hypothesized may be prevalent in those high in antisocial personality traits. Confirming our hypothesis, these cognitions were associated with ratings on different antisocial personality scales and with antisocial and detachment scores in the alternative model of personality disorders of the DSM-5 (AMPD) in three non-clinical samples, but not with depressive symptoms or neuroticism. Cognitions including harm to others were differentially associated with high sadism. These findings empirically characterize classes of cognitions that are shared by individuals with antisocial tendencies, and that differ from those associated with depressive symptoms.

Measuring maladaptive personality traits with the Structured Clinical Interview for DSM-IV Axis II Screening Questionnaire using a common metrics approach

The classification of personality disorder (PD) is undergoing a paradigm shift in which categorically defined specific PDs are being replaced by dimensionally defined maladaptive trait domains. To bridge the classificatory approaches, this study attempts to use items from the categorical PD model in DSM-IV to measure the maladaptive trait domains described in DSM-5 Section III/ICD-11. A general population sample comprising 1228 participants completed the Screening Questionnaire of the Structured Clinical Interview for DSM-IV Axis II (SCID-II-SQ), the Personality Inventory for DSM-5 (PID-5), and the anankastia scale of the Personality Inventory for ICD-11 (PiCD). Using item response theory models and a psychometric linking technique, SCID-II-SQ items were evaluated for their contribution to measuring maladaptive trait domains. The best discriminating items were then selected to derive proxy scales. We found that convergent validity of these proxy scales was in a similar range to that of other self-report measures for PD, except for the proxy scale for PiCD anankastia. However, only the proxy scale for negative affectivity showed acceptable reliability that would allow its application in research settings. Future studies should seek to establish a common metric between specific PDs and maladaptive trait domains using self-report measures with higher specificity or semi-structured interviews.

A randomized controlled trial to compare the effects of time-restricted eating versus Mediterranean diet on symptoms and quality of life in bipolar disorder

BACKGROUND

The primary objective of this randomized controlled trial (RCT) is to establish the effectiveness of time-restricted eating (TRE) compared with the Mediterranean diet for people with bipolar disorder (BD) who have symptoms of sleep disorders or circadian rhythm sleep-wake disruption. This work builds on the growing evidence that TRE has benefits for improving circadian rhythms. TRE and Mediterranean diet guidance will be offered remotely using self-help materials and an app, with coaching support.

METHODS

This study is an international RCT to compare the effectiveness of TRE and the Mediterranean diet. Three hundred participants will be recruited primarily via social media. Main inclusion criteria are: receiving treatment for a diagnosis of BD I or II (confirmed via DIAMOND structured diagnostic interview), endorsement of sleep or circadian problems, self-reported eating window of ≥ 12 h, and no current mood episode, acute suicidality, eating disorder, psychosis, alcohol or substance use disorder, or other health conditions that would interfere with or limit the safety of following the dietary guidance. Participants will be asked to complete baseline daily food logging for two weeks and then will be randomly allocated to follow TRE or the Mediterranean diet for 8 weeks, during which time, they will continue to complete daily food logging. Intervention content will be delivered via an app. Symptom severity interviews will be conducted at baseline; mid-intervention (4 weeks after the intervention begins); end of intervention; and at 6, 9, and 15 months post-baseline by phone or videoconference. Self-rated symptom severity and quality of life data will be gathered at those timepoints, as well as at 16 weeks post baseline. To provide a more refined index of whether TRE successfully decreases emotional lability and improves sleep, participants will be asked to complete a sleep diary (core CSD) each morning and complete six mood assessments per day for eight days at baseline and again at mid-intervention.

DISCUSSION

The planned research will provide novel and important information on whether TRE is more beneficial than the Mediterranean diet for reducing mood symptoms and improving quality of life in individuals with BD who also experience sleep or circadian problems.

TRIAL REGISTRATION

ClinicalTrials.gov ID NCT06188754.

Replicability of the five-factor structure of DSM-5 and ICD-11 trait systems and their associations with binge eating and bipolar spectrum psychopathology

Since the research on contemporary personality models-and psychopathology-mainly originate from the Western world, we aimed to test the factorial structure of two trait systems assessed with the Personality Inventory for DSM-5 (PID-5) in a non-Western sample and to compare the extracted models' relative associations with binge eating disorder (BED) and bipolar spectrum disorder (BSD) symptoms. A community sample (N = 516; 72% female) was administered the PID-5, which can operationalize both the DSM-5 and ICD-11 systems. The factor structures of both systems were tested using exploratory structural equation modeling (ESEM). The congruence coefficients of all factor loadings with international studies were calculated. The Binge Eating Scale (BES), Bipolar Spectrum Diagnostic Scale (BSDS), and Hypomania Checklist-32-Revised (HCL-32) were used to measure the criterion variables. Linear regression models were used for comparing the DSM-5 and ICD-11 systems in predicting the BED and BSD. The findings supported five-factor solutions for both trait systems. Both systems significantly predicted dimensional measures of both BED and BSD (all p < 0.001). The present findings support an acceptable five-factor structure for both personality systems in the non-Western sample. Different algorithms of maladaptive domains on both systems are related to binge eating and bipolar spectrum psychopathology.

Establishing circularity: development and validation of the circular work value scale (CWVS)

Objectives

Addressing the lack of German-language instruments, this study aims to develop a questionnaire that enables the measurement of work values. According to the theory of basic human values (Schwartz, 1992), a culturally fitting questionnaire is validated by covering constructs in the four broader dimensions of Social, Prestige, Intrinsic, and Extrinsic work values. Convergent, discriminant and incremental congruent validity are assessed.

Method

Data were collected in a cross-sectional online-based panel survey. Individuals working more than 20 h per week were included (N = 1,049). Using a genetic algorithm, an economical and valid questionnaire was designed to assess work values.

Results

The 11 work values are measurable with three items each. They provide a good fit to the data with support for strict measurement invariance. The empirical associations to estimate construct validity overall reflect expected relations to social and individualistic work motives, neuroticism, environmental awareness, and basic values. Furthermore, congruent incremental validity is supported with relations to value congruence of the person-organization fit, and multidimensional scaling supports the assumed theoretical circularity of the work values.

Implications

This study developed a questionnaire that enables a theory-based valid measurement of work values. The questionnaire allows practitioners to economically collect information about the value structure of employees or applicants. Future research should consider the development of work values over time and investigate whether more distinctive constructs provide a better fit in the nomological network.

Maladaptive personality traits in patients with epilepsy and psychogenic non-epileptic seizures

OBJECTIVE

We aimed to evaluate the sociodemographic, clinical, and psychological characteristics associated with psychogenic non-epileptic seizures (PNES) in patients with epilepsy, with particular emphasis on the personality profile assessed from a dimensional perspective.

METHODS

The cohort study included 77 consecutive inpatients with active epilepsy aged 36-55 years; 52 (67.5%) were female. The presence of PNES was confirmed by video-EEG monitoring. All patients underwent the Mini-International Neuropsychiatric Interview to diagnose psychiatric disorders. All participants completed the Neurological Disorders Depression Inventory in Epilepsy, the Epilepsy Anxiety Survey Instrument - brief version, and the Personality Inventory for DSM-5 and ICD-11 Brief Form Plus Modified. Chi-square and Fisher's exact tests were used to compare categorical variables, and the Brunner-Munzel test was used for quantitative variables.

RESULTS

Twenty-four patients (31.2%) had both epilepsy and PNES. There were no significant differences in social, demographic or clinical characteristics, psychiatric diagnoses or depression severity. Compared to patients with epilepsy alone, patients with epilepsy and PNES had higher anxiety scores and more pronounced maladaptive personality traits such as disinhibition and psychoticism.

SIGNIFICANCE

The main novelty of our study is that using the recently proposed dimensional approach to personality disorders and an appropriate instrument we assessed all personality domains listed in two of the most widely used classifications of mental disorders (DSM-5 and ICD-11) in PWE with and without PNES. To our knowledge, this is the first study to demonstrate the association of the maladaptive traits of psychoticism and disinhibition with the development of PNES in PWE.

Examining Measurement Invariance in the Personality Inventory for DSM-5 Brief Form Across Sexual and Gender Minority Status

The Personality Inventory for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Brief Form (PID-5-BF) was developed with an assumption of invariance across sexual and gender minority (SGM) individuals. This assumption has yet to be tested empirically. Using multigroup confirmatory factor analysis, we examined measurement invariance in the PID-5-BF across the SGM status in clinical (N = 1,174; n = 254 SGM) and nonclinical (N = 1,456; n = 151 SGM) samples. Measurement invariance was supported for the PID-5-BF structure, item thresholds, and factor loadings, but not at the item intercept level. SGM individuals endorsed higher negative affectivity, antagonism, disinhibition, and psychoticism domains in both samples. In the clinical sample, adjusting for partial invariance decreased detachment and antagonism levels for SGM persons. In the nonclinical sample, adjusting for partial invariance reduced antagonism disparities in the SGM group, even rendering original group differences null. Our results support the use of the PID-5-BF in SGM populations but indicate that some measurement bias may drive observed disparities in maladaptive trait domains and, in turn, personality disorder diagnosis.

Efficacy of an Internet-based self-help intervention with human guidance or automated messages to alleviate loneliness: a three-armed randomized controlled trial

Loneliness is a prevalent and stigmatized phenomenon associated with adverse (mental) health outcomes. However, evidence-based interventions to alleviate loneliness are scarce. This randomized controlled trial (ClinicalTrials.gov-ID: NCT04655196) evaluated the efficacy of an internet-based cognitive behavioral self-help intervention (ICBT) to reduce loneliness by comparing two intervention groups with guidance or automated messages against a waitlist control group. Adults (N = 243) suffering from loneliness were recruited from the general public and then randomly assigned (2:2:1) to a 10-week ICBT with human guidance (GU) or automated messages (AM) or to a waitlist control group (WL). Loneliness, assessed with the UCLA-9, was the primary outcome. Outcomes were assessed at baseline and 10 weeks (post) and analyzed using mixed-effects models. The pooled intervention conditions resulted in lower loneliness scores at post-assessment than the WL (Cohen's d = 0.57, 95% CI [0.25; 0.89]) and reduced depressive symptoms, social anxiety, social avoidance behavior, and rejection sensitivity (d = 0.32-0.52). The GU group had lower loneliness scores at post-assessment than the AM group (d = 0.42, 95% CI [0.13; 0.70]). ICBT effectively alleviated loneliness, and guidance increased the reduction in loneliness compared to automated messages. Alleviating loneliness with ICBT further seems to reduce the overall burden of psychopathological symptoms.

Predictors and moderators of outcome of ICBT for loneliness with guidance or automated messages - A secondary analysis of a randomized controlled trial

Internet-based cognitive behavioral therapy (ICBT) is promising in alleviating loneliness in adults. Identifying individuals who benefit from ICBT for loneliness is pivotal to offering this intervention in a more targeted way and improving the intervention for those who do not benefit. This secondary analysis of a randomized controlled trial (RCT) aimed to identify predictors and moderators of outcome of an ICBT with guidance or automated messages for loneliness. In the RCT, 243 participants suffering from loneliness were randomly assigned to an ICBT with guidance (n = 98), automated messages (n = 97), or a waitlist-control condition (n = 48). In total, 180 participants completed the post-assessment (i.e., 10 weeks post-randomization). Outcomes were treatment outcome assessed with the UCLA-9 Loneliness Scale at post-assessment and treatment response, i.e., reliable improvement on the UCLA-9 from pre- to post. The relationship between a wide range of patient characteristics (grouped into socio-demographic, clinical, loneliness-specific, and treatment-related variables) and outcome was analyzed using multiple linear and logistic regressions. Feeling less burdened by loneliness resulted in higher odds of reliable improvement in guided ICBT compared to the waitlist-control condition. No treatment outcome or response moderators were identified for ICBT with automated messages compared to the waitlist-control group. Across active intervention groups, loneliness at baseline, age and fit between the tasks and goals of the intervention and participants' need predicted treatment outcome. Predictors of treatment response for ICBT with guidance and automated messages were not identified, and no variables differentially predicted the effects of ICBT with guidance or automated messages on the outcomes. In conclusion, individuals less burdened by their feelings of loneliness benefited more from guided ICBT. Lower baseline loneliness scores, younger age, and a better match between tasks and goals of the intervention and participants' needs also predicted a more favorable treatment outcome for both ICBT with guidance and automated messages.

A new performance-based measure of personality functioning impairment: development and preliminary evaluation of reliability and validity

Personality functioning impairment is at the center of many dimensional models of personality. Available measures of personality functioning impairment are limited to self-report, clinician-/informant-rated, and interview methods. Although researchers have begun investigating established performance-based instruments' potential for assessing personality functioning impairment, administration and scoring of these instruments is complex and the latent variables they measure diverge from personality functioning impairment as described in the ICD-11 and the Alternative Model for Personality Disorders (AMPD) of the DSM. We address this absence by developing and psychometrically evaluating the Level of Personality Functioning Scale-Questionnaire-based Implicit Association Test (LPFS-qIAT). The LPFS-qIAT's psychometric properties were evaluated across four studies, producing initial evidence supporting the new instrument's reliability as well as its convergent, discriminant, and criterion-related validity. As the first performance-based measure of personality functioning impairment that aligns with the AMPD and, to a degree the ICD-11, that is easily administered, scored, and interpreted, the LPFS-qIAT shows potential to become a valuable tool in both research and clinical practice.

[Quality characteristics and relevance to care of psychodynamic training outpatient clinics:The QVA Project]

Introduction: Quality assurance (QA) in outpatient psychotherapy is currently undergoing a process of change. Hitherto, QA has been conducted by means of an expert review procedure (the so-called "Gutachterverfahren"), inter- and supervision as well as further mandatory training. Data-based QA systems have been increasingly discussed in recent years. On behalf of the G-BA, the IQTIG has recently published a draft of a legally binding QA procedure, which has, however, raised substantial concerns and resistance. Design: TheQVA project has two objectives. First, it provides participating training outpatient clinics with a data-driven QA system that enables an automated and risk-adjusted overall evaluation based on relevant patient and referral parameters. Second, the data is used to conduct research on important issues regarding the relevant psychotherapeutic care provided by outpatient clinics. Results: Since the start of data collection in 2022, n = 2058 patients have been recruited so far (March 2023), and a complete baseline diagnostic report has been generated for n = 1112 patients. The cross-sectional analyses of all patients assessed so far show a high burden of depression, interpersonal problems and impaired quality of life with severe impairment of personality functions, pronounced conflict diagnosis and high utilization of inpatient and day hospital treatments. Discussion: This paper describes an easy-to-implement data-based QA system for psychodynamic training outpatient clinics, while at the same time allowing for the examination of healthcare- relevant questions in a large sample. The first experiences show that the system works technically stable and was well-received by the participating outpatient clinics.

Convergence between the dimensional PD models of ICD-11 and DSM-5: a meta-analytic approach

In the current diagnostic systems, the International Classification of Diseases-11th rev. (ICD-11) and the Diagnostic and Statistical Manual of Mental Disorders-5th ed. (DSM-5), the evaluation and diagnosis of personality disorder (PD) aim at dimensional examination of the severity of its dysfunction and the stylistic features that accompany it. Since their implementation, or even before, several measures have been developed to assess PD severity and traits in both models. Thus, convergent validity metrics have been reported with various PD measures; however, the convergence of the same constructs included in the measures of these two models remains undefined. The objective of the present review was to examine whether there is a sufficient relationship between PD measures of the ICD-11 and DSM-5 AMPD in the general population. For this meta-analytic review, systematic searches were conducted in Web of Science, PubMed, Scopus, and Google Scholar. We included studies that reported Pearson's r correlations without restrictions on language, age, sex, setting, type of sample, or informant of the measures. We excluded associations with anankastia, psychoticism or the borderline pattern because they were not comparable between one dimensional model and the other. We examined the quality of the evidence with the JBI Critical Appraisal Checklist for Analytical Cross Sectional Studies, and performed the random effects meta-analysis with the 'meta' package of the RStudio software. Of the 5,629 results returned by the search, 16 studies were eligible; and showed moderate quality. The risk of bias was manifested by not specifying the details of the sample, the recruitment environment, and the identification and control of confounding factors. Thirteen studies provided two or more correlations resulting in a total of 54 studies for meta-analysis. The overall effect size estimate (correlation) was moderate for the overall model (r = 0.62, 95% CI [0.57, 0.67], p < 0.0001, I2 = 97.6%). For the subgroup of associations, ICD-11 severity model and DSM-5 AMPD severity model, the correlation was also moderate (k = 10, r = 0.57, 95% CI [0.48; 0.66]; I2 = 92.9%); as for the subgroup of associations, ICD-11 traits model and DSM-5 AMPD traits model (k = 44, r = 0.63, 95% CI [0.57; 0.69], I2 = 97.9%). The convergent validity between measures of PD severity and traits between one diagnostic system and another has been demonstrated in this review and they can probably be used interchangeably because they also measure the same constructs. Future research can address the limitations of this study and review the evidence for the discriminant validity of these measures.

A Short Measure of the Big Five Aspects: Development and Validation of the BFAS-40

We present psychometric evidence for the BFAS-40, an abbreviated measure of the Big Five Aspects Scale (DeYoung et al., 2007). In Study 1, we developed the BFAS-40 using metaheuristic algorithms and cross-validated the factor structure of the shortened measure. In Study 2, we demonstrated that the BFAS and BFAS-40 correlate with external criteria in similar ways. In Studies 3 and 4, we provide convergent validity evidence by examining correlations between the BFAS-40 and other measures of typical and clinically relevant personality. Finally, in Study 5, we provide evidence of test-retest reliability as well as additional construct validity evidence. Across these five studies, we demonstrate that the BFAS-40 is a short, reliable, and valid measure of the Big Five Aspects.

Examining the construct validity of the Personality Assessment Questionnaire for ICD-11 (PAQ-11) personality trait domains in a community sample

The ICD-11 has a new diagnostic system for personality disorder, which includes five optional trait specifiers to characterize the diagnosed pathology. The current study evaluated the internal structure and construct validity of the Personality Assessment Questionnaire for ICD-11 (PAQ-11) personality trait domains in a US population-representative community sample. An exploratory factor analysis revealed the support for a four-factor model underlying the 17 PAQ-11 items, reflecting four of the five ICD-11 trait domains (Negative Affectivity, Detachment, Disinhibition and Anankastia). Moreover, correlation analyses revealed that the PAQ-11 domain scale scores were associated, as expected, with their counterparts from two other ICD-11 trait domain measures, as well as with traditional personality disorder scores. More broadly, the results raised questions about the structural integrity of the Dissociality domain scale, and the discriminant validity of the Disinhibition and Anankastia scales. The overall conclusion was nevertheless promising with respect to the PAQ-11 serving as a brief screening measure for the ICD-11 trait domains.

Impaired Personality Functioning in Children and Adolescents Assessed with the LoPF-Q 6-18 PR in Parent-Report and Convergence with Maladaptive Personality Traits and Personality Structure in School and Clinic Samples

To investigate if the Personality Disorder (PD) severity concept (Criterion A) of the ICD-11 and DSM-5 AMPD is applicable to children and adolescents, following the ICD-11 lifespan perspective of mental disorders, age-specific and informant-adapted assessment tools are needed. The LoPF-Q 6-18 PR (Levels of Personality Functioning Questionnaire Parent Rating) was developed to assess Impaired Personality Functioning (IPF) in children aged 6-18 in parent-reported form. It is based on the established self-report questionnaire LoPF-Q 12-18. Psychometric properties were investigated in a German-speaking clinical and school sample containing 599 subjects. The final 36-item version of LoPF-Q 6-18 PR showed good scale reliabilities with 0.96 for the total scale IPF and 0.90-0.87 for the domain scales Identity, Self-direction, Empathy, and Intimacy/Attachment and an acceptable model fit in a hierarchical CFA with CFI = 0.936, RMSEA = 0.078, and SRMR = 0.068. The total score discriminated significantly and with large effect sizes between the school population and (a) adolescent PD patients (d = 2.7 standard deviations) and (b) the younger patients (6-11-year-olds) with internalizing and externalizing disorders (d = 2.2 standard deviations). Informant agreement between parent and self-report was good at 0.47. Good construct validity can be assumed given sound covariation with related measures of psychopathology (CBCL 4-18, STiP-5.1, OPD-CA2-SQ PR) and maladaptive traits (PID5BF+ M CA IRF) in line with theory and matching the result patterns obtained in older samples in self-report. The results suggest that parent-reported assessments of IPF and maladaptive traits are equivalent to self-reported measures for Criterion A and B. Assessing IPF as early as age six might be a valuable step to foster early detection of PD, or maladaptive personality development, respectively individuals at risk.

The temporal dynamics of dissociation: protocol for an ecological momentary assessment and laboratory study in a transdiagnostic sample

BACKGROUND

Dissociation is a ubiquitous clinical phenomenon. Dissociative disorders (DD) are primarily characterized by dissociation, and dissociative states are also a criterion for borderline personality disorder (BPD) and the dissociative subtype of post-traumatic stress disorder (PTSD). Dissociative reactions (e.g., depersonalization/derealization or gaps in awareness/memory) across diagnostic categories are believed to be affect contingent and theorized to serve affect regulation functions. What is not clear, however, is how self-reported affect and physiological reactivity unfold within dissociative episodes. To address this issue, the present project aims to investigate the hypothesis (1) whether self-reported distress (as indicated by arousal, e.g., feeling tense/agitated, and/or valence, e.g., feeling discontent/unwell) and physiological reactivity increase before dissociative episodes and (2) whether self-reported distress and physiological reactivity decrease during and after dissociative episodes in a transdiagnostic sample of patients with DD, BPD, and/or PTSD.

METHODS

We will use a smartphone application to assess affect and dissociation 12 times per day over the course of one week in everyday life. During this time, heart and respiratory rates will be remotely monitored. Afterwards, participants will report affect and dissociative states eight times in the laboratory before, during, and after the Trier Social Stress Test. During the laboratory task, we will continuously record heart rate, electrodermal activity, and respiratory rate, as well as measure blood pressure and take salivary samples to determine cortisol levels. Our hypotheses will be tested using multilevel structural equation models. Power analyses determined a sample size of 85.

DISCUSSION

The project will test key predictions of a transdiagnostic model of dissociation based on the idea that dissociative reactions are affect contingent and serve affect regulation functions. This project will not include non-clinical control participants. In addition, the assessment of dissociation is limited to pathological phenomena.

[The Personality Inventory for ICD-11 (PiCD): Reliability and Validity of the German Version in a Clinical and Non-Clinical Sample]

The 11th version of the International Statistical Classification of Diseases and Related Health Problems (ICD-11) marks a paradigm shift in the diagnosis of personality disorders: In the near future, their classification will no longer be categorical, but dimensional along the severity of personality impairments and optionally regarding the presence of maladaptive personality traits. This study examines the reliability and validity of the German version of the Personality Inventory for ICD-11 (PiCD), a questionnaire designed to assess ICD-11 maladaptive personality domains, in a clinical and nonclinical sample (N=939). The factor structure of the PiCD was examined using Exploratory Factor Analysis (EFA) and showed a tendency for a four-factor model (Negative Affectivity, Dissociality, Detachment, and a bipolar factor Disinhibition-Anankastia). The subscales of the PiCD demonstrated acceptable to excellent reliability coefficients with Cronbach's α (0.79 - 0.89) and McDonald's ω (0.76 - 0.90). Convergent and discriminant validity were examined in conjunction with other questionnaires and were found to be satisfactory. The results suggest that the German version of the PiCD is a reliable and largely valid measurement instrument for assessing ICD-11 maladaptive personality traits. However, further research on factor structure, appropriate cut-off as well as norm values is needed.

Cross-walking personality disorder types to ICD-11 trait domains: An overview of current findings

The ICD-11 has adopted a classification of Personality Disorders (PD) that abolishes the established categorical PD types in favor of global severity classification with specification of individual trait domains. To facilitate and guide this profound transition, an overview of current research on empirical associations between established PD types and ICD-11 trait domains seems warranted. We identified a total of 9 relevant studies from 2018 to 2022, which were based on both clinical and community samples from U.S., China, Brazil, Denmark, Spain, Korea, and Canada. The patterns of associations with ICD-11 trait domains were systematically synthesized and portrayed for each PD type. Findings overall showed expected and conceptually meaningful associations between categorical PD types and ICD-11 trait domains, with only few deviations. Based on these findings, we propose a cross-walk for translating categorical PD types into ICD-11 trait domains. More research is needed in order to further guide continuity and translation between ICD-10 and ICD-11 PD classification in mental healthcare, including facet-level ICD-11 trait information. Moreover, the nine reviewed studies only relied on self-reported ICD-11 trait domains, which should be expanded with clinician-rated trait domains in future research. Finally, future research should also take ICD-11's essential PD severity classification into account.

Burnout among Male Physicians: A Controlled Study on Pathological Personality Traits and Facets

There is a high prevalence of job burnout in physicians, impacting both the professional and personal levels. This study aimed to investigate whether physicians with burnout show specific pathological traits and facets of their personalities compared with healthy controls, according to the dimensional personality models in the ICD-11 and DSM-5. The role of perceived stress, anxiety, and depression were exploratively investigated regarding group differences. Male physicians (n = 60) were recruited into two groups (burnout vs. healthy). The Personality Inventory for the DSM-5 Brief Form Plus (PID5BF+) and the Maslach Burnout Inventory (MBI) were applied. The Wilcoxon rank-sum test (WRS) showed group differences in five of the six traits and in six of the seventeen facets of the PID5BF+. Multiple binary logistic regression, controlling for age, showed that deceitfulness (3.34 (1.36–9.35), p = 0.013) and impulsivity (10.20 (2.4–61.46), p = 0.004) significantly predicted burnout. Moreover, the WRS showed significant group differences in perceived stress, depressive, and anxiety symptoms (all p < 0.00)]. The findings suggest a relationship between pathological personality facets and burnout in a sample of male physicians. In particular, the facets of deceitfulness and impulsivity appear to play an important role. Furthermore, burnout showed well-known associations with perceived stress, depressive, and anxiety symptoms.

Clinical Implications of ICD-11 for Diagnosing and Treating Personality Disorders

PURPOSE OF REVIEW

The International Classification of Diseases 11th revision (ICD-11) introduced a new approach to personality disorders and related traits. This paper reviews recent literature on the assessment of ICD-11 personality disorders and implications for clinical diagnosis, decision-making, and treatment.

RECENT FINDINGS

We reviewed findings on two measures developed for the ICD-11 model of personality dysfunction and six inventories for the ICD-11 trait specifiers. The psychometric qualities of these tools are promising, and they allow for both rapid screening and fine-grained assessment. Implications for clinical diagnosis and treatment of personality disorders are reviewed including utility for forensic practice. Based on evidence and our experience, we provide some recommendations for severity- and trait-informed interventions. Initial evidence supports the available instruments for assessing ICD-11 personality disorders. More research is needed including development of clinician-rating forms and diagnostic interviews as well as treatment protocols and trials based on the new ICD-11 classification.

Increasing the effectiveness of psychotherapy in routine care through blended therapy with transdiagnostic online modules (PsyTOM): study protocol for a randomized controlled trial

BACKGROUND

In blended therapy, face-to-face psychotherapy and Internet-based interventions are combined. Blended therapy may be advantageous for patients and psychotherapists. However, most blended interventions focus on cognitive behavioral therapy or single disorders, making them less suitable for routine care settings.

METHODS

In a randomized controlled trial, we will compare blended therapy and face-to-face therapy in routine care. We intend to randomize 1152 patients nested in 231 psychotherapists in a 1:1 ratio. Patients in the blended therapy group will receive access to a therapeutic online intervention (TONI). TONI contains 12 transdiagnostic online modules suited for psychodynamic, cognitive behavioral, and systemic therapy. Psychotherapists decide which modules to assign and how to integrate TONI components into the psychotherapeutic process to tailor treatment to their patients' specific needs. We will assess patients at baseline, 6 weeks, 12 weeks, and 6 months. Patients enrolled early in the trial will also complete assessments at 12 months. The primary outcomes are depression and anxiety at 6-month post-randomization, as measured by PHQ-8 and GAD-7. The secondary outcomes include satisfaction with life, level of functioning, personality traits and functioning, eating pathology, sexual problems, alcohol/drug use, satisfaction with treatment, negative effects, and mental health care utilization. In addition, we will collect several potential moderators and mediators, including therapeutic alliance, agency, and self-efficacy. Psychotherapists will also report on changes in symptom severity and therapeutic alliance. Qualitative interviews with psychotherapists and patients will shed light on the barriers and benefits of the blended intervention. Furthermore, we will assess significant others of enrolled patients in a sub-study.

DISCUSSION

The integration of online modules which use a common therapeutic language and address therapeutic principles shared across therapeutic approaches into regular psychotherapy has the potential to improve the effectiveness of psychotherapy and transfer it into everyday life as well help save therapists' resources and close treatment gaps. A modular and transdiagnostic setup of the blended intervention also enables psychotherapists to tailor their treatment optimally to the needs of their patients.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS) DRKS00028536. Registered on 07.06.2022.

The Road to Hell Is Paved With Good Intentions: How Common Practices in Scale Construction Hurt Validity

Sound scale construction is pivotal to the measurement of psychological constructs. Common item sampling procedures emphasize aspects of reliability to the disadvantage of aspects of validity, which are less tangible. We use a health knowledge test as an example to demonstrate how item sampling strategies that focus on either factor saturation or construct coverage influence scale composition and demonstrate how to find a trade-off between these two opposing needs. More specifically, we compile three 75-item health knowledge scales using Ant Colony Optimization, a metaheuristic algorithm that is inspired by the foraging behavior of ants, to optimize factor saturation, construct coverage, or a compromise of both. We demonstrate that our approach is well suited to balance out construct coverage and factor saturation when constructing a health knowledge test. Finally, we discuss conceptual problems with the modeling of declarative knowledge and provide recommendations for the assessment of health knowledge.

You are simply not funny: Development and validation of a scale to measure failed humor in leadership

Research has recently established the notion that humor in leadership contributes to the development of a positive professional relationship between leaders and followers. This relationship has been supposed to be the core mechanism via which humor in leadership unfolds its effects on work attitudes and behaviors. However, research has neglected the option that humor used by leaders might fail to amuse their followers. In this study, we investigate the role of failed humor for the relationship between leader and follower. More concretely, we develop a new scale for measuring failed humor in leadership and demonstrate its factorial and criterion-related validity. Using an automated item selection algorithm, we optimized the newly developed scale and derived a well-fitting six-item scale out of a pool of 12 items. In a study based on a sample of 385 employees, we were able to show that our newly developed scale is factorially valid. Moreover, we showed a negative correlation between failed humor and leader-member exchange. Furthermore, we showed incremental validity of failed humor in that failed humor predicted variance in leader-member exchange beyond well-established humor constructs such as affiliative and aggressive humor. Our study contributes to the development of the field of humor in leadership and opens up new options for further inquiry. Moreover, our study demonstrates the use of automated item selection algorithms in the applied field.

A meta-structure for DSM-5 and ICD-11 pathological traits and the differentiation of personality functioning at different trait levels in older adults

OBJECTIVES

Categorical criteria are not well suited to inform personality disorder (PD) diagnoses in older adults. More promising are the ICD-11 and DSM-5 alternative models. Both conceptualize PD by level of severity and maladaptive traits. Severity is conditional for making a PD diagnosis. Trait levels portray stylistic differences in PD expression. Yet, in older adults the hierarchical trait structure is unknown. Neither is the differentiation of the severity criterion from maladaptive traits confirmed.

METHODS

A series of exploratory factor analyses with progressively greater numbers of factors were conducted to examine the hierarchical trait structure in 293 community dwelling older adults. The on average differentiation of a single higher order personality functioning factor from trait factors at succeeding levels of the hierarchy was estimated with Cohen q effect size.

RESULTS

Six meaningful trait levels were identified. From the fourth trait level on the general personality functioning factor shared less than 15% variance on average with the trait factors. Trait factors at the sixth level corresponded to both DSM-5 and ICD-11 pathological traits.

CONCLUSION

A future nosology integrating DSM-5 and ICD-11 trait proposals would be applicable in older adults. Personality functioning can be differentiated from traits, so separate assessment of traits and severity is worthwhile.

You're Prettier When You Smile: Construction and Validation of a Questionnaire to Assess Microaggressions Against Women in the Workplace

Gender microaggressions, especially its subtler forms microinsults and microinvalidations are by definition hard to discern. We aim to construct and validate a scale reflecting two facets of the microaggression taxonomy: microinsults and microinvalidations toward women in the workplace, the MIMI-16. Two studies were conducted (N1 = 500, N2 = 612). Using a genetic algorithm, a 16-item scale was developed and consequently validated via confirmatory factor analyses (CFA) in three separate validation samples. Correlational analyses with organizational outcome measures were performed. The MIMI-16 exhibits good model fit in all validation samples (CFI = 0.936–0.960, TLI = 0.926–0.954, RMSEA = 0.046–0.062, SRMR = 0.042–0.049). Multigroup-CFA suggested strict measurement invariance between all validation samples. Correlations were as expected and indicate internal and external validity. Scholars on gender microaggressions have mostly used qualitative research. With the newly developed MIMI-16 we provide a reliable and valid quantitative instrument to measure gender microaggressions in the workplace.

Evaluation of the Efficacy of Two Internet-based Self-help Interventions for Chronic Loneliness: Study Protocol for a Three-arm Randomized Controlled Trial (Preprint)

Background

Loneliness, or perceived social isolation, is prevalent in both the general population and clinical practice. Although loneliness has repeatedly been associated with mental and physical health, research on interventions that reduce loneliness effectively is still rather scarce.

Objective

This study aims to evaluate the efficacy of a guided and an unguided version of the same internet-based cognitive behavioral self-help program for loneliness (SOLUS-D) for adults.

Methods

A total of 250 participants will be randomly assigned to 1 of 2 intervention groups (SOLUS-D with guidance or SOLUS-D without guidance) or a wait-list control group (2:2:1 allocation ratio). Adult participants experiencing high levels of loneliness will be recruited from the general population. Individuals currently experiencing at least moderately severe depressive symptoms, an ongoing severe substance use disorder, previous or current bipolar or psychotic disorder, or acute suicidality will be excluded from the trial. Assessments will take place at baseline, 5 weeks (midassessment), and 10 weeks (postassessment). The primary outcome is loneliness assessed using the 9-item University of California, Los Angeles Loneliness Scale at the posttreatment time point. Secondary outcomes include depressive symptoms, symptoms of social anxiety, satisfaction with life, social network size, and variables assessing cognitive bias and social behavior. The maintenance of potentially achieved gains will be assessed and compared at 6 and 12 months after randomization in the 2 active conditions. Potential moderators and mediators will be tested exploratorily. Data will be analyzed on an intention-to-treat basis.

Results

Recruitment and data collection started in May 2021 and are expected to be completed by 2022, with the 12-month follow-up to be completed by 2023. As of the time of submission of the manuscript, 134 participants were randomized.

Conclusions

This 3-arm randomized controlled trial will add to the existing research on the efficacy of loneliness interventions. Furthermore, it will shed light on the role of human guidance in internet-based treatments for individuals with increased levels of loneliness and the possible mechanisms of change. If SOLUS-D proves effective, it could provide a low-threshold, cost-efficient method of helping and supporting individuals with increased levels of loneliness.

Trial Registration

ClinicalTrials.gov NCT04655196; https://clinicaltrials.gov/ct2/show/NCT04655196

International Registered Report Identifier (IRRID)

DERR1-10.2196/36358

Implementation of the DSM-5 and ICD-11 Dimensional Models of Maladaptive Personality Traits Into Pre-bariatric Assessment

Background: Personality pathology does not have to be a contraindication to a bariatric surgery if a proper pre-surgical assessment is done. Indicating subgroups of patients with their specific needs could help tailor interventions and improve surgical treatment outcomes. Objectives: Using the Alternative DSM-5 model for personality disorders (AMPD) and the ICD-11 model for PDs to detect subgroups of patients with obesity based on a specific constellation of maladaptive personality traits and the level of overall personality impairment. Methods: 272 consecutively consented patients who underwent a standard pre-surgical psychological assessment. The majority were women (58.0%), age range was 22-79 years (M = 48.06, SD = 10.70). Patients' average body mass index (BMI) was 43.95 kg/m². All participants were administered the Personality Inventory for DSM-5 (PID-5) from which Level of Personality Functioning Scale-Self Report (LPFS-SR) and Standardized Assessment of Severity of Personality Disorder (SASPD) scores were gained using the "crosswalk" for common metric for self-reported severity of personality disorder. The k-means clustering method was used to define specific subgroups of patients with obesity and replicated for equality testing to the samples of non-clinical respondents and psychiatric patients. Results: The cluster analysis detected specific groups in the sample of patients with obesity, which differed quantitatively from the samples of non-clinical respondents and psychiatric patients. A vast majority of patients with obesity showed above-average values in most of the PID-5 facets compared to the United States representative general community sample. In two out of the three clusters defined, patients demonstrated moderate (> M + 1.5 × SD) to severe (> M + 2.0 × SD) personality psychopathology within the Detachment and Negative Affectivity domains according to PID-5, which in one of the clusters corresponded to the mild overall impairment in both, LPFS-SR (M = 2.18, SD = 0.27) and SASPD (M = 8.44, SD = 2.38). Moreover, higher levels of psychopathology prove to be associated with higher age and use of psychiatric medication. Conclusions: The dimensional DSM-5 and ICD-11 trait models are suitable procedures for defining specific "characters" of patients in a pre-bariatric setting. As such, they help to identify subgroups of patients with obesity who are different from general population and psychiatric patients. Implications for clinical practice and further research are discussed.

Self-reported narcissistic traits in patients with addiction through the lens of the ICD-11 model for personality disorders

BACKGROUND

There is a presumption that pathological narcissism, or narcissistic personality disorder per se, can be considered a precursor to addiction. Although the ICD-11 model does not distinguish specific personality disorders, narcissistic psychopathology should be captured through personality trait qualifiers.

OBJECTIVES

To verify the capacity of the ICD-11 model in the detection of narcissistic psychopathology in patients with addiction; to test its discrimination capacity, convergent validity, and specificity toward the gender and the type of addiction.

MATERIALS AND METHODS

Two samples were employed in the study. Sample 1 (n = 421) consisted of patients with addiction; Sample 2 (n = 567) consisted of general population volunteers. Age range was 18-75 years and a battery of self-assessment questionnaires containing Personality Inventory for DSM-5-Brief Form Plus Modified; Triarchic Psychopathy Measure; Hypersensitive Narcissism Scale; and Level of Personality Functioning Scale-Self-Report was administered by pencil-and-paper method.

RESULTS

The following was confirmed: (1) capacity of the ICD-11 model in relation to capture narcissistic pathology; (2) the differentiation capacity between the clinical and non-clinical population; (3) gender specificity in relation to grandiose and vulnerable narcissism; (4) the connection between the overall degree of impairment in personality functioning and most of trait qualifiers; (5) certain specifics of patients with addiction in relation to the type of addiction.

CONCLUSION

Results support the empirical and clinical relevance of the ICD-11 model in capturing narcissistic pathology in addicted patients. Clinical implications concerning assessment and treatment in addiction settings, and certain limits regarding the Anankastia domain are discussed.

A person-centered perspective on the combined DSM-5 AMPD/ICD-11 personality model: Utility, relationship with the categorical personality disorder model, and capacity to differentiate between levels of identity functioning

BACKGROUND

Both the ICD-11 classification of Personality Disorders and the DSM-5 Alternative Model for Personality Disorders (DSM-5 AMPD) conceptualize personality pathology in a dimensional way, but differ in the way they carve up their respective pathological personality domains. Recently, a combination of ICD-11 and DSM-5 AMPD descriptive pathological personality traits, the Modified Personality Inventory for DSM-5-Brief Form Plus (PID5BF + M), was developed.

THE CURRENT STUDY

We investigated the utility of the additional ANANKASTIA domain (not represented in the DSM-5 AMPD) as well as of the additional PSYCHOTICISM domain (not represented in the ICD-11 model) in the identification of meaningful pathological personality domain clusters based on the PID5BF + M. Next to the classical 2- and 3-cluster solutions, we examined whether the presence of the additional ANANKASTIA domain would also gave rise to a meaningful 4-cluster solution. We then validated these clusters by investigating differences between them in mean DSM-5 Section II cluster A, B, and C personality disorder scores. Finally, we investigated whether cluster membership was able to differentiate between levels of identity functioning, a key feature of personality disorder severity in both the ICD-11 model and the DSM-5 AMPD.

MATERIALS AND METHODS

We used a Flemish community sample of 242 participants, and applied k-means cluster analyses in a two-step manner on PID5BF + M domains to investigate 2-, 3-, and 4-cluster solutions. We used MANOVAs to examine differences between clusters in PID5BF + M domains, DSM-IV/DSM-5 Section II Assessment of Personality disorders (ADP-IV) cluster A, B, and C scores, and Self-Concept and Identity Measure (SCIM) scores.

RESULTS

Cluster analyses on PID5BF + M pathological personality domains (1) revealed meaningful 2-, 3-, and 4-cluster solutions, with the 4-cluster solution explaining the most variance in the clustering variables, (2) allowed to identify a classical Overcontrolled cluster which DSM-5 AMPD PID-5 does not, and (3) demonstrated the utility of representing ANANKASTIA and DISINHIBITON as separate pathological personality domains. PID5BF + M clusters (5) were informative of DSM-5 Section II cluster A, B, and C personality disorder scores and (6) showed different levels of clinical-developmental Identity functioning.

CONCLUSION

Current results demonstrate the utility of a combined ICD-11/DSM-5 AMPD view from a person-centered perspective.

Transdiagnostic Mechanisms of Mental Health During the COVID-19 Pandemic on Adults and Families in Germany: Study Protocol of a Cross-Sectional and 1-Year Longitudinal Study

Background: Since the outbreak of COVID-19 pandemic, psychological distress is increased. Transdiagnostic mechanisms, including trauma, personality functioning, mentalizing and emotion regulation are considered relevant to the development and maintenance of mental health problems and therefore may play a role in individuals’ reactions to the pandemic.

Aim: To identify moderating and mediating factors associated with pandemic-related distress and mental health problems in adults and families, we aim to investigate the interactions of interpersonal trauma (childhood trauma and domestic violence), psychological capacities (personality functioning, mentalizing and emotion regulation) and pandemic-related adversity on psychological distress during the COVID-19 pandemic. Furthermore, we aim to investigate behavioral and cognitive consequences of the pandemic (e.g., media consumption, vaccination status, conspiracy beliefs).

Methods: Using an online-based cross-sectional and longitudinal design, we will investigate a sample of adult participants recruited via online platforms in German-speaking countries over the course of 1 year with four measurements points via self-report instruments (personality functioning: PID5BF +; mentalizing: MentS, PRFQ; emotion regulation: DERS-SF; mental health problems: PHQ-9, GAD-7; a composite pandemic-related stress score). Structural equation and multi-level modeling will be performed for data analyses.

Implications: This study will provide data on the moderating and mediating effects of trauma, personality functioning and mentalizing during the pandemic in a large community sample, particularly on vulnerable groups like families. Identifying transdiagnostic mechanisms of psychopathology in the course of a pandemic crisis may provide valuable insight for the development of pre- and intervention measures for potential psychological distress during and post the pandemic.

Erstellung und Validierung einer Kurzversion des Fragebogens zur Erfassung aversiver und protektiver Kindheitserfahrung (APK-18)

Zusammenfassung. Die Erfassung von Kindheitserfahrungen stellt einen wichtigen Baustein für Verständnis und Behandlung psychischer Belastungen im Erwachsenenalter dar. Dabei kommt der Erfassung protektiver Kindheitserfahrungen neben etablierten aversiven Erlebnissen eine wachsende Bedeutung zu. Ziel der vorliegenden Studie ist die Erstellung einer validen, reliablen und zeitökonomischen Kurzform des Fragebogens zur Erfassung aversiver und protektiver Kindheitserfahrungen (APK). Mithilfe des Ant-Colony Optimization (ACO) Algorithmus wurden an einer klinisch-psychotherapeutischen Stichprobe ( n = 701) aus den 59 Items der Langversion ein Set von 18 Items identifiziert und an einer nicht-klinischen Stichprobe ( n = 643) validiert. Die Kurzversion (APK-18) zeigte gute Reliabilität und Validität und unterschied anhand latenter Mittelwertunterschiede zuverlässig zwischen klinischen und nicht-klinischen Teilnehmenden. Einschränkungen bezüglich der Reliabilität ergaben sich bei 2 der insgesamt 8 Sub-Skalen, „Sonstige traumatische Ereignisse“ und „Trennungserfahrungen“. Mit der Kurzversion APK–18 liegt ein ökonomisches und valides Messinstrument vor, welches in klinische Routineerhebungen integriert werden kann.

Does app-based unguided self-management improve mental health literacy, patient empowerment and access to care for people with mental health impairments? Study protocol for a randomised controlled trial

INTRODUCTION

Mental disorders pose a huge burden to both individuals and health systems. Symptoms and syndromes often remain undetected and untreated, resulting in comorbidity and chronification. Besides limited resources in healthcare systems, the treatment-gap is-to a large extent-caused by within-person barriers impeding early treatment seeking. These barriers include a lack of trust in professionals, fear of stigmatisation, or the desire to cope with problems without professional help. While unguided self-management interventions are not designed to replace psychotherapy, they may support early symptom assessment and recognition by reducing within-person barriers. Digital self-management solutions may also reduce inequalities in access to care due to external factors such as regional unavailability of services.

METHODS AND ANALYSIS

Approximately 1100 patients suffering from mild to moderate depressive, anxiety, sleep, eating or somatisation-related mental disorders will be randomised to receive either a low-threshold unguided digital self-management tool in the form of a transdiagnostic mental health app or care as usual. The primary outcomes will be mental health literacy, patient empowerment and access to care while secondary outcomes will be symptom distress and quality of life. Additional moderator and predictor variables are negative life events, personality functioning, client satisfaction, mental healthcare service use and application of self-management strategies. Data will be collected at baseline as well as 8 weeks and 6 months after randomisation. Data will be analysed using multiple imputation and analysis of covariance employing the intention-to-treat principle, while sensitivity analyses will be based on different multiple imputation parameters and a per-protocol analysis.

ETHICS AND DISSEMINATION

Approval was obtained from the Ethics Committee of the Faculty of Educational Science and Psychology at the Freie Universität Berlin. The results will be submitted to peer-reviewed specialised journals and presented at national and international conferences.

TRIAL REGISTERATION

The trial has been registered in the DRKS trial register (DRKS00022531);Pre-results.