[Personality Assessment as Contribution to Diagnostic Differentiation Between ADHD and RAD in Middle Childhood]. / Persönlichkeitserfassung als Beitrag zur Differentialdiagnostik zwischen Patienten mit ADHS und Bindungsstörung in der mittleren Kindheit.

Personality Assessment as Contribution to Diagnostic Differentiation Between ADHD and RAD in Middle Childhood Early and prolonged social and emotional deprivation can result in symptoms of both ADHD and attachment disorder (RAD). The present study compares children between 7 and 13 years of age diagnosed with either ADHD or RAD, regarding their disorder specific behavior by using the Conners Rating Scale, a RAD screening scale, the overall psychopathology in the CASCAP-D, and the children's personality using the California Child-Q-sort (CCQ). The RAD group showed an increased overall psychopathology score and both increased ADHD and RAD symptomatology. In addition, they also were characterized as lower in self-regulatory personality characteristics (e. g. ego-resiliency). The results suggest that children with a RAD diagnosis do not show two comorbid disorders (RAD plus ADHD) but are characterized by an even more intense deficit of self-regulation in social and emotional contexts, compared to the children of the pure ADHD group. This should be considered in diagnosis and treatment.

Attachment in young children with incarcerated fathers.

The present study examined young children's attachment behaviors during paternal incarceration and reported on initial validity of a new measure used to rate children's attachment-related behaviors and emotions during visits in a corrections setting. Seventy-seven children, age 2 to 6 years, and their jailed fathers and current caregivers participated in the home visit portion of the study, whereas 28 of these children participated in the jail visit. The results indicated that 27% of children witnessed the father's crime and 22% of children witnessed the father's arrest, with most children who witnessed these events exhibiting extreme distress; children who witnessed these events were more likely to have insecure attachments to their caregivers. Consistent with attachment theory and research, caregivers who exhibited more sensitivity and responsivity during interactions with children and those who provided more stimulating, responsive, learning-oriented home environments had children who were more likely to have secure attachments (measured with the Attachment Q-Sort). We also found preliminary evidence for the validity of our new measure, the Jail Prison Observation Checklist, in that children's attachment-related behaviors and emotions during the jail visit correlated with their attachment security observed in the home. Our observations indicate that, in certain contexts, noncontact visits with incarcerated parents can be stressful for children and that children's caregivers may play a significant role during these visits.

Assessing Anaclitic and Introjective Characteristics Using the SWAP-200 Q-Sort: Concurrent Validity with the Inventory of Interpersonal Problems Circumplex Scales.

This investigation's goal was to assess the concurrent validity of the four scales of the Anaclitic and Introjective Depression Assessment (AIDA), a newly developed clinician-rated measure, and the Inventory of Interpersonal Problems Circumplex Scales (IIP-64). The AIDA is composed of Shedler-Westen Assessment Procedure items and is comprised of two primitive and two more mature scales of introjective and anaclitic personality types. Specific predictions of relationships were made and are discussed further in this paper. The participants in this study were 106 outpatients engaged in psychodynamic psychotherapy. Patients completed the IIP-64 upon assessment and were rated by their therapist on the Shedler-Westen Assessment Procedure 200 (SWAP-200). The present findings demonstrated several expected relationships between the SWAP-derived AIDA and the IIP-64. Primitive levels of Anaclitic and Introjective characteristics on the AIDA were related to more difficulties involving Affiliation and Dominance on the IIP. The primitive Introjective-Dismissive (Dismissive Depression) scale was related to difficulties involving high Dominance and low Affiliation. The more adaptive Introjective-Self-Critical (Self-Critical Depression) scale was not related to any interpersonal problem. The more adaptive Anaclitic-Needy (Needy Depression) scale was related to difficulties involving high Affiliation, and the primitive Anaclitic-Submissive (Submissive Depression) scale was associated with difficulties related to high Affiliation, as well as problems related to low Dominance in one of two domains. Our results bolster the concurrent validity of the four AIDA scales and add to current knowledge of the differential interpersonal patterns of individuals with more mature and primitive levels of anaclitic and introjective personality types. Copyright © 2016 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE: Clinicians can utilize the Anaclitic and Introjective Depression Assessment (AIDA; Rost, Fonagy, & Luyten, 2014), derived from Shedler-Westen Assessment Procedure (SWAP) items, to assess if their patients possess Anaclitic or Introjective characteristics. This measure can also be used to assess if the Anaclitic and Introjective characteristics are of a more primitive or mature nature. Clinicians should be aware that individuals with more primitive levels of Anaclitic and Introjective characteristics experience more difficulties involving Affiliation and Dominance than individuals with more mature levels of personality development. Specifically, the more primitive Introjective individual will likely encounter difficulties involving high Dominance and low Affiliation. The more adaptive Introjective individual will likely not demonstrate difficulties in these areas. The more primitive Anaclitic individual will likely encounter more difficulties related to high Affiliation, as well as problems related to low Dominance. The more adaptive Anaclitic individual also likely will encounter difficulties involving high Affiliation.

The World at 7:00: Comparing the Experience of Situations Across 20 Countries.

The purpose of this research is to quantitatively compare everyday situational experience around the world. Local collaborators recruited 5,447 members of college communities in 20 countries, who provided data via a Web site in 14 languages. Using the 89 items of the Riverside Situational Q-sort (RSQ), participants described the situation they experienced the previous evening at 7:00 p.m. Correlations among the average situational profiles of each country ranged from r = .73 to r = .95; the typical situation was described as largely pleasant. Most similar were the United States/Canada; least similar were South Korea/Denmark. Japan had the most homogenous situational experience; South Korea, the least. The 15 RSQ items varying the most across countries described relatively negative aspects of situational experience; the 15 least varying items were more positive. Further analyses correlated RSQ items with national scores on six value dimensions, the Big Five traits, economic output, and population. Individualism, Neuroticism, Openness, and Gross Domestic Product yielded more significant correlations than expected by chance. Psychological research traditionally has paid more attention to the assessment of persons than of situations, a discrepancy that extends to cross-cultural psychology. The present study demonstrates how cultures vary in situational experience in psychologically meaningful ways.

Comparison of two scales for evaluation of smile and dental attractiveness.

OBJECTIVE: To compare the visual analogue scale (VAS) and the simplified Q-sort method used to investigate the highest level of agreement among dentists, orthodontists and laypeople when assessing smile and dental attractiveness. MATERIAL AND METHODS: An album containing 258 photos of 86 individuals with their lips at rest, a slight and broad smile, was assessed by 25 dentists (general clinicians and various specialties), 23 orthodontists and 27 laypeople with regard to smile and dental attractiveness. To this end, both VAS and simplified Q-sort method were used. Agreements were calculated by intraclass correlation coefficient (ICC). RESULTS: For the single measurement between the VAS method and the simplified Q-sort method, all simplified Q-sort rates were higher in all groups. The simplified Q-sort method results ranged between 0.42 and 0.49 while those of the VAS method varied between 0.37 and 0.42. The simplified Q-sort method also presented higher mean measurement values (0.95 and 0.96) in comparison to VAS (0.94 and 0.95). CONCLUSIONS: Both scales may be considered reliable for evaluating smile and dental attractiveness; however, the simplified Q-Sort method presented slightly higher values than the VAS method.

Interaction structures formed in the psychodynamic therapy of five patients with borderline personality disorder in crisis.

OBJECTIVES: To identify interaction structures (i.e., patterns of reciprocal interaction) that characterize the treatments of patients with borderline personality disorder (BPD) in crisis. DESIGN: A 6-month naturalistic psychotherapy process and outcome study in which interaction structures were correlated with outcome data. METHODS: Five BPD patients in crisis participated in 6 months of three-times-per-week psychodynamic therapy. Patients completed a measure of psychological distress every week. One hundred and twenty-seven sessions were audiotaped and coded using the Psychotherapy Process Q-Set. RESULTS: Four interaction structures were identified: (1) collaborative relationship with supportive, reassuring therapist (IS1), (2) therapist empathic attunement (IS2), (3) erotized therapeutic relationship (IS3) and (4) directive therapist with compliant patient (IS4). The magnitude of these four interaction structures varied within and between the five therapist-patient dyads over time. Interaction structures correlations with time were inversely proportional to interaction structures correlations with distress levels. IS2 was correlated with two different outcomes in patient 3's and patient 5's treatments--a positive outcome for patient 3's treatment and a negative outcome for patient 5's treatment. CONCLUSIONS: An effective treatment model for BPD patients in crisis needs to promote the emergence of empathically attuned interactions as well as supportive and directive interventions as dictated by the patient's individual needs. These treatments require flexibility to accommodate the patient's unique presentation in crisis. The therapeutic dyad senses which interaction structures to increase or decrease over time to reduce the patient's distress.

Attitudes towards establishing a daily supervised school-based toothbrushing programme--determined by Q-sort methodology.

OBJECTIVES: This study used Q-sort methodology to determine the views of staff involved in a national school-based daily toothbrushing programme. METHODS: Q-methodology is a mixed-method approach in which participants are asked to sort a collection of statements according to degree of agreement with them. Factor analysis identified subgroups of like-minded participants and revealed areas of consensus and disagreement. 24 Community Dental Service staff managing or delivering the toothbrushing programme were asked to rank 49 statements derived from previous qualitative interviews. RESULTS: Varimax rotation produced a three-factor solution with five/six participants loading significantly into each group. Groups divided largely according to staff role: Factor 1, mainly support workers (assistants with no oral-health background); Factor 2, managers; and factor 3, oral health educators (dental nurses with teaching qualifications). As staff new to the area of oral-health, the views of support workers were of particular interest. Unlike others, this group saw Designed to Smile as a unique health promotion scheme and wanted to involve as many children as possible, regardless of oral-disease risk. Managers' perceptions of issues affecting the establishment of the programme differed from those staff in day-to-day contact with the 515 schools in which the toothbrushing took place. CONCLUSIONS: This study used a long established but little used technique to ascertain the commonality of views of staff These data may be of value not only in managing the current programme, but for anyone who may be considering developing such a toothbrushing scheme.

Women entering clinical psychology: Q-sort narratives of career attraction of female clinical psychology trainees in the UK.

The great majority of the UK clinical psychology workforce are women, and this fact prompted an examination of the various ways clinical psychology might be seen as attractive to women--a neglected research topic. Female clinical psychology trainees from a variety of training programmes Q-sorted statements of potential job attractors. The process of analysis is outlined before most of the article is devoted to explicating the five narratives of attraction generated: making a difference, waiting for what I want, idealising challenge, identifying with distress and acknowledging power and privilege. Two super-ordinate 'stories' spanning the narratives are suggested--an over-riding attraction to the profession and a rebuttal of the suggestion that this attraction may be based on any overtly gendered grounds. In the absence of previous empirical data of women's attraction to clinical psychology, the small but significant contribution to understanding the profession made by the analysis is acknowledged--as is the need for further research to confirm and develop the findings.

Preparing for DSM 5 - assessment of personality pathology during psychoanalytic and psychiatric treatments.

BACKGROUND: Currently, the conceptualization and treatment of personality pathologies are mainly theory driven. The resulting categorical classification of personality disorders leads to inaccurate diagnoses and is therefore being criticized by many researchers and clinicians. A consensus exists that in the upcoming edition of the DSM (DSM 5), the classification of personality disorders should rather adopt a dimensional approach, where patients are assessed depending on their character traits, inner-defense mechanisms, and interpersonal functioning. However, the basis (theoretical or empirical) of this classification-system is still a topic of dispute. This study presents assessment methods based on both theoretical and empirical assumptions. OBJECTIVE: To determine whether psychodynamic instruments employed in psychoanalytic settings are also useful for measuring changes in personality pathology in psychiatric inpatient settings. METHODS: Matched pairs between two groups of patients, one receiving outpatient psychoanalytic care (n = 10; mean age 36 ± 11), the other inpatient social-psychiatric treatment (n = 10; mean age 27 ± 6), were created and subsequently analyzed (mean observation period 20 ± 11 days). Patients were assessed using psychodynamic instruments measuring changes in quality of object relations (QORS) and affect regulation and experience (AREQ). To allow conclusions concerning the respective mechanisms of change, the influence of the therapeutic relationship, measured by using instruments evaluating transference (PRQ) and countertransference (CTQ) patterns, was also assessed. RESULTS: The instruments aforementioned were shown to be suited for both psychoanalytic and psychiatric patients. Typical short-term developments of the distinctive therapeutic procedures were evident; however, in both settings a positive working alliance was shown to be crucial for therapeutic progress. CONCLUSION: The psychodynamic instruments introduced in this study proved to be effective in measuring personality pathology in psychiatric inpatients and in helping clinicians throughout the indication and recommendation process during transition from inpatient to outpatient treatment. Since components of such assessment methods are being considered for DSM 5, their practical utility is shown in this study.

Personality subtypes in adolescents with panic disorder.

This study examined personality subtypes of adolescents diagnosed with Panic Disorder (PD). As part of an NIMH-funded study of adolescent personality and its relation to psychopathology, randomly selected experienced licensed psychologists and psychiatrists used a Q-sort instrument to describe adolescents in their care, of whom 57 had been diagnosed with PD. Q-factor analysis yielded three personality subtypes: High Functioning/Dysphoric, Emotionally Dysregulated, and Avoidant. The subtypes differed on axis I and II pathology, adaptive functioning, and developmental and family history variables. Personality constellations showed substantial incremental validity in predicting adaptive functioning above and beyond DSM-IV axis I diagnoses. The results resemble subtypes recently identified in adults and suggest that adolescents who present with panic symptoms are a heterogeneous group, whose personality needs to be considered in understanding and helping them clinically.

Measuring infant attachment security in rhesus macaques (Macaca mulatta): adaptation of the attachment Q-set.

John Bowlby defined offspring-parent attachment as a relationship in which an infant or child uses one or a few preferred adults as a secure base from which to explore and as a haven of safety. He defined attachment security in terms of confidence in the adult's availability and responsiveness and the smooth organization of exploration and proximity seeking. Developmental psychologists have found this perspective productive in both observational and laboratory research. At the same time, they emphasize that such a construct cannot be operationalized in terms of one or a few behaviors. Instead, naturalistic observations of human infant attachment typically employ the Q-sort method to develop the Attachment q-set (AQS), 90 behaviorally descriptive items sorted in terms of how characteristic each item is of the infant's typical behavior. Meta-analyses of research using the AQS attest to its reliability and validity. This article reports an adaptation of the AQS to the task of assessing infant attachment security in nonhuman primates and illustrates its use. The availability of comparable measures of attachment security will contribute to an expanded understanding of patterns of attachment behavior in nonhuman primate societies and will facilitate interaction between comparative and developmental psychologists.

Four different patterns of fatigue in rheumatoid arthritis patients: results of a Q-sort study.

OBJECTIVES: Many patients with RA complain about fatigue. Whereas qualitative studies have covered the meaning of fatigue for RA patients, it was still unknown whether subgroups of patients could be distinguished. This study aimed to describe different perspectives on the experience of fatigue. METHODS: Participants were 30 outpatients with established controlled RA of the Medical Spectrum Twente, with a mean fatigue severity score of 4.67 (visual analogue scale 0-10). They evaluated 57 statements about fatigue according to Q-methodology. Data were analysed with PCQ for Windows (Portland, OR, USA), using centroid factor analysis with varimax rotation (i.e. the participants but not the items of a scale are the variables). Factor scores of statements on the different dimensions were calculated to investigate which items are relevant when describing and distinguishing fatigue experiences. Demographic and clinical patient characteristics were collected to describe each of the dimensions that resulted from centroid factor analysis. RESULTS: After statistical and theoretical considerations, a four-factor structure of the data was obtained. Each factor represented a perspective on the experience of fatigue, shared by a certain group of patients. Physical, psychological and social patient characteristics seemed to be associated with those experiences. The factors were labelled as: 'Little impact of fatigue'; 'Good coping and bad sleep'; 'Search for balance'; and 'High distress'. CONCLUSIONS: Results indicated that fatigue experience is a complex phenomenon. Existing questionnaires to measure fatigue do not meet this complexity. Extensive research is warranted and new efforts to develop instruments that take into account all aspects of fatigue are indicated.

Situational similarity and personality predict behavioral consistency.

A new method for assessing situations is employed to examine the association between situational similarity, personality, and behavioral consistency across ecologically representative contexts. On 4 occasions across 4 weeks, 202 undergraduate participants (105 women, 97 men) wrote descriptions of a situation they had experienced the previous day. In addition, they rated its psychological features using the recently developed Riverside Situational Q-Sort (RSQ) Version 2.0 (Wagerman & Funder, 2009) and their behavior using the Riverside Behavioral Q-Sort (RBQ) Version 3.0 (Funder, Furr, & Colvin, 2000; Furr, Wagerman, & Funder, 2010). Independent judges also rated the situations using the RSQ, on the basis of the participants' written descriptions. Results indicated (a) participants' ratings of their behavior were impressively consistent across the 4 situations; (b) the 4 situations experienced by a single participant tended to be described more similarly to each other than to situations experienced by different participants; (c) situational similarity, especially from the individual's own point of view, strongly predicted behavioral consistency; and (d) personality characteristics predicted behavioral consistency even after controlling for situational similarity. Relatively consistent persons described themselves as ethically consistent, conservative, calm and relaxed, and low on neuroticism. These results imply that behavioral consistency in daily life stems from multiple sources, including situation selection and the distinctive influence of personality, and further suggest that tools for situational assessment such as the RSQ can have wide utility.

Convergence of internal and external structure for the California Child Q-set.

The language of personality traits includes single-word trait descriptors, and longer phrases or sentences. Evidence has accumulated that abstract, semantic relationships among single words have the same underlying structure as the empirical relationships when words are applied to individuals. The present study examines whether these two kinds of structure are also isomorphic for longer trait descriptors. Empirical descriptions and judgements of semantic similarity were collected among the descriptors comprising the California Child Q-set, or CCQ, and analysed with multidimensional scaling. Canonical correlation showed the solutions to be closely related to one another, and to independent sets of ratings available for the CCQ items. Informants' similarity judgements were not affected by the context in which they were made. The dominant dimensions of the solutions reproduce dimensions found previously for the single-word personality lexicon, indicating the two trait-descriptive languages to be closely parallel.

Personality subtypes of suicidal adults.

Research into personality factors related to suicidality suggests substantial variability among suicide attempters. A potentially useful approach that accounts for this complexity is personality subtyping. As part of a large sample looking at personality pathology, this study used Q-factor analysis to identify subtypes of 311 adult suicide attempters using Shedler-Westen Assessment Procedure-II personality profiles. Identified subtypes included internalizing, emotionally dysregulated, dependent, hostile-isolated, psychopathic, and anxious somatizing. Subtypes differed in hypothesized ways on criterion variables that address their construct validity, including adaptive functioning, Axis I and II comorbidity, and etiology-related variables (e.g., history of abuse). Furthermore, dimensional ratings of the subtypes predicted adaptive functioning above DSM-based diagnoses and symptoms.

Convergent validity of the SWAP-200 dependency scales.

The present study examined the convergent validity of the Shedler-Westen Assessment Procedure Q-Sort (SWAP-200; ) dependency scales (Dependent Personality Disorder [DPD] Clinical Prototype and DPD composite description) by examining links between these variables with Inventory of Interpersonal Problems Circumplex Scales (IIP-C; Alden et al., 1990; Horowitz et al., 2000; Horowitz et al., 1988), and DSM-IV diagnoses of DPD in a clinical sample (N = 85). Results showed that SWAP-200 DPD Clinical Prototype was significantly related to a DSM-IV diagnosis of DPD, higher scores on the IIP-C Affiliative/Submissive Quadrant summary scale, and elevations on Nonassertive and Overly-accommodating Octant Scales. Additional analyses revealed significant positive relationships between the DPD composite description with DSM-IV diagnosis of DPD, the Affiliative/Submissive Quadrant summary scale, and the Overly Accommodating and Self-Sacrificing Octant Scales. We discuss the implications of these findings with regard to theoretical, empirical, and clinical aspects of interpersonal dependency.

Using QMethodology to identify reasons for distress in burn survivors postdischarge.

Reasons for distress after burn injuries have not been codified based on any type of acceptable empirical or statistical technique. The unique design methodology proposed in this study can identify the most common reasons cited for causing distress in burn survivors after discharge. A Q-sort task was developed with the assistance of our burn advisory group. After identifying 50 possible reasons for distress after discharge, each reason was placed on a laminated game card. In compliance with Qmethodology, a game board was developed that allowed patients to rank order each reason from "not causing distress" to "causing significant distress." A total of 69 burn survivors were enrolled in the study at four different time points: 1 month, 6 months, 1 year and 2 years postdischarge. After factor analysis, four factors accounted for all of the participants across time points. This indicates that at least four distinct groups of people can be categorized according to themes raised in rating reasons for distress. This Q-sort technique allowed us to capture the complexity of conceptualizing human distress by categorizing clusters of reported problems into similar groups. This methodology shows great promise for developing interventions that target unique needs of burn survivors.

Questioning the coherence of histrionic personality disorder: borderline and hysterical personality subtypes in adults and adolescents.

After the introduction of histrionic personality disorder (HPD), nosologists struggled to reduce its overlap with borderline personality disorder and other PDs. We studied the coherence of HPD in adults and adolescents as part of 2 larger studies. Clinicians described a random patient with personality pathology using rigorous psychometrics, including the SWAP-II (a Q-sort that captures personality and its pathology in adults) in study 1 and the SWAP-II-A (the adolescent version) in study 2. Using DSM-IV-based measures, we identified patients who met HPD criteria with varying degrees of diagnostic confidence. Central tendencies in the SWAP-II and SWAP-II-A profiles revealed that both the most descriptive and most distinctive features of the patients included some features of HPD but also many features of borderline personality disorder. Q-factor analyses of the SWAP data yielded 3 types of patients in each of the 2 samples. The HPD diagnosis may not be sufficiently coherent or valid.

Refining the construct of narcissistic personality disorder: diagnostic criteria and subtypes.

OBJECTIVE: Narcissistic personality disorder has received relatively little empirical attention. This study was designed to provide an empirically valid and clinically rich portrait of narcissistic personality disorder and to identify subtypes of the disorder. METHOD: A random national sample of psychiatrists and clinical psychologists (N=1,201) described a randomly selected current patient with personality pathology. Clinicians provided detailed psychological descriptions of the patients using the Shedler-Westen Assessment Procedure-II (SWAP-II), completed a checklist of axis II diagnostic criteria, and provided construct ratings for each axis II personality disorder. Descriptions of narcissistic patients based on both raw and standardized SWAP-II item scores were aggregated to identify, respectively, the most characteristic and the most distinctive features of narcissistic personality disorder. RESULTS: A total of 255 patients met DSM-IV criteria for narcissistic personality disorder based on the checklist and 122 based on the construct ratings; 101 patients met criteria by both methods. Q-factor analysis identified three subtypes of narcissistic personality disorder, which the authors labeled grandiose/malignant, fragile, and high-functioning/exhibitionistic. Core features of the disorder included interpersonal vulnerability and underlying emotional distress, along with anger, difficulty in regulating affect, and interpersonal competitiveness, features that are absent from the DSM-IV description of narcissistic personality disorder. CONCLUSIONS: These findings suggest that DSM-IV criteria for narcissistic personality disorder are too narrow, underemphasizing aspects of personality and inner experience that are empirically central to the disorder. The richer and more differentiated view of narcissistic personality disorder suggested by this study may have treatment implications and may help bridge the gap between empirically and clinically derived concepts of the disorder.

Aesthetics of streetscapes: influence of fundamental properties on aesthetic judgments of urban space.

This experiment was designed to investigate the relationship between the fundamental visual, spatial properties of existing complex streetscapes and aesthetic judgments. Participants performed aesthetic judgments over 35 photographs of typical spatial situations taken along the Meissner Strasse in Radebeul, Germany. In a modified Q-Sort procedure, the participants assigned the pictures to five categories, including 1 (beautiful) and 5 (not beautiful). Vegetation, Stylistic Uniformity, Homogeneity of Scale, and Symmetry were identified as primary components of aesthetic judgment by using principal component analysis. Stimuli, photographically edited according to these factors, were then tested using the same Q-Sort procedure, which confirmed these determinants. These results are intended to help the development of the theoretical understanding of the link between the influence of selected spatial properties and the aesthetic judgment of the visual quality of urban spaces.