Identity and Personality Pathology in Adult Forensic Psychiatric Patients and Healthy Controls.

Since the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), identity impairment has become a diagnostic criterion for all personality disorders. The current study examined the occurrence of identity dimensions, clinically relevant identity impairments and personality pathology, and associations between these constructs in 92 forensic patients and 139 healthy controls. Patients showed higher levels of almost all identity dimensions, identity impairments, personality disorders, and almost all maladaptive personality traits than controls. Various identity dimensions were associated with consolidated identity as well as identity impairments in both groups. Both patients and controls with high ruminative exploration and identity malfunctioning showed more personality pathology. Different associations between identity functioning and particularly antisocial and borderline personality disorder showed to be stronger in patients than in controls. Our results highlight the importance of identity impairment as a crucial criterion to assess and treat personality pathology in forensic patients.

Psychopathic traits in the interpersonal context: Is the effect of psychopathic traits on prosocial behavior mediated by peer problems?

Psychopathic traits are often investigated within the individual, while most traits come to expression within the interpersonal context. Low social communion might even be an important overlooked core feature of psychopathy. This raises the question how psychopathic (i.e., Grandiose-Manipulative, Callous-Unemotional, and Irresponsible-Impulsive) traits affect the tendency to show prosocial behavior, and whether peer problems explain this relationship. Besides, the effects of gender on these subrelations are explored. In total, 541 community adolescents and emerging adults (26.4 % men; 16-25 years old, Mage = 21.7, SDage = 2.50) completed questionnaires, measuring psychopathic traits, prosocial behavior, and peer problems. The relationship between psychopathic traits and prosocial behavior was investigated with three separate moderated mediation regression analyses (for Grandiose-Manipulative, Callous-Unemotional, and Impulsive-Irresponsible traits separately) including peer problems as mediator and gender as moderator. Significant direct negative effects of Grandiose-Manipulative and Callous-Unemotional traits on prosocial behavior were found, though not for Impulsive-Irresponsible traits. Peer problems did not mediate this relation and gender was no moderator. The significant moderation effect indicated that only for women a significant direct positive effect of Callous-Unemotional traits on peer problems was found, but not for men nor other psychopathic traits. More gender differences were found with men (vs. women) scoring significantly higher on all three psychopathic traits and lower on prosocial behavior. Implications of psychopathic traits within the interpersonal context are discussed and future research could further investigate how this relationship can be explained, for example by including different types of measures and other potential mediators (e.g., empathy).

Burnout, work engagement and workaholism in a group of Dutch judges: distinctiveness and two-year structural stability.

The aim of this two-wave study is to investigate whether burnout, work engagement and workaholism can be empirically distinguished in one model and whether this model shows structural stability over a period of 2 years (i.e. whether the distinguishability between the constructs holds across time). The study was conducted among 118 judges in the Netherlands who completed questionnaires measuring burnout, work engagement and workaholism. The results showed that these are relatively distinguishable constructs, despite a considerable overlap of professional efficacy loading on work engagement (instead of burnout; as hypothesized), absorption loading on workaholism (in addition to work engagement; as hypothesized) and exhaustion loading on workaholism (in addition to burnout), which represents a new finding. These extra loadings led to model modifications, which were found at both time points. As hypothesized, this model appeared to be stable over time. Nevertheless, further clarification and conceptualization of these constructs are undoubtedly needed.

Personality moderators of the cross-sectional relationship between job demands and both burnout and work engagement in judges: The boosting effects of conscientiousness and introversion.

The central question of this study is whether buffering, boosting and exacerbating effects of the Big Five personality factors extraversion, openness to experience, agreeableness, conscientiousness and neuroticism can be demonstrated in the relationship between two job demands (i.e., work pressure and working overtime) and both burnout and work engagement in 257 Dutch judges. It is important to better understand the interaction effects between various job demands (work pressure and working overtime) and personality on both burnout and work engagement in judges given their increased risk of burnout and lower work engagement due to cognitively and their emotionally demanding work. Three hypotheses were tested in a cross-sectional design study. Moderation analyses showed that, as expected, conscientiousness significantly boosted the relationship between working overtime and work engagement. Hence, high scorers on conscientiousness showed more work engagement when working overtime. Also, extraversion moderated the relation between working overtime and work engagement, but only at a low level of extraversion. Thus, contrary to expectations, introverts showed more work engagement when they work overtime. Also, significant main effects were found. Work pressure and neuroticism related positively to burnout, while extraversion and agreeableness related negatively to burnout. Moreover, extraversion, agreeableness and conscientiousness related positively to work engagement. In our study, conscientiousness, extraversion and agreeableness can be considered as personal resources for judges, in line with the Conservation of Resources (COR) theory. Especially conscientiousness can facilitate judges to cope with challenging working circumstances and introversion ensures that judges stay engaged despite working overtime.

The Tilburg Pregnancy Distress Scale revised (TPDS-R): Psychometric aspects in a longitudinal cohort study.

Pregnant women may be specifically prone to experience pregnancy-specific distress, which has been associated with adverse maternal, pregnancy and child outcomes. Accurately identifying pregnancy-specific distress is thus crucial. The Tilburg Pregnancy Distress Scale (TPDS) - translated into many different languages - was previously developed to measure pregnancy-specific distress, resulting in a 16-item screening scale with a partner involvement dimension (PI) and a negative affect dimension (NA). A critical evaluation of the psychometric properties of the TPDS-NA items and feedback from pregnant women over the last decade has led to the need to revise the TPDS. Therefore, in the current study, we describe the procedure for revision and evaluate the psychometric properties of the revised TPDS (TPDS-R). More specifically, we describe the revision of the TPDS-R-PI (4 items) and the TPDS-R-NA (10 items: five-item pregnancy and five-item childbirth subcomponent). A sample of 1081 pregnant women participating in the Brabant Study completed the TPDS-R at 12, 20 and 28 weeks of pregnancy. An exploratory factor analysis and confirmatory factor analysis, descriptive statistics and repeated measures ANOVA demonstrated good test-retest reliability, concurrent validity, internal consistency, and construct validity of the TPDS-R. The TPDS-R provides a robust screening tool to accurately identify pregnant women at risk of pregnancy-specific distress.

Towards a better understanding of adolescent obsessive-compulsive personality traits and obsessive-compulsive symptoms from growth trajectories of perfectionism.

Although there is increasing attention for the interrelationship between obsessive-compulsive personality disorder (OCPD) and obsessive-compulsive disorder (OCD), their shared characteristics in terms of childhood trait antecedents remain understudied. Perfectionism may be a viable candidate trait antecedent, given its role in the clinical manifestation of both OCPD and OCD in adulthood, and the evidence that perfectionism reflects a dispositional tendency observable from childhood onwards. However, little is known about childhood trajectories of perfectionism with prospective links to later OCPD versus OCD. Using latent growth curve modeling, this study explored the baseline and growth of childhood perfectionism in 485 community and referred children (55.5% girls, 7.17-14.78 years old, Mage = 10.74, SD = 1.50) across three waves. Adolescent OCPD traits and OCD symptoms were measured in Wave 4. An overall decreasing trend of perfectionism from childhood through adolescence appeared, without inter-individual differences in growth. Individual differences in baseline levels of childhood perfectionism were significant, and equally predicting adolescent OCPD and OCD outcomes. At a more specific level, childhood perfectionism predicted most strongly the rigid perfectionism component of OCPD, and the orderliness/cleanliness/perfectionism and obsession domain of OCD. This demonstrates the value of childhood perfectionism for understanding differential outcomes of adolescent OCPD traits and OCD symptoms.

Associations Between Resilience, Psychological Well-Being, Work-Related Stress and Covid-19 Fear in Forensic Healthcare Workers Using a Network Analysis.

Forensic healthcare workers deal with patients with severe psychiatric and behavioral problems that put them at an increased risk of developing work-related stress and burnout. Working with this target group of patients during the Coronavirus disease 2019 (Covid-19) pandemic with far-reaching restrictive measures can negatively affect the psychological well-being of forensic workers. Research suggests that resilience can buffer workplace stress and contribute positively to psychological well-being. However, research on resilience, psychological well-being and work-related stress among forensic healthcare workers is still lacking. Therefore, in this study, we investigated the interrelations between psychological well-being and resilience on the one hand and work-related stress and Covid-19 fear-related symptoms on the other hand. Self-report data were obtained from 318 healthcare workers (73.9% women) working in three Forensic Psychiatric Centers (M age = 44.20, SD = 14.31) and are in direct contact with forensic patients. The data were analyzed using network analysis. Consistent with previous research, the results showed that workplace stress and fear associated with the Covid-19 pandemic can be detrimental to workers' psychological well-being, while resilience can serve as a protective factor against being personally attacked or threatened by patients at the workplace. Last but not least, we identified highly central symptoms, namely tremors due to the fear of the coronavirus and anxiety when other people coughing, which would be the best candidates for future treatment targets. This knowledge can help clinicians optimize interventions to reduce workplace stress and fear due to the pandemic. Future studies should aim to replicate our findings in a larger and more representative sample of forensic healthcare workers.

Trajectories of Dynamic Risk Factors During Forensic Treatment: Growth Trajectory of Clinical Risk Factors in a Sample of Dutch Forensic Patients.

In this study, growth trajectories (from admission until unconditional release) of crime-related dynamic risk factors were investigated in a sample of Dutch forensic patients (N = 317), using latent growth curve modeling. After testing the unconditional model, three predictors were added: first-time offender versus recidivist, age, and treatment duration. Postanalyses were chi-square difference tests, t tests, and analyses of variance (ANOVAs) to assess differences in trajectories. Overall, on scale level, a decrease of risk factors over time was found. The predictors showed no significant slope differences although age and treatment duration differed significantly at some time points. The oldest age group performed worse, especially at later time points. Treatment duration effects were found at the second time point. Our results that forensic patients show a decrease in crime-related risk factors may indicate that treatment is effective. This study also found differences in growth rates, indicating the effect of individual differences.

A latent profile analysis of the Psychopathic Personality Inventory in a representative sample of referred boys.

A long tradition of theoretical and empirical work has described different variants (or subtypes) of psychopathy, in an attempt to delineate similarities and differences among constellations of psychopathic traits. Research in this area has the potential to increase our understanding of the etiology of different psychopathy variants, their associated risk, and protective factors, as well as to inform the development of tailored interventions. Drawing on data from a large, representative sample of referred boys incarcerated in the United States (N = 629; Mage = 15.49 years, SD = 1.23), the current study adopted a person-centered approach to identify variants of incarcerated youth based on scores on the 8 Psychopathic Personality Inventory-Short Form (PPI-SF) subscales. Latent profile analysis results identified 5 variants of youth: a high-psychopathy variant, a variant with moderate psychopathy scores, and 3 variants with distinct elevations on some PPI-SF subscales. Over one third of the participants had substantially high levels of psychopathic traits, and high levels of psychopathy were associated with a severe history of delinquency. Latent profile analysis findings also supported traditional and contemporary perspectives on psychopathy variants according to which different constellations of psychopathic traits are associated with different degrees of delinquent behavior, internalizing symptoms, substance use, and victimization. Finally, it appears that, individually, none of the trait domains assessed by the PPI-SF can explain differences across variants, and that it is the co-occurrence of all of the features that characterizes the most severe form of psychopathy. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Parent-Reported BIS/BAS Scales for Children: Factor Structure and Measurement Invariance Across Age and Gender.

The present study examined the factor structure and measurement invariance of the Behavioral Inhibition System/Behavioral Approach System (BIS/BAS) scales parent-report in children and adolescents (N = 1,444, 58% girls) across age (Group 1, 2-5 years; Group 2, 6-9 years; Group 3, 10-13 years; Group 4, 14-18 years old) and gender. The results consistently underscored a four-factor structure, resembling the original factor structure, with one BIS-factor and three BAS-factors. Multigroup confirmatory factor analysis showed full measurement invariance across gender as well as across Group 1 and 2, and Group 2 and 3. Strong measurement invariance was found across Group 3 and 4, Group 1 and 3, and Group 2 and 4. Configural and metric invariance was found across Group 1 and 4. Hence, mean-level BIS/BAS scores can be compared across gender and age although comparison between preschool children (Group 1) and late secondary school children (Group 4) should be done with caution.

The DSM-5 Trait Measure in a Psychiatric Sample of Late Adolescents and Emerging Adults: Structure, Reliability, and Validity.

The inclusion of a dimensional trait model of personality pathology in DSM-5 creates new opportunities for research on developmental antecedents of personality pathology. The traits of this model can be measured with the Personality Inventory for DSM-5 (PID-5), initially developed for adults, but also demonstrating validity in adolescents. The present study adds to the growing body of literature on the psychometrics of the PID-5, by examining its structure, validity, and reliability in 187 psychiatric-referred late adolescents and emerging adults. PID-5, Big Five Inventory, and Kidscreen self-reports were provided, and 88 non-clinical matched controls completed the PID-5. Results confirm the PID-5's five-factor structure, indicate adequate psychometric properties, and underscore the construct and criterion validity, showing meaningful associations with adaptive traits and quality of life. Results are discussed in terms of the PID-5's applicability in vulnerable populations who are going through important developmental transition phases, such as the step towards early adulthood.

Understanding adolescent personality pathology from growth trajectories of childhood oddity.

Research on developmental trajectories of early maladaptive features for understanding later personality disorders (PDs) is increasingly recognized as an important study area. The course of early odd features is highly relevant in this regard, as only a few researchers have addressed childhood oddity in the context of emerging PDs. Using latent growth modeling, the current study explores growth parameters of odd features in a mixed sample of Flemish community and referred children (N = 485) across three measurement waves with 1-year time intervals. Personality pathology was assessed at a fourth assessment point in adolescence. Beyond a general declining trend in oddity characteristics, the results demonstrated that both an early onset and an increasing trend of oddity-related characteristics over time are independent predictors of adolescent PDs. Childhood oddity tends to be the most manifest precursor for PDs with a core oddity feature (i.e., the schizotypal and borderline PD), but also appears to predict most of the other DSM-5 PDs. Results are discussed from an overarching developmental framework on PDs (Cicchetti, 2014), specifically focusing on the principle of multifinality. From a clinical perspective, the significance of increasing or steady-high childhood oddity trajectories for adolescent PDs highlights the relevance of systematic screening processes across time.

A five-factor model of developmental personality pathology precursors.

There is growing consensus that the dimensional structure of early personality pathology can be organized within a similar framework as in adults (De Clercq, De Fruyt, Van Leeuwen, & Mervielde, 2006; Tromp & Koot, 2008). From this perspective, the Dimensional Personality Symptom Itempool (DIPSI) was recently expanded from a 4- to a 5-dimensional trait structure (Verbeke & De Clercq, 2014), including Disagreeableness, Emotional Instability, Introversion, Compulsivity, and Oddity. This developmental maladaptive trait structure is in need of further research, however, before it can be accepted as a valid framework for describing early manifestations of personality dysfunction. By use of exploratory structural equation modeling (ESEM) analyses, the current study explored the fit of the 5-factor DIPSI framework across 4 different samples (N = 1456), and replicated 5 higher-order factors that demonstrated scalar invariance across age and metric invariance across informants and clinical status. These results underscore the robustness of 5 underlying dimensions of personality pathology at a young age and highlight adequate psychometric properties of the proposed DIPSI measure for describing childhood personality pathology precursors. (PsycINFO Database Record

Exploring the complexity of the childhood trait-psychopathology association: Continuity, pathoplasty, and complication effects.

Four different models have been generally proposed as plausible etiological explanations for the relation between personality and psychopathology, namely, the vulnerability, complication, pathoplasty, and spectrum or continuity model. The current study entails a joint investigation of the continuity, pathoplasty, and complication models to explain the nature of the associations between early maladaptive traits and psychopathology over time in 717 referred and community children (54.4% girls), aged from 8 to 14 years. Across a 2-year time span, maladaptive traits and psychopathology were measured at three different time points, thereby relying on comprehensive and age-specific dimensional operationalizations of both personality symptoms and psychopathology. The results demonstrate overall compelling evidence for the continuity model, finding more focused support for pathoplasty and complication effects for particular combinations of personality symptoms and psychopathology dimensions. As expected, the continuity associations were found to be more robust for those personality-psychopathology associations that are conceptually closer, such as the emotional instability/introversion-internalizing problems association and the disagreeableness-externalizing problems association. Continuity associations were also stronger when personality was considered from a maladaptive rather than from a general trait perspective. The implication of the findings for the treatment of psychopathology and personality symptoms are briefly discussed.

Obsessive-compulsive symptoms in children and adolescents: symptomatology, impairment and quality of life.

Although the "presence of obsessive-compulsive (OC) symptoms" and "OC-related impairment" are the main criteria to diagnose obsessive-compulsive disorder, the significance of symptomatology versus impairment in explaining quality of life remains unclear. The present study relies on two samples including 462 children (8-11 years old) and 265 children and adolescents (10-17 years old) and explores how self-ratings of specific OC symptoms and OC impairment are associated with father ratings of childhood quality of life. Hierarchical regression analysis was used to investigate the additive effect of OC impairment beyond OC symptomatology (and vice versa) in predicting quality of life. The results demonstrated that specific OC symptoms and OC impairment are differentially related to quality of life, underscoring the additive value of OC impairment beyond OC symptomatology, whereas the reverse was not the case. This finding highlights the importance of measuring impairment besides symptomatology to identify those OC features in childhood that are most significantly related to decreased quality of life.

The continuity between DSM-5 obsessive-compulsive personality disorder traits and obsessive-compulsive symptoms in adolescence: an item response theory study.

OBJECTIVE: Various studies have shown that obsessive-compulsive symptoms exist as part of not only obsessive-compulsive disorder (OCD) but also obsessive-compulsive personality disorder (OCPD). Despite these shared characteristics, there is an ongoing debate on the inclusion of OCPD into the recently developed DSM-5 obsessive-compulsive and related disorders (OCRDs) category. The current study aims to clarify whether this inclusion can be justified from an item response theory approach. METHOD: The validity of the continuity model for understanding the association between OCD and OCPD was explored in 787 Dutch community and referred adolescents (70% female, 12-20 years old, mean = 16.16, SD = 1.40) studied between July 2011 and January 2013, relying on item response theory (IRT) analyses of self-reported OCD symptoms (Youth Obsessive-Compulsive Symptoms Scale [YOCSS]) and OCPD traits (Personality Inventory for DSM-5 [PID-5]). RESULTS: The results support the continuity hypothesis, indicating that both OCD and OCPD can be represented along a single underlying spectrum. OCD, and especially the obsessive symptom domain, can be considered as the extreme end of OCPD traits. CONCLUSIONS: The current study empirically supports the classification of OCD and OCPD along a single dimension. This integrative perspective in OC-related pathology addresses the dimensional nature of traits and psychopathology and may improve the transparency and validity of assessment procedures.

A general and maladaptive personality perspective on youth obsessive-compulsive symptoms.

Based on Krueger's (2005) conceptual model of the personality-psychopathology relationship, this study examines how personality predicts different youth obsessive-compulsive symptoms, comparing the relative contribution of general and maladaptive personality traits. Three-hundred forty-four adolescents provided self-reports on an obsessive-compulsive scale, and their mothers rated their child's general and maladaptive personality. Hierarchical regression analyses revealed that personality differentially predicts obsessive-compulsive symptomatology, and that the relative significance of general versus maladaptive personality predictors differs across various forms of obsessive-compulsive pathology. The results are discussed in terms of the value of including both general and maladaptive personality measures in the assessment of early obsessive-compulsive difficulties.

Callous-Unemotional traits in youth from a DSM-5 trait perspective.

The current study investigated how the Callous-Unemotional (CU) trait specifier is empirically associated with the proposed trait system for personality pathology in DSM-5, and addressed the use of multiple raters in the assessment of CU traits and additional maladaptive traits in an adolescent community sample. Both mothers and adolescents (N = 197) participated in the present study. Results showed that CU traits are located in different parts of the personality space, and are significantly associated with four broad maladaptive trait dimensions, Negative Affect, Detachment, Antagonism, and Disinhibition. Despite moderate agreement between raters, self- and maternal-rated CU traits were related in a congruent manner with PID-5 traits, and adolescents provided incremental information in CU trait assessment above maternal ratings. The present results have clear implications for the conceptualization of CU traits within the overarching model of personality pathology, proposed in DSM-5, and partially supported the application of a multi-informant approach in CU trait assessment.