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.     

Posttraumatic Stress Disorder in Maltreated Youth: A Review of Contemporary Research and Thought

Youths who have been maltreated often experience symptoms of posttraumatic stress disorder (PTSD), and this special population has received increased attention from researchers. Pathways toward maladaptive effects of maltreatment and PTSD are remarkably similar and reflect specific biological diatheses and psychological vulnerabilities that produce wide-ranging self-regulation deficits. Developmental models of effects of maltreatment and of PTSD are thus increasingly intertwined and have begun to inform specialized assessment and treatment strategies for this population. This review covers key aspects of posttraumatic stress disorder in maltreated youth, including epidemiology, symptomatology, outcome, and risk factors as well as assessment and treatment strategies and challenges for these youths.     

Evidence-based assessment of anxiety disorders in adults

This article discusses issues related to the development and dissemination of evidence-based assessment strategies for anxiety disorders and associated problems. It begins with a review of the criteria that should be considered when determining whether particular assessment procedures are evidence-based. These include such factors as reliability, validity, cost-effectiveness, consumer acceptability, utility across different populations, and ease of dissemination. The importance of considering the purpose of the assessment process when deciding whether a procedure is evidence-based is emphasized. Next, the major assessment domains that are particularly important in the area of anxiety disorders (e.g., triggers for anxiety symptoms, avoidance behaviors) are reviewed. Finally, some potential obstacles to the dissemination of evidence-based assessment procedures are discussed along with suggestions for managing these obstacles.     

Behavioral Assessment in the Schools:

This article discusses behavioral assessment as a way of obtaining and evaluating information used to individualize programming for special needs pupils. Behavioral assessment offers a range of techniques for gathering and for evaluating information. Strategies for obtaining information that are described are self-monitoring, direct observation, permanent product review, and retrospective ratings using behavior checklists. Strategies for evaluating information that are discussed are single-case research designs and social validation. These strategies assist in identifying pupil problems and selecting interventions, evaluating student progress, assessing treatment fidelity, determining causality, and revising individualized programs by providing a broad base for decision-making.     

Social Status as a Predictor of At-Risk Children

The purpose of this paper is to review the importance of children's social status as a predictor of social and academic success in school. Behavioral and cognitive correlates of social status are described, and the research on intervention strategies is discussed. Procedures for assessing children's social status are reviewed with a discussion of advantages and disadvantages of each procedure. Suggestions are made for the use of assessment and intervention procedures by classroom teachers. The author calls for a priority in the schools for promoting conditions that facilitate social acceptance of children.     

Family-Focused Relational Psychotherapy: An Integrative Approach and Its Application to Adult Children of Divorce

This paper presents an integrative model of treatment—family focused relational psychotherapy—and applies it to work with adult children of divorce (ACDs). Three areas of assessment are identified—(a) assessment of individual ego development, (b) assessment of family of origin functioning, and (c) assessment of the nature of the parents' divorce (e.g., level of conflict). Based on this assessment, the treatment model is presented, which integrates strategies from relational/psychodynamic therapy, family of origin work, and experiential techniques. Case examples are presented to demonstrate the appropriate integration of these techniques with clients at different levels in the assessment schema. In addition, a review of the literature on the long-term effects of divorce on children suggests several specific issues that may arise in treatment. These include low self-esteem, emotional distress, externalizing problems, and interpersonal problems such as fear of commitment, difficulty trusting, a high rate of divorce, and strained relationships with parents.     

Assessment of Trauma History and Trauma-Related Problems in Ethnic Minority Child Populations: An INFORMED Approach

Youth who experience traumatic events are at risk for a range of negative outcomes, including posttraumatic stress disorder, other anxiety disorders, depression, substance use, and health risk behaviors. It is important to identify valid methods to assess individuals for exposure to traumatic events, as well as the types of problems or symptoms they may be experiencing as a result of these events.

An individual's cultural values, beliefs, and practices can affect the ways that trauma-related sequelae are manifested and presented upon evaluation. Obtaining information about a child's ethnic background, including cultural beliefs and practices, can be a useful component of a trauma assessment. In this paper, the authors will (a) review standard guidelines for assessment of trauma in the general population; (b) present an argument for modification of standard trauma assessment strategies used with culturally diverse populations; (c) describe the culturally INFORMED model, comprised of 8 empirically based recommendations for modifying trauma assessment of culturally diverse populations; and (d) provide an example of how this model has been applied to a trauma assessment protocol with a Mexican immigrant population. Implications of how culturally modified assessment can be used to inform culturally modified cognitive-behavioral treatment of trauma symptoms in children also are addressed.     

Assessing Children’s Exposure to Intimate Partner Violence

Child exposure to intimate partner violence (IPV) is widely acknowledged as a threat to the psycho-social and academic well-being of children. Unfortunately, as reflected in the literature, the specific link between such exposure and childhood outcomes is ambiguous. Based on a review of the literature, this article suggests that this state of affairs is due, in part, to the manner with which exposure to IPV is operationally defined. After reviewing the dominant strategies for operationally defining exposure to IPV and the problems associated with those strategies, this article reports original data contrasting three measures derived from maternal reports, three measures derived from child reports, and the limited concordance among those different indices of exposure to IPV. The implications of these findings for research on child outcomes and the clinical assessment of children who might have been exposed to IPV are discussed.     

Developmental prosopagnosia: a review

This article reviews the published literature on developmental prosopagnosia, a condition in which the ability to recognize other persons by facial information alone has never been acquired. Due to the very low incidence of this syndrome, case reports are sparse. We review the available data and suggest assessment strategies for patients suffering from developmental prosopagnosia. It is suggested that developmental prosopagnosia is not a unitary condition but rather consists of different subforms that can be dissociated on the grounds of functional impairments. On the basis of the available evidence, hypotheses about the aetiology of developmental prosopagnosia as well as about the selectivity of deficits related to face recognition are discussed.     

The Expression of Posttraumatic Stress Symptoms in Daily Life: A Review of Experience Sampling Methodology and Daily Diary Studies

This review examined the assessment of posttraumatic stress symptoms (PTSS) in daily life using experience sampling methodology (ESM)/ecological momentary assessment (EMA) and daily diary studies in adult samples. Fifteen peer-reviewed studies were identified and categorized into areas of total PTSD/multiple PTSS (studies including three or more symptom clusters), intrusive memories, and mood and anxiety symptoms. Overall, ESM and the daily diary method proved feasible for assessing the real-world expression of PTSS, resulted in minimal reactivity, and offered a number of advantages over classical assessment. Even within the two measurement types of ESM and daily diary, there was great variability in study design and analysis. The benefits and limitations of the different approaches are discussed. Different themes in content emerged as well, such as coping strategies and affective instability throughout the course of a day. Gaps in our current understanding are highlighted and suggestions for methodology and future areas of research are proposed.     

Clinical assessment applications of ambulatory biosensors

Ambulatory biosensor assessment includes a diverse set of rapidly developing and increasingly technologically sophisticated strategies to acquire minimally disruptive measures of physiological and motor variables of persons in their natural environments. Numerous studies have measured cardiovascular variables, physical activity, and biochemicals such as cortisol in psychopathology and treatment research. The physiological concomitants of many behavior and medical disorders and the benefits of a multimethod assessment strategy provide strong rationales for clinical applications of ambulatory biosensor measurement. A number of psychometric dimensions of evaluation are important in clinical applications of biosensor measurement, including accuracy and validity, reliability and consistency, clinical utility, incremental validity and utility, sensitivity to change, generalizability, cost benefits, and the conditional nature of dimensions of biomeasure evaluation. The authors review ambulatory biosensor methods and make recommendations for use of the technology.     

Virtual reality in brain damage rehabilitation: review.

Given the high incidence of brain injury in the population, brain damage rehabilitation is still a relatively undeveloped field. Virtual reality (VR) has the potential to assist current rehabilitation techniques in addressing the impairments, disabilities, and handicaps associated with brain damage. The main focus of much of the exploratory research performed to date has been to investigate the use of VR in the assessment of cognitive abilities, but there is now a trend for more studies to encompass rehabilitation training strategies. This review describes studies that have used VR in the assessment and rehabilitation of specific disabilities resulting from brain injury, including executive dysfunction, memory impairments, spatial ability impairments, attention deficits, and unilateral visual neglect. In addition, it describes studies that have used VR to try to offset some of the handicaps that people experience after brain injury. Finally, a table is included which, although not an exhaustive list of everything that has been published, includes many more studies that are relevant to the use of VR in the assessment and rehabilitation of brain damage. The review concludes that the use of VR in brain damage rehabilitation is expanding dramatically and will become an integral part of cognitive assessment and rehabilitation in the future.     

Interpersonal Assessment in Counseling and Psychotherapy

This article provides a review of some of the major instruments, methodologies, and strategies available to assess clients' interpersonal functioning. The focus is on instruments that provide characterizations of clients' and counselors' overt interpersonal behavior and covert reactions translated onto interpersonal circle models. A suggested interpersonal assessment battery is presented, and how the information obtained from this battery can be applied to assist in conceptualization and treatment efforts is described.     

Employee well-being: A multilevel model linking work and nonwork domains

In this article, we review recent methodological developments that have enabled conceptual advances addressing intraindividual processes leading to psychological well-being. We contend that the introduction of dynamic assessment methodologies for sampling experiences, feelings, and behaviours on and off the job, together with the implementation of multilevel modelling strategies in organizational research on well-being, should lead to the development of richer models of employee well-being (compared to existing theoretical models). Accordingly, we develop a model of employee well-being that considers both personal and situational predictors, and both work and nonwork well-being indicators, as well as the real-time relationships between well-being antecedents and indicators across these two life spheres.     

New strategies in the assessment of psychological factors affecting medical conditions

In this article, we examine research that may lead to a better assessment of psychological factors affecting medical conditions. We performed a review of the psychosomatic literature using both Medline and manual searches. We selected papers that were judged to be relevant to new strategies of assessment, with particular reference to the use of the Diagnostic Criteria for Psychosomatic Research. We assessed 8 areas concerned with the assessment of psychological factors in the setting of medical disease: hypochondriasis, disease phobia, persistent somatization, conversion symptoms, illness denial, demoralization, irritable mood, and Type A behavior. A new subclassification of the Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM-V]; not yet published) category of psychological factors affecting physical conditions appears to be feasible and may provide the clinician with better tools for identifying psychological distress.     

New Strategies in the Assessment of Psychological Factors Affecting Medical Conditions

In this article, we examine research that may lead to a better assessment of psychological factors affecting medical conditions. We performed a review of the psychosomatic literature using both Medline and manual searches. We selected papers that were judged to be relevant to new strategies of assessment, with particular reference to the use of the Diagnostic Criteria for Psychosomatic Research. We assessed 8 areas concerned with the assessment of psychological factors in the setting of medical disease: hypochondriasis, disease phobia, persistent somatization, conversion symptoms, illness denial, demoralization, irritable mood, and Type A behavior. A new subclassification of the Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM-V]; not yet published) category of psychological factors affecting physical conditions appears to be feasible and may provide the clinician with better tools for identifying psychological distress.     

Establishing Treatment Fidelity in Evidence-Based Parent Training Programs for Externalizing Disorders in Children and Adolescents

The current review evaluates the use of treatment fidelity strategies in evidence-based parent training programs for treating externalizing disorders. We used a broad framework for evaluating treatment fidelity developed by the National Institutes of Health Treatment Fidelity Workgroup that includes the aspects of treatment design, treatment delivery, training providers, and assessment of participant receipt of treatment and enactment of treatment skills. Sixty-five articles reporting outcome trials of evidence-based parent training programs met inclusion criteria and were coded for treatment fidelity strategies. The mean adherence to fidelity strategies was .73, which was higher than two previous review studies employing this framework in the health literature. Strategies related to treatment design showed the highest mean adherence (.83), whereas training of providers and enactment of treatment skills had the lowest (.58). In light of an increasing emphasis on effectiveness and dissemination trials, the broader treatment fidelity framework as applied in this review focuses needed attention on areas often overlooked in fidelity practices, such as training providers and generalization of treatment skills. We discuss the strengths and limitations of fidelity practices in parent training studies, implications of these findings, and areas for future research.     

Detection of feigned mental disorders: a meta-analysis of the MMPI-2 and malingering

The validity of test data from multiscale inventories is dependent on self-reports that may be easily distorted by malingering. In examining the Minnesota Multiphasic Personality Inventory-2's (MMPI-2) role in the assessment of feigning, this review provides a conceptual analysis of the detection strategies underlying the MMPI-2 validity scales. The conceptual analysis is augmented by comprehensive meta-analysis of 65 MMPI-2 feigning studies plus 11 MMPI-2 diagnostic studies. For the rare-symptoms strategy, Fp (Cohen's d = 2.02) appears especially effective across diagnostic groups; its cut scores evidence greater consistency than most validity indicators. The data supported the F as an effective scale but questioned the routine use of Fb. Among the specialized scales, Ds appeared especially useful because of its sophisticated strategy, consistent cut score, and minimalfalse-positives. General guidelines are offeredfor specific MMPI-2 validity scales in the assessment of malingering with specific diagnoses.