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

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

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

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: Publication: Verheul, Andrea et al (2008). Psychol Assessment, 20, 23-34

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:

Psychometric qualities final model 1.Good model fit among different populations: 2.Good internal consistency facets (median Cronbach’s .77; range ) 3.Good test-retest reliability (median ICC.92; range ) NChi-sqRMSEANNFICFISRMR PD-pts (test sample) Additional PD-pts Mental health pts General population Website:

Validity studies New results I: Validity studies

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)

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

Comparison with other personality measures (I): SIPP – NEO / CIP SIPP NEO Self-controlIdentity Integration Relational capacities Responsi- bility Social concordance Neuroticism Extraversion Openness to experiences Agreeable- ness Conscien- tiousness CIP-total N=114 PD (Norway) Higher correlations refer to plausible associations

SIPP DAPP higher order Self-controlIdentity Integration Relational capacities Responsi- bility Social concordance Emotional dysregulation Dissocial behavior Inhibition Compulsivity Overall median correlation: Partially convergent, partially discriminative validity Verheul, Andrea et al (2008). Psychol Assessment, 20, Comparison with other personality measures (II): SIPP – DAPP

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

Sensitivity to change New results II: Sensitivity to change

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

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

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

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

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: (click on heading sipp-main menu; five subpages) 