14c
Chloe M. Evans, Trevor F. Williams, and Leonard J. Simms
We thank the commentators (Carnovale & Bagby, this volume; Helle, Meyer, Min, & Mullins-Sweatt, this volume) for their feedback on our chapter, which we believe significantly enhances our original discussion of the dimensional assessment of personality pathology. In response, we would like to expand upon three issues (mentioned in either one or both commentaries) that we anticipate will be key areas for the personality assessment literature to resolve in the near future: multi-source assessment, longitudinal assessment, and clinical utility.
Multi-Source Assessment
First, we were pleased to see general agreement regarding the potential importance of obtaining information on an individual’s personality from multiple sources. In addition, both commentaries also emphasized the need for additional research on multi-source personality data and how it should be interpreted. In particular, topics such as the choice of informant, measuring informant biases (e.g., socially desirable responding), potential biases in structured interviews (e.g., reliance on honest interviewees), between-source discrepancies, and the promise of meta-perceptual reports are important avenues for basic research. Beyond this, however, Carnovale and Bagby (this volume) raise important questions regarding the applied practicality of contacting one or more informants for a personality assessment; we believe the issue of practicality is worth further discussion.
Although it is true that gathering data from informants as part of an assessment is potentially burdensome, it is worth noting, for example, that such burden is less controversial within the domain of attention deficit hyperactivity disorder (ADHD). In ADHD assessments, parents, teachers, coworkers, and peers may all become involved in the assessment and provide relevant data (e.g., Seixas, Weiss, & Müller, 2012). This is supported by research documenting the unique contributions that these additional sources make (e.g., Sibley et al., 2012). Given the strength of personality assessment research indicating the value of informant-reports (Connelly & Ones, 2010; Oltmanns & Turkheimer, 2009), perhaps a normative shift is necessary. Put otherwise, although additional research is needed to develop the precise tools and practices for efficient multi-source personality assessment, work also is needed to disseminate and implement such multi-source methods in applied settings.
Longitudinal Assessment
Second, we would like to reiterate the importance of longitudinal assessment of personality pathology, as discussed by Carnovale and Bagby. As research continues to demonstrate that personality pathology is less stable than previously assumed (e.g., Morey & Hopwood, 2013), it makes good sense that personality assessment measures are capable of capturing dynamic processes that unfold over time (and across contexts). Given that the within-person processes measured by longitudinal assessment typically are the targets of treatment (as opposed to between-person variance captured by cross-sectional assessment), and given that longitudinal assessment is required to monitor treatment progress, the ability of an assessment measure to capture change over time should be considered when evaluating its clinical utility.
In response to the need for longitudinal personality assessment, Zimmermann and colleagues (2019) recently developed the Personality Dynamics Diary (PDD), a 32-item self-report measure that assesses daily behavioral manifestations of personality traits as well as the environmental contexts that may influence trait expression. Somewhat surprisingly, therapists who piloted the PDD indicated that information gleaned from the measure provided little incremental utility in treatment planning beyond the initial assessment (Zimmermann et al., 2019). In addition, the most commonly cited reason that therapists declined to pilot the PDD was fear of overburdening clients with a daily measure (Zimmermann et al., 2019). Thus, despite the potential relevance of longitudinal measurement to the treatment of personality pathology, work remains to convince clinicians of these measures’ clinical utility. Specifically, researchers will need to demonstrate that the incremental utility of longitudinal assessment outweighs any anticipated client burden (although it is notable that clients in Zimmermann et al.’s study did not find daily completion of the PDD particularly onerous). Further, the development of clear guidelines linking certain longitudinal data patterns to specific treatment interventions likely will facilitate dissemination efforts.
Clinical Utility
Finally, we appreciate the added comments by both commentaries regarding the need for greater clinical utility in the dimensional PD assessment literature and in clinical applications more generally. As noted in our chapter, features like validity scales, adequate norms, and proper interpretive and training materials largely are lacking for modern dimensional PD measures, especially those within the PD functioning domain. Clearly, much more is needed if we wish to influence the way practitioners interact with and adopt PD assessment methods that are rooted in modern conceptualizations of PD.
Professional inertia likely serves as one of many impediments to change in this domain. However, little systematic data exist on this point. In our lab, we currently are studying the factors that influence how clinicians make decisions about psychological assessment and classification, including in the PD realm. We’ve started running focus groups and later will follow-up with a more systematic national survey of mental health practitioners. Our results thus far are far from complete or definitive, but our early inspections of the qualitative data suggest that we may face a very steep climb if we truly wish to influence the assessment behavior of mental health practitioners. The pressures exerted on clinicians – e.g., billing/reimbursement policies, demands for brief assessments, and the need to see increasing numbers of clients – leave many clinicians adopting suboptimal measures (or none at all!) in the service of more efficient service. We hope our work on this project, when complete, will permit the field to better understand these pressures and adopt practices that will better engage clinicians who face such pressures.
One factor that may be especially detrimental to clinical utility is the dizzying array of PD models and measures available for use. Efforts to consolidate this work (e.g., see HiTOP consortium; Kotov et al., 2017) hopefully will serve to catalyze research and measurement work in the service of a single transdiagnostic model of psychopathology and thus, perhaps, clarify the modern work for clinicians who might have been inclined to adopt it but have been put off by the lack of unity in the field.
References
Connelly, B. S., & Ones, D. S. (2010). An other perspective on personality: Meta-analytic integration of observers’ accuracy and predictive validity. Psychological Bulletin, 136(6), 1092–1122.
Kotov, R., Krueger, R. F., Watson, D., Achenbach, T. M., Althoff, R. R., Bagby, R. M., … Zimmerman, M. (2017). The Hierarchical Taxonomy of Psychopathology (HiTOP): A dimensional alternative to traditional nosologies. Journal of Abnormal Psychology, 4, 454–477.
Morey, L. C., & Hopwood, C. J. (2013). Stability and change in personality disorders. Annual Review of Clinical Psychology, 9, 499–528.
Oltmanns, T. F., & Turkheimer, E. (2009). Person perception and personality pathology. Current Directions in Psychological Science, 18(1), 32–36.
Seixas, M., Weiss, M., & Müller, U. (2012). Systematic review of national and international guidelines on attention-deficit hyperactivity disorder. Journal of Psychopharmacology, 26(6), 753–765.
Sibley, M. H., Pelham Jr, W. E., Molina, B. S., Gnagy, E. M., Waschbusch, D. A., Garefino, A. C., … Karch, K. M. (2012). Diagnosing ADHD in adolescence. Journal of Consulting and Clinical Psychology, 80(1), 139–150.
Zimmermann, J., Woods, W. C., Ritter, S., Happel, M., Masuhr, O. Jaeger, U., … Wright, A. G. C. (2019). Integrating structure and dynamics in personality assessment: First steps toward the development and validation of a personality dynamics diary. Psychological Assessment, 31(4), 516–531.