ROLE OF PERSONALITY DISORDERS IN PREDICTION OF ACHENBACH SYSTEM OF EMPIRICALLY BASED ASSESSMENT OF PROBLEM BEHAVIORS AMONG ADULTS

Abstract

Literature suggests that personality pathology plays a crucial role in onset and maintenance of problem behaviors, yet they go undetected and are overshadowed by other mental health problems or diseases. Despite of this agreement, personality disorders are often not assessed properly at the time of initial assessment which leads to minimal adherence to treatment and poor treatment outcomes. Keeping this in mind, a prime objective of present study was to validate System of Empirically based assessment (that includes: Adult Self Report and Adult Behavior Checklist) and DSM IV Personality Disorder into Urdu language. The present study comprised of pilot study and the main study. Employing the technique of convenience and purposive sampling for the pilot study data was collected from clinical (N = 50, M = 33.92, SD = 12.84) and non-clinical adults (N = 50, M = 33.60, SD = 12.33) with age between 18-59 years. The objectives were to explore psychometric properties and preliminary trends of association between personality disorders and problem behaviors (assessed via Adult Self Report). The main study was carried out on clinical (N = 408, M = 37.17, SD =11.21) and non-clinical (N = 487, M = 33.81, SD = 11.74) samples with age ranges between 18-59 years. Evidence of validity was furnished for both samples through Confirmatory Factor Analysis, Mono-trait Multimethod Matrix, and contrasted group validity. Psychometric properties of Adult Self Report (ASR; Achenbach & Rescorla, 2003), Adult Behavior Checklist (ABCL; Achenbach & Rescorla, 2003), and Assessment of DSM IV Personality Disorders Questionnaire (ADPIV; Hassan, 2012) were found satisfactory, therefore, further analysis including prevalence, predictive relationship, and group differences were established. Prevalence indicated higher problem behaviors across broad band scales (both internalizing and externalizing) in clinical as compared to non-clinical sample. Across ADP IV, borderline personality disorder was most prevalent among clinical sample whereas obsessive compulsive personality disorder was most prevalent across non-clinical sample. Across gender for both samples, non-significant differences were apparent across broad band scales of internalizing behavioral problems whereas higher number of males had externalizing behavioral problems. Across ADP IV for clinical sample, PDs were more prevalent among males except for borderline personality disorder, Not Otherwise Specified Depressive (NOS-DE) and Not Otherwise Specified Passive Aggressive personality disorder (NOS-PA) in comparison to females. For non-clinical samples these differences were non-significant. Across age, more individuals in late adulthood had both internalizing and externalizing behavioral problems for clinical sample. However, only externalizing behavioral problems were more prevalent in late adulthood for non clinical sample. Predictive relationship through stepwise regression were examined to test the hypotheses across broadband and narrowband scales. Results indicated that for both samples from cluster A paranoid and schizotypal PDs predicted internalizing behavioral problems. However, for externalizing behavioral problems all three disorders (schizotypal, paranoid, and schizoid) emerged as significant predictors for clinical sample and only paranoid emerged as significant predictors for non-clinical sample. Similarly, from Cluster B for clinical sample both borderline and narcissistic PDs predicted internalizing behavioral problems and only borderline predicted it for non-clinical sample. Additionally, externalizing behavioral problems were predicted by antisocial and borderline for clinical sample whereas only anti-social predicted it for non-clinical sample. From Cluster C, only dependent personality disorder predicted internalizing behavioral problems for clinical sample whereas for non-clinical sample xxii both dependent and avoidant predicted it. Both obsessive compulsive and dependent predicted externalizing behavioral problems for clinical sample and only dependent predicted it for non-clinical sample. In case of not otherwise specified PD for clinical sample only not otherwise specified depressive predicted internalizing behavioral problem whereas for non-clinical sample both not otherwise specified depressive and not otherwise specified passive aggressive predicted it. Similarly, not otherwise specified passive aggressive predicted externalizing behavioral problems for clinical sample and for non-clinical sample not otherwise specified depressive predicted externalizing behavioral problems. From these findings, it was apparent that paranoid, borderline, and dependent personality disorders emerged as a common predictor for both internalizing and externalizing behavioral problems across both samples. Moderation analysis indicated that relationship between personality disorders and problem behaviors (broad and narrow band) was buffered by adaptive functioning and gender. In order to examine the group differences across demographic variables mean differences were computed. These differences across gender for clinical sample indicated that females scored higher on anxious depressed and somatic complaints whereas males scored higher on aggressive, rule breaking, and intrusive behavioral problems. Non-significant differences were apparent across withdrawn, thought, and attention problems for clinical sample whereas for non-clinical sample only significant mean difference was apparent across externalizing behavioral problem where males scored higher. Across gender for ADP IV for clinical sample, males scored higher on all PDs except for not otherwise specified dependent personality disorder where the difference was non-significant. For non-clinical sample females scored higher on paranoid, histrionic, avoidant, and dependent PDs. In case of both clinical and non clinical sample individuals with a history of suicide scored higher on ADP IV and syndrome-based scales of ASR. The results of the study highlighted that both personality pathology and problem behaviors could be best understood by incorporating cultural perspective as the relationship pattern that emerged across both sample is in line with the existing literature but the findings regarding prevalence and the group differences can be attributed to the cultural context of Pakistan. To conclude personality pathology plays a significant role in other psychopathologies and factors like age, gender, education, and adaptive functioning play a crucial role in establishing a comprehensive picture of psychopathology. Recommendations can be provided to mental health practitioners and policy makers at government level for incorporating personality pathology in overall assessment in order to enhance the system of assessment in clinical settings.