1. Severity Indices of Personality Problems (SIPP-118) as a clinical instrument Dineke Feenstra, Helene Andrea and Joost Hutsebaut APA Annual Meeting, 2009 San Francisco

2. Introduction  Personality development includes the development of adaptive capacities  Link between adaptational level and severity of personality problems  Lack of instruments measuring adaptive capacities and change  SIPP developed and tested in both an adult as an adolescent population

3. How to use the SIPP-118?  Some guidelines for the assessment of personality pathology: –Screening for symptoms (SCL-90) –Semi-structured interviews for axis I and axis II disorders (SCID I and SCID II) –Use personality questionnaires (SIPP-118) –Use if necessary projective tests, like the TAT, Rorschach etc.

4. Structure of the SIPP  Self-report questionnaire;  Patients are asked to fill in 118 statements about themselves, referring to the last 3 months  Example: I know exactly who I am and what I am worth. □□□□ FullyPartlyPartlyFully disagreedisagreeagreeagree

5. Structure of the SIPP DomainsFacets Self-controlEmotion regulation Effortful control Identity integrationSelf respect Stable self image Self-reflexive functioning Enjoyment Purposefulness Relational capacitiesIntimacy Enduring relationships Feeling recognized Social concordanceAggression regulation Frustration tolerance Cooperation Respect ResponsibilityResponsible industry Trustworthiness

6. Case I  16-year old adolescent;  Further information has been omitted because of privacy reasons.

7. Case I  Screening of symptoms: –Brief symptom inventory (BSI): Very high level of symptomatic distress Especially fear and depressive symptoms –Child behavior Checklist (CBCL): Parents report both internalizing as well as externalizing problems

8. Case I  Semi-structured interviews: –SCID I: Dysthymic disorder Panic attacks Flashbacks, no PTSD –SCID II: Borderline personality disorder Some dependent characteristics

9. Case I DomainFacetNorm clinical populationNorm general population Self-controlEmotion regulationLowVery low Effortful controlLowVery low Identity integrationSelf respectLowVery low Stable self imageMediateVery low Self-reflexive functioningMediateVery low EnjoymentMediateVery low PurposefulnessLowVery low Relational functioningIntimacyLowVery low Enduring relationshipsMediateLow Feeling recognizedLowVery low Social concordanceAggression regulationMediateVery low Frustration toleranceMediateLow CooperationMediate RespectMediateLow ResponsibilityResponsible industryMediate TrustworthinessMediateLow

10. Case I

11.  Conclusion: –high level of symptoms, not unusual for the classifications that were found with the interviews; –very low to low scores on the SIPP, indicating severe maladaptive personality functioning. –Further information has been omitted, because of privacy reasons.

12. Case II  24-year old woman;  Further information has been omitted because of privacy reasons.

13. Case II  Screening of symptoms: –Brief symptom inventory (BSI): High level of symptomatic distress Especially obsessive-compulsive symptoms

14. Case II  Semi-structured interviews: –SCID I: PTSD Symptoms of general anxiety –SCID II: No diagnosis But the interviewer is not sure…

15. Case II DomainFacetNorm clinical populationNorm general population Self-controlEmotion regulationHighMediate Effortful controlMediate Identity integrationSelf respectHighMediate Stable self imageHighMediate Self-reflexive functioningMediateLow EnjoymentHighMediate PurposefulnessMediate Relational functioningIntimacyMediate Enduring relationshipsMediate Feeling recognizedMediate Social concordanceAggression regulationHighMediate Frustration toleranceMediate CooperationMediate RespectMediate ResponsibilityResponsible industryMediate TrustworthinessMediate

16. Case II

17.  Conclusion: –high level of distress. –the SIPP shows a good profile, suggesting that the complaints are best explained by the PTSD. –Further information has been omitted because of privacy reasons.

18. Conclusions SIPP  The SIPP seems to be a promising instrument that can be used as an outcome tool, but certainly also as an assessment tool  The SIPP can be used for adults as well as adolescents  The SIPP is best used in combination with other instruments  The SIPP can give information about the more structural characteristics of personality, and especially about the severity of a disorder.

19. Contact  Website: –www.vispd.nlwww.vispd.nl –www.deviersprong.nlwww.deviersprong.nl  Email: –dineke.feenstra@deviersprong.nldineke.feenstra@deviersprong.nl –helene.andrea@deviersprong.nlhelene.andrea@deviersprong.nl –joost.hutsebaut@deviersprong.nljoost.hutsebaut@deviersprong.nl