Dysfunctional cognitions in personality pathology: the structure and validity of the Personality Belief Questionnaire

Abstract

Background: This study examines the structure of the Personality Belief Questionnaire (PBQ), a self-report instrument designed to assess dysfunctional beliefs associated with personality pathology, as proposed by the cognitive theory of personality dysfunction.

Method: The PBQ was examined using exploratory factor analysis (EFA) with responses from 438 depressed out-patients, and confirmatory factor analysis (CFA) with responses from 683 treatment-seeking psychiatric out-patients. All participants were assessed for personality disorder (PD) using a standard clinical interview. The validity of the resulting factor structure was assessed in the combined sample (n=1121) by examining PBQ scores for patients with and without PD diagnoses.

Results: Exploratory and confirmatory analyses converged to indicate that the PBQ is best described by seven empirically identified factors: six assess dysfunctional beliefs associated with forms of personality pathology recognized in DSM-IV. Validity analyses revealed that those diagnosed with a PD evidenced a higher average score on all factors, relative to those without these disorders. Subsets of patients diagnosed with specific DSM-IV PDs scored higher, on average, on the factor associated with their respective diagnosis, relative to all other factors.

Conclusions: The pattern of results has implications for the conceptualization of personality pathology. To our knowledge, no formal diagnostic or assessment system has yet systematically incorporated the role of dysfunctional beliefs into its description of personality pathology. The identification of dysfunctional beliefs may not only aid in case conceptualization but also may provide unique targets for psychological treatment. Recommendations for future personality pathology assessment systems are provided.

Figures

Figure

Within-Group Comparison of Factor Scores within 5 Personality Disorder Diagnoses Subgroups were formed on the basis of 5 personality disorder diagnoses: Dependent, Avoidant, Obsessive-Compulsive, Narcissistic, and Paranoid. The height of each bar represents the raw mean score for that factor within the given subgroup. Within each subgroup, the black bar represents the factor most closely associated with that type of personality pathology. The gray bars represent the remaining factors. Separate repeated measures ANOVAs were conducted for each disorder subgroup, and the omnibus tests of within-group differences among the factor scores were significant for each, (all ps<0.001). d-type effect sizes were calculated from the raw means and standard deviations by comparing the value of the black bar (the index factor for a given group) to the value of each gray bar within each subgroup. Statistical significance for each comparison was determined by the repeated measures ANOVA models. For each subgroup, scores on the index factor for that group were significantly higher than scores on the remaining factors. The specific comparisons are as follows: Dependent subgroup: Avoidant & Dependent > Obs. Comp. d=0.61***, Narc. d=0.43***, Autonomy d=0.59***, Paranoid d=0.66***, Histrionic d=0.37**, Schizoid d=1.21*** Avoidant subgroup: Avoidant & Dependent > Obs. Comp. d=0.24**, Narc. d=0.55***, Autonomy d=0.31***, Paranoid d=0.17*, Histrionic d=0.17*, Schizoid d=0.22** Obsessive Compulsive subgroup: Obsessive-Compulsive > Dep. Avoid. d=0.37***, Narc. d=0.29***, Autonomy d=0.25***, Paranoid d=0.26***, Histrionic d=0.32***, Schizoid d=0.17* Narcissistic subgroup: Narcissistic > Dep. Avoid. d=1.13***, Obs. Comp. d=0.85***, Autonomy d=0.33*, Paranoid d=0.67***, Histrionic d=0.57**, Schizoid d=0.64*** Paranoid subgroup: Paranoid > Dep. Avoid. d=0.82***, Obs. Comp. d=0.95***, Narc. d=0.54***, Autonomy d=0.5**, Histrionic d=0.7***, Schizoid d=0.5** PD = Personality Disorder; OCPD = Obsessive Compulsive Personality Disorder; Dep. Avoid. = Dependent & Avoidant; Obs. Comp = Obsessive Compulsive; Narc. = Narcissistic. * p