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Revised NEO Personality Inventory

Personality Traits and the Inventories that Measure Them

Michael C. Ashton , in Individual Differences and Personality (Second Edition), 2013

The NEO Personality Inventory Revised (NEO-PI-R) and the NEO Five-Factor Inventory (NEO-FFI)

The NEO-PI-R (with its earlier version, the NEO-PI) and the NEO-FFI were developed to measure five major dimensions of personality (Costa & McCrae, 1985, 1992b). The NEO-PI-R is the longer inventory, with 240 items that are grouped into 30 scales measuring narrower personality traits, with those scales in turn grouped into the five scales measuring broader characteristics: Neuroticism (N), Extraversion (E), Openness to Experience (O), Agreeableness (A), and Conscientiousness (C). (See Chapter 3 for descriptions of the 30 scales.) The NEO-FFI is a shorter, 60-item inventory that measures the five broad dimensions only. The scales of both questionnaires have shown very good levels of reliability and validity, and have probably become the most widely used personality inventories in psychological research.

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Measures of Personality across Cultures

Velichko H. Fetvadjiev , Fons J.R. van de Vijver , in Measures of Personality and Social Psychological Constructs, 2015

NEO Personality Inventory, Revised (NEO-PI-R)

(Costa & McCrae, 1992).

The NEO-PI-R measures the five factors of the FFM (Extraversion, Agreeableness, Conscientiousness, Neuroticism, and Openness) as well as 30 lower level facets, six per factor. The NEO-PI-R is one of the most researched and widely used inventories measuring the FFM. It provides scores both on the level of higher order domains and of lower order facets. The inventory has a self-report and a peer-report form. Church et al. (2011) reported Cronbach alpha coefficients for the facet scales ranging from .24 to .82, with median values across countries ranging from .62 to .70; see Table 26.1. For the peer-report form, McCrae, Terracciano, and 78 Members of the Personality Profiles of Cultures Project (2005a) reported alpha coefficients ranging from .25 to .96, with median values across the five factors ranging from .88 to .94 (Table 26.1). McCrae (2002) examined the validity of the NEO-PI-R self-report form at country level by analyzing its associations with EPQ data in 18 countries. Both Neuroticism (r=.80) and Extraversion (r=.51) were positively correlated between the two inventories. McCrae, Terracciano, and 79 Members of the Personality Profiles of Cultures Project (2005b) analyzed country-level associations of the NEO-PI-R peer-report form with the self-report form and with two sets of EPQ data. Support was found especially for the validity of N, E, O, and C. As well, country-level associations with external variables such as beliefs, attitudes, and values have been documented (McCrae, 2002; McCrae et al., 2005b).

Both the self- and peer-report form have been translated into tens of languages from several language families, sometimes with minor item adaptations. The self-report form has been used in 36 countries (McCrae, 2002). The factor structure of the total sample was target-rotated toward the US structure; the congruence coefficients of N, A, and C were over .90, but those of E (.85) and O (.87) were lower. On an individual level, Rolland (2002) examined the structural equivalence in 16 cultures and found average congruence coefficients mostly above .90, with a number of individual coefficients failing to reach that value (Table 26.1). The peer-report form was administered in 50 cultures (McCrae et al., 2005a). The congruence coefficients of the total sample with the US (self-report) structure were all above .95. The congruence coefficients of individual countries were on average above .90, although there were individual coefficients as low as .53. African countries had some of the lowest congruence coefficients. The authors examined two hypotheses explaining the weak congruence: that it may be due to a distinctive African personality structure different from the FFM or to questionnaire inapplicability in this cultural context. They found more evidence for the latter hypothesis.

In one of the few studies on metric equivalence of the NEO-PI-R, Church and colleagues (2011) examined DIF in the US, Philippines, and Mexico. They found DIF in 40% to 50% of cultural comparisons and interpreted the results as warranting caution in cross-cultural comparisons of personality profiles.

Extensive data have been presented on the NEO-PI-R's cross-cultural applicability. There is evidence for structural equivalence across cultures, although deviations are also found, especially in African data. Cross-level analyses can also be performed given the evidence for isomorphism of the constructs at individual and country level. There is less support, however, for scalar equivalence, which should be kept in mind when scale score comparisons are considered.

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Assessment of Patients with Personality Disorders

PAUL S. LINKS , in Psychiatric Clinical Skills, 2006

CONFIRMING THE DIAGNOSIS

After a clinical interview is completed with a patient with a suspected personality disorder, you should attempt to confirm the personality disorder diagnosis by reviewing the full criteria from the DSM-IV-TR for the specific suspected diagnosis. If you can confirm the diagnosis after reviewing the criteria, then you should make a mental note of those features that first raised your suspicions for the diagnosis. Experienced clinicians can rapidly develop diagnostic hypotheses based on previous encounters with similar patients.

If you are unable to confirm the personality disorder diagnosis after reviewing the full criteria set, several steps to confirm the diagnosis should be considered. A patient with an acute axis I disorder will be difficult to assess for a personality disorder diagnosis. The personality disorder diagnosis may appropriately be deferred until the symptoms of the acute disorder have improved. During the acute state, clinicians are likely to overdiagnose personality disorders, and patients will likely overendorse personality pathology. ³⁷ You should seek collateral information from family or friends about the patient's personality features. However, research findings indicate that agreement between the patient's report and the collateral informant is often poor, ³⁷ and inconsistencies between the different sources of information can be difficult to reconcile. Zimmerman ³⁷ suggested that the patient's report should be used for information about affective or cognitive aspects of personality, whereas the informant may be more reliable about the person's interpersonal or behavioral functioning.

If you are still uncertain about the personality disorder diagnosis, many assessment tools are available to confirm or refute your clinical impression. These assessment tools fall into four categories: self-report measures for personality traits rather than disorders, self-report measures for personality disorders, semi-structured interviews for personality traits, and semi-structured interviews for personality disorders. For an extensive discussion of these instruments, Clark and Harrison ³⁸ provide an excellent overview of all the measures in each category. One example from each type of measure will be highlighted, including a discussion of how you might utilize this or other similar measures in your assessment.

Self-Report Measures for Personality Traits

The NEO Personality Inventory–Revised is a widely used instrument that assesses subjects for five domains of normal personality: neuroticism, extraversion, conscientiousness, agreeableness, and openness. The so-called Five-Factor Model of personality appears to capture the central dimensions that make up normal personality. The scale is usually administered and scored by a clinical psychologist, and the inventory contains 240 items and takes about 50 minutes to administer. ^{39, 40}

Self-Report Measures for Personality Disorders

The Millon Clinical Multiaxial Inventory (MCMI-III) was developed to reflect its author's conceptions of the various personality disorder constructs rather than DSM personality disorders. However, this instrument has been widely used to make a range of personality disorder diagnoses for both clinical and research purposes. The test is usually administered and scored by a clinical psychologist. The test involves answering 175 true/false questions, and about 30 minutes are required to administer the test. ^{41, 42}

Semi-Structured Interview for Personality Traits

The Psychopathy Checklist–Revised was specifically developed to assess subjects for the concept of psychopathy. The ratings are made based on information from a clinical interview and a review of collateral information; however, these ratings require considerable clinical judgment and expertise. Although psychopathy is somewhat related to antisocial personality disorder, the measure has been primarily used to predict recidivism in forensic settings. ^{43, 44}

Semi-Structured Interview for Personality Disorders

There are five established semi-structured interview assessments for making DSM personality disorder diagnoses. One of the most widely used versions is called the Structured Clinical Interview for DSM-IV Axis II Personality Disorders. This measure requires trained interviewers and takes more than an hour to administer, sometimes several hours. The structured interviews have allowed for improved inter-rater agreement compared with that obtained from a clinical interview; however, the validity of these instruments has not been adequately demonstrated. Typically, these structured interviews are used for research purposes or in tertiary specialized clinical settings. ^45–47

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Response Bias, Malingering, and Impression Management

Edward Helmes , ... Matthias Ziegler , in Measures of Personality and Social Psychological Constructs, 2015

Measures Reviewed Here

1.

NEO-PI-R & NEO-PI-3 (PPM & NPM Scales) (McCrae & Costa, 2010)

2.

EPQ-R Lie Scale (Eysenck & Eysenck, 1991)

3.

16PF (5th ed.) IM Scale (Cattell, Cattell, & Cattell, 1993)

4.

Balanced Inventory of Desirable Responding – 7 (Paulhus, 1998)

5.

Marlowe–Crowne Social Desirability Scale (Crowne & Marlowe, 1960)

6.

Personality Research Form E – Desirability Scale (Jackson, 1984)

7.

Structured Interview of Reportable Symptoms (2nd ed.) (Rogers, Sewell, & Gillard, 2010)

8.

MMMPI-2-Restructured Form (L, K, F Scales) (Ben-Porath & Tellegen, 2008)

9.

PAI (INF, ICN, NIM, & PIM Scales) (Morey, 2007)

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Molecular Genetics and Human Behavior☆

D.A. Forero , ... Y. González-Giraldo , in Reference Module in Neuroscience and Biobehavioral Psychology, 2017

Main Findings From Genetics of Personality

One of the most used questionnaires in scientific research of personality is the Revised NEO Personality Inventory (NEO-PI-R), it contains five domain scales: Neuroticism, Emotional Stability, Extraversion, Openness to Experience, Agreeableness, and Conscientiousness. Neuroticism in the NEO-PI-R includes traits such as anxiety, angry hostility, depression, self-consciousness, impulsiveness and vulnerability ( Widiger and Costa, 2012). Another commonly used inventory is the Eysenck Personality Questionnaire (EPQ), which has three global factors: Neuroticism, Extraversion and Psychoticism (Kennis et al., 2013). Neuroticism is a personality trait defined as a temperamental factor that is presumed to be relatively stable over time, associated with a greater tendency to experience negative affect (Barnhofer and Chittka, 2010). Neuroticism is of fundamental importance for psychological well-being and public health. Higher neuroticism is related to considerable public health and economic costs, because it is highly associated with several psychiatric disorders, including major depressive disorder, anxiety disorders, substance misuse disorders, personality disorders and schizophrenia (Distel et al., 2009; Hakulinen et al., 2015). Fig. 2 provides a graphical overview of the potential relationships of personality dimensions and descriptors of psychological adjustment.

Figure 2. Schematic representation of the personality traits of the big five and some descriptors of psychological adjustment.

There is evidence that personality dimensions are substantially heritable, with estimates of genetic contributions to individual differences ranging between 30% and 50% (Plomin et al., 2013), of which between 15% and 37% is explained by variation in common single-nucleotide polymorphisms (SNPs), detectable using the genome-wide association study (GWAS) paradigm (van den Berg et al., 2014; de Moor et al., 2015). A meta-analysis, with a combined sample of more than 100   000 participants from 12 countries, showed that 39% of individual differences in personality are due to genetic causes (Vukasovic and Bratko, 2015).

It has been proposed that individual differences in personality traits are associated with changes in the activity of specific neurotransmitter pathways (Luciano et al., 2012) and as a result, various candidate genes with known functional effects on these pathways have been investigated (Hariri, 2009). Table 4 provides an overview of main genetic associations for neuroticism extracted from available GWAS and meta-analyses (Luciano et al., 2012; de Moor et al., 2015; Smith et al., 2016; Okbay et al., 2016; Lee and Prescott, 2014; Terracciano et al., 2010; Frustaci et al., 2008).

Table 4. An overview of main findings of genetics of neuroticism

Gene	p value	Effect size	Sample size	Personality inventory	Study
MPI	1.00   ×   10−6	Not reported	6   032	EPQ	Luciano et al. (2012)
SCAMP2	1.00   ×   10−6	Not reported	6   032	EPQ	Luciano et al. (2012)
ULK3	1.00   ×   10−6	Not reported	6   032	EPQ	Luciano et al. (2012)
COX5A	2.00   ×   10−6	Not reported	6   032	EPQ	Luciano et al. (2012)
POLR3A	1.00   ×   10−6	Not reported	6   032	EPQ	Luciano et al. (2012)
MAGI1	9.26   ×   10−9	−0.04	63   661	NEO PI-R, EPQ	de Moor et al. (2015)
GRIK3	3.8   ×   10−8	Not reported	91   370	EPQ, NEO PI-R	Smith et al. (2016)
PVRL3	2.0   ×   10−8	Not reported	91   370	EPQ, NEO PI-R	Smith et al. (2016)
PTRD	9.4   ×   10−9	Not reported	91   370	EPQ, NEO PI-R	Smith et al. (2016)
ELAVL2	3.2   ×   10−8	Not reported	91   370	EPQ, NEO PI-R	Smith et al. (2016)
CELF4	1.2   ×   10−8	Not reported	91   370	EPQ, NEO PI-R	Smith et al. (2016)
MSRA	5.00   ×   10−5	Not reported	170   911	EPQ	Okbay et al. (2016)
FDFT1		Not reported	170   911	EPQ	Okbay et al. (2016)
MTMR9		Not reported	170   911	EPQ	Okbay et al. (2016)
BLK		Not reported	170   911	EPQ	Okbay et al. (2016)
MFHAS1		Not reported	170   911	EPQ	Okbay et al. (2016)
COMT Val158Met	0.03–0.004	−0.16	15   979	NEO PI-R, EPQ	Lee and Prescott (2014)
5-HTTLPR	0.005	0.01–0.02	2333	NEO PI-R	Terracciano et al. (2010)
BDNF Val66Met	No reported	−0.24	1633	NEO PI-R	Frustaci et al. (2008)

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Trait And Neurobiological Correlates Of Individual Differences In Dream Recall And Dream Content

Mark Blagrove , Edward F. Pace-Schott , in International Review of Neurobiology, 2010

B Amygdala

A subcortical structure associated with affective labeling of stimuli, the amygdala has been most often associated with experience of threat and fear, although amygdala responses are also associated with encoding appetitive responses (Sergerie et al., 2008). For example, amygdala activation in response to emotionally positive pictures has been correlated with NEO-PI extraversion, whereas amygdala activity in response to negative pictures correlated with NEO-PI neuroticism (Canli, 2004; Canli et al., 2001). Similarly, amygdala responses to happy faces correlated with extraversion, but not with any of the other 4 Big Five personality traits (Canli et al., 2002). In contrast, NEO-PI neuroticism was correlated with activation of the amygdala in a Stroop-like task when the affective tone of presented words conflicted highly (versus little) with that of simultaneously presented facial expressions (Haas et al., 2007).

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Research and Methods

Thomas A. Widiger , Kimberly I. Saylor , in Comprehensive Clinical Psychology, 1998

3.07.2.6.2 Neo Personality Inventory-Revised

The most comprehensive model of personality trait description is provided by the five-factor model (Saucier & Goldberg, 1996; Wiggins & Pincus, 1992). Even the most ardent critics of the five-factor model acknowledge its importance and impact (e.g., Block, 1995; Butcher & Rouse, 1996; Millon et al., 1996). And, the predominant measure of the five-factor model is the NEO-PI-R (Costa & McCrae, 1992, 1997; Ozer & Reise, 1994; Widiger & Trull, 1997).

The 240 item NEO-PI-R (Costa & McCrae, 1992) assesses five broad domains of personality: neuroticism, extraversion (vs. introversion), openness (vs. closedness), agreeableness (vs. antagonism), and conscientiousness. Each item is rated on a five-point scale, from strongly disagree to strongly agree. Each domain is differentiated into six underlying facets. For example, the six facets of agreeableness vs. antagonism are trust vs. mistrust, altruism vs. exploitiveness, compliance vs. oppositionalism or aggression, tender-mindedness vs. tough-mindedness (lack of empathy), modesty vs. arrogance, and straightforwardness vs. deception or manipulation. The domains and facets of the NEO-PI-R relate closely to other models of personality, such as the constructs of affiliation and power within the interpersonal circumplex model of personality (McCrae & Costa, 1989; Wiggins & Pincus, 1992). The NEO-PI-R assessment of the five-factor model also relates closely to the DSM-IV personality disorder nomenclature, despite its original development as a measure of normal personality functioning (Widiger & Costa, 1994).

The application of the NEO-PI-R within clinical settings, however, may be problematic, due to the absence of extensive validity scales to detect mood state and response-set distortion (Ben-Porath & Waller, 1992). A valid application of the NEO-PI-R requires that the respondent be capable of and motivated to provide a reasonably accurate self-description. This is perhaps a safe assumption for most cases (Costa & McCrae, 1997), but the NEO-PI-R might not be successful in identifying when this assumption is inappropriate. Potential validity scales for the NEO-PI-R, however, are being researched (Schinka, Kinder, & Kremer, 1997).

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Personality Structure

Michael C. Ashton , in Individual Differences and Personality (Second Edition), 2013

3.4.2 Personality inventories and the Five-Factor Model

By the 1980s, many researchers had begun to accept the Big Five factors as the major categories of personality traits. Among the psychologists who adopted the Big Five factors were Paul Costa and Robert McCrae. Costa and McCrae were interested in studying personality in relation to the aging process, but they wanted to develop a complete and efficient system for measuring personality. They conducted some analyses of questionnaire scales that Cattell had developed on the basis of his earlier lexical research, and then combined the results of those analyses with results from recent lexically based findings. Taken together, these results convinced Costa and McCrae that the Big Five framework was the best way to organize personality traits. To measure the factors of this "Five-Factor Model," Costa and McCrae (1985) constructed a questionnaire called the NEO Personality Inventory, and this instrument was soon being widely used in personality research. Its more recent versions, the NEO Personality Inventory–Revised and the shorter NEO Five-Factor Inventory (Costa & McCrae, 1992b; see Chapter 2), have become so popular that many psychologists are familiar with the Big Five factors chiefly through the high profile of those instruments, and are not even aware of the lexically based research that led to the discovery of those factors. These NEO questionnaires were used in a series of studies by Costa and McCrae during the 1980s and 1990s, in which they showed that nearly all of the scales of other personality inventories were related to one or more of the five factors (e.g., Costa & McCrae, 1988a), and that the NEO scales themselves produced five factors even when administered (in translation) in other countries (e.g., McCrae & Costa, 1997; McCrae, Zonderman, Costa, Bond, & Paunonen, 1996).

For most purposes, the Five-Factor Model as assessed using the NEO inventories can be considered to be the same as the Big Five structure. As seen in Table 3-4, the characteristics that are measured within the five broad factors of the NEO Personality Inventory–Revised are generally very similar to those that defined the Big Five factors in lexical studies (see Table 3-3). But one difference involves the name of the Big Five Intellect or Imagination factor, which in the Five-Factor Model is instead labeled Openness to Experience. This alternative name emphasizes the characteristics that Costa and McCrae view as the central elements of this factor, such as a willingness to examine new ideas, to explore one's imagination, and to try new things. It also downplays the role of intellectual ability, which Costa and McCrae (and many other researchers) consider to be something different from a personality characteristic. Another minor difference involves the Agreeableness factor, within which Costa and McCrae have included some traits—such as straightforwardness and modesty—that were only weakly related to the Big Five Agreeableness factor as found in early English lexical studies of personality structure.

Table 3-4. Broad personality factors and narrower personality traits assessed by the NEO Personality Inventory (NEO-PI-R)

Neuroticism	Agreeableness
Anxiety	Trust
Angry Hostility	Straightforwardness
Depression	Altruism
Self-Consciousness	Compliance
Impulsiveness	Modesty
Vulnerability	Tender-mindedness
Extraversion	Conscientiousness
Warmth	Competence
Gregariousness	Order
Assertiveness	Dutifulness
Activity	Achievement Striving
Excitement-Seeking	Self-Discipline
Positive Emotions	Deliberation
Openness to Experience
Openness to Fantasy
Openness to Aesthetics
Openness to Feelings
Openness to Actions
Openness to Ideas
Openness to Values

Note. The six headings refer to the five broad factors (i.e., dimensions, domains) assessed by the NEO-PI-R; the four names under each heading refer to the six narrower traits (i.e., facets) that form each of the broad factors.

Source: Costa and McCrae (1992b).

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Link between environmental factors, personality factors, and addiction

Amitava Dasgupta , in Alcohol, Drugs, Genes and the Clinical Laboratory, 2017

Personality factors and alcohol/drug use

The five factor model of personality developed by McCreae and John is one of the most commonly used models in psychology. The model was derived initially from studies in English language with an aim of identifying essential domains of personality. Later studies in other languages found agreement with the initial five factor model developed from research in English language. The model consists of five personality factors which can be evaluated using revised NEO Personality Inventory Facet Scale [32].

•

Openness (Various facets: Fantasy, Aesthetics, Feelings, Actions, Ideas, and Values)

•

Conscientiousness (Various facets: Competence, Order, Dutifulness, Achievement Striving, Self-Discipline, and Deliberation)

•

Extraversion (Various facets: Warmth, Gregariousness, Assertiveness, Activity, Excitement-Seeking, and Positive Emotions)

•

Agreeableness (Various facets: Trust, Straightforwardness, Altruism, Modesty, and Tender-Mildness)

•

Neuroticism (Various facets: Anxiety, Angry Hostility, Depression, Self-Consciousness, Impulsivity, and Vulnerability)

Gore and Widiger commented that the DSM-5 maladaptive trait dimensional model proposal which included 25 traits organized within 5 broad domains (i.e., negative affectivity, detachment, antagonism, disinhibition, and psychoticism) may align with the five factor model. For example, negative affectivity would align with neuroticism of the five factor model while disinhibition would align with low conscientiousness. The authors, based on a study of 445 undergraduates along with the personality inventory of DSM-5, concluded that the results provided support for the hypothesis that all 5 domains of the DSM-5 dimensional trait model are maladaptive variants of the five factor model general personality structure [33]. A substantial body of research also indicates that the personality disorders included within the DSM-5 can be understood as extreme and/or maladaptive variants of the five factor model [34].

Martin and Sher, based on a study of 468 young adults, observed that AUD was positively associated with neuroticism and negatively associated with agreeableness and conscientiousness [35]. Terracciano et al. observed that compared to never users, current marijuana abusers scored higher on openness, average on neuroticism, and lower on agreeableness as well as conscientiousness. Compared to never users, current cocaine users scored higher on neuroticism and lower on conscientiousness. The authors concluded that high levels of negative affect and impulsive traits were associated with substance abuse. Moreover, there was also a link between low score on conscientiousness and substance use [36]. Users of drugs are more prone to negative emotions (neuroticism) and tend to be distrustful, manipulative, unreliable, and undisciplined. Sutin et al. also observed the same pattern of elevated neuroticism, decreased agreeableness, and decreased conscientiousness among current users of cocaine/heroin. Interestingly, low conscientiousness was a risk factor for drug use only among those with relatively more financial resources. Individuals who are high on neuroticism, low on agreeableness, or low on conscientiousness tend to act on impulse when faced with high level of emotional distress. Constellations of these traits have also been observed in alcohol dependence, smoking, gambling, and risky sexual behavior [37].

Impulsivity is related to risk taking, quick decision making, and lack of planning. Such behavior is often committed in a spur of the moment without paying attention to consequences, including negative effects. The five factor model can be used to clarify the multifaceted nature of impulsivity [38]. However, impulsivity is commonly determined by using Barratt Impulsivity Scale (BIS-11), which is a psychometric measure. Temperament consists of four traits including novelty seeking, harm avoidance, reward dependence, and persistence. Character consists of three dimensions; self-directedness, cooperativeness, and self-transcendence. Cloninger defines impulsive behavior as the coexistence of four heritable temperament traits; high novelty seeking, low harm avoidance, low persistence and rarely, high reward dependence [39]. Impulsivity is closely linked to alcohol and substance abuse, both as a contributor to use and as consequences of use. Bozkurt et al., based on a study of alcohol dependent patients (n=94) and healthy controls (n=63), observed that the mean impulsivity score was higher in alcohol dependent subjects than control (BIS-11 score; 69.34 in alcohol dependent subjects vs 58.81 in health controls) [40]. Mudler suggested that the most vulnerable individuals to substance dependency might be those with high impulsivity and/or high novelty-seeking behavior [41]. Novelty seeking is positively associated with extraversion and negatively with conscientiousness in the five factor model. Individuals with high novelty-seeking behavior tend to be quick tempered, excitable, curious, exploratory, easily bored, impulsive, and disorderly [42]. Wingo et al. commented that the novelty-seeking trait, which is affected by both genetic and environmental factors, is positively associated with drug addiction in humans [43].

Interestingly, there are similar relationships between five factor model of personality and behavioral addiction. Andreassen et al. showed positive associations between neuroticism with Internet addiction, exercise addiction, compulsive buying, and study addiction. Extraversion was positively associated with Facebook addiction, exercise addiction, mobile phone addiction, and compulsive buying. Openness to experience was negatively associated with Facebook addiction, and mobile phone addiction. Agreeableness was negatively associated with Internet addiction, exercise addiction, mobile phone addiction, and compulsive buying. Conscientiousness was negatively associated with Facebook addiction, video game addiction, Internet addiction, and compulsive buying. However, conscientiousness was positively associated with exercise addiction and study addiction [44].

Comorbid substance use disorder and personality disorder

When two disorders occur simultaneously in the same person it is referred to as comorbid (Table 5.3). Many individuals with substance use disorder have comorbid mental illness, and vice-versa. Comorbid mental illness and substance use disorder may occur through any of the three mechanisms [45]:

Table 5.3. Common mental disorders and personality disorders where prevalence of substance abuse/comorbid substance abuse disorders is significant

Anxiety disorder (generalized anxiety disorder, panic disorder, and social anxiety/phobia)

Antisocial personality disorder

Avoidant personality disorder

Bipolar disorder

Borderline personality disorder

Delusional disorder

Dysthymia

Histrionic personality disorder

Major depressive disorder

Narcissistic personality disorder

Obsessive compulsive disorder

Paranoid personality disorder

Schizophrenia

Schizotypal

Schizoid disorder

Posttraumatic stress disorder

•

Alcohol or drug abuse may cause a mental problem, e.g., alcohol induced depressive disorder, cocaine induced psychotic disorder, and stimulant induced anxiety disorder. This is the most common situation.

•

Substance abuse may be secondary to mental illness. For example a person may drink alcohol to alleviate symptoms of an anxiety disorder such as social phobia.

•

Substance abuse and mental disorder are may be coincidental and not related to each other.

There are several personality disorders and psychiatric disorders which are associated with higher prevalence of substance use disorders. Smith et al. also observed higher prevalence of substance abuse among people with ASPD. This type of personality disorder is characterized by a pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 in persons of at least 18 years of age. In general, fulfilling three of the seven criteria (failure to follow social norms, deceitfulness, impulsivity, irritability, and aggressiveness, reckless disregard for safety of the individual person and others, consistent irresponsibility and lack of remorse after illicit behavior) can establish that the person has ASPD. It has been estimated that 1–3% of the general population (3.0–6.8% among male and 0.8–1% in females) may have ASPD but in the prison population the prevalence is estimated to be 35–47% and prevalence is 18–40% among substance-dependent individuals. In one study involving rural populations using nonmedical prescription opioids, the authors observed that 31% had ASPD. In multivariate analyses, the authors observed that distrust and conflict within an individual's social network, as well as past 30 days use of heroin and crack cocaine, male gender, younger age, lesser education, heterosexual orientation, and comorbid major depressive disorder were associated with meeting diagnostic criteria of ASPD [46].

Decades of research have shown that anxiety disorders and substance abuse disorders co-occur at greater rates than expected by chance alone. Anxiety disorders are more strongly associated with substance dependence than substance abuse. Generalized anxiety disorders and panic disorders with or without agoraphobia showed the highest association with substance use disorders. There are also associations between obsessive compulsive disorder (OCD) and alcohol use [47]. Clinical data clearly established an association between PTSDs with alcohol or drug use. PSTD is due to direct experience of a traumatic stressor or witnessing such stressors which may cause serious harm to an individual, including death. Such traumatic stressors include military combat, sexual assault, severe violence, serious accidents, natural disasters such as earthquakes or man-made disasters, e.g., terrorist attack. The association between PTSD and alcohol/drug use disorders is well established, particularly among veterans, adolescents, and patients enrolling in substance abuse programs. Individuals who meet the criteria of PTSD have up to 4.5 times higher likelihood of having alcohol or substance abuse disorder compared to the normal population. It has been postulated that individuals exposed to PTSD are at risk of substance abuse because they may wish to manage symptoms of PSTD by substance or alcohol intake. PTSD symptoms such as elevated hyperarousal symptoms (hypervigilance, irritability, etc.) are associated with drug use while avoidance and numbing symptoms are associated with alcohol use [48].

Driessen et al. investigated the prevalence of PTSD among 459 treatment-seeking subjects with substance dependence and observed that 25.3% of all subjects had PSTD. However, among subjects using both alcohol and drugs the prevalence was 34.1%, among subjects using only drugs it was 29.9%, but the prevalence of PTSD among subjects abusing alcohol only was significantly lower at 15.4%, indicating that prevalence of PTSD was much higher among subjects abusing drugs compared to subjects abusing only alcohol. The comorbidity of substance use disorder with PTSD resulted in lower levels of social functioning and more psychological distress as well as poor outcome from treatment for substance abuse [49]. Smith et al. concluded that PTSD is more strongly associated with substance use for women than men [50].

The presentation of major depression disorder is often complicated by co-occurance of substance abuse disorder such as alcohol or illicit drug abuse or dependence. Nearly one-third of patients with a major depressive disorder also have substance abuse disorder and the comorbidity is associated with higher rates of suicide and greater social or personal impairment [51]. Dysthymic disorder is defined as a low-grade chronic depression that lasts for 2 years for adults. This disorder has a prevalence of 6% in the general population. There is an elevated comorbidity rate between various mood disorders including dysthymia and substance abuse. Cassidy et al. concluded that substance abuse is a major comorbidity in bipolar patients with nearly 60% reporting a history of some lifetime substance abuse [52].

Toftdahl et al., based on a survey of 463,003 psychiatric patients in the Danish Register, observed that the out of that patient population 140,811 (30.4%) patients were also enrolled in different registers with diagnosis of substance abuse. Out of 463,003 patients, 114,359 (24.7%) used alcohol, 17,563 used opioids (3.8%), 20,964 used cannabis (4.5%), 21,520 used sedatives (4.7%), 3368 used cocaine (0.7%), 6182 used psycho-stimulants (1.35%), and 1514 used hallucinogens (0.3%). Additional substance abuses included solvent (426 patients), multiple drugs, or other psychoactive substances (15,994 patients). The authors observed that prevalence of any lifetime substance abuse disorder was 37% for schizophrenia, 35% schizotypal disorder, 28% for other psychoses, 32% for bipolar disorder, 25% for depression, 25% for anxiety, 11% for OCD, 17% for PTSD, and 46% for personality disorders. These personality disorders included paranoid, schizoid, dissocial, emotionally unstable, histrionic, anankastic, anxious, dependent, unspecified, and mixed disorders [53]. Mauri et al. also reported that 34.7% of first episode schizophrenia patients had a lifetime history substance abuse. The age of onset of schizophrenia was significantly lower for drug abusers than patients without any type of abuse and for alcohol abusers. In multidrug users, cannabis was used more frequently (49%), followed by alcohol (13%), and cocaine (4%) [54]. Noorbakhsh et al. observed a significant correlation between stimulant use and histrionic personality disorder, ASPD, and narcissistic personality disorder. In addition, correlation between avoidant, histrionic, narcissistic, depressed, antisocial, and borderline personality disorder and narcotic use was significant [55].

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Measures of Sensation Seeking

Marvin Zuckerman , Anton Aluja , in Measures of Personality and Social Psychological Constructs, 2015

Construct/Factor Analytic

Zuckerman et al. (1993) performed an exploratory factor analysis (EFA) with the EPQ-R (Eysenck Personality Inventory – Revised), the ZKPQ (Zuckerman–Kuhlman Personality Questionnaire, form III – Revised; Zuckerman et al., 1993), and the NEO-PI-R (NEO Personality Inventory Revised; Costa & McCrae, 1992). The Neuroticism scales from the EPQ-R and the NEO-PI-R grouped together with the Neuroticism–Anxiety Scale of the ZKPQ-III-R. In a second factor, the Extraversion Scales of the EPQ-R and the NEO-PI-R grouped with the Sociability and Activity Scales of the ZKPQ. The three instruments share common factors of Extraversion and Neuroticism within two of the primary factors.

In the three-factor structure, the Psychoticism Scale of the EPQ-R, and the Agreeableness and Conscientiousness Scales of the NEO-PI-R define the third factor. Impulsive Sensation Seeking and the Aggression–Hostility of the ZKPQ have their largest loadings on this factor. In the four-factor structure, the Psychoticism factor was split into two factors. Conscientiousness, Psychoticism, and Impulsive Sensation Seeking define one of them, whereas Agreeableness, Aggression–Hostility, and Openness load mainly on the other. In another analysis, the 30 facets of the NEO-PI-R were used instead of the Big-Five factor scales. These results corroborated the previous 4-factor structure plus an additional factor exclusively formed by the 6 NEO Openness facets. Correlations between the ZKPQ ImpSS and EPQ and NEO scales were: 0.55, 0.28, 0.01, −0.51, 0.28, 0.01, 0.23, and 0.00 for Psychoticism, Extraversion, Neuroticism of EPQ and Conscientiousness, Extraversion, Neuroticism, Agreeableness and Openness, respectively.

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