Arabic Version of the Personality Inventory for the DSM-5 (PID-5) in a Community Sample of United Arab Emirates Nationals

1. INTRODUCTION

The Diagnostic and Statistical Manual of Mental Disorders (APA) and the International Classification of Mental and Behavioural Disorders (WHO) are currently shifting towards a more evidence-based dimensional conceptualization of Personality Disorders (PDs), as the traditional categorical paradigm has proven to be conceptually and empirically problematic [1, 2] with limited clinical utility [3]. This has resulted in many patients being undiagnosed, receiving multiple Personality Disorder (PD) diagnoses, or, most commonly, diagnosed with a PD not otherwise specified [4].

A reflection of this was the inclusion of the Alternative DSM-5 Model for Personality Disorders (AMPD) in Section III of the DSM-5 [5] and more than 200 publications on its main diagnostic criteria: the assessment of impairment in personality function (Criterion A) and the presence of maladaptive personality traits (Criterion B), that followed its publication. The primary measure for the assessment of the AMPD [5] mal-adaptive traits is provided by The Personality Inventory for the DSM-5 (PID-5) [6], which is a self-rated inventory that characterizes 25 trait facets organized into five high order domains of personality variation (Negative Affectivity, Detachment, Antagonism, Disinhibition, and Psychoticism).

The PID-5 psychometric properties have been extensively examined and review studies have consistently shown it to be a reliable measure with internal consistency coefficients ranging from acceptable at the trait facets level to high at the domain trait level [7], and with the ability to capture individual differences that were stable during four weeks up to four months intervals [8, 9]. Furthermore, in regards to its factor structure, the PID-5 confirmed a five-factor structure similar to the Five Factor Model (FFM), both in clinical and non-clinical studies and across different countries [10]. However, researchers also reported that the loading pattern of some trait facets appeared to deviate from the model, such as Suspiciousness that belongs to the Detachment domain, but was more often loaded in Negative affectivity, or Hostility that belongs to domain Negative affectivity, but frequently loaded in the Antagonism domain [11].

The PID-5 facets and domains had conceptually and meaningfully converged with other established measures of personality and personality pathology [12-15], including The Personality Inventory for the ICD-11 [16]. Also, a vast body of research has conceptualized the PID-5 trait domains as mal-adaptive extensions of general personality traits and supports the continuum between adaptive and mal-adaptive personality trait models [17, 18], established by the association between Negative affectivity with Neuroticism, Detachment with Extraversion, Antagonism with Agreeableness and Disinhibition with Consciousness. The relation between Psychoticism and Openness is less clear and debatable [19].

Additionally, the PID-5 has proven its ability to capture the DSM-5 Section II PDs categories and symptoms [20], and other studies claimed its utility for treatment planning [21], as well as predicting psychosocial impairment [22].

The PID-5 has been translated into different languages and cultures and can be found in Arabic [23], Czech [24], Danish [25], Dutch [26], French [27], German [28], Indonesian [29], Italian [30], Norwegian [31], Persian [32], Polish [33], Portuguese [8], Brazilian-Portuguese [34], Russian [35], Spanish [36], and Swedish [37].

The translation study of the Arabic PID-5 [23] was conducted with college students in three Middle-East countries (Bahrain, Kuwait, and Qatar) and is written in Modern Standard Arabic (MSA), which is the formal written expression used in the literature, as well as in the translation of psychological tests, common to all the Arabic speaking countries [38, 39]. However, the Arabic language is a diglossic language [40, 41] that, beyond the MSA derived from the Classic Arabic, is also comprised of colloquial forms used to orally communicate ideas, feelings, and emotions, but for which there is no written form of expression, resulting in the inability to use it in the translation of psychological tools. The MSA, although useful as a standard form of the Arabic language, carries some limitations such as the use of outdated terms that are no longer used colloquially, and some MSA words might have different meanings across countries [40, 41]. In a recent lexical study on personality traits, using the MSA in the Arab Levant, the authors reported an under representation of terms to describe some dimensions of general personality, such as Openness [42], which is related with Fantasy, Aesthetics, Feelings, Actions, Ideas, and Values [43]. These findings are not surprising considering that these topics, although extremely relevant for the psychological assessment, are more often communicated using the colloquial Arabic forms. Therefore, assuming the generalizability of the Arabic PID-5 [23], or other translated tests, to all Arabic speaking countries could carry important reliability and validity issues that might be minimized by validity studies, in Arabic speaking clinical and non-clinical samples, for which this study aimed to contribute through the following objectives: (a) to test possible cultural variations between Western and non-Western cultures by comparing the Emirati community sample results as well as the ones obtained in the PID-5 Arabic translation study [23], with the original test data, (b) to address the PID-5 scales’ internal consistency and test-retest reliability, as the PID-5 traits stability was not addressed in the Arabic translation study [23], (c) to explore the association between the PID-5 domains with the FFM, measured by the Arabic NEO – Five Factor Inventory (NEO-FFI), [4, 5] and (d) to examine the PID-5’s factor structure in the Emirati community sample.

2. METHODS

3. RESULTS

4. DISCUSSION

The current study aimed to examine the psychometric properties of the PID-5 in an Emirati community sample and addressed the cross-cultural replicability of its factor structure in a non-Western culture.

The findings in the Emirati sample were comparable to the original US study [6], in terms of the PID-5 internal consistency, convergent validity with the NEO-FFI and factor structure. However, significant differences were identified in the mean scores, with higher scores in most of the facets and domains, similar to the results found in the Arabic translation study [23]. The facets Cognitive and perceptual dysregulation and the domain Antagonism showed the larger effect size (≥.90). These results might suggest that the response style obtained could reflect situational factors or cultural specificities as if a certain numerical score represents the same absolute trait level in different cultures, and if the intensity or difficulty of a given item changes across languages [43, 46]. Nevertheless, the PID-5 has demonstrated that it is a reliable measure and perhaps some specific items are compensated by the scales’ overall sum.

Moreover, the Arabic PID-5, beyond adequate internal consistency at the facet (mean alpha .74) and domain level (mean alpha .86), also demonstrated good temporal reliability, in line with previous studies (for a review see Al-Dajani, Gralnick, and Bagby [7]).

As expected, the five domains of the Arabic PID-5 displayed meaningful associations with the five domains of the Arabic NEO-FFI [23, 47, 48]. Nonetheless the positive relationship between Psychoticism and Openness to experience was rather small [14, 49], which might be related to the conceptual nature of these domains and how they are assessed. Openness is mostly an adaptive domain of personality (measured by the NEO-FFI) whereas Psychoticism is entirely a mal-adaptive domain (measured by the PID-5), which might decrease the probability of both domains load in the same direction and in the same factor, once they have opposite functions, as one is adaptative and the other is mal-adaptive [50].

With regards to the Arabic PID-5 factor structure in the Emirati sample, these findings confirmed a five-factors solution similar to the one displayed by Krueger et al. [6] and by Al-Attiyah et al. [23]. The first four factors featured the domains Negative affectivity, Detachment, Distractibility, and Antagonism. Although the loading patterns of some facets deviated from the original structure, particularly in the fifth Factor, where Grandiosity, Rigid perfectionism, and Unusual beliefs and experiences were primarily loaded, resembling an imperfect conjunction of the fifth (Compulsivity) and sixth (Schizotypy) domains, initially proposed by the AMPD [5]. However, if it is considered that the facets Cognitive and perceptual dysregulation and Eccentricity loaded secondarily in this factor, perhaps it might be also considered that this factor is similar to the Psychoticism domain.

One possible reason for this deviant factor could be that Psychoticism, beyond encompassing the tendency to have unusual beliefs and experiences, behave eccentrically, and manifest cognitive dysregulation, might also enclose some aspects of Antagonism and low Disinhibition, such as being self-centered or superior and having the need to impose a rigid and dogmatic order towards others and their environment [51]. In this regard, some studies have found evidence for an association between some features of Obsessive-Compulsive PD with Schizotypal PD [52]. In fact, although the domain Psychoticism primarily emerged from features of Negative affectivity, Disinhibition, and Detachment [53, 54], it has been pointed as heterogeneous, and some studies found deviant facet loading in this domain [29, 55]. Others even reported its absence from their factor structure in a clinical sample [56]. Furthermore, studies that tried to harmonize the DSM-5 trait model with the ICD-11 personality model stated that in order to facilitate the communication between clinicians, the domain Psychoticism should not be conceptualized in terms of personality pathology, as it is considered under the spectrum of schizophrenia disorder by the World Health Organization [57, 58]. However, a trait profile does not correspond to arbitrary diagnose categories or syndromes, but instead denotes stylistic dimensions that contribute to the expression of the personality dysfunction under the umbrella of a more general factor of psychopathology [59]. On this note, a recent study by Bastiaens et al. [60], which claimed the PID-5 clinical utility to discriminate between patients with and without a psychotic disorder, concluded that the patients significantly differed on all PID-5 domains, except for Antagonism, and that lower Detachment, lower Negative Affect, lower Disinhibition, and higher Psychoticism were the trait profiles that best discriminated patients with a psychotic disorder from patients with other diagnoses.

Considering the findings, future studies in non-Western countries should try to establish normative values for the general population in order to better identify the presence of mal-adaptive traits, and examine how the facet traits could help to discriminate between what is normal and abnormal in a given culture or language.

This study has several limitations that should be considered in future research. First, the sample was predominantly composed by female college students and their acquaintances, which might have biased the results considering that women often report a higher level of Neuroticism compared to men [61, 62] and that gender roles and expectations tend to be more clearly demarcated in Arabic cultures when compared to Western cultures [63]. Also, data was collected from a Governmental University in only two of the seven Emirates (Abu Dhabi and Dubai), and most of the participants had medium to high economic status as well as high educational levels, which might have influenced the response to the test. Second, the test-retest sample size was small due to many losses between the 1^st and the 2^nd data collection sessions.

Finally, given that the PID-5 is a clinical diagnostic measure, the expansion of this research to clinical Emirati samples is a crucial endeavor , that will bridge the current study limitations with future developments and provide relevant data on the PID-5’s predictive validity.

CONCLUSION

Notwithstanding the aforementioned, this study concluded that the Arabic version of the PID-5 is a valid measure to describe pathological personality traits in the Emirati population of the United Arab Emirates, and provides additional evidence for the generalizability of the AMPD [5] to other Arab countries.

REFERENCES