Corresponding Author Information: Emily Mariotti, M.S.

Session Abstract: Background and purpose: The meta-constructs of autonomy (AUT) and communion (COM) are linked to functioning across personality, interpersonal relationships, and psychopathology, and can inform psychotherapeutic treatment strategies. We report on the development and initial validation of content-based scales for AUT and COM as they correspond to the Two Polarities Model. We searched within a self-report measure of Level of Personality Functioning (LPF), the DSM-5 Level of Personality Functioning Questionnaire [DLOPFQ], for item content reflection AUT and COM constructs.

Subjects: Item selection was done by 23 raters. These included 18 advanced graduate students trained in using the AMPD and five doctoral-level psychologists with expertise in the AMPD and interpersonal theory.

Methods and materials: We used a sequential multi-tier strategy for item selection. First, items from both instruments were rated for the target constructs. DLOPFQ items were retained based on empirical item performance in a derivation (college student) and a cross validation (clinical) sample. The items that achieved high mean ratings for the constructs were given to four external experts for independent second-tier construct ratings. Final candidate items for AUT and COM scales were selected by the requirement that three of four experts agreed the item was essential for the construct. AUT and COM content-based scales were assembled for the Work and Social contexts of the DLOPFQ. Next, AUT and COM were further refined by examining convergent and divergent item correlations with an attachment style measure.

Analyses: We used a tri-partite approach to construct validity and assessed substantive (content), structural (item-scale relations and internal consistency), and external components of construct validity in developing AUT and COM scales. External validity analyses included convergent and divergent correlations with external assessment measures. Intraclass correlation coefficients (ICC) and content validity ratios (CVR) were used to evaluate items and rater agreement. After winnowing of candidate items into seed scales, corrected item-total correlation (CIC) and internal consistency analyses were determined in a development and a cross-validation sample. Convergent and divergent AUT and COM item correlation with a measure of attachment style provided a final inclusion criterion.

Results: Interrater reliability was robust with ICCs ranging from .81 to .95 for level one item selection, and .79 to .90 for second tier raters. The DLOPFQ and yielded a final scale with 15 AUT items and 16 COM items. Correlations for AUT and COM construct ratings with LPFS domain ratings were strong and consistent with theory (e.g., .6 to .7 range). Results showed that these scales are not isomorphic with the Self and Interpersonal partitioning of the DLOPFQ subscales. A series of multiple regressions predicting scores on the Relationship Profile Test and SOS-10 jointly by AUT, COM, and PID-5-BF variables were conducted. Results showed that AUT and COM contributed substantial and incremental variance in relation to traits. The use of these scales is illustrated in a clinical case vignette.

Conclusion: These findings may expand the theoretical and clinical utility of these instruments for LPF and draw on the nomological net of the Two Polarities model. AUT and COM scales are closely linked to LPF Self and Other functioning domains but they are not identical to the sum of these two domains, respectively. Implications for the use of AUT and COM scales are discussed as well as limitations and directions for future research.


Emily Mariotti, M.S. | University of Tennessee

Mark H. Waugh, Ph.D. | University of Tennessee; Oak Ridge National Laboratory

Cara M. McClain | University of Tennessee

Lorrie G. Beevers, Ph.D. | Private Practice (Oak Ridge, TN)

Jill Clemence, Ph.D. | Albany Stratton VA Medical Center (Albany, NY)

Katie C. Lewis, Ph.D. | Austin Riggs Center (Stockbridge, MA)

Racheli Miller, Ph.D. | Center for Compassion Focused Therapy (New York, NY)

Abby L. Mulay, PhD | Medical University of South Carolina (Charleston, SC)

Jeremy Ridenour, Psy.D. | Austen Riggs Center (Stockbridge, MA)

Steven Huprich, Ph.D. | University of Detroit Mercy

Dr. LewisDr. Katie C. Lewis

Katie C. Lewis, PhD is a staff research psychologist and medical staff member at the Austen Riggs Center. Her research examines personality processes in adults diagnosed with complex psychopathology through a psychoanalytic lens using experience sampling methodology. Dr. Lewis received a doctorate in clinical psychology (PhD) from the Brooklyn campus of Long Island University. She is a former graduate student representative on the Ethics Board of Division 39 and former Fellow of the American Psychoanalytic Association (APsaA). Her research has received funding support from the Robert Wallerstein Fellowship in Psychoanalytic Research, the American Foundation for Suicide Prevention, the Division 39 Fund for Psychoanalysis, and the National Institute of Mental Health (NIMH). She has published and presented on a wide range of topics including suicide and self-harming behaviors, personality psychopathology and assessment, and the ethics of confidentiality in clinical writing. She currently serves as a Consulting Editor and Special Section Editor (Clinical Applications and Case Studies) for the Journal of Personality Assessment, and as an Associate Editor for the Journal of the American Psychoanalytic Association.

Headshot of Dr. Mulay

Dr. Abby Mulay

Dr. Mulay is a licensed clinical psychologist and Clinical Instructor in the Community and Public Safety Psychiatry Division in the Department of Psychiatry and Behavioral Sciences of the Medical University of South Carolina (MUSC). She first earned a Bachelor's of Music in Jazz Voice Performance from the Manhattan School of Music and worked as a professional singer for several years in New York City. Dr. Mulay then obtained her Ph.D. in clinical psychology from Long Island University (Brooklyn Campus). She completed her pre-doctoral internship in clinical psychology (forensic track) at the University of North Carolina School of Medicine/Federal Correctional Complex (Butner, NC). After internship, she completed a postdoctoral fellowship in clinical forensic psychology at MUSC. In her current role at MUSC, Dr. Mulay conducts forensic evaluations (e.g., competency to stand trial, criminal responsibility, pre-employment/fitness for duty), supervises trainees in their forensic work, and delivers clinical services within the South Carolina Department of Corrections (SCDC). She also maintains a small outpatient psychotherapy practice, where she uses an integrative approach, drawing upon the principles of Dialectical Behavior Therapy (DBT) and Cognitive Behavioral Therapy (CBT), as well as the relational psychodynamic tradition. In addition to her clinical work, Dr. Mulay has several research projects underway examining issues related to forensic evaluation. She also studies the clinical utility of the Alternative DSM-5 Model for Personality Disorders (AMPD). Dr. Mulay was recently a co-editor of a book that outlines the use and research support of the AMPD, entitled, The DSM-5 Alternative Model for Personality Disorders: Integrating Multiple Paradigms of Personality Assessment. She is an active member of the Society for Personality Assessment and the American Psychology-Law Society, and she serves as a reviewer for several personality and criminal justice journals.

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