Session Abstract: The Personality Assessment Inventory (PAI; Morey, 1991) is a self-report, broadband measure of personality and psychopathology. The PAI has accrued substantial empirical support over the years across a diverse array of applied settings and is regularly used by clinicians in psychological evaluations. This symposium will examine the psychometric properties of a scoring approach that estimates scores on measures of personality impairment (Criterion A; General Personality Pathology Scale) and pathological traits (Criterion B; Personality Inventory for DSM-5) from the Alternative Model for Personality Disorders (see Busch et al., 2017). The overarching goal of this symposium is to cover ongoing research into whether these estimated scores work as intended within forensic and clinical populations, particularly because this scoring approach is available in updated PAI scoring software for applied use. The first paper explores the associations among the SPECTRA, an instrument intended to measure psychopathology in a framework consistent with the Tri-Dimensional Hierarchical Model, and the AMPD estimates within an outpatient clinical sample. This paper examines the link between these AMPD estimates with SPECTRA indicators of an over-arching general factor of psychopathology (p), group factors (internalizing, externalizing, and reality-impairing), cognitive functioning, and psycho-social functioning. The second paper examines the relation between AMPD estimates and interview-based life events and psychiatric history using a large outpatient and inpatient dataset. This paper connects the estimated scores with patients’ lived experiences, such as a history of trauma, criminal behavior, and suicidality. The third paper uses a forensic dataset of Sexually Violent Predator evaluations to determine the overlap between PAI-generated estimates of AMPD Antisocial Personality Disorder and the psychopathy specifier with the Psychopathy Checklist-Revised. The fourth paper utilizes a dataset of intake evaluations for group Dialectical Behavior Therapy. Evaluations involve a clinical interview, the PAI, and the Structured Clinical Interview for DSM-IV for Axis II Personality Disorders (First et al., 1997). This paper explores the convergence of the PAI-generated estimates of AMPD Borderline Personality Disorder (BPD) with life event data and symptoms of BPD from the categorical model. Researchers will also examine whether scores on AMPD-designated BPD traits are sensitive to treatment. This symposium covers both research and clinical implications of this scoring approach across clinical (inpatient, outpatient) and forensic settings.
Chair Information: Jared Ruchensky, PhD
Discussant Information: Jared Ruchensky, PhD
Presentation 1 Title: Associations Among the SPECTRA: Indices of Psychopathology and the Personality Assessment Inventory Alternative Model for Personality Disorders Estimates
Presentation 1 Abstract: There is growing empirical evidence that psychopathology and personality disorders are best conceptualized as a few inter-related dimensions rather than as a multitude of unique individual conditions. Psychological assessment is beginning to incorporate these changing perspectives. The SPECTRA: Indices of Psychopathology (SPECTRA; Blais & Sinclair, 2018) is a broadband assessment inventory designed to measure psychopathology in a manner consistent with the Tri-Dimensional Hierarchical Model (T-DHM). The SPECTRA measures psychopathology along three higher-order dimensions (Internalizing, Externalizing, & Reality Impairing) and the over-arching global (p-factor) dimension. The T-DHM has been widely replicated using diverse (e.g., children, adolescents, and adults) samples and measures (e.g., self-report scales, semi-structured interviews, and DSM disorder counts). Likewise, the Alternative Model for Personality Disorders (AMPD; Section III DSM-5) re-conceptualizes personality pathology using a hybrid categorical-dimensional model containing 25 facets that form five broad domains (Negative Affectivity, Detachment, Antagonism, Disinhibition, & Psychoticism). A potential benefit of the contemporary dimensional models for clinical assessment is the ability to integrate personality and psychopathology findings in a more concise and coherent manner. The present research sought to explore the associations among the SPECTRA’s hierarchical dimensions of psychopathology and the Personality Assessment Inventory (PAI; Morey, 1991 [see Busch, et al., 2017]) generated AMPD facets and domains using a clinical sample. The paper will also explore the associations of the PAI-AMPD scales with psycho-social and cognitive functioning. The paper will conclude with a discussion of the clinical implications of these models.
Author:
Mark A. Blais, PsyD | Massachusetts General Hospital and Harvard Medical School
Presentation 2 Title: Using the Personality Assessment Inventory to Assess the Alternative Model for Personality Disorders: Criterion Validity in a Clinical Sample
Presentation 2 Abstract: The Personality Assessment Inventory (PAI) is a broadband measure of psychopathology that is widely used in applied settings. Recently, researchers developed regression-based estimates of the Alternative Model for Personality Disorders (AMPD) – a hybrid dimensional and categorical approach to conceptualizing personality disorders (see Busch et al., 2017). Although prior work has linked these estimates to formal measures of the AMPD, there is little work investigating the clinical correlates of this scoring approach of the PAI. The current study examines associations between these PAI-based AMPD estimates and life data in a large, archival dataset of outpatients and inpatients. We expect higher estimated scores on the Criterion A (General Personality Pathology Scale) and Criterion B (Personality Inventory for DSM-5) measures to relate to more negative life events and greater psychiatric history. For example, we hypothesize higher Negative Affect domain and facet-level scores will relate to a greater history of self-harm, trauma, and psychiatric hospitalizations. We predict those higher on Antagonism will have a greater history of violence, more interactions with the criminal justice system (e.g., arrests, incarceration), and a history of childhood conduct disordered behavior. We hypothesize that higher scores on the Psychoticism domain and facets will have a greater history of hallucinations, paranoid ideation/ideas of reference, and mania.
Participants were outpatients (N = 817; 75.1 %) and inpatients (N = 271; 24.9 %) referred for psychological assessment in the department of psychiatry within an academic medical center in the northeastern United States. Participant data were collected as part of ongoing clinical work since 2008 and routinely entered into a collective dataset by clinicians for analysis. Assessment protocol typically includes a clinical interview for life events and psychiatric history and administration of the PAI as a broadband measure of personality and psychopathology. The sample was predominately White (84.4%), almost evenly split amongst men (N = 588; 54.0%) and women (N = 500; 46.0%) and were on average middle-aged adults (Mage = 41.97 years, SDage = 15.33). Patients typically presented for evaluation with complex, severe psychopathology.
We found general support for the validity of AMPD estimate scores, such that a theoretically consistent pattern of associations emerged with indicators such as prior academic achievement, antisocial behavior, psychiatric history, and substance abuse. For Negative Affect, individuals characterized as emotionally unstable (emotional lability), sensitive to abandonment and/or rejection (separation insecurity), and inflexible in behavioral patterns (perseveration) are more likely to endorse a history of childhood trauma. For Antagonism, individuals who are superficially charming (manipulativeness) and dishonest (deceitfulness) endorsed a history of physical violence and arrests. Psychoticism was related to lower academic achievement and a history of physical violence, auditory hallucinations, visual hallucinations, paranoid ideation, mania. These results provide novel evidence supporting the use of the PAI-generated AMPD estimates in applied and research settings – at least for demographically and psychiatrically similar clinical samples. We will discuss more detailed results, implications for researchers and clinicians, limitations of the current study, and suggestions for future research using these estimates.
Authors:
Jared R. Ruchensky, PhD | Sam Houston State University
Shannon E. Kelley, PhD | William James College
Christina Massey, PhD | Massachusetts General Hospital and Harvard Medical School
Laura A. Richardson, PhD | Massachusetts General Hospital and Harvard Medical School
Mark A. Blais, PsyD | Massachusetts General Hospital and Harvard Medical School
Michelle B Stein, PhD | Massachusetts General Hospital and Harvard Medical School
Presentation 3 Title: Estimating Scores for the Alternative Model for Personality Disorders in Sexually Violent Predator Evaluations: Associations with the Psychopathy Checklist
Presentation 3 Abstract: The alternative model of personality pathology is a hybrid categorical-dimensional approach that conceptualizes personality disorders as personality impairment (Criterion A) and pathological traits (Criterion B) (Zimmerman et al., 2019). Recently, Busch and colleagues adapted the Personality Assessment Inventory (PAI), a widely researched self-report measure of psychopathology with norms for correctional settings (Ruiz et al., 2014), to generate estimates of Criterion A (General Personality Pathology Scale) and Criterion B (Personality Inventory for DSM-5). This scoring approach holds substantial practical utility for clinicians working with justice-involved populations given the high prevalence within these settings (e.g., Spaans et al., 2017).
This paper will investigate these PAI estimates in a sample of individuals convicted of sexual offenses and evaluated for sexually violent predator (SVP) status in the state of Texas. SVP status is a form of civil commitment following release from prison designed for individuals that pose a high risk for re-offense upon release and can include restrictions such as being unable to live near schools and parks or other areas frequently occupied by children, forcing many to live in rural areas to accommodate the severe restrictions (Sreenivasan et al., 2020). Psychologists often conduct these evaluations using psychological measures like the PAI and the Psychopathy Checklist – Revised (PCL-R). Although the PAI has been researched in forensic settings, it remains unclear how these scores relate to constructs frequently examined in forensic settings, such as antisocial personality disorder (APSD) and psychopathy. This current project will examine the relationship between AMPD estimates of Antisocial Personality Disorder and the psychopathy specifier relate to models of the PCL-R using a dataset of Sexually Violent Predator evaluations collected as part of regular forensic work. Both the four-facet (interpersonal, affective, lifestyle, and antisocial) and two-factor (interpersonal/affective and impulsive/antisocial behavior) models of the PCL-R will be examined.
This paper will focus on both clinical and research implications of these findings. Both the PAI and PCL-R are regularly used in SVP evaluations. The ability to generate AMPD-based scores of ASPD and the psychopathy specifier could supplement existing SVP evaluations without burdening clinicians with additional assessment protocols. Along these lines, incorporating self-reported (PAI) and interview/file-based (PCL-R) information on antisocial personality disorder and psychopathy is consistent with calls for a multi-method approach to personality assessment (Hopwood, 2014). Additionally, the psychopathy specifier conceptually draws from the triarchic model of psychopathy, providing some of boldness (low anxiety, social potency; Patrick et al., 2009). These findings hold important implications regarding ongoing debates about how to define psychopathy, particularly because there is no research investigating the psychopathy specifier within SVP evaluations. We will discuss implications of these findings for both researchers and clinicians with a focus on integration of the alternative model into existing practices.
Authors:
Alison B. Concannon, MA | Sam Houston State University
Jared R. Ruchensky, PhD | Sam Houston State University
Jorge G. Varela, PhD | Sam Houston State University
Samantha M. Holdren, MA | Sam Houston State University
Samantha J. Kurus, MA | Sam Houston State University
Paige B. Harris, PhD | Sam Houston State University
Darrell B. Turner, PhD | Private Practice
Presentation 4 Title: Convergent Validity of the Alternative Model for Personality Disorder (AMPD) pathological personality traits for BPD in a sample of patients seeking Dialectical Behavior Therapy
Presentation 4 Abstract: The Alternative Model for Personality Disorders (AMPD) in Section III of the Fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013) uses a hybrid categorical-dimensional approach to conceptualize personality disorders. Criterion A focuses on personality impairment (categorical) and Criterion B focuses on pathological traits (dimensional). Using PID-5 generated estimates from the Personality Assessment Inventory (PAI; Morey, 1991), this study explores the utility of Criterion B in assessing pathological personality traits associated with borderline personality disorder (i.e., Emotional Lability, Anxiousness, Separation Insecurity, Depressivity, Impulsivity, Risk-Taking, and Hostility) for patients being evaluated for a Dialectical Behavior Therapy (DBT) group. Our sample consisted of 156 patients at an outpatient clinic held within a large academic medical center. Their mean age was 39.2 (SD=11.1) and had 15.4 (SD=2.4) years of education. They completed both the PAI and Structured Clinical Interview for DSM-IV for Axis II Personality Disorders (SCID-II; First et al., 1997), as part of the standard intake evaluation process. We hypothesize that there will be significant positive associations between SCID-II BPD criteria, PID-5 generated BPD traits, and life event data (i.e., psychiatric hospitalizations and suicidality). We also hypothesize that the severity of select Criterion B BPD traits will reduce over the course of a DBT group. Clinical implications and future directions will be discussed and explored.
Authors:
Michelle B Stein, PhD | Massachusetts General Hospital and Harvard Medical School
Whitney Erby, MA | Massachusetts General Hospital and Harvard Medical School
Rebecca Harley, PhD | Massachusetts General Hospital and Harvard Medical School
Kendra Becker, PhD | Massachusetts General Hospital and Harvard Medical School
Jared R. Ruchensky, PhD |Sam Houston State University
Mark A. Blais, PsyD | Massachusetts General Hospital and Harvard Medical School