Measuring changes in personality pathology : The Severity Indices for Personality Pathology SIPP

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Measuring changes in personality pathology
The Severity Indices for Personality Pathology
(SIPP)
Helene Andrea (PhD), Caspar Berghout (MSc), Jan
van Busschbach (PhD), Petra van der Kroft (MSc),
Roel Verheul (PhD) Viersprong Institute for
Studies on Personality Disorders (VISPD) SPR
Congress, Montreal, 24 June 2005
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Contents

• A new instrument why?
• Development of the SIPP
• Description and psychometrics
• The SIPP as outcome instrument

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Goals of psychotherapy for axis-II disorders

• Symptomatic improvement Reduction of
  psychological and psychosomatic complaints
• Structural improvement
• Reduction of personality pathology A new
  instrument can be useful
• Functional improvement Increased social and
  occupational functioning

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As yet not integrated in one questionnaire

• Broad scope of personality pathology
• Generic
• Developed to measure change
• Relating adaptive to maladaptive capacities
• Good psychometric properties
• Easy to administer

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Aim new questionnaire

• To measure generic and changeable aspects of
  personality disorders, containing both an
  adaptive and maladaptive level of functioning

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Item and subscale generation

• Meetings between clinical experts
• 25 subscales (facets), 277 items
• Higher score more adaptive level of functioning
• Lower score more maladaptive level of
  functioning
• Examples

Fully disagree Partly
disagree Partly agree Fully agree
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Item and subscale selection

• Exclusion of 9 subscales and 159 items
• Insufficient face validity items
• Missing values or insufficient variance items
• Insufficient internal consistency or genericity
  subscales

Final SIPP 16 subscales (facets) and 118 items
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Results confirmative factor analysis
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Correlation between five domains
Median r 0.24, range 0.10-0.56
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Psychometric qualities final model

• Good model fit among different populations
• Good internal consistency facets(median
  Cronbachs ? .77 range .69-.88)
• Good test-retest reliability (median ICC .92
  range .85-.95)

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The SIPPas an outcome instrument

• Scores before and after treatment
• Associations with changes on a symptomatic and
  functional level

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Baseline descriptives patients (n181)

• 35 1 PD30 2 PDs19 3 PDs16 gt3 PDs
• 64 female
• Mean age 35 years(sd 10 range 19-56)

• 66 single, 23 married, 10 divorced
• 60 employed, 26 work disability, 8
  unemployed, 6 other

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Treatment characteristics

• 91 inpatient versus 9 outpatient treatment
• Mean treatment duration 6.2 months(sd 3.0
  months, range 3 12 months)
• Measurements before treatment, after treatment
  and 6 months after treatment

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Measurements

• Structural level
• 5 SIPP-domains
• Identity integration
• Relational functioning
• Responsibility
• Self-control
• Social concordance

• Symptomatic level
• Global Severity Index (GSI)
• Functional level
• Social role (subscale OQ-45)

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Same pattern for all five domains

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Domain scores before and after treatment
plt.001
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Changes on the SIPPComparison with symptomatic
and functional changes
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Conclusions

• The model behind the SIPP is robust
• The SIPP seems sensitive to personality pathology
  changes as a result of treatment
• The SIPP seems to focus on structural change that
  can be (partly) distinguished from symptomatic
  and functional change

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Necessary further steps

• Convergent and discriminant validity
• Larger study group of patients receiving
  treatment
• - Broader range of treatments - More follow-up
  measurements
• Predictive validity
• - Is symptomatic improvement necessary for
  structural improvement? - Is structural
  improvement necessary for functional
  improvement?

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Severity Indices for Personality Pathology (SIPP)

• Diagnostic version 118 itemsOutcome version 60
  items
• Available in Dutch, English, Norwegian and
  Spanish (Swedish and Italian in progress)
• Website (in English)
• www.vispd.nl/sipp.htm
• Email
• Helene.andrea_at_deviersprong.nl