Clinical Validity of Prototype Personality Disorder Ratings in Adolescents

A growing body of research shows that personality pathology in adolescents is clinically distinctive and frequently stable into adulthood. A reliable and useful method for rating personality pathology in adolescent patients has the potential to enhance conceptualization, dissemination, and treatment effectiveness. The aim of this study is to examine the clinical validity of a prototype matching approach (derived from the Shedler Westen Assessment Procedure–Adolescent Version) for quantifying personality pathology in an adolescent inpatient sample. Sixty-six adolescent inpatients and their parents or legal guardians completed forms of the Child Behavior Checklist (CBCL) assessing emotional and behavioral problems. Clinical criterion variables including suicide history, substance use, and fights with peers were also assessed. Patients’ individual and group therapists on the inpatient unit completed personality prototype ratings. Prototype diagnoses demonstrated substantial reliability (median intraclass correlation coefficient =.75) across independent ratings from individual and group therapists. Personality prototype ratings correlated with the CBCL scales and clinical criterion variables in anticipated and meaningful ways. As seen in prior research with adult samples, prototype personality ratings show clinical validity across independent clinician raters previously unfamiliar with the approach, and they are meaningfully related to clinical symptoms, behavioral problems, and adaptive functioning.     

ICD-11 guidelines for psychotic,mood, anxiety and stress-related disorders in Mexico: Clinical utility and reliability

Background/Objective: The World Health Organization's diagnostic guidelines for ICD-11 mental and behavioural disorders must be tested in clinical settings around the world to ensure that they are clinically useful and genuinely global. The objective is evaluate the inter-rater reliability and clinical utility of ICD-11 guidelines for psychotic, mood, anxiety- and stress-related disorders in Mexican patients. Method: Adult volunteers exhibiting the selected symptoms were referred from the pre-consultation unit of a public psychiatric hospital to an interview by a pair of clinicians, who subsequently assigned independent diagnoses and evaluated the clinical utility of the diagnostic guidelines as applied to each particular case, on the basis of a scale developed for this purpose. Results: 23 clinicians evaluated 153 patients. Kappa scores were strong for psychotic disorders (.83), moderate for stress-related (.77) and mood disorders (.60) and week for anxiety and fear-related disorders (.43). A high proportion of clinicians considered all diagnostic guidelines to be quite to extremely useful as applied to their patients. Conclusions: ICD-11 guidelines for psychotic, stress-related and mood disorders allow adequate inter-rater consistency among Mexican clinicians, who also considered them as clinical useful tools.     

Assessment and DSM-IV Diagnosis of Personality Disorders: A Primer for Counselors

The DSM-IV categorizes 10 personality disorders, long-term patterns of personality traits that result in impairment of social and occupational functioning. The author details steps in the recognition and diagnosis of personality disorders, with emphasis on using the DSM-IV diagnostic framework.     

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.     

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.     

Homogeneity of Personality in Occupations and Organizations: A Comparison of Alternative Statistical Tests

Purpose

The attraction?Cselection?Cattrition (ASA) model has served as the foundation for numerous investigations. However, the generally supportive evidence for ASA??s homogeneity hypothesis has often been based on statistical tests (e.g., MANOVA) that rely on between-group differences to evaluate within-group agreement. The primary purpose of this article was to discuss advantages of direct statistical tests of homogeneity??average deviation (AD) and r _wg??when testing ASA??s homogeneity hypothesis, and advantages of other statistical tests for testing other aspects of ASA theory. A secondary goal was to evaluate the extent to which occupational homogeneity is distinct from organizational homogeneity.

Design/Methodology/Approach

Data were obtained from the Center for Creative Leadership (CCL) and included scores on the Myers-Briggs Type Indicator^? (MBTI) personality measure for 1,103 managers from 25 organizations and 17 occupations.

Findings

Results were generally supportive of the homogeneity hypothesis. AD values showed that most groups were homogeneous on most assessed personality dimensions. A comparison analysis using traditional statistical tests (i.e., MANOVA) indirectly suggested within-group homogeneity by revealing a significant between-groups effect. In addition, results suggested possible boundary conditions to ASA; notably, meaningful heterogeneity was observed for the S?CN (sensing-intuition) MBTI^? dimension.

Implications

The current study provides direct support for ASA??s homogeneity hypothesis for both organizations and occupations and offers guidance for future research on ASA theory and its possible boundary conditions.

Originality/Value

This is one of the first studies to test the predictions of ASA in both organizations and occupations using a direct index of agreement.     

A case-controlled field study evaluating ICD-11 proposals for relational problems and intimate partner violence

Background/Objective: Intimate partner relationship problems and intimate partner abuse and neglect — referred to in this paper as “relational problems and maltreatment” — have substantial and well-documented impact on both physical and mental health. However, classification guidelines, such as those found in the International Classification of Diseases (ICD-10), are vague and unlikely to support consistent application. Revised guidelines proposed for ICD-11 are much more operationalized. We used standardized clinical vignette conditions with an international panel of clinicians to test if ICD-11 changes resulted in improved classification accuracy. Method: English-speaking mental health professionals (N = 738) from 65 nations applied ICD-10 or ICD-11 (proposed) guidelines with experimentally manipulated case presentations of presence or absence of (a) individual mental health diagnoses and (b) relational problems or maltreatment. Results: ICD-11, compared with ICD-10, guidelines resulted in significantly better classification accuracy, although only in the presence of co-morbid mental health problems. Clinician factors (e. g., gender, language, world region) largely did not impact classification performance. Conclusions: Despite being considerably more explicated, raters’ performance with ICD-11 guidelines reveals training issues that should be addressed prior to the release of ICD-11 in 2018 (e. g., overriding the guidelines with pre-existing archetypes for relationship problems and physical and psychological abuse).     

Comparative Personality Judgments: Replication and Extension of Robust Findings in Personality Perception Using an Alternative Method

The scientific study of accuracy in personality judgment typically involves the utilization of rating scales to make absolute decisions about a target individual. Although this method has many merits, it restricts some experimental options and is further removed from ecological validity than one would desire. These studies represent an attempt to develop an alternative methodology for the study of personality judgment—specifically for use in explorations of judgment process. A series of photo sets containing pictures of 3 individuals, each representing a different level of a specific personality trait, was created. The participant's task was to select high and low scorers on a dimension from the photos. Study 1 demonstrates that people can select targets with extreme scores from a photo lineup at a rate better than chance across several personality dimensions. Study 2 shows that this ability has some degree of temporal consistency. Study 3 represents an improvement on the general method via enhanced criteria for stimulus selection, incorporating both self and peer reports.     

SASB: A Bridge Between Personality Theory and Clinical Psychology

The World Wide Web has inarguably become an integral part of the daily lives of the majority of the world's population. Many people spend more time online than with any given person on any particular day, yet the cognitive impact of being online remains understudied in psychology. We examine the research that has been done, and relate other related research findings, in an effort to attract more research to this area. We analyze some of the key factors that may have an impact on what and how we learn online, whether we are interacting with the cloud mind interpreted by Google or with other people via text based communication. We investigate how this development changes our perception of reality and how we may evaluate online information in ways that differ from face-to-face encounters. Living our lives in cyberspace changes what kinds of information we most frequently process and how we habitually deploy our cognitive resources, for better and for worse. When people interact with the Internet they may adopt particular mind-sets, modulating basic psychological processes. We integrate disparate lines of research in an effort to provide avenues for future investigation.     

Symptom dimensions in obsessive-compulsive disorder: implications for the DSM-V

In the absence of definitive etiological markers of vulnerability or a unitary profile of pathophysiology for obsessive-compulsive disorder (OCD), obsessive-compulsive (OC) symptom dimensions seem to offer a fruitful point of orientation. The complex clinical presentation of OCD can be summarized using a few consistent and temporally stable symptom dimensions. These can be understood as a spectrum of potentially overlapping features that are likely to be continuous with "normal" worries and extend beyond the traditional nosological boundaries of OCD. Although the understanding of the dimensional structure of obsessive-compulsive symptoms (OCS) is still imperfect, this quantitative approach to phenotypic traits has the potential to advance our understanding of OCD and may aid in the identification of more robust endophenotypes. Preliminary data suggest that these dimensional phenotypes may be useful in studies of the natural history, genetics, neurobiology, and treatment outcome of OCD. A dimensional approach is not mutually exclusive of other methods to parse the larger spectrum of disorders related to OCD. Thus far, age-of-onset of OCS and the individual's "tic-related" status seem to be particularly useful categorical distinctions. Finally, existing assessment methods are inadequate and new dimensional scales are needed to take full advantage of a dimensional approach in clinical and population-based studies.     

Equilibria in Personality States: A Conceptual Primer for Dynamics in Personality States

We provide a basic, step-by-step introduction to the core concepts and mathematical fundamentals of dynamic systems modelling through applying the Change as Outcome model, a simple dynamical systems model, to personality state data. This model characterizes changes in personality states with respect to equilibrium points, estimating attractors and their strength in time series data. Using data from the Personality and Interpersonal Roles study, we find that mean state is highly correlated with attractor position but weakly correlated with attractor strength, suggesting strength provides added information not captured by summaries of the distribution. We then discuss how taking a dynamic systems approach to personality states also entails a theoretical shift. Instead of emphasizing partitioning trait and state variance, dynamic systems analyses of personality states emphasize characterizing patterns generated by mutual, ongoing interactions. Change as Outcome modelling also allows for estimating nuanced effects of personality development after significant life changes, separating effects on characteristic states after the significant change and how strongly she or he is drawn towards those states (an aspect of resiliency). Estimating this model demonstrates core dynamics principles and provides quantitative grounding for measures of ‘repulsive’ personality states and ‘ambivert’ personality structures. © 2020 European Association of Personality Psychology     

Integrating normal and abnormal personality structure: a proposal for DSM-V

The personality disorders section of the American Psychiatric Association's fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) is currently being developed. The purpose of the current paper is to encourage the authors of DSM-V to integrate normal and abnormal personality structure within a common, integrative model, and to suggest that the optimal choice for such an integration would be the five-factor model (FFM) of general personality structure. A proposal for the classification of personality disorder from the perspective of the FFM is provided. Discussed as well are implications and issues associated with an FFM of personality disorder, including validity, coverage, feasibility, clinical utility, and treatment implications.     

Externalizing psychopathology in adulthood: a dimensional-spectrum conceptualization and its implications for DSM-V

Mental disorders involving antisocial behavior and substance use are genetically linked and vary continuously. The authors present a review and integrative conceptualization of these observations in terms of a dimensional and hierarchically organized externalizing spectrum. As a foundation for this conceptualization, the authors introduce a quantitative, model-based approach to comparing categorical and continuous conceptions of psychopathology and apply this approach in an empirical study of patterns of comorbidity among externalizing disorders as defined in the Diagnostic and Statistical Manual of Mental Disorders. The authors present evidence that comorbidity among externalizing disorders is best modeled by an underlying normally distributed continuum of risk for multiple disorders within the externalizing spectrum. The authors conclude by discussing implications of the externalizing spectrum conceptualization for classification of disorders in the upcoming 5th edition of the Diagnostic and Statistical Manual of Mental Disorders.     

ICD-11 prolonged grief disorder: Prevalence,predictors, and co-occurrence in a large representative sample

The International Classification of Diseases has recently defined Prolonged Grief Disorder (PGD) with symptoms such as longing, worry, and intense emotional pain that exceed sociocultural norms more than 6 months after the loss. This study aims to (a) estimate the prevalence of this new diagnostic category, (b) identify its sociodemographic and loss-related predictors, and (c) assess the co-occurrence of PGD with other psychological disorders and substance abuse. A large representative sample of Spanish adults (N = 1498) participated. Several multivariate binary logistic regression and multivariate logistic regression models were used. Results showed a 9.95% prevalence in the total sample. Catholic beliefs were a positive predictor, while higher income and more time since loss significantly decreased the odds of PGD. PGD significantly increased the likelihood of anxiety, depression, somatisation, post-traumatic stress disorder, loneliness and substance use. Our study contributes to assessing the multicultural PGD validity, as our results from a large representative sample are comparable to those in other countries with the PGDS. Our findings have direct implications for the assessment and treatment of bereavement, identifying for practitioners variables that make individuals more vulnerable to PGD. Results highlighted the high co-occurrence of PGD with other psychological illnesses and increased drug use.     

Prevalence and correlates of ICD-11 adjustment disorder: Findings from the Zurich Adjustment Disorder Study

Background/Objective: The 11th revision of the International Classification of Diseases (ICD-11) will provide a new definition of adjustment disorder (AjD). The aim of the present study is to report on prevalence and correlates of ICD-11 AjD in a high-risk sample. Method: Three hundred thirty persons who had lost their job involuntarily were sampled by local job centres. The Munich Composite International Diagnostic Interview was administered with a new AjD module. Associations between AjD and correlates were investigated with logistic regression analyses. Results: 27.3% of the participants reported the AjD core symptom pattern. 13.8% men and 17.2% women met diagnostic guidelines of ICD-11 AjD. Prevalence increased with age and exposure to multiple stressors. The AjD core symptom pattern was associated with various sociodemographic correlates (e. g., lower financial household budget), whereas the full ICD-11 diagnosis including the exclusion algorithm was not. Regarding work-related factors, AjD occurred with a lower probability if the last job position had higher responsibilities and more general confidence for the future. Conclusions: ICD-11 AjD has a high prevalence among persons who lost their jobs involuntarily. Healthcare professionals should be aware of this problem. Research to investigate the ICD-11 AjD concept in the general populations and other subpopulations is needed.     

Prenatal Depression: Best Practice Guidelines for Diagnosis and Treatment

The purpose of this article is to provide counselors with an overview of best practices for the treatment of women who experience prenatal depression (PND). The authors first discuss issues in the screening and diagnosis of PND. Next, the 2 most common treatments, antidepressants and psychotherapy, are reviewed and discussed in relation to current best practice guidelines. Guidelines for counselors' roles in treatment and advocacy are also provided.     

Aging and Ethnicity: Issues for Clinical Practice

Due to dramatic improvements in life expectancy among Americans from diverse ethnic groups, the graying of America is resulting in a particularly marked increase in ethnic diversity in late life. Clinicians must be prepared to address the problems of older ethnic minority patients, who present with distinct problems during late life and may present these problems in culturally prescribed ways. Cultural variations in views about the nature of mental disorders, issues in assessing and treating depression and dementia, and attention to issues of family caregivers are deserving of special attention.