Transcript Dia 1 - de Viersprong
Severity Indices of Personality Problems (SIPP-118) in adolescents: Factor structure, Reliability and Validity Joost Hutsebaut & Dineke Feenstra APA Annual Meeting San Francisco, 2009
Personality Disorders in adolescence
PD categories may be applied to children and adolescents in those relatively unusual instances in which the individual’s particular maladaptive personality traits appear to be pervasive, persistent, and unlikely to be limited to a particular developmental stage or an episode of an axis I disorder.
(DSM-IV-TR, 2000, p687)
Estimates of frequency of PDs in adolescence
Community sample (CIC study, Johnson et al., 2006)
– PD general 14,4%
Clinical sample (Feenstra et al., in prep.)
– PD general 56,0% • BPD 22,6% • PDNOS 22,96%
Validity of PDs in adolescents
Increasing evidence for the validity of PD diagnoses in adolescents
– Concurrent validity: PD diagnosis identifies a severely disturbed group of adolescents (Westen et al., 2003; CIC-study f.ex. Johnson et al., 2005; Kazan et al., 2007) – Predictive validity: PD diagnosis in adolescents is highly predictive for maladaptive functioning in (young) adulthood (CIC study)
Recent studies using a dimensional approach on personality pathology in adolescence
Dimensional Personality Symptom Item Pool (DIPSI) (De Clercq et al., 2003; 2006)
– DIPSI reveals a factor structure similar to adult personality pathology questionnaires
Dimensional Assessment of Personality Pathology (DAPP-BQ-A (Tromp & Koot, 2008)
– DAPP-BQ-A has a factor structure similar to DAPP-BQ
Shedler-Westen Assessment Procedure for Adolescents (SWAP-A) (Durrett & Westen; Westen et al., 2003)
This study
Replication of original study aims in adolescents
– Factor structure – Reliability of facet and domain scores – Validity of SIPP as a measure of severity of personality pathology – Validity of SIPP as a measure of changeable components of PP
Discussion on a life-span perspective on PDs
Methods
Participants & instruments
– Normal sample: • N = 406 • Mean age 16.3
• 84 male, 322 female • Instruments: SIPP, SCL-90, DAPP-BQ – Clinical sample 1: • N = 129 • Mean age 16.9
• 21 male, 108 female • Instruments: SIPP, SCL-90, DAPP-BQ – Clinical sample 2: • N = 263 • Mean age 16.3
• 42 male, 221 female • Instruments: SIPP, SCL-90, DEQ-A • Measurement at start, after 6 en 12 months
Domains 1. Self control 2. Identity integration 3. Relational capacities 4. Social concordance 5. Responsibility
Factor structure
Facets Emotion Regulation Effortful control Stable self image Enjoyment Purposefulness Self respect Self-reflexive functioning Intimacy Enduring relationships Feeling recognized Respect Co-operation Frustration tolerance Aggression regulation Trustworthiness Responsible industry
Results CFA and reliability of facet and domain scores 1. Homogeneity of facets
Median Crohnbach’s alpha was .79 (range .68 - .90)
2. Factor structure
CFA gives acceptable fit indices ( χ²/df=5.28; NNFI=.97; CFI=.97, SRMR=.062)
Validity:
comparing facet scores of clinical and normal sample Clinical versus non-clinical
4 3,5 3 2,5 2 1,5 1 E m ot io n re gu E la tio ffo rtf n ul c on S tro el l f r S es ta S bl el pe e f r ct se ef lf le im xi ag ve fu e nc tio ni ng E nj oy P m ur en po t se fu ln E es nd s ur In in tim g ac re la y tio Fe el ns in hi g A ps re gg co re gn ss io iz n Fr ed re us gu tra la tio tio n n to le ra nc e C oo pe ra R tio n es R po es ns pe ib ct le in du Tr st us ry tw or th in es s Non-clinical sample Clinical sample
Validity:
comparing facet scores of PD and no-PD subgroups within clinical sample PD versus no-PD
4 3,5 3 2,5 2 1,5 1 E m ot io n re gu la E tio ffo n rtf ul c on tro S el l f r S es ta S bl pe el e f r ct se ef lf le im xi ag ve e fu nc tio ni ng E nj oy P m ur en po t se fu ln E es nd s In ur tim in g ac re y la tio Fe ns el in hi g A ps re gg co re gn ss iz io ed n Fr re us gu tra la tio tio n n to le ra nc e C oo pe ra tio R n es R po es pe ns ib ct le in du Tr st us ry tw or th in es s No PD sample PD sample
Validity:
comparing domain scores of 4 subgroups with a different number of PD traits
Severity of personality pathology (number of PD traits)
Responsibility Social concordance Relational functioning Identity integration Selfcontrol 0 1 2 3 4 5 6 Quartile4 Quartile3 Quartile2 Quartile1
Validity
Personality pathology: correlation with DEQ-A DEQ-A scales DEQ dependence DEQ self-criticism DEQ efficacy Median Self control domain -.43
-.54
-.09
-.43
SIPP domains Identity integration domain -.53
Relational functioning domain -.37
Social concordance domain -.27
Responsibility domain -.20
-.76
-.04
-.53
-.74
-.07
-.37
-.48
-.15
-.27
-.35
-.05
-.20
Validity
SIPP DAPP higher order Self-control Identity Integration Emotional dysregulation
-.66
-.82
Dissocial
-.57
-.32
Relational functioning Responsi bility Social concordance
-.64
-.36
-.39
-.66
-.50
-.67
Inhibition
-.39
Compulsivity
.02
-.63
-.17
-.63
-.13
-.19
.47
-.22
-.01
Sensitivity to change
SIPP
7 6 5 4 3 2 1 0 Start treatment 6-months 12-months Selfcontrol Social concordance Identity integration Relational functioning Responsibility
Adolescent PD compared to adult PD
6 5 4 3 2 1 0 Se lf Soc Ide nt SIPP dom ains Re l funct r e s p Adult PD Adole s ce nt PD
Conclusions
Promising instrument for measuring severity of personality pathology in adolescents
– Factor structure comparable to adult factor structure – Good reliability – Good validity (so far)
Useful as an outcome instrument, sensitive to change
Preliminary evidence for the need of a developmental perspective
– Structure of personality pathology is highly similar – Personality of PD adolescents seems to be less adaptive
Need for further research
First study in adolescent sample, more studies are needed.
Validity needs to be established further; e.g. what is the added value of the SIPP compared to other PP instruments
Similarities and differences between adolescent PP and adult PP
Does the instrument need change to include a life span perspective more explicitly?
– Do the items express personality pathology in adolescents in a sufficient developmentally sensitive way? – Do the facets and domains encompass all aspects of personality pathology in adolescence?
– …
Only a first step has been taken…
Contact
Website:
– – www.vispd.nl
www.deviersprong.nl
Email: