The structure of pathological personality traits and temperament in a Persian community sample.

The present study examined the extent to which the currently established factor structure of the Personality Inventory for DSM-5 (PID-5; Krueger et al., 2013) generalizes to a large Persian community sample, as well as relations between the resulting PID-5 factors and two temperament measures. Cross-sectional data came from 946 adults (65% female) from western Iran. With the use of exploratory structural equation modeling (ESEM) with target rotation, we found factor loadings that showed fairly similar patterns to those found in two previous meta-analytic PID-5 studies with predominantly North American and European samples (Watters & Bagby, 2018; Somma et al., 2019). Despite slight differences in each of the target rotations, there were moderate congruence coefficients (~0.85) between loadings for the five PID-5 domains, with the weakest evidence supporting the Disinhibition factor. The resulting PID-5 factors showed meaningful associations with temperament domains assessed via the Temperament and Character Inventory (TCI; Cloninger, 1994) and Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Autoquestionnaire (TEMPS-A; Akiskal et al., 2005). Overall, our findings suggest that the documented structure of personality pathology assessed by the PID-5 generalizes somewhat to this sample of Persian participants, and pathological personality traits show important overlap with temperament, although these constructs are meaningfully distinct.

Meta-Analytic Review of Temperamental Correlates of the Five-Factor Model and Hierarchical Taxonomy of Psychopathology Domains.

Background: There is little and heterogeneous knowledge on the links between the temperamental predispositions of psychopathology and the contemporary dimensional models of psychopathology, such as the Hierarchical Taxonomy of Psychopathology (HiTOP) classification system, which can be aligned with the five-factor model (FFM) of personality. This meta-analysis seeks to expand the temperamental theoretical basis of the HiTOP model by incorporating associations of temperament traits of two temperamental theories measured, respectively, by the Temperament and Character Inventory (TCI) and the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A) with (a) the FFM's personality domains and (b) HiTOP's five psychopathological spectra. Methods: A systematic search was done on Web of Science, Scopus, PubMed, ProQuest, Cochrane Database, and Google Scholar for all articles published in English from January 1990 to August 2020. Because of heterogeneity in the results of almost 70% of studies, pooled estimates of correlation coefficients were calculated using the random-effects method. Risk of bias (low-quality studies) and publication bias are reported. Results: The pooled correlations obtained from the analysis of 35 studies showed that the temperamental profile associated with each FFM domain and HiTOP spectra is distinct. Specifically, TCI-harm avoidance (HA) and all TEMPS temperaments were more strongly related to neuroticism/internalizing, extraversion/low detachment, and conscientiousness/disinhibition. In contrast, TCI-novelty seeking was more strongly related to both disinhibited/antagonistic externalizing and thought disorder. Conclusions: A large body of research supports maladaptive variants of all FFM domains and some psychopathological spectra of HiTOP related to the abnormal-range temperaments.

Clinical cut scores for the Persian version of the personality inventory for DSM-5.

BACKGROUND: The cut points of psychological tools to diagnose clinical conditions are not universal and depend on the region and prevalence of the disorder. Thus, we aimed to identify the cutoff points of the Persian original version of the personality inventory for DSM-5 (PID-5; 220 items) that would optimally distinguish nonclinical from clinical groups. METHODS: Both nonclinical (N = 634, 73% female, 34.0 ± 10.8 years) and clinical (N = 454, 29% female, 29.5 ± 7.4 years) samples from the West of Iran participated in the study. Data were analyzed using receiver operating characteristic (ROC) and Youden's index was used to determine the cutoff scores across the PID-5 domains and facets. The means and standard deviations of both the clinical male and female were compared with the nonclinical group using Cohen's d and independent t-tests. RESULTS: All the PID-5 algorithms and facets significantly distinguished clinical from nonclinical samples with some unique findings for male and female samples. The mean score of all the PID-5 algorithms and facets in the clinical male and female samples were respectively 1.0-2.0 SD and 0.5-1.0 SD above the mean for the nonclinical counterparts. A score higher than 1.5 on ranging from 0 to 3 in each domain or facet indicated clinical status. CONCLUSION: Raw cutting scores throughout the PID-5 algorithms can be well used to diagnose any pathology of personality and the severity of the disorder in clinical patients. The cut scores provide a useful tool for the clinical use of the original version of PID-5 in Iran.

A head-to-head comparison of eight unique personality systems in predicting somatization phenomenon.

BACKGROUND: If somatization is an independent personality trait, it is not clear whether it is specific to the temperament or maladaptive spectrum of personality. We aimed at the head-to-head comparison of temperament and maladaptive systems and spectra of personality to predict both somatization and somatic symptom and related disorders (SSRD). METHODS: The samples included 257 cases with SSRD (70.8% female) and 1007 non-SSRD (64.3% female) from Western Iran. The Personality Inventory for DSM-5 (PID-5), Personality Diagnostic Questionnaire-4 (PDQ-4), Temperament and Character Inventory (TCI), Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire (TEMPS-A), Affective and Emotional Composite Temperament Scale (AFECTS), and Positive Affect and Negative Affect Model (PANAS) was used to data collection. A somatization factor plus temperament and maladaptive spectra of personality were extracted using exploratory factor analysis. Several hierarchical linear and logistic regressions were used to test the predictive systems and spectra. RESULTS: All personality systems jointly predict both somatization and SSRD with a slightly higher contribution for temperament systems. When the temperament and maladaptive spectra were compared, both spectra above each other significantly predicted both somatization (R2 = .407 versus .263) and SSRD (R2 = .280 versus .211). The temperament spectrum explained more variance beyond the maladaptive spectrum when predicting both the somatization factor (change in R2 = .156 versus .012) and SSRD (change in R2 = .079 versus .010). CONCLUSION: All temperament and maladaptive frameworks of personality are complementary to predicting both somatization and SSRD. However, the somatization is more related to the temperament than the maladaptive spectrum of personality.

Construct and criterion validity of the HiTOP spectra to predict dimensional and categorical somatization in a large non-western sample.

The Hierarchical Taxonomy of Psychopathology (HiTOP) is a phenotypic data-driven framework for the classification of psychopathology. We tested the construct and criterion validity of the HiTOP spectra measured by the Personality Inventory for DSM-5 (PID-5) using exploratory structural equation modeling (ESEM) and hierarchical regressions both to predict somatic symptom and related disorders (SSRD) and a somatization factor. The case-control study used hierarchical logistic regressions to distinguish 257 cases with SSRD from 1007 healthy controls by both the maladaptive and the temperament factors. The extracted factors were also used in hierarchical linear regressions to predict the dimensional somatization factor. The seven temperament factors explained more variance above and beyond the five maladaptive factors when predicting SSRD (pseudo R2 = 0.169 to 0.266 versus 0.125 to 0.196; change in pseudo R2 = 0.055 to 0.087 versus 0.011 to 0.017). The temperament factors also explained more variance above and beyond the maladaptive factors when predicting the somatization factor (R2 = 0.392 versus 0.269; change in R2 = 0.146 versus 0.023). Although the HiTOP spectra measured by PID-5 are significant structures related to the categorical and dimensional measurements of somatoform, our findings highlight potential problems with both the construct and criterion validity of the HiTOP spectra.

Comparison of the relative sensitivity of two dimensional personality models to the psychopathological symptoms: the section III DSM-5 maladaptive traits versus affective temperaments.

BACKGROUND: The Personality Inventory for DSM-5 (PID-5) and Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A) are tools designed for personality dispositions for mental health symptoms. The present study was conducted to compare these models in terms of their relative sensitivity to the symptoms of personality disorders (PDs) and non-personality disorders (NPDs). METHODS: Subjects in this cross-sectional study were 1232 (805 female; 63.5%) community samples in western Iran. Data were collected using the PID-5, the TEMPS-A, the Symptom Checklist-90 (SCL-90-R), and the Personality Diagnostic Questionnaire (PDQ-4). Correlations and Regression models were used to examine associations between traits and symptoms. RESULTS: Maladaptive traits assessed by the PID-5 were more strongly associated with PD symptoms, whereas affective temperaments measured by the TEMPS-A were more strongly associated with NPD symptoms. CONCLUSION: The present findings highlighted the practical utility of both the PID-5 and TEMPS-A indicating risk for psychopathology, but also suggest a distinction between PDs and NPDs in terms of underlying personality dispositions.

Comprehensive meta-analysis of associations between temperament and character traits in Cloninger's psychobiological theory and mental disorders.

OBJECTIVE: To explore the relationship between temperament and character traits in Cloninger's psychobiological theory and mental disorders.Methods: A systematic literature search was conducted of five international databases for all articles published in English between January 1990 and April 2019 (PROSPERO-CRD42019133214). Owing to heterogeneity, pooled estimates of correlations for personality disorders and standardized mean differences for case-control studies related to other mental disorders were calculated using the random-effects method. RESULTS: The pooled effect sizes obtained from 149 studies showed that high harm avoidance (related to 22/24 diagnostic categories), low self-directedness (21/23), low cooperativeness (17/23), high self-transcendence (14/23), low reward dependence (11/24), high novelty-seeking (10/24), low novelty-seeking (7/24), high persistence (2/23), low persistence (2/23) and high reward dependence (2/24) were related to psychopathology. CONCLUSIONS: All traits provided unique psychobiological tools for differential diagnosis of mental disorders. However, high harm avoidance and low self-directedness played a canonical role in psychopathology. Despite the study limitations, additional studies are warranted to evaluate the differential diagnoses suggested by the present model.

Personality Pathology among Adults with History of Childhood Sexual Abuse: Study of the Relevance of DSM-5 Proposed Traits and Psychobiological Features of Temperament and Character.

BACKGROUND: The main aim of this study was to determine whether childhood sexual abuse (CSA) is reflected in the pathological traits of the alternative model of personality disorders (AMPD) in section-III of DSM-5 and Cloninger's temperament and character profiles. METHODS: The Persian versions of Personality Inventory for DSM-5 (PID-5), Temperament and Character Inventory (TCI-125), and Structured Clinical Inventory for DSM-IV-TR-Axis II-Screening Questionnaire (SCID-II-SQ) were administered to 43 Iranian college students who reported a history of CSA and 390 participants who did not. Bivariate Pearson correlations and general linear model repeated measures (GLMRM) were used to compare results. RESULTS: Bivariate correlations indicated that both the PID-5 and TCI-125 were significantly associated with their relevant personality disorders. Profile analysis showed that the pathological trait domains of the PID-5, except for negative affectivity, were significantly greater in those with an experience of CSA. Of the seven dimensions of TCI-125, novelty seeking and persistence were higher in those with an experience of CSA, but reward dependence, self-directedness, and cooperativeness were lower. CONCLUSIONS: These results confirmed a correlation between CSA and personality dysfunction. The pattern of dysfunction was complex and somewhat different from the two facet measures used.

The Construct Validity of the ICD-11 Severity of Personality Dysfunction Under Scrutiny of Object-Relations Theory.

The current classification of personality disorder in ICD-11 includes a description of personality functioning, derived from a number of theoretical paradigms, but most notably consistent with the psychodynamic approach. Concurrently, an object-relations model of personality functioning in a dimensional assessment of severity is provided in the Structured Interview of Personality Organization-Revised (STIPO-R). To date, there are no published measures of International Classification of Diseases-11 (ICD-11) personality severity, though the construct is very comparable to the concepts assessed in the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) levels of personality functioning concept, which is measured by the Level of Personality Functioning Scale-Self-Report (LPFS-SR). This study examined the validity of ICD-11 personality functioning, as measured by the LPFS-SR, by evaluating its associations with the STIPO-R in Kurdistan region. The samples included 231 University students and 419 inpatient participants across four hospitals (267 with a diagnosed personality disorder). All the components of LPFS-SR and STIPO-R were positively and significantly intercorrelated. The components of each measure discriminated PD and non-PD patients from a University, non-clinical group adequately. Despite slightly better performance of the STIPO-R in this discrimination, the measures had a high congruence in predicting personality dysfunction. Overall, the findings of the present study support the validity of ICD-11 construct for evaluating personality functioning.

The ICD-11 Personality Disorder Trait Model Fits the Kurdish Population Better Than the DSM-5 Trait Model.

The ICD-11 Classification of Personality Disorders and the DSM-5 Alternative Model of Personality Disorders (AMPD) operate with trait domains that contribute to the individual expression of personality disturbance (i.e., negative affectivity, detachment, dissociality, disinhibition, anankastia, and psychoticism). To date, these trait frameworks have not been investigated sufficiently in Middle Eastern cultures. Thus, the present study explored the structure of the ICD-11 and AMPD personality disorder (PD) trait domains in a large mixed sample from the Kurdistan zone of Iran. The ICD-11 and AMPD trait domains were operationalized using empirically supported algorithms for the Personality Inventory for DSM-5 (PID-5). The PID-5 was administered to a large mixed sample (N = 3,196) composed of 2,678 community and 518 clinical participants. Structural validity was investigated using Exploratory Factor Analysis (EFA), whereas differential construct validity was explored by comparing clinical and community scores. Model fit and the expected factor structure were deemed appropriate for the ICD-11 trait model, but less adequate for the DSM-5 trait model (i.e., disinhibition did not emerge as a separate factor). All domain and facet scores showed significant differences between clinical and community subsamples with moderate to large effects, mostly for disinhibition and dissociality/antagonism while least for anankastia. The findings of the present study may suggest that the ICD-11 trait model is more cross-culturally fitting than the DSM-5 AMPD trait model, at least with respect to a large mixed sample from the region of Kurdistan. Accordingly, there is evidence for using PID-5 data for WHO ICD-11 purposes in this part of the World.

Temperaments and characters: incompatible or complementary components for criterion B of the alternative model in predicting DSM-5 section II personality disorders?

BACKGROUND: Many studies have found clear correspondence among the domains of the five-factor model of personality (FFM) and the alternative model of personality disorders (AMPD) in DSM-5-III, which is assessed with the Personality Inventory for DSM-5 (PID-5). However, very few studies have compared the PID-5 with the other well-known established dimensional models of personality such as Cloninger's model. The present study examined whether the Temperament and Character Inventory (TCI-125) dimensions, PID-5 dimensions, or a combination would represent PD-scale scores more accurately. PARTICIPANTS AND PROCEDURE: In this regard, 437 college students completed the Persian version of the PID-5, TCI-125 and SCID-II Screening Questionnaire.RESULTS The results indicated that cooperativeness (low), self-directedness (low), and self-transcendence (high) characters of the TCI-125 and the psychoticism (high) domain of the PID-5 are the most consistent predictors of all PD-scale scores. CONCLUSIONS: Overall, the findings showed that an integrative model, combining dimensions of the TCI-125 and PID-5, represented the features of PD-scale scores most effectively.

Challenging the role of challenge in intensive short-term dynamic psychotherapy for social anxiety disorder: A randomized controlled trial.

OBJECTIVES: Intensive short-term dynamic psychotherapy (ISTDP) requires the technique of challenge to defenses when treating resistant patients. As the technique of challenge is difficult for some therapists to practice, it leads us to question whether challenge can be replaced by clarification of defenses without losing treatment effectiveness. This study compared ISTDP with two different technical emphases while treating social anxiety disorder (SAD). METHOD: Forty-two subjects with DSM-5 SAD were randomly assigned to either a waitlist control, 10 sessions of ISTDP with the use of challenge or 10 sessions of ISTDP without the use of challenge. RESULTS: ISTDP led to significant, sustained symptom reduction on the Liebowitz Social Anxiety Scale (LSAS-SR) compared with the control group. There were no significant outcome differences between standard ISTDP and ISTDP where challenge was restricted. CONCLUSION: ISTDP is efficacious for SAD. ISTDP may be effective for SAD without the use of challenge elements.

Examining the Contribution of Perfectionistic Traits to the Construct Validity of the DSM-5 Alternative Model of Personality Disorder.

Scholars of perfectionism have proposed significant modifications to DSM-5's alternative model of personality disorders (AMPD), such that (1) perfectionism be expanded beyond the inclusion of a singular trait-rigid perfectionism-and (2) perfectionistic traits be specified as trait descriptors of personality disorders (PDs) other than obsessive-compulsive PD. In this study, we evaluate these proposals by examining the degree to which (a) perfectionistic traits are already instantiated in Section II and Section III models of personality pathology; and (b) perfectionistic traits meaningfully augment the construct validity of AMPD PDs. We conducted these approaches in a large sample (N =3D 435) from an Iranian undergraduate population that is atypically found in the literature. Results showed that perfectionistic traits are already fairly well instantiated in Section III Criterion B. Perfectionistic traits minimally improved the construct validity of OCPD, but did not meaningfully do so for other PDs. Future investigation into the clinical utility of perfectionistic traits is needed.

The Efficacy of Intensive Short-Term Dynamic Psychotherapy for Social Anxiety Disorder: Randomized Trial and Substudy of Emphasizing Feeling Versus Defense Work.

This research examined the efficacy of intensive short-term dynamic psychotherapy (ISTDP) in the treatment of social anxiety disorder (SAD) and compared the therapeutic outcomes of ISTDP when feeling focus or defense work is emphasized. A three-group randomized design with 6-month follow-up was used. Forty-one subjects were selected among volunteer college students diagnosed with SAD. They were assigned randomly into three groups; 14 cases to feeling-focused ISTDP (FF-ISTDP) group, 14 cases to defense-focused ISTDP (DF-ISTDP) group, and 13 cases to a control group. All subjects were evaluated at pretest, posttest, and six-month follow-up through clinical interviewing using DSM-5 criteria for SAD along with the Liebowitz Social Anxiety Scale. Each experimental group had a course of 8 to 10 sessions of ISTDP treatment. Analysis of variance showed that ISTDP is an effective treatment for SAD compared with a control group. No outcome differences were found between FF-ISTDP and DF-ISTDP in treating SAD.

A systematic review of personality temperament models related to somatoform disorder with main focus on meta-analysis of Cloninger's theory components.

The systematic review aims to identify four personality temperament models related to somatoform disorder with the main focus on the meta-analysis of temperaments and characters in Cloninger's theory. The literature search was performed on PubMed (Medline), Scopus, Web of Science, Cochrane, and ProQuest for all articles published in English from January 1990 to April 2019. Due to heterogeneity, pooled estimates of the standard mean difference between cases and controls were calculated using the random-effects model. Based on our inclusion criteria, 14 studies were identified, 7 of which were included in the meta-analysis. The results show that there is a significant difference between cases and controls with regard to harm avoidance (HA) (z = 5.322, P < 0.001), self-directedness (z = -4.719, P < 0.001), and self-transcendence (z = 2.848, P = 0.004). Compared to controls, HA and self-transcendence were higher and self-directedness was lower in cases. With regard to other subscales, there was no difference between the two groups (P > 0.05). The publication bias was not seen (P > 0.05 for Egger statistics). Up to now, very few studies have been focused on the relationship between personality temperament models and somatoform disorder. Among the components of the Cloninger's model, the poor self-directedness along with the abnormally high self-transcendence and HA is the personality component related to the somatoform disorder. Thus, Cloninger's model may potentially draw a personality profile for vulnerability to somatoform disorder. Given the limited number of studies available, future studies may challenge the results of the present study.

The Differential Profile of Social Anxiety Disorder (SAD) and Avoidant Personality Disorder (APD) on the Basis of Criterion B of the DSM-5-AMPD in a College Sample.

BACKGROUND: The present study was conducted to determine the differential profile of social anxiety disorder (SAD) and avoidant personality disorder (APD) based on dimensional diagnosis in criterion B of the DSM-5 Alternative Model for Personality Disorders (DSM-5-AMPD) in a college sample. METHODS: Samples of this cross-sectional study included 320 (23.08 ± 2.66 years; 57% female) college students in western Iran during February 2015 to December 2017. Liebowitz-social anxiety scale, PID-5, SCID-II, SCID-II-SQ and diagnostic interview for SAD were the tools. The data were analysed using Pearson correlation and multiple linear regression analysis. RESULTS: Forty-three and 38 participants met criteria for SAD alone and APD, respectively. Five main domains of PID-5 could explain 29% and 54% of the variance of SAD and APD, respectively. Facets of negative affect, detachment, antagonism, disinhibition, and psychoticism could explain 25% versus 43%, 26% versus 54%, 7% versus 27%, 21% versus 41%, 13% versus 30% of the variance of SAD and APD, respectively. CONCLUSION: SAD and APD probably refer to two distinct mental states having prominent anxiety, emotional instability, and interpersonal pattern of avoidance and detachment of challenge. SAD is a simple form of mental disturbances with anxiety in its core features; although, APD is possibly referring to more complicated psychopathology.