Theodore Millon's Contributions to Conceptualizing Personality Disorders

We review Theodore Millon's contributions to conceptualizing personality disorders in contemporary clinical science and practice. Millon worked tirelessly across professional domains and theoretical orientations, developing a rich integrative theory of personality and its pathology, directly and indirectly impacting the evolving iterations of the Diagnostic and Statistical Manual of Mental Disorders (DSM–III through DSM–5), and advocating for the personality disorders through his contributions to cofounding the International Society for the Study of Personality Disorders and the Journal of Personality Disorders. We conclude with a closer look at Millon's final major contributions to conceptualizing personality disorders as well as the strengths and limitations of his approach.     

Personality Psychology in the First Decade of the New Millennium: A Bibliometric Portrait

Nine principal personality psychology journals—Journal of Personality and Social Psychology (JPSP), Journal of Personality (JP), Journal of Research in Personality (JRP), European Journal of Personality (EJP), Personality and Individual Differences (PAID), Personality and Social Psychology Bulletin (PSPB), Personality and Social Psychology Review (PSPR), Journal of Personality Assessment (JPA), and Journal of Personality Disorders (JPD)—have published 8510 research papers from 2001 to 2010. These papers have been cited 149 108 times (September 2011) by papers published in journals indexed in the Web of Science. Although personality psychologists from the US published the largest number of papers (4924, 57.9%) and had the largest number of citations (101 875, 68.3%), their relative contribution to personality literature has slightly diminished during the first decade of the new millennium. Unlike other countries, personality psychologists residing in the US demonstrated a strong country self‐citation bias: They were about 14% more likely to cite papers which were written by their compatriots rather than non‐US authors in three leading journals JPSP, PSPB, and PSPR. The intensity and pattern of citations indicate that personality psychology indeed occupies one of the core positions at the heart of psychological knowledge. Copyright © 2012 John Wiley & Sons, Ltd.     

A Psychometric Review of the Personality Inventory for DSM–5 (PID–5): Current Status and Future Directions

The paradigm of personality psychopathology is shifting from one that is purely categorical in nature to one grounded in dimensional individual differences. Section III (Emerging Measures and Models) of the Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM–5]; American Psychiatric Association, 2013), for example, includes a hybrid categorical/dimensional model of personality disorder classification. To inform the hybrid model, the DSM–5 Personality and Personality Disorders Work Group developed a self-report instrument to assess pathological personality traits—the Personality Inventory for the DSM–5 (PID–5). Since its recent introduction, 30 papers (39 samples) have been published examining various aspects of its psychometric properties. In this article, we review the psychometric characteristics of the PID–5 using the Standards for Educational and Psychological Testing as our framework. The PID–5 demonstrates adequate psychometric properties, including a replicable factor structure, convergence with existing personality instruments, and expected associations with broadly conceptualized clinical constructs. More research is needed with specific consideration to clinical utility, additional forms of reliability and validity, relations with psychopathological personality traits using clinical samples, alternative methods of criterion validation, effective employment of cut scores, and the inclusion of validity scales to propel this movement forward.     

Borderline Personality Disorder in Adolescence Through the Lens of the Interview of Personality Organization Processes in Adolescence (IPOP-A): Clinical Use and Implications

Borderline personality disorder can be assessed in adolescence mainly through a dimensional approach that takes into account strengths and weaknesses of emerging personality patterns. Clinical interviews could help clinicians to gather information about adolescent’s functioning, fostering therapeutic alliance and promoting a mentalizing stance during the assessment of borderline adolescents. In this article, the Interview of Personality Organization Processes in Adolescence (IPOP-A) is presented through clinical case material to show its usefulness in clinical and research settings. The IPOP-A assesses an adolescent’s emerging personality along three dimensions: identity, quality of object relations and affect regulation. These dimensions are the core of borderline personality in adolescence.     

Ant Colony Optimization and Local Weighted Structural Equation Modeling. A Tutorial on Novel Item and Person Sampling Procedures for Personality Research

Measurement in personality development faces many psychometric problems. First, theory‐based measurement models do not fit the empirical data in terms of traditional confirmatory factor analysis. Second, measurement invariance across age, which is necessary for a meaningful interpretation of age‐associated personality differences, is rarely accomplished. Finally, continuous moderator variables, such as age, are often artificially categorized. This categorization leads to bias when interpreting differences in personality across age. In this tutorial, we introduce methods to remedy these problems. We illustrate how Ant Colony Optimization can be used to sample indicators that meet prespecified demands such as model fit. Further, we use Local Structural Equation Modeling to resample and weight subjects to study differences in the measurement model across age as a continuous moderator variable. We also provide a detailed illustration for both tools with the Neuroticism scale of the openly available International Personality Item Pool – NEO inventory using data from the UK sample (N = 15 827). Combined, both tools can remedy persistent problems in research on personality and its development. In addition to a step‐by‐step illustration, we provide commented syntax for both tools. © 2019 European Association of Personality Psychology     

Personality Predicts Health Declines Through Stressful Life Events During Late Mid‐Life

Personality predicts the occurrence of dependent stressful life events (SLE; i.e., events reliant, at least in part, on an individual's behavior). This process, termed stress generation, contributes to psychiatric outcomes, but its role in physical health is unknown. Data were included from 998 participants (aged 55–64) in the St. Louis Personality and Aging Network (SPAN) study. Assessments occurred every 6 months for 18 months. Neuroticism, impulsivity, and agreeableness were measured with the Revised NEO Personality Inventory. Dependent (e.g., divorce) and independent (e.g., family death) SLE occurring within 6 months following baseline were assessed with the List of Threatening Experiences and confirmed by interviews. Health problems occurring within a year after SLE were the outcome. Analyses examined whether neuroticism, impulsivity, and agreeableness indirectly predict the onset of new health problems through exposure to dependent SLE. Each personality trait was associated with dependent, but not independent, SLE. Only dependent SLE predicted new health problems. Each personality trait indirectly predicted the onset of new health problems through dependent SLE. Findings suggest that personality‐driven stress generation influences physical health during late mid‐life. Addressing personality in interventions may reduce the occurrence of SLE, in turn decreasing health risks.     

Specific Personality Traits and General Personality Dysfunction as Predictors of the Presence and Severity of Personality Disorders in a Clinical Sample

This study examined the associations of specific personality traits and general personality dysfunction in relation to the presence and severity of Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM–IV]; American Psychiatric Association, 1994) personality disorders in a Dutch clinical sample. Two widely used measures of specific personality traits were selected, the Revised NEO Personality Inventory as a measure of normal personality traits, and the Dimensional Assessment of Personality Pathology-Basic Questionnaire as a measure of pathological traits. In addition, 2 promising measures of personality dysfunction were selected, the General Assessment of Personality Disorder and the Severity Indices of Personality Problems. Theoretically predicted associations were found between the measures, and all measures predicted the presence and severity of DSM–IV personality disorders. The combination of general personality dysfunction models and personality traits models provided incremental information about the presence and severity of personality disorders, suggesting that an integrative approach of multiple perspectives might serve comprehensive assessment of personality disorders.     

Personality trait scores among occupationally active bullied persons and witnesses to bullying

There is little research on the personalities and emotional stability of persons who report being bullied or witnessing bullying at work. Men and women (N = 247) from 19 to 64 years of age and in manual labour completed a questionnaire concerning the psychosocial work climate, bullying and personality. Three groups were defined: bullied (N = 14), witnesses (N = 31) and non-bullied respondents (N = 202). The Swedish universities Scale of Personality was used to assess personality traits related to the three major dimensions of neuroticism, extraversion, and aggressiveness. Bullied persons had higher scores on all six scales within the neuroticism dimension as well as higher irritability (aggressiveness dimension) and impulsiveness scores (extraversion dimension), when compared with their non-bullied work colleagues. To conclude, bullied persons display a self-image that is dominated by mistrust and embitterment as well as irritability and impulsiveness. Accordingly, when dealing with bullying at work, the need for ego-supportive actions should be considered in conjunction with more organisational, collective oriented action.     

The role of “dark personalities” (narcissism, Machiavellianism, psychopathy), Big Five personality factors, and ideology in explaining prejudice

The so-called Dark Triad (narcissism, Machiavellianism, psychopathy) represent correlated subclinical personality traits capturing “dark personalities”. How might darker personalities contribute to prejudice? In the present study (n = 197), these dark personality variables correlated positively with outgroup threat perceptions and anti-immigrant prejudice. A proposed two-stage structural equation model, assuming indirect personality effects (Dark Personality, Big Five) on prejudice through ideology and group threat perceptions, fit the data well. Specifically, a latent Dark Personality factor predicted social dominance orientation, whereas (low) Openness to Experience predicted right-wing authoritarianism; these ideological variables each predicted prejudice directly and indirectly through heightened intergroup threat. The authors recommend that personality models of prejudice incorporate both normal-range and subclinical personality predictors, in addition to ideological and social psychological mediators.     

How do personality disorders modify suicide risk?

There is a lack of psychological autopsy studies assessing the influence of axis II disorders on other risk factors for suicide. Therefore, we investigated if the estimated suicide risk for axis I disorders and socio-demographic factors was modified by personality disorders. Psychiatric disorders were evaluated by a semi-structured interview including the Structured Clinical Interview for DSM-IV Axis I (SCID-I) and Personality Disorders (SCID-II) by psychological autopsy method in 163 completed suicides and by personal interview in 396 population-based control persons. Personality disorders modify suicide risk, differently for affective disorders, substance use disorders, smoking, life events during the last three months, and socio-demographic factors such as being single. Estimated suicide risk for socio-demographic factors and life events is not substantially altered following adjustment for affective disorders or substance use disorders. These findings suggest that treatment of personality disorders is essential for suicide prevention.     

The DAPP–SF as a Screener for Personality Disorder in a Forensic Setting

Studies on the Dimensional Assessment of Personality Pathology–Short Form (DAPP–SF) have shown its ability to identify treatment-seeking patients with personality disorders. This study focuses on its screening potential for personality disorder in 89 criminal suspects (77 men, 12 women; M age = 37.0 years) undergoing residential pretrial psychological assessments in a high-security setting. It was expected that Structured Interview for DSM–IV Personality (SIDP–IV) criteria met for personality disorder(s) would be associated with higher DAPP–SF scores. A floor effect was found in DAPP–SF scores: The forensic population reported less personality pathology than the general population. Only moderate associations between DAPP–SF and SIDP–IV outcome were found. Receiver operating characteristic analysis showed that some DAPP–SF subscales did not exceed chance level in their ability to screen for personality disorders. It is concluded that the DAPP–SF has limited usefulness as a screener for personality disorders in a forensic pretrial setting. Alternative forensic screening instruments are presented.     

Tracking Fluctuations in Psychological States Using Social Media Language: A Case Study of Weekly Emotion

Personality psychologists are increasingly documenting dynamic, within-person processes. Big data methodologies can augment this endeavour by allowing for the collection of naturalistic and personality-relevant digital traces from online environments. Whereas big data methods have primarily been used to catalogue static personality dimensions, here we present a case study in how they can be used to track dynamic fluctuations in psychological states. We apply a text-based, machine learning prediction model to Facebook status updates to compute weekly trajectories of emotional valence and arousal. We train this model on 2895 human-annotated Facebook statuses and apply the resulting model to 303 575 Facebook statuses posted by 640 US Facebook users who had previously self-reported their Big Five traits, yielding an average of 28 weekly estimates per user. We examine the correlations between model-predicted emotion and self-reported personality, providing a test of the robustness of these links when using weekly aggregated data, rather than momentary data as in prior work. We further present dynamic visualizations of weekly valence and arousal for every user, while making the final data set of 17 937 weeks openly available. We discuss the strengths and drawbacks of this method in the context of personality psychology's evolution into a dynamic science. © 2020 European Association of Personality Psychology     

The international personality item pool and the future of public-domain personality measures

Seven experts on personality measurement here discuss the viability of public-domain personality measures, focusing on the International Personality Item Pool (IPIP) as a prototype. Since its inception in 1996, the use of items and scales from the IPIP has increased dramatically. Items from the IPIP have been translated from English into more than 25 other languages. Currently over 80 publications using IPIP scales are listed at the IPIP Web site (http://ipip.ori.org), and the rate of IPIP-related publications has been increasing rapidly. The growing popularity of the IPIP can be attributed to five factors: (1) It is cost free; (2) its items can be obtained instantaneously via the Internet; (3) it includes over 2000 items, all easily available for inspection; (4) scoring keys for IPIP scales are provided; and (5) its items can be presented in any order, interspersed with other items, reworded, translated into other languages, and administered on the World Wide Web without asking permission of anyone. The unrestricted availability of the IPIP raises concerns about possible misuse by unqualified persons, and the freedom of researchers to use the IPIP in idiosyncratic ways raises the possibility of fragmentation rather than scientific unification in personality research.     

Self and partner personality in intimate relationships

Two studies were conducted to examine the relations between both partners' personality and marital quality in married or cohabiting heterosexual couples. In Study 1 (N = 1380, or 690 couples), personality was assessed by means of the Dutch Personality Questionnaire, whereas in Study 2 (N = 564, or 282 couples) personality was assessed by means of the Five‐Factor Personality Inventory. We expected neuroticism to relate negatively, and extraversion positively, to marital quality. Furthermore, we expected that spouses would only marginally resemble each other with regard to personality, and that differences in personality would not affect marital quality, when controlling for the individual's levels of personality. All expectations were confirmed. Copyright © 2005 John Wiley & Sons, Ltd.     

The Network Constellation of Personality and Substance Use: Evolution from Early to Late Adolescence

There is a well-established link between substance use and four personality traits of anxiety–sensitivity, hopelessness, impulsivity, and sensation-seeking. However, construct-level models of personality may conceal indicator-level personality–outcome associations. The current study aims to investigate evolution of the network constellation of personality and cannabis/alcohol use from early to late adolescence. Data comes from the longitudinal Co-Venture cohort (N = 3800). Personality indicators, measured by Substance Use Risk Profile Scale (SURPS) items, and the frequency of cannabis/alcohol use were assessed at four consecutive years (13–17 years old). Network constellations of the SURPS items and cannabis/alcohol use were estimated using Bayesian Gaussian graphical models at four time points. Results highlighted the age-specific associations between personality indicators and substance use. The positive role of the sensation-seeking trait (e.g. attitude towards transgression) was constant, whereas the positive role of hopelessness indicators (e.g. not being enthusiastic about future) and the negative role of anxiety–sensitivity indicators (e.g. fear of having unusual body sensations) were more prominent at early adolescence. The current study provides a novel perspective on the network structure of personality and substance use in adolescence and suggests substance-specific and age-adjusted targets in intervention efforts. © 2020 European Association of Personality Psychology     

Disagreeable narcissism mediates an effect of BAS on addictive behaviors

Some forms of personality dysfunction that are associated with substance use and other externalizing behaviors, such as Narcissistic Personality Disorder, are characterized by low five-factor Agreeableness. Low Agreeableness and high Extraversion are both associated with the Behavioral Approach System in the revised Reinforcement Sensitivity Theory of Personality (RST; McNaughton & Corr, 2008). Meta-analyses examining personality predictors of Substance Use Disorders (Kotov et al., 2010) and Pathological Gambling (MacLaren et al., 2011) have implicated low Agreeableness but not Extraversion. In the present study, we sampled undergraduate students (N = 346) to examine relationships between two aspects of grandiose narcissism measured by the Narcissistic Personality Inventory (NPI), approach motivation measured by the BIS/BAS scales, and self-reported addictive behaviors. Disagreeable and Extraverted subscales of the NPI were examined for possible mediation of associations between BAS and addictive behaviors. The more disagreeable aspect of narcissism mediated the effects of BAS on drug use, gambling, sex, and maladaptive intimate relationships. These results suggest that one mechanism through which the Behavioral Approach System may promote addictive behavior among grandiose Narcissists is through its association with their aggressive and antagonistic interpersonal style.     

Age-Related Personality Differences in Inpatients with Personality Disorder: A Cross-Sectional Study

There are few empirical studies of age-associated differences in personality characteristics of individuals diagnosed with Personality Disorder (PD), and none that comparatively examine multiple personality characteristics, with a variety of psychological measures, across a wide age range in adults diagnosed with PD and coexisting substance abuse. Personality test data of 392 psychiatric inpatients diagnosed with PD were analyzed by age group. Patients were assessed with the California Psychological Inventory, Psychological Inventory of Personality and Symptoms, Diagnostic Inventory of Personality and Symptoms, Minnesota Multiphasic Personality Inventory-1, and the Millon Clinical Multiaxial Inventory-1. There were no age differences in the number of patients diagnosed with PD, but older adults were significantly less likely to be diagnosed with more than one PD. Older patients with PD were significantly less impulsive, paranoid, high-energy, antisocial, and irresponsible than younger patients with PD. It appears that, with aging, there is a general mellowing of personality for those diagnosed with PD, which may be related to the proposed geriatric variants of PD.     

The personality disorders: A review and critique of contemporary assessment strategies

Despite the prevalence of personality disorders, only recently have they become the topic of extensive clinical research. Unfortunately, much of this research suffers from various assessment problems including poor interrater agreement, an overreliance on cross-sectional assessment, and inconsistencies across measures. The present review examines the strategies used to assess personality disorders. Three comprehensive tables are used to provide a quantitative review of existing studies. Although specific measures are examined, the focus remains on general strategies for assessment. Personality disorder assessment may be enhanced through the use of aggregation methods. Aggregating over raters can reduce the subjective biases inherent in any one person's perception. Aggregating data over time reduces the instability of personality assessment, while aggregating data across measures reduces the reliance on any one measure to assess personality disorders accurately. Thus, future research should be able to refine the strategies used to study personality disorders.     

Artistic style and personality in creative painters

The present study attempted to demonstrate a correspondence between artistic style and the personality of the creator. Personality style, defined as a cognitive-affective system of defenses and controls, was identified for 20 renowned painters through an analysis of their individual Rorschach protocols. Their creative work was classified independently by a jury of 4 persons (one art critic; two eminent painters and the junior author) into stylistic categories similar to those elaborated by the senior author for the Rorschach. The overall correspondence achieved was statistically significant (.72, p < .01), with individual correlations ranging from .75 to .86 (p < .01).