Assessing the DSM-IV structure of personality disorder with a sample of Chinese psychiatric patients

The validity of the three-cluster system of personality disorders (PDs) in the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; APA, 1994) was examined in a sample of Chinese psychiatric patients (n = 227), who completed the self-report Personality Disorders Questionnaire for DSM-IV (PDQ-4; Hyler, 1994) and who were also administered the clinician-rated Personality Disorders Interview-IV (PDI-IV; Widiger, Mangine, Corbit, Ellis, & Thomas,). Using confirmatory factor analysis, a three-factor model corresponding to the DSM-IV clusters was tested and compared statistically to a one-factor model and a set of random, three-factor models. Only the clinician-rated instrument supported the DSM-IV three-cluster model, and then only when the factors were allowed to correlate. Results from the theoretically more rigorous uncorrelated model testing did not support the DSM-IV model for either assessment modality.     

Validity of the Personality Diagnostic Questionnaire-4 (PDQ-4+) among mentally ill prison inmates in Singapore

We examined the validity of the Personality Diagnostic Questionnaire--4+ (PDQ-4+) as a screening instrument for personality disorders among mentally ill prison inmates in Singapore. A total of 313 prison inmates completed the PDQ-4+ and the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II). The subjects were 303 (96.8%) males and 10 (3.2%) females with a mean (SD) age of 40.7 (8.8) years. Kappa agreement between PDQ-4+ and SCID-II for the presence at least one personality disorder was moderate with high sensitivity and low specificity. For specific personality disorders and clusters, we found that the PDQ-4+ diagnosed more subjects as having each of the personality disorders than SCID-II with high negative predictive values. The area under the curve indicated moderate discriminatory capabilities. Our results suggest that the PDQ-4+ could be used as a potential screening instrument for personality disorders in prison inmates.     

Comparison of Three Self-Report Measures of Personality Pathology

Levels of convergence were examined among three personality instruments: the Personality Diagnostic Questionnaire-4+ (PDQ-4+), the Structured Clinical Interview for DSM-IV Axis II Personality Disorders Questionnaire (SCID-IIQ) and the Multi-source Assessment of Personality Pathology (MAPP). Each personality questionnaire was administered three times in an alternating sequence over nine consecutive weekdays to a sample of college students. There was some degree of convergence among the three instruments, but there were also substantial empirical differences between them. The data suggest three related conclusions: (1) in general, the self-report version of the MAPP is more conservative than the other two questionnaires, (2) these questionnaires are not interchangeable measures of personality disorders, and (3) the breadth of measurement provided varies as a function of both the questionnaire and the personality disorder being measured.     

Integrating psychopathology and personality disorders conceptualized by the MMPI-2-RF and the MCMI-III: a structural validity study

The Minnesota Multiphasic Personality Inventory-2-Restructured Form (Ben-Porath & Tellegen, 2008 ) Restructured Clinical scales and Higher Order scales were linked to the Millon Clinical Multiaxial Inventory-III (Millon, Millon, Davis, & Grossman, 2009 ) personality disorder scales and clinical syndrome scales in a Flemish/Dutch sample of psychiatric inpatients and outpatients, substance abuse patients, correctional inmates, and forensic psychiatric patients (N = 968). Structural validity of psychopathology and personality disorders as conceptualized by both instruments was investigated by means of principal component analysis. Results reveal a higher order structure with 4 dimensions (internalizing disorders, externalizing disorders, paranoid ideation/thought disturbance, and pathological introversion) that parallels earlier research on pathological personality dimensions as well as research linking pathological personality traits with mental disorders. Theoretical and clinical implications are considered.     

Psychometric properties of the Spanish version of the self-report Personality Diagnostic Questionnaire -4+ (PDQ-4+) in psychiatric outpatients

We examined the psychometric properties of the Spanish version of the self-report Personality Diagnostic Questionnaire-4+ (PDQ-4+) in a sample of 437 psychiatric outpatients. Psychometric properties were assessed through internal consistency analysis, exploratory factor analysis (EFA) and concurrent validity. Results indicate that the Spanish version of the PDQ-4+ has moderate internal consistency, which was acceptable for 7 of the 12 self-report scales. The factor structure roughly replicated the DSM-IV clusters. The presence of Personality Disorders was associated with the character dimensions of the Temperament and Character Inventory (TCI).     

Comparing clinical and social-personality conceptualizations of narcissism

There is a lack of consensus surrounding the conceptualization of narcissism. The present study compared two measures of narcissism-one used in clinical settings (Personality Diagnostic Questionnaire, PDQ-4+; Hyler, 1994) and one used in social-personality research (Narcissistic Personality Inventory, NPI; Raskin & Terry, 1988)-across two samples. Sample 1 (N=271) was composed of undergraduates, whereas Sample 2 (N=211) was composed of parents of the Sample 1 participants. The scales were significantly interrelated but manifested divergent relations with general personality traits, personality disorders (including expert prototypal ratings of narcissism), recollections of parenting received, and psychological distress and self-esteem. PDQ-4 narcissism captured an emotionally unstable, negative-affect-laden, and introverted variant of narcissism; NPI narcissism captured an emotionally resilient, extraverted form. The clinical and social-personality conceptualizations of narcissism primarily share a tendency to use an antagonistic interpersonal style. Implications for the DSM-V are discussed.     

Correspondence among observer ratings of Rorschach,Big Five Model,and DSM-IV personality disorder constructs

Observer ratings were collected using instruments designed to measure the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) personality disorders (Personality Diagnostic Questionnaire-4+ [PDQ-4+]; Hyler, 1994), the Big Five model (B5M; Goldberg's [1999] International Personality Item Pool), and Rorschach-derived constructs. For the latter, we revised the Rorschach Rating Scale (Meyer, Bates, & Gacono, 1999) to lower its reading level and renamed it the Rorschach Construct Scale (RCS) to emphasize its reliance on rated constructs. The RCS consists of 6 factors. Joint factor analysis of RCS, PDQ-4+, and B5M items also resulted in 6 factors: Self-Centeredly Exploitative, Poor Ego Resiliency, Extraversion, Task Conscientiousness, Openness to Ideas, and Emotional and Expressive Constriction. The first 2 factors received high loadings from RCS, PDQ-4+, and B5M variables. The sixth factor received high loadings from just RCS variables.     

Examination of the screening properties of the personality diagnostic questionnaire 4+ (PDQ-4+) in a prison population

There is a high prevalence of personality disorder in most prison populations. Many pass through the system undiagnosed. A screening instrument would improve identification. This study examined the screening properties of the Personality Diagnostic Questionnaire-4+ (PDQ-4+) in prisoners convicted of violent and sexual offenses. A sample of British prisoners completed the self-report PDQ-4+ and were interviewed using the Structured Clinical Interview for DSM-IV Axis II disorders. When used to generate a total score, the PDQ-4+ had an acceptable overall accuracy as measured by the area under the Receiver Operating Characteristics (ROC) curve. The PDQ-4+ appears to have the properties suitable for use as a screening instrument, particularly when screening for the presence or absence of personality disorder rather than for individual personality disorder categories. A graph is presented from which choices of cut-off score for different combinations of sensitivity and specificity can be made. A cut off total score of 25 or above yielded near optimal sensitivity and specificity. The suggested cut off score for this population is lower than that previously suggested.     

Maladaptive personality traits in adolescence: Psychometric properties of the Personality Diagnostic Questionnaire-4+

The Personality Diagnostic Questionnaire-4+ (PDQ-4+) is a self-report used for the assessment of personality disorder traits, however, its psychometric characteristics have yet to be tested in community samples of adolescents. The main goal was to analyze the psychometric properties of the PDQ-4+ scores in a large sample of non-clinical adolescents (N = 1,443; M = 15.9 years; SD = 1.2). The PDQ-4+ scores showed adequate psychometric properties. Reliability of the subscales, incorporating a Likert-type 5-point response format, ranged from .62 to .85. The study of the internal structure at item level revealed that the PDQ-4+ subscales were essentially one-dimensional. Analysis of the internal structure at the subscale level by means of exploratory factor analysis and exploratory structural equation modeling yielded a possible three-dimensional solution. The PDQ-4+ subscales correlated moderately with emotional and behavioural variables measured by the Strengths and Difficulties Questionnaire. The results have clear implications for the understanding of maladaptive personality traits in adolescents.     

中国人人格量表（QZPS）的编制过程与初步结果

旨在编制能够反映中国人人格结构特点的中国人人格量表（QZPS）。文中首先分析了直接采用或修订西方人格量表的问题和潜在危险,以及目前国内使用的各种人格量表存在的局限;按照人格研究的“词汇学假设”,根据杨国枢和王登峰（1999）以及后来的研究所确定的中国人人格结构的七因素模型,提出了QZPS的编制原则和操作程序。按照人格特质形容词的含义编写测量项目,并根据小因素和大因素的含义对项目进行修改,初步确定了1600多个项目。经2280名被试的评定,初步筛选出409个项目。再经1099名被试评定,确定了215个项目构成QZPS,测量中国人人格的7个维度和18个小因素。文中还报告了对QZPS的项目分析的结果     

Correspondence between self-report and interview-based assessments of antisocial personality disorder

Antisocial personality disorder (ASPD) is associated with suicide, violence, and risk-taking behavior and can slow response to first-line treatment for Axis I disorders. ASPD may be assessed infrequently because few efficient diagnostic tools are available. This study evaluated 2 promising self-report measures for assessing ASPD--the ASPD scale of the Personality Diagnostic Questionnaire-4 (PDQ-4; S. E. Hyler, 1994) and the Personality Assessment Inventory (PAI; L. Morey, 1991, 2007)--as well as the ASPD module of the Structured Clinical Interview for DSM-IV Axis II (SCID-II; M. B. First, R. L. Spitzer, M. Gibbon, J. B. W. Williams, & L. S. Benjamin, 1997). The measures were administered to 1,345 offenders in court-mandated residential substance abuse treatment programs and prisons. PDQ-4 and PAI scores related strongly to SCID-II symptom counts (rs = .67 and .51, respectively), indicating these measures convey useful clinical information about the severity of offenders' ASPD pathology. The dimensional association between the measures was relatively invariant across gender, race, and site, although differences in mean scores were observed. Levels of agreement of the SCID-II with the PDQ-4 (kappa = .31) and PAI (kappa = .32) in classifying participants as ASPD was limited. Alternative thresholds for both self-report measures were identified and cross-validated.     

Society for Personality Assessment 1971 Program

The aim was to study the validity of 2 personality instruments, the Health-Relevant Personality Inventory (HP5i) and the Junior Temperament and Character Inventory (JTCI), among adolescents with a substance use problem. Clinical interviews were completed with 180 adolescents and followed up after 12 months. Discriminant validity was demonstrated in the lack of correlation to intelligence in both instruments’ scales. Two findings were in support of convergent validity: Negative affectivity (HP5i) and harm avoidance (JTCI) were correlated to internalizing symptoms, and impulsivity (HP5i) and novelty seeking (JTCI) were correlated to externalizing symptoms. The predictive validity of JTCI was partly supported. When psychiatric symptoms at baseline were controlled for, cooperativeness predicted conduct disorder after 12 months. Summarizing, both instruments can be used in adolescent clinical samples to tailor treatment efforts, although some scales need further investigation. It is important to include personality assessment when evaluating psychiatric problems in adolescents.     

Clinical utility of the Cross-Cultural (Chinese) Personality Assessment Inventory (CPAI-2) in the assessment of substance use disorders among Chinese men

This study examined the clinical utility of the Cross-Cultural (Chinese) Personality Inventory (CPAI-2) in differentiating the personality characteristics of Chinese men with substance use disorders from other psychiatric patients and normal control participants. The CPAI-2 profile of 121 Chinese men with substance use disorders was contrasted with that of a matched psychiatric comparison group (n = 172) and a normal comparison group (n = 187). Multivariate analyses of variance and logistic regression results supported the utility of the CPAI-2 clinical scales, especially Pathological Dependence, Antisocial Behavior, and Depression, for assessing substance use disorders. The Pathological Dependence scale (cutoff T score of 64) achieved good sensitivity and specificity. Apart from the universal personality traits related to neuroticism, conscientiousness, and agreeableness found in Western studies, the indigenously derived CPAI-2 personality scales, including Family Orientation and Harmony, highlighted deficits in social adjustment and interpersonal relationship as important cultural features in the personality characteristics of these participants. The study provided a cross-cultural extension to research on the relationship between personality and substance use disorders and could assist clinicians in considering culturally relevant treatment approaches.     

人格结构的中西方差异与中国人的人格特点

该文旨在通过对中西方人格结构的比较和分析揭示文化与人格结构的关系,并探寻中国人人格结构的文化意义。根据词汇学假设进行的中西方人格结构的研究结果表明,人格结构的形成是建立在对行为归类的基础之上的,中西方人格结构的差异最直接的原因就在于中西方对行为归类的差别。中国文化比较强调整体性、联系性以及评价性是造成中国人与西方人行为归类差异的原因,而更深层次的原因则是中西方文化中对人性看法的差异。中国人人格量表有着比较理想的预测效度,而且与西方大五人格量表相比更高的预测效度,这些均表明中国人人格结构的合理性。文中还提出了进一步研究的展望     

Psychological androgyny and personality adjustment in college and psychiatric populations

In two separate studies, 106 female and 84 male undergraduates and 48 female and 48 male psychiatric inpatients were administered the Bem Sex Role Inventory (BSRI) and the Faschingbauer Abbreviated Minnesota Multiphasic Personality Inventory. The masculine, feminine, androgynous, and undifferentiated groups identified from the BSRI differed on a variety of personality scales in both normal and clinical populations. Androgynous females were significantly lower on the Depression (D) and Social Introversion (Si) scales than feminine females, and, in the college sample, were also lower on the Schizophrenia and Mania scales than masculine females. In the hospitalized male sample, this pattern was partially sustained, with androgynous and masculine subjects being significantly less deviant than feminine on the Si scale, and tending to score lower on the D scale. In the group of college males, androgynous males scored lower on the Si scale than feminine males. Hypotheses concerning the relationship of sex-role flexibility (androgyny) to mental health appear to be supported for females in both college and psychiatric populations by these results. These results also indicate that sex-role conformity may relate differently to personality development and psychological functioning for males and females.     

Detection of malingering in psychiatric unit and general population prison inmates: a comparison of the PAI, SIMS, and SIRS

In this study, we compared the utility of three instruments, the Personality Assessment Inventory (PAI; Morey, 1991), the Structured Inventory of Malingered Symptomatology (Smith & Burger, 1997), and the Structured Interview of Reported Symptoms (SIRS; Rogers, Bagby, & Dickens, 1992) to detect malingering among prisoners. We examined 4 inmate samples: (a) prisoners instructed to malinger, (b) "suspected malingerers" identified by psychiatric staff, (c) general population control inmates, and (d) psychiatric patients. Intercorrelations among the measures for the total sample (N = 115) were quite high, and receiver operating characteristic analyses suggested similar rates of overall predictive accuracy across the measures. Despite this, commonly recommended cut scores for these measures resulted in widely differing rates of sensitivity and specificity across the subsamples. Moreover, although all instruments performed well in the nonpsychiatric samples (i.e., simulators and controls), classification accuracy was noticeably poorer when attempting to differentiate between psychiatric patients and suspected malingerers, with only 2 PAI indicators significantly discriminating between them.     

Predicting dimensions of personality disorder from domains and facets of the Five-Factor Model

We compared the utility of several trait models for describing personality disorder in a heterogeneous clinical sample (N = 94). Participants completed the Schedule for Nonadaptive and Adaptive Personality (SNAP; Clark, 1993b), a self-report measure that assesses traits relevant to personality disorder, and two measures of the Five-Factor Model: the Revised NEO Personality Inventory (NEO-PI-R; Costa and McCrae, 1992) and the Big Five Inventory (BFI; John, Donahue, & Kentle, 1991). Regression analyses indicated substantial overlap between the SNAP scales and the NEO-PI-R facets. In addition, use of the NEO-PI-R facets afforded substantial improvement over the Five-Factor Model domains in predicting interview-based ratings of DSM-IV personality disorder (American Psychiatric Association, 1994), such that the NEO facets and the SNAP scales demonstrated roughly equivalent levels of predictive power. Results support assessment of the full range of NEO-PI-R facets over the Five-Factor Model domains for both research and clinical use.     

Structural analysis of the facets and domains of the Zuckerman-Kuhlman-Aluja Personality Questionnaire (ZKA-PQ) and the NEO PI-R

Aluja, Kuhlman, and Zuckerman (2010) developed an instrument for American and Spanish populations (Zuckerman-Kuhlman-Aluja Personality Questionnaire [ZKA-PQ]) that includes 4 facets for each 5 basic traits of Zuckerman's psychobiological personality model. This new instrument is intended to improve the previous measure based on the same personality model, the Zuckerman-Kuhlman Personality Questionnaire (ZKPQ), by including the narrower traits (facets) defining the factors. This article explores the convergent and discriminant validity of the new instrument relative to the NEO PI-R in a sample from the Spanish general population. A series of exploratory factor analyses comparing both instruments was conducted. Results showed good convergent and discriminant validity between both instruments, although the ZKA-PQ had a slightly better structure than the NEO PI-R. The results support the validity of the ZKA-PQ factor domains and the facets composing them. The new instrument might be useful in both applied and research settings.     

Distancing oneself from God: relationships with borderline personality symptomatology

Self-harm behaviour traditionally has been associated with borderline personality disorder. In this study, we examined the relationship between borderline personality symptomatology and intentionally distancing oneself from God as self-punishment, based on the assumption that such self-punishment may represent a form of self-harm behaviour. Data from four previous samples of primary care outpatients collected over a two-year period were combined (N?=?1511). Borderline personality was assessed with two measures: the borderline personality scale of the Personality Diagnostic Questionnaire-4 (PDQ-4) and the Self-Harm Inventory (SHI). Point-biserial correlation coefficients revealed that those who endorsed distancing oneself from God as punishment scored relatively higher on both the PDQ-4 (r?=?0.40, p?<?0.001) and the SHI (r?=?0.46, p?<?0.001). Similarly, when compared to respondents who denied ever having distanced themselves from God as punishment, those who did were more likely to exceed the clinical cut-off score on the PDQ-4 (47.3% vs. 10.9%, X^{2 ?}=?152.53, p?<?0.001) and the SHI (57.3% vs. 11.4%, X^{2 ?}=?224.12, p?<?0.001). Findings support our hypothesis that distancing oneself from God as punishment may be a form of self-harm behaviour associated with borderline personality symptomatology.     

Relationships between the MAPI and the MMPI in the assessment of adolescent psychopathology.

Although the Minnesota Multiphasic Personality Inventory (MMPI) and the Millon Adolescent Personality Inventory (MAPI) are both widely used in the clinical assessment of adolescents, no research has examined the interrelationship between these two instruments. We investigated MMPI and MAPI responses from 199 adolescents assessed at entrance to inpatient or outpatient psychiatric programs in Florida and Virginia. Univariate correlation analyses identified areas of significant associations between these measures, with coefficients ranging widely from -.70 to .72. Substantial diagnostic differences were found between these instruments. The MAPI, for example, yielded no depression-related diagnoses, but produced many more adjustment disorder and personality disorder diagnoses than the MMPI. The rates of diagnostic assignment agreements between diagnoses produced by clinical judgment, MMPI findings, and MAPI interpretive reports were typically quite low.