Comparing factor analytic models of the DSM-IV personality disorders.

There is little agreement about the latent factor structure of the Diagnostic and Statistical Manual of Mental Disorders (DSM) personality disorders (PDs). Factor analytic studies over the past 2 decades have yielded different results, in part reflecting differences in factor analytic technique, the measure used to assess the PDs, and the changing DSM criteria. In this study, we explore the latent factor structure of the DSM (4th ed.; IV) PDs in a sample of 1200 psychiatric outpatients evaluated with the Structured Interview for DSM–IV PDs (B. Pfohl, N. Blum, & M. Zimmerman, 1997). We first evaluated 2 a priori models of the PDs with confirmatory factor analysis (CFA), reflecting their inherent organization in the DSM–IV: a 3-factor model and a 10-factor model. Fit statistics did not suggest that these models yielded an adequate fit. We then evaluated the latent structure with exploratory factor analysis (EFA). Multiple solutions produced more statistically and theoretically reasonable results, as well as providing clinically useful findings. On the basis of fit statistics and theory, 3 models were evaluated further—the 4-, 5-, and 10-factor models. The 10-factor model, which did not resemble the 10-factor model of the CFA, was determined to be the strongest of all 3 models. Future research should use contemporary methods of evaluating factor analytic results in order to more thoroughly compare various factor solutions. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Challenges associated with a polythetic diagnostic system: Criteria combinations in the personality disorders.

Converging research on the diagnostic criteria for personality disorders (PDs) reveals that most criteria have different psychometric properties. This finding is inconsistent with the PD diagnostic system according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994), which weights each criterion equally. The purpose of the current study was to examine the potential effects of using equal weights for differentially functioning criteria. Data from over 2,100 outpatients were used to analyze and score response patterns to the diagnostic criteria for 9 PDs within an item response theory framework. Results indicated that combinations that included the same number of endorsed criteria yielded differing estimates of PD traits, depending on which criteria were met. Moreover, trait estimates from subthreshold criteria combinations often overlapped with diagnostic (at-threshold or higher) combinations, indicating that there were subthreshold combinations of criteria that indicated as much or more PD than did some combinations at the diagnostic threshold. These results suggest that counting the number of criteria an individual meets provides only a coarse estimation of his or her PD trait level. Implications for the assessment of polythetically defined mental disorders and for the PD proposal for the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of comorbid psychopathy on criminal offending and emotion processing in male offenders with antisocial personality disorder.

Antisocial personality disorder (ASPD) and psychopathy are two syndromes with substantial construct validity. To clarify relations between these syndromes, the authors evaluated 3 possibilities: (a) that ASPD with psychopathy and ASPD without psychopathy reflect a common underlying pathophysiology; (b) that ASPD with psychopathy and ASPD without psychopathy identify 2 distinct syndromes, similar in some respects; and (c) that most correlates of ASPD reflect its comorbidity with psychopathy. Participants were 472 incarcerated European American men who met Diagnostic and Statistical Manual (4th ed., American Psychiatric Association, 1994) criteria for ASPD and Psychopathy Checklist criteria for psychopathy, who met the criteria for ASPD but not for psychopathy, or who did not meet diagnostic criteria for either ASPD or psychopathy (controls). Both individuals with ASPD only and those with ASPD and psychopathy were characterized by more criminal activity than were controls. In addition, ASPD with psychopathy was associated with more severe criminal behavior and weaker emotion facilitation than ASPD alone. Group differences in the association between emotion dysfunction and criminal behavior suggest tentatively that ASPD with and ASPD without prominent psychopathic features may be distinct syndromes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An item response theory analysis of DSM-IV personality disorder criteria across younger and older age groups.

Many of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV; American Psychiatric Association, 1994) personality disorder (PD) diagnostic criteria focus on a younger social and occupational context. The absence of age-appropriate criteria for older adults forces researchers and clinicians to draw conclusions based on existing criteria, which are likely inadequate. To explore which DSM-IV PD criteria contain age group measurement bias, the authors report 2 analyses of data on nearly 37,000 participants, ages 18-98 years, taken from a public data set that includes 7 of the 10 PDs (antisocial, avoidant, dependent, histrionic, obsessive-compulsive, paranoid, and schizoid). The 1st analysis revealed that older age groups tend to endorse fewer PD criteria than younger age groups. The 2nd analysis revealed that 29% of the criteria contain measurement bias. Although the latent variable structure for each PD was quite similar across younger and older age groups, some individual criteria were differentially endorsed by younger and older adults with equivalent PD pathology. The presence of measurement bias for these criteria raises questions concerning the assessment of PDs in older adults and the interpretation of existing data. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Identifying persistently antisocial offenders using the Hare Psychopathy Checklist and DSM antisocial personality disorder criteria.

Early starting, lifetime criminal persistence has been called sociopathy, antisocial personality disorder, and psychopathy. There is, however, disagreement about its core features and which measure is best for identifying such individuals. In the 1st of 2 studies of male offenders (n = 74), we found a large association between scores on the Psychopathy Checklist-Revised (PCL-R; R. D. Hare, 1991) and the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV; American Psychiatric Association, 1994) antisocial personality disorder criteria scored as a scale. The second study (n = 684) replicated this finding and found that, as previously shown for PCL-R scores, a discrete class (or taxon) also underlies scores on items reflecting antisocial personality disorder. The high association among these sets of items and their similarity in predicting violence suggested that the same natural class underlies each. Results indicated that life-course-persistent antisociality can be assessed well by measures of psychopathy and antisocial personality disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correspondence between self-report and interview-based assessments of antisocial personality disorder.

Antisocial personality disorder (ASPD) is associated with suicide, violence, and risk-taking behavior and can slow response to first-line treatment for Axis I disorders. ASPD may be assessed infrequently because few efficient diagnostic tools are available. This study evaluated 2 promising self-report measures for assessing ASPD--the ASPD scale of the Personality Diagnostic Questionnaire-4 (PDQ-4; S. E. Hyler, 1994) and the Personality Assessment Inventory (PAI; L. Morey, 1991, 2007)--as well as the ASPD module of the Structured Clinical Interview for DSM-IV Axis II (SCID-II; M. B. First, R. L. Spitzer, M. Gibbon, J. B. W. Williams, & L. S. Benjamin, 1997). The measures were administered to 1,345 offenders in court-mandated residential substance abuse treatment programs and prisons. PDQ-4 and PAI scores related strongly to SCID-II symptom counts (rs = .67 and .51, respectively), indicating these measures convey useful clinical information about the severity of offenders' ASPD pathology. The dimensional association between the measures was relatively invariant across gender, race, and site, although differences in mean scores were observed. Levels of agreement of the SCID-II with the PDQ-4 (κ = .31) and PAI (κ = .32) in classifying participants as ASPD was limited. Alternative thresholds for both self-report measures were identified and cross-validated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Continuity and change in psychopathic traits as measured via normal-range personality: A longitudinal-biometric study.

The discriminant validity of the interpersonal-affective and social deviance traits of psychopathy has been well documented. However, few studies have explored whether these traits follow distinct or comparable developmental paths. The present study used the Multidimensional Personality Questionnaire (A. Tellegen, in press) to examine the development of the psychopathic traits of Fearless Dominance (i.e., interpersonal-affective) and Impulsive Antisociality (i.e., social deviance) from late adolescence to early adulthood in a longitudinal- epidemiological sample of male and female twins. Results from mean- and individual-level analyses revealed stability in Fearless Dominance from late adolescence to early adulthood, whereas Impulsive Antisociality declined over this developmental period. In addition, biometric findings indicated greater genetic contributions to stability in these traits and greater nonshared environmental contributions to their change over time. Collectively, these findings suggest distinct developmental trends for psychopathic traits from late adolescence to early adulthood. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Egomania rageosis: A proposed new syndrome for the Diagnostic and Statistical Manual of Mental Disorders (V).

This paper describes a serious new disorder--Egomania Rageosis--which is approaching epidemic incidence in academia. The symptoms, epidemiology, and treatment of Egomania are described, and empirical work is reviewed. It is proposed that the syndrome be included in the Diagnostic and Statistical Manual of Mental Disorders (V). Those persons in whom a prolonged relationship with academia has given rise to deep-seated, unconscious feelings of irreverence will find the paper of both heuristic and therapeutic value. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Limitations in the Assessment of DSM-IV Cannabis Tolerance as an Indicator of Dependence in Adolescents.

The usefulness of the Diagnostic and Statistical Manual's (4th ed.; DSM-IV; American Psychiatric Association, 1994) tolerance criterion as an indicator of dependence has been debated. The authors of this study evaluated the performance of DSM's cannabis tolerance criterion, operationally defined as a percentage increase in quantity needed to get high, in distinguishing adolescents with and without cannabis dependence. Two samples of adolescent cannabis users (ages 12-19) provided data (ns = 417 and 380). Tolerance, defined as a percentage increase (median increase = 300% and 175%, respectively, in the samples), had only moderate overall sensitivity and specificity in distinguishing those with and without cannabis dependence. Results suggest limitations of the DSM-IV and change-based operational definition of tolerance in adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A genetic factor explains most of the variation in the psychopathic personality.

The psychopathic personality can be conceptualized as three interrelated dimensions, (a) an interpersonal style of glibness, grandiosity, and manipulation; (b) an affective disposition of callousness, lack of empathy, and unemotionality; and (c) a behavioral/lifestyle dimension of impulsivity, need for stimulation, and irresponsibility, underpinning a higher order construct, psychopathic personality. The authors used a self-report questionnaire (The Youth Psychopathic Traits Inventory) to study the importance of genetic and environmental influences on psychopathic personality traits in a sample of 1,090 monozygotic and dizygotic twin pairs, aged 16-17 years. Results showed a strong genetic influence behind the higher order "psychopathic personality" factor, underpinned by the three psychopathic personality dimensions. Over and above the effects to the higher order factor, significant unique genetic influences were also found in the callous/unemotional and in the impulsive/irresponsible dimension, but not in the grandiose/manipulative dimension. The authors propose that this latent psychopathic personality factor is a meaningful target for future etiological research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictive validity of childhood oppositional defiant disorder and conduct disorder: Implications for the DSM-V.

Data are presented from 3 studies of children and adolescents to evaluate the predictive validity of childhood oppositional defiant disorder (ODD) and conduct disorder (CD) as defined in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM–IV; American Psychiatric Association, 1994) and the International Classification of Diseases, Version 10 (ICD-10; World Health Organization, 1992). The present analyses strongly support the predictive validity of these diagnoses by showing that they predict both future psychopathology and enduring functional impairment. Furthermore, the present findings generally support the hierarchical developmental hypothesis in DSM–IV that some children with ODD progress to childhood-onset CD, and some youth with CD progress to antisocial personality disorder (APD). Nonetheless, they reveal that CD does not always co-occur with ODD, particularly during adolescence. Importantly, the present findings suggest that ICD-10 diagnostic criteria for ODD, which treat CD symptoms as ODD symptoms when diagnostic criteria for CD are not met, identify more functionally impaired children than the more restrictive DSM–IV definition of ODD. Filling this “hole” in the DSM–IV criteria for ODD should be a priority for the DSM–V. In addition, the present findings suggest that although the psychopathic trait of interpersonal callousness in childhood independently predicts future APD, these findings do not confirm the hypothesis that callousness distinguishes a subset of children with CD with an elevated risk for APD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The use of the MMPI for cross-cultural personality study: A preliminary report on the German translation.

Structured personality tests have seldom been used in intercultural comparisons, but present certain advantages over other techniques. The first study using a German translation of the MMPI has been reported. German men and women attending a summer course at the University of Marburg in 1948 showed profiles significantly higher on most scales than American students. Since there is a mixture of factors which might have effects, interpretation of the results is not clear, but the method seems to merit serious attention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Set and content scores for personality scales and response styles in the MMPI.

Set and content scores from 3 MMPI scales, Edwards SD scale, the Manifest Anxiety scale (MA), and the Masculinity-Femininity (Mf) scale, were derived by an adaptation of the Helmstadter technique for obtaining separate (acquiescence) set and content scores from personality scales. In a factor analysis of scores for 150 male college Ss on 54 variables, the MA-Set and SD-Set variables defined a common factor, but only the Mf-Set variable loaded the 2nd, or acquiescence, factor. The inconsistency of these results indicated that the set formula was not consistently measuring, or reflecting, acquiescence, or any other construct, and furthermore suggested the need for caution in making acquiescence interpretations based on the Helmstadter procedure. Some speculations were advanced to account for the disparate results of the set variables, such as the degree of true-false and SD-SUD keying in the "parent" scales. A systematic variation of such scale keying in future research may indicate what the set procedure is measuring and have potential implications for the clarification of the nature of acquiescence in personality scales. (34 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical utility: A prerequisite for the adoption of a dimensional approach in DSM.

A potential obstacle to implementing dimensional representations in the Diagnostic and Statistical Manual of Mental Disorders (DSM) is lack of data about clinical utility and user acceptability. Adopting a dimensional approach would likely complicate medical record keeping, create administrative and clinical barriers between mental disorders and medical conditions, require a massive retreating effort, disrupt research efforts (e.g., meta-analyses), and complicate clinicians' efforts to integrate prior clinical research using DSM categories into clinical practice. Efforts to empirically demonstrate the clinical utility of dimensional alternatives should be a prerequisite for their future implementation in order to establish that their advantages outweigh the disadvantages. Approaches to promote user acceptability and the development of an empirical database include dimensionalizing existing DSM categories and including research dimensions in the DSM appendix. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alcohol dependence and abuse in three groups at varying familial alcoholism risk.

Three groups of young men varying in familial alcoholism risk were compared for lifetime and current Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) diagnoses. A withdrawal gate diagnostic model (WGM) requiring withdrawal for a dependence diagnosis was also evaluated. Extremely high lifetime DSM-IV diagnostic rates were found for all groups (≥78%), with the highest rate in the highest risk group. Similar group differences obtained for individual criteria or symptoms. Although lifetime diagnostic rates were similar for the WGM and DSM-IV, virtually all cases of dependence were preceded by abuse for the WGM, unlike DSM-IV. The findings underline the importance of distinguishing degrees of familial alcoholism risk. The WGM model temporal onset findings versus DSM-IV and the high lifetime diagnostic rates obtained suggest some limitations of the DSM-IV diagnoses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Global self-esteem in relation to structural models of personality and affectivity.

Three studies examined global self-esteem in relation to structural models of personality and affectivity. In every study, self-esteem was strongly negatively correlated with Neuroticism/Negative Affectivity and moderately to strongly related to Extraversion/Positive Affectivity. Additional findings, however, revealed that self-esteem is better viewed at the lower order level. For instance, global self-esteem correlated -.79 with the Depression facet of the Revised NEO Personality Inventory (P. T. Costa, Jr., & R. R. McCrae, 1992) in Study 3. Moreover, confirmatory factor analyses produced very strong correlations between self-esteem and depression in both Study 2 (r = -.82) and Study 3 (r = -.86). Taken together, the data suggest that global self-esteem measures define one end of a bipolar continuum, with trait indicators of depression defining the other. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Age differences in five personality domains across the life span.

The present study addresses the issue of age differences in 5 personality domains across the life span in a cross-sectional study. In contrast to most previous studies, the present study follows a methodologically more rigorous approach to warrant that age-related differences in personality structure and mean level can be meaningfully compared. It uses data on 50 items of the Five-Factor Personality Inventory (FFPI) available from a study in a large and representative Dutch sample (N = 2,494; age range: 16 to 91 years) conducted in 1996 for the purpose of establishing norms for the FFPI. After having established strict measurement invariance, tests were made for factor covariances to be equal across age groups, revealing structural continuity of personality. Additionally, factor variances were shown to be equal across age groups. A number of age differences in the mean level of the five personality domains emerged. Specifically, older adults were, on average, more agreeable and, especially, more conscientious than middle-aged and younger adults. Findings from our study suggest that both continuity and change may mark personality over the course of life. (PsycINFO Database Record (c) 2010 APA, all rights reserved)