Psychological Assessment 1992, Vol. 4, No.

1,5-13

In the public domain

Normal Personality Assessment in Clinical Practice: The NEO Personality Inventory
Paul T. Costa, Jr., and Robert R. McCrae
Gerontology Research Center National Institute on Aging, National Institutes of Health Baltimore, Maryland Personality psychologists from a variety of theoretical perspectives have recently concluded that personality traits can be summarized in terms of a 5-factor model. This article describes the NEO Personality Inventory (NEO-PI), a measure of these 5 factors and some of the traits that define them, and its use in clinical practice. Recent studies suggest that NEO-PI scales are reliable and valid in clinical samples as in normal samples. The use of self-report personality measures in clinical samples is discussed, and data from 117 "normal" adult men and women are presented to show links between the NEO-PI scales and psychopathology as measured by Jackson's (1989) Basic Personality Inventory and Morey's (1991) Personality Assessment Inventory. We argue that the NEO-PI may be useful to clinicians in understanding the patient, formulating a diagnosis, establishing rapport, developing insight, anticipating the course of therapy, and selecting the optimal form of treatment for the patient.

In the past two decades there has been remarkable progress in one of the oldest branches of personality psychology: the study of traits or individual differences. The conceptual status of traits has been clarified (Costa & McCrae, 1980; Funder, 1991; Tellegen, in press), and trait measures have shown evidence of convergent and discriminant validity across instruments (McCrae, 1989) and observers (Kenrick & Funder, 1988). Longitudinal studies of both self-reports and ratings have shown impressive stability of a wide range of traits across the adult lifespan (Block, 1981; McCrae & Costa, 1990). Perhaps most exciting is the growing agreement among personality psychologists that most individual differences in personality can be understood in terms of five basic dimensions: Neuroticism (N) vs. Emotional Stability; Extraversion (E) or Surgency; Openness to Experience (O) or Intellect; Agreeableness (A) vs. Antagonism; and Conscientiousness (C) or Will to Achieve (Digman, 1990; John, 1990; Norman, 1963; Wiggins & Trapnell, in press). These factors have been recovered in studies of self-reports and ratings, lay adjectives and standardized questionnaires, adults and children, and several different cultures. This five-factor model is a theoretical advance that has important implications for many applied areas, including clinical practice. By assessing traits from each of the five factors, the clinician can obtain a comprehensive portrait of the client's personality, and the clinical researcher can systematically examine relations between personality and treatment variables. Recent articles and symposia have examined the utility of the five-factor model in counseling (McCrae & Costa, 1991), abnormal psychology (Widiger & Trull, in press), and clinical psychology (Spielberger, 1989). This article is intended to de-

Correspondence concerning this article should be addressed to Paul T. Costa, Jr., Laboratory of Personality and Cognition, Gerontology Research Center, 4940 Eastern Avenue, Baltimore, Maryland 21224.

scribe a measure of the five factors, the NEO Personality Inventory (NEO-PI; Costa & McCrae, 1985, 1989), and its use in clinical settings. Of course, "normal" personality assessment, using such instruments as the Sixteen Personality Factor Questionnaire (16PF; Cattell, Eber, & Tatsuoka, 1970) and the California Psychological Inventory (CPI; Gough, 1957), has long been part of clinical practice. The NEO-PI is, however, the first inventory based on the five-factor model, and a discussion of its use may provide some fresh perspectives on the relevance of normal personality traits to clinical psychology. Clinicians often think of psychological assessment as part of the diagnostic process. Although not designed as a measure of psychopathology, we believe the NEO-PI can contribute information that is relevant to diagnosis. But perhaps more important are the ways in which the instrument may help the clinician understand the patient, select appropriate treatments, and anticipate the course and outcome of therapy. For these purposes, much more is needed than measures of psychopathology; the full range of personality characteristics must be considered, and it is here that the five-factor model provides a guide. The first factor, Neuroticism, is most familiar to clinicians. It represents the individual's tendency to experience psychological distress, and high standing on N is a feature of most psychiatric conditions. Indeed, differential diagnosis often amounts to a determination of which aspect of N (e.g., anxiety or depression) is most prominent. We will discuss later the relations between this dimension of personality and psychopathology. Extraversion is the dimension underlying a broad group of traits, including sociability, activity, and the tendency to experience positive emotions such as joy and pleasure. Patients with histrionic and schizoid personality disorders differ primarily along this dimension (Wiggins & Pincus, 1989), and Miller (1991) has pointed out that talkative extraverts respond very

and those who are unfamiliar with the fivefactor model are well advised to attend first to the distinctions among the domains. Although these traits are probably considered desirable by most clinicians. The NEO-PI is intended to offer both a global portrait of the individual's personality and more detailed information on specific facets of the broad domains. 1981). Costa. In the long run. and the self-spouse correlations in the fifth column are also evidence of the validity of Form R scales. patients scored about one standard deviation higher in N and about one-half Assessing Personality: The NEO-PI The NEO-PI was developed over the past 15 years as a measure of the five-factor model. C should also affect the outcome of therapy. however. separate norms for college students. 1980. As Table 1 shows. the latter to antisocial personality disorder (Lyons. the scales of Form R show a pattern of reliability and stability very similar to that seen for Form S. McCrae & Costa. Despite the brevity of the facet scales. High-A individuals are trusting. and cooperative. Conscientiousness is a dimension that contrasts scrupulous.and third-person. 1985. Merla. Differences in O are related. callous. they are intellectually curious. We use the term to refer to a broader constellation of traits. E. In all three samples. A is clinically important because it directly affects the rapport between patient and therapist (Muten. it is natural to focus on the five broad domains rather than on the individual traits that constitute them. and lackadaisical individuals. with parallel items phrased in first. and O—each containing many more specific traits or facets (Costa & McCrae. 1989). a short. high-O individuals tend to use intellectualization as a defense. and expert ratings based on spontaneous self-concept descriptions (Costa & McCrae. 1991). 18-item scales to measure A and C when the NEO-PI was published in 1985. 1991). both ends of this factor may be associated with psychopathology. disorganized. Table 1 lists the domain and facet scales of the NEO-PI and some of their psychometric properties. Finally. in press). Muten. however. Although lay observer rating scales have been widely used in personality research. to the extent that psychotherapy can be considered work. JR. 1991). in press-c)." Until recently. well-organized. 1991). behaviorally flexible. Three recent studies have examined the instrument in three different clinical settings: a behavioral medicine clinic (Muten. & Hyler. or NEO-FFI) that gives scores for the five domains only and may be useful when time for assessment is limited. Additional validity studies have examined correlations with peer ratings. and a private clinical practice (Miller. 1989). High-O individuals are imaginative and sensitive to art and beauty and have a rich and complex emotional life. As Homey (1945) pointed out in her distinction between moving toward and moving against others. low-A individuals are cynical. but the distinction between them is often critical in selecting appropriate treatment. and antagonistic. Perhaps the most important data in Table 1 are given in the last column: These are validity coefficients that demonstrate significant and substantial agreement across sources for all 18 facets and five domain scales. 1990). and larger correlations are seen when ratings are aggregated across peers (McCrae & Costa. and all show substantial stability (which is a lower-bound estimate of reliability) over a 6-year interval. Form R of the NEO-PI is available in two versions (one for rating men and the other for rating women) and has profile sheets based on normative studies of adults. whereas low-O individuals use suppression or denial. The current 181-item version of the inventory has two forms: S for self-reports. suaded us to include two newer. Similar results (with rs ranging from .. they are not necessarily associated with good mental health: Conventionality and conformity are also viable paths to adjustment. scoring. Clinical psychologists may recognize Openness to Experience as one of the goals of Rogerian therapy. and there is some evidence that it does (Miller. 1985. like E. 1991). McCrae. and diligent people with lax. Ozer. Recent reviews of the instrument are provided by Hogan (1989) and Leong and Dollinger (1990). 1991). Our original interest was in only three of the factors that we conceptualized as broad domains— N. The nature of the sample or the conditions of administration could affect the validity of the instrument. In addition. The NEO Inventory (as it was then called) included six 8-item facet scales for each of the three domains. The former are more prone to compulsive personality disorder. Agreeableness. a sexual behaviors consultation unit (Pagan et al.. Conscientiousness is associated with academic and vocational success (Digman & Takemoto-Chock. sympathetic. and scales are balanced to control for the effects of acquiescence. AND ROBERT R. and a test feedback sheet (Your NEO Summary) that can be used to involve the patient therapeuticalry in what McReynolds (1989) called "client-centered assessment. the detailed information that clinicians need can only be provided by an instrument that makes distinctions within the domains. anxiety and depression are both aspects of N.PAUL T. and nondogmatic in their attitudes and values (McCrae & Costa. in press-c. a mail-in scoring system. & Dye. and interpretation. p < . 1991). sentence completions. Other features designed to make the NEO-PI more useful to clinicians include computer administration. most have good internal consistency. For example.32 to . a wide variety of other questionnaires and adjective checklists.54. to the manifestations of psychopathology (e. in press) and to the types of treatment that the patient is likely to find acceptable. Research on the five-factor model per- . In a brief introduction such as this. 60-item version (the NEO Five Factor Inventory. We believe that ratings by knowledgeable others can and should be more widely used as an adjunct to the self-reports usually found in clinical assessment (cf. and R for observer ratings. they have rarely been published. and clinicians may rightfully wonder how well its psychometric properties hold up in clinical populations when used as part of clinical assessment. McCRAE differently to talk-oriented psychotherapies than do reserved and reticent introverts. is primarily a dimension of interpersonal behavior.g. almost all research on the NEO-PI was conducted on normal volunteer samples.001) are found for individual peer ratings. Items are answered along a 5-point Likert scale from strongly disagree to strongly agree. COSTA. Facet scales for A and C are being developed and should be available soon (Costa & McCrae.

A.51 . Such findings suggest that clinician ratings of personality are likely to concur with patient self-reports.73 .73 . The presence of an anxiety disorder.81 .66 .79 .79 . These studies are certainly encouraging.77 .53 .77 . . need not affect one's intellectual curiosity or need for achievement.90.47 .53 .94 . there are two issues that require special consideration here: (a) problems of test invalidity due to defensiveness.73 .45 .71.73 .73 .86 .75 .32 .82 .79 .76.'.63 . (1990) reported significant correlations between NEO-PI domain scales and expert ratings of four of the factors based on psychiatric interviews.76 . and C.29 to .94.82 . Although there are certainly circumstances (such as advanced dementia or catatonia) in which the assessment of normal personality is impossible and perhaps meaningless. we believe that most patients can be profitably described in terms of the dimensions of the fivefactor model.51 .81 . Special Concerns in Clinical Assessment The traditional distinction between normal and abnormal psychology has led some clinicians to the belief that instruments designed for the measurement of normal personality dimensions are irrelevant to or inappropriate for clinical assessment.38 .81 .75 .70 .53 .79 . and that the NEO-PI will be a useful way to measure standing on these dimensions.75 .54 . E.79 . suggesting that the metric provided by the norms is appropriate for clinical samples.50 .68 .80 .84 .SPECIAL SECTION: NEO-PI IN CLINICAL PSYCHOLOGY Table 1 Some Psychometric Properties of NEO-PI Scales for Self-Reports (Form S) and Spouse Ratings (Form R) Coefficient alpha NEO-PI scale Neuroticism Anxiety Hostility Depression Self-consciousness Impulsiveness Vulnerability Extraversion Warmth Gregariousness Assertiveness Activity Excitement Seeking Positive Emotions Openness Fantasy Aesthetics Feelings Actions Ideas Values Agreeableness Conscientiousness FormS (n = 983) Form R (n = 167) 6-year stability FormS (n = 398) Form R (n = 167) Self-spouse agreement («=135) . for two reasons. and significantly correlated with spouse ratings on Form R. but they represent only the first stages of research on the use of the NEO-PI in clinical samples.75 . psychotics.84 . All correlations significant at p < .83 .67 .72 .73 .79 . and many of the patients whom clinical psychologists treat are relatively well-adjusted individuals facing situational stressors.64 .48 . adolescents) is the NEO-PI appropriate? How does treatment affect NEO-PI scores? What are the personality profiles of different diagnostic groups? How do personality traits of the clinician interact with those of the patient? How well do self-reports or lay ratings agree with clinician's views of the patient's personality? Does the NEO-PI offer incremental validity over traditional measures of psychopathology in predict- ing diagnosis or prognosis? Research on all these topics would be welcome. many aspects of personality are relatively unaffected by psychopathology.87 .68 .84 .88 .66 .76 .86 . with cross-observer correlations ranging from .84 .74 .83 .75 . . Agreeableness and Conscientiousness were not measured at baseline. for example.72 .93 .53 . standard deviation lower in A and C than did normal volunteers.76 . socially desirable respond- . Many questions need to be addressed in future studies: For what other clinical populations (inpatients. they did not differ in E or O. Adapted from Costa & McCrae. Pagan et al.78 .75 .88 .76 — — . In the public domain.77 .79 .43 .79 .75 .74 .77 .79 . standard deviations themselves were comparable to normative values.72 .73 .47 .53 .74 .83 .68 .74 . 1988. respectively (values that are virtually identical to those found in the first column of Table 1) and replicated the factor structure of the facet scales.75 . Piven et al.74 . O. the populations overlap considerably: An appreciable number of individuals in normal volunteer samples would be found to have diagnosable psychiatric disorders if they were systematically assessed.54 .87 . Muten showed that Form S NEO-PI scales were meaningfully related to other self-report scales in his behavioral medicine sample.91 .72 .40 .73 .43 Note. We believe this conclusion is unjustified.85 for N.70 .76 . and .89 .87 .69 .001. However.89 .87.60 .79 .71 — — .62 .75 . reported reliabilities for the domains of . First.85 .73 .70 . Second.60 .70 .82 . Further.91 .

Effects of Psychopathology on Scale Scores Responses to personality questionnaire items are based on the self-image. faking. frequently lack insight into their own personalities. such irrational beliefs about the self may affect personality trait measures. and most clinical instruments (such as Jackson's. 1983. In some cases. 1989). special validity scales are not included. social desirability. 1989). We think these instructions will lead to valid scores in most cases. interest. 1986. There are three major ways in which the resulting personality scale scores can be interpreted. Although NEO-PI interpreters are of course advised to check protocols for missing data and evidence of gross acquiescence or random responding (Costa & McCrae. and that honest responses will contribute to the success of clinical evaluation or therapy. These paradoxical findings result from the inability of most social desirability scales to distinguish between individuals who falsely present themselves as having desirable characteristics and those who accurately report desirable traits. the view the individual has of him. The MMPI used empirically keyed scales with subtle items. Muten's (1991) data show similar levels of agreement between patients' self-reports and their spouses' ratings on the NEO-PI. Nevertheless. and thus scale scores. It is probably the case that all three interpretations are correct to some extent. 1990) samples have found negative correlations between narcissism and self-reported Agreeableness. either in general or on the specific occasion when the test is administered. A single item that baldly asks respondents whether they have answered the questions honestly and accurately is the only validity check. The most straightforward is to view them as measures—fallible measures. But studies using both normal (Costa & McCrae. and may portray themselves as well-adjusted. and we suspect that the same will hold true in clinical samples. AND ROBERT R. Social Desirability. particularly those with emotional and interpersonal problems. questionnaire responses. and the clinician must keep this possibility in mind when interpreting scores. and that individuals..31 to . Defensiveness. or correct for these sources of invalidity. in many cases it substantially reduces their validity (McCrae. We would not deny that personality scores are sometimes distorted by response sets and styles. We think it is unlikely that useful information will be obtained from self-reports in such cases.05). For example. so apparently narcissists are not prone to describe themselves as humble. trustworthy. 1991. McCRAE There is also evidence that attempts to improve the validity of self-reports through the use of special items or scales is often counterproductive. We recommend that clinicians who use the NEO-PI explain to their patients that it measures some of the important ways in which people differ in their thoughts. and thus actually estimates—of what the individual is really like. and actions. McCrae et al. psychometricians have expended prodigious efforts seeking ways to avoid. There are doubtless occasions when self-reports are not trustworthy. The success of psychological assessment depends in considerable measure on the clinician's ability to elicit the patient's trust. One example is provided by narcissism.8 PAUL T. We would encourage clinicians to use ratings from knowledgeable informants such as spouses or parents as an adjunct to or substitute for self-reports whenever there is reason to suspect that self-reports may be seriously distorted. social desirability. and perhaps conscientious. In this view.66. they ask directly about the characteristics they are intended to measure. It is in regard to this issue that the NEO-PI breaks most clearly with the traditions of testing in clinical psychology. Wrobel and Lachar (1982) showed that scales using subtle items were less valid than those composed of obvious items. ing. these correlations rose as high as . the interpreter's task is to determine how much weight to assign to each. that is. extraverted. or socially desirable responding. from delusions of grandeur to distortions of bodyimage among anorectics. 1989. Narcissists have an inflated self-image. The use of instruments designed to outwit or entrap the respondent hardly contributes to the development of rapport. defensiveness. but a decision based on several lines of evidence and reasoning that need to be understood by users of the NEO-PI. Certainly for normal samples the dangers of mistakenly distrusting valid self-reports outweigh the benefits of identifying invalid responses. JR. feelings. and malingering have created in the minds of many clinicians a profound mistrust of patient self-reports. scores represent the ways in which the individual wishes to be viewed by others. can be seen as self-presentation. sympathetic. but clinical psychology provides many counterexamples. and this was one of the major reasons we developed and validated the observer rating form of the NEO-PI. and defensiveness scales does not increase their validity with respect to external criteria—indeed.or herself. A patient may be uncooperative or cognitively impaired. personality rat- . and Malingering NEO-PI items are obvious.. second interpretation is that they represent the individual's self-concept: how he or she sees him. 1990) and psychiatric (Lyons et al. concerns about defensiveness. and that there are better ways to deal with them than through the use of validity scales. Perhaps because of the early influence of psychoanalysis (with its emphasis on unconscious processes and mechanisms of defense). and (b) effects of psychopathology itself on personality scale scores. The omission of validity scales was not an oversight. Third. Jackson (1989) showed convergent correlations between Basic Personality Inventory (BPI) scales and professional ratings of hospitalized psychiatric patients.. COSTA. detect.51 (all p < . or malingering. in general. Personality Assessment Inventory) include validity scales to measure lying. But we believe that these problems are not as crippling as they are often portrayed. Studies comparing self-reports with observer ratings support the conclusion that self-images are generally accurate (McCrae & Costa. with or without the use of corrections. McCrae & Costa. ranging from . or self-effacing.or herself. and cooperation. or may have powerful incentives to distort self-presentation. In response. 1989). Basic Personality Inventory and Morey's. corrected for unreliability of the ratings. A series of studies using normal volunteer samples has shown that correcting self-reports using lie. There is substantial evidence that self-reports from patients are. A more subtle.

it is of interest to consider first their convergent and discriminant validity as alternative measures of psychopathology. but it appears that the major effect of depression is to exaggerate scores on measures of N.48. Comparison of means shows that the present sample is similar to the normative group of normals in most respects. In addition to 11 clinical scales (most with subscales). Underwood. Both of these instruments were . The PAI is a new instrument designed "to provide information on critical clinical variables" (Morey. we would argue that most dimensions of psychopathology have parallels in dimensions of individual differences in the normal range. reversed) decreased over a 1-year period for depressed patients who had recovered. 1962) and the Guilford Zimmerman Temperament Survey (GZTS. 1990. which show relatively little variance in this predominantly older sample. 1983). 1990. Previous studies (Costa & McCrae. and Fieve (1979) have reported that Neuroticism scores. Paranoia and Antisocial Features are negatively related to A. Borderline Features. (1983) administered the Maudsley Personality Inventory (MPI. in press)? Whatever the form of the relationship. depression is unlikely to affect scores on E and O. and coefficients alpha for the PAI clinical and treatment scales. and five scales related to treatment and case management. increased as patients entered a depressive phase. Interpersonal Problems with A. 1983) and the Millon Clinical Multiaxial Inventory (MCMI. Millon. One of the intriguing questions for future research concerns the nature of the relation between traits and psychiatric disorders: Do traits predispose individuals to certain disorders or result from the disorders. Social Introversion with E. Both instruments were administered to a subsample of men and women in the Baltimore Longitudinal Study of Aging (BLSA. In general.. Most important. the Minnesota Multiphasic Personality Inventory (MMPI. Because both these instruments are relatively new. Intercorrelations among all the scales in Tables 2 and 3 are available from us. Hathaway & McKinley. We have recently collected data on two newer measures of psychopathology: Jackson's BPI and Morey's Personality Assessment Inventory (PAI). standard deviations.SPECIAL SECTION: NEO-PI IN CLINICAL PSYCHOLOGY ings might be particularly useful in cases in which a diagnosis of narcissism is suspected. and pointing out these correspondences may be a useful way to acquaint the clinician with the constructs measured by the NEO-PI.72) with BPI Hypochondriasis. most of the scales were related to N or E. is unrelated to any of the five factors. and one on which there is already some research. It appears that the primary effect of this bias is seen on measures related to Neuroticism. as well as correlations with NEOPI domain scales. Table 3 provides means. Anxiety. and Schizophrenia are strongly related to N. are needed here. especially including measures of A and C. For example. but not Extraversion scores. this bias is unlikely to change the overall shape of the personality profile. It is notable that only one of the BPI scales. 1989). but not for those who had not. Eysenck. Stallone. respectively). Should we conclude that some individuals score low on N because they deny undesirable traits they possess. There is considerable evidence that temporary moods do not influence scores on personality inventories in normal samples (Costa & McCrae. 370) and illustrates the complementary nature of measures of personality and psychopathology. it also contains four validity scales. Recovery from depression did not lead to changes in GZTS General Activity and Ascendance (measures of E) or GZTS Thoughtfulness (a measure of O). Denial with O. is the effect of mood disorders on self-presentation. Mania is related to E. Framing. dimensions that may be useful in selecting the optimal form of therapy (Miller. Dunner.. we know from many studies that there is substantial overlap between measures of personality and psychopathology. Widiger & Trull. two interpersonal scales. they show the parallelism between psychopathological and normal personality dimensions that we hypothesized. with mean ages of 67. and none of the scales is strongly related to O or C. Data from observer ratings would be needed to resolve this issue. p. The inclusion of treatment scales is an interesting feature of the PAI. The 60 men and 57 women who provided data on one or both instruments ranged in age from 21 to 94. Guilford. Correlations of the clinical scales with the NEO-PI domains show a pattern previously seen in analyses of the MMPI and MCMI. Thinking Disorder. 1991. The negative correlation between BPI Denial and N illustrates the problematic nature of validity scales. 1). 1984) who had completed the NEO-PI 2 years earlier. But clinical depression does affect self-image: Depressed patients have lowered self-esteem that is manifested in their responses. PAI Somatic Complaint had its highest correlation (r = . or are mental disorders merely extreme forms of otherwise normal personality characteristics (cf. Aggression and Suicidal Ideation refer to characteristics of the individual that clinicians should attend to.5. 1991) have examined correlations between the NEO-PI factors and scales from two of the most widely used clinical instruments. This finding is consistent with earlier speculations that "a sixth dimension of aberrant cognitions might be needed to fully describe personality disorders" (Costa & McCrae. & Moore. The correlations of Anxiety with N. respectively. although Linking Clinical and Normal Personality Instruments We have argued that most clinical populations are not dramatically different from normal volunteer samples with regard to the structure of personality. . in press-b. good agreement was found. p. Because individuals who are prone to depression are also likely to have elevated premorbid N scores (Hirschfeld et al. Table 2 gives correlations between the NEO-PI domain scales and BPI scales.5 and 64. Zimmerman. or should we conclude that people low on N really have fewer undesirable traits? Both are logically possible. PAI Anxiety and Anxiety-Related Disorder scales had their highest correlations with BPI Anxiety (rs = . and we suspect the latter is more plausible. Liebowitz. Internal consistencies are high except for the Drug Problems and Stress scales. Additional studies. 1991). 1980). Shock et al.66. & Guilford. Similarly. 1976) twice to depressed men and women and reported that measures of N (MPI Neuroticism and GZTS Objectivity. intended to provide psychometrically sophisticated measures of major dimensions of psychopathology in both normal and clinical populations. Hirschfeld et al. A more pervasive problem. and Impulse Expression with C require little comment. McCrae.

of course.38*** .01 . **p<. 1990).07 -.51*** .26** .15 -. N = Neuroticism.001.29*** -.17 .9 13.19* -.19* Note: One item (of 24) is missing from the Depression scale.10 -.02 .33*** .45*** ..67*** .16 -. */><.81 .05 .4 SD 8.4 5.9 6.36*** -.9 3.68 .30*** -. ***/>< .77 .6 6. .39*** .52*** -.0 14.07 -.26** Extroversion -.27** .37*** -.05.07 -.10 -.26** .7 6.00 -.76 . note the negative correlation between Aggression scores and A.26** -.15 -.03 -.02 Openness -.8 3.36*** -.17 Conscientiousness -.16 -.05 -.35*** -. There are.07 .43*** .25** -.19* .32*** -.1 13.03 . **/?<.03 .18 .27** -.3 2. The correlations in Tables 2 and 3 illustrate meaningful links between clinical constructs and normal personality dimensions.2 4.60*** . But in many cases the difference is one of degree.01 -.86 .5 2. COSTA.6 5.08 -. Disagreeable people also report less social support.04 -.08 .23* -.13 . between mania and high-spirited extraversion.20* . O . A = Agreeableness.7 15.1 17.07 .13 -.9 11.19* -.06 -.03 .43*** -.08 .Openness.3 21.08 .75 .00 -.7 8. volunteer sample.20* -. McCrae.18 -. ***p<. self-report measures of stress and social support are affected by neuroticism (cf.04 -.14 .15 -.63*** .7 3.74 .9 3.0 3.83 . These variables are usually conceptualized as situational factors.17 -. Finally.02 */><.11 -.14 -. C = Conscientiousness.0 13.26** -.86 .09 -.9 8.59 .18 . there is a strong negative correlation between N and treatment rejection—a perfectly reasonable result: In this normal.16 -.19* -. important differences between clinical depression and normal dejection.55*** .00 -.37*** -. perhaps because they have antagonized the people who would otherwise provide it. AND ROBERT R.18 .16 . E =» Extraversion.13 .27** .08 .20* -.00 -.71 N E O A .09 -.11 -.01 Agreeableness -.33*** .28** -.21* -.18 -.03 .2 6.08 .12 .01 .06 -.60*** -.21* -.01.6 3.02 -.35*** -. they are not necessarily the basis of particular psychiatric diagnoses.07 -.70 .07 -.14 -.56*** -.8 2.2 3.24** .1 14.43*** .07 -.05.10 PAUL T. between obsessive-compulsive behaviors and conscientious organization.21* -.33*** .01.21* . McCRAE Table 2 Correlations ofNEO Personality Inventory Domain Scales With Jackson's Basic Personality Inventory (BPI) Scales (N = 109) NEO Personality Inventory domain BPI scale Hypochondriasis Depression Denial Interpersonal Problems Alienation Persecutory Ideas Anxiety Thinking Disorder Impulse Expression Social Introversion Self Depreciation Deviation Neuroticism .19* .77 .38*** .40*** .57 .16 .23* .38*** .17 -.84 .27** -.001.10 .04 -. and one item (of 12) is missing from the Alcohol Problems scale.32*" .14 -.29** . but as Table 3 shows.04 .27** -.38*** . well-adjusted people see little need for psychotherapy.7 . JR.12 . The clinician may also want an indication of how much stress the individual is exposed to and how much social support he or she receives.29** .9 10. Dimensions of psychopathology are Table 3 Correlations of NEO Personality Inventory Domain Scales With Personality Assessment Inventory (PAI) Scales (N = 114) NEO Personality Inventory domain PAI scale Clinical scales Somatic Complaints Anxiety Anxiety-Related Disorders Depression Mania Paranoia Schizophrenia Borderline Features Antisocial Features Alcohol Problems Drug Problems Treatment scales Aggression Suicidal Ideation Stress Nonsupport Treatment Rejection M 12.40*** -.48*** .08 -.44*** -.7 7.35*** .28** -.74 .07 .

But more recently. No form of therapy is likely to affect a complete cure of lifelong dysthymia or a borderline personality disorder. In the case of extremely high N scores. Law C scores can alert the clinician to the need to provide structure and motivation for the patient. Personality dispositions and the disorders to which they predispose individuals tend to be very stable in adulthood. clinicians should measure progress . allowing a more rapid development of rapport. McReynolds (1989) has called this approach client-centered assessment. and the NEO-PI can signal potential problems in these areas.g. Elevated N scores are common among patients in psychotherapy. many of the most important insights in this regard have come from practicing psychotherapists who have used the NEO-PI themselves (Pagan et al. further. should lead the clinician to consider the diagnosis of Social Phobia. keep a diary of emotional reactions). The patient with very low A scores may be skeptical about the entire therapeutic enterprise and expect the clinician to prove him. just as they need to consider age. excessively high A scores can point to an overly compliant patient who easily becomes dependent on the therapist. instead. and capacity for therapeutic benefit. Patients who are relatively well-adjusted to begin with are those who benefit most from therapy. Muten. Conversely. Clinical Uses of Personality Data In 1986 we argued that clinicians could benefit from routine assessment of the five basic factors of personality (McCrae & Costa. Anticipating the Course of Therapy The success of psychotherapy depends not only on the therapist's skill.SPECIAL SECTION: NEO-PI IN CLINICAL PSYCHOLOGY 11 not a world apart from dimensions of personality. there is considerable evidence that the NEO-PI provides relatively accurate information on patients from a variety of clinical populations. 1991). Because the fivefactor model is comprehensive.. very high E scores are inconsistent with the diagnosis of schizoid personality disorder). Patients with deficiencies in these areas need special attention from the therapist. the clinician needs to foster realistic expectations about the benefits of therapy. and cultural background. the value of sharing test results has been emphasized. At least one clinician (Muten. both are spanned by the same five dimensions. sex. some people are more prone to take such assignments seriously than others are.or herself. a patient may be very extraverted without being histrionic). or are they symptoms of enduring and pervasive maladjustments? Diagnosis NEO-PI scores may suggest possible diagnoses or be used to rule out various disorders. Patients who are very low in C may not even remember to keep therapy appointments. 1991. Scores on A are particularly relevant to issues of trust and cooperation. Not surprisingly. 1991) routinely reviews the full profile sheet with patients. education. Research is needed to establish the utility of this process and the patient populations for which it is appropriate. As in academic settings. has been developed to provide feedback to individuals who take the NEO-PI or NEO-FFI. in which sessions spent learning about the patient may be time lost from treatment. which is distinguished by a persistent fear of acting in a way that will be humiliating or embarrassing. this is true for some instruments and some patients.g. the profile the NEO-PI provides covers the full range of personality traits and can give the clinician a sense of both the patient's strengths and weaknesses. We summarize some of their experience here. the scale scores are tied to concrete examples of problematic behavior to help the patient achieve insight into his or her behavior. Knowledge of personality traits can also set in context the specific problems that led the patient to therapy: Are they reactions to recent events or difficult situations. Understanding The most basic function of psychological assessment is to give the clinician a sense of what the patient is like. it is easier to discuss with patients the results from a measure of normal personality than from measures of psychopathology. 1986). and this is gauged chiefly by C. Clinicians themselves may also find it easier to empa- thize with patients when they consider nonpathological aspects of personality. interpersonal. Miller. however. 1991. such as the individual's intellectual interests or capacity for joy. attitudinal. Feedback and Insight Traditionally. that more is needed than a guide to the elements of personality: Clinicians also need to learn how to use this information. experiential. Your NEO Summary. but extreme scores are often contraindicative of certain diagnoses (e.. motivation to work. taking the time to explain the labels for the scales and the interpretation of normed scores.g. Extreme scores on normal personality traits are not necessarily an indication of psychopathology (e. Clearly. and they expect therapists to be experts at understanding human nature. Very high Self-Consciousness scores. In this way. When therapists are informed by NEO-PI results early in the therapeutic process. the results of clinical assessments have been for the eyes of the therapist only. and a brief. Empathy and Rapport Patients want to be understood. Finally. It seemed obvious to us that they would want to understand the enduring emotional. but also on the patient's cooperation. Certainly. for example. it was assumed that they would be confusing and upsetting to patients. but clinical experience to date is encouraging. chart eating behaviors. scores on N are prognostic of ultimate outcome. and motivational styles of their patients. This is particularly important in short-term therapy. record dreams.. the goal of therapy may be to limit distress or teach the patient how to manage it. It soon became clear to us. they appear more knowledgeable and empathic to the patient. nontechnical sheet. but the particular facets of N that are most elevated may focus attention on specific diagnoses. he refers back to this profile as relevant issues arise in therapy. Although self-reports are not infallible. Many kinds of therapy require that the patient do some form of homework between sessions (e.

& McCrae. and will find therapies that require interpersonal interaction congenial. T. Champaign. R. S. R. comparison. R. Barclay. N. Costa. Journal of Personality Disorders. 695-699. FL: Psychological Assessment Resources. W. Costa. Shea (1988) has shown that interpersonally involved depressed patients benefit more from interpersonal therapy. Hirschfeld. References Block. R. G. B. Conoley & J. X. Costa.. NE: Buros Institute of Mental Measurements. P. 27-43). R. Jr. N. R. Annual Review of Psychology. A. Costa. Personality structure: Emergence of the five-factor model. B. . Rabin. Psychological Science. FL: Psychological Assessment Resources. 417-440.. (1945). E. L. A. Tucker (Eds. Jr.. Digman. Baltes & O. (1957). 362-371.... European Journal of Personality.. X. San Diego. and the five-factor model provides a comprehensive framework within which to conduct research on the relation of individual differences to treatment outcomes. R. and demonstrative. & McCrae. Wise. R. In S. We believe that a consideration of personality traits may be more fruitful. 191 -232). L. This is an area in which much more research is needed. R. psychoanalysis. 57. Kramer (Eds). A comparison of five-factor personality dimensions in males with sexual dysfunction and males with paraphilia. IL: Institute for Personality and Ability Testing. Eysenck. (1991). (1990). (1985). R X. L. X. T. 140. R. CT: JAI Press.. & McCrae. 4. (Eds).). Horney. Zimmerman. Jr. R. The NEO-Pl/NEO-FFI manual supplement. (1976).. R. In A. McCrae.. Cattell. Eber. L. (1980). & McCrae. & McCrae. Personality stability and its implications for clinical psychology. California Psychological Inventory manual. Guilford. Jr. P. It is certainly true that what the patient prefers is not necessarily what the patient needs: Group therapy may be exactly what an avoidant introvert requires. The Maudsley Personality Inventory. M. C. X. In J. Ponticas.. C. (1990). R.. 3. Gestalt... 12. J. C. The handbook for the Sixteen Personality Factor Questionnaire. (1983). In P. D. Personality and Individual Differences. Klerman. Jr.. Matching Treatments to Patients Therapists have known for decades that some treatments work better with some patients than with others. Personality disorders and the five-factor model of personality. & McCrae.. New York: Wiley. Personality measures (Vol. New York: Academic Press. CA: EdITS. R. (1989). M.. Clinical Psychology Review. 887898. P. J. Still stable after all these years: Personality as a key to some issues in adulthood and old age. G. P. in which the therapist has a more active role. The medical model suggests that the diagnosis should dictate the treatment.. Jr. Jr. & Xakemoto-Chock. Lavori. J. Patients who are high in O are much more willing to consider novel ideas and to try out unusual approaches to problem solving. (in press-c). Hirschfeld. Assessing personality: Effects of depressive state of trait measurement. 65-102). and interpretation of six major studies. & McCrae. but this model is often inapplicable to psychotherapy. P. Premorbid personality assessments of first onset of major depression. & Dye. talkative. W S. M. C. (1983). 31-39. 345-350. Research on client variables in psychotherapy. (1962). Jr. R. 407-423. or client-centered therapies that provide emotional support. COSTA. (1981). AND ROBERT R. pp. Multiple uses for longitudinal personality data. P. FL: Psychological Assessment Resources. Facet scales for Agreeableness and Conscientiousness: A revision of the NEO Personality Inventory. New York: Norton. Digman. & Tatsuoka. J. Garfield. R. S. Jr. Hathaway. P. H. Y. CA: Consulting Psychologists Press. McDonald-Scott. and they will probably prefer directive psychotherapies that offer sensible advice. (1989). R. & R. Greenwich. T. 434-448. B. Research on the differential effectiveness of different kinds of therapy has emphasized patient characteristics such as gender and social class (Garfield. P. The tenth mental measurements yearbook. Palo Alto. But the clinician who understands the enduring dispositions of the patient will be in a much better position to select a treatment and to explain to the patient why it is needed and how it should work. McCRAE Costa. Odessa. New \brk: Psychological Corporation. M. behavioral techniques that teach concrete skills.). & Coryell. Miller (1991) has noted that both client-centered therapy and psychoanalysis require considerable spontaneous speech from the patient and are difficult for introverts. G. R. 6. R. Individuals who are closed to experience are conventional in their tastes and beliefs. Klerman. K. Cheek (Eds. Costa. Jr. R. pp.. Personality in adulthood: A six-year longitudinal study of self-reports and spouse ratings on the NEO Personality Inventory. R. W. Lincoln. The NEO Personality Inventory manual. & McKinley. (1991). Odessa. Bergin (Eds. M. Odessa. Keller. Manual for the Revised NEO Personality Inventory (NEO-PIR) and NEO Five-Factor Inventory (NEO-FFI). American Journal of Psychiatry. Archives of General Psychiatry. 2. Costa. R.. Further explorations in personality (pp. J. The two dimensions of clearest relevance to the choice of therapies are E and Q Extraverts are sociable. (1970). I.. The Minnesota Multiphasic Personality Inventory manual. P X.. Jr. Our inner conflict's. M. 54. (1988). D. R. Marshall. J. Life span development and behavior (Vol. (in press-b). P. against this standard. (1986). low-E patients may prefer and benefit more from behavior therapy or Gestalt. S. Keller. San Diego.. Brim. Some enduring and consequential structures of personality. JR. Garfield & A. The NEO Personality Inventory. Costa.. [Review of The NEO Personality tinattory]. 853-863. A. P. M. P. R. R. G. J. J. P. P. B. 16. detached patients benefit more from antidepressant medications. Pagan.. M. 1986).. Jr. W (1989). Handbook of psychotherapy and behavior change: An empirical analysis (2nd ed. & Costa. J. & Larkin.. J. Costa. P. (1978). Costa. Gough. 41. M. D.. 149-170. Hogan.. Journal of Personality and Social Psychology. K. R. It is also reasonable to hypothesize that differences in O will affect the patient's response to therapy. A. Griffith. Clayton. Global traits: A Neo-Allportian approach to personality. (in press-a). rather than against the often unrealistic standard of perfect mental health (Costa & McCrae. (1981).. 46.12 PAUL T. (1991). New York: Wiley-Interscience. & McCrae. Aronoff. 1). Journal of Personality Assessment. X. H. The Guilford-Zimmerman Temperament Survey Handbook: Twenty-five years of research and application. or Jungian analysis may appeal to them. & McCrae. Briggs & J. R. By contrast. H.). CA: EdITS.. Factors in the natural language of personality: Re-analysis.. Schmidt. In S. 1978) and has offered only limited insights. X. B. Funder. P. Multivariate Behavioral Research. T. & Guilford. A.

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