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.

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.

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.

Social Contagion of Vasovagal Symptoms in Blood Donors: Interactions With Empathy.

BACKGROUND: Vasovagal reactions (VVRs) are commonly experienced in medical situations such as blood donation. Many believe that psychosocial contagion can contribute to the development of VVRs, but this is largely clinical lore. PURPOSE: The goal of the present investigation was to examine the physiological effects of observing another experience a reaction, focusing on the potential moderating effects of empathy. METHODS: This study was part of a randomized controlled trial of behavioral techniques on the prevention of VVRs in blood donors. The sample was composed of 530 healthy university students. Measures of symptoms were obtained with the Blood Donation Reactions Inventory (BDRI) and through observation. Physiological variables were measured using respiratory capnometry and a digital blood pressure monitor. The Affective and Cognitive Measure of Empathy was administered to 230 participants. RESULTS: Donors who witnessed another experiencing a reaction were more likely to spontaneously report symptoms during the blood draw, to be treated for a reaction, to score higher on the BDRI, and to exhibit smaller compensatory heart rate increases. Donors with higher affective empathy reported more symptoms, exhibited hyperventilation, and were more likely to be treated. Donors with higher cognitive empathy were less likely to require treatment if they witnessed a reaction. CONCLUSION: These results suggest that psychosocial contagion of physical symptoms can occur. The moderating effects of empathy differed depending on the subtype of empathy. Perhaps a better cognitive understanding of how other people are feeling functions as a coping response, whereas feeling sympathetic about others' distress increases one's own.

A Comparison of Limited-Information Test Statistics for a Response Style MIRT Model.

An increased use of models for measuring response styles is apparent in recent years with the multidimensional nominal response model (MNRM) as one prominent example. Inclusion of latent constructs representing extreme (ERS) or midpoint response style (MRS) often improves model fit according to information criteria. However, a test of absolute model fit is often not reported even though it could comprise an important piece of validity evidence. Limited information test statistics are candidates for this task, including the full (M2), ordinal (M2*), and mixed (C2) statistics, which differ in whether additional collapsing of univariate or bivariate contingency tables is conducted. Such collapsing makes sense when item categories are ordinal, which may not hold under the MNRM. More generally, limited information test statistics have gone unevaluated under nominal data and non-ordinal latent trait models. We present a simulation study evaluating the performance of M2, M2*, and C2 with the MNRM. Manipulated conditions included sample size, presence and type of response style, and strength of item slopes on substantive and style dimensions. We found that M2 sometimes had inflated Type I error rates, M2* always had little power, and C2 lacked power under some conditions. M2 and C2 may provide complementary and valuable information regarding model fit.

Are Alcohol Trajectories a Useful Way of Identifying At-Risk Youth? A Multiwave Longitudinal-Epidemiologic Study.

OBJECTIVE: Trajectory approaches are a popular way of identifying subgroups of children and adolescents at high risk for developing alcohol use problems. However, mounting evidence challenges the meaning and utility of these putatively discrete alcohol trajectories, which can be analytically derived even in the absence of real subgroups. This study tests the hypothesis that alcohol trajectories may not reflect discrete groups-that the development of alcohol use is continuous rather than categorical. METHOD: A multiwave longitudinal-epidemiologic twin study was conducted using 3,762 twins (1,808 male and 1,954 female) aged 11 to 29 years from the Minnesota Center for Twin and Family Research (MCTFR). The main outcome measures included various assessments of substance use, psychopathology, personality, and cognitive ability. RESULTS: Although multiple trajectories are derived from growth mixture modeling techniques, these trajectories are arrayed in a tiered spectrum of severity, from lower levels of use to higher levels of use. Trajectories show perfect rank-order stability throughout development, monotonic increases in heritability, and perfect rank-order correlations with established correlates of alcohol use, including other substance use behaviors, psychiatric disorders, personality traits, intelligence, and achievement. CONCLUSION: Alcohol trajectories may represent continuous gradations rather than qualitatively distinct subgroups. If so, early detection and interventions for youth based on trajectory subtyping will be less useful than continuous liability assessments. Furthermore, a continuous account of development counters the notion that individuals are predestined to follow one of a few categorically distinct pathways and promotes the opposite idea-that development is mutable, and its continuous terrain can be traversed in many directions.

Fixing the Problem With Empathy: Development and Validation of the Affective and Cognitive Measure of Empathy.

Low empathy is a criterion for most externalizing disorders, and empathy training is a regular component of treatment for aggressive people, from school bullies to sex offenders. However, recent meta-analytic evidence suggests that current measures of empathy explain only 1% of the variance in aggressive behavior. A new assessment of empathy was developed to more fully represent the empathy construct and better predict important outcomes--particularly aggressive behavior and externalizing psychopathology. Across three independent samples (N = 210-708), the 36-item Affective and Cognitive measure of Empathy (ACME) was internally consistent, structurally reliable, and invariant across sex. The ACME bore significant associations to important outcomes, which were incremental relative to other measures of empathy and generalizable across sex. Importantly, the affective scales of the ACME-particularly a new "Affective Dissonance" scale--yielded moderate to strong associations with aggressive behavior and externalizing disorders. The ACME is a short, reliable, and useful measure of empathy.

Assessment of the Harmful Psychiatric and Behavioral Effects of Different Forms of Child Maltreatment.

IMPORTANCE: Several widely held beliefs about child abuse and neglect may be incorrect. It is most commonly assumed that some forms of abuse (eg, physical and sexual abuse) are more harmful than others (eg, emotional abuse and neglect); other assumptions are that each form of abuse has specific consequences and that the effects of abuse differ across sex and race. OBJECTIVE: To determine whether widely held assumptions about child abuse and neglect are valid by testing the hypothesis that different types of child maltreatment (CM) actually have equivalent, broad, and universal effects. DESIGN, SETTING, AND PARTICIPANTS: This observational study assessed 2292 racially and ethnically diverse boys (1254 [54.7%]) and girls (1038 [45.3%]) aged 5 to 13 years (mean [SD] age, 9.0 [2.0] years) who attended a research summer camp program for low-income, school-aged children from July 1, 1986, to August 15, 2012. Of these children, 1193 (52.1%) had a well-documented history of maltreatment. Analysis was conducted from September 25, 2013, to June 1, 2015. MAIN OUTCOMES AND MEASURES: Various forms of internalizing and externalizing personality and psychopathologic traits were assessed using multiple informant ratings on the California Child Q-Set and Teacher Report Form as well as child self-reported depression and peer ratings of aggression and disruptive behavior. RESULTS: Structural analysis showed that different forms of CM have equivalent psychiatric and behavioral effects, ranging from anxiety and depression to rule-breaking and aggression. We also found that nonsexual CM alters 2 broad vulnerability factors, internalizing (ß = 0.185; SE = 0.028; P < .001) and externalizing (ß = 0.283; SE = 0.023; P < .001), that underlie multiple forms of psychiatric and behavioral disturbance. We show that CM has comparable consequences for boys and girls of different races, and our results allowed us to describe a base rate and co-occurrence issue that makes it difficult to identify the unique effects of child sexual abuse. CONCLUSIONS AND RELEVANCE: Our findings challenge widely held beliefs about how child abuse should be recognized and treated-a responsibility that often lies with the physician. Because different types of child abuse have equivalent, broad, and universal effects, effective treatments for maltreatment of any sort are likely to have comprehensive psychological benefits. Population-level prevention and intervention strategies should emphasize emotional abuse, which occurs with high frequency but is less punishable than other types of child maltreatment.

The effects of racial heterogeneity on mental health: A study of detained youth across multiple counties.

A majority of detained adolescents experience mental health and substance use problems. Limited research has examined the interaction between the race/ethnicity of an individual youth and county-level racial heterogeneity on adolescent mental health outcomes. Participants were identified through a statewide mental health screening project that took place in detention centers across 11 different counties in a Midwestern state during January 1, 2008, to May 10, 2010. A total of 23,831 detained youth (ages 11-18 years), identified as non-Hispanic White (46.6%), Black (43.5%), or Hispanic (9.8%), completed a mental health screener that assessed problems in alcohol/drug use, depression-anxiety, anger-irritability, trauma, somatic complaints, and suicide ideation. Census data were gathered to determine the racial heterogeneity of each county and other county-level variables. Hierarchical linear regression analyses were used to test the independent and interactive effects of youth race/ethnicity and county-level variables (including racial heterogeneity of the county) on adolescent mental health. Independent of other community characteristics, as county-level racial heterogeneity increased, mental health problems among detained youth decreased. In future research on the development and persistence of mental health problems in detained youth, both community and individual-level factors should be considered.

The (non)relation between empathy and aggression: surprising results from a meta-analysis.

Assumptions regarding the importance of empathy are pervasive. Given the impact these assumptions have on research, assessment, and treatment, it is imperative to know whether they are valid. Of particular interest is a basic question: Are deficits in empathy associated with aggressive behavior? Previous attempts to review the relation between empathy and aggression yielded inconsistent results and generally included a small number of studies. To clarify these divergent findings, we comprehensively reviewed the relation of empathy to aggression in adults, including community, student, and criminal samples. A mixed effects meta-analysis of published and unpublished studies involving 106 effect sizes revealed that the relation between empathy and aggression was surprisingly weak (r = -.11). This finding was fairly consistent across specific types of aggression, including verbal aggression (r = -.20), physical aggression (r = -.12), and sexual aggression (r = -.09). Several potentially important moderators were examined, although they had little impact on the total effect size. The results of this study are particularly surprising given that empathy is a core component of many treatments for aggressive offenders and that most psychological disorders of aggression include diagnostic criteria specific to deficient empathic responding. We discuss broad conclusions, consider implications for theory, and address current limitations in the field, such as reliance on a small number of self-report measures of empathy. We highlight the need for diversity in measurement and suggest a new operationalization of empathy that may allow it to synchronize with contemporary thinking regarding its role in aggressive behavior.

Basic traits predict the prevalence of personality disorder across the life span: the example of psychopathy.

Personality disorders (PDs) may be better understood in terms of dimensions of general personality functioning rather than as discrete categorical conditions. Personality-trait descriptions of PDs are robust across methods and settings, and PD assessments based on trait measures show good construct validity. The study reported here extends research showing that basic traits (e.g., impulsiveness, warmth, straightforwardness, modesty, and deliberation) can re-create the epidemiological characteristics associated with PDs. Specifically, we used normative changes in absolute trait levels to simulate age-related differences in the prevalence of psychopathy in a forensic setting. Results demonstrated that trait information predicts the rate of decline for psychopathy over the life span; discriminates the decline of psychopathy from that of a similar disorder, antisocial PD; and accurately predicts the differential decline of subfactors of psychopathy. These findings suggest that basic traits provide a parsimonious account of PD prevalence across the life span.

Antisocial personality disorder in DSM-5: missteps and missed opportunities.

This paper evaluates the proposal for antisocial personality disorder (ASPD) in the Diagnostic and Statistical Manual of Mental Disorders-fifth edition (DSM-5). Some aspects of the proposal are appealing: personality disorders will be assessed using trait criteria, and these criteria are similar to trait descriptions of DSM-IV ASPD. Other aspects of the proposal are less appealing. First, the DSM-5 will depend on a newly constructed personality trait system rather than relying on a well validated, widely studied one. Second, the trait profile of ASPD is incomplete; although this profile reflects the traits included in DSM-IV, it maps poorly onto the full personality profile of ASPD. Third, the DSM Workgroup missed an opportunity to finally unify ASPD and psychopathy; history and research suggest that these disorders have diverged mistakenly. Fourth, the newly proposed criteria of impairments in self- and interpersonal functioning are of questionable derivation and utility.

Generalizing the nomological network of psychopathy across populations differing on race and conviction status.

Psychopathy has shown good construct validity in samples of Caucasian inmates. However, little is known about how well the nomological network surrounding psychopathy generalizes to non-Caucasian and nonincarcerated populations. Using longitudinal and concurrent data from the middle sample of the Pittsburgh Youth Study, this study demonstrates that the validity of total- and facet-level psychopathy is preserved in African American and nonincarcerated samples. Specifically, similar patterns of association were obtained for child variables (child psychopathy, socioeconomic status, risk status, parenting, delinquency, peer delinquency, and impulsivity) and adult variables (children, education, incarceration, unemployment, personality, substance use, and antisocial personality disorder) across ethnicity and conviction status.

Depressive personality and treatment outcome in major depressive disorder.

Depressive personality disorder (DPD) is currently included in the DSM-IV Appendix B, Criteria Sets and Axes Provided for Further Study. Evidence of the clinical utility of DPD will likely play an important role in the determination of whether it warrants inclusion in future editions of DSM. The current investigation examines the capacity of DPD traits to predict overall and preferential treatment outcome for patients with Major Depressive Disorder (MDD) (N = 120) using data from a randomized control trial, which included cognitive behavioral therapy (CBT), interpersonal therapy (IPT), and antidepressant medication (ADM) treatment arms. Patients were treated for 16-20 weeks and completed the Structured Clinical Interview for DSM-IV Axis II Personality Disorders Questionnaire (SCID-II/PQ) and the 17-item Hamilton Rating Scale for Depression immediately before and after treatment. Higher scores on a dimensionalized SCID-II/PQ subscale assessing DPD traits were associated with poor outcome for IPT, but not CBT or ADM. This result remained after accounting for variance associated with other personality disorder (PD) traits; none of the other 10 main text PDs predicted treatment outcome.

Pathological gambling subtypes.

Although pathological gambling (PG) is regarded in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) as a unitary diagnostic construct, it is likely composed of distinct subtypes. In the current report, the authors used cluster analyses of personality traits with a non-treatment-seeking community sample of gamblers and identified 3 PG subtypes. Gamblers partitioned into a simple PG cluster, characterized by low rates of comorbid psychopathology and trait scores near the normative mean; a hedonic PG cluster, characterized by moderate rates of comorbid psychopathology and a proclivity for excitement seeking and positive affect; and a demoralized PG cluster, characterized by high rates of comorbid psychopathology and a propensity toward negative affect, low positive emotionality, and disinhibition. The findings provide preliminary support for an empirically based typology of gamblers, distinguishable in terms of personality structure, which may reflect different etiologies.