Using the Personality Assessment Inventory to Assess the Alternative Model for Personality Disorders

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.

Presenting Anthor

Jared Ruchensky | Sam Houston State University

Authors

Shannon Kelley | William James College

Christina Massey | Massachusetts General Hospital and Harvard Medical School

Laura Richardson | Massachusetts General Hospital and Harvard Medical School

Mark Blais | Massachusetts General Hospital and Harvard Medical School

Michelle Stein | Massachusetts General Hospital and Harvard Medical School