Journal of Personality Disorders, 21(6), 626637, 2007 2007 The Guilford Press

EVALUATION OF THE SCID-II PERSONALITY DISORDER TRAITS FOR DSM-IV: COHERENCE, DISCRIMINATION, RELATIONS WITH GENERAL PERSONALITY TRAITS, AND FUNCTIONAL IMPAIRMENT
Andrew G. Ryder, PhD, Paul T. Costa, Jr., PhD, and R. Michael Bagby, PhD, C Psych

The utility of the DSM personality disorder (PD) system remains a concern. The strategy employed represents one approach designed to evaluate and improve the diagnostic efficiency of the SCID-II PDs. Using a sample of 203 patients, SCID-II PD itemsbased on the criterion sets of the 10 DSM-IV PDswere evaluated with respect to (a) convergent validity; (b) divergent validity; (c) relation to general personality traits; and (d) association with functional impairment. Only Borderline PD items were satisfactory on all four evaluation criteria. Histrionic and Obsessive-Compulsive PD items met criteria for convergent and divergent validity and relation to personality dimensions of the Five-Factor Model of Personality (FFM) but were not related to functional impairment, suggesting they might be reconsidered as disorders. Schizotypal PD items met three of the four criteria but showed no relation to FFM dimensions, suggesting that it may be a candidate for reassignment to Axis I.

The flaws of the DSM PD system are well known and include excessive within-disorder diagnostic heterogeneity, poor reliability and validity, high rates of between disorder diagnostic overlap (both Axis I and II), poor relation to impairment, and failure to capture the full domain of personality psychopathology (Widiger, 1997; Widiger & Frances, 2002). Previous investigators have examined the coherence of the traits within each PD criterion set as well as overlap with other PD criteria (Blais, Hilsenroth, & Castlebury, 1997; Blais & Norman, 1997; Grilo et al., 2001; Maffei et al., 1997; McGlashan et al., 2000). These studies provided information on which individual PD traits contribute significantly to the overall diagnostic inclu-

From Concordia University (A. G. R.); National Institute of Aging (P. T. C.); and Centre for Addiction and Mental Health, University of Toronto (R. M. B.). Address correspondence to R. Michael Bagby, Ph.D., C. Psych., Centre for Addiction and Mental Health, Clarke Site, 250 College Street, Toronto, Ontario, Canada M5T 1R8; E-mail: michael_bagby@camh.net

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sion criteria, revealing that many individual PD traits lack utility. We believe that these earlier studies left unexamined two important issuesthe relation of PD traits to general personality trait dimensions and the association of PD traits with functional impairment. Overall, internal consistency and inter-rater reliability of the DSM-IV personality disorder criteria meet or exceed standard cut-offs (Blais & Norman, 1997; Blais et al., 1997; Maffei et al., 1997). The major concern is instead with co-morbidity across diagnoses. Blais and colleagues (Blais & Norman, 1997; Blais et al., 1997) reported several significant correlations between individual DSM-IV PD criteria and nonparent scales indicating a lack of discriminant validity. McGlashan and colleagues (2000) found that despite high retest and inter-rater reliability for diagnoses of Schizotypal, Borderline, Avoidant, and Obsessive-Compulsive obtained using multiple interview measures, each of these diagnoses was on average co-morbid with 1.4 other PD diagnoses. Skodol and colleagues (2005) report, meanwhile, that the personality dimensions underlying the PDs have more clinical validity than do the the PDs themselves, especially including a much greater degree of temporal stability. A steadily increasing number of reports by personality and PD researchers suggest that the problematic PD categories should ultimately be replaced by dimensional alternatives (e.g., Clark, Livesley, & Morey, 1997; Ryder, Bagby, & Schuller, 2002; Skodol et al., 1999). There is considerable evidence that the DSM-IV PD traits have a structure mostly compatible with the Five-Factor Model (FFM), suggesting that PD traits may be pathological variants of core personality features (Bagby et al., 1999; Costa & Widiger, 2002; Saulsman & Page, 2004; Widiger, 2005). From a clinical perspective, the FFM can be used to describe adequately the characteristic features of individual PDs (Lynam & Widiger, 2001). Warner and colleagues (2004) demonstrated that most of the stability observed for individual PDs over a two year interval is accounted for by FFM traits associated with individual PDs. Establishing the relation between PDs and personality dimensions is important, as the traits that compose the FFM were derived in nonpathological populations and thus are not conflated with Axis I psychopathology. Although previous studies have looked at the relation between PDs and the FFM, this study considers whether each constituent PD trait can be said to relate in some way to the broad domain of personality. Instances in which PD traits are not linked to the FFM will require future investigation to determine whether our understanding of personality requires broadening to include additional content, or whether certain PD traits are better seen as Axis I psychopathology. Perhaps the cardinal attribute of a PD criterion is its association with overall impairment, an aspect of clinical utility. According to the DSM-IV, the assignment of a PD diagnosis is predicated on the assumption that each of the traits in the criterion set is related to significant impairment. PD traits that are not related to impairment may well represent important

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features of personality, but it is questionable whether they should be labeled pathological and regarded as such. One could argue that these traits should nonetheless be retained because it is only necessary for collections of traits (i.e., specific PDs) to be associated with impairment. We would argue that as researchers increasingly cast doubt on the integrity of the DSM-IV PDs and instead turn to the individual traits as pathological trait indicators, it is important to consider whether these indicators describe psychopathology. Moreover, most, if not all, of the individual PD traits are written in such a way to imply maladjustment and clinicians will in part decide whether a trait should be recorded as being present based on the extent to which it interferes with normal functioning. Investigating the relation of individual PD traits to impairment is consistent with First and colleagues (2004) call for increased attention to clinical utility. In this study we attempt to replicate previous investigations examining the PD criterial traits. We extend evaluation of these earlier efforts beyond the issue of symptom-to-disorder diagnostic validity by examining each criterion in terms of (a) convergent validity, (b) divergent validity, (c) association with FFM personality traits, and (d) ratings of functional impairment.

METHOD PARTICIPANTS
The sample consisted of 203 patients (108 men, 95 women) assessed at a large tertiary care, medical-school affiliated, psychiatric facility (M age = 39.2 years, SD = 11.5). Of these, 167 (82%) were outpatients (M age = 37.8, SD = 10.8) and 36 were inpatients (M age = 35.4, SD = 11.6). This sample was diagnostically heterogeneous, composed of patients with a variety of Axis I diagnoses, including alcohol dependence, affective disorders, anxiety disorders, schizophrenia, somatoform disorder, and substance dependence and use. Seventy patients (35%) also met criteria for one or more Axis II PD diagnosesall ten PDs were represented.

MEASUREMENT AND PROCEDURE

Patients were evaluated in an assessment and consultation service and interviewed with the Structured Clinical Interview for DSM-IV, Axis I Disorders (SCID-I/P; First, Spitzer, Gibbon, & Williams, 1995) and the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II; First, Gibbon, Spitzer, Williams, & Benjamin, 1997). Patients also completed the SCID-II Personality Questionnaire (SCID-II/PQ; First et al., 1997) and the Revised NEO Personality Inventory (NEO PI-R). The Revised NEO Personality Inventory (NEO PI-R; Costa & McCrae, 1992) is a 240-item questionnaire designed to measure the five major factors or domains of personality: Neuroticism (N); Extraversion (E); Open-

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ness to Experience (O); Agreeableness (A); and Conscientiousness (C). Each factor is defined further by six specific traits, or facets. Studies using the NEO PI-R and other measures have established that all five traits (a) show high rank-order stability over periods of many years; (b) can be assessed by self-reports or the ratings of knowledgeable informants, with modest to moderate agreement across these different sources; (c) are strongly heritable; and (d) are useful in the prediction of a variety of behaviors and outcomes, from vocational interests to longevity. Because of these properties, traits of the FFM have assumed an increasingly prominent role in clinical, developmental, health, and industrial/organizational psychology. Interviewers were trained extensively in the SCID-I and SCID-II interviews. Administration of the SCID-II follows a two-tiered procedure. First, respondents complete the 119-item SCID-II/PQ, which uses a Yes/No response format. Each of the questions corresponds to a diagnostic criterion for either one of the main text PDs or the two additional PDs listed in Appendix B of DSMIV (i.e., Passive-Aggressive and Depressive PD). Only scores for the main text PDs were used in this study. After respondents have completed the questionnaire, the interviewer identifies those personality disorders for which respondents endorsed sufficient criteria for a particular PD diagnosis. Persons meeting self-report criteria for any given PD are then administered the corresponding portions of the SCID-II interview in order to assign a formal diagnosis. Interviewers also rated each of the patients using the Global Assessment of Functioning Scale (GAF). The GAF ratings were done after the SCID assessments and based on the information obtained during the interview and patients medical record file. Inter-rater reliability for the GAF was assessed using a sub-sample (n = 50) of the patient record files that were randomly extracted and then examined by an independent rater, which did not include results from the personality assessment. The inter-rater agreement was calculated using the intraclass reliability coefficient and was statistically significant, intraclass r = .94, p < .001.

EVALUATION CRITERIA
Each SCID-II/PQ item/symptom was examined using four evaluation criteria: (I) symptom-to-disorder coherence within a given PD; (II) the distinctiveness of each PD symptom relative to other PDs; (III) the relation of each PD symptom to one or more personality dimensions of the FFM; and (IV) the association of each PD symptom with impairment. For Criterion I, each SCID-II symptom was correlated with the total score for the relevant PD i.e., the corrected item-total r. Coefficients .20 were considered acceptable (Nunnally & Bernstein, 1994), representing adequate symptom-todisorder coherence. For Criterion II, the corrected item-total r calculated above was compared with the correlations between the symptom and other PDs. Symptoms correlating more highly with their own PD as compared with other PDs were considered sufficiently discriminating. For Criterion

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III, symptoms were correlated with the 30 facets of the NEO-PI-R. Symptoms that correlated significantly (Bonferroni corrected (.05/30), p < .002) with one or more facets were considered adequately related to the universe of general personality traits. Finally, for Criterion IV, symptoms were correlated with the GAF ratings. Significant correlations were considered to show adequate evidence of a relation with functional impairment.

RESULTS & DISCUSSION Table 1 displays the summary statistics for the four evaluation criteria as applied to each of the ten PDs. For the first criterion, convergent validity, 70.6% of the SCID-II symptoms met the standard (Median = 64.2%; range = 42.9% to 100.0%), including every criterion of Obsessive-Compulsive PD and Schizoid PD. On the other hand, fewer than 60.0% of the Histrionic PD and Avoidant PD items did so. For the second criterion, divergent validity, 53.2% of the SCID-II symptoms met the standard (Median = 48.4%; range = 28.6% to 100.0%), including every symptom of Obsessive-Compulsive PD. Only one further diagnosis, Schizoid PD, showed divergent validity for more than 60.0% of the constituent items. For the third criterion, relation with personality traits, 57.2% of the SCID-II symptoms met the standard (Median = 56.3%; range = 18.2% to 87.7%), with no PD criterion set showing an association with FFM traits for every symptom. Fewer than 60.0% of the items for Antisocial, Obsessive-Compulsive, Paranoid, Schizoid, and Schizotypal PDs were associated with FFM traits. Finally, for the fourth criterion, relation to functional impairment, 21.8% of the SCID-II symptoms met the standard (Median = 12.9%; range = 0.0% to 60.0%), with no PD criterion set showing an association with impairment for every symptom. Every diagnosis other than Borderline PD showed a lack of association with impairment for the majority of its constituent items, and no association was found for any symptom of Histrionic or Obsessive-Compulsive PD. Results for individual PD symptoms, grouped within each of the 10 PDs, can be reviewed in the appendices.
TABLE 1. Summary of Criteria Evaluation Set for 10 DSM-IV Personality Disorders Personality Disorders SCID-II PD Scale # Items Criterion I Criterion II Criterion III Criterion IV 13.3 28.6 60.0 12.5 0.0 11.8 0.0 12.5 42.9 36.4 relation

Antisocial (ATS) 15 73.0 60.0 Avoidant (AVD) 7 57.1 57.1 Borderline (BDL) 15 80.0 46.7 Dependent (DEP) 8 62.5 50.0 Histrionic (HST) 7 42.9 28.6 Narcissistic (NAR) 17 64.9 35.5 Obsessive-Compulsive (OBC) 9 100.0 100.0 Paranoid (PAR) 8 62.5 37.5 Schizoid (SCZ) 7 100.0 71.4 Schizotypal (SZT) 17 63.6 45.4 Note. Criterion I = convergent validity; Criterion II = divergent validity; to personality dimension(s); Criterion IV = relation to impairment.

46.7 85.7 80.0 62.5 85.7 70.6 44.4 50.0 28.6 18.2 Criterion III =

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In general, most of the PD traits were found to be related to their parent disorder (i.e., Criterion I). More problematic was divergent validity (i.e., Criterion II). Many of the traits showing acceptable associations with their parent disorder had higher associations with other disorders. Such overlap surely contributes to the high rates of co-occurrence among PDs that are commonly reported. Specific traits that were unrelated to their parent disorder and/or were more closely related to a different disorder should be modified or even eliminated from the PD system. Many of the PD traits were related to FFM personality traits, suggesting that most PDs are composed of symptoms that reflect personality (i.e., Criterion III). A few disorders do show a more tenuous link with personality, suggesting at least that a qualitative difference exists between these constructs and extremes of normal personality and raising the possibility that perhaps these constructs are not, should be moved to Axis I. Far fewer PD symptoms were related to impairment, compromising their clinical utility (i.e., Criterion IV). This study provides a strategy, anchored to fundamental principles related to diagnostic validity, for evaluating PD traits. We believe that the strategy could be used to modify and improve the PD system where needed. To do so, we would recommend focusing first on Criteria I and II. Doing so would ensure that each PD is composed of a coherent and relatively nonoverlapping set of symptoms, and might require the addition, rewriting, or elimination of items. The next step would be to examine Criteria III and IV, to ensure that each PD criterion relates both to personality and to disorderi.e., to traits associated with impairment. Changes in the item pool might also be required. The result of this process might be a revised set of symptoms that preserve the current PDs while simultaneously responding to many of the criticisms that have been leveled at this system. An alternative strategy might be to abandon the effort to relate PD traits to the existing 10 disorders, and focus exclusively on Criteria III and IV. The goal here would not be to generate a set of more coherent PDs to facilitate categorical diagnosis. Indeed, we have doubts about whether this goal could be achieved, given that more than half of the symptoms currently fail to meet both Criteria I and IIsuggesting that a significant overhaul would be required to rebuild the ten PDs needed to retain the current structure. We would instead hope to identify PD traits that could be integrated into a comprehensive dimensional system incorporating both normal and abnormal personality. Such traits should be related to FFM traits (Criterion III) and to impairment (Criterion IV), but it would no longer be necessary for them to defer to the current problematic PD categories. Such an undertaking would expand our understanding of personality psychopathology beyond the PDs while grounding this understanding in a wellestablished and thoroughly research model of personality traits. At the same time, our knowledge of basic personality and the FFM would be enriched by explicit inclusion of psychopathology.

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APPENDIX SCID-II-Q Self-Report Question (PD trait) I Paranoid Personality 41. Do you often have to keep an eye out to stop people from using you or hurting you? 1 42. Do you spend a lot of time wondering if you can trust your friends or the people that you work with? 1 43. Do you find that it is best not to let other people know much about you because they will use it against you? 1 44. Do you often detect hidden threats or insults in things people say or do? 1 45. Are you the kind of person who holds grudges or takes a long time to forgive people who have insulted or slighted you? 0 46. Are there many people you cant forgive because they did or said something to you a long time ago? 1 47. Do you often get angry or lash out when someone criticizes or insults you in some way? 0 48. Have you often suspected that your spouse or partner has been unfaithful? 0 Ratio: Number of traits meeting criterion to overall number of traits 5/8 Percentage of traits meeting criterion 62.5% Schizoid Personality 58. Are there very few people that youre really close to outside of your immediate family? 60. Is it NOT important to you whether you have any close relationships? 61. Would you almost always rather do things alone than with other people? 62. Could you be content without ever being sexually involved with anyone? 63. Are there really very few things that give you pleasure? 64. Does it NOT matter to you what people think of you? 65. Do you find that nothing makes you very happy or very sad? Ratio: Number of traits meeting criterion to overall number of traits Percentage of traits meeting criterion Schizotypal Personality 49. When you are out in public and see people talking, do you often feel that they are talking about you? 50. Do you often get the feeling that things that have no special meaning to most people are really meant to give you a message? 51. When you are around people, do you often get the feeling that you are being watched or stared at? 52. Have you ever felt that you could make things happen just by making a wish or thinking about them? 53. Have you had personal experiences with the supernatural? 54. Do you believe that you have a sixth sense that allows you to know and predict things that others cant? 55. Does it seem that objects or shadows are really people or animals or that noises are actually peoples voices? 56. Have you had the sense that some person of force is around you, even though you cannot see anyone? 57. Do you often see auras or energy fields around people? 58. Are there very few people that youre really close to outside of your immediate family?

II

III

IV

0 1 1 0 0 0 0 1 3/8 37.5%

0 0 1 1 0 1 1 0 4/8 50.0%

0 0 0 0 0 1 0 0 1/8 12.5%

1 1 1 1 1 7/7 100%

1 1 1 1 0 5/7 71.4%

1 0 1 0 0 2/7 28.6%

0 0 1 0 1 3/7 42.9%

1 1 1 0 1 0 1 1 0 0

1 0 1 0 1 1 1 0 0 0

0 0 0 0 0 0 0 1 0 0

1 0 1 0 0 0 0 0 0 1

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SCID-II-Q Self-Report Question (PD trait) I 59. Do you often feel nervous when you are with other people? 1 Ratio: Number of traits meeting criterion to overall number of traits 7/11 Percentage of traits meeting criterion 63.6% Antisocial Personality 105. Before you were 15, would you bully or threaten other kids? 1 106. Before you were 15, would you start fights? 1 107. Before you were 15, did you hurt or threaten someone with a weapon, like a bat, brick, broken bottle, knife or gun? 1 108. Before you were 15, did you deliberately torture someone or cause someone physical pain and suffering? 1 109. Before you were 15, did you torture or hurt animals on purpose? 0 110. Before you were 15, did you rob, mug, or forcibly take something from someone by threatening him or her? 1 111. Before you were 15, did you force someone to have sex with you, to get undressed in front of you, or touch you sexually? 0 112. Before you were 15, did you set fires? 1 113. Before you were 15, did you deliberately destroy things that werent yours? 0 114. Before you were 15, did you break into houses, other buildings, or cars? 1 115. Before you were 15, did you lie a lot or con other people? 1 116. Before you were 15, did you sometimes steal or shoplift things, or forge someones signature? 0 117. Before you were 15, did you run away from home and stay away overnight? 1 118. Before you were 13, did you often stay out very late, long after the time you were supposed to be home? 1 119. Before you were 13, did you often skip school? 1 Ratio: Number of traits meeting criterion to overall number of traits 11/15 Percentage of traits meeting criterion 73% Borderline Personality 90. Have you often become frantic when you thought that someone you really cared about was going to leave you? 91. Do your relationships with people you really care about have lots of extreme ups and downs? 92. Have you all of a sudden changed your sense of who you are and where you are headed? 93. Does your sense of who you are often change dramatically? 94. Are you different with different people or in different situations, so that you sometimes dont know who you really are? 95. Have there been lots of sudden changes in you goals, career plans, religious beliefs, and so on? 96. Have you often done things impulsively? 97. Have you tried to hurt or kill yourself or threatened to do so? 98. Have you ever cut, burned or scratched yourself on purpose? 99. Do you have a lot of sudden mood changes? 100. Do you often feel empty inside? II 0 5/11 45.45 III 1 2/11 18.2%

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IV 1 4/11 36.4%

1 1 1 1 0 0 0 1 1 0 1 1 1 0 0 9/15 60%

0 0 0 1 1 1 0 0 0 0 1 1 0 1 1 7/15 46.7%

0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 2/15 13.3%

1 1 1 0 0 1 1 0 1 1 1

1 1 1 0 0 1 1 0 0 1 1

0 1 1 1 1 1 1 1 1 0 0

0 0 0 0 0 1 1 1 1 1 1

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SCID-II-Q Self-Report Question (PD trait) 101. Do you often have temper outbursts or get so angry that you lose control? 102. Do you hit people or throw things when you get angry? 103. Do even little things get you very angry? 104. When you are under a lot of stress, do you get suspicious of other people or feel especially spaced out? Ratio: Number of traits meeting criterion to overall number of traits Percentage of traits meeting criterion

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I 1 1 1 1 12/15 80% II 0 0 0 0 7/15 46.7% 0 0 1 0 1 0 0 2/7 28.6% III 1 1 1 1 12/15 80% 1 1 1 1 0 1 1 6/7 85.7% IV 1 1 0 1 9/15 60% 0 0 0 0 0 0 0 0/7 0%

Histrionic Personality 66. Do you like to be the center of attention? 0 67. Do you flirt a lot? 0 68. Do you often find yourself coming on to people? 1 69. Do you try to draw attention to yourself by the way you dress or look? 1 70. Do you often make a point of being dramatic and colorful? 1 71. Do you often change your mind about things depending on the people youre with or what you have just read or seen on TV? 0 72. Do you have a lot of friends that are you very close to? 0 Ratio: Number of traits meeting criterion to overall number of traits 3/7 Percentage of traits meeting criterion 42.9% Narcissistic Personality 73. Do people often fail to appreciate your very special talents or accomplishments? 0 74. Have people told you that you have too high an opinion of yourself? 1 75. Do you think a lot about the power, fame or recognition that will be yours someday? 1 76. Do you think about the perfect romance that will be yours someday? 0 77. When you have a problem, do you almost always insist on seeing the top person? 1 78. Do you feel it is important to spend time with people who are special or influential? 1 79. Is it important to you that people pay attention to you or admire you in some way? 0 80. Do you think that its not necessary to follow certain rules or social conventions when they get in your way? 1 81. Do you feel that you are the kind of person who deserves special treatment? 0 82. Do you often find it necessary to step on a few toes to get what you want? 1 83. Do you often have to put your needs above other peoples? 1 84. Do you often expect other people to do what you ask without question because of who you are? 1 85. Are you NOT really interested in other peoples problems or feelings? 0 86. Have people complained to you that you dont listen to them or care about their feelings? 1 87. Are you often envious of others? 1 88. Do you feel that others are often envious of you? 1 89. Do you find that there are very few people that are worth your time and attention? 0 Ratio: Number of traits meeting criterion to overall number of traits 11/17 Percentage of traits meeting criterion 64.7%

1 1 0 0 1 1 0 0 0 1 0 0 0 0 0 1 0 6/17 35.3%

0 1 1 0 0 1 1 1 0 1 1 1 1 1 0 1 1 12/17 70.6%

0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 3/17 11.8%

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SCID-II-Q Self-Report Question (PD trait) I Avoidant Personality 1. Have you avoided jobs or tasks that involved having to deal with a lot of people? 1 2. Do you avoid getting involved with people unless you are certain they like you? 1 3. Do you find it hard to be open even with people you are close to? 0 4. Do you often worry about being criticized or rejected in social situations? 1 5. Are you usually quiet when you meet new people? 0 6. Do you believe that youre not as good, as smart, or as attractive as most other people? 1 7. Are you afraid to try new things? 0 Ratio: Number of traits meeting criterion to overall number of traits 4/7 Percentage of traits meeting criterion 57.1% Dependent Personality 8. Do you need a lot of advice or reassurance from others before you can make everyday decisionslike what to wear or what to order in a restaurant? 1 9. Do you depend on other people to handle important areas in your life such as finances, childcare, or living arrangements? 1 10. Do you find it hard to disagree with people even when you think they are wrong? 0 11. Do you find it hard to start or work on tasks when there is no one to help you? 1 12. Have you often volunteered to do things that are unpleasant? 0 13. Do you usually feel uncomfortable when you are by yourself? 1 14. When a close relationship ends, do you feel you immediately have to find someone else to take care of you? 0 15. Do you worry a lot about being left alone to take care of yourself? 1 Ratio: Number of traits meeting criterion to overall number of traits 5/8 Percentage of traits meeting criterion 62.5% II III

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IV

0 1 0 1 1 1 0 4/7 57.1%

1 1 1 1 0 1 1 6/7 85.7%

0 0 0 0 0 1 1 2/8 28.6%

1 1 0 1 0 1 0 0 4/8 50%

1 0 1 1 0 0 1 1 5/8 62.5%

0 0 0 0 0 0 0 1 1/8 12.5%

ObsessiveCompulsive Personality 16. Are you the kind of person who focuses on details, order, and organization or likes to make lists and schedules? 1 1 1 0 17. Do you have trouble finishing jobs because you spend so much time trying to get things exactly right? 1 1 0 0 18. Do you or other people feel that you are so devoted to work (or school) that you have no time left for anyone else or for just having fun? 1 1 1 0 19. Do you have very high standards about what is right and what is wrong? 1 1 1 0 20. Do you have trouble throwing things out because they might come in handy some day? 1 1 1 0 21. Is it hard for you to let other people help you unless they agree to do things exactly the way you want? 1 1 0 0 22. Is it hard for you to spend money on yourself and other people even when you have enough? 1 1 0 0 23. Are you often so sure you are right that it doesnt matter what other people say? 1 1 0 0 24. Have other people told you that you are stubborn or rigid? 1 1 0 0 Ratio: Number of traits meeting criterion to overall number of traits 9/9 9/9 4/9 0/9 Percentage of traits meeting criterion 100% 100% 44.4% 0% Note. I = convergent validity; II = divergent validity; III = relation to personality dimension(s); IV = relation to impairment.

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REFERENCES
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