Complementary approaches to the assessment of personality disorder. The Personality Assessment Schedule and Adult Personality Functioning Assessment compared

Nonconsensual Sexual Experience Histories of Incarcerated Men: A Mixed Methods Approach

Nonconsensual sexual experiences (NSEs) may contribute to mental health concerns among incarcerated individuals, yet NSEs are understudied in this population. This study takes a novel approach in examining the prevalence of NSEs among incarcerated males by utilizing both quantitative and qualitative measures. The sample consisted of 189 men from three provincial maximum-security prisons in Ontario, Canada. Based on quantitative findings, 44.2% of the sample experienced NSEs before the age of 18, and 41.7% of the sample endorsed an experience that fit the legal definition of a NSEs as adults. Participants also responded to a qualitative open-ended question about their history of NSEs. Based on qualitative findings, a total of 23% of the men reported at least one incident of a NSE (e.g., child and adult). Based Findings highlight the high prevalence of NSEs among incarcerated men with quantitative responses demonstrating how the use of a behavioral questionnaire may, to some extent, correct for underreporting of NSEs. Qualitative responses illustrate the lived experience of incarcerated men and provide a deeper understanding of their NSEs. Responses also speak to the lack of resources and support available to these men. Findings underscore the need for proactive approaches in meeting mental health needs of incarcerated men in general and with regard to NSEs in particular. Results may inform the development of future correctional procedures (i.e., intake protocols that account for men with NSEs) and resources to support incarcerated men in navigating the psychological impact of non-consensual sexual experiences.

Evaluating the role of functional impairment in personality psychopathology

DSM-5's Section III Alternative Model for Personality Disorder (AMPD) model states that an individual must show impairment in self and interpersonal functioning for PD diagnosis. The current study investigated dimensional personality trait associations with impairment, including differential patterns of impairment across specific PDs, and whether traits have improved our assessment of functional impairment in PDs. Two-hundred and seventy-seven participants were administered measures of Antisocial PD, Avoidant PD, Borderline PD, Narcissistic PD, Obsessive-Compulsive PD, and Schizotypal PD from the perspectives of Section II (PDQ-4) and Section III (PID-5) PD models, as well as measures of functional impairment in interpersonal and intrapersonal domains. Pearson correlations showed associations between ratings of impairment and most Section II and Section III PDs and trait facets, with the exception of narcissistic PD. Hierarchical regression analyses revealed that Section III PDs added predictive validity beyond Section II PDs in predicting impairment, except narcissistic PD. These findings provide support both for the impairment criterion in the AMPD and for the association between trait-based PDs and impairment, and suggest that this trait-based measurement adds uniquely to the understanding of functional impairment.

Altered memory and affective instability in prisoners assessed for dangerous and severe personality disorder

Background

Previous studies of borderline personality disorder report neuropsychological impairments in several domains, including memory. No studies have compared memory functioning in high-risk prisoners with borderline personality disorder with similar prisoners with other personality disorders.

Aims

To explore mnemonic impairments in prisoners undergoing personality assessment as part of the dangerous and severe personality disorder initiative or detained in a medium secure facility.

Method

We investigated memory function in 18 prisoners with borderline personality disorder and 18 prisoners with other personality disorders.

Results

Prisoners with borderline personality disorder exhibited a pattern of multi-modal impairments in the immediate and delayed recall of verbal and visual information, with some association with affective instability. These deficits were not associated with the severity of personality disturbance.

Conclusions

These data suggest that memory deficits have some specificity in relation to the constituent traits of borderline personality disorder and indicate that neuropsychological assessment may be a source of useful adjunctive information for distinguishing between the cognitive and psychological difficulties of individual prisoners.

The Personality Inventory for DSM-5 Brief Form: Evidence for Reliability and Construct Validity in a Sample of Community-Dwelling Italian Adolescents

To assess the reliability and construct validity of the Personality Inventory for DSM-5 Brief Form (PID-5-BF) among adolescents, 877 Italian high school students were administered the PID-5-BF. Participants were administered also the Measure of Disordered Personality Functioning (MDPF) as a criterion measure. In the full sample, Cronbach's alpha values for the PID-5-BF scales ranged from .59 (Detachment) to .77 (Psychoticism); in addition, all PID-5-BF scales showed mean interitem correlation values in the .22 to .40 range. Cronbach's alpha values for the PID-5-BF total score was .83 (mean interitem r = .16). Although 2-month test-retest reliability could be assessed only in a small ( n = 42) subsample of participants, all PID-5-BF scale scores showed adequate temporal stability, as indexed by intraclass r values ranging from .78 (Negative Affectivity) to .97 (Detachment), all ps <.001. Exploratory structural equation modeling analyses provided at least moderate support for the a priori model of PID-5-BF items. Multiple regression analyses showed that PID-5-BF scales predicted a nonnegligible amount of variance in MDPF Non-Cooperativeness, adjusted R² = .17, p < .001, and Non-Coping scales, adjusted R² = .32, p < .001. Similarly, the PID-5-BF total score was a significant predictor of both MDPF Non-Coping, and Non-Cooperativeness scales.

The impact of persisting hyperactivity on social relationships: a community-based, controlled 20-year follow-up study

OBJECTIVE

The purpose of this study was to examine whether persisting hyperactivity into adulthood was associated with impaired family, friendship, and partner relationships or poor coping skills in everyday life.

METHOD

A 20-year community-based follow-up of 6- to 7-year-old boys showing pervasive hyperactivity (n = 40) and unaffected controls (n = 25) was conducted. At age 27 years, participants were assessed with detailed interview techniques as well as self-report ratings.

RESULTS

ADHD in adulthood was associated with problems in intimate relationships and negotiation skills. Antisocial behavior did not influence the association, but remitting childhood hyperactivity was not associated with social relationship difficulties in adulthood.

CONCLUSION

In an untreated, community-based sample of hyperactive children, the risk for unsatisfactory social relationships is largely confined to those patients who still show ADHD in adulthood. The majority of patients who experience childhood hyperactivity have positive social relationships in adulthood.

Examination of the Section III DSM-5 diagnostic system for personality disorders in an outpatient clinical sample

The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013), includes a novel approach to the diagnosis of personality disorders (PDs) in Section III, to stimulate further research with the possibility that this proposal will be included more formally in future DSM iterations. This study provides the 1st test of this proposal in a clinical sample by simultaneously examining its 2 primary components: a system for rating personality impairment and a newly developed dimensional model of pathological personality traits. Participants were community adults currently receiving outpatient mental health treatment who completed a semistructured interview for DSM-IV PDs and were then rated in terms of personality impairment and pathological traits. Data on the pathological traits were also collected through self-reports using the Personality Inventory for DSM-5 (PID-5). Both sets of trait scores were compared with self-report measures of general personality traits, internalizing symptoms, and externalizing behaviors. Interrater reliabilities for the clinicians' ratings of impairment and the pathological traits were fair. The impairment ratings manifested substantial correlations with symptoms of depression and anxiety, DSM-5 PDs, and DSM-5 pathological traits. The clinician and self-reported personality trait scores demonstrated good convergence with one another, both accounted for substantial variance in DSM-IV PD constructs, and both manifested expected relations with the external criteria. The traits but not the impairment ratings demonstrated incremental validity in the prediction of the DSM-IV PDs. Overall, these results support the general validity of several of the components of this new PD diagnostic system and point to areas that may require further modification.

Attachment, borderline personality, and romantic relationship dysfunction

Previous studies have implicated attachment and disturbances in romantic relationships as important indicators for Borderline Personality Disorder (BPD). The current research extends our current knowledge by examining the specific associations among attachment, romantic relationship dysfunction, and BPD, above and beyond the contribution of emotional distress and nonromantic interpersonal functioning in two distinct samples. Study 1 comprised a community sample of women (N = 58) aged 25-36. Study 2 consisted of a psychiatric sample (N = 138) aged 21-60. Results from both Study 1 and Study 2 demonstrated that (1) attachment was specifically related to BPD symptoms and romantic dysfunction, (2) BPD symptoms were specifically associated with romantic dysfunction, and (3) the association between attachment and romantic dysfunction was statistically mediated by BPD symptoms. The findings support specific associations among attachment, BPD symptoms, and romantic dysfunction.

X. Conclusions: overview of findings from the era study, inferences, and research implications

In this monograph, we have brought the findings of the English and Romanian Adoptee (ERA) study up to age 15 years and, in so doing, have focused especially on the question of whether there are deprivation-specific psychological patterns (DSPs) that differ meaningfully from other forms of psychopathology. For this purpose, our main analytic strategy was to compare the subgroup of young people who had received institutional care in Romania that persisted up to at least the age of 6 months and a pooled comparison group that comprised the remainder of the sample. In chapter II, we presented the evidence that there were no significant variations among the three subgroups that made up the pooled comparison group. A large proportion of this pooled comparison group came from the 52 individuals adopted before the age of 6 months from within the United Kingdom, who had not experienced institutional care or other major deprivation experiences. In addition, there were 45 children who had experienced institutional care that had ceased before the age of 6 months. Finally, there was a small group of 21 Romanian individuals who had come from a severely deprived background but who had not experienced institutional care. In the young people who experienced institutional deprivation, we found that a cut-off at 6 months marked the division between those without appreciable sequelae and those with a substantial proportion of persisting deficits. Because we found that the rate of deficits in the group who had experienced institutional care for 46 months did not vary according to the duration of institutional care, we pooled the entire group of individuals experiencing institutional care up to at least the age of 6 months. We found that these two pooled groups differed substantially and significantly in the rate of maladaptive outcomes. The details of the evidence justifying this pooling and a two-way comparison are provided in chapter II. Because of our interest in exploring the possibility of DSPs, our main subdivision within the above 6-month group was between those individuals showing the putative DSPs and those showing other forms of psychopathology or not showing deficits at all.

Social domain dysfunction and disorganization in borderline personality disorder

BACKGROUND

Social dysfunction in personality disorder is commonly ascribed to abnormal temperamental traits but may also reflect deficits in social processing. In this study, we examined whether borderline and avoidant personality disorders (BPD, APD) may be differentiated by deficits in different social domains and whether disorganization of social domain functioning uniquely characterizes BPD.

METHOD

Patients were recruited from psychiatric clinics in Pittsburgh, USA, to provide a sample with BPD, APD and a no-personality disorder (no-PD) comparison group. Standardized assessments of Axis I and Axis II disorders and social domain dysfunction were conducted, including a new scale of 'domain disorganization' (DD).

RESULTS

Pervasive social dysfunction was associated with a 16-fold increase in the odds of an Axis II disorder. Both APD and BPD were associated with elevated social dysfunction. Romantic relationship dysfunction was associated specifically with BPD symptoms and diagnosis. DD was associated specifically with a categorical BPD diagnosis and with a dimensional BPD symptom count.

CONCLUSIONS

A focus on the inherently interpersonal properties of personality disorders suggests specific mechanisms (within and across interpersonal domains) that may help to account for the origins and maintenance of some disorders. In particular, BPD reflects disturbances in romantic relationships, consistent with a role for attachment processes, and in the organization of functioning across social domains.

Assessment and diagnosis of personality disorder: perennial issues and an emerging reconceptualization

This chapter reviews recent (2000-2005) personality disorder (PD) research, focusing on three major domains: assessment, comorbidity, and stability. (a) Substantial evidence has accrued favoring dimensional over categorical conceptualization of PD, and the five-factor model of personality is prominent as an integrating framework. Future directions include assessing dysfunction separately from traits and learning to utilize collateral information. (b) To address the pervasiveness and extent of comorbidity, researchers have begun to move beyond studying overlapping pairs or small sets of disorders and are developing broader, more integrated common-factor models that cross the Axis I-Axis II boundary. (c) Studies of PD stability have converged on the finding that PD features include both more acute, dysfunctional behaviors that resolve in relatively short periods, and maladaptive temperamental traits that are relatively more stable-similar to normal-range personality traits-with increasing stability until after 50 years of age. A new model for assessing PD-and perhaps all psychopathology-emerges from integrating these interrelated reconceptualizations.

Measures of positive adult behavior and their relationship to crime and substance use

Drawing on diverse approaches to the study of youth development and adult functioning, as well as social capital and citizenship, this investigation identifies measures of positive adult behavior. Although prevention researchers study protective factors, as well as risk factors, for problem behaviors and other negative outcomes, less attention is given to positive behavior outcomes and there is little understanding of the relationships between positive and negative outcomes. Analyses included 765 participants from the Seattle Social Development Project interviewed at age 21. Seven measures of positive adult behavior were identified: volunteerism, group involvement, neighborliness, interpersonal connection, constructive engagement, financial responsibility, and honesty. Measures related to distal social relationships (group involvement and neighborliness) had relatively weak associations with crime and substance use. In contrast, the measures of constructive engagement, financial responsibility, and honesty had significant negative associations with multiple measures of crime and substance use. Results indicate that the seven measures provide relatively independent variables useful for assessing positive adult behavior. These measures can be used to assess positive outcomes in adulthood of intervention studies, or to assess the prevalence of positive adult behavior in different populations or groups.

Perceived relationships with parents and paranoid delusions: comparisons of currently ill, remitted and normal participants

BACKGROUND

Paranoid delusions are associated with abnormal attributions and abnormal beliefs about the self. Some researchers have also reported an association between paranoid beliefs and abnormal attachment representations.

SAMPLING AND METHODS

Perceptions of relationships with the family of origin were measured in 14 currently ill paranoid patients, 9 remitted paranoid patients and 15 healthy controls, using two methods: the Parental Bonding Instrument (PBI), and the Relationship with Family of Origin Scale (REFAMOS), an interview-based assessment.

RESULTS AND CONCLUSIONS

On the PBI, both currently ill and remitted patients reported low parental care and overprotectiveness during childhood. Similar negative accounts of relationships with parents during the 16-20 years age period, and also at the time of assessment, were elicited from both the ill and remitted patients on the REFAMOS. These findings might reflect the influence of illness on patients' perceptions of their parents. However, the fact that the remitted patients did not differ from the currently ill patients raises the possibility that dysfunctional relationships are a common feature of the history of paranoid patients, perhaps contributing to the development of paranoid thinking.

Roles and relationships: a psychoeducational approach to reviewing strengths and difficulties in adulthood functioning

The authors developed a psychoeducational protocol to help psychiatric patients review their patterns of interpersonal relationships. The conceptual framework is based on the Adult Personality Functioning Assessment (Hill, Fudge, Harrington, Pickles, & Rutter, 1995; Hill, Harrington, Fudge, Rutter, & Pickles, 1989). Seven domains of functioning are addressed: friendships, romantic relationships, family relationships, social contacts, therapeutic relationships, relationships with addictive substances and activities, and work. The intervention aims at fostering participants' reflectiveness about their relationships to enhance their capacity for social support. The introduction sets the protocol in context; an annotated version of patient materials includes commentary on each domain.

Adult psychosocial functioning following childhood cancer: the different roles of sons' and daughters' relationships with their fathers and mothers

BACKGROUND

Adult survivors of childhood cancer have impaired psychosocial functioning, but not much is known about the causes. In this study we examined the role of relationships with parents as a possible mediating factor.

METHOD

One hundred and two adult survivors (82% of those eligible, 35 female and 57 male) of childhood Acute Lymphoblastic Leukaemia and Wilms' Tumour, and 102 matched controls (74% of those eligible) aged 19-30 were interviewed. Interpersonal and social role functioning, and current relationships with each parent were assessed in standardised investigator-based interviews with subjects.

RESULTS

Adult survivors were more likely than controls to have impaired close relationships (love relationships and friendships), and poorer day-to-day coping. Lower encouragement from fathers and greater involvement with mothers were each independently associated with impaired close relationships outside the family. This association was evident across the sample and in the cancer survivor group. It was much stronger in young adult females. Lower paternal encouragement was also associated with poor day-to-day coping, and this association was stronger in young men. There was, however, little evidence that quality of relationships with parents mediated the link between childhood cancer and adult psychosocial functioning.

CONCLUSIONS

Within this cross-sectional design we could not determine the direction of influence, nor exclude third variable effects. However, the findings indicate that mothers and fathers have different roles in the transition to adult life, and understanding these may assist the development of interventions designed to improve adult psychosocial functioning.

Biological, psychological and social processes in the conduct disorders

BACKGROUND

This paper reviews recent evidence on the causes and maintenance of aggressive and disruptive behaviours in childhood and adolescence. It considers the relative merits of several different ways of conceptualising such problems, in relation to the contribution of biological, psychological and social factors.

METHOD

It focuses on conduct problems appearing in young childhood, which greatly increase the likelihood of persistent antisocial behaviours in adolescence and adult life in association with wider interpersonal and social role impairments. It considers the contribution of individual factors, including impaired verbal skills, deficits in executive functions, and an imbalance between behavioural activation and inhibition systems. These are viewed in interaction with commonly associated environmental disadvantages such as hostile or intrusive parenting. The roles of attributional biases, unrealistic self-evaluations, and insecure attachment are considered in relation to affect regulation, and effective social action. The contributions of the wider social environments of peers, neighbourhood and socio-economic conditions are evaluated.

CONCLUSIONS

The paper concludes that, although considerable progress has been made over the past ten years, there is a need to further refine our conceptualisation of the behaviours to be explained, to develop a coherent theory of the causal and maintaining processes, and to carry out prospective studies with adequate numbers of high risk children.

Child sexual abuse, poor parental care and adult depression: evidence for different mechanisms

BACKGROUND

Child sexual abuse (CSA) and poor parental care (neglect and institutional care) are associated with depression in adult life. Little is known about possible mechanisms underlying these associations.

AIMS

To examine the role of adult intimate-love relationships as differential mediators or moderators of the associations between CSA, poor parental care and adult depression.

METHOD

Sampling was carried out in two phases. In the first, questionnaires were sent to women aged 25-36 years in five primary care practices. Second-phase subjects for interview (n=198) were drawn from three strata defined on the basis of childhood adversities. Recalled childhood experiences and recent adult relationships and depression were assessed and rated independently. Frequencies of predictor and response variables, effect estimates and their confidence intervals were weighted back to the general population questionnaire sample.

RESULTS

The risk for depression associated with CSA was unaffected by quality of adult relationships, while the risk associated with poor parental care was substantially altered.

CONCLUSIONS

There may be different pathways linking CSA and poor parental care to adult depression.