Evolution of Millon's Personality Prototypes

In 1969, Millon proposed 8 personality prototypes that could be conceptualized at lower levels of severity than the level of the personality disorders. These personalities were fit into a theoretical system that emphasized the strength of the interpersonal attachment and the mode of accommodation. Disorders such as schizophrenia and depression were pictured as a decompensation of the basic personality. This article traces the evolution of Millon's theory from the original inception, through the influence of the 3rd and 4th editions of the Diagnostic and Statistical Manual of Mental Disorders, and onto its present form. Now visualized as resulting from 3 polarities, the model has expanded the number of personalities to include 3 additional prototypes.     

An Overview of Issues Related to Categorical and Dimensional Models of Personality Disorder Assessment

Despite long-standing efforts to improve the current diagnostic system for Axis II, problems remain with the categorical conceptualization of personality disorders (PDs). Due in part to these problems, interest has developed in dimensional models of PD classification. In this article, we discuss four issues relevant to categorical vs. dimensional assessment of PDs: (a) problems with self-reports in PD patients, (b) methodological issues in behavioral and clinician assessment of PDs, (c) challenges that arise when dimensional models are applied to patient and nonpatient samples, and (d) clinical implications of categorical and dimensional PD models. We suggest that researchers and clinicians address these concerns to avoid implementing a new PD assessment model that—although different from the current system—would otherwise remain fraught with difficulties.     

Millon's Contributions to Preadolescent and Adolescent Personality Assessment: Searching Onward and Upward

Theodore Millon was one of the most influential personality theorists of the 20th century. His theory was originally rooted in biosocial learning models and later reconceptualized as an evolutionary model. This foundation of Millon's work encompasses the entire life span. He had a genuine concern for humankind, especially children. His theory encompasses a comprehensive understanding of the relationship among childhood experiences, parenting styles, and recurring events throughout the life span in shaping the personality. Notable contributions to child and adolescent assessment are the Millon Adolescent Personality Inventory (Millon, Green, & Meagher, 1982 Millon, T., Green, C., & Meagher, R. B. (1982). Millon Adolescent Personality Inventory manual. Minneapolis, MN: National Computer Systems. [Google Scholar]), the Millon Adolescent Clinical Inventory (Millon, Millon, & Davis, 1993 Millon, T., Millon, C., & Davis, R. (1993). Millon Adolescent Clinical Inventory manual. Minneapolis, MN: National Computer Systems. [Google Scholar]), and the Millon Pre-Adolescent Clinical Inventory (M–PACI; Millon, Tringone, Millon, & Grossman, 2005 Millon, T., Tringone, R., Millon, C., & Grossman, S. (2005). Millon Pre-Adolescent Clinical Inventory manual. Minneapolis, MN: Pearson. [Google Scholar]). Given Millon's influence on the personality disorders section of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the aforementioned instruments have personality constructs tied to familiar DSM categories, and among them, cover the age range of 9 to 18 years old. His development of the Millon Inventories revolutionized personality assessment in the United States and abroad. Millon's legacies will live on through his works and through the respect and compassion he demonstrated toward others.     

Contextualized Personality Questionnaires: A Case for Copulas in Structural Equation Models for Categorical Data

For structural equation models (SEMs) with categorical data, correlated measurement residuals are not easily implemented. The problem lies mainly in the absence of a categorical analogue to the multivariate normal distribution and the absence of closed form formulas in SEMs for categorical data. We present a novel technique to handle measurement residuals that keeps the attractive SEM mainframe intact yet adds flexibility in dependence modeling without excessive computational burden. The technique is based upon the concept of copula functions and is introduced with a data set of ordinal responses originating from a contextualized personality study on aggression. Focus is on models arising in a multitrait-multimethod context, where the flexibility in dependence structures allows for method effects that can vary across the latent trait dimension. The empirical application illustrates that ignoring design-implied correlated measurement residuals can potentially influence study results and conclusions in both a quantitative as well as a qualitative way. Model parameter estimates can be biased, but more important, model inferences can be heavily distorted.     

Combining Prototypes: A Selective Modification Model

We propose a model that accounts for how people construct prototypes for composite concepts out of prototypes for simple concepts. The first component of the model is a prototype representation for simple, noun concepts, such as fruit, which specifies: (1) the relevant attributes of the concepts, (2) the possible values of each attribute, (3) the salience of each value, and (4) the diagnosticity of each attribute. The second component of the model specifies procedures for modifying simple prototypes so that they represent new, composite concepts. The procedure for adjectival modification, as when red modifies fruit, consists of selecting the relevant attribute(s) in the noun concept (color), boosting the diagnosticity of that attribute, and increasing the salience of the value named by the adjective (red). The procedure for adverbial modification, as in very red fruit, consists of multiplication-by-o-scalar of the salience of the relevant value (red). The outcome of these procedures is a new prototype representation. The third component of the model is tversky's (1977) contrast rule for determining the similarity between a representation for a prototype and one for an instance. The model is shown to be consistent with previous findings about prototypes in general, as well as with specific findings about typicality judgments for adjective-noun conjunctions. Four new experiments provide further detailed support for the model.     

Categorical or Dimensional: A Reanalysis of the Anxiety Sensitivity Construct

Anxiety sensitivity, or the fear of anxiety sensations, has been implicated in the etiology of anxiety disorders, particularly panic disorder. Recently, inconsistent findings have been reported regarding the latent structure of anxiety sensitivity. Whereas some taxometric studies of anxiety sensitivity have reported evidence of categorical latent structure, others have found evidence of a latent dimension. The purpose of the present research was to further examine the latent structure of anxiety sensitivity using taxometric procedures and commonly utilized measures of anxiety sensitivity. To this end, three mathematically independent taxometric procedures (MAXEIG, MAMBAC, and L-Mode) were applied to data collected from two large nonclinical samples (n's = 1,171 and 2,173) that completed the Anxiety Sensitivity Index and the Anxiety Sensitivity Index-Revised. Results from both studies converged in support of a dimensional conceptualization of anxiety sensitivity. A third study was conducted using indicators derived from the newly revised Anxiety Sensitivity Index-3 in a separate sample of 1,462 nonclinical participants. Results of these analyses provided further support for a dimensional anxiety sensitivity solution. The implications of these results for anxiety sensitivity research are discussed, and several potential directions for future research are considered.     

A General Factor of Personality in the Millon Clinical Multiaxial Inventory-III, the Dimensional Assessment of Personality Pathology, and the Personality Assessment Inventory

A General Factor of Personality (GFP) occupies the apex of the hierarchy in three prominent personality disorder inventories. On the Millon Clinical Multiaxial Inventory-III, a GFP accounted for 41% of the variance in two second-order factors, 31% of the variance in five first-order factors, and 26% of the variance in all 24 scales. On the Dimensional Assessment of Personality Pathology, a GFP accounted for 61% of the variance in six first-order factors and 36% of the variance in all 18 scales. In a cross-validation study of the Personality Assessment Inventory, a GFP accounted for 65% of the variance in two second-order factors, 47% of the variance in five first-order factors, and 27% of the variance in all 18 scales.     

人格测量：从累积式模型到展开式模型

当前大多数人格测量都采用的是累积式反应模型方法,该模型假设被试在测验上的得分随其能力或特质提高而增加,但是随着人格测量技术的不断发展,这一模型的实施效果遭到了质疑,研究者们开始关注展开式模型,该模型认为被试的反应取决于被试能力和项目阈值的匹配程度,当被试能力与项目阈值完全匹配时,被试做出肯定回答的概率达到最高点,称之为“理想点”,展开式模型的目的就是找到被试的理想点,从而寻找其真正的态度强度或人格特质水平。GGUM作为一种比较成熟的展开式模型,已经开始应用于人格测量的各个领域,但仍需要进行大规模的试测,在评估和预测效度方面积累经验,建立业界认可的心理测量学标准,不断探讨和开发相应的心理测量理论和简便易行的统计程序。     

An Actuarial-Experimental Model of Personality Assessment

A proposal has been made for a new, more powerful approach to personality assessment. The model is an integration of the characteristics of the actuarial principles of test construction with the experimental method. The experimental method should prove to be effective in controlling the error variance arising out of the accidental influences on the responses, and the actuarial paradigm should reduce the error stemming from both a possible low construct validity and the subjectivity of the clinician's judgment. The resultant increase in the clinician's power to differentiate between responses indicative of enduring traits and those which are the outcome of accidental influences should thus help in breaking the impasse currently restricting the usefulness of projective techniques.     

The DSM-III-R Categorical Personality Disorder Diagnoses: A Critique and an Alternative

Thepurpose of this article is to review the Diagnostic andStatistica1 Manual ofMental Disorders (DSM-III-R; American Psychiatric Association, 1987) categorical diagnosis of personality disorders and to provide an alternative. The results from a variety of studies indicate that the categorical distinctions provided in DSM-ZII-R lack empirical support and that a dimensional model of classification would provide more reliable and valid assessments of personality disorder. The arguments favoring the categorical model--familiarity, tradition, simplicity, ease, and consistency with clinical decisions-are also addressed An alternative approach based on the five-factor model of personality is presented. Two concerns regarding this model are the relevance of the openness-to-experience dimension and the differentiation of abnormality from normality, but neither concern is problematic when personality disorders are understood to be maladaptive variants of normal personality traits.     

Dimensional Assessment of Emotional Disorder Outcomes in Transdiagnostic Treatment: A Clinical Case Study

Current classification systems for mental disorders emphasize categorical assessment. In the domain of emotional disorders, this is inconsistent with a growing consensus that anxiety, depressive, and related disorders are best conceptualized as variations on shared underlying processes, chiefly heightened negative affect, and aversion to unwanted emotional experiences. Dimensional assessment of transdiagnostic emotional disorder constructs offers advantages for clinical and research applications, including increased parsimony and improved validity, yet there are drawbacks to many dimensional assessment systems for emotional disorders. The case presented in this paper illustrates the potential clinical utility of a new self-report instrument—the Multidimensional Emotional Disorders Inventory (MEDI)—which assesses nine dimensions characteristic of emotional disorders. MEDI scores for a highly comorbid patient are examined over the course of transdiagnostic emotion-focused cognitive-behavioral treatment. At baseline, midtreatment, and posttreatment, the MEDI offered information above and beyond DSM categorical assessment, including detection of subclinical symptoms and symptom change, while remaining parsimonious. Implications for possible use as a treatment planning instrument, integration with categorical assessment, and future research directions are discussed.     

The Dimensional Structure of Asian American Acculturation: An Examination of Prototypes

This study investigated the dimensional structure of acculturation for three prototypic groups of Asian Americans: those who were more Asian identified, those who were more American identified, and those who were jointly Asian and American identified. Three-way multidimensional scaling revealed a two-dimensional structure in which the first dimension consisted of language and culture domains and the second dimension contained cultural identity and values domains. These findings are consistent with the theoretical literature that distinguishes between external and internal aspects of acculturation (e.g., Kwan & Sodowsky, 1997). The first dimension was salient for the American identified prototype group, the second dimension was salient for the Asian identified group, and both dimensions were salient for the Asian and American identified group. Implications of the dimensional structure are discussed with respect to the predominant models of acculturation and identity for Asian Americans (e.g., Berry, 1989; Sue & Sue, 2003; Suinn, Rickard-Figueroa, Lew, & Vigil, 1987), the role of sociocultural context, and Linville's (1987) theory of cognitive complexity. Recommendations are made for the assessment of acculturation among Asian Americans.     

The hierarchical structure of the Dimensional Assessment of Personality Pathology (DAPP-BQ)

Hierarchical personality models have the potential to identify common and specific components of DSM-IV personality disorders (PDs), and may offer a solution for the re-tooling of personality pathology in future versions of the DSM. In this paper, we examined the hierarchical structure of the Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ; Livesley & Jackson, 2009) and the capacity of various trait components at different levels to predict DSM-IV PD symptoms. Participants were 275 psychiatric outpatients and 365 undergraduate students. Goldberg's (2006) bass-ackwards method was used to investigate the hierarchical structure of the DAPP-BQ. The predictive capacity of hierarchy components was assessed. We found that Level 5 of the hierarchy enhanced the capacity of the DAPP-BQ for predicting DSM PD symptoms beyond a four-factor structure, particularly for borderline PD.     

How Can I Help You? Dimensional versus Categorical Distinctions in the Assessment for Child Analysis and Child Psychotherapy

ABSTRACT

This paper describes the process of a psychoanalytically-informed or a psychodynamic diagnostic assessment with children, contrasting it with a DSM-like diagnostic process. The importance of understanding and sensitively addressing the experience of parents when they bring their child to a professional for help is highlighted. The promotion of a psychoanalytic atmosphere, the unique contribution of a child analyst or psychodynamic clinician to the general mental health field, is an approach which promotes the development of a therapeutic alliance. This allows both parents and children to express their underlying issues as openly as possible. In addition to the basic assumptions of psychoanalysis (the ubiquity of unconscious mental activity and the impact of the past on the present/the developmental perspective), several factors are crucial to bear in mind: the importance of understanding the nature of the child’s (and the parent’s) emotions, emotion regulation, development of mental representations of self and other, and their conflicts and defense mechanisms. Potential therapeutic approaches are highlighted, including stressing the need to empirically study how decisions are made by a mental health provider when moving from assessment to treatment recommendation.     

Diagnosis of Personality Disorders: A Case Study

In this article, I report a case highlighting diagnostic uncertainty about psychopathology on both Axes I and II. It concerns in part the problem of comorbidity in relation to diagnostic classification of Axis II personality disorders. After commenting on these uncertainties in relation to categorical and dimensional models, I also consider a psychoanalytic explanation to illustrate an example in which a theoretical model informs diagnostic interviewing. I emphasize how the clinical information that unfolds from an interview based on this theoretical model generates inferences about psychopathology that extend clinical understanding beyond the formal diagnostic assessment of Axes I and II disorders and assessment by self-report.