The Self-Concept and Identity Measure in Patients with Personality Disorders: A Psychometric Evaluation and Associations With Identity Processes,Core Domains of Self-Functioning,and Personality Disorder Symptoms

Abstract

As developmental and clinical research on identity has largely developed in disconnect, scholars recommend adopting a developmental psychopathology perspective on identity, which considers adaptive and pathological identity functioning. Such a perspective has also been introduced in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) Alternative Model for Personality Disorders (AMPD), which suggests that all personality disorders (PDs) are marked by moderate to extreme deficits in self-functioning (i.e., identity and self-direction). The present study aims to validate the Dutch Self-Concept and Identity Measure (SCIM), a 27-item self-report questionnaire that assesses consolidated identity, disturbed identity, and lack of identity, in 153 psychiatric inpatients with PDs (75.2% female; M_age = 31.73). We investigated the factor structure and reliability of the SCIM, and examined associations of SCIM scales with typical identity processes, AMPD domains of self-functioning, and symptoms of all PDs. Results indicated that a 23-item Dutch SCIM produced valid and reliable scores among patients with PDs. Furthermore, SCIM scales were significantly and differentially related to identity commitment processes, ruminative identity exploration, domains of self-functioning, and symptoms of all PDs. Moreover, findings indicated that PDs varied regarding the severity of identity impairment.

Keywords

SCIM identity developmental psychopathology personality disorders AMPD patients

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References

Albarello

Crocetti

Rubini

(2018). I and us: A longitudinal study on the interplay of personal and social identity in adolescence. Journal of Youth and Adolescence, 47, 689–702. https://doi.org/10.1007/s10964-017-0791-4

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

Anderson

J. L.

Sellbom

(2018). Evaluating the DSM-5 section III personality disorder impairment criteria. Personality Disorders: Theory, Research, and Treatment, 9(1), 51–61. https://doi.org/10.1037/per0000217

Arnett

J. J.

(2006). The psychology of emerging adulthood: What is known, and what remains to be known?. In Arnett

J. J.

Tanner

J. L.

(Eds.), Emerging adults in America: Coming of age in the 21st century (pp. 303–330). American Psychological Association. https://doi.org/10.1037/11381-013

Billen

Garofalo

Schwabe

Jeandarme

Bogaerts

(2022). Emotional, cognitive and behavioral self-regulation in forensic psychiatric patients: Changes over time and associations with childhood trauma, identity and personality pathology. Psychology Crime and Law. Advance online publication. https://doi.org/10.1080/1068316X.2022.2044813

Blatt

S. J.

(2008). Polarities of experience: Relatedness and self-definition in personality development, psychopathology, and the therapeutic process. American Psychological Association. https://doi.org/https://doi.org/10.1037/11749-000

Bogaerts

Claes

Buelens

Gandhi

Kiekens

Bastiaens

Luyckx

(2021a). The self-concept and identity measure in adolescents: Factor structure, measurement invariance, and associations with identity, personality traits, and borderline personality features. European Journal of Psychological Assessment, 37(5), 377–387. https://doi.org/10.1027/1015-5759/a000623

Bogaerts

Claes

Verschueren

Bastiaens

Kaufman

E. A.

Smits

Luyckx

(2018). The Dutch Self-Concept and Identity Measure (SCIM): Factor structure and associations with identity dimensions and psychopathology. Personality and Individual Differences, 123, 56–64. https://doi.org/10.1016/j.paid.2017.11.007

Bogaerts

Luyckx

Bastiaens

Kaufman

E. A.

Claes

(2021b). Identity impairment as a central dimension in personality pathology. Journal of Psychopathology and Behavioral Assessment, 43, 33–42. https://doi.org/10.1007/s10862-020-09804-9

10.

Bogaerts

Garofalo

De Caluwé

Janković

(2021c). Grandiose and vulnerable narcissism, identity integration and self-control related to criminal behavior. BMC Psychology, 9, Article 191. https://doi.org/10.1186/s40359-021-00697-1

11.

Byrne

B. M.

(2001). Structural equation modeling with AMOS: Basic concepts, applications, and programming (2nd ed.). Lawrence Erlbaum.

12.

Campbell

S. M.

Zimmer-Gembeck

Duffy

(2021). At the junction of clinical and developmental science: Associations of borderline identity disturbance symptoms with identity formation processes in adolescence. Journal of Personality Disorders, 35, 8–28. https://doi.org/10.1521/pedi_2020_34_484

13.

Campbell

S. M.

Zimmer-Gembeck

M. J.

Duffy

(2019). Friends and education: Identity patterns across domains and associations with emotion dysregulation and identity disturbance. Journal of Youth and Adolescence, 48, 703–716. https://doi.org/10.1007/s10964-018-0924-4

14.

Chen

S.-Y.

Feng

(2017). A general introduction to adjustment for multiple comparisons. Journal of Thoracic Disease, 9(6), 1725–1729. https://doi.org/10.21037/jtd.2017.05.34

15.

Chen

T.-H.

Hsiao

R. C.

Liu

T.-L.

Yen

C.-F.

(2019). Predicting effects of borderline personality symptoms and self-concept and identity disturbances on internet addiction, depression, and suicidality in college students: A prospective study. The Kaohsiung Journal of Medical Sciences, 35(8), 508–514. https://doi.org/10.1002/kjm2.12082

16.

Clarkin

J. F.

Cain

N. M.

Lenzenweger

M. F.

(2018). Advances in transference-focused psychotherapy derived from the study of borderline personality disorder: Clinical insights with a focus on mechanism. Current Opinion in Psychology, 21, 80–85. https://doi.org/10.1016/j.copsyc.2017.09.008

17.

Crocetti

Rubini

Meeus

(2008). Capturing the dynamics of identity formation in various ethnic groups: Development and validation of a three-dimensional model. Journal of Adolescence, 31, 207–222. https://doi.org/10.1016/j.adolescence.2007.09.002

18.

Cumming

(2009). Inference by eye: Reading the overlap of independent confidence intervals. Statistics in Medicine, 28, 205–220. https://doi.org/10.1002/sim.3471

19.

D’Agostino

Pepi

Monti

M. R.

Starcevic

Price

(2021). Measuring emptiness: Validation of the Italian version of the Subjective Emptiness Scale in clinical and non-clinical populations. Journal of Affective Disorders, 6, 100226. https://doi.org/10.1016/j.jadr.2021.100226

20.

Debast

Rossi

Van Alphen

S. P. J.

Pauwels

Claes

Dierckx

Peuskens

Santens

Schotte

C. K. W.

(2015). Age neutrality of categorically and dimensionally measured DSM-5 section II personality disorder symptoms. Journal of Personality Assessment, 97, 321–329. https://doi.org/10.1080/00223891.2015.1021814

21.

De Doncker

Schotte

C. K. W.

Cosyns

. (2000). ADP-IV questionnaire: Aspects of reliability and validity. European Psychiatry, 15, 73–73.

22.

De Meulemeester

Lowyck

Luyten

. (2021). The role of impairments in self-other distinction in borderline personality disorder: A narrative review of recent evidence. Neuroscience and Biobehavioral Reviews, 242–254. https://doi.org/10.1016/j.neubiorev.2021.04.022

23.

Erikson

E. H.

(1950). Childhood and society. Norton.

24.

Erikson

E. H.

(1968). Identity, youth and crisis. Norton.

25.

Gamache

Savard

Leclerc

Côté

. (2019). Introducing a short self-report for the assessment of DSM–5 level of personality functioning for personality disorders: The Self and Interpersonal Functioning Scale. Personality Disorders: Theory, Research, and Treatment, 10(5), 438–447. https://doi.org/10.1037/per0000335

26.

George

Mallery

(2003). SPSS for windows step by step: A simple guide and reference (4th ed.). Allyn & Bacon.

27.

Hemphill

J. F.

(2003). Interpreting the magnitudes of correlation coefficients. American Psychologist, 58, 78–79. https://doi.org/10.1037/0003-066X.58.1.78

28.

Huprich

S. K.

Bornstein

R. F.

Schmitt

T. A.

(2011). Self-report methodology is insufficient for improving the assessment and classification of Axis II personality disorders. Journal of Personality Disorders, 25, 557–570. https://doi.org/10.1521/pedi.2011.25.5.557

29.

Huxley

Seaton

D. C.

Grenyer

B. F. S.

(2021). Remembered childhood invalidation as a predictor of narcissism, personality functioning, and wellbeing. Personality and Individual Differences, 175, Article 110686. https://doi.org/10.1016/j.paid.2021.110686

30.

Jørgensen

C. R.

Bøye

(2021). How does it feel to have a disturbed identity? The phenomenology of identity diffusion in patients with borderline personality disorder: A qualitative study. Journal of Personality Disorders, 35, Article 526. https://doi.org/10.1521/pedi_2021_35_526

31.

Kaufman

E. A.

Crowell

S. E.

(2018). Biological and behavioral mechanisms of identity pathology development: An integrative review. Review of General Psychology, 22(3), 245–263. https://doi.org/10.1037/gpr0000138

32.

Kaufman

E. A.

Cundiff

J. M.

Crowell

S. E.

(2015). The development, factor structure, and validation of the Self-Concept and Identity Measure (SCIM): A self-report assessment of clinical identity disturbance. Journal of Psychopathology and Behavioral Assessment, 37(1), 122–133. https://doi.org/10.1007/s10862-014-9441-2

33.

Kaufman

E. A.

Meddaoui

(2021). Identity pathology and borderline personality disorder: An empirical review. Current Opinion in Psychology, 37, 82–88. https://doi.org/10.1016/j.copsyc.2020.08.015

34.

Kaufman

E. A.

Montgomery

M. J.

Crowell

S. E.

(2014). Identity-related dysfunction: Integrating clinical and developmental perspectives. Identity, 14, 297–311. https://doi.org/10.1080/15283488.2014.944699

35.

Kaufman

E. A.

Puzia

M. E.

Crowell

S. E.

Price

C. J.

(2019). Replication of the Self-Concept and Identity Measure (SCIM) among a treatment-seeking sample. Identity, 19, 18–28. https://doi.org/10.1080/15283488.2019.1566068

36.

Kernberg

O. F.

(1984). Object-relations theory and clinical psychoanalysis. Yale University Press.

37.

Kernberg

O. F.

(2006). Identity: Recent findings and clinical implications. The Psychoanalytic Quarterly, 75, 969–1004. https://doi.org/10.1002/j.2167-4086.2006.tb00065.x

38.

Kernberg

O. F.

Caligor

(2005). A psychoanalytic theory of personality disorders. In Lenzenweger

M. F.

Clarkin

J. F.

(Eds.), Major theories of personality disorder (2nd ed., pp. 114–156). Guilford press.

39.

Kline

R. B.

(2004). Principles and practice of structural equation modeling (2nd ed.). Guilford press.

40.

Kohut

(1977). The restoration of the self. International Universities Press.

41.

C.-H.

(2016). Confirmatory factor analysis with ordinal data: Comparing robust maximum likelihood and diagonally weighted least squares. Behavior Research Methods, 48, 936–949. https://doi.org/10.3758/s13428-015-0619-7

42.

Liggett

Carmichael

K. L. C.

Smith

Sellbom

(2017). Validation of self-report impairment measures for Section III obsessive-compulsive and avoidant personality disorders. Journal of Personality Assessment, 99(1), 1–14. https://doi.org/10.1080/00223891.2016.1185613

43.

Lind

Sharp

Dunlop

W. L.

(2022). Why, how, and when to integrate narrative identity within dimensional approaches to personality disorders. Journal of Personality Disorders, 1–22. https://doi.org/10.1521/pedi_2012_35_541

44.

Linehan

M. M.

(1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford press.

45.

Luyckx

Schwartz

S. J.

Berzonsky

M. D.

Soenens

Vansteenkiste

Smits

Goossens

(2008). Capturing ruminative exploration: Extending the four-dimensional model of identity formation in late adolescence. Journal of Research in Personality, 42, 58–82. https://doi.org/10.1016/j.jrp.2007.04.004

46.

Marcia

J. E.

(1966). Development and validation of ego-identity status. Journal of Personality and Social Psychology, 3, 551–558.

47.

Marcia

J. E.

(2006). Ego identity and personality disorders. Journal of Personality Disorders, 20, 577–596. https://doi.org/10.1521/pedi.2006.20.6.577

48.

Marsh

H. W.

Hau

K.-T.

Wen

(2004). In search of golden rules: Comment on hypothesis-testing approaches to setting cutoff values for fit indexes and dangers in overgeneralizing Hu and Bentler’s (1999) findings. Structural Equation Modeling, 11, 320–341. https://doi.org/10.1207/s15328007sem1103_2

49.

McAdams

D. P.

(1996). Personality, modernity, and the storied self: A contemporary framework for studying persons. Psychological Inquiry, 7(4), 295–321. https://doi.org/10.1207/s15327965pli0704_1

50.

McAdams

D. P.

(2001). The psychology of life stories. Review of General Psychology, 5, 100–122. https://doi.org/10.1037/1089-2680.5.2.100

51.

Mehlum

(2021). Mechanisms of change in dialectical behaviour therapy for people with borderline personality disorder. Current Opinion in Psychology, 37, 89–93. https://doi.org/10.1016/j.copsyc.2020.08.017

52.

Meisner

M. W.

Lenzenweger

M. F.

Bach

Vestergaard

Petersen

L. S.

Haahr

U. H.

Kongerslev

Simonsen

(2021). Exploring identity disturbance and psychotic spectrum symptoms as predictors of borderline and schizotypal personality disorders. Psychopathology, 54, 193–202. https://doi.org/10.1159/000516209

53.

Miller

C. E.

Townsend

M. L.

Grenyer

B. F. S.

(2021). Understanding chronic feelings of emptiness in borderline personality disorder: A qualitative study. Borderline Personality Disorder and Emotion Dysregulation, 8(24), 1–9. https://doi.org/10.1186/s40479-021-00164-8

54.

Miller

J. D.

Hoffman

B. J.

Gaughan

E. T.

Gentile

Maples

Keith

C. W.

(2011). Grandiose and vulnerable narcissism: A nomological network analysis. Journal of Personality, 79, 1013–1042. https://doi.org/10.1111/j.1467-6494.2010.00711.x

55.

Miller

J. D.

Price

Gentile

Lynam

D. R.

Campbell

W. K.

(2012). Grandiose and vulnerable narcissism from the perspective of the interpersonal circumplex. Personality and Individual Differences, 53, 507–512. https://doi.org/10.1016/j.paid.2012.04.026

56.

Muthén

L. K.

Muthén

B. O.

(2017). Mplus user’s guide (8th ed.).

57.

Norman

(2010). Likert scales, levels of measurement and the “laws” of statistics. Advances in Health Sciences Education, 15, 625–632. https://doi.org/10.1007/s10459-010-9222-y

58.

Paris

(2004). Gender differences in personality traits and disorders. Current Psychiatry Reports, 6, 71–74. https://doi.org/10.1007/s11920-004-0042-8

59.

Pasupathi

(2014). Identity development: Dialogue between normative and pathological developmental approaches. Journal of Personality Disorders, 28, 113–120. https://doi.org/10.1521/pedi.2014.28.1.113

60.

Pesigan

I. J. A.

Luyckx

Alampay

L. P.

(2014). Brief report: Identity processes in Filipino late adolescents and young adults: Parental influences and mental health outcomes. Journal of Adolescence, 37, 599–604. https://doi.org/10.1016/j.adolescence.2014.04.012

61.

Pincus

A. L.

(2011). Some comments on nomology, diagnostic process, and narcissistic personality disorder in the DSM-5 proposal for personality and personality disorders. Personality Disorders: Theory, Research, and Treatment, 2, 41–53. https://doi.org/10.1037/a0021191

62.

Podsakoff

P. M.

MacKenzie

S. B.

Lee

J.-Y.

Podsakoff

N. P.

(2003). Common method biases in behavioral research: A critical review of the literature and recommended remedies. Journal of Applied Psychology, 88(5), 879–903. https://doi.org/10.1037/0021-9010.88.5.879

63.

Price

A. L.

Mahler

H. I. M.

Hopwood

C. J.

(2022). Construction and validation of a self-report subjective emptiness scale. Assessment, 29(3), 397–409. https://doi.org/10.1177/1073191120968275

64.

Roche

M. J.

Jaweed

(2021). Comparing measures of Criterion A to better understand incremental validity in the alternative model of personality disorders. Assessment, 1–17. https://doi.org/10.1177/10731911211059763

65.

Samuel

D. B.

Sanislow

C. A.

Hopwood

C. J.

Shea

M. T.

Skodol

A. E.

Morey

L. C.

Ansell

E. B.

Markowitz

J. C.

Zanarini

M. C.

Grilo

C. M.

(2013). Convergent and incremental predictive validity of clinician, self-report, and structured interview diagnoses for personality disorders over 5 years. Journal of Counseling and Clinical Psychology, 81(4), 650–659. https://doi.org/10.1037/a0032813

66.

Schermelleh-Engel

Moosbrugger

Müller

(2003). Evaluating the fit of structural equation models: Tests of significance and descriptive goodness-of-fit measures. Methods of Psychological Research, 8, 23–74.

67.

Schotte

C. K. W.

De Doncker

Vankerckhoven

Vertommen

Cosyns

(1998). Self-report assessment of the DSM-IV personality disorders, measurement of trait and distress characteristics: The ADP-IV. Psychological Medicine, 28, 1179–1188. https://doi.org/10.1017/S0033291798007041

68.

Schwartz

S. J.

Beyers

Luyckx

Soenens

Zamboanga

B. L.

Forthun

L. F.

Hardy

S. A.

Vazsonyi

A. T.

Ham

L. S.

Kim

S. Y.

Whitbourne

S. K.

Waterman

A. S.

(2011). Examining the light and dark sides of emerging adults’ identity: A study of identity status differences in positive and negative psychosocial functioning. Journal of Youth and Adolescence, 40, 839–859. https://doi.org/10.1007/s10964-010-9606-6

69.

Sharp

Wall

(2021). DSM-5 level of personality functioning: Refocusing personality disorder on what it means to be human. Annual Review of Clinical Psychology, 17, 313–337. https://doi.org/10.1146/annurev-clinpsy-081219-105402

70.

Sleep

C. E.

Lynam

D. R.

Widiger

T. A.

Crowe

M. L.

Miller

J. D.

(2019). An evaluation of DSM-5 Section III personality disorder Criterion A (impairment) in accounting for psychopathology. Psychological Assessment, 31(10), 1181–1191. https://doi.org/10.1037/pas0000620

71.

Sullivan

G. M.

Artino

A. R.

(2013). Analyzing and interpreting data from Likert-type scales. Journal of Graduate Medical Education, 5, 541–542. https://doi.org/10.4300/jgme-5-4-18

72.

Torgersen

Kringlen

Cramer

(2013). The prevalence of personality disorders in a community sample. In The science of mental health: Personality and personality disorder (Vol. 7, pp. 132–138). Taylor and Francis.

73.

Verheul

Andrea

Berghout

C. C.

Dolan

Busschbach

J. J. V.

van der Kroft

P. J.

Bateman

A. W.

Fonagy

(2008). Severity indices of personality problems (SIPP-118): Development, factor structure, reliability, and validity. Psychological Assessment, 20, 23–34. https://doi.org/10.1037/1040-3590.20.1.23

74.

Verschueren

Luyckx

Kaufman

E. A.

Vansteenkiste

Moons

Sleuwaegen

Berens

Schoevaerts

Claes

. (2017). Identity processes and statuses in patients with and without eating disorders. European Eating Disorders Review, 25(1), 26–35. https://doi.org/10.1002/erv.2487

75.

Verschueren

Claes

Palmeroni

Raemen

Buelens

Moons

Luyckx

(2021). Identity functioning and eating disorder symptomatology: The role of cognitive emotion regulation strategies. Frontiers in Psychology, 12, Article 667235. https://doi.org/10.3389/fpsyg.2021.667235

76.

Widiger

T. A.

Bach

Chmielewski

Clark

L. A.

DeYoung

Hopwood

C. J.

Kotov

Krueger

R. F.

Miller

J. D.

Morey

L. C.

Mullins-Sweatt

S. N.

Patrick

C. J.

Pincus

A. L.

Samuel

D. B.

Sellbom

South

S. C.

Tackett

J. L.

Watson

Waugh

M. H.

. . . Thomas

K. M.

(2019). Criterion A of the AMPD in HiTOP. Journal of Personality Assessment, 101(4), 345–355. https://doi.org/10.1080/00223891.2018.1465431

77.

Zimmermann

Lannegrand-willems

Safont-Mottay

Cannard

(2013). Testing new identity models and processes in French-speaking adolescents and emerging adults students. Journal of Youth and Adolescence, 44, 127–141. https://doi.org/10.1007/s10964-013-0005-7