[The alternative model of personality disorders among the French population: Assessment with brief tools]. / Le modèle alternatif des troubles de la personnalité en population française : évaluation avec des outils brefs.

OBJECTIVES: The aim of this work was to study whether the French versions of the brief tools available to clinicians within the framework of the Alternative Model of Personality Disorders (AMPD) can account for the risks of personality disorders in the general population. Tools are available to accurately investigate either the Level of Personality Functioning (LPF) or the Pathological Personality Dimensions (PPD) which in turn allow the validation of the relevance of the AMPD for its criteria A and B. As these tools, such as Morey's Level of Personality Functioning Scale Self Rated (LPFS-SR) for Criteria A or the Personality Inventory for DSM-5 (PID5) by Krueger et al. for Criteria B, are lengthy, the question arises as to the use of the short tools derived from them. METHOD: Data was collected from a sample of 433 people recruited on a volunteer basis with a complete protocol. The sample was predominantly female (83% female, 16% male, 2 people who did not wish to report their gender) and rather young (67% were 18-24 years old). The short version, the LPFS- BF of Hutsbaut et al., which we used in this work allows, as confirmed by several works, to consider on the basis of 12 items the global level of personality functioning. In order to assess the pathological dimensions of personality (PPD), we chose the short version of the Personality Inventory for DSM 5 (PID 5 BF) by Krueger et al. and used its validated French translation that satisfies the factor composition of the original version: Negative Affectivity, Antagonism, Detachment, Disinhibition and Psychoticism. To assess the intensity of personality disorders we used the dedicated subscale (Items 19 and 20) that the DSM 5 proposes in its Cross-Cutting Symptoms Measures of Level 1, in its French translation. A score higher than 2 was our Gold Standard when we tested the metric capacity of the two questionnaires to evaluate the A Criteria and then the B Criteria of the AMPD. RESULTS: The overall results (Table 1) show levels that place the group in a non-clinical level. In terms of the severity of personality disorders it can be seen that 27 % are at risk of personality disorder (PDs>2). Comparing these two sub-groups (Table 1), we observed significant differences for all the factors studied, pointing towards a higher score for people at risk of PDs. A logistic regression analysis of the evaluation of persons at risk lead us to find that gender and age do not have a significant influence (p=0.225 and p=0.065 respectively) in a valid model (chi square=157, df=4, p<0.001) including the overall score on the LPFS (z=5.76, p<0.001) and the PID 5 (z=2.26, p<0.001). The Area Under the Curve (AUC=0.859) of this translation (Table 3) is consistent with the original version (AUC=0.84). It has metrological qualities (Sn=73.91%, Sp=85.33%, LR+=5.1, LR-=0.3005) that allowed us to use a threshold of 24 as a discriminant of a risk of moderate or severe personality disorder. In addition, if we followed the AMPD and considered the threshold of 24 on the LFPS-BF to be a risk score for personality disorder, we could see (Fig. 2) that the scores on the PID 5 BF fairly well reflected the expected pattern with a large AUC (0.901). According to the AMPD, the cut-points for the dimensions that would evoke the presence of criteria B in the case of the presence of criterion A (LPFS-BF>24) could be either a score greater than 2 for Negative Affectivity, a score greater than 0.8 for Detachment, Antagonism and Disinhibition, or a score greater than 1.2 for Psychoticism (Table 4). DISCUSSION: The translation of the LPFS-BF that we used in this work has sufficient qualities to assess situations at risk of personality disorders when higher than 24. Its consistency was good (=0.84), and its factor composition in two factors (Self and Interpersonal Relations) was equivalent to the original version. The use of PID5-BF could therefore be used as a complement to the screening of AMPD A criteria, with a 25 for cut-point. The evaluation of the AMPD B criteria with the PID5-BF seemed relevant in view of our results; each of the subscales seemed to be able to correctly evaluate (AUC) persons with an LPFS-BF score at risk. However, the risk thresholds need to be confirmed in further work because of the essential role that the dimensions play in the diagnosis of types of personality disorders.

[Validation of a French translation of Krueger's personality inventory for DSM-5 in its brief form (PID-5 BF)]. / Validation d'une version française de la forme brève de l'inventaire des troubles de la personnalité pour le DSM-5 (PID-5 BF) de Krueger.

OBJECTIVE: Since the publication of the DSM-5 (APA, 2013), the dimensional conception of the personality disorders is co-existing with the classical categorical paradigm. Tools have been proposed for the evaluations of five big pathological factors to be explored further according to the APA (negative affectivity, detachment, antagonism, disinhibition, psychoticism). Despite numerous works using these questionnaires (30 works in 3 years according to Al-Adjani et al., 2015), none of them have yet been translated into French. Also, the main objective of the paper is to present a French translation of the Personality Inventory for DSM -5 by Kruegger et al. (2013) in its brief form of 25 items (PID-5 BF). METHOD: To reach this goal, we have employed the classic translation-retranslation method (Vallerand, 1989) and tested the consistence and the validity of this French version among a non-clinical sample (n=216) of young adults (age=31.4, SD=4.8), in joining some other questionnaires in their short forms to study the external validity of the PID-5 about the psychological distress (SCL-10, Nguyen, 1983), the categorical diagnosis of personality disorders (SAPAS, Moran et al., 2003) and the classical Big Five dimensions of the personality (BDI 10, Ramamstedt and John, 2007). The internal consistency of this translation has been studied through the classical outcomes on factor analysis for the dimensional repartitions of the items in 5 scales and Cronbach's alpha for the consistency of each found dimensions. The external validity has been explored by studying Pearson's correlations between the outcomes on each dimension of the PID-5 BF and both the clinical dimensions of SCL-10, personality dimensions of the BFI-10 or personality disorders (SAPAS). RESULTS: Factor analysis led to the same repartition of the 25 items as the original versions. Each of the dimensions is consistent enough (α>.65) to be taken into account as clinically significant. The items of the French version of the PID-5 BF follow the expected repartitions in 5 dimensions, which are consistent enough. Although their mean scores are significantly not different from the outcomes found by Krueger with the PID-5 200 items among another non-clinical population (n=264), one cannot say that is enough to ensure the external validity of our translation, for it uses neither the same tools nor sample. A comparison with a French translation of the PID-5 would be more significant. However, the external validity of the French version seems to be significant enough. Global score on the PID-5 is correlated both to the Global Severity Index of the SCL-10, which reflects global psychological distress, and SAPAS's score, which evaluates the suspicion of personality disorder. The clinical validity of the PID-5 is confirmed by the relationships between negative affectivity and anxiety or depression or antagonism and hostility, although the clinical scale of the SCL-10, with one item by dimension, is less sensitive than the complete original version in 90 items (DeRogatis, 1974). PID-5 score and domains are also correlated with the Big Five personality dimension and global score of personality disorders which led us to think that it is coherent with the evaluation of personality suffering (r=.34) and dimensions. The links between negative affectivity and neurosism (r=.48) or between desinhibition and extraversion (r=.32) or the negative correlation between psychoticism and conscientiousness (r=-0.16) are consistent with the expectations related both to the descriptions of the domains by the DSM and outcomes on the comparisons between PID-5 200 item scales and NEO-PI or BFI 45 items. DISCUSSION: This translation offers enough consistency and validity to be used in future studies. This could lead us to either continue studying a more representative general population or testing its validity in focusing on a clinical sample where personality disorders are prevalent, such as homeless men or substance users. As soon as a French version of the PID-5 200 items is published, one can compare the outcomes on PID-5 BF and PID-5 to lead to estimations of personality disorders and pathological domains among French populations and explore personality disorders throughout a dimensional paradigm instead of syndromic perspective. One can also see whether the items that have been kept for each dimension are as saturated in the French version as in the original one. Among general populations, comparisons with clinical distress, syndromic personality disorders or dimensional aspect of personality could be done with complete versions of PID-5, Symptom Check-list, Personality Disorders Questionnaires or Big Five Inventory; therefore, the brief forms of any questionnaire could be used among any people whose psychological distress or side effects impaired their attention and concentration.

[Path causal analysis of a model of a functional organization between defense mechanisms and coping strategies]. / Analyses en pistes causales d'un modèle d'une organisation fonctionnelle des relations entre mécanismes de défense et stratégies de coping.

BACKGROUND: In the psychological literature, two concepts are often used to approach psychological and social adaptation: defense mechanisms and coping strategies. Many empirical studies deal with these strategies independently of each other. However, the nature of their relationship is still debated, making empirical studies necessary jointly evaluating these two types of strategies to better reflect the adaptive process. OBJECTIVE: To test Chabrol and Callahan's theoretical model of the relationship between defence mechanisms and coping strategies. According to theses authors, defence mechanisms and coping strategies are distinct mechanisms, functionally organized: defenses appear first and modulate the emergence of coping strategy defenses through threat representation. METHOD: Ninety-four young adult volunteers completed the Coping Inventory for Stressful Situations (CISS), the Defense Style Questionnaire (DSQ-40) and the Perceived Stress Scale (PSS14). The data were treated according to the structural equation modeling method. RESULTS: Overall, the results support the theoretical model proposed by Chabrol and Callahan. The statistical model provides a good fit to the data (chi(2)/df=18.62/22=.85, P=.67, RMSEA=.00 (90% CI: .00-.07), CFI=1, TLI=1.04). It explains from 7 to 24% of coping variability scores (Avoidant Coping: R(2)=.07, P<.01; emotional coping and problem-focused coping: R(2)=24, P<.01). Results also show that the relationships between defence mechanisms and copings strategies are mediated by perceived distress and perceived controllability. Defence impact on coping strategies is not the same whether one considers problem-focused coping or emotional and avoidant coping. Immature and mature defences' impact on problem-focused coping is underpinned by a simple mediation: perceived controllability. Defences' impact on emotional coping and avoidant coping is more complex and underpinned by a double mediation: first by the perceived controllability and then, in a second time, the perceived distress. Finally, the results show the existence of a feedback loop from emotional copings to immature defences. CONCLUSION: It is now clearly relevant for the therapist to simultaneously work on defence mechanisms and coping strategies without assimilating these two categories of processes. Such work involves being able to identify them in their specificities. One of the crucial therapeutic targets is to understand the role of defences on the mental construction of reality in order to maximize adaptive reactions, critical in stress management.

[On the dynamics of psychological functioning through speech analysing]. / Dynamique d'un fonctionnement psychologique à travers l'étude de l'énonciation.

OBJECTIVE: The aim of this study is to focus on the clinical aspects of four linguistic indicators that emerge from automatic speech analysis. BACKGROUND: From a theoretical point of view, the number of proposals deals with cognitive activity, the number of modelizations with emotional activity, the number of connections with judgment activity and the number of action verbs can refer to behavioral activity. METHODS: To test these hypotheses we have studied two protocols of Thematic Aperception Test (TAT) randomized from non-clinical groups for the former and from a group of schizophrenic patients for the latter. RESULTS: The outcomes regarding the non-clinical protocols lead to the conclusion that the four indicators are coherent (α=0.93) and correlated; this confirms the clinical data on the cohesive personality of this young lady. The absence of correlations within the schizophrenic protocols reflects the dissociative syndrome of this patient. CONCLUSION: Finally, the study of the dynamics of this protocol, using our four linguistic criteria, confirms both the affective indifference and the increase of behavioral activity of this patient when the mentalization fails. After discussion and despite its capacity to describe clinical cases, the validity of this method needs to be completed (by relating the language indicators to production time stories) in further explorations, even if its reliability is good (α=0.93).

[Defense mechanisms and perceived adverse effects in a population of 70 HIV infected adults]. / Styles défensifs et perception des effets indésirables dans une population de 70 adultes séropositifs au VIH.

OBJECTIVE: We assessed the relations between defense mechanisms and perceived adverse effects of ART in a population of 70 HIV positive patients. DESIGN: The Bond Defense Style questionnaire was used to evaluate defense mechanisms. We used Justice's questionnaire to assess adverse effects and their psychological impact. We carried out multiple regression and mediation analyses to define the relations between the number of adverse effects, defensive styles, and the impact of adverse effects. RESULTS: The global model accounts for nearly 40 % of the score variance. Mature and immature defense styles bring significant contribution to understanding the impact of adverse effects, even when their number is controlled. CONCLUSION: Working on defense mechanisms should lower the psychological impact of adverse effects, therefore, improving the patient's quality of life and compliance.

[Impact of personality disorders in a sample of 212 homeless drug users]. / Impact des troubles de la personnalité dans un échantillon de 212 toxicomanes sans domicile fixe.

INTRODUCTION: The impact of the mental disorders (axis I and II, according to DSM IV) on psychosocial problems (axis IV) is now a well-known fact, notably when substance abuse disorders are encountered on axis I. This leads to the conclusion that personality disorders increase the risk of substance abuse, that substance abuse increases the risk of homelessness, that dual diagnosis has a high impact on homelessness and underlines interactions between personality disorders (PD), drug abuse (DA) and homelessness. The aim of this paper is also to study these interactions. METHOD: We will process the classical epidemiological measures, which have already produced interesting findings on other substance-linked disorders. We will study the multiplicative interaction (I(AB)) and the etiological fraction (EFi) linked to interaction, which evaluate the effects of two factors on another. According to the authors, the I(AB) determines whether the co-occurrence of two risk factors in a group induces more cases than each factor acting together; also if the I(AB) is greater than 1 it is possible to estimate the EFi, that proportionally measures the number of cases of the third factor that can be attributed to the co-occurrence. We will also study the interactions of homelessness and PD on DA, of the PD and DA on homelessness, and of this association DA and homelessness on PD. The data we will use in the paper deal with the prevalence of PD in general, drug users (n=226), homeless (n=999) and homeless drug abusers (n=212). The two last data are extracted from the same population and have been collected through clinical interviews, and the diagnosis follows the DSM criteria. They are comparable to Kokkevi et al.'s sample regarding the drug (heroin), the mean age (28 years for Kokkevi et al., 27 years in our sample), and the geographic origin of the populations (Mediterranean basin). RESULTS: The repartition of PD differs significantly (0.001) in the homeless population and the homeless drug abusers (chi(2)=70.5, df=20). Therefore, the intensity of this link is low (rphi=0.30), which is a consequence of the high prevalence of PD in the homeless population (80% versus 10% in general population). On the other hand, the reparation of PD in the homeless drug abusers sample and Kokkevi et al.'s drug abusers is different at 0.001 (chi(2)=92.64, df=20). The link is high (rphi=0.45) and could be interpreted as a supplementary effect of PD's linked to homelessness and in the PD linked to DA, thus motivating further exploration of the interactions. The comorbidity DA/PD multiplies by 7 the risk of homelessness and explains 46% of the cases of homelessness of our sample (n=212). According to table 4, the association PD/homelessness multiplies by 13 the risk of DA and explains three-quarter of the cases of DA in the personality-disordered homeless people. Moreover, PD appear as basic in the etiopathology of such a morbid constellation since the frequency of their observation is independent of the association homelessness/DA. These findings rejoin the outcomes of similar studies on other addictions. DISCUSSION: It could be objected that our sample of homeless men presents a high prevalence (20%) of DA; therefore agreeing with epidemiological works on the homeless population. The results could be discussed regarding other outcomes in drug abuser populations, in which a higher prevalence of PD has been found. Hence, the main results concerning interactions would not change and would have still led to the conclusion that PD are not influenced by the association homelessness/DA. This does not mean that neither homelessness nor DA have an impact on PD. Indeed, some authors have shown that there are variations in drug users' PD or in the neuropsychological effects of drugs. According to this and to the theory of a central role of PD in substance abuse, PD could influence drug use and be increased by the abuse. This hypothesis should be tested in another study. CONCLUSION: Clinically, the association between DA and PD in homeless populations is a major concern regarding the future of these persons. This paper leads to the conclusion that the association PD/homelessness is a risk factor for DA, as is the dual diagnosis PD/DA for homelessness. In other words, in the case of PD, the DA increases the risk of homelessness, which is a risk factor for DA. Lastly, these findings confirm the interest of therapeutic approaches focused on PD.