Associations between DSM-5 section III personality traits and the Minnesota Multiphasic Personality Inventory 2-Restructured Form (MMPI-2-RF) scales in a psychiatric patient sample.

Psychological Assessment 2015, Vol. 27, No. 3, 801– 815

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Associations Between DSM-5 Section III Personality Traits and the Minnesota Multiphasic Personality Inventory 2-Restructured Form (MMPI-2-RF) Scales in a Psychiatric Patient Sample Jaime L. Anderson

Martin Sellbom

University of Alabama

Australian National University

Lindsay Ayearst

Lena C. Quilty

University of Toronto Scarborough

Centre for Addiction and Mental Health, University of Toronto

Michael Chmielewski

R. Michael Bagby

Southern Methodist University

University of Toronto

Our aim in the current study was to evaluate the convergence between Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) Section III dimensional personality traits, as operationalized via the Personality Inventory for DSM-5 (PID-5), and Minnesota Multiphasic Personality Inventory 2–Restructured Form (MMPI-2-RF) scale scores in a psychiatric patient sample. We used a sample of 346 (171 men, 175 women) patients who were recruited through a university-affiliated psychiatric facility in Toronto, Canada. We estimated zero-order correlations between the PID-5 and MMPI-2-RF substantive scale scores, as well as a series of exploratory structural equation modeling (ESEM) analyses to examine how these scales converged in multivariate latent space. Results generally showed empirical convergence between the scales of these two measures that were thematically meaningful and in accordance with conceptual expectations. Correlation analyses showed significant associations between conceptually expected scales, and the highest associations tended to be between scales that were theoretically related. ESEM analyses generated evidence for distinct internalizing, externalizing, and psychoticism factors across all analyses. These findings indicate convergence between these two measures and help further elucidate the associations between dysfunctional personality traits and general psychopathology. Keywords: MMPI-2-RF, DSM-5, personality disorders, personality traits

scholars, including both psychologists and psychiatrists (e.g., Clark, 2007; Clemence, Perry, & Plakun, 2009; Livesley, 2001; Vinnars & Barber, 2008; Watson, Clark, & Chmielewski, 2008; Widiger & Mullins-Sweatt, 2010). Research has highlighted problems with this categorically based diagnostic system since its inception in the DSM-III (APA, 1980), which included issues such as the temporal instability of PDs, poor convergent and discriminant validity across the disorders, excessive diagnostic comorbidity, and excessive heterogeneity within diagnoses (for reviews, see, e.g., Clark, 2007; Skodol et al., 2011; Widiger & Trull, 2007). For this reason, many researchers have called for a dimensional model that is more consistent with literature on PDs (see, e.g., Widiger, Simonsen, Sirovatka, & Regier, 2006). In response to the criticisms of the PD operationalization in earlier versions of the DSM, the DSM-5 Personality and Personality Disorders (P&PD) workgroup developed an alternative PD model that is more reflective of past empirical research supporting a dimensional trait system for the characterization of personality pathology (Harkness & McNulty, 1994; Krueger, Eaton, Derringer, et al., 2011; Samuel & Widiger, 2008; Watson, Clark, & Hartness, 1994; Widiger & Simonsen, 2005; among others). This

The current operationalization of the diagnosis of personality disorders (PDs) in Section II of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013), which is virtually identical to that employed for the Axis II PDs in the DSM-IV-TR (APA, 2000), is widely believed to be flawed by most personality psychopathology

This article was published Online First March 30, 2015. Jaime L. Anderson, Department of Psychology, University of Alabama; Martin Sellbom, Research School of Psychology, Australian National University; Lindsay Ayearst, Department of Psychology, University of Toronto Scarborough; Lena C. Quilty, Centre for Addiction and Mental Health, Department of Psychology, University of Toronto; Michael Chmielewski, Department of Psychology, Southern Methodist University; R. Michael Bagby, Department of Psychology, University of Toronto. Portions of this research were funded by two grants from the University of Minnesota Press, publisher of the MMPI-2-RF. Correspondence concerning this article should be addressed to Martin Sellbom, Research School of Psychology, Building 39, The Australian National University, Canberra ACT 2601, Australia. E-mail: martin.sellbom@ anu.edu.au 801


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model is a hybrid dimensional/categorical model, which includes impairment criteria, dimensional personality traits, and six categorical PD diagnoses (operationalized by a combination of functional impairment and maladaptive traits for each disorder). The focus of the current study, the dimensional personality model (Criterion B of the model), is a set of 25 dimensional, lower order maladaptive personality traits or facets, which can be combined to create five, higher order personality domain traits and differentially configured to assess one of the six personality disorders in Section III of the DSM-5 (American Psychiatric Association, 2013). To operationalize this model, the workgroup developed a new instrument, the Personality Inventory for DSM-5 (PID-5; Krueger, Eaton, Clark, et al., 2011)—a 220-item self-report inventory. Previous research on this trait model has shown associations with other well-validated and widely accepted dimensional models of personality such as the five-factor model (FFM; De Fruyt et al., 2013; Gore & Widiger, 2013; Thomas et al., 2013; Widiger, Costa, Gore, & Crego, 2013) and the Personality Psychopathology Five (PSY-5; Anderson et al., 2013; Finn, Arbisi, Erbes, Polusny, & Thuras, 2014; Harkness, Finn, McNulty, & Shields, 2012). In addition, research has been conducted on more recently developed dimensional measures of personality psychopathology. For instance, Kushner, Quilty, Tackett, and Bagby (2011) evaluated the factor structure of the Dimensional Assessment of Personality Pathology–Basic Questionnaire (DAPP-BQ) and found four of the five factors were conceptually related to the PID-5 domain structure. Van den Broeck et al. (2014) evaluated this empirically and found convergence between four of the five PID-5 domains (including Antagonism, Disinhibition, Negative Affectivity, and Detachment) and theoretically similar DAPP-BQ traits. Furthermore, Wright and Simms (2014) found convergence between the Computerized Adaptive Test of Personality Disorder–Short Form (CAT-PD-SF; Simms et al., 2011), NEO Personality Inventory– Revised (NEO PI-R; Costa & McCrae, 2008), and the PID-5 in that they aligned as conceptually expected at every hierarchical level of analyses (i.e., two through five factors). More specifically, this study showed a five-factor structure best accounted for the traits found on all three measures. The DSM-5 PD proposal for the hybrid model formulated by the P&PD workgroup was ultimately rejected by the American Psychiatric Association Board of Trustees for inclusion in Section II due to a general lack of accumulated scientific evidence supporting its validity and clinical utility. As a result of this decision, the DSM-IV-TR nosology for the PDs was retained in full as the primary diagnostic model in the DSM-5 Section II chapter for the personality disorders. The hybrid model was instead relegated to Section III of the DSM-5 in a chapter entitled “Emerging Models and Measures,” with the expectation and hope that researchers would begin to examine the hybrid PD model in Section III and to accumulate a larger base of evidence bearing on its validity. For this reason, more research is needed to better understand this alternative hybrid model and, in particular, the core dimensional traits, which form the diagnostic “backbone” of Criterion B. In light of previously established associations between personality traits and general psychopathology (for a review, see Kotov, Gamez, Schmidt, & Watson, 2010), which go beyond just relations to PDs (Hopwood & Sellbom, 2013; Krueger, Hopwood, Wright, & Markon, 2014; Krueger & Tackett, 2003), it is important to

further elucidate the association between this trait model and broadband measures of psychopathology. Indeed, the idea of categorical (rather than dimensional) diagnosis has little to no empirical support (Haslam, Holland, & Kuppens, 2012), and researchers have therefore moved toward conceptualizing both personality and psychopathology dimensionally. Furthermore, previous research has shown a strong connection between PDs and other forms of psychopathology, and dimensional personality traits have at times shown greater associations with DSM-IV-TR “Axis I” disorders than “Axis II” disorders (Kotov et al., 2010; Samuel & Widiger, 2008). Therefore, with the advent of the DSM-5 Section III alternative model, we are now provided a method in the DSM with which we can more closely examine the association between pathological personality traits and other types of psychopathology and move further toward their integration. To assess general psychopathology, many clinicians use wellknown and well-validated omnibus measures of psychopathology, such as the Minnesota Multiphasic Personality Inventory 2–Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2011) and the Personality Assessment Inventory (PAI; Morey, 1991, 2007). These clinicians may continue to rely on these more comprehensive and time-efficient measures to assess for personality psychopathology, particularly if a sufficient amount of research shows the PID-5 measurement of personality psychopathology to be related to these omnibus measures. Indeed, recent studies have already begun to establish preliminary associations between omnibus clinical measures of psychopathology, such as the MMPI-2-RF and the PAI and the DSM-5 Section III trait model. More specifically, these studies examined the associations between PID-5 trait scales and conceptually relevant scales on these measures (Anderson et al., 2013; Hopwood et al., 2013; Sellbom, Anderson, & Bagby, 2013). Hopwood et al. (2013) evaluated the convergence between the PID-5 and the PAI scales using a sample of university undergraduate students. They found substantial and meaningful correlations between scales on these instruments and that most PAI scale scores could be mapped onto the PID-5 five-factor structure. Anderson et al. (2013) supported the convergence between the conceptually linked domain structures of the MMPI-2-RF PSY-5 scales and PID-5 trait scale scores in a large undergraduate sample. Similarly, Sellbom et al. (2013) conducted a study using the entire scale set of the MMPI2-RF, in which they examined the extent to which this measure could be utilized to assess for Section III traits and diagnoses using a combined Canadian and U.S. university sample. These authors found that the MMPI-2-RF scale scores generally converged with both PID-5 trait scales and DSM-5 Section III PDs (as defined by their respective trait profiles) as conceptually expected. However, these authors specifically aimed to evaluate the extent to which MMPI-2-RF scales could capture Section III personality traits and did not examine the conjoint factor structure of these two measures to determine general associations between the two models of psychopathology. Moreover, research has not yet examined the associations between Section III dimensional traits and omnibus clinical personality measures in psychiatric patient samples, in which there is a substantially greater range of psychopathology. In the current study, we aimed to examine the associations between the PID-5 measurement of the DSM-5 Section III dimensional trait structure and MMPI-2-RF scale scores. The MMPI2-RF is a widely used and well-validated omnibus inventory of


DSM-5 TRAITS AND MMPI-2-RF IN A PATIENT SAMPLE

personality and psychopathology composed of 338 items, which aggregate into 42 “substantive” scales arranged in a hierarchical fashion and map well onto contemporary models of personality and psychopathology (e.g., Bagby et al., 2014; Sellbom, BenPorath, & Bagby, 2008; Tellegen & Ben-Porath, 2011). The MMPI-2-RF can help assess the way in which Section III traits are associated with general psychopathology given the wide range of clinical problems that this instrument is designed to assess. For instance, the MMPI-2-RF measures clinically relevant constructs such as internalizing and externalizing psychopathology, thought dysfunction, interpersonal difficulties, somatic symptom complaints, and dimensional personality psychopathology. It is hypothesized the PID-5 measurement of Section III traits will converge well with the hierarchical psychopathology structure as operationalized via MMPI-2-RF scale scores. Similar to the findings of Sellbom et al. (2013), we expected the internalizing scales on the MMPI-2-RF would be most highly associated with Negative Affectivity and Detachment domain scales on the PID-5, the externalizing MMPI-2-RF scales would be most strongly associated with Antagonism and Disinhibition PID-5 domains, and the MMPI-2-RF Psychoticism scales would show the greatest associations with PID-5 Psychoticism scales. This information is important for several reasons. First, it continues to establish the relationship between different forms of dysfunctional personality traits and more general psychopathology, which has both conceptual and practical implications. In addition, this study will aid in further validating the personality trait structure included in Section III by examining its associations with the well-validated MMPI-2-RF hierarchical structure, as well as further elucidate the role of the MMPI-2-RF in measuring these traits if/when this trait structure becomes the primary method for PD diagnosis.

Method Participants The sample used in this study included 435 patients who were recruited from a patient research registry maintained at a university-affiliated addiction and mental health center in Toronto, Canada.1 Some of these patients had previously participated in the American Psychiatric Association DSM-5 field trial and who were subsequently entered into the patient research registry; others in the registry pool had been recruited before or after the field trial. To be entered into the registry, all patients had to provide written informed consent and agree to be contacted for future research studies. The study sample can be best described as diagnostically heterogeneous and included those with anxiety disorders (e.g., obsessive-compulsive disorder, posttraumatic stress disorder, generalized anxiety disorder, social phobia), mood disorders (e.g., bipolar, major depression, dysthymia), psychotic disorders (e.g., schizophrenia, schizoaffective, attenuated psychotic disorder), substance and alcohol disorders, pathological gambling, and personality disorders (e.g., antisocial, avoidant, borderline, dependent, obsessive-compulsive, schizoid, schizotypal). Of these, 89 participants (20.5%) were removed from the data analysis because the MMPI-2-RF protocols were deemed invalid due to excessive inconsistent or overreported responding (here defined by MMPI-2-RF Cannot Say scale scores ⬎18, Variable Response Inconsistency scale scores ⬎80T, True Response Inconsistency scale

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sores ⬎80T, Infrequent Responses scale scores ⬎120T, and Infrequent Psychopathology Responses ⬎100T), leaving a total of 346 patients. The final sample used in the data analyses was composed of 171 men and 175 women, with a mean age of 38.94 years (SD ⫽ 10.17). The majority of participants self-identified as White (68.9%), Asian (9.7%), or Black (4.3%); the remaining reporting being “mixed” or of “other” ethnoracial background, with 85.5% speaking English as their first language. The diagnoses for the patients were derived from the patient’s chart (in the case of the research registry participants) or from the psychiatrist’s referral (in the case of the field trial participants). All patients were treatment seeking.

Measures MMPI-2-RF. The MMPI-2-RF (Ben-Porath & Tellegen, 2011) is a restructured version of the MMPI-2 consisting of 338 true or false items. This inventory includes nine validity scales, three Higher-Order (H-O) scales, nine Restructured Clinical (RC) scales, 23 Specific Problems (SP) scales, two Interest scales, and five PSY-5 scales. In the current study, estimates of internal consistencies (i.e., Cronbach’s coefficient alpha) ranged from .83 (Behavioral/Externalizing Dysfunction) to .94 (Emotional/Internalizing Dysfunction) for the H-O scales, .83 (Antisocial Behavior) to .94 (Demoralization) for the RC scales, .60 (Disaffiliativeness) to .87 (Social Avoidance) for the SP scales, and .78 (Aggressiveness) to .86 (Introversion/Low Positive Emotionality) for the PSY-5 scales. A list of all scales (and the abbreviations used to designate them throughout this article), along with descriptive statistics, is displayed in Table 1. PID-5. The PID-5 (Krueger, Eaton, Clark, et al., 2011) is a 220-item self-report inventory developed to index the 25 DSM-5 Section III personality trait facets and the five personality trait domains as reported in Criterion B of the Section III personality and personality disorder model. Item responses are based on a 4-point rating scale ranging from 0 (very false) to 3 (very true). Domain scores are calculated as an average of the three most representative facet scores included under each domain as per formal scoring procedures (American Psychiatric Association, 2014). Internal consistencies (Cronbach’s coefficient alpha) ranged from .75 (Suspiciousness) to .95 (Eccentricity) for the facet scores and from .92 (Antagonism) to .95 (Psychoticism) for the domain-level scales. Descriptive statistics are displayed in Table 2.

Procedures Research registry patients were approached by trained research coordinators or assistants, under the supervision of a registered clinical psychologist, about participating in the current study. Participants in the DSM-5 field trial were asked to return at a later date to complete an additional battery of self-report measures. All participants had to be 18 years of age or older. The Research Ethics Board at the center approved the use of the patient research registry in general and for the current study in particular. Patients were monetarily compensated for their participation. 1 A portion of this sample has been utilized in previous studies (e.g., Markon, Quilty, Babgy, & Krueger, 2013; Quilty et al., 2013). However, the research aims and analyses included in the current study are unique and have yet to be examined empirically.

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804 Table 1 List of MMPI-2-RF Scales and Descriptive Statistics


Scale abbreviation

Full scale name

Higher-Order scales EID THD BXD Restructured Clinical scales RCd RC1 RC2 RC3 RC4 RC6 RC7 RC8 RC9 Somatic/Cognitive Specific Problems scales MLS GIC HPC NUC COG Internalizing Specific Problems scales SUI HLP SFD NFC STW AXY ANP BRF MSF Externalizing Specific Problems scales JCP SUB AGG ACT Interpersonal Specific Problems scales FML IPP SAV SHY DSF Personality Psychopathology Five scales AGGR-r PSYC-r DISC-r NEGE-r INTR-r

M

SD

Range

Emotional/Internalizing Dysfunction Thought Dysfunction Behavioral/Externalizing Dysfunction

66.51 61.14 55.70

14.81 16.70 12.34

33–92 39–100 32–94

Demoralization Somatic Complaints Low Positive Emotions Cynicism Antisocial Behavior Ideas of Persecution Dysfunctional Negative Emotions Aberrant Experiences Hypomanic Activation

67.56 65.23 65.54 55.17 60.60 65.24 60.94 59.22 50.42

13.86 13.81 16.69 12.49 13.00 17.05 14.51 15.22 11.98

37–86 36–100 34–99 34–83 34–99 43–100 34–94 39–100 25–88

Malaise Gastrointestinal Complaints Head Pain Complaints Neurological Complaints Cognitive Complaints

66.59 62.41 59.25 64.79 65.57

13.93 16.46 12.46 14.29 15.56

38–87 46–96 42–85 41–100 40–96

Suicidal/Death Ideation Helplessness Self-Doubt Inefficacy Stress/Worry Anxiety Anger Proneness Behavior Restricting Fears Multiple Specific Fears

65.12 63.15 62.53 60.10 61.04 65.85 56.81 58.64 48.72

20.14 15.43 13.16 12.66 12.26 18.81 12.13 15.11 8.22

45–100 40–88 42–76 36–80 36–81 44–100 39–80 43–100 36–78

Juvenile Conduct Problems Substance Abuse Aggression Activation

58.05 57.77 53.95 52.21

12.71 14.72 12.44 12.99

40–84 41–93 37–92 33–83

Family Problems Interpersonal Passivity Social Avoidance Shyness Disaffiliativeness

60.17 52.17 58.47 53.12 59.69

13.63 11.48 13.83 10.91 15.75

37–90 34–81 36–80 37–75 44–100

Aggressiveness Psychoticism Disconstraint Negative Emotionality/Neuroticism Introversion/Low Positive Emotionality

48.80 60.22 53.39 62.86 61.03

11.27 16.40 11.68 13.91 15.30

28–83 38–100 31–85 32–95 32–93

Note. Only scales used in the current analyses are included in this table. The Minnesota Multiphasic Personality Inventory 2⫺Restructured Form (MMPI-2-RF) also includes a set of nine validity scales and two interest scales, which are not listed here.

Results Correlation Analyses We examined associations between MMPI-2-RF scales and PID-5 domain and facet scales using zero-order correlations. We used a highly conservative alpha level of .0016 (.05 divided by 30 PID-5 domains and facets) due to the large number of correlations in these analyses. Given the current sample size, an absolute correlation of .17 was considered statistically significant. However, due to the possibility of shared method variance possibly artificially inflating effect size magnitudes, we focused our inter-

pretations on correlations of moderate (i.e., r ⫽ .30 –.49) or large (r ⱖ .50) magnitude (Cohen, 1992). These results are organized by MMPI-2-RF scale sets (i.e., H-O scales, RC scales, SP scales, and PSY-5 scales), presented in Tables 3 through 6. H-O scales. Generally, the associations were as expected between the MMPI-2-RF H-O scales and PID-5 domain and facet scales. These results are shown in Table 3. For instance, although EID (Emotional/Internalizing Dysfunction) had moderate correlations with four of five domains (PID-5 Antagonism being the exception), this scale had its largest associations with the PID-5 Detachment and Negative Affectivity domains and their respective



Table 2 List of Personality Inventory for DSM-5 Scales and Descriptive Statistics Scale

M

SD

Range

Antagonism Manipulativeness Deceitfulness Grandiosity Attention Seeking Callousness Disinhibition Irresponsibility Impulsivity Distractibility Risk Taking Rigid Perfectionism Detachment Withdrawal Anhedonia Intimacy Avoidance Restricted Affectivity Negative Affectivity Depressivity Suspiciousness Emotional Lability Anxiousness Separation Insecurity Perseveration Submissiveness Hostility Psychoticism Unusual Thoughts and Beliefs Eccentricity Cognitive and Perceptual Dysregulation

.77 .85 .77 .70 .95 .48 1.11 .77 1.12 1.43 1.19 1.11 1.25 1.33 1.46 .97 .97 1.38 1.23 1.23 1.46 1.69 1.00 1.22 1.33 1.17 .91 .77 1.17 .79

.57 .76 .68 .61 .75 .47 .63 .64 .78 .80 .59 .72 .65 .79 .80 .82 .69 .71 .83 .64 .86 .84 .81 .68 .76 .70 .61 .67 .81 .58

0–2.80 0–3 0–2.80 0–3 0–3 0–2.36 0–2.88 0–2.86 0–3 0–3 0–2.86 0–3 0–3 0–3 0–3 0–3 0–3 0–3 0–3 0–3 0–3 0–3 0–3 0–2.89 0–3 0–2.90 0–2.51 0–2.63 0–2.92 0–2.58

Note. DSM-5 ⫽ Diagnostic and Statistical Manual of Mental Disorder, fifth edition.

facets. THD (Thought Dysfunction) showed its highest correlations with PID-5 Psychoticism and its facets but was also moderately associated with the PID-5 Negative Affectivity domain and its facets. Finally, as would be anticipated, the BXD (Behavioral/ Externalizing Dysfunction) scale generally had the largest associations with the PID-5 Antagonism and Disinhibition domains and their facets. RC scales. An expected pattern of associations was also found with regard to the MMPI-2-RF RC scales (see Table 3). RCd (Demoralization) and RC7 (Dysfunctional Negative Emotions) had their largest associations with the PID-5 Negative Affectivity domain and its facets but also evinced large associations with the Detachment domain and its facets. However, quite unexpectedly, RCd and RC7 showed very high associations with the Disinhibition domain and its facets, indicating a potential lack of discriminant validity for this trait domain. RC1 (Somatic Complaints) had its highest correlations with PID-5 Negative Affectivity and its facets (particularly PID-5 Anxiousness and Emotional Lability), and RC2 (Low Positive Emotions) had its largest associations with the Detachment domain, particularly the Anhedonia facet. RC3 (Cynicism) had at least moderate associations with the majority of PID-5 domains and facets but had particularly high correlations with the PID-5 Suspiciousness and Hostility facets, reflective of a paranoid ideation. RC scales commonly associated with externalizing (RC4 and RC9) were expectedly highly associated with the

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externalizing PID-5 domains (Antagonism and Disinhibition) and their facets. More specifically, RC4 (Antisocial Behavior) was particularly highly associated with PID-5 Hostility and Impulsivity facets, whereas RC9 (Hypomanic Activation) also had a high correlation with the PID-5 Psychoticism domain, which was not particularly surprising given the large prevalence of individuals with psychotic and manic symptoms in this sample. Finally, MMPI-2-RF RC scales most associated with psychosis, RC6 (Ideas of Persecution) and RC8 (Aberrant Experiences), evinced their largest associations with the PID-5 Psychoticism domain and its facets. In addition, RC6 also had a large correlation with the PID-5 Suspiciousness facet, as theoretically expected. SP scales. Again, expected correlations were generally found with the MMPI-2-RF SP scales. These results are shown in Tables 4 and 5. Generally, the SP scales were most highly associated with PID-5 Negative Affectivity, although these scales typically evinced moderate to large correlations with the PID-5 Disinhibition and Detachment domains as well. The COG (Cognitive Complaints) scale showed a different pattern, and its highest correlations were with the PID-5 Psychoticism domain as well as the PID-5 Distractibility facet—neither of which was conceptually unexpected. With regard to the SP scales of an internalizing nature, with the exception of MSF (Multiple Specific Fears), which did not exhibit moderate correlations with any PID-5 scales, the internalizing scales typically had the largest associations with the PID-5 Negative Affectivity domain and its facets. In addition, high correlations were observed with the Disinhibition and Detachment domains, although typically smaller in magnitude relative to the Negative Affectivity domain and facets. Not surprisingly, the externalizing SP scales tended to evince their largest correlations with the PID-5 Antagonism and Disinhibition domains and their facets. The MMPI-2-RF AGG (Aggression) scale was an exception to this pattern; although moderate to large associations were found between this scale and the externalizing PID-5 scales, this scale also tended to have moderate to large associations with the Negative Affectivity domain and its facets. Finally, with regard to the interpersonal SP scales, the pattern of associations was dependent on the MMPI-2-RF scale. Overall, however, these patterns were theoretically expected. Although many scales, including SAV (Social Avoidance), SHY (Shyness), and DSF (Disaffiliativeness), had the largest associations with the PID-5 Detachment domain and its facets, FML (Family Problems) had its largest associations with PID-5 Negative Affectivity, and IPP (Interpersonal Passivity) was most highly associated (negatively) with PID-5 Antagonism. PSY-5 scales. Finally, the PSY-5 scales generally converged with the PID-5 domains and facets in a pattern that was expected and consistent with prior research. Generally, each PSY-5 scale was most highly associated with its thematically relevant PID-5 counterpart (i.e., MMPI-2-RF Aggressiveness with PID-5 Antagonism, MMPI-2-RF Psychoticism with PID-5 Psychoticism, MMPI-2-RF Negative Emotionality/Neuroticism with PID-5 Negative Affectivity, and MMPI-2-RF Introversion/Low Positive Emotionality with PID-5 Detachment). The DISC-r (Disconstraint) scale differed from this pattern slightly in that it was most highly associated with PID-5 Negative Affectivity. In addition, it was associated with both its PID-5 Disinhibition counterpart but also with PID-5 Antagonism. However, this was not unexpected, given previous research that has shown a similar pattern of associations

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Table 3 Correlations Between PID-5 Domains and Facets and MMPI-2-RF Higher-Order and Restructured Clinical Scales

Antagonism Manipulativeness Deceitfulness Grandiosity Attention Seeking Callousness Disinhibition Irresponsibility Impulsivity Distractibility Risk Taking Rigid Perfectionism Detachment Withdrawal Anhedonia Intimacy Avoidance Restricted Affectivity Negative Affectivity Depressivity Suspiciousness Emotional Lability Anxiousness Separation Insecurity Perseveration Submissiveness Hostility Psychoticism Unusual Thoughts and Beliefs Eccentricity Perceptual Dysregulation

EID

THD

BXD

RCd

RC1

RC2

RC3

RC4

RC6

RC7

RC8

RC9

.14 .09 .29 ⫺.05 .06 .22 .59 .49 .36 .62 ⫺.07 .32 .69 .59 .81 .27 .17 .73 .86 .52 .61 .76 .46 .62 .35 .51 .38 .41 .45 .12

.25 .18 .21 .24 .15 .19 .26 .16 .26 .21 .08 .17 .14 .15 .14 .06 .05 .34 .20 .42 .27 .34 .25 .31 .06 .23 .62 .43 .56 .66

.47 .44 .44 .26 .40 .40 .42 .35 .47 .25 .46 .18 .10 .12 .11 .00 .11 .26 .19 .33 .26 .20 .18 .22 ⫺.02 .51 .36 .37 .27 .26

.22 .18 .35 .00 .17 .21 .66 .52 .43 .69 .01 .34 .63 .52 .79 .22 .17 .76 .84 .51 .64 .77 .50 .65 .39 .53 .46 .47 .51 .20

.13 .14 .19 ⫺.03 .04 .10 .40 .26 .35 .36 .11 .26 .29 .31 .31 .08 .06 .48 .35 .42 .45 .44 .30 .37 .17 .35 .38 .33 .42 .25

⫺.08 ⫺.12 .10 ⫺.17 ⫺.20 .17 .34 .31 .13 .41 ⫺.21 .16 .66 .58 .71 .30 .19 .44 .66 .35 .33 .51 .26 .40 .18 .26 .20 .25 .26 ⫺.02

.43 .33 .41 .32 .24 .38 .38 .31 .35 .29 .20 .30 .35 .32 .38 .14 .20 .41 .40 .55 .35 .39 .29 .33 .18 .48 .41 .40 .35 .29

.41 .40 .41 .17 .31 .34 .49 .41 .51 .31 .40 .18 .22 .23 .22 .08 .11 .38 .34 .41 .35 .34 .26 .26 .06 .52 .37 .37 .33 .25

.25 .16 .23 .24 .19 .24 .23 .13 .26 .17 .06 .20 .19 .19 .19 .08 .01 .39 .26 .56 .31 .39 .28 .31 .10 .33 .50 .39 .43 .49

.28 .24 .37 .08 .17 .22 .59 .46 .45 .56 .04 .39 .51 .48 .56 .20 .13 .78 .67 .59 .67 .78 .49 .65 .39 .58 .55 .51 .58 .53

.28 .22 .26 .21 .16 .17 .35 .26 .31 .29 .15 .17 .15 .15 .15 .07 .11 .33 .21 .29 .30 .31 .23 .35 .10 .20 .73 .55 .65 .74

.56 .49 .49 .40 .55 .40 .43 .31 .47 .30 .48 .30 ⫺.02 .04 .04 ⫺.12 .08 .35 .17 .39 .39 .27 .22 .34 .09 .55 .49 .50 .35 .38

Note. An absolute r of .17 is significant at the .0016 level. Correlations of at least moderate magnitude are bolded. MMPI-2-RF ⫽ Minnesota Multiphasic Personality Inventory 2⫺Restructured Form; PID-5 ⫽ Personality Inventory for Diagnostic and Statistical Manual of Mental Disorders, fifth edition; EID ⫽ Emotional/Internalizing Dysfunction; THD ⫽ Thought Dysfunction; BXD ⫽ Behavioral/Externalizing Dysfunction; RCd ⫽ Demoralization; RC1 ⫽ Somatic Complaints; RC2 ⫽ Low Positive Emotions; RC3 ⫽ Cynicism; RC4 ⫽ Antisocial Behavior; RC6 ⫽ Ideas of Persecution; RC7 ⫽ Dysfunctional Negative Emotions; RC8 ⫽ Aberrant Experiences; RC9 ⫽ Hypomanic Activation.

for this scale (see Anderson et al., 2013). These results are shown in Table 6.

Exploratory Structural Equation Modeling We further examined associations between MMPI-2-RF scales and PID-5 facets using exploratory structural equation modeling (ESEM) to better understand the organization of the PID-5 and MMPI-2-RF trait constructs in a conjoint fashion. Four separate structural models were estimated using the 25 PID-5 facets in each and separating the MMPI-2-RF scales into models with the H-O scales, RC scales, SP scales, and PSY-5 scales, respectively. For each model, several factor structures were evaluated and the bestfitting (both statistically and theoretically) model was chosen in each set of analyses.2 We tested a series of factor models based on theory. No less than three factors were evaluated to account for the three-factor model of psychopathology (internalizing, externalizing, and psychoticism), and up to seven factors were evaluated to account for the number of possible distinct personality and clinical factors that could come out of these data. For instance, the MMPI2-RF SP scales include fear and distress internalizing symptoms, interpersonal difficulties, somatic/cognitive symptoms, and impulsive and aggressive externalizing symptoms. For this reason, up to seven factors were evaluated in this model. Similarly, the PSY-5

and PID-5 were not theoretically expected to converge beyond a five-factor structure (see Anderson et al., 2013), so three-, four-, and five-factor models were evaluated for those analyses. In addition, to prevent the PID-5 and MMPI-2-RF from simply creating their own method factors, additional latent instrument factors were estimated and constrained to allow all of the scales to otherwise freely associate with one another without influence of the measure (see Hopwood et al., 2013, for a similar procedure with PID-5 and PAI). We used maximum likelihood estimation, and all missing data were handled via full-information maximum likelihood estimation. Moreover, we used standard absolute (root mean square error of approximation [RMSEA] ⱕ .08, standardized root mean square residual [SRMR] ⱕ .08) and incremental (Comparative Fit Index [CFI] ⱖ .90) fit indices to make decisions about model fit (see, e.g., Little, 2013), given that the chi-square statistic is typically inflated due to large sample size. Finally, we inter-

2 Only the chosen models are presented in the current study. Although several models had similar fit theoretically, models that were not chosen typically had significantly worse statistical model fit than the models chosen for analysis in this study. The additional models that were evaluated (but ultimately not selected) are available from the corresponding author upon request.


807


Table 4 Correlations Between PID-5 Domains and Facets and MMPI-2-RF Somatic/Cognitive and Internalizing Specific Problem Scales


MLS

GIC

HPC

NUC

COG

SUI

HLP

SFD

NFC

STW

AXY

ANP

BRF

MSF

.07 .06 .20 ⫺.09 .00 .16 .46 .39 .23 .54 ⫺.07 .19 .54 .46 .65 .19 .12 .51 .60 .33 .45 .51 .31 .43 .17 .35 .30 .30 .36 .12

.10 .14 .15 ⫺.06 .04 .12 .34 .28 .27 .31 .09 .17 .31 .30 .36 .09 .08 .44 .38 .36 .40 .41 .29 .29 .10 .35 .27 .26 .33 .12

.04 .05 .13 ⫺.09 .00 .04 .28 .17 .24 .27 .03 .28 .24 .25 .30 .02 .02 .43 .33 .39 .39 .40 .29 .30 .12 .32 .28 .24 .32 .18

.09 .08 .10 .03 .02 .08 .31 .20 .29 .27 .08 .14 .19 .22 .14 .09 .11 .26 .17 .21 .27 .24 .13 .28 .13 .19 .37 .30 .39 .28

.17 .12 .26 .05 .14 .18 .62 .44 .44 .66 .08 .22 .43 .33 .53 .17 .18 .58 .54 .39 .50 .58 .40 .54 .31 .36 .60 .57 .59 .38

.13 .13 .19 .00 .17 .14 .29 .26 .22 .24 .06 .19 .32 .22 .42 .12 .05 .41 .60 .26 .39 .37 .28 .29 .23 .33 .25 .25 .30 .09

.07 .02 .20 ⫺.04 .02 .19 .39 .33 .22 .41 ⫺.14 .25 .54 .41 .66 .24 .12 .51 .71 .37 .41 .53 .38 .42 .29 .32 .28 .32 .32 .07

.16 .14 .30 ⫺.07 .16 .13 .56 .47 .35 .58 ⫺.05 .24 .53 .42 .68 .19 .15 .67 .76 .44 .53 .68 .47 .55 .40 .44 .36 .39 .42 .13

.15 .09 .26 .03 .12 .18 .53 .43 .35 .56 ⫺.08 .32 .46 .40 .54 .17 .12 .65 .59 .49 .50 .65 .47 .59 .40 .43 .36 .39 .42 .13

.17 .13 .26 .02 .14 .13 .49 .35 .32 .53 .06 .38 .37 .33 .49 .08 .07 .64 .57 .47 .55 .71 .35 .56 .27 .43 .37 .38 .42 .16

.15 .15 .23 ⫺.02 .10 .03 .36 .25 .27 .36 .00 .26 .33 .29 .42 .09 .00 .64 .51 .43 .52 .69 .39 .46 .28 .33 .45 .38 .52 .28

.33 .27 .38 .17 .25 .33 .51 .38 .48 .41 .23 .36 .30 .31 .35 .06 .04 .56 .45 .49 .62 .47 .29 .41 .13 .76 .32 .35 .32 .13

.10 .12 .10 .03 .13 .02 .27 .18 .23 .27 ⫺.08 .27 .21 .18 .22 .11 .03 .44 .23 .32 .33 .37 .41 .27 .18 .22 .24 .18 .28 .18

⫺.05 ⫺.03 ⫺.04 ⫺.06 .01 ⫺.12 ⫺.02 ⫺.02 .02 ⫺.06 ⫺.22 .01 .00 ⫺.01 ⫺.02 .04 ⫺.13 .17 .04 .08 .10 .14 .21 .03 .04 ⫺.01 .00 ⫺.09 .07 .06

Note. An absolute r of .17 is significant at the .0016 level. Correlations of at least moderate magnitude are bolded. MMPI-2-RF ⫽ Minnesota Multiphasic Personality Inventory 2⫺Restructured Form; PID-5 ⫽ Personality Inventory for Diagnostic and Statistical Manual of Mental Disorders, fifth edition; MLS ⫽ Malaise; GIC ⫽ Gastrointestinal Complaints; HPC ⫽ Head Pain Complaints; NUC ⫽ Neurological Complaints; COG ⫽ Cognitive Complaints; SUI ⫽ Suicidal/Death Ideation; HLP ⫽ Helplessness; SFD ⫽ Self-Doubt; NFC ⫽ Inefficacy; STW ⫽ Stress/Worry; AXY ⫽ Anxiety; ANP ⫽ Anger Proneness; BRF ⫽ Behavior Restricting Fears; MSF ⫽ Multiple Specific Fears.

preted fully standardized factor loadings of .40 or greater as meaningful. H-O scales and PID-5 facets. After evaluating models with three to five factors, we concluded that a three-factor model best accounted for the variance in the MMPI-2-RF H-O and PID-5 facet scales. The estimated model was associated with an RMSEA of .09, SRMR of .04, CFI of .89, and ␹2(265) ⫽ 956.441, with interfactor correlations ranging from .23 (internalizing/externalizing factors) to .37 (externalizing/psychoticism factors). Standardized loadings for all scales on each factor are shown in Table 7. This model rendered three clear factors consistent with other three-factor models of psychopathology reported in the extant literature (e.g., Kotov et al., 2011) as well as included in the MMPI-2-RF (Internalizing, Externalizing, and Thought Dysfunction).3 For instance, MMPI-2-RF EID and PID-5 Anhedonia, Depressivity, and Anxiousness (among others) loaded onto an internalizing factor. Similarly, MMPI-2-RF BXD and PID-5 Risk Taking, Manipulativeness, and Attention Seeking (among others) loaded onto an externalizing factor. Finally, PID-5 Eccentricity, Perceptual Dysregulation, and Unusual Thoughts and Beliefs loaded together with MMPI-2-RF THD onto a psychoticism factor. Although there were four PID-5 facets (PID-5 Intimacy Avoidance, Restricted Affectivity, Rigid Perfectionism, and Submissive-

ness) that did not load significantly on any factor, the remaining scales converged with their conceptually expected factors, with only two significant cross-loadings (PID-5 Hostility and Irresponsibility loaded onto both internalizing and externalizing factors) between factors. RC scales and PID-5 facets. We evaluated three- to sevenfactor models for the RC scales and PID-5 facets and concluded that a five-factor model was the best fit. The estimated model was associated with an RMSEA of .08, SRMR of .03, CFI of .90, and ␹2(561) ⫽ 8,772.070, p ⬍ .001, with interfactor correlations ranging from .06 (detachment/internalizing factors) to .37 (psychoticism/externalizing factors). These results are shown in Table 8. These factors appeared to represent the “big three” psychopathology factors—internalizing, externalizing, and thought dysfunction—in addition to smaller and more specific detachment and paranoid personality factors. The internalizing factor was best represented by scales such as PID-5 Anhedonia and Depresssivity 3 Although a five-factor model aligning with the PID-5 structure was both expected and tested, four-factor and five-factor models failed to converge and could not be estimated using the PID-5 facets and MMPI2-RF H-O scales.

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Table 5 Correlations Between PID-5 Domains and Facets and MMPI-2-RF Externalizing and Interpersonal Specific Problem Scales


JCP

SUB

AGG

ACT

FML

IPP

SAV

SHY

DSF

.30 .28 .29 .15 .25 .29 .32 .22 .38 .19 .27 .09 .11 .13 .04 .11 .11 .19 .11 .30 .17 .17 .13 .11 ⫺.03 .35 .26 .27 .20 .20

.32 .34 .30 .12 .20 .23 .38 .38 .38 .20 .37 .05 .14 .12 .19 .02 .07 .24 .27 .20 .24 .19 .15 .15 .06 .34 .23 .23 .21 .14

.40 .35 .39 .23 .31 .46 .39 .32 .39 .27 .29 .29 .20 .25 .25 ⫺.01 .06 .41 .37 .44 .45 .36 .23 .33 .04 .68 .36 .40 .31 .20

.32 .30 .29 .18 .36 .15 .39 .25 .41 .29 .35 .26 ⫺.01 .02 ⫺.03 ⫺.01 .01 .37 .14 .24 .43 .29 .21 .33 .16 .33 .49 .48 .40 .38

.22 .20 .22 .10 .16 .26 .33 .24 .29 .30 .15 .29 .23 .25 .30 .01 .05 .50 .40 .48 .42 .49 .34 .38 .15 .45 .35 .35 .36 .21

ⴚ.32 ⴚ.32 ⫺.17 ⴚ.30 ⴚ.34 ⫺.18 .02 .05 ⫺.10 .09 ⴚ.34 ⫺.19 .29 .20 .25 .23 .06 .08 .20 ⫺.10 ⫺.01 .14 .08 .06 .28 ⴚ.31 ⫺.02 ⫺.01 .06 ⫺.10

⫺.07 ⫺.12 .01 ⫺.05 ⴚ.36 .21 .16 .13 .03 .24 ⫺.23 .19 .61 .68 .46 .34 .29 .22 .37 .20 .17 .33 .05 .27 .00 .17 .13 .18 .13 .00

.01 ⫺.04 .12 ⫺.05 ⫺.10 .11 .32 .28 .19 .32 ⫺.10 .20 .55 .58 .50 .25 .26 .40 .48 .33 .24 .48 .28 .40 .33 .19 .23 .24 .27 .08

.22 .11 .26 .20 ⫺.03 .42 .31 .31 .18 .29 .07 .18 .60 .63 .37 .44 .40 .19 .36 .27 .18 .24 .05 .29 .07 .32 .25 .26 .28 .10

Note. An absolute r of .17 is significant at the .0016 level. Correlations of at least moderate magnitude are bolded. MMPI-2-RF ⫽ Minnesota Multiphasic Personality Inventory 2⫺Restructured Form; PID-5 ⫽ Personality Inventory for Diagnostic and Statistical Manual of Mental Disorders, fifth edition; JCP ⫽ Juvenile Conduct Problems; SUB ⫽ Substance Abuse; AGG ⫽ Aggression; ACT ⫽ Activation; FML ⫽ Family Problems; IPP ⫽ Interpersonal Passivity; SAV ⫽ Social Avoidance; SHY ⫽ Shyness; DSF ⫽ Disaffiliativeness.

and MMPI-2-RF RCd, RC2, and RC7. The externalizing factor included scales such as PID-5 Manipulativeness and Deceitfulness and MMPI-2-RF RC4 and RC9. The third factor appeared to represent detachment, because this factor had loadings that included PID-5 Withdrawal and Restricted Affectivity as well as MMPI-2-RF RC2. Similar to the previous analyses with the MMPI-2-RF H-O scales, the psychoticism factor included PID-5 Eccentricity, Perceptual Dysregulation, and Unusual Thoughts and Beliefs, along with MMPI-2-RF RC6 and RC8 loaded onto this factor. Finally, the fifth factor appeared to represent a paranoid personality style, with representative factor loadings of PID-5 Suspiciousness, Hostility, and, to a lesser degree, MMPI-2-RF RC6. PID-5 Intimacy Avoidance, Rigid Perfectionism, and MMPI2-RF RC3 did not load onto any factor. SP scales and PID-5 facets. After evaluating models with three to seven factors, we concluded that a six-factor model best accounted for the variance in the MMPI-2-RF SP scales and PID-5 facets. The estimated model was associated with an RMSEA of .06, SRMR of .04, CFI of .89, and a ␹2(1, 128) ⫽ 11,517.690, p ⬍ .001, with interfactor correlations ranging from .02 (lack of suicidality/detachment factors) to .55 (negative emotionality/internalizing factors). These results are shown in Table 9. These analyses also rendered factors, which appeared to represent the “big three” in addition to smaller factors representing more specific negative

emotionality, detachment, and lack of suicidality. Generally, the PID-5 facet loadings remained similar to previous internalizing, externalizing, and psychoticism scales from the RC scale analyses, and the MMPI-2-RF SP scales typically conformed to a similar structure. The internalizing factor included scales such as PID-5 Anhedonia, Distractibility, and MMPI-2-RF HLP (Helplessness) and SFD (Self-Doubt). The general externalizing factor included scales such as PID-5 Callousness and Hostility as well as MMPI2-RF AGG and (low) IPP. Not surprisingly, the psychoticism factor remained virtually identical and included PID-5 Eccentricity, Perceptual Dysregulation, and Unusual Thoughts and Beliefs. No MMPI-2-RF SP scales loaded onto this factor, which is not surprising because the MMPI-2-RF thought dysfunction hierarchy of scales ends with the RC scales. Some of the internalizing scales bifurcated into two different factors as well, representing detachment and negative emotionality, respectively. The negative emotionality factor included expected scales such as PID-5 Anxiousness and Suspiciousness and MMPI-2-RF AXY (Anxiety) and STW (Stress/Worry). The detachment factor included scales such as PID-5 Withdrawal and Restricted Affectivity along with relevant MMPI-2-RF interpersonal scales SAV and DSF. Finally, this model also rendered a sixth factor representing disavowal of suicidal ideation, onto which MMPI-2-RF SUI (Suicidal Death Ideation) was the sole factor loading in the negative direction. The


809


Table 6 Correlations Between PID-5 Domains and Facets and MMPI-2-RF PSY-5 Scales


AGGR

PSYC

DISC

NEGE

INTR

.42 .39 .28 .37 .38 .33 .04 .01 .16 ⫺.06 .37 .19 ⫺.22 ⫺.12 ⫺.19 ⫺.21 ⫺.01 ⫺.03 ⫺.13 .17 .08 ⫺.09 ⫺.06 ⫺.02 ⫺.27 .42 .17 .11 .01 .17

.29 .21 .25 .27 .18 .19 .31 .20 .30 .27 .08 .18 .16 .16 .17 .07 .07 .36 .22 .37 .29 .33 .28 .35 .13 .24 .66 .46 .60 .70

.44 .42 .40 .27 .39 .37 .39 .32 .42 .25 .52 .11 .05 .07 .07 ⫺.03 .16 .15 .13 .23 .15 .10 .12 .16 .00 .37 .33 .35 .24 .24

.23 .19 .33 .03 .16 .16 .58 .43 .44 .57 .02 .38 .47 .41 .35 .17 .04 .78 .66 .57 .70 .78 .48 .59 .32 .57 .45 .44 .51 .23

⫺.15 ⫺.19 ⫺.03 ⫺.14 ⴚ.37 .17 .14 .16 ⫺.04 .24 ⴚ.30 .12 .65 .63 .58 .35 .25 .22 .47 .20 .15 .33 .07 .24 .05 .15 .05 .10 .11 ⫺.09

Note. An absolute r of .17 is significant at the .0016 level. Correlations of at least moderate magnitude are bolded. MMPI-2-RF ⫽ Minnesota Multiphasic Personality Inventory 2⫺Restructured Form; PID-5 ⫽ Personality Inventory for Diagnostic and Statistical Manual of Mental Disorders, fifth edition; PSY-5 ⫽ Personality Psychopathology Five; AGGR ⫽ Aggressiveness; PSYC ⫽ Psychoticism; DISC ⫽ Disconstraint; NEGE ⫽ Negative Emotionality/Neuroticism; INTR ⫽ Introversion/Low Positive Emotionality.

MMPI-2-RF SP scales ACT (Activation), SUB (Substance Abuse), MSF, NUC (Neurological Complaints), HPC (Head Pain Complaints), and GIC (Gastrointestinal Complaints) did not load meaningfully on any factor. PSY-5 scales and PID-5 facets. Finally, we evaluated threeto five-factor models for the PSY-5 scales and PID-5 facets and concluded that a five-factor model was the best fit. The estimated model was associated with an RMSEA of .08, SRMR of .03, CFI of .90, and ␹2(435) ⫽ 7,059.924, p ⬍ .001, with interfactor correlations ranging from ⫺.01 (psychoticism/aggression factors) to .36 (externalizing/psychoticism factors). These results are shown in Table 10. These factors appeared to represent negative affectivity, general externalizing, psychoticism, and detachment factors, as well as a specific aggression factor. The negative affectivity factor included scales such as PID-5 Anxiousness and Emotional Lability as well as MMPI-2-RF NEGE-r (Negative Emotionality/Neuroticism). The externalizing factor included the majority of PID-5 facets from the Antagonism and Disinhibition domains (particularly PID-5 Risk Taking and Deceitfulness) as well as and MMPI-2-RF DISC-r (and, to a lesser degree, MMPI2-RF AGGR-r). A separate detachment domain was rendered, which included scales such as PID-5 Restricted Affectivity and Withdrawal as well as MMPI-2-RF INTR-r. The psychoticism

factor again remained identical with the exception of the addition of the MMPI-2-RF PSYC-r scale. Finally, this model also rendered a fifth factor appearing to represent aggression, as it included the scales PID-5 Hostility and MMPI-2-RF AGGR-r. In this model, PID-5 Grandiosity and Submissiveness did not load meaningfully onto any of the five factors.

Discussion In the current investigation, we examined the convergence between dimensional DSM-5 Section III personality traits and the MMPI-2-RF scale scores. Correlation analyses rendered an overall expected pattern of results. MMPI-2-RF scales of an internalizing nature typically had the greatest associations with negative affectivity and detachment domains and facets on the PID-5. This pattern of results is similar to that which was reported by Sellbom et al. (2013) using university students from two different countries, although the magnitude of associations was generally greater in this patient sample. For instance, MMPI-2-RF EID, RCd, RC2, RC7, INTR-r, NEGE-r, and internalizing SP scales were, generally speaking, highly associated with the PID-5 Detachment and Negative Affectivity domains and their facets. Similarly, externalizing MMPI-2-RF scales such as BXD, RC4, RC9, DISC-r, AGGR-r,

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Table 7 MMPI-2-RF Higher Order Scales and PID-5 Facets ESEM Model

PID-5 Anhedonia Anxiousness Depressivity Distractibility Emotional Lability Perseveration Separation Insecurity Suspiciousness Withdrawal Attention Seeking Callousness Deceitfulness Grandiosity Hostility Impulsivity Irresponsibility Manipulativeness Risk Taking Eccentricity Perceptual Dysregulation Unusual Thoughts and Beliefs Intimacy Avoidance Restricted Affectivity Rigid Perfectionism Submissiveness MMPI⫺2-RF EID BXD THD

Factor 1

Factor 2

Factor 3

⌰

.88 .76 .91 .63 .58 .60 .44 .47 .63 ⫺.03 .15 .21 ⫺.16 .48 .29 .46 .01 ⫺.16 .28 .34 ⫺.10 .31 .18 .33 .39

⫺.13 ⫺.08 ⫺.03 .16 .20 .07 .09 .13 ⫺.02 .58 .55 .58 .45 .55 .54 .46 .60 .67 .23 .01 ⫺.02 ⫺.13 .11 .14 ⫺.06

⫺.04 .22 .01 .10 .14 .27 .17 .24 .00 .12 ⫺.01 .08 .28 ⫺.05 .07 ⫺.02 .10 ⫺.03 .51 .65 .90 .02 .05 .15 .14

.24 .27 .18 .47 .38 .43 .53 .58 .34 .55 .43 .50 .61 .38 .49 .49 .59 .58 .39 .33 .23 .67 .53 .79 .79

.97 .06 .01

⫺.10 .63 ⫺.09

⫺.03 .05 .77

.09 .50 .27

Note. Underlined factor loadings indicate an absolute factor loading of .40. MMPI-2-RF ⫽ Minnesota Multiphasic Personality Inventory 2⫺Restructured Form; PID-5 ⫽ Personality Inventory for Diagnostic and Statistical Manual of Mental Disorders, fifth edition; ESEM ⫽ exploratory structural equation modeling; EID ⫽ Emotional/Internalizing Dysfunction; THD ⫽ Thought Dysfunction; BXD ⫽ Behavioral/Externalizing Dysfunction.

and externalizing SP problem scales were generally most highly associated with PID-5 Disinhibition and Antagonism domains and facets. Finally, MMPI-2-RF scales associated with symptoms of psychoticism (i.e., THD, RC6, RC8, and PSYC-r) were highly associated with the PID-5 Psychoticism domain and its facets. The ESEM analyses also generally produced results that would be expected. Although the PID-5 five-factor structure was not clearly replicated in this sample, three distinct factors representing internalizing, externalizing, and psychoticism were represented in each model. This factor structure was most salient when the PID-5 facets were evaluated with the MMPI-2-RF H-O scales. In the subsequent models, this pattern continued to emerge. However, when these subsequent models were forced into a three-factor structure, the models were typically associated with poor model fit and a greater number of variables that did not meaningfully load on any factor. Particularly with respect to the externalizing structure, this could be due to the fact that multiple indicators for the higher order domains allow for more reliable variance relative to the lower order domains, which might account for greater convergence at the H-O scale level.

The PID-5 and MMPI-2-RF appeared to measure a three-factor model of psychopathology in a similar fashion, and it was only when the internalizing and externalizing factors began to bifurcate into multiple factors that these two measures began to assess psychopathology differently. For instance, in the current study, differences also emerged with the internalizing factors, where clear negative affectivity and detachment domains did not always emerge when these scales were evaluated in latent space. In addition, the way in which these measures separate the externalizing factor into antagonism/aggression and disinhibition/disconstraint domains differs, and this separation was not adequately captured in the present analyses using ESEM models. However, as previously noted, Anderson et al. (2013) and Sellbom et al. (2013) have also found that the MMPI-2-RF and PID-5 scales scores appear to better converge at the broader externalizing level of psychopathology (see also Morey et al., 2013; Wright et al., 2012), with only greater specificity at the measurement of hostility/ aggression. In addition, the consistent “big three” factors that emerged were not surprising given past research using the MMPI2-RF. Similar results were seen at the three-factor level by Bagby and colleagues (2014), who analyzed the PSY-5 factor structure using Goldberg’s (2006) “bass-ackward” method in a patient sample. Several PID-5 facets did not load on any factor in several estimated models. In particular, PID-5 Rigid Perfectionism, Intimacy Avoidance, and Submissiveness did not load on any factor in multiple models. This could have particularly problematic implications for the diagnostic conceptualization of obsessive-compulsive PD in Section III, given that Rigid Perfectionism and Intimacy Avoidance are two facets that make up this disorder. Future research should further investigate these facets and, more specifically, how these results may affect the categorical PD diagnoses present in this model. The most unexpected findings were those that included MMPI2-RF internalizing scales (e.g., EID, RCd, RC7, and NEGE) and PID-5 Disinhibition, in that these associations were larger than those that involved the MMPI-2-RF externalizing scales. This PID-5 domain is scored as an average of PID-5 Distractibility, PID-5 Irresponsibility, and PID-5 Impulsivity, with the former two being more strongly associated with negative affectivity than externalizing in both the zero-order and multivariate analyses. Thus, in this psychiatric inpatient sample, inability to focus, concentrate, and engage in responsible, consistent behavior is better tied to internalizing proclivities than acting out (see also Quilty, Ayearst, Chmielewski, Pollock, & Babgy, 2013). PID-5 Impulsivity, however, which is arguably a better core marker for disinhibition than any other scale, was appropriately most strongly associated with MMPI-2-RF scales reflective of externalizing behavior. Although results were generally conceptually expected, it is nonetheless important to note that deviations from expected patterns may also be a product of the measurement being used. The PID-5 was developed as a measure to assess for Section III personality traits; however, PID-5 scale scores are not, themselves, these constructs but rather measurements of them. Therefore, the interpretations of these results should take this into account, and implications about the model itself should be limited to the construct validity of the PID-5 measure. In particular, issues of PID-5 discriminant validity in the Disinhibition domain should be further evaluated given its strong associations with MMPI-2-RF internalizing scales.


811


Table 8 MMPI-2-RF Restructured Clinical Scales and PID-5 Facets ESEM Model

PID-5 Anhedonia Anxiousness Depressivity Distractibility Emotional Lability Perseveration Separation Insecurity Submissiveness Suspiciousness Withdrawal Attention Seeking Callousness Deceitfulness Grandiosity Hostility Impulsivity Irresponsibility Manipulativeness Risk Taking Restricted Affectivity Eccentricity Perceptual Dysregulation Unusual Thoughts and Beliefs Intimacy Avoidance Rigid Perfectionism MMPI-2-RF RCd RC1 RC2 RC7 RC4 RC9 RC6 RC8 RC3

Factor 1

Factor 2

Factor 3

Factor 4

Factor 5

⌰

.84 .86 .90 .65 .66 .67 .56 .50 .49 .50 .04 ⫺.03 .15 ⫺.18 .42 .26 .37 ⫺.01 ⫺.23 .02 .25 .36 ⫺.06 .21 .39

⫺.05 ⫺.13 .04 .23 .11 .05 .05 ⫺.02 .03 .05 .57 .61 .69 .44 .47 .56 .63 .68 .66 .24 .29 .08 .05 ⫺.04 ⫺.03

.25 ⫺.17 .08 ⫺.02 ⫺.25 ⫺.16 ⫺.32 ⫺.30 ⫺.01 .45 ⫺.50 .37 ⫺.03 ⫺.11 .02 ⫺.05 .15 ⫺.17 ⫺.05 .41 .03 ⫺.03 ⫺.04 .35 ⫺.20

⫺.09 .06 ⫺.07 .04 .03 .11 .04 ⫺.01 .08 .00 ⫺.10 ⫺.04 ⫺.01 .09 ⫺.17 .08 .02 ⫺.02 .01 .06 .44 .59 .82 .06 ⫺.03

⫺.03 .14 ⫺.04 ⫺.18 .15 .06 ⫺.03 ⫺.21 .48 .14 ⫺.02 .30 ⫺.01 .25 .41 ⫺.05 ⫺.26 ⫺.02 .02 ⫺.04 .06 ⫺.07 .03 ⫺.03 .36

.23 .22 .20 .42 .29 .38 .56 .65 .39 .34 .39 .38 .41 .52 .28 .44 .31 .48 .58 .39 .40 .30 .26 .69 .67

.94 .41 .75 .74 .17 ⫺.01 .16 .02 .27

.03 ⫺.04 ⫺.22 .00 .48 .58 ⫺.05 ⫺.01 .27

.02 .07 .41 ⫺.04 .05 ⫺.25 ⫺.01 .06 .08

⫺.02 .29 ⫺.03 .18 .03 .07 .42 .89 .05

⫺.08 .10 ⫺.02 .14 .20 .30 .38 ⫺.04 .34

.08 .64 .26 .20 .56 .13 .53 .19 .52

Note. Underlined factor loadings indicate an absolute factor loading of .40. MMPI-2-RF ⫽ Minnesota Multiphasic Personality Inventory 2⫺Restructured Form; PID-5 ⫽ Personality Inventory for Diagnostic and Statistical Manual of Mental Disorders, fifth edition; ESEM ⫽ exploratory structural equation modeling; RCd ⫽ Demoralization; RC1 ⫽ Somatic Complaints; RC2 ⫽ Low Positive Emotions; RC3 ⫽ Cynicism; RC4 ⫽ Antisocial Behavior; RC6 ⫽ Ideas of Persecution; RC7 ⫽ Dysfunctional Negative Emotions; RC8 ⫽ Aberrant Experiences; RC9 ⫽ Hypomanic Activation.

These results have several implications. One implication is that these two inventories converged on the measurement of core psychopathology domains (internalizing, externalizing, and psychoticism). However, the instruments also diverged in several ways. For instance, although typically there were significant associations with each of the MMPI-2-RF and PID-5 scales, there are also some specific scales on each measure that were not well captured by the other. Most notably, the MMPI-2-RF scale set did not capture the PID-5 Restricted Affectivity, Submissiveness, and Rigid Perfectionism scales well relative to the other PID-5 scales. Similarly, PID-5 did not appear to capture MMPI-2-RF MSF and BRF (Behavior Restricting Fears) scales with the same magnitude with which it captured other MMPI2-RF scales. It is also important to note that several scales did not load onto any factor meaningfully in the ESEM analyses (although this may not have been the case if we had used a more liberal factor loading of .30). On the PID-5, the Intimacy Avoidance, Rigid Perfectionism, and Submissiveness facets did not load onto any factor in two sets of analyses. More research on these facets may be needed to

assess their respective utility on the PID-5. In addition, several MMPI-2-RF scales were not captured in the ESEM models. Not surprisingly, many of the somatic SP scales (NUC, HPC, and GIC) did not load meaningfully onto any of the factors. In addition, RC3, ACT (Activation), SUB, and MSF also did not load onto any factor. This was somewhat surprising given the conceptual basis for these scales. One might expect, for instance, SUB and ACT to load onto an externalizing factor or for MSF to load onto an internalizing factor. However, generally, these scales tended to have lower associations with PID-5 scales (relative to other MMPI-2-RF scales), and this could have accounted for these findings. Another important implication is that clinicians may use the MMPI-2-RF to infer information regarding the DSM-5 Section III personality traits. This is particularly important given that many clinicians may be hesitant to administer an additional fairly lengthy personality inventory, particularly in cases where they already administer a broadband personality and psychopathology instrument such as the MMPI-2-RF. Similar to research by Anderson et al. (2013) and

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Table 9 MMPI-2-RF Specific Problems Scales and PID-5 Facets ESEM Model

PID-5 Anhedonia Depressivity Distractibility Irresponsibility Perseveration Separation Insecurity Submissiveness Callousness Deceitfulness Grandiosity Hostility Impulsivity Manipulativeness Risk Taking Anxiousness Emotional Lability Rigid Perfectionism Suspiciousness Eccentricity Perceptual Dysregulation Unusual Thoughts and Beliefs Attention Seeking Intimacy Avoidance Restricted Affectivity Withdrawal MMPI-2-RF MLS COG SUI HLP SFD NFC ANP JCP AGG IPP STW AXY BRF FML SAV SHY DSF ACT SUB MSF NUC HPC GIC

Factor 1

Factor 2

Factor 3

Factor 4

Factor 5

Factor 6

⌰

.72 .40 .64 .61 .42 .43 .49 ⫺.08 .20 ⫺.30 .08 .36 .00 .00 .40 .37 ⫺.07 .05 .26 .37 ⫺.02 .14 .12 .04 .10

⫺.01 .06 .13 .31 .09 ⫺.02 ⫺.23 .64 .44 .42 .80 .42 .43 .52 ⫺.01 .30 .26 .30 .22 .01 .02 .38 ⫺.07 .10 .13

.04 .04 ⫺.01 ⫺.24 .27 .31 .08 ⫺.10 ⫺.03 .01 .32 ⫺.03 .01 ⫺.23 .60 .42 .44 .52 ⫺.01 .04 .02 ⫺.03 ⫺.08 ⫺.25 .20

⫺.04 .01 .04 .00 .20 .07 .15 .08 .13 .34 ⫺.16 .03 .16 .08 .11 ⫺.01 .11 .12 .55 .65 .79 .17 .12 .25 .06

.30 .08 .03 .03 .06 ⫺.28 ⫺.13 .38 ⫺.03 .11 .08 ⫺.15 ⫺.13 ⫺.19 .00 ⫺.20 .09 .08 .07 .01 ⫺.03 ⫺.40 .51 .57 .77

⫺.20 ⫺.39 .28 .16 .09 ⫺.04 ⫺.03 ⫺.01 ⫺.02 .01 .00 .25 ⫺.07 .15 ⫺.04 .04 ⫺.10 ⫺.07 .10 .00 .03 ⫺.02 ⫺.05 .00 ⫺.02

.25 .03 .33 .33 .41 .55 .68 .42 .26 .60 .18 .47 .23 .60 .17 .35 .67 .47 .33 .29 .36 .50 .68 .54 .17

.59 .55 .56 .69 .74 .45 .06 ⫺.13 ⫺.04 .46 .36 .27 .03 .04 .01 .28 .03 .00 .26 ⫺.09 .08 .08 .21

⫺.01 ⫺.04 .12 ⫺.06 .00 .03 .66 .47 .73 ⫺.63 .08 ⫺.06 ⫺.05 .29 ⫺.05 ⫺.15 .25 .31 .39 ⫺.15 .01 .08 .15

.08 .09 ⫺.02 .07 .19 .38 .43 .11 .28 ⫺.12 .45 .48 .43 .45 .26 .27 .02 .17 ⫺.12 .32 .11 .38 .26

⫺.08 .27 .04 ⫺.04 ⫺.07 ⫺.03 ⫺.23 .06 ⫺.06 .03 ⫺.01 .23 .10 .06 ⫺.07 ⫺.01 .08 .30 ⫺.01 .03 .25 .05 .00

.17 .01 ⫺.07 .13 ⫺.01 .04 .01 .03 .00 .22 ⫺.03 ⫺.08 ⫺.03 .00 .72 .40 .59 ⫺.26 ⫺.10 ⫺.10 .07 .05 .04

.02 .27 ⫺.41 ⫺.21 ⫺.03 .18 .13 .08 ⫺.06 .07 .12 ⫺.03 .14 ⫺.02 .02 .08 ⫺.01 .24 ⫺.05 ⫺.05 .24 .03 .03

.39 .31 .58 .43 .30 .38 .27 .75 .41 .51 .41 .42 .72 .59 .36 .51 .53 .55 .77 .84 .50 .50 .57

Note. Underlined factor loadings indicate an absolute factor loading of .40. MMPI-2-RF ⫽ Minnesota Multiphasic Personality Inventory 2⫺Restructured Form; PID-5 ⫽ Personality Inventory for Diagnostic and Statistical Manual of Mental Disorders, fifth edition; ESEM ⫽ exploratory structural equation modeling; MLS ⫽ Malaise; GIC ⫽ Gastrointestinal Complaints; HPC ⫽ Head Pain Complaints; NUC ⫽ Neurological Complaints; COG ⫽ Cognitive Complaints; SUI ⫽ Suicidal/Death Ideation; HLP ⫽ Helplessness; SFD ⫽ Self-Doubt; NFC ⫽ Inefficacy; STW ⫽ Stress/Worry; AXY ⫽ Anxiety; ANP ⫽ Anger Proneness; B ⫽ Behavior Restricting Fears; MSF ⫽ Multiple Specific Fears; JCP ⫽ Juvenile Conduct Problems; SUB ⫽ Substance Abuse; AGG ⫽ Aggression; ACT ⫽ Activation; FML ⫽ Family Problems; IPP ⫽ Interpersonal Passivity; SAV ⫽ Social Avoidance; SHY ⫽ Shyness; DSF ⫽ Disaffiliativeness.

Sellbom et al. (2013) using student samples, the current findings provide additional support that clinicians can use the MMPI-2-RF to gain insight into Criterion B of Section III PDs when/if this model becomes the primary method for diagnosing PDs in future iterations of the DSM.

Finally, this study also showed general support for the connection between general psychopathology and personality traits. Analyses with both measures continue to support extant findings that psychopathology falls broadly into a three-factor structure, including internalizing, externalizing, and psychoticism, with core per-


813


Table 10 MMPI-2-RF PSY-5 Scales and PID-5 Facets ESEM Model

PID-5 Anhedonia Anxiousness Depressivity Distractibility Emotional Lability Hostility Perseveration Rigid Perfectionism Separation Insecurity Suspiciousness Attention Seeking Callousness Deceitfulness Impulsivity Irresponsibility Manipulativeness Risk Taking Intimacy Avoidance Restricted Affectivity Withdrawal Eccentricity Perceptual Dysregulation Unusual Thoughts and Beliefs Grandiosity Submissiveness MMPI-2-RF NEGE DISC INTR PSYC AGGR

Factor 1

Factor 2

Factor 3

Factor 4

Factor 5

⌰

.67 .88 .77 .53 .82 .66 .65 .55 .54 .65 .06 .05 .12 .28 .21 ⫺.02 ⫺.16 .06 ⫺.18 .40 .26 .32 ⫺.02 ⫺.09 .30

⫺.04 ⫺.15 .05 .24 .07 .43 .04 ⫺.07 .05 .01 .53 .57 .68 .57 .66 .66 .67 ⫺.01 .26 .07 .26 .08 .01 .38 .00

.38 ⫺.07 .17 .06 ⫺.27 .05 .00 ⫺.04 ⫺.32 .01 ⫺.45 .40 ⫺.02 ⫺.13 .13 ⫺.14 ⫺.15 .48 .59 .63 .08 .03 ⫺.02 .01 ⫺.18

⫺.04 .09 ⫺.06 .05 .02 ⫺.12 .17 .08 .04 .15 .00 .05 .02 .03 ⫺.04 .02 ⫺.02 .08 .14 .04 .48 .59 .90 .25 .03

⫺.08 ⫺.03 ⫺.12 ⫺.21 .07 .42 ⫺.02 .34 ⫺.16 .25 .03 .31 ⫺.03 ⫺.17 ⫺.33 .02 .01 ⫺.11 ⫺.03 .05 ⫺.02 ⫺.14 .03 .30 ⫺.39

.29 .22 .23 .44 .27 .21 .40 .61 .55 .50 .36 .39 .39 .41 .28 .44 .56 .68 .44 .29 .40 .32 .19 .51 .54

.86 ⫺.04 .44 .16 ⫺.01

⫺.03 .59 ⫺.26 ⫺.07 .42

⫺.06 ⫺.04 .64 ⫺.03 ⫺.16

.06 .06 ⫺.08 .75 .00

.00 .07 .02 .05 .63

.25 .53 .27 .36 .26

Note. Underlined factor loadings indicate an absolute factor loading of .40. MMPI-2-RF ⫽ Minnesota Multiphasic Personality Inventory 2⫺Restructured Form; PSY-5 ⫽ Personality Psychopathology Five; PID-5 ⫽ Personality Inventory for Diagnostic and Statistical Manual of Mental Disorders, fifth edition; ESEM ⫽ exploratory structural equation modeling; AGGR ⫽ Aggressiveness; PSYC ⫽ Psychoticism; DISC ⫽ Disconstraint; NEGE ⫽ Negative Emotionality/Neuroticism; INTR ⫽ Introversion/Low Positive Emotionality.

sonality traits and psychopathology symptoms converging in the same conjoint structure (Chmielewski & Watson, 2007; Hopwood et al., 2013; see also Hopwood & Sellbom, 2013; Krueger et al., 2014). These measures differed in how the internalizing and externalizing factors bifurcated into disinhibition/antagonism and negative affectivity/detachment factors, but the overarching threefactor higher order structure was clear throughout these analyses. This is, again, consistent with previous literature showing support for a three-factor structure of psychopathology more broadly (Kotov et al., 2010; Kotov et al., 2011; Wright et al., 2013) and lends support to the idea that not only can general psychopathology be captured dimensionally but also that personality psychopathology can and does converge with these broad dimensional psychopathology models. This has implications for clinicians as well, given that currently the DSM models of psychopathology view personality psychopathology as falling into distinct categories separate from other disorders. However, this provides support that personality traits are useful in understanding other types of psychopathology as well. Several limitations in the current study should be noted. First, although we utilized a diagnostically heterogeneous psychiatric patient sample in the current analyses, which stands in contrast

to most previous investigations assessing PID-5 validity that have mostly used college student samples, the diagnoses were not derived from structured diagnostic interviewing. We used two self-report measures in this study, which introduces the possibility of inflated effect size magnitudes due to shared method variance. We attempted to control for this by using a very conservative alpha level and only interpreting moderate effect sizes in our correlation analyses, but it is nonetheless important to note that this could have had an effect on our results. Naturally, future research would benefit from utilizing other methods, such as clinician ratings and other lay ratings of DSM-5 Section III traits. Finally, although the personality traits measured by the PID-5 are one component of the DSM-5 Section III model, they are not a stand-alone measurement of PDs. The current study did not evaluate the association between the MMPI-2-RF and Section III impairment criteria or categorical PD diagnoses. Therefore, the implications of this study are limited to how the MMPI-2-RF can be used to measure Section III dimensional traits as measured by the PID-5. Furthermore, although the PID-5 was developed to measure the Section III trait model, it is not, itself, a component of the model but rather the measurement thereof.

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In conclusion, the current study adds to the growing literature on the PID-5 measure and its associations with well-validated measures of personality and psychopathology. Although these associations did not converge as we would have hypothesized in every case, the general pattern of results was consistent with theoretical expectations given the nature of the scales used in these analyses. This not only shows support for clinicians to utilize the MMPI2-RF in the future to measure personality psychopathology as set forth in the DSM-5 Section III trait model, but also, more broadly, extends the growing literature to support the convergence of personality traits and psychopathology constructs beyond a section focused exclusively on PDs.

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Received June 20, 2014 Revision received November 17, 2014 Accepted January 6, 2015 䡲

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Relationship between MCMI-II scales and normal personality traits.

An adoption and a cross-fostering study of the Minnesota Multiphasic Personality Inventory (MMPI) Psychopathic Deviate Scale.

The MMPI-2 Restructured Form Personality Psychopathology Five Scales: bridging DSM-5 Section 2 personality disorders and DSM-5 Section 3 personality trait dimensions.

Associations between changes in normal personality traits and borderline personality disorder symptoms over 16 years.

The Personality Inventory Scales: a self-rating clinical instrument for diagnosis of personality disorder.

Reliability and validity of the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) in evaluations of chronic low back pain patients.

Criterion Validity and Practical Utility of the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) in Assessments of Police Officer Candidates.

The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF): incremental validity in predicting early postoperative outcomes in spine surgery candidates.