3 Simple Questions Screen for Common Personality Disorders
By: Grant H Brenner
Tags: Psychology, Personality Development, Personal Development, Therapy, Coaching

3 Simple Questions Screen for Common Personality Disorders

According to the American Psychiatric Association:

“Personality is the way of thinking, feeling and behaving that makes a person different from other people. An individual’s personality is influenced by experiences, environment (surroundings, life situations) and inherited characteristics. A person’s personality typically stays the same over time. A personality disorder is a way of thinking, feeling and behaving that deviates from the expectations of the culture, causes distress or problems functioning, and lasts over time.”

How common are personality disorders? An estimated 9 percent of the general population has one or more personality disorders, a number approaching one-third (33 percent) in outpatient psychiatric clinical settings.

Diagnosing personality disorders

There are 10 defined personality disorders[1] in the current U.S. diagnostic manual, the DSM-5. The 10 personality disorders are organized into Clusters, A, B and C. Cluster A are more socially detached, odd or eccentric, Cluster B more emotionally unstable, and Cluster C more anxious. The personality disorders are: paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder (A); antisocial personality disorder, borderline personality disorder, histrionic personality disorder, and narcissistic personality disorder (B); and avoidant personality disorder, dependent personality disorder, and obsessive-compulsive personality disorder (C ).

An alternative model for understanding personality disorders has also been proposed, identifying maladaptive traits rather than specific personalities. There are 7 core traits: Compulsivity, Detachment, Negative Affect, Psychoticism, Disinhibition, Antagonism, and Submissiveness. We can all have these traits to varying degrees. It is only when they come together significantly in one individual and are associated with distress or dysfunction, that a personality disorder diagnosis can be made.

Diagnosing personality disorders is complex, and as with diagnosing any medical condition needs to be done thoughtfully, with a positive expectation of grounding therapeutic change. For personality disorders, diagnosis is made through careful clinical history and examination, review of collateral evidence, and standardized testing. Such testing is meticulous and time-consuming, very useful if used properly.

Validating a brief screen for personality issues

In order to address the need for a brief personality disorder screen, which would be helpful given how intensive full evaluation is, researchers from the University of Pittsburgh School of Medicine, described in their recent paper in The Journal of Personality Disorders (2020), tested a brief scale to screen for personality issues through the degree of agreement or disagreement with 3 key items. Using data from 842 participants, researchers correlated full evaluation with the Inventory of Interpersonal Problems-3 (IIP-3):

I am too sensitive to rejection It is hard for me to take instructions from people who have authority over me I argue with other people too much

The extensive study measures included: the Inventory of Interpersonal Problems (127 items); the Personality Assessment Inventory — Borderline Scale (24 items); the McLean Screening Instrument for Borderline Personality Disorder (10 items); the Iowa Personality Disorder Screen (19 items); the Temperament and Character Inventory — Self-Directedness Scale (226 items); the Structured Interview for DSM-IV Personality (a lengthy one-on-one interview to assess 10 areas of personality function); diagnostic interviews to define Alternative Aspects of Personality e.g. negative character traits based; and a consensus measure of Severity of Personality Disorder based on multiple clinician consensus.

Attachment style was measured using the Experiences in Close Relationships Scale (36 items); a clinician-determined Adult Attachment Rating; the Hierarchy of Attachment Organization scale, which defines four severity levels for attachment difficulties[2], and the Attachment Q-Sort, which measures attachment based on communication style. Emotion regulation was assessed with the Adult Temperament Questionnaire — Effortful Control Scale (35 items); the Difficulties in Emotion Regulation Scale (36 items); and the Emotion Regulation Questionnaire (10 items). For a subset of participants, interviews with life partners were included in the data.

The data was analyzed to see how well the IIP-3 correlated with estimates of personality disorder, attachment difficulty, and emotional dysregulation based on the larger battery of tests and clinical examination.

Can three questions screen for personality dysfunction?

Results showed that the IIP-3 correlated well with self-reports from participants, their significant others, and test results and interview findings. Mathematical coefficients ranged from 0.5 to nearly 0.7. These are robust correlations, and all were statistically significant, showing the IIP-3 has significant screening utility for common personality problems, attachment issues, and emotion dysregulation.

However, the IIP-3 was better for some issues than others. First, the IIP-3 picks up Cluster B features best, capturing “dramatic, expressive” behaviors, with emotional instability and difficulty with self-control. Along similar lines, the IIP-3 was correlated with the anxious and preoccupied attachment style.

It is worth noting that the participants in the study were all patients receiving psychiatric care. In that group, rates of personality disorders are higher than the 9 percent in the general population. In addition, symptoms from depression, anxiety, developmental trauma, and other psychiatric conditions can overlap with personality. Given the careful evaluation for personality disorders in this study, however, the IIP-3 correlations with personality are distinct.

Taken together, the analysis suggests that the IIP-3 is a good screening tool, especially for Cluster B personality. This is useful, as this cluster is common, resulting in significant suffering, functional issues, and hardship.

Compassionate candor

For non-clinicians, the IIP-3 items pose actionable questions, which can be used to identify problem areas, and in conjunction with therapeutic and personal development efforts may be useful targets for deliberate practice:

Am I too sensitive to rejection? Is it hard for me to take instructions from people who have authority over me? Do I argue with people too much?

These simple questions get at underlying maladaptive traits like antagonism, negative emotions, psychopathy, and submissiveness. How one feels about these questions is also informative. Do I feel overly guilty? Do I feel remorseful or unapologetic? Do I feel pessimistic or empowered? Do I feel curious or avoidant? What do these questions evoke in me?

Rather than providing ammunition for self-blame, and especially when accompanied by recognition of positive traits and strengths, asking oneself tough questions in the spirit of compassionate inquiry can serve as a springboard to enhance personal development and improve social and professional relationships.

We can also ask these questions about those around us — avoiding diagnosing inappropriately or using them to criticize or shame others — as we consider beginning new personal and professional relationships, and in our ongoing appraisal of whether our choices about work and personal relationships are best serving long-range goals for well-being and life satisfaction.

Learn more about personality, and personality change:

How To Polish Your Personality

Doorknob Comments Podcast: Personality Talks

Notes

[1] A detailed description of personality disorders from APA:

Antisocial personality disorder: a pattern of disregarding or violating the rights of others. A person with an antisocial personality disorder may not conform to social norms, may repeatedly lie or deceive others, or may act impulsively.

Avoidant personality disorder: a pattern of extreme shyness, feelings of inadequacy, and extreme sensitivity to criticism. People with an avoidant personality disorder may be unwilling to get involved with people unless they are certain of being liked, be preoccupied with being criticized or rejected, or may view themselves as not being good enough or socially inept.

Borderline personality disorder: a pattern of instability in personal relationships, intense emotions, poor self-image, and impulsivity. A person with a borderline personality disorder may go to great lengths to avoid being abandoned, have repeated suicide attempts, display inappropriate intense anger, or have ongoing feelings of emptiness.

Dependent personality disorder: a pattern of needing to be taken care of and submissive and clingy behavior. People with a dependent personality disorder may have difficulty making daily decisions without reassurance from others or may feel uncomfortable or helpless when alone because of fear of inability to take care of themselves.

Histrionic personality disorder: a pattern of excessive emotion and attention-seeking. People with a histrionic personality disorder may be uncomfortable when they are not the center of attention, may use physical appearance to draw attention to themselves, or have rapidly shifted or exaggerated emotions.

Narcissistic personality disorder: a pattern of need for admiration and lack of empathy for others. A person with a narcissistic personality disorder may have a grandiose sense of self-importance, a sense of entitlement, take advantage of others or lack empathy.

Obsessive-compulsive personality disorder: a pattern of preoccupation with orderliness, perfection, and control. A person with an obsessive-compulsive personality disorder may be overly focused on details or schedules, may work excessively not allowing time for leisure or friends, or may be inflexible in their morality and values. (This is NOT the same as obsessive-compulsive disorder.)

Paranoid personality disorder: a pattern of being suspicious of others and seeing them as mean or spiteful. People with a paranoid personality disorder often assume people will harm or deceive them and don’t confide in others or become close to them.

Schizoid personality disorder: being detached from social relationships and expressing little emotion. A person with schizoid personality disorder typically does not seek close relationships, chooses to be alone, and seems to not care about praise or criticism from others.

Schizotypal personality disorder: a pattern of being very uncomfortable in close relationships, having distorted thinking, and eccentric behavior. A person with a schizotypal personality disorder may have odd beliefs or odd or peculiar behavior or speech or may have excessive social anxiety.

[2] Four levels of attachment organization are included: (a) disorganization and lack of structure (with three variants — unresolved states of mind; incoherence characterized by effectively intense, shifting, and mood-dependent states of mind; and incoherence characterized by low intensity, vague, and confusing states of mind), (b) excessively rigid structure (with two variants — hostile, controlling patterns of relationships; and compulsive caregiving), © functional but not optimal structure (with two variants — preoccupied and dismissive attachment), and (d) flexible and balanced structure (secure attachment, with an appropriate mix of attachment and autonomy).

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“Reproduction of selected IIP items by special permission of the Publisher, Mind Garden, Inc., www.mindgarden.com from the Inventory of Interpersonal Problems by Leonard M. Horowitz et al. Copyright © 2000 by Leonard M. Horowitz et al. Further Reproduction is prohibited without the Publisher’s written consent.”