1. The Severity Indices of Personality Problems (SIPP): The Severity Indices of Personality Problems (SIPP): A new dimensional questionnaire for measuring (mal)adaptive personality functioning Helene Andrea (PhD) 1 Roel Verheul (PhD) 2 Joost Hutsebaut (PhD) 2 Dineke Feenstra (MSc) 1 Espen Arnevik (PhD) 3 1 Viersprong Institute for Studies on Personality Disorders (VISPD), Halsteren, the Netherlands 2 Center for Psychotherapy de Viersprong, Halsteren, the Netherlands 3 Dept Research & Education, Ulleval University Hospital, Oslo, Norway APA Annual Meeting, San Francisco, 18 May 2009

2. Contents Background  Why a new questionnaire  Psychometrics (factor structure, reliability) New results  Discriminant validity (symptomatic measurements)  Convergent validity (personality measurements)  Sensitivity to change Discussion & further research

3. Why a new questionnaire Dimensional measurement that combines:  Broad scope of central elements personality pathology  Relating maladaptive to adaptive capacities  Developed to measure change  Easy to administer (self-report & limited number of items) Verheul, Andrea et al (2008). Psychol Assessment, 20, 23-34

4. Overview SIPP-questionnaire 118 items, 16 facets (subscales), 5 higher-order domains  Lower score = more maladaptive level of functioning  Higher score = more adaptive 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 Website: http://hdl.handle.net/1765/10066http://hdl.handle.net/1765/10066 Publication: Verheul, Andrea et al (2008). Psychol Assessment, 20, 23-34

5. Results confirmative factor analysis Domain Facet (subscale) Self control Emotion regulation Effortful control Identity integration Purposefulness Enjoyment Self-respect Stable self-image Self-reflexive functioning Relational capacities Enduring relationships Intimacy Feeling recognized Social concordance Aggression regulation Frustration tolerance Cooperation Respect Responsibility Responsible industry Trustworthiness Website: http://hdl.handle.net/1765/10066http://hdl.handle.net/1765/10066

6. Psychometric qualities final model 1.Good model fit among different populations: 2.Good internal consistency facets (median Cronbach’s .77; range.69-.88) 3.Good test-retest reliability (median ICC.92; range.85-.95) NChi-sqRMSEANNFICFISRMR PD-pts (test sample)555218.80.0560.9510.9780.030 Additional PD-pts308450.60.0550.9530.9630.040 Mental health pts157504.40.0670.9350.9470.064 General population468624.10.0650.9460.9560.051 Website: http://hdl.handle.net/1765/10066http://hdl.handle.net/1765/10066

7. Validity studies New results I: Validity studies

8. StudypopulationNSCL-90CIPNEO-PI-RDAPP PD multi-centre (Netherlands) 1483XX PD Viersprong (Netherlands) 112X PD Ulleval Hospital (Norway) 114XX General population (Netherlands) 468X Method: Study samples & Instruments SCL-90: Symptom Check List (Derogatis, 1983; Arrindell et al, 2003) CIP: Circumplex of Interpersonal Problems (Pederson, 2000) NEO-PI-R: NEO Personality Inventory-Revised (Costa & McCrae, 1992) DAPP: Dimensional Assessment of Personality Pathology (Livesley & Jackson, 2002)

9. SIPP & Symptomatic distress (SCL) SIPP SIPPSCL Self- control Identity Integration Relational capacities Responsi- bility Social con- cordance Total score (Norway) -0.23-0.49-0.38-0.28-0.12 Total score (Netherlands) -0.44-0.60 -0.39-0.26-0.32 Correlation SCL-subscale >.50 Hostility (-0.60) Depression (-0.68) Interpers. sensitivity (-0.52) --Hostility (-0.56) Overall median correlation: -0.28 Discriminative validity (partially) present

10. Comparison with other personality measures (I): SIPP – NEO / CIP SIPP NEO Self-controlIdentity Integration Relational capacities Responsi- bility Social concordance Neuroticism -0.55-0.53 -0.24-0.17-0.25 Extraversion -0.17 0.30 0.48-0.30-0.05 Openness to experiences -0.00 0.25 0.31-0.10-0.01 Agreeable- ness 0.43 0.09 0.22 0.37 0.62 Conscien- tiousness 0.44 0.28 0.03 0.77 0.15 CIP-total N=114 PD (Norway) -0.17-0.34 -0.41 -0.27-0.17 Higher correlations refer to plausible associations

11. SIPP DAPP higher order Self-controlIdentity Integration Relational capacities Responsi- bility Social concordance Emotional dysregulation -.68 -.76 -.57-.51-.54 Dissocial behavior -.53-.34 -.54 -.58 Inhibition -.13-.38 -.09-.14 Compulsivity -.06.26-.14 Overall median correlation: -0.36 Partially convergent, partially discriminative validity Verheul, Andrea et al (2008). Psychol Assessment, 20, 23-34 Comparison with other personality measures (II): SIPP – DAPP

12.  Evidence for meaningful associations with other personality measurements (convergent validity)  Also evidence for lower associations with symptomatic measurements (discriminative validity) Summary Validity Studies

13. Sensitivity to change New results II: Sensitivity to change

14. Method Setting PD patients % (n) Average treatment duration Outpatient26% (n=156)13.8 (sd 7.3) months Day hospital35% (n=214)9.1 (sd 4.0) months Inpatient39% (n=238)7.6 (sd 3.5) months  Follow ups: 1 year and 3 years after start treatment

15. SIPP domains at baseline and follow-ups More adaptive scores after treatment Effect sizes: 0.73 & 1.02 Effect sizes: 0.95 & 1.17 Effect sizes: 0.57 & 0.69 Effect sizes: 0.18 & 0.58 Effect sizes: 0.18 & 0.40

16. Discussion Discussion Values of the SIPP  Dimensional measurement core components personality pathology Self-control, identity integration, relational capacities, social concordance, responsibility  Promising psychometric results Factorial model, reliability, validity  More adaptive scores after treatment

17. Further research  SIPP as outcome instrument in effectiveness studies  Predictive validity: - Symptomatic improvement necessary for improvement on SIPP? - Improvement on SIPP necessary for functional improvement?  SIPP part of studies DSM-V personality disorders workgroup

18. Availability of the SIPP  Diagnostic version: 118 items, 16 facets, 5 domains Outcome version (SIPP-SF): 60 items, 5 domains  Available in Dutch, English, Norwegian, Spanish and Italian  In exchange for research data  Websites: www.vispd.nl (click on heading sipp-main menu; five subpages) http://hdl.handle.net/1765/10066  Email: Helene.andrea@deviersprong.nl