Severity Indices for Personality Problems (SIPP): Factor structure, reliability, validity, and sensitivity to change Helene Andrea (PhD) Roel Verheul (PhD) Jan van Busschbach (PhD) Viersprong Institute for Studies on Personality Disorders (VISPD) ISSPD Congress, the Hague, 21 September 2007

Why a new questionnaire Dimensional measurement that combines:  Broad scope of central elements personality pathology  Relating maladapative to adaptive capacities  Developed to measure change  Easy to administer (self-report)

The SIPP questionnaire 118 items, 16 facets/subscales, 5 higher-order domains  Higher score = more adaptive level of functioning  Lower score = more maladaptive level of functioning Examples Fully disagree Partly disagree Partly agree Fully agree ItemFacet/subscaleDomain I usually have adequate control over my feelingsEmotion regulation Self-control I can easily accept people the way they are, even when they are different RespectSocial concordance

Study populations 1.N=1208 PD / personality pathology patients 67% female, mean age 33.8 (9.9) 2.N=157 psychiatric outpatients 78% female, mean age 29.1 (10.4) 3.N=478 general population 68% female, mean age 36.0 (11.6)

1. Reliability Internal consistency (facets): Median Cronbach’s alpha.77 (range ) Test-retest correlation (domains): n=32 student sample, preliminary results days interval Median correlation.93 (range )

2. Factor analyses (exploratory)

2. Factor analyses (confirmative) Good fit in PD, outpatient and normal population

3. Validity a.Concurrent validity: Differentiation between normal and clinical populations b.Convergent validity: Relationship with personality disorder severity (number of PDs) c.Discriminant validity: Correlations with DAPP-dimensions

Clinical populations vs general population Support for concurrent validity

3. Validity a.Concurrent validity: Differentiation between normal and clinical populations b.Convergent validity: Relationship with personality disorder severity (number of PDs) c.Discriminant validity: Correlations with DAPP-dimensions

SIPP domains – Number of PDs Support for convergent validity

3. Validity a.Concurrent validity: Differentiation between normal and clinical populations b.Convergent validity: Relationship with personality disorder severity (number of PDs) c.Discriminant validity: Correlations with DAPP-dimensions

Correlations SIPP - DAPP Self-controlIdentity Integration Relational functioning Responsi- bility Social concordance DAPP-higher order Emotional dysregulation Dissocial Inhibition Compulsivity Discriminative validity (partly) present

4. Sensitivity to change Preliminary follow-up sample PD patients (n=60):  n=28 outpatient (47%)  n=32 day hospital (53%)  Follow ups: 1 year and 2 years after start treatment

SIPP domains after treatment More adaptive scores after treatment

Discussion Discussion Values of the SIPP  Dimensional measurement core components (personality) pathology Self-control, identity integration, social concordance, responsibility, relational functioning  Factorial model complex but robust  Reliability and validity results satisfying  More adaptive scores after treatment

Further research  Association with symptomatic measures (divergent validity) Prospective studies:  SIPP as outcome instrument in effectiveness studies  Are SIPP-scores indicative for structural improvement (predictive validity)?

Availability of the SIPP  Diagnostic version: 118 items, 16 facets, 5 domains Outcome version: 60 items, 5 domains  Freely available in Dutch, English, Norwegian, Spanish and Italian  In exchange for research data  Website: (click on heading sipp; five subpages) 