The Severity Indices of Personality Problems The Severity Indices of Personality Problems (SIPP)(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

ContentsContents

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 questionnaireWhy 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-questionnaireOverview 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

Item Facet/subscale Domain

I usually have adequate control over my feelings Emotion regulation

Self-control

I can easily accept people the way they are, even whenthey are different

Respect Social concordance

Website: http://hdl.handle.net/1765/10066

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

Results confirmative factor analysisResults confirmative factor analysisDomainDomain Facet (subscale)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/1765/10066

Psychometric qualities final model1. 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)

NN Chi-sqChi-sq RMSEARMSEA NNFINNFI CFICFI SRMRSRMR

PD-pts (test sample) 555 218.8 0.056 0.951 0.978 0.030

Additional PD-pts 308 450.6 0.055 0.953 0.963 0.040

Mental health pts 157 504.4 0.067 0.935 0.947 0.064

General population 468 624.1 0.065 0.946 0.956 0.051

Website: http://hdl.handle.net/1765/10066

New results I:

Validity studiesValidity studies

Study Study

populationpopulation NN SCL-90SCL-90 CIPCIP

NEO-NEO-

PI-RPI-R DAPPDAPP

PD multi-centre

(Netherlands)

1483 X X

PD Viersprong

(Netherlands)

112 X

PD Ulleval Hospital

(Norway)

114 X X

General population

(Netherlands)

468 X

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 & Symptomatic distress (SCL)

SIPPSIPP

SCLSCL

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 -0.60-0.60 -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

Comparison with other personality measures Comparison with other personality measures (I): (I):

SIPP – NEO / CIPSIPP – NEO / CIP SIPP

NEO

Self-control Identity

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 toexperiences

-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-totalN=114 PD

(Norway)

-0.17 -0.34 -0.41 -0.27 -0.17

Higher correlations refer to plausible associations

SIPP

DAPP

higher order

Self-control Identity

Integration

Relational capacities

Responsi-

bility

Social

concordance

Emotional dysregulation

-.68 -.76 -.57 -.51 -.54

Dissocial

behavior-.53 -.34 -.34 -.54 -.58

Inhibition -.13 -.38 -.38 -.09 -.14

Compulsivity -.06 -.06 -.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): Comparison with other personality measures (II): SIPP – DAPPSIPP – DAPP

Evidence for meaningful associations with other personality measurements (convergent validity)

Also evidence for lower associations with symptomatic measurements (discriminative validity)

Summary Validity StudiesSummary Validity Studies

New results II:

Sensitivity to changeSensitivity to change

Method Method

Setting

PD patients

% (n)

Average treatment

duration

Outpatient 26% (n=156) 13.8 (sd 7.3) months

Day hospital 35% (n=214) 9.1 (sd 4.0) months

Inpatient 39% (n=238) 7.6 (sd 3.5) months

Follow ups: 1 year and 3 years after start treatment

SIPP domains at baseline and follow-upsSelf-control

31

33

35

37

39

41

More adaptive scores

after treatment

Identity integration

25

27

29

31

33

35

Relational capacities

28

30

32

34

36

38

Baseli

ne

1 ye

ar

3 ye

ar

Social concordance

36

38

40

42

44

46

Responsibility

35

37

39

41

43

45

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

DiscussionDiscussionValues of the SIPP

Dimensional measurement core components personality pathology Self-control, identity integration, relational capacities, social concordance, responsibility

Promising psychometric resultsFactorial model, reliability, validity

More adaptive scores after treatment

Further researchFurther 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 SIPPAvailability of the SIPP

Diagnostic version: 118 items, 16 facets, 5 domainsOutcome 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