Search

The development of factor analysis is uniquely situated within psychology, and the development of many psychological theories and measures are likewise tethered to the common use of factor analysis. In this paper, we review modern methodological controversies and developments through concrete demonstrations of how to use factor analytic methods across the exploratory-confirmatory continuum. We illustrate best practices for working through common challenges in personality disorders research. To help researchers conduct risker tests of their theory-implied models, we review what factor analysis is and is not, as well as some dos and don’ts for engaging in the process of model evaluation and selection. Throughout, we also emphasize the need for closer alignment between factor models and our theories, as well as clearer statements about which criteria would support or refute the theories being tested. Consideration of these themes appears promising in terms of advances in theory, research, and treatment surrounding the nature and impact of personality disorders.

Factor analytic models of common mental disorders have been hypothesized to be affected by various methodological features, which could undermine the assumption that Internalizing and Externalizing reflect part of the natural structure of psychopathology. In this study, we addressed this issue by testing whether and how methodological features affect the empirical structure of psychopathology using meta-analytic measurement invariance models of Internalizing and Externalizing across multiple sample characteristics. Published studies estimating factor analytic models from Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnoses were screened. A total of 47 samples (N = 118,966) were included in the meta-analysis. Data were pooled into meta-analytic correlation matrices using random effects models that accounted for sampling variability. Multigroup confirmatory factor analytic models of Internalizing and Externalizing were fit to the pooled matrix of DSM diagnoses to test invariance of the structure, factor loadings, and factor covariance. Results supported partial or full invariance across (a) samples selected versus not selected for psychopathology, (b) diagnoses defined by binary DSM thresholds versus dimensional symptoms counts, and (c) diagnoses based on lifetime versus current symptoms. Tentative analyses indicated noninvariance across samples that made diagnoses using hierarchical exclusion rules versus those that did not. Our study suggests that the Internalizing and Externalizing structure is largely robust to common methodological characteristics thought to impact factor analytic models. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Humans adapt to a dynamic environment while maintaining psychological equilibrium. Systems theories of personality hold that generalized processes control stability by regulating how strongly a person reacts to various situations. Research shows there are higher order traits of general personality function (stability) and dysfunction (general personality pathology [GPP]), but whether they capture individual differences in reactivity is largely theoretical. We tested this hypothesis by examining how general personality functioning manifests in everyday life in two samples ( Ns = 205 and 342 participants and 24,920 and 17,761 observations) that completed an ambulatory assessment protocol. Consistent with systems theories, we found that (a) there is a general factor reflecting reactivity across major domains of functioning and (b) reactivity is strongly associated with stability and GPP. Results provide insight into how people fundamentally adapt to their environments (or not) and lay the foundation for more practical, empirical models of human functioning.

Emotional and behavioral variability are unifying characteristics of borderline personality disorder (BPD). Ambulatory assessment (AA) has been used to assess and quantify this variability in terms of the categorical BPD diagnosis, but growing evidence suggests that BPD instead reflects general personality pathology. This study aimed to clarify the conceptualization of BPD by mapping indices of variability in affect, interpersonal behavior, and perceptions of others onto general and specific dimensions of personality pathology. We studied a sample of participants that met diagnostic criteria for BPD (n=129) and healthy controls (n=47) who reported on their interactions throughout the day during a 21-day AA protocol. Multi-level structural equation modeling was used to examine associations between shared and specific variance in maladaptive traits with dynamic patterns of interpersonal functioning. We found that variability is an indicator of shared trait variance and Negative Affectivity, not any other specific traits, reinforcing the idea BPD is best understood as general personality pathology.

Personality and social, emotional, and behavioral (SEB) skills are closely related and independently predict life outcomes. This implies that although tightly connected, what a person tends to do (personality traits) and what they are capable of doing (skills) are not always perfectly aligned. In this study, we investigated whether matches and mismatches between traits and skills predict important life outcomes. We studied a diverse sample of high school students (N = 897) who self-reported their Big Five personality traits, five SEB skill domains, and an array of academic, social, and emotional outcomes. Using response surface analysis, we found that youth with matching, high levels of corresponding traits and skills, as well as those with higher skill levels relative to their traits reported better outcomes. By contrast, youth with matching, low levels of traits and skills, as well as those with higher trait levels relative to skills, were more anxious and depressed. Our findings provide insights into functioning that are missed by solely focusing on direct effects, and also show that SEB skills can enhance people’s personality strengths and buffer against shortcomings.

The time between adolescence and adulthood is a transformative period of development. During these years, youth are exploring work, relationships, and worldviews while gaining the capacities needed to take on adult roles. These social and psychological processes are reflected in how personality develops across this period. Most youth personality development research has focused on the Big Five domains, ignoring the hierarchical structure of personality and missing broader, higher-order processes and more specific, lower-order processes. Towards a more comprehensive account, this study examines how personality develops from adolescence into emerging adulthood at the metatrait (Stability, Plasticity), domain (Big Five), and facet levels. Data come from a longitudinal study of Mexican-origin youth (N=645) with few socioeconomic resources who were assessed five times from ages 14–23. We used latent growth curve models to investigate mean-level change, rank-order consistency, and the maintenance of trajectories for self-reported personality metatraits, domains, and facets. We found distinct developmental processes unfolding at each level of the hierarchy¬, including: (1) mean-level changes in the metatraits and domains indicating increases in exploratory tendencies (i.e., Plasticity) and maturity (i.e., increases in Agreeableness and Conscientiousness, decreases in Neuroticism), and divergent change patterns between facets within each domain indicating nuanced maturational processes; (2) comparable levels of rank-order consistency for metatraits, domains and facets; and (3) evidence that deviations from youth’s developmental trajectories did not persist over time. Our findings offer insights into personality development that would be impossible to glean from the domain-level alone and adds needed sociocultural diversity to the literature.

Quantitative, empirical approaches to establishing the structure of psychopathology hold promise to improve on traditional psychiatric classification systems. The Hierarchical Taxonomy of Psychopathology (HiTOP) is a framework that summarizes the substantial and growing body of quantitative evidence on the structure of psychopathology. To achieve its aims, HiTOP must incorporate emerging research in a systematic, ongoing fashion. In this paper, we introduce the conceptual background, organizing principles, core assumptions, and procedures for revising the HiTOP framework. Informed by strengths and shortcomings of previous classification systems, the proposed revisions protocol is a formalized system focused around three pillars: 1) prioritizing systematic evaluation of quantitative evidence by a set of transparent criteria and processes, 2) balancing stability with flexibility, and 3) promoting inclusion over gatekeeping in all aspects of the process. We detail how the revisions protocol will be applied in practice, including the scientific and administrative aspects of the process. Additionally, we describe areas of the HiTOP structure that will be a focus of early revisions and outline challenges for the revisions protocol moving forward. The proposed revisions protocol will ensure that the HiTOP framework reflects the current state of scientific knowledge on the structure of psychopathology and fulfills its potential to advance clinical research and practice.

College students are at heightened risk of engaging in unhealthy alcohol use that leads to negative consequences (e.g., motor vehicle accidents, poor academic performance). Understanding how individual differences, such as maladaptive personality traits, contribute to that risk could improve intervention efforts. A potential pathway through which personality confers risk for consequences is by influencing students' motivation to drink. In this study of 441 college students, we investigated whether different motivations to pregame, a particularly risky and common drinking practice on college campuses, accounts for links between maladaptive traits and alcohol-related consequences. Results of bivariate analyses showed that all pregaming motives and maladaptive traits (except detachment) were strongly correlated with negative consequences. In path analytic models that adjusted for shared variance between pregaming motives and between maladaptive traits, results showed that traits had indirect effects on total drinking consequences via individual differences in pregaming motives as well as direct effects that were independent of motives. Specifically, antagonism, disinhibition, and negative affectivity predicted more drinking consequences via stronger motives to pregame for instrumental reasons over and above the general motivation to pregame, whereas detachment predicted fewer consequences via weaker instrumental pregaming motives. Antagonism and disinhibition were also associated with more drinking consequences, and detachment with fewer consequences, over and above pregaming motives and general personality problems. Our study indicates that one way maladaptive personality traits may shape alcohol-related consequences in college students is by associations with their motivations to pregame. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Objective: Interpersonal and emotional functioning are closely linked, and reciprocally influence one another. Contemporary Integrative Interpersonal Theory (CIIT) offers a useful framework to study these patterns. Stress processes offer several candidate targets for empirical investigation with methods that allow for fine-grained analyses in the context of daily life. Method: Four samples of adults (Sample 1 N=145; Sample 2 N=160; Sample 3 N=297; Sample 4=89 dyads, 178 individuals) completed ecological momentary assessment protocols focused on a variety of interpersonal and emotional experiences (Sample 1 Observation N= 14,219; Sample 2 Observation N=8,137; Sample 3 Observation N=5,400; Sample 4 Observation N=5,537). Samples were enriched for aggressive and self-harming behavior (Sample 1), trait hostility (Sample 2), interpersonal problems (Sample 3), and personality disorder features (Sample 4). Results: Using multilevel dynamic structural equation modeling, we investigated how emotions and interpersonal functioning operate over brief timescales in daily life. We found evidence for a normative vicious socio-emotional cycle across all four samples, whereby negative emotions led to interpersonal conflict (i.e., perceptions of and enacting cold, antagonistic, or quarrelsome behavior) which in turn led to increased negative emotions. Although individuals differed in the strength of this process, it was unrelated to trait negative affectivity. Conclusions: Viewing these results through the lens of CIIT, we discuss multiple intervention points highlighted by these dynamic results whereby the vicious cycle can be changed.

Personality disorders (PDs) are among the most common and severe classes of psychopathology. From a clinical perspective, it is challenging to help individuals with personality disorders because treatment ruptures, discontinuation, reversals, and failures are relatively common. An additional clinical challenge is that the model used to diagnose personality disorders is demonstrably incorrect. Recent efforts to improve diagnosis of personality disorders apply two criteria: the first distinguishes personality disorders from other kinds of psychopathology and the second distinguishes different types of personality disorders. However, this approach has been problematic in that, as currently operationalized, it does not provide a clear demarcation for personality disorders, and it uses a framework for individual differences that is more apt as a model of variation in psychopathology in general. This article proposes that the core of personality disorders involves difficulties understanding and relating to self and others, and thus the personality disorders should be recast as the interpersonal disorders. Interpersonal dysfunction explains extreme social challenges and treatment difficulties that are characteristic of this class of psychopathology. This approach provides a clearer model for distinguishing these kinds of problems, as demonstrated by reformulating traditional personality disorder symptoms from an interpersonal perspective. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The accumulation of day-to-day stressors can impact mental and physical health. How people respond to stressful events is a key mechanism responsible for the effects of stress, and individual differences in stress responses can either perpetuate or prevent negative consequences. Most research on daily stress processes has focused on affective responses to stressors, but stress responses can involve more than just affect. Additionally, most research has been on the role of neuroticism in shaping those responses, but many other individual differences are associated with stress outcomes. In this study, we more comprehensively characterized daily stress processes by expanding the nomological networks of stress responses to include Big Five personality states. We also linked those stress responses to all Big Five traits, as well as individual differences in stress exposure and stress appraisal. We studied a sample of participants (N = 1,090) who reported on stressful events, their appraisal of events in terms of severity and controllability, and their Big Five personality states daily for 7-10 days (N = 8,870 observations). Multi-level structural equation models were used to separate how characteristics of the perceived stressful situation and characteristics of the person play into daily stress processes. Results showed that (1) all Big Five personality states shift in response to perceived stress, (2) all Big Five personality traits relate to average levels of perceived stress exposure and appraisals, (3) individual differences in personality and average perceived stress exposure and perceived severity relate to the strength of personality state responses to daily stress. Our results point to new pathways by which stressors affect people in everyday life and begin to clarify processes that may explain individual differences in risk or resilience to the harmful effects of stress.

Perceptions of situations are a critical mechanism linking persons and situations. Many personality theories assume that the abstractness of situational attributes is a key dimension that magnifies or minimizes individual differences in how people respond to situation¬s. In this pre-registered study, we evaluated this basic property of situations and situation-perception processes by examining interrater agreement on in-situ ratings of situation features in everyday life varying in abstractness. We studied a sample of 94 romantic couples who rated their interactions with one another multiple times per day for 21 days. We used multi-level structural equation modeling to quantify the degree of social consensus on location, whether others were present, duration of interaction, and conversation topic. Results showed that (1) situation attributes vary in the extent of socially consensual vs. unshared meaning, and (2) there is more social consensus on less abstract situation attributes and more unshared perceptions of more abstract attributes.

Pain is a complex construct contributing to significant impairment, particularly among physically injured patients seeking treatment in trauma and orthopedic surgery settings in which social workers are an integral component of care. The biopsychosocial theory, fear-avoidance, and cognitive mediation models of pain suggest that psychological factors (for example, depression) affect one’s ability to tolerate distress, leading to negative pain appraisals, such as catastrophizing. This study examined whether distress tolerance serves as a mechanism by which depression is associated with pain catastrophizing. We administered a health survey to outpatient trauma and orthopedic surgery clinic patients who were using opioid medications; 84 patients were included in the final analysis; 39.3 percent screened positive for depression. A multilevel mediation model using structural equation modeling revealed a significant direct effect from depression to pain catastrophizing (ß = .31, z = 3.96, p < .001) and a significant indirect effect by distress tolerance (Δß = .27, z = 3.84, p < .001). These results, which suggest that distress tolerance partially mediated the path from depression to pain catastrophizing, can inform social workers and other members of the multidisciplinary team about both the critical role of psychosocial factors after injury and interventions to improve postinjury recovery.

Background The Hierarchical Taxonomy of Psychopathology (HiTOP) is a classification system that seeks to organize psychopathology using quantitative evidence – yet the current model was established by narrative review. This meta-analysis provides a quantitative synthesis of literature on transdiagnostic dimensions of psychopathology to evaluate the validity of the HiTOP framework. Methods Published studies estimating factor-analytic models from diagnostic and statistical manual of mental disorders (DSM) diagnoses were screened. A total of 120,596 participants from 35 studies assessing 23 DSM diagnoses were included in the meta-analytic models. Data were pooled into a meta-analytic correlation matrix using a random effects model. Exploratory factor analyses were conducted using the pooled correlation matrix. A hierarchical structure was estimated by extracting one to five factors representing levels of the HiTOP framework, then calculating congruence coefficients between factors at sequential levels. Results Five transdiagnostic dimensions fit the DSM diagnoses well (comparative fit index = 0.92, root mean square error of approximation = 0.07, and standardized root-mean-square residual = 0.03). Most diagnoses had factor loadings >|0.30| on the expected factors, and congruence coefficients between factors indicated a hierarchical structure consistent with the HiTOP framework. Conclusions A model closely resembling the HiTOP framework fit the data well and placement of DSM diagnoses within transdiagnostic dimensions were largely confirmed, supporting it as valid structure for conceptualizing and organizing psychopathology. Results also suggest transdiagnostic research should (1) use traits, narrow symptoms, and dimensional measures of psychopathology instead of DSM diagnoses, (2) assess a broader array of constructs, and (3) increase focus on understudied pathologies.

Interpersonal theory organizes social behavior along dominant (vs. submissive) and warm (vs. cold) dimensions. There is a growing interest in assessing these behaviors in naturalistic settings to maximize ecological validity and to study dynamic social processes. Studies that have assessed interpersonal behavior in daily life have primarily relied on behavioral checklists. Although checklists have advantages, they are discrepant with techniques used to capture constructs typically assessed alongside warmth and dominance, such as affect, which typically rely on adjective descriptors. Further, these checklists are distinct from the methodologies used at the dispositional level, such as personality inventories, which rarely rely on behavioral checklists. The current study evaluates the psychometric performance of interpersonal adjectives presented on a visual analogue scale in five different samples. Validity of the visual interpersonal analogue scale (VIAS) approach to momentary assessment was evaluated by comparing its performance with an interpersonal behavior checklist and by examining associations among the VIAS warmth and dominance scales and other momentary and dispositional constructs. Results were generally consistent with an existing interpersonal behavior checklist at the within-person level but diverged somewhat at the dispositional level. Across the five samples, the VIAS generally performed as hypothesized at both the within- and between-person levels.

Neuroticism is a basic dimension of personality with profound implications for mental and physical health. The link between neuroticism and health problems is thought to be driven by experiencing higher average levels of negative emotion and more emotional variability. However, because of the statistical dependency between mean levels and variability of negative emotion, neuroticism’s association with emotional variability has been questioned. If adjusting for mean levels eliminates evidence for associations between neuroticism and emotional variability, this would suggest a total revision of theory and measurement. Our meta-analysis investigated conceptual and statistical shortcomings of adjusting for the mean and tested whether the simple solution of adjusting for the median or mode instead is a better approach to account for average emotion levels and overcome the mean-variance confound. We analyzed 15 ambulatory assessment studies (N=2,088 participants; 146,823 observations) and showed that: (1) the mean-variance association is largely driven by the skewed distribution of negative emotions, (2) adjusting negative emotion variability with the mean overcorrects for their association, (3) the mode was least confounded with variability, and (4) adjusting for the median or mode strengthened evidence for the role of negative emotion variability in neuroticism. Results from our meta-analysis indicate that adjusting for the mean is an overcorrection that underestimates the association between negative emotion variability and neuroticism. Instead of adjusting for the mean, we recommend using the mode to study negative emotion dynamics related to neuroticism on theoretical and empirical grounds when there is a desire to adjust for the average.

Several personality traits increase the risk for atherosclerotic cardiovascular disease. Because many of these traits are correlated, their associations with disease risk could reflect shared variance, rather than unique contributions of each trait. We examined a higher-order personality trait of Stability as related to preclinical atherosclerosis and tested whether any such relationship might be explained by correlated variation in cardiometabolic risk factors.Among 798 community volunteers, lower-order traits of Neuroticism, Agreeableness, and Conscientiousness were modeled as latent variables (from self- and informant ratings) and used to estimate the second-order factor, Stability. Cardiometabolic risk was similarly modeled from indicators of glycemic control, blood pressure, adiposity, and lipids. Carotid artery atherosclerosis was measured as intima-media thickness (IMT) by duplex ultrasonography.A structural equation model incorporating direct and indirect effects showed lower Stability associated with greater IMT, and this relationship was accounted for by the indirect pathway via cardiometabolic risk. Secondary analyses showed that: (1) Neuroticism, Agreeableness, and Conscientiousness were unrelated to IMT independent of Stability; and (2) Stability predicted variation in IMT when estimated from informant-, but not self-rated, traits.Personality traits may associate with atherosclerotic burden through their shared, rather than unique, variance, as reflected in Stability.

Personality pathology is increasingly conceptualized within hierarchical, dimensional trait models. The Comprehensive Assessment of Traits Relevant to Personality Disorders (CAT-PD; Simms et al., 2011) is a pathological-trait measure with potential to improve on currently prevailing instruments because it has wider content coverage; however, its domain-level structure, which is of scientific and clinical interest, is not established. In this pre-registered study, we investigated the structure and construct validity of the CAT-PD’s domain level to facilitate wider use of the measure. We estimated five- and six-factor models with exploratory factor analysis in a pooled sample of 8 independent subsamples (N=3,987) and found that both models fit the data well; each had interpretable factors that were invariant across gender, sample type, and black/white racial groups; and the factors had good convergent validity with other measures of maladaptive traits, Big Five personality, and interpersonal problems. Our results support the validity of the CAT-PD for assessing multiple levels of the pathological trait hierarchy.

Interpersonal functioning involves an interplay of subjective perceptions and overt behavior. This study examines alignment between self and informant perceptions of momentary behavior to enrich the nomological networks for the domains of dominance and affiliation. We studied a sample of romantic couples ( N = 210 individuals) who rated their own and their partner’s interpersonal behavior during a 21-day ambulatory assessment (AA) protocol. We used multi-level structural equation modeling to estimate self-informant agreement on averages and variability of dominance and affiliation (between-person level) and on situational shifts in behavior (within-person level). We also examined convergence between self- and informant reported behavior measured by AA with cross-sectional self-report trait dominance, affiliation, and interpersonal problems. Results showed no self-informant agreement on dominance measured by AA, but moderate to strong agreement on affiliation at the between- and within-person levels. Self- and informant reported average affiliation measured by AA correlated with self-reports of trait affiliation, but only AA self-reports correlated with affiliation problems. Both self- and informant report dominance variability, and informant report affiliation variability, correlated with self-report interpersonal distress. Evidence for (mis)alignment in how dominance and affiliation are perceived by self and others have important implications for the role of these behaviors in everyday interpersonal functioning.

Widiger and Hines raise a number of significant concerns with the Alternative Model of Personality Disorders (AMPD). This places the major class of psychiatric difficulties represented by the personality disorders in a precarious position because the model used in prior editions of the Diagnostic and Statistical Manual of Mental Disorders and currently reprinted in Section II is moribund if not dead, and with the AMPD’s significant problems their future is unclear. Although we agree that Widiger and Hines’ criticisms have merit, they are not the whole picture. We review additional relevant research that supports the contention that what differentiates personality disorders from other psychopathology is the self and interpersonal dysfunction, as Criterion A of the AMPD currently states. We emphasize the importance of drawing a distinction between the conceptual model and its operationalization. We argue that paradoxically, to save personality disorders we need to do away with them and replace them with the “interpersonal disorders”. There is strong theory, empirical research, and ethical arguments in favor of this conceptual reframing.

Background: Several personality traits increase risk for atherosclerotic cardiovascular disease. Because many of these traits are correlated, their associations with disease risk could reflect shared variance, rather than unique contributions of each trait. We examined a higher-order personality trait of Stability as related to preclinical atherosclerosis and tested whether any such relationship might be explained by correlated variation in cardiometabolic risk factors.Method: Among 798 community volunteers, lower-order traits of Neuroticism, Agreeableness, and Conscientiousness were modeled as latent variables (from self- and informant ratings) and used to estimate the second-order factor, Stability. Cardiometabolic risk was similarly modeled from indicators of glycemic control, blood pressure, adiposity, and lipids. Carotid artery atherosclerosis was measured as intima-media thickness (IMT) by duplex ultrasonography.Results: A structural equation model incorporating direct and indirect effects showed lower Stability associated with greater IMT, and that this relationship was accounted for by the indirect pathway via cardiometabolic risk. Secondary analyses showed that: 1) Neuroticism, Agreeableness, and Conscientiousness were unrelated to IMT independent of Stability; and 2) Stability predicted variation in IMT when estimated from informant-, but not self-rated, traits.Conclusion: Personality traits may associate with atherosclerotic burden through their shared, rather than unique, variance, as reflected in Stability.

Despite enthusiasm for using intensive longitudinal designs to measure day-to-day manifestations of personality underlying differences between people, the validity of personality state scales has yet to be established. In this study, we evaluated the psychometrics of 20-item and 10-item daily, Big Five personality state scales in three independent samples ( N = 1,041). We used multilevel models to separately examine the validity of the scales for assessing personality variation at the between- and within-person levels. Results showed that a five-factor structure at both levels fits the data well, the scales had good convergent and discriminative associations with external variables, and personality states captured similar nomological nets as established global, self-report personality inventories. Limitations of the scales were identified (e.g., low reliability, low correlations with external criterion) that point to a need for more, systematic psychometric work. Our findings provide initial support for the use of personality state scales in intensive longitudinal designs to study between-person traits, within-person processes, and their interrelationship.

Studying the interface between personality and psychopathology has generated significant insight into the nature of individual differences. Because personality disorders are the clearest point of convergence, much of this literature originates from contention surrounding how to define personality pathology. Shifts in how personality disorders are conceptualized, diagnosed, and treated illuminate fundamental issues for psychological science such as how to bridge theory and research, the importance of matching measurement to construct, and how to integrate diverse intellectual traditions. In this chapter, we contextualize these issues in historical and ongoing efforts to understand personality pathology. We emphasize how pathological personality processes have been simultaneously inextricable and elusive throughout these efforts; clinical theories have emphasized dysfunctional, within-person dynamics but lack scientific operationalization, and formal taxonomies have focused on describing between-person differences that obscure the underlying processes. We suggest a comprehensive model that mechanistically links nomothetic structure to contextualized processes is necessary for advancing our understanding of personality and psychopathology.

A model of personality pathology including both general and specific components distinguishes severity of personality dysfunction from the characteristic style of its expression. This model has been proposed as an empirically based, dimensional alternative to categorical models. In this study, we evaluated this conceptual structure by examining associations between general and specific features of personality pathology and momentary interpersonal dynamics. By assessing whether dynamic variability reflects general impairment or a specific trait style, we also sought to link existing findings of heterogeneity in behavior and affect among persons diagnosed with categorical borderline personality disorder with dimensional models. We examined these issues in a large sample of adults (N = 605) drawn from two protocols-an initial exploratory study and a preregistered replication. Ambulatory assessment was used to measure affect and dominant and warm behavior of self and other during everyday interpersonal interactions. We examined individuals' average affects, behaviors, and perceptions of the others' behaviors, as well as variability in these constructs in relation to personality pathology using multilevel structural equation modeling. To our knowledge, this is the first study to examine maladaptive traits or general personality pathology in relation to momentary measures. Results supported the incremental validity of general and specific features and suggested that variability is most closely associated with general personality pathology. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Few studies have examined behaviors in romantic relationships associated with borderline personality disorder (BPD). We assessed critical variables from marital research: the "emotional bank account" (positive-to-negative behaviors; Gottman, 1993) and the "four horsemen of the apocalypse" (criticism, defensiveness, contempt, and stonewalling; Gottman & Silver, 1999; Gottman & Krokoff, 1989). Couples (N = 130, or 260 participants) engaged in a conflict task and reported relationship satisfaction at intake and 12-months. Clinician-rated BPD and avoidant PD (APD) criteria were examined. People with more BPD symptoms and their partners were less satisfied, which worsened by follow-up. Conflict behaviors partially explained these associations. Partners of people with more BPD symptoms had a worse emotional bank account, which then predicted (a) poorer satisfaction for both members and (b) worsening partner satisfaction. People with more BPD symptoms criticized more; their partners defended and stonewalled more. APD predicted worsening satisfaction. BPD appears to link specifically with relationship dysfunction, partly through associations with partner behavior.

Empathy theoretically serves an affiliative interpersonal function by satisfying motives for intimacy and union with others. Accordingly, empathy is expected to vary depending on the situation. Inconsistent empirical support for empathy’s affiliative role may be because of methodology focused on individual differences in empathy or differences between controlled experimental conditions, which fail to capture its dynamic and interpersonal nature. To address these shortcomings, we used ecological momentary assessment to establish typical patterns of empathy across everyday interactions. Associations among empathy, affect, and interpersonal behaviour of self and interaction partner were examined in a student sample ( N = 330), then replicated in a preregistered community sample ( N = 279). Multilevel structural equation modelling was used to distinguish individual differences in empathy from interaction-level effects. Results show that people are more empathetic during positively valenced interactions with others perceived as warm and when expressing warmth. By confirming the typically affiliative role of empathy, existing research to the contrary can be best understood as exceptions to the norm.

Anti-psychotic medication is considered one of the most efficaciousinterventions for the treatment of severe schizophrenia, yet ratesof adherence are notoriously and consistently low despite volume...

Objectives Community pharmacy continues to play a crucial role in the national response to the opioid epidemic. The purpose of this article is to describe the protocol for a pilot study that is examining the feasibility and acceptability of the Motivational Intervention–Medication Therapy Management (MI-MTM) model. This study also examines the preliminary clinical effect of MI-MTM for improving opioid medication misuse and patient activation in self-management of health conditions that increase risk for misuse. Design MI-MTM is a pharmacy-based integrated care model made up of 4 evidence-based practices: medication therapy management; brief motivational intervention; patient navigation; and naloxone training and referral. To test MI-MTM compared with Standard Medication Counseling (SMC), we are conducting a 2-group randomized single-blinded controlled trial with assessments at 3 time points. Setting and participants The study is being conducted within a western Pennsylvania university-based community pharmacy with 46 patients with opioid misuse (MI-MTM = 23; SMC = 23). Main outcome measures Feasibility will be measured by capturing patient completion rate of MI-MTM sessions. Acceptability will be measured by administering satisfaction surveys regarding pharmacist and patient navigator services. Acceptability will also be captured by conducting intensive qualitative interviews. Preliminary effect of the intervention on misuse will be measured with the use of the Prescription Opioid Misuse Index and the Opioid Compliance Checklist. Activation in self-management will be measured with the use of the Patient Activation Measure. Results This project is currently recruiting, and results are to come. Conclusion This study is the first in the United States to implement an evidence-based integrated behavioral intervention into the community pharmacy setting to address opioid medication misuse among pharmacy patients. The results of this study will provide necessary foundational data that allow further testing of this intervention model in a larger trial.

There is growing interest in relationships between borderline personality disorder (BPD) pathology and physical health outcomes. Diagnostic BPD and BPD-related traits, for instance, have been shown to associate with self-reported cardiovascular disease and various cardiometabolic risk factors. However, potential confounding of these associations by comorbid depression, which itself contributes to risk for heart disease, remains unresolved, and previous research is limited by nearly uniform reliance on self-reported health status. In the present study, we examine the association of BPD traits and contemporaneously assessed depressive mood with instrumented measures of cardiometabolic risk in a midlife community sample (N = 1,295). BPD pathology was measured using dimensional, multi-informant trait measures; depressive symptomology was self-reported; and cardiometabolic risk was indexed via multiple indicators of insulin resistance, adiposity, dyslipidemia, and blood pressure. Structural equation modeling was used to estimate the effects of BPD traits and depressive symptoms on aggregated cardiometabolic risk, adjusting for their shared variance. Results showed both BPD features and depressive symptomatology related to the extent of cardiometabolic risk; when examined simultaneously, only BPD associated independently with risk indicators. In further supporting a link between BPD pathology and cardiovascular disease risk, these findings warrant future work to elucidate intervening behavioral and biological mechanisms. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Background Injured patients are at risk for prolonged opioid use after discharge from care. Limited evidence exists regarding how continued opioid use may be related to opioid medication misuse and opioid use disorder (OUD) following injury. This pilot study characterized opioid consumption patterns, health characteristics, and substance use among patients with active prescriptions for opioid medications following injury care. Methods This study was a cross-sectional screening survey combined with medical record review from February 2017 to March 2018 conducted among outpatient trauma and orthopedic surgery clinic patients. Eligible patients were 18–64 years of age, admitted/discharged for an injury or trauma-related orthopedic surgery, returning for clinic follow-up ≤6 months post hospital discharge after the index injury, prescribed opioid pain medication at discharge, and currently taking an opioid medication (from discharge or a separate prescription post discharge). Data collected included demographic, substance use, mental health, and physical health information. Descriptive and univariate statistics were calculated to characterize the population and opioid-related risks. Results Seventy-one participants completed the survey (92% response). Most individuals (≥75%) who screened positive for misuse or OUD reported no nonmedical/illicit opioid use in the year before the index injury. A positive depression screen was associated with a 3.88 times increased likelihood for misuse or OUD (95% confidence interval [CI] = 1.1–13.5). Nonopioid illicit drug use (odds ratio [OR] = 1.89, 95% CI = 1.1–3.4) and opioid craving (OR = 1.29, 95% CI = 1.1–1.5) were also associated with increased likelihood for misuse or OUD. Number of emergency department visits in the 3 years previous to the index injury was associated with a 22% likelihood of being misuse or OUD positive (95% CI = 1.0–1.5). Conclusions Patients with behavioral health concerns and greater emergency department utilization may have heightened risk for experiencing adverse opioid-related outcomes. Future research must further establish these findings and possibly develop protocols to identify patients at risk prior to pain management planning.

Two dimensional, hierarchical classification models of personality pathology have emerged as alternatives to traditional categorical systems: multi-tiered models with increasing numbers of factors and models that distinguish between a general factor of severity and specific factors reflecting style. Using a large sample (N=840) with a range of psychopathology, we conducted exploratory factor analyses of individual personality disorder criteria to evaluate the validity of these conceptual structures. We estimated an oblique, “unfolding” hierarchy and a bifactor model, then examined correlations between these and multi-method functioning measures to enrich interpretation. Four-factor solutions for each model, reflecting rotations of each other, fit well and equivalently. The resulting structures are consistent with previous empirical work and provide support for each theoretical model.

Personality disorders (PDs) are commonly associated with romantic relationship disturbance. However, research has seldom evaluated who people with high PD severity partner with, and what explains the link between PD severity and romantic relationship disturbance. First, we examined the degree to which people match with partners with similar levels of personality and interpersonal problems. Second, we evaluated whether the relationship between PD severity and romantic relationship satisfaction would be explained by attachment styles and demand/withdraw behavior. Couples selected for high PD severity (n = 130; 260 participants) engaged in a conflict task, were assessed for PDs and attachment using semi-structured interviews, and self-reported their relationship satisfaction. Dyad members were not similar in terms of PD severity but evidenced a small degree of similarity on specific attachment styles and were moderately similar on attachment insecurity and interpersonal problems. PD severity also moderated the degree to which one person's attachment anxiety was associated with their partner's attachment avoidance. In addition, using a dyadic analytic approach, we found attachment anxiety and actor and partner withdrawal explained some of the relationship between PD severity and relationship satisfaction. Our results indicate people often have romantic partners with similar levels of attachment disturbance and interpersonal problems and that attachment styles and related behavior explains some of the association between PD severity and relationship satisfaction. (PsycINFO Database Record (c) 2019 APA, all rights reserved).