Sharon M. Nelson

A New Scale for Assessing Behavioral Agitation in Dementia

The primary purpose of the present study was to develop a reliable and valid rating instrument for assessing treatment efficacy for behavioral problems in the cognitively impaired elderly. The Behavioral and Emotional Activities Manifested in Dementia (BEAM-D) Scale was developed for the operational assessment of troublesome and disruptive behaviors in dementia. Each behavioral category of the BEAM-D was clinically considered to be a significant deviation from normative behavior for the geriatric dementia patient. The reliability and validity of the BEAM-D was assessed in a group of 45 patients diagnosed with primary degenerative dementia. The mean interrater reliability of BEAM-D items was 0.90. Concurrent validity was established by comparison with currently used rating scales, the Brief Psychiatric Rating Scale (BPRS) and the Sandoz Clinical Assessment-Geriatric (SCAG). Stepwise regression analysis revealed that the items of the BEAM-D had a strong relationship with conceptually similar behavioral dimensions on the BPRS and SCAG.

Malignant self-regard: Accounting for commonalities in vulnerably narcissistic, depressive, self-defeating, and masochistic personality disorders

Several personality disorders (PDs) have been of interest in the clinical literature, yet failed to have been adequately represented in the diagnostic manuals. Some of these are masochistic, self-defeating, depressive, and narcissistic PDs. The theoretical and empirical relationships among these disorders are reviewed. It is proposed that a particular type of self-structure, malignant self-regard (MSR), may account for similarities among all of them and provide a better framework upon which to understand the nature of these personality types and their discrimination from related constructs. Subsequently, a questionnaire to assess MSR was created and evaluated for its psychometric properties. The measure was found to be reliable (Cronbachs alpha=.93) and valid, given its correlations with measures of self-defeating, depressive, and vulnerably narcissistic personalities (rs range from .66 to .76). MSR also can be meaningfully differentiated from a nomological network of related constructs, including neuroticism, extraversion, depression, and grandiose narcissism. The utility of assessing self-structures, such as MSR, in the diagnostic manuals is discussed.

A quantitative and qualitative evaluation of trainee opinions of four methods of personality disorder diagnosis.

Four methods of how to assess and diagnose personality disorders have received much attention within the literature: the Shedler-Westen Assessment Procedure (Shedler & Westen, 1998), the DSM–5 Section III Personality Disorders section (APA, 2011), the DSM–5 Section III trait model (APA, 2013), and the Psychodynamic Diagnostic Manual (PDM; PDM Task Force, 2006) descriptions of 15 personality disorders. Given that much of the debate has been driven by clinician concerns, it is important to consider clinical utility when evaluating the usefulness of each method. The present study compares the 4 models on ratings of several dimensions of clinical utility provided by 329 graduate student clinicians and psychology interns from across the United States. Findings suggest that participants rated the DSM–5 trait model significantly higher in most clinical utility domains. Additionally, qualitative analyses of the open-ended responses provided by participants indicated that each method had strengths and weaknesses. Most notably, participants commented positively on the PDM’s level of comprehensiveness and appreciated the SWAP-II’s inclusion of a health category, despite the ease of use not being as highly rated for these methods.

Introduction of the DSM-5 Levels of Personality Functioning Questionnaire.

With the introduction in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) of a hybrid system of personality disorder assessment, the ability to assess patients’ traits, as well as their level of personality functioning, has become increasingly important. To assess this criterion, the DSM-5 Levels of Personality Functioning Questionnaire (DLOPFQ) was developed. The DLOPFQ assesses individuals’ self-impairments and other impairments in several domains (self-direction, identity, empathy, and intimacy) and across 2 contexts (work/school and relationships). A sample of 140 psychiatric and medical outpatients was administered the DLOPFQ and several other measures to assess its reliability and construct, incremental, and discriminant validity. The internal consistency and convergence with validation measures yielded generally meaningful and expected results. Several DLOPFQ scales and subscales were significantly correlated with measures of DSM-5 trait domains and levels of personality functioning. DLOPFQ scales also correlated with self-reported ratings of overdependence, detachment, healthy dependency, and overall mental health and well-being. The DLOPFQ also predicted interpersonal and general functioning beyond DSM-5 trait domains. These results support the reliability and validity of the DLOPFQ, which appears to be suitable for clinical use and warrants ongoing study.

Advancing the Assessment of Personality Pathology With the Cognitive-Affective Processing System

The Cognitive-Affective Processing System (CAPS) is a dynamic and expansive model of personality proposed by Mischel and Shoda (1995) that incorporates dispositional and processing frameworks by considering the interaction of the individual and the situation, and the patterns of variation that result. These patterns of cognition, affect, and behavior are generally defined through the use of if … then statements, and provide a rich understanding of the individual across varying levels of assessment. In this article, we describe the CAPS model and articulate ways in which it can be applied to conceptualizing and assessing personality pathology. We suggest that the CAPS model is an ideal framework that integrates a number of current theories of personality pathology, and simultaneously overcomes a number of limits that have been empirically identified in the past.

Object relations predicts borderline personality disorder symptoms beyond emotional dysregulation, negative affect, and impulsivity

Many studies have determined that the traits of emotional dysregulation, negative affect, and impulsivity are the strongest predictors of borderline personality disorder (BPD). Although psychodynamic, empirically supported BPD treatments (i.e., transference-focused, mentalization based) focus upon changing the internal representations of self and other, no studies have simultaneously evaluated the contribution of object relations in relation to these traits in predicting BPD symptoms. This study sought to determine the combined effects of emotional dysregulation, negative affect, impulsivity, and object relations in the prediction of BPD through the use of mediation modeling in 4 a priori hypothesized relationships among these variables. One hundred sixty-nine psychiatric outpatients and 171 undergraduate students were evaluated with self-reported trait and object relations measures and were administered 2 semistructured diagnostic interviews for BPD. Although all trait and object relations measures were correlated with BPD symptoms, the best fitting model was one in which object relations partially mediated the relationship of negative affect and impulsivity with BPD symptoms. Direct effects of the traits were also observed in mediation. Self-reported object relational quality had more of an effect on the prediction of BPD than previously recognized within a trait-framework, thus further supporting the model explicated in psychodynamic and relationally based treatments for BPD.

Expanding the utility of the malignant self-regard construct

The empirical and theoretical literature suggest that several proposed personality disorders (PDs) - Masochistic/Self-Defeating, Depressive, and Vulnerably Narcissistic - may be related through a common self-representation know as Malignant Self-Regard (MSR). To assess this construct, the MSR Questionnaire (MSRQ) was developed. Though its initial psychometric properties were very strong, the present study extended these findings by examining the relationship of the MSRQ with measures of other PDs and depressive subtypes, and by establishing four-week and eight-week test-retest reliability in two samples (Ns=840, 911) of undergraduate students. The MSRQ was internally consistent and temporally stable over four and eight weeks. It was positively correlated with measures of introjective and anaclitic depression, measures of Self-Defeating, Depressive, and Vulnerably Narcissistic personalities (rs ranging between 0.60 and 0.82), and other select PDs. After controlling for depressive symptoms and self-esteem, the highest remaining partial correlations were with Vulnerably Narcissistic, Self-Defeating, Depressive, and Avoidant personalities. A factor analysis of the MSRQ with measures of other PDs yielded a two-factor solution, with MSR loading most strongly on one factor, along with Vulnerably Narcissistic, Avoidant, Depressive, and Self-Defeating personalities. It is concluded that MSR is a psychometrically supported construct that might have good clinical utility in explaining personality pathology that has historically been difficult to assess.

Factor Structure of the Assessment of Qualitative and Structural Dimensions of Object Representations (AOR) Scale

The Assessment of Qualitative and Structural Dimensions of Object Representations assessment instrument (AOR; Blatt, Chevron, Quinlan, Schaffer, & Wein, 1992) is one measure of parental representations used in the literature that assesses nonconscious processes while minimizing self-presentation biases. However, only 2 studies have considered the latent factor structure, with mixed findings reported that raise questions about the constructs being assessed. This study used archival data from 4 previous studies containing clinical and nonclinical samples, totaling 722 participants. Individuals were divided into 2 groups in which an exploratory factor analysis (EFA) was followed by a confirmatory factor analysis (CFA). Results of both the EFA and CFA suggested that a 3-factor solution was best, with factors that were labeled Agency, Communion, and Punitive based on previous research. The implications of these findings are explored, particularly with regard to the punitive aspect of maternal representations, as well as a possible revision to the scoring rubric.

Are malignant self-regard and vulnerable narcissism different constructs?

In the clinical and empirical literature, vulnerable narcissism and malignant self-regard (MSR) have been found to be highly interrelated and associated with theoretically related personality constructs, suggesting that the two constructs may be much more similar than different. The present study set out to test this hypothesis by examining the relationship of vulnerable narcissism and MSR to experiences and expressions of anger, the factor structure of grandiose and vulnerable narcissism with MSR, the associations of MSR and vulnerable narcissism to the five factor model of personality, and to global self-esteem in self-report measures within 1168 undergraduate students. A separate study of 158 undergraduates also assessed how MSR and vulnerable narcissism predicted state and trait anxiety and anger after receiving positive or negative feedback, and the extent to which negative feedback interacted with MSR and vulnerable narcissism. Overall, compared with grandiose narcissism, both MSR and vulnerable narcissism were more associated with experiencing anger internally, self-reports of state and trait anger, high levels of neuroticism and openness, and lower levels of extraversion and global self-esteem. Both vulnerable narcissism and MSR uniquely predicted trait levels of anger and anxiety and state levels of anger after receiving negative feedback. It is concluded that MSR and vulnerable narcissism are likely identical constructs.

Expanding the validity of the Malignant Self-Regard construct in an Italian general population sample

Malignant self-regard (MSR) was proposed as a particular type of self-structure that may account for similarities among a set of clinically relevant Personality Disorders (PDs) such as masochistic/self-defeating and depressive PDs that yet have failed to be adequately represented in the diagnostic manuals. The investigation on the MSR may provide a better framework upon which to understand the nature of these personality types and their discrimination from related constructs. The present study examines the psychometric properties of the Italian adaptation of the Malignant Self-Regard Questionnaire (MSRQ). Reliability and validity indicators are determined in a large sample of adults from general population (n = 2574). The measure was found to be reliable and valid, given its correlations with measures of depressive personality, negative affectivity, self-defeating, and vulnerably narcissistic personalities. MSR also can be meaningfully differentiated from a nomological network of related constructs, including sadness rumination, depression, neuroticism, extraversion, and grandiose narcissism. These findings suggest that MSR may be a personality component which includes a negativistic self-representation, vulnerability and hypersensitivity to judgment, sometimes compensated by perfectionistic tendencies. As a whole, results seem to support the reliability and the validity of the Italian adaptation of the MSRQ as a measure of the MSR.