Screening for Personality Disorders: A Comparison of the Dimensional NEO-FFI with the Categorical SAPAS-SR

Sara Germans, Alexander Rath, Guus L. Van Heck, Paul P. G. Hodiamont

Departement of Psychiatry, Hospital of Namsos, Namsos, Norway.
Department of Psychiatry, Radboud University Nijmegen, Nijmegen, The Netherlands.
Department of Psychology, Tilburg University, Tilburg, The Netherlands.
Department of Psychology, University Nijmegen, Nijmegen, The Netherlands.

DOI: 10.4236/psych.2013.42016                

Abstract

In psychiatric outpatients, the usefulness of the dimensional NEO-FFI as a screening instrument for personality disorders (PDs) was compared with the categorical screening instrument SAPAS-SR using the SCID-II as the gold standard. Major research questions are: 1) is the NEO-FFI a useful screening instrument for PDs? 2) does the NEO-FFI outperform a categorical screening instrument (SAPAS-SR)? 3) does combining both instruments improve the screening results? Extreme raising on Big Five personality trait domains (NEO-FFI) domain scores were examined in relation to the presence and the number of PDs as diagnosed, with to the SCID-II. Additionally, the NEO-FFI, in conjunction with a short self-report screening instrument (SAPAS-SR), was analysed with respect to sensitivity and specificity for screening of PDs. According to the SCID II, 97 patients (50%) were suffering from a PD. The majority of them had no (35.9%) or only one (40%) extreme score on one of the Big Five personality domains. There were no significant relationships between separate extreme traits on PD or five factor profiles, as proposed in the literature, and the presence of a SCID-II PD. Comparisons of the NEO-FFI with the SAPAS-SR showed no significant relationships. Using both screeners in conjunction resulted in an increase in specificity and the number of correctly classified cases at the expense, however, of the sensitivity. Correlation and regression analyses showed that personality traits are statistically significant predictors for each of the12 PDs. However, the associations between NEO-FFI scores and the DSM-VI-TR PD criteria were rather modest. Support could not be obtained for the view that separate extreme scores on basic personality traits or combinations of such scores in five-factor profiles will provide adequate screening possibilities for PDs. The SAPAS-SR has better screening potential than the NEO-FFI or the SAPAS-SR and the NEO-FFI together.

Keywords

Personality Disorders; Big Five; Personality Screening Instrument

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington, DC: Ameri can Psychiatric Association.
[2]	Costa, P. J., & McCrae, R. (1990). Personality disorders and the five-factor model of personality. Journal of Personality Disorders, 4, 362-371. doi:10.1521/pedi.1990.4.4.362
[3]	Costa, P. J., & McCrae, R. (1992). Revised NEO Personality Inventory (NEO-PI-R) and NEO Five-Factor Inventory (NEO-FFI) professional manual. Odessa, FL: Psychological Assessment Resources
[4]	Costa, P. J., & McCrae, R. (1992).The five-factor model of personality and its relevance to personality disorders. Journal of Personality Disorders, 4, 343-359. doi:10.1521/pedi.1992.6.4.343
[5]	Digman, J. (1990). Personality structure: Emergence of the five-factor model. Annual Review of Psychology, 41, 417-440. doi:10.1146/annurev.ps.41.020190.002221
[6]	DSM-5 Work Group (1990). Re: Personality and personality disorders. URL (last checked 12 December 2012) http://www.dsm5.org/Pages/Default.aspx
[7]	First, M., Spitzer, R., Gibbon, M., & Williams, J. (1995). The structured clinical interview for DSM-III-R personality disorders (SCID II): Part I: Description. Journal of Personality Disorders, 9, 92-104. doi:10.1521/pedi.1995.9.2.92
[8]	Germans, S., Van Heck, G. L., & Hodiamont, P. P. G. (2011). The Quick Personality Assessment Schedule (PAS-Q): Validation of a brief screening test for personality disorders in a population of psychiatric outpatients. Australian and New Zealand Journal of Psychiatry, 45, 756-762. doi:10.3109/00048674.2011.595683
[9]	Germans, S., Van Heck, G. L., Langbehn, D. R., & Hodiamont P. P. G. (2010). The Iowa Personality Disorder Screen (IPDS): Preliminary results of the validation of a self-administered version in a Dutch population. European Journal of Psychological Assessment, 26, 11 18. doi:10.1027/1015-5759/a000003
[10]	Germans, S., Van Heck, G. L., Moran. P., & Hodiamont, P. P. G. (2008). The self-report Standardized Assessment of Personality-Abbreviated Scale; Preliminary results of a brief screening test for personality disorders. Personality and Mental Health, 2, 70-76. doi:10.1002/pmh.34
[11]	Goldberg, L. R. (1990). An alternative “description of personality”: The big-five factor structure. Journal of Personality and Social Psychology, 59, 1216-1229. doi:10.1037/0022-3514.59.6.1216
[12]	Hoekstra, H. A., Ormel, J., De Fruyt, F. (1996). NEO-FFI big five per soonlijkheidsvragenlijst (NEO-FFI big five personality questionnaire). Lisse: Swets & Zeitlinger B.V.
[13]	Hyler, S. E., Skodol, A. E., Kellman, H., Oldham, J. M., & Rosnick, L. (1990). Validity of the Personality Diagnostic Questionaire-Revised: Comparison with two structured interviews. American Journal of Psychiatry, 147, 1043-1048.
[14]	Hyler, S., Skodol, A., Oldham, J. M., Kellman, H. D., & Doidge, N. (1992). Validity of the Personality Diagnostic Questionnaire-Revised: A replication in an outpatient sample. Comprehensive Psychiatry, 33, 73-77. doi:10.1016/0010-440X(92)90001-7
[15]	Langbehn, D. R., Pfohl, B. M., Reynolds, S., Clark, L. A., Battaglia, M., Bellodi, L., Cadoret, R., Grove, W., Pilkonis, P., & Links, P. (1999). The Iowa Personality Disorder Screen: Development and preliminary validation of a brief screening interview. Journal of Personality Disorders, 13, 75-89. doi:10.1521/pedi.1999.13.1.75
[16]	Maffei, C., Fossati, A., Agostoni, I., Barraco, A., Bagnato, M., Deborah D. et al. (1997). Interrater reliability and internal consistency of the structured clinical interview for DSM IV axis II personality disorder (SCID II) version 2.0. Journal of Personality Disorders, 11, 85-92. doi:10.1521/pedi.1997.11.3.279
[17]	Moran, P., Leese, M., Lee, T., Walter, P., Thornicroft, G., & Mann, A. (2003). Standardised Assessment of Personality-Abbreviated Scale (SAPAS): Preliminary validation of a brief screen for personality disorder. British Journal of Psychiatry, 183, 228-232. doi:10.1192/bjp.183.3.228
[18]	Moran, P., Walsh, E., Tyrer, P., Burns, T., Creed, F., & Fahy, T. (2003). The impact of co-morbid personality disorder on violence in psycho sis—Data from the UK700 trial. British Journal of Psychiatry, 182, 129-134. doi:10.1192/bjp.182.2.129
[19]	Morey, L. C., Waugh, M. H., & Blashfield, R. K. (1985). MMPI scales for DSM-III personality disorders: Their derivation and correlates. Journal of Personality Assessment, 49, 245-251. doi:10.1207/s15327752jpa4903_5
[20]	Newton-Howes, G., Tyrer, P., & Johnson, T. (2006). Personality disorder and the outcome of depression: Meta-analysis of published studies. British Journal of Psychiatry, 188, 13-20. doi:10.1192/bjp.188.1.13
[21]	Reich, J. (1989). Update on instruments to measure DSM-III and DSM-III-R personality disorders. Journal of Nervous and Mental Disease, 177, 366-370. doi:10.1097/00005053-198906000-00008
[22]	Rottman, B., Ahn, W., Sanislow, C., & Kim, N. (2009). Can clinicians recognize DSM-IV personality disorders from five-factor model de scriptions of patient cases? American Journal of Psychiatry, 166, 427-433. doi:10.1176/appi.ajp.2008.08070972
[23]	Samuel, D., & Widiger, T. (2008). A meta-analytic review of the relationships between the five-factor model and DSM-IV-TR personality disorders: A facet level analysis. Clinical Psychological, 28, 1326 1342. doi:10.1016/j.cpr.2008.07.002
[24]	Schotte, C., De Doncker, D., Vankerckhoven, C., Vertommen, H., & Cosyns, P. (1998). Self-report assessment of the DSM-IV personality disorders. Measurement of trait and distress characteristics: The ADP-IV. Psychological Medicine, 28, 1179-1188. doi:10.1017/S0033291798007041
[25]	Shedler, J., & Westen, D. (2004). Refining personality disorder diagnosis: Integrating science and practice. American Journal of Psychiatry, 161, 1350-1365. doi:10.1176/appi.ajp.161.8.1350
[26]	Spitzer, R., Williams, J., Gibbon, M., & First, M. (1990). Structured clinical interview for the DSM-III-R personality disorders (SCID-II). Washington, DC: American Psychiatric Press.
[27]	Trull, T. (1992). DSM-III-R Personality disorders and the five-factor model of personality: An empirical comparison. Journal of Abnormal Psychology, 101, 553-560. doi:10.1037/0021-843X.101.3.553
[28]	Van Horn, E., Manley, C., Leddy, D., Cicchetti, D., & Tyrer, P. (2000). Problems in developing an instrument for the rapid assessment of personality status. European Psychiatry, 15, 29-33. doi:10.1016/S0924-9338(00)90497-8
[29]	Verheul, R., & Van den Brink, W. (1999) Persoonlijkheidsstoornissen (Personality disorders). In A. De Jong, W. Van den Brink, J. Ormel, & D. Wiersma (Eds.), Handboek psychiatrische epidemiologie (Handbook of psychiatric epidemiology) (pp. 355-359) Maarsen: Elsevier/De Tijdstroom.
[30]	Weertman, A., Arntz, A., Dreessen, L., Van Velzen, C., & Vertommen, S. (2003). Short-interval test-retest interrater reliability of the Dutch version of the Structured Clinical Interview for DSM-IV personality disorders (SCID-II). Journal of Personality Disorders, 17, 562-567. doi:10.1521/pedi.17.6.562.25359
[31]	Weertman, A., Arntz, A., & Kerkhofs, M. (1997). Gestructureerd Klinisch Interview voor de DSM-III Persoonlijkheidsstoornissen (Structured clinical interview for the DSM-III personality disorders). Lisse: Swets Test Publisher.
[32]	Westen, D., & Shelder, J. (1999). Revising and assessing Axis II, Part I: Development of a clinically and empirically valid assessment method. American Journal of Psychiatry, 156, 258-272.
[33]	Westen, D., & Shelder, J. (1999). Revising and assessing Axis II, Part II: Toward an empirically based and clinically useful classification of personality disorders. American Journal of Psychiatry, 156, 273-285.
[34]	Widiger, T., Costa, P., & McCrae, R. (2002). A proposal for Axis II: Diagnosing personality disorders using the five-factor model. In Personality disorders and the five-factor model of personality (2nd ed., pp. 431-456). Washington, DC: American Psychological Association. doi:10.1037/10423-025
[35]	Widiger, T. A., & Mullins, S. (2003). Personality disorder. In A. Tasman, J. Kay, & J. A. Lieberman (Eds.), Psychiatry (2nd ed., pp. 1603-1637). Chichester: John Wiley & Sons.
[36]	Wiggins, J., & Pincus, A. (1989). Conceptions of personality disorders and dimensions of personality. Psychological Assessment: Journal of Consulting and Clinical Psychology, 1, 305-316.
[37]	World Health Organization (1992). International classification of diseases (10th Revision) Geneva: World Health Organization