Broader Issues in Test Translation and Validation: A Commentary Inspired by Macina et al. (2023).

Macina et al. (2023) recently reported mixed results on the German translation of the Self and Interpersonal Functioning Scale (SIFS). By focusing on suboptimal indices of structural validity, they recommended choosing other available instruments over the SIFS in future research on personality impairment. Reflecting on Macina et al.'s overall conclusions inspired us to consider broader issues in the field of personality impairment assessment. In this commentary, we discuss some issues regarding test translation and validity raised by Macina et al.'s article. We advise against assuming equivalence between original and translated versions of a test and discuss some caveats regarding comparison between different instruments based on structural validity. We also call into question whether the latter should be the litmus test for judging the quality of a measure. Finally, we discuss how the proliferation of personality impairment measures can benefit the broader field. Notably, this would allow moving toward a "what works for whom" approach that considers the match between psychometric property, desired use of the instrument, and characteristics of the target population.

Time to put aside the false dichotomy between personality disorders and psychotic symptoms.

Unlike internalizing and externalizing symptoms, psychotic symptoms (e.g., hallucinations, delusions) are manifestations of personality disorders (PDs) that are more controversial and poorly understood. This leaves clinicians with very little guidance for clinical practice, especially for diagnosis. What is more, most reviews have focused strictly on the links between psychotic symptoms and the categorically defined borderline PD, which contrasts with the growing movement that emphasizes a dimensional perspective (especially in psychology). Thus, the objectives of this critical review will be to (a) expose typical cases where PDs and psychotic symptoms might cooccur; (b) assess the state of scientific knowledge surrounding PD and psychotic symptoms; and (c) provide clinicians and researchers with recommendations to keep the field moving forward. We conclude that researchers and clinicians should move past the false "PD or psychosis" dichotomy since they often cooccur, avoid (as far as possible) making psychotic symptoms an exclusion criterion in PD research to enhance ecological validity, and consider dimensional PD diagnosis as a potential unifying solution to the dilemma posed by this cooccurrence.

Revisiting the vulnerable dark triad hypothesis using a bifactor model.

Miller et al. (2010) previously suggested that borderline pathology, vulnerable narcissism, and Factor 2 psychopathy share a common "Vulnerable Dark Triad" (VDT) core. The present study (N = 1,023 community participants) aims to test that hypothesis using exploratory and confirmatory bifactor analyses. We found support for a bifactor model that obtained satisfactory fits and other adequate validity indices, which included a general VDT factor and three group factors (Reckless, Entitled, Hiding). The general VDT factor was mostly saturated with borderline symptoms items reflecting self-hatred and worthlessness, which did not form a group factor; these results add to previous research suggesting that features of borderline pathology may represent the core of personality pathology. The three group factors had distinctive relationships with Dark Triad traits, pathological trait domains, and aggression. In contrast with the three group factors, the general VDT factor more strongly incremented the prediction of negative affectivity and hostility; the group factors more strongly incremented the prediction of grandiosity, egocentrism, callousness, Machiavellianism, and direct (physical/verbal) aggression. Alignment of the retained bifactor model with influent models of personality pathology and conceptual/methodological implications of the present results for research on the hypothesized VDT are discussed, as well as some clinical implications of the findings.

An Appraisal of Narcissistic Rage Through Path Modeling.

Pathological narcissism and borderline traits have been consistently associated with interpersonal aggression. Shame has been identified as an important trigger of aggressive behaviors in individuals with pathological personality traits, especially for narcissistic vulnerability and borderline traits. This is in line with Kohut's theory on narcissistic rage, that is, aggression, anger, and destruction that act as a protection for a grandiose self. The present study aims to investigate the interrelations between pathological narcissism, borderline traits, shame, and trait aggression, concepts that are parts of the narcissistic rage phenomenon introduced by Kohut, using path models. A total of 399 participants completed self-report questionnaires assessing personality traits (narcissistic grandiosity and vulnerability, and borderline traits), shame, and aggression. Three path models including these variables were tested and compared to one another on fit indices. Results show that shame acts as a mediator between pathological traits (narcissistic vulnerability and borderline traits) and trait aggression, whereas the relationship between narcissistic grandiosity and aggression was direct (i.e., shame was not involved). Results expand the narcissistic rage theory by suggesting that it might represent an internalizing type of aggression that manifests in the context of narcissistic vulnerability and borderline traits, which is not the case for narcissistic grandiosity that exerts a direct effect on trait aggression.

Stalking perpetration through the lens of the alternative DSM-5 model for personality disorders.

Emerging dimensional models of personality disorders such as the Alternative DSM-5 Model for Personality Disorders (AMPD) provide new opportunities to explore the associations between personality pathology and harmful interpersonal behaviours such as stalking perpetration. Two goals are pursued by this study: (a) To document associations between stalking, level of personality pathology, and pathological personality domains/facets; and (b) to determine the relative importance of maladaptive personality facets in the statistical prediction of stalking. Data from 1489 young adults (18-30 years old) from a community sample were analysed. Moderate positive significant correlations were found between stalking, level of personality pathology, and maladaptive personality domains. A clear gradient of severity of stalking behaviours was found across five severity degrees of personality pathology. Dominance analyses revealed that Deceitfulness was the most dominant statistical predictor in women. Unusual Beliefs and Experiences, a facet from the Psychoticism domain, made an important contribution in the prediction of stalking in men only. Impulsivity was a key predictor in both genders but more markedly in men. Results suggest that the AMPD represents a useful framework to study stalking perpetration. Identification of key personality predictors might prove relevant for identifying risk factors, underlying motives, and treatment targets for stalking perpetrators.

Profiles of theory of mind impairments and personality in clinical and community samples: integrating the alternative DSM-5 model for personality disorders.

Introduction: Deficits in theory of mind (ToM)-the ability to infer the mental states of others-have been linked to antagonistic traits in community samples. ToM deficits have also been identified in people with personality disorders (PD), although with conflicting evidence, partly due to the use of categorical diagnoses. The DSM-5 Alternative Model for Personality Disorders (AMPD) provides an opportunity for a more precise understanding of the interplay between ToM abilities and personality pathology. Therefore, the study aims to determine whether and how individuals with diverse ToM profiles differ regarding personality impairment (AMPD Criterion A) and pathological facets (AMPD Criterion B). Method: Adults with PD (n = 39) and from the community (n = 42) completed tests assessing ToM skills and self-reported questionnaires assessing AMPD Criteria A and B. Hierarchical agglomerative and TwoStep cluster analyses were consecutively computed using scores and subscores from ToM tests as clustering variables. Multivariate analyses of variance were subsequently performed to compare the clusters on both AMPD Criteria. Five clinically and conceptually meaningful clusters were found. The most notable differences across clusters were observed for Intimacy and Empathy dysfunctions (Criterion A), as well as for the Deceitfulness, Callousness, and Hostility facets from the Antagonism domain and the Restricted affectivity facet from the Detachment domain (Criterion B). Discussion: The results support the association between antagonistic personality facets and ToM deficits. However, clusters showing impairments in ToM abilities did not necessarily exhibit high levels of personality dysfunction or pathological facets, emphasizing that both constructs are not isomorphic. Nevertheless, specific profiles can help refine existing interventions to make them more sensitive and specific to the nature of ToM dysfunctions while considering personality functioning and facets.

Contribution of the alternative model for DSM-5 personality disorders to relationship satisfaction.

Introduction: Personality is a central factor associated with relationship discord, conflicts, and separation, as well as with dyadic adjustment and relationship stability. The Alternative Model for Personality Disorders (AMPD) of the DSM-5 offers a hybrid model for understanding personality based on personality dysfunction (Criterion A) and pathological domains and facets (Criterion B). So far, few studies have integrated this model into the understanding of relationship quality. Therefore, the aim of this study was to examine the contribution of Criterion B to relationship satisfaction in individuals involved in an intimate relationship. We also explored the joint contribution of Criteria A and B, as well as their interaction effects, to relationship satisfaction. Methods: Participants were drawn from two clinical samples: patients with personality disorders (PD; N = 101) and clients consulting in private practice clinics (PPC; N = 350). They completed self-report questionnaires assessing relationship satisfaction and AMPD Criteria A (only for PPC sample) and B. Results: Hierarchical regressions showed that, for the PD sample, the Detachment and Negative Affectivity domains, especially the pathological facets of Intimacy Avoidance and Separation Insecurity, explained 22.5% of relationship satisfaction's variance. For PPC clients, Detachment, Negative Affectivity, and Antagonism domains, and especially the pathological facets of Intimacy Avoidance, Anxiousness, and Grandiosity, contribute significantly to relationship satisfaction, explaining 14.8% of its variance. Criterion A elements did not evince incremental value to the regression models in the PPC sample, and no Criteria A and B interaction effects were found. Clinical implications as well as limitations of the study are discussed.

Associations between the Personality Inventory for DSM-5 trait facets and aggression among outpatients with personality disorder: A multimethod study.

BACKGROUND: Most research on the Personality Inventory for DSM-5 (PID-5) was conducted with self-reports. One of the specific areas for which a multimethod design has yet to be implemented is for the PID-5's associations with aggression. The main objectives of this study were to (a) compare the PID-5 associations with self-reported and file-rated aggression, (b) compare these associations between women and men, and (c) identify the relative importance of PID-5 facet predictors. METHODS: A sample of outpatients with personality disorder (N = 285) was recruited in a specialized public clinic to complete questionnaires, and a subsample was assessed for file-rated aggression (n = 227). Multiple regression analyses were performed with PID-5 facets as statistical predictors but using distinct operationalizations of aggression (self-reported vs. file-rated). Moderation analyses were performed to identify the moderating effect of biological sex. Dominance analyses were computed to identify the relative importance of predictors. RESULTS: PID-5 facet predictors of self-reported and file-rated aggression were very consistent in both conditions. However, the amount of explained variance was reduced in the latter case (from 39% to 14%), especially for women (from 40% to 2%). The most important predictors were Hostility, Risk Taking, and Callousness. CONCLUSION: Pertaining to the statistically significant facets associated with aggression, strong evidence of multimethod replication was found. The women-men discrepancies were not most obvious in their specific associations with aggression, but rather in their amount of explained variance, maybe reflecting examiners' or patients' implicit biases, and/or different manifestations of aggression between women and men.

Do we over-diagnose ADHD in North America? A critical review and clinical recommendations.

There has been a marked increase in the prevalence of attention-deficit/hyperactivity disorder (ADHD) in the last 25 years in North America. Some see this trend as positive and believe that it reflects a better identification of ADHD and even think that the disorder is still under-diagnosed. Others, however, contend that ADHD is over-diagnosed. To help mental health clinicians to maintain an informed and nuanced perspective on this debate, this critical review aims to (1) summarize empirical results on factors that might contribute to increase the number of ADHD diagnoses and (2) propose clinical recommendations coherent with these findings to improve clinical practices for ADHD assessment and treatment. We conclude that artifactual factors such as current formulation of diagnostic criteria, clinical practices, and inordinate focus on performance, which is rampant in North America, likely contribute to inflated prevalence rates.

A Scoring Procedure for Malignant Narcissism Based on Personality Inventory for DSM-5 Facets.

The current study focuses on the development and validation of a scoring procedure for malignant narcissism using the Personality Inventory for DSM-5, a self-report measure of Criterion B from the Alternative Model for Personality Disorders. In Study 1, a prototype matching approach was used to aggregate ratings from 15 clinicians specializing in personality disorder treatment and/or assessment. Indices of inter-rater agreement and inter-rater reliability revealed high convergence as to the most important maladaptive facets for malignant narcissism. The scoring procedure, based on additive counts for score computation, included eleven Criterion B facets covering core features of malignant narcissism. Study 2 evaluated the criterion and incremental validity of the scoring procedure in a sample of 288 patients from a personality disorder treatment clinic, as well as in a sample of 1103 participants from the community. In both samples, results from nonparametric mean comparisons, receiver operating characteristic curves, bivariate Pearson correlations, and hierarchical multiple linear regressions showed significant associations between malignant narcissism and broader components of personality functioning, as well as with relevant emotional, relational, and/or behavioral features. This new scoring procedure is a simple and valid method for measuring malignant narcissism, and is suitable for clinical and research settings.

Preliminary Steps Toward Extracting the Specific Alternative Model for Personality Disorders Diagnoses From Criteria A and B Self-Reports.

The Alternative DSM-5 Model for Personality Disorders (AMPD) retains six specific personality disorders (PDs) that can be diagnosed based on Criterion A level of impairment and Criterion B maladaptive facets. Those specific diagnoses are still underresearched, despite the preference expressed by most PD scholars for a mixed/hybrid classification. This study explores the possibility of using Criterion A and B self-report questionnaires to extract the specific AMPD diagnoses. Plausible prevalence estimates were found in three samples (outpatient PD, private practice, community; N = 766) using the facet score ≥ 2 and t score > 65 methods for determining the presence of a Criterion B facet; diagnoses had meaningful correlations with external variables. This study provides evidence-albeit preliminary-that the extraction of the specific AMPD PDs from self-report questionnaires might be a viable avenue. Ultimately, it could promote the use and dissemination of those diagnoses for screening purposes in clinical and research settings.

A French adaptation of the Affective and Cognitive Measure of Empathy (ACME-F).

Vachon and Lynam (2016) recently introduced a new measure of empathy, the Affective and Cognitive Measure of Empathy (ACME). Besides assessing the traditional dimensions of cognitive and affective empathy, the ACME includes an affective dissonance scale that covers "antiempathy," an important feature of the construct with prominent predictive value not included in other empathy measures. The aim of this study is to provide data on the French version of the ACME. A sample of 851 community-dwelling participants (59.4% female) completed online the ACME questionnaire along with other measures of empathy, dark and pathological personality traits, and aggression. The original ACME bifactor exploratory structural equation modeling structure (i.e., the three empathy dimensions of Cognitive, Affective Resonance, and Affective Dissonance with positive and negative wording items as method bifactors) was successfully reproduced with the French version. Furthermore, these scales displayed satisfying internal consistency coefficients, as well as good item properties according to Classical Test Theory. Convergent validity indices were also similar to those reported for the original English version, and scale scores reached full invariance across gender and proved to be partially invariant across language when comparing the present data to those from the original validation study. The French version of the ACME is well aligned with the original English version and offers a valuable alternative to French researchers and clinicians interested in measuring the various dimensions of empathy. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Analysis of the interaction between personality dysfunction and traits in the statistical prediction of physical aggression: Results from outpatient and community samples.

The Alternative Model for Personality Disorders (AMPD), included in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) and the World Health Organization's International Classification of Diseases (11th ed.; ICD-11) are, respectively, hybrid categorical-dimensional and dimensional frameworks for personality disorders (PDs). Both models emphasize personality dysfunction and personality traits. Previous studies investigating the links between the AMPD and ICD-11, and self-reported physical aggression have mostly focused on traits and did not take into account the potential interaction between personality dysfunction and traits. Thus, the aim of this study is to identify dysfunction*trait interactions using regression-based analysis. Outpatients with personality disorder from a specialized public clinic (N = 285) and community participants (N = 995) were recruited to complete self-report questionnaires. Some small-size, albeit significant and clinically/conceptually meaningful personality dysfunction*trait interactions were found to predict physical aggression in both samples. Interaction analyses might further inform, to some degree, about the current discussion pertaining to the potential redundancy between dysfunction and traits, the optimal personality dysfunction structure (in the case of the AMPD), as well as clinical assessment based on AMPD/ICD-11 PD frameworks.

Impact of level of personality pathology on affective, behavioral, and thought problems in pregnant women during the coronavirus disease 2019 pandemic.

Among at-risk groups for psychological distress in the context of the Coronavirus Disease 2019 (COVID-19) pandemic, pregnant women might be especially vulnerable. Identifying subgroups of pregnant women at high risk of poor adaptation might optimize clinical screening and intervention, which could, in turn, contribute to mitigating the potentially devastating effects of prenatal stress on mothers and fetus. Level of personality functioning may be a good indicator of who may be more vulnerable to distress in challenging periods like the COVID-19 pandemic, as adults with high levels of personality dysfunction may experience significant difficulties in mentalizing threatening situations. The aims of the present study are (a) to determine the impact of level of personality pathology on affective, behavioral, and thought problems in pregnant women during the COVID-19 pandemic; and (b) to test a model where mentalization of trauma mediates the impact of personality pathology on symptomatology. Data from 1,207 French-Canadian pregnant women recruited through social media during the COVID-19 pandemic were analyzed. Latent profile analysis, using the Criterion A elements of the alternative model for personality disorders (Identity, Self-Direction, Empathy, Intimacy) as latent indicators, yielded four profiles: Healthy, Mild Self-Impairment, Intimacy Impairment, and Personality Disorder. Profiles showed significant associations with diverse indicators of symptomatology. Mediation models showed both direct and indirect (through mentalization of trauma) significant associations between level of personality functioning and affective/behavioral/thought problems. Results have clinical implications on prophylactic measures for at-risk pregnant women, especially in challenging contexts such as the COVID-19 pandemic. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Development and Validation of the Stalking and Obsessive Relational Intrusions Questionnaire (SORI-Q).

Stalking and obsessive relational intrusions both refer to a pervasive and unwanted pattern of pursuit behaviors, the former being a criminal offense evoking fear and a sense of menace in the victim, while the latter may be perceived as annoying or otherwise undesirable, but not necessarily fear inducing. While the individual and societal costs of stalking and obsessive relational intrusion are increasingly recognized, research regarding these behaviors and their consequences has been limited by measurement issues, as most studies have relied on questionnaires and checklists based on very limited validation data. The goal of the present study is to report on the development and validation of the Stalking and Obsessive Relational Intrusions Questionnaire (SORI-Q), a 28-item self-report questionnaire designed to probe for perpetration of stalking-like behaviors. Young adults (age 18-30 years) from a community sample (N = 1,804; 82.6% women) were recruited online. They completed the SORI-Q, along with measures of dark personality traits, insecure attachment dimensions, and intimate partner violence. Overall, the SORI-Q displayed sound psychometric properties. Exploratory and Confirmatory Factor Analysis yielded a two-factor solution (Hyper-intimacy and Domineering control) with adequate to good fit indices. The total scale and the two factor scores showed high internal consistency (above 0.70 for all indices). A number of gender differences were observed at total-, factor-, and item-level, the most outstanding being that women had a higher score on the total SORI-Q score, and on the Domineering control factor and most of its items. The questionnaire showed conceptually meaningful positive correlations with dark personality traits, attachment anxiety, and intimate partner violence. Dominance analysis revealed that attachment anxiety and Machiavellianism were the strongest statistical predictors of SORI-Q scores. The SORI-Q should be seen as a promising new measure of stalking-like and ORI behaviors in young adults from community settings.

[Validation of a screening procedure for borderline personality disorder based on the Alternative DSM-5 Model for Personality Disorders]. / Validation d'une procédure de dépistage du trouble de personnalité limite selon le Modèle alternatif pour les troubles de la personnalité du DSM-5.

Objectives The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes an Alternative Model for Personality Disorders (DSM-5), which defines personality disorders based on two dimensional criteria. Criterion A corresponds to the severity of personality dysfunction in the areas of self and interpersonal functioning, while Criterion B comprises five pathological domains including a total of 25 facets. Six specific disorders, including borderline personality disorder (BPD), are defined in the AMPD based on Criteria A and B. However, there is currently very little data on these diagnoses as they are operationalized in the MATP. This study aims to present data on this recent operationalization of BPD. More specifically, we will first introduce a procedure, based on self-reported questionnaires covering the two main MATP criteria, implemented to generate the BPD diagnosis from the AMPD. Then, we will assess its validity (a) by documenting its prevalence in a clinical sample; (b) by determining its degree of correspondence with the "traditional" BPD categorical diagnosis and with a dimensional measure of borderline symptomatology; (c) by presenting convergent validity data with constructs relevant to the study of BPD (impulsivity, aggression); and (d) by determining the incremental validity of the proposed procedure in contrast with a simplified approach where only Criterion B would be considered. Method Data from 287 patients recruited as part of the admission process at the Centre de traitement le Faubourg Saint-Jean of the CIUSSS-Capitale-Nationale were analyzed. The BPD diagnosis from the MATP was generated based on two validated self-report questionnaires, in their French version, namely the Self and Interpersonal Functioning Scale (Criterion A) and the Personality Inventory for DSM-5-Faceted Brief Form (Criterion B). Results The BPD diagnosis, as operationalized in the AMPD, had a prevalence of 39.7% in the sample. A moderate fit with the clinician's diagnosis of BPD according to the traditional DSM-5 categorical model was observed, as well as a strong correlation with a dimensional measure of borderline symptomatology. Nomological network analysis revealed high and theoretically expected correlations between the disorder and measures of aggression and impulsivity. The proposed diagnostic extraction procedure, which uses Criteria A and B, showed incremental validity in the statistical prediction of external variables (borderline symptomatology, aggression, impulsivity) compared to a simplified procedure using only Criterion B. Conclusions The proposed procedure for generating the BPD diagnosis according to the MATP definition yields promising results and could allow screening for the disorder based on this contemporary conceptualization of personality pathologies.

[Perpetrators and victims of intimate partner violence: Personological profiles of people with borderline personality disorder]. / Violence conjugale commise et subie : profils personnologiques de personnes avec un trouble de personnalité limite.

Objective Personality disorders and intimate partner violence (IPV) are two problems recognized as major public health issues associated with serious individual and societal repercussions. Several studies have documented the links between borderline personality disorder (BPD) and IPV; however, we know very little about the specific pathological traits contributing to IPV. The study aims to document the phenomenon of IPV committed and suffered in persons with BPD and to draw profiles from the personality facets of the DSM-5 Alternative Model for Personality Disorders (AMPD). Method One hundred and eight BPD participants (83.3% female; Mage = 32.39, SD = 9.00) referred to a day hospital program following a crisis episode completed a battery of questionnaires including the French versions of the Revised Conflict Tactics Scales, evaluating physical and psychological IPV committed and suffered, and the Personality Inventory for the DSM-5- Faceted Brief Form, evaluating 25 pathological facets of personality. Results Among the participants, 78.7% report having committed psychological IPV, while 68.5% have been victims, which is more than the estimates published by the World Health Organization (27%). In addition, 31.5% would have committed physical IPV, while 22.2% would have been victims. IPV appears to be bidirectional since 85.9% of participants who are perpetrators of psychological IPV also report suffering from it and 52.9% of participants who are perpetrators of physical IPV report being also victims. Nonparametric group comparisons indicate that Hostility, Suspiciousness, Duplicity, Risk-Taking, and Irresponsibility facets distinguish physically and psychologically violent participants from nonviolent participants. High results on Hostility, Callousness, Manipulation, and Risk-taking facets characterize participants who are victims of psychological IPV, while an elevation in Hostility, Withdrawal, Avoidance of intimacy, and Risk-taking facets and a low result on the Submission facet distinguish participants who are victims of physical IPV from non-victims. Regression analyzes show that the Hostility facet alone explains a significant variance in the results of IPV perpetrated, while the Irresponsibility facet contributes substantially to the variance of the results of IPV experienced. Conclusion Results show the high prevalence of IPV in a sample of persons with BPD, as well as its bidirectional nature. Beyond the diagnosis of BPD, certain specific facets of the personality (including Hostility and Irresponsability) make it possible to target persons at greater risk of committing and suffering from psychological and physical IPV.

[Shame Proneness in Borderline Personality Disorder: Critical Reflection Based on Data from the Province of Quebec]. / La propension à la honte dans le trouble de personnalité limite : réflexion critique à partir de données québécoises.

Objectives Shame is a painful feeling that one feels when under the impression of having committed an offence or contravened to a personal or moral standard. Shame experiences are often intense and entail a global, negative self-evaluation; persons then feel like they are bad, weak, worthless, or deserving others' contempt. Some people are more prone to shame feelings. Although shame is not listed as a diagnostic criterion of borderline personality disorder (BPD) in the DSM-5, studies suggest that shame is an important feature in individuals with BPD. The aim of this study is to garner additional data to document shame proneness in individuals presenting with borderline symptomatology in the population from the Province of Quebec. Method Overall, 646 community adults from the Province of Quebec completed online the brief version of the Borderline Symptom List (BSL-23), measuring the severity of symptoms associated with BPD from a dimensional perspective, and to the Experience of Shame Scale (ESS), measuring shame proneness in various areas of a person's life. Participants were then compared on their shame scores after they were assigned to one of the four groups based on Kleindienst et al. (2020) classification of severity of borderline symptoms: (a) none or low symptoms (n = 173), (b) mild symptoms (n = 316), (c) moderate symptoms (n = 103), or (d) high, very high or extremely high symptoms (n = 54). Results Between-group differences were found with large effect sizes in all shame areas measured by the ESS, suggesting that shame feelings tend to be greater in persons presenting more borderline traits. Conclusion Results are discussed in a clinical perspective of BPD, emphasizing the importance of having shame as a clinical target in psychotherapy with these clients. Furthermore, our results raise conceptual questions regarding how to integrate shame in the assessment and treatment of BPD.

[Psychotherapy prognostic factors for personality disorders (PD) treatment: The role of self-reported questionnaires]. / Facteurs pronostiques à la psychothérapie chez les troubles de la personnalité : implication de questionnaires autorapportés.

Objectives Dropout rates in psychotherapy are known to be high in patients with personality disorders (PD; ranging from 25% and 64% for Borderline PD). Faced with this observation, the Treatment Attrition-Retention Scale for Personality Disorders (TARS-PD; Gamache et coll., 2017) was developed to precisely identify patients with PD at high risk of abandoning therapy based on 15 criteria, regrouped in 5 factors: Pathological Narcissism, Antisocial/Psychopathy, Secondary Gain, Low Motivation, and Cluster A Features. However, we have limited knowledge about the relevance of self-reported questionnaires commonly used with PD patients to establish treatment prognosis. Thus, the purpose of this study is to evaluate the link between such questionnaires and the five factors of the TARS-PD. Method Data was retrospectively retrieved from the clinical files of 174 participants with a PD (including 56% with borderline traits or PD), who were evaluated at the Centre de traitement le Faubourg Saint-Jean and completed the French version of the following questionnaires: Borderline Symptom List (BSL-23), Brief Version of the Pathological Narcissism Inventory (B-PNI), Interpersonal Reactivity Index (IRI), Buss-Perry Aggression Questionnaire (BPAQ), Barratt Impulsiveness Scale (BIS-11), Social Functioning Questionnaire (SFQ), Self and Interpersonal Functioning Scale (SIFS) and Personality Inventory for DSM-5- Faceted Brief Form (PID-5-FBF). The TARS-PD was completed by well-trained psychologists specialized in PD treatment. Descriptive analyses and regression between self-reported questionnaires and the five factors of the TARS-PD as well as its total score were performed to determine which variables from the self-reported questionnaires completed by the individuals contribute most strongly to the statistical prediction of the variables of the TARS-PD rated by the clinicians. Results The subscales that significantly contribute to the Pathological Narcissism factor (adjusted R2=0,12) are: Empathy (SIFS), Impulsivity (negatively; PID-5), and Entitlement Rage (B-PNI). The subscales associated with the Antisociality/Psychopathy factor (adjusted R2=0,24) are Manipulativeness, Submissiveness (negatively), and Callousness from the PID-5, and Empathic Concern (IRI). The scales contributing substantially to the Secondary gains factor (adjusted R2=0,20) are Frequency (SFQ), Anger (negatively; BPAQ), Fantasy (negatively) and Empathic Concern (IRI), Rigid Perfectionism (negatively) and Unusual Beliefs and Experiences (PID-5). Low motivation (adjusted R2=0,10) is significantly explained by Total BSL score (negatively) and Satisfaction (SFQ) subscale. Finally, the subscales significantly associated to Cluster A features (adjusted R2=0,09) are Intimacy (SIFS) and Submissiveness (negatively, PID-5). Conclusion Some scales from self-reported questionnaires demonstrated modest but significant associations with TARS-PD factors. Those scales might be useful in the scoring of the TARS-PD and provide additional information for patients' clinical orientation.

A Proposed Classification of ICD-11 Severity Degrees of Personality Pathology Using the Self and Interpersonal Functioning Scale.

Background: The 11th version of the World Health Organization's International Classification of Diseases (ICD-11) has adopted a dimensional approach to personality disorder (PD) nosology. Notably, it includes an assessment of PD degree of severity, which can be classified according to five categories. To date, there is no gold standard measure for assessing degree of PD severity based on the ICD-11 model, and there are no empirically-based anchor points to delineate the proposed categories. With the operationalization of PD degrees of severity in the ICD-11 PD model now being closely aligned with Criterion A of the DSM-5 Alternative Model for Personality Disorders (AMPD), sharing a focus on self and interpersonal dysfunction, self-report instruments developed for the latter model might prove useful as screening tools to determine degrees of severity in the former. Methods: The Self and Interpersonal Functioning Scale, a brief validated self-report questionnaire originally designed to assess level of personality pathology according to the AMPD framework, was used to derive anchor points to delineate the five severity degrees from the ICD-11 PD model. Data from five clinical and non-clinical samples (total N = 2,240) allowed identifying anchor points for classification, based on Receiver Operating Characteristic curve analysis, Latent Class Analysis, and data distribution statistics. Categories were validated using multiple indices pertaining to externalizing and internalizing symptoms relevant to PD. Results: Analyses yielded the following anchor points for PD degrees of severity: No PD = 0-1.04; Personality Difficulty = 1.05-1.29; Mild PD = 1.30-1.89; Moderate PD = 1.90-2.49; and Severe PD = 2.50 and above. A clear gradient of severity across the five categories was observed in all samples. A high number of significant contrasts among PD categories were also observed on external variables, consistent with the ICD-11 PD degree of severity operationalization. Conclusions: The present study provides potentially useful guidelines to determine severity of personality pathology based on the ICD-11 model. The use of a brief self-report questionnaire as a screening tool for assessing PD degrees of severity should be seen as a time-efficient support for clinical decision and treatment planning.