Selecting the most informative items in the IIP scales for personality disorders: an application of item response theory.

The first goal of the present analyses was to shorten the five scales (Pilkonis, P. A., Kim, Y., Proietti, J. M., & Barkham, M. [1996]. Journal of Personality Disorders, 10, 355-369) for personality disorders (PDs) developed from the Inventory of Interpersonal Problems (IIP), thereby increasing their attractiveness for screening purposes. The second goal was to illustrate, for more general purposes, the utility of item response theory (IRT) for such scale refinement. IRT analyses were performed using data collected from six different samples (N = 1149) at five sites and a two-parameter (2P) graded model designed for multiple response items like those on the IIP. The five most informative items from each scale were identified, based on the magnitude of item discrimination parameters and the range and elevation of individual item information functions. Preliminary analyses of the reliability and validity of the short forms of the scales (totaling 25 items) supported their value as alternatives to the longer forms (consisting of 47 items), although definitive tests of their psychometric properties await crossvalidation in independent samples. Analyses of the quality receiver operating characteristics (QROC) of the long and short forms showed that both versions can be useful in predicting the presence versus absence of any PD diagnosis arrived at by using either a "best estimate" clinical consensus method or a structured Axis II interview.     

Screening for personality disorders in a nonclinical population

Based on the Inventory of Interpersonal Problems (IIP), the IIP-PD and the IIP-C screening scales were developed to distinguish personality disorder (PD) from non-PD and Cluster C from other PD, respectively, in a clinic population. Two studies were conducted to determine (a) validity and reliability of these IIP scales for PD screening in a nonclinical population, (b) specificity of IIP-C for identifying Cluster C, and (c) usefulness of the IIP scales for screening Cluster A. College students were screened using the IIP scales (Study 1, N = 454, Study 2, N = 87). High and low scorers completed PD-related questionnaires in Study 1 and a clinical interview for PD symptomatology in Study 2. Results indicated strong test-retest reliability, internal consistency, and factorial, convergent, and external validity. The scales tapped a common deficit in interpersonal relatedness, with some distinction between externalizing and internalizing dimensions, respectively, and both scales were positively and significantly associated with schizotypal traits. In conclusion, the IIP-PD and IIP-C are useful and valid screening instruments for identifying any versus no PD in nonclinical populations.     

Interpersonal sensitivity, partner support, patient-physician communication, and sexual functioning in men recovering from prostate carcinoma

Prostate carcinoma (PC) is the most commonly diagnosed cancer in men. Treatments for localized PC are associated with side effects including sexual dysfunction, which has been linked to decrements in health-related quality of life and elevated distress levels. In this study, we examined the relationship between 2 personality traits, interpersonal sensitivity and lack of sociability, assessed by the Inventory of Interpersonal Problems (IIP; Pilkonis, Kim, Proietti, & Barkham, 1996) and recovery of sexual functioning in 121 men (M age = 60.6 years) recently treated with radical prostatectomy. Interpersonal sensitivity refers to the predisposition to perceive and elicit criticism and rejection from others; lack of sociability refers to chronic difficulties taking the initiative in interpersonal situations. After adjusting for relevant covariates, interpersonal sensitivity, but not sociability, was significantly associated with lower levels of sexual functioning. Patient-physician communication and partner perceived social support were explored as mediators of this relationship. Although interpersonal sensitivity was significantly associated with both poorer patient-physician communication and lower levels of partner support, the results did not support mediation. This study provides preliminary evidence that certain IIP-assessed interpersonal styles may complicate the recovery of sexual functioning after surgical treatment for PC.     

Development and validation of a new procedure for the diagnostic assessment of personality disorder: the Multidimensional Personality Disorder Rating Scale (MPDRS)

Data from a community-based prospective longitudinal study were used to investigate the utility of a structured assessment of the DSM-IV General Diagnostic Criteria for a Personality Disorder (PD). The Structured Clinical Interview for DSM-IV PDs (SCID-II) was administered to 154 adults. After completing the interview, an experienced clinician assessed the General Diagnostic Criteria for a PD using a structured rating scale. PD diagnoses, based solely on the rating scale data, demonstrated strong agreement with diagnoses obtained using the diagnostic thresholds for specific PDs (Kappa = 0.89). The sensitivity, specificity, predictive power, and internal reliability of the rating scale were satisfactory. PD diagnoses, based on both of the assessment procedures, were associated with substantial impairment and distress. These findings suggest that a structured assessment of the DSM-IV General Diagnostic Criteria for a Personality Disorder may constitute a useful alternative or supplement to standard assessments of the diagnostic thresholds for specific DSM-IV PDs.     

Evaluation of the SCID-II personality disorder traits for DSM-IV: coherence, discrimination, relations with general personality traits, and functional impairment

The utility of the DSM personality disorder (PD) system remains a concern. The strategy employed represents one approach designed to evaluate and improve the diagnostic efficiency of the SCID-II PDs. Using a sample of 203 patients, SCID-II PD items-based on the criterion sets of the 10 DSM-IV PDs-were evaluated with respect to (a) convergent validity; (b) divergent validity; (c) relation to general personality traits; and (d) association with functional impairment. Only Borderline PD items were satisfactory on all four evaluation criteria. Histrionic and Obsessive-Compulsive PD items met criteria for convergent and divergent validity and relation to personality dimensions of the Five-Factor Model of Personality (FFM) but were not related to functional impairment, suggesting they might be reconsidered as disorders. Schizotypal PD items met three of the four criteria but showed no relation to FFM dimensions, suggesting that it may be a candidate for reassignment to Axis I.     

Diagnostic validity of the Eppendorf Schizophrenia Inventory (ESI): a self-report screen for ultrahigh risk and acute psychosis

Providers of mental health services need tools to screen for acute psychosis and ultrahigh risk (UHR) for transition to psychosis in help-seeking individuals. In this study, the Eppendorf Schizophrenia Inventory (ESI) was examined as a screening tool and for its ability to correctly predict diagnostic group membership (e.g., help seeking, mild psychiatric complaints, highly symptomatic mood or anxiety disorder, UHR, acute psychosis). Diagnostic evaluation with established instruments was used for diagnosis in 3 research samples. UHR status was assessed with the Structured Interview for Prodromal Symptoms/Scale of Prodromal Symptoms (Miller et al., 1999) and the Bonn Scale for the Assessment of Basic Symptoms Prediction list (Gross, Huber, Klosterk?tter, & Linz, 1987; Klosterk?tter, Hellmich, Steinmeyer, & Schulze-Lutter, 2001). This study showed that members of different diagnostic groups rate themselves significantly differently on the ESI and its subscales. A new subscale was constructed, the UHR-Psychosis scale, that showed good utility in detecting individuals with interview-diagnosed UHR status and acute psychosis. The scale is also sensitive to the threshold between UHR and acute psychosis. Practical applications of the ESI include use as a diagnostic tool within various settings.     

Refinement of the MMPI-2 F(p) scale is not necessary: a response to Gass and Luis

Gass and Luis (2001) reported that four MMPI-2 Lie scale items contained on the F(p) scale do not measure symptom exaggeration but measure defensiveness. They hold that elimination of the four Lie scale items improves the utility of the F(p) scale in the identification of exaggeration in VA samples. To directly address the assertion that removal of the L scale items from the F(p) scale enhances the predictive validity of F(p), data derived from a previously published study where 74 psychiatric inpatients were asked to retake the MMPI-2 and either feign psychopathology or respond in an honest manner were reanalyzed. The intact F(p) scale demonstrated a stronger correlation with group membership, increased incremental validity, and superior classification rates compared with the F(p) scale without the 4 Lie scale items. Consequently, the F(p) refinement recommended by Gass and Luis is unnecessary.     

The Use of the Devereux Scales of Mental Disorders in the Assessment of Attention-Deficit/Hyperactivity Disorder and Conduct Disorder

The present study was designed to gather validity data on the Devereux Scales of Mental Disorders (DSMD) for distinguishing among children and adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD; N = 32), Conduct Disorder (CD; N = 34), or no clinical diagnosis (NC; N = 65). Three types of indicators were compared: (a) DSMD scale, composite, and total scores, (b) the number of ADHD or CD-related items endorsed, and (c) diagnostic efficiency statistics (e.g., sensitivity, positive and negative predictive power). The clinical groups did not differ significantly from each other, but both were significantly higher than the NC group on all DSMD scales. Moreover, there were significant differences between the ADHD and the CD groups on the number of respective ADHD and CD-related items endorsed. A cut-off of seven to eight items yielded the best discrimination between the two diagnostic groups. Diagnostic efficiency statistics indicate that the DSMD may be effective at differentiating between similar disruptive behavior disorders.     

Portability of a screener for pediatric bipolar disorder to a diverse setting

Robust screening measures that perform well in different populations could help improve the accuracy of diagnosis of pediatric bipolar disorder. Changes in sampling could influence the performance of items and potentially influence total scores enough to alter the predictive utility of scores. Additionally, creating a brief version of a measure by extracting items from a longer scale might cause differential functioning due to context effects. The authors of current study examined both sampling and context effects of a brief measure of pediatric mania. Caregivers of 813 youths completed the parent-reported version of the General Behavior Inventory (PGBI) at an academic medical center sample enriched for mood disorders. Caregivers of 481 youths completed the PGBI at a community mental health center. Caregivers of 799 youths completed 10 items extracted from the PGBI at a community setting. Caregivers of 159 youths completed both versions of the PGBI and a semistructured diagnostic interview. Differential item functioning indicated that across samples some items functioned differently; however, total observed scores were similar across all levels of mania. Receiver operating characteristic analysis indicated that the 10 extracted items discriminated bipolar disorder from nonbipolar behavior as well as when the items were embedded within the full measure. Findings suggest that the extracted items perform similarly to the embedded items in the community setting. Measurement properties appear sufficiently robust across settings to support clinical applications.     

Assessment of dysfunctional beliefs in borderline personality disorder

This study had two aims: to test the hypothesis that borderline personality disorder (BPD) patients hold numerous dysfunctional beliefs associated with a variety of Axis II disorders, and to construct a BPD belief scale which captures these beliefs. Beliefs were measured using the Personality Belief Questionnaire (PBQ) which is designed to assess beliefs associated with various personality disorders, although not specifically BPD. Eighty-four BPD patients and 204 patients with other personality disorders (OPD) were randomly split into two study samples. Fourteen PBQ items were found to discriminate BPD from OPD patients in both samples. These items came from the PBQ Dependent, Paranoid, Avoidant, and Histrionic scales and reflect themes of dependency, helplessness, distrust, fears of rejection/abandonment/losing emotional control, and extreme attention-seeking behavior. A BPD beliefs scale constructed from these items showed good internal consistency and diagnostic validity among the 288 study patients. The scale may be used to assist in diagnosis and cognitive therapy of BPD.     

MCMI-II diagnosis of borderline personality disorder: base rates versus prototypic items.

The Millon Clinical Multiaxial Inventory-II (MCMI-II) profiles of 26 psychiatric inpatients diagnosed as having borderline personality disorders were compared with profiles of 42 patients with no personality disorders. The borderline group scored significantly higher on the following scales: Disclosure (X), Debasement (Z), Passive-Aggressive (8A), Self-Defeating (8B), Borderline (C), and Major Depression (CC). Differences approaching significance were also found on substance abuse measures: the Alcohol Dependence (B) scale and Drug Dependence (T) scale. These findings are consistent with criteria established in the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R]; American Psychiatric Association, 1987) and the results of other studies utilizing the MCMI-II. In addition, diagnostic efficiency of Scale C was assessed at various cutoff points defined by either base rate (BR) scores or the number of prototypic items endorsed. The greatest efficiency was found when a cutoff of seven or more prototypic items was utilized, with nearly 80% of the patients correctly classified. Results are discussed in terms of their relevance for further research.     

A Review of “The reviewer's guide to quantitative methods in the social sciences”

The Millon Clinical Multiaxial Inventory-II (MCMI-II) profiles of 26, psychiatric inpatients diagnosed as having borderline personality disorders were compared with profiles of 42 patients with no personality disorders. The borderline group scored significantly higher on the following scales: Disclosure (X), Debasement (Z), Passive-Aggressive (8A), Self-Defeating (8B), Borderline (C), and Major Depression (CC). Differences approaching significance were also found on substance abuse measures: the Alcohol Dependence (B) scale and Drug Dependence (T) scale. These findings are consistent with criteria established in the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R] American Psychiatric Association, 1987) and the results of other studies utilizing the MCMI-II. In addition, diagnostic efficiency of Scale C was assessed at various cutoff points defined by either base rate (BR) scores or the number of prototypic items endorsed. The greatest efficiency was found when a cutoff seven or more prototypic items was utilized, with nearly 80% of the patients correctly classified. Results are discussed in terms of their relevance for further research.     

Inventory of interpersonal problems: a three-dimensional balanced and scalable 48-item version

Interpersonal relating has been a focus of attention in psychiatry for decades. To address this domain, a self-rating scale, the Inventory of Interpersonal Problems (IIP; Horowitz, Rosenberg, Baer, Ure?o, & Villase?or, 1988), was developed. Analysis of the psychometric properties of IIP presented in this article was performed by principal component analysis (PCA) for the purpose of obtaining subscales with a balanced, bipolar dimensionality. The model was validated by the resulting dimensions' ability to discriminate among different categories of personality disorders (PDs). The problem of a General Complaint factor affecting PCAs of questionnaires such as the IIP is discussed thoroughly, and ways of avoiding the problem are outlined. We present a three-dimensional structure of the IIP with both theoretically appealing and statistically robust dimensions of Assertiveness, Sociability, and Interpersonal Sensitivity based on 48 (out of 127) items. Balanced, additive indexes using the subset of 48 items appeared psychometrically sound by showing much lower correlations internally and less confounding from the General Complaint factor than extant indexes derived from the IIP. External validity seemed to be bolstered by all subscales' discriminating significantly between different PDs versus no PDs, on both cluster and single diagnosis levels. Our analysis seemed to substantiate the reliability (scalability) of three dimensions of the IIP tapping different areas of the interpersonal relational field.     

Dependent personality disorder: comparing an expert generated and empirically derived five-factor model personality disorder count

Assessment of the Diagnostic and Statistical Manual of Mental Disorders (4th Ed.; DSM-IV ) personality disorders (PDs) using five-factor model (FFM) prototypes and counts has shown substantial promise, with a few exceptions. Miller, Reynolds, and Pilkonis suggested that the expert-generated FFM dependent prototype might be misspecified in relation to the DSM-IV because of the overemphasis of high Agreeableness and underemphasis of low Conscientiousness in the experts' conception. A meta-analytic review of the relations between the FFM facets and Dependent PD (DPD) was conducted and used to create a revised, empirically based FFM DPD profile and count. The revised profile and count were more strongly correlated with DSM and non-DSM conceptualizations of maladaptive dependency. In addition, the revised FFM DPD profile was able to recreate the patterns of comorbidity typically found when using DSM-IV measures of DPD. Possible explanations for the discrepancy between the expert ratings and the meta-analytic results are offered.     

Construction of Circumplex Scales for the Inventory of Interpersonal Problems

We constructed a set of circumplex scales for the Inventory of Interpersonal Problems (IIP; Horowitz, Rosenberg, Baer, Ureno, & Villasenor, 1988). Initial scale construction used all 127 items from this instrument in two samples of university undergraduates (n = 197; n = 273). Cross-sample stability of item locations plotted against the first two principal components was high. A final set of eight 8-item circumplex scales was derived from the combined sample (n = 470) and cross-validated in a third university sample (n = 974). Finally, we examined the structural convergence of the IIP circumplex scales with an established measure of interpersonal dispositions, the Revised Interpersonal Adjective Scales (IAS-R; Wiggins, Trapnell, & Phillips, 1988). Although both circumplex instruments were derived independently, they shared a common Circular space. Implications of these results are discussed with reference to current research methods for the study of interpersonal behavior.     

Diagnostic Discrimination of Patients with Different OCD Main Symptom Domains from each Other and from Anxious and Depressive Controls

The extent to which the subscales of multidimensional OCD measures accurately distinguish patients with specific OCD main symptom domains from controls at different cutscores has not yet been examined. Diagnostic accuracy of OCD measures usually is determined by comparing the total scores of heterogeneous OCD samples and controls and therefore may underestimate the measures’ discrimination potential. In the current study, subtype-specific diagnostic accuracy and criterion-related validity of the Obsessive-Compulsive Inventory-Revised (OCI-R) subscales were examined in 327 patients with OCD, anxiety, and/or depressive disorders. All subscales demonstrated good to excellent criterion-related validity and diagnostic accuracy for distinguishing patients with specific OCD main symptom domains from controls. As expected, the single OCI-R subscales lead to more accurate diagnostic decisions than the total scale. Thus, the subscale-specific cutscores significantly improve the OCI-R’s utility for subtype-specific treatment planning and outcome measurement. Furthermore, an alternative classification algorithm distinguishing patients with OCD from controls based on subscale cutscores leads to a better sensitivity, but also to a lower specificity than discrimination based on the total scale cutscore.     

Self-Report Measures of Intelligence: Are They Useful as Proxy IQ Tests?

Correlations between single-item self-reports of intelligence and IQ scores are rather low (.20–.25) in college samples. The literature suggested that self-reports could be improved by three strategies: (1) aggregation, (2)item weighting, and (3) use of indirect, rather than direct, questions. To evaluate these strategies, we compared the validity of aggregated and unaggregated versions of direct measures with four indirect measures (Gough's Intellectual efficiency scale, Hogan's Intellect composite scale, Sternberg's Behavior Check List, and Trapnell's Smart scale). All measures were administered to two large samples of undergraduates ( N s = 310, 326), who also took an IQ test. Although results showed some success for both direct and indirect measures, the failure of their validities to exceed .30 impugns their utility as IQ proxies in competitive college samples. The content of the most valid items referred to global mental abilities or reading involvement. Aggregation benefited indirect more than direct measures, but prototype-weighting contributed little.     

The MCMI-II depression scales: do they assist in the differential prediction of depressive disorders?

This study examined the diagnostic efficiency of the Millon Clinical Multiaxial Inventory-II (MCMI-II) Major Depression (CC) and Dysthymia (D) scales for the differential prediction of unipolar depressive disorders. The MCMI-II was administered to 109 inpatients at a large private psychiatric hospital in the Midwest. All patients had a primary Axis I diagnosis of a depressive disorder, given at discharge by the attending psychiatrists. When CC scores were compared to clinician diagnoses, results indicated that the sensitivity of the CC scale was improved over what had previously been reported for studies involving the MCMI-I CC scale. However, overall, the D scale functioned slightly better as a predictor of major depression than did the CC scale. One likely factor in explaining this finding is that the CC scale contains very few items assessing vegetative/somatic symptomatology, which are the critical factors in distinguishing major depression from other unipolar depressive disorders.     

A simplified technique for scoring DSM-IV personality disorders with the Five-Factor Model

The current study compares the use of two alternative methodologies for using the Five-Factor Model (FFM) to assess personality disorders (PDs). Across two clinical samples, a technique using the simple sum of selected FFM facets is compared with a previously used prototype matching technique. The results demonstrate that the more easily calculated counts perform as well as the similarity scores that are generated by the prototype matching technique. Optimal diagnostic thresholds for the FFM PD counts are computed for identifying patients who meet diagnostic criteria for a specific PD. These threshold scores demonstrate good sensitivity in receiver operating characteristics analyses, suggesting their usefulness for screening purposes. Given the ease of this scoring procedure, the FFM count technique has obvious clinical utility.     

A Short MMPI Scale to Identify People Likely to Begin Smoking

An item analysis of the Minnesota Multiphasic Personality Inventory (MMPI) was conducted to develop questionnaires that best discriminated (a) individuals who ever smoked versus those who never smoked and (b) ex-smokers from current smokers. The analyses were based on a sample of subjects who took the MMPI during 1964-1967 and reported their smoking status during 1987 Although no items distinguished individuals who quit versus continued to smoke, several items discriminated people who ever smoked from nonsmokers. These items formed two factors: Extroversion and Unconventionalism. These results provide support for the importance of extroversion, impulsivity, and antisocial tendencies as personality predictors of smoking initiation. The utility of this MMPI scale is discussed.