Advances in personality assessment 9781315825571, 1315825570, 9781317838265, 1317838262, 9781317838272, 1317838270, 9781317838289, 1317838289

Table of contents :
Content: 1. Personality profiles in the U.S. foreign service / Samuel Karson and Jerry W. O'Dell --
2. Identification of dysthymia and cyclothymia by the general behavior inventory / Richard A. Depue and Michael J. Fuhrman --
3. The interview questionnaire technique : reliability and validity of a mixed idiographic-nomothetic measure of motivation / Eric Klinger --
4. Measurement of irrational beliefs : a critical review / Nerella V. Ramanaiah, Joel R. Heerboth, and Thomas R. Schill --
5. The cognitive-perceptual approach to the interpretation of early memories : the earliest memories of Golda Meir / A. Rahn Bruhn and Sheri Bellow --
6. The assessment of shame and guilt / David W. Harder and Susan J. Lewis --
7. Holistic health : definitions, measurement, and applications / Richard H. Dana and Tom Hoffmann --
8. Assessment of cognitive affective interaction in children : creativity, fantasy, and play research / Sandra W. Russ.

Citation preview

ADVANCES IN P E R SO N A L ITY ASSESSMENT Volume 6

Edited by

Jam es N. Butcher Charles D. Spielberger

Ö Routledge

Taylor&FrancisCroup

ADVANCES IN PERSONALITY ASSESSMENT V o lu m e 6

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AD VAN CES IN PERSONALITY ASSESSMENT Volume 6

Edited by

James N. Butcher University of Minnesota

Charles D. Spielberger University of South Florida

¡1

Routledge Taylor & Francis Croup

NEW YORK A N D L O N D O N

First Published by Lawrence Erlbaum Associates, Inc. Publishers 365 Broadway Hillsdale. New Jersey 07642 Transferred to Digital Printing 2009 by Routlcdgc 270 Madison Avc, New York NY 10016 27 Church Road, Hove, East Sussex, BN3 2FA Copyright © 1987 by Lawrence Erlbaum Associates, Inc. All rights reserved. No part o f this book may be reproduced in any form, by photostat, microform, retrieval system, o r any other means, without the prior written permission o f the publisher.

L ib ra ry o f C ongress C ataloging in P ublication D ata

ISSN ISBN

0 -2 7 8 -2 3 6 7 0 -8 9 8 5 9 - 6 6 0 -2

P u b lish er’s Note The publisher has gone to great lengths to ensure the quality o f this reprint but points out that some imperfections in the original may be apparent.

Contents

Preface

ix

1. Personality Profiles in the U S. Foreign Service Samuel Karson and Jerry W. O’Dell Demographic Characteristics of the Subjects A Study of M EDAVACs 4 Characteristics of Alcoholic Subjects 6 The Factor Analysis 8 Summary and Conclusions 11 Recommendations 11 References 12 2.

3

identification of Dysthymia and Cyclothymia by the General Behavior Inventory Richard A. Depue and Michael J. Fuhrman The Behavioral Paradigm and the Problem of Identification 15 The Nature of the General Behavior Inventory External Validation of the Inventory 20 Dysthymia and Bipolar Affective Disorder 22 Modification of the GBI 24 A Pilot Study of the Revised GBI 26 References 28

1

13

17

v

CONTENTS

The Interview Questionnaire Technique: Reliability and Validity of a Mixed Idiographic-Nomothetic Measure of Motivation Eric Klinger The Current Concerns Construct 33 The Interview Questionnaire 35 Summary 45 Conclusion 46 References 46

Measurement of Irrational Beliefs: A Critical Review Nerella V. Ramanaiah,Joel R. Heerboth, and Thomas R. Schill Global Measures and Irrational Beliefs 51 Evaluation of Global Measures 54 Multi-Dimensional Inventories of Irrational Beliefs Evaluation of Multi-Dimensional Inventories 60 Evaluative Summary and Future Directions 63 References 65

57

The Cognitive-Perceptual Approach to the Interpretation of Early Memories: The Earliest Memories of Golda Meir A. Rahn Bruhn and Sheri Bellow The Cognitive-Perceptual Model for Interpreting EM s Personality, Pathology, and Early Memories 72 Early Memories and Afterthoughts 74 Golda Meir’s Earliest Memory 75 Meir’s Second Early Memory 76 Family Myths as Early Memories 77 Group Memoires 80 Discussion 81 Early Memories and the Assessment Process 85 References 86

The Assessment of Shame and Guilt David W. Harder and Susan J. Lewis Method 101 Results 101 Discussion 108 References 112

70

CONTENTS

7.

Vii

Holistic Health: Definitions, Measurement, and Applications 115 Richard H. Dana and Tom Hoffmann Definitions and Instruments Self-Responsibility 117 Dimensions 119 Holistic Health Instruments Discussion 130 Summary 134 References 134 Appendix A 139

116

123

8. Assessment of Cognitive Affective Interaction in Children: Creativity, Fantasy, and Play Research Sandra W. Russ Creativity, Fantasy, and Play 142 Affective Processes in Play and Creative Problem Solving Guidelines for Future Research 152 References 153

Author Index Subject Index

157 163

141

144

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Preface

The field o f personality assessment has never been more alive and filled with novel approaches than it is today. The psychological assessment literature abounds with sound, empirical research, and a varied array o f theoretical view­ points and new alternative approaches to personality appraisal. Our continuing goal in the Advances in personality assessment series to is disseminate informa­ tion about major new research or applied developm ents in the growing field o f personality assessment. The range of papers presented in this volume clearly fulfills our ideal in this series and provides an interesting example o f the extensive domain of personality assessment in contemporary psychology. The papers include two interesting applications of personality assessment techniques, some detailed explorations o f new potentially fruitful assessment methods, and a number o f papers shed new light on some psychological processes through the application o f assessment techniques. Unique practical applications o f assessment procedures included are the dis­ cussion in Chapter 1 by Karson and O ’Dell on the use o f personality assessment techniques with foreign service personnel and the presentation in Chapter 7, by Dana and Hoffm ann, on the use of assessment methods in holistic medicine. Two novel assessment techniques are included in the book: In Chapter 2, Dupue and Fuhrman discuss the assessment o f dysthymia and cyclothymia using the GBI; and Klinger, in Chapter 3, discusses the idiographic-nomothetic application o f the Interview Questionnaire Technique. Several other intersting applications o f assessment methodology are included in this book. Ramanaiah and Heerboth, in Chapter 4, provide an interesting survey o f approaches to assessing irrational beliefs; Bruhn and Bellow describe an insightful assessment o f early memories in ix

X

PREFACE

C hapter 5; H arder & L ew is, in C hapter 6, detail the assessm ent o f sham e and guilt; and R uss, in C hapter 8, discusses the assessm ent of cognitive affective interaction in children. Diversity in approach, m ethod, and assessm ent philosophy are clearly re­ flected in this collection of papers. O ne o f our central goals in publishing this series is to incorporate a broad range o f assessm ent approaches and to provide a com prehensive, if not unified, perspective on the field o f personality assessm ent. W e hope that this volum e achieves som e success in bringing together the varied assessm ent approaches and contributes, to som e m easure, to the integration o f the field o f personality assessm ent. Janies N . B utcher C harles D. Spielberger

A D VAN CES IN PERSONALITY ASSESSMENT V o lu m e 6

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Personality Profiles in the U.S. Foreign Service

S a m u e l K arso n Florida Institute of Technology Jerry W. O 'D ell Eastern Michigan University

Members of the Foreign Service are among the most highly selected of all United States governm ent employees. Only about 1 in 100 applicants for these positions actually obtains employment. Typically each year, some 20,000 candidates ap­ ply for and take the required entrance examinations; approximately 200 are subsequently appointed as junior Foreign Service officers. Thus the intellectual and medical screening that the candidates undergo is very rigorous indeed, and the competition for appointments is unrivalled in any other branch of the federal service. The average American tends to have a rather romantic and unrealistic view of life and work in overseas American embassies and consulates. Life there is often fantasized as a long series o f embassy parties, meetings with important digni­ taries, and the like. So it comes as a surprise to many to learn that most American Foreign Service officers work long and hard at their difficult jobs. These posi­ tions or cones include political, econom ic, consular, and security officers; per­ sonnel and administrative officers; couriers, auditors, comm unicators, secre­ taries, physicians, nurses, and laboratory medical technicians. Some of these dedicated em ployees succum b to the demands o f their jobs every year. The most obvious o f these stressful situations was the Iranian hostage crisis of 1979-1980; other, less publicized kidnappings and terrorist activities occur from time to time. Another well-known source o f stress was the falsely suspected, albeit highly publicized, bombardment with high intensity microwave radiation of the American Embassy in M oscow. Further causes o f discom fort include the very real threats to one’s physical health and well being. Pernicious diseases exist in tropical countries that are

1

2

K A R SO N A N D O 'D ELL

unknown here. The poor level o f sanitation in many posts is appalling to som e­ one used to the amenities of North American life— the very food and water is unsafe in many countries. In other lands child health and dental care are at a very minimal level if they exist at all; medicines and procedures that we take for granted simply are not available. In this regard it is o f interest to note that depending on many health and safety factors, overseas posts are classified as 0% , 10%, 15%, 20% , or 25% posts for pay differential purposes. Higher pay also may be awarded to those in locations officially classified as dangerous when the situation warrants it (for exam ple, in Beirut, Lebanon). Many sources o f psychological stress exist. The most obvious arises from what has been called “ culture shock” — all of the factors involved in living in a strange, perhaps unfriendly society. Even in congenial countries, relative un­ familiarity with the language and customs may lead many em ployees to feel isolated. Officers who have been overseas for many years often admit to feelings o f homesickness and loneliness. Legal protections that we take for granted often are absent in many foreign countries. Many Foreign Service personnel at certain posts work what are essentially 12-hour days, 6 days per week on a routine basis. Even when not at their primary jobs, their behavior is closely scrutinized both by their rating officers and by representatives o f foreign governm ents. At a party, for example, they must never forget their diplomatic status and the fact that they are always regarded by the host country as representatives o f their nation. Under such circum stances, true relaxation may be unknown. Foreign Service personnel are also subject to temptations that are unknown in our country; moral props and support systems such as friends and relatives that have reinforced proper behavior at home are frequently absent. Alcoholic bev­ erages are available in many posts in unlimited quantities and at very low prices. Dangerous drugs such as heroin, long banned in the United States, may be easily available. Prostitution often flourishes openly, and can become a frequent tem p­ tation for a lonely employee. The combination o f great pressure with the ready availability o f drugs is a particularly dangerous one for many officers and their families. Stress-related problems are not limited to persons directly employed by our government. The families o f Foreign Service personnel often accompany them on assignments. The problems o f adjustm ent previously mentioned are fre­ quently magnified for these family members. Spouses may suffer from even greater isolation; job satisfaction that helps the Foreign Service m em ber sustain an identity may not be available to the spouse, because the host foreign country may not allow the husband or wife to work. Such a routine matter as childbirth may be vastly complicated by political considerations. A woman may be forced by circumstances to give birth in a foreign hospital, under difficult sanitary conditions. She may not even know the language. Adolescents whose superegos and habits are im perfectly formed may have great difficulties in coping with

1.

FO REIG N SER V IC E P ER SO N N EL

3

obvious drug and sexual temptation. T hus, stress factors in dependents can be even more troublesome at times than for the Foreign Service members them ­ selves. It has been estim ated that 60% of all referrals for medical treatment in the Foreign Service have a stress-related or psychological basis. Even in 1949, more money was spent for treatment o f emotional disorders than for any other medical problem other than surgical and gastrointestinal problems (D eVault, 1982). Until recently, treatment o f these disorders was handled by using part-time psychiatric consultants. But, with an increase in the problem , a formal position o f Mental Health Services director was established in 1976 and Dr. Herbert C. Haynes, a senior psychiatrist, was appointed. A position for a senior psychologist officer was added in 1977. Later, as the mental health programs gained increased acceptance, positions for regional psychiatrists were established overseas in every bureau on a perm anent career b a sis.1 When they arise, medical and psychological problems are handled, whenever possible, at the post where the officer is em ployed. If appropriate treatment cannot be arranged there, various regional treatment centers may be used, and, that failing, patients are “ evacuated” to W ashington, DC either for further evaluation and treatment or for hospitalization. These persons are referred to as MEDEVACs. The term psychiatric M ED EVAC refers to employees or depen­ dents whose psychological or psychiatric problems are so persistent or severe as to warrant the patient’s return to the United States. As former chief clinical psychologist for the U. S. Department o f State, the senior author (S .K .) had the opportunity to study the psychological charac­ teristics o f these psychiatric MEDEVACs as well as certain other Foreign Ser­ vice personnel who were referred for evaluation. This chapter is a description of the results o f that research.

D E M O G R A P H IC CH AR ACTERIST IC S OF THE SU B J E C T S Statistics for the period M ay, 1983 through January, 1984 show that the average age o f employees M ED EV ACed for all medical reasons was 41.7; 60% o f them were male. The mean age o f the sample o f 464, used in the following factor analysis, was 39.96; 57% were male. T hus, the sam ple is quite comparable in these characteristics to the larger group.

■The first Foreign Service officer to serve overseas as a regional mental health officer was Dr. Richard W estmaas, a clinical psychologist who was posted in Kabal in 1974-1976, and who by all accounts did an outstanding job.

4

K A R SO N A N D O 'D ELL

A S T U D Y OF M ED EV A C s The major purpose of this study was to look for significant differences on psychological tests between people with psychological problems who were medi­ cally evacuated and those who were not. A sample of 106 Foreign Service employees of both sexes who had been M EDEVACed was compared with a sample of 101 Foreign Service employees of both sexes with no history of psychiatric medical evacuation. Both groups were selected with great care from the psychological files o f the Mental Health Service in W ashington, DC, where all of the evaluations had been accomplished between 1978 and 1981.2 The two groups had routinely been administered the M M PI, Form R, the 16 PF, Forms A and B, and the Shipley Institute for Living Scale, a well-known intelligence test. These three tests, plus the B ender-G estalt test comprised the basic battery that was administered to all referrals for psychological evaluation at that time. Typically, the testing o f the M EDEVACs was accomplished routinely within a few days o f arrival back in the department. All o f the testing in both groups was done under the supervision o f the senior author by an experienced secretary who individually administered and scored all o f the tests on both groups. Preliminary ANOVA analysis with all subjects showed that the interaction of sex with all other variables was not significant. Therefore, for case o f presenta­ tion, only simple ANOVAS combining the two sexes were calculated on each scale. The results arc presented in Table 1.1; the standard scores presented were calculated by using means and standard deviations provided in the Handbooks for the respective tests. The results are rather surprising. O f the seven significant differences found, fo u r were with respect to intellectual functioning, especially abstract reasoning ability. Those persons evacuated for psychological reasons obtained lower scores on the 16 PF Intelligence scale (B), and on all three o f the Shipley scales. Thus, it is clear that the intellectual functioning o f the M EDEVACs was substantially impaired. It seems reasonable that this was largely because o f the disrupting anxiety and depression these patients were experiencing that initiated their evacuation. The M EDEVACs low er score on the 16 PF M (W alter Mitty factor) scale might likewise be reflecting a lower propensity for imaginative thinking, making fantasy activity less available as an habitual coping or escape mechanism. Further, the M EDEVACs also scored lower on the 16 PF I scale, showing a more “ m acho,” toughm inded, realistic, no-nonsense approach to problems. This result, how ever, was not quite statistically significant. The MEDEVACs also scored higher on the MMPI Pd scale than did the control group. Scale 4 on the MMPI has indicated anger, resentment o f authori2The authors gratefully acknowledge the help of Deena Flowers, M .S.W . with this part o f the study.

1.

MEDVAC VS.

MEDVAC NonMEDVAC (N=106) (N=101)

16 P F S c a l e s .. .. 3.. 4.. 5., 6 . 7.. 8 ,. 9,. 1 0 . 1 1 ,. 1 2 ,. 13 . 14 . 15 . 16 . 17 . 18 . 19 . 2

. ,. 22 . 23 , . 24 , . 25 . 25.. 26 . . 27., 28., 29. 30. 2 1

B)

A B C E F G H I L M N O Q1

(Warmth) (Intelligence) (Ego S t r e n g t h ) (Dominance) (im pulsivity) (Group C o n f o r m i ty ) (Boldness) (Tender-M indedness) (Suspiciousness) (Im agination) (Shrewdness) (G uilt Proneness) (Rebelliousness) Q2 ( S e l f - S u f f i c i e n c y ) Q3 ( C o m p u l s i v i t y ) Q4 ( F r e e - F l o a t i n g A n x i e t y ) F a k i n g Bad (r aw s c o r e ) F a k i n g G ood ( r a w s c o r e ) Random ( r a w s c o r e )

MMPI 20

(A a n d

( F o r m R)

(not K -corrected)

Lie-Scale F-Scale K-Scale 1 (H ypochondriasis) 2 (Depression) 3 (H ysteria) 4 (P sychopathic D eviate) 6 (Paranoia) 7 (Psychaesthenia) 8 (Schizophrenia) 9 (Hypomania) 0 (Social In tro v ersio n )

M iscellaneous 31. 32. 33. 34.

Ag e i n y e a r s S h i p l e y - H a r t f o r d VS S h i p l e y - H a r t f o r d AS S h i p l e y - H a r t f o r d CQ

*p < .05,

5

TA8LE I . I NonMEDVAC ANOVA R e s u l t s

Scale

1

F O R E IG N S E R V IC E P E R S O N N E L

Sten

S c o re Means

5.07 7.18 5.71 5.96 5.53 5.55 6 . 1 0

6.26 4.94 5.93 5.63 4.96 6.06 6.06 6.38 5.31 1.51 5.79 2.54 T Score 51.49 51.56 58.45 49.43 60.16 61.20 58.05 57.79 49.25 49.16 54.30 49.16

F

4.87 7.77 6.05 6.28 5.34 4.99 6.04 6.73 4.75 6.56 5.50 4.50 6.54 6.06

.38 6.69* 1.15 .96 .39 3.55 .03 3.62 .42 7.02** .17 2.23 2.87

6 . 1 2

1 . 2 1

4.81 1.61 5.95 2.04

2 . 47 .15 .15 4.86*

. 0 2

Means 49.42 50.91 59.20 47.61 57.17 60.66 54.13 57.50 47.38 46.82 52.96 48.85

3.80 .34 .29 1.59 2 . 8 8 . 1 2

6.61* .03 2.09 3.38 1.06 .04

Raw S c o r e s 41.5 34.8 27.0 89.1

40.7 36.5 31.3 95.6

.45 8.18** 20.55** 12.29**

**p. e .01

ty, and even aggressiv en ess in m any studies. T his in terp retatio n m ight also be supported by the M E D E V A C ’s co m p arativ ely high sco re on the 16 PF R andom scale. T his scale w as d erived in a m an n er sim ilar to the M M P I F scale (see Karson & O ’D ell, 1976), and sim ply m easures unusual responses to item s. Such responses can be ob tain ed by som eone w ho w ants to “ m ake a bad im p ressio n ” ; on the other h an d , a high score on the R andom scale w ill result if a person has m any peculiar psych o lo g ical sy m ptom s and has d ifficu lty co n cen tratin g on the item s. T his is a reaso n ab le interpretation fo r m ost o f th e M E D E V A C sam ple.

6

K A R SO N A N D O'DELL

A tendency toward greater pathology may be seen in the fact that the MEDEVACs’ MMPI Scale 2 (Depression), Scale 8 (Alienation), and Lie scale scores were higher than those o f the control group. These scores only approached significance, however, so that these results must therefore be viewed with some caution. Thus, the patients returned to the U. S. were found to be more intellectually impaired both with words and numbers (but especially the latter), to be more concrete and engage in less fantasy activity, to be more angry and resentful, and to give more unusual answers to personality test items than a control group. All of these results can be interpreted as lending support to the medical-administrative decision typically made by the regional medical officers at their respec­ tive posts that these employees needed to be returned to the United States for further evaluation and treatment.

C H A R A C T ER IST IC S OF ALCO H O LIC SU B JE C T S As suggested earlier, alcohol abuse and alcoholism are among the principal medical-psychiatric disorders found in the Foreign Service, as is true everywhere else. The ready availability of alcohol in many overseas posts, the perceived necessity for drinking at many diplomatic functions, and the relative stress and demands of many positions lead many employees to abuse ethanol. Because of the comparative prominence of alcoholism among diplomatic personnel, it was believed to be of interest to compare a group of alcoholic subjects (N= 122) with a control group o f nonalcoholic psychological referrals (¿V= 342). The diagnosis of alcoholism was arrived at with great care. It was based on (a) a medical examination, (b) a series of laboratory tests conducted by certified laboratory medical technicians including routine liver function tests, (c) a clinical psychological evaluation including the basic battery previously de­ scribed plus the B ender-G estalt, Color-Form, and Porteus Maze tests, (d) a psychiatric evaluation conducted by board certified psychiatrists each one of whom had over 10 years experience in evaluating Foreign Service personnel and, finally, (e) an evaluation by an experienced and adroit alcohol counselor who heads the alcohol awareness program o f the Department o f State. Because the psychological testing was used in arriving at a diagnosis of alcoholism (unlike the decision to MEDEVAC), the possibility exists for criteri­ on contamination. However, we suspect that it was minimal because the diag­ nosis was rarely made without support from the medical examination or cor­ roborating evidence from a staff psychiatric social worker from the family and work history. Results of the analysis of variance for these two groups are found in Table 1.2. These findings show a number of things. First, we find that those with alcoholism are older than the nonalcoholics by about 7 years. One hypothesizes

1.

A l c o h o l i c Vs .

Alcoholic (N = 1 2 2 )

16

PF

1. 2. 3. 4. 5. 6 . 7. 8 . 9. 1 0 . 11. 12. 13. 14. 15. 16. 17. 18. 19.

A ( Wa rmt h) B (Intelligence) C (Ego S t r e n g t h ) E (Dominance) F (Im pulsivity) G (Group C o n fo rm i ty ) H (Boldness) I (Tender-M indedness) L (Suspiciousness) M (Im agination) N (Shrewdness) 0 (G uilt Proneness) Q1 ( R e b e l l i o u s n e s s ) Q2 ( S e l f - S u f f i c i e n c y ) Q3 ( C o m p u l s i v i t y ) Q4 ( F r e e - F l o a t i n g A n x i e t y ) F a k i n g Bad (r aw s c o r e ) F a k i n g G ood ( r a w s c o r e ) Random ( r a w s c o r e )

20. 21. 22. 23. 24. 25. 25. 26. 27. 28. 29. 30.

Scales

(A a n d

( F o r m R)

B)

Sten

6 . 1 0

6 . 2 2

. 30 6.34 5.22 1.48 6.23 2.87 6

Age i n y e a r s Shipley-H artford Shipley-H artford Shipley-H artford

*p< .05,

6 . 1 2

6.48 5.12 6.14 5.63 4.98

8 8 . 1

.0 0

6 . 0 2

.55 2.65 2.54

5.33 1.73 5.72 2.46

2.03 3.32 4.06*

5.96

49.96 52.86 58.08 50.94 60.59 62.09 58.05 56.92 50.19 50.32 54.75 49.58

Raw S c o r e VS AS CQ

.38 . 26 .08 2.03 13.86** 1.87 4.04* 6.19* 1.52 .94 .14

. 2 2

T S c o r e Means

50.62 53.95 57.15 47.40 57.60 58.33 58.54 56.63 48.58 49.29 54.75 49.79

45.3 35.4 26.6

F

S c o r e Means 4 .74 7.34 5.69 6.16 5.72 5.13

(not K -corrected)

Lie-Scale F-Scale K-Scale 1 (H ypochondriasis) 2 (Depression) 3 (H ysteria) 4 (P sychopathic Deviate) 6 (Paranoia) 7 (Psychaesthenia) 8 (Schizophrenia) 9 (Hypomania) 0 (Social In tro v ersio n )

N onalcoholic (N = 3 4 2 )

4.87 7.23 5.76 5.81 4.91 5.41 5.64 5.86 4.87 5.96 5.68 4.98

M iscellaneous 31. 32. 33. 34.

7

TABLE 1 .2 N o n a l c o h o l i c ANOVA R e s u l t s

Scale

MMPI

F O R E IG N S E R V IC E P E R S O N N E L

38.1 35.0 28.7 91.7

.49 1.09 1.32 8 . 0 2 ** 3.73 13.13** .19 .03 1.98 .78 . 0 0 . 0 2

Means 44.36** .72 6 . 28* 5.26*

* * p < .01

that older officers tum to drink because they may have difficulty in keeping pace with their younger competitors. It may be that the meaning of life also becomes more obscure at this life stage. As with the MEDEVAC sample, we discover that factors measuring intellec­ tual impairment and abstract ability are important here. The alcoholics are lower on two scales of the Shipley test, namely abstract reasoning and conceptual quotient. The vocabulary score did not change. The same result, was found in the 16 PF B or “ Intelligence” scale.

8

K A R SO N A N D O 'D ELL

The alcoholics score a good deal lower on extraversión than the nonalcoholic psychiatric referrals. This is shown by their lower scores on the 16 PF F (Impulsivity) and H (Boldness) scales, both o f which appear prominently on the second-order 16 PF extraversión factor. This may well indicate a relative social isolation on their part. Like the M ED EV ACs, the alcoholics are a good deal more tough-minded and “ m acho” than the controls, as shown by their lower score on the 16 PF 1 (Sensitivity) scale. It is notable that the alcoholics show lower scores on all three o f the MMPI “ neurotic triad” scales. Significantly lower scores are found on Scales 1 (H y­ pochondriasis) and 3 (H ysteria), and the difference closely approaches signifi­ cance on Scale 2 (Depression). It appears safe to assume that these alcoholics arc simply not programmed to develop classic psychoneurotic symptoms. This, in turn, may be related to their respective ego ideals and value systems. With respect to validity scales, we find that the alcoholics obtained a higher score than the controls on the 16 PF Random scale. As with the M EDEVACs, it appears that this may be due to the presence o f somewhat bizarre symptoms in the experimental group; o f course we know this to be the case. Thus, in the alcoholic group we find a serious impairment in intellectual functioning, particularly with regard to abstract reasoning, related to older age as well as drinking. In addition, the tests show increased seriousness and absence o f enthusiasm, lower venturesomeness and interest in the opposite sex, greater introversion, fewer neurotic symptoms (including high anxiety), and a higher level o f peculiar answers.

THE FA CTO R A N A L Y S IS Because there has been no previous report in the professional psychological assessment literature on the U. S. Foreign Service, it was thought worthwhile to factor analyze the test data on all samples reported herein. It was hoped that we could see whether the factors that emerged were sim ilar to those found in other groups of governm ent em ployees, such as air traffic controllers (Karson & O ’Dell, 1974). To obtain the second order factors, the data from all 464 subjects was factor analyzed on all variables. A simple principal components solution was used, with varimax rotation. Inspection o f the eigenvalues, in the spirit o f the “ scree” test (Cattell, 1966), suggested that 10 factors should be rotated, and this was done. The results o f the factor analysis are presented in Table 1.3. Only loadings with absolute values greater than 0 .4 0 are listed. Factor I is clearly the fam iliar 16 PF factor o f “ Anxiety vs. Dynamic Integra­ tion” . In M M PI term s, it is very' sim ilar to W elsh’s A (anxiety) Scale derived from factor analysis (W elsh, 1956). This is an important factor seemingly found

Factor

T A B L E I .3 L o a d i n g s G r e a t e r Than

.AO

Factor I Salients Anxiety vs . Dynamic Integration

Factor II Salients Extraversión vs. Introversion

16 PF 16 PF 16 PF 16 PF 16 PF 16 PF 16 PF 16 PF MMPI MMPI MMPI MMPI MMPI MMPI MMPI MMPI MMPI

16 PF 16 PF 16 PF 16 PF 16 PF MMPI MMPI

C H L 0 Q3 Q4 FB FG Lie F K Hs D Pd Pt Sc Si

-.86 -.56 .74 .83 -.55 .87 .42 -.61 -.44 .55 -.86 .49 .51 .53 .81 .73 .62

Factor III Salients Intelligence 16 PF 16 PF MMPI Ship Ship Ship

B Rand L VS AS CQ

.68 -.52 -.49 .59 .88 .79

Factor V Salients Sensitivity Emotional : vs. Toughmindedness 16 PF I Sex

.84 .82

A F II Q2 FB Ma Si

-.59 -.73 -.62 .69 .42 -.51 .58

Factor IV Salients Independence vs . Subduedness 16 16 16 16

PF PF PF PF

E M N Ql

.74 .67 -.55 .73

Factor VI Salients MMPI Neuroticism MMPI MMPI MMPI

Hs D Ily

.71 .56 .88

Factor VII Salients MMPI PassiveAggressiveness

Factor VIII Salients Positive Character Integration

16 PF MMPI MMPI MMPI MMPI

16 PF G 16 PF FG

Rand F Pd Pa Sc

.41 .52 .56 .63 .49

.75 .49

Factor IX Salients Age/Alcoholism

Factor X Salients Type (MEDEVAC;

Age Alcoholism

Type

.73 .72

.91

9

10

K A R SO N A N D O'DELL

in all factor analyses of personality inventories. It includes the primary indicators of pathology in both tests. Factor II is again easy to identify. This is the 16 PF second order factor of “ Extraversión vs. Introversion. ” It includes the usual 16 PF components, plus the Faking Bad Scale. In addition, notice that the two MMPI dimensions that one might expect to be on this factor, namely Scales 9 (Ma) and 0 (Si), are found here. There can be no doubt that Factor III measures “ Intelligence” ; the 16 PF B Scale, and all of the Shipley-H artford scales load on it. It is interesting to note, however, that two validity scales, the 16 PF Random Scale, and the MMPI Lie Scale, also load on this factor. One might infer that people of lower intelligence are more likely to dissimulate on either test. Factor IV is purely a 16 PF factor, previously identified by Cattell (Cattell, Eber, & Tatsuoka, 1970), as “ Independence vs. Subduedness” because of its combination of hostile elements (16 PF E and Q l) with intellectual qualities (16 PF M and —N). Factor V consists mainly of the 16 PF I Scale (Emotional Sensitivity), and hence the name given to the second order factor. Notice, however, that sex loads highly on this factor, implying that sex and sensitivity are highly correlated in this sample. Primaries A and M also typically load here so that this factor is frequently identified as “ Cortical Alertness vs. Pathemia” (Cattell, Eber, & Tatsuoka, 1970). It is interesting to note that MMPI Scale 5 (MF) loads + .87 on this factor. This value is not included in Table 1.3 because the MF scale was scored with two different keys for the two sexes, but the high loading deserves comment, for it clearly shows the very high relationship in this sample between Scale 5 on the MMPI and Factor I (Emotional Sensitivity) on the 16 PF. In Factor VI, we again encounter one of W elsh’s early factors, namely Factor R (for repression). Only the moderate negative loading on Scale 9 is missing. For obvious reasons, this factor has been labelled “ MMPI Neuroticism” . It is fas­ cinating to note that almost nothing on the 16 PF loads on this scale. As we get to the last few factors, identification, as always, becomes more difficult. We have called Factor VII “ MMPI Passive-Aggressiveness” because of the high loadings on Scales 6 (Pa) and 4 (Pd), but these do not necessarily jibe well with the inclusion o f the 16 PF random score, and MMPI F and 8 (Sc) scales on the factor. The results suggest that anger and resentment accompany unusual response set scores and alienation in our Foreign Service patient samples. Factor VIII is clearly a superego factor, involving the 16 PF G (Group Con­ formity) scale, and the Faking Good scale. We have called this factor “ Positive Character Integration” , although Q3 (Ability to Bind Anxiety), which usually loads on this factor, is missing here. Factor IX shows clearly the relationship between age and alcoholism that we have already discussed. Finally, Factor X contains MEDEVAC-nonMEDEVAC status alone, because none of the test vari­ ables met our requirement for saliency, namely a loading of 0.40 or more.

1.

FO REIG N SER V IC E P E R SO N N E L

11

S U M M A R Y A N D C O N C L U SIO N S W ork in the Foreign Service seems to impose special stresses on employees over 40 who have a vulnerability to alcoholism , either through family history and/or personality. Alcoholism in the Foreign Service was found to be related to the existence of: (a) relatively low extraversión or dependency gratification obtained through interaction with others, (b) too much inhibition and glum , sober se­ riousness, (c) too little enthusiasm and fun-loving venturesomeness, and (d) a value system that imposes strong controls over the expression o f feelings. The conclusion is inescapable for both the MMPI and 16 PF that more accu­ rate measurem ent and increased validity will depend upon the availability of local norms for these tests. Such norms should be based on Foreign Service personnel who have been tested prior to developing sym ptom s. General popula­ tion norm s, such as used in this study do not appear to apply well to this group. Fulkerson, Freud, and Raynor (1958) reached the sam e conclusion many years ago in their work with Air Force pilots.

R E C O M M E N D A T IO N S As an antidote, we recom mend a group “ therapy” program targeted for em ­ ployees over 40, their spouses, and adolescent children. Such meetings would help increase interpersonal interaction, and perhaps lead to less dependency on ethanol. The easy availability o f nonalcoholic beverages at all embassy functions also deserves mention. W eekly showings o f educational films such as Something o f the D anger that Exists with Dr. Stanley G itlow, directed by Dr. H. C. ( “ Pat” ) H aynes, could well become a regularly scheduled late Friday afternoon event at all major overseas posts on a twice monthly basis throughout the year. This would be especially valuable if it were followed, whenever possible, by a ques­ tion and answer period led by the regional medical officer, chaplain, nurse, or community liaison officer. A similar program on at least a twice monthly basis could also be initiated at the local American International School for latency age and adolescent children, and expanded to include drug abuse other than ethanol when necessary; such a program could be under the direction o f the regional mental health officer an d /o r the school psychologist. With regard to reducing the num ber and costs o f medical evacuations, we are less optim istic, and more hesitant about proposing a program . This conclusion is based on our assumption that it is unlikely that one could materially reduce the approximately 50 to 60 psychiatric medical evacuations per year. This figure has been fairly constant over the past several years and seems relatively low based on the estim ated thousands o f overseas governm ent employees. Finally, a few words on a smoking prevention program that has many advo­ cates at overseas posts. Based on our own experience we feel a group program

12

K A R SO N A N D O 'D ELL

with a behavioristic emphasis has much to offer in this regard. This especially would be the case if there were a mental health professional or nurse at the post to provide leadership and initiate a program involving regular participation and the maintenance o f a daily log on the part of the participants. Because smoking addiction and ethanol addiction are frequently both present in the same person, it is believed that a double-edged attack can serve as a valuable reinforcer in attempts to break these life-threatening habits. In conclusion, based on observations at many overseas posts, we found the American Foreign Service officer to be a dedicated, hard-working em ployee, one who frequently functions under very difficult if not impossible circumstances. Such employees and their families deserve all of the help that our technology can provide. With proper training in stress management techniques, Foreign Service officers and their families can be educated to overcom e successfully many of the threats they face to self-preservation and personality integrity encountered in overseas living. The country owes them the opportunity to participate in such training and the field o f psychology currently has the technology available to provide the knowhow.

REFERENCES Cattell, R. B. (1966). The meaning and strategic use o f factor analysis. In R. B. Cattell (F.d.), Handbook o f m ultivariate experimental psychology (pp. 174-243). Chicago: Rand-McNally. Cattell, R. B ., Liber, H. W ., & Tatsuoka, M. M. (1970). Handbook fo r the sixteen personality facto r questionnaire. Champaign, IL: Institute for Personality and Ability Testing. DeVault, V. T. (1982). The origins and development o f the office o f m edical services: Department o f state. W ashington, DC: U. S. Department o f State. Fulkerson, S. C ., Freud, S. L ., & Raynor, G. H. (1958). The use of the MMPI in the psychological evaluation o f pilots. Journal o f Aviation Medicine, 29, 122-129. Karson, S. & O 'D ell, J. W. (1974). Personality makeup o f the American air traffic controller. Aerospace Medicine, 45, 1001-1007. Karson, S. & O ’Dell, J. W. (1976). A guide to the clinical use o f the 16 PF. Cham paign, IL: Institute for Personality and Ability Testing. Welsh, G. S. (1956). Factor dimensions A and R. In G. S. Welsh & W. G. Dahlstrom (Eds ). Basic readings on the M M PI in psychology and medicine (pp. 264-281). Minneapolis: University of Minnesota Press.

2

Identification of Dysthymia and Cyclothymia by the General Behavior Inventory

Richard A. Depue Michael J. Fuhrman University of Minnesota

Traditionally, psychopathologists have narrowly defined disorder in terms of its more severe, full syndromal forms. Clinically, of course, we see and treat mainly the patients at the extreme end of a severity continuum, so accordingly, the symptomatology and course of these patients form the basis of our illustrative descriptions of disorder. Moreover, these arc the patients on whom diagnostic criteria are formulated, psychobiologic hypotheses tested, and the efficacy of treatments assessed. This narrow focus has often been fruitful in both clinical and research contexts, but as some researchers have emphasized (Akiskal, 1981a; Turner & King, 1983), until recently diagnosis has focused on hospitalized patients to the extent that the milder forms of disorder existing in the premorbid histories of these patients have been ignored or given only slight attention. Psychiatric genetics has led the way in broadening our conception of psycho­ pathology to include milder forms of disorder. The repeated finding of an excess of subsyndromal forms of disorder in the relatives of ill probands or in the adoptees of psychiatrically ill biological parents necessitated a broadening of the definition of disorder (Gershon, Bunney, & Leckman, 1976; Heston, 1966, 1970; Shields, Heston, & Gottesman, 1975; Wetzel, Cloninger, & Hong, 1980). This broadening has had an impact on several different areas of psychiatry. For instance, it has required modification of arbitrary concepts of disease dependent on sensitivity of measurement of gene expression, such as the geneticist’s notion of penetrance (Meehl, 1973; Vogel & Motuisky, 1982); the epidemiologist’s prevalence, sensitivity, and specifity (Weissman & Myers, 1978); and the psy­ chologist’s true and false positive and negative rates (Meehl & Rosen, 1955). Definitional expansion has also meant that previous genetic estimates of mor­ bidity risk and of modes of transmission of a disorder are plagued by the problem 13

14

DEPUE A N D FU H RM AN

of incomplete identification of afflicted relatives; hence, subsequent research has assessed milder forms of disorder (Turner & King, 1983; Vogel & Motulsky, 1982; Wetzel et al., 1980). Similar recognition of mild disorders has been evident in recent epidemiologic research in the United States (Myers & Weissman, 1980; Weissman & Myers, 1978), and in the concern that has appeared in the recent clinical literature for their appropriate treatment (Akiskal, 1983; Akiskal, Djenderdejian, Rosenthal, & Khani, 1977; Akiskal, Khani, & ScottStrauss, 1979). Although the necessity of identifying mild forms of disorder is generally recognized, complete consensus on the nature of the relation of mild to full syndromal disorder does not exist (Depue, Slater, W olfstetter-Kausch, Klein, Goplerud, & Farr, 1981). However, in the affective disorders, historically precedented by Kraepelin’s (1921) position on this issue, there has been increasing support for viewing subsyndromal forms as directly related to full syndromal forms (Akiskal, 1981a, 1981b, 1983; Akiskal et al., 1977; Depue et al., 1981; Turner & King, 1983; Wetzel et al., 1980). The work on the cyclothymia-bipolar I relationship demonstrates this position most convincingly. Not only has cyclothymia been found to merge behaviorally imperceptibly with the bipolar II (and sometimes bipolar I) form of bipolar disorder1 (Akiskal et al., 1977; Depue et al., 1981), but also equivalent rates of bipolar disorder have been found in the first- and second-degree relatives of cyclothymic and bipolar I patients (Akiskal et al., 1977). Others have demonstrated an excess of cyclothymia and dysthymia in the biological offspring of affectively ill probands (Akiskal, 1981b; Klein, Depue, & Slater, in press). Furthermore, in at least seven pedigrees, cyclothymic probands have provided the link for the transmission of full syndromal bipolar disorder in three consecutive generations (Akiskal et al., 1977; Turner & King, 1983). In addition, one study (Akiskal et al., 1977) found that an equivalent proportion of cyclothymics and bipolar I patients experienced induction of hypomanic episodes by tricyclic antidepressants, a phenomenon that may serve as a marker for the bipolar genotype (Bunney, 1978). Finally, in 2- to 3-year followup studies, nonpatient (Depue et al., 1981; Klein & Depue, 1984) and outpatient (Akiskal et al., 1977) cyclothymics evidenced more severe episodes, indicating that cyclothymia is characterized by an increased risk for developing a full syndromal bipolar disorder. It is findings such as these, and data from others showing cyclothymic behavioral disturbance as a precursor to full syndromal bipolar disorder (W aters, 1979), that led to the inclusion of cyclothymia in the affective disorders section of DSM-III. The extent to which other mild affective forms are related to full syndromal affective disorders is less well known, al­

1Bipolar I disorder is characterized by both manic and depressive episodes that require treatment and usually hospitalization. Bipolar II disorder is characterized by a family history of mania or hypomania and requires treatment and often hospitalization for depressive episodes; however, where manic or hypomanie symptoms exist, they have not led to hospitalization (Depue & Monroe, 1978).

2.

IDENTIFICATION OF D Y ST H Y M IA A N D CYCLO THYM IA

15

though initial cvidcnce in support of a specific type of dysthymia-bipolar disor­ der association has been reported (Akiskal, 1983). The importance o f this work is that it supports a continuum model of behav­ ioral disturbance between cyclothymia and full syndromal bipolar affective dis­ orders. The basic assumption o f this model is that the episodic characteristics and the core behavior comprising the primary features of cyclothymic disorder are qualitatively similar to, although quantitatively less severe than, those of bipolar 1 disorder. Such a model is not, however, incompatible with the notion of a genetic-biologic distinction between normalcy and cyclothymia (Depue & Monroe, 1983; Depue et al., 1981; Gottesman & Shields, 1972). There are two major implications of the continuum model. First, because the behavioral and episodic features that characterize bipolar I disorder are assumed to be qualitatively similar to those of cyclothymia, these may be used to identify cyclothymia, although issues concerning the milder intensity, shorter duration, and any potential dissimilarity o f course in cyclothymes must be addressed. Second, the behavioral and episodic features that distinguish bipolar I and nor­ mal phenotypes also are assumed to distinguish cyclothymic and normal phe­ notypes, although the discrimination problem is much greater in the latter case. Taken together, these two implications provide the framework for a paradigm in which cyclothymic individuals are identifiable as having bipolar affective disor­ der on the basis of their behavioral patterns. As several studies have demon­ strated (Akiskal et al., 1977; Depue et al., 1981; Kraepelin, 1921), a sizable portion of the cyclothymic population is at increased risk for developing bipolar 1 or II disorder in the future. Hence, behavioral identification of cyclothymia is placed within a risk framework, and so the entire approach may be referred to as the behavioral high-risk paradigm (Depue et al., 1981).

THE BEH A V IO RA L P A R A D IG M A N D THE PRO BLEM OF IDENTIFICATION The features of the behavioral high-risk paradigm as applied to bipolar affective disorder are as follows. Onset o f bipolar subsyndromal behavioral disturbance (cyclothymia) usually occurs during early or mid-adolescence (14 years of age on the average: Akiskal et al., 1977; Campbell, 1953; Depue et al., 1981). For individuals experiencing subsyndromal onset, two major outcomes seems possi­ ble: (a) the continuation of cyclothymic disorder at similar, reduced, or increased levels of severity; or (b) the onset o f some form of full syndromal bipolar disorder, where initial untreated episodes occur at about 24 years of age on the average (Akiskal et al., 1977; Depue & Monroe, 1978). Considering the ages of subsyndromal and full syndromal onsets together, this yields an approximately 10-year identification period during which individuals comprising the cyclothy­ mia risk pool could be potentially identifiable on the basis o f full syndromal

16

DEPUE A N D FU H R M A N

behavioral and episodic features. O f course, the goal in using the paradigm is to identify cyclothymes as early in the identification period as possible. It is because behavioral identification holds the promise o f great economy that its use is so alluring to researchers. In cases where the behaviors com prising the risk index can be validly assessed in the form o f a self-report inventory, as described following the behavioral paradigm is extremely efficient as a firststage case-identification procedure (Depue & Evans, 1981; Goldberg, 1972). There are, however, many problems in applying a high-risk paradigm based on a behavioral index. Bipolar affective disorder displays the features of a common disorder (Gottesman & Shields, 1972; M eehl, 1973; Vogel & Motulsky, 1982). As such, when considered across its full spectrum, it presents with a phenotype that varies greatly in intensity. At more extreme intensities, identification o f the bipolar phenotype is not generally problematic. At very mild intensities, how ev­ er, the bipolar phenotype will merge almost imperceptibly with the norma! phenotype (e.g ., where mild cyclothymes are behaviorally indistinguishable from highly variable norm als). As one attempts to identify milder and milder cases, the threshold between case and noncase becomes increasingly arbitrary. This problem o f discrim inability inherent to many common disorders is greatly magnified by the use o f behavior as the risk indicator, because behavior is far removed from the action of the genes underlying the proposed distinction be­ tween normal and pathological phenotypes. How, then, may a behavioral index be used effectively? O ur approach to behavioral identification (Depue & Evans, 1981; Depue et a l., 1981) differs substantially from previous work (Chapman, Chapman, & Raulin, 1976; M eehl, 1973). In view o f the fallibility of behavior as a risk indicator, we believed that an effective use o f the behavioral paradigm would be to calibrate the risk index such that, at a minim um, a cyclothymic phenotype that is distinctly different from the normal phenotype is identified. Put another way, we were interested in identifying a risk group that is largely uncontaminated by false positives, even if we erred in the direction o f creating false negatives (i.e ., where very mild cyclothymic phenotypes fall below the best case-defining threshold), as long as the latter rate did not go too high. It is unclear whether such an approach to constructing a risk index is effective for epidem iologic purposes, because maximal separation o f the nonrisk and risk population is not fully attempted. There are, however, at least two contexts in which such an index might prove very useful. If the index is calibrated to identify cyclothymic phenotype that is (a) distinct from the normal phenotype, on the one hand, but which is (b) not so severe as to exclude mild to moderate cyclothymic phenotypes, on the other, then it may be useful in the detection o f a broad intensity range o f cyclothymic phenotypes in the clinical setting. If the index took the form o f a self-report measure, it might be useful as a screening device, where the identified group is given further clinical evaluation. This would be an important addition to the diagnosis o f cyclothymia in the clinic, where these

2.

IDENTIFICATION OF D Y ST H Y M IA A N D CYCLO THYM IA

17

patients so often go undetected and, hcnce, arc not comprehensively treated (Akiskal, 1981b; 1983; Akiskal et al., 1977). The second context for which such an index would be appropriate is research. The index is constructed to provide an upper cutting-score that defines a relatively pure true-positive group of cyclothymcs. However, by use of a two cutting-score system (Meehl & Rosen, 1955) a lower cutting-score may be used to provide a true-negative (normal) group, uncontaminated by very mild cyclothymic phe­ notypes (i.e., false negatives). Thus, the researcher may define two relatively pure, contrasting groups for psychobiologic, genetic, or pharmacologic studies. Additionally, when this strategy is applied to the general population (Depue et a l., 1981), the resulting nonpatient cyclothymic groups would offer several research advantages not available through the study o f outpatient or hospitalized subjects, such as longitudinal analysis o f morbid and intcrmorbid periods in the same individuals, a necessary approach for theoretical modeling of phenomena like cycles and the switch process (Depue & Monroe, 1983); and investigation of the individual in the natural environment, where naturalistic studies o f environmental stress-biology interactions may be carried out.

THE N ATU RE OF THE G EN ER A L BEHAVIO R IN V EN T O R Y Motivated by these advantages, we applied the behavioral paradigm to bipolar disorder in the form of a sclf-rcport measure called the General Behavior In­ ventory (GBI, Dcpuc et al., 1981). Because our interest was in separating a population into cases and noncases, a psychometric model of disorder based on a single, quantitative axis ranging from normality to severe disturbance seemed less than optimal (Goldberg, 1972). Under such a model, an individual’s total score is thought of as a quantitative estimate of degree of disturbance, or of the extent to which an individual is characterized by a dimensional trait (Goldberg, 1972; Jackson, 1971; Loevinger, 1957). All respondents may be distributed in a continuous fashion, and no psychometric methods for rendering qualitative dis­ tinctions among individuals are applied, either in the construction of the invento­ ry or in its analysis. Typically, inventories employed in epidemiological research are constructed on the basis of this model. That is, they incorporate only one dimension of disease, which is operationalized as a list o f behavioral symptoms. In some cases, a dimension o f frequency is incorporated (Radloff, 1977), but its useful­ ness is minimal because it is applied to a time span o f only 1 week (Depue et al., 1981). The recurring problem when epidemiologists apply behavioral identifica­ tion via self-report inventories is an unacceptably high false-positive rate (non­ disordered individuals scoring above the cutting-score) (Boyd, Weissman, & Thompson, 1982; Lewinsohn & Teri, 1982). It should not be surprising that a

18

DEPUE A N D FU H RM AN

dimensional approach to measurement is inadequate when it is asked to max­ imally separate two populations into dichotomous categories assumed to differ qualitatively at some level. Certainly the distinction between bipolar and normal phenotypes rests on more than the number of behavioral symptoms present. An alternative psychometric model is the binomial model of disturbance. Under this model, each inventory item is viewed as one representation (behav­ ioral symptom) of the pathological phenotype and, accordingly, is treated con­ ceptually as a dichotomous variable (i.e., presence-absence o f the symptom). A total inventory score represents a probability estimate of the respondent’s having that phenotype (Goldberg, 1972; Loevinger, 1957). The group of respondents falling above the best case-defining threshold is assumed to have the pathological phenotype and, hence, to be qualitatively different from the normal phenotype. In constructing the GBI, the binomial model was adopted and operationalized in two major ways. First, five dimensions that characterize the distinctness of bipolar disorder were identified and incorporated in the GBI. The first consists of the core behavior of full syndromal bipolar I disorder, where behaviors reflecting diencephalic dysregulation (the behavioral, somatic, and vegetative symptoms; Depue & Evans, 1981; Depue & Monroe, 1978) were emphasized. Behaviors that occur significantly often in other disorders were excluded so as to avoid the problem of some epidemiologic inventories that mainly assess general psycho­ logical distress (Dohrenwend, Levav, & Shrout, in press; Roberts & Vernon, 1983; Vernon & Roberts, 1982). Actual selection of behavioral content areas was guided by several sources: clinical literature; symptoms particularly charac­ terizing bipolar patients during the depressed phase (Depue & Monroe, 1978); descriptions o f the behavioral characteristics of cyclothymia (Akiskal et al., 1977; Akiskal et al., 1979; Campbell, 1953); and symptoms described for Minor and Major Depressive Disorders and Manic and Hypomanic disorders in the 1978 Research Diagnostic Criteria (RDC) manual by the Spitzer group (Spitzer, Endicott, & Robins, 1978). The remaining four dimensions are nonbehavioral dimensions that define clinical episodes and that, we believe, define the distinctness between normal and cyclothymic phenotypes; the core behavior of bipolar disorder alone is not sufficient to make the distinction. The dimensions are: (a) the intensity reached by episodic behaviors; (b) the duration o f behaviors at episodic intensity; (c) the rapid behavioral shifts that occur in bipolar disorder, often within a day, which are not generally typical o f the normal experience; and (d) the frequency of episodes, to control for the fact that psychiatrically healthy individuals can, at times, manifest fully the behavioral and nonbehavioral aspects of depressive episodes (as in bereavement). The dimensions of intensity, duration, and rapid shift were built into the actual wording o f GBI items. An attempt was made for items to describe an intensity and duration o f a certain behavior definitely beyond that o f normal

2.

IDENTIFICATIO N OF D Y S T H Y M IA A N D C Y C LO T H Y M IA

19

experience but below an intensity and duration characteristic of full syndromal disorder. Intensities and durations were derived from clinical reports of cyclothy­ mia (Akiskal et al., 1977; Akiskal et a l., 1979; C am pbell, 1953), from the manuals (Spitzer et al., 1978) and interview schedules (SADS) developed by the Spitzer group (Spitzer & Endicott, 1977), and from our interviews with cyclothymic outpatients. The dim ension of frequency was added by having the respondent note each item on a 4-point frequency scale: 1 = never or hardly ever; 2 = sometimes; 3 = often; 4 = very often. The advantage o f a scale with a multiple-response design and an even-num ber o f alternatives is significant, and these and other psychom etric properties o f the GBI are discussed elsewhere (Depue et al., 1981). An example o f a GBI item may help to illustrate the m anner in which the aforementioned dim ensions were operationalized: lack of energy and fatigue. “ Have there been times of several days or more, when you were not physically ill, that you were so tired and worn out it was very difficult or even impossible to do your normal everyday activities?” The item begins with “ Have there been tim es” to provide the framework of more enduring time periods. This phrase is followed by “ several days or m ore” as a duration criterion. This is followed by a phrase that rules out the behavior having occurred during periods of physical illness. Next, the actual behavior is introduced ( “ tired and worn o u t” or lack of energy and fatigue), and this is elaborated by the intensity dim ension that is operationalized as a behavioral impairment criterion, “ very difficult or even im possible to do your normal everyday activities.” Finally, this and all other items are rated on the frequency scale. A second method to operationalize a binomial model in the GBI was applied by coordinating item writing with a scoring system that is oriented to separating cases and noncases. W hen the dim ensions o f intensity, duration, and frequency are com bined, it is possible for normals to experience some o f the items “ hardly ever” or “ som etim es” , but it is less likely that normals will experience many of the behaviors of such intensity and duration “ often” or “ very o fte n .” This indicates that a large conceptual distance exists between Points 2 and 3 on the frequency scale. Indeed, the intensity and duration o f each item were worded so as to create that large distance. That is, items were written such that if they were rated “ often” or “ very o fte n ,” the respondent’s behavioral experience was considered to be outside normal limits and within the subsyndromal range of experience. This format was used in order to coordinate the form o f items with a dichotomous scoring system (i.e ., case scoring; G oldberg, 1972), where an item is counted in the total score only if it receives a rating o f 3 or 4. Thus, a total score on the GBI represents the num ber o f behavioral items on which a re­ spondent met the subsyndromal criteria o f intensity, duration, and frequency (Loevinger, 1957).

20

D EPU E A N D F U H R M A N

EXTERN AL VALIDATIO N OF THE IN VEN TO RY The validity of the GBI was addressed by generating an external validation network, which is represented in Fig. 2.1. Here the construct o f cyclothymia is related to bipolar affective disorder via the continuum model of disturbance previously discussed. The substantive validity considerations that guided the construction of the GBI also are based on the continuum model. A series o f features that characterizes the nature o f bipolar disorder is shown in the row of ovals. These features are operationalized as external validation studies, which are shown in the bottom row o f boxes. The external validation studies serve as nontest criteria for assessing the G B I’s validity as a measure o f the construct of cyclothymia (Jackson, 1971; Loevinger, 1957). That is, to the extent that the group identified by the GBI shows characteristics on the nontest criteria that would be hypothesized for a full syndromal bipolar disorder group, one has demonstrated support for the validity o f the GBI as a measure o f the construct of cyclothymia. Those external validation studies in Fig. 2.1 that are associated with a solid arrow are completed studies, and their results have been reported recently in detail elsewhere (Depue & Evans, 1981; Depue et a l., 1981). These studies dem onstrated five important points about the group o f indi­ viduals scoring above the best cutting-score on the GBI; 1. The GBI does what it was constructed to do in that, in both nonciinicai and psychiatric outpatient populations, the identified case group was largely uncon- Substantive -

1

Continuum

( B ip o lo r C is o rd o r)-«

i

"ST

^ C o u ise )(^ V c r io biliTy)

| D ia g n o s is | |

ZA_

Fomily I History

fO fftpringl

Climecl Features

Behavioral R a tings

i ( A m in e s ')

^ D ru g s^

I Biochem istry) ¡D rug — J [ T r ia ls

[patient | |Others

FIG. 2.1. An external validation network for validating the General Behavior Inventory (GBI) as a measure of the construct of cyclothymia.

2.

IDENTIFICATIO N OF D Y S T H Y M IA A N D C Y C LO TH Y M IA

21

taminated by false positives. This means that the specificity o f the G BI— its ability to correctly identify noncases— is also excellent. W hat is additionally significant is the the G B I’s specificity is not limited to excluding normals from the case group. Several analyses showed that the case group is largely uncon­ taminated by nondepressed normals; by normals suffering unhappiness, mild depression, or general self-esteem problems; and by subjects with neurotic fea­ tures and a mixture o f personality problems and/or moderate psychiatric distur­ bance. 2. Diagnoses of the nonclinical subjects scoring above the best cutting-score were almost uniformly bipolar in nature. Analyses o f their clinical characteristics demonstrated that the onset, sym ptom atology, duration o f episodes, and course features o f these subjects were almost identical to the clinical features of Akiskal et a l.’s (1977) outpatient cyclothym ics and to the detailed clinical descriptions of cyclothymia provided by others. These data offer the first direct behavioral evidence in support o f the continuum model o f the behavioral high-risk para­ digm. 3. Direct interviews o f the high GBI case group’s closest associates yielded diagnoses quite sim ilar to those derived from interviewing the high GBI subject per se. This indicated that both the depressive and hypomanic behaviors exhib­ ited by the high scorers are salient enough to be observed by others in close proximity, and arc sufficiently intense to meet diagnostic criteria for affective disorder diagnoses. This interpretation was supported by the finding of pro­ nounced interpersonal and social-civic role dysfunction in the high GBI scorers. 4. Fifty percent o f the high GBI scorers of the nonclinical population had a positive family history o f affective disorder, whereas only 3% o f low scorers were so afflicted. M oreover, half o f those probands having at least one firstdegree relative with affective disorder had at least one relative with bipolar affective disorder. Looked at another way, bipolar disorder accounted for 50% of the psychiatric disorders shown by the total number o f afflicted relatives o f highscoring probands. These findings support a direct relation between the disorder o f the group scoring high on the GBI and bipolar affective disorder. 5. When high and low GBI scorers perform behavioral self-ratings daily for 28-consecutive days, the high scorers manifest frequent, high-magnitude fluctua­ tions between depressive and mild hypomanic moods and behaviors. This form of variability was found for both within-day and across-day comparisons. There­ fore these findings support the G B I’s validity in measuring one o f the m ajor defining characteristics o f the construct o f cyclothymia; frequent, high m agni­ tude fluctuations in behavior. Thus, collectively, these studies strongly support the validity o f the GBI as an efficient first-stage case identification procedure for cyclothym ia. Perhaps most reassuring is that they converged on the validity o f the inventory through the use o f multiple methods and data sources. Results were consistent across studies

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using several clinical research strategies (interview validation, family history, external validation by close associates, and longitudinal behavioral assessment), and different sources of information (subjects, close associates, and mood and behavioral ratings). As shown in Fig. 2.1, two important extensions of the external validation of the GBI were needed. One is to demonstrate that the group scoring high on the GBI, or some portion of this group, manifests dysfunction on a biologic variable that is also disturbed in function in full syndromal bipolar disorder. Such a finding would suggest a biologic concordance between the GBI-identified group and bipolar disorder. We completed this validation study by assessing serum free cortisol in GBI-identified cyclothymics (Depue, Kleiman, Davis, Hutchinson, & Krauss, 1985). The findings showed a pattern of dysfunction in cyclothymics that is similar to that found in full syndromal bipolar disorder: Relative to controls, cyclothymics were characterized by overall hypersecretion of cortisol, extremely high intraindividual variation in cortisol over a 3-hour protocol, and slower recovery in cortisol after a stress task. Not only do these results support the validity o f the GBI as a measure of cyclothymia; they also demonstrate that cyclothymia is characterized by poorly regulated hormonal systems, a finding concordant with results in bipolar disorder (Depue et al., 1985). A second important extension is to compare the case identification power of the behavioral paradigm against a more established high-risk paradigm, such as the genetic paradigm. In this case, when the GBI and an interview are both administered to the offspring of bipolar patients, it may be that the GBI will efficiently indicate greater differential risk than is available from general identifi­ cation of the offspring group via the genetic paradigm. A study (Klein, Depue, & Slater, in press) was completed using the same GBI cutting-scorc as in previous studies (Depuc et al., 1981). It was found that the GBI very precisely identified the cyclothymic offspring of bipolar parents (i.e., they scored above the cutting-score), but did not identify nondisordered offspring of bipolar parents nor any of the offspring of control parents who had nonaffective psychiatric disorders. Hence, the behavioral high-risk paradigm, as opera­ tionalized by the GBI, provided an important index of differential risk among offspring identified by the genetic high-risk paradigm.

D Y S T H Y M IA A N D BIPO LAR AFFECTIVE D ISO R D ER Although the aforementioned studies have provided strong support for the valid­ ity of the GBI as a measure o f cyclothymia, a major deficiency o f the inventory concerns its relatively poor detection o f dysthymic individuals. This deficiency has been apparent in both outpatient samples (Depue et al., 1981) and in the offspring of bipolar parents (Klein et al., in press). From the standpoint of identification o f a representative high-risk pool for bipolar affective disorder, the

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23

failure of the GBI to accurately identify dysthymia is unacceptable because it appears likely that certain forms of dysthymia are, indeed, genetically related to bipolar disorder. In his classic treatise, Kraepelin (1921) noted that cyclothymia was only one of several subaffective conditions in the premorbid histories and family pedigrees of manic-depressive patients. In fact, the most prevalent of these conditions was subsyndromal depression or dysthymia. Kraepelin found that patients with a premorbid history of dysthymia later experienced full syndromal episodes of both depression and mania and, accordingly, he concluded that dysthymia, in addition to cyclothymia, was a genetic precursor of bipolar disorder. These considerations prompted us to explore more fully the phenomenology of dysthymia. In DSM-III, most low-grade depressive conditions are subsumed under the rubric of dysthymic disorder, which replaces the nonspecific DSM-II diagnosis of neurotic depression (Akiskal, 1983; Akiskal, Bitar, Puzantian, Rosenthal, & Walker, 1978; Klerman, Endicott, Spitzer, & Hirschfeld, 1979). The cardinal feature of dysthymic disorder is chronic-intermittent depression that lacks the severity of a major depressive episode. Because chronic depression is a concomitant of numerous psychiatric and medical illnesses, dysthymic disorder encompasses an extremely heterogeneous group o f afflictions. As a result, the relationship between dysthymic disorder and full syndromal bipolar affective disorder is not unitary. Akiskal (1983) has proposed a nosologic framework that attempts to delineate the heterogeneity of dysthymic disorder. The framework encompasses four prin­ cipal subtypes of dysthymia: 1. Chronic primary dysthymia, which supervenes following incomplete re­ covery from a major depressive episode. Patients with chronic primary dys­ thymia apparently do not manifest dysthymia premorbidly, so they are not perti­ nent to a behavioral high-risk paradigm. 2. Chronic secondary dysphoria, which complicates the course of a pre­ existing medical or nonaffective psychiatric illness. Dysphoria parallels the course of the underlying illness and does not appear to represent a primary affective process. 3. Character spectrum disorder, which encompasses a melange of conditions in which personality disturbance and chronic dysphoria are prominently inter­ mixed. These conditions begin insidiously before adulthood and pursue a chron­ ic, lifelong course. 4. Subaffective dysthymic disorder, which represents a mild form of primary affective illness. Like cyclothymia, this disorder has an early developmental onset and an intermittent, fluctuating course. In a comprehensive study o f 137 patients with chronic subsyndromal depres­ sion, Akiskal has obtained evidence that subaffective dysthymic disorder is

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nosologically distinct from the other dysthymic subtypes and is continuous with primary affective illness. Patients with subaffective dysthymia display several pathognomonic features o f major depression, including reduced REM latency and favorable response to antidepressant pharmacotherapy (Akiskal, Rosenthal, Haykal, Lemmi, Rosenthal, & Scott-Strauss, 1980), as well as positive family history for affective disorder (Akiskal, King, Rosenthal, Robinson, & ScottStrauss, 1981). In addition, most o f these patients experience superimposed episodes o f major depression, with postmorbid reversion to subaffective dys­ thymia (Akiskal et al., 1980). In view o f these findings, Akiskal and his col­ leagues prefer to limit the operational territory o f dysthymic disorder to subaffec­ tive dysthymia only. Other dysthymic subtypes are best conceptualized as secondary or residual depressions. Akiskal’s research also provided evidence that subaffective dysthymia is re­ lated mainly to bipolar disorder. An equivalent rate of familial bipolar disorder and of tricyclic-induced hypomania has been observed among probands with subaffective dysthymia, cyclothymia, and bipolar disorder (Akiskal et al., 1977, 1980, 1981a, 1981b). Also, subaffective dysthymia can occur in the offspring of bipolar patients with a prevalence equal to that o f cyclothymia (Akiskal, 1981b; Klein et al., in press). In addition, the subaffective dysthymic group displays other characteristic features of bipolar disorder (Depue & Monroe, 1978), such as retarded-hypersomnolent phenomonology, favorable response to lithium, and equal sex ratio (Akiskal, 1983; Akiskal et al., 1980). These data suggest that at least one form of subaffective dysthymia is related to bipolar disorder and, hence, we shall refer to this group as bipolar dysthymia. It appears, then, that the genetic risk pool for bipolar affective disorder is com­ prised of both unipolar (dysthymia) and bipolar (cyclothymia) subsyndromal phenotypes. These phenotypes are best viewed as continuous, rather than cate­ gorical, phenomena, where a continuous progression from dysthymia, to pre­ dominantly depressed cyclothymia, to balanced cyclothymia, and to predomi­ nantly hypomanic cyclothymia may be observed (Depue et al., 1981).

MODIFICATION OF THE GBI Previous studies with the GBI suggested that, in order to identify bipolar dys­ thymia in addition to cyclothymia, the inventory would require modification. These modifications encompass three aspects o f the GBI: the item pool, the frequency rating scale, and the scoring system.

Item Pool Modification o f the item pool of the GBI seemed necessary on two counts if bipolar dysthymia is to be identified. First, previous GBI studies indicated that dysthymes were not identified by the GBI cutting-score partially because of a

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25

numcrosity factor. That is, the GBI cutting-score was derived on the basis of total scores that incorporated both depression, hypomania, and biphasic items. Cyclothymes fall above the cutting-score because they adopt all three types of items. Dysthym es, on the other hand, adopt mainly the depression items and, hence, generally fall below the cutting-score. Only very severe dysthym es, who adopt most o f the depression items, will receive a total score sufficiently high to fall above the cutoff. To partially correct this problem , the num ber o f depression items was in­ creased. The nature o f the content of the additional depression items, however, would require a carefully conceived framework for selection. Here, as in the construction o f the original GBI item pool, we turned to the phenomenology of bipolar dysthymia. Five points were considered important to characterize bipolar dysthymia and, in areas where the GBI seemed deficient, items were generated to correct the deficiency. 1. Course: D ysthym ia is characterized by a chronic low-grade depressive course, intermittently marked by episodic exacerbations o f 3 or more days dura­ tion. Existing GBI depression items did not reflect chronicity well, so several items were constructed to correct that situation. 2. Severity: Although the episodic exacerbations o f bipolar dysthymia may be short, they arc typically characterized by intense symptomatic levels. Hence, many of the existing depression items were rew orded to increase severity, and several new items were constructed for the same purpose. 3. A kiskal’s criteria for subaffective dysthymia: The original selection of GBI depression items did not use A kiskal’s (1983) criteria for bipolar dysthymia as a selection framework. M ost criteria, in fact, were already incorporated in the GBI, but those that were not (e.g ., worse in a.m ., brief extraverted episodes during depression) were added. 4. Schneider’s depressive personality features: Part o f A kiskal’s (1983) dys­ thymia criteria include Schneider’s (1958) characterization of the dysthym e’s personality features. Those features not covered by GBI depression items were incorporated through the addition o f new items. 5. The defining behavioral features o f bipolar depression: Full syndromal bipolar depression is characterized, relative to other forms o f depression, by psychom otor retardation and hypersomnia (Depue & M onroe, 1978). Akiskal (1983) also found these behaviors to be defining features o f bipolar dysthymia. Although the original GBI depression item pool included these behaviors, there was room for expansion and refinem ent of these behavioral domains. For exam ­ ple, psychom otor retardation encompasses many defining features: slowed psy­ chomotor behavior; delayed initiation o f psychom otor behavior; shuffling feet; hunched-over posture; a slowing and delayed initiation o f speech; low, m onoto­ nous speech; unchanging faces; reduced frequency o f eyeblinking; and turning en bloc (Depue & Evans, 1981). Therefore, retardation and hypersomnia items were increased in number and quality.

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The Frequency Rating Scale To further increase the sensitivity of the GBI to the chronic-intermittent course characteristic of dysthymia, the end point on the frequency scale, which is used to rate each item’s frequency of occurrence, was modified from “ very often” to “ very often or almost constantly.” The dual descriptors allow for the occurrence of both a recurrent episodic course of depression ( “ very often” ) as well as a chronic course ( “ almost constantly” ).

The Scoring System The use of all the aforementioned modifications would help to elevate the total scores of dysthymes and, thus, their representation above the cutting-score would be increased. Although this represents an improvement over the original GBI, differential identification of dysthymia and cyclothymia would still not be possible from analysis of total scores. Therefore, a two-dimensional scoring system was developed, whereby each respondent receives a total score on the depression items and a total score on the hypomania-biphasic items combined. Thus, each respondent is plotted in a two-dimensional space reflecting intensity of both depressive and hypomanic behaviors. In concordance with our descrip­ tion of subsyndromal phenotypes in the bipolar risk pool, the two-dimensional scoring system provides a continuous, rather than categorical, representation of subsyndromal phenotypes, ranging from “ pure” dysthymia (minimal hypo­ mania-biphasic score but high depression score) to severe cyclothymia (high on both dimensions). By the way, researchers interested in hyperthymia may find it useful to identify such cases on the GBI by selecting respondents high on hypomania items but low on depression items.

A PILOT S T U D Y OF THE R EV ISED GBI The revised GBI was piloted in 1983 in two ways. First, the GBI was adminis­ tered to approximately 800 university students and the percent adoption of each item by three groups was analyzed: normals (falling in the lower 80% o f the population on both depression and hypomania-biphasic score distributions), dys­ thymes (falling in the upper 7% on depression but in the lower 30% on the hypomania-biphasic), and cyclothymes (falling in the upper 7% on depression and upper 5% on hypomania-biphasic). Relative to similar analyses with the original GBI, results showed that almost all items in the revised GBI differentiate much better than items of the original GBI in that few normals adopt the items. This reflects our attempt to increase item severity level. Moreover, inspection of all the newly constructed items indicated excellent discriminability in every case.

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Next, in order to determine if the revised GBI with a two-dimensional scoring system was effective in identifying dysthymia, 30 subjects from the high depres­ sion-low hypomania score pattern were randomly selected and administered a structured interview. Subsequently, a combination of Akiskal’s dysthymia crite­ ria and DSM-III criteria for Dysthymic Disorder were applied to the 30 cases. All 30 subjects met criteria for Dysthymic Disorder broadly defined as in DSM-III. Furthermore, one third of the subjects had been either treated for depression with tricyclic antidepressants, hospitalized for depression, or had seen a mental health professional for psychotherapy for depression. Treated cases tended to cluster in the top 4% of the GBI depression score distribution. Thus, from a general standpoint, the two-dimensional scoring system had clearly been remarkably effective in identifying dysthymes. From another perspective, however, the problem appeared to be just begin­ ning. The dysthymia represented in the 30 subjects was heterogeneous as to type. Indeed, at least three types were represented: (a) bipolar dysthymes, which were characterized by a hypersomnic, psychomotor retarded, and brief extraversión in depression; (b) agitated-hyposomnic dysthymes that appeared more tense and highly reactive to stress with anxiety and depression; and (c) the character spec­ trum dysthymia described by Akiskal (1983), which is characterized by an al­ most constant (as opposed to fluctuating) dysphoria (rather than depression) and sense o f emptiness that are secondary to characterological personality traits that result in poor ability to cope, a fatalistic outlook, anhedonia, and a very poor interpersonal developmental level. Thus, although our attempt to identify bipolar dysthymia appears to be successful, we have identified many more types of dysthymia than we ever wanted. We arc uncertain whether GBI item subsets used alone will be capable of differentiating, or of at least selectively identifying, bipolar dysthymia from the rest of the dysthymic cases. We are currently running a large interview validation study of the revised GBI, one of the goals of which will be to attempt to develop such discriminating item subsets. To compliment this approach, however, dif­ ferentiating dimensions between the dysthymic subtypes were rationally derived by our research team, and these dimensions have been operationalized in a new inventory that is administered along with the revised GBI. This inventory, the Dysthymia Subtype Inventory, is currently being evaluated against interview data in the validation study previously noted. Should this inventory work, we shall all approach, first hand, the ecstasy of mood we so often longingly observe in our hypomanic subjects.

ACKNO W LEDG M ENT The research reported in this chapter was supported by NIMH Research Grants MH 33083 and MH 37195 awarded to the first author.

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REFERENCES Akiskal, H . S . (1981 a). Dysthymic and cyclothymic disorders: A paradigm fo r high-risk research in psychiatry. Brook Lodge Symposium, Upjohn Company, Kalamazoo, MI. Akiskal, H. S. (1981b). Subaffective disorders: Dysthymia, cyclothymia and bipolar II disorders in the “ borderline” realm. Psychiatric Clinics o f North America, 4, 25-46. Akiskal, H. S. (1983). Dysthymic disorder: Psychopathology of proposed chronic depressive sub­ types. American Journal o f Psychiatry, 140, 11-20. Akiskal, H. S., Bitar, A. H ., Puzantian, V. R ., Rosenthal, T. L., & Walker, P. W. (1978). A prospective three-to-four-year follow-up examination in light of the primary-secondary and unipolar-bipolar dichotomies. Archives o f General Psychiatry, 35, 756-766. Akiskal, H. S., Djenderdejian, A. H ., Rosenthal, R. H ., & Khani, M. (1977). Cyclothymic disor­ der: Validating criteria for inclusion in the bipolar affective group. American Journal o f Psychia­ try, 134, 1227-1233. Akiskal, H. S., Khani, M ., & Scott-Strauss, A. (1979). Cyclothymic tempcrmental disorders. Psychiatric Clinics o f North America, 2, 522-554. Akiskal, H. S., King, D., Rosenthal, T. L., Robinson, D ., & Scott-Strauss, A. (1981). Clinical and familial characteristics in 137 probands. Journal o f Affective Disorders, 3, 297-315. Akiskal, H. S., Rosenthal, T. L., Haykal, R. F., Lemmi, H., Rosenthal, R. H ., & Scott-Strauss, A. (1980). Clinical and sleep EE6 findings separating subaffcctivc dysthymias from character spectrum disorders. Archives o f General Psychiatry, 37, 777-783. Boyd, J. H., Weissman, M. M ., & Thompson, W. D. (1982). Screening for depression in a community sample. Archives o f General Psychiatry, 39, 1195-1204. Bunney, W. E., Jr. (1978). Psychopharmacology of the switch process in affective illness. In M. H. Lipten, A. Dimascio, & K. F. Killam (Eds.), Psychopharmacology: A generation o f progress (pp. 1249-1260). New York: Raven. Campbell, J. D. (1953). Manic-depressive disease: Clinical and psychiatric significance. Phila­ delphia: Lippincott. Chapman, L. J., Chapman, J. P., & Raulin, M. L. (1976). Scales for physical and social anhedonia. Journal o f Abnormal Psychology, 85, 373-382. Dcpuc, R. A., & Evans, R. (1981). The psychobiology of depressive disorders: From pathophysiol­ ogy to predisposition. In B. A. Maker (Ed.), Progress in experimental personality research (Vol. 10, pp. 1-114). New York: Academic. Dcpuc, R. A ., Kleiman, R ., Davis, P., Hutchinson, M ., &Krauss, R. (1985). The behavioral highrisk paradigm and bipolar affective disorder, VIII: Serum free cortisol in cyclothymic subjects selected by the GBI. American Journal o f Psychiatry, 142, 175-180. Depue, R. A ., & Monroe, S. M. (1978). The unipolar-bipolar distinction in the depressive disor­ ders. Psychological Bulletin, 85, 1001-1030. Depue, R. A., & Monroe, S. M. (1983). Psychopathology research. In M. Heisen, A. Kazelin, & A. Bellack (Eds.), Clinical psychology handbook (pp. 239-264). New York: Pergamon. Depue, R. A ., Slater, J. F ., Wolfstetter-Kausch, H ., Klein, D., Goplerud, E ., & Farr, D. (1981). A behavioral paradigm for identifying persons at risk for bipolar depressive disorders: A conceptual framework and five validation studies. Journal o f Abnormal Psychology, 90, 381-437. Dohrenwend B. P., Levav, I., & Shrout, P. E. (in press). Screening scales from the Psychiatric Epidemiology Research Inverview (Peri). In J. K. Myers & M. M. Weissman (Eds.), Epi­ demiologic community surveys. New York: Neal Watson Academic Publications. Gershon, E. S., Bunney, W. E ., & Leckman, J. E. (1976). The inheritance of affective disorders: A review of data and of hypotheses. Behavior Genetics, 6, 227-261. Goldberg, D. P. (1972). The detection o f psychiatric illness by questionnaire. New York: Oxford University Press. Gottesman, I. I., & Shields, J. (1972). Schizophrenia and genetics: A twin study vantage point. New York: Academic.

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Heston, L. L. (1966). Psychiatric disorders in foster home reared children of schizophrenic moth­ ers. British Journal o f Psychiatry, 112, 819-825. Heston, L. L. (1970). The genetics of schizophrenic and schizoid disease. Science, 167, 249-256. Jackson, D. N. (1971). The dynamics of structured personality tests: 1971. Psychological Review, 78, 229-248. Klein, D., & Depue, R. (1984). Continued impairment in persons at risk for depression. Journal o f Abnormal Psychology, 93, 234-239. Klein, D., Depue, R., & Slater, J. (in press). Inventory identification of cyclothymia in the off­ spring of bipolar patients. Archives o f General Psychiatry. Klerman, G. L ., Endicott, J., Spitzer, R., & Hirschfeld, R. M. A. (1979). Neurotic depressions: A systematic analysis of multiple criteria and meanings. American Journal o f Psychiatry, 136, 5 7 61. Kracpelin, E. (1921). Manic-depressive illness and paranoia. Edinborough: E & S Livingstone. Lewinsohn, P. M ., & Tcri, L. (1982). Selection of depressed and nondepressed subjects on the basis of self-report data. Journal o f Consulting Clinical Psychology, 50, 590-591. Loevinger, J. (1957). Objective tests as instruments of psychological theory. Psychological Re­ ports, 3 (Suppl. 9), 635-694. Meehl, P. E. (1973). Psychodiagnosis: Selected papers. Minneapolis: University of Minnesota Press. Meehl, P. E ., & Rosen, R. (1955). Antecedent probability and the efficiency of psychometric signs, patterns, or cutting scores. Psychological Bulletin, 52, 194-216. Myers, J. K., & Weissman, M. M. (1980). Use of a self-report symptom scale to detect depression in a community sample. American Journal o f Psychiatry, 137, 1081-1084. Radloff, L. S. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurements, 1, 385-401. Roberts, R. E., & Vernon, S. W. (1983). The Center of Epidemiologic Studies Depression Scale: Its use in a community sample. American Journal o f Psychiatry, 140, 41-46. Schneider, K. (1958). Psychopathic personalities. (M. W. Hamilton, Trans.). London: Casell. (Original work published 1921). Shields, J., Heston, L. L ., & Gottesman, I. I. (1975). Schizophrenia and the schizoid: The problem for genetic analysis. In R. R. Fieve, D. Rosenthal, & H. Brill (Eds.), Genetic research in psychiatry (pp. 167-198). Baltimore: Johns Hopkins University Press. Spitzer, R. L., & Endicott, J. (1977). Schedule fo r Affective Disorders and Schizophrenia. New York: Biometrics Research, New York State Psychiatric Institute. Spitzcr, R. L ., Endicott, J., & Robins, E. (1978). Research diagnostic criteria (RDC) fo r a selected group o f functional disorders. New York: Biometrics Research, New York State Psychiatric Institution. Turner, W. J., & King, S. (1983). BPD2 an autosomal dominant form of bipolar affective disorder. Biological Psychiatry, 18, 63-88. Vernon, S. V., & Roberts, R. E. (1982). Use of the SADS-RED in a tri-ethnic community sample. Archives o f General Psychiatry, 39, 47-52. Vogel, F., & Motulsky, A. G. (1982). Human genetics. New York: Springer-Verlag. Waters, B. G. H. (1979). Risks to bipolar affective psychosis. In B. Shopsin (Ed.), Manic illness (pp. 247-261). New York: Raven. Weissman, M. M ., & Myers, J. K. (1978). Affective disorders in a U.S. urban community. Archives o f General Psychiatry, 35, 1304-1311. Wetzel, H. D ., Cloninger, G. R., & Hong, B. (1980). Personality as a subclinical expression of affective disorders. Comprehensive Psychiatry, 21, 197-205.

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3

The Interview Questionnaire Technique: Reliability and Validity of a Mixed Idiographic-Nom othetic Measure of M otivation

Eric K linge r University of Minnesota

M otivation has for some time been one o f the coldest spots in the field of personality assessm ent, displaced and even appropriated by cognitive attribution concepts and, more recently, by affect. Cognition and affect certainly have a lot to do with m otivation, but they are not al! there is to it. One likely reason for the loss o f interest in motivational assessm ent is that popular theories currently make little use o f motivational constructs. Another probable reason is that past efforts to assess motivation yielded results disappointing to those concerned with psy­ chometric quality.

Measures of Needs Thematic Apperceptive M ethods. A case in point is the research tradition established by McClelland and Atkinson and their associates, which was charac­ terized by efforts to assess projectively certain o f the “ needs” postulated by Murray (1938). Murray had already worked out a scoring system , but this was greatly elaborated in the subsequent research, especially for achievement but also for affiliation, pow er, and other needs (e .g ., Atkinson, 1958; M cClelland, Atkinson, Clark, & Lowell, 1953). Despite the distinguished research and theory developm ent spawned by that approach around the world (e.g ., Atkinson & Feather, 1966; Atkinson & R aynor, 1974; H eckhausen, 1963, 1967, 1980), efforts to relate their them atic apperceptive motivational scores to nonexperimental variables met with limited success, and the reliability o f those scores, both homogeneity across test stimuli and stability over tim e, fell far short o f that needed for individual prediction (e .g ., Entw isle, 1972; K linger, 1966). As a result, the measures are little used today, even in research. A reworking o f the M cC lelland-A tkinson them atic apperceptive measures produced a method that 31

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yielded encouraging validity evidence (Heckhausen, 1963, 1980) but did not come into general use in achievement motivation research in the United States and has not seen significant use in applied settings. When the concept o f need (or motive) is interpreted as an individual’s affec­ tive (and hence evaluative) response to given classes of incentives, the concept performs a legitimate, important function in personality theory. It is likely, however, that needs are to some degree idiographic attributes, or personal d is­ positions (Allport, 1961), although this possibility has seemingly not been inves­ tigated directly. That is, the classification o f incentives into functionally hom o­ geneous incentive groups varies from one individual to the next, with the result that psychologically meaningful incentive classes are not completely comparable among different individuals. No existing assessm ent procedure for individual needs, including projective measures, makes full provision for this possibility. For instance, in the M cC lelland-A tkinson system , the most widely used system for scoring achievem ent needs in thematic apperceptive stories, invention is automatically accepted as achievement imagery and running for president is automatically excluded, regardless of what these activities might in fact signify for the individuals in question. This failure to consider the functional meaning of scoring categories for individual respondents could account for a part o f the shortfall in predictive validity o f such measures in “ real-life” settings. The motivation literature launched by the work on need concepts has itself become rapidly differentiated and has branched into a variety o f directions, all of which underline the oversim plicity o f the original conception on which most procedures for assessing personality needs are based. T hus, Atkinson and Birch (1970) have argued the importance o f goal-related stimuli as amplifiers o f re­ sponse tendencies and o f goal-directed activity as a satiation process. Raynor (1974) has emphasized the im portance o f taking into account goal hierarchies. Heckhausen (1977, 1980), together with his coworkers (Heckhausen & Kuhl, 1985), has proposed an extensive differentiation o f the motive construct to in­ clude self-evaluative im plications, reference norms that serve as evaluative guides, and the cognitive processes associated with the formulation o f selfconcepts. The proposed theoretical structure further includes a detailed consid­ eration o f the processes that take place between initial attraction to an incentive and active pursuit o f the incentive-become-goal. These extensive advances in conceptual developm ent and basic research have yet, how ever, to be matched by corresponding assessm ent methods available for general use. Response-lim ited M easures. Within a few years after the first publication of the thematic apperceptive m easures o f need by M cClelland, Atkinson, and their coworkers, tw o nonprojective inventories o f M urray-style needs appeared— The Adjective Checklist (Gough & Heilbrun, 1965) and the Edwards Personal Prefer­ ence Schedule (Edw ards, 1959), followed a decade later by the Personality Research Form (Jackson, 1967). The first o f these is marked by excessively high interscale correlations. The second introduced a num ber o f im portant psycho­

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metric advances but its ipsativity perm its interindividual comparisons only with regard to the relative strengths o f different needs within each respondent. The Personality Research Form has been hailed as the psychom etrically most sophis­ ticated o f the group. U nfortunately, in sharp contrast to the thematic appercep­ tive measures, these instruments have made no substantial theoretical contribu­ tion to the field o f motivation. Their scores fail to correlate appreciably with cognate thematic apperceptive scales; and, in each instance, the evidence for their validity as measures o f the motivational constructs after which they are named is, to put it kindly, yet to be established (H eilbrun, 1972; Hogan, 1978; M cKee, 1972; Rezmovic & Rezm ovic, 1980; Rorer, 1972; W essler & Loevinger, 1972; W oodm ansee, 1978).

Measures of Drives The chief com petitor to the concept o f need was H ull’s (e .g ., 1952) construct of drive. Although it was reasonably well specified and operationalized, the theory with which it was most closely identified failed under the weight o f hard-toaccommodate evidence. The role played by drive is now viewed rather differ­ ently than it was during its theoretical heyday (Klinger, 1971). Today the Taylor Manifest Anxiety Scale (1953) appears to be the only major monument to the drive construct in personality assessm ent. It has com piled a respectable record of validity and contributed in quite fundamental ways to the developm ent o f moti­ vational theory, particularly in regard to interactions between arousal and perfor­ mance. It has, how ever, been superceded in most applications by other measures that are no longer clearly motivational ones, and, in any event, it addresses a very limited sector of the motivational domain.

Other Measures Other special domains o f motivation also have seen the developm ent o f special nonprojective measuring instrum ents, such as those for hostility (Edmunds & Kendrick, 1980) and sensation seeking (Zuckerm an, 1979). They have each compiled reasonable validity histories that will not be reviewed here. They assess broad personality traits with clear motivational relevance, although they also cover limited portions o f the motivational domain. It is unclear whether the underlying constructs should be classified as drive levels, need dispositions, response styles, or other kinds o f constructs.

THE C U R R EN T C O N C E R N S C O N ST R U C T A desire to circum vent the limitations o f need and drive concepts led to a fresh conceptual start in the form o f current concerns theory. A current concern is defined simply as the state o f an organism betw een the tim e it becomes com m it­

34

KLINGER

ted to pursuing a particular goal and the time that it either consummates the goal or abandons its pursuit and disengages from the goal. Because this definition is in terms o f a state it makes no assumptions about the representation o f the concern in consciousness. For all but very brief concerns, one may, in fact, assume that during much of the time the concern exists it is not reflected in the person’s conscious mental activity. Because there is a different current concern corre­ sponding to each goal to which someone has become com m itted, each person possesses a variety o f sim ultaneous, overlapping concerns. These may be about eating lunch, going camping next weekend, finishing the writing o f a book, getting the garden planted, and so on. Current concerns presumably possess some hierarchical relationships among themselves corresponding to goals, sub­ goals, and subsubgoals, as well as antagonistic relationships in the case of conflict. Assessment o f a current concern is inherently idiographic, because the specif­ ic goal that forms the object o f the concern is defined according to the indi­ vidual’s conception o f the goal, which may not correspond to other people’s conceptions in any o f several ways: category width, the outcom es accepted as goal attainm ents, associative links to the goal, and other attributes. Such idiosyncratically conceived goals do not lend themselves directly to comparisons among different individuals. The current concern construct is, how ever, also nomothetic in that concerns can be characterized through a number o f other variables, such as the value o f the goal, probability o f success, time pressures, the status o f the goal pursuit, con­ tent classifications, and other variables. On these one can indeed compare differ­ ent individuals. In addition, functional relationships linking concerns with thought content, affect, and behavior can be described in ways valid for indi­ viduals in general. Looking back at the previous literature on play, dream s, and thematic apper­ ception, the construct o f current concerns can account for results better than need or drive can (Klinger, 1971). It has also provided a theoretical tool for the analysis o f many other motivational and social data sets (Klinger, 1977). In new investigations, the current concerns construct has been able to predict thought and dream content. The experim ental paradigm here is to assess indi­ vidual subjects’ current concerns, to make up verbal cues that allude to some o f those concerns or to things that are not those subjects’ concerns, and then to present these cues in some reasonably nonobvious way. Table 3.1 presents some illustrative results. W aking subjects are much more responsive to verbal cues related to their concerns than they are to cues related to other people’s concerns. For one thing, they are more likely to attend to and recall the concern cues and to tum their thoughts to the respective concerns (Klinger, 1978). The concerns here were identified prim arily through interviews. In other studies, concerns were assessed with a Concern D imensions Questionnaire (Klinger, Barta, & Maxeiner, 1980), an instrum ent that shares m any o f the characteristics o f the Inter-

3.

Q U E S T IO N N A IR E R ELIA BILIT Y A N D V A LID IT Y

35

TABLE 3.1 C o g n i t i v e R e s p o n s iv e n e s s to Con cern - and N o n co n ce rn -R el at e d Cues

Dependent V a ria b le

C o n c e r n :N o n c o n c e r n

Significance of D ifference

Waking S u b j e c t s Ti me s p e n t l i s t e n i n g No . o f p a s s a g e s p e r session recalled Passages per session re la te d to thoughts Skin r e s i s t a n c e change Sleeping

74.6

(%)

58.9

.0005

2.78

1 . 38

. 0 0 0 1

3.73 .58

1.95 .32

. 0 0 0 1

.05

Subjects

Proportion of cues in­ c o r p o r a t e d i n t o REM sleep

.34

.

11

.05

Note: The f i r s t three rows o f data arc taken from Klinger (1978), the fourth row (skin resista n ce change) from Klinger and Larson-Gutman (in prep aration ), and the la s t row from Hoelscher, K linger, § Barta (1981).

view Q uestionnaire (IntQ ). H ere, w aking subjects’ galvanic skin responses were larger after conccm cues (K linger & L arson-G utm an, in preparation). Sim ilarly, sleeping subjects are m uch m ore likely to incorporate concern-related cues into their dream s (H oelscher, K linger, & B arta, 1981). A related construct (the personal project) has generated variables correlated w ith w ell-being (Palys & Little, 1983). It is clear from these data that the concept o f current concerns constitutes a pow erful tool for controlling the contents o f consciousness.

THE IN T ER V IE W Q U E S T IO N N A IR E The IntQ was developed out o f predecessor interview and questionnaire pro­ cedures (K linger, B arta, & M axeiner, 1981) for m easuring subjects’ current concerns. It identifies concerns sim ply by asking subjects to list and describe their concerns, and it jo g s th eir m em ories by dividing the answ er sheet into m ajor life areas. T hereafter, the form asks subjects to characterize each concern on a variety o f dim ensions. T hese were draw n partly from the previous m otivational literature and partly from experience w ith the predecessor procedures. Figure 3.1 illustrates the response process w ith a filled-in page from an IntQ. O ne im portant dim ension o f any concern is the nature o f the subject’s wish regarding the goal— w hether the w ish is appetitive, aversive, o r agonistic. To assess this, subjects are asked to w rite the description o f each concern using a verb draw n from 1 o f 12 verb classes (Verb). Subjects are asked to indicate how directly they are involved in the goal pursuit (Role) and how m uch they feel com m itted to it (C om m itm ent). V alue is assessed using tw o dim ensions— the

co o>

Answer sheet #2 CONCERN

Step 3

( S t a r t i n g With an A c t i o n Word)

4. do: f o r example, (do) e n r o l l in a f r i e n d s h i p g ro u p , (do) f i l e a com p lain t to your boss » (do) f o l l o w s a f e t y r u l e s Role

Step

h

Step 5

Step 6

Commi tment

Joy

Unhappi ness

Step 7

Sorrow

Step 8

P r o b a b i 1 i ty o f Su c c e s s

Step 9

P r o b a b i 1 i ty î f no Act i on

Step 10

Time Ava i 1a b le

Step 11

Nearness

25

Do f i n d new f r i e n d s h i p s and p o s s i b l y s t a r t d a t i n g a gain.

2

6

9

2

10

6

0

0

0

53

Do s t a r t g o in g to church.

1

5

9

1

8

8

0

0

0

53

Do more re ad in g.

1

5

8

1

6

9

0

0

0

77

Do go out and do more dancing.

5

9

0

9

8

0

2wks.

2w ks.

85

Do s t a r t e x e r c i s i n g .

1

5

8

\

7

8

0

0

0

89

Do s t a r t a t t e n d i n g support group.

1

5

7

1

8

9

0

2wks.

2w ks.

94

Do s t a r t g o in g to d i v o r c e group.

1

5

7

2

8

9

0

2w ks.

2wks.

Do take the time to t r a v e l .

1

5

8

1

7

6

0

2wks.

2w ks.

101

FIG. 3 .1 .

A sa m p le p a g e o f a c o m p le te d In terv iew Q u e stio n n aire o f the version used by K lin g er &

C o x (in press).

3.

Q U E S T IO N N A IR E RELIABILITY A N D VALIDITY

37

value o f attaining a goal (Positivity or Joy) and the negative value of not attaining it (Loss or Sorrow)— on the basis o f evidence that gain and loss involve different motivational systems (K linger, 1977). Evidence that value reflects potential affect (Klinger, 1977; Pervin, 1983) led to the decision to assess value through questions about the affect anticipated if the goal were attained or lost. To assess ambivalence, subjects were also asked to assess their unhappiness upon attaining the goal (Negativity or Unhappiness). The IntQ assesses subjective Probability o f Success which, along with value m easures, appeal^to constitute the best available predictors o f choice and, presum ably, o f com m itm ent to goals. H owever, proba­ bility of success will have different effects on action according to the likelihood o f succeeding without taking any action (Heckhausen, 1977). Therefore, the IntQ assesses this (Probability I f N o Action or Internality). The existence o f temporal gradients for both motivation and emotion led to the inclusion of scales assessing the imminence o f having to do som ething about the goal pursuit (Time Available) and the anticipated time interval to goal attainm ent (Nearness). Be­ cause motivation is influenced by difficulties in the goal pursuit (Klinger, 1977), the questionnaire includes questions relating to these.

Estimating Reliability of the IntQ Data such as those produced by the IntQ do not lend themselves readily to conventional measures o f reliability. The quantitative scales all relate to a sub­ je c t’s particular concerns and these differ from one person to the next. One approach is to obtain mean ratings across an individual subject’s concerns and to examine the stability or homogeneity o f the mean ratings. Distributions o f appe­ titiveness or aversiveness o f concerns, o f affect ratings, o f expectancies, and so on can provide useful information about individual lives. Measures based on an assortm ent o f different current concerns preclude the possibility o f estim ating their reliability by examining homogeneity, unless one were to group the concerns, thereby violating the idiographic character o f the data. We have some data on stability, but even stability estim ates o f reliability are only partly appropriate, because current concerns vary greatly in their dura­ tion, ranging from moments to years. Lack o f stability over longer time periods need not be attributable to lack o f reliability. Table 3.2 presents test-retest correlation coefficients for 42 alcoholic inpa­ tients (Klinger & C ox, in press). They were tested within 1 week after intake and again 1 month later. Because the month spans a change in both their chemistry and in the behaviors targeted by the treatment program, this design constitutes something o f an acid test for stability. For 22 variables, the range o f correlations was from —.03 to .77, with a median o f .31. About half o f the variables showed statistically significant correlations. The more stable scores were those that m ea­ sured response style or structural variables— num ber o f concerns listed, type of role, verb distributions, mean Tim e Available, and mean Probability o f Success. The unstable scores were those that measured the distribution o f concern content

38

KLINGER TABLE 3 . 2 In t Q V a r i a b l e Me a ns , S t a n d a r d D e v i a t i o n s ,

IntQ

V ariable Mean C o n c e r n F r e q u e n c i e s No. o f c o n c e r n s

1

(N *

60)

and T c s t - R c t e s t C o r r e l a t i o n s

IntQ j

(N = 4 2 )

SD

28.20

16.79

23.17

15.23

.03 .03 .07

.03

.03

. 0 0

. 0 1

. 0 2

.04

. 2 1

.08 .16 .03 .06 .04 .19 . 0 1

.13 .24 .32* .42** .41** 7 5 ***

. 53 .63

.07 .31*

Mean P r o p o r t i o n s o f C o n c e r n s G oals to approach alcoholism therapy Alcohol approach Alcohol avoidance A ctive ro le V icarious role Interpersonal R eligion H ealth Crime A ppetitive goals Avoidance g o a ls A ttack goals

. 0 2 . 0 1

.05 .53 .05 .34 .04

Mean

SD

.20

. 1 1

.62 .05 .36 .04 .09 .03 .69 .13

. 0 0

. 0 1

. 0 0

5.10 Commitment l e v e l 2.90 Joy a t a tta in m e n t Unhappiness a t goal 1 . 23 attainm ent Sorrow o v e r f a i l u r e 2.26 6.52 P robability of success 4.12 Internality 236.11 Time a v a i l a b l e (da y s) Nearness to goal a t t a i n ­ 178.89 ment (days)

. 58 .63

5.26 3.00

1.14

2.64 619.58

.78 2.23 6.94 4 .44 178.26

1.45 2.32 285.12

236.86

121.15

173.64

Mea n C o n c e r n

T est-R etest C orrelation

Mean

.07 . 1 0

.04 .61

.03 .06 .03 .17

. 1 1

. 2 1

. 1 2

.

6 6

***

.46*** -.03 .64*** .41** .4 7***

In

Ratings

. 8 8

1 . 12

.92

1.02

.22 .19 ^4 7 * **

.20 t 77

** *

.22

No t e . Th e s e f i g u r e s a r e b a s e d on d a t a f r o m K l i n g e r a nd Cox ( i n p r e s s ) . Mean Co nce r n F r e q u e n c i e s and Mean P r o p o r t i o n s o f C o n c e r n s r e f e r t o means o f t h e f r e q u e n c i e s o r p r o p o r t i o n s o f c on ce rn s w i t h i n i n d i v i d u a l IntQs .

*p < . 0 5 , * * p < . 0 1 , * * * p < . 0 0 1 .

and mean affect associated with current concerns. Because the IntQ was not particularly designed to assess traits, the lack o f stability in som e o f its measures does not impugn its reliability. N evertheless, there are som e aspects o f IntQ responses that stay stable. These kinds o f statistics do not, how ever, make much use o f the finer-grained information available in the instrument. What can w e say about the reliability of the individual concern data provided by our subjects? To answer this question w e devised an approach that em ploys a variant o f the stability strategy (Church, Klinger, & Langenberg, 1984). T w elve subjects (mostly students) took the IntQ tw ice with a month between. Follow ing the second administration, they were asked to identify the concerns listed in each administration that corresponded to the concerns listed in the other. For concerns that appear only once, subjects indicated the reason, ranging from having forgot­ ten to list the concern to having already attained the goal before the second administration. Thus, it was possible to form estimates o f reliability by exam in­ ing instability due to error.

3. QUESTIONNAIRE RELIABILITY AND VALIDITY

39

Figures that bear on these reliability estimates appear in Table 3.3. The proportion of IntQ! concerns listed or reported as terminated at the time o f IntQ2 was .74 (95% confidence interval: .65 to .83). The remaining concerns either continued in full force at IntQ2 and had simply been forgotten (. 19 of the IntQ j concerns) or they had become too unimportant to list (.07 o f the IntQ, concerns). To put this another way, .81 (95% confidence interval: .73 to .90) of the IntQ! concerns were either listed on the IntQ2 or omitted from it for legitimate reasons. The reverse figures present a very similar picture. Of the concerns listed on the IntQ2, .78 (95% confidence interval: .68 to .88) had either been listed on the IntQj or had not yet commenced. The rest had existed at the time of IntQ, but had been forgotten (.17) or had not yet become important enough to list (.05). Thus, from the subjects’ viewpoint, .83 (.95% confidence interval: .72 to .93) o f the IntQ2 concerns had been listed or justifiably omitted from IntQr In short, from the standpoint o f test-retest design, about 76% o f the concerns on one administration were either present or accounted for on the other; and if we accept subjects’ subjective statements of which concerns warranted listing, then

Sta b ility of

TABLE 3.3 I n t e r v i e w Q u e s t i o n n a i r e Re sp o n se s A c r o s s the A d m i n i s t r a t i o n s

S tatistic variable

Mean

SD

Median

Maxi mum M in i m u m

No.

of

IntQ^

CCs

53

25.1

47

103

29

No.

of

IntQ

2

CCs

36

26.1

25

108

18

No.

of

IntQj,

CCs 34

17.4

32

75

15

18

13.3

15

56

7

m issing N o.

of

not

on

IntQ on

IntQ

2

CCs

IntQ^

P roportion CCs n o t on

2

of

IntQ^

forgotten

IntQ2

Proportion

of

CCs l i s t e d

on

or

ended

already

Proportion CCs n o t on

CCs

IntQ

. 8 8

.94

.50

IntQ

.74

.14

.80

.89

.48

.83

.16

.85

1 .0 0

.40

.15

.83

.97

.40

2

forgotten

of

listed not

.13

2

IntQ^

Proportion

or

of

.81 IntQ.^

yet

IntQ on

2

IntQ^

begun

.78

•

N o te . From Combined Id io g ra p h ic and Nom othetic Assessm ent o f th e Current Concerns M o tiv ation al C onstruct by A. T. Church, E. K lin g er, and C. Langenberg. A r t ic le subm itted fo r p u b lic a tio n . C op yrigh t, 1984 by th e a u th o rs. R eprinted by p erm issio n . "CCs" means "Current C oncerns." S t a t i s t i c s are based on the means o f each 12 s u b j e c t s .

40

KLINGER

the percentage rises to about 82% . There is no way o f knowing how many concerns may have been present that cropped up on neither administration, but of those we know about, the great majority found their way into each IntQ.

Evidence Regarding the Validity of the IntQ Earlier, I described evidence that knowledge of a person’s current concerns permits prediction o f which verbal cues the person will respond to cognitively and electrodermally. Insofar as the IntQ shares features with the interview pro­ cedures or with the Concern Dimensions Q uestionnaire used in those investiga­ tions— as it clearly does— that evidence can also serve as evidence in support of validity o f the IntQ. In fact, the Concern Dimensions Questionnaire differs from the IntQ chiefly in providing a briefer list of concerns. However, we now also have somewhat more direct evidence.

Relationship to Subsequent Activities To estimate the validity o f the IntQ more directly, it was necessary to assume that current concerns are at some point translated into overt behavior. The same 12 subjects who provided the stability evidence just described also kept daily re­ cords o f their plans and activities for the latter 3 o f the 4 weeks between adm in­ istrations o f the IntQ (Church, Klinger, & Langenberg, 1984). A fter the second administration of the IntQ, they were asked to indicate which, if any, o f the concerns listed on the IntQs were addressed by each of their recorded activities. Let us take a sam pling o f 5 diary days and use as a base the total num ber o f activities that subjects bothered to list on each day. Table 3.4 shows the propor­ tion of those activities that subjects were later able to relate to one or more o f the current concerns from their first IntQ. The proportions are im pressive, ranging from .81 on the first diary day (a week after the first IntQ) to .56 10 days after that. The data indicate that even a month later the IntQ concerns account for a majority o f a subject’s more noteworthy activities. It might be objected that a certain proportion of anybody’s activities are likely to be matchable to a broad list o f current concerns. To check on the extent to which the data in Table 3.4 represent this kind o f artifact, we enlisted the help o f 5 judges blind to everything in the experim ent except their judging task. Each judge was given the activities o f 2 subjects o f the same sex on their first diary day, the activities having been listed in random order, and the two separate lists o f IntQ concerns for the 2 subjects. The judges rated the likelihood that each activity was related to each concern. It was then possible to examine the degree o f relationship between activities and concerns according to whether they came from the same or from different subjects. For each activity, judges also made a global judgm ent as to which o f the 2 subjects (represented by the two IntQ! concern lists) was most likely to have reported the activity'. One way o f exam ining the resulting judgm ents is to take the highest two

3.

Q U E S T IO N N A IR E R E L IA B IL IT Y A N D V A L ID IT Y

41

TABLE 3 . 4 S e l f - R e p o r t e d R e l a t i o n s h i p o f I nt Q Con c e r n s t o D a i l y A c t i v i t i e s : Some Mean S t a t i s t i c s

Number o f Days S i n c e C o m p l e t i n g I n t C ^ V ariable

8

9

10

18

28

6.8

5.6

6.2

4.2

5.6

9.9

8.9

9.0

7.2

8.2

No. o f I n t Q ^ CCs r e la te d to a c t i v i t i e s T o t a l n o . o f DPL activ ities Proportion of a c t i v i t i e s related

t o I n t Q ^ CCs

.81

. 76

.69

.56

.60

Note. From Combined Idi ogr aphi c and Nomothetic Assessment of the Current Concerns Motivational Construct by A. T. Church , E. Klinger, and C. Langenberg, article submitted for publication. Copyright 1984 by the authors. Re­ printed by permission. N = 12 subjects. The eights post-IntQj day was the first of 21 days on which subjects recorded daily activities on a struc­ tured diary form, the Daily Personal Log (DPL). "CCs" stands for "Current Concerns."

rating levels ( “ Activity is probably directed at this concern . . . ” and “ It is highly likely that this activity is directed at this concern . . . ” ) as the criterion for judging that an activity had been directed at a goal. By this criterion, 50% of the activities were judged to be related to the conccms of the subject who reported the activity, and only 24% were judged to be related to the conccms of the other subject in the pair (/(9) = 2.46, p < .05), where the percentages arc means of the 10 subjects’ percentages. Judges also were able to use the concern lists to recognize which subject in each subject pair originated each activity. Their judgments were correct far more often than chance— in fact, 77% of the time (Table 3.5). The table yields chisquarc (1) = 28.2, p < .001. The phi coefficient is .54 against a maximum phi value of .78. It is apparent, then, that the concerns that subjects listed on their IntQts described the objectives toward which these subjects directed most o f their TABLE 3.5 A b i l i t y o f B l i n d Judges to Match A c t i v i t i e s

to Same vs. Other Su b j e ct 's Concerns Judgm ents o f which S u b je c t Reported A ctivity Subject A Subject B Total

A ctual S u b ject Reporting A c tiv ity Subject A

Subject B

T otal

41 5

17 33

58 38

46

50

96

Note. From Combined Idiographic and Nomothetic Assessment of the Current Concerns Motivational Construct by A. T. Church, E. Klinger, and C. Langenberg, article submitted for publication. Copyright 1984 by the authors. Reprinted by permission. Data are based on five samesex pairs of subjects. Chi-square (1) = 28.2, p