Emanuele Preti

Psychometric properties of the Italian version of the SCL-90-R: A study on a large community sample ☆

We present the factor structure and psychometric properties of the Italian version of the SCL-90-R based on a large sample of the Italian population. The sample (N=3631) included high-school and university students and adults from the community (age range=13-70 yrs; 39.2% males). Principal component analysis (PCA) supported by parallel analysis, yielded eight components, partially overlapping those in the original version; no evidence of Psychoticism and Paranoid Ideation as separate subscales emerged. Twenty-one items were consecutively deleted, leading to a 69-item version of the scale. Internal coherence was good for all subscales (α values between 0.70 and 0.96). However, the eight-factor solution did not prove consistent when analyses were replicated after dividing the sample in subgroups according to gender and age. A second-order PCA yielded a single factor, supporting the adoption of the GSI as an index of general distress. A 69-item brief version of the scale has been empirically derived in this study, and can possibly be adopted as a screening measure for general distress in Italian adults and adolescents; however, caution should be exercised when interpreting the clinical profile due to the instability of factor structure.

The facets of identity: personality pathology assessment through the Inventory of Personality Organization.

This work aims to further validate the object-relations-based model of personality pathology assessment, evaluating the psychometric properties of the Italian version of the Inventory of Personality Organization (IPO), a self-report instrument for the assessment of personality organization according to O. Kernbergs model of personality pathology. Six hundred ninety-six nonclinical volunteers and 121 psychiatric patients completed a set of questionnaires including the IPO, the Severity Indices of Personality Problems, the Borderline Personality Disorder Checklist, the Response Evaluation Measure 71, and the Symptom Checklist 90-Revised. Confirmatory factor-analyses on the IPO items supported the 1-, 2-, 3-, and 4-factor solutions. The last (Instability of sense of self/others, Instability of goals, Instability of behaviors, Psychosis) resulted in relatively better fit indexes. Invariance across samples (nonclinical, clinical) and gender was confirmed. The 4 IPO subscales showed good levels of internal coherence and, in the nonclinical sample, good test-retest reliability. Associations with the convergent measures were in line with theoretical expectations and supported the benefit of adopting a 4-factor solution. The 4 factors showed the expected criterion relations: All the dimensions discriminated between clinical and nonclinical subjects, whereas only Instability of self/others and Instability of goals discriminated patients with borderline personality disorder from patients with other diagnoses. Our results suggest that the Italian version of the IPO is a reliable and valid tool for the assessment of personality organization according to Kernbergs model. Results are discussed in the context of the current directions in the evaluation of personality disorders proposed by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition.

Dimensions of personality structure among patients with substance use disorders and co-occurring personality disorders: A comparison with psychiatric outpatients and healthy controls

BACKGROUND Although dual diagnosis has been a topic of great scientific interest for a long time, few studies have investigated the personality traits that characterize patients suffering from substance use disorders and co-occurring personality disorders through a dimensional approach. The present study aimed to evaluate structural personality profiles among dual-diagnosis inpatients to identify specific personality impairments associated with dual diagnosis. METHODS The present study involved 97 participants divided into three groups: 37 dual-diagnosis inpatients, 30 psychiatric outpatients and 30 nonclinical controls. Dimensions of personality functioning were assessed and differences between groups were tested using Kernbergs dimensional model of personality. RESULTS Results showed that dual diagnosis was associated with the presence of difficulties in three main dimensions of personality functioning. Dual-diagnosis inpatients reported a poorly integrated identity with difficulties in the capacity to invest, poorly integrated moral values, and high levels of self-direct and other-direct aggression. CONCLUSIONS The present study highlighted that a dimensional approach to the study of dual diagnosis may clarify the personality functioning of patients suffering from this pathological condition. The use of the dimensional approach could help to advance research on dual diagnosis, and it could have important implications on clinical treatment programs for dual-diagnosis inpatients.

Polydrug abuse and personality disorders in a sample of substance-abusing inpatients

In the last two decades, polydrug abuse has gained increasing attention and many studies have reported high prevalence rates of this phenomenon. The psychological and demographic correlates and negative associated outcomes of polydrug abuse have also been investigated. These findings support the need of an exploration of the relationship between polydrug abuse and comorbid personality pathology. In fact, although the issue of comorbidity between personality disorders (PDs) and substance use has become an established field of study, the association between dual diagnosis and polydrug abuse has received little attention in the literature. The present study aims to investigate the prevalence of polydrug abuse and personality pathology in a sample of substance-abusing inpatients and to compare polydrug abusers and monodrug abusers in terms of sociodemographic characteristics, medical and case history data, outcome variables, and PDs. The files of 117 consecutively admitted inpatients were reviewed, and inform...

The centrality of affective instability and identity in Borderline Personality Disorder: Evidence from network analysis

We argue that the series of traits characterizing Borderline Personality Disorder samples do not weigh equally. In this regard, we believe that network approaches employed recently in Personality and Psychopathology research to provide information about the differential relationships among symptoms would be useful to test our claim. To our knowledge, this approach has never been applied to personality disorders. We applied network analysis to the nine Borderline Personality Disorder traits to explore their relationships in two samples drawn from university students and clinical populations (N = 1317 and N = 96, respectively). We used the Fused Graphical Lasso, a technique that allows estimating networks from different populations separately while considering their similarities and differences. Moreover, we examined centrality indices to determine the relative importance of each symptom in each network. The general structure of the two networks was very similar in the two samples, although some differences were detected. Results indicate the centrality of mainly affective instability, identity, and effort to avoid abandonment aspects in Borderline Personality Disorder. Results are consistent with the new DSM Alternative Model for Personality Disorders. We discuss them in terms of implications for therapy.

Individual differences in components of impulsivity and effortful control moderate the relation between borderline personality disorder traits and emotion recognition in a sample of university students.

Dysfunctions in social cognition characterize personality disorders. However, mixed results emerged from literature on emotion processing. Borderline Personality Disorder (BPD) traits are either associated with enhanced emotion recognition, impairments, or equal functioning compared to controls. These apparent contradictions might result from the complexity of emotion recognition tasks used and from individual differences in impulsivity and effortful control. We conducted a study in a sample of undergraduate students (n=80), assessing BPD traits, using an emotion recognition task that requires the processing of only visual information or both visual and acoustic information. We also measured individual differences in impulsivity and effortful control. Results demonstrated the moderating role of some components of impulsivity and effortful control on the capability of BPD traits in predicting anger and happiness recognition. We organized the discussion around the interaction between different components of regulatory functioning and task complexity for a better understanding of emotion recognition in BPD samples.

Clinician-Guided Assessment of Personality Using the Structural Interview and the Structured Interview of Personality Organization (STIPO)

ABSTRACT This article demonstrates the utility of a theory-guided psychodynamic approach to the assessment of personality and personality pathology based on the object relations model developed by Kernberg (1984). We describe a clinical interview, the Structural Interview (SI; Kernberg, 1984), and also a semistructured approach, the Structured Interview of Personality Organization (STIPO; Clarkin, Caligor, Stern, & Kernberg, 2004) based on this theoretical model. Both interviews focus on the assessment of consolidated identity versus identity disturbance, the use of adaptive versus lower level defensive operations, and intact versus loss of reality testing. In the context of a more clinically oriented assessment, the SI makes use of tactful confrontation of discrepancies and contradictions in the patients narrative, and also takes into account transference and countertransference phenomena, whereas the more structured approach of the STIPO incorporates clinical judgment informed by clinical theory into a well-guided interaction with the patient. Both interviews have good interrater reliability and are coherent with the alternative model for personality disorder diagnosis proposed by the Diagnostic and Statistical Manual of Mental Disorders (5th ed.), Section III. Finally, they provide the clinician with specific implications for prognosis and treatment planning and can rationally guide clinical decision making.

At the border: reflections on psychoanalytically oriented counselling in an Italian university setting

This paper analyses the ‘border’ position of counselling services in Italian universities. The concept of ‘border’ has great relevance in the work of psychoanalytically oriented university students’ counsellors. Counselling is part of a continuum of interventions, from befriending to psychotherapy. This closeness encompasses the need for identifying specificities and differences among interventions. Moreover, a university counselling service occupies a ‘marginal’ position, continuously confronted with the risks of rejection and/or assimilation. The concept of ‘border’ is also useful to define the developmental phase of university students, crossing the border between late adolescence and young adulthood, as represented by Conrads novel The shadow line (1917/1999), recently analysed by Green (2008) as the metaphoric demarcation line between youth and adulthood. Finally, most of the students referring to our counselling service come from families that for the first time crossed the border of university education.

The Role of Identity Instability in the Relationship Between Narcissism and Emotional Empathy.

Empirical literature has shown that narcissism is often associated with limited empathy, but the mechanism underlying this association is still unclear. The present study investigated the role of identity instability as a mediator of the relationship between narcissistic traits and empathic capabilities. Narcissistic traits, identity instability, and cognitive and emotional empathic capabilities were assessed among 462 nonclinical participants through self-report measures. Results showed a positive association between narcissistic traits and cognitive empathy. On the other hand, a negative association between narcissistic traits and emotional empathy emerged. Furthermore, the study showed that the association between narcissistic traits and impairments in emotional empathy was partially explained by identity instability. Results thus demonstrated that narcissistic traits were associated with higher identity instability, and this, in turn, was associated with decreased abilities to be emotionally involved in others’ affect states. These findings are discussed in the context of an object relations formulation of narcissistic personality.

Rejection sensitivity and psychopathology symptoms in early adolescence: The moderating role of personality organization

INTRODUCTION Emerging personality organization may play an important role in the psychological adjustment of early adolescents, but research in this area is still limited. The current study evaluated if personality organization moderates the association between rejection sensitivity and adverse psychological outcomes in early adolescence. METHODS Three-hundred eighty-six early adolescents (age range 13-15 years; 51% Female) attending junior high schools in Italy completed the semi-structured Interview of Personality Organization Processes in Adolescence (IPOP-A), the Childrens Rejection Sensitivity Questionnaire (CRSQ), and the Youth Self Report/11-18 (YSR). RESULTS Disruption in the emerging personality organization was associated with increasing symptom problems in early adolescence. Conversely, the successful development of personality organization buffered the relation between rejection sensitivity and negative psychological outcomes (i.e., conduct and affective problems). CONCLUSION These findings encourage to accurately evaluate personality organization in adolescence, in order to take into account difficulties but also strengths in personality organization when treating early adolescents.