Multidimensional Personality Questionnaire profiles of veterans with traumatic combat exposure: Externalizing and internalizing subtypes.

This study used the Multidimensional Personality Questionnaire (MPQ; A. Tellegen, in press) to identify personality-based subtypes of posttraumatic response. Cluster analyses of MPQs completed by combat veterans revealed subgroups that differed on measures relating to the externalization versus internalization of distress. The MPQ profile of the externalizing cluster was defined by low Constraint and Harmavoidance coupled with high Alienation and Aggression. Individuals in this cluster also had histories of delinquency and high rates of substance-related disorder. In comparison, the MPQ profile of the internalizing cluster was characterized by lower Positive Emotionality, Alienation, and Aggression and higher Constraint, and individuals in this cluster showed high rates of depressive disorder. These findings suggest that dispositions toward externalizing versus internalizing psychopathology may account for heterogeneity in the expression of posttraumatic responses, including patterns of comorbidity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

PTSD and substance-related problems: The mediating roles of disconstraint and negative emotionality.

The authors examined competing hypotheses regarding the role of 2 personality dimensions, disconstraint and negative emotionality, in mediating the relationship between posttraumatic stress disorder (PTSD) severity and substance-related problems. Data were drawn from a large sample of male Vietnam veterans. The best-fitting structural model included significant indirect paths from PTSD to both alcohol- and drug-related outcomes through disconstraint, and a significant indirect path from PTSD to alcohol-related problems through negative emotionality. There were no direct effects of PTSD on either substance-related outcome. These findings indicate distinct pathways to different forms of substance-related problems in PTSD and underscore the role of personality in mediating these relationships. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Externalizing psychopathology and marital adjustment in long-term marriages: Results from a large combined sample of married couples.

The current study evaluated the associations between externalizing psychopathology and marital adjustment in a combined sample of 1,805 married couples. We further considered the role of personality in these associations, as personality has been found to predict both the development of externalizing psychopathology as well as marital distress and instability. Diagnostic interviews assessed conduct disorder, adult symptoms of antisocial personality disorder, and alcohol dependence. Personality was assessed using the Multidimensional Personality Questionnaire. The Dyadic Adjustment Scale was used to measure marital adjustment. Results indicate that more externalizing psychopathology, greater negative emotionality, and lower communal positive emotionality were associated with reduced marital adjustment in both individuals and their spouses. Low constraint was associated with reduced marital adjustment for individuals but not for their spouses. Multivariate analyses indicated externalizing psychopathology continued to predict marital adjustment even when accounting for overlap with personality. These results highlight the importance of examining the presence of externalizing psychopathology and the personality attributes of both members of a dyad when considering psychological predictors of marital adjustment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress disorder and the genetic structure of comorbidity.

This study used structural equation modeling to examine the genetic and environmental architecture of latent dimensions of internalizing and externalizing psychiatric comorbidity and explored structural associations between posttraumatic stress disorder (PTSD) and these dimensions. Data were drawn from the Vietnam Era Twin Registry and included lifetime diagnoses for PTSD and a range of other psychiatric disorders for 3,372 male–male twin pairs. Examination of the phenotypic structure of these disorders revealed that PTSD cross-loaded on both Internalizing and Externalizing common factors. Biometric analyses suggested largely distinct genetic risk factors for the latent internalizing and externalizing comorbidity dimensions, with the total heritability of the Externalizing factor (69%) estimated to be significantly stronger than that for Internalizing (41%). Nonshared environment explained the majority of the remaining variance in the Internalizing (58%) and Externalizing (20%) factors. Shared genetic variance across the 2 dimensions explained 67% of their phenotypic correlation (r = .52). These findings have implications for conceptualizations of the etiology of PTSD and its location in an empirically based nosology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"The MMPI–2 Restructured Clinical Scales in the assessment of posttraumatic stress disorder and comorbid disorders”: Correction.

Reports an error in "The MMPI-2 Restructured Clinical Scales in the assessment of posttraumatic stress disorder and comorbid disorders" by Erika J. Wolf, Mark W. Miller, Robert J. Orazem, Mariann R. Weierich, Diane T. Castillo, Jaime Milford, Danny G. Kaloupek and Terence M. Keane (Psychological Assessment, 2008[Dec], Vol 20[4], 327-340). The URL for the supplemental material was incomplete. The complete URL is http://dx.doi.org/10.1037/a0012948.supp (The following abstract of the original article appeared in record 2008-17693-002.) This study examined the psychometric properties of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Restructured Clinical Scales (RCSs) in individuals with posttraumatic stress disorder (PTSD) receiving clinical services at Department of Veterans Affairs medical centers. Study 1 included 1,098 men who completed the MMPI-2 and were assessed for a range of psychological disorders via structured clinical interview. Study 2 included 136 women who completed the MMPI-2 and were interviewed with the Clinician Administered Scale for PTSD. The utility of the RCSs was compared with that of the Clinical Scales (CSs) and the Keane PTSD (PK) scale. The RCSs demonstrated good psychometric properties and patterns of associations with other measures of psychopathology that corresponded to current theory regarding the structure of comorbidity. A notable advantage of the RCSs compared with the MMPI-2 CSs was their enhanced construct validity and clinical utility in the assessment of comorbid internalizing and externalizing psychopathology. The PK scale demonstrated incremental validity in the prediction of PTSD beyond that of the RCSs or CSs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trajectories of PTSD and substance use disorders in a longitudinal study of personality disorders.

This study investigated the co-occurrence of posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) in a sample (N = 668) recruited for personality disorders and followed longitudinally as part of the Collaborative Longitudinal Personality Disorders Study. The study both examined rates of co-occurring disorders at baseline and temporal relationships between PTSD and substance use disorders over 4 years. Subjects with a lifetime history of PTSD at baseline had significantly higher rates of SUDs (both alcohol and drug) than subjects without PTSD. Latent class growth analysis, a relatively novel approach used to analyze trajectories and identify homogeneous subgroups of participant on the basis of probabilities of PTSD and SUD over time, identified 6 classes, which were compared with respect to a set of functioning and personality variables. The most consistent differences were observed between the group that displayed low probabilities of both SUD and PTSD and the group that displayed high probabilities of both. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Relations of Problem Behavior Status to Children's Negative Emotionality, Effortful Control, and Impulsivity: Concurrent Relations and Prediction of Change.

The relations of children's internalizing and externalizing problem behaviors to their concurrent regulation, impulsivity (reactive undercontrol), anger, sadness, and fearfulness and these aspects of functioning 2 years prior were examined. Parents and teachers completed measures of children's (N = 185; ages 6 through 9 years) adjustment, negative emotionality, regulation, and behavior control; behavioral measures of regulation also were obtained. In general, both internalizing and externalizing problems were associated with negative emotionality. Externalizers were low in effortful regulation and high in impulsivity, whereas internalizers, compared with nondisordered children, were low in impulsivity but not effortful control. Moreover, indices of negative emotionality, regulation, and impulsivity with the level of the same variables 2 years before controlled predicted stability versus change in problem behavior status. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Child Personality and Parental Behavior as Moderators of Problem Behavior: Variable- and Person-Centered Approaches.

Parenting × Child Personality interactions in predicting child externalizing and internalizing behavior were investigated in a variable-centered study and a person-centered study. The variable-centered study used data from a 3-year longitudinal study of 600 children 7 to 15 years old at Time 1 and 512 children 10 to 18 years old at Time 2. Parents rated child personality (five factor model), negative control, positive parenting, and child problem behavior, whereas children rated parental behavior. Hierarchical moderated regression analyses showed significant Parenting × Child Personality (benevolence and conscientiousness) interactions, principally for externalizing behavior. The interactions were largely replicable across informants and across time. The person-centered study, which classified participants into 3 types, showed that negative parental control was more related to externalizing behavior for undercontrollers than for resilients. Negative parental control enhanced internalizing behavior for overcontrollers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Faking specific disorders and temporal response consistency on the MMPI-2.

The ability of persons faking posttraumatic stress disorder (PTSD) or closed-head injury (CHI) to respond consistently across serial testings on the Minnesota Multiphasic Personality Inventory—2 (MMPI-2; J. Butcher, W. Dahlstrom, J. Graham, A. Tellegen, & B. Kaemmer, 1989) was investigated. Results showed that individuals faking PTSD obtained 2-week test–retest reliability scores comparable to individuals completing the MMPI-2 with standard instructions; individuals faking CHI obtained reliability coefficients significantly lower than individuals faking PTSD. A 3?×?2 (Response Style?×?Time) analysis of variance indicated that individuals faking a disorder obtained significantly elevated scores on validity scales sensitive to overreporting; no main effect for time was found. Results suggest that test-takers faking specific disorders can describe symptoms consistently on repeated testing and that type of disorder may affect temporal response consistency. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The relations of temperament reactivity and effortful control to children’s adjustment problems in China and the United States.

The relations of parents’ and teachers’ reports of temperament anger–irritability, positive emotionality, and effortful control (attention focusing and inhibitory control) to children’s externalizing and internalizing problems were examined in Chinese (N = 382) and U.S. (N = 322) samples of school-age children. Results suggested that in both cultures, low effortful control and high anger–irritability were associated with high externalizing problems, although the relations were stronger in the Chinese sample than in the U.S. sample. Low positive emotionality was associated with high internalizing problems in both cultures. However, high positive emotionality was associated with noncomorbid externalizing problems (teachers’ reports) in the Chinese sample but not in the U.S. sample. These findings suggest that there are considerable cross-cultural similarities in the temperament–adjustment associations, although some cross-cultural differences might exist. Implications of the findings for the detection and intervention of adjustment problems in Chinese children are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The MMPI-2 Restructured Clinical Scales in the assessment of posttraumatic stress disorder and comorbid disorders.

[Correction Notice: An erratum for this article was reported in Vol 21(1) of Psychological Assessment (see record 2009-03401-005). The URL for the supplemental material was incomplete. The complete URL is http://dx.doi.org/10.1037/a0012948.supp] This study examined the psychometric properties of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Restructured Clinical Scales (RCSs) in individuals with posttraumatic stress disorder (PTSD) receiving clinical services at Department of Veterans Affairs medical centers. Study 1 included 1,098 men who completed the MMPI-2 and were assessed for a range of psychological disorders via structured clinical interview. Study 2 included 136 women who completed the MMPI-2 and were interviewed with the Clinician Administered Scale for PTSD. The utility of the RCSs was compared with that of the Clinical Scales (CSs) and the Keane PTSD (PK) scale. The RCSs demonstrated good psychometric properties and patterns of associations with other measures of psychopathology that corresponded to current theory regarding the structure of comorbidity. A notable advantage of the RCSs compared with the MMPI-2 CSs was their enhanced construct validity and clinical utility in the assessment of comorbid internalizing and externalizing psychopathology. The PK scale demonstrated incremental validity in the prediction of PTSD beyond that of the RCSs or CSs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The joint structure of DSM-IV Axis I and Axis II disorders.

The Diagnostic and Statistical Manual (4th ed. [DSM–IV]; American Psychiatric Association, 1994) distinction between clinical disorders on Axis I and personality disorders on Axis II has become increasingly controversial. Although substantial comorbidity between axes has been demonstrated, the structure of the liability factors underlying these two groups of disorders is poorly understood. The aim of this study was to determine the latent factor structure of a broad set of common Axis I disorders and all Axis II personality disorders and thereby to identify clusters of disorders and account for comorbidity within and between axes. Data were collected in Norway, through a population-based interview study (N = 2,794 young adult twins). Axis I and Axis II disorders were assessed with the Composite International Diagnostic Interview (CIDI) and the Structured Interview for DSM–IV Personality (SIDP–IV), respectively. Exploratory and confirmatory factor analyses were used to investigate the underlying structure of 25 disorders. A four-factor model fit the data well, suggesting a distinction between clinical and personality disorders as well as a distinction between broad groups of internalizing and externalizing disorders. The location of some disorders was not consistent with the DSM–IV classification; antisocial personality disorder belonged primarily to the Axis I externalizing spectrum, dysthymia appeared as a personality disorder, and borderline personality disorder appeared in an interspectral position. The findings have implications for a meta-structure for the DSM. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic symptomatology in children and adolescents after an industrial fire

OBJECTIVE: This investigation evaluated the extent and nature of posttraumatic symptomatology (PTS) in children and adolescents 9 months after an industrial fire at the imperial Foods chicken-processing plant in Hamlet, North Carolina, caused extensive loss of life. METHOD: Using a PTS self-report measure plus self- and teacher reports of comorbid symptoms the authors surveyed 1,019 fourth- to ninth-grade students in the community where the fire occurred. RESULTS: Three factors comprising PTS were identified: reexperiencing, avoidance and hyperarousal. Reexperiencing and avoidance were positively correlated; hyperarousal proved weakly correlated with reexperiencing, perhaps because exposure was largely indirect. Using a T score cutoff of 65 on the reexperiencing factor as indicative of PTS 9.7% of subjects met criteria for PTS; 11.9% met criteria for posttraumatic stress disorder (PTSD) using DSM-III-R PTSD criteria. Degree of exposure was the most powerful predictor of PTS. Race (African-American) and gender (female) posed significant risk factors for PTS. Self-reported internalizing symptoms and teacher-reported externalizing symptoms were positively predicted by intercurrent PTS, and independently of PTS, by degree of exposure. Comorbid symptoms showed interesting interactions with exposure, race, and gender. Lack of self-attributed personal efficacy predicted PTS but did not moderate the effects of race or gender on PTS risk. CONCLUSIONS: This study, which used a population-based sampling strategy, strengthens and extends findings from earlier literature on pediatric PTSD in showing that (1) PTS and comorbid internalizing and externalizing symptoms rise in direct proportion to degree of exposure; (2) gender and race show variable effects on risk for PTS and comorbid symptoms; and (3) comorbid symptoms are positively correlated with PTS and may represent primary outcomes of traumatic exposure in their own right.     

Personality patterns among Black, White, and Hispanic combat veterans.

Little is known about racial and ethnic differences in personality pathology in combat veterans. This investigation explored the relationship between race, ethnicity, and personality disorders (PDs) in a sample of 96 combat veterans. Ethnoracial group status was based on self-identification, and the groups were mutually exclusive. PDs were assessed with the MCMI-III, posttraumatic stress disorder (PTSD) was assessed with the Clinician Administered PTSD scale, and combat exposure was assessed with the Combat Exposure Scale. The findings suggest that Hispanic veterans were more likely to have cluster A PDs compared to non-Hispanic veterans, even after controlling for demographics, level of combat exposure, and current PTSD. Implications of the results for the research and treatment of culturally diverse individuals with PDs are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multidimensional structure of the Hypomanic Personality Scale.

The structure of the Hypomanic Personality Scale was explored in a sample of young adults (N = 884); resulting structures were validated on subsamples with measures of personality traits, internalizing symptoms, and externalizing behaviors. Hierarchical cluster analysis and estimates of general factor saturation suggested the presence of a weak general factor, as well as 3 subordinate clusters. The 3-cluster subscales (Social Vitality, Mood Volatility, and Excitement) were moderately correlated but conceptually distinct and were correlated in opposing patterns with a range of personality and psychopathology measures. Results show that cluster subscales suppress total score associations with validity measures. Recommendations are made to analyze Hypomanic Personality Scale data by subscale, and theoretical implications are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Longitudinal relations of children’s effortful control, impulsivity, and negative emotionality to their externalizing, internalizing, and co-occurring behavior problems.

The purpose of the study was to examine the relations of effortful control (EC), impulsivity, and negative emotionality to at least borderline clinical levels of symptoms and change in maladjustment over four years. Children’s (N = 214; 77% European American; M age = 73 months) externalizing and internalizing symptoms were rated by parents and teachers at 3 times, 2 years apart (T1, T2, and T3) and were related to children’s adult-rated EC, impulsivity, and emotion. In addition, the authors found patterns of change in maladjustment were related to these variables at T3 while controlling for the T1 predictor. Externalizing problems (pure or co-occurring with internalizing problems) were associated with low EC, high impulsivity, and negative emotionality, especially anger, and patterns of change also related to these variables. Internalizing problems were associated with low impulsivity and sadness and somewhat with high anger. Low attentional EC was related to internalizing problems only in regard to change in maladjustment. Change in impulsivity was associated with change in internalizing primarily when controlling for change in externalizing problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Type D personality and the development of PTSD symptoms: A prospective study.

Psychological trauma and prolonged stress may cause mental disorders such as posttraumatic stress disorder (PTSD). Pretrauma personality is an important determinant of posttraumatic adjustment. Specifically, trait neuroticism has been identified as a risk factor for PTSD. Additionally, the combination of high negative affectivity or neuroticism with marked social inhibition or introversion, also called Type D personality (Denollet, 2000), may compose a risk factor for PTSD. There is no research available that examined pretrauma Type D personality in relation to PTSD. The present study examined the predictive validity of the Type D personality construct in a sample of Dutch soldiers. Data were collected prior to and 6 months after military deployment to Afghanistan. Separate multiple regression analyses were performed to examine the predictive validity of Type D personality. First, Type D personality was defined as the interaction between negative affect and social inhibition (Na × Si). In a second analysis, Type D was defined following cutoff criteria recommended by Denollet (2000). Results showed that negative affectivity was a significant predictor of PTSD symptoms. Social inhibition and the interaction Na × Si did not add to the amount of explained variance in postdeployment PTSD scores over the effects of childhood abuse, negative affectivity, and prior psychological symptoms. A second analysis showed that Type D personality (dichotomous) did not add to the amount of explained variance in postdeployment PTSD scores over the effects of childhood abuse, and prior psychological symptoms. Therefore, Type D personality appears to be of limited value to explain development of combat-related PTSD symptoms. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Meta-analysis of the relations of anxiety sensitivity to the depressive and anxiety disorders.

There is a substantial literature relating the personality trait anxiety sensitivity (AS; tendency to fear anxiety-related sensations) and its lower order dimensions to the mood and anxiety (i.e., internalizing) disorders. However, particularly given the disorders’ high comorbidity rates, it remains unclear whether AS is broadly related to these disorders or if it shows a pattern of differential relations. Meta-analyses of the concurrent relations of AS with the internalizing disorders were conducted based on 117 studies and 792 effect sizes. Mean Anxiety Sensitivity Index scores by diagnostic group and AS–symptom correlations both indicated that AS is most strongly related to panic, generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD). More specific analyses were also conducted on (a) AS correlations with symptom dimensions within individual disorders and (b) correlations between lower order AS components and symptoms. The meta-analytic correlation matrix for higher order AS–disorder relations was submitted to path analysis, modeling latent Distress disorders and Fear disorders that control for much of the shared variance among the disorders. Results of the path analysis indicated that AS is broadly related to these disorders but that agoraphobia, GAD, panic, and PTSD have the strongest associations. In addition, AS was more strongly related to the latent distress disorders than the fear disorders. Because of the contemporaneous assessment of AS and internalizing disorders in these studies, the results should not be taken to mean that AS has a stronger casual association with certain disorders. Implications for concurrent AS–internalizing relations, interpretations of the AS construct, and structural models of personality and psychopathology are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ego control, ego resiliency, and the Five-Factor Model as predictors of behavioral and emotional problems in clinic-referred children and adolescents.

The relations of Ego control (EC), Ego resiliency (ER), and the Five-Factor Model of Personality (FFM) with behavioral and emotional problems were explored among 116 clinic-referred children. Within the EC-ER model, Ego undercontrol was most important in predicting externalizing problems, and both Ego brittleness (the relative absence of ER) and Ego undercontrol made equal contributions to predicting internalizing problems. Within the FFM, Extraversion and Agreeableness were independent predictors of externalizing problems, whereas only Neuroticism predicted internalizing problems. When the EC-ER model was tested against the FFM, the latter model appeared to outperform the former in predicting externalizing but not internalizing problems; when clinical syndrome groups were examined, dimensions from both personality models were differentially salient for children with primary internalizing, externalizing, or comorbid problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The etiology of associations between negative emotionality and childhood externalizing disorders.

Despite consistent documentation of associations between childhood negative emotionality and externalizing psychopathology, few genetically informative studies have investigated the etiology of that association. The goal of the current study was to delineate the etiology of the covariation of negative emotionality and childhood externalizing problems (e.g., oppositional defiant disorder, conduct disorder, inattention, and hyperactivity/impulsivity). Twin families were recruited from Georgia state birth records and completed parental report questionnaires of negative emotionality and common Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000) child psychiatric disorders. Results suggest both genetic and environmental influences underlying negative emotionality and each externalizing symptom dimension, with additional evidence for sibling competition/rater contrast effects for inattention and hyperactivity/impulsivity. Bivariate model-fitting analyses indicated that a portion of the additive (43%–75%) and nonadditive (26%–100%) genetic influences underlying each symptom dimension was accounted for by the genetic influences underlying negative emotionality. Finally, an independent pathways model examining the etiology of the association between negative emotionality and the externalizing dimensions indicated that a substantial portion of the additive genetic, nonadditive genetic, and nonshared environmental influences underlying externalizing behavior is shared with negative emotionality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)